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Making Results Handling Safer
Delivering the Scottish Patient Safety Programme in Primary Care
Enabling health and social care improvement
Making Results Handling Safer Delivering the Scottish Patient - - PowerPoint PPT Presentation
Making Results Handling Safer Delivering the Scottish Patient - - PowerPoint PPT Presentation
Making Results Handling Safer Delivering the Scottish Patient Safety Programme in Primary Care Enabling health and social care improvement Back to 2015... Inspiration? Quality Planning When your ark is sinking, you look for the
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Back to 2015...
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Inspiration…?
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Quality Planning
When your ark is sinking, you look for the elephants…
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Identifying Your Priorities
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Scope
- Full Blood Count (FBC)
- Urea and Electrolytes (U&E)
- Liver Function Tests (LFT)
- Thyroid Function Test (TFT)
- On the day of the data collection each month
randomly pick 20 patients who had one or more of the blood tests taken 3 weeks previously.
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Care Bundle
Making Results Handling Safer Bundle Elements
- Are ALL the individual blood test(s) requested by the clinician clearly recorded?
- Are ALL the individual blood test(s) taken clearly recorded?
- Have ALL the results of the blood tests ordered been returned to the practice?
- Were ALL the test(s) results forwarded to a practice clinician for review within 2
working days of being received by the practice?
- Was a definitive decision recorded by a practice clinician on ALL test(s) results within
7 calendar days of being received by the practice?
- Have the decisions for ALL test results been ‘actioned’ by the practice, including the
patient being informed if required? (Where no actions are required record as Y)
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Process Mapping
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Discussion Points
Systems How does our practice ensure the results are work-flowed, reviewed and acted on in a timely manner? How does our practice ensure it actions emergency test results communicated by the laboratory? Tracking What is our practice’s tracking system for reconciling samples sent with results returned and ensure appropriate clinical follow up? Communication How do clinicians record which blood tests are required? Does our practice (including non-clinical staff) have agreed wording for communicating test results to patients? Training How are staff, including locums, trained in the results handling system? Patient Experience How does our practice help patients understand the results handling system – and when and how to access their test results? How does our practice record that it has notified patients of their results and actions required?
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Communication
Unclear or ambiguous test result communication by doctors on reviewing results can lead to uncertainty about what action needs to take place and what should be communicated to patients. “ They don’t really give us enough information to pass it onto the patient.” It is suggested that all staff ensure they fully understand an agreed set of practice-wide terms, words and abbreviations related to the results handling process.
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Examples of comments that REQUIRE action
- Add/Change Medication
- Contact patient and inform them
- Make an appointment for bloods
- Kidney function slightly abnormal – repeat in 1 week – phone patient
- Make an appointment for fasting bloods
- No action today – workflow to usual GP to advise
- Repeat test(s)
- Prescription required
- Prescription issued
- Inform Pharmacy
- Tried to contact patient – failed please try again
- Inform patient acceptable
- Please repeat in xxxxx weeks
- Repeat as per DMARDs protocol
- Make URGENT in person / telephone appointment with DOCTOR
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Examples of comments that DO NOT require action
- Results are normal
- Normal see task
- Continue on current prescription
- Inform patient when they phone in
- Patient has been informed
- Noted reduced kidney function – no action needs to be taken
- Review already organised
- Document has been seen – no action required
- Results slightly out with normal range but acceptable and no further
action is needed
- GP has spoken to patient
- Nurse has already spoken to patient
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Year 2: 2016/17
99 37 16 41 6
Employment breakdown of attendees
GPs Practice Managers Practice Nurses Admin/Reception Other title given
This is a really good topic for patient safety that will hopefully improve patient care PLIG group doing good work, helpful to know we can bring problems to them Another interesting session & looking forward to trying out this new initiative GPOC talk very useful & helpful, thank you Being new to 'GP land’ from hospital, found this very informative and applicable to myself
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Support for practices
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Care Bundle
Making Results Handling Safer Bundle Elements
- Are ALL the individual blood test(s) requested by the clinician clearly recorded?
- Are ALL the individual blood test(s) taken clearly recorded?
- Have ALL the results of the blood tests ordered been returned to the practice?
- Were ALL the test(s) results forwarded to a practice clinician for review within 2
working days of being received by the practice?
- Was a definitive decision recorded by a practice clinician on ALL test(s) results within
7 calendar days of being received by the practice?
- Have the decisions for ALL test results been ‘actioned’ by the practice, including the
patient being informed if required? (Where no actions are required record as Y)
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Quality Improvement: some examples
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Patient Experience
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Bundle Data – all practices 2016/17
93% 98% 98% 96% 99% 98% 97% 98% 96% 97% 91% 82% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Percentage (%)
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Challenges
IT Cumulative reporting Reconciliation Measure High bundle compliance
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QI Capacity & Capability: the barriers
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QI Capacity & Capability: the enablers
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How We Work
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Systems thinking: the legacy
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Keep in touch
Enabling health and social care improvement