Your Logo Project Plan Implementation of National Inpatient Medication Chart (NIMC) at XXX Hospital Project statement To implement the National Inpatient Medication Chart at XXX Hospital Relevant outcome/partnership area/s National Inpatient Medication Chart implemented for all inpatients at XXX Hospital Document revision history Version Date Prepared by Comments 0.1 First draft circulated for comment to key stakeholders 0.2 Incorporating comments from key stakeholders 1.0 Final approved version Part A: Business Case Project scope Purpose As a result of this project, we (at XXX Hospital) expect to see: • Implementation of the National Inpatient Medication Chart (NIMC) in all inpatient units of XXX Hospital. (Paediatric, extended care, mental health, oncology and palliative care may consider using specially adapted charts as they become available). • Improvement in the quality of medication use due to the facilitation of safe, effective and efficient communication of the decision to treat (prescribing of medicines) and the safe and effective administration of medicines to patients. Key performance indicator • All inpatient beds using the NIMC at the completion of implementation. Benefits Achievement of the project purpose will contribute to the following benefits: • Standard medication chart in all health services Australia-wide. • Reduction in medication prescribing, dispensing and administration errors, and therefore reduction in associated patient harm. • Standardised training for medical staff on prescribing across health services (and associated decrease in need for education /orientation as staff move between sites). • Standardised training for nursing staff on administration across health services. • Reduction in the number of different medication charts being used across the country. • Bulk purchasing power of NIMC. • Proven template for use in electronic medication management. Rationale Estimates suggest that each year in excess of 70,000 hospital admissions are associated with an adverse drug event, resulting in 8,000 deaths and $350 million in direct hospital costs. 1 Evaluation of the medication use process suggests that about 50 per cent of the errors resulting in patient harm are associated with the prescribing process. Work conducted nationally and within Victoria has demonstrated that the safety and efficiency of the prescribing process can be improved by changes to the medication chart. The Australian Council for Safety and Quality In Health Care, in conjunction with a national inpatient medication chart working party, has developed and piloted the NIMC, which has been designed to reduce potential for error in prescribing, dispensing and administration of medicines. Evaluation of the use of the chart at pilot sites has demonstrated a 25 per cent reduction of relative risk of frequency errors and a 30 per cent reduction in toxic levels of warfarin. In addition to reduction in patient harm, the standardisation of training of medical, nursing and pharmacy staff on the use of a standard chart, and the bulk purchasing power of the NIMC, are anticipated to be additional benefits of implementing the chart at XXX Hospital. 1 Australian Council for Safety and Quality in Health Care. “Second National Report on Medication Safety”, 2002. Commonwealth Department of Health, Canberra. Objectives By the end of the project we (at XXX Hospital) will have: • Implemented the NIMC for use in acute inpatient wards at XXX Hospital. • Educated medical, nursing and pharmacy staff on the use of the NIMC. • Evaluated the impact of implementing the chart on prescribing and administration processes and errors. Key performance indicators • single inpatient medication chart in all units, • number of prescriptions charted using the NIMC, • proportion of medical, nursing and pharmacy staff educated on the use of the NIMC, • number of prescribing and administration errors recorded in pre-and post-implementation audits. Strategies • education of medical, nursing and pharmacy staff, • standardisation of training and education, • comprehensive communication strategy. Assumptions • availability of NIMC and associated educational materials, • existing inpatient medication chart will be replaced by NIMC, • education and sustainability to be met within existing hospital resources, • hospitals currently use a medication chart to prescribe inpatient medication and to record the administration of medicines to the patient. Constraints • limited staffing resources, • existing education processes and resources. Exclusions This chart is not intended to replace: • outpatient and discharge prescriptions, • PBS prescriptions, • other medication charts for specified high risk drugs (for example insulin, heparin and IV infusion charts). This project is not intended to address prescribing issues associated with effective and efficient medication choice. This project is not intended to address or implement electronic medication management. Related activity/projects (examples) Guiding principles to achieve continuity in medication management, Australian Pharmaceutical Advisory Council, July 2005. Pharmaceutical review, Joint communiqué, April 2004. Standards of practice for clinical pharmacy, SHPA, August 2005. Understanding the medicines management pathway, Journal of Pharmacy Practice and Research, 2004. Project partners/clients/stakeholders Partners/clients • medical staff (director of medicine /surgery, staff specialists) • nursing staff (nurse unit managers) • pharmacy staff • medical records /health information management departments • hospital executive • risk management • quality unit • staff education unit • supply departments • patients. Project timeframe 3 months Resources Project resources Item Resources 1. Allocation of project staff 2. Associated non labour resources 3. Other, for example, lease of photocopier Project budget-total Resource contribution from Department of Human Services (DHS) NIMC implementation toolkit, including poster, guidelines and PowerPoint presentation templates, plus advice from project staff. Cost implications post-project 1. Recurrent cost of NIMC versus current version XXX Hospital currently prints /purchases XXXX medication charts each year at a cost of $XXX. The cost of the NIMC is anticipated to be $XXX. In agreement with Pharmacy (initially) and the Forms Committee (when able to take over the function), these charts will be available centrally, thereby capitalising on bulk purchasing power. Savings (albeit non-cashable directly) are also anticipated in standardised training on prescribing and reduced adverse events associated with medication charts (either in prescribing, dispensing or administering). 2. Ongoing training Ongoing training will form part of the existing medical officer and nursing staff training packages (i.e. orientation). Overall project risk Low -The NIMC has been implemented in over 130 sites Australia-wide and has been shown to reduce the potential for patient harm. Part B: Project management Human resource management Governance a) Structure Governance Structure Project Officer Director of Pharmacy (Nursing or Medicine) Medication Chart Working Party Drug and Therapeutics Committee Chief Executive OfficerWorking Party membership to include (but not limited to): • chief executive officer • director of pharmacy • director of medical services (or delegate) • director of nursing • director of health information management • quality unit representative • risk management unit representative • staff education representative b) Roles and responsibilities Project role Name/s Responsibilities Project officer Overall project coordination and implementation Project Sponsor Chief Executive Officer Escalation point for unresolved issues Working Party Members Ensure project is being well managed and implemented Ensure adequate progress towards meeting project objectives c) Key decision points (higher authority) Key project decision points Higher authority for approval/sign-off Approval of project plan Chief Executive Officer Release of project resources Chief Executive Officer Pre-implementation review (if relevant) Drug & Therapeutics Status reports Drug & Therapeutics Exception reports Drug & Therapeutics Significant variations to project plan Chief Executive Officer Approval to progress to finalisation phase (final status report) Chief Executive Officer Project completion report Drug & Therapeutics Chief Executive Officer d) Human resource development For example, professional development and training 7 Project Schedule Strategy/Activity Accountable Months Officer/s Duration Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Project strategy implementation /finalisation activities Planning Identify key stakeholders Complete project plan NIMC documentation pre-audit Development Review and adapt resources from DHS Education packages – as per DHS Posters, flyers and newsletter article Approval Table at Committees: Drug & Therapeutics, Risk Management, Health Information Systems Final sign off by CEO Implementation Communication strategy Deliver education sessions Ordering and distribution of NIMC Recall of ‘old’ medication charts Evaluation Post implementation audit 8 Risk management Risk Risk Management Activities Preventive Contingent Resistance to change Sell project as multidisciplinary Use local evidence & share Escalate to CEO Lack of representation from key disciplines Include key disciplines in working party and collaborate closely with senior “champions” Escalate to CEO Lack of senior support Use local and state wide evidence Escalate to clinical champions Lack of resources for auditing and monitoring Use internal quality improvement staff for data entry and reporting data Engage assistance of working party and relevant executive stakeholders Time restraints Plan effectively to optimise use of resources Select realistic timeframes Escalate to working party Quality management Quality standards/benchmarks/guidelines (Insert relevant hospital quality indicators) Project evaluation Achievement of objectives • Meet key performance indicators. Strategy implementation • number of clinical staff educated • number of education sessions conducted. 9 Project management • NIMC implemented in all identified clinical units within XXX Hospital Post implementation review • medication chart audit • staff satisfaction survey. Communication management Communication What How With/To Whom When/how often Marketing of implementation Flyers on unit, library noticeboards Hospital Newsletters Posters All clinical staff Prior to ‘go-live’ Project status Unit meetings Lunch time clinical sessions Nurse, doctors, pharmacists Weekly Information management Document Type/Name Electronic Location Hard copy location NIMC Guidelines Medication Poster NIMC audit tool PowerPoint presentation