Mid Sussex trust
This is a mixed acute, community and mental health trust. An internal review in 1995 led to an extended pharmacy technician's role, freeing pharmacists for ward work.
Since then, the pharmacy's main role has been to reduce risk to patients by developing incident monitoring and clinical audit projects, followed by corrective actions.
The project found prescribing errors could be made at admission because of inadequate information.
Drugs were sometimes wrongly selected or administered to the wrong patients during ward rounds.
Patients could be confused by having drugs supplied before admission and on discharge. GPs did not act on discharge information because they did not regard it as accurate.
The drug supply process has now been redesigned so that patients' own drugs are used during inpatient stays. When drugs are supplied, they are issued to individual patient drug cabinets at the bedside and supplied in discharge format. Pharmacists are used to pass information to GPs and community pharmacists.
Drug rounds now take less time, patients are more likely to get the correct medication and discharge is faster. GPs now regard information as accurate and useful and therefore update their repeat prescribing systems.
The judges said:
The judges liked the thorough assessment and mapping of risk and the wholesystems approach to change. They admired the persistence of the staff and the pragmatic leadership shown by the chief pharmacist.
This trust takes a creative approach to problem solving, gathering ideas from others and adapting them to Mid Sussex.
South Cheshire HA
This project was set up to manage cardiovascular disease systematically by using computer templates for primary care.
The project was promoted by the HA's medical adviser with support from the local medical committee and the GPs on the audit advisory committee. In the first year, 63 practices took part.
But this year only two or three have not joined in.
The project is based on evidence-based guidelines developed by a consensus team of GPs, practice nurses, pharmacy advisers, public health and hospital consultants. These were turned into clinical datasets that could be loaded on to GP computers as templates. The templates cover angina, myocardial infarction, atrial fibrillation, stroke and hypertension and can be used to guide the management of a patient during a consultation or annual review.
A risk-management strategy has evolved for GPs. Practices with results that vary from the norm receive a report identifying patients whose care may be suboptimal. PCGs can identify morbidity at practice level and patients can have more confidence in their care.
The judges said:
The judges thought this was an admirable attempt to tackle the logistic problems of clinical risk management in a large at-risk population and were impressed by the involvement of all but two practices. It integrated well with clinical governance, which poses particular challenges in primary care.
South Tees Acute trust
The obstetric directorate piloted the European Quality Foundation model, before its successful implementation trustwide. Other recent initiatives have included the development of an obstetric critical care team, the opening of a maternity day unit and the introduction of midwife medical management of miscarriage.
The directorate has also developed a multidisciplinary approach to managing risk through a critical incident analysis/audit process (CIA).
This provides a systematic, critical analysis of the care provided, set against standards of best practice.
It allows for the prompt investigation of adverse incidents and patient complaints. A full and frank explanation is always given to the patient. Debriefing sessions can be held to help staff who have been involved in traumatic situations. Changes introduced as a result of the process can be evaluated in turn.
The directorate has now been identified as the lead in the implementation of a clinical risk strategy for the whole trust.
The judges said:
Through the leadership of a CIA co-ordinator they have implemented a four-stage process for managing risk that provides a framework for identification, investigation and analysis, action, evaluation and review. The judges thought this was a strong, clear and robust process that promises to deliver impressive results in the future.