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Medication Management
Plan Implementation
An Emergency Department
Perspective
Mixed Adult and Paediatric
Major Urban
51000 presentations per year
Approximately 150 patients per day
40% admission rate
Jointly started by hospital pharmacy and ED
Hospital wide short education sessions
including ED
Posters
Intensive education sessions in Dec
2014/January 2015
Continuing posters/education session (but less
intensive)
District Educator
Interactive 20 minute session
All ED doctors and nurses
Daily sessions
HETI online module
ED Staff specialist : JMO teaching session,
Registrar teaching session, Facebook page
reminders, email reminders
16 Dec 2014: 71% compliance with MMP
Commitment by hospital pharmacy,
Emergency department and hospital executive
to improve compliance with MMP
Education and senior buy in
MMP added to JMO Ward checklist
Directive from hospital executive that MMP
must be kept at the bedside
Extension of what we should be doing anyway
Advised staff to complete when they are
taking the history
Doubling up between MMP and medical
record
Allowed to use MMP only
In practice written in both
Does not take long
Time to complete
Senior buy in
Nurses had difficulty getting medication lists
from GPs
Inpatient teams think it is ED’s job to do it
100% compliance in February, 2015
In June, 2015, still >95% compliance
Continuing education sessions
Consultant checking on rounds
Consultant sign off and Nursing sign off
Regular teaching sessions for JMO/Registrar
Emails and social media (Facebook page
reminders)
Pharmacist in ED checking
All clinical staff are educated from district
educators
MMP Policy Directive developed, approved by Clinical Council and disseminated to staff
MMP Resource Folders Reference cards for MMP issued to clinical staff MMP Integration into existing QI initiatives eg
Patient Journey Boards Process commences in ED for emergency
admissions and Pre-admission Clinic for elective surgical patients
Blue handover stickers for medical officers amended to include MMP as a handover action
Four consecutive audits were conducted from
December 2014 to February 2015.
Total of 401 MMPs captured
Audit focused on use of MMP on admission
and BPMH
73%
94% 98%
100%
0
10
20
30
40
50
60
70
80
90
100
16-Dec-14 28-Jan-15 04-Feb-15 10-Feb-15
% o
f p
atie
nts
wit
h M
MP
39%
61%
87%
92%
0
10
20
30
40
50
60
70
80
90
100
16-Dec-14 28-Jan-15 4-Feb-15 10-Feb-15
% o
f p
atie
nts
N1=87 N2=103 N3=105 N4= 106
0% 20% 40% 60% 80% 100%
1
Percentage of MMPs initiated by profession
Pharmacist
Medical Officer
Nurse
MMP included on Patient Journey Boards (PJB) –
Business Rules developed and implemented
MMP included in nursing clinical handover tools
Peri-operative clinical handover document
includes MMP
Orientation programs reviewed to include MMP
Pharmacists rostered to attend PJB rounds
Pharmacists allocated pagers to facilitate their
attendance in PJB rounds
Need senior ED clinical leadership
Patient safety enhancement
Not a massive change from current practice
Collaborative approach between ED and
inpatient team
Regular reinforcement
The MMP project won the South Western
Sydney Local health district quality award for
2015 for category of " Patient and carers as
partners".
The title of the submission was " The new
multidisciplinary team : Doctors , pharmacists,
nurses administrative staff and patients.