Review: Medication Safety Thermometer event


We have been doing some work with our partners at Harm Free Care on restructuring and revamping their communications and online presence. We attended their Medication Safety Thermometer event on Thursday 23 January and below is what happened.

The Harm Free Care Medication Safety Thermometer event on Thursday 23 January was a great event for idea sharing about the safety thermometer. Over 90 people attended from more than 20 organisations from across England.  Speakers included Matt Fogarty, Head of Patient Safety Policy and Strategy at NHS England, Dr David Cousins, Senior Head of Patient Safety for Safe Medication Practice and Medical Devices, NHS England and Maxine Power, Director of Innovation and Improvement Science, Salford Royal Foundation Trust and Managing Director of Haelo.

Matt Fogarty opened the event by outlining the reasons why everyone was at the event and discussing the progress of the Medication Safety Thermometer so far. It was then over to the first of the fantastic speakers at the event, Dr David Cousins.

David began by saying that he received over 150,000 incidents related to medication safety last year and expects more than that in 2014.  He went on to say that “11% of incidents reported nationally are related to medicine” and that “omitted and delayed medicines” are the number one incident reported for medicines. David ended his presentation by posing the question, “how can we improve this?”.

Get a feel for how the day went by watching our event snapshot film.

Taking ownership

Kurt Bramfitt, Haelo Project Manager, and Steve Williams, Consultant Pharmacist in Medicine and Medication Safety at UHSM, then discussed how the pilot for the Medication Safety Thermometer was progressing and what they had learnt from the data so far.

Steve discussed moving from “error free care to harm free care” and said that the Medication Safety Thermometer “will help to make a difference”. Kurt talked about the process being a “multidisciplinary approach” with “monthly testing using PDSA cycles”. The presentation ended with the pair urging people to “take ownership” of the safety thermometer and use it for improvement on a “ward and section level”.

To get the attendees on the tables working together there was a quiz on medication safety which “Charlie’s Angels” and “The Team with No Name” were joint winners of with 10/10. It was then time for table discussions with some interesting and lively debates about how medication errors could be reduced, with ideas including “patient smart data cards” and “24/7 clinical verification”.

Last to present was Maxine Power who gave a presentation looking towards the future for the Medication Safety Thermometer. Maxine thanked NHS England for the work that has been done so far and said that the thermometer is a “natural progression” building on the “foundations that have already been laid”.

She then compared medication safety to skiing, describing the subject as the “black run of safety” but added that just because “it is going to be difficult, does not mean that it should not be done”. There was a real energy in the room as Maxine closed the day by saying that those who attended the day should use it as a “call to action” and ensure that “they follow up on pledges”.

The event was organised by Haelo, who manage the NHS Safety Thermometer programme for NHS England and took place at the Reebok Stadium, Bolton.


All of the presentations used on the day are available below:

What do you think?

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