Medication management matters

Prescribing errors in Australian hospitals are common, occurring at a rate of 2-5 errors per patient during an inpatient encounter. ¹ Admission to hospital is a particularly high-risk transition, with 60-80% of patients demonstrated to have at least one medication error on their initial medication chart. ¹

Early medication history and reconciliation activities are known to reduce the risk of medication related harm, however, there is currently significant variation in the delivery of these services to high-risk patients admitted to hospitals within our district. There is currently no standardised criteria or process by which to identify high risk patients, or to monitor for changes in their risk throughout admission. Patients are impacted by this, with 46% of high-risk patients interviewed believing they received incorrect medications whilst in hospital.

The Medication Management Matters project aims to improve patient safety and clinician experience by reducing the risk of medication related errors in high-risk patients admitted to SESLHD hospitals. By utilising data and analytics, we aim to improve the identification of patients at risk of medication error. Through redesigning medication management processes and workflows, we then plan to improve efficiency, reduce variation in service delivery and ensure high-risk patients are prioritised for early medication reviews to reduce the risk of harm.

Co-designing solutions and plans for implementation

Extensive diagnostic research has been undertaken using a wide variety of methods including patient interviews, staff surveys, focus groups, workplace observations and audit. A deliberate effort was made to involve stakeholders from across all district sites in both diagnostic activities and in the co-design of solutions and implementation plans. This resulted in four solutions endorsed by the project steering committee:

1. High risk patient framework – an automated tool that uses a validated algorithm, combining previous health diagnoses, known risk factors and current investigation results to prioritise patients by their risk of medication error. This algorithm is still in development but is intended to be piloted in early 2024 and will be used by clinicians to prioritise patients for medication reviews. The framework also includes the standardisation of pharmacy referral processes and roles and responsibilities of clinicians in delivery of medication management tasks across the district.
2. Patient completed medication lists – a form co-designed with consumers which is to be completed by patients or their carers whilst waiting in ED. This will provide a further source information to clinicians completing the medication history.
3. Interhospital transfer BPMH documentation process – the new process, currently being piloted, aims to improve the accuracy of documented medication history information for patients transferred between facilities.
4. Partnered pharmacist work plan – undertake re-design clinical pharmacy workload allocation so that pharmacists work in pairs/groups with responsibility for specific tasks.

Our four solutions are in various stages of solution-design and early implementation. A key challenge has been ensuring ongoing engagement of stakeholders given the broad scope and scale of the project. This has required careful planning, a comprehensive communication plan and strategy to ensure there is a visible presence of the project at each site.

References