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Claire Cox

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  • 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
    Patient Safety - December 2022 Patient Safety - September 2022 Patient Safety - June 2022 Patient Safety - March 2022 Patient Safety - January 2022 Special Issue: Pharmacy Education and Practice Patient Safety - December 2021 Patient Safety - September 2021 Patient Safety - June 2021 Patient Safety - March 2021 Patient Safety-December 2020 Patient Safety - September 2020 Patient Safety Journal - June 2020 Patient Safety March 2020 Patient Safety - December 2019 Patient Safety - September 2019
  2. Content Article
    Belonging to a group, a tribe, is important to me. Shared challenges, shared purpose, shared experiences and shared knowledge in what I do - these are the reasons why it’s important to me. Alone, we are not able to reach our full potential, but together we are strong and are able to stand on the shoulders of giants. Why do we need a network? For the past few years, a perfect storm has been brewing. The need for a network of patient safety managers has never been more evident. There were three themes playing on my mind - each one was troubling me and affecting the way I was performing at work: 1. Recurring harm Every year, avoidable harm leads to the deaths of thousands of patients, each an unnecessary tragedy. Unsafe care also causes the long-term suffering of tens of thousands and costs the health service billions of pounds. Many people have been doing good work over the last 20 years, but patient safety remains a persistent problem.[1] This was evident during my Darzi Fellowship. Understanding why learning from incidents was not shared between trusts, departments and wards was fascinating. There are many barriers to why we don't share, some of which are deep-rooted in ‘the way things are done around here’ - the organisational culture and unwritten rules. But the overriding barrier was that there was no mechanism to share. If there was a mechanism to share, would it even make any difference? The only way to find out was to try, so in 2019 Patient Safety Learning launched the hub, a free platform to share learning for patient safety. A knowledge repository with open access for all. So far the hub has had 10,000 resources uploaded and has had 637,000 page views from over 200 countries, with communities of interest for people to discuss patient safety concerns and how to address them. the hub is a fantastic resource, but what we need is more of the human element - human interaction where tacit knowledge is shared. 2. Isolation I started my first patient safety management role in September 2020, as we were coming out of the first wave of the pandemic and heading straight into the second. Times were turbulent. I wasn’t based in the office and working from home made forging relationships tricky. The feeling of isolation was particularly challenging for me. The need to reach out was strong. When working clinically as a nurse, the bond with my colleagues was strong. As nurses, no matter where we work, we understand each other. We understand each other’s challenges, we are able to support each other and we know we are not alone. There are also many of us, so it’s not too difficult to find another nurse where you work to debrief, learn from each other and gain support. Coming from working clinically to now working as a patient safety manager, I miss the sense of belonging. I no longer fit into the ‘nurse’ box, at least that’s the way it feels to me. There are fewer peers around me that I can debrief, share and learn with. 3. Roll out of Patient Safety Incident Response Framework (PSIRF) Currently, we are stuck on a hamster wheel of investigating; investigating in such detail and at such volumes that we have no time for organisational learning, implementing robust actions or involving families and patients. The PSIRF is a key part of the NHS Patient Safety Strategy published in July 2019.[2] It supports the strategy’s aim to help the NHS improve its understanding of safety by drawing insight from patient safety incidents. This strategy gives permission for the healthcare system to ‘do safety differently’. I know I am very excited about the new framework. The whole reason I came into patient safety was to make it easy to do the right and safe thing, but there are still so many questions about PSIRF: How will it work? What do I need to do to start making changes? What methodologies do I use? What training do I need? Where do I start? To test the PSIRF, NHS England is first working with a small number of early adopters who are using an introductory version of the framework in their organisations. My Trust is not an early adopter, so we remain using the existing Serious Incident Framework.[3] Each trust has nominated Patient Safety Specialists (PSS) - in my Trust, they are the directors of patient safety. They will have the responsibility of leading the changes, whereas I will be implementing their strategy. There is a PSS network which has been created by NHS England to keep trusts abreast of how the early adopters are proceeding and provide updates on implementation timelines. However, I am unable to join this network as I am not a PSS. This network does not include my peers. I want to reach out to others on what I would call the ‘nuts and bolts’ of patient safety: how to reduce pressure damage, how to capture Duty of Candour, how to interview staff after a serious incident, how others involve patients and families.[4] The PSS network certainly isn’t the right forum for that. How did the network evolve? Scoping what was out there and identifying need After realising that the PSS network was not aimed at people like me, I looked at what was around for patient safety managers. Some of us are clinical, some of us are not, so a platform that we could all access was non-existent. There were forums on specific issues such as falls and tissue viability, but I couldn't find anything that encompasses patient safety and the management of patient safety. I knew I wanted to reach out to others, but were others ready to reach out too? By putting out a call on social media, it became acutely evident that I wasn’t alone. A poll that I put out on Twitter came back with a resounding, "Yes – we want a network!" Developing shared purpose Having a shared purpose for the network was the key to success, so we decided on these aims: To facilitate and nurture private conversations between a community of like-minded individuals. To share our insights and lessons learned so that all may benefit from our collective wisdom. To provide peer support when others in our community are in need of help. To collaborate on new ideas, solutions and research that might lead to improved patient safety. To introduce new thinking from both within and outside health and care that could accelerate patient safety improvements within our own organisations. To gain a better, shared understanding of new policies, guidance, directives and regulations that impact our work. To share knowledge resources that others might use in striving to improve patient safety within their own organisations. To enable PSMN members to influence relevant regional and national policies and add their voices en masse to campaigns that seek to improve patient safety for all (either directly or indirectly). Ensuring a safe space One of the barriers to sharing concerns and stories is that we are unsure who we can share with. Sharing non-patient identifiable information is OK. Sharing policies, process and action plans is acceptable. But the narratives behind these policies and action plans are far more insightful - however, to get this information you need to speak to people face to face. In a funny way the pandemic did us all a favour, as we are now all experts in using Microsoft Teams and managing online meetings (although I still forget to unmute myself – there's always one!) We know and trust Teams, so it's been a great way of getting people from across the UK together cheaply and easily. To ensure we have ‘real’ patient safety managers there is a process for joining the network. Firstly, applicants need to be a member of the hub. Once they have signed up they are screened by me and when we know they are a ‘real’ patient safety manager, they gain access to the meeting links and the private community page on the hub I’m really grateful to Patient Safety Learning for hosting the network on the hub and helping us capture discussions, such as this latest blog about the amazing work of the Patient Safety team in Sussex Community Foundation Trust. And to BD for providing Patient Safety Learning with some tech set-up funding for the forum on the hub. Deciding on a structure "Not another meeting!" No, it’s not just another meeting. In our private community we have: no agenda no action log an informal setting no hierarchy cameras on no recordings drop in, drop out a summary note on the dedicated hub page for those that can’t attend. Progress so far The network launched on 25 June 2021 and so far: we have had 17 meetings. we have 150 members (and growing fast). we have had 10 external speakers including NHS England, early adopters and the Healthcare Safety Investigation Branch. we have discussed what is important to us, including subjects like human factors and investigation, involving families, medication errors and duty of candour. Measuring success and impact The impact this group has had on patient safety has not been measured, and would be difficult to measure. Getting caught up in trying to measure and justify the network isn’t my priority; my priority is to keep the network going. If people continue to attend the meetings, continue to share their ideas and continue to find solutions from each other – then the network is serving an important purpose and will continue. The future and vision In the future I see a national patient safety management network with sub-groups – one for community, one for mental health, one for acute care, one for primary care, one for care homes and one for ambulance services. Each of these sub-groups would feed up to the national group for a yearly conference where we would share and discuss learning across all groups. Currently, I convene the meetings. However, I work full time as a patient safety manager and it would require a full-time person to run the network for it to reach its full potential. But for now – we have a fledgling network with passionate people who want to make a difference and get it right. We have made a start and we are trying! How to get involved Are you a patient safety manager interested in joining the Patient Safety Management Network? You can join by signing up to the hub today. If you are already a member of the hub, please email claire@patientsafetylearning.org References [1] Patient Safety Learning, The Patient-Safe Future: A Blueprint for Action, 2019 [2] NHS England and NHS Improvement, The NHS Patient Safety Strategy, 2 July 2019 [3] NHS England and NHS Improvement, Serious Incident framework, Last Accessed 25 October 2021 [4] Care Quality Commission, Regulation 20: Duty of candour, Last Accessed 25 October 2021
  3. Community Post
    Years ago I remember never being allowed a drink at the desk. It was against infection control is what I was told. however I do remember breaking the rules and then promptly spilling the drink across the keyboard 🤦🏼‍♀️ As an outreach nurse , we are travellers around the hospital. I know where all the water stations are in each department - the trouble is that there are sometimes a lack of cups. Disposable cups are not environmentally friendly , however if you are a HCP that moves around wards you can’t always take a bottle with you - especially if you are running to an emergency. If you are based on the wards , the culture where I work is that you are able to have a bottle at the desk. working on COVID wards , regular breaks were taken as hydration was much more focussed on than ever before. Not sure who controls the heating in all hospitals, but turning that off in the summer would help!!
  4. Content Article
    We have just come out of a second lockdown. This time my experiences working in the NHS are very different from the first lockdown back in March 2020. As you may have read in my past blogs, the first lockdown wasn’t really a lockdown for me. As a critical care outreach nurse I was going to work as usual; however, the work I was doing had changed. The way we were adapting our environment, our processes was almost exciting – to be able to directly influence rapid change in a usually bureaucratic organisation was novel. I remained at work, there was no furlough, and there was no isolation, no Joe Wicks and no cleaning out my cupboards, unlike some of my non-NHS friends. This time, the second lockdown, things were different for me. I have come away from clinical practice and have entered the world of patient safety management. Not only have I started a new role, I have started it in a new Trust. Moving into a new role in a new Trust during a global pandemic has been challenging to say the least. I had spent the past 24 years in the same Trust, the people around me had seen me grow up – literally. Many of my past colleagues felt like family. It would take me a day to walk round the wards, just once, as every five steps I would meet someone I knew for a chat. I knew who to ask if I had a problem, I knew the nuances of each ward and most importantly, I had tacit knowledge of how work ‘got done’ and how to ‘get it done’. During the first lockdown I spent much of my time on the intensive care unit and the COVID wards. There was great sense of comradery, team work and a support network. Yes, the work was difficult, but we had each other and we were able to openly talk about our fears, shed tears and sometimes laugh about what had happened throughout the shift. In an odd way, it felt comfortable. The second lockdown working for the NHS could not be more different for me. I have changed roles completely. I have been interested in patient safety for a number of years and have done a little quality improvement (QI). Quality improvement in the patient safety space is something that I very much enjoyed as a nurse; however, I found that I didn’t have the time, the headspace or, sometimes, the support to immerse myself into a project that made an impact. It always felt as if I wasn’t doing QI ‘properly’. We were dipping in and out of it, not always following a methodology and grabbing time here and there to write bits up. It often felt we were papering over the cracks and not addressing the bigger problem or tackling multiple problems in a strategic manner. The upside of doing QI clinically is that you can see the impact your change has made in the work that is being done. Working with many of the stakeholders, who you have a close relationship with, you are able to have brief chats with them about the project without the need for formalised meetings. You feel as if you are making a difference to your world and the patient’s experience. Being a quality improvement and patient safety manager seemed the logical next step for me. But I now find myself in an alien world. Weirdly my surroundings are very familiar – I’m working from home. So how do I do QI from my dining room table, in a huge new Trust with people I have never met? It can’t be done. I can’t make any meaningful change in my own house 60 miles away from a hospital I have not worked in… can I? During the beginning of my Darzi fellowship we were ‘taught’ to pay attention to the way we were feeling and the stories we were telling ourselves. The story I was telling myself was not enabling me to be open to the new challenges and opportunities that were awaiting. I remembered being in my comfort zone back in my old role. Yes, I missed that feeling of knowing what I was doing and feeling confident, but I also remembered why I wanted to move. I want to make meaningful differences to the patient experience, safety and to make it easier for staff to do the right thing at the right time. If I was going to move to a new role, I was stepping out of my comfort zone. When stepping out of your comfort zone it will feel uncomfortable at times (most of the time). At the moment I am orbiting the fear zone and trying desperately to break into the learning zone. Although the fear is real, it’s manageable. Slightly odd as it almost feels like excitement too. Image from 'Step outside your comfort zone' Action Coach Learning within a new role is always difficult. You might spend time watching others, taking example from role models, shadowing and asking questions when problems or queries arise… but what can you do when there isn’t anyone to ask, when there is no one to watch, no one to guide you? Skype, MS Teams, Zoom – there are many online tools to help. Interacting with people via a computer is not natural to me. I expect it can’t be natural to anyone? I have come from a role where interacting with people is the main part of the job. Picking up subtle cues from body language, tone of voice and mannerisms count for so much. This is almost impossible to achieve from a computer screen. Striking up a rapport with someone new is a real skill and a skill I prided myself on. The skill I had in reality doesn’t seem to work online. My humour is lost (my jokes were rubbish anyway), time is often limited and conversation is structured around tasks – relationship building comes with time, talking at break times and sharing stories. The team I work with have been amazing. They are there at the end of the phone at any point. I have been supported. But I’m longing to be surrounded by a bustling environment again. Where ideas can be bounced around, projects discussed and problems resolved rather than booking in one-dimensional, online meetings. This won’t be forever, but we are in the midst of working in a different way and finding our feet. As for QI from the dining room table… it can’t be done. I can’t make any meaningful change in my own house 60 miles away from a hospital I have not worked in… can I? Yes you can. You can make a huge difference. My next blog will be how working remotely you can make relationships, influence and introduce change.
  5. Content Article
    This blog in the BMJ, recognises that bullying also occurs with in patient advocacy role and the patient community.
  6. Content Article
    The recommendations set out in the report are addressed to all leaders who influence the workplace experience of nursing and midwifery staff Recommendations Key recommendation 1: Authority, empowerment and influence Introduce mechanisms for nursing and midwifery staff to shape the cultures and processes of their organisations and influence decisions about how care is structured and delivered. Key recommendation 2: Justice and fairness Nurture and sustain just, fair and psychologically safe cultures and ensure equity, proactive and positive approaches to diversity and universal inclusion. Key recommendation 3: Work conditions and working schedules Introduce minimum standards for facilities and working conditions for nursing and midwifery staff in all health and care organisations. Key recommendation 4: Teamworking Develop and support effective multidisciplinary teamworking for all nursing and midwifery staff across health and care services. Key recommendation 5: Culture and leadership Ensure health and care environments have compassionate leadership and nurturing cultures that enable both care and staff support to be high-quality, continually improving and compassionate. Key recommendation 6: Workload Tackle chronic excessive work demands in nursing and midwifery, which exceed the capacity of nurses and midwives to sustainably lead and deliver safe, high-quality care and which damage their health and wellbeing. Key recommendation 7: Management and supervision Ensure all nursing and midwifery staff have the effective support, professional reflection, mentorship and supervision needed to thrive in their roles. Key recommendation 8: Learning, education and development Ensure the right systems, frameworks and processes are in place for nurses’ and midwives’ learning, education and development throughout their careers. These must also promote fair and equitable outcomes.
  7. Content Article
    This guidance set out by Public Health England explains how patients/the public and clinicians can mitigate falls.
  8. Content Article
    This article, from John Hopkins Medicine, demonstrates some breathing exercises for you to try at home to aid recovery.
  9. 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
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