Authors (including presenting author) :
Chan CSS, Tse KY, Au W, Chan SY, Ho YKE, Kam MY, Szeto TL
Affiliation :
Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Medication incidents (MI) pose significant threats to patient safety and care quality in healthcare settings. To address this challenge, the Medication Incident Response Team (MIRT) was established, comprising six nursing staff, a ward manager, associate nurse consultants, and a training coordinator. The team collaborates closely with acute medical ward managers and frontline staff to enhance medication safety practices, foster a proactive safety culture, and standardize practice in acute medical wards.
Objectives :
1. To enhance the safety of medication administration practices.
2. To promote a proactive culture in addressing medication incidents.
Methodology :
The MIRT takes a proactive approach by regularly reviewing guidelines and safety alerts. Key interventions include:
• Conducting incident sharing sessions on medication safety
• Designing safety alert signage and slogans to improve efficiency and standardize practices (Examples include the "Do Not Dilantin" signage on IPMOE devices and the "Klean-Prep Preparation & Reconstitution" slogan for proper drug preparation)
• Sharing good practices through daily teleconferences with operational managers and ward staff
• Collecting frontline feedback to inform system enhancements
• Participating in safety ward rounds to ensure appropriate interventions
• Delivering quarterly incident sharing webinars for frontline staff
A six-question survey was conducted to evaluate nurses' views on safety measures and a ten-question multiple-choice quiz was adopted to assess their knowledge.
Result & Outcome :
The implementation of these measures led to high staff satisfaction, with over 96% expressing satisfaction with the prompt actions and increased awareness. During this period, no medication errors were reported. Nurses' competency in medication procedures also improved significantly, with post-test scores (M=9.74, SD=0.43) being statistically higher than pre-test scores (M=7.05, SD=1.12), p< 0.001.
The MIRT's collaborative and responsive initiatives have successfully improved medication safety practices and fostered a proactive culture in addressing medication incidents. This approach effectively reduces medication errors and enhances overall patient safety.
Healthcare institutions should consider adopting similar timely, proactive, and collaborative approaches to reduce the risks of medication incidents and improve patient outcomes.
