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 September and October 2017 at the Midland Regional Hospital Portlaoise, Royal Victoria Eye and Ear Hospital, St Luke’s General Hospital Kilkenny and the Coombe Women & Infants University Hospital.

Midland Regional Hospital Portlaoise

During an announced inspection at the Midland Regional Hospital Portlaoise on 28 September 2017, HIQA found that the hospital had an established Drugs and Therapeutics Committee that provided governance and oversight of the medication management safety systems within the hospital. However, inspectors found that while the hospital had ward stock lists of drugs, it did not have a hospital-wide drug formulary or written criteria to support the addition or removal of medications from the pharmacy ward stock lists.

The hospital had a system for reporting and addressing medication errors and near misses and, while there was an overall downward trend in the number of medication incidents being reported since 2015, medication incident reporting had increased throughout 2017.

While the hospital did not have a medication strategy in place, inspectors were provided with examples of quality improvement initiatives which improved medication safety practices as a result. The hospital should now look to further progress its work in this area by devising a formalised medication safety strategy and plan with clearly defined objectives, prioritised on the basis of identified risk. In addition, current medication safety auditing arrangements should be strengthened to continue to provide assurance to the hospital’s Senior Management Team about medication safety.

Royal Victoria Eye and Ear Hospital

An announced inspected on 28 September 2017 by HIQA identified that the Royal Victoria Eye and Ear Hospital had an established Drugs, Therapeutics and Antimicrobial Stewardship Committee in place to support medication safety. Systems, processes, practices and audits were in place to support medication safety.

The hospital had an established system for reporting and addressing medication errors and near misses, and promoted an open reporting culture for learning from medication-related incidents and near misses. Despite this, the hospital had identified that medication-related incidents were under reported at the hospital and there had been a decline in reporting rates in recent times. The hospital had conducted a number of audits and used key performance indicators to monitor medication safety.

Overall, HIQA found that medication safety was prioritised at organisational level with clear leadership from the Senior Pharmacist and the support of the Drugs, Therapeutics and Antimicrobial Stewardship Committee. Hospital management and other staff should continue to build on their work to date to progress the implementation of a formalised medication safety strategy that sets out a clear vision for medication safety across the organisation.

St Luke’s General Hospital, Kilkenny

During an announced inspection on 11 October 2017 HIQA found that St Luke’s General Hospital had an established Drugs and Therapeutics Committee in place. The hospital’s medication safety programme was in the early stages of development and was progressing through the Medication Safety Committee.

Although clinical pharmacy services were resourced to provide dedicated pharmacy services to all general adult wards, there were no dedicated services to the paediatric and maternity units. HIQA recommended that this be evaluated in view of risks with medication use in these settings. Furthermore, a local medication formulary did not exist in the hospital at the time of inspection.

The hospital had an established system for reporting and addressing medication errors and near misses and had implemented a number of medication safety measures using a proactive approach. This included a pilot of a pharmacy-led discharge medication reconciliation initiative using electronic technology for a cohort of higher risk patients who would benefit the most.

The hospital had conducted a number of audits relating to medication management but audit activity was neither strategically driven nor centrally coordinated and the hospital should build on work to date using a more structured approach to the planning of audit. This could be aligned to a formal medication safety strategy to strengthen existing approaches to improving medication safety.

Coombe Women & Infants University Hospital

An announced inspection in the Coombe Women & Infants University Hospital on 25 October 2017 found that the medication safety agenda was being actively progressed at the hospital and a functional Drugs and Therapeutics Committee was in place. There was clear leadership from the Chief Pharmacist supported by the multidisciplinary team and senior hospital managers working to provide medication safety across the hospital. The hospital had a clear medication management plan which was being actively progressed through the Medication Safety Committee, under the governance of the Drugs and Therapeutic Committee.

The hospital demonstrated a variety of medication safety quality improvement initiatives which had been implemented including smart pump technology, prescribing guidelines available to staff through smart technology, leadership and quality walk-rounds and medications safety walk-rounds.

Medicines-related incidents and near misses were tracked, trended and graded and, where trends were identified, action was taken to prevent reoccurrence of such variance.

There was evidence that audits undertaken by hospital staff supported medication safety. The hospital should continue its good work to promote these quality assurance systems and its strong focus on medication safety.