By Eilidh G M Gunn, Medical Student, University of Dundee, Scotland

As final-year medical students at the University of Dundee, Scotland, we are lucky enough to have the opportunity to undertake the IHI program as part of a month-long block surrounding patient safety and quality improvement. Ninewells Hospital and NHS Tayside, the trust where I am based, has longstanding patient safety and quality improvement initiatives and programs in place, which allow students like myself to become part of this well-established network and undertake our own quality improvement projects using the IHI framework.

I selected this month-long placement, which is run by Professors Peter Davey and Vicki Tully, because I heard positive feedback about it from colleagues. Additionally, during the course of my clinical placements in 4th year, I recognized the role of patient safety and the significant improvement that could occur on a ward through implementing relatively small changes. This interested and intrigued me as the main body of research I had contributed to in the past was clinical in nature, and I wanted to understand the ethos of the IHI program further.

My project partner, Ellie, and I worked together on a project based on the Acute Surgical Receiving Unit, as surgery where my personal interest lies and she was easy going! Our project was centered around "medication reconciliation," the process by which the patient's current medications are identified on acute admission to the ward. This process wasn’t working well and led to prescribing errors in the past. Improving medication reconciliation is also part of national patient safety initiative, so this made finding a supervisor and establishing realistic measures within the time frame far easier.

I found it surprising how swiftly everything came together and how quickly we were completing our first PDSA cycles. But I found it harder to adapt to this method of improvement than first imagined. Due to my previous background in research, I kept looking for tight fixed aims, inclusion and exclusion criteria with in depth statistical analysis. (This was probably driving Ellie mad, as she had done previous improvement work.) It was not until I began to run through the IHI online courses that I realized that I was completely missing the aim behind quality improvement and that it was specifically designed the way it was to allow for rapid change and analysis so that positive changes could be swiftly implemented. (This is something which could not happen using traditional clinical research methodology.)

I found it rewarding that our results came so quickly and that we could progress forward, and make further amendments and changes in an attempt to improve medication reconciliation on the ward. Through this time, I continued with the online courses. At times, I found them a little laborious, but highly accessible. They made the principles of quality improvement and patient safety clear and digestible. I found that they especially helped when it came to completing and submitting the Practicum module. (I am just awaiting the final approval as I write this.)

We must have completed endless PDSA cycles in our project, which despite our best efforts to improve the process and checklist behind medication reconciliation, didn’t result in improvement. We were miles away from achieving our outcome measure, which although disheartening in some ways, was also a great learning experience and highlighted the multiple human factors and system errors that were combining with the ward culture to result in this longstanding problem. Using the PSDA cycle reports and driver diagrams helped to emphasize where the issues lay and what we could do in the future in attempt to further improve medicines medication reconciliation on the ASRU. I hope to use the knowledge I gained during this month — and through completing the IHI courses — in the future as a junior doctor and continue with quality improvement projects on the wards I am based.

Finally, through the project work we had done, Ellie and I earned a poster presentation slot at the Scottish Safety Programme Regional Meeting in Dundee at the start of March. By attending, I was able to share the skills I had learned during the month through helping to facilitate and interactive Learning Loops session and discussing my experiences with the other delegates. I believe this is one of the most attractive aspects of the IHI program: Through joining, you are instantly part of a global community, and can discuss your projects and issues that may arise with people from all health care professions from around the world.