A large number of people use the healthcare service daily and a majority of them receive safe and high-quality care, however things can go wrong and mistakes can be made. Recently a high number of high profile cases, detailing neglect, show that there is still a lot more we can do to ensure the safety of all individuals when using the healthcare service. As a healthcare scientist, it is our responsibility and duty to ensure that all individuals receive the safest and highest quality of care.
A cardio-respiratory department in a district general hospital moves to a new site. You have been asked to assist in making sure that the ‘exercise tolerance-testing suite’ is safe and ready to use. Describe the process you would undertake to assess the safety of the room.
To ensure that the ‘exercise tolerance testing suite’ is safe and ready to use, it is important that an effective risk assessment is carried out. This will help the department to achieve its objectives and provide better services. The national reporting and learning service has produced a range of resources to help managers and staff with risk assessment relating to patient safety.
During the risk assessment, we must ask ourselves, “What can go wrong?” “How bad?” or “how often?” and finally “is there a need for action?” These four questions will help us look at the potential hazards and risks, which may pose. For each hazard that is acknowledged, it is important for us to decide whether it is significant and whether appropriate and adequate controls or contingencies are in place to ensure that the risk is suitably controlled. To help us carry out an easy risk assessment. There are five steps that we can take:
Step 1. Identifying the hazards (What can go wrong?) To prevent harm to both the patient and us, it is important to recognise not only what can go wrong but also how and why it may go wrong. Think through the activity within the setting of the physical and emotional environment, and the culture of the organisation and the staff who complete the activity. Take into consideration things that have gone wrong in the past and near miss incidents.
Step 2. Decide, who might be harmed, and how? People will make mistakes. It is important to anticipate some level of human error and try to prevent the error from resulting in harm.
Step 3. Evaluate the risks and decide on the precautions. Consider both consequences and the likelihood. Is there a need for additional action? The law states that, everyone providing a service to do everything reasonably practical to protect patients from harm. If it possible, use the organisation risk matrix.
Step 4. Record your findings, proposed action and identify who will lead on what action. Documentation must be produced showing that a thorough check was made to identify all the hazards and treat all the significant risks. That the precautions are reasonable, the remaining risk is acceptable and finally that the solutions are realistic, sustainable and effective.
Step 5. Review your assessment and update if necessary. Model risk assessment forms are available on the national patient safety agency website and these can be used to help carry out the risk assessment.
The ETT suite should be large enough to accommodate all the equipment necessary; this includes emergency equipment such as a crash trolley and defibrillator. It is vital that there is adequate access to the patient in any case of an emergency. Under the national health services policy for patient safety, it states that we regulate all medicines and medical devices in the UK by making sure they work and are safe to use. The medicines and healthcare products regulatory agency (MHRA) ensures that all medicines and equipment used in healthcare from painkillers to pacemakers work properly and are acceptably safe. The ETT suite must be well lighted, clean and well ventilated.
The room must also have enough space for all the items required for patient preparation and testing. Privacy is a very important matter for the patient and the physiologist and therefore it is good to ensure that there is a curtain to allow this. For continuous monitoring of heart rhythm and evaluation of ischemic ECG changes during exercise and recovery, all rooms must contain a suitable ECG recording system to allow this. Some hospitals use manual auscultation as it’s still the most feasible method of monitoring blood pressure during exercise and the easiest to use, others opt for an automated blood pressure unit.
The suite must have cuffs of various sizes, including large and paediatric. It is also important that all equipment should be cleaned and inspected regularly. Finally the treadmill should be electronically driven and should accommodate a variety of body weights and also have a wide range of speeds. For patient safety and stability, padded rails towards the front and sides are recommended. An emergency stop button must easily be visible and readily accessible for when needed.
2. The department has been open for around two months. A female patient, age 76, attends for an exercise test. During the test the patient develops chest pain and the leading practitioner makes the decision to stop the test. Before the treadmill can safely come to a stop it appears to suddenly jam and the patient trips awkwardly, twists her ankle and is visibly shaken. How should the leading practitioner deal with this situation? Are there any formal processes that need to be undertaken?
In the following scenario, it is important that the healthcare staff present in the room ensure that the patient is attended to and removed from any further potential harm. Whilst the healthcare staff is attending to the patient, the lead practitioner needs to be looking into the patient’s complaint of chest pain immediately as this is very important. Ensuring that the patient has not had any significant ST changes or arrhythmias making it safe to proceed. The staff should continue to provide support and comfort as the patient is visibly shaken. Once we have ensured the health and safety of the patient it is important that we report the incident. Key points for effective reporting are:
Ensuring quality reporting. Here we are required to implement the recommendations in data quality standards.
Engage frontline staff and management. This is to stimulate reporting within organisations and demonstrate the importance of reporting.
Reporting regularly. Hospitals that report regularly suggest a stronger organizational culture of safety. They understand the importance of linking incidents with learning.
Report serious incidents quickly It is important that healthcare staff report serious safety risks promptly so that once again action can be taken to protect others from harm and lessons can be learned.
Make reporting matter. Review the steps that can be taken to increase reporting.
Ensure consistency A consistent approach to coding the degree of harm by NHS organisations ensures that the NPSA can compare and analyse data to take action to improve patient safety.
In regards to the treadmill, an equipment failure report must be completed. Before this is done, the faulty or damaged equipment must be taken out of service immediately. The staff member present or aware of the fault should attach a notice stating, “Do not use – out of order” and then report the fault to the manager. The equipment must also be reported to the manufacturer.
I feel that it is very important that all incidents and mistakes are reported, whether it is your own or someone else’s, primarily so that the incident can be learned from and prevented in the future.
Something that we should always be aware of is the seven steps to patient safety.
Step 1 – Build a safety culture. Step 2 – Lead and support your staff. Step 3 – Integrate your risk management activity. Step 4 – Promote reporting. Step 5 – Involve and communicate with patients and the public. Step 6 – Learn and share safety lessons. Step 7 – Implement solutions to prevent harm.
Following the seven steps will help safeguard that the care provided is as safe as possible, and that when things do go wrong the right course of action is taken.
3. The following week another patient arrives for an exercise test. Whilst taking a history the patient becomes extremely distressed. He tells you that his wife died recently and begins to cry uncontrollably. You have a limited time slot to perform this test. Describe in detail how you could handle this situation in an empathetic manner.
“To see with the eyes of another, to hear with the ears of another, to feel with the heart of another” – Alfred Adler
People who use health and care services have the right to be treated with respect, dignity and compassion by the staff that hold the skills and time to care for them. We want compassion to be a part of all health and social care services. This means making the quality of care as important as the quality of treatment.
“Empathy is the ability to understand another’s experience, to communicate and confirm that understanding with the other person and to then act in a helpful manner.”
In my opinion, empathy should be the basis of all patient care and the cornerstone of the healthcare professional-patient relationship. Studies have also shown that showing clinical empathy to patients can improve their satisfaction of care; motivate them to stick to their treatments plans and lower malpractice complaints.
In this scenario, I would listen to the patient and give them the chance to release their emotions. I would then try and calm them and sympathise with the situation. Losing someone can be very difficult for some people. I think if someone may find some consolation in speaking about it, then it’s important you give them that opportunity as you may be the first person they have opened up to. I would potentially share my emotions with the patient about losing someone so that the patient understands that we share some common ground. I would empathise with the patient and proceed to explain that his health is important and that he needs to look after himself for his family and that it is important that the exercise test is carried out.
At the same time, however, I believe that it is important that we don’t push the patient too much and if he isn’t in a fit state or emotionally stable to carry out the exercise test, we reschedule it for a better time. Although it is important to care and show compassion to the patient we must also take into consideration the time constraints within the NHS and try to resolve the patients concerns quickly and effectively, this can be done by using further NHS services, such as the national cruse helpline or to speak to his GP to help him contact local bereavement services. A bereavement councillor would be able to give this gentleman the time and space to talk about his feelings, fears and future.
To care for and show compassion for patients requires emotional strength and resilience. It necessitates staff to see the person in the patient, listen to their fears, concerns and worries, to understand and to imagine yourself in their position, not least to be able to help them improve.
4. An elderly patient with dementia attends for a respiratory test. She is accompanied by a carer. When the carer leaves the room, the patient tells you that the carer has been stealing money from her handbag. How should you deal with this situation? Are there any formal procedures you should follow?
Safeguarding means protecting people’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect. It is essential to creating high-quality health and social care. Everyone has the right to live in safety, free from abuse and neglect. There are many different types of abuse; however the one we are dealing with in this scenario is financial abuse. Safeguarding encompasses six key concepts: Empowerment, protection, prevention, proportionate responses, partnership and accountability.
In this scenario, I would start off by talking to the person in private and try and get them to tell me as much information as possible. After this, I would ask the patient what they would like me to do. I would assure them that I can help them and that I can seek help on their behalf. I think it’s important to listen to what the patient says and not to charge into action if this isn’t what they want. The wishes of the adult are imperative and they should ‘experience the safeguarding process as empowering and supportive’. If the patient is happy for this to be reported, as what the carer is doing is a criminal offence, it is important we take action straight away.
What we must initially ask ourselves is, is the person in immediate danger? If not, we then should approach the manager or adult safeguarding lead nurse. If we still have concerns at this point, we then refer to social services; this is called the safeguarding referral. The social worker should acknowledge receipt of referral and decide on the next course of action within one working day. Concerns about the adult’s immediate safety need to be addressed and finally we must participate in the investigation as appropriate. It is important that we monitor the investigation, namely to develop and maintain high standards of care in practice.
After answering each scenario, we understand how important patient and staff health and safety is and how it is important to have policies and guidelines in place. To help everyone work towards developing and maintaining set high standards of care in practice. The aim of having policies and regulations is to provide a patient centred healthcare service, which meets the physical and emotional needs of the population.
