Five 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 April and May 2018 at Wexford General Hospital, St John’s Hospital Limerick, University Hospital Waterford, Our Lady’s Hospital Navan and the Regional Hospital Mullingar.    

Wexford General Hospital 

During an announced medication safety inspection on 11 April 2018 in Wexford General Hospital, inspectors found that the hospital had formalised governance arrangements in place to support medication safety. The hospital had a medication safety programme and had implemented elements of this with oversight from the Hospital’s Drugs and Therapeutics Committee and supported by the Pharmacy Department.

However, considering the complexity of the services provided by the hospital, inspectors found that the lack of a clinical pharmacy service provided to ward areas was a risk to patient safety. This risk was highlighted by the hospital to the Ireland East Hospital Group, and subsequently four additional pharmacist posts had been approved.

During inspection it was found that the hospital did not have a medicines formulary, there was a low level of medication incident reporting (which was significantly low in the six months preceding this inspection) and medication safety audits were neither strategically planned nor coordinated.

While the hospital’s Drugs and Therapeutic Committee had identified areas for improvement in the medication management system, engagement and support from senior hospital management and clinicians is needed to drive change and provide assurance that medication safety is a priority.

St John’s Hospital Limerick

During an announced medication safety inspection in St. John’s Hospital Limerick on the 17 April 2018, HIQA found some systems, processes and practices in place to support medication safety, however others were still in the process of being implemented.

The hospital had identified and was in the process of implementing a number of quality improvement activities related to medication safety. However, the Drugs and Therapeutics Committee did not have oversight of this work because it did not hold the required meetings to provide the necessary governance and oversight. 

Inspectors found the hospital provided a team-led clinical pharmacy service that gave advice and guidance to staff and provided a medication reconciliation service on admission. Inspectors noted that the reporting of medication-related incidents requires improvement following a significant decline in recent months.

The hospital did not have a local formulary of medicines at the time of the inspection. This should be developed and could be supported by collaboration with other hospitals within the hospital group.

Overall, inspectors found that the hospital had a medication safety programme that was actively supported by the hospital’s Medication Safety Working Group with engagement and support from senior hospital clinicians.

University Hospital Waterford 

The announced inspection in University Hospital Waterford on 02 May 2018 was the second medication safety inspection at the hospital. HIQA previously conducted a medication safety inspection at the hospital in December 2016 which identified considerable scope for improvement. This inspection aimed to determine the progress made in addressing the deficits since then.

The hospital had formalised governance arrangements in place for medication safety. There was a medication safety strategy and good evidence of improvements in relation to medication safety, for example, medicines information was available to staff and medication-related audit.

Although many risks identified in the previous inspection in December 2016 were being addressed, inspectors found risks associated with a failure to control and monitor the temperature conditions for the storage of refrigerated medicinal products and uncontrolled access to a treatment room in a paediatric area. In response to these risks, HIQA wrote to the hospital following the inspection to seek assurances as to how these specific risks would be mitigated as a matter of urgency.

The hospital still lacked some of the essential elements required to support medication safety by comparison to some of the hospitals of a similar size and service type inspected during this series of HIQA inspections.These included a relative lack of clinical pharmacy services and a hospital formulary. These deficits require continued internal leadership and support, and could benefit from external support and sharing of expertise from the South/South West Hospital Group.

Our Lady’s Hospital Navan

During an announced medication safety inspection at Our Lady’s Hospital Navan on 02 May 2018, HIQA found that the hospital had formalised governance arrangements and systems in place to support medication safety, although these were in the early stages of development and implementation.

The hospital had a medication safety programme plan in place for 2017 to 2018, which was overseen by the Drugs and Therapeutics Committee. Inspectors found that improvements in relation to medication safety were progressing, but oversight of this work was not provided and formalised reporting arrangements were not consistently taking place.

Inspectors found elements to support medication safety required improvement; for example the provision of a clinical pharmacy service, a medicines formulary and locally produced or adapted information to support the safe use of medicines.

The hospital should continue to progress work identified in relation to policies, procedures and guidelines and ensure that clinical staff have up-to-date information to guide the safe use of medicines at the point of prescribing, preparation and administration.

Overall, inspectors found some systems in place to monitor medication safety but more work is required to strengthen the monitoring and evaluating arrangements for medication safety systems.

Regional Hospital Mullingar

The announced inspection in Regional Hospital Mullingar on 17 May 2018 was the second medication safety inspection at the hospital. Since the previous medication safety inspection in April 2017, the hospital had initiated a number of improvements. However, on the day of the inspection, inspectors were not assured that sufficient progress had been made in the implementation of the essential elements required to fully ensure and promote medication safety.

The ongoing lack of a clinical pharmacy service continued to constitute a risk to patient safety. The hospital was in the process of recruiting new pharmacy staff and had developed a plan for the introduction of a clinical pharmacy service.

The hospital did not have a medicines formulary but had made some progress in the development of new policies, procedure and guidelines to support medication safety. However, inspectors found that a cohesive, multidisciplinary approach to providing medication information resources was lacking and there was a need for the hospital to ensure that all medicines-related information is up to date and available to staff. The lack of local nursing supports to provide educational assistance to front-line staff was notable in comparison to other similar sized hospitals.

There still continues to be under-reporting of medication incidents.  Although inspectors found a number of medication-related audits had been undertaken, the hospital needs to develop a clinical audit plan aligned to the medication safety plan.

The Regional Hospital Mullingar requires further improvement to bring medication safety in the hospital up to the level expected and observed in other similar sized hospitals inspected by HIQA so far under this inspection programme.