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Patient Safety Learning

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Everything posted by Patient Safety Learning

  1. Content Article
    Top tips for men on keeping healthy and advice on prostate and testicular cancer.
  2. Content Article
    Prostate cancer is the most common cancer in men, but most men with early prostate cancer don’t have symptoms. So what should you do? Click the link below and and answer three quick questions to find out.
  3. News Article
    Not a single resident has contracted the coronavirus at Goodwin House’s small residential facility in Northern Virginia, USA, where about 80 seniors live in homey apartments and keep their own sleeping and meal schedules. There’s been just one case at the Woodlands at John Knox Village in Broward County, Fla., where all 140 residents live in private rooms and are cared for by nurses who earn enough not to take a second job. These facilities, part of a national movement in the US to create less-institutionalised long-term care, stand out in a pandemic that has killed more than 61,000 nursing home residents in the US since March. At “Green House” homes, the best-known nontraditional model, residents are one-fifth as likely to get the coronavirus as those who live in typical nursing homes — and one-twentieth as likely to die of the disease it causes. The model has been praised by academics and doctors and seems far better suited than traditional facilities to stave off the spread of infection and the isolation that has devastated the elderly in recent months. But it remains on the fringes of a $137 billion industry. Read full story Source: The Washington Post, 3 November 2020
  4. Event
  5. Content Article
    Dave Noakes talks about his cancer journey, the feelings he went through and the impact it has had on his life in this blog for Movember.
  6. Content Article
    In a recent survey from the Samaritans, men gave the reasons why they were struggling to cope: 42% of men said that pandemic restrictions have had a negative impact on their mental health. 40% of men said that talking to others helped with concerns and worries they had during the pandemic. We understand the power of human connection and how talking can help when you’re finding life tough. The Samaritans have collated real stories from men who have been through tough times, encouraging other men to seek help.
  7. Content Article
    At greater than 95%, the odds of survival for men with testicular cancer are better than good – but for some men, long-term treatment-related side effects, mean quality of life is severely compromised. This web pages focuses on getting these predominantly young men back to living full and healthy lives.
  8. Content Article
    The aim of this study from Choi et al. was to investigate the scope and severity of the second victim problem among nurses in South Korea by examining the experiences and effects of patient safety incidents (PSIs) on them. The study found a considerable number of nurses experienced psychological difficulties due to PSIs at levels that could interfere with their work. The effect of PSIs on nurses with direct experience of PSIs was greater compared with those with indirect experience. There need to be psychological support programmes for nurses to alleviate the negative effects of PSIs.
  9. Content Article
    Last week a letter signed by 435 GP practice staff on access to GP practices was published in The Times. The letter was drafted by a group of grass root GPs, in response to the recent misleading allegations that GPs have been “closed” during the pandemic. These headlines damage the reputation and morale of the workforce. Responsible media reporting is a patient safety issue, as those patients who believe this false rhetoric may not seek help for worrying symptoms. We have already seen reduced rates of cancer diagnosis during the pandemic by around 40%, along with reduced presentations of other major non-covid illnesses. Irresponsible media may also cause inappropriate use of emergency departments and the NHS 111 helpline, which adds further pressure on our secondary care colleagues at a critical time for the NHS. GPs Simon Hodes and Neena Jha discuss this further in this BMJ Opinion article.
  10. Content Article
    The onset of COVID-19 caused some patients throughout the United States to delay their surgeries as many hospital systems postponed nonemergent procedures. This led to a potentially large backlog of case volume. In a recent McKinsey survey of health system leaders, hospital executives said they may struggle to address this backlog given workforce availability, enhanced sanitation protocols, and reserved inpatient capacity. Without healthcare systems recalibrating demand and capacity, patients could face long backlogs for procedures, and potentially experience higher morbidity and mortality rates. Solutions may include 1) reducing the unnecessary deferral of care, 2) effectively addressing new throughput challenges, 3) using advanced analytics to better forecast demand and manage capacity in real time, and 4) reimagining operating room operations to increase long-term capacity. Berlin et al. explore these solutions further in this article.
  11. Content Article
    The 2008 Second Global Patient Safety Challenge sponsored by the World Health Organization articulated 10 “essential objectives for safe surgery”. One of these is to “establish routine surveillance of surgical capacity, volume, and results” at the hospital level. There can be little doubt that this recommendation was made in the expectation that longitudinal surveillance and analysis of surgical results could lead to quality improvements in care and improved patient outcomes. In this linked study, Duclos and colleagues investigated a surveillance system the central feature of which was the use of Shewhart control charts. Originally developed to monitor industrial processes, control charts track variability in key process indicators over time and provide visual feedback on both positive and negative trends. This allows evaluation of the impact of process changes or, in the case of a negative trend, it triggers investigation into the causes and the formulation of appropriate responses. They found that the implementation of control charts with feedback on indicators to surgical teams was associated with concomitant reductions in major adverse events in patients. Understanding variations in surgical outcomes and how to provide safe surgery is imperative for improvements.
  12. Content Article
    NHS Pharmacy aseptic services in England provide sterile controlled environments for the preparation of injectable medicines into Ready to Administer (RtA) formats for patients. Although not highly visible to patients, £3.84 billion is spent on injectable medicines across the NHS in England each year. Services are subject to high levels of regulatory control and quality assurance. Products include chemotherapy, injectable nutrition and clinical trials for new medicines. This has the potential to release nursing time for care, improve patient safety and support more patient care closer to home. Pharmacy aseptic services are an essential cornerstone of many critical NHS services. They make the chemotherapy that treats cancer patients, the intravenous feed that keeps very sick children and those with intestinal failure alive and the innovative medicines that target complex diseases. The report was commissioned by the Minister of State for Health to provide advice to the government and NHS England and Improvement (NHSE-I), to regional, system, and trust pharmacy leads, as well as independent sector aseptic pharmacy providers.
  13. Content Article
    The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. The aim of this study from Tanner et al. was to audit SSI definitions and data collection methods used by hospital trusts in England.
  14. Content Article
    This study from Harris et al. estimated the effect of prompt admission to critical care on mortality for deteriorating ward patients. They found that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.
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    IV KCl.jpg
    Two different renal dialysates - what's the chances of this going wrong?
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    Indistinct chlorhexidine
    There have been many incidences where chlorhexidine was mistaken for saline or other colourless solutions. It's recommended all skin antiseptic solutions to be coloured in a way that distinguishes them. Sadly this recommendation isn't always followed.
  17. Content Article
    The NHS is full of dedicated staff who, at a one-to-one level with patients, offer deeply personal and compassionate care. But too often the system as a whole seems institutionally deaf to the patient voice. This report from the Patient Experience Library explores the reasons for that. It shows how the NHS – at an institutional and cultural level – fails to take patient experience evidence seriously enough. It calls for a few simple and entirely feasible steps that would strengthen evidence-based practice and ensure that the patient voice is better heard.
  18. Content Article
    In this short analysis from the Health Foundation, data from the GP patient survey, an annual independent survey run by Ipsos MORI on behalf of NHS England, was used to explore who gets good access to general practice, unpicking how patient satisfaction with the service they receive varies by deprivation, age and ethnicity. Note: The 2020 GP patient survey data were mostly collected before the COVID-19 pandemic, therefore this analysis doesn’t reflect patient experiences or service changes during the pandemic.
  19. Event
    The best way to solve problems is to identify their root causes. With RCA, you’re equipped to build a learning culture, help identify frequent modes of failure and take action to develop new policies or training to prevent incidents from happening in the future. Incorporate and blend taxonomies to support your organisation’s key initiatives. Increase efficiency by initiating a root cause analysis from multiple existing files in RL6. Leverage dashboards and reports to learn and drive safety improvements. Utilize the Joint Commission and RCA2 framework to uncover the root cause(s) and opportunities for risk reduction. Register
  20. Event
    Streamline your policy management workflow in the cloud with PolicyStat. From single hospitals to multi-facility organisations, all your policies and procedures are in one easily accessible library and always kept current. Efficiently organise and govern policies, procedures and related documentation . Stay compliant and audit ready to avoid penalties and drive better outcomes. Optimise policy workflows and change management to improve performance. Align culture, process and people for better document control and regulatory compliance. Register
  21. Event
    Optimise your time with a centralised, secured data system that helps you remain compliant with organisational standards and supports your safety and quality initiatives Implement tailored access to provide enhanced security and make reviews easier for committees, reviewers and subjects. Maintain reviewers’ complete confidentiality from staff members and other reviewers. Seamlessly integrate Peer Review with other RL6 Modules including Risk, Feedback, Claims and Root Cause Analysis to optimise communication and monitor adherence to policies Quickly and easily review provider performance and care quality from custom reporting and dashboards . Register
  22. Event
    Facilitate effective communication and manage quality efforts across your organisation with a platform that promotes staff engagement and encourages proactive risk mitigation. Learn how Safety Huddles can help your organisation prevent potential harm from happening in the first place. Empower staff to share ideas for improvement and speak up about patient safety concerns. Configure your huddle format to collect the information that matters most. Capture customised quick notes, reference pertinent files or patients and create targeted tasks. Measure huddle performance and effectiveness with robust dashboards and reports. Register
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    When things go wrong - doctors in the dock series provides a unique opportunity to hear real patients discuss their experience of medical errors. Well-known witnesses of clinical errors will talk about their first-hand experiences, what happened, how they and their family had to deal with them, and how they have dealt with the aftermath in the most constructive way possible. Gain more experience and insight about the best way to deal with clinical errors as professionals, and from a patient perspective, and convert them into an opportunity for improvement for all involved, even leading to very successful careers. Register
  24. Event
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    Join this interactive webinar for an overview of the benefits of exercise and physical activity on wellbeing for healthcare professionals. Anja Hudson, specialist physiotherapist and Dr Elizabeth Haxby, immediate Past President of the RSM Patient Safety Section, will explore the benefits of exercise on our physical and mental health. Outlining the risks associated with working from home and how this may affect wellbeing, this session will arm you with the resources, confidence and motivation needed to pursue exercise in the coronavirus era. We will also offer you tools to facilitate exercise during lockdown along with some general physiotherapy and musculoskeletal advice to maximise your exercise goals. Register
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    Explore the key role of sleep in physical and mental health and wellbeing in the third episode of the Royal Society of Medicine's Patient Safety Section's Optimising Strength and Resilience webinar series. Dr Allie Hare, consultant physician in respiratory and sleep medicine, and Dr Elizabeth Haxby, immediate Past President of the RSM Patient Safety Section, will help you to understand what happens when you sleep and how to improve your sleep. Arguably the most undervalued component of health in today’s society, sleep is the foundation of energy recovery, growth and repair. Even small amounts of sleep deprivation can affect us. Fast-paced modern life and busy wards and clinics can leave little time to rest and relax, which can be detrimental to health and impact our ability to unwind and sleep well. This webinar will offer evidence-based tips and techniques to help you improve the quality and quantity of your sleep to enhance your health, wellbeing and productivity. Register
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