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Patient Safety in Community Pharmacy: the importance of teamwork

19 Oct

by Tomasz Niebudek, Pharmacist

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My name is Tomasz Niebudek. I work as a community pharmacist in the Salford area. Last year at the end of May our Superintendent Pharmacist forwarded to me an e-mail asking if anybody would be interested in taking part in a project at The University of Manchester. In a nutshell, the aim of the project was to improve safety in community pharmacy. I expressed my interest in participating, thinking that this would be an interesting challenge, that would allow me to reflect on and improve safety in my pharmacy and across the whole company.

One of the key things that I learnt by joining the collaborative is that we should look, not only at reactive ways of analysing errors, but also use proactive methods  to prevent errors from occurring before they’ve happened. The tool that, in my opinion, had the biggest impact on my practice was PRIMO (Proactive Risk Monitoring for Organisational Learning). This was basically a questionnaire given to all staff members in my team to find out what affects their ability to dispense accurately. This led to many interesting observations and reflections. It was encouraging to see that staff members who are usually quiet during the staff meetings had very strong views on certain matters. Some team members identified a problem and were able to provide a solution to it almost immediately. It was so motivating to see that they care about safety and it was also interesting to discover that my staff members have observed issues that I have never picked up on. 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. As you all know, change within organisations can be met with resistance by staff. However, the fact that the ideas were generated by the staff themselves made a huge difference (a positive one, of course). Doing that questionnaire made me realise that staff need to be fully onboard when safety is being considered.

I now encourage all staff in my branch to report near misses and dispensing errors, as previously, this was a task only/usually undertaken by myself. We work together to think of ideas to improve practice and safety in the pharmacy. Initially, I was worried that some staff might have the attitude that “this is not my problem”, which is an approach that I think is partially to blame for errors in primary care. However, I’ve learned that if you respect your team for the valuable input they can have in improving practice, and work with them to achieve this aim, it pays back.

Big thanks to The University of Manchester researchers in helping us to look at safety from a different perspective.

The purpose of the Community Pharmacy Patient Safety Collaborative is to work as a group exchanging ideas and sharing experiences. The same approach must be used on an individual pharmacy level- pharmacists can only improve the safety of their patients with his or her team on board.

Safety Informatics: Using every opportunity to learn

11 Sep

by Niels Peek, Research Lead for Safety Informatics theme

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As our world is quickly becoming more connected, a transformative potential emerges to make it safer. Digital technologies are now commonplace within the NHS and in our daily lives, producing rich data on all aspects of health.

For instance, my smartphone captures my whereabouts through its GPS sensor and thus knows that I’m currently in China. It also measures my physical activity by counting my daily steps. The electronic health record maintained by my GP describes all interactions that I’ve had with primary care, including symptoms, observations, measurements, test results, prescriptions, and referrals. Hospital records capture rich data on diseases (e.g. through high-resolution images) and provide detailed accounts of any hospital care that I have received.

Connecting these data sources can help us gain a deep understanding of patient safety issues and the factors that can increase risk. Not only can they tell us that an adverse event has happened (e.g. someone was admitted to A&E) but they can also help us to trace back the chain of events leading up to this (e.g. a trip abroad; followed by a period of staying at home, not feeling well; a GP visit).

Advanced analytical methods such as Artificial Intelligence can subsequently facilitate early assessments of risk, and support patients and clinicians in preventing adverse events. This structured, system-level approach is also known as a learning healthcare system: an integrated healthcare system which harnesses the power of data and analytics to learn from every opportunity, and feed the knowledge of “what works best” back to patients, clinicians, public, health professionals and other stakeholders to create rapid cycles of continuous improvement.

The Safety Informatics theme within the NIHR Greater Manchester PSTRC will utilise the learning healthcare system approach to understand real-world contexts in which safety issues arise and what is required to take corrective actions. We will build on the established “ACTION” infrastructure to provide real-time feedback to primary care clinicians in Greater Manchester which is already used to improve medication safety, support long-term conditions management, and facilitate antibiotic stewardship.Specific projects will focus on:

  • reducing diagnostic errors
  • enabling automated monitoring of late treatment effects in cancer survivors
  • prevention of pulmonary complications after surgery
  • more timely and accurate computer-assisted monitoring of lab test results by both    patients and clinicians.

Patient safety and children with long-term health conditions

4 Sep

by Sue Kirk, Professor of Family and Child Health

Juvenile diabetes patient with his mother

Increasing numbers of children and young people are living with a long-term health condition such as diabetes or asthma. Over the past 20 years we have also seen more children with complex healthcare needs being cared for in their own home rather than in hospital.  These changes have led to parents (and the children themselves) taking on roles and responsibilities that would have been unthinkable in the past. This includes monitoring their individual health, managing their own medication and treatment, using complex medical equipment such as ventilators, acting as care coordinators, and in some cases organising and managing home care teams.

Parents and young people don’t only manage these health conditions within the relatively controlled environment of the home. Children and young people go to school and college, take part in social activities with their peers and families, go on holiday and may spend time in hospices and other care settings. They may also receive services from a vast array of health, social care and voluntary sector organisations. This presents challenges for communication, both between professionals and between families and professionals, and consequently for care integration. This is worsened as young people transfer to adult services.

Surprisingly there has been little research that has examined patient safety for this marginalised group. We don’t know how families or health care professionals understand, monitor and manage safety in this complex situation or how safety could be promoted and improved.  This is what we intend to look at as part of the Safety in Marginalised Groups: Patients and Carers theme of the Greater Manchester PSTRC.

Placing ALL patients and carers at the heart of patient safety research: introducing our new theme on marginalised groups

23 Aug

by Caroline Sanders, Research Lead in Safety in Marginalised Groups: Patients and Carers

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In his 2013 review for improving patient safety, Don Berwick emphasised the importance of seeking out the voice of patients and carers, and ensuring they are ‘present, powerful and involved’ at all levels. This has been a major focus of our earlier research, our involvement and engagement work, and led to our priority setting partnership in conjunction with the James Lind Alliance in March 2017. This identified the number 1 question for future research is to understand ‘How can patient safety be assured for the most vulnerable in society?’. This recognises the widespread concerns and evidence showing that patients and carers who are already disadvantaged and marginalised, may also be at greater risk of harm within the healthcare system.  Additionally, we have not yet done enough to ensure we hear the voices and understand the experiences of marginalised groups to be able to develop appropriate and effective interventions to support patient safety for ALL patients and carers.

Our starting point for the new research that will evolve along with our further Patient and Public Involvement (PPI) work, is to acknowledge that people may be disadvantaged and marginalised by multiple factors such age, disability, ethnicity, sexuality, gender, and socio-economic disadvantage.  For example, we know that BME groups have poorer health outcomes, and poorer access and experiences of healthcare services. People may also be marginalised because of stigma and poor access to services for specific conditions (e.g. mental health problems); or they may be marginalised because of the circumstances or settings in which they live (e.g. living alone, caring for someone at home, living in a rural setting, in a care home or prison, being homeless).

In this theme, we will be working closely with other themes and our PPI contributors to focus on and understand safety risks and concerns for specific population and patient groups. For example, what are the particular challenges in relation to communication, which we know is considered by patients and carers to be a crucial foundation for safe care? What are the challenges for marginalised groups of patients in the ever-changing care context, where there are new responsibilities and health care practices expected as a part of enabling better self-management? We will co-design or adapt tools to support patient safety that will be tailored for such groups.  This may include use of mobile apps or other technologies, and we will also focus on the help and support that people might need to make sure they can use these, or enable appropriate alternatives. We know this means we need to be creative in reaching out to communities and groups who currently feel disempowered or hidden in relation to healthcare research and service provision. We are looking forward to this exciting opportunity to seek out some of the quietest and most hidden voices to ensure the most vulnerable can have better and safer care.

Please see our webpage or contact us for further information or to share any comments and suggestions.

Patient Safety: the way forward

8 Aug

by Stephen Campbell, Director of the NIHR Greater Manchester PSTRC

University campus

Seventy five percent of patient safety research is focused on hospitals. Less is known about patient safety outside hospitals, yet 85% of NHS contacts happen in these settings, mostly in general practice and in pharmacies. The scale of primary care in England is huge. There are 340 million general practice consultations annually, with 2% involving a patient safety incident, which means 6.8 million times each year where a patient is potentially at risk of harm. There are one billion prescriptions issued per year outside of hospitals, with 4.9% having an error – 49 million every year. And 20% of patients discharged from hospital will report an adverse event, which could lead to costly readmission to hospital. On 1 August 2012, the Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC) started, funded by the National Institute for Health Research (NIHR).  Our PSTRC has been a groundbreaking centre as it was the first patient safety centre to focus on primary care (general practice, community pharmacies etc.) as well as the interfaces with hospital care. The focus on primary care was intentional and needed.

We have achieved many improvements in primary care safety over the last 5 years. For example, we have developed a “Safer Prescribing” e-learning course for GPs, which has reduced prescribing errors.  We have developed a Medication Safety Dashboard as a “missed opportunity detector” that has resulted in fewer patients being at risk of potentially hazardous prescribing. We have used mobile technology such as smartphone apps to deliver safer healthcare. As an example, ClinTouch monitors symptom change in people with serious mental illness. We have worked in partnership with patients, GPs and pharmacists to create a Patient Safety Guide for general practice.

I am a health services researcher who has focused on the quality and safety of primary care for 25 years. Over that time there have been many advances in improving quality and safety but equally people are living longer, often with several health conditions requiring care from many different sources, in a world that becomes ever more complex with new digital technologies and “intelligent healthcare communities”. Most research and advances in patient safety are typically found within single care settings, such as the emergency department. Less attention has been paid to safety between (transitional) community providers and hospital care settings. Delayed diagnosis, incomplete patient information and medication errors are examples of problems, which may occur both within settings and across an interface. That is why we shall focus on primary care but also on transitional care settings in our second period of 5-years of funding from the National Institute for Health Research (NIHR), which started on 1 August 2017.

Over the next 5 years, our research will focus on:

  • Safety Informatics – developing technologies and behaviours that create safer care systems and to prevent diagnostic errors – working with the Health e-Research Centre
  • Medication Safety –developing safety management systems to ensure safer prescribing and treatment and to prevent medication errors
  • Safer Care Systems and Transitions – a new theme, to make care safer for patients moving between care settings
  • Safety in Marginalised Groups – a new theme – to enable patients and carers to take control of their care. There will be a key focus on patients and carers as well as mental health, working with the Centre for Mental Health and Safety

Service responsibility and patient responsibility for patient safety go hand-in-hand. They are equal. A member of the public seeking healthcare as a patient for themselves or a loved-one deserves the safest and best quality care possible. That is the duty of healthcare providers and professionals. Avoiding errors, or identifying and correcting them, is a high priority. Equally, patients can do much to keep themselves safer in terms of accessing care appropriately, taking medications as prescribed, self-managing a healthy lifestyle with sensible eating and drinking as well as exercising etc. This is the responsibility of each member of the public. It is a shared responsibility that requires co-design and partnership working, which underpins everything we do.

A key aspect of our work, and something which I think is crucial to the PSTRC, is capacity building and training people to be able to conduct and apply research. This includes recruiting PhD students, helping a group of pharmacists to work together on research projects in their own pharmacies, and training researchers as well as members of the public and patients. Healthcare isn’t just about a medical procedure or treatment option, it is about people, both those who deliver the care and those who receive it or work in partnership together. The PSTRC aims to be an interactive research centre working with healthcare professionals, the NHS, local authorities, industry and patients, carers and members of the public to make healthcare safer.

Much is happening in Greater Manchester that gives us opportunities to make a real difference. We will work across Greater Manchester’s newly-integrated Health and Social Care Partnership which serves 3 million people. The Connected Health Cities programme across the north of England will help us get our research implemented. We will continue to work in partnership with colleagues at the University of Nottingham, especially in the research on safer transitions and medication safety. We look forward to new collaborations with colleagues at the Christie NHS Foundation Trust and Central Manchester NHS Foundation Trust. There is much we can do using new digital technologies and behavioural interventions to improve safety and healthcare for the benefit of patients.

I want to thank everyone who has been involved with the PSTRC over the last 5 years. I look forward to working with everyone in the new PSTRC to continue our exciting, innovative and important research. The PSTRC has many outstanding and world-leading researchers and an excellent core staff. There is much to do but we will continue to build the capacity to make care safer.

The PSTRC has a strong involvement and engagement agenda working alongside members of the public and patients as well as healthcare professionals. If you would like to find out more about our research and how you can get involved then please email Zarina Saeed at zarina.saeed@manchester.ac.uk .

 

My final article

28 Jul

by Max Scott

Part nine of the series The desperate fight to be heard, and supported, when living with the invisible struggles of Multimorbidity

Introduction to the blog series is here.

Max Scott_My final article

Well, this is, sadly, my final piece for Greater Manchester PSTRC, on my own personal experiences with Multimorbidity. I have enjoyed the experience of not only having a platform to vent my own frustration, but to hopefully interest, inform, and help others in a similar situation.

Ironically, the update that I do have since my last post is a perfect example of why I wrote these articles in the first place – it is the ultimate case of a patient not being listened to.

I have been in receipt of Disability Living Allowance (DLA) since my Pituitary surgery in 2005. Well, this year my DLA was changed to PIP (Personal Independence Payment). I didn’t expect much of a problem, as all the evidence and back up from medical professionals was there to be seen. However, it did take a week of putting a couple of hours in a day, with the help of my wife, to get the PIP form done. Naturally, that proved very stressful and tiring for someone like myself who has severe chronic fatigue. The form asked if I would give my permission for them to contact any medical professionals who had treated me, and I agreed to this.

Much to our surprise, I was sent for a PIP assessment, which basically consists of having somebody who has never met you before fire questions at you for an hour, and ask if you can raise your hands above your head, bend your knees, and touch the inside of your leg with the opposite foot. Then it is “Goodbye, you should hear from us in six to eight weeks”. Well, I did. I had failed. Apart from the emotional upset and anger it caused, that meant a large loss of income to me and my wife after receiving DLA unquestioned because all the proof was there for 12 years. The only change during that time is that my conditions have become steadily worse.

Why did this happen? Because they completely ignored the facts. Not opinions, facts. They made sure that I was “two points short” in their scoring system. My wife is my carer, but they said I didn’t need a carer. I have memory problems, they said I don’t have memory problems. I have cognitive dysfunction, they said I did not have cognitive dysfunction. My wife has to administer my medication as I get muddled and make mistakes, they said I sort my own medication out. I have aids in the bathroom, including a frame, a raised toilet seat, and a squatting stool, for severe problems that have been medically recorded. They said I did not need these aids. Not only all of this… but they did not contact any of my doctors or specialists, seemingly because they knew that they would back me up. We applied for a reconsideration; they once again ignored the facts and turned me down.

We have put in an appeal and sought the back-up of our local MP, and he was only too happy to help as he could see the decision was nonsense. We are now in the process of waiting for the date for this appeal, something made even more painful as we are also going to have to attend a coroner’s inquest into the passing of my dear Mother last December, and this is expected to take place between October and December.

In summing up, I can only say how sad I am that, during the process of my series of articles, nothing in the way of Multimorbidity services has happened, no progress has been made for the many sufferers of this life-changing affliction, and I cannot see anything changing in the near future. Marching down Whitehall to Downing Street, chanting and waving placards is not for us… most of us haven’t got the energy! But, eventually, somebody of influence needs to make a noise about this, and the only way for that to happen is to somehow voice our unhappiness and frustration as much as we can and to whom we can, until the term “Multimorbidity” is no longer met with bewildered looks from the vast majority of the population who have never heard of it.

In conclusion, I’d like to wish Greater Manchester PSTRC all the best in its future research and endeavours. To all who have read my articles and have a daily struggle with their health, thank you and I hope you find something that makes life that bit easier and more enjoyable. Perhaps that may even be in the form of a medical practitioner who… listens.

Introducing…Safety in Marginalised Groups: Mental Health

5 Jul

by Nav Kapur and Roger Webb

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Safety in mental health services:  reducing suicide and self-harm

Nav Kapur, Research Lead, says:

‘It’s fantastic to be involved in the new NIHR Patient Safety Translational Research Centre.  It is particularly exciting that safety in mental health services will be a prominent part of the new work.  We are really looking forward to getting started.  We will be making new appointments (both Research Associates and funded PhD students) in order to make this a world-beating research programme.  The focus on both suicide and self-harm is really pertinent given the current policy and health priority on these very important outcomes.  So over the summer and autumn we will get going on the actual research using a variety of methods.  Personally I can’t wait to start working with the internationally-leading team of researchers, academics and clinicians across the PSTRC’.

Roger Webb, key project lead, says:

‘I’m enthused by this wonderful new initiative, which enables our Centre for Mental Health and Safety to join forces in working collaboratively with a much larger group of internationally renowned experts in the patient safety field. Our planned work programme, focussing on self-harm and suicide, encompasses a number of ground-breaking studies.

These studies include:

  • evaluating how changes to health service provision may impact on national suicide  rates
  • developing and testing psychological treatments following self-harm
  • investigating key transitions from institutional care to living back in the community, among discharged patients and released prisoners with enduring mental health problems
  • assessing clinical management of common mental health problems across healthcare sectors, and subsequent risks of self-harm, suicide and other causes of premature death.’