1. Supervision of General Practitioners Practises
Openness about malfunctioning in medical practice
Supervision of General Practitioners Practises
Charlotte Hjort
Head of one TR department, MD, PhD, MPG
Danish Patient Safety Authority

2. Denmark – few facts Population: 5.75 million 3421 GP´s
Wanted (1600 pt.) 3593
Lack of GP´s approx. 175
42,924 square kilometres
17. november 2018

3. Openness about malfunctioning in medical practice How
Supervision at GP´s 2017
How
17. november 2018

4. Selection of theme Adverse events - statistics
In lack of other data, we asked:
our own employees
our Strategic Board with representatives from
Patient organisations
Doctors, dentists and nurses organisations
Danish Regions
Local Government Denmark
For 2017: Medication and test results in transitions (of patient flow)
17. november 2018

5. Selection of clinics
From journals from our hospital supervision (random selection)
From list of claims – whether or not criticism was given (risk based)
From list of prescription habits (risk based)
- opioids
- benzodiazepins
In 2017: Approx. 250 clinics
17. november 2018

6. Indicators – review of patient record
Indication of examination and treatment Informed consent Decision of lifeprolonging treatment Discharge summary Following clinical guidelines of lung dissease (COLD) Following clinical guidelines of depression (suicide)
17. november 2018

7. Indicators – interview of doctors and staff
Delegation of medication and vaccination Handling of anaphylaxis Prescription - iteration Review of patients medication Use of written instructions Prescription habits concerning addictive medicine Handling of test results from paraclinic investigations Instruction of the staff – in general and for specific procedures Hygiene
17. november 2018

8. Indicators - observation
Outdated medicine
Outdated sterilized products
Hygiene
In general
Instruments
Equipment
Clinic rooms
17. november 2018

9. Supervisory team
Two doctors Or One doctor and one nurse One doctor alone
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10. The supervisory visit
Beforehand: Two instructions send beforehand – delegation and paraclinic) Out there: Introduction and setting the scene Interview Review of patient records Termination – what have we found – no conclusion Afterwards: Report – obligation to publis
17. november 2018

11. Openness about malfunctioning in medical practice What do we find?
Supervision at GP´s 2017
What do we find?
17. november 2018

12. Until now: Visited 23 GP´s No statistics yet
We have seen many good things
We have seen same general problems in all clinics
We have seen specific problems in some clinics
17. november 2018

13. Written consent
Some GP´s do not agree in the necessity of writing this in the patient record
We have talked about the treatment – the patient know what to do
We do not have time for it
The important informations is hidden by all the unnecessary things
Then we just put a standard phrase in – the secretary can do so
17. november 2018

14. Medication
Some GP´s do not agree in the legal order of prescription of addictive medicine
We do not have time to see patients evry time they need an iteration of the prescription
The cost of seeing all these patients so often is too high
If the patient have endured the medication for 2 years then we can control it once a year
17. november 2018

15. Following guidelines
Some GP´s do not agree in the correctness of guidelines
In primary care evry patient is unique and do not fit to the guidelines
Guidelines are just guiding – I know better
Guidelines are made far away from daily practice
I do not have time to follow the guideline
17. november 2018

16. Openness about malfunctioning in medical practice Dilemmas
Supervision at GP´s 2017
Dilemmas
17. november 2018

17. Following guidelines Same shortcoming in two GP´s – trust/no trust
Same number of un-fullfilled indicators – big difference
Our focus – maybe sometimes hide more important issues
Our selection – how to find ”the red ones”
17. november 2018

18. Thank you for your attention!
17. november 2018