Tag Archives: Patient Safety

The Performance Improvement plaN GeneratoR (PINGR)

27 Jan

Working on laptop, close up of business man

A web-based software application that suggests bespoke improvements to the care patients receive from GP practices and pharmacies (primary care) is being developed by researchers at the NIHR Greater Manchester PSTRC.

The Performance Improvement plaN GeneratoR (PINGR) analyses electronic health records shared by pharmacies and GPs to audit the care patients are receiving against best practice clinical guidelines.

Dr Ben Brown, the lead researcher who developed PINGR is also a Salford based GP. He said: “PINGR is unique because it doesn’t simply tell you that patient care could be improved, it suggests specific actions for how this could be achieved. This focus on action over information is empowering for clinicians, and is more likely to lead to safer patient care.”

Whenever care is found to be suboptimal, PINGR suggests to GPs and pharmacists changes that can be made to improve the organisation of care and the management of individual patients. PINGR is used in a number of patient-safety related projects, one of which is Direct Oral Anticoagulants (DOAC) dose monitoring.

DOACs are a group of anticoagulant drugs comprising of Apixaban, Dabigatran, Rivaroxaban & Edoxaban that patients take to thin their blood if they are predisposed to blood clots. Patients taking one of these drugs may require changes to the dose depending on its effect on their renal function and other characteristics. It is very important to get the dosing right – if it’s too low the patient may have a blood clot, if it’s too high then the patient may bleed.

To help address this, the DOAC Dose Monitoring indicator was developed within PINGR. The indicator finds patients prescribed one of the DOAC medications, and determines whether they are on a safe dose given their kidney function and weight.

When a patient is found to be suffering from renal impairment, PINGR flags them as not meeting the standard for the indicator and suggests an action of ‘Review dose’.  The patient’s creatinine clearance level and their current dose are used to provide further information on recommended dose adjustments.

Additionally, if a patient doesn’t have a recent weight measurement on record (necessary for accurately estimating kidney function) they are also flagged as not meeting the standard. In these cases PINGR makes a suggestion for the patient to be contacted so they can be weighed.

Ben added: “Over the last few years we have been trialling PINGR in GP practices across Salford with positive results. Patients have seen an improvement in their healthcare and GPs have welcomed its implementation. The next step is wide scale adoption both as a tool in GP surgeries and as a programme that can be used in other areas of healthcare.”

PINGR is a partnership between The Wellcome Trust and the NIHR PSTRC. It is led by Dr Ben Brown, a GP and Senior Lecturer. Find out more here.

New paper reviews approaches used to improve discharge from mental health inpatient care

24 Jan

Photo for Natasha Tyler blog on systematic review_small

More research is needed to understand transitions from hospital based mental health care to services provided in the community such as pharmacies and GP practices, a  paper published in the BMC HSR has revealed.

The paper by Dr Natasha Tyler, who works in the Safer Care Systems and Transitions theme at the NIHR GM PSTRC, reviewed 45 studies carried out across the world that aimed to improve discharge from mental health inpatient care. However, very few conclusions could be drawn about the effectiveness of the interventions as they varied considerably in quality. Readmission was the most commonly reported outcome in the studies that were reviewed.

Natasha Tyler, the Lead Researcher on the project, said: “Discharge from acute mental health services back into community or primary care has previously been described as emotionally-driven and chaotic. It is also associated with an increased risk of suicide, self-harm and homelessness. Therefore, high quality research is needed to identify interventions which can improve patient safety.”

“We found, overall, the most effective interventions focus on addressing a single problem. These interventions clearly express the problem they aim to address and show how success can be measured. This is evident in the success of the interventions that aim to improve homelessness following discharge from mental health wards.”

“Many of the  interventions we reviewed aimed to solve different problems. For example, while some interventions were designed to reduce medication errors by involving pharmacists more closely in pre- and post-discharge care, other interventions used increased contact with health professionals post-discharge to attempt to reduce outcomes such as suicide and readmission.”

Professor Justin Waring who previously led the Safer Care Systems and Transitions theme at the GM PSTRC, said:

“The most promising results in terms of reducing readmission involve decreasing the professional and physical boundaries between hospital and community.”

The most successful intervention to ensure patients continued to take their medication as prescribed, was an increase in the frequency of contact with healthcare professionals post-discharge from hospital.

Dr Nicola Wright, Associate Professor of Mental Health based in Nottingham added: “In terms of accelerating discharge and reducing length of stay, the most successful interventions used a step-by-step approach, focusing on improving how multi-agency teams can work together across the care pathways. “

It is thought that 17% of people who died by suicide had recently been discharged from mental health services. While, suicide following discharge is rare it is more common in this population.  We found that very early post-discharge contact improved outcomes and patient safety.  Whereas, studies that involved the use of letters or distant forms of contact, or contact a long time after discharge, were generally less successful.

Lloyds Pharmacy launches pilot in Greater Manchester to help support mental health patients

20 Jan

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Qasim Bhatti, one of the LloydsPharmacy pharmacists involved in the pilot scheme

LloydsPharmacy is piloting an innovative new service that offers extra help and support to mental health patients. Funded by The National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), which is a partnership between The University of Manchester and Salford Royal, the pilot is being carried out in ten community pharmacies in Greater Manchester.

The new service, referred to as AMPLIPHY, enables pharmacists to provide personalised support to people who have been newly prescribed a medicine for depression or anxiety, or those who have experienced a recent change to their prescription.

The pilot programme has been funded and designed by researchers at the NIHR GM PSTRC in collaboration with LloydsPharmacy. Central to the programme is the ability for patients to lead the direction of support they receive. They set their own goals and objectives and the pharmacist supports them in these. The goals can be anything, from wanting to spend more time outside to taking up a new hobby.

Professor Darren Ashcroft, Deputy Director of the NIHR Greater Manchester PSTRC, said:

“The NIHR Greater Manchester PSTRC focuses on improving patient safety across four themes which include Medication Safety and Mental Health. AMPLIPHY covers two of these areas and we believe it has the potential to make a difference to patients, by providing enhanced support for their care in the community.”

Dr Hayley Gorton, who has helped develop the project and deliver training with the NIHR GM PSTRC and is Senior Lecturer in Pharmacy Practice at the University of Huddersfield, said:

“Community pharmacists are the most visited healthcare provider in England and 1.6 million people visit one every day. They represent a significant opportunity when looking at how to improve patient safety in the treatment of mental health conditions. We welcomed the opportunity to work with LloydsPharmacy on this pilot because we could see the potential for real impact. In our previous research, pharmacy teams themselves suggested the incorporation of a service related to medicines for mental health problems.”

During an initial consultation, a pharmacist will discuss the medication with the patient, chatting through the correct way to take it as well as what to do if they experience any potential side effects.  If they have any further questions or concerns it will be ensured they know who to contact at the pharmacy.

After the initial consultation, AMPLIPHY includes another meeting 7 to 14 days later, then a follow-up every time the patient picks up a prescription, for the first three months of treatment. It doesn’t have to be a face to face consultation; it is up to the patient.

Gary Pickering, Professional Support Manager at McKesson UK, parent company of LloydsPharmacy, said:

“We’re excited to be involved in a partnership that is helping to improve the lives of people living with mental health conditions. The AMPLIPHY service has been designed with patients in mind. Ten pharmacies are delivering the service, all of which have been chosen because of the pharmacist’s desire to be engaged in the project and enthusiasm to make a difference. All the pharmacists involved have received specialised training, which includes suicide awareness training to further improve patient safety.”

The aim is to recruit twelve people into the service in each of the 10 community pharmacies, generating a sample group of at least 100 patients.

Gary continues:

“Treatment for mental health conditions can often present ups and downs for patients during the first few months. As such, treatment failure rates can be quite high. By supporting the patients through this journey and giving reassurances that what they’re experiencing is normal, the hope is that the treatment outcomes will significantly improve. Pharmacists see patients regularly and already offer advice on medications. They are ideally placed to provide support and counselling for mental health patients and to help make sure their treatment is as effective as possible. It’s essential that we use this pilot as an opportunity to listen and to learn so we can find out what people want and expect from their interactions with pharmacists.”

The pilot is set to run until April 2020 when its impact will be evaluated before a decision is made on the next steps.

Participating pharmacies are located across Greater Manchester, and one is LloydsPharmacy, Health and Social Care Centre, Salford.


Researchers invited to the Community Pharmacy Patient Safety Collaborative Forum

16 Jan

Community Pharmacy Patient Safety Collaborative meeting_cropped

The Medication Safety theme at the NIHR Greater Manchester Patient Safety Translational Research Centre works with community pharmacists to improve safety. One of the ways it does this is by holding monthly meetings of the Community Pharmacy Patient Safety Collaborative Forum. It is now inviting researchers from across academia to bring along any relevant research ideas or studies to the monthly meeting for the opportunity to receive feedback from the pharmacists who attend.

Lisa Riste, a researcher at the GM PSTRC, which is a partnership between The University of Manchester and Salford Royal, who works with the group, said: “The collaborative has been running for more than 5 years and provides valuable stakeholder feedback on research. The pharmacists who come along are able to share their experience and give input which helps to ensure research is relevant and has the biggest impact. They’re able to flag potential issues or give their professional opinion which often proves invaluable insight.

“At the PSTRC we are working on a number of studies to minimise prescribing errors and have found the input from the collaborative invaluable. However, we’re also aware that research is taking place elsewhere which may benefit from this input from the experienced pharmacists who attend our forum.”

Once a month around 8 pharmacists meet, along with researchers from the GM PSTRC, to discuss current research. They share experiences of working with patients and give honest feedback on how any research findings could translate in the real world of a pharmacy. 

Lisa added: “We are inviting researchers to bring anything along to our meetings that they believe could benefit from stakeholder feedback. It may be a completed study, or just an idea that they’re considering researching.”

The GM PSTRC is one of three similar patient safety-focused centres which are located nationally and is responsible for research across four themes: Safety Informatics, Medication Safety, Safer Care Systems and Transitions, and Safety in Marginalised Groups. It is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust in collaboration with the University of Nottingham. It is funded by the National Institute for Health Research (NIHR) for five years from 2017 to 2022.

To book a slot at the monthly meeting, please contact: lisa.riste@manchester.ac.uk or phone, 0161 275 8357.

Developing Artificial Intelligence to triage patients

13 Jan

by Sarah Darley and Niels Peek

Blur medical background clinic service counter lobby with patient paying bill at cashier desk  in hospital

Work is underway to develop a new system which uses Artificial Intelligence to triage patients.

We are developing the Patient Automated Triage and Clinical Hub Scheduling (PATCHS) which is designed to be more accurate than previous automated triage systems as it takes into consideration factors such as a patient’s medical history.

To access the system patients will visit their GP practice website and enter the reason they need to contact a GP. They’ll be asked a number of relevant questions. PATCHS will analyse this information along with the data already stored about the patient such as their age and medical history, all of which will combine to provide a tailored triage decision.

In a feasibility study that has been completed, PATCHS was trained to make triage decisions in the same way as a GP. This involved the system learning how to use data from 10,000 triage decisions historically made by GPs. When the outcomes were compared, PATCHS was found to have achieved similar levels of accuracy as a GP.

As PATCHS has proved to be successful it is now being tested on a larger scale using 150,000 triage decisions across Salford and Manchester. This next stage of the testing will also examine how it’s implemented, how easy it is to use for patients and all GP practice staff, as well as the potential to roll it out on a large scale.

We believe that the potential for PATCHS to make a real difference to primary care is huge and wide reaching. Not only can it reduce waiting times but it could also increase access to GP services, and extend appointment times while helping patients to receive the right care for them.

There are also benefits for GP practice staff and if it saves money this can be used to improve patient care. Interestingly, PATCHS will give us insight into the use of AI in healthcare.

PATCHS is funded by Innovate UK. The project is led by Dr Ben Brown, a GP and senior lecturer, and the software is being developed by the technology company Spectra Analytics.

Getting to know you… Leah Quinlivan

10 Oct
Leah Quinlivan_photo

Leah Quinlivan, Research Fellow in Marginalised Groups: Mental Health

What’s your role within the PSTRC?

Donna and I work as a team and look after all the PPI and self-harm/ suicide prevention research with the PSTRC. Specifically, my work focuses on improving healthcare services for people who have harmed themselves.

What is the single most important thing you do in your role?

To facilitate the transition of high-quality research into practice. This is done through working closely with our PPI group, clinician advisors, and NHS trusts.

We have excellent research around mental health assessments and psychological therapies following self-harm, but there is wide variability in what services can offer patients. The most important aspect of my role is to close these gaps, and improve services for the people that present to hospital after harming themselves.

Why did you create a PPI group?

Donna and I were determined to set-up meaningful PPI involvement for the GM NIHR PSTRC self-harm and suicide prevention research. We are both passionate about involvement and had our own previous experience involving people in research and engagement events. The PPI group was set up to ensure our full research process was appropriate, meaningful, and relevant to patients and carers in mental health services.

We wanted to include patients, carers, and mental health clinicians throughout the process, so that’s reviewing our research questions, methods, study documents, analysis, results, dissemination, and implementation strategies. It’s back to the gaps in service provision again, if we want to translate our findings to clinical practice, then we need PPI involvement!

Why is it so important for your research?

Healthcare research should be carried out with patients and carers rather than about them. It’s essential for us to include PPI throughout the research process to ensure we are asking the right questions, taking the right approach, telling the right people, and sharing our results where it matters. Self-harm and suicide prevention research are sensitive topics and there are significant gaps between evidence, policy, and practice. If we want to close the gap, then we need to carefully listen and learn from patients, carers, and the staff working in services. Our aim is to avoid ‘ivory tower’ assumptions which can lead to shelved research studies with little practical benefit to patients or clinicians.

So far what is the most important thing the group has achieved?

Our PPI group named themselves MS4MH, Mutual Support for Mental Health and was formed only a year ago this month. They have significantly added to our large and complex health studies on self-harm and suicide prevention. Their involvement has led to a lot of success in recruiting patients to our online survey of assessments and aftercare following self-harm and for Donna’s family involvement in mental healthcare study.

The event we held for World Suicide Prevention Day at Manchester Town hall, #seedsofhope, was co-designed by MS4MH. The members of the group had excellent ideas for the event and wanted to highlight what hope means to them in an interactive and meaningful way. The #seedsofhope event was attended widely by the general public, Manchester City Councillors, patients, carers, and researchers. The members co-facilitated the event on the day and were truly outstanding in engaging with the public.

What are the biggest challenges the group has faced so far?

We are fortunate as the MS4MH group are developing great expertise in involvement in sensitive research topics. We look to our members for advice on any potential issues. So far, the challenges are offset as we discuss everything together at an early stage.

What are your hopes for the future achievements of the group?

That we continue to build on the empowerment ethos of the group and members receive more training and development in facilitation and research.

We are determined that the #seedsofhope event develops in a truly co-designed manner and the members take over a leading role in facilitating the installation at events. We plan to establish the PPI panel as a permanent and valued feature in the GM NIHR PSTRC, the Centre for Mental Health and Safety, and the Faculty of Biology, Medicine and Health in the University of Manchester. The group have already developed an outstanding reputation for involvement in often complex mental health research studies and imagine this will only improve as time goes on!

Have there been any unexpected outcomes of the group? Anything that surprised you?

It’s not unexpected but it still surprises me just how much people develop when they are involved in research. It’s always one of myself and Donna’s key drivers for the benefits of research involvement. Not just for patients and carers, but for research staff and clinician stakeholders too. Members develop personally and professionally; new identities and relationships are forged throughout the process.

Donna and I have developed alongside the members. The PPI meetings are one of the highlights of our work. The set-up, facilitation, and de-briefs provide a great opportunity for reflection about what we are trying to achieve in our research. The PPI involvement keeps us firmly grounded in the necessity and realties of improving services for self-harm and suicide prevention. One of the best outcomes is seeing the development and empowerment of the MS4MH throughout the process. What they have achieved in a year is outstanding!

Is there anything special about the PSTRC which allows it to make a real difference to mental health treatment?

For sure, the PSTRC is a fundamental driver for real world research that makes a difference to patient safety in healthcare services. The focus on translation, patient safety, involvement and engagement provide our team with the opportunity to close the persistent gap between evidence, policy, and practice in mental health services. We receive excellent support and development opportunities from the GM NIHR PSTRC throughout the research process and for our PPI/IE work which significantly strengthens our work.

NIHR Greater Manchester PSTRC Symposium 2019 – through the eyes of an attendee

9 Sep

by Angela Ruddock – lay member of the PSTRC’s Executive Management Board (EMB)

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Delegates at the NIHR Greater Manchester PSTRC annual symposium

In May, the NIHR Greater Manchester PSTRC held its annual symposium. As a lay member of the centre’s Executive Management Board (EMB), I was looking forward to attending.

I’m one of two lay members of the EMB and my role is to ensure that the patient/public voice is fully represented and to give updates on how patients have been involved in research while encouraging more public involvement.

My personal experiences both past and present allow me to provide meaningful input into the EMB. The PSTRC has an innovative approach to public and patient involvement/engagement and I’m able to play a part in shaping it.

The symposium – on the day

As a member of the EMB I had heard about the plans for the symposium across many months. I was looking forward to the presentations, in particular, Richard Preece from a Greater Manchester perspective and Aidan Fowler who spoke regarding patient safety nationally. The other planned sessions on transitions of care and Artificial Intelligence interested me greatly, so knowing international experts were speaking on these topics was genuinely exciting.

The list of attendees included academics, NHS decision-makers, researchers, policymakers and experts in their fields. Having all these people in a room to take part in panel discussions was an interesting prospect.

The session on Artificial Intelligence was particularly thought provoking for me. The recent Citizens’ Juries commissioned by the PSTRC were discussed and a booklet of the results and process was available. The work, looking at Artificial Intelligence (AI) and decision making in healthcare, was carried out in partnership with the Information Commissioner’s Office (ICO).

The juries concluded that accuracy in decision-making should be prioritised over the ability to explain how a decision is reached. It was very interesting to hear the jurors’ viewpoints being discussed by experts who are leaders in the field of Artificial Intelligence. They were able to explain some of the issues in a way that was relatable.

International speakers

As well as hearing about research currently underway at the PSTRC, the symposium was an opportunity to learn from experts working on similar projects outside of the centre.

Professor Anita Burgun, Professor of Medical Informatics at Paris Descartes University, presented on the role AI can play in providing accurate and detailed information to help ensure the safety of patients. For me, she highlighted the need for further discussions with patients and patient contributors in developing public understanding of the role AI can play in drilling down accurate and timely patient information.

Professor Karina Aase, Centre Director for SHARE at the Centre of Resilience at the University of Stavanger in Norway, gave a keynote speech on Quality and Safety in Care Transitions – Expanding our Understanding.

She began by sharing a very human case study around an elderly patient with multiple morbidity issues who was nearing the end of his life. The situation was so familiar to me and, no doubt, to other ex-carers and patients. The story focussed on missed communication between the patient, his relatives and the healthcare professionals, which led to avoidable lapses in safety across care transitions. Karina stressed the importance of effective communication to ensure his family’s wishes were taken into account and that these wishes were given priority over information obtained through algorithms, to ensure the patient’s peaceful exit from life.

Karina’s work relates well to the PSTRC’s Safer Care Transitions theme and identified some common issues around the importance of ensuring the concerns of patients and their carers are fully listened to, particularly when weighed with, rather than against, other available information about the patient.

Highlight of the day

The symposium opened my eyes to the role AI has in patient safety both now and in the near future. It was clear that there’s work to do in educating patients on how AI can improve accuracy and speed in relation to diagnosis and treatment. 

The PSTRC is playing an important role and there’s potential to do more in the coming months and years. The commissioning of the Citizen’s Juries was a positive step and I look forward to hearing how this work is built upon.