Improvement Stories
Sharing how we are improving our services and the care we provide is an important part of our improvement work at Nottinghamshire Healthcare.
You can read some of our improvement stories below delivered by our colleagues and see how patients, their families and carers play an important part in quality improvement bringing their experience and knowledge to address what matters to them most leading to more meaningful and effective change.
Psychotropic Medication in Children and Young People’s Mental Health In-patient Services
The idea
The CAMHS Inpatient Service wanted to implement their idea under the QI programme to understand psychotropic medication* prescribing, 'as required' (PRN) prescribing, the extent of polypharmacy (taking multiple medications concurrently), the views of children and young people and parents/carers about the prescribing in CAMHS and the medication information and support they receive.
They also wanted to compare their prescribing with that of other young people's mental health services and where possible those with a similar population and function.
It was important for the team to be able to reflect on the findings relating to CAMHS and wherever possible, benchmark similar services as well as develop a quality improvement psychotropic medication action plan.
*Psychotropic medication prescribing is the process where a qualified healthcare professional, usually a psychiatrist or other medical doctor, assesses a patient's mental health condition and determines if medication is an appropriate treatment.
The aim of implementing this project was to:
encourage prescribers to reflect on their prescribing habits and whether they are following national guidelines.
promote the de-prescribing of psychotropic medication.
provide patients, relatives and carers with a platform to explain how they feel about the prescribing in CAMHS, and the medication information and support they receive.
enable CAMHS to identify where improvements can be made and develop achievable action plans.
The service used online questionnaires to gain the views and experiences of the children and young people staying in the unit and the views of their parent or carers about their child's medication. An online medication census tool was also completed by clinicians to capture prescribing practices around psychotropic medication
The actions achieved from the QI project were:
Pegasus ward plan to re-do the medication census, as the ward consultant felt the ward was unusually quiet when the initial census took place, and it was not representative of what Pegasus ward is usually like.
Weekly pharmacy education sessions, followed by 1:1 medication counselling on request, will restart on Hercules and Phoenix ward.
Pharmacy and medics will develop a leaflet to be given to parents/carers on admission explaining: the process of prescribing medications for young people, off-label use, who they can speak to about medications on the ward, how to access advice and signposting to reputable sources of information.
Hercules ward consultant will ensure they provide patient information leaflets to parents/carers for PRN medications.
The Hercules consultant and ward manager plan to review their parent/carer and young person feedback process going forward.
Reflecting on the QI project, Katie Burton said:
The QI project helped us to reflect on our prescribing practices, where we are doing well and how we can improve. It gave patients and parents/carers an opportunity to express how they feel about the prescribing in our service and the medication information they receive. The QI process encouraged the whole team to reflect on our approach to prescribing and providing medication information to patients and parents/carers. This enabled us to develop an effective action plan that targets different topics, such as prescribing and medication information, in different ways and settings.
The action plan involves different staff groups across all the CAMHS wards including consultants, activity co-ordinators and pharmacy technicians. This means we are all working together to make improvements across the service.
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