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Content ArticleIn this report, Patient Safety Learning considers the roles and responsibilities of Integrated Care Systems (ICSs) in relation to patient safety, and how this fits in with the wider patient safety landscape in England. This article contains a summary of the report, which can be read in full here or from downloading the attachment below.
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Content ArticleThe Joint Commission's National Patient Safety Goals address patient care and safety to give healthcare organisations a framework for improvement. This article from the University of Southern California takes a look at the current National Patient Safety Goals, the role of healthcare administration in patient safety, strategies to implement safety goals in hospitals and evaluating the effectiveness of safety goals.
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News Article
Welsh Government criticised for failing to appoint a Patient Safety Commissioner
Patient Safety Learning posted a news article in News
The Welsh Government is facing criticism after refusing to appoint an independent Patient Safety Commissioner – a role established in England last year and currently being legislated for in Scotland. The moves in England and Scotland follow publication of the Independent Medicines and Medical Devices Safety Review in 2020, which investigated a series of scandals where patients suffered because of negligence and inaction. The review recommended the establishment of a Patient Safety Commissioner in England, and last September Dr Henrietta Hughes became the first such commissioner. The Scottish Parliament is currently legislating to introduce a Patient Safety Commissioner. A Welsh Government spokesman said: “The situation here is different to the other devolved nations. We’ve recently introduced our own legislation and other measures to improve patient safety. “We strengthened the powers of the Public Service Ombudsman for Wales to undertake their own investigations and introduced new duties of quality, including safety, and candour for NHS bodies. We have created [the body] Llais to give a stronger voice to people in all parts of Wales on their health and social care services. It has a specific remit to consider patient safety and has the power to make representations to NHS bodies and local authorities and undertake work on a nationwide basis. “Our view is that introducing a Patient Safety Commissioner in Wales at this time would create considerable complexity and confusion. Also one of the main roles of the proposed commissioner is in relation to medicines and medical devices, which are not devolved to Wales.” Read full story Source: Nation Cymru, 6 July 2023- Posted
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Content ArticleThe Patient Safety Movement Foundation offers a unique educational opportunity for healthcare professionals around the world to expand their knowledge in the theory and practice of patient safety. Please apply to this fellowship programme from the link if you are interested in joining the 2024 cohort of fellows. Application deadline is 1 August 2023.
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Content ArticleVideo of the 10th Annual World Patient Safety, Science & Technology Summit presentations. The event fostered a high-level exchange of ideas and initiatives to improve global patient safety with expert speakers and panelists, inspiring messages from hospital executives, and the sharing of tragic patient stories. The programme ignited further momentum to reach ZERO harm. You can view all the speaker presentations by clicking on the image below. There is also a link to the Patient Safety Movement Foundation website with all the presentations at the end of the page.
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Content ArticlePatients are vulnerable during emergency episodes outside the formal care sector, for example, care provided by paramedics responding to a stroke or heart attack at home. Yet much less is known about the safety of Emergency Medical Services (EMS) as compared with primary or secondary healthcare. This relative lack of information is important given there are aspects of EMS care that create unique patient safety challenges. This BMJ Editorial discusses how we can improve patient safety in the Emergency Medical Services.
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Content ArticleThis blog provides an overview of a Patient Safety Management Network (PSMN) meeting discussion on 9 June 2023. At this meeting, members of the Network were joined by Dr Henrietta Hughes, Patient Safety Commissioner for England. The PSMN is an informal voluntary network for patient safety professionals in England. Created by and for patient safety managers, it provides a weekly drop-in session with guests to talk through issues of importance to patient safety managers, providing information, peer support and safe space for discussion. Find out about the network.
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Content ArticleThe 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.
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Content ArticlePatient Safety Learning has developed a unique set of patient safety standards, resources and tools to help organisations not only establish clearly defined patient safety aims and goals, but also support their delivery and demonstrate achievement. This page provides an overview of our Standards with links to further information.
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Content ArticleIn this blog Aiden Fowler, the National Director of Patient Safety in England and a Deputy Chief Medical Officer at the Department of Health and Social Care, reflects on progress made in implementing the NHS Patient Safety Strategy, four years on from its publication. He outlines some of the main programmes of work associated with this and considers their impact on avoidable harm in the NHS.
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Content ArticleThe role of Patient Safety Specialist was introduced by the NHS in England in 2019, as part of wider plans designed to help improve patient safety. There are currently several hundred Specialists in place. All NHS organisations in England are required to identify at least one Patient Safety Specialist, and they will play a key role in delivering the NHS Patient Safety Strategy. The This Institute wants a detailed understanding of the background to the Patient Safety Specialist role and its implementation to date. This study aims to offer insights into the challenges and opportunities associated with delivering improvement though a designated role like the Patient Safety Specialist. The study aims to highlight ways to support Patient Safety Specialists and provide recommendations to NHS England about future policy and strategy around their role.
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Content ArticleThis review covers the impact the Eastern AHSN has delivered throughout the East of England and beyond in 2022/23, including an increased focus on fostering an innovation culture, tackling health inequalities, and supporting innovators to turn their ideas into positive health impact.
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Content ArticleThe AHSN Network comprises 15 AHSNs across England, established by NHS England in 2013 to improve health and generate economic growth in regionally distinct ways. In 2021, they launched their five-year strategy where they set out their ambition to support the NHS through an increased emphasis on health outcomes, their innovation pipeline, and by using knowledge and learning to build and embed greater momentum for NHS pathway transformation. Here is their latest progress report and achievements.
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Content ArticleThe inpatient diabetes team at University Hospital Southampton NHS Foundation Trust recently launched D1abasics, an initiative that aims to improve inpatient care for people with diabetes. In this blog, Diabetes Consultant Mayank Patel and Inpatient Diabetes Specialist Nurse Paula Johnston outline the approach and explain how it will equip staff across all specialties with the basic knowledge to care safely for people with diabetes in hospital.
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Content ArticleThe Royal United Hospital Bath NHS Trust project tested different ways to communicate with staff about patient safety, to encourage the reporting of incidents and to promote a learning culture.
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Content ArticleThis framework supports the health and disability sector to mitigate and respond to healthcare harm in Aotearoa New Zealand. Healthcare harm as defined in this framework can be a physical, psychological, social, spiritual injury or experience that occurs during the provision of care. In Aotearoa New Zealand, harm also occurs and endures due to the impacts of imperialism, colonisation and racism. In te ao Māori, harms are conceived as diminishing of the tapu and mana of people, their environments and their spiritual connection. The framework was developed by the National Collaborative for Restorative Initiatives in Health in partnership with a diverse range of stakeholders over an 18-month period. The recommendations in the framework aim to enhance the overall health and wellbeing of consumers and providers of healthcare, while accounting for the unique features of the health system context.
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Content ArticleThis 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.
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Content Article
Patient Safety Commissioner for England website
Patient Safety Learning posted an article in England
The role of the Patient Safety Commissioner for England is to promote patient safety in relation to medicines and medical devices and to promote patients’ voices. This site provides information and resources related to this role and is for everyone interested in promoting patient safety and making sure that patients’ voices are heard.- Posted
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Content ArticleThe Global Patient Safety Action Plan was formally adopted at the World Health Assembly on 28 May 2021. It provides a 10-year roadmap and actions to work towards its vision of a world in which no one is harmed in healthcare and every patient receives safe and respectful care. This report provides a snapshot of progress made in achieving the strategic objectives and strategies of the global action plan based on the WHO Member State survey coordinated by the secretariat. This interim report will be replaced by a final Global Patient Safety Report 2023 later in the year.
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News ArticleThe Royal College of Midwives says the need for a maternity strategy in Northern Ireland has gone beyond urgent and is now critical. The warning comes as the RCM is publishing a report on Northern Ireland's maternity services at Stormont on Tuesday. The report will highlight growing challenges as more women across the country with additional health needs are being cared for by maternity services. The RCM report will outline three steps to deliver high quality and safe services for women and families. Develop, publish and fund the implementation of a new maternity and neonatal strategy for Northern Ireland. Sustain the number of places for new student midwives at their recent, higher level. Focus on retaining the midwives in the HSC. Read full story Source: ITV News, 30 May 2023
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Content ArticleWebinar with Dr Chris Sirrs, Research Fellow at the Centre for the History of Medicine, University of Warwick, on the histories of patient safety in the NHS.
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Content ArticleThe Patient Safety Authority (PSA) is an independent state agency that collects reports of patient safety events from Pennsylvania healthcare facilities. Pennsylvania is the only state that requires acute care facilities to report all incidents of harm (serious events) or potential for harm (incidents). Long-term care facilities report infections into the Pennsylvania Patient Safety Reporting System (PA-PSRS). The PSA analyses those reports to prevent recurrence—either by identifying trends unapparent to a single facility or flagging a single event that has a high likelihood of recurrence— and disseminates that information through multiple channels. Here is the PSA's 2022 Annual Report.
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Content ArticleOn 23–24 February 2023, the 5th Global Ministerial Summit on Patient Safety in Montreux, Switzerland, marked the first convening of global leaders to discuss patient safety for more than 3 years. The summit provided the opportunity to reimagine the way safe care is delivered using learnings from the COVID-19 pandemic. In this correspondence in the Lancet, Shaw et al. hopes we will look back at the Montreux summit as a turning point in patient safety: the catalyst for moving from plans to actions, so that at future summits we can discuss shared learning and evaluation of health systems that deliver safe care to all.
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News ArticleTwo years ago, administrators and caregivers at St. Bernard Hospital in Chicago were stunned when they flunked a basic standard for patient safety. "It was a real jolt," said Charles Holland, the hospital's president and CEO. "We thought we were doing patient safety and we thought we were doing it well." But the Leapfrog Group, a nonprofit health care watchdog organisation, found the hospital fell short on documenting and having comprehensive approaches to hand-washing, medication safety systems and fall and infection prevention. The wake-up call led Holland to hire a Patient Safety and Quality Officer and to use Leapfrog's criteria as a roadmap for improving patient safety. It worked. In its latest annual review of hospital safety, released Wednesday, Leapfrog awarded the century-old charity hospital an A. The fact that St. Bernard could turn around so quickly and so effectively without spending a fortune in the process shows that patient safety is an attainable goal, said Leah Binder, Leapfrog's president and CEO. Read full story Source: USA Today, 3 May 2023
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Content ArticleThe Dutch Hospital Patient Safety Program started in 2008. It initially ran for five years, and its aim was to decrease adverse events by 50% in all Dutch hospitals. A second National Safety Program launched in 2020. This focuses on reflection, interprofessional collaboration and explaining process variation in daily practice. It also looks to foster more patient involvement and shared decision making. The ultimate aim is to reach a significant reduction in preventable patient harm. This webinar provides an overview of patient safety in the Netherlands and discusses these two initiatives and their implementation, outcomes and ongoing impact.
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