News
NHS England prepares to publish a local breakdown of ‘never event’ data online Statistics relating to serious errors in care at every hospital trust will be made available for first time By Sophie Blakemore LOCAL DETAILS on the number of ‘never events’ occurring at each hospital trust in England are being made available for the first time. Until now, data on the events – serious errors in care that put patients at risk of harm and that should not happen if full preventative procedures are in place – have only been published annually at national level. But from April, the information will be published every month on the NHS England website for patients, the public, healthcare professionals and managers to view and dissect. A provisional quarterly breakdown of never events was published just before Christmas. Never events include wrong-site surgery, items such as swabs and other medical equipment being left inside a patient, and chemotherapy being administered in the wrong way. The provisional data show that 102 NHS trusts and eight independent hospitals
Learning from mistakes National director of patient safety at NHS England Mike Durkin said he expected reporting of these incidents to increase as the NHS becomes more transparent and as the types of incidents that are classed as never events continue to increase with developments in patient safety practices. Dr Durkin said: ‘This publication is not about naming and shaming, it is about telling the public about mistakes, and further ensuring that we talk about and learn from them. That is the way to minimise errors and take every step we can to drive avoidable harm out of the NHS. ‘By making this detailed data fully open to public scrutiny, we are fulfilling a key recommendation of the Francis Review,
Provisional guidance for end of life care available in Scotland
Interim Guidance: Caring for People in the Last Days and Hours of Life is available at www.scotland.gov.uk/ Resource/0044/00441053.pdf
INTERIM GUIDANCE on end of life care has been published in Scotland after health minister Alex Neil announced the Liverpool Care Pathway (LCP) will be phased out in the next 12 months. It was produced by the Living and Dying Well National Advisory Group, and advises that nurses and doctors must explain carefully to relatives the reasons for withdrawing hydration and nutrition. The group was established after a government-commissioned review said the LCP should be scrapped in England. NURSING MANAGEMENT
had at least one never event between April and September 2013. There were 37 instances of wrong-site surgery in the period, and 70 incidents of foreign objects accidentally left inside patients.
Senior nurses and managers recognised in New Year honours PROFESSOR OF nursing at the University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Catherine Gerrish, has been made a CBE, along with the chief executive of South Devon Healthcare NHS Foundation
but more importantly we are making a big step towards further reducing these events.’ In addition to the publication of local never event data, a surgical safety task force has been carrying out an in-depth review of surgical never events and is due to report imminently. RCN head of policy and international Howard Catton said: ‘Transparency and benchmarking are important drivers to improving safety and, potentially, culture. However, it’s crucial that individuals are not blamed for systematic failures or that unnecessary additional bureaucracy is created.’ Professor Don Berwick, the US expert who led a landmark review into patient safety in England last year, hailed the move as an important step forward for the NHS. ‘One way to help improve safety is by openly and honestly recognising, discussing and examining mistakes in care. That helps us create continually better systems and procedures,’ he said.
i Find out more Local never events data is available at tinyurl.com/never-data
Trust, Paula Vasco-Knight (pictured). Susan Bale, assistant nurse director, research and development at Aneurin Bevan Local Health Board; Tara Bartley, national nursing representative at the Society for Cardiothoracic Surgery; and Janet Sheard, former executive director of nursing and allied health professionals, Nottingham Healthcare NHS Trust, were made OBEs. Charge nurse at Abertawe Morgannwg University Health Board, Nigel Board; ward sister at Nevill Hall Hospital, Julie Brown; director of nursing at NHS Greater Glasgow and Clyde, Rosslyn Crocket; and matron in acute adult care at the Royal Bolton Hospital, Suzanne Lomax, were made MBEs. Matron at King Edward VII Hospital, Caroline Cassels, was made an LVO. February 2014 | Volume 20 | Number 9
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NHS England prepares to publish a local breakdown of ‘never event’ data online Statistics relating to serious errors in care at every hospital trust will be made available for first time By Sophie Blakemore LOCAL DETAILS on the number of ‘never events’ occurring at each hospital trust in England are being made available for the first time. Until now, data on the events – serious errors in care that put patients at risk of harm and that should not happen if full preventative procedures are in place – have only been published annually at national level. But from April, the information will be published every month on the NHS England website for patients, the public, healthcare professionals and managers to view and dissect. A provisional quarterly breakdown of never events was published just before Christmas. Never events include wrong-site surgery, items such as swabs and other medical equipment being left inside a patient, and chemotherapy being administered in the wrong way. The provisional data show that 102 NHS trusts and eight independent hospitals
Learning from mistakes National director of patient safety at NHS England Mike Durkin said he expected reporting of these incidents to increase as the NHS becomes more transparent and as the types of incidents that are classed as never events continue to increase with developments in patient safety practices. Dr Durkin said: ‘This publication is not about naming and shaming, it is about telling the public about mistakes, and further ensuring that we talk about and learn from them. That is the way to minimise errors and take every step we can to drive avoidable harm out of the NHS. ‘By making this detailed data fully open to public scrutiny, we are fulfilling a key recommendation of the Francis Review,
Provisional guidance for end of life care available in Scotland
Interim Guidance: Caring for People in the Last Days and Hours of Life is available at www.scotland.gov.uk/ Resource/0044/00441053.pdf
INTERIM GUIDANCE on end of life care has been published in Scotland after health minister Alex Neil announced the Liverpool Care Pathway (LCP) will be phased out in the next 12 months. It was produced by the Living and Dying Well National Advisory Group, and advises that nurses and doctors must explain carefully to relatives the reasons for withdrawing hydration and nutrition. The group was established after a government-commissioned review said the LCP should be scrapped in England. NURSING MANAGEMENT
had at least one never event between April and September 2013. There were 37 instances of wrong-site surgery in the period, and 70 incidents of foreign objects accidentally left inside patients.
Senior nurses and managers recognised in New Year honours PROFESSOR OF nursing at the University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Catherine Gerrish, has been made a CBE, along with the chief executive of South Devon Healthcare NHS Foundation
but more importantly we are making a big step towards further reducing these events.’ In addition to the publication of local never event data, a surgical safety task force has been carrying out an in-depth review of surgical never events and is due to report imminently. RCN head of policy and international Howard Catton said: ‘Transparency and benchmarking are important drivers to improving safety and, potentially, culture. However, it’s crucial that individuals are not blamed for systematic failures or that unnecessary additional bureaucracy is created.’ Professor Don Berwick, the US expert who led a landmark review into patient safety in England last year, hailed the move as an important step forward for the NHS. ‘One way to help improve safety is by openly and honestly recognising, discussing and examining mistakes in care. That helps us create continually better systems and procedures,’ he said.
i Find out more Local never events data is available at tinyurl.com/never-data
Trust, Paula Vasco-Knight (pictured). Susan Bale, assistant nurse director, research and development at Aneurin Bevan Local Health Board; Tara Bartley, national nursing representative at the Society for Cardiothoracic Surgery; and Janet Sheard, former executive director of nursing and allied health professionals, Nottingham Healthcare NHS Trust, were made OBEs. Charge nurse at Abertawe Morgannwg University Health Board, Nigel Board; ward sister at Nevill Hall Hospital, Julie Brown; director of nursing at NHS Greater Glasgow and Clyde, Rosslyn Crocket; and matron in acute adult care at the Royal Bolton Hospital, Suzanne Lomax, were made MBEs. Matron at King Edward VII Hospital, Caroline Cassels, was made an LVO. February 2014 | Volume 20 | Number 9
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 03, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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