Jump to content
 View Profile  See their activity

  • Posts

    1,216

  • Joined

  • Last visited

PatientSafetyLearning Team

PSL Moderators

 Content Type 

Everything posted by PatientSafetyLearning Team

  1. Content Article
    ORCHA is the world’s leading health app evaluation and advisor organisation. In this interview, Chief Executive, Liz Ashall-Payne, tells us how ORCHA is driving safety improvements across the globe, empowering patients and highlights the danger of a poorly designed health app. 
  2. Content Article
    Helen Hughes, Chief Executive of Patient Safety Learning, highlights the importance of organisational patient safety standards, creating a culture that is free from fear and collaborating with both patients and frontline staff.
  3. Content Article
    This publication presents UK-focused analysis of The Commonwealth Fund’s 2019 International Health Policy Survey of Primary Care Doctors in 11 Countries. This includes responses to several UK-specific questions funded by the Health Foundation. The Health Foundation present their analysis of the data, including comparisons with the 2015 survey where possible, under three main themes: how GPs view their job what care GPs are providing and how it is changing how GPs work with other professionals and services.
  4. Content Article
    This article, published by the British Medical Journal, argues that the NHS cannot afford to divert more and more money to litigation and we need to tackle the problem at source. Tim Draycott and colleagues set out four principles to reduce avoidable harm: Invest in staffing and infrastructure Really commit to learning Learn from high performance Enable and support system-wide safety improvements.
  5. Content Article
    This pay-walled article, published in The Sunday Times, highlights patient safety concerns identified in relation to West Suffolk hospital, with specific reference to two incidences of avoidable patient harm. In the case of Daniel Parsons, a drugs error caused an adverse affect on the functioning of Daniel's heart and led to his death. The coroner for the inquest concluded that Daniel's death could have been avoided if doctors had heeded the early warning signs of anaphylaxis. The second incident highlighted by the authors is that of Paul Farmer, who was left blind and with severe brain damage following avoidable harm. Concerns raised within the article include: Prioritisation of reputation management (an 'outstanding' status) over patient safety Reluctance to investigate Unfair reprisal for staff raising patient safety concerns Lack of response from Health Secretary Matt Hancock. Further reading: Bullying executives left West Suffolk Hospital staff ‘sobbing, shaking, rocking in despair’ (March 2020)
  6. Content Article
    This pay-walled article, published in The Sunday Times, highlights serious concerns raised by staff at West Suffolk Hospital around: unfair reprisal and treatment of staff who raise valid patient safety concerns a prioritisation of reputation over patient safety  bullying behaviour from executives and management.  Further reading: I thought Daniel was safe with the NHS, he wasn't (March 2020)
  7. Content Article
    Patient Safety Learning has submitted the attached response to the consultation for the national patient safety syllabus. The NHS Patient Safety Strategy, published in June 2019, sets out three strategic aims around Insight, Involvement and Improvement which will enable it to achieve its safety vision. It defines the Involvement aim as ‘equipping patients, staff and partners with the skills and opportunities to improve patient safety throughout the whole system’. A key action associated with this aim is the creation of a system-wide patient safety syllabus which is capable of ‘producing the best informed and safety-focused workforce in the world’. The Academy of Medical Royal Colleges (AOMRC) has been commissioned by Health Education England (HEE) to develop a new National patient safety syllabus. The Academy has now published its first version of this for review and feedback. At Patient Safety Learning, we’ve been working with the AOMRC and HEE in the initial stage of development to share our thoughts on the initial proposals in this syllabus. Now that this has been formally published for consultation, we want to share our submission as part of the consultation process which closed on Friday 28 February 2020. We welcome the development of a National patient safety syllabus and believe that it’s very important that this acts as a key driver for achieving a step change in patient safety across the NHS.  In our response to the consultation we identify several areas where there are significant gaps in the initial draft that need to be addressed and comment on the development process of the syllabus, inviting a more inclusive and transparent process that enables a wide range of stakeholders to engage and contribute.
  8. Content Article Comment
    Hi @Cally yes of course, no problem. Apologies to anyone who is still having difficulty downloading these, do flag it to us in these comments if you are not able to view them. We are continuing to look into the reason for this so that these can be accessed easily.
  9. Content Article
    Incident reporting systems are commonly deployed in healthcare but resulting datasets are largely warehoused. This study, published in the International Journal of Health Care Quality Assurance, explores if intelligence from such datasets could be used to improve quality, efficiency, and safety. Results indicate that healthcare incident reporting data is underused and, with a small amount of analysis, can provide real insight and application to patient safety.
  10. Community Post
    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.
  11. Content Article
    This conceptual article published in The Joint Commission Journal on Quality and Patient Safety describes the barriers and facilitators of adopting, implementing, and sustaining the Patient and Family Advisory Councils on Quality and Safety (PFACQS) model across a large, geographically diffuse health system. Successful strategies that emerged include active board engagement, co-creation and mentorship by experienced patient advocates to support enhanced engagement by local PFACQS community members, and clear alignment with and line of sight on organisational quality and safety goals. It concludes that implementing a robust network of PFACQS focused on improving quality and patient safety requires leadership commitment to transparency, as well as mutual respect and trust. Establishing clear guidelines, structures, and processes supports early adoption. Openness to continuous improvement and adaptations are important to programme success and contribute to programme sustainability.
  12. Content Article
    By addressing new challenges and forming Actionable Patient Safety Solutions (APSS) the Patient Safety Movement Foundation believe they can reduce the number of preventable deaths in hospitals to zero. Here you will find links to 18 challenges and over 30 solutions to overcome some of the leading patient safety challenges facing hospitals today. Resources are available to download and share.
  13. Content Article
    The purpose of these three films is to share insights about inquests and support all staff working in the NHS who are called to give evidence, so that they can prepare well following the death of a patient in their care.  They are intended to be used as a stand-alone product by those called to be a witness as well as integrated as a part of full inquest training package.
  14. Content Article
    NHS Digital are proposing to make changes in how private healthcare data is collected and with whom it is shared. This will involve trialling the suitability of existing NHS systems for the collection of private healthcare data and bringing it into line with the standards, processes and systems used for NHS funded care. These proposed changes are based on feedback the Acute Data Alignment Programme (ADAPt) programme has already received from a wide range of stakeholders. Wider insight from private and NHS healthcare providers, clinicians, the public and other key stakeholders is now welcomed as part of this consultation to ensure that we address any significant issues and concerns which could prevent the successful implementation of these changes. We expect this survey will take no more than 20 minutes to complete but will vary depending on the level of detail in your response.
  15. Content Article
    This study, published in the British Medical Journal, found that current algorithm based smartphone apps cannot be relied on to detect all cases of melanoma or other skin cancers. Test performance is likely to be poorer than reported here when used in clinically relevant populations and by the intended users of the apps. The current regulatory process for awarding the CE (Conformit Europenne) marking for algorithm based apps does not provide adequate protection to the public.
  16. Content Article
    When James Titcombe is hit by the biggest tragedy imaginable to any parent, he and his wife need to confront a tragedy on a bigger scale still: the structural learning disabilities of the organisation that robbed them of their child. The ‘complexity of failure’ video documents the struggle to get the largest employer of the land to account for what was lost. Behind the bureaucracy and posturing, the lies and denials, it discovers a humanity and a richly facetted suffering by many others. It drives a determined James Titcombe to change how we learn from failure forever.
  17. Content Article
    In this PharmaTimes article, Anna Smith discusses a survey, published by Medicspot, that has revealed that pharmacists are “worried” about the supply of medicines to the UK, after we officially left the European Union (EU) on 31 January 2020.
  18. Content Article Comment
    1554354997_DeterirorationCQUINsummary2020 (1).pptx Time to ACT proforma_31st Jan 2020.pptx
  19. Content Article Comment
    Hi @Nic Mathieu yes no problem. I'm unsure why they are opening for some and not others...I shall continue to investigate!
  20. Content Article Comment
    I've included some links below to a series of blogs about investigation by Human Factors expert, Martin Langham, which may be of interest: Why investigate? Part 1 Why investigate? Part 2: Where do facts come from (mummy)? Who should investigate? Part 3 Human factors – the scientific study of man in her built environment. Part 4 of the ‘why investigate’ series
  21. Community Post
    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?
  22. Community Post
    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?
  23. Content Article
    This is the response form the Parliamentary Under-Secretary of State for Health and Social Care, Nadine Dorries MP, to an urgent question from Sir Roger Gale MP on maternity care failings at the East Kent Hospitals University NHS Foundation Trust. It was followed by questions from MPs in the chamber and Ms Dorries’ responses.
  24. Content Article
    Multidrug resistant Gram-negative organisms (MDRGN) are a type of Gram-negative bacteria with resistance to multiple antibiotics. Infections by MDRGN are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, the authors of this study, published by Antimicrobial Resistance & Infection Control, conducted a utilitarian review based on literature published from 2014 until 2019.
  25. Content Article
    Interventions information related to the patient’s medication and hospital stay is provided to the community pharmacists on discharge from hospital, who undertake a two-part service involving medicines reconciliation and a medicine use review. To investigate the association of this discharge medicines review (DMR) service with hospital readmission, a data linking process was undertaken across six national databases. The objective of this research, published by BMJ Open, was to evaluate the association of the DMR community pharmacy service with hospital readmissions through linking National Health Service data sets.
×
×
  • Create New...