Clinical Governance & MI: An Introduction Mark Cheeseman Education & Training and Secondary Care Support Medicines Information Pharmacist East Anglia Medicines Information Service

Aims & Objectives By the end of this session you should: Understand the principles of clinical governance, risk management and quality assurance Be able to describe the main tools used to ensure quality assurance Be able to apply these principles and tools in your own workplace

Session Background Methods Key tools for MI Available support Summary

What does Clinical Governance mean to you?

Definition “a framework through which NHS organisations are accountable for continuously improving the quality of the services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”

History WHO. Principles of quality assurance; 1983. DH. A First Class Service: Quality in the new NHS; 1998. CMO/CNO. Supporting implementation of clinical governance. NHS Exec; 1999

How did this affect Pharmacy? RPSGB published ‘Achieving excellence in pharmacy through practice’ (1999) Clear lines of responsibility Quality improvement activities Risk Management Poor Performance Clear lines of responsibility and accountability for overall quality of clinical care A comprehensive programme of quality of improvement activities (e.g. audit, CPD, R&D) Clear policies aimed at managing risks Procedures for identification of poor performance

What has MI done? UKMi Clinical Governance Working Group “Clinical Governance – a briefing paper for Medicines Information Services” Focus: Framework Tools

Framework Right climate = acceptance and implementation Features: Good ideas and practice shared Education and research valued Blame only used in exceptional circumstances Collaboration rather than competition

Does anyone have all these?

How can we achieve quality? Defining standards Ensuring delivery of standards Quality Checking delivery of standards

What tools can we use to ensure quality?

Tools for Quality Standards Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice CPD Training programmes

Tools for Quality Standards Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice CPD Training programmes UKMi Standards QA Visits MI User Survey Workload Survey Enquiry Answering! Personal CPD NMITC, Advanced MI Training, NMITTC

Tools for Quality Risk Assessment/ Management Schemes Appraisal schemes Incident/near miss reporting schemes Dialogue with principal stakeholders Involvement with commissioning specialist services

Tools for Quality Risk Assessment/ Management Schemes Appraisal schemes Incident/near miss reporting schemes Dialogue with principal stakeholders Involvement with commissioning specialist services Risk Management Policy Peer Review IRMIS Who are yours? Who commissions your service?

How can we achieve quality? UKMi Standards & Clinical Governance Working Group Resources, CPD, Job description, E&T, SLA’s, KSF, Service commissioning Competency Framework Quality Defining standards Ensuring delivery of standards Checking delivery of standards National standards Audit, Peer review / bench marking, Outcomes / indicators, Near-miss / incidents reports

So what does the UKMi Clinical Governance Working Group do?

What should you be aware of? UKMi Standards QA Visits MI User Survey Peer Review Risk Management Policy IRMIS

Standards Enquiry Answering Process Education & Training Publications Clinical Governance Risk Management

Quiz

Quiz (1) How quickly should the MI phone be answered within? A) 10 seconds B) 30 seconds C) 60 seconds The pharmacist supervising trainees in MI does not need to have attended the National MI training course? True or False

Quiz (2) 3. How long should enquiries be kept for? A) 8 years B) 25 years C) A and b 4. A pharmacist should be available to take a call A) Straightaway B) Within 2 minutes C) Within 5 minutes

Quiz (3) 5. Non-MI pharmacists should have MI training as part of their induction. True or False 6. When receiving an enquiry via email, it should be acknowledged within A) 1 hour B) 4 hours C) 30 minutes

Quiz (4) 7. What is the ‘National Standard’ for an enquiry ‘answer’? B) 95% C) 90% 8. How long should pre-registration pharmacists spend in MI? A) 4 weeks B) 6 weeks C) 8 weeks

Quiz (5) 9. How often should the MI centre’s risk management policy be reviewed? A) Every year B) Every 2 years C) Every 3 years

Quiz (6) 10. How soon after a MI Pharmacist has started in their role should they attend the National MI training course? A) Within 6 months B) Within 12 months C) Within 24 months

Quiz (7) 11. Which of the following should be kept by a MI centre: A dated record of all pharmacists offered training and those who accept it. A dated record of all pharmacists who borrow a book/journal from the centre. None of the above 12. Which of the following are MI services expected to provide: A) A paper and electronic guide to basic MI resources for all on-call pharmacists B) An electronic guide to basic MI resources for all ward pharmacists C) Both of the above

Quiz (8) 13. If a MI centre is producing a publication which of the following is necessary: A) Protocol checklist B) Author of material is identifiable C) Both of the above

Quiz (9) 14. MI technicians should undertake the UKMi Accredited MI Technician Training scheme within: A) Within 6 months B) Within 12 months C) Within 24 months

QA Visits Regional centre -> Regional centre Regional centre -> Local centre Audit centre against national standards AND peer review sample of enquiries National template

National Template Summary of the MI service, recommendations from last visit and this visit Performance Review Enquiry Answering Education and Training Publications Clinical Governance Risk Management

MI User Survey Developed to provide statistically robust questionnaire. Eleven questions linked to provide validity Three categories measuring different aspects of user satisfaction: Answer satisfaction General Helpfulness/Time Satisfaction Ease of Contact Satisfaction

What do you think is important to users of the service?

Questions Initially I was able to contact the service easily I was informed when I could expect an answer The answer provided was sufficiently detailed for my needs In general I found the service to be helpful I had to contact the MI centre more than once before I received a response I received the answer to my enquiry too late for it to be useful

Questions The information was received when requested I did not receive the information that I required I received the answer to my enquiry within the time requested I was happy with the answer to my question My question was answered in full

MI User Survey Conducted at least once per annum Minimum of 40 questionnaires should be sent out to generate a minimum of 20 responses. Consider 10% of enquiries each month

Peer Review Monitor standard of enquiry answering All centres expected to undertake peer review Encourage sharing of: Experience Knowledge Expertise Should be non-judgmental Provide professional support

Peer Review Peer review allows: Regular objective feedback on performance Feedback and suggestions on improving the quality of the service Sharing of ideas and learning from colleagues Development of own practice and service Identification of learning needs

Peer Review UKMi provide: Definition for ranking enquiries Summary of criteria for grading answers to enquiries using documented evidence Enquiry assessment form

Peer Review Documentation Analysis Coverage Answer

Peer Review Internal External Sample enquiries (manager led) Sample enquiries (team led) Sample enquiries (user feedback) Group discussion External Peer Review visits Regional network meeting

Peer Review Workshop

Workshop Group work Peer Review enquiry Use national documentation Present findings to the group What did you like about doing this? What did you not like?

Risk Management Policy Environment Equipment & Information Resources Outputs People

Risk Management Policy

IRMIS Incident Reporting in Medicines Information System Secure web-based database (NHSnet) Complement existing NHS reporting systems – NOT a replacement Incidents – local and IRMIS Anonymous data

IRMIS - what information is recorded? Title Enquirer status Summary of enquiry and incident Enquiry Category

IRMIS - what information is recorded? Near miss or error Date Type When did it occur? Detected by? Enquiry received by? Processed by? Checked by? Answer given by? Cause of incident Potential Risk Actual Outcome Action (s) for prevention

IRMIS- What happens to the data? Serious incidents Notified to IRMIS monitor (electronic) Reporter consent Learning points circulated to Regional Directors Data used to compile quarterly report. Routine Incidents Dataset used to compile quarterly report

IRMIS- What happens to the data? Incident Number Title Date of incident Potential Risk Actual Outcome Action (s) for prevention ***Enquiry and hospital number removed***

IRMIS- What happens to the data? IRMIS monitor ensure report is completely anonymous Learning points highlighted Report presented to UKMi Exec Paper copy -> regional MI managers for discussion at local meetings Summary posted on UKMi site

What about wider clinical governance issues? Hospital clinical pharmacy services Formularies Medicines management programmes Prescribing advice MMC/Area Prescribing Committees Local guideline writing/protocols Dissemination of good practice Input into audit programmes and quality initiatives Training and CPD programmes Shared care support

Where can you access Clinical Governance information for MI?

Summary You should now: Understand the principles of clinical governance, risk management and quality assurance Be able to describe the main tools used to ensure quality assurance Be able to apply these principles and tools in your own workplace

Tel No. 01473 704431 mark.cheeseman@ipswichhospital.nhs.uk Questions Tel No. 01473 704431 mark.cheeseman@ipswichhospital.nhs.uk