Patient Safety Horizon Scanning Volume 5 Issue 6

June 25, 2014

Patient safety alert on standardising the early identification of Acute Kidney Injury

June 25, 2014

Source:  NHS England

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Date of publication:  June 2014

Publication type:  News item

In a nutshell:  A patient safety alert on standardising the early identification of Acute Kidney Injury (AKI) has been issued by NHS England. All NHS acute trusts and foundation trusts providing pathology services have received the alert. A national algorithm, standardising the definition of AKI has been agreed, which has been endorsed by NHS England. It is recommended that the algorithm is implemented across the NHS.

Length of Publication:  1 web page


Improving surgical ward care: development and psychometric properties of a global assessment toolkit

June 25, 2014

Source:  Annals of surgery 259/5 pp. 904-9

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Date of publication:  May 2014

Publication type:  Journal article

In a nutshell:  The authors of this study aimed to develop a toolkit to cover the skills required for effective, safe surgical ward care. A comprehensive evidence-based and expert-derived toolkit was developed. It included a novel clinical checklist for ward care (Clinical Skills Assessment for Ward Care: C-SAW-C); a novel team assessment scale for wards rounds (Teamwork Skills Assessment for Ward Care: T-SAW-C); and a revised version of a physician-patient interaction scale (Physician-Patient Interaction Global Rating Scale: PP-GIS). The toolkit can be used to train and debrief residents’ skills and performance.

Length of Publication:  6 pages

Some important notes:  Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.


Managing Clostridium difficile infection in hospitalised patients

June 25, 2014

Source:  Nursing Standard 28/33 pp. 37-43

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Date of publication:  April 2014

Publication type:  Journal article

In a nutshell:  Checklists are used commonly in health care to improve patient safety. The development and integration of a daily review checklist process to support the care and management of patients with Clostridium difficile infection in one NHS trust hospital are described in this article. The objective of the checklist is to assist staff in early recognition of disease severity, identification of potential complications and prevention of cross-transmission of C.difficile.

Length of Publication:  7 pages

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.


Can technology improve patient safety?

June 25, 2014

Source:  The Guardian Tuesday 20 May 2014

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Date of publication:  May 2014

Publication type:  News item

In a nutshell: This report asks whether, in an era when people can manage every aspect of their life from a device little bigger than a credit card, technology can help to improve patient safety. One advantage technology has is that it obeys a rigid set of instructions and behaves consistently. IT can aid clinicians in making the right diagnosis, and re-evaluate care by making effective use of information about us. Making the information available does depend on having all the relevant information about you stored and accessible in an electronic record, and shared. Technology’s biggest strength is also its weakness as it has no capacity to think for itself and symbiotically needs the very thing that it helps make safe, to make it safe too. A danger is that we could just trade one risk for another.

Length of Publication:  1 web page


Pursuing Zero – a winning approach to safety

June 25, 2014

Source:  The Health Foundation

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Date of publication:  May 2014

Publication type:  News item

In a nutshell: In May, a team from Great Ormond Street Hospital Foundation Trust was named Berwick Patient Safety Team of the Year at the BMJ Awards. The team have helped the Trust to develop a culture where every member of staff focuses on the importance of providing safe, high quality care for children. The ‘Zero harm, no waits, no waste’ programme was established by Great Ormond Street Hospital (GOSH) seven years ago, with the aim of eliminating all harm to children in their care. The programme aims to embed a culture of improvement and safety throughout the organisation and key to this has been developing strong leadership for change. Throughout the programme the team has also made a point of involving patients and carers.

Length of Publication:  1 web page


Sign up to Safety

June 25, 2014

Source:  NHS England

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Date of publication:  June 2014

Publication type:  News item

In a nutshell:  A new campaign to make the NHS the safest healthcare system in the world, building on the recommendations of the Berwick Advisory Group, has been launched by the Secretary of State for Health. The campaign sets out a three-year shared objective to save 6,000 lives and to halve avoidable harm as part of NHS England’s aim to ensure patients get harm free care every time, everywhere. The Sign up to Safety campaign is for everyone in the NHS. For more information visit the Sign up to Safety website.

Length of Publication:  1 web page