Background Numerous practical daily hassles are experienced by patients, carers and professionals to get the right palliative medications at the right time (Yardley, Francis, Dean Franklin, et al. BMJ Open. 2022;12:e061754). Our research study ‘Getting prescription medications right at home, in hospital & hospice’ (Francis, Yardley, Franklin, et al. Getting palliative medications right: an activity theory analysis to improve patient safety and carer confidence. Marie Curie Palliative Care Research Department, University College London; 2024) used Activity Theory – a ‘whole system’ method to understand experiences of everyone involved in managing palliative medications. Hidden work (unaccounted for in policies/service specifications) is widespread and burdensome for patients, carers and professionals, and particularly problematic when people move between care settings.

Aims

1. Implement a toolkit, created from our research, into practice.

2. Explore if a multicentre impact project, comprising a joint team of researchers, healthcare professionals and people with lived experience, can accelerate improvement.

Method Local teams including service users from Marie Curie Bradford, Devon, Glasgow and West Midlands partnered with the research team. We applied the toolkit over six workshops, in a participative approach guided by the Activity System Evaluation Framework (ASEF) (Allen, Norman. A guide to the Activity Systems Evaluation Framework. Leeds University Business School; 2020) to identify ‘pain points’ and opportunities.

Results The toolkit functioned as a sensitising evidence-base for identifying what mattered most to improve medication management and how in each locality, leading to focus on:

• Building relationships between the hospice and community pharmacies to enable timely access to medication (Bradford).

• Improving relationships between Marie Curie and District Nursing teams to understand systems, expectations and experiences of responsibilities for shared care (Devon).

• Managing patients’ own drugs following hospice admission; balancing desire to reduce waste and carer stress with associated nursing and pharmacy workload (Glasgow).

• Analysing modes and content of communication to design proactive pre–discharge medication processes (West Midlands).

We will present each locality’s achievements alongside our evaluation of added value from the multicentre impact model and research-practice partnerships.

Conclusion This work has established connections with potential to grow into a collaborative improvement network. Bringing people with lived experience into each team was especially valuable to directly inform improvements.

Acknowledgements Participating members of the Marie Curie Teams - Bradford: Helen Ankrett, Molly Kenyon, Merton, Frances Mulley, Natalie Sanderson, Wilma Saville. Devon: Lee Stevenson, Rachel Oakley, Charlotte Bullivant, Emma Rogers, Virginia Turbett, Anna Ferguson Montague. Glasgow: Eileen McGinley, Libby Ferguson, Nancyanne Smith, Lindsay Wilkins, Jackie Gilfoyle. West Midlands: Chloe Ward, Emma-may Ward, Janet Lester, Dawn Doughty, Maxine Koker.