Patient Safety in Primary care Tina Eriksson

“All doctors have a moral and professional responsibility to ensure that the healthcare that they provide is safe and that patients do not incur any adverse consequences as a result” “Quality and patient safety are linked. We need to develop a culture where patients can expect the highest and safest quality of care wherever they live across Europe”

“We may acquire the technology and we can develop safer systems but little progress can take place unless all those involved in patient care develop a culture of personal awareness, openness and a commitment to improvement.” “We will need to extend the practitioner’s horizons from a narrow personal perspective to a wider team based approach which follows a non blame philosophy with the patient’s needs in the centre.”

Errors in UK primary care An adverse event is experienced in 1-2% of consultations with estimates being as high as 8% (The Evidence Centre, 2011). Medication errors occur in up to 11 per cent of prescriptions, mainly due to errors in dosage (Sanders and Esmail 2003) Elderly patients are particularly at risk. Mean adverse drug event prevalence rate % (compared to 5.2% for adults) (Linneaus 2012).

Discuss with your neighbor What are – your attitudes towards patient safety? – the issues and dangers in your practice/your last clinical workplace? Do you get any help and support?

Linneaus Euro-PC A Danish initiative on PATIENT INVOLVEMENT IN PRIMARY CARE PATIENT SAFETY – Jonas Egebart A German on DEVELOPING A TAXONOMY OF ERRORS FOR PRIMARY CARE – Kerstin Klemp A UK-Manchester one on PATIENT SAFETY CULTURE AND PERFORMANCE IN PRIMARY CARE – Dianne Parker A UK-Kings College London one on DIAGNOSTIC ERROR IN PRIMARY CARE A Salzburg one on MEDICAL SAFETY IN PRIMARY CARE – Andreas Soennichsen One based in Nijmegen: LEARNING FOR PATIENT SAFETY – Michel Wensing

Linneaus EURIPA EQuiP project 1.A WAY TO REPORT, ANALYZE AND MAKE USE OF ERRORS AND NEAR MISSES IN GP/FM 2.WORKING WITH PATIENT SAFETY CULTURE AND PERFORMANCE IN PRIMARY CARE USING THE MaPSaF 3.PATIENT INVOLVEMENT IN PRIMARY CARE PATIENT SAFETY In rural practices all over Europe

Adverse events - HOW Develop reporting systems (building networks: local, regional and national) Record critical incidents and establish a process to discuss and analyse the episodes in a non-blame environment – Report periodically – Train root cause analysis – Form new or use existing peer groups to discuss events and implement change

MaPSaF is a team based self-reflection exercise Discuss your profiles with the rest of your team. You may notice that there are differences between staff groups. If this happens, discuss possible reasons. Address each dimension in turn and see if you can reach consensus consider the overall picture of your organisation and/or team. You will almost certainly notice that the emerging profile is not uniform – that there will be areas where your organisation is doing well and less well. Where things are going less well, consider the descriptions of more mature risk management cultures. Why is your organisation not more like that? How can you move forward to a higher level?

Involve patients The patient is the only person to be present trough his course of contacts with the health care system. Involvement of patients is important: Patients and relatives may contribute to safer care, be the last barrier to prevent errors Patient preferences for care and treatment are taken into account

Take home messages Develop reporting systems (building networks: local, regional and national) Record critical incidents and establish a process to discuss and analyse the episodes in a non- blame environment Make links with the local pharmacist and establish a dialogue to help reduce prescribing and dispensing errors Establish team meetings in the practice Identify a patient representative/s who can help identify areas for improvement and change Establish a complaints and compliments register

Online resources WHO Europe: Patient Safety and Rights Linneaus EURO-PC Home page Linneaus Presentations on patient safety Linneaus Bibliography on Patient Safety Health Foundation UK: Patient Safety safety/ safety/ National Patient Safety Agency (UK) Seven steps to patient safety in general practice (UK National Patient Safety Agency) safety/?entryid45=61598 USA National Patient Safety Foundation IHA National Patient Safety Initiative (USA) launches-new-patient-safety-initiative-.htmlhttp:// launches-new-patient-safety-initiative-.html EQuiP: European Association for Quality in General Practice/Family Medicine Patient Safety First (UK) WHO Patient Safety Manchester Patient Safety Framework (MaPSaF) National Primary Care Research and Development Centre: Patient Safety Research Network archive/archive/ProjectDetail.cfm/ID/130.htm archive/archive/ProjectDetail.cfm/ID/130.htm