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

The challenge is to deliver Scotland-wide scale up and spread of two digital decision support innovations that have evaluated highly successfully in pilot projects:

Patient-specific decision support for high risk prescribing, embedded in primary care electronic health record systems. This decision support uses algorithms derived from the NHS Scotland polypharmacy guidance. It detects high risk combinations of medicines, conditions and test results, also omissions of essential co-prescribing.
A decision support web and mobile app for care home and care at home services. This provides UK CA marked assessment tools – including frailty assessment, early detection of deterioration, malnutrition screening, assessment of lower urinary tract infections – and a toolkit for palliative and end of life care by care workers.
Scale up of these tools depends on bringing together the improvement and spread skills of QI experts with the world of design, development and evaluation of digital decision support.

What does your project aim to achieve?

National scale up of these decision support tools will reduce unwarranted variation in practice, and improve patient safety in primary care and social care / community contexts. It will:

Reduce medicines-related adverse events and medicines-related emergency admissions.
Support informed conversations and shared decisions with patients about the risks and benefits associated with their medicines.
Ensure timely identification of concerns in care home residents and clients in their own homes. This will enable appropriate care management, clinical review and escalation to be organised.
Facilitate communication and integrated working across sectors, by equipping care home and care at home staff with the confidence to communicate information to the wider multi-professional team in a shared language and using common tools.
Support demand-capacity management by reducing decision density and stress
Builds confidence and skills among care workers in delivering emotional, spiritual and physical care to people with palliative and end of life needs.

How will the project be delivered?

The project will be delivered as a series of iterative quality improvement cycles, using Plan-Do-Study-Act methodology. Initially, the aim will be to achieve successful spread within 2-4 early adopter organisations in each arm of the project. As successful spread takes root, other organisations will be onboarded.

Improvement facilitators will support the implementation leads in each organisation to meet regularly via Teams as part of the “Study” phase of PDSA cycles, to share learning and their plans for next stages of implementation.

An evaluation framework will be used to gather metrics that illustrate impact of decision support on short term outcomes (e.g. levels of usage of the decision support tools, knowledge, skills, confidence), medium term outcomes (e.g. change in prescribing or assessment/referral practice), and longer term patient and service outcomes.

Training and workforce development and systematic documentation of processes and procedures will be key components of sustainable implementation.

How is your project going to share learning?

Learning will be shared through two multi-stakeholder learning ecosystems – one for prescribing decisions; one for home care decisions. These ecosystems will include invited representation from patients/citizens, health and social care practitioners, digital services and quality improvement, education and research, policy and management, funding bodies and third sector representatives. Sharing learning will include virtual roadshows to showcase achievements, webinars and networking events, newsletters and social media campaigns.

Implementation guidance will be documented, shared and updated and evaluation reports will be published.

Learning will also be shared through meetings with key groups and networks including:

The National Decision Support Implementation Group
Scottish Care, comprising the majority of independent and third sector care homes and care at home
National Polypharmacy Steering Group
NHS Board Directors of Pharmacy, Prescribing Management Groups and Primary Care Prescribing Leads.
National Primary Care Quality Improvement Leads network.
Royal College of General Practitioners and Royal Pharmaceutical Society