Rationale for a pharmacist-led medication safety service

Abstract

Medication safety is an intrinsic function of hospital quality systems. The aim of the study was to develop a pharmacy-led hospital medication safety service following a psychometric analysis of patient safety attitudes amongst a segment of Mater Dei Hospital staff members. A pre-validated AHRQ questionnaire on patient safety attitudes of staff1 was distributed amongst a pre-selected cohort of 235 participants from areas including anaesthesia, pharmacy and hospital administration. Results were compared with aggregate data from 680 hospitals in the United States of America who had participated in the same survey during 2016. An internal hospital audit was carried out using an international safety tool designed by the ISMP2. Subsequently, a pharmacy-led medication safety service was developed in line with findings. With a response rate of 45 % (N=105), 36 % of the responses revealed an ‘Acceptable’ local patient safety attitude (n=37). Participation in error reporting was low with 52 % not being involved in any reporting (n=55). Eight attitude composite scores exceeded minimum aggregate hospital scores whilst 4 scored below aggregate hospital minima. Findings from the audit together with a Pareto analysis of survey responses, led to the prioritisation of 8 attitude aspects; ‘Supervisor expectations promoting patient safety’, ‘Management support for patient safety’, ‘Overall perceptions on patient safety’, ‘Frequency of events reported’, ‘Teamwork across units’, ‘Staffing’, ‘Handoffs and transitions’ and ‘Non punitive response to error’. Interventions were focused on three domains impacting the medicationuse process; drug distribution dynamics, safety improvement of parenteral medicines, and handling of safety alerts. The study identified how apharmacist-led medication safety service in the hospital setting can contribute to the identification of priority areas to align local practices to established international targets. The approach developed in this study is now being extended to other areas within the hospital. This study can be used as part of a conventional (Plan-Do-Study-Act) PDSA quality cycle and method transfer is appropriate to other hospitals where medication safety services need to be established or updated.