Patient_Safety_Learning

The phenomenon of acute behavioural disturbance (ABD) (also known as acute behavioural disorder or excited delirium) is an under recognised and potentially life-threatening syndrome, and an emergency in psychiatric settings. In this article from Cambridge University press, causes are discussed and the pathophysiology explained. The challenges faced by practitioners are highlighted, including how ‘standard’ control and restraint can exacerbate symptoms. Initial treatment strategies are suggested.

Acute behavioural disturbance (ABD) is a term used in law enforcement and healthcare, but there is a lack of clarity regarding its meaning. Common language should be used across staff groups to support the identification, prioritisation and delivery of care to this group of patients. The terminology currently used is inconsistent and confusing. This study, published in the Emergency Medicine Journal, aimed to reach a consensus on the criteria for identification and management of ABD, and to agree when other care pathways or guidelines might be more appropriately used.

The objective of this study, published in BMJ Sexual & Reproductive Health, was to explore experiences of pain during medical abortion and provide patient-centred recommendations for improving abortion experience and pain counselling. Authors concluded: Abortion providers should use patient-centred recommendations to better prepare patients for pain during medical abortion. Setting realistic expectations can improve abortion experience and support informed method choice. Further research is needed to develop and test patient-centred counselling materials.

Harry Vass was a 24yr old, he had a history of ADHD, poor mental health, psychosis, paranoia secondary to recreational drug use and illicit drug dependency including cocaine.  Harry attended the A&E department of Southmead Hospital on 26th December 2022 at 16.42hrs, with the reason recorded as “mental health”, he was expressing paranoid thoughts. He had a high heart rate and was sweating. He underwent a physical assessment and was assessed by the Mental Health Team.   At some point he took cocaine in the toilet of the hospital after which he became more agitated and there were concerns being raised that others in the department felt threatened. At one point he absconded from the unit but was brought back, a doctor in the emergency department gave him medication to calm him down. The police were called but when they attended Harry was calm from the effects of the medication.    The police were called and attended again when Harry’s agitation increased. It was during this discussion that the police officer raised the possibility of Harry having ABD (acute behavioural disturbance). The police officer said that he’d seen close to a dozen cases, that Harry had similar symptoms.   The two mental health practitioners said that they knew very little about ABD. After some discussions with the police officer, the two mental health practitioners and the consultant in emergency medicine Harry was deemed medically fit and he was admitted under s136 Mental Health Act to The Mason Unit (a place of safety) within the hospital at around 23.00hrs.  Once on the Mason Unit Harry continued to be distressed and agitated, he was given further medication to calm him. Harry remained disturbed but had periods of calm, he became fearful of isolation, he became sleepy and at around 3.30hrs on 27th December 2022, he vomited. Observations were carried out confirming that Harry had low oxygen saturations and a high temperature. At 4.45hrs his extremities were discolouring, and he became unresponsive, an ambulance was called. He was transferred back to the A&E department but died at 06.36hrs.  The coroner's report included the following matters of concern: Due to Harry’s level of agitation, he did not undergo the level of observations that would and should have happened either in the emergency department or once on the Mason Unit which may have assisted in assessing his physical health. It was clear that none of the mental health nursing staff were aware of ABD and the fact it is a medical emergency. The decision as to whether a person has ABD is important, Dr Delaney said that” this group are vulnerable to cardiac arrest”, that “deaths are multifactorial”, that “normally in the background a body is maintaining safe limits for e.g. pulse rate, blood pressure, temperature, but with acute disturbance in behaviour the body loses control of these safe parameters.” The full report can be found via the link below. You can also read the Royal College of Nursing response here.

A major clinical trial, led by the University of Sheffield, has revealed survival rates for patients with operable bladder cancer are significantly improved by adding an immunotherapy drug to before and after surgery.

In this article for Health Service Journal (paywalled), Trust chair Matthew Swindells argues NHS managers must be held accountable for efficiency and quality, but transparency, fair funding allocations, and a balanced performance regime are also key to driving improvements.

This document from Avon and Somerset Constabulary outlines a number of improvements initiatives they have put in place to help make sure people with mental health issues get the right care from the right person. This includes: Training five constables to perform a new role which is called the Mental Health Link Officer (MHLO). Right Care Right Person (RCRP) Avon & Somerset principles. Partnership working with Western Ambulance Service Foundation Trust (SWASFT). The positive impact of Mental Health Link Officers.  For more detail please see the attached document.   

On 18 December 2024, the World Health Organization (WHO) prequalified the first diagnostic test for glucose-6-phosphate dehydrogenase (G6PD) deficiency which can help to safely deliver WHO-recommended treatments to prevent relapse of Plasmodium vivax (P. vivax) infection. The prequalification of this G6PD diagnostic test marks a significant milestone in facilitating safe and effective P. vivax malaria treatment, reaffirming WHO’s dedication to ensuring equitable access to life-saving health solutions globally. Some 500 000 people die each year from malaria, most of them children.

Doctors in Distress focuses on supporting medical staff to prevent worsening of mental health issues. If you feel like you are struggling and want immediate help , please have a look at the support services listed on their website via the link below.

Patient safety (PS) is a basic principle of healthcare worldwide. In Saudi Arabia, medical colleges have integrated PS modules into their regular curricula. This study investigated undergraduate medical students’ and interns’ attitudes regarding PS at King Abdulaziz University (KAU), Jeddah. The findings highlight that most participants’ attitudes needed to be more positive. Gender disparities were found in PS attitudes among Saudi medical students and interns, while no significant variance was noted between interns’ and medical students’ scores.

In the field of healthcare, ensuring patient safety is a critical priority that has garnered global recognition as a pressing public health concern. Despite notable progress in medical treatments and diagnostic technologies, patients continue to be at risk of adverse events and harm during the perioperative period. Anaesthetists hold a pivotal position in this phase of patient care and have the potential to greatly impact safety and outcomes. This research sought to assess the knowledge, attitudes, and influencing factors of anaesthetists concerning patient safety in government referral hospitals situated in Addis Ababa, Ethiopia. The study revealed that over half of the participants had good knowledge (56.7%) and a positive attitude (68.9%). Factors significantly associated with patient safety knowledge included having patient safety information during continuing education [AOR = 4.016; 95% CI: (1.99–8.07)] and having a working experience of more than 15 years [AOR = 3.9; 95% CI: (1.23–12.29)]. Additionally, those who received patient safety training [AOR =2.0; 95% CI: (1.2–3.64)] were more likely to have a positive attitude than those who did not receive such training. The study found that a majority of Ethiopian anaesthetists hold a favourable view toward patient safety, with 56.7% demonstrating good patient safety knowledge and 68.9% exhibiting a favourable attitude toward patient safety. Work experience, continuous education, patient safety training, and strong knowledge were identified as crucial factors in ensuring patient safety. Therefore, it is recommended that anaesthesia professionals participate in educational programs and receive training in patient safety to address these concerns.