RESUMEN
BACKGROUND: GP trainees may not have experienced a systematic and comprehensive education in safe prescribing. Therefore, a self-assessment prescribing review was developed. AIM: To determine whether the assessment was feasible, had face validity, and did not disadvantage particular groups of participants. DESIGN & SETTING: An online survey that evaluates the opinions of GPs in training of a prescribing assessment in the UK. All full-time UK trainees who started their final year of GP training in August 2019 undertook the prescribing assessment along with their trainers, after which they completed an online anonymous feedback questionnaire. METHOD: The questionnaire completed by trainees sought their opinions of the assessment, and collected ethnicity and disability data. The trainer questionnaire was similar but did not include any demographic information. RESULTS: The questionnaire was completed by 1741 trainees and 1576 trainers. There was no evidence that ethnic group and disability were related to aspects of the review. Most of the trainees (76.4%, n = 1330) and trainers (82.0%, n = 1293) agreed or strongly agreed that the prescribing review was helpful for assessing and learning about the trainee's prescribing. However, most participants (63.2%, n = 1092) took >4 hours to review their prescriptions. A majority of trainees (90.2%, n = 1571) reported that completing the assessment had resulted in a change in their prescribing practice. CONCLUSION: The majority of trainers and trainees reported that the prescribing assessment was helpful. The study was not able to assess whether there had been an actual change in practice that resulted in an error reduction.
RESUMEN
BACKGROUND: Discharge summaries are essential for communicating patient information from secondary care to general practice on hospital discharge. Although there has been extensive research into their design and completion in secondary care, very little is known about primary care processing of these documents. AIM: To explore what general practice staff think are the factors associated with failure to respond to actions requested in discharge summaries and what practices do to mitigate this. DESIGN & SETTING: Semi-structured interviews were undertaken with primary care staff in three geographical regions of England. METHOD: Interviews with 10 practice managers and 10 GPs (one of each at each of the 10 practices) were undertaken to explore management of discharge summaries. RESULTS: Five themes emerged from the interviews. The 'secondary care factors' theme describes participants' perspectives on the design of summaries, which are inconsistent and often require improvement. The 'safety features of processing systems' theme focuses on document handling in primary care. A theme devoted to 'medicines reconciliation' followed. 'Error and harm as a result of faulty processing' is a theme describing 'human error' and other factors that participants believed contributed to failure to respond to requested actions. Finally, the 'strategies for safety improvement' theme describes initiatives to prevent failures of safer transitions of care. CONCLUSION: Correct processing of discharge summaries is essential to ensure patients experience a safe transition of care and not just a hospital discharge. Based on the interview findings, strategies to mitigate against faults in the processing of discharge summaries have been suggested to enhance safer transitions of care.
RESUMEN
BACKGROUND: There is a need to ensure that the risks associated with medication usage in primary health care are controlled. To maintain an understanding of the risks, health-care organizations may engage in a process known as "mindful organizing." While this is typically conceived of as involving organizational members, it may in the health-care context also include patients. Our study aimed to examine ways in which patients might contribute to mindful organizing with respect to primary care medication safety. METHOD: Qualitative focus groups and interviews were carried out with 126 members of the public in North West England and the East Midlands. Participants were taking medicines for a long-term health condition, were taking several medicines, had previously encountered problems with their medication or were caring for another person in any of these categories. Participants described their experiences of dealing with medication-related concerns. The transcripts were analysed using a thematic method. RESULTS: We identified 4 themes to explain patient behaviour associated with mindful organizing: knowledge about clinical or system issues; artefacts that facilitate control of medication risks; communication with health-care professionals; and the relationship between patients and the health-care system (in particular, mutual trust). CONCLUSIONS: Mindful organizing is potentially useful for framing patient involvement in safety, although there are some conceptual and practical issues to be addressed before it can be fully exploited in this setting. We have identified factors that influence (and are strengthened by) patients' engagement in mindful organizing, and as such would be a useful focus of efforts to support patient involvement.