Supporting Medication
Nina Muscillo and Andrew Hargreaves
November 2014
Clinical Excellence Commission
The Clinical Excellence Commission promotes and
supports best practice clinical care, safety and quality
across the NSW health system by:
• conducting high-level analysis and review that
identifies risks and opportunities for improvement
• providing expert support, advice, tools and
• working collaboratively with patients, clinicians,
managers, health service partners and the broader
• Continuity of Medication Management (CMM)
• Medication Reconciliation Toolkit
- Development
- Content
- Piloting
- Future plans
• Partnering with eHealth NSW
CMM Program
Support the safe and quality use of medicines
at transfers of care
• Focus on medication reconciliation
• Provides Local Health Districts (LHDs) with
tools, resources and support to meet
• Guided by CMM Expert Advisory Group
Medication Reconciliation Toolkit
• Gap evident in NSW Health system
• In line with the National Safety and Quality
Health Service Standards
• Adaptable to suit local needs
• Incorporates lessons learned from international
Medication Reconciliation Toolkit
• Promote medication reconciliation as a
multidisciplinary activity
• Use clinical practice improvement/re-design
• Embed into clinical practice (not as an add on)
• Continual improvement activity
• Sustain and spread
Building on Lessons Learned
• Motivation of frontline staff
- Patient stories
- Clinical champion/lead
• Collect early baseline data
- Current gaps in care
• Leadership support
- Additional roles and responsibilities
• Educational tools
- Shared understanding
• Continual review and feedback
- Build measurement into workflow
Medication Reconciliation Toolkit
1. Establishing governance
2. Improving practice
3. Education and Training
4. Monitoring and Evaluation
5. Sustaining and Spreading
Establishing governance
Improving practice
Education and Training
Monitoring and Evaluating
Sustaining and Spreading
Medication Reconciliation Toolkit
• 4 hospitals, metropolitan and regional
Site visits to assist with:
Reviewing current practices and identifying gaps
Baseline data collection
Implementation plan
• Audit results being used to promote change
Medication Reconciliation Toolkit
…useful for assessing
current processes
The user guide was
clear and‘Was
(audit tool) was easy to use
Medication Reconciliation Toolkit
Future Plans
• CMM webpage
• Communication of the availability of the toolkit
• Official launch in early 2015
• Support pilot sites progress
Partnering with eHealth NSW
• Assist hospitals improve medication records
on admission and discharge
• Support LHDs with the re-design of their
medication reconciliation processes
• Collaborate to develop best practice electronic
eHealth NSW Electronic Medication
Management Program
$170m program
Centrally led
Locally delivered
Safety and quality
3 initial sites currently designing, building or
• Detailed planning studies conducted across
remainder of NSW
IMRAD Project – what’s in a name?
• Improving Medication Records on Admission
and Discharge
• 3 streams of activity
– Local Health District
– Electronic Medical Record
– Electronic Medication Management System
Clinical Systems Redesign
• Opportunities
– Understanding problem
– Solution design
– Implementation / Monitoring
• Barriers
Electronic Medical Record vs Electronic
Medication Management
• Variation in adoption of full EMM systems
– Readiness
– Schedule/Cost
• Minimum Requirements
– Documentation and validation of medication history
– Documentation of changes to medications during
– Communication of final medication list to patient and
– Medication list stored for reference during future
• Medication reconciliation isn’t about widget’s
and gizmo’s
• Medication reconciliation is about:
– People
– Process
Thank You

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