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Content ArticleMidwives, public health nurses and practice nurses are in an ideal position to address mental health and emotional well-being with women in the perinatal period. However, research involving midwives, public health nurses and practice nurses in Ireland indicates that there is considerable variation in perinatal mental health assessment and care. All three groups identify the following issues as barriers to addressing perinatal mental health issues: Lack of knowledge on the range of perinatal mental health problems Lack of skill in opening a discussion and developing a plan of care with women Organisational issues, such as lack of policies, guidelines and care pathways This document produced by the Irish Health Service Executive, aims to provide an evidence-based guidance document for midwives, public health nurses and practice nurses in the area of perinatal mental health care.
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News Article
Largest private-sector nurses strike in U.S. history begins in Minnesota
Patient Safety Learning posted a news article in News
About 15,000 nurses in Minnesota walked off the job Monday to protest understaffing and overwork — marking the largest strike of private-sector nurses in U.S. history. Slated to last three days, the strike spotlights nationwide nursing shortages exacerbated by the coronavirus pandemic that often result in patients not receiving adequate care. Minnesota nurses charge that some units go without a lead nurse on duty and that nurses fresh out of school are delegated assignments typically held by more experienced nurses, across some 16 hospitals where strikes are expected. The nurses are demanding a role in staffing plans, changes to shift scheduling practices and higher wages. “I can’t give my patients the care they deserve,” said Chris Rubesch, the vice president of the Minnesota Nurses Association and a nurse at Essentia Health in Duluth. “Call lights go unanswered. Patients should only be waiting for a few seconds or minutes if they’ve soiled themselves or their oxygen came unplugged or they need to go to the bathroom, but that can take 10 minutes or more. Those are things that can’t wait.” Read full story (paywalled) Source: Washington Post, 12 September 2022 -
Content ArticleIssues with medication management and errors in medication administration are major threats to patient safety. This article for the US Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network takes a look at the AHRQ's current areas of focus for medication safety. The authors look at evidence-based solutions to improve medication safety in three areas: High-risk medication use and polypharmacy in older adults Reducing opioid overprescribing, increasing naloxone access and use and other interventions for opioid medication safety Nursing-sensitive medication safety The article also explores future research directions in medication safety and highlights that these will advance patient safety overall.
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Content ArticlePatient safety culture is a vital component in ensuring high-quality and safe patient care. This cross-sectional study aimed to assess doctors’ and nurses’ perceptions of patient safety culture in five public general hospitals in Hanoi, Vietnam. The study found that the mean scores among nurses were significantly higher than that among physicians for several categories: supervisor/manager expectations staffing management support for patient safety teamwork across units handoffs and transitions Nurses reported significantly higher patient grades than physicians (75% vs 67.1%) and around two-thirds of physicians and nurses reported no event in the past 12 months (62.8 and 71.7% respectively). The authors recommend that hospitals develop and implement intervention programs to improve patient safety, including around teamwork and communication, encouraging staff to notify incidents and avoiding punitive responses.
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Content ArticleHypothermia is a common problem in the operating theatre, and it contributes to many poor outcomes including rising costs, increased complications and higher morbidity rates. This literature review in the Journal of PeriAnesthesia Nursing aimed to determine the best method and time to prewarm a patient in order to prevent hypothermia during or after surgery. The authors suggest that forced-air warming is most effective in preventing perioperative hypothermia. Eighty-one percent of the experimental studies reviewed found that there was a significantly higher temperature throughout surgery and in the post-operative care unit for patients who received forced-air prewarming.
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News ArticleNurses in North Carolina, USA, can now be sued for patient harm that results from them following physicians' orders, the state Supreme Court ruled last month. The 19 August ruling strikes down a 90-year-old precedent set by the 1932 case Byrd v. Marion General Hospital, which protected nurses from culpability for obeying and executing orders from a physician or surgeon, unless the order was obviously negligent. The North Carolina Supreme Court overturned this ruling in a 3-2 opinion as part of a separate case involving a young child who experienced permanent anoxic brain damage during an ablation procedure at a North Carolina hospital in 2010. The ruling means the certified registered nurse anaesthetist involved in the ablation could be held liable for the patient's harm. "Due to the evolution of the medical profession's recognition of the increased specialization and independence of nurses in the treatment of patients over the course of the ensuing ninety years since this Court's issuance of the Byrd opinion, we determine that it is timely and appropriate to overrule Byrd as it is applied to the facts of this case," Justice Michael Morgan wrote in the opinion. Read full story Source: Becker's Hospital Review, 6 September 2022
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EventuntilHuman activity is driving global warming at an alarming rate. Extreme temperatures, air pollution, drought and floods affect all nations – including the UK and Republic of Ireland. This climate emergency is also a health emergency. As nurses and midwives, we must act now as a profession to safeguard our patients and services from the effects of a warming world. This joint Royal College of Nursing and NHS England conference builds on the aspirations of the United Nations Sustainable Development Goals. Join to raise awareness of the impact of care provision on greenhouse gas emissions, and explore the opportunities this challenge presents to improve health and care services. Register
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News Article
Nurse says she faced hours of racist abuse
Patient Safety Learning posted a news article in News
A nurse who was racially abused at work has urged Health Minister Robin Swann to take action on racism towards healthcare staff. Beverly Simpson, a nurse for more than 25 years, said she was subjected to hours of abuse while working last weekend. The incident at the weekend took place in a private healthcare setting, Ms Simpson told BBC Radio Foyle. She said she was called racist slurs by a patient for several hours. "I want to do nursing, I have always been a nurse," she said. "I never realised that I would be placed in such a vulnerable position and I actually question myself if I should walk away." Ms Simpson said she wanted to speak publicly to make sure "any other nurse from a black or minority ethic group did not feel alone". "There is abuse going on, it's something that is happening," she said. "I felt, for the first time in a long while, about quitting. I asked myself: 'What is the point?' "I understand that when people are sick their defences may be down, they're more vulnerable and they may say things they shouldn't, but there was a nastiness to it." In a statement, the Department of Health said racism was not something that any colleague in Health and Social Care (HSC) should have to endure. "We want to send a clear message, from the very top of our health and social care system, that such behaviour is totally unacceptable and will not be tolerated," the department said. "We fully recognise and respect the hard work, commitment and dedication of HSC staff from within the BAME [black, Asian and minority ethnic] community." Read full story Source: BBC News, 6 September 2022 -
Content ArticleThese tools and resources from the National Institute for Health and Care Excellence (NICE) accompany the NICE guidance on Hypothermia: prevention and management in adults having surgery. Resources available for download include: Audit and service improvement baseline assessment tool Implementation support advice document Education information Shared learning information Practical steps to improving the quality of care and services using NICE guidance
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Content ArticleWhen hospital patients do not have their teeth brushed it can lead to them developing pneumonia—poor dental hygiene in hospital is believed to be a leading cause of hundreds of thousands of cases of pneumonia a year. In this blog for Medscape, reporter Brett Kelman looks at the link between dental hygiene and hospital-acquired pneumonia, which kills up to 30% of patients who are infected with it. He highlights a lack of understanding of the impact of failing to brush inpatients' teeth, in spite of a growing body of research evidence that links lack of adequate toothbrushing to pneumonia infection.
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News Article
Minnesota nurses’ strike vote puts safety and conditions in spotlight
Patient-Safety-Learning posted a news article in News
Nurses at 15 hospitals in the Twin Cities area (Minneapolis-St Paul) and Duluth, Minnesota, that are negotiating new union contracts with their respective hospitals have overwhelmingly voted to authorize a strike. A date for the work stoppage has not been set yet by the union, the Minnesota Nurses Association, which represents about 15,000 nurses who voted on the strike authorization, but a 10-day notice must be given ahead of any strike. If a strike is carried out, it would be one of the largest nurses’ strikes in US history. Jayme Wicklund, a registered nurse at the Children’s hospital in St Paul, Minnesota, and member of the negotiating committee, said, “We need more resources to take care of the patients. The hospitals are very focused on wages. We have to be comparable to other places. But that’s all that they focus on. Once you start talking about wages, they don’t want to talk about the other important issues around patient safety or actually, other ways to save money.” Read full story Source: The Guardian (23 August 2022) -
News Article
UK to recruit nurses from Nepal under new government deal
Patient-Safety-Learning posted a news article in News
Up to 100 nurses are to be recruited from Nepal to work in the NHS, despite global restrictions on employing health workers because of staff shortages in the country. The Department of Health and Social Care (DHSC) and the Government of Nepal have signed a new government-to-government agreement regarding the recruitment of Nepali health professionals to the UK. The move comes after the new health and social care secretary Steve Barclay announced plans to “significantly increase” overseas recruitment of health workers to help mitigate staff shortages in the UK. A 15-month pilot phase will initially see up to 100 nurses recruited from Nepal to work at Hampshire Hospitals NHS Foundation Trust. Read full story Source: Nursing Times (23 August 2022) -
News Article
NHS trialling 'smart goggles' so nurses can see more patients
Patient Safety Learning posted a news article in News
NHS nurses will wear “smart goggles" as part of efforts to see more patients under a £400,000 pilot scheme. Health chiefs said the virtual reality headsets would mean details of a consultation could be directly transcribed, reducing the amount of time spent filling in patients’ notes. The technology will also allow live footage to be streamed to hospital specialists for second opinions, so patients do not have to have extra appointments in hospitals. The intention is to give nurses more time for clinical duties such as checking blood pressure, dressing wounds and assessing a patient’s health needs. Dr Tim Ferris, NHS director for transformation, said: “These new smart glasses are the latest pioneering tech and really show us what the future of the NHS could look like. “They are a win-win for staff and patients alike, freeing up time-consuming admin for nurses, meaning more time for patient care.” Read full story (paywalled) Source: The Telegraph, 20 August 2022 -
News ArticleA care home nurse has been struck off after he gave a brain tumour patient sugar and water instead of pain relief. Vijayan Rajoo said he felt the patient was "just being lazy" and did not need pain relief. Rajoo, 64, also failed to check supplies in the controlled drug cupboards at the start and end of his shifts, according to a misconduct panel. He was struck off for 18 months after a deputy manager at the home, St Fillans in Colchester, Essex, discovered 20ml of liquid morphine Oramorph was unaccounted for in June 2019. Rajoo later confessed to not giving the brain tumour patient a dose of Oramorph as a form of pain relief as he felt the patient "did not need it". It was reported the patient could immediately tell the sugar and water mix "didn't taste right". The misconduct panel found all charges against Rajoo proven. In their conclusions, the panel said Rajoo showed a "serious lack of compassion". Read full story Source: ITV News, 13 August 2022
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News ArticleSpecialist nurses at an NHS hospital have been told they may be taken off clinical shifts to help clean wards, it has emerged. Bedfordshire Hospitals NHS Foundation Trust has said it asked nursing staff to help clean wards as the hospital faced the “most challenging circumstances” it has ever faced. Clinical specialist nurses, who are advanced nurses and can usually have hundreds of patients under their care, were among those asked to spend entire shifts helping other wards “cleaning”, “tidying” and “decluttering”. The news has prompted criticism from unions, however, multiple nurses have reported that the requests happen “often” during winter. Alison Leary professor of healthcare and workforce at South Bank University warned that asking specialist nurses to drop their work was “very risky”. She said: “This problem keeps cropping up-as soon as there is pressure on wards they are expected to abandon their patients. It usually happens in winter and so it’s concerning that it has now started to happen in summer. “This also shows very little respect for nursing generally and will not help retention. Trusts need to plan workforces accordingly and should ensure they have the right amount of cleaning, administrative and housekeeping staff-all staff groups which contribute to patient safety and care quality." Read full story Source: The Independent, 8 August 2022
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Community Post
Are you currently working on an inpatient mental health ward in the UK?
AmaniKrayem posted a topic in Calls for research/funding opportunities
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Are you currently working on an inpatient mental health ward in the UK? We would like to learn about how you feel towards restrictive practices on mental health wards. Go to https://tinyurl.com/restrictivepractices to find out more.
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Content Article
Laurence Goldberg, an independent pharmaceutical consultant, discusses the effectiveness and also the potential for harm of unit-dose medicines distribution. -
Content ArticleThe importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine’s (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes”. Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety. Researchers have generally found that lower staffing levels are associated with heightened risks of poor patient outcomes. Staffing levels, particularly those related to nurse workload, also appear related to occupational health issues (like back injuries and needlestick injuries) and psychological states and experiences (like burnout) that may represent precursors for nurse turnover from specific jobs as well as the profession. This chapter from the Patient Safety and Quality: An Evidence-based Handbook for Nurses summarises and discusses the state of the science examining the impact of nurse staffing in hospitals and other health care organisations on patient care quality, as well as safety-focused outcomes. To address some of the inconsistencies and limitations in existing studies, design issues and limitations of current methods and measures will be presented. The chapter concludes with a discussion of implications for future research, the management of patient care and public policy.
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Content ArticleThis paper from Claire Su-Yeon Park aims to propose Park's sweet spot theory-driven implementation strategy, which makes optimal safe staffing policy really work in nursing practice.
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News Article
Private provider says its ‘robust nursing pipeline’ can benefit NHS
Patient Safety Learning posted a news article in News
A large private provider says it is finding it harder than ever to fill its staffing vacancies, but is optimistic that its investment in nursing apprenticeships and overseas recruitment can help expand NHS-commissioned capacity. In an interview with HSJ, Shelley Thomas, group HR director for Spire Healthcare, said the company is facing the same staffing difficulties as NHS providers. She said: “We’re all feeling the same things at the moment… high sickness absence, high holidays, teams that are worn out. We’re all… experiencing the same from a workforce perspective.” However, she said Spire is “working harder than ever” to fill vacancies, and now has a “really robust pipeline” of apprentices and oversees recruits. Despite the waiting list backlogs which have ballooned since the pandemic began, and a £10bn framework in place for the NHS to utilise private sector capacity, analysis suggests NHS activity undertaken by private hospitals has been below pre-covid levels in almost all specialities. Ms Thomas suggested the staffing difficulties had been a factor in that, but acknowledged there were more conversations to be had locally about how the private sector could undertake more activity. She said the pandemic was a “huge catalyst for stronger working partnerships” between the NHS and the private sector and that relationships are “stronger than they’ve ever been”. Read full story (paywalled) Source: HSJ, 4 August 2022 -
Content ArticlePatient safety culture is the foundation of patient safety and refers to a healthcare organisation’s shared values, norms and beliefs that influence staff’s behaviour and actions. This study in BMJ Open Quality aimed to assess nurses’ reporting on the predictors and outcomes of patient safety culture and the differences between patient safety grades and the number of events reported. It aimed to fill a gap in research by looking at patient safety culture in terms of both predictors and outcomes. The author developed a cross-sectional comparative research design and recruited 300 registered nurses to take part in a survey on patient safety culture. The author found that nurses generally perceived patient safety culture as 'moderate', and identified areas that should be prioritised to improve patient safety culture. They concluded that assessing patient safety culture is the first step in improving hospitals’ overall performance and quality of services, and that improving patient safety practices is essential to improving culture and clinical outcomes.
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Community PostIn unit-dose dispensing, medication is dispensed in single doses in packages that are ready to administer to the patient. It can be used for medicines administered by any route, but oral, parenteral, and respiratory routes are especially common. The system provides a fully closed loop process where the patient, the drug and the healthcare professional are identified by machine readable codes and the drug administration process is linked directly to the electronic prescription. and is fully recorded There are many variations of unit-dose dispensing. As just one example, when physicians write orders for inpatients, these orders are sent to the central pharmacy . Pharmacists verify these orders and technicians place drugs in unit-dose carts. The carts have drawers in which each patient's medications are placed by pharmacy technicians—one drawer for each patient. The drawers are labelled with the patient's name, ward, room, and bed number. Sections of each cart containing all medication drawers for an entire nursing unit often slide out and can be inserted into wheeled medication carts used by nurses during their medication administration cycles. Alternatively, electronic medicine storage cabinets can be located on wards and these are attached to medicine carts which are then filled from the cabinets. Studies often compare unit-dose dispensing to a ward stock system. In this system, bulk supplies are issued from the pharmacy; the drugs are stored in a medication room on the ward. The correct number of doses must be taken out of the correct medication container for each cycle and taken to the patient for administration. Liquids must be poured by the nurse from the appropriate bottle and each dose carefully measured. Evidence for Effectiveness of the Practice Though the practice of unit-dose dispensing is generally well accepted and has been widely implemented, the evidence for its effectiveness is modest. Most of the published studies reported reductions in medication errors of omission and commission with unit-dose dispensing compared with alternative dispensing systems such as ward stock systems. Potential for Harm Unit-dosing shifts the effort and distraction of medication processing, with its potential for harm, from the ward to central pharmacy. It increases the amount of time nurses have to do other tasks but increases the volume of work within the pharmacy. Like the nursing units, central pharmacies have their own distractions that are often heightened by the unit-dose dispensing process itself, and errors do occur. Overall, unit-dose appears to have little potential for harm. The results of most of the observational studies seem to indicate that it is safer than other forms of institutional dispensing. However, the definitive study to determine the extent of harm has not yet been conducted. A major advantage of unit-dose dispensing is that it brings pharmacists into the medication use process at another point to reduce error. Yet about half of the hospitals in a national survey indicated that they bypass pharmacy involvement by using floor stock, borrowing patients' medications, and hiding medication supplies. Unit dose drug distribution is being introduced across Europe. In Germany, a recent study showed a saving of 2.61 WTE nurses per 100 beds. There is now growing interest in UK hospitals and pilot sites to develop the system are being established.
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News Article
Five hospital wards run with one registered nurse each
Patient Safety Learning posted a news article in News
Five wards at Scotland's largest hospital had to operate with one registered nurse on duty each. Staff at the Queen Elizabeth University Hospital in Glasgow experienced the shortage on Monday night. It is an example of the severe pressure affecting health services across the country, which has intensified due to the Covid-19 pandemic. Greater Glasgow and Clyde health board said nurses were supported by a number of other staff. Originally reported in the Daily Record, the shortage was described to staff in an email sent on Monday afternoon. The email said nurse staffing levels across medicine were critical, despite attempts to seek support from bank or agency workers. It said admin staff had been asked to stay on to offer support including answering phones and door buzzers for the rest of the week. As well as staffing problems, the pandemic has caused more bed blocking in Scotland's hospitals and longer waits for both emergency and outpatient treatment. Norman Provan, associate director at the Royal College of Nursing Scotland said the shortage had an impact on patient safety as well as staff wellbeing - concerns that had been raised with the health board and the Scottish government. He added: "We're in this situation largely because of the failure of Scottish government to address the nursing workforce crisis, which has seen registered nurse vacancies reach a record high. "Urgent action is needed to protect patient safety, address staff shortages and demonstrate that the nursing workforce is valued as a safety critical profession." Read full story Source: BBC News, 24 July 2022 -
Content ArticleThe National Infusion and Vascular Access Society (NIVAS) is a multidisciplinary organisation made up of healthcare professionals with a special interest in vascular access and IV therapy. This white paper by NIVAS lays out evidence that having a nursing-led vascular access team in every hospital in the UK will improve patient safety, reduce workload pressures for other staff, and save the NHS money. Vascular access involves the use of devices such as catheters to deliver or remove fluids, blood or medication from a patient’s bloodstream. The paper examines the arguments advocating for Vascular Access Services Team (VAST) across the NHS, acknowledging the current pressures of restarting the NHS following the pandemic and the roadmap to reduce the elective waiting lists. It also outlines how integrating a standardised model of VAST into the healthcare systems of the NHS will benefit patients, the new Integrated Care Systems (ICS) and the wider objectives of the NHS.
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News ArticleA nurse who recorded she had given medication to care home residents when in fact she had delegated the task to unqualified staff has been struck off. Adelaide Maloane was working a night shift at Somerleigh Court in Dorchester, Dorset, in August 2019 when the incident took place. Ms Maloane delegated giving 16 medicines to residents to an unqualified healthcare assistant at the home. The Nursing and Midwifery Council said Ms Maloane had "failed to acknowledge the seriousness of her misconduct and dishonesty and the implications of her actions for residents, colleagues and the reputation of the nursing profession". Read full story Source: BBC News, 21 July 2022
