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Patient_Safety_Learning

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Everything posted by Patient_Safety_Learning

  1. Content Article
    In this blog Dr Henrietta Hughes, Patient Safety Commissioner for England, outlines the activities included in the Patient Safety Commissioner Business Plan 2024-25.
  2. Community Post
    In 2010, it emerged that implants manufactured by the French company Poly Implant Prothese (PIP) had been made with substandard silicone made for mattresses, not cosmetic surgery, and had a high splitting rate. PIP was liquidated and the company's founder was sentenced to four years in prison for fraud. Patient groups say there has been little support, recognition or information for those affected in the UK, and that thousands of women continue to experience health problems.[1] Have you had a PIP implant? What has your experience been? Please comment below (sign up here first, for free) or get in touch with the team at content@pslhub.org [1] Woman pays £11,000 to fix ruptured breast implant
  3. Content Article
    One of the core ambitions of Care Quality Commission is to ensure that the services it regulates have a stronger safety and learning culture. Through their new quality statements, they are looking to assess both ‘safety through learning’ and ‘learning culture’. To ensure they take the best approach to assessing providers on this topic and to ensure they are able to give providers the best quality information on what good looks like in this area, the CQC would like your feedback through this short survey.
  4. Content Article
    Sands is the UK's leading charity working to save babies' lives and support bereaved families. In this blog, Julia Clark and Mehali Patel from the Sands Saving Babies’ Lives research team, draw on their recent Listening Project to illustrate the value of working with bereaved parents. Julia and Mehali argue that hearing and amplifying these unique insights is vital to developing safer, more equitable neonatal and maternity care.
  5. Community Post
    Physician associates are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor, providing care to patients in primary, secondary and community care environments. First introduced in 2003, PAs have become increasingly talked about in healthcare and in the media, with many discussions focused on the safety of the current approach. We want to hear from patients and carers. Have you, or someone you care for, got an experience of being seen by a PA that you would like to share? Do you feel more information about the PA role would be useful for patients? Do you have any other comments, concerns or perspectives you would like to add? Please comment below (you'll need to sign up first, for free) or contact the team at content@pslhub.org
  6. Content Article
    Panorama investigates a private hospital chain being used to help clear the NHS waiting list. With more than six million people in England alone waiting for an operation on the NHS, Monika Plaha investigates the safety record of one of the UK's biggest private healthcare providers.
  7. Content Article
    Antimicrobial Resistance (AMR) is well recognized as a silent pandemic posing a threat to human health, terrestrial and aquatic animal health, plant health, food production, food safety, environmental safety and global developmental goals. After adoption of the Global Action Plan on Antimicrobial Resistance (GAP-AMR) with five key strategic objectives and in 2015, many countries of the world developed and implemented National Action Plans for combating AMR with a One Health approach. Sri Lanka has developed and implemented the country’s first National Strategic Plan for combating AMR in 2017 (NSP 2017-2022) aligned with the strategic objectives of the GAP-AMR. Country AMR response has been organized and implemented by the national AMR focal point with focal points from human health, terrestrial and aquatic animal health and production, plant health and production, food safety and environment sectors. A  National Advisory Committee (NAC-AMR) and a National Action Plan Implementation Strengthening Team (NAPIST) have been appointed with representatives from the above sectors. The end-term evaluation of the progress in implementation of NSP 2017-2022 was conducted by a team of Sri Lankan consultant microbiologists with the support of coordinators representing One Health sectors (human health, terrestrial and aquatic animal health and production, plant health and production, food safety and environment). This activity was conducted from April-June 2023 with the support of WHO. The same team of consultants and sector coordinators continued to work to develop the revised and updated National Strategic  Plan 2023- 2028 and the National Action Plan for combating antimicrobial resistance in Sri Lanka for the next five-year period from 2023 to 2028 (NAP-AMR 2023-2028). This plan includes the indicators for Monitoring and Evaluation (M&E) framework for the implementation of NAP with selected outcome indicators to monitor the impact.
  8. Content Article Comment
    @Joy Ford thank you for taking the time to recount your experience. The impact of poor communication can be, as you have illustrated, immeasurable. You have highlighted the value in clinicians really taking the time to listen to family, patients and carers, in order to provide the best care. I am sorry you did not experience this and that his care and life was impacted as you have described. The report Miriam talks about in the blog, looks at how these barriers to good, safe care can affect people's relationships and trust with the healthcare system. I am sure it has for you. If you would like to share your experience with others to highlight areas for improvement, you can contact us at content@pslhub.org
  9. Content Article
    Following consultation, the Care Quality Commission have now published final guidance to help providers understand and meet the new fundamental standard on visiting and accompanying in care homes, hospitals, and hospices. The guidance (on Regulation 9A: visiting in care homes, hospitals, and hospices) also sets out what people using health and social care services and their families, friends or advocates can expect.
  10. News Article
    Thousands of people who are unknowingly living with hepatitis C in England could be identified and treated due to an expanded NHS testing initiative. The initiative includes new liver scanning and portable testing units to be rolled out in communities where people may be at a higher risk of contracting the infection. Also included in the initiative are testing events happening at GP surgeries and community outreach at drug and alcohol support services. Read full story Source: Guardian 8 April 2024
  11. News Article
    More than 150,000 patients had to wait a day in A&E before getting a hospital bed last year, according to new data. Freedom of information data compiled by the Liberal Democrats from 73 hospital trusts – about half the total – found that the number of patients forced to wait more than 24 hours in A&E before a bed could be found for them has increased by tenfold since 2019. The majority of those forced to wait were elderly or frail, with two-thirds of the patients over the age of 65. Read full story Source: Guardian 8 April 2024
  12. News Article
    Black women are up to six times more likely to experience some of the most serious birth complications during hospital delivery across England than their white counterparts, with the figures being described as “stark” and disheartening”, according to analysis. Black women made up 26% of women who experienced the birth complication pre-eclampsia superimposed on chronic hypertension during delivery, despite making up just 5% of all deliveries across England, according to a Guardian analysis of NHS figures for 2022-23. They were six times more likely to experience this pregnancy complication than their white counterparts, who made up 47.2% of these cases despite making up 70% of all deliveries. Read full story Source: Guardian, 8 April 2024
  13. News Article
    Pre-eclampsia affects between 1% and 5% of pregnant women, but more can be done to inform people about its dangers. While pregnant with her son in 2015, Chipiliro Kalebe-Nyamongo’s pregnancy was generally smooth – until she reached about 33 weeks. She started to develop high blood pressure, and was admitted to hospital to be monitored. It was during this period that Kalebe-Nyamongo became concerned when she didn’t feel her baby’s movements as usual. Read full story Source: Guardian, 8 April 2024
  14. News Article
    A woman died when a major private healthcare provider failed to transfer her to NHS intensive care quickly enough after she became critically ill. Sabrina Khan said Spire Healthcare staff "should have known something was wrong" with her mother, Nafisa. The BBC also obtained testimony from doctors - contracted by the company to work up to 168 hours a week - who say long hours could put patients at risk. Spire Healthcare has apologised for failings in Nafisa Khan's care. The death of Mrs Khan from east London is one of several deaths following surgery at Spire Healthcare, looked at by BBC Panorama. Read full story Source: BBC News, 8 April 2024
  15. Content Article
    You may have heard about substandard or falsified syrup harming children and even causing deaths. There have been reports of falsified diabetes and weight loss treatments. How can you protect yourself? How does WHO keep you safe from substandard or falsified medical products? WHO’s Pernette Bourdillon Esteve explains in Science in 5.
  16. Content Article
    This report sets out Care Quality Commission's activity and findings during 2022/23 from our engagement with people who are subject to the Mental Health Act 1983 (MHA) as well as a review of services registered to assess, treat and care for people detained using the MHA.
  17. Content Article
    This is an official NHS letter sent to:all general practicesall primary care network clinical directorsintegrated care board CEOsNHS England regional directors.The letter highlights guidance and actions to support the practices that employ physician associates on the implementation of roles as part of the delivery of the NHS Long Term Workforce Plan.
  18. Content Article
    The purpose of this paper, published in the Annals of Internal Medicine, was to conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation.
  19. Content Article
    With a record number of patients stuck in A&E, Healthwatch England’s CEO Louise Ansari wants to see a longer-term plan to improve conditions in which people wait for life-saving care. This should include real-life monitoring and reporting on patient experience.
  20. Content Article
    The State of the State blends two forms of research to provide a view of the state from the people who depend on it and the people who run it. To understand public attitudes, Deloitte and Reform commissioned Ipsos UK to conduct an online survey of 5,815 UK adults aged 16-75 between 27 October and 1 November 2023. Quotas were set to reflect the known profile of the UK adult offline population and a boost sample was achieved in each of the UK nations. In total 821 responses were achieved in Scotland, 713 in Wales and 420 in Northern Ireland. For the UK figures, results have been weighted back to the correct proportion for each nation. Where responses do not sum to 100 this is due to computer rounding or questions which require multiple answers to be chosen. To bring a strategic perspective, our qualitative research comprises interviews with more than 100 leaders in government and public services, which is double the number from last year. They include permanent secretaries and other senior civil servants, police chief constables, council chief executives, NHS leaders and elected representatives. The interviews took place between September and December 2023
  21. Content Article
    Aqua is an NHS health and care quality improvement organisation working across the NHS, care providers and local authorities to identify, refine and embed sustainable strategies for high-quality care and regulatory excellence. Aqua’s Strategy for 2024 to 2027 outlines their aims and priorities for this period. Through their discussions with partners and colleagues they have identified 5 key areas: Safe care Culture and Leadership excellence Listening and acting on users’ experience Continuous improvement Governance and regulatory support.  
  22. Content Article
    Sharon shares her experience of using an external female catheter. This is an example of where person centred care has a positive impact on the physical and mental wellbeing of a patient.
  23. Content Article
    In this 6 minute video, Laurence describes his experiences of post-ICU delirium.
  24. Content Article
    Person-centred interactions should be marked by listening, dignity, compassion and respect. One practical approach to providing person-centred care can be in the use of the five "Must Do With Me" elements of care to design the interactions between people receiving services and those delivering them: What matters to you? Your personal goals and the things that are important to you are discussed and form the basis of your care or treatment. Who matters to you? You are asked about the people that matter most in your life and have opportunity to involve them in the way that you choose. What information do you need? You get understandable full information and are supported to make decisions that take account of your personal goals and the things that are important to you. Nothing about me without me. You are always given the opportunity to be involved in discussions. All information exchanges and communication between professionals or between different services are transparent and always provide you with the opportunity either to be present or to contribute to the process. Personalised contact. As much as possible, the timing and methods by which you contact and use services or supports are flexible and can be adapted to your personal needs. Find out more via the link below to the Healthcare Improvement Scotland website.
  25. Content Article
    In this Guardian article, Theopi Skarlatos explains how she was making a documentary about the UK’s midwife crisis when she lost her baby. By then she had heard time and again about understaffing, depression, burnout …
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