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175 A ied Heal Services NMH Annual Rep t | 2020 of alcohol hand gel in the face of greatly increased demand, requiring the team to think outside the box in securing supplies from a variety of sources. Faced with a serious run on medications due to uncertainty regarding global supply chains, NMH pharmacy staff ensured patients and hospital staff had continued access to their regular medications, working with suppliers to obtain adequate stocks to meet demand, all while operating in the context of continuing supply chain uncertainty due to Brexit. Pharmacy performed clinical review of patient charts 21,232 times in 2020, performing activities in 14% of these reviews. This high level of clinical pharmacy activity was facilitated through remote review of patients' charts using the MN-CMS, demonstrating the value of the electronic healthcare record during the pandemic. Drugs and Therapeutics / Medication Safety Committees Medication Safety Where possible and taking into consideration the demands placed on NMH by the COVID-19 pandemic, the medication safety programme continued to implement the 5-year (2019-2023) medication safety strategy through use of the annual workplan. Eight medication safety or medication-related audits were conducted in 2020: • "Red Tasks" on MN-CMS Drug Chart for Postnatal Analgesia • Documentation on MN-CMS of Booking and Actual Weights • Re-audit of Pharmacy Out-of-Hours Supplies • Postnatal Prescribing and Administration in the setting of the MN-CMS • Point Prevalence Survey of Antimicrobial Prescribing • Patient's own Medication and Opinion of Self- Administration in Hospital • Audit of Insulin Prescribing and Documentation on the electronic healthcare record (MN-CMS) • Incidence of Pyelonephritis in the National Maternity Hospital Medication safety training sessions held: 28 for medical staff, 26 for midwifery/nursing, and 7 multidisciplinary. Quality improvement initiatives performed included: medication specific patient information leaflets for trimethoprim, zidovudine, lamivudine, misoprostol/ mifepristone, Ferinject®, and omeprazole suspension; Access to "Medicines Complete" online compendium; Online NCHD induction in medication safety and Antimicrobial Stewardship training; Insulin prescribing – rapid improvement exercise; MN-CMS complex medication notification, Direct-acting Oral Anticoagulant notification, Epilepsy and Pethidine rule; Gentamicin prescribing flowchart; First trimester miscarriage prescribing, documentation and communication to patients; Online early pregnancy educational classes for patients; Online medication education for patients on NMH website's E-Learning Hub including the Epilepsy Medication in Pregnancy Information Leaflet Medication policies, procedures, protocols, guidelines: 9 new were approved, 26 were updated Antimicrobial Stewardship • Antimicrobial consumption was 29.9 DDD/100 BDU for Q1/Q2 2020, a 10% decrease of the index value since 2019 and the lowest figure since 2012. Due to redeployment of staff in the HPSC as a result of COVID-19, figures for Q3/Q4 consumption were not available at the time of writing • Prevalence of antimicrobial prescribing during national Point Prevalence Survey was 14%, in line with the steady decline in antimicrobial consumption in recent years • 17 patients prescribed carbapenems, 88% in line with guidelines or received Microbiology approval Medication Incident Reporting Pharmacy began online reporting of medication incidents in July 2020. Since then, the online portal for reporting has been expanded to a number of clinical areas with the aim of eventual removal of paper-based reports. High incident reporting rates are associated nationally and internationally with a strong patient safety culture. A significant improvement in incident reporting was observed in 2020, with 442 medication incident reports (419 incidents, 23 near misses) received by the Clinical Risk and Legal Departments (CRLD). The majority of reports came from clinical pharmacy review of patients' charts (83.2%), followed by midwifery/ nursing (15.6%), and medical (0.7%). Despite this success in improving incident reporting rates, medication- related near misses are still likely under reported. The reporting of incidents is of value as the data collected can be analysed to identify trends or patterns in relation to risk, and resulting recommendations for improvement can be shared with frontline staff. Analysis of incident reports found that: • Incidents most commonly occurred at the point of prescribing (32.7%) followed by administration (24.0%) • "Policy not conformed to" was by far the most common primary contributory factor at 58.3%, followed by 'Checking Procedure Not Followed' at 11.3% and 'Calculation Error' at 7.5%