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

mark.cheeseman@ipswichhospital.nhs.ukmark.cheeseman@ipswichhospital.nhs.uk