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Medication Safety Results from the Hospital Pharmacy in Canada report Medication Safety Results from the Hospital Pharmacy in Canada report Patricia Lefebvre.

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Presentation on theme: "Medication Safety Results from the Hospital Pharmacy in Canada report Medication Safety Results from the Hospital Pharmacy in Canada report Patricia Lefebvre."— Presentation transcript:

1 Medication Safety Results from the Hospital Pharmacy in Canada report Medication Safety Results from the Hospital Pharmacy in Canada report Patricia Lefebvre Millcroft Pharmacy Leadership Conference June 1-3, 2007

2 Objective Provide participants with a view of the state of patient safety from a pharmacy perspective in Canada Provide participants with a view of the state of patient safety from a pharmacy perspective in Canada Highlights of the 2005/2006 Annual Report – Hospital Pharmacy in Canada Highlights of the 2005/2006 Annual Report – Hospital Pharmacy in Canada

3 Medication Errors

4 Medication Errors MEDMARX Medications most commonly involved Hospital Pharmacy, 2006:41 S3-S10

5 2005/06 Hospital Pharmacy in Canada: survey methodology 2005/06 Hospital Pharmacy in Canada: survey methodology List of hospital pharmacies and membership list of the Association of Canadian Academic Healthcare Organizations (ACAHO) and telephone survey to obtain name and address of the Director of Pharmacy and the hospitals Chief Executive Officer List of hospital pharmacies and membership list of the Association of Canadian Academic Healthcare Organizations (ACAHO) and telephone survey to obtain name and address of the Director of Pharmacy and the hospitals Chief Executive Officer s sent to Directors of Pharmacy and CEOs in June 2006; second to Directors of Pharmacy in July. s sent to Directors of Pharmacy and CEOs in June 2006; second to Directors of Pharmacy in July. Period to fill survey: June 23 to September 1, 06 Period to fill survey: June 23 to September 1, 06 Eligibility: total of 100 beds and at least 50 acute care beds Eligibility: total of 100 beds and at least 50 acute care beds Response rate: 74% (142/193) Response rate: 74% (142/193) Hospital Demographic Info, Qc: 30% (42/142) Hospital Demographic Info, Qc: 30% (42/142) Québec response rate: 71% (42/59) Québec response rate: 71% (42/59)

6 Disclosure Policy Hospital has a policy on the disclosure of incidents to patients and/or their families (ROP – Culture) Hospital has a policy on the disclosure of incidents to patients and/or their families (ROP – Culture) 2005/ /04 80 % 63 %

7 Disclosure Policy Disclosure is documented in the health record Disclosure is documented in the health record 2005/ /04 91% 81%

8 Medication Incident Reporting A medication incident reporting system is in use A medication incident reporting system is in use 2005/ /04 96% 100%

9 Medication Incident Reporting Medication incident reports can be used during an individual healthcare providers performance assessment 2005/ /04 Medication incident reports can be used during an individual healthcare providers performance assessment 2005/ /04 12% 21% Respondents: Academic Health Centres: 0% Academic Health Centres: 0% Non Academic Health Centres: 16% Non Academic Health Centres: 16%

10 Committee responsible for the review of medication incidents Committee responsible for the review of medication incidents 2005/ /04 Committee responsible for the review of medication incidents 2005/ /04 80% 80% If yes, committee is dedicated to Medication Safety 44% 17%

11 Medication safety self- assessment Medication safety self- assessment has been completed (ROP) 2005/ /04 Medication safety self- assessment has been completed (ROP) 2005/ /04 71% 51% 71% 51% ISMP: 91% ISMP: 91% Autres: 6% (Qc: 31 %) Autres: 6% (Qc: 31 %)

12 Medication History Taking When a patient visits the ED, When a patient visits the ED, a comprehensive medication history is conducted a comprehensive medication history is conducted 45% 45% The patients medication history is reconciled with medication orders written at the time of admission or ER visit The patients medication history is reconciled with medication orders written at the time of admission or ER visit 45% 45%

13 Medication History Taking When a patient is admitted to the organization, a comprehensive medication history is conducted When a patient is admitted to the organization, a comprehensive medication history is conducted (POR – communication – and with the involvement of the patient/client) (POR – communication – and with the involvement of the patient/client) 42% 42% Medication history is reconciled with medication orders written at the time of admission Medication history is reconciled with medication orders written at the time of admission 46% 46%

14 Medication History Taking When patient is transferred between levels of care within the facility, reconcile the patients medications and communicate that information to the next provider of care When patient is transferred between levels of care within the facility, reconcile the patients medications and communicate that information to the next provider of care (POR – communication, with the patient/client) 38% (All: 20% / Sel: 78%) 38% (All: 20% / Sel: 78%)

15 Medication History Taking When patient is transferred outside the facility, reconcile the patients medications and communicate that information to the next provider of care When patient is transferred outside the facility, reconcile the patients medications and communicate that information to the next provider of care (POR – communication, with the patient/client) 35% (All: 8% /Sel: 90%) 35% (All: 8% /Sel: 90%)

16 Medication History Taking Implementation of medication reconciliation is planned or underway Implementation of medication reconciliation is planned or underway The facility has examined the desirability and feasibility but additional resources would be required The facility has examined the desirability and feasibility but additional resources would be required The facility has not yet examined the desirability and feasibility The facility has not yet examined the desirability and feasibility The facility has examined the desirability and feasibility.. But.. There are not enough other supports The facility has examined the desirability and feasibility.. But.. There are not enough other supports 43% 34% 22% 13% Upon transfer between levels of care and/or at the time of discharge, the more significant barriers to provide a reconciled list of the patients medication are:

17 Ordering Operational Operational Approved plan to implement Approved plan to implement No CPOE plan approved No CPOE plan approved Integrated with a clinical decision support system Integrated with a clinical decision support system Interface with PIS Interface with PIS Computerized Prescriber Order Entry Systems (CPOE) 2005/ /04 6%5% 23%18% 70%76% N=6N=1 N=4N=2

18 Verbal Medication Orders Verbal and telephone orders are limited to situations in which the patient is at risk for harm and physician is unable to physically write a medication order = 90% = 90% 2005/ / / /04 42% 38% 42% 38%

19 Ordering There is a list of dangerous abbreviations that are NOT accepted in the organization 2005/ / / /04 58% 40% 58% 40%

20 Formal process to review and approve Pre-printed medication orders Pre-printed medication orders Prescriber order sets (i.e: computer order entry) Prescriber order sets (i.e: computer order entry) Infusion dosage charts and guidelines Infusion dosage charts and guidelines 2005/06 87% 42% 77% Ordering

21 Pharmacy Management Dispense Medication The patients allergy status is known prior to a medication order being dispensed = 90% = 90% 2005/ /04 68% 72% 68% 72%

22 Pharmacy Management Dispense Medication Drug distribution systems 2005/ / / / / /02 Unit dose (= 90% of beds) : 38% 31%24% Unit dose (= 90% of beds) : 38% 31%24% Centralized automated dispensing – UD : 66% 61% Centralized automated dispensing – UD : 66% 61% Automation used (65 respondents) Automation used (65 respondents) Canister : 83% (54/65) Canister : 83% (54/65) Robotic :17% (11/65) Robotic :17% (11/65)

23 Pharmacy Management Dispense Medication Drug distribution systems (Contd) 2005/ / / /04 Unit based automated dispensing systems Unit based automated dispensing systems 32% 20% 32% 20% Unit based automated dispensing (=90% of beds) Unit based automated dispensing (=90% of beds) n= 8n = 6 Unit dose – IV Admixture Services (=90% of beds) : Unit dose – IV Admixture Services (=90% of beds) : 62% 56 %

24 Pharmacy Management Select medication Bar Coding is used in the Medication-Use-System to: Bar Coding is used in the Medication-Use-System to: drug selection prior to dispensing from the pharmacy drug selection prior to dispensing from the pharmacy drug selection prior to patient administration drug selection prior to patient administration Identify patient during medication administration Identify patient during medication administration Return doses to inventory in the pharmacy Return doses to inventory in the pharmacy stocking of unit-dose bins stocking of unit-dose bins stocking of automated dispensing cabinets stocking of automated dispensing cabinets 2005/ /04 (35%, 50/142) 26% 16% 4% 3% 8% 3% 42% 34% 22% 13% 22% 16%

25 Pharmacy Management: Medication Inventory Standardize and limit the number of available infusion concentrations for the following high-alert medications (ROP: medication use) 2005/ /04 Heparin 75%81% Heparin 75%81% Insulin 48%47% Insulin 48%47% Morphine 57%47% Morphine 57%47% Hydromor- 53%41% phone Hydromor- 53%41% phone

26 Pharmacy Management: Medication Inventory Remove concentrated electrolytes from patient/client care units Remove concentrated electrolytes from patient/client care units (ROP – medication use) (ROP – medication use) 94% of respondents (133/142) 2005/ / / /04 KCL 85% 72% KCL 85% 72% Other 53%

27 Pharmacy Management: Medication Inventory Remove concentrated narcotics from patient/client care units (MSSS directives) Remove concentrated narcotics from patient/client care units (MSSS directives) 94% of respondents (133/142) 94% of respondents (133/142) 2005/ / / /04 65% 47% 65% 47%

28 Administration Management: Administer Medication =90% of beds =90% of beds 2005/ /04 40% 31% 40% 31% Policy requiring that two patient identifiers (neither to be the patients room number) are checked before administering medications

29 2005/ /04 C-MARs: ? 56% E-MARs ? Bedside, Bar Code 8% (n =4) 3% Smart pump ? (All, Selected patients) Administration Management: Document Administration

30 Education Provide patient with a copy of the MAR or similar document Provide patient with a copy of the MAR or similar document Allow viewing of the MAR by the patient Allow viewing of the MAR by the patient Provide counselling pamphlets for each prescribed medication Provide counselling pamphlets for each prescribed medication Provide a pharmacists consultation during in hospital stay Provide a pharmacists consultation during in hospital stay Provide contact information for other available sources of drug information Provide contact information for other available sources of drug information Process to facilitate patient teaching with regards to their medication therapy (ROP): 2005/06 selected all 30% 1% 21% 5% 65% 1% 78% 2% 62% 2%

31 Dedicated staff for DI /DUE 37% (2005/06) Dedicated staff for DI /DUE 37% (2005/06) 52% (2003/04) 52% (2003/04) Drug Information Drug Information Pharmacist: 1.4 FTE Pharmacist: 1.4 FTE Support staff: 0.7 FTE Support staff: 0.7 FTE Drug Use Evaluation Drug Use Evaluation Pharmacist: 1.1 FTE Pharmacist: 1.1 FTE Support staff: 0.4 FTE Support staff: 0.4 FTE Drug Information & Drug Use Evaluation

32 Monitor Evaluate/ Response: Intervene for medication errors / adverse drug events 45% ME - decentralized pharmacists 94% ME with negative outcome - decentralized pharmacists Bond & al. Pharmacotherapy 2001;21(9)

33 Monitor Evaluate/ Response: Intervene for medication errors / adverse drug events Bond & al. Pharmacotherapy 2002;22(2)

34

35 Proportion of time spent by Pharmacists in each activity: Clinical Services 2005/ /04 Drug Distribution43%48% Clinical Services41% 38% Teaching 6% 5% Research 2% 1% Non-patient 8% 8% care

36 Strategies implemented to improve internal reporting of ADEs Strategies implemented to improve internal reporting of ADEs 2005/062003/04 41% 38% 41% 38% Strategies implemented to trace and document the occurrence of ADEs Strategies implemented to trace and document the occurrence of ADEs 2005/062003/ /062003/04 41% 54% 41% 54% Monitoring and Surveillance

37 Preventing Medication Errors: Quality Chasm Series At least 25% of all medication- related injuries are preventable At least 25% of all medication- related injuries are preventable HCP should seek to create high- reliability organizations that constantly improve the safety and quality of medication use; HCP should seek to create high- reliability organizations that constantly improve the safety and quality of medication use; should implement active internal monitoring programs so that progress toward improved medication safety can be accurately demonstrated should implement active internal monitoring programs so that progress toward improved medication safety can be accurately demonstrated Establish and maintain a strong provider-patient partnership Establish and maintain a strong provider-patient partnership

38 Preventing Medication Errors: Quality Chasm Series (contd) Effective Error Prevention Strategies are available, in the hospital setting: Good evidence for: Good evidence for: the effectiveness of computerized order entry with clinical decision-support systems and for clinical decision-support systems themselves; the effectiveness of computerized order entry with clinical decision-support systems and for clinical decision-support systems themselves; Pharmacists participation on hospital rounds Pharmacists participation on hospital rounds Show promise, but their efficay has not yet been clearly demonstrated: Show promise, but their efficay has not yet been clearly demonstrated: Bar coding Bar coding Smart intravenous (IV) pumps Smart intravenous (IV) pumps

39 Internet sites Preventing Medication Errors: Quality Chasm Series. Preventing Medication Errors: Quality Chasm Series. Conseil canadien dagrément des services de santé. Buts du CCASS en matière de sécurité des patients et pratiques organisationnelles requises (POR). Conseil canadien dagrément des services de santé. Buts du CCASS en matière de sécurité des patients et pratiques organisationnelles requises (POR). Rapport annuel sur les pharmacies hospitalières au Canada Rapport annuel sur les pharmacies hospitalières au Canada Joint Commission on Accreditation of Healthcare Organizations National Patient Safety Goals. Joint Commission on Accreditation of Healthcare Organizations National Patient Safety Goals. The Institute for Safe Medication Practices (ISMP US et ISMP Canada). et The Institute for Safe Medication Practices (ISMP US et ISMP Canada). et Institut canadien pour la sécurité des patients. Institut canadien pour la sécurité des patients. Kit de départ: bilan comparatif des médicaments Kit de départ: bilan comparatif des médicaments

40 Internet sites Société canadienne des pharmaciens dhôpitaux. Lignes directrices sur la déclaration des erreurs de médication et la prévention des erreurs/incidents de médication. Société canadienne des pharmaciens dhôpitaux. Lignes directrices sur la déclaration des erreurs de médication et la prévention des erreurs/incidents de médication. American Society of Health-Systems Pharmacists. ASHP Guidelines on Reporting Medication Errors/ Preventing Medication Errors. American Society of Health-Systems Pharmacists. ASHP Guidelines on Reporting Medication Errors/ Preventing Medication Errors. National Coordinating Council on Medication Error Reporting and Prevention (NCC MERP). National Coordinating Council on Medication Error Reporting and Prevention (NCC MERP). United States Pharmacopeia. Summary of the information submitted to MEDMARX a national database for hospital medication error reporting. United States Pharmacopeia. Summary of the information submitted to MEDMARX a national database for hospital medication error reporting.


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