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Found 139 results
  1. Content Article
    Findings: Most of these risk controls – 35 out of 42 – would be classified as ‘administrative’ by the HoC, and thus considered weak. The risk controls that fell into this ‘administrative’ category included training, standardising processes and procedures, and changing the design and organisation of care. Since other evidence shows these approaches can sometimes be very successful in healthcare, it is probably a mistake to automatically assume they are weak. Completely eliminating reliance on human behaviour is very difficult in the healthcare context and would introduc
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    The free, one-day, virtual conference will explore the themes and issues arising from the report recently published by the Authority, Safer care for all – solutions from professional regulation and beyond. It will be an opportunity to hear a range of views, debates and discussions about some of the issues in the report with the aim of moving towards solutions to support safer care for all. Safer care for all – solutions from professional regulation and beyond is the Authority’s contribution to the debate on some of the key patient and service user safety challenges within health and socia
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    Dr Sam Machen shares her thematic review template, which can be downloaded below.
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  8. News Article
    Patients are being excluded from life-saving eating disorder treatment as services are severely underfunded, experts have warned. Adult eating disorder services are so severely underfunded and understaffed that they are having to employ rationing measures and turn away patients, leading psychiatrist Dr Agnes Ayton told The Independent. In their research, Dr Ayton and 22 other psychiatrists found that in 2019-20, just 31% of eating disorder services accepted all patients, regardless of the level of illness. The researchers warned that the situation had become more serious followi
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    "I’d like to see health care make a significant effort to identify which processes are universally critical to the delivery of care and develop uniform standards — not just here in Massachusetts but across the country. That is why I think the Betsy Lehman Center and the Massachusetts Coalition for the Prevention of Medical Errors are so important. I wish every state had similar groups. A national coalition of these groups could join together and start doing this very important work." "I’m convinced we can drive unnecessary variation out of health care, but it will take leadership to help
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    Extravasation injuries occur when some intravenous drugs leak outside the vein into the surrounding tissue causing trauma. From 1 April 2010 until the 1 December 2021, NHS Resolution received 467 claims relating to extravasation injuries. This virtual forum featured a panel discussion with the following speakers: Andrew Barton, Chair of NIVAS and IV nurse consutlant (NIVAS and Frimley NHS Trust) Alison Macefield, Deputy Head of Midwifery (Royal Devon and Exeter NHS Foundation Trust) Jorge Leon-Villapalos, Consultant in Plastic Surgery and Burns (Chelsea & Westmins
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    The vision-based patient monitoring and management system described in this article has been deployed, or scheduled for deployment, in 18 Mental Health Trusts in NHS England (in April 2020). The system is not a replacement for nursing skills. Rather, it provides an enhancement to nursing practice. As with the adoption of any new technology into clinical workflows, it is important for practitioners to learn how to manage the cultural shift required to take advantage of a vision-based patient monitoring and management system. The engineering framework described in this article will help the
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    The COVID-19 pandemic has profoundly impacted nearly all countries’ health systems and diminished their capability to provide safe health care, specifically due to errors, harm and delays in diagnosis, treatment and care management. “Implications of the COVID-19 pandemic for patient safety: a rapid review” emphasises the high risk of avoidable harm to patients, health workers, and the general public, and exposes a range of safety gaps across all core components of health systems at all levels. The disruptive and transformative impacts of the pandemic have confirmed patient safety as a critical
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    Complaints from staff are not being heeded. Why is it that healthcare staff's opinions and pleas for their safety and the safety of patients do not matter? Here are just some examples of where safety has been compromised: Disposable gowns are being reused by keeping them in a room and then reusing after 3 days. There were no fit tests. Staff were informed by management that "one size fits all, no testers or kits available and no other trusts are doing it anyway". Only when the Health and Safety Executive (HSE) announced recently that fit tests were a legal requirement, then fi
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    A GP surgery that provides treatment to about 5,600 patients has been placed in special measures by a regulator. London Street Surgery, in Reading, Berkshire, was found to have "significant backlogs of test results and care-related tasks". The Care Quality Commission (CQC) found there was "poor identification of risks to patients" during an inspection in April. The surgery has been approached for comment. The regulator rated the surgery's safety and leadership as inadequate, and said it had insufficient processes to ensure services' safety and effectiveness. Repeat pre
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    How do we know we are safe? This is the Holy Grail that has led to many publications and much research. Authors such as Berwick, Dekker and Syed have written insightful and clear reports that detail that safety is about much more than mere compliance to rules, reporting of incidents and monitoring risk. Local context In my previous blog I shared Solent NHS Trust’s staff survey results, which show high confidence in our staff about safety, having a voice and speaking up. The organisation works hard to define how safe we are and uses a variety of measures for this. Inci
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