Reflective Template:  Quality Improvement Activity (QIA)

This reflective template has been designed to use with the SOAR Database (Scottish Online Appraisal Resource).  When you have completed this reflection, please upload it to SOAR / Form 3 and submit it to your interview to share with your Appraiser.	3-step guide to completing this form:

1)	Save this form (using “Save As”) to your computer (e.g. My Documents, Desk top), and customise the file name (e.g. QIA Reflection 2012)
2)	Proceed to filling out the form - when finished, Save and Close the document.
3)	Login to SOAR and Upload this file from where you had saved it (from step 1), either to the Documents Library, or directly to Form 3.	

This reflection template form should be used for Domain 2: Safety and Quality.
The boxes will expand automatically as you type into them.

What supporting information have you provided for your QIA?
Glad you brought it up: a patient-centred programme to reduce PPI prescribing in general practice.	

What strengths or achievements does it demonstrate?
This is a service evaluation of a patient-centred specialist nurse-led programme to reduce the prescribing of proton pump inhibitors (PPI). The programme demonstrated that 83% of those eligible for inclusion were able to reduce or stop their PPI. The estimated annual net saving was £3180. Self-reported understanding of symptom self-management increased from 30% to 90%. 

A paper describing the project was published in Quality in Primary Care in 2012. The programme was presented to the Scottish Prescribing Advisers Association Conference in 2012. An educational pack replicating the methodology and tools with a DVD containing FAQs has been developed for use in other practices.	

Did you encounter any difficulties in this process?
Data collection and retrieval was undertaken by a nurse advisor working with a pharmaceutical company. Access and analysis was difficult. The project took 4 years to complete and it was hard maintaining enthusiasm, but working with another GP made it bearable.	

Have you been able to make any changes as a result of undertaking this activity?
Our prescribing has improved.	

What have you learned from undertaking this activity?
PPIs are very effective at relieving symptoms of GORD and it requires a huge investment of time and effort to achieve a small reduction. Nurse/ prescribing advisers are effective at running this programme and I doubt if many GPs will have the time or the motivation.	

Is there anything else that you would like to/ need to do to follow it up?
The practice needs to continue to review repeat prescribing of PPIs.