INTERVENTIONS TO IMPROVE
MEDICATION SAFETY IN A
UNIVERSITY HOSPITAL IN THAILAND
Wimon Anansakunwatt,
Uraiwan Silpasupagornwong,
Umporn Yoobang,
Naruemon Dhana,
Monwarat Laohajeeraphan
Problem Statement
 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
Objective
To study common success factors of interventions to improve
medication safety during 2000-2010
Design
Observational descriptive study
Setting
Siriraj Hospital, the 2,300 beds tertiary-care teaching
hospital of Mahidol University, Thailand
Study population
Interventions used for medication safety
improvement in the hospital
during 2000 to 2010
Methods
Reports and minutes of team meeting review
Discussion with key persons of each team
Outcome measures
Number of ME reports
ADR prevention reports
Phone calls to DIS&PCC
Score of test in education programs
Factors influenced success of interventions
Drug Information Services (DIS) and Poison Control
Center (PCC) Initiation
 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
What do they want to know?
3000
2500
2000
1500
1000
500
0
ADR
Availability
Compat./Stab.
Cost
Dosage/Adm.
Herbal/Conv.med
Identification
Interactions
Law/Policy
Phar.kinetics
Pharmaceutics
Preg.& Lact.
Ther.use/Efficacy
Adverse Drug Reaction (ADR) Monitoring Program
 Intervention:
 computerized alert in
pharmacy prescription
processing
 promoted asking
patients a prime
question for known
allergy
Note to nurse is
printed in prescription
processing
ADR pink label on
inpatient’s chart
 Result:
 could prevent more
repeated known allergy
cases from 152 cases to
3,139 cases per year
Note to pharmacist is
printed in prescription
processing
Red wrist band for patient
with known allergy
ADR pink label on
outpatient’s chart
Medication Error Reporting
 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)
Pharmacist’s note to
prescriber
Color strips were
used to distinguish
look-alike
packaging
 Reports were used for
communication and error
prevention.
Pharmacy newsletter
Staff Education Program
 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)
90
80
70
60
50
40
30
20
10
0
Pre
post
HAD
drug admin
Patient Education
Program
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
Results from Staff Interview
 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
What we have learned from this study:
Common success factors of interventions to improve
medication safety are:
 Accreditations from external organizations
 Multidisciplinary team approach
 Using information technology
 Patient participation
 Devoted personnel
Recommendation
Enhancing these success factors in interventions is
valuable to improve medication safety
Economic outcome studies of these interventions are
suggested
THANK YOU FOR YOUR ATTENTION