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What is the challenge your project is going to address and how does it connect to your chosen theme?

The dramatic increase in people taking multiple medicines has led to initiatives such as DHSC’s Review into Overprescribing and WHO’s Global Patient Safety Challenge as increasing medicines use increases risk of harm. Perez et al (2018), found that 45-51% of older adults admitted to hospital were suffering potentially inappropriate prescribing. Deprescribing is a means by which to tackle this challenge.  Guided by a person-centred approach and shared decision-making, it enables the safe and effective withdrawal of medicines that are no longer appropriate, beneficial or wanted.

The English Deprescribing Network (EDeN) is a national initiative (400 members) which brings together a range of healthcare professionals, researchers, policy makers and patients with an interest in promoting appropriate prescribing.  Working across these professional, organisational and geographical boundaries a system wide cultural change can be driven forward to improve medicines use and safety.

 

What does your project aim to achieve?

EDeN is focussed on creating a network that allows people to connect, share and drive change. We understand that a key aspect to culture change and quality improvement is the need to focus on local solutions to problems. Communities of Practice (CoPs) have been associated with driving sustained improvements and spreading learning, innovation and good practice.  We aim to facilitate the development of a community of CoPs across our network in order to address inappropriate polypharmacy and overprescribing in clinical practice and increase the available resources and evidence base.

Developing and facilitating a CoP can be challenging. 24 members of the network will be recruited as Conveners and supported through a leadership development programme. Developing valuable skills and supported to help the community to thrive and create the right environment to develop improvement capabilities across boundaries.

Personal narratives and knowledge transfer will be used to evaluate the project.

How will the project be delivered?

The Health Innovation Network has extensive experience in supporting CoPs. The grant will be used to commission their Leadership Development Programme for CoPs (5 one day modules followed by reflective webinars and individual leadership work with communities to help them to grow).

A selection process for conveners will be applied to ensure diverse geographical spread and a multi-professional group. Candidates must have organisational support and commit to convene at least 5 face to face community meetings during the course of the programme to fulfill the experiential learning aspect of the programme and to ensure a high chance of a return on investment.

The wider Academic Health Science Network has committed to help disseminate the knowledge and learning and to strengthen the impact and value of the communities.  EDeN will provide a forum for discussions and assistance to spread their ideas and innovations. We will liaise with Q’s CoP group to work thorough any barriers that may arise.

What and how is your project going to share learning throughout?

We will capture the knowledge and learnings from the CoPs, sharing within our network via our online platform and via the Q community online groups on an ongoing basis and formally at the end of the project through the development of case studies and a project evaluation report.

By identifying enablers and barriers we hope to use EDeN’s influence to inform the national strategy so that the wider healthcare community and public can benefit from the learning that this project brings.

We are also keen to capture the learning that comes from reviewing the development of a community of CoPs. EDeN will have the unique opportunity to promote system leadership across the country and can evaluate how these local communities interact with each other to form a larger national community that grows organically.

Benefits for the communities and organisations involved will be ongoing, they will have the lived experience any learning can be transferred to address other ‘wicked’ problems faced they face.

How you can contribute

  • Potential collaborators, especially people who have experience of convening communities of practice.
  • Suggestions for measuring impact
  • To promote our idea and act as a champion for this work

Plan timeline

17 Nov 2019 Applications for leadership programme opens
15 Dec 2019 Applications close and conveners recruited
15 Jan 2020 Community of Practice Leadership Programme begins
16 Jan 2020 Ongoing capturing and sharing of knowledge and innovations
30 Nov 2020 Community of Practice Leadership Programme finishes
10 Jan 2021 Sharing day to showcase learning
31 Jan 2021 Evaluation of project and communities of practice starts
31 Mar 2021 Final report circulated

Comments

  1. Great idea! Would love to see this on a poster in a GP clinic in the future for concerned patients to have their say on their medications. Such a savings booster and more importantly quality of life.

  2. Hi There,

    I've experience of a CoP for pharmacists - I have helped set up one for practice pharmacists in Wales. An evaluation by Cardiff University showed its success in developing the QI skills of participants. I'm also a pharmacist myself and part of the HF CoP programme.

    We are setting up something similar to this in Wales to support our national Medicines Safety Programme so would be great to compare notes and collaborate if possible.

    In the meantime - you've got my vote!

    1. Hi Paul,

      Yes it would be useful to compare notes, I’m sure lots of learning will be generated across the country.
      Thanks also for the support.

      Cherise

  3. Although a bit dated the following two reports are worth reading: Design for Patient Safety (2003) and follow up report Design for Patient Safety (2004). The recommendations made in the reports are still valid.

    1. Thanks, will check them out.

  4. My on-line CoP is now almost completed. From my experience gained in its development I could help with any on-line CoP ideas that come out of your project. My on-line CoP process illustrations could be developed to form a template for online CoPs.

    1. Hi Thomas,

      Thanks for getting in contact, it would be useful to learn from your experiences, happy to help towards testing a template. Fingers crossed we are successful in securing the funding. Thanks again Cherise

  5. Hi

    certainly would want to champion this national (and international) hot topic of managing overprescribing for the benefit of our patients.  A CoP approach, with formal links to EDeN (and wider) and to try to draw together all the work and pockets of good practices that is possibly already happening but invisible to us would be great.

    Regards and good luck

    Michael

     

     

    1. Thanks Mike, yes we hope we can make this a reality as the learning from the 24 CoPs will be very valuable and help to further this area of practice. It would also be interesting to see the different approaches that are adopted across the country.

      Cherise

  6. Hi Cherise,
    Have you put something in Q's Communities of Practice group about your project?
    It's here: https://q.health.org.uk/community/groups/communities-of-practice/

    They might have some great additional insights - and be a source of help and support.

    1. Thanks Matthew

  7. This is really closely aligned to the approach we are taking - Chris Collinson has some really interesting work related to knowledge sharing in networks if you haven`t come across him? Best wishes, Kirsten

  8. Great idea!!

    A possible way to measure the impact of your project is to measure (through questionnaire) a number of patients attending chronic disease clinics who have just been initiated on a new medication if they had been made aware by the prescriber that the medication initiated may need to stop in the future if things change and if it becomes inappropriate for the medication to be continued as part of the consultation. To also measure the number of patients who felt empowered enough by the prescriber to believe they can speak up at any time in the future to say they no longer wanted to take specific medication or if they had polypharmacy concerns.To repeat the questionnaire and measure again after chronic disease prescribers have engaged with network and shown evidence of engagement.

    Not sure what you think about this but the it's a good way of measuring patient impact too!

     

    Good luck.

    1. Thanks Sundus

  9. Hi Cherise,

    Sounds very interesting and I'm hoping your project will be successful!

    I've tried to use the Q Med Management SIG page to ask feedback on some less "wicked" problems with varying levels of success.

    On another note, I am closely involved with a Human Factors CoP in the NorthEast which has a large membership but most are struggling to attend our quarterly meetings. Chris Collison has recently shared a blog through Q which might be useful?

    https://q.health.org.uk/blog-post/cooking-up-a-community-of-practice/

    Good luck!

    Kind regards,

    Alda

    1. Guest

      Thanks Alda

      I've checked out Chris's recording, it was very useful. Also joined the SIG.

      Cherise

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