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Standard 4: Medication Safety Advice Centre Network Meeting Margaret Duguid Pharmaceutical Advisor February 2013
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Standard 4: Medication Safety
Advice Centre Network Meeting
Margaret DuguidPharmaceutical AdvisorFebruary 2013
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.
Standard 4Medication 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. Standard 4
Medication Safety
Five criteria (Part 1)
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.
2. Documentation of patient information• The clinical workforce accurately records a patient’s
medication history and this history is available throughout the episode of care.
3. 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 4Medication Safety
1. Governance and systems for med safety
4.1 Governance arrangements and organisation policies
• Group/Committee • Responsible for medication safety• Reports to executive/management
• Day procedure service• Facility manager, specialist
clinicians (Anaesthetist in day surgeries), nurse ± pharmacist
Standard 4Medication 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
4.5.2 Quality improvement activities
Q Do Day procedure services have to follow labelling recommendations?
• Yes. Where Aust & NZ Standards for labelling medicines in syringes in anaesthesia do not apply.
• Label containers, conduits for medicines, fluids in perioperative area
Standard 4Medication Safety
Private Hospitals Day Surgery Chart
http://www.safetyandquality.gov.au/our-work/medication-safety/medication-chart/private-hospital-and-private-hospital-day-surgery-nimc/
Q. Many facilities only give sedation, anaesthetic, and pain relief or anti-emetics post op. How relevant is national medication chart?
1. Governance and systems for med safety
4.2 Assess medication use system
• How?• Use Accreditation Workbook to guide assessment
- ANZCA Guidelines for administration anaesthetic agents
• Identify what you are doing well, evidence to demonstrate actions have been met
• Identify areas for improvements
• Develop an action plan.
• Q Do we have to action all problems identified• Prioritise areas using risk matrix• http://www.safetyandquality.gov.au/our-work/accreditation/
accreditation-newsroom/
Documentation of patient information
4.6.1 Document “best possible” medication history
Q. Do you need to document a medication history?
A. All patients should have a medication history taken prior to prescribing medicines
• Documented in patient record
• At pre-admission
4.8.1 Medicines are documented and reconciled• Not applicable to day procedure services
Standard 4Medication Safety
Documentation of patient information
4.7 Documenting previous known allergies, adverse drug reactions (ADRs)
Q. Where should allergies and ADR information be recorded ?• Medication chart – “Source of truth”• Other charts
- 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 4Medication Safety
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 • Errors with these products are not necessarily more common, but the effects can
be more devastating.
• PINCH/APINCH, neuromuscular blocking agents
• 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?
Standard 4Medication Safety
Medication management processes
4.10.2 Use Tall Man Lettering in storage and labelling
Q. Is Tall Man Lettering applicable to a day surgery ?• Use on shelf/drawer labelling where there are confusable
names
Q. Should doctors use Tall Man Lettering on their scripts?• Only for names on labels, shelving, It (e-prescribing systems)
Standard 4Medication 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 day procedure services, dental services?• Referring doctor informed of changes to medicines
• Patient informed of changes, amend patients own list
Standard 4Medication Safety
Communicating with patients and carers
4.14 Information provided to patients and carers in a format that is understood and meaningful
Q. Most patients are given a script to have filled by their local pharmacists. How much information does facility have to give the patient?• Community pharmacy should give Consumer Medicines
Information
• Facility verbal information , documented in notes
• If use prepacks – include CMI .
Standard 4Medication 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
Standard 4Medication Safety
Australian Commission on Safety and Quality in Health Care
Medication Safety Program
www.safetyandquality.gov.au
Email: [email protected]
