Measuring and improving patient safety in general practice in Ireland
Curran, Ciara Maria Patricia
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Due to the large volume of primary care consultations and increasing patient complexity, there is substantial potential for unintentional patient harm. Measuring and monitoring of safety is essential to identify the contributory factors to patient harm and to strengthen safety systems to reduce the risk of future harm. Whilst proactive safety assessment methods are emerging in primary care, General Practitioners (GPs) report difficulty in knowing how to improve patient safety. A multi-method approach was taken to examine how patient safety can be measured, monitored and improved in primary care and how GPs can use this information to improve patient safety. Study 1 is a systematic review of the safety climate (SC) survey instruments that have been utilized in primary care. It considers the reliability and validity of these measures and their suitability for use in primary care settings. Study 2 reports the findings from a survey of perceived SC across primary care practitioners and staff in Ireland and compares the findings to similar SC surveys conducted in primary care in England and Scotland. These findings highlight the negative impact of workload on perceived SC across the three studies. Study 3 describes the feasibility of implementing a patient safety intervention developed to proactively improve safety in primary care. It specifically addresses the impact of the intervention on SC and the acceptability of the intervention to GPs and practice staff. Finally, study 4 identifies contributory factors to patient safety incidents in primary care using the critical incident technique interview approach. The findings from these four studies highlight the importance of choosing measurement instruments that are valid, reliable, feasible and context-specific. These studies demonstrate that there are a wide range of approaches to support safety improvement in primary care. The challenge is how to encourage and support the use of these techniques in busy GP practices.
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