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PatientSafetyLearning Team

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Everything posted by PatientSafetyLearning Team

  1. Content Article
    There is widely shared agreement that the Canadian healthcare system needs a sharper patient safety focus. The rate of preventable harm in all care settings is alarming, yet poorly understood, leading to complacency and acceptance of patient safety risks. 2018-2019 brought about a change in the strategic direction of the Canadian Patient Safety Institute. Their aim is to inspire and advance a culture committed to sustained improvement for safer healthcare. In this first year of their new five-year business plan, they've laid the groundwork to demonstrate what works and strengthen commitment for end-to-end patient safety improvements and are using those strategic elements to make care safer. Read this annual report to learn more about their priorities and progress.
  2. Content Article Comment
    Hi @Ellis I'm sorry you are having difficulties, I am not sure why you are unable to download the documents but I will look into it. For now, I shall send you the attachments in a direct message through your hub account.
  3. Community Post
    Here is the interview on Women's Hour for those interested:
  4. Content Article
    Dr Matt-Inada-Kim, National Clinical Lead for Sepsis and Deterioration, shares the proforma he has developed to document management and treatment for the deteriorating patient for the new CQUIN, coming soon. This proforma ensures that all the CQUIN data is captured when it comes to audit. He has shared his accompanying slide set explaining about the CQUIN.  
  5. Content Article Comment
    Thanks @Dean If anyone wants to join the conversation around pain and hysterectomy, please follow this link:
  6. Content Article
    This blog, written by Human Factors expert Stephen Rice and published by Forbes, looks at what healthcare can learn from the success of the aviation industry when it comes to safety.
  7. Content Article
    Following the news of the appointment of the UK's first harms prevention nurse consultant at Ashford and St Peter's Hospital NHS Foundation Trust, we interviewed Sue Harris on her new role.
  8. Content Article
    The World Health Organization has produced a list of questions and answers to help provide the public with accurate information on the coronavirus.
  9. Content Article
    The Secret Midwife is a heart-breaking, engrossing and important book. Joyful and profoundly shocking, this is the story of birth, straight from the delivery room. The author argues that the system which is supposed to support the midwives and the women they care for is starting to crumble. Short-staffed, over worked and underappreciated – these crippling conditions are taking their toll on the dedicated staff doing their utmost to uphold our NHS, and the consequences are very serious indeed.
  10. Content Article
    In this podcast, Peter Duffy, Consultant Urologist, addresses University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT). He speaks of the significant and damaging challenges faced by himself and others who raise concerns about patient safety, including bullying, harassment and abuse. He argues that whistleblowers are suffering personally and professionally when they speak up on behalf of patients. Duffy states: "There remain safety critical issues that the governors need to hold the Board to account over, if the Board is to regain the full confidence of staff and patients".
  11. Content Article
    An interview with Jennifer Block, author of Everything Below The Waist: Why Health Care Needs A Feminist Revolution. This interview was published on the Hysterical Women website. 
  12. Content Article
    As a cancer professional, there can sometimes be barriers to engaging patients and carers in your work. This film, made by a group of people affected by cancer working with professionals, highlights some top tips to help you get started.
  13. Content Article
    A communication passport is a way of supporting a vulnerable person with communication difficulties when they have to transition through different events, such as changing schools, or their first job. Ryan’s family made a specific communication passport for his medical file so that all the medical professionals could learn a little about Ryan before they met him and therefore be better prepared and able to interact with him. Here, his mum shares their example to illustrate how it can be used to improve quality of care.
  14. Content Article
    There are few validated tools to identify treatment‐related adverse events across cancer care settings. This study seeks to develop oncology‐specific 'triggers' to flag potential adverse events among cancer patients using claims data.
  15. Content Article
    This study, published in Patient Education and Counseling, seeks to gain understanding of breast cancer care providers’ attitudes regarding communicating with patients about diagnostic errors, to inform interventions to improve patient-provider discussions.
  16. Content Article
    In this candid blog, 'The Secret Midwife', gives her account of the pressure and lack of resource and support that makes it so difficult to provide safe care.
  17. Content Article
    The NHS has recently conducted a consultation on its updated Standard Contract for use in 2020/21. Once finalised this contract is published by NHS England and used by commissioners to contract for all healthcare services other than primary care services. The contract is regularly updated to reflect changes in legislation, policies and technical improvements. In this year’s consultation there have been several changes proposed that specifically relate to patient safety and in this blog we outline the main patient safety changes proposed and detail Patient Safety Learning’s formal consultation response.
  18. Community Post
    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
  19. Content Article
    ADASS, is a charity that provides a national voice and leadership for adult social care. In 2019, they published a report, Sort out social care, for all, once and for all, setting out what they believe needs to be done by the Government to tackle the crisis. The report called for: Short-term funding, including continuation of the Better Care Fund and Improved Better Care Fund, to prevent the further breakdown of essential care and support over the course of the next financial year. Long-term funding and reform following, to enable us to build care and support for the millions who need it and create a social care system that is truly fit for the 21st century. A long-term plan for adult social care which means a support system in place that links with other public services including the NHS and supports resilient individuals, families and communities. 
  20. Content Article
    Mark Chassin, M.D., president and CEO of The Joint Commission, sat on the Institute of Medicine committee that authored the landmark 1999 report, To Err is Human. In this podcast, he speaks to Nancy Foster, AHA vice president for quality and patient safety, about its impact on health care safety. He speaks about the need to reflect more on the type of culture that exists within zero harm organisations. He also argues that we need to ensure people feel free to speak up and ensure that everyone is accountable for consistently upholding safety processes and standards.
  21. Community Post
    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?
  22. Content Article
    The objective of this study, published in Health Services Research, was to determine whether a communication and resolution approach to patient harm is associated with changes in medical liability processes and outcomes.
  23. Content Article
    Medicines optimisation and shared decision making are frequently used buzzwords, but what do these terms mean in practice? Steve Turner shares some patient stories to reflect on.
  24. Content Article
    Steve Turner's blog look at a workshop session delivered jointly by a facilitator and a user of mental health services. The aims of the session were to discuss adherence to medicines and treatments, relate this to practice through group work and discuss this with a user of mental health services
  25. Content Article
    Steve Turner's blog discusses the use of psychotropic medicines for people with learning disabilities who show symptoms of distress. Steve offers a useful guide to help those prescribing these drugs consider all of the relevant factors so they can keep patients safe.
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