870-Anansakunwatt-_b
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Transcript 870-Anansakunwatt-_b
INTERVENTIONS TO IMPROVE
MEDICATION SAFETY IN A
UNIVERSITY HOSPITAL IN THAILAND
Wimon Anansakunwatt,
Uraiwan Silpasupagornwong,
Umporn Yoobang,
Naruemon Dhana,
Monwarat Laohajeeraphan
Problem Statement
Adverse Drug Events were found a major complication
for hospitalized patients and most of them were
preventable.
Interventions were implemented in Siriraj Hospital during
the year 2000-2010
Medication error (ME) reporting system
Drug Information Service and Poison Control Center
(DIS&PCC)
Adverse Drug Reaction (ADR) monitoring
Staff education
Patient education programs
No study to compare and conclude the success factors
Objective
To study common success factors of interventions to improve
medication safety during 2000-2010
Design
Observational descriptive study
Setting
Siriraj Hospital, the 2,300 beds tertiary-care teaching
hospital of Mahidol University, Thailand
Study population
Interventions used for medication safety
improvement in the hospital
during 2000 to 2010
Methods
Reports and minutes of team meeting review
Discussion with key persons of each team
Outcome measures
Number of ME reports
ADR prevention reports
Phone calls to DIS&PCC
Score of test in education programs
Factors influenced success of interventions
Drug Information Services (DIS) and Poison Control
Center (PCC) Initiation
Intervention:
changing from 8 hour
service to 24 hour
service
including toxicologist as
consultants
providing staff education
programs
Result:
DIS&PCC received more
phone calls from 2,057
calls in 2005 to 20,054
calls per year in 2010
What do they want to know?
3000
2500
2000
1500
1000
500
0
ADR
Availability
Compat./Stab.
Cost
Dosage/Adm.
Herbal/Conv.med
Identification
Interactions
Law/Policy
Phar.kinetics
Pharmaceutics
Preg.& Lact.
Ther.use/Efficacy
Adverse Drug Reaction (ADR) Monitoring Program
Intervention:
computerized alert in
pharmacy prescription
processing
promoted asking
patients a prime
question for known
allergy
Note to nurse is
printed in prescription
processing
ADR pink label on
inpatient’s chart
Result:
could prevent more
repeated known allergy
cases from 152 cases to
3,139 cases per year
Note to pharmacist is
printed in prescription
processing
Red wrist band for patient
with known allergy
ADR pink label on
outpatient’s chart
Medication Error Reporting
Intervention:
the manual reporting was
changed to on-lined system
gathering manual monthly
reports from nursing and
pharmacy department to
risk management office
Results:
Medication Error reporting
increased significantly
(p<0.05)
Pharmacist’s note to
prescriber
Color strips were
used to distinguish
look-alike
packaging
Reports were used for
communication and error
prevention.
Pharmacy newsletter
Staff Education Program
Intervention:
Staff education programs were
provided
Results:
scores were significantly increased
from pre-test to post-test
• 68.1% to 88.7% in high alert drugs
(HAD) training (N= 312)
• 63.5% to 81.8% in drug
administration training (N= 242)
90
80
70
60
50
40
30
20
10
0
Pre
post
HAD
drug admin
Patient Education
Program
Intervention:
Patients were
empowered to use their
medicines correctly and
monitor themselves
Results: Patients increased
their knowledge scores
from 29% to 55%
(N=70, p<0.05) in
transplantation clinic
from 58.60% to 93.33%
(N=1,502, p<0.05) in
anticoagulation clinic
Results from Staff Interview
There were the terms of
standards
quality
accreditation survey
multidisciplinary
computer program
counseling
education
in the meeting minutes and
discussions
Key persons of each
intervention worked after office
hours to improve the
interventions
What we have learned from this study:
Common success factors of interventions to improve
medication safety are:
Accreditations from external organizations
Multidisciplinary team approach
Using information technology
Patient participation
Devoted personnel
Recommendation
Enhancing these success factors in interventions is
valuable to improve medication safety
Economic outcome studies of these interventions are
suggested
THANK YOU FOR YOUR ATTENTION