Presentation on theme: "Risk management in general practice Eric Bater 6 th November 2013."— Presentation transcript:
Risk management in general practice Eric Bater 6 th November 2013
Aim of programme to apply the principles of risk management to practical situations and relate these to personal experiences to improve the quality of care by implementing initiatives to remedy deficiencies in the service provided.
Aim To help reduce the risk of harm to patients, staff and visitors by improving safety and the quality of care in practice
Harvard Medical Practice Study New England Journal of Medicine 1991 3.7% patients suffered an adverse event Of these 13% died 58% events related to system errors
Summary of New Complaints Procedure (1998, 9/12 period) MDU experience Failure or delay in diagnosis most common reason (28%) 24% of complaints made after bereavement Non-clinical issues accounted for 34% of complaints 10% of complaints related to attitude 93% settled at local resolution
MDU Settled Claims Against UK GPs Failure to diagnose - 51% Medication error - 26% Pregnancy including labour - 13% Minor surgical procedure - 7% Other - 3%
MDU Claims Settled Quality of medical care - 7% Medical record issues -60% System failures-33%
Risk “The possibility of incurring misfortune or loss”
Living with risks Risk is part of everyday life At home When travelling With patients You can minimise your risks by improving your systems
In general practice… Average GP will provide about 200,000 consultations during their career 25% of adverse events occur in primary care And, it is estimated that 1% of GP consultations (one a week) are associated with a significant adverse outcome Making amends DH 2003
Incident reports to the National Patient Safety Agency 2600 reports from October 2006 to September 2007 from general practice: 29% Medication errors 14% Documentation 11% Access/admission/transfer/discharge 10% Consent/communication/ confidentiality 0.33% of all reports received NPSA National Reporting and Learning Data Summary Issue 7 December 2007
Top key risks in UK general practice 95% Confidentiality 92% Prescribing 90% Health and safety 85%Communication 84% Record keeping 84% Test results MPS Risk Consulting August 2006
Confidentiality Common issues: Breaches of confidentiality in waiting rooms and reception areas Staff contracts do not include a clause covering confidentiality post-employment Not all patient-identifiable information is shredded Patient medical records are not securely stored Computers may be left on and unattended
Breach of confidentiality Can lead to: Breakdown of practitioner/patient relationship Lack of trust/confidence in other healthcare professionals Failure to seek further treatment Disciplinary action by GMC and employers
Prescribing Common issues: No repeat prescribing protocol No designated receptionist to record or generate repeat prescriptions Reception staff are allowed to add medication to the computer Medication reviews are undertaken on an ad hoc basis. No system for recalling patients on long-term medication Uncollected prescriptions are destroyed
Record keeping Common issues: Illegible writing in the records Letters scanned into wrong record Telephone advice not always recorded Medical records go missing Home visits not always recorded on the computer
Test results Common issues: No tracker system to ensure that patients are followed up No system of knowing when all a patient’s test results have been returned Test results not recorded onto the computer Non-clinical staff allowed to inform patients of their result and treatment required
Infection control Common issues: No infection control policy Specimen handling Hand washing issues
Hand washing For effective hand washing consider the following : Liquid hand dispenser Paper towels Elbow/foot operated mixer taps Alcohol based hand rub No sink plug Remove jewellery Designated hand wash basin
■ Common sense ■ Identification, measurement and control of risk to avoid harm to patients and staff ■ Involves everyone ■ Relates to the whole package of care ■ Equates to good practice What is clinical risk management?
RISK MANAGEMENT A careful examination of what 1.could cause harm 2.its significance and 3.what precautions are needed to eliminate the risk or reduce it to an acceptable level
Risk Management Benefits for patients – improved quality of care and service – enhanced patient safety – confidence in the service for health care professionals – protection of confidence and reputation – quality procedures and staff involvement – decreased numbers of complaints and claims
The four principles of risk management 1. Identify the risks – what’s likely to go wrong? 2. Assess the risk – what are the chances of it going wrong, what could happen, does it matter? 3. Reduce/eliminate the risk – what can you do about it 4. Cost the risk – what are the costs of getting it right v. the cost of getting it wrong?
Risk Management Techniques Complaint handling Risk assessment Staff awareness/training Protocol and guidelines monitoring Good medical records Adverse incident reporting
Risk Areas Staff - especially locums Organisation adequate staffing regular guideline review Communication Consent Record keeping
Clip 2 – Morning Surgery Identified Risks Breaches of confidentiality – front desk/reception area etc. Health and safety issue. Lack of systems. Phone call interruptions. Verbal requirements regarding nurse visit. Inappropriate roll/responsibilities of receptionist. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?
Clip 3 – Test Result / Minor Surgery Identified Risks Dealing with smear results. Aseptic techniques. Lack of chaperones. Unreasonable patient request. Lack of informed consent. Disposal of clinical waste/needles. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?
Clip 4 – Home Visit Identified Risks Examination. Response to collapsed patient. Communication regarding hospital admission. Communication with mother. Dealing with request for repeat prescription. Dealing with aggressive patient. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?
Aims of Assessment Improve patient care Ensure safe standards of practice Ensure patient/staff safety and well being Decrease the number of complaints and claims Lessen the stress associated with litigation
The ‘three bucket’ model for assessing risky situations (Reason, 2004) SELFCONTEXTTASK The fuller your buckets, the more likely something will go wrong, but your buckets are never empty.
Self Bucket Level of knowledgenewly qualified Level of skillcompetence and experience Level of experienceinvoluntary automaticity, under/over confidence Current capacity to do the task fatigue, time of day, negative life events
Equipment and devicesusability, not available Physical environmentlighting, noise, temperature Workspaceworking environment, writing space, Team and supportleadership, stability and familiarity, trust Organisation and management safety culture, culture, targets and workload Context Bucket
Errorsomission errors, primary goal achieved before all steps complete, lack of cues from previous steps Task complexity calculations Novel taskunfamiliar or rare events Processtask overlap, multi-tasking Task Bucket
Reason’s Swiss cheese model
Department of Consumer and Employment Protection Resources Safety Reason’s Swiss cheese model James Reason’s ‘Swiss cheese model’