Trust in collaboration develops a programme to improve the quality of care for patients with Parkinson’s, encouraging self-medication and reducing readmission rates

Outline:

The Leeds Teaching Hospitals NHS Trust (LTHT) Parkinson’s Quality Improvement Collaborative is a team of NHS staff working in collaboration with people with Parkinson’s (PwP) and carers, with the aim of reducing avoidable delays and omissions of medications for inpatients. A key aspect of our improvement work was partnership with Parkinson’s UK, in particular our local Area Development Managers to improve inpatient Parkinson’s care in Leeds.

We developed and tested interventions on adult wards, some of these we adapted from Parkinson’s UK educational materials. The most successful interventions became our ‘intervention bundle’ including bedside posters to alert staff to time-critical medication, small alarm clocks worn by nursing staff, posters summarising key medical contacts within the Trust as well as a twice-yearly educational masterclass.

Our interventions produced sustained improvement in average delay in first dose of medication administration from 7 hours to less than 1.5 hours. The average percentage of medication omissions has dropped from 15% to 1.3%. Our collaboration with Parkinson’s UK has allowed us to include a ‘breakout’ session in our masterclass run by PwP . This session has received positive feedback as a personal insight into being a hospital inpatient with Parkinson’s

Challenges:

Our team formed following a letter from Jane, the wife of a person with Parkinson’s. Her husband had experienced poor care during an inpatient stay at LTHT- due primarily to omitted and delayed medications.We invited Parkinson’s UK local representatives to our faculty meetings to establish a realistic and achievable aim yet one which we hoped would bring about a real improvement in standards of care for PwP in Leeds.

We set a provisional aim of establishing timely Parkinson’s medication omission on pilot wards within 6 months. A secondary aim was that we wanted to reduce the rates of Parkinson’s inpatients transferred to neurology for ‘rescue care’ We also wanted to empower patients to self-medicate within the hospital where possible.

Through collaboration with Parkinson’s UK and the Trust Patient Experience department we ran a workshop on self-medication for Trust staff and PwP to brainstorm ways in which to make self-medication a realistic possibility for PwP when admitted to hospital. As a result we now have increased numbers of patients who are opting to self-medicate when admitted to the Trust

Outcomes:

The team measured delays in first dose of medication administration as well as omissions in Parkinson’s medication administration over a twenty four hour period. Data was collected from all adult wards within the hospital (over 90) where PwP were admitted.

Challenges included spreading interventions to all adult wards in such a large hospital Trust. Collaboration with Parkinson’s UK was invaluable to determine which wards we should target initially as ‘pilot’ wards. Following Collaborative formation, the average delay in first dose of Parkinson’s medication administration after admission reduced from over 7 hours to less than 1.5 hours and the number of omitted Parkinson’s medications fell from 15.1% to 1.3 %. In addition we feel our work has had an important positive effect on staff behaviour and culture.

Staff feel empowered through the QI work we initiated in conjunction with Parkinson’s UK and that safe care for PwP should be ‘everybody’s business’ Jane has said of recent improvements: “We are so impressed with the work of the Quality Improvement Group which really has made a difference.”

Spread:

Collaboration and endorsement with Parkinsons UK has allowed us to spread our work both locally, nationally and internationally.

• We have visited other hospital Trusts in Yorkshire and the North East to discuss our interventions as well as establish how best to adapt these for use in other hospital Trusts.

• We were invited to talk about our work at BritModis 2018 a national movement disorders conference.

• We created an educational video on our work to improve Parkinson’s medication management and Parkinson’s UK secured a celebrity introduction to this which has helped to highlight and reinforce our message. This video is featured as an educational resource on the Parkinson’s UK website which we hope will allow other professionals to achieve timely medication administration and excellent care for PwP.

• As a result of the work with Parkinson’s UK including the online publicity, a hospital team in New Zealand have also contacted us to facilitate similar interventions to their wards.

Value:

Our collaboration with Parkinson’s UK has had a positive impact reaching far beyond our primary aim of establishing timely medication administration for PwP within our Trust.

Secondary outcomes demonstrating improved patient safety and care include:

• No internal transfers to Neurology ward for ‘rescue care’ of Parkinson’s in 2 years • A step reduction in readmission rates for PwP

• Spread to other hospitals within the UK And most importantly patient and carer experience has significantly improved which is what we are most proud of.

To quote Jane: “We are so impressed with the work of the Quality Improvement Group which really has made a difference.”

Involvement:

Stakeholders were Trust Executives including the Chief Executive, Chief Medical Officer as well as the Trust Patient Experience Team. Inviting a carer to join our QI faculty was a novel step for the Trust but one which was particularly important to establish senior support and engagement as Jane’s unique personal insight into the clinical problem highlighted this important patient safety issue .

Parkinson’s UK were enormously important in helping to publicise the work done in Leeds nationally. We collaborated with them to produce a patient safety video which can be viewed at https://www.youtube.com/watch?v=- Qr9mylzAV0 Other key stakeholders included Trust clinical staff.

Establishing their support of the project and achieving behavioural change was a challenge but has been instrumental to the support of the project. Jane’s story was a significant factor in engaging them with this important patient safety work. In addition SPC run charts demonstrating significant improvement in care enabled us to spread the work to other wards and services.