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Risk Management in Primary Care

Risk Management in Primary Care. Context. Australian GP incident-monitoring study. 805 incidents reported 76% preventable Report errors = basic oversights failure to review patient’s history complications from drug treatments poor legibility of prescriptions

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Risk Management in Primary Care

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  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 patient’s 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failure 5% • lack of training 5% • other (e.g. problems with staffing, continuity of care, equipment) 5% (PIE, Seattle: Unpublished Study)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. confidentiality communication complaints equipment medical records out of hours primary/secondary care interface prescribing referrals test results training Some areas for review

  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 • H&S 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. Risk? A4/ Lloyd George Mixed use 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

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