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Content Article
Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study (16 March 2023)
Patient-Safety-Learning posted an article in Medication including labelling
Improving medication safety during transitions of care is an international healthcare priority. While existing research reveals that medication-related incidents and associated harms may be common following hospital discharge, there is limited information about their nature and contributory factors at a national level which is crucial to inform improvement strategy. This study in the journal Therapeutic Advances in Drug Safety aimed to characterise the nature and contributory factors of medication-related incidents during transitions of care from secondary to primary care. The authors found several themes for future research that could support the development of interventions, including: commonly observed medication classes older adults increase patient engagements improve shared care agreements for medication monitoring post hospital discharge. -
Content ArticleNHS Wales has published a new report detailing the good progress being made to investigate and learn from hospital-acquired COVID-19 in Wales. Established in April 2022, the National Nosocomial COVID-19 Programme is supporting NHS Wales organisations to carry out a review of nosocomial (hospital acquired) COVID-19 patient safety incidents that occurred between March 2020 and April 2022. The programme has prioritised the investigation of the most complex cases, with an aim to provide as many answers as possible for service users, families, carers and staff impacted by nosocomial COVID-19. The programme also aims to maximise learning opportunities across NHS Wales, to drive quality and safety improvements.
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Content ArticleThis report from the National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme (NACAP) shows what happened after people were admitted to hospital with an asthma attack or COPD exacerbation between 2018 and 2020. The data show that many people are being readmitted to hospital within three months of going home and that some, particularly with COPD, are dying within three months of their exacerbation.
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Content ArticleThis report by the National Paediatric Diabetes Audit (NPDA) looks at diabetes care for children in England and Wales in 2021-22. The effectiveness of diabetes care is measured against NICE guidelines and includes treatment targets, health checks, patient education, psychological wellbeing, and assessment of diabetes-related complications including acute hospital admissions, all of which are vital for monitoring and improving the long-term health and wellbeing of children and young people with diabetes. In 2021/22, 100% of paediatric diabetes teams participated in the NPDA.
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News Article
Wales ‘displaying a dangerous and growing reliance’ on agency nurses
Patient-Safety-Learning posted a news article in News
The NHS in Wales could move to a model in which most or all nursing care is outsourced to private companies, if its increasing reliance on agency staff continues, a union report has claimed. According to the Royal College of Nursing, the Welsh health service risks moving to a situation where it no longer directly employs staff to provide patient care. NHS Wales spent between £133m and £140m on agency nursing during 2021-22, based on different freedom of information (FOI) requests and official figures, the RCN’s report suggested. RCN Wales said, “If this trend continues, Wales will move to a situation where NHS Wales no longer directly employs staff to provide patient care and instead moves to a model in which most or all nursing care is outsourced to private companies.” Read more Source: Nursing Times, 4 December 2022 -
Content ArticleThis study in BMJ Evidence-Based Medicine examined coroners’ Prevention of Future Deaths (PFDs) reports to identify deaths involving Covid-19 that coroners saw as preventable. The authors found that: there was geographical variation in the reporting of PFDs; most (39%) were written by coroners in the North West of England. the coroners raised 56 concerns, problems in communication being the most common (30%), followed by failure to follow protocols (23%). NHS organisations were sent the most PFDs (51%), followed by the government (26%). responses to PFDs by these organisations were poor. The study concludes that PFDs contain a rich source of information on preventable deaths that has previously been difficult to examine systematically. It identified concerns raised by coroners that need to be addressed during the government’s inquiry into the handling of the Covid-19 pandemic, to reduce the likelihood of mistakes being repeated.
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Content ArticleThis report from the National Maternity and Perinatal Audit assesses care inequalities using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales. The National Maternity and Perinatal Audit (NMPA) is led by the Royal College of Obstetricians and Gynaecologists (RCOG) in partnership with the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene and Tropical Medicine (LSHTM).
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Content ArticleThis review by Healthcare Inspectorate Wales considers the impact of ambulance waits outside emergency departments on the overall experience of patients, which included their safety, care, privacy and dignity. It covers the period between 1 April 2020 and 31 March 2021, during the Covid-19 pandemic. The report highlights that although patients were positive about their experience with ambulance crews, handover delays are having a detrimental impact upon the ability of the healthcare system to provide responsive, safe, effective and dignified care to patients. It makes 20 recommendations for consideration by the Welsh Ambulance Services NHS Trust, health boards and the Welsh Government.
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Content ArticleDiagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. This study in BMC Emergency Medicine sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015. The authors identified the priority areas for intervention to reduce the occurrence of diagnostic error. The study found that system modifications are needed to support clinicians in assessing patients and interpreting investigations. Interventions to reduce diagnostic error need to be evaluated in the emergency department setting, and could include standardised checklists, structured reporting and technological investigation improvements.
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Content ArticleThis Annual Quality Statement provides a summary of the work of Cardiff and Vale University Health Board in 2019-2020, with a particular focus on community mental health.
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Content ArticleThis report provides an overview of the work of Healthcare Inspectorate Wales (the independent inspectorate and regulator of healthcare in Wales) during 2020-21. It discusses National Reviews undertaken in this period and trends emerging from its quality checks of health services. It also highlights areas of innovation, new methods of public and staff engagement and the delivery of care in new settings as a result of the COVID-19 pandemic.
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Content ArticleDalila, who lives in Cardiff, was diagnosed with systemic lupus erythematosus during childhood. In this blog for Lupus Awareness Month she talks about her experiences with the condition and the differences in the care she’s received between England and Wales. The experience of people like Dalila is why the Rare Autoimmune Rheumatic Disease Alliance are calling for change in how people with rare autoimmune rheumatic diseases are cared for in Wales. They are calling for: A properly commissioned specialised centre for rare autoimmune rheumatic diseases in Wales. A network, where this specialised centre can support local hospitals to deliver better care. Urgent action to resolve workforce issues in rheumatology in Wales.
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Content ArticleThis study in the BMJ Open examines the links between between adverse childhood events and trust in Covid-19 health information, attitudes towards and compliance with Covid-19 restrictions and vaccine hesitancy. The study found correlations between adverse childhood events and: low trust in NHS Covid-19 information feeling unfairly restricted by government supporting removal of social distancing and ending of mandatory face coverings breaking Covid-19 restrictions vaccine hesitancy. The authors concluded that as adverse childhood events are common across many populations, there is a need to understand how they impact trust in health advice and uptake of medical interventions. This could play a critical role in the continuing response to Covid-19 and approaches to controlling future pandemics. In addition, as individuals with adverse childhood events suffer greater health risks throughout life, better compliance with public health advice is another reason to invest in safe, secure childhoods for all children.
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Content ArticleThis report by the National Audit of Dementia (NAD) presents the results of the fifth round of audit data. For the first time, the audit has been undertaken prospectively, which will enable hospitals to take earlier action to improve patient care and experience. However, this has demonstrated that many hospitals still have no ready mechanism to identify people with dementia once admitted. One notable improvement is delirium screening (dementia is the biggest risk factor for developing delirium). Screening for delirium has improved from 58% in round 4 to 87% in the current audit. In addition, a high number of pain assessments are also being undertaken within 24 hours of admission (85%). Although encouraging, the report highlights that 61% of these assessments were based only on a question about pain—an approach that can be unreliable in patients with dementia. While this report acknowledges that our health services have experienced an extraordinarily difficult and challenging time, it does shine a light on a need for more training. It states that is encouraging that many staff have received Tier 1 dementia training (median 86%), but suggests that a much higher proportion of ward-based patient facing staff should have received Tier 2 dementia training (median 45%). It found that only 58% of hospitals are able to report the proportion of staff who have received training. As such, the report recommends that any member of staff involved in the direct care of people with dementia should have Tier 2 training, and this training should be recorded to provide assurance to the public and regulators.
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Content Article
Duty of Candour for Wales
Gethin posted an article in NHS Wales (Gig Cymru)
The Duty of Candour for Wales statutory guidance. -
Content ArticleWales' national policy on patient safety incident reporting and management.
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Content ArticleThe Digital Medicines Transformation Portfolio aims to use digital technologies to make prescribing, dispensing and administering medicines everywhere in Wales, easier, safer and more efficient for patients and professionals. It brings together the programmes and projects that will deliver a fully digital prescribing approach in all care settings in Wales. This video outlines the different elements of the portfolio that will be introduced across primary and secondary care, including the Shared Medicines Record, which will store information about a patient's medications all in one place.
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Content ArticleThis report by Healthcare Inspectorate Wales (HIW) relates to vascular services provided by Betsi Cadwaladr University Health Board following the de-escalation of these services as a Service Requiring Significant Improvement (SRSI). The review outlines that while progress has been made against all nine recommendations made by the Royal College of Surgeons, the health board still has improvements to make.
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Content Article
Welsh Health Equity Solutions Platform
Patient-Safety-Learning posted an article in Health inequalities
Wales has a long history and tradition of upholding universal policies, welfare, sustainability and rights-based approaches to population wellbeing. However, the trends in reducing the health gap are mixed, the rate of improvement is slower than anticipated, and new groups are emerging with disproportionately higher risk of poor health and premature death and disease. The Welsh Health Equity Solutions Platform has been designed as a resource to find data and solutions relating to health equity. It includes an interactive data dashboard, policy and healthy equity frameworks and international case studies. It aims to support and accelerate healthy prosperous lives for all in Wales. -
Content ArticleDuring the first waves of the Covid-19 pandemic, the UK shielding policy was introduced with the intention to protect people at the highest risk of harm from Covid-19 infection. This study in the journal Public Health aimed to describe intervention effects in Wales at one year. The authors retrospectively compared linked demographic and clinical data for cohorts of people identified for shielding from 23 March to 21 May 2020 with the rest of the population. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). The study found that: Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders, but lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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News Article
Welsh Government announce £12.5m to reduce NHS pressures
Patient Safety Learning posted a news article in News
A further £12.5 million has been made available to help the NHS recovery, alleviate waiting times and reduce “extremely challenging” winter pressures, the Welsh Government has said. Health minister Eluned Morgan said the extra money will be spent on supporting people out of hospitals and into independent living, and pharmacies so they can help more people stay well without needing to see a GP. Around £10 million of the pot will be distributed across the country’s 22 local authorities to buy equipment such as flow mattresses, patient turning systems, stair lifts, hoists and telecare equipment for people’s homes – allowing individuals to be discharged more quickly and freeing up hospital beds, it was revealed. Pharmacies will get £2.5 million to improve access to treatment and advice for a range of common ailments, reducing pressures on GPs and other NHS services. Baroness Morgan said: “The pressures on the health and social care system remains extremely challenging. We all need to work together to support our health and social care services and help us to help you this winter. “Simple things like visiting local pharmacies or minor injuries units for advice on minor health concerns, checking symptoms online using the NHS 111 Wales website or getting a Covid vaccine can make a high difference to our NHS and help people look after their health this winter." Read full story Source: The National, 11 January 2022 -
News Article
Mental health access frustration for deaf people
Patient Safety Learning posted a news article in News
Deaf people are twice as likely to suffer mental health problems than those with hearing, a report has found. The All Wales Deaf Mental Health and Wellbeing Group said help in Wales was behind the rest of the UK and it wants to see significant improvements. It also described the inequalities faced by deaf people trying to access mental health support as "really frustrating". The Welsh government said it would consider the findings of the report. Ffion Griffiths, 23, from Neath, has been deaf since birth, and accessing child and adolescent mental health services in Wales has been a problem over the years. She had to travel to England to get the support she needed. "It's really frustrating because deaf people in England have more opportunities," she said. It means they can be treated and get better quicker but for us, how can we do that?" "How can we expect to recover if we don't have access to the services or any pathways for us to follow to get the treatment that we need in Wales?" Read full story Source: BBC News, 8 December 2021 -
News Article
Calls for major overhaul of the Welsh NHS
Patient Safety Learning posted a news article in News
More than 20 different health organisations have joined forces to call for a complete overhaul of the National Health Service in Wales. It comes after the worst ever performance figures for hospital emergency departments and the ambulance service were published, as well as warnings from doctors across the country that patients are dying in ambulances and waiting rooms due to overcrowding. The group of 22 organisations working across health and social care say Wales needs a single national body with a strategic oversight of the Welsh NHS in order to drive improvements in patient care and hold health boards to account. They have launched the 'Ending the postcode lottery' campaign which calls for "an end to fragmented health services". Those involved include the the Royal College of Physicians Wales, the British Heart Foundation, Parkinson's UK and Cancer Research UK. They claim that a single, independent national NHS Wales executive would be better placed to improve patient care and deliver on the aims of a healthier Wales. The organisations are calling for an independent body with the right powers would have the authority to: Support system transformation across health board boundaries Play a national leadership role in service improvement Collect and analyse data to improve performance Improve patient outcomes across clinical specialties, public health and inequalities Provide strong governance and accountability to ensure that the NHS in Wales gets the best value from its combined resources. Dr Abrie Theron, chair of Academy of Medical Royal Colleges in Wales, said: "I cannot see how the Welsh NHS is going to implement the changes needed for a Covid recovery without a NHS Executive team facilitating health boards working together as one for the patients of Wales." Read full story Source: The National, 22 November 2021 -
Content ArticleMore must be done to avoid harm to patients while waiting for treatment. The backlog for planned care is one of the biggest challenges for the NHS in Wales. Waiting times targets have not been met for many years. This backlog has been made much worse due to the pandemic. In February 2022, there were nearly 700,000 patients waiting for planned care, a 50% increase since February 2020. Over half of the people currently waiting have yet to receive their first outpatient appointment which means that they may not know what they’re suffering from and their care cannot be effectively prioritised. Modelling shows it could take up to seven years or more to return waiting lists to pre-pandemic levels. This report makes five recommendations based on what the Welsh Government needs to do as it implements its national plan.
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Content ArticleThis report by NHS Wales summarises the ways in which the cost of living crisis can impact on health and well-being. It takes a public health lens to identify actions for policy makers and decision-makers to protect and promote the health and well-being of people in Wales in their response to the cost of living crisis, outlining what a public health approach to the crisis could look like in the short and longer-term.
