Medicines Management
Issue no 3, p11-12
May/June 2002
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Medicines Management |
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Features |
How to make sure medicines management is not the missing part
Following the first mention of the term in 1999, the NHS grappled to determine what clinical governance was.Now, three years later, the NHS and multidisciplinary teams working at the sharp end caring for patients, struggle to find something that is not covered by this all encompassing phrase. Likewise we are finding that medicines management is also inextricably linked into the systems that find themselves part of this huge agenda. No longer can medicines management be viewed as a stand-alone system. Prescribing advisers need to ensure that medicines management is an integral part of their organisation's clinical governance development agenda. Clinical governance is a way for organisations and individuals to ensure the delivery of high quality healthcare and continuously to monitor and improve standards of care. It focuses on: • Quality improvement activities • Identifying and managing risks • Continuing professional development But it is not just about having systems and structures in place. It is about creating the right environment and culture to ensure that these systems are used to support the quality improvement agenda. There is no point, for example, in setting up a concerns policy within an organisation if staff do not feel safe in reporting them. It means you can tick the box marked "Organisation has developed a concerns policy" in any performance management scheme but little else. The culture needs to change to ensure that all NHS staff feel supported to share "concerns", "near misses" and, of course, positive significant events. Since the advent of prescribing advice in primary care during the early 1990s, the culture within this arena has changed dramatically. Gone (well, mostly) is the "how dare you tell me what I can prescribe" reaction to pharmacists working with GPs. The number of prescribing advisers now employed by PCTs to improve the quality of care gives testimony to this. Now that is clinical governance. Key clinical governance systems So in what clinical governance systems does medicines management play a part? And how can prescribing advisers be promoting medicines management within these systems? How can prescribing advisers be promoting clinical governance within primary care teams? Can we reach the parts of practice teams that other professionals trying to embed clinical governance in primary care cannot? Questions, questions! And there are no easy answers but here are a few thoughts you may want to think about in your own patch. Multidisciplinary audit An audit programme in an organisation must underpin key priority areas. Are you involved in developing your programme? Is it in conjunction with secondary care? Do audit findings in your organisation change the way services are delivered to patients? Enabling practice teams to look at significant events via audit is a great way to get them working together. By looking at what has gone well (eg, following a thank you letter from a patient) and at what has not gone quite as well (eg, following a complaint), teams can look at ways they need to change systems to ensure that they get more "good" and less "bad" comments. Evidence-based practice How to enable staff to access evidence-based information, for example, NICE guidance? Information systems Are you linked into the local implementation strategy? Are clinicians involved? Are you involved in deciding what systems are being developed? Without systems across primary and secondary care, underpinning the delivery of clinical governance, we are not going to be able to prove an increase in quality at all. Research and development This is not just about academics and men in white coats with petri dishes. It is about all NHS professionals being encouraged to look at new ways of delivering services and, with appropriate training and support, carrying out research into matters where no easy answer exists. Education and training Organisations need to give protected time to all staff for education and training. Learning is at three levels: • Self • Team • Organisation Personal and practice development plans and appraisal as well as national priorities will be essential to help plan an organisation's strategy. Concerns and complaints As well as meeting NHS standards on handling complaints, auditing these complaints will give organisations useful information on what risks there may be in a system and where systems need redesigning. Similarly any adverse reporting system needs to look at what can be learnt from things going wrong rather than blaming individuals. Do we really learn from dispensing errors that are probably due to busy pharmacists working long hours with no lunch breaks? Risk management We all know that NHS is a risky place for both patients and staff. How do we identify and register potential risks (both clinical and environmental)? How do we prioritise which risks are so serious that they need to be tackled immediately. So often our priorities are driven by reacting to adverse events. In medicines management, electronic prescribing may eliminate many of the everyday risks we live with, but will it bring other risks (eg, in the field of patient confidentiality)? All the above systems (and the ones that there has not been space to mention, eg, managing poor performance) need to be developed with real and meaningful user/carer involvement. By 30 June, all organisations will need to develop a clinical governance development plan for submission to their appropriate merged health authority. Have you got medicines management stitched in? Think of clinical governance as a jigsaw. Each system is part of the jigsaw. If any of the pieces is missing it is not possible to see the whole picture. Make sure that medicines management is not the missing piece in your organisation. |
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