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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.

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.

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.

Making prescribing safer with PINCER

16 Mar

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Recent news reports brought home the importance of reducing medication errors in healthcare. The news coverage highlighted that research, conducted by university academics in Manchester, Sheffield and York estimated 230,000 errors each year in the administering of medication in the NHS, contributing to 22,000 deaths. While the majority of these errors are spotted (and corrected) at the point of error, or do not threaten patient safety, a drastic reduction in the number of errors is now being called for. A change from the current culture of blame to a learning culture is one solution being discussed, but there are other, more practical interventions already in existence.

Once such intervention, called PINCER, is a pharmacist-led intervention developed at the Universities of Nottingham, Manchester and Edinburgh. PINCER has been shown to be an effective method for reducing a range of clinically important and commonly made medication errors in primary care.  Using a set of ‘prescribing safety indicators’ which identify common, but potentially harmful, medication prescribing errors, the intervention involves:

  •         Running searches on GP computer systems to identify patients at risk from common and important prescribing and drug monitoring errors
  •         Pharmacists – trained in the PINCER approach – working with individual general practices to develop an action plan to address the issues identified
  •         Pharmacists (and pharmacy technicians) working with and supporting general practice staff to implement the action plan.

With funding from the Health Foundation and East Midlands Academic Health Science Network, PINCER has been rolled out to 360 practices across the East Midlands since September 2015.  Over 2.9 million patient records have been searched, identifying over 21,000 instances of hazardous prescribing. Applying trends from data collected as part of the evaluation of the rollout, it is estimated that over 10,500 patients have received an active intervention resulting in safer care as a direct benefit of implementing the intervention.

The PINCER intervention has been incorporated into national guidelines to support medicines optimisation by NICE and a more detailed evaluation of the rollout in the East midlands is being done as part of a new NIHR funded programme grant called PRoTeCT to explore whether implementing PINCER reduces avoidable medication-related harm and hospital admissions.

A Patient Safety Toolkit for general practice

15 Mar

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The development and testing of a Patient Safety Toolkit for general practice has taken place over a number of years by a partnership of researchers at the Greater Manchester PSTRC in Nottingham (including Tony Avery, Brian Bell, Sarah Rodgers, Ndeshi Salema, Rachel Spencer) and Manchester (including Stephen Campbell, Kathy Perryman) the NIHR School for Primary Care Research at the Universities of Birmingham, Keele, Oxford and Southampton, as well as the University of Exeter.

The Patient Safety Toolkit is hosted on the Royal College of General Practitioners (RCGP) website. The RCGP is a network of over 52,000 family doctors. The Toolkit is important in preventing patients from being harmed. It is designed to be used by any general practice in the UK and covers the following topics:

  • safe systems
  • safety culture
  • communication
  • patient reported problems
  • diagnostic safety
  • prescribing safety

This range of topics addresses the fact that patient safety is complex and multidimensional. Improving patient safety requires preventing, identifying and addressing issues using practical and actionable information. The collection of tools is hosted on a single platform, which makes it easy to use and enables general practices to identify safety deficits. They can then review and change procedures to improve their patient safety across a key set of patient safety issues.

The research team has published a summary paper, which has been published in the Journal of Patient Safety: A Patient Safety Toolkit for Family Practices

How do I get more involved in my patient safety?

1 Feb

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We have been working together with patients, carers, members of the public, GPs and pharmacists to design a PSTRC patient safety guide for patients and carers. This will be a useful resource to help answer key questions about primary care patient safety and to identify points where patients and carers can make their own care safer.

The guide consists of a short booklet, website and cue card prompts which people can use flexibly:

  • to plan for a consultation
  • as a memory aid
  • to help make the most of the time a person has with a healthcare professional
  • to support their own care at home.

As part of this project, the PSTRC has held co-design events which have brought together members of the public, patients, carers, GPs and pharmacists to discuss how everyone can work together to make care safer. Discussions have focused on key points in the care pathway and actions that each person could identify to improve their patient safety with the priorities that were identified for their own care. These discussions were then used to develop and refine the guide.

Since completing the initial development stage of the patient safety guide, work has been taking place with key national stakeholders to further refine the guide and the centre will continue to co-develop the project and the testing of it with patients, carers and healthcare professionals.

If you’re interested in hearing more about the guide, or to find out more about future co-design events, please contact Rebecca Morris at rebecca.morris@manchester.ac.uk.

Where next for the James Lind Alliance? After 50 James Lind Alliance partnerships, what does the future hold?

1 Feb

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Last year, the PSTRC asked members of the public, patients, carers and healthcare professionals ‘What are your questions about primary care patient safety?’ This process was called a James Lind Alliance (JLA) Priority Setting Partnership (PSP). The aim of the JLA is to work with patients, carers and healthcare professionals to identify the questions they believe are a  priority for research to address. For our PSP the top 10 priorities included questions focused on the most vulnerable in society, holistic whole-person care, safer communication and co-ordination between care providers, work intensity, continuity of care, suicide risk, complex care at home, and confidentiality. This was the first national prioritisation of future research for primary care patient safety and helped shaped our new PSTRC focus.

There have now been over 50 JLA partnerships which have asked people to identify future research questions about a range of different healthcare areas from schizophrenia to endometrial cancer. In November 2017, the JLA hosted a meeting to reflect on the partnerships, identify key issues and to share learning. People shared their experiences to help shape the future of the JLA process and to reflect back on the process to identify the parts that worked well and where there might be room for improvement. Key to all the partnerships is that they have all prominently championed the voices of patients, carers and healthcare professionals to help prioritise research questions that are of importance. The JLA is overseen by the NIHR to support the research priorities identified through the partnerships so that they can feed directly into national funding priorities.