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Safer Healthcare - Charles Vincent


Year 2016

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1 Progress and Challenges for Patient SafetyProgress on Patient SafetyHarm Has Been Defined Too NarrowlySafety Is a Moving TargetOnly Part of the Healthcare System Has Been AddressedWe Are Approaching Safety in the Same Way in All SettingsOur Model of Intervention Is LimitedHealthcare Is ChangingKey PointsReferences2 The Ideal and the Real Box 2.1 Observation of Patients at Risk of Suicide: When Working Conditions Make It Difficult to Follow ProceduresThe Day-to-Day Realities of HealthcareComparing Actual Care with the Care Intended by GuidelinesReliability of Clinical Systems in the British NHSFollowing the Rules: Reliability of Human BehaviourThe Ideal and the Real: Five Levels of CareThe Cumulative Impact of Poor Quality CareExplicit Discussion of the Real Standard of Care Is CriticalWhat Is the Impact of Improving Quality Standards?Levels of Care and Strategies for Safety ImprovementKey PointsReferences3 Approaches to Safety: One Size Does Not Fit AllApproaches to Risk and Hazard: Embrace, Manage or AvoidThree Approaches to the Management of RiskEmbracing Risk: The Ultra-adaptive ModelManaging Risk: The High Reliability ApproachAvoiding Risk: The Ultra-safe ApproachRules and AdaptationHow Many Models for Healthcare?Moving Between ModelsReflections on the Safety IdealKey PointsReferences4 Seeing Safety Through the Patient's Eyes What Do We Mean by Harm?Safety and Quality of Care from the Patient's PerspectiveSafety Through the Patient's EyesThe Patient Potentially Has the Most Complete PictureThe Healthcare professional's View Is Necessarily IncompleteThe Resources of the Patient and Family Are Critical to Safe CareCoordination of Care Is a Major Safety IssueRethinking Patient SafetyKey PointsReferences5 The Consequences for Incident Analysis What Are We Trying to Learn When We Analyse Incidents?Essential Concepts of ALARMESelect Problems for Analysis Which Are Important to PatientsWiden the Time Frame of Analysis: Review the Patient JourneySuccess and Failure in Detection and RecoveryAdapting the Analysis to ContextKey PointsReferences6 Strategies for SafetyWhat Options Do We Have for Improving Safety?Five Safety StrategiesStrategy I: Safety as Best PracticeStrategy II: Improvement of Work Processes and SystemsStrategy III: Risk ControlStrategy IV: Monitoring, Adaptation and ResponseStrategy V: MitigationInnovationSelection and Customisation of Strategies to Clinical ContextKey PointsReferences7 Safety Strategies in HospitalsA Little HistoryThe Enthusiasm of the Early Years, 1995–2002The Advent of Professionalism 2002–2005Safety Culture, Multifaceted Interventions, and Teamwork 2005–2011Reflections on Safety in HospitalsSafety in Hospital: Distinguishing Current and Future StrategiesSafety as Best PracticeImproving the SystemReducing the Burden on Staff: Simplification and DeclutteringRisk ControlControl of MedicationPotential for 'Go and No-Go' Controls in SurgeryPlacing Limits on CareMonitoring, Adaptation and ResponsePatients and Families as Problem DetectorsTeam Training in Monitoring, Adapting and ResponseBriefings and Debriefings, Handovers and Ward RoundsMitigationSupport Systems for Staff and PatientsRegulatory and Political Determinants of Approaches to SafetySafety in Context: The Many Hospital EnvironmentsKey PointsReferences8 Safety Strategies for Care in the HomeAn Ageing Population and the Expansion of Home CareThe Challenges of Delivering Healthcare in the HomeThe Hazards of Home Care: New Risks, New ChallengesAccidental Injury in the HomeAdverse Events in Home CareAdverse Drug EventsRisk to Family and Other Care GiversProblems of Transition and CoordinationInfluences on Safety of Healthcare Delivered in the HomeSocio-economic Conditions Take on a Much Greater ImportanceThe Home Environment as Risk FactorIncreasing Responsibilities of CarersThe Training and Experience of Home Care AidesFragmented Approach of Healthcare ProfessionalsSafety Strategies and Interventions in the HomeOptimization Strategies in Home Care: Best Practice and System ImprovementBox 8.1. Difficult Challenge for Optimisation Strategies: Lessons from a Centralised Nurse-led Cholesterol-Lowering ProgrammeDischarge Planning and the Journey from Hospital to HomeTraining of Patients and CarersRisk Control Strategies in Home CareMonitoring, Adaptation and Response Strategies in Home CareDetecting DeteriorationMitigationThe Responsibilities of CarersMitigation Strategies in Home HaemodialysisReflections on Home Care SafetyKey PointsReferences9 Safety Strategies in Primary Care Challenges for Primary CareThe Nature of Risk in Primary CareError and Harm in Primary CareDiagnostic ErrorsSafety as Best PracticeImproving the SystemRisk Control StrategiesControl by Assessment of CompetencyControl of HazardsMonitoring, Adaptation and ResponseDeveloping a More Systematic Approach to Watching and WaitingImproving Transitions Between Hospital and Primary CareMitigationReflections on Safety in Primary CareKey PointsReferences10 New Challenges for Patient SafetyThe Changing Nature of HealthcareImproved Safety in Some ContextsNew Challenges for Patient SafetyIncreasing ComplexityThe Challenges and Risks of Care CoordinationThe Benefits and Risks of ScreeningThe Benefits and Risks of Information TechnologyThe Burden of Healthcare: Impact on Patients and CarersA Global Revolution Rather Than a Local EvolutionKey PointsReferences11 A Compendium of Safety Strategies and InterventionsSeeing Safety Through the Patient's EyesConsidering Benefit and Harm Along the Patient JourneyPatient Safety as the Management of Risk Over TimeAdopting a Range of Safety ModelsDeveloping a Wider Range of Safety StrategiesA Compendium of Safety StrategiesKey PointsReferences12 Managing Risk in the Real World Implications for Patients, Carers and FamiliesImplications for Frontline Clinicians and ManagersImplications for Executives and BoardsImplications for Regulatory Agencies and GovernmentFuture Directions for Research and Practice
 
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