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Showing results for tags 'Ambulance'.
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Content Article
GREATix: Reporting the positive
PatientSafetyLearning Team posted an article in Safety culture programmes
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Content Article
I think you’re on mute… a blog by Sally Howard
Sally Howard posted an article in Culture
Anyone who has the pleasure of virtual meetings in the current climate will hear the phrase "I think you’re on mute" at least two or three times a week. And this may not be the only place where people feel they are ‘on mute’. The dangers we know: voices unheard, frustrations hidden, staff feeling overwhelmed, undervalued. So if this is you, here’s three simple tips that may help: Make time to talk things through 1:1 Create a safe space to talk things through with a trusted colleague, maybe your boss or a colleague, a good friend or a trained coach. The NHS Leadership Academy offers access to trained coaches: https://www.leadershipacademy.nhs.uk/resources/coaching-register/. Make time for a 5–10 minute daily check-in with people around you Less a luxury more a necessity, especially now. A lot of teams have daily huddles in place. It’s a time to listen, a time to ask the right questions and have your say. What you think, what you see; your great ideas matter. Appreciate those around you Nancy Kline recommends a 5 to 1 ratio of praise to criticism. It really does work. And finally be kind to yourself Years ago a brilliant colleague recommended her three treats approach: A daily treat Maybe a special coffee or a just take a bit of fresh air during another long shift A weekly treat Long walk, lovely meal, whatever gets you in a happy place, A monthly treat Very long walk (only joking) – you’ll think of something. "You can buy your employees' time and muscle... but their hearts and minds come free.” Stephen Covey- Posted
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News Article
North West Ambulance Service declares 'major incident' over high level of calls
Patient Safety Learning posted a news article in News
North West Ambulance Service has declared a “major incident” over a high number of calls. People were warned they could be asked to make their own way to hospital if their call was not life-threatening, while some patients faced delays. There were no signs the surge in demand was linked to coronavirus, a spokesperson for the service said. “North West Ambulance Service has declared a major incident due to the high level of activity in the North West region, in particular the Greater Manchester area,” the service said on Monday evening. “If your call is not life-threatening, you may be asked if you can seek an alternative source of care or make your way to hospital by alternate means," the statement on Facebook said. The Independent understands at one point hundreds of calls were live - which triggered the major incident alert. Read full story Source: The Independent, 3 November 2020 -
News ArticleAmbulance chiefs have warned coronavirus precautions in hospital emergency departments are putting patients’ lives at risk because of long delays before patients are being treated. West Midlands Ambulance Service has written a formal warning to three hospitals in the region over the delays to handing over patients from ambulance to hospital staff. In one case, a patient was left waiting with ambulance crews for up to three and a half hours. According to the letter, obtained by the Health Service Journal, the delays are being caused because of tougher infection control measures with ambulance bosses warning the situation is “dangerous”. Director of nursing Mark Docherty said the delays meant ambulances could not be sent to “life threatening emergencies”, and warned: “Lives will be put at risk and patients will come to harm as a result”. He added: “I alerted you to a serious concern about patients being kept on ambulances outside your hospital. Of great concern is the fact that a hospital risk assessment identifies this process as a mitigation to reduce risk in your hospital…" Read full story Source: The Independent, 29 October 2020
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News ArticleFollowing a damning report by the Care Quality Commission (CQC), the East of England Ambulance Service NHS Trust (EEAST) has been placed into special measures. It comes after inspectors uncovered a culture of bullying and sexual harassment at the trust. As a result of the decision, EEAST will receive enhanced support to improve its services. A statement from NHS England and NHS Improvement outlined that the Trust would be supported with the appointment of an improvement director, the facilitation of a tailored ‘Freedom to Speak Up’ support package, the arrangement of an external ‘buddying’ with fellow ambulance services and Board development sessions. This follows a CQC recommendation to place the trust in special measures due to challenges around patient and staff safety concerns, workforce processes, complaints and learning, private ambulance service (PAS) oversight and monitoring, and the need for improvement in the trust’s overarching culture to tackle inappropriate behaviours and encourage people to speak up. Ann Radmore, East of England Regional Director said, “While the East of England Ambulance Service NHS Trust has been working through its many challenges, there are long-standing concerns around culture, leadership and governance, and it is important that the trust supports its staff to deliver the high-quality care that patients deserve." “We know that the trust welcomes this decision and shares our commitment to reshape its culture and address quality concerns for the benefit of staff, patients and the wider community.” Read full story Source: Bedford Independent, 19 October 2020
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Content ArticleThe report Assessment of patient management arrangements within emergency medical service clinical contact centres outlines the findings of the review. Key findings: Delays caused by hospital handover, resulting in reduced ambulance availability, are a frequent occurrence, limiting ambulance resource and affecting the Trust’s ability to respond in a timely way to demand. This can have a detrimental impact upon outcomes for patients. Concerns were highlighted with the consistency of incident reporting, with a need for the Trust to ensure a consistent understanding of what constitutes a reportable incident. There was a strong team ethos within the Trust’s Emergency Medical Service Clinical Contact Centres (EMSCCCs) in what is a stressful environment, with staff striving to deliver services, often in extremely difficult circumstances. The pressurised working environment was however having a negative impact on staff well-being with inadequate staffing levels impacting on the safe delivery of the service. Staff raised concerns that the training and support they received needed to be improved, in order to carry out their roles effectively. The report sets out 27 recommendations on how the Welsh Ambulance Service Trust might be able to improve its service. To read the document in full and to access an Easy Read version, follow the link below.
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News ArticleAn ambulance service could be put in special measures after a damning report criticised poor leadership for fostering bullying and not acting decisively on allegations of predatory sexual behaviour towards patients. East of England Ambulance Service Trust failed to protect patients and staff from sexual abuse, inappropriate behaviour and harassment, the Care Quality Commission said. It failed to support the mental health and wellbeing of staff, with high levels of bullying and harassment. Staff who raised concerns were not treated with respect and some senior leaders adopted a “combative and defensive approach” which stopped staff speaking out. “The leadership, governance and culture still did not support delivery of high-quality care,” the CQC said. Read full story (paywalled) Source: HSJ, 30 September 2020
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Community PostDuring the COVID pandemic, it was clear that Emergency Departments across the UK needed to adapt and quickly, with my trust not exempt from this. We have increased capacity, increased our nursing and doctors on the shop floor, obviously with nurse in charge being responsible for all areas. We have different admission wards in terms of symptoms that the patient has, but also have a different type of flow, which i am getting my head around to be able to share I have seen departments split into 2 and various other ideas coming out from various trusts. Which got me thinking about patient safety and how well this is managed. So.... How is your department responding to the pandemic? Do you have any patient safety initiatives as a result of the response? Is there a long term plan? The reason why i am asking this, is so we can share practice and identify individual trust responses.
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Content ArticleThere are three work programmes to explore workforce retention and configuration in healthcare. The first programme will combine and align multiple large datasets from 20 NHS trusts across secondary care and mental health and 10 ambulance trusts. This will enable the analysis of multiple variables and their effect on workforce retention, and how these variables, in combination with workforce retention, subsequently impact patient outcomes. The second work programme will involve designing and testing an infrastructure for the routine extraction, combination and analysis of these large datasets. This will enable the adoption of these techniques across the NHS. The nursing element (NuRS) will start first, with the ambulance staff (AmReS) element following approximately six months later. A third programme will examine the effect of the COVID-19 pandemic on patient safety in terms of reporting behaviours, for example; and will explore how nursing and ambulance workforce configuration in response to a pandemic affects patient safety and quality of care. This project is a unique opportunity to unlock the key underlying drivers of nurse and ambulance retention and determine their impact on care quality, helping to tackle the challenge of supply in the NHS and ensure that high quality, sustainable care is available to all.
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News Article
NHS ambulance wait figures prompt call to tackle shortages
Patient Safety Learning posted a news article in News
Almost a million people waited at least half an hour for an ambulance after having a medical emergency such as a heart attack or stroke last year, NHS figures show. Ambulance crews responding to 999 calls in England took more than 30 minutes to reach patients needing urgent care a total of 905,086 times during 2019–20. Of those, 253,277 had to wait at least an hour, and 35,960 – the equivalent of almost 100 patients a day – waited for more than two hours. In addition to heart attacks and strokes, the figures cover patients who had sustained a serious injury or trauma or major burns, or had developed the potentially lethal blood-borne infection sepsis. Under NHS guidelines, ambulances are meant to arrive at incidents involving a medical emergency – known as category 2 calls – within 18 minutes. The Liberal Democrat MP Layla Moran, who obtained the figures using freedom of information laws, said: “It’s deeply shocking that such huge numbers of seriously ill patients have had to wait so long for an ambulance crew to arrive after a 999 call. It shows the incredible pressure our ambulance services were under even before this pandemic struck. “Patients suffering emergencies like a heart attack, stroke or serious injury need urgent medical attention, not to be left waiting for up to two hours for an ambulance to arrive. These worryingly long delays in an ambulance reaching a seriously ill or injured patient could have a major long-term impact on their health.” Read full story Source: The Guardian, 16 August 2020 -
News Article
Patient deaths prompt ambulance chiefs to look for alternative defibrillators
Patient Safety Learning posted a news article in News
Ambulance chiefs are looking at alternative defibrillators after coroners highlighted confusion over how to correctly use their existing machines. London Ambulance Service (LAS) Trust has received two warnings from coroners since 2016 after the delayed use of Lifepak 15 defibrillators “significantly reduced” the chances of survival for patients, including a 15-year-old boy. Coroners found some paramedics were unaware the machines had to be switched from the default “manual” mode to an “automatic” setting. The first warning came after the death of teenager Najeeb Katende in October 2016. A report by coroner Edwin Buckett said the paramedic who arrived had started the defibrillator in manual mode and did not detect a heart rhythm that was appropriate for administering the device, so it was not used until an advanced paramedic arrived on scene 24 minutes later. The report stated the defibrillator had been started in manual mode but it needed to be switched to automatic to detect a shockable heart rhythm. The coroner warned LAS that further deaths could occur if action was not taken to prevent similar confusion. But another warning was issued to the LAS in March this year, following the death of 35-year-old Mitica Marin. Again, a coroner found the paramedic, who was on her first solo shift, had started the machine in manual mode and had not detected a shockable rhythm. It was suggested this caused a four minute delay in the shock being administered. Coroner Graeme Irvine said this was “not an isolated incident” for LAS and noted the trust had reviewed other cases of delayed defibrillation. They found that the defibrillator’s manual default setting was a “contributing factor” to the delays. Read full story (paywalled) Source: HSJ, 10 August 2020 -
News Article
Falls team on the up thanks to North Wales volunteers
Clive Flashman posted a news article in News
A dedicated team of 32 volunteers are hitting the roads across North Wales assisting the Welsh Ambulance Service in dealing with fallers. Based out of the Ambulance headquarters in St Asaph, the Community First Responder Falls Team was launched on 30 April this year and has already assisted almost 250 people. The team was created to use the talents and experience of the familiar Community First Responders (CFRs) who had to be stood down from their normal duties at the start of the Covid-19 pandemic. Read the full article here. -
Content Article
Whole system flow: From front door to front door
Claire Cox posted an article in Processes
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Content Article
Podcast: Incident reporting
PatientSafetyLearning Team posted an article in Good practice
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News Article
Overdose calls may be getting too low priority for ambulances
Patient Safety Learning posted a news article in News
Ambulance services have been urged to look at how suspected overdose and poisoning cases are prioritised after paramedics took 45 minutes to reach a woman with known mental health problems. Helen Sheath, 33, had been discharged from a mental health unit in early July last year and was still waiting for an outpatient appointment with a psychological assessment and treatment service when she took a fatal dose of sodium nitrate on 20 August. Her father called an ambulance at 6.20pm when she had locked herself in a bathroom and was threatening to take the sodium nitrate. But Bedfordshire and Luton senior coroner Emma Whitting said her father could not tell whether or not she had taken it, and that in view of her history of suicidal ideation, the call should have been treated as a category two – with an 18 minutes response target – rather than a category three incident. The first ambulance which was sent to her was diverted on route and it was only after a second call to the East of England Ambulance Service at 6.48pm, that the call was upgraded to category two – when the call handler selected a different set of questions, after being told she had ingested the chemical. A rapid response vehicle arrived at 7.05pm and the mental health street triage team attended six minutes later. Shortly afterwards she became acutely unwell and was taken to Bedford Hospital, where she received treatment but died shortly afterwards. In a prevention of future deaths report Ms Whitting said: “If the first call had been coded as a category two, it seems likely that the rapid response vehicle, mental health street triage team (and even possibly the double staffed ambulance) would have arrived on scene much earlier (potentially just before or just after Helen had ingested the sodium nitrate) which could potentially have altered the outcome.” The case comes just months after two other ambulance trusts were criticised in cases involving suspected or threatened overdoses. The prevention of future deaths report was sent to the Association of Ambulance Chief Executives and the emergency call prioritisation advisory group, which is run by NHS England. Neither would comment other than saying they would respond to the coroner. Read full story Source: HSJ, 15 June 2020 -
Content ArticleFor anyone who is not familiar with undertaking critical care transfers or for staff looking for a brief refresher, here are a few notes that I hope will help any clinical staff (please note, these are my views and not necessarily those of my employer's). Planning: Despite normally being stable prior to transfer, by nature, critical patients are unstable and may deteriorate. Plan for this and know where you are going, expected journey time accounting for traffic conditions and what hospitals are along the route in case of emergency. Equipment: If a team is not travelling, you ideally won’t take unfamiliar devices. If you do, the least you should know and plan for/discuss is how to manage failure; i.e. a syringe pump giving inotropic support or ongoing sedation that may be able to be given manually. Equipment: Is different in subtle ways and it won’t be a simple case of copying hospital settings. If moving a patient from hospital equipment to yours, don’t leave straight away. Give the patient time to “settle” on your equipment and make any changes to setting necessary to maintain the patient. Vehicle: Ensure normal vehicle checks are complete, you know where your own equipment is and that it is working. Also make sure that electrical/12V/USB ports all work in case they are needed for transfer equipment. Have all rescue kit (airways, BVM etc.) to hand. Oxygen: An oxygen dependent or ventilated patient can use a lot of O2 and this needs to be calculated along with extra in case of delays. Formulas that can be used: 2 x flow (L/min) x length of transfer (min) 2 x transport time in minutes x (minute volume x FiO2) + ventilator driving gas. Airway: Always important but vital for a patient who has an airway adjunct in place prior to transfer. Plan for immediate actions if the patient loses this adjunct during transfer. Have emergency kit laid out PRIOR to transfer and allocate pre-planned roles in case of an airway emergency during transfer. Breathing: A patient on a ventilator will have a ventilation strategy depending on their condition. Try to have a basic understanding of this in case you need to take over with a BVM in the event of a ventilator failure. ALWAYS have rescue kit laid out and to hand in case of emergency enroute. Circulation: The patient may be on some sort of circulatory support (fluids, pressors, inotropes etc) dependent on their underlying condition. Again, try to understand their current fluid status and support needs in case you need to intervene or have an equipment failure enroute. Disability: If a patient is sedated/anaesthetised, be vigilant for signs this may be wearing off. Some signs to look for are tearing, increase in heart rate or BP or a Curare cleft on waveform capnography. Be aware that patient sedation needs may change due to movement during transfer. Monitoring: In the sedated/anaesthetised patient, monitoring may be your first indicator that something is changing. Don’t just assume strange values are due to movement and constantly check your patient. If something changes, start at the patient and work back to the monitor to look for issues.
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News Article
Fears some ambulances 'left Covid patients at home'
Patient Safety Learning posted a news article in News
Some seriously ill COVID-19 patients in London may not have been taken to hospital by ambulance because of a system temporarily used to assess people, a BBC investigation suggests. Patients could have "become very sick or died at home" instead, a paramedic claimed. One family said they had to plead to get hospital care. Medical professionals use 'NEWS2', as one way of identifying patients at risk of deteriorating, a check normally used for sepsis patients. Under normal circumstances, ambulance teams would blue-light anyone with a score of five or above to hospital. But on 18 March, LAS workers were told to apply the NEWS2 check to suspected Covid patients and that many of those with a score up to seven could be "suitable for community care", even if there were issues with breathing rate, oxygen supply and consciousness. But one paramedic, who wanted to remain anonymous because she did not have permission to speak to the media, said she believed that as a result of the NEWS2 advice, crews went to patients "who may have been seen by ambulance before and then suddenly became very sick or even just dropped dead." Read full story Source: BBC News, 23 April 2020 -
News Article
Warning as UK coronavirus outbreak leads to sharp rise in deaths at home
Patient Safety Learning posted a news article in News
The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned. Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them. And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden. “People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.” Read full story Source: The Guardian, 16 April 2020 -
News Article
Coronavirus: Ambulance staff 'feeling unprotected'
Patient Safety Learning posted a news article in News
Ambulance staff are being put at risk by a lack of protective equipment to guard them against coronavirus, according to a trade union. GMB says its members are "scared" about their own safety and their families. The union claims one in five ambulance staff in London are off sick with coronavirus-related sickness. The government says hundreds of millions of protective items have been delivered to NHS staff around the country. According to the GMB Union, 679 frontline ambulance crew in the London Ambulance Service are off sick due to Covid-19-related sickness. Among those at work, some say they feel unprotected either because of a lack of or inadequate personal protective equipment (PPE). Read full story Source: BBC News, 8 April 2020 -
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Content ArticleThis guideline includes recommendations on: hand decontamination use of personal protective equipment safe use and disposal of sharps waste disposal long-term urinary catheters enteral feeding vascular access devices. Who is it for? commissioners and providers healthcare professionals working in primary and community care settings, including ambulance services, schools and prisons children, young people and adults receiving healthcare for which standard infection-control precautions apply in primary and community care, and their families and carers.
