Is there scope for rapid implementation of pharmacoepidemiology findings using quality improvement methods?

Background
The Scottish Patient Safety Programme – Pharmacy in Primary Care collaborative has developed High Risk Medicine (HRM) Care Bundles (CB). These CBs, which are interventions that improve care processes and outcomes, focus on clinical assessment and patient education. Using quality improvement methods, these have been implemented in 28 community pharmacies in four health service regions – two focus on Warfarin and two on non-steroidal anti-inflammatories. The intent is for national roll out of a HRM CB, where a standardised process may act as a platform to accelerate uptake of pharmacoepidemiology findings into routine practice.

Objective
To develop a generic HRM CB process map to facilitate implementation.

Methods
Regional process maps were developed through data collection in four pharmacies, involving simulation of the CB process, staff interviews and documentation of resources. Following validation by the onsite pharmacist, commonalities among the process maps were collated to create a process map for each HRM. To develop a generic HRM process map, these were validated by 93% (n=26) of participating pharmacies.
Consent was gained throughout. Ethical approval was not sought as this was service evaluation.

Results
Although some regional variation existed, the validation identified six core stages required for successful CB delivery: patient identification, clinical assessment, patients’ eligibility flagged, CB delivery, enrolling non-attending patients and documentation. The commonalities were sufficient to develop a generic process map encompassing staff and patients' journey, its integration into usual practice and resources utilised.

Conclusion
To maximise implementation success, the process map allows for targeted development of resources to facilitate each core stage. The feasibility of developing a generic process map suggests adaptability of the CB to varying clinical contexts, strengthening the CBs potential to facilitate national implementation of health informatics research. Safety concerns highlighted by pharmacoepidemiology studies could be addressed by adapting the CBs' content, allowing seamless translation of evidence into practice.