Reducing the level of severe avoidable medication harm

The Irish Medication Safety Network (IMSN) is a voluntary, independent group of hospital pharmacy based specialists with an interest in medication safety, including representatives with specialist interest in high risk medications (i.e. potassium, insulin, opioids, anticoagulants), mental health, obstetrics, oncology and paediatrics. Our aim is to improve patient safety with regard to the use of medicines, writes Niamh O’Hanlon, Treasurer, Irish Medication Safety Network, Chief II Pharmacist, St Vincent’s University Hospital, Dublin.

The network provides guidance on medication safety in Irish hospitals through the provision of publications of medication safety briefings, guidelines and alerts.  We also provide guidance on management of identified high alert drugs e.g. concentrated potassium, insulin, and sound alike look alike drugs (SALADs).

The IMSN was established in 2007 with key initial support from the Clinical Indemnity Scheme at the National Treasury Management Agency. The network has grown considerably since, with over 50 members representing major hospitals in the country in both the public and private sector.

The IMSN acts as medication safety liaison with relevant State bodies e.g. HPRA, HSE, HIQA, NCCP and the Department of Health.  The Network  is a member of the Medication Safety Forum, facilitated  by the Department of Health as a result of the Report  “Building a Culture of Patient Safety”  (The Madden report). The IMSN also forms part of HIQA’s expert advisory group for the medication safety monitoring programme.

The IMSN meets bimonthly to promote the exchange of information on medication safety issues, and to facilitate national and global initiatives to help minimize patient risk. Between meetings, outputs are collated via working groups from different stakeholder hospitals, and including external participant stakeholders as relevant to the subject at hand.

Information provided by the IMSN (via www.imsn.ie), is periodically updated by members, and takes the form of:

1. Alerts:  Alerts are one page documents highlighting a medication safety issue for patients attending Irish hospital.They are typically formatted with background to the issue, evidence of harm, and how to mitigate risk of harm to patients.  Some examples of the Alerts we have produced include:
   1. Safe use of prostaglandin analogues in obstetrics
   2. Safety alert with direct/novel oral anticoagulants
   3. Risk of cross-contamination with insulin preparations
2. Best Practice Guidelines: These guidelines focus on practical strategies that Irish hospitals can adapt to mitigate risk with high alert medications or processes. The IMSN’s first guideline related to the safe use of concentrated potassium in Irish hospitals, given that concentrated potassium can be fatal when not prepared and administered properly. Other guidelines include safe use of insulin and guidelines for prescribing and monitoring lithium therapy. The IMSN also provides guidance on medication incident reporting in Irish hospitals.
3. Briefing documents: these are more detailed than alerts and describe potential areas of error with subsequent risk to patient safety. Examples include: reducing preventable harm to patients with known drug allergies, medication and falls risk, safety with oral anticancer medicines, and managing Sound Alike Look Alike Drug (SALAD) pairs.

The global challenge is to reduce the level of severe avoidable harm related to medications by 50% over five years.

With Department of An Taoiseach’s approval, and the support of the Department of Health, the Network hosts an annual conference at Farmleigh House in Phoenix Park to highlight specific medication safety initiatives at both local and national level.  Conference attendees include patient advocates, Department of Health, HSE, and HIQA representatives, risk managers, chief pharmacists of Irish hospitals, chairs of Drugs & Therapeutics committees, among others.  To date conference themes (presentations available at www.imsn.ie) have included:

Year    IMSN Conference
2010    Medication safety for patients in the acute healthcare setting
2011    Networking for safety in cancer care
2012    Systematic approach to medication safety in recessionary times
2013    Medication safety: tales of the unexpected
2014    Pitfalls in pain management
2015    National medication safety summit with Institute of Safe Medication Practice and the HSE – towards a national approach
2016    Leadership in medication safety
2017    Person centred care – a collaborative approach

The 10th Anniversary of the IMSN in 2017 coincided with the launch of the WHO Global Patient Safety Challenge – Medication without Harm. The global challenge is to reduce the level of severe avoidable harm related to medications by 50% over five  years. The IMSN welcomes this global call for action, as we continue to promote the exchange of information on medication safety and facilitate national and global initiatives. For further detail on the work of the Irish Medication Safety Network, visit www.imsn.ie