Clinical Governance & MI: An Introduction

Clinical Governance & MI: Clinical Governance & MI: An IntroductionAn Introduction

Mark CheesemanMark CheesemanEducation & Training and Education & Training and

Secondary Care Support Medicines Secondary Care Support Medicines Information PharmacistInformation Pharmacist

East Anglia Medicines Information ServiceEast Anglia Medicines Information Service

AimsAims

Provide you with an introduction to the Provide you with an introduction to the principles of clinical governance, risk principles of clinical governance, risk management and quality assurance.management and quality assurance.

Describe the main tools used to ensure Describe the main tools used to ensure quality assurance in MI, including IRMIS.quality assurance in MI, including IRMIS.

Enable you to apply these principles and Enable you to apply these principles and tools in your own workplace.tools in your own workplace.

Learning OutcomesLearning Outcomes

By the end of this session you should be able By the end of this session you should be able

to:to:

Describe 15 of the UKMi standards.Describe 15 of the UKMi standards.

Be able to peer review an enquiry and Be able to peer review an enquiry and provide feedback.provide feedback.

SessionSession

BackgroundBackground

MethodsMethods

Key tools for MIKey tools for MI

Available supportAvailable support

SummarySummary

What does Clinical What does Clinical Governance mean to you?Governance mean to you?

DefinitionDefinition

““a framework through which NHS a framework through which NHS

organisations are accountable for organisations are accountable for

continuously improving the quality of the continuously improving the quality of the

services and safeguarding high standards of services and safeguarding high standards of

care by creating an environment in which care by creating an environment in which

excellence in clinical care will flourish.”excellence in clinical care will flourish.”

HistoryHistory

WHO. Principles of quality assurance; 1983.WHO. Principles of quality assurance; 1983.

DH. A First Class Service: Quality in the DH. A First Class Service: Quality in the new NHS; 1998.new NHS; 1998.

CMO/CNO. Supporting implementation of CMO/CNO. Supporting implementation of clinical governance. NHS Exec; 1999clinical governance. NHS Exec; 1999

How did this affect Pharmacy?How did this affect Pharmacy?

RPSGB published RPSGB published ‘Achieving excellence in ‘Achieving excellence in pharmacy through practice’ (1999)pharmacy through practice’ (1999)

1.1. Clear lines of responsibilityClear lines of responsibility

2.2. Quality improvement activitiesQuality improvement activities

3.3. Risk ManagementRisk Management

4.4. Poor PerformancePoor Performance

What has MI done?What has MI done?

UKMi Clinical Governance UKMi Clinical Governance Working GroupWorking Group

““Clinical Governance – a Clinical Governance – a briefing paper for briefing paper for Medicines Information Medicines Information Services”Services”

Focus:Focus:– FrameworkFramework– ToolsTools

FrameworkFramework

Right climate = acceptance and Right climate = acceptance and implementationimplementation

Features:Features:– Good ideas and practice sharedGood ideas and practice shared– Education and research valuedEducation and research valued– Blame only used in exceptional circumstancesBlame only used in exceptional circumstances– Collaboration rather than competitionCollaboration rather than competition

Does anyone have all these?Does anyone have all these?

Quality

Defining standards

Ensuring delivery of standards

Checking delivery of standards

How can we achieve quality?How can we achieve quality?

What tools can we use to What tools can we use to ensure quality?ensure quality?

Tools for Quality Tools for Quality

StandardsStandards

Audit programmesAudit programmes User satisfaction surveysUser satisfaction surveys Benchmarking schemesBenchmarking schemes Evidence-based practiceEvidence-based practice CPDCPD Training programmesTraining programmes

Tools for QualityTools for Quality

StandardsStandards

Audit programmesAudit programmes User satisfaction surveysUser satisfaction surveys Benchmarking schemesBenchmarking schemes Evidence-based practiceEvidence-based practice CPDCPD Training programmesTraining programmes

UKMi StandardsUKMi Standards

QA VisitsQA Visits MI User SurveyMI User Survey Workload SurveyWorkload Survey Enquiry Answering!Enquiry Answering! Personal CPDPersonal CPD NMITC, Advanced MI NMITC, Advanced MI

Training, NMITTCTraining, NMITTC


Risk Assessment/Risk Assessment/Management SchemesManagement Schemes

Appraisal schemesAppraisal schemes Incident/near miss Incident/near miss

reporting schemesreporting schemes Dialogue with principal Dialogue with principal

stakeholdersstakeholders Involvement with Involvement with

commissioning commissioning specialist servicesspecialist services


Risk Assessment/Risk Assessment/Management SchemesManagement Schemes

Appraisal schemesAppraisal schemes Incident/near miss Incident/near miss

reporting schemesreporting schemes Dialogue with principal Dialogue with principal

stakeholdersstakeholders Involvement with Involvement with

commissioning commissioning specialist servicesspecialist services

Risk Management Risk Management PolicyPolicy

Peer ReviewPeer Review IRMISIRMIS

Who are yours?Who are yours?

Who commissions Who commissions your service?your service?

UKMi Standards & Clinical Governance Working 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

How can we achieve quality?How can we achieve quality?

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

Monitor and continuously update national standards

for MI Services

Liaise with UKMi Exec& NPSA

Maintain IRMIS

Co-ordinate

audit/surveys Collate data from QA

programmes

Monitor implementation of QA programmes

Develop QA programmes

& documentation

Advise UKMi Exec

Respond to UKMi Exec

relating to Clinical Governance.

Conduct research

UKMi CGWG

What should you be aware of?What should you be aware of?

UKMi Standards UKMi Standards

QA VisitsQA Visits

MI User SurveyMI User Survey

Risk Management PolicyRisk Management Policy

IRMISIRMIS

Peer ReviewPeer Review

StandardsStandards

Resources Resources

Enquiry answering Enquiry answering processprocess

Publications and pro-Publications and pro-active workactive work

TrainingTraining

Research & Research & developmentdevelopment

Risk ManagementRisk Management

Specialist Advisory Specialist Advisory ServicesServices

StandardsStandards

StandardStandard

Risks of non-ImplementationRisks of non-Implementation

Potential outcomes if not implementedPotential outcomes if not implemented

SatisfactorySatisfactory

CommendedCommended

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.

ExampleExample

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

QuizQuiz

Quiz (1)Quiz (1)

1.1. How quickly should the MI phone be answered How quickly should the MI phone be answered within?within?A) 10 secondsA) 10 secondsB) 20 secondsB) 20 secondsC) 40 secondsC) 40 seconds

2.2. MI staff supervising trainees in MI do not need to MI staff supervising trainees in MI do not need to have attended formal training in training. have attended formal training in training. True or False?True or False?

Quiz (2)Quiz (2)

3.3. How long should enquiries be kept for?How long should enquiries be kept for?A) 8 yearsA) 8 yearsB) 25 yearsB) 25 yearsC) A and bC) A and b

4.4. A MI pharmacist/technician should be A MI pharmacist/technician should be available to take a call within 5 minutesavailable to take a call within 5 minutesSatisfactory or commended?Satisfactory or commended?

Quiz (3)Quiz (3)

5.5. Which of the following statements is correct:Which of the following statements is correct:

a)a) Non-MI pharmacists should have MI training as Non-MI pharmacists should have MI training as part of their inductionpart of their induction

b)b) Non-MI pharmacists receive MI training as an Non-MI pharmacists receive MI training as an annual refresher/updateannual refresher/update

c)c) Both of the aboveBoth of the above

6.6. Headsets should be used by all MI staff when using Headsets should be used by all MI staff when using MiDatabank True or false?MiDatabank True or false?

Quiz (4)Quiz (4)

7.7. What is classed as a ‘satisfactory’ answer when What is classed as a ‘satisfactory’ answer when reviewing enquiries? reviewing enquiries? A) 80% - 90%A) 80% - 90%B) 85% – 95%B) 85% – 95%C) 100%C) 100%

8.8. How long should pre-registration pharmacists spend in How long should pre-registration pharmacists spend in MI?MI?A) 2 weeksA) 2 weeksB) 4 weeksB) 4 weeksC) 6 weeksC) 6 weeks

Quiz (5)Quiz (5)

9.9. How often should the MI centre’s risk How often should the MI centre’s risk management policy be reviewed?management policy be reviewed?

A) Every yearA) Every year

B) Every 2 yearsB) Every 2 years

C) Every 3 yearsC) Every 3 years

Quiz (6)Quiz (6)

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

A) Within 3 months A) Within 3 months

B) Within 6 monthsB) Within 6 months

C) Within 12 monthsC) Within 12 months

Quiz (7)Quiz (7)

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

True or False?True or False?

12. All permanent MI pharmacists should identify a 12. All permanent MI pharmacists should identify a research project they plan to undertake or research project they plan to undertake or supportsupport

Satisfactory or commended?Satisfactory or commended?

Quiz (8)Quiz (8)

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


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


Quiz (9)Quiz (9)

15. MI technicians should undertake the UKMi 15. MI technicians should undertake the UKMi Accredited MI Technician Training scheme within:Accredited MI Technician Training scheme within:

A) Within 6 months A) Within 6 months

B) Within 12 monthsB) Within 12 months

C) Within 24 monthsC) Within 24 months

QA VisitsQA Visits

Regional centre -> Regional centreRegional centre -> Regional centre

Regional centre -> Local centreRegional centre -> Local centre

Audit centre against national standards AND Audit centre against national standards AND peer review sample of enquiriespeer review sample of enquiries

National templateNational template

National TemplateNational Template

Summary of the MI service, recommendations from last Summary of the MI service, recommendations from last visit and this visitvisit and this visit

– Performance ReviewPerformance Review– Resources Resources – Enquiry answering processEnquiry answering process– Publications and pro-active Publications and pro-active – workwork– TrainingTraining– Research & developmentResearch & development– Risk ManagementRisk Management– Specialist Advisory ServicesSpecialist Advisory Services

Audit StandardsAudit Standards

User SurveyUser Survey

What do you think is What do you think is

important to users of your important to users of your

MI service?MI service?


Developed to provide statistically robust Developed to provide statistically robust questionnaire.questionnaire.

Eleven questions linked to provide validityEleven questions linked to provide validity Three categories measuring different Three categories measuring different

aspects of user satisfaction:aspects of user satisfaction:– Answer satisfactionAnswer satisfaction– General Helpfulness/Time SatisfactionGeneral Helpfulness/Time Satisfaction– Ease of Contact SatisfactionEase of Contact Satisfaction


Conducted at least once per annum or more Conducted at least once per annum or more frequently or on an ongoing basisfrequently or on an ongoing basis

No. of questionnaires sent out should be a No. of questionnaires sent out should be a suitable sample related to the no. of suitable sample related to the no. of enquiries. enquiries.

e.g. 0-100 enquiries/month, 60 surveys per e.g. 0-100 enquiries/month, 60 surveys per yearyear

Examples of risk in Examples of risk in

your MI centre?your MI centre?

Risk Management PolicyRisk Management Policy

EnvironmentEnvironment

Equipment & Information ResourcesEquipment & Information Resources

OutputsOutputs

PeoplePeople

Incident Reporting in Medicines Incident Reporting in Medicines Information System (IRMIS)Information System (IRMIS)

Secure web-based database (NHSnet)Secure web-based database (NHSnet) Complement existing NHS reporting systems Complement existing NHS reporting systems

– NOT a replacement– NOT a replacement Incidents Incidents

– – local and IRMISlocal and IRMIS Anonymous dataAnonymous data

IRMIS - what information is IRMIS - what information is recorded?recorded?

What information is recorded?What information is recorded?

Near miss or error?Near miss or error?

Near miss or error?Near miss or error?

Near miss Near miss Any situation where wrong, misleading or incomplete Any situation where wrong, misleading or incomplete information or advice which may or may not have caused information or advice which may or may not have caused harm to a patient, would have been given to the enquirer if an harm to a patient, would have been given to the enquirer if an intervention had not been made.intervention had not been made.

Error Error Any situation where wrong, misleading or incomplete Any situation where wrong, misleading or incomplete information or advice may or may not have caused harm to a information or advice may or may not have caused harm to a patient, was given to an enquirer.patient, was given to an enquirer.

ExamplesExamples

SSRIs in pregnancySSRIs in pregnancy

IV compatibility – furosemide and ISDNIV compatibility – furosemide and ISDN

Sodium hyaluronate - refrigerationSodium hyaluronate - refrigeration

IRMIS- What happens to the data?IRMIS- What happens to the data?

Serious incidents Serious incidents – Notified to IRMIS monitor (electronic)Notified to IRMIS monitor (electronic)– Reporter consentReporter consent– Learning points circulated to Regional DirectorsLearning points circulated to Regional Directors– Data used to compile quarterly report.Data used to compile quarterly report.

Above and routine incidentsAbove and routine incidents– IRMIS monitor ensure report is completely anonymousIRMIS monitor ensure report is completely anonymous– Learning points highlightedLearning points highlighted– Report presented to UKMi ExecReport presented to UKMi Exec– Paper copy -> regional MI managers for discussion at local Paper copy -> regional MI managers for discussion at local

meetingsmeetings– Summary posted on UKMi siteSummary posted on UKMi site


Monitor standard of enquiry answering Monitor standard of enquiry answering All centres expected to undertake peer reviewAll centres expected to undertake peer review Encourage sharing of:Encourage sharing of:

– ExperienceExperience– Knowledge Knowledge – ExpertiseExpertise

Should be non-judgmentalShould be non-judgmental Provide professional supportProvide professional support


Peer review allows:Peer review allows:– Regular objective feedback on performanceRegular objective feedback on performance– Feedback and suggestions on improving the Feedback and suggestions on improving the

quality of the servicequality of the service– Sharing of ideas and learning from colleaguesSharing of ideas and learning from colleagues– Development of own practice and serviceDevelopment of own practice and service– Identification of learning needsIdentification of learning needs


UKMi provide:UKMi provide:

– Definition for ranking enquiriesDefinition for ranking enquiries

– Summary of criteria for grading answers to Summary of criteria for grading answers to enquiries using documented evidenceenquiries using documented evidence

– Enquiry assessment formEnquiry assessment form


DocumentationDocumentation

AnalysisAnalysis

CoverageCoverage

AnswerAnswer


InternalInternal– Sample enquiries (manager led)Sample enquiries (manager led)– Sample enquiries (team led)Sample enquiries (team led)– Sample enquiries (user feedback)Sample enquiries (user feedback)– Group discussionGroup discussion

ExternalExternal– Peer Review visitsPeer Review visits– Regional network meetingRegional network meeting


WorkshopWorkshop

WorkshopWorkshop

Group workGroup work

Peer Review enquiryPeer Review enquiry

Use national documentationUse national documentation

Present findings to the groupPresent findings to the group

What did you like about doing this?What did you like about doing this?

What did you not like?What did you not like?

What about wider clinical What about wider clinical governance issues?governance issues?

Hospital clinical pharmacy servicesHospital clinical pharmacy services FormulariesFormularies Medicines management programmesMedicines management programmes Prescribing advicePrescribing advice MMC/Area Prescribing CommitteesMMC/Area Prescribing Committees Local guideline writing/protocolsLocal guideline writing/protocols Dissemination of good practiceDissemination of good practice Input into audit programmes and quality initiativesInput into audit programmes and quality initiatives Training and CPD programmesTraining and CPD programmes Shared care supportShared care support

Where can you access Clinical Where can you access Clinical Governance information for MI?Governance information for MI?

SummarySummary

Provided you with an introduction to the Provided you with an introduction to the principles of clinical governance, risk principles of clinical governance, risk management and quality assurance.management and quality assurance.

Described the main tools used to ensure Described the main tools used to ensure quality assurance in MI, including IRMIS.quality assurance in MI, including IRMIS.

Enabled you to apply these principles and Enabled you to apply these principles and tools in your own workplace.tools in your own workplace.

Learning OutcomesLearning Outcomes

You should now be able to:You should now be able to:

Describe 15 of the UKMi standards.Describe 15 of the UKMi standards.

Be able to peer review an enquiry and Be able to peer review an enquiry and provide feedback.provide feedback.

QuestionsQuestions

ContactContact

WebsiteWebsitehttp://www.ipswichhospital.nhs.uk/microsites/pharmacy/information.asphttp://www.ipswichhospital.nhs.uk/microsites/pharmacy/information.asp

Tel No. Tel No.

01473 70443101473 704431

Email Email [email protected]@ipswichhospital.nhs.uk

http://www.ipswichhospital.nhs.uk/microsites/pharmacy/information.asp

mailto:[email protected]

Clinical Governance & MI: An Introduction

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