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Content Article
COVID-19: voices from the front line
Claire Cox posted an article in Stories from the front line
The COVID-19 pandemic has changed most lives internationally. Households have shifted, balancing financial concerns and anxieties about the health of family and friends with the trials and responsibilities of childcare. During this pandemic it became clear that while many were struggling with the same issues, a series of shared stories could help the wellbeing of frontline NHS staff who might feel isolated and alone. The following voices are not unique to Guy’s and St Thomas’ NHS Foundation Trust, anaesthesia or healthcare in the UK, but they were selected from the department to represent some of many healthcare workers who have taken on new professional roles as well as radically different ways of working and living. -
Content Article
Remaking a children's hospital in Minecraft
Claire Cox posted an article in Patient recovery
Microsoft teamed up with staff at Great Ormond Street Hospital for Sick Children to recreate the hospital in minecraft so that children visiting have a 'virtual tour' before arriving. -
News Article
After coronavirus, we may not recognise changed NHS
Patient Safety Learning posted a news article in News
In many ways it is wrong to talk about the NHS restarting non-coronavirus care. A lot of it never stopped — births, for instance, cannot be delayed because of a pandemic. However, exactly what that care looks like is likely to be very different from what came before. There are more video and telephone consultations and staff treat patients from behind masks and visors. That is likely to be the case for some time, experts have told The Times. Read full story (paywalled) Source: The Times, 6 June 2020 -
Content Article
Dirty Dozen and COVID-19 (webinar, May 2020)
Claire Cox posted an article in Coronavirus (COVID-19)
There are fears around maintaining personal safety whilst ensuring patient safety. Staff need to protect both themselves and their families at home. Equally, it is essential that staff feel supported in identifying risks and the potential for errors with a robust mechanism in place to reduce, eliminate or mitigate such risks. The Human Factors 'Dirty Dozen' is a concept developed by Gordon DuPont. He described elements that can act as precursors to accidents or incidents, or influence people to make mistakes. This webinar, from the Clinical Excellence Commission, looks at ways you can identify risks or 'hot spots' in your area of work and then discuss with your team at handover and huddles and plan strategies to reduce, eliminate or mitigate the risks -
Content ArticleBased on the Health & Safety Executive Guidance (HSE (2013) INDG451 ‘Heat Stress in the workplace’), Dr Susan Whalley-Lloyd has produced a document and flowchart addressing what happens to us when we experience extreme heat. This can be the result of extreme outside air temperature due to the weather or heat build-up in a work area due to equipment generating heat, or restricted workspace, or large areas of glass within a building, or air conditioning problems or windows that won’t open, or a combination of conditions eg high energy tasks whilst wearing PPE and few rest breaks for fluid intake.
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Content Article
Designing a safe space for neonatal care
Claire Cox posted an article in Process improvement
As well as designing specific products, ergonomists and human factors specialists can help understand how the space within which we work can be best designed. This can help encourage effective communication in a workplace, as well as considering the comfort of all those present. The Chartered Institute for Ergonomics and Human Factors have come together with stakeholders involved in the care of neonates to design a space that is safe for newborn babies and staff that care for them. -
Content ArticleLondon clinicians have shared their top 10 tips to help prepare NHS staff in other parts of the country facing the COVID-19 crisis. UCLPartners asked clinicians working in a range of specialties across its region, the first in the UK to deal with a major escalation in COVID-19, to share their practical advice to support NHS staff elsewhere in the country preparing for a large number of COVID-19 cases.
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Content Article
Critical Care Recovery
Claire Cox posted an article in Suggest a useful website
Researchers, patients, family members, health care staff and website developers have come together to create this website. It is based on over 120 interviews with former Intensive Care patients and family members at different stages of recovery. This website is aimed at: patients who have been on intensive care relatives and families who have been affected by their loved one being in intensive care. -
Content ArticleFree online mental health and emotional wellbeing services have been set up to support frontline workers. Frontline19 was set up by a small team of experienced pyschotherapists as a crisis response to the COVID-19 epidemic. They are working in partnership with Helpforce and are guided by a steering committee of industry professionals. If you are a frontline worker directly affected by COVID-19 and you need support to help you through this difficult time, please register for more info. Its quick, easy and absolutely free of charge.
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Event
Human Factors for Patient Safety Course
Patient Safety Learning posted an event in Community Calendar
Patient Safety is an essential part of health and social care that aims to reduce avoidable errors and prevent unintended harm. Human Factors looks at the things that can affect the way people work safely and effectively, such as the optimisation of systems and processes, the design of equipment and devices used and the surrounding environment and culture, all of which are key to providing safer, high quality care. New for September 2020, this part-time, three year, distance learning course, from the Centre of Excellence Stafford, focuses specifically on Human Factors within the Health and Social Care sectors with the aim of helping health and social care professionals to improve performance in this area. The PgCert provides you with the skills to apply Human Factors to reduce the risk of incidents occurring, as well as to respond appropriately to health, safety or wellbeing incidents. Through the study of Human Factors, you will be able to demonstrate benefit to everyone involved, including patients, service users, staff, contractors, carers, families and friends. Further information -
Content ArticleA significant amount of professional time is wasted during a medical ward round retrieving patient notes from the ward trolley. If the efficiency of this non-clinical, non-functional interaction could be improved it would save time, maintain continuity and have financial implications. One identified constraint was the structure of the traditional ward trolley; a stationary filing tray with vertical sleeves. During ward round, time is spent returning and retrieving each patients notes from outside the patient bay and additional time may be wasted if the notes are misplaced or in use elsewhere. To resolve this, the ‘Vista 90’ trolley with horizontal, transparent trays, is portable and has an ergonomic writing surface was selected as a potential second generation replacement. An assessment of the impact of the Vista 90 trolley over the traditional trolley in the clinical setting was carried out on Erringham (medical) Ward, Worthing Hospital, West Sussex Hospital Trust, UK. This was by way of qualitative analysis performed by semi-structured interview of 12 doctors and other healthcare professionals who regularly interacted with the Vista 90 and traditional trolley in December 2012. The audit found that those interviewed preferred using the Vista 90 trolley over its predecessor as it improved the efficiency of the ward round and subsequent clinical work. It’s mobility allowed it to be easily transported with the ward round, reducing disruption during a consultation and between consecutives ones. The ergonomic writing surface was noted to improve legibility of documentation due to greater comfort and if placed appropriately, did not interfere with the doctor-patient interaction. The financial savings of this greater efficiency was found to be of significance and justify the cost of the Vista 90 within two weeks.
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Content Article
Protecting the mental health of UK paramedics (January 2019)
Claire Cox posted an article in Mental health
It is estimated that the average member of the public within the UK will experience one or maybe two traumatic situations in a lifetime – whether that be through witnessing or being involved in an accident, natural disaster, collision, medical episode or traumatic event. Those working in frontline emergency ambulance services however are exposed to distressing and traumatic events on a much more frequent basis. This paper, Published in the Journal of Paramedic Practice, discusses Post Traumatic Stress Disorder (PTSD) among emergency workers, the effects it has on them and what can be done to support them. -
News Article
Prime Minister urged to give NHS 100 new hospitals plus an extra £7bn a year
Patient Safety Learning posted a news article in News
NHS leaders have urged Boris Johnson’s government to build 100 new hospitals and give the service an extra £7bn a year for new facilities and equipment. They want the Prime Minister to commit to far more than the 40 new hospitals over the next decade that the Conservatives pledged during the general election. So many hospitals, clinics and mental health units are dilapidated after years of underinvestment in the NHS’s capital budget that a spending splurge on new buildings is needed, bosses say. Too many facilities are cramped and growing numbers are unsafe for patients and staff, they claim. Johnson has promised £2.7bn to rebuild six existing hospitals and pledged to build 40 in total and upgrade 20 others, although has been criticised for a lack of detail on the latter two pledges. The call has come from NHS Providers, which represents the bosses of the 240 NHS trusts in England that provide acute, mental health, ambulance and community-based services. Read full story Source: The Guardian, 3 February 2020 -
Content ArticleIn my previous blogs I described the investigation process and where facts come from. We also pre-empted the content in this blog by saying that human factors (HF) is the scientific study of humans done by science types. It’s now time to talk ‘people’.
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Content ArticleHuman factors and ergonomics (HFE) approaches to patient safety have addressed five different domains: usability of technology; human error and its role in patient safety; the role of healthcare worker performance in patient safety; system resilience; and HFE systems approaches to patient safety.
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Content ArticleLong dreary corridors, impersonal waiting rooms, the smell of disinfectant — hospitals tend to be anonymous and depressing places. Even if you’re just there as a visitor, you’re bound to wonder, “How can my friend recover in such an awful place? Will I get out of here without catching an infection?” But the transformation of the Rotterdam Eye Hospital suggests that it doesn’t have to be this way. Over the past 10 years, the hospital’s managers have transformed their institution from the usual, grim, human-repair shop into a bright and comforting place. By incorporating design thinking and design principles into their planning process, the hospital’s executives, supported by external designers, have turned the hospital into a showplace that has won a number of safety, quality, and design awards.
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Content ArticleSeveral organisations, researchers and clinicians have discussed the need for a patient safety culture in dentistry. Strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry. Published by the British Dentistry Journal, this article: discusses the history of patient safety initiatives in healthcare and dentistry describes strategies that can be applied to identify patient safety issues in dentistry emphasises the importance of both process and cultural factors in developing a safer healthcare environment.
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Content ArticleWe tend to think of burnout as an individual problem, solvable by “learning to say no,” more yoga, better breathing techniques, practicing resilience — the self-help list goes on. But evidence is mounting that applying personal, band-aid solutions to an epic and rapidly evolving workplace phenomenon may be harming, not helping, the battle. With “burnout” now officially recognised by the World Health Organization (WHO), the responsibility for managing it has shifted away from the individual and towards the organisation.
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Content ArticleImperial College Hospital NHS Trust have launched their new falls safety improvement video to highlight the importance of safe mobility in hospital. Watch the video and join the conversation on Twitter.
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Content ArticleIn this blog published in the New York Times, Theresa Brown explains why American healthcare has become one giant workaround. "The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait." These 'work arounds ' pose a significant patient safety risk. What work around problems do you have in your department? Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing.
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News ArticleDoctors and nurses must adapt their routines and improvise their actions to ensure continued patient safety, and for their roles to be effective and to matter as new technology disrupts their working practices. Research from Lancaster University Management School, published in the Journal of Information Technology, found electronic patient records brought in to streamline and improve work caused changes in the division of labour and the expected roles of both physicians and nursing staff. These changes saw disrupted working practices, professional boundaries and professional identities, often requiring complex renegotiations to re-establish these, in order to deliver safe patient care. Managers implementing these systems are often quite unaware of the unintended consequences in their drive for efficiency. Read full story Source: EurekAlert, 25 November 2019
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News Article
Hospital alarms prove a noisy misery for patients
Patient Safety Learning posted a news article in News
When Kea Turner’s 74-year-old grandmother checked into Virginia’s Sentara Virginia Beach General Hospital in the US, with advanced lung cancer, she landed in the oncology unit where every patient was monitored by a bed alarm. “Even if she would slightly roll over, it would go off,” Turner said. Small movements — such as reaching for a tissue — would set off the alarm, as well. The beeping would go on for up to 10 minutes, Turner said, until a nurse arrived to shut it off. Tens of thousands of alarms shriek, beep and buzz every day in every US hospital. All sound urgent, but few require immediate attention or get it. Intended to keep patients safe by alerting nurses to potential problems, they also create a riot of disturbances for patients trying to heal and get some rest. Alarms have ranked as one of the top 10 health technological hazards every year since 2007, according to the research firm ECRI Institute. That could mean staffs were too swamped with alarms to notice a patient in distress, or that the alarms were misconfigured. The Joint Commission, which accredits hospitals, warned the nation about the “frequent and persistent” problem of alarm safety in 2013. It now requires hospitals to create formal processes to tackle alarm system safety, but there is no national data on whether progress has been made in reducing the prevalence of false and unnecessary alarms. The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85-99% do not require clinical intervention. Staff, facing widespread “alarm fatigue,” can miss critical alerts, leading to patient deaths. Patients may get anxious about fluctuations in heart rate or blood pressure that are perfectly normal, the commission said. Read full story Source: The Washington Post, 24 November 2019 -
Content ArticleIn recent years, there has been an increasing focus on the role of safety culture in preventing incidents such as medication errors and falls. However, research and developments in safety culture has predominantly taken place in hospital settings, with relatively less attention given to establishing a safety culture in care homes. Despite safety culture being accepted as an important quality indicator across all health and social care settings, the understanding of culture within social care settings remains far less developed than within hospitals. It is therefore important that the existing evidence base is gathered and reviewed in order to understand safety culture in care homes.
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Content Article
Museum of failure
Claire Cox posted an article in Miscellaneous
Museum of Failure is a collection of failed products and services from around the world. The majority of all innovation projects fail and the museum showcases these failures to provide visitors a fascinating learning experience. Every item provides unique insight into the risky business of innovation.The idea for the museum was born out of frustration. ‘I was so tired of reading and hearing the same boring success stories, they are all alike’ says the museum’s curator, Samuel West. ‘It is in the failures we find the interesting stories that we can learn from.’ Innovation and progress require an acceptance of failure. The museum aims to stimulate discussion about failure and inspire us to have the courage to take meaningful risks.Could we learn from our 'failures' in healthcare in the same way? -
Content Article
How a 'Red Stripe' can improve patient safety
Claire Cox posted an article in Implementation of improvements
In the heat of the moment it may be difficult to locate the buzzer in an emergency. The PatientSafe Network showcase the implementation of a solution to the problem.
