Download Standard 4 PPT

Standard 4:
Medication Safety
Standard 4- Medication Safety # 1
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WI 35A (Healthcare – NSQHS Standards & NSMHS).
Standard 4- Medication Safety # 2
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www.safetyandquality.gov.au
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National Standards and Accreditation:
• Accreditation and the NSQHS Standards
• Clinical Care Standards
• Mental Health.
Standard 4- Medication Safety # 3
We acknowledge the excellent work done by
the Quality & Safety Branch of the Victorian
Department of Health and Human Services
in the development of these training
materials and their kind permission for
TQCSI to use them.
Standard 4- Medication Safety # 4
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to ensure clinicians safely prescribe, dispense and administer
appropriate medicines to informed patients and carers
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Standard 4 also relates to Standard 1: Governance for Safety and
Quality in Health Service Organisations and Standard 2:
Partnering with Consumers.
Standard 4- Medication Safety # 5
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governance and systems for medication safety
o systems implemented for the safe prescribing, dispensing,
supplying, storing, manufacturing, compounding and
monitoring of the effects of medicines
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documentation of patient information
o the accurate recording of patient’s medication history available
throughout care
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medication management processes
o medical team is supported during prescribing, dispensing,
administering, storing, manufacturing, compounding and
monitoring of medicines;
Standard 4- Medication Safety # 6
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continuity of medication management
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a complete list of patient’s medications provided to the
receiving medical team and patient during handover or when
medication changes
communicating with patients and carers
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medical team informs patients regarding options, risks and
responsibilities for an agreed medication management plan.
Standard 4- Medication Safety # 7
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medicines are associated with a higher incidence of errors and
adverse event, more than any other health care intervention
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medication incidents are the second most reported incident
following falls (in public hospitals)
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underlying cause of medication errors relates to poor systems and
processes.
Standard 4- Medication Safety # 8
Best practice in safe medication management comprises of:
• minimising risk to patient harm by ensuring:
o optimum patient/clinician communication
o effective communication within the medical team and support
staff (eg handover)
o accurate medical history is documented and made available to
relevant medical practitioners
o accurate patient identification and medicine matching is
undertaken
o policies and procedures are followed and training is provided;
Standard 4- Medication Safety # 9
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accurately documenting all aspects of medication management
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reporting and reviewing of adverse medicine events and
medication errors
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patient and carers must be:
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informed of the risks and benefits of using medicines
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engaged in the development of the management plan
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given medication information that is easily understood.
Standard 4- Medication Safety # 10
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organisations must have governance arrangements in place which
includes systems, policies and procedures
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medication management may include committees such as:
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Drug and Therapeutics Committee
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Medication Management Committee
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Medication Safety Committee
‘Achieving effective medicines governance: Guiding Principles for the roles and
responsibilities of Drug and Therapeutic Committees in Australian public
hospitals’ – www.catag.org.au.
Standard 4- Medication Safety # 11
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accurate, timely and ongoing assessment of patient’s medication
history
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recording of patient medication must be current and appropriate to
the patients condition and needs
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risk to medication error is decreased if the patient and carer are
involved in the medication management plan.
Standard 4- Medication Safety # 12
Best Possible Medication History
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histories are often incomplete with missing or incorrect doses of
medicines
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BPMH should be:
o obtained through the patient or carer
o confirmed through other sources such as GP or pharmacy
o reconciled against medicines ordered on the medication chart
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BPMH should include:
o all current and recently ceased medicines
o over-the-counter and complementary medicines
o allergies and adverse drug reactions (ADR), including
description.
Standard 4- Medication Safety # 13
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ADRs must be:
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available at the point of care
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recorded on the medication chart or in the electronic
medication management system, if available
discrepancies must be resolved.
Standard 4- Medication Safety # 14
Medication Reconciliation
Medication reconciliation is the process of:
• obtaining, verifying and documenting an accurate list of a patient’s
current medicines on admission
• comparing this list to the admission, transfer, and/or discharge
medication orders
• identifying and resolving any discrepancies.
Standard 4- Medication Safety # 15
Medication Management Plan
Medication management (action) plan should:
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be developed by relevant clinicians in consultation with patients and
carers
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be based on BPMH and revised according to needs
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include actual and possible medication management issues, goals
and strategies
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include roles and responsibilities of those involved in and reviewing
the plan
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be included in patient’s medical record.
Standard 4- Medication Safety # 16
Compliance with Scope of Practice and Legal
Requirements
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all clinicians must be aware of, and comply with, legislation and
scope of practice requirements and any local health service
requirements.
Standard 4- Medication Safety # 17
Authorisation and Competencies
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authorised staff can only prescribe, dispense and administer
medication
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competencies or learning modules may be required for individual
healthcare services to prescribe, dispense or administer certain
medications
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record of completion must be retained.
Standard 4- Medication Safety # 18
Medicines Information Resources
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use of current, independent and evidence based medicines
information and support tools are essential for safe and effective
medicine management (eg MIMS Annual).
Standard 4- Medication Safety # 19
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medications must be prescribed by an authorised medical or health
professional
prescriptions recorded on the medical chart or discharge
prescription must contain:
o patient identification details
o generic name (active ingredient)
o dose, route, frequency and timing of administration
o duration of therapy as appropriate
o acceptable abbreviations and units of measure
clinicians must check for allergies or ADRs every time a new
medicine is prescribed, dispensed or administered.
Standard 4- Medication Safety # 20
National Inpatient Medication Chart
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NIMC developed to reduce the risk of prescribing, dispensing and
administration errors
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documents developed to present information in a standard and
consistent format
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mandatory use of medication charts and support materials.
Standard 4- Medication Safety # 21
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accurate dispensing of medicines in accordance with the
prescription is vital to patient safety
must be accurately labelled and appropriate for the patients needs
person responsible for dispensing must consider and confirm:
o medicine name, dose, frequency and route of administration
o indication for use
o duration of treatment
o interactions with other medicines
o patient’s condition and medication history
o patient’s clinical parameters (eg weight & renal function)
o allergies and ADRs;
Standard 4- Medication Safety # 22
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barcoding can ensure medications are dispensed accurately
product selection errors are the main cause of dispensing errors.
Standard 4- Medication Safety # 23
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systems must be implemented to ensure medications are safely and
correctly stored and distributed to minimise errors
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systems may include:
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the use of technology (eg barcoding)
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standard labelling techniques and separation of ‘like’ products
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processes to reduce administration errors
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storage requirements and temperature sensitive medicines must be
handled accordingly
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process in the event systems fail.
Standard 4- Medication Safety # 24
Medicine Disposal
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policies and procedures must be implemented to ensure safe
disposal of unused, unwanted or expired medications
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particular attention must be given to Schedule 8, cytotoxic and
other hazardous preparations.
Standard 4- Medication Safety # 25
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prior to administering any medications, clinicians must:
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identify patient using 3 identifiers (eg patient name, DOB,
address)
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match patient’s identity to details on the medication chart or
prescription
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check the patient’s allergies and ADRs
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match the medicine with the order on the prescription or
medication chart
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ensure that the medicine name, dose, route, frequency, indication
and duration of therapy are correct;
Standard 4- Medication Safety # 26
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ensure the medicine is safe and appropriate for the patient
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determine appropriate administration route (eg use an oral
dispenser for liquid medicines administered orally or via
nasogastric or other enteric tubes, to avoid wrong route errors)
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label injectable medicines in accordance with local policy and
procedures
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double check medicines in accordance with local policy, with
caution for high risk, Schedule 8 and paediatric medicines;
Standard 4- Medication Safety # 27
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medicine administration must be documented on the medication
chart, including the time and initials of the person administering
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withholding medication must be documented and the reason for
withholding.
Standard 4- Medication Safety # 28
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documented, patient monitoring is essential to prevent unintended
adverse events (AE) and that the prescribed medication is having
the desired therapeutic effect
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Clinicians should consider:
o comparing baseline or prior measurement responses
o monitoring or assessment tools are validated and suitable for
purpose (eg pain score tool for a paediatric patient)
o results reviewed as soon as possible to manage patients
accordingly
o particular attention is given to patients with multiple medications
for possible drug interactions
o managing, documenting and reporting any AEs promptly.
Standard 4- Medication Safety # 29
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‘the transfer of professional responsibility and accountability for
some or all aspects of care for a patient, or group of patients, to
another person or professional group on a temporary or
permanent basis’ (ACSQHC, 2010)
high risk situation for patient safety due to medication errors on
discharge or transfer of care, particularly between facilities, wards,
shifts
comprehensive and current list of medicines must be supplied to
receiving clinician, patient and carer on transfer or discharge
medication management plan should be communicated to the
patient’s GP for continuity.
Standard 4- Medication Safety # 30
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patients or carers should be encouraged to be involved in their
medication management by:
o explaining the need for repetitive identification
o explaining the patient’s role in the safety process
o reporting any side effects from new medicines prescribed
o providing information about medicines in a format the patient
or carer can understand
o offering information in languages other than english for
culturally and linguistically diverse patients.
Standard 4- Medication Safety # 31
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Adverse Drug Events (ADRs) and medication errors are harm or
complications related to the use of a medicine
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poor or absent patient identification is commonly associated with
medication errors
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medication errors are usually predictable and preventable
Australian studies have shown that administration errors occur in up to
18% of cases - furthermore, up to 70% of intravenously administered
drugs have one or more clinical errors (ACSQHC 2012).
Standard 4- Medication Safety # 32
Adverse Drug Reactions (ADRs)
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is a harmful, unintended reaction to a medicine that occurs at
doses that are normally used for treatment
many ADRs are not preventable
prior to commencement of new medicines, potential AEs should
be discussed with patients
patients and carers should be instructed to report these to
clinicians if an adverse reaction occurs
patients should be advised in writing about any ADR which has
occurred, in order to prevent re-occurrence.
Standard 4- Medication Safety # 33
Adverse Drug Reaction Reporting
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any ADRs should be reported to the supervising clinician and must
be documented
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certain ADRs should be reported to the Therapeutic Goods
Administration (TGA)
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reporting to the TGA assists in the detection of safety risks
associated with medicines when they are used outside the
controlled conditions of clinical trials.
Standard 4- Medication Safety # 34
Medication Errors
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all healthcare workers are responsible in prescribing, dispensing
and administration of medicines to the right patient
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important to identify factors which may have contributed to any
medication error
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communication between clinicians about errors and associated
factors may also assist in error prevention
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patients and carers should be fully informed of any AEs and the
organisation’s open disclosure processes implemented.
Standard 4- Medication Safety # 35
Medication Errors
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some medicines have a high risk of causing serious harm or death
if they are misused, or used in error
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high risk drug errors are not necessarily more common, but the
effects can be more devastating
Patients at Risk of Medication Related Harm
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some patients are more susceptible to harm when using
medications (eg aged, multiple use of medications)
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patient’s risk must be assessed and strategies to minimise risk are
documented on the medication management plan.
Standard 4- Medication Safety # 36
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regular auditing identifies areas of medication management
requiring improvement or implementing change where required
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allows health services to measure their performance and take
action to continuously enhance the quality and safety of medicines
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measurement and reporting can be used to form the basis of
medication management action plans.
Standard 4- Medication Safety # 37
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evaluation is essential following the implementation of any
improvement plan
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audits and measurement of relevant quality indicators provide
useful means to achieve this
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indicators and tools have been developed to test appropriateness,
effectiveness and safety of medicine use
(eg The Medication Safety Self Assessment® NSW Therapy Advisory Group).
Standard 4- Medication Safety # 38
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Advisory A13-02 (Interim accreditation of new health services)
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N/A for first 12 months (history)
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prescribed core and developmental actions
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within 10 days of commencing health service
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voluntary accreditation 90 day rule does not apply.
Standard 4- Medication Safety # 39
Standard 4- Medication Safety # 40