Medication safety and electronic decision support team at ISQua 2019

Medication safety and electronic decision support team at ISQua 2019

36th International Society for Quality in Health Care International Conference, Cape Town, 20-23 October, 2019


Prof Johanna Westbrook, Dr Peter Gates and Dr Kim Lind represented the Medication Safety and Electronic Decision Support team at the ISQua International Conference in Capetown in October 2019. They delivered five presentations and posters.

Prof Johanna Westbrook presented results of a study examining whether double checking during medication administration is associated with a reduction in medication administration errors. Data was collected using direct observations of nurses administering medication in a tertiary paediatric hospitals. The results of the study have the potential to inform hospital policies and procedures related to medication administration procedures.

Dr Gates presented results from his systematic review and meta-analysis on the prevalence of medication errors among paediatric inpatients. The full paper can be found here. The review of 71 studies found that medication errors were particularly prevalent in intensive care wards and emergency departments. Notably, the introduction of eMM systems tended to reduce error rates.

Dr Gates also presented on the development of a tool to be used for classifying the harm associated with medication errors - the Harm Associated with Medication Errors Classification tool, or HAMEC. The full paper can be found here. This new tool is the result of a systematic process to synthesise the defining elements and strengths, and mitigate any limitations, of the many existing tools. The HAMEC is freely available for use in clinical and research settings.

Work by the team detailing the process and methods developed and piloted for reviewing patient records to assess harm arising from medication errors was also presented (authored by Dr Virginia Mumford, presented by Dr Gates, and co-authored by Dr Magda Raban and Prof Johanna Westbrook). These methods are currently being applied in the Delivering safe and effective care for children project  assessing the impact of eMM on medication errors and harm, in partnership with the Sydney Children’s Hospital Network. A related publication can be found here .

Dr Kim Lind presented her work on using eMM and electronic records in residential aged care to assess appropriateness of medication use. In her work she examined whether the use of medication across three conditions complied with guidelines. Her presentation focused on answering three questions:

  • Are residents with dementia using antipsychotics for less than 12 weeks?
  • Are residents with osteoporosis receiving vitamin D or antiresorptive medications?
  • Are residents at risk of adverse effects from oral NSAIDs avoiding them?
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