Less Temptation To Exceed The Speed Limit Or Towards Vision Zero

In 2020 the Lithuanian Government approved traffic safety programme Vision Zero. One of the integral measures applied to improve traffic safety and to reduce the number of road traffic infringements is the development of average speed cameras’ network on state significance roads. It is planned that the network of average speed cameras will cover more than 800 km of state significance road network in Lithuania in 2020-2021. Initially, it was planned to implement these measures only on rural roads. However, taking into consideration the principles of road eligibility for average speed camera installation, some road sections crossing the so-called linear settlements were selected to test the impact of such systems on driving habits as well. It is presumed that from the beginning of exploitation of these systems the reduction in the consequences of severe traffic accidents on the selected most dangerous state significance road sections will be observed.

431 Electronic Structured Response Tool for Deteriorating Surgical Patients

Aim The Scottish Patient Safety Programme created the National Early Warning Score to have early recognition of deteriorating patients. Clear communication and documentation during and after episodes were found to improve outcomes. SIGN guidance recommended 9-component that should be included in structured response, creating a paper-based structured response tool (SRT). We aimed to review medical assessments of deteriorating patients in general surgical wards and compare to a formulated electronic SRT in promoting best practice. Method Patients scoring over NEWS 4 were identified at eight 2-week time points over a 18-month period and initial assessments evaluated. Results 101 patients were identified with a NEWS ≥ 4 between July 2018-Feb 2019. Implementation of electronic SRT occurred in Nov 2018 and Feb 2019. Average NEWS was 5.9 (range 4-12). Comparing collection periods, following electronic SRT implementation, documentation of re-review times rose from 37.5% to 79.5%. Documentation of frequency of observations and management plans increased from 24.5% to 65% and 79% to 97% respectively. There was a statistically significant rise in recording of escalation plans following implementation of electronic SRT from 35% to 94% (p = 0.008). Conclusions Usage of electronic SRT promoted documentation of all components recommended by SIGN. There is further scope to extend usage outside of surgical wards for all junior doctors by introducing electronic SRT at medical induction.

NHS ‘Learning from Deaths’ reports: a qualitative and quantitative document analysis of the first year of a countrywide patient safety programme

ObjectivesTo review how National Health Service (NHS) Secondary Care Trusts (NSCTs) are using the Learning from Deaths (LfDs) programme to learn from and prevent, potentially preventable deaths.IntroductionPotentially preventable deaths occur worldwide within healthcare organisations. In England, inconsistencies in how NSCTs reviewed, investigated and shared LfDs, resulted in the introduction of national guidance on ‘LfDs’ in 2017. This guidance provides a ‘framework for identifying, reporting, investigating and LfDs’. Amendments to NHS Quality Account regulations, legally require NSCTs in England to report quantitative and qualitative information relating to patient deaths annually. The programme intended NSCTs would share this learning and take measurable action to prevent future deaths.MethodWe undertook qualitative and quantitative secondary data, document analysis of all NSCTs LfDs reports within their 2017/2018 Quality Accounts (n=222).ResultsAll statutory elements of LfDs reporting were reported by 98 out of 222 (44%) NSCTs. The percentage of deaths judged more likely than not due to problems in healthcare was between 0% and 13%. The majority of NSCTs (89%) reported lessons learnt; the most common learning theme was poor communication. 106 out of 222 NSCTs (48%) have shared or plan to share the learning within their own organisation. The majority of NSCTs (86%) reported actions taken and 47% discussed or had a plan for assessment of impact. 37 out of 222 NSCTs (17%) mentioned involvement of bereaved families.ConclusionsThe wide variation in reporting demonstrates that some NSCTs have engaged fully with LfDs, while other NSCTs appear to have disengaged with the programme. This may reveal a disparity in organisational learning and patient safety culture which could result in inequity for bereaved families. Many themes identified from the LfDs reports have previously been identified by national and international reports and inquiries.

The Kids Are Alright: Outcome of a Safety Programme for Addressing Childhood Injury in Australia

Globally, injuries are the leading cause of death and represent the highest burden of ongoing disease amongst children 1–16 years of age. Increasingly, prevention programmes are recognising a growing need for intervention strategies that target children. The purpose of this study was to determine the efficacy of the SeeMore Safety Programme, designed to teach children (4–6 years of age) how to make conscious decisions about their own capabilities related to safety and how to manage risk. This retrospective study examined de-identified pre- and post-programme data from a sample of 1027 4 to 6-year-old pre-school children over the four-year period who participated in the SeeMore Safety Programme. Results show a significant improvement in each of the post-test scores and when compared to the pre-test scores (p < 0.001). Children from rural areas, as well as those from areas of greater disadvantage, also showed significant improvement in their pre- and post-test scores (p < 0.001). Overall, the findings highlight that the SeeMore Safety Programme over the four-year period demonstrates an increase in the children’s capacity to recognise and identify danger and safety amongst all children, offering great promise for reducing the burden of injury on children, their families and society.

Implementation challenges to patient safety in Guatemala: a mixed methods evaluation

BackgroundLittle is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala.MethodsWe used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation.ResultsWe found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions.ConclusionImplementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.

The Identification and Referral to Improve Safety Programme and the Prevention of Intimate Partner Violence

Introduction: Intimate Partner Violence (IPV) is a global epidemic which 30% of women experience world-wide. Domestic violence has serious health consequences, with an estimated cost of 1.7 billion annually to the NHS. However, healthcare professionals remain uncertain on how to manage IPV. In 2007, the Identification and Referral to Improve Safety (IRIS) was introduced within primary care to address this shortcoming. The aim of this project is to analyse the impact of IRIS, whilst discussing the extension into secondary care. Materials and Methods: A literature review was conducted using PubMed, Cochrane Library and Google scholar. The official IRIS publication list for randomized controlled trial data. Results: General practices with IRIS displayed a threefold increase in the identification of IPV and sevenfold increase in referrals. IRIS is cost-effective and under the NICE threshold of GBP 20,000 per quality-adjusted life year gained. Additionally, a systematic review illustrated that one in six women presenting to the fracture clinic experienced IPV within the last year. Conclusions: The implementation of IRIS into general practice proved to be cost-effective. Orthopaedic fracture clinics are at the forefront of dealing with IPV, and therefore an adapted IRIS programme within this setting has potential in the prevention of IPV.