Clinical Governance & MI: An Introduction Mark Cheeseman Education & Training and Secondary Care...
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Transcript of Clinical Governance & MI: An Introduction Mark Cheeseman Education & Training and Secondary Care...
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
Aims & ObjectivesAims & Objectives
By the end of this session you should:By the end of this session you should:
Understand the principles of clinical governance, Understand the principles of clinical governance, risk management and quality assurancerisk management and quality assurance
Be able to describe the main tools used to ensure Be able to describe the main tools used to ensure quality assurancequality assurance
Be able to apply these principles and tools in your Be able to apply these principles and tools in your own workplaceown workplace
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
Tools for QualityTools for Quality
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
Tools for QualityTools for Quality
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
Peer Review Peer Review
Risk Management PolicyRisk Management Policy
IRMISIRMIS
StandardsStandards
Enquiry Answering ProcessEnquiry Answering Process
Education & TrainingEducation & Training
PublicationsPublications
Clinical GovernanceClinical Governance
Risk ManagementRisk Management
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 seconds
B) 30 secondsB) 30 seconds
C) 60 secondsC) 60 seconds
2.2. The pharmacist supervising trainees in MI does The pharmacist supervising trainees in MI does not need to have attended the National MI not need to have attended the National MI training course? training course? True or FalseTrue 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 pharmacist should be available to take a callA pharmacist should be available to take a callA) StraightawayA) StraightawayB) Within 2 minutesB) Within 2 minutesC) Within 5 minutesC) Within 5 minutes
Quiz (3)Quiz (3)
5.5. Non-MI pharmacists should have MI training as Non-MI pharmacists should have MI training as part of their induction.part of their induction.True or FalseTrue or False
6.6. When receiving an enquiry via email, it should be When receiving an enquiry via email, it should be acknowledged within acknowledged within A) 1 hourA) 1 hourB) 4 hoursB) 4 hoursC) 30 minutesC) 30 minutes
Quiz (4)Quiz (4)
7.7. What is the ‘National Standard’ for an enquiry ‘answer’? What is the ‘National Standard’ for an enquiry ‘answer’? A) 100%A) 100%B) 95%B) 95%C) 90%C) 90%
8.8. How long should pre-registration pharmacists spend in MI?How long should pre-registration pharmacists spend in MI?A) 4 weeksA) 4 weeksB) 6 weeksB) 6 weeksC) 8 weeksC) 8 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 10. How soon after a MI Pharmacist has started in their role should they attend the started in their role should they attend the National MI training course?National MI training course?
A) Within 6 months A) Within 6 months
B) Within 12 monthsB) Within 12 months
C) Within 24 monthsC) Within 24 months
Quiz (7)Quiz (7)
11.11. Which of the following should be kept by a MI centre:Which of the following should be kept by a MI centre:A)A) A dated record of all pharmacists offered training and those who A dated record of all pharmacists offered training and those who
accept it.accept it.B)B) A dated record of all pharmacists who borrow a book/journal from A dated record of all pharmacists who borrow a book/journal from
the centre.the centre.C)C) None of the aboveNone of the above
12.12. Which of the following are MI services expected to Which of the following are MI services expected to provide:provide:A) A paper and electronic guide to basic MI resources for all on-call A) A paper and electronic guide to basic MI resources for all on-call
pharmacists pharmacists B) An electronic guide to basic MI resources for all ward pharmacistsB) An electronic guide to basic MI resources for all ward pharmacistsC) Both of the aboveC) Both of the above
Quiz (8)Quiz (8)
13. If a MI centre is producing a publication 13. If a MI centre is producing a publication which of the following is necessary:which of the following is necessary:
A) Protocol checklist A) Protocol checklist
B) Author of material is identifiableB) Author of material is identifiable
C) Both of the aboveC) Both of the above
Quiz (9)Quiz (9)
14. MI technicians should undertake the UKMi 14. MI technicians should undertake the UKMi Accredited MI Technician Training scheme Accredited MI Technician Training scheme within: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 Summary of the MI service, recommendations from last visit and this visitfrom last visit and this visit
Performance ReviewPerformance Review– Enquiry AnsweringEnquiry Answering– Education and TrainingEducation and Training– PublicationsPublications– Clinical GovernanceClinical Governance– Risk ManagementRisk Management
MI User SurveyMI User Survey
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
What do you think is important What do you think is important to users of the service?to users of the service?
QuestionsQuestions
Initially I was able to contact the service easilyInitially I was able to contact the service easily
I was informed when I could expect an answerI was informed when I could expect an answer
The answer provided was sufficiently detailed for my needsThe answer provided was sufficiently detailed for my needs
In general I found the service to be helpfulIn general I found the service to be helpful
I had to contact the MI centre more than once before I I had to contact the MI centre more than once before I received a responsereceived a response
I received the answer to my enquiry too late for it to be usefulI received the answer to my enquiry too late for it to be useful
QuestionsQuestions
The information was received when requestedThe information was received when requested
I did not receive the information that I requiredI did not receive the information that I required
I received the answer to my enquiry within the time I received the answer to my enquiry within the time requestedrequested
I was happy with the answer to my questionI was happy with the answer to my question
My question was answered in fullMy question was answered in full
MI User SurveyMI User Survey
Conducted at least once per annum Conducted at least once per annum
Minimum of 40 questionnaires should be Minimum of 40 questionnaires should be sent out to generate a minimum of 20 sent out to generate a minimum of 20 responses. responses.
Consider 10% of enquiries each monthConsider 10% of enquiries each month
Peer ReviewPeer Review
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 ReviewPeer Review
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
Peer ReviewPeer Review
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
Peer ReviewPeer Review
DocumentationDocumentation
AnalysisAnalysis
CoverageCoverage
AnswerAnswer
Peer ReviewPeer Review
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
Peer ReviewPeer Review
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?
Risk Management PolicyRisk Management Policy
EnvironmentEnvironment
Equipment & Information ResourcesEquipment & Information Resources
OutputsOutputs
PeoplePeople
Risk Management PolicyRisk Management Policy
IRMISIRMIS
Incident Reporting in Medicines Information Incident Reporting in Medicines Information SystemSystem
Secure web-based database (NHSnet)Secure web-based database (NHSnet) Complement existing NHS reporting Complement existing NHS reporting
systems – NOT a replacementsystems – NOT a replacement Incidents – local and IRMISIncidents – local and IRMIS Anonymous dataAnonymous data
IRMIS - what information is IRMIS - what information is recorded?recorded?
TitleTitle
Enquirer statusEnquirer status
Summary of enquiry and incidentSummary of enquiry and incident
Enquiry CategoryEnquiry Category
IRMIS - what information is IRMIS - what information is recorded?recorded?
Near miss or errorNear miss or error
DateDate
TypeType
When did it occur?When did it occur?
Detected by? Detected by?
Enquiry received by?Enquiry received by?
Processed by?Processed by?
Checked by?Checked by?
Answer given by?Answer given by?
Cause of incidentCause of incident
Potential RiskPotential Risk
Actual OutcomeActual Outcome
Action (s) for preventionAction (s) for prevention
IRMIS- What happens to the data?IRMIS- What happens to the data?
Serious incidents Serious incidents – Notified to IRMIS Notified to IRMIS
monitor (electronic)monitor (electronic)– Reporter consentReporter consent– Learning points Learning points
circulated to Regional circulated to Regional DirectorsDirectors
– Data used to compile Data used to compile quarterly report.quarterly report.
Routine IncidentsRoutine Incidents– Dataset used to compile Dataset used to compile
quarterly reportquarterly report
IRMIS- What happens to the data?IRMIS- What happens to the data?
Incident NumberIncident Number TitleTitle Date of incidentDate of incident Potential RiskPotential Risk Actual OutcomeActual Outcome Action (s) for preventionAction (s) for prevention
***Enquiry and hospital number removed******Enquiry and hospital number removed***
IRMIS- What happens to the data?IRMIS- What happens to the data?
IRMIS monitor ensure report is completely IRMIS monitor ensure report is completely anonymousanonymous
Learning points highlightedLearning points highlighted Report presented to UKMi ExecReport presented to UKMi Exec Paper copy -> regional MI managers for Paper copy -> regional MI managers for
discussion at local meetingsdiscussion at local meetings Summary posted on UKMi siteSummary posted on UKMi site
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
You should now:You should now:
Understand the principles of clinical governance, Understand the principles of clinical governance, risk management and quality assurancerisk management and quality assurance
Be able to describe the main tools used to ensure Be able to describe the main tools used to ensure quality assurancequality assurance
Be able to apply these principles and tools in your Be able to apply these principles and tools in your own workplaceown workplace
QuestionsQuestions
Tel No. 01473 704431Tel No. 01473 704431
[email protected]@ipswichhospital.nhs.uk