الخلاصة

Objective The Scottish Patient Safety Programme – Pharmacy in Primary Care collaborative is a quality improvement initiative adopting the Institute of Healthcare Improvements Breakthrough Series collaborative approach. It has developed and implemented High Risk Medicine (HRM) Care Bundles (CB) within 27 community pharmacies over 4 NHS Regions focused on warfarin and non-steroidal anti-inflammatories (NSAIDs). Each CB involves clinical assessment and patient education, although the content of the bundles varies between regions. To support national implementation, this study aims to understand the CBs integration into routine practice to support development of a generic HRM CB process map. Methods Regional process maps were developed in 4 pharmacies through simulation of the CB process, staff interviews and documentation of resources. Commonalities were collated to develop a process map for each HRM, which were used to explore variation during an exercise at a national programme event. A single, generic HRM Process Map was developed which underwent validation by case study testing. Results The findings allowed development of a single generic HRM process map, applicable to both warfarin and NSAID CB adoption. Five steps were identified as required for successful CB delivery: patient identification; clinical assessment; pharmacy CB prompt; CB delivery; and documentation. The generic HRM CB process map encompasses both the staff and patients' journey and the CB’s integration into routine community pharmacy practice. Pharmacist involvement was required only for clinical assessment, indicating suitability for whole-team involvement. Conclusions Understanding CB integration into routine practice has positive implications for successful implementation. The generic HRM process map generated in this study can be used to develop targeted resources, and/or be disseminated to facilitate CB delivery and foster whole team involvement within pharmacies. A similar methodology could be utilised within other settings, to allow those developing novel services to distill the key processes and consider their integration within routine workflows to effect maximal, efficient implementation and benefit to patient care.