Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions
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Background While evidence on implementation of medication safety strategies is increasing, reasons for selecting and relinquishing distinct strategies and details on implementation are typically not shared in published literature. Objective We aimed to collect and structure expert information resulting from implementing medication safety strategies to provide advice for decision-makers. Setting Medication safety experts with clinical expertise from thirteen hospitals throughout twelve European and North American countries shared their experience in workshop meetings, on-site-visits and remote structured interviews. Methods We performed an expert-based, in-depth assessment of implementation of best-practice strategies to improve drug prescribing and drug administration. Main outcome measures Workflow, variability and recommended medication safety strategies in drug prescribing and drug administration processes. Results According to the experts, institutions chose strategies that targeted process steps known to be particularly error-prone in the respective setting. Often, the selection was channeled by local constraints such as the e-health equipment and critically modulated by national context factors. In our study, the experts favored electronic prescribing with clinical decision support and medication reconciliation as most promising interventions. They agreed that self-assessment and introduction of medication safety boards were crucial to satisfy the setting-specific differences and foster successful implementation. Conclusion While general evidence for implementation of strategies to improve medication safety exists, successful selection and adaptation of a distinct strategy requires a thorough knowledge of the institute-specific constraints and an ongoing monitoring and adjustment of the implemented measures.
KeywordsComputerized physician order entry CPOE Expert discussion Inpatient care Medication reconciliation Medication safety Quality improvement
The authors wish to thank all participating experts and their respective institutions for their greatly appreciated support and efforts in this assessment, particularly the consultant experts (Blanca Argüello, Hospital de Leon, Leon, Spain; Laila Irene Bruun, Oslo University Hospitals, Oslo, Norway; Birgit Eiermann, Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Pharmacology, Stockholm, Sweden; Annsofie Fyhr, Pharmaceutical Supply, Operational Support and Service, Jönköping County Council, Sweden; Allen R. Huang, McGill University Health Centre, Montreal, Canada; Karin Dorner, Allgemeines Krankenhaus der Stadt Wien, Vienna, Austria; Lilian Brøndgaard Nielsen, Hospital Pharmacy Central Denmark Region, Horsens, Denmark; Juan Ortiz de Urbina, Hospital de Leon, Leon, Spain; Diane Seger, Brigham and Women’s Hospital, Boston, USA; Anne Marie Timenes, Oslo University Hospitals, Oslo, Norway).
The study was supported by the Federal Ministry of Health, Germany [#2512 ATS 002] and a final report in German is available online.
Conflicts of interest
The authors declare that they have no competing interests with regard to this work.
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