The Health Care Improvement Foundation, in collaboration with the Institute for Safe Medication Practices (ISMP), launched a nine-month regional demonstration project in February 2011 to improve the safe use of HYDROmorphone in Southeastern Pennsylvania.
HYDROmorphone, a derivative of morphine used in the management of moderate to severe pain, is associated with an increasing rate of medication errors and patient harm. Data from the Pennsylvania Patient Safety Authority show that there were nearly 1,700 HYDROmorphone errors between January 2008 and October 2009, with almost 70% reaching the patient. The aim of the project was to reduce these serious errors by 50% in the hospitals that participated in the project.
Participating hospitals included urban, suburban, teaching, and non-teaching hospitals in Southeastern Pennsylvania. Each hospital convened a multidisciplinary improvement team to develop and implement an improvement plan; completed baseline and follow-up measurement components; and participated in project activities, which included data collection, a spring 2011 workshop, an audioconference series, and an onsite consulting visit by ISMP.
This demonstration project was made possible by grant funding from Hospira, the Cardinal Health Foundation, and the Partnership for Patient Care.