PROFESSIONAL SUPPORT AND EXPERT ADVICE

General practice – risky business?

General practice – risky business?

Reducing Risk – Improving patient safety

and quality of patient care

Reducing Risk – Improving patient safety

and quality of patient care

E D U C A T I O N Y O U C A N P U T I N T O P R A C T I C E

Copyright 2008 All Rights Reserved

Aim

■ To help reduce the risk of harm to patients, staff and visitors by improving safety and the quality of care in practice

Risk

“The possibility of incurring misfortune or loss”

Living with risks

Risk is part of everyday life

■ At home

■ When travelling

■ With patients

You can minimise your risks by improving your systems

In hospitals…

■ Study in England estimates that around 10% (900,000) patients admitted to NHS hospitals have experienced an adverse event (patient safety incident)

■ 50% could have been prevented ■ 33% led to moderate or greater disability

or death.

Vincent C et al BMJ 322:517-19

Seven steps to patient safety NPSA 2003

In general practice…

■ Average GP will provide about 200,000 consultations during their career

■ 25% of adverse events occur in primary care

■ And, it is estimated that 1% of GP consultations (one a week) are associated with a significant adverse outcome

Making amends DH 2003

Incident reports to the National Patient Safety Agency

■ 2600 reports from October 2006 to September 2007 from general practice:■ 29% Medication errors

■ 14% Documentation

■ 11% Access/admission/transfer/discharge

■ 10% Consent/communication/ confidentiality

0.33% of all reports received

NPSA National Reporting and Learning Data Summary

Issue 7 December 2007

MPS Risk Consulting

Experience of clinical risk assessments:

400 CRSAs completed

Many practices – above average, excellent systems in place

All practices had a number of areas where further action would improve level of service

Top key risks in UK general practice

95% Confidentiality

92% Prescribing

90% Health and safety

85%Communication

84% Record keeping

84% Test results

MPS Risk Consulting August 2006

Excellence

Examples of good practice

■ The dedication and commitment of all the staff

■ The organisation of the practice administration team

■ The impressive ‘learning from events’ system

■ The test results process

■ The clinical and administrative audits undertaken

Confidentiality

Common issues:

■ Breaches of confidentiality in waiting rooms and reception areas

■ Staff contracts do not include a clause covering confidentiality post-employment

■ Not all patient-identifiable information is shredded

■ Patient medical records are not securely stored

■ Computers may be left on and unattended

Breach of confidentiality

Can lead to:

■ Breakdown of practitioner/patient relationship

■ Lack of trust/confidence in other healthcare professionals

■ Failure to seek further treatment

■ Disciplinary action by GMC and employers

Prescribing

Common issues:

■ No repeat prescribing protocol

■ No designated receptionist to record or generate repeat prescriptions

■ Reception staff are allowed to add medication to the computer

■ Medication reviews are undertaken on an ad hoc basis.

■ No system for recalling patients on long-term medication

■ Uncollected prescriptions are destroyed

Health and Safety

Common issues

■ No health and safety assessment undertaken

■ No personnel protective clothing provided

■ Storage of waste and sharps

■ No panic alarms

■ Unsafe furniture/fixtures

Record keeping

Common issues:

■ Illegible writing in the records

■ Letters scanned into wrong record

■ Telephone advice not always recorded

■ Medical records go missing

■ Home visits not always recorded on the computer

Test results

Common issues:

■ No tracker system to ensure that patients are followed up

■ No system of knowing when all a patient’s test results have been returned

■ Test results not recorded onto the computer

■ Non-clinical staff allowed to inform patients of their result and treatment required

Infection control

Common issues:

■ No infection control policy

■ Specimen handling

■ Hand washing issues

Hand washing

For effective hand washing consider the following :

■ Liquid hand dispenser

■ Paper towels

■ Elbow/foot operated mixer taps

■ Alcohol based hand rub

■ No sink plug

■ Remove jewellery

■ Designated hand wash basin

■ Common sense

■ Identification, measurement and control of risk to avoid harm to patients and staff

■ Involves everyone

■ Relates to the whole package of care

■ Equates to good practice

What is clinical risk management?

About MPS

■ The leading provider of comprehensive professional indemnity and expert advice

■ 250,000 members worldwide

■ Not an insurance company

What does MPS offer to GPs

■ Comprehensive indemnity

■ The best professional protection

■ First rate serviceOver 21,000 GP members

■ The GP Practice Package

■ Education and Risk Management

MPS publications

■ Casebook

■ Your Practice

■ GP Registrar

■ Fact sheets

■ Medicolegal booklets

■ ‘Clinical Risk Management in Primary Care’

The MPS website

■ Update personal details or renew membership

■ Courses and events

■ Case reports

■ Practice Packages

■ Request publications

■ Subscription rates

http://www.medicalprotection.org/uk

Bev Hampshaw

GP Account Executive

Contact me by email, telephone/fax