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Showing results for tags 'Transfer of care'.
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Community PostMorning all, As a Critical Care Outreach nurse of many years, one of my greatest bugbears is SBAR handover, or there lack of! Within my trust, there is an SBAR proforma attached to the NEWS2 chart, which appears to be fit for purpose currently. (We are still on paper obs charts, moving to e-obs by the end of the year) SBAR is taught and embedding in all our teaching and training, the candidates at the time of the courses are all able to giver perfect SBAR handovers in simulation but as soon as they walk out the door all of that seems to disappear. It is all too often we receive poor handovers for referrals, the lack of information and clarity means that we cannot prioritise patients effectively. I am currently looking at the nuts and bolts of why this is and what we need to do to address the issues. I have started by sending a survey out to all registered nursing staff so that we can get feedback from those who should be using it. Hopefully, from the responses this may mean we can formulate a plan to improve this. Does anyone else have the same issues/ concerns in you line of work? Has anyone got anything that they do in their trust that works?
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Transfers of Care Around Medicines (TCAM)
Claire Cox posted an article in Medication including labelling
This is what the Transfers of Care Around Medicine (TCAM) project aims to address: When patients discharged from hospital are identified as needing extra support, they are referred through a safe and secure digital platform for advice from their local community pharmacist. Original work in the North East showed that patients who see their community pharmacist after they’ve been in hospital are less likely to be readmitted and, if they are, will experience a shorter stay. Many AHSNs, including Wessex and the West of England, have worked with trusts and Local Pharmaceutical Committees to help set up a secure electronic interface between the hospital IT systems and PharmOutcomes, the community pharmacy system used in their area. This has further enhanced TCAM by providing patient data quickly and seamlessly to their community pharmacist. Wessex AHSN developed an awareness campaign to encourage people to seek help with their medicines, featuring a character called Mo in a series of animated films and accompanying poster resources for pharmacies. The films have been viewed almost 64,000 times. Through the national implementation of TCAM in 2018-2020, each AHSN will support their local trusts to establish a TCAM pathway. This will enable all suitable patients to be referred to their community pharmacy or GP pharmacist where appropriate. -
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COVID-19 rehab centre takes first patients
Patient Safety Learning posted a news article in News
The first hospital dedicated to helping coronavirus patients recover from the long-term effects of the illness has received its first patients. Surrey's NHS Seacole Centre opened this month at Headley Court, a former rehab centre for injured soldiers. COVID-19 patients can be left with tracheostomy wounds from having a tube inserted in the windpipe or need heart, lung or muscle therapy, the NHS said. Others who have survived the virus may need psychological or social care. NHS chief executive Sir Simon Stevens said: "While our country is now emerging from the initial peak of coronavirus, we're now seeing a substantial new need for rehab and aftercare." He said while patients had survived life-threatening complications, many would see a longer-lasting impact on their health. Read full story Source: BBC News, 29 May 2020 -
Content ArticleFor anyone who is not familiar with undertaking critical care transfers or for staff looking for a brief refresher, here are a few notes that I hope will help any clinical staff (please note, these are my views and not necessarily those of my employer's). Planning: Despite normally being stable prior to transfer, by nature, critical patients are unstable and may deteriorate. Plan for this and know where you are going, expected journey time accounting for traffic conditions and what hospitals are along the route in case of emergency. Equipment: If a team is not travelling, you ideally won’t take unfamiliar devices. If you do, the least you should know and plan for/discuss is how to manage failure; i.e. a syringe pump giving inotropic support or ongoing sedation that may be able to be given manually. Equipment: Is different in subtle ways and it won’t be a simple case of copying hospital settings. If moving a patient from hospital equipment to yours, don’t leave straight away. Give the patient time to “settle” on your equipment and make any changes to setting necessary to maintain the patient. Vehicle: Ensure normal vehicle checks are complete, you know where your own equipment is and that it is working. Also make sure that electrical/12V/USB ports all work in case they are needed for transfer equipment. Have all rescue kit (airways, BVM etc.) to hand. Oxygen: An oxygen dependent or ventilated patient can use a lot of O2 and this needs to be calculated along with extra in case of delays. Formulas that can be used: 2 x flow (L/min) x length of transfer (min) 2 x transport time in minutes x (minute volume x FiO2) + ventilator driving gas. Airway: Always important but vital for a patient who has an airway adjunct in place prior to transfer. Plan for immediate actions if the patient loses this adjunct during transfer. Have emergency kit laid out PRIOR to transfer and allocate pre-planned roles in case of an airway emergency during transfer. Breathing: A patient on a ventilator will have a ventilation strategy depending on their condition. Try to have a basic understanding of this in case you need to take over with a BVM in the event of a ventilator failure. ALWAYS have rescue kit laid out and to hand in case of emergency enroute. Circulation: The patient may be on some sort of circulatory support (fluids, pressors, inotropes etc) dependent on their underlying condition. Again, try to understand their current fluid status and support needs in case you need to intervene or have an equipment failure enroute. Disability: If a patient is sedated/anaesthetised, be vigilant for signs this may be wearing off. Some signs to look for are tearing, increase in heart rate or BP or a Curare cleft on waveform capnography. Be aware that patient sedation needs may change due to movement during transfer. Monitoring: In the sedated/anaesthetised patient, monitoring may be your first indicator that something is changing. Don’t just assume strange values are due to movement and constantly check your patient. If something changes, start at the patient and work back to the monitor to look for issues.
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Standard Operating Procedure for ICU/HDU Handover
Claire Cox posted an article in Transfers of care
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News ArticleThe next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalised with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus — and of the emergency treatments that allowed them to survive it. “The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine. Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices. Read full story Source: Science, 8 April 2020
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We need a Nightingale model for rehab after COVID-19
Patient Safety Learning posted a news article in News
A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris. A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity. While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection. One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available. Read full story Source: HSJ, 9 April 2020 -
Content ArticleThis alert relates to the risk of harm caused by the interruption of HFNO to babies, children and adults in acute respiratory failure without hypercapnia during patient transfer. Some HFNO delivery devices have a transport mode, but most require mains power and will not deliver oxygen during transfer unless attached to a compatible uninterruptible power supply (UPS) device. The alert asks providers to add clear labels to HFNO delivery devices to make staff aware that even brief interruptions to mains power supply could lead to respiratory and cardiac arrest; and that HFNO in any emergency department or short stay unit must not be started without a plan for how to transfer the patient onwards. Where a UPS is used, action must be taken on the storage and maintenance of UPS devices to ensure they are ready for use and staff know where to locate them.
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The problem with medication reconciliation
Claire Cox posted an article in Medication including labelling
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New pharmacy referral service to help patients avoid hospital readmission
Patient Safety Learning posted a news article in News
From July, hospitals will be able to refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy. Patients will be digitally referred to their pharmacy after discharge from hospital. The NHS Discharge Medicines Service will help patients get the maximum benefits from new medicines they’ve been prescribed by giving them the opportunity to ask questions to pharmacists and ensuring any concerns are identified as early as possible. This is part of the Health Secretary’s ‘Pharmacy First’ approach to ease wider pressures on A&Es and general practice. Read full story Source: Department of Health and Social Care, 23 February 2020 -
Content Article1. Introduction and scope 2. Guidance 3. Software and data implications
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Hospital ‘bed blocking’ numbers hit highest level since 2017
Patient Safety Learning posted a news article in News
The number of patients stuck in hospitals because they could not be transferred is at its highest quarterly level since 2017, reversing years of progress amid ongoing crises in health and care services. “Delayed transfers of care” – often known as “bed blocking” – rose in the mid-2010s as austerity hit council-run adult-care services, meaning hospitals were unable to discharge patients into the community. The number of “delayed days” in the NHS increased from an average of 114,000 a month in 2012 to more than 200,000 in October 2016, before extra funding and higher council taxes brought the numbers back down. But the latest NHS figures show the problem is returning. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years. Read full story Source: The Guardian, 23 February 2020 -
Content ArticleWorking with clinicians and patients, the PRSB have published this standard along with implementation guidance for digital referrals from GPs to hospitals. Once implemented, it will ensure that clinicians have the right information they need to provide the best care for patients. The standard was produced in collaboration with the Royal College of Physicians Health Informatics Unit and input from the Royal College of General Practitioners. By using the standard professionals will have access to all relevant information in a timely manner results in safer and more consistent care for people using health and care services. The information will include data about medication, previous history, allergies and current symptoms, as well as a patient’s concerns and expectations. This standard has now been updated to version 1.1. Detailed release notes are available outlining the changes. These can be found in the supporting documents link above. The standard has been updated in-line with new PRSB digital medications information assurance. The PRSB has worked in partnership with the Health Informatics Unit at the Royal College of Physicians to produce these standards.
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Mental Health inpatient discharge V2.1
Claire Cox posted an article in Transfers of care
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Passport to health
Claire Cox posted an article in Learning disabilities
It can be easy to make assumptions about a person’s quality of life, which can colour our judgements about the support, care and treatment of individuals, and how and what they should receive. So it is vital that the person and those who know them best are involved in their care, so that a more complete picture of an individual’s life can emerge and their needs, likes and dislikes can be shared with those providing care and support. This should improve the quality of the care and treatment that a person receives. It was with this in mind that the hospital passport was developed, containing important information about the person, such as their health and health difficulties, likes and dislikes, and any medication that they may be on. The idea was adapted from one created by Gloucestershire NHS primary care trust and introduced at St George’s Hospital in south west London. It was created by people with learning disabilities and health professionals from Wandsworth and Merton community learning disability teams and the acute hospital to ensure a better experience and health outcome for people with learning disabilities and their families in St George’s. -
Content ArticleThe project aim was to establish a monthly multi-disciplinary analysis of all the Paediatric cases transferred from the Paediatric Emergency Department and the Paediatric ward at the Royal Free, to identify areas of clinical learning and patient safety improvement.
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NHS e-health systems 'risk patient safety'
Patient Safety Learning posted a news article in News
Hospitals across England are using 21 separate electronic systems to record patient health care – risking patient safety, researchers suggest. A team at Imperial College say the systems cannot "talk" to each other, making cross-referencing difficult and potentially leading to "errors". Of 121 million patient interactions, there were 11 million where information from a previous visit was inaccessible. The team from London's Imperial College's Institute of Global Health Innovation (IGHI) looked at data from 152 acute hospital trusts in England, focusing on the use of electronic medical records on the ward. Around a quarter were still using paper records. Half of trusts using electronic medical records were using one of three systems: researchers say at least these three should be able to share information. 10% were using multiple systems within the same hospital. Writing in the journal BMJ Open, the researchers say: "We have shown that millions of patients transition between different acute NHS hospitals each year. These hospitals use several different health record systems and there is minimal coordination of health record systems between the hospitals that most commonly share the care of patients." Lord Ara Darzi, lead author and co-director of the IGHI, said: "It is vital that policy-makers act with urgency to unify fragmented systems and promote better data-sharing in areas where it is needed most – or risk the safety of patients." A spokesperson for NHSX, which looks after digital services in the NHS, said: "NHSX is setting standards, so hospital and general practioner IT systems talk to each other and quickly share information, like X-ray results, to improve patient care." Read research article Read full story Souce: BBC News, 5 December 2019 -
Content ArticleThe transport of the ICU patient is a complicated process and can lead to patient harm. In the Department of Critical Care Medicine, Calgary Health Region, staff underestimated the risks of intrahospital transport, which led to the two adverse events mentioned above. This article published in Healthcare Quarterly has describes the development of an ICU patient transport decision scorecard to support the safe transport of ICU patients for diagnostic testing. The scorecard is a visual assessment tool. Each item on it is a decision point and a simple reminder to ensure that appropriate resources are available prior to transport. Outcome measures have been added to begin to measure the effectiveness of the tool. Several lessons were learned from the development of this tool: the need to form a subgroup with team members from all sites and disciplines to ensure early buy-in; the involvement of a human factors expert to make the tool easier to use; and the need to continuously retest the tool using PDSA cycles.
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Community PostHi everybody This is Jaione from Spain (we are in the North, Basque Region) and i am a nurse working in collaboration with the Patient Safety Team in our local NHS (Basque Health Service). First of all, I would like to congratulate the team for this hub which i think is a wonderful idea. Secondly, i would like to apologize for the language, since, although i lived in England many years ago, that is not the case anymore and I'm afraid i don't speak as well as I used to. I would like to comment a problem that we encounter very often in our organization which is related to patient's regular medications when they are admitted to hospital. We do have online prescriptions for both acute and community settings but the programs don't really speak to each other so, for example, if I take a blood pressure pill everyday and i get admitted into hospital, chances are that my blood pressure tablet won't get prescribed during my in-hospital stay. The logical thing to do would be to change both online systems so they communicate to each other, but that's not possible at the moment. I wanted to ask whether other systems have the same problem and, if so, if there is any strategy implemented to alleviate this issue. I hope i have expressed myself as clearly as possible. Thanks very much once more for this hub! Kind regards Jaione
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Healthcare for offenders (last updated October 2019)
Patient Safety Learning posted an article in Prison setting
Guidelines and information on: healthcare in prisons in England healthcare for offenders in the community in England healthcare for offenders in Wales Community Sentence Treatment Requirements National Partnership Agreement for Prison Healthcare in England 2018-2021.
