Rebecca Morris: Communication is more important than ever in patient safety research

In this blog Rebecca Morris, Research Fellow in the NIHR Greater Manchester Patient Safety Translational Research Centre, explains the relevance of the Patient Safety Guide during the Coronavirus (COVID-19) pandemic.

Work has been underway at the GM PSTRC to develop a Patient Safety Guide and researchers believe that it is more relevant than ever while keeping patients safe during the COVID-19 pandemic. Some small changes have been made to reflect the challenges being faced as a result of the pandemic. Fundamental to the guide is communication which has never been so important. Rebecca Morris, who leads the development of the Guide, explains its relevance at this time.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic has impacted us all in lots of ways and we are all incredibly grateful for the work that is being done by all health and social care workers in public and private settings as well as everyone on the frontline keeping us supplied. Thank you to you all.

The pandemic has also changed research. Many projects in clinical settings and health services research projects have been paused. Universities are in lockdown with staff working from home adapting to not being able conduct meetings in person and using Zoom instead. Yet the research that we at the GM PSTRC do on patient safety is more important than ever, and the project I’ve been leading is particularly relevant.

This is because, for most patients not affected by COVID-19, the priorities of patient safety remain the same and delivering new approaches and interventions that make care and services safer are important. How we access care, what we ask and the role that patients and carers have in terms of patient safety has never been so visible. Importantly, how we can support our health and care services as they change to adapt is key.

My project, the Patient Safety Guide for patients and carers aims to support patients and carers to address key patient safety questions and identify key points where they can make their care safer. The Guide remains the same but the context in which it is being developed and tested has changed with Covid-19. For example, most routine general practice consultations are taking place remotely via telephone or video, rather than face-to-face, often after a remote triage model using online consultations.

While the context has changed, the fundamentals of general practice and good quality of care have not. What remains the same are the fundamentals of communication and trust for involving people in their care and safety when treatment and care options change. What this will entail may evolve. How this develops over time as services and people adapt to the new ways of working, whether temporarily or permanently, must include such fundamentals at the heart of discussions. This includes issues around understanding the impact on equity of experience as not everyone can or do use remote modes of communication. Otherwise this may lead to upset and frustration by patients or carers trying to access care and by healthcare professionals delivering care in this new way, which may have longer term impacts. For example, being told that your ongoing treatment has been stopped indefinitely without any information about how to manage, what to do or who to contact if your condition worsens can leave patients feeling concerned and unclear what they should do. Our Guide aims to help support communication with prompts to support people and prepare them for their remote consultations.

It is as imperative to think about how people can be involved in their patient safety as the traditional forms of care have evolved and there have been delays or postponements in scheduled care. In addition, changes need to be considered in light of how the pandemic might affect people who are already marginalised. For example, a move to remote consultations may exclude or reinforce existing difficulties in accessing care for people who are deaf or have acquired hearing loss, or with dementia.

The services that have developed and adapted because of COVID-19 leave questions outstanding about care and patient safety to be answered. Changes to care have been communicated via letters with limited, or no direct discussion, with doctors or nurses and may leave patients feeling a sense of uncertainty and vulnerability. The context of being a patient or carer have changed overnight yet communication as always has been a key element of care and if people feel isolated or helpless this is more important than ever.

But how we can we support patients and carers with this? The GM PSTRC Patient Safety Guide has been co-developed with patients, carers, GPs, and pharmacists and is being adapted to reflect the new context. For example, the Guide focuses on where patients might go for health care (i.e. pharmacy or GP), how they can prepare for a consultation and the actions that are required as a result of it.

We are working to ensure the Guide evolves to reflect the changes currently taking place in care practices. For example, how people use remote consultations, what support they may need to do this effectively, and how people have adapted from different communities and what we can learn from them to help each other. We believe the Guide has a part to play in improving patient safety.

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