PatientSafetyLearning Team

The following comment came from the Associate Director of Allied Health: Patient Safety and Quality at Wellington Hospital. 

I'm noticing a national trend here in NZ for hospital pharmacy departments to significantly reconfigure their services in response to COVID-19. There are several key changes I'm noticing:

1. Moving from a ‘normal business hours plus on-call after hours and short-day weekend service’ to ‘a seven day service’ but I think these will mostly still be business hours with on-call only for AH.

2. Splitting teams into 'hot' and 'cold' teams and alternating on and off site, generally along lines of four days on/off to enable covering the 7-day service but also to reduce the risk of COVID sharing.

3. Reductions in clinical service in order to maintain supply services across seven days. This is happening in a variety of ways. Some are still doing medicines reconciliation with full patient interviews as before but to fewer areas, some are stopping the interviews for COVID patients and aiming to do these by phone consult (for patients who are admitted and able to communicate), and some are only doing clinical services remotely so as to not be going to and from the ward to the main department. This latter option is a high level of restriction but somewhat justified due to the risk of having one team member exposed and the whole supply chain potentially forward-exposed and at risk.

I thought I'd share this to note the planning we’re doing but also to see if others have any learnings around this topic. Hospital pharmacy teams are often in situations in NZ whereby they perform two key functions – medicines supply and clinical advice – the medicines supply is considered "core" and almost always prioritised over the clinical advice function; however, the clinical advice function has become so well ingrained that activities, such as medicines reconciliation now rely on the clinical pharmacists to do this activity well. They're also somewhat unique to other hospital teams in that the back-up to the main supply team is the clinical team and both teams generally share the same departmental space. This could be adjusted, but in order to have a robust system, with all well-trained in the supply function, we really need to see the clinical teams being pulled back and available to swap in/out with the supply teams. So over time, as the situation ramps up, it seems likely that the clinical function may become on request only or something along the highly restricted lines. This is also due to quite a limited capacity at the best of times for the clinical service in most areas.

I’d be really interested to hear how other teams, pharmacy in particular, are managing this from a practical sense.

Ngā mihi (best wishes)

Dan

Dr Daniel Bernal (BPharm, hons, PhD)

Recommendations for Rapid Response Teams (RRTs) and Critical Care Outreach (CCO) services in the context of the COVID-19 pandemic (23 March 2020)

Over the past few weeks I have become increasingly anxious about the donning and doffing process.
What we know from evidence is that fatigue and speed of doffing (specifically) can have an impact
on staff safety and potential exposure. There is good evidence from the Ebola outbreak of
healthcare staff contracting the disease because PPE donning and doffing was not completed in the
correct order or with sufficient care.

We have also had a lot of anxiety about PPE from staff who have never had to wear PPE.

Inspired by the Breathing Apparatus Entry Control Officer role used in the Fire Service, I came up
with the idea. We tested a few ideas amongst the infection control team - we also considered using
'doffing buddy' - but we wanted the role to be taken seriously, hence the 'PPE Safety Officer'.

There are two types of functions.

1. Heightened presence across the organisation so that colleagues feel safe. The PPE Safety Officer will be able to answer questions and give reassurance. It also gives confidence to colleagues that their safety is now the highest priority.
2. In clinical settings (red zones) the PPE Safety Officer will support the donning and doffing procedure - going through a stepwise checklist (like the Fire Service).

We started implementation on Friday last week, early indications are that it is welcomed by the
team, it is giving a sense of reassurance and security at a very uncertain time.

Steve Hams

Director of Quality and Chief Nurse Director of Infection Prevention and Control at
Gloucester Hospitals NHS Trust.

Do you have something similar set up at your local hospital?

Do you think it would help to have a PPE Safety Officer? 

Is staff protection being prioritised? 

BACCN: Resources for nurses redeployed or returning to critical care during the COVID-19 crisis

The following comment was shared with us through the Global Patient Safety Network:

From the ICU trenches as an intensivist, I send my regards to all of you.

My 2 cents as it is busy and getting busier by the hour:

This is the time when our challenge as patient safety experts, advocates and enthusiasts to go back to the bedside and gain our front-staff confidence that we help them do their mission rather than present them with one more bureaucratic barrier they need to overcome to take care of the patient.

1. Staff need PPE; aggressive PPE. If we lose our workforce, we lose it all.

2. Staff needs less training modules and emails of new policies, and more on the ground assistance (e.g. tips/protocols for proning patients, facilitation of direct knowledge exchange across borders between similar practitioners, and facilitation of off-label use of medications that are showing promise).

Stay well.

Haytham.

Haytham Kaafarani, MD, MPH, FACS

Do you usually access cancer-related services, treatment or care? Or perhaps you are waiting for tests or appointments that will help diagnose whether or not you have cancer?

We want to know how cancer care is being impacted by the coronavirus outbreak.

We’re asking for patients, carers, family members and friends to share their stories, highlight weaknesses or safety issues that need to be addressed and share solutions that are working. We will be identifying themes and reporting to healthcare leaders with your insights. We want to help close the gaps that might emerge as everyone focuses on the pandemic.

Please share your stories in the comments below. You’ll need to sign up (for free) to join the conversation. Register here - it's quick and easy. 

Do you usually access services, receive treatment or take medication for mental health difficulties? 

How is this being impacted by the coronavirus outbreak? 

We’re asking for patients, carers, family members and friends to share their stories, highlight weaknesses or safety issues that need to be addressed and share solutions that are working. We will be identifying themes and reporting to healthcare leaders with your insights. We want to help close the gaps that might emerge as everyone focuses on the pandemic.

Please share your stories in the comments below. You’ll need to sign up (for free) to join the conversation. Register here - it's quick and easy.

The link below shows a powerful essay that has gone viral among patients, public and healthcare staff. It is written by Dr. Joshua Lerner, an Emergency Room (ER) doctor who currently works at the Leominster campus of UMass Memorial Health Alliance-Clinton Hospital in the US. He speaks with passion, anger and frustration at the disregard for staff safety and calls for action from multi million companies who have the resources to help.

How did Dr Joshua's words make you feel? Please share your thoughts in the comments below. 

Patient Safety Learning has now drafted a submission to national patient safety syllabus consultation, which is available through the below link.

Please do take a look and provide any feedback before Friday 28 February, which is the deadline for our finalised submission.

Hi @Florrie it looks like this study took place in Egypt, I am not sure whether this treatment is available in the UK. Perhaps this was a small research sample only and it is not widely available. They conclude that: 'Flushing of the cervical canal and uterine cavity with local anaesthetic significantly decreased pain sensation in women undergoing office hysteroscopy.' 

Does anyone else know if this is offered in the UK?

We've just published a link to a recent paper on the value of endocervical and endometrial lidocaine flushing before office hysteroscopy. Does anyone have experience of this they are happy to share. How effective was it for managing pain? 

Here is the interview on Women's Hour for those interested: 

Here are some of the resources on the hub around this topic:

Why should healthcare agencies refer to restorative justice?

A restorative justice innovation: Responding to harm from surgical mesh in New Zealand

Blog: Using a restorative approach to respond to adverse events

Restorative justice brings those harmed by crime or conflict and those responsible for the harm into communication, enabling everyone affected by a particular incident to play a part in repairing the harm and finding a positive way forward. This is part of a wider field called restorative practice.

Restorative practice can be used anywhere to prevent conflict, build relationships and repair harm by enabling people to communicate effectively and positively. This approach is increasingly being used in schools, children’s services, workplaces, hospitals, communities and the criminal justice system.

What are your thoughts on how this approach would work in a healthcare setting? Does anyone have any experience of using restorative practice?

@Jayne Addison this thread may be of interest to you/ relevant to your role. What are your thoughts? 

This recent report from New Zealand looks at restorative approaches and may also be of interest:

A restorative justice innovation: Responding to harm from surgical mesh in New Zealand (December 2019)

Thank you for sharing it on the hub @Jo Wailling

Hi @Sophie E Caswell the following resources around consent may be helpful...
GMC - Consent: patients and doctors making decisions together (June 2008, currently under review)

Consent: The Montgomery Ruling (2015)
 

Below is another link to an incivility resource and also a fact sheet that highlights some of the issues incivility can cause and how these can impact patients. 

Civility Saves Lives – the impact and importance of civility in the workplace

Here are some resources we have on the hub now that look at workplace incivility and the impact that rudeness can have on patient safety. This includes a really interesting TEDx talk from Chris Turner who founded Civility Saves Lives.

TEDx: When rudeness in teams turns deadly (Chris Turner)

The impact of rudeness on medical team performance: a randomised trial

Make or break: incivility in the workplace

BMJ Quality & Safety: Exposure to incivility hinders clinical performance in a simulated operative crisis

And a news article from Nursing Notes:

Nurses need to be kinder to each other or patients will be negatively affected, warns Senior Nurse

Hi @Sarah Clerk thank you for sharing the website address. Are you able to give a bit more information around the work of the organisation and why people following this thread may find it useful? 

If anyone else is interested, the webinar that @Evelyn Prodger mentioned on clinical burnout can be accessed retrospectively. Just register via the link on our events calendar.