Repeat Prescription Process
Claire Gregory
Director , Xytal
Sue McInnes
Consultant, Xytal
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PGP Overview Film
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Institute for Innovation and Improvement 2011
Prescriptions module
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Prescriptions modules
:
This module will help you to make improvements to your
Repeat prescription process
• from the patient requesting a repeat prescription to the patient
collecting the prescription.
This module can also help you to make improvements to your
Clinical decision making
• helping you to understand what your team defines as good
prescribing and agreeing common principles which are shared
across the practice.
I
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How to use the Prescriptions module…..
……we will use the process module structure to guide
us through the module.
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Process module structure – Prescriptions
1
About the module – why is this module important
2
Getting
Started
Define and
Scope
3
Understanding your current state
4
Identifying the changes you will make
5
Implement
your changes
Pilot & Implement
6
Maintain
improvement
Monitor &your
Sustain
Prescriptions module – why it is important?
Delivering excellence:
The vast majority of consultations end with a prescription for medication.
A good prescriber strives to maximise benefit and minimise harm.
However, being clear about how to do this for every single patient is not
always easy.
Managing demand:
Approximately 926.7 million prescriptions are written in primary care in
England every year, with the number of items prescribed growing at around
4.6% annually (NHS Information Centre, 2011).
These numbers, as well as the associated
costs, are likely to increase as patients are
living longer and the incidence of long term
conditions grows.
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Prescriptions module – why it is important?
Releasing time:
Approximately half of your practice’s population will be receiving
repeat prescriptions (Harris and Dajda, 1996), with around 200 repeat
prescriptions generated every week per GP (Cabinet Office, 2002).
Improving patient experience:
Patients, especially those requiring long term medication, have frequent
contact with the practice and the service they receive can often be used as a
quality marker – eg how easy it is for patients to request and receive
a repeat prescription.
Clinical decision making:
Often, prescribing reviews are driven
by performance management
measures and safety guidelines.
But how else could you look at this?
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Critical success factor - Changing the way
you think will lead to a change in behaviours – is
middle of the pack good enough for your practice?
‘The Prescriptions module helped us to quickly realise we had
no shared understanding as a team of what good prescribing
was. We focus a lot on comparing ourselves with other
practices, but we don’t replicate that challenge internally and
compare
our own prescribing levels.’
Dr Anita Campbell, GP, Richmond Medical Centre, Sheffield
‘We thought our prescriptions system was pretty good. ‘We felt we
should do the Front of House module first, because our reception
staff were a bit isolated. But working through the Prescriptions
module, we came up with plenty of areas for improvement.’
Fiona Dalziel, general manager, Elmbank Group Practice, Aberdeen
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You can achieve a range of benefits
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Prescriptions Film
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Process module structure
1
About the module – why is this module important
2
Getting
Started
Define and
Scope
3
Understanding your current state
4
Identifying the changes you will make
5
Implement
your changes
Pilot & Implement
6
Maintain
improvement
Monitor &your
Sustain
© NHS Institute for Innovation and Improvement 2011
Getting started
1. Familiarise yourself and the practice with the module
2. Create the module team:
•
•
•
Overall module team lead – Practice Manager
Representative from each staff group:
– GP
– Nurse
– Reception/back office staff
– Dispensing or pharmacy team
Patient representative.
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Getting started
3. Communicate, engage and raise awareness
Example of a Story board
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Process module structure
1
About the module – why is this module important
2
Getting
Started
Define and
Scope
3
Understanding your current state
4
Identifying the changes you will make
5
Implement
your changes
Pilot & Implement
6
Maintain
improvement
Monitor &your
Sustain
© NHS Institute for Innovation and Improvement 2011
Understand your current state
This section will help you to understand your current state by
focusing on three key areas:
• Gather and review relevant data
• Gather feedback from the staff
and patients
• Map your current state
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Understand the demand for repeat
prescriptions
Repeat prescription demand template
Once you have collected the data,
you can use Pareto charts to
interpret and display it in a more
visual and engaging way.
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How long does it take to turn round repeat
prescriptions?
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Displaying your turnaround time data
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Interruptions for prescriptions
Prescriptions interruptions sheet
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Prescription enquiries
Prescriptions enquiries sheet
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Gather feedback from patients
Patient feedback
•
•
•
•
•
•
The Improving Patients in Improvement module
Patient compliments and complaints
Patient focus groups
Repeat prescriptions patient questionnaire
National GP Patient Survey
Other ways to involve patients
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Gather feedback from staff
Staff feedback
•
•
Staff experience questionnaire
Frustrations and celebrations
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Map your current state – 3 methods to help you
understand how your processes are performing
The data and feedback the team gathers from patients and staff (eg through
questionnaires and forums) is vital, but it won’t give the full picture.
If we want to know how processes are performing, we need to consider
more than just the outcomes of the process (eg 48 hour turnaround time for
repeat prescriptions).
Understanding what has led to an outcome (eg the steps taken from the
patient requesting a repeat prescription, to it being signed) is also crucial
and can provide valuable insights into how processes actually work.
Methods can be used to build a clear and factual picture of the
current state, including:
1. Process mapping
2. Spaghetti diagrams
3. Timing process
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Map your current state – process mapping
1. Process mapping the repeat prescription process
‘We found the receptionists had a
sequence with repeat prescriptions
once they were signed – but the
doctors’ didn’t really have a system
for signing so it didn’t fit that method:
doctors now sign in sequence with
reception to avoid delays.’
Fiona Dalziel, general manager
Elmbank Group Practice, Aberdeen
Process mapping is a visual and inclusive activity that helps teams work out
where the problems are and what the solutions might be.
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Spaghetti diagram and Timing the process
2. Spaghetti diagram showing the
movement to find a prescription
3. Statistical process control chart showing
the time taken to find a prescription
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Process module structure
1
About the module – why is this module important
2
Getting
Started
Define and
Scope
3
Understanding your current state
4
Identifying the changes you will make
5
Implement
your changes
Pilot & Implement
6
Maintain
improvement
Monitor &your
Sustain
© NHS Institute for Innovation and Improvement 2011
Identify the changes you will make
This stage involves 5 parts:
• Review your data
• Agree and Prioritise areas for improvement
• Review ideas that have worked elsewhere
• Map the future state
• Choose your module measures
‘The tools within the module were great, the data collection sheets were
useful, and the mapping was very useful.’
Fiona Dalziel, General Manager, Elmbank Group Practice, Aberdeen
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Prioritise areas to focus on
2. Priority matrix
As a team consider
each area identified
and decide on the level
of complexity and
benefit.
The quadrant which
you may want to focus
on first is……..
WHY?
You could also use
the ranking matrix
3. Review ideas that have worked elsewhere
Examples covered in this modules include:
•
Releasing reception staff time and improving patient satisfaction by improving
the turnaround time for prescription collection
•
Reducing lost or missing prescriptions caused a large amount of
inconvenience to patients and staff.
•
Reducing the number of urgent requests for repeat prescriptions – the practice
found that a high number of enquiries were due to urgent requests and that this
also led to a high number of interruptions for the duty doctor
Before 5S
After 5S
A prescription charter is now
attached to each prescription
ready for collection.
4. When mapping your future state Inspire staff and trigger ideas
Encourage people to ‘think outside
the box’ and come up with their
own ideas and solutions.
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•
Start by brainstorming
improvement ideas.
•
Draw on successful examples in
your own practice; where are
things already working well?
Choose your module measure
Can you think of any module measures?
These are some examples of measures used by other practices.
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Process module structure
1
About the module – why is this module important
2
Getting
Started
Define and
Scope
3
Understanding your current state
4
Identifying the changes you will make
5
Implement
your changes
Pilot & Implement
6
Maintain
improvement
Monitor &your
Sustain
© NHS Institute for Innovation and Improvement 2011
The Model for Improvement
The Model for Improvement provides a useful framework that helps
teams:
• set clear objectives and targets
• measure against a plan
• test out improvement ideas
in small, manageable stages
before rolling them out on a
wider scale
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Implement your changes
•
Create an implementation plan.
•
Test the changes and monitor progress.
•
Support the team through the changes.
•
Communicate progress.
© NHS Institute for Innovation and Improvement 2011
Process module structure
1
About the module – why is this module important
2
Getting
Started
Define and
Scope
3
Understanding your current state
4
Identifying the changes you will make
5
Implement
your changes
Pilot & Implement
6
Maintain
improvement
Monitor &your
Sustain
© NHS Institute for Innovation and Improvement 2011
Maintain your improvement
Celebrate your successes
Example of a story board
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Maintain the improvements
Repeat the Plan, Do, Study,
Act cycle – continuous
improvement
Support Plan
• Introductory session – today
• On site visits – 3 x 3hrs
– Understand your current situation
– Process Mapping
– Analyse, gain insight and implementation
• Group Learning session - 22.9.15
Next Steps
• Decide who will lead this work
• Read the book about the repeat
prescription process
• Set up the workstream team
• Book 3 x practice support visits on
bookitlive
• Think about communication and patient
engagement
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