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Claire Cox

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  1. Content Article
    Primary care services provide an entry point into the health system which directly impact's people well-being and their use of other health care resources. Patient safety has been recognised as an issue of global importance for the past 10 years. Unsafe primary and ambulatory care results in greater morbidity, higher healthcare usage and economic costs. According to data from World Health Organisation (WHO), the risk of a patient dying from preventable medical accident while receiving health care is 1 in 300, which is much higher than risk of dying while travelling in an airplane. Unsafe medication practices and inaccurate and delayed diagnosis are the most common causes of patient harm which affects millions of patients globally. However, majority of the work has been focussed on hospital care and there is very less understanding of what can be done to improve patient safety in primary care. Provision of safe primary care is priority as every day millions of people use primary care services across the world. This paper, published in The Journal of Family Medicine and Primary Care, focuses on various aspects of patient safety, especially in the primary care settings and also provides some potential solutions in order to reduce patient harm as much as possible. Some important challenges regarding patient safety in India are also highlighted.
  2. Content Article
    This video is to help dental patients make sure they are getting safe care from their dental practitioners.  Developed by the Dental Board of Australia, it aims to: help patients know what infection prevention and control protocols to expect when visiting their dental practitioner encourage patients to ask their treating dental practitioner questions about infection prevention and control and how their treating dental practitioner can ensure that they meet their infection control obligations to inform patients on what to do if they have a concern about their dental practitioner’s infection control practices.
  3. Content Article
    Professor Anne-Sophie Darlington speaks to ecancer at the 2019 EORTC Groups Annual Meeting (EGAM) about the importance of including the patient's experiences and voice during clinical trial assessments. Professor Darlington details the use of questionnaires to measure these patient parameters and how these must be carefully developed to allow flexibility to withstand the evolving environment of clinical trial research. 
  4. Content Article
    Safety in healthcare has traditionally focused on avoiding harm by learning from error. This approach may miss opportunities to learn from excellent practice. Excellence in healthcare is highly prevalent, but there is no formal system to capture it. We tend to regard excellence as something to gratefully accept, rather than something to study and understand. The preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation. It is time to redress the balance. It is believed that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale. This page is for useful resources for setting up and maintaining an excellence reporting programme: Resources LfE Quality Improvement Toolkit (based on PRAISe project) Quick start up guide LfE (July 2016) LfE top 10 tips (Jan 2017) How to get started – a few tips from our experience Framework for “reverse SIRI” (now named IRIS) – adapted from Appreciative Inquiry methodology Template (in MS word) for IRIS meetings Example LfE FAQs – for you to adapt for your organisation Mini-AI template – Mini-AI template, as used in PRAISe project 10 uses for LfE & AI LfE how to set up checklist LfE Appreciation card template – front LfE Appreciation card template – back
  5. Content Article
    Here is a template for an entrance interview, produced by Learning from excellence. It has been designed using Appreciative Inquiry (AI) principles. It is envisaged to be used at the start of a new job or rotational placement to guide formation of personal development plans. However it could be adapted for permanent staff at times of appraisal.
  6. Content Article
    Antimicrobial resistance leads to increased morbidity, mortality and healthcare costs worldwide. In order to contain antimicrobial resistance, Antibiotic Stewardship Programs (ASP) have been developed to measure and improve the appropriateness of antimicrobial use. A common way to measure the appropriateness of antimicrobial use is by evaluating whether antimicrobials are prescribed according to local guidelines and if not available, to national or international guidelines. This study, published by Antimicrobial Resistance & Infection Control, shows that in hospital outpatient clinics, prophylaxis accounted for a quarter of the antimicrobial prescriptions and had in general a good guideline-adherence rate, with the exception of unnecessarily prescribed post-surgical/intervention prophylaxis, whereas a substantial part of the therapeutic prescriptions were inappropriate. Amoxicillin-clavulanic acid was the most inappropriately prescribed antimicrobial agent, regarding non-adherence to the guideline and also regarding the lack of considering renal function for dosage adjustment. Altogether, it is believed that antimicrobials prescribed at the hospital outpatient clinics warrant ASP attention. The variation of the guideline adherence rate between the investigated hospitals, as well as the differences with prior studies addressing antibiotic use in ambulatory settings in general, emphasise that (hospital) outpatient antimicrobial use should be audited locally.
  7. Content Article
    This guidance wriiten by the Royal College of Nursing, is for health care professionals, service providers and those involved with planning and commissioning services. It sets out the RCN’s perspective on contemporary and future children and young people’s nursing services in the home and community setting. It also underlines the increasingly crucial role played by community children’s nurses as they provide integrated care closer to home. It explores the legislative and policy agenda, defines the role of the CCN, sets out the core principles of providing care, considers variations in how the needs of families are assessed across the four countries of the UK and outlines examples of current models of care and service delivery.
  8. Content Article
    Ten Thousand Feet UK is a Consultancy led by Rob Tomlinson in collaboration with the Association for Perioperative Practice. Rob is a clinical nurse in the NHS and is leading the way to improving patient safety through clinician-led culture change in the UK. Rob has already delivered workshops on a national scale with success for teams who have embraced the new procedure.  'Never Events' within the NHS are still on the rise with distraction and a loss of situational awareness still being cited as one of the main causes. Ten Thousand Feet aim to embed new patient safety culture into operating theatre teams nationwide, so at any time, anyone working in the theatre who needs to focus their attention at the task in hand can can use the language tool “Ten Thousand Feet” to improve team efficiency and most importantly patient safety. At the end of the workshop theatre staff will be educated and empowered to use this concept in a safe and effective manner.
  9. Content Article
    Patient safety event reporting systems are a mainstay in non-punitive reporting of near misses and adverse events. The authors of this study, published in the American Journal of Surgery, hypothesised that an upgraded reporting system that included the ability to report positive behaviours would increase behavioural reports in the perioperative environment. After implementation of an upgraded reporting system that includes an option for positive reporting, the number and length of reports increased. The authors believe that a robust reporting system has contributed to a culture of safety at their institution.
  10. Community Post
    Can any one share? The trust I work in delivers patient safety training as part of the mandatory training. I was wondering if any other trust does this, if so would they mind sharing Thier slides as I'm not sure what it should include. Thanks!
  11. Content Article
    The Marmot Review into health inequalities in England was published on 11 February 2010. It proposes an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities. Summary of findings and recommendations People living in the poorest neighbourhoods in England will on average die seven years earlier than people living in the richest neighbourhoods. People living in poorer areas not only die sooner, but spend more of their lives with disability – an average total difference of 17 years. The Review highlights the social gradient of health inequalities - put simply, the lower one's social and economic status, the poorer one's health is likely to be. Health inequalities arise from a complex interaction of many factors – housing, income, education, social isolation, disability - all of which are strongly affected by one's economic and social status. Health inequalities are largely preventable. Not only is there a strong social justice case for addressing health inequalities, there is also a pressing economic case. It is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS. Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community.
  12. Content Article
    The Health Foundation commissioned the Institute of Health Equity to examine progress in addressing health inequalities in England, 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review). Led by Professor Sir Michael Marmot, the review explores changes since 2010 in five policy objectives: giving every child the best start in life enabling all people to maximise their capabilities and have control over their lives ensuring a healthy standard of living for all creating fair employment and good work for all creating and developing healthy and sustainable places and communities. For each objective the report outlines areas of progress and decline since 2010 and proposes recommendations for future action, setting out a clear agenda at a national, regional and local level.  The report highlights that: people can expect to spend more of their lives in poor health improvements to life expectancy have stalled, and declined for the poorest 10% of women the health gap has grown between wealthy and deprived areas place matters – living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly five years less.
  13. Content Article
    Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination. This must be done on the basis of an explanation by a clinician. Consent from a patient is needed regardless of the procedure, whether it's a physical examination, organ donation or something else. The principle of consent is an important part of medical ethics and international human rights law. This link below, leads to an NHS web page that covers: the definition of consent how consent is given consent from children and young people when consent is not needed consent and life support how to complain if you think consent was not given.
  14. Content Article
    There has been an increase in the number of units providing anaesthesia for magnetic resonance imaging and the strength of magnetic resonance scanners, as well as the number of interventions and operations performed within the magnetic resonance environment. More devices and implants are now magnetic resonance imaging conditional, allowing scans to be undertaken in patients for whom this was previously not possible. There has also been a revision in terminology relating to magnetic resonance safety of devices.  These guidelines, by the Association of Anaesthetists, have been put together by organisations who are involved in the pathways for patients needing magnetic resonance, reinforce the safety aspects of providing anaesthesia in the magnetic resonance environment and suggest that hospitals should develop and audit governance procedures to ensure that anaesthetists of all grades are competent to deliver anaesthesia in the magnetic resonance environment.
  15. Content Article
    Ageing populations have greater incidences of dementia. People with dementia present for emergency and, increasingly, elective surgery, but are poorly served by the lack of available guidance on their peri-operative management, particularly relating to pharmacological, medico-legal, environmental and attitudinal considerations. These guidelines seek to provide information for peri-operative care providers about dementia pathophysiology, specific difficulties anaesthetising patients with dementia, medication interactions, organisational and medico-legal factors, pre-, intra- and postoperative care considerations, training, sources of further information and care quality improvement tools. These guidelines by the Association of Anaesthetists are a concise document designed to help peri-operative physicians and allied health professionals provide multidisciplinary, peri-operative care for people with dementia and mild cognitive impairment. They include information on: involving carers and relatives in all stages of the peri-operative process administering anaesthesia with the aim of minimising peri-operative cognitive changes training in the assessment and treatment of pain in people with cognitive impairment.
  16. Content Article
    The 5th National Audit Project (or NAP5) of the Royal College of Anaesthetists and Association of Anaesthetists was the largest ever study into accidental awareness during general anaesthesia (AAGA). Numerous publications emerged from the project and whereas a comprehensive list of 64 recommendations were made, the full report and associated publications were primarily academic outputs not accessible to all practitioners as a day-to-day ready reference, nor did they provide practical recommendations that individuals could use in their daily practice. The purpose of this publication is to distil and interpret the findings of the 5th National Audit Project into actions that individuals (and organisations) can follow to reduce the risk of accidental awareness.  Key recommendations All patients should be informed of the risks of general anaesthesia, including the possibility of AAGA, before their surgery. When consenting patients, practitioners should use a form of words that proportionately conveys the risks of AAGA. Consent for sedation should emphasise that the patient will be awake and therefore may have recall for at least parts of the procedure. Practitioners should identify certain situations or certain patient factors as constituting a higher risk for AAGA (including organisational factors such as overbooked or reorganised surgical lists) and highlight these at the WHO premeet/team brief. During induction of anaesthesia, practitioners should adhere to suitable dosing of intravenous agent, check anaesthetic effect before paralysis or instrumentation of the airway and maintain anaesthetic administration, including during transfer of patients (which is facilitated by a simple ABCDE checklist). If AAGA is suspected during maintenance (e.g., by patient movement), prompt attention should be paid to giving verbal reassurance to the patient, increasing analgesia, and deepening the level of anaesthesia. For cases requiring paralysis, the minimum dose of neuromuscular blocking drugs (NMBDs) that achieves sufficient neuromuscular blockade for surgery should be used, and the nerve stimulator is an essential monitor to titrate the dosing of NMBDs to this minimum. Where total intravenous anaesthesia (TIVA) is used, practitioners should adhere to the relevant recently published guidelines. At emergence, practitioners should first confirm that surgery is complete, then ensure NMBDs are adequately reversed before allowing the patient to regain consciousness. Practitioners should then manage the patient experience, particularly during awake extubation, by speaking to the patient. Cases of AAGA should be managed using the NAP5 pathway as a guide.
  17. Content Article
    The responsibility of anaesthetists in prescribing and administering controlled drugs has extended not only to the recovery room and intensive therapy unit, but also to acute and chronic pain services both in hospital and home care. These guidelines written by the Association of Anaesthetists recommend best practice for the safe preparation, distribution and disposal of controlled drugs to meet current clinical demands in peri-operative care. Issuing of controlled drugs within the operating department and key holding Ordering and transferring of drugs Unused controlled drugs Security requirements Disposal of controlled drugs.
  18. Content Article
    Anaesthetists are thought to be at increased risk of suicide amongst the medical profession. The aims of the following guidelines written by the Association of Anaesthetists are: increase awareness of suicide and associated vulnerabilities, risk factors and precipitants; to emphasise safe ways to respond to individuals in distress, both for them and for colleagues working alongside them; and to support individuals, departments and organisations in coping with a suicide.
  19. Content Article
    The location of care for many brain-injured patients has changed since 2012, following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, the Association of Anaesthetists have included an expanded section on paediatric transfers.  This guideline has also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of the recommendations. These guidelines remain a mix of evidence-based and consensus-based statements.
  20. Content Article
    In this article, Prof Chris Frerk, Consultant Anaesthetist at Northampton General Hospital and trustee of the Clinical Human Factors Group explains what to do when things don’t go according to plan and we can learn from airway events.
  21. Content Article
    In this video, Prof Kevin Fong, Consultant Anaesthetist at UCL (University College London) is joined in a panel discussion by three other experts in Human Factors and Ergonomics (HFE): Dr Fiona Kelly, Consultant Anaesthetist and Intensivist at Royal United Hospitals Bath and lead of the Difficult Airway Society (DAS) group on HFE Prof Chris Frerk, Consultant Anaesthetist at Northampton General Hospital and CHFG (Clinical Human Factors Group)Trustee Mr Clinton John, Operating Department Practitioner and Head for Clinical Education at UCLH. They will discuss and share their top tips about HFE in the context of airway management. This forms part of a free course from Future Learn Airway Matters course to  help others explore key concepts underlying safe, multidisciplinary airway management.
  22. Content Article
    Matt Darling was worried when his 15-month-old daughter, Jem Darling, began to show signs of brain cancer. When his worst fears were confirmed, Matt took on the role of an advocate for his daughter. While in the hospital, Matt witnessed firsthand the harm that is caused by a fragmented information environment in hospitals, spurring his development of the world's first safety critical clinical workflow engine. In this short film, produced by The Patient Safety Movement (Australian based), Matt tells his story. 
  23. Content Article
    The government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ in the NHS. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round. This study, published by Health Services and Delivery Research, aimed to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances. The evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.
  24. Content Article
    This study, published in Health Services and Delivery Research, identified five key themes that help explain how patient experience data work could lead to quality improvements in acute hospital trusts.
  25. Content Article
    Following the traumatic death of an anaesthetic trainee who was returning home after a night shift, the Fatigue Group supported by the Association of Anaesthetists and RCoA have surveyed UK trainees about shift working and fatigue. With a 60% response rate, the survey highlights a wide variation in access to rest facilities, commuting distances and concerning effects of fatigue on trainees. Fatigue self-assessment and fatigue risk management are not familiar steps in routine daily practice. This is due in part to a lack of awareness about the causes and effects of fatigue and limited education opportunities. It is also due to working culture where openness about fatigue and tiredness is not encouraged and collective responsibility for staff wellbeing is poorly developed. Using the results from the survey, the Fatigue Group have developed resources designed to enhance individuals’ knowledge and understanding and to support the culture change required within departments and organisations. To reduce variation in practice and to better manage expectations, standards have been defined for rest facilities and rest culture at work and individual responsibilities both within and outside of the workplace. These provide a platform to support local audit and quality improvement activity. This webpage has posters, guidelines and standards for you to download and use in your Trust.

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