CLINICAL GOVERNANCE and MI Services : An introduction National MI Training Course University of...
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Transcript of CLINICAL GOVERNANCE and MI Services : An introduction National MI Training Course University of...
CLINICAL GOVERNANCE and MI Services :An introduction
National MI Training Course
University of Leicester
5th July 2007Mark Cheeseman
East Anglia MI Service, Ipswich
UK Medicines Information
Objectives
• Understand the principles of clinical governance, risk management and quality assurance; and apply these to the provision of Medicines Information Services
• Be aware of the UKMi Clinical Governance support programme
UK Medicines Information
Session Outline
Introduction
Clinical Governance overview 20 minutes
Practical : Using the Clinical Governance checklist 15 minutes
Discussion 5 minutes
UK Medicines Information
Session Outline continued
Introduction to Peer Review 5 minutes
Peer Review Workshop 30 minutes
Peer Review - report back 10 minutes
UK Medicines Information
Session outline continued
IRMIS Introduction 5 minutes
IRMIS Workshop 20 minutes
IRMIS Workshop - feedback 5 minutes
Concluding remarks 5 minutes
UK Medicines Information
Clinical Governance
“ Clinical Governance is the way in which NHS organisations quality assure their services and ensure that they are safe as well as creating the conditions for quality improvement year on year”
Chief Medical OfficerDoH website May 2003
www.dh.gov.uk/cmo
UK Medicines Information
Clinical Governance in pharmacy
• March 1998 - UKMi publishes “Risk Management Plans for MI Services”
• In September 1999, the Royal Pharmaceutical Society (RPSGB) published its framework - “Achieving Excellence in Pharmacy Through Clinical Governance”– identifies four main components for achieving
excellence in practice
UK Medicines Information
Clinical Governance in pharmacy continued
• Components of RPSGB’s “Achieving Excellence…”:- Clear lines of responsibility and accountability
for overall quality of clinical work
- Comprehensive programme of quality improvement activities (e.g. Audit, CPD, R&D)
- Clear policies aimed at managing risk
- Procedures for identification of poor performance
UK Medicines Information
Clinical Governance & MI services
CGWG remit :
• To develop QA programmes and associated documentation for MI services in the UK
• To monitor implementation of these schemes
UK Medicines Information
Clinical Governance & MI services continued
• To collate data on a national basis to inform discussion on service provision and E&T needs
• To advise UKMi Exec on quality aspects of MI services in the UK
• To maintain IRMIS and to share experience to improve practice and prevent recurrence of incidents
UK Medicines Information
Clinical Governance & MI services continued
Purpose of QA programmes :• Provide objective assessment of local
and regional MI services
• Provide feedback and recommendations to managers of MI services to ensure delivery of a high quality service
• Provide data for local service commissioners
UK Medicines Information
Clinical Governance & MI services continued
• In September 2000, UKMi published a briefing paper on Clinical Governance for MI services. This covers :– Framework
– Tools
– Formulating a Clinical Governance Action Plan
– Check List
UK Medicines Information
Quality
Achieving quality in MI services
Defining standards
Ensuring delivery of standards
Checking delivery of standards
UK Medicines Information
Achieving quality in MI services continued
UKMi Standards & Clinical Governance Group
National standards
Resources, CPD, Job description, E&T, SLA’s, KSF, Service commissioning
Competency Framework
Audit, Peer review / bench marking, Outcomes / indicators, Near-miss / incidents reports
Quality
Defining standards
Ensuring delivery of standards
Checking delivery of standards
UK Medicines Information
Clinical Governance framework for MI services
Components– Evidence-based practice– Risk Management– Research & Development– Continuing Professional Development– Audit– User involvement– Professional self-regulation
UK Medicines Information
Tools for Clinical Governance
Audit programmes
User satisfaction surveys
Benchmarking schemes
Evidence-based practice
Training programmes
Risk assessment
Risk management
Peer review
UK Medicines Information
Tools for Clinical Governance continued
Standards
Critical incident/ “near miss” reporting schemes
CPD
Dialogue with stakeholders
UK Medicines Information
Formulating a Clinical Governance Action Plan
….. a multistep process
• Baseline assessment of current practice
• Areas of focus
• Development of an action plan
• Action on agreed priorities
• Continuous monitoring
UK Medicines Information
Standards & guidance – UKMi
• UKMi Exec have set national standards
for:– Enquiry answering– Education and Training in MI– Publications– Risk Management– Clinical Governance– Specialist Information & Advisory Services
UK Medicines Information
Standards & guidance – UKMi continued
• UKMi Exec have produced an audit toolkit to assist the QA process - this programme involves :
– audit against national standards– current status report– discussions with MI pharmacist and manager– recommendations – final report provided
UK Medicines Information
Standards & guidance – UKMi continued
• Other QA initiatives included peer review, internal audit (e.g. enquirer satisfaction surveys) and benchmarking
UK Medicines Information
Risk Management - audit
Audit Report Template
• Action points from previous audit
• Summary of recommendations
• Centre profile
• Resources
UK Medicines Information
Risk Management - audit continued
Audit Report Template
• Performance review
• Comments by Local MI Pharmacist/
Pharmacy Manager
• External audit of RMICs
UK Medicines Information
Risk Management - Technicians
UKMi Accredited MI Training Scheme for Pharmacy Technicians
Stages Meet entry requirements for MI department and
technician
Pre-course work experience (start portfolio) Two-day residential induction course
Skill assessment
UK Medicines Information
Risk Management - Technicians
UKMi Accredited MI Training Scheme for Pharmacy Technicians continued…
Five practice enquiries for each enquiry type selected
Five competent formal observed assessments for each enquiry type selected
Regional assessment interview
Probationary period Certificate of accreditation
UK Medicines Information
Risk Management - policy
• Environment
• Equipment/Information Resources
• Outputs
• People
UK Medicines Information
Peer Review
• Tool to support Clinical Governance in MI
• Can be used within MI departments or between MI units
• Additional checking mechanism for enquiry answering
Continued:…
UK Medicines Information
Peer Review continued
• Promotes information sharing and spread of good practice
• Support regional MI audit programmes
• Guidance and examples on UKMi website (http://www.ukmi.nhs.uk/activities/clinicalGovernance/default.asp?pageRef=3)
UK Medicines Information
Peer Review Workshop
Three example enquiries to score according to UKMi QA criteria (provided)- assign level of complexity- score the four elements of the enquiry :
DocumentationAnalysisCoverageAnswer
UK Medicines Information
IRMIS
Aims:• Enables UKMi Exec, MI Managers and
SPMs to collate data on errors and near misses in MI
• To identify common themes and look at ways of avoiding future incidents
• To provide a datafeed to NPSA
UK Medicines Information
Risk Management - MI Incidents Reporting Scheme – IRMIS
Construction of data sets
– patient type– enquiry received by– enquiry processed by– answer checked by– answer given by– error detected by
– error type– reporter’s view of cause– estimated patient risk– enquirer acted on answer– patient outcome
UK Medicines Information
Risk Management - MI Error Reporting Scheme
• Secure web-based database hosted on NHSnet
• Anonymous reports
• Electronic reporting only
• CGWG monitor data
• Available to MI pharmacists and their managers
UK Medicines Information
IRMIS
• Scheme launched in January 2005 after pilot scheme in 2004
• 146 reports between January 2005 and April 2007
UK Medicines Information
Looking ahead
• Records Management (Good practice guide)• Electronic documentation of enquiry
(MiDatabank). Aim for all UKMi centres to adopt by 2008
• A model for provision of MI services in the UK• Workload Survey