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Medication Management

Plan Implementation

An Emergency Department

Perspective

Mixed Adult and Paediatric

Major Urban

51000 presentations per year

Approximately 150 patients per day

40% admission rate

Jointly started by hospital pharmacy and ED

Hospital wide short education sessions

including ED

Posters

Intensive education sessions in Dec

2014/January 2015

Continuing posters/education session (but less

intensive)

District Educator

Interactive 20 minute session

All ED doctors and nurses

Daily sessions

HETI online module

ED Staff specialist : JMO teaching session,

Registrar teaching session, Facebook page

reminders, email reminders

16 Dec 2014: 71% compliance with MMP

Commitment by hospital pharmacy,

Emergency department and hospital executive

to improve compliance with MMP

Education and senior buy in

MMP added to JMO Ward checklist

Directive from hospital executive that MMP

must be kept at the bedside

Extension of what we should be doing anyway

Advised staff to complete when they are

taking the history

Doubling up between MMP and medical

record

Allowed to use MMP only

In practice written in both

Does not take long

Time to complete

Senior buy in

Nurses had difficulty getting medication lists

from GPs

Inpatient teams think it is ED’s job to do it

100% compliance in February, 2015

In June, 2015, still >95% compliance

Continuing education sessions

Consultant checking on rounds

Consultant sign off and Nursing sign off

Regular teaching sessions for JMO/Registrar

Emails and social media (Facebook page

reminders)

Pharmacist in ED checking

All clinical staff are educated from district

educators

MMP Policy Directive developed, approved by Clinical Council and disseminated to staff

MMP Resource Folders Reference cards for MMP issued to clinical staff MMP Integration into existing QI initiatives eg

Patient Journey Boards Process commences in ED for emergency

admissions and Pre-admission Clinic for elective surgical patients

Blue handover stickers for medical officers amended to include MMP as a handover action

Four consecutive audits were conducted from

December 2014 to February 2015.

Total of 401 MMPs captured

Audit focused on use of MMP on admission

and BPMH

73%

94% 98%

100%

0

10

20

30

40

50

60

70

80

90

100

16-Dec-14 28-Jan-15 04-Feb-15 10-Feb-15

% o

f p

atie

nts

wit

h M

MP

39%

61%

87%

92%

0

10

20

30

40

50

60

70

80

90

100

16-Dec-14 28-Jan-15 4-Feb-15 10-Feb-15

% o

f p

atie

nts

N1=87 N2=103 N3=105 N4= 106

0% 20% 40% 60% 80% 100%

1

Percentage of MMPs initiated by profession

Pharmacist

Medical Officer

Nurse

MMP included on Patient Journey Boards (PJB) –

Business Rules developed and implemented

MMP included in nursing clinical handover tools

Peri-operative clinical handover document

includes MMP

Orientation programs reviewed to include MMP

Pharmacists rostered to attend PJB rounds

Pharmacists allocated pagers to facilitate their

attendance in PJB rounds

Need senior ED clinical leadership

Patient safety enhancement

Not a massive change from current practice

Collaborative approach between ED and

inpatient team

Regular reinforcement

The MMP project won the South Western

Sydney Local health district quality award for

2015 for category of " Patient and carers as

partners".

The title of the submission was " The new

multidisciplinary team : Doctors , pharmacists,

nurses administrative staff and patients.