clinical governance and mi services : an introduction national mi training course university of...

CLINICAL GOVERNANCE and MI Services :An introduction

National MI Training Course

University of Leicester

5th July 2007Mark Cheeseman

East Anglia MI Service, Ipswich

UK Medicines Information

Objectives

• Understand the principles of clinical governance, risk management and quality assurance; and apply these to the provision of Medicines Information Services

• Be aware of the UKMi Clinical Governance support programme


Session Outline

Introduction

Clinical Governance overview 20 minutes

Practical : Using the Clinical Governance checklist 15 minutes

Discussion 5 minutes


Session Outline continued

Introduction to Peer Review 5 minutes

Peer Review Workshop 30 minutes

Peer Review - report back 10 minutes


Session outline continued

IRMIS Introduction 5 minutes

IRMIS Workshop 20 minutes

IRMIS Workshop - feedback 5 minutes

Concluding remarks 5 minutes


Clinical Governance

“ Clinical Governance is the way in which NHS organisations quality assure their services and ensure that they are safe as well as creating the conditions for quality improvement year on year”

Chief Medical OfficerDoH website May 2003

www.dh.gov.uk/cmo


So what’s pharmacy doing about it...?

Clinical Governance...


Clinical Governance in pharmacy

• March 1998 - UKMi publishes “Risk Management Plans for MI Services”

• In September 1999, the Royal Pharmaceutical Society (RPSGB) published its framework - “Achieving Excellence in Pharmacy Through Clinical Governance”– identifies four main components for achieving

excellence in practice


Clinical Governance in pharmacy continued

• Components of RPSGB’s “Achieving Excellence…”:- Clear lines of responsibility and accountability

for overall quality of clinical work

- Comprehensive programme of quality improvement activities (e.g. Audit, CPD, R&D)

- Clear policies aimed at managing risk

- Procedures for identification of poor performance


Clinical Governance & MI services

CGWG remit :

• To develop QA programmes and associated documentation for MI services in the UK

• To monitor implementation of these schemes


Clinical Governance & MI services continued

• To collate data on a national basis to inform discussion on service provision and E&T needs

• To advise UKMi Exec on quality aspects of MI services in the UK

• To maintain IRMIS and to share experience to improve practice and prevent recurrence of incidents



Purpose of QA programmes :• Provide objective assessment of local

and regional MI services

• Provide feedback and recommendations to managers of MI services to ensure delivery of a high quality service

• Provide data for local service commissioners



• In September 2000, UKMi published a briefing paper on Clinical Governance for MI services. This covers :– Framework

– Tools

– Formulating a Clinical Governance Action Plan

– Check List


Quality

Achieving quality in MI services

Defining standards

Ensuring delivery of standards

Checking delivery of standards


Achieving quality in MI services continued

UKMi Standards & Clinical Governance 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


Clinical Governance framework for MI services

Components– Evidence-based practice– Risk Management– Research & Development– Continuing Professional Development– Audit– User involvement– Professional self-regulation


Tools for Clinical Governance

Audit programmes

User satisfaction surveys

Benchmarking schemes

Evidence-based practice

Training programmes

Risk assessment

Risk management

Peer review


Tools for Clinical Governance continued

Standards

Critical incident/ “near miss” reporting schemes

CPD

Dialogue with stakeholders


Formulating a Clinical Governance Action Plan

….. a multistep process

• Baseline assessment of current practice

• Areas of focus

• Development of an action plan

• Action on agreed priorities

• Continuous monitoring


Standards & guidance – UKMi

• UKMi Exec have set national standards

for:– Enquiry answering– Education and Training in MI– Publications– Risk Management– Clinical Governance– Specialist Information & Advisory Services


Standards & guidance – UKMi continued

• UKMi Exec have produced an audit toolkit to assist the QA process - this programme involves :

– audit against national standards– current status report– discussions with MI pharmacist and manager– recommendations – final report provided


Standards & guidance – UKMi continued

• Other QA initiatives included peer review, internal audit (e.g. enquirer satisfaction surveys) and benchmarking


Risk Management - audit

Audit Report Template

• Action points from previous audit

• Summary of recommendations

• Centre profile

• Resources


Risk Management - audit continued

Audit Report Template

• Performance review

• Comments by Local MI Pharmacist/

Pharmacy Manager

• External audit of RMICs


Risk Management - Technicians

UKMi Accredited MI Training Scheme for Pharmacy Technicians

Stages Meet entry requirements for MI department and

technician

Pre-course work experience (start portfolio) Two-day residential induction course

Skill assessment


Risk Management - Technicians

UKMi Accredited MI Training Scheme for Pharmacy Technicians continued…

Five practice enquiries for each enquiry type selected

Five competent formal observed assessments for each enquiry type selected

Regional assessment interview

Probationary period Certificate of accreditation


Risk Management - policy

• Environment

• Equipment/Information Resources

• Outputs

• People


Practical

Clinical Governance checklist


Peer Review

• Tool to support Clinical Governance in MI

• Can be used within MI departments or between MI units

• Additional checking mechanism for enquiry answering

Continued:…


Peer Review continued

• Promotes information sharing and spread of good practice

• Support regional MI audit programmes

• Guidance and examples on UKMi website (http://www.ukmi.nhs.uk/activities/clinicalGovernance/default.asp?pageRef=3)


Peer Review Workshop

Three example enquiries to score according to UKMi QA criteria (provided)- assign level of complexity- score the four elements of the enquiry :

DocumentationAnalysisCoverageAnswer


IRMIS

Aims:• Enables UKMi Exec, MI Managers and

SPMs to collate data on errors and near misses in MI

• To identify common themes and look at ways of avoiding future incidents

• To provide a datafeed to NPSA


Risk Management - MI Incidents Reporting Scheme – IRMIS

Construction of data sets

– patient type– enquiry received by– enquiry processed by– answer checked by– answer given by– error detected by

– error type– reporter’s view of cause– estimated patient risk– enquirer acted on answer– patient outcome


Risk Management - MI Error Reporting Scheme

• Secure web-based database hosted on NHSnet

• Anonymous reports

• Electronic reporting only

• CGWG monitor data

• Available to MI pharmacists and their managers


IRMIS

• Scheme launched in January 2005 after pilot scheme in 2004

• 146 reports between January 2005 and April 2007


IRMIS Workshop

4 scenarios


Looking ahead

• Records Management (Good practice guide)• Electronic documentation of enquiry

(MiDatabank). Aim for all UKMi centres to adopt by 2008

• A model for provision of MI services in the UK• Workload Survey


In conclusion...

• Safe systems of work are not an optional extra

• Clinical Governance involves all of us

• Risk Management is a major part of safe working and Clinical Governance

• Be aware of areas of risk and how they can be minimised

clinical governance and mi services : an introduction national mi training course university of...

Documents

regional mi services

managers of mi services

quality aspects of mi

practice slide

ipswich slide

anglia mi service

recurrence of incidents

continued introduction