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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.

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.

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.

Health Innovation Manchester Patient Safety Collaborative

3 May

The PSTRC’s second core aim is to deliver “a translation pipeline” that feeds the outputs, products and learning from our work to local and national policymakers and health and care providers. The PSTRC works closely with Health Innovation Manchester, which is an academic health science system that brings together the research, education and clinical excellence of the Department of Health and Social Care (DHSC)-designated Manchester Academic Health Science Centre (MAHSC) with the expertise and national connections of the Greater Manchester Academic Health Science Network (GM AHSN). This will ensure scarce financial and workforce resources are used to provide value for money and safer health and care.

The PSTRC has developed strong links with the Health and Social Care system in Greater Manchester and Health Innovation Manchester, as well as the Patient Safety Collaboratives and Academic Health Science Networks in Greater Manchester and the East Midlands.  PSTRC staff are members of the Health Innovation Manchester Patient Safety Collaborative Steering Group (Ashcroft, Campbell) and the Research and Evaluation Committee for Patient Safety Collaborative-East Midlands (Waring).

Examples of specific projects will include the PSTRC working with:

  • The Greater Manchester Patient Safety Collaborative on its deteriorating patient agenda with plans to develop an ‘early warning’ tool for identifying and responding to deteriorating patients following discharge from hospital to a community setting
  • The Christie NHS Foundation Trust on on optimising safe follow-up and patient experience after discharge from out-patient care
  • A range of health and care and voluntary organisations in developing its research on homelessness
  • NHS England and NHS Improvement to reduce the level of medication error across the NHS
  • NICE, DHSC, NHS England and Health Education England to reduce suicide rates and self-harm
  • The Manchester Patient Safety Collaborative to implement the Patient Safety Toolkit across Greater Manchester.

How was it for you? Reflections on involvement

3 May

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This edition’s reflection comes from Lauren Worrall, a pharmacist who is involved in the NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative.

Lauren, why did you become involved in the Greater Manchester Community Pharmacy Patient Safety Collaborative?

My motivation to join the collaborative was to receive training on different skills and techniques to improve patient safety within my own practice area.  Furthermore I wanted to explore the world of research within pharmacy.

How do you think the Greater Manchester PSTRC benefitted from your involvement – what difference do you feel that you made?

As a group we devise potential ways to improve practice and develop various interventions.  As an individual I can then go out and test the efficacy of the interventions in pharmacy practice settings. My experience in community pharmacy allows me to positively contribute to the work of the collaborative.

Personally and professionally, how do you feel you benefitted from your involvement?

Getting involved with the group has allowed me to work with other pharmacists and safety experts to reflect upon and improve my own practice. It has also afforded me a better knowledge of what is involved in research.

Would you recommend becoming involved in research to other healthcare professionals? If so, why?

Participating in research allows you to be creative and explore innovative methods in whichever healthcare setting you are working in. If you are interested in improving your practice and that of others then I would highly recommend getting involved.

Pharmacists working towards safety improvements

3 May

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The Greater Manchester PSTRC’s Community Pharmacy Patient Safety Collaborative was set up by the PSTRC to encourage a mutually-beneficial dialogue between community pharmacy workers and researchers, and ultimately to improve patient safety.

The PSTRC’s Medication Safety team shares their knowledge on best practice in patient safety and risk management techniques with the Collaborative and in turn, the Collaborative shares their experiences and insights of practical day-to-day pharmacy practice with the PSTRC.

The group of 9 pharmacists are employed in a range of pharmacies from small independents to large chains, and they meet on a monthly basis. Sessions involve teaching of safety concepts and risk management techniques, sharing of experiences and discussions on the issues currently impacting on the safety of work in pharmacies. Outside of the sessions, the Collaborative engages in research-based activities – such as audits, or applying the taught risk management techniques to their own practice – with a view to sharing their insights within the group.

Pharmacists have seen real-world benefit through their involvement in the Collaborative:

  • James Hind, Community Pharmacist, says:  “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).”
  • Tomasz Niebudek, Community Pharmacist, says: “The tool that, in my opinion, had the biggest impact on my practice was PRIMO (Proactive Risk Monitoring for Organisational Learning). This was a questionnaire given to all staff members in my team to find out what affects their ability to dispense accurately. I have very carefully analysed all the data from those questionnaires and shared my conclusions with my whole team during a staff meeting. We have straight away implemented changes to our practice.”

You can read more about the Community Pharmacy Patient Safety Collaborative in our blog series.