Active patient participation in improving anticoagulant medication safety University College London Hospitals NHS Foundation Trust

The University College London Hospitals NHS Foundation Trust project supported patients to become active partners in their own care, to reduce patient harm arising from anticoagulant medication.

The project team developed and tested two innovations:

• patient-led discharge summary ‘time outs’, where patients were involved in reviewing their discharge summary before leaving hospital care, to improve communication between hospital and GP
• patient-centred run charts showing test results, drug doses and target levels in picture format, to inform patients and engage them with their anticoagulant management plans.

The innovations were developed and then tested on wards using 90 day rapid improvement cycles. 

Who was involved

The project was led by the trust’s director of quality and safety, with the head of quality improvement acting as project manager. Others involved included the corporate medical director, a pharmacist, a senior nurse and a ward sister. A GP liaison committee provided feedback throughout the project.

Impact

• Initial testing of the run chart involved patients engaged in a discharge time out. None of these patients were readmitted within 30 days or involved in reported incidents.
• Patient-centred run charts became routine practice at the trust's Heart Hospital.
• A baseline audit showed that out of 33 readmissions, 13 involved patients on an anticoagulant and 3 were directly related to poor anticoagulant management. During the testing period, the number of readmissions remained at 33, with 13 patients on anticoagulation, but no readmissions related to poor anticoagulant management.

Challenges

The team experienced challenges with nursing engagement, staff turnover, ward leadership of the project and identifying surgeons to lead testing of the discharge summary time out. They also found fewer inpatients on anticoagulation than they had anticipated.