Developing a Patient Safety Programme in Primary Care Workplan 2011-2013

1. Developing a Patient Safety Programme in Primary Care Workplan 2011-2013

2. Our workplan sets out how NHS QIS in conjunction with key partners will develop a Scottish Patient Safety Programme in Primary Care • Our aim is to develop a comprehensive programme for primary care that will be available for testing in pilot sites from March 2012 and ready to be launched in March 2013.

3. Patient Safety in Primary Care Workstreams: • Safer medicines, for example high risk medications and medicines reconciliation in the community. • Improving communication between secondary and primary care, for example letters to and from hospital outpatient clinics, laboratory results, and information regarding discharge from inpatient care. • Develop a programme which aligns with the work of the Long Term Conditions Collaborative, for example develop care bundles to implement reliable care for Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD). • Develop a programme to take forward the HAI element of the Quality Strategy in the community, for example develop community based interventions to improve anti microbial prescribing.

4. Project Phases • Communicate and engage with primary care professionals, patients, partner agencies, and Scottish Government • Identify current improvement activity in Primary Care Services across Scotland and internationally (eg aims, measures and outcomes) • Capture and analyse learning from current improvement initiatives (including Health Foundation funded high-risk prescribing pilots, SIPC, SPSP Acute, Paediatrics and Mental Health) • Engage with key stakeholders and experts to develop aims, measures and interventions • Ensure alignment with key national programmes (eg long term conditions, CHD) • Establish infrastructure to support a primary care programme • Develop capability and capacity within NHS Boards and primary care • Launch the programme

5. Learning from Current InitiativesSIPC 1 and 2 Programmes

6. Safety Improvement in Primary Care 1(SIPC 1) Neil Houston GP National Clinical Lead

7. Patient Safety - Acute Focus

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

9. Reporting in Primary care • Level of harm unknown • No culture of reporting • 0.5% of NPSA • Co-mission • Omission

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

11. Not a new agenda……. • Significant Event Analysis • Complaints reviews • IT systems • Prescribing Systems -Adverse reactions – interactions • Managing Results • Monitoring high risk medicines

12. Collaborative • 32 Volunteer Practices • Patients • Effectiveness / Governance Staff

13. Common Risks • Warfarin Methotrexate • Patients with Complex conditions • Medication Reconciliation • Results lost to follow up • Communication, Communication, Communication • Interface issues

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

15. SIPC1 Aims To enable 80 Primary Care teams to: 1. Identify and reduce risk and harm to patients 2. Improve reliability of care for patients • On High Risk Medications • With Heart Failure

16. Improve: Safety culture Patient Involvement Interface working

17. Model for Improvement

18. Knowledge • Harm - trigger tool • Culture – Climate Surveys • Reliability - Bundles • Patient Involvement • What to spread • Inform national programme

19. Links to Scottish patient Safety Programme • Prevent harm from high alert medications • Deliver evidence-based care for congestive heart failure • Drive a change in the safety culture • Trigger Tools • Methodology

20. Experience so far • Trigger tools • Bundles • Patient Involvement • Climate survey • Spread

21. SIPC 2 “To develop and test specific change packages in three areas that are a major source of clinical risk to patients as they move across the health system.”

22. Areas of Focus Medication Reconciliation - at discharge Managing results Clinical communication between specialist outpatient clinics and primary care

23. Medication Reconciliation

24. Medication ReconciliationTayside • Unreliable at admission • Inaccurate and delayed medication history at discharge, • Unreliable systems in place in primary care • Link to SPSP

25. Aims – Med Rec • To develop and implement reliable systems for reconciling medication at admission and at discharge.

26. Results? Borders 51% significant results not followed up 60% of hospital tests results not relayed to Primary care Lack of reliable tracking Responsibility for action unclear Cause of complaints and claims “WHO identified poor test follow up as a major cause of harm to patients resulting in serious lapses in patient care”

27. Aims - Results • To help practices and hospital services to develop reliable systems for tracking and actioning results of test being ordered in their practices.

28. Communication after outpatients • 50% medication errors due to poor handovers Primary Secondary care • Numerous formats • Often unstructured • Recommendations unclear and not carried out • Little GP communication after referral

29. Aims - Communication • Help hospitals communicate treatment changes more effectively ? SBAR • Practices to reliably implement changes to treatment and management, • Consider and test how practices could better communicate with hospitals apart from at referral.

30. What are HF looking for • Developmental- gain knowledge • Literature and Mapping exercise – • where the harm is occurring • what risks have been identified • what interventions have been tried • Identify what reliable safe systems would look like • Implementing and measuring of bundles and measure the impact of this approach • Generate and Implement solutions • Case studies which describe the journey - the process, outcomes and learning of our work in each work stream.

31. SIPC 2 Development • What does the evidence say? • Recruit practices and acute sector • Process mapping exercise • Collect data • Where are the areas of risk • What would a reliable system look like? • Define measures for testing - bundle

32. Testing • Use defined bundle • Do improvement work in these areas • Value Streaming/ visioning • Identify examples of good practice • Generate new solutions • Measure change

33. Questions