Standard 4 Medication Safety Advice Centre Network Meeting

Standard 4: Medication Safety Advice Centre Network Meeting Margaret Duguid Pharmaceutical Advisor February 2013

Intent of Standard 4 – Medication Safety u Ensure competent clinicians safely prescribe, dispense, and administer appropriate medicines safely to informed patients and carers • Reduce medication incidents, adverse events • Improve safety and quality of medicine use. Standard 4 Medication Safety

Standard 4 – Medication Safety u The Medication Safety Standard describes the elements of a safe medication management system. u It requires hospitals have in place strategies and systems known to reduce the risk of common causes of medication error. • standardisation and systemisation of processes • improving clinical workforce and clinician-patient communication • using technology to support information recording and transfer • providing better access to patient information and clinical Standard 4 decision support at the point of care. Medication Safety

Five criteria (Part 1) 1. Governance and systems for medication safety • 2. Documentation of patient information • 3. Health service organisations have mechanisms for the safe prescribing, dispensing, supplying, administering, storing, manufacturing, compounding and monitoring of the effects of medicines. The clinical workforce accurately records a patient’s medication history and this history is available throughout the episode of care. Medication management processes • The clinical workforce is supported for the prescribing, dispensing, supplying, administering, storing, manufacturing, compounding and monitoring of medicines. Standard 4 Medication Safety

Five criteria (Part 2) 4. Continuity of medication management • The clinician provides a complete list of a patient’s medicines to the receiving clinician and patient when handing over care or changing medicines. 5. Communicating with patients and carers • The clinical workforce informs patients about their options, risks and responsibilities for an agreed medication management plan. Standard 4 Medication Safety

1. Governance and systems for med safety 4. 1 Governance arrangements and organisation policies • Drug and Therapeutics Committee (DTC) - Medication Safety Committee - Report to safety and quality governance, executive Standard 4 Medication Safety

1. Governance and systems for med safety - Policies www. safetyandquality. gov. au/our-work/medication-safety/ Resources, list of jurisdictional contacts

1. Governance and systems for med safety 4. 2 Assess medication use system • How? • Use a structured tool e. g. Medication Safety Self Assessment - Multidisciplinary team - Every three years • Identify what you are doing well, evidence actions met • Identify areas for improvements • Develop an action plan. • NIMC national audit Q. Hospitals uses non conforming chart. Can we enter data into NIMC audit database?

1. Governance and systems for med safety 4. 2. 2 Assess medication use system Q Do we have to action all problems identified • Prioritise areas using risk matrix • http: //www. safetyandquality. gov. au/ourwork/accreditation-newsroom/

1. Governance and systems for med safety 4. 5. Quality improvement activities • NIMC mandatory Q Hospital implementing e-MMS does not use NIMC • NIMC mandatory if using paper charts • Follow guide to safe implementation of e. MMS • www. safetyandquality. gov. au/our-work/medicationsafety/electronic-medication-managementsystems/ Standard 4 Medication Safety

Safety and Quality Improvement Guide Criterion: Documentation of patient informatio

Documentation of patient information u 4. 7 Documenting previous known allergies, ADRS Q. Do you need to document all ADR information on all medication charts ? • NIMC – “Source of truth” • Other charts - Specialist charts, clozapine, heparin - Cross reference to NIMC • Electronic health record • One source in EHR • Active transfer information to e- medication management system, pharmacy system • On prescribing screen • Active alerts Standard 4 Medication Safety

Documentation of patient information 4. 8. 1 Current medicines are documented and reconciled at admission and transfer of care Q. Who can document history, reconcile medicines? • Health professionals trained to reconcile medicines - Nurses, doctors, pharmacists, pharmacy technicians • Nurse: Pharmacist model - Nurse consults with pharmacists re discrepancies u Q. Can we use NIMC audit as evidence for no. patient’s whose medicines reconciled u Q. What is medication management plan, where is it available ? Standard 4 Medication Safety

2. Documentation of patient information Medication Management Plan supports workforce to: u Take and record a complete and accurate medication history (BPMH) (4. 6. 1) u Document ADRs on admission (4. 7. 1) u Reconcile discrepancies between history and medication orders (4. 8. 1) Standard 4 Medication Safety

Documentation of patient information Medication reconciliation Resources http: //www. safetyandquality. gov. au/our-work/medicationsafety/medication-reconciliation/ 2. Documentation of patient information Medication Management Plan + implementation resources 15

Medication management processes 4. 11 Managing high risk medicines Q. What is a high risk medicine? • Medicines that have a high risk of causing serious injury or death to a patient if they are misused or used in error • Errors not necessarily more common, effects more devastating. • PINCH/APINCH • Institute of Safe Medication Practices list • www. safetyandquality. gov. au/our-work/medicationsafety/medication-alerts/ u Q. Can we prioritise actions to address risks with high risk medicines? Standard 4 Medication Safety

Continuity of medication management 4. 12 Current, comprehensive list of medicines provided to receiving clinician and patient at clinical handover Q. Does 4. 12. apply to outpatients ? • Referring doctor informed of changes to medicines • Patient informed of changes, amend patients own list Standard 4 Medication Safety

Communicating with patients and carers 4. 14 Medication management plan developed in partnership with patients, carers Q. What is a medication management plan? Is it the National Medication Management Plan? • Consumer Medication Action Plan referred to in APAC Guiding principles to achieve continuity of medication management. • Plan for patient’s medication management • Treatment goals, list meds, changes • Provided to patient, carer • Commission developing a template Standard 4 Medication Safety

Medication Safety Standard: Summary u Ensuring that competent clinicians safety prescribe, dispense and administer appropriate medicines to informed patients and carers is an essential element of safe and high quality care. u Purpose of the Standard is to improve outcomes for patients by ensuring that there is a systematic approach to medicines management and safety u Outcomes to be achieved are clear – methods to get there will vary depending on context Standard 4 Medication Safety

Australian Commission on Safety and Quality in Health Care Medication Safety Program www. safetyandquality. gov. au Email: mail@safetyandquality. gov. au Margaret. duguid@safteyandquality. gov. au