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Patient_Safety_Learning

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Everything posted by Patient_Safety_Learning

  1. Content Article
    This guidance was developed by the Mental Health and Learning Disability Nurse Directors Forum in collaboration with experts by experience and the Care Quality Commission.Four key themes were identified:Co-design evidence-based approach ligature harm reduction planning: Incorporate local expertise through collaborations with staff and experts by experience when reviewing ligature harm risks.Therapeutic environment: Consider the balance of safety versus privacy and dignity when assessing and controlling for potential ligature harm, including the extent to which restrictions may impact on patient recovery.Individualised risk assessment: Focus on individualised approaches to risk assessment rather than tools to predict future suicide risk and treatment. Minimise use of blanket restrictions to manage known risks to aid reduction in institutional dependence.Integration into other aspects of treatment and care planning: Consider the role of other aspects of treatment and support (for example, levels of observations) and how risk assessment should be integrated into care planning and therapeutic risk assessment and co-produced safety planning, where possible.Read the full guidance via the link below.
  2. Content Article
    Two reproductive health conditions common in women, polycystic ovary syndrome and dysmenorrhea, are each associated with increasing cardiovascular disease risk, according to two preliminary studies presented at the American Heart Association’s Scientific Sessions 2023. 
  3. Content Article
    Falsified, potentially harmful Ozempic and Saxenda products have been found in the UK. This drug safety update from the Medicines and Healthcare products Regulatory Agency (MHRA) asks healthcare professionals to remind patients using these products to always obtain prescription medicines from a qualified healthcare provider and not to use products they suspect are falsified as this may lead to serious health consequences. Healthcare professionals must also remain vigilant for symptoms linked to hypoglycaemia in patients who may have obtained a falsified product containing insulin. Read the full update and advice for healthcare professionals and the public via the link below.
  4. Content Article
    This leaflet helps signpost people to support and information about prostate cancer, both nationally and regionally. It has been produced as part of the Overcoming the Barriers to Engaging with Prostate Cancer project led by Orchid, the UK’s leading charity for those affected by male cancer. The regional signposting section covers: Birmingham Bradford Bristol Dudley Leeds Liverpool Manchester Newcastle Nottingham Wolverhampton
  5. Content Article
    Paediatric drug optimization (PADO) exercises aim to identify key priority products and their preferred product characteristics for research and development. These have been successfully undertaken for HIV, hepatitis C, tuberculosis and antibiotics, demonstrating their potential and impact to accelerate access to optimal formulations in the context of fragmented, small markets for medicines for children. WHO convened and facilitated a paediatric exercise for neglected tropical diseases to ensure that more targeted research and development efforts can address the specific needs of infants and children. These are schistosomiasis, human African trypanosomiasis (HAT), scabies, onchocerciasis and visceral leishmaniasis (VL).
  6. Content Article
    Watch this short film about what to do if you experience pain in your testicle/s, by Cardiff Fertility Studies and the British Fertility Society, made in partnership with Orchid. 
  7. Content Article
    In this episode of the British Journal of General Practice podcast, the host talks to Dr Georgia Richards, a Research Fellow in the Centre for Evidence-Based Medicine at the University of Oxford, about her recent study into opioid prescribing. Opioids can also be acquired from outside of NHS services, including private prescribers, over-the-counter (e.g. CoCodamol), and through online healthcare services and pharmacies or the “dark web”. Without exploring non-NHS data, the full picture of opioid use in England cannot be understood. This is one of the first studies that sought to fill this important gap by investigating opioid prescribing in the private sector.
  8. Content Article
    Download the free Let’s Talk Clots patient information app from Thrombosis UK, and help reduce your risk of Deep Vein Thrombosis and Pulmonary Embolism in hospital.
  9. Content Article
    A survey, carried out by The Aortic Dissection Charitable Trust, assessed how Acute Aortic Syndrome is managed across NHS trusts in Great Britain, revealing some significant areas for improvement. The survey showed that the majority of NHS trusts have established policies for managing patients with chest pain, a common symptom of AAS. This demonstrates a good degree of preparedness in identifying and treating cardiovascular issues. However, the survey also found that only about half of the trusts have dedicated teaching on AAS for emergency department staff. Furthermore, there’s a lack of uniform policy for the recognition and treatment of AAS specifically. This absence of standardised guidelines and insufficient educational focus could lead to delays in diagnosis and treatment, potentially affecting patient outcomes. Find out more via the link below.
  10. Content Article
    The Care Quality Commission's new assessment framework will apply to providers, local authorities and integrated care systems. Their ratings and key questions will stay central to their approach. They will continue to use: 5 key questions (safe, effective, caring, responsive and well-led) 4-point ratings scale (outstanding, good, requires improvement and inadequate).
  11. Content Article
    The Care Quality Commission (CQC) have published the findings of their five local authority pilot assessments. Assessing how local authorities meet their duties under Part 1 of the Care Act (2014) is a new responsibility for CQC. During the pilots, the CQC looked at nine of their quality statements to assess how well each local authority is meeting its responsibilities. This enabled them to give an indicative rating. Birmingham City Council – indicative rating of good Lincolnshire County Council – indicative rating of good North Lincolnshire Council – indicative rating of good Nottingham City Council – indicative rating of requires improvement Suffolk County Council – indicative rating of good.
  12. Content Article
    This pragmatic and modular tool is user friendly, flexible, easy to navigate, and adaptable to the needs of countries. It can be used to calculate and visualise detailed costs for prioritised activities included in the NAPs on AMR. Taking into account the different country contexts, the tool can be filled using a modular approach which allows different sectors, ministries or event departments to fill in the tool independently and these plans can then be consolidated into one national costed plan.
  13. Content Article
    At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That’s why we created the hub; providing a space for people to come together and share their experiences, resources and good practice examples. To mark Men's Health Awareness Month, we are sharing 10 resources relating to men's health, including information about male cancers, how to engage men earlier and insights around the impact of traditional ideas of masculinity on patient safety.
  14. News Article
    Three patients died after delayed transfers from a private hospital within a nine-month period, coroner’s findings reveal. Three prevention of future deaths reports reviewed by HSJ raised concerns about the deaths of patients whose transfer from Spire’s Norwich facility to the NHS hospital in the same city was delayed. The sites, which are one mile apart, are run by £1bn-turnover private company Spire Healthcare and Norfolk and Norwich University Hospitals Foundation Trust respectively. Read full story Source: HSJ, 15 November 2023 Prevention of Future Deaths reports: Geoffrey Hoad (13 September 2023) Prevention of Future Deaths report: Christina Ruse (3 October 2022) Prevention of Future Deaths report: Barbara Hollis (3 October 2022)
  15. Content Article
    Research fellow, Lavanya Thana, talks to Patient Safety Learning about her latest project, looking at experiences of healthcare-related harm in the NHS. Lavanya explains why this research is so important, how people can register to take part and her hopes for how the findings might help improve safety for patients from minority backgrounds.
  16. Content Article
    On Nov 7 2023, NHS Resolution’s Safety and Learning team, hosted a virtual forum on learning from venous thromboembolism (VTE) claims in primary care. The purpose was to raise awareness of the cost and scale of harm, discuss the challenges and recommendations around recognition and treatment of VTE in general practice. We heard from a range of experts in the field with experience in developing and spreading best practice.
  17. News Article
    Large numbers of midwives report being left feeling undervalued and afraid to speak up due to bullying and widespread staffing shortages, which some say is putting mothers’ and babies’ lives at risk, according to a new publication shared with HSJ. The Say No to Bullying in Midwifery report comprises hundreds of accounts, ranging from students, newly qualified and senior midwives, heads of midwifery, maternity support workers and more. It aims to publicise and share concerns they have raised online. The report said: “Midwives have described their experiences of toxic cultures within their workplaces, with cliques, preferential treatment, unfounded allegations and poor working conditions leading to a negative impact on their health and wellbeing, including suicide attempts and midwives leaving their job or profession. Read full story Source: HSJ, 13 November 2023 Order a copy of the report
  18. Content Article
    *Trigger warning: This report contains accounts of bullying behaviours and consequences and may trigger those who have experiences of bullying. The Say No to Bullying in Midwifery report comprises hundreds of accounts, ranging from students, newly qualified and senior midwives, heads of midwifery, maternity support workers and more. It aims to publicise and share concerns they have raised online. In the numerous accounts shared all areas of the system from CQC, CEO, HR, midwifery management, universities and the unions are described as being complicit, inadequate, disinterested and even corrupt. Accounts also refer to: Unsafe work environments Exit interviews not being performed, recorded or acted upon Staff not being valued Whistle-blowers being demonised until they leave Health and safety issues and truly evidence-based practice ignored with no lessons learned. To order your copy, follow the link below.
  19. Content Article
    Orchid is the UK’s leading charity for those affected by male cancer. Since 1996, Orchid has been working to save men’s lives from testicular, penile and prostate cancer through a range of support services, education and awareness campaigns and a world-class research programme. Visit the website via the link below to find out more.
  20. Event
    In commemoration of World Diabetes Day 2023, the WHO Regional Office for the Eastern Mediterranean is organizing a thought-provoking and informative 3-hour webinar under the theme "Access to diabetes medicines and care: using WHO packages as enablers". The meeting intends to serve as a platform for information exchange between Member States, WHO country offices, the WHO Regional Office for the Eastern Mediterranean, HQ, and experts. 10am-1pm GMT. Register here
  21. Content Article
    In this article, published by Psychology Today, Eva Krockow looks at research questioning the notion that we can run out of willpower. Key points:Decision fatigue describes a depletion of choice quality with repeated decision-making.Previous studies suggested people make poorer choices late in the day, possibly affecting healthcare outcomes.Recent findings question the existence of decision fatigue and suggest a self-fulfilling prophecy.Read the full article via the link below.
  22. Content Article
    Steven Shorrock begins this editorial, published by Hindsight, by explaining what he means by work-as-judged: "We all have a habit that we are hardly even aware of; we judge others’ work performance, every day, throughout the day. Whether it’s the work of people in other organisations, in other parts of our organisation, in our own immediate work environment, when driving home, or at home, we evaluate, appraise and judge others’ performance. We don’t pay much attention to how we judge, but we ask ourselves all sorts of questions: “Did they do a good job?” “Did they work with due care and attention?” “Would I have done that?” I call this ‘work-as-judged’,and it has several characteristics that we should bear in mind." Read the full article via the link below.
  23. Content Article
    The 6 Cs are a set of values required by all patient-facing health and social care staff. This includes not only registered healthcare professionals, but also clinical support staff and non-clinical staff who may come into contact with patients or members of the public. 
  24. Content Article
    This report makes several recommendations to unlock the preventative potential of Prevention of Future Deaths (PFD) Reports. These reports should be viewed as an opportunity for organisations to improve, share good practice, and ultimately prevent custodial deaths – not as criticism to be avoided at all costs. PFD reports have an integral function in ensuring compliance with the state’s duties under Article 2 of the European Convention of Human Rights (ECHR), the right to life, both locally and nationally. This, as well as their immense importance to bereaved families, must be borne firmly in mind.
  25. Content Article
    This report published by the 99% Organisation, takes a non-partisan, citizen-focussed, data-driven, and strategic view and asks: "...is there evidence that changing the fundamental business model of the NHS – e.g. introducing insurance-based funding or breaking the NHS up into smaller units which can be privatised – could be effective as ways of tackling the current issues?"
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