Download 2005/06 2003/04 - Hospital Pharmacy in Canada

Medication Safety
Results from the Hospital
Pharmacy in Canada report
Patricia Lefebvre
Millcroft Pharmacy Leadership Conference
June 1-3, 2007
Objective


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
Medication Errors
Medication Errors
MEDMARX 2000-2004
Medications most commonly involved
Hospital Pharmacy, 2006:41 S3-S10
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 e-mail address of the
Director of Pharmacy and the hospital’s Chief
Executive Officer
E-mails sent to Directors of Pharmacy and CEOs
in June 2006; second E-mail to Directors of
Pharmacy in July.
Period to fill survey: June 23 to September 1, 06
Eligibility: total of 100 beds and at least 50 acute
care beds
 Response rate: 74% (142/193)
 Hospital Demographic Info, Qc: 30% (42/142)
 Québec response rate: 71% (42/59)
Disclosure Policy

Hospital has a policy on the
disclosure of incidents to
patients and/or their
(ROP – Culture)
families
2005/06
80 %
2003/04
63 %
Disclosure Policy

Disclosure is documented in
the health record
2005/06
91%
2003/04
81%
Medication Incident Reporting

A medication incident
reporting system is in use
2005/06
2003/04
96%
100%
Medication Incident Reporting

Medication incident reports can
be used during an individual
healthcare provider’s
performance assessment
2005/06
12%


2003/04
21%
Respondents:
Academic Health Centres: 0%
Non Academic Health Centres: 16%
Committee responsible for the
review of medication incidents

Committee responsible for the
review of medication incidents
2005/06
80%
2003/04
80%
If yes, committee is dedicated to
Medication Safety
44%
17%
Medication safety selfassessment

Medication safety selfassessment has been
completed (ROP)
2005/06
71%


ISMP: 91%
Autres: 6%
2003/04
51%
(Qc: 31 %)
Medication History Taking


When a patient visits the ED,
a comprehensive medication history
is conducted
45%
The patient’s medication history is
reconciled with medication orders
written at the time of admission or
ER visit
45%
Medication History Taking

When a patient is admitted to the
organization, a comprehensive
medication history is conducted
(POR – communication – and with the involvement of the
patient/client)
42%

Medication history is reconciled
with medication orders written at
the time of admission
46%
Medication History Taking


When patient is transferred
between levels of care within
the facility, reconcile the
patient’s medications and
communicate that information
to the next provider of care
(POR – communication, with the
patient/client)
38% (All: 20% / Sel: 78%)
Medication History Taking


When patient is transferred
outside the facility, reconcile
the patient’s medications and
communicate that information
to the next provider of care
(POR – communication, with the
patient/client)
35% (All: 8% /Sel: 90%)
Medication History Taking
Upon transfer between levels of care and/or
at the time of discharge, the more
significant barriers to provide a reconciled
list of the patient’s medication are:




Implementation of
medication reconciliation is
planned or underway
43%
The facility has examined
the desirability and
feasibility but additional
resources would be
required
34%
The facility has not yet
examined the desirability
and feasibility
22%
The facility has examined
the desirability and
feasibility.. But.. There are
not enough other supports
13%
Ordering
Computerized Prescriber Order
Entry Systems (CPOE)
2005/06





2003/04
6%
5%
23%
18%
70%
76%
Integrated with a
clinical decision support
system
N=6
N=1
Interface with PIS
N=4
N=2
Operational
Approved plan to
implement
No CPOE plan approved
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%
2005/06
2003/04
42%
38%
Ordering
There is a list of dangerous
abbreviations that are NOT
accepted in the organization
2005/06
2003/04
58%
40%
Ordering
Formal process to review and
approve
2005/06



Pre-printed
medication orders
87%
Prescriber order
sets (i.e: computer
order entry)
42%
Infusion dosage
charts and guidelines
77%
Pharmacy Management
Dispense Medication
The patient’s allergy status is
known prior to a medication
order being dispensed

= 90%
2005/06 2003/04
68%
72%
Pharmacy Management
Dispense Medication
Drug distribution systems
2005/06



2003/04
2001/02
Unit dose (= 90% of beds) :
38%
31%
24%
Centralized automated dispensing – UD :
66%
61%
Automation used (65 respondents)
 Canister : 83% (54/65)

Robotic :17% (11/65)
Pharmacy Management
Dispense Medication
Drug distribution systems (Cont’d)
2005/06

Unit based automated dispensing systems
32%

20%
Unit based automated dispensing (=90% of beds)
n= 8

2003/04
n=6
Unit dose – IV Admixture Services (=90% of
beds) :
62%
56 %
Pharmacy Management
Select medication
Bar Coding is used in the
Medication-Use-System to:






2005/06
(35%, 50/142)
2003/04
 drug selection prior to
dispensing from the
pharmacy
26%
16%
 drug selection prior to
patient administration
4%
3%
Identify patient during
medication administration
8%
3%
Return doses to inventory
in the pharmacy
42%
34%
 stocking of unit-dose
bins
22%
13%
 stocking of automated
dispensing cabinets
22%
16%
Pharmacy Management:
Medication Inventory
Standardize and limit the number of available infusion
concentrations for the following high-alert medications
(ROP: medication use)
2005/06
2003/04
 Heparin
75%
81%

Insulin
48%
47%

Morphine
57%
47%
Hydromorphone
53%
41%

Pharmacy Management:
Medication Inventory

Remove concentrated
electrolytes from
patient/client care units
(ROP – medication use)
94% of respondents (133/142)
2005/06
KCL
Other
85%
53%
2003/04
72%
Pharmacy Management:
Medication Inventory

Remove concentrated
narcotics from patient/client
care units (MSSS directives)
94% of respondents (133/142)
2005/06
2003/04
65%
47%
Administration Management:
Administer Medication
Policy requiring that two patient
identifiers (neither to be the
patient’s room number) are
checked before administering
medications

=90% of beds
2005/06
40%
2003/04
31%
Administration Management:
Document Administration
2005/06
2003/04
56%

C-MARs:
?

E-MARs
?
Bedside,
Bar Code


Smart pump
8% (n =4)
3%
? (All, Selected patients)
Education
Process to facilitate patient teaching with
regards to their medication therapy (ROP):





Provide patient with a
copy of the MAR or
similar document
2005/06
selected
all
30%
1%
Allow viewing of the
MAR by the patient
21%
5%
Provide counselling
pamphlets for each
prescribed medication
65%
1%
78%
2%
62%
2%
Provide a pharmacist’s
consultation during in
hospital stay
Provide contact
information for other
available sources of
drug information
Drug Information &
Drug Use Evaluation

Dedicated staff for DI /DUE
37% (2005/06)
52% (2003/04)


Drug Information
 Pharmacist: 1.4 FTE
 Support staff: 0.7 FTE
Drug Use Evaluation
 Pharmacist: 1.1 FTE
 Support staff: 0.4 FTE
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)
Monitor Evaluate/ Response:
Intervene for medication errors
/ adverse drug events
Bond & al. Pharmacotherapy 2002;22(2)
Proportion of time spent by
Pharmacists in each activity:
Clinical Services
2005/06 2003/04
Drug Distribution 43%
Clinical Services 41%
Teaching
6%
Research
2%
Non-patient
8%
care
48%
38%
5%
1%
8%
Monitoring and Surveillance

Strategies implemented to
improve internal reporting of
ADEs
2005/06
41%

2003/04
38%
Strategies implemented to
trace and document the
occurrence of ADEs
2005/06
41%
2003/04
54%
Preventing Medication Errors:
Quality Chasm Series


At least 25% of all medicationrelated injuries are preventable
HCP should seek to create highreliability 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
Establish and maintain a strong
provider-patient partnership
Preventing Medication Errors:
Quality Chasm Series (cont’d)
Effective Error Prevention Strategies
are available, in the hospital
setting:

Good evidence for:

the effectiveness of
computerized order entry with
clinical decision-support systems
and for clinical decision-support
systems themselves;

Pharmacists participation on
hospital rounds

Show promise, but their efficay has
not yet been clearly demonstrated:

Bar coding

Smart intravenous (IV) pumps
Internet sites

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Preventing Medication Errors: Quality Chasm
Series. http://www.nap.edu/catalog/11623.html
Conseil canadien d’agrément des services de
santé. Buts du CCASS en matière de sécurité des
patients et pratiques organisationnelles requises
(POR). www.cchasa-ccass.ca
Rapport annuel 200506 sur les pharmacies
hospitalières au Canada www.lillyhospitalsurvey.ca.
Joint Commission on Accreditation of Healthcare
Organizations. 2006 National Patient Safety
Goals. www.jcaho.org.
The Institute for Safe Medication Practices
(ISMP US et ISMP Canada). www.ismp.org et
www.ismp-canada.org.
Institut canadien pour la sécurité des patients.
http://www.patientsafetyinstitute.ca/accueil.html
Kit de départ: bilan comparatif des médicaments
http://soinsplussecuritairesmaintenant.ca
Internet sites
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Société canadienne des pharmaciens
d’hôpitaux. Lignes directrices sur la
déclaration des erreurs de médication et
la prévention des erreurs/incidents de
médication. www.cshp.ca
American Society of Health-Systems
Pharmacists. ASHP Guidelines on Reporting
Medication Errors/ Preventing Medication
Errors. www.ashp.org.
National Coordinating Council on
Medication Error Reporting and Prevention
(NCC MERP). www.nccmerp.org.
United States Pharmacopeia. Summary of
the information submitted to MEDMARX a
national database for hospital medication
error reporting. www.usp.org