Download Medication Reconciliation Medication Reconciliation

SPSP Medicines
Paediatric Networking
Event
Prepared by: David Maxwell
Key Points
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Building on existing work within SPSP regarding medicines
Opportunity to standardise and coordinate activity
Capture and share local priorities/innovation
Key priorities for Phase 1
– Medication reconciliation
– High risk medicines
• Clinical advisory group established
• Whole system approach
SPSP
Acute Adult
Primary Care
Mental Health
MCQIC
Safer Use of Medicines
Healthcare Associated Infections
Sepsis VTE
GMS
Essentials
Pharmacy
SPSI
Nursing
9 Priorities
Dentistry
Medicines
Restraint
Communication
Leadership
&Culture
Risk Assessment
Maternity
Neonates
Paediatrics
Clinical Advisory Group
Primary Care – General Practice
% of medicines reconciled for patients at discharge (from hospital)
% compliance with DMARDs (methotrexate and azathioprine) prescribing and monitoring bundle
% compliance with warfarin prescribing and monitoring bundle
Improvement in combined % of INRs within range per practice/board according to local guideline
(for example reduction in combined % of INRs <1.5 and > 5.0/6.0)
Number of INR tests per 1000 population carried out per quarter
Primary Care – Community Pharmacy
TBC – currently being tested by pilot sites in four NHS Boards (medication reconciliation, warfarin, NSAIDS)
Mental Health
TBC – forming part of ‘safety principals’ related to medicines. Current proposal includes medication reconciliation;
high risk medicines – clozapine lithium and high dose antipsychotics; missed doses; patient education
regarding medicines.
Acute Adult
% of patients with medication reconciliation performed on admission
% of patients with medication reconciliation performed on discharge
% of INRs > 6
MCQIC – Neonates
% compliance with gentamicin bundle
% prescriptions (gentamicin) which have correct dose & frequency
% of gentamicin levels within therapeutic range
% compliance with vancomycin bundle
% of vancomycin levels within therapeutic range
% prescriptions of [identify drug] were correct concentration, rate & dose
Number of days between incidences involving high risk drugs
MCQIC – Paediatrics
Medicines harm (outcome) – number of medication incidents that are high and very high (local reporting systems)
% of prescriptions of [locally identified drug] where the correct concentration, rate & dose are prescribed
Days between incorrectly prescribed [locally identified drugs]
% uninterrupted intravenous drug reconstitutions
% compliance with the high risk drug [locally identified] bundle
% of appropriate children and young people with medicines reconciled within 24 hours of admission (local optional)
% of medicines errors* (local optional – gentamicin and vancomycin)
MCQIC – Maternity
TBC – options paper for future improvement activity includes a proposal for a measure related to oxytocin, identified
as a high risk medicine in maternity services and medication reconciliation for high risk/red pathway women
Medication Reconciliation
SPSP Programme
Acute Adult
Mental Health
MCQIC – Maternity
Medication
Reconciliation
MQQIC - Neonates
MCQIC –
Paediatrics
Primary Care –
General Practice
Primary Care –
Community
Pharmacy
Improvement activity / measurement
Admission and discharge
Being incorporated into the Mental Health
measurement plan for both admission and discharge.
Medication reconciliation for high risk women in
maternity services is being discussed as part of next
steps for MCQIC.
N/A
Admission only (optional)
For patients discharged from acute care
Bundles are being tested by pilot sites in two boards
What we know nationally:
• MR on admission
- 9 boards consistently reporting data
- Median at pilot site: 30% to 94%
- Multiple site/Area data being submitted by some
boards
• MR on discharge
- 3 boards consistently reporting data
- Median at pilot site: 30% to 86%
95% of patients with process and
accurate proxy outcome:
Medication Reconciliation
- medication chart
- immediate discharge letter
- GP records
- community pharmacy PCR
Opportunities:
• Improve engagement and reporting on medication reconciliation processes in acute care for both
admission and discharge
• Sharing between boards changes in practice that have supported improvements
• Develop mechanisms for whole-systems learning for medication reconciliation, particularly at the
interface between primary and secondary care
• Create a library of patient and staff stories describing the impact of medication reconciliation across
the interface, to complement process measures
• Increase service user/carer involvement in the medication reconciliation process
• Collaboration with other national groups to raise the profile of medication reconciliation
High Risk Medicines
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low therapeutic index
administered by the wrong route or when other system errors occur
requires dose / frequency modification according to specific parameters
SPSP Programme
Acute Adult
Mental Health
MCQIC – Maternity
MQQIC - Neonates
MCQIC – Paediatrics
Primary Care – General
Practice
Primary Care –
Community Pharmacy
Improvement activity / measurement
INRs > 6 (related to warfarin toxicity)
Lithium, clozapine and high dose antipsychotics identified as high
risk medicines (particularly for patients being cared for outwith
mental health services)
Safe oxytocin use being discussed as part of next steps for MCQIC
Vancomycin and gentamicin care bundles
Vancomycin and gentamicin care bundles
Care bundles for warfarin, methotrexate and azathioprine
Testing in pilot sites care bundles for warfarin and non-steroidal
anti-inflammatory drugs (NSAIDS)
95% compliance with the existing
HRM ‘bundles’
High Risk Medicines
Opportunities:
•To test a set of generic principles/criteria for a high risk medicine bundle, applicable to any medicine in
any setting (processes of care)
• Extend current improvement activity from a single setting to a system approach – to process map a
pathway of care for a patient on a high risk medicine, explore safety
processes in each of the care settings, with an aim to have a ‘system’ view
• Create a library of patient and staff stories describing the harm associated with high risk medicines
and patent stories describing the impact of reliable processes, to complement existing
bundles/measures
• Collaboration with other national groups regarding specific medicines / medicine groups
Other Local Priorities
• Error free administration
– Wong patient
– Missed doses
• Health and social care integration
Questions / Discussion