Clinical Governance & MI: An Introduction

1. Clinical Governance & MI: An Introduction Mark Cheeseman Education & Training and Secondary Care Support Medicines Information Pharmacist East Anglia Medicines Information Service

3. Aims • Provide you with an introduction to the principles of clinical governance, risk management and quality assurance. • Describe the main tools used to ensure quality assurance in MI, including IRMIS. • Enable you to apply these principles and tools in your own workplace.

4. Learning Outcomes By the end of this session you should be able to: • Describe 15 of the UKMi standards. • Be able to peer review an enquiry and provide feedback.

5. Session • Background • Methods • Key tools for MI • Available support • Summary

6. What does Clinical Governance mean to you?

7. Definition “a framework through which NHS organisations are accountable for continuously improving the quality of the services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”

8. History • WHO. Principles of quality assurance; 1983. • DH. A First Class Service: Quality in the new NHS; 1998. • CMO/CNO. Supporting implementation of clinical governance. NHS Exec; 1999

9. How did this affect Pharmacy? • RPSGB published ‘Achieving excellence in pharmacy through practice’ (1999) • Clear lines of responsibility • Quality improvement activities • Risk Management • Poor Performance

10. What has MI done? • UKMi Clinical Governance Working Group • “Clinical Governance – a briefing paper for Medicines Information Services” • Focus: • Framework • Tools

11. Framework • Right climate = acceptance and implementation • Features: • Good ideas and practice shared • Education and research valued • Blame only used in exceptional circumstances • Collaboration rather than competition

12. Does anyone have all these?

13. Defining standards Ensuring delivery of standards Quality Checking delivery of standards How can we achieve quality?

14. What tools can we use to ensure quality?

15. Standards Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice CPD Training programmes Tools for Quality

16. Standards Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice CPD Training programmes UKMi Standards QA Visits MI User Survey Workload Survey Enquiry Answering! Personal CPD NMITC, Advanced MI Training, NMITTC Tools for Quality

17. Risk Assessment/ Management Schemes Appraisal schemes Incident/near miss reporting schemes Dialogue with principal stakeholders Involvement with commissioning specialist services Tools for Quality

18. Risk Assessment/ Management Schemes Appraisal schemes Incident/near miss reporting schemes Dialogue with principal stakeholders Involvement with commissioning specialist services Risk Management Policy Peer Review IRMIS Who are yours? Who commissions your service? Tools for Quality

19. Resources, CPD, Job description, E&T, SLA’s, KSF, Service commissioning Competency Framework Ensuring delivery of standards Defining standards Quality Checking delivery of standards How can we achieve quality? UKMi Standards & Clinical Governance Working Group National standards Audit, Peer review / bench marking, Outcomes / indicators, Near-miss / incidents reports

20. So what does the UKMi Clinical Governance Working Group do?

22. What should you be aware of? • UKMi Standards • QA Visits • MI User Survey • Risk Management Policy • IRMIS • Peer Review

23. Resources Enquiry answering process Publications and pro-active work Training Research & development Risk Management Specialist Advisory Services Standards

24. Standards • Standard • Risks of non-Implementation • Potential outcomes if not implemented • Satisfactory • Commended

25. Example

26. Quiz

27. Quiz (1) • How quickly should the MI phone be answered within? A) 10 seconds B) 20 seconds C) 40 seconds • MI staff supervising trainees in MI do not need to have attended formal training in training. True or False?

28. Quiz (2) 3. How long should enquiries be kept for? A) 8 years B) 25 years C) A and b 4. A MI pharmacist/technician should be available to take a call within 5 minutes Satisfactory or commended?

29. Quiz (3) • Which of the following statements is correct: a) Non-MI pharmacists should have MI training as part of their induction b) Non-MI pharmacists receive MI training as an annual refresher/update c) Both of the above • Headsets should be used by all MI staff when using MiDatabank True or false?

30. Quiz (4) • What is classed as a ‘satisfactory’ answer when reviewing enquiries? A) 80% - 90% B) 85% – 95% C) 100% 8. How long it is advised that pre-registration pharmacists should spend in MI? A) 2 weeks B) 4 weeks C) 6 weeks

31. Quiz (5) 9. How often should the MI centre’s risk management policy be reviewed? A) Every year B) Every 2 years C) Every 3 years

32. Quiz (6) 10. How soon after a MI Pharmacist has started in their role should they attend the National MI training course? A) Within 3 months B) Within 6 months C) Within 12 months

33. Quiz (7) 11. It is not necessary to have back-up facilities for electronic records held on MiDatabank True or False? 12. All permanent MI pharmacists should identify a research project they plan to undertake or support Satisfactory or commended?

34. Quiz (8) 13. Only answers involving ‘complex calculations’ need to be checked by another pharmacist, technician or pre-registration pharmacist. True or False? 14. Peer review of enquiries by MI staff should be undertaken by regional MI centres only. True or False?

35. Quiz (9) 15. MI technicians should undertake the UKMi Accredited MI Technician Training scheme within: A) Within 6 months B) Within 12 months C) Within 24 months

36. QA Visits • Regional centre -> Regional centre • Regional centre -> Local centre • Audit centre against national standards AND peer review sample of enquiries • National template

37. National Template • Summary of the MI service, recommendations from last visit and this visit • Performance Review • Resources • Enquiry answering process • Publications and pro-active • work • Training • Research & development • Risk Management • Specialist Advisory Services

38. Audit Standards

39. User Survey

40. What do you think is important to users of your MI service?

41. MI User Survey • Developed to provide statistically robust questionnaire. • Eleven questions linked to provide validity • Three categories measuring different aspects of user satisfaction: • Answer satisfaction • General Helpfulness/Time Satisfaction • Ease of Contact Satisfaction

42. MI User Survey • Conducted at least once per annum or more frequently or on an ongoing basis • No. of questionnaires sent out should be a suitable sample related to the no. of enquiries. • e.g. 0-100 enquiries/month, 60 surveys per year

43. Examples of risk in your MI centre?

44. Risk Management Policy • Environment • Equipment & Information Resources • Outputs • People

45. Incident Reporting in Medicines Information System (IRMIS) • Secure web-based database (NHSnet) • Complement existing NHS reporting systems – NOT a replacement • Incidents – local and IRMIS • Anonymous data

46. IRMIS - what information is recorded?

47. What information is recorded?

48. Near miss or error?

49. Near miss or error? Near miss Any situation where wrong, misleading or incomplete information or advice which may or may not have caused harm to a patient, would have been given to the enquirer if an intervention had not been made. Error Any situation where wrong, misleading or incomplete information or advice may or may not have caused harm to a patient, was given to an enquirer.

50. Examples • SSRIs in pregnancy • IV compatibility – furosemide and ISDN • Sodium hyaluronate - refrigeration