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Found 63 results
  1. Content Article
    It can be easy to make assumptions about a person’s quality of life, which can colour our judgements about the support, care and treatment of individuals, and how and what they should receive. So it is vital that the person and those who know them best are involved in their care, so that a more complete picture of an individual’s life can emerge and their needs, likes and dislikes can be shared with those providing care and support. This should improve the quality of the care and treatment that a person receives. It was with this in mind that the hospital passport was developed, containing important information about the person, such as their health and health difficulties, likes and dislikes, and any medication that they may be on. The idea was adapted from one created by Gloucestershire NHS primary care trust and introduced at St George’s Hospital in south west London. It was created by people with learning disabilities and health professionals from Wandsworth and Merton community learning disability teams and the acute hospital to ensure a better experience and health outcome for people with learning disabilities and their families in St George’s.
  2. News Article
    Hospitals are having to redeploy nurses from wards to look after queues of patients in corridors, in a growing trend that has raised concerns about patient safety. Many hospitals have become so overcrowded that they are being forced to tell nurses to spend part of their shift working as “corridor nurses” to look after patients who are waiting for a bed. The disclosure of the rise in corridor nurses comes days after the NHS in England posted its worst-ever performance figures against the four-hour target for A&E care. They showed that last month almost 100,000 patients waited at least four hours and sometimes up to 12 or more on a trolley while hospital staff found them a bed on the ward appropriate for their condition. “Corridor nursing is happening across the NHS in England and certainly in scores of hospitals. It’s very worrying to see this,” said Dave Smith, the Chair of the Royal College of Nursing’s Emergency Care Association, which represents nurses in A&E units across the UK. "Having to provide care to patients in corridors and on trolleys in overcrowded emergency departments is not just undignified for patients, it’s also often unsafe.” A nurse in south-west England told the Guardian newspaper how nurses feared the redeployments were leaving specialist wards too short of staff, and patients without pain relief and other medication. Some wards were “dangerously understaffed” as a result, she claimed. She said: “Many nurses, including myself, dread going into work in case we’re pulled from our own patients to then care for a number of people in the queue, which is clearly unsafe. We’re being asked to choose between the safety of our patients on the wards and those in the queue." Read full story Source: The Guardian, 12 January 2020
  3. News Article
    Hundreds of sexual assaults are reported each year on mixed-sex mental health wards in England, HSJ can reveal, highlighting the urgent need for investment to improve facilities. New figures obtained by HSJ show there have been at least 1,019 reports of sexual assaults between men and woman on mixed wards since April 2017 to October 2019. This compares to just 286 reports of incidents on single-sex mental health wards over the same period. Of those reports made on mixed-sex wards, 491 were considered serious enough to refer to safeguarding, and 104 were reported to the police. The level of incidents still being reported suggests patients are not being protected from sexual assault on mixed wards, despite the issue being highlighted by several national reports in recent years. Read full story (paywalled) Source: HSJ, 7 January 2020
  4. News Article
    Two patients have died as a result of NHS hospitals failing to heed warnings about the use of super-absorbent gel granules, which patients mistakenly eat thinking they are sweets or salt packets. A national patient safety alert has been issued by NHS bosses to all hospitals, ambulance trusts and care homes instructing them to stop using the granules unless in exceptional circumstances. An earlier alert in 2017 warned the granules, which are used to prevent liquid being spilled, had caused the death of one patient who choked to death after eating a sachet left in an empty urine bottle in their room. The 2017 alert warned hospitals there had been a total of 15 similar incidents over a six-year period between 2011 and 2017. The latest warning from NHS England says most hospitals concentrated on “raising awareness” rather than stopping the use of gel granules. Read alert Read full story Source: The Independent, 4 December 2019
  5. Content Article
    The Norfolk and Norwich University Hospital introduced NNUH at Home in January 2019 as part of a pilot project. NNUH is working in partnership with HomeLink Healthcare to deliver this service, which will benefit patients by supporting them to leave hospital as soon as they are clinically stable. Some clinically selected patients are able to go home to recover for the last few days of their acute episode of care. These patients remain under the care of the hospital and will be supported at home with bespoke care services such as therapy, nursing care, personal care and IV antibiotics. Patients are able to complete the remainder of their care in the comfort of their own homes, with the full support of their medical consultant and the NNUH and HomeLink teams. The NNUH at Home team comprises of nurses, physiotherapists, occupational therapists and Healthcare Support Workers. Patients transferred to the NNUH at Home service will remain under the care of their hospital consultant until they are formally discharged by the hospital to their GP at the end of their agreed length of stay. NNUH at Home will complements existing NHS community services.
  6. Community Post
    Hi everybody This is Jaione from Spain (we are in the North, Basque Region) and i am a nurse working in collaboration with the Patient Safety Team in our local NHS (Basque Health Service). First of all, I would like to congratulate the team for this hub which i think is a wonderful idea. Secondly, i would like to apologize for the language, since, although i lived in England many years ago, that is not the case anymore and I'm afraid i don't speak as well as I used to. I would like to comment a problem that we encounter very often in our organization which is related to patient's regular medications when they are admitted to hospital. We do have online prescriptions for both acute and community settings but the programs don't really speak to each other so, for example, if I take a blood pressure pill everyday and i get admitted into hospital, chances are that my blood pressure tablet won't get prescribed during my in-hospital stay. The logical thing to do would be to change both online systems so they communicate to each other, but that's not possible at the moment. I wanted to ask whether other systems have the same problem and, if so, if there is any strategy implemented to alleviate this issue. I hope i have expressed myself as clearly as possible. Thanks very much once more for this hub! Kind regards Jaione
  7. Content Article
    We have all heard of the terrible stories of nurses going to the coroner’s court. These stories have been fed to us by our seniors, our mentors, our lecturers since we were students. "If you don’t document properly, you will end up in the coroner’s court, you might even get struck off!" These stories strike the fear of god into you. No one wants to go to coroner’s court, no one wants to be criticised for the work they have spent years training to do. No one wants to be publicly humiliated. This is my story of what happened when I attended a coroner's hearing on a patient who was in my care. I was a band 6 at the time. It was a usual day on the medical ward. Busy. I had a bay of six patients. Three of them were fit for discharge, but no community placement for them to go to, two medical patients and one who was a surgical patient. The surgical patient was under the medics and the surgeons. He came with abdominal pain; he was waiting for a surgical review. Many patients are under numerous teams on the medical ward. One of my roles is to ensure that they get seen by each team every day to ensure a plan for treatment. Today was no different. The patient was seen by the medical team who said "await surgeons". I chase up the surgeons, but they are in theatre. From experience I know that they will be out of theatre by late afternoon – so hopefully I can catch them then. In the meantime, the surgical patient becomes unwell. His blood pressure drops, his NEWS of 5 from 0. He is tachycardic. I call the medics who attend – they want me to call the surgeons… no answer. Intensive care team arrive – to this day I’m not sure how they knew to come, perhaps one of the medics called them? The intensive care doctors I hear raging down the phone at a poor surgeon who is in theatre. The surgeon comes to the ward and soon realises the gravity of the situation. There are discussion that are being had away from the bedside – I’m not sure what was being said or plans that were being made. I was not part of the process. I’m busy doing observations every 5 minutes as requested, plus trying to look after my other five patients. All of a sudden we are going to theatre. I’m still unsure what’s going on. What’s he going there for? The patient looks really scared. I bet I look scared too! I help wheel him down to the operating theatre. As soon as we arrive in the anaesthetic room he has a cardiac arrest. We try and resuscitate him to no avail. I went back to the ward; bewildered, sweating from doing chest compressions, confused and with tears in my eyes. I have a quick cup of tea and I’m back out on the ward again. Three months later my manager asks to see me in the office. ‘What have I done wrong?’ When anyone asks for you to come to the office, its usually bad. They ask if remember the surgical patient who arrested a few weeks back. Of course, I do. I had been thinking about it ever since. I had been worrying about it. I felt it was my fault. They tell me that the case is going to the coroner's court and I was to be called as a witness. I cry. That’s me done then. I’m going to be struck off. I’m going to be found out that I am a rubbish nurse. My manager was amazing. They had experience in these hearings. They explained the whole process. From what would happen from now until the end of the hearing. That afternoon I was contacted by the Trust investigation team. They were lovely too. They asked me exactly what happened and help me write a statement. They put me at ease. It was made clear that what happened was not my fault and that they want to find out what happened to prevent it happening again. The next week or so I had contact with the Trust legal team. I had never spoken to a legal team before in my life. I did feel as if I was a criminal at first. The legal team were also brilliant. They spoke through the actual process; who was in the room, the layout of the room, what questions I might be asked, what the outcomes often are. They gave me advice on how to answer questions; answer what you know as fact, not opinion. If you don’t know, say you don’t know. Be honest. I had two further meetings with the legal team and the investigating team. This was to check I was ok, to make sure I was supported. For what could be an extremely stressful period of my career, was made so much easier by people taking the time out just to check I was ok. I carried on working throughout this period and working with confidence. The hearing came. I knew what to expect. I knew the layout of the room. I knew the patient’s relatives were in the front row, I knew I had to swear an oath, I knew I had support from my Trust. I was able to speak freely – even the bad bits; no covering up or making excuses for others. I was asked what happened that day. I was honest. I didn’t know what was going on. I didn’t know what was wrong with my patient. I was not used to caring for surgical patients. Admitting that I ‘didn’t know’ was awful. I should know, shouldn’t I? When I was saying this, I could feel the eyes of the patient's widow bore into me. I had let my patient down and I had failed. The coroner asked me many questions related to escalation of care to seniors, the policy, my adherence to the NEWS policy – to which I had followed. My part was over in a flash. The next was the surgeon, who got most of the grilling. Why was he not there, where was his documentation, why did he not come when asked repeatedly? It wasn’t his fault either. He was in theatre with another patient. He can’t be in two places at once. I felt really sorry for him. I hope he got the same support I did. The outcome of the hearing was to issue a regulation 28. This ensures that a report is sent to the government by the Trust as the coroner believes that action needs to be taken can to prevent future preventable deaths. So, what happened then? I went back to work and carried on as usual. The ward where I worked no longer takes surgical patients. They made a new unit called the ‘surgical assessment unit’ where surgical nurses care for this cohort of patients. I wanted to share this – yes, there are many issues surrounding this, but the point I wanted to get across is that the investigation team, my manager and the legal team supported me through this difficult time. I am not sure if other Trusts have this level of support for staff attending coroners court.
  8. Community Post
    We are looking into introducing a new device to deliver CPAP at ward level into our trust. Currently we use NIPPY machines which can deliver some PEEP when in a selected mode, however the downfall to this is, it can only produce an oxygen concentration of around 50%. Often, the patient groups that require this intervention are on high oxygen requirements and so particularly in the early stages would benefit from a device that could deliver both. I have previously worked with Pulmodyne 02-Max trio which allows up to 90% oxygen and PEEP up to 7.5cmH20. Majority of patients responded very well to this treatment. I wondered whether any other trusts/ team have any other experiences/ devices that they may use and recommend? @Danielle Haupt@Claire Cox@Emma Richardson@Mandy Odell@PatientSafetyLearning Team@Patient Safety Learning@Patient safety Hub@CCOT_Southend
  9. 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?
  10. Content Article
    The resources include peer-reviewed content on identifying and managing sepsis in the community, in older people and in children from Emergency Nurse, Nursing Children and Young People, Nursing Older People and Primary Health Care.
  11. Content Article
    Following a review of the events that led up to Amy’s death Great Ormond Street Hospital have already made changes to practice: They have improved the way clinical information is shared between different specialist teams, to make sure staff have as comprehensive a picture as possible when making complex decisions about a patient’s treatment. They now use a single log-in electronic patient record system which means staff can quickly access clinical information about a patient and have the right information at the right time, rather than routinely having to use multiple systems. They have improved consultant availability. This means there is more consultant time for each patient being looked after in our paediatric intensive care unit. They have introduced a new process to make sure the care of patients, like Amy, who have both complex spinal and heart conditions is routinely considered by the hospital’s specialist joint cardiology committee.
  12. Content Article
    Ward leader, Sarah King, had only been in post for 1 month when all of these concerns came to light and she was set an improvement action plan to improve the feel of the ward by developing the leadership team and creating a strong and supportive environment for a junior workforce. Following the inspection, Sarah developed an action plan that included setting the leadership team clear goals and objectives, improving record keeping, improving medicines management, addressing low moral on the ward and changing a chaotic feeling ward into a busy but controlled feeling ward.
  13. Content Article
    One issue raised by the group at the meeting was the lack of trust for transplant patients in regards to immunosuppression. At home, transplant patients were expected to take their medications, but as soon as they stepped onto the ward, their medications would be locked up. This resulted in immunosuppression being given later than usual and occasionally incorrect doses. This was even more difficult when admitted to hospitals without renal units and it was impossible for patients to challenge healthcare professionals. Indeed, a few patients commented that immunosuppression had been withheld for no seemingly good reason. They felt that more knowledge on immunosuppression would allow them to challenge healthcare professionals more confidently.
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