Quality improvement resource pack

New resource to introduce and improve situation awareness in hospitals is now available on the Royal College of Paediatrics and Child Health’s website.

This free, online resource pack aims to improve communication, build a safety-based culture and deliver better health outcomes for children and young people.

It includes informative presentations and useful tools with worked examples in six areas.

  • Quality improvement
  • Patient safety culture
  • Structured communication
  • Recognising deterioration
  • The ‘huddle’
  • Evaluation and spread

The resource pack has been developed as part of the final phase of the College’s flagship quality improvement programme, Situation Awareness for Everyone (S.A.F.E).

Access the S.A.F.E resource pack

Find out more about the S.A.F.E programme

Video introducing key concepts:

Drug company is suspended from UK industry body after “deception on a grand scale”

O’Dowd, A. BMJ. 2016. 353:i3574

https://commons.wikimedia.org/wiki/File:VariousPills.jpg
Image source: Wikipedia // CC BY-SA 3.0

The UK subsidiary of a prominent Japanese drug firm has had its membership of the United Kingdom’s industry representative body suspended after what has been described as “deception on a grand scale.”

The Association of the British Pharmaceutical Industry’s one year suspension of Astellas UK, from 24 June, was made because of serious breaches of the association’s code of practice that related to covert attempts to market prostate cancer drugs to doctors.

The decision came after a complaint about an advisory board meeting that was held in Milan in February 2014 and was ruled to be in breach of the code, including of clause 2, which deals with actions likely to bring discredit on, or reduce confidence in, the drug industry.

An anonymous health professional who complained said that he or she had been invited by Astellas, along with colleagues, to what was described as an “educational event” meeting in Milan where they could obtain advice about prostate cancer and share their expertise.

More than 100 other clinicians attended this meeting, and Astellas presented the benefits of its prostate cancer drug enzalutamide (Xtandi) for what was at the time an unlicensed indication. The complainant alleged that Astellas was not truthful in explaining why delegates had been invited to the meeting, and that the company promoted something it should not have done.

Read the full article here

Working together to prevent maternal mortality

Royal College of Physicians and Surgeons of Glasgow / Royal College of Obstetricians and Gynaecologists, June 2016

It’s better to ask: working together to prevent maternal mortality

mathealth
image source: rcpsg.ac.uk/

The RCPSG and the RCOG have produced an animated video to help doctors assess unwell pregnant or postpartum women, which aims to help reduce the number of maternal deaths in the UK. It is accompanied by a poster, which highlights the main causes of maternal death and provides midwives and doctors with advice for assessing pregnant and postpartum women who are feeling unwell.

More information available from the Royal College of Midwives here

Patients’ experiences of deep brain stimulation for Parkinson’s disease

Mathers, J. et al. BMJ Open. 2016. 6:e011525

http://creativecommons.org/licenses/by-sa/4.0
Image source: Andreashorn – Wikipedia // CC BY-SA 4.0

Objective: To review and synthesise qualitative research studies that have explored patients’ experience of deep brain stimulation (DBS) in advanced Parkinson’s disease (PD).

Design: Systematic review and meta-synthesis of 7 original papers, using metaethnography.

Setting: Studies conducted in Denmark, France and Sweden.

Participants 116 patients who had undergone DBS and 9 spouses of patients.

Results: Prior to surgery, the experience of advancing PD is one of considerable loss and a feeling of loss of control. There are significant hopes for what DBS can bring. Following surgery, a sense of euphoria is described by many, although this does not persist and there is a need for significant transitions following this. We suggest that normality as a concept is core to the experience of DBS and that a sense of control may be a key condition for normality. Experience of DBS for patients and spouses, and of the transitions that they must undertake, is influenced by their hopes of what surgery will enable them to achieve, or regain (ie, a new normality).

Conclusions: There is a need for further qualitative research to understand the nature of these transitions to inform how best patients and their spouses can be supported by healthcare professionals before, during and after DBS. In assessing the outcomes of DBS and other treatments in advanced PD, we should consider how to capture holistic concepts such as normality and control. Studies that examine the outcomes of DBS require longer term follow-up.

Read the full article here

Related video: How does DBS work?

What makes a good leader in today’s NHS?

Johnson, S. The Guardian. Published online: 22 June 2016

followership
Image source: Tranductrung2009 – Wikimedia Commons// CC BY-SA 4.0

Good leadership is often credited with being able to save the NHS. For individuals willing to take on leadership roles, the rewards can be great. However, with a general feeling of demoralisation in the workforce and services facing unprecedented demand, the challenges are even greater.

Marcus Powell, director of leadership and organisational development at The King’s Fund, recognises that leaders get “buffeted in all sorts of situations” and that they must have the ability to absorb problems and make sure their team feels safe.

He says that interference from the government and national bodies holds leaders back from fulfilling their potential: “The politics of healthcare gets in the way of the job people need to do … the interference is a drag on people’s resilience.”

Powell says that every member of staff working in the NHS should demonstrate leadership qualities. He says leaders should foster a culture whereby employees feel able to speak out if standards slip in order to improve care.

People should explore their responsibilities as a leader and learn how to listen, empathise and create conditions where people feel cared for – it’s impossible to lead a complex organisation as a cut-throat, coercive or bullying leader, he says.

Read the full article here

Study addresses safety concerns for older adults with diagnosed/undiagnosed dementia

ScienceDaily. Published online: 23 June 2016

B0005919 The criminal mind
Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

Dementia currently affects some 5 million people in the U.S., and that number is expected to triple by 2050. Having dementia affects the way you think, act, and make decisions.

In a study published in the Journal of the American Geriatrics Society, researchers examined how often older adults who have diagnosed and undiagnosed dementia engage in potentially unsafe activities.

The researchers examined 7,609 Medicare beneficiaries aged 65 to more than 90-years-old. Based on various cognitive tests, the researchers determined that 1,038 of the people they observed had probable dementia. Of that group, 457 had been diagnosed with dementia and 581 had not been diagnosed with dementia.

Nearly 1,000 participants tested as having “possible” dementia and 5,575 did not have dementia. Of the older adults with probable dementia, the researchers learned that:

  • 23 percent were still driving
  • 31 percent prepared hot meals
  • 22 percent managed their own finances
  • 37 percent managed their own medications
  • 21 percent attended doctors’ appointments alone

Read the full commentary here

Read the original research abstract here

Ban fast food deliveries to schools

RSPH. Published online: 23rd June 2016

https://www.rsph.org.uk//download.cfm?docid=2D739A14-9944-4C72-B38D942310F756C7
Image source: RSPH

A new report, published by RSPH, the Youth Health Movement and Slimming World, is calling for a ban on fast food takeaway deliveries to schools and the introduction of new initiatives such as film-style classifications on unhealthy food and a loyalty card to reward healthy food choices, as part of a raft of ideas put forward by young people to tackle the childhood obesity epidemic.

The move to ban deliveries to school is backed by three quarters of UK parents. In the report, young people point the finger at the temptation of fast food takeaways and unclear food labelling for the childhood obesity epidemic. Key findings from the research, which was developed from a roundtable workshop involving 19 young people aged 13-18 and a follow-up survey of more than 500 children, include:

rsph child2
Image source: RSPH
  • Almost half of young people (49%) blame fast food takeaways as the companies or brands most at fault for childhood obesity
  • A quarter (25%) of young people have ordered a takeaway to their school; half of young people (50%) have ordered a takeaway via their smartphone
  • More than four in five (82%) think food manufacturers are misleading people when they provide fat, salt and sugar for single servings rather than for the entire product
  • More than two in five (42%) can walk from their school to somewhere selling unhealthy food in under two minutes

Read the full report here

Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies

Fayaz, A. et al. BMJ Open. 2016. 6:e010364

https://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=1&_IXSR_=8sKizCGXHJ9&_IXSS_=_IXMAXHITS_%3d250%26_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26%252asform%3dwellcome%252dimages%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26i_pre%3d%26IXTO%3d%26t%3d%26_IXINITSR_%3dy%26i_num%3d%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26w%3d%26%2524%253ds%3ddigital%2btarget%26IXFROM%3d%26_IXSUBMIT_%3dSubmit%26_IXshc%3dy%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26_IXrescount%3d15&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: Matthew Herring – Wellcome Images // CC BY-NC-ND 4.0

Objectives: There is little consensus regarding the burden of pain in the UK. The purpose of this review was to synthesise existing data on the prevalence of various chronic pain phenotypes in order to produce accurate and contemporary national estimates.

Design: Major electronic databases were searched for articles published after 1990, reporting population-based prevalence estimates of chronic pain (pain lasting >3 months), chronic widespread pain, fibromyalgia and chronic neuropathic pain. Pooled prevalence estimates were calculated for chronic pain and chronic widespread pain.

Results: Of the 1737 articles generated through our searches, 19 studies matched our inclusion criteria, presenting data from 139 933 adult residents of the UK. The prevalence of chronic pain, derived from 7 studies, ranged from 35.0% to 51.3% (pooled estimate 43.5%, 95% CIs 38.4% to 48.6%). The prevalence of moderate-severely disabling chronic pain (Von Korff grades III/IV), based on 4 studies, ranged from 10.4% to 14.3%. 12 studies stratified chronic pain prevalence by age group, demonstrating a trend towards increasing prevalence with increasing age from 14.3% in 18–25 years old, to 62% in the over 75 age group, although the prevalence of chronic pain in young people (18–39 years old) may be as high as 30%. Reported prevalence estimates were summarised for chronic widespread pain (pooled estimate 14.2%, 95% CI 12.3% to 16.1%; 5 studies), chronic neuropathic pain (8.2% to 8.9%; 2 studies) and fibromyalgia (5.4%; 1 study). Chronic pain was more common in female than male participants, across all measured phenotypes.

Conclusions: Chronic pain affects between one-third and one-half of the population of the UK, corresponding to just under 28 million adults, based on data from the best available published studies. This figure is likely to increase further in line with an ageing population.

Read the full article here

Call for the personal possession and use of all illegal drugs to be decriminalised @R_S_P_H @FPH

RSPH. Published online: 16 June 2016

rsph2
Image source: RSPH

The call forms part of a wider package of measures aimed at moving UK drugs strategy away from a predominantly criminal justice approach towards one based on public health and harm reduction.

A representative poll of more than 2,000 UK adults found more than half (56%) agree drug users in their area should be referred to treatment, rather than charged with a criminal offence. Less than a quarter (23%) disagreed.

The recommendation is made in a new RSPH report, Taking a New Line on Drugs, endorsed by FPH and with the backing of Parliamentarians, drugs reform charities and law enforcement groups. The report, which is published ahead of the Government’s expected drugs strategy, argues a new approach is needed since, although overall drug use has fallen in recent years, drug-related harm – including drug-related death – has continued to rise. Read the full embargoed report here.

Other key recommendations include:

rsph
Image source: RSPH
  • Universal provision of evidence-based drugs education to young people through statutory Personal, Social, Health and Economic (PSHE) education in schools.
  • Moving lead responsibility for drugs strategy from the Home Office to the Department of Health and aligning more closely with alcohol and tobacco strategies.
  • Use of evidence-based drug harm profiles to inform enforcement priorities and public health messaging.

Read the full report here

Read the full commentary here

Proportion of women giving birth recorded as smokers falls to lowest level since series began in 2006/07

HSCIC. Published online: 16 June 2016

https://www.flickr.com/photos/zipporah/2898155676/
Image source: ~zipporah~ // CC BY-NC-ND 2.0

Latest statistics published by the Health and Social Care Information Centre (HSCIC)1today show that in 2015-16 10.6 per cent2 of pregnant women in England were recorded as smokers at the time of giving birth3. This represents 67,200 of 631,230 maternities4.

This is lower than in 2014-15 (when it was 11.4 per cent) and is also the lowest annual figure since this series was first published in 2006-07 (when it was 15.1 per cent). This decrease means the national annual percentage of women recorded as smokers at the time of giving birth in a financial year was below the national target of 11.0 per cent5 for the first time.

However, there were areas in England where up to a quarter of women giving birth over the last 12 months were smokers.

Statistics on Women’s Smoking Status at Time of Delivery is a quarterly and annual report, which provides a picture at Commissioning Region, Area Team and Clinical Commissioning Group level.

The report shows wide regional variation in the 12 months up to March 2016:

  •  Of England’s 209 Clinical Commissioning Groups (CCGs), NHS Blackpool had the highest prevalence, with one in four (26.0 per cent) women recorded as being smokers at the time of delivery.
  •  The CCG with the lowest prevalence was NHS Central London (Westminster) at 1.5 per cent.
  •  Overall, 103 CCGs in England (49.3 per cent) met or surpassed the national 11 per cent target.
  •  The area team with the highest prevalence was Cumbria and North East with 16.0 per cent of women recorded as smokers at the time of giving birth.
  •  The Area Team with the lowest prevalence, London, had 4.9 per cent of women recorded as smokers at the time of delivery.

Find all the statistics here