Changing for the Better provides best practice guidance on provide clear guidance for patients, the public and NHS staff on the processes underpinning changes to acute NHS services arising from the NHS Next Stage Review.

The researchers for this paper interviewed 28 GPs working in different settings and environments. They identified four factors that might affect the way GPs work and influence the decisions they might make.

Personal Beliefs and Medical Practice from the GMC is guidance for medical staff that states  doctors must not allow their personal beliefs to compromise patient care. The guidance explores how doctors should deal with a range of dilemmas including abortion, the wearing of face-veils and male circumcision.  It also looks at patients’ own beliefs and how they can affect the doctor/patient relationship.  It aims to balance a doctors’ right to practise in accordance with their views and beliefs, and the patients’ right to receive timely and appropriate medical care.

The GMC has producted an interactive web resource for its Good Medical Practice guidance. Good Medical Practice in Action opens with four patients in a waiting room and users can click on each patient to watch and listen to their consultation with a doctor. The user is then invited to decide on the best course of action from a range of options.

Topics covered include

• Communication Skills
• Conscientious objection
• Advertising
• Professional Discipline and Whistleblowing

To use this journal you’ll need your NHS Athens password from Liverpool PCT (You can register here to get one if you work for the PCT.  If you need any training for this or any other electronic resources and you work for the PCT use the contact form at the bottom of this post to request it.

The influence of patient and doctor gender on diagnosing coronary heart disease
Ann Adams, Christopher D. Buckingham, Antje Lindenmeyer, John B. McKinlay, Carol Link, Lisa Marceau and Sara Arber

• Abstract

Jumping off and being careful: children’s strategies of risk management in everyday life

Pia Christensen and Miguel Romero Mikkelsen

pages 112–130

• Abstract

To use this journal you’ll need your NHS Athens password from Liverpool PCT (You can register here to get one if you work for the PCT.  If you need any training for this or any other electronic resources and you work for the PCT use the contact form at the bottom of this post to request it.

Quality Lines
David P Stevens
Qual Saf Health Care 2008; 17: 1. [Extract] [Full text] [PDF]

Handovers and Debussy
D P Stevens
Qual Saf Health Care 2008; 17: 2-3. doi:10.1136/qshc.2007.025916 [Extract] [Full text] [PDF]

Structuring flexibility: the potential good, bad and ugly in standardisation of handovers
E S Patterson
Qual Saf Health Care 2008; 17: 4-5. doi:10.1136/qshc.2007.022772 [Extract] [Full text] [PDF]

Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure
C Hobgood, J H Tamayo-Sarver, and B Weiner
Qual Saf Health Care 2008; 17: 65-70. doi:10.1136/qshc.2006.021758 [Abstract] [Full text] [PDF]

Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study
E M A Witherington, O M Pirzada, and A J Avery
Qual Saf Health Care 2008; 17: 71-75. doi:10.1136/qshc.2006.020842 [Abstract] [Full text] [PDF]

Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system
P D Mills, J Neily, L M Kinney, J Bagian, and W B Weeks
Qual Saf Health Care 2008; 17: 37-46. doi:10.1136/qshc.2006.021816 [Abstract] [Full text] [PDF]

Adverse outcomes after discharge: occurrence, treatment and determinants
P J Marang-van de Mheen, N van Duijn-Bakker, and J Kievit
Qual Saf Health Care 2008; 17: 47-52. doi:10.1136/qshc.2007.023309 [Abstract] [Full text] [PDF]

Patient safety events reported in general practice: a taxonomy
M A B Makeham, S Stromer, C Bridges-Webb, M Mira, D C Saltman, C Cooper, and M R Kidd
Qual Saf Health Care 2008; 17: 53-57. doi:10.1136/qshc.2007.022491 [Abstract] [Full text] [PDF]

Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York
W B Weeks, A N West, A K Rosen, and J P Bagian
Qual Saf Health Care 2008; 17: 58-64. doi:10.1136/qshc.2006.020735 [Abstract] [Full text] [PDF]

Intensive care unit nurses’ perceptions of safety after a highly specific safety intervention
N C Elder, S M Brungs, M Nagy, I Kudel, and M L Render
Qual Saf Health Care 2008; 17: 25-30. doi:10.1136/qshc.2006.021949 [Abstract] [Full text] [PDF]

What is quality and how is it achieved? Practitioners’ views versus quality models
P Hudelson, A Cléopas, V Kolly, P Chopard, and T Perneger
Qual Saf Health Care 2008; 17: 31-36. doi:10.1136/qshc.2006.021311 [Abstract] [Full text] [PDF]

Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey
S M Borowitz, L A Waggoner-Fountain, E J Bass, and R M Sledd
Qual Saf Health Care 2008; 17: 6-10. doi:10.1136/qshc.2006.019273 [Abstract] [Full text] [PDF]

A theoretical framework and competency-based approach to improving handoffs
V M Arora, J K Johnson, D O Meltzer, and H J Humphrey
Qual Saf Health Care 2008; 17: 11-14. doi:10.1136/qshc.2006.018952 [Abstract] [Full text] [PDF]

Integrating the chronic-care model and the ACGME competencies: using shared medical appointments to focus on systems-based practice
S R Kirsh and D C Aron
Qual Saf Health Care 2008; 17: 15-19. doi:10.1136/qshc.2006.020925 [Extract] [Full text] [PDF]

Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors
J F Crofts, C Bartlett, D Ellis, C Winter, F Donald, L P Hunt, and T J Draycott
Qual Saf Health Care 2008; 17: 20-24. doi:10.1136/qshc.2006.021873 [Abstract] [Full text] [PDF]

Homeopathy or regular medicine? Cook County Hospital, Chicago, Illinois, 1882–1887: evidence, politics, customer choice and provider perceptions at work
D Neuhauser and M Diaz
Qual Saf Health Care 2008; 17: 76-78. doi:10.1136/qshc.2007.023705 [Extract] [Full text] [PDF]

Practice guidelines for haemodialysis in Egypt
Qual Saf Health Care 2008; 17: 79. doi:10.1136/qshc.2007.023325 [Extract] [Full text] [PDF]

Impact of the European Working Time Directive on specialty training
Qual Saf Health Care 2008; 17: 79-80. doi:10.1136/qshc.2007.023234 [Extract] [Full text] [PDF]

Improved Health System Performance Through Better Care Coordination (Health Working Paper No. 30) from the OECD attempts to assess whether–and to what degree–better care coordination can improve health system performance in terms of quality and cost-efficiency.

The local press brought news of a fascinating site, the e-learning portal of the EU funded project ETSL for the dissemination of Greek, Finnish and English Sign Language for hearing and hearing impaired people. Videos demonstrate sign langauge to you in each language. Cool stuff.

National Care of the Dying Audit generic report 2006/2007 considers the care of the dying in five key areas and finds that:

Physical Comfort of the Patient 

• Medication was assessed and non-essential medication was stopped in 93% of patients.

• Anticipatory prescribing was undertaken for pain relief in 91% of cases, for agitation in 84% of cases, for the prevention of respiratory tract secretions in 80% of cases, for nausea in 80% of cases and for breathlessness in 67% of cases.

• Inappropriate blood tests and antibiotics were discontinued in 87% and 91% respectively, and recording of ‘not for Cardio Pulmonary Resuscitation’ (where appropriate) documented in 93% of patients.

• In regard to ongoing care the presence or absence of symptoms could be recorded for patients during the last 24 hours of life. The status was not recorded for 18% - 19% of those assessments. Where the status was recorded patients were assessed as being symptom controlled in 95% for pain; 94% for agitation; 91% for respiratory tract secretions and 99% for nausea and vomiting of occasions.

Psychological and Spiritual Aspects of Care

On commencement of the LCP (Initial Assessment)

• Patient awareness of diagnosis and recognition of the dying phase was recorded as having been achieved in 57% and 45% of patients respectively. In one third of cases there was no documentation on the LCP suggesting a need for further education and training for healthcare staff.  Some hospitals, however, did achieve 100%.
• In over 80% of cases, carers were recorded as being aware of the diagnosis and dying phase, suggesting that healthcare staff find it easier to talk to carers
• The spiritual needs of patients and carers were recorded as being assessed in 34% and 53% (respectively) of appropriate cases

Communication with Patient,Carer and Healthcare Professionals

This is variable but carers were more likely to have had the care plan explained to them than the patient:

• At Initial Assessment, documentation confirmed that patients had the care plan communicated to them in over one third of cases, compared with 78% of carers.  It was recorded that 90% of those carers understood the care plan after it was explained to them.

• Communication with primary care (both on commencement of the LCP and after the death of the patient) was documented as having taken place in only about a third of cases, although there were pockets of good practice

Information Giving and Receiving

• Contact information about the most important person to contact in case the patient’s condition deteriorates was achieved at Initial Assessment in 79% of cases and Hospital information leaflets regarding facilities and access were given out in 59% of cases at that time
• Around the time of death or deteriorating condition of the patient (Initial Assessment), only half of families were recorded as having been given appropriate information about local and national procedures that may need to be followed.

Following Appropriate Procedures

• Following death, appropriate hospital procedures for laying out of bodies, storing of patient’s belongings and other activities were documented as having been followed in around half of cases.  However, the high level of care after death goals that are left blank at the point of delivery of care requires more investigation before firm conclusions can be made. 

The Knowledge and Skills Framework (KSF) which we all have to undertake under Agenda for Change (A4C) means we all also have to undertake Personal Development Reviews (PDR) and develop Personal Development Plans (PDP) on an annual basis. As a result of some training with the Learning and Development Bureau recently on Performance Management we came up with the concept of PDR Reading lists. These work for both Reviewer and Reviewee in that if there is an identified development area in the PDR they identify the library resources available to support development in that area.

New List:

• Fade KSF Reading List - Leadership

Joins:

• Fade KSF Reading List - Communication

• Fade KSF Reading List - Facilitation

• Fade KSF Reading List - Time Management

• Fade KSF Reading List - Interview Skills

The Knowledge and Skills Framework (KSF) which we all have to undertake under Agenda for Change (A4C) means we all also have to undertake Personal Development Reviews (PDR) and develop Personal Development Plans (PDP) on an annual basis. As a result of some training with the Learning and Development Bureau recently on Performance Management we came up with the concept of PDR Reading lists. These work for both Reviewer and Reviewee in that if there is an identified development area in the PDR they identify the library resources available to support development in that area.

So far we have developed 3 reading lists which you can either grab from the links below or at the bottom of the side bar on your right.

Fade KSF Reading List - Communication

Fade KSF Reading List - Facilitation

Fade KSF Reading List - Time Management

Stop Press - Interview Skills List!

Fade KSF Reading List - Interview Skills

If you want to subscribe to the RSS Feed to be notified as new reading list are developed you can here:

Fade PDR Reading Lists Feed

A reading list is in development on Interview Skills and if there are any other topics that you would like to see developed please contact us using the form below.