The announced medication safety inspection in University Hospital Limerick on 29 May 2018 was the second medication safety inspection at the hospital. 

Since the last inspection changes had been made to strengthen governance structures and reporting arrangements for medication safety, and a medication safety programme and medication safety officer were in place. The inspection team found that some quality improvements were being initiated by the hospital including improved medication incident reporting and medication reconciliation practices. The hospital had conducted some audits related to medication safety and commenced the development of a local formulary. 

However, HIQA found that some of the risks identified in the previous inspection in 2017 were still present, including the ongoing lack of clinical pharmacy services at the hospital, a relative lack of access to information to guide clinical staff in the safe use of medicines and disparities in the implementation of medication safety measures. Details of these risks were communicated to hospital management so that the hospital could act to mitigate and manage these risks as a matter of urgency.

The hospital must focus its efforts to address the risks and findings identified to ensure that the necessary arrangements are in place to protect patients from the risk of medication-related harm.
 

The announced medication safety inspection at Temple Street Children’s University Hospital on the 05 June 2018 was the first medication safety inspection at the hospital. 

The hospital had a Medication Safety Quality Improvement Plan and was collaborating with other hospitals within the Children’s Hospital Group to streamline systems to improve medication safety. This included a plan to develop a joint formulary within the Children’s Hospital Group. 

Given the greater complexity with prescribing and administering medication for children and the higher potential for harm when an error does occur, the availability of a clinical pharmacy service for all patients needs to be prioritised. Inspectors also found audits of medication safety and systems for medication reconciliation could be further developed.

There was a significant increase in medication safety incident reporting in the hospital which reflected the emphasis placed by managers and the willingness of front-line staff to provide information to reduce the risk of reoccurring harm to patients. However, all healthcare staff should be encouraged to report incidents. 

Overall, HIQA found Temple Street Children’s University Hospital had governance arrangements and systems in place to support medication safety driven by local leadership and executive management support. 

The announced inspection at Cork University Hospital on 15 June 2018 was the first medication safety inspection at the hospital. Cork University Hospital had formalised governance arrangements in place, including a Drugs and Therapeutics Committee that oversaw the hospital’s medication safety programme.

Clinical pharmacy services were provided to most areas. While the hospital continues to address gaps, clinical pharmacy services must be kept under review in order to provide inpatients with the required level of clinical pharmacy service as identified by the hospital. 

The hospital should progress and expand on the work completed to date with the hospital’s preferred list of medicines and move towards the development of a defined formulary process to outline medicines that are approved for use in the hospital. This work could be supported through collaboration with other hospitals within the South/South West Hospital Group.

Inspectors found examples of medication safety quality improvement initiatives being strategically driven by learning gained from identifying risks and medication incidents. However, current arrangements for auditing and evaluating medication safety systems at the hospital should be strengthened and formalised to provide assurance to senior hospital management about medication safety at the hospital.

Overall, HIQA found that systems, processes and practices were in place to support medication safety, some of which were in the process of implementation. 

The announced inspection in Letterkenny University Hospital on 26 June 2018 was the second medication safety inspection at the hospital. 

Since the last inspection, the hospital had put governance structures in place by re-establishing its Drugs and Therapeutics Committee and establishing a Medication Safety subgroup. The Drugs and Therapeutics Committee met regularly with good attendance from members. Inspectors found some auditing of medication safety and improved medication incident reporting since the last inspection. 

However, HIQA identified specific risks during this inspection including the absence of clear direction and an overarching strategic plan for medication safety, limited implementation of effective medication safety quality improvements, a sustained lack of clinical pharmacy services in high-risk areas (such as maternity and paedriatric units) and limited locally developed or adapted information to guide clinical staff in the safe use of medicines.

Overall, HIQA found limited progress had been made to address the areas for improvement identified during the previous medication safety inspection in August 2017. Details of these risks were communicated to hospital management so that the hospital could act to mitigate and manage these risks as a matter of urgency. The hospital should ensure that those responsible for medication safety address the findings in this and previous medication safety reports.

The announced medication safety inspection at Beaumont Hospital on 03 July 2018 was the first medication safety inspection at the hospital. The hospital had a medication safety programme plan in place for 2018 and demonstrated progress across identified areas.

Although some areas of the hospital did not have a clinical pharmacy service, it was evident that pharmacy resources were deployed using a risk-based approach to target high-risk areas and high-risk patients. The hospital should continue to review and monitor clinical pharmacy services provided using this risk-based approach and ensure that plans are put in place to address gaps in service delivery for clinical areas that do not have a clinical pharmacy service.

There was evidence that medication safety was informed and improved by incident reporting and clinical audit so that relevant data was used as the basis for decision-making, action and change. 

Further improvement in relation to medication safety should focus on improving reporting of medication-related incidents across all disciplines and clinical areas, rationalising the number and use of medicines available on the hospital formulary and enhancing patient education on medicines. 

Overall, inspectors found that the hospital had established governance arrangements and systems in place to support medication safety driven by effective local leadership and executive management support.