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Found 368 results
  1. Content Article
    The following key emergent themes of the Future Doctor Programme will help to prioritise the next stage of medical education reform: Patient-Doctor Partnership Doctors in the future clinical team have the patient firmly front and centre to promote supported shared-decision making and enable patients to make the best use of available care and support. The Extensivist and Generalist Future Doctors will have confidence in a greater breadth of practice across disciplines and specialties due to a strong base of generalist skills, which will enable them to deliver complex, comprehensive care managing co-morbidities in changing healthcare environments. Leadership, Followership and Team Working Future Doctors will demonstrate compassionate and collaborative leadership and effective teamworking. The Transformed Multi-professional Team Future Doctors will espouse and promote a culture where each member of the multi-professional team is acknowledged, respected, valued and empowered to accept shared responsibility. Doctors will promote other healthcare roles to patients and the public. Population Health and Sustainable Healthcare Future Doctors will learn, while embedded in their local community, to better understand population needs and use resources optimally to improve the physical, mental and social wellbeing of the whole population. They will embrace a culture of stewardship and a sense of community responsibility. Adoption of Technology Technology will be employed by Future Doctors as an enabler for change in clinical care and in education (e.g. remote supervision and care delivery and AI augmenting clinical decision making). Work-life Balance and Flexibility Throughout a Career Future Doctors will have flexibility in training and working, with access to portfolio careers and lifelong learning opportunities for changing careers. Driving Research and Innovation Every Future Doctor will be a scholar and will support patients to make informed choices around engaging in research. Future clinical academics will be local leaders in co-ordinating local, regional and national research and innovation.
  2. News Article
    The GMC has responded to senior medical leaders’ frustration at news that the Government is again delaying long-promised plans for its reform which would ease the strain felt by doctors. Its chief executive said its Council shared widespread disappointment at the hold-up in changing the legislation – which was expected this year, but will not now happen until 2024-25. Charlie Massey told Independent Practitioner Today: "Physician associates and anaesthesia associates are an important part of the health workforce and we welcome progress to bring them into regulation, which we will do within 12 months of legislation being laid by Government. "But we are disappointed that the outdated legislation for doctors will not be replaced at the same time. "The current framework stops us from being responsive and flexible in how we address patient safety concerns and register doctors to join the UK workforce. That isn’t good for patients and puts unnecessary strain on doctors. "The Government has said that it expects to deliver reforms for doctors as a priority following its work on physician associates and anaesthesia associates." Mr Massey called for a clearer commitment on the specific timing of that work, adding that the GMC wanted to progress better regulation for both doctors and medical associate professionals (MAPs) as soon as the Department of Health and Social Care laid the necessary legislation. "It is now the department’s decision when and how to implement these changes. When the department does implement these changes, we will be ready to start the process to put the reform changes into practice," he said. Read full story Source: Independent Practitioner Today, 9 August 2022
  3. News Article
    Doctors and nurses often “weight-shame” people who are overweight or obese, leaving them feeling anxious, depressed and wrongly blaming themselves for their condition, research has found. Such behaviour, although usually the result of “unconscious weight bias”, leads to people not attending medical appointments, feeling humiliated and being more likely to put on weight. Dr Anastasia Kalea and colleagues at University College London analysed 25 previous studies about “weight stigma”, undertaken in different countries, involving 3,554 health professionals. They found “extensive evidence [of] strong weight bias” among a wide range of health staff, including doctors, nurses, dieticians, psychologists and even obesity specialists. Their analysis found that a number of health professionals “believe their patients are lazy, lack self-control, overindulge, are hostile, dishonest, have poor hygiene and do not follow guidance”, said Kalea, an associate professor in UCL’s division of medicine. She added: “Sadly, healthcare, including general practice, is one of the most common settings for weight stigmatisation and we know this acts as a barrier to the services and treatments that can help people manage weight. “An example is a GP that will unconsciously show that they do not believe that the patient complies with their eat less/exercise more regime they were asked to follow as they are not losing weight." “The result is that patients are not coming back or they delay their follow-up appointments, they avoid healthcare prevention services or cancel appointments due to concerns of being stigmatised due to their weight.” Read full story Source: The Guardian, 10 August 2022
  4. News Article
    The medical body at Norfolk and Suffolk Foundation Trust has written to the trust’s chair saying that it is unable to provide safe care and expressing a lack of confidence in the board. The letter, which has been seen by HSJ, is signed by 140 of doctors at the mental health provider. It claims the trust’s “clinical services are unable to provide good basic care and are unsafe”. Significant criticism is reserved for the trust’s senior management, with the letter stating “there is a general dysfunction with perpetual changes of key staff in executive posts and ever increasing layers of management” and that “major decisions are frequently made by a handful of people at an executive level without clinical consultation”. The letter continues: “Doctors are by and large used as clinical workhorses. Many carrying huge workloads and holding unacceptable clinical risks”. The letter, first revealed by BBC Look East, asks for an urgent meeting with the chair and states that the medical body “lacks confidence in the executive board to resolve the plight of NSFT”. Read full story (paywalled) Source: HSJ, 10 August 2022
  5. Content Article
    In unit-dose dispensing, medication is dispensed in single doses in packages that are ready to administer to the patient. It can be used for medicines administered by any route, but oral, parenteral, and respiratory routes are especially common. The system provides a fully closed-loop process where the patient, the drug and the healthcare professional are identified by machine readable codes and the drug administration process is linked directly to the electronic prescription and is fully recorded There are many variations of unit-dose dispensing. As just one example, when doctors write orders for inpatients, these orders are sent to the central pharmacy. Pharmacists verify these orders and technicians place drugs in unit-dose carts. The carts have drawers in which each patient's medications are placed by pharmacy technicians—one drawer for each patient. The drawers are labelled with the patient's name, ward, room and bed number. Sections of each cart containing all medication drawers for an entire nursing unit often slide out and can be inserted into wheeled medication carts used by nurses during their medication administration cycles. Alternatively, electronic medicine storage cabinets can be located on wards and these are attached to medicine carts which are then filled from the cabinets. Studies often compare unit-dose dispensing to a ward stock system. In a ward stock system, bulk supplies are issued from the pharmacy; the drugs are stored in a medication room on the ward. The correct number of doses must be taken out of the correct medication container for each cycle and taken to the patient for administration. Liquids must be poured by the nurse from the appropriate bottle and each dose carefully measured. Evidence for effectiveness of the practice Though the practice of unit-dose dispensing is generally well accepted and has been widely implemented, the evidence for its effectiveness is modest. Most of the published studies reported reductions in medication errors of omission and commission with unit-dose dispensing compared with alternative dispensing systems such as ward stock systems. Potential for harm Unit-dosing shifts the effort and distraction of medication processing, with its potential for harm, from the ward to central pharmacy. It increases the amount of time nurses have to do other tasks but increases the volume of work within the pharmacy. Like the nursing units, central pharmacies have their own distractions that are often heightened by the unit-dose dispensing process itself and errors do occur. Overall, unit-dose appears to have little potential for harm. The results of most of the observational studies seem to indicate that it is safer than other forms of institutional dispensing. However, the definitive study to determine the extent of harm has not yet been conducted. A major advantage of unit-dose dispensing is that it brings pharmacists into the medication use process at another point to reduce error. Yet about half of the hospitals in a national survey indicated that they bypass pharmacy involvement by using floor stock, borrowing patients' medications and hiding medication supplies. Unit dose drug distribution is being introduced across Europe. In Germany, a recent study showed a saving of 2.61 WTE nurses per 100 beds. There is now growing interest in UK hospitals and pilot sites to develop the system are being established. What are your thoughts on unit-dose dispensing?
  6. News Article
    A 65-year-old man died after doctors failed to notice serious abnormalities on his X-ray, an investigation by the Parliamentary and Health Service Ombudsman (PHSO) has revealed. The investigation comes a year after a landmark report by the Ombudsman highlighted failings in how X-rays and scans are reported and followed up in the NHS. Mr B, who was admitted to University Hospitals Birmingham NHS Foundation Trust in May 2019, had been unwell for several days. He was admitted to hospital suffering from abdominal pain and vomiting. An X-ray of his abdomen was taken, which two doctors said did not show any apparent abnormalities. The following day the man’s condition deteriorated. He suffered a heart attack and died. A PHSO investigation found the Trust failed to notice a blockage in his intestine on the X-ray. Because of this failure, Mr B did not receive treatment that could have saved his life. Speaking on this case Ombudsman Rob Behrens said: “The case of Mr B highlights the devastating impact mistakes like this can have. If the Trust had picked up the abnormalities on his X-ray sooner, Mr B could still be with his family today. “As the NHS faces the challenge of rebuilding after the pandemic, it must not lose momentum in improving the way X-rays and scans are handled during a patient’s care.” Progress has been made by the NHS in implementing recommendations made by the Ombudsman in the report; however, Rob Behrens has said more needs to be done to protect patients from serious harm. “Attention and buy-in from the NHS’s senior leaders is crucial if we want to see sustained and meaningful change in how X-rays and scans are managed during a patient’s care. We need more collaboration across clinical specialties, looking at the whole patient journey once a scan has been carried out. "I want to see the NHS treating complaints as a source of insight to drive improvements in patient care. Not learning from mistakes will mean missed opportunities to diagnose patients earlier. In the most serious cases, like that of Mr B, it will mean a death which should never have happened.” Read full story Source: PHSO, 20 July 2022
  7. News Article
    On 24 June the US Supreme Court overturned Roe v Wade, the 1973 decision that legalised abortion and left the regulation of abortion to the states.4 At present, about half of the 50 states ban or severely limit abortions, but the picture is changing daily as century old bans go into place in some states, bans are challenged in courts, and state legislatures debate changes to their laws. The American College of Obstetricians and Gynecologists (ACOG) said, “Each piece of legislation is different, using different language and rationales. State legislators are taking it upon themselves to define complex medical concepts without reference to medical evidence. Some of the penalties for violating these vague, unscientific laws include criminal sentences.” Doctors report being confused and fearful about how they can continue to practise in states where abortion laws are changing day by day and sometimes hour by hour. Katie McHugh, an obstetrician and gynaecologist in Indianapolis, where abortion until 20 weeks is legal for the moment, told The BMJ about a patient who arrived from another state (around 200 miles away) with a miscarriage. “A fetal heartbeat could still be detected. The local hospital sent her home and told her to come back if she became very sick.” Instead she travelled two and a half hours by car to McHugh. “I don’t blame the physicians in [the other state]. I don’t know if abortion is legal now a trigger law is in effect. They could face lawsuits. As a physician, it’s unacceptable to have to watch the news to know what’s legal and how to practise,” said McHugh. Read full story Source: BMJ, 1 August 2022
  8. News Article
    People who go to hospital for non-covid treatment are at higher risk of the virus compared with the general public, which is why high levels of hospital-acquired Covid-19 in England are worrying some doctors. They fear that the coronavirus is becoming a potential hazard of a hospital stay for older or vulnerable people, in a similar way to “superbugs” such as methicillin-resistant Staphylococcus aureus (MRSA). People who go to hospital for non-covid-19 treatment are at higher risk from the virus compared with the general public, says Tom Lawton, an intensive care doctor in Bradford, UK. Read full story (paywalled) Source: The New Scientist, 21 July 2022
  9. News Article
    Over a third of doctors say they feel sleep deprived on at least a weekly basis and over a quarter have been in a position where tiredness has impacted their ability to treat patients, a new survey by the Medical Defence Union (MDU) has found. The UK's leading medical defence organisation carried out the survey among its doctor members. Of 532 respondents one in four doctors (26%) said tiredness had affected their ability to safely care for patients, including almost 40 near misses and seven cases in which a patient actually sustained harm. In addition, six in ten respondents said their sleep patterns had worsened slightly or significantly during the pandemic. Dr Matthew Lee, MDU chief executive, said: "Doctors and their healthcare colleagues are running on empty. Our members have come through a period of immense pressure caused by the pandemic and it is affecting all aspects of their life, including sleep patterns. Previous studies have shown that fatigue can increase the risk of medical error and affect doctors' health and wellbeing. In our survey, side effects doctors reported due to sleep deprivation included poor concentration (64%), decision making difficulties (40%), mood swings, (37%) and mental health problems (30%). "Taking regular breaks is vital in the interests of doctors and their patients yet in our survey, three in ten doctors got no breaks at all during the working day despite many working long shifts. In addition, 21% didn't have anywhere to go such as a staff room, or quiet area, to take a break. "Pressures on frontline healthcare workers are likely to get worse for doctors in the coming weeks. At a time of considerable staff absence in the NHS it is more important than ever that those staff who are fit to work are properly supported so they can care for patients safely." Read full story Source: MDU, 17 January 2022
  10. Event
    This Masterclass is aimed at consultants and will be led by Dr Marcy Rosenbaum, Professor of Family Medicine and Faculty Development Consultant, Office of Consultation and Research in Medical Education, University of Iowa. Marcy is an expert in the skills that make difficult healthcare conversations easier, has published widely on the topic and is world renowned in training clinicians to use these skills effectively. The Masterclass will involve skills rehearsal with simulated patients and families. It provides consultants with an opportunity to refresh their expertise an to learn about the specific skills being taught to their trainees and NCHSs in the Human Factors in Patient Safety programmes. Register for the Masterclass
  11. Content Article
    This research from Benjamin Kah Wai Chang and Pia Matthews was conducted between May and August 2021, during which COVID-19 hospital cases were relatively low and pressures on NHS resources were near normal levels. Data were collected via online survey sent to doctors of all levels and specialties, who have worked in the NHS during the pandemic. In total, 231 participants completed the survey. The research found that over half of participants reported making more patients DNACPR than prepandemic, and this was due, at least in part, to an increased focus on factors including patient age, Clinical Frailty Scores and resource limitations. In addition, a sizeable minority of participants reported that they now had a higher threshold for escalating patients to ITU and a lower threshold for palliating patients, with many attributing these changes to formative experiences gained during the pandemic. The study found that there has not been a statistically significant change in the views of clinicians on the legalisation of euthanasia or physician-assisted suicide since the start of the pandemic. The authors concluded that the COVID-19 pandemic appears to have altered several aspects of end-of-life decision making, and many of these changes have remained even as COVID-19 hospital cases have declined.
  12. Content Article
    This guidance document seeks to provide a framework to help your local simulation-based endeavours achieve the most benefit for the needs in your organisation and department. Further resources and examples of practice to support each domain of the framework are currently being collated for sharing nationally in the immediate future. Working in collaboration, The Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists have developed this website to provide the UK intensive care and anaesthetic community with information, guidance and resources required to support their understanding of and management of COVID-19. Intensive care practitioners and anaesthetists are integral to the safe and effective care of patients diagnosed with COVID-19, and play a role in informing and reassuring the public about this viral outbreak.
  13. Content Article
    Key recommendations Ask the patient if they would like to have the conversation and how much information they would want. All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences. Conversations about the future can and should be initiated at any point. The conversation is a process not a tick-box, and does not have to reach a conclusion at one sitting. Be aware of the language you use with patients and those they have identified as being important to them, and try to involve all the relevant people in agreement with the patient.
  14. Content Article
    ICS: Guidance for prone positioning of the conscious COVID patient 2020 National Patient Safety Alert Interruption of high flow nasal oxygen during transfer National Institute of Clinical Excellence (NICE): COVID-19 rapid guideline: critical care in adults COVID-19 guidance on DNACPR and verification of death Resuscitation Council (UK): COVID-19 Resources: Healthcare Settings NHS England: Specialty guides: Coronavirus treatment Royal College of Nursing (RCN): Frequently asked questions about COVID-19 and work World Health Organization (WHO): Coronavirus disease (COVID-19) technical guidance: Infection prevention and control / WASH (including PPE guidance) West Middlesex Hospital: Talking to relatives: a guide to compassionate phone communication during Covid-19 Share your #safetystories Have you noticed things that aren't working well, or seem unsafe? Help us raise awareness of safety issues by sharing your story here. Or perhaps you have introduced an initiative in your hospital to help improve safety for staff or patients during the pandemic? Like the nurse who introduced a PPE Safety Officer Role to reassure staff and prioritise their safety. Share your good practice and safety tips.