medication error

No room for error: How Philippine hospitals are tackling medication errors

Raising reporting levels and adopting digital tools amongst strategies taken to address risk of medication errors, say Philippine hospitals in focus group discussions

The issue of medication error is one that affects healthcare providers and patients around the world. The World Health Organization pointed out that with higher medication use, increasing co-morbidities in ageing populations and rapid introduction of new medications into the market, the risk of harm caused by medications is growing.

While this is a universal issue, studying this issue and searching for solutions would require contextualising it in each country’s context, as every country faces its own unique set of challenges and opportunities.

To this end, Hospital Management Asia ran two exclusive focus group discussions with a total of nine hospitals in Philippines, namely Asian Hospital & Medical Center, Central Luzon Doctors Hospital, Lorma Medical Center, Makati Medical Center, St. Elizabeth Hospital, Davao Doctors Hospital, Manila Doctors Hospital, Mary Mediatrix Medical Center and National Kidney and Transplant Institute. We spoke to representatives of each hospital – Medical or Nursing Directors, Heads of Quality, pharmacists and patient safety officers – to find out the impact of medication errors on their respective facilities, how they currently addressing the issue, and what measures they are looking at implementing in the future.

Building a culture of safety and reporting

Participating hospitals raised pharmacovigilance, the hospitals’ systems and processes relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine/vaccine related problem, as a common issue impacting medication errors.

Roles and responsibilities of everyone in the hospital towards reducing medication errors need to be clearly defined. In particular, clinical pharmacists play a key role in this process, working on the floors to monitor and prevent errors. However, hospital executives unanimously noted that they are facing a lack of clinical pharmacists – while it would have been ideal to have one per unit, some hospitals are coping with just two or three for the whole facility. Hospitals are also seeing high attrition and turnover rates, which mean that they have to constantly train new staff on relevant procedures.

Interviewed hospitals suggested the following strategies to manage medication errors:

  • Education programmes for all staff, to bring across the point that medication error management is everyone’s responsibility
  • No-blame culture or anonymous reporting, that encourages reporting by removing stigma and punishment
  • Develop teal-time tracking and monitoring of data, that helps hospitals quickly identify trends or recurring issues that need to be prioritised. The analysis can be aided by automated or sophisticated IT systems
  • Adopt guidelines from reputable accreditation bodies like Joint Commission International (JCI), which have comprehensive recommendations for medication safety
  • More robust reporting on national level (Philippine Food Drug Administration) and international level (World Health Organization)
  • Categorising adverse events from medication errors based on severity from type 1 to 4, with type 4 being the most severe; with dedicated committees regularly investigating causes of errors reported, and developing mitigating solutions
  • Work redesign, where administrative tasks are taken on by pharmacist assistants, so clinical pharmacists are freed up to focus on their clinical roles
  • Simplified formularies, with reduction of drugs held in inventory, to lower chances of errors and improve efficiency
  • Involving patients and their families or caregivers in the process, so they may ask questions and catch errors in time.
  • Adopt technology (see below section)

How can technology help?

With widespread digitalisation across the healthcare sector, hospitals are looking to digital tools to address medication errors, for example:

  • Going paperless with Electronic Medical Record (EMR) system – this avoids errors caused by misinterpretation or illegible handwriting on paper orders, and also verbal miscommunications
  • Technology implemented across the medication management process, such as:
    • Prescribing:
      • Dosage calculators for accurate dosage dispensing
      • Automated drug screening systems, which issue alerts if risks or warnings are detected in prescriptions
      • Digital drug information databases, which provide constantly updated information on drug interactions, new drugs and so on – easily accessible via mobile apps
    • Administering
      • Automated medication cart, which uses barcodes to ensure medications are dispensed correctly; and barcodes used to tag prescriptions to patients

Indeed, digital tools hold much potential in mitigating the risk of medication errors. However, hospitals raised the need to also consider each system to each facility and unit’s needs, and customisation requirements. A significant financial investment is needed to build up IT infrastructure, so careful consideration is needed before making the decision to adopt a particular tool. The expanded role of digital also needs to go hand in hand with boosting education and training for new and existing staff. This can be done via regular reviews, trainings and seminars on common mistakes, such as similar abbreviations, look-alike or sound-alike drugs, and also latest learnings and best practices.

All in all, participating hospitals are taking medication errors seriously, and have taken firm steps towards tackling this challenge. Despite challenges in manpower, hospitals are looking to strengthen safety and learning culture – coupled with new digital tools that help to reduce human error and improve tracking and screening of prescriptions – to further reduce medication errors in the future.

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