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Claire Cox

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About Claire Cox

  • Rank
    Senior

Profile Information

  • First name
    claire
  • Last name
    cox
  • Country
    United Kingdom

About me

  • About me
    I am the Associate Director for Patient Safety Learning alongside being a critical care outreach nurse.
    If you would to contribute to the hub, but would like some advise or support with the content please contact me.
  • Organisation
    patient safety learning
  • Role
    Associate Director for Patient Safety

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  1. Content Article
    This resource includes: What is medicines management? The right medicine for the right patient and the right time Becoming an independent prescriber Competencies and maintaining competence Specialist prescribing Delegation Unregistered staff and social care Administration Prescribing and administration Transcribing Nursing associates and medicines management Summary of available guidance
  2. Content Article
    Background: Acute kidney injury (AKI) in critically ill patients is multifactorial. There is little reliable UK data on the incidence and outcomes of patients with COVID-19 and AKI outside the ICU. At this stage we do not have a full understanding of the aetiology of AKI in COVID-19 and the pathogenic role of systemic inflammation, hypovolaemia or other COVID-19 related pathology (such as thrombotic microangiopathy) in its genesis. Volume status is critical in reducing the incidence of AKI but the balance between respiratory and kidney function can be challenging. Preventing avoidable AKI should be a key goal of the management of hospitalised patients, to reduce demand for renal replacement therapy (RRT). AKI should be promptly recognised and managed appropriately, within the limits of our current understanding. AKI confers an adverse risk of mortality and its presence reflects underlying morbidity and current illness severity. The presence of AKI should inform assessments of prognosis and in some cases the appropriateness of escalation of care. It is critical that we build on existing processes and knowledge and carry on doing the things we currently do well.
  3. Content Article
    Key points: Student paramedic practice, especially in the placement environment, mirrors human factors seen post registration, but also has its own unique set which require further research. The relationship between student and mentoring paramedics is a unique and important human factor in student development. Many clinicians may not feel prepared or willing to undertake a mentorship role. More training and support for mentoring paramedics would be of benefit. Emotional stresses faced by students when they initially encounter emotive aspects of the placement environment should be recoginised. Institutions and placement providers should encourage students to identify and practise coping mechanisms as well as offer support. Placement environments vary nationally and globally, and due to the nature of the job, it is difficult to nurture confident students and clinicians. However, adaptions could be made to reduce stresses on both parties.
  4. Community Post
    Oh Alice, I bet you feel scared stiff. I know there are many women on this forum who may be able to offer some words of advice/comfort to you. @Katharine Tylko I am glad you have found our site as this will put you in touch with women around the UK who understand your anxieties and are battling for a safer hysteroscopy.
  5. Content Article Comment
    Thanks Jonathan! The narrative of a datix is so important. I am new to the patient safety manager role, so I have limited experience in dealing with the 'back end' of datix. From the small amount that I have seen - you get many (tonnes actually) that are no harm, and you can tell that 'I am going to datix you' type reports. Datix may not be the best place to report these type of incidents - but where else can you log them? When reading the narrative you can get a sense of what is going on and the theme of it - communication, frustration with current systems/processes. These reports should not be ignored as, if looked at and themed with others, tell a powerful story about what is happening in that area. It may highlight risk hot spots or a poor culture of speaking up in certain areas, it may be an indicator of a deeper problem at play. Reporting systems are process driven. What you do with that information is not always process driven. The serious incidents are a process - but the no harm incidents often don't follow a process, so are often left aside. These small, seemingly insignificant events with a narrative are important. I am not sure what other patient safety managers do , but I am collecting the themes of all no harm events that happen in my directorates and will be looking at them on a monthly basis to spot trends and hotspots. We have a process to capture incidents. This is not the problem. The problem is with what we are doing with the information captured. How we interpret the data, who we involve, how we feed back and how we share actions and how we change practice - this is the hard work. It is easy to complain about Datix or any other incident reporting system and its functionality - its not so easy to act on the information it is giving us. As I mention, I am new to this area - 1 month in. Naive? Possibly, wanting the best for patients and staff? Definitely
  6. Community Post
    Hi , I am new to patient safety management, after 25 years working clinically it has been a learning curve. I have seen RCA reports, some poor reports that need to be re written and many good ones too. This takes up a huge amount of time by many different people of differing roles. Co-ordinating meeting, feedback and discussion can take time and hold up actions for dissemination. There is much effort put into severe and moderate harm, internal RCAs where it is not a serious incident but it doesn't warrant a serious incident investigation. However, the very low/no harm incidents don't get much of a look in (there are tonnes of them!) If you take a look at the 'accident triangle ' (which I am sure you will be aware of ) - near misses and no harm happen the most frequent and may often lead to the more serious incidents if left. I would suggest much more emphasis, effort needs to be directed into the no harm/near miss incidents. They may seem petty and not sexy, like an SI - but they are great indicators of when the next SI may appear. An over sight of all no/low harm incidents with thematic problems highlighted and then fed into either a local (ward, department) or Trust wide QI project would be a fantastic way of changing practice from the 'ground up'. Capability of ALL staff trained in QI is happening in Trusts but not all Trusts. It would be a fabulous question for the CQC lines of enquiry 'how many staff are trained in QI?' This can be linked to well led and safety, but thats a whole other subject! As I mentioned, I am new to this role, but these are my observations so far. Claire
  7. Content Article

    Faded rainbows

    Claire Cox
    When driving to work at the beginning of the pandemic, I felt a sense of worry and apprehension of what I would be faced with. As a critical care outreach nurse I never know what I may be faced with, but this has never bothered me. However, during the pandemic it did bother me. I worried how I could do my job; would I get sick and how would I navigate my way through the new ways of working? Seeing the brightly coloured rainbows in people’s windows gave me some hope. I knew that the public were thinking of us; they knew the risks we were putting ourselves at and our families. For a time, I felt special. It sounds pathetic, I know. For a time, I felt valued. Valued by the public, valued by the trust I work for and valued by politicians. As NHS staff we had priority shopping, we had discounts from big stores, we had free parking, we had donations of food every day while we were at work, we were donated hand creams and toiletries. School children drew us pictures to put on the walls of our staff room saying ”thank you”. What made me feel valued more than anything was staff wellbeing being at the forefront. Extra staff were redeployed to work on the ITU, we were made sure we had all our breaks and we were made to feel that each and every one of us counted. Relatives of patients wrote and expressed their gratitude, even if they were unable to visit their dying family – they were truly grateful to us. The ITU where I work received so many beautifully written letters and cards. We pinned every one onto the wall so we were reminded that we were shining bright despite the darkness. Then there was the Thursday clap. Personally, I thought this was an odd thing to do, but it seemed to bring people together and have a shared purpose – even if it was for a fleeting 5 minutes a week. When I think back at those months, it seems like a lifetime ago. Eve Mitchell’s recent blog on the hub highlighted that care homes are receiving complaint letters and some are even receiving threats of litigation. “Not enough PPE”, “lack of care given to my family member”, “my family member was neglected during the pandemic” – frustration and anger are palpable. Frustration and anger because families were unable to visit their relatives in their last days, frustration and anger that these precious moments have been denied from them. If it were my mum or dad would I feel the same? Of course I would. I would be the loudest voice there. Is it the fault of the care home? Should they be vilified for the protection of their residents? And now it’s the turn of the hospitals. We now have over a million people waiting on lists for operations, procedures, appointments. Some have already waited months before the pandemic started. Some have already died as a result of not having surgery at the right time. Patients have received surgery and treatment late and this has led to complications and a longer hospital stay – which then increases their mortality. At some point the gratitude from the public will turn to anger and frustration, as it has with the care homes. Would I be angry if my mum was waiting for an operation and died as a result of a prolonged wait? Yes I would. It is a natural response to blame the very people who should have helped – the NHS staff. I now drive to work and see faded rainbows in windows, I will be paying for parking again in the next few weeks, the donations of food have dried up, staff are back at ‘normal’ levels and I am back to having no breaks some days, not to mention that nurses were not included in the recent pay rise. I feel that we have served our purpose. ‘Thanks very much – now get back to normal, sort the waiting lists out and work harder to make sure it happens’. I don’t envy our senior leaders in acute Trusts. They are stuck in the middle of the Department of Health and Social Care and NHS England who are trying to fathom out a strategy to get the waiting lists down, and support frontline staff who are exhausted and a frustrated public that may erupt at any moment. Frontline workers have been through it the last few months. Navigating our way through complaints and litigation and an angry public who feel that they are not receiving the care that they expect in the coming months fills me with dread. We are not equipped. Faded rainbows – is this a representation of the fading support we are receiving in the NHS?
  8. Content Article
    The first presentation draws on a recent National Institute for Health Research (NIHR) funded mixed-methods evaluation of the translation into practice of several ‘post-Francis’ policies that have aimed to improve openness in the NHS, and identifies key conditions necessary for policies to make sustainable impact on culture and behaviour. The second presentation reflects on material from a forthcoming book which will offer unfiltered accounts from patients, carers and healthcare professionals about their good and bad experiences of how care is organised, from birth up to the end of life. Their testimonies indicate the salience of kindness and attentiveness combined with efficiency and competence. Finally, the context for a culture of openness and for patient-centred services will be presented, alongside the development of a culture change programme which is being used in 70 Trusts in England. Significant and unacceptable variations in the availability of high quality care and in staff wellbeing persist across the NHS and social care, exemplified by very different COVID-19 experiences across the sector. How far does this kind of research on culture and these kinds of programme interventions help us to gain whole system traction in this important area of laying the conditions for reliably compassionate patient care? How can positive cultures and new working practices that have developed during the COVID-19 pandemic be sustained?
  9. Content Article
    This leaflet includes patient information on: why is patient safety important how you can help your medicine recognising acute illness what happens if your Early Warning Score increases? what should relatives or friends do if they are worried that your health is worsening or not improving? blood clots safe surgery infections falls prevention advice preventing pressure ulcers.
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