Medication safety monitoring inspections in public acute hospitals publication statement 9 March 2020

Date of publication:

The Health Information and Quality Authority (HIQA) has today published five inspection reports on medication safety focusing on governance arrangements and systems in place to support the safe use of medicines especially high-risk medicines (a medicine which could causing significant patient harm or death if used in error) and high-risk situations in public, acute hospitals. The monitoring programme aims to monitor a health service’s compliance with the National Standards for Safer Better Healthcare and to promote quality improvement in the services provided. 

Inspections were conducted between October and December 2019 at: 

  • Royal Victoria Eye and Ear Hospital
  • Midland Regional Hospital Portlaoise
  • Rotunda Hospital 
  • Ennis Hospital
  • St James’s Hospital. 

Royal Victoria Eye and Ear Hospital, 2 October 2019

The second announced medication safety inspection at the Royal Victoria Eye and Ear Hospital was conducted on 2 October 2019.  

The hospital had good systems in place to support medication safety and were implementing identified priorities from their medications safety strategy. 

The hospital had a full clinical pharmacy service for all clinical areas, which was to be commended. The hospital had a system in place for the approval of new medications and all new medications were included in the hospital’s formulary (a list of medicines) which was reviewed annually. Medication reconciliation was conducted on all patients on admission to and discharge from the hospital. 

The hospital had some risk-reduction strategies in place to protect patients from the risk of harm from high-risk medications and staff were aware of these. 

Overall, while the hospital had good systems in place for medication safety, there were opportunities for improvement in the area of medication incident reporting and auditing. Improvement in these areas would enhance medication safety at the hospital. 
 

Midland Regional Hospital Portlaoise, 30 October 2019

The hospital had systems in place for the management of high-risk medications and staff had an awareness of the risk-reduction strategies to protect patients from risk of harm. 

The hospital had a clinical pharmacy service for the general wards. Medication reconciliation was conducted on admission to the hospital. There was a system in place for the reporting of medication incidents; however, there was an over-reliance on pharmacy staff to report such incidents. 

Overall, while the hospital had good systems in place for medication safety, there were opportunities for improvement that, if acted on, could enhance medication safety at the hospital. All patients should have medication reconciliation conducted on discharge from the hospital. Hospital management should implement initiatives to increase the reporting of medication incidents amongst medical, nursing and midwifery staff. The hospital should introduce a formulary (a list of medicines) setting out the approved medications used in the hospital and this should be regularly reviewed. 

Rotunda Hospital, 26 November 2019

The Rotunda Hospital had a well-established medication safety programme in place. The hospital had set clear objectives for medication safety outlined in a medication safety strategy with short, medium and long-term operational plans in place to support the implementation of the strategy. Progress with medication safety plans was evident to inspectors during this inspection, and it was clear that medication safety was prioritised at executive level in the hospital with strong leadership from the Chief Pharmacist.

A clinical pharmacy service was provided to almost all clinical areas apart from the delivery suite and operating theatre. The hospital identified high-risk medications and have implemented risk-reduction strategies to protect women and babies from the risk of harm. Since the last medication safety inspection, the hospital had implemented an electronic health record system for all women and babies which enabled the hospital to apply safety measures for high-risk medications. 
The hospital had a system in place for the reporting of medication incidents and all staff were aware of the need to report such incidents. Medications were included in the hospital’s formulary (a list of medicines) which was reviewed annually. 

Overall the hospital had good systems in place for medication safety. There were opportunities for improvement, such as the introduction of medication reconciliation for all women on admission to and discharge from the hospital and progress with implementation of risk reduction strategies that the hospital had themselves identified. 

Ennis Hospital, 5 December 2019

The hospital had identified high-risk medications and had implemented risk-reduction strategies to reduce the risk of harm to patients. 

The hospital is part of the UL Hospitals hospital group which have an established Drugs and Therapeutics Committee. However, while Ennis Hospital was a member of this committee, the hospital was not always present at meetings of the Committee. 

Clinical pharmacy services were not available in all clinical areas and medication reconciliation was not conducted on all patients on admission to and discharge from the hospital. The hospital had an electronic formulary (a list of medicines) and a system in place for the approval of new medications, both of which was under the governance of the UL Hospitals’ Drugs and Therapeutic Committee.

The hospital monitored medication safety initiatives; however, the rate of reporting medication incidents at the hospital was low when compared to other hospitals of similar size and function. 

Hospital management needs to progress with its plan to address deficiencies in clinical pharmacy resources in Ennis Hospital and ensure that a representative from the hospital attends all meetings of the Drugs and Therapeutics Committee. The hospital should also continue to identify and support targeted promotion of medication incident reporting, so that a culture of reporting is enhanced across the hospital. 

St. James’s Hospital, 12 December 2019

The hospital had a medication safety strategy and medication safety was prioritised at senior management level with effective leadership from the Medication Safety Facilitator. The hospital identified high-risk medications and had implemented risk- reduction strategies to reduce the risk of harm for patients.

Since the last medication safety inspection, the hospital had implemented an electronic patient record and this enabled the hospital to implement safety measures for high-risk medications. 

The hospital had a formulary (a list of medicines) that was regularly reviewed and provided a clinical pharmacy service for the majority of inpatients and an out-of-hours pharmacy service was provided, which was to be commended. The hospital had a system in place for reporting medication incidents and all staff were aware of the need to report such incidents. Medication reconciliation was not conducted on all patients on admission to and discharge from the hospital.  

Overall, the hospital had good systems in place for medication safety. Inspectors found that the hospital had the potential to expand and enhance medication safety auditing, to ensure that actions and recommendations arising from audits are monitored and implemented.