23rd May 2014

Brisbane

The Council of Australian Therapeutic Advisory Groups (CATAG) is an authoritative, expert, consensus-based collaboration of representatives from all Australian State and Territory Therapeutic Advisory Groups or their jurisdictional committee equivalents. Supported by funding from NPS Medicineswise.

CATAG aims to standardise and improve medicines use primarily (but not exclusively) in the hospital sector across Australia through information sharing advice and advocacy activities.

www.catag.org.au

DTCs make difficult decisions

DTCs have wide variations in functions,

structure and operation

Literature suggests shift in responsibilities of

DTCs

Dynamic nature of Australian Health System

National Safety and Quality Heath Service

Standards

DEFINITION

A DTC is a multidisciplinary committee with

responsibility for the overall governance of the

medication management system that ensures the

safe and effective use of medicines in their

organisation1

1. Australian Commission on Safety and Quality in Health Care. Safety and

Quality Improvement Guide Standard 4: Medication Safety Sydney: ACSQHC;

October 2012

Aim:

To investigate current activities of Drug and Therapeutics Committees (DTC)

To develop national guiding principles on the roles and responsibilities of DTCs in Australian public hospitals.

Objectives

Provide a framework against which the DTC may review their established practice including;

Scope and Functions

Structure

Operation & Processes

Communication

Resources

Guiding principles address the importance of clearly defining the scope and functions of a DTC

Provide recommendations for the structure, operation and processes, communication and resources for an effective DTC

Provide a framework against which the DTC may review their established practice

Implementation of the principles will assist health service organisations meet the governance criteria in the National Safety and Quality Heath Service Standards 1 and 4.

Descriptive literature review

National DTC survey (with Ethics approval)

Survey of current scope of DTC activities

Sent to 149 DTCs

Qualitative interviews

Project team developed draft Guiding Principles

Representative Expert Advisory Group formed to

refine CATAG Guiding Principles for DTCs

External consultation

PROJECT TEAM

Lisa Pulver

Dr Matthew Pincus

Gillian Sharratt

Ruth Hay

Joel Heeg

Catherine Spiller

Eliana Della Flora

Jane Donnelly

Stephanie Boydell

EXPERT ADVISORY GROUP

Prof Lloyd Sansom (Chair)

Ms Helen Dowling

Ms Margaret Duguid

Sasha Bennett

Dr Jason Armstrong

Mr Luke Christofis

Professor Albert Frauman

Dr Michael McGlynn

Steve Morris

85 responses representing 79 DTCs (53%)

responses DTCs

ACT 1 1/2 (50%)

NSW 31 31/62 (50%)

NT 1 1/1 (100%)

QLD 13 8/16 (50%)

SA 10 10/10 (100%)

TAS 1 1/1 (100%)

VIC 13 13/41 (32%)

WA 15 14/16 (88%)

Total 85 79/149 (53%)

• Majority of surveys completed by the Chair or

Secretary (72%)

• Majority were hospital based DTCs (65%)

Key activity

%

Not a key

activity %

Not

undertaken %

Medication safety 82 14 3

Policy and alerts implementation 77 16 7

Formulary (medical) 75 16 8

Policies and guidelines 68 26 5

Non-formulary medicines 62 18 17

Medicine errors 61 25 13

IPU applications 60 23 16

QUM interventions 59 27 10

Monitoring of adverse effects 56 29 14

Antimicrobial stewardship 55 30 13

Developing treatment guidelines 51 38 9

Developing QI plans 48 25 22

Formulary (Nonmedical) 47 23 26

Auditing medicine use/KPIs 44 36 18

Drug budget oversight 44 34 21

n = 84 %

Safety & Quality / Risk management

/ Medication Safety Standard Group 37 44

Clinical Governance / Advisory /

Reference Committee 34 40

CEO / Regional executive / Director 17 20

Area DTC 16 19

Acute care executive 7 8

Director-General 1 1

Other (please specify) 7 8

Other includes state-wide committees, Director of medical

services, undetermined, other executives.

SCOPE and FUNCTIONS

1. Each DTC should have oversight of the medicines management system within a hospital, local health district/ network or state and territory

2. DTCs should have clear terms of reference that articulate its position within a hospital, local health district/ network or state and territory its clinical and corporate governance structure.

3. DTC should consider the local environment when defining their functions.

Most had medical, pharmacy and nursing

representation

Others

Clinical governance

Quality improvement

Consumer representative (7%)

Finance/business manager

Administrator

Mean of 14 committee members

STRUCTURE

4. DTCs should have formalised reporting

structures to the organisation’s executive

or clinical governance lead.

5. Membership of the DTC should be

multidisciplinary, with a range of expertise

and skills to reflect the functions of the

DTC.

6. DTCs may establish sub-committees to

manage specific tasks.

n = 75 (%)

Use of patient's own medicine 81%

Medicines access program 76%

Managing the use of medication samples 73%

Controlling the access of pharmaceutical

company representatives and promotional

literature to hospital staff

73%

OPERATION and PROCESSES

7. Standardised procedures for decision-

making regarding formulary management

need to be defined and applied.

8. Standardised procedures for decision-

making regarding individual patient

requests need to be defined and applied.

9. Standardised processes and documentation

should be implemented by the DTC.

10. DTCs should be both proactive and

responsive to issues arising and develop an

annual work plan.

20/77 (26%) respondents stated that DTCs measured their own effectiveness

Various methods KPIs

Compliments and complaints

Survey of membership

NIMC, MSSA

Number of drugs approved

Number of non-formulary drugs converted to Formulary

IPU assessment and recommendations

Monitoring of drug errors, adverse reactions, ADR documentation on NIMC

OPERATION and PROCESSES

11. DTCs should undertake risk assessments

with respect to medicines use and

recommend strategies to mitigate that risk.

12. DTCs should identify and prioritise a

systems improvement plan and assign

responsibilities and timeframes for

completion.

13. DTCs should have monitoring systems in

place to evaluate their own effectiveness.

n =71 %

Intranet 37 52

Printed material 26 37

Hospital noticeboard 3 4

Targeted emails to staff 54 76

In-service programs 22 31

Circulation of minutes 41 58

The majority of DTCs (66%) communicate with other

hospitals/DTCs/state-wide committees regarding

decision making

Few (11%) DTCs have contacts with Medicare Locals

COMMUNICATION

14. DTCs should develop a communication

strategy that ensures timely, effective and

appropriate information for the intended

audience.

15. DTCs should promote safe and quality use

of medicines throughout the medicines

management pathway by engaging with

internal and external stakeholders.

n = 86 %

Financial - budget line to support

DTC’s activities

6 7

Financial - other (e.g. funds for

research)

1 1

Funded staff support (e.g.

secondment)

6 7

Funded administrative support

(e.g. secretarial help)

20 23

None 45 52

RESOURCES

16. DTCs should be adequately resourced to

undertake their functions and

responsibilities

Governance structure

Membership Attendance, investment & training

new ways of interacting with consumers

Reactive to proactive

Measurement of effectiveness

Communication

Resources Handle potential conflict among national, regional

and local decision making processes

Manage the relationship between formularies and therapeutic guidelines

Embrace the possibilities of electronic health systems

A self- assessment tool for DTCs

Signpost to;

Training packages, documentation, information

sources, quality improvement tools.

Next Steps

Follow-up survey of DTCs to determine awareness, usefulness, and utilisation of the resource

Online training resources new technology assessment

critical review