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Found 26 results
  1. News Article
    Fewer people with mental illnesses would endure the trauma of being sectioned if advanced choice documents – setting out a treatment plan while they are well – were included in Mental Health Act reforms, a leading psychiatrist has said. Advanced choice documents are the only proven way to reduce the number of people detained under the Mental Health Act in England and Wales, which is one of the reforms’ core objectives, said Dr Lade Smith, the president of the Royal College of Psychiatrists. Research suggests that the use of these documents can reduce compulsory detention rates in psychiatric units, often known as sectioning, by 25%, minimising traumatic experiences for people with bipolar, schizophrenia and other psychotic illnesses. “It’s high time there was reform of the Mental Health Act because the rates of detention are increasing, especially for marginalised groups, those who are poor or from a minoritised ethnic community, especially black Caribbean … Advanced choice docs were a recommendation of the review, I don’t know why they haven’t gone through,” said Smith. Advanced choice documents are especially effective in reducing the significantly higher detention rates for black people with mental illnesses, as they can help patients feel more autonomous and reduce unconscious bias. Advanced choice documents are similar to those used in palliative care. Patients work with a healthcare professional when they are well to outline the signs that they are experiencing a manic or psychotic episode, effective treatments, and their personal preferences. This could include background information and trigger questions to help healthcare practitioners establish delusional thought patterns; medications and doses which have been effective previously; and requests to be put in hospital for their own safety, or – more unusually – that of others. Read full story Source: The Guardian, 12 February 2024
  2. Content Article
    Clinical trial documents are complex and may have inconsistencies, leading to potential site implementation errors and may compromise participant safety. This study characterises the frequency and type of administrative and potential patient safety interventions (PPSIs) made during the review of oncology trial documents for clinical trial implementation by centralized clinical content specialists. The study demonstrates a gap in patient safety when assessing trial documents for clinical trial implementation. One solution to address this gap is the utilisation of a centralised team of clinical specialists to preemptively review trial documents, thereby enhancing patient safety during clinical trial conduct.
  3. News Article
    Four hospitals in Greater Manchester are struggling with a near ‘total IT failure’ which has forced staff in all key services to use handwritten lists and notes. The problems have affected multiple IT systems across Royal Oldham, Fairfield General, Rochdale Infirmary and North Manchester General hospitals. Staff at the sites are running theatre and emergency departments using handwritten patient lists and notes, while bloods and scan results are also being written by hand. Patient histories are largely unavailable. HSJ spoke to staff who said there are major concerns over patient safety, as the lack of digital systems increases the risk of errors, and also slows down multiple processes. They described the problems as a “total IT failure”. Chris Brookes, deputy CEO and chief medical officer, said: “Patient safety and maintaining essential services remains our priority. We are doing everything we can to fix the IT issues and to limit disruption to patients and our services." Read full story (paywalled) Source: HSJ, 25 May 2022
  4. Content Article
    A gap analysis identified the need for process improvement surrounding the identification and reporting of adverse drug reactions related to moderate sedation. A change to documentation was selected to address this gap. The challenge was disseminating the change in a meaningful way during a time of high census and limited staffing due to the COVID-19 pandemic. Complex adaptive systems theory was used to plan interventions in these conditions.
  5. Content Article
    The NHS is in a state of crisis, with increasingly long delays for ambulances and emergency care. Often people believe that hospital delays and bottlenecks are caused entirely by the difficulty of discharging patients to social care. But there is another factor which is just as much of a problem, and which should be far easier to fix: the masses of unnecessary paperwork doctors and nurses have to fill out every day. Gordon Caldwell explores this issue in an article in the Spectator.
  6. News Article
    Complaints about NHS care cannot always be investigated properly because of medical records going missing, the public services watchdog has said. Ombudsman Nick Bennett said many people were left "suspicious" and thought there was a "darker motivation". One woman whose notes went missing said she no longer trusted what doctors said and had lost faith in NHS transparency. The Welsh NHS Confederation said staff were "committed to the highest standards of care". In a report called Justice Mislaid: Lost Records and Lost Opportunities, Mr Bennett found 70% of 17 cases he looked at in Welsh NHS hospitals and care settings could not be properly investigated because of lost documents. Read full story Source: BBC News, 10 March
  7. News Article
    Paging systems used across B.C could be exposing sensitive health data of patients, and the privacy researcher who first discovered the data breach believes it’s likely happening across the country. “I wouldn’t be surprised to find this everywhere in Canada,” said privacy researcher Sarah Jamie Lewis, in an interview with CTVNews.ca in Vancouver. Lewis first discovered and reported the breach to Vancouver Coastal Health in November 2018. Now, internal emails released this month through a Freedom of Information request show that the vulnerability is not limited to Vancouver. Read full story Source: CTV News, 13 December 2019
  8. Content Article
    This investigation by the Healthcare Commission examined the cases of ten women who died during pregnancy or within 42 days of delivery at Northwick Park Hospital, North West London Hospitals NHS Trust, between April 2002 and April 2005. This number of maternal deaths was significantly higher statistically when compared with other trusts that serve similar populations.
  9. Content Article
    This study in the Journal of Patient Safety aimed to assess the impact of a pro forma that standardises medical record-keeping on ward rounds. The pro forma was developed by analysing notes entered in patient charts and comparing them with standards set out by the Royal College of Surgeons of Ireland and England, as well as Medical Council guidelines from the two countries. The authors found that the pro forma improved compliance of ward round notes when compared with internationally recognised guidelines, with no additional time required during ward rounds.
  10. News Article
    Nurses are a crucial part of care across a wide range of sectors, with patients and other professionals often reliant on their expertise. That’s why the Professional Records Standard Body (PRSB) has been asked to develop a new nursing standard by NHSx for use across all the different health and social care settings. The standard aims to improve quality and safety of care in key nurse-led areas, including care planning. It will reflect best practice and standardise documentation across different nursing settings, to free nurses and give them more time to care. For example, it will standardise information that a district nurse in a care home setting can access and share in the same way as a mental health or hospital nurse, with a focus on the person’s overall wellbeing. Read full story Source: PRSB, 30 March 2021
  11. Event
    until
    Be a part of history and join leading minds to explore clinical documentation's impact on patient safety, financial sustainability, and data integrity, in Australia's inaugural CDI conference. Targeting a broad array of health care stakeholders including CEOs, CFOs, Quality Managers, clinical staff, HIMs, Coders, and Clinical Documentation Specialists in Australia, New Zealand, and the Middle East. The conference will provide invaluable networking opportunities both in person and virtually with industry experts and like-minded individuals. Register
  12. Content Article
    There is an overall dearth of information on implementation and compliance with patient safety standards in developing countries. In recognition of this, the World Bank Group’s Health in Africa Initiative, WHO and the PharmAccess Foundation came together with the ministries of health to conduct an assessment of patient safety at Kenyan health facilities. The study is the first nationwide assessment of patient safety levels based on documented processes and levels of risk, and is meant to serve as a baseline against which future interventions can be measured.
  13. Content Article
    This NCEPOD report looks at the quality of care provided to patients with Parkinson’s disease (PD) aged 16 years and over who were admitted to hospital when acutely unwell. It highlights the findings of a review into the pathway of care for patients with Parkinson’s disease (PD) which explored multidisciplinary care and organisational factors in the process of identifying, screening, assessing, treating and monitoring their ability to swallow. You can view and download the following diagrams related to the report: Full report Summary report Summary sheet Recommendation checklist   Infographic Slide set Commissioners' guide Fishbone diagram Recommendations Audit toolkit
  14. Content Article
    Most healthcare systems across the globe are dealing with the reality of limited resources and staffing shortages. Therefore, it is more important than ever to ensure that health care professionals spend time on doing what matters most and providing the most value for service users. Meaningful time spent face to face is a high priority for both service users and health care professionals. Paying more attention to computers than people because of the demands of burdensome documentation diverts our attention from direct care. It is a situation that is unsatisfactory for all parties. The Danish municipality of Sønderborg, a safety leader in nursing home and home-based care for more than a decade, decided to see what could be done. With improvement science already embedded in their organisation, they decided to take a deep dive into their processes as a first step. Mistakes in documentation, coordination, and communication have been identified as among the top 10 of root causes of patient safety incidents in Denmark, so it made sense to start there. Patient safety is often cited as the reason for documentation, but some research indicates that burdensome documentation is associated with increased medical errors, mistakes in documentation, and burnout among health care providers. Working from the theory that safely simplifying or streamlining documentation would free up time for direct care, Sønderborg and the Danish Society for Patient Safety embarked on an improvement journey that started with understanding the workflow of documentation that enabled staff to seek and share information from one another to plan and perform different tasks.
  15. Content Article
    A formal management system or framework can help you manage health and safety. The Health and Safety Executive (HEE) highlights standards, documentation and useful resources.
  16. Event
    Streamline your policy management workflow in the cloud with PolicyStat. From single hospitals to multi-facility organisations, all your policies and procedures are in one easily accessible library and always kept current. Efficiently organise and govern policies, procedures and related documentation . Stay compliant and audit ready to avoid penalties and drive better outcomes. Optimise policy workflows and change management to improve performance. Align culture, process and people for better document control and regulatory compliance. Register
  17. Content Article
    It is hypothesized that 90% of antibiotic allergies documented in patients’ health records are not actual, potentially life threatening, type I allergies. This distinction is important because such documentation increases antibiotic resistance, as more second-choice and broad-spectrum antibiotics are then used. Evidence is lacking regarding causes of this inappropriate documentation. To develop interventions aimed at improving documentation, the authors of this study, published in the Annals of Family Medicine, explored experiences of family physicians and pharmacists in this area. They found that the professionals involved perceived that antibiotic allergy documentation is seldom accurate, which may contribute to development of antibiotic resistance, increased costs, and decreased patient safety.
  18. Content Article
    With the widespread adoption of electronic health records (EHRs), there is an increased focus on addressing the challenges of EHR usability; that is, the extent to which the technology enables users to achieve their goals effectively, efficiently, and satisfactorily. Poor usability is associated with clinician job dissatisfaction and burnout and could have patient safety consequences. Using EHR surveillance data collected by the ONC, researchers from the MedStar Health National Center for Human Factors analysed over 350 reports regarding EHR issues that violated the federal certification programme. They found that roughly 40% of ONC-certified EHRs had the potential for patient harm.
  19. Content Article
    This anonymous blog high lights the vulnerability of patients, especially when it come to consent. This is a shocking account of events by a well informed patient when they were wrongly consented for a gynaecological procedure.
  20. Content Article
    Warren et al. 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. They found 117 (77.0%) hospital trusts were using electronic health records (EHR), but there was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research published in BMJ Open highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve EHR system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
  21. Content Article
    To ensure consistency and effectiveness of responses to health information under threat, Alberta Health has instituted the Provincial Reportable Incident Response Process (PRIRP) for all health stakeholders managing or accessing Alberta’s provincial Electronic Health Record (EHR), including its subsystems and repositories. This process covers incidents of data confidentiality, data integrity, and data availability and is divided into five phases. PRIRP is applicable to all health stakeholders managing, accessing, or regulating Alberta’s EHR, including its subsystems and repositories. • Health stakeholders use PRIRP to report a suspected or known security incident to Alberta Health. Alberta Health will assess the threat from the incident, and if valid will assemble an Incident Response Team (IRT). The IRT will be led by the Alberta Health Security team and include the reporting health stakeholder(s) and other applicable resources for any particular incident. The IRT will communicate as needed with other stakeholders impacted by the incident.
  22. Content Article
    Doctors and nurses must adapt their routines and improvise their actions to ensure continued patient safety, and for their roles to be effective and to matter as new technology disrupts their working practices. Research from Lancaster University Management School on the use of a computerised physcian order entry system in a hospital in Saudi Arabia, published in the Journal of Information Technology, found electronic patient records brought in to streamline and improve work caused changes in the division of labour and the expected roles of both physicians and nursing staff. These changes saw disrupted working practices, professional boundaries and professional identities, often requiring complex renegotiations to re-establish these, in order to deliver safe patient care. Managers implementing these systems are often quite unaware of the unintended consequences in their drive for efficiency.
  23. Content Article
    What happens if a surgeon accidentally drops an instrument on the floor, picks it up and reuses, without it going through a steriliser? Should this be allowed to happen? Well it did! 
  24. Content Article
    Following the inquest into the death of former patient Amy Allan and the subsequent Preventing Future Deaths report given to Great Ormond Street Hospital for Children, Chief Executive Matthew Shaw would like to outline how the hospital is learning from this and what action has been taken to address the concerns that have been raised.
  25. Content Article
    Clinical negligence claims are often built upon a lack of adequate documentation of what was said and allegations that patients have not been properly counselled about risks and alternatives. Elizabeth Thomas explores in this HSJ article what this means for the increasingly significant role of telemedicine and the steps which can go a long way in reducing the burden on patients and the public purse
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