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Australian Journal of Pharmacy : May 2008
education clinical practice hospitals, the pathway works for services provided in community pharmacy practice, medication management reviews and other quality use of medicines (QUM) roles undertaken by pharmacists. When you get used to the pathway concept, it becomes clear that it is applicable to the use of all medicines, independent of the setting, the health professionals involved and the funding source. Opportunities for consumer harm exist within the pathway and within each step. Therefore, understanding the pathway, and human factors associated with each step, may help to ensure the safe, effective and efficient use of medicines. The pathway can assist consumers and healthcare professionals to understand their own role, and how their actions can improve medication safety. Being able to identify the steps of the medicines management pathway is of most importance to the practice of individual pharmacists. Medicine misuse, underuse, overuse and adverse reactions result in 140,000 hospital admissions each year, and most of these adverse drug events are preventable. The Australian Council for Safety and Quality in Health Care’s report Improving Medication Safety2 noted that ‘in order to recognise what can go wrong with the use of medicines, we need to understand the processes that are involved’. There are many different steps involved when consumers take medicines, and to fully understand the interplay, it is helpful to use a ‘process map’ of the system: from the decision to prescribe a medicine, through to monitoring the outcome of using the medicine. tHe MedicineS ManaGeMent PatHWaY The Guiding Principles to achieve the Continuity in Medication Management produced by the Australian Pharmaceutical Advisory Council3 medicine management pathway which are critical to achieving consumer continuity of care. This article explores the general concept of the medicines management pathway, which is generic in nature, and independent of: • the setting (eg. home, residential care or hospital) and the independence of the consumer; • the involvement of health professionals in prescribing, dispensing or administering the medicine; • the type of medicine (including prescription, over-the-counter and complementary medicines); and • the funding source for the medicine. Figure One presents an overview of the cycle of the medicines management pathway. There are nine key steps, and focuses on the steps of the The pathway can assist consumers and healthcare professionals to understand their own role, and how their actions can improve medication safety. three background processes in the pathway. The steps are both cognitive and physical. Opportunities for error exist within each step and, as the processes are interdependent, they influence each other. The pathway is a closed loop, as feedback on the effect of the medicine and transfer of information regarding the previous steps, influences future treatment decisions in the next cycle. In some circumstances, steps occur in parallel rather than in sequence (eg. an electronic prescribing system with decision support, may simultaneously ‘review the medicine order’ at the ‘record of medicine order’ step). On occasions, the steps may not occur in sequence (eg. when (consumer) medicine information is provided as the medicine is ordered). The same person may be responsible for consecutive steps. Generally, each step will be undertaken when medicines are used, although, how they are undertaken may differ depending on the setting. The consumer is the central focus of the pathway with direct involvement in some or all of the steps. tHe StePS in detaiL 1. Decision on appropriate treatment and decision to prescribe medicine The prescriber needs access to accurate, complete and up-to-date consumer-specific information and consumer input in order to assess the most appropriate treatment option, considering the best available evidence, and the consumer’s treatment goals. If the most appropriate option is the use of a medicine, the decision becomes the choice of the most appropriate, safe and the australian journal of pharmacy vol.89 may 2008 83