Reducing the potential risk of high risk medicines (HRM...

MethodThe SPSP-PPC Collaborative has been an ambitious two year programme (November 2014 to October 2016) funded by the Health Foundation to “improve patient safety by strengthening the contribution of community pharmacy and improving communications within the primary care team”. In the first year, the programme sought to achieve this through the formation of a collaborative and use of established improvement tools and approaches in 27 community pharmacies and two dispensing practices for: High Risk Medicines and Safety Culture. The programme has involved the use of the Breakthrough Series Collaborative Model2 which offers structured learning sessions (national and local learning events), allowing collaborative learning, broken up by action periods where changes are tested in practice. The programme was evaluated by the University of Strathclyde and NHS Education for Scotland (NES) using a realistic evaluation methodology.

NHS board aimsThe four territorial NHS boards involved chose

which high risk medicine to focus on and

developed their own driver diagrams with

individual aims. These are represented in

Figure 2.

Bundle questions were then developed from

these driver diagrams.

References:

[1] Healthcare Improvement Scotland. Safer Use of Medicines: Infographic, August 2015.

[2] www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx

[3] http://spsp.scot/programmes/primary-care/Pharmacy-in-Primary-Care

Reducing the potential risk of high risk medicines through improved education and communication

http://spsp.scotThe Improvement Hub (ihub) is part of Healthcare Improvement Scotland

Results and evaluation• The eSBAR tool improved the quality of

information that was sent and received

between GPs and community pharmacies;

100% of GPs and community pharmacies

who trialled it endorsed its use (n=29).

• Quality improvement skills and knowledge

increased within all pharmacies as well as

recognition of its usefulness.

• Overall, compliance with the bundle

questions increased in all four NHS boards.

This is seen in the run chart examples

below (Figure 4).

• Feedback on patient satisfaction flagged

that applying the high risk medicine bundle

on a regular basis may be laborious for

some patients; but they appreciated the

channel this offered to extend engagement

with the pharmacy team.

Outcomes and resources• Quality improvement methodology was

embedded into the community pharmacy

contract.

• The pilot sites produced a variety of innovative

and functional educational resources (Figure 3)

that are freely available for sharing on the SPSP

website3.

• An electronic SBAR (eSBAR) communication tool

was produced and has been developed further

for national roll out as a tool within the

Pharmacy Care Record system.

That 95% cumulated

compliance with the five warfarin bundle questions

is achieved by 31 July 2016.

SPSP-PPC ambition

Figure 3: Educational resources

Figure 2: Aims of NHS boards

‘The eSBAR tool structured information from pharmacists so that a number of time-consuming phone calls were avoided with information that can easily be added to the patient record’ ~ GP

The use of quality improvement methodology in the community pharmacies improved patient education with high risk medicines and

improved multidisciplinary communication.

Conclusion

• To involve pharmacists in driving improvements (particularly in communication and closer working between pharmacy teams and GP practices).

• To increase participants’ knowledge and skills of using quality improvement methodology.

• To introduce a safety climate survey to facilitate improvements in safety culture.

To reduce the co-prescribing of

High Risk Drug Combinations

(NSAIDS + other medication) by

90% by 30 June 2016.

To improve education and

understanding for 90% of

patients/carers whose warfarin is dispensed from a

participating community

pharmacy by July 2016.

Reducing the risks associated with

use of non-steroidal anti-inflammatory

drugs (NSAIDs).

‘I feel more empowered to speak to patients about their medicines. We thought we were doing all we could with patient safety… but we weren’t’ ~ Healthcare Assistant

‘I’ve fallen in love with my profession again. This work has reminded me why I wanted to become a pharmacist. Improving patient health and patient safety’ ~ Pharmacist‘It’s allowed us to have a second look, get

the opinion of everybody in the shop so not just the pharmacist and the technicians because the counter assistants had such good ideas that nobody had thought of as well’ ~ Trainee Checking Technician

Figure 1: Five classes of medicines

With thanks to all participating pilot sites, NHS boards, The Health Foundation, NES and Strathclyde University evaluation team

Authors: Alec Murray, Associate Improvement Advisor; Jill Gillies, Portfolio Lead Primary Care; Wendy Forbes, Project Officer; Healthcare Improvement Scotland

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NHS FIFE Warfarin Overall Bundle Compliance

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NHS HIGHLAND Overall Communication Bundle Compliance

BackgroundThere will be 61,000 non-elected hospital admissions due to medications prescribed within primary care this year1. Evidence shows the majority of these admissions involve five main classes of medicines (Figure 1).

Figure 4: Examples of NHS boards’ run charts