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We know acute mental health wards are not safe for patients or staff. Efforts to reduce coercion and restrictive practice are often complex and are poorly implemented. Services continue failure to understand incidents and the dynamic milieu of wards in real-time. The staffing and skill mix of services are under constant pressure. Recent research, #WardSonar, has successfully focused on enabling patients to highlight when the pressure on wards is building and can predict when incidents might occur. The challenge remains enabling staff to listen to and respond to real-time data. Register- Posted
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This paper identifies some of issues around transitions of care when a patient leaves an intensive care unit (ICU) for ‘a general medical ward (or other de-escalated care settings, such as a step-down unit) for observation, treatment, and discharge planning.’ The authors describe a checklist to support safe ICU transfers of patients to medical wards or step-down units. The proposed 7-step checklist has the mnemonic SIMPLER: Stable vital signs Intact aeration Medications reviewed Prepared psychology Lingering catheters Extreme laboratory findings, and Return plans. The authors state: "The first 3 steps are prerequisites in a medical ward and denote the importance of stable vitals signs, intact aeration, and a diligent medication check. The next 3 steps are priorities in the ICU and involve determining patient expectations, managing catheters or other devices, and reviewing laboratory results. The final step concerns contingency plans for unforeseen deteriorations and goals of care."- Posted
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People 'dying in pain due to end-of-life care gaps'
Patient Safety Learning posted a news article in News
Marie Curie said one in five hospital beds in Wales were occupied by people in the last year of their lives and "bold, radical" action was needed for services which were at "breaking point". One family said they had to fight to ensure their 85-year-old father could die peacefully at home rather than in a hospital ward. The Welsh government said it provided more than £16m a year to ensure people had access to the best possible end-of-life care. Marie Curie said gaps in care meant "too many people are spending their final days isolated, in pain, and struggling to make ends meet". "End-of-life care in Wales is at breaking point," said Senior Policy Manager Natasha Davies. "Services and staff are struggling to deliver the care people need, when and where they need it. There is an urgent need for change." The charity recognised while hospital was the best place for many palliative care patients, better community and out-of-hours care would allow people to be cared for in their homes. "It also means having meaningful conversations with dying people about their care preferences, so their wishes are heard and respected," added Ms Davies. The Welsh government said good palliative and end-of-life care could make a "huge difference" to helping people die with dignity. Read full story Source: BBC News, 2 June 2025- Posted
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Poor quality ward rounds contribute to a large proportion of patient complications, delayed discharge, and increased hospital cost. This systematic review investigated all interventions aiming to improve patient and process-based outcomes in ward rounds. The review included 84 studies, from 18 countries, in 23 specialties, involving 43 570 patients. It found that checklist interventions significantly reduced ICU length of stay, improved overall documentation, and did not increase ward round duration. Structure interventions did not increase the time spent per patient or impact 30-day readmission rates or patient length of stay.- Posted
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This study looked at the factors influencing nurses' recognition and response to patient deterioration. Seventeen studies were reviewed and appraised. Recognising patient deterioration was encapsulated in four themes: (1) assessing the patient; (2) knowing the patient; (3) education and (4) environmental factors. Responding to patient deterioration was encapsulated in three themes; (1) non-technical skills; (2) access to support and (3) negative emotional responses. The study concluded that issues involved in timely recognition of and response to clinical deterioration remain complex, yet patient safety relies on nurses’ timely assessments and actions.- Posted
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This US cohort study aimed to explore how antimicrobial resistance (AMR) has changed between 2012 and 2022. The findings showed that overall resistant cases per 10,000 hospitalizations declined between 2012 to 2016. However, progress varied across pathogens and was inconsistent before the Covid-19 pandemic. The pandemic was associated with notable increases in hospital-onset cases of AMR. -
Content Article
The phenomenon of a 'weekend effect' refers to a higher potential for adverse outcomes in patients receiving care over the weekend. Few prior studies have comprehensively investigated the effects of postoperative weekend care on surgical outcomes in a generalisable cohort. The aim of this study was to examine differences in short-term and long-term postoperative outcomes of patients undergoing surgical procedures immediately before vs after the weekend. In a cohort study involving 429 691 patients undergoing 25 common surgical procedures in Ontario, Canada, those who underwent surgery immediately before the weekend experienced a statistically significant increase in the composite outcome of death, complications, and readmissions at 30 days, 90 days, and 1 year compared with those treated after the weekend. These findings suggest that patients treated before the weekend are at increased risk of complications, emphasising the need for further investigation into processes of surgical care to ensure consistent high-quality care and patient outcomes. It is important for healthcare systems to assess how this phenomenon may impact their practices to ensure that patients receive excellent care irrespective of the day.- Posted
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This study in BMJ Quality and Safety aimed to retrospectively estimate the prevalence of harmful diagnostic errors in a randomly selected sample of 675 patients receiving general medical care in a US hospital between July 2019 and September 2021. The researchers developed and validated a structured case review process to enable clinicians to interrogate the electronic health record (EHR) to evaluate the diagnostic process for hospital patients, assess the likelihood of a diagnostic error and characterise the impact and severity of harm. Their findings estimate that harmful diagnostic errors may be occurring in as many as 1 in every 14 (7%) hospital patients. Read a easy-read press release about the research- Posted
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Virtual ward cost similar to inpatient care, says contentious study’s author
Patient Safety Learning posted a news article in News
The cost of discharging patients to virtual wards becomes “equitable” with inpatient care over time, analysis suggests – despite initial findings that it was much more expensive. A research project conducted at Wrightington, Wigan and Leigh Teaching Hospitals in 2022 published its results last year, which found the cost of avoiding a bed day in hospital by discharging a patient to a virtual ward was £935 per day, compared to an average cost of £536 per day for keeping a patient in a general inpatient hospital bed. But, the study’s lead author has now told HSJ that, following a second year of monitoring, the cost of step-down virtual ward care had decreased to be roughly the same as traditional inpatient care. The initial study sparked significant debate, and was met with criticism from NHS England, which said the results were “misleading”, particularly due to its limited scope and time frame. Having evaluated WWL’s virtual ward provision again in 2023, Martin Farrier, director of digital medicine at WWL and lead author of the original paper, said the cost of step-down virtual ward care was “still significant” but now “equitable” with keeping a patient in a hospital bed. Dr Farrier said the majority of the cost per patient was from staffing, and this had fallen significantly in year two. He said: “In the first year, [staff] said they were flat out, but they weren’t flat out, they were just getting used to their system. They sped up with time, [so] the capacity of the system becomes much larger… [There’s] a mixture of things going on. But what you then get… is the costs come down and they become equitable with the cost of hospital care.” Read full story (paywalled) Source: HSJ, 10 March 2025- Posted
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Parkinson’s is the fastest growing neurological condition in the world. Currently there is no cure for Parkinson’s, but medication plays a vital role in managing symptoms and preventing deterioration. In this blog, Joanne explains how delays to her mother’s time-critical medication in hospital led to her condition deteriorating. I want to share my story about my mother’s treatment after she was admitted to hospital with a sore knee. She lived independently and walked with one stick prior to her admission. Her Parkinson’s was well managed with her medication. Right at the beginning of my mother’s inpatient stay she received the wrong amount of her time critical medication and her usual timings were not honoured, despite information given to medical staff on admission. My mother lost all her function which caused her to fall, she couldn’t sit up properly and was lying to the side and hunched over. She managed to feed herself a few times in this lying to the side/hunched over position. This in turn meant she aspirated and then took pneumonia. She also has heart failure, and the amount of antibiotics needed to shift the pneumonia then caused fluid overload which made her heart failure worse. We were not given much hope for her. She lost 4 stone of weight and was hospitalised for a total of 96 days. At times, she could not even coordinate her hand to mouth to eat. I was constantly having to chase the medical staff for her medication to be given at the correct times. I was made to feel like a pest. They even ran out at one stage, and the dosage was over 2 hours late. My mother was never incontinent on admission to hospital but that also soon changed. She deconditioned, was frail and then had trouble with orthostatic hypotension which restricted her rehab. She had several urinary tract infections which in turn caused delirium which was very upsetting. It is of my opinion that the medication delays caused the problems. I complained about the care and got her moved to a local hospital. She came on leaps and bounds, and they were bang on time constantly with her meds. No issues at all. Two physiotherapists had her up and walking. She was finally discharged from hospital on day 96 with a Zimmer frame with wheels and the assistance of two people. The physiotherapy team felt confident she wasn’t at her baseline and could improve to having the Zimmer and assistance of one. Things felt more positive. She then went to a rehab care centre where the physiotherapy input was minimal. The physiotherapist there reassessed her and told me that she would never walk again as it was too unsafe. Medical advice was to find a permanent nursing home for her. I then contacted a private neuro physiotherapist who specialises in Parkinson’s and he has hope for her and has had her up and walking again. I’m so very upset and traumatised by what has happened to my mother. It’s a very sad situation that we are currently faced with and I have no doubt that it all has been caused by an incorrect dosage and delays to the set timings of her Parkinson’s medication during her hospital admission. I do not feel the medical staff understood the importance of her time critical medication. There needs to be more awareness throughout health trusts and training for any staff involved in dispensing these medications. Guidelines or standards should be implemented and in place for time critical medication. It is not acceptable to follow general medication guidelines for time critical Parkinson’s medication. Share your story Have you or someone you care for been affected by any of the issues raised in Joanne's blog? Or perhaps you are a healthcare professional putting measures in in place to reduce errors around time-critical medication? You can comment below (sign up for free first) or email us at [email protected] to share your insights. Related reading Medication delays: A huge risk for inpatients with Parkinson’s Keeping patients with Parkinson’s safe in hospital: 4 key actions for staff Preparing to go into hospital – tips for people with Parkinson's and their carers Lightning Learning: Time Critical Medications ‘Every minute counts’: taking a national approach to time-critical medicines- Posted
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News Article
Norovirus hospital cases reach highest level ever
Patient Safety Learning posted a news article in News
There are a record number of patients in hospital with Norovirus in England. Data from NHS England showed 1,160 patients a day on average were in hospital with the vomiting bug last week – double the level at the same period last year. It comes after a 22% rise on the week before, pushing it to the highest level since records began in 2012. It means more than 1% of beds are occupied by patients ill with the bug. But Norovirus puts added pressure on hospitals because of the need to isolate and clean infected wards – nearly 300 empty beds a day were taken out of action because of this. NHS England medical director Prof Sir Stephen Powis said: "It is concerning to see the number of patients with Norovirus hit an all-time high and there is no let up for hospital staff who are working tirelessly to treat more than a thousand patients each day with the horrible bug, on top of other winter viruses. "To help stop the spread of Norovirus, it is important to remember to wash your hands frequently with soap and water and avoid mixing with other people until you have not had symptoms for two days." Read full story Source: BBC News, 20 February 2025 -
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NHS faces £5.7bn bill for patching up hospitals before demolishing them
Patient_Safety_Learning posted a news article in News
The repairs bill at 18 crumbling hospitals is set to soar to £5.7bn because replacing them will take so long, new analysis shows. Reconstruction of 18 of the 40 new hospitals in England first promised by Boris Johnson in 2019 will not start until at least 2030 – the date by which all 40 were originally meant to open – to help spread the cost, amid stretched public finances. NHS trust bosses have warned that some of the 18 hospitals hit by the delays, such as St Mary’s in London, will collapse before work starts because they are already in such an advanced state of disrepair. Read full story Source: Guardian, 16 February 2025 -
News Article
Woman stuck for 18 months on an NHS ward evicted from her hospital bed
Patient Safety Learning posted a news article in News
"I feel very angry, upset, worthless, and like my mental health and my life does not matter," says Jessie, propped up in a hospital bed. She is recording this in a video diary. Blue NHS curtains are drawn around the bed and all her possessions are stacked up in the tiny chaotic space this creates. Among the piles of boxes and bags sit the dolls she holds to keep her calm. Thirty-five-year-old Jessie spent 550 days in Northampton General Hospital. For nearly all that time, she was medically fit to leave but finding her a suitable place to go to was difficult. The BBC has followed her story for more than five months as the NHS trust took costly High Court action against her, to have her evicted from the hospital bed she was occupying. Jessie was eventually arrested and taken to a care home where she says she feels anxious. Her story is an extreme example, but it demonstrates the acute pressures faced by a care system coping with more complex cases, the knock-on effect to the NHS, and how the person at the heart of it can feel lost. North Northamptonshire Council, which is responsible for her housing and care, says it cannot comment because of an ongoing police investigation into Jessie's behaviour. The hospital says it "is not the best environment for patients who are not in need of acute medical care". The Department of Health and Social Care has told the BBC: "This is a troubling case which shows how our broken NHS discharge system is failing vulnerable people." Read full story Source: BBC News, 8 February 2025- Posted
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On the 16 January 2025, the Royal College of Nursing (RCN) published a new report presenting the findings of a survey of nursing staff outlining the extent of corridor care across the UK. This blog sets out Patient Safety Learning’s response to this report. In a new report this month, On the frontline of the UK’s corridor care crisis, the RCN have set out in stark terms how corridor care has become normalised in the NHS.[1] [2] Documenting the experiences of more than 5,000 nursing staff, the report reveals the widespread issues of corridor care across the UK. It also highlights from a survey of RCN members that: Almost 7 in 10 (66.8%) of those surveyed said they were delivering care in over-crowded or unsuitable places. More than 9 in 10 (90.8%) of those surveyed said patient safety is being compromised. Corridor care can broadly be defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. In the RCN survey, when asked what inappropriate settings staff had provided care for patients, the main responses were corridors (62.34%), additional bed or chair in a bay (16.12%) and waiting rooms (5.93%). However, 15.31% of respondents also cited other settings, including bathrooms, cloakrooms, chairs in lounges, store cupboards and ward reception areas. Implications for patient safety Corridor care raises significant patient safety concerns. It can present problems providing appropriate care, as these unsuitable spaces can make it difficult to administer specific treatments, such as intravenous medication, or the ability to access oxygen, medication and lifesaving treatment in an emergency. It also makes it more difficult to monitor patients, which can result in delays in providing further treatment if their condition begins to deteriorate. But it is not just the physical environment that’s the challenge, it’s also an indication of an organisation that isn’t coping with the demand and capacity being exceeded, in the emergency department and also on the wards. The overspill into corridors is a reflection of that. It is also highly likely that the organisational infrastructure and clinical support services are struggling to cope—for example, getting diagnostic tests and scans. These will take longer, contributing to delays in clinical review and decision making, which in turn could lead to delays in treatment and care. The constraints on space that working in these conditions impose may mean that relatives are not able to be accommodated, reducing their ability to support patients whose condition may not otherwise be closely monitored. This lack of space can also result in physical hazards, with the potential for escape routes becoming blocked in emergencies. Corridor care also has a particular negative impact on patient dignity and confidentiality. Reflecting of examples of this in practice, in a blog shared on the hub last year a nurse noted that: “Often, we need to perform an ECG, which involves removing clothes from the upper body. There is supposed to be a room set aside for this, but it is often occupied by someone else in need—a mental health patient, a family member or a woman who has just miscarried. This task then has to be completed in the corridor. The screens we have do not provide any privacy and this leaves patients feeling exposed, vulnerable and cold. One other example relating to this lack of dignity happened when a patient’s catheter overflowed because it had not been emptied. He was on a narrow trolley with a thin mattress and had become very wet. I simply couldn’t offer him the personal care he needed. There was not enough space, no privacy and no easily accessible hot water. Once I was able to gain support from staff to help me change the patient he had been laying in wet clothes and sheets for the whole morning—four hours. This is basic nursing care that I was not able to perform."[3] Working in these conditions also has a significant impact on healthcare professionals too, trying to do their best in less than ideal circumstances that are now a daily occurrence. No-one joins a caring profession to continually deliver sub-optimal care that isn’t safe and this adds to the trauma already experienced by patients. Reflecting this, the RCN report included the following response highlighting the impact on one staff member: “It was cold room with no natural light or access to toilet or shower facilities near by. Temporary measure for no beds in the hospital. Patients felt undervalued and forgotten about. It was out the way of the main ward and felt unsafe. I escalated these concerns nothing was done. I am now in the process of leaving the NHS due to the pressure and culture after a 10 year nursing career. It is fraying at the seam’s and has left me with mental health problems and trauma.”[1] Normalisation of corridor care Thirty years ago corridor care was rare, but it is now so normalised that in September last year NHS England published new guidance setting out principles for providing safe and good quality care in what it describes as ‘temporary escalation spaces’ (TES).[4] The guidance contradicts itself stating that the delivery of care in temporary escalation spaces is not acceptable, but then goes on to say that the principles have been developed to support staff to provide the safest, most effective and highest quality care possible. Reflecting on this from a frontline NHS perspective, a anonymous blog contributor on the hub highlighted various problems with this position, stating that: “I am unsure which patients are ‘suitable’ for the corridor. I am not aware of anyone who would like to be cared for in an open space, with no privacy or dignity, with no access to emergency equipment or appropriate staffing.”[5] This guidance has also drawn national criticism in the form of a position statement issued from the Royal College of Emergency Medicine in December 2024, stating that: “Advice from arm’s length bodies that appear out of touch with what is happening in our departments was always going to be poorly received. Where such spaces are in use it is inevitable that this will be associated with long waits in Emergency Departments. We know that long waits in Emergency Departments are associated with measurable harm to patients. Care will therefore not be safe.”[6] Further to this guidance, we are also now seeing corridor care become part of workforce planning, with examples of Trusts specifically recruiting nursing roles specifically to carry out shifts in corridors.[7] A systemic problem Corridor care is a complex issue that is the result of a range of systemic problems faced by the health and care sector. The roots of this have been considered in a range of previous articles and reports, and recently in a report by the RCN published last summer, Corridor care: unsafe, undignified, unacceptable.[8] [9] [10] Factors contributing to there being insufficient capacity in hospitals that are leading to the persistence and growth of corridor care include: Lack of sustainable investment across the health and care system. Infrastructure investment, in both new healthcare facilities and essential maintenance for existing buildings, not keeping pace with service requirements. Increasing healthcare demand, with an ageing population living for longer in ill health. ·Lack of hospital bed capacity, exacerbated by delayed hospital discharges due to a lack of access to appropriate social care. Staff shortages, with demand for health and care services outstripping workforce growth. Patients waiting longer for diagnostic tests or elective services and becoming more unwell whilst they wait, which could lead to an increase in demand for emergency care. Lack of investment in prevention and public health, with worsening wider population health. Commenting on the winter pressures faced by the NHS, the Health and Social Care Secretary Wes Streeting MP said in the House of Commons this week: “I want to be clear, I will never accept or tolerate patients being treated in corridors. It is unsafe, undignified, and I am determined to consign it to the history books.”[11] There is no quick fix to achieve this. It will require system leaders to get to grips with these issues and, supported by evidence and research, put in place plans to address them. If the Government is to realise its ambition to consign corridor care to the history books, this work must be an integral part of the forthcoming 10-Year Health Plan.[12] Reporting incidences of corridor care Patient Safety Learning believes that corridor care should be avoided whenever possible. Even in the context of the ongoing immense pressures being faced by the health service, this should not be normalised. In situations where this is unavoidable, there clearly needs to be guidance and safeguards put in place to minimise risks as far as possible. But we do not think this can ever really be characterised as good quality care, which is far removed from the patient and healthcare professional experience of this. As we have noted, to eliminate corridor care will ultimately depend on long-term action to address its systemic causes. However, we do think there are actions that can be taken now to better understand and respond to the patient safety problems that this raises. We support the recent calls by an RCN-led coalition on the UK government to commit to transparency on the true extent of the corridor care. It is important that there is regular reporting of incidents of corridor care, and we agree with their recommendation that: “Mandatory reporting about incidents of care in inappropriate spaces, including TES, must be implemented by the UK government to NHS England, in partnership with local NHS Trusts. This data should be released publicly on a regular basis alongside A&E attendance and waiting time data, forming part of NHS England’s winter situation report data series and monthly performance statistics release.”[13] We also welcome the recent NHS England announcement that it will begin to report on the number of patients who receive care within temporary escalation spaces from the 25 January onwards.[8] Capturing the patient safety consequences of corridor care While it is important incidences of corridor care are regularly recorded, we also need to better understand the patient safety consequences of this and how organisations are mitigating risks to patients and staff. We believe that the NHS needs to give further consideration as to how incidents of avoidable harm, where corridor care is a contributory factor, are captured. One aspect of this would be looking at how such incidents can be recorded in the Learn from Patient Safety Events (LfPSE) service. LfPSE is the national NHS service for the recording and analysis of patient safety events that occur in healthcare. Trusts can currently see reports of their own data in this, but it would be beneficial if they could also access system-wide findings from this on issues such as corridor care to help them assess risk or engage with others. Consideration also needs to be given to the ease at which staff are be able to record incidents of near misses and incidents in corridor care. If this is an increasingly frequent occurrence, this may become difficult to manage in addition to providing patient care in an overstretched healthcare setting. We also believe that NHS England should look at how learning and recommendations from investigations related to corridor care at individual healthcare providers under the Patient Safety Incident Response Framework are shared widely for national improvement. If patients’ safety has been compromised by being cared for in unsuitable environments, this must be captured and shared for learning. We believe that organisations should share how they are mitigating the risks to patient and staff safety. NHS England’s guidance suggests that patient safety considerations should be imperative when using temporary escalation spaces. It states that: “Local patient safety checklists should be used to ensure the patient is safe to be cared for in this setting. This should include an inclusion and exclusion checklist.”[4] However, it is not immediately clear what checklists this is referring to, with a localised approach meaning this could vary from organisation to organisation. There does not currently appear to be much evidence on how organisations are responding to this guidance, or shared examples of where this has been implemented well that could be used by others. Further to this, to ensure we are capturing and acting on the patient safety consequences of corridor care, it is important that: Patients, families and carers are invited to and feel able to feedback about their experiences, both at a local and national level, to inform learning and improvement. Frontline staff are supported and feel able to report patient safety concerns around corridor care. This requires a wider organisational culture that enables speaking up and demonstrates that the organisation listens to and acts on the findings of incident reports. Healthcare managers need to maintain a focus on ensuring patient safety issues relating to corridor care are consistently identified and acted on, despite the enormous pressures the system faces. Organisational leaders should maintain a credible and meaningful focus on patient safety as a priority agenda item internally and externally to create the culture and landscape for solutions to be identified and implemented. However, the above points can only be realised if system leaders, from Integrated Care Boards up to the Department of Health and Social Care, buy into this. This requires honesty and transparency about the scale of corridor care and a commitment to work collaboratively to share practices to minimise the patient safety risks it creates. Share your views and experiences with us We would welcome your views on the patient safety concerns raised in this blog. Are you a patient, or a friend or family member of a patient, who has experienced corridor care? Or perhaps a healthcare professional who has experience of delivering corridor care and would like to share your story? You can share your views and experiences with us directly by emailing [email protected]. References Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Royal College of Nursing. Corridor care: ‘Devastating testimony’ shows patients are coming to harm, 16 January 2025. Anonymous. A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift, Patient Safety Learning, 22 February 2024. NHS England. Principles for providing safe and good quality care in temporary escalation spaces, 16 September 2024. Anonymous. A nurse’s response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces, Patient Safety Learning, 20 September 2024. Royal College of Emergency Medicine. RCEM Position Statement on NHS guidance ‘Principles for providing safe and good quality care in temporary escalation spaces’, 16 December 2024. Lintern S, Wheeler C. Hospital advertises for ‘corridor care’ nurses to ease NHS crisis. The Times, 11 January 2025. Hadden C, Tse J. Corridor care: unsafe, undignified, unacceptable. Royal College of Nursing, 3 June 2024. Wilson H. We shouldn’t get comfortable with corridor ‘care’. The Health Foundation, 14 February 2024. Royal College of Emergency Medicine. The management of emergency department crowding, January 2024. Department of Health and Social Care. Oral statement to Parliament – Health and Social Care Secretary’s statement: winter 2025, 15 January 2025. Department of Health and Social Care. Change NHS: help build a health service fit for the future, 18 November 2024. Royal College of Nursing. Corridor care: RCN-led coalition demands transparency and mandatory reporting, 13 January 2024- Posted
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Corridor care can broadly be defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. This report from the Royal College of Nursing presents the findings of a survey of nursing staff outlining the extent of corridor care across the UK. The responses confirm that corridor care is a widespread issue, with hundreds of unedited responses included in the report. You can read Patient Safety Learning's response to this report here.- Posted
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The hospitals so rundown they are 'outright dangerous', NHS chiefs say
Patient_Safety_Learning posted a news article in News
Multiple NHS hospitals are now so rundown they pose a serious risk to patient and staff safety, internal health service documents reveal. Named and shamed facilities include Stepping Hill hospital in Stockport, three hospitals in Doncaster and Bassetlaw, Croydon hospital in south London, and multiple hospitals run by Barts Health trust, also in the capital. Hazards include fires, floods from ageing pipes and tanks, electrical issues and even potentially dangerous bacterial infection from decaying infrastructure. Some of the patients deemed at risk include cancer patients, those receiving life-saving care and even some specialist services caring for vulnerable babies. Read full story Source: Daily Mail, 30 December 2024 -
News Article
NHS patients at risk as hospital urgent repair costs triple in decade
Patient_Safety_Learning posted a news article in News
A decade-long failure to address urgent repairs in hospitals across England has led to a dramatic rise in issues posing a “high risk” to patients and staff, ministers are being warned. The cost of dealing with this backlog has almost tripled since 2015 in real terms, to £2.7bn this year. High-risk repairs have been the fastest growing part of the lengthy maintenance list over that time. It includes issues that could lead to serious injury to both staff and patients, or to major disruption of services or “catastrophic failure”. The NHS lost more than 600 days – or 14,500 hours – of clinical time because of infrastructure failures in the last year, according to a new analysis seen by the Observer. The total maintenance backlog has now ballooned to £13.8bn in 2023-24, an 18% increase from last year. The figure is more than the NHS’s entire capital budget for the year. Read full story Source: Guardian, 28 December 2024- Posted
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In this interview, David Osborn, chartered occupational safety and health practitioner and member of the Covid-19 Airborne Transmission Alliance (CATA), speaks to Lotty Tizzard, Digital Content Manager at Patient Safety Learning, about how CATA was established during the pandemic to advocate for adequate respiratory protection for NHS employees. David explains how CATA advocated for the government and heath service to recognise that Covid-19 is passed on by aerosol transmission (through microscopic particles in the air). He also outlines why surgical masks do not adequately protect people against catching airborne viruses and describes how inadequate respiratory protective equipment (RPE) contributed to thousands of NHS staff catching Covid-19 at work. As a result, many healthcare workers died and a large number still live with the ongoing symptoms of Long Covid. David describes CATA's involvement as a Core Participant in the Covid-19 Inquiry and outlines what he hopes will be done to ensure the UK is better prepared for future pandemics. Patient Safety Learning is also a member of CATA. Clarification David wishes to clarify a point raised in the interview: "When talking about the “IPC Cell” I said that they 'didn’t produce minutes'. In fact, notes or minutes were taken at all IPC Cell meetings. The point I was making is that they were not published ('produced' in the sense of being released into the public domain), when the minutes of most other groups such as SAGE and NERVTAG were published. The few IPC Cell minutes that have trickled into the public domain have mostly been as a result of Freedom of Information requests by a colleague and a few that I have managed to obtain myself. In some cases, public authorities have taken around 18 months to disclose documents, and it has required the intervention of the Information Commissioner's Office. I anticipate that more minutes will be disclosed for public scrutiny as time goes on." You can read more about CATA and the Covid-19 Inquiry in David's blogs and presentations on the hub: Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn Healthcare workers with Long Covid: Group litigation – a blog from David Osborn Covid-19 : A risk assessment too far? A blog by David Osborn CATA and the UK Covid-19 Public Inquiry: Presentation from David Osborn Join the conversation Were you working in health and social care during the pandemic? We'd like to hear about your experience of health and safety at work. Were you provided with adequate PPE to carry out your job safely? Did you catch Covid-19 while at work? You can join the conversation by commenting below (you'll need to sign up first) or get in touch with us directly by emailing [email protected]- Posted
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News Article
The NHS faces “real problems this winter”, the health secretary has admitted as he refused to rule out the prospect of people waiting on trolleys and in corridors over the coming months. Speaking on a joint visit to St George’s Hospital with chancellor Rachel Reeves, Wes Streeting said the extra money the health service is set to receive in Wednesday’s Budget might not prevent avoidable deaths and another winter crisis over the coming months. Read full story Source: Independent, 29 October 2024- Posted
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Content Article
The purpose of this study was to look at reported patient safety events at the interface between hospital and care home including what active failings and latent conditions were present and how reporting helped learning. Two care home organisations, one in the North East and one in the South West of England, participated in the study. Reports relating to a transition and where a patient safety event had occurred were sought during the Covid-19 virus prepandemic and intrapandemic periods. All reports were screened for eligibility and analysed using content analysis. The findings highlight potentially high levels of underreporting. The most common safety incidents reported were pressure damage, medication errors, and premature discharge. Many active failings causing numerous staff actions were identified emphasizing the cost to patients and services. Additionally, latent conditions (failings) were not emphasized; similarly, evidence of learning from safety incidents was not addressed.- Posted
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Content Article
At a recent Patient Safety Education Network meeting, Karen Male, ward leader at the University Hospital Southampton, gave a presentation on how she reduced falls on her ward. We asked Karen to share her journey and insights in a blog for the hub. The Patient Safety Education Network is a informal voluntary peer network for those in patient safety education and training roles. It provides a monthly drop-in session with guests to talk through issues of importance to those in patient safety education and training roles and now has over 470 members. You can find out about the network here. The challenge I joined the ward 14 months ago at a time when there was a high number of falls. In one year there was 72 falls, including four high-harm falls, and we would regularly have three falls a day. Falls prevention and staff confidence was low in the management and assessment of falls, and policies and procedures were not being followed. The ward layout was challenging—a corridor with three-bedded bays, long and narrow. Many of the patients were older and there had been a lot of Covid infections. My goal was simple: to reduce the falls in our ward. What I did I organised an entire ward awayday focusing on falls education, prevention, management of falls, and policies and procedures—everyone attended at the same time. This allowed the staff to discuss the way they worked ('work as done'). Back at the ward a Baywatch bay and a PHUDD scoring system was set up with the aim to reduce falls, particularly unwitnessed falls, by identifying if someone is high, medium or low risk of falling. The ward is a long corridor so one to two Baywatch bays are required. The PHUDD scoring system was used to identify those patients most at risk and to identify where they can go on the ward for the safest outcomes and if additional support is needed. It’s completed at least once daily for patients. On the PHUDD scoring system, 1 point was given to each question where the answer is yes. A point was added for any fall in the hospital. This was then used to decide which patient needed to be in the Baywatch bay. This score is on the handover and reviewed daily and at catch ups. Outcomes We have significantly reduced our falls—there has been 61.7% reduction in falls. There has been two long periods with no falls (one for a 48-day period and one for a 50-day period). Since the education day, we have had 1 or 2 falls a month rather than 5-11 falls every month. In the last 4 month we have had 6 falls instead of the potential 44. Staff are now educated on policies and procedure around the prevention of falls and the management of falls. Staff are proactive in the prevention of falls. Everyone knows that the Baywatch bay is the priority. And then everyone has their ends of the bay but we all cover each other. We have signs to say that’s it’s a Baywatch bay—for staff but also for relatives to say we can’t leave this bay. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed. Night staff feel empowered to move patients who were most at risk to higher observation beds as they are the staff group most affected by falls on the ward. Bay nursing introduced handovers conducted outside of the bays, which enhanced the communication as opposed to being in an area away from the patients. We have completed a falls After Action Review and were praised for our significant improvement in post falls management and documentation. Senior management across our Trust have asked to learn more about the falls reduction plan. Barriers faced I met barriers. Staff were not acting in the way I wanted so I met resistance. But I was very honest with them. Told them what the consequences were. Got the most resistant on board first and then everyone else was easier. At the beginning the staff were demotivated and didn’t feel part of a team. We need to keep our teams valued and motivated. It’s an ongoing commitment to staff. We are always looking at how we can improve and asking staff what their ideas are. I think the biggest thing I did was look at what was my one main priority. And that’s what we focused on—falls. Now we are moving to pressure ulcers. If you pick one big thing to work on it’s easier. Give it a big focus and then, once sorted, move on to the next thing rather than trying to do everything at once. Next steps Training and education is essential—this has continued regularly from the ward leadership team. I’d like to do some simple quantification—more cost effective, efficient. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed. We are now doing another nurse-led trial setting daily goals for patient mobility. We are very clear what the goals are, to increase mobilisation, and these goals are on the handover sheets for everyone to see. Further reading on the hub Yellow kits - an innovation to reduce the risk of falls in Accident and Emergency departments "The greatest part of this adventure has been the sharing of information." The Patient Safety Education Network one year on Implementing the aSSKINg pressure ulcer care bundle – a blog by Susan Martin Have you implemented a new initiative in your organisation? Have you improved patient safety where you work? We would love to hear from you and share on the hub your journey. If you are a member, you can share directly on the hub or please contact [email protected] to discuss further.- Posted
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The National Audit of Inpatient Falls (NAIF) is a continuous audit of all inpatients who have a fall that results in a femoral fracture. This report looks at clinical data on falls collected in 2023. Based on 1,609 cases, it states that falls prevention activity should not focus solely on older people’s wards, finding that nearly half of all inpatient femoral fractures (IFFs) occur on general medical wards. To address the potential for harm caused by hospital-acquired deconditioning, this report presents a new approach to risk factor assessment that focuses on promoting activity to ensure each patient is fit to move as safely as possible. This covers factors such as vision, medication review, delirium, mobility and continence, and provides information on the proportion of patients affected by each in 2023, compared to 2022 and 2021. It contains five key recommendations, four of which state that Trusts and health boards should: Review their policies and practice to ensure that older hospital inpatients are enabled to be as active as possible Ensure that there are robust governance processes in place to understand when post-fall checks fail to correctly identify a fall related injury’ Have processes in place to hasten time to administration of analgesia after an injurious fall Prepare for the audit expansion in January 2025. The fifth recommendation states that NHS England and the Welsh Government should implement national drivers to ensure that all older people are screened for delirium upon hospital admission and reviewed for changes suggestive of a new onset of delirium for the duration of their admission.- Posted
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Event
This webinar for UK healthcare professionals will be delivered by DISN UK Group committee members. It will focus on using diabetes technology–insulin pumps, CGM, POCT–in the hospital. We will discuss and outline the newest JBDS technology guideline and provide the attendees with most up to date information regarding using diabetes technology when a person with diabetes is admitted to hospital. Educational outcomes – 3 points: Recognise different types of diabetes technology Use of diabetes technology in the different scenarios in inpatient setting Effective support for people with diabetes and use of diabetes technology when admitted to hospital Register for the webinar- Posted
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Event
Ward accreditation for quality
Patient Safety Learning posted an event in Community Calendar
This conference focuses on developing systems and processes for locally driven ward and unit accreditation for quality. These approaches can be used as a tool to encouraging ownership of continuous quality improvement at ward, unit or service level, reduce variation and increase staff pride and team working within their practise. Through practical case studies of organisations that have successfully introduced locally driven ward and unit accreditation systems the conference will provide practical guide to implementing systems, and improving staff engagement in driving forwards improvement for the benefit of patients, service users and communities. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/ward-accreditation-for-quality-conference or email [email protected]. hub members receive a 20% discount. Email [email protected] for discount code. Follow this conference on Twitter @HCUK_Clare #wardaccreditation -
Community Post
People with diabetes' experience of care in hospitals
Patient-Safety-Learning posted a topic in Diabetes
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These comments were made by people with diabetes in response to a Twitter thread asking "Why is a hospital stay scary if you have diabetes?" If you have diabetes, or care for someone who does, please share your experience with us by adding a comment to this community thread, “I was in ICU after a car accident—none of the staff knew how to work my CGM and/or my insulin pump. I had to manage my own care” “For me it was when I went into hospital for surgery and the nurse said 'Type 1... so do you take insulin for that?'... that's not a reassuring thing to hear minutes before you're taken into the theatre!” “Lucky to get out alive.” “DKA 10 years ago, once back in normal range the consultant insisted I didn't need anymore insulin & refused to let me have any. Obvs within 3 hours I was back in DKA, he wouldn't come see me but had a convo with my husband on the ward phone where hubs explained how T1 works.” “I've been given a full day's bolus, through my iv and then told I was wrong when I said that I only bolused when I ate. Massive hypo followed quickly. I was then told it was my fault and I should have said something.” “After being admitted as an emergency, my own insulin ran out. I was given 2 (2!) of the wrong types of insulin and told that 'it would be okay'.” “They were often confused about T2 versus T1 - lots of emphasis about low fat foods and only being allowed a low fat yoghurt for puddings even though I was on a pump! I had a bag of snacks though as it was a planned hospital stay” “After a major medical issue I was denied insulin in the ICU for over 24 hours but was told I could have some pills to treat my type 1 diabetes” “Last time I went to the hospital, they took my pump (forcefully) and refused to give it back. When I protested, they sedated me. I was in and out of sedation having a panic attack bc I couldn’t breathe. They sedated me again and put me on DKA protocol, even tho I wasn’t in DKA.” “it’s so scary right like you know that you’re the expert on your condition and your needs but that power gets totally taken away” “Handing over your care over to a group of nurses who have no idea what they are doing. It’s super scary. I hate it when they lock it all away and you can’t get to it.” “I didn’t feel safe either. Told them on a few occasions I felt ‘low’. Finally Lucozade got wheeled out but it was almost an inconvenience” “Totally understand why they don’t know much about it if it’s not their specialism BUT some are so arrogant that what they were told one afternoon 10yrs ago is the absolutely way to deal with, and that the person living with it doesn’t know what they’re talking about!” Sarcastic responses “You seem to know a lot about it!” “The neurologist told me I am a terrible diabetic.” “I never feel safe because they don’t allow me to dose my own insulin and last time dropped me from 600 to 40 in three hours and then shot me back up so fast when i specifically told them that i would go low and high from that much insulin” Report of being diagnosed with type 1 diabetes while in hospital, despite telling every healthcare professional she had T1. “I smuggled in my own tester and meds and took care of myself.” “I think the biggest thing for me is them not understanding insulin dose when they’re writing up your chart and how you don’t really have a “typical” insulin dose that fits neatly into their charts because of carb counting or correction doses/reduction dose. It’s strange, when I’ve had DKA admissions and I’m on the sliding scale IV it’s fine because there’s clear guidelines but for just day to day injection management it’s soooo difficult.” "Daughter had food and insulin withheld in a mental hospital." “the ward nurses didn’t even know I had T1 until the more mobile lady opposite me went and fetched a nurse who had been ignoring my call button. I was hypo and couldn’t reach my treatment.” "Taken off insulin for two days as no doctor to prescribe." “Particularly bad experience when a nurse left the glucose drip on but turned off the insulin. It terrifies me to think how bad this could have been.”- Posted
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