Dimension: Medication Management

Rationale for measurement

Medicines are the most common treatment used in health care and contribute to significant improvement in health when used appropriately. However, medicines can also be associated with harm and the common use of medicine means they are associated with more errors and adverse events than any other aspect of health care. While rates of serious harm are low, errors can affect health outcome. The prevalence of medication errors is of particular concern because the majority of these errors are generally preventable.

Measurement methodology

In the absence of an internationally accepted robust method for measuring medication incidents, incidents are calculated per 1000 Bed Days Used (BDU).

  • Data source: Hospital reporting to National Incident Management System (NIMS)
  • Incidents are calculated per 1000 Bed Days Used (BDU)

Target

  • Rate of 3.0 medication incidents as reported to NIMS per 1,000 bed days used (HSE National Service Plan 2022)
  • In the UK, rate of 4.5 medication incidents are reported per 1,000 bed days used (National Reporting and Learning System (UK))

Performance

RCSI Hospital Groupimg-818

  • Beaumont, Cavan & Monaghan, Drogheda & Louth County and Rotunda Hospitals are equal to or under HSE target rate of 3.0/1,000 BDU
  • Connolly Hospital is above HSE target rate of 3.0/1,000 BDU
  • data is reflected two months in arrears

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  • YTD, Beaumont, Drogheda & Louth County and Rotunda Hospitals are under HSE target rate of 3.0/1,000 BDU
  • YTD, Connolly and Cavan/Monaghan Hospitals are above HSE target rate of 3.0/1,000 BDU

Introduction

The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy Index (NCC MERP©) provides an alternative method of medication incident categorisation. The taxonomy is divided into nine categories:

Category A – Circumstances or events that have the capacity to cause error

Category B – An error occurred but the error did not reach the patient

Category C – An error occurred that reached the patient but did not cause patient harm

Category D – an error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm

Category E – An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention

Category F – An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalisation

Category G – An error occurred that may have contributed to or resulted in permanent patient harm

Category H – An error occurred that required intervention necessary to sustain life

Category I – An error occurred that may have contributed to or resulted in patient’s death

Adverse Drug Reactions (ADRs)1 – An ADR is an unwanted or harmful reaction experienced following the administration of a drug or combination of drugs under normal conditions of use, which is suspected to be related to the drug

Rationale for measurement

The NCC MERP© index clearly identifies when a medication error reaches the patient. The descriptions of each category allow for ratings to be based on the most likely outcome of the error in terms of patient harm2.

Measurement methodology and data sources

Data source: Local hospital data extrapolated for analysis and publication

References

1 https://www.pharmacologyeducation.org/clinical-pharmacology (accessed 15 November 2023)

2 Fahmy, S. Garfield, S. Furniss, D. Blandford, A. Franklin, B, D.(2018), A comparison of two methods of assessing the potential clinical importance of medication errors, Safety in Health {accessed 27 September 2023}.

Performance

Beaumont Hospital, Categorisation of Medication Incidents using NCC MERP November 2023 (n=32)
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Cavan & Monaghan Hospitals, Categorisation of Medication Incidents using NCC MERP November 2023 (n=20)img-842

Connolly Hospital, Categorisation of Medication Incidents using NCC MERP November 2023 (n=59)img-895

Drogheda & LCH Hospitals, Categorisation of Medication Incidents using NCC MERP November 2023 (n=20)img-21

Rotunda Hospital, Categorisation of Medication Incidents using NCC MERP November 2023 (n=10)img-512

© 2023 National Coordinating Council for Medication Error Reporting and Prevention

Rationale for measurement

The use of medication remains the most common intervention in health care. The complexity of both medication use and the medication management process, especially in the in-patient setting, create a significant risk for hospitalized patients.

The indicators below are checking that all prescribed medication is administered in accordance with local and national policies, procedures, protocols and guidelines (PPPGs) and as documented in the Guidance for Nurses and Midwifery on medication management (NMBI 2020).

  • Patient’s weight and date of weight are recorded on the front page of the medication record
  • The patient’s identification wristband is on the patient and details are legible and correct
  • There are at least two identifiers, name and Date of Birth (DOB) (if Healthcare Record Number is not in use)
  • The allergy status is clearly identifiable on the front page of the medication record
  • The prescription is legible with correct use of abbreviations
  • All medicines were administered at the prescribed frequency

Measurement methodology and data sources

Based on total bed capacity, samples of 25% of patient records are randomly selected per month from each ward/unit with a minimum of 5 data collections per month for each ward/unit.

Target

90% compliance of the key indicators identified. Quality Care Metrics KPI set is identified as ‘areas of good practice’ are demonstrated 90-100%; ‘areas requiring some improvement’ 80-89%; ‘areas requiring immediate attention and action plans’ 0-79%.

Performance – % Compliance 2024img-100

  • RCSI Hospitals achieved target of 90% in Jan-24 with the exception of Connolly Hospital
  • national data not collected

Rationale for measurement

Appropriate storage and custody of all medicines including higher risk medicinal products is key to safe medication management in the hospital setting. All medicinal products should be stored in a secure manner and systems followed to ensure that control and supply of drugs is in accordance with regulation.

The indicators below check that the storage and custody of medication are in accordance with local and national policies, procedures, protocols and guidelines (PPPGs) and as documented in the Guidance for Nurses and Midwives on Medication Management (An Bord Altranais, 2007) and Guidance for Nurses and Midwives on Medication Administration (NMBI, 2020):

  • A registered nurse is in possession of the keys for medicinal product storage
  • All medication trolleys are locked and secured as per local organisational policy and open shelves on the medication trolley are free of medicinal products when not in use
  • MDA drugs are checked & signed at each changeover of shift by nursing staff (member of day staff & night staff)
  • The MDA Drugs cupboard is locked
  • The MDA drugs keys are held by the CNM or senior nurse designee
  • The MDA drugs keys are held separate or detached from all other sets of keys
  • The patient bed space is free of any unsecured prescribed medicinal products

Measurement methodology and data sources

As per the indicators above, medication storage and custody practices and records are checked on wards/units as part of the monthly Quality Care Metric audit.

Target

95% compliance of the key indicators identified.

Performance – % Compliance – 2024img-679

  • RCSI Hospitals achieved target of 95% in January 2024