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01.10.2010 www.imsn.ie
June O’Shea and Paul Tighe
Inaugural IMSN Conference 1st Oct 2010 -
‘Networking for safety’
Setting the Standards-Safeguarding our Patients
01.10.2010 www.imsn.ie
Outline
• Introduction & background
• JCI accreditation – Who, what & why?
• Outline of JCI standards
• Spin-off from IMSN / JCI synergy
• Future partnerships
01.10.2010 www.imsn.ie
Introduction• Private & Public Hospital representation• Medication management experience from
accreditation processes• Networking for safety• National standards
– Pharmacy (Pharmacy Act 2007)– HIQA Draft National Standards for Safer
Better Healthcare (2010)
• Collaborate with HIQA on medication safety standards?
01.10.2010 www.imsn.ie
What are standards?
“ the criteria or set of rules that describe the expected levels of clinical and system behaviour as well as courses of action based onresearch and experience”
Davis 1997
01.10.2010 www.imsn.ie
What is accreditation?
“a process to provide a visible commitment by an organisation to improve the safety and quality of patient care, ensure a safe care environment and continually work to reduce risks to patients and staff”
Joint Commission
01.10.2010 www.imsn.ie
Accreditation Experience
- Pilot site in 2001 for IHSAB- First full survey 2004- 2009 applied for JCI accreditation- 2010 surveyed & accredited
- survey by JCI in 2002 & accredited- 4th survey in 2011
01.10.2010 www.imsn.ie
Joint Commission International (JCI)
• US-based non-profit organisation
• Focused on improving safety of patient care& organisation management through provision of accreditation & certification
• Work directly with healthcare organisations to achieve goals of providing quality clinical care and services in safe, efficient & well-managed facilities
01.10.2010 www.imsn.ie
Sharing Learning from Accreditation
• 17 Irish JCI accredited organisations– Highest number in EU (59 total)
• All represented at IMSN
• Sharing medication safety initiatives & knowledge of medication safety standards
01.10.2010 www.imsn.ie
What is different?
• Role of pharmacy in medication management in organisation
• Proactive identification of risks• Policies • Training• Quality methodology
01.10.2010 www.imsn.ie
Overview of JCI standards
Patient centered standards (8)
Healthcare Organisation Management Standards (6)
Focus on patient safety
01.10.2010 www.imsn.ie
WHO HIGH 5’s• Concentrated Injectable Medicines
– JCI patient safety goal
• Medication Accuracy at Transitions in Care– JCI standard
• Correct Procedure at the Correct Body Site
• Communication Failures during Patient Handovers
• Addressing Health Care-Associated Infections
01.10.2010 www.imsn.ie
JCI Patient Safety Goals(IPSG)
1. Identify Patients Correctly2. Improve Effective Communication3. Improve Safety of High-Alert Medications4. Ensure Correct-Site, Correct-Procedure,
Correct-Patient Surgery5. Reduce Risk of Health Care–Associated
Infections6. Reduce Risk of Patient Harm Resulting
from Falls
01.10.2010 www.imsn.ie
JCI Patient Safety Goal 3
• Improve the safe use of high-alert medications
• Concentrated electrolytes
• New 4th edition standards
• High-Alert medications specific to your organisation
01.10.2010 www.imsn.ie
IMSN work & JCI Patient Safety Goals
Oral methotrexate safety alertOxycodone alertTransdermal opioid medicationsBest practice guidelines for the safe use of potassiumInsulin best practice guidanceBriefing document on sound alike look alike drugsBriefing document on Vinca alkaloidsIn progress, medication and falls
01.10.2010 www.imsn.ie
JCI Medication Management & Use (MMU) standard
MMU 4 Measurable element 6• Initial medication orders compared to the list of medications taken prior to admission, according to the organization’s established process• Facilitates medication reconciliation for each patient
Draft National Standards for Safer Better Healthcare Medication management including safe prescribing & reconciliation (Standard 4.1 Criteria 4.1.8)
01.10.2010 www.imsn.ie
JCI Standards and medication safety
Standard MMU 7.1 • ‘Medication errors, including near misses are reported
through a process & time frame defined by organisation’
Draft National Standards for Safer Better HealthcareService providers effectively document, report on & respond to safety incidents in a timely manner in line with national legislation, policy, guidelines & guidance. (Standard 4.2 Criteria 4.2.3)
01.10.2010 www.imsn.ie
JCI Standards and medication safety
Measurable elements of Standard MMU 7.11. Medication Error & Near Miss defined through a
collaborative process2. Medication Errors & Near Misses reported in a
timely manner using an established process3. Those accountable for taking action are identified4. Organisation uses reporting information to improve
medication use processes
01.10.2010 www.imsn.ie
Quality Improvement & Patient Safety (QPS) standard
• Standard QPS.8The organisation uses a defined process for the identification and analysis of near-miss events
• Organisation must track, measure & monitor near miss events
• Draft National Standards for Safer Better Healthcare(Standard 4.2 Criteria 4.2.3 & 4.2.4)
01.10.2010 www.imsn.ie
Quality approach
• What is your organisation’s quality methodology?
• RCA and FMEA
• Performance indicators
• Self audit
• Tracer methodology
01.10.2010 www.imsn.ie
Setting standards –Does it safeguard patients?
• Learning from Aviation industry• Hygiene standards• Standards for symptomatic breast disease
services• Organisational standards e.g. cardiac
standards – door to cath lab• Performance indicators for medication safety
01.10.2010 www.imsn.ie
Strategic Partners
• IMSN sharing & communicating medication safety strategies nationally
• IMSN in unique position to become strategic partner in setting medication safety standards in Ireland
• Precedent in U.S. – www.ismp.org
01.10.2010 www.imsn.ie
Conclusion
• Specific medication safety standards (as in JCI accreditation scheme) safeguard patients
• IMSN in unique position to assist with national medication safety standards
• “A hospital is a place to be sick”Paul Tighe and June O’Shea
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