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

3. Aims  Provide you with an introduction to the principles of clinical governance, risk management and quality assurance.  Describe the main tools used to ensure quality assurance in MI, including IRMIS.  Enable you to apply these principles and tools in your own workplace.

4. Learning Outcomes By the end of this session you should be able to:  Describe fourteen of the UKMi standards.  Be able to peer review an enquiry and provide feedback.

5. Session  Background  Methods  Key tools for MI  Available support  Summary

6. What does Clinical Governance mean to you?

7. 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.”

8. 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

9. How did this affect Pharmacy?  RPSGB published ‘Achieving excellence in pharmacy through practice’ (1999) 1.Clear lines of responsibility 2.Quality improvement activities 3.Risk Management 4.Poor Performance

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

11. 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

12. Does anyone have all these?

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

14. What tools can we use to ensure quality?

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

16. 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

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

18. 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?

19. 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?

20. So what does the UKMi Clinical Governance Working Group do?

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

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

24. Quiz

25. Quiz (1) 1.How quickly should the MI phone be answered within? A) 10 seconds B) 30 seconds C) 60 seconds 2.The pharmacist supervising trainees in MI does not need to have attended the National MI training course? True or False

26. 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

27. 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

28. Quiz (4) 7.What is the ‘National Standard’ for an enquiry ‘answer’? A) 100% B) 95% C) 90% 8.How long should pre-registration pharmacists spend in MI? A) 4 weeks B) 6 weeks C) 8 weeks

29. 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

30. 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

31. Quiz (7) 11.Which of the following should be kept by a MI centre: A)A dated record of all pharmacists offered training and those who accept it. B)A dated record of all pharmacists who borrow a book/journal from the centre. C)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

32. 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

33. 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

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

35. 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

36. 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

37. What do you think is important to users of your MI service?

38. 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

39. 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

40. 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

41. Examples of risk in your MI centre?

42. Risk Management Policy  Environment  Equipment & Information Resources  Outputs  People

43. 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

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

45. 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

46. 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

47. 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***

48. 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

49. 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

50. 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

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

52. Peer Review  Documentation  Analysis  Coverage  Answer

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

54. Peer Review Workshop

55. 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?

56. 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

57. Where can you access Clinical Governance information for MI?

61. Summary  Provided you with an introduction to the principles of clinical governance, risk management and quality assurance.  Described the main tools used to ensure quality assurance in MI, including IRMIS.  Enabled you to apply these principles and tools in your own workplace.

62. Learning Outcomes You should now be able to:  Describe fourteen of the UKMi standards.  Be able to peer review an enquiry and provide feedback.

63. Questions

64. Contact  Website http://www.ipswichhospital.nhs.uk/microsites/pharmacy/information.asp  Tel No. 01473 704431  Email mark.cheeseman@ipswichhospital.nhs.uk