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  1. Today
  2. Patient Safety Learning started following Mental health unit death raises coroner fears
  3. News Article
    A coroner has raised concerns about how a family was allowed to bring a restricted item that contributed to a man's death into a mental health unit. Joshua Sahota, 25, died as a result of asphyxia and psychosis in Bury St Edmunds, Suffolk, on 9 September 2019. Suffolk coroner Nigel Parsley said Mr Sahota's relatives were not told the item they brought in when visiting was on a restricted list. The NHS trust which runs the unit said it had improved its internal processes. Mr Sahota, from Kennett in Cambridgeshire, was taken to the Wedgewood Unit on the West Suffolk Hospital
  4. Content Article
    Joshua Sahota had been admitted to Southgate Ward at Wedgewood House on 9 August 2019 following a stay as an inpatient at Addenbrookes Hospital, where he had been seen by a psychiatrist and deemed to be at a continuing high risk of self-harm. His family were asked to take fresh clothes to the Southgate Ward, which they did so in a plastic carrier bag. It had not been communicated to them that this was a ‘restricted item’ on the ward. Joshua was subsequently transferred to Northgate Ward, also within Wedgewood House, on the 15 August 2019. On the 9 September 2019, Josh was found in his roo
  5. Content Article
    Each report seeks to increase the number of people living with dementia with a diagnosis by: reducing regional variation in diagnosissupporting those from an ethnic minority community to access a diagnosisincreasing diagnosis for people residing in a care home or hospital setting.The reports set out a roadmap in how to achieve this change. But a diagnosis is not done in isolation. It requires all health and social care professionals involved in dementia care to recognise the symptoms of dementia and to initiate the process to diagnosis, which itself facilitates access to vital care and support
  6. Patient Safety Learning started following Tissue Viability Society: Infection and Surgery wounds
  7. Event
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    The aim of this day is to further enhance the understanding of delegates in the causes of surgical wound breakdown, the recognition and management of wound infection and the management of dehisced surgical wounds. Learning Objectives At the end of this study day, delegates will have: An awareness of national guidance and best practice with regard to prevention of surgical wound infection. A good understanding of how to recognise unusual signs of infection in surgical wounds including wound swabbing, how to do it when and why. A basic understanding of NPWT (Negativ
  8. Image Comment
    Calcium Gluconate and Sodium Chloride solutions.jpg
    Left is Calcium Gluconate solution, the right is Sodium Chloride solution. In a reply to the tweet asking why this was a concern the doctor said: "One is a calcium based drug that could be really dangerous if given in too large quantities... The other is a saline solution that we often given as a flush after injecting other medications and things through a cannula."
  9. Patient Safety Learning started following Medication - generic names.png and Calcium Gluconate and Sodium Chloride solutions.jpg
  10. Gallery Image
    Calcium Gluconate and Sodium Chloride solutions.jpg
  11. Image Comment
    Medication - generic names.png
    Why isn't the generic name on medication labelling bigger than the trade and company name to make it easier to read?
  12. Gallery Image
    Medication - generic names.png
  13. Content Article
    Researchers surveyed 3,065 11- to 17-year-olds in England who tested positive for Covid-19 in a PCR test between January and March. They also surveyed a matched control group of 3,739 11- to 17-year-olds who tested negative over the same period. Initial results show that, 15 weeks after their positive test: 14% more young people in the test positive group had three or more symptoms of ill health than the test negative group 7% more young people in the test positive group had five or more symptoms of ill health than the test negative group. Professor Sir Terence Stephen
  14. News Article
    The Care Quality Commission’s (CQC) outgoing chief inspector of hospitals has called on integrated care system leaders to be ‘courageous’ in putting quality first. Speaking at the HSJ’s Patient Safety Congress, Ted Baker implored ICS leaders to not focus solely on financial and operational targets, although he also acknowledged “there is a lot of pressure to meet [those] targets”. In his speech yesterday, he said: “It’s often taken really courageous leaders to put quality first ahead of financial targets and operational targets… You have to be courageous to do that and I think some o
  15. News Article
    The health service ombudsman has warned he will ‘be in no position to investigate’ the behaviour of another watchdog under the government’s health service reforms. Rob Behrens, the Parliamentary and Health Service Ombudsman, said plans to create a “closed safe space” for the information provided by clinicians to the Healthcare Safety Investigation Branch (HSIB) will mean a reduction in his powers and he will not be able to hold HSIB to account. Mr Behrens, speaking at HSJ’s Patient Safety Congress, said that although coroners would be able to access information gathered by HSIB inves
  16. News Article
    A major acute trust in the East Midlands has been forced to restrict how much chemotherapy it is able to offer due to staff shortages. Nottingham University Hospitals Trust confirmed in a statement its chemotherapy service has been affected by long-term staff sickness and staff vacancies. A trust spokeswoman said: “We continue to provide chemotherapy to patients who benefit most from the treatment and the small number of patients affected have been contacted directly by their specialist cancer team and offered support.” She added: “We are recruiting to posts as well as working
  17. News Article
    Scotland's Health Secretary Humza Yousaf says the NHS is facing the "biggest crisis" of its existence. There's a shortage of beds, the demand for ambulances is soaring and waits in accident and emergency departments are getting longer. On top of that, COVID-19 admissions have been rising fast as the number of infections in Scotland spiralled at the end of the summer. BBC News share five charts illustrating the enormous pressures currently being felt by NHS Scotland. Read full story Source: BBC News, 23 September 2021
  18. News Article
    Record numbers of children and young people are seeking access to NHS mental health services, figures show, as the devastating toll of the pandemic is revealed in a new analysis. In just three months, nearly 200,000 young people have been referred to mental health services – almost double pre-pandemic levels, according to the report by the Royal College of Psychiatrists. Experts say the figures show the true scale of the impact of the last 18 months on children and young people across the country. “These alarming figures reflect what I and many other frontline psychiatrists are
  19. News Article
    A woman with stage 4 endometriosis said she was told she needed to "be more positive" before her diagnosis - despite heavy blood loss and pain. Anna Cooper, from Newbridge, Wrexham, started her periods at 11 and by the time she turned 14, her mother was pushing for a referral. Since then she has had 13 surgeries, with a 14th due in the coming months. She said: "It is not taken seriously enough. It seems to be that we are just not being heard at the minute." Watch video Source: BBC News, 9 September 2021
  20. Content Article
    Putting quality and safety above all else is the first NHS Wales core value. This focus has been strengthened more recently through the Health and Social Care (Quality and Engagement) (Wales) Act (2020), the National Clinical Framework for Wales (2021) and the Quality and Safety Framework (2021). Collectively these set out an aspiration for quality-led health and care services, underpinned by prudent healthcare principles, value-based healthcare and the quadruple aim. In response, and in the context of the challenges at this stage of the pandemic and moving into a recovery phase, Improvement C
  21. Yesterday
  22. Content Article
  23. Content Article
    Emergency Department Safer Nursing Care Tool makes an innovative and valuable contribution by providing the following: Establishment set by Annual Attendance as well as Acuity and Dependency Care Hours to Contact metrics on the current and recommended establishments A Deployment arm showing the hourly staffing requirement aligned to the acuity & dependency. In response to the COVID-19 pandemic, the tool has been further developed to consider the implications of COVID-19 on staffing. From major trauma centres to district general hospitals with emergency departments
  24. Content Article
    Click here to view the report Click here to view the action plan
  25. News Article
    Consultants at a major tertiary centre have written to their chief executive, warning services are in ‘an extremely unsafe situation’ and calling for elective work to be diverted elsewhere. Surgeons and anaesthetists at the former Brighton and Sussex University Hospitals Trust — now part of University Hospitals Sussex Foundation Trust — said: “We are devastated to report that the care we aspire to is not being provided at UHS… we are forced to contemplate that it is not safe to be open as a trauma tertiary centre and we feel elective activity must be proactively diverted elsewhere.”
  26. News Article
    It was "regrettable" that the government said there was "no conclusive proof" AIDS could be transmitted by blood products in 1983, a public inquiry has heard. Giving evidence, former secretary of state Lord Fowler said it would have been better to add that it was likely NHS treatment could be contaminated. But he said he didn't think the change would have made a crucial difference. Survivors have accused ministers of playing down the risks at the time. It's thought around 3,000 haemophiliacs died of AIDS and hepatitis C after being treated with a blood-clotting product called Fa
  27. News Article
    A catalogue of failures among prison and health professionals has been highlighted in an investigation report into the death of a teenager’s baby after she gave birth alone in her cell at the largest women’s prison in Europe. The Prisons and Probation Ombudsman published the devastating report into the events in September 2019 at HMP Bronzefield in Ashford, Middlesex on Wednesday. The case was first revealed by the Guardian and the baby’s death triggered 11 separate inquiries. The report details a disturbing series of events that culminated with the young woman, who cannot be named,
  28. News Article
    Leaked results from a national survey of NHS staff has revealed a sharp drop in those who believe their health and wellbeing is being supported by their employer. The People Pulse is a national, monthly survey launched in 2020. It enables provider and commissioner organisations to monitor the NHS workforce’s health and wellbeing. According to a snapshot of the results recorded between May and August seen by HSJ, there was a drop of 9.6 percentage points in “perceptions of wellbeing support”, with “positivity” sitting at 57.3%. Almost a quarter of the survey respondents reported
  29. Tracey02 Tracey02 joined the community
  30. News Article
    Many patients are being prescribed unnecessary and even harmful treatments, a new report warns. The review, in England, suggests one-tenth of items dispensed by primary care are inappropriate or could be changed. Around 15% of people take five or more medicines a day - some are to deal with the side-effects of the others. The government is appointing a prescribing tsar to help with the issue and stop waste. Overprescribing can happen when: a better alternative is available but not given the medicine is appropriate for a condition but not the individual patient
  31. Content Article
    Overprescribing can happen when: a better alternative is available but not given the medicine is appropriate for a condition but not the individual patient a condition changes and the medicine is no longer appropriate the patient no longer needs the medicine but continues to be prescribed it. This independent review was guided by a short life working group (SLWG), which brought together senior stakeholders from across the healthcare system, together with patient and third sector representation. It looked at reducing inappropriate prescribing, with a particular f
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