Medication safety monitoring inspections in public acute hospitals publication statement 28 August 2019

Date of publication:

The Health Information and Quality Authority (HIQA) has today published three inspection reports on medication safety in public acute hospitals. HIQA monitors medication safety in hospitals against the National Standards for Safer Better Healthcare. Hospitals were inspected under HIQA’s medication safety monitoring programme, which included an additional focus on high-risk medicines and high-risk situations in 2019. 

Inspections took place between March and April 2019 at Bantry General Hospital, Connolly Hospital Dublin and St John’s Hospital Limerick. 

Click below to find out more about each hospital.

Bantry General Hospital, 21 March 2019

Although Bantry General Hospital had strengthened governance arrangements for medication safety since the last HIQA inspection in 2016, HIQA inspectors identified significant concerns in relation to the overall leadership, governance and management of medication safety during this announced medication safety inspection. Specifically, practices observed did not support safe medication practices and highlighted a lack of risk-reduction strategies in place to ensure safety with the management and the storage of anticoagulant medication.

The hospital did not have a medication safety strategy to direct improvement but a quality improvement plan had been initiated based on the gaps identified in the 2016 medication safety report. Progress had been made on the development of intravenous medication administration guidelines, a preferred medications list (formulary) and auditing aspects of medication safety. Progress had also been made to improve rates of medication incident reporting but analysis and trending of medication incidents should be communicated to front-line staff and used to identify areas for targeted improvement. 

A failure to implement recognised medication safety systems such as the provision of a clinical pharmacy services and formalised medication reconciliation, which are essential to ensuring medication safety in clinical settings, were also identified. 

Bantry General Hospital did not have comprehensive established systems in place for all high-risk medications which were relevant to the services provided. The hospital had identified high-risk medications in use and had implemented risk-reduction strategies for some medications such as potassium chloride and insulin. However, the management of anticoagulant medications at the time of the inspection did not support safe medication practices and as a result HIQA wrote to the hospital to seek assurances as to how the hospital would address specific risks identified. 

Overall, the hospital had acted to strengthen medication safety through medication safety governance arrangements and had implemented some safety initiatives. Medication safety at the hospital was an evolving process but there is scope for further improvement.

Connolly Hospital, 03 April 2019

Connolly Hospital had strengthened governance arrangements for medication safety since the previous medication safety inspection in 2016 that included setting up a medication safety programme and Medication Safety Committee. The hospital did not have a medication safety strategy but had gathered medication safety information to identify priorities for improvement to inform a strategy. Medication safety information was communicated to staff through education and other initiatives, to share learning.

Where clinical pharmacy services were present, HIQA found established systems in place to support the safe prescribing and administration of medications. However, clinical pharmacy services and medication reconciliation were not available to some inpatient clinical areas which was of concern. In addition, although overall medication safety incident reporting had increased, areas that did not have a clinical pharmacy service were potentially underreporting incidents as a high percentage of reports were made by clinical pharmacists. Similar to the last inspection the hospital did not have a list of medications approved for use (formulary).

Connolly Hospital had developed a high-risk medications list adapted from literature and local incidents with some associated risk-reduction strategies in place to improve medication safety. However, opportunities for implementation of high leverage risk-reduction strategies were either at the planning or early implementation stage and required further progression following the inspection.

Overall, the hospital had a focus on medication safety with good oversight from management, and should continue to work towards improving medication safety by progressing areas for improvement identified by the hospital and outlined in this report.           

St John's Hospital Limerick, 16 April 2019

Since the previous HIQA inspection in 2018, St John’s Hospital had strengthened governance arrangements in place for medication safety. The hospital had a Medication Safety Programme directed by an agreed Medication Safety Strategy to outline priorities and direct improvements with medication safety. Progress was monitored by the Medication Safety Working Group with oversight from the Drugs and Therapeutics Committee. 

St John’s Hospital had a full clinical pharmacy service in place for all in patients using a team-based pharmacy approach, and completed medication reconciliation for all patients on admission which was to be commended. 

St John’s Hospital had developed a high-risk medications list adapted from literature and local incidents with some associated risk-reduction strategies in place. HIQA found opportunities for improvement in the risk-reduction strategies in place for some high-risk medication and situations, and the hospital provided assurance that these issues would be addressed immediately. 

The hospital had a number of medication information sources available which were accessible to staff. The hospital also provided structured medication safety education using a variety of classroom and ward-based education sessions to keep staff up to date and informed on issues relating to medication safety.

Overall, St John’s Hospital had established systems in place to support medication safety with good oversight and governance arrangements and should continue its work in progressing medication safety throughout the hospital.