Medication safety assessment shows progress, challenges

Hospitals have increased medication safety in the past decade, but further improvement is still necessary, a recent study found.

Hospitals have increased medication safety in the past decade, but further improvement is still necessary, a recent study found.

The Institute for Safe Medication Practices (IMSP) Medication Safety Self-Assessment was first launched in 2000 in partnership with the American Hospital Association and the Health Research & Educational Trust. The goal of the assessment was to help hospitals assess medication safety practices and identify areas of improvement. Hospitals submitted their findings anonymously and confidentially to ISMP for analysis. The assessment was repeated in 2004 and again in 2011. Researchers from the partnership organizations compared findings from the 2011 assessment with findings from 2000 and identified key areas of greatest improvement and greatest need. The results of this comparison were published in the February Joint Commission Journal on Quality and Patient Safety.

A total of 1,310 hospitals submitted data from the 2011 assessment to ISMP, representing a response rate of 23% of all hospitals registered in the U.S. (n=5,786). The response rate in the 2000 study was also 23% (1,435 of 6,180 hospitals). Hospitals that submitted data in both 2000 and 2011 were more likely than those that did not to be larger and nonprofit, to have a physician training program, to be part of a larger health system and to provide more medical and surgical services. Overall scores on the assessment improved significantly from 2000 to 2011, from a mean of 56% to a mean of 71% (P<0.001).

The researchers found that hospitals in the 2011 assessment made the greatest improvements in communication of drug orders and other drug information, patient education, and quality processes and risk management. The key elements with the lowest scores in 2011 were management of patient information (e.g., linking inpatient and outpatient computer order entry systems), staff competency and education (e.g., orientation and education and safety education) and drug information (e.g., medication reconciliation). The researchers analyzed factors affecting 2011 scores and found that hospitals with a strong safety culture were more likely to have better medication safety and that safety measures were more likely to be implemented if they were inexpensive and uncomplicated. In addition, hospitals that employed a medication safety officer were more likely to have higher scores on all key elements in the assessment that those that did not.

The authors acknowledged that their study relied on self-reported data and that the study sample may not have been representative of all U.S. hospitals, among other limitations. However, based on the assessment results, they compiled a list of recommended national priorities for improvement in medication safety in the areas of technology enhancements (e.g., improving order entry systems), clinical improvement (e.g., improving care of patients receiving opioids), expanded pharmacy role (e.g., expanded outpatient services), increased patient education, increased staff education (e.g., teaching risk identification and prevention strategies), and management of risk and safety (e.g., measuring medication safety).

“Our study demonstrates that medication safety improvements have been substantial in the last decade, lending support to a more optimistic viewpoint that patients are clearly safer today than a decade ago,” the researchers wrote. “Yet, our task is far from completed. Although we should take pride in the progress we have made thus far, much still remains to be done.”