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Posts Tagged ‘Patient safety’

Doctors must not sign up to ‘gagging clauses’

By Mike Broad - 26th January 2012 10:03 am

Doctors cannot enter into contracts or agreements with ‘gagging clauses’ and have a duty to act when they believe patient safety is at risk, new GMC guidance stipulates.

The new guidance Raising and acting on concerns about patient safety seeks to increase doctors’ sense of responsibility for the care they witness and to encourage ‘whistleblowing’.

The guidance explains when doctors need to raise concerns if patient safety is at risk, or when a patient’s care or dignity is being compromised, and advises on the help and support available to them, including how to tackle any barriers that they may face.

Niall Dickson, chief executive of the GMC, said: “These clauses are totally unacceptable. Doctors who sign such contracts are breaking their professional obligations and are putting patients, and their careers, at risk.”

Doctors also have responsibility for the safety and wellbeing of patients when performing non-clinical duties - including when they are working as a manager. New guidance Leadership and management for all doctors has also been issued with the aim of helping doctors understand their responsibilities in relation to employment issues, teaching and training, as well as planning and using and managing resources.

Responding to the guidance, defence body MPS said employers had to do more to support doctors in raising concerns and remove “the barriers”.

Dr Stephanie Bown, director of policy and communications at MPS, said: “We receive calls from members who have seen things that cause them concern, and who are seeking clarification about what to do. Unfortunately many express fear about the potential consequences of ‘rocking the boat’ and that they might be penalised for speaking up.

“The readiness of doctors to fulfil this professional responsibility has been clouded by fear of the potential consequences. It’s unacceptable for organisations and clinical leaders to simply pay lip service to ‘raising concerns’ about patient safety - they have to live it and they have to lead by example.”

The GMC’s new local liaison service will use the guidance and work with medical directors, doctors and patients groups to help foster openness and a willingness to speak out.

Dickson said: “Being a good doctor involves more than simply being a good clinician. It means being committed to improving the quality of services and being willing to speak up when things are not right - that is not always easy but it is at the heart of medical professionalism.

“Our new guidance also makes clear that doctors must not sign contracts that attempt to prevent them from raising concerns with professional regulators such as the GMC and systems regulators, such as the CQC. Nor must doctors in management roles promote such contracts or encourage other doctors to sign them. Those who promote or sign such agreements are breaking their professional obligations and putting their careers at risk.”

The guidance comes into effect on 12 March 2012.

MPS’s Brown added: “It is not about an organisation having a ‘policy folder’ that they dust off when there is an issue, it’s about the organisation developing the type of working environment which encourages and supports their staff to raise concerns openly, following the appropriate procedure.”

Read the raising concerns guidance and leadership guidance.

Tags: Leadership, Patient safety, Whistleblowing
Posted in Hospital Dr News | 1 Comment »

More consultants would improve weekend care

By Mike Broad - 28th November 2011 10:38 am

Patients are less likely to get treated promptly and more likely to die if they are admitted to hospital at the weekend, a report reveals.

Overall, 8.1% of those admitted at weekends died compared to 7.4% from Monday to Friday, once those having elective operations such as hip and knee replacements were discounted, the Hospital Guide - by health information company Dr Foster - suggests.

Doctors’ representatives are pointing to the report as evidence that the government must continue to support growth in consultant numbers.

The report says the chances of survival are better in hospitals that have more senior doctors on site. But some hospitals have too few senior doctors in hospital at weekends or overnight.

The report calls for re-organisation of services to ensure safe care 24/7. Examples of innovation from Poole, London, and Northumbria show this can be done to ensure access to high quality services at any time of day or night, it says. Local A&E departments need to identify the services they can provide safely and link with others to provide the services they can’t.

Hospital Guide provides an assessment of hospitals on four key measures of mortality. Chelsea and Westminster Hospital NHS Foundation Trust stands out as the only hospital with low rates on every measure. At the other extreme, Hull and East Yorkshire Hospitals NHS Trust is notable for consistently high rates, the report claims.

The four measures are:

Hospital Standardised Mortality Ratio (HSMR) - a measure of in-hospital deaths;

Summary Hospital-level Mortality Indicator (SHMI) - a measure of mortality both in-hospital and for deaths outside of hospital within 30 days;

Deaths after Surgery - surgical patients who have died from a possible complication; and

Deaths in low-risk conditions - deaths from conditions where patients would normally survive.

Roger Taylor, director of research and co-founder of Dr Foster, said 19 trusts showed high mortality rates.

“A safe NHS is an NHS that provides care 24/7. This year’s guide shows we are some way from that target with significantly reduced services at weekends and nights,” he said.

“However, fewer people died in 2009 than in any year since the mid 1950s - despite the population being larger and older. A large part of that success is down to improvements in care with in-hospital mortality rates falling steadily over the last 10 years.”

The Hospital Guide also identifies 31 trusts that have an above expected rate for not treating hip fracture patients within the recommended two days of admission.

Commenting on the report, Sir Richard Thompson, president of the Royal College of Physicians, said: “At last we have data that clearly links higher numbers of senior doctors in hospitals at the weekend with lower mortality rates. Over the past 10 years the number of doctors in the NHS has steadily increased and it is therefore not surprising that mortality rates have fallen.

“We must ensure that consultant numbers continue to increase to allow higher levels of staffing at the weekend in all hospitals. The findings support the RCP’s 2010 recommendation that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week. No other duties should be scheduled during this time.”

Tags: Consultants, Patient safety
Posted in Hospital Dr News | 1 Comment »

Foundation Programme curriculum being revised

By Mike Broad - 15th August 2011 2:34 pm

The Foundation Programme is being updated to address criticisms that juniors are having to work beyond their competency.

A draft curriculum has been released following an evaluation of the Foundation Programme by Medical Education England last autumn which suggested that juniors were working beyond their competency and compromising patient safety.

The Foundation Programme curriculum sets out the framework for educational progression in the first two years of professional development after graduation from medical school.

Professor Collins led the MEE review and suggested that supervision deteriorated in specialties with a large number of foundation placements.

The Academy of Medical Royal Colleges says the new draft curriculum revises and updates competencies. It also outlines the purpose of foundation and ‘high level descriptors’, differentiating between F1 and F2 outcomes.

The Collins review called on trainees to “step up” in their level of responsibility as they move from F1 to F2 but under appropriate supervision. This edition of the curriculum identifies the importance of supervised, practice-based learning.

The curriculum says: “Learning is best achieved when there is frequent observation of practice in the workplace with immediate feedback on performance from a senior clinician. Every clinical experience is a learning opportunity whether it occurs during ward rounds, in clinics, in primary care settings, on call, during procedures, etc.”

Other Collins review recommendations included greater focus on the total patient, long-term conditions, the increasing role of community care and the need for team-working.

Meanwhile, the way in which medical students are selected for the Foundation Programme is changing. Situational judgement tests are set to replace the current ‘white space’ questions after being piloted this autumn.

Candidates answer white space questions in their own time, which makes it harder to ensure that the work is their own.

Read the revised curriculum.

Offer your views to manjula.das@aomrc.org.uk

Tags: Foundation years, Patient safety
Posted in Hospital Dr News | No Comments »

Touchy-feely nonsense is key to patient safety

By Kathy Teale - 6th May 2011 10:56 pm

I was a little disturbed to hear myself described as an “expert” on operating theatre safety last week, when I was giving a lecture on my favourite pet subject on our surgical MSc course. This was thanks to my role as (ex)theatre director and nagger-in-chief for the WHO checklist.

My interest in safety has been fuelled by being on the receiving end of theatre adverse incident reports for the last five years (the main message from which is that doctors are very bad at submitting AIRs unless it’s about the lack of theatre blues in the changing rooms). And, of course there’s nothing like giving evidence at an inquest to concentrate one’s mind about safety and I’ve had to do that twice this month.

So, back to those non-technical skills in theatre. Before you all switch off, let me say that my response was similar to yours when I first started reading about this subject but my attitude has changed. As doctors, our training, (or mine, anyway) was almost entirely around technical skills and academic knowledge (admittedly quite important) and anything about ’soft’ skills (communication, leadership) was regarded as touchy-feely, politically correct nonsense.

By the time we graduate, our professional attitudes are fixed. Start talking about ’situational awareness’ or ‘communication styles’ at this stage and it will elicit a predictable response from most surgeons (and anaesthetists). In aviation, in contrast, non-technical skills are taught to students from day one. Pilots know that technical excellence alone will not guarantee a safe flight. We need to be teaching these skills much earlier in our medical education.

Anyone who works in theatre will see these non-technical skills come into play. If Mr Grumpy is in a mood because there weren’t enough sodding theatre blues (again), that will affect how the whole operating list runs. Although I hate to admit it, the person wielding the scalpel generally functions as the team leader - if Mr Grumpy snaps at the scrub nurse when asked about what kit he wants and everyone’s walking on eggshells, that’s when disasters happen. There’s little communication, staff don’t ask questions and there’s precious little interest from the rest of team (remember those occasions when things start to go wrong and all we can hear in the background is the ODP discussing the X-factor, completely oblivious to impending disaster).

The medical profession has not been good at learning from it’s mistakes - for a start, we’re bad at reporting and acknowledging them and, secondly, we think it’ll never happen to us if we work hard and know our anatomy. Take the nephrectomy disaster in Wales in 2000 (when due to human error surgeons removed the patient’s wrong kidney) - everyone thought that was a one-off which could never happen again. Despite massive publicity, it has been repeated at least three times in the UK.

Evidence shows that theatre teams which gel well, communicate freely and trust each other can retrieve potentially catastrophic situations. Mr Grumpy’s team, I suspect, wouldn’t get away with it if things went wrong. And, anything which keeps me out of the coroner’s court gets my vote.

Tags: Patient safety, Surgery, WHO
Posted in Katherine Teale | 2 Comments »

High profile patient safety campaign disappoints

By Mike Broad - 4th February 2011 8:58 am

Quality and safety of NHS care has shown a clear improvement but a high profile patient safety programme has proved disappointing, two studies reveal.

In 2005, the Health Foundation launched the Safer Patients Initiative (SPI) to test ways of delivering safer care on an organisation-wide basis.

The first phase of the study involved four NHS hospitals (one in each country in the UK) and 18 control hospitals over an 18-month period. In an innovative study design, the second phase of the study included nine SPI and nine control hospitals.

The aim of the programme was to improve frontline care processes in designated clinical areas, and build leadership and expertise in patient safety to change the culture of organisations.

Although the researchers found improvements in quality and safety across the NHS, no additional effect of the Safer Patients Initiative could be detected. Quality of care and patient safety improved to the same extent in both intervention and control hospitals.

Richard Lilford, professor of clinical epidemiology at the University of Birmingham, and lead author, said that the considerable improvements in quality seen across the NHS “may have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI may be observable only in the longer term”.

An accompanying editorial on bmj.com says these studies “should be a wakeup call to those implementing patient safety programmes”.

Three US experts argue that the quality improvement field “needs to embrace science, favour evidence over anecdote, and move beyond using only one generic framework for improvement”. They also point out the importance of having “buy-in” from clinicians to lead patient safety efforts.

Tags: Patient safety
Posted in Hospital Dr News | No Comments »

Deanery threatens trainee withdrawal from hospital

The Independent - 23rd September 2010 9:55 am

One of Britain’s largest NHS trusts is at the centre of “grave” safety concerns after confidential documents revealed inadequately skilled temporary doctors were being left to treat critically ill patients.

The London Deanery, which oversees the training of qualified doctors, is threatening to withdraw all trainee anaesthetists from Queen Elizabeth Hospital because of “major patient-safety concerns”.

The threat follows a confidential report which revealed that junior and locum doctors are routinely left to deal with patients unsupervised, at times working 36-hour stretches because of a shortage of consultants. The damning report says junior doctors felt pressured into undertaking activities “beyond their competence” and were not being properly trained. Complaints of bullying were also common.

More trusts report patient safety incidents

By Mike Broad - 21st September 2010 9:18 am

Reported instances of death, severe and moderate harm are falling against a backdrop of increased reporting by trusts across England.

NPSA figures show that the total number of reported patient safety incidents was 569,165 between 1 October 2009 and 31 March 2010 - an increase of 4%.

The number of trusts reporting incidents to the NPSA has increased from 99% to 99.7% and the volume of patient safety incidents that have occurred and resulted in severe harm or death has dropped from 3,572 to 3,509 during the same periods.

Findings also show that awareness of the importance of reporting no or low harm patient safety incidents has also increased. They show a rise in the number of no and low harm patient safety incidents occurring between 1 October 2009 and 31 March 2010 from 473,162 to 494,540 compared to the previous period.

The most commonly reported categories related to patient accident (30%), medication (11%), and treatment procedures (10%).

Director of patient safety Dr Suzette Woodward said: “Trusts across England are reporting more patient safety incidents to us, giving the service an even greater opportunity to learn and to ensure the risk of repeated episodes are minimised as much as possible.

“These data also give trusts the opportunity to examine closely their own patterns of reporting and look at how they compare against other similar organisations. It will also aid understanding of their performance and help identify patient safety areas that require local action planning to reduce harm to patients.”

Read the full figures.

Tags: Patient safety
Posted in Hospital Dr News | No Comments »

Putting the blame game in perspective

By Katherine Teale - 29th August 2010 12:55 pm

I was walking down the corridor today when I almost bumped into one of my colleagues. When I say “bumped into” I mean he nearly knocked me down the stairs in his effort to pretend I don’t exist.

The three people with me were greeted with cheerful ‘hellos’, but I have evidently committed a crime for which I must be soundly ignored. I’ve no idea what this offence is - perhaps he holds me, as clinical director, personally responsible for the hospital’s economic doldrums.

Whatever it is he’s kept this up for six months now without accidentally letting slip even a hint of a smile when we pass one another in theatre, so you have to admire his reflexes and persistence. It must be quite an effort to be so consistent about this - I doubt whether I could remember whom I’m not saying ‘hello’ to quite so successfully. Perhaps he keeps a list written on the back of his hand.

Talking about blame, there’s been lots of it around this week. The internet is full of the shocking story of the two year old who had a plaster of Paris cast applied to the wrong arm. This wasn’t noticed by anyone until the following day when mum was so traumatised that she had to go straight to the press.

This report is followed by the inevitable seven pages of public vitriol, the gist of which is that doctors and nurses are an overpaid, underworked bunch of idiots who can’t even tell right from left and should be sacked. Or worse. The fact that the nurse involved had tried to calm the distressed toddler by putting a cast on her teddy bear first only seemed to fan the flames of public outrage, as apparently they had managed to treat the correct arm on the teddy, but sadly not on the child.

Anyone who has tried to treat a distressed, screaming two-year-old will understand that it wouldn’t be immediately obvious which was the arm with the greenstick fracture. Presumably all the angry citizens expressing disbelief that the NHS can be so crap have A. never made a mistake, and B. never heard of ‘human error’.

I suppose it’s just more fun to post, while frothing at the mouth, about how some incompetent junior doctor, who might even have been foreign, took three attempts to put a drip up when you were in casualty. Of course, what the hospital in question needs to do, after publishing a grovelling apology, is institute a checklist system in A&E whenever a procedure like that is performed, even when the patient is awake.

We’re already doing this in theatres using the WHO check list which has been mandated by the National Patient Safety Agency. It’s entirely about avoiding human error - children can’t tell you when you’re doing the wrong thing, and even wide awake adult patients will allow nerve blocks, for instance, to be performed on the wrong side, without a word of protest.

Despite what we might think from the internet message boards, most patients assume we know what we’re doing. Whether they’re always justified in doing so is another question.

Tags: Patient safety
Posted in Katherine Teale | 1 Comment »

Weekend emergencies are more likely to die

By Mike Broad - 22nd June 2010 9:20 am

People admitted to English hospitals in an emergency at the weekend have a greater chance of dying than those admitted during the week, a study finds.

The study, in Quality & Safety in Health Care, analysed the deaths of patients admitted as emergencies to 163 acute hospital trusts in England during 2005/06. It reveals a 7% higher mortality rate for emergency admissions over the weekend. It was particularly evident in conditions like heart attack, heart failure, stroke, some cancers and aortic aneurysms.

The study’s authors say the higher than expected mortality rates may be linked to less consistent specialist services, such as diagnostics, at weekends and a decrease in the availability of senior hospital staff.

In the study, by researchers from Imperial College London and Dr Foster Intelligence, the researchers reviewed 215,054 deaths out of a total of 4,317,866 admissions.

Comparing the expected number of deaths with the actual number of deaths identified at the weekend the researchers found there were 3,369 more deaths than expected at the weekend in 2005/06.

Author Dr Paul Aylin said: “We need to get to the bottom of what this means. Staffing levels are often lower at weekends, with fewer senior medical staff around, and some specialist services are less available. We believe this may be contributing to the increase in mortality rates on Saturdays and Sundays but we would like to see more research.

“Hospitals have been reassessing the working hours and rotas of their doctors and, considering the impact that staff availability may be having on mortality rates, this is a timely reminder to hospitals that they must take care not to jeopardise the quality and standard of patient care available at weekends when devising new staffing rotas.”

These findings follow the Temple review into training under the Working Time Regulations which found that the NHS was “too reliant” on junior doctors who are often left to work unsupervised on wards overnight and at weekends.

The report also criticised the working hours of consultants who often prefer to work a standard week which inevitably impacts on patient treatment and junior staff training.

Tags: Patient safety
Posted in Hospital Dr News | 4 Comments »

Surgery targets endanger patient safety, poll reveals

BBC Health - 17th June 2010 10:01 am

Pressures over hospital budgets and targets may be damaging safety in operating theatres, a survey suggests.

About one in five of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.

Many complained of having to operate on patients they had not seen before, or a lack of time for complex operations.

The government says “a culture of micromanagement” has endangered safety.

A total of 549 general surgeons responded to the online questionnaire - about one in four members of the Association of Surgeons of Great Britain and Ireland.

Of these 40% said they had been involved in an untoward event where a patient was nearly harmed, and a further 19% where there was actual harm, during the two-week period covered by the survey.