Patient Safety Learning

Kathy's blog on hydrogen peroxide mentioned above is now on the hub: 

Thanks Kathy!

Thanks for highlighting this Jon. We've updated the PSIRF page on the hub to reflect this: 

We received the following post from a member of the hub who wishes to remain anonymous:

Recently, in South West London, mental health patients assessed under section 136* of the Mental Health Act were struggling to find a 'place of safety'. The Metropolitan Police were unable to hand over care as there were no safe havens. So, after four hours of care provided by the Met Officers (who have little training in mental health issues), patients were transferred to the care of the security teams at the acute trust until a safe place was found for them.

There is an urgent need for:

• more training for the Metropolitan Police who are overwhelmed with mental health calls
• assurance that security guards at trusts are skilled and understand the needs of mental health patients.

Have you been affected by similar issues as a patient, clinician, relative or member of staff? Please share your thoughts, concerns or experiences. 

*Section 136 is part of the Mental Health Act 1983. It enables a police officer to bring an individual to hospital if they are concerned that person may have a mental disorder and should be seen by a mental health professional. The police officer may feel that person needs immediate care and that it is in their interest, or for the protection of others, for them to be brought to hospital to be assessed. 

Copy of the patient information leaflet for anyone brought to hospital under section 136.

Thanks for sharing Dani! I've uploaded the leaflet in Learn.

Do continue sharing on the hub the feedback and impact the leaflet has.

Interesting blog posted today in the Learn library about the language we use. Do you stop to think about the language you use when speaking to your patients? Are we all guilty of using jargon rather than taking the time to explain what we mean? Have you tried any exercises as a team to help improve communication, in order to improve patient safety? Please share your tips.

Thanks Jo. Great blog. I've added it to the hub library: 

Thanks Sophie.  @HelenH @Ed Marsden @Keith Bates @MartinL Any thoughts and experience around written consent or lack of it? Are there any guidelines or documents we can put on the hub around this?

@Carol Menashy has just posted an amazing initiative she has developed at her trust.

Great blog in Learn from Martin on who should be in an investigation team - the expertise of the team, their roles and responsibilities. Do you agree? 

@Catherine Evans @DrFSaeed 

Some resources on the hub you may find useful:

• Northamptonshire Healthcare NHS Foundation Trust: Identifying, reporting, investigating and learning from deaths in care
• Lincolnshire Community Heath Services NHS Trust: Learning from deaths: mortality review policy (July 2019)
• Using the structured judgement review method: A guide for reviewers (2016)
• Dorset Healthcare University NHS Foundation Trust: Policy for reporting and investigating deaths (August 2017)
• A report for Norfolk and Suffolk NHS Foundation Trust: Independent review of unexpected deaths, April 2012 – December 2015

Does anyone else have examples we could add to the hub?

@lzipperer You might be interested in the new NHSX report out last week which gives an overview of the current state of play of data-driven technologies within the UK health and care system.

https://www.pslhub.org/learn/organisations-linked-to-patient-safety-uk-and-beyond/government-and-alb-direction-and-guidance/nhs-x/nhs-x-artificial-intelligence-how-to-get-it-right-october-2019-r849/

@Danielle Haupt @Claire Cox @Luke Brown Any thoughts? Any additional tips you can suggest or have tried?

One of the interesting discussions at our Patient Safety Learning Annual Conference was what do future directors of patient safety look like? What are the skills and attributes that they will possess? 

Andy Burrell wrote an excellent blog for the hub following this:

What are you thoughts and suggestions?

Interesting blog posted from @Sarahjane Jones on her research findings on staff safety:  

Do you work in mental health? We'd be interested to hear your own experiences? What challenges do you face?

World Sepsis Day is on Friday. Do let us know your plans. We'd love to share your ideas and resources on the hub. Look out for a video from our topic lead, Ron, which we will be sharing on the day.