Quality Use of Medicines (QUM): The opportunity presented by health informatics

16 June - 2005, Crowne Plaza Hotel, Auckland

This one day seminar showcased DHB based projects in QUM in the Northern Region commencing with an overview of key issues by Dr Dwayne Crombie, CEO of Waitemata District Health Board. PLUS …HL7 presented by Dr.Stephen Chu, vice-chair of NZ HL7 User Group

This introduction session is designed to provide basic information about HL7 and provide an insight into the myth of "self describing XML".

Programme:

8.30am            Registration and Coffee

8:50 am            Chairman’s Introduction

9.00am             The District Health Boards NZ (DHBNZ) Safety and Quality Use of Medicines Group Project

A strategic overview of the DHBNZ Safety and Quality Use of Medicines (QUM) Group from a Group CEO Sponsor. Quality use of medicines (QUM) is about optimizing medicines use to get the best outcomes for patients – when medicines are the right option, they need to be used wisely and safely. The purpose of the DHBNZ group is to agree and implement a best practice strategy and model among DHBs to promote the quality use of medicines, reduce adverse events within hospitals and primary care including the primary-secondary interface. 

Speaker: Dwayne Crombie is currently CEO of the Waitemata District Health Board.  Waitemata DHB covers a population of 480,000 people living in North West Auckland as well delivering specific regional services in community and mental health to metropolitan Auckland.  Dr Crombie has a background in medicine, public health and management.

9.30am             e-Pharmacy in the Auckland Region

ADHB is midway through the development and implementation of a new Pharmacy system and single common drug database, which will eventually be used across the region. The introduction of electronic prescribing and drug administration is planned as the second phase of the project. This presentation looks at the nature and scope of the regional pharmacy project and some of the complexities faced during implementation. The future for electronic prescribing and drug and drug administration within ADHB will also be discussed.

Speaker:  John Cox , Following a period of six years working as a management accountant for Llyods bank in the UK, John Cox joined Auckland District Health Board in 1996. For the next five years John managed the Radiology Departments at Auckland Greenlane hospital through a significant period of change that culminated in the introduction of public MRI scanning and the development of the new Medical Imaging facility in the Auckland City Hospital. More recent focus has been on the management of hospital wide information system projects including the clinical workstation, regional results repository and PACS digital radiology system. John is currently managing the selection and introduction of a Regional Pharmacy system at ADHB as well as a regional electronic prescribing project.

10.30am            Warfarin Integration in Waitemata

Audits of clinical practice in Waitemata District in 2002 showed that warfarin management was sub-optimal. We established this project in 2003 with the overall aim of improving the care of patients on warfarin.

Our key objectives were to improve patient safety through-

• A district wide systems approach to manage people on warfarin
• To find simple and effective ways to standardise hospital and community practice
• To improve patient understanding through increased education and consistent practice by health professionals in hospitals general practices and community pharmacies

A small working group undertook a district wide stocktake to quantify the problem.

This has resulted in

·         Development of user friendly guidelines for hospital and primary care

·         Multidisciplinary learning , to encourage and support consistent information and treatment to patients

·         A systematic approach for discharge to community

Systematic feedback loops indicate we have made significant improvements. Measurement is ongoing.

Speaker: Avril Lee- Integration Pharmacist. Born and raised in Northern Ireland. B. Sc in Pharmacy and M.Sc in Applied Pharmacology , Post-Grad Diploma in Service Management. Background of managingment  in pharmacy practice and managing multidisciplinary teams.  Avril is currently working in an Integration role between Waitemata DHB and HealthWEST PHO.  She has a strong interest in integration between primary and secondary care, and improving health outcomes at population level and was Elizabeth Brookbanks- Clinical Pharmacist, Waitemata DHB. M.Clinical Pharmacy. Avril is an experienced practitioner in hospital pharmacy, with a special focus on drug use evaluation (DUE). Skilled as a coach and tutor for recently graduated pharmacists and a strong interest in a systematic approach to the use of medicines.

11.00am            Transfer of Patient Medication Information – Yellow Patient-Held Card

The aim of this project is to develop a district-wide agreed format for the patient-held yellow medication.  Historically these cards are completed in hospital and given to patient to take home.  The card lists all the patient’s current medications in a patient-friendly format.  It is hoped that increasing the usage of the card across the district will assist in the transfer of information about a patient’s current medications between health professionals.  There are challenges with ensuring the information on the card is accurate.  Potential electronic solutions will also be discussed.

Speaker:  Mary-Anne O’Rourke, QUM Project Manager, Waitemata DHB.  Mary-Anne has worked in both hospital and community pharmacy.  She has also worked for the Pharmaceutical Society developing continuing professional development requirements for pharmacists.

11.30am            Questions and Discussion

12:45 pm          WDHB Initiative – Post Renal Drug Dosing

Renal drug dosing - The aim of the renal drug dosing project is to ensure that doses are reduced in patients with renal impairment. Changes to the software in Pharmacy and General Practitioner's computers may assist health professionals in improving the safety of medicines for patients.

Speaker: Lenore Jansen , Clinical Pharmacist and Project Manager, Waitemata DHB.  Lenore has worked in hospital and community pharmacy, both in New Zealand and the UK.  She has also had governmental roles in NZ involving the management of pharmaceuticals.

1.15pm             Pyxis MedStations – The Future of Medication Management

Pyxis MedStations are automated units used for the distribution and storage of medications, and have progressively been installed in all medical and surgical wards, the Perioperative Unit and the Coronary Care Unit at North Shore Hospital. As all medications are reviewed by a clinical pharmacist, and nurses are guided to the correct location of the required medicine, the clinical risk associated with the prescribing, dispensing and administration of medicines has been significantly reduced.

The range of medications immediately available for administration, and the “time to first dose” have been improved; medications are stored securely and their use tracked in real-time; and costs can be identified down to patient level providing excellent data for review of clinical practice. The project has achieved significant cost savings of 19.7% per occupied bed day in the medical wards, and 20.3% in the surgical wards, realising net annual cost savings of $93,428.

The introduction of the Pyxis MedStation has minimised the clinical risks associated with the use of medicines and reduced the expenditure on medicines by reducing wastage. In addition efficiencies have been gained with clinical staff spending less time in the ordering and distribution of medicines, increasing the time available for patient focussed activities.
 

Speakers: Marilyn Crawley & David Ryan

1:45pm             Going Back to Basics with Medication Safety at Starship Children’s Health (SCH) - The 5R’s “the right medicine in the right dose to

the right patient by the right route at the right time” campaign The results, challenges and tribulations from the medication safety campaign conducted in Starship Children's Hospital in 2004.

The campaign mission was to empower staff to go “back to the basics” with the medication administration process so they question, check and challenge the medicine administration systems used to ensure “the right medicine in the right dose by the right route at the right time gets to the right patient"

Speaker: Nirasha Parsotam is the Prinicipal Pharmacist - Medication Safety at ADHB. She has a strong interest in clinical governance and risk project management. Nirasha returned from the UK last year, where she was responsible for delivery of the National health Sevice (NHS) Control Assurance Standards for Medicines Management as part of the NHS Agenda for Change in a central London teaching hospital.

2.45pm             An introduction to HL7 presented by Dr Stephen Chu

HL7 has been widely implemented as health messaging standard in 30 countries around the world.  NZ is one of the earliest implementer countries of HL7. With the introduction of XML, many (developers and DHB IT staff) are questioning the need for HL7.  The "self-describing XML" has been hailed as "sexy" technology that can replace HL7.  This introduction session is designed to provide basic information about HL7 and provide an insight into the myth of "self describing XML.