The Monitoring Risk and Improving System Safety (MoRISS) checklist for priority safety issues.
Practice processes for checking priority safety issues that can impact on the health and wellbeing of patients AND GP team members are highly variable and can be inconsistently applied which often contributes to why significant events happen.
When combined with everyday workloads and stresses our memory spans and attention to detail are affected. This means we can often forget to undertake necessary checks of important safety tasks as planned – this can lead to errors being made, sometimes this has no real consequences but on other occasions it impacts negatively on patients, staff and the practice.
Checklists are used routinely in high risk industries such as aviation, nuclear power and many hospitals to help staff remember critical tasks to be undertaken to ensure mistakes are not made and help make patients and the workplace safer.
The purpose of this checklist is to help ensure that tasks that are considered to be important from a safety perspective are actually checked on a routine basis and action is taken where needed to improve overall compliance. It aims to combine some existing checking processes into a single checking system which is undertaken every four months to ensure that the necessary checks are completed on a timely basis.
The preliminary checklist was developed based on a combination of what we know can go wrong when things that should be checked routinely in practice are not, and the knowledge and expertise of a large group of practice managers, practice nurses and GPs who contributed to its design and content over several workshops and surveys.
It is important to note that it is not mandatory – but is a flexible guide, you will not necessarily agree with all of the content nor may it always be relevant to your practice. Use your own judgement and apply your own common sense. In these cases, simply tick Yes for being fully compliant.
As far as possible the development process was informed by human factors/systems thinking and guidance to make the checklist content relevant and understandable and to cover all aspects of the general practice workplace.
If the checklist is not an improvement on existing checking processes then it is unlikely to be used, although bear in mind that some practices do this inconsistently and infrequently compared with others. The prevailing safety culture within a practice will also influence how seriously the checklist and checking processes are taken i.e. the checklist itself will not make the practice processes safer, like any improvement activity this is always down to the leadership, team-working and commitment of the GP team.
Simply work your way through the checklist (it has been sub-divided to make it easier to follow and complete) and use a combination of checking and your own professional judgement to determine whether you are fully compliant with each of the issues outlined.
What is the General Practice Safety Checklist?
Many significant events in general practice are related to a lack of timely checking processes and inadequately designed practice work systems. The MoRISS Checklist Tool for General Practice is a comprehensive checklist designed by GP teams that allows practices to take a systems based approach to related monitoring, learning and improvement
Why would you choose this?
This method can be used to ensure current systems are up to date and adequate, and to proactively identify systems hazards that, if not addressed, could cause harm to patients, visitors and the GP team
What is it useful for?
• It is useful to proactively identify areas for improvement and to ensure that current practice systems are safe
What is it not useful for?
• It is not useful for retrospectively analysing particular incidents – LEA is a better tool.
• It is a tool that identifies potential system problems, not specific details. An audit/care bundle may be better for analysing QI in criterion-specific areas.
• Due to the large variation between practices it is useful to drive improvement within the individual practice organisation and to measure practice improvement towards the standards. A practice could measure highly but miss critical things in just one area therefore simply comparing overall score between practices is not helpful. Although this is a tool for individual practices to use, within a local context, e.g. a cluster group, it may be helpful to compare practices as local variation could highlight areas for individual practice improvement and identify ways to achieve improvement
Who can do/lead it?
Anyone with adequate understanding of current practice processes and of each individual domain. Different members of the practice team may be more appropriate for different sections. The PM may have a safety leadership role in coordinating implementation of the checklist
How do you do it?
• The practice team should agree together to use the checklist each domain has specific methods to best measure it. These involve documentation review, observations and spot checks.
• After completing the checklist, the findings should be discussed with the practice team and agreement made on how to modify systems to reduce potential for harm.
• The checklist should be applied once every three months to ensure safety issues remain up to date
Who else does it involve?
It involves the whole team being willing to review and implement changes as indicated by regular use of the checklist
Practice checklist Top Tips
• All normal Top Tips for QI apply here
• Different team members will have different expertise in the various domains. Use the most appropriate member.
• To work optimally the checklist should be reviewed three monthly
The checklist is available online and can be accessed here and to understand the different domains it is recommended that time should be taken to read through it. Several practices in Ayrshire agreed to use the checklist in their practice and share results as part of a QI project. An example of how evidence was recorded and of some of the areas highlighted, across the practices, and actions taken, are shown below
|Domain & item
|Medication Safety (Prescription pads) Pads securely stored
|Pads in drawer but not locked.
|Changes to drawer.
|Medication safety (controlled drugs) Securely stored
|Stored in locked cabinet Checked cabinet locked and key in key safe.
|Housekeeping (Infection control) Premises are cleaned in line with practice policy
|Premises cleaned unsure about toys
|We no longer have soft toys, play table is wiped – not sure about books. Will speak to cleaners
|Housekeeping (stocking of clinical rooms) Sharps containers are available, correctly assembled, not over filled, out of reach of children and do not contain inappropriate waste
|All clinical rooms have small bins out of reach on worktops.
|Housekeeping (Infection Control) ALL staff trained in standard infection control precautions
|All clinical staff aware but the non-clinical staff are not
|Medication Safety (Vaccinations) Evidence of expiry date rotation
|Nurses check, however there is no system in place
|Stock requires to be checked and rotated, need system in place – discuss with nurse.
Download the checklist and rationale here: