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

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

Question 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.

James Hind, member of the Community Pharmacy Patient Safety Collaborative, scoops Clinical Excellence Award at Superdrug’s annual Awards Ceremony

by Penny Lewis, Medication Safety theme

James Hind, pharmacist and member of the Greater Manchester Community Pharmacy Patient Safety Collaborative, scooped the Clinical Excellence Award at Superdrug’s Annual Awards ceremony in Heathrow last week. The ceremony which aims to celebrate employees’ successes and achievements also marked 25 years of Superdrug Pharmacy. Other awards included Nurse of Year, Operational Excellence Award and Pharmacist of the Year (for which James was also nominated). James was awarded this honour after being recognised for his outstanding contribution to patient safety as part of his work with the Community Pharmacy Patient Safety Collaborative.

James, who has undergone training in risk assessment techniques and incident analysis as part of the collaborative, has shared his learning across the company via their online ‘Hub’. One of James’ innovations has been the design and production of bag labels to prompt both staff and patients to check their medications or ask any questions before leaving the pharmacy. James has conducted a survey to explore patients’ views of the label which has shown that the label is well received by patients and can, in some cases, prompt patients to take a more proactive approach to checking. James hopes to evaluate the impact of the label on patient safety incidents over the next few months.

James’s passion for improving patient safety engendered by his work with the collaborative has inspired James to work more closely with Superdrug’s Safety Office and also suggest improvements to their incident reporting system. James also noted that error reporting has increased threefold as a result of his participation in the collaborative and that his team are now far more reflective of their practice when things go wrong.

Well done James!

Read James Hind’s blog post on his involvement with the Community Pharmacy Patient Safety Collaborative here

Reflections on ISQua 2016

by Sally Giles, Research Fellow in Core theme

This year’s International Society for Quality in Healthcare (ISQua) conference took me to the vibrant city of Tokyo, famous for its incredible technological growth, its seismic activity and geological features. For me, as a former geographer, this diversity was certainly fascinating and a real attraction! The Tokyo International Forum was the chosen venue, and with its numerous different levels, it even provided a challenge to those with the best sense of direction! 

The conference this year covered eight main themes, with hundreds of concurrent sessions to choose from; including 50 minute plenary sessions, 90 minute workshops and 15 or 5 minute oral presentations. There was also an impressive display of posters in the exhibition hall. One of the main highlights of the conference was the Japanese Bento lunch boxes, which made a welcome change to the often bland and uninteresting lunches provided at conferences. I was however slightly disappointed to see so little primary care research. I therefore challenge all Greater Manchester PSTRC researchers to place primary care patient safety research on the ISQua agenda in 2017.

This year I was allocated a 15 minute oral slot as part of the Person Centred Care theme. I took to the rather large stage and presented the findings from an NIHR Research for Patient Benefit (RfPB) study, “Developing a Patient-Led Electronic Feedback System for Quality and Safety within an existing Electronic Health Record”, which has since been accepted for publication in the Journal of Renal Care. My presentation was well received with particular interest in how we were going to take the patient reporting system forward and what training would be required for the patients who may wish to use it. Definitely food for thought!

Patient Safety in Dentistry

By Barry Kinshuck, Dental Adviser representing the British Dental Association

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.

 

Dangerous GP surgeries are named and shamed… Why is the patient’s voice unheard?

by Jill Stocks, GM PSTRC Research Fellow for Core theme Most patients receive safe quality care from their general practice. However headlines such as these will not be surprising to many of us. Prof Steve Field, the CQC’s new chief inspector of GPs, commenting on the Care Quality Commission’s preliminary report, said the problems highlighted in the checks had sometimes been known about locally for years. “We are hearing about problems that people are very worried about but no-one has tackled in the past.” If our concerns about our GP practices are not being acted on then should we be complaining louder and more often? Most of us are probably unaware of how to raise our concerns with our GP practices. If we look at the information provided by the NHS we are encouraged to complain to our GP first (NHS complaints). Naturally we feel intimidated and uncomfortable about complaining directly to the GP yet the means to raise our concerns with an independent body is not readily accessible. We can go to the Parliamentary and Health Service Ombudsman, although we are supposed to complain to our GP practice in the first instance, or we can read the NHS constitution to discover the formal procedures. However a recent survey by the Patients Association shows that even those who are aware of the NHS constitution do not know how to enforce these rights. The National Reporting and Learning System collects reports of patient safety incidents. Only NHS staff can report to this and only about 0.5% of reports come from GP practices. Does this mean the complaints are not being reported or are they not being made by the patients to the NHS staff? I have made a complaint on behalf of my mother who was prescribed a dose of a drug large enough to kill her. I felt that the investigation by the Primary Care Trust did not deal with the problem adequately yet I never had the opportunity to comment formally on the investigation. This is why we just grumble to anybody who will listen when we have a problem with our GP practice, even when that might seriously affect our own or someone else’s safety. We need an accessible, fast-acting, responsive route to raise our safety concerns about primary care now. Not until we ask the patients about safety in GP practices will we have the true picture.

 

 

A game of two halves: GM PSTRC at ISQua 2013

by Denham Phipps, Research Fellow on Medication Safety theme and Sally Giles, Research Fellow on Core theme What do healthcare trust directors and premiership football managers have in common? This was just one of the things that 2013’s International Society for Quality (ISQua) conference led us to think about.  This year the conference took place in Edinburgh, much to the delight of those who like hills as much as they do healthcare research.  The clicker-count alone was impressive, with 1200 delegates arriving from 73 countries to listen to 250 speakers and look at 370 posters.  That’s a lot to pack into four days by anyone’s standards, and so we were able to experience only a sample of what ISQua had to offer.  The proceedings opened on Sunday with a session on the Francis Report.  As well as being informative, it led to some lively and thought-provoking discussion, including that analogy involving trust directors.  Like their sporting counterparts, their positions are apparently less secure than they once were, given the level of scrutiny that now tends to be directed at any individual holding either type of post.  Is it a good thing for trusts (or football clubs) to have a constant turnover of leader?  Do we pay as much attention to addressing the social, political and economic factors that set the scene for the problems at Mid Staffordshire?  And why do we hear less about the high-performing trusts? On the next three days came the main conference sessions.  There were many interesting presentations here; a particularly creative one was the mock trial of a nurse, doctor, pharmacist and hospital director who had apparently been involved in a serious medication error.  It was instructive for us in the audience to hear these healthcare professionals being grilled by a real-life legal professional, and to be given the task of delivering the verdict on each of them.  The take-home message was clear: the justifications that one might create in the office to support risky practice can, in the courtroom, turn out to be a house of cards. It was particularly reassuring to see a strong emphasis on involving patients and the public to help improve quality and safety at ISQua 2013.  There were examples from different countries; such as involving patients’ families in death review in New Zealand, patients accessing their medical records in Taiwan, and in the UK, patients reporting patient safety concerns in a hospital setting.  One presentation that we saw included the relative of a patient who had been harmed as a result of a medical error; a great example of how healthcare professionals, healthcare researchers and service users can work in collaboration to bring about improvements in quality and safety.  However, although there was a clear message that involving patients and the public is worthwhile, there were only a small number of examples of how this can be done successfully, none of which were in a primary care setting.  So, it seems, there is a need for further work in this area, and we at GM PSTRC aim to rise to that challenge. We look forward to ISQua 2014 where we can bring primary care into the PPI in patient safety arena!