While traditional education methods often fall short in addressing medication safety, innovative microlearning techniques offer an effective but flexible solution to support hospital pharmacy teams and colleagues. Here, Gerry Hughes explores the ‘Medication Safety Minute’ initiative, which aims to enhance knowledge through concise, engaging content to drive improved patient safety and care.
Medication safety is a crucial component of any hospital pharmacy department and the wider hospital quality and safety strategy. A recent meta-analysis of 100 studies focusing on medication-related adverse events, published between 2000 and 2022, estimated that the overall prevalence of preventable medication-related harm was 5%. This equated to 10,237 patients with preventable medication-related harm of the 487,162 included in the analysis, with the largest proportion of medication-related harm being attributed to antibacterial agents.
A 2021 publication on medication safety in England estimated that ‘definitely avoidable’ adverse drug events cost the NHS over £98m per year, consuming over 181,000 bed-days, and attributable to 1,708 deaths.
Since 2017, the World Health Organization has placed a special focus on medication safety through its Global Patient Safety Challenge: Medication Without Harm initiative. It aims to correct the weaknesses in health systems that lead to medication errors and severe harm by addressing four domains: patients and the public, healthcare professionals, medicines and systems and practices of medication.
Impactful education and training for all healthcare professionals in acute care on appropriate medication use transcends these domains.
Microlearning in the clinical environment
In the fast-paced and demanding environment of clinical practice, traditional learning methodologies often fall short in meeting the needs of hospital healthcare professionals. Seminars, workshops and didactic lectures, while valuable, can be difficult to fit into busy schedules. These traditional methods also tend to be less flexible and often do not provide the just-in-time learning opportunities that are crucial in a dynamic clinical setting.
Widespread internet access means modern clinical learning methods, such as e-learning, have emerged as effective and flexible alternatives to traditional approaches. This enables access to educational curricula outside of a traditional classroom, either through distance learning or computer-assisted learning. It also involves the ability to provide up-to-date information that can be quickly integrated into clinical practice.
Microlearning is a subset of e-learning that has gained traction in clinical environments due to its targeted and concise approach to education. It involves delivering educational content in small, easily digestible segments that can be completed in a short period of time, typically ranging from a few seconds to 15 minutes.
This method is particularly beneficial in clinical settings where time is limited, and immediate application of knowledge is crucial. By breaking down complex information into manageable pieces, microlearning facilitates continuous professional development and enhances the ability to retain and apply new knowledge effectively.
The relationship between e-learning and microlearning is symbiotic, with microlearning serving as a focused, bite-sized component of the broader e-learning framework. Together, they provide a comprehensive and flexible educational strategy that can adapt to the unique demands of hospital healthcare professionals, including hospital pharmacists and clinicians.
Medication safety and microlearning
The concept of microlearning in clinical practice has been recognised and embraced by pioneering medication safety pharmacist Dr Eileen Relihan. Early in her career, Dr Relihan completed a PhD in medication safety and set up the first acute care electronic medication safety reporting system in Ireland.
As a trusted authority on medication safety, she has also led work by the Irish Medication Safety Network sharing expertise on building a medication safety programme in acute care, which outlines the fundamental steps for implementation rooted in best practice.
Based at St James’s Hospital (SJH) in Dublin, Ireland, Dr Relihan is passionate about sharing her expertise and providing healthcare professionals with knowledge and skills to manage medications safely and effectively.
The Medication Safety Minute microlearning initiative was born out of this and involves a collaboration with two SJH colleagues: emergency department consultant Dr Una Kennedy and consultant respiratory physician Dr Barry O’Connell.
The impetus for the initiative was an awareness in the hospital that pharmacists, doctors and nurse prescribers were working in a very challenging environment of multiple competing priorities, constant interruptions, and continual pressure to keep their knowledge and skills up to date.
‘This started out as, and continues to be, a collaborative project,’ Dr Relihan explains. We recognised that it was difficult to capture clinicians for medical education training due to busy schedules and rosters. We needed something that would draw people in and that wasn’t too burdensome.’
As such, the trio looked to create a microlearning initiative that would engage prescribers and provide them with brief, focused safety messages that they could read and review in 60 seconds or less.
Medication Safety Minute explained
These ‘Minutes’ are bite-sized, weekly medication safety messages for prescribers to supplement long-form learning and detailed education sessions. They are intended to act as ‘the cherry on top’, according to Dr Relihan, reiterating information prescribers are likely to have already heard to refresh their memories and bring to their attention real-world medication safety examples that are of concern in the hospital.
As of September 2023, the initiative covers 16 core medication safety topics, such as opioids, anticoagulants, anaphylaxis and antimicrobials. These span a range of clinical areas, with each topic broken down into multiple ‘Minutes’.
To circumnavigate the challenges posed by traditional learning methods, the ‘Minutes’ are designed to optimise engagement and make best use of available time by incorporating:
- A two-slide format with a teaser question on the first slide to provoke curiosity, which is then resolved by access to a succinct answer on the second slide
- Minimal text with graphics used to convey all the relevant information where possible to aid retention
- 60-second video content where possible
- Strategic use of colour and font styles.
When asked about her favourite ‘Minute’, Dr Relihan says: ‘That is a difficult one. We have published over 150 at this stage. One of the earlier ones on pharmacokinetic drug interactions sticks in my mind [Minutes number 13 and 14 in the flipbook]. I remember thinking that it would have been so useful for me as a pharmacy student to have this resource in highlighting high risk drugs.’
Sharing microlearning messages
To ensure strategic dissemination of the microlearning content, multiple modes of communication are used to saturate the target audience, for example email, social media, hospital intranet, doctor teaching sessions and medical update meetings. Additionally, less conventional dissemination strategies are also used, such as WhatsApp messages to doctors on their personal mobile phones, where appropriate.
But while the ‘Minutes’ were initially intended for healthcare professionals at SJH, they are now shared with the majority of hospitals across Ireland, as well as being used for undergraduate and postgraduate medical and nursing training at Trinity College Dublin and by the Royal College of Physicians of Ireland.
The ‘Minutes’ can be accessed by the wider healthcare community via the handle @medsafetymin on X (formerly Twitter), by accessing a free digital flipbook or by individual hospitals and healthcare organisations subscribing to a weekly email of the latest publication.
In 2021, the Medication Safety Minute was awarded a ‘Cheers Award’ by the US-based Institute for Safe Medication Practices – a non-profit organisation devoted entirely to preventing medication errors and adverse drug events. The project was the only European initiative to be conferred with an award at the 24th annual awards ceremony and remains a highlight of the project.
The future of medication safety
Dr Relihan is a firm believer that a reframed approach is required in managing medication safety, and this is something she spoke about in a session at the 2024 European Association of Hospital Pharmacists Congress in March.
The more traditional approach to medication safety is based on Safety-I, in which risks are identified, assessed, minimised where possible and a reactionary approach is taken when things go wrong. However, the increasingly complex nature of healthcare environments does not always lend itself to this strategy.
On the other hand, Safety-II considers medication safety from a different perspective, focusing on conditions that promote successful medication safety and the contextual adaptations that achieve this. Central to all of this is human behaviour.
‘We will likely always need a Safety-I approach, but incorporating Safety-II ensures a more balanced view, enabling the conditions to get things right as much as possible,’ Dr Relihan explains. ‘It is important that any medication safety incident report recognises this by identifying the elements that work well, along with those that don’t.’
