Table 3 Changes made in the clinics per standard
Name of standard | Changes made (with clinic identifiers in parenthesis) |
|---|---|
1. The professional quality | • Increased and improved use of diagnosis coding in the patient records (6, 7). |
2. Use of good clinical practice | • More systematic call-in of patients with COPD and diabetes for check-ups (2, 7). • Clarification of task division between GPs and nurses in diabetes and COPD procedures (4, 10, 12). • Purchased a new spirometer (2). • Preventive and follow up home visits by a nurse to elderly patients (6). • Increased focus on dementia patients (7, 8). • Clearer task division regarding patients with psychiatric problems and alcohol and drug abuse (12). |
3. Adverse events | • Found out how to report adverse events and have reported some (4). • Adverse events have become a regular topic at monthly meetings (8). |
4. Patient evaluations | • Changed telephone system to one with queue function (1, 10). • Improved entry for wheelchair users (1). • GP closes the office door in the morning when having phone consultations (2). • Water now available in the waiting room (4). |
5. Prevention of confusion of patient’s identity | • Ask more often for the patient’s social security numbers when performing tests (2, 3, 5, 6, 7, 8, 10, 11, 12). • GP places test-samples and social security number together in small boxes and the nurse labels them (before they were placed on the table together, but with the risk of being mixed up) (10). • Always label a test sample container with the patient’s social security number before putting it aside (12). |
6. Prescription of medicine and renewal of prescriptions | • A clearer division of tasks when prescribing medicine (6). • New procedure for renewal of medicine, where patients can only renew some types of medicine prescriptions by having a consultation in the clinic (12). |
7. Paraclinical tests | • Use of reminder functionality in the computer system to ensure monitoring of incoming test results and patients getting the result (3, 4, 6, 8, 12). • Introduced a paper and pencil system to monitor received feedbacks of test results (2). • After a paraclinical examination patients with chronic diseases are now scheduled to a consultation with the GP (2). • Clearer task division in the clinic regarding reception and forwarding of test results (3). • New, clear procedures to ensure that deviant test result are delivered to the patient e.g. by keeping and regularly checking a copy of the test requisition (5, 8, 10, 11). • All test results (deviating as well as normal) are now given to the patients (previously only deviating results) (7, 8). • Introduced a procedure for checking that test samples from the clinic have reached the laboratory (6). • Stopped cultivating urine samples themselves, now sending the samples to the lab instead (12). |
8. Emergency response and cardiac arrest | • Made or updated emergency medicine box (3,4, 5, 6, 7, 12) • Procured information on correct intervals for control and renewal of the defibrillator and made a schedule with fixed timespans for future controls (10). • Purchased a heart defibrillator (12). |
9. The patient health record, data safety and confidentiality | • No papers with social security numbers or patient records are visible lying around (3, 5, 6, 7, 12). • Stopped mentioning social security number on the phone or at the secretary’s desk (2, 6). • No name or social security numbers on things thrown in the garbage (5). • Lock the computer screen when exiting a room (1, 4, 6). • Lock cabinets in the patient waiting area (8). • Signs on the doors marking no entrance allowed (1, 6). • GP closes the office door in the morning when having phone consultations (2). • Placed a discretion line on the floor in front of the secretary’s desk (3). • More frequent use of shredder (5, 12). • Added a code to insert in the patient record indicating informed consent (4). • More meticulous registration of CAVE in the patient record (4, 6). • Copy medicine list from the electronic medicine module to the patient record to comply with record keeping obligation (6). |
10. Accessibility | • Changed telephone system to one with queue function (1, 10). • Engaged an extra part time secretary to ease patients’ phone access (12). • Opened a Facebook site with news and information (12). • Improved entry for wheelchair users (1). |
11. Referral | • Update the electronic medicine module more frequently when referring patients to hospitals (6). |
12. Coordination of patient care | |
13. Acquisition, storage and disposal of clinical utensils and medicine/vaccines | • More systematic control of expiration dates of medicine and vaccines, and of refrigerator temperature (3, 5, 6, 7, 10, 11, 12). • Purchased an electronic thermometer with data-logging for measuring refrigerator temperature giving continuous temperature overview and alarms in case of critical fluctuations (4, 6). • Replaced old refrigerators with a new one (6). • Cleaned up medicine room and medical bag and disposed of the expired medicine (5, 6). • Regular control of medical bag (10). • Store medical bag so it is inaccessible to patients (4). • More correct disposal of utensils and vaccines (6, 12). • Thorough clean-up of equipment (e.g. disposal of syringes past expiration date) (7, 10). |
14. Hygiene | • Toys completely removed from the waiting room or thrown out toys not suitable for the dishwasher, while cleaning remaining toys weekly (1, 12). • Replaced a normal oven with an autoclave for sterilization (3, 5). • More systematic and frequent controls of the autoclave (4, 6). • Added disinfection between washing of instruments and autoclavation (2, 4, 10). • Use bags for storage of instruments after sterilization (4, 8). • Purchased a new dishwasher for cleaning instruments (8). • More spirit dispensers and/or use more spirit (3, 6, 7). • Use a log sheet when performing systematic controls e.g. of tape for sterile utensils (1). • More fixed time intervals for control of equipment (3). • Changed open cabinets for storing utensils with closed ones (3). • Blood pressure monitors lent to patients for measurement at home are now cleaned every time they are returned to the clinic after use (6, 12). • Use more single-use equipment or changed to only single-use equipment (6, 12). • More frequent cleaning of chairs and examination couch (4, 5, 12). • Daily cleaning and control of the toilets (4). • Well defined areas and clearer labeling of clean and unclean surfaces (6, 8) • Purchased clinic clothes with short sleeves (used their own clothes before) (6). • Do not use wristwatches (6). • Have two types of gloves (6). • Acquired special suits to use in case of contagious patients (5, 10). • Set up a room for handling contagious patients and a procedure for scheduling them at the end of the day (12). • Installation of a hand dryer instead of towels at the patients’ toilet (12). • Thorough cleaning of the clinic before the survey (5, 11). |
15. Management and operational activities | • Made an annual planning wheel displaying tasks in the clinic on a monthly basis (6, 8, 12). |
16. Hiring, introduction and competency development | • Made an introduction program for new staff (12). |