Medication safety audit tool

A simple structured form is required to help reporting and analysis. Feedback, regular reports, and the implementation of corrective actions are all necessary [ 17 ]. Near misses and medication errors are usually reported, but rarely adverse events [ 18 ]. An increasing number of reports does not necessarily betoken poor practice, but is related to improved capture of events.

The advantages of voluntary reporting are the discovery of active and latent systems failures, evidence of the critical nature of processes, the correction of contributory factors, and the diffusion of a culture of safety [ 12 , 17 , 18 ]. Every experience underlines the existence of common barriers to physician involvement in reporting of errors, in fact this is minimal compared with the nurses' involvement [ 19 ].

Although the vast majority of incidents will be reported locally, the existence of another independent and confidential reporting system provides a safety net for staff. Patient monitoring, with interviews, using structured forms, by mail, telephone, or visits, or by satisfaction questionnaires and focus groups, can discover medication errors and associated adverse events in outpatients [ 12 ], where many errors arise from poor communication.

In future the focus will be on long-term care, primary care, and outpatients. In Florence Nightingale used audit to prevent postsurgical mortality. In , Working for Patients , a UK Government white paper, proposed standardization of audit as part of professional healthcare. Clinical audit is generally retroactive, caused by the occurrence of near-miss events and adverse or critical events involving a multidisciplinary team.

The team's discussion is confidential, anonymous, and blame-free; its aim is to monitor critical events, revisiting care actually provided and learning for the future. Recommendations from these reviewers are often not pursued, as there is no systematic method to follow. Users' views about quality of care, when available, are evaluated. Audit is also an educational activity, which promotes high-quality care and should be carried out regularly.

Edwards Deming, — and offers a systematic framework for investigating and assessing the work of healthcare professionals and for introducing and monitoring improvements.

The audit process involves a characteristic sequence of events, the audit cycle [ 20 ]:. Planning the audit by identifying the problem, the objectives, the current state of the art, the participants five to seven multiprofessional, interested people, a leader, a secretary , activities, responsibilities, times, limits, and resources.

Defining objectives, standards, or protocols of best practice against which performance can be compared evidence based medicine and nursing, scientific reviews, guidelines, benchmarking data, leaders' opinions , and developing evaluation criteria for adherence to these standards and indicators; the standards, criteria, and indicators must be clear, written, and agreed [ 21 ].

Gathering systematic and objective evidence of performance according to stated criteria. Clinical audit should be an objective way of measuring and monitoring practice against a set of agreed standards and of detecting mismatches between the written word and actual practice.

Audit is not a means for measuring outcomes, but a way of comparing what we do against what research evidence indicates should be done — auditing performance against a reference standard [ 21 ].

Audit enables assessment of the appropriateness of specific healthcare decisions, services, and outcomes. However, none of them is superior for all changes in all settings. Interventions that are targeted at specific obstacles to change seem to be more effective than those that are not [ 9 ]. Audit and feedback seem to be effective when they target the ordering of tests and preventive activities, but the effect size can be modulated by feedback, depending on its source, format, and frequency or intensity of presentation.

Feedback is recommended in combination with education, outreach visits, or reminders. The audit process is better used in the USA, UK and Australia, where it has influenced clinical practice and management, changing the culture of healthcare providers, enabling them to appreciate written guidelines and protocols and to develop a sense of clinical accountability, interprofessional understanding, and sensitivity to patients' needs [ 6 , 17 , 18 ].

However, it has some drawbacks: it takes time and effort, it is resource intensive, and facilitators need to be trained. Clinical audit can also be used proactively, in the hope of avoiding medication errors or adverse events that have not yet occurred, but have been outlined in surveillance alerts like JCAHO Sentinel Event Alert and National Patient Safety Goals NPSGs , or in order to pay attention to a known critical step for example, prescription dispensing forms, discharge therapy, oral anticoagulant prescription [ 22 ].

To conduct proactive risk assessment the use of Failure Mode, Effect, and Criticality Analysis is recommended, in order to survey critical processes e. It analyses all potential failure modes and consequent failure effects inside the system, as perceived by the user. A block diagram gives an overview of the major components of the steps in the process and how they are related. The process is mapped step by step, by subprocesses and activities, with their single possible failures.

Failures can be prioritized according to the RPN, the highest being given the highest priority for corrective or preventive actions [ 23 ]. Prevention of medication errors relies on epidemiological knowledge, detection of errors, and improvements in performance.

Chart review is the gold standard in detecting adverse drug-related events and, in future, computerized monitoring will be the method of capturing adverse events before they occur. Audit is a relatively simple tool for evaluating actual performance and in planning corrective actions to reduce the risk of medication errors. National Center for Biotechnology Information , U. Br J Clin Pharmacol. Germana Montesi and Alessandro Lechi. Author information Article notes Copyright and License information Disclaimer.

Correspondence Dott. B Rossi — P. Scuro, 10, Verona, Italy. Received Feb 18; Accepted Mar This article has been cited by other articles in PMC. Abstract Medication errors have important implications for patient safety, and their identification is a main target in improving clinical practice errors, in order to prevent adverse events.

Keywords: clinical audit, clinical risk management, incident reporting, medication error, patient safety. Detection In order to build safer systems we must be able to learn from previous errors [ 6 ], and detection is the first crucial step. Table 1 Detection methods used to investigate medication errors and adverse events.

Open in a separate window. Chart review Chart review is retrospective and based on practice sources medical charts and laboratory data, prescription data, and administrative data [ 2 , 10 , 11 , 12 ]. Computerized monitoring Computerized monitoring is the modern version of voluntary pharmacist reporting pharmacy logs [ 13 ]. Administrative databases Administrative databases screen International Classification of Diseases, 9th revision codes, for statistical purposes.

Claims data The value of screening of claims data is limited by the underlying reasons for litigation, which are sometimes frivolous, and by the involvement of small numbers of local claims.

Direct observation Direct observation is the only method available for detecting errors of administration of medications. Reporting systems Reporting systems derive from procedures in high-reliability organizations. Audit Tool for Hypothermia. Audit Tool for Instrument Cleaning. Audit Tool for Laser Safety. Audit Tool for Local Anesthesia. Audit Tool for Medication Safety. Audit Tool for Minimally Invasive Surgery. Audit Tool for Moderate Sedation. Audit Tool for Packaging Systems.

Audit Tool for Patient Information Management. Audit Tool for Patient Skin Antisepsis. Audit Tool for Pneumatic Tourniquet. At A Glance Anesthesia. Hand-Over Tools. Room Setup. Skin Prep. ARIN Books. Guidelines and Tools for the Sterile Processing Team. Accreditation Joint Commission. Your IP address:. Association of periOperative Registered Nurses. Link to Facebook. Link to Twitter.

Link to Instagram. Link to ORLN. All rights reserved. The intent of this standard is to ensure that patients receive comprehensive care — that is coordinated delivery of the total health care required or requested by a patient.

The intent of this standard is to ensure timely, purpose-driven and effective communication and documentation that support continuous, coordinated and safe care for patients.

Acute deterioration includes physiological changes, as well as acute changes in cognition and mental state. Sidebar navigation. The plans provide an understanding of how the questions in the audit tool have a direct association with the actions required in the standard. Clinical Governance Standard The intent of this standard is to implement a clinical governance framework that ensures that patients and consumers receive safe and high-quality health care.