Standard 4: Medication Safety
Advice Centre Network Meeting
Margaret Duguid
Pharmaceutical Advisor
February 2013
Intent of Standard 4 – Medication Safety

Ensure competent clinicians safely
prescribe, dispense, and administer
appropriate medicines safely to informed
patients and carers
• Reduce medication incidents, adverse
events
• Improve safety and quality of medicine
use.
Standard 4
Medication
Safety
Standard 4 – Medication Safety

The Medication Safety Standard describes the elements
of a safe medication management system.

It requires hospitals have in place strategies and
systems known to reduce the risk of common causes of
medication error.
• standardisation and systemisation of processes
• improving clinical workforce and clinician-patient communication
• using technology to support information recording and transfer
• providing better access to patient information and clinical
Standard 4
decision support at the point of care.
Medication
Safety
Five criteria (Part 1)
1.
Governance and systems for medication safety
•
2.
Documentation of patient information
•
3.
Health service organisations have mechanisms for the safe
prescribing, dispensing, supplying, administering, storing,
manufacturing, compounding and monitoring of the effects of
medicines.
The clinical workforce accurately records a patient’s
medication history and this history is available throughout the
episode of care.
Medication management processes
•
The clinical workforce is supported for the prescribing,
dispensing, supplying, administering, storing, manufacturing,
compounding and monitoring of medicines.
Standard 4
Medication
Safety
Five criteria (Part 2)
4. Continuity of medication management
•
The clinician provides a complete list of a patient’s medicines
to the receiving clinician and patient when handing over care
or changing medicines.
5. Communicating with patients and carers
•
The clinical workforce informs patients about their options,
risks and responsibilities for an agreed medication
management plan.
Standard 4
Medication
Safety
1. Governance and systems for med safety
4.1 Governance arrangements and organisation policies
• Drug and Therapeutics Committee (DTC)
- Medication Safety Committee
- Report to safety and quality governance,
executive
Standard 4
Medication
Safety
1. Governance and systems for med safety - Policies
www.safetyandquality.gov.au/our-work/medication-safety/
Resources, list of jurisdictional contacts
1. Governance and systems for med safety
4.2 Assess medication use system
• How?
• Use a structured tool e.g. Medication Safety Self
Assessment
- Multidisciplinary team
- Every three years
• Identify what you are doing well, evidence actions met
• Identify areas for improvements
• Develop an action plan.
• NIMC national audit
Q. Hospitals uses non conforming chart.
Can we enter data into NIMC audit database?
1. Governance and systems for med safety
4.2.2 Assess medication use system
Q Do we have to action all problems identified
• Prioritise areas using risk matrix
• http://www.safetyandquality.gov.au/ourwork/accreditation/accreditation-newsroom/
1. Governance and systems for med safety
4.5.Quality improvement activities
• NIMC mandatory
Q Hospital implementing e-MMS does not use NIMC
• NIMC mandatory if using paper charts
• Follow guide to safe implementation of eMMS
• www.safetyandquality.gov.au/our-work/medicationsafety/electronic-medication-management-systems/
Standard 4
Medication
Safety
Safety and Quality Improvement Guide
Criterion: Documentation of patient information
Documentation of patient information

4.7 Documenting previous known allergies, ADRS
Q. Do you need to document all ADR information on all medication
charts ?
• NIMC – “Source of truth”
• Other charts
- Specialist charts, clozapine, heparin
- Cross reference to NIMC
• Electronic health record
• One source in EHR
• Active transfer information to e- medication management system, pharmacy
system
• On prescribing screen
• Active alerts
Standard 4
Medication
Safety
Documentation of patient information
4.8.1 Current medicines are documented and reconciled at
admission and transfer of care
Q. Who can document history, reconcile medicines?
• Health professionals trained to reconcile medicines
- Nurses, doctors, pharmacists, pharmacy technicians
• Nurse:Pharmacist model
- Nurse consults with pharmacists re discrepancies

Q. Can we use NIMC audit as evidence for no. patient’s
whose medicines reconciled

Q. What is medication management plan, where is it
available ?
Standard 4
Medication
Safety
2. Documentation of patient information
Medication Management Plan
supports workforce to:

Take and record a complete and
accurate medication history (BPMH)
(4.6.1)

Document ADRs on admission
(4.7.1)

Reconcile discrepancies between
history and medication orders
(4.8.1)
Standard 4
Medication
Safety
Documentation of patient information
Medication reconciliation Resources
http://www.safetyandquality.gov.au/our-work/medicationsafety/medication-reconciliation/
2. Documentation of patient information
Medication Management Plan
+ implementation resources
15
Medication management processes
4.11 Managing high risk medicines
Q. What is a high risk medicine?
• Medicines that have a high risk of causing serious injury or death to a
patient if they are misused or used in error
• Errors not necessarily more common, effects more devastating.
• PINCH/APINCH
• Institute of Safe Medication Practices list
• www.safetyandquality.gov.au/our-work/medicationsafety/medication-alerts/

Q. Can we prioritise actions to address risks with high risk
medicines?
Standard 4
Medication
Safety
Continuity of medication management
4.12 Current, comprehensive list of medicines provided to
receiving clinician and patient at clinical handover
Q. Does 4.12. apply to outpatients ?
•
Referring doctor informed of changes to medicines
•
Patient informed of changes, amend patients own list
Standard 4
Medication
Safety
Communicating with patients and carers
4.14 Medication management plan developed in partnership
with patients, carers
Q. What is a medication management plan? Is it the National
Medication Management Plan?
• Consumer Medication Action Plan referred to in APAC
Guiding principles to achieve continuity of medication
management.
• Plan for patient’s medication management
• Treatment goals, list meds, changes
• Provided to patient, carer
• Commission developing a template
Standard 4
Medication
Safety
Medication Safety Standard: Summary

Ensuring that competent clinicians safety prescribe, dispense and
administer appropriate medicines to informed patients and carers is
an essential element of safe and high quality care.

Purpose of the Standard is to improve outcomes for patients by
ensuring that there is a systematic approach to medicines
management and safety

Outcomes to be achieved are clear – methods to get there will vary
depending on context
Standard 4
Medication
Safety
Australian Commission on Safety and Quality
in Health Care
Medication Safety Program
www.safetyandquality.gov.au
Email: mail@safetyandquality.gov.au
Margaret.duguid@safteyandquality.gov.au