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Found 72 results
  1. Content Article

    Walk on by...

    Anonymous

    Anonymous posted an article in Florence in the Machine

    It's midnight on the acute floor, just before Christmas. As I walk through the Emergency Department (ED), I can hear the ambulances reverse up to the door, people shouting, doors opening and closing, phones ringing and the general white noise of the department. You wouldn’t know it was night-time at all, the lights are beaming and it's as noisy now as it is in the day. I am a junior doctor. I’m on my fourth night shift of six. I have a patient on the acute medical admission unit that I need to check up on. I take the opportunity to seek some darkness and quiet away from the hustle and bustle of the ED. As I go into the unit, I spot a young man in his 20s. He has a carer at his bedside. I stop. I say "hi"’ to the carer and just take a quick glance at the saturation probe that is on the young man’s finger. It’s reading 94% (normal is >95%). "Is that number of 94% normal for Eddie*?" I ask the carer. "Yes" he confirms. "What about the heart rate, that’s reading 140?" I asked, but didn’t want to come across alarmed, as this is quite high. "No. It usually reads 90. I was worried, but assumed you were dealing with it". My time is limited, I should be checking on my patient I originally came in to see. I have now seen a vulnerable adult with an abnormally high heart rate. However, the nurses are here… they can act on it , can’t they? I need to see my patient. I have patients backing up in ED, what about the four-hour target? Those thoughts go through my head in a split second. I now find myself pulling up a chair alongside Eddie and his carer. I find out that he has been admitted as his feeding tube had fallen out; he is here to have it replaced in the morning in theatre. I find out that it had fallen out 18 hours ago. As Eddie is unable to swallow without the risk of choking, he relies on the tube for all his medication and fluids. I take a look at the observations. Respiratory rate 18, heart rate 140, blood pressure 89/48, aprexial, not confused. He has a NEWS2 Score of 6. I see a sepsis screening tool that has been completed. It has been deemed that Eddie has a high suspicion of sepsis. But... he’s only come in for a tube change? I use the expertise of the carer. I find out that Eddie hasn’t had any fluids all day and his pads have been dry. At this point he should have had 3 litres of fluid via his tube. He also has not had his medication for his seizures. This is vitally important as it is highly likely he will seize this admission. I put some fluids up. I need to be quite aggressive with replacing his fluids as he may go into acute kidney injury. I write up his epilepsy medication, this time via his cannular. I explain to the nurses to give hourly observations and to call me if there are any problems. I check on Eddie that morning. He’s bright as a button. Smiling and ready for his tube replacement. If I walked on by, what might have happened? Eddie would continue to be treated for sepsis when he wasn’t septic and received antibiotics he didn’t need. Eddie would become more dehydrated and possibly acquired an acute kidney injury. Eddie may have suffered a seizure that could have been prevented. Due to these complications, Eddie may not have been fit for his tube replacement. Eddie's length of stay may have been increased, therefore increasing his risk of contracting a hospital acquired infection. What stopped me from walking by? Eddie reminded me of my brother, *Sam. My brother has cerebral palsy and needs 24-hour care. He’s funny, he can wrap mum around his little finger, he can play pranks on you, he is still my annoying little brother but coming into hospital always poses such a huge stress on us as a family, not to mention Sam. He always has people around him that know him. So, coming into this environment is alien. Due to his physical problems, he doesn’t ‘fit the normal patient mould'. Will he get the right treatment? Will he get his medication on time? Will there be anywhere for the carer to stay? Will the nurses know how to re-position Sam? How will they communicate to Sam? Will they read his patient passport? Will they act on his patient passport? Or will they walk on by? *Names in this blog have been changed for confidentiality purposes.
  2. News Article
    Family doctors are under intense pressure and general practice is running on empty, warns the Royal College of GPs (RCGP). It says severe staff shortages are causing "unacceptable" delays for patients in England. In a letter to Health Secretary Matt Hancock, its chairman says ministers must take urgent action to deal with the lack of GPs. The government said it had recruited a "record number" of GP trainees. Ministers are committed to recruiting 6,000 more GPs in England by 2025. Prof Martin Marshall, who took over as RCGP chairman in November, says GPs are struggling with an escalating workload, which is causing many to burn out and leave the profession. Dr Andrew Dharman, who works at the The Avenue surgery in Ealing, said the stress has got worse because of the enormous workload placed on GPs. He said: "Sometimes it feels like you're drowning. You know you're trying to stay afloat and on top of all the workload. And you're trying to make sure you're providing the kind of care that you envisage when you go to medical school." "You feel frustrated sometimes that you can't necessarily do that because of the amount of work and patients." Read full story Source: BBC News, 9 January 2020
  3. News Article
    New research from the UK’s Drug Safety Research Unit (DSRU) has found that hospital pharmacists, doctors and nurses only recorded batch numbers for biologic medicines between 38% and 58% of the time during routine hospital practice. Further, an analysis of spontaneous adverse drug reaction (ADR) reports showed that brand names were only included 38% of the time, while batch number traceability was only 15%. Because of the study results, the DSRU is encouraging health professionals to improve the recording in order to aid patient safety, suggesting that it has “some way to go to encourage health professionals to record this information.” Read full story Source: PharmaTimes Online, 7 January 2020
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    The WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results, improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals – especially for nurses.
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    In this short film, Dr Peter-Marc Fortune discusses the role of human factors in the recognition, response and escalation of the deteriorating child.
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    This page by the Academic Health Science Network includes a case study and a video demonstrating the triage in action
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  13. News Article
    Women are having their appendixes removed wrongly in nearly a third of cases, British research suggests. Researchers said too many female patients were being put under the knife when they should have undergone investigations for period pain, ovarian cysts or urinary tract infections. They said the study, which compared practices in 154 UK hospitals with those of 120 in Europe, suggests that Britain may have the highest rate of needless appendectomies in the world. Surgeons said they were particularly concerned by the high rates among women, with 28% of operations found to be unnecessary. They said the NHS was too quick to book patients in for surgery, when further scans and investigations should have been ordered. Researchers warned that such operations put patients at risk of complications, as well as fuelling NHS costs. Read full story Source: The Telegraph, 4 December 2019
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    Professor Helen Stokes-Lampard is chairwoman of the Royal College of General Practitioners, and she’s also a doctor in Staffordshire.
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    This poster was created by the Royal Free Nursing team on the intensive care unit. It demonstrated how they reduced turnover of staff on the unit by implementing 'Joy in Work'.
  19. News Article
    Hospitals are so short of doctors and nurses that patients’ safety and quality of care are under threat, senior NHS leaders have warned in a dramatic intervention in the general election campaign Nine out of 10 hospital bosses in England fear understaffing across the service has become so severe that patients’ health could be damaged. In addition, almost six in 10 (58%) believe this winter will be the toughest yet for the service. The 131 chief executives, chairs and directors of NHS trusts in England expressed their serious concern about the deteriorating state of the service in a survey conducted by the NHS Confederation. The findings came days after the latest official figures showed that hospitals’ performance against key waiting times for A&E care, cancer treatment and planned operations had fallen to its worst ever level. However, many service chiefs told the confederation that delays will get even longer when the cold weather creates extra demand for care. “There is real concern among NHS leaders as winter approaches and this year looks particularly challenging,” said Niall Dickson, the chief executive of the confederation, which represents most NHS bodies, including hospital trusts, in England." “Health leaders are deeply concerned about its ability to cope with demand, despite frontline staff treating more patients than ever." Read full story Source: 19 November 2019
  20. Content Article
    In two studies, researchers found that doctors with high levels of burnout had between 45% and 63% higher odds of making a major medical error in the following three months, compared with those who had low levels. To ensure well-being and motivation at work, and to minimise workplace stress, people have three core needs, and all three must be met. A - Autonomy/control – the need to have control over our work lives, and to act consistently with our work and life values. B - Belonging – the need to be connected to, cared for, and caring of others around us in the workplace and to feel valued, respected and supported. C - Competence – the need to experience effectiveness and deliver valued outcomes, such as high-quality care. The review identified inspiring examples of organisations that meet these three core needs for doctors. An integrated, coherent intervention strategy will transform the work lives of doctors, their productivity and effectiveness, and thereby patient care and patient safety.
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    This paper presents a narrative review of the evidence relating to the quality and safety of locum medical practice. Its purpose is to develop our understanding of how temporary working in the medical profession might impact on quality and safety and to help formulate recommendations for practice, policy and research priorities. The authors conclude that there is very limited empirical evidence to support the many commonly held assumptions about the quality and safety of locum practice, or to provide a secure evidence base for the development of guidelines on locum working arrangements. It is clear that future research could contribute to a better understanding of the quality and safety of locum doctors working and could help to find ways to improve the use of locum doctors and the quality and safety of patient care that they provide.
  23. Content Article
    I am a GP in Northampton and for some time, around 2006, I was concerned that my practice did not have a robust system for monitoring patients on dangerous drugs such as methotrexate and azathioprine. We tried to keep a manual database for our patient register, but with patients stopping and starting these drugs, moving in and out of the practice, and needing different tests at different time intervals, it was a really difficult task, and I suspected that we were missing patients and, therefore, it was hard to keep track of who needed reminding regarding tests. I tried working with my Practice Manager to create a more sophisticated spreadsheet in Microsoft Excel, then when that failed, within Microsoft Access. Again, we kept on coming across problems and I knew we hadn’t cracked the problem yet. Then I started talking to Tim – Tim is an IT software developer and, while we were watching our children’s swimming lesson, I was explaining to him the complexities of what I was trying to achieve, and he immediately took up the challenge and promised to write me a bespoke programme. Two years later and many Sunday afternoons spent drinking oodles of cups of tea, Neptune was created. We have been successfully running Neptune in my GP surgery since 2008, following which we introduced it to four beta testing sites. The system worked remarkably well from the start and very quickly we expanded to other local practices. Over the past 2 years we have been fortunate enough to roll out across the whole of Leeds Clinical Commissioning Groups (CCGs)(approximately 100 GP practices). Neptune’s success lies in its simplicity. It is a relational database that stores information about as many drugs as you would like, such as generic and brand name, BNF category and what monitoring tests are required. It uses three simple reports from the GP practice system to upload patient, drug and testing information and then puts this all together into a reminder list and either prints reminder letters, sends an email through a secure nhs.net account or produces an SMS text alert via MJOG. If the patient does not respond to their reminder, then a second reminder and then a third reminder is sent, with the final reminder being an alert to the prescribing GP. Like all new developments, we have faced a few challenges along the way. Not least was how to roll out to 100 practices in Leeds which is a long way from Northampton. We brought other members on to our team, and now have two trainers and two other software support as well as me and Tim. We love going into GP practices and seeing how everyone has tackled this problem differently, or not at all in some places. We have found, in general, the better the system already in place, the more Neptune is appreciated as the practice already appreciates what a difficult task this is. Neptune continually evolves and we love to change according to user feedback. We are now on to version 4, with version 5 just around the corner. Our current project is to include not just CCG defined amber drugs for the Near Patient Testing Direct Enhanced Service, but all drugs that require monitoring such as diuretics, ACE inhibitors and thyroid drugs. This will increase the patient population that Neptune monitors considerably, but the impact on patient safety will be immeasurable and, hopefully, will improve safety, reduce hospital admissions and, ultimately, iatrogenic harm and even death. We would love to roll out Neptune to as many practices as possible as we believe this is the best, most accurate and efficient way of performing this challenging task.
  24. Content Article
    What will I learn? Organisations who can support you. Practical tools and advice. Raising concern externally. Advice and reflections from the front line.
  25. Content Article
    I work in, both, the work imagined and prescribed, but practice in the world of work done. It’s interesting working in both worlds and has made me ask these questions: Why this happens? What are the consequences? How can we manage this disconnect? Real-life scenario What happened? A patient on a ward needs a nasogastric tube (NGT) for feeding and giving medication due to an impaired swallow following head and neck surgery. The nurse prints off the policy for placing an NGT from the Trust's infonet. The nurse inserts the NGT and checks the policy on how to test if it is in the correct position. The tube could be in the stomach (the right place) or it could be placed in the lungs (not a great place for medicines and feed to go!). The nurse calls the nurse in charge for support. It’s been a long time since she has placed an NGT and she wants to check she iss doing the right thing. The senior nurse arrives, before the feed is commenced. The senior nurse notices that the policy that the nurse is using is out of date. Checking the position of NGTs had changed. The senior nurse prints out the updated policy – NGT was in the correct position. This was a near miss event. So what? If an NGT is in the lung and you give medication and liquid feed there is a high chance the patient would contract fatal pneumonia at worst or a protracted stay on the intensive care unit on a ventilator at best. In both these cases, it would need to be declared to the regulators as they are classed as serious incidents. What next? This incident was one of many near misses that were collected over four shifts. This incident was discussed with the Deputy Chief of safety within that Trust. His first reaction was: "When was this? We had a Datix last year of the same incident – why has this happened again and why don’t I know?" It was true, there were a few similar incidents last year and an action plan was put in place to mitigate another incident like this happening again. All the old policies were to be removed from the infonet and replaced with the updated versions. Not only this, the Trust was now moving towards a web-based search facility that enables the clinician to have all the updated evidence for policies, antibiotic therapies, prompt charts, documentation and prescribing advice. The guide would be updated and the old policies would automatically be replaced, thus mitigating clinicians using out of date policies and procedures. The document management system was put in place to ensure it is easier to do the right thing. So, if this forcible function was in place, how did this incident happen again? Not all staff know about the new document system. Some nurses think this search facility is for doctors only. Nurses are prohibited to use their mobile phones on the ward. Clinicians not always able to get to a computer. It takes too long to update when opening the browser – therefore people are using it offline. The final point is an interesting one. Making it easy to do the right thing is one of a number of aspects that a safe system is comprised of; however, if part of that system i.e. the Wifi is not set up to support the change, that system is at risk of a ‘work around’. Work arounds are what healthcare staff do to enable them to get through that shift without immediate detriment to themselves or the patient, make swift complex decisions easily and to ‘tick the box’. Time is a precious commodity, especially when you are a frontline worker. We know the document management system will have the updated policy; we wait for the download. We wait. We wait a bit longer. Eventually it loads. Remembering it takes a long time, we save it and use it ‘offline’ for future access. By using the guide offline makes it quick and easy. We are using Trust policy; however, that policy may now be out of date. So what? Implementation of this online guide was made to make our lives easier and safer for patients and ourselves. Due to an oversight of how clinicians ‘actually’ use and interact with this change in the work environment, it could have an adverse outcome for patients. How would the safety team know this was happening? Near misses seldom get reported. Chance meetings in corridors, chance conversations overheard, a reliance on staff that may know the answer – if we ‘fixed’ the problem for that near miss, why should we report it? No harm came to the patient after all. We have a good culture of reporting in the Trust; however, our safety team are overwhelmed with incidents to investigate. The current system is set up to investigate when harm has happened rather than seeking out ways to prevent harm. I’m part of the problem, so I can be part of the solution? I would welcome any support on this. Does anyone have any solutions or strategies in place where frontline staff are involved in the reporting of near miss events and are part of the solution to mitigate them?
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