This example of improvement case study gives examples from NHS trusts. You can view the case study below or download it as a PDF

Working with Groups - Building Effective Networks, a Medicines Management Case Study

This case study details some of the ways in which you can develop your network. It also summarises improvement work that some trusts have undertaken across healthcare interfaces through the use of effective networks.

If you want to develop your network never miss an opportunity. Here are some ways in which you can improve your network:

Never attend an event without making it a point to meet someone new. This can apply to almost every event. Overcome your fears and get to know people wherever you go. The person sat next to you at the next event you attend could be just the person you need in your network to take your next medicines management improvement idea forward.

Get your name known. When opportunities arise to get involved take them. Offer to join a focus group or committee, or give a presentation about the work you do to one of the networks you are interested in becoming part of. Once people hear your name in conversation, see it in an email or read it on an agenda, they will begin to recognise it when it appears in the future. However, although it is important to participate in a variety of activities, try to avoid overloading yourself with commitments. If you start volunteering to do things that you don’t have the capacity to deliver on your name could become associated with unreliability!

Set up a few fact finding interviews for yourself. If you are interested in working in a particular area or want to get involved in an area of special interest try to meet with key people within that area. Let people know you are interested in their work and in learning more about what they do.

Do your homework. When you finally do manage to meet a key person make sure you know what you want to accomplish. Do you want their email address, or permission to follow up a contact? What are you going to say to break the ice and to keep the conversation flowing? Think about what you can do for them, and not just what you want them to do for you. You will increase your confidence and feel more at ease if you plan your meetings ahead.

Examples of Improvement

The following are examples of improvement collected by the National Prescribing Centre over a number of years. They highlight some of the benefits of effective networks within medicines management when working across healthcare interfaces.

Patient Knowledge
Wycombe PCT produced an evidence-based leaflet based on the work of primary and secondary care sites in Buckinghamshire. Health care professionals use the leaflet when they are counselling patients to explain the appropriate blood glucose-testing regime for particular treatments.

Admission & Discharge
Hinchingbrooke Health Care NHS Foundation Trust identified that poor communication between hospital and primary care could be improved. An earlier audit undertaken in Huntingdonshire PCT showed that 49% of patients recently discharged from hospital did not understand the reason for taking one or more of their medications. The Hinchingbrooke team agreed to try to increase the number of discharge summaries sent to primary care which have correctly detailed information about medication changes.

Gateshead Health NHS Foundation Trust decided to focus on the flow of medicines information into and out of the hospital. Work was carried out to redesign the discharge summary, removing unnecessary sections to make more space for changes to medication to be documented. The ward clerks on the Medical Admissions Unit are now faxing all of their discharge summaries to GPs using a designated fax machine. This has been programmed with the fax numbers of all the practices in Gateshead to reduce the risk of faxes being sent to the wrong place. In addition to this, junior doctors now also receive additional training on completing discharge summaries. The data collected showed a clear improvement in the number of discharges received and a reduction in the average number of days the summaries took to reach the GP practice.

Green Bags Scheme
In 2005, Nottingham City University Hospital NHS Trust won the Health & Social Care Patient Safety Award for the Midlands and East Region for the work they had done on the development and design of a patient-focused 'Patient's Own Medicines Bag', for use when patients attended any healthcare appointment at which up-to-date medicine-related information was needed. In clear and simple terms, the bag effectively reminds the patient to take along all their regular prescribed medicines, together with any medicines purchased over the counter, to any appointment with a healthcare professional. It also reminds the patient to ask for up-to-date printed information. The bag acts as an interface tool between the patient and healthcare professional, ensuring effective dialogue and understanding on both sides.

In work undertaken at Northumbria Healthcare NHS Foundation Trust - primary and secondary care staff looked at communication issues between them. The outcome of this was to produce a trust-wide discharge prescription. The discharge script was redesigned to allow patients, carers, GP’s and community nurses to understand the information whilst not being too arduous for hospital staff to complete

Supply of Specialist Medicines
Royal United Hospital Bath NHS Trust (RUHB) worked on reducing the workload for hospital pharmacy staff and improving patient care. The team agreed to have specialist drugs delivered to the patients’ general practice surgery. To enable this to happen a pathway was developed for the GP. The RUHB would remain responsible for the drugs, checking and auditing the medicine journey through from pharmacy, to transport, to GP practice, checking that the medicines have arrived safely and advising the patient when the medicines are at the surgery and available for collection.

Joint Medication Reviews
North Eastern Derbyshire PCT has been undertaking medication reviews for patients on care of the elderly wards in community hospitals. The hospital’s ward pharmacists look at all of the clinical aspects of the patient’s medication and liaise with consultants around changes to be made. A PCT medicines review technician then reviews compliance/ concordance issues for that patient. This includes liaising with the patient’s family, friends, carers, social services, community pharmacy, ward staff, and GP practice staff as appropriate. These reviews have proven to be extremely beneficial and worthwhile, both from a patient’s perspective and in helping to reduce readmissions

Taunton Deane PCT has employed pharmacists to provide clinical services to the local community hospitals. This has enabled follow up by community pharmacists to patients following discharge. Patients are assessed initially by phone, and then if the pharmacist feels a patient is at particular risk, a home visit is arranged. The assessment helps identify problems with current medication and improves the patient’s understanding of their treatment.

Job Shadowing
Milton Keynes PCT has worked on improving the communication between the GP surgery and pharmacy. To help achieve this, a community pharmacist invited a local GP to shadow him at work for half a day. The GP found it an invaluable experience and gained a large amount of useful information. The GP now plans to make much greater use of the local pharmacist’s skills and has discovered that pharmacists can assist the practice in a number of different ways

MRSA Screening
East Hull, West Hull and East Riding PCTs are working together with their local secondary care trust to test for MRSA prior to a planned admission. Patients undergoing some types of operation are now being tested at their pre-op assessment for certain bacteria and are then undergoing treatment if necessary