Led by Northumbria Healthcare NHS Foundation Trust, this project aimed to reduce the amount of medicines prescribed to care home residents unnecessarily and to involve patients and their families o...
Jo Mackintosh is Service Improvement Project Lead in the patient experience team at Northumbria Healthcare NHS Foundation Trust. Following on from our interview with Annie Laverty, the Trust’s Director of Patient Experience, Jo tells us about her role in measuring patient experience and her involvement in the Trust’s Shine project, which is enabling frail older people to take part in decisions about their care.
Real-time insights to improve care
Much of what we do in the patient experience team at Northumbria is about giving wards a real-time snapshot of patient care. We really want to understand what care feels like for patients on our wards, so we ask them to tell us about their experiences. Service design and improvement has to be underpinned by real insights from patients – it’s a key part of achieving and sustaining quality improvement.
At the moment we visit 34 wards twice a month and we plan to eventually extend the programme to all hospital wards across the Trust. At each visit we aim to speak to at least half of the patients on the ward. We ask questions like ‘Overall, on this ward do you feel you were treated with respect and dignity?’ and ‘Were you involved as much as you wanted to be in decisions about your care and treatment?’
We report the findings to the ward teams on the same day and this is highly motivating for staff – it allows them to both celebrate the positive aspects of the care they provide and understand which aspects of care their patients feel could be improved.
It’s important to us to get an accurate picture of patient experience, so we also measure the experience of inpatients and outpatients two weeks after discharge. Research shows that until this point, feedback can be influenced by the gratitude patients feel towards those that cared for them.
Supporting innovative projects
A large part of my role involves leading on patient experience for service improvement projects across the Trust. Through our innovative Shine project we’ve developed a framework to encourage older people in nursing homes to be involved in decisions about their medication.
The project arose from the recognition that older people in nursing homes are often prescribed more medicines than they need to be. Sometimes inappropriate medicines are prescribed too, for example if someone was given medication for preventing bone fractures when they were mobile, and it hadn’t been stopped even though they’d since lost their mobility.
At the heart of the Shine project is an ambition for every patient or their representative to be actively involved in the medication review process. But we know that this isn’t always realistic – patients might lack the capacity to fully engage in complex decisions themselves, they might not have a family advocate, or their family advocate might live too far away to be closely involved. Our framework supports different levels of engagement, from a face-to-face discussion with the patient or their family, through to a phone call or letter to the family. We can provide the level of involvement that suits each individual.
The Shine project is a truly multidisciplinary partnership between GPs, pharmacists and the psychiatry of old age team, as well as the patient experience team. Professionals from different clinical specialisms are drawing on one another’s expertise and developing their own skills and knowledge, which is improving their ability to navigate often complex ethical issues around prescribing and de-prescribing.
We started the project in early 2013 and so far, for every two patients reviewed, one has had at least one medicine stopped. Early feedback from patients and family members has been very positive and we’re well on track to meet our goals of reducing medicines-related risk, achieving a better quality of life for residents through fewer side effects, freeing up care home staff time through administering fewer medicines and reducing prescribing costs.