Facilitators and barriers in implementing medication safety practices across hospitals within 11 European Union countries
Background: The study was carried out as part of the European Network for Patient Safety (EUNetPas) project in 2008-2010.
Objective: To investigate facilitators and barriers in implementation process of selected medication safety practices across hospitals within European Union countries.
Methods: This was an implementation study of seven selected medication safety practices in 55 volunteering hospitals of 11 European Union (EU) member states. The selected practices were: two different versions of medicine bed dispensation; safety vest; discharge medication list for patients; medication reconciliation at patient discharge; medication reconciliation at patient admission and patient discharge, and sleep card. The participating hospitals submitted an evaluation report describing the implementation process of a chosen practice in their organisation. The reports were analysed with inductive content analysis to identify general and practice-specific facilitators and barriers to the practice implementation.
Results: Altogether 75 evaluation reports were submitted from 55 hospitals in 11 EU member states. Implementation of the medication safety practices was challenging and more time consuming than expected. The major reported challenge was to change the work process because of the new practice. General facilitators for successful implementation were: existence of safety culture, national guidelines and projects, expert support, sufficient resources, electronic patient records, interdisciplinary cooperation and clinical pharmacy services supporting the practice implementation.
Conclusions: The key for the successful implementation of a medication safety practice is to select the right practice for the right problem, in the right setting and with sufficient resources in an organization with a safety culture.
Institute of Medicine. To Err Is Human: Building a Safer Health System. Ed. Kohn KT, Corrigan JM, Donaldson MS. Washington, DC: National Academy Press; 2000
World Health Organization (WHO). Medication without harm: WHO´s Third Global Patient Safety Challenge. http://www.who.int/patientsafety/medication-safety/en (accessed May 31, 2019).
National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP). About medication errors: What is a medication error? http://www.nccmerp.org/about-medication-errors (accessed Nov 15, 2017).
Dückers M, Faber M, Cruijsberg J, Grol R, Schoonhoven L, Wensing M. Safety and risk management interventions in hospitals - a systematic review of the literature. Med Care Res Rev. 2009;66(6 Suppl):90S-119S. https://doi.org/10.1177/1077558709345870
Foy R, Eccles M, Grimshaw J. Why does primary care need more implementation research? Fam Pract. 2001;18(4):353-355. https://doi.org/10.1093/fampra/18.4.353
Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3:32. https://doi.org/10.1186/s40359-015-0089-9
Rapport F, Clay-Williams R, Churruca K, Shih P, Hogden A, Braithwaite J. The struggle of translating science into action: Foundational concepts of implementation science. J Eval Clin Pract. 2018;24(1):117-126. https://doi.org/10.1111/jep.12741
Ovretveit J. Understanding the conditions for improvement: research to discover which context influences affect improvement success. BMJ Qual Saf 2011;20(Suppl 1):i18-i23. https://doi.org/10.1136/bmjqs.2010.045955
The Council of the European Union. Council conclusions on patient safety and quality of care, including the prevention and control of healthcare-associated infections and antimicrobial resistance (2014/C 438/05). Official Journal of the European Union 2014;C 438:7-11.
Groene O, Klazinga N, Walshe K, Cucic C, Shaw CD, Suñol R. Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union. Qual Saf Health Care 2009;18(Suppl I):i69–i74. https://doi.org/10.1136/qshc.2008.029447
Council of Europe. Creation of a better medication safety culture in Europe: Building up safe medication practices. Expert Group on Safe Medication Practices 2006. https://www.edqm.eu/medias/fichiers/Report_2006.pdf (accessed May 31, 2019).
European Medicines Agency (EMA). Medication errors. https://www.ema.europa.eu/en/human-regulatory/post-authorisation/pharmacovigilance/medication-errors/recommendations-medication-errors (accessed May 31, 2019).
European Network for Patient Safety (EUNetPas): Project homepages. http://90plan.ovh.net/~extranetn/index.php?option=com_content&task=view&id=1&Itemid=2 (accessed Aug 15, 2016).
The European Union Network for Patient Safety and Quality of Care (PaSQ). Project homepages. http://www.pasq.eu/Project/Project.aspx (accessed Nov 15, 2017).
Shekelle PG, Pronovost PJ, Wachter RM. Assessing the Evidence for Context-Sensitive Effectiveness and Safety of Patient Safety Practices - Developing Criteria. AHRQ Publication No. 11-0006-EF, 2010. https://archive.ahrq.gov/research/findings/final-reports/contextsensitive/context.pdf (accessed May 31, 2019).
European Network for Patient Safety (EuNetPas). Good medication safety practices in Europe – Compendium I: Results of the implementation. EuNetPas 2010
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. https://doi.org/10.1177/1049732305276687
Vrbnjak D, Denieffe S, O'Gorman C, Pajnkihar M. Barriers to reporting medication errors and near misses among nurses: A systematic review. Int J Nurs Stud. 2016;63:162-178. https://doi.org/10.1016/j.ijnurstu.2016.08.019
Hansen LO, Herrin J, Nembhard IM , Busch S, Yuan CT, Krumholz HM, Bradley EH. National quality campaigns: who benefits? Qual Saf Health Care. 2010 Aug;19(4):275-278. https://doi.org/10.1136/qshc.2009.036087
Graig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. https://doi.org/10.1136/bmj.a1655
Halligan M, Zecevic A. Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Qual Saf. 2011 Apr;20(4):338-343. https://doi.org/10.1136/bmjqs.2010.040964
Taylor SL, Dy S, Foy R, Hempel S, McDonald KM, Ovretveit J, Pronovost PJ, Rubenstein LV, Wachter RM, Shekelle PG. What context features might be important determinants of the effectiveness of patient safety practice interventions? BMJ Qual Saf. 2011 Jul;20(7):611-617. https://doi.org/10.1136/bmjqs.2010.049379
Holmström AR, Laaksonen R, Airaksinen M. How to make medication error reporting systems work – Factors associated with their successful development and implementation. Health Policy. 2015;119(8):1046-1054. https://doi.org/10.1016/j.healthpol.2015.03.002
Burnett S, Benn J, Pinto A, Parand A, Iskander S, Vincent C. Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes. Qual Saf Health Care. 2010;19(4):313-317. https://doi.org/10.1136/qshc.2008.030759
Westbrook JI, Li L, Hooper TD, Raban MZ, Middleton S, Lehnbom EC. Effectiveness of a “Do not interrupt” bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Qual Saf. 2017;26(9):734-742. https://doi.org/10.1136/bmjqs-2016-006123
Mekonnen AB, McLachlan AJ, Brien JA. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(2):128-144. https://doi.org/10.1111/jcpt.12364
Redmond P, Grimes TC, McDonnell R, Boland F, Hughes C, Fahey T. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev. 2018;8:CD010791. https://doi.org/10.1002/14651858.CD010791.pub2
Rose AJ, Fischer SH, MD, Paasche-Orlow MK. Beyond Medication Reconciliation:The Correct Medication List. JAMA. 2017;317(20):2057-2058. https://doi.org/10.1001/jama.2017.4628
The National Patient Safety Foundation. Free from Harm – Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human. http://www.ihi.org/resources/Pages/Publications/Free-from-Harm-Accelerating-Patient-Safety-Improvement.aspx (accessed May 31, 2019).