Scottish Patient Safety Programme

Part of the debate – in the Scottish Parliament on 2nd March 2017.

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Photo of Maree Todd Maree Todd Scottish National Party

I am delighted to participate in the debate. As many members will know, I worked as a clinical pharmacist, specialising in mental health, until my election last May. I can honestly say that, in my 20 years of working in a hospital, nothing came close to the effectiveness of the Scottish patient safety programme for change management. I hope that the debate will reassure my Lib Dem colleagues that a step change is already occurring in mental health services.

The SPSP is about delivering reliable and safe care for every patient, every time—24 hours a day, seven days a week. As the cabinet secretary mentioned, in mental health, the safety programme has supported improvements at ward level, where there have been examples of reductions of up to 70 per cent in the number of patients who self-harm, 57 per cent in the number of incidents in which physical restraint has to be used and 78 per cent in the number of incidents of physical violence on wards. Those figures are phenomenal, and they come from some of the most disturbed wards in Scotland.

What is so special about the SPSP? The methodology empowers staff to identify what is not working well, to make changes and to monitor their impact by on-going use of data collection. Data is incontrovertible, which makes it really powerful for instigating change.

I will tell members about some of the progress that has been made at the hospital that I used to work at—New Craigs hospital in Inverness. At the time when I left, we were using SPSP methodology for medicines reconciliation. It might seem simple, but the process of creating the most accurate list that is possible of all the medications that a patient is actually taking and comparing it with their records at transition points, when errors are most likely to occur, has dramatically reduced errors.

The next focus of our attention was “as required” medication, which is used to alleviate symptoms of distress and agitation, so it is not a regular prescription. For some time, coloured stickers—red for intramuscular injections and yellow for oral drugs—had been used in patient notes to highlight the use of such medication. The stickers prompted staff to record how well the patient responded and the bright colours in the notes were a crude visual cue as to how well the patient might be.

An audit of the stickers at New Craigs found that, when such drugs were being used, more than 50 per cent of the time the patient had only a slight improvement or no improvement in symptoms. Of course, the discovery that an intervention does not work half the time warrants a response. The pilot team proposed seeing whether alternatives to medication might be of more benefit to patients. All the staff, including my pharmacy colleagues, had training on decider skills. The training was excellent and the techniques are popular with staff and patients alike. It is clear that learning those skills and teaching them to patients has the potential to have a much longer-lasting benefit than medication has. Now, in addition to the yellow and red stickers system, a green sticker is used to record the score of psychological interventions from the perspective of both the nurse and the patient. I hope that that example demonstrates the power of such incontrovertible data to drive change.

Fundamentally, the SPSP empowers staff at the coalface. My colleagues are increasingly turning to the methodology as a standard approach to problem solving and process improvement. As I have mentioned before, the Government is enabling all healthcare professionals to develop and take on new roles. To support GPs and other primary care colleagues, the pharmacists at New Craigs have all trained as prescribers and are taking their skills from the hospital into the community. The SPSP methodology will be ingrained in that change, to identify and improve any processes that are not working well.

Scotland is leading the way with the Scottish patient safety programme. Our ambitious and comprehensive approach to improving the safety and quality of care might have caught the interest of the rest of the world, but it is the results that have made it really impressive.