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This resource by the Cancer Council advises these safety guidelines to reduce exposure to chemotherapy drugs at home, both for you and your family and friends during the recovery period at home. Safety precautions can vary depending on the drugs you receive, so ask your treatment team about your individual situation.

The report makes the following recommendations: National review: the government should proceed with its national review of deaths of people on post-release supervision in the community following a custodial sentence to establish the scale, nature and cause of the problem. Data: more detailed and accurate data should be made available along with regular reporting to the Minister responsible and Parliament alongside the publication of an annual report. Investigations: deaths of people on post custody supervision should be investigated by an independent body with adequate resources allocated to allow this to happen. There needs to be a threshold for this with a range of factors taken into account. Improve scrutiny and learning: the Government needs to confirm oversight at a local and national level.

What will I learn? Basic personal alarms for the elderly. Alarms that send a signal for assistance. Personal alarms and telecare. Fall detectors and alarms. How much does a personal alarm cost? Lifeline alarm services. Choosing and buying a personal alarm.

My much loved daughter-in-law, Mariana Pinto, died on 16 October 2016. She was 32. Her tragic and unexpected death raised many questions for us about standard practice by psychiatric services and about patient safety. The evening before she died, Mariana was taken by ambulance to her local A&E department, escorted by four police officers, and handcuffed for her own safety. She was psychotic – delusional, paranoid, violent and very distressed. She had attacked her husband (my son) who had visible bite marks, scratches and bruises. It was a first episode and totally out of character. She had not eaten or slept for several days. In A&E she was brought food and drink but spat it out, believing it to be poisoned. She kept trying to escape from the cubicle. The police stayed, stating that she was extremely vulnerable. Eventually she agreed to take a sedative – but not before she had held it under her tongue for some time, and only after we, her family, were able to persuade her that she should take it. Once she was finally sedated, she was given various tests to rule out any physical cause, and a mental health act assessment. This was done with her and her husband together. There was no attempt to see him separately. She was deemed competent to make decisions about her care, and as she wanted to go home, was discharged, with a referral to the local Crisis Team, who we were told would receive the referral at 8 am the following morning and would arrange to visit. The psychiatric team operate within A&E but for a separate mental health trust. This same trust runs the Crisis Team. It is deemed outstanding by the Care Quality Commission (CQC). The following morning, there was no contact from the Crisis Team. My son rang them at midday to ask when they would visit. They said normally between 5 and 7 pm on Sundays and to ring back if he needed to. He rang back at 3.30 pm stating that she had deteriorated rapidly and asking for the visit to be brought forward. He was told that it could not be. At 4.00 pm Mari ran out of the open door to the roof terrace and jumped off it. She did not survive her injuries. The Coroner gave a narrative verdict, making it clear that Mariana did not know what she was doing, though her actions were deliberate. She also gave a Prevention of Future Deaths Report. Whilst the trust is obliged to reply, there is no statutory obligation to demonstrate that the actions they have promised have actually been taken. There was no attempt at any risk assessment. There was no attempt to check that my son could speak freely (he could not – it was a studio apartment). There was no attempt to call the emergency services on his behalf, and no attempt to check he had been able to do so. None of this is regarded as negligent or especially problematic. Since her death the Crisis Team do visit on Sunday mornings. We also found out that the number we were given to call was for service users already allocated a key worker, rather than a more general number – but as my son spoke to senior staff on each call, this should not have made a difference. After her death we raised the following questions: Surely given the bite marks and bruising, her husband should have been allowed to give his information to the psychiatric team separately? No, it turns out that while this would have been good practice, it was not negligent. Surely, given that her family knew and loved her, we should have been asked post sedation if she seemed like herself (she did not). No, it turns out that this is not seen as necessary. It’s not even regarded as good practice. Surely, given that she was paranoid and had told the police that she did not trust her husband, her husband should have been given private space to discuss the discharge and rehearse what to do if things went wrong once the sedative wore off? And surely we should have been told that the Crisis Team is not instead of calling 999 in an emergency. And efforts made to help us to decide if the situation was an emergency. No, it turns out that while this would have been good practice, it was not negligent. The mental health trust has now introduced a written discharge template for care and contingency planning. We have been told that the circumstances of Mariana’s death were unusual and could not have been foretold. That may be. But there are still lessons to be learnt. To improve patient safety in mental health crisis and to learn from deaths, we need to change standard practice. It should become standard to: See family and friends separately if someone is paranoid, to understand the family’s concerns, learn more about the patient and work together to consider how best the patient can be kept safe and helped. Provide written care and contingency plans to patients and their family Use one number for a Crisis Team helpline, with clear policies to offer help and support to service users and to their carers, and proper protocols in place to assess risk and intervene if someone is at immediate risk of harm. Make it very clear to patients that a referral to a Crisis Team is not a substitute for calling 999 in an emergency (where there is an immediate risk of harm to the patient or others) and to distinguish between a crisis and an emergency. Other professionals have a role in this too: On discharge, the A&E staff (who were very kind and very concerned) could invite the family to come back if the situation deteriorates, making it clear that it was an emergency, was a legitimate use of 999 and of A&E, and that the Crisis Teams are not for emergencies. The police could do the same, if they are trusted by the family (in many cases they are not).

How you can contribute: The project leads are looking for suggestions from colleagues who may have worked with domiciliary carers and tested ideas around deterioration. Any advice on measures and impact and data sources is also encouraged.

Outstanding models of district nursing explores the elements that need to be in place to support an outstanding District Nursing service. It includes the views and experiences of a wide range of stakeholders including patients, carers, commissioners and GPs. It recommends that the Government and NHS: Urgently increase investment in the District Nursing service to give it the capacity and capability to meet the challenges of the 21st century Maintain the post-qualifying District Nurse Specialist Practice Qualification (DNSPQ), which develops DNs’ professional growth and enhances their clinical skills Develop a strategy to expand commissioners’, providers’ and the public’s understanding and knowledge of the District Nurse role, enabling them to recognise the added value they bring to the local health economy and particularly to the wider Health and Social Care system Develop a standardised data collection system and data set, collecting meaningful data that recognises value for money, promoting a strong economic case for investment in the District Nursing service Develop a standardised approach to the assessment of quality, to measure District Nurse effectiveness in England, providing reliable data, enabling innovation and cost-effective practice to be recognised and disseminated Explore the co-location of District Nursing teams within Primary Care Networks to provide personalised care, continuity of care and enhanced working relationships across primary and community care teams.

The website includes links to: Information on the #FakeMeds campaign Register of authorised online sellers of medicine How to use self-test kits safely Yellow Card to report any suspected fake medicines or side effects Information about the CE Mark

The video provides recommendations, strategies, and tools for realising five guiding principles for advancing the safety of home care.

In 2017, a group of NHS and local government organisations in West Suffolk, who had joined forces in a project to support older people to live independently at home, initiated a test-and-learn of the Buurtzorg model. They recruited a team of nurses and assistant practitioners to provide health and social care to people in line with the principles of the Buurtzorg model. The King's Fund has been working with this team to support them to learn about their experiences as they go along.

The challenge Some patients leaving hospital need advice and support to help them take their medicines correctly and safely. Around 60 per cent of patients have three or more changes made to their medicines during their stay in hospital, and only 10 per cent of older patients are discharged with the same medication they were taking before they went into hospital. In some cases, errors or unintentional changes to a patient’s medication can occur because of miscommunication. This can lead to patients becoming unwell and being readmitted to hospital, causing unnecessary distress to the patient and placing an avoidable burden on NHS resources. It is estimated that 6.5 per cent of emergency admissions are a result of adverse drug reactions, of which it is estimated that 72 per cent are avoidable. Actions taken In 2016, NHS England in Cheshire and Merseyside, in partnership with the Innovation Agency, received funding from NHS England to support the implementation of systems enabling the transfer of care from hospitals to community pharmacies. Soon afterwards, the initiative was adopted nationally by all Academic Health Science Networks and is one of the AHSN Network’s key innovation programmes. A secure digital system enables a hospital’s pharmacy team to inform the patient’s local pharmacy of the patient’s medicines on discharge, so the pharmacist can follow up with advice and services. Impacts Of all referrals from hospitals to community pharmacies through Transfer of Care Around Medicines, around 40 per cent require follow-up action from the pharmacist. It is estimated that for every 10 completed referrals, eight avoidable bed days are saved for the NHS. As of March 2019, Transfer of Care Around Medicines in Cheshire and Merseyside has been implemented in 10 trusts, including 11 hospitals, two mental health trusts and all 635 community pharmacies in the region – the fastest adoption and widest spread of the initiative in any region in England. There have been 14,853 referrals to community pharmacists at March 2019, of which 6,224 have been completed with further actions from the pharmacist, resulting in calculated savings of 5,103 bed days, or £9.5 million, to the NHS as well as improved patient safety and quality of care. Testimonial Una Harding, pharmacist at Day Lewis Pharmacy in Aintree, said: “We now get notifications on our system on a daily basis, it’s a platform we use every day. New discharges or referrals are the first thing you see when you log on. If we see a patient has recently been in hospital we can make a note to speak to them about their medication when they next come in." "Patients now understand we can deliver more for them. There’s a culture now where people are realising that their GP doesn’t always have to be the first port of call. They know now that if they come into the pharmacy we can talk to them about the changes to their medication." "It’s fabulous. Finally we’re getting more information so we can make more clinical decisions without having to hunt for information from different sources.” Hassan Argomandkhah, Chair of Pharmacy Local Professional Network NHS England Cheshire and Merseyside, said: “What started as an idea – we’ve managed to achieve it, and even if we’ve made just one small change in the quality of life of one patient in the past two years it’s been well worth it. None of this would have happened without the dedication of the pharmacists and their teams – whether in NHS England, in the community pharmacies, or in the hospital pharmacy teams – and all the other ancillary staff surrounding them. Without that support and encouragement we wouldn’t have achieved this.”