Berwick review into patient safety

A promise to learn – a commitment to act: improving the safety of patients in England

Recommendations to improve patient safety in the NHS in England.  PDF, 359KB, 46 pages

Don Berwick’s letter to senior government officials and senior executives in the health service

PDF, 37.5KB, 2 pages

Don Berwick’s letter to the clinicians, managers, and all staff of the NHS   PDF, 38.6KB, 2 pages

We are recommending four guiding principles, among others, to help the English NHS get better faster, and I urge you to think about these and ask how you can help incorporate them into your own daily work.

• Place the quality and safety of patient care above all other aims for the NHS. (This, by the way, is your safest and best route to lower cost.)
• Engage, empower, and hear patients and carers throughout the entire system, and at all times
• Foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work.
• Insist upon, and model in your own work, thorough and unequivocal transparency, in the service of accountability, trust, and the growth of knowledge.

Don Berwick’s letter to the people of England    PDF, 40.2KB, 2 pages

Jain, Y, Kokan,J; European Journal of Surgical Oncology; May 2013

Is there a role for routine chest X-ray in diagnosing metastatic disease in invasive breast cancer patients?

This article was published in the European Journal of Surgical Oncology by Yogesh Jain, Jalal Kokan of Macclesfield District General Hospital, Macclesfield, UK

Our survey still needs YOU!

For staff and students of East Cheshire Trust

IF you haven’t already completed our quick and easy survey, please can you do so.  We only need a few more respondents to achieve the necessary quota and it really doesn’t take up much of your time.

Please let us have your comments by clicking here OR copy and paste this link http://www.surveymonkey.com/s/78XCMGF into your browser.

Thank you.

Care of the dying patient in the community

CLINICAL REVIEW

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4085 (Published 3 July 2013)

Cite this as: BMJ 2013;347:f4085

 CME
General practice / family medicine
End of life decisions (ethics)
End of life decisions (geriatric medicine)
Extract from BMJ:The consensus from international studies of patient preferences is that, given adequate support, most people would prefer to die at home. However, more than half of all deaths in the United Kingdom occur in hospital, with only 18% of people dying in their own home. Suggested reasons for this include a lack of anticipatory care planning, poor coordination between healthcare agencies, and insufficient community resources. National and local policies now focus on facilitating home deaths, and recently there has been a small increase in the proportion and absolute number of people dying at home.

The demographics of deaths across Europe are changing with the ageing population, with deaths from dementia, cancer, and chronic diseases becoming more common.  Caring for such patients in hospital will probably become unsustainable in terms of capacity, cost, and patient satisfaction. The focus of end of life care is therefore shifting to the community—to homes and care homes—where the role of the general practitioner, with support from the community palliative care team, is key. The onus is on all health and social care professionals to work collaboratively across settings to enable patients to receive high quality end of life care in the place of their choice.

Anderson S.G., Roberts H., Malipatil N., Dunn G., Heald A.H: Diabetic Medicine

A higher index of multiple socioeconomic deprivation predisposes to development of painful peripheral neuropathy in Type 1 diabetes.

Anderson S.G., Roberts H., Malipatil N., Dunn G., Heald A.H.

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2013 Manchester United Kingdom. Conference Start: 20130313 Conference End: 20130315. Conference Publication: (var.pagings). 30  (pp 70), 2013. Date of Publication: March 2013.

DOI http://dx.doi.org/10.1111/dme.12091

Maintaining High Professional Standards Consultation

Extract from NHS Employers 

This short survey aims to gather views on the disciplinary framework for doctors and dentists employed by the NHS. The changes to the structure of the NHS and the introduction of medical revalidation have influenced the way in which the framework operates. Comments are being welcomed until 6th September 2013.

• Survey
• NHS Employers – news

GPs list of reporting requirements from NHS England

Extract from PULSE

GP practices are being asked to report huge reams of data to NHS England so that their performance can be monitored and any ‘unwarranted variation’ can be investigated, it has emerged.

Practices are being asked to log onto an NHS England website to complete details on their surgery’s practice staff, suitability, premises and equipment, access to and availability of practice services, information about the practice and its procedures and its governance.

The ‘assurance management’ website, www.primarycare.nhs.uk, replaces the annual reports that were historically collected by PCTs, will allow for NHS England to spot any outliers and hold GPs to account in a ‘robust and fair’ way.

Public consultation on Mid Staffs

A public consultation on the future of Stafford Hospital opens later.

Administrators have said Mid Staffordshire NHS Trust should be dissolved, with many services at Stafford Hospital taken on by nearby hospitals.  Under the plans, maternity services and seriously ill children would no longer be treated at Stafford.

The proposals, announced last Wednesday, were initially met with criticism by people in the area.

Extract from BBC Health news

Also in the news:  Doctors in Stoke-on-Trent are insisting the city’s hospital will be able to cope if services are moved there from Stafford Hospital.

NICE guidance – updates

Keeping you up-to-date

Guidance by topic: the following guidance topics matching your health area preferences have been published or updated

• Acute coronary syndrome – rivaroxaban [ID532]                                                          
• Antenatal and postnatal mental health (update)                                                            
• Antenatal care                                                                                                                
• Arrythmias – ICDs & Heart failure – cardiac resynchronisation [ID481]                        
• Arthritis of the hip (end stage) – hip replacement (total) and resurfacing arthroplasty (Rev TA2, TA44) [ID540]   
• Asthma – diagnosis and monitoring                                                                               
• Atrial fibrillation (stroke prevention) – rivaroxaban                                                      
• Atrial fibrillation – dabigatran etexilate                                                                          
• BMI and waist circumference – black, Asian and minority ethnic groups                      
• Breast cancer (HER2 negative, oestrogen receptor positive, locally advanced or metastatic) – everolimus (with an aromatase inhibitor) [ID538]                                                                                        
• Colorectal cancer (metastatic) – regorafenib [ID593]                                                   
• EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing         
• Familial breast cancer                                                                                                    
• Gene expression profiling and expanded immunohistochemistry tests to guide the use of adjuvant chemotherapy in early breast cancer management: MammaPrint, Oncotype DX, IHC4 and Mammostrat  
• Intrapartum care                                                                                                           
• Lung cancer (non-small-cell, anaplastic lymphoma kinase fusion gene, previously treated) – crizotinib [ID499]    
• Mega Soft Patient Return Electrode for use during monopolar electrosurgery             
• Multiple myeloma – bortezomib (induction therapy) [ID610]                                        
• Non Hodgkin’s lymphoma (relapsed refractory) – pixantrone monotherapy [ID414]    
• Prostate cancer (hormone relapsed, metastatic) – enzalutamide (after docetaxel)       
• Psoriatic arthritis (active, progressive) – ustekinumab [ID607]                                   
• Pulmonary embolism (acute treatment, VTE prevention) – rivaroxaban [ID569]          
• Pulmonary embolism and recurrent venous thromboembolism – rivaroxaban              
• Self-monitoring coagulometers (CoaguChek XS system, INRatio2 PT/INR monitor and ProTime Microcoagulation system), for self-testing or self-managing coagulation status in people for whom long-term vitamin K antagonist therapy is intended.                                                                                                       
• Systemic lupus erythematosus (autoantibody-positive) – belimumab [ID416]             
• Tuberculosis (update)                                                                                                   
• Ulcerative colitis                                                                                                            
• WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension                                                                                                                                       

 

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BMJ topics: August 2013

Here’s a selection of content from this month’s BMJ – click on this link if you want to read the full issue.

Feature

Patient information leaflets: “a stupid system”    Margaret McCartney

The growth of medical marijuana  Owen Dyer

Sharing data from clinical trials: where we are and what lies ahead  Elizabeth Loder

News

GPs taking on out of hours work face higher indemnity fees   Gareth Iacobucci

New dementia targets are proposed for GPs in next year’s QOF    Adrian O’Dowd

Don’t call low risk lesions cancer, experts say   Michael McCarthy

Opposition to abortion is growing in Southern and Midwestern US states    Michael McCarthy

Doctors should have to be accredited to support whiplash claims, say MPs    Ingrid Torjesen

Rescue boards are set up in England to deal with “significant deterioration” in A&E departments Matthew Limb

Editorials

Physician Payment Sunshine Act  José G Merino

The Liverpool care pathway: a cautionary tale  Katherine E Sleeman and Emily Collis

Medical savings accounts: Singapore’s non-solution to healthcare costs  Martin McKee and Reinhard Busse

India’s new policy to protect research participants   Jeremy Sugarman, Anant Bhan et al

Government’s plans for universal health checks for people aged 40-75   Felicity Goodyear-Smith

Leading healthcare in London: time for a radical response?   Naomi Fulop and Rosalind Raine

BMJ Best Practice looks at Assessment of Dementia

 

 
In this module Best Practice begins with an overview, then goes on to emergencies, diagnosis and finally resources relating to this increasingly common syndrome.

Assessment of dementia 

Dementia is a syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living. Decline in cognition is extensive, often affecting multiple domains of intellectual functioning. [1] [2]

The prevalence of dementia is approximately 1% at the age of 60 years, and doubles every 5 years, to reach 30% to 50% by the age of 85 years.
Continue reading at BMJ Best Best Practice

Finally: make sure you keep checking Google Play for the new Android version of the Best Practice App, and the app store for the updated version of the IOS Best Practice App.

Abstract included in BMJ ‘Gut’

Abstract PTU-028 

SYMPTOM ASSESSMENT OF PATIENTS IN THE CHESHIRE BOWEL CANCER SCREENING PROGRAMME WITH A FINDING OF CANCER
doi:10.1136/gutjnl-2013-304907.120

1,*A Bond, 2J Everall, 2I London, K Koss. Gastroenterology, East Cheshire NHS Trust, Macclesfield; 2Gastroenterology/BCSP, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK

Introduction:
When attending the bowel cancer screening (BSC) programme patients undergo pre-colonoscopy assessment of their symptoms. This is conducted by the specialist screening practitioner for the BCS programme. Following a diagnosis of bowel cancer at colonoscopy the questions were asked again, after a 3–6 month period. Comparison could then be made to assess the validity of the pre-assessment questionnaire. It would also allow us to look at whether patients reported all symptoms during pre-assessment.