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Content ArticleMany people see their GP with symptoms that could either get better without treatment, or be a sign of serious illness; their diagnosis is uncertain. Research has explored how GPs and patients can work together to develop follow-up plans (a process known as safety-netting). New recommendations could help GPs manage uncertain diagnoses. To avoid unnecessary referrals, GPs may adopt a ‘watch and wait’ strategy when someone has an uncertain diagnosis. This strategy should come with a clear follow-up plan so that people understand the possible causes of their symptoms, how to look after themselves and what to do if symptoms persist. This is good safety-netting. Without good safety-netting, watch and wait carries risks. For example, late cancer diagnoses have been linked to poor safety-netting. However, professional guidance on safety-netting is lacking. This is a knowledge and practice gap. A study from Friedemann Smith explored the best ways to deliver safety-netting advice. It suggests that people are more likely to follow advice if they are involved in developing the follow-up plan. They need to understand: why they are receiving this advice what actions are required, and by whom. The lack of time within primary care consultations is well known. This may need to be addressed for clinicians to have long enough to develop a safety-netting plan. Professionals may also need training to develop the appropriate communication skills.
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Content ArticleNHS England have developed a review tool to support NHS organisations in reducing inequalities in patient safety.
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Content ArticleThis blog by Brita Lundberg of Lundberg Health Advocates looks at how healthcare providers can sometimes blame the patient for their condition, errors in treatment and communication issues. She looks at the role that language used in medical settings and historical views of the medical profession have on the tendency to blame patients, and highlights how the issue is also present in wider society. She offers three potential steps to help tackle patient-blaming: Recognise the problem, as it is difficult if not impossible to solve a problem until one recognises that it exists. Families, friends and clinicians should start with the assumption that the patient is correct and question others, particularly any in authority. All of us can be much too quick to dismiss patients’ concerns and to reassure them. It’s a bad habit. Instead–it is prudent never to eliminate any diagnosis, particularly one suggested by the patient, until all the supporting and contradictory evidence for each is carefully considered. Listen–that terribly overused and so little practiced—word. Listening instead of interrupting right away not only helps preserve the flow of the narrative but also gives us time to think about what is being said, and time to formulate a more considered response.
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Content ArticleIn this interview with the publisher Bloomsbury, freelance health journalist and founder of the Hysterical Women blog Sarah Graham talks about her book, Rebel Bodies: A guide to the gender health gap revolution. She discusses the recurrent themes she came across in her work as a health journalist which inspired her to set up her blog: women's experiences of gaslighting, dismissal and disbelief by the medical system. Sarah talks about how her book aims to bring together all the stories and ideas she has worked on for the last five or so years and highlight how closely they’re linked. The book also celebrates the resilience, determination, sisterhood and solidarity Sarah has witnessed from patient advocates and campaigners across the sphere of women’s health and trans health. Read Sarah's 2020 blog, Gender bias: A threat to women’s health, on the hub.
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Content ArticleHealthcare professionals are encouraged to use feedback from their patients to inform service and quality improvement. This study in the journal Sociology of Health and Illness aimed to understand how three NHS Trusts in England were interacting with patient feedback through online channels. The authors found that organisations demonstrated varying levels of ‘preparedness to perform’ online, from invisibility through to engaging in public conversation with patients within a wider mission for transparency. Engagement varied between the Trusts; one organisation employed restrictive ‘cast lists’ of staff able to respond to patients, while another devolved responding responsibility amongst a wide array of multidisciplinary staff.
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EventPRSB is hosting a live podcast which will feature a vibrant discussion on the importance of human connection and personalised approach in providing care. Attendees will hear from Sarah Woolf, Movement Psychotherapist, who will talk about her own experience of how personalised care helped her recover from her condition, not only physically, but also emotionally and mentally. Sarah had the chance to describe her story in an article for the BMJ. The podcast will provide the opportunity for Q&A, and attendees will also be encouraged to share their own experiences and how they think personalised care can meet people's needs and expectations of care. The event is free to attend and everyone is welcome to join. Register
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Content ArticleSarah Woolf shares the impact her cancer treatment had on her mental health and describes why it is important to see each patient as a whole person, understanding that their body has meaning for them
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Content ArticleIn this post, Amber Clour, author of the Diabetes Daily Grind blog, talks about her experience of managing her type 1 diabetes while attending the emergency room for suspected appendicitis. She describes the steps she took to make sure her blood sugar levels were managed safely and with her consent, including communicating clearly with all healthcare professionals, ensuring her continuous glucose monitor (CGM) was not removed and bringing her own supply of glucose tablets to manage hypoglycaemia. Further reading Blog - “I felt lucky to get out alive”: why we must improve hospital safety for people with diabetes
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Content ArticleThis blog published by the Irish Health Service Executive (HSE) tells the story of Mark, who was diagnosed with schizophrenia 15 years ago, aged 15. It describes the issues he and his mother faced in getting him the care he needed, including being treated inappropriately and without dignity during emergency department visits, problems accessing ongoing community support and a reluctance to assist him with reducing his medication dosage. It also highlights how his family were not included in care plans and treatment decisions, and their needs as carers were rarely considered.
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Content ArticlePsychological safety is the belief that you won’t be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. This article by the Center for Creative Leadership explores why psychological safety is so important to foster in workplaces. It suggests eight steps toward creating more psychological safety at work and describes the four stages of psychological safety.
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Content ArticleThis research by the Nuffield Trust looked at how smaller hospitals have fared over the pandemic. Smaller hospitals are sometimes overlooked when system planning gets done, so this report focuses on the operational responses and management approaches taken by staff from 10 smaller hospitals over the course of the first and second waves of the pandemic. It aims to tell the stories of those working in small hospitals in order to understand what happened to acute and emergency care in these institutions during the pandemic. The authors interviewed staff in smaller hospitals around the country during 2021 to understand their key concerns. The report makes a set of recommendations for future crisis planning and response.
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Content ArticleInadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project, published in Patient Safety, aims to improve hand-off communication from hospital to SNF by utilising a standardised hand-off tool. Authors conclude that the use of standardised hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardised hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.
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News Article
"Doctors discuss my daughter like she's nothing"
Patient Safety Learning posted a news article in News
A doctor in Cambridge is spearheading a project to help to reform "blunt" medical language that patients and their families can find upsetting. Ethicist Zoe Fritz said language that "casts doubt, belittles or blames patients" was long overdue for change. Sixteen-year-old Josselin Tilley from Wiltshire has charge syndrome that reduces her life expectancy. Her mother Karen said Josselin's death was often referred to in correspondence "like she's not a person. "It's not person-centred at all, it's like she's just nothing." The example she gave was an extract from a typical letter in November that she was copied in to by a community paediatrician addressed to colleagues. "Death below 35: On discussion with Josselin's mum early death has been discussed with her, and there is plan, discussed with Josselin's mother about a wishes document being done." Mrs Tilley, from Westbury, said she objected to the use of language that "very bluntly discusses Josselin's death like she's something going off in the fridge". Doctor Fritz said the reason she and doctor Caitriona Cox were running the campaign at Cambridge University was because they recognised language regularly used by clinicians was often problematic for anyone outside of medical practice. "Even just (the term) presenting [a] complaint. Patients coming into hospital with whatever's bothering them we [doctors] talk about as a complaint and I think that infantilises the patient. They're not complaining when telling us what's going on." Read full story Source: BBC News, 17 January 2023 Further reading on the hub: Presenting complaint: use of language that disempowers patients -
Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Ian talks to us about rebuilding patient trust in the healthcare system, how the Private Healthcare Information Network (PHIN) is helping to improve decision making for patients in the private sector, and why recognising the link between physical and mental health is vital to patient safety. -
News Article
Pandemic care home death: Family to sue over mother's end-of-life consent
Patient Safety Learning posted a news article in News
A man plans to sue a nursing home because, he says, during the pandemic his mother was put on end-of-life care without her family being told. Antonia Stowell, 87, did not have the mental capacity to consent because she had dementia, say the family's lawyers. Her son, Tony Stowell, said if end-of-life care had been discussed, he would not have agreed to it. Rose Villa nursing home in Hull says all proper process in Mrs Stowell's care was followed with precision. As a prelude to legal action, Mr Stowell's lawyers have obtained his mother's hospital records which, they say, show she was diagnosed with suspected pneumonia while living in the home. End-of-life drugs were then prescribed and ordered by medical professionals. In a statement, Rose Villa said: "We believe that our dedicated and professional team provided Antonia with the very best care under the direction of her GP and medical team, and all proper process in the delivery of this care was followed with precision." Mr Stowell's lawyers, Gulbenkian Andonian solicitors, said his mother's hospital records reveal the decision to put her on end-of-life care was made two days before the family was told. In their letter to the home announcing the planned legal action, they said Mrs Stowell could have had "48 additional hours on a ventilator with treatment… with the necessary implication that Antonia Stowell could still be with us today or at least survived". The lawyer dealing with the case, Fadi Farhat, told the BBC: "As a matter of law, there is a presumption in favour of treatment which would preserve life and prolong life, irrespective of one's age or condition. "Therefore to deviate from that presumption means a patient, or family members, should be consulted as soon as that decision is made or contemplated." He adds: "What is particularly concerning for me is this case occurred at the height of the pandemic. That should worry everybody because it demonstrates that rights can be suspended in times of crisis, when the very purpose of legal rights is to protect us during times of crisis." Read full story Source: BBC News, 9 January 2023 -
Content ArticleOn the 5 February 2020 an inquest was opened into the death of Hayley Smith. The jury concluded on 9 March 2022 with a narrative conclusion “The deceased died from complications of anorexia nervosa.” Hayley had developed severe and enduring anorexia nervosa at around the age of nine or ten and was resistant to treatment including several hospital admissions both voluntary, and at times compulsory treatment under the Mental Health Act. She was repeatedly admitted to hospital. On the 23 December 2019 Hayley had not eaten, became confused and unwell, and an ambulance was called. The correct emergency treatment was provided but Hayley responded quickly and regained consciousness and refused further treatment or admission to hospital. On 24 December she became unwell again and this time was taken to Queen Elizabeth the Queen Mother hospital where she again refused treatment and discharged herself against medical advice. The responsible medical officer from the Kent Eating disorder team gave evidence that had the team known of either of these episodes they would have taken steps to admit her and treat her.] On Christmas Day 2019 she collapsed for a final time and this time, had an out of hospital cardiac arrest, and was admitted to Queen Elizabeth the Queen Mother hospital and transferred to Intensive care where she was diagnosed as suffering from hypoxic brain damage as a result of her cardiac arrest due to severe hypoglycaemia as a consequence of her Anorexia Nervosa. She died on 29 December 2019 at the age of 27.
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Content ArticleThis video by Solent NHS Trust looks at the role of Community Partners in helping the Trust engage in conversations with the community in a meaningful, sustained way. It includes interviews with: Anastasia Lungu-Mulenga, Head of Community Engagement at Solent NHS Trust Annie Clelow, Manager of Communicare Southampton Anne Cato, Community Partner Joe Jennes, Senior coordinator, Carers in Southampton Ellie and Ray from the CAMHS youth participation group Sapna Vohra, Community engagement facilitator Sarah Balchin, Associate director, community engagement
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Content ArticleCancer Research UK, in partnership with London-based tech company Stitch, are piloting an app for patients to use whilst participating in a clinical trial. The Trialmap app, which was co-created with patients, is being piloted on a clinical trial run by Cancer Research UK’s Centre for Drug Development. The aim of the app is to ensure patients feel valued for their participation, and to improve patient experience during clinical trials. This article looks at how the app: allows patients to easily view information about the trial gives reminders about appointments and what patients might need to do to prepare for them gives patients the opportunity to provide real-time feedback regarding their time on the trial.
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Content ArticleThis is the recording of a webinar hosted by The Patients Association, about working with partners in industry to allow patient voices to influence care and treatment. The webinar was part of Patient Partnership Week 2022 and featured: Sarah Louis, patient participant and Sarah Whitehead, External Relations and Public Affairs Manager, Novo Nordisk talking about a biosimilars project Carolyn Wheatley, patient participant and Robert Browne MSc, Senior Scientific Affairs Manager, Nutricia, talking about the nutrition checklist Fran Husson, patient participant and Dr Aman Gupta, Medical Affairs Manager Pfizer, on work in antimicrobial resistance.
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Content ArticleThe Royal College of Anaesthetists set up PatientsVoices@RCoA to help the College improve the delivery of safe, more effective, patient-centred care to enhance patients’ experience of anaesthesia and perioperative care. This plan by PatientsVoices@RCoA aims to set out a clear direction for our future work which ensures patients’ voices are clearly heard across all relevant activities, as the College delivers its strategic aims over the next five years.
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Content ArticleRegina Kamoga, Executive Director of the Community Health And Information Network (CHAIN) in Uganda, delivered this presentation to the 6th Annual Pharmacovigilance Stakeholder Meeting on 30 November 2022. The presentation outlines how CHAIN is working to develop and support expert patients and patient groups in underserved communities in Africa, as well as highlighting the key medication safety issues faced by these communities, including low health literacy, poor reporting culture and healthcare worker knowledge gaps. The presentation then looks at how CHAIN implemented the World Health Organization's (WHO) Global Patient Safety Challenge in Ugandan communities through patient engagement and healthcare worker education. To conclude the presentation, Regina makes recommendations to improve medication safety: Sustain advocacy for medication safety and become a voice to the voiceless Adopt a culture of safety that incorporates the patient as a care team member not a perceived receiver of care Build and strengthen networks on patient safety Communication and open discussion between healthcare providers and patients to improve patient doctor relationship Increase collaboration with civil society organisations and patient organisations Adopt Start Early In Life initiative to instil a safety culture early in life Establish medication safety multidisciplinary working group Patient, family and community engagement should be at the core of key stakeholders interventions
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Content ArticleThis report commissioned by the NHS Confederation and written by the Centre for Mental Health sets out a vision for what mental health, autism and learning disability services in England should look like in ten years’ time. It brings together research and engagement with a wide range of stakeholders including people who bring personal and professional experience. The report identifies ten interconnecting themes that underpin the vision and three key requirements that would turn the vision into reality.
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Content ArticleIn this blog for Medpage Today, US doctor Diane Solomon talks about the power of apologising to patients. Outlining the tendency of healthcare professionals to defend their practice, she describes how being honest and open with patients about errors demonstrates humanity and compassion. She talks about the importance of being sincere when apologising and outlines how taking responsibility builds trust and can positively change future outcomes.
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Content Article
HSIB: Safety investigation jargon buster
Patient Safety Learning posted an article in HSSIB investigations
A guide to the terms commonly used in safety investigations and their definitions. -
Content Article
This online comic has been developed by the Royal College of Anaesthetists and the Association of Paediatric Anaesthetists of Great Britain and Ireland to help children aged 7-11 understand what it’s like to have a general anaesthetic, using familiar Beano characters to help reduce any anxiety they may have about surgery. It is a fun and playful way to help children understand more about their operation and how to prepare for it, and includes links to other resources. Readers can accompany Dennis on a fun-filled journey as he prepares to have his tonsils removed, from diagnosis to discharge from hospital. The comic answers children's questions, including: what is a general anaesthetic and is it safe? how will I feel when I wake up? how can I prepare for my operation? what should I do if I am worried or have questions? 'Dennis has an anaesthetic' will also help children and their parents and carers understand what happens in the run-up to an operation, the care children will need afterwards and how they can best prepare.
