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Found 47 results
  1. News Article
    Police have carried out more than 5,500 investigations into patients who have been reported missing from NHS facilities in Scotland since 2019. The figures were outlined in a written response from Keith Brown, the justice secretary, to Jamie Greene, the Conservative MSP. Greene, who is the justice spokesman for the Conservatives, said the figures gave serious cause for concern. He said that the complete figure could be much higher because the data provided only included those reported to police. He urged Brown and Humza Yousaf, the health secretary, to provide adequate resources for policing and the health sector to ensure vulnerable patients were not slipping through the cracks. Greene said: “These figures are deeply alarming. Relatives expect their loved ones to be safe while they are staying, or being treated in, an NHS facility. It gives serious cause for concern that over 200 investigations have had to be launched in just the last few years to determine the whereabouts of young people who went missing from NHS grounds.” Read full story (paywalled) Source: The Times, 3 January 2023
  2. News Article
    One in four 17- to 19-year-olds in England had a probable mental disorder in 2022 – up from one in six in 2021, according to an NHS Digital report. Based on an online survey, rates among teenage boys and girls were similar – but twice as high in 17- to 24-year-old women compared with men. The charity Mind said the UK government "will be failing an entire generation unless it prioritises investment in young people's mental-health services". Matthew Rimmington, 24, is working full-time after studying acting at university, but aged 18, he felt his life was falling apart. It started with symptoms of anxiety, which deteriorated until his feelings really started scaring him. Despite going to his GP and being referred to NHS mental-health services, Matthew received no early support. "I was put on one waiting list and then another one," he says. "It was a constant back and forth and we never got anywhere." Mind interim chief executive officer Sophie Corlett said funding should be directed towards mental-health hubs for young people in England, where they can go when they first start to struggle with their mental health. "The earlier a young person gets support for their mental health, the more effective that support is likely to be," she said. "Young people and their families cannot be sidelined any longer by the government, who need to prioritise the crisis in youth mental health as a matter of national emergency." Read full story Source: BBC News, 29 November 2022
  3. News Article
    A growing number of children with mental health problems are being treated on adult psychiatric wards as services struggle to cope with a surge in demand following the pandemic, the NHS watchdog has warned. There were 249 admissions of under-18s to adult psychiatric wards in England in 2021-22, according to data provided by NHS trusts to the Care Quality Commission (CQC), up 30% on the year before. Of the children admitted to adult wards, 58% of cases were because the child needed to be admitted immediately for their safety. But in more than a quarter of cases, 27%, the child was admitted to the adult ward because there was no alternative child inpatient or community outreach service available. The findings come more than 15 years after the government set a target to end inappropriate admissions of children to adult psychiatric wards. The number of admissions gradually reduced but has now risen again, the CQC figures suggest. Dr Elaine Lockhart, chair of the Child and Adolescent Faculty at the Royal College of Psychiatrists, said the figures were “a concern but not a surprise. We’ve got a lot of children and young people who have become more unwell. Services are really struggling to meet their needs,” she said. Read full story Source: The Guardian, 30 October 2022
  4. News Article
    Some of the most senior gender identity specialists in the UK have accused their professional body of “contributing to an atmosphere of fear” around young people receiving gender-related healthcare. More than 40 clinical psychologists have signed an open letter to the Association of Clinical Psychologists UK in protest at the organisation’s recent position statement on the provision of services for gender-questioning children and young people. They say they believe there was a failure to properly consult experts in the field or service users, resulting in a “misleading” statement that “perpetuates damaging discourses about the work and gender-diverse identities more broadly”. About half of those signatories are current or former holders of senior roles – including the current director – at what was the only NHS gender identity service for children in England and Wales, the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS foundation trust in London. NHS England announced in July it would be closing the GIDS and replacing it with regional hubs, after being warned by the interim report of the Cass Review into gender services for young people that having only one provider was “not a safe or viable long-term option”. In 2021, inspectors rated the service “inadequate” overall and highlighted overwhelming caseloads, deficient record-keeping and poor leadership, suggesting that record waiting lists meant thousands of vulnerable young people were at risk of self-harm as they waited years for their first appointment. In a position statement published last month, the ACP-UK wrote that “the new, regional services will have to offer a radical alternative [after the closure of GIDS] to meet the needs of all young people with gender dysphoria.” The letter suggests: “An alternative interpretation is that it is possible to provide support for distress related to gender identity where mental health needs and neurodiversity are also present, and remain cognisant of all factors within formulation-based practice”. Read full story Source: The Guardian, 2 November 2022
  5. News Article
    The number of people under 40 in the UK being diagnosed with type 2 diabetes is rising at a faster pace than the over-40s, according to “shocking” and “incredibly troubling” data that experts say exposes the impact of soaring obesity levels. The UK ranks among the worst in Europe with the most overweight and obese adults, according to the World Health Organization. On obesity rates alone, the UK is third after Turkey and Malta. The growing numbers of overweight and obese children and young adults across the UK is now translating into an “alarming acceleration” in type 2 diabetes cases among those aged 18 to 39, analysis by Diabetes UK suggests. There is a close association between obesity and type 2 diabetes. There is a seven times greater risk of type 2 diabetes in obese people compared with those of healthy weight, and a threefold increase in risk for those just overweight. “This analysis confirms an incredibly troubling growing trend, underlining how serious health conditions related to obesity are becoming more and more prevalent in a younger demographic,” Chris Askew, the chief executive of Diabetes UK, said. He added: “While it’s important to remember that type 2 diabetes is a complex condition with multiple other risk factors, such as genetics, family history and ethnicity, these statistics should serve as a serious warning to policymakers and our NHS. “They mark a shift from what we’ve seen historically with type 2 diabetes and underline why we’ve been calling on the government to press ahead with evidence-based policies aimed at improving the health of our nation and addressing the stark health inequalities that exist in parts of the UK.” Read full story Source: The Guardian, 1 November 2022
  6. News Article
    Charities are warning that young cancer patients facing soaring living costs are in a "desperate" situation. Both Macmillan Cancer Support and Young Lives vs Cancer say they've seen dramatic increases in the number of people asking for emergency grants. Research suggests tens of thousands of 18 to 39-year-olds with cancer are struggling to pay basic living costs. Shell Rowe was among those who told BBC Newsbeat they're worried about becoming financially independent. She was diagnosed with stage four non-Hodgkin's lymphoma at age 20 in 2019, just as she was about to study film in California for her third year of university. "Prices have skyrocketed. I haven't been able to work and haven't been able to save and get a job," she says. "How am I ever going to be able to be financially independent? It really scares me." More than half of the 18 to 39-year-olds with cancer surveyed by Macmillan and Virgin Money said they needed more financial support to manage the rising cost of living. One in four young people are getting further into debt or have fallen behind paying rent and energy bills because of increased living costs, according to the survey of 2,000 people across all age groups. More than a tenth (11%) of those surveyed say they've had to delay or cancel medical appointments due to the rising cost of petrol. Many people have to travel long distances for treatment, often in their own cars or a taxi because the risk of infection rules out taking public transport. "It's never been as bad as this. Young people with cancer are in really desperate circumstances, because of the cost-of-living crisis," says Rachel Kirby, chief executive of Young Lives vs Cancer. "No young cancer patient should have to think about the choice of putting fuel in the car to get to treatment, or whether they can heat their homes. But those are the kinds of situations they're facing," Read full story Source: BBC News, 3 October 2022
  7. Content Article
    Key points The report highlights the following key findings about children and young people's mental health: One in six children aged 6 to 16 were identified as having a probable mental health problem in July 2021, a huge increase from one in nine in 2017. Boys aged 6 to 10 are more likely to have a probable mental disorder than girls, but in 17 to 19-year-olds this pattern reverses, with rates higher in young women than young men. By the age of eight, 7 in 10 children report at least one adverse childhood experience (ACE).Three in four adolescents exposed to ACEs develop mental health problems by the age of 18, including major depression, conduct disorder, alcohol dependence, self harm, suicide attempts, and posttraumatic stress disorders (PTSD). In 2018, the suicide rate in women aged under 25 years had significantly increased since 2012 to its highest ever recorded level of 3.3 per 100,000. Nearly half of 17–19-year-olds with a diagnosable mental health disorder have selfharmed or attempted suicide at some point, rising to 53% for young women. In 2018-19, 24% of 17-year-olds reported having self-harmed in the previous year, and seven percent reported having self-harmed with suicidal intent at some point in their lives. 16% reported high levels of psychological distress. There was a 47% increase in the number of new emergency referrals to crisis care teams in under-18-year-olds between December 2019 and April 2021. Consistent findings showing people in marginalised groups are at greater risk of mental health problems, including people from Black, Asian and other minority ethnic backgrounds, lesbian, gay, bisexual and transgender people, disabled people and people who have had contact with the criminal justice system, among others. Recommendations A commitment from the next Prime Minister to fund an immediate £1bn children and young people’s mental health wellbeing recovery programme to improve the quality and effectiveness of mental health care and support, with guaranteed appointment and treatment times as part of a wider post pandemic commitment to children and young people. New local frameworks for children and young people’s wellbeing (aged 0-25) between health, children’s services, schools, youth offending teams and the police to provide an integrated approach with common performance targets and pooled financial contributions from all partners. Guaranteed mental health assessments for children and young people at points of vulnerability. This would mean an automatic assessment and guaranteed mental health package for children entering care and automatic assessments for children and young people at risk of exclusion from school, who go missing, at the point of arrest, or are involved in violence or crime. It would include a guarantee of assessment by education psychologists for any child at risk of exclusion. A national implementation programme to embed a whole school and college approach to mental health and wellbeing across all education settings in the country. This should include a commitment from Government to provide a funding package for Mental Health Support Teams beyond 2023/24 to ensure that all schools have access to this vital additional support by 2030. An ambitious programme of drop in mental health hubs delivered in the community. These new community drop-in centres will provide vital drop in access and work with local community groups to provide outreach support, funded by the new recovery programme. A national ‘Programmes on Prescription’ scheme in every area. Building on emerging local approaches, the roll out of a major funded programme of social prescribing for mental health wellbeing that enables GPs and health professionals to pay for sports and arts sessions, music, drama, activities, youth clubs, outings, and volunteering programmes to improve young people’s confidence, self-esteem, and skills and make friends. A major recruitment programme with ambitious targets to build the children and young people workforce required to meet this expansion of services. It is vitally important to ensure that this workforce is diverse and culturally competent. Wellbeing and mental health training and support for all professionals working with children and young people. Identifying and understanding the mental health needs of children is vital if they are to be offered the help they need. Make co-production and community work a cornerstone of mental health care to ensure long-term trusted relationships for young people and to give them a constant point of contact. Improved wellbeing on digital platforms. We know that many children feel more comfortable and sometimes prefer help online, which should also be extended and supported as an important strand of a local strategy. Better information and support for parents to support children and young people’s positive mental health and wellbeing. Improving the mental health and well-being of young people at risk of harm and being involved in the criminal justice system. This should be measured as a core aspect of NHS equality targets with leadership, resources, and delivery plans.
  8. News Article
    England's first women's health ambassador is calling for "one-stop shops" where women can sort out their health needs. Dame Lesley Regan, also a practising doctor, wants to make it easier for women and girls to access care such as contraception and smear tests in the community. Her new role aims to close the "gender health gap". She will also support the upcoming government-led women's-health strategy. "At the moment, we waste a lot of resource in telling girls and women that they cannot have things," she told BBC News. "So you might go off to your doctor or gynaecologist or heart specialist and get told, well, you cannot have a smear here, even if it is due, or you need to go somewhere else for this, that and the other. "We should make it very, very easy for people to access this out in the community - why do you need to go to a secondary or tertiary facility for things that are very easy to provide?" Instead, she wants health hubs where women could "go for half a day and get all these things sorted out" and then get on with their lives. "A one-stop shop is what I want for myself and what I want for my daughters and I'm sure it is what every other girl and woman wants and what every man and boy wants for the women in their lives, to be looked after that way," Dame Lesley said. Read full story Source: BBC News, 17 June 2022
  9. Content Article
    What is Redthread? Redthread, a Youth Violence Intervention Programme, runs in hospital emergency departments in partnership with the major trauma network. The innovative service aims to reduce serious youth violence and has revolutionised the support available to young victims of violence. Every year thousands of young people aged 11–24 come through hospital doors as victims of assault and exploitation. It is then, at this time of crisis, that our youth workers use their unique position embedded in the emergency departments alongside clinical staff to engage these young victims. Redthreads extensive experience tells us that this moment of vulnerability, the ‘Teachable Moment’, when young people are out of their comfort zone, alienated from their peers, and often coming to terms with the effects of injury, is a time of change. In this moment many are more able than ever to question what behaviour and choices have led them to this hospital bed and, with specialist youth worker support, pursue change they haven’t felt able to before. Redthread workers focus on this moment and encourage and support young people in making healthy choices and positive plans to disrupt the cruel cycle of violence that can too easily lead to re-attendance, re-injury, and devastated communities. Redthread and the Homerton Redthread is embedded within Homerton’s A&E department. The Redthread youth work team work hand in hand with the emergency department team to safeguard young people between the ages of 11-24 who are at risk of violence or exploitation. Emergency department clinicians send referrals for at-risk young people to the Redthread team, who work on an individual basis with the young people to support them and endeavour to alleviate the risk in their environment. Redthread achieves this by liaising with statutory services such as CAMHS, Children’s Social Care and Housing to ensure that the young person is being placed first. By linking up services, Redthread ensures that the young person is the focal point and that help is being given, without duplicating existing services. Redthread works in several major trauma centres across the UK; however, the Homerton practice is the first community hospital based service. The Redthread service would not be possible without the support of the emergency department staff. Not only is the clinical and non-clinical body supportive of the service and actively referring young people, the emergency department as a whole takes an active interest in Redthread’s work – talking to Redthread staff about their work, fundraising and attending training sessions. Thanks to the initial efforts of emergency department doctors and nurses in gaining funding and support for this project at Homerton, and the continued work and collaboration by the emergency department and Redthread, the service has excellent track record after its 1 year of service. The Redthread youth workers work closely with young people in a way that clinicians do not have time to. This means that patients are cared for both medically and holistically. Though difficult to quantify results, a strong qualitative difference to the service is that there is a caring external presence within the emergency department. For young people in crisis, being seen one-to-one by someone in a non-clinical role means that there is someone solely on their side. In a lot of cases, a Redthread worker might be the first person in a long time to ask if they are ok, and to see them for who they are as opposed to the trauma that they have suffered. For the emergency department team, having a constant youth work presence acts as a reassurance that when a safeguarding issue does arise, this will be followed up and the young person will continue to be cared for. The emergency department safeguarding has improved as awareness has grown among staff members of safeguarding procedures. The Redthread collaboration has also prompted staff to be more inquisitive with the patients they see, and to consider how that patient’s behaviour may be a manifestation of underlying problems. As such, young people coming into the emergency department are safer as they are more likely to be seen and understood by clinicians, as well as receiving long term assistance as part of the emergency department care package. As the first community hospital in the Redthread network, the Homerton Redthread team have tailored and changed their service to best fit the community it serves. The team spend longer working with young people, in addition to working more closely with them than in other hospitals – taking on a constant role in our young people's lives. The breadth of presentations seen at Homerton has also resulted in a broader case-load. The result is a service which is ready to adapt to individual cases to best serve young people both in hospital and out in the community. Redthread at Homerton are also innovating and adding value structurally by meeting young people at the earliest opportunity – the statistic is that young people present to hospitals like Homerton four to five times on average before they are injured to the extent that they have to be taken to a major trauma centre. By being embedded in a local hospital such as this, we have an opportunity to engage people and help them to change their trajectories and avoid escalating harm. We’re also pioneering work around contextual safeguarding, by listening to young people and feeding back to local authorities when for example unsafe spaces in the community are identified.
  10. Content Article
    Main findings: Many investigations were of poor quality and took too long to complete. There was a lack of leadership, focus and sufficient time spent in the Trust on carefully reporting and investigating deaths. There was a lack of family involvement in investigations after a death. Opportunities for the Trust to learn and improve were missed. Of the 1,454 deaths recorded at the Trust during this period, 722 were categorised as unexpected by the Trust. Of these 540 were reviewed and 272 unexpected deaths received a significant investigation.
  11. Content Article
    What’s the worst thing you have ever seen? For those that work on the frontline in healthcare you may have heard this question asked many times… usually by friends or people you meet when you are trying to relax outside of work. They often want to hear some awful blood and guts story, something unusual being stuck in an unfortunate person’s orifice or a heroic story of a dramatic rescue. We all have something to tell along these lines. Especially when you work in ED, like me. Yep, they are awful episodes, especially for those involved, these awful stories often happen in ED. Car crashes, trauma, cardiac arrests, injured, sick children… you name it, I’ve probably seen it. When tragic things happen, we have support to get us through them. We have support from our wonderful work colleagues who understand – most of the time black humour gets us through. I want to tell you about the worst thing I ever saw, I still see, we all still see. It wasn’t a one off, I didn’t get any support, we didn’t get any support. In fact, it went unnoticed and it happened multiple times and often for hours on end. It’s like being in a recurrent bad dream, the trouble is that it isn’t a dream. It’s real and it's probably happening in hospitals up and down the country today. Rose tinted spectacles… It’s a Tuesday afternoon. It’s a warm, sunny day. I have had 2 whole days off. I’m rested and ready for the day ahead. I drive to work in a good mood. Today is going to be a great day. I walk up to the ED entrance. My hopes of a good day are dashed. There are already eight ambulances outside. I hear the sirens of another in the distance coming up the road. Perhaps the department was already empty… it might not be that bad? I step inside. Two paramedics wheel an elderly man up to the desk. He looks frail, he has a bruised face and blood running from his nose. He looks frightened. He has fallen in his rest home. "… you will have to park him in the corridor, love..." The corridor is now an ‘area’ in our ED. It’s not a walkway between two clinical areas, it’s now clinical area itself. We even have allocated a ‘corridor nurse’ to care for this group of patients. The corridor is full. Each side of the corridor there are people. People on trollies, in chairs, in wheelchairs. I feel their eyes staring at me. Someone is calling out for water, someone has vomited on the floor, an elderly lady is wandering around with her hospital gown on, it's not done up properly and everyone can see her bottom. Every few steps I take I hear someone ask when they are going to be seen. I see a couple crying, trying to console each other in full view of the onlooking people who have nothing else to do but wait. I must walk down to get to the staff room to start my shift. I feel like I am running the gauntlet. I need to get changed and get on with moving people out of the department. I hear staff members muttering "thank god the day staff are here" and "good luck, you’re going to need it". Ok, If I was able to nurse the way I have been taught; ensuring patients are listened to, made comfortable, had medication on time, are given food and water, turned if required, clean… basic nursing care, maybe I wouldn’t feel as crap as I do when I go home. Maybe I’m in the wrong job? But… this type of nursing takes time. Time is forever ticking, especially in ED. It's all about flow. Get them seen, treated and moved – within 12 hours. Sounds a long time 12 hours, doesn’t it? It’s not in healthcare. Blink, 12 hours have gone in a flash. Site managers constantly circle the nurses’ station with their clip boards, trying to strategically place patients on appropriate wards. Single sexed bays, side room, isolation rooms, monitored beds, surgical, medical, trauma, elective, the list goes on. It must be like playing one of those online strategy games, but it never ends. I’m now waiting for handover. The noise is deafening. White noise. I try and block out other people’s instructions, conversations, phones ringing, doors banging. My senses are overloaded. Not only is it too loud, the smell of stale alcohol and vomit is left in the air from an overdose that came in earlier, the irony smell of blood left by lady with a bleeding ulcer, the heat of the corridor and a hint of pseudomonas from a leaking leg ulcer – there are no windows here to give us any relief. This is my next 12 hours. People who are wearing lanyards appear. I see them when things go ‘tits up’. No idea who they are, what they do or where they come from. Never have they spoken to me and I have never seen them speak to a patient. They arrive in immaculate clothing and smell fresh, whereas I have been here a few hours and already blended in with the current smells. They are obsessed with how long people have stayed in the department. I see them frown and start talking to the site managers, who then speak to our nurse in charge, who then will speak to me. "We need to move X number of patients out of here in the next 2 hours." So, if I choose to help a man who may have soiled himself – this may take up to 40 minutes. That’s too long. I should have been preparing my patients to move off. But then if I don’t help him, the ward he moves onto will report me. Notes to prepare, IV antibiotics to give with in 1 hour, comfort rounds every 2 hours, mouth care, turn charts, feeding regimes, safety documentation to be completed, toileting, venepuncture, sepsis pathways, NEWS charting, escalation protocols… so many targets to be met. I can’t do this. It’s impossible. ‘The standard you walk past is the standard you accept’ Every time I walk down that corridor – I say this in my head. I have failed. We have failed our patients. That is the worst thing I have ever seen.
  12. Content Article
    So, what does it feel like working in chronically depleted staffing levels? "We are down three nurses today" – this is what I usually hear when I turn up for a shift. It has become the norm. We work below our template, usually daily, so much so that when we are fully staffed, we are expected to work on other wards that are ‘three nurses down’. Not an uncommon occurrence to hear at handover on a busy 50-bedded medical ward. No one seems to bat an eyelid; you may see people sink into their seat, roll their eyes or sigh, but this is work as usual. ‘Three nurses down’ has been the norm for months here, staff here have adapted to taking up the slack. Instead of taking a bay of six patients, the side rooms are added on making the ratio 1:9 or sometimes 1:10, especially at night. This splitting up the workload has become common practice on many wards. "That was a good shift" – no one died when they were not supposed to, I gave the medications, I documented care that we gave, I filled out all the paperwork that I am supposed to, I completed the safety checklists. Sounds a good shift? Thinking of Erik Hollnagel’s ‘work as done, work as imagined’ (Wears, Hollnagel & Braithwaite, 2015) – this shift on paper looks as if it was a ‘good shift’ but in fact: Medications were given late; some were not given at all as the pharmacy order went out late because we had a patient that fell. Care that was given was documented – most of the personal care is undertaken by the healthcare assistants (HCA) now and verbally handed over during the day – bowel movements, mobility, hygiene, mouth care, nutrition and hydration. As a nurse, I should be involved in these important aspects of my patients’ care, but I am on the phone sorting out Bed 3’s discharge home, calling the bank office to cover sickness, attending to a complaint by a relative. It’s being attended to by the HCA – so it's sorted? I have documented, probably over documented which has made me late home. I’m fearful of being reprimanded for the fall my patient had earlier on. This will be investigated and they will find out using my documentation what happened. The safety checklists have been completed for all my patients; comfort rounds, mouth care, falls proforma, bed rails assessment, nutritional score, cannular care plan, catheter care plan, delirium score, swallow test, capacity test, pre op assessments, pre op checklists, safe ward round checklist, NEWS charting, fluid balance charting and stool charting… the list is endless. Management have made things easier with the checklist ‘if it’s not written down it didn’t happen’ so now we can ‘tick’ against the check list rather than writing copious notes. However, I cut corners to enable me to complete all my tasks, some ticks are just ‘ticks’ when no work has been completed. No one would know this shift would they? What looks as if it has been a ‘good shift’ for the nurse, has often been the opposite for the patients and their family. There is a large body of research showing that low nurse staffing levels are associated with a range of adverse outcomes, notably mortality (Griffiths et al, 2018; Recio-Saucedo et al, 2018). What is the safest level of staff to care for patients? Safe staffing levels have been a long-standing mission of the Nursing and Midwifery Council (NMC)/Royal College of Nursing (RCN) in recent years. In the UK at present, nurse staffing levels are set locally by individual health providers. The Department of Health and professional organisations such as the RCN have recommended staffing levels for some care settings but there is currently no compliance regime or compulsion for providers to follow these when planning services (Royal College of Nursing 2019). I was surprised to find that there are no current guidelines on safe staffing within our healthcare system. It left me wondering… is patient safety a priority within our healthcare system? It seems not. While the debate and fight continues for safe staffing levels, healthcare staff continue to nurse patients without knowing what is and isn’t safe. Not only are the patients at risk and the quality of care given, but the registration of that nurse is also at risk. What impact does low staffing have on patients and families? ‘What matters to them’ does not get addressed. I shall never forget the time a relative asked me to get a fresh sheet for their elderly mother as there was a small spillage of soup on it. I said yes, but soon forgot. In the throes of medication and ward rounds, being called to the phone for various reasons, answering call buzzers, writing my documentation, making sure Doris doesn't climb out of bed again, escorting patients to and from the CT scanner, transferring patients to other wards – I forgot. My elderly patients’ daughter was annoyed, I remember she kept asking and I kept saying "in a minute", this made matters worse. She got annoyed, so that I ended up avoiding her altogether. How long does it take to give her the sheet? Five minutes tops, so why not get the sheet? MY priority was the tasks for the whole ward, tasks that are measured and audited on how well the ward performs by the Trust; filling out the observations correctly, adhering to the escalation policy, completing the 20 page safety booklet, completing the admission paperwork, ensuring everyone had their medication on time, making sure no one fell – changing a sheet with a small spot of soup on it was not on my priority list. It was a priority for my patients’ family. My patient was elderly, frail and probably wouldn’t get out of hospital alive this time. Her daughter was the only family she had left. It’s no wonder families feel that they are not listened to, are invisible, are getting in the way and not valued. These feelings do not encourage a healthy relationship between patients/families and healthcare workers. Studies have shown that involving patients and families in care is vital to ensure patient safety. Patients and their relatives have the greatest knowledge of patients and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems (O’dell et al, 2011). If our relationship is strained, how can we, as nurses, advocate for the safety of our patients? So, what impact does low staffing have on the staff member? "Fully staffed today!" The mood lifts at handover. People are sat up, smiling, quiet excitable chatter is heard. This uplifting sentence is quickly followed by either: "Let’s keep this quiet" or "someone will be moved" or "someone will have to move to XX ward as they are down three nurses". Morale is higher when wards are fully staffed. The mood is different. There are people to help with patient care, staff can take their breaks at reasonable times, staff may be able to get home on time and there is emotional support given by staff to other staff – a camaraderie. The feeling does not last long. Another department is ‘three nurses down’. Someone must move to cover the shortfall. No one wants to go When you get moved, you often get given the ‘heavy’ or ‘confused’ patients. Not only that, you are working with a different team with different dynamics – you are an outsider. This makes speaking up difficult, asking for help difficult, everything is difficult: the ward layout, where equipment is stored, where to find documentation, drugs are laid out differently in the cupboard, the clinical room layout is not the same. The risk of you getting something wrong has increased; this is a human factors nightmare, the perfect storm. I am in fear of losing my PIN (NMC registration) at times. At some point I am going to make a mistake. I can’t do the job I have been trained to do safely. The processes that have been designed to keep me and my patients safe are not robust. If anything, it is to protect the safety and reputation of the Trust, that’s what it feels like. Being fully staffed is a rarity. Being moved to a different department happens, on some wards more than others. Staff dread coming to work for threat of being moved into a different specialty. Just because you trained to work on a respiratory, doesn’t mean you can now work on a gynae ward. We are not robots you can move from one place to another. I can see that moving staff is the best option to ensure efficiency; but at what cost? Another problem in being chronically short staffed is that it becomes the norm. We have been ‘coping’ with three nurses down for so long, that ‘management’ look at our template. Is the template correct, we could save money here? If we had written guidance on safe staffing levels, we still have the problem of recruitment and retention of staff; there are not enough of us to go around. Thoughts please... Does this resonate with you? Has anyone felt that they feel ‘unsafe’ giving care? What power do we have as a group to address this issue of safe staffing levels? References 1. Wears RL, Hollnagel E, Braithwaite J, eds. The Resilience of Everyday Clinical Work. 2015. Farnham, UK: Ashgate. 2. Griffiths P et al. The association between nurse staffing and omissions in nursing care: a systematic review. Journal of Advanced Nursing 2018: 74 (7): 1474-1487. 3. Recio-Saucedo A et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing 2018; 27(11-12): 2248-2259. 4. O’dell M et al. Call 4 Concern: patient and relative activated critical care outreach. British Journal of Nursing 2001; 19 (22): 1390-1395.
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    Day 2 – Visit to the medical ICU and medical ward Today started off with a 10-minute meeting with the medical emergency and cardiac arrest team at RUSH University Hospital, Chicago. This team consisted of a critical care outreach nurse, the medical intensive care unit (ICU) doctor, a respiratory therapist and a pharmacist – "yes, a pharmacist!" This is so drugs can be sent up to the ward without delay, pre-prepared and appropriate for the patient. Respiratory therapists assist with intubation and oxygenation of the patient. Unfortunately, the meeting was cut short due to a ‘code blue’, a cardiac arrest. I’m not sure what I was expecting; a bunch of doctors and nurses calmly following the protocol while dramatic music was playing in the background maybe? Seems I must watch too much drama on TV. It was nothing like that. For all those who work in a hospital and are aware of what a cardiac arrest is like where you work… it was like that. Lots of people in a room, some initial disorganisation, lots of voices, equipment being sought, people walking in and out of the room trying to find stuff, sounds familiar? It was like that. Nurse patient ratio is 1:2 on the medical ICU. In the UK our ratio is 1:1 for ventilated patients; they require close observation as they may pull out their breathing tube. The patients here at RUSH are cared for in single rooms and to ensure they do not pull their tubes out they physically restrain their patients using straps on the wrists. This practice is unheard of in the UK. When questioning the ICU team they were shocked that we chemically restrained our patients, as they don’t use as much sedation as the UK. "One of the intubated patients was sat up comfortably watching TV, a sight we had not seen before!" Family members play a large part in care here. They allow 24-hour visiting and encourage them to stay with the patient overnight on the sofa bed in the room. Family members play an active role in the ward round, they are able to voice their concerns and make suggestions. At RUSH hospital there are around 700 beds, 100 of these beds are ICU beds. The ICU beds are not as much as a premium as they are in the UK. If a patient on the ward or ED needs a bed there is minimum waiting time. The whole hospital is paperless: documentation, doctors notes, pharmacy, drug charting… everything. "Imagine an IT system that talks to pathology, imaging and pharmacy." By having everything computerised it allows for more robust patient safety solutions by using a forcible function. For example, nephrotoxic drugs cannot be prescribed to a patient who has an acute kidney injury (AKI) showing up on their blood results; the computer will not allow it until certain checks have been completed. Some hospitals use this technology; however, it is not yet standard practice. That morning we also attended a ‘town hall meeting’. This was a meeting where the Chief Operating Officer (Cynthia) informed staff of what new plans there were for the hospital, strategies and updates. Questions from the floor were actively encouraged from an audience of over 200 people! Questions ranged from parking problems to staff safety. The town hall meeting is held four times a year and is a chance for staff to engage with the senior leader team. "Conversations were honest and non-hierarchical." In the afternoon we observed on an acute medical ward. Processes such as patient escalation, end of life care, track and trigger scoring, and patient observations were different to the UK. Critical care outreach teams (CCOT) are in their infancy here, while the UK has established CCOTs since the early 2000s. Granted, the UK CCOTs are not standardised; however, this is something that the National Outreach Forum are working towards. Today was enlightening; it highlighted the importance of collaboration of the RUSH CCOT and the UK CCOT. We can learn so much from each other, building lasting relationships that will, in-turn, improve outcomes for our patients. Read part 1 of Claire's blog
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