Claire Cox

Hi All,

I was looking through a recent coroners case  ( https://www.judiciary.uk/wp-content/uploads/2020/01/Julie-Taylor-2019-0454.pdf )  Where a learning disability patient deteriorated while in an acute care setting.  

One of the recommendations was that the Trust should have used a 'reasonable adjustment care plan'.  I haven't heard or seen one of these before.   So I had a quick look on the internet and found this.

 http://www.bristol.ac.uk/sps/media/cipold_presentations/workshop3presentation1-linda-swann.pdf

Does anyone else use a care plan that they wouldn't mind sharing?

Thanks - Claire

Hi Jon 

I worry about yet another layer of ‘management’. 
I work clinically too, working here allows me to see what work is being done and why it’s being done in that way.  
having a specialist is great, but they will need to understand what actually goes on in that department as each department has its own culture and nuances. 
a safety specialist can give advice, guidance and have an overall gauge on the safety of a trust, but I don’t think they should be solely responsible or the implementation of providing a safe place for patients, it’s everyone’s responsibility.

Claire  

When I used to work on the cardiac ward patients would have to swab themselves for MRSA pre op.  
 

It surprised me how many didn’t know where their perineum was.  
 

I remember trying to explain where it was to a man who didn’t even know he had a perineum.   After a long while trying to tactfully explain where it was located he exclaims ‘oh you mean the bit between your b******s and your a*** h***, why didn’t you just say?’ 

Use of appropriate language is needed, depending on the patient.  Not easy to judge sometimes  

The use of medical language is a huge barrier when talking to patients.  I try and use plain English when explaining what I am doing , but not always that plain! 

Hi .... I'm planning to do a project on this where I work.  I was thinking this very thing the other day.

I think it depends what the 'thing' is that you prevented and who found it and how serious the implication mitigated was.

In my experience so far, many people do not know what they are ....... we have become 'immune' to the near miss, we work in a system full of them, we work around them or 'dodge them' as we go.

I'm very excited about my up coming project...watch this space

@Emma Richardson has just started C4C in the smaller of our Trusts in Brighton.  We started off at the smaller one, just in case we got bombarded with calls.  We started in July.

Emma can give you more information on how many calls we had.  Its around 10 since we started.  We also give out our leaflets to our follow up group.

We have not been stuck with 'difficult' patients at all, they have all been great calls.

Happy to discuss more if you have anything specific to ask

Claire

@SarahHart This thread may be of help for you?

Following the posting of the recent anonymous blog by a brave nurse  - a discussion was started on Twitter about the aspect of accountability, duty of candour mixed with a no blame culture.

If there has been a drug error:

• The person who did the error needs to feel secure in the knowledge that there is a no blame culture, otherwise they may not report it in the first place. 
• The patient needs to be told that they has been an error with their care
• The person who did the error needs to be held to account

So, can these three points coexist or are we wanting the impossible?

@Kirsty Wood @Rob what a fantastic idea...... i see a trip for you rob to Kettering!!

I would be interested if you experience psychological safety in your workplace - even if it is not in healthcare.   Do you feel safe to own up to mistakes?  Do you feel that your opinion is listened to and your wellbeing looked after if you have been involved in an incident?

Interesting blog on the hub explaining this...

I work with @Emma Richardson in the same trust.  We have recently gone 24/7 on one of our sites, plus electronic observations.  Its amazing what goes on / not goes on at night.

Something that I have noticed is the 'culture' of when observations are taken.  Traditionally we have taken them at specific times......06:00, 12:00, 16:00, 20:00 .    Changing to electronic observations disrupts this routine, quite rightly.

The work that @Emma Richardson is doing will highlight what the barriers and enablers are to safer monitoring at night.

I'm really interested to find out!

Hi @Kirsty Wood we use the trilogy, however we only use it for BiPAP.  It does do CPAP but we , as a Trust, have decided that we wont use CPAP as a therapy on the wards.  We might start it while we wait for an ITU bed, but not as a long term measure.  This machine is great as it is portable, has a good battery life and doesn't require the air port.

Patients bring in their own NIPPY from home if they require it, but only on their normal settings.

I hope that helps

claire

Lets talks NEWS...

Nurse and carer worry, I like to think that Critical Care outreach teams take this very seriously and that the 'worry' has a heavy influence in our management.  Many of our patients may score 0, but warrant a trip to the ITU (AKI patients for instance).

However, as part of our escalation policy it states that staff should alert the doctor and or the Outreach team when NEWS is 5 or 3 in one parameter.  This causes the 'radar referral effect'.  We often have a group of these patients on our list.  Personally, I find them difficult to prioritise as they are often receiving frequent observations and have a plan.  By concentrating on this group and make sure they have everything in place can take time, but... what about those not scoring in this threshold?  Do they get pushed to the bottom of the list?  Should nurses follow this protocol to safeguard themselves as well as the patient or are we not looking for sick patients in the right place?

Don't get me wrong,  the NEWS has been revolutionary in the way we deal with deterioration, but as a tool to prioritise this may not be the case. 

There are softer signs at play here....has anyone got any solutions to deal with the 'radar referals'

Lots to discuss @Ron Daniels @Emma Richardson @LIz Staveacre @Danielle Haupt @Kirsty Wood 

@Yesh How do we engage patients in the Operating room?

Hi Aine!

Great to hear from you.  We can put you in touch with @Joanne Hughes @Jono Broad @Douglas Findlay who may be able to help you.

Its great to have you here on the hub!!

what would they win?

@Jono Broad and @Joanne Hughes what a brilliant idea...... could any of you help?

Hi - I was wondering if anyone has used the freedom to speak up (FTSU) guardian service where they work?

It is FTSU month in October and I was wondering if anyone had used the service, would they like to answer a few questions.  We can post this on the hub, so people can see how the system works and how it felt to raise concerns.  This of course would be dealt with strict anonymity, as these issues may be sensitive.

Please get in touch!

@Evelyn Prodger would you have any insights from working in a smaller organisation, like the Hopsice?

I feel strongly that having courage to come to work to do your job and improve care for patients is a symptom of a failed system.  Giving safe care or innovating ways to give safe care should be a 'thing we all do' not a 'thing other people do' .

Thanks Neal - I'm going to pop these on the hub!

Thanks Neal,  This was a question the people from twitter were asking.  I had no clue! (neither did any one else)

Hi @Danielle Haupt  we dont have anything on paper.  But give out the hub address....i shall see what we can get together.  @Margot

Hi @Alex Entwisle  what about putting the essay up on here so we can see - or tell us a brief synopsis of it

@Danielle Haupt and @Luke Brown and @Emma Richardson what are you doing in your hospitals?

https://www.pslhub.org/applications/core/interface/file/attachment.php?id=54

Here is Brighton's leaflet for call for concern @Danielle Haupt