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Found 86 results
  1. News Article
    A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris. A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity. While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection. One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available. Read full story Source: HSJ, 9 April 2020
  2. News Article
    From July, hospitals will be able to refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy. Patients will be digitally referred to their pharmacy after discharge from hospital. The NHS Discharge Medicines Service will help patients get the maximum benefits from new medicines they’ve been prescribed by giving them the opportunity to ask questions to pharmacists and ensuring any concerns are identified as early as possible. This is part of the Health Secretary’s ‘Pharmacy First’ approach to ease wider pressures on A&Es and general practice. Read full story Source: Department of Health and Social Care, 23 February 2020
  3. News Article
    The number of patients stuck in hospitals because they could not be transferred is at its highest quarterly level since 2017, reversing years of progress amid ongoing crises in health and care services. “Delayed transfers of care” – often known as “bed blocking” – rose in the mid-2010s as austerity hit council-run adult-care services, meaning hospitals were unable to discharge patients into the community. The number of “delayed days” in the NHS increased from an average of 114,000 a month in 2012 to more than 200,000 in October 2016, before extra funding and higher council taxes brought the numbers back down. But the latest NHS figures show the problem is returning. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years. Read full story Source: The Guardian, 23 February 2020
  4. News Article
    Hospitals across England are using 21 separate electronic systems to record patient health care – risking patient safety, researchers suggest. A team at Imperial College say the systems cannot "talk" to each other, making cross-referencing difficult and potentially leading to "errors". Of 121 million patient interactions, there were 11 million where information from a previous visit was inaccessible. The team from London's Imperial College's Institute of Global Health Innovation (IGHI) looked at data from 152 acute hospital trusts in England, focusing on the use of electronic medical records on the ward. Around a quarter were still using paper records. Half of trusts using electronic medical records were using one of three systems: researchers say at least these three should be able to share information. 10% were using multiple systems within the same hospital. Writing in the journal BMJ Open, the researchers say: "We have shown that millions of patients transition between different acute NHS hospitals each year. These hospitals use several different health record systems and there is minimal coordination of health record systems between the hospitals that most commonly share the care of patients." Lord Ara Darzi, lead author and co-director of the IGHI, said: "It is vital that policy-makers act with urgency to unify fragmented systems and promote better data-sharing in areas where it is needed most – or risk the safety of patients." A spokesperson for NHSX, which looks after digital services in the NHS, said: "NHSX is setting standards, so hospital and general practioner IT systems talk to each other and quickly share information, like X-ray results, to improve patient care." Read research article Read full story Souce: BBC News, 5 December 2019
  5. Content Article
    Out-of-hours discharge from the intensive care unit (ICU) to the ward is associated with increased in-hospital mortality and ICU readmission. This study in the journal Critical Care Medicine was part of the REcovery FoLlowing intensive CarE Treatment mixed methods study. It aimed to map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night. The study identified significant limitations in out-of-hours care provision following overnight discharge from ICU. The authors recommend changes to help make daytime discharge more likely, and new systems to ensure patient safety where night time discharge is unavoidable.
  6. Content Article
    'Virtual wards' have existed for a number of years, but Covid-19 has led to further research and pilot schemes exploring their use. How have they been used during the pandemic and what does the future hold? This explainer by Holly Walton and Naomi Fulop provides some answers.
  7. Content Article
    This report by the Healthcare Safety Investigation Branch (HSIB) has been published as part of a pilot launched to evaluate HSIB’s ability to carry out effective local investigations at specific hospitals and trusts, while still identifying and sharing relevant national learning. After an evaluation, it will be decided whether this model can be implemented more widely by HSIB. The investigation reviewed the case of a patient who had a stroke and was due to be taken to his local hospital emergency department (ED), but the ED advised paramedics this was not possible as their stroke service was closed. The alternative was to take him to a neighbouring hospital, but they also advised that they could also not take the patient. This was then referred back to the original ED, who restated their position, eventually leading to the neighbouring hospital agreeing to accept the patient. Once the patient arrived he then had to wait 40 minutes in an ambulance as the ED was very busy.
  8. Content Article
    Where a new or under-recognised risk identified through the NHS England's review of patient safety events doesn’t meet the criteria for a National Patient Safety Alert, NHS England look to work with partner organisations, who may be better placed to take action to address the issue. To highlight this work and show the importance of recording patient safety events, they publish regular case studies. These case studies show the direct action taken in response to patient safety events recorded by organisations, staff and the public, and how their actions support the NHS to protect patients from harm.
  9. Content Article
    In this editorial for BMJ Quality & Safety, Dr Tamasine Grimes makes the case for greater patient involvement in managing medication, particularly at points of transition in care. She comments on a recent report on the effects of MARQUIS2, an evidence-based toolkit trialled in North American hospitals to help manage complex medication. The report found that interventions that involved patients in managing their medication had a significant effect in decreasing medication discrepancies, while purely system-level interventions did not.
  10. Content Article
    Medication reconciliation broadly defined includes both formal and informal processes that involve the comprehensive evaluation of a patient’s medications during each transition of care and change in therapy. The medication reconciliation process is complex, and studies have shown that up to 91% of medication reconciliation errors are clinically significant and 1–2% are serious or potentially life-threatening. The Pennsylvania Patient Safety Reporting System (PA-PSRS) identified 93 serious events related to the medication reconciliation process reported between January 2015 and August 2020.
  11. Event
    until
    The International Alliance of Patients’ Organizations (IAPO) and Patient Academy for Innovation and Research (PAIR Academy) in partnership with Dakshama Health are launching a series of webinars to introduce the Strategic Framework of the Global Patient Safety Challenge - Medication Without Harm. The theme of the 6th webinar of the medication without harm webinar series is "Medication Safety in Polypharmacy and Transitions of Care”. Register for the webinar The patient safety series of webinars will focus on the strategic framework of the Global Patient Safety Challenge, which depicts the four domains of the challenge: patients and the public, health care professionals, medicine, and systems and practices of medication, and the three key action areas—namely polypharmacy, high-risk situations, and transitions of care, The series of webinars will share challenges, technical strategies, tools, and patient experiences in implementing the Strategic Framework of the Global Patient Safety Challenge to reduce medication-related harm.
  12. Community Post
    I've been posting advice to patients advising them to personally follow up on referrals. Good advice I believe, which could save lives. I'm interested in people's views on this. This is the message I'm sharing: **Important message for patients relating to clinical referrals in England** We need a specific effort to ensure ALL referrals are followed up. Some are getting 'lost'. I urge all patients to check your referral has been received, ensure your GP and the clinical team you have been referred to have the referral. Make sure you have a copy yourself too. Things are difficult and we accept there are waits. Having information on the progress of your referral, and an assurance that is is being clinically prioritised is vital. If patients are fully informed and assured of the progress of their referrals in real-time it could save time and effort in fielding enquiries and prevent them going missing or 'falling into a black hole', which is a reality for some people. It would also prevent clinical priorities being missed. Maybe this is happening, and patients are being kept fully informed in real-time of the progress of their referrals. It would be good to hear examples of best practice.
  13. Community Post
    Hi everybody This is Jaione from Spain (we are in the North, Basque Region) and i am a nurse working in collaboration with the Patient Safety Team in our local NHS (Basque Health Service). First of all, I would like to congratulate the team for this hub which i think is a wonderful idea. Secondly, i would like to apologize for the language, since, although i lived in England many years ago, that is not the case anymore and I'm afraid i don't speak as well as I used to. I would like to comment a problem that we encounter very often in our organization which is related to patient's regular medications when they are admitted to hospital. We do have online prescriptions for both acute and community settings but the programs don't really speak to each other so, for example, if I take a blood pressure pill everyday and i get admitted into hospital, chances are that my blood pressure tablet won't get prescribed during my in-hospital stay. The logical thing to do would be to change both online systems so they communicate to each other, but that's not possible at the moment. I wanted to ask whether other systems have the same problem and, if so, if there is any strategy implemented to alleviate this issue. I hope i have expressed myself as clearly as possible. Thanks very much once more for this hub! Kind regards Jaione
  14. Community Post
    Morning all, As a Critical Care Outreach nurse of many years, one of my greatest bugbears is SBAR handover, or there lack of! Within my trust, there is an SBAR proforma attached to the NEWS2 chart, which appears to be fit for purpose currently. (We are still on paper obs charts, moving to e-obs by the end of the year) SBAR is taught and embedding in all our teaching and training, the candidates at the time of the courses are all able to giver perfect SBAR handovers in simulation but as soon as they walk out the door all of that seems to disappear. It is all too often we receive poor handovers for referrals, the lack of information and clarity means that we cannot prioritise patients effectively. I am currently looking at the nuts and bolts of why this is and what we need to do to address the issues. I have started by sending a survey out to all registered nursing staff so that we can get feedback from those who should be using it. Hopefully, from the responses this may mean we can formulate a plan to improve this. Does anyone else have the same issues/ concerns in you line of work? Has anyone got anything that they do in their trust that works?
  15. Content Article
    The Child Health Clinical Outcome Review Programme has produced this review of the barriers and facilitators in transitioning children and young people with complex chronic health conditions into adult health services. Based on data on children and young people with one of 12 complex conditions identified from a sample period between 1st October 2019 and 31st March 2021, the report concludes that there is no clear pathway for the transition from healthcare services for children and young people to adult healthcare services. The report finds that the process of transition and subsequent transfer is often fragmented, both within and across specialties, and that adult services often sit only with primary care. It argues that developmentally appropriate healthcare should be everyone’s responsibility, with adequate resources needed to allow this to happen. The Inbetweeners also calls for services to: involve young people and parent/carers in transition planning and transition to adult services improve communication and coordination between all specialties be organised to enable young people to transfer to adult services effectively, and provide strong leadership at Board and specialty level at all stages of transition and transfer. The report’s recommendations highlight areas that are suitable for regular local clinical audit and quality improvement initiatives by those providing care to this group of patients. It suggests that the results of such work should be presented at quality or governance meetings, and action plans to improve care should be shared with executive boards.
  16. News Article
    Serious patient safety and wellbeing concerns about the latest hospital discharge guidance have been raised to HSJ by senior clinicians and charities. Senior geriatricians warned that the guidance could prompt an increase in “urgent readmissions”, “permanent disability” and “excess mortality”, while charities said families could be left with “unsustainable caring responsibilities” because of the new rules. The government guidance, Hospital Discharge Service: policy and operating model, published in August, said clinicians should consider discharging patients when they were “medically optimised” rather than “medically fit”. It said 95% of these patients would return straight home with additional social care and rehabilitation support if needed. Many of the concerns raised surround the retention of the “criteria to reside”. This was originally agreed in March when there was a push from NHS England to free up acute beds over fears hospitals would become overwhelmed with covid admissions as the pandemic hit the UK. The criteria has, however, been maintained in the new guidance, despite a significant fall in infections and deaths from the virus. Rachel Power, chief executive of The Patients Association charity, warned: “This guidance makes it clear that the NHS is still having to take drastic emergency action in the face of covid-19, that will continue to take a heavy toll on patients. It is clear that many patients will be rushed home who would normally have had a longer period of hospital care.” Read full story (paywalled) Source: HSJ, 8 September 2020
  17. Content Article
    Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. This systematic review in BMJ Quality & Safety aimed to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.
  18. Content Article
    When critically ill premature infants require transfer by ambulance to another hospital, they frequently require mechanical ventilation. This observational study investigated acceleration during emergency transfers and looked at whether they result from changes in ambulance speed and direction, or from vibration due to road conditions. It aimed to assess how these forces impact on performance of neonatal ventilators and on patient-ventilator interactions. The authors found that infants are exposed to significant acceleration and vibration during emergency transport. Although these forces do not interfere with overall maintenance of ventilator parameters, they make the pressure-volume loops more irregular.
  19. Content Article
    The Quality Network for Inpatient Working Age Mental Health Services (QNWA) based within the Royal College of Psychiatrists' Centre for Quality Improvement are pleased to announce the publication of their 8th edition standards. Since the publication of the first edition standards in 2006, the Network has grown to include over 140 members from the NHS and private sector. This new edition of standards aims to reflect the changes in working practices and legislation over the last two years in addition to placing greater emphasis on equality, diversity and inclusion as well as sustainability in inpatient mental health services. The eighth edition standards have been drawn from key documents and expert consensus and have been subject to extensive consultation with professional groups involved in the provision of inpatient mental health services, and with people and carers who have used services in the past.
  20. Content Article
    This Healthcare Safety Investigation Branch (HSIB) investigation explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. HSIB has published an interim report outlining early investigation findings, and recommends a national response to tackle this urgent issue. Findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. For its reference case, the investigation looks at the case of a patient who was found unconscious at home and taken to hospital by ambulance. The patient was then held in the ambulance at the emergency department for 3 hours and 20 minutes, and during this wait their condition did not improve. They were taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
  21. Content Article
    In order to become competent clinicians, doctors need to appropriately calibrate their clinical reasoning, but lack of follow-up after transitions of care can present a barrier to this. This study in the Journal of Hospital Medicine aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. The authors concluded that structured feedback for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.
  22. Content Article
    This report by the Academy of Medical Royal Colleges looks at the possibilities for establishing a system of staggered changeover start dates for trainee doctors. Evidence suggests that there is an increase in patient morbidity and mortality at the beginning of August each year, which corresponds with the time when trainee doctors rotate positions. The paper, produced by the Academy’s Staggered Trainee Changeover Working Group (STCWG), recommends that the most effective solution for safe trainee changeover is a roll forward model of staggering, where the more senior trainees rotate one month later. A survey of Foundation doctors demonstrated support for a system where all Specialty Training programmes start at the beginning of September, one month after the end of the Foundation Programme.
  23. Content Article
    Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. In recognition of this, in 2017 the World Health Organization (WHO) launched the Third WHO Global Patient Safety Challenge: Medication Without Harm, aimed at improving medication safety. This article provides information and resources related to the Challenge.
  24. Content Article
    The Professional Record Standards Body (PRSB) has published the final draft standard for 111 referral, which defines the information that should be shared from 111 or 999 services when a person is referred on to another service. The standard applies to: all 111 and 999 service referrals to wherever the person goes next. referrals through 111 online, call handler or clinical assessment services and 999 services, and is not specific to any triage system. all age groups including children. The standard is UK-wide and was developed in consultation with a wide range of professionals from all four nations, including from 111 services, receiving services, IT suppliers and people who use services. It does not apply to transfers between 111 services (e.g. across a country border) or between 111 and 999 services.
  25. Content Article
    This report outlines the Royal College of Psychiatrists in Scotland's priorities for the Scottish Parliament. The report centres on the idea that there should be 'no wrong door' for individuals in all communities to accessing the right care, in the right place, at the right time for mental ill health. It highlights the significant effects of the Covid-19 pandemic on the mental health of the population: The number of people with high levels of psychological distress (indicating a potential psychiatric disorder) has doubled during the Covid-19 pandemic to 35.6%. Those most vulnerable to psychological distress (67%) were those with pre-existing mental ill health–the population already supported by psychiatrists. Women, young people, ethnically diverse communities and the economically disadvantaged have also been disproportionately affected.
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