Quality Improvement Posters 1000 – 1006
1000 Improving Medicines Reconciliation on Admission to an Acute Surgical Unit
Background Medicines Reconciliation is defined by Institute for Healthcare Improvement (IHI) as: “The process of obtaining an up-to-date and accurate medication list that has been compared with the most recently available information and has documented any discrepancies, changes, deletions or additions resulting in a complete list of medication accurately communicated,” The importance and effectiveness of a robust medicines reconciliation within all care settings is vital in ensuring patient safety. Medicines reconciliation is part of the initial focus of the Scottish Patient Safety Programme medicines programme.
The Scottish Government has set out a target for 95% compliance with medicines reconciliation within 24 hours of admission.AimTo improve medicines reconciliation in a high volume acute surgical unit in an inner city teaching hospital.
Method Retrospective audit of all emergency admissions over 5 day periods in February 2016 and April 2016. Case note review to assess whether a medicines reconciliation form has been completed for each patient on admission. Baseline Data: February 116 admissions over the 5 day period; 68.1% of patients had a medicines reconciliation form completed; April 89 admissions over the 5 day period; 74.2% of patients had a medicines reconciliation form completed
Intervention A standardised admissions proforma was introduced to the acute surgical unit on 15 June 2016. This incorporated the medicines reconciliation form previously used in the department. This integration should encourage medical staff admitting the patient to complete the initial medicines reconciliation, and allowing the ward pharmacist to later verify the medication. Completion of the audit cycle, Re-audit of completion of medicines reconciliation paperwork following introduction of admissions proforma will take place over the next few months.
1001 General Practice leadership – Improving quality of care for people living in care homes aligned to practices in Leeds West CCG
People living in care homes have complex health and social care needs. Standard contractual mechanisms for providing care to this potentially vulnerable population do not allow clinicians the necessary time and resource to provide the high quality, proactive care planning they need. The Enhanced Care Homes Scheme in Leeds West CCG provides additional funding and resources for General Practitioners to deliver medical, community-based leadership as part of an enhanced team of physiotherapists, OTs, dieticians, SLTs and Specialist Pharmacists.
The scheme aims to improve quality of care through this multi-disciplinary approach, leading to improved patient experience, reduction in unscheduled primary care workload, and reduction in the rate of hospital admissions and length of stay. We will present a number of key learning points, including: barriers in implementing and delivering a large-scale scheme; impact upon primary and community care; early results, including impact upon hospital admissions and care at the end of life.
Leeds West CCG has made a significant investment in this scheme, which provides opportunity for primary care clinicians to lead change in the way care is provided and continually improved. The therapeutic teams can evidence impact upon patient experience of care and rehabilitation, and the Specialist Pharmacy teams can demonstrate significant impact in terms of medication safety and reduction in errors, as well as significant cost savings.
General Practitioners are crucial in providing continuity and medical leadership, ensuring this vulnerable and complex population are cared for safely and effectively in the community, and reducing avoidable hospital admissions.
1002 Live Well with dementia programme: the design, development and value of a programme based on self-management principles for people living with early stage dementia
Programme aims To help people living with early stage dementia develop the understanding, skills and practical tools, to empower and support them to take an active role in the management of their health and well-being.
Presentation content: Outline of development following research findings in 2013, which found that people with dementia have much less access to the benefits of Self-management programmes, compared to other long term conditions; Learning outcomes from 5 pilots in 2013 followed by adaptation to the programme in 2014 and outcomes of 20 further programmes delivered 2015 – 2016; Description of the model directly informed by participants of the programme in development and based on the lived experience of dementia and participation in the programme.
University of Brighton’s external evaluation: ‘It is clear that this programme remains at the cutting edge and at the forefront of a very current and developing area of research and interest’.
Relevance: In 2016/2017 the project is focusing on the ‘timely offer’ of the programme to people from the point of diagnosis. Alzheimer’s Society are working with primary and secondary healthcare providers to strengthen the bridge of accessibility to the programme, from point of diagnosis to living well with dementia.
Outcomes/discussion: To give the delegates an opportunity to further explore how this programme may benefit the post-diagnostic offer to people living with early stage dementia.Impact headline: early evidence indicates the exciting, positive value and future potential of this programme for people living with early stage dementia.
1003 Making better use of real world data to assess population health
Aims The aim of this research is to describe how GPs can use routine data in order to provide real world evidence (RWE) about their local population health, taking the changes in incidence and prevalence of type 2 diabetes (T2DM) as an exemplar. Key elements include differentiating new from ongoing cases, using “episode type”, and adjusting for the age-sex profile of the locality population, using direct standardisation.
Relevance NHS England is stressing the importance of primary care providers understanding their population and ensuring commissioning meets health needs. Accurate estimation of prevalence and incidence of chronic conditions, taking into account the population structure, can provide GPs with a deeper understanding of their target population.
Outcomes Using the RCGP Research and Surveillance database (n=1.2 million patients), we estimated the crude prevalence of T2DM in adults to be 5.78%. Just looking at 2015 cases, 4.07% are recorded as first/new episodes; 4.18% are ongoing episodes; and 1.71% lacked an episode type. The directly standardised rate, using age and gender, was 5.50% [95% CI 5.45 – 5.54].
Discussion Although “episode typing” (defining a new or ongoing case) makes little difference for individual patient care, this element of data quality needs to be improved in order to accurately calculate incidence of a condition. Similarly, not adjusting for age and gender means that prevalence estimates vary by around 5%. Improving data quality and applying simple epidemiological methods can improve our ability to generate RWE from locality data, and better understand the needs of the local population.
1004 Identifying barriers to healthcare for chronic hepatitis B in Chinese patients. A qualitative study of Health Practitioners
Aims: CHB is a viral infection of the liver prevalent in Chinese populations (1 in 10); it is silent but can result in serious complications in up to 40% if acquired perinatally, resulting in early but preventable death. Access to healthcare is low in UK Chinese populations. Effective interventional strategies need to hinge on evidence from all areas of healthcare.
Methods: We conducted a qualitative study of healthcare practitioners; this was informed by findings of a systematic review and community study arm. Analysis of data were informed by the concepts of ‘candidacy’ and ‘dissonance’.
Results: Semi-structured interviews were conducted with 8 primary care, 6 secondary care, 4 sexual health practitioners and 3 midwives. Barriers of communication beyond language and misconstruction of behaviour influence delivery of healthcare; there were examples of effective health advocacy. Testing was thought to be desirable but was not considered a priority and this contrasted with reports from community participants. Practitioners reported low awareness of CHB, benefits of therapy and high prevalence in Chinese populations unless working in Asylum health services. Primary and secondary care practitioners were not aware of national guidelines for screening but are aware of discipline related screening guidelines.
Conclusion: There is an interplay of factors acting at the level of the clinical encounter, practitioners workload and responsibilities for testing. Interventions should consider modifiable health services factors and the importance of advocacy. The study had 3 arms: community, practitioners, commissioners and included a systematic review of evidence.
1005 Are we doing enough to keep patients safe after discharge; novel solution to crack down on substandard discharge letters
Substandard discharge summaries have long been a thorn in general practice’s side and with ever growing pressures faced by primary care, consequences of such inappropriate and unsafe requests on patient care is damaging. Quality improvement has been difficult due to lack of auditing, and practice variation in managing such discharges. We aimed to produce a novel score-based tool designed to objectively assess discharge summaries.
Working around existing guidance, weighting for various mandatory criteria was carefully formulated after extensive focus groups with senior practitioners. Clear defined outcomes were created with corresponding score ranges, based around a traffic light system. Red dictated which summaries required escalation to the CQC; amber summaries were sent back to teams for clarification or inappropriateness; and green being satisfactory.
Responses were fed back and discussed at multi-practice meetings throughout. In one inner-city general practice 325 letters were analysed across three 4-month phases, by 6 junior doctors given extensive training of the tool. Overall only 26% of all summaries were deemed green; the majority, 38% were classed as amber, and unfortunately a significant proportion 36%, were classed red and escalated, some being serious incidents. Operators were also asked to blindly assess other previously scored summaries.
On analysing this and data across the three phases, although there was operator variation in scoring, there was no statistically significant variation with regard to traffic light outcome, a testament to its robustness. With more stringent guidance moving forward, electronic document management software can incorporate this template, and ultimately help advance patient safety.
1006 Identifying Patients for the Palliative Care Register in a Time-Efficient Manner
Aim Over the past decade, a paradigm shift towards palliative care in the community for patients with end stage chronic co-morbidities has started to emerge. This study aimed to identify COPD patients at a general practice for inclusion on the Palliative Care Register (PCR) in response to the “Find your 1%” campaign, supported by the “Dying Matters” coalition.
Methods Aspects of the Prognostic Indicator Guidance (PIG) and Supportive and Palliative Care Indicators Tool (SPICT) indicators were utilized to determine two criteria, thought to be predictive of COPD patients in the last year of life:2 or more admissions to A&E in the last 12 monthsOther significant co-morbidities
Results 143 COPD patients were identified. From this, 16 patients (11.2%) met the criteria. Two of these 16 patients (12.5 %) were already on the PCR. The remaining 14 patients were screened by a GP partner to determine eligibility for the PCR based on practitioner knowledge. Of these 14, 8 (50 %) were deemed suitable for inclusion on the PCR. Conclusion/ImpactThe number of COPD patients on the PCR increased from 2 to 10, representing a 400% increase.
Discussion Effective expansion of the practice PCR in a time-efficient manner is possible through the application of selective, read-coded, PIG and SPICT criteria. A study of the outcome of these patients would help to determine how appropriate their inclusion was and provide valuable data on the specificity of the criteria, as applied to this practice population.