What is ‘Safety in Practice' in Primary Care?
‘Safety in Practice' in Primary Care is a collaborative programme led by Counties Manukau DHB with Waitemata DHB and the Primary Healthcare Organisations for these districts. We are working with four general practice medical centres within Waitemata DHB's catchment to improve patient safety in three of four areas:
1. Medication reconciliation
When someone goes to hospital, their medications are often changed. We want to make sure that:
- any changes to medications prescribed (i.e. new, changed or stopped) while in hospital are identified by hospital clinical pharmacists and medical staff
- the general practice is aware of any changes and that they update their patient’s file in a timely way
- the patient understands the changes to their medications
2. Laboratory results handling
A large number of blood tests are ordered by general practices for their patients. We want to make sure that:
- the right test is ordered at the right time
- there is a plan in place when the test results comes back
- all tests and plans of care are documented in the patient’s file so that general practitioners and/or practice nurses involved in their care are able to understand what needs to happen
3. Prescribing and monitoring of Warfarin
Warfarin is used to prevent the development of blood clots related to a number of medical conditions. It is a medication that requires regular monitoring as each patient will have a different reaction to the medication e.g. one patient may only need a small amount of Warfarin for it to work well for them while another may need a larger amount.
We want to make sure that:
- each patient is kept safe while taking Warfarin
- each patient understands their own reaction to the Warfarin
- blood-testing is only done when indicated
- Primary health care relates to the professional health care provided in the community, often from a general practitioner (GP), practice nurse, pharmacist or other health professional working within a general practice. Primary Healthcare Organisations (PHOs) are funded by district health boards to ensure the provision of essential primary health care services, mostly through general practices, to those people who are enrolled with the PHO.
4. Trigger Tool
Practices can use a review process known as a ‘Trigger Tool’, which involves a team of staff reviewing the way that the practice has provided care to their patients and seeing if any decisions made (or absence of a decision) has resulted in harm being caused to the patients. Based on their findings, improvements in care can be identified that go beyond the scope of the three areas noted above.
A Trigger Tool lists a range of possible 'triggers (clues of potential harm) that alert a reviewer to possible harm caused to the patient. The tool also lists categories of harm according to the type of harm and severity of harm. A multi-disciplinary team or pair of reviewers randomly select a small sample of patient notes and rapidly scan the notes to identify triggers of potential harm. If any triggers are identified, the reviewers examine the notes more carefully to identify harm and then categorise the harm. When anything that may have harmed a patient is identified, teams are encouraged to take steps to improve care processes and continue rapid audit cycles regularly to monitor changes over time.
What are we doing?
Practices have attended learning sessions on how to implement change. A quality improvement advisor from Waitemata DHB is providing support and advice to our general practices on how to make and measure changes to practice systems and processes.
[View highlights from a Safety in Practice learning sessions]
On-going monthly training and communication sessions are held so that the project team can review progress with the general practices. This is an opportunity to discuss what’s going well, where support is required and how the programme might target specific issues.
Where to from here?
Small tests of change will continue to see how general practices can improve the care that is provided to their patients and how their day-to-day working life can run smoothly and efficiently.
Further learning sessions are planned and will provide an opportunity to feedback on what is going well and what needs improvement. This is an excellent opportunity for practices to share successes and failures and learn from each other.
We will report on progress in next year’s quality account.
For more information go to http://koawatea.co.nz/campaigns/safety-in-practice/