Implementation of the national inpatient medication chart at hospital

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Implementation of the national inpatient
medication chart at hospital

• Name
• Position
• Hospital
• Date

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Overview

• background
• change management strategy
• chart mechanics the how to

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Background 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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Background 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 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 patient harm
The Age (October 2005)
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NIMC implementation - requirements
rationale
tools and approach
education
change
contingencies
evaluation
communication
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Implementing change

• rationale
• Health Ministers communiqué
• standardisation of best practice in patient
  safety
• tools and approach
• engage project team and identify stakeholders
• clarify roles and responsibilities of team
  members
• establish Clinical Governance framework
• develop implementation plan
• which wards and when?
• ordering new charts / removal of old charts
• education
• who? when? how?
• integrate with existing programs

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Implementing change

• communication
• with whom? what? how often?
• how? eg presentations, posters, flyers, website,
  newsletters
• evaluation
• ACSQHC Audit tool
• who? (nurse doctor/pharmacist) when? (3-6
  months post)
• existing performance indicators
• contingencies
• identify barriers and solutions

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Communicating change

• Department of Human Services website
• implementation register
• change register
• issues log
• evaluation

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• Using the chart

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Patient identificationwrong patient errors
occur when ID not visible

• affix patient ID label on pages 3 and 4
• check labels are correct , initial
• print patient name on pages 3 and 4

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Chart numberingaim to keep chart numbers to a
minimum to reduce risk of duplication and omission
additional charts
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Adverse drug reactionsre-exposure is a
preventable cause of harmnot all ADRs are
clinically significant

• TICK BOX - if patient has nil known allergies or
  unknown allergies status sign, print, date entry
• if known ADR, note
• - drug name
• - reaction details, date of reaction sign, print
  name and date entry

- if any amendments or additions made to this
section, initials and date of entry required -
attach ADR sticker to pages 3 and 4 required for
patient case notes
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Once only, pre-medication and nurse initiated
medicinesseparate from regular medication to
reduce risk of continued administration
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Telephone ordersimportant for rural and private
sites

• must be confirmed by second nurse
• must be countersigned by prescribing doctor
  within 24 hours

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Medications taken prior to admissionimportant
for medication reconciliation
Document medicines taken prior to presentation
section included to facilitate quick and
effective documentation of, access to
medication history
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Regular medications variable dose section, for
example steroids and aminoglycosides
- allows ordering of medications requiring
variable dosing based on lab results or as a
reducing protocol e.g. prednisolone - for more
than once daily dosing, use a regular drug box
and follow variable dose format
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Regular medications warfarin ordering section
(high risk drug)
- target INR indication gives decision support
info for dosing - documentation of results -
specified dose time 1600 hours - guidelines
available on target INR, duration of therapy,
dosing, managing excessive bleeding and drug
interactions
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Regular medications

• date started not date written
• generic prescribing
• doctor to enter dosing times
• slow release box must be ticked where
  appropriate
• doctor contact details
• document indication useful info if drug has
  different uses
• route acceptable abbreviations only

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Frequencyguidance only
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Abbreviationsunderstood
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Abbreviationsmisunderstood
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Limited duration and ceased medication orders

• Limited duration
• ordered only for certain days
• block out day/times when NOT to be given
• indicate using (X)
• Ceasing medications
• must NOT be obliterated
• doctor to put single line through prescription
  admin record sections
• write CEASE and date

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Reasons for not administering
Enter code and circle (ensures it wont be
misread as persons initials)
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Additional information required
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As required (prn) medications
Recording of Indication and Hourly frequency
for PRN medications gives clear administration
instructions and maximum daily dose
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Results from the pilot sites (1)
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Results from the pilot sites (2)
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Results from the pilot sites (3)
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Results from the pilot sites (4)
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Summary

• changes in prescribing behaviour can occur
• opportunity to examine, identify risks and
  improve medication management
• keys to successful implementation were
• leadership, education, resources, willingness to
  change and use as opportunity for review
• until SQ commission in place state wide
  jurisdictions responsible for roll out.

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The End

• This is not the end this is just the beginning
  of a nationwide move to standardising and
  improving the safety of medication management
  systems

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NIMC contact details and information
Hospital Coordinator(s) Name(s)
Department(s) Email Ph Website
www.health.gov.au/vmac/projects/nimc.htm