Implementation of the NRLS is taking place throughout 2004. For the national implementation targets to be met by December 2004, the programme management arrangement must allow for NRLS to be implemented in approximately 50 trusts/local health boards per month from January 2004 onwards. Rolling out the NRLS dataset and/or eForm will provide a significant opportunity to raise awareness of both the patient safety agenda and the range of tools available from (and being developed by) the NPSA.
Rolling out the NRLS may require NHS organisations to change the way that they record and report patient safety incidents internally. There are many different approaches currently in use to collect data about patient safety incidents. It is estimated that around 90% of NHS organisations are currently using commercial local risk management systems (LRMS), around 6% are using systems which have been developed ‘in-house’ and around 4% of sites have no automated data system in place at the present.
The electronic form devised by the NPSA (eForm) will be used as a data capture mechanism only in NHS organisations that do not have an LRMS application. The eForm would be used in those sites that either do not have a commercial LRMS application or have developed their own local system which cannot transmit the required data to the NRLS.
Figure 1: Levels of severity of harm
Patient safety/incident
No harm Low Moderate Severe Death
Impact not
Core elements of the implementation process
Although there will be variation in how NHS organisations report to the NRLS, the following are three core foundation stones for successful implementation of the NRLS.
1 Awareness and understanding:NHS organisations will need to
know about the NPSA and in particular the NRLS. They need to understand what is being asked of them – in particular, what is
required locally, what the NRLS will be doing nationally, and how these two levels of activity link up.
2 Readiness and planning:NHS organisations will need to assess their
own readiness for implementation of the NRLS; in particular their preferred approach to reporting patient safety incidents to the NPSA. They will then need to develop an implementation plan for establishing their agreed approach to data capture.
3 Installation and connectivity:NHS organisations will need to access
technical support from the NPSA (and the LRMS vendor where appropriate) to ensure successful establishment of data capture facilities. They will also need support for data mapping; whether from their own staff, vendors and/or NPSA support. The key steps involved in implementation are as follows:
• all NHS organisations will need to appoint a local lead contact for NRLS implementation within a specified timeframe (in many cases this contact is likely to be the organisation’s risk manager);
• the local lead contact will need to work with their local NPSA patient safety manager to agree an implementation plan;
• the local lead contact will decide their preferred reporting route to the NPSA. If they intend to report via the eForm they will need to complete an implementation plan with agreed dates for installation. If they intend to report via their LRMS system they will need to liaise with their LRMS vendor about availability of the NPSA-compliant upgrade. If they intend to report via their bespoke risk management system they will need to:
• review their current system against NPSA technical standards;
• decide if they have the expertise to develop a solution which is NPSA- compliant;
• complete an implementation plan with agreed dates for technical work, installation, data mapping and RCA learning set training.
with agreed dates for installation (in conjunction with their LRMS vendor) and data mapping.
Once completed each local organisation will then be able to sign up to the root cause analysis network training for up to eight members of their staff, described in Step Six.
How can the NPSA help?
To help organisations develop their local implementation plans, and support roll out of the NRLS, the NPSA will:
• support NHS organisations to understand the NRLS and decide their
preferred reporting pathway using information leaflets and face to face discussions – patient safety managers will take the lead in much of this work with an implementation team for backup and support;
• develop and agreean overall implementation plan based on the local
implementation plans and vendor agreement/liaison in conjunction with the patient safety managers;
• coordinate and scheduleagreed data mapping, technical installation
and root cause analysis training dates;
• run data mapping workshops (described below) involving primarily
the NPSA staff and the local risk managers mapping their local dataset with the national dataset and then validating agreed data mapping to NPSA standards;
• support technical installation,involving primarily the NPSA IT team;
• approve successful connectivity,involving primarily the NPSA IT team.
Figure Two: Data capture pathways for NRLS staff reporting
eForm via NHSnet eForm via web from within organisation
eForm via web from outside local organisation e.g. from home PCs (via internet)
via existing LRMS systems (commercial and bespoke)
NRLS
Database ReportingTools Reportsand Analysis
Data mapping
The correct mapping of data is essential to ensure NRLS data quality and consistency of reporting and analysis. At its simplest level, data mapping is tracking and recording how the organisation’s dataset can ‘fit’ into the NRLS dataset. The NHS organisation dataset is likely to have far greater depth than the NRLS dataset.
The data mapping exercise will involve a local representative (risk manager or clinical governance lead) and a member of the NPSA information team. The NPSA will support the mapping process and review the results of the mapping exercise once it has been completed. The time that is required for mapping will depend on the size of the NHS organisation (and its corresponding dataset) and the knowledge and experience of the local staff involved.
Support functions
Help desk:it is planned that, wherever possible, the queries of NHS
organisations will be dealt with in the first instance by the relevant patient safety manager. However, it will also be necessary to operate an NRLS implementation help desk to ensure that calls are dealt with appropriately and directed when they come to the NPSA’s central office. The help desk will also maintain a contact database and coordinate the resolution of any queries with IT, communications, patient safety managers and so on.
Regional and Welsh implementation forums:these will coordinate
and manage the overall scheduling and timetable for data mapping workshops, technical installation, site visits and connectivity to the NRLS.
Detailed guidance on how to get connected:guidance on the roll
out of the NRLS will be available from NPSA patient safety managers.
NRLS readiness review checklist:the role of the checklist is two-
fold. It will help NHS organisations to review their incident reporting processes – guiding them through the technical, reporting, change management and workflow issues. The checklist will also help the NPSA to find out more about the NHS organisations (e.g. risk
management processes, software used and key contacts). This will be used by the patient safety manager as a structured tool to work through with NHS organisations.
NRLS implementation planning template:this will provide a
consistent template for NPSA’s overall project and performance management of the NRLS implementation. Sites can also use it to develop their own local plan for NRLS implementation. Key content
will include the method of data capture, dates for NPSA (and LRMS) installation where appropriate, dates for data mapping workshop, dates for RCA training and agreed participants. This local
implementation plan would need to be agreed with the NPSA (and the LRMS vendor where appropriate) and would form the basis of the formal relationship between an NHS organisation and the NPSA.
eForm templates:These are for use by NHS organisations if they
want to adapt their existing paper-based reporting systems to provide all required NRLS data. It is suggested that this is provided by the patient safety manager on request.
Bibliography
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