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  • A qualitative study exploring how routinely collected Medication Safety Thermometer data have been used for quality improvement purposes using case studies from three UK hospitals

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Qualitative research
Research
A qualitative study exploring how routinely collected Medication Safety Thermometer data have been used for quality improvement purposes using case studies from three UK hospitals
  1. Paryaneh Rostami1,
  2. Abigail Harrison2,
  3. Gareth Parry3,4,
  4. Darren Ashcroft1,5,
  5. Mary P Tully1
  1. 1 Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester School of Health Sciences, Manchester, UK
  2. 2 Salford Royal Foundation Trust, Haelo, Salford, UK
  3. 3 Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  4. 4 Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Greater Manchester Patient Safety Translational Research Centre, National Institute for Health Research, Manchester, UK
  1. Correspondence to Paryaneh Rostami; P.Rostami{at}nhs.net

Abstract

Objectives The Medication Safety Thermometer (MedsST) is a medication safety data collection tool, which has been used by over 100 UK healthcare organisations to enable measurement of medication safety for improvement purposes. This study aimed to explore whether, and how, data collected by the MedsST have been used in organisations to facilitate medication safety improvements.

Design Routine MedsST data collected between October 2013 and July 2016 were analysed using Run charts. Identified changes were investigated using interviews with staff from each hospital trust. The interviews were analysed using a framework based on Normalisation Process Theory, focusing on use of the MedsST and its data.

Setting Three National Health Service hospital trusts in the North West of England, which have used the MedsST for the longest period.

Participants Eight interview participants, purposely sampled based on their involvement with the MedsST, included pharmacists, pharmacy technicians and nurses.

Results Improvement was often at ward level and focused on particular areas of medication safety, led by clinical champions. The most sustainable improvements involved changes to systems, such as introducing new guidelines. Although some improvement occurred, internal communication about improvements was poor, and large amounts of data remained unused, often due to a lack of ownership of data review and use.

Conclusions Simply collecting data is not sufficient; a system of data collection, review and use for improvement is required. Issues with such systems may have been recognised and averted if implementation theory had been used in the early stages of national development and implementation. However, implementation theory could be used within organisations to fix issues locally, particularly to increase ward-level ownership of this system, which could lead to considerable improvements.

  • medication safety
  • quality improvement
  • patient safety
  • measurement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-025292

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    Footnotes

    • Contributors All authors have made substantial contributions to the conception or design of the work and have been involved in acquiring, analysing or interpreting the data. All authors have been active in drafting, critically reviewing and revising the manuscript and have approved the final version to be published. Concept: all authors. Data collection: PR. Data analysis: PR, MPT, DA and AH. Article drafting: PR, MPT, DA and GP. Critical revision: all authors.

    • Funding PR is a PhD student funded by Haelo.

    • Competing interests The main author (PR) is a PhD student funded by Haelo who previously facilitated and managed the development of the MedsST. However, PR was predominantly based at and supported by University of Manchester.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The MedsST data for all organisations, which have been referred to in this study, are available online (www.safetythermometer.nhs.uk). To access a dedicated dashboard presenting the data in graphical format, the ’Medication' tab must be selected, followed by the ’analyse data' button. Since this study was conducted, management of the MedsST data has been transferred from Haelo to the Quality Observatory team at South, Central and West Commissioning Support Unit on behalf of National Health Service Improvement, who can be contacted for more recent raw data. In terms of qualitative data, short interview excerpts are available within the text. Participants in our in-depth interviews consented to participate in the study. which stated that identifying information would remain confidential. However, they did not provide consent to have their full interview notes made publicly available, which would potentially lead to identification of participants and their organisations. Many of the quotes used have been amended with ellipsis (…) to remove the identifiable data.

    • Patient consent for publication Not required.