National pilot program «progress!»

Safe medication at interfaces

Medication errors are common - also in Switzerland. In this nation, 20 000 hospital stays per year are caused by medication-related problems. Every tenth hospital patient is harmed by medication errors or adverse effects. Since hospital admissions and discharges are particularly risky moments for medication errors, this national program focuses on this point.

Background

Typical errors during hospital admissions and discharges are the missing or the addition of medications, as well as dosage errors. To prevent this, systematic medication reconciliation has proven to be an effective measure in other countries. The program has therefore introduced and implemented systematic medication reconciliation in Switzerland. Based on the findings of successful projects in the USA, Canada and Europe, support materials for professionals and patients as well as a pilot project for Swiss acute hospitals were developed.

Medication reconciliation

Systematic medication reconciliation involves the documentation of all medications and preparations taken by the patient before admission to hospital in a list. This forms the basis for a reliable medication prescription and for all other medication-related processes in the hospital - from admission to transfers to discharge. For this purpose, the medication list is always reconciled in the hospital when medications are added, changed or discontinued. The systematic reconciliation thus starts at the time of hospital admission, is repeated for each internal transfer and is finally carried out at the time of discharge. The aim is to record and communicate medication information accurately, comprehensively and consistently across all treatment interfaces.

Systematic medication reconciliation in the hospital comprises two elements:

  1. the systematic compilation of a comprehensive medication list
  2. the consistent reconciliation of this list when medications are prescribed

In-depth project

In an in-depth project with several Swiss pilot hospitals, experience was gained from March 2015 to the end of 2016 on the implementation of the recommendations entitled «Systematic Medication Reconciliation in Acute Care Hospitals». For reasons of time and resources, the project focused on hospital admissions. Medication reconciliation on admission forms the basis for optimal and safe medication prescription in the hospital - and later for effective medication reconciliation during internal transfers and when leaving the hospital.

Interprofessional program concept with defined schedule and selected activities

  • Workshops with inputs and exchange
  • Support materials, such as poster templates and presentations for internal knowledge transfer as well as training guidelines on medication anamnesis
  • Visit/exchange during the start-up phase and site visit during the implementation phase by Patient Safety Switzerland.
  • Surveys: Development of instruments and evaluations

Requirements and obligations on the part of pilot hospitals

  • Hospital management explicitly supports the project and provides the necessary internal resources for it
  • Implementation of systematic medication reconciliation on admission to an acute internal medicine unit
  • Interprofessional project group whose members participate in the workshops of the in-depth project.

Premises

  • Willingness to change and cooperate
  • Openness, commitment, obligation, confidentiality

Pilot hospitals

The following hospitals participated in the two-year in-depth project (2015 - 2016). They had an optimal mix: adequate representation of the different parts of the country; different sizes of operation and types of hospitals (e.g. specialties); different forms of documentation (Cardex or electronic patient dossiers) as well as different experiences in the use of medication lists.

Expert advisory board

  • Prof. Dr. med. Stefano Bassetti, Head of the Clinic for Internal Medicine, University Hospital Basel
  • Dr. Johnny Beney, PD, Pharmacien d'hôpital FPH / Pharmacien-chef du Service de Pharmacie, Hôpital du Valais (RSV) Institut Central (ICHV)
  • Prof. Dr. Karin Fattinger, Head of Internal Medicine, Member of the Hospital Management, Bürgerspital Solothurn
  • Brigitte Garessus, Head of Kleinbasel, SPITEX BASEL
  • Prof. Dr. E. Kurt Hersberger, Pharmaceutical Care Research Group
  • Dr. med. Marc Jungi, Specialist in General Internal Medicine FMH / Deputy Managing Director Sanacare AG, Group Practice Berne
  • Dr. phil. Markus Lampert, Head Hospital Pharmacist Clinical Pharmacy, Solothurner Spitäler AG
  • Dr. med. Marc Oertle, Medical Informatics, Thun Hospital
  • Ph.D. Anthony Staines, Consultant, FHV Fédération des hôpitaux vaudois
  • Brigitte Waldispühl, Capo servizio processi clinici informatizzati, Ente Ospedaliero Cantonale
  • Franziska Zúñiga, MSN, Institute for Nursing Science, University of Basel / Head of Quality Management, KZU Centre of Competence for Nursing and Health
  • Barbara Züst, lic. iur. HSG, Managing Director Swiss Patient Foundation SPO

Funding

The basic principles of the program were developed in close cooperation with numerous experts from the Swiss health care system.
The pilot program was initiated by the Federal Office of Public Health (FOPH) and developed and implemented by the Swiss Patient Safety Foundation.
The progress! programs are part of the Confederation's quality strategy in the Swiss health care system and are largely financed by the FOPH.