Adverse incident reporting system
Incident reporting has proved to be a useful tool in preventing error in high-risk industries, such as aviation, nuclear and petro-chemical industries. It has increased investment in the development of proactive and reactive safety systems. If an aviation incident occurs it is reported, investigated and lessons are learnt. Is there an incident reporting system at your practice? Reporting when things go wrong is essential, as it explores the underlying causes of patient safety incidents and allows learning to be obtained from them.
Is there an incident reporting system at your practice?
All GP practices should have protocols that encourage staff to report untoward incidents. Staff should feel they can report incidents without the fear of personal reprimand. A positive patient safety culture is one that has open communication, mutual trust, shared perceptions of the importance of safety and confidence in the efficacy of preventative measures.
If a test or a referral is urgent, make sure the request is marked “urgent” and that you make a diary note to check that it has been actioned
Box 15: Suggestions
- If a test or a referral is urgent, make sure the request is marked “urgent” and that you make a diary note to check that it has been actioned. Telephone the laboratory or department if necessary.
- If a letter needs to be typed, mailed, faxed or e-mailed urgently, impress the need for speed on the secretarial staff.
- Make sure there is a formal system for recording and passing on telephone messages – scraps of paper and post-it notes are easily ignored or mislaid.
- Arrange a foolproof system for reviewing results of investigations: if a test result is abnormal, deal with it promptly and appropriately.
- Make sure records are filed properly.
- If you tell a patient you will do something – such as sending further information, or making a referral – record it in the case notes, and either do it before seeing your next patient or make a note of it on a “Things to Do Today” list.
- Write or dictate referral letters promptly, and make sure that appropriate individuals receive copies.
Continuity of care
We frequently see claims arising from communication gaps when patients consult a series of GPs in the course of one illness
The concept of the “family doctor” is changing as busy people (especially infrequent attenders) choose to take the first doctor available for an appointment rather than wait to see “their” doctor. In urban areas especially, a growing number of patients “shop around”, either consulting a variety of doctors about a particular condition or consulting a different doctor for each episode of illness.
The continuity of care that GPs have traditionally provided is gradually becoming a casualty of our modern world, but patients may be at risk without it. At MPS we frequently see claims arising from communication gaps when patients consult a series of GPs in the course of one illness.
Here are some tips for maintaining continuity of care when multiple doctors are available:
- Impress on patients, via notices in the waiting room and on the practice’s
website, if you have one, why it’s important to see the same doctor regarding an ongoing complaint. Making clear follow-up arrangements and using language like “Come back and see me if it gets worse” will help to reinforce this message. - Draw up protocols for reception staff taking appointments. It could be standard practice, for example, for them to ask the patient if they have attended the practice recently about the same problem and, if the answer is "yes", to suggest that they see the same doctor. Explain to staff why this is important.
- Write sufficiently comprehensive notes at each consultation so that any one else who sees the patient can understand fully what happened in the consultation, understand the progress of a patient’s condition and be fully aware of what has already been done.
- Read the most recent entries in a patient’s medical record so that you are aware of any ongoing problems that have not been resolved or that might have a bearing on the consultation.
- Institute an alert system so that investigations and tests are followed up and, if necessary, acted upon.
- Make arrangements for a colleague to check your emails and correspondence while you are off sick or on leave.
- Be especially careful if you are doing out of hours work or home visits, where you might not have access to the patient’s notes, to take a thorough history and ensure either that it is inserted into the patient’s notes or that the patient’s GP gets a copy at the first available opportunity.