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49 th EQuiP Assembly Meeting 2016 European Society for Quality and Safety in Family Practice Patient Safety in Primary Care April 22-23, 2016, Prague www.equip2016.cz
Transcript of Patient Safety Primary Care - WONCA Europe€¦ · of patient safety in primary care?: results of a...
49th EQuiP Assembly Meeting 2016
European Society for Quality and Safety in Family Practice
Patient Safety
in Primary Care
April 22-23, 2016, Prague
www.equip2016.cz
49th EQuiP Assembly Meeting 2016, Prague
Patient Safety in Primary Care
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Organizers
European Society for Quality and Safety in Family Practice
Partners of the Meeting
WONCA Europe
The Czech Society of General Practice CMA JEP
The Ministry of Health of the Czech Republic
The EQuiP Conference hosted by the Czech Society of General Practice CMA JEP is supported by the Ministry of Health of the Czech Republic. Svatopluk Němeček, MD, MBA, (Minister of Health of the Czech Republic) acts as a Honorary President of the Conference.
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Programme Overview
Friday, April 22, 2016
09:00-09:30 Welcome and Opening Session (Piet Vanden Bussche, BE; Jan Kovar, CZ)
09:30-10:15 Plenary Session / Moderator: Bohumil Seifert, CZ Keynote: David Marx, CZ: Patient Safety Sustainability - Ever Climbing, Never Rest!
10:30-11:00 Coffee and Tea
11:00-12:30 Workshop 1 What is Patient safety in Primary Care
Workshop 2 EQuiP´s Patient Safety Culture Survey
Oral Presentations 1 Chair: Jan Kovar, CZ
12:30-14:00 Lunch
14:00-15:00 Plenary Session / Moderator: Jose Miquel Bueno Ortiz, ES Keynote: Maria Pilar Astier-Pena, ES: Are Spanish Healthcare professionals aware of patient safety in primary care?: results of a national survey on patient safety culture in primary care.
15:00-16:30 Workshop 3 The aftermath of adverse events (AE) in primary care: interventions to reduce its impact on healthcare teams
Workshop 4 Assessment by GPs of a GPs capacity to deliver healthcare which is safe for them and their patients
Oral Presentations 2 Chair: Dijana Ramic, CR
16:30-17:00 Coffee and Tea
17:00-18:00 Panel Discussion: How can we engage our colleagues (doctors and staff) Moderator: Piet Vanden Busche, BE Job Metsemaker, NL, Isabell Dupie, FR, Tina Errikson DK, Jochen Genischen, GE, Maria Pilar Astier-Pena, ES
19:00 Conference Dinner: Altany Kampa
Saturday, April 23, 2016
09:00-10:00 Plenary Session Moderator: Ynse de Boer, DK Keynote: Aneez Esmail, UK: Researching patient safety in primary care: Now and in the future
10:00-11:30 Workshop 5 How to deal with unintended events
Workshop 6 How to measure patient safety
11:30-12:00 Coffee and Tea
12:00-13:00 Conclusion Remarks: Where to go next with patient safety for primary care Piet Vanden Bussche, BE, Job Metsemaker, NL, Ynse de Boer, DK
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Workshops and Oral Presentations
Workshop 1
Title What is Patient safety in Primary Care
Speaker Ynse de Boer, DK; Helle Soegaard Frappart, DK
Date Friday, April 22, 2016, 11:00-12:30
Room Malostransky Room (1st Floor)
Workshop 2
Title EQuip’s Patient Safety Culture Survey
Speaker Isabelle Dupie, FR; Andre Nguyen Van Nhien, FR
Date Friday, April 22, 2016, 11:00-12:30
Room St. Nicolas Room (1st Floor)
Oral Presentations 1
Chair Jan Kovar, CZ
Lectures 1. Janecke Thesen, DK: Don't assume that your patient is straight 2. Guido Schmiemann, GE: Inappropriate medication in nursing home residents– How to improve medication safety 3. Ivana Orlic Neretljak, CR: How do healthcare professionals assess patient safety culture in family medicine in Croatia? 4. Ana Marcelino, PT: Quality improvement in antibiotic prescription in uncomplicated Lower Urinary Tract Infections 5. Eva Arvidsson, FI: Patient safety for patients with chronic diseases
Date Friday, April 22, 2016, 11:00-12:30
Room Emma Destinnova Hall (2nd Floor)
Workshop 3
Title The aftermath of adverse events (AE) in primary care: interventions to reduce its impact on healthcare teams
Speaker Maria Pilar Astier-Pena, ES
Date Friday, April 22, 2016, 15:00-16:30
Room Malostransky Room (1st Floor)
Workshop 4
Title Assessment by GPs of a GPs capacity to deliver healthcare which is safe for them and their patients
Speaker Andree Rochfort, IRL; Zlata Ozvacic Adzic, CR
Date Friday, April 22, 2016, 15:00-16:30
Room St. Nicolas Room (1st Floor)
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Oral Presentations 2
Chair Dijana Ramic, CR
Lectures 1. Rebecca Hays, UK: Feeling safe in primary care: preliminary findings from a longitudinal, ethnographic study (MAXIMUM) of older people with multimorbidity 2. Beate S. Müller, GE: To report or not to report: That is the question! Using the theory of planned behavior to explain healthcare professionals’ use of CIRS in primary care. 3. Bohumil Seifert, CZ: Strengthening capacities to improve quality and patient safety in primary care. Experience from the Czech Republic 4. Martin Beyer, GE: The German Critical Incident Reporting System for Primary Care www.jeder-fehler-zaehlt.de is productive since 12 years – Content and perspectives 5. Marc Chaneliere, FR: PRisM study: assessment of a multifaceted program on teamwork and risk management in primary care (PC). 6. Kolozsvári László Róbert, HU: Patient safety in primary care in Hungary
Date Friday, April 22, 2016, 15:00-16:30
Room Emma Destinnova Hall (2nd Floor)
Workshop 5
Title How to deal with unintended events
Speaker Piet Vanden Bussche, BE
Date Saturday, April 23, 2016, 10:00-11:30
Room Malostransky Room (1st Floor)
Workshop 6
Title How to measure patient safety
Speaker Ynse de Boer, DK; Aneez Esmail, UK
Date Saturday, April 23, 2016, 10:00-11:30
Room St. Nicolas Room (1st Floor)
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Abstracts – Keynotes
PATIENT SAFETY SUSTAINABILITY - EVER CLIMBING, NEVER REST!
David Marx
Although health care industry has been for long time known as a highly risky one, the introduction of risk-reduction tools into everyday clinical practice has been much slower that in other areas. Systematic quality improvement and patient safety measures started in the Czech republic in 1998, but it took over 10 years to launch nationwide tools to improve patient safety - in 2009 the country has introduced National patient safety goals and launched Action plan for patient safety. The presentation describes most frequent implementation obstacles observed in applying sustainable patient safety programs and examples of successful practice.
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ARE SPANISH HEALTHCARE PROFESSIONALS AWARE OF PATIENT
SAFETY IN PRIMARY CARE?: RESULTS OF A NATIONAL SURVEY
ON PATIENT SAFETY CULTURE IN PRIMARY CARE
Maria Pilar Astier-Pena Background Knowledge about safety culture improves patient safety (PS) in health-care organizations. The first contact a patient has with health care occurs at the primary level. We conducted a survey to measure patient safety culture (PSC) among primary care professionals (PCPs) of health centres (HCs) in Spain and analyzed PS dimensions that influence PSC. Methods We used Agency for Healthcare Research and Quality (AHRQ) Medical Office Survey on Patient Safety Culture translated and validated into Spanish to conduct a cross-sectional anonymous postal survey. We randomly selected a sample of 8378 PCPs at 289 HCs operated by 17 Regional Health Services. Statistical analysis was performed on sociodemographic variables, survey items, PS dimensions and a patient safety synthetic index (PSSI), calculated as average score of the items per dimension, to identify potential predictors of PSC. We used AHRQ data to conduct international comparison. Results A total of 4344 PCPs completed the questionnaire. The response rate was 55.69%. Forty-two percent were general practitioners, 34.9% nurses, 18% administrative staff and 4.9% other professionals. The highest scoring dimension was ‘PS and quality issues’ 4.18 (4.1–4.20) ‘Work pressure and pace’ was the lowest scored dimension with 2.76 (2.74–2.79). Professionals over 55 years, with managerial responsibilities, women, nurses and administrative staff, had better PSSI scores. Professionals with more than 1500 patients and working for more than 11 years at primary care had lower PSSI scores. Conclusions This is the first national study to measure PSC in primary care in Spain. Results may reflect on-going efforts to build a strong PSC. Further research into its association with safety outcomes and patients’ perceptions is required.
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RESEARCHING PATIENT SAFETY IN PRIMARY CARE: NOW
AND IN THE FUTURE
Aneez Esmail
Over the past 10 years, there has been an explosion of research on patient safety in primary care. However, if we were to ask whether patients were any safer than they were 10 years ago, the answer would be elusive. We still can’t answer fundamental questions such as: Has patient care been safe in the past? Are our clinical systems and processes reliable and are we responding and improving? Is care safe today and will it be safe in the future? Can we collaborate to improve safety in a primary care system in Europe that is so heterogeneous that it can challenge many of our precepts about what works and what can be done?
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Abstracts – Oral Presentations
DON'T ASSUME THAT YOUR PATIENT IS STRAIGHT
Janecke Thesen1, Gunnar F Olsen2
1NKLM, Uni Research Health, University of Bergen, Bergen, Norway 2Kantarellen Legesenter, Oslo, Norway
To secure good healthcare and counteract stereotypes of LGBT patients we developed an educational “package” for young GP specialty trainees to be used in educational quality circles (QC’s). Our aim is to contribute to GP’s knowledge based practice and attitudes when meeting LGBT patients. The National LGBT Association (LLH) has – together with national authorities and professional associations for doctors, nurses, psychologists and midwifes – published a brochure called “Don’t assume that the patient is heterosexual”. There also exists recent Norwegian research on health and living conditions for LGB(T) people. Our educational package is based on these and international sources. Some members of the QC read selected pages from the research reports before a QC meeting – thus serving as updated “local experts”. The group meets and goes through a self-instructing slide show to stimulate discussion in the QC. By making this material available on the web, any QC interested in the theme can conduct a meeting without the need of an outside “expert”. In this workshop we will show examples from the educational package and conduct a discussion on how this material can be freely shared and translated into other languages and national cultural and research contexts. “We” are a professional group of GP’s in the Norwegian Medical Association (NMA) called “Reference group for LGBT health”, including researchers and self-defined LGB donctors. We are presently updating ourselves on the theme of trans people, because we see an emerging need for good-enough health services for this group as well.
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INAPPROPRIATE MEDICATION IN NURSING HOME RESIDENTS– HOW
TO IMPROVE MEDICATION SAFETY
Guido Schmiemann1,2 , Alexandra Pulst1,2, Anne Dehlfing1,2 , Falk Hoffmann3
1Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany, 2Health Sciences Bremen, University of Bremen, Bremen, Germany, 3Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany Background Due to multimorbidity and polypharmacy nursing home residents are at high risk for developing drug related side effects. Renal insufficiency and the lack of dose adjustment for impaired renal function further increase these risks. Our aims were to estimate the prevalence of renal failure in nursing home residents, to assess the level of medication adjustments and to develop interventions to overcome detected problems. Methods A mixed method approach consisting of a) a cross sectional study in German nursing homes collecting anonymized data (sociodemographic data, renal function, medication scheme) by nursing staff and b) focus group (FG) discussions (nursing home staff, general practitioner, pharmacists, specialists in renal medicine) were conducted. Based on results of a) and content analysis of FG discussion possible interventions were formulated. In a modified Delphi process the relevance and feasibility of these interventions were judged by nursing home staff, general practitioners and pharmacists. Results 852 residents in 21 nursing homes were recruited. Severe renal failure (eCCr<30 ml/min) was present in 15.5% (95% CI: 12.4-18.6%). Overall, 19.7% received at least one scheduled medication that was either contraindicated or not adequately adjusted for the calculated eCCr. In two FG 12 experts discussed possible interventions to improve medication safety in nursing home residents with renal impairment. From content analysis of the FG 12 possible interventions were formulated. Further results from the Delphi process judging feasibility and relevance of the interventions will be available at the conference.
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HOW DO HEALTHCARE PROFESSIONALS ASSESS PATIENT SAFETY
CULTURE IN FAMILY MEDICINE IN CROATIA?
Ivana Orlic Neretljak1, Venija Cerovecki1,2, Goranka Petricek1,2, Zlata Ozvacic Adzic1,2 1Zagreb Centar Health Center, Zagreb, Croatia, 2Department of Family Medicine, "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
Background A positive patient safety culture consists of the shared norms, values and behavior patterns of the healthcare professionals that guide them toward viewing patient safety as one of their highest priorities. A strong safety culture is an essential element of safe medical practice. The aim of this study was to assess safety attitudes of healthcare professionals in family medicine (FM) in Croatia.
Methods A cross-sectional study on a sample of physicians (N=90) and nurses (N=90) working in the FM service has been conducted. Data on respondents’ demographic and professional characteristics, practice characteristics and elements of perceived patient safety culture in FM offices (Medical Office Survey on Patient Safety Culture, MOSOPS) has been collected.
Results Out of 122 respondents (55.3% physicians, 44.7% nurses; response rate 67.8%), most respondents (74,9%) gave their medical office an Average overall quality and patient safety rating of very good (42,0%) or excellent (32,9%). Following composites were identified as areas of strength for the medical offices (average percent positive response for the composite >75%): Teamwork (91,9%), Overall Perceptions of Patient Safety and Quality (83,7%), Communication About Error (80,4%) and Communication Openness (75,9%). Two composites were identified as areas for improvement (average percent positive response for the composite <50%): Owner/Managing Partner/Leadership Support for Patient Safety (39,9%) and Work Pressure and Pace (34,4%).
Conclusion The study results have identified potential areas of strength and areas needing improvement regarding patient safety culture in FM in Croatia.
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QUALITY IMPROVEMENT IN ANTIBIOTIC PRESCRIPTION IN UNCOM-
PLICATED LOWER URINARY TRACT INFECTIONS
Ana Marcelino1, Ana Silva2, Ana Teixeira3, Cátia Barão4, Mariana Carvalho3, Miguel Almeida5, Sara Santos5
1USF Ouriceira, ACES Oeste Sul, Ericeira, Portugal; 2USF D. Jordão, ACES Oeste Sul, Lourinhã, Portugal; 3USF Gama, ACES Oeste Sul, Torres Vedras, Portugal; 4USF Andreas, ACES Oeste Sul, Mafra, Portugal; 5USF Costa Campos, ACES Oeste Sul, Sobral de Monte Agraço, Portugal
Introduction Lower urinary tract infections (LUTIs) are the second most common bacterial infection in the community. According to national guidelines, the first line of treatment includes nitrofurantoin, fosfomycin or amoxicillin-clavulanate. Objective: Assess guideline adherence for the empirical treatment of uncomplicated LUTI in primary care and the impact in prescription quality after local intervention.
Methods We used the electronic medical record system to identify all female patients aged ≥ 18 years with uncomplicated LUTIs (ICPC-2 U71) from 5 primary healthcare units. That data was collected throughout one month (Group A). A local intervention was then performed, consisting in awareness and information on LUTIs antibiotic treatment. Additional data was obtained from the first month after the intervention (Group B) and 4 months later (Group C). Patients who were pregnant, had ongoing unmedicated LUTI, Diabetes mellitus (T89/T90), malformation and other urinary tract diseases (U85/U99) were excluded.
Results Group A included 115 patients: 81.8% treated according to national guidelines (66.1% fosfomycin, 7% nitrofurantoin, 8.7% amoxicillin-clavulanate). Group B included 124 patients: 79.1% treated according national guidelines (60.5% fosfomycin, nitrofurantoin 8.1% and 10.5% amoxicillin-clavulanate). Group C included 106 patients: 76,4% treated according to national guidelines (65,1% fosfomycin, 3,8% nitrofurantoin, 7,8% amoxicillin-clavulanate).
Discussion / Conclusion We found a high concordance to national guidelines for the choice of treatment of uncomplicated LUTIs. The results were superior compared to similar national studies. No improvement in antibiotic prescription quality was verified after the intervention. The study period might have been too short and the intervention itself could have lacked dynamism.
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PATIENT SAFETY FOR PATIENTS WITH CHRONIC DISEASES
Eva Arvidsson Research and Development unit for Primary Care, Futurum, Region Jönköpings län
Audits of primary care centres in Sweden has pointed out shortcomings at several levels: patients who don’t attend their follow-up visits might “get lost” if they don’t take responsibility to make a new appointment themselves, staff forget to order routine samples or to carry out annual exams (such as the foot examination of patients with diabetes) and patients are not always offered medication according to recent guidelines. Use of information from electronic medical records in a continuous and systematic manner can be utilized to improve patient safety in primary care for these patients with chronic disease, and to ensure that nobody "falls through the cracks." In Jönköping County type of audit and feedback has been done by the County’s Research and Development unit for several years, by collecting data from electronic medical records from all health centres, private and public, and reporting back during visits to all health centres in the region. A similar system for audit and feedback from electronic medical records is now being developed for the whole of Sweden.
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FEELING SAFE IN PRIMARY CARE: PRELIMINARY FINDINGS FROM
A LONGITUDINAL, ETHNOGRAPHIC STUDY (MAXIMUM) OF OLDER
PEOPLE WITH MULTIMORBIDITY
Rebecca Hays, Gavin Daker-White, Peter Bower NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom Background Approximately half of people aged 65 or over live with multiple long-term conditions (multimorbidity). These patients interact frequently with healthcare, have complex treatment regimes, and can face challenges such as deprivation and depression. Thus, they are likely to be at increased risk of patient safety failures. However, there is limited evidence regarding how such failures occur and how people respond. We sought to address this gap. Method Twenty-six older people (65+) with multimorbidity were recruited to a longitudinal, applied ethnographic study (MAXIMUM). Data were collected through interviews with patients, their carers, GPs, and other healthcare staff; and from observations, healthcare diaries, and medical records. Data were analysed thematically and using a conceptual model developed from a previous synthesis of qualitative studies. Results A range of precursors to patient safety failures were identified during the first 12 months of this study. Key among these is a lack of communication and trust between patients and healthcare staff. Patients’ sense of safety was threatened when they felt their needs were ignored, and responses were insensitive or inappropriate. Patients also expressed concern about what was not said or done, as opposed to what was articulated by healthcare staff. Conclusions Our findings support those of other recent studies that suggest safety, for patients, is a continually re-negotiated feeling. Our research indicates a need for interventions for older people with multimorbidity that set realistic expectations for primary care and empower them to assertively express their needs without adversely affecting the patient-provider relationship.
49th EQuiP Assembly Meeting 2016, Prague
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TO REPORT OR NOT TO REPORT: THAT IS THE QUESTION! USING
THE THEORY OF PLANNED BEHAVIOR TO EXPLAIN HEALTHCARE
PROFESSIONALS’ USE OF CIRS IN PRIMARY CARE.
Müller, Beate S.; Bauer, Anna; Beyer, Martin; Blazejewski, Tatjana; Güthlin, Corina; Gerlach, Ferdinand Institute of General Practice, Center for Health Sciences, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
Background Critical incident reporting systems (CIRS) are established instruments to register, analyze and learn from critical incidents. The Frankfurt CIRS for primary care practices “Jeder Fehler zählt” (“every error counts”, www.jeder-fehler-zaehlt.de) was created 11 years ago. Even though the use of a CIRS is mandatory for German practices since 2014, there is no need to use an online CIRS, and report numbers remain more or less static. We wanted to know which attitudes, subjective norms and perceived behavioral control shape primary healthcare professionals’ behavioral intentions and behavior regarding critical incident reporting. Method Using Ajzen’s theory of planned behavior (TPB) we created a questionnaire for primary care practice teams (doctors and health care assistants). The questionnaire consisted of 20 TPB questions and 10 questions asking for basic personal data. Five copies were sent to each of 70 practices of a German practice net. “Jeder Fehler zählt” had been promoted in these practices during the prior 6 months. Results At the time of abstract data collection was underway - the first questionnaires had been answered. We expect a response rate of 50% (150-200 questionnaires). Analysis will comprise descriptive statistics as well as correlations between planned behavior and personal characteristics e.g. age, profession, duration of tenure. Discussion The concerning practice net is proactive in regard to patient safety activities. Still, we expect answers to differ significantly e.g. between health care assistants and doctors. We hope to discover crucial factors helping us to develop further patient safety interventions tailored to primary care practices’ needs.
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STRENGTHENING CAPACITIES TO IMPROVE QUALITY AND PATIENT
SAFETY IN PRIMARY CARE. EXPERIENCE FROM THE CZECH
REPUBLIC
Bohumil Seifert1, Jana Vojtiskova1, Petr Struk2 1First Faculty of Medicine, Charles University in Prague, Czech Republic; 2Medtel, Prague, Czech Republic
Background The Czech Society of General Practice has recently implemented Accreditation Standards for GP. The management of undesirable events and medical errors (ME) has been a part of this standard. This agenda has been currently neither executed nor generally perceived, and its significance is not appreciated by GPs in the Czech Republic. Aim and methods The primary objective was to create an environment in which ME in daily practice could be monitored, registered and classified, could become a source of learning for the practice personnel and could help to avoid situations that may be prevented.The project plan included: recruitment of GP volunteers, provision of information and learning on patient safety, methods of ME registration, classification, management and reporting to the academic centre. The project was scheduled for six months. Results 15 GPs were recruited for the project and 14 GPs finally participated. The educational packet included an adapted version of the International Taxonomy of ME in Primary Care, ME registration sheets and relevant articles. In total 55 completed standardised forms have been received by the centre; 77% of them related to process ME and 23% ME concerned with knowledge and skills. Conclusion The project has shown that GPs still have reservations about sharing information on the weak points of their work. The feedback was positive from half of the participating GPs. The authors strongly suggest a further information campaign on patient safety for GPs. The introduction of a national system of anonymous reporting of ME seems to be currently unrealistic.
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THE GERMAN CRITICAL INCIDENT REPORTING SYSTEM
FOR PRIMARY CARE WWW.JEDER-FEHLER-ZAEHLT.DE IS
PRODUCTIVE SINCE 12 YEARS – CONTENT AND PERSPECTIVES
Martin Beyer, Tatjana Blazejewski, Corina Guethlin, Ferdinand M Gerlach, Beate S Mueller Institute of General Practice, Goethe University Frankfurt Background We developed a Critical Incident Reporting System (CIRS) for Primary Care in 2004 and are continuously operating it. A small, but significant portion of German GPs (and other health professions) uses. It is openly accessible and provides services, particularly to learn from failure: error reporting, discussion, searchable database, exemplary cases/analyses, additional information on different aspects of patient safety. The database might be the largest publicly accessible in the web for safety problems in GP.
Methods The records are coded following error type (LINNEAUS classification), severity, participants, drugs involved, and other criteria. In the meantime, particular interest was raised for interface safety problems, e.g. GP/pharmacy, or ambulatory/hospital care.
Results Presently 698 reports were received and 2990 comments. 4.500 users/p.m. We will present current content data to the conference; following our last publication 74.2% of the reports described process errors and only 25.8% knowledge/skills errors. 54.2% therapy/medication, 16.4% diagnoses. 35.6% of the cases reported no harm to the patient (near misses are invited), whereas 14.6% involved considerable harm or death of patient. A current project embeds our CIRS into the routine of GPs in the environment of physician networks to increase participation and improve the link between patient safety and quality improvement strategies.
Conclusion CIRS are not functional to study quantitative data, but to detect safety problems and to offer opportunities to learn. Allover the world, CIRS are not widely used in primary care (opposite to hospital!), we need strategies to implement them in everyday care. To be discussed during conference.
49th EQuiP Assembly Meeting 2016, Prague
Patient Safety in Primary Care
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PRISM STUDY: ASSESSMENT OF A MULTIFACETED PROGRAM
ON TEAMWORK AND RISK MANAGEMENT IN PRIMARY CARE (PC)
Marc Chaneliere1,2,3, Karine Buchet-Poyau2, Sandrine Touzet2,3, Maud Keriel-Gascou1, Anouk Haeringer-Chollet4, Jean-Luc Quenon5, Cyrille Colin2,3
Background We can nowadays observe an evolution in the mode of practice in French PC, with the development of medical offices (MO) gathering a wide variety of health professionals (HP). Our first purpose is to assess the impact of a risk management program (RMP) on Patient Safety Incident (PSI) reporting within these new structures. Secondary purposes are to assess the impact on the Patient safety culture (PSC) and to validate a French version of the Medical Survey On Patient Safety (MSOPS). Methods National prospective controlled multicenter randomized study. Several kinds of MO are considered as clusters. In a first period of 3 months, all HP were encouraged to report PSI (online reporting system) and an initial assessment of their PSC was performed. In a second period of 15 months post randomization, the RMP -e-learning, Morbidity and Mortality Review meetings (MMR) was implemented in half of the structures. PSI reporting is maintained over the entire study period. At the end PSI reporting rates will be compared in both groups. We will proceed to a final assessment of PSC and a qualitative side is scheduled. Results (first period) Several tools were created: a French version of the MSOPS (pilot study), 5 e-learning modules (knowledges in safety field), and a PSI reporting website with recoding scales (kind, root causes and corrective measures). 36 MO included (651 full-time equivalents from 5 to 64 FTE/MO) with 415 PC HP investigators for reporting and PSC assessment. The response rate was 60% for the initial assessment of PSC and HP reported about 1 PSI/FTE/year before randomization.
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PATIENT SAFETY IN PRIMARY CARE IN HUNGARY
László Róbert Kolozsvári1, Béla Muzsik2 1University of Debrecen, Faculty of Public Health, Department of Family and Occupational Medicine, Debrecen, Hungary; 2National Healthcare Service Center, Budapest, Hungary
There are governmental initiatives to improve the quality and safety of health care in Hungary (Quality Improvement and Patient Safety Strategy) [MIBES]. This includes an action plan for the accreditation of healthcare providers for the security of patient care [BELLA] (in- and outpatient care and pharmacies), recommendations for actions to be taken following serious adverse events [NEKED]. Hungary also takes part in the PaSQ Joint Action (European Union Network for Patient Safety and Quality of Care). There is an e-learning training programme for patient safety coordinators. Improving quality of care and patient safety are important issues in the development of primary care in Hungary. The principles of the patients’ safe treatment are regulated by the law (minimum requirements of providing health care services, rules of prescribing medications etc.). There is also a financial incentive programme to help with the settlement of GPs in the vacant practices. The indicator based quality evaluation of GPs might also improve patient safety. A complex national eHealth system, which connects the GPs with the different levels of the health care system is also under development. This system can help the GPs to get all the patient data needed for everyday care. The development of new guidelines, standards and the GPs’ continuous education and training contain elements which also improve patient safety in primary care.
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Abstracts – Workshops
PATIENT SAFETY, WHAT IS IT ABOUT?
Helle Soegaard Frappart, riskmanager for primary care in the Capital Region af Denmark, Ynse de Boer, patient safety - consultant in the Capital Region af Denmark
General practice is known for taking care of a lot of patients every day. It is inevitable mistakes happen. Most health professionals can tell about minor or more serious events they have been part of. A lot of those events can be prevented. But how to do this? In this workshop we want to introduce the basic ideas end principles of patient safety. What kind of events are perceived in primary care, and how can we reduce the risk for they will happen. We will ask participants to share their own experiences, and will use this information to illustrate basic thoughts and principles for patient safety We will try to define what unintended events are, and try to convince the audience it is worthwile to include patient safety in a systematic way in daily work. The workshops primary target are participants with none or limited experience with patient safety. We have been doing this workshop with success in our region in Denmark. Hence a secondary target group can be course-organisers that want to be inspired in this field.
49th EQuiP Assembly Meeting 2016, Prague
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THE MEDICAL OFFICE SURVEY ON PATIENT SAFETY CULTURE :
IS THE TOOL WORTH USING?
Isabelle Dupie, France, Andre Nguyen Van Nhien, France
Background Safety culture is a broad concept defined in the UK Health and Safety Commission Report (1993) as : “The safety culture of an organization is the product of the individual and group values, attitudes, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of,an organization’s health and safety programs. Organizations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventative measures’.”
Many questions arise about patient safety culture. How to measure it? What for? How and why compare the results between various organizations? What are the links between a positive safety culture and the safety-related outcomes for patients? Is it just a tool for research or the first step of a safety program?
The EQuiP working group chose to begin the exploration of the concept with the Agency for Health care Reseach and Quality ( AHRQ) survey designed to measure patient safety culture in a medical office by assessing the opinions of staff at all levels—from physicians to receptionists. We proposed to spread the tool among EQuiP delegates. We asked them to complete the questionnaire. The question now adressed to the delegates is: “Is the tool worth using?”
Learning goals - Objective 1. Better know the Medical Office Survey on Patient safety Culture (MOSPSC) 2. Express opinion about patient safety culture and its measure 3. Exchange with EQuiP delegates on the feasibility of such a survey in various European countries
Method 1. Presentation: What is the MOSPSC?
Feasibility study on patient safety culture assessment in European primary care organizations: first results
2. Focus group: Record and Moderate a discussion exploring the opinion of participants on the MOSPCS.
3. Conclusion: What could be the next step for you ?Permit discussion to emerge and see the opportunity to get into a quality and safety improvement process.
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WORKSHOP: THE AFTERMATH OF ADVERSE EVENTS (AE) IN
PRIMARY CARE: INTERVENTIONS TO REDUCE ITS IMPACT ON
HEALTHCARE TEAMS.
Maria Pilar Astier-Pena, Spain Medical errors and unanticipated negative patient outcomes can damage the well-being of health care providers. These affected individuals, referred to as "second victims," can experience various psychological and physical symptoms. Support resources provided by health care organizations to prevent and reduce second victim-related harm are often inadequate. We present the tools or instrument that can assist family practice to implement and track the performance of second victim support resources based on our research proyect on Second Victims: http://www.segundasvictimas.es/ This workshop can be used by primary care teams to assist second victim experiences of their staff and improve existing support resources. It can also provide health care organization leaders with information on second victim-related support resources.
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ASSESSMENT BY GPS OF A GPS CAPACITY TO DELIVER HEALTHCARE
WHICH SAFE FOR THEM AND THEIR PATIENTS
Andrée Rochfort 1, Zlata Ozvacic Adzic 2, Ulrik Bak Kirk, EQuiP Manager, assistant at workshop 1Director of Quality Improvement & Doctors’ Health in Practice Programme Irish College of General Practitioners 4/5 Lincoln Place Dublin, Ireland, 2Assistant Professor, Department of Family Medicine, "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb Rockefellerova 4, 10000 Zagreb, Croatia,
Background Researchers have called for further research into the relationship between doctors’ ill-health and safe patient care (Harrison 2008) Sick physicians may constitute a risk of substandard patient care (Verstappen, Gaal et al 2015). Yet, GPs experiencing burnout were not detected by patients or independent observers (Orton, Orton & Gray 2012) and burnout was not associated with lower patient enablement using a patient– reported outcome measure of quality of interpersonal care (Ozvacic et al, 2013). However, GPs need to deliver high quality healthcare which is safe for their patients, but also safe for themselves.
Method A presentation will be followed by small group work on five scenarios: Doctors with:
1. serious life threatening illness (like cancer) 2. chronic illnesses (diabetes, rheumatoid) 3. acute illness (infection, etc) 4. mental illness / substance misuse 5. surgical / medical procedures
Each group will explore /answer the following questions: 1. When should a GP advise a GP to take absence from work? 2. How does a GP decide when a GP is fit to return to work after illness? 3. When should specialised opinions be sought by a treating GP? From whom? 4. What is the current situation in your country? How could it be improved?
Results Participants will have the opportunity to share knowledge and experience and to learn how other GPs make decisions and assessments of GPs need for sick leave.
Conclusions This information can assist EQuiP work towards a consensus document on this topic.
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HOW TO DEAL WITH UNINTENDED EVENTS “EVERY FAULT IS
A TREASURE”
P Vanden Bussche, Belgium
Background: A lot of quality improvement and safer care can start when we are confronted with unintended events in the practice. When things go wrong, this is threatening for doctor and patient. But it also offers opportunities to learn and prevent new problems. Learning Goals: Participants should be able to organize small group sessions to analyse unintended events in their own organisation and learn from that how to plan safer care. Methods: After a short introduction, participants are invited to share experiences of critical incidents in small groups. They learn to analyse their cases in a systematic way and discuss it in a safe environment. Participants will experience how faults and unintended events can offer changes to improve the safety of the daily work and how to communicate with patients about it.
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Patient Safety in Primary Care
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HOW CAN WE MEASURE AND MONITOR SAFETY FROM
THE PERSPECTIVE OF PRIMARY CARE?
Aneez Esmail, United Kingdom, Ynse de Boer, Denmark This will build on the ground breaking work of Charles Vincent and think about how we can apply this to primary care. Using this framework, how can we apply it to primary care?
Resources: http://www.health.org.uk/sites/default/files/TheMeasurementAndMonitoringOfSafety_summary.pdf http://www.health.org.uk/sites/default/files/MeasuringAndMonitoringSafetyAPrimaryCarePerspective.pdf
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Abstracts – Posters
INCREASING PATIENT SAFETY THROUGH TRAINING MEDICAL
STUDENTS WITH VIRTUAL PATIENTS
Monika Sobočan, Zalika Klemenc Ketiš Medical Faculty, University of Maribor, Maribor, Slovenia
INTRODUCTION: Patient safety has increasingly gained momentum in the undergraduate medical curriculum. Although there is an identified need for a patient safety component of the curriculum, Alper (2011) states that most US medical schools have safety components as an implicit topic in the curriculum. Patient safety is thought through: analysis of medical errors, improving physician order writing, national patient safety goals and standardization of medical care through templates and guidelines. Virtual patients (VPs), which are computer assisted clinical scenarios enabling students to lead the decision making process in patient care enable students to learn standardized procedures before even entering clinical wards. The assumption therefore was that virtual patients could enable students a more patient centered outlook and standardized procedure to improve patient safety. METHODS: We conducted a qualitative study with focus groups among 4th year medical students after using VPs during their Family Medicine Course. The data was analyzed using the grounded theory-based coding method (open coding). RESULTS: Students liked that they had the possibility to revise the standardized procedure with VPs although they witnessed differences in practice and that they had the opportunity to learn about different clinical cases not seen in the wards. CONCLUSIONS: Virtual patients can be used as a preparation tool for real life situations (clinical states, communication). VPs can also be a correction tool for unstandardized real life practical work (revising guidelines) in standardized procedures.
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NECESSARY LEVEL OF SKILLS AND ABILITIES OF FAMILY
PHYSICIANS FROM PATIENTS’ VIEWPOINTS IN TRANSITIONAL
KOSOVO
Gazmend Bojaj1,2, Katarzyna Czabanowska3,4, Fitim Skeraj2, Genc Burazeri2,3
1 Principal Family Medicine Center, Kline, Kosovo; 2 University of Medicine, Tirana, Albania; 3 Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; 4Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
Aim: Besides the health professionals’ perspective, it is equally important to assess the perceptions of the users of health care services with regard to abilities, skills and competencies of their family physicians. Our aim was to assess the level of competencies of family physicians from patients’ viewpoint in transitional Kosovo. Methods: A nationwide survey was conducted in Kosovo in 2013, including a representative sample of 1340 primary health care users aged ≥18 years (49% males aged 50.7±18.4 years and 51% females aged 50.4±17.4 years; response rate: 89%). Participants were asked to assess the level of competencies of their respective family physicians regarding different domains of the medical encounter. The self-administered questionnaire included 37 items structured into six domains. An overall summary score related to family physicians’ competencies was calculated for each participant [range: from 37 (minimal competencies) to 185 (maximal competencies)]. Results: Mean value of the overall summary score for the 37-item instrument was 118.0±19.7. It was higher among the younger and the low-income participants, and in patients who reported frequent health visits and those not satisfied with the quality of the medical encounter.Conclusions: Our findings indicate a relatively high level of competencies of family physicians from patients’ perspective in post-war Kosovo. Future studies should comprehensively assess the main determinants of self-perceived competencies of family physicians among primary health care users in Kosovo. Keywords: competencies, family physicians, primary health care users, quality of care.
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