Medication Safety Resources Needed

The first HIQA reports on medication safety in public acute hospitals in Ireland have found that where effective medication safety governance arrangements were in place, patients were better protected from potential harm related to medication use.

It also found that some hospitals lacked some necessary resources which would assist in promoting greater safety in the use of medicines, and further support in this regard might help to assist in improving medication safety.

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.

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Seven inspections were carried out between November and December 2016. HIQA found a wide variation in the medication safety arrangements in place across the seven hospitals.

Sean Egan, HIQA’s Acting Head of Healthcare Regulation said: “Error associated with medication use constitutes one of the major causes of patient harm in hospital. Medication safety should be a priority area for all acute hospitals as they seek to ensure a high-quality and safe service for patients.

“These inspections found that while all hospitals have some scope for further improvement, some hospitals were well organised to ensure safer use of medicines for patients, and had good arrangements in place to monitor, identify and manage risk associated with medicines use.”

A number of examples of good practice in relation to medication safety were found during these inspections. For example in Naas General Hospital, the Mater Misericordiae University Hospital and Sligo University Hospital, HIQA found that medication safety was effectively supported by senior management in the hospitals, a formal and structured medication safety programme was established, an open incident and near-miss reporting culture was promoted and a process was in a place for learning from medication-related incidents.  It also found that medication safety audits were carried out and learning was shared with all staff, up-to-date medication policies were in place, and good leadership was shown from key clinical staff to support medication safety.

“However, these inspections also found that learning from hospitals that have more advanced medication safety programmes in place should be shared nationally, as more needed to be done in other hospitals to better promote safer use of medicines,” said HIQA.

“A key building block for any medication safety programme is the presence of an effective governance committee – usually known as a Drugs and Therapeutics Committee – which oversees how the hospital anticipates, monitors, identifies and responds to risk related to medicines use.”

Medication safety has been identified internationally as a key focus for improvement in all healthcare settings and it is estimated that on average, at least one medication error per hospital patient occurs each day. While most of these errors do not result in patient harm, in a small but significant number of cases patient harm does occur.

Recent research on medication use in the health system found:

  • Twenty six per cent of Irish people over 50 years of age use five or more medicines daily.
  • Up to 20% of readmissions to hospital within a year of discharge are medicines-related.
  • Up to 8% of all emergency hospital admissions in Ireland are medicines-related.
  • Six per cent of hospital discharge prescriptions were found to have a potentially severe medication prescribing error.

HIQA’s medication safety inspections evaluated the medication safety structures in place in hospitals under the following six themes – governance and risk management, audit and evaluation, medication safety support structures and initiatives, person-centred care, policies procedures and guidelines and access to information and training and education

HIQA’s guide to medication safety can be found at https://www.hiqa.ie/reports-and-publications/guide/guide-medication-safety-monitoring-acute-hospitals