Repeat prescribing of medications: a system-centred risk management model for primary care organisations

Rationale, aims and objectives: Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods: All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results: Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0). Conclusions: The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally

Complex Care Management Program Overview - Technology

This report provides an overview of technology based complex care management programs, including:Cook County Health and Hospitals System - Computer Assisted Quality of Life and Symptom Assessment of Complex PatientsUniversity of Missouri - TigerPlaceWenatchee Valley Medical Center - Health Buddy -- Patient Telemonitoring Progra

Surfacing ERP exploitation risks through a risk ontology

Purpose – The purpose of this paper is to develop a risk identification checklist for facilitating user companies to surface, organise and manage potential risks associated with the post-adoption of Enterprise Resource Planning (ERP) systems. Design/methodology/approach – A desktop study, based on the process of a critical literature review, was conducted by the researchers. The critical review focused on IS and business research papers, books, case studies and theoretical articles, etc. Findings – By systematically and critically analysing and synthesising the literature reviewed, the researchers identified and proposed a total of 40 ERP post-implementation risks related to diverse operational, analytical, organisation-wide and technical aspects. A risk ontology was subsequently established to highlight these ERP risks, as well as to present their potential causal relationships. Research limitations/implications – For researchers, the established ERP risk ontology represents a starting point for further research, and provides early insights into a research field that will become increasingly important as more and more companies progress from implementation to exploitation of ERPs. Practical implications – For practitioners, the risk ontology is an important tool and checklist to support risk identification, prevention, management and control, as well as to facilitate strategic planning and decision making. Originality/value – There is a scarcity of studies focusing on ERP post-implementation in contrast with an over abundance of studies focusing on system implementation and project management aspects. This paper aims to fill this significant research gap by presenting a risk ontology of ERP post-adoption. It represents a first attempt in producing a comprehensive model in its area. No other such models could be found from the literature reviewed

Integrated risk management planning in Nottinghamshire

Nottingham Trent University's Emergency Planning Research Unit has been carrying out research on the emerging new National Framework for fire and rescue services. This has been happening ever since former Fire Minister Bob Neill announced a strategic review of the previous framework shortly after taking office in June 2010. NTU has been collaborating with NFRS and the fire authority on the implementation of the IRMP as part of its Fire Cover Review (FCR) project. The FCR was carried out between 2010 and 2012 and was based on the authorities first IRMP. Although the process started before the budget restrictions, it inevitably had to confront them after the 2010 Comprehensive Spending Review

STOP-IT: strategic, tactical, operational protection of water infrastructure against cyberphysical threats

Water supply and sanitation infrastructures are essential for our welfare, but vulnerable to several attack types facilitated by the ever-changing landscapes of the digital world. A cyber-attack on critical infrastructures could for example evolve along these threat vectors: chemical/biological contamination, physical or communications disruption between the network and the supervisory SCADA. Although conceptual and technological solutions to security and resilience are available, further work is required to bring them together in a risk management framework, strengthen the capacities of water utilities to systematically protect their systems, determine gaps in security technologies and improve risk management approaches. In particular, robust adaptable/flexible solutions for prevention, detection and mitigation of consequences in case of failure due to physical and cyber threats, their combination and cascading effects (from attacks to other critical infrastructure, i.e. energy) are still missing. There is (i) an urgent need to efficiently tackle cyber-physical security threats, (ii) an existing risk management gap in utilities’ practices and (iii) an un-tapped technology market potential for strategic, tactical and operational protection solutions for water infrastructure: how the H2020 STOP-IT project aims to bridge these gaps is presented in this paper.Postprint (published version