1. Implementing the Scottish Patient Safety Programme in Primary Care
Dr Neil Houston

2. Aims of the next 2 days
Learn about:
The aims and objectives of the SPSP-Primary Care
The tools and resources
The methodology
Share resources, challenges and learning
Highlight next steps for HIS and board teams

3. Aims of this session Why are we here? Our journey so far
Aims of the Programme
It’s Focus
Expectations/Milestones/Goals
Methodology
Roles and responsibilities

4. Adverse events in primary care cause:
PATIENT SAFETY IN PRIMARY CARE - WHY BOTHER?
90% of patient contacts
Ageing population
Multiple morbidities
Adverse events in primary care cause:
1 in 20 deaths in hospital
5 -17% of admissions linked to adverse reaction to medication
4% of hospital bed capacity
70% preventable
To Err is Human 1999
Howard et al Br J pharmacology 2006
Zhang et al BMJ 2009
Howard et al qshc 2003

5. Admissions Over the next year in Scotland
Approx 290,000 Acute medical Admissions
21,000 due to medication side effects
14,000 preventable?

6. How Safe are we? Adverse Event rate 1- 2% Consultations
More with frail elderly
300 million consultations in UK pa
“Absolute number of those harmed may be just as large or greater than secondary care”
Health Foundation 2011

7. 2.5 million consultations 25,000 – 50,000 adverse events?
Over the next 2 days in the UK……
2.5 million consultations
25,000 – 50,000 adverse events?
That’s only in consultations……

8. Causes of harm Medication adverse effects Systems Issues e.g.
Prescribing errors
Administration errors - records
Results Handling
Communication

10. 5% Prescriptions have an error 1 in 550 serious But NHS Scotland
GP Prescribing
5% Prescriptions have an error
1 in 550 serious
But NHS Scotland
89 million prescriptions p.a.
162,000 serious errors

11. Over the next 5 minutes in Scotland
5 serious prescribing errors
One per minute……..

12. Why did these prescribing errors occur.
Time pressures
Frequent distractions and interruptions
Little training
Team communication
IT Issues
Interface communication

13. Systems Thinking IT systems Prescribing / Results
And now the Good News
Systems Thinking
IT systems
Prescribing / Results

15. More Good News Safety Culture Reflective Practice - SEAs Data
Openness and transparency
Rapid tests of change
Primary care collaborative

17. Comparison of CHPs vs FV and Scotland
Cephalosporins—Items/1000 patients per day by Financial Quarter (Primary Care prescribing).
Comparison of CHPs vs FV and Scotland

18. Making a high class service world class!

19. Delivering Quality in Primary Care
Design and implement a Patient Safety Programme in Primary Care” 19

20. World First

21. Development and Testing Safety Improvement in Primary Care 1 and 2

23. The Tools Collaborative Model for improvement Care Bundles
Trigger Tools
Safety Climate
Patient Involvement

24. DVD

25. Warfarin Bundle Compliance

26. Successes - Improved:
Patient Care
Systems
Knowledge, Skills & Attitudes
Safety Culture
Team-working
Patient Involvement
Less Stress
Efficiency

27. Overall
82% said the programme had benefited their practice
75% said the Programme had improved the safety culture of their practice

28. Challenges - Practices and Boards
Understanding
Time Pressures
Competing priorities
Staff and IT changes
Team Involvement
Team culture

30. Innovation Adoption Curve
This is best highlighted in Roger’s Innovation Adoption Curve,
There is no point in trying to get clinician by-in from the masses. Convince the innovators and early adopters and optimise them. . 30

31. Rapid Organic Spread 60 Practices + 6 HB
Spread to 90% practices in 2 HB
3 more boards testing
GP training
GP Appraisal
Export Market!

32. Why the spread? Topics are of interest Builds on professionalism
Tools are useful
They work
Provide
Focus
Insights
Energy for change

33. Implementing the Scottish Patient Safety Programme in Primary Care

34. Focus Stage 1 General Medical Services, for example GP practices
Programme launch March 2013
Stage 2
Community Pharmacy and Nursing
Proto-typing and testing from mid-2013
Stage 3
Expanding to other Primary Care Healthcare Professionals,
Exploratory work from September 2013
Similar implementation and spread plans will require to be drawn up for the remaining stages (2–4) covering pharmacy and nursing, dentistry and optometry work streams when high risk areas have been identified and testing work undertaken 34

35. Programme Ambition
To reduce the number of events which cause avoidable harm to people from healthcare delivered in any primary care setting.

36. Aims
All NHS territorial boards and 95% of primary care clinical teams will be developing their safety culture and achieving reliability in 3 high-risk areas by 2016.

37. 3 Workstreams Safety Culture and Leadership Safer Medicines
Safe and reliable patient care within practice and across the interface

39. Francis Report and Culture
There was an atmosphere of fear of adverse repercussions
There was a lack of openness
It did not listen sufficiently to its patients and staff or correct deficiencies highlighted
Above all it failed to tackle an insidious negative culture involving tolerance of poor standards

40. Safety Culture and Leadership
95% of practices will be undertaking Safety Climate Surveys
and
Trigger tool case note review 
by April 2014 40

41. Safer Medicines
95% of practices implement systems for reliable prescribing and monitoring of high risk medications by e.g. Warfarin and Methotrexate
95% of practices have safe and reliable systems for medicines reconciliation following discharge by 2016 41

42. Medication Reconciliation

43. Med Rec Unreliable at admission Inaccurate and delayed at discharge,
Unreliable systems in place in primary care for updating
Causes harm

44. Safe and reliable patient care within practice and across the interface
95 % of GP practices have safe and reliable systems for handling written communication received from external sources
95% Health Boards and GP practices have safe and reliable results handling systems 44

45. “WHO identified poor test follow up as a major cause of harm to patients resulting in serious lapses in patient care”

46. Evidence in Primary Care
Practices do not track requests for tests,
Lack protocols on how to inform patients of results.
400 Clinical Risk Self Assessments
84% of practices had risks associated with test results.
Cause of delayed diagnosis complaints and harm

47. Methodology – collaborative within a collaborative
National Learning Sessions
NHS Board Learning Sessions
Collaborative Interactive Workshops (Awareness raising) Oct–Dec 2012
Learning Session 1
14th and 15th March 2013
Local Learning Session (1 day) May / June 2013
Learning Session 2 (1 day) Sep–early Nov 2013
Local Learning Session (1/2 day) Nov/Dec 2013

48. Why this approach? Size of primary care Local flexibility
Opportunities for learning / development
Interface improvement
Links with other SPSP workstreams

49. National Collaborative

50. HIS will provide: National Leadership and Influence Website
Tools and guidance
National Collaborative
Expertise and Support

51. National Collaborative
HIS and NHS Board Staff
Build capacity and knowledge
Share resources/ experience
Learning across NHS Scotland
Identify successes and challenges
Build network
Starts now……

52. Local Collaborative

53. Local Collaboratives for Primary Care teams Boards need to provide …
Dedicated programme management
Clinical leadership and QI support to:
Attend national events
Run local collaborative
Build knowledge and skills
Support practices

54. Local Collaborative Learning sets 1.5 days p.a. Practice staff Engage
Learn about tools
Share resources
Successes and challenges
Support practices to use the tools and drive improvements

55. Next steps for board teams
Create your team
Get familiar with the tools
Choose topic
Recruit practices via enhanced service
Plan your learning sets
Identify additional needs / support

56. What will Practices be doing:
Attend Local Collaborative
Monthly Data collection and improvement
1 high risk area per annum
(Enhanced Service)
Trigger Tool Review 2 x 25 records per year - QOF
Safety Climate Survey annually - QOF
Share their data, improvements, challenges and successes

61. Board Teams

64. Levers
CEL 03 (2013)
HIS to support national collaborative and programme
Boards to prioritise:
Create Board team and run collaborative
Practices
Professionalism
QOF
Local Improvement Enhanced Service

65. Improvement Enhanced Service
Develop QI and patient safety skills of practice teams
Initial focussed on Safety
Develop skills and drive improvement
Attend collaborative
One high risk process per year bundle data – achieve reliability
Involve patients

66. The Risk

68. “The day provided a well presented and fascinating introduction to patient safety in primary care and has helped others in the locality (...) see the importance and relevance of patient safety in the primary care setting”
“I felt it really got the message across to the NHS Board that they are going to have to start 'looking the right way”

69. What’s in it for Boards and Practices
More effective care
Fewer admissions
Improved Teamwork
More Confidence in systems
Less things going wrong
Less Stress
More Efficient
Better interface working
Informed pro - active patients
Culture change

72. Margaret’s Story - DVD