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Reducing Medication Errors Across the Whole Patient Journey Gordon Thomson Lead Pharmacist, Urgent Care and Medicine NHS Tayside

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Page 1: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Reducing Medication Errors Across the Whole Patient

Journey

Gordon Thomson Lead Pharmacist, Urgent Care and

Medicine NHS Tayside

Page 2: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

The Tay Rail Bridge Disaster 18????

Page 3: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication
Page 4: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Framework in Scotland

Quality Strategy – medicines reconciliation

eHealth Strategy – vision for single shared medication record

History of data sharing across care boundaries

Use of single patient identifier

Scottish Clinical Information (SCI) systems

Scottish Patient Safety Programme – medicines reconciliation and high risk medicines

HEPMA in 3 acute hospitals only!

Page 5: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Aims: To deliver the highest quality healthcare services to the people of Scotland For NHS Scotland to be recognised as world-leading in the quality of healthcare it provides

Page 6: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Is it important to get the medicines right?

Pirmohamed et al BMJ (July 2004)

18,820 admissions over 6 month period

6.5% of admissions related to medicines

2.3% of those died as a result of the ADR

Accurate medication history required for appropriate management

Accurate data on medicines required at discharge

Page 7: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Keeping Patients Safe (Royal Pharmaceutical Society Report June 2012)

<10% chance that an elderly patient will be discharged form hospital on the same medicines as at admission

28-40% of medicines are discontinued during a hospital stay

45% of medicines prescribed on discharge are new

60% of patients have 3 or more medicines changed during their hospital stay

Page 8: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Almost half of Scots over 65 are receiving 5 or more prescribed medicines

Poly-pharmacy in Scotland May – July 2011

Source: PIS Provisional Analysis

Page 9: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

ATOS data 22% of admissions to AMU were

“medicines-associated” Incidence of Medicines Involved

0 2 4 6 8 10 12 14

PPI

Thiazide Diuretics

Loop Diruetics

ACE-Inhibitors

AII Antagonists

B-Blockers

Nitrates

Digoxin

Other Antihypertensives

Antiplatelets

Anticoagulants

Statins

Opioid Analgesia

Other Analgesia

NSAIDs

Antimicrobials

Antidiabetics

Others

Page 10: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication
Page 11: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Don Berwick, Institute for Healthcare Improvement

The Scottish Patient Safety Programme is without doubt one of the most ambitious patient safety initiatives in the world –

national in scale, bold in aims, and disciplined in science.

It harnesses the energies and wisdom of Scotland’s health care

leaders – NHS executives, QI experts,, clinical professionals, civil

servants, , and more – all aligned toward a common vision,

making Scotland the safest nation on earth from the

viewpoint of health care.”

Page 12: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Medicines Reconciliation

Reliability in process of medicines reconciliation

Variation in accuracy of medicines reconciliation on admission and discharge.

In Tayside, medicines reconciliation on admission has spread to 94% of clinical areas.

NHS Tayside Medicines Reconciliation Policy and flow chart posters for all clinical areas

National policy awaiting approval from Scottish Government – see later!

95% accuracy on admission

95% accuracy at discharge

95% accuracy on transfer

Page 13: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

NHS Scotland: Medicines Reconciliation

Page 14: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Make it easier to do the right thing!

Page 15: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication
Page 16: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Maximising use of eHealth solutions

Emergency Care Summary/Vision 360

Electronic Discharge Document(EDD)

Import of medicines from GP list

“Stopped” medicines clearly highlighted

Sent directly to GP Practice on discharge

Clinical Portal hosts these systems and others

Page 17: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Acute

System

s

Nationa

l

Systems

Local

System

s

GP

System

s

CP

System

s

ASCribe 8/9

ChemoCare

Central Vision

Monitor

Summaries

E-Discharge e.g. Medication discharge letter

Clinical

Messaging

Lab Result

Enquiry

Test

Requesting

Clinical System e.g. VISION

N3/Local Network

Access

PMR System

Prescription Tracer

eMM

SCI Store

New PRISMS

ePharmacy Message

Store

Patient Registration

System (PRS)

PSD

A/CHI Ascribe B/Obj

LTC SCI-DC

Hearts/ SCI-CHD

TARDIS

TEARS

Stroke

Controlled Drugs

Clinical Portal

National CHI

Amended Slide

PARTNERS

e-Financials

Page 18: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Developing the Electronic Discharge Document(EDD) in NHS Tayside

Collaborative in-house development involving clinical and ehealth teams

Functionality of previous cardiology system

(SCI-CHD) enhanced

Initially tested in 2 wards with high volume complex discharges

System refined and functionality enhanced

Spread plan implemented – iterative approach to refinement

Page 19: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Features of EDD

Provides workflow for clinicians to construct discharge record from point of admission to discharge from hospital

Uses information from primary care (ECS) to support discharge process

Populates the shared patient record

Uses national standard DM&D drug dictionary

Utilises Electronic Document Transfer (EDT) technology

Built-in safety features – warfarin, medicine changes

Optimises Pharmacy workflow

Page 20: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Benefits of EDD

Ensures effective and timely communication between clinicians

Enhances collaboration between hospital and primary care

Improves medicines reconciliation across care boundaries

Improves accessibility to discharge records Reduces delays in prescriptions reaching

pharmacy Final discharge letter not always required

Page 21: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Pharmacy Care Plan

Testing a model for clinical communication at interface

High risk patients identified in secondary care Locality pharmacist resource can be directed to

the high risk patients in primary care Streamlined follow up of pharmaceutical care

needs Phase 2 allows creation of care plan not related

to hospital discharge Aim to involve community pharmacy in care

planning process(January 2014)

Page 22: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

The plan

Extract from eHealth Delivery Plan 2011 -14 Targets agreed with Scottish eHealth Department To support the move to a paperless environment the undernoted actions will be undertaken:-

A plan will be in place to deliver all communications covering the 14 national clinical information sources via Clinical Portal Clinical Portal will be available to all GP practices by 31st March 2012. 50% of Tayside clinicians will be accessing the portal by 31st March 2012

A single pharmacy care plan shared between Hospital and practice pharmacists will be piloted by 31st March 2012

New order communications and reporting service will be introduced to all GP practices by March 2012 New order communications and reporting service will be introduced to 75% of all secondary care by March 2012

By 31st March 2012 50% of all Immediate discharge summaries will be processed electronically via the EDD service

By April 2014 95% of referrals from optometrists to hospital eye services will be done electronically with the necessary business changes in place (Eyecare Integration project)

By April 2014 95% of all optometry claims will be made electronically (Eyecare Integration project)

Stewart Hunter eHealth Programme Manager November 2011

Page 23: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Foundation Doctor quote – Ninewells Hospital June 2013

“Use of the Clinical Portal has completely changed how I admit a patient”

Page 24: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Beena Raschkes, GP, Tayside

“The Electronic Discharge Document is delivered direct to the doctor’s desktop as soon as the patient is discharged. It’s legible, clear, consistent and concise and includes current and amended medication details. This is a great example of collaborative working within the NHS to support superb patient care”

Page 25: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

Tayside – where are we now?

60 wards using EDD

4000 EDD discharges per month

Spreading to Paediatrics and Mental Health

ePharmacy Care Plan tested and being spread as part of NHS Tayside Pharmacy Strategy

Page 26: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

What would we do differently?

Secure nursing engagement from the outset

Shift responsibility for implementation to clinical teams

Direct link to patient management system

Manage expectations

Expect new errors

Page 27: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

“Hot of the Press”

CMO letter(September 2013)-Medical Directors

accountable to Scottish Government for medicines reconciliation. Updated definition and measures

“Prescription for Excellence”(September 2013) – Scottish Government 10 year vision for

Pharmacy

Safer Use of Medicines Network – national

focus for multidisciplinary collaboration on medicines

reconciliation and high risk medicines

Page 28: Reducing Medication Errors Across the Whole Patient · PDF fileFramework in Scotland Quality Strategy – medicines reconciliation eHealth Strategy – vision for single shared medication

NHS Scotland eHealth Vision – single shared medication record


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