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Content Article
My experience of speaking up as a healthcare assistant in a care home
Anonymous posted an article in By health and care staff
A frank account from a healthcare assistant on the bullying she experienced after raising concerns at the care home she worked in. I was employed as a healthcare assistant in a care home, where I worked for about three months. During this time, I found out that patient safety and quality of care were undermined by healthcare assistants, and the management and the nurses did not seem to realise it. Examples included: Carers were given a box of gloves each and they were expected to use them for up to two weeks. When asked for more gloves, the manager would check the last time they took a box of gloves and would question what they had done with the last ones they collected. In order to save the gloves, carers used one pair of gloves to deliver personal care to three to five residents before changing them. They would take the rest of the gloves home and bring them back to work in the next shift. Genital care was totally neglected. Residents’ genitals were not cleaned. I spoke to a nurse in another unit about this and all she said was she thought it was being done. When carrying out personal care to one lady, I found dried faeces wrapped in her pubic hair which took me a good number of minutes to clean. When I finally finished doing it, the lady pointed at her private part and said to me “it can breathe now” and when I asked why, she said “because it has been washed”. Infection control. One of the problems was that there was never any soap in the bathrooms and places where there were wash hand basins. So, after personal care, especially after caring for residents who had opened their bowels, we could only wash our hands with clear water. Hand sanitiser dispensers were hanging empty with no sanitising gel, so no opportunity for either visitors or staff to sanitise their hands whilst in the care home. Healthcare assistants apparently had no clue about catheter care, even those working at the nursing unit where there were a few residents that had catheters. I never saw any of them doing catheter care and one day when I was doing it, my colleague was really frightened, held my hand back and said I was going to pull the catheter out. Most of the times when residents opened their bowels, carers would either clean it very shallowly, or they would only take out the soiled pads and replace them with clean ones without cleaning the area at all. As such, when you took over the shift, during the first checks you would think that a resident had opened bowels but find out that the pad was dry and clean at that moment, but the faeces on it and on their skin was dried up. Oral and nail care was another issue. Carers never did oral care, and those who bothered to document would say “resident denied oral care”. Some of the residents’ beds were not functioning, especially in the nursing unit where most of the residents were bed-ridden. This meant that healthcare assistant staff had to bend and strain their backs each time they were giving personal care, which would lead to backaches. After trying to share my concerns on the above issues with three nurses to no avail, I was only left with the choice of talking to the management. I wrote a letter of observation, accompanied by some recommendations. I ended my letter by letting the management know that I was ready to discuss my concerns with them at any time. They did not call me up for any discussion. A change in behaviour... A few days later I started noticing a change of behaviour from all staff towards me. Most of them did not talk to me, many times I found out that people were whispering things about me as when they saw me approaching them they would stop talking. One unit reported that I was very slow, and I was never assigned to work there anymore. People ignored me when I tried to join in a conversation. Each time I was working, nobody would let me do personal care. I was only allowed to work as an assistant to fellow healthcare assistants. In some rooms where I went in first and started doing personal care, they would tell me that I was taking too much time. My opinion on anything did not count. One day when I came to work, there was a small problem which needed to be fixed between one of the nurses and myself, but she refused to listen to me and insisted that I should go back home. I went home as she had asked, and the next day I called and told the manager that I was sent home last night. He started blaming me based on what the nurse had told him, which was not true, without listening to my own side of the story. I insisted that he should call a meeting where he could listen to both of us, because what the nurse had said was untrue. His response to me was that I would need a reference from him so I should be careful about the way I did things. However, he finally accepted and we agreed on a date for the meeting. But when it came to the day of the meeting, the nurse was not there. I explained myself to my manager, in the presence of the secretary. His response to the letter I wrote with my concerns in was that he appreciated it, but he thought that the care home was not the right place for me, and that he thought that I was too qualified for the job. He suggested that everybody felt threatened with my presence. I told him that that it sounded to me like he wanted to remove me from my job; a job which I very much wanted to do. When I came back for the next shift, I discovered that my shift had been cancelled and I had been replaced by someone else. I spoke to a senior carer who called my manager and he told me that he was not expecting me to come to work because of what had happened the other night. I went back home. The next day he called and told me that after due consideration, he had decided to extend my probation time to a further three months, and that I should compose myself, come to work and do only what I was expected to do. Psychologically tortured As I continued working, things got worse each day. I experienced colleagues laughing at me, talking about me, not talking to me, ignoring me; the list could go on and on. I was psychologically tortured. I developed a violent headache. Each time I thought I was going back to work I felt sick, got palpitations, felt so hot as if I had fever, at times shivering, with painful nerves. I kept asking myself whether I was wrong to have done what I did. I did a lot of self-counselling and told myself that I was going to stay at the workplace if I was not dismissed. This was because I was planning to write more letters. I had only highlighted a few of the many issues in my first letter. My hope was that one day someone was going to understand me and things would improve. One night I stopped a colleague from putting a pad on a resident she had not cleaned properly. I cleaned the resident and did vaginal and catheter care, before putting on the pad. There was another resident who was very wet, from their pyjamas to the bedding; my colleague wanted us to only change the pad and let the resident lay with the wet clothes on the wet bed “since they were going to wash her in the morning anyway”. This was the 1am check, and I argued that I could not imagine her being able to fall asleep in that condition. We ended up changing the resident’s pyjamas and putting a towel and an extra pad on the bed to make her feel comfortable. Forced into resigning My colleague became angry with me. I was surprised because I had done nothing wrong. There was altercation and she confronted me. I couldn’t tell anyone as no one would believe me. I felt excluded and alone and the only thing that came to my mind was that I should resign. When I finished work in the morning I went and told my manager that I was resigning. He told me that I was expected to give two weeks’ notice and that I should write my resignation letter that day, which I did. He told me it was rather unfortunate that it hadn’t worked out for me in the care home… Did I do the right thing? What would you do?- Posted
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In a dynamic healthcare environment, patient safety is crucial. A "Conscious Actions Reduce Errors" (C.A.R.E) approach is needed to safeguard safety and reduce medical errors. The dual process theory highlights two thinking modes: intuitive (fast, automatic) and analytical (slow, deliberate). Intuitive thinking, though quick and often effective, can lead to cognitive biases like anchoring and availability heuristics. A C.A.R.E approach incorporating tools like the TWED checklist (Threat, What if I'm wrong? What else?, Evidence, Dispositional factors) and Shisa Kanko (Japanese method of pointing and calling) can help to improve decision-making and action precision in clinical settings.- Posted
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Community Post
Better use of data for medication safety in hospitals
Kenny Fraser posted a topic in Medicine management
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NHS hospital staff spend countless hours capturing data in electronic prescribing and medicines administration systems. Yet that data remains difficult to access and use to support patient care. This is a tremendous opportunity to improve patient safety, drive efficiencies and save time for frontline staff. I have just published a post about this challenge and Triscribe's solution. I would love to hear any comments or feedback on the topic... How could we use this information better? What are hospitals already doing? Where are the gaps? Thanks- Posted
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- Interoperability
- Precision medicine
- Start-Up
- Safety assessment
- Safety behaviour
- Safety management
- Improved productivity
- Medication - related
- Patient identification
- Patient safety strategy
- Policies
- protocols and procedures
- User-centred design
- Workforce management
- Information sharing
- Staff engagement
- Training
- Time management
- Allergies
- Deep vein thrombosis
- Falls
- Parkinsons disease
- Substance / Drug abuse
- Urinary tract infections
- Antimicrobial resistance (AMR)
- Benchmarking
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Content Article
These new updated guidelines, produced in collaboration between the Healthcare Infection Society and The European Society of Clinical Microbiology and Infectious Diseases, used NICE-accredited methodology to provide further advice on which practices in the operating theatre are unnecessary. The guidelines are intended for an international audience. Specifically, they discuss the current available evidence for different rituals that are commonplace in the operating theatre and highlight the gaps in knowledge with recommendations for future research.- Posted
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In this article Steven Shorrock argues that understanding the complexities and nuances of human work is critical if we are to improve how work really works. In healthcare, as clinicians and other healthcare professionals navigate their roles, they encounter a diverse array of situations that create goal conflicts, dilemmas and other challenges. One way to explore these is via micro-narratives. These are short stories based on personal observations and experiences. One method to capture these is via simple written postcards. Postcards from Work (Healthcare Edition) delves into these experiences. A sample of the cards is shown within the article.- Posted
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I this article for the Institute for Health Improvement, Rachel Hock highlights some of the safety concerns and issues that can arise through discriminatory attitudes and stigma associated with weight.- Posted
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In a three-part series of blogs for the hub, Norman Macleod explores how systems behave and how the actions of humans and organisations increase risk. In part 1 of this blog series, Norman suggested that measuring safety is problematic because the inherent variability in any system is largely invisible. Unfortunately, what we call safety is largely a function of the risks arising from that variability. In this blog, Norman explores how error might offer a pointer to where we might look. Safety as risk propagation It is common in safety management to talk in terms of hazards. We can identify three classes of hazards: substances or objects that could cause loss or harm; engineered situations where humans engage in activity involving known hazards but under controlled conditions; acts by individuals that inadvertently expose the operation to a hazard (we might call these ‘errors’). Controls are put in place to contain hazards but controls are designed by humans and are fallible. Healthcare is an example of a hazardous condition: things are done to patients that would be illegal if inflicted upon a healthy person. Procedures act as controls in these situations but there is always a tension between work-as-imagined (WAI) and work-as-done (WAD). WAI describes the least-risky solution to a problem that will work in most circumstances (or, at least, those envisaged by the procedure designers), whereas WAD reflects the inherent flexibility needed in the real world. In a study of maritime accidents,[1] it was found that collisions have occurred between ships actively trying to follow the ‘rules of the road.’ Procedures contain affordance spaces, or lacunae, that must be filled by actors applying expertise. Procedures, or rules, form a hierarchy. At the top there are rules about goals: ‘first, do no harm.’ Then there are IF-THEN rules that aid decision-making: IF <symptom> THEN <condition>. The lowest order of rules are task prescriptions: step 1, step 2, step n. As we ascend the hierarchy, actors need more extensive training to cope with the lacunae that invariably exist. Many airlines use a process called the Line Operations Safety Audit (LOSA).[2] Trained observers monitor flight crew under normal flight conditions and log departures from procedures, crew responses and subsequent outcomes. In most cases, 95% of errors are inconsequential: error is very much noise in the system. LOSA can let us see what happens when crew attempt to fill in the gaps in procedures. The observer can tag an error as 'intentional’ (an INC) if certain criteria are met and figures of between 8.8% and 26.4% of INC errors have been seen. However, ‘Intentional’ errors are usually attempts to adapt to local circumstances or to solve problems. These departures from prescribed activity reflect system buffering. The outcome of an error can be categorised in LOSA as ‘inconsequential’, can trigger an additional error or results in an ‘Undesired Aircraft State’ (UAS) if the observer feels that safety has been jeopardised. In one study I looked at UASs arising from INCs versus non-intentional errors. INCs were twice as likely to result in a UAS. I then looked at who committed the error. For INCs, captains accounted for 91.66% of UASs compared with 40.6% when the error was non-intentional. The data suggests that agents actively choose courses of action that contravene procedures to maintain the flow of work but those decisions increase risk. Captains are over-represented in the data because they are the primary decision-makers in the team. Ironically, compliance with procedures is often the starting point for any safety investigation. However, rather than police ‘compliance’, organisations should probably find ways to capture variability and render it as knowledge. What error does To view error simply as failure, however, is to miss the fact that they change the work process in a way that needs to be addressed if safety is to be maintained. This can happen in one of three ways. First, they reduce performance margins. Even slight departures from the optimum aircraft configuration mean that, should a subsequent event occur, the crew have less flexibility to respond. In the flight data shown in the previous blog, an aircraft operating in the outer bands of the distribution is migrating towards the margins of the safe space. Something as commonplace as a change in windspeed or direction could result in a critical outcome. Second, error transfers risk when my action affects others. For example, passengers have been killed when aircraft have flown into turbulence. If a pilot delays or fails to turn on the seat belt sign in time the cabin crew and passengers are exposed to risk because they will not have taken steps to protect themselves (such as sitting down or fastening seat belts). Sometimes, and in contravention of procedures, pilots start the ‘after landing’ checklist early to save time. This usually results in pausing the checklist while air traffic control issues directions to the terminal building. LOSA shows that crew then often forget to finish the checklist and aircraft park with the weather radar still turned on, exposing the ground handlers to a radiation hazard. Finally, separation reduction describes the condition where aircraft are placed in closer proximity to hazardous objects (other aircraft, the ground) than was intended. Again, should something happen, the crew will have less time to react. Error, then, can reveal how the risk profile is shaped by the deliberate actions of crew. What goes on here? This examination of normal work suggests two candidate domains for measures of safety. First, what is the organisation’s understanding of the utility of its control structures (policies and procedures, codes of conduct)? How well-written and comprehensive are the structures? Where are the contradictions and ambiguities that flow from multiple stakeholders in the process of oversight? Second, what is the skills mix of those required to work within the system, recognising the need to cope with the variability inherent in the real world. Does the organisation have a competence model for the different functions in the system? What are the risks associated with substituting staff (bank staff, staff on loan)? Conclusion In this post I have looked how workplace variability shapes risk. I have suggested two key aspects of the structure of an organisation – control and competence – that could be candidates for measuring ‘safety’. In my final blog I want to explore how organisations actively design unsafety into their operations. References Belcher P. ‘A Sociological Interpretation of the COLREGS”. Journal of Navigation, 2002; 55(02): 213-224. Klinect JR, 1st Klinect JR. Line Operations Safety Audit: A Cockpit Observation Methodology for Monitoring Commercial Airline Safety Performance. Unpublished PhD thesis, 2005. University of Texas. Unpublished PhD thesis. University of Texas. Read part one and part three of Norman's blog series.- Posted
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Content Article
#Saynotobullyinginmidwifery
Patient_Safety_Learning posted an article in Maternity
*Trigger warning: This report contains accounts of bullying behaviours and consequences and may trigger those who have experiences of bullying. The Say No to Bullying in Midwifery report comprises hundreds of accounts, ranging from students, newly qualified and senior midwives, heads of midwifery, maternity support workers and more. It aims to publicise and share concerns they have raised online. In the numerous accounts shared all areas of the system from CQC, CEO, HR, midwifery management, universities and the unions are described as being complicit, inadequate, disinterested and even corrupt. Accounts also refer to: Unsafe work environments Exit interviews not being performed, recorded or acted upon Staff not being valued Whistle-blowers being demonised until they leave Health and safety issues and truly evidence-based practice ignored with no lessons learned. To order your copy, follow the link below. -
News Article
Tackle hidden racism in the NHS to improve staffing
Patient_Safety_Learning posted a news article in News
Racism is a significant issue affecting recruitment, retention, and patient care. With this in mind, the Royal College of Psychiatrists launched the Act Against Racism campaign, offering guidance and actions to combat racism in the workplace for better staff well-being and patient care, writes Adrian James In June, HSJ revealed that mental health trusts in England are among the biggest users of locum doctors in the NHS. With one in seven medical posts in mental health trusts vacant, many providers now rely on locum doctors to deliver essential services to patients. Read full story Source: HSJ, 9 August 2023- Posted
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The publication of a new single, shared improvement approach, ‘NHS Impact’, is an exciting milestone. It reflects recognition, at the highest level in the English NHS, that improvement principles need to be part of the mainstream approach to the challenges facing the sector. Penny Pereira, Q’s Managing Director, considers the new approach, its potential impact and what it means for members and others working to improve health and care in England and beyond.- Posted
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Content Article
NHS Impact resources
Patient Safety Learning posted an article in NHS England
NHS Impact ‘improving patient care together’ is the term NHS England is using for the new single, shared NHS improvement approach. This includes the five components which form the ‘DNA’ of all evidence-based improvement methods, which underpin a systematic approach to continuous improvement: Building a shared purpose and vision. Investing in people and culture. Developing leadership behaviours. Building improvement capability and capacity. Embedding improvement into management systems and processes. When these 5 components are consistently used, systems and organisations create the right conditions for continuous improvement and high performance, responding to today’s challenges, and delivering better care for patients and better outcomes for communities. Delivery and continuous improvement review Information about the delivery and continuous improvement review. Resources and materials Access improvement resources including good practice pathways and guidance documents. Real-time data Access real-time data to support improvement activities. Urgent and emergency care improvement These resources provide guidance and support to drive continuous improvement in urgent and emergency care services. Elective care improvement These resources provide guidance and support to drive continuous improvement in elective care improvement. Primary care improvement These resources provide guidance and support to drive continuous improvement in primary care improvement.- Posted
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News Article
Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found. Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill. A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS. Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said. “There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association. The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added. “In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said. Read full story Source: The Guardian, 28 December 2023- Posted
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untilDespite decades of attention to safety, the 2023 New England Journal of Medicine article titled "The Safety of Inpatient Health Care" ushers in a stark reminder that patients continue to experience unacceptably frequent, and often serious, harms while receiving care. This 2023 IHI Patient Safety Awareness Week free webinar features lead author and globally renown safety expert, Dr. David Bates, who will share perspective on the history of harm in health care, key findings, and insights from this recent publication, associated opportunities to improve identification and measurement of events, and methods for anticipating and preventing harm. Whether you’re a health care leader, safety or quality professional, direct care provider, or work in any setting or role in health care, you’ll leave this illuminating discussion with refreshed thinking about what’s essential for a radical reboot of safety and the role that you and your organizations can take to eliminate and prevent harm. Register- Posted
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Event
This one day masterclass will focus on how to use Behavioural Insights and Nudge Theory to look at patient safety and safety culture. Nudge-type interventions have the potential for changing behaviours. It will look at examples of Nudge Theory use in healthcare and external organisations and how we can use these to improve patient safety and also to reduce inefficiency and waste. It will look at the type of interventions suitable for nudges and how to develop them. Key learning objectives: Behavioural Insights. Nudge Theory. Use of nudge theory to improve patient safety. Developing nudges. Opportunities for Nudge-type interventions. For further information and to book your place visit ttps://www.healthcareconferencesuk.co.uk/conferences-masterclasses/improve-patient-safety-safety-culture or email [email protected]. hub members receive a 20% discount. Email [email protected] for discount code.- Posted
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This one-day masterclass will focus on how to use behavioural insights and nudge theory to look at patient safety and safety culture. "Nudge Theory is based upon the idea that by shaping the environment, also known as the choice architecture, one can influence the likelihood that one option is chosen over another by individuals. A key factor of Nudge Theory is the ability for an individual to maintain freedom of choice and to feel in control of the decisions they make. " Nudge-type interventions have the potential for changing behaviours. We will look at examples of nudge theory use in healthcare and external organisations and how we can use these to improve patient safety and also to reduce inefficiency and waste. We will look at the type of interventions suitable for nudges and how to develop them. Key learning objectives: Behavioural insights. Nudge theory. Use of nudge theory to improve patient safety. Developing nudges. Opportunities for nudge-type interventions. Facilitated by Perbinder Grewal. Register hub members receive a 20% discount. Email [email protected] for a discount code.- Posted
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This one day masterclass is part of a series of masterclasses focusing on how to use Human Factors in your workplace. Leadership in the NHS is the responsibility of all staff. Understanding human factors will allow healthcare to enhance performance, culture and organisation. These masterclasses have been re-designed in line with the new Patient Safety Syllabus. It will look at why things go wrong and how to implement change to prevent it from happening again or mitigate the risks. This masterclass will focus on risk and behaviour to improve patient safety. Key learning objectives: Evaluating risk Using mapping techniques Safety interventions Behaviour Assessing safety culture Register- Posted
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This one day masterclass will focus on improving Patient Safety through enhancing psychological safety and safety culture. It looks at effective ways to encourage health professionals to routinely embed high-quality clinical evidence into their everyday work. We will explore the characteristics of relatively successful behaviour change interventions. All Clinical Staff and Team Leads should attend. Key learning objectives: psychological safety safety culture behaviour human factors how to improve safety reporting. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/improving-psychological-safety-patient-safety or email [email protected] hub members receive a 20% discount. Email [email protected] for discount code- Posted
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untilMaking Families Count has developed a new Webinar, based on extensive experience of it's members, to explore how mental health professionals can work effectively with families when they raise safety concerns about their relatives. This webinar focusses on effective risk management in the community and how healthcare professionals can work better with families when they raise safety concerns about their relatives. This webinar explores what happens when critical information is absent from treatment plans and how to utilise families effectively as part of the care team. It will also address issues of how to work well and effectively with families after a serious incident or mental health homicide. Use this link to find out who is speaking and to book your place for this online event: https://www.makingfamiliescount.org.uk/what-we-do/webinars/#managing-risk- Posted
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Elizabeth Dixon death inquiry 'exposes 20-year cover-up' of mistakes
Patient Safety Learning posted a news article in News
The death of a premature baby in 2001 led to a "20-year cover-up" of mistakes by health workers, an independent inquiry has found. Elizabeth Dixon, from Hampshire, died due to a blocked breathing tube shortly before her first birthday. The government, which ordered the inquiry in 2017, said the mistakes in her care were "shocking and harrowing". The inquiry report by Dr Bill Kirkup said some of those involved had been "persistently dishonest". Elizabeth, known as Lizzie, died from asphyxiation after suffering a blockage in her tracheostomy tube while under the care of a private nursing agency at home. Dr Bill Kirkup, who was appointed by the government to review the case, said her "profound disability and death could have been avoided". He said: "There were failures of care by every organisation that looked after her, none of which was admitted at the time, nor properly investigated then or later." "Instead, a cover-up began on the day that she died, propped up by denial and deception." Read full story Source: BBC News, 26 November 2020 Patient Safety Learning's statement on the Dixon Inquiry report- Posted
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Cluster of never events has sparked ‘great deal of soul searching’ says trust CEO
Patient Safety Learning posted a news article in News
An acute trust’s record of eight never events in the last six months has raised concerns that quality standards have slipped since it was taken out of special measures. The never events occurred at Royal Cornwall Hospitals Trust. They included three wrong site surgeries within the same speciality and an extremely rare incident in which a 30cm (15 inch) wire was left in a cardiology patient. Kate Shields, chief executive of the trust, said the incidents have led to a “great deal of soul searching”. Prior to the incidents the trust had gone 13 months without recording a never event, and Ms Shield acknowledged that pressure created by the pandemic was likely to have been a contributing factor behind the cluster of never events. She stressed that none of the patients affected had suffered physical harm. Read full story (paywalled) Source: HSJ, 12 November 2020- Posted
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A hospital that was at the centre of a major inquiry into unsafe maternity care five years ago is facing new questions over its safety after bosses admitted a baby boy would have survived if not for mistakes by hospital staff. Jenny Feasey, from Heysham in Lancashire, is still coming to terms with the loss of her son Toby who was stillborn at the Royal Lancaster Infirmary, part of the University Hospitals of Morecambe Bay Foundation Trust in January 2017 after a series of mistakes by staff who did not act on signs she had pre-eclampsia. Jenny, 33, has backed The Independent’s campaign for improved maternity safety and called on midwives to learn lessons after what happened to her family. She added: “This was an easily avoidable situation. They just didn’t piece it together, all they had to do was carry out a test and I lost my son because of it." Read full story Source: The Independent, 25 October 2020- Posted
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In this reflection, published in the BMJ's Post Graduate Medical Journal, Dr John Launer talks about an exercise to help people to become better supervisors, to use peer supervision as a safe space for people to develop better interactional skills generally – and particularly to cultivate their curiosity.- Posted
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The Serenity Integrated Mentoring (SIM) model is described as "an innovative mental health workforce transformation model that brings together the police and community mental health services, in order to better support 'high intensity users' of Section 136 of the Mental Health Act (MHA) and public services." The SIM model is part of a 'High Intensity Network' (HIN) approach, which is now live in all south London boroughs. In this hub post, Steve Turner highlights the benefits and risks of this approach and seek your views on it. Background In 2018, SIM was selected for national scaling and spread across the Academic Health Science Networks (AHSNs). The High Intensity Network (HIN) has been working with the three south London Secondary Mental Health Trusts: The South London and Maudsley NHS Foundation Trust, Oxleas NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust, and the Metropolitan Police, London Ambulance Service, A&E, CCG commissioners, and the innovator and Network Director of the High Intensity Network. The model can be summarised as: A more integrated, informed, calm approach in the way we respond to individuals that have unique needs during a crisis and A better form of multi-skilled, personalised support after the crisis event is over. So in July 2013 the Serenity Integrated Mentoring (SIM) model of care was proposed. This is how it works: SIM brings together all the key urgent care agencies involved in responding to high-intensity crisis service users around the table, once a month. This multi-agency panel selects each individual based on demand/risk data and professional referrals. They use a national 5-point assessment process to ensure that the right clients are chosen and in a way where we can ensure a delicate balance between their rights as an individual but our need to safeguard. Selected individuals are then allocated to a SIM intervention team. The SIM team is led principally by a mental health professional (who leads clinically) and a police officer (who leads on behaviour, community safety, risk and impact). The team supports each patient, to better understand their crises and to identify healthier and safer ways to cope. In the most intensive, harmful or impactive cases, the team also does everything it can to prevent the need for criminal justice intervention. Together, the mental health clinician, the police officer and the service user together create a safer crisis plan that 999 responders can find and use 24 hours day. The crisis plan is then disseminated across the emergency services. The SIM team reinforces these plans by training, briefing and advising front line responders in how to use the plans and how to make confident, consistent, higher quality decisions. What are the benefits and risks of this approach? Benefits: It is claimed that this is a more integrated, calm and informed approach to responding to individuals in crisis and the HIN provides "better multi-skilled, personalised support after a crisis event was over". The HIN website states: "Across the UK, emergency and healthcare services respond every minute to people in mental health crisis and calls of this nature are increasing each year. But did you know that as much as 70% of this demand is caused by a small number of ‘high-intensity users’ who struggle with complex trauma and behavioural disorders? These disorders often expose the patient to higher levels of risk and harm and can simultaneously cause intensive demand on police, ambulance, A&E departments, and mental health crisis teams." Risks: This approach has been subject to strong criticism from some users of mental health services, mental health clinicians and mental health support organisations. Concerns have been raised about whether the HIN/SIM approach is safe, effective or appropriate. I believe we need an open and inclusive discussion about High Intensity Networks, with users of mental services leading the debate. As a former mental health nurse in an Assertive Outreach team I'm keen to learn: How users of services were involved in the initial development of the model? What are the similarities and differences between High Intensity Networks and an Assertive Outreach model? How this approach compares with approaches in other countries? How users of services are involved in evaluating and adapting the model? What the specific benefits are for users of services and are there any risks to this approach? Does this lead to a long term improvements for users of services? I hope people will feel able to contribute openly to this discussion, so we can learn together. #HighIntensityNetwork #mentalhealth- Posted
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News Article
Private hospital threatens nurses refusing to treat COVID-19 patients
Patient Safety Learning posted a news article in News
Nurses at a hospital run by a major private healthcare provider have been threatened with disciplinary action after apparently refusing to treat coronavirus patients, according to a leaked email seen by HSJ. The email was sent on Sunday by a senior matron at Nuffield Health’s Cheltenham Hospital, which has been made available to the NHS during the COVID-19 outbreak. She said: “I’m hoping to get another undisturbed day as I’m going to have to formally take on everyone who won’t help on the C19 side." “Unfortunately, it will be a disciplinary matter and referral to the [Nursing and Midwifery Council]. I really don’t want to go down that route but they’re giving me little choice.” It is not clear why staff had refused to help with COVID-19 work, but one staff member who spoke with HSJ said nurses had objected to working without personal protective equipment. A spokesman for Nuffield Health said: “We can categorically state that we have been provided with a full supply of PPE from the local NHS trust so that all members of the team are protected when they treat COVID-19 patients. The team has also been given the appropriate training to ensure they can carry out their roles safely.” Read full story Source: HSJ, 14 April 2020- Posted
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News Article
Inside an ICU: how long can we stay calm in the face of the coronavirus crisis?
Patient Safety Learning posted a news article in News
Matt Morgan, an intensive care doctor, describes in this Guardian article how his ICU are preparing for the coronavirus crisis. "ICUs are as prepared as they can be. Locally business as usual has made way for preparations for caring for high numbers of patients. We are finding every ventilator we may have and identifying every suitably qualified member of staff. We will work together to fill gaps as best we can. There’s a sense of anticipation about what the next eight, 10, 12 weeks are going to bring in terms of work. Anyone who works in healthcare is also a mum, dad, daughter, brother, son. We want to give everything to saving lives and work and care, but equally we’re thinking about the logistics of personal lives and elderly relatives too." Matt says his worst nightmare is having insufficient workforce and equipment to meet patient needs. Whether or not that will come to fruition is tough to predict. He also says that his ICU has a psychologist who’s doing a huge amount of thinking about putting in place wellbeing resources for staff who might be in moral distress after having to prioritise one patient over another. "If there are 500 patients and only 200 ventilators then that’s when we need national guidance from the government and other bodies. It can’t be up to individual doctors. The age of playing God is long behind us. The question is who should we be making decisions with: the public, government or within the profession?" Read full story Source: The Guardian, 13 March 2020- Posted
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