|
|
|
|
|
|
Primary care
management
-
Participate in meetings run by the practice that
illustrate how a practice can start to build and enhance a safety
culture.
-
Describe how organisations and individuals can
learn to be vigilant for PSIs (Patient Safety
Incidents).
-
Contribute to the regular significant event audit
(SEA) meetings and observe the benefits of a multidisciplinary
team.
-
Be aware of the existing training tools available
for SEAs from the defence associations,5,6 NPSA (National Patient
Safety Agency7
-
Participate in and write up an SEA from a patient
seen during the general practice period of
training.
-
Reflect on the learning and consider whether
reporting locally or nationally would be
appropriate.
-
Demonstrate the measures that the organisation
takes to ensure that reports are dealt with fairly and that
the appropriate learning and
action takes place.
-
Describe the elements that contribute to an
appropriate infrastructure for risk management, such as:
the essential features of a
practice that create a culture that is open and fair; policies that
commit the organisation to being open about serious
incidents that involve permanent harm or death; policies that state
the actions that staff should
take following an incident; individual roles and accountability;
the mechanism of investigation; support that
should be given to patients, family and staff; staff
training.
-
Describe how changes in the IT structure of the
NHS will impact upon the possibility for both
reducing and increasing the chance of
PSIs.
|
|
Person-centred
care
Communicate openly, listen
and take patients’ concerns seriously. Consider patient
issues when reflecting on consultation
experiences.
Be aware of current clinical
governance guidelines that impact on patient safety within a
practice.
Be prepared to consider
the Being Open
Policy9 as advised
by the NPSA when a PSI has occurred or could have potentially
occurred.
Tell patients and their
families as soon as possible when incidents occur and do so fully,
honestly and compassionately. |
|
Specific problem-solving
skills
-
List and identify the systems and processes that
are in place in practices to manage risk in a primary care setting
and compare these with colleagues in other
practices.
-
Know how to assess the organisation’s
reporting and learning culture.
-
Demonstrate awareness of evidence-based tools to
identify and assess risk. Give examples, from a personal
educational portfolio throughout your current training, that show
an understanding of the benefits and disadvantages of such
tools.2,5
-
Describe the criteria for when the organisation
should undertake a root cause analysis or significant event audit.
These criteria should include all incidents that have led to
permanent harm or death.
-
Demonstrate an awareness of the limitations of
your own skills in risk management and illustrate that you
understand when the skills of colleagues trained more extensively
in risk management should be called upon.
|
|
A comprehensive
approach
-
Demonstrate an awareness of the all-encompassing
approach to patient safety; for example, by keeping a log diary of
consecutive consultations for at least one day per month and
comment on any actual or potential PSIs within those
consultations.
-
Describe the risks to patient safety by
considering an illness pathway/journey in which a variety of
healthcare professionals have been involved. In particular, to
reflect on the interface issues arising from the current multitude
of such providers and be able to comment on the ways in which, as a
GP, you can work to minimise these.10
-
Describe the structures and processes for managing
clinical and non- clinical risk, and how these are integrated with
patient and staff safety, complaints, clinical negligence and
financial and environmental risk.
|
|
Community
orientation
-
Demonstrate the ability to involve and communicate
with patients and the public by practising the
Being Open approach.9
-
Be able to make contact with the local Patient
Advocacy Liaison Service (PALS) or equivalent support team and be
aware of the current pattern of patient
comments.
-
Describe the ways in which general practice and
community pharmacy can minimise the potential for
PSIs.
-
Describe how patient groups may be put at
increased risk of mishap by virtue of their particular
characteristics, such as language, literacy, culture and health
beliefs. The latter may be manifest through the patient’s
ability and willingness to work in partnership with the doctor in
the management of the problem.
-
Illustrate an awareness of the potential benefits
for patient safety of good working relationships with colleagues
from longstanding community services.
-
Describe any new roles that have emerged in the
community setting (e.g. community matrons) and give examples of how
these new roles have impacted on patient
safety.11
|
|
A holistic
approach
-
Describe how the lessons of patient safety can be
applied prospectively to doctor–patient interactions,
especially through the identification and discussion of
risk.
-
Describe the local clinical governance
arrangements.12
-
Describe and show usage of the various options for
reporting PSIs both locally and
nationally.1
-
Comment on the participation of whole teams in
significant event audit2
within the practice and give reasons for inclusion
or exclusion of different team members.
-
If relevant to the training practice, help
facilitate the implementation of solutions to prevent harm, by
embedding any lessons learnt in the practice processes and
systems.
-
Describe how to share lessons from the analysis of
PSIs within the team.
-
Identify which other elements of patient services
may be affected in future and share learning more widely on the
basis of this.
|
|
Contextual
aspects
-
Identify how, as a specialty registrar (GP) within
the team environment of general practice, his or her experiences
gained in undergraduate and early postgraduate education can be
shared with colleagues. Recognise that the formal Patient Safety
Agenda1 is
relatively recent and still changing so may be unfamiliar to well
established colleagues in primary care.
-
Describe the impact of the working environment on
the care the doctor provides and the likelihood of adverse
incidents as a result of this.
|
|
Attitudinal
aspects
-
Demonstrate a preparedness to admit when an error
has occurred, apologise for failings in the delivery
of care and to communicate this openly to patients
and their families, reassuring them that the appropriate
lessons have been
learned.9
-
Discuss examples that describe a clear
appreciation of how a change in the behaviour and/or systems
can influence patient
safety.
-
Describe experiences gained from discussing with
colleagues in different practices how high-quality
multi-professional working can benefit patient
safety. Consider the steps needed to facilitate such co-
working.2
|
|
Scientific
aspects
Describe the tools that can
be applied in risk management and patient safety issues accessible
from sites such as www.NPSA.nhs.uk8,2 and medical indemnity
sites.5,6
Describe the basic
principles of human error.13,14
Describe the basic
principles of risk assessment.2
Demonstrate how to compile a
simple risk matrix.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
1. The consultation
