1. Controlled drugs	Safe and secure keeping is necessary to prevent theft and misuse which could harm patients and members of the public Lack of in-date stock may lead to inability to treat acutely ill patient
2. Emergency drugs and equipment	Lack of necessary emergency drugs or out-of-date emergency drugs can lead to patient safety being compromised, for example, adrenaline for anaphylaxis Similarly, malfunctioning emergency equipment, such as defibrillator with a ‘dead’ battery, may lead to an inability to resuscitate a collapsed patient
3. Prescriptions and pads	Protects these items from potential theft which can lead to unauthorised prescriptions of high-risk drugs being dispensed to vulnerable patients or members of the public who may harm themselves as a result
4. Vaccinations	Poor re-ordering system may affect drug availability while lack of monitoring may lead to expiry of drug dates Safe and secure keeping is necessary to prevent theft and misuse which could harm patients and members of the public Lack of in-date stock may lead to inability to provide timely disease prevention treatments to patients
5. All other drugs on premises	Patients, including children, ingesting non-prescribed medications and suffering related harms Stolen drugs with the potential to cause harm without medical monitoring being used ‘on the street’ Efficacy and safety of medications being given if out-of-date
6. Infection control	Healthcare acquired infection is a major source of patient safety incidents across all health sectors. Staff and patients, including children, obtaining a needle stick injury from overfilled ‘sharps’ bins Patients at risk of infection from spilled hazardous waste on clinical surfaces/equipment Patients at risk of infection from non-immunised staff members
7. Stocking of clinical rooms	Patients and staff at risk of cross-contamination from blood/bodily fluids Risk of cross-infections from, for example, people, equipment, and clinical surface areas Efficient stock management is a good system design issue to minimise time wasted locating these items
8. Confidential waste	Breaches of patient confidentiality can impact on patient safety via patients’ suffering psychological harm from knowing their medical history has been disclosed publicly
9. Clinical equipment maintenance	Malfunctioning equipment (for example, defibrillator or blood pressure monitoring equipment) can impact on the safety of patient care by providing un-calibrated readings which may result in false reassurance of clinical condition and erroneously affect decision making, for example inappropriate treatment with antihypertensive drugs due to poor condition of blood pressure monitor
10. The practice business continuity plan is up-to-date?	Can impact on how safe patient care is delivered in an emergency situation; for example, electrical outage to the practice affecting IT systems and how to manage and deliver care in such a situation
11. The back-up of all significant IT systems can be verified?	Loss of, or limited access to, timely patient, medical, and prescribing data can lead to poorly informed clinical decision making
12. Data protection	Impacts on how evidence-based care is delivered potentially affecting the safety and efficacy of care provision because latest evidence and options are not available May lead to inappropriate access to patient records
13. Record keeping	Poor data coding can lead to inappropriate/poor follow-up care Administration of drugs that cause avoidable side-effects (for example, allergic reactions)
14. Registration checks	All are patient safety-critical checks which protect the local patient population and the practice as an organisation
15. CPR and anaphylaxis training	Although rare the practice teams should be trained to deal with these types of acute medical emergencies
16. Induction processes	Staff or locum staff who are unfamiliar with safety-critical operations in the practice (for example, the test results handling system, where emergency equipment is stored, how to gain access to GP in an emergency) may not follow correct procedures thereby potentially endangering patients
17. All staff have access to ongoing patient safety-related training opportunities (for example, needle stick injury, health and safety/fire safety, coding data)	Errors in coding can lead to poor or wrong medical care being provided as it is also shared with other health care sectors (for example, acute hospitals) Staff are aware of the risks of injury to themselves and patients and how to manage related accidents
18. Information for patients on how to access the practice urgently or in an emergency is widely available in different formats (for example, posters, leaflets, booklet, website)	Patients not fully understanding how to access the practice for urgent or emergency care can further prolong illness, delays in treatment, and lead to unnecessary visits to other health services
19. Standardised patient identification (ID) verification	Numerous significant events in general practice are related to mix-ups over patient identification leading to patient’s being subjected to unnecessary treatments, hospital visits, and investigations, and breaches of confidentiality which can cause avoidable physical and emotional harm
20. Building safety and insurance	All are legally required and are there to protect the health, safety, and wellbeing of staff, patients, and visitors Notification of workplace accidents to the Health & Safety Executive is required by law where an individual is required to take ≥3 days off work as a consequence Although a medical establishment, a first aid arrangement is still a safety requirement similar to any other place of work
21. Environmental awareness	Hazards in the workplace which are not identified and attended to can lead to harm; for example, a patient sustaining a head injury from walking into a low lying light Lack of thermal comfort can act as a distraction and make staff uncomfortable, thereby impacting on physical and mental health and increasing risk of error and poor performance
22. Staff health and wellbeing	Disorganisation of work and lack of clarity of roles and tasks can cause confusion, impact on mental health, and raise the risk of poor performance and error which could compromise patient safety Staff can be subject to abuse, anger, threatening behaviour, and violence and should be trained to manage these situations to protect the safety and wellbeing of themselves and patients Inadequate work station design, poor display screen and equipment training and practice, and lack of knowledge of manual handling guidance can impact on the physical (musculoskeletal injury) and mental health (for example, increased stress levels) and wellbeing of staff (for example, job satisfaction, and motivation), affecting performance levels and increasing the risks of errors being made (for example, attention levels when confirming patient ID on a computerised system or coding safety-critical patient data)