Claire Cox

The Human Connection is a comprehensive set of clear and resonant stories that illustrate the impact of ergonomics and human factors, produced by the Chartered Institute of Ergonomics and Human Factors (CIEHF). The 60-page document is intended to be of value to a wide range of audiences, including government, policy makers, industry, third sector groups, educators, research funders, regulatory bodies and collaborators. The case studies, available here as the complete set or individually, have been written to increase understanding of the complexity, range and value of the discipline of ergonomics and human factors. The full case studies document is free to download. Request a copy by completing the request form, after which you will receive a link to the document on screen and by email.

This poster by University Hospitals Birmingham NHS Foundation Trust, gives an overview on the different types of test for COVID-19 for patients and the general public. It explains the differences between the antigen PCR test and the antibody test. See the attachment for a downloadable file of the below infographic.

The Government has given the green light for dental practices to reopen in England from 8 June 2020. For a dental practice to treat you, they will need fully compliant Personal Protective Equipment, to exercise social distancing measures and apply appropriate cross-infection control. This means there may be a delay before your dental practice can fully reopen and the range of treatments on offer might be limited. Follow the link below to watch a short video on how you can access dental care, treatment and advice as dental practices begin to reopen.

The COVID-19 pandemic has resulted in an overall surge in new cases of depression and anxiety and an exacerbation of existing mental health issues, with a particular emotional and physical toll on health care workers. Limited resources, longer shifts, disruptions to sleep and to work-life balance and occupational hazards associated with exposure to COVID-19 have contributed to physical and mental fatigue, stress and anxiety and burnout. In this article, published by Wolters Kluwer, the Houston Methodist Hospital share the lessons learned collectively by an interdisciplinary team of Intensive Care Unit (ICU) leadership and collaborating scientists about the experience of occupational fatigue and burnout of intensive care personnel as a result of responding to the COVID-19 pandemic. They propose specific policy recommendations and guidelines for organisational readiness, resilience and disaster mitigation.

The Crown Prosecution Service (CPS) prosecutes criminal cases that have been investigated by the police and other investigative organisations in England and Wales. The CPS is independent and make their decisions independently of the police and government. This web page includes information on: What is a 'death in custody'? Death following contact with the Police Handling of death in custody cases Who investigates deaths in custody? Who advises on charge and prosecutes death in custody cases? Self-defence and Reasonable Force CPS contact with families The Coroner The Inquest.

I have been honest in my blogs during the pandemic. I have been apprehensive, scared and, at times, excited to work in the pandemic. So why do I feel so low at this moment? I am experiencing feelings that I have not had before. I have thoughts of leaving nursing. Surely, I can’t be the only one? Why now? Why am I feeling like this? This blog is to explore why this might be. It has now been over 70 days since lockdown. Yes, the restrictions are easing – and this is great news for people who have been isolated for so long, it is great for the economy – but we are waiting for the second wave. My last blog spoke about how we are going to get back to ‘normal work’ and my anxieties about how we were going to do this. Slowly, we have been trying to get back to some kind of normal, but it feels confusing, slow and uncertain. None of us can see the ‘end’. None of us knows what the ‘end’ will look like, when it will happen or will even know when it happens. Remembering the early days of lockdown, the streets were empty, the roads were quiet, there were huge queues for food, and everyone seemed scared. It was a little like the post-apocalyptic film '28 Days Later'. We have all had our highs and lows: the NHS clap every Thursday, rainbows in windows, connecting with family, being furloughed, has meant some people have enjoyed lockdown. The flip side is that for some it has been a living nightmare: money worries, domestic violence, child abuse, operations cancelled and bereavements. Unlike the film that lasts 113 minutes, has a set plot that it follows and ends up with them being rescued, we are still stuck 70 days plus in and there seems no hope of a rescue. Real life does not offer us closure, does not always have a happy ending and, unlike dramas on the BBC, life is not always fair. I’m not even sure we are in the middle, which makes me feel even more helpless. I have been nursing for over 20 years. I have loved working with patients; I have even loved working in the institution that is the NHS. The politics, the hierarchy, the culture, yes, it's difficult work trying to negotiate around obstacles and blockers, but we do it and, weirdly enough, enjoy it. But this pandemic is different. In all honesty, I can’t do this anymore. Work was hard enough, but now it’s even harder. Knowing how to care for patients safely in the right area, wearing PPE all day, not being able to communicate properly through the masks, and having procedure and policy changing weekly, sometimes daily, is wearing. I feel like a new starter every day, especially after days off. I’m tired of it and can’t see an end. Due to this lack of enthusiasm, I feel I am failing at giving the care I want to, failing to give patients the care they deserve. This feeling is horrible. What kind of a nurse are you if you have ‘run out of care’? I know this is burnout. I didn’t want it to be. But it is. In January, I didn’t feel like this. This burnout has been because of the pandemic. I am interested to find out why now? I can’t be burnt out from a few months of difficult working conditions, can I? While looking into this and trying to make sense of my feeling, I came across Kanter’s Law. Rosabeth Kanter is a Harvard Business School Professor and according to her “in the middle, everything looks like a failure". Everyone feels motivated by the beginnings and obviously we love happy endings, but it is in the middle where the hard work happens. She states that in the middle, we all have doubts. This feeling is principally produced because important changes are not developed the way we would like it to, lineal and smooth. The changes that remain usually involve two steps forward and one step back. This is evident when we are trying to get back to ‘business as usual’ but new cases of the virus are detected and we can’t proceed as we thought. In addition, it’s easy to feel that when we are in the middle we are very far away from the expectations we had made. Unexpected events take place as well as deviations. What it had been estimated in regard to the need of resources appear to not be enough. It is then when despondency appears. We can’t plan, we can’t mitigate risks effectively, which often leads us into failure. This is why it’s important to fully understand that failure is a necessary part of change, because there will be periods of confusion in which the temptation to abandon will be great. I’m at the abandon bit! This work is difficult. I am not in the position where I can make big changes in my Trust. I must trust that others are making good decisions and they will support us if things don’t go as expected. Call to action I can’t be the only person feeling this now. What are Trusts doing to guide staff through uncertainty, prevent burnout and inform staff of plans for the future?

The Chartered Institute of Ergonomics and Human Factors (CIEHF) presents advice from the experts. Consultant Anaesthetist Michael Moneypenny discusses how Human Factors experts can help NHS staff cope with fatigue, while Professor Kristy Sanderson discusses the risks and tactics. Both the President and the Chief Executive of the CIEHF offer their expert opinion in this short podcast aimed at frontline workers.

As the NHS takes it's first steps out of lockdown, the safety of the workplaces is crucial. Kim McAllister spoke to three experts in psychology, human factors and ergonomics to discuss the physical, emotional, psychological and cognitive issues around returning to work safely. This podcast, from the Chartered Institute of Ergonomics and Human Factors Group offers advice to employers and employees alike.

Safety Differently are a safety news site, crafted by professionals and enthusiasts from various industries around the globe. They share innovative and critical safety ideas to empower a community of change-makers to make an impact and do safety differently.

'When problems occur we hunt for a single root cause, that one broken piece or person to hold accountable. Our analyses of complex system breakdowns remains linear, componential and reductive.' This is evident in healthcare. Barry O’Reilly is a business advisor, entrepreneur and author who has pioneered the intersection of business model innovation, product development, organisational design and culture transformation. In this blog he discusses the 'drift into failure', i.e. we had the warning signs but accepted them as the norm.

If a nasogastric tube (NGT) has been misplaced into the respiratory tract and this is not detected before fluids, feed or medication are given, death or severe harm can be caused. The consequences are even more likely to be fatal for patients who are already critically ill. Most nasogastric ‘Never Events’ of feeding into the respiratory tract through a misplaced tube continue to arise from misinterpretation of x-rays by staff who had not been given training in the ‘four criteria’ technique and were unaware that relying on the position of the tube tip alone on a radiograph can be a fatal error.  This easy reference guide has been produced because: Some aspects of COVID-19 presentation and treatment present special challenges for safely confirming nasogastric tube position. The dense ground-glass x-ray images can make x-ray interpretation more difficult, and the increasing use of proning manoeuvres in conscious patients increases the risk of regurgitation of gastric contents into the oesophagus and aspiration into the lungs which will render pH checks less reliable. This aide-memoire is not designed to replace existing, established, NHSI compliant practice of NG confirmation. If a critical care provider is in the fortunate situation of having nursing and medical staff who have all completed local competency-based training in nasogastric tube placement confirmation aligned to local policy, they would be able to continue more complex local policies. Such policies might include specific advice indicating which critical care patients could have pH checks for initial placement confirmation, and which require x-tray confirmation, and how second-line checks should be used if first-line checks are inconclusive. However, staff returning to practice, or redeployed to critical care environments, including in Nightingale hospitals, will be helped by reminders of established safety steps in a form that can be used for all critical care patients, rather than requiring different processes for different patients. This is version 2 of the aide memoire, which includes additional advice on situations where providers can continue to safely use more complex local polices. Other changes were minor refinements of language and use of capital letters to emphasise application to checks before first use.

The results of Digital Health Intelligence’s first survey of CNIO Network members provides a ’state of the nation’ insight into nursing and allied health professional leadership in healthcare IT. This webinar offers a chance to learn about some of the key findings of the survey and to hear from senior nursing figures on their thoughts about what it means for where we go next. This webinar will be of interest to: anyone currently working in a nursing/allied health professionals (AHP) clinical informatics role those who aspire to develop their career in this area those who are seeking to set up such a role within their organisation those currently working with CNIOs/AHP informatics leads. Attendees will learn: more about how CNIO/AHP informatics roles are currently set up in the NHS – time commitment, reporting structures etc what the profile is of those holding such roles about possible challenges in connections between CNIOs/AHPs in informatics roles and CCIOs and CIOs thoughts on whether the CNIO/AHP informatics role should be formally recognised further views from senior leaders on the future of these roles.

This blog has been written for the Health Foundation and looks at the impact COVID 19 has had on patients with long term condions. The purpose of this blog was to examine the impact of COVID-19 on access to and use of health care services for people with pre-existing health conditions including asthma, cancer diabetes, heart disease and mental health illness. The Health Foundation supported an online YouGov survey of members of the public, designed by the Resolution Foundation. 6,005 UK citizens responded to the survey between 6 and 11 May. This blog draws on the data and looks at: the level of reduction in access for care management the reasons behind the reduction in access.

The current COVID-19 pandemic has necessitated the redeployment of NHS staff to acute-facing specialties, meaning that care of dying people is being provided by those who may not have much experience in this area. This report published by Future Healthcare Journal, details how a plan, do, study, act (PDSA) approach was taken to implementing improved, standardised multidisciplinary documentation of individualised care and review for people who are in the last hours or days of life, both before and during the COVID-19 pandemic. The documentation and training produced is subject to ongoing review via the specialist palliative care team's continuously updated hospital deaths dashboard, which evaluates the care of patients who have died in the trust. It is hoped that sharing the experiences and outcomes of this process will help other trusts to develop their own pathways and improve the care of dying people through this difficult time and beyond.

The COVID-19 pandemic is challenging the Canadian emergency departments (EDs) in unparalleled ways. As part of the frontline response, EDs have had to adapt to the unique clinical difficulties associated with the constant threat of COVID-19, developing protocols and pathways in the setting of limited and evolving information. In addition to the disruption of routine clinical care practices, an underlying perception of danger has resulted in a challenging clinical environment in which to make time-sensitive, high-stakes decisions. This has created an urgent need for targeted and adaptive training for all members of the emergency medicine healthcare team. The following commentary, published here by the Cambridge University Press, reflects the perspective of four emergency medicine simulation educators during the Canadian response to COVID-19.

The prone position is defined as lying in a horizontal position with the front of the body facing downwards. Its use with critically ill patients with respiratory compromise is known to improve short-term oxygenation and lung compliance. The desired outcome of prone positioning is to improve lung perfusion and oxygenation in patients who are in the early stages of pneumonia or who have an acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) which is common in COVID–19 patients. One of the most common complications of nursing patients in the prone position is the occurrence of pressure ulcers. Pressure ulcers are likely to occur as patients are repositioned far less frequently once in prone (generally only after 16 hours) and also the patient may develop significant facial oedema. It is important therefore to take precautions to reduce the risk of pressure ulcers when preparing for and caring for the patient in the prone position. This NHS guidance promotes good skin care during prone positioning. 

Several factors can compromise patient safety, such as ineffective teamwork, failed organisational processes and the physical and psychological overload of health professionals. Studies about associations between burnout and patient safety have shown different outcomes. In this paper, published by Medicina (Kaunas), a team in Brazil analysed twenty-one studies, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses and it is associated with external factors such as: high workload, long journeys and ineffective interpersonal relationships.

There have been about 1,500 deaths in police custody since 1990, and about one third of those who died were from black and minority ethnic backgrounds. About a tenth of identified deaths in police custody were people from black and minority ethnic backgrounds. This is based on figures from the charity INQUEST, which has identified 1563 deaths in total during or following police contact in England and Wales since 1990.

We all can experience mental health problems, whatever our background or walk of life. But the risk of experiencing mental ill-health is not equally distributed across our society. Those who face the greatest disadvantages in life also face the greatest risk to their mental health. The distribution of infections and deaths during the COVID-19 pandemic, the lockdown and associated measures, and the longer-term socioeconomic impact are likely to reproduce and intensify the financial inequalities that contribute towards the increased prevalence and unequal distribution of mental ill-health. This briefing discusses the mental health effects of these financial inequalities in the context of the COVID-19 pandemic. It draws evidence from the “Coronavirus: Mental Health in the Pandemic” research – a UK-wide, long-term study of how the pandemic is affecting people’s mental health. The study is led by the Mental Health Foundation, in collaboration with the University of Cambridge, Swansea University, the University of Strathclyde and Queen’s University Belfast.

Lt Col Chris Gibson, MBE, Specialist Leadership Adviser, Former Lieutenant Colonel, Defence Medical Directorate, gives the keynote address at the Kings Fund event in June 2018, Innovation in health and care: overcoming the barriers to adoption and spread.

Army, Navy and Air Force medical personnel care for Soldiers, Sailors, Airmen, Marines, Coast Guardsmen and all who come in harm's way – on and off the battlefield. This video, in less than 4.5 minutes, provides a glimpse of the unique mission and benefits of military medicine.

The Department of Defence (DoD) Patient Safety Program's Resource Guide was developed to engage, educate and equip readers with products, services, tools and solutions to help ensure the safe delivery of health care in the Military Health System. This comprehensive 18-page guide includes: Training and enrollment information for patient safety champions and facilities interested in teamwork using the  TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based teamwork system designed to improve the quality, safety and efficiency of healthcare. TeamSTEPPS consists of a collection of instructions, materials and tools to help drive a successful teamwork initiative from the initial planning to implementation through to sustainment. The system is designed to improve patient safety using a three-phase approach: Phase I Assessment: Facility determines organisational readiness; Phase II Planning, Training & Implementation: Facility “decides what to do” and “makes it happen;” and Phase III Sustainment: Facility spreads the improvements in teamwork performance, clinical processes and outcomes resulting from the TeamSTEPPS initiative.TeamSTEPPS method. Learning opportunities for commanders, leaders, providers and patients. Information about the measurement and reporting of events that could cause harm to patients and how to apply changes through documented studies. Online DoD PSP and partner resources and publications. An overview of continuing education credit-eligible learning opportunities offered by the DoD PSP. The guide also provides helpful links and contact information for readers interested in learning more about the highlighted resources. The majority of DoD PSP tools and resources are available to anyone providing care in the Military Health Service. These evidence-based resources offer opportunities to make any heath care facility safer and more open to discussions to build a culture of safety.

This toolkit is available by request to the Department of Defence Patient Safety Programme. The benefits of team events like briefs and huddles are documented. Briefs, or briefings, are planning events that occur before a case (for example, in the operating room), a shift, a procedure, a day in the clinic/office, or before an intervention. The brief allows the team leader to explain what is going to happen, cover pertinent contingencies, get input from each member of the team (including the patient), and ensure that each team member knows his or her roles and responsibilities. Huddles are team events for problem solving and updating the plan. Anyone can call for a huddle to deal with new issues, added complexities, unusual circumstances, or any need to adapt the earlier plan. Huddles occur frequently throughout the health care system and many times throughout the day. Briefs and huddles can be used in virtually any health care venue. The Briefs and huddles toolkit contains everything you need to implement briefs and huddles in your health care organisation. The toolkit includes: Toolkit overview Toolkit user guide Briefs and huddles facilitation guide Briefs and huddles facilitation slides Handout Briefs and huddles quick review Additional resources Action planning guide Toolkit evaluation form.