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

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

4. 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

5. 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.

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

7. 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.

8. 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.

9. 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

10. 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

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

12. 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
Learning Session 2 (1 day) Sep–early Nov 2013
Local Learning Session (1/2 day) Nov
Learning Session 3 (1 day) Apr 2014
Local Learning Session (1 day) May

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

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

15. 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

16. 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

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

18. 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

20. Ice and Cars

22. Which way is your board looking…

23. 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

24. 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

25. 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?

26. 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

27. 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

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

31. 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

32. 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

33. 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

34. Why wouldn’t we?

35. Implementing the Patient Safety Programme in Primary Care Next Steps

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

37. 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

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