National inpatient medication chart: background

1
National inpatient medication chart background

• Helen J Leach and Kylie McIntosh
• Senior Advisor and Project Officer
• Victorian Medicines Advisory Committee
• Quality Safety Branch

2
Overview

• joint communiqué
• rationale
• errors and patient harm
• medication management cycle
• practices to improve medication safety
• medication chart development
• implementation toolkit
• scope of implementation
• inclusions
• exclusions
• roles and responsibilities

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Joint communiqué
To reduce the harm to patients from
medication errors, by June 2006, all public
hospitals will be using a common medication
chart. This means that the same chart will be
used wherever a doctor or nurse works and
wherever the patient is within a hospital.
Australian Health Ministers Conference, 23
April 2004
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Rationale

• drug therapy errors occur in 5-20 per cent of
  drug administrations in Australian hospitals1
• 43 per cent of adverse drug events preventable2
• medication interventions save lives, reduce
  length of stay, reduce admissions and reduce
  costs3
• 1. Australian Council for Safety and
  Quality in Health Care. July 2002.
• 2. Wilson RM, Runciman WB, Gibberd RW
  et al. Med J Aust 1995 163 458-71.
• 3. Dooley MJ, Allen KM, Doecke CJ et
  al. BJCP 2004 57 513.

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Rationale errors and patient harm
The Age (October 2005)
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Rationale medication management cycle
7
Doctor
Nurse
Pharmacist
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Practices to improve patient safetythe UK
experience

• All-Wales inpatient medication chart
• first developed in 1969
• redeveloped/updated in 2004
• prescribing writing standards developed
• e-learning package and prescription standards
• England support for similar initiative

9
Practices to improve patient safetythe
Australian perspective

• Guiding principles for continuity in medication
  management1
• National competencies for prescribing2
• Pharmaceutical Review3
• Standards of practice for clinical pharmacy4
• Understanding the medicines management pathway5
• HealthSMART
• 1. Australian Pharmaceutical Advisory Council,
  July 2005.
• 2. Society of Hospital Pharmacists of Australia
  (SHPA), June 2005.
• 3. Joint communiqué, April 2004.
• 4. SHPA Standards of Practice for Clinical
  Pharmacy, August 2005.
• 5. Stowasser DA, Allinson YM and O'Leary KM. J
  Pharm Pract Res 2004.

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Practices to improve patient safetyNational
Inpatient Medication Chart (NIMC)

• Benefits of implementing the NIMC
• standardisation of best practice approach to the
  medication management cycle
• standardisation of undergraduate and postgraduate
  education in the medication management cycle
• one chart - no need for retraining between
  institutions
• identify the benefits and risks, plus provide a
  standard platform for the implementation of
  HealthSMART
• no duplication of effort in redesigning charts
• reduction in prescribing, dispensing and
  administration errors improved quality of care

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Practices to improve patient safetyNIMC
development

• August 2004 - Australian Council for Safety
  Quality in Healthcare formed national working
  party to develop and pilot NIMC
• January to May 2005 NIMC pilot in 31 pilot
  sites across Australia
• NIMC pilot at six Victorian sites

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Practices to improve patient safetyNIMC
implementation in Victoria pilot

• Six Victorian pilot sites
• Broadmeadows Hospital
• Freemasons Hospital
• The Royal Melbourne Hospital
• Warrnambool Hospital
• West Gippsland Hospital
• Western District Health Service

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Practices to improve patient safetyNIMC pilot
outcomes

• Change register
• Feedback incorporated into Change Register
  changes impacting on patient safety incorporated
  into revised NIMC draft
• Ipsos report
• Ipsos survey conducted across pilot sites to
  evaluate process for implementing the NIMC
• Interim specifications
• provide guidance on version control
• Aggregate report
• summarises results captured from pilot

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Practices to improve patient safetyaggregate
report summary

• Improvements
• ADR reaction documented and signed by doctor
• use of generic names
• drug form (SR) present and clear
• orders ceased as per hospital policy
• administration times entered by clinician and
  correlating with frequency
• documentation of indication
• maximum doses stated on prn orders
• orders signed clearly, legible doctors name
• documentation of medication history
• pharmacist annotation of review
• warfarin education recorded

• Not improved / not changed
• use of ID labels
• prescription legibility
• circling not administered codes
• use of ADR stickers/bracelets
• documentation of weight
• patient name handwritten under the ID label

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Scope of implementation

• Inclusions
• public hospitals and health services

• Possible exclusions
• out-patient prescriptions
• discharge prescriptions
• specialist services including paediatrics, mental
  health, palliative care
• private hospitals
• insulin, heparin and intravenous infusion charts

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NIMC implementation - requirements
rationale
tools and approach
education
change
contingencies
evaluation
communication
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Leadership and change management

• precursor to death being in a state whereby a
  living system is less responsive to change
  (Pascale)
• evolution not the strongest or the most
  intelligent that survive but those most
  responsive to change (Darwin)

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Roles and responsibilities

• Facilitation
• Helen Leach, Senior Advisor, Victorian Medicines
  Advisory Committee
• Project management
• project teams within healthcare organisations

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NIMC contact details and information
Victorian state coordinator Helen Leach
Senior Advisor Victorian Medicines Advisory
Committee Email helen.leach_at_dhs.vic.gov.au
Ph 9616 7786 Website www.health.gov.au/vmac/
projects/nimc.htm