professional support and expert advice general practice – risky business? reducing risk –...
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PROFESSIONAL SUPPORT AND EXPERT ADVICE
General practice – risky business?
General practice – risky business?
Reducing Risk – Improving patient safety
and quality of patient care
Reducing Risk – Improving patient safety
and quality of patient care
E D U C A T I O N Y O U C A N P U T I N T O P R A C T I C E
Copyright 2008 All Rights Reserved
Aim
■ To help reduce the risk of harm to patients, staff and visitors by improving safety and the quality of care in practice
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 hospitals…
■ Study in England estimates that around 10% (900,000) patients admitted to NHS hospitals have experienced an adverse event (patient safety incident)
■ 50% could have been prevented ■ 33% led to moderate or greater disability
or death.
Vincent C et al BMJ 322:517-19
Seven steps to patient safety NPSA 2003
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
MPS Risk Consulting
Experience of clinical risk assessments:
400 CRSAs completed
Many practices – above average, excellent systems in place
All practices had a number of areas where further action would improve level of service
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
Excellence
Examples of good practice
■ The dedication and commitment of all the staff
■ The organisation of the practice administration team
■ The impressive ‘learning from events’ system
■ The test results process
■ The clinical and administrative audits undertaken
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
Health and Safety
Common issues
■ No health and safety assessment undertaken
■ No personnel protective clothing provided
■ Storage of waste and sharps
■ No panic alarms
■ Unsafe furniture/fixtures
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?
About MPS
■ The leading provider of comprehensive professional indemnity and expert advice
■ 250,000 members worldwide
■ Not an insurance company
What does MPS offer to GPs
■ Comprehensive indemnity
■ The best professional protection
■ First rate serviceOver 21,000 GP members
■ The GP Practice Package
■ Education and Risk Management
MPS publications
■ Casebook
■ Your Practice
■ GP Registrar
■ Fact sheets
■ Medicolegal booklets
■ ‘Clinical Risk Management in Primary Care’
The MPS website
■ Update personal details or renew membership
■ Courses and events
■ Case reports
■ Practice Packages
■ Request publications
■ Subscription rates
http://www.medicalprotection.org/uk
Bev Hampshaw
GP Account Executive
Contact me by email, telephone/fax