Quality Improvement Skills Training (QIST) - A project leading improvement in patient safety

Kelly Jones is a pharmacist who completed her Silver IQT training with the QIST Team in April 2019. Kelly then went on to undertake a project, “Improving the process of medicines reconciliation in dementia patients at Neath Port Talbot Hospital”, which was submitted for marking and accreditation in October 2020. Marking was completed and accreditation awarded in May 2021, with excellent feedback including a recommendation that the project be shared widely across Wales due to the patient safety issues addressed. It was also suggested that it could be a potential submission for the NHS Awards in the Patient Safety Category.

Here, Kelly talks about her project and shares her experience of undertaking IQT Silver with the QIST Team:

“Following the reconfiguration of Neath Port Talbot Hospital in 2012, the pharmacy department embraced a lot of changes and has evolved alongside other departments within the hospital to provide the best care for patients with dementia. With an ageing population, the demographic seen at NPTH is a frailer patient with more complex needs taking a higher number of medications. Medicines reconciliation at NPTH has definitely become a more complex longer process, resulting from patients being unable to accurately confirm medication history and incomplete medication lists obtained from GP surgeries (patients obtaining additional medications from specialist clinics). The picture that we were seeing at NPTH was anti-dementia medication being missed during initial clerking and transferred dementia patients presenting with worsening symptoms, increased delirium & behavioural issues requiring rapid referral to the elderly mental health team. The current process of medicines reconciliation was therefore potentially inefficient and potentially putting dementia patients at risk of not receiving the right medicine at the right time.

Attending the QIST Pharmacy Silver IQT Workshop Programme, led by Dr Gethin Pugh (QIST Programme Lead HEIW), was invaluable and showed me how to use specific tools to enable identification & scoping of the problem discussed and how best to identify certain stakeholders to allow implementation of small tests of change through a series of PDSA cycles to allow improvement of work streams and systems. The course consolidated the importance of team work to bring about change to improve patient centred care.

The main aim of our IQT project was to streamline medicines reconciliation, to prevent anti-dementia medications from being missed during initial clerking and to reduce the time taken to retrieve an accurate medication history. The IQT framework was fundamental in our approach not only as a guide to help identify deficiencies within our system but to identify possible solutions through communication and teamwork.

The findings of this quality improvement project have been positive, and we have reached our aim of reducing the time taken to retrieve the anti-dementia medication information by 50%.  Our team are continuing to drive this project to reduce the number of missed anti-dementia medications to zero and have had interim success at obtaining read-only access to the new anti-dementia database but are currently waiting on Primary Care and the proposal for GP’s to implement prescribing according to specialist recommendations to ensure a safe, sustainable and robust service is established.

I would like to thank Dr Gethin Pugh for his immense encouragement, teaching & expertise. His input was invaluable & the main driving force to see change occur”.

For information on the QIST programme or the HEIW Improvement Prize, please contact the QIST team on: HEIW.QIST@wales.nhs.uk