Clinical Governance & MI: An Introduction

Transcription

1 Clinical Governance & MI: An Introduction Mark Cheeseman Education & Training and Secondary Care Support Medicines Information Pharmacist East Anglia Medicines Information Service

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3 Aims Provide you with an introduction to the principles of clinical governance, risk management and quality assurance. Describe the main tools used to ensure quality assurance in MI, including IRMIS. Enable you to apply these principles and tools in your own workplace.

4 Learning Outcomes By the end of this session you should be able to: Describe 14 of the UKMi standards. Be able to peer review an enquiry and provide feedback.

5 Session Background Methods Key tools for MI Available support Summary

6 What does Clinical Governance mean to you?

7 Definition a framework through which NHS organisations are accountable for continuously improving the quality of the services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

8 History WHO. Principles of quality assurance; DH. A First Class Service: Quality in the new NHS; CMO/CNO. Supporting implementation of clinical governance. NHS Exec; 1999

9 How did this affect Pharmacy? RPS published Achieving excellence in pharmacy through practice (1999) 1. Clear lines of responsibility 2. Quality improvement activities 3. Risk Management 4. Poor Performance

10 UKMi Clinical Governance Working Group What has MI done? Clinical Governance a briefing paper for Medicines Information Services Focus: Framework Tools

11 Framework Right climate = acceptance and implementation Features: Good ideas and practice shared Education and research valued Blame only used in exceptional circumstances Collaboration rather than competition

12 Does anyone have all these?

13 How can we achieve quality? Defining standards Ensuring delivery of standards Quality Checking delivery of standards

14 What tools can we use to ensure quality?

15 Tools for Quality Standards Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice CPD Training programmes

16 Tools for Quality Standards Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice CPD Training programmes UKMi Standards QA Visits MI User Survey Workload Survey/KPIs Enquiry Answering! Personal CPD/In-house training Local/regional training This course!

17 Tools for Quality Risk Assessment/ Management Schemes Appraisal schemes Incident/near miss reporting schemes Dialogue with principal stakeholders Involvement with commissioning specialist services

18 Tools for Quality Risk Assessment/ Management Schemes Appraisal schemes Incident/near miss reporting schemes Dialogue with principal stakeholders Involvement with commissioning specialist services Risk Management Policy Peer Review IRMIS Who are yours? Who commissions your service?

19 How can we achieve quality? UKMi Standards & Clinical Governance Working Group Resources, CPD, Job description, E&T, SLA s, KSF, Service commissioning Competency Framework National standards Defining standards Ensuring delivery of standards Quality Checking delivery of standards Audit, Peer review / bench marking, Outcomes / indicators, Near-miss / incidents reports

20 So what does the UKMi Clinical Governance Working Group do?

21 Monitor and continuously update national standards for MI Services Conduct research Respond to UKMi Exec relating to Clinical Governance Liaise with UKMi Exec & other organisations Advise UKMi Exec UKMi CGWG Maintain IRMIS Develop QA programmes & documentation Co-ordinate audit/surveys Collate data from QA programmes Monitor implementation of QA programmes

22 What should you be aware of? UKMi Standards QA Visits MI User Survey Risk Management Policy IRMIS Peer Review

23 Standards Resources Enquiry answering process Publications and proactive work Research & development Risk Management Specialist Advisory Services Training

24 Standards Standard Risks of non-implementation Potential outcomes if not implemented Satisfactory Commended

25 Example Specialist advisory services These standards apply to all designated specialist advisory services listed in the UKMi directory. MICs wishing to provide a new specialist advisory service should demonstrate a need for the specialist advisory service by presenting a 'business case' to the UKMi Executive. Services should be introduced based on need, rather than an individual s interest in a subject. Specialist service (e.g. renal, dental): Risks of non-implementation Lack of high quality service delivery. Inadequate knowledge and skill set for advanced practice No sharing of good practice, research findings or service developments with other MI centres in the UK or further afield. Potential outcomes if not implemented Service does not fulfil the needs of its users MI is not valued nationally by Mi colleagues or the wider service community. No positive publicity for the MI centre/pharmacy locally or nationally. Satisfactory Commended 1. Service should always be available during the opening hours of the MI centre, (but not necessarily out of hours). Service is extended to out-of-hours availability

26 Quiz

27 Quiz (1) 1. How quickly should the MI phone be answered within? A) 10 seconds B) 20 seconds C) 40 seconds 2. MI staff supervising trainees in MI do not need to have attended formal training in training. True or False?

28 Quiz (2) 3. How long should enquiries be kept for? A) 8 years B) 25 years C) A and b 4. A MI pharmacist/technician should be available to take a call within 5 minutes Satisfactory or commended?

29 Quiz (3) 5. Which of the following statements is correct: a) Non-MI pharmacists should have MI training as part of their induction b) Non-MI pharmacists receive MI training as an annual refresher/update c) Both of the above

30 Quiz (4) 6. Headsets should be used by all MI staff when using MiDatabank True or false? 7. What is classed as a satisfactory answer when reviewing enquiries? A) 80% - 90% B) 85% 95% C) 100% 8.

31 Quiz (5) 8. How long is it advised that pre-registration pharmacists should spend in MI? A) 2 weeks B) 4 weeks C) Not stated

32 Quiz (6) 9. How often should the MI centre s risk management policy be reviewed? A) Every year B) Every 2 years C) Every 3 years

33 Quiz (7) 10. How soon after a MI Pharmacist has started in their role should they attend the National MI training course? A) Within 3 months B) Within 6 months C) Within 12 months

34 Quiz (8) 11. It is not necessary to have back-up facilities for electronic records held on MiDatabank True or False? 12. All permanent MI pharmacists should identify a research project they plan to undertake or support Satisfactory or commended?

35 Quiz (9) 13. Only answers involving complex calculations need to be checked by another pharmacist, technician or pre-registration pharmacist. True or False? 14. Peer review of enquiries by MI staff should be undertaken by regional MI centres only. True or False?

36 Quiz Answers 1. How quickly should the MI phone be answered within?

37 Quiz Answers 1. How quickly should the MI phone be answered within? B) 20 seconds

38 Quiz Answers 2. MI staff supervising trainees in MI do not need to have attended formal training in training.

39 Quiz Answers 2. MI staff supervising trainees in MI do not need to have attended formal training in training. False

40 Quiz Answers 3. How long should enquiries be kept for?

41 Quiz Answers 3. How long should enquiries be kept for? C) A and b

42 Quiz Answers 4. A MI pharmacist/technician should be available to take a call within 5 minutes

43 Quiz Answers 4. A MI pharmacist/technician should be available to take a call within 5 minutes Satisfactory

44 Quiz Answers 5. Which of the following statements is correct:

45 Quiz Answers 5. Which of the following statements is correct: c) Both of the above

46 Quiz Answers 6. Headsets should be used by all MI staff when using MiDatabank

47 Quiz Answers 6. Headsets should be used by all MI staff when using MiDatabank True

48 Quiz Answers 7. What is classed as a satisfactory answer when reviewing enquiries?

49 Quiz Answers 7. What is classed as a satisfactory answer when reviewing enquiries? A) 80% - 90%

50 Quiz Answers 8. How long is it advised that pre-registration pharmacists should spend in MI?

51 Quiz Answers 8. How long is it advised that pre-registration pharmacists should spend in MI? C) Not stated

52 Quiz Answers 9. How often should the MI centre s risk management policy be reviewed?

53 Quiz Answers 9. How often should the MI centre s risk management policy be reviewed? A) Every year

54 Quiz Answers 10. How soon after a MI Pharmacist has started in their role should they attend the National MI training course?

55 Quiz Answers 10. How soon after a MI Pharmacist has started in their role should they attend the National MI training course? B) Within 6 months

56 Quiz Answers 11. It is not necessary to have back-up facilities for electronic records held on MiDatabank

57 Quiz Answers 11. It is not necessary to have back-up facilities for electronic records held on MiDatabank False

58 Quiz Answers 12. All permanent MI pharmacists should identify a research project they plan to undertake or support

59 Quiz Answers 12. All permanent MI pharmacists should identify a research project they plan to undertake or support Satisfactory

60 Quiz Answers 13. Only answers involving complex calculations need to be checked by another pharmacist, technician or pre-registration pharmacist.

61 Quiz Answers 13. Only answers involving complex calculations need to be checked by another pharmacist, technician or pre-registration pharmacist. False

62 Quiz Answers 14. Peer review of enquiries by MI staff should be undertaken by regional MI centres only.

63 Quiz Answers 14. Peer review of enquiries by MI staff should be undertaken by regional MI centres only. False

64 QA Visits Regional centre -> Regional centre Regional centre -> Local centre Audit centre against national standards AND peer review sample of enquiries National template

65 National Template Summary of the MI service, recommendations from last visit and this visit Performance Review Resources Enquiry answering process Publications and pro-active work Training Research & development Risk Management Specialist Advisory Services

66 Audit Standards (UKMi Audit Toolkit) Clinical Governance > Service Standards

67 User Survey Clinical Governance > Enquiry Answering

68 What do you think is important to users of your MI service?

69 MI User Survey User survey is a validated tool Enquirers opinions of enquiry answering service. Structured - succinct, easy to complete and analyse. Incorporates issues that were determined to be most important to enquirers in preliminary research.

70 MI User Survey Available in two formats: download and print off electronic use An online survey tool, e.g. Survey Monkey, could also be used as an alternative method.

71 MI User Survey Designed to provide a positive or negative opinion on a number of aspects of service provision. Not a paper exercise Ensures your MI centre meets the needs of your users. Provide high-quality, patient-centred enquiry answering service.

72 MI User Survey Positive results - provide a valuable endorsement for the service Negative results - used to identify areas that require improvement/investment Each questionnaire returned should be individually evaluated in a timely manner.

73 MI User Survey Negative result /negative comments: Review enquiry involved. Any identified areas for concern should be addressed to minimise the risk of problems recurring.

74 MI User Survey May be appropriate to notify the enquirer of any remedial action taken to assure them that their concerns are taken seriously. May also be beneficial to offer follow-up assistance.

75 MI User Survey Also be valuable to follow up any user survey response which rates the overall service as 4 out of 6, or lower.

76 MI User Survey Collate the results obtained from user survey in a running log Highlights strengths or weaknesses of the service. Editable spreadsheets and instructions are provided for this purpose.

77 MI User Survey Generates results in graph form Average score for the overall rating of the service is useful. This score will be used for audit purposes.

78 Number Example 9 Number per Score each Month 1 = Poor 6 = Excellent Score 1 Score 2 Score 3 Score 4 Score 5 Score Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

79 MI User Survey Useful to record enquirers comments, which may help provide support for the MI service. Audit Standards will be amended.

80 Examples of risk in your MI centre?

81 Environment Risk Management Policy Equipment & Information Resources Outputs People

82 Risk Management Policy Clinical Governance > Risk Management

83 Incident Reporting in Medicines Information System (IRMIS) Secure web-based database (NHSnet) Complement existing NHS reporting systems NOT a replacement Incidents local and IRMIS Anonymous data

84 IRMIS - what information is recorded?

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86 Near miss (enquiry)

87 Near miss (enquiry) When wrong, misleading or incomplete information or advice was detected in a completed enquiry before the response was given to the enquirer. NB. This should not include anything picked up whilst processing the enquiry. If the incident is identified once an answer has been formulated, but before the answer was given, this should be classified as a near miss.

88 Error (enquiry)

89 Error (enquiry) When wrong, misleading or incomplete information or advice is given to the enquirer.

90 Near miss (pro-active/publications)

91 Near miss (pro-active/publications) Any situation where wrong, misleading or incomplete information or advice is contained in a document but this was detected before the document was published and available to the intended audience. NB. This should not include anything picked up whilst processing the document. If the incident is identified while the document is being prepared, but before the document is published, this should be classified as a near miss.

92 Error (pro-active/publications)

93 Error (pro-active/publications) Any situation where wrong, misleading or incomplete information or advice is contained in a document that is published and available to the intended audience.

94 IRMIS- What happens to the data? Serious incidents Notified to IRMIS monitor (electronic) Reporter consent Learning points circulated to Regional Directors Data used to compile quarterly report. Above and routine incidents IRMIS monitor ensure report is completely anonymous Learning points highlighted Report presented to UKMi Exec Paper copy -> regional MI managers for discussion at local meetings Summary posted on UKMi site

95 Learning Points Taken from the IRMIS Annual Report 2011 Learning Point Drugs with similar sounding names can be misheard which can result in an incorrect, misleading or irrelevant answer. Calculations are a potential source of error Information resources can contain misleading or incorrect information Recommendation Confirm the spelling with the enquirer of any drug names which have the potential to be misheard. Normally all appropriate calculations should be checked by an independent person (use professional judgement because even simple calculations have been responsible for errors). Be aware of the limitations of information sources. Check more than one source of information

96 Peer Review Monitor standard of enquiry answering All centres expected to undertake peer review Encourage sharing of: Experience Knowledge Expertise Should be non-judgmental Provide professional support

97 Peer review allows: Peer Review Regular objective feedback on performance Feedback and suggestions on improving the quality of the service Sharing of ideas and learning from colleagues Development of own practice and service Identification of learning needs

98 UKMi provide: Peer Review Definition for ranking enquiries Summary of criteria for grading answers to enquiries using documented evidence Enquiry assessment form

99 Documentation Peer Review Analysis Coverage Answer

100 Peer Review Internal Sample enquiries (manager led) Sample enquiries (team led) Sample enquiries (user feedback) Group discussion External Peer Review visits Regional network meeting

101 Peer Review Workshop

102 Workshop Group work Peer Review enquiry Use national documentation Present findings to the group What did you like about doing this? What did you not like?

103 What about wider clinical governance issues? Hospital clinical pharmacy services Formularies Medicines management programmes Prescribing advice MMC/Area Prescribing Committees Local guideline writing/protocols Dissemination of good practice Input into audit programmes and quality initiatives Training and CPD programmes Shared care support

104 Where can you access Clinical Governance information for MI?

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108 Summary Provided you with an introduction to the principles of clinical governance, risk management and quality assurance. Described the main tools used to ensure quality assurance in MI, including IRMIS. Enabled you to apply these principles and tools in your own workplace.

109 Learning Outcomes You should now be able to: Describe 14 of the UKMi standards. Be able to peer review an enquiry and provide feedback.

110 Questions

111 Contact Website

112 MI User Survey Developed to provide statistically robust questionnaire. Eleven questions linked to provide validity Three categories measuring different aspects of user satisfaction: Answer satisfaction General Helpfulness/Time Satisfaction Ease of Contact Satisfaction

113 MI User Survey Conducted at least once per annum or more frequently or on an ongoing basis No. of questionnaires sent out should be a suitable sample related to the no. of enquiries. e.g enquiries/month, 60 surveys per year