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Found 786 results
  1. Content Article
    This article explains the emerging role of simulation in improving quality and safety. It is part of the Cambridge University Press 'Elements of Improving Quality and Safety in Healthcare' series. The article covers: Healthcare Simulation as an Improvement Technique Definition and Description of Healthcare Simulation How Simulation Became Integrated into Approaches to Improve Quality and Safety Simulation in Action Exploring Working Environments and the Practices and Behaviours of Those in Them Improving Clinical Performance and Outcomes Testing Planned Interventions and Infrastructural Changes Helping Healthcare Professionals to Learn about and Embed a Culture of Improvement Critiques of Simulation Is Simulation an Effective Technique for Improvement? How Should We Integrate Simulation into Healthcare Improvement? Can We Build a Business Case for Simulation?
  2. Content Article
    ‘Human factors’ is the science of improving performance by understanding individual or team behaviour and cognitive biases. This can allow a redesign of clinical systems and environments to improve patient safety. This course aims to help healthcare professionals understand human factors in complex healthcare setting and can be delivered as a full day, half day or a conference talk. It was developed by Professor Robert Galloway, Emergency Medicine Consultant at University Hospitals Sussex NHS Trust. The course covers: the principles of ‘human factors’–why errors occur. human cognitive biases (in memory, reasoning, decision-making). practical skills and tools to improve individual/team performance and patient safety. You can email Rob Galloway for more information on booking this course.
  3. Content Article
    Providing an overview of the work of the Group and its key findings, the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants presents a suite of 16 recommendations spanning the areas of areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation.
  4. Content Article
    These practical guides from NHS England are suitable for those working at all levels in the health service, from ward to board. They provide information on how to make better use of data. Guides include: Making data count - getting started Making data count - strengthening your decisions
  5. Content Article
    Healthcare relies on high levels of human performance; however, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. This narrative review in the journal Anaesthesia aims to describe what is known about human factors in anaesthesia to date.
  6. Content Article
    This video and written summary from the Institute of Health and Social Care Management (IHSCM) look at the principles of running virtual wards, where patients are monitored and cared for in their own homes with the help of remote treatment options and supported by technology. Hosted by health policy analyst Roy Lilley, speakers include: Professor Alison Leary Elaine Strachan-Hall Steph Lawrence Alexandra Evans Dr Elaine Maxwell
  7. Content Article
    The Royal College of Emergency Medicine (RCEM) ‘Wales' Emergency Medicine Workforce Census 2023’ is an in-depth analysis of the state of the Emergency Medicine workforce, providing an insight into the working patterns of clinicians and allowing a forecast to be made around the future workforce needs of Emergency Departments in Wales.
  8. Content Article
    This qualitative study, published in Patient Safety, aims to describe the lived experiences of new nurses’ safe transition into practice and their perceptions of functioning as safe practitioners.
  9. Content Article
    In a blog for National Voices, the leading coalition of health and social care charities in England, Patient Safety Learning’s Chief Executive Helen Hughes discusses an independent report written by risk expert Tim Edwards that highlights serious and widespread safety concerns around the misdiagnosis of pulmonary embolism.
  10. Content Article
    Digital transformation across adult social care is occurring rapidly, however, uptake is not uniform, and the care sector is yet to fully harness digital tools to transform care delivery. With unprecedented service pressure and demand across health and care services, using digital tools in care settings has the potential to relieve some pressure by increasing efficiency and better supporting the workforce. This report by the think tank Public Policy Projects brings together the thoughts and ideas of many Adult Social Care experts regarding the future of the care sector, and the opportunities which digital advancements can bring. Chaired by Damian Green MP, it is intended as a thought-piece to guide action and further work on the area, as a guideline for future development.
  11. Content Article
    Dr Freya Smith, a Specialty Trainee in General Practice, reflects on the sinister and toxic side of medicine, using the recent Paterson and vaginal mesh scandals to demonstrate how patients have been let down by the system. In an honest and personal account, she shares with us the horror and sadness she felt at learning of these scandals and how she aspires to keep her future patients safe.
  12. Content Article
    In this interview for the Betsy Lehman Center in Massachusetts, Lee Kim Erickson, Senior Vice President and Chief Quality Officer at Wellforce, talks about maintaining a focus on patient safety during times of crisis, the impact of the Covid-19 pandemic on training for healthcare workers and the importance of maintaining a focus on care from the patient's point of view.
  13. Content Article
    This study, published in The Organization of Primary Healthcare during the COVID-19 Pandemic, aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of primary care practices. It found that: "Training young GPs has an important positive impact on the health system. It safeguards the health workforce of the future (and the present), while also being associated with higher quality and safety of the practices involved in training while lowering the risk of distress for qualified GPs participating in vocational training".
  14. Content Article
    The Patient Safety Education Project (PSEP) uses a high impact, conference-based education program grounded in adult learning principles to teach systems-based patient safety methodology to healthcare professionals. This PSEP participants handbook covers: Gaps in patient safety: A call to action External influences: Law and other factors What is patient safety?: A conceptual framework  Advancing patient safety: How to teach and implement Systems thinking: Moving beyond blame to safety  Human Factors design: Application for healthcare Communication: Building understanding Teamwork: Being an effective team member Organization and culture: Essential to patient safety Technology: Impact on patient safety Patients as partners: Engaging patients and families Leadership: Everybody’s job
  15. Content Article
    Jenny Edwards died in February 2022 from pulmonary embolism, following misdiagnosis. In this blog, her son Tim introduces us to Jenny, illustrating the deep loss felt following her premature passing. He talks about the care she received and argues that there were multiple points at which pulmonary embolism should have been suspected. Tim found the investigation that followed Jenny’s death to be lacking in objectivity and assurance that any learning could be taken forward. He has since produced an independent report, drawing on existing data, freedom of information requests and his mother’s case, to highlight broader safety issues.
  16. Content Article
    This paper asked healthcare workers who are considered to be theatre safety experts—theatre managers, matrons and clinical educators—to take part in the second round of a Delphi study. These individuals work at the coalface in operating theatres and deliver the surgical safety checklist daily. It addresses information raised as part of a Delphi study of NHS hospital operating theatres in England. The aim of the second Delphi study round was to establish the views of theatre users on the theatre checklist and local safety standards for invasive procedures. Likert scale responses and a combination of closed and open-ended questions solicited specific information about current practice and researched literature that generated ideas and allowed participants freedom in their responses of how the World Health Organisation’s (WHO's) Surgical Safety Checklist (SSC) is currently being used in the peri-operative setting as part of a strategy to reduce surgical ‘never events’. The paper is part of a literature review undertaken by the author towards a Doctor of Philosophy (PhD). Read the findings of round one of the Delphi study
  17. Content Article
    In this blog, Louise Pye, Head of Family Engagement at the Healthcare Safety Investigation Branch (HSIB) highlights how the Patient Safety Incident Response Framework (PSIRF) can help NHS trusts involve patients and families in the face of extreme winter pressures. She highlights how the seven themes set out in the PSIRF guidance will help patient safety leaders ensure the involvement of patients and families is maintained even when services are dealing with extreme pressures.
  18. Content Article
    Pulmonary embolism is the third most common cause of cardiovascular death worldwide after stroke and heart attack. Although life-threatening, when diagnosed promptly survival rates are good.  This report, authored by risk expert Tim Edwards and published by Patient Safety Learning, highlights serious and widespread patient safety concerns relating to the misdiagnosis of pulmonary embolisms.  Drawing on existing data, freedom of information requests and his mother’s case, he outlines nine calls for action to improve pulmonary embolism care. 
  19. Content Article
    The Between the Flags (BTF) system is a 'deteriorating patient safety net system' for patients who are cared for in New South Wales (NSW) public health facilities in Australia. It is designed to assist clinicians to recognise when patients are deteriorating and to respond appropriately when they do.
  20. Content Article
    This 15-minute training video by the Parkinson's Excellence Network pulls together the key symptoms and issues that can impact on a person with Parkinson's and their care when admitted to a hospital ward. it aims to help ward staff understand the key issues when caring for people with Parkinson's.
  21. Content Article
    This article by Rebecca Rosen and Trisha Greenhalgh in the BMJ looks at the safety of remote GP consultations. It begins by looking at the case of student David Nash, who tragically died in 2020 after four telephone consultations with his GP; he was denied an in-person appointment for a painful ear infection that led to a fatal brain abscess. One coroner has raised concerns that this is not a one-off incident, noting that in five inquest reports they wrote during the pandemic, they question whether deaths could have been prevented by in-person consultations. The authors look at the recommendations of the ongoing 'Remote by Default 2' study, which is exploring how best to embed remote consulting in future GP services. They highlight better triage of appointment requests, active listening, checking back, increasing the use of video consulting and better training for clinicians as factors that could improve the safety of remote consultation.
  22. Content Article
    A culture of patient safety is essential for the continual improvement of service and reducing errors. This study in Risk Management and Healthcare Policy aimed to examine how the scores of patient safety culture items impact accreditation compliance percentages in primary care settings in Kuwait.
  23. Content Article
    This letter from Dr Robert Farley, President of the Institute of Physics and Engineering in Medicine (IPEM) to Karen Reid, the Chief Executive Officer of NHS Education for Scotland (NES) highlights that lack of funding for Clinical Scientist training places is putting patient safety in Scotland at risk. Dr Farley says, "We understand NHS Education for Scotland are proposing funding that equates to less than a single training post in medical physics and clinical engineering in 2023. ‘This is despite the Scottish Government's Chief Healthcare Science Officer’s public acknowledgement of the importance of training. "Scotland currently has a 10 per cent Clinical Scientist vacancy rate across the medical physics specialisms. This equates to seven vacancies in radiotherapy, three in nuclear medicine, four in diagnostic radiology and radiation protection. These posts are critical to supporting diagnostics and cancer treatments."
  24. News Article
    Mandatory training for treating people with autism and learning disabilities is being rolled out for NHS health and care staff after a patient died. It comes after Oliver McGowan, 18, from Bristol, died following an epileptic seizure. At the time, in November 2016, he had mild autism and was given a drug he was allergic to despite repeated warnings from his parents. His mother Paula lobbied for mandatory training to potentially "save lives". A spokesman for the NHS said the training had been developed with expertise from people with a learning disability and autistic people as well as their families and carers. The first part of the Oliver McGowan Mandatory Training is being rolled out following a two-year trial involving more than 8,300 health and care staff across England. Mark Radford, chief nurse at Health Education England said: "Following the tragedy of Oliver's death, Paula McGowan has tirelessly campaigned to ensure that Oliver's legacy is that all health and care staff receive this critical training. "Paula and many others have helped with the development of the training from the beginning. "Making Oliver's training mandatory will ensure that the skills and expertise needed to provide the best care for people with a learning disability and autistic people is available right across health and care." Read full story Source: BBC News, 2 November 2022
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