Abstract
BackgroundThis paper presents Part 2 of a literature review examining medication safety in the Australian acute care setting. This review was undertaken for the Australian Commission on Safety and Quality in Health Care, updating the 2002 national report on medication safety. Part 2 of the review examined the Australian evidence base for approaches to build safer medication systems in acute care.MethodsA literature search was conducted to identify Australian studies and programs published from 2002 to 2008 which examined strategies and activities for improving medication safety in acute care.Results and conclusionSince 2002 there has been significant progress in strategies to improve prescription writing in hospitals with the introduction of a National Inpatient Medication Chart. There are also systems in place to ensure a nationally coordinated approach to the ongoing optimisation of the chart. Progress has been made with Australian research examining the implementation of computerised prescribing systems with clinical decision support. These studies have highlighted barriers and facilitators to the introduction of such systems that can inform wider implementation. However, Australian studies assessing outcomes of this strategy on medication incidents or patient outcomes are still lacking. In studies assessing education for reducing medication errors, academic detailing has been demonstrated to reduce errors in prescriptions for Schedule 8 medicines and a program was shown to be effective in reducing error prone prescribing abbreviations. Published studies continue to support the role of clinical pharmacist services in improving medication safety. Studies on strategies to improve communication between different care settings, such as liaison pharmacist services, have focussed on implementation issues now that funding is available for community-based services. Double checking versus single-checking by nurses and patient self-administration in hospital has been assessed in small studies. No new studies were located assessing the impact of individual patient medication supply, adverse drug event alerts or bar coding. There is still limited research assessing the impact of an integrated systems approach on medication safety in Australian acute care.
Highlights
This paper presents Part 2 of a literature review examining medication safety in the Australian acute care setting
This paper is the second in a two-part literature review of medication safety in the Australian acute care setting [1]. It examines the Australian evidence-base for strategies to reduce medication errors and updates the data presented in the Second National Report on Patient Safety - Improving Medication Safety [2]
Evidence for systems to improve prescription writing The National Inpatient Medication Chart A National Inpatient Medication Chart (NIMC) aims to improve medication safety through standardisation of medication ordering in all Australian public hospitals, and a number of private hospitals
Summary
This paper presents Part 2 of a literature review examining medication safety in the Australian acute care setting. This paper is the second in a two-part literature review of medication safety in the Australian acute care setting [1] It examines the Australian evidence-base for strategies to reduce medication errors and updates the data presented in the Second National Report on Patient Safety - Improving Medication Safety [2]. The systems may provide automated checks or alerts such as drug-drug interaction checking or drug allergy alerts These systems can reduce adverse drug events in hospital settings [3] there have been reports of increased error rates when implementation problems have occurred [4]. Most studies have examined "home-grown" CPOE/CDSS systems developed and used within an institution; commercially developed systems have been less well studied [3]
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