Medication safety strategy

Medication Safety Strategy 2015-2018What is the Medication Safety Strategy 2015-2018

The Medication Safety Strategy (the Strategy) provides patients, clinicians and management staff with a clear framework and action plan for improving medication safety at Waitemata DHB hospitals.

What are we trying to achieve?

Medicines are one of the highest causes of preventable harm to patients, so improving medication systems is fundamental to making our hospitals safer for patients.

The Medication Safety Strategy aims to make systemic change and improvement in the way medicines are handled and used. A main focus is on designing systems and using new technologies to reduce human error. We will work to empower our patients / clients to better manage their care and achieve better health outcomes.

Our medication safety vision is:

To provide and be recognised as an organisation with reliable, resilient and responsive medication systems which achieves safe and patient-centred outcomes that are among the best in the world.

How safe are our current medication systems?

We were one of the first hospitals in New Zealand to implement the Medication Safety Self-Assessment (MSSA®); a tool which has been used in approximately 2000 hospitals across the US, Canada, Australia and other countries. The MSSA® tool is made of 250 medication safety best practice statements, eg Item 10.44: machine readable coding (i.e. barcoding) is used at the point of care to verify drug selection prior to administering medications.

We used this to compare ourselves against ideal medication safety practices (gap analysis) and we achieved a score of 63% (as of November 2014), a result which compares favourably to other demographically similar hospitals across Australasia. From self-assessment results, areas in need of further improvement have been identified.

MSSA® - Key elements

The following diagram provides an overview of our hospital’s assessment scores against each of the 10 key elements from the MSSA® tool. When comparing to other similar hospitals:

  • our most successful area was for 'E1: Patient information'
  • our main area for improvement was 'E7: Environmental factors, workflow and staffing patterns'

Waitemata DHB's assessment scores against each of the key elements from the MSSA® tool
Waitemata DHB's assessment scores against each of the key elements from the MSSA® tool

MSSA® - Core characteristics

The following diagram provides an overview of our hospital’s assessment scores against each of the 20 key core characteristics from the MSSA® tool. When comparing to other similar hospitals:

  • our most successful areas were in general about drug information availability [C2], labelling and packaging [C5], medication safety surveillance [C18], and electronic prescribing and administration [C19]
  • our main area for improvement were in general about interoperability of drug related e-systems [C4], barcoding systems in place [C6], staffing and workload issues [C8], staff education about high risk medicines respectively [C13, C15], and infection control practices [C20]

Waitemata DHB's assessment scores against each of the core characteristics from the MSSA® tool

What have we done?

Based on the MSSA© findings, research evidence and inter-disciplinary feedback, we have developed a medication safety strategy to guide improvement initiatives for the next three years.

With a view to achieving our medication safety vision, we identified three broad aims and measures:

Medication Safety Aims

Measures of Success

  1. Enhance the reliability, resiliency and responsiveness of Waitemata DHB medication systems to optimise medicines use

Improve from a baseline ISMP-MSSA* score of 63% (FY2014-2015) to ≥65% by FY2018

* ISMP-MSSA: Institute of Safe Medication Practice’s Medication Safety Self-Assessment score

  1. Achieve safe outcomes

To observe improved trends in medication related patient health outcomes by FY2018

Defined as both adverse and beneficial consequences associated with medication use (e.g. errors, adverse drug events, falls, survival)

  1. Achieve patient centred outcomes

To improve patient experiences related to medication use to 80% by July 2018

Defined by the following questions:

  • Did a member of staff tell you about medication side effects to watch out for when you went home?
  • Do you feel you received enough information from the hospital on how to manage your condition after your discharge?
  • Were you involved as much as you wanted to be in decisions about your care and treatment?
  • Overall, was the way staff involved you in decisions about your care very poor or very good (0-10)


Five medication safety priorities

To achieve our three medication safety aims, we have identified five priorities which span across the entire medicines management pathway:

  1. Waitemata DHB Medication Safety Strategy 2015-2018Nurture a Safe and Just Culture
    To nurture and develop a collective and shared belief in the importance of, and commitment to, medication safety among all staff and demonstrated through leadership, caring, communicative, situationally aware, learning and non-punitive attitudes, mind-sets and behaviours
  2. Optimise Capacity and Capability
    To optimise physical environments, infrastructure and workforce training programs according to current professional knowledge to increase the likelihood of safe medication use
  3. Implement Electronic Medicines Management Systems
    Automation, interoperability and clinician decision support systems are feasibly implemented at all stages of the medicines use pathway wherever possible.
  4. Manage High Risk Areas
    There is a coordinated and targeted improvement system in place to identify, monitor, and manage high risk medicines areas to increase the likelihood of safe medicines use
  5. Best Care for Everyone
    Provision of patient centered care that is respectful and responsive to individual preferences, needs and value and where patients are empowered and actively participate in the use of medicines to achieve optimised health outcomes.


Where to from here?

We are continuing to work towards achieving our vision and priorities. Some examples of initiatives underway or completed which are featured in this quality account are:

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