Pub Date : 2016-07-01DOI: 10.1177/1356262216659030
Rekha Elaswarapu
The National Health Service (NHS) is the third largest public sector employer in the world. There are 1.6 million employees who provide care for the population of the UK. The NHS in England forms the biggest part of the health service in the UK with more than 1.3 million staff which includes over 40,000 general practitioners (GPs), 351,446 nurses, 18,576 ambulance staff, and 111,963 hospital and community health service (HCHS) medical and dental staff. In addition, there are other non-clinical staff who play an equally important role in the functioning of the NHS. The NHS is currently undergoing major reforms and has become a focus of political debate. Many concerns have been raised about the pressures under which the staff have to carry out their duties, and links from this to patient safety risks. Reports such as the Francis review into Mid Staffordshire, the Berwick review into NHS patient safety, and the Keogh review to urgent care services all highlight the need to empower staff to raise concerns about patient safety. Many NHS Trusts have found themselves in focus for not being able to provide a safe working environment for their employees when they have raised concerns about the practices in their Trust. Concerns about bullying and harassment in the NHS and NHS culture have been prevalent for some considerable time and it has been named ‘the silent epidemic’. There are many reports that highlight the extent of bullying and harassment in the NHS. A 2014 GMC report found that 1 in 10 doctors reported to have been subjected to bullying and harassment in the workplace. The 2014 national NHS staff survey indicated that while more than 90% staff knew how to raise concerns about patient safety only 68% would feel secure in doing so about unsafe clinical practices and only 57% would feel confident that their organisation would address their concerns. These concerns led to the review into whistleblowing by Sir Robert Francis QC, who recommended a Duty of Candour to make it a legal duty for all staff to speak up against undesirable practices in the NHS which compromise patient safety, respect, and dignity. The review also recommended key tenets of a culture that promotes raising concerns:
国民保健服务(NHS)是世界上第三大公共部门雇主。有160万雇员为英国人民提供医疗服务。英格兰的NHS是英国医疗服务的最大组成部分，拥有130多万名员工，其中包括4万多名全科医生(gp)、351446名护士、18576名救护车工作人员以及111963名医院和社区卫生服务(HCHS)医疗和牙科工作人员。此外，还有其他非临床工作人员在国民保健服务的运作中发挥同样重要的作用。国民保健服务目前正在进行重大改革，并已成为政治辩论的焦点。人们对工作人员履行职责所承受的压力以及由此带来的患者安全风险提出了许多担忧。诸如弗朗西斯对中斯塔福德郡的审查，贝里克对NHS患者安全的审查，以及基奥对紧急护理服务的审查等报告都强调了授权员工提高对患者安全的关注的必要性。许多NHS信托基金发现，当他们对信托基金的做法提出担忧时，他们无法为员工提供安全的工作环境，因此受到关注。在相当长的一段时间里，对NHS和NHS文化中的欺凌和骚扰的担忧一直很普遍，它被称为“无声的流行病”。有许多报道强调了NHS中欺凌和骚扰的程度。2014年GMC的一份报告发现，十分之一的医生报告称在工作场所遭受过欺凌和骚扰。2014年全国NHS员工调查表明，虽然超过90%的员工知道如何提高对患者安全的关注，但只有68%的员工对不安全的临床实践感到安全，只有57%的员工对他们的组织会解决他们的担忧感到自信。这些担忧导致罗伯特·弗朗西斯爵士(Sir Robert Francis QC)对检举人进行了审查，他建议设立“坦率义务”(Duty of Candour)，使所有员工都有法律义务公开反对NHS中有损患者安全、尊重和尊严的不良做法。该审查还建议了促进提出关切的文化的主要原则:
{"title":"Dignity at work: Policies and legislative framework","authors":"Rekha Elaswarapu","doi":"10.1177/1356262216659030","DOIUrl":"https://doi.org/10.1177/1356262216659030","url":null,"abstract":"The National Health Service (NHS) is the third largest public sector employer in the world. There are 1.6 million employees who provide care for the population of the UK. The NHS in England forms the biggest part of the health service in the UK with more than 1.3 million staff which includes over 40,000 general practitioners (GPs), 351,446 nurses, 18,576 ambulance staff, and 111,963 hospital and community health service (HCHS) medical and dental staff. In addition, there are other non-clinical staff who play an equally important role in the functioning of the NHS. The NHS is currently undergoing major reforms and has become a focus of political debate. Many concerns have been raised about the pressures under which the staff have to carry out their duties, and links from this to patient safety risks. Reports such as the Francis review into Mid Staffordshire, the Berwick review into NHS patient safety, and the Keogh review to urgent care services all highlight the need to empower staff to raise concerns about patient safety. Many NHS Trusts have found themselves in focus for not being able to provide a safe working environment for their employees when they have raised concerns about the practices in their Trust. Concerns about bullying and harassment in the NHS and NHS culture have been prevalent for some considerable time and it has been named ‘the silent epidemic’. There are many reports that highlight the extent of bullying and harassment in the NHS. A 2014 GMC report found that 1 in 10 doctors reported to have been subjected to bullying and harassment in the workplace. The 2014 national NHS staff survey indicated that while more than 90% staff knew how to raise concerns about patient safety only 68% would feel secure in doing so about unsafe clinical practices and only 57% would feel confident that their organisation would address their concerns. These concerns led to the review into whistleblowing by Sir Robert Francis QC, who recommended a Duty of Candour to make it a legal duty for all staff to speak up against undesirable practices in the NHS which compromise patient safety, respect, and dignity. The review also recommended key tenets of a culture that promotes raising concerns:","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"46 - 50"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216659030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216685787
S. Moore
This was undertaken by minimally invasive surgery (MIS) using the direct anterior approach. Mr Fekry had played a large part in the introduction of this procedure by the trust. Its use was approved in August 2008. The operation involves a relatively short incision, followed by the placing of four retractors to pull aside the soft tissues obscuring access to the operation site. They are placed opposite one another and retractor 4 will normally be in place for about 30min in an uncomplicated operation. It is a recognised risk of hip replacement surgery that an injury may be sustained by the patient’s FN during the course of the operation. However, the incidence of FN injury during a total hip replacement procedure is rare. Published literature gives a maximum of 2.4% of cases, and in many studies the figure is below 0.1%. A 2008 paper by Brown and others states that FN injuries result primarily from improper placement of retractor 4, since its tip is placed near the FN. The respective experts agreed that four retractors must be used during this operation and that the process of retracting soft tissues will inevitably impact upon the FN. Careful management of the retractors involves the surgeon ensuring that only the force necessary to enable access to the operation site is employed, and that the potential impact on the FN should be relieved by intermittent breaks in applying traction. It was also agreed that a further possible mechanism of injury was that if the point of retractor 4 was not placed directly onto the bony structure of the pelvic rim, but rather positioned so as to trap or impale soft tissue containing the nerve, a direct injury will be caused.
{"title":"Hip operation – Nerve lesion not negligent: Susan Moore v Plymouth Hospitals NHS Trust (High Court, 29 September 2016 – Mr Recorder Moger QC)","authors":"S. Moore","doi":"10.1177/1356262216685787","DOIUrl":"https://doi.org/10.1177/1356262216685787","url":null,"abstract":"This was undertaken by minimally invasive surgery (MIS) using the direct anterior approach. Mr Fekry had played a large part in the introduction of this procedure by the trust. Its use was approved in August 2008. The operation involves a relatively short incision, followed by the placing of four retractors to pull aside the soft tissues obscuring access to the operation site. They are placed opposite one another and retractor 4 will normally be in place for about 30min in an uncomplicated operation. It is a recognised risk of hip replacement surgery that an injury may be sustained by the patient’s FN during the course of the operation. However, the incidence of FN injury during a total hip replacement procedure is rare. Published literature gives a maximum of 2.4% of cases, and in many studies the figure is below 0.1%. A 2008 paper by Brown and others states that FN injuries result primarily from improper placement of retractor 4, since its tip is placed near the FN. The respective experts agreed that four retractors must be used during this operation and that the process of retracting soft tissues will inevitably impact upon the FN. Careful management of the retractors involves the surgeon ensuring that only the force necessary to enable access to the operation site is employed, and that the potential impact on the FN should be relieved by intermittent breaks in applying traction. It was also agreed that a further possible mechanism of injury was that if the point of retractor 4 was not placed directly onto the bony structure of the pelvic rim, but rather positioned so as to trap or impale soft tissue containing the nerve, a direct injury will be caused.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"76 - 80"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216685787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216678350
S. Macleod
The National Maternity Review has proposed an insurance-based Rapid Resolution and Redress scheme be considered by the Department of Health. This article will outline and examine the Maternity Review’s proposals; drawing parallels and highlighting contrasts between the proposals and other schemes.
{"title":"The National Maternity Review’s Rapid Resolution and Redress scheme model: A comparison with other worldwide compensation schemes","authors":"S. Macleod","doi":"10.1177/1356262216678350","DOIUrl":"https://doi.org/10.1177/1356262216678350","url":null,"abstract":"The National Maternity Review has proposed an insurance-based Rapid Resolution and Redress scheme be considered by the Department of Health. This article will outline and examine the Maternity Review’s proposals; drawing parallels and highlighting contrasts between the proposals and other schemes.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"61 - 66"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216678350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216682113
H. Merrett
An attendee at a patient safety conference recently asked the speakers whether we felt that the effect of being placed in special measures was so devastating to staff morale as to render improvements at the organisation in question almost impossible. This prompted me to think about trust and communications across the health community, and their role in facilitating – or blocking – the open and transparent culture that is surely a prerequisite to improving safety. Securing healthy levels of trust is made complex by the multiplicity of relationships between different stakeholders in that community. Within healthcare organisations, the challenge is considerable. In order to identify problems and then find and implement solutions to them, there is a need for staff to trust management; patients to trust healthcare professionals, and different groups of staff to trust each other. In most organisations, there will be varying levels of trust. Somewhere in the policies of all NHS institutions, you will almost certainly find a statement on openness and willingness to learn and improve, rather than to blame. When you ask staff how well this statement translates into practice, it is likely that responses will differ according to local circumstances or personalities, and, sadly, there is still ample evidence that many risks, concerns and failures go unreported. This is due to a range of issues, from lack of belief that anything will happen as a result of reporting, to fear of recriminations for calling practice into question. On the other hand, there are undoubtedly many clinical and other teams which actively learn from experience just as there are also NHS trusts where management has developed and maintained open and positive communications with staff. However, at the macro level, the expectations and behaviours of regulators, politicians and the media add another level of complexity to the challenge of encouraging an open culture which learns from experience and improves its practice. Sir Robert Francis spoke at the recent Annual Regulation Conference in Edinburgh on 31 October 2016 about the need to ‘‘rethink the regulator’s role in patient safety.’’ He told the Heath Service Journal (9th November 2016) of the need for liaison between regulators, a focus on systemic problems and the support and recognition of those who raise concerns in good faith. What marks his comments out, however, is the acknowledgment of the need to win the ‘‘trust and confidence’’ of the public in achieving real change. He suggests, for example:
最近，在一次病人安全会议上，一位与会者问发言者，我们是否觉得，采取特殊措施对员工士气的影响是如此之大，以至于使有关组织的改进几乎不可能。这促使我思考整个卫生界的信任和沟通，以及它们在促进或阻碍开放和透明文化方面的作用，而开放和透明文化无疑是改善安全的先决条件。该社区中不同利益攸关方之间关系的多样性使确保健康的信任水平变得复杂。在医疗机构中，挑战是相当大的。为了发现问题，然后找到并实施解决方案，员工需要信任管理层;病人要信任医护人员，不同群体的工作人员要相互信任。在大多数组织中，会有不同程度的信任。在所有NHS机构的政策中，你几乎肯定会发现一个关于开放和愿意学习和改进，而不是责备的声明。当你问员工这句话在实践中转化得如何时，他们的回答很可能会因当地情况或个性而有所不同。遗憾的是，仍有大量证据表明，许多风险、担忧和失败都没有得到报告。这是由于一系列的问题，从不相信任何事情都会因为报道而发生，到害怕质疑实践而受到指责。另一方面，毫无疑问，许多临床和其他团队积极地从经验中学习，就像NHS信托基金一样，管理层已经与员工建立并保持了开放和积极的沟通。然而，在宏观层面上，监管机构、政治家和媒体的期望和行为给鼓励一种从经验中学习并改进其实践的开放文化的挑战增加了另一层复杂性。在2016年10月31日于爱丁堡举行的年度监管会议上，Robert Francis爵士谈到了“重新思考监管机构在患者安全中的角色”的必要性。他告诉《健康服务杂志》(health Service Journal)(2016年11月9日)，监管机构之间需要联络，关注系统性问题，并支持和认可那些真诚提出担忧的人。然而，他的言论的突出之处在于，他承认，要实现真正的变革，需要赢得公众的“信任和信心”。例如，他建议:
{"title":"A matter of trust","authors":"H. Merrett","doi":"10.1177/1356262216682113","DOIUrl":"https://doi.org/10.1177/1356262216682113","url":null,"abstract":"An attendee at a patient safety conference recently asked the speakers whether we felt that the effect of being placed in special measures was so devastating to staff morale as to render improvements at the organisation in question almost impossible. This prompted me to think about trust and communications across the health community, and their role in facilitating – or blocking – the open and transparent culture that is surely a prerequisite to improving safety. Securing healthy levels of trust is made complex by the multiplicity of relationships between different stakeholders in that community. Within healthcare organisations, the challenge is considerable. In order to identify problems and then find and implement solutions to them, there is a need for staff to trust management; patients to trust healthcare professionals, and different groups of staff to trust each other. In most organisations, there will be varying levels of trust. Somewhere in the policies of all NHS institutions, you will almost certainly find a statement on openness and willingness to learn and improve, rather than to blame. When you ask staff how well this statement translates into practice, it is likely that responses will differ according to local circumstances or personalities, and, sadly, there is still ample evidence that many risks, concerns and failures go unreported. This is due to a range of issues, from lack of belief that anything will happen as a result of reporting, to fear of recriminations for calling practice into question. On the other hand, there are undoubtedly many clinical and other teams which actively learn from experience just as there are also NHS trusts where management has developed and maintained open and positive communications with staff. However, at the macro level, the expectations and behaviours of regulators, politicians and the media add another level of complexity to the challenge of encouraging an open culture which learns from experience and improves its practice. Sir Robert Francis spoke at the recent Annual Regulation Conference in Edinburgh on 31 October 2016 about the need to ‘‘rethink the regulator’s role in patient safety.’’ He told the Heath Service Journal (9th November 2016) of the need for liaison between regulators, a focus on systemic problems and the support and recognition of those who raise concerns in good faith. What marks his comments out, however, is the acknowledgment of the need to win the ‘‘trust and confidence’’ of the public in achieving real change. He suggests, for example:","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"44 - 45"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216682113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216676131
A. Sultan, Andrew Ritchie QC, Giles Mooney
Obstetric anal sphincter injuries (OASIS) are the leading cause of anal incontinence in women and are increasing in incidence. The NHSLA 10-year report on maternity claims identified perineal trauma as being the fourth highest indication for claims, with £31 million in legal pay-outs alone. OASIS could be classed as moderate to severe harm in the National Patient Safety Agency (NPSA) stratifi cation (http://www.npsa.nhs.uk/corporate/news/npsareleases-organisation-patient-safety-incident-reportingdata-england/). There are also initiatives to declare it as a patient safety indicator (www.oecd.org/dataoecd/53/ 26/33878001.pdf). More recently, in Davison v Leitch EWHC 3092, a High Court Judge awarded £1.6 million in damages where the breach of the duty of care included failure to comply with national guidelines (NICE, Royal College of Obstetricians and Gynaecologists (RCOG)) to perform an episiotomy which was adequately angled away from the anal sphincter muscles (mediolateral episiotomy). Other findings included a failure adequately to diagnose the injury, inadequate postoperative care, failure to inform the patient and her general practitioner about the condition and inappropriate use of forceps. Given the potentially devastating physical injuries suffered by the patients and the financial loss to the NHS when OASIS arises, this is an issue which demands careful attention from the medico-legal community.
{"title":"Obstetric anal sphincter injuries: Review of recent medico-legal aspects","authors":"A. Sultan, Andrew Ritchie QC, Giles Mooney","doi":"10.1177/1356262216676131","DOIUrl":"https://doi.org/10.1177/1356262216676131","url":null,"abstract":"Obstetric anal sphincter injuries (OASIS) are the leading cause of anal incontinence in women and are increasing in incidence. The NHSLA 10-year report on maternity claims identified perineal trauma as being the fourth highest indication for claims, with £31 million in legal pay-outs alone. OASIS could be classed as moderate to severe harm in the National Patient Safety Agency (NPSA) stratifi cation (http://www.npsa.nhs.uk/corporate/news/npsareleases-organisation-patient-safety-incident-reportingdata-england/). There are also initiatives to declare it as a patient safety indicator (www.oecd.org/dataoecd/53/ 26/33878001.pdf). More recently, in Davison v Leitch EWHC 3092, a High Court Judge awarded £1.6 million in damages where the breach of the duty of care included failure to comply with national guidelines (NICE, Royal College of Obstetricians and Gynaecologists (RCOG)) to perform an episiotomy which was adequately angled away from the anal sphincter muscles (mediolateral episiotomy). Other findings included a failure adequately to diagnose the injury, inadequate postoperative care, failure to inform the patient and her general practitioner about the condition and inappropriate use of forceps. Given the potentially devastating physical injuries suffered by the patients and the financial loss to the NHS when OASIS arises, this is an issue which demands careful attention from the medico-legal community.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"57 - 60"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216676131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216661469
R. Bethune, M. Dahill, K. Finucane, C. van Hamel, Joanne Watson, Patricia Woodhead
Introduction Despite an increasing and widespread understanding of the importance of quality improvement in healthcare, medical students and junior doctors receive variable training in improvement methods. The South West Foundation Doctor quality improvement programme attempted to equip junior doctors with the skills to develop and improve healthcare services. Methods A questionnaire-based evaluation was undertaken of a cohort of first-year doctors who took part in a 9-month quality improvement educational intervention. The study was conducted across a whole training region with some of the hospitals running the quality improvement educational intervention and one acting as the natural control cohort. A previously validated questionnaire was sent out at the start and end of their first year. Results In questions related to attitudes to all domains of quality improvement first-year doctors consider it an important part of their role as doctors to improve the quality of healthcare. However, they do not think they are equipped with the skills to do this improvement. During their first year as doctors, these self-reported skills increased dramatically in the hospitals that took part in the programme but not in the single hospital that did not run the programme. Conclusion First-year doctors consider improving the quality of healthcare to be an important part of their job. This can be contrasted to their self-reported skills related to quality improvement when they start their first year. In hospitals that run a structured, supported experiential quality improvement programme, these self-reported skills increase statistically significantly.
{"title":"Developing the next generation of quality improvers: An evaluation of a region wide structured support quality improvement training programme","authors":"R. Bethune, M. Dahill, K. Finucane, C. van Hamel, Joanne Watson, Patricia Woodhead","doi":"10.1177/1356262216661469","DOIUrl":"https://doi.org/10.1177/1356262216661469","url":null,"abstract":"Introduction Despite an increasing and widespread understanding of the importance of quality improvement in healthcare, medical students and junior doctors receive variable training in improvement methods. The South West Foundation Doctor quality improvement programme attempted to equip junior doctors with the skills to develop and improve healthcare services. Methods A questionnaire-based evaluation was undertaken of a cohort of first-year doctors who took part in a 9-month quality improvement educational intervention. The study was conducted across a whole training region with some of the hospitals running the quality improvement educational intervention and one acting as the natural control cohort. A previously validated questionnaire was sent out at the start and end of their first year. Results In questions related to attitudes to all domains of quality improvement first-year doctors consider it an important part of their role as doctors to improve the quality of healthcare. However, they do not think they are equipped with the skills to do this improvement. During their first year as doctors, these self-reported skills increased dramatically in the hospitals that took part in the programme but not in the single hospital that did not run the programme. Conclusion First-year doctors consider improving the quality of healthcare to be an important part of their job. This can be contrasted to their self-reported skills related to quality improvement when they start their first year. In hospitals that run a structured, supported experiential quality improvement programme, these self-reported skills increase statistically significantly.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"51 - 56"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216661469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216661678
P. Balen
Compartment syndrome after complex bowel surgery. Claim against leading expert and centre of excellence. Adoption of unique operating position without risk analysis or peer review. New defence argument only surfacing at trial dismissed. Judge criticises defence experts. Usually, a compartment syndrome case involves an allegation of delay in diagnosis and treatment. In this case, there was prompt diagnosis aided by the immediacy and magnitude of the compartment syndrome which was described as being equivalent to a crush injury. It is probable that the increased weight on the calves while the patient was in the low Lloyd Davies position combined with a lack of perfusion and acidosis in the first part of the operation caused an ischaemic injury in a patient who was at risk due to his size and muscle structure; the Trendelenburg position adopted in the second part of the operation is known to cause compartment syndrome but this patient already had ischaemia before the operation reached that stage. Reperfusion at the end of the operation caused the immediate damage and in spite of prompt reoperation the patient suffered a desperately severe illness and subsequent permanent disability. This case illustrates how a Claimant can succeed even against a renowned international surgeon and a centre of excellence if in spite of his outstanding reputation the surgeon fails to keep abreast of medical developments or consider the impact of his ‘invention’ on a particular patient. A position of high repute within a profession, whether institutional or personal does not provide protection from the legal tests for breach of duty.
{"title":"Nerve damage due to positioning during surgery","authors":"P. Balen","doi":"10.1177/1356262216661678","DOIUrl":"https://doi.org/10.1177/1356262216661678","url":null,"abstract":"Compartment syndrome after complex bowel surgery. Claim against leading expert and centre of excellence. Adoption of unique operating position without risk analysis or peer review. New defence argument only surfacing at trial dismissed. Judge criticises defence experts. Usually, a compartment syndrome case involves an allegation of delay in diagnosis and treatment. In this case, there was prompt diagnosis aided by the immediacy and magnitude of the compartment syndrome which was described as being equivalent to a crush injury. It is probable that the increased weight on the calves while the patient was in the low Lloyd Davies position combined with a lack of perfusion and acidosis in the first part of the operation caused an ischaemic injury in a patient who was at risk due to his size and muscle structure; the Trendelenburg position adopted in the second part of the operation is known to cause compartment syndrome but this patient already had ischaemia before the operation reached that stage. Reperfusion at the end of the operation caused the immediate damage and in spite of prompt reoperation the patient suffered a desperately severe illness and subsequent permanent disability. This case illustrates how a Claimant can succeed even against a renowned international surgeon and a centre of excellence if in spite of his outstanding reputation the surgeon fails to keep abreast of medical developments or consider the impact of his ‘invention’ on a particular patient. A position of high repute within a profession, whether institutional or personal does not provide protection from the legal tests for breach of duty.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"69 - 75"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216661678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/1356262216667163
Sandra Patton
The claimant underwent left total knee replacement surgery for osteoarthritis in November 2007. He had a number of pre-existing health problems, including type II diabetes, psoriasis and diverticulitis. He had previously undergone a successful replacement of his right knee. Surgery proceeded without complication, but within three to four days the wound began to bleed, opened up, and on 13 December 2007,he attended A&E. The wound was red and painful. A swab was taken and he was given Flucloxacillin. No instruction was given for him to telephone for results. The lab reported Group B Streptococcus that was sensitive to flucloxacillin but at very high doses and recommended changing to amoxicillin. He was not informed of the result, and no change was made to the antibiotics. His condition continued to deteriorate and on 22 December 2007, he was admitted as an emergency. He underwent open debridement, wash out and liner exchange on 22 December 2007, and it was confirmed the infection was ‘as before’ and also present in his blood stream, so he had Group B streptococcal septicaemia. The standards of hygiene in the hospital were very poor, with dirty dressings on windowsills, clean sheets put on top of soiled sheets, and empty hand-sanitizer bottles. Following discharge and review, it was decided the implant needed to come out, and he underwent firststage revision surgery on 1 February 2008. Tissue samples grew coagulase negative staphylococcus, but no Group B strep. He was given IV vancomycin for two weeks and oral linezolid for three weeks. The claimant was discharged in a leg splint and was significantly disabled in his home, which is a Victorian terraced house built on four levels with an upstairs bathroom. He was effectively confined to two rooms downstairs. He underwent second stage of revision surgery on 23 May 2008 and was prescribed prophylactic Cefuroxime peri-operatively, but no intra-operative samples were taken for microscopy and culture. A wound swab taken on 27 May 2008 grew coagulase negative staphylococcus, the same organism found at the time of the first-stage revision surgery, but no further intravenous antibiotics were prescribed. The claimant was discharged on 26 May 2008 with the wound still oozing; it continued to discharge and he was re-admitted on 29 May 2008. A wound swab
{"title":"Failure to investigate and treat infection after total knee replacement, leading to above-knee amputation","authors":"Sandra Patton","doi":"10.1177/1356262216667163","DOIUrl":"https://doi.org/10.1177/1356262216667163","url":null,"abstract":"The claimant underwent left total knee replacement surgery for osteoarthritis in November 2007. He had a number of pre-existing health problems, including type II diabetes, psoriasis and diverticulitis. He had previously undergone a successful replacement of his right knee. Surgery proceeded without complication, but within three to four days the wound began to bleed, opened up, and on 13 December 2007,he attended A&E. The wound was red and painful. A swab was taken and he was given Flucloxacillin. No instruction was given for him to telephone for results. The lab reported Group B Streptococcus that was sensitive to flucloxacillin but at very high doses and recommended changing to amoxicillin. He was not informed of the result, and no change was made to the antibiotics. His condition continued to deteriorate and on 22 December 2007, he was admitted as an emergency. He underwent open debridement, wash out and liner exchange on 22 December 2007, and it was confirmed the infection was ‘as before’ and also present in his blood stream, so he had Group B streptococcal septicaemia. The standards of hygiene in the hospital were very poor, with dirty dressings on windowsills, clean sheets put on top of soiled sheets, and empty hand-sanitizer bottles. Following discharge and review, it was decided the implant needed to come out, and he underwent firststage revision surgery on 1 February 2008. Tissue samples grew coagulase negative staphylococcus, but no Group B strep. He was given IV vancomycin for two weeks and oral linezolid for three weeks. The claimant was discharged in a leg splint and was significantly disabled in his home, which is a Victorian terraced house built on four levels with an upstairs bathroom. He was effectively confined to two rooms downstairs. He underwent second stage of revision surgery on 23 May 2008 and was prescribed prophylactic Cefuroxime peri-operatively, but no intra-operative samples were taken for microscopy and culture. A wound swab taken on 27 May 2008 grew coagulase negative staphylococcus, the same organism found at the time of the first-stage revision surgery, but no further intravenous antibiotics were prescribed. The claimant was discharged on 26 May 2008 with the wound still oozing; it continued to discharge and he was re-admitted on 29 May 2008. A wound swab","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"67 - 68"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216667163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1177/1356262216672614
Angela M Cook
Obtaining consent is a legal and ethical necessity prior to midwifery care provision. Furthermore, midwives must act in the best interests of women at all times and make sure that properly informed consent is obtained and documented prior to carrying out any action. Although the judgment made at the Supreme Court, in Montgomery v Lanarkshire Health Board, involved an obstetrician, the recommendations of this case will have far reaching implications for midwives within the consent process. Midwives will be required to consider informing women of any material risks involved in any recommended care and treatment, including how likely women are to attach significance to such risk. The risk discourse that pervades maternity care is well cited and midwives need to strive to achieve a safe, holistic, woman-centred approach to care whilst implementing the recommendations of Montgomery. Challenges exist for midwives in obtaining informed consent particularly resulting from sub-standard communication issues. This clearly impacts negatively upon patient safety issues. Ultimately, NICE advocate that pregnant women should be offered evidence based information and support to enable them to make informed decisions about their care and treatment. Montgomery provides the highest level of legal support for this position.
{"title":"Midwifery perspectives: The consent process in the context of patient safety and medico-legal issues","authors":"Angela M Cook","doi":"10.1177/1356262216672614","DOIUrl":"https://doi.org/10.1177/1356262216672614","url":null,"abstract":"Obtaining consent is a legal and ethical necessity prior to midwifery care provision. Furthermore, midwives must act in the best interests of women at all times and make sure that properly informed consent is obtained and documented prior to carrying out any action. Although the judgment made at the Supreme Court, in Montgomery v Lanarkshire Health Board, involved an obstetrician, the recommendations of this case will have far reaching implications for midwives within the consent process. Midwives will be required to consider informing women of any material risks involved in any recommended care and treatment, including how likely women are to attach significance to such risk. The risk discourse that pervades maternity care is well cited and midwives need to strive to achieve a safe, holistic, woman-centred approach to care whilst implementing the recommendations of Montgomery. Challenges exist for midwives in obtaining informed consent particularly resulting from sub-standard communication issues. This clearly impacts negatively upon patient safety issues. Ultimately, NICE advocate that pregnant women should be offered evidence based information and support to enable them to make informed decisions about their care and treatment. Montgomery provides the highest level of legal support for this position.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"25 - 29"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216672614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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