ABSTRACT
BACKGROUND: Since development of the Institute for Safe Medication Practices (ISMP) Medication Safety Self Assessment for Hospitals in 2000, hospitals have used the tool to assess medication safety practices and identify opportunities for improvement. The Assessment was updated in 2011 to create a new baseline of hospital medication safety efforts and determine if progress has been achieved in the interim. METHODS: Hospitals in the United States were asked to voluntarily complete the 2011 Assessment and submit their data confidentially to ISMP from April to October 2011. The Assessment contained 270 items organized into 10 key elements and then further divided into 20 core characteristics. RESULTS: By October 2011, 1,310 hospitals had submitted data to ISMP for a response rate of 23% for all 5,786 hospitals. Scores in 2011 increased significantly from 2000. The largest percent improvements were in core characteristics related to communication of drug orders, patient education, and quality processes and risk management. Hospitals in 2011 scored lowest in areas related to patient information, staff competency and education, and drug information. Higher scores for the core characteristics related to the organizational culture and staff education about medication error prevention were associated with higher scores for the core characteristic associated with error detection, reporting, and analysis. Hospitals with a medication safety officer scored higher in all key elements than hospitals without. CONCLUSIONS: While substantial medication safety improvements have been achieved within the last decade, opportunities still exist to improve medication safety. Widespread adoption of key safety strategies will be more effective if influential groups work together and external forces provide the necessary pressure via regulations, standards, public policy, or incentives.
Subject(s)
Medication Errors/prevention & control , Medication Systems, Hospital/organization & administration , Quality of Health Care/organization & administration , Safety Management/organization & administration , Communication , Electronic Prescribing , Inservice Training , Organizational Culture , Patient Education as Topic , Patient Safety , United StatesABSTRACT
PURPOSE: The association between fall risk and inpatient medications was evaluated. METHODS: A retrospective, case-control study was performed to compare the medication use of patients sustaining at least one fall during hospitalization (case group) with a control group of patients who did not fall. Data were collected from medical records and generated reports. A fall was defined by the hospital as an event in which the patient comes to rest on the floor from a lying, standing, or sitting position. Adult patients (≥18 years of age) admitted between January 1 and December 31, 2006, experiencing a fall at least 48 hours after hospital admission were included in the case group. Each case was matched with one control by age (within five years), sex, admission date (within 30 days), patient care unit, and length of stay. Medications administered within 48 hours before the fall for the case group or designated fall date and time for the control group were documented. RESULTS: Of the 414 documented fall events, 209 patients met the inclusion criteria. Of those patients, 96 matched control patients on all criteria. Significantly more case patients received a greater number of central nervous system (CNS) agents compared with matched control patients (p = 0.017). There was no statistically significant difference in the number of medications from all other drug classes or the total number of medications received by the groups. CONCLUSION: In a sample of hospitalized patients, CNS agents were significantly associated with falls.
