Primary Care Trust NHS Western Cheshire invests in Patient Safety with Datix
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Leading NHS Trust in Cheshire shortlisted for patient safety award following use of effective incident and risk management system for patient services.

NHS Western Cheshire is a Primary Care Trust (PCT) that commissions health services for the local population ensuring that local healthcare needs are met. Each year it spends about £370 million of public money with the bulk of its budget directed towards hospital care, family doctor services and prescribed medicines. NHS Western Cheshire recently split its responsibilities into two separate areas: commissioning and providing services.

The main local provider of acute hospital care is the Countess of Chester Hospital NHS Foundation Trust, where approximately 90% of hospital patients in Western Cheshire are treated. The other hospital providers include Wirral University Hospitals NHS Foundation Trust, North Cheshire Hospitals NHS Trust and Mid Cheshire Hospitals NHS Trust, while mental health services are commissioned from Cheshire and Wirral Partnership NHS Foundation Trust. Outside of hospital care, the organisation commissions services from 36 general medical practices and community care from Community Care Western Cheshire, plus services from dentists, opticians and pharmacies.

Patient safety a priority

Patient safety is an important focus for NHS Western Cheshire. The commissioning arm of the Trust now has responsibility for incident reporting and performance monitoring, previously the responsibility of the Strategic Health Authority. To help meet its statutory obligations, it has recently implemented Datix patient safety software to record and report on all patient incidents across its commissioned services, including its 36 GP practices. In the first year of implementing Datix, there has been a significant increase in the number of incidents that have been captured.

“Now with one system being used to record and investigate incidents, we have a better view of what is happening, which in turn means we can put things right,” said Andy Chambers, Risk Manager at NHS Western Cheshire. “For example, GP practices have recorded 500 incidents this year alone, whereas an average of 180 a year were reported over the previous three years. Now we are able to make significant changes to processes and systems and serious incidents are investigated on an individual basis. In addition, GP practices can see feedback and investigation results improving communication and ultimately patient safety.” The increase in reporting figures is not because more incidents are occurring but more are reported to NHS Western Cheshire.

Recording incidents with Datix

The Datix system was implemented in mid 2008, replacing an old database that had been used to record incidents. With the old system, information on incidents and significant events was collected from across the organisation on paper forms, details of which were then entered onto the database. It was difficult to get reports back out of the database for trend analysis or statutory reporting.

In addition, incidents were often not reported in a timely manner. This was because the statutory obligations of the Quality and Outcomes Framework require that practices only submit twelve significant event analysis forms every three years (four per year).

“Not only were we getting incidents recorded long after the event, they could be reported by phone or email to the medical director and not directly to the risk team.” explained Andy Chambers. “Often this meant it could be a long time before we heard anything about the incidents and it would be too late to recommend or take action.”

Rolling out Datix across the practices

At the time Datix was selected, it was already being used successfully by the Countess of Chester NHS Hospital Trust and the Cheshire and Wirral Partnership Trust so it was a logical step for the risk management team to adopt the same system.

Working with two Practice Managers, the Risk Management team adapted the GP web incident reporting form to have a similar format as the original one used by the practices. Following initial trials, the new form was then rolled out across all of the GP practices, accessed via N3, the secure NHS network.

The governance team at NHS Western Cheshire also has access to the incidents reported by the GP practices, picking up the data for the Quality Outcomes Framework. This has reduced duplication of data and work. Reports can be run easily, as and when incidents happen, rather than leaving things until the February deadline when the reports are required.

Following installation in December 2008, the team transferred incidents from the old system on an individual basis, to ensure that the data was accurate. With Datix, information is more easily shared between the departments and the practices are able to record the action taken and investigations carried out.

Faster, easier reporting

One of the key benefits of the new system is that the Risk Management Team now holds Quality and Risk Meetings at Director level with all of the Trust service providers, where incident reporting and trends are reported on.

“Datix has made it much easier for reporting,” said Mr Chambers. “We have better information on incidents, trends and investigations that we can share widely across our management teams. The multi-disciplinary and partnership approach to investigation means that the managers have a current and overall view of all incidents and clear pathways for investigation. The whole process is much faster and avoids duplication.”

Following the success of incident reporting, the team has implemented the Datix Risk Register module. The Complaints module and PALS module (to manage enquiries and other contacts for the Patient Advice and Liaison Service) are also now used by the Trust.

Improved communication across the organisation

Andy Chambers attributes the success of the Datix system to its ease of use when recording and reporting on incidents, as well as the initial work that was carried out visiting and meeting with people within the GP practices to show them how the system works and gain co-operation and feedback.

Communication throughout the organisation has improved greatly, with users who have logged an incident now able to quickly see what is being done about it. Andy Chambers cites an example: “There has been a complete change in the Orthotics department for surgical appliances (including wigs, false limbs and glasses) in the Countess of Chester NHS Hospital Trust. Following incident reporting and complaints captured and analysed using Datix, their working systems have been changed and services redesigned to really benefit the patients.”

Looking forward - building on success

The team is positive about the Datix application and the service provided by the company. Andy Chambers says the initial training was good and the application itself has been very reliable. He is now investigating the possibility of enabling users working for provider units to access and log incidents on the Datix database used by the commissioning services. This would enable incidents relating to GP practices to be shared by the provider and the commissioning services, reducing the need for email information exchange which can result in delays, duplication and error.

NHS Western Cheshire also plans to roll out Datix to other partner providers including care homes, pharmacies, dentists and optometrists. “There is no doubt that Datix has enabled us to really improve our incident recording and investigations, underlining our commitment to patient safety across the organisation,” concluded Andy Chambers.

The recent shortlisting of NHS Western Cheshire for a Health Service Journal HSJ Patient Safety Award serves as an endorsement of this success.