Patient safety updates - 4 April 2013

New policy, guidance and initiatives from across the UK relevant to patient safety. For more information about the patient safety theme see Quality and Safety eBulletin: patient safety.

Some of the resources linked to are in PDF format - see how to access PDF files.

American Society Healthcare Risk Management: 10 Tips to Help Promote Patient Safety (PDF 276KB). The American Society for Healthcare Risk Management has produced this 4-page fact sheet listing 10 patient safety concerns and offers tips to address them.

BBC Health: Whistleblower hotline is launched for NHS staff in Scotland. A free, confidential phoneline has been launched to allow employees to raise any concerns about practices in NHS Scotland. The National Confidential Alert Line for NHS staff is a year-long pilot. The trial was first announced in November following a BBC investigation into hospital safety.

Canadian Foundation for Healthcare Improvement: Is your doctor well rested and alert? Sleep deprivation is common among doctors, putting patient safety at risk. Yet Canadians don't consider doctors' fatigue levels as a factor affecting their care. The solution? More sleep for medical professionals while promoting a culture of teamwork and proper handovers to colleagues.

Canadian Foundation for Healthcare Improvement: When it comes to drugs and devices, newer is always better. ‘There's a common fallacy, in healthcare as in other industries, that newer is better and worth the extra cost. But research shows that sometimes existing drugs and devices for managing health conditions can be as good or better, safer and cheaper than new technologies.’

Department for Education: Working together to safeguard children. Revised guidance published by the Government clarifies the responsibilities of professionals towards safeguarding children, and strengthens the focus away from processes and onto the needs of the child.
Press release: Revised safeguarding guidance for professionals working with children.
RCN: RCN welcomes new guidance and framework to protect children and vulnerable adults.

DH: Responding to the threat of antimicrobial resistance. A new UK 5-year Antimicrobial Resistance Strategy and Action Plan is in development and is expected to be published in the summer. The 2013 to 2018 strategy will accelerate progress and build on previous work to address antimicrobial resistance. It will also deal with the issues raised by the Chief Medical Officer in Volume 2 of her annual report.

DH: Vaccine Update: issue 200 March 2013. A newsletter for immunisation practitioners, with the latest developments in vaccines, and vaccination policies and procedures.

DH: Protecting patients from avoidable harm. A million people use healthcare services every 36 hours, and the vast majority of them receive safe and high quality care. But things do go wrong, and mistakes are made. Recent high profile cases (such as the neglect of patients at Stafford Hospital) show that there is still a lot to do to ensure that everyone is treated safely when they use healthcare services. From April 2013, patient safety will be the responsibility of the NHS Commissioning Board (NHS England) but the Department of Health will continue to help set the standards that the NHS services must meet.

Health EU – Newsletter: Patient safety gets better treatment across EU countries. Issue 107, 27 March 2013. “When a patient is treated in a hospital, they expect to get well and receive the best care possible without being exposed to medical errors that could lead to adverse health effects or infection. However, nearly half of EU citizens feel they could be harmed while being treated: both in hospital and in primary care settings.”

Health Foundation: Safety culture: What is it and how do we monitor and measure it? On 20 February 2013, the Health Foundation hosted a roundtable event to discuss what is understood as ‘safety culture’, why it is important and how it can be measured and monitored. This roundtable was held as part of the Health Foundation's work to lead a step-change in thinking about patient safety. Patient safety experts from academia, public policy, quality improvement and frontline care came together to share their knowledge and learning in order to build understanding in this area, and to recommend some practical next steps. This event report summarises the discussion and identifies themes that should be explored further.

Healthcare Foundation: The Health Foundation calls for a statutory duty of candour. “Part of being accountable to patients is being open when things go wrong and it will be important to ensure that a duty of candour is carefully implemented and embedded in culturally and at all levels of the system.”

Health in Wales: MMR vaccination rates too low to halt epidemic as measles cases in Wales double in three weeks. Public Health Wales is urging parents, carers and communities to ensure that all children are given the measles, mumps and rubella (MMR) jab as cases in the outbreak centred on Swansea reach 432.

Health Protection Agency (HPA): HPA signs unique polio vaccine license deal. The Health Protection Agency (HPA) has recently agreed a non-exclusive Material Transfer, Patent and Know-How License Agreement with the pharmaceutical company GlaxoSmithKline (GSK) for the development and manufacture of a ‘next generation’ polio vaccine which could be a major step in the eradication of polio.

Health Protection Scotland (HPS): Publication of 24th National Hand Hygiene NHS Campaign Compliance with Hand Hygiene - Audit Report. Health Protection Scotland has published the 24th bi-monthly Compliance with Hand Hygiene - Audit Report as part of the National NHS Hand Hygiene Campaign. The report describes occasions when NHSScotland staff have taken the opportunity to carry out hand hygiene at the points where care is delivered as described in the National Infection Prevention and Control Manual.

Medicines and Healthcare Products regulatory Agency (MHRA): Simplification measures announced following Red Tape Challenge. The MHRA has announced a package of simplification proposals. This follows participation in the Cabinet Office Red Tape Challenge exercise last year.

MHRA: Medicines and Healthcare Products Regulatory Agency Expands. The National Institute for Biological Standards and Control (NIBSC), previously part of the Health Protection Agency (HPA), is now a new centre of the Medicines and Healthcare Products Regulatory Agency alongside the Clinical Practice Research Datalink (CPRD).

National Patient Safety Foundation (NPSF): Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. ‘Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.’ This American report looks at the current state of health care as a workplace, highlights vulnerabilities common in health care organisations, discusses the costs of inaction, and outlines what a healthy and safe workplace would look like. The report concludes with seven recommendations for actions that organisations need to pursue to effect real change.

NHS Education for Scotland (NES): Patient Safety and Clinical Skills Leaflets. Two new leaflets have been published which provide useful information on NES Patient Safety educational resources and materials.