Safety and Improvement in Primary Care
This page contains information and tools on building a safety and improvement culture in primary care, developed or supported by members of the NES Patient Safety Multi-disciplinary Group, including:
- Three
articles on improving safety in primary care
- A series of Safety Climate
resources
- A series of Trigger Tool
resources
Maximising harm reduction in
early general practice specialist training (GPST): development of a
preliminary checklist (poster, 2011) [PDF]
This poster, by Paul Bowie, John McKay and Moya Kelly,
introduces a preliminary checklist for GP Supervisors to
assist them in prioritizing and addressing essential
safety-critical issues during the early period of specialist
training in general practice.
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The evidence for patients suffering preventable harm in well-funded, technologically advanced healthcare settings staffed by highly educated clinical workforces is incontestable. Consequently, making patient care safer is of international concern and a key priority of the World Health Organization and UK government. However, improving patient safety is a multi-faceted challenge that will require a significant change in thinking and culture throughout the NHS. These three articles highlight the scale and type of safety risks in primary care, while introducing a small selection of concepts and improvement tools that can begin to help build and sustain a strong patient safety culture:
Building a Safety and Improvement Culture in Primary Care (Paul
Bowie, Practice Nurse, 5 November 2010) [link -
requires Athens log-in]
Being well trained, caring about your job and working hard does not
necessarily mean that you will never make mistakes. Complacency
over safety in primary care will lead, albeit unintentionally, to
patient harm.
- This article considers the nature of harm, the size of the
problem and the human factors that can affect patient safety.
Reporting and Learning from Harmful Incidents (Paul Bowie,
Practice Nurse, 19 November 2010) [link - requires
Athens log-in]
Key to building a safety and improvement culture, and to
making patient safety a primary care
priority, is reversing the current under-reporting of
harmful incidents.
- This article outlines some simple, audit-based tools which
can help to uncover previously undetected harm events.
Leadership and Implementing a Safety Culture (Paul Bowie,
Practice Nurse, 10th December 2010) [link -
requires Athens log-in]
While it takes time to change the culture of an organisation, there
are plenty of simple measures that strong leaders can implement to
achieve some 'quick wins' as first steps towards advancing patient
safety in primary care.
- This article provides some tips for leaders on
implementing a strong safety culture in primary care, including
"Points for Practice", and ways to engage patients for
improvement.
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Safety Climate resources, produced by Carl de Wet for use in the Safety Improvement in Primary Care (SIPC) [link] initiative:
An
Introduction to Safety Climate - overview (2010)
[PDF]
A positive and strong safety culture is essential to improve and
assure patient safety. Building a safety culture is therefore
strongly promoted as an important activity for all NHS
organisations. It is arguably even more desirable for UK primary
care as the majority of health care is delivered in this
setting. The term 'safety climate' refers to the
measurable components of safety culture.
- This document gives an overview of how the
concepts of safety culture and safety climate fit together, and
explains the purpose and benefits safety climate
measurement.
An Introduction to Safety Climate - summary (2010)
[PDF]
- A summary of the above document, with some key information
about: safety culture, safety climate, measuring safety
climate, SafeQuest, and the benefits of safety climate
measurement.
Safety
Climate Questionnaire (SafeQuest) (2010) [PDF]
Also available at: http://hf.gpsafetyclimate.com/ - Primary
Care Teams can use this questionnaire to find where they could
improve in areas which have been shown to be important to patient
safety.
Safety
Climate Report Guidance: Making the most of your safety climate
survey report (2010) [PDF]
- The delivery of the report is one of the important
steps in the process to build a strong and positive safety culture
- it is not the end point. Further steps include sharing the
results with all practice team members, including those that did
not participate, and discussing and reflecting on the findings in
the report (a practice team meeting is the ideal setting for
this). This template has been successfully used by other
practice teams to facilitate meetings. It is completely flexible
and you may choose to use all, parts of or none of it,
depending on your local needs.
See also the on-line community for Safety Improvement Primary Care (SIPC) participants [link].
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A trigger tool is a simple checklist containing a selected number of clinical 'triggers' that a reviewer searches for when screening medical records for patients who may have been unintentionally harmed. The trigger tool process facilitates the structured, focused and rapid review of a sample of medical records by primary care clinicians. More information also available at: https://secure.gptriggertool.com/
Screening electronic
patient records to detect avoidable harm: a trigger tool process
for primary care (poster, 2011) [PDF]
This poster, by Carl de Wet, Lyn Halley, Jill Gillies, Neil
Houston, Paul Bowie, describes how to apply the trigger tool
process - a rapid method of screening electronic patient records to
detect patient harm - as a feasible part of routine practice -
and promotes the idea that the trigger method will enable the
primary care team to refocus their measurement, learning and
improvement efforts on one of the most serious issues facing the
NHS - minimising the risk to patients of unintentional but
avoidable harm.
The Primary Care Trigger Tool: Practical Guidance for GP Teams:
Reviewing electronic patient records to detect avoidable harm
- Including key points for reviewers and teams, and a
summary of the trigger tool process.
Trigger
Tool Data Collection Proforma
- For use in carrying out the review process.
Trigger Tool Case Study: Example of a General
Practice Medical Record (Mr. Joe Bloggs, D.O.B.
01/01/1935)
- This fictional medical record is intended to be used
as part of the practical training in the use of the trigger tool
method. It purposefully imitates an authentic printed summary sheet
that the vast majority of practices generate on a daily basis. The
correspondence and investigation results that are included have
been designed to represent printed copies of documents as they
would commonly be used in Scotland's general medical
practices.
- Linked:
Trigger Tool Case Study Discussion
Trigger Tool
Case Study: Example of a General Practice Medical Record (Ms.
Annette Curtain, D.O.B. 01/01/1935)
- This fictional medical record is intended to be used
as part of the practical training in the use of the trigger tool
method. It purposefully imitates an authentic printed summary sheet
that the vast majority of practices generate on a daily basis. The
correspondence and investigation results that are included have
been designed to represent printed copies of documents as they
would commonly be used in Scotland's general medical
practices.
- Linked:
Trigger Tool Case Study Discussion
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Perceptions
of Safety Climate in Primary Care: A Cross Sectional Study
(poster, 2009) (PDF)
This poster, by Carl de Wet, Paul Johnston, Alex McConnachie and
Paul Bowie, gives an overview of this study, which aimed to:
- To measure the perceptions of safety climate in primary
teams variation between practices
- To determine whether there is significant variation between
practices
- To determine whether perceptions vary according to specific
practice and participant characteristics.
