Registered nurse delivers leadership support for clinical safety in online consultations

Providing clinical leadership to risk assess feedback and issues in managing clinical conditions with the roll-out of online consultations to practices and guidance on best practice to minimize risk.


The challenge

Prior to COVID-19, a large number of practices had been encouraged to procure digital solutions to offer online triage and consultations as part of the NHSE/I Digital First Primary Care Programme in NHSE/I.  However, many did not have the time or resources to develop the new working practices necessary to deliver a Total Triage primary care service.  With the arrival of COVID-19, the need for online triage and consultations became urgent to avoid people coming into practices. SCW’s Registered Nurse, Maggie Lay, in her capacity as an Accredited Clinical Safety Officer was able to support NHSE/I to rapidly procure and deploy software systems for those areas which did not already have them and to optimize the use of existing software.

The approach

Clinical Risk Management (CRM) in health IT systems is a structured way of describing a clinical risk and its mitigations in terms that others will understand. 

It is mandated by NHSX in order to promote and help embed clinically safer working practice methods and patient safety solutions, enabled by IT, applied consistently across the NHS. It consists of two information standards:

  • Clinical safety in the manufacture of health IT systems: DCB 0129
  • Clinical safety in the use of health IT systems: DCB 0160

As Clinical Safety Officer for the rapid procurement program, Maggie reviewed supplier clinical risk management documentation and led clinical risk management activities associated with deployment and optimization of the products. This involved looking at what could go wrong, how badly it could go wrong, how likely it was to happen, and what could be done to put it right.

The role of a Clinical Safety Officer is to pull together this complex risk analysis into documents senior leaders can understand so that they know what resources must be in place to ensure a safe and effective deployment.

The result

  • Nationally in response to COVID-19, general practice has moved from carrying out around 90% of consultations with patients as face-to-face appointments to managing more than 85% of consultations remotely and 95% of practices now having video consultation capability live with more being added.
  • By working centrally and at pace we have helped minimize risk, maximize benefit and reduce duplication of effort, but have reinforced the importance of local risk ownership and local pathways.
  • By taking a pragmatic and operational-focused approach we have encouraged people to see that Clinical Safety is not just about ticking a box. It is about adding value through a systemized and structured way of describing and measuring risk. This, in turn, quantifies the importance of transformational change and effective communication in delivering successful Health IT projects.
  • The experience, expertise, and understanding of Clinical Risk Management within SCW has produced documentation and processes that will continue to be useful for NHSE/I, for Digital First Primary Care, for commissioners, and, most importantly, for primary care organizations.
  • As more digital is rolled out Clinical Risk Management expertise will enable better conversations between clinicians and commissioners.

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