Patient safety is at the heart of healthcare. So much is this taken for granted that it was a huge shock when the unnecessary deaths of hundreds of people at two hospitals run by Mid-Staffordshire Foundation NHS Trust came to light in 2009.
The investigation that followed took nearly three years to complete at a cost of around £13m. The resulting report in 2013 (known as the Francis Report after barrister Robert Francis, who chaired the inquiry) described catastrophic failings that started at patients’ bedsides with overstretched nurses, went up through the ranks of managers who were obsessed with balancing the books and failed to report problems, and continued all the way to the regulators and ministers who failed to provide the necessary oversight.
The Francis Report brought patient safety, quality of care and leadership into much-needed focus. Not only did it identify warning signs that should have triggered action at the trust in question, it also made a series of recommendations to tackle the problems, not just by those directly affected by the failings, but across the NHS.
Celesio UK used this as an opportunity to review its own processes, looking at the entire journey made by a prescription from NHS trust via GP to dispensary and patient. “Doing this opened our eyes to how thoroughly our branches could be working on safety and improving patient [care] standards,” says Victoria Steele, head of clinical governance and professional standards for LloydsPharmacy. “Even though we were already doing well, we wanted to make it part of our culture.”
The SaferCare programme was introduced across the company in October 2013, with every store asked to nominate a staff member to become a SaferCare Champion.
“We specified that these people should not be pharma-cists as we wanted different eyes and minds,” says Victoria, who is also deputy superintendent. A four-week schedule was introduced, with checklists and a 20-30 minute team briefing during the fourth week to discuss dispensing issues in depth, look at a case study and assess anything considered a risk at branch level.
Kelly Cawood, who is a non-pharmacist manager at LloydsPharmacy’s New Romney branch in Kent, volunteered to become a SaferCare Champion, not just for her store but also on a regional basis for another 22 branches. “I went into each pharmacy to talk to the champions in store and spread the message that safety is everyone’s job,” she says. “I’d help update daily rotas, look at SOPs and audits, and see if near miss and error logs were being used. Basically, we stripped everything back.”
It wasn’t always an easy process, she says. “It became clear that many people had lost sight of the fact that everything they were doing had a person at the end of it. There was a sense that safety was the pharmacist’s responsibility, and personal accountability had got lost along the way. Near misses weren’t being recorded because staff felt that logs were a punishment rather than an opportunity to learn, and managers weren’t always sharing information as freely as they should have been.”
The pilot was widened out and the SaferCare programme revamped and relaunched in 2016. The weekly checklists are still in place but now focus on one area at a time – environment, people or process – with a full staff briefing taking place in week four, aided by a dedicated noticeboard on which anyone can log incidents or highlight an issue they wish to discuss.
The cycle is repeated three times, with week 13 concerned with the accuracy of data entry and labelling. The ex-Sainsbury’s pharmacies that moved across to LloydsPharmacy towards the end of 2016 went live with SaferCare in April.
“Our error rate has halved,” says Victoria Steele, “partly due to instilling SaferCare but also because of cracking team work across the branches. In places, it has been taken so much to heart, that there is utter brilliance going on. Outside the company, it has been noticed. Our insurers have commented on it, the General Pharmaceutical Council has described it as “a leading patient safety tool”, and we have shared our work with other organisations such as the NPA, CCA and AIMp.
“It has had unplanned positive outcomes too. For example, we have identified significant talent across our estate that may otherwise have gone unnoticed. People are passionate about safety, so are showing leadership and communication skills that have led to them being put onto our internal development programme. It has opened up channels of communication and encouraged branch staff to get to know each other and work together.”
Natalie Millar is pharmacist manager at LloydsPharmacy’s Tannahill Centre branch in Paisley. “SaferCare has made a huge difference to how we work,” she says. “Everyone is now really focused on the fact that there is a patient at the end of everything we do, and we are now so much more careful. Our error and near miss rate has dropped, and we never make the same mistake twice because we look at what went wrong and take action straightaway to put it right.
“The importance of SaferCare really hit home after a very serious dispensing error was made at the branch recently. As the manager, I would normally deal with it, but I was away and it was thanks to SaferCare that the staff knew exactly what to do. When the incident was investigated, the individuals involved didn’t feel isolated, the whole team took accountability and talked it through: that is SaferCare right there.”
Area champion Kelly Cawood says that, across her region, the benefits of SaferCare are really showing, “particularly on GPhC inspections when everyone is now able to answer everything because they are used to working in a way that puts the patient or customer first, and this shows in our ratings.
“SaferCare really makes you think about the whole system and everything we do. We know what good looks like and challenge it when it doesn’t [look good]. Care is safer across the board, not just for people who come into the pharmacy, but those of us who work here, too. Everybody wins.”
Everyone is really focused on the fact there is a patient at the end of everything we do