Hiqa finds medication safety risks in hospitals

Inspections of a number of hospitals have found under-reporting of medication ‘near misses’ and incidents.

Some hospitals did not have up-to-date approved lists of medications stocked while patients screened at one hospital found almost 80% had their medication corrected after the process.

The Health Information and Quality Authority (Hiqa) published the first inspection reports on medication safety in public acute hospitals. It examined seven hospitals and found “a wide variation in the medication safety arrangements in place”.

The inspection at Bantry General Hospital found an immediate high risk over medication safety, with an intravenous medication administration guidance document specifically designed for use in Cork University Hospital in use in Bantry. “There was therefore a risk that instructions for administration of intravenous medications could be incorrect, resulting in patient harm,” it said.

“While efforts were extended by the pharmacist to support staff in safe medicines usage, the hospital was not sufficiently resourced to provide a comprehensive clinical pharmacy service,” said Hiqa.

Risks were also identified at University Hospital Waterford, including the availability in clinical areas of outdated and potentially conflicting reference information for the reconstitution and administration of intravenous medication, and inadequate arrangements to identify, report and manage risks associated with medication use.

A common theme in some hospitals was the low numbers of medication- related incidents reported.

The report into the inspection at Connolly Hospital, Blanchardstown, Dublin said: “Medication-related incidents were likely significantly under-reported at the hospital.”

There was a similar finding at Sligo University Hospital. A a report into Nenagh Hospital in Tipperary stated: “Near misses in relation to medication-related issues were not being reported. Senior management recognised that this level of reporting was not in line with internationally accepted norms and were aware of the need for improvement.”

The same report said: “On the day of the announced inspection Nenagh Hospital did not have essential governance arrangements in place in relation to medication safety. The hospital did not have clear objectives, goals or plans for medication safety.” Good practice was still reported in the hospitals while the report into the Mater Misericordiae University Hospital in Dublin highlighted the growing rates of reporting which Hiqa said was a positive sign.

“The 2015 medication variance annual report showed medication incidents and near-miss reporting had risen over 50% (to 1,165 in 2015) since 2013,” it said.

A formal structured pharmacy-led medication reconciliation service found that, last October, 78% of patients admitted through the emergency department aged over 65 had their medications reconciled during clinical pharmacy service hours. Preliminary analysis identified 1.5 discrepancies per patient. n www.hiqa.ie

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