Table 1.
Types of tools found in the review, where possible well-known US examples of the type of tool are given in order to aid understanding
| Type of tool (Explanation of tool) | Used in the US? | Used in the UK? | US Example | Data source | Number of primary care tools of this type identified |
|---|---|---|---|---|---|
| Prescribing Indicator Packs | Yes | Yes | Beers criteria [20] | EHR | 15 main sets, much overlap -3 |
| (criteria for ‘never events’ in prescribing) - other prescribing tools | GRAM reports [21], MAI [22] (Geriatric Risk Assessment MedGuide™ Medications Appropriateness Index) | EHR, staff | |||
| Trigger Tools | |||||
| -General | Yes | Yes | IHI Outpatient Adverse | EHR | 5 |
| -Medications | Yes | No | Event Trigger Tool [23] | 3 | |
| -Surgery | Yes | Yes | Adverse drug events among older adults in primary care [24] Ambulatory surgery [25] | 1 | |
| (Criteria are screened for in a sample of medical records ‘triggering’ more detailed review) | |||||
| Event Reporting Systems (National systems for informing relevant authorities about safety problems with all aspects of healthcare) | Yes | Yes | ASIPS [26] (Applied Strategies for Improving Patient Safety) | EHR, Staff and patients | 6 |
| Medicines/device Reporting Systems | Yes | Yes | MEADERS [27] | EHR, Staff and Patients | 4 |
| (National systems for informing relevant authorities about safety problems specific to the above) | (Medication Error and Adverse Drug Event Reporting System) VAERS [28] (Vaccine Adverse Events Reporting System) | ||||
| Safety Climate/Culture Measures (The practice team rate themselves against safety criteria and discuss the results to make changes) | Yes | Yes | Safety Attitudes Questionnaire [14] | Staff | 10 |
| Significant Event Analysis Tools (The practice team discuss untoward events, using a standardised structure, in order to learn from them) | No | Yes | UK example - NHS Education for Scotland [29] | Staff, EHR and patients | 5 |
| General Primary/Secondary Interface Tools (standardised systems for handling patient care at transition in care level – often electronic discharge summaries) | Yes | Yes | ‘Care Transitions Approach’ [30] | EHR, hospital records | Only 3 within the direct control of family doctors |
| Medication Reconciliation Tools (aligning medication histories after secondary care contact) | Yes | No formal tool used | Partner’s Post Discharge Tool [31] | EHR, hospital records | 3 |
| PROMs for safety (questionnaire determining the patient perspective of safety in their practice) | Yes | Yes | SEAPS [32] (Seniors Empowerment and Advocacy in Patient Safety) | Patients | 8 |
| Other Patient Involvement Measures (variety of tools including literature for patients, computerised systems and medications specific tools) | Yes | Yes | ‘Speak-Up’ from JCAHO [33] | Patients | 4 |
| IT Measures | Yes | Yes | SEMI-P [34] | EHR | 11 |
| (not just CDSS but a variety of measures often tackling systems error, many relate to prescribing safety) | (Safety Enhancement and Monitoring Instrument that is Patient centred) | ||||
| Diagnostic Tools (Mainly CDSS designed to improve diagnosis) | Yes | No | DxPlain [35] | EHR | 3 |
Abbreviations:
CDSS Computer Decision Support Software.
EHR Electronic Health Record.
PROM Patient reported outcome measures.
UK United Kingsdom.
US United States.