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The Clinical Excellence Commission The eChartbook


Medication Safety Self Assessment Program (MSSA) For more information, click here
Participation in the CEC's Medication Safety Self Assessment Program
For more information about this CEC program, click here
 


Why is this important?


The management of medications is complex and there are many opportunities for errors and other adverse events to occur. Medication related admissions have been estimated to cost the Australian health care system upwards of $1.2 billion per year and medication incidents represent 27 per cent of all clinical incidents occurring in Australian hospitals [1],[2]. In NSW, medication and intravenous fluid-related incidents are the third-most frequently reported incident type [3]. Each year, approximately 20,000 incidents involving medications and IV fluids are reported to the NSW Incident Information Management System [3]. Some of these incidents result in patient harm, occasionally this harm is severe.


The Medication Safety Self-assessment (MSSA) is a tool comprised of 247 self-assessment questions related to the systems and processes that are in place to ensure the safe use of medicines. It was developed by the Institute for Safe Medication Practices (ISMP) in the USA and adapted for use in Australia by the Clinical Excellence Commission (CEC) and the NSW Therapeutic Advisory Group, with the permission of ISMP in 2006, and officially launched in 2007. The aims of the MSSA are to heighten awareness of the structures and practices that define a safe medication use system, to provide a structured framework for assessing current medication management practices and to enable hospitals to systematically identify gaps in practice and areas for improvement. The self-assessment is divided into ten key elements:

  1. 1. patient information
  2. 2. drug information
  3. 3. communication of drug orders and other drug information
  4. 4. drug labelling, packaging and nomenclature
  5. 5. drug standardisation, storage and distribution
  6. 6. medication delivery device acquisition, use and monitoring
  7. 7. environmental factors, workflow and staffing patterns
  8. 8. staff competency and education
  9. 9. patient education
  10. 10. quality processes and risk management.

These key elements have been shown to significantly influence the safety of medicines use. The MSSA has been used extensively throughout North America, where it has been a key driver for improving medication management systems and reducing opportunities for patient harm. The Australian tool is supported by an on-line database developed and supported by ISMP-Canada. This allows facilities to obtain a score for the self-assessment, for key elements and for individual questions. The scores obtained can be used to prioritise areas for action and to measure improvement over time.



References

[1] Roughhead L, Semple S, Rosenfeld E, Literature Review: Medication Safety in Australia (2013). Australian Commission on Safety and Quality in Health Care, Sydney
[2] Runciman, W., Roughead, E., Semple, S., & Adams, R. Adverse drug events and medication errors in Australia. International Journal for Quality in Health Care. 2003; 15(suppl 1): i49-i59.
[3] Clinical Excellence Commission. Patient Safety and Clinical Incident Management in NSW: Analysis of IIMS Data 2010 to 2014. Sydney: Clinical Excellence Commission.


Findings


Chart MA01 shows that up to May 2015, a total of 196 hospitals in NSW (both public and private) completed the MSSA and submitted their data to the CEC with 81 hospitals (41%) completing the survey more than once.


Chart MA02 demonstrates that 76 per cent (110 out of 145) of NSW public hospitals in peer groups A1 (acute hospitals treating more than 30,000 acute casemix weighted separations per annum) to D2 (non-acute, treating less than 200 separations, or 2,000 or less acute casemix weighted separations per annum), completed the MSSA and submitted their data to the CEC.


Overall participation rate in the MSSA program is very high. Gaps in uptake are largely in smaller sites where completion of the tool may be more difficult (participation for D peer group 56% compared to A at 81%). A number of factors, including, but not limited to, lack of pharmacists to participate and lead the self-assessment, differences in the way medicines are managed, workforce shortages leading to the inability to form the multi-disciplinary team required to complete the tool, may be involved.


As of May 2015, participation by Murrumbidgee and Illawarra Shoalhaven hospitals remains considerably lower than that of the other LHDs.


Chart MA03 presents the aggregate scores recorded for the MSSA by 81 NSW hospitals (public and private) during their first and second self-assessment. The self-assessment is designed to provide a weighted score, as a percentage of the maximum possible score, for the entire assessment and for component elements.


The mean aggregate overall self-assessed weighted score improved from 50 per cent in the first assessment to 58 per cent in the second assessment. The greatest improvement was seen in ‘medication delivery’ and ‘staff competency and education’.


Chart MA04 presents the aggregate scores recorded for the MSSA by 22 NSW hospitals (public and private) during their first, second and third self-assessments. The mean aggregate overall self-assessed weighted score improved from 48 per cent in the first assessment to 62 per cent in the third assessment.


Implications


The majority of NSW public hospitals have assessed their medication management systems for potential risks to patient safety. In doing so facilities have highlighted opportunities for local improvement and gathered baseline data, against which they can measure their performance over time.


The high participation rate shows a firm commitment to improve medication management systems and, in doing so, reduce the risk of patient harm. Chart MA03 and MA04 demonstrate that repeated assessments are useful to illustrate local improvements that have been made to medicines use systems over time. The commitment to medication safety, demonstrated through participation, needs to be matched by a commitment to improve systems and processes that support medicines use.


What we don't know


We do know that patients are harmed by inappropriate or unsafe use of medicines and that certain actions, as highlighted in the MSSA, can help to reduce this harm. It has proven very difficult, however, to measure reliably the safety of medicines use. Many different measures and methods of collecting them have been tested. Some can tell us meaningful information about discrete aspects of medicines use or about outcomes in particular disease categories. Determining one robust and reliable global measure of safe medicines use, however, has not been possible.


This limits the ability to draw conclusions about the absolute impact of the MSSA program. We know that facilities have identified areas where they can act to improve the safety of medicines use. We know that some facilities have actively made improvements to their systems. We do not, however, know what absolute impact this has had on the incidence or severity of harm to patients from inappropriate or unsafe medicines use.

Chart MA01 - Participation in Medication Safety Self-Assessment (MSSA), NSW
 

Number of self-assessment rounds completed by facilities (n=196) and time of assessment,
NSW, 2007 - May 2015



eChartbook

Source: Medication Safety Self-Assessment (MSSA) program data collection: Clinical Excellence Commission.



Chart MA02 - Participation in the MSSA by LHD (A1 to D2 peer groups)
 

Percent of A1 to D2 peer hospitals* participating in the MSSA by LHD,
May 2007- May 2015 (n(MSSA)=110, N(NSW)=145)

eChartbook
Source: Medication Safety Self Assessment program data collection: Clinical Excellence Commission.

Note: Total includes one VIC network hospital and Justice Health. *Public and private hospitals.



Chart MA03 - Average scores for 10 key elements (%), for hospitals that have completed 2 assessments
 

The score expressed as percentage of maximum weighted score for each element, 81 public and private hospitals completed 2 assessments of the MSSA program

eChartbook

Source: Medication Safety Self Assessment program data collection: Clinical Excellence Commission.

Note: Total includes one VIC network hospital and Justice Health. *Public and private hospitals.



Chart MA04 - Average scores for 10 key elements (%), for hospitals that have completed 3 assessments
 

The score expressed as percentage of maximum weighted score for each element, 22 public and private hospitals completed 3 assessments of the MSSA program

eChartbook
Source: Medication Safety Self Assessment program data collection: Clinical Excellence Commission.
Note: Total includes one VIC network hospital and Justice Health. *Public and private hospitals.


End Matter


Contributors
Drafted by: CEC Medication Safety team
Data analysis by: CEC eChartbook team

Reviewed by: CEC Medication Safety team
Edited by: CEC eChartbook team


Suggested citation
Clinical Excellence Commission [access year]. eChartbook Portal: Safety and Quality of Healthcare in New South Wales. Sydney: Clinical Excellence Commission. Available at: http://www.cec.health.nsw.gov.au/echartbook/cec-indicators-intro-chartbook/cec-indicators-mssa-chartbook Accessed (insert date of access).


© Clinical Excellence Commission 2015
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Clinical Excellence Commission (CEC). Requests and enquiries concerning reproduction and rights should be directed to the Director, Corporate Services, Locked Bag 8, Haymarket, NSW 1240.


Evidence-base for this initiative The Medication Safety Self-assessment (MSSA) tool was developed by the Institute for Safe Medication Practices (ISMP) in the United States of America and was adapted for use in Australia by the Clinical Excellence Commission (CEC) and the NSW Therapeutic Advisory Group with the permission of ISMP in2006 and officially launched in 2007.


Reported elsewhere
CEC Medication Safety Self-assessment (MSSA) Report


Data Definitions


Chart: MA01

Admin Status: Current, May 2015

Indicator Name: Participation in the CEC’s Medication Safety Self-Assessment (MSSA) program, NSW

Description: Number of self-assessments completed by facility, frequency and time of assessment, NSW, 2007-2015

Dimension: Patient safety

Clinical Area: Initiatives in safety and quality healthcare

Data Inclusions: All public and private hospitals that participated in the MSSA program, during May 2007 - May 2015

Data Exclusions: None

Numerator: Number of NSW public and private hospitals that participated in the MSSA program

Denominator: None

Standardisation: None

Data Source: Medication Safety Self-Assessment program data collection, Clinical Excellence Commission and NSW Ministry of Health

Comments: Not Applicable
 

Chart: MA02

Admin Status: Current, May 2015

Indicator Name: Participation in the CEC’s Medication Safety Self-Assessment (MSSA) program by LHD (A1 to D2 Hospital peer groups)

Description: Percent of A1 to D2 peer hospitals (public and private) participating in the CEC's MSSA program by LHD, May 2007 - May 2015

Dimension: Patient safety

Clinical Area: Initiatives in safety and quality healthcare

Data Inclusions: Number of eligible peer group hospitals (A1 to D2, public and private) that participated in MSSA program by LHD between May 2007 and May 2015

Data Exclusions: NSW peer group hospitals classified as D3 and above were excluded

Numerator: Number of NSW hospitals (A1 to D2) that participated in MSSA program by LHD, May 2007 - May 2015

Denominator: Total number of NSW A1 to D2 peer hospitals by LHD

Standardisation: None (percentage was calculated)

Data Source: Medication Safety Self-Assessment program data collection, Clinical Excellence Commission and NSW Ministry of Health

Comments: Not Applicable
 

Chart: MA03

Admin Status: Current, May 2015

Indicator Name: Self-Assessed score obtained through participation in the CEC’s MSSA program

Description: Average scores for 10 key elements of the MSSA program, expressed as percentage of maximum weighted score for each element, 81 hospitals that participated in the CEC's MSSA and completed at least 2 assessments

Dimension: Patient safety

Clinical Area: Initiatives in safety and quality healthcare

Data Inclusions: Number of eligible hospitals (public and private) that participated in MSSA program by LHD

Data Exclusions: Hospitals outside NSW

Numerator: Weighted average self-assessed score for each of the key elements by LHD

Denominator: Possible maximum score which can be achieved for each of the key elements by LHD

Standardisation: None (crude rate per 100 was calculated) Score (per cent) = (weighted score/maximum possible score) X 100

Data Source: Medication Safety Self-Assessment program data collection, Clinical Excellence Commission and NSW Ministry of Health

Comments:

Each of the 10 Key elements of medication item contains a set of specific core questions. ISMP assigns a weight to each question for the purpose of calculating an absolute score in the self-assessment of each item, core characteristic, key element and self-assessment as a whole. Each of the items in self-assessment has a score range from A to E.
A. There has been no activity to implement this item.
B. This item has been formally discussed and considered, but has not been implemented.
C. This item has been partially implemented in the organisation for some or all areas, patients, drugs and/or staff.
D. This item is fully implemented in the organisation for some or all areas, patients, drugs and/or staff.
E. This item is fully implemented throughout the organisation for all patients, drugs and/or staff. The scoring is not same for all items, as some identify situations representing a higher safety risk than others. The minimum score for each of item is 0 and maximum score for each item ranges from 4 to 16 (0 for A; 1 to 3 for B; 2 to 8 for C; 3 to 12 for D; 4 to 16 for E).

 
Chart: MA04

Admin Status: Current, May 2015

Indicator Name: Self-Assessed score obtained through participation in the CEC’s MSSA program

Description: Average scores for 10 key elements of the MSSA program, expressed as percentage of maximum weighted score for each element, 22 hospitals that participated in the CEC's MSSA and completed at least 3 assessments

Dimension: Patient safety

Clinical Area: Initiatives in safety and quality healthcare

Data Inclusions: Number of eligible hospitals (public and private) that participated in MSSA program by LHD

Data Exclusions: Hospitals outside NSW

Numerator: Weighted average self-assessed score for each of the key elements by LHD

Denominator: Possible maximum score which can be achieved for each of the key elements by LHD

Standardisation: None (crude rate per 100 was calculated) Score (per cent) = (weighted score/maximum possible score) X 100

Data Source: Medication Safety Self-Assessment program data collection, Clinical Excellence Commission and NSW Ministry of Health

Comments: Each of the 10 Key elements of medication item contains a set of specific core questions. ISMP assigns a weight to each question for the purpose of calculating an absolute score in the self-assessment of each item, core characteristic, key element and self-assessment as a whole. Each of the items in self-assessment has a score range from A to E.
A. There has been no activity to implement this item.
B. This item has been formally discussed and considered, but has not been implemented.
C. This item has been partially implemented in the organisation for some or all areas, patients, drugs and/or staff.
D. This item is fully implemented in the organisation for some or all areas, patients, drugs and/or staff.
E. This item is fully implemented throughout the organisation for all patients, drugs and/or staff. The scoring is not same for all items, as some identify situations representing a higher safety risk than others. The minimum score for each of item is 0 and maximum score for each item ranges from 4 to 16 (0 for A; 1 to 3 for B; 2 to 8 for C; 3 to 12 for D; 4 to 16 for E).