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Content Article
NHS Pathways
Patient Safety Learning posted an article in Care pathways
NHS Pathways is a clinical tool used for assessing, triaging and directing the public to urgent and emergency care services. -
News ArticleHealthcare apps that triage patients should be put through a ‘fair test of clinical performance’ published by NHS England to ensure their safety, according to the Care Quality Commission (CQC). In addition, the Department of Health and Social Care should look into whether ‘safety-netting’ advice should be available to the public about how to use symptom checkers, said the CQC. The CQC made the recommendations as part of work to shape its approach to regulating healthcare apps. It found digital triage tools are currently not fully clinically validated or tested by product regulators and discovered ‘there is great variation in their clinical performance’. NHS England and other bodies should assess where people have been wrongly escalated, resulting in undue anxiety, as well as where tools have failed to address people’s ill health, said the CQC. Read full story Source: PULSE, 30 January 2020
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News Article
Better tech: not a ‘nice to have’ but vital to have for the NHS
Patient Safety Learning posted a news article in News
In a keynote speech at the Healthtech Alliance on Tuesday, Secretary of State for Health and Social Care, Matt Hancock, stressed how important adopting technology in healthcare is and why he believes that it is vital for the NHS to move into the digital era. “Today I want to set out the future for technology in the NHS and why the techno-pessimists are wrong. Because for any organisation to be the best it possibly can be, rejecting the best possible technology is a mistake.” Listing examples from endless paperwork to old systems resulting in wasted blood samples, Hancock highlights why in order to retain staff and see a thriving healthcare, embracing technology must be a priority. He also announced a £140m Artificial Intelligence (AI) competition to speed up testing and delivery of potential NHS tools. The competition will cover all stages of the product cycle, to proof of concept to real-world testing to initial adoption in the NHS. Examples of AI use currently being trialled were set out in the speech, including using AI to read mammograms, predict and prevent the risk of missed appointments and AI-assisted pathways for same-day chest X-ray triage. Tackling the issue of scalability, Hancock said, “Too many good ideas in the NHS never make it past the pilot stage. We need a culture that rewards and incentivises adoption as well as invention.” Read full speech -
News Article
Patient had wrong eye injected after software error
Patient Safety Learning posted a news article in News
Herefordshire clinicians injected a patient in the wrong eye after a technical blunder, board papers have revealed. The Wye Valley Trust patient was injected with an antivascular endothelial growth factor to treat age-related macular degeneration. They did not come to harm as a result of the incident. The mistake occurred after the ophthalmology department deleted a poor quality image of one of the patient’s eyes. This shifted up the other images, which were stored sequentially using software called IMAGEnet6, which led to the mistake. Although initially reported as a “never event,” the incident was downgraded to a “serious incident” after a review by the Herefordshire Clinical Commissioning Group (CCG). The trust, which is still using the software, is updating its standard operating procedure and has installed new technology that can take higher quality images. A spokesman said: “Patient safety is the trust’s priority. While no harm was caused to this patient, the trust has taken this incident seriously.” Read full story (paywalled) Source: HSJ, 21 January 2020 -
Content ArticleMedicines errors in care homes are unacceptably high. A key study found that residents taking 7 or more medicines had a 79% chance of being a victim of a medicines error (Alldred et all 2009). In his article, published by Care Right Now, Steve Turner discusses the benefits and challenges of electronic MAR charts and best practice in medicine record keeping.
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News Article
Ways to identify EHR usability issues and reduce patient harm
Patient Safety Learning posted a news article in News
An electronic health record (EHR) bug that transmits and medication order for 25 mg of a drug – not the prescribed 2.5 mg – could be the difference between life and death. And it’s that seemingly impossible reality that’s bringing more industry stakeholders to the table working to better understand EHR usability and its effects on patient safety. “Often times when people think about usability, they think about design and then they think about the EHR vendor,” Raj Ratwani, PhD, Director of MedStar Health Human Factors Center, said in an interview with EHRIntelligence. “In reality, it's a very complex space. The products that are being used by frontline clinicians are shaped by the vendor. But they are also shaped by how that product is implemented at that provider site, how it's customized, and how it’s configured. All of those things shape usability.” EHR usability issues are an exceptionally common issue, Ratwani reported in a recent JAMA article. About 40% EHRs reported having an issue that can potentially lead to patient harm and about 786 hospitals and 37,365 individual providers may have used EHRs with potential safety issues based on required product use reporting. Direct safety challenges typically come from EHR products that are sub-optimally designed, developed, or implemented. Usability issues stem from a very cluttered interface or a complex medication list. Seeing a cluttered list can lead to a clinician selecting the wrong medication. A major usability issue also comes from data entry. EHR users want that process to be as clean as possible. Consistency in the way information is entered is also key, Ratwani explained. Ratwani also wants to ensure that certification testing is as realistic as possible. He compared it to when a vehicle is certified to meet certain safety standards each year. This type of mechanism does not exist when it comes to EHRs because right when the product is certified, it then gets implemented, and there is no further certification of safety done at all after the initial testing. “One way to do that, at least for hospitals, is to have that process be something that the Joint Commission looks to do as part of their accreditation standards,” Ratwani said. “They could introduce some very basic accreditation standards that promote hospitals to do some very basic safety testing.” Read full story Source: EHR Intelligence, 13 January 2020 -
News Article
From stargazing to mole-gazing
Patient Safety Learning posted a news article in News
Astrophysics and dermatology are colliding through a new research project led by the University of Southampton – with potentially lifesaving consequences. The project, dubbed MoleGazer, will take algorithms used for detecting exploding stars in astronomical imaging data and develop them to be used to spot changes in skin moles and, therefore, detect skin cancer. MoleGazer, led by Professor Mark Sullivan, Head of the School of Physics and Astronomy at the University, and Postdoctoral Researcher Mathew Smith, has been awarded a Proof of Concept Grant from the European Research Council (ERC). It is the first time the University has won such a grant. Currently, patients at high risk of developing skin cancer are photographed at regular intervals and a consultant visually compares images to detect changes. MoleGazer could automate this process, potentially leading to earlier diagnoses and improved survival rates. “It’s a really exciting project that came along from nowhere,” added Professor Sullivan. “It also highlights the importance of blue sky science – curiosity-driven scientific research will always have a fundamentally important role to play.” Read full story Source: University of Southampton, 10 January 2020 -
Content ArticleHealth and social care faces a conflict between safe and appropriate staffing and the (government) directive to be cost efficient. In a time of clinical and support staff shortages, increasing demand for services and financial austerity, there is a need for a consistent approach to workforce analysis, benchmarking and planning across the health and social care to enable informed decision-making across finance, HR and nursing management to put the patient and their safety at the centre of all we do. 'Establishment Genie' is an online workforce planning, safe staffing and benchmarking tool. It has been co-developed and tested with more than 300 teams across acute, community, residential care, hospice and independent providers of care. This has been supported by input from NHSE, NHS Professionals, The Florence Nightingale Foundation, Safe Staffing Alliance, Royal College of Nursing, Health Education England, Queen’s Nursing Institute and academic nurse staffing experts.
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Content ArticleJen Gilroy-Cheetham, Programme Manager at the Innovation Agency, talks about her experiences as a patient and makes a plea for a different way of doing things. Jen was speaking at the Innovation Agency's Eco 18 event, held at Haydock Racecourse in March 2019, focusing on innovating to meet NHS and social care workforce challenges.
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Content ArticleHealthy eating and fitness mobile apps are designed to promote healthier living. However, for young people, body dissatisfaction is commonplace, and these types of apps can become a source of maladaptive eating and exercise behaviours. Furthermore, such apps are designed to promote continuous engagement, potentially fostering compulsive behaviours. This study, published by JMIR Publications, highlights the necessity for careful considerations around the design of apps that promote weight loss or body modification through fitness training, especially when they are used by young people who are vulnerable to the development of poor body image and maladaptive eating and exercise behaviours.
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Content ArticleSoftware is playing an expanding role in modern medical devices, raising the question of how developers, regulators, medical professionals, and patients can be confident in the devices' reliability, safety, and security. Software- related errors in medical equipment have caused people's deaths in the past, so the issue is not simply theoretical. Device manufacturers need to provide safety assurance for complex software that is being developed in a competitive environment where price and time-to-market are critical factors. Further, security issues that previously were not a major concern now need to be anticipated and handled. In this interview, published by Electronic Design, Dr. Benjamin Brosgol, senior member of the technical staff at Adacore, talks about these issues.
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Content ArticlePrescription drug errors are a leading source of harm in health care, resulting in substantial morbidity, mortality and healthcare costs estimated at more than $20 billion annually in the US. Currently, clinical decision support (CDS) alerting tools – computerised alerts and reminders – are widely used to identify and reduce medication errors. However, CDS systems have a variety of limitations, including that they are rule based and can identify only medication errors that have been previously identified and programmed into the alerting logic. A new study from Rozenblum et al., published in The Joint Commission Journal on Quality and Patient Safety, used retrospective data to evaluate the ability of a machine learning system – a platform that applies and automates advanced machine learning algorithms – to identify and prevent medication prescribing errors not previously identified by and programmed into the existing CDS system.
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News Article
Pager systems used in healthcare could be exposing patient data across Canada
Patient Safety Learning posted a news article in News
Paging systems used across B.C could be exposing sensitive health data of patients, and the privacy researcher who first discovered the data breach believes it’s likely happening across the country. “I wouldn’t be surprised to find this everywhere in Canada,” said privacy researcher Sarah Jamie Lewis, in an interview with CTVNews.ca in Vancouver. Lewis first discovered and reported the breach to Vancouver Coastal Health in November 2018. Now, internal emails released this month through a Freedom of Information request show that the vulnerability is not limited to Vancouver. Read full story Source: CTV News, 13 December 2019 -
Content ArticleWith the widespread adoption of electronic health records (EHRs), there is an increased focus on addressing the challenges of EHR usability; that is, the extent to which the technology enables users to achieve their goals effectively, efficiently, and satisfactorily. Poor usability is associated with clinician job dissatisfaction and burnout and could have patient safety consequences. Using EHR surveillance data collected by the ONC, researchers from the MedStar Health National Center for Human Factors analysed over 350 reports regarding EHR issues that violated the federal certification programme. They found that roughly 40% of ONC-certified EHRs had the potential for patient harm.
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Content ArticleChances are, you’ve heard of an electronic health record, or EHR. Over the past 10 years, the vast majority of healthcare providers in the United States have implemented this technology to use in caring for their patients. EHRs have benefited us in many ways and hold tremendous promise. Given their widespread use, this technology now plays a significant role in the routine delivery of health care. Less understood outside the healthcare profession, however, is that EHRs have introduced new kinds of risks to the safety and quality of care, due to serious challenges with EHR usability, or the effectiveness and efficiency of using the technology. These well documented issues can lead to clinician burnout and errors that directly impact patient safety. In response, the MedStar Health National Center for Human Factors in Healthcare teamed up with the American Medical Association to show what they mean by sharing rare videos of real and simulated EHR usability challenges. They believe improving EHR design, development, and implementation to eliminate known patient safety risks and make them easier to use is the responsibility of healthcare providers, EHR vendors, policymakers, and patients, all working together.
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News Article
NHS e-health systems 'risk patient safety'
Patient Safety Learning posted a news article in News
Hospitals across England are using 21 separate electronic systems to record patient health care – risking patient safety, researchers suggest. A team at Imperial College say the systems cannot "talk" to each other, making cross-referencing difficult and potentially leading to "errors". Of 121 million patient interactions, there were 11 million where information from a previous visit was inaccessible. The team from London's Imperial College's Institute of Global Health Innovation (IGHI) looked at data from 152 acute hospital trusts in England, focusing on the use of electronic medical records on the ward. Around a quarter were still using paper records. Half of trusts using electronic medical records were using one of three systems: researchers say at least these three should be able to share information. 10% were using multiple systems within the same hospital. Writing in the journal BMJ Open, the researchers say: "We have shown that millions of patients transition between different acute NHS hospitals each year. These hospitals use several different health record systems and there is minimal coordination of health record systems between the hospitals that most commonly share the care of patients." Lord Ara Darzi, lead author and co-director of the IGHI, said: "It is vital that policy-makers act with urgency to unify fragmented systems and promote better data-sharing in areas where it is needed most – or risk the safety of patients." A spokesperson for NHSX, which looks after digital services in the NHS, said: "NHSX is setting standards, so hospital and general practioner IT systems talk to each other and quickly share information, like X-ray results, to improve patient care." Read research article Read full story Souce: BBC News, 5 December 2019 -
Content ArticleWarren et al. from London's Imperial College's Institute of Global Health Innovation (IGHI) looked at data from 152 acute hospital trusts in England, focusing on the use of electronic medical records on the ward. They found 117 (77.0%) hospital trusts were using electronic health records (EHR), but there was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research published in BMJ Open highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve EHR system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
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Content ArticleNeptune's Dr Catherine Massey, Clinical Director, and Sophie Britt, Lead Trainer, tell us about their initiative and the difference it has made to patient safety and how it felt to win a Patient Safety Learning Award. They also discuss what they plan to do next. View video
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News Article
Royal Cornwall Hospital deploys AI tool for secure surgical videos
Patient Safety Learning posted a news article in News
Royal Cornwall Hospital has deployed an artificial intelligence (AI) tool that allows clinicians to view case videos safely and securely. Touch Surgery Enterprise enables automatic processing and viewing of surgical videos for clinicians and their teams without compromising sensitive patient data. These videos can be accessed via mobile app or web shortly after the operation to encourage self-reflection, peer review and improve preoperative preparation. James Clark, consultant upper gastrointestinal and bariatric surgeon at the trust, said: “Having seamless access to my surgical videos has had an immense impact on my practice both in terms of promoting patient safety and for educating the next generation of surgeons." Read full story Source: Digital Health, 28 November 2019 -
Content ArticleIn this US-based article, Christopher Jason discusses recent evidence that highlights how electronic health records (EHRs) have the potential to cause patient harm in various ways.
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News ArticleDoctors and nurses must adapt their routines and improvise their actions to ensure continued patient safety, and for their roles to be effective and to matter as new technology disrupts their working practices. Research from Lancaster University Management School, published in the Journal of Information Technology, found electronic patient records brought in to streamline and improve work caused changes in the division of labour and the expected roles of both physicians and nursing staff. These changes saw disrupted working practices, professional boundaries and professional identities, often requiring complex renegotiations to re-establish these, in order to deliver safe patient care. Managers implementing these systems are often quite unaware of the unintended consequences in their drive for efficiency. Read full story Source: EurekAlert, 25 November 2019
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Content ArticleThis film features frontline staff from The Royal Liverpool and Broadgreen University Hospitals NHS Trust explaining how they are using technology to improve the lives, treatment and outcomes of patients with sepsis.
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Content ArticleThe North West London Integration Toolkit is intended to support communities, people and partners as they work towards the shared vision of integrated care. The toolkit is the culmination of over 200 individuals and organisations across North West London coming together to share knowledge and develop ideas as to how to implement whole systems integrated care. The toolkit is a living document and repository of collective learnings. It will evolve and be updated as local areas start to implement their plans and lessons are learned and shared.
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Content ArticleImperial College Healthcare NHS Trust maternity service provides care for around 10,000 babies and their mothers each year throughout pregnancy, labour, and the postnatal period. The Trust introduced the Cerner electronic patient record system including a maternity module for clinical documentation in 2014. Contractions and foetal and maternal heart rate are monitored using cardiotocograph (CTG) devices. Previously, the readings were printed out on rolls of paper. Midwives added handwritten clinical observations to these ‘foetal strips’ and used them to make critical decisions about the management of labour. These paper records were hard to share to quickly get a second opinion. They were prone to fading over time so did not always provide a permanent record and they were not integrated into the electronic patient records for our patients.
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Content ArticleA Global Digital Exemplar (GDE) is an internationally recognised NHS provider delivering improvements in the quality of care, through the world-class use of digital technologies and information. Exemplars will share their learning and experiences through the creation of blueprints to enable other trusts to follow in their footsteps as quickly and effectively as possible. The GDE Blueprinting workstream forms part of the national Provider Digitisation Programme. GDE blueprints are expected to help other NHS Trusts deliver digital capabilities more quickly and cost effectively than has been possible in the past.
