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Found 59 results
  1. Community Post
    Hello I would be interested in hearing from anyone who has done any work on how we monitor patient deterioration overnight? I am currently working on am improvement project looking at patient surveillance of deterioration during night shifts. I have chosen this project as part of a Clinical Improvement Scholarship Program I am on. The program is combined with my day job as a Critical Care Outreach Sister as well as enabling me to develop my research and leadership skills alongside implementing improvements in clinical care. I am in the early stages of my work, however I have some literature and local research around deficiencies in how we monitor patients for deterioration overnight (as well as personal experiences as a CCOT nurse) which is why this topic is so important to me. I would be interested in hearing from anyone who has worked on anything similar, or can point me in the direction of anyone who maybe able to help. Thank you 🙂
  2. Content Article
    Patient Safety Learning works with experts on guidance around ventilator safety As part of the Government’s fast track approach to the development of ventilators, the Medicines & Healthcare products Regulatory Agency (MHRA) issued guidance for clinical requirements based on ‘minimally acceptable’ performance. [2] Patient Safety Learning approached a range of human factors/ergonomics experts, asking for their input on the procurement of these new ventilators due to the involvement of new manufacturers, flexing of established guidelines and ‘safety in use’ issues. We asked them what they believed the key issues were in ensuring that these ventilators are safe in use. Experts did express concerns, identifying several risks: By moving at speed and developing non-standard ventilators (with some manufacturers with no prior experience in this area), we may unintentionally be designing a system than has numerous points of failure, increasing risk for patients. How ventilators can be used safely, particularly for staff redeployed in the pandemic who may be inexperienced or untrained in using them. How safe will ventilators be to operate for staff wearing full Personal Protective Equipment (PPE)? Should patients die as a result of safety problems with ventilators, their deaths may not be identified as such, instead being attributed to Covid-19. There are already known safety issues relating to the use of ventilators. For example, there are currently multiple designs of machines used by the NHS, with different training requirements for different devices. We worked with this expert group, who provided detailed advice and guidance to address these risks. Patient Safety Learning then immediately developed proposals for urgent action to ensure that ventilators are safe for use with patients. We called for the healthcare system to work at a pace, together with manufacturers and experts in human factors/ergonomics, in order to minimise the usability safety risks. With our proposals, we provided details of what is required to ensure ventilator safety in use. Experts called for the MPV (Minimum Viable Product) specification to be revised to reflect ‘safety in use’ requirements with an immediate design, development and test sprint approach with human engineering user trials, task analysis and hazard analysis. NHS and Chartered Institute of Ergonomics and Human Factors (CIEHF) work quickly to design new guidance So, what happened next? Initially there was a swift response. NHS England and NHS Improvement asked the CIEHF to provide designers and manufacturers with guidance aiding the rapid production of new ventilators. CIEHF subsequently designed guidance, sending it to NHS England within 48 hours. The guide, Human Factors in the Design and Operation of Ventilators for Covid-19, was then to be sent to manufacturers of ventilators in the UK.[3] Soon after CIEHF also developed a ‘rapid and easy to use’ testing protocol to assist manufacturers with testing. CIEHF have developed overarching advice and guidance and testing protocol. To support this, a detailed set of user requirements has been developed by Dr Sue Whalley Lloyd and Karen Priestly. They have worked with, and adapted, Yorkshire Water’s general human factors guidance and have produced a detailed Engineering Specification: Ventilator HF Design guidance. We need to address the risk to patient safety We’ve seen an enormous amount of activity these past few weeks towards the design and production of new ventilators; something that would usually take months or even years. However, there are still serious concerns about the process to date and outstanding safety issues. It’s vital that we meet the urgent need for additional ventilators in the UK, however it cannot be at the cost of patient safety. Concerns about the Government’s response The Government has come under increasing pressure in recent weeks over its handling of this issue. This has been, in part, because it decided not to order ventilators through the EU’s procurement scheme. This has resulted in a more urgent need for scaling up production within the UK.[4] There have also been questions raised around the number of ventilators required. Initial estimates of 30,000 have since been cut down by more than a third to 18,000. [5] [6] [7] Efforts to engage more UK manufacturers in the production of new ventilators have also proved to be complicated, with only one new model to date, Penlon’s ESO2 device, receiving approval from the MHRA.[8] While this covers a provisional order for 5,000 ventilators, there are a significant number of other applications still waiting the regulatory clearance that will be needed to meet the revised 18,000 target. Meanwhile, another provisional order has been forced to withdraw, as a model from the Renault and Red Bull Formula 1 teams was found to not be suitable for treating patients with Covid-19. [9] “Don’t bother, you’re wasting your time” There has been increasing clinical concern about the Government’s decision to move away from standard specification and known manufacturers. Some of these concerns have related to the minimum specification for the ventilator programme set out by the MHRA, suggesting that it will not lead to the production of machines that are suitable for treating Covid-19 patients. Dr Alison Pittard, Dean of the Faculty of Intensive Care Medicine, has raised concerns about the minimum specifications.[10] The MHRA guidance states that “it is proposed these ventilators would be for short-term stabilisation for a few hours”.[11] Dr Pittard has said that the group of medical professionals that advised the Government on this in March suggested that these machines should be capable of working for the a patient’s full time in intensive care.[12] She noted that: “If we had been told that that was the case, that the ventilators were only to treat a patient for a few hours, we’d have said: “don’t bother, you’re wasting your time. That’s of no use whatsoever.”[13] Compounding this issue, the standards that currently exist in this area are not formal regulatory requirements. The MHRA state that: “They are not formal regulatory requirements, but many are harmonised against regulatory requirements. Consider them as helpful advisory standards for now. MHRA will lead an exercise to define which can be ‘safely’ relaxed for this emergency situation.”[14] This is not simply a technical issue. If we can’t ensure ventilators are being produced to the right standards, to deliver the right care and to be used safely, then it will inevitably result in errors and could ultimately cost lives. Critical safety questions for the Government Considering these concerns, Patient Safety Learning believes that it is vital that the Government responds to the following critical ventilator safety questions: Safety standards Are the standards for ventilators issued to manufacturers fit for purpose? Are MHRA ensuring that these standards are being applied? These standards are not currently formal regulatory requirements. Should they be? Utilising expertise Has the expert guidance on ventilator safety in use, developed by CIEHF and others, been issued to manufacturers by NHS England and NHS Improvement or the MHRA? If yes, are manufacturers required to apply this guidance? Is it advisory or is it mandatory? Are manufacturers who comply with the guidance and usability protocols given an advantage in the procurement process? Are regulators signing off new ventilators against this guidance? Delivery, communication and timescales Currently only one of the manufacturers of new ventilators has received approval. What is the timescale for delivery of the new ventilators and how does this match estimated demand? How are the NHS and MHRA communicating with patients, staff and the public to assure them that the new ventilators will be safe in use? Monitoring performance How will ventilator ‘safety in use’ be monitored and reported on? Are NHS providers and clinicians being asked to strengthen their incident reporting, particularly where manufacturers have developed novel approaches? References Gov.uk, Call for business to help make NHS ventilators, Last Accessed 15 April 2020. Medicines & Healthcare products Regulatory Agency, Rapidly Manufactured Ventilator System, 10 April 2020. Chartered Institute of Ergonomics & Human Factors, Human Factors in the Design and Operation of Ventilators for Covid-19, Last Accessed 1 April 2020. The Guardian, UK missed three chances to join EU scheme to bulk-buy PPE, 13 April 2020. The Guardian, How the UK plans to source 30,000 ventilators for the NHS, 26 March 2020. The Guardian, How close is the NHS to getting the 18,000 ventilators it needs? 14 April 2020. Health Service Journal, NHS needs a third fewer ventilators than forecast, says Hancock, 5 April 2020. Gov.uk, Regulator approves first Ventilator Challenge device, 16 April 2020. The Guardian, UK scraps plans to buy thousands of ventilators from Formula One group, 14 April 2020. Financial Times, Ventilator standards set out for UK makers ‘of no use’ to Covid patients, 15 April 2020. Medicines & Healthcare products Regulatory Agency, Rapidly Manufactured Ventilator System, 10 April 2020. Financial Times, Ventilator standards set out for UK makers ‘of no use’ to Covid patients, 15 April 2020. Ibid. Medicines & Healthcare products Regulatory Agency, Rapidly Manufactured CPAP System (RMCPAPS), 29 March 2020.
  3. Content Article
    What are human factors/ergonomics? How does this relate to healthcare? The study of human factors/ergonomics considers both the physical and mental characteristics of people, as well as wider organisational factors. It applies scientific methods to the design and evaluation of jobs, equipment, environments and systems to make them more compatible with the needs, capabilities and limits of people.[3] How does this relate to the production of ventilators for use in healthcare? It’s important when designing and developing these machines to ensure their usability – that we account for the people who are using them. That means making sure they are as intuitive and easy to use for frontline staff as possible, reducing the potential for error. This is especially pertinent in the current crisis, where doctors and nurses who are not necessarily experts in the use ventilators will be deployed to operate these while working under considerable pressure. Ensuring that safety considerations are taken on board during the development and design of ventilators can help to reduce errors and ultimately save lives. Procurement of new ventilators Manufacturers are being actively encouraged by the Government to design and deliver the extra ventilators required to meet the increasing demand as a result of the coronavirus. To meet the scale of the challenge this includes not just established manufacturers of these products, but also companies who haven’t previously produced these machines. Understandably priority is being given to the fast delivery of additional ventilators. The Department of Health and Social Care has been 'weighing up whether manufacturers could come up with new designs, issuing specifications for a “minimally acceptable” rapidly manufactured ventilator system’.[4] The importance of patient safety in design and development The human factors/ergonomics experts that we have spoken to have noted that there will be risks to patient safety which are linked with the need to manufacture new ventilators as quickly as possible. There are already some existing patient safety issues that relate to the ease of use of ventilators, due to multiple designs of these machines being in use within the NHS, with different training requirements for different devices. It is important that when putting in place minimum standards to speed up production that we don’t create additional risks to patient safety. It is also important to account for people who will be using these machines. Particularly those who may be inexperienced or untrained in the use of ventilators, meaning that ease of use is a crucial consideration when developing these. Another factor is how well you are able to operate these machines while wearing full personal protective equipment (PPE) when treating coronavirus patients. There is a risk that by moving at speed and developing non-standard ventilators to reduced standards (some produced by manufacturers who don’t have prior experience in this area) that we may unintentionally be designing a system than has numerous points of failure, increasing risk for patients. Should ventilators fail to be safe in use, we may not even realise this, as patients who are already seriously unwell with coronavirus may have deaths as a result of these failures attributed to the virus itself. The need is great, and the timescale is short Due to the time constraints and urgency to produce new ventilators, a full human factors/ergonomics development and usability testing process is not possible. However, we are connecting with experts working in this area who are committed to collaborate to make these new ventilators as safe as possible. Human factors/ergonomics experts fundamentally want to ensure any product, particularly with relation to the safety, are usable and account for human error. How we can ensure ventilator safety? It is important that these ventilators are developed with the principle the residual risk is reduced as far as reasonably practicable. It’s important that we build existing knowledge to bring in committed recognised experts and fast track the development of safe ventilators. Action is needed now. In the last 48 hours the human factors/ergonomics experts we have engaged have identified requirements and proposed actions: 1. Sharing current knowledge and expertise: Sharing usability testing from current manufacturers for the user interface/use specifications for already approved ventilators. 2. Contributing to this fast development of ventilators with specialist human factor/ergonomics and clinical input including: Safety in use is included in specification and procurement. Current knowledge of best practice and risk informs ventilator design and use. Ventilators can be used safely by staff. Patient needs are included in the design brief. Their proposals include: Developing a set of user requirements. Human engineering and user trials with hazard identification. Human factors requirements must be included in procurement. The healthcare system, working together with manufacturers and experts in human factors/ergonomics, can ensure that we not only deliver the ventilators needed to tackle the coronavirus pandemic, but that we do so while ensuring patient safety. We call for everyone working at pace to deliver these ventilators to call on the knowledge and expertise of human factors/ergonomists to minimise the usability safety risks. References 1. Gov.uk. Call for businesses to help make NHS ventilators. Last Accessed 30 March 2020. https://www.gov.uk/government/news/production-and-supply-of-ventilators-and-ventilator-components 2. Financial Times. UK steps up efforts to supply tens of thousands of ventilators. 30 March 2020. https://www.ft.com/content/8eca845b-56c8-4724-bd77-d7d83c005bfb 3. Clinical Human Factors Group. What are clinical human factors? Last Accessed 30 March 2020. https://chfg.org/what-are-clinical-human-factors/ 4. The Guardian. Government chooses design of ventilators that UK urgently needs. 23 March 2020. https://www.theguardian.com/business/2020/mar/23/carmakers-make-nhs-ventilators-coronavirus-uk-government-nissan-rolls-royce
  4. Content Article
    These guidelines by the Association of Anaesthetists are a concise document designed to help peri-operative physicians and allied health professionals provide multidisciplinary, peri-operative care for people with dementia and mild cognitive impairment. They include information on: involving carers and relatives in all stages of the peri-operative process administering anaesthesia with the aim of minimising peri-operative cognitive changes training in the assessment and treatment of pain in people with cognitive impairment.
  5. News Article
    An advanced nurse practitioner working in primary care services at Grimsby Hospital has called on the hospital senior leadership to ‘see for themselves how unsafe it is’. The nurse, who has penned a letter to bosses at Northern Lincolnshire and Goole NHS Foundation Trust says they are having “worst experience to date” in their career and fears somebody will die unnecessarily unless something is urgently done. “I have never in my whole career seen patients hanging off trolleys, vomiting down corridors, having ECGs down corridors, patients desperate for the toilet, desperate for a drink. Basic human care is not being given safely or adequately," says the nurse. Hospital bosses say they are taking the letter seriously and are investigating. Earlier this month it was revealed that some hospitals were being forced to deploy ‘corridor nurses’ in a bid to maintain patient safety while dealing with unprecedented demand. Dr Peter Reading, Chief Executive, said: “I can confirm we have received this email and that the hospital and North East Lincolnshire CCG are taking these concerns seriously. The person who raised the concerns with us has been contacted and informed that we are jointly investigating what they have told us. Read full story Source: Nursing Notes, 22 January 2020
  6. Content Article
    This course, is for all members of the multidisciplinary team who provide airway support to patients, or care for patients with a compromised airway. This includes anaesthetists, anaesthesia associates, operating department practitioners, nurses, physiotherapists, adult and paediatric intensivists, prehospital and emergency medicine physicians, paramedics, head and neck surgeons and members of the cardiac arrest team. By the end of the course, you'll be able to: improve your strategies to deal with the unexpected difficult airway and explore guidelines to use in special circumstances. identify the key learning points and recommendations from the 4th National Audit Project (NAP4) on major complications of airway management in the UK. apply the principles of multidisciplinary planning, communication and teamwork in shared airways interventions. describe the technical and non-technical aspects of safe airway management for patients undergoing elective or emergency surgery, and the critically ill. engage in a global discussion on airway matters with health professionals from around the world.
  7. Content Article
    The survey measures: workload communication teamwork safety systems learning leadership. The SCS for dental practice teams opened on Thursday 1 August 2019 and will close on Tuesday 31st March 2020.
  8. Content Article
    The WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results, improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals – especially for nurses.
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