Pill cases and Quality Improvement

Pill cases and Quality Improvement

by: Justin Vandergrift

I have been Levine Children’s Hospital’s ImproveCareNow parent representative for nearly 18 months. Over this time I have heard many mentions of quality improvement work (QI) and the effects it has on care processes and outcomes. I have seen numerous run charts and listened to presentations on how QI work is changing—and will continue to change—the future of care for kids just like mine.

All of these concepts are big picture; they can feel like they are detached from the day-to-day and there is a lot of “lingo” involved. It can feel somewhat overwhelming. Most of the parents I speak with are focused on the healthcare of one—their child. Their needs are immediate, tangible, seemingly micro and extremely focused. Their voices are soft, even muted, and sometimes get lost in the machine that healthcare can become.

But by working with my care center, I have seen how much we can accomplish – simply by working together and trusting each other. There is one turning point I still remember that makes me beam with pride; it remains one the most significant things my child’s care team and I have done together.

On a routine call with the center’s Nurse Practitioner and ImproveCareNow coordinator, Ryan Shonce, I heard her frustration with a family’s experience dealing with a prednisone taper. Prednisone is a steroid sometimes used for initial treatment of IBD; the immediate effects of the drug are magical. It has the ability to quickly force relief; however sustained use creates a multitude of issues. The most severe side effect of the drug can be the development of osteoporosis as calcium stores in the bones are depleted quickly. When it must be used, it is best used quickly and discontinued. When the drug is removed from treatment, the patient is typically tapered off over several weeks.

(Indeed, a key goal for all ImproveCareNow centers is to reduce the proportion of patients that are taking prednisone and to strive for prednisone-free remission.)

The patient Ryan described was on their fourth taper attempt. The family was struggling to make the process work for their child. Prednisone is cheap and the pills are small. Taking it every night seems inconsequential; after all it is just a little pill. But by missing doses, this child was at enormous risk for complications down the road.

This was a risk that I had to help mitigate. The solution was simple and immediate: a simple box of AM/PM pill cases.  Levine is fortunate to have a pharmacy just outside the office door. Prescriptions can be filled and the taper sequence loaded into the pill cases by Levine’s staff for the patient before they even leave the clinic.

On the surface, the QI solution to the problem was simple. The cost was minimal and the testing and implementation was nearly immediate. The process went from unreliable to highly reliable. This would have never occurred had Ryan and Levine not reached out to me as a partner in care delivery—as someone who could change the outcome for children other than my own. She embraced my input and we formulated a solution together. This may not show up as a highlighted intervention  on a run chart and whitepapers will not be written about it, though maybe they should. It was a healthcare of one solution that may or may not end up benefitting many. But somehow it feels good knowing there are a handful of kids  who are less likely to deal with osteoporosis later in life because of a few simple pill cases, the commitment of the staff at Levine, and their willingness to learn from me—a parent indeed, but also a valued member of their team.

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