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

Use of Multi-compartment Compliance Aids (MCAs) is a national challenge because of resource needed to produce them, wastage, risk of errors during re-packaging and administration, and risks of errors during transfer of care. MCAs are mainly used for high risk and vulnerable patients – those with dementia, frailty, multi-morbidities and polypharmacy. An AHSN study by Yeung (2019) found that pharmacies are dispensing high numbers of MCAs without appropriate assessment or review. Whilst MCAs are part of the picture for improving adherence that may help people to maintain healthy independent lifestyles, they will not help with intentional non-adherence and are known to have a negative impact on patient autonomy. Initial discussions suggest that all of these issues are replicated locally in Swindon; this project would help identify and prioritise those with greatest need and reduce risk of errors. This project will involve primary, secondary and social care and bring system wide benefits.

What does your project aim to achieve?

The aim of the project is to reduce the number of inappropriate MCAs used and develop processes to ensure where used they are safe, effective and patient-centred. This reduction will support safe medicines administration and free up resources in terms of staff time and funding. This will involve scoping the scale of the problem, agreeing a local initial and on-going assessment process for MCAs and  developing a Swindon wide strategy for sharing documentation across organisations. Our aim is to see a reduction in inappropriate usage of MCAs which will be achieved by offering appropriate alternatives to an MCA at the assessment stage (including deprescribing, alternative compliance aids) and educating  healthcare professionals, carers, patients and their families on the different options available to support adherence.  Project measures will be developed during the project, to include outcome measures (eg. number of dosettes) and process measures (eg. compliance with assessment process).

How will the project be delivered?

The project will be led jointly by CCG and Community Health Pharmacists, with engagement from Primary Care, Community Pharmacies, hospital pharmacy, social care, re-enablement sevices, carers, patient representation and the AHSN. Local QI members and leads are also supporting the project. These stakeholders will bring a wide range of experience and knowledge across the whole system to enable us to consider the impact across different settings. An initial engagement meeting suggested that there is an appetite across the system to address the issues. Funding from this project will enable us to engage dedicated project management and pharmacy support to maintain the momentum of the project, keep the stakeholders engaged and ensure timelines are met and support spread of any agreed process system wide. There will be additional resource provided for this project from the key stakeholders and local medicines and QI leads will continue to ensure this project is embedded into practice.

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

Inappropriate usage of MCAs and managing the risks around their usage are national priorities and therefore the learning will be of value to all healthcare professionals nationwide. Results and learning from this project will be shared locally via newsletter, presentation at stakeholder meetings (including local Integrated Care Alliance Board) and local AHSN events. This work builds on work currently undertaken by work by the AHSN and learning will be shared nationally throughout the system using the AHSN network and utilising the ‘adoption and spread’ model.

Learning will also be shared across the Q Community and nationally via poster and abstract submission to relevant conferences (eg Clinical Pharmacy Congress).

How you can contribute

  • We’d welcome any comments on our proposal. If you are involved with medication review or assessments around adherence, we’d like to hear from you to help us develop and share our ideas.

Plan timeline

1 Nov 2019 Define local problem; inc process mapping and local data
1 Apr 2020 Define aim; develop of test of change ideas, inc measures
1 Jul 2020 Implement test of change using PDSA methodology
31 Oct 2020 Evaluation, report and develop sustainability plan

Comments

  1. Guest

    Tania Farrow 1 year, 8 months ago

    This is a significant and growing issue across the country and this type of project is exactly what is needed to develop a practical tool kit for use in assessing patient need. This study could produce resources that would be easily transferable to other areas and would lead to huge improvements in patient care and reduction in clinical risk. I hope the proposal is successful and look forward to reading the results of the study.

  2. Guest

    Kay Haughton 1 year, 8 months ago

    What a fantastic idea to tackle these pressing issues, over prescribing and waste whilst involving patients. For a long time now I have questioned the efficacy of dosette boxes and this is a perfect system wide opportunity to review other options.

  3. This sounds like a great project. It's fantastic that you'll be focusing on tackling wastage, and making patient-centred, effective, system-wide improvements.

  4. Guest

    Hannah Little 1 year, 8 months ago

    Excellent! Fingers crossed!

  5. Guest

    Fiona Castle 1 year, 8 months ago

    I am really excited to be involved with this project - recognising that the issues with inappropriate MDS span so many healthcare professionals and family pre-conceptions and often fail to put the patient at the centre of decision-making

  6. Guest

    Chris Shields 1 year, 8 months ago

    This project sounds like it will yield good results in reducing patient risk when a MDS tray is provided inappropriately. I look forward to the results, good luck!

  7. Guest

    Bisola Sonoiki 1 year, 8 months ago

    Long awaited opportunity!!

  8. Guest

    Rebecca Henley 1 year, 8 months ago

    This is an exciting project and there is an urgent need for innovative ideas which can be shared nationally to tackle the patient risks associated with dossette boxes.

  9. A fantastic project that will change patient's healthcare for the better. Well done, I look forward to hearing the results and wish you luck!

  10. This is a great project and love that it will be working across system and organisational boundaries!

    1. Thanks Kevin. Patient's move within the system and therefore it's so important to have a systems approach to solving complex problems. In this context there seems to be a different understanding across the system about how, when and why medicine compliance aids can be used. It also seems like the vast variety of options available to pharmacists to help support patients is poorly understood by those working in the wider health and social care system. We're hoping that this project can build on the work already undertaken by others and we can create a unified way to assess and best meet patient's needs.

  11. This sounds like a great project!

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