Inter-professional education and primary care : EFPC position paper

Inter-professional education (IPE) can support professionals in developing their ability to work collaboratively. This position paper from the European Forum for Primary Care considers the design and implementation of IPE within primary care. This paper is based on workshops and is an evidence review of good practice. Enablers of IPE programmes are involving patients in the design and delivery, providing a holistic focus, focussing on practical actions, deploying multi-modal learning formats and activities, including more than two professions, evaluating formative and summative aspects, and encouraging team-based working. Guidance for the successful implementation of IPE is set out with examples from qualifying and continuing professional development programmes

A multi-faceted approach to optimising a complex unplanned healthcare system

Unscheduled and urgent health care represents the largest area of activity and cost for the UK’s National Health Service (NHS). Like typical complex systems unplanned care has the features of interdependence and having structures at different scales which requires modelling at different levels. The aim of this paper is to discuss the development of a multifaceted approach to study and optimise this complex system. We aim to integrate four different methodologies to gain better understanding of the nature of the system and to develop ways to enhance its performance. These methodologies are: (a) Lean/ Flow theory to look at the process and patients and other flows; (b) Simulation/ System Dynamics to undertake analytical analysis and multi-level modelling; (c) stakeholder consultation and use of system thinking to analyse the system and identify options, barriers and good practice; and (d) visual analytic modelling to facilitate effective decision making in this complex environment. Of particular concern are the boundary issues i.e. how changes in unplanned care will impact on the adjacent facilities and ultimately on the whole Healthcare system

Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review.

Several guidelines support polypharmacy management in individual patients. More organisational-level focus is needed on the use of implementation frameworks. The aim of this scoping review was to characterise the peer-reviewed literature on implementation frameworks, focussing on barriers and facilitators to implementation at organisational level in the context of polypharmacy management. A scoping review protocol was devised, supporting retrieval of studies published in English, reporting from any sector of practice. Medline, International Pharmaceutical Abstracts, Cumulative Index of Nursing and Allied Health Literature and Business Source Complete were searched to January 2022 using Medical Subject Headings including: 'polypharmacy', 'deprescriptions', 'strategic planning' and 'organizational innovation'. A narrative approach to data synthesis was applied. Searching, data extraction and synthesis were undertaken independently by two reviewers. After screening 797 records, eight papers remained. Two were descriptive, outlining details of specific initiatives; six used qualitative methods to explore determinants for implementation, including barriers and enablers. Barriers at the organisation level included: poor organisational culture with a lack of sense of urgency and national plans, resource availability and communication issues including patient information and at transitions of care. Organisational facilitators included availability of government funding and regulatory environment promoting patient safety, a national emphasis on quality of care for older adults, co-ordinated national efforts and local evidence. Limited literature focusses on the use of implementation frameworks at organisational levels. This review highlights the need for further work on implementation frameworks in this context to help achieve effective organisational change

A novel tool for organisational learning and its impact on safety culture in a hospital dispensary

Incident reporting as a key mechanism for organisational learning and the establishment of a stronger safety culture are pillars of the current patient safety movement. Studies have suggested that incident reporting in healthcare does not achieve its full potential due to serious barriers to reporting and that sometimes staff may feel alienated by the process. The aim of the work reported in this paper was to prototype a novel approach to organisational learning that allows an organisation to assess and to monitor the status of processes that often give rise to latent failure conditions in the work environment, and to assess whether and through which mechanisms participation in this approach affects local safety culture. The approach was prototyped in a hospital dispensary using Plan-Do-Study-Act (PDSA) cycles, and the effect on safety culture was described qualitatively through semi-structured interviews. The results suggest that the approach has had a positive effect on the safety culture within the dispensary, and that staff perceive the approach to be useful and usable

DEveloping a Complex Intervention for DEteriorating Patients using Theoretical Modelling (DECIDE study): study protocol

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enacting expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, un-recorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into 'belief statements'. Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalised) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques /mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, 'sub-optimal care' of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e., targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research. This article is protected by copyright. All rights reserved

Supporting safe medicines transition for residents entering care homes

Postponed access: the file will be accessible after 2022-05-19Master´s Thesis in PharmacyFARM399/05HMATF-FAR

A theoretical exploration of hospital clinical pharmacists' perceptions, experiences and behavioural determinants in relation to provision of optimal and suboptimal pharmaceutical care.

Pharmaceutical care describes a range of patient-focused activities delivered by pharmacists. The activities aim to optimise medicines use for patients and to reduce harm from adverse events with medicines. This study was conducted in an NHS Scotland organisation, where the clinical pharmacy service has an established quality management system. It was evident that some gaps existed in the quality assurance parameters for clinical pharmacy services and pharmaceutical care, with there being no clearly defined route to report adverse events or near misses that arose from within the service. In quality management terms this meant it was difficult to determine whether optimal pharmaceutical care was being delivered, or to establish how accurate clinical pharmacists were in their pharmaceutical care activities. Additionally, this meant it was difficult to evidence areas for quality improvement. This study aimed to explore the perceptions, experiences and behavioural determinants of the hospital clinical pharmacists in relation to optimal and suboptimal pharmaceutical care within an NHS organisation in Scotland using a theoretical framework. The research used the concept of suboptimal pharmaceutical care to describe the gap between pharmaceutical care as intended and pharmaceutical care as delivered. This research used qualitative study design and a phenomenological approach, and was conducted in two phases with the first phase influencing the design of the second phase. In Phase 1, focus group methodology was used to determine perceptions of hospital clinical pharmacists to optimal and suboptimal pharmaceutical care. Study participants (n=20) were hospital clinical pharmacists recruited from hospitals across the NHS Scotland health board. A topic guide focused the discussions on the activities related to medicines reconciliation and Kardex/medicines review. Data generated from focus groups was in the form of written statements and audio-recorded narrative to describe participants' perceptions of barriers and enablers to providing optimal pharmaceutical care. The Theoretical Domains Framework (TDF), an integrative theoretical framework that describes behavioural determinants, was used to analyse the findings. Phase 2 used in-depth interviews to explore participants' (n=10) experiences of optimal and suboptimal pharmaceutical care. A semi-structured interview schedule was developed using TDF, to facilitate identification of behavioural determinants to the provision of optimal and suboptimal pharmaceutical care. Within Phase 1, participants perceived that there were barriers to the delivery of optimal pharmaceutical care, citing as contributory elements time factors, lack of policy and procedure, conflicting priorities (including uncertainty over efficiency versus thoroughness), poor underpinning knowledge of medicines by doctors, and inadequate skills in completing and documenting activities. In Phase 2, key determinants were elicited, including knowledge (of trainees), time, policy, procedure or guidance on suboptimal pharmaceutical care, and personal and professional barriers and enablers, including professional embarrassment and hierarchy. The study has allowed an exploration of an underacknowledged topic in clinical pharmacy practice and identified behaviours, including role uncertainty and embarrassment, that may contribute to lack of reporting on suboptimal pharmaceutical care. Recommendations have been made using behavioural change technique interventions and include educational interventions, skills training, modelling, enablement, persuasion, incentivisation, coercion, restriction and environmental restructuring. Implementation of these interventions and evaluation of their effectiveness will enable the organisation to have more robust quality assurance parameters within the clinical pharmacy service, and to ensure continued conformance with the quality management system. Across the wider clinical pharmacy community, lessons may be learned about perceptions and experiences relating to suboptimal pharmaceutical care, and consideration made to capturing the learning opportunities that can arise when considering suboptimal pharmaceutical care in practice