Medication safety infrastructure in critical-access hospitals in Florida.
OBJECTIVE
The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated.


METHODS
Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure.


RESULTS
The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation.


CONCLUSIONS
Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.
Winterstein
Almut G
AG
Department of Pharmacy Health Care Administration, College of Pharmacy, University of Florida (UF), Gainesville 32610-0496, USA. almut@cop.ufl.edu
Hartzema
Abraham G
AG
Johns
Thomas E
TE
De Leon
Jessica M
JM
McDonald
Kathie
K
Henshaw
Zak
Z
Pannell
Robert
R
D004339:Drug Compounding; D004346:Drug Information Services; D004348:Drug Labeling; D004356:Drug Storage; D005431:Florida; D019538:Health Care Surveys; D006780:Hospitals, Rural; D016347:Medical Records Systems, Computerized; D008508:Medication Errors; D008510:Medication Systems, Hospital; D011785:Quality Assurance, Health Care; D012013:Reference Books