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Patient-Safety-Learning

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Everything posted by Patient-Safety-Learning

  1. Content Article
    This letter from Dr Robert Farley, President of the Institute of Physics and Engineering in Medicine (IPEM) to Karen Reid, the Chief Executive Officer of NHS Education for Scotland (NES) highlights that lack of funding for Clinical Scientist training places is putting patient safety in Scotland at risk. Dr Farley says, "We understand NHS Education for Scotland are proposing funding that equates to less than a single training post in medical physics and clinical engineering in 2023. ‘This is despite the Scottish Government's Chief Healthcare Science Officer’s public acknowledgement of the importance of training. "Scotland currently has a 10 per cent Clinical Scientist vacancy rate across the medical physics specialisms. This equates to seven vacancies in radiotherapy, three in nuclear medicine, four in diagnostic radiology and radiation protection. These posts are critical to supporting diagnostics and cancer treatments."
  2. Content Article
    The Patient Safety Database (PSD), previously called the Anesthesia Safety Network, is committed in the delivery of better perioperative care. Its primary goal is to make visible the lack of reliability of healthcare and the absolute necessity to build a new system for improving patient safety. This year, PSD has also been involved in the development of the SafeTeam Academy, an e-learning training platform associated with the Patient Safety Database, which offers video immersive courses using the power of cinema to train healthcare professionals. This is the latest newsletter from PSD, featuring a wide range of content by safety experts across Europe.
  3. Content Article
    Core20PLUS5 is NHS England's approach to reducing health inequalities at both national and system level. The approach defines a target population cohort and identifies five focus clinical areas that require accelerated improvement. This infographic outlines the specific Core20PLUS5 approach to reducing health inequalities for children and young people.
  4. Content Article
    In this blog, Judy Walker, Senior Business Consultant at iTS Leadership, describes an After Action Review (AAR) that took place at a large London hospital following the first wave of Covid-19. As part of the AAR, Emergency Department porter Aaron described his experience of the first Covid 19 surge—wheeling large numbers of patients who had died through an empty hospital. Judy describes the value of staff listening to different perspectives as a way to reflect on their own experiences and understand the impact events have on different individuals. She highlights the importance of listening to the process of learning for individuals and teams.
  5. Content Article
    This article in Computer Weekly outlines the tribunal proceedings and judgement in high-profile case brought by whistleblower Chris Day. Dr Day claimed that Lewisham and Greenwich NHS Foundation Trust had concealed evidence when a director deleted up to 90,000 emails before he was due to testify at an earlier tribunal, concerning allegedly false and detrimental public statements about Dr Day made by the Trust. Dr Day’s lengthy legal battle first began when he was a junior doctor working at Queen Elizabeth Hospital Woolwich’s intensive care unit in 2013, where he spoke up about under-staffing at the ICU.
  6. Content Article
    The Industrial Injuries Advisory Council (IIAC) is an independent scientific advisory body that looks at industrial injuries benefit and how it is administered. Since the start of the Covid-19 pandemic in 2020, the IIAC has been reviewing and assessing the increasing scientific evidence on the occupational risks of Covid-19. This report builds on an IIAC interim Position Paper published in February 2021 and considers more recent data on the occupational impacts of Covid-19, particularly around the longer term health problems and disability caused by the virus. IIAC found the most convincing and consistent evidence was for health and social care workers in certain occupational settings, who present with five serious pathological complications following Covid-19 that have been shown to cause persistent impairment and loss of function in some workers.
  7. Content Article
    This report by NHS Wales summarises the ways in which the cost of living crisis can impact on health and well-being. It takes a public health lens to identify actions for policy makers and decision-makers to protect and promote the health and well-being of people in Wales in their response to the cost of living crisis, outlining what a public health approach to the crisis could look like in the short and longer-term.
  8. Content Article
    Patient safety remains a global challenge for society today; in high income countries, it is estimated that one patient in ten is subject to adverse events while receiving hospital care. This article by Laís Junqueira, Quality, Patient Safety and Innovation Manager at Elsevier, in The Journal of mHealth looks at how enabling safer healthcare decision-making could reduce the burden of avoidable harm. Junqueira highlights the need to recognise that non-analytic and implicit decisions occur in healthcare systems, and that these have an impact on patient safety. He argues that as healthcare systems evolve, there must be an increased focus on the importance of an environment that fosters safe decision-making.
  9. Content Article
    In this press release, The Health Foundation responds to the Autumn Statement delivered by the Chancellor of the Exchequer Jeremy Hunt on 17 November 2022. They highlight that although the planned additional funding for the NHS and social care is welcome, abandoning planned changes to introducing a cap in social care costs will leave older and disabled people without the care they need, with many facing catastrophic costs. They also highlight that although the Chancellor committed to publishing long-term workforce projections, he did not offer additional funding or any plan to actually expand the workforce.
  10. Content Article
    The Health Survey (Northern Ireland) has run annually, on a continuous basis, since 2010/11. The 2021/22 survey included questions relating to general health, mental health and wellbeing, smoking and drinking alcohol. The sample size for the survey was 3,154 individuals aged 16 and over. This article presents the key findings of the Health Survey (Northern Ireland): First Results 2021/22 report. One important finding was that of respondents who had been in contact with the health and social care system in the last year, 73% were either very satisfied or satisfied with their experience (down from 85% in 2020/21), while almost a fifth (18%) were either dissatisfied or very dissatisfied (double that in 2020/21 – 9%).
  11. Content Article
    The National Institute for Health and Care Excellence (NICE) is looking for feedback on how people currently keep up to date with NICE guidance and what they do when an update has been made to NICE guidance. NICE will use your feedback to help shape the future of its guidelines. The survey takes around 10 minutes to complete. The closing date of the survey is 28th November 2022.
  12. Event
    until
    This free event celebrates the global health data revolution, and aims to help build the knowledge, collaborations and public trust needed to enable data-driven discoveries which improve peoples’ lives. The last few years have demonstrated the enormous power of data to advance medical knowledge and deliver radical improvements to people’s lives. Treatments, vaccines and life-saving policies have all been delivered in record time thanks to large-scale data, advanced analytics and innovative developments in data governance. But these benefits must not be limited to Covid-19. They must extend to people living with other conditions such as mental illness, cancer, heart disease and diabetes. And they must be inclusive of and accessible to the entire global population. Health Data Research UK’s annual scientific conference will be a free one-day, hybrid event hosted in Birmingham, UK, to celebrate this progress and allow us to come together and build momentum in the health data research revolution. Register for an in-person or virtual ticket
  13. Content Article
    The National Audit of Inpatient Falls (NAIF) has published its latest report into the care given to patients who fell while they were in hospital and sustained a hip fracture. Based on data from 1,394 patients in 2021, the report presents information on post-fall management and tracks performance against National Institute for Health and Care Excellence (NICE) Quality Standard 86, which includes checking the patient for injury before moving, using safe lifting equipment and prompt medical assessment after the fall.
  14. Content Article
    Antimicrobial resistance (AMR) is a major challenge to the UK’s health security, and is already responsible for a significant burden of death, disability and prolonged illness globally. The growing resistance of bacteria, viruses and fungi to the drugs commonly used to treat them threatens modern medicine, and our ability to carry out standard medical procedures. This report draws on the expert input of a roundtable held by public service think tank Reform in October 2022, to assess progress made against proposals published by Reform in 2020.
  15. Content Article
    This 15-minute training video by the Parkinson's Excellence Network pulls together the key symptoms and issues that can impact on a person with Parkinson's and their care when admitted to a hospital ward. it aims to help ward staff understand the key issues when caring for people with Parkinson's.
  16. Content Article
    In 2021, cybersecurity attacks on healthcare providers in the US reached an all-time high, with one study indicating that more than 45 million people were affected by these attacks in 2021 – a 32% increase on 2020. This report published by the Office of Senator Mark R Warner outlines the risk to patient safety posed by cyberattacks and proposes ways to improve federal leadership, enhance healthcare providers' preparedness for cyber emergencies and establish minimum cyber hygiene practices for healthcare organisations.
  17. Content Article
    This opinion piece in the BMJ by Partha Kar, Director of Equality for Medical Workforce in the NHS, explores racial inequalities in the NHS workforce. Partha is currently leading work on the Medical Workforce Race Equality Standard (MWRES), which aims to challenge trusts and systems openly and transparently about race-based inequalities faced by NHS doctors.
  18. Content Article
    This article in the HSJ explores the challenges in implementing the Patient Safety Incident Response Framework (PSIRF) and looks at how it will help achieve effective learning and improvement. Liz Hackett, health advisory partner at Hempsons law firm, addresses the following questions: Who does PSIRF apply to? How does PSIRF help achieve effective learning and improvement? What is required? Involving patient safety and addressing inequalities The challenge
  19. Content Article
    The Sentinel Stroke National Audit Programme (SSNAP), which assesses the care provided for patients during and after they receive inpatient care following a stroke, has published its ninth annual report. Based on data from April 2021 to March 2022, the report aims to identify which aspects of stroke care need to be improved with a particular focus on changes in stroke care over the last two years and the ‘roads’ that need to be followed in order to restore the quality of care. SSNAP measures the process of care against evidence-based quality standards referring to the interventions that any patient may be expected to receive. These standards are laid out in the latest clinical guidelines and include: whether patients receive clot busting drugs (thrombolysis). interventions for clot retrieval (thrombectomy). how quickly they receive a brain scan. how much therapy is delivered in hospital and at home.
  20. Content Article
    The National Vascular Registry, which measures the quality and outcomes of care for adult patients who undergo major vascular procedures in the NHS, has published its latest annual report. This report provides comparative information on five major emergency and elective vascular interventions between 2019 and 2021: Repair of aortic aneurysms, including elective infra-renal, ruptured infra-renal, and more complex aneurysms Lower limb bypass Lower limb angioplasty/stenting Major lower limb amputation Carotid endarterectomy The report also includes the results from an organisational audit of NHS vascular services in 2022.
  21. Content Article
    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Tracey talks to us about the role of NHS Supply Chain in ensuring the products procured through the NHS Supply are of high quality and are safe for healthcare organisations to use. She also highlights the vital importance of complaints and the need for staff who don’t work in direct care delivery to recognise their role in patient safety.
  22. Content Article
    This interactive tool developed by the Office for National Statistics (ONS) can be used to explore how health changed in each local authority area across England between 2015 and 2020, according to the Health Index.
  23. Content Article
    Established in 2006, the National Neonatal Audit Programme (NNAP) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and delivered by the Royal College of Paediatrics and Child Health (RCPCH). It assesses whether babies admitted to neonatal units receive consistent high-quality care in relation to the NNAP audit measures that are aligned to a set of professionally agreed guidelines and standards. The NNAP also identifies variation in the provision of neonatal care at local unit, regional network and national levels and supports stakeholders to use audit data to stimulate improvement in care delivery and outcomes. This report summarises the key messages and national recommendations developed by the NNAP Project Board and Methodology and Dataset Group, based on NNAP data relating to babies discharged from neonatal care in England and Wales between January and December 2021.
  24. Content Article
    Teamwork is critical in delivering quality medical care, and failures in team communication and coordination are substantial contributors to medical errors. This study in JAMA Internal Medicine aimed to determine the effectiveness of increased familiarity between medical resident doctors and nurses on team performance, psychological safety and communication. The authors found that increased familiarity between nurses and residents promoted rapid improvement of nursing perception of team relationships and, over time, led to higher team performance on complex cognitive tasks in medical simulations. They argue that medical systems should consider increasing team familiarity as a way to improve doctor-nursing teamwork and patient care.
  25. Content Article Comment
    Thanks for your comment Laura, some of the references should be helpful in understanding the link. You might also like to read this article by Emer Joyce which explores the issue further. I've been in touch with the author of the blog, and this is what they said in response to your question: "Is there a cure for myocarditis linked to Covid? I think the key things to do are to avoid exercise in the middle of an acute viral infection. If myocarditis is present, there is a small risk of sudden cardiac death. The other thing is to make sure chest pain and fast heart rate are investigated. Avoiding significant exertion for 3-6 months can allow the heart to heal. Treatment would be according to what a cardiologist advises. We do not know what the long term outcomes are yet."
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