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Found 9 results
  1. Community Post
    Some years ago I stopped writing for journals, in favour of blogging & volgging. My reasons were: I specialise in patient involvement and inclusion, so I want the work of me and my colleagues to be easily found by everyone We didn't want our work to end up behind a paywall We work across disciplines and try to bypass hierarchies, especially in promoting action learning and patient led care I can see there are some really good Open Access Journals around. So my question for us all is: Which are the best Open Access Journals? Here a link to my digital profile: https://linktr.ee/stevemedgov This is our developing model of working, a away of working in healthcare that all use and participate in:
  2. Content Article
    Background From 2008 to 2014 my company ran education sessions on managing medicines in a mental health trust. In common with some other mental health trusts, the provider also looked after paediatric community services. This is not a mental health service. It covers children with complex health needs including enteral feeding tubes, ventilation, epilepsy and rapidly changing medicines. Children under the care of this service may be taking in excess of 15 different medicines per day, have complex titration regimes, emergency drugs with associated care plans, plus numerous ‘as required’ (prn) medicines. It is not unusual for children with complex conditions to be under the care of up to five different providers, and to move between three different providers in one day. For example, from a home care service to the special school, to respite care, maybe also being seen in an outpatient clinic on the same day too. As a result, parents frequently have to repeat the information on their child’s medicines every time they move to another service, or a new person is involved. Understanding the safety issues The idea for change came about because of concerns that the staff in children’s respite care were not learning what they needed about children’s medicines, as the learning was geared to the majority of staff who worked in mental health. So a new learning package for children’s staff was commissioned. Part of the work to design the learning package included a baseline assessment which was conducted with parents and staff. This soon revealed that training alone was not the answer. It showed delays in medicines information reaching GPs, workarounds for obtaining information in order to administer medicines in the houses and a general lack of confidence in the whole process. The status quo was risky and disliked by many As a result we looked at the whole system starting with the area where most concerns had been raised, which was having an up to date complete list of a child’s medicines available at all times (medicines reconciliation). The system in place for respite care involved paying a local GP (not usually from the child’s GP Practice) to write up a medicines chart for each child. The process was fraught with difficulties and delays and widely disliked by everyone directly involved. So we set about looking for a new way to manage the lists of medicines with more training and more input for the staff in the services involved. We came up with a new (and much more robust) process for medicines reconciliation in the respite care. This was fully documented in a new policy, and involved cross checking by both the staff and the parents. The “My Medicines” chart Just before this went live, we asked the parents to review and comment on it and they said ‘If you’re producing an accurate and up-to-date list of my child’s medicines, why keep it in the respite care, can’t it go with my child?’ So the "My Medicines" chart, which travels with the child, was born. The "My Medicines" process led to the design and production of a new chart which has to be signed and checked by the parents. It resulted in 40 children with complex conditions being offered a hand held paper record of their medicines (produced and validated by clinicians), which they take around with them wherever they go. Benefits and reduction of risk The new process, which continues to evolve, means that: the child’s GP is now directly involved in day-to-day medicines reconciliation (they weren’t before) the parents are always asked to check and sign the charts (they weren’t before) verbal messages about medicines are never taken incomplete (or missing) directions are rapidly rectified (never worked around). Further specific benefits of the new process include: It has reduced the risks of error, by providing full and accurate information on children’s medicine across their entire pathway. It cuts out the need for parents to keep having to repeat what medicines their child is taking to different professionals and care agencies. It frees up medical and clinical time which was previously spent chasing missing information. It has reduced the number of third part handovers and transcribing of prescription information. Looking back it’s hard to believe that the old ways of working, which caused so many difficulties (especially for frontline staff), were carried out for so long. These risky practices, or similar, are believed to still be commonplace in England. Revealing hidden incidents and near misses In evaluation phase of the project we raised 17 medicines near misses. Of these, 11 related to problems with communication of information across the child’s pathway. Resolving these has resulted in improved communication and engagement between different clinical groups and providers, and a desire from all quarters to take the project further. Previously many of these incidents were not logged or tracked across organisations. In some cases, it was only due to the vigilance of the staff and parents that they were spotted and errors avoided. Embedding change The project was well received by parents and staff and resulted in improved communication and engagement between different clinical groups and providers. This included the Consultant Paediatricians (working for the secondary care provider), who were initially sceptical. The project was less well received by the relevant medicines and prescribing committees, who were understandably concerned about who owned the “My Medicines” chart and had agreed its content. Explaining this was made more difficult because it is hard to get across the complexity of the arrangements, due to the critical nature of the children’s illnesses, in a committee setting. Working in ways that support safety I make no apologies for ensuring from the outset that it was the parents who owned the charts, which were designed by the project team (not a committee) to meet all best practice standards. It always worries me that when it comes to cross- organisational working the formal committees and systems in place can inadvertently act as a barrier to safety rather than promoting it. There is no doubt we had designed a safer process and my company was happy to take accountability for any associated risks. As a legacy of the project, a Community Paediatric Pharmacist was appointed specifically to work with this group of children. So, whatever evolves will be based on inter-disciplinary thinking and working and will have clear safety parameters. I am grateful to the enlightened thinking of the leaders who commissioned this work and supported this novel approach.
  3. Content Article
    The pandemic’s effect on non COVID-19 care and treatment While the healthcare system has rightly focused its attention on the deadly effects of COVID-19, we made the case this year that we need to pay attention to patient safety now more than ever; the pandemic has both magnified existing patient safety issues and created new challenges. One major area of our focus has been the pandemic’s impact on non COVID-19 care and treatment, and the consequences for patient safety. To develop our understanding of this issue, in March we launched our #safetystories campaign, asking for patients with issues not related to COVID-19 – and yet facing new challenges because of it – to share their stories with us on the hub. Our aim was to find common themes and report to healthcare leaders with our insights, so we could help close emerging patient safety gaps as the health and care system prioritised COVID-19. Later that month, we published our first blog on the potential impact of COVID-19 on patient safety, outlining where we thought the pandemic would have the biggest impact on patient safety. The pandemic continues: identifying and addressing further risks to patient safety As the year progressed and we identified different risks to patient safety that were exposed by the pandemic, we urged: For patient safety considerations to be placed at the heart of the design and development of new ventilators for the NHS (March). At the time, the Government was focusing on the fast delivery of additional ventilators to meet increasing demand. This included development of ventilators, not just by established manufacturers, but also by companies who hadn’t previously produced them. For the Government to tackle patient and staff safety concerns arising from the increased pressure on social care (April). Social care was already under immense pressure well before the spread of COVID-19 but, as the pandemic took hold, the sector had to respond to additional risks, such as short supplies of PPE and the increased number of rapid hospital discharges. For trusts to address patient safety concerns impacting maternity services, particularly in relation to women choosing to have home births (April). This came after evidence suggested that more women were requesting to birth at home to reduce the risk of contracting COVID-19 while in hospital. For clarity around the large number of false negative COVID-19 test results (April). A high rate of false negative COVID-19 test results means that a significant number of people could be carrying the virus, wrongly assured they are not infectious. For the NHS to put in place a clear strategy to address the backlog of cases for elective surgery (June). We stressed the importance of this being done in a systemic way, with a published strategy that would help to ensure decisions regarding the priority of cases are made transparently and with patient safety at the forefront. Ensuring the voices of patients and staff are central to our work As our work in this area progressed, in May, we held a webinar with HealthPlusCare, titled ‘Patient safety: Time for questions? Non COVID-19 care and treatment’. Over 500 participants, including clinicians and patients, joined our discussion on the impact of the pandemic on non COVID-19 care and treatment. We used feedback from the discussion to inform our submission to the Health and Social Care Select Committee’s Inquiry, ‘Delivering Core NHS and Care Services during the Pandemic and Beyond’. Many issues we raised were highlighted in their report, published at the start of October. Looking forward As 2020 comes to a close and we move into the new year, the pandemic continues to hugely impact health and social care. We remain an independent voice for patient safety in this area, bringing attention to patient safety issues the pandemic exposes or creates, and engaging with partners to call for the NHS and Government to act urgently and reduce avoidable harm.
  4. Content Article
    Today is International Day of People With Disabilities so a good day to read about the Human Rights Model of Disability which replaces the Social Model still taught in many UK medical and nursing schools and the even more outdated Medical Model, which is still the dominant model across much of the NHS. The AdsFoundation will be publishing three short #LearnWithDrDog video scribe films, one on each of the models, early in 2021. As with all #LearnWithDrDog films, they will explain the concepts in fun, easy to access, 5 minute films, which will be free to use for educational purposes.
  5. Content Article
    Key points The impact of the COVID-19 pandemic has been severe in England and has affected disproportionally people who use and provide long-term care. Since the beginning of the pandemic and until the 6 November, 15,659 people had died in the care home and their deaths were linked to COVID-19 in the death register. An estimate of the deaths of care home residents (including those who died in hospital) suggests that, until the 13 November, 20.799 care home residents died whose deaths were attributed to COVID-19. An estimate of excess deaths in care homes suggests that 22,948 more people died until the 30 October, compared to the previous 5 years. This would represent around 5% all care home residents. There have also been increased deaths among people receiving care at home, people who work in social care provision, and the people with learning disabilities and dementia. The initial COVID-19 policy responses did not adequately consider the social care sector. A social care action plan was not introduced until mid-April, almost a full month after the Prime Minister announced the country would go into lockdown. With the response almost entirely focused on the NHS, too little consideration was given to the fragmented social care system, which was already in a fragile state prior to the pandemic, and into which many people were being discharged from hospital. Delays in access to personal protective equipment and staff and service user testing are likely to have contributed to the high death toll in the sector. Since the first wave, there has been improvement in terms of availability of guidance, access to Personal Protection Equipment and testing. In the second wave, care providers continue to face challenges with testing capacity (and speed), visiting policies and the financial implications of the additional costs of the pandemic and decreases in revenue. In the absence of standardised and robust national data on the sector, finding data about the impact of the pandemic on people who use and provide long-term care remains a challenge. The pandemic has laid bare long-standing problems in the long-term care system in England, such as the fragmentation of responsibilities, funding and workforce pressures, as well as the unequal relationship between the health and social care systems and the invisibility of groups such as working age adults with disabilities and unpaid carers in social care planning.
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