Using third sector experience to positively influence change – Andrew H D Wynd

Posted on January 31, 2019

awsep06 Why an involvement in the pregnancy and newborn screening (PNBS) standards was so important to SBH Scotland.

For over 50 years Spina Bifida Hydrocephalus Scotland (SBH Scotland) have supported and provided information to the individuals and families in Scotland who are affected by the neural tube defect, Spina bifida. We also support those affected by hydrocephalus as an allied or sole condition. We work closely with parents from the 20 week scan when a spina bifida parent’s journey begins and no matter where their journey may lead them we are always there.

SBH Scotland welcomed an invitation to be involved in offering our feedback on Healthcare Improvement Scotland’s draft pregnancy and newborn screening (PNBS) standards. The standards themselves specify a minimum level of performance for pregnancy and newborn screening services and will apply to all screening services in Scotland, where directly provided by an NHS board or secured on behalf of an NHS board.

Whilst the PNBS’s work covers a suite of standards including Fetal Anomaly, Haemoglobinopathies, Infectious Diseases, Newborn Bloodspot and Newborn Hearing, SBH Scotland were asked to feedback specifically on fetal anomalies and their current screening process.

In July 2018 we hosted our consultation session for the Healthcare Improvement Scotland team to offer our thoughts based on decades of first-hand experience working with parents and family members who have been through the fetal anomaly process across Scotland.

“I was so proud to see the passion of our staff, and the care they have for our families shone through in discussions. I hope that by being involved in this consultation process that we have eloquently advocated for our parents.”

Taking place in our head office and family support centre in North Lanarkshire, the SBH Scotland participants included board members who are medical practitioners, and family support workers who intensively support parents directly impacted by the standards.

SBH Scotland have long had concerns over the information which is readily available to expectant mums on spina bifida at the point of diagnosis during the fetal anomaly scan. As this takes place, at the 20-week mark, it is half way through the pregnancy. Choices are given as to whether the mum-to-be would like to continue with the pregnancy and any decisions have to made expeditiously, and, in many cases before the mum has been to see a specialist to discuss the scan in further detail.

In the 12 months prior to the consultation our East support team had independently started small focus groups with mums on the topic of ‘experience at diagnosis’ in the hope of being able to influence change in the current system. We were able to share our qualitative information which showed that SBH Scotland families’ experiences have not always been positive in terms of factual and current information being delivered. We believe strongly that wherever an important decision is to be made then informed choice is paramount.

“With the knowledge that the standards have been published, I am hopeful that our input, alongside a range of other organisations, will make a positive change for future generations of pregnant women and their unborn children.”

I was so proud to see the passion of our staff, and the care they have for our families shone through in discussions. I hope that by being involved in this consultation process that we have eloquently advocated for our parents. It was certainly an incredibly positive experience for our staff team and board members to have their knowledge and experience recognised and I feel the continued inclusion of third sector organisations in such consultations should be of paramount importance.

With the knowledge that the standards have been published, I am hopeful that our input, alongside a range of other organisations, will make a positive change for future generations of pregnant women and their unborn children.

Visit the Healthcare Improvement Scotland website to download the standards.

Andrew H D Wynd MBE – Andy Wynd has spent most of his working life in the Scottish voluntary sector, supporting children, young people and families. He joined Spina Bifida Hydrocephalus Scotland (formerly known as Scottish Spina Bifida Association) in 1989 and is their Chief Executive and Company Secretary.

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Reducing cardiac arrests: How we’re improving care for people at risk of deterioration – Calum McGregor

Posted on December 12, 2018

Calum The great strides that Scotland has made to reduce the number of deaths from Sepsis is now well documented – as is the impact of the Scottish Patient Safety Programme (SPSP) which is now celebrating its 10^th year of driving improvements in patient safety. Less known, but no less important, is the growing progress we’re making in reducing cardiac arrests in Scotland’s acute hospitals.

The UK resuscitation council describes a cardiac arrest as a sudden loss of blood flow resulting from the failure of the heart to effectively pump. This happens when the heart stops beating and clinical staff then attempt to restart it. These attempts involve chest compressions, delivery of high-voltage electric shocks across the chest, attempts to ventilate the lungs and an injection of drugs. In some cases a cardiac arrest happens as a result of a heart attack or another sudden health event, but in other cases the cardiac arrest comes after a period of deterioration in physical observations such as blood pressure or pulse rate.

“Since 2013, there has been a 27% drop in the cardiac arrest rate in general ward areas in 15 Scottish hospitals who have reported data to SPSP. This means that on average, there are 18 fewer people per month not suffering from this harmful and distressing experience in hospitals.”

I’m delighted to say that since 2013, there has been a 27% drop in the cardiac arrest rate in general ward areas in 15 Scottish hospitals who have reported data to SPSP. This means that on average, there are 18 fewer people per month not suffering from this harmful and distressing experience in hospitals. Key to achieving this progress has been SPSP focus on ’deteriorating patients’ since its launch in 2008. However, it is also testament to the hard work of the clinical staff in NHS boards across Scotland who have worked together to improve the recognition and response to acutely deteriorating patients.

The foundation to this reduction is early recognition of deterioration and a timely response – this is critical as it allows staff to plan and provide treatment as soon as possible to reduce the chance of cardiac arrest and death.

There are many different reasons why patients deteriorate, and we know that some patients will not benefit from certain treatment options when they do deteriorate. Therefore a range of different interventions are required in order to respond appropriately and prevent cardiac arrests. Here is a brief summary of some of the key actions that have contributed to the improvement in cardiac arrest rate:

Improve the recognition of a deteriorating patient through implementation of the National Early Warning Score (NEWS): NEWS is an evidence-based tool which helps staff to recognise deterioration early. NEWS is a critical step in improving communication in patient care which has now been implemented in 14 NHS boards and the Scottish Ambulance Service.
Improve the timely treatment for patients with Sepsis: Clinical teams have tested and implemented the Sepsis Six care bundle. Evidence tells us that reliable delivery of this care bundle can improve outcomes for people. To date, mortality rates from Sepsis have fallen by 21% and Hospital Standardised Mortality (HSMR) has fallen by 11.2% from August 2016.
Improve the response to a deteriorating patient: A structured response that includes a treatment escalation plan allows staff to provide the right treatment as soon as possible to reduce the chance of a cardiac arrest. A treatment escalation plan – that is based on an individual’s clinical condition and goals of care – supports person-centred care planning to achieve the best outcome.
Improve awareness and communication of deteriorating patients: NEWS and treatment escalation planning have become common terminology, and are a standard item on ward and hospital safety briefs – they are regularly highlighted in visual prompts, for example on ward whiteboards.
Support education. SPSP has developed educational cards and posters to support clinical staff alongside an online module to increase awareness and understanding of NEWS. SPSP have hosted networking events to share successes and challenges and support staff to learn from each other.

In short, the focus is on identifying the critical connection between NEWS, early recognition of deterioration and decision-making that uses a person-centred approach.

“The falling figures on cardiac arrests, the actions being taken in Scotland and the changing culture and understanding of staff over the last decade, are all great progress in reducing the number of cardiac arrests – in the end it all comes down to the hard work, resilience and openness of staff in the NHS in Scotland to making improvements to care.”

The falling figures on cardiac arrests, the actions being taken in Scotland and the changing culture and understanding of staff over the last decade, are all great progress in reducing the number of cardiac arrests – in the end it all comes down to the hard work, resilience and openness of staff in the NHS in Scotland to making improvements to care.

We know that there are still plenty of opportunities to reduce harm for people in health and social care. We’ll continue to collaborate and maintain our focus on prevention, recognition and response to deterioration for people in Scotland wherever they are cared for.

Dr Calum McGregor is Clinical Lead for the Acute Care portfolio of the Scottish Patient Safety Programme (SPSP)

More information

SPSP National Early Warning Score (NEWS) learning module

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The importance of listening to shape clinical guidelines in a fast-changing world – Jenny Bennison

Posted on December 7, 2018

SIGN’s stakeholder feedback report was published in August of this year and it’s my job as Chair of the Strategy subgroup of SIGN Council to ensure we listen to that feedback and act upon it.

A lot has changed in NHSScotland since we published our first SIGN clinical guideline on prophylaxis of venous thromboembolism in 1996. The World Wide Web had only come into being in 1991 and busy healthcare professionals had to search for information about new therapies from scientific journals held in medical libraries, or rely on clinical update lectures, whilst trying to avoid the lures of pharmaceutical advertising and sponsorship. Today, information about the latest clinical trial is available anytime, anywhere and accessible from a smartphone – the challenge, for clinicians and patients alike, is how to identify the information which is useful and trustworthy and separate it from the rest.

“Healthcare professionals no longer need to know whether an intervention is better than placebo: they want to know how best to influence the outcomes for the patient in front of them. They want to know how to address their patients’ co-morbidities and help their patients choose the interventions that impact on the outcomes that matter to them.”

In addition to the speed of access to new information, the purpose of guidelines has changed too. Healthcare professionals no longer need to know whether an intervention is better than placebo: they want to know how best to influence the outcomes for the patient in front of them. They want to know how to address their patients’ co-morbidities and help their patients choose the interventions that impact on the outcomes that matter to them.
The stakeholder feedback report confirmed that we have a reputation we can be proud of at SIGN: users are positive about clinician engagement in the production of guidelines, trust the robust methodology and approve of the ease of access, range of products and content and format of our guidelines. However, there is definitely room for improvement in some areas, especially the thorny problem of keeping guidelines up to date, and we face new challenges, for instance providing rapid responses to new developments, improving our support for the implementation for guidelines, and working more collaboratively with other parts of Healthcare Improvement Scotland and the wider health systems in the Scotland, UK and further afield.

It has been really exciting to be involved with SIGN in the time of Realistic Medicine: the heath service is budget-constrained and healthcare professionals need guidance to avoid or reduce ineffective and inappropriate interventions. It is not obvious that guidelines are the answer to the problems of the NHS in terms of spending, overdiagnosis and overtreatment, and the challenge is to share the understanding that guidelines provide part of the context in which careful conversations can be had with patients. ‘What matters to you?’ is a question we do not ask often enough, and can open the door to discussions about how to steer the right path, for that individual person, through the often overwhelming, sometimes conflicting, and often burdensome demands of that person’s particular situation.

As a GP, I frequently meet people who have visited several different hospital clinics and received instructions that for them seem irrelevant and confusing. We need to appreciate the burden associated with some evidence-based advice (for instance the number of different medications recommended as secondary prevention in ischaemic heart disease or glycaemic control in Type 2 diabetes and find a way of discussing this with people as they live their lives. Stopping smoking, for example, will often make more of a difference to someone than anything else, and if I can find a way to facilitate this for my patient, it might be better in the long run to focus on this for now and worry less about the best possible diabetic or blood pressure control. For another person, simply providing a food bank voucher might be the most useful thing I can do for them today. And for yet another – someone already living the healthiest lifestyle, of the required weight and fitness, and able to follow all the advice they are given – then ensuring their blood pressure and diabetic control is near perfect will be entirely appropriate.

“It is not obvious that guidelines are the answer to the problems of the NHS in terms of spending, overdiagnosis and overtreatment, and the challenge is to share the understanding that guidelines provide part of the context in which careful conversations can be had with patients.”

We realised at the recent Guidelines International Network Conference in Manchester that our work on ‘patient versions’ of the guidelines is world-leading, and another thing we can be justifiably proud of. I’ve found that signposting my patients to these – especially those about autism spectrum disorders, and other difficulties facing children and their families – very helpful, and another way to support informed conversations we have about choices to be made.

So, as we mark our 25^th anniversary at SIGN, I look forward to the next 25 years, understanding that listening to patients and professionals in a dynamic, fast-changing world is crucial to supporting Scotland’s healthcare professionals and their patients, as they seek to make the most appropriate choices about health and lifestyle.

Jenny Bennison is Vice-Chair of SIGN Council and Chair of the SIGN Strategy Group. She represents Royal College of GPs on SIGN Council and is a GP at Niddrie Medical Practice in Edinburgh.

Useful links

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Using SIGN to improve diabetes care in a forensic mental health service – Claire Borthwick

Posted on November 27, 2018

At The State Hospital, a high-security forensic mental health service for patients from Scotland and Northern Ireland, our team used SIGN 116 guidelines for the management of diabetes to develop our service.

The following recommendation was identified as a clinical need: Children and adults with type 1 and type 2 diabetes should be offered psychological interventions (including motivational interviewing, goal setting skills and CBT) to improve glycaemic control in the short and medium term.

“A range of professionals were willing to provide input during the development phase and their expertise and contributions were integral to the successful development of the programme manual.”

The lead dietician approached me (a trainee health psychologist) with a request for a group psychological intervention to be developed for patients in our service with diabetes.

This intervention was to be evidence-based, drawing on appropriate psychological theory and suitable for inpatients with a mental illness.

I reviewed relevant literature for evidence of psychological interventions that promoted self-management and improved glycaemic control. I sought input from a range of professionals during the development phase and contributions were offered from a Professor of Health Psychology, chartered Health Psychologist, Consultant Clinical Psychologist, Lead Dietician and Practice Nurse. The programme that we developed adopted a cognitive-behavioural approach and was underpinned by health psychology models of illness and behaviour. The 5-week intervention was piloted with a group of participants and evaluated using a mixed-methods design.

A range of professionals were willing to provide input during the development phase and their expertise and contributions were integral to the successful development of the programme manual. I would therefore recommend multi-disciplinary team consultation to anyone undertaking a similar piece of work. The State Hospital clinical teams were supportive of the new initiative and willing to refer patients to the pilot group which also helped the project to run well.

In terms of challenges, I found that finding clear evidence to support the use of a particular psychological theory or behaviour change strategy for improving glycaemic control was difficult. As this was an in-patient setting with a smaller population of diabetes patients than may be observed in a community setting, the focus of the programme was to be suitable for individuals with both Type 1 and Type 2 diabetes, which added additional complexity.

“In addition to clinical benefits, developing this psychological group programme has allowed the service to meet a recommendation outlined by SIGN 116 guidelines and increase the range of available treatment options.”

The pilot evaluation that we carried out yielded positive results, with BMI reducing slightly in 80% of the pilot group over 12 weeks. HbA1c (the measure of the amount of glucose in the blood) was also reduced in 60% of patients, although for some patients this improvement was small. As this was a new initiative, only a small number of patients attended the pilot group so these shifts in HbA1c and BMI were not statistically significance.

However, as there appeared to be some positive outcomes, and the intervention was deemed acceptable to patients attending the group, we intend to roll the programme out across the hospital. This now gives clinical teams responsible for direct patient care an additional treatment option that they are able to refer patients with diabetes to.

In addition to clinical benefits, developing this psychological group programme has allowed the service to meet a recommendation outlined by SIGN 116 guidelines and increase the range of available treatment options.

Patients now have access to a wider range of services to help with diabetes management. The programme was well received and appeared acceptable to the patients who attended the pilot group. During post-group interviews, patients reflected on the benefits of having a shared group experience which appeared to enhance their motivation and learning.

As the patient feedback was largely positive, this group programme will continue to be offered within our service although we acknowledge that group work isn’t suitable for all patients. We plan to continue considering ways of adapting diabetes support to ensure that it is accessible to all patients within our service.

Claire Borthwick is a trainee health psychologist at The State Hospital, Carstairs.

You can read the latest Guidelines and find out more about the work of SIGN by visiting the SIGN website.

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Staff culture can really help unlock improvements in the care of older people – Eddie Docherty

Posted on November 19, 2018

Eddie_Docherty_2 Last year, Scotland’s population was estimated to be 5,424,800 – a record high and an increase of 6% on 2017. The largest increase was in the 75 and over age group (+31%). It is, of course, good news that we are all living longer. However that increase in older age groups is hugely significant for our health and social care system.

The likelihood of being admitted to hospital is, as expected, highly correlated with the age of the population. Around one person in three of the Scottish population aged over 75 was admitted at least once to hospital in 2016/17. By way of contrast, just under one in 11 people aged 25-44 were admitted.

“Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they possibly could.”

At the same time as we have an increasing demand in our hospitals, we have other pressures to manage which can impact on care, for example ongoing difficulties in recruiting to a range of posts, and a perennially challenging financial context.

Acute hospital care In Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they possibly could.

So when the inspections on the care of older people in two of our hospitals highlighted a number of concerns and challenges, it was a very difficult message for staff to manage – even though we knew the findings were accurate.

There is a natural emotional response that comes from staff who are working hard, doing their best and feeling like the criticism is unfair. After all, no-one was coming to work to do a bad job. I have no doubt many who have received challenging inspection reports have felt the same.

Yet, after that initial, understandable, emotional response, what has happened since those inspection reports were published has been hugely positive. That subsequent reaction has been down to the staff themselves who chose to respond to the challenges in a way that that has empowered them and benefited patients.

Culture was the key

The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors which included:

An understanding that answers to improvements lay ‘in the room’
Teams delivering care were empowered to make the changes they needed to make (eg if paperwork was not helping manage care then they could change it to something that did)
We had a strong group of individuals who wanted to make the changes
The key thing to change was culture (of person-centred care) and it was staff who could shape this
Staff felt strongly connected with the patients and their families as the hospitals and their workforces were an integral part of the local community.

So, having weathered the challenge, staff developed an action plan and used improvement methodology from Healthcare Improvement Scotland’s ihub to support the improvements, look at best practice from elsewhere to understand how to make change happen.

“The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors.”

It has taken at least 6-8 months for changes to feel tangible and there have also been some personnel changes which have added impetus to the cultural change. However, it is important to say that it is the teams themselves that have taken responsibility for change.

The impact

The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care. It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive perception of inspections themselves. Staff will now welcome the inspectors and the inspection process, knowing that this is an opportunity to get better. And they know that they can make the most of the improvement support that is available from Healthcare Improvement Scotland and feel they are able to embrace both aspects.

“The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care. It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive perception of inspections themselves.”

Added benefits

One of the added benefits of the changes was that, across the service in Dumfries and Galloway there has been a less fragmented feeling, and more of a feeling of a team ethos. In addition, it also feels like there has been change in the working environment to one that is a more open, learning environment.

No resting on laurels

There remains room for improvement and I’m not saying we have solved all issues. But it feel like we are more confident and in a better place to use challenges from inspections, and the improvement support available, to improve care in a way that might not have happened before. And for that, the staff in Dumfries and Galloway hospitals can take a huge amount of credit.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway.

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Why cervical screening is important and how you can shape the standard of care – Karen Grant

Posted on November 16, 2018

Karen Grant Every three years, I receive a letter in the post. It’s an invitation that could change my life. Unfortunately, it is not an invitation to Bradley Cooper’s Hollywood mansion – it is, in fact, way more important than that. The invitation is for me to attend for my smear test. Every time the letter arrives, I feel my heart sink. I really don’t want to go. But, I know what it means and how important the test is in detecting early signs of cervical cancer.

“Every three years, I receive a letter in the post. It’s an invitation that could change my life. Unfortunately, it is not an invitation to Bradley Cooper’s Hollywood mansion – it is, in fact, way more important than that. The invitation is for me to attend for my smear test.”

I read the information leaflet that comes with the invitation and it tells me everything I need to know – most important of all, that a smear test could save your life. According to Jo’s Cervical Trust, cervical screening saves around 5,000 lives in the UK every year and the resulting treatment prevents 8 out of 10 cervical cancers from developing.

I make the appointment and go for the test, because I really don’t want cancer.

What is cervical screening?

Cervical screening is the technical term for a smear test. This is because the nurse will take a ‘smear’ or swab of cells from the inside of your cervix to send off to the lab for testing. In the next year, the way cervical screening is done in Scotland will be changing. Cervical cancer can be caused by genetics, but in most cases it can be caused by a group of viruses called the human papilloma virus (HPV). People will still have a smear test, but instead of the cells being analysed in the lab for abnormal growth (called cytology), the cells will be put in a special liquid to be tested for the HPV virus. This gives a lot more accuracy to the test and means that people get their results back faster (within two weeks).

A vaccination programme has been in a place for a few years against the HPV. Although effective against HPV, the HPV vaccine will not protect you against all types of cervical cancer. So even if you have had the HPV vaccine, you should still come for cervical screening.

The new standards

Nearly a third of eligible people in Scotland did not get their smear test in 2018. According to ISD, the NHS’s statistical division, the majority of those individuals were from high deprivation areas, meaning that mortality from cervical cancer may be influenced by social determinants of health.

Although evidence suggests that cervical screening is highly effective, many people avoid cervical screening. This may be because they don’t understand what the test involves or they are embarrassed to go. We can address some of these issues within the standards. We can also think about the language we use to ensure that nobody is excluded because of their cultural background, gender identity or because they have a disability.

I have been developing standards with Healthcare Improvement Scotland for 10 years. Developing the cervical screening standards is my first project as a Programme Manager and has been one of the best projects I’ve ever worked on. The development group has been tremendous; so engaged, and the project has given me the opportunity to work with a wide range of people. I have been able to capture the most important elements of good quality cervical screening services, and listen to the stories of people who have experienced cervical screening services and any barriers they have faced or issues they feel are important to them.

“Although evidence suggests that cervical screening is highly effective, many people avoid cervical screening. This may be because they don’t understand what the test involves or they are embarrassed to go. We can address some of these issues within the standards.”

Even though I attend every one of my cervical screening appointments, I have learned so much more about cervical screening and how the NHS in Scotland works to deliver this. There have been snags along the way (aren’t there always?), but I’ll be sad, yet at the same time proud, when it’s finished.

The draft standards will go out for consultation for eight weeks. During this time, we are looking for people’s thoughts on the standards, to see if there is anything we have missed or need to change, and to make sure that the work we produce is informed by people’s real experiences and what matters to them.

Have your say

If you would like to provide us with your comments on the draft standards, please complete our online survey. For more information, or if you would like to engage with us further, please contact hcis.standardsandindicators@nhs.net

Visit the Healthcare Improvement Scotland website to download the standards.

The deadline for all comments on the draft standards is Friday 4^th January 2019

Karen Grant is a Programme Manager within the Standards Team of Healthcare Improvement Scotland

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How pharmacy teams are helping to reduce harm from high risk medicines – Mark Easton

Posted on November 12, 2018

Measton In Scotland, one in five adults are dispensed five or more medicines at any one time and there are 4 million prescribing errors occurring in primary care every year. With a pharmacy almost on every high street, the numbers involved are huge which is why improving safety in pharmacy, particularly around high risk medicines, is a vital piece of work.

As a community pharmacist and the National Pharmacist Clinical Lead for the Scottish Patient Safety Programme, I’m working with pharmacies to help improve safety.

A few years ago, I became involved in some pilot work within NHS Grampian as part of the Scottish Patient Safety Programme (SPSP) Pharmacy in Primary Care Collaborative, which was funded by The Health Foundation.

We tested a pharmacy Patient Safety Climate Survey, which produces a ‘snapshot’ of the safety culture in a pharmacy. It is designed to start a conversation about patient safety and provide a focus on where pharmacies can make improvements. We also tested care bundles for warfarin and for non-steroidal anti-inflammatory drugs (NSAIDs), which are a range of medicines that can relieve pain, reduce inflammation, and bring down a high temperature. These can include medicines such as aspirin and ibuprofen. NSAIDs are widely available on prescription and across the counter. However, this class of drugs is associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. Some UK studies have shown that almost 30% of all adverse drug reaction related hospital admissions are linked to NSAIDs and Scottish data indicates that NSAIDs are implicated in over 50% of all bleed related hospital admissions and 60% of deaths due to bleeds. As both the bleed risk and the Acute Kidney Injury (AKI) risk are linked to NSAIDs, these outcomes are predictable, and therefor potentially preventable.

We discovered that pharmacies undertaking the Pharmacy Patient Safety Climate Survey led to conversations about patient safety and a focus on where pharmacies can make improvements. As a result, some pharmacies introduced a daily communication huddle or a communication record book. These in turn led to improvements in key safety and patient information being shared and disseminated more effectively, while other pharmacy teams improved their data collection around ‘near misses’. This led to a better focus on areas of potential harm and improved training.

The Pharmacy Patient Safety Climate Survey is now available to every community pharmacy team in Scotland through the national pharmacy contract, meaning that people all over Scotland are receiving safer care from their pharmacy.

“We discovered that pharmacies undertaking the Pharmacy Patient Safety Climate Survey led to conversations about patient safety and a focus on where pharmacies can make improvements. As a result, some pharmacies introduced a daily communication huddle or a communication record book. These in turn led to improvements in key safety and patient information being shared and disseminated more effectively.”

This improvement drive was further developed in a large piece of work that I have been involved in this year which has seen the roll out of an NSAIDs Pharmacy Pack.

We knew that there were clear ways to improve care. For example, informing people to take NSAIDs with or after food reduces the risk of gastrointestinal side effects .We knew that earlier recognition by patients of the side effects allows action to be taken before they develop into something more serious. We also knew that raising awareness among patients of the medicine sick day rules can reduce the risk of acute kidney injury, as a result of a dehydrating illness.

To help pharmacies prevent adverse drug reactions, the NSAIDs care bundles were developed into the NSAIDs Pharmacy Pack, which gives clear guidance and improvement resources to help reduce gastric bleeding and acute kidney injury.

Pharmacy staff who are using the pack have reported that they are having better quality conversations with patients, and are informing them of the ‘medicine sick day rules’ which is to stop taking certain medicines if they have a dehydrating illness and restart their medication when they are well again. Before many patients were unaware of this key information. An unintended result of the better quality conversations has been that patients are willing to share additional key information relevant to their health which the pharmacist was previously unaware of, this has the potential to significantly improve the safe delivery of pharmaceutical care.

“To help pharmacies prevent adverse drug reactions, the NSAIDs care bundles were developed into the NSAIDs Pharmacy Pack, which gives clear guidance and improvement resources to help reduce gastric bleeding and acute kidney injury.”

One patient who has been prescribed NSAIDs told us that he had previously had an episode of sickness and became acutely unwell spending several days in hospital due to the reaction of his sickness with his medication. He said: “I was picking up my prescription and the pharmacist gave me a little card, this told me what to do if I had another dehydrating illness. Sometime later, I had another episode of sickness, but I remembered the card. As a heart failure patient you have it drilled into you that you must take your medication, but I followed the instructions on the card and I stopped taking the NSAIDs medication. I then became better. So, that little card made a big difference, to me as I didn’t have to spend days in hospital again.”

The NSAIDs Pharmacy Pack has now been distributed to every community pharmacy in Scotland and is supporting pharmacy teams to provide key safety messages to patients and customers whenever NSAIDs are dispensed or purchased, which will make a real difference to people’s health outcomes.

I’m looking forward to continuing to build on safety work by supporting pharmacists and pharmacy technicians in their improvement journey, and through the development of new models of care in GP practices and through better use of prescribing data, leading to better integration of pharmaceutical care across the primary care sector.

Mark Easton is National Clinical Lead (Pharmacist) at the ihub Primary Care Improvement Portfolio.

More information about the Pharmacy Safety Climate Survey is available by visiting the ihub website

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