Increasing the proportion of vulnerable patients receiving defect free medicines at the point of transfer of care.
Read how Haelo, commissioned by the Greater Manchester Academic Health Science Network (GM AHSN), delivered a Breakthrough Series Collaborative to reduce harm from medicines in Greater Manchester. The programme ran for 12 months from April 2015, with a 3 month lead in period.
Medicines are central to healthcare. They are the most common therapeutic intervention and they save lives. However, ensuring medicines are delivered safely is complex.
Achieving safe medicines on transfers of care is an issue which impacts on patients and clinicians, which is relevant across a health economy as patients move through the system from one setting to another, for example, general practice, community pharmacies, nursing homes, district nursing, community hospitals, intermediate care, mental health services and acute hospitals.
In England, there were 163,776 reported incidents related to medicines in 2015. Baseline data collected for this programme identified that only 26.6% of patients in participating health economies are receiving ‘defect free’ medicines care.
Introducing the BTS Collaborative
In April 2015, the GM AHSN commissioned a one year collaborative programme, delivered by Haelo, to focus on improving medicines safety at transfers of care.
A Breakthrough Series (BTS) collaborative model was used to bring 8 whole health economy teams together from across Greater Manchester to work together following a shared theory of change to support Plan, Do, Study, Act cycles to test potential improvement ideas.
Aim: 95% of people experiencing a transfer of care will have ‘defect free medicines care’ by April 2016.
This aim is supported by a theory of change which identified three primary drivers:
reliable reconciliation process
shared management and decision making between the patient and the clinician
harnessing available technologies
The structure of this collaborative was based upon the Institute for Healthcare Improvement’s Breakthrough Series (BTS) collaborative framework . Between June 2015 and April 2016, teams were invited to attend a series of Learning Sessions, interspersed with three ‘Action Periods’.
Led by experts in healthcare improvement, participating teams received training in improvement science methodologies, such as the Plan, Do, Study, Act cycle and bespoke coaching sessions via site visits.
Haelo brought together expert speakers, such as Martin Bromiley OBE (Clinical Human Factors Group) and Dr Neil Houston (Healthcare Improvement Scotland), and facilitated thematic knowledge exchange sessions, for example, to explore patient and public involvement, providing teams with the opportunity to learn and share experiences.
Using the Medications Safety Thermometer as a framework to review ‘defect free medicines care’, Haelo developed a shared measurement strategy and data collection processes for the collaborative to answer the question “how do we know that change is an improvement?”.
In addition to delivering the collaborative, Haelo supported teams delivering their improvement projects with:
training and education presentation to hospital pharmacists to teach improvement methodology and promote the collaborative
review and consultation of additional data collected locally by teams
filming of a case study with the team from Wigan, Wrightington and Leigh NHS Foundation Trust (below) to promote the project and support future scale-up activity
Visit the IMS programme page to access resources, films and event reviews from all three learning sessions and the summit.
“I was more surprised than anyone to find that three little words ‘special cause variation’ would make me so happy!”
Gary Masterman, Wrightington, Wigan and Leigh NHS Foundation Trust
A 58% improvement in the outcome measures from 26.6% (baseline) to 42.4% (rebased period) has been recorded and represented below:
Our top 3 lessons learned throughout this programme are as follows:
The BTS collaborative approach has potential to deliver system-wide engagement and accelerate the pace of change. As a result of this programme, participating teams have increased capacity to deliver improvement through improved relationships across health economies, individuals better equipped with the skills and knowledge to lead change and also the engagement of patient representation to drive forward improvements across health systems.
This programme has initiated improvement and generated momentum for change, but there is still a lot more to be done. In looking at the data collected it is possible to conclude that medicines care for patients is safer at the point of transfer of care (a 52% improvement at an aggregate level), however medicines care for patients in Greater Manchester cannot be assessed as being safe (only 42.4% patients are receiving ‘defect free medicines care’).
Measurement is absolutely critical for improvement projects. Shared metrics are useful to demonstrate change over time across a whole collaborative. However, for a collaborative-wide measurement strategy to be successful it needs to be co-designed and developed with project teams from the outset, allowing a period of time before the collaborative itself begins to allow data collection processes to bed-in and to establish a robust baseline.
What happens next?
At the summit event, the 8 health economy teams came together to showcase their projects and learn from each other.
Whilst the 1-year programme has now drawn to a close, work continues to Improve Medicines Safety as teams are supported by the GM AHSN to sustain successful changes and scale these up across health economies, with the hope that these projects will snowball and lead to much wider organisational change.
“We are really keen to continue and develop the wider working relationships we have built with the CCG, GPs and community pharmacists during this project...”
Kate O’Donnell, University Hospitals South Manchester
“...we have come away from the events thinking about how we can use some of the learning to support patient safety across all areas of our work, not just the IMS project specifically.”
Kirsten Clayton, Mental Health and Social Care Trust
 The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)