Programs Performance Indicators and Medication Safety Project
The two-phased Performance Indicators and Medication Safety (PIMS) project focused on improving medication safety systems and monitoring performance in quality use of medicines (QUM) in Australian hospitals.
The NSW Therapeutic Advisory Group (NSW TAG) and the Clinical Excellence Commission worked together on this important project to improve medication safety in Australian hospitals.
Program Overview
Phase I
The first phase of the PIMS project involved adaptation for Australian use of the Medication Safety Self Assessment® for Australian Hospitals and the Medication Safety Self Assessment® for Australian Hospitals and the Medication Safety Self Assessment® for Antithrombotic Therapy in Australian Hospitals, originally developed by the Institute for Safe Medication Practices (ISMP) in the US.
These self assessments are risk assessment tools specifically designed to help hospitals take a proactive and system-based approach to medication safety. They will assist hospitals in meeting their obligations for accreditation and can drive change by identifying, and measuring, areas for improvement.
The tools allow self assessment of the medication safety practices within a hospital, identification of improvement opportunities and comparison with the aggregate experience of demographically similar hospitals.
Hospitals are actively implementing the tools in Australia. For more information about the self assessment tools email mssa@cec.health.nsw.gov.au
Phase II
The second phase of the PIMS project involved the revision of the 1998 NSW TAG Manual of Indicators for Drug Use in Australian Hospitals and the NSW TAG Performance Indicators for Drug and Therapeutics Committees.
This newly revised manual of Indicators for Quality Use of Medicines in Australian Hospitals has been produced by NSW TAG in collaboration with the Clinical Excellence Commission. The manual will enable hospital managers and clinicians to guide improvements in medication management in all types of hospitals across Australia.
The manual can be downloaded in full or as individual indicators. Where indicators are downloaded individually, we recommend the front section of the manual is also downloaded. The front section contains critical information on using the indicators to facilitate change as well as information on background to the project and the indicator development process.
To facilitate use of the manual, individual indicators may be reproduced with the following conditions:
- Indicators should be reproduced in their entirety including the copyright statement;
- Excerpts of these indicators may be used providing NSW Therapeutic Advisory Group is acknowledged by referencing the excerpt to the Indicators for Quality Use of Medicines in Australian Hospitals.
Recommended citation:
- Indicators for Quality Use of Medicines in Australian Hospitals: NSW Therapeutic Advisory Group, 2007.
Publications
Manual: Indicators for QUM in Australian Hospitals
This manual is hosted by the Clinical Information Access Program website.
Complete Manual
- Download the complete manual - PDF ~1.09mb
Sections of the Manual
- Introduction - PDF ~655kb
Includes: Foreword; Introduction to NSW TAG and CEC; Acknowledgements; Background; Developing the indicators; Using the indicators; Indicator summary; Indicator format and References. - Appendix - PDF ~53kb
Individual Indicators
Antithrombotic therapy
- 1.1 Percentage of admitted adult patients that are assessed for risk of venous thromboembolism
- 1.2 Percentage of patients at high risk of venous thromboembolism that receive appropriate prophylaxis
- 1.3 Percentage of patients prescribed enoxaparin whose dosing schedule is appropriate
- 1.4 Percentage of patients prescribed hospital initiated warfarin whose loading doses are consistent with a Drug and Therapeutics Committee approved protocol
- 1.5 Percentage of patients with an INR above 4 whose dosage has been adjusted or reviewed prior to the next warfarin dose
- 1.6 Percentage of patients with atrial fibrillation that are discharged on warfarin
Antibiotic therapy
- 2.1 Percentage of patients undergoing specified surgical procedures that receive an appropriate prophylactic antibiotic regimen
- 2.2 Percentage of prescriptions for restricted antibiotics that are concordant with Drug and Therapeutics Committee approved criteria
- 2.3 Percentage of patients with a toxic or sub-therapeutic aminoglycoside concentration whose dosage has been adjusted or reviewed prior to the next aminoglycoside dose
- 2.4 Percentage of adult patients with community acquired pneumonia that are assessed using an appropriate validated objective measure of pneumonia severity
- 2.5 Percentage of patients presenting with community acquired pneumonia that are prescribed guideline concordant antibiotic therapy
Medication ordering
- 3.1 Percentage of patients whose current medications are documented and reconciled at admission
- 3.2 Percentage of patients whose known adverse drug reactions are documented on the current medication chart
- 3.3 Percentage of medication orders that include error-prone abbreviations
- 3.4 Percentage of paediatric medication orders that include the correct dose per kilogram (or body surface area) and a safe total dose
- 3.5 Percentage of medication orders for intermittent therapy that are prescribed safely
- 3.6 Percentage of patients receiving cytotoxic chemotherapy whose treatment is guided by a hospital approved chemotherapy treatment protocol
Pain management
- 4.1 Percentage of postoperative patients whose pain intensity is documented using an appropriate validated assessment tool
- 4.2 Percentage of postoperative patients that are given a written pain management plan at discharge and a copy is communicated to the primary care clinician
Continuity of care
- 5.1 Percentage of patients with acute coronary syndrome that are prescribed appropriate medications at discharge
- 5.2 Percentage of patients with chronic heart failure that are prescribed appropriate medications at discharge
- 5.3 Percentage of discharge summaries that include medication therapy changes and explanations for change
- 5.4 Percentage of patients discharged on warfarin that receive written information regarding warfarin management prior to discharge
- 5.5 Percentage of patients with a new adverse drug reaction (ADR) that are given written ADR information and a copy is communicated to the primary care clinician
- 5.6 Percentage of patients with asthma that are given a written asthma action plan at discharge and a copy is communicated to the primary care physician
- 5.7 Percentage of patients receiving sedatives at discharge that were not taking them at admission
Hospital wide medication management policies
- 6.1 Percentage of medication storage areas outside pharmacy where potassium ampoules are available
- 6.2 Percentage of patients that are reviewed by a clinical pharmacist within one day of admission
- 6.3 Percentage of parenteral opioid dosage units that are pethidine
- 6.4 Percentage of submissions for formulary listing of new chemical entities for which the Drug and Therapeutics Committee has access to adequate information for appropriate decision making
