BMJ Open Quality最新文献

{"title":"Leveraging a multifaceted digital medication refill system on improving patients' medication adherence and reducing medication oversupply among elderly patients with hypertension.","authors":"Bushra Al Mubarak, Lamiaa Nehad Elmasry, Matuk Qoronfulah, Bodour AlOtaibi, Muhammad Hasan Abid, Dakhelullah AlOsaimy, Ammar Hawsawi, Faris AlShehri","doi":"10.1136/bmjoq-2024-002840","DOIUrl":"10.1136/bmjoq-2024-002840","url":null,"abstract":"<p><p>The COVID-19 pandemic has disrupted healthcare, causing challenges in managing chronic diseases like hypertension. Al-Hada Armed Forces Hospital's Pharmaceutical Care Department aims to provide safe, efficient, and effective medication refills for elderly patients pre-and post the pandemic. An improvement project was conducted at Al-Hada Armed Forces tertiary hospital to enhance medication refill processes and adherence among elderly patients with hypertension. Data on medication adherence, including refill cycle times and factors contributing to longer cycles, were collected through the Hospital Information System. The Institute for Healthcare Improvement Model for Improvement guided a study to implement a digital medication refill system. Pre-intervention and post-intervention analyses demonstrated the effectiveness of the digital system in improving medication refill processes for elderly patients with hypertension. We improved the medication refill process, reducing wait times from 40 to 5 minutes by 2022. Our system monitored medication adherence and oversupply, and it also utilized features like delivery services, online medication refills, the Tebtom system and SMS reminders. Tebtom system is an Arabic term that means 'get well soon' in English. The system includes a variety of services, such as obtaining a waiting number for upcoming appointments within 30 minutes, booking appointments, accessing medical reports, laboratory results, radiology requests, and refilling medications. The study showed a significant improvement in refill duration. Medication adherence increased from 35% to 79% with timely reminders, fewer missed doses and increased coverage of medication days. Patient medication oversupply decreased from 50% to 19%, and the system improved communication and refill convenience. A successful quality improvement method has significantly impacted our medication refill system, the effectiveness of message reminders, and patient safety through ensuring compliance with medications and reducing oversupply. During COVID-19, the digital system played a crucial role in maintaining medication access. This project highlights the positive impact of a digital refill system on efficiency and reducing medication oversupply among elderly patients with hypertension before and after the pandemic.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing unplanned medical intensive care unit admissions by the critical care outreach team: a quality improvement report.","authors":"Jiaqing Xiong, Sandra Hui, Khaing Zin That, Sheena Ng, Mashithah Mansor, Cheryl Ho, Kangqi Ng","doi":"10.1136/bmjoq-2024-003288","DOIUrl":"10.1136/bmjoq-2024-003288","url":null,"abstract":"<p><p>Unplanned admissions to the intensive care unit (ICU) are frequently associated with an increased risk of hospital mortality, greater severity of illness and extended hospital stay. A leading cause of unplanned ICU admission is delayed recognition of a deteriorating patient. The aim of the project was to reduce the rate of unplanned medical ICU admissions by implementing an active surveillance programme through proactive rounding.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement project to routinely identify sensory and eating challenges in childhood neurodevelopmental movement disorders.","authors":"Sandra-Eve Bamigbade, Sara Sopena, Tammy Hedderly, Osman Malik, Tamsin Owen, Amanda K Ludlow","doi":"10.1136/bmjoq-2024-002919","DOIUrl":"10.1136/bmjoq-2024-002919","url":null,"abstract":"<p><p>Sensory, eating and mealtime (SEM) challenges are common among young people with neurodevelopmental movement disorders but are rarely assessed during initial clinical consultations. This quality improvement project aimed to evaluate the impact of routine SEM screening on identifying these challenges and improving documentation and follow-up in a specialist paediatric movement disorder clinic in England. Using the SHIFT-Evidence Framework and a Plan-Do-Study-Act approach, the project implemented and evaluated a series of interventions. In the <b>'PLAN'</b> phase, clinicians participated in a workshop to raise awareness of SEM challenges and inform the development of screening questions to support routine SEM assessment. The <b>'DO'</b> phase involved implementing routine SEM screening during a 3 month trial, supported by active measures such as project champions, weekly reminders and team discussions to encourage sustained practice. The <b>'STUDY'</b> phase included analysis of assessment outcome letters from three time points (baseline, trial and outcome retention phases) to evaluate changes in documentation and the sustainability of improvements. In the <b>'ACT'</b> phase, findings were shared with the team, resulting in improved signposting, targeted recommendations and ongoing collaborations with feeding clinics. Findings demonstrated increased documentation of SEM challenges in assessment letters, with mentions rising from 33% at baseline to 71.9% during the trial and 64.3% in the retention phase. However, actionable recommendations and interventions remained limited during the trial but showed improvement in the retention phase, where letters included more tailored guidance and specific advice for SEM challenges. This project highlights the prevalence of SEM challenges among young people with neurodevelopmental movement disorders and underscores the importance of routine SEM screening. Developing standardised assessment tools and protocols could further aid clinicians in identifying and addressing these challenges during initial assessments.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of home blood pressure monitoring in preoperative anaesthesia assessment clinic.","authors":"Xinyan Zhang, Shuhuei Neo, Avinash Gobindram, Xuan Han Koh, Anne S C Kiew, Eeteng Ong","doi":"10.1136/bmjoq-2024-003097","DOIUrl":"10.1136/bmjoq-2024-003097","url":null,"abstract":"<p><p>Elevated preoperative blood pressure (BP) is a common problem and often results in late surgery cancellation and wastage of theatre resources. High BP readings in the preoperative anaesthetic assessment clinic (PAAC) could be the result of the white coat effect (WCE) and may not reflect patients' baseline BP. A preliminary audit conducted in our hospital revealed a significant number of unnecessary referrals to the general practitioners (GPs) and the emergency department (ED) based on high BP readings in PAAC alone.This study aimed to determine the prevalence of WCE in elective surgical patients and develop a workflow to reduce unnecessary referrals and case cancellations.A multidisciplinary team established a new hypertension workflow by introducing home BP monitoring and involving internal medicine specialists in perioperative care. 214 patients with clinic BP higher than 160/90 mm Hg in PAAC were recruited. They were instructed to check their home BP twice a day with a machine on loan from PAAC and seek medical assistance if their home BP exceeded 160/90 mm Hg. WCE was diagnosed when the discrepancy between the average clinic BP and home BP exceeded 20/10 mm Hg.WCE was observed in 92.1% of patients (162/176, 95% CI 87.0 to 95.6) and 57.4% of those with WCE (57.4%, 95% CI 49.7 to 64.8) had normal home BP measurement. None of the patients had surgery cancelled due to high BP readings on the day of the operation, and the number of unnecessary GP/ED referrals was significantly reduced after implementation of the new workflow.The comprehensive perioperative workflow using home BP monitoring offers an effective and feasible method to detect WCE. This approach has saved healthcare resources and improved patient satisfaction.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Quality Improvement to improve serious incident reporting in the English NHS.","authors":"Carlos Santos, Abiola Ajayi-Obe, Marco Aurelio","doi":"10.1136/bmjoq-2024-003234","DOIUrl":"10.1136/bmjoq-2024-003234","url":null,"abstract":"<p><strong>Background: </strong>Timely completion of serious incident reports is crucial for patient safety and regulatory compliance. Delays hinder organisational learning and compromise patient outcomes. Between May 2021 and April 2022, East London NHS Foundation Trust (ELFT), a provider of mental health, community health and primary care services to approximately 1.8 million people across London and Bedfordshire, faced a significant backlog of serious incident reports. Completion times averaged 208 days-well beyond the 60-day target set by NHS England at the time.</p><p><strong>Methods: </strong>A quality improvement (QI) initiative employing structured methodologies, including the ELFT Sequence of Improvement, statistical process control, Ishikawa analysis, a driver diagram and plan-do-study-act cycles to diagnose and address process inefficiencies.</p><p><strong>Interventions: </strong>Three main change ideas were tested and implemented: concise reporting templates to streamline documentation, a caseload tracker for real-time monitoring and team escalation meetings to improve communication and accountability.</p><p><strong>Results: </strong>These interventions led to a 65% reduction in average completion time, decreasing from 208 days to 74 days. Additionally, staff collaboration and workflow efficiency improved, fostering a culture of continuous improvement, continuous learning and accountability.</p><p><strong>Conclusions: </strong>This project demonstrates the effectiveness of structured QI methodologies in improving serious incident reporting. The implemented changes are sustainable and provide a scalable model for other healthcare organisations aiming to enhance patient safety and compliance. Future work will focus on embedding these improvements into routine practice and exploring their impact on broader organisational learning.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthesiologists' Non-Technical Skills in Denmark Form: cross-cultural adaptation, reliability and validity of Turkish version in paediatric surgery team.","authors":"Nazmiye Celik, Senay Sarmasoglu Kilikcier, Gulsen Tasdelen Teker, Gulsen Keskin, Mine Akın, Sengul Ozmert, Melih Elcin, Emrah Senel","doi":"10.1136/bmjoq-2024-003249","DOIUrl":"10.1136/bmjoq-2024-003249","url":null,"abstract":"<p><strong>Background: </strong>The Anaesthesiologists' Non-Technical Skills in Denmark Form (ANTSdk) is a widely accepted, practical, and comprehensive measurement tool used by anaesthesiologists and other healthcare professionals. This study aims to adapt the ANTSdk into Turkish as a valid and reliable assessment instrument. By doing so, it will contribute to establishing a common language and standardised terminology for integrating non-technical skills into the Turkish healthcare system.</p><p><strong>Methods: </strong>We conducted a standardised cross-cultural adaptation process. The psychometric properties of the Turkish-adapted version of the ANTSdk were evaluated through observations of 81 real paediatric surgical operating room teams, assessed simultaneously by two independent observers. Validity was examined using content validity analysis and confirmatory factor analysis. Internal consistency and inter-rater reliability of the Turkish version of ANTSdk (ANTStr) were also assessed.</p><p><strong>Results: </strong>The specified factorial model retained the same grouping of elements into four domains as in the original version of ANTSdk. All standardised factor loadings were greater than 0.3. The inter-rater reliability, measured by the intraclass correlation coefficient of the global score, was 0.98. The Cronbach's alpha coefficient for the scores provided by the first rater ranged from 0.83 to 0.94, while for the second rater, it ranged from 0.84 to 0.94. The generalisability coefficient calculated for ANTStr was exceptionally high at 0.96.</p><p><strong>Conclusion: </strong>The Turkish version of ANTSdk demonstrates strong psychometric properties for evaluating paediatric surgical team performance in the operating room. This translated instrument can be used to assess non-technical skills in paediatric surgical teams within real clinical settings, facilitating benchmarking and international collaboration.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delphi analysis of how the practice team should organise event analysis in primary care.","authors":"Karena Hanley, Duncan McNab, Paul Bowie, Alexia Pellowe, Veronica Rainey","doi":"10.1136/bmjoq-2024-003282","DOIUrl":"10.1136/bmjoq-2024-003282","url":null,"abstract":"<p><strong>Introduction: </strong>Significant event analysis is a common quality improvement activity in UK general practice (GP). How well do general practice (GP) teams conduct their analyses? There is little guidance and no measuring tool. This is a Delphi analysis among Scottish multidisciplinary primary care team members to establish a set of quality indicators by which practices can self-assess their practice processes in conducting their event analyses.</p><p><strong>Methods: </strong>A Delphi method specifically for identifying quality indicators in healthcare was used. Purposeful selection was of primary care team members with known experience of significant event analysis; informed participants. After setting a consensus score, 29 items for the first round Delphi survey, drawn from the literature, were sent out with the ability to comment on each. The second Delphi round contained those items which had passed the consensus score, the aggregated comments on those items and any suggestions for new items.</p><p><strong>Results: </strong>Of 24 informed participants approached, 10 (37.5%) agreed to undertake the full cycle of the Delphi process. 17 items from the first Delphi survey passed the consensus score with one additional item suggested. With the amalgamation of items, 16 statements were presented in the second Delphi, of which 15 passed the consensus score.</p><p><strong>Conclusions: </strong>Learnings from our Delphi are that practitioners prefer the term 'learning event analysis' to 'significant event analysis', and that practice nurses may need specific encouragement to become more involved in event analysis. There is reluctance to involve patients or patient representatives in the event analysis itself. Engagement in well-conducted event analysis strengthens the whole practice team.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a multicomponent intervention including clinical decision support (CDS), e-course and feedback to improve general practitioners' radiology referrals: a feasibility study and study protocol.","authors":"Aslak Bjarne Aslaksen, Mia Louise Halsvik Mowinckel-Nilsen, Stefán Hjörleifsson, Nicolas Melchior Frederic Øyane, Satya Pal Sharma, Erik Vang, Miriam Hartveit, Stig Harthug","doi":"10.1136/bmjoq-2024-003256","DOIUrl":"10.1136/bmjoq-2024-003256","url":null,"abstract":"<p><strong>Introduction: </strong>Overuse of high-cost imaging like MRI and CT scans is a growing concern, with 4-100% of examinations deemed of low value. This contributes to unnecessary healthcare costs and patient risks such as overdiagnosis. Norwegian general practitioners (GPs) demonstrate variable referral practices, with many referrals being inconsistent with guidelines. The study aimed to evaluate the feasibility and usability of 'VeRaVest,' a multicomponent intervention targeting improved radiology referral practices among GPs in Western Norway.</p><p><strong>Methods: </strong>The intervention combined three elements: (1) referral guidelines integrated into electronic systems, (2) group-based courses on guideline compliance using quality improvement principles and (3) a web-based feedback system. The study was conducted with 139 GPs recruited in two cohorts in 2023, evaluated using a step-wedge design. Data sources included qualitative feedback from GPs and quantitative measures like referral completion rates. Participants' referral data were anonymised and analysed using a PACS/RIS (Pictures Archive and Communications System/Radiology Information System) system.</p><p><strong>Results: </strong>Preliminary results indicate high GP satisfaction with the intervention. About 76% of participants reported changes in referral practices, including improved indication assessments, better referral descriptions and enhanced patient communication. GPs emphasised the importance of accessible guidelines, peer-based learning and actionable feedback. Integration of decision support tools and guideline-based training was pivotal in aligning practices with national standards.</p><p><strong>Discussion: </strong>The multicomponent VeRaVest intervention demonstrated feasibility and potential to reduce low-value imaging practices. Success hinged on embedding guidelines into workflows, fostering peer engagement and ensuring practical relevance. Future evaluations will focus on quantitative outcomes, including referral rates and quality. Findings suggest scalability to other healthcare settings and regions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling team needs: a qualitative study of simulation training for endovascular cerebral thrombectomy.","authors":"Caroline Guldberg Fugelli, Britt Sætre Hansen, Hege Ersdal, Martin Kurz","doi":"10.1136/bmjoq-2024-002981","DOIUrl":"10.1136/bmjoq-2024-002981","url":null,"abstract":"<p><strong>Background: </strong>Effective multidisciplinary teamwork is crucial for successful endovascular thrombectomy (EVT) treatment, a critical stroke intervention classified as a non-operating room anaesthesia (NORA) procedure. Our hospital incorporated EVT training into regular stroke simulation training. This study aimed to investigate team members' experiences of simulation training in preparation for clinical EVT, including how the training and related clinical procedures could be improved to address their identified needs.</p><p><strong>Methods: </strong>Six focus group interviews (one anaesthesia-only professional, five mixed healthcare professionals) were conducted with a purposeful sample of EVT team members. The data were analysed using inductive qualitative content analysis.</p><p><strong>Results: </strong>EVT team members considered simulation training an essential introduction to the clinical procedure, particularly for familiarisation with the angio suite, equipment, team roles and communication. However, they reported that the simulation did not prepare them for challenges inherent to NORA procedures encountered during clinical EVT. These included managing multidisciplinary task interactions, maintaining haemodynamic and respiratory stability, and working within spatial and access constraints. Consequently, the experience of disorganised teamwork persisted in clinical EVT. The team members reported a lack of shared understanding of roles, responsibilities and communication expectations, particularly between anaesthesia professionals and other team members. This contributed to unfamiliarity with team dynamics and workflow. The clinical EVT team leader inconsistently facilitated collaboration, impacting team communication and effectiveness. The participants proposed modifications to the simulation training and clinical procedure to address these issues.</p><p><strong>Conclusions: </strong>Our study highlights the need to incorporate the multidisciplinary challenges of NORA procedures into EVT simulation training, emphasising active input from all professional groups involved in the EVT team, particularly anaesthesia. Practical recommendations for planning and implementing such simulation training are proposed.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the rates of inpatient HbA_1c assessment and medication deintensification in people with diabetes and frailty.","authors":"Ali Kareem, Hnin Lwin, Mohamed Fazil, Anu Thomas, Kevin Thottungal, Garima Gupta, Kashish Gera, Jawad Malik, Htet Lynn, Vishnusankar Umasankar, HayMar Tun, Aung Myo Naing, Sadaf Saeed, Meri Davitadze, Eka Melson, Alison Gallagher, Kath Higgins","doi":"10.1136/bmjoq-2024-003223","DOIUrl":"10.1136/bmjoq-2024-003223","url":null,"abstract":"<p><strong>Background: </strong>Intensive glucose management in people with diabetes and frailty presents significant risk which outweighs potential benefit. Hospital admission presents an opportunity for interventions that may reduce the impact of overtreatment in people with diabetes and frailty. Our previous study has shown low rates of glycated haemoglobin(HbA_1c) assessment and inpatient medication deintensification in people with diabetes and frailty.</p><p><strong>Methods: </strong>We conducted a three-intervention quality improvement programme and studied the effectiveness of the interventions aiming to improve the inpatient HbA_1c assessment and management of inpatients with diabetes and frailty. A baseline assessment was conducted prior to cycles 1 and 2, with another audit conducted post-cycles 1 and 2. A further audit was then carried out with another audit post-cycle 3.</p><p><strong>Interventions: </strong>Interventions 1 and 2 involved publishing an infographic to aid assessment and medication deintensification in patients with diabetes and frailty, followed by spreading awareness among resident doctors of the baseline audit results and the infographic via email and WhatsApp groups. Intervention 3 involved allocating 'Diafrailty Champion' the medical wards to help improve the assessment and management of patients with diabetes and frailty.</p><p><strong>Results: </strong>A total of 291 patients with diabetes and moderate-severe frailty were included in our audits (96 patients in baseline audit, 102 post-cycles 1 and 2 audit, 92 post-cycle 3 'Diafrailty Champion' audit). Improvements were observed for the rates of HbA_1c assessment and deintensification in the post-interventions 1 and 2 audit, and these persisted following the introduction of 'Diafrailty Champion'.</p><p><strong>Conclusions: </strong>Interventions that included raising awareness of the inpatient assessment and management of people with diabetes and frailty were successful in improving inpatient HbA_1c assessment and deintensification rates. The improved HbA_1c assessment and deintensification rates persist following the engagement of a resident doctor 'Diafrailty Champion'.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}