Quality improvement project using a care bundle approach on the management of the immediate discharge document (IDD) within a single general practice.

The Scottish Patient Safety Programme in Primary Care (SPSP-PC) aims to improve the medicines reconciliation process in primary care to help reduce the number of adverse events causing avoidable harm. [1] The aim of this project is to improve the process for handling Immediate Discharge Documents (IDDs) in a single practice and develop a protocol using the care bundle approach. The care bundle consisted of: 1. Medicines reconciled and repeat prescription updated 2. Follow up documented 3. Diagnosis coded 4. Were all actions completed? A baseline audit was performed followed by three PDSA cycles. Interventions included: education at each cycle, decision that all Doctors would use the Medicines Reconciliation Polypharmacy LES template and constructing an electronic checklist for the care bundle. Compliance with the care bundle rose from 20% in the baseline measurement to 100% in PDSA cycles two and three. In conclusion, a protocol was developed for the processing of IDDs utilizing the care bundle approach with an electronic checklist, resulting in an improvement in the practice management of IDDs.