Risk Management in Primary Care

1
Risk Management in Primary Care
2
Context
Australian GP incident-monitoring study

• 805 incidents reported
• 76 preventable
• Report errors basic oversights
• failure to review patients history
• complications from drug treatments
• poor legibility of prescriptions
• abnormal test results missed or not acted on
• Bhasale (1998)

3
Analysis of Settled Claims

• clinical judgment 50
• faulty technique/procedure 20
• communication failure 10
• inadequate medical records 5
• system/administration failure 5
• lack of training 5
• other (e.g. problems with staffing,
• continuity of care, equipment) 5
• (PIE, Seattle Unpublished Study)

4
Some areas for review

• confidentiality
• communication
• complaints
• equipment
• medical records
• out of hours

• primary/secondary care interface
• prescribing
• referrals
• test results
• training

5
Confidentiality

• environmental
• siting of telephones, computer screen
• contracts of employment
• awareness
• wider context (Data Protection Act, GMC guidance)

6
Staff Security

• difficult, abusive, violent patients
• level of support/training
• DoH tackling violence towards GPs and their
  staff, HSC 2000/001
• www.nhs.uk/zerotolerance

7
Communication

• message taking
• recording home visits
• practice meetings

8

• Prescribing systems

9
Prescribing

• Systems for
• right patient, drug, dose and route
• warning about potential problems with medication
• monitoring
• repeat prescription
• shared care
• audit

10
Repeat Prescribing

• means of requesting repeat prescription
• system for ensuring follow up
• uncollected scripts

11
Test Results

• record of tests requested and returned
• practice system for abnormals
• multiple tests
• receptionists script

12
Hospital Communication

• quality and timeliness of discharge information
• LHG/DGH issue

13
Health Safety

• level of understanding
• HS assessments
• RCGP publication
• Health Safety at Work Guidance for General
  Practitioners (ISBN 0 85084 259X)

14

• Medical records

15
Medical Records

• Systems/policies for
• authorising entries
• filing
• ensuring continuity of clinical information for
  out of hours, GP co-operative, deputising
  services
• security/disclosure
• content/format

16
Medical Records/Computerisation
Paperless
17
Training

• staff induction
• communication skills, including handling of
  messages and results

18
Equipment

• fit for purpose
• installation
• training
• maintenance

19
Referrals/DNAs

• point of dictation
• aide memoire/prompt
• review of DNAs

20
Out of Hours

• timelines and quality of information from
  deputising service
• recording of out of hours consultations

21
Remember

• simple precautions
• - cost nothing
• no precautions
• - can cost a lot