Medication safety monitoring inspections in public acute hospitals publication statement 03 February 2020

Date of publication:

The Health Information and Quality Authority (HIQA) has today published five 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 October and November 2019 at Roscommon University Hospital, South Tipperary General Hospital, Our Lady’s Hospital Navan, Children’s Health Ireland at Temple Street and St Vincent’s University Hospital.

Roscommon University Hospital, 9 October 2019

The announced medication safety inspection at Roscommon University Hospital on the 09 October 2019 was the hospital’s second medication safety inspection. The hospital had a Drugs and Therapeutics Committee that provided oversight of medication safety at the hospital. However, attendance at meetings was not in line with the Committee’s terms of reference and inspectors noted the large number of committees in existence that required attendance by the same pool of staff.

The hospital did not have a strategy to direct improvement with medication safety and there remained a lack of pharmacy services in clinical areas. There was also no formal medication reconciliation for patients to ensure their medications were correct when coming into and leaving the hospital. Despite these challenges inspectors found there were systems in place for reducing risk with high risk medications and the hospital had implemented a new medication record.

Overall inspectors found limited progress with recommendations made during the last medication safety inspection and a need for further progress with medication safety.

South Tipperary General Hospital, 15 October 2019

Since the previous HIQA inspection, the hospital had strengthened governance arrangements and had implemented a number of safety initiatives to improve medication safety. The hospital’s Drugs and Therapeutics Committee oversaw the medication safety plan for 2019 and inspectors found that although not all goals had been achieved there was evidence of progress to improve medication safety.

The lack of clinical pharmacy service at the hospital remained a concern to HIQA considering the size and complexity of the services provided by the hospital. While acknowledging efforts to recruit additional pharmacy resources, the hospital should ensure that the pharmacy service is utilised most appropriately, with high risk areas prioritised, to mitigate risk and promote patient safety.

South Tipperary General Hospital had systems in place for high-risk medications. However, the hospital should ensure that the risk reduction strategies and policies in place are audited to provide assurance to hospital management that they have been effectively and consistently implemented across all clinical areas. HIQA also determined there was scope to improve the culture and ownership of medication safety incident reporting by clinical staff.

Considering the limited clinical pharmacy resources available, HIQA concluded that medication safety was evolving at South Tipperary General Hospital and progress to date demonstrated a commitment to advancing improvements with medication safety for the benefit of patients.

CHI at Temple Street, 14 November 2019

The announced medication safety inspection at Children’s Health Ireland at Temple Street on the 14 November 2019 was the hospital’s second medication safety inspection. During this inspection HIQA identified a lack of clearly defined objectives for medication safety, such as a medication safety strategy, and this was a potential barrier to improving medication safety at the hospital.

Although there was some increase in clinical pharmacy resources since the last inspection, the continued lack of clinical pharmacy services in some clinical areas remained a concern for HIQA as there is greater complexity and potential risk with prescribing and administration of medication for children.

Children’s Health Ireland at Temple Street had implemented some risk-reduction strategies for high-risk medications but inspectors found that audit and monitoring of medication safety could be further developed and strengthened to provide assurance around medication safety practices at the hospital.

Overall, Children’s Health Ireland at Temple Street had established governance arrangements in place with some systems and processes to support medication safety in the hospital. However, there was further scope to improve awareness and oversight of high-risk medications and implement evidence-based higher-leverage strategies to protect children against the harm associated with high-risk medications.

St Vincent’s University Hospital, 7 November 2019

Inspectors found clear lines of accountability and effective governance over medication safety at St Vincent’s University Hospital. There were clear objectives set out in the hospital’s medication safety plan and progress to improve medication safety was evident during the inspection.

The hospital had systems in place for high risk medications and had a comprehensive clinical pharmacy service. Formal medication reconciliation was conducted for all patients admitted to the hospital which is commendable.

There was opportunity to improve areas with low reporting of medication safety incidents, to develop key performance indicators and time bound action plans in response to audits to enhance safety surveillance and ensure that required improvements are achieved.

Overall the findings from this inspection were that St Vincent’s University Hospital continued to promote and implement effective medication safety strategies to protect patients and improvements were driven over a long period of time by strong local leadership with management support.

Our Lady’s Hospital Navan, 26 November 2019

Since the last medication safety inspection the hospital had embedded the governance arrangements in place for medication safety. The hospital had developed a medication safety programme but although they had not reviewed this regularly to monitor progress they had progressed other medication safety initiatives.

Similar to the last inspection there was no clinical pharmacy service available for inpatients which was of concern to HIQA. There was also no progress with the development of a formulary and the update of medication-related policies, procedures and guidelines viewed by inspectors.

Inspectors found systems in place for high risk medications and medication reconciliation had been introduced two days per week in the Emergency Department but this was not completed for any patients on discharge. Monitoring and evaluation of medication safety had improved since the last inspection and this should be sustained.

Overall although staff were striving to improve and promote medication safety, many essential elements to support medication safety were still absent or only partially in place.