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The Benchmarking Network is the in-house benchmarking service of the NHS. The Network is hosted by East London NHS Foundation Trust.

I started my career in a care of the elderly ward (geriatrics), which was exciting as my first job, and I felt that my time management needed to be worked on prior to me starting my career in what I knew at the time to be emergency nursing. I stayed in this area for a year, taking charge of the shift and also managing a bay of eight patients, which was the norm (or so I thought). After about 1 year, I thought about moving on, continuing to learn, and I started working in an intensive care unit (ICU). During my time in ICU, I made a drug error involving a controlled drug. Without going into too much detail, there was a lot of factors involved in this case and I was told I was going down the disciplinary route. This was a real low point for me and I felt like I really needed support, not only to come to terms with the error itself, but also support from a reflective side – what I can do, so this doesn’t happen again. I was a new band 5 nurse in the department with no previous ITU experience, with a new Band 6 and Band 7 leading the team which we were working with solidly. They chose not to suspend me, but keep me working without being able to complete medications. I continued to work as per rota, never taking a day off sick, etc. This continued for about 3 months unable to complete my job role to its full potential, and continuing the days and nights and the weekend shifts, along with personal issues of my own to contend with also. I thought at the time it was normal to feel like this post an error, but in hindsight, the support I received was not adequate. In fact, I would go as far as to say I didn’t get any support, other than the normal "are you okay" at the start of each shift. By the time the disciplinary happened, I was 'rock bottom', which is banded around a lot, but I didn’t see a way out, without my family and partner saying that I needed to get out, I don’t know what I would have done. Nevertheless, I left for new horizons, and changed my speciality. I went to A&E where I knew I wanted to be, with a great team, with great management and culture. However, one day I let them down. I completed a second drug error. This was involving an insulin/dextrose infusion for hyperkalaemia, which I mixed up for hyperglycaemia. This error rattled me again. I felt like I was going down that 'rabbit hole' yet again, becoming more and more anxious and needing extra support, more than ever. Fortunately, the patient was okay and was identified quickly. The error was serious and after talking to my manager, they suspended me from clinical duties whilst the investigation was occurring. This was absolutely devastating to me. I felt like I was just settled in my job, feeling more positive about my career that I love so much. Whilst the investigation was going on, I continued my non-clinical work, completing various tasks that would normally take an age to complete. This is where I fell in love with the non-clinical side of the department and continue to work in this area today. However, in contrast to the first incident, I was asked whether I was okay, but also followed up with regular 1:1 welfare meetings, and felt like my manager was actively supporting me. I also started a piece of work on preventing this incident happening again. I have now gone up the ladder in the same organisation, and continue to feel settled. However, this really put the importance of supporting people as one of the main priorities in my daily practice. It also put into context the real need for establishing and integrating a no blame culture and getting rid of the culture of fear. It is very easy to forget the mental health aspect. Patient safety is aimed at patients (quite rightly so), but I think somewhere in the mix, we forget about that individual who takes this home day in, day out. I understand that there is accountability and there is taking responsibility for your actions as per the Nursing & Midwifery Council (NMC) Code of Conduct. But I think we forget about humanity and the need for support and coming together when one of your team is 'down'. I can honestly say, without my team and my managers, I wouldn’t be the nurse I am today, and I am forever grateful. And those people who have done errors or know what this is like, maybe you’re going through this today; there is light at the end of the tunnel. I share my story with the upmost respect and apologies to the patients involved and also to my team!

The team talk about an app that is now used across all wards in the Trust to measure the physical and therapeutic observation of service users. They explain how this app is helping identify deteriorating patients much earlier on, as well as freeing up more time for direct patient care and providing more accurate results. Viewers will also learn how they can adopt what the team have done within their own organisation through the blueprint that has been created of this project. The GDE blueprints can be found on the FutureNHS platform. To register, email: gdeblueprints@nhsx.nhs.uk

Main findings: Many investigations were of poor quality and took too long to complete. There was a lack of leadership, focus and sufficient time spent in the Trust on carefully reporting and investigating deaths. There was a lack of family involvement in investigations after a death. Opportunities for the Trust to learn and improve were missed. Of the 1,454 deaths recorded at the Trust during this period, 722 were categorised as unexpected by the Trust. Of these 540 were reviewed and 272 unexpected deaths received a significant investigation.

Our recent observational study, published in the Health Informatics Journal, focussed on staff safety in the mental healthcare setting. We worked with a mental healthcare provider to extract and analyse incidents of adverse events. In one aspect of the work, we looked specifically at the incidents that were reported that had recorded a member of staff as a ‘victim’ of the adverse event. From the 1 September 2014 to the 31 March 2017, 19,693 members of staff were reported as victims across 10,119 adverse events. For context, this was the equivalent of around 25 incidents per week, but it is important to keep in mind that this was for both harmful and non-harmful incidents and near misses. The most common incident was ‘aggression by patient on staff or other’. We were interested in exploring whether nurse staffing levels affected adverse events on staff. To investigate this we made use of nurse staffing data for each inpatient area. We were able to obtain data that quantified the planned, the clinically required and the actual, staffing level of nurses. We found that, in many cases, registered nurse staffing affected staff safety. Where there were more registered nurses, there tended to be less adverse events on staff. We also found that, although there was also a relationship with unregistered nurses, staff harm was more resilient to understaffing of unregistered nurses. This leads us to hypothesise that the role of the registered nurse provides additional benefits to risk mitigation and that it’s not simply about head count but rather the type of skills and care provision that the healthcare team provides. However, it is important to note that these relationships were not consistent across all locations and all shifts. On the night shift, for example, we found that as the clinically required level of unregistered nurses decreased, the number of adverse events to staff increased. This suggested that where the perceived clinical demand was low, the risk to staff was highest. This has important implications. This implies that the perceived clinical demand for nursing staff doesn’t appropriately consider the risk of harm to staff, particularly during the night shift when the clinically required levels of unregistered nurses is insufficient to project staff from harm. The use of these data in this way is novel and as researchers, we are very excited about the promise of utilising routinely collected data to predict both patient harm and staff harm. We hope that this will provide significant opportunities to improve healthcare safety. In order to provide effective and sustained high levels of mental health care, we need to understand the challenges presented by the mental healthcare environment, and the need to staff these environments in such a way that keeps the workforce safe. We are doing a long term study to explore the environment and workforce retention in secondary and mental healthcare. You can find out more here.