QI In Action: Mental Health Virtual Clinical Pharmacy Service (VCPS) Project

Get Inspiration for the QI Awards from 2022 Winner, Hunter New England Health District and learn about the continued success of their project one year on from winning the Awards.

The QI Awards are an annual recognition of achievement and encouragement for quality improvement activities, programs or strategies that have been implemented into healthcare organisations. The Awards provide an opportunity to share patient-focused innovation and communicate their quality improvement achievements to the healthcare industry.  

Read and be inspired by The Healthcare Measurement Award Winner 2022, Hunter New England Local Health District’s winning project that addressed significant gaps in medication management practices in three remote mental health units in their ‘Virtual Clinical Pharmacy Service Project – Mental Health’.  

Background: 

The most common therapeutic intervention in Australian hospitals is the use of medicines* (Source: CEC). This intervention is also one of the most complex, and can therefore result in a higher incidence of errors and adverse events. Hospital pharmacists are instrumental in ensuring safe and appropriate medication use and engage in a variety of processes to be able to control this. 

Transitions of care and discharge have been highlighted as a time of increased risk of medication errors and readmission due to medication issues. Studies have shown that when there is involvement of clinical pharmacists in these steps, there is a significant reduction in medication error or risk of error, which can consequently reduce the number of Emergency Department (ED) presentations and hospital readmissions (Duguid, 2012; Mekonnen et al, 2016; Pronovost et al, 2003; Ravn-Nielsen et al, 2018; Tong et al, 2017). 

The Hunter New England Mental Health Service (HNE MHS) includes three Mental Health (MH) units based in Tamworth, Taree, and Maitland Hospitals. These units house 70 adult acute psychiatric beds and the onsite hospital pharmacies at these sites fulfil a medication supply function only for mental health (MH) inpatients. The lack of clinical pharmacy services at these locations has been highlighted in gap analysis reports for many years. 
 

Project Summary: 

The Hunter New England (HNE) Mater MH Pharmacy service received funding for a pharmacist at 0.4 FTE to set up a Virtual Clinical Pharmacy Service (VCPS) for the three MH units in Tamworth, Taree, and Maitland. The model of care was designed to provide a high-quality, accessible, and sustainable virtual pharmacy service to these rural and remote communities that did not already have access to these specialist services. 

Three MH pharmacists became part of the multi-disciplinary team (MDT) by attending meetings virtually. The virtual nature of the project allowed these experienced practitioners to be involved across all three sites with oversight provided by the MH Director of Pharmacy, ensuring continuity of care. 

The MH pharmacists key supporting tasks were: 

• Obtaining best possible patient medication histories 

• Reconciling medications on admission 

• Allergy and adverse drug reaction documentation 

• Regular MDT ward round virtual attendance 

• Provision of medicines information and prescribing guidance 

• Dosing and administration advice 

• Medication reviews 

• Patient counselling 

• Discharge medication reconciliation 

Following MDT meetings, pharmacists provided clinical advice with clear actions for doctors to follow, resulting in immediate actions that are trackable and measurable. The use of CAP, MedChart, and treatment summaries allowed records of these interventions to be accurately assessed.  

One year on: 

Ms Cecilia Bjorksten, Director of Pharmacy at the HNE MHS, had some exciting updates to share with the team at ACHS. Speaking recently on the impact of the service 12 months later – “The Virtual Clinical Pharmacy Service (VCPS) continues to be a great success, achieving sustained improvements in service delivery to rural sites. It has been permanently funded since July 2022, with an extra day per week funded from July 2023 and the project's scope has increased to support 7 Mental Health (MH) teams across 3 sites.” 

The positive outcomes of the service are continuing to be recognised, as Cecilia mentions, “The VCPS team has recently compiled a further 12 months of data to 30/6/23, which we were invited to submit for the 2023 NSW Premier’s Awards. The team was also recently interviewed for a NSW Health Awards story ‘Virtual pharmacy a reality in reconnecting mental health patients’, after winning the 2022 NSW Health Award for Excellence in the Provision of Mental Health Services. This VCPS project has strengthened our relationship with the rural mental health teams, with very fortuitous timing, as it has also enabled a more streamlined rollout of the NSW medicines formulary across all HNE mental health units this month.” 

The MH pharmacists involved in this work have cited that it has allowed them to grow in their roles, and that the virtual engagement with rural doctors has built rapport, cohesion, and trust within the MDTs they support. The positive outcomes of the VCPS continue to show those involved just how much can be done via virtual care. 

Source: HNELHD

Awards experience and success: 

Ms Bjorksten on the experience of the ACHS QI Awards – “Winning the ACHS QI award for Healthcare Measurement in 2022 was a fantastic and inspirational experience for VCPS team members. There was so much energy and sense of achievement and motivation in the room at the awards evening, which was really encouraging for taking on projects in the future. It was a great opportunity to see what health professionals can do at all stages of their career and great to see all of the other projects first-hand. It also increased the pharmacy team's understanding of how valuable collecting data can be, which has enabled us to demonstrate ‘proof of concept’ and show that this can work for allied health teams in Mental Health.” 

The ACHS QI Awards continue to highlight great innovations in safety and quality in healthcare. It is inspirational to see the continued success of those projects that enter the awards continuing, and the positive experience motivates those that enter, validating the life-changing work they’re engaged in.  

Read the full project submission here.
 

Do you have a quality improvement project to showcase? 
 
If you have implemented a quality improvement activity in the last two years you may be eligible to enter this years’ QI Awards.  
 
Apply now and get national recognition for your improvement initiatives.   

Submissions close on Friday, 8 September 2023 at 5pm (AEST).