Enhancing public safety in primary care

Publisher Website
Google Scholar
Abstract
Improving the safety record of the NHS is a national priority. This is not surprising, as recent research shows that up to 850 000 adverse events occur in hospitals every year.1 Up to 90 000 iatrogenic deaths may occur each year in hospitals in the United States,2 and the picture is likely to be similar in the United Kingdom. The landmark report To Err is Human has led to substantial investment in the US Agency for Health Research and Quality's safety unit.2 This was closely followed in the United Kingdom by the Department of Health reports An Organisation with a Memory and Building a Safer NHS, heralding the introduction of the National Patient Safety Agency. 3 4 Our understanding of the causes of iatrogenic adverse events in secondary care has increased substantially over the past decade, but the same cannot be claimed of primary care. In this paper, we consider public safety in primary care. What do we know about the main causes of harm to patients? To what extent are these preventable? How can we enhance public safety? We use these deliberations as a basis from which to propose a strategic response to the pressing challenge of improving the safety record of primary care. #### Summary points Safety is of increasing concern to the public and profession alike, but until now attention has been focused on secondary care Valuable research on safety has been conducted in primary care, and many other sources of information indicate where the major causes of harm might occur Safety is a major concern in four main areas—diagnosis, prescribing, communication, and organisational change Prescribing is the area about which most is known—3-5% of all prescriptions in primary care might cause problems, and one third of these can be classified as serious Of all adverse incidents …