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Community Pharmacy Patient Safety Collaborative: Safety Initiatives

14 Jun

Chui Cheung photo

My name is Chui Cheung, working as a community pharmacist in Wigan, Lancashire.  I joined the NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative Study with the University of Manchester in November 2015.  Looking back, it was curiosity that led to my participation and I was worried how I would handle the research projects.  Nevertheless, the title of patient safety attracted me to find out more.

Patient safety is at the centre of our everyday tasks whether we are pharmacists, technicians, dispensers, medicine counter assistants or other members of the team. Whatever we do in the course of our work, we must do it safely.

At the start of the first year project, there were 8 to 10 pharmacists with a range of different working backgrounds and age groups.  We attended a full day session every 4 to 6 weeks at the University.  We were relieved to discuss openly and share our experience on patient safety.  The aim was to build a safety case using our working environment and team resources.  My project centred on dispensing safety: ‘Are we dispensing safely?’ and later on was refined to a quantitative safety incident claim.

We were introduced to specific tools: Hierarchial Task Analysis (HTA), Failure Mode and Effect Analysis (FMEA), System Human Error Reduction & Production Approach (SHERPA) to help our analysis of the safety profile. Our team broke down the complex dispensing tasks into smaller working steps or processes systematically. On a practical application, the Proactive Risk Monitoring (PRIMO) questionnaire was helpful to use as a team to identify various patient safety risk factors.  We then made risk assessments of the dispensing processes through the SHERPA and used Plan, Do, Study, Act (PDSA) cycles to evaluate improvement.

The whole team began to monitor and record near misses and dispensing incidents on a more conscious level than before and made voluntary changes towards an open, no-blame working culture. The goal of safer dispensing became a number one priority all the times.  The team’s brainstorming revealed many common triggers or events of ‘the vulnerable moment’ during the dispensing processes.  Several checking procedures were used as checker reminders.

The pooled data of errors showed high times of errors, typical error categories and even the common medicines.  Individually, we were able to find out when and how we perform best and made aware of the pitfalls.  We discovered that we were prone to errors particularly when we were ‘expected’ to have ultra-quick dispensing.  Through a member’s suggestion and our dispenser’s effort, we now display a shop poster giving a summary of ‘the way we prepare your medicines’ and give customers opportunities to read through the additional copies whenever there is a queue forming.  It works really well and the feedback is positive too.  The team and customers seem happier.

In year 2 of the project, we came across analytical tools (Faulty Tree Analysis, Bowtie diagram) to look at our safety claim.  We continued to expand our safety interests and used a more sophisticated reporting form called  ‘Incident Investigation Form’ which covers error description, the factors causing the error, the risk category, course of the event and improvement plans.   We have since modified the form for in-house use.  The bundle of safety data showed how we had been dispensing safely or otherwise.  As a result, we implemented a couple of measures (such as safety shelf reminders, Top 20 common error medicines list) to help us improve on a regular basis.  The data is also useful in staff appraisal.

Moreover, we felt fortunate to have the ready-made patient safety data for Quality Payment application.  My experience in the patient safety collaborative has been overwhelmingly good and positive.  I wouldn’t have known about these analytical methods and thought about the improvement plans if I hadn’t been part of the study group.

I recommend that any pharmacy team who is interested should come along for a taster session to see if this is right for you.

How can we improve safe communication and co-ordination of care between primary and secondary care?

19 Apr

Part four in the James Lind Alliance Primary Care Patient Safety Priority Setting Partnership blog series: Part One, Part Two, Part Three

by John Taylor, patient attendee of the JLA Primary Care Patient Safety PSP final workshop

JLA PSP Top 10_Number 3Question 1 for me is, have there been any high grade research papers published already on this subject? If yes, then are there meta-analyses showing useable findings, and how old are these and have the findings been overtaken by newer recommendations?

Acting as Devil’s Advocate I would ask ‘who has posed this topic’ and ‘what evidence has been the basis for it’ and ‘how reliable or high grade is the evidence?’

As a  patient with multimorbidity, I personally feel that communications and coordination of care between primary care in its broadest sense and secondary care are often multi-centred and compartmentalised by ‘treatment episodes’ only indirectly linked, and even then through less than state of the art IT systems which may or may not be multi-site interoperable, which makes communication often slow, occasionally lost in space or paper chases and definitely not entirely in the best interest of good patient care.

So, how could improvements which would benefit the whole system be researched and put into practice?

Should lessons be learned from commercial users of communication systems who successfully run large scale businesses and care for the wants and needs of customers in ways which fulfil demand and generate repeat business, i.e. satisfied end users, and also learn from systems which have failed in their purpose due to poor design or uneconomic cost over runs or just failing to understand the needs of the users. Best practice should produce the designed outcomes consistently and be adaptable to cope with new needs as they are identified and designed to do this with minimum disruption and cost, there are many Healthcare Providers who have produced local workarounds which suit the needs of patients and providers with safe communications and care, NHS England, NHS Digital or NIHR RfPB (National Institute for Health Research Research for Patient Benefit) might be the vector to investigate how these develop and how well they might scale up.

I am constantly amazed and delighted at how, for example, Amazon handle their returns communications and customer care, they will respond to a ring back request within seconds, take the details, issue a printable label, arrange pick up and confirm by email then refund or replace as soon as the item is received at their depot. If Amazon and others can do this why is it so difficult for primary, secondary and, dare I say it, social care to learn how to communicate safely, rapidly and without arguing over ownership between themselves and patients, so that information flows freely, accurately and safely through the system, benefiting patients and providers alike.

Accurate and timely information is the key to good outcomes and thus improvements need to be constantly sought and implemented, carrying on doing what we have always done is not an option.

Thinking outside of the box: presenting patient safety issues creatively

30 Mar

by Sally Giles, Research Fellow in PPI Research and Jackie Nightingale, member of the Greater Manchester PSTRC Research User Group

In 2016 Sally Giles (Research Fellow, Core Theme) took part in the Academy of Creative Minds programme which brought together a dynamic, disparate group of artists, from composers to circus performers, directors to writers. These artists shared their ‘tricks of the trade’ with health researchers, to help them build confidence and expertise in using the creative arts to convey research messages in a more powerful and meaningful way.

As part of the programme Sally was required to work with one or more of the artists to produce a creative way of conveying a research message of her choice.  Sally worked with a circus performer to develop a way of highlighting communication issues in general practice and how this can affect patient safety.  As part of this process Jackie Nightingale (a member of the Greater Manchester PSTRC Research User Group) was asked to get involved in developing this performance.  Jackie played a starring role as the main patient in the scene.  Their full performance was a major part of the NHS R+D North West Annual Research Conference (video above).

Both Jackie and Sally thoroughly enjoyed the experience and would recommend the course to anyone who would like the opportunity to think outside of the box when trying to get research messages across in an enjoyable and innovative way.

Community Pharmacy Patient Safety Collaborative: Involving the Patient

18 Oct

By James Hind

james-hind_cropped

Over the last year I had made some contacts with the University of Manchester’s undergraduate pharmacy programme – offering student placements and assessing the first year OSCE examinations. The tentacles of the University email system must have decided that I’d be up for something a bit different – out of the blue I received an email about the patient safety collaborative and it looked like it would be a really interesting idea.

Patient safety was something that I felt I could benefit from being challenged about so I decided to contact Penny, and I’ve been part of the collaborative for the last 6 months. I’m the Pharmacy Manager at Superdrug’s Manchester city centre branch – I’ve been there for almost 10 years now, and one of the things that I’ve noticed over the years is the move toward a more patient-centered approach.

Concordance has replaced compliance; services are geared toward the patients’ needs,  and one of the things that struck me, having been involved in this initiative was how best to include the patient in the process of dispensing their prescriptions.

I thought about how I’d always been told that pharmacists are the last step between the doctor writing the prescription and the patient taking their medication, and I realised that this wasn’t really true – it’s patients who are the last step. They decide whether or not to take what we dispense to them, and perhaps our challenge is to involve them more, and in a more consistent way, at the point where we hand over their medication.

I developed the idea of label that could be attached to the dispensing bag. I wanted something that could be used as a quick check (have we got the right patient; did we tell them what their medication was for, and are they confident that they know how to use it). I also wanted it to give some of the ownership back to the patient – sometimes things go wrong, and could a label be used as a prompt for the patient, to give them the confidence to contact us if they were unsure about anything or if they felt there may have been a mistake?

james-holt_safety-label

Part of the work of the collaborative is for the participants to make a safety case. It involves taking a critical look at the systems and processes currently in place and the types of near misses and incidents that are occurring. The challenge is then to identify any interventions we could make, put them into practice, and  evaluate them to see if they were successful or not.

I’m still working my way through this process. Being part of the collaborative though has already had a really positive impact on the way I work and the discussions that I have with my team. We’re recording a lot more near-misses, because we’re all now more aware of them. More importantly, we’re really trying to analyse why they’re happening and learn from them. Patient safety can only improve as a result.

Read part one of the blog series.

Read part two of the blog series.

Community Pharmacy Patient Safety Collaborative part two: Assessing safety

31 Aug

by Sarah Wood, Member of the NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative

Sarah Wood_Pharmacy Collaborative post_CROPPED_Aug16

I heard about the community pharmacy patient safety collaborative about 6 months ago through an advertisement by Community Pharmacy Greater Manchester. As a community pharmacy operations manager with some previous research experience, I have a keen interest in assessing and improving the safety of the many processes in community pharmacy and learning from other industries and experts to do so. As such, I wrote to Dr Penny Lewis to see how I could get involved.  Since then I have been attending monthly training sessions at the University and trying out my new skills back at the pharmacy I work in.

One particular risk to safety that I am interested in are interruptions, such as the phone ringing or customers waiting at the counter. These interruptions are a common occurrence in community pharmacies and can lead to problems when they disturb pharmacy staff who need to focus on the task dispensing medicines accurately. As a result of my involvement in the collaborative, I have produced a safety case on interruptions in the dispensing process in one of my pharmacies and have also identified potential areas for future safety cases. The process of gathering the data, observing the pharmacy, consulting on safety issues with my colleagues and writing up the safety case has made me view company safety mechanisms completely differently. An example of this is how we record errors in community pharmacy: it’s easy to get caught up in how many errors are reported and why they are happening (obviously very important) but we don’t always look at what is best for our staff and which recording mechanisms are easier for them to use on a day to day basis – this is something I will be looking at in future.

The collaboration is also taking on more community pharmacy professionals and, as such, one of my colleagues, an accuracy checking technician, will be joining me in the production of the next safety case. This will be even more beneficial for our company as we can produce and compare safety across different branches.

In the next stage of the collaborative I aim to put together a business case for improving safety. There are obvious, clinical reasons for improving safety in community pharmacy but not much is known about the impact a lack of safety has on our business e.g. loss of customer confidence and possibly loss of custom. This is something I think the wider profession will be interested in and may encourage businesses to be even more proactive when addressing safety issues.

Read part one of the blog series.

Read part three of the blog series.

Patient Safety in Dentistry

29 Jul

By Barry Kinshuck, Dental Adviser representing the British Dental Association

BDA Logo

My name is Barry Kinshuck and I have been asked to represent dentistry by the British Dental Association in the excellent project to be undertaken by the James Lind Alliance Primary Care Patient Safety Priority Setting Partnership.

As a dental practitioner in Wigan for nearly 40 years and a dental adviser in Wigan and now Greater Manchester I have seen continuous changes and improvements in patient safety in dentistry.

The dental profession is committed to providing safe dental care, which is necessary for ensuring good general health, and aims to minimise risks and establish an open culture of patient safety, in which practitioners can learn from their own and others’ experience.

Duty of Care

Responsibilities for health and safety are set out in the Health and Safety at Work Act 1974 (the Act) and associated regulations. The Act seeks to protect all those at work – employers, employees and the self-employed, as well as members of the public who may be affected by the work activities of these people.

Care Quality Commission inspects dental practices and wants to see evidence that a dental practice is:

  1. Safe
  2. Effective
  3. Caring
  4. Responsive to patients’ needs
  5. Well led

Safety is top of the list and dental practices should be able to demonstrate how they:

  • Manage risk
  • Prevent infection
  • Provide suitable premises and equipment
  • Manage  and maintain equipment
  • Manage medical devices
  • How lessons are learnt and improvements are made when something goes wrong
  • What systems, processes and practices are in place to keep people safe and safeguard them from abuse?

The General Dental Council

This is the organisation that regulates dental professionals and in their document Standards for the dental team makes several statements of relevance with respect to patient safety:

  • Principle one (put patient’s interests first) states in standard 1.5.4 ‘You must record all patient safety incidents and report them promptly to the appropriate national body’.
  • Principle eight (raise concerns of patients at risk) states in standard 8.1 ‘You must always put patients’ safety first’.

The James Lind Alliance Primary Care Patient Safety Priority Setting Partnership provides an opportunity for the British Dental Association to understand what areas of patient safety matter most to patients and healthcare professionals.

 

The NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative: part one

20 Apr

by Penny Lewis, Medication Safety theme

Comm Pharm Pt Safety Collaborative

The community pharmacy patient safety collaborative has reached six months of age. Over this period, ten pharmacists who work across Greater Manchester have come together regularly with research staff from the Greater Manchester PSTRC to learn about quality and safety improvement.

The collaborative members’ first assignment has been to create a ‘safety case’ for their pharmacies. Safety cases are a recognised approach to safety management in other safety critical industries (such as aviation and petrochemicals) but are relatively new to healthcare. As far as we are aware, this is the first time that safety cases have been used in community pharmacy. In order to write their cases, the collaborative members have learned how to use risk assessment techniques such as Failure Modes Effect Analysis (FMEA), Systematic Human Error Reduction and Prevention Analysis (SHERPA), Proactive Risk Monitoring for Organisational learning (PRIMO), Hierarchical Task Analysis (HTA) along with Plan Do Study Act (PDSA) cycles to explore potential and actual patient safety issues in pharmacies.  As well as familiarising themselves with a ridiculously large number of acronyms, the collaborative has used their newly acquired knowledge to investigate and deal with the risks associated with community pharmacy activities such as medication dispensing, provision of monitored dosage systems and delivery services.

In addition to hearing from Greater Manchester PSTRC researchers, the collaborative has also had a guest presentation from Professor Todd Boyle of St Francis Xavier University, Canada, who talked about his work in quality improvement across pharmacies in Canada, and Sarah Ingleby, lead nurse in acute care at Central Manchester University Hospital, who popped over to talk about her involvement in producing a safety case for sepsis in secondary care.

The next few months will hopefully see the recruitment of more collaborative members, including pharmacy technicians. In future meetings we will be exploring further risk management techniques and finding out more about the initiatives that have already been implemented.   In future blogs you will hear from members of the collaborative, who will share their experiences of being involved in patient safety research.  For now, the team at the Greater Manchester PSTRC would like to thank all those who have contributed to the success of the collaborative so far.

Read part two of the blog series.

Read part three of the blog series.