ISMP extends its sincere appreciation to the many readers who completed our survey regarding satisfaction and effectiveness of the ISMP Medication Safety Alert! Your input is highly valued and will be used to improve the newsletter and other services that ISMP provides to the healthcare community. What follows is a brief description of the overall survey results.
Overall satisfaction with the ISMP newsletter content was high among respondents (mean score of 4.53 on a scale from 1 to 5, with 5 reflecting the highest satisfaction). At least 90% of readers who took our survey agreed that the newsletter:
----Increases their understanding of the causative factors leading to medication errors (97%)
----Serves as a credible, respected, and reliable resource regarding medication safety (96%)
----Includes recommendations that are practical and helpful (95%)
----Increases their understanding of how to prevent errors (95%)
----Facilitates the identification of medication safety issues and implementation of potential solutions (93%)
----Has helped reduce or prevent harmful medication errors in their hospital (90%)
While most respondents (89%) reported making specific changes in their own practices based on information provided in the newsletters, the lowest scoring items dealt with spreading the newsletter recommendations throughout the organization. For example, only 73% reported using the ISMP Quarterly Action Agenda to facilitate hospital-wide change, and only 79% said that past newsletters were used as a resource when planning hospital-wide medication safety strategies.
Implementing Key Recommendations
Overall, approximately half of our readers told us that their hospitals had taken action to implement key ISMP recommendations, if applicable, that had been published in our newsletter during the past year (see Table 1 in the PDF version of the newsletter). Another 6% to 20% reported partial adoption of the recommendations, and anywhere from 8% to 32% of hospitals reported that the recommendations had already been implemented prior to publication in our recent editions of the newsletter. Therefore, the overall adoption rate of many of the medication safety recommendations in at least some areas of the hospital approaches two-thirds to three-quarters of respondents. However, between one-quarter and one-half of all respondents indicated that the key recommendations were “not applicable” to the hospital or that they “did not know” if action had been taken. The latter condition—not knowing whether action had been taken—is more plausible given the broad applicability of all but a few ISMP recommendations selected for the survey.
The most frequent adoption of risk-reduction strategies occurred with recommendations that had been made earlier in 2012 or repeated from prior years, such as reviewing policies for safe disposal of fentaNYL patches (65%), establishing a team or process to manage drug shortages (63%), and revising policies on the timing of medication administration after CMS revised the 30-minute rule (56%). The least frequent action was associated with a recent 2013 recommendation to transition away from or re-evaluate the use of insulin pens in hospitals (34%).
Barriers to Implementation
According to respondents, various barriers to implementing the ISMP key recommendations are sometimes encountered (mean score of 2.41 on a 1 to 5 scale, with 5 representing “always” encountered). The most common barriers included: scarcity of human resources (3.06), vendor/manufacturer reluctance to make recommended changes (2.88), scarcity of financial resources (2.56), and a belief that the ISMP recommendations were not feasible in their organizations (2.54). Scarcity of knowledge and skill to plan and implement the interventions and lack of senior leadership engagement was felt to be a significant barrier by 16% and 20% of respondents, respectively.
The least common barriers to implementing the ISMP recommendations were associated with the validity of the recommendations. Only 6% of respondents felt that the ISMP recommendations were not always consistent with the safety literature (1.64 mean score), and only 11% felt there was insufficient scientific evidence of effectiveness for some recommendations to support system-wide change (2.15 mean score). Also, only 11% of responding hospitals did not agree with some of the ISMP recommendations (2.17) or felt some recommendations did not provide sufficient details to implement them in their organizations (2.25). Although these barriers should be addressed, they are less concerning than the finding that 11% of respondents also thought the errors addressed by the ISMP recommendations could never happen in their facilities (1.98).
ISMP applauds all healthcare organizations that routinely use the ISMP Medication Safety Alert! and other literature as a lens to examine their own medication practices and to proactively implement risk-reduction strategies. Please keep in mind that ISMP recommendations are built upon the continuous learning that accompanies thorough analysis of a wide variety of medication error reports sent to the ISMP National Medication Errors Reporting Program, ongoing literature review to ensure the application of scientific evidence when available, and an expert peer review process. Again, we thank our readers who provided us with a glimpse of how the newsletter is being used to support medication safety. Your input helps us ensure that the newsletter remains an important vehicle for medication safety improvements.