Standard 4: Medication Safety

1. Standard 4: Medication Safety Advice Centre Network Meeting Margaret DuguidPharmaceutical AdvisorFebruary 2013

2. Standard 4 Medication Safety Intent of Standard 4 – Medication Safety • 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.

3. Standard 4 Medication Safety Standard 4 – Medication Safety • The Medication Safety Standard describes the elements of a safe medication management system. • 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 decision support at the point of care.

4. Five criteria (Part 1) Governance and systems for medication safety Health service organisations have mechanisms for the safe prescribing, dispensing, supplying, administering, storing, manufacturing, compounding and monitoring of the effects of medicines. Documentation of patient information 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

5. 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

6. 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

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

8. 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?

9. 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/our-work/accreditation/accreditation-newsroom/

10. 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 eMMS www.safetyandquality.gov.au/our-work/medication-safety/electronic-medication-management-systems/ Standard 4 Medication Safety

11. Safety and Quality Improvement Guide Criterion: Documentation of patient information

12. Standard 4 Medication Safety Documentation of patient information • 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

13. 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 • Q. Can we use NIMC audit as evidence for no. patient’s whose medicines reconciled • Q. What is medication management plan, where is it available ?

14. Medication Management Plan supports workforce to: Take and record a complete and accurate medication history (BPMH) (4.6.1) Document ADRs on admission (4.7.1) Reconcile discrepancies between history and medication orders (4.8.1) 2. Documentation of patient information Standard 4 Medication Safety

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

16. Medication management processes Standard 4 Medication Safety 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/medication-safety/medication-alerts/ • Q. Can we prioritise actions to address risks with high risk medicines?

17. 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

18. Communicating with patients and carers Standard 4 Medication Safety 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

19. Standard 4 Medication Safety Medication Safety Standard: Summary • 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. • Purpose of the Standard is to improve outcomes for patients by ensuring that there is a systematic approach to medicines management and safety • Outcomes to be achieved are clear – methods to get there will vary depending on context

20. 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