Improving Patient Safety in Primary Care in NHS Scotland

1. Improving Patient Safety in Primary Care in NHS Scotland

2. NHS Scotland Quality Strategy 2010 “Design and Implement a Patient Safety Programme in Primary Care” New Agenda? Who? What? How?

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4. Patient Safety in Primary Care - Why Bother? High VolumeIncreasingly complex Adverse Events cause: 1 in 8 Admissions to hospital 1 in 20 Deaths Largely preventable

5. Harm – Co-mission • Level of harm unknown – NPSA • 11% prescriptions contain errors • In a care home - 50% chance of ADE • 60,000 patients - high risk prescription pa

10. Harm thro Omission Lack of reliable care Methotrexate – 12% not monitored Mix of strengths 30% Not prescribed weekly

11. (un)Reliable Heart Failure Care ACE inhibitor 88% B Blocker 70% B blocker at target dose 28% Pneumococcal 71% NYHA 71% All 5 - 23%

12. High Risks • Warfarin • Methotrexate • Patients with complex conditions • Medication Reconciliation • Results • Communication

13. Safety Improvement in Primary Care 1(SIPC 1)

14. Aims • To enable 80 Primary Care teams to: • 1. Identify and reduce harm to patients • 2. Improve reliability of care for patients • On High Risk Medications • With Heart Failure • 3. Develop safety Culture • 4. Involve Patients in QI

15. The Tools • Collaborative • Bundles • Patient Involvement • Trigger Tools • Safety Climate

16. Knowledge • Topics • Tools • What to spread? • How to spread?

17. Reliable Care -Care Bundles 4 or 5 elements of care Evidence based Across Patients Journey Creates teamwork Done reliably All or nothing Small frequent samples

18. Heart Failure Bundle • 1.Maximise medical therapy – • On a licensed B Blocker • B Blocker at max tolerated dose • 2.Functional assessment - NYHA recorded in last year • 3.Immunisation - pneumococcal vaccine ever • 4.Self Management- information given to patient on recognition of deterioration

19. DMARDS Full blood count in the past 6 weeks? Abnormal results acted on? Review of blood tests prior to issue of last prescription? Had pneumococcal vaccine? Asked re side effects last time blood was taken?

20. Bundles - Successes “The care bundle was useful because it identified gaps” “ Not as reliable as we thought we were” Focus for improvement

21. 2 - Data

22. Seeing Improvement “You can see week by week, month by month, whether or not you are showing any improvement, we seem to be improving and that’s good”

23. Tayside DMARD Compliance

24. NHS Forth Valley

25. Lothian - Warfarin Compliance

26. Outcome Data

27. Safety Improvement in Primary Care PATIENT INVOLVEMENT IN LOTHIAN Isobel Miller, Public Partner

28. Patient Involvement Scottish Health Council SIGN Public Partnership Forum Personal involvement in own healthcare with own healthcare workers Scottish Medicines Consortium Healthcare Environment Inspectorate

29. Active Patients • Develop resources to help patients & practices • Health professionals at one practice write leaflet • Patients comment and suggest changes • Edited version adopted and adapted by other practices

30. Change and Improve • Capture experience of patients on warfarin • Use that information to change and improve care • Compare patients’ experience with practice’s process map

31. Process Map

32. Methodology • Focus group for warfarin patients from all seven practices involved in pilot project • What went well; what went not so well; what would you change? • Focus groups for individual practices

33. Results • Patients were happy with most parts of process • Key topics identified • Practices considered all issues raised • Feedback to patients: You said - we did

34. Feedback • You Said • Our Response Only half of the patients attending the meeting had a ‘yellow pack’ (warfarin information) When you attend for a blood test you will be asked if you have a yellow pack and this will be recorded in your notes so that we know that everyone has one who wants one Some patients had heard about a new drug which might be taking over from warfarin There is no information on when this will be available but any news will be given out in the education session.

35. What went well? • Better informed patients better outcomes • Practices more open to patients’ concerns • Patients felt listened to and practice staff had a few surprises • Improvements made

36. What went not so well? • Practices did not engage with large focus group issues • Not all practices participated • Patients were not representative

37. What would we change? • Practice specific focus groups • Increase educational aspect of focus group • Explore ways to involve hard to reach groups • Share the experience

38. Other Boards • Patient Self Care • Board Groups • Practice groups

41. “The main learning was that they appreciate being involved in their own care”

42. “Barriers have just been ourselves” • Need • Resources • Facilitators • Expertise

43. The Trigger Tool and GP-SafeQuest Measuring – Learning – Improving Carl de Wet MBChB DRCOG MRCGP MMed (Fam)GP / Patient Safety Advisor

44. Overview • The trigger tool(12 minutes) • What, why and how? • The story so far… • 2. GP SafeQuest(8 minutes) • What, why and how? • The story so far…

46. SUB HEADING The trigger tool: Review of medical records Rapid, focused, structured, active Screen for undetected harm / error

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50. Aim? Patient and medical records Data? Practitioner level Sampling: size and method? Practice team Individual and Team responsibilities? Primary-secondary care interface Triggers: number and type? 2. Review records 3. Reflection, further action 1. Plan and prepare Can triggers be detected? Yes. For each detected trigger, consider: No Did harm occur? Review the next record Yes. Summarize the harm incident and judge three characteristics: No. Continue to next trigger or record Severity? Origin? Preventability?