In Safe Hands - Patient safety and improvement work in primary care

The Danish Safer Primary Care Programme named In Safe Hands is a collaboration between the Danish Ministry of Health, Local Government Denmark (the interest group and member authority of Danish municipalities), and the Danish Society for Patient Safety.

The project has been completed in two rounds so far. The first part during the years between 2013-2016 included five municipalities and the second part during 2016-2019 consisted of an additional 13 municipalities. In Safe Hands 3 with 15 new municipalities was begun in September 2020.

The aim of the programme is to improve patient safety in the primary care in the Danish municipalities and doing so by early discovery and by reducing pressure ulcers, medication errors, falls, infections, malnutrition and unintended weight loss.

Systematical education of key persons in improvement methods (Model for Improvement), great leadership involvement, data development, and feedback are some of the important issues of the programme. The content of the Danish Safer Primary Care Programme correspond with recognized and accepted best practices.

Quality of elderly care improved
The Danish municipalities are running about 90 % of the home care and nursing homes in Denmark. 

The program In Safe Hands has significantly improved the quality of Danish nursing homes and home care by reducing the number of medication errors, pressure ulcers, falls and infections.

In Safe Hands has helped to create a system, an organisation, and a culture for improving quality and patient safety that permeates quality work. At the same time, In Safe Hands has intensified cooperation with citizens and their relatives, increased the professionalism of the staff and created a new form of management in the municipalities.

The goals for the initiatives in the municipalities have been:

• that the right citizen receives the right care and treatment at the right time
• to reduce the number of pressure ulcers by 75%
• to reduce the number of medication errors that require medical contact by 50%
• that the municipality builds a safety culture
• that the municipality builds a lasting platform for improvement work.

Bundles and workstreams 
In Safe Hands does not intend to teach new clinical knowledge, but rather to promote agreed upon knowledge in quality improvement. In doing so the programme uses the care bundle principle and will implement four clinical bundles, also called 'packages'.

The first bundle deals with pressure ulcer and was launched in 2013. In 2014 the 'package' about medication errors and the bundle of falls were introduced. The bundle dealing with infections was introduced in 2015.

Other focus areas are malnutrition and unintended witgh loss, early discovery, leadership and involvement of citizens and their relatives.

Two workstreams (leadership workstream and patient-carers workstream) support the implementation of the four bundles.

Measurements
The Danish Safer Primary Care Programme introduces a systematic and sequenced approach for health professionals to incorporate measurements and data to track whether safe, quality care is provided. Real time data will be used to identify opportunities for improvement and motivate the health professionals to make rapid changes in order to track these improvements.

In Safe Hands has created results that mean improvements for the elderly at healthcare centres, in nursing homes and in home care.

The programme has resulted in:

• More municipalities have many healthcare centres and units with 500 days and 600 days without medication errors.
• More municipalities have many healthcare centres and units with 500 days and 600 days without pressure ulcers.
• In Safe Hands has created a culture where one can to a greater extent create learning from one’s mistakes.
• In Safe Hands has supported the development of data-driven professionalism at all levels of the organisation.
• In Safe Hands has helped to promote that managers put patient safety on the agenda.
• Experience shows that the work with systematic improvements has significantly strengthened the professionalism of the health professionals.

Approximately one third of the municipalties in Denmark has been involved in the programme (33 of 98). The ambition is to spread the experiences and results throughout all of Denmark.