MPs call for new national patient safety body to lead clinical accident investigations

Source:  BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1707 (Published 30 March 2015)

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Date of publication:  March 2015

Publication type:  News item

In a nutshell: MPs say that an independent national investigator of clinical accidents should be created to improve on the speed, quality, and thoroughness of investigations. MPs of the House of Commons Public Administration Select Committee are asking the next government to make changes to improve the current system for dealing with clinical incidents. In a recent report, the committee called on the next health secretary after the general election to establish a national independent patient safety investigation body. The MPs say this body should be a centre of knowledge and promote good investigatory practice and skills, and investigations should ideally be carried out locally.

Length of Publication:  1 web page

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

A strategy to maintain safety in clinical incidents

Source:  Nursing Times 2/110 (34-35) pp.16-8.

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Date of publication:  August 2014

Publication type:  News item

In a nutshell:  Team leaders in the NHS are often in a position where they have to manage and control a clinical situation. They can also be actively involved in delivering patient care because of low staffing levels or inappropriate skill mixes, which can lead to the potential for loss of situational awareness and risk to patient and staff safety. “Inner and outer circles” is an approach that could reduce risks and increase patient safety. It is used in pre-hospital and industrial environments and could be adapted to suit inpatient and other settings.

Length of Publication:  3 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

Patient safety alert to improve reporting and learning of medication and medical devices incidents

Source:  NHS England

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Date of publication:  March 2014

Publication type:  News item

In a nutshell:  Two patient safety alerts have been issued by NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA) to help healthcare providers increase incident reporting for medication errors and medical devices. The alerts will improve data report quality and will see the establishment of national networks to maximise learning and provide guidance on minimising harm in relation to these types of incidents. The alerts call on large healthcare provider organisations across a range of healthcare sectors and healthcare commissioners to identify named leaders in both medication and medical device safety roles. The leaders will be supported by two new national networks for medication and medical device safety.

Length of Publication:  1 web page

Patient safety alert on placement devices for nasogastric tube insertion

Source:  NHS England

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Date of publication:  December 2013

Publication type:  News item

In a nutshell:  NHS England has issued a patient safety alert on the use of placement devices for inserting nasogastric tubes. Available from the Central Alerting System (CAS), this alert will ensure all hospitals and community services that use nasogastric tubes continue to follow previous guidance issued by the National Patient Safety Agency even when placement devices are used. It has been issued in response to two recently reported patient safety incidents.

Length of Publication:  1 web page

Patient safety: threats and solutions

Source:  Nursing Standard vol/iss 27/44 pp. 48-55

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Date of publication:  July 2013

Publication type:  Journal article

In a nutshell:  The issues surrounding patient safety are explored in this article, including the language associated with harm and error. The authors discuss the types of patient safety incidents that can occur and they provide insights into why these incidents can occur and explain some of the underlying factors. Preventive strategies and the role of patients and family members in enhancing safety are discussed.

Length of Publication:  8 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 patients report patient safety incidents in a hospital setting?

Source:  BMJ Quality & Safety

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Date of publication: May 2012

Publication type:  Journal article

In a nutshell:  This article looks at the current situation of whether patients can report incidents while they are in the hospital, and whether this should be something to build on in the future.

Length of publication:  9 pages

Some important notes:   If an item requires an Athens username and password.  This article is available in full text to all NHS Staff using Athens, for more information about accessing full text fllow this link to find your local NHS Library

Disclosure of patient safety incidents : a comprehensive review

Source:  International Journal for Quality in Health Care  Volume 22 Issue 5 p371-9

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Date of publication:  October 2010

Publication type:  Review

In a nutshell:  When adverse events occur one of the most challenging and difficult issues are communicating these to patients and families.  This review looks at this area, and the gap between ideal disclosure and the reality.  Perspectives of care team and patients are included along with suggestions on how to improve communication.

Length of publication:  9 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.

Achnowledgement:  MEDLINE

Organisation Patient Safety Incident Reports March 2010

Source: National Reporting and Learning Service

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Date of publication:  March 2010

Publication type:  Report

In a nutshell:  Access patient safety incident reports for individual NHS organisations in England and Wales.

Length of publication:  1 web page

Achnowledgements:  National Patient Safety Agency