1. Scottish Patient Safety Programme
Pharmacy in Primary Care, Pilot Project: Warfarin Bundle
INTRODUCTION
The Scottish Patient Safety Programme (SPSP) in conjunction with Healthcare Improvement Scotland (HIS) initiated a pilot project for Pharmacy in Primary Care (SPSP-PPC) This would run for approximately 2 years; July 2014 – September The aim of the project was to reduce the number of events which cause avoidable harm from healthcare delivered in any primary care setting through:
Improving medicines safety in primary care
Raising awareness of safety culture in community pharmacy
Enhancing communication between pharmacists, GP’s and the acute hospital setting
The pilot project focus being:
Year 1 – high risk medicines and safety climate, working within pharmacy teams
Year 2 – medicines reconciliation involving joint working between pharmacy, GP’s and the acute hospital setting using the electronic Immediate Discharge letter
NHS Grampian (NHSG) was one of only four boards recruited to participate in the pilot along with NHS Highland, NHS Fife and NHS Greater Glasgow & Clyde.
Community pharmacy teams
All community pharmacists in NHSG were invited to apply to participate in the pilot and five teams were selected. The pharmacies ranged in size and are a mixture of independent and multiples.
Enthusiastic members from each of the pharmacy teams attended the National Launch Event in Edinburgh in November 2014, a further National Learning and Sharing Event in November 2015 and 2 Local Learning Events, March 2015 and June 2016.
High Risk Medicines
Year 1 of the pilot focused on high risk medicines. NHSG chose warfarin which also linked well with work that General Practices across Grampian continued to undertake at the time. The pharmacy teams collected data on all of their Warfarin patients (314 in total for 5 teams) so our data is cumulative. Since September 2015 we have been collecting data on 5 random patients/ monthly to ensure reliability is built into day to day practice.
Evaluation
A formal evaluation has been undertaken on behalf of HIS by the University of Strathclyde. Informal feedback from the pharmacy teams has been very positive, patients are reportedly delighted to have the opportunity to discuss their warfarin management and care. It has also been noted that some patients are now engaging more with the community pharmacy teams around other medication issues.
PROGRESS TO DATE
Next Steps
Over the next few months the pharmacy teams along with the Clinical Lead will be supporting other Community Pharmacy teams to undertake improvement work around Warfarin and encouraging their participation in the Safety Climate Survey. Local and National “Road Shows” and learning events are planned to allow information sharing and collaborative learning.
The teams themselves have already been planning how to spread the bundle approach so they can look at other high risk medicines such as Lithium, Methotrexate and Insulin.
Further national development of a combined Non Steroidal Anti Inflammatory Drug (NSAID) bundle will be tested within the origonal 5 teams in NHSG over the next
6 – 9 months.
Key Contacts
Mark Easton, Pharmacist Clinical Lead
Tel:
@harrysgranda
Louise C Black, Quality Improvement Facilitator, Patient Safety
Tel:
@louise_64spsp