NHS70 Excellence in Primary Care Award for Nottingham’s Medicine Safety Research Group

22 May

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The Medicine Safety Research Group at The University of Nottingham is the regional winner of the Excellence in Primary Care Award category of the NHS70 Parliamentary Awards and is shortlisted for the national award.

The research group was nominated by the East Midlands Academic Health Science Network (EM AHSN), who highlighted a number of developments which are already improving, and will continue to improve, prescribing safety in primary care. These include:

  1. Improving the safety of medicines prescribing through the design and testing of an intervention called PINCER.
  2. Development of ‘prescribing safety indicators’ which are now used in GP computer software to avoid prescribing errors
  3. Identifying the frequency, nature and causes of prescribing errors in general practice, leading to:
  4. Developed a Patient Safety Toolkit for GPs, which is available on the RCGP website and has been accessed over 10,000 times.

The Medication Safety theme of the NIHR Greater Manchester PSTRC has worked closely with the award-winning Nottingham-based research team on many of the developments. A number of these projects and interventions will be developed further over the coming years, through a continued collaboration between the Greater Manchester PSTRC and the University of Nottingham.

Coded fairy tales at Medical Informatics Europe conference

16 May

Sleeping Beauty_cropped

Niels Peek and Richard Williams from the NIHR Greater Manchester PSTRC’s Safety Informatics theme recently attended Medical Informatics Europe (MIE) in Gothenburg, Sweden. MIE is the leading European health informatics conference and saw delegates attending from all corners of the world. While there, Richard beat off stiff competition to win the prestigious Science Slam – a competition held at MIE where contestants have up to 8 minutes to present their work in a humorous and entertaining way.

Richard talked about clinical codes, which clinicians use as a short cut to describe medical concepts e.g. hypertension is represented by the code G2 and Type 2 diabetes by the code C10F. Richard highlighted the absurdity of some clinical codes such as “U102700 – Fall involving ice-skates, skis, roller-skates or skateboards, occurrence on farm”, the dreaded “TE63100 – Moray eel bite”, and that there are no fewer than 11 codes for falling off a cliff including “U10F200 – Fall from cliff, occurrence at school”.

Richard then translated fairy tales into clinical codes – care to guess the following?

1. Female baby (634..12), black magic (13y8.00), wiccan (13yD.00), puberty (ZV21100), accident caused by spinning machine (TG3y500), excessive sleep (1BX1.00), contact with plant thorns and spines and sharp leaves occurrence at other specified place (U12Ay00), concussion with more than 24 hours loss of consciousness and (S603.00)… manual resuscitation (8731.00) …return to pre-existing conscious level (S603.00 cont.), married (1332.00).

2. Newly wed (1332.12), infertility problem (1AZ2.11), specific food craving (E275800), unborn child subject to child protection plan (13Iv000), female baby (634..12), imprisonment (ZV62511), abnormalities of the hair (M242.00), fall from turret (TC25.00), accident caused by plant thorn (TG4y600), foreign body entering into or through eye or natural orifice occurrence at other specified place (U11Qy00), acquired blindness both eyes (F490900), length of time homeless (13D8.00), tearing eyes (1B87.14), patient cured (2129.00).

3. Female baby (634..12), pale colour (1674.00), mother dead (12K3.00), father remarried (13HJ.00), has stepmother (133D100), hunter’s syndrome (C375.12), ran away (13HW.00), mining engineers (058..12), dwarfism (C1z4.00), found dead (R213100), manual resuscitation (8731.00), found dead (R213100), manual resuscitation (8731.00), found dead (R213100), suspected food poisoning (1J8..00), manual resuscitation (8731.00), married (1332.00).

Answers on a postcard.

On a more serious note, the talk also highlighted that the current coding system used in UK general practice (Read Codes) is in the process of changing to SNOMED (an internationally recognised coding system). This is a major project with potential implications for the continuity of patient care if managed poorly, but also with large implications for researchers in the UK who have much experience of working with databases of Read Codes but little experience of working with SNOMED.

What does the future hold? “God only knows (R2yz.11)”.

Past PhD Fellows: where are they now? Jonathan Stokes

3 May

In this series, we catch up with past Greater Manchester PSTRC PhD Fellows to see what they are doing now and how their PhD projects affected patient safety. This edition, our past PhD Fellow is Jonathan Stokes.

What did you learn during your PhD project?

My PhD project examined evidence for effectiveness of ‘New Models of Care’ (commonly called ‘integrated care’) for patients with multiple long-term conditions (multimorbidity).

As well as learning a great deal about the specific topic, I also learned a number of transferable research skills. For example, the requirement to balance the ideal question, data and methodology with what is realistically possible to do and answer; the publishing process, to accept paper rejection based on the priorities of some journals and to positively move on and improve a paper in response to reviewer comments; that research evidence does not automatically translate to policy change, that the policymaker has more to consider than the scientific evidence (e.g. public opinion), and that a research paper also needs to be written in additional formats (e.g. blogs, policy briefs, media) to improve its usefulness in the policy arena.

How has your PhD changed the patient safety landscape?

My research showed the limitations of one of the most popular integrated care models being rolled out, case management. It highlighted that an increase in one outcome, e.g. patient satisfaction, does not necessarily translate to a beneficial effect in another desired outcome, e.g. improving health or reducing the cost of care. We don’t always know what’s good for us/what’s good for us might not be what’s good for the overall system…

More recent emphasis on new models of care has been to focus on delivering organisational and incentive changes to promote more preventative care. Incentives have changed for primary care in an attempt to improve the case management process too, by trying to identify less high-risk patients (who might already be past the point of successful intervention). I hope my research contributed in some small way to this change in focus.

What you are doing now and where you see yourself going in your future career?

I’m currently working as a Research Fellow in the Manchester Centre for Health Economics. I’m working on a multi-country EU project, similarly to my PhD, looking at how models of care can be improved for treating patients with multimorbidity.

In the future, I’d like to continue a similar vein of research, but I hope to focus forthcoming work on understanding how we can improve prevention of developing multimorbidity, rather than just better treatment.

Working together to help patients and carers to be more involved in safety

3 May

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The patient safety guide has been co-developed with patients, carers, general practitioners and pharmacists. We have worked together from the initial idea, to decide the focus of the guide, the first draft all the way through to refining it.

One key discussion we had early was a preference to develop a digital app based version to compliment the paper version which we are now doing. In March we held two more co-design events. In the first event we discussed what the app should include and key features that people like in an app, what they don’t like and what the guide app should include.

At the second event we discussed testing and piloting the guide package in practice for patients and carers and how would it be used with GPs, pharmacists and other healthcare staff. These discussions will be used to shape the next phase of the guide project to develop an app and test the full guide package.

Thanks to everyone who came along and got involved! If you’d like to find out more about the patient safety guide project or future opportunities to get involved please contact Dr Rebecca Morris.

Risk Management: developing a learning resource to support pharmacy teams across England

3 May

Risk man guide supported by NIHR GM PSTRC

Good risk management is well recognised as the cornerstone of safe practice in the workplace and risk assessment has long been part of legal requirements for health and safety in UK workplaces.

In 2017, the World Health Organisation highlighted the importance of medication error by choosing the issue of medication-related harm as the focus of its Global Challenge. In response to this, the Medication Safety theme of the Greater Manchester PSTRC worked with CPPE (The Centre for Pharmacy Postgraduate Education) to develop their learning resources on Risk Management.

This was an ideal opportunity for the PSTRC, allowing the team to apply their broad expertise in theoretical risk management concepts to the challenges of the pharmacy context but also enabling them to incorporate the expertise and insights from the PSTRC’s Community Pharmacy Patient Safety Collaborative – a group of current in-practice community pharmacists working in the Greater Manchester region (see blog post for more information).

This ensured that the guide would be both theoretically sound in terms of risk management but also enriched with examples that pharmacists saw as pertinent to their day to day work.

Through the co-development of this guide, it was recognised that this could be part of something with much greater impact and, as a result, CPPE dedicated their 2018 learning campaign to be focussed on the topic of Patient Safety, using the guide as a focal point to provide the theoretical background for the campaign.

The guide was distributed to over 67 500 pharmacy professionals as part of CPPE Patient Safety campaign. The PSTRC continued to support CPPE designing appropriate learning activities that would be delivered by CPPE – including face to face “focal point” sessions with over 100 events due to run nationally throughout England and online weekly activities in Feb/Mar 2018 – including an e-challenge quiz and encouraging involvement via Twitter, Instagram and Facebook. This resulted in over 1500 individuals signing up to the campaign activities over the six week period and continuing beyond this with pharmacists still adding their intentions to improve patient safety on CPPE’s ‘Pledge Wall’.

Matthew Shaw, interim director of CPPE, was delighted at the opportunity to collaborate with PSTRC recognising the huge value of building an evidence base into this core learning programme. He commented “It has been a great opportunity to work with PSTRC to link theory with practice and through this to support pharmacy professionals across the country to make their practice safer, and to reduce the risks to people using our services.”

PhD Fellow Focus: Ahmed Ashour

3 May

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Ahmed Ashour is the latest PhD student to join the NIHR Greater Manchester Patient Safety Translational Research Centre at The University of Manchester. Ahmed began his PhD in January 2018, having graduated with a distinction MPharm degree in the summer of 2017. He has worked in community pharmacy since 2014 in a variety of roles including as a dispenser, pre-registration pharmacist and ultimately a community pharmacist. Ahmed’s main passion derives from personal development and he has taken an active interest in ways of developing communication skills, especially in young people.

Ahmed’s research will revolve around identifying the skills that are essential to patient safety in community pharmacy. These skills are complementary to the technical knowledge acquired by pharmacists at university and while on their pre-registration placement. Since the 1970s, other sectors have extensively researched the impact non-technical skills have on outcomes, with many areas in healthcare now using specific classifications to identify these skills, in addition to the elements and behaviours attributed to safe practice.

Ahmed aims to present these skills to be able to ensure pharmacists in the future are well equipped with the skills that are necessary for the central role they now play in the health of communities all around the country. Ahmed will aim to identify these skills by first looking at the role community pharmacists currently play within the healthcare team, and then extracting the skills that are required to complete the tasks involved within this role.

British Journal of General Practice Research Conference 2018

3 May

BJGP banner & Sudeh combined

Dr Sudeh Cheraghi-Sohi recently attended the inaugural British Journal of General Practice (BJGP) Conference, held at the Royal College of General Practitioners (RCGP), on March 23rd. This one-day conference was opened by Dr Helen Stokes-Lampard, Chair of the RCGP, and the journal’s editor Professor Roger Jones. Plenaries were provided by Professor Richard Hobbs and Professor Pali Hungin, who gave an overview of some the key primary care research successes and discussed the future of general practice respectively.

Common to both talks was the focus on the growing primary care workforce crisis and the increasing workload that the diminishing workforce is attempting to deliver. From a patient safety perspective, safe staffing levels in hospitals and from an access perspective, GP provision are critical to safe service delivery.

Various solutions were suggested and the acknowledgement that there was no magic bullet. Dr Cheraghi-Sohi gave an oral presentation on her work on measuring diagnostic errors in UK general practice. An audience of primarily clinicians attended the fifteen minute presentation and engaged in a lively and positive debate on the topic once the presentation finished covering various aspects of the methods and findings. Indeed, the issue of workload was discussed and how this may contribute to the increasing occurrence of diagnostic errors.

In addition to the oral presentations, poster sessions and workshops on critical reading, peer review and how to beat procrastination in your writing were offered throughout the day.  In summary, there was a well-balanced structure to the conference programme with plenty of free-time for networking.