Medication Safety At Risk, Australia

Main Category: Public Health
Article Date: 20 Jan 2008 - 12:00 PDT

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Two articles in the latest Medical Journal of Australia raise concerns about the safety of medication practices in hospitals, one analysing the reasons for prescribing errors by interns and the other identifying problems with the standard national inpatient medication chart (NIMC) adopted by the Australian Health Ministers' Advisory Council (AHMAC) in 2004, for implementation in 2006.

Mr Ian Coombes, Pharmacist and researcher at the University of Queensland, and co-authors analysed 21 of 47 prescribing errors by interns identified by pharmacists at a Brisbane hospital.

New prescribing errors (when starting or changing drugs or doses) involved inexperienced interns who were often tired, hungry and distracted, prescribing for patients with complex disorders. These errors were frequently associated with such factors as poor supervision and ambiguous instructions.

Represcribing errors (continuing therapy on admission, during stay or on discharge) often stemmed from difficulties with the design of medication charts and discharge prescriptions.

The errors "will happen again unless changes at many levels are made," the authors conclude.

Training to develop safe prescribing skills and to make doctors aware of risks, and standardised charts have been implemented in Queensland and reduce errors.

"A cultural shift, in which prescribing is seen as important, must occur, with continual senior review and tailored supervision of interns in an atmosphere that encourages clarification and learning."

In the second article, Professor Alasdair Millar, Clinical Pharmacologist in the Department of Internal Medicine at Royal Perth Hospital, and his co-authors conclude not only that the NIMC is inferior to the chart that RPH previously used, but also that its implementation process was flawed.

The overall design chosen for the national chart originated from a standard chart used in Queensland, and was implemented at RPH in 2006 following a letter from the Western Australian Director General of Health to all doctors, setting out its virtues.

But a design assessment and compliance audit reported that five of seven advantages (71 per cent) claimed for the NIMC by the Director General were not confirmed in practice and identified 10 design features with a potentially adverse effect on medication safety.

The article points out that the NIMC would not have been introduced without the involvement of AHMAC and the then Australian Council for Safety and Quality in Healthcare (ACSQH) "whose joint authority acted as a forcing mechanism for implementation with little further creative input.

"There was no field testing in any WA teaching hospital. The official audit relied on surrogate markers of benefit, which tend to give the appearance but not the substance of quality. Finally, the mandated implementation prevented adequate discussion of the NIMC by drugs and therapeutics committees within individual hospitals.

"These problems highlight essential disadvantages of a 'top-down' system of health administration in which solutions to problems are imposed rather than negotiated."

The Medical Journal of Australia is a publication of the Australian Medical Association.

Australian Medical Association