Transcript No Slide Title

CLINICAL GOVERNANCE
and MI Services :
An introduction
National MI Training Course
University of Leicester
5th July 2007
Mark Cheeseman
East Anglia MI Service, Ipswich
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
IRMIS Workshop
5 minutes
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 Officer
DoH website May 2003
www.dh.gov.uk/cmo
UK Medicines Information
Clinical Governance...
So what’s
pharmacy
doing about
it...?
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
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Formulating a Clinical Governance Action
Plan
–
Check List
UK Medicines Information
Achieving quality in
MI services
Defining
standards
Ensuring delivery
of standards
Quality
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
Defining
standards
Ensuring delivery
of standards
Quality
Checking delivery of
standards
Audit, Peer review / bench marking, Outcomes / indicators,
Near-miss / incidents reports
UK Medicines Information
Clinical Governance
framework for MI services
Components
–
–
–
–
–
–
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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
Training programmes
User satisfaction surveys
Risk assessment
Benchmarking schemes
Risk management
Evidence-based practice
Peer review
UK Medicines Information
Tools for Clinical Governance
continued
Standards
Critical incident/
“near miss” reporting
schemes
UK Medicines Information
CPD
Dialogue with
stakeholders
Formulating a Clinical
Governance Action Plan
….. a multistep process
•
Baseline assessment of current practice
•
Areas of focus
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Development of an action plan
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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
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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
 Two-day
 Skill
work experience (start portfolio)
residential induction course
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
Practical
Clinical Governance
checklist
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
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Promotes information sharing and spread
of good practice
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Support regional MI audit programmes
•
Guidance and examples on UKMi website
(http://www.ukmi.nhs.uk/activities/clinical
Governance/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 :
Documentation
Analysis
Coverage
Answer
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
–
–
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patient type
enquiry received by
enquiry processed by
answer checked by
answer given by
error detected by
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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
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Anonymous reports
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Electronic reporting only
•
CGWG monitor data
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Available to MI pharmacists and their
managers
UK Medicines Information
IRMIS
•
Scheme launched in January 2005 after
pilot scheme in 2004
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146 reports between January 2005 and
April 2007
UK Medicines Information
IRMIS Workshop
4 scenarios
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
UK Medicines Information
In conclusion...
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Safe systems of work are not an optional
extra
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Clinical Governance involves all of us
•
Risk Management is a major part of safe
working and Clinical Governance
•
Be aware of areas of risk and how they
can be minimised
UK Medicines Information