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Found 77 results
  1. Content Article
  2. Content Article
    The objectives of this study protocol is to establish baseline data related to the types and frequency of infusion pump alarms from the B. Braun Outlook 400ES Safety Infusion System with the accompanying DoseTrac Infusion Management Software. This exploratory study will analyse the aggregate alarm data for each hospital by care area, drug infused, time of day, and day of week, including overall infusion pump alarm frequency (number of alarms per active infusion), duration of alarms (average, range, median), and type and frequency of alarms distributed by care area. Infusion pump alar
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  4. News Article
    A London hospital has launched an investigation after a woman whose baby died in the womb had to deliver her son at home due to lack of beds and keep his remains in her fridge when A&E staff said they could not store them safely. Laura Brody and her partner, Lawrence, said they were “tipped into hell” after being sent home by university hospital Lewisham to await a bed when told their baby no longer had a heartbeat but no beds were immediately available to give birth, the BBC reported. Two days later, after waking up in severe pain, Brody, who was four months into her pregnancy,
  5. News Article
    Hundreds of organisations, including drug companies, private healthcare providers and universities, have breached patient data sharing agreements but not had their access to patient data withdrawn, a report reveals. “High risk” breaches were revealed to have occurred at healthcare groups, pharmaceutical giants and educational institutions including Virgin Care, GlaxoSmithKline (GSK) and Imperial College London, during audits by NHS Digital, according to an investigation by the BMJ. This means these organisations were handling information outside the remit agreed in data contracts and
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    Dozens of hospital trusts have failed to act on alerts warning that patients could be harmed on its wards, The Independent newspaper has revealed. Almost 50 NHS hospitals have missed key deadlines to make changes to keep patients safe – and now could face legal action. One hospital, Birmingham Women’s and Children’s Foundation Trust, has an alert that is more than five years past its deadline date and has still not been resolved. Now the Care Quality Commission (CQC) has warned it will be inspecting hospitals for their compliance with safety alerts and could take action against hospi
  10. Content Article
    In the late eighties, I attended a presentation on the future of the UK Medtech sector presented on behalf of the government by KPMG. The main message being the government’s desire for the industry to focus on research and development whilst transferring manufacturing to China! What relevance does this have to patient safety? Fast forward some twenty years and I am presenting the case for adoption of one of our most successful unique patented patient safety products (successful global use at this point around the 5 million patient level) to one of the largest NHS trusts. The difficu
  11. Content Article
    This is a template that can be used by health professionals carrying out medicines reconciliation.
  12. Content Article
    We have all heard of the terrible stories of nurses going to the coroner’s court. These stories have been fed to us by our seniors, our mentors, our lecturers since we were students. "If you don’t document properly, you will end up in the coroner’s court, you might even get struck off!" These stories strike the fear of god into you. No one wants to go to coroner’s court, no one wants to be criticised for the work they have spent years training to do. No one wants to be publicly humiliated. This is my story of what happened when I attended a coroner's hearing on a patient who
  13. Content Article
    Five tips: People aren't machines Push the button Differeing shapes and sizes Stamina and repetition Look around
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    Safety clutter is the accumulation of safety procedures, documents, roles, and activities that are performed in the name of safety, but do not contribute to the safety of operations. Safety clutter is a problem because of the opportunity cost of ineffective activity, because clutter results in cynicism and ‘surface compliance,’ and because clutter can hamper innovation and get in the way of getting work done. The authors of this paper identify three main mechanisms that generate clutter: duplication, generalisation, and over-specification of safety activities. These mechanisms in turn are
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    What can I learn? Patient experience remains the weakest of the three arms of quality; it doesn’t get the same attention as safety and clinical effectiveness and still tends to be seen as a nice add-on. This needs to change. Don’t measure, unless you’re willing and able to improve. Start small, but start. Don’t be focussed on the barriers. Measure well. Feedback responsibly, link it to improvement. Don’t worry about unleashing high patient expectations that can’t be met.
  23. Content Article
    What can I learn? This web page gives you information on: the friends and family test patient insight group an animation on how the quality framework works.
  24. Content Article
    Prompt cards can be used by all members of the Emergency Department Team. If used correctly they will improve patient safety and reduce human factor errors. Prompt Card Version 3.0.pptx
  25. Content Article
    My much loved daughter-in-law, Mariana Pinto, died on 16 October 2016. She was 32. Her tragic and unexpected death raised many questions for us about standard practice by psychiatric services and about patient safety. The evening before she died, Mariana was taken by ambulance to her local A&E department, escorted by four police officers, and handcuffed for her own safety. She was psychotic – delusional, paranoid, violent and very distressed. She had attacked her husband (my son) who had visible bite marks, scratches and bruises. It was a first episode and totally out of character.
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