Medication Safety in Norway

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Griffin Clark
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1 Medication Safety in Norway In Safe Hands 24-7; Norwegian Patient Safety Program 1 Anne-Grete Skjellanger, Head of Secretariat October 2014

2 Adverse events in Norway: Approx. 13 % of hospitalized patients are subject to patient harm Approx. 8 % of the incidents lead to more pronlonged hospital stay Nearly 40 % of the avoidable harm has been reduced from

3 Risk areas: (percentage of all hospital admissions) Medication harm 2,1 % Urinary tract infections 1.7 % Postoperative wound infections 1,7 % Surgical complication, other 1,6 % Infection, other 1,8 % Respiratory infection 1,7 % 3

4 Creating the safest healhcare in the world 5-year national program Aims: 25% reduction of avoidable harm Build competence and lasting structures for patient safety Improve patient safety culture 4

5 How: 13 Bundles interventions Hospital and primary health care Improvement model Measurements Learning collaboratives 5

Interventions Fall Stroke treatment Urinary tract infections Safe surgery/post operative infections Central line infections Medication reconciliation Preassure

6 Interventions Fall Stroke treatment Urinary tract infections Safe surgery/post operative infections Central line infections Medication reconciliation Preassure ulcer Drug review in home care Prevent overdose Drug review in nursing homes Prevent suicide Leading patient safety Side 6

7 Implementation 1 pilot 20 teams All 20x20 National program Healthcare services 7

8 Harm caused by medication 8

9 Medication review in nursing homes Medication reconciliation Medication review and reconciliation in home based care 9

10 Medication reconciliation 1. Reconcile, update, and deliver the medication list to all patients (GP) 2. Reliable recording and follow-up of medication history during hospital admission/ outpatient treatment 3. Ensure that the updated, reconciled medication list is attached to the discharge summary. 4. Give the patient an updated and reconciled medication list on discharge from the hospital. After outpatient consultation, give an updated medication list when there have been changes in medication use. 10

11 Medication review in nursing homes 1. Interdisciplinary medication review on arrival, half-year and annual check-up 2. Establish structure in the EPJ that ensures documentation of medication reconciliation and medication review with follow up. 3. Ensure follow up of prescribed medication with professional observation, assessments, and documentation in the EPJ within 24 hours following any changes. 4. Ensure multidisciplinary teaching and case meetings about optimal medication use by the patients 11

12 Medication review and reconciliation in home care 1. Medication reconciliation between patient, home care service and GP 2. Multidisciplinary structured medication review of patients living at home who are receiving help in administration of medication when this is deemed necessary based on medical and nursing assessment 3. Ensure follow up of the prescribed medication with professional observations, assessments, and documentation in the EPJ within two working days following any changes. 4. Establish structure in the EPJ that ensures documentation of medication reconciliation and medication review with follow up 12

13 User empowerment 13

14 14 Results Example: Patients with updated medication list upon discharge

15 Results, e.g: Medication with indication upon perscription 15

16 Results E.g patients with structured medication review 16

17 - I have never been so proud as a doctor. During 30 years in hospital, we did the same mistakes over and over again. With structured medication review, we learn from our mistakes, we cooperate well as a team, and the patiens recieve better care. - Bjørn Schreiner, doctor, Nygård nursing home 17

18 Hans Andersen 18

19 Challenges Medication reconciliation Engaging doctors Costs of involving pharmacists Full scale implementation in primary health care Competence in Med. Rec. and Med. Review Incompatible documentation systems User involvement 19 Legemidler i pasientsikkerhetsprogrammet

20 2 /19 12 /24 12 /24 13/44 24 /36 9 /26 6 /25 11 /26 10 /22 Akershus:13 /22 28 /33 9 /26 13 /21 14 /18 8 /15 13 /15 12 /18 Oslo: 10 /50 nursing homes 14 /15 city districts (home based care) Vestfold: 12 /14 20

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AMBULATORY BREAST CANCER SURGERY AT KING S BREAST CARE (KBC) Jo Marsden, Terri Baxter, Uli Fountain Kings College Hospital Foundation Trust London

AMBULATORY BREAST CANCER SURGERY AT KING S BREAST CARE (KBC) Jo Marsden, Terri Baxter, Uli Fountain Kings College Hospital Foundation Trust London AMBULATORY BREAST CANCER SURGERY AT KING S BREAST CARE