Scottish patient safety programme: Pharmacy in primary care

Healthcare Improvement Scotland

  • Led by Healthcare Improvement Scotland, in partnership with NHS Education for Scotland and the University of Strathclyde.
  • Worked with four NHS health boards in Scotland.
  • Aimed to improve patient safety by strengthening the contribution of pharmacists in primary care and improving communication within a more integrated primary care team.
  • Used established improvement tools and approaches, including a safety climate survey and care bundles for high-risk medicines and medicine reconciliation.

The Scottish Patient Safety Programme is a unique national programme to improve the safety of health care and reduce the level of harm experienced by people using health and social care services. The programme began in primary care in 2010 and in 2014 it was extended to community pharmacy through the Closing the Gap in Patient Safety project. 

There were 29 community pharmacies/dispensing practices involved across four health boards: NHS Fife, NHS Grampian, NHS Greater Glasgow and Clyde, and NHS Highland.  

The project aimed to strengthen the contribution of community pharmacy and improve communication within the primary care team. Established improvement tools and approaches were introduced, focused on high-risk medicines, safety culture and medicines reconciliation. Initiatives included: a high-risk medicines care bundle for either warfarin or non-steroidal anti-inflammatory drugs; a pharmacy safety climate survey; and a medicines reconciliation care bundle.

Evaluation of the project used a mixed methods approach to identify successes, challenges, outcomes and impact of the programme. Data collection methods included questionnaires, interviews, observational case studies, process mapping, documentary evidence and patient impact vignettes.

There was evidence of a sharp increase in the understanding of quality improvement and patient safety within community pharmacy during the project, as well an increase in knowledge, understanding and confidence in using the tools. 

The positive impact of the project has been evidenced through patient stories, feedback from pharmacy teams, and the quality and quantity of locally developed supporting resources. Feedback suggests the improvement tools have been incorporated into everyday working practices, despite the pharmacies being very busy. Delivery of the care bundles is still ongoing in the practice sites and there is a strong willingness for this work to continue.

The medicines reconciliation process seemed particularly beneficial for those patients who are hard to reach, and facilitated an open communication channel between the patient, the pharmacy and secondary care providers.

The collaborative approach was viewed positively by those involved and work is ongoing to raise awareness of the pilot and to address the learning needs of community pharmacies not previously involved.

Challenges included the difficulties of getting teams together to discuss the results of the safety climate survey. Discussing results at existing team meetings and safety huddles helped to overcome this.

Elements of the programme are now being spread, for example the project team is working with the Scottish Government and other professional organisations to facilitate the pharmacy safety climate survey.

Contact details

For further information about the project, please email Jill Gillies and Wendy Forbes at Healthcare Improvement Scotland.

About this programme

Programme

Closing the Gap in Patient Safety

This programme ran from 2014 to 2017, and offered funding for projects to implement and evaluate tested, evidence-based patie...

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