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Category: Patient Safety

  • Mastering Your Risk – MPS course

    The Medical Protection Society run a series of educational courses which are free to members (or a modest fee for non-members).  I have been on three of them now & have found all of them particularly useful.  The most recent one I attended was the Mastering Your Risk.  This was a particularly useful one to go on especially after our last Human Error Problem Case meeting.  I will try & summarise briefly some of my key take home messages.

    It was a workshop based around managing risk before an adverse event occurs (there is also one for after when the adverse event has occurred). This is important as 50% of patients decide to sue before the adverse event actually happens which was news to me. This is for several reasons for example unrealistic expectations and poor communication skills.

    The former was something we may be guilty of in aspects of our practice relating to rehabilitation.  The concept of ‘over promising’ and ‘under delivering’ was discussed.  It is a model which simply doesn’t work in business.  Better to under promise & over deliver.  However as clinicians we do not do this.  I think of the number of referrals to physiotherapy or the amount of time our patients spend under rehabilitation when actually we should be realistic in what can be achieved.  We are not helped by the system penalising patients who are unable to complete all physical tasks. We therefore, as patient advocates, do everything we can to try & restore full function.  In a number of cases this is highly unlikely to be achieved and indeed increases our risk of litigation.

    The latter aspect, communication, we generally do well as GPs.  We use several consultation models usually involving exploring of ideas, concerns & expectations.  The course introduced another model, C.L.E.A.R. ©. This is a 5 part consultation model the mnemonic standing for Connect, Listen, Empathise, Ask, Review (& check).  It reminded me of Roger Neighbours model.  However the important difference was the L.E.A. parts were similar to Pendleton & Tate’s model.  It was a nice combination and whilst discussing & practising it, I thought it might be useful for a Registrar to use.  Neighbour’s model is a useful summary but with an emphasis on safety with Pendleton & Tate’s being thorough yet lengthy.  I have been given permission to discuss this in small groups so I can bring it along to the next PBSGL or Trainer’s Group.

    The workshop was based on some very good research.  The take home article which puts a very poignant perspective on why patients take legal action was by a lady called Susan Sheridan & Martin Hatlie (Sheridan, S. and M. Hatlie (2007). “We’re not your enemy: An appeal from a consumer to re-imagine tort reform.” Patient Saf Qual Healthc 4: 22-26.).  I haven’t read it yet but will have done so by our next PBSGL.  It is an American article but it does have relevant themes.

    Finally the facilitator discussed ‘medical jousting’.  This is the process of criticising other healthcare professionals involved in the care of the same patient.  I think I have probably come across it most with junior hospital doctors criticizing GPs.  I have had several consults where the patient was quoted the F2 ED doctor saying the GP should have given their son/daughter some antibiotics for their ear infection.  It increases the risk of a complaint and subsequent legal action.  I think the take home point is often we do not have all the information to hand so criticism may not be warranted. We also have to ask ourselves ‘would the other doctor concerned want to know what is being said about them by the patient or me?’.  I certainly would & if there is a problem with a clinical decision I have made, I would like to know.  Offer empathy, explain you may not have all the information to hand and certainly offer to contact or liaise with the other healthcare professionals involved.  It can help defuse a situation & lead to a complaint being prevented.

    I have some other interesting nuggets plus an excellent information booklet.  I am happy to share themes and references at the next meeting or discuss anything via this blog in the interim.

  • June Meeting – Patient Safety

    The June meeting used the Patient Safety – learning from Human Error module.  This was a really useful module as it was less didactic and the members really got into it. The examples from other industries and professions was a good way at analyzing what we do.  The ‘sterile cockpit’ analogy was something we all agreed could be used, for example, simply by shutting down Outlook and re-opening it at lunchtime.  This would allow us to remain undisturbed by e-mails.

    Themes discussed during the session invariably led to how unsafe DMICP is especially when it is not accessible.  There were some positives though.  For example, the hospital referral template letter was shared.  The two week wait Macro enters some text plus the READ code to be used (2WW).  We talked about making a Macro for routine referrals as well.  The use of taskers was also discussed and since the meeting I have adopted this for my own practice.  The tasker menu can be modified in its setup to send admin taskers to oneself.

    One of the module case studies looked at the Kegworth air disaster when the pilot shut down the wrong engine. Despite all the passengers knowing this, no-one did anything about it.  The captain is always right. I prefer the comment of one of my favourite chefs, Nino Ladenis, who said ‘the customer is not always right’  (this related to a customer requesting tomato ketchup for his Michelin three starred meal).  We went on from this to talk about an anonymous safety reporting system but agreed if the SEA/PSIR system is working well and you foster a climate of open reporting and no blame, this is not necessary.

    Several resources were discussed.  Jennie has since circulated her task sheet and the book ‘Do It Tomorrow’ was mentioned.  The use of taskers for electronic referrals at Bulford is impossible due to the number the Practice Administrator gets (5 to 20 notifications a day for confidentiality breaches).

    It will be interesting to see how everyone gets on with looking at access to them and how they can manage that. It would be useful if members can look at their own practice and reflect on it.  When was the last PSIR you had down to human error?  How can you mitigate when DMICP goes down?