Protecting patients through safe practice
Prof Tony Avery and Kate Marsden, Research Associate, Faculty of Medicine & Health Sciences, University of Nottingham
What is patient safety?
Patient safety has been defined as the “avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of health care”. It is a complex, multidimensional concept that encompasses many different dimensions in primary care, including diagnostic and prescribing safety, communication (both within and between practices and other healthcare settings), organisational safety culture, and patient reported problems. Each of these requires different methods of assessment.
What is the Patient Safety Toolkit?
The identification and reduction of avoidable harm is a major priority for the NHS. There has been widespread attention to this issue in secondary care, and primary care is now increasingly coming under the spotlight. With funding from NIHR School for Primary Care Research, a team of researchers has developed a Patient Safety Toolkit for general practices. This brings together a set of tools that have been shown to be useful to GPs and practice staff, and which could play an important role in preventing patients from being harmed.
How was it developed?
The Patient Safety Toolkit project sought to identify those tools which were considered potentially suitable for assessing safety in general practices. This was done by literature reviews and a survey of international general practice organisations and experts in this field.
These tools were then piloted in general practices recruited from the North West and Central England. A combination of qualitative and quantitative techniques was used to test the attributes of the different elements of the Toolkit. As a result of this, a final set of tools was identified and these were implemented in 48 different practices across England.
What does it contain?
The Patient Safety Toolkit comprises the following tools:-
- The Trigger Tool – this is an efficient way of performing a case note review to highlight any potential safety concerns. It can be used as a routine tool to screen for patient harm or patient safety incidents.
- Medicine Reconciliation Tool – this assesses the safety of the interface between primary and secondary care in terms of the general practice role in medication reconciliation following a patient’s discharge from hospital.
- PC SafeQuest – this is an on-line anonymised questionnaire that can be used by all members of a general practice team. It allows staff to rate the perceived safety climate within their practice.
- Prescribing Safety Indicators – these are a set of computerised indicators to assess prescribing safety. The package involves the use of CHART (Care and Health Analysis in Real Time) software to identify patients at risk of medication-related injury.
- Safe Systems Checklist – this focuses on the safety of practice systems and covers a variety of areas, e.g. dealing with laboratory test results and hospital correspondence.
- Patient Reported Experiences of Safety in Primary Care (PREOS-PC) - this is a questionnaire for patients to record their experience with respect to patient safety in general practice.
How is it going to be rolled out?
The RCGP Spotlight project will enable the Patient Safety Toolkit to be hosted on the RCGP website so that it will be available for general practices to use. This work is being done in collaboration with the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, which has covered the costs of this project. The roll-out of the toolkit through the RCGP Spotlight project has great potential for improving patient safety in primary care.