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Transcript
Medication Management:
Revised: February 19, 2014
Standardized Medication
Concentrations for Parenteral
Infusion
Agenda
•
Medication Management
•
•
Provincial Parenteral Manual
•
•
•
Background
Roll-out & Transition
Access & Support
Standardized Medication Concentrations (SMCs)
•
•
•
SMC Lists & Policy
What you need to do
Next Steps
Medication Management
Mission
Vision
Values
 Collaborative approach to
prevent and minimize
medication errors and near
misses to increase patient
safety
Medication
Concentration
Narcotics
Safety
Medication
Reconciliation
 Addresses all medication
aspects from prescription,
selection, preparation, and
dispensing to the administering
of medication and ongoing
monitoring of patients
High Alert
Medication
Medication
Management
Concentrated
Electrolytes
Heparin
Safety
Antimicrobial
Stewardship
Others?
Provincial Parenteral
Monographs (PPM)
The new Provincial Parenteral Monographs provides:
•
Single common parenteral monograph throughout the
province
•
•
Ensures patient safety and consistent medication administration and
management
Electronic reference for drug therapy guidelines and
parenteral drug information
•
Provincial Parenteral Manual - Link
•
Although PPM can be access electronically, a hard copy must be
maintained for downtime instances
NOTE:
The new Provincial Parenteral Monographs are NOT
a comprehensive drug reference – if further information required,
please consult other sources (i.e. Drug Information Services)
Provincial Parenteral
Monographs (PPM)
•
Ongoing roll-out of the new PPM will take place as
therapeutic drug classes are completed
•
Use existing site specific monographs until new provincial monograph
is available
CompassionNet
(homepage)
Old legacy
sites will link
to new AHS
monographs
Parenteral Manual
(top blue bar)
AHS Provincial
Parenteral Manual
(InSite page)
New Provincial
Parenteral
Monographs
No new monograph updated
Use existing old
legacy parenteral
monographs
Click Here
Click Here
Standardized Medication
Concentrations (SMCs)
What are SMCs:
•
Medication infusions which are mixed according to a
limited number of pre-determined drug concentrations
•
•
Focused on high alert medications
Established based on stakeholder input, focusing on the
Institute for Safe Medication Practices’ (ISMP) list of highalert medications
•
Took into account: legacy lists, parenteral drug monographs, stakeholder
feedback, leading practices, availability from manufacturer, and
concentrations implemented at other sites within Canada & USA
Standardized Medication
Concentrations (SMCs)
Two (2) NEW Standardized Medication Concentration Lists:
Adult Standardized Medication Concentration List:
•
Currently, a total of 50 drugs with 104 concentrations
Neonatal Standardized Medication Concentration List:
NOTE:
Roll-out for Insulin and Vasopressin will need to be deferred
*** April 1st: begin smart pump software upgrade & drug libraries updates
*** Revise pre-printed patient care orders and mixing sheets based on new
Standardized Medication Concentrations List
Standardized Medication
Concentrations (SMCs)
Why SMC Lists?
•
Safety
•
Minimizing medication errors to ensure patient safety
Decreasing number of concentration and volume options available for the
same medication reduces the risk that a healthcare provider will select,
dispense, or administer the wrong concentration
•
Standardization and Consistency
•
•
Reduce the number of steps and processes and the reliance on
human memory and vigilance
Compliance
•
Accreditation Canada’s Medication Management ROP 2.5 – Major
Test for Compliance:
“The orgnizational limits and standardizes concentrations and volume options
available for high-alert medications”
Standardized Medication
Concentrations (SMCs)
Facts:
•
Medication errors are the LARGEST identified source of
preventable hospital medical errors
•
Parenteral Administration errors are three (3) times as likely to cause
harm or death compared with other errors
•
79% of reported harmful or fatal medication errors involve the IV
route
•
58% of these errors occurred during administration of the medication
•
Healthcare expenses due to preventable errors cost Canadians $750
million/year
•
A hospital patient can expect to be subjected to more than one (1)
medication error a day (Institute of Medicine 2006)
Standardized Medication
Concentrations (SMCs)
Errors in the Medication Use Process:
Standardized Medication
Concentrations (SMCs)
Facts:
•
We are Human – Humans are Fallible!
•
Sometimes, we make mistakes, no matter how familiar we are
Aoccdrnig to rscheearch at Cmabrigde Uinervtisy, it
deosn’t mttaer in waht oredr the ltteers in a wrod are,
the olny iprmoent tihng is that the frist and lsat ltteer be
at the rghit pclae. The rset can be a tatol mses and you
can sitll raed it wouthit a porbelm. This is bcuseae the
huamn mnid deos not raed ervey lteter by istlef, but the
wrod as a wlohe. Amzanig huh
•
We must design our work processes to help us reduce the possibility of
mistakes/errors and ensure that mistakes/errors are detected and
corrected.
Standardized Medication
Concentrations (SMCs)
Policy & Procedure:
 Ordering Medications
•
Concentrations may or may not be part of the order
•
If ordering a non-SMC, must document clinical reason why and
indicate clearly the preferred medication concentration
 Processing Medication Orders
•
Concentrations to be clarified by a Health Care Professional and
documented as per site processes on chart
Standardized Medication
Concentrations (SMCs)
Policy & Procedure:
 Preparing Medications
•
Use ready-to –administer format whenever/wherever possible
•
Use parenteral monographs for mixing instructions
Labels & Instructions
Standard Concentrations
• No label required
High Concentrations
Non-Standardized
Concentrations
+
IDC on calculations &
preparation
Standardized Medication
Concentrations (SMCs)
Policy & Procedure:
 Administering Medications
•
Utilize smart pump drug libraries
•
If non-SMC are used, manual programming of the pump is
required with verification via an IDC
 Auditing
•
Pharmacy to audit compliance by reviewing: infusions dispensed,
medication orders, MARs, and/or patient charts
•
Nursing to audit compliance using data from: smart pumps,
MARs, and/or patient charts
Standardized Medication
Concentrations (SMCs)
What do you need to do?
 Nursing
•
CNEs to notify staff on new SMCs and how to how to mix and
handle orders (either with no specified SMCs, or with non-SMC
specified)
•
Identify sources required: mixing sheets, pocket cards, posters,
etc.
•
Units to ensure appropriate drug supply in areas of med storage
not supplied by Pharmacy (i.e. crash carts)
•
Ensure smart pumps have version 12 drug library after April 1st
•
Audit compliance with SMCs (i.e. data from smart pumps, using
MARs and/or patient profiles/charts)
Standardized Medication
Concentrations (SMCs)
What do you need to do?
 Pharmacy
•
Amend pharmacy computer system to reflect new SMCs
•
Update stock in pharmacy and on nursing units if needed
•
Update wardstock lists
•
Purchase or make products whenever possible
•
Update sterile manufacturing worksheets for IV room if needed
•
Train staff on how to handle orders (either with no SMC specified,
or with the wrong SMC specified)
•
Audit compliance with SMCs (i.e. review of orders, infusions
dispensed, review of MARs/patient profiles/charts)
Standardized Medication
Concentrations (SMCs)
What do you need to do?
 Prescribers
•
Ensure medication order comply with SMCs when ordering
standardized concentrations (i.e. magnesium sulfate)
•
Ensure using SMCs when mixing on own (i.e. anesthetists)
•
Specify preferred concentration and clinical reason why SMC will
not meet the patient’s needs of want to use and non-SMC
 All users of PPCOs
•
Ensure PPCOs comply with SMCs and revise as needed
What Now?
Communicate
Educate
Familiarize &
Learn
Lead
SMC Implementation
Roll-out: April 1st, 2014
March 3-7 March 10-14 March 17-21 March 24-28 March 31-April 4 April 7-11 April 14-18
April 21-25
April 28-May 2
May 5-9
Staff Training (provided by CNE)
PharmacyTraining
GNCH
RAH
UofA
MCH
Legend:
April 1, 2014:
Smart Pump Drug
Library Update &
SMC List Available
Training
Smart Pump Upgrade
For More Information…
•
Parenteral Monographs
http://intraweb01.albertahealthservices.ca/Pharmacy/pm_edm/index.asp
•
Smart Pump Library
http://www.intranet.capitalhealth.ca/smartivpumps/Reports.htm
•
Policy and Procedures
Will be located on CompassionNet once finalized
Questions