Clin Med
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Comparative Study
Insulin, hospitals and harm: a review of patient safety incidents reported to the National Patient Safety Agency.
Patient safety incidents involving insulin are frequent and cause considerable distress to people with diabetes and anxieties to their families and carers. This article describes an analysis of the National Reporting and Learning System database of patient safety incidents concerning insulin reported from NHS providers in England and Wales over six years. The main causes are discussed and the ongoing developments by the National Patient Safety Agency and partner organisations to reduce insulin errors are described.
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Since the purchaser/provider split was first introduced in the early 1990s, there have been successive attempts to enhance and strengthen the role of commissioners in the English NHS. Their role is to ensure that health services are planned and delivered in a way that meets the interests of patients and taxpayers rather than healthcare providers. ⋯ It is too early to say whether these reforms are likely to transform commissioning and finally place payers, rather than providers, in the driving seat of the NHS. However they unfold they are likely to have a significant impact on healthcare professionals in commissioning, primary care and specialist roles.
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In April 2009 a 'considerative checklist' was developed to ensure that all important aspects of care on a team's routine and post-take general internal medicine ward rounds had been addressed and in order to answer the question: How long should a ward round take, when conducted to high standards of quality and safety at the point of care? The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. Overall, the average time per patient was 12 minutes (10 minutes on routine rounds and 14 minutes on post-take rounds). The considerative checklist has encouraged and enabled documented evidence of high quality and safe medical care, and anecdotally improved team working, communication with patients, and team and patient satisfaction.
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This paper outlines the development and evaluation of the utility of workplace-based assessments in higher medical training: case-based discussion (CbD); the acute care assessment tool (ACAT); audit assessment; teaching observation and patient survey (PS). The study population included trainees in higher medical training (ST3+) from physician specialties in the U. K. ⋯ For adequate reliability (co-efficient 0.7) a total of 12 CbDs; three ACATs and 16 PS raters are required. There was evidence for the validity and positive educational impact of all the tools. There were difficulties with the feasibility of the PS.