professional support and expert advice general practice – risky business? reducing risk –...
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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
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Aim
■ To help reduce the risk of harm to patients, staff and visitors by improving safety and the quality of care in practice
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Risk
“The possibility of incurring misfortune or loss”
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Living with risks
Risk is part of everyday life
■ At home
■ When travelling
■ With patients
You can minimise your risks by improving your systems
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Infection control
Common issues:
■ No infection control policy
■ Specimen handling
■ Hand washing issues
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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
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■ 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?
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About MPS
■ The leading provider of comprehensive professional indemnity and expert advice
■ 250,000 members worldwide
■ Not an insurance company
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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
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MPS publications
■ Casebook
■ Your Practice
■ GP Registrar
■ Fact sheets
■ Medicolegal booklets
■ ‘Clinical Risk Management in Primary Care’
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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
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Bev Hampshaw
GP Account Executive
Contact me by email, telephone/fax