Tag Archives: #pharmacy

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.

Introducing…Safer Care Transitions

1 Jun

by Justin Waring (University of Nottingham) and Harm van Marwijk (University of Manchester)

Safer Care Transitions will be one of the research themes in the NIHR PSTRC Greater Manchester which will run from 1 August 2017 until 31 July 2022.

Safer Care Transitions blog icon

Patient journeys are full of care transitions. By transitions, we mean that the responsibility for patient care is transferred or handed over from one team, department or organisation to another.

If we think about someone who experiences an accident at work, they might be seen at first by a paramedic before being transported by ambulance to their local hospital’s emergency department. There they might receive urgent care before being admitted into the hospital for follow-up care. When recovered, the patient will then be discharged home or to community setting where they could receive rehabilitation, nursing care, social care and follow-up treatments by their GP, under the primary medical responsibility of the GP.  The GPs’ medical records can follow most of such transitions and provide an overarching view, but others (patients) cannot access such data now. GPs would be seen to have an overarching responsibility to facilitate seamless management between settings but little work has been done on this.

Transitions are common to virtually all patient journeys, because healthcare services are provided by specialists and professionals who work in different clinics, surgeries and hospitals. Although there is now better understanding of what makes for safer care within each of these care settings, there is less of a clear picture about what makes for safer care transitions between these care settings, and how to develop problem-based records that capture transitions and are accessible to more than GP practices.

There is mounting evidence from around the world that care transitions are a high-risk stage in the patient journey. Research from the US, for example, suggests that as many as two out of every ten hospital discharges will experience some form of safety incident. These safety incidents take the form of incorrect medicines, missing equipment, or inappropriate care planning.  Research within the NHS suggests that it is often difficult to coordinate the involvement of different professionals and specialists because of common communication breakdowns and the difficulties of finding time to work together to identify solutions to common problems or work from a shared and validated record. A recent Healthwatch report highlighted the enormous suffering and anxiety experienced by patients as they approach hospital discharge, often because of the uncertainties about when they will go home, who will look after them, and how they will cope. Current resources constraints within the health and social care sectors have seemed to make these problems worse, with limits on the availability of social care to support safe hospital discharge.

The Patient Safety Translational Research Centre Greater Manchester is leading a programme of research that will develop new learning about what makes for safer care transitions. It will look to ways of working and technological breakthroughs in other sectors to learn lessons for the NHS. For example, many courier and supply chain services use advanced technologies to track their deliveries. There is also greater scope to empower patients to coordinate their own care through developing smart technologies that enable them to manage and share their own records with different healthcare professionals. There is also much healthcare services could learn from other industries about ensuring continuous accountability for care, so that someone is always there to speak up for and protect the safety of patients, and ways to develop such support for the most vulnerable trajectories such as around cancer and frail older people.

The projects developed in this theme will address the safety of care transitions in primary and secondary care, in mental health services, in chronic conditions, cancer care, and end of life care, to ensure learning and innovations are shared across the health and social care sectors.

Further information:

Healthwatch (2016) Safely Home, London: Healthwatch. http://www.healthwatch.co.uk/safely-home

Waring, J., Bishop, S., & Marshall, F. (2016). A qualitative study of professional and carer perceptions of the threats to safe hospital discharge for stroke and hip fracture patients in the English National Health Service. BMC health services research, 16(1), 297.

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1568-2

Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals of internal medicine, 138(3), 161-167.

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

Community Pharmacy Patient Safety Collaborative part two: Assessing safety

31 Aug

by Sarah Wood, Member of the NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative

Sarah Wood_Pharmacy Collaborative post_CROPPED_Aug16

I heard about the community pharmacy patient safety collaborative about 6 months ago through an advertisement by Community Pharmacy Greater Manchester. As a community pharmacy operations manager with some previous research experience, I have a keen interest in assessing and improving the safety of the many processes in community pharmacy and learning from other industries and experts to do so. As such, I wrote to Dr Penny Lewis to see how I could get involved.  Since then I have been attending monthly training sessions at the University and trying out my new skills back at the pharmacy I work in.

One particular risk to safety that I am interested in are interruptions, such as the phone ringing or customers waiting at the counter. These interruptions are a common occurrence in community pharmacies and can lead to problems when they disturb pharmacy staff who need to focus on the task dispensing medicines accurately. As a result of my involvement in the collaborative, I have produced a safety case on interruptions in the dispensing process in one of my pharmacies and have also identified potential areas for future safety cases. The process of gathering the data, observing the pharmacy, consulting on safety issues with my colleagues and writing up the safety case has made me view company safety mechanisms completely differently. An example of this is how we record errors in community pharmacy: it’s easy to get caught up in how many errors are reported and why they are happening (obviously very important) but we don’t always look at what is best for our staff and which recording mechanisms are easier for them to use on a day to day basis – this is something I will be looking at in future.

The collaboration is also taking on more community pharmacy professionals and, as such, one of my colleagues, an accuracy checking technician, will be joining me in the production of the next safety case. This will be even more beneficial for our company as we can produce and compare safety across different branches.

In the next stage of the collaborative I aim to put together a business case for improving safety. There are obvious, clinical reasons for improving safety in community pharmacy but not much is known about the impact a lack of safety has on our business e.g. loss of customer confidence and possibly loss of custom. This is something I think the wider profession will be interested in and may encourage businesses to be even more proactive when addressing safety issues.

Read part one of the blog series.

Read part three of the blog series.

The NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative: part one

20 Apr

by Penny Lewis, Medication Safety theme

Comm Pharm Pt Safety Collaborative

The community pharmacy patient safety collaborative has reached six months of age. Over this period, ten pharmacists who work across Greater Manchester have come together regularly with research staff from the Greater Manchester PSTRC to learn about quality and safety improvement.

The collaborative members’ first assignment has been to create a ‘safety case’ for their pharmacies. Safety cases are a recognised approach to safety management in other safety critical industries (such as aviation and petrochemicals) but are relatively new to healthcare. As far as we are aware, this is the first time that safety cases have been used in community pharmacy. In order to write their cases, the collaborative members have learned how to use risk assessment techniques such as Failure Modes Effect Analysis (FMEA), Systematic Human Error Reduction and Prevention Analysis (SHERPA), Proactive Risk Monitoring for Organisational learning (PRIMO), Hierarchical Task Analysis (HTA) along with Plan Do Study Act (PDSA) cycles to explore potential and actual patient safety issues in pharmacies.  As well as familiarising themselves with a ridiculously large number of acronyms, the collaborative has used their newly acquired knowledge to investigate and deal with the risks associated with community pharmacy activities such as medication dispensing, provision of monitored dosage systems and delivery services.

In addition to hearing from Greater Manchester PSTRC researchers, the collaborative has also had a guest presentation from Professor Todd Boyle of St Francis Xavier University, Canada, who talked about his work in quality improvement across pharmacies in Canada, and Sarah Ingleby, lead nurse in acute care at Central Manchester University Hospital, who popped over to talk about her involvement in producing a safety case for sepsis in secondary care.

The next few months will hopefully see the recruitment of more collaborative members, including pharmacy technicians. In future meetings we will be exploring further risk management techniques and finding out more about the initiatives that have already been implemented.   In future blogs you will hear from members of the collaborative, who will share their experiences of being involved in patient safety research.  For now, the team at the Greater Manchester PSTRC would like to thank all those who have contributed to the success of the collaborative so far.

Read part two of the blog series.

Read part three of the blog series.

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/ .

 

 

An appeal to GPs, Pharmacists and other healthcare staff

22 Jan

by Professor Aneez Esmail, Director of the NIHR Greater Manchester PSTRC

AneezEsmail_appealtoGPsblog_Jan15

I have recently been involved in research that seeks to reduce the amount of drugs that elderly patients are given. We are increasingly aware of the problem of people taking multiple medications and the detrimental effect that this can have on patient’s quality of life and more importantly on the real threats to patient safety that can arise from overprescribing. What has surprised me is the lack of information that exists on prescribing in the elderly – for example, there is very little information from clinical trials to show the efficacy of statins, antihypertensives and treatments for diabetes for patients over the age of 75.

The purpose of this research is to develop a software tool, integrated with the clinical record, to help general practitioners make the decision as to which treatments have an evidence base and the important drug interactions that should sometimes make us question the decision to add another drug to a large number of drugs that many elderly people already take. It forces us to question many of the assumptions that underpin current clinical practice; for example, by looking at whether reducing drugs can improve patient outcomes.

There are other examples of important work that we are involved in – for example trying to develop mechanisms to support general practitioners in making the correct diagnosis. Engaging with us in research provides opportunities to help define the research questions, work at the cutting edge of scientific research and thought, and ultimately begin the process of changing clinical practice.

Most practices that get involved in research usually end up recruiting patients for trials that are testing existing or newly developing treatments. This is important. However working with early stage translational research is a qualitatively different undertaking.  Translational research might appeal to the inquisitive clinician who is always asking questions about ‘why’ certain things happen rather than ‘what’ actually happens.

So this is an appeal to all those inquisitive clinicians and healthcare professionals, working in practices where the day-to-day pressure of work can sometimes overwhelm us. Engaging with research can also impact on our day-to-day clinical work – for example I am already more aware of the problems in prescribing in the elderly and I believe that it has made me a better clinician. Those clinicians who are working with us on diagnostic error are beginning to understand a lot more about what can influence diagnoses. So this is relevant and directly related to patient care.

Most of our research is funded so that we can buy out clinical time and provide clinicians with dedicated time to get engaged with research. It’s interesting and challenging so please, get in touch with us if you want to get involved.

Current opportunities for professionals to get involved: