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Tag Archives: Severe Harm
Medication Errors: an Open Learning Culture Recommended to Reduce Patient Harm (BBC News / Department of Health / EEPRU / Department of Health and Social Care)
Summary Medication errors, which include (i) wrong medications given, (ii) incorrect doses and (iii) delays in medication being administered, cause an estimated 700 deaths per year and might play a role in something between 1,700 to 22,300 further avoidable deaths. … Continue reading →
Posted in Acute Hospitals, BBC News, Commissioning, Community Care, Department of Health, Department of Health and Social Care (DHSC), For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, Integrated Care, Management of Condition, National, NHS, Pharmacological Treatments, Quick Insights, Standards, Statistics, UK, Universal Interest, World Health Organization (WHO)
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Tagged Acute Care and Quality, Acute Care and Workforce, Adult Psychiatric Intensive Care Services, Adverse Drug Reactions, Adverse Drug Reactions (ADRs), Adverse Drug Reactions in the Elderly, BBC Health News, Blame Culture, Care Home Culture, Care Home Environments, Care Homes, Centre for Health Economics: University of York, Choosing Wisely Campaign, Choosing Wisely in the NHS, CHUMS Study, Clinical Pharmacists, Clinical Responsibility for Patients (Choosing Wisely and New Deal), Community Pharmacists, Continuous Learning Culture, CQC Investigations and Quality Policy, Culture and Behaviour Change, Culture and Leadership, Culture Change, Culture of Raising Concerns, Department of Health Policy Research Programme, Division of Population Health Health Services Research and Primary Care: University of Manchester, Electronic Prescribing and Medicines Administration (EPMA), Electronic Prescribing Systems, EQUIP Study, Former Health Secretary Jeremy Hunt, Global Patient Safety Challenge (WHO), HePMA, Hospital E-Prescribing and Medicines Administration, Hospital Electronic Prescribing and Medicines Administration (HePMA), Hospital Pharmacists, Learning Culture, Making Choices Together (Previously Choosing Wisely Wales), Manchester Centre for Health Economics: University of Manchester, Medication Errors, Medication Errors and Adverse Drug Reactions, Medication Without Harm (WHO), Medicines Safety Programme (WHO), Medicines Value Programme (NHS England), NHS Culture, NHS Culture Change, NHS Patient Safety Culture, NHS Specialist Pharmacy Service, No Harm Culture, Old Age Psychiatry, Open and Transparent Culture, Openness, Openness and Collaboration, Openness and Honesty When Things Go Wrong, Openness and Transparency, Partnering with Patients and Families, Patient and Family Engagement, Patient and Public Engagement (PPE), Patient and Public Involvement, Patient and Public Involvement (PPI), Patient Engagement, Patient Engagement Strategies, Patient Harm, Patient Harms and Harm Free Care, Patient Safety, Patient Safety Champions, Patient Safety Improvement, Patient Safety Indicators, Patient Safety Strategies, Patients With Polypharmacy Risks, Pharmacist Buddy Scheme (County Durham and Darlington NHS Foundation Trust), Pharmacist-Led Information Technology Intervention (PINCER), Pharmacists, PINCER Intervention, Policy Research Programme (PRP), Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU), Polypharmacy, Potentially Preventable Complications in Hospitalis, PREPARE: Partnership for Responsive Policy Analysis and Research, PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study, Prescription Errors in Psychiatry, Preventable Deaths in English Acute Hospitals, Preventable Hospital Deaths, Preventable Hospital Mortality, Preventable Mortality, Primary Care Adverse Drug Reactions, PROTECT Programme, Putting Patients First, Quality Improvement Culture, Reducing Inappropriate Polypharmacy, Reducing Litigation Costs, Report of the Short Life Working Group on Reducing Medication-Related Harm, Reporting Culture, Reporting of Incidents, Research on Medication Error, Rt Hon Jeremy Hunt MP: Former Secretary of State for Health and Social Care, ScHARR: University of Sheffield, School of Health and Related Research (ScHARR): University of Sheffield, SDM: Shared Decision Making, Secondary Care Adverse Drug Reactions, Serious Mistakes, Severe Harm, Shared Care and Education, Shared Decision-Making, Short Life Working Group (SLWG), Short Life Working Group on Reducing Medication-Related Harm, Stop the Over-Medication of People With a Learning Disability or Autism (STOMP) Campaign, Transparency, Transparency and Accountability, Transparent Learning Culture, UK Department of Health Policy Research Programme, United States National Coordinating Council for Medication Error Reporting and Prevention, University of Manchester, University of Sheffield, University of York, University of York Centre for Health Economics (CHE), WHO Domain: Health Care Professionals, WHO Domain: Medicines, WHO Domain: Patients and the Public, WHO Domain: Systems and Practice of Medication, WHO Domains, WHO Global Patient Safety Challenge
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Professional Duty of Candour: Openness and Honesty When Things Go Wrong (NMC / GMC / Nursing Times / BBC News)
Summary The General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) have jointly published guidance explaining the standards expected of doctors, nurses and midwives in the UK when things go wrong during healthcare. Professionals, in turn, require the … Continue reading →
Posted in Acute Hospitals, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), In the News, National, Northern Ireland, Person-Centred Care, Practical Advice, Quick Insights, Scotland, Standards, UK, Universal Interest, Wales
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Tagged Apologising to Patients, BAPEN: British Association of Parenteral and Enteral Nutrition, British Association of Parenteral and Enteral Nutrition (BAPEN), Buckinghamshire Healthcare Trust, Candour, Candour: Safety and Improvement, Common Professional Standards (NMC / GMC), Consent, Consent: Patients and Doctors Making Decisions Together, Consequences of the Francis Inquiry Report, Culture Change in the NHS, Culture of Candour, Culture of Raising Concerns, Culture of Reflective Practice, Culture of Safety, Dehydration, Dehydration in Frail Older People, Duty of Candour, Ethical Considerations, Face to Face Explanations / Apologies from Doctors Nurses and Midwives, Freedom to Speak Up Report: Principle 1: Culture of Safety, Freedom to Speak Up Report: Principle 2: Culture of Raising Concerns, Freedom to Speak Up Report: Principle 7: Raising and Reporting Concerns, General Medical Council (GMC), GMC: General Medical Council, GMC’s Good Medical Practice, Good Medical Practice, Hampshire Hospitals Foundation Trust, Health and Social Care Services in Northern Ireland, Healthcare Quality Strategy for NHS Scotland, Honesty, Honesty and Transparency, Hospital Nurse Staffing and Quality of Patient Care, Hydration and Nutrition, Implications of the Francis Inquiry Report, Incident Reporting, Incidents Errors and Near Misses, Learning Culture, Learning From Mistakes, Misdiagnosis, Moderate Harm, National Health Service (Concerns Complaints and Redress Arrangements) (Wales) Regulations 2011, Near Misses, NHS Culture, NHS Patient Safety Culture, Nurse Staffing Levels, Nursing and Midwifery Council (NMC), Open and Honest Working Environment, Openness, Openness and Honesty When Things Go Wrong, Openness and Honesty When Things Go Wrong (GMC / NMC), Openness and Transparency, Patient Harms, Patient Safety, Professional Duty of Candour, Professional Duty of Candour: NMC's Nursing Case Studies, Professional Standards, Professional Standards and Ethics, Professional Standards of Practice and Behaviour for Nurses and Midwives, Prolonged Psychological Harm, Protection From Unfair Criticism Detriment or Dismissal, Repercussions From the Francis Inquiry Report, Reporting Culture in the NHS, Reporting Systems, Scottish Patient Safety Programme, Severe Harm, Severe Harm Attributable to Problems in Healthcare, Severe Harm Leading to Death, Statutory Duty of Candour, Statutory Duty of Candour For Care Organisations (UK), Transparency, Transparency and Public Trust, Transparent Learning Culture, Welsh Government’s Health and Care Standards Framework
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Practical and Measurable Patient Safety Improvement Plans (BBC News)
Summary Health Secretary Jeremy Hunt wants NHS trusts to develop plans for halving, by 2016-17, “avoidable harm” to patients arising from preventable problems such as medication errors, blood clots and bedsores. It is estimated that this could eliminate a third of … Continue reading →
Posted in Acute Hospitals, BBC News, Department of Health, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Social Workers (mostly), In the News, National, NHS, NHS Digital (Previously NHS Choices), Patient Care Pathway, Quick Insights, Standards, UK, Universal Interest
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Tagged Action Against Medical Accidents, Action against Medical Accidents (AvMA), Active Engagement, Acute Care, Acute Hospital Care, Acute Hospitals, Aligning Forces for Quality, American Hospital Association – Health Research & Educational Trust (AHA-HRET) Survey of Hospitals on Patient Engagement Strategies, Armstrong Institute for Patient Safety and Quality at Johns Hopkins, Avoidable Harm, Avoidable Mortality, Avoidance of Litigation, Barriers to Engagement, Bed Sores, Candour, Candour: Safety and Improvement, Care of Older Adults in Acute NHS Trusts, Consumer Engagement in Patient Safety, Contractual Duty of Candour, Covering-Up Mistakes, Declaration on Engagement for Global Health, Engagement on Quality, Former Health Secretary Jeremy Hunt, General Hospital Care, General Hospitals, Gordon and Betty Moore Foundation, Hospital Aquired VTE, How Safe Is My Hospital (NHS Choices), Hydration, Improving Patient Safety, Incentivising Candour, Incident Reporting, Learning From Mistakes, Learning Organisations, Litigation Claims, Local Change Agents, Lower-Than-Expected Incident Reporting (Problematic), Measures of Harm, Measuring Harm Free Care, Medication Errors, Misdiagnosis, MITSS (Medically Induced Trauma Support Services), National Committee for Quality Assurance (NCQA), National Patient Safety Foundation’s Lucian Leape Institute, National Report and Learning System, NHS Litigation Authority, NHS Litigation Authority (NHS LA), NHS Patient Safety Culture, NHS: Safest Healthcare System in the World (Ambition), NPSF: National Patient Safety Foundation, Open and Honest Incident Reporting, Openness and Transparency, Participation in Diagnosis, Partnering with Patients and Families, Patient and Family Engagement, Patient Engagement, Patient Engagement Strategies, Patient Experience, Patient Safety, Patient Safety Champions, Patient Safety Improvement, Patient Safety Indicators, Patient Safety Strategies, Potentially Preventable Complications in Hospitalis, PPE: Patient and Public Engagement, Pressure Ulcers, Pressure Ulcers: Prevention, Pressure Ulcers: Risk Assessment, Preventable Deaths in English Acute Hospitals, Preventable Hospital Deaths, Preventable Hospital Mortality, Preventable Mortality, Putting Patients First, Reducing Litigation Costs, Reporting Culture, Reporting of Incidents, Roundtable on Consumer Engagement, Rt Hon Jeremy Hunt MP: Former Secretary of State for Health, SAFE: Safety Action for England, Safety Action for England (Safe) Team, Safety Is Personal, Safety Metrics, SDM: Shared Decision Making, Serious Mistakes, Severe Harm, Sign up to Safety, Statutory Duty of Candour, Surveillance and Reporting, Threshold for Duty of Candour, Transparency, Transparency and Accountability, Unconscious Incompetence, Unsafe Care, User Experience, Venous Thromboembolisms (VTEs), Virginia Mason Hospital: Seattle, VTE (Venous Thromboembolism), VTE Risk Assessment, World Innovation Summit for Health (WISH), Zero Harm
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Chief Inspector of Hospitals Announces Inspection Plans (CQC)
Summary The Care Quality Commission (CQC) is overhauling how it inspects hospitals following the Keogh Review. Professor Sir Mike Richards, Chief Inspector of Hospitals, has decided the revised hospital inspection plans will commence in August 2013. The inspection methodology behind … Continue reading →
Posted in Acute Hospitals, Commissioning, CQC: Care Quality Commission, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), In the News, Local Interest, National, New Cross Hospital, NHS, Patient Care Pathway, Person-Centred Care, Quick Insights, Royal Wolverhampton NHS Trust, Standards, UK, Universal Interest, Wolverhampton
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Tagged Abuse, Acute Care, Acute Hospital Care, Acute Hospitals, Airedale NHS Foundation Trust, Barking Havering and Redbridge University Hospitals NHS Trust, Barts Health NHS Trust, Care Quality Commission (CQC), Chief Inspector of Hospitals, Complaints, CQC Acute Care Indicator Definitions and Sources, CQC Compliance Teams, CQC Surveillance Model for NHS Acute Trusts, CQC’s Share Your Experience Web Form, Croydon Health Services NHS Trust, Dartford and Gravesham NHS Trust, Death, Deaths in Low Risk Conditions, Delayed Discharges, Delayed Transfers of Care, Discharge, Emergency Readmissions, Frimley Park Hospital NHS Foundation Trust, General Hospital Care, General Hospitals, General Medical Council Concern, General Medical Wards, Harrogate and District NHS Foundation Trust, Heart of England NHS Foundation Trust, Hospital Inspections, Hospital Standardised Mortality Ratios (HSMRs), Integration, Keogh Review, Moderate Harm, Mortality Outlier Hospitals, Never Events, NHS Acute Services, NHS Acute Trusts: CQC Surveillance Model, NHS Choices Feedback Pages, Nottingham University Hospitals NHS Trust, NRLS Under-Reporting, Patient Care, Patient Complaints, Patient Experience, Patient Opinion, Patient Safety, Patient Satisfaction, Percentage of Occupied Consultant Led Beds, Percentage of Occupied Non-Consultant Led Beds, Professor Sir Mike Richards: Former Chief Inspector of Hospitals (CQC), Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Surrey County Hospital NHS Foundation Trust, Royal United Hospital Bath NHS Trust, Royal Wolverhampton NHS Trust, Safeguarding Enquiries (CQC), Salford Royal NHS Foundation Trust, Severe Harm, Shadow Rating (CQC), SHMI: Summary Hospital-level Mortality indicator, South London Healthcare NHS Trust, Staff Surveys, Staffing, STEIS, Summary Hospital-level Mortality indicator (SHMI), Surveillance Model for NHS Acute Trusts (CQC), Taunton and Somerset NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, User Complaints, Weekend Effect, Whistleblowing Enquiries (CQC)
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