Presentation Information
[P-27-04]Improving Duty Clinician Decision-Making for Medication Side Effects in Patients with Multimorbidity and Polypharmacy: A Quality Improvement Project
*Tejbir Singh Deol1, Wyeshnavi Chitrangan1, Rohit Nagaraj1, Madhusudan Dalvi1,2, Lucia Laskowski2 (1.King's College London(UK), 2.Kent and Medway NHS and Social Care Partnership Trust(UK))
Keywords:
Triage Psychriatry,Administrative psychiatry,Quality improvement Project,Old Age Psychriatry,Reducing Re-admissions
Background/introduction:Patients referred to the Shepway Old Age Psychiatry service often have multimorbidity and polypharmacy, leading to medi-cation side effects that compromise safety and cause unnecessary re-admissions.
Aim(s)/objectives:The QIP sought to reduce unnecessary referrals, ensure timely intervention for high-risk cases, and optimise clinic efficiency by implementing a triage poster to guide clinicians in deciding whether patients required re-admission or alternative referrals (e.g., A&E or GP).
Methods:There were three PDSA cycles. Cycle 1 involved implementing a triage poster and comparing re-admission rates pre- and post-intervention over three weeks using a two-sample t-test. Cycle 2 included a teaching session on the poster’s content, with feedback collected via questionnaires and the teaching session’s effectiveness was assessed using the Wilcoxon Signed-Rank Test and qualitative analysis. Cycle 3 used an improved poster, which accounted for high-prevalence comorbidities and medications identified in cycle 1 and assessed its impact over eight weeks using a two-sample t-test. Comparing the 3 cycles was done using an Anova test and Mann-Whitney U Test.
Results:For cycle 1, weekly re-admissions increased significantly from 2.33 (SD = 1.53) pre-intervention to 5.00 (SD = 0.00) post-intervention (t(4) = -2.92, p = 0.043), indicating the poster did not reduce re-admissions and may have had the opposite effect.
Discussion/conclusion:The triage poster was associated with increased re-admissions, contrary to the QIP’s aims. Further investigation into confounding factors, like seasonal variability, and extended data collection are needed to refine the intervention and achieve the QIP’s goals of improving patient safety and service efficiency.
Aim(s)/objectives:The QIP sought to reduce unnecessary referrals, ensure timely intervention for high-risk cases, and optimise clinic efficiency by implementing a triage poster to guide clinicians in deciding whether patients required re-admission or alternative referrals (e.g., A&E or GP).
Methods:There were three PDSA cycles. Cycle 1 involved implementing a triage poster and comparing re-admission rates pre- and post-intervention over three weeks using a two-sample t-test. Cycle 2 included a teaching session on the poster’s content, with feedback collected via questionnaires and the teaching session’s effectiveness was assessed using the Wilcoxon Signed-Rank Test and qualitative analysis. Cycle 3 used an improved poster, which accounted for high-prevalence comorbidities and medications identified in cycle 1 and assessed its impact over eight weeks using a two-sample t-test. Comparing the 3 cycles was done using an Anova test and Mann-Whitney U Test.
Results:For cycle 1, weekly re-admissions increased significantly from 2.33 (SD = 1.53) pre-intervention to 5.00 (SD = 0.00) post-intervention (t(4) = -2.92, p = 0.043), indicating the poster did not reduce re-admissions and may have had the opposite effect.
Discussion/conclusion:The triage poster was associated with increased re-admissions, contrary to the QIP’s aims. Further investigation into confounding factors, like seasonal variability, and extended data collection are needed to refine the intervention and achieve the QIP’s goals of improving patient safety and service efficiency.