Cosma Rochat Monica, Bulteel Jérémi, Voirol Pierre, Rapin Joachim, Lehn Isabelle, Caci Mirela University Hospital of Lausanne (CHUV), Lausanne, Switzerland
Medication safety: A new complementary approach to CIRS in a Swiss university hospital Background
Results
Medication error is an important factor of morbidity and mortality. Numerous guidelines and recommendations exist to enhance patient safety. The critical incident reporting system (CIRS) is a fundamental component of risk management in health care system, which offers an a posteriori approach, without identifying a priori the risk zones in drug processes.
The results are displayed per unit and can be aggregated from a micro-level (unit, ward) to a meso-level (department) and macro-level (hospital).
(contd)
Your score Structural risk of your unit
Min
Max
69%
77%
60% 47% 76% 75% 60% 62% 53% 63% 100%
75% 68% 79% 79% 60% 63% 71% 83% 100%
73% High score means high risk
Fig. 1: Drug risk management in our hospital
Method
Security axis of your unit
We performed a systematic review and identified English, French and German tools used to assess the medication safety practices in hospitals. One tool met our pre-defined requirements, initially developed in France (InterDiag®) by Agence Nationale d’Appui à la Performance des Etablissements de Santé, and deployed in more than 300 hospitals in several countries.
Axis 1 Axis 2 Axis 3 Axis 4 Axis 5 Axis 6 Axis 7 Axis 8 Axis 9
High score means high risk control
Prevention Leadership Patient admission/transfert/discharge Drug prescription Drug dispensing Drug preparation and administration Unit pharmacy organization Unit pharmacy management Emergency trolley management
68% 57% 78% 77% 60% 63% 62% 73% 100%
Fig. 3: Aggregated results shown as radar and detailed scores in two pilot wards
We needed to adapt the original tool for Swiss health care system, according to legal and local settings. A task force was formed, including doctors, nurses, pharmacists, clinical pharmacologists, risk managers, quality managers. This adapted tool was deployed in two pilot wards (medical and surgical) prior to the whole hospital to test its acceptability and feasibility.
Prevention Prevention
Security policy of the care Security policy of the care unit unit
Results
# # 2 2 2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 22 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
# 2 2 2 # 2 2 2 2 2 2 2 2 2 2 22 2
# # 3 3 3 3 3 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
# 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 # 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 related to computerized Risks 2 2 2 Risks related to computerized 2 2 drug order entry 2 drug order entry 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
2 2 2 2 2 2
# 2 2# 2 22 22 2 2 22 22 22 22 2 2 2 22 22 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 22 22 22 2 22 22 22 22 2 2 2 22 22 2 2 2 2 2
2 2 2 2 2 2
Feedback Feedback
Information / training Information / training
3 3 3 3 33 33 33 3 33 33 33 33 3 3 33 33 3 3 3 33 3 3 3 3 (manual 3 3 Protocols/ procedures / procedures (manual 3 Protocols 3 3 3 or management) or dematerialized dematerialized management) 3 3 3 3 33 33 33 3 33 33 33 33 3 3 3 33 33 3 3 3 33 3
The remodeled tool includes 167 items (38 original and 129 new). A multidisciplinary team (doctors, nurses, pharmacists, risk managers, quality managers) was invited for a 2 - 2,5 hours workshop in order to map the risks in the medication process. This self-assessment tool explores:
Patient admission/transfer/discharge Patient admission/transfer/discharge 3 33 3 3 33 33 33 3 33 33 33 3 3 33 33 33 3 3 3 3 3 3 3 3 33 3 3 33 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Patient and Patientadmission admission and medical medicalrecord record
Three main themes (security policy, medication practices, storage safety) Nine security axes (prevention, leadership, patient admission/ transfer/discharge, drug prescription, dispensing, preparation, administration, storage, emergency trolley management).
Medication safety practices Medication safety practices
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 33 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3 3 3 3 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 33 33 33 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3 3 3 3 3 3 3 3 3
3 3 3 3 3 3
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Synergy with the Central Synergy with the Central CHUV Pharmacy CHUV Pharmacy
ProperProper use of drugs use of drugs
Drug prescription Drug prescription 3 3 3 3 3 3
Drug dispensing Drug dispensing
3 33 33 3 3 3 33 33 33 3 3 3 33 33 33 33 3 33 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Prescription Prescription
3 3 3 3 3 3
3 33 33 33 3 33 33 3 3 3 3 3 3 33 33 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Patient's personal treatment Patient's personal treatment
33 3 3 3 3 23 2 2 2 2 2 3 23 3 23 3 3 2 3 3 2 3 3 3 3 3 3 3 2 2 2 2 2 2
Doctor(s)
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 22 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 33 33 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 22 22 22 2 2 2 2 2 2 2 2 2 2 2 22
Unit pharmacy conception Unit pharmacy conception
Storage safety
Storage safety
Drug supply Drug supply
Unit pharmacy control
Unit pharmacy control
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
2 2 22 22 22 2 2 2 22 22 22 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
2 2 2 2 2 2
3 3 3 3 3 3 3 3
3 3 3 3 3 3
for drug Preparing forPreparing drug administrationadministration
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 2 2 3 2 2 32 2 32 2 2 2 2 2 2 2 2 2 2 2 2 2 2 32 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3
Nominal drug dispensation Nominal drug dispensation
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Administration Administration
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Patient's discharge Patient's discharge preparation preparation
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Drug and preparation and administration Drug preparation administration
Pharmaceutical Pharmaceutical analysis analysis
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Drug intake aid Drug intake aid
Unit pharmacy organization Unit pharmacy organization
Nurse(s)
Leadership Leadership
Unit pharmacy management Unit pharmacy management 3 3 3 3 3 3
3 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Supply of the unit pharmacy Supply of the unit pharmacy 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 33 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 22 2
Global drug dispensation Global drug dispensation
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Reception and storage
Reception and storage
3 3 3 3 3 3
Emergency trolley management Emergency trolley management 3 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Emergency trolley Emergencymanagement trolley management
3 3 3 3 3 3 3 3
2 2 2 2 2 2 2 2
Fig. 4: Results shown as detailed map of risk control Pharmacist(s)
Riskmanager(s) manager(s) Risk
Tool implementation strategy
Quality manager(s)
Fig. 2: InterDiag® CHUV V1 tool for the multidisciplinary workshop
Conclusion
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This Swiss tool allows a precise risk mapping of medication processes and permits to design and implement corrective actions for each unit, but also transversal actions for the entire hospital in order to improve medication safety, with a shared priority assessment.
