A template approach to quality improvement activity: a primary care example

Abstract

Introduction. This paper demonstrates the use of a Quality Framework and Implementation Template to review processes for improving the quality and safety of opiate prescribing for chronic non-malignant pain (CNMP). Escalating use of prescription opiates for chronic pain is of national and international concern, with major implications for personal and public health as well as for patient safety and health service quality and safety. Objectives. This paper uses opiate prescribing for CNMP as a worked example to illustrate use of the Quality Framework for self-directed quality improvement in smaller specialist medical or community-based practices. Methods. An Implementation Template, comprising a series of focussed questions derived from the Quality Framework, was applied to one specific quality improvement activity arising from clinical practice (opiate prescribing for CNMP). This helped the practice team understand current systems and processes, identify actual and potential problems, and find possible solutions to institute interventions for change. Conclusion. The template approach to quality activity is very applicable within smaller specialist or community health service settings, enabling such health services to focus on their own quality improvement activities and address topics of importance to the practice in a systematic and productive manner. What is known about the topic? There are complex interactions and activities to be considered when undertaking quality improvement within community practice. Repeat opiate prescribing for CNMP is a significant issue for practices and patients. What does this paper add? This paper examines the specific case of improvements to quality and safety of repeat prescribing of opiates for CNMP in small clinics and other community-based health services. This example shows how users may utilise an Implementation Template to perform a systematic and comprehensive review of their systems and processes in relation to any chosen aspect of practice-based quality improvement activity. Services could apply these same principles to any topic of interest, or practice and/or organisational activity, to undertake systematic quality improvement. What are the implications for practitioners? The Implementation Template was designed for use by clinical practice teams. It will be helpful for practices that wish to undertake a quality improvement activity but lack the knowledge of how to proceed. Use of the template approach provides practice teams with the means to ensure that they consider the area of concern from all angles, and helps to uncover areas that might not otherwise have been considered.