SPSP MedicinesPaediatric Networking EventPrepared by: David Maxwell

Key Points

• 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

Mental HealthAcute Adult Primary Care MCQIC

Sepsis VTE

Essentials

SPSI

GMS

Pharmacy

Nursing

MedicinesRestraint

CommunicationLeadership &Culture

Risk Assessment

9 Priorities Dentistry

Maternity

Neonates

Paediatrics

Safer Use of Medicines Healthcare Associated Infections

Clinical Advisory Group

% 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 bundleImprovement 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 – General Practice

TBC – currently being tested by pilot sites in four NHS Boards (medication reconciliation, warfarin, NSAIDS)

Primary Care – Community Pharmacy

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.

Mental Health

% of patients with medication reconciliation performed on admission% of patients with medication reconciliation performed on discharge% of INRs > 6

Acute Adult

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 prescribedDays 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)

% 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 & doseNumber of days between incidences involving high risk drugs

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

MCQIC – Neonates

MCQIC – Paediatrics

MCQIC – Maternity

Medication Reconciliation

MedicationReconciliation

SPSP Programme Improvement activity / measurementAcute Adult Admission and discharge Mental Health Being incorporated into the Mental Health

measurement plan for both admission and discharge.MCQIC – Maternity Medication reconciliation for high risk women in

maternity services is being discussed as part of next steps for MCQIC.

MQQIC - Neonates N/AMCQIC – Paediatrics

Admission only (optional)

Primary Care – General Practice

For patients discharged from acute care

Primary Care – Community Pharmacy

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%

Medication Reconciliation

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

95% of patients with process and accurate proxy outcome:- medication chart- immediate discharge letter- GP records- community pharmacy PCR

High Risk Medicines• low therapeutic index• administered by the wrong route or when other system errors occur• requires dose / frequency modification according to specific parameters

SPSP Programme Improvement activity / measurementAcute Adult INRs > 6 (related to warfarin toxicity)Mental Health Lithium, clozapine and high dose antipsychotics identified as high

risk medicines (particularly for patients being cared for outwith mental health services)

MCQIC – Maternity Safe oxytocin use being discussed as part of next steps for MCQICMQQIC - Neonates Vancomycin and gentamicin care bundlesMCQIC – Paediatrics Vancomycin and gentamicin care bundlesPrimary Care – General Practice

Care bundles for warfarin, methotrexate and azathioprine

Primary Care – Community Pharmacy

Testing in pilot sites care bundles for warfarin and non-steroidal anti-inflammatory drugs (NSAIDS)

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

95% compliance with the existing HRM ‘bundles’

Other Local Priorities

• Error free administration– Wong patient– Missed doses

• Health and social care integration

Questions / Discussion