Claire Cox

This guidance is intended for doctors, nurses and allied healthcare professionals looking after children. It is therefore written in a manner to be accessible to all groups. It is intended to improve the care of children at risk of, or with, Acute Kidney Injury (AKI).

Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. In this article, published by the Journal of Paramedic Practice, looks at a case study which highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated.   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.

As the colourful rainbows in people's windows are beginning to fade, is the public support for our frontline workers also fading? Has gratitude and thank you's been replaced with frustration and anger from the public? In her latest blog, critical care outreach nurse Claire reflects on the impact this is having on the wellbeing of already exhausted frontline staff. 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?

Connection, inclusion and compassion are certain, unchanging, and provide a safe refuge to deal with what feels frightening and isolating for so many. The challenge set by the Francis Inquiry Report – to create a compassionate, inclusive organisational culture – is now amplified in the COVID-19 era, which the NHS entered with pre-existing record levels of staff stress and chronic excessive workloads. This workshop from the University of Manchester, explores the problems and opportunities associated with changing healthcare organisation cultures. 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?

This communication skills guide to practice, developed by Ausmed, explores several common communication scenarios that you may find yourself in as a health professional, and help you navigate and master each interaction you have in your day-to-day practice.

A two minute video on COVID-19 and systemic inequality by David Nabarro, Special Envoy of WHO Director-General on COVID-19. COVID is the great revealer. It reveals inequality and issues around wealth, gender, race and climate. "You want to get on top of this disease? You've got to address systemic inequality". David gives advice on what you can do.

Despite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient- and family-initiated escalation of care schemes. This short video by the University of Michigan Health System explains more.

In this short film, Nadine Montgomery presents her story that led to the landmark ruling on consent (Montgomery v Lanarkshire Health Board, 2015)

Northampton General Hospital NHS Trust has produced this leaflet to help keep patients safe in hospital. 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.

Despite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient-and family-initiated escalation of care schemes. Existing systematic review evidence to date has tended to focus on identifying the impact or effectiveness of these schemes in practice. However, they have not tended to focus on qualitative evidence to consider the experience of deterioration and the factors that may promote or hinder engagement with these schemes in the practice setting. The aim of this review, published in Systemic Reviews, is to explore patients’, relatives’ and healthcare professionals’ experiences of deterioration and their perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards.

Near miss events are much more common than events where harm actually reaches a patient, as much as 7-100 times more frequent. However, reporting systems for such events are much less common. At Faulkner Hospital, over 75% of the safety event reports the hospital captures in RL6 are near misses.

The Imperial Simulation Team, led by Dr Malik, filmed this Immersive Simulation of a SARS-CoV2 patient with COVID-19 disease who had a cardiac arrest. Filmed at Imperial College Healthcare NHS Trust/Imperial College London.

Mouth Care Matters have launched a video – Supporting Patients in Hospital Who Are Resistant to Mouth Care. As part of their work with trusts in England, care resistant behaviour was the number one barrier to providing mouth care. They have developed a video is to explain why a patient may be resistant towards mouth care, and some ways that may help manage this. This video is aimed at all healthcare professionals. Covering techniques, use of distraction and products, we hope after watching this video you will have picked up many new tips towards delivering better care, to a patient who may at first be resistant to mouth care.

In everyday life and in health care environments, distractions and interruptions are threats to human performance and safety. A distraction may occur when a driver is texting while in traffic or when a health care professional is interrupted during a high-risk task such as prescribing or administering a medication. Interruptions—ringing telephones, active alarms or computerized alerts, or even being asked a question – are ubiquitous in society, and health care is no exception. This article by nurse, Suzanne Beyea, discusses how mindfulness can reduced distraction and improve patient safety. Published by the Patient Safety Safety Network.

This resource, from NHS Education for Scotland, has been designed for acute general hospital staff to help them develop their abilities in supporting people with dementia, their families and carers. It will help you develop the knowledge and skills set out at the ‘Dementia Skilled Practice Level’ of Promoting Excellence: a framework for all health and social services staff working with people with dementia, their families and carers. Evidence suggests that care, treatment and outcomes of hospital admission are markedly poorer for people with dementia than for those without. Several potential factors may contribute to this, including: pressures of acute care the unique and complex needs of the person with dementia not being recognised organisational systems and processes – acute general hospitals are fast-paced and intense, with a focus on rapid responses, meeting acute needs and achieving discharge as soon as possible. These can lead to a number of risks for people with dementia, including: prolonged stay in hospital increased complications, such as pressure ulcers, falls and delirium increased adverse drug reactions loss of previous abilities and increased levels of dependence incidents of incontinence that can become permanent decline in cognitive function an increased likelihood of admission to a care home increased morbidity and mortality.

Dementia is a cause of disability and dependency associated with high demands for health services and expected to have a significant impact on resources. Care policies worldwide increasingly rely on family caregivers to contribute to service delivery for older people, and the general direction of health care policy internationally is to provide care in the community, meaning most people will receive services there. Patient safety in primary care is therefore important for future care, but not yet investigated sufficiently when services are carried out in patients’ homes. In particular, we know little about how family carers experience patient safety of older people with dementia in the community. This was an explorative study, with qualitative in-depth interviews of 23 family carers of older people with suspected or diagnosed dementia. Family carers participated after receiving information primarily through health professionals working in dementia care. A semi-structured topic guide was used in a flexible way to capture participants’ experiences. A four-step inductive analysis of the transcripts was informed by hermeneutic-phenomenological analysis.

Lack of transparency helped Ian Paterson to operate unchecked for years, according to inquiry The recent report of the Paterson Inquiry identified multiple levels of dysfunction across England’s health system. These allowed surgeon Ian Paterson to practise unchecked for many years, causing serious harm to thousands of patients. Among the less surprising of the failings is the lack of transparency in reporting activity and outcomes by the private hospitals where he worked. As the report notes, transparency is no panacea, but it is essential for protecting patients from harm. This BMJ editorial argues that urgent action is now needed to improve reporting by independent sector providers to bring them in line with standards in the NHS.

The Acute Data Alignment Programme (ADAPt) is a joint programme between NHS Digital and the Private Healthcare Information Network (PHIN) which is looking to adopt common standards for data collections and performance measures across both the NHS and private healthcare. This will ensure that relevant information is consistently recorded and available so it can be more easily analysed and compared. The aims of ADAPt: To make it easier to monitor the quality and safety of services by including private healthcare data within healthcare reporting systems. To help staff keep accurate and complete records when a patient journey spans both private and public providers. To ensure transparency for patients by publishing comparable performance measures relating to quality of care and patient safety for both privately funded and NHS funded healthcare. To identify where the burden of data collection and reporting by NHS and private care providers can be reduced. Find out via the link below.

This report by the Center for Health and the Public Interest, brings together what is known about patient safety in private hospitals. It offers insights into the number of patient safety incidents in private hospitals, analyses the potential risks inherent in the way that these services operate, and makes recommendations to improve transparency in the private sector. The report also confirms that the NHS serves as a ‘safety net’ for the private sector with around 6,000 people a year transferred to NHS hospitals following treatment in private hospitals. Read the press release and coverage on BBC News, the Telegraph and Health Service Journal Read a blog on patient safety from Peter Walsh Sources of further information on patient safety private hospitals Read a blog from Colin Leys exploring the issues in the report.

Kate and Jenny Sanger’s 'Communication Passport' gives a voice to the voiceless and enables those being supported and those providing that support to have the two-way conversation that leads to a happy and positive relationship. The passport is a powerful support tool for staff, giving them confidence and job satisfaction that they are doing their best for the person they support. Kate and Jenny Sanger created the communication passport originally for Kate’s daughter, Laura. The aim of the passport is to enable a range of professionals and specialists access important information so that care can be delivered more holistically. The communication passport has now been shared widely to help other families and individuals with complex needs. Kate and Jenny Sanger speak in this webinar about building a communication passport.

What does good end of life care planning look like? What should you talk about, how and when should you talk about it? Big questions. It’s hard enough for any of us to plan for our time of declining health and dying. Much harder, still, for people with learning disabilities. And much, much harder still at this time of COVID-19. There is a danger that we talk about it at an unhelpful time or in an unhelpful way. This danger is greatest if there is a tick-box approach to “end of life care planning” (or, as it is often called, “advance care planning”), where the focus is on completed paperwork rather than on communication. In this webinar, Professor Irene Tuffrey-Wijne talks about what end of life care planning is (and what it isn’t), and talks through her top tips on how to approach this with people with learning disabilities. She will also discuss some of the particular challenges we face now, during COVID-19, in relation to end of life care planning.