Congratulations to the CNWL Pharmacy Team who have been accepted to share their improvement work at the IHI/BMJ International Forum on Quality and Safety in Healthcare. The forum will be held in Gothenburg, Sweden in June this year. 

Improvement Advisor, Bridget Browne caught up with Yogita Dawda, Clinical Lead for Mental Health Pharmacy and Niina Ezewuzie, Associate Chief Pharmacist for Jameson about their project to reduce unplanned medicines-related readmissions to mental health wards and Crisis Resolution Home Treatment teams (CRHTTs).  

Can you give us a bit of background about your project? 

Hospital readmission is common in mental health. Unplanned readmission within 30 days is considered a poor indicator of quality. 

We investigated the potential role of medication related factors in unplanned readmissions to mental health wards and CRHTTs and looked at whether a collaborative multidisciplinary Quality Improvement approach could help to reduce medicines-related readmissions.  

What did you do to understand the problem and start to develop change ideas? 

Notes for patients admitted to 16 wards and 6 CRHTTs over a 2-week period were checked to identify a previous admission.  

For the 213 cases identified, notes were reviewed and GP practices and patients interviewed to assess if medication contributed to readmission either ‘significantly’, ‘partly’ or ‘not’.  

Where readmission was identified as medicines-related, we identified whether:  

  • the patient had received discharge medication at the previous discharge and left with their medication  
  • a discharge notification was sent and received by patients’ GP  
  • post discharge follow-up was completed (either at 3 or 7 days)  

Once we understood the factors that contributed to medicines related re-admissions we used a multidisciplinary QI approach to test the impact of systemwide changes on medicines-related readmissions.  

What has been the outcome of your work? 

Using a QI approach, medicines-related readmissions reduced from 58% to 2-5% in 6 months.  

What is the benefit of this work for patients? 

  • Readmission is distressing for patients and their families – reducing readmission reduces this distress. 
  • Reducing readmission has positive benefits for patient safety, outcomes and continuity of care. 

What is the benefit to staff? 

  • Improved knowledge of the role of medication in readmission 
  • Improved sharing of information between primary and secondary care (discharge notifications) 
  • A collaborative and consistent approach to discharge planning and post-discharge follow-up  

What is the benefit to the system? 

  • Supports the wider health economy by reducing unnecessary admissions 
  • Reduction of readmission supports increased bed capacity 
  • Systems and processes embedded to reduce medicines-related readmissions  
  • Better communication across interfaces with the aim to avoid unplanned medicines-related readmissions   

What have you learnt as a result of this work? 

  • Readmission is used as a gauge for quality of care and has negative health economic effects.  
  • Medicines are the most common healthcare intervention and medication changes during admission are common. 
  • Timely communication to GP post-discharge is essential to avoid discrepancies.  
  • The importance of ensuring patients are not discharged without an adequate supply of their medicines.   
  • QI methodology can significantly reduce medicines-related readmissions by multidisciplinary approach to discharge planning and continuity of care. 

What would you say are the key factors for successful change? 

  • Good engagement with key stakeholders 
  • Coproduction – involving patients and carers is key 
  • Clearly defined goal and aims 
  • Clearly defined measures  
  • Good planning  
  • Start small to test your ideas 
  • Continuous monitoring 
  • Be flexible and open to changes  
  • Share your work to influence wider change across the healthcare system 

This project was also shared in the Pharmaceutical Journal.