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Content ArticlePolicy to date has mostly focused on the role of 'whistleblowers' in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 hours of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), Tarrant et al., in a paper published in Social Science & Medicine, studied how personnel gave voice to concerns about patient safety or poor practice.
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Content ArticlePatients with delirium have changes in their thinking and are often confused and cannot pay attention. About half of patients in an intensive care unit (ICU) have delirium during their stay. Research has shown that patients with delirium are more likely to die or to have long-term brain problems, including posttraumatic stress disorder, depression and other mental health issues, than those without delirium. Although nurses and doctors have tools to measure delirium in the ICU, it can be hard to identify and, in some cases, may be missed. Family members may be the first to notice that their loved ones have changes in their thinking or cannot pay attention. There are tools called the Family Confusion Assessment Method (FAM-CAM) and Sour Seven questionnaire that can be used by family members to detect delirium. However, neither of these tools has been used in an ICU. This study from Krewulak et al., published in CmajOPEN, shows that these tools can be used by family members to measure delirium in the ICU. The results from this study could lead to a change in policy that would involve partnering with family members to improve the diagnosis of delirium in the ICU. In turn, this would improve patient and family care and outcomes in the ICU.
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Content ArticleBack in January 2019, we started a regular team newsletter. Initially this was aimed at only the critical care unit (CCU) team; however, very quickly it developed into an all trust audience. In this post I discuss the multiple benefits the newsletter has offered as well as the challenges I came across. I want to share my experience on developing the newsletter to encourage other teams to consider writing a regular newsletter if they don’t already have one. This followed on from several outreach teams contacting me personally for assistance in writing their own newsletters.
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The Point of Care Foundation – Behind closed doors (July 2017)
Claire Cox posted an article in Culture
This briefing highlights evidence on NHS staff, their experience at work, the pressures they face and the consequences for patients. The Point of Care Foundation believes that it’s critically important that NHS employers pay attention to staff and their experience at work because when staff feel positive and engaged with work it has a positive impact on patient experience.- Posted
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Oxford University surgical lectures: Retained swabs
Claire Cox posted an article in By health and care staff
Dr Clare Dollery reflects on a retained swab 'never event' in Churchill Hospital theatres. Incidents, such as operating on the wrong body part or leaving instruments inside patients are categorised by the Department of Health as 'never events'. Dr Dollery is Oxford University Hospital's Deputy Medical Director. The Surgical Grand Rounds lecture series, hosted by the Nuffield Department of Surgical Sciences at Oxford University, is the key educational meeting for consultants, juniors and medical students. Presentations revolve around clinical cases.- Posted
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Integrity in health care: a nurse's story
Claire Cox posted an article in Stories from the front line
Karen Sanders, Senior Staff Nurse at North Bristol NHS Trust, describes the moral challenges of working in a busy Emergency Department.- Posted
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Barbara, the whole story
Claire Cox posted an article in Dementia
Created by nurses at Guy's and St Thomas' to raise awareness of dementia among staff, Barbara's Story is a series of six films which have changed attitudes to dementia in hospitals across the world. The film here tells the story of how and why Barbara's Story was made and includes a condensed version of all six episodes. -
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The Parable of the Blobs and Squares
Claire Cox posted an article in Patient engagement
A great animated video brought to you by No More Throw Away People – voiced by Brian Blessed, this tale of blobs and squares paints an accurate picture of how co-production matters. This short animation shows why its vitally important to engage and include our patients and service users in clinical system design. It explains simply what may happen if we don't listen to all parts of our system to make care safer. -
Content ArticleIn February 2019, Claire, a Critical Care Outreach Sister, and Patient Safety Learning's Associate Director, had the great privilege to visit Rush University Hospital, Chicago, as a visiting nurse scholar to shadow the critical care outreach team. The objectives of this visit were to (1) collaborate to harness and direct the strengths of two teams from two different countries, in two unique settings; and (2) to promote best practices that facilitate early recognition and management of patient deterioration to improve patient outcomes. In this blog, Claire talks about this amazing opportunity to see how the UK and USA systems differ and how we can learn from one another.
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Content ArticleThis study from Westbrooke et al. published in BMJ Quality and Safety evaluates the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.
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Content ArticleThe Nursing and Midwifery Council exists to protect the public. They do this by making sure that only those who meet the requirements are allowed to practise as a nurse or midwife in the UK, or a nursing associate in England. They take action if concerns are raised about whether a nurse, midwife or nursing associate is fit to practise.
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Releasing Time to care, The NHS Productive Series (NHS Improvement)
Claire Cox posted an article in Environmental
The successful NHS Productives series, from NHS Improvement, are about ‘the how not the what’ and use a learning by doing approach that builds knowledge and skills to support frontline teams to make real and lasting improvements for themselves.- Posted
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Content ArticleRichard Greenwood is Trust Decontamination Lead & Head of Sterile Services at University Hospitals of Morecambe Bay (UHMB) NHS Foundation Trust. As with many NHS Trusts, UHMB were faced with problem of managing surgical instrument stocks, migration of the instruments from sets, and tracking and tracing single instruments through the decontamination process back to the patient. This case study shows how they solved this problem.
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Content ArticleThe Safer Nursing Care Tool has been developed by the Shelford Group to help NHS hospital staff measure patient acuity and/or dependency to inform evidence-based decision making on staffing and workforce. The tool, when allied to Nurse Sensitive Indicators (NSIs), offers nurses a reliable method against which to deliver evidence-based workforce plans to support existing services or to develop new services. The Shelford Group is an organisation comprising Chief Executives of 10 of the leading NHS multi-specialty academic healthcare organisations in England. The Chief Nurses of each of these NHS Trusts belong to a subgroup of the organisation and they meet every two months to share best-practice, benchmark and work towards improving standards in nursing.
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- Work / environment factors
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Content ArticleIn intensive care units (ICU) and operating theatres, arterial lines are used to accurately measure a patient’s blood pressure and take numerous and repetitive blood samples. In order to prevent bacterial contamination and blood spillage from the arterial line, red arterial connectors, which are closed cap coverings, are placed on the sampling port of the arterial line. Doctors from The Queen Elizabeth Hospital NHS Foundation Trust, Kings Lynn have collaborated with Eastern Academic Health Science Network and the Patient Safety Collaborative on this patient safety solution.
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Webinar: Using Human Factors in Hospital Technology Procurement
Claire Cox posted an article in Equipment design
Healthcare information technology procurement is critical for healthcare organisations, as procurement decisions on medical devices and IT infrastructure will impact safety, efficiency, staff and patient experiences. In this webinar, Svetlena Taneva, from Healthcare Human Factors, University Health Network, discusses using Human Factors in hospital technology. -
Content ArticleChapter 28 of this book covers The Impact of Facility Design on Patient Safety.
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Content ArticleCall for Concern is an initiative from the Royal Berkshire NHS Foundation Trust enabling patients and their families to directly refer patients to the critical care outreach team.
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Content ArticleNHS Improvement have published a number of case studies on appropriate use of clinical risk assessment tools, developing new evidence-based alerting systems and developing personalised risk management plans for people who use services, to manage risks positively.
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Content ArticleThis decision tree, used at the Brighton and Sussex University Hospitals NHS Trust, was developed as a ‘quick reference’ aid for nurses setting up non-invasive ventilation (NIV). It highlights key settings and signposts users to the full trust policy for more detailed explanation. It is adapted from the British Thoracic Society guidelines for acute NIV.
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Content ArticleKat Dalton, Critical Care Outreach Sister in Brighton and Sussex University Hospitals NHS Trust, reflects on her experience training nurses using non-invasive ventilation (NIV) in ward areas. The Trust’s NIV steering group reviewed how they could improve NIV care and keep up with current national recommendations. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD)’s report ‘Acute Non-invasive Ventilation: Inspiring Change’, published in 2017, highlighted 21 recommendations for acute NIV care, including that: “All staff who …make changes to acute non-invasive ventilation treatment must have the required level of competency as stated in their hospital operational policy. A list of competent staff should be maintained.” With this in mind, and as part of the NIV steering group, Kat volunteered to take on training nurses using NIV in ward areas.
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When doing your 'best' isn't enough
Patient Safety Learning posted an article in Stories from the front line
Blog by critical care outreach sister, Claire Cox, on a typical night shift and how it led her to the Darzi Fellowship.- Posted
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Content ArticleThe neonatal practice development nurse and infant feeding midwife at Bedford Hospital NHS Trust led a programme of work to adopt and implement the ‘RAPP’ (Respirations, Activity, Perfusion, Position/Tone) tool in their maternity unit. This programme led to improved outcomes for new-born babies in the unit.
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Content ArticleThis paper from Kneebone et al, published in BMC's Advances in Simulations proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues.
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Content ArticleHealthcare Safety Investigation Branch (HSIB) report on the inadvertent administration of an oral liquid medicine into a vein. This report indicated the importance of using human factors in the investigation process. The investigation reviewed the effectiveness of the current processes for the storage of medicines, equipment design, and the prescribing, preparation, checking and administration of medication. It also considered the contextual, environmental and human factors that influenced the inadvertent administration of an oral solution into a vein. The effectiveness of current processes for implementation of local safety standards for invasive procedures was also considered. A human factors expert was involved in the investigation and a dedicated report was written based on the evidence reviewed, a reconstruction of the event and a simulation of what should have happened.
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- Medication
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