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Use of Medicines Strategy

Thu, 6 May 2004

National forum to discuss the Quality Use of Medicines Strategy

Opening the forum on a Quality Use of Medicines Strategy for New Zealand, Health Minister Annette King said medicines were central to an effective and efficient health care system.

Thank you Dwayne Crombie and to the DHBNZ Safe Use of Medicines Group for inviting me here today. It's a real pleasure to open this forum, and I am sure it will be useful and informative for all those present.

In particular, I would like to thank the speakers who have travelled all the way from Australia to be involved today. The more people we can draw experience and knowledge from, the more successful this forum will be. I am told our Australian guests have very busy schedules, but I hope you manage to find some free time to see some other parts of our beautiful country while you are on this side of the Tasman.

I am pleased to have the opportunity today to talk about an issue that is very real to all New Zealanders. People place great faith in being able to obtain medicine when they need it and, even more importantly, in being able to rely on the safety of the medicine they are prescribed and its safe administration. It is easy to overlook how this certainty and security represents a great advance on what our grandparents' generation had available to them. Times have certainly changed, and we should be really grateful for that.

Medicine is a key therapeutic tool used in nearly all areas of health care. In New Zealand in the year ending June 2003, there were more than 22 million prescriptions written, and more than $570 million was spent on prescription medicines and related products. There are currently 2600 government-subsidised prescription medicines and related products.

When you hear those sorts of figures, you can see that they add up to a massive proportion of New Zealand health care. As you know, medicines are central to an effective and efficient health care system. That is why it is important that we are all here today. Establishing this project is an imperative step in ensuring the medicines we use are safe and effective, and that they are safely packaged and administered.

Despite the safety systems in place, it is inevitable that some problems will occur because of the high volume of medicines being prescribed, dispensed and administered. It is our job to minimise and prevent these problems.

It is important to acknowledge that we are lucky to be able to learn from the experience of other countries, such as Canada and the United States. We also need to realise that we can learn from our own studies and experiences. Studies such as the Adverse Events in New Zealand Public Hospitals: Principal Findings From a National Survey, done by Professor Peter Davis and colleagues, are essential for learning from the past and putting in place strategies to prevent harm in the future.

My understanding is that the purpose of this group is to agree and implement a best-practice strategy and model among DHBs to promote the quality use of medicines, reduce medication errors and adverse events within hospitals and across the primary/secondary interface. The project will build on any existing knowledge or work in the sector that has already been identified. This specifically includes the Quality Use of Medicines Strategy, which will be discussed tomorrow. It has had significant input from the Hospital Pharmaceutical Advisory Group and Pharmac. The project team has identified five objectives for the first phase of the work: · Firstly, to complete a stocktake of existing processes and systems for prescribing, administration and dispensing medications among DHBs. · Secondly, to identify all related quality improvement initiatives and any associated evaluation among DHBs. ·The third objective is to carry out a worldwide literature review to identify and summarise current knowledge on effective practice to reduce medication error and associated adverse events.

·The fourth objective is to design a systematic approach to improving the quality use of medicines. This should include the reduction of medication error and adverse events in hospitals information systems, and management across the interface with primary care, and should utilise current best practice. · The fifth objective is to make recommendations to DHB CEOs on priorities for implementation (incorporating any cost-benefit information). Since the first meeting in April 2003 the group has established a list of six high-risk medicines to target for urgent action: potassium, warfarin, heparin, diltiazem, insulin and morphine. The development of information technology systems is fundamental in reducing the risk associated with medication systems. A national cohesive approach is imperative, aiming for a maximum of one or two systems across the country. Work has taken place on the following areas:
· Stocktake of existing IT systems at a DHB level ·

Development of standards for a systems approach to medication management

Updates on e-prescribing projects within the country. Otago DHB is currently implementing an e-prescribing system (Hatrix), which will eventually be integrated with the pharmacy computer system (Windose).

A health consortium is applying for FoRST funding to develop an electronic pharmacy and electronic prescribing system

Auckland DHB, Counties-Manukau DHB and Waitemata DHB have collaborated on the choice of a regional pharmacy computer system (Windose) that will replace the systems currently used and allow for e-prescribing in the future. With regard to the primary/secondary interface, issues that have been identified include information transfer about medicines and treatment from primary to secondary care. There has been a proposal for a National Drug Information Service based in Christchurch. This service would address issues around specialist information resources, provide standardised drug information and access to unbiased information. The provision of a clinical pharmacy service is fundamental in managing the clinical risk associated with the use of medicines. Reporting and monitoring medication incidents is crucial. Ways of encouraging and highlighting areas of concern nationally have been identified. There needs to be consistency on definition, recording, categorisation and reporting of medication errors. There also needs to be a national alert system for sentinel events to promote immediate sharing of information and the opportunity to learn from errors occurring both locally and nationally. In September 2003 I released Improving Quality (IQ): A Systems Approach for the New Zealand Health and Disability Sector. I am confident that this strategy will have long-term benefits for the way we ensure quality is maintained and improved in the sector.

Improving Quality is a commitment to supporting continuous quality improvement by each person who works within the system, by the people cared for and supported by the system, and by the system itself. We want to put people at the heart of the system, particularly at the interface between those receiving health and disability services and those delivering them. I am sure you will acknowledge that quality can always be enhanced, even though excellent work is already being done.

Improving Quality reflects this approach by including an ongoing review and updating process. I am confident that this document will help all health professionals to provide continually improving health services to all New Zealanders.

Other countries and jurisdictions have found the development of a national health sector quality improvement strategy useful. It improves safety and outcomes for patients, improves processes for the way in which health care providers operate, allows the implementation of innovation in the sector and has led to positive outcomes for health practitioners.

Improving Quality is a central vision for quality, understood and shared by everyone. It aims to:

· Set clear standards and priorities for quality improvement · Encourage public and patient involvement · Assure and improve quality as an every day activity · Develop a strong system for reducing risk and promoting patient safety.

Action 5.1 of the Improving Quality action plan relates particularly well to today's forum. It states that national projects must be "scoped to respond to the findings in the Adverse Events in New Zealand Public Hospitals Survey specifically targeting a national reduction of health care-acquired infection and medication errors in health services".

There is a requirement for New Zealand to develop a national policy on the safe and quality use of medicines. This forum gives an opportunity to inform people on the project to date, engage people in future work, receive input from around New Zealand and the international community, and to consider the need for and possible development of a national strategy for the quality and safe use of medicines.

Forgive me using a cliché, but prevention really is better than cure. And I'm sure you will all agree with me that any project that results in the prevention of harm is worthwhile. Thank you all for being here today to support such an important project, and thank you again for inviting me. I wish you all the best for a productive and successful forum.


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