Patient safety toolkit
Additional Resources
This guide will aid GPs and their teams to maximise opportunities for learning from patient safety incidents. The guide provides guidance on sharing learning via organisational or national reporting systems, and outlines a process for learning from patient safety incidents.
The National Institute for Health Research School for Primary Care Research is a partnership between nine leading academic centres for primary care research in England. The school's main aim is to increase the evidence base for primary care practice, through high quality research and strategic leadership.
NHS Education for Scotland is a special health board supporting NHS services in Scotland by delivering education and training for those who work in NHS Scotland. Its vision is for 'Quality Education for a Healthier Scotland' and its mission is to provide educational solutions that support excellence in healthcare for the people of Scotland.
HIS is the national healthcare improvement organisation for Scotland and part of NHS Scotland. Health Improvement Scotland works with staff who provide care in hospitals, GP practices, clinics, NHS boards and with patients, carers, communities and the public. HIS plays an important role in helping others put into place the improvements to patient care that matter most to health care providers.
The CQC produce guidelines and targets regarding quality. Many of these have a safety component as well. It is the independent regulator of health and social care in England.
PRIMIS promotes patient care by using general practice data to improve quality and accessibility, supporting access to patient data, and transforming data into information.
Reporting safety incidents from general practices in England
Patient safety incidents are any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving NHS funded healthcare. In England general practitioners can report these incidents electronically. It is recommend that the ‘e-form icon’ is downloaded to desktops (a simple drag and drop process) for quick access to the new GP e-form. A guide to completing the form is available.
Quality Improvement
To access shared learning networks to assist you in applying practical QI methodologies to better treat this clinical area, join our QI Ready platform.
Patient safety priorities in primary care
The PatIent SAfety (PISA) research group at Cardiff University have carried out a series of national-level analyses of patient safety incidents reported from general practice and wider primary care.
In their published reports, the PISA group have summarised the patient safety priorities that you can explore, or investigate further, in your system (GP practice, cluster, PCN, CCG) as well as potential solutions to mitigating risk and improving safety for patients.
Major studies completed, include:
- Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice – published in the NIHR HS&DR journal
- Patient safety incidents involving sick children in primary care in England and Wales: A mixed methods analysis – published in PLOS Medicine
- Safety incidents involving children in general practice– published in Pediatrics
- Harms from discharge to primary care: Mixed methods analysis of incident reports – published in British Journal of General Practice
- Nature of blame in patient safety incident reports: Mixed methods analysis of a national database – published in Annals of Family Medicine
- Paediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database– published in Vaccine
- Sources of unsafe primary care for older adults: A mixed-methods analysis of patient safety incident reports – published in Age and Ageing
- Quality improvement priorities for safer out-of-hours palliative care: Lessons from a mixed-methods analysis of a national incident-reporting database – published in Palliative Medicine
- Patient safety in palliative care: A mixed-methods study of reports to a national database of serious incidents – published in Palliative Medicine
- Patient safety incidents in primary care dentistry in England and Wales: A mixed-methods study – published in the Journal of Patient Safety
- Patient safety incidents in advance care plans for serious illness: a mixed methods analysis – published in BMJ Supportive and Palliative Care
- Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports– published in Archives of Disease in Childhood.
- A mixed-methods analysis of patient safety incidents involving opioid substitution treatment with methadone or buprenorphine in community-based care in England and Wales – published in Addiction.