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
• Group/Committee
• Responsible for medication safety
• Reports to executive/management
• Day procedure service
• Facility manager, specialist clinicians (Anaesthetist in day
surgeries), nurse ± pharmacist
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
4.5.2 Quality improvement activities

Q Do Day procedure services have to follow labelling
recommendations?
• Yes. Where Aust & NZ Standards for labelling
medicines in syringes in anaesthesia do not
apply.
• Label containers, conduits for medicines, fluids in
perioperative area
Standard 4
Medication
Safety
Private Hospitals Day Surgery Chart
Q. Many facilities only give sedation, anaesthetic, and pain relief or anti-emetics post op.
How relevant is national medication chart?
http://www.safetyandquality.gov.au/our-work/medication-safety/medicationchart/private-hospital-and-private-hospital-day-surgery-nimc/
1. Governance and systems for med safety
4.2 Assess medication use system
• How?
• Use Accreditation Workbook to guide assessment
- ANZCA Guidelines for administration anaesthetic agents
• Identify what you are doing well, evidence to demonstrate actions
have been met
• Identify areas for improvements
• Develop an action plan.
• Q Do we have to action all problems identified
• Prioritise areas using risk matrix
• http://www.safetyandquality.gov.au/ourwork/accreditation/accreditation-newsroom/
Documentation of patient information

4.6.1 Document “best possible” medication history
Q. Do you need to document a medication history?
A. All patients should have a medication history taken
prior to prescribing medicines
• Documented in patient record
• At pre-admission

4.8.1 Medicines are documented and reconciled
• Not applicable to day procedure services
Standard 4
Medication
Safety
Documentation of patient information

4.7 Documenting previous known allergies, adverse drug reactions
(ADRs)
Q. Where should allergies and ADR information be recorded ?
• Medication chart – “Source of truth”
• Other charts
- 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
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
• Errors with these products are not necessarily more common, but the
effects can be more devastating.
• PINCH/APINCH, neuromuscular blocking agents
• 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
Standard 4
Medication
medicines?
Safety
Medication management processes
4.10.2 Use Tall Man Lettering in storage and labelling
Q. Is Tall Man Lettering applicable to a day surgery ?
• Use on shelf/drawer labelling where there are confusable
names
Q. Should doctors use Tall Man Lettering on their scripts?
• Only for names on labels, shelving, It (e-prescribing systems)
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 day procedure services, dental
services?
•
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 Information provided to patients and carers in a format
that is understood and meaningful
Q. Most patients are given a script to have filled by their local
pharmacists. How much information does facility have to
give the patient?
•
Community pharmacy should give Consumer Medicines
Information
•
Facility verbal information , documented in notes
•
If use prepacks – include CMI .
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