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Showing results for tags 'Transparency'.
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Content ArticleIn the two weeks before his death Robbie was seen seven times by five different GPs. The child was seen by three different GPs four times in the last three days when he was so weak and dehydrated he was bedbound and unable to stand unassisted. Only one GP read the medical records, six days before death, and was aware of the suspicion of Addison's disease, the need for the ACTH test and the instruction to immediately admit the child back to hospital if he became unwell. The GP informed the Powells that he would refer Robbie back to hospital immediately that day but did not inform them that
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News ArticleAn NHS trust has become the first in the country to individually contact every family of patients who caught coronavirus while they were in hospital in a large-scale bid to be transparent over the scale of infections. Bosses at the Queen Elizabeth Hospital Kings Lynn NHS Trust have set up a team to work through hundreds of cases where patients caught coronavirus in hospital. At least 99 patients are known to have died after becoming infected with more cases still to review. In a unique approach to transparency the trust is sending a letter by recorded delivery to every affected
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News ArticleHospitals have been accused of “unnecessary secrecy” for refusing to disclose how many of their patients died after catching Covid on their wards. The Patients Association, doctors’ leaders and the campaign group Transparency International have criticised the 42 NHS acute trusts in England that did not comply fully with freedom of information request for hospital-acquired Covid infections and deaths. The Guardian revealed on Monday that up to 8,700 patients lost their lives after probably or definitely becoming infected during the pandemic while in hospital for surgery or other treat
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News ArticleNearly 90% of organisations representing doctors agree that the UK should have a mandatory and public register of doctors’ interests, a survey by The BMJ has found. Last year the Independent Medicines and Medical Devices Safety Review, chaired by Julia Cumberlege, called for the General Medical Council (GMC) to expand its register to include a list of financial and non-pecuniary interests for all doctors. That review investigated harmful side effects caused by the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate, and surgical mesh. One of its key conclusions
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Content ArticleGrundy et al. used Carol Bacchi’s problem-questioning approach to policy analysis to compare the Sunshine policies in three different jurisdictions, the United States, France and Australia. We found that transparency had emerged as a solution to several different problems including misuse of tax dollars, patient safety and public trust. Despite these differences in the origins of disclosure policies, all were underpinned by the questionable assumption that informed consumers could address conflicts of interest. The authors conclude that, while transparency reports have provided an unprecedente
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Content ArticleA recent blog I wrote (see link below) brings together key information for clinicians, and especially for prescribers, from a variety of sources, including patients, relatives and carers. The aim is to help to prevent patients with autism and learning disabilities being harmed by inappropriate medicines. I began this in 2018 following the death of Oliver McGowan, which I cover in teaching for (non-medical) prescribing students and in my clinical education work. It links to the NHS Learning Disability Mortality (LeDeR) Review Programme. Key points: Most of the prescribing in thi
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EventuntilThe importance of healthcare data and good data practices continues to grow as the COVID-19 pandemic drives further digitalisation and creates new data streams. This free online event from the King's Fund explores the importance of patients trusting that their health and care data will be safely and responsibly used by the NHS. Now is the time to come together and look at how we can modernise protocols and ensure trust is built with the public. This event is the first in a series exploring how we put trust, transparency and fair value at the centre of digital health and care. Our expert
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In the early days of my career, I worked with clinical teams while managing a hospital and later a network of hospitals. I must say, the experience I gathered in these different roles shaped me into what I am today. I can fit into healthcare conversations easily because of these early relationships and interactions with clinical experts. When I look back to my experience as a hospital administrator, a particular incident keeps coming back to mind; I sometimes link this to my later involvement in patient safety but most times I feel it is my conscience speaking to me. There was a patient w -
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Patient Safety Movement: Improving patient safety using CANDOR
Sam posted a calendar event in Community Calendar
The approach to resolution of adverse events in hospital and healthcare organisations has remained subpar for decades and open and honest communication is often compromised in favour of litigation. Models like CANDOR have been recognized as essential to transparency, person-centeredness, and healthcare quality and safety. The impactful implementation of CANDOR into organisational culture requires commitment, prioritisation, involvement from all, and event analysis for continuous improvement. Register -
News ArticleThe chief inspector of hospitals has called for honesty about the impact of the coronavirus pandemic on patients warning poor care could become normalised. Professor Ted Baker told The Independent it was vital staff continued to report incidents and revealed the Care Quality Commission had seen a 60% rise in whistleblowing concerns during the last national lockdown in November. He said staff must report incidents and be free to speak up about any concerns as well as being transparent with families where things have gone wrong. He emphasised that where a patient was unable to get
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News ArticlePatient Safety Learning Press Release 10th December 2020 Today the Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust published its first report on its findings.[1] The report made recommendations for actions to be implemented by the Trust and “immediate and essential actions” for both the Trust and the wider NHS. The Review was formally commissioned in 2017 to assess “the quality of investigations relating to new-born, infant and maternal harm at The Shrewsbury and Telford Hospital NHS Trust”.[2] Initially it was focused on 23 cases but has be
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NHS urged to publish delayed report on hospital 'witch-hunt'
Patient Safety Learning posted a news article in News
The NHS is under pressure to publish a delayed review into a bullying scandal at Matt Hancock’s local hospital that involved senior clinicians being asked to provide fingerprint samples in a “witch-hunt” for a whistleblower. The “rapid review” into West Suffolk hospital, which Hancock had to recuse himself from because of his friendship with the boss at the trust, was ordered in January and had been due for completion in April. Its publication was put back to this month because of the coronavirus pandemic. But it is now not expected until spring. The Doctors’ Association UK suspects -
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Restorative healing after healthcare harm webinar
Patient Safety Learning posted a calendar event in Community Calendar
untilHarmed Patients Alliance we will be hosting an online webinar focusing on restorative healing after healthcare harm. This online webinar will explore the issue of second harm in healthcare with a range of patient, academic and clinical expert members of our advisory group. Each panel member will give a presentation sharing their experience and perspective, followed by an interactive panel discussion chaired by Shaun Lintern, Health Correspondent for the Independent. Register -
News ArticleThe lateral flow devices used in the community testing pilot in Liverpool only picked up half the COVID-19 cases detected by polymerase chain reaction (PCR) tests and missed 3 out of 10 cases with higher viral loads, according to the government’s own policy paper. Given the low sensitivity of the Innova lateral flow devices when used in the field, experts are questioning how they can be used to allow care home residents to have contact with relatives over Christmas safely or for students to know for certain that they are not infected before returning home. The information can only be
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News ArticleThe Department of Health and Social Care (DHSC) has been criticised by the national health ombudsman for the ‘maladministration’ of a 2018 review into the death of a teenage girl under the care of one of England’s top specialist hospitals, HSJ can reveal. The Parliamentary and Health Service Ombudsman (PHSO) came to the conclusion after investigating a DHSC review into the 1996 death of 17-year-old Krista Ocloo which had been requested by her mother. Krista died at home of acute heart failure in December 1996. She had been admitted to the Royal Brompton Hospital with chest pains in J
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Community PostI've been posting advice to patients advising them to personally follow up on referrals. Good advice I believe, which could save lives. I'm interested in people's views on this. This is the message I'm sharing: **Important message for patients relating to clinical referrals in England** We need a specific effort to ensure ALL referrals are followed up. Some are getting 'lost'. I urge all patients to check your referral has been received, ensure your GP and the clinical team you have been referred to have the referral. Make sure you have a copy yourself too. Things
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Community PostDo you have a patient safety newsletter in your Trust? It would be very interesting for others to see how your is set out and the content. Here is one from Cardiff and Vale.
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Content ArticleWhen considering the persistence of unsafe care, a recurring theme that emerges is a failure to involve patients in their own care. Patient safety concerns raised by patients and family members are too often not acted on and, when harm occurs, they are often left out of the investigation process. As set out in Patient Safety Learning’s A Blueprint for Action, we share the view that patient engagement is key to improving patient safety, with this forming one of our six foundations of safer care.[1] The NHS Patient Safety Strategy identifies the involvement of patients in patient safety “th
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AHRQ Pharmacy Health Literacy Center
Patient Safety Learning posted an article in Medicine management
The tools include: Seven health literacy tools for pharmacy: Pharmacy Health Literacy Assessment Tool & User's Guide. Training Program for Pharmacy Staff on Communication. Guide on How To Create a Pill Card. Telephone Reminder Tool To Help Refill Medicines On Time. Explicit and Standardized Prescription Medicine Instructions. How to Conduct a Postdischarge Followup Phone Call Health literacy tools to improve communication for providers of medication therapy management Curricular modules for pharmacy faculty. Resources for pharmacist
