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Content ArticleThe rate at which nursing and ambulance staff are leaving the NHS is increasing. The number of nurse vacancies has risen to over 40,000 – a record high. The ambulance service has recorded an 80% per cent increase in staff leaving the profession since 2010. These rates are unequally distributed across professions, specialties and geographical regions, introducing inevitable inequalities in patient care. This Efficiency Research project aims to use this variation to detect underlying contributory factors for better or worse nurse and ambulance staff retention, and determine its effect on patient outcomes. A research team from Staffordshire University will use their experience of applying ‘big data’ analytics and unifying large datasets from three previous studies on the effect of nurse staffing on patient safety. Projects began in 2019 and will run until December 2023.
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News Article
Patients don’t feel safe in A&E, research finds
Patient Safety Learning posted a news article in News
Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50. Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off. Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77). Read full story (paywalled) Source: HSJ, 3 September 2020- Posted
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- Virus
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News Article
Coronavirus: Charity seeks judicial review on care home visit guidance
Patient Safety Learning posted a news article in News
A dementia charity is seeking a judicial review of the government guidance on care home visits. John's Campaign says many care homes in England are still refusing regular face-to-face visits, often essential for people with severe dementia. Dr Angela McIntyre, a retired doctor backing the campaign, has not seen her 92-year-old mother since March. A Department of Health spokesman said: "We know limiting visits in care homes has been difficult for many families." He added: "Our first priority is to prevent infections in care homes, and this means that visiting policy should still be restricted with alternatives sought wherever possible. "Visiting policies should be tailored by the individual care home and take into account local risks in their area." But John's Campaign believes the guidance does not take into account how important visits from family members are for dementia patients and believes it could be in breach of the law. Read full story Source: BBC Health, 3 September 2020 -
News ArticleNurses and essential healthcare staff could be left redundant in the middle of the pandemic as local authorities look to make changes to healthcare contracts that would leave patients facing major disruption, NHS bosses have warned. NHS Providers, which represents all NHS trusts, and NHS Confederation, which represents health and care organisations, said that the decision to put contracts for public health services out to tender as workers battle coronavirus in the community is “completely inappropriate” and a “damaging distraction”, creating uncertainty for those who have spent the past six months on the COVID-19 frontline. Shadow health minister Jonathan Ashworth told The Independent: “This process is disruptive and wasteful at the best of times, but to be doing this mid-pandemic is risky, unnecessary and undermines the ability of frontline health workers to focus not only on preparations for a potential second wave, but a whole host of other health issues, such as Covid rehabilitation, community mental health services and children’s health, all of which are now urgent priorities.” Read full story Source: The Independent, 1 September 2020
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News Article
Not wearing a mask a ‘serious conduct issue’, CEO warns staff
Patient Safety Learning posted a news article in News
A London acute trust has told its staff they may not be paid for time at home self-isolating if it transpires they were not wearing a mask near someone with coronavirus. Staff at Chelsea and Westminster Hospital Foundation Trust were told that if they have to stay at home self-isolating because they were not wearing a mask, that time would have to be taken as annual or unpaid leave. Chief executive Lesley Watts told all staff in an email today, seen by HSJ, that a worker had tested positive for COVID-19, and that four staff members had spent more than 15 minutes with them “without appropriate [personal protective equipment]” and must all now isolate themselves at home for 14 days. The trust considers it “a serious conduct issue not to wear a mask where you are putting colleagues or our patients at risk – this will be dealt with under our formal processes going forward”, Ms Watts said in the email. “If you are sent home to isolate for two weeks because you have not worn a mask, I am now informing you that you will be required to take this as annual or unpaid leave. The four staff members “would not be having to go home to isolate if the use of face masks and social distancing had been in place appropriately”. A Chelsea and Wesminster Hospital spokesman told HSJ: “The guidance around PPE has changed a number of times over the course of the pandemic and we felt it was important to be clear on the trust’s position and to reiterate how seriously we take staff and patient safety." Read full story (paywalled) Source: HSJ, 28 August 2020- Posted
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Content ArticleThis video from NHS Resolution looks at the criteria that need to be met in order for patient consent to be legally valid. Advice is provided on how to ensure practitioners obtain legally valid consent.
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Content Article
As college students return, a crisis in campus care awaits
lzipperer posted an article in Coronavirus (COVID-19)
Health services in college and university campuses are under pressure to respond to COVID-19 with patient safety in mind. This article from Abelson et al. in The Seattle Times discusses weakness in university health services that undermine their ability to do so. It shares interviews with students that discuss misdiagnosis and diagnostic delays due to the impact of the pandemic.- Posted
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- Pandemic
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Content ArticleLeaflets and a poster aimed at providing information on influenza (flu) and vaccination.
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News ArticleNearly three-quarters of coronavirus patients admitted to hospital suffer ongoing symptoms three months later, new research suggests. A total of 81 patients out of 110 discharged from Southmead Hospital in Bristol were still experiencing symptoms from the virus, including breathlessness, excessive fatigue and muscle aches, after 12 weeks. Many were struggling to carry out daily tasks such as washing, dressing or going back to work, the study found. The majority of patients reported improvements in the initial symptoms of fever, cough and loss of sense of smell, and most had no evidence of lung scarring or reductions in lung function. The findings are part of North Bristol NHS Trust's Discover project, which is studying the longer-term effects of coronavirus - so-called Long COVID. An intensive care doctor, Dr Jake Suett, told Sky News in June that he was still suffering COVID-19 symptoms three months after contracting the disease. Dr Jake Suett, 31, had no underlying health conditions but was still suffering chest pain, breathlessness, blurred vision, memory loss, a high temperature, concentration problems. Dr Rebecca Smith, from North Bristol NHS Trust, said: "There's still so much we don't know about the long-term effects of coronavirus, but this study has given us vital new insight into what challenges patients may face in their recovery and will help us prepare for those needs." Read full story Source: Sky News, 20 August 2020
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Content Article
Pressure Ulcer Path: prevent and treat step by step
Patient Safety Learning posted an article in Pressure ulcers
Research has shown that frontline staff understand the dangers of pressure sores but experience significant challenges in their attempts to prevent them. The research, undertaken by NHS Midlands and East and downloadable below, showed that staff feel they do not have the time to treat patients and need improved communication between the patients, their carers and the homes from which they might have come. In response to this, NHS Midlands and East has created the Pressure Ulcer Path, a tool to support staff in preventing pressure ulcers and treating them, alongside a number of useful resources.- Posted
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- Ulcers / pressure sores
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News Article
COVID-19: Impact of long term symptoms will be profound, warns BMA
Patient Safety Learning posted a news article in News
A third of doctors have treated patients with long term COVID-19 symptoms, including chronic fatigue and anosmia, a survey conducted by the BMA has found. Richard Vautrey, chair of the BMA’s GP committee for England, said it was clear that the long term impact of COVID-19 on patients and the NHS would be profound. “With more patients presenting with conditions as the result of infection, it’s essential that sufficient capacity is in place to support and treat them,” Vautrey said. “With the growing backlog of non-COVID-19 treatment, the likelihood of a season flu outbreak, and the possibility of a second wave of infections we need to see a more comprehensive long term plan to enable doctors to care for their patients this winter and beyond.” The survey also asked doctors about their own experiences of COVID-19: 63% said they did not believe they had contracted the virus, 12% had had a diagnosis of COVID-19 confirmed by testing, and 14% believed they had been infected with the virus. David Strain, co-chair of the BMA’s medical academic staff committee, said that the NHS could not afford more failures of quality and supply in personal protective equipment. “Risk assessments should be available to all working in the NHS and appropriate steps should be put in place to mitigate the risk of catching the virus, even in those that have a low risk of a bad outcome from the initial infection,” he said. Read full story Source: BMJ, 13 August 2020 -
News ArticleFollowing four deaths and more than 300 incidents with steroid replacement therapy involving patients with adrenal insufficiency in the past two years, patients at risk of adrenal crisis will be issued with a steroid emergency card. All adults with primary adrenal insufficiency (AI) will be issued an NHS steroid emergency card to support early recognition and treatment of adrenal crisis, a National Patient Safety Alert has said. The cards will be issued by prescribers — including community pharmacists — from 18 August 2020. AI is an endocrine disorder, such as Addison’s disease, which can lead to adrenal crisis and death if not identified and treated. Omission of steroids in patients with AI, particularly during physiological stress such as an additional illness or surgery, can also lead to an adrenal crisis. The alert has requested that “all organisations that initiate steroid prescriptions should review their processes/policies and their digital systems/software and prompts to ensure that prescribers issue a steroid emergency card to all eligible patients” by 13 May 2021. Read full story Source: The Pharmaceutical Journal, 17 August 2020
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Content ArticleA joint National Patient Safety Alert has been issued by NHS Improvement and NHS England national patient safety team, Royal College of General Practitioners, Royal College of Physicians and Society for Endocrinology, regarding the introduction of a new Steroid Emergency Card to support the early recognition and treatment of adrenal crisis in adults.
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News Article
Hospital has 'closed its doors' to patients, LMC warns NHS England
Patient Safety Learning posted a news article in News
GP leaders have written to NHS England to demand that an NHS hospital trust urgently restores routine referrals as it has 'closed its doors' to some patients, ‘destabilising’ practices in the process. Oxfordshire LMC said local GPs are ‘concerned and angry’ about the ‘ongoing closure’ to routine referrals across multiple ‘high-demand’ specialties by Oxford University Hospital Foundation Trust, while warning GPs are also being asked to carry out tests that should be done in hospital. A ‘significant’ number of specialties are affected, including ENT, general gynaecology, dermatology, ophthalmology, endoscopy and urology, as well as plastics and maxillofacial, it added. The hospital trust said it had remained open for urgent and emergency care and was accepting clinically urgent and suspected cancer referrals, while reinstating services to support 'the vast majority' of routine referrals. But Oxfordshire LMC has this week written to NHS England and the council of governors at OUHFT to demand that there are ‘no further delays’ in restoring the services amid concerns of ‘patient harm’. It said: ‘The LMC believes the continuing closure of some specialty services to routine referrals is now so serious for patients that it has taken a decision to formally raise the concerns of Oxfordshire’s GPs with NHS England.’ Read full story Source: Pulse, 13 August 2020- Posted
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Content ArticleThe aim of the project was to introduce and evaluate a Call for Concern (C4C) service that provides patients and relatives with direct access to the Critical Care Outreach (CCO) team, to give patients and relatives more choice about who they can consult with about their care, and facilitate the early recognition of the deteriorating ward patient. The project involved two phases: a six month pilot phase to evaluate the C4C service for feasibility, and its effects on patients, relatives and the health care teams. a three month phase implementing the C4C service onto two surgical wards to test and evaluate the findings of the feasibility phase in preparation for expansion to all hospital wards. Between 1st Sept 2009 and 23rd Sept 2010, the CCO team received 37 C4C referrals representing 0.5% of total CCO activity. Critical deterioration of a patient was prevented in at least two cases, and the service received positive feedback from patients and relatives. In the words of a relative, C4C provided: ‘…a better quality of care…and…reduces the risk of death.’
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- ICU/ ITU/ HDU
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Content ArticlePippa Kent is one of those people who were told that from 1 August they no longer needed to shield to protect themselves from the coronavirus. While you might assume that, having been trapped inside her house for the past 18 weeks, she would embrace this newfound freedom with enthusiasm, the reality remains far from it. For those whose pre-existing medical conditions greatly increase the risk from COVID-19, there, naturally, is hesitation to embrace this sweeping change. Read Pippa's blog, published in the Guardian, on her first trips out and the fears she felt.
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News Article
NHS told to let patients initiate follow-up appointments
Patient Safety Learning posted a news article in News
Trusts are being encouraged to adopt a system in which patients initiate follow up appointments by the lastest guidance from NHS England designed to help the NHS recover from the covid crisis. It is hoped the approach can reduce unnecessary demand and therefore help trusts cut waiting lists that have soared as a result of the restrictions placed on hospital activity during the pandemic. Under 'patient initiated follow up' (PIFU) patients decide when they require follow up appointments. They are given guidance as to what symptoms and other factors they should take into account when deciding if a follow up appointment is necessary. PIFU is already used by some trusts, but it has not yet become widely adopted. The plan to increase PIFUs was set out in a guidance published today designed to underpin the “phase three letter” sent out to NHS leaders last week. The guidance, Implementing phase 3 of the NHS response to COVID-19 pandemic , says “individual services should develop their own guidance, criteria and protocols on when to use PIFUs”. The document also sets out some overarching principles. It says services will be rated against the following headline metrics: “total number and proportion of patients on the PIFU pathway; patient outcomes, e.g. recovery rates, relapse rates; waiting times; and DNA rates”. Read full story (paywalled) Source: HSJ, 7 August 2020- Posted
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Content Article
Nadine’s story: Informed consent (the Montgomery case)
Claire Cox posted an article in Consent and privacy
In this short film, Nadine Montgomery presents her story that led to the landmark ruling on consent (Montgomery v Lanarkshire Health Board, 2015) -
Content ArticleNorthampton General Hospital NHS Trust has produced this leaflet to help keep patients safe in hospital.
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- Safety behaviour
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Content Article
Building a communication passport
Claire Cox posted an article in Learning disabilities
Kate and Jenny Sanger’s 'Communication Passport' gives a voice to the voiceless and enables those being supported and those providing that support to have the two-way conversation that leads to a happy and positive relationship. The passport is a powerful support tool for staff, giving them confidence and job satisfaction that they are doing their best for the person they support. Kate and Jenny Sanger created the communication passport originally for Kate’s daughter, Laura. The aim of the passport is to enable a range of professionals and specialists access important information so that care can be delivered more holistically. The communication passport has now been shared widely to help other families and individuals with complex needs. Kate and Jenny Sanger speak in this webinar about building a communication passport.- Posted
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- Learning disabilities
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Content ArticleCompulsory face coverings pose particular challenges when patients are deaf or have dementia. This blog by Lesley Carter give practical advice on how to communicate clearly with patients when wearing a face mask.
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- Secondary impact
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Content ArticleThis animation has been made to help patients stay safe while they are in hospital. It has been developed by Haelo, an innovation and improvement centre in Salford, in partnership with Guy’s and St Thomas’, and is based on the airline-style safety card developed by Guy’s and St Thomas’. Designed as part of their award-winning Welcome Pack, the safety card supports our commitment to patient safety and enables patients to play an active role in their care.
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- Patient
- Patient involvement
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Content ArticleThis patient information leaflet produced by Guys and St Thomas' NHS Foundation Trust gives 8 simple steps to keep yourself safe during your stay in hospital. These include; Preventing falls Preventing blood clots Preventing infection Your medicines Pressure ulcers Identification Your concerns Leaving hospital.
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Content Article
Advanced Care Planning (Macintyre)
Claire Cox posted an article in Learning disabilities
Advance Care Planning (ACP) is becoming increasingly important in ensuring that people receive good care and ultimately experience a “good death”. ACP can lead to less aggressive or invasive medical care, better quality of life near death, decreased rates of hospital admission, and people being more likely to receive care that is aligned with their wishes and dignity. It can be a difficult subject to discuss and can be confusing for health and social care professionals, staff and families, due to a lack of knowledge about ACP and a lack of awareness regarding the legal position.- Posted
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- Learning disabilities
- End of life care
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Content ArticlePeople with a learning disability must be involved in all decisions about their health, and be in control over these choices. Some of the barriers to equal access to healthcare faced by people with a learning disability are: Lack of information that is easy to understand. ‘Diagnostic overshadowing’ - when signs and symptoms are mistakenly attributed to the person’s learning disability. Family carers and others who know the person well are not listened to when they are often able to describe changes in the person in a way that will aid diagnosis. A hospital might assume that the person has 24-hour support, when in fact they only get a few hours’ support a week and will need some extra help to follow the post-discharge treatment plan.
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- Information sharing
- Patient / family support
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