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

Performance

RCSI Hospital Group

  • Beaumont and Drogheda & Louth County Hospitals are under target rate of 3.0/1,000 BDU
  • Connolly, Cavan/Monaghan and Rotunda Hospitals are above target rate of 3.0/1,000 BDU
  • data is reflected one month in arrears

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

  • Beaumont, Cavan/Monaghan and Drogheda Hospitals achieved target of 90% in Oct-22
  • Connolly Hospital did not achieve target of 90% in Oct-22
  • 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

100% compliance of the key indicators identified.

Performance – % Compliance

  • Monaghan, Louth County and Drogheda Hospitals achieved target of 100% in Oct-22
  • Beaumont, Cavan and Connolly Hospitals did not achieve target of 100% in Oct-22