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

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

UK Medicines Information Session Outline Introduction Clinical Governance overview20 minutes Practical : Using the Clinical Governance checklist15 minutes Discussion 5 minutes

UK Medicines Information Session Outline continued Introduction to Peer Review 5 minutes Peer Review Workshop30 minutes Peer Review - report back10 minutes

UK Medicines Information Session outline continued IRMIS Introduction 5 minutes IRMIS Workshop20 minutes IRMIS Workshop - feedback 5 minutes Concluding remarks 5 minutes

UK Medicines Information 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

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

UK Medicines Information Clinical Governance in pharmacy March 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 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 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 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

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

UK Medicines Information 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

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

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

UK Medicines Information 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 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

UK Medicines Information 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

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

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

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

UK Medicines Information 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 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

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

UK Medicines Information Practical Clinical Governance checklist

UK Medicines Information 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 Peer Review continued Promotes information sharing and spread of good practice Support regional MI audit programmes Guidance and examples on UKMi website ( Governance/default.asp?pageRef=3) Governance/default.asp?pageRef=3

UK Medicines Information 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 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

UK Medicines Information 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

UK Medicines Information 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 IRMIS Scheme launched in January 2005 after pilot scheme in reports between January 2005 and April 2007

UK Medicines Information IRMIS Workshop 4 scenarios

UK Medicines Information 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

UK Medicines Information 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