Archive | February, 2014

“We need to come up with more things that work”: Prof Mary Dixon-Woods on patient safety

26 Feb

by Gavin Daker-White, Research Fellow for Multimorbidity theme

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Today, Sally Giles and I were present at the inaugural meeting of the Yorkshire Medical Sociology Group, where Mary Dixon-Woods gave the keynote address: “Knowing about patient safety: how hard can it be?”

Mary, began with a historical survey of the measurement of adverse events in hospital settings, beginning with William Petty (1623-1687). In the UK, such efforts are currently encapsulated in the NHS Atlas, which shows variations in quality and outcomes for different regions. She then considered the various problems with “intelligence” and “measurement” in patient safety research and initiatives.  For example, hospitals found to be ‘unsafe’ previously ranked highly on various quality indicators. The ways in which information is collected, coded and classified is subject to variation. For example, current incident reporting systems around medication errors mean that such information is unlikely to reflect the “true” rate of such incidents in clinical practice.

Intelligence about patient safety has a “fugitive” character; difficult to define or grasp. For Mary Dixon-Woods, such information can be as much about “the business of judgement” as it is about harder, objective, scientific matters. For example, her own research with the Health Foundation on catheter-associated bloodstream infections found that clinical workers were excluding patients judged to be at either low or high risk of such infections. In a version of Goodhart’s Law, when data are used with regulation or control purposes, they may cease to be effective as a measure of the phenomenon of interest.

There are problems in collecting, recording and counting patient safety-relevant statistics. From the point of view of health boards and those commissioning services, what is needed is “intelligence.” On the face of it, “problem-sensing behaviour” – perhaps associated with an avowed honesty around clinical outcomes would be preferable. However, “comfort seeking behaviour” – such as routinely ticking off a patient checklist once an hour during a hospital stay – can lead to patient safety “blind spots.”

The technical and measurement tasks essential to patient safety are tied to normal social practices. For example, the primary literatures sources used as “scientific facts” for patient safety statistics were written based on historical data collected by imperfect methods (e.g. reviews of patients’ hospital records). Other studies have used “trigger tools” to measure adverse events, which are strongly biased according to the skills of the individual using them in each case.

Mary, ended her presentation with a call for translational research to “come up with more things that work” in relation to improving patient safety. A current dearth of such examples means it is not always easy to engage clinicians and others in patient safety initiatives. In discussion afterwards, one audience member pointed to the importance of the “ownership” of systems of reporting and control residing with the health workers who collect and handle patient safety information. I was left wondering whether the main issues in hospital safety: “clinical monitoring, diagnosis, drugs and fluids” would also apply to primary care.

‘The earlier the better’ – why visiting your local pharmacy sooner rather than later could make all the difference

11 Feb

by Christian Thomas, 1st year PhD student in Medication Safety theme Christian Thomas NHS pic_cropped The beginning of 2014 sees the introduction of the new NHS campaign “The earlier, the better”. Designed to reduce the increased pressure experienced by our A&E departments and GP surgeries during the winter months, this campaign sets out to change public behaviour on a large scale.  Mainly aimed at elderly and frail individuals who are often admitted to hospital with respiratory conditions which may have been brought on by immobility, cold environments and viral illnesses – the aim is to begin treating these conditions before a visit to the GP or a stay in hospital is required, through a visit to the local pharmacy. Professor Keith Willett, NHS England’s Director for Acute Care said many of the patients seen in hospital are those who have not had or sought help early enough. Commenting, “We have to do better at helping people stay well, not just picking up the pieces when they fall seriously ill. Too many people make the mistake of soldiering on, losing the opportunity to nip things in the bud.” How then, can the general public become more aware of the services provided in their local pharmacies? The NHS are proposing a national PR campaign, where the public will see adverts in the national newspapers and on websites, hear adverts on local and national radio stations and see posters in their local pharmacy. It is believed however, that word of mouth will be a vital means in which to encourage people that may be our family, our friends, our neighbours or even ourselves to visit the local pharmacy. Speaking up about suffering from a bad cough, cold or sore throat could be crucial in preventing a minor illness developing into something more serious. It can be easy to underestimate the local pharmacy, with many unaware of the range of services that numerous pharmacies provide. Clare Howard, Deputy Chief Pharmaceutical Officer at NHS England explains, “Pharmacists and their teams are well trained and well placed to be able to offer advice to people seeking help. They can provide medicines’ advice and support for minor ailments, advise you about how to manage a long term condition and tell you if something needs more urgent medical attention from your GP, or even your local hospital.” As somebody who works as a dispenser in a community pharmacy, I am fully supportive of this campaign, having witnessed countless instances of customers coming into the pharmacy for what is sometimes, lifesaving advice. At times the most important advice can be in ensuring an individual does visit their GP or the local hospital for something that they were sure ‘is probably nothing’. There is great satisfaction in knowing that had it not been for their visit to the pharmacy their condition may have been left either unnoticed or worse still, untreated. Therefore, perhaps the most important aspect of this campaign could be in raising the public’s awareness that the pharmacy is another option for those who may put off going to visit the doctor for “just a cold”. It is always better to check your symptoms, at most it could save your life and at the very least, you are sure to feel better in the long run. For more information, please visit http://www.nhs.uk/asap.

Look Who’s Looking at my Data Now

5 Feb

by Richard Williams, Research Fellow for the Interface and Informatics theme Image Sneaky woman picture by CALI is licenced under CC It was announced recently that patient data is to be collected from GP practices, combined with hospital data, and stored by the NHS Health and Social Care Information Centre (HSCiC).  This anonymised data will then be made available to researchers, potentially leading to an improved quality of health care for patients. This is excellent news, as it is widely believed that one of the main sources of patient safety issues is at the boundary between primary and secondary care.  For all the technology available, a hospital worker will still find it hard if not impossible to access a patient’s health record, including their pre-existing conditions, current medications and allergies.  Analysis of the consolidated data will find the main issues, which in turn will lead to changes in policy or new systems to address the problems. And yet it could have been so much better… The NHS Connecting for Health programme aimed to build a single patient record database accessible to the patients themselves, and all healthcare professionals involved in their care.  It would have allowed for much more joined-up thinking between GPs and hospitals, leading to better patient care and fewer safety issues.  It didn’t work – as pointed out by this press release.  However when it was discontinued in March 2013, its remaining responsibilities were taken over by the HSCiC, and this announcement must be seen as one of the positives from the programme. I can understand why the data is anonymised because you need to persuade people that their personal information is kept safe, however it becomes a problem when people using the data identify patients who are at risk and there is then no way to communicate this information back to that patient’s GP.  Future policy can be changed, but it doesn’t help the at risk patients who have been detected. Salford already has a dataset combining GP and hospital data and the university has been using it for some time now.  It’s a brilliant and unique resource and although the data we receive is anonymous, the people who hold the data have a link back to the patient’s NHS number.  If a patient safety issue is identified, although we as researchers can’t identify the patient, the patient’s GP could.  This enables us to perform research to direct future policy, while at the same time identifying patients who are at risk now. Anonymous datasets are a useful tool, but to perform real-time patient safety monitoring the link back to the patient needs to be maintained.