Improving medication safety in care homes using quality improvement methods
Marian House Nursing Home (located in Sutton Coldfield, Birmingham) successfully implemented a quality improvement project to improve the safety of medicines rounds for residents in their care.
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Medicine rounds are a safety critical activity and it is widely acknowledged the distraction errors may increase the risk of error which could lead to potential harm for vulnerable residents.
In March 2021, the staff in the Care Home expressed an interest in undertaking a QI project to reduce the number of interruptions to medicine rounds. The Patient Safety Collaborative team at the West Midlands Academic Health Science Network (WMAHSN) offered intensive QI support to the manager and staff in the Nursing home with this QI project. Medicines safety improvement in care homes is aligned to one of the national patient safety improvement priorities. Using QI methodology the nursing home improved the safety culture of medicines rounds delivered significant and sustained reductions in the number of interruptions to medicine rounds.
How did the Innovation Exchange help?
Staff at the care home started by undertaking a baseline survey about the safety culture at the home. This was followed by collection of baseline data by staff undertaking the medicine rounds for approximately three weeks. Infromation was collated about the frequency and nature of interruptions (who was interrupting and the reason for the interruption) at different medicine rounds.
A quality improvement meeting was then held with staff and the results of the culture survey and the baseline interruptions data was presented and discussed. Baseline data showed that the average medicine rounds were interrupted between 3-4 (3.8) times per round. Staff collectively agreed a SMART aim for the project which was to reduce the number of interruptions by 33% over the next month. They reviewed and discussed the information from the baseline interruptions data (particularly the key reasons for interruptions) to identify a number of improvement ideas. They identified a number of changes that they agreed to test out to see if it would have the desired outcome of reducing the frequency of interruptions. These included reallocation of the telephone to care staff, respectful challenge of interruptions deemed avoidable and using other methods of communication to relay information. Staff then continued to audit medicine round interruptions to monitor the impact of these tests of change.
The safety culture survey was also repeated after three months to see if there had been a change in culture from the baseline survey.
The Patient Safety Collaborative team at the WMAHSN offered intensive QI support to the manager and staff in the nursing home. The WMAHSN advised on baseline data collection and supported the care home with quality improvement methodology. They facilitated a workshop with staff to develop an aim and generate improvement ideas. The WMAHSN also supported the development of a dashboard for ongoing data collection of interruptions data. The interruptions dashboard demonstrated significant and sustained reduction in interruptions and the care home will continue to audit medicine rounds and enter data onto the dashboard to ensure that the improvement is sustained over time. The results of this successful QI project may be used to as evidence that the service at this care home is well led, responsive, safe and effective in CQC visits and other quality inspections.
The approach and resources have been shared with other AHSNs across the country who are embarking on similar work.
Impact & Outcomes
There was a significant and sustained reduction in the number of overall number interruptions to medicine rounds from 3.8 to 0.79 post intervention. The morning round which was the most frequently interrupted round was reduced from a mean of 2.48 pre intervention to 0.44 post intervention. Reduced numbers of interruptions to medicine rounds is likely to result in reduced distration errors, thereby improving safety for the residents in the care home.
Data was also collected about duration of medicine rounds. In this particular care home there did not appear to be a correlation between duration of medicine rounds and frequency of interruptions. However, it may be the case that in other care homes a reduction in duration of medicine rounds resulting from less interruptions may release staff to undertake other aspects of care.
The safety culture survey which was repeated after the QI project showed a positive shift in safety culture in the domains relating to safety climate and perceptions of management compared to the safety culture survey prior to the QI project.
The care home sector has high levels of staff recruitment and retention and any interventions which may impact positively on staff morale may impact positively on staff retention.
The improvements achieved in the care home could be used as evidence for quality visits including Care Quality Commission (CQC) inspection. The improvement project provides evidence for the following CQC lines of enquiry: Safe, Effective, Responsive and Well Led.