1. What barriers and facilitators influence the implementation of new high-risk medicine services in Scottish community pharmacies?
Ms Natalie Weir1, Dr Rosemary Newham1, Mrs Emma Dunlop Corcoran1, Prof Marion Bennie1,2
1Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
2Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom. Contact:
Abstract submission:
Background
The Scottish Patient Safety Programme - Pharmacy in Primary Care (SPSP-PPC) collaborative is a Quality Improvement (QI) initiative striving to improve patient safety within community pharmacy. One element of the collaborative has involved implementation of High Risk Medicine (HRM) Care Bundles (CBs) which focused on non-steroidal anti-inflammatories and warfarin. These were implemented in 27 pharmacies across four NHS regions by applying the Institute of Healthcare Improvements’ “Breakthrough Series Collaborative Model”. This study reports on (1) implementation of the HRM CBs and (2) application of the collaborative model.
Methods
Mixed-method evaluation involved questionnaires, semi-structured interviews, case studies, process mapping and documentary evidence. Analysis was informed by two theoretical frameworks: the Kirkpatrick Model to investigate impact of training delivered; and Proctor’s Taxonomy of Implementation Outcomes to understand the factors influencing implementation.
Results
The evaluation involved approximately 187 participants. The collaborative model was rated positively, provided networking opportunities and motivation to engage, yet further consideration of learning needs and how best to deliver the QI approach at scale requires attention. The CBs were considered acceptable, appropriate, feasible and compatible within community pharmacy practice. Adoption of QI methods was variable and risks to sustainability included lack of whole-team involvement in CB delivery. Significant variation of the CBs between NHS regions existed; posing challenges for further implementation, such as equality of patient care.
Conclusion
The findings demonstrate capacity for community pharmacy to deliver safety-focused initiatives within a collaborative. Application of frameworks helped develop key recommendations informing strategic decision-making. Key issues are being taken forward through consolidation and further testing of the CBs, and resource development to facilitate whole-team engagement.
Background
Aims
Within the UK, 6.5% of hospital admissions are attributed to preventable adverse effects of high-risk medicines, including warfarin and non-steroidal anti-inflammatory drugs (NSAIDs)
In 2017, warfarin and NSAIDs care bundles were implemented in 24 community pharmacies in NHS Scotland
These care bundles are short, pharmacy-based interventions which focus on identifying interactions and educating patients
Identify the barriers and facilitators influencing the successful implementation of the warfarin and NSAIDs care bundles
Develop recommendation for the national implementation of the care bundles
Methods
A questionnaire exploring barriers and facilitators of the care bundles was developed and underwent validity and reliability testing 1
The questionnaire was disseminated in June 2017 to staff (n=217) within the 24 participating community pharmacies
Multivariate regression analysis was conducted to identify the barriers and facilitators influencing successful implementation of the care bundles
Results
The factors associated with successful implementation of the care bundles are presented in Table 12
Multivariate regression analysis for predictors of successful implementation (n=74, from 17 pharmacies)
Recommendation for national implementation strategy
Care bundle
Success factor
NSAIDs
(p<0.001, R2=0.633)
Knowledge about NSAIDs
Disseminate information to community pharmacy staff about NSAIDs to ensure minimum level of knowledge to deliver the care bundle
Sufficient funding
Incorporate care bundle within community pharmacy contract to ensure funding model aligns with workload demands
Workload
Incentives
Reinforce the evidence on the risk associated with NSAIDs use and the rationale behind the care bundle to incentivise
Promote use of quality improvement ‘run-charts’ to incentivise local improvements in care bundle delivery
Warfarin (p<0.001, R2=0.752)
Patients’ perceptions
Adopt patient engagement strategies, such as signposting or campaigns
Compatibility within pharmacy
Promote the use of small testes of change (e.g. ‘Plan-Do-Study-Act’ cycles) for pharmacies to use a trial and error approach to integrate the bundle within their pharmacy
Table 1. Success factors identified for the care bundles and recommendations for the national implementation
Conclusions and future developments
The success factors identified were used to inform the national implementation strategies for the care bundles (Table 1), with the NSAIDs care bundle progressing onto national roll-out
Evaluation of the care bundles’ integration into practice and patient perceptions refined these recommendations
The different success factors identified between the care bundles demonstrates the need to develop tailored strategies for innovations
References
Weir NM, Newham R, Dunlop Corcoran E, Bennie M. Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research. Manuscript under review for Implement Sci.
Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10(1):21.