Claire Cox

This bedside guide, from the Chartered Institute of Ergonomics and Human Factors, is intended for the use of all healthcare staff who are looking after adult patients with tracheostomies. The tasks described should not be attempted by those who have not received training or been deemed as competent in tracheostomy care and management. This guide includes posters, checklists and practical resources to aid the safe care of patients with tracheostomies. This guide does not override the responsibility of the healthcare provider to use professional judgement and make decisions appropriate to the circumstances of each patient in consultation with the patient and/or guardian. Whilst this document is aimed primarily at staff working in secondary care, much of the material is applicable to primary care (GPs, community care homes and carers). It is designed to help you provide consistent, high quality care for your patients with a tracheostomy.

In this short video, Dr Michael Kaufmann discusses five fundamentals of civility and how to be civil in a healthcare workplace.  Dr Michael Kaufmann is a Consultant in physician health and addiction medicine and Medical Director of the Physician Workplace Support Program (PWSP).

Following the first confirmed case of COVID-19 in Pennsylvania, facilities began submitting patient safety reports to the Pennsylvania Patient Safety Reporting System related to management of this emerging infection. Events in the analysis most often took place in the Emergency Department, on a Medical/Surgical Unit, or in the Intensive Care Unit. This is a study of 343 Event Reports From 71 Hospitals in Pennsylvania. The table within this document outlines the factors associated with patient safety concerns within COVID-19.

In this issue of Patient Experience you can find topics discussed by the people who are living inside the health and care systems and are sharing their stories. Topics include: reasonable adjustments for people with learning difficulties and autism when they come into hospital hospital gowns and how it may make some people feel patient engagement online support groups.

Double checking medication administration in hospitals is often standard practice, particularly for high-risk drugs, yet its effectiveness in reducing medication administration errors (MAEs) and improving patient outcomes remains unclear. This systematic review of studies, published in BMJ Quality & Safety, evaluates evidence of the effectiveness of double checking to reduce MAEs. There is insufficient evidence that double versus single checking of medication administration is associated with lower rates of MAEs or reduced harm. Most comparative studies fail to define or investigate the level of adherence to independent double checking, further limiting conclusions regarding effectiveness in error prevention. Higher-quality studies are needed to determine if, and in what context (eg, drug type, setting), double checking produces sufficient benefits in patient safety to warrant the considerable resources required.

Sepsis can develop rapidly and lead to serious illness and death. If the diagnosis is missed and treatment isn’t given swiftly, the consequences can be dramatic. About 48,000 patients lose their lives to sepsis in the UK every year. It is a national priority. The diagnostic and treatment guidance is fluid and responsive to changing best practice. This can cause issues with implementation of guidance and ensuring patients receive appropriate treatment. This Advancing Quality (AQ) report provides a summary of the progress that has been made in the North West of England over the last decade in the timely diagnosis and treatment of people with sepsis as well as improvement in outcomes. The report is also intended to outline the variation and shortfalls that still exist for patients with sepsis.

The study by Traverse aimed to explore the knock-on effects of coronavirus for health and wellbeing in the UK by understanding the experiences of people whose care has been disrupted. It is based on interviews with 12 people in the week beginning 20th April, just after the second 3-week lockdown period was announced in the UK.

When patients give feedback to healthcare providers, the topic of "communication" often features prominently. That is because when people are feeling vulnerable, the way they are spoken to, and the words that are used, matter a great deal. There can be few experiences that are more distressing than the death of a baby. So we need to think very carefully about how bereaved parents are spoken to. This paper looks at clinical terms such as "miscarriage", "stillbirth" and "neo-natal death" and finds that "These categorisations based on gestational age and signs of life may not align with the realities of parental experience". This study, published by the International Journal of Obstetrics and Gynaecology, explored the healthcare experiences of parents whose babies had died just before 24 weeks of gestation. Those interviewed "felt strongly that describing their loss as a "miscarriage" was inappropriate and did not adequately describe their lived experience".

"Over half of the disease burden in England is deemed preventable", says this report, "with one in five deaths attributed to causes that could have been avoided". It notes however, that progress has stalled on reducing the number of people with preventable illness and that compared to other high-income countries, we are underperforming. The authors call for a paradigm shift in prevention policy, from interventions that "blame and punish" to those that "empathise and assist". Regressive taxes and bans have not, they say, delivered the transformation required. Key to any new prevention strategy is the online information environment. Over 60% of British adults use the internet to check symptoms or self-diagnose, with the NHS website considered to be the most trustworthy. There is also, however, a "pernicious prevalence of false information". Polling shows that less than half of the population believe obesity is linked to cancer (misinformation), while over a third either agree that vaccinations can cause autism, or say they don't know (disinformation). The report states that the COVID-19 crisis shows how rapidly disinformation spreads. A poll revealed that nearly half (48%) of all British people had either seen or been sent "fake news" about COVID-19, online since the outbreak began. In addition, almost two in five (17%) said they did not know whether they had come across fake news, suggesting that the ability to identify and report the spread of misinformation is less than perfect. In this context, health education, on its own, is insufficient. We need to build health literacy (people's ability to understand health information), and work towards the goal of patient activation (enabling people to exert control over the determinants of health). The report makes a series of recommendations, including the introduction of a permanent "disinformation unit" to correct false information and help shape public health narratives. The authors conclude that "New technologies have created opportunities to reach wider audiences, but ... It is also clear that the NHS and health sector more broadly need to take a more proactive approach. As an extremely trusted source of health information, it is imperative the NHS stays ahead of the curve".

Patients remain the same, but the way that care is organised and delivered around us is changing. We are currently working in a state of flux. In her latest blog, Claire expresses concern around the lack of clarity and standardised updated guidance available for staff, which is leading to different interpretations of the rules and a lack of trust in our leaders, and highlights the impact this is having on staff and patient safety. She is calling for evidenced-based guidance, clarity, better communication and strong leadership to instill trust and the assurance that patient and staff safety is a core priority. Patients that I care for remain the same. Medically they are the same as they ever were. They have bowel obstructions, they have heart attacks, they have infections, they break bones, and there will always be a constant flow of patients that need the services of the NHS. One day it will be you and it will be me, at some point we will rely on NHS care. However, the way that care is organised and delivered around us will change. We have no idea what it will look like in the future, but it will be different to what we knew before the pandemic hit. At the moment we are all working in a state of flux. I work part time as a critical care outreach nurse, so there are times when I am not at the hospital for a few days in a row. When I am due back at work, I get what I call the ‘Sunday night fear’. I used to get this every Sunday night before I had to go to school. I would worry about fitting in, had I done my homework, have I got all my books together and whether I was going to have a good hair day. Now I find myself worrying about what new protocols I need to follow, what briefings have I missed, which wards are green, which are red. Now I have a new habit of looking through work emails to find out if I need to do anything different when I come to work. I’m not enjoying this habit one bit. I feel like I am starting a new job every time I turn up after two or three days. One of the roles of the critical care outreach nurse is to provide role modelling and support to staff on the wards. More often than not I have no idea what the ‘rules’ are now. Every decision is difficult. My patient needs to go to theatre urgently; they are slowly occluding their airway. Before the theatre will take them, they need a covid swab result. How do I get a swab result quickly? A new rapid test is now available (I only find this out by someone telling me this as they were passing). How do I get this swab? Does it look different? How do you perform the swab? How do I send it? How quick does it come back? How do I find the result? How reliable is it (at this point, I’m not bothered – just get it done, tick that box). Next call – cardiac arrest on one of the wards. Pre-covid we have been taught "Good chest compressions are linked with better outcomes for patients. Keep time off the chest to a minimum". This has been drummed in to us for years. It is now second nature to make sure that chest compressions are given as soon as we confirm cardiac arrest. But now we are advised by our Trust resuscitation team and the Resuscitation Council UK that performing chest compressions is an aerosol generating procedure (AGP), despite the advice from Public Health England who state that chest compressions is not classed as an AGP. There are a few issues here... As frontline healthcare staff we want to do the best for our patients, and we want to be kept safe by our employers. We need clarity on what we are supposed to be doing; this lack of clarity and standard guidance leads us into different interpretations of the rules and a lack of trust in our leaders. I recently taught on an Advanced Life Support Course. Here, I was teaching a range of healthcare professionals from differing hospitals from inner and outer London. I was amazed at the different practices that were going on. Some were wearing full personal protective equipment (PPE) for cardiac arrests despite covid status, some were not. The lack of clarity here made teaching very difficult as they were not sure who was right and who was wrong. They were then worrying if they had been exposed and are now losing trust in their leaders. In the NHS we use guidance that is evidence based. At present we have such a small evidence base, if any, on how we should treat patients during the pandemic. This is leading to differing local policies of which no one knows which is best. This lack of clarity and guidance also has an impact on the patient. If we are to wear full PPE for AGPs (in the cardiac arrest situation) there will be a delay in performing chest compressions; this has a negative impact on patient outcomes. Cardiac arrests are stressful; donning PPE at breakneck speed so that you can treat your patient is compounding the anxiety. It made me question – if covid is here to stay, should we be rewriting the resuscitation guidelines? Then I thought, how can you rewrite guidance in a time of flux? Things change all the time; nothing is the same from 48 hours ago – so how can meaningful standards and guidance be written if they will be out of date before they get uploaded? And re-writing guidance with consensus from experts and professional bodies takes time. What do we do in the meantime? At this stage we need guidance, we need clarity and we need to feel we can trust in those that lead us through. Call for action We need evidenced-based guidance, we need clarity and we need to feel we can trust in those that lead us through. How are leaders communicating best practice and updated relevant guidance to staff and instilling trust that patient and staff safety is a core priority?

This is a report of a qualitative survey that explored unsafe, premature discharge from hospital. The Patients Association has regularly heard from helpline callers that patients believed that they had been discharged too early from hospital,and that as a result they had either suffered harm or been at risk of harm.

The Salford Medication Safety Dashboard (SMASH) was successfully used in general practices with the help of on-site pharmacists. SMASH is a web application that flags up a list of patients who are potentially at risk from medicines they have been prescribed.

Restrictive interventions are deliberate acts on the part of other person(s) that restrict a patient’s movement, liberty and/or freedom to act independently in order to: 'Take immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is undertaken, and end or reduce significantly the danger to the patient or others.' This guide, from the Advancing Quality Alliance (AQuA) has been developed to provide a brief overview of restrictive practice and the legislation that underpins it and outline ways to reduce its use during the COVID-19 pandemic and beyond. 

In this vlog, Peter Ledwith, Safety Programme Manager reflects on the work that the Advancing Quality Alliance (AQuA) has carried out in direct response to the current and predicted conditions faced by frontline staff in health and care. Peter reflects on the Psychological Safety package that has been created in collaboration with Psychologica, which aims to develop psychologically safe environments to support effective staff wellbeing.

IMPARTS is an evidence based website with guides aimed at people with long term conditions (such as acute kidney injury, COPD and diabetes) and COVID-19. IMPARTS has put together a list of resources from condition-specific charities which they hope will help and provide reassurance during this time. This includes specific advice on the following: Coping with stress during COVID-19 (World Health Organisation) Sleep anxiety: tips to manage and improve sleep (The Sleep Council) Looking after your mental health during Coronavirus (The Mental Health Foundation) Coronavirus and your wellbeing (MIND) COVID recovery online course (Lancashire Teaching Hospitals NHS Foundation Trust) Health unlocked – a holistic approach to healthcare OCD and COVID-19 survival tips (OCD UK).  

This short blog provides a ‘glimpse of brilliance’ video on donning and doffing of PPE – this includes some reflections on experience of a care home manager in Salford.  This information is sourced from Safer Salford. 

This guide, published by the Advancing Quality Alliance, has been developed to help managers support their staff and themselves with managing stress.  It also highlights the potential issue of secondary trauma and is an introduction to this subject and part of a phased package that will cover both the crisis and recovery phase in meeting wellbeing needs of the workforce.

The Whole System Flow programme has been accepted for presentation at the International Conference of Integrated Care in San Sebastien in April 2019. This poster provides an overview of the programme’s structure and outputs. We will be opening applications in April for the next group of systems to work with on a system pathway that they choose.

In this blog, published by In Health Associates, David Gilbert discusses some of the frustrations that he has with NHS Trusts who say they want patient involvement but pay lip service or who decline offers of help. This blog invites you to comment, to discuss and debate this issue. David Gilbert is a patient director at Sussex MSK Partnership. This is a new and pioneering role in the NHS. David has strategic leadership of how the Partnership relates with patients, carers and the communities they serve, including: learning from what people think of our services (patient experience) patients as partners in care decisions (Information, choice and shared-decision making) helping people look after themselves and care for their own condition (supported self-management) patients as partners for change (patient and public engagement; patient leadership).

A recent Health Foundation long read suggests that the COVID-19 pandemic could be a watershed moment in creating the social and political will to build a society that values everyone’s health – now and in the long term. The global pandemic and the wider governmental and societal response, is certainly bringing health inequalities into sharp focus. And it has been apparent from the early stages of the pandemic that some groups are at much higher risk of catching and dying from the virus than others. Factors such as age, gender, ethnicity and socioeconomic deprivation are all known to be important. Critically, these factors combine in complex ways to put some people at much greater risk. In addition, the measures taken to control the spread of the virus are having unequal socioeconomic impacts, which are likely to deepen health inequalities in the long term. Over the coming months, the Health Foundation will continue to round up key evidence on COVID-19 and inequalities. In this article the Health Foundation give an overview of some key themes emerging from recent work on the unequal impact of COVID-19, focusing on how children and young people are being affected, and the economic effects of the pandemic.