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Found 323 results
  1. Content Article
    On the 23 January 2023 the Minister for Mental Health and Women’s Health Strategy, Maria Caulfield MP, announced the commencement of a rapid review into patient safety in mental health inpatient settings in England. The review Chair, Dr Geraldine Strathdee, was asked to consider how improvements could be made to the way that data and information is used in relation to patient safety in mental health inpatient care settings and pathways, including for people with a learning disability and autistic people. This report contains the findings of this review and an associated set of recommendations.
  2. Content Article
    This strategy sets out how the Care Quality Commission (CQC) will listen, inform and involve people and work in partnership with organisations that represent people. The new strategy will run to 2026 and has four objectives: Build a trusted feedback service where people’s experiences drive improvements in care Create a trusted, accessible public information service designed around people’s expectations and needs Develop an inclusive approach to proactively involving people who use services, their family, carers and organisations that represent or act on their behalf in shaping our plans, policies and products Work in partnership with organisations that represent or act on behalf of people who use services to improve care
  3. Content Article
    The Armstrong Institute for Patient Safety and Quality provides an infrastructure that oversees, coordinates and supports patient safety and quality efforts across Johns Hopkins' integrated healthcare system. Their mission is to eliminate patient harm, achieve best patient outcomes at the lowest possible cost and share that knowledge through research and training The Armstrong Institute for Patient Safety and Quality leads regional, national and international projects that reduce preventable harm, improve patient and clinical outcomes, and decrease health care costs. They apply a scientific approach to improvement, employing robust measures and rigorous data-collection methods that can be broadly disseminated and sustained.
  4. Content Article
    Sickle cell disease is the name for a group of inherited red blood cell disorders that affect haemoglobin, which is a protein in red blood cells that carries oxygen through a person’s body. It mainly affects people from African or Caribbean backgrounds, though it can affect anyone. It affects approximately 15,000 people in the UK. In November 2021, the All-Party Parliamentary Group for Sickle Cell and Thalassaemia published a report detailing the issues that people with sickle cell disease experience in relation to their care. The report made 31 recommendations to organisations across the healthcare system to help address these issues. HSIB launched two investigations (see also: Management of sickle cell crisis) to find out what additional learning or knowledge could be added in this area and to provide further insights into the practical challenges that patients with sickle cell disease may face when receiving NHS care. This investigation set out to review the care of patients with sickle cell disease who need to have an invasive procedure. Invasive procedures involve accessing the inside of a patient’s body, either through an incision (cut) or one of the body’s orifices. Specifically, the investigation focused on: how haematology teams – the specialists who treat people with blood disorders – are involved and informed when a patient with sickle cell disease is treated in another area of healthcare how patients with sickle cell disease are prepared for invasive procedures how and where clinical information relevant to the patient is shared.
  5. News Article
    Women who underwent mesh surgery were not given accurate information before the life-altering procedure, a case review has found. The study also said poor communication between patients and doctors led, in some cases, to mistrust. Medical notes were often misleading or did not detail the surgery that had occurred or its outcomes. The review spent two years looking at the cases of 18 women who received transvaginal mesh implants. It has now called for a comprehensive register to be set up to keep track of women who have had operations to remove mesh in Scotland, abroad and privately. The Transvaginal Mesh Case Record Review by Glasgow Caledonian University makes a series of other recommendations, including: Better aftercare following surgery Clear language so patients understand exactly what surgery is going to achieve. Read full story Source: BBC News, 21 June 2023
  6. Content Article
    Academic Health Science Networks (AHSNs) host England’s fifteen Patient Safety Collaboratives. They are experts in supporting quality improvement projects using methodology from the Institute of Healthcare Improvement model for improvement. This resource pack by The AHSN Network provides an overview of the different ways Patient Safety Collaboratives can support safety improvement projects and includes case studies and resources.
  7. Content Article
    Digital delivery of information is the new normal and it’s important that healthcare providers adapt quickly. Informed consent in the UK needs to be backed up by the BRAN principle: Benefits, Risks and Alternatives including the option of doing Nothing.  In this blog, Julie Smith, Content Director at EIDO Healthcare, will use the same principles to consider the use of digital solutions for patient information. This blog is not exhaustive but will hopefully provide some food for thought around the patient safety considerations relating to digital information. 
  8. Event
    until
    Join Prostate Cancer UK to hear from men with lived experience as we explore the truth behind common prostate cancer myths. Together with our Specialist Nurses, we'll be answering questions and offering advice on tackling difficult subject matters with your loved ones, ensuring they understand the facts. Together, we can help men understand their risk of prostate cancer and save lives. Register for the webinar
  9. Content Article
    Public and patient expectations of treatment influence health behaviours and decision-making. This study aimed to understand how the media has portrayed the therapeutic use of ketamine in psychiatry. It found that ketamine treatment was portrayed in an extremely positive light, with significant contributions of positive testimony from key opinion leaders (e.g. clinicians). Positive research results and ketamine's rapid antidepressant effec were frequently emphasised, with little reference to longer-term safety and efficacy. The study concluded that information pertinent to patient help-seeking and treatment expectations is being communicated through the media and supported by key opinion leaders, although some quotes go well beyond the evidence base. Clinicians should be aware of this and may need to address their patients’ beliefs directly.
  10. Content Article
    This letter is a resource for patients to help GPs identify the complications of pelvic mesh. It explains signs and symptoms of women presenting with pelvic mesh-related conditions and if required, where to signpost them for further help. It has been issued by the Patient Safety Commissioner for England, developed in partnership with the patient campaign groups Sling the Mesh and the Rectopexy mesh victims and support.
  11. Content Article
    In the first in a series of blogs looking at the range of investigation methods used by HSIB, Nichola Crust reflects on how Appreciative Inquiry can be used to examine patient safety and identify opportunities for learning.
  12. News Article
    An integrated care board (ICB) has advised its GP practices not to give patients automatic access to their records, contradicting NHS England national requirements. Instead, North East London ICB has suggested practices only allow access where patients request it, and subject to conditions. The national go-live date for patients to be allowed automatic access to future entries in their records has been repeatedly delayed since initially being set at December 2021. GPs have argued they needed more time to redact sensitive information, ensure records are not inappropriately shared, and train staff. They have cited workload and safeguarding concerns. The ICB’s chief clinical information officer Osman Bhatti, who is a GP, told HSJ the ICB instead “wanted a process where patients could access both prospective and retrospective records safely, with less workload for GPs and so patients who actually want access can have it”. Read full story (paywalled) Source: HSJ. 1 June 2023
  13. News Article
    The US Food and Drug Administration has proposed to add to what you get with your prescription drugs. The proposed rule would require the prescriptions you get to come with a new kind of single-page medication guide with an easy-to-use set of directions and easy-to-understand safety information, a goal the FDA has been working toward for years. One study found that nearly 75% of Americans have had trouble taking their medicine as directed. A lot of that is due to cost – people might not be able to afford their medicine, so they don’t take it – but some is due to confusion. They might get more than one kind of written information with their prescription, or the information they receive can be conflicting, incomplete or repetitive, the FDA said. When people are confused or misinformed about their prescription, there is a good chance they will not take it or will stop taking it, and that can directly hurt their health. “Research suggests that medication nonadherence can contribute to nearly 25% of hospital admissions, 50% of treatment failures, and approximately 125,000 deaths in our country each year,” the FDA says. The agency said the new proposal is also meant to help fight the “nation’s crisis with health care misinformation and disinformation.” Read full story Source: CNN, 30 May 2023
  14. Content Article
    Halfloop are a team of senior doctors and developers building a digital platform where patients can store information securely about their medical implants and share their progress and outcomes securely with their clinical team. They would like to hear your views by asking you to complete their short survey.
  15. Content Article
    Dehydration can be a significant risk to people taking certain medicines. These Sick Day Rules cards aid patients in understanding the medicines they should stop taking temporarily during illness which can result in dehydration, such as vomiting, diarrhoea and fever. They are intended for use as a tool to support conversations between healthcare professionals and patients about their medicines and dehydration.
  16. News Article
    A woman who had a hysterectomy has said she was discharged without sufficient information on its impact on her physical and mental health. Mechelle Davis, from County Down, said it was crucial women left hospital with appropriate medication and advice. Her operation involved removal of her womb, ovaries, fallopian tubes, and cervix. Ms Davis was 48 when she had her operation and said she had no option but to look online for advice, something she described as "unsatisfactory". "I had the operation in October 2022 and didn't go on HRT until the following February," she told BBC News NI. "Every woman who is going through the menopause - including surgically induced - needs support. In its online tool for clinicians, British Menopause Society advise that HRT plays a significant role in managing surgical menopause, especially in women under 45 - provided there are no contradictions such as personal history of hormone dependant cancer. It also adds that "all women undergoing surgical menopause should have counselling and be provided with information about the hormonal consequences of surgery and the role of HRT, both before surgery and before leaving hospital with clear communication to the primary care team." BBC News NI has spoken to other women who, after having a hysterectomy, were discharged without advice or a HRT prescription. Read full story Source: BBC News, 23 May 2023 Further reading on the hub: World Menopause Day 2022: Raising awareness of surgical menopause
  17. Content Article
    Recently, there has been a concerning increase in the number of deaths of pregnant women, especially from Black, Asian and deprived backgrounds. In addition, there have been several investigations into safety issues in maternity services, such as the Ockenden, East Kent, and Shrewsbury and Telford report. This National Institute for Health and Care Research (NIHR) Collection highlights evidence in priority areas, identified in the East Kent report, to support high-quality care and avoid safety issues in maternity services.
  18. Content Article
    To support patients to understand the risks of taking sodium valproate during pregnancy, NHS England has launched two new shared decision-making tools. This is part of an NHS-wide effort to reduce the use of valproate in people who can get pregnant, and to help those that do continue with valproate to prevent pregnancies.
  19. Content Article
    Healthcare systems rely on self-advocacy from service users to maintain the safety and quality of care. Systemic bias, service pressures and workforce issues often deny agency to patients at times when they need to have most control over representation of their story. This drives diagnostic error, treatment delay or failure to treat important conditions. In maternal care, perinatal mental health and thrombosis are significant challenges. With funding from SBRI Health care, Ulster University and Southern Health and Social Care Trust are developing an NLP powered platform that will empower mothers to be more active agents in their perinatal care. Download the poster below.
  20. News Article
    Blind people are being put “at risk” when the NHS provides them with “inaccessible” information about their health, a charity has warned. People with sight loss have missed appointments, cancer screenings or been unable to use home test kits because of a lack of clear instructions in an accessible format, according to the sight loss charity RNIB. It warned that denying people access to their information can also “cause embarrassment and loss of dignity”. Linda Hansen, from Bradford, who is severely sight-impaired, said that she needed to get her daughter to read her the results of a medical exam which was sent to her in print format. Ms Hansen, 62, said: “I can get my bank statement or a gas bill in accessible formats, but yet I still receive health information that I can’t read. What could be more personal than your health status?” A new RNIB campaign – My Info My Way – has been launched calling for all blind and partially sighted people to be given accessible information. The charity said that a failure to provide information in an accessible format is putting blind and partially sighted people “at risk”. Read full story Source: The Independent, 16 May 2023
  21. Content Article
    This webinar shares the findings of a co-production project in Nottingham and Nottinghamshire Integrated Care Board (ICB) to remove barriers to shared decision making. The partners in the project were the ICB’s Personalised Care Team, the My Life Choices lived experience panel, the Patient Information Forum (PIF) and the Patients Association. Over the course of six co-production meetings, they developed simple resources to support patients and professionals to have better shared decision making conversations. Speakers discuss practical solutions to help patients and professionals get the most from limited appointment times which can be applied nationally.
  22. Content Article
    This patient resource created by Prostate Cancer Research aims to equip patients and the public with information about prostate cancer. It contains information on: testing and diagnosis treatment choices living with side effects clinical trials.
  23. Content Article
    This case study published by The Beryl Institute looks at an initiative to collect real-time feedback on patient experiences at the Stanford Health Care emergency department in California. Previously, the department had sent a survey to patients well after their visit, but the team realised that capturing this information sooner was critical. Matthew Lim, Patient Experience Manager at Stanford Health Care describes the practical and replicable steps the organisation took in implementing a QR code-based feedback system. He describes the results, lessons learned and potential future developments.
  24. Content Article
    Patients benefit from guideline-based preventive, chronic disease, and acute care, but many do not receive it. A limitation to providing high-quality care is insufficient time for primary care providers (PCPs). The aim of this study was to quantify the time needed to provide preventive care, chronic disease care, and acute care for a nationally representative adult patient panel by a PCP alone, and by a PCP as part of a team-based care model. The authors concluded that PCPs do not have enough time to provide the guideline-recommended primary care. With team-based care the time requirements would decrease by over half, but still be excessive.
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