Medication Safety Self-Assessment Research Articles

Establishing a multidisciplinary taskforce to improve anticoagulation safety at a large health system

Abstract Purpose To describe the development of a multidisciplinary anticoagulant safety taskforce (ASTF) to address anticoagulation-related issues across the medication-use system. Summary Oral and parenteral anticoagulants have been classified as high-alert medications because of their potential for harm. Errors at the point of prescribing, monitoring, and administering therapy have been noted in safety literature. Our hospital system, which includes 1 academic medical center, 6 community hospitals, and 1 long-term care facility, designed a multidisciplinary ASTF to address anticoagulation-related issues. The ASTF used the 2017 Institute for Safe Medication Practices (ISMP) Medication Safety Self-Assessment for Antithrombotic Therapy as the primary tool for reviewing current practices, performing gap analyses, and identifying our greatest areas of opportunity. The top 8 best practice elements related to anticoagulant use were identified for initial efforts of ASTF activity. Meetings were led by a medication safety pharmacist who reviewed process opportunities and actions to address gaps. The hospital chief quality and patient safety officer and the vice president of quality were the executive sponsors of the ASTF. Key stakeholders such as the medication safety committee chair and the president of the medical staff were instrumental in leading the initiative. Recommendations from the ASTF were reviewed and approved by the system medication safety committee and the system pharmacy and therapeutics committee to support system-wide implementation. The ASTF accomplished more than initially planned within its first year. Error mitigation occurred through policy revisions, order set development and modification, and implementation of practice changes to comply with each best practice. The ISMP antithrombotic self-assessment score improved from 67% to 87%, surpassing the initially targeted score of 75%. To overcome implementation barriers with the electronic health record, we enlisted support from our informatics leadership to leverage information technology. Overall, the success of the taskforce was attributed to the teamwork and leadership of key individuals within the organization. Conclusion Leveraging interest from key stakeholders across multiple disciplines with an established assessment tool was key in developing a productive and successful ASTF. The group came together to evaluate anticoagulant-related issues and implement sustainable changes to decrease anticoagulation error potential.

National Survey of Medication Safety Practice: Patient Education, Quality Process and Risk Management at Primary Healthcare Centers/Community Pharmacies in Riyadh, Saudi Arabia

Pharmacology, Toxicology and Biomedical Reports,2019,5,1,36-43.DOI:10.5530/PTB.2019.5.7Published:January 2019Type:Research ArticleAuthors:Yousef Ahmed Alomi, Zainab Abdulmunem Almuallem, Manar Mohammed Alslim, Khulud Abdulrahman Alamoudi, Adel Mehmas H. Alragas, and Rana Mohammed Alslim Author(s) affiliations:Yousef Ahmed Alomi*, The Past General Manager of General Administration of Pharmaceutical Care, Head, National Clinical Pharmacy and Pharmacy Practice, Head, Pharmacy R & D Administration, Ministry of Health, Riyadh- 11392, SAUDI ARABIA. Zainab Abdulmunem Almuallem, Saudi Food and Drug Authority, Riyadh, SAUDI ARABIA. Manar Mohammed Alslim, Staff Pharmacist, Prince Sultan Military Medical City, Riyadh, SAUDI ARABIA. Khulud Abdulrahman Alamoudi, Narcotic in-charge, Alhammadi Hospital, Riyadh, SAUDI ARABIA. Adel Mehmas H. Alragas, Medical City-king Saud University, Riyadh, SAUDI ARABIA. Rana Mohammed Alslim, Staff Pharmacist, Ministry of Health, Riyadh, SAUDI ARABIA. Abstract:Objective: To explore the national medication safety practice such as patient education, quality process and risk management at primary healthcare centers (PHCs) and community pharmacies (CPs) in Riyadh city, Kingdom of Saudi Arabia. Methods: This is a four-month cross-sectional medication safety practice survey conducted at PHC pharmacies and CPs in Riyadh city. The survey consisted of the modified version of the Medication Safety Self-Assessment® for Community/Ambulatory Pharmacy from the Institute of Safe Medication Practice (ISMP). The survey consisted of a demographic section and 10 domains with 198 questions. The domains included questions on patient information; drug information; communication of drug orders and other drug information; drug labeling and packaging and nomenclature; use of devices; environmental factors; staff competency and education; patient education; quality processes; and risk management domain. In this study, we emphasized on patient education, quality process and risk management; it is a finding from medication safety self-assessment for community/ ambulatory pharmacy in Riyadh city. Results: The survey was distributed to 13 PHC pharmacies and 23 CPs. The average score of all ISMP-self assessment of medication safety items at PHCs was 2.75±0.36 (54.94%) (95% confidence interval (95% CI)=2.55–2.95; P<0.05; range=2.04–3.38). The average score of all ISMP-self assessment of medication safety items at CPs was 3.14±0.42 (62.86%) (95% CI=2.90–4.38; P<0.05; range=2.40–3.88). The average score of patient education at PHCs was 3.04±0.365 (60.8%) (95% CI=2.89–3.19; P<0.05; range=2.00–3.73) and at CPs, it was 3.73±0.29 (74.6%) (95% CI=3.61–3.85; P<0.05; range=3.11–4.22). The average score of quality processes and risk management at PHCs was 2.76±0.35 (55.2 %) (95% CI=2.64–2.88; P<0.05; range=2.09–3.50) and at CPs, it was 3.20 ±0.38 (64%) (95% CI=3.07–3.33; P<0.05; range=2.47–3.89). Conclusion: The implementation of patient education and quality processes and risk management at PHCs and CPs were inadequate. Targeting to improve all meditations safety assessment tools at PHCs and CPs is highly recommended in the Kingdom of Saudi Arabia. Keywords:Community Pharmacies, Education, Medication, Primary Healthcare Centers, Quality, Risk Management, Riyadh, Safety, Saudi ArabiaView:PDF (384.85 KB) PDF PDF Images National Survey of Medication Safety Practice: Patient Education, Quality Process and Risk Management at Primary Healthcare Centers/Community Pharmacies in Riyadh, Saudi Arabia

National Survey of Medication Safety Practice: Preparation of Medication and Dispensing at Primary Healthcare Centers/Community Pharmacies in Riyadh, Saudi Arabia

Pharmacology, Toxicology and Biomedical Reports,2018,4,3,49-57.DOI:10.5530/PTB.2018.4.15Published:September 2018Type:Research ArticleAuthors:Yousef Ahmed Alomi, Adel Mehmas H. Alragas, Manar Mohammed Alslim, Rana Mohammed Alslim, Khulud Abdulrahman Alamoudi, and Zainab Abdulmunem Almuallem Author(s) affiliations:Yousef Ahmed Alomi1, Adel Mehmas H. Alragas2, Manar Mohammed Alslim3, Rana Mohammed Alslim4, Khulud Abdulrahman Alamoudi5, Zainab Abdulmunem Almuallem​6 1The Former General Manager of General Administration of Pharmaceutical Care, The Former Head, National Clinical pharmacy and pharmacy practice, The Former Head, Pharmacy R and D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. 2Medical city-king Saud university, Riyadh, SAUDI ARABIA. 3Staff pharmacist, Prince Sultan Military Medical City, Riyadh, SAUDI ARABIA. 4Staff pharmacist, Ministry of Health, Riyadh, SAUDI ARABIA. 5Narcotic in-charge, Alhammadi hospital Riyadh, SAUDI ARABIA. 6Saudi Food and Drug Authority Riyadh, SAUDI ARABIA. Abstract:Objective: To explore the national medication safety practice in terms of medication preparation and dispensing at Primary Healthcare Centers (PHCs) and Community Pharmacies (CPs) in Riyadh, Kingdom of Saudi Arabia. Methods: This is a 4-month cross-sectional medication safety practice survey conducted at PHCs and CPs in Riyadh. The survey consisted of the modified version of the Medication Safety Self-Assessment® for Community/Ambulatory Pharmacy from the Institute for Safe Medication Practices (ISMP). The survey consisted of a demographic section and 10 domains with 198 questions. The 10 domains included patient information; drug information; communication of drug orders and other drug information; drug labeling, packaging and nomenclature; use of medical devices; environmental factors; staff competency and education; patient education; quality processes; and risk management. This study emphasizes on the medication preparation and dispensing as per the Medication Safety Self-Assessment for Community/Ambulatory Pharmacy, Riyadh. Results: The survey was distributed to 13 PHCs and 23 CPs. The average score of all the ISMP self-assessment of medication safety items at PHCs was 2.75±0.36 (54.94 %) with 95% confidence interval (95% CI) = 2.55–2.95 (P<0.05; range = 2.04–3.38). The average score of all the ISMP self-assessment of medication safety items at CPs was 3.14±0.42 (62.86%) with 95% CI = 2.90–4.38 (P<0.05; range = 2.40–3.88). The average score of the communication of drug orders and other drug information domain at all hospitals were 2.57±0.38 (51.4 %) with 95% CI = 2.36–2.78 (P<0.05; range = 1.92–3.25) at PHCs and in the CPs, it was 2.44±0.35 (48.8 %) with 95% CI = 2.245–2.635 (P<0.05; range = 2.00–3.09). The average score of drug labeling, packaging and nomenclature domain at all hospitals was 2.57± 0.41 (51.4 %) with 95% CI = 2.35–2.79 (P<0.05; range = 1.83–3.08) at PHCs and in CPs, it was 3.2±0.59 (64%) with 95% CI = 2.89–3.51, (P<0.05; range = 2.20–4.05). Conclusion: Fifty percent of medication safety critical elements of ISMP standards was implemented during the preparation and dispensing of medication in the PHCs and CPs. Targeting to improve medication safety key at PHCs and CPs to prevent drug-related problems is required in the Kingdom of Saudi Arabia. Keywords:Adverse drug reaction, Ministry of Health, Pharmaceutical Care, Saudi Arabia, SystemView:PDF (316.8 KB) PDF PDF Images Scores of Items of Communication of Drug Orders and other Drug Information Domain.

National Survey of Medication Safety Practice: Patient Information at Primary Healthcare Centers/Community Pharmacies in Riyadh, Saudi Arabia

Pharmacology, Toxicology and Biomedical Reports,2018,4,3,43-48.DOI:10.5530/PTB.2018.4.14Published:September 2018Type:Research ArticleAuthors:Yousef Ahmed Alomi, Rana Mohammed Alslim, Manar Mohammed Alslim, Khulud Abdulrahman Alamoudi, Zainab Abdulmunem Almuallem, and Adel Mehmas H. Alragas Author(s) affiliations:Yousef Ahmed Alomi1, Rana Mohammed Alslim2, Manar Mohammed Alslim3, Khulud Abdulrahman Alamoudi4, Zainab Abdulmunem Almuallem​5, Adel Mehmas H. Alragas6 1The Former General Manager of General Administration of Pharmaceutical Care, The Former Head, National Clinical pharmacy and pharmacy practice, The Former Head, Pharmacy R and D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. 2Staff pharmacist, Ministry of Health, Riyadh, SAUDI ARABIA. 3Staff pharmacist, Prince Sultan Military Medical City, Riyadh, SAUDI ARABIA. 4Narcotic in-charge, Alhammadi hospital Riyadh, SAUDI ARABIA. 5Saudi Food and Drug Authority Riyadh, SAUDI ARABIA. Adel Mehmas H. Alragas, Medical city-king Saud university, Riyadh, SAUDI ARABIA. 6Medical city-king Saud university, Riyadh, SAUDI ARABIA. Abstract:Objective: To explore patient’s information regarding national medication safety Practice At Primary Healthcare Centers (PHCs) and Community Pharmacies (CPs) in Riyadh city, Kingdom of Saudi Arabia. Methods: This is a 4-month cross-sectional survey conducted on medication safety practice at PHCs and CPs in Riyadh city. In this study, the survey was adapted and modified from the Institution of Safe Medication Practice (ISMP) medication safety self-assessment for community/ambulatory pharmacy. It consists of a demographic section and 10 domains with 198 questions. The domains captured the following information: patient information; drug information; communication of drug orders and other drug information; drug labeling, packaging and nomenclature; use of medical devices; environmental factors; staff competency and education; patient education; quality processes; and risk management domain. The survey was conducted at the PHCs of the Ministry of Health and at CPs located in Riyadh city. This study is focused on the first domain, that is, patient information in PHCs and CPs in Riyadh city. Results: The survey was distributed to 13 PHCs and 23 CPs. The average ± Standard Deviation (SD) of all ISMP-self assessment items of medication safety practice at PHCs was 2.75±0.36 (54.94 %) (95% confidence interval (95% CI) = 2.55–2.95; P<0.05; range = 2.04–3.38). The average ± SD score of all ISMP-self assessment items of medication safety practice at CPs was 3.14±0.42 (62.86%) (95% CI = 2.90–4.38; P<0.05; range = 2.40–.88). The average ± SD score of patient information at PHCs was 2.80±0.467 (56 %) (95% CI = 2.54–3.58; P<0.05; range = 2.08–3.45), whereas that of the CPs was 2.60±0.667 (52 %) (95% CI = 2.23–2.97; P<0.05; range = 1.36–3.96). Conclusion: The PHCs and PCs implemented almost half the of ISMP medication safety critical elements including the patient information related issue. Targeting to improve medication safety system at PHCs and CPs is highly recommended in the Kingdom of Saudi Arabia Keywords:Community Pharmacy, Information, Medication, Patient, Primary Healthcare Center, Riyadh, Safety, Saudi Arabia.View:PDF (218.85 KB) PDF PDF Images The Highest Scores Items of Core Domain Essential Patient Safety of ISMP Medication Safety at Primary Healthcare Centers and Community Pharmacies.

Adapting and remodelling the US Institute for Safe Medication Practices' Medication Safety Self-Assessment tool for hospitals to be used to support national medication safety initiatives in Finland.

The US Institute for Safe Medication Practices' (ISMP) Medication Safety Self-Assessment (MSSA) tool for hospitals is a comprehensive tool for assessing safe medication practices in hospitals. To adapt and remodel the ISMP MSSA tool for hospitals so that it can be used in individual wards in order to support long-term medication safety initiatives in Finland. The MSSA tool was first adapted for Finnish hospital settings by a four-round (applicability, desirability and feasibility were evaluated) Delphi consensus method (14 panellists), and then remodelled by organizing the items into a new order which is consistent with the order of the ward-based pharmacotherapy plan recommended by the Ministry of Social Affairs and Health. The adapted and remodelled tool was pilot tested in eight central hospital wards. The original MSSA tool (231 items under ten key elements) was modified preliminarily before the Delphi rounds and 117 items were discarded, leaving 114 items for Delphi evaluation. The panel suggested 36 new items of which 23 were accepted. A total of 114 items (including 91 original and 23 new items) were accepted and remodelled under six new components that were pilot tested. The pilot test found the tool time-consuming but useful. It was possible to adapt the ISMP's MSSA tool for another hospital setting. The modified tool can be used for a hospital pharmacy coordinated audit which supports long-term medication safety initiatives, particularly the establishment of ward-based pharmacotherapy plans as guided by the Ministry of Social Affairs and Health.

DD-004 Turnaround time for urgent or restricted prescriptions for drugs from the pharmacy dispensary

BackgroundIn Spain wards usually order medicines electronically. Urgent or restricted medicines can be handwritten and are dispensed immediately.PurposeTo measure the time taken for technicians to dispense medicines in the pharmacy...

Safety Implications of Standardized Continuous Quality Improvement Programs in Community Pharmacy

Standardized continuous quality improvement (CQI) programs combine Web-based technologies and standardized improvement processes, tools, and expectations to enable quality-related events (QREs) occurring in individual pharmacies to be shared with pharmacies in other jurisdictions. Because standardized CQI programs are still new to community pharmacy, little is known about how they impact medication safety. This research identifies key aspects of medication safety that change as a result of implementing a standardized CQI program. Fifty-three community pharmacies in Nova Scotia, Canada, adopted the SafetyNET-Rx standardized CQI program in April 2010. The Institute for Safe Medication Practices (ISMP) Canada’s Medication Safety Self-Assessment (MSSA) survey was administered to these pharmacies before and 1 year into their use of the SafetyNET-Rx program. The nonparametric Wilcoxon signed-rank test was used to explore where changes in patient safety occurred as a result of SafetyNETRx use. Significant improvements occurred with quality processes and risk management, staff competence, and education, and communication of drug orders and other information. Patient education, environmental factors, and the use of devices did not show statistically significant changes. As CQI programs are designed to share learning from QREs, it is reassuring to see that the largest improvements are related to quality processes, risk management, staff competence, and education.

Preliminary results from the 2011 ISMP medication safety self-assessment for hospitals

Preliminary results from the 2011 ISMP medication safety self-assessment for hospitals

Adapting the US Institute for Safe Medication Practices' Medication Safety Self Assessment tool for community pharmacies in Finland

To adapt a US Institute for Safe Medication Practices' Medication Safety Self Assessment (MSSA) tool to, and test its usefulness in, Finnish community pharmacies. A three-round Delphi survey was used to adapt self-assessment characteristics of the US MSSA tool to Finnish requirements, and to obtain a consensus on the feasibility and significance of these characteristics in assessing the safety of medication practices in community pharmacies. The Delphi modified self-assessment tool was piloted in 18 community pharmacies in order to refine the tool, using a questionnaire containing structured and open-ended questions. A total of 211 self-assessment characteristics were accepted to the self-assessment tool for pilot use by expert panellists in the Delphi rounds. Most pilot users considered the tool as useful in: identifying medication safety targets for development; medication safety assessment; and identifying the strengths of medication safety. The substance of the self-assessment tool was considered as comprehensive and essential for medication safety. Most criticism was regarding: the multiplicity of self-assessment characteristics; interpretation of some characteristics; and that all the characteristics were not yet available. After the modification, according to the pilot users' comments, the final Finnish tool consisted of 230 medication safety characteristics. The study indicated the feasibility of adapting a US medication safety self-assessment tool for use in community pharmacy practice in Finland. More efforts should be made to familiarise Finnish community pharmacists with the self-assessment tool and its benefits, and get them to use the tool as part of their long-term quality improvement.

Enhancing medication use safety: benefits of learning from your peers

Background:Maryland hospitals have been improving the safety of medication use practices since 2000. A retrospective analysis of 35 hospitals was conducted for 2005–2007 to determine the changes in medication use...

Assessment of Risk in Medication-Use Systems: Learning from the Medication Safety Self-Assessment

INTRODUCTION Interest in tools for enhancing patient safety has grown with the patient safety movement. The Medication Safety Self-Assessment (MSSA), a comprehensive assessment program originally developed by the Institute for Safe Medication Practices (ISMP) in the United States, is one such tool. The MSSA was adapted for use in Canada in 2001 and has been used by individual hospitals, regional health authorities, and provincial governments to identify and prioritize areas for improvement in medication-use systems.1 The Canadian MSSA program is administered by ISMP Canada, independent of ISMP (US), and includes additional features not available with the US version. The MSSA assists interdisciplinary hospital teams to evaluate the safety of medication practices in their institutions and to heighten awareness of the characteristics of a safe medication system. The MSSA consists of a series of safe medication practice characteristics, which are grouped into 10 key elements of medication-use systems (Table 1). Each key element is defined by one or more core distinguishing characteristics. Several self-assessment items describing safe medication practices are then used to determine the level of success for each of the key elements. Some of the items purposely represent innovative practices and system enhancements that are not widely implemented in Canadian hospitals but that are grounded in scientific research and expert analysis of medication errors and their causes. When completing the self-assessment, respondents must select 1 of 5 responses, ranging from no activity or discussion about a particular item to full implementation throughout the organization. Although ISMP Canada is not itself a standardssetting organization, several items are under consideration for inclusion in the new standards of the Canadian Council on Health Services Accreditation. The principal values of the MSSA are the ability of individual hospitals to identify opportunities for improvement and to track their improvement efforts over time. These values are enabled through a unique feature of the Canadian MSSA, whereby a Web-based program allows participants to immediately compare their current results to the aggregate national, provincial, and regional results, as well as to their own previous results in real time, as soon as responses have been electronically submitted. This functionality is not available for the US version. At the time of writing, in late 2006, a total of 273 Canadian hospitals had completed at least one self-assessment. This article describes one hospital’s experience with the MSSA program.

Take a Proactive Approach with the Medication Safety Self-Assessment

Take a Proactive Approach with the Medication Safety Self-Assessment

Medication safety infrastructure in critical-access hospitals in Florida

The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

Medication Safety Self-Assessment for Hospitals Reports Improvement

Medication Safety Self-Assessment for Hospitals Reports Improvement

Findings from the ISMP Medication Safety Self-Assessment® for Hospitals

Hospital medication practices should be assessed, awareness of the characteristics of a safe medication system heightened, and baseline data to identify national priorities established. A cross-sectional survey of U.S. hospitals (N = 6,180) was conducted in May 2000. The survey instrument contained 194 self-assessment items organized into 20 core characteristics and 10 larger domains. Hospitals were asked to voluntarily submit their confidential assessment data to the Institute for Safe Medication Practices (ISMP) for aggregate analysis. A weighting structure was applied to the individual items and used to calculate core characteristic scores, domain scores, and overall self-assessment scores. These scores were then compared to identify areas most in need of improvement. The 1,435 participating hospitals scored highest in domains related to drug storage and distribution; environmental factors; infusion pumps; and medication labeling, packaging, and nomenclature issues. These hospitals scored lowest in domains related to accessible patient information, communication of medication orders, patient education, and quality processes such as double-check systems and organizational culture. Enormous opportunities exist to improve medication safety, especially in domains related to culture, information management, and communication.