SPSP Medicines Paediatric Networking Event Prepared by: David Maxwell

Key Points Building on existing work within SPSP regarding medicines Opportunity to standardise and coordinate activity Capture and share local priorities/innovation Key priorities for Phase 1 –Medication reconciliation –High risk medicines Clinical advisory group established Whole system approach

SPSP Mental Health Acute Adult Primary Care MCQIC Sepsis VTE Essentials SPSI GMS Pharmacy Nursing Medicines Restraint Communication Leadership &Culture Risk Assessment Medicines Restraint Communication Leadership &Culture Risk Assessment 9 Priorities Dentistry Maternity Neonates Paediatrics Safer Use of Medicines Healthcare Associated Infections Safer Use of Medicines Healthcare Associated Infections

Clinical Advisory Group

% of medicines reconciled for patients at discharge (from hospital) % compliance with DMARDs (methotrexate and azathioprine) prescribing and monitoring bundle % compliance with warfarin prescribing and monitoring bundle Improvement in combined % of INRs within range per practice/board according to local guideline (for example reduction in combined % of INRs 5.0/6.0) Number of INR tests per 1000 population carried out per quarter Primary Care – General Practice TBC – currently being tested by pilot sites in four NHS Boards ( medication reconciliation, warfarin, NSAIDS ) Primary Care – Community Pharmacy TBC – forming part of ‘safety principals’ related to medicines. Current proposal includes medication reconciliation ; high risk medicines – clozapine lithium and high dose antipsychotics ; missed doses; patient education regarding medicines. Mental Health % of patients with medication reconciliation performed on admission % of patients with medication reconciliation performed on discharge % of INRs > 6 Acute Adult

Medicines harm (outcome) – number of medication incidents that are high and very high (local reporting systems) % of prescriptions of [locally identified drug] where the correct concentration, rate & dose are prescribed Days between incorrectly prescribed [locally identified drugs] % uninterrupted intravenous drug reconstitutions % compliance with the high risk drug [locally identified] bundle % of appropriate children and young people with medicines reconciled within 24 hours of admission (local optional) % of medicines errors* (local optional – gentamicin and vancomycin ) % compliance with gentamicin bundle % prescriptions ( gentamicin ) which have correct dose & frequency % of gentamicin levels within therapeutic range % compliance with vancomycin bundle % of vancomycin levels within therapeutic range % prescriptions of [identify drug] were correct concentration, rate & dose Number of days between incidences involving high risk drugs TBC – options paper for future improvement activity includes a proposal for a measure related to oxytocin, identified as a high risk medicine in maternity services and medication reconciliation for high risk/red pathway women MCQIC – Neonates MCQIC – Paediatrics MCQIC – Maternity

Medication Reconciliation

SPSP ProgrammeImprovement activity / measurement Acute AdultAdmission and discharge Mental HealthBeing incorporated into the Mental Health measurement plan for both admission and discharge. MCQIC – MaternityMedication reconciliation for high risk women in maternity services is being discussed as part of next steps for MCQIC. MQQIC - NeonatesN/A MCQIC – Paediatrics Admission only (optional) Primary Care – General Practice For patients discharged from acute care Primary Care – Community Pharmacy Bundles are being tested by pilot sites in two boards What we know nationally: MR on admission - 9 boards consistently reporting data - Median at pilot site: 30% to 94% - Multiple site/Area data being submitted by some boards MR on discharge - 3 boards consistently reporting data - Median at pilot site: 30% to 86%

Medication Reconciliation Opportunities: Improve engagement and reporting on medication reconciliation processes in acute care for both admission and discharge Sharing between boards changes in practice that have supported improvements Develop mechanisms for whole-systems learning for medication reconciliation, particularly at the interface between primary and secondary care Create a library of patient and staff stories describing the impact of medication reconciliation across the interface, to complement process measures Increase service user/carer involvement in the medication reconciliation process Collaboration with other national groups to raise the profile of medication reconciliation 95% of patients with process and accurate proxy outcome: - medication chart - immediate discharge letter - GP records - community pharmacy PCR

High Risk Medicines low therapeutic index administered by the wrong route or when other system errors occur requires dose / frequency modification according to specific parameters SPSP ProgrammeImprovement activity / measurement Acute AdultINRs > 6 (related to warfarin toxicity) Mental HealthLithium, clozapine and high dose antipsychotics identified as high risk medicines (particularly for patients being cared for outwith mental health services) MCQIC – MaternitySafe oxytocin use being discussed as part of next steps for MCQIC MQQIC - NeonatesVancomycin and gentamicin care bundles MCQIC – PaediatricsVancomycin and gentamicin care bundles Primary Care – General Practice Care bundles for warfarin, methotrexate and azathioprine Primary Care – Community Pharmacy Testing in pilot sites care bundles for warfarin and non-steroidal anti-inflammatory drugs (NSAIDS)

High Risk Medicines Opportunities: To test a set of generic principles/criteria for a high risk medicine bundle, applicable to any medicine in any setting (processes of care) Extend current improvement activity from a single setting to a system approach – to process map a pathway of care for a patient on a high risk medicine, explore safety processes in each of the care settings, with an aim to have a ‘system’ view Create a library of patient and staff stories describing the harm associated with high risk medicines and patent stories describing the impact of reliable processes, to complement existing bundles/measures Collaboration with other national groups regarding specific medicines / medicine groups 95% compliance with the existing HRM ‘bundles’

Other Local Priorities Error free administration –Wong patient –Missed doses Health and social care integration

Questions / Discussion