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EM Consultant’s Very Personal Commitment to RCEM’s Latest Quality Improvement Programme

6 November 2023

An Emergency Medicine Consultant, himself living with a life-changing illness, is the driving force behind a new Royal College of Emergency Medicine (RCEM) Quality Improvement Programme (QIP) which aims to make visits to A&Es safer for thousands of people every year.

Dr Jonny Acheson, who is an EM Consultant working in Leicester, has been living with Parkinson’s since being diagnosed in 2016.

His unique insight into Emergency Medicine and the needs of people with the condition – as well as his work with the charity Parkinson’s UK – led him to submit an idea for one RCEM’s three-year Quality Improvement Programmes – known as QIPs.

Each year the College runs a competition where it invites members to submit QIP topic ideas. And last year, that is exactly what Jonny did.

His submission focused on the topic of Time Critical Medications (TCM) in the Emergency Department. TCM are drugs which patients with certain conditions must receive at specific times. If they do not it can put them at risk.

Jonny’s QIP – launched today (6 November 2023) and backed by leading healthcare charity Parkinson’s UK – is aimed at examining how such medications are dealt with in practice when patients come to the Emergency Department, and how clinical methods and patient safety, can be improved.

Commenting on the launch of his new QIP, Jonny said: “I know what it feels like not to get your medication on time, within the NHS TCM is not a concept that is as well recognised or understood as it should be. This QIP is vital so we can ensure staff understand and are educated in the importance of Time Critical Medication. For example, many people don’t know the impact or risks that a 30-minute delay can have for a person with Parkinson’s.

“When I was first diagnosed, I found it difficult to treat a patient with Parkinson’s in the Emergency Department as I didn’t want to see how my symptoms may progress in the future but now I see that I have a responsibility to ensure that they are looked after as best as they can be when they are in our departments.”

Dr Rowan Wathes, Associate Director of Policy and Health Strategy at Parkinson’s UK, commented: “The majority of people with Parkinson’s don’t receive their medication on time, every time when they’re in hospital.

“Even short delays can cause stress, anxiety, immobility, severe tremors, and in some cases death. Parkinson’s UK is here to help healthcare professionals give great care and improve standards.

“If more people can be given or have access to their Parkinson’s medication on time, this should result in their improved health and wellbeing and shorter hospital stays. That’s why we’re delighted to be collaborating with the Royal College of Emergency Medicine on this very important quality improvement project.”

A comprehensive information pack about the TCM QIP is available, and from today NHS Trusts across the country will be able to sign up for the programme by completing a registration form.

The TCM QIP will be undertaken by a ‘Topic Team’ led by Jonny and will run from November to October 2026. It will focus on different types of TCMs each year and on the patient journey from arrival to departure. The first important date to consider for participants in the QIP is for data submission, which will run from November 2023 to October 2024 so can present their findings.

The QIP will also be collecting data for people living with Parkinson’s who take oral levodopa medication and for patients living with Diabetes Mellitus on subcutaneous insulin for the first year of the programme.

“Missing a dose of levodopa increases a patient’s length of stay and can cause them to have a poor outcome with little chance of them returning to their baseline,” added Jonny (pictured above). “The average time a person with Parkinson’s spends as an inpatient is four days longer than others, one of the reasons being that they didn’t receive their TCM when they needed them.

Jonny continued: “Can you imagine the anxiety and psychological harm of lying in a bed knowing the staff have your time critical medication and you have no idea when you are going to be given them as your tremor and stiffness worsen, your voice becomes weaker and the decline in your mobility increases your chances of falling?”

The programmes’ later years will look at medications used by people who have epilepsy, adrenal insufficiency, Diabetes Insipidus and those who need to take immunosuppressants.

In 2010, the National Patient Safety Agency (NPSA), issued an alert regarding the omission and delayed administration of medicines in hospitals, but despite trusts compiling lists and guidance and regularly auditing this there are still numerous incidents around delayed or omitted doses of TCM.

In 2011 The Institute for Safe Medication Practices defined TCM as: ‘Time Critical scheduled medications are those where early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm or result in substantial sub-optimal therapy or pharmacological effect.’

This has never been looked at nationally despite RCEM producing a safety alert in 2017 for people with Parkinson’s, IDDM, and Epilepsy on TCM.

Dr Ian Higginson, Vice President of RCEM, stated: “The topic of missed time critical medications has grown in importance in the context of crowding. It is something that worries our patients, who have had the need to take their medications regularly and on time impressed upon them by both healthcare professionals and personal experience.

“It is also a cause of avoidable harm. We would encourage organisations to register for this QIP and to have a look at their current practice, and any improvements that can be made. This is something we can influence, and which matters.”

Johnny concluded: “I am so pleased that the vision for TCM is now a national QIP. Emergency Departments are busy places, with this project we have a real opportunity to improve the quality of care that people with Parkinson’s receive.

“I believe that the solutions are not difficult to implement, they just need some planning which will give people a chance to get home where they belong at their baseline. Being part of that journey as a clinician has to be a good thing so get registering and watch how your Emergency Department goes from strength to strength for all patients on TCM.”

Find out more about RCEM’s previous and current QIPs, and details about the next QIP competition.

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