Development of a Multi-Disciplinary Team Memory Clinic Checklist: A Quality Improvement Project

Abstract

Aims

Although “to err is human”, human error in medical practice can be costly for both patients and the healthcare organisation. Different preventive methods have been developed and one of the approaches is the use of checklist. The conceptualisation of this quality improvement project (QIP) came about after a near-miss prescribing error occurred in the memory clinic. Therefore, the Memory Clinic Multi-disciplinary Team (MDT) Checklist has been created to make the documentation process of diagnosis, investigation, and treatment more systematic and structured, which will in turn reduce the risk of errors associated with it. The checklist is separated into the subtype of Initial Assessment and Follow Up. This article is aimed to share the outcome of the QIP.

Methods

The QIP was carried using the Plan-Do-Study-Act (PDSA) model. Version 1 of the checklist was made based on the guidance from the National Institute of Clinical Excellence (NICE) guideline NG97, which was tried in the Memory Clinic MDT discussion of Older Person Mental Health Community Team of Wrexham Maelor Hospital (OPCMHT WMH), Betsi Cadwaladr University Health Board (BCUHB). Microsoft Forms survey was performed to capture the feedback from the junior doctors using the checklist. The following five properties were ranked using a five-point Likert scale (with one as the lowest and five as the highest): ease of use, time efficiency, environmentally friendly, capturing important information and space availability. The checklist was then updated based on the qualitative feedback and PDSA cycle was repeated until the feedback was rated more than 4/5 on average for all domains.

Results

Two PDSA cycles were needed to reach the version that was rated as more than 4/5 on average for all domains and the final version of the checklist was accepted as the completed version, i.e. the Version 3. There was a significant improvement in the ease of use, time efficiency, environmentally friendly and space availability. All versions of the Memory Clinic MDT checklists were good for capturing important information but not performing well for the other domains.

Conclusion

The Memory Clinic MDT Checklist are now fully in use in OPCMHT WMH BCUHB. Long term evaluation is still required to maximise the efficiency of the checklist. There is further plan of expanding the use of checklist in different memory clinic of BCUHB.