Wimon Anansakunwatt, Uraiwan Silpasupagornwong, Umporn Yoobang, Naruemon Dhana,

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

2. Problem Statement • Adverse Drug Events were found a major complication for hospitalized patients and most of them were preventable. • Interventions were implemented in SirirajHospital 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

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

4. 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

5. 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

6. 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 2,057calls in 2005 to 20,054 calls per year in 2010

7. What do they want to know?

8. Adverse Drug Reaction (ADR) Monitoring Program • 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 Note to nurse is printed in prescription processing ADR pink label on inpatient’s chart Note to pharmacist is printed in prescription processing Red wrist band for patient with known allergy 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 Color strips were used to distinguish look-alike packaging Pharmacy newsletter

10. 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)

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. 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

13. What we have learned from this study: Common success factors of interventions to improve medication safetyare: • 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

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