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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 .

 

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.

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

23 Feb

by Penny Lewis, Medication Safety theme

james-hind-superdrug-awards_cropped

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

NIHR Greater Manchester PSTRC Meet the Team – Jane Sarginson

18 Jan

The third in our NIHR Greater Manchester PSTRC ‘Meet the Team’ series introduces Jane Sarginson, Daphne Jackson Fellow in Medication Safety theme.

Jane Sarginson_Meet the Team

Jane Sarginson_Meet the Team_Page_1Jane Sarginson_Meet the Team_Page_2

World Suicide Prevention Day: Increasing awareness amongst pharmacists

10 Sep

by Hayley Gorton (@hayley_gorton | @meds_safety), PhD student in Medication Safety theme and Pharmacist

World Suicide Prevention Day_HGblog

Every year, over 800,000 people die by suicide, worldwide. Suicide is, therefore, a major public health issue which the World Health Organization are committed to reduce – a 10% reduction in suicide deaths is pledged by 2020 [1]. Today, 10th September 2015, is World Suicide Prevention Day. I tentatively suggest that surprisingly few people will have heard of this international awareness day and perhaps realise the contribution of suicide as a cause of death worldwide. Recently, I attended the 28th World Congress of the International Association for Suicide Prevention (IASP) in Montréal. Fantastic work was presented by researchers from different backgrounds and there was a real sense of community and camaraderie between these researchers who are striving towards a common goal. On realising that I am in a unique position as a pharmacist researching in this field, I reflected on the likely awareness of suicide demographics and risk factors amongst my peers. As pharmacists are often the front line of public health, I have taken it as my duty to raise awareness within my field. To begin, I have written an article aimed at pharmacists published online in the Pharmaceutical Journal, the journal of the Royal Pharmaceutical Society, website: http://www.pharmaceutical-journal.com/opinion/blogs/suicide-an-unspoken-public-health-problem/20069127.blog

If you, or somebody you know if affected by suicidal thoughts or actions, please seek help; Samaritans 0845 790 9090

References

  1. World Health Organisation. Preventing Suicide: A global imperative. [Internet]. 2014 [cited 2014 Sept 12]. Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ .

 

 

The Drugs Don’t Work – the importance of using antibiotics responsibly

26 Jun

by Christian Thomas, PhD student in Medication Safety theme

Antibiotic Guardian _Christian Thomas blog_June 15

This summer saw the Chief Medical Officer of the NHS, Professor Dame Sally Davies present at the annual Cockroft Rutherford alumni lecture at the University of Manchester. The theme of the lecture was ‘The Drugs Don’t Work’ and focused on the real threat that the misuse of antibiotic medication poses to patient safety both nationally and worldwide (view the full lecture). Antibiotic medicines work by killing or preventing the growth of bacteria. When antibiotic medicines are used inappropriately bacteria can fight back and become ‘resistant’. This can happen when we take antibiotics that we don’t need (such as for a cold which is caused by a virus), or when we don’t take antibiotics the correct way (such as not finishing the whole course of a prescription). When bacteria become resistant, antibiotics are no longer effective at killing them. This means that the drugs used to treat bacterial infections are less likely to work and that infections could get worse or be passed on to others. Bacterial resistance is a growing problem and over 23,000 people die each year from bacterial infections that are resistant to antibiotics (1).

HowAntibioticResistanceHappens_CT_June15

1. Prevention CfDCa. About Antimicrobial Resistance 2013 [cited 2015 16th of June].

Before antibiotics were discovered, infections could often be life-threatening. Simple operations and procedures were more risky due to the infection risk, and as late as the 1930s people died from infections. Today, not only do we rely on antibiotics when we have an infection, many patients rely on antibiotics to survive including patients receiving chemotherapy, dialysis, organ transplants and caesareans. Whilst researchers are trying to find new antibiotics, little progress has been made over the last over thirty years. Therefore, it is very important that we do everything that we can to ensure that the antibiotics we have remain as effective as possible. Sadly, not doing so risks taking us back to a time where common infections and minor injuries pose a serious threat to patient safety.

There are many ways in which we can help to slow antibiotic resistance. One simple thing that we can all do is wash our hands thoroughly as this helps to stop the spread of bacteria. Other important steps we can all take are to use antibiotics only when they are deemed necessary by a health professional. We should not expect antibiotics to be prescribed for a common cough or cold, as these are more likely to have been caused by a virus rather than a bacterial infection. If antibiotics are given, we should make sure to finish the whole course, even if we are feeling better. Finally, we should never share antibiotics with friends or family or use leftover prescriptions. Visit the Antibiotic Guardian webpage for more information on antibiotic resistance and to pledge to become an antibiotic guardian.

Sci-art: It works!

26 Nov

by Hayley Gorton, PhD student in Medication Safety theme of the Greater Manchester PSTRC

Mosi Wonder Drug Roadshow_sculpture

As a pharmacist and scientist, the concept of combined science and art work is somewhat of a mystery to me. Then, on a trip to the Wellcome Collection, Marc Quinn’s sci-art caught my eye: a sculpture made from a combination of wax and HIV medicines, to depict the individuality and personalities of people who are suffering from HIV. Whether you understand science, art, or both; this was sure to strike a chord.

In order for the public to understand our medication safety roadshow (28th-30th October 2014), perhaps we also needed some ‘abstract ‘approaches? We took this challenge to our fantastic year 10 students at Manchester Health Academy…

In our workshop, I delivered key messages about medication safety and Kate asked students to design artwork to represent key messages. On our return, two weeks later, I was thrilled that they had remembered some of our key medication safety messages! In one hour, half of the group produced two fantastic pieces of artwork. One depicted “stop, think, beware!”, to remind the public that we all have a role in medication safety and the second was a head filled with medicines, to show thought processes regarding medicines and what may go wrong. The other half of the class piloted our roadshow activities, and were not short of honest feedback, which helped us target activities to suitable age groups.

Thanks to staff and students @Health_Academy for welcoming us and to all who came to the roadshow!

Continue the conversation @meds_safety #mymedsafety