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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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Overview
• Patient safety in Connecting for Health• NPSA commissioned study• Safety Management Requirements• IT solutions to patient safety problems• Process re-design
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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
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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
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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
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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
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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
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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)
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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
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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)
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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
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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
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Conclusion
NPfIT not addressing safety in an explicit, proactive, structured and robust manner and….
Other industries would!
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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
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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.
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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
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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
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IT solutions to patient safety problems
• Right patient right care
• Clinical Hand-offs
• Interface issues
• Management of investigations and results
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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
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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