Healthcare News & Insights

Medication safety practices: Hospitals need to up their game

178568081How are American hospitals doing when it comes to medication safety? 

They’re making strides when it comes to medication safety practices. However, there’s still room for improvement.

That’s according to data from a survey developed by the Institute for Safe Medication Practices (ISMP).

The survey, “Assessing the State of Medication Practices Using the ISMP Medication Safety Self Assessment for Hospitals: 2000 and 2011,” is part of a series conducted by ISMP in cooperation with the Health Research & Educational Trust (HRET) and the American Association of Hospitals (AHA) through a grant by the Commonwealth Fund.

The self-assessments have allowed U.S. hospitals to evaluate medication safety practices and identify opportunities for improvement. The assessment was updated in 2011 to create a new baseline of hospital medication safety efforts and determine if any progress has been made.

More than 1,300 hospitals voluntarily took part in the 2011 assessment, which contained 270 items organized into 10 key elements and further broken down into 20 core characteristics.

Biggest improvements

The largest percent improvements were in core characteristics:

1. Communication of drug orders and drug order information
While this was one of the lowest-scoring key elements in 2000, it had a 57.4% improvement between 2000 and 2011. This can be attributed in large part to substantial increases in the implementation of computerized prescriber order entry (CPOE).

A few of the other areas that experienced significant improvements were:

  • Maintaining a list of prohibited error-prone abbreviations
  • Requiring a complete new set of orders upon admission/transfer, and
  • Implementing effective process for resolving conflicts about order safety.

2. Patient education
Nabbing the second highest percentage improvement was patient education. Reason: In 2011, a greater percentage of prescribers (90%) and nurses (96%) were involved in educating patients about their medication usage than in 2000, which was 74% and 77% respectively. Also, in 2011, 95% of hospitals reported they provided patients with up-to-date written information about medications prescribed to them at discharge, which is up from 83% in 2000.

Some of the other areas that made significant progress in this category are:

  • Providing customized drug administration schedules to patients at high risk for nonadherence with drug therapy on discharge, and
  • Teaching patients about the potential for errors with drugs that have a reputation for being problematic.

3. Quality processes and risk management
The key elements that brought this category third place was the use of bar-coding technology in pharmacies, which jumped from 10% to 53%, and at the point of care which jumped from 3% to 58%. One area for improvement, however, was consistently reviewing metrics from the system at the point of care. Only 54% of respondents did it.

Other key areas of improvement:

  • Surveying practitioners periodically to assess the organization’s culture (9% to 84%), and
  • Providing leadership and peer support to all staff involved in serious error (22% to 64%).

National priorities

Based on the latest survey’s results, ISMP compiled a list of national priorities that, according to the institute, require public policy directives; local, state and national initiatives; and a collaborative effort for nationwide adoption. These 15 priorities represent strategies that U.S. hospitals scored as low implementation.

Here’s a handful of them:

  • Improve order entry systems (vendor and user)
  • Expand key technologies
  • Better manage alert fatigue
  • Update/test technology more frequently, and
  • Use technology data more consistently to provide safety.

A complete copy of the survey results were published in the February 2014 issue of The Joint Commission Journal on Quality and Patient Safety.

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