Four inspection reports on medication safety in public acute hospitals have been published today by the Health Information and Quality Authority (HIQA). HIQA monitors medication safety in hospitals against the National Standards for Safer Better Healthcare. Inspections were carried out in June 2017 at Kilcreene Regional Orthopaedic Hospital, Kilkenny; Roscommon University Hospital, Roscommon; St. Columcille’s Hospital, Loughlinstown, Dublin; and St. Luke’s Hospital, Rathgar, Dublin.

The four inspections identified considerable variation in the medication safety arrangements in place in each hospital.

Kilcreene Regional Orthopaedic Hospital, Kilkenny

An announced inspection of Kilcreene Regional Orthopaedic Hospital was carried out on 14 June 2017. On the day of inspection, HIQA found that the overarching governance arrangements relating to medication safety at the hospital and at hospital group level required considerable improvement. Elements of medication safety were reported into both the South/South West Hospital Group and the Ireland East Hospital Group. St. Luke’s General Hospital was responsible for the provision of pharmacy services to Kilcreene Regional Orthopaedic Hospital, while University Hospital Waterford had overall accountability and responsibility for medication safety at Kilcreene Regional Orthopaedic Hospital.

Despite the complexity of governance arrangements in place at the hospital, shared ownership, accountability and responsibility relating to medication safety was evident at ward level on the day of inspection. The size of the hospital, elective nature of the patients admitted and commitment of staff on a day-to-day basis had facilitated some oversight of medication safety issues at local level.

The complex arrangements viewed by inspectors had resulted in weaknesses in the management of medication safety at the hospital and represents a latent risk that needs to be addressed as a matter of priority. Fundamentally, many of the identified opportunities for improvement require the governance arrangements between Kilcreene Regional Orthopaedic Hospital, St. Luke’s General Hospital and University Hospital Waterford to be clarified.

Roscommon University Hospital, Roscommon

An announced inspection of Roscommon University Hospital, Roscommon took place on 16 June 2017. Inspectors found the hospital had a Drugs and Therapeutics Committee in place that was responsible for the governance and oversight of the hospital’s medication management systems and safety. However, HIQA found that the leadership, governance and oversight of medication management systems by the committee needed to be strengthened to ensure medication safety.

The hospital did not have a defined medication safety programme with clear objectives underpinned by a written strategy. HIQA recommends that an agreed written medication strategy or plan, targeted on the basis of risk, should be developed and implemented by the hospital, and shared with the wider Saolta Hospital Group.

Inspectors found that the number of medication-related incidents and near misses reported at Roscommon University Hospital was low. The hospital needs to begin to better measure and report medication-related risks through improved reporting by all healthcare staff.

Roscommon University Hospital had no medicines formulary in place to ensure appropriate governance around the approval of medicines for use and that a proper safety evaluation occurs before medications are introduced into practice at the hospital. As Roscommon University Hospital formed part of the Saolta Hospital Group, the hospital should have a representative on the Galway University Hospitals’ Drugs and Therapeutics Committee to support governance arrangements for medication safety and collaborate to develop a formulary. Collaboration within the hospital group in relation to medication safety would provide a valuable opportunity to share learning, experience and resources.

St. Columcille’s Hospital, Loughlinstown, Dublin

An announced inspection of St. Columcille’s Hospital, Loughlinstown, Dublin took place on on 21 June 2017. During the inspection, HIQA found that the medication safety agenda was being proactively progressed at the hospital. Medication safety was prioritised at organisational level and it was evident that this had been led by effective local leadership and executive management support. There was strong multidisciplinary involvement, and it was evident that senior clinicians worked collaboratively to maximise the quality of medication safety across the hospital.

The Drugs and Therapeutics Committee had effective leadership and clear governance arrangements in place with systems, processes and practices to support medication safety in the hospital. The committee had formal and effective links with St. Vincent’s University Hospital’s Drugs and Therapeutics Committee which promoted learning and collaboration across sites.

Inspectors found that medication-related incidents and near misses were tracked, trended and graded, and where trends were identified, action was taken to prevent re-occurrence. However, the reporting of medication incidents by all healthcare staff was identified by HIQA and the hospital as an area requiring further improvement.

St. Luke’s Hospital, Rathgar, Dublin

An announced inspection of St. Luke’s Hospital, Rathgar, Dublin was carried out on 21 June 2017. Inspectors found on the day of inspection that the Drugs and Therapeutics Advisory Committee in the hospital provided the leadership and structure to select appropriate medications for the recently developed formulary and promoted rational drug use. However, inspectors found that the committee was primarily focused on formulary management. There was no reference to matters relating to medication safety in the minutes of meetings viewed by inspectors. Hospital management acknowledged that governance arrangements for medication safety within the hospital needed to be further developed and fully formalised.

While some medication safety interventions were in place, the medication safety programme in place at St. Luke’s Hospital, Rathgar was informal. Nevertheless, at the time of inspection it was evident that a more structured approach to medication safety at the hospital was beginning to emerge. The hospital had recently developed a draft medication safety programme, however, the programme had not been implemented at the time of inspection. Inspectors determined that the hospital should build on their work to date to develop and implement a medicines safety strategy and operational plan that sets out a clear vision for medication safety across the organisation.

Inspectors found that there remains scope for improvement to promote a more effective culture of medication error and near miss reporting as part of a wider, more formalised approach to the development of a comprehensive medication safety programme at the hospital.

St. Luke’s Hospital, Rathgar was actively collaborating with other hospitals within the Dublin Midlands Hospital Group, and through the National Cancer Control Programme, to standardise practice in order to progress a shared working approach to improving medication safety.

Notes for Editors

• HIQA’s medication safety monitoring programme, which commenced in November 2016, aims to examine and positively influence the adoption and implementation of evidence-based practice in public acute hospitals regarding medication safety. 
• HIQA’s Guide to the Health Information and Quality Authority’s Medication Safety Monitoring Programme in Public Acute Hospitals outlines the requirements for service providers under phase one of the inspection programme.