IMH Project 3 Step 1 (Alisha Thomas).xlsx

	A	B	C	D
1	My Prioritized Issue (from Project 2): (Write the issue here exactly as you framed it in your output table — Observable Issue, Who Is Affected, Hidden Risk, Internal Process Gap)
2	Discharge & handover — A patient leaves with only three days of medication, although the next clinical review is about one week away. Medication supply and appointment timing are not aligned.
3	Why I'm starting here: (In 2–3 sentences, explain why this issue matters enough to investigate further. What made you prioritize it?)
4	I prioritized this because an avoidable gap between discharge medication and follow-up can leave a patient without prescribed treatment or a clear route to obtain it. In the Project 2 case, discharge occurred on 10 February, the three-day supply ended around 13 February, and review was scheduled for 17 February; the delayed follow-through made the gap especially concerning.
5	Observable Issue	Who Is Affected	Hidden Risk	Internal Process Gap

6	Patient discharged with medication for only three days, despite a follow-up review roughly seven days later.	Patient and support network; also the treating team, care coordinator, and community follow-up service.	Interruption in prescribed treatment, symptom deterioration, crisis presentation, and avoidable readmission risk.	Discharge medicine quantity, next appointment date, and responsibility for an interim supply were not reconciled into one confirmed plan in this case.
7	Guideline 1
8	Field	Your Notes
9	Title of document	Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (NG5)
10	Publishing organization	National Institute for Health and Care Excellence (NICE)
11	Year published	2015
12	Link / Source	https://www.nice.org.uk/guidance/ng5/chapter/recommendations
13	Type of document	Evidence-based clinical guideline
14	What it recommends	Transfer accurate medication details across care settings: medication name, dose, frequency, timing, last dose, changes and review needs; reconcile discrepancies, share information with the patient, and define responsibilities.
15	Who it applies to	Clinical teams handing over or receiving care; trained doctors, nurses, pharmacists/pharmacy technicians; patients and carers where appropriate.
16	What it says about timing	Share medication information ideally within 24 hours of a transfer. In acute settings, reconcile medicines within 24 hours or sooner when clinically necessary; timing for other settings varies.
17	What it says about ownership	The sending and receiving teams must share, document, and act on medicine information; organisations designate a professional accountable for the reconciliation process.
18	What it says about escalation	Unresolved medication discrepancies or an impending supply gap require timely review by an appropriately qualified clinician under local escalation procedures; this guideline does not prescribe a universal refill-escalation threshold.
19	How it connects to my prioritized issue	A three-day supply with a seven-day wait should have prompted a documented check of the last available dose, the review date, and access to an authorised interim supply.
20	What this changes about how I see the problem	Medication handover is not complete simply because a follow-up appointment has been made; the patient needs a workable plan for the days between.
21
22	Guideline 2
23	Field	Your Notes
24	Title of document	Transition between inpatient mental health settings and community or care home settings (NG53)
25	Publishing organization	National Institute for Health and Care Excellence (NICE)
26	Year published	2016
27	Link / Source	https://www.nice.org.uk/guidance/ng53/chapter/recommendations
28	Type of document	Mental health transition and discharge clinical/service guideline
29	What it recommends	Plan discharge with the person, identify a care-plan owner, include medicines and follow-up arrangements, communicate the care plan, and provide support during the early period after leaving hospital.
30	Who it applies to	People leaving inpatient mental health care; hospital and community care teams, including case managers who coordinate follow-up, and licensed professionals responsible for medicines.
31	What it says about timing	Send the care plan and discharge letter within 24 hours; follow up within 7 days after discharge, or within 48 hours when suicide risk has been identified. Consider a GP appointment within 2 weeks.
32	What it says about ownership	A designated practitioner prepares the care plan; the hospital psychiatrist ensures prompt discharge communications; the receiving care team must know its responsibilities.
33	What it says about escalation	Identify clinical risks, including suicide risk, during transition and arrange appropriate enhanced follow-up; an urgent medication-access problem should be escalated through local clinical pathways, not handled by a case manager prescribing.
34	How it connects to my prioritized issue	The case shows why the next appointment, medication details, and early support all need to be coordinated before discharge rather than handled as unrelated tasks.
35	What this changes about how I see the problem	A clear transition involves named ownership and a plan the patient can actually follow, not merely an appointment recorded in the system.
36
37	Guideline 3 (optional but recommended)
38	Field	Your Notes
39	Title of document	Medication safety in transitions of care (technical report)
40	Publishing organization	World Health Organization (WHO)
41	Year published	2019
42	Link / Source	https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.9
43	Type of document	Patient-safety technical report and improvement framework
44	What it recommends	Use structured medication reconciliation, verify medication information, communicate changes to receiving teams, involve patients and carers, and support the work with reliable records, tools, and monitoring.
45	Who it applies to	Health systems, clinicians, pharmacy/nursing teams, care coordinators, patients and their caregivers across transfers of care.
46	What it says about timing	Calls for timely, dependable information exchange and greater attention to high-risk transitions; it does not set one universal number of days for a bridging prescription.
47	What it says about ownership	Healthcare leaders and multidisciplinary teams should agree roles and implement reliable cross-team systems, rather than leaving the entire check to one person.
48	What it says about escalation	Identify and prioritise high-risk medication discrepancies and provide timely clinical review under established local safety processes; no single numeric escalation trigger is imposed.
49	How it connects to my prioritized issue	A mismatch between the days of medicine supplied and the date of review is a medication-transition safety risk that a structured handover check could reveal.
50	What this changes about how I see the problem	The solution should be a repeatable process with checks, owners and visibility—not a reminder that an individual case manager must simply be more careful.
51	Cross-Guideline Synthesis
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53	What do these guidelines agree on? (What common standards or expectations appear across more than one source?)
54	These sources agree that medication continuity depends on accurate reconciliation, early communication, clear responsibility, and a reliable handover to the next care team. Patients must know their treatment plan, next appointment, and who to contact if medicines will not last.
55	What gaps or contradictions did you notice? (Do any guidelines conflict with each other, or leave something important unaddressed?)
56	No direct contradiction emerged. NICE NG53 addresses mental health discharge, NICE NG5 details safe medication communication, and WHO focuses on systems for transition safety. None sets a universal bridging-prescription duration; clinical decisions must follow local policy and prescriber judgement. These international guidelines provide comparison standards, not proof of IMH's internal policy.
57	What does "best practice" look like for your prioritized issue, based on your research? (Summarize in 3–5 sentences what should be happening, according to the standards you found.)
58	Before discharge, the clinical team should reconcile medicines and compare the supplied quantity with the next review date. If treatment may run out first, an authorised prescriber/pharmacist should decide how to maintain safe access; the case manager can coordinate that referral and document its outcome. Under the provided IMH role description, the case manager should make telephonic contact within two working days of discharge, monitor wellbeing and adherence, and follow the first TCU visit. A documented owner, escalation route and shared status would prevent this safety check from depending on memory alone.
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