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Found 322 results
  1. Content Article
    This resource, published by the AHA Physician Alliance and the American Hospital Association, is a guide for health system leaders developing well-being programmes, focusing on the challenges of burnout due to COVID-19. This resource is in two-parts: COVID-19-specific resources and a guide to walk you through well-being program development and execution. These resources will help leaders build on tools already in place and learn from others who are doing this work.
  2. Content Article
    At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That's why we created the hub; providing a space for people to come together and share their experiences, resources and good practice examples.  This month, our Content and Engagement Manager, Steph, has hand-picked seven resources, particularly relevant for patient safety managers working in hospital settings. Shared with us by hub members and patient safety advocates, they are jam-packed with practical tools and rich insights. 
  3. Content Article
    An original article that explores the significance of both staff physical safety in the workplace as well as their psychological safety and wellbeing. In particular, I highlight the impact the COVID-19 pandemic has had on both these areas, and discuss the importance of ensuring all aspects of staff safety.
  4. Content Article
    Approximately 1,000[1] UK health and care workers have died from Covid-19. Many were working with Covid-positive patients and with substandard Personal Protective Equipment (PPE). It is estimated that a further 122,000 health service workers who contracted Covid-19 are struggling with prolonged symptoms, often referred to as Long Covid. It has also become clear that a significant number of inpatients who had Covid-19, acquired the virus whilst in hospital.[2][3] In this opinion piece, Dr David Tomlinson argues that current PPE guidance still fails to adequately protect staff and patients against the airborne nature of the Covid-19 virus. David highlights the attempts made by many to raise their related safety concerns; arguing that the response to date has been inadequate, unsafe and unlawful.  
  5. Content Article
    In April 2009 a 'considerative checklist' was developed to ensure that all important aspects of care on a team's routine and post-take general internal medicine ward rounds had been addressed and in order to answer the question: How long should a ward round take, when conducted to high standards of quality and safety at the point of care? The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. Overall, the average time per patient was 12 minutes (10 minutes on routine rounds and 14 minutes on post-take rounds). The considerative checklist has encouraged and enabled documented evidence of high quality and safe medical care, and anecdotally improved team working, communication with patients, and team and patient satisfaction.
  6. Content Article
    Dr Gordon Caldwell believes that patient safety should be an active process of checking for avoidable errors. In this blog for the hub, he describes how he developed a checklist for his ward rounds and how this became incorporated into the daily clinical review notes to ensure that all the important aspects of care on a team’s routine ward rounds are actively addressed.
  7. Content Article
    It is important that people with Parkinson's get their medication on time. Planning for a hospital stay when you have Parkinson’s will help you manage your condition and make sure you can leave hospital as quickly as possible and recover well. Parkinson's UK have developed this resource to help people with Parkinson's have a safe stay while they are in hospital.
  8. Content Article
    This booklet has been produced for hospital staff, by Parkinson's UK, for hospital staff. It tells you everything you need to know about Parkinson's, and how to provide the highest quality care for your patients.
  9. Content Article
    In this article for the Patient Safety Network, the authors highlight ways in which the Covid-19 pandemic initiated drastic modifications to the way in which health services are delivered across care settings, in particular in hospital emergency departments and inpatient units. They examine particular challenges highlighted by patient safety organisations (PSOs), including increases in safety incidents relating to pressure sores, sepsis, infections and communication issues. The article also highlights innovations to support safety that have been developed during the pandemic.
  10. Content Article
    HSJ’s inboxes are currently heaving with frustration and fury on a rare consistency of theme; the build up of medically fit patients who can’t be discharged from hospitals. Here’s one example from an exasperated, experienced manager, who spoke of “real failure in social care – long stays growing and no capacity to discharge to, a. Homes closed due to infection, b. Homes going out of business c. Homes unable to come and assess patients as no spare staff, d. No care packages as staff sick or none available due to lack of capacity e. social workers and others needed to make assessments in very short supply”. “We keep getting told we’ll cope and get through but we’re really not… The will to continue is beginning to break down with refusals to redeploy and high sickness absence on top of enforced absence due to covid. A seemingly mad commitment to grind through elective stuff…
  11. Content Article
    This article, published in BMC Health Services Research, reviews the effectiveness of hospital accreditation. It found no evidence to suggest accreditation and certification of hospitals leads to improved quality of care.
  12. Content Article
    Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. This paper, published in the Cochrane Database of Systematic Reviews, considers the effectiveness of interventions to reduce medication errors in adults in hospital settings. The review covered 65 studies involving 110,875 participants.
  13. Content Article
    This article looks at an incident of unsafe prescribing of haloperidol that resulted in overdose and the death of an elderly patient.
  14. Content Article
    This article looks at the issue of oxygen hoses becoming disconnected from transport ventilators when patients are moved between hospitals, which led to a patient death. Following the incident, the National Patient Safety team worked with national partners involved in transfer of patients to ensure a ‘tug test’ is incorporated into local practice.
  15. Content Article
    This case study looks at how plastic cord clamps used in caesarean sections are not visible on x-ray, which could be a patient safety issue.
  16. Content Article
    This article, published in the International Journal for Quality in Health Care, explores the usage of participatory engagement in patient-created and co-designed medical records for emergency admission to the hospital. It is advocated as a means to improve patient safety.
  17. Content Article
    The pandemic has shone a stark spotlight on so many inequities and inconsistencies in access to health and social care. Unfortunately, many of these inequities were already there and so, in some respects, its nothing new. In this blog, I want to draw attention to how visiting restrictions can result in worse outcomes for patients and their families. I will focus mainly on the needs of older adults in hospital or care, and those with dementia, because that has been my own experience. But these restrictive practices have affected so many groups: among them, those with mental health conditions and those with learning and behavioural difficulties. 
  18. Content Article
    This article, published in PLoS One, explores how occupational worker wellness and safety climate are key determinants of healthcare organisations' ability to reduce medical harm to patients while supporting their employees. A longitudinal study was carried out to evaluate the association between work environment characteristics and the patient safety climate in hospital units, and concludes that improvements in working conditions are needed for enhancing patient safety.
  19. Content Article
    This article, published in BMC Health Services Research, discusses the effectiveness of using checklists as training and operational tools to assist in improving the skills of general ward staff on the rescue of patients with abnormal physiology.
  20. Event
    This conference will bring together current and aspiring Ward Managers to understand current issues and the national context, and to develop your skills as an effective Ward Manager. The conference will open with reflections on the characteristics and qualities required for the role, and understanding your role within quality and specifically meeting the CQC Quality Ratings at Ward level. The conference will include a look at the challenges and issues as a result of the Covid-19 pandemic for Ward Managers. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/effective-ward-manager or email frida@hc-uk.org.uk. hub members receive a 20% discount code. Email info@pslhub.org for discount code. Follow the conference on Twitter @HCUK_Clare #wardmanager
  21. Event
    This conference focuses on improving nutrition and hydration on the wards. Through expert guidance and practical case studies and advice the conference aims to support and equip you to improve practice on your ward and reduce the risk of malnutrition in patients. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/improving-nutrition-hydration-ward or email kate@hc-uk.org.uk. hub members receive a 20% discount. Email info@pslhub.org for discount code. Follow the conference on Twitter @HCUK_Clare #NHSNutrition
  22. Event
    until
    This participatory event, concerning research undertaken on patient safety, will consist of a 45 minute talk followed by a Q&A/interactive discussion about how hospital care can be improved and how the public can be empowered to be involved in their care. The talk will specifically draw upon Dr Elizabeth Sutton's recent research, which explored how patients understood patient safety, and how this affected the ways that they were involved in their care when hospitalised. The Head of Patient Safety at University Hospitals of Leicester NHS Trust will be participating in the event and there will be a screening of an animated video based upon Dr Sutton's research on patient perceptions and experiences of involvement in their safety. What’s it about? We are all likely to receive hospital care at some point in our lives or have relatives who have experienced hospital care. This makes it vitally important that we are well informed about what patients experience when hospitalised and how best to improve that care. This event aims to highlight what patient safety means to patients, why it matters and to find ways of empowering the public to be involved in their hospital care. I want to find out whether these experiences resonate with you. How could patient safety be improved? What would you like to see happen? How can we best help patients to speak up about their care when hospitalised? As an attendee, you will hear about research on this topic and have the opportunity to ask questions and put across your point of view. This event will be led by Dr Elizabeth Sutton, Research Associate, University of Leicester. It will be of particular interest to anyone who has experience of hospital care or whose relative has received hospital care and patient groups. Book a place a the event
  23. Event
    until
    This participatory event, concerning research undertaken on patient safety, will consist of a 45 minute talk followed by a Q&A/interactive discussion about how hospital care can be improved and how the public can be empowered to be involved in their care. The talk will specifically draw upon Dr Elizabeth Sutton's recent research, which explored how patients understood patient safety, and how this affected the ways that they were involved in their care when hospitalised. The Head of Patient Safety at University Hospitals of Leicester NHS Trust will be participating in the event and there will be a screening of an animated video based upon Dr Sutton's research on patient perceptions and experiences of involvement in their safety. What’s it about? We are all likely to receive hospital care at some point in our lives or have relatives who have experienced hospital care. This makes it vitally important that we are well informed about what patients experience when hospitalised and how best to improve that care. This event aims to highlight what patient safety means to patients, why it matters and to find ways of empowering the public to be involved in their hospital care. I want to find out whether these experiences resonate with you. How could patient safety be improved? What would you like to see happen? How can we best help patients to speak up about their care when hospitalised? As an attendee, you will hear about research on this topic and have the opportunity to ask questions and put across your point of view. This event will be led by Dr Elizabeth Sutton, Research Associate, University of Leicester. It will be of particular interest to anyone who has experience of hospital care or whose relative has received hospital care and patient groups. Book a place a the event
  24. Community Post

    Better use of data for medication safety in hospitals

    Kenny Fraser

    Kenny Fraser posted a topic in Medicine management

    NHS hospital staff spend countless hours capturing data in electronic prescribing and medicines administration systems. Yet that data remains difficult to access and use to support patient care. This is a tremendous opportunity to improve patient safety, drive efficiencies and save time for frontline staff. I have just published a post about this challenge and Triscribe's solution. I would love to hear any comments or feedback on the topic... How could we use this information better? What are hospitals already doing? Where are the gaps? Thanks
  25. Community Post
    These comments were made by people with diabetes in response to a Twitter thread asking "Why is a hospital stay scary if you have diabetes?" If you have diabetes, or care for someone who does, please share your experience with us by adding a comment to this community thread, “I was in ICU after a car accident—none of the staff knew how to work my CGM and/or my insulin pump. I had to manage my own care” “For me it was when I went into hospital for surgery and the nurse said 'Type 1... so do you take insulin for that?'... that's not a reassuring thing to hear minutes before you're taken into the theatre!” “Lucky to get out alive.” “DKA 10 years ago, once back in normal range the consultant insisted I didn't need anymore insulin & refused to let me have any. Obvs within 3 hours I was back in DKA, he wouldn't come see me but had a convo with my husband on the ward phone where hubs explained how T1 works.” “I've been given a full day's bolus, through my iv and then told I was wrong when I said that I only bolused when I ate. Massive hypo followed quickly. I was then told it was my fault and I should have said something.” “After being admitted as an emergency, my own insulin ran out. I was given 2 (2!) of the wrong types of insulin and told that 'it would be okay'.” “They were often confused about T2 versus T1 - lots of emphasis about low fat foods and only being allowed a low fat yoghurt for puddings even though I was on a pump! I had a bag of snacks though as it was a planned hospital stay” “After a major medical issue I was denied insulin in the ICU for over 24 hours but was told I could have some pills to treat my type 1 diabetes” “Last time I went to the hospital, they took my pump (forcefully) and refused to give it back. When I protested, they sedated me. I was in and out of sedation having a panic attack bc I couldn’t breathe. They sedated me again and put me on DKA protocol, even tho I wasn’t in DKA.” “it’s so scary right like you know that you’re the expert on your condition and your needs but that power gets totally taken away” “Handing over your care over to a group of nurses who have no idea what they are doing. It’s super scary. I hate it when they lock it all away and you can’t get to it.” “I didn’t feel safe either. Told them on a few occasions I felt ‘low’. Finally Lucozade got wheeled out but it was almost an inconvenience” “Totally understand why they don’t know much about it if it’s not their specialism BUT some are so arrogant that what they were told one afternoon 10yrs ago is the absolutely way to deal with, and that the person living with it doesn’t know what they’re talking about!” Sarcastic responses “You seem to know a lot about it!” “The neurologist told me I am a terrible diabetic.” “I never feel safe because they don’t allow me to dose my own insulin and last time dropped me from 600 to 40 in three hours and then shot me back up so fast when i specifically told them that i would go low and high from that much insulin” Report of being diagnosed with type 1 diabetes while in hospital, despite telling every healthcare professional she had T1. “I smuggled in my own tester and meds and took care of myself.” “I think the biggest thing for me is them not understanding insulin dose when they’re writing up your chart and how you don’t really have a “typical” insulin dose that fits neatly into their charts because of carb counting or correction doses/reduction dose. It’s strange, when I’ve had DKA admissions and I’m on the sliding scale IV it’s fine because there’s clear guidelines but for just day to day injection management it’s soooo difficult.” "Daughter had food and insulin withheld in a mental hospital." “the ward nurses didn’t even know I had T1 until the more mobile lady opposite me went and fetched a nurse who had been ignoring my call button. I was hypo and couldn’t reach my treatment.” "Taken off insulin for two days as no doctor to prescribe." “Particularly bad experience when a nurse left the glucose drip on but turned off the insulin. It terrifies me to think how bad this could have been.”
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