Application of consensus methods to refine high risk medicines care bundles

Research output: Contribution to conferencePoster


High Risk Medicine care bundles (CBs) have been piloted in 27 community pharmacies since November 2014 as part of the Scottish Patient Safety Programme – Pharmacy in Primary Care (SPSP-PPC) collaborative, with intent for national implementation across Scotland. CBs are interventions designed to improve patient outcomes and health service processes. Four NHS regions were involved; two focused on Warfarin and two on non-steroidal anti-inflammatories (NSAIDs). Each region developed their own CB and resultantly there was variation between the CB measures and patient cohort. As the NHS Healthcare Quality Strategy for NHS Scotland advocates reducing unnecessary variation, there was a strategic desire to develop a single NSAID CB and a single warfarin CB for further piloting.
An interactive consensus method was chosen to allow for collaborative learning from the initial pilot to shape and develop consolidated CBs. Phase 1 involved a preparatory Scoping Survey completed by the SPSP-PPC Regional Leads to obtain up-to-date information on the CBs. This was following by a one-day Consensus Workshop (Phase 2), applying modified Nominal Group Techniques (NGT). This involved: i) silent generation of opinions and/or thoughts on the variable CB measures and patient cohort; ii) round-robin feedback; iii) group discussion; iv) ranking of the variables; and v) discussion and formal consensus on the final CBs. Consensus was defined as 70% of participants being in agreement. A multispecialty group were purposefully selected, including the SPSP-PPC Steering Group. An information pack was disseminated which enclosed updated, anonymous information on the CBs from the Scoping Survey. Phase 3 concluded the study and involved a videoconference “WebEx” with the SPSP-PPC Steering Group to reflect on how the CBs would be operationalised.
A representative from each NHS Region completed the Scoping Survey, which revealed iterative changes to the CBs since initial development. Sixteen individuals participated in the Consensus Workshop, with representation from NHS Regions (n=8), Healthcare Improvement Scotland (n=4), NHS Education for Scotland (n=1) Academia (n=1), Scottish Government (n=1) and a patient representative (n=1). The nominal group successfully developed consolidated NSAID and Warfarin CBs (see Supporting File 1) with agreed patient cohorts. A six-question NSAID CB focussing on communication and prescribing risk was developed (93% agreement), for prescribed NSAID and OTC supplies (93% agreement); and a six-question Warfarin CB focusing on patient knowledge and understanding was developed (100% agreement), for delivery to regular and non-regular patients with repeated delivery of the CB to patients (88% agreement). Final refinements made during the videoconference “WebEx” included updating the wording, guidance and reference material to be nationally applicable across Scotland.
This study presents an inclusive decision making process successful in attaining consensus of the CB measures and patient cohort, which has progressed onto testing. This reduction in variation offers equality of patient care, easier implementation, and facilitates evaluation of service and clinical outcomes. The modified NGT method has been successfully re-applied within another collaborative in a different health care setting, suggesting it to be a transferrable method able to facilitate a reduction in health services variation.
Original languageEnglish
Publication statusPublished - 7 Jul 2017
EventHealth Services Research UK Symposium - Nottingham Conference Centre, Nottingham, United Kingdom
Duration: 6 Jul 20177 Jul 2017
Conference number: 10


ConferenceHealth Services Research UK Symposium
Abbreviated titleHSRUK
Country/TerritoryUnited Kingdom


  • high risk medicines
  • Scottish Patient Safety Programme
  • care bundles
  • patient safety


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