Nursing can help end the travesty of 'Datix abuse'

Patient falls while under supervision: trends from incident reporting

In one large UK hospital trust, data from the electronic incident reporting system were studied to determine the number of falls within one division taking place while patients were under enhanced supervision. This supervision was commonly carried out by registered nurses or healthcare assistants. It was noted that, despite increased supervision, patients were still falling and when they did the degree of harm they suffered was often greater than for those patients not under supervision. It was also noted that more male patients fell under supervision than female patients, although the reasons for this were not clear, suggesting an area for further research. A large number of patients fell while in the bathroom, where they were often left alone for periods of time. This shows an increasing need to find a balance between maintaining patient dignity and ensuring patient safety.

What became of the 'eyes and the ears'?: exploring the challenges to reporting poor quality of care among trainee medical staff

The importance of trainee medical staff in alerting Trusts to patient safety risks and low-quality care was established by the Francis Report, yet many remain hesitant about speaking up. Known barriers include lack of feedback, sceptical attitudes to the likelihood of change and fear of consequences. The author explores other factors including moral orientation in the workplace, role modelling by senior clinicians, discontinuity, 'normalisation of deviance', human reactions to burnout/moral injury, loyalty and the spectrum of motivation. The issues of absent feedback and fear are discussed in detail. Challenges met by those receiving reports are also described, such as how to collate soft intelligence, putting concerns into context (the 'bigger picture') and stewardship of resources. Initiatives to encourage reporting of trainees' concerns such as speak up guardians, 'Speak Up for Safety' campaign and simulation training are described. A proposal to embed proactive intelligence-gathering arrangements is presented.