qum indicator 5.3 a quality improvement program ensuring explanations for changes to medication...

QUM Indicator 5.3

A Quality Improvement Program

Ensuring explanations for changes to medication therapy in the discharge summary

Presenter

Insert your hospital logo here

Explaining changes on the discharge medicines list

Overview

• Background

• Aims and methods

• Feedback on current practices

• Education- ‘Support 4 Success’

• Questions


Background

• NSW Therapeutic Advisory Group (NSW TAG) survey to identify top 3 issues in medication safety.

-SAFER Medicines Group -TAG and TAG Net members

• Top issue to address: Medication changes and explanations for changes in the discharge summary


About NSW TAG

• Independent, not-for-profit organisation• Membership consisting of clinical

pharmacologists, pharmacists and other clinicians from teaching hospitals

• Representatives from every Drug and Therapeutics Committee across NSW.

• Core goal to promote the Quality Use of Medicines

• www.nswtag.org.au


What is the purpose of the discharge summary?

Frequently, the discharge summary is the only communication provided to the General Practitioner (GP) about their patients’ and the events that occurred whilst their patients’ were in hospital.


Medication Error and ADEs

• Transferring patients are those most vulnerable.1

• Poor quality communication1


Identified gaps in practice

• “Inaccurate, incomplete and illegible” information are common deficiencies within the discharge summary2

In the medicines list:

-Omitted medications 3,4

-Medication not previously prescribed (or justified) 3,4


Aims

1. To use drug use evaluation (DUE) methodology to describe the extent to which explanations for medicine therapy changes are being documented in discharge summaries from participating NSW and ACT hospitals.

2. To increase awareness of the APAC Guiding Principles within the hospital setting, in particular “communicating medicines information” (Guiding Principle 9).5

3. To optimise the discharge summary as a communication tool to General Practitioners (GPs) on explanations for alterations to patients’ medicine therapy.


QUM Indicator 5.3

• What are the Quality Use of Medicine (QUM) Indicators?

• QUM Indicator 5.3 aims to measure6: Percentage of discharge summaries

that include medication therapy changes and explanations for changes

• Quality improvement initiative involving 16 hospitals across NSW/ACT


Defining “changes” to and “explanations” for medication therapy?

Refers to changes to the patient’s pre-admission regimen which are intended to continue after discharge2

– New medication– Change in the dose, form, route or frequency of a

medicine taken prior to admission– Cessation of a medicine taken prior to admission

Explanations for changes: Should include sufficient detail to inform future management decisions in the discharge summary or discharge letter.


Completing high quality discharge summaries

National E-Health Transition Authority (NEHTA) Continuity of Care

program March 20107

Barriers include:

• devaluing of discharge summaries

• over emphasis on coding requirements

• uncertainty over what information a GP desires


Support for quality improvement in the discharge summary

Work toward improving the processes and forms required to produce a quality discharge summary is underway.

Nationally: Australian Pharmaceutical Advisory Council (APAC)

National E-Health Transition Authority (NEHTA)Australian Commission for Safety and Quality in Health Care

Statewide:NSW Health Systems SupportForms committeeNSW Therapeutic Advisory Group NSW/ACT program (QUM Indicator 5.3)


DUE Methodology

Feedback

SHPA Drug Use Evaluation Cycle8


Program Methods

Ethics approval

Support from senior clinicians

Data collection

Education and Feedback

Data collection

Evaluation, Feedback and Sustainability

August 2010

June 2011


Pre-intervention results continued

Hospital NSW/ACT

Baseline Baseline

Patients discharged where a discharge summary is documented in the notes

Patients who had medication reconciliation undertaken on admission

Discharge summaries which comply with NSW Policy (PD2007_092) for a documented list of medications on admission and on discharge


Pre-intervention results

Hospital NSW/ACT

Baseline Baseline

Discharge summaries which should have explanations for medicine therapy changes

Discharge summaries which document all changes to medicine therapy

Number of medicine therapy changes which require an explanation

Of those, proportion which had a documented explanation for the change


Pre-intervention results continued…

Hospital NSW/ACT

Baseline Baseline

Of the discharge summaries reviewed, those which were computer generated

Discharge summary templates prompting documentation for changes to medications

Number of discharge summary templates reviewed


Discussion

• Encouraging aspects of our results

• Aspects to improve


EDUCATION


Educational Tools: Expert Advisory Committee

• Clinical Education and Training Institute (CETI) Representatives:– JMO Forum – Prevocational Training Council / Director Medical

Services

• Head of Department , General Paediatrics• General Practitioner• Education and Training Pharmacist• Quality Manager• Head of Department, Clinical Pharmacology


Educational Intervention Tools

• Discharge Summary Workshop

• “Top Tips” lanyard cards

• Checklist for JMO Term Supervisors

• Feedback presentation today!


Discharge Summary Workshop

• Target audience: Junior Medical Officers

• Consists of:

-PowerPoint® presentation

(Good, great and ugly discharge summary examples)

-Practical case examples and activities


Lanyard Cards


Checklist for JMO Term Supervisors


Support 4 Success!

Many staff members can provide support and contribute to make this program an successful• JMOs• Term supervisors and their senior team

members• Pharmacists• Nursing


Hospital Program Contacts

• Clinical Champion:

xxxxx

• Local Project Team:

xxxxx


References

1. Easton K, Morgan T, Williamson M. Medication safety in the community: A review of the literature. National Prescribing service. Sydney, June 2009.

2. Wong JD, Bajcar JM, Wong GG et al. Medication reconciliation at hospital discharge: Evaluating Discrepancies. Ann Pharmacother 2008;42:1373-1379.

3. Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential. Int J for Qual in Health Care 2005; 17(1):15-22.

4. Perren A, Previsdomini M, Cerutti B, et al. Omitted and unjustified medications in the discharge summary. Qual Saf Health Care 2009;18:205-208.

5.Guiding principles to achieve medication management: Australian Pharmaceutical Advisory Council; 2005:1-55.

6. Indicators for Quality Use of Medicines in Australian Hospitals: NSW Therapeutic Advisory Group, 2007.

7.Continuity of Care Program- National E-Health Transition Authority, March 2010: Issues and barriers faced by Junior Hospital Doctors for the Implementation of the Discharge Summary (unpublished)

8. SHPA Committee of Specialty Practice in Drug Use Evaluation. SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals. JPPR 2004; 34(3): 220-222.

.


Acknowledgements

• NSW TAG – SAFER Medicines Group– Drug Use Evaluation Support Group

• Indicator 5.3 Expert Advisory Committee


Questions/Discussion

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