Tag Archives: primary care

What patient safety incidents are causing the most harm to my patients?

21 Jun

 

Andy Carson-Stevens_300x300

Andrew Carson-Stevens MBBCh PhD
Cardiff University PI for the Avoidable Harm study. Patient Safety Lead, PRIME Centre Wales

 

340 million primary care consultations take place across the UK each year.  Of those, around 2% of patients experience a so-called ‘patient safety incident’ which is defined as any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving healthcare.(1) Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go wrong.”? With upwards of 6.8 million people experiencing unsafe primary care in the UK each year, there are a lot of opportunities to learn how to make future care safer.

Efforts to learn from medical error in hospitals have enabled an era of implementing interventions to reduce the burden of harm. Patient safety research in primary care is often talked about as lagging behind hospital efforts. However, in the UK, a collaboration comprised of Cardiff University, the University of Nottingham, the University of Manchester and the University of Edinburgh, have led major studies of national and international relevance to move this agenda on. We have undertaken the largest analysis of patient safety incidents from general practice internationally, (2) and have developed methods like coding frameworks aligned to the World Health Organization’s International Classification for Patient Safety to support the detection of incidents that cause the most severe harm to patients.(3,4) With the Royal College of General Practitioner’s Spotlight programme, we launched a workshop series for primary care teams, developed an open access e-learning module on RCGP learning, and have written a practical guide for practices to identify and learn from patient safety incidents experienced by their patients. (5) However, at workshops, attendees want to know, “What patient safety incidents are causing the most harm to my patients?” The problem is our best answers can only be informed by insights from previous studies of variable quality,(1) or based on hypotheses generated from patient safety incident reporting and learning systems.(2)

Led by Professor Tony Avery at the University of Nottingham, with collaborators from the aforementioned universities, the Department of Health and Social Care has funded a study called ‘Understanding the Nature and Frequency of Avoidable Harm In Primary Care’. The study’s aim is to identify the most severe harm experienced by patients in primary care to start to prioritise the design of safer care processes for future patients. We  recruited 12 general practices from across England to review the electronic case notes belonging to their patients. Our specially trained GPs reviewed the notes for evidence of omissions (i.e. not doing what they should have done to reduce the risk of harm, as per evidence-based guidelines) or commissions (i.e. doing something wrong and causing harm) made in care delivery. This process has enabled us to identify the systemic weaknesses that contributed to error(s) and to outline priorities for intervention development to prevent future recurrences.

For further information, we’ve published the study protocol with BMJ Open.(6) We complete the study at the end of June 2018 and will report on our findings shortly afterwards.

References

  1. Panesar SS, deSilva D, Carson-Stevens A, Cresswell KM, Salvilla SA, Slight SP, Javad S, Netuveli G, Larizgoitia I, Donaldson LJ, Bates DW, Sheikh A. How safe is primary care? A systematic review. BMJ Qual Saf. 2016 Jul;25(7):544–53.
  2. Carson-Stevens A, Hibbert P, Williams H, Evans HP, Cooper A, Rees P, Deakin A, Shiels E, Gibson R, Butlin A, Carter B, Luff D, Parry G, Makeham M, McEnhill P, Ward HO, Samuriwo R, Avery AJ, Chuter A, Donaldson LJ, Mayor S, Panesar S, Sheikh A, Wood F, Edwards A. Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice. Southampton (UK): NIHR Journals Library; Health Services and Delivery Research 2016 4(27).
  3. World Health Organization. The conceptual framework for the international classification for patient safety. World Health Organization. 2009;2009:1–149.
  4. Cooper J, Williams H, Hibbert P, Edwards A, Butt MA, Wood F, Parry G, Smith P, Sheikh A, Donaldson L, Carson-Stevens A. Classification of patient-safety incidents in primary care. Bulletin of the World Health Organization. Available online first from: http://www.who.int/bulletin/online_first/BLT.17.199802.pdf?ua=1
  5. Carson-Stevens A and Donaldson L. Reporting and learning from patient safety incidents in general practice: a practical guide. Royal College of General Practitioners; 2017 Apr. Available from: http://www.rcgp.org.uk/-/media/Files/CIRC/Patient-Safety/Reporting-and-learning-from-patient-safety-incidents.ashx?la=en
  6. Bell BG, Campbell S, Carson-Stevens A, Evans HP, Cooper A, Sheehan C, Rodgers S, Johnson C, Edwards A, Armstrong S, Mehta R, Chuter A, Donnelly A, Ashcroft DM, Lymn J, Smith P, Sheikh A, Boyd M, Avery AJ. Understanding the epidemiology of avoidable significant harm in primary care: protocol for a retrospective cross-sectional study. BMJ Open. 2017 Feb 17;7(2):e013786.

Helping parents of children with respiratory tract infections decide when to consult primary care

19 Jun

Mother taking care of her sick child

Primary care is under extreme pressure and struggling to cope with demand for care. Children with Respiratory Tract Infections (RTI) are the most common reason for parents contacting primary care internationally. Parents and patients are offered little, if any, advice on if, when or how to use primary care services. Methods to improve the appropriateness of seeking help could assist primary care to deliver an improved service to the patients in most need. There is considerable parental uncertainty regarding if and when to consult a general practice healthcare professional when children fall ill with RTIs and RTI consultation rates vary widely between GP practices. Safer, cost-effective and more practical interventions are needed urgently to help parents make better use of scarce resources. This requires clear, relevant and unambiguous advice. Valid and reliable criteria are needed to support parents when they are deciding whether (and when) to consult when their child has a (suspected) RTI.

Funded by the NIHR School for Primary Care Research, researchers from the NIHR Greater Manchester PSTRC (Stephen Campbell, Rebecca Morris) and the Universities of Bristol (Alastair Hay) and Oxford (Gail Hayward) will see if professional consensus can be reached on the signs and symptoms that should be used by parents / guardians when deciding if and when to consult, both during the day and out of hours. It will use the RAND/UCLA Appropriateness Method to develop symptom scenarios and appropriateness criteria.  These will enable us to work with patients / members of the public and health professionals to develop a practical guide to support parents in deciding whether they need to contact clinical services for their child. A study working group will oversee the study involving representation from relevant health professions and including PPI/parental representation as an integral part of the research. Co-design events with parents, patients, GPs and pharmacists will then be used to develop the practical guide for parents as well as to develop the support tool for using the guide.

The guide for parents will inform the design of future interventions that could (once proven safe and effective) be implemented by GP practices and other NHS primary care providers (such as NHS 111), e.g. via general practice and NHS websites.

WellMed and clinical uncertainty

8 Jun

WellMed

Dr Sudeh Cheraghi-Sohi recently attended the Third International Meeting on Wellbeing and Performance in Clinical Practice (WELLMED 3) held in Thessaloniki, Greece.  The conference, which takes place every two years, focuses on the connection between physician health and the quality and safety of care they provide.  The keynote presentation was from Professor Christina Maslach, University of California, Berkeley, USA. As the author of the most widely used tool to measure burnout, the Maslach Burnout Inventory (MBI), Professor Maslach’s perspective on burnout in health care staff, which is a growing problem , was informative as was her recommendation for policy-makers to  focus on the workplace environment and not just the individual.

Dr Sudeh Cheraghi-Sohi chaired and presented a symposium on Clinical Uncertainty, which comprised of three presentations followed by discussion.  Dr Sudeh Cheraghi-Sohi introduced the topic and discussed two recent studies in the area to illustrate how uncertainty is composed of cognitive, emotional and ethical aspects as well as being dynamic. She also noted that the literature in the area is scarce but that uncertainty has real consequences on patients, physicians and the health system.

Dr Evelyn Tsiga presented a study on physicians’ emotional reactions to uncertainty and its impact on decision making in primary care to illustrate how physician behaviour can be affected by uncertainty resulting in undesirable behaviours, such as over-referrals.

The final presentation was given by Dr Avril Danczak. Dr Danczak presented her work on training to manage uncertainty, which highlighted that physicians value such training. She emphasised that clinical uncertainty is normal and it has consequences, yet medical curricula and professional training does not acknowledge or equip clinicians to manage it.

The symposium generated much discussion and the need to address the issue of uncertainty was agreed to be an area of importance for future research.

NHS70 Excellence in Primary Care Award for Nottingham’s Medicine Safety Research Group

22 May

Print

The Medicine Safety Research Group at The University of Nottingham is the regional winner of the Excellence in Primary Care Award category of the NHS70 Parliamentary Awards and is shortlisted for the national award.

The research group was nominated by the East Midlands Academic Health Science Network (EM AHSN), who highlighted a number of developments which are already improving, and will continue to improve, prescribing safety in primary care. These include:

  1. Improving the safety of medicines prescribing through the design and testing of an intervention called PINCER.
  2. Development of ‘prescribing safety indicators’ which are now used in GP computer software to avoid prescribing errors
  3. Identifying the frequency, nature and causes of prescribing errors in general practice, leading to:
  4. Developed a Patient Safety Toolkit for GPs, which is available on the RCGP website and has been accessed over 10,000 times.

The Medication Safety theme of the NIHR Greater Manchester PSTRC has worked closely with the award-winning Nottingham-based research team on many of the developments. A number of these projects and interventions will be developed further over the coming years, through a continued collaboration between the Greater Manchester PSTRC and the University of Nottingham.

Working together to help patients and carers to be more involved in safety

3 May

Patient Safety guide logo_cropped

The patient safety guide has been co-developed with patients, carers, general practitioners and pharmacists. We have worked together from the initial idea, to decide the focus of the guide, the first draft all the way through to refining it.

One key discussion we had early was a preference to develop a digital app based version to compliment the paper version which we are now doing. In March we held two more co-design events. In the first event we discussed what the app should include and key features that people like in an app, what they don’t like and what the guide app should include.

At the second event we discussed testing and piloting the guide package in practice for patients and carers and how would it be used with GPs, pharmacists and other healthcare staff. These discussions will be used to shape the next phase of the guide project to develop an app and test the full guide package.

Thanks to everyone who came along and got involved! If you’d like to find out more about the patient safety guide project or future opportunities to get involved please contact Dr Rebecca Morris.

How do I get more involved in my patient safety?

1 Feb

Patient Safety Guide_combined images with arrow

We have been working together with patients, carers, members of the public, GPs and pharmacists to design a PSTRC patient safety guide for patients and carers. This will be a useful resource to help answer key questions about primary care patient safety and to identify points where patients and carers can make their own care safer.

The guide consists of a short booklet, website and cue card prompts which people can use flexibly:

  • to plan for a consultation
  • as a memory aid
  • to help make the most of the time a person has with a healthcare professional
  • to support their own care at home.

As part of this project, the PSTRC has held co-design events which have brought together members of the public, patients, carers, GPs and pharmacists to discuss how everyone can work together to make care safer. Discussions have focused on key points in the care pathway and actions that each person could identify to improve their patient safety with the priorities that were identified for their own care. These discussions were then used to develop and refine the guide.

Since completing the initial development stage of the patient safety guide, work has been taking place with key national stakeholders to further refine the guide and the centre will continue to co-develop the project and the testing of it with patients, carers and healthcare professionals.

If you’re interested in hearing more about the guide, or to find out more about future co-design events, please contact Rebecca Morris at rebecca.morris@manchester.ac.uk.

Where next for the James Lind Alliance? After 50 James Lind Alliance partnerships, what does the future hold?

1 Feb

James Lind Alliance logo-transparent-background

Last year, the PSTRC asked members of the public, patients, carers and healthcare professionals ‘What are your questions about primary care patient safety?’ This process was called a James Lind Alliance (JLA) Priority Setting Partnership (PSP). The aim of the JLA is to work with patients, carers and healthcare professionals to identify the questions they believe are a  priority for research to address. For our PSP the top 10 priorities included questions focused on the most vulnerable in society, holistic whole-person care, safer communication and co-ordination between care providers, work intensity, continuity of care, suicide risk, complex care at home, and confidentiality. This was the first national prioritisation of future research for primary care patient safety and helped shaped our new PSTRC focus.

There have now been over 50 JLA partnerships which have asked people to identify future research questions about a range of different healthcare areas from schizophrenia to endometrial cancer. In November 2017, the JLA hosted a meeting to reflect on the partnerships, identify key issues and to share learning. People shared their experiences to help shape the future of the JLA process and to reflect back on the process to identify the parts that worked well and where there might be room for improvement. Key to all the partnerships is that they have all prominently championed the voices of patients, carers and healthcare professionals to help prioritise research questions that are of importance. The JLA is overseen by the NIHR to support the research priorities identified through the partnerships so that they can feed directly into national funding priorities.