Risk assessment

1998 ◽  
Vol 173 (6) ◽  
pp. 540-543 ◽  
Author(s):  
Frank Holloway
Keyword(s):  
Clinical Skills ◽  
Front Page ◽  
Dark Side ◽  
Professional Misconduct ◽  
Actual Performance ◽  
Department Of Health ◽  
Complex Procedure ◽  
The Uk ◽  
Suicidal Patients ◽  
Community Team

Reading about the assessment and management of risk began, in earnest, for me in 1993. Previously, I had assumed that good training in the management of suicidal patients, reasonable clinical skills, a high-quality community team and the rarely utilised option of referring worrying patients to the forensic psychiatrists together represented an adequate basis for practice in an inner-city catchment area. This naïve assumption was challenged by the popular and political reaction to the actions of Christopher Clunis and Ben Silcock in December 1992, both people with a schizophrenic illness known to services whose dangerous behaviour put them on the front page of newspapers in the UK. A groundbreaking textbook demonstrates that other medical specialities have, partly because of the threat of litigation, been more effective in analysing sources of risk and developing strategies to manage risk (Vincent, 1995). Improving quality is a central plank of the latest National Health Service reform (Department of Health, 1998). There is no doubt that the political driver for this is “the dark side of quality” (Vincent, 1997), how to deal with perceived or actual performance failures in health care such as the seminal ‘Bristol case’, in which cardiothoracic surgeons with an unusually high mortality rate in carrying out a complex procedure were found guilty of serious professional misconduct (Smith, 1998).

A study of the role and educational needs of ophthalmic specialist nurses

2021 ◽  
Vol 30 (14) ◽  
pp. 858-864
Author(s):  
Pornjittra Rattanasirivilai ◽  
Amy-lee Shirodkar
Keyword(s):  
Clinical Skills ◽  
Active Role ◽  
Educational Needs ◽  
Assessment Tools ◽  
Standards Of Care ◽  
Learning Needs ◽  
Hands On ◽  
Specialist Nurses ◽  
The Uk ◽  
Training Opportunities

Aims: To explore the current roles, responsibilities and educational needs of ophthalmic specialist nurses (OSNs) in the UK. Method: A survey of 73 OSNs ranging from band 4 to band 8 was undertaken in May 2018. Findings: 73% of OSNs undertake more than one active role, with 59% involved in nurse-led clinics; 63% felt formal learning resources were limited, with 63% reporting training opportunities and 21% reporting time as major barriers to further training. More than 38% emphasised hands-on clinic-based teaching had a greater impact on their educational needs. Some 64% were assessed on their skills annually and 59% felt confident with their skill set. Conclusion: The Ophthalmic Common Clinical Competency Framework provides a curriculum and assessment tools for OSNs to use as a structure to maintain clinical skills and knowledge. Eye departments should use this as guidance to target learning needs and improve standards of care to meet the changing needs of society.

scholarly journals Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies’ lives care bundle to reduce stillbirth

2020 ◽  
Vol 9 (2) ◽  
pp. e000756
Author(s):  
Yu Zhen Lau ◽  
Kate Widdows ◽  
Stephen A Roberts ◽  
Sheher Khizar ◽  
Gillian L Stephen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Stakeholder Involvement ◽  
Care Bundle ◽  
Intrapartum Care ◽  
National Guidelines ◽  
Department Of Health ◽  
The Uk

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.

The NACPDE: new opportunities for dentists trained overseas

2009 ◽  
Vol 91 (8) ◽  
pp. 283-283 ◽  
Author(s):  
Margaret Wilson
Keyword(s):  
Royal College ◽  
Clinical Training ◽  
Dental Education ◽  
Postgraduate Education ◽  
Dental Surgery ◽  
Department Of Health ◽  
The World ◽  
The Uk

The National Advice Centre for Postgraduate Dental Education (NACPDE) was founded in 1978 and is based in the Faculty of Dental Surgery of The Royal College of Surgeons of England and funded by the Department of Health. The UK has traditionally played an important part in providing clinical training and postgraduate education for dentists from all parts of the world. But it is equally important to recognise the contribution oversea-strained dentists have made to the NHS.

scholarly journals The National Stroke Strategy – Is it Achievable?

2009 ◽  
Vol 91 (8) ◽  
pp. 641-644 ◽  
Author(s):  
TD Reid ◽  
LJ Finney ◽  
AR Hedges
Keyword(s):  
Education Programme ◽  
Medical Emergency ◽  
Minor Stroke ◽  
Amaurosis Fugax ◽  
Symptomatic Carotid ◽  
Public Response ◽  
Department Of Health ◽  
Mean Waiting Time ◽  
Rapid Access Clinic ◽  
The Uk

INTRODUCTION Timing of intervention in symptomatic carotid disease is critical. The UK Department of Health's National Stroke Strategy published in December 2007 recommends urgent carotid intervention within 48 h, in appropriate patients, who have suffered a transient ischaemic attack (TIA), amaurosis fugax or minor stroke. Despite the running of a rapid-access clinic for patients with symptoms of TIA, the time from symptom to surgery is rarely less than 2 weeks. To date, there has been little published research on the UK public response to the symptoms of TIA, and no study at all of the response of primary care to such patients. The aim of this study was to ascertain both these responses to see whether a 48-h target is achievable. PATIENTS AND METHODS A total of 402 men attending our aortic aneurysm screening sessions were asked to complete a questionnaire requesting their most likely response to an episode of amaurosis fugax or TIA. All 45 GP practices in the hospital catchment area were asked how they would respond to patients requesting to be seen with the symptoms used in the questionnaire. RESULTS Nearly one in six patients would ignore the symptom unless it recurred, approximately half would request a GP appointment and a third would see an optician if they had amaurosis fugax. The mean waiting time to see a GP was 2 days for a routine appointment and within 24 h for an emergency appointment. CONCLUSIONS It is clear that a significant number of people would ignore the first symptom of carotid ischaemia; for those with amaurosis fugax, nearly a third would initially seek help from their optician. Those given a routine GP appointment would have to wait a minimum of 2 days. If the Department of Health is serious about reducing the incidence of stroke and introducing a target of 48 h from symptom to treatment, then there needs to be a wide-spread public and healthcare education programme, in particular alerting opticians and GP receptionists that these symptoms constitute a medical emergency.

scholarly journals The International Fellowship Scheme for consultant psychiatrists: trainees' perspective

2006 ◽  
Vol 30 (6) ◽  
pp. 229-231 ◽  
Author(s):  
Sanju George ◽  
Bill Calthorpe ◽  
Sudhir Khandelwal
Keyword(s):  
Royal College ◽  
Home Country ◽  
Department Of Health ◽  
Job Opportunities ◽  
International Fellowship ◽  
The Uk

The NHS International Fellowship Scheme for consultants offers overseas consultants, in specialties including psychiatry, an opportunity to work in the UK (Goldberg, 2003). This was launched by the Department of Health in 2002 and so far over 100 consultant psychiatrists have been recruited. However, there are several aspects of the project that are unclear. How long will this recruitment continue? Are there any arrangements in place to encourage overseas consultants to return to their home country at the end of their fellowship? Are they eligible to train senior house officers (SHOs) and specialist registrars (SpRs)? Will the recruitment under the scheme have an impact on job opportunities for SpRs currently training in the UK? Why is membership of the Royal College of Psychiatrists being granted to the newly recruited consultants without an examination? These and many more concerns have arisen in the wake of this scheme. In this article, we evaluate the scheme, discuss its implications and suggest possible ways forward.

A lack of foresight? Jurisdictional uncertainties in the regulatory interface between the HFEA, the UK Stem Cell Bank and beyond

Legal Studies ◽  
2007 ◽  
Vol 27 (3) ◽  
pp. 511-535 ◽  
Author(s):  
Ryan Morgan
Keyword(s):  
Embryonic Stem ◽  
Embryo Research ◽  
Es Cell ◽  
Statutory Interpretation ◽  
Cell Bank ◽  
Human Fertilisation ◽  
Department Of Health ◽  
Regulatory Architecture ◽  
Policy Objectives ◽  
The Uk

Much of the legal attention surrounding human embryonic stem (ES) cell research within the UK has, to date, focused on cloning techniques. Whilst this is both understandable and appropriate given litigation on this topic, there has been less focus on other areas. This paper identifies and analyses areas of incoherence and deficiency within the regulatory architecture governing human ES cell derivation and research within the UK. This is not merely a theoretical exercise, as there are indications that many of the policy objectives currently being pursued in this area have, at best, a shaky jurisdictional basis. It is all too easy to recall that lobby groups have challenged the Human Fertilisation and Embryology Act 1990, the legislative foundation for embryo research and most infertility treatment, on the basis of jurisdictional uncertainty and statutory interpretation. Whilst many pro-life campaigners are opposed to ES cell research on ethical grounds, the arguments utilised thus far in relation to litigation have been entirely legal, involving issues of statutory interpretation and whether the regulator, the Human Fertilisation and Embryology Authority (HFEA), or the Department of Health have acted ultra vires the 1990 Act. This paper will reveal that there are a number of further areas which might be open to attack on this basis.

The UK Policy Agendas Project

2019 ◽  
pp. 176-183
Author(s):  
Shaun Bevan ◽  
Will Jennings
Keyword(s):  
Front Page ◽  
British Politics ◽  
Policy Agenda ◽  
The Public ◽  
External Pressures ◽  
Wide Range ◽  
Policy Agendas ◽  
The Times ◽  
Rich Data ◽  
The Uk

The UK Policy Agendas Project has collected a wide range of data on the policy agenda of major institutional venues in British politics and on the public and media agendas. This rich data source allows systematic and consistent analysis across institutions, and across countries, extending back over a century in the case of some agendas. The data provide measures of the policy agenda of the executive (the Speech from the Throne) and the legislature (Acts of UK Parliament), along with aggregate survey data about the public agenda (public opinion about the most important problem), media (front-page stories of The Times), Prime Minister’s Questions, and bills and hearings of the Scottish Parliament. Through its extensive collection of data, the project has enabled novel insights into the policy agenda of UK government, how it responds to shocks and external pressures, and how patterns of policy change and stability compare to other countries.

Psychiatry

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
Mental Health ◽  
Mental Health Patient ◽  
Self Mutilation ◽  
Cry For Help ◽  
Mental Health Patients ◽  
Health Expert ◽  
Self Harm ◽  
Mental Health Expert ◽  
The Uk ◽  
Suicidal Patients

It is estimated that 1 in 4 people in a year will have some kind of mental health problem, and that mixed anxiety and depression is the most common disorder in the UK. There is an increasing number of mental health patients attending the ED, and a new FY doctor in the ED will encounter such patients from their first shift onwards. The approach to a mental health patient is only marginally different from the approach to those presenting under other specialties. The assessment largely depends on careful history taking and attentively listening to the patient’s narrative. There are only a few situations in psychiatry in which a physical examination and investigations are required in the ED to make a diagnosis. As it would not be possible to cover all the areas of psychiatry which come through the doors of the ED in one chapter, only a few questions have been included here to provide a flavour of the common psychiatric situations that FY1/2s may come across in their early training period. The UK has the highest rate of self-harm in Europe and so one of the most important points is to recognize suicidal patients who can harm themselves seriously and manage them appropriately. If such patients are discharged following an inadequate assessment, they may go on to commit suicide and the attending doctors would have missed the opportunity to support and save them. In this category of patients, when they present to the ED, no matter how minimal is the level of their self-mutilation, it is a serious ‘cry’ for help. Our job is to listen to the patient and support them with the maximum help we can provide. As it may be difficult to occasionally get to the bottom of the problem, particularly within the time constraints in the ED, a low level of suspicion should be kept to ask for the assistance of the mental health expert. Self-harm and depression go almost hand in hand. The suicidal rate is higher in depressed patients than in the general population.

scholarly journals The College: an analysis of members' views

1999 ◽  
Vol 23 (1) ◽  
pp. 11-15 ◽  
Author(s):  
R. E. Kendell ◽  
R. Duffett
Keyword(s):  
British Journal ◽  
Random Sample ◽  
Response Rate ◽  
Education And Training ◽  
Republic Of Ireland ◽  
Department Of Health ◽  
The Republic ◽  
Large Random Sample ◽  
The Uk ◽  
And Training

Aims and methodIn November 1997 a questionnaire was sent to a large random sample of members, fellows, affiliates and inceptors living in the UK or the Republic of Ireland.ResultsOne thousand four hundred and seventy-six completed questionnaires were available for analysis, a response rate of 63%. The College was complemented for raising standards of education and training in psychiatry and criticised for not trying hard enough, or failing, to influence the policies of the Department of Health. A high proportion of respondents highly valued the British Journal of Psychiatry and Psychiatric Bulletin but few made use of the library. A high percentage of Irish, Welsh and Scottish members, and of members of the five smaller faculties, participated in and expressed their appreciation of the activities of the College.ImplicationsWhatever its other failings the College is not dominated by general psychiatrists and their interests, or by London-based psychiatrists. It is surprisingly successful at involving Scottish, Welsh and Irish psychiatrists, and members of the smaller faculties, in its activities. To some extent, however, the faculties are thriving at the expense of the English divisions.

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