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Advanced clinical practice invites curiosity, rationalising the reasoning behind clinical symptoms. Developing one's own style of critical thinking is a journey that is influenced by a variety of factors including stress, risk, time and knowledge. There has been significant scrutiny in practice around making a clinical judgement when a person is entering the terminal phases of life, yet little clarity exists for clinicians regarding what information is required to make this decision. Within the role of advanced clinical practitioner (ACP) in palliative care there is an expectation to offer guidance and support to persons and families as well as junior nursing and medical staff of the changing phases of a person's illness. There is 'one chance to get it right', yet predicting death and dying remains predictably unpredictable. [ABSTRACT FROM AUTHOR]

This article examines several factors that can affect how raising of concerns can be supported. Nurse leaders play a vital role in this process to maintain patient safety and act accordingly within the Nursing and Midwifery Council Code. Considerations are provided to explore how the nurse leader can facilitate communication with all team members to influence organisational culture, where colleagues feel confident in voicing concerns. Professional responsibilities pertinent to this process are highlighted, including the nurse leader as an advocate and supporting constructive challenge. [ABSTRACT FROM AUTHOR]

Background: Incidence of peripheral venous cannula (PVC) bacteraemia have been rising in a trust in the south-west of England, with a 267% increase noted over the 2022/23 financial year compared with the previous year. Aim: To use a multimodal approach to reduce the incidence of PVC bacteraemia and improve patient safety. Methods: The initiative consisted of an educational poster highlighting the severity of infection associated with PVCs alongside key prevention messages rooted in Trust policy. Teaching sessions, complementing the poster, were delivered by the infection prevention and control team to each clinical area. Findings: The data showed that the provision of further educational resources and wider support resulted in a 54.5% decrease in the incidence of PVC bacteraemia in 2023/24 compared with the previous year. An audit undertaken in the fourth quarter of 2023/24 (January−March) found zero cases of PVC bacteraemia for the first time in 2 years. Conclusion: Dedication and collaborative working are vital for securing the success of quality improvement projects. PVC-related bacteraemias and the severity of infection remain an under-acknowledged and under-recognised topic within health care, with further research required. [ABSTRACT FROM AUTHOR]

HIGHLIGHTS: PIVCs often cause pain, irritation, or infection. Regular and careful catheter checks can decrease complications and improve patient outcomes. Implementation of the I-DECIDED® tool led to fewer idle catheters and complications. We present ideas for implementing the tool and how to overcome some common barriers. Introduction: Peripheral intravenous catheter (PIVC) assessment and decision making should be evidence based to minimize risks and enhance patient care. Exploring implementation strategies from successful outcome studies can raise health care professionals' awareness, boost adherence to evidence-based protocols, and elevate PIVC care standards. Aim: To describe the implementation of the I-DECIDED® device assessment and decision tool for PIVC management in the Australian and Brazilian contexts. Methods: The Promoting Action on Research Implementation in Health Services (PARIHS) framework (evidence, context, facilitation) was used to prospectively plan the implementation of the tool in adult inpatient units in Australia and to retrospectively analyze the implementation of the tool in a pediatric inpatient unit in Brazil. Similarities and differences in the implementation studies were explored. Results: Implementation of the tool in Australia and Brazil demonstrated that prevention and early detection of PIVC complications is achievable with standardized assessment and decision prompts. Both contexts witnessed a reduction in idle PIVCs, decreased insertion site complications, improved dressing quality, and significant improvements in documentation following implementation. Common implementation strategies included champions, education, badge cards, and posters. Enabling flexibility and context-specific education strategies was essential. Conclusion: Standardization of PIVC assessment and decision making using the I-DECIDED® tool reduced the prevalence of idle catheters and complications in Australia and Brazil. Implementation of the tool in different contexts confirms its utility and relevance for PIVC management in diverse health care settings. Promotion and adoption of the tool as a PIVC management bundle could increase patient safety and reduce health care costs. [ABSTRACT FROM AUTHOR]

Specialist nurses working in Therapeutic Apheresis Services (TAS) at NHS Blood and Transplant participate in an on-call rota. This means working above and beyond their rostered hours and can lead to them working 24 hours in one period. There is a noted risk of fatigue for people who work more than 13 hours in one stretch, and therefore it is important to understand how to recognise and manage the signs of fatigue. A literature review was performed to understand fatigue in various industries and how this was managed. This was then coupled with TAS internal data collection, exit interview data and sickness data to inform the design of a Fatigue Identification Questionnaire filled out by nurses during on-call working. Due to the strong link between fatigue and the hours worked, it is recommended that further work is undertaken to implement fatigue-management processes. [ABSTRACT FROM AUTHOR]

Introduction: In response to the SARS-CoV-2 pandemic in March 2020 and required adherence to infection control measures and patient and staff safety, an integrated respiratory team (IRT) developed guideline-based templates to support the team in teleconsultation reviews of their patients. Patients had been diagnosed with sleep disordered breathing, chronic obstructive pulmonary disease, asthma, interstitial lung disease or had oxygen assessment needs. Methods: Nine IRT members collaboratively developed content for the templates to assist in clinical reviews. In February 2023 semi-structured interviews were conducted and recorded with eight of the IRT members using Microsoft Teams, then thematically analysed. Results: Qualitative analysis revealed 13 themes. The templates were considered time-saving and advantageous in teleconsultation reviews. They supported evidence-based, structured, and consistent reviews. They were felt to uphold patient safety, supporting knowledge and skills. IRT members reported the templates had no adverse effects on autonomy, patient-professional relationships or person-centred care. They facilitated good multidisciplinary team working and communication. One interviewee reported that the templates supported the Nursing and Midwifery Council Code. Conclusion: The templates continue to be used across the regional service by the IRT. Their benefit has been realised beyond the pandemic. Refinements will be made as guidelines are updated. The development of these innovative templates may be of interest and value to other respiratory teams. [ABSTRACT FROM AUTHOR]

In health care, work-related musculoskeletal disorders are largely attributed to patient-handling tasks. Reliable assessments of patient mobility are imperative to mitigate the musculoskeletal burden on healthcare providers. This study explores the reliability of MK5 Mobility Classes, a patient mobility classification system. Authentic video material was collected, which enabled many healthcare providers to evaluate patient mobility within a highly realistic practical environment. Inter-rater and intra-rater reliability were determined using the intraclass correlation coefficient (ICC). A total of 147 raters completed the MK5 assessment for 40 distinct practical cases. Additionally, 75 raters repeated the assessments. The high level of inter-rater reliability, ICC value of 0.82, demonstrates the consistent performance of MK5 in assessing patient mobility across diverse scenarios. Intra-rater reliability results showed moderate agreement, with an average ICC of 0.59. This study confirms the reliability of the MK5 Mobility Classes in assessing patient mobility in healthcare settings. [ABSTRACT FROM AUTHOR]

The '5 Moments' approach is a time–space framework that delineates when hand hygiene should be performed and provides a resource for educators and auditors. It has become the dominant paradigm for organisations, practice, policy, and research in relation to hand hygiene. It is a concept that adopts the 'precautionary principle' that if the relative risk of a specific care task is unknown, a safe system must be to treat them on an equal level. However, a literal interpretation will frequently result in an extraordinary, implausible number of hand-hygiene opportunities and if this then becomes the standard to audit practice, within a policy document that espouses zero tolerance, it is likely to generate inauthentic data. If used effectively the 5 Moments concept provides an opportunity to enhance practice and reduce healthcare-associated infections but the healthcare provider organisation must embody a 'just culture' and collect the data in a climate of openness, transparency, and learning. [ABSTRACT FROM AUTHOR]

Infiltration and extravasation injuries are a common complication of intravenous therapy and vascular access practice. However, there remains a lack of awareness and understanding surrounding these injuries. The first of two articles (Barton, 2024) reported on data from a study showing that the use of ivWatch infusion site surveillance technology can dramatically reduce the number of infiltration and extravasation injures with peripheral intravenous infusions of vesicant preparations, which can improve patient safety and have a positive financial impact. This second of two articles on infiltration and extravasation examines the financial and academic burdens. [ABSTRACT FROM AUTHOR]

Background: The insertion of a PIVC is the most commonly performed invasive procedure in healthcare. Despite its frequency in placement in hospitalized patients, PIVCs are generally perceived as being safe; however, the prevalence of failure ranges from 35%-50%. Additionally, complications are common and often deemed 'acceptable' by clinicians. Healthcare provider and clinician foundational knowledge and competency is lacking nationally. Considering the mere volume of PIVCs placed, the failure and complication rates, the human impact is significant. Methods: The Association for Vascular Access (AVA) has led a collaborative effort with representatives from the Infusion Nurses Society (INS), the American Association of Critical Care Nurses (AACN), ECRI, and content experts representing nursing vascular access, infusion therapy, infection prevention, critical care, pediatrics, healthcare leadership, a physician, and a patient representative. Our aim is to provide concise guidance that will enhance and standardize practices related to PIVC. By consolidating current standards of practice into a comprehensive document, our framework seeks to advance the quality of care and improve patient safety. Results: This document has undergone meticulous scrutiny to ensure its quality, including incorporation of current standards, methodology for consensus from the expert panel, and input received from public comments. Conclusions: We anticipate that this work will have a significant impact on healthcare professionals, policymakers, and, most importantly, patients' experiences by the promotion of consistent, high-quality treatment, safety, and comfort for patients receiving a PIVC. [ABSTRACT FROM AUTHOR]

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a care plan to guide emergency treatment when the person cannot contribute. ReSPECT is important in supporting adults at risk of decline. Aim: To implement, evaluate and embed ReSPECT conversations to improve patient safety out of hours and support involvement of patients and their families. Methods: A quality improvement design underpinned by normalisation process theory (NPT) undertaken in a 35-bed community hospital ward between May 2022 and September 2023. Organisational prioritisation, facilitators, and champions supported the plan. Evaluation analysed ReSPECT plans, observations and a follow-up focus group. Results: ReSPECT conversations increased by 43% over 1 year (23 to 32 patients), and in quality (from 15/23 patients with a do not attempt cardiopulmonary resuscitation decision recorded and no ReSPECT plan to 32/35 with an individualised ReSPECT plan). Conclusions: ReSPECT could be implemented in community hospitals with facilitators and champions to deliver and embed change. The implementation plan is informing wider rollout across community hospital wards for adults with frailty and multiple conditions. [ABSTRACT FROM AUTHOR]

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation. [ABSTRACT FROM AUTHOR]

The article discusses the fifth annual webinar focused on research regarding the occupational exposure of nurses to hazardous drugs and the protective benefits of closed system transfer devices (CSTDs). Topics include research findings on occupational exposure to cytotoxic agents, implementation case studies of closed systems for systemic anti-cancer therapy (SACT), and recent guidance and regulations addressing the safe handling of hazardous drugs.

The article discusses enhancing systemic anti-cancer treatment (SACT) capacity by implementing subcutaneous atezolizumab for lung cancer treatment. Topics include the increasing demand for SACT in the United Kingdom, the benefits of subcutaneous over intravenous administration in reducing clinic time and improving patient comfort, and the need for wider adoption of subcutaneous immune checkpoint inhibitors to ease the burden on healthcare systems.

Infection prevention and control (IPC) is essential in nursing practice to safeguard patient health and reduce healthcare-associated infections. This article explores IPC strategies, including hand hygiene, the use of personal protective equipment, environmental cleaning, safe injection practices, and antimicrobial stewardship. It discusses the implementation challenges and solutions, such as ensuring compliance through education, monitoring and strong leadership. IPC measures are crucial in preventing infections such as catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections, and ventilator-associated pneumonia. By integrating personalised IPC strategies into nursing practice, healthcare providers can significantly improve infection control outcomes and enhance overall patient safety and quality of care. [ABSTRACT FROM AUTHOR]

Aims: This evaluation combines clinical and non-clinical collaborative breast referral triage to gain an understanding relating to the value of triage, by identifying 'suspected cancer' and 'cancer not suspected' populations, improve the patient pathway, and facilitate optimised resource availability. Method: An iterative service improvement method was used, with distinct phases of the process outlined to facilitate testing of ideas. The evaluation ran for 13 weeks in 2022. Regular team member meetings were arranged to discuss and agree improvement aims and outcomes. Findings: A triage flowchart was developed collaboratively, and subsequently adopted by the non-clinical booking team. Bespoke clinics were established, demonstrating no evidence of increased risk to patients, and meeting 28-day Faster Diagnosis Standard (FDS) requirements. Conclusion: breast referral triage of 'suspected cancer' and 'cancer not suspected' patients, using a clinical and non-clinical collaborative approach facilitates improved service visibility, prioritisation, management, and measurement. This also supports delivery of the 2019 NHS Long Term Plan to enhance earlier and faster cancer diagnosis by optimising access to diagnostic resources where required. [ABSTRACT FROM AUTHOR]

The purpose of this article is to explore the key themes and safety considerations connected to the inter-hospital transfer of critically unwell adults. First, the evidence base surrounding the subject is critically explored and clinical guidelines and national policy are discussed. Second, safety considerations are explored that highlight the risks and challenges associated with the inter-hospital transfer of critically unwell people. [ABSTRACT FROM AUTHOR]

Peripherally inserted central catheters (PICCs) are vital in delivering intravenous therapy. Despite their advantages, PICCs can lead to complications such as catheter exit site bleeding, which can cause patient distress and increase infection risk. This study evaluated the efficacy of StatSeal, a topical haemostatic device, in managing PICC exit site bleeding. StatSeal uses a hydrophilic polymer and potassium ferrate to form a seal, reducing access site bleeding and minimising dressing changes. For this study, Patients were recruited at Frimley Health NHS Foundation Trust; the trial involved 177 patients with StatSeal, and shows that 99% did not require additional dressing changes within the standard 7-day period. The findings demonstrate StatSeal's effectiveness in improving patient outcomes by reducing exit site bleeding and associated complications, enhancing the efficiency of vascular access maintenance and potentially lowering associated healthcare costs. The trial emphasises the importance of innovative solutions such as StatSeal to advance PICC care and improve patient experience. [ABSTRACT FROM AUTHOR]

The number of urgent '2-week-wait' referrals to hospital for people with suspected head and neck cancer being sent by primary care is constantly growing and it is becoming increasingly difficult for head and neck cancer services to meet this demand. In order for trusts to meet their Faster Diagnosis Standards, there needs to be an effective and efficient way to ensure there is capacity for patients to receive the appropriate assessments and diagnostic investigations without compromising the quality of care delivered. This article presents the proposal of introducing a nurse-led 2-week-wait clinic to meet the ever-growing demands on the service. There is discussion of the consultant-led training programme used to upskill an advanced nurse practitioner in a single-centre study, as well as explanation of the processes followed to maintain patient safety throughout the pilot project. There will also be consideration of clinical governance and discussion of how patient satisfaction with the novel service will be measured. [ABSTRACT FROM AUTHOR]

The practice of administering blended food via enteral feeding tubes has been growing in popularity in recent years. Concerns have been raised as this practice was perceived to increase risk of gastrointestinal intolerance, allergic reactions, nutritional insufficiency, tube blockages, and infection compared with using commercial enteral feed (CEF), the gold standard, as well as risk of litigation against the professional due to their support of practice that is not evidence-based. However, research has shown that the physical, social and emotional benefits from receiving blended diet may outweigh the previously suggested risks. Guidance has been updated to encourage discussions around blended diet while informing the tube-fed individuals, families and carers of potential risks, potential benefits, barriers, considerations for training, safety and contraindications. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of preoperative skin decolonization in preventing surgical site infections (SSIs). It discusses the evolution of surgical disinfection techniques, the challenges posed by antimicrobial resistance, and the need for revolutionary strategies to address healthcare-associated infections. It emphasizes the role of bundled interventions, including preoperative bathing with antimicrobial agents.

Following a serious incident and inquest after the death of a patient due to choking at Sheffield Teaching Hospitals NHS Foundation Trust, the Trust put in place an action plan and implemented strategies to reduce the risk of recurrence. Four key actions were identified as essential to try to reduce the risk of a similar event: introduction of a standard operating procedure for mealtimes that included a pre-meal safety 'pause'; use of an electronic communication icon to indicate modified diet/fluid requirements, from emergency department and onward as a patient is transferred; job-specific mealtime safety training; and use of bedside posters with specific dietary requirements (in line with the International Dysphagia Diet Standards Initiative Framework). A new role of Lead Educator for Nutrition was introduced to support the changes and provide training. Changes were also made to the incident reporting system to ensure easy identification of events relating to dysphagia, so that these could be monitored, themes identified and lessons shared. A series of audits following the changes have shown that more staff across disciplines and teams have accessed training on nutrition and hydration practices, wards have increased the use of the icon and posters, and successfully implemented pre-meal safety pauses. The Lead Educator for Nutrition has helped embed learning, and increased awareness and knowledge about nutrition and hydration. [ABSTRACT FROM AUTHOR]

HIGHLIGHTS: Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Background: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. Design and Methods: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. Aims and Objectives: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. Results: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. Conclusions: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures. [ABSTRACT FROM AUTHOR]

Occasionally, the administration of intravenous (IV) therapies can go wrong. Infiltration or extravasation is a complication when a drug or IV therapy leaks into the tissues surrounding the vascular access device. Extravasation can cause serious and often life-changing injuries. Extravasation is often associated with systemic anti-cancer therapy but non-chemotherapy drugs have been reported as having a greater risk of serious complications. This study outlines the first UK Infusion unit evaluation of the ivWatch infusion monitoring device which was undertaken from August 2023 to January 2024. Out of 2254 infusions monitored with ivWatch, the device prevented 122 cases of infiltration and extravasation from causing any harm to the patient, corresponding to a 5.4% 'check IV' notification rate. [ABSTRACT FROM AUTHOR]

The previous article discussed the pathophysiology involved in disorders of the nervous system. Having considered some of the most prevalent disorders, this second part uses a case study to explore effective patient assessment and emphasise the importance of facilitating patient self-management for improved outcomes. By addressing these key aspects, nursing professionals can enhance the quality of care and the support provided to individuals experiencing neurological disorders. [ABSTRACT FROM AUTHOR]

Unit/ward accreditation programmes have been widely implemented by nursing and midwifery teams across healthcare providers in the UK over the recent years and have many associated benefits. These include promoting quality improvement on a wider scale across the organisation, strengthening oversight and accountability of quality and safety from ward to board and vice versa, promoting shared learning, and providing opportunities for sharing and celebrating excellence. The Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust have recognised the value of this approach, launching a clinical accreditation programme in April 2023. This initially focused on nursing and midwifery, with plans to widen the approach to other disciplines and specialist teams. Up to the time of writing, 56 visits had been undertaken with 30 clinical areas accredited. The remaining visited areas are awaiting their accreditation outcome. The approach has positively contributed to improvements in patient outcomes, such as more patient observations being completed on time, a reduction in patient falls and improvements in pressure ulcers. Colleagues participating in the programme and frontline staff working in the clinical areas assessed have reported how positive the approach has been, providing opportunities for shared learning and celebrating excellence. [ABSTRACT FROM AUTHOR]

Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices. [ABSTRACT FROM AUTHOR]

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain. [ABSTRACT FROM AUTHOR]

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses some recent reports on the NHS complaints system and the statutory duty of candour [ABSTRACT FROM AUTHOR]

The article focuses on the challenges posed by the National Health Service model of free healthcare and its impact on patient safety, particularly regarding the controversial practice of corridor care. Topics include the normalization of temporary escalation spaces for patient treatment, legal and ethical implications of corridor care, and the disparity between theoretical guidelines and the reality of patient safety in overcrowded hospitals.

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses some recently published reports considering the national patient safety picture and issues around the duty of candour [ABSTRACT FROM AUTHOR]

The article focuses on ongoing developments in NHS patient safety policy for 2025 and the government's approach to addressing key issues. Topics include the government's consultations on patient safety issues, such as the reviews of the NHS Constitution and Never Events, which have been launched in 2024, and the possibility of reforms in the NHS patient safety framework.

The article focuses on the natural tendency of individuals, including nurses, to form strong professional identities and alliances within their specialties, which can both enrich professional experiences and lead to collaborative efforts in achieving goals like innovation and evidence-based practice. Topics include the challenges faced by the NHS in maintaining high-quality care amidst increasing demands and changing demographics.

The article presents the discussion on exercise professional accountability to ensure patient safety in accordance with laws, policies and regulations. Topics include nursing is hugely diverse with a multitude of specialties and individual nurses working to differing levels; and strategies provide a framework that supports working within one's scope of practice and minimises the risk of inadequate self-reflection.

The aim of this project was to introduce and evaluate the Call 4 Concern© (C4C) service, which provides patients and relatives with direct access to critical care outreach services (CCOS). This allows patients and relatives an additional platform to raise concerns related to the clinical condition and facilitate early recognition of a deteriorating patient. The introduction of Call 4 Concern at a district general hospital was inspired by the Royal Berkshire Hospital, where staff have been pioneering the service in the UK since 2009. They were able to demonstrate the potential to prevent clinical deterioration and improve the patients' and relatives' experiences. The project was originally inspired by the Condition H(elp) system in the USA, which was set up following the death of an 18-month-old child who died of preventable causes. Similar tragic cases in the USA and the UK have prompted campaigning by affected families, resulting in the widespread adoption of comparable services. The project was rolled out in the authors' trust for all adult inpatients. There was a 2-week implementation phase to raise awareness. Between 22 February 2022 and 22 February 2023, the CCOS team received 39 C4C referrals, representing approximately 2.13% of the total CCOS activity. Clinical deterioration of a patient was prevented in at least three cases, alongside overwhelming positive feedback from service users. [ABSTRACT FROM AUTHOR]

This article provides clinical guidance on performing cannulation on an adult. The site, equipment selection and aseptic non-touch technique will be discussed. The clinical procedural technique of cannulation will be explained and the article will also provide an awareness of the dangers and complications of this invasive technique for both the patient and the health professional. [ABSTRACT FROM AUTHOR]

HIGHLIGHTS: CLABSIs are a major concern in both the adult and pediatric patient population. Contamination of catheter hubs is a common cause of CLABSI. A novel, transparent line guard protects CVAD hubs from gross contamination. Central line-associated blood stream infections (CLABSIs) are a serious and potentially deadly complication in patients with a central venous access device (CVAD). CVADs play an essential role in modern medicine, serving as lifelines for many patients. To maintain safe and stable venous access, infection prevention bundles are used to help protect patients from complications such as CLABSI. Despite most CLABSIs being preventable, rates have been on the rise, often disproportionately impacting critically ill children. New solutions are needed to strengthen infection prevention bundles and protect CVADs from pathogen entry at catheter hubs and line connections. A novel, Food and Drug Administration–listed device has become available recently to guard CVADs from sources of gross contamination, addressing this apparent gap in infection prevention technology and practice. [ABSTRACT FROM AUTHOR]

The clinical telephone helpline discussed here is a communication channel for family members and caregivers whose loved ones are in hospital. It makes full use of the effect families can have on the care experience and complements standard visiting as well as when hospital visits are restricted. The helpline helps to meet family members' health information and emotional wellbeing needs and is a reciprocal patient safety communication channel. Three main benefits have been identified. Flrst, communication between patients, relatives, communities and staff is enhanced. The helpline provides comprehensive patient clinical updates to relatives and caregivers using live digital healthcare records, and person-centred care is facilitated by patient-specific information being obtained by helpline clinicians from relatives. Second, it releases time to care. The helpline runs remotely, away from wards, enabling ward-based clinicians to prioritise direct patient care. Finally, clinical staff who are unable to work directly within wards maintain their active engagement in care provision, supporting relatives, patients and their ward-based colleagues. [ABSTRACT FROM AUTHOR]

Background: Independent second-checking of medication is part of everyday practice across many parts of the NHS. A robust, independent second check is built into medication administration protocols to reduce the risk of drug errors affecting patients. Aim: This work aims to determine the barriers and facilitators regarding a robust independent second check of medication before administration to patients within adult critical care. Method: Nurses in adult critical care were invited to participate in focus groups. They were asked to discuss factors that they felt enabled or prevented a robust second check of medication. Thematic analysis was undertaken by three critical care pharmacists Findings: The major themes identified as barriers to an independent second check were: geography of the critical care unit; IT; routine; complex process; and personnel. Conclusion: There are complex barriers to undertaking a robust second check and addressing some of these could improve patient safety. [ABSTRACT FROM AUTHOR]

Due to advances in elastomeric pump technology, there are now devices available that can be filled with intravenous (IV) therapy at the bed or chair side. These devices are safe, reliable and enable the patient to be mobile when having their infusion. The Surefuser™+ elastomeric infusion pump is available in multiple configurations and allows patients to remain independent and receive IV therapy infusions in their own homes. The pump can also be used in the acute healthcare setting where traditional electronic infusion pumps may not be available. This article provides an overview of the Surefuser+ elastomeric infusion pump, its features and mode of action and how it can be used in clinical practice. [ABSTRACT FROM AUTHOR]

Elective surgical patients need accurate drug charts to reduce missed medication doses, decreasing the chance of peri-operative complications. The quality improvement project described in this article used four interventions to improve the percentage of missed medication doses. A driver diagram was produced to interrogate the current pathway which highlighted multiple interventions, including changes to elective pro formas, the initial clerking process and nurse-based prescribing. Once implemented, a plan-do-study-act (PDSA) cycle was completed as per NHS Improvement guidelines. Overall, missed medication dose percentage decreased from 9.8% to 0% after the interventions. Two of these changes have been deemed sustainable and have been integrated into elective patient pathways, improving both patient safety and streamlining surgical elective patient services. This project highlights the importance of prescribing practice in a multidisciplinary team. Simple changes to established systems allow for better patient care, and the authors’ project provides evidence that empowering nursing staff to take the lead in the medication management of patients can reduce the likelihood of negative outcomes in a patient’s admission. [ABSTRACT FROM AUTHOR]

Background: Two major avoidable reasons for adverse events in hospital are medication errors and intravenous therapy-induced infections or complications. Training for clinical staff and compliance to patient safety principles could address these. Methods: Joint Commission International (JCI) consultants created a standardised, 6-month training programme for clinical staff in hospitals. Twenty-one tertiary care hospitals from across south-east Asia took part. JCI trained the clinical consultants, who trained hospital safety champions, who trained nursing staff. Compliance and knowledge were assessed, and monthly audits were conducted. Results: There was an overall increase of 29% in compliance with parameters around medication preparation and vascular access device management. Conclusion: The programme improved safe practice around preparing medications management and managing vascular access devices. The approach could be employed as a continuous quality improvement initiative for the prevention of medication errors and infusion-associated complications. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous (IV) fluids are routinely used in hospitalized patients. As IV fluids are an everyday occurrence, their importance is often overlooked. Many patients receive large volumes of fluid during resuscitation to aid in the promotion of tissue perfusion. Nurses regularly administer IV fluids as part of maintenance infusions or as life-saving therapies and, therefore, need to understand these fluids' impact on their patients. Understanding nurses' existing perceptions of IV fluid management practices are crucial to improving practice. Methods: This study used an online survey to gather information on nursing perceptions of IV fluids. Four hundred and sixty-two Canadian nurses from diverse backgrounds were surveyed, including registered nurses, licensed practical nurses and student nurses. Results: The study found that the majority of participants agreed that IV fluids, including type, amount, and rationale for infusion, were important. They also agreed that fluids could impact patient outcomes. However, the study found that, despite recognizing the value and importance of fluid management, many nurses struggled with recognizing how to determine a patient's fluid status versus fluid responsiveness. Conclusion: This study supports improving nursing education to understand better the differences between fluid volume status and volume responsiveness. Our study also provides evidence that nurses need access to more sophisticated tools to conduct dynamic assessments and better meet patients' needs. [ABSTRACT FROM AUTHOR]

Historically, gaining peripheral intravenous (IV) access for patients with difficult intravenous access (DIVA) has been problematic and associated with increased complications, central venous access device insertion and reduced patient satisfaction. Consequently, extended-length peripheral intravenous catheters (PIVCs) have been developed, but to date no real-world data exploring their effectiveness with NHS patients has been published. This article reports on the results of introducing extended-length PIVCs, inserted using ultrasound guidance in patients with DIVA by a vascular access team. This began in 2019, across an adult tertiary hospital setting in the NHS with about 750 beds. The specialties at this hospital include, but are not limited to, emergency medicine; head and neck; vascular; diabetes and endocrinology; respiratory; care of the older person; stroke services; gastroenterology; and trauma and orthopaedics. The vascular access team recorded 1485 individual insertions between 2019 to 2022, with a mean dwell time of 6 days, a first attempt success rate of 91%, and a therapy completion rate of 75 and 78% for inpatient and outpatients respectively. Indications included administration of IV fluids, medication, blood products and access for investigations or procedures. Obtaining reliable IV access in patients with DIVA prevents treatment delays, cancelled or delayed procedures, both of which benefit patients and the healthcare organisation. The data presented in this study support the use of extended-length PIVCs in patients with DIVA and has led to the development of new referral pathways. [ABSTRACT FROM AUTHOR]

Depression and anxiety are common, with one in six people experiencing symptoms in any given week. Of these people, 8.32 million are prescribed antidepressants. People living with HIV are likely to experience psychiatric disorder, with one in three experiencing depression and anxiety, and being at greater risk of developing post-traumatic stress disorder. Sexual side-effects of psychotropic medication are very common, cause distress, and can persist even after the medication has been withdrawn. Antidepressants are powerful drugs and can have severe interactions with many other substances. This article seeks to raise awareness of sexual side-effects of psychotropic medications and draw attention to ethical issues related to post selective serotonin reuptake inhibitor sexual dysfunction (PSSD). Additional risk factors and interactions between psychotropic medications and recreational drugs are identified. Recommendations are made to improve care and clinical outcomes through the development of therapeutic alliances. [ABSTRACT FROM AUTHOR]

The article presents the discussion on infection control is an integral part of healthcare practice. Topics include actively preventing infections is a crucial strategy in reducing the necessity for antibiotic prescriptions; and bacterial infections is still increasing, underscoring the urgent need for efficient and proactive infection prevention strategies.

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, looks to 2025 and how the NHS patient safety landscape might change along with some recent patient safety and clinical negligence reports [ABSTRACT FROM AUTHOR]

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses several recently published patient safety reports [ABSTRACT FROM AUTHOR]

The article discusses the ongoing changes to the British National Health Service (NHS) health regulation and governance system, driven by reviews initiated by Secretary of State for Health and Social Care Wes Streeting to streamline patient safety oversight in the United Kingdom. Topics include the review of NHS patient safety organizations, the need for rationalization of overlapping functions, and the impact of recent scandals on public confidence in the regulatory framework.

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses a new report and consultation on NHS patient safety culture development [ABSTRACT FROM AUTHOR]