Developing a Primary Care Patient Safety Guide: co-producing a tool for patients and carers with GPs, pharmacists, patients and carers

Problem

Increasingly interventions to improve primary care patient safety are moving beyond involving patients in the identification of errors to actively involving them in preventing and reducing them as part of a wider learning system. Increasingly support is given to person-centred approaches in healthcare which empower patients and carers to actively be involved in their patient safety. Co-production approaches have been used to develop, implement and evaluate participatory approaches in quality improvement initiatives in a variety of settings by working in collaboration with the end-users of the intended initiatives. This project aimed to use a co-production approach to develop a patient safety guide and identify processes that may enable or constrain its implementation into routine primary care.

Approach

The co-design approach was used to develop a prototype of the patient safety guide (including paper and online versions) and cue cards. After an initial scoping exercise of patient safety issues was conducted, 2 co-design events were conducted with a mix of GPs, pharmacists, patients and carers where participants mapped the phases of care in terms of patient safety in priority areas, planned ways of improving patient safety at key points of care, and then worked together to refine the guide and cue cards. Semi-structured interviews with 20 patients and carers were conducted to examine in-depth existing strategies for patient safety and examine the work required to implement the patient safety guide for patients and carers.

Findings

Healthcare professionals, patients, carers, and researchers working together to co-design and refine the patient safety enabled the identification of key patient safety questions that need to be addressed, such as developing a shared understanding of patient safety, understanding each other’s role in safety, and to support collaborative improvement. Participants identified the main factors that impacted on their engagement with patient safety and actions that could be implemented to improve patient safety along the primary care interface. The qualitative study identified the work involved to implement the guide in routine care. Factors affecting uptake and use of the guide related to collective engagement within and across services as well as uncertainties around how to embed it in clinical encounters. The use of cue cards during consultations, and a longer guide for reference before and after consultations, was preferred.

Consequences

Using a co-production approach and in-depth qualitative study examining the implementation of the patient safety guide identified important points where patient safety in routine primary care can be improved using patient and clinician experiences. Involving patients and clinicians in the development of the guide and cue cards supported a collaborative approach to improvement. This has implications for the development and implementation of patient safety initiatives and their future sustainability.