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Found 323 results
  1. Content Article
    Why is it hard for a highly trained professional to speak or report about mistakes made by him or her? Jean-Pierre Kahlmann, a retired Military and Airline Pilot, and now Co-owner and CEO of Yes Human Factors Ltd, believes that every staff member in an organisation should feel safe to use her or his voice to speak about safety issues, mistakes and how to learn and improve. In this TEDx presentation, Jean-Pierre takes you on a trip through his Airforce and civil aviation career to show the added value of Just Culture in high reliability organisations. He talks about his, initial, internal resistance against speaking about his mistakes and he sees the same resistance within the culture of health care professionals.
  2. Content Article
    Medicines and prescribing are highly risky areas of health care. It is estimated that more than 200 million medication errors occur in NHS every year, and that avoidable adverse drug reactions (ADRs) cause 712 deaths per year, at a financial cost of at least £98.5 million every year.[1] Many medicines and prescribing issues have been highlighted in reports and investigations into patient deaths over the years, yet the issues around prescribing competency are yet to be fully addressed. It is time this omission was rectified. This blog explains why I believe patients, the public and healthcare practitioners, need to be aware of the Prescribing Competency Framework.[2] It outlines why the framework must be applied in practice, used in clinical supervision and CPD, and why we must all speak out of it is not being followed. The benefits of this will include prevention of unnecessary medicines being prescribed, avoidance of drug related harm, and lives saved.
  3. Content Article
    In this chapter, Wilkinson and Savulescu describe the background to the Charlie Gard case and how it played out over the first half of 2017. They will look at how decisions about medical treatment are normally made and the role of the court in decisions. They outline some of the important ethical questions raised by the Gard case.
  4. Content Article
    On 8 June 2017, the Supreme Court in the United Kingdom rejected a legal appeal in the high-profile case of Charlie Gard, a British infant with a severe genetic disorder whose parents had disagreed with medical professionals and were requesting treatment that the doctors believed was futile. The case was the latest in a series of UK legal cases where courts have authorised withdrawal of treatment against the wishes of parents. In such disputes, British judges have, with rare exception, sided with health professionals. In contrast, in North America when disputes have reached the court, the courts have invariably sided in favour of life-sustaining medical treatment requested by a loving family. Paris et al. discuss the case of Charlie Gard.
  5. Content Article
    On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017. This paper from Dominic Wilkinson and Julian Savulescu summarises the case and looks at the key factual and ethical questions arising from the Charlie Gard case, and parents’ role in decision-making for children.
  6. Content Article
    Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.By having discussions that are informed by the doctor, but take into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.
  7. Content Article
    NHS Resolution received 1,223 claims for incidents occurring between 2012 and 2017 that have cost the NHS £233 million so far. Of these cases, 728 claims are under review due to the complexities around consent. Consent can be a common contributing factor in many claims. This leaflet looks at examples of failure to provide adequate consent, a breakdown of these kinds of claims by clinical speciality, the importance of the Montgomery ruling and what supported decision making looks like.
  8. Content Article
    Shared decision making is when health professionals and patients work together. This puts people at the centre of decisions about their own treatment and care. When making decisions together, it's important that: care or treatment options are fully explored, along with their risks and benefits different choices available to the patient are discussed a decision is reached together with a health and social care professional. The link below includes guidance and tools to support patients and healthcare staff with shared decision making.
  9. Content Article
    Julie Smith is Content Director for EIDO Healthcare, an organisation that provides health professionals with resources and support around informed consent. In this blog, Julie explains what it means to give your ‘informed consent’ as a patient, and why it is so important to read the information given to you. 
  10. Content Article
    As winter pressures combined with COVID-19 create more stress for the NHS, hospitals could look at reducing exacerbating factors such as acute kidney injury, says Dr Mark Ratnarajah, managing director, UK, of digital health company C2-Ai. A study by researchers at University Hospital Southampton NHS Foundation Trust, found that Acute Kidney Infection (AKI) was a significant factor for COVID-19 admissions to Intensive Care Units (ICU) and deaths. AKI was present in 31 per cent of Covid-19 hospital patients, and the condition was associated with 27 per cent of admissions to ICU. The findings also showed that more than twice the number of COVID-19 patients with AKI died, compared to those without it. As AKI can commonly be acquired in hospital, it would be beneficial to both patients and hospitals if clinicians are able to consider the likelihood of anyone contracting the condition. For this, an individualised risk-assessment of a patient is needed, rather than a generalised catch-all approach. Click on the link below to read the full article, published in the Journal of mHealth.
  11. Content Article
    Organisations expect to see consistency in the decisions of their employees, but humans are unreliable. Judgments can vary a great deal from one individual to the next, even when people are in the same role and supposedly following the same guidelines. And irrelevant factors, such as mood and the weather, can change one person’s decisions from occasion to occasion. This chance variability of decisions is called noise, and it is surprisingly costly to companies, which are usually completely unaware of it.
  12. Content Article
    Support in clinical decision making is recognised as an educational development need for pharmacists. The health policy landscape puts the pharmacist in a central role for clinical management of long-term complex morbidities, making clinical decision making and taking responsibility for patient outcomes increasingly important. This is compounded by the COVID-19 pandemic, where healthcare environments have become more complex and challenging to navigate. In this environment, foundation pharmacists were unable to sit the GPhC registration assessment during the summer of 2020 but provisionally the registration assessment is due to take place online during the first quarter of 2021. In response to this, a suite of resources has been developed with collaboration between Chartered Institute of Ergonomics and Human Factors (CIEHF) and Health Education England (HEE). These resources are aimed in particular at early career pharmacists and their supervisors, especially those in foundation pharmacist positions managing the transition from education to the workplace environment.
  13. Content Article
    The Cynefin framework is a conceptual framework used to aid decision-making. Created in 1999 by Dave Snowden when he worked for IBM Global Services, it has been described as a "sense-making device". Cynefin is a Welsh word for habitat. The Cynefin Framework allows executives to see things from new viewpoints, assimilate complex concepts, and address real-world problems and opportunities. Using the Cynefin framework can help executives sense which context they are in so that they can not only make better decisions but also avoid the problems that arise when their preferred management style causes them to make mistakes. In this video, Dave Snowden introduces the Cynefin Framework with a brief explanation of its origin and evolution and a detailed discussion of its architecture and function.
  14. Content Article
    This guidance from the Chartered Institute of Ergonomics and Human Factors (CIEHF) is aimed at early career pharmacists, especially those in foundation pharmacist positions managing the transition from education to the workplace environment.  Support in clinical decision-making is recognised as an educational development need for early career pharmacists, making the transition from a university education where there is very little exposure to the clinical environment into the work environment. This situation is compounded by a policy landscape which puts the pharmacist in a central role for clinical management of long-term complex morbidities, making clinical decision making and taking responsibility for patient outcomes increasingly important. The guidance will also be of use to those involved in the education and mentorship of early career pharmacist.
  15. Content Article
    Some patients die after major surgery. Risk prediction tools can help shared decision making with the patient, aiding decisions on whether to operate, how to prepare and use of critical care. An international multi-centre prospective observational cohort study in 274 sites with 22,631 patients compared risk prediction with 30-day mortality. In 88.7% of cases clinicians exclusively used subjective assessment. The best predictions were from the SORT tool combined with clinical assessment. P-POSSUM Surgical Risk Scale, SRS and SORT all over-predicted risk, with SORT performing best. This 10-question SORT model has been updated including clinician assessment and provides an accurate means of predicting perioperative risk.
  16. Content Article
    Staff safety is fundamental to running an effective health service and delivering quality care. This year has highlighted how important risk assessments are in protecting the NHS workforce, as it continues to respond to the COVID-19 pandemic. We know that frontline healthcare staff are more at risk of becoming infected with COVID-19. We also know the virus has a disproportionate impact on staff from minority ethnic communities, and that many NHS workers are considered “clinically vulnerable” to COVID-19. There are also risk factors that relate to gender, age, weight and many more. This can understandably leave staff feeling confused about what they should and shouldn’t be doing to look after themselves and their colleagues.  On 24 June, it became mandatory for all trusts to complete occupational risk assessments of vulnerable NHS workers. In this interview, Patient Safety Learning speaks to James Duez, CEO of Rainbird. James tells us how his company developed an automated decision-making tool, able to produce individualised risk assessments so that appropriate measures can be put in place quickly. 
  17. Content Article
    Dr. Donna Prosser is joined by Dr John James, a patient safety advocate, and the author of A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care. The team discusses the meaning of informed consent for clinicians and patients, the steps to a genuine shared decision making dialogue, and the components that should be addressed in the decision making process. Informed consent cannot be separated from the person-centeredness of an organization. While the shared decision making between clinicians and patients and loved ones does require time, attention, and attentiveness to the patient's wishes and goals, it should be a priority for all healthcare organisations.
  18. Content Article
    The involvement of patients in decisions about their care is essential to help effectively manage long-term conditions and help achieve the best possible patient outcome. ‘Shared decision making’ ensures that individuals are supported, by their healthcare partners, to make decisions about their care or treatment, that are right for them. Shared decision making is included in the NHS Constitution, and AbbVie, a research-driven biopharmaceutical company. hopes to help continue raising the profile of patient involvement. AbbVie wants to see shared decision making be widely adopted across NHS services. To support this ambition, AbbVie held the Shared Decision Making Showcase in Parliament on the 10 March 2020. A year on from the publication of the NHS Long Term Plan, and Universalised Personalised Care Plan – which established ambitious targets to put shared decision making at the heart of patient care – the showcase provided a platform for patient groups, NHS Trusts, and healthcare providers to share their innovative work. The projects showcased ranged from MS, arthritis, Lymphoma, Autism, Hepatitis C, kidney dialysis and more—all focused on empowering patients to take an active part in decisions about their treatment and care. AbbVie has supported a number of organisations and projects to develop and enable shared decision making including two of the showcased initiatives: a survey of treatment decision experience amongst psoriasis patients and the work of the Patient Information Forum to develop and implement the Perfect Patient Information Journey.
  19. Content Article
    The OSIRIS programme is a major project of research, to understand and improve the shared decision making process for patients at high risk of medical complications as they contemplate major surgery. Led by Barts Health NHS Trust & Queen Mary University London and funded by the National Institute for Health Research (NIHR), research will be conducted with patients, doctors and carers to understand the surgical decision making process. The OSIRIS team aim to understand the values and beliefs about long-term outcomes amongst high-risk patients contemplating major surgery, how these differ from doctors’ opinions, how these affect decisions about surgical treatments, and whether patients’ opinions change once they experience surgery. They will co-design with patients and doctors, a decision support intervention, to provide an accurate and individualised forecast of the risks and benefits of surgery for each high-risk patient. You can find out more about the research methodology and the aims of the project through the link below. 
  20. Content Article
    Stress urinary incontinence is when you leak urine accidentally, especially during exercise or when you cough, laugh or sneeze. The National Institute for Health and Care Excellence (NICE) has produced a diagram that shows what treatments NICE recommends as options for managing stress urinary incontinence. If you have tried to manage your condition without surgery, but this hasn’t worked, you might like to think about surgery. This decision aid can help you and your surgeon decide together which type of surgery is best for you. You might also decide that you don’t want to have any surgery. It is important to make the choice that you feel is right for you. This will depend on your individual circumstances and how you feel about each type of surgery. Every woman is different, so this decision aid is only a guide. Information about how this decision aid was produced and the evidence on which it is based is available on the NICE website.
  21. Content Article
    Stress urinary incontinence (SUI) is the loss of urine when coughing, laughing, sneezing or exercising. It is a common and distressing condition, with negative impact on quality of life. If conservative treatment, e.g. pelvic floor muscle training, is not successful, the most successful surgical procedures are mid-urethral mesh tape, colposuspension, autologous fascial sling and urethral bulking agent injections.
  22. Content Article
    The great majority of medical diagnoses are made using automatic, efficient cognitive processes, and these diagnoses are correct most of the time. This analytic review from Berner and Graber in The American Journal of Medicine concerns the exceptions: the times when these cognitive processes fail and the final diagnosis is missed or wrong. The authors argue that physicians in general underappreciate the likelihood that their diagnoses are wrong and that this tendency to overconfidence is related to both intrinsic and systemically reinforced factors. They present a comprehensive review of the available literature and current thinking related to these issues. The review covers the incidence and impact of diagnostic error, data on physician overconfidence as a contributing cause of errors, strategies to improve the accuracy of diagnostic decision making, and recommendations for future research.
  23. Content Article
    The vast majority of healthcare is provided safely and effectively. However, just like any high-risk industry, things can and do go wrong. There is a world of advice about how to keep people safe but this delivers little in terms of changed practice. Written by Suzette Woodward, a leading expert in the field with over two decades of experience, Rethinking Patient Safety provides readers with a critical reflection upon what it might take to narrow the implementation gap between the evidence base about patient safety and actual practice. This book provides important examples for the many professionals who work in patient safety but are struggling to narrow the gap and make a difference in their current situation. It provides insights on practical actions that can be immediately implemented to improve the safety of patient care in healthcare and provides readers with a different way of thinking in terms of changing behaviour and practices as well as processes and systems. Suzette Woodward shares lessons from the science of implementation, campaigning and social movement methods and offers the reader the story of a discovery. Her team has explored an approach which could profoundly affect the safety culture in healthcare; a methodology to help people talk to each other and their patients and to listen through facilitated safety conversations. This is their story.
  24. Content Article
    Each baby counts is the Royal College of Obstetricians and Gynaecologist's national quality improvement programme to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour. Watch the Each baby counts human factors video for information on how to address issues within your unit.
  25. Content Article
    Connor Sparrowhawk died in July 2013 while he was in the care of Southern Health NHS Foundation Trust. An independent report concluded that Connor’s death was preventable and that there were significant failings in his care and treatment. This moving film describes what Connor was like by his friends and family and highlights the failings that caused the avoidable death of Connor.
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