Patient safety
action or reassessment can then take place. “We have to be honest that there are structural barriers. I think COVID probably didn’t help, with the lack of visiting during COVID. We have to ask ourselves, ‘have we re-created adequate opportunities for patients, families, and staff to interact?’” he commented. “Our publication Modern ward rounds focuses on patient involvement in care decisions, but we know that element isn’t widely implemented.” Dr. Dean went on to highlight the ‘PIER’
framework for implementation which relates to: ‘Prevent, Identify, Escalate and Respond’. “We need to not only identify and respond when patients deteriorate, but to act early in treatment to prevent that. Uniquely, in the UK, we have national systems to identify when patients are deteriorating or are at risk of deterioration – for adult patients, for children and for women who are pregnant. “These tend to look at physiological markers.
But we’re now looking at the soft signs, that professional, patients and families pick up. We now know that this is an earlier warning sign of the patient deteriorating,” said Dr. Dean. He called for the use of a single question
every day, which asks the patient: are you feeling the same, better, or worse than the previous assessment? He described this as “a fundamental change that will help”. “When we pick up if somebody is
deteriorating, how do we escalate? Who do we escalate to, as health professionals and as patients, and will that be responded to? “If a patient is deteriorating, it is right that we bring in other healthcare professionals with expertise in that area, to help us not to be biased into a single diagnosis, and to step back and say ‘what’s going on? Have we got this right?’ I think the response element is absolutely key. Fundamentally, we need to have a flattened hierarchy, systems that support interaction across the healthcare team and with patients and families, maximising the use of soft signs, as we learn about those – but, importantly, we need to have this safety net in place,” he concluded.
The Royal Berkshire approach The Royal Berkshire NHS Foundation Trust previously implemented an initiative, Call 4 Concern – a patient safety service run by the Critical Care Outreach Team. Call 4 Concern enables patients and families to call for immediate help and advice if they feel that the healthcare team has not recognised their own or their loved one’s changing condition. After prioritising the urgency of the problem, the team visits the ward to discuss any concerns, assess the situation and instigate
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treatment or further review if necessary. The insights gained from this initiative are now helping to inform the roll out of Martha’s Rule. Steve McManus, Chief Executive of the Royal
Berkshire NHS Foundation Trust, commented that he is “absolutely passionate about safety culture”. “It was a privilege to be part of the policy
development group that Polly was talking about, working with Henrietta Hughes, last year, regarding the Martha’s Rule policy development,” Steve commented.
He explained that the approach at the Royal
Berkshire NHS Foundation Trust was introduced in 2010, and the data generated from this provides an opportunity for improvement both at a process level but also at a cultural level. The opportunity around the improvement mindset is especially important, he pointed out.
“In terms of cultural improvement, we use the data we generate from our Call 4 Concern programme to point to communication issues between clinicians, between clinicians and teams, and between clinicians and patients and their loved ones,” Steve continued. “There is an opportunity to triangulate the data in relation to staff stability data and complaints data in relation to communication, to identify cultural hotspots where there are issues with communication and listening.” He added that listening to the voice of the service user is also an important output - simple, daily interventions, such as asking the patient if they are feeling better or worse, can avoid the need to trigger a call regarding Martha’s Rule. Steve observed that there is also an opportunity to think more broadly about the culture of an organisation - not just
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