Safe medication management

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 12

Abstract

The Safe Medication Management program is a government funded initiative designed to reduce adverse drug events throughout the health sector. The program comprises medicine reconciliation, packing drugs in unit doses, bedside verification, standardized hospital information systems and links with medicine management, standardized medication charts, and e-medication records and e-prescribing.

Purpose of health policy or idea

The Safe Medication Management program is a government funded initiative to improve patient safety by reducing adverse drug events. Although the focus of the program will initially be on prescribing, dispensing, administering and reviewing medication in public hospitals and in their interface with primary care, the program will also develop systems for safe medication management across the entire health sector.

Work streams within the program are:

• Medicine reconciliation;
• Packaging pharmaceuticals at unit dose with barcodes on wrappers or labels, and introduction of  bedside verification;
• Standardizing hospital medicine information systems, and linking all information systems connected with medicine management;
• Standardizing medication charts, and introduction of an e-medication record or e-prescribing or a clinician point of entry system.

A universal medicines list is also being developed as part of the program to ensure common language around the medication process. All of the work streams incorporate the training and support of staff. The program will run for four years.

Main points

Main objectives

The main objective is to improve patient safety by reducing the number of adverse drug events.

Groups affected

District Health Boards, Patients, General practice, Primary Health Organisations and other providers

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Political and economic background

International awareness of the incidence and cost of adverse drug events in hospitals has been increasing over the past two decades. In New Zealand, a study undertaken in 1998 indicated that 12.9% of admissions to public hospitals in New Zealand were associated with an adverse event, with around four fifths of these occurring within the hospital setting.  One third of the adverse events were in medicine, most of which were drug related. This has encouraged hospital managers and policymakers to consider how these adverse events might be avoided through the implementation of quality improvement programs.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

International awareness of adverse drugs events has encouraged many countries to introduce various mechanisms and procedures for reducing these adverse events. This program draws on these international experiences to develop a set of initiatives that are appropriate and relevant for the New Zealand setting.

The Safe Medication Management program is one of five projects which are being implemented in New Zealand as part of a national quality improvement program, the broad aim of which is to address quality and safety issues in public hospitals. The program was developed by the Quality Improvement Committee, a statutory committee set up under the New Zealand Public Health and Disability Act  2000. The five projects were developed in 2007 and funding was made available in 2008 for their implementation (www.qic.health.govt.nz/moh.nsf/indexcm/qic-improvementprogrammes).

Initiators of idea/main actors

• Government

• Providers

• Patients, Consumers

Approach of idea

The approach of the idea is described as:
renewed: Many countries have introduced initiatives for reducing adverse drug events in hospitals.

Stakeholder positions

At this early stage of the program's development, all key stakeholders appear to be very supportive. All of the 21 District Health Boards - who will be primarily responsible for implementing the program -  have agreed to participate in the program. As yet there appears to be no broad opposition from any groups. The project is taking a multidisciplinary approach with national representation in an attempt to ensure that the needs and interests of all of those involved in medication management are considered and to secure buy-in from all key stakeholders.

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Providers
District Health Boards	very supportive		strongly opposed
General practitioners	very supportive		strongly opposed
Professional organisations	very supportive		strongly opposed
Patients, Consumers
Hospital patients	very supportive		strongly opposed

Actors and influence

Government
Ministry of Health	very strong		none
Providers
District Health Boards	very strong		none
General practitioners	very strong		none
Professional organisations	very strong		none
Patients, Consumers
Hospital patients	very strong		none

Positions and Influences at a glance

Adoption and implementation

Implementation of the program is being guided by a national Steering Group together with a clinical advisory panel. The Steering Group, which comprises personnel from District Health Boards plus consumer representatives, will work with key stakeholders at the governance and senior management level. Below the Steering Group is a nine person Project Team whose role is to deliver the program. The Project Team has formed multi-disciplinary Working Groups comprising more than 60 members drawn from across the District Health Boards. They include clinicians, nurses, managers, IT personnel, pharmacists, etc. Their role will be to develop documentation, guidelines and processes to guide implementation. The program will then be introduced into selected pilot sites.

Monitoring and evaluation

Evaluation is seen as a core part of this program and is the focus of a separate work stream. Evaluation criteria are currently being developed.

Expected outcome

The expected outcome from this program is a measurable reduction in harm from adverse drug events. If the current level of support from key stakeholders is maintained and the program is implemented successfully within the four year period, there appears to be no reason why this objective cannot be achieved.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

Research indicates that adverse events in hospitals can be very costly both in financial terms as well as in terms of the impact on patients. This suite of projects, if implemented succesfully and adopted widely, has the potential to improve the safety and quality of care for patients in hospitals and also in the community. It may also secure net savings for District Health Boards. 

References

Sources of Information

• National Quality Improvement Programme. Safe Medication Management Programme. www.safemedication.org.nz/index.php.
• Quality Improvement Committee. www.qic.health.govt.nz.
• Davis, Peter, Roy Lay-Yee, Robin Briant, et al. Adverse Events in New Zealand Public Hospitals I: Occurrence and Impact. The New Zealand Medical Journal, 115 (1167), 271-276, 2002.
• Davis, Peter, Lay-Yee, R.,  Briant, R., et al. Adverse Events in New Zealand Public Hospitals II: Preventability and Clinical Context. The New Zealand Medical Journal, 116 (1183), 624-634, 2003.

Author/s and/or contributors to this survey

CHSRP

Suggested citation for this online article

CHSRP. "Safe medication management". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/nz/a12/3