Published: 10 January 2018
Finding straightforward and effective ways to improve patient safety is a particular interest of mine. It means I can easily incorporate changes into my day-to-day work.
To help me improve safety and outcomes for patients, I’ve benefited from receiving quality improvement reports produced by the Royal College of General Practitioners (RCGP) and Clinical Practice Research Datalink (CPRD), using my practice’s own data. CPRD is a Government organisation that provides anonymised patient data for public health research, and my practice has been contributing to CPRD and supporting this research for a number of years.
So, I was very interested when I heard of an additional benefit – a free feedback report developed with RGCP that is tailored to each contributing practice. Because the report is tailored, it means GPs have information specific to their practice, without having to search for it themselves.
The report uses prescribing safety indicators from RCGP’s Patient Safety Toolkit, a system which allows practices to look at different aspects of patient safety with a view to making improvements.
The indicators are:
- Prescription of Non-steroidal anti-inflammatory drugs (NSAIDs) to patients with heart failure
- Prescription of NSAIDs to patients with chronic kidney disease (CKD)
- Prescription of thiazolidinediones (glitazones) to patients with heart failure
- Aspirin monotherapy for stroke prevention in patients with atrial fibrillation
One of the biggest challenges facing modern GPs is the rising numbers of patients diagnosed with multimorbidities and it is crucial that we ensure that any medication we prescribe does not cause other side effects.
The report provides information for assessing patient care, and for flagging up where review and discussions with patients may need to take place. However, it’s important to remember that not all patients included in the report are on unsafe treatment. As ever, it’s for us as GPs to decide on treatment according to the patient’s circumstances.
How have I been using the reports?
The report is a helpful addition to the processes I already use to review patient care, and I used it to carry out prescribing audits on patient lists.
Because the reports have been compiled using Read codes, which are a standardised and coded ‘thesaurus’ of clinical terminology, they can identify patients that could otherwise be missed by a practice GP searching through records manually. This provides a valuable extra audit.
The report shows each practice’s rates for prescribing the drugs in question to relevant patients, for example NSAIDs to heart failure patients, benchmarked against all practices in the CPRD network. This helps us to compare ourselves with peers and set our own performance in context.
One thing that took a little time, but for good reason, was re-identifying patients using the anonymised identifiers in the report, as only my practice can identify patients in our report. You can see how the information looks in a sample version of the report on the CPRD website.
How else could the reports be used?
The report also includes recommendations for next steps for reviewing patient care plans, based on NICE guidance, as well as links to further information. All good stuff for wider quality improvement work and preparing evidence for revalidation.
I know at least one GP in the UK who has used the report to review process as evidence for an annual appraisal.
It could also be used as an agenda item for practice meetings, for discussions on safe prescribing.
RCGP is working with CPRD to regularly produce these innovative reports, to help GPs to improve the quality of the services for patients by making optimal use of routinely collected data.
There are plans to add more indicators for future reports, and I have fed back suggestions of what could be included.
Because the reports are based on the CPRD data extract, to receive the report for your practice you will need to join CPRD by completing the application form. It’s an easy, one-off process.
Further information will be available at RCGP’s ‘Quality Improvement in Patient Safety’ workshop in Glasgow on 16 January, 2018 - where I’ll be speaking - and the workshop on 15 February, 2018, in Birmingham.