The safety competencies is a practical framework designed for all healthcare professionals. Created by the Canadian Patient Safety Institute, it has six core competency domains:
Contribute to a culture of patient safety – a commitment to applying core patient safety knowledge, skills and attitudes to everyday work.
Work in teams for patient safety – working within interprofessional teams to optimise patient safety and quality of care.
Communicate effectively for patient safety – promoting patient safety through effective healthcare communication.
Manage safety risks – anticipating, recognising and managing situations that place patients at risk.
Optimise human and environmental factors – managing the relationship between individual and environmental characteristics in order to optimise patient safety.
Recognise, respond to and disclose adverse events – recognising the occurrence of an adverse event or close call and responding effectively to mitigate harm to the patient, ensure disclosure and prevent recurrence.
Key learning points
Always consider individual benefits and risks when making decisions about pregnancy.
Continuing medication or preventing illness with vaccination may be the best way to keep both mother and baby healthy - ask a specialist.
Black and Asian women have a higher risk of dying in pregnancy.
Older women are at greater risk of dying
Be body aware - some symptoms are normal in pregnancy but know the red flags and always seek specialist advice if symptoms persist.
Overweight or obese women are at higher risk of blood clots including in early pregnancy.
The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families (the Guide) is a resource to help primary care practices partner with patients and their families to improve patient safety. The Guide is composed of materials and resources to help primary care practices implement patient and family engagement to improve patient safety.
Involving patients in improving safety states that supporting patient involvement in safety improvement will not solve all the safety issues in the NHS, nor does it negate the responsibility of health systems and professionals to provide safe care. However, involving patients and carers can be an important component of broader strategies.
It highlights that, as patients come to be seen and treated as partners in their care, there is significant potential to make real gains in patient safety.
Main approaches identified to involving patients in safety improvement
Collecting feedback retrospectively.
Asking patients to help plan broad service change.
Encouraging patients to help identify risks when they are receiving care.
Mandy Odell, Nurse Consultant, Critical Care, Royal Berkshire NHS Foundation Trust, Reading, has implemented this initiative in her hospital and beyond.
Five years following the introduction of a whole-hospital, 24-hour critical care outreach (CCO) service, an additional service was introduced that enabled patients and their families to directly call the CCO team if they had concerns that were not being acknowledged by the patient’s clinical team. The aim of this review, published in the Journal of Nursing, was to report on 7 years of patient and family referrals using quantitative and free text data extracted from the CCO referral database.
What will I learn?
Simple tests that have been recommended by NICE for frailty in primary care are gait speed, self-reported health status and the PRISMA 7 questionnaire.
Exercise programmes, particularly high intensity interventions, may improve gait, balance and strength and have positive effects on fitness.
Medication review forms part of the holistic medical review of people with frailty.
Supported self-management can improve health outcomes. However, the value of case management is still to be proven.
Discussion about end-of-life care is important to most older people, but is often neglected.
This issue (episode 2) focuses on:
the most common safety issues associated with measuring patient weight
steps to eliminate drug concentration confusion
understanding Patient Care Analgesia (PCA) by proxy.
This work aimed to reduce the percentage of pressure ulcers across multiple care settings in North East and North Cumbria (NENC) where the incidence of pressures ulcers was higher than the national average. The Patient Safety Collaborative (PSC) funded and supported a two-year Pressure Ulcer Collaborative (PUC), involving secondary care, community services, care homes and the ambulance service, where they had been developed by patients within their care. The Breakthrough Series Collaborative Model from the Institute for Healthcare Improvement (IHI) provided the implementation framework. In year 1, pressure ulcers were reduced by 36%, and 33% in year 2 with an estimated cost saving of £513,000, and a reduction in the number of bed days between 220 and 352.
Patient safety is about maximising the things that go right and minimising the things that go wrong. It is integral to the NHS’ definition of quality in healthcare, alongside effectiveness and patient experience. This strategy describes how the NHS will continuously improve patient safety, building on the foundations of a safer culture and safer systems.
The framework outlined in this document provides a structure for thinking about engaging patients in patient safety and gives examples of how this can be achieved. It is mindful of the criticisms of approaches to patient engagement in patient safety and is a first step towards adopting a theoretical approach to this context. Some factors which influence engaging with patients in patient safety which were identified from this work are also presented.
The framework describes three levels of patient engagement in patient safety across three levels of the NHS healthcare system. It also presents real-world examples of patient engagement in patient safety and applies these to the framework.
For the purposes of the framework:
Patient safety is defined as freedom from healthcare associated preventable harm.
Patient engagement is the encouragement of patients, carers and families to work with healthcare professionals, healthcare service providers, commissioners and policy makers to improve health and healthcare. Descriptors of three levels of patient engagement are presented in the framework.
Patients may be someone receiving care and giving ‘real-time’ feedback, patients who have previously received care or treatment, patients who have experienced harm, or members of the public.
Between April and June 2018, the RCPCH Children and Young People’s Engagement Team met with over 130 children, young people and families to collect their views on ‘service contact ability’ and family mental health. Over 2335 questionnaires were submitted by children, young people and their carers.
This submission demonstrates:
impact from patient and public involvement
embedded involvement to sustain QI
The web page includes resources on:
Improving the proportion of smoke-free pregnancy.
Optimisation and stabilisation of the very preterm infant.
Detection and management of diabetes in pregnancy.
Early recognition and management of deterioration of mother or baby.
Reduce incidence of falls and harm.
Embed falls prevention into everyday practice.
Engage clinical staff to identify patients at risk and implement harm prevention strategies.
Process for target wards:
Present data for the past 12 months for falls by severity, as baseline metric.
Present serious falls and actions undertaken.
Falls Risk Assessment audit as baseline metric.
Falls Link Worker ensures a display board is refreshed with falls prevention displays and audit result.
Ward team set own targets for improvement weekly.
Teaching sessions delivered. These may be ward sessions or in the Quality Improvement and Innovation (QII) hub.
Weekly audits continue.
Meeting with the team to discuss programme results, falls incidences, post fall assessment themes and audit results.
Link worker provides evidence of training undertaken and plan for those who have not received training.
Improvement plan agreed to be delivered by the link worker.