Ensuring patient safety: Are your practice’s processes letting you down?

Unless you are in a solo practice, there will be a number of staff involved in running the business and delivering healthcare. Sound systems and processes support the safety and efficiency, so any gaps or failures in processes can have serious implications for the doctor.

Avant received 2,443 calls from practices in 2018 and many more from doctors seeking advice on situations involving practice staff. Situations such as the one below show how simple mistakes can lead to serious harm and legal action.

Patient identity confusion

A 62-year-old male patient was called from the waiting room using his first name only. The GP opened the patient’s electronic file and made notes about the patient’s reason for attendance. A chest infection was diagnosed and antibiotics prescribed, noting no known allergies or current medications.

After the patient arrived with a prescription at the pharmacy, the pharmacist phoned the GP to inform him the patient was allergic to the prescribed antibiotic and his address and contact details were incorrect.

Upon investigation, it was discovered the incorrect patient had been entered into the electronic appointment system by reception staff when the appointment was booked. The GP had then opened the patient file from the appointment schedule.

The patient had not been adequately identified by staff at any stage throughout their visit to the practice. The GP also has a responsibility to ensure they are consulting with the correct patient and failed to confirm the patient’s full name. Thankfully, the error was picked up before any harm was done, but the outcome could have been significantly different both for the patient and the practice.

Preventative processes

Having sufficiently robust processes in place which are followed by all practice staff is essential.  

• Policies and procedures need to be easily accessible and searchable online to ensure all staff are aware. In the above situation, having a policy in place which requires identification of patients using one of three approved patient identifiers, would have helped. Under the RACGP’s Standards for general practices (5^th edition), items of information that are accepted for use to identify a patients include:   
• Family name and given names
• Date of birth
• Gender (as identified by the patient)
• Address
• Patient health record number, where it exists
• Individual Healthcare Identifier
• Have a streamlined and efficient induction process to make on-boarding new staff simple and consistent. Induction protocols with training and accountability sign-off ensure staff treat the policies seriously.
• Reinforce staff understanding on a regular basis using comprehensive training modules in areas such as patient health records, and privacy and confidentiality.

Despite policies and procedures being in place, errors can still occur. Instilling a protocol in which the reception staff check the identity of all patients on arrival, not only makes the patient feel welcome, but provides an opportunity to confirm the correct patient has been selected.

Support team members have an important role to play in delivering safe healthcare. Training and compliance currency need to be prioritised so they know they are doing things correctly.

Errors made by support staff can contribute to poor patient outcomes and complaints or legal actions against the practice. Staff actions may not be covered under the doctor’s personal indemnity  insurance, which is one of the reasons why the practice entity requires practice medical indemnity cover.

More information

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Medico-legal Advisory Service

If you require advice, visit our website or email our Medico-legal Advisory Service (MLAS) at: nca@avant.org.au or call 1800 128 268 for expert advice, 24/7 in emergencies.

*IMPORTANT: The Practice Medical Indemnity Policy is issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. This policy is available at www.avant.org.au or by contacting us on 1800 128 268. Practices need to consider other forms of insurance including directors’ and officers’ liability, public and products liability, property and business interruption insurance, and workers compensation.