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Patient_Safety_Learning

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Everything posted by Patient_Safety_Learning

  1. Content Article
    This guidance, from the Government Finance Function and HM Treasury, establishes the concept of risk management.
  2. Content Article
    The Health Action Process Approach (HAPA) suggests that the adoption, initiation, and maintenance of health behaviours must be explicitly conceived as a process that consists of at least a motivation phase and a volition phase.  Follow the link below to be directed to more information and resources on the HAPA approach.
  3. Content Article
    In this blog, Jo Jerrome, CEO of Thrombosis UK, explains the dangers of deep vein thrombosis (DVT) and why it is important for patients and staff to be aware of the risk factors. Jo offers advice on how we can all manage our risk of DVT, and introduces their award-winning, free patient app – “Let’s talk clots”.  
  4. News Article
    The Royal Pharmaceutical Society (RPS) is leading a new project to examine the causes of the growing challenge of medicines shortages and help tackle their impact on patients and pharmacy practice. A new advisory group, convened by RPS and chaired by RPS Fellow Dr Bruce Warner, will meet later this month and bring together experts from primary and secondary care, patients, the pharmaceutical industry, suppliers, regulators, government and the NHS. Read full press release Source: The Royal Pharmaceutical Society, 13 March 2024
  5. Community Post
    An interview published today on the hub that may be of interest:
  6. Content Article
    In this interview, we talk to Darren Powell, Clinical Lead for NHS England and Community Pharmacist, about medication supply issues. Darren shares his experiences of how medication shortages and tariffs are affecting patients and staff and offers insights into the complexity of the situation.  He tells us his thoughts on potential causes and barriers, as well as suggesting three actions for wider system safety. 
  7. Content Article
    Over the years, we have worked with many amazing women who share our aim of reducing avoidable harm in health and social care. In this blog, to mark International Women’s Day 2024, we are celebrating women who campaign for patient safety. 
  8. Content Article
    Are you a surgical doctor working in the NHS? Could you spare 1 hour of your time to share your insights and help researchers explore psychological safety? Shinal Patel-Thakkar, a trainee Clinical Psychologist, is seeking participants for a qualitative research study into psychological safety in surgical environments. In this interview she tells us more about the study, how people can register their interest, and provides reassurance that confidentiality will be maintained.
  9. Content Article
    Online healthcare services and apps can help people take more control of their health, by getting access to care easily and when it suits them. You need to make sure any medicine, treatment or health advice you get is safe and right for you. These six top tips from UK health organisations will help you keep safe if you decide to go online.
  10. Content Article
    Dr Georgia Richards provides oral evidence to the UK Parliamentary Justice Select Committee's follow-up inquiry to the Coroner Service on 20 February 2024. Watch all of the evidence given by Georgia including: Part 1: Inconsistencies in coroner reports Part 2: Could sanctions improve the Coroner Service? Part 3: Improving the status and ability of coroner reports Part 4: Barriers to making changes Part 5: The potential future utility of the Tracker In part 1, shown in the below video, Dr Richards is asked what the evidence is for variation in writing coroner reports in England and Wales.
  11. Content Article
    Safety leader Helen Macfie describes why she appreciates that Safer Together: A National Action Plan to Advance Patient Safety includes workforce safety as one of its foundational areas.
  12. Content Article Comment
    Hi @Sue Deakin, thank you for sharing these experiences. They reinforce the need for electronic systems to be safe and for changes to services, like the ceasing of funding, to be communicated to key stakeholders. These communication failures can contribute to a loss of faith in the NHS, as Miriam says in her blog. In your experience, what do you think would make a difference to patient safety when it comes to improving communications?
  13. Content Article
    Demos is Britain's leading cross-party think tank, working on different policy areas, from improving public services to building a more collaborative democracy. In this blog, Miriam Levin, Director of Participatory Programmes at Demos, tells us about their recent report, “I love the NHS but…”: Preventing needless harms caused by poor communication in the NHS. She argues there is an urgent need to improve NHS communications for patients and staff if we are to prevent people falling through the gaps and suffering worse health outcomes. Miriam highlights key issues with NHS referrals, disjointed computer systems and gaps in patient information, and offers some potential solutions. 
  14. Content Article
    Despite its reported benefits, breastfeeding rates are low globally, and support systems such as the Baby Friendly Initiative (BFI) have been established to support healthy infant feeding practices and infant bonding. Increasingly reviews are being undertaken to assess the overall impact of BFI accreditation. A systematic synthesis of current reviews has therefore been carried out to examine the state of literature on the effects of BFI accreditation. 
  15. Content Article
    Although several studies have tried to quantify the cost of ‘adverse events’ in healthcare, the true costs remain unknown. To understand the ‘true cost’ of serious incidents, Jane Carthey argues we need to consider:The cost of additional treatment for the affected patient.The opportunity costs that accrue from reporting and managing incidents, claims and complaintsBusiness costs that accrue when, for example, healthcare staff are suspended.Costs resulting from implementing the duty of candour process, andPenalties and sanctions imposedIn other industries, the HSE’s Incident Cost Calculator is used to quantify the true costs of incidents. Inspired by this tool, Jane developed the Healthcare Serious Incident Cost Calculator. Available via the link below.
  16. Content Article
    This video, was produced by Long Covid Support to show why effective Long Covid research is urgently needed.
  17. Content Article
    North Central London Integrated Care System has piloted new guidelines and a local dashboard to ensure there is a safety net in place for females taking sodium valproate.This is a paywalled article published by the Pharmaceutical Journal.
  18. Event
    until
    NHS Resolution’s Safety and Learning team, are hosting a virtual forum on the recently published research conducted by Dr Rebecca Payne and Professor Greenhalgh into the safety of remote consultations. The purpose is to raise awareness of the research evidence from incidents, claims and complaints which inform the findings and recommendations on patient safety in remote consultations. This will be of interest to all involved in telephone consultations across primary and urgent care but also of relevance to telephone consultations taking place in secondary care. The format is interactive, with presentations followed by questions and panel discussion Event programme: Patient safety in remote encounters in primary care Q&A panel discussion Contributors: • Dr Rebecca Payne - NIHR in-practice fellow, General practictioner | University of Oxford and Chair | NICE Quality Standards Committee • Prof Trisha Greenhalgh - Professor of Primary Health Care | University of Oxford • Dr Anwar Khan - Senior Clinical Advisor for General Practice | NHS Resolution Book your place
  19. News Article
    Covid vaccines have been linked to small increases in heart, blood, and neurological disorders, according to the largest global study of its kind. An international coalition of vaccine experts looked for 13 medical conditions among 99 million vaccine recipients across eight countries in order to identify higher rates of those conditions after receiving the shots. They confirmed that the shots made by Pfizer, Moderna, and AstraZeneca are linked to significantly higher risk of five medical conditions - including a nerve-wasting condition that leaves people struggling to walk or think. Read full story Source: Daily Mail, 19 February 2024
  20. News Article
    An inquest into the death of a baby has been adjourned after a whistleblower claimed hospital inspectors ignored safety concerns about a NHS trust. Ian Kemp has raised concerns the University Hospitals of Morecambe Bay NHS Trust was "covering up" the death. The former health watchdog inspector said he had been asked to investigate maternity care at the trust in December 2019 after the death of Ida Lock. Read full story Source: BBC News, 19 February 2024
  21. News Article
    The Liverpool Care Pathway (LCP) was abolished in every hospital and hospice in the country just under a decade ago. This end-of-life-care protocol was scrapped by the Government as a “national disgrace”, in the words of Norman Lamb, then Care Services Minister, after a review by Baroness Neuberger found widespread failings and abuses. But troubling evidence since the scrapping suggests that the practises established under the LCP are in fact still continuing today in the UK’s National Health Service (NHS). Read full story Source: Catholic Herald, 18 February 2024
  22. News Article
    Another inquiry has been launched into the sudden death of a second teenage girl in the Accident and Emergency department of University Hospital Limerick three weeks ago. The 16-year-old girl died suddenly on January 29, hours after she was rushed to UHL suffering from breathing difficulties. The girl, a much-loved only child, died in front of her mother in what an informed source described as “deeply traumatic circumstances”. It is the latest tragedy under review at UHL following the death of Aoife Johnston (16) from Shannon, Co Clare, Read full story Source: Irish Independent, 20 February 2024
  23. Content Article
    Intravenous therapy is an essential aspect of modern healthcare. While the benefits of using intravenous therapy usually outweigh the risks, occasionally the administration of IV therapies can go wrong. Infiltration and extravasation is a complication whereby the drug or IV therapy leaks into the tissues surrounding the vascular access device. This toolkit, developed by the National Infusion and Vascular Access Society (NIVAS), is intended to enable local services and healthcare organisations to implement polices, protocols and guidelines that will increase awareness about non-chemotherapy extravasations.
  24. Content Article
    This BMJ article summarises a selection of new and updated recommendations within The National Institute for Health and Care Excellence (NICE) guidelines on intrapartum care for healthy women and babies.
  25. Community Post
    Thank you @Lisa Riste for sharing your experience and the related safety risks of patients not being able to access their full prescriptions. Patient insights like yours will help to build a picture of the range of issues faced, and the impact these can have on individuals physical health and mental health.
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