The Australian Commission on Safety and Quality in Health Care held a one day national seminar in Sydney on 11 October 2010 to introduce the National Medication Management Plan (MMP) and other resources to assist in the implementation of medication reconciliation in hospitals.
The objectives of the seminar were to:
- Introduce the National Medication Management Plan (MMP) as a standard form for recording medication histories and reconciling medicines;
- Inform participants about the tools and resources available to support the implementation of the MMP and the process of medication reconciliation; and
- Provide a forum where representatives from the jurisdictions and invited speakers could showcase initiatives for implementing medication reconciliation and improving continuity of medication management.
Program for the seminar (PDF 35 KB)
The seminar was attended by representatives from the 15 health services across Australia participating in the World Health Organisation (WHO) High 5s Medication Reconciliation patient safety initiative as well as medication safety experts, representatives and clinicians from the States and Territories, the private hospital sector, and members of the Commission’s Medication Continuity Expert Advisory Group.
Question
Answer which opens up
Morning session
- Opening Address from Professor Chris Baggoley
Professor Chris Baggoley, Chief Executive of the Australian Commission on Safety and Quality in Health Care (the Commission) welcomed attendees and presented the case for medication reconciliation (PDF 528 KB). He presented evidence that as many as 50% of hospital medication errors occur at interfaces of care (Sullivan C, Gleason KM et al, J Nurse Care Qual 2005) with errors occurring at all points of transition in care. There was good evidence that the process of medication reconciliation reduces medication errors and adverse drug events (Tam VE, Knowles SR et al CMAJ, 2005 and Rozich JD, Rsear RK et al Jt Comm J Qual Saf, 2004)
- The Case for Medication Reconciliation – Margaret Duguid
Medication reconciliation was one of six high priority areas for action identified in the National Medication Safety Scoping Study Committee Report (PDF 2088 KB) published in 2009. Professor Baggoley confirmed the Commission’s commitment to improving continuity of medication management through Australia’s involvement in the WHO High 5s Medication Reconciliation patient safety initiative and the inclusion of criteria relevant to medication reconciliation within the National Safety and Quality Medication Safety Standard.The very real adverse outcomes that can occur when there is no formal process of medication reconciliation in place in hospitals were highlighted by two case studies in The Case for Medication Reconciliation Patient Stories by Margaret Duguid, Pharmaceutical Advisor (PDF 192 KB). This session was followed by an overview of the medication reconciliation process, and an introduction to the Medication Management Plan form andmedication reconciliation resources (PDF 1990 KB) by Margaret Duguid, Pharmaceutical Advisor, Australian Commission on Safety and Quality In Health Care. The MATCH UP Medicines educational poster and brochure on medication reconciliation were presented.
- Queensland Health MAP 4 years down the track – Dr Ian Coombes and Nina Muscillo
Queensland Health MAP 4 years down the track (PDF 432 KB)Dr Ian Coombes and Nina Muscillo (Safe Medication Management Unit, Medication Services, Queensland Health) presented on the state wide implementation of the Medication Action Plan in Queensland from 2006 to the present. The presentation included an analysis of the drivers and enablers for successful implementation of medication reconciliation and the unique challenges faced by rural facilities without onsite pharmacists.
- Medication Reconciliation in WA – Luke Slawomirski
Medication Reconciliation in WA (PDF 453 KB)Luke Slawomirski from the Office of Safety and Quality in Healthcare, WA Health, provided an overview of Western Australia’s Safety and Quality Investment for Reform (SQuIRE) program. This program provides funding for quality improvement initiatives in public hospitals in WA. Medication Reconciliation is one of eight programs in the SQuIRE bundle. Hospitals implementing this initiative are required to report on percentage of patients with all steps of the medication reconciliation completed on admission and on discharge. There has been a steady increase in the numbers of patients receiving medication reconciliation on admission and discharge during the period from January 2007 to May 2009. However several challenges remain including the need for greater engagement of clinicians and senior management.
- South Australian Initiatives in Medication Reconciliation – Naomi Burgess
South Australian Initiatives in Medication Reconciliation – wins, losses and performance indicators (PDF 708 KB)Naomi Burgess of the Pharmaceutical Services and Strategy Branch, SA Health, described how medication reconciliation had been introduced during the implementation of the APAC Guiding principles for achieving continuity of medication management throughout the public hospital sector in South Australia. A set of key performance indicators have been developed which hospitals are required to report on. There have been significant improvements in the percent of patients being supplied with correct medicines at admission and discharge. There has also been a reduction in the cost of medicines and risks of medicine misadventure on discharge.
Afternoon session
- NSW Ambulance T.A.B.L.E.T.S Program – Phil Good
NSW Ambulance T.A.B.L.E.T.S Program (PDF 662 KB)Phill Good (Patient Safety Manager, New South Wales Ambulance Service) recounted the success of the T.A.B.L.E.T.S project in New South Wales. The Tablets are bagged letting emergency treat safely (T.A.B.L.E.T.S) project started in 2006 with one ambulance station and is now state-wide covering 178 stations. All ambulance vehicles carry clear plastic bags with a medication label and ambulance officers are instructed to keep the blood pressure cuff in the plastic bag to act as a reminder to retrieve patients’ medicines. Over 80% of patients transported via ambulance to hospital in NSW now arrive with their medicines.
- Medication Reconciliation – successful models – Dr Simone Taylor
Medication Reconciliation – successful models (PDF 1041 KB)Dr Simone Taylor, (Senior Pharmacist – Emergency Medicine and Research, Austin Health, Victoria.) summarised the latest Australian and international evidence in support of medication reconciliation. A successful model of medication reconciliation was considered to be timely (within 24 hours was suitable for most admitted patients), available to all patients, accurate, comprehensive and sustainable. Dr Taylor summarised the challenges involved in providing a comprehensive medication reconciliation service across the hospital including inpatient and outpatient care. Whilst it was acknowledged that reconciling medicines was a role mainly performed by pharmacists there was a need for other healthcare professionals to become involved and take responsibility for ensuring medication accuracy across the continuum of care. Dr Taylor presented a range of possible solutions including capacity building of other craft groups to assist pharmacists with medication reconciliation, the use of pharmacy technicians to take medication histories, more pharmacists in emergency departments, education of consumers and the development of a risk screening tool to enable high risk patients to be targeted.
- Medication Reconciliation Using Electronic Tools – The Tasmanian Experience – Ben Chalmers
Medication reconciliation using electronic tools – The Tasmanian experience (PDF 1114 KB)Ben Chalmers, (Specialist Pharmacist Information Management, Royal Hobart Hospital, Tasmania,) presented the Tasmanian experience of implementing an electronic system for medication reconciliation Two software tools were used : one for clinical pharmacy admission interviews, reconciliation and medication management and another to electronically transfer discharge information to General Practitioners. The project has achieved a number of successes but has also faced some challenges. There were barriers to implementation of the clinical pharmacy system throughout hospitals in the areas of : governance of the project, human issues with change, and hardware and information technology (IT) issues. Work is ongoing to upgrade hardware, align with new NeHTA standards and to improve integration of systems across the various clinician groups to improve the overall useability of the software systems.
- Implementing Medication Reconciliation processes – Applying best practice in the rural setting – Wendy McIntosh
Implementing Medication Reconciliation processes – Applying best practice in the rural setting (PDF 705 KB)Wendy McIntosh (Program Manager Clinical Quality, Western Australian Country Health Service) provided an account of the innovative approaches being adopted by rural health practitioners to overcome the tyranny of distance faced by clinicians working within the WA country health service, an area which spans 2.5 million square kilometres and includes 70 hospitals. The area has very limited pharmacy resources, a high staff turnover and large numbers of visiting medical practitioners. Medication reconciliation was implemented in six regional resource centres as part of the SQuIRE initiative. A number of innovative solutions using various technologies have been introduced. However using technology did not necessarily mean “no errors” and there were barriers, including limited access to suitable printers and the reluctance by some clinicians to use new technologies or to change their business practices. Medication reconciliation was not being done consistently because of the complex environment of multiple providers, competition for scare resources and a lack of clarity around ownership of the process. Future solutions include improving communication between providers using technology where possible, development of a standard operating protocol for medication reconciliation, using the principles of lean thinking and clarification around the role of various clinicians in the process.
- Presentation: Medication reconciliation in the private sector – Dr Megan Robertson (PDF 91 KB)
- Are you making a difference? Measuring performance in medication reconciliation – Helen Stark
Are you making a difference? Measuring performance in medication reconciliation (PDF 1268 KB)
International Medication Reconciliation websites (PDF 101 KB)Helen Stark (Senior Project Officer, Australian Commission on Safety and Quality in Health Care) provided an overview of international medication reconciliation initiatives and websites including the Canadian Safer Healthcare Now! Campaign and the IHI 5 million lives saved campaign. There was no shortage of measures and tools available for hospitals to measure performance in medication reconciliation. Medication reconciliation indicators will be included in the revision of the Indicators for Quality Use of Medicines in Australian Hospitals that will occur in 2011. - Panel Discussion
During the final session of the day a panel provided their perspectives on the challenges of implementing medication reconciliation across the continuum of care. The panel session was moderated by Dr Ian Coombes (Safe Medication Management Unit, Medication Services, Queensland Health). Each of the panellists commented on how the adverse events from the two case studies presented in the morning session could have been prevented. See below for a summary of the comments made by the panellists:
- Run a public education campaign on managing medicines wisely which could be run in high schools, in the media, on community radio, T.V and in other places like buses, trains, supermarkets, clubs as well as doctors’ surgeries Panel member – Consumer
- Put in place a process in medical practices to ensure that practice nurses and doctors and receptionists check that patients have a list of their medicinesPanel member – Consumer
- Implement systems to ensure accurate and timely arrival of discharge summaries to GP surgeriesPanel member – General Practitioner
- Implement an electronic solution with forcing functions in software to ensure medication reconciliation occurs every time on admission and dischargePanel member – Specialist Physician
- Engage nursing staff in medication reconciliation process as they are the largest clinical workforce in hospitalsPanel member – Nurse
- Ensure medication review occurs on a timely basis during hospitalisation and confirm medication history with more than one sourcePanel member – Hospital Pharmacist
- Make better utilisation of community pharmacists in preparing up-to-date medication lists for patients being admitted to hospitalPanel member – Community Pharmacist
- Use innovative technologies for medication reconciliationPanel member – Rural Health Practitioner
- Form a multi-disciplinary committee (metro/rural and community-based providers as well as hospitals) to discuss medication reconciliation with a focus on admission and discharge, clarification of roles and responsibilities and development of some performance measures to monitor implementation progressPanel member – State and Territory Quality and Safety Practitioner
During the panel discussion Ms Patti Warn (Consumer Health Forum of Australia) provided a compelling account of the range of experience of elderly patients presenting to an Emergency Department. Her interview notes (PDF 9 KB) are available for viewing.
- Where to next?
Participants learned that medication reconciliation is a complex, multidisciplinary activity requiring the involvement of nursing and medical staff as well as pharmacists. There was a need to build capacity amongst practitioners with the skills to obtain a best possible medication history and competently reconcile medicines. The tools being developed by the Commission would assist in this process. Successful implementation of medication reconciliation requires a mix of top down and grass roots activities as hospitals, and even teams units within hospitals, may require different models.Hospitals partnering with community care providers such as pharmacists and general practitioners would lead to improvement in the quality and timeliness of individual patient’s medicines information on admission as would increasing the patient and carer’s awareness of the importance of an accurate medicines list.Although electronic systems had the potential to improve the transfer of accurate and current information about medicines, there were significant challenges in their implementation.Products identified for development by the Commission included:
- performance measures, indicators suitable for use at local, state and national level
- template for a business case for medication reconciliation for hospitals to use
- MATCH UP Medicines brochure for consumers.
These will be considered by the Medication Continuity Expert Advisory Group.
Acknowledgements
The Commission thanks the organising committee for their contribution to the planning for the seminar and the panellists for their contribution on the day.
Organising Committee Members
- Ms Naomi Burgess (Pharmaceutical Services and Strategy Branch SA Department of Health)
- Mr Daniel Lalor (NSW Clinical Excellence Committee)
- Ms Helen Leach (Quality Use of Medicines Program, Victorian Department of Health)
- Ms Elizabeth Manias (The University of Melbourne, Victoria)
- Ms Nina Muscillo (Safe Medication Management Unit, Medication Services, Queensland Health)
- Ms Susie Welch (St Vincent’s Hospital, NSW)
Panellists
- Dr Ian Coombes (Safe Medication Management Unit, Medication Services, Queensland Health)
- Ms Patti Warn (Consumer Health Forum of Australia and consumer representative, Medication Continuity Expert Advisory Group, Australian Commission on Safety and Quality in Health Care)
- Dr Keith McArthur (General Practitioner, Tasmania)
- Dr Paul Kubler (Chair, Medication Continuity Expert Advisory Group, Australian Commission on Safety and Quality in Health Care)
- Ms Helen Leach (Quality Use of Medicines Program Victorian Department of Health)
- Mr John Bell (Pharmacist)
- Ms Gabrielle Lambert (Director of Pharmacy, Redland Hospital)
- Ms Wendy McIntosh (Program Manager Clinical Quality, Western Australian Country Health Service)