Practices Improving the Safety of Medicines in Salford, otherwise known as PrISMS, was a Breakthrough Series Collaborative designed to improve medication safety in 8 Salford GP practices with a view to scale up across all GP practices in Salford.
Commissioned by Salford Clinical Commissioning Group (CCG) and delivered jointly by the CCG and Haelo, the programme included eight GP practices within Salford and ran for 12 months from September 2015.
According to NHS England, primary care accounts for 85 to 90% of patient contact with the NHS, with the majority of medicines prescribed and monitored also within primary care.
As we know, medicines are central to healthcare and save lives. However, ensuring medicines are delivered safely and without error is complex. 59% of drug-related hospital admissions are preventable, this equates to 4% of all hospital admissions.
Within Salford alone there were approximately 16,000 reported incidents related to medication errors in 2014. 
In September 2015, Salford CCG commissioned Haelo to run a Breakthrough Series (BTS) Collaborative with eight GP practices focusing on improving the prescribing, monitoring and reconciliation of a discrete group of high risk medications, specifically Non-Steroidal Anti Inflammatory Drugs (NSAIDS), Methotrexate and Amiodarone.
Based on the PINCER audit tool , Haelo along with the innovation team at Salford CCG and the expert faculty developed a suite of measures, a shared measurement strategy and data collection processes for the collaborative to answer the question “how do we know that change is an improvement?”
Aim: 95% of patients on high risk medicines (NSAIDS, Methotrexate and Amiodarone) will have optimised medicines care by October 2016.
The below driver diagram was developed for the programme and articulates the collaborative theory for change and how the collaborative practices will achieve the aim.
The structure of this collaborative was based upon the Institute for Healthcare Improvement’s Breakthrough Series (BTS) collaborative framework . During the course of the collaborative the GP practice teams were invited to attend a series of learning sessions, interspersed with three ‘action periods’.
Within the learning sessions participating teams received training in improvement science methodologies. Using the Model for Improvement, the practices worked together following a shared theory of change to support Plan, Do, Study, Act cycles to test their change ideas on how to improve the current system.
Teams also attended talks by expert clinical faculty including Dr Neil Houston, GP and National Clinical Lead, Safety Improvement in Primary Care, Healthcare Improvement Scotland and had the opportunity to learn and share experiences from each other. In the action periods Haelo provided measurement support and bespoke coaching sessions via practice visits.
All of the eight outcome measures showed statistically significant change. This means that 6.1% more patients across the eight practices received optimised medicines care by the end of the collaborative.
As a result of the collaborative, we learnt:
At the summit event in October 2016, the eight GP practice teams came together to showcase results and reflections from their projects with the aim to learn from each other. The programme celebrated positive results and feedback from all programme stakeholders and the completion of the PrISMS Collaborative Intervention Bundle.
The PRISMS Collaborative Intervention Bundle contains refined change ideas that when implemented at scale we believe will make real difference to medicines safety in primary care. An intervention bundle is a group of interventions which, when adopted and applied will address a particular problem. Many of these interventions interlink and will be most effective when they are combined together as a bundle rather than when they are used individually.
A PrISMS poster, on improving medicines safety in general practice, was showcased at The International Forum on Quality and Safety in Healthcare, one of the world’s largest conferences for healthcare professionals committed to improving patient care and their safety, in April 2017 when the International Forum returned to London.
Whilst the one year programme has now drawn to a close, work continues to improve the safety of medicines within primary care in Salford as part of the Safer Salford programme. We hope to have more information to share soon.
Find out more on the PrISMS programme page.
Day 7 of our Haelo celebration will be looking at the ERAS+ programme. Keep up with the conversation on twitter, using @_Haelo #celebratinghaelo