1. Wimon Anansakunwatt, Uraiwan Silpasupagornwong, Umporn Yoobang, Naruemon Dhana, Monwarat Laohajeeraphan INTERVENTIONS TO IMPROVE MEDICATION SAFETY IN A UNIVERSITY HOSPITAL IN THAILAND

2.  Adverse Drug Events were found a major complication for hospitalized patients and most of them were preventable.  Interventions were implemented in Siriraj Hospital during the year 2000-2010  Medication error (ME) reporting system  Drug Information Service and Poison Control Center (DIS&PCC)  Adverse Drug Reaction (ADR) monitoring  Staff education  Patient education programs  No study to compare and conclude the success factors Problem Statement

3. To study common success factors of interventions to improve medication safety during 2000-2010 Objective Design Observational descriptive study Setting Siriraj Hospital, the 2,300 beds tertiary-care teaching hospital of Mahidol University, Thailand

4.  Interventions used for medication safety improvement in the hospital during 2000 to 2010  Reports and minutes of team meeting review  Discussion with key persons of each team Study population Methods

5.  Number of ME reports  ADR prevention reports  Phone calls to DIS&PCC  Score of test in education programs  Factors influenced success of interventions Outcome measures

6.  Intervention:  changing from 8 hour service to 24 hour service  including toxicologist as consultants  providing staff education programs  Result:  DIS&PCC received more phone calls from 2,057 calls in 2005 to 20,054 calls per year in 2010 Drug Information Services (DIS) and Poison Control Center (PCC) Initiation

7. What do they want to know?

8.  Intervention:  computerized alert in pharmacy prescription processing  promoted asking patients a prime question for known allergy  Result:  could prevent more repeated known allergy cases from 152 cases to 3,139 cases per year Adverse Drug Reaction (ADR) Monitoring Program ADR pink label on inpatient’s chart Note to nurse is printed in prescription processing Red wrist band for patient with known allergy Note to pharmacist is printed in prescription processing ADR pink label on outpatient’s chart

9.  Intervention:  the manual reporting was changed to on-lined system  gathering manual monthly reports from nursing and pharmacy department to risk management office  Results:  Medication Error reporting increased significantly (p<0.05)  Reports were used for communication and error prevention. Medication Error Reporting Pharmacist’s note to prescriber Pharmacy newsletter Color strips were used to distinguish look-alike packaging

10.  Intervention:  Staff education programs were provided  Results:  scores were significantly increased from pre-test to post-test 68.1% to 88.7% in high alert drugs (HAD) training (N= 312) 63.5% to 81.8% in drug administration training (N= 242) Staff Education Program

11. Intervention:  Patients were empowered to use their medicines correctly and monitor themselves Results: Patients increased their knowledge scores  from 29% to 55% (N=70, p<0.05) in transplantation clinic  from 58.60% to 93.33% (N=1,502, p<0.05) in anticoagulation clinic Patient Education Program

12.  There were the terms of  standards  quality  accreditation survey  multidisciplinary  computer program  counseling  education in the meeting minutes and discussions  Key persons of each intervention worked after office hours to improve the interventions Results from Staff Interview

13. Common success factors of interventions to improve medication safety are:  Accreditations from external organizations  Multidisciplinary team approach  Using information technology  Patient participation  Devoted personnel What we have learned from this study: Recommendation Enhancing these success factors in interventions is valuable to improve medication safety Economic outcome studies of these interventions are suggested

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