Implementing the Scottish Patient Safety Programme in Primary Care (SPSP – PC)

Scottish Patient Safety Programme in Primary Care: Focus Aims What are we spreading? Methodology Infrastructure: Levers Roles and responsibilities 3

Focus Stage 1 General Medical Services Programme launch March 2013 Pharmacy and Nursing Proto-typing and testing from late 2012 Stage 3 Dentistry Exploratory work spring 2013 Stage 4 Optometry Exploratory work from summer – 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 4

Programme Aims To reduce the number of events which could cause avoidable harm to people from healthcare delivered in any primary care setting. 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 2018.

What are we spreading? 3 Workstreams: Safety Culture and Leadership Safer Medicines Safe and reliable patient care within practice and across the interface

Safety Culture and Leadership Aim:  To develop a safety culture that engages with patients to support the delivery of safe and reliable care in primary care teams. Increase awareness of safety issues within practice, through practice teams undertaking Safety Climate Surveys. Practices identify, reduce and learn from adverse events identified through trigger tool reviews. Safety walkrounds to ensure Safety in Primary Care is embedded within the NHS Board safety agenda.

Safer Medicines Aim: To Provide Safe and Effective Medicines Management in Primary Care Implement systems for reliable prescribing and monitoring of warfarin, methotrexate and azathioprine. Practices have safe and reliable systems for medicines reconciliation following discharge. Implement systems for safe and reliable insulin administration. Implement systems to support reliable prescribing and monitoring of high risk medications in community pharmacy. Use existing electronic data to support targeted application of clinical judgment to reduce high risk prescribing.

Medication reconciliation Practices have a system for ensuring patients medication records are updated to reflect changes during a patient’s consultation, admission or following an outpatient attendance and this is communicated appropriately to patients and care providers

Safe and reliable patient care within practice and across the interface Aim: To provide safe and reliable patient care across the interface and at home. GP practices have safe and reliable systems for handling written communication received from external sources Health Boards and GP practices have safe and reliable results handling systems Reduce harm from pressure ulcers Reduce harm from falls Reduce incidence of catheter-associated urinary tract infection

Rate of Spread: Not all at once Menu Build over time Practices and boards prioritise

Methodology – collaborative within a collaborative National Learning Sessions NHS Board Learning Sessions Collaborative Interactive Workshops (Awareness raising) Oct–Dec 2012 Learning Session 1 & Formal launch (2 days) – end Mar 2013 Local Learning Session (1 day) May 2013 Learning Session 2 (1 day) Sep–early Nov 2013 Local Learning Session (1/2 day) Nov 2013 Learning Session 3 (1 day) Apr 2014 Local Learning Session (1 day) May 2014

National Collaborative NHS Board Staff Train the trainers Share resources/ experience Learning across NHS Scotland Identify successes and challenges Build network

Local Collaborative Practice staff attend (3 members) Learn about tools Share resources Share successes and challenges Support practices

What will Practices be doing: Attending Local Collaborative Learning Events 3 team members – 1.5 days pa Data collection and improvement 1 high risk process per annum Trigger Tool Review (25 records twice a year) Safety Climate Survey annually Share their data, improvements, challenges and successes

Successful implementation needs . . . Commitment of Boards, HIS and SGHD Build on the professionalism of front line staff Prioritised within existing and adapted contracts Alignment with GP Appraisal and Revalidation

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

Boards need to provide … Executive buy in - Prioritise this programme Dedicated programme management, clinical leadership and QI support to: Run local collaborative Build knowledge and skills Support practices

Ice and Cars

Which way is your board looking…

What’s in it for boards? Fewer adverse events Fewer Admissions Safe effective prescribing Fewer Falls/ UTIs/Pressure ulcers Improved Interface working – SPSP Engagement with Primary care

Adverse events in primary care in NHS Scotland cause: 39,000 Admissions pa 21,000 pa admissions are drug side effect related 14,000 pa preventable 6,500 from Warfarin, NSAIDS, Diuretic, Anti-platelets alone Based on 327,000 acute medical emergency admissions 2010/11 - ISD Howard et al Br J pharmacology 2006 Howard et al qshc 2003

Discussion How does this align with current board priorities and activities? What will be the benefits and challenges for your board, practices and patients of the programme? How will you engage with your board and primary care teams to prioritise and implement this programme?

What’s in it for Clinicians Doing the best for your patients Working better as a team More confidence in your systems Less things going wrong Less stress More Efficient Better Interface working

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. . 27

Revalidation Safety core to revalidation and GMC guidance Bundles, Trigger Tool and Climate Survey evidence for GP appraisal

Enhanced Service To support Improvement in key areas of the programme Attending Collaborative Learning Event Data collection and improvement 1 high risk process per annum Trigger Tool Review (25 records biannually) Safety Climate Survey annually Safety as Core in Scottish Focussed Contract

Frustrations/celebrations Alignment PGP PGP Tools Getting Started Creating the team Raising awareness Engage Team Attend Collaborative PGP Tools Using Data Process mapping Frustrations/celebrations Process reliability PDSA Collect Warfarin Data Care Unreliable

And for Patients… Better Informed Better Understanding More in control of health Actively engaged in improving services More confident in systems More reliable care Less chance of being harmed/ admitted Better QOL

Why wouldn’t we?

Implementing the Patient Safety Programme in Primary Care Next Steps

HIS What next Awareness raising Clarify Levers Finalise tools Website Capacity Building March 2013

Boards Actions Raise awareness Clarify: leadership and support Clinical QI and programme management Engage with PC GP sub etc Set up programme team Identify who to attend national collaborative Recruit practices Select topic

Feedback What was good? What was not so good? What could we do to improve the session?