The governance arrangements in place for medication safety in Naas General Hospital had been reviewed and strengthened since the last HIQA inspection in 2016. The hospital had a developed a draft three year strategic plan which incorporated the medication safety objectives for 2019. There was, however, opportunity for improvement with reporting from the Drugs and Therapeutics Committee to the Executive Management team. 

The hospital had systems in place for high-risk medications relevant to the services provided with risk reduction strategies embedded into practice. The hospital had proactively addressed medication safety risks by focusing resources on medication reconciliation and the provision of a team based pharmacy across all services. 

The level of reporting of medication-related incidents and near misses at the hospital was relatively low in the context of the hospital’s activity levels and there is scope to improve the culture of incident reporting as a result. 

Overall, Naas General Hospital had systems in place to effectively support medication safety and should continue to work towards improving medication safety practices by addressing the findings of this report and progressing the implementation of initiatives identified through its own monitoring of practices.
 

Inspectors found limited oversight of medication safety practices by the Cork University Hospital Group Drugs and Therapeutics Committee which was responsible for the governance and oversight of medication safety at Mallow General Hospital. 

Medication incidents reporting had increased in 2018, following active promotion of incident reporting. However, the overall reporting level remained low, and as a result key medication related risks could not be recorded, analysed, mitigated or escalated effectively by the hospital.

The hospital had a list of high risk medications with associated risk reduction strategies in place. Inspectors found opportunities for improvement with the rationalisation and storage of heparin, supports for monitoring antimicrobial medication and strategies to reduce risk with sound-alike-look-alike medications.

The hospital had a very limited clinical pharmacy service and medication reconciliation was not undertaken for patients on admission or on discharge. This was of concern to HIQA and needs to be addressed. Despite the limited resources, inspectors found the pharmacy service was very accessible for advice and had a positive impact both on the promotion of medication safety and the implementation of strategies to reduce risk. 

Overall there was potential to improve medication safety governance between Mallow General Hospital and Cork University Hospital Group. The hospital should continue to work in collaboration with the Cork University Hospital Group Drugs and Therapeutics Committee to improve medication safety governance and practices.
 

Children’s Health Ireland at Crumlin was proactive in identifying areas of risk for its paediatric population and had implemented a suite of risk-reduction strategies to mitigate, in so far as possible, the associated risks for their high-risk population. Inspectors found some opportunities for improvement in relation to the storage of heparin solutions and the use of concentrated potassium.  

Medication safety incidents were analysed and trended, with learning opportunities identified and shared with frontline staff. The numbers of medication incidents reported continued to rise each year. However, there was still opportunity to improve medication incident reporting in some disciplines. 

A clinical pharmacy service was available on all inpatient areas and in the absence of formal medication reconciliation, the hospital had prioritised the service for some high-risk patients. The hospital should now develop a formal medication reconciliation service for all patients on transition of care.

Overall, Children’s Health Ireland at Crumlin had the essential elements in place for the oversight and governance of medication safety with clear objectives for the hospital’s medication safety programme, driven by local leadership with executive management support.