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CLINICAL GOVERNANCE and MI Services : An introduction

CLINICAL GOVERNANCE and MI Services : An introduction. National MI Training Course University of Leicester 5 th July 2007. Mark Cheeseman E ast Anglia MI Service, Ipswich. Objectives.

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CLINICAL GOVERNANCE and MI Services : An introduction

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  1. CLINICAL GOVERNANCE and MI Services :An introduction National MI Training Course University of Leicester 5th July 2007 Mark Cheeseman East Anglia MI Service, Ipswich

  2. 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 UKMiClinical Governance support programme UK Medicines Information

  3. Session Outline Introduction Clinical Governance overview 20 minutes Practical : Using the Clinical Governance checklist 15 minutes Discussion 5 minutes UK Medicines Information

  4. Session Outline continued Introduction to Peer Review 5 minutes Peer Review Workshop 30 minutes Peer Review - report back 10 minutes UK Medicines Information

  5. Session outline continued IRMIS Introduction 5 minutes IRMIS Workshop 20 minutes IRMIS Workshop - feedback 5 minutes Concluding remarks 5 minutes UK Medicines Information

  6. 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 Officer DoH website May 2003 www.dh.gov.uk/cmo UK Medicines Information

  7. Clinical Governance... So what’s pharmacy doing about it...? UK Medicines Information

  8. 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 UK Medicines Information

  9. 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 UK Medicines Information

  10. 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 UK Medicines Information

  11. Clinical Governance & MI services continued • To collate data on a national basis to inform discussion on service provision and E&T needs • To advise UKMiExec on quality aspects of MI services in the UK • To maintain IRMIS and to share experience to improve practice and prevent recurrence of incidents UK Medicines Information

  12. Clinical Governance & MI services continued 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 UK Medicines Information

  13. Clinical Governance & MI services continued • 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 UK Medicines Information

  14. Defining standards Ensuring delivery of standards Quality Checking delivery of standards Achieving quality in MI services UK Medicines Information

  15. Resources, CPD, Job description, E&T, SLA’s, KSF, Service commissioning Competency Framework Ensuring delivery of standards Defining standards Quality Checking delivery of standards Achieving quality in MI services continued UKMi Standards & Clinical Governance Group National standards Audit, Peer review / bench marking, Outcomes / indicators, Near-miss / incidents reports UK Medicines Information

  16. Clinical Governance framework for MI services Components • Evidence-based practice • Risk Management • Research & Development • Continuing Professional Development • Audit • User involvement • Professional self-regulation UK Medicines Information

  17. Audit programmes User satisfaction surveys Benchmarking schemes Evidence-based practice Training programmes Risk assessment Risk management Peer review Tools for Clinical Governance UK Medicines Information

  18. Standards Critical incident/ “near miss” reporting schemes CPD Dialogue with stakeholders Tools for Clinical Governance continued UK Medicines Information

  19. 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 UK Medicines Information

  20. Standards & guidance – UKMi • UKMiExec have set national standards for: • Enquiry answering • Education and Training in MI • Publications • Risk Management • Clinical Governance • Specialist Information & Advisory Services UK Medicines Information

  21. Standards & guidance – UKMicontinued • UKMiExec 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 UK Medicines Information

  22. Standards & guidance – UKMicontinued • Other QA initiatives included peer review, internal audit (e.g. enquirer satisfaction surveys) and benchmarking UK Medicines Information

  23. Risk Management - audit Audit Report Template • Action points from previous audit • Summary of recommendations • Centre profile • Resources UK Medicines Information

  24. Risk Management - audit continued Audit Report Template • Performance review • Comments by Local MI Pharmacist/ Pharmacy Manager • External audit of RMICs UK Medicines Information

  25. 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 UK Medicines Information

  26. Risk Management - Technicians UKMi Accredited MI Training Scheme for Pharmacy Technicianscontinued… • 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 UK Medicines Information

  27. Risk Management - policy • Environment • Equipment/Information Resources • Outputs • People UK Medicines Information

  28. Practical Clinical Governance checklist UK Medicines Information

  29. 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:… UK Medicines Information

  30. 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) UK Medicines Information

  31. 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 : Documentation Analysis Coverage Answer UK Medicines Information

  32. IRMIS Aims: • Enables UKMiExec, 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 UK Medicines Information

  33. 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 Incidents Reporting Scheme – IRMIS UK Medicines Information

  34. 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 UK Medicines Information

  35. IRMIS • Scheme launched in January 2005 after pilot scheme in 2004 • 146 reports between January 2005 and April 2007 UK Medicines Information

  36. IRMIS Workshop 4 scenarios UK Medicines Information

  37. Looking ahead • Records Management (Good practice guide) • Electronic documentation of enquiry (MiDatabank). Aim for all UKMicentres to adopt by 2008 • A model for provision of MI services in the UK • Workload Survey UK Medicines Information

  38. 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 UK Medicines Information

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