Levels of maturity with respect to a safety culture E. Risk management D. We are is an integral always on part of the alert C. We everything for risks have that we do that might systems in B. We do emerge place to something A. Why manage all when we waste our identified have an time on risks incident safety? Generative Pathological Reactive Bureaucratic Proactive
• Practice safety is not new • Apply systems thinking • Each of us are part of a system • System needs to be made safe
So how can we improve Safety in Primary Care?
A quality improvement programme for primary care that has a particular focus to reduce preventable patient harm ADHB WDHB
Nearly 1000 practices Warfarin Medication Reconciliation Results Handling NSAIDS Methotrexate 82% Benefited their practice 75% Improved safety culture 2014 Pharmacy pilot National 2017
From Haggis to Pavlova
SiP Collaborative
2014/15 23 practices 2015/16 32 practices 2016/17 40 practices 2017/18 61 practices - 4 urgent care clinics 20 community pharmacies pilot 2018/19 64 general practice, 46 pharmacies, 1 urgent care Joint learning sessions
Community Pharmacy so far Testing and development Adapt Scottish tools for NZ use Expert group 20 Community Pharmacy teams Collaborative 9 months pilot Review (feedback) Sustain and Spread
Programme Aims Reduce preventable harm to patients Create safer more reliable systems Promote a culture of safety Develop quality improvement skills
Evidence based focus on high risk areas
General Practice Results Handling Medication Reconciliation Warfarin NSAIDs Opioids DMARDs – methotrexate azathioprine Protecting kidneys + prevention AKI
Community Pharmacies Medication Reconciliation Anticoagulants NSAIDS Opioids
Urgent care Deteriorating patient NSAIDs
Using IHI Break Through Series Collaborative approach Primary Health Care Teams Prework Development of topic, LS2 LS4 Learning Session LS1 LS3 framework and changes Practice Visit Supports: visits / emails / calls New Practices PHO facilitators – Clinical Leads – IAs
What could we measure? 3 to 5 elements of care Across patient’s journey Different members of practice team Mix of easy and hard All or nothing Small frequent samples
Sharing and Learning
Supports Cornerstone / Foundation Results Handling - 23 Incident management - 28 Quality Improvement - 29 Culture of safety and teamwork - 38
MOPS Audit
Video
What will primary healthcare teams do? Eleri Clissold
Improving Patient Safety in Primary Care Quality Improvement Tools Sue French Shona Muir Tim Denison
Learning objectives By the end of this session you will have a fundamental understanding of: What Quality Improvement is and why it is important The Model for Improvement, and its four key elements How to set up and run a Plan, Do, Study and Act improvement cycle (and practice it) How to translate what you did in the PDSA practice run into your workplace
What is Improvement anyway… Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. ( HRSA, USA 2011 ) Improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable. ( The Health Foundation, UK 2013 ) Research enables us to determine what is possible Audit tells is what is actual Improvement science was designed to reduce the gap between what is actual and what is possible. (courtesy of Barbara Corning-Davis 2018 )
How can QI help us create change
What do you want to achieve – what is the problem what is your aim What will you measure/audit What actions will you take to deliver on your aim
Getting started - Writing an Aim Statement An aim statement: Describes the goal of your improvement work in specific terms (but it does not tell you how) Describes your intention objectively, and in observable terms Describes your aim in quantifiable and observable terms A good aim statement will describe the 5 ‘W’s Apply the 5 ‘W’ What Who Where When why
Example of an Aim Statement for Warfarin management “Increase the number of patients receiving Warfarin education every 12 months” Better: “Increase the number of patients on Warfarin receiving appropriate education every 12 months by 20%” Best: “increase the number of patients receiving yearly warfarin education from 30% to 80% within 12 weeks ”
Why we measure and what we measure? We measure to: Enable us to ‘see’ how we are doing ‘See’ the variation that lives in our daily processes and routines Tell us whether we are getting closer to our aims? What are we doing well, or not? And Why
Recommend
More recommend
