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Experts gathered to discuss patient safety at symposium in Manchester

26 Jun
PSTRC Symposium - Dr Aidan Fowler, Prof Stephen Campbell and Dr Richard Preece

l-r: Dr Aidan Fowler (NHS National Director of Patient Safety), Prof Stephen Campbell (Director, NIHR Greater Manchester PSTRC), Richard Preece (Executive Lead Quality, Greater Manchester Health and Social Care Partnership)

A symposium was held by the National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC) in Manchester to discuss some of its areas of research. Experts from Paris and Norway joined NHS National Director of Patient Safety, Dr Aidan Fowler to speak at the event which around 100 academics, researchers, policy makers, and NHS executives attended last month.

The Greater Manchester PSTRC is one of three national NIHR funded patient safety research centres and is based at the University of Manchester. It works in partnership with Salford Royal NHS Foundation Trust. The centre carries out research across four themes which investigate patient safety in primary care and transitions of care. Its work is being adopted by the NHS, making a real difference.

The event gave attendees the opportunity to learn about crucial patient safety issues from experts and panel sessions allowed for meaningful discussion and insight.

The main areas of patient safety covered at the event were Artificial Intelligence and patience safety, transitions of care and patient safety, avoidable harm and patient safety, as well as the unique health and social care infrastructure in Greater Manchester.

Richard Preece, Executive Lead Quality Greater Manchester Health and Social Care Partnership spoke about the Greater Manchester Quality Improvement framework which he published at the end of last year. He highlighted that it is a framework for system safety. Richard, said: “We work in partnership and this involves our universities and research centres such as the Greater Manchester PSTRC, as well as patients and staff, to make care safer and to improve the outcomes and experiences of patients and service users.

“The symposium was a valuable opportunity to hear about some of the research underway and to speak to researchers and decision makers because by working together in this way we can start to improve the care system.”

Professor Anita Burgun from Paris Descartes University and Paris Artificial Intelligence Research Institute delivered a keynote speech on hybrid approaches in AI and its relevance to patient safety. She talked about her recent research looking at the overall prevalence of adverse events reported in social media.

Anita joined a panel, along with the PSTRC’s Theme Lead for Safety Informatics, Professor Neils Peek, Lecturer in Health Informatics at the University of Leeds, Professor David Wong and Professor David Clifton from the Department of Science and Engineering at the University of Oxford who chaired the session. The panel discussed the PSTRCs recent work on AI and patient safety.

The international input continued with Professor Karina Aase, Centre Director for SHARE, Centre for Resilience in Healthcare, University of Stavanger, Norway.  Karina presented some highlights from her research around Quality and Safety in Care Transitions, Expanding our Understanding. Karina spoke about creating common ground, widening the current perspective on care transitions and trying to work out a framework for researching it.

Professor Stephen Campbell, Director of the NIHR Greater Manchester PSTRC, said: “We were delighted that so many experts in patient safety could join us at our first symposium where we were all in agreement that the patient should be at the centre of everything we do. Working together and sharing research will help us to continue to improve patient safety.

“We value the input from all speakers and attendees who asked probing and insightful questions during our panel sessions. The research we undertake is making a tangible difference in the NHS and we are looking forward to seeing more of our research in practice, improving safety for patients.”

New PSTRC research: Mental health assessments and psychological therapies following self-harm

26 Mar

by Leah Quinlivan, Donna Littlewood, Liz Monaghan, Stephen Marks, Clive Turpin, Roger Webb, Nav Kapur

Quinlivanstudy image_500x333

Mental health assessments and psychological therapies can be beneficial in helping people keep safe and reducing repeat self-harm. Researchers in  the NIHR Greater Manchester PSTRC are conducting a study to understand what helps and does not help people receive assessments and aftercare following self-harm. The results of the study can then be used to inform the design of better services for people who self-harm, as well as the National Suicide Prevention Strategy.

Self-harm presentations to hospitals are a key patient safety issue in mental health services and may have serious consequences.(1) People who self-harm are at an elevated risk of suicide.(2,3) Repeat self-harm is common and usually happens quickly.(4,5,6)  Hospital services have an important opportunity to increase patient safety though good quality assessments and prompt aftercare.(7)

Clinical guidelines recommend that all individuals should receive an assessment of their individual needs and be offered psychological therapy following self-harm.(8) However, there are wide differences in the quality of care for people who self-harm, and not everyone receives an assessment or referral to psychological services.(9)

The study will investigate the gap between evidence and practice in how assessments and aftercare are provided following self-harm. As part of the study, Dr Leah Quinlivan is interviewing clinicians from 37 hospitals in England and is conducting an online survey of patients and carers. The study is ongoing and will continue until 2021.

The study was developed in conjunction with patient/carer and clinician advisory panels.  Liz Monaghan who is a member of the study’s patient/care advisory panel shared her thoughts about the importance of this study:

“As a suicide and self-harm survivor/service-user/carer, I welcome research which seeks to understand the complex factors, triggers and issues around this sensitive and difficult topic, all things which a good assessment should explore. I see the value of this research in improving service provision, shifting societal attitudes to mental health and informing good practice.

“By involving people like me with diverse lived experience of many aspects of mental health care, we have, as a group, been given an opportunity to shape and direct this research, hopefully adding relevance and insights about service provision which are only evident to those who have experienced it first-hand. It’s been great to be welcomed as a valued group within the research team and, for me, works as an important ‘re-vision’ of some of the worst times in my life. I am immensely grateful for the opportunity to take part in ways which are meaningful and empowering.”

This sentiment was echoed by Stephen Marks, Advanced Nurse Practitioner Trainee and member of the clinician advisory panel, who said:

“I think this is a really valuable study because it’s tackling an important patient safety issue which needs to be addressed. Good quality, timely, and appropriate care for this client group is undoubtedly associated with positive outcomes related to self-harm reduction and suicide prevention. Involving frontline clinicians makes this research relevant and realistic, and helps to ensure that the findings are grounded in the reality of everyday clinical practice.”

Similarly, Clive Turpin, a Cognitive Analytic Psychotherapist stated that:

 “Having worked in the area of self-harm, initially on a research project that evolved into a clinical service, I have seen the benefit, and necessity, in bringing both parts together. Sometimes this can be very simple, other times more complex, but being in dialogue with both feels essential in improving people’s experiences of mental health services and ultimately trying to promote and facilitate understanding, hope and change. Although I no longer work in a dedicated self-harm service, it remains a part of my therapy work and I maintain my interests and commitments to promoting and supporting research and its integration into clinical practise”.

Working in collaboration with patient/carer and clinician advisors, dissemination and implementation plans will be developed with the goal of narrowing the gap between evidence-based policy and implementation in practice.

If you are interested in hearing more about the clinician interview study, please contact the lead researcher, Dr Leah Quinlivan by email leah.quinlivan@manchester.ac.uk, or phone: 0161 275 0727.

The website for the patient and carer online survey study provides more information and links to participate in the study.


References

1.       Bergen, H., Hawton, K., Waters, K., Cooper, J., & Kapur, N. (2010). Psychosocial assessment and repetition of self-harm: the significance of single and multiple repeat episode analyses. Journal of Affective Disorders, 127(1), 257-265.

2.       Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital management of self-harm patients and risk of repetition: Systematic review and meta-analysis. Journal of Affective Disorders, 168, 476-483.

3.       Hawton, K., Bergen, H., Cooper, J., Turnbull, P., Waters, K., et al. (2015). Suicide following self-harm: findings from the multicentre study of self- harm in England, 2000 – 2012. Journal of Affective Disorders, 175, 147-51.

4.       Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature death after self-harm: a multicentre cohort study. The Lancet, 380(9853), 1568-1574.

5.        Kapur, N., Cooper, J., King-Hele, S., Webb, R., Lawlor, M., Rodway, C., & Appleby, L. (2006). The repetition of suicidal behavior: a multicenter cohort study. Journal of Clinical Psychiatry. 67, 1599-1609.

6.       Steeg, S., Cooper, J., & Kapur, N. (2014). Early Intervention for Self-Harm and Suicidality. In P. Byrne, and A. Rose, (Eds.) EI of Nearly Everything for Better Mental Health Early Intervention in Psychiatry (pp. 255-266). UK. Wiley & Sons, Ltd.

7.       Holmes, E. A., Ghaderi, A., Harmer, C. J., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., . . . Shafran, R. (2018). The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science. The Lancet Psychiatry, 5(3), 237-286.

8.       NICE. (2012). Self-harm. The NICE Guideline on Longer-term management. National Clinical Guideline Number 133. National Collaborating Centre for Mental Health. London: The British Psychological Society and The Royal College of Psychiatrists.

9.  9.     Cooper, J., Steeg, S., Bennewith, O., Lowe, M., Gunnell, D., House, A., … & Kapur, N. (2013). Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ Open, 3(11), e003444.

Improving access to innovative cancer treatments for North Manchester residents

17 Dec

Chemotherapy

by Andrew Wardley, Medical Director of NIHR / CRUK, Christie Research Facility

A new collaboration of the National Institute for Health Research (NIHR) Manchester Clinical Research Facility and NIHR Greater Manchester Patient Safety Translational Research Centre aims to improve access to the latest cancer treatments and clinical trials to people in the North East of Greater Manchester.

The NIHR Manchester Clinical Research Facility (CRF) is the largest and most comprehensive Clinical Research Facility in the UK, trialling research discoveries for the first time in humans through experimental medicine. The NIHR Clinical Research Facility at The Christie is a centre of excellence for cancer research studies.

Recent work shows that there is three times more research participation in affluent areas close to the four Clinical Research Facility sites in Greater Manchester than in more deprived and/or ethnically diverse areas.

Systemic anti-cancer therapy (SACT), which is chemotherapy and other molecular-targeted treatments, have greatly improved the chances of surviving cancer in the last two decades. The Christie, the largest single site cancer centre in Europe, provides chemotherapy and targeted treatments to people through Greater Manchester and parts of Cheshire through the Greater Manchester Cancer SACT pathway. In 2011 there was a major strategy to increase delivery of these treatments closer to where patients live, reducing the challenges they face to access treatment. The greatest challenge to improving access affects the more deprived and/or ethnically diverse parts of Greater Manchester.

Access to innovative new treatments in clinical trials extends and improves the length and quality of life for cancer patients. Current chemotherapy patient, Anna Friedenthal, says:

“Over the last 15 years I have taken part in five clinical trials at The Christie. I firmly believe that without these trials I would not be here today. They are our hope for the future – mine, my children’s as well as so many other families in similar circumstances. I feel so lucky to be a patient at The Christie, it is such a centre of excellence in every way.”

The lack of access to innovative cancer treatments affects members of the population that are least able to navigate the healthcare system. This represents a patient safety issue. We aim to reduce this social inequality and increase access to cutting edge cancer medicines by reaching all of Greater Manchester’s population. Specifically we will provide experienced cancer leadership to work with local health care and community teams to educate and facilitate access to the very best treatment innovations.

Safer medicines after hospital discharge

29 Oct

Involvement opportunity_small

by Mark Jeffries

Salford Royal NHS Foundation Trust (SRFT) is introducing an electronic system which will enable hospital pharmacists to refer patients to community pharmacists when they leave hospital, in order to receive advice about their medicine taking.  It is hoped these patients (or their carers) will be able to discuss their medicines with their community pharmacist and that this might resolve potential medication related issues, as well as improving patient knowledge and understanding about their medicines. This may help with the avoidance of errors and may help patients better understand any changes in their medicines. A positive outcome of this initiative is hoped to be patients taking their medicines more safely after spending time in hospital.

As part of our planned evaluation of the service we hope to talk to patients (and carers) about their experiences of using the electronic system and their interactions with the community pharmacists.

We are looking for a patient representative who could be involved in the project and might provide the research team with help and guidance at the different stages of project design, recruitment, data collection and data analysis. If you are interested, or would like more information, please contact Mark Jeffries at mark.jefferies@manchester.ac.uk.

Risk Management: developing a learning resource to support pharmacy teams across England

3 May

Risk man guide supported by NIHR GM PSTRC

Good risk management is well recognised as the cornerstone of safe practice in the workplace and risk assessment has long been part of legal requirements for health and safety in UK workplaces.

In 2017, the World Health Organisation highlighted the importance of medication error by choosing the issue of medication-related harm as the focus of its Global Challenge. In response to this, the Medication Safety theme of the Greater Manchester PSTRC worked with CPPE (The Centre for Pharmacy Postgraduate Education) to develop their learning resources on Risk Management.

This was an ideal opportunity for the PSTRC, allowing the team to apply their broad expertise in theoretical risk management concepts to the challenges of the pharmacy context but also enabling them to incorporate the expertise and insights from the PSTRC’s Community Pharmacy Patient Safety Collaborative – a group of current in-practice community pharmacists working in the Greater Manchester region (see blog post for more information).

This ensured that the guide would be both theoretically sound in terms of risk management but also enriched with examples that pharmacists saw as pertinent to their day to day work.

Through the co-development of this guide, it was recognised that this could be part of something with much greater impact and, as a result, CPPE dedicated their 2018 learning campaign to be focussed on the topic of Patient Safety, using the guide as a focal point to provide the theoretical background for the campaign.

The guide was distributed to over 67 500 pharmacy professionals as part of CPPE Patient Safety campaign. The PSTRC continued to support CPPE designing appropriate learning activities that would be delivered by CPPE – including face to face “focal point” sessions with over 100 events due to run nationally throughout England and online weekly activities in Feb/Mar 2018 – including an e-challenge quiz and encouraging involvement via Twitter, Instagram and Facebook. This resulted in over 1500 individuals signing up to the campaign activities over the six week period and continuing beyond this with pharmacists still adding their intentions to improve patient safety on CPPE’s ‘Pledge Wall’.

Matthew Shaw, interim director of CPPE, was delighted at the opportunity to collaborate with PSTRC recognising the huge value of building an evidence base into this core learning programme. He commented “It has been a great opportunity to work with PSTRC to link theory with practice and through this to support pharmacy professionals across the country to make their practice safer, and to reduce the risks to people using our services.”

A Patient Safety Toolkit for general practice

15 Mar

Patient-Safety-Toolkit_Banner2

The development and testing of a Patient Safety Toolkit for general practice has taken place over a number of years by a partnership of researchers at the Greater Manchester PSTRC in Nottingham (including Tony Avery, Brian Bell, Sarah Rodgers, Ndeshi Salema, Rachel Spencer) and Manchester (including Stephen Campbell, Kathy Perryman) the NIHR School for Primary Care Research at the Universities of Birmingham, Keele, Oxford and Southampton, as well as the University of Exeter.

The Patient Safety Toolkit is hosted on the Royal College of General Practitioners (RCGP) website. The RCGP is a network of over 52,000 family doctors. The Toolkit is important in preventing patients from being harmed. It is designed to be used by any general practice in the UK and covers the following topics:

  • safe systems
  • safety culture
  • communication
  • patient reported problems
  • diagnostic safety
  • prescribing safety

This range of topics addresses the fact that patient safety is complex and multidimensional. Improving patient safety requires preventing, identifying and addressing issues using practical and actionable information. The collection of tools is hosted on a single platform, which makes it easy to use and enables general practices to identify safety deficits. They can then review and change procedures to improve their patient safety across a key set of patient safety issues.

The research team has published a summary paper, which has been published in the Journal of Patient Safety: A Patient Safety Toolkit for Family Practices

Improving patient safety: linking PSTRC research and expertise to policy and practice

14 Mar

Nav Kapur

Linking up with policy-makers and clinical services is an important part of the work of the NIHR Greater Manchester PSTRC.  Nav Kapur, who is a Professor at the University of Manchester and one of the Research Leads for the Centre, really values the wider engagement he has had with NICE (he chaired the NICE self-harm and depression guidelines), the Department of Health and Social Care,  and Health Education England amongst others.  

Nav says: “We are proud to be a leading centre for research into self-harm and suicide and it’s been a privilege to inform policy and practice.  As an academic, being involved in guideline development allows you to get a wider view of the worldwide literature and its impact on patients.  As a clinician, I like the fact that being involved in guidelines and policies allows you to improve the care of all patients, not just the patient in front of you.”

He continues: “As part of my role as a member of the National Suicide Prevention Strategy Advisory Group for England I contributed to the new suicide prevention strategy, particularly its emphasis on self-harm, as well as contributing to initiatives on confidentiality and responding to new methods of suicide.  My work with Health Education England aims to develop competencies for all NHS staff in the assessment of patients who present with suicidal thoughts or self-harm.” 

Nav also values his role contributing to the induction of new chairs for NICE Guidelines. He explains: “In some ways I find it quite strange that I am now one of the most experienced guideline chairs!  But I really enjoy sharing my experiences of chairing groups and guideline development with people just embarking on the process and I hope they find it helpful too.” 

Nav and colleagues including Roger Webb and Caroline Sanders who lead the Safety in Marginalised Groups theme are looking forward to contributing further to guidelines and policy and practice.  In particular the planned work on the management of self-harm, the safety of mental health services, and improving care for marginalised groups could have a major impact on patient safety and patient care.