safer it systems for the nhs

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Safer IT Systems for the NHS Dr. Maureen Baker CBE DM FRCGP Special Clinical Adviser NPSA Clinical Safety Officer CfH

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Safer IT Systems for the NHS. Dr. Maureen Baker CBE DM FRCGP Special Clinical Adviser NPSA Clinical Safety Officer CfH. Overview. Patient safety in Connecting for Health NPSA commissioned study Safety Management Requirements IT solutions to patient safety problems Process re-design. - PowerPoint PPT Presentation

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Page 1: Safer IT Systems for the NHS

Safer IT Systems for the NHS

Dr. Maureen Baker CBE DM FRCGP

Special Clinical Adviser NPSA

Clinical Safety Officer CfH

Page 2: Safer IT Systems for the NHS

Overview

• Patient safety in Connecting for Health• NPSA commissioned study• Safety Management Requirements• IT solutions to patient safety problems• Process re-design

Page 3: Safer IT Systems for the NHS

National Programme for IT (NPfIT) in NHS

AIMS• To deliver a 21st Century health service that is

better for patients, citizens, clinicians and people working in the NHS through the efficient use of ICT

• To improve the convenience, quality and SAFETY of patient-centred care by ensuring that those who give and receive care have the right information, at the right time

Page 4: Safer IT Systems for the NHS

Why do we need it?

• Medical and clinical knowledge continually expanding

• Patients want more involvement in their care• Traditional paper-based recording and storage

systems can no longer provide effective support for NHS

• Many hospitals and most general practices now have some form of electronic patient record that cannot easily be shared

• Data and information not easily shared across NHS

Page 5: Safer IT Systems for the NHS

Why is this important to NPSA?

• Huge potential to support clinicians in practising safely – prescribing, transfer of information, clinical decision support

• Platform to enable NPSA solutions work – right patient right care, transfer of care

• Opportunity to exert major influence for safety on £6B programme

Page 6: Safer IT Systems for the NHS

Maximising safety in primary care systems

• NPSA funded study (£55,000) from University of Nottingham

• Conducted during 2003

• Emerging findings conveyed to NPSA while study on-going and influenced programme of work

Page 7: Safer IT Systems for the NHS

Objectives of study

• Identify the most important safety issues regarding GP computer systems

• Assess GP computer systems in terms of these safety features

• Determine GPs’ knowledge, views and training needs in relation to computerised safety features

• Work with stakeholders to produce specifications for GP computer suppliers and for training practice staff

Page 8: Safer IT Systems for the NHS

Primary care contacts

• 1 million consultations with GPs in UK every working day (NHS Plan, 2000)

• 100,000 home visits by community nurses every day (NHS Plan, 2000)

• 617 million prescriptions dispensed by community pharmacists in year 2002-3 in England (source PPA)

• 50 million prescriptions dispensed in dispensing practices in year 2002-3 in England (source PPA)

Page 9: Safer IT Systems for the NHS

Medication errors - English general practice

• Medication error rate between 1% and 10% of all prescriptions generated

• From lower estimate could be 6,500,000 medication errors

• Estimated 1% of medication errors in general practice are clinically significant

• Could be 65,000 cases of harm in England annually

Page 10: Safer IT Systems for the NHS

Results from NPSA funded study (University of Nottingham)

• Allergy alert may not be generated• Hazard alert generated every third prescription• Single keystroke to over-ride alert• No audit trail• Not all safety functionality activated (eg contra-

indications)• Hazards generated by drop-down menus• GPs unsure of safety functionality on systems• Some think functionality is present when it isn’t

(eg contra-indications)

Page 11: Safer IT Systems for the NHS

Development of Safety Management Approach in NPfIT

• DCMO requested NPSA to conduct high-level risk assessment of NPfIT

• NPSA Risk Adviser conducted assessment early summer 2004

• Report delivered to NPSA and NPfIT June 2004

Page 12: Safer IT Systems for the NHS

Report findings

NPfIT currently not• Formally incorporating safety as a benefit to drive

the programme• Formally risk assessing systems and processes• Formally risk assessing solutions to ensure no

new risks introduced• Relying on those involved to instinctively

address patient safety

Page 13: Safer IT Systems for the NHS

Conclusion

NPfIT not addressing safety in an explicit, proactive, structured and robust manner and….

Other industries would!

Page 14: Safer IT Systems for the NHS

NPfIT Action

• Work in partnership with NPSA to address safety concerns

• Safety Management Approach evolved in workshops Autumn 2004

• Based on IEC 61508 (international standard for safety critical software)

• Agreed with and supported by NPSA• Implemented January 2005

Page 15: Safer IT Systems for the NHS

Aims of Safety Management Approach

• To deliver IT systems which improve clinical safety.

• To provide suppliers with an easy to use and robust safety management system.

• To provide Trusts with assurance and clear guidance on the actions they need to take to ensure systems are deployed in an effective and safe manner.

Page 16: Safer IT Systems for the NHS

Safety Management Requirements

Every CfH product, and every product that connects over the spine to have

• End-to-end hazard assessment• Safety justification case• Safety closure report

When closure report signed off, then ‘certificate of authority to deploy’ issued

Page 17: Safer IT Systems for the NHS

Responsibilities

• The Director of Clinical Safety, Professor Muir Gray, Chairs the CfH Monthly Safety Committee.

• The National Patient Safety Authority (NPSA) have seconded Dr Maureen Baker as the Clinical Safety Officer.

• Muir and Maureen will ensure liaison with the CfH Programme Development Board and RIDs

Page 18: Safer IT Systems for the NHS

IT solutions to patient safety problems

• Right patient right care

• Clinical Hand-offs

• Interface issues

• Management of investigations and results

Page 19: Safer IT Systems for the NHS

Process design

• Poor processes can lead to patient safety incidents

• Automating poor processes still yields poor results for patient safety

• Clinicians need to feed into development of systems

• Change in working processes should be determined by clinical requirements, not by the way in which IT systems have been designed

Page 20: Safer IT Systems for the NHS

Safety Principles

• Systems designed to deliver safer patient care• Patient safety embedded at every level –

specification; design; testing and quality assurance; implementation and use in clinical setting

• Structured risk assessment incorporated into development processes

• Aim for inherently safe systems

Page 21: Safer IT Systems for the NHS

ANY QUESTIONS?

www.npsa.nhs.uk

[email protected]