CCHSA Accreditation: New Standards for Managing Medications Jessica Peters Lead, Research & Product Development CCHSA

Presentation Outline Vision, Mission and Values The Accreditation Program Program Enhancements The New Standards for Managing Medications Next Steps

CCHSA’s Vision and Mission The leader in raising the bar for health quality Mission Driving quality in health services through accreditation

CCHSA’s Values Within an environment focused on clients and committed to quality of worklife, partnerships, and personal growth, our values are: Excellence Integrity Respect Innovation

CCHSA’s Accreditation Program Canadian accreditation program - incorporated in 1958 Not-for-profit High participation rates; continued growth Surveyors (approx. 400) are senior health care professionals Surveys may be regional, institution specific, national or market specific (i.e. First Nations, Corrections, Canadian Forces) Average 400+ surveys per year Three year cycle Both public and private organizations participate

Role of Accreditation Quality Improvement – at the organization level and at the system level Change management Standards of excellence – raising the bar on health care Standards of clinical practice Governance Leadership

CCHSA Standards Standards of excellence ‘Raise the bar’ for health care practice Enable an organization/team to stretch to improve care, to reach or raise the bar Developed with the input and guidance of experts in the field and updated on a regular basis to ensure relevance and value Are applicable to different regions and service delivery settings Will continue to be used by organizations, but in a new way Describe that CCHSA standards continue to be….. Standards are still the benchmarks but you will no longer use them to guide you through every step of the self-assessment. Physically, they will be more of a reference tool but the content will be embedded throughout the process. For example, the self-assessment will be partly administered through online questionnaires which are essentially a roll-up of the standards. The questionnaires use wording directly from the standards. But, that’s a topic for another day… Draft target areas based on literature review, evidence, CCHSA experience Input from experts, key informants Draft standards Extensive consultation with stakeholders Revision process Pilot testing Standards finalized * Ideas in and direction of standards are decided largely by those who will use them

Evolution of CCHSA Program Speak to why/rationale for ever-evolving programs… i.e. changing environment, accountability, etc.

The New Accreditation Program Benefits: 1. Standards that: Capture the most recent governance/managerial and clinical best practices Reflect the emerging trends or disease (and wellness) patterns in healthcare Have an increased level of specificity Can be used or integrated into the daily work of organizations 2. Streamlined and more flexible process that: Supports and aligns better to an organizations’ quality improvement initiatives Is adaptable no matter how small or how complex the organization may be The design and development of the new accreditation program has been guided by the desire to realize the following benefits for client organizations

The New Accreditation Program Benefits: 3. Greater focus on the provision of safe quality care and service in a variety of health care settings 4. Planned and predictable accreditation activities with a on-site survey that is customized to the organizations’ needs 5. Automated measurement tools that allow: Greater and faster data exchange Improved standardization and objectivity The design and development of the new accreditation program has been guided by the desire to realize the following benefits for client organizations

The standards have a brand new structure… Structure or configuration ? New standards for laboratory, pharmacy, diagnostic imaging, operating room procedures, and other therapeutic -technologies are being developed — areas prone to significant risk and associated with the largest volume of adverse events. This new content will strengthen the way these elements are reviewed in the -accreditation program. Ongoing and increased emphasis on population health Increased attention to primary care, including emergency medical services, teletriage, and primary care networks Enhanced outcome-related content Focus on integrated quality management

Standards Areas EFFECTIVE AND SUSTAINABLE GOVERNANCE PROACTIVE AND SUPPORTIVE ORGANIZATION SERVICE EXCELLENCE CCHSA standards are still organized into areas . Let us look at this a little more closely. This table outlines the new standards model. Four (4) main standards areas are envisioned. These areas are: Responsible and sustainable governance Proactive and supportive Organization Service Excellence (these are the revised Client Services/Care standards) –and include population-based standards, sector/service based standards, and new specific standards in some areas, i.e. infection prevention and control, managing medications, diagnostic imaging. Positive Client Experience POSITIVE CLIENT EXPERIENCE

Managing Medications: Background The development of the new standards for managing medications was driven by: Importance of safe medication management processes in protecting client safety Feedback from client organizations and surveyors Changing health care environment Development began in 2004 Expert working group including representatives from organizations and ISMP-Canada Standards circulated for consultation in late 2005 to approximately 15 organization

The New Standards for Managing Medications… Standards target medication processes in an institutional setting, i.e. hospital, long term care Focus on the safe use of medications from selection and procurement through administration Address a number of key themes: Working Together to Promote Medication Safety Carefully Selecting and Procuring Medications Properly Labelling and Storing Medications Appropriately Ordering and Transcribing Medications Accurately Preparing and Dispensing Medications Safely Administering Medications to Clients Monitoring Quality and Achieving Positive Results CCHSA is currently exploring/testing the application of the standards in a wider range of organizations.

Working Together to Promote Medication Safety Recognizing pharmacists and pharmacy staff as integral members of the interdisciplinary team Actively involving the pharmacy staff in designing the organization’s medication use and medication management processes Providing access to accurate medication-related information, formally approved drug information tools and education about safe medication use Evaluating the competency of all service providers who participate in the medication use process

Carefully Selecting and Procuring Medications Maintaining an up-to-date and evidence-based list of available medications Minimizing the number of procured and available medications Minimizing the medications available – includes the REQUIRED ORGANIZATIONAL PRACTICE: The organization standardizes and limits the number of drug concentrations available.

Properly Labeling And Storing Medications Reducing the possibility of errors with drug product nomenclature, labeling, and packaging Labeling all drug concentrations clearly and legibly Providing suitable space for drug storage in pharmacies and client/unit medication areas Carefully selecting stock drugs for each client area Storing hazardous chemicals away from clients, service providers, and drug preparation areas Selecting stock drugs – includes ROP: The organization has removed all concentrated electrolytes from client areas/units.

Ordering and Transcribing Medications Appropriately Maintaining accessible and up-to-date client information Communicating drug orders and other drug information in a standardized way Reviewing all prescriptions or medication orders for accuracy and appropriateness

Accurately Preparing and Dispensing Medications Preventing contamination when preparing medications Dispensing medications in a safe, accurate, and timely way Having a system to safely dispense medications where there is no internal pharmacy or when the pharmacy is closed Transporting medication in a safe, secure, and timely manner way

Safely Administering Medications To Clients Educating clients about their medications and delivery devices, and ways to prevent errors Following a process to allow and monitor clients’ self-administration of their medications Safely and accurately administers medications Reducing the risk of error through careful procurement, maintenance, use, and standardization of medication delivery devices Monitoring clients following medication administration Medication administration: REQUIRED ORGANIZATIONAL PRACTICE: Service providers use at least two identifiers before administering medications. Medication delivery devices: REQUIRED ORGANIZATIONAL PRACTICE: The organization provides all staff and service providers with ongoing, effective training on all infusion pumps.

Monitoring Quality And Achieving Positive Outcomes Having a coordinated risk management program to reduce medication-related errors and sentinel events Regularly monitoring and evaluating the quality of the medication management and pharmacy system

Current Status of the New Program 13 pilot sites will test various elements of the program starting March to December 2007 National consultation on standards Customized transition plan for each client in 2008 Pan Canadian information sessions in major cities to support transition Ongoing communication CCHSA web site teleconferences

The leader in raising the bar for health quality Canadian Council on Health Services Accreditation The leader in raising the bar for health quality