Information
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National Standard 4 - Medication Safety (for Dental Practices)
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Client / Site
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Conducted on
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Conducted by Marrianne Beaty (DHSV Oral Health National Standards Advisor)
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Personnel
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Add location
Standard 4 - Audit Report
Criterion 1 - Governance and systems for medication safety
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4.1.1 Governance arrangements are in place to support the development, implementation and maintenance of organization wide medication safety systems
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4.1.2 Policies, procedures and/or protocols are in place that are consistent with legislative requirements, national, jurisdictional and professional guidelines
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4.2.1 The medication management system is regularly assessed
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4.2.2 Action is taken to reduce the risks identified in the medication management system
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4.3.1 A system is in place to verify that the clinical workforce have medication authorities appropriate to their scope of practice
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4.3.2 The use of the medication authorization system is regularly monitored
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4.3.3 Action is taken to increase the effectiveness of the medication authority system
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4.4.1 Medication incidents are regularly monitored, reported and investigated
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4.4.2 Action is taken to reduce the risk of adverse medication incidents
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4.5.1 The performance of the medication management system is regularly assessed (Developmental)
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4.5.2 Quality improvement activities are undertaken to reduce the risk of patient harm and increase the quality and effectiveness of medicines use (Developmental)
Criterion 2 - Documentation of patient information
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4.6.1 A best possible medication history is documented for each patient
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4.6.2 The medication history and current clinical information is available at the point of care
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4.7.1 Known medication allergies and adverse drug reactions are documented in the patient clinical record
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4.7.2 Action is taken to reduce the risk of adverse reactions
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4.7.3 Adverse drug reactions are reported within the organisation and to the TGA.
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4.8.1 Current medicines are documented and reconciled at admission and transfer of care between healthcare settings (Not Applicable for Dental Practices)
Criterion 3 - Medication management processes
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4.9.1 Information and decision support tools for medicines are available to the clinical workforce at the point of care
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4.9.2 The use of information and decision support tools is regularly reviewed
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4.9.3 Action is taken to improve the availability and effectiveness of information and decision support tools
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4.10.1 Risks associated with secure storage and safe distribution of medicines are regularly reviewed
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4.10.2 Action is taken to reduce the risks associated with storage and distribution of medicines
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4.10.3 The storage of temperature sensitive medicines is monitored (Not Applicable for Dental Services)
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4.10.4 A system that is consistent with legislative and jurisdictional requirements for the disposal of unused, unwanted or expired medications is in place
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4.10.5 The system for disposal of unused, unwanted or expired medications is regularly monitored
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4.10.6 Action is taken to increase compliance with the system for storage, distribution and disposal of medications
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4.11.1 The risks for storing, prescribing, dispensing and administration of high‑risk medicines are regularly reviewed
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4.11.2 Action is taken to reduce the risks of storing, prescribing, dispensing and administering high-risk medicines
Criterion 4 - Continuity of medication management
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4.12.1 A system is in use that generates and distributes a current and comprehensive list of medicines and explanation of changes in medicines (Not applicable for Dental Services)
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4.12.2 A current and comprehensive list of medicines is provided to the patient and/or carer when concluding an episode of care (Not applicable for Dental Services)
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4.12.3 A current comprehensive list of medicines is provided to the receiving clinician during clinical handover (Not applicable for Dental Services)
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4.12.4 Action is taken to increase the proportion of patients and receiving clinicians that are provided with a current a comprehensive list of medicines during clinical handover (Not applicable for Dental Services)
Criterion 5 - Communicating with patients and carers
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4.13.1 The clinical workforce provides patients with patient specific medicine information, including medication treatment options, benefits and associated risks (Developmental)
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4.13.2 Information that is designed for distribution to patients is readily available to the clinical workforce (Developmental)
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4.14.1 An agreed medication management plan is documented and available in the patient’s clinical record (Not Applicable for Dental Services)
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4.15.1 Information on medicines is provided to patients and carers in a format that is understood and meaningful (Not Applicable for Dental Services)
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4.15.2 Action is taken in response to patient feedback to improve medicines information distributed by the health service organization to patients (Not Applicable for Dental Services)