The Introduction of "Safety Science" into an Undergraduate Nursing Programme at a Large University in the United Kingdom.

Implementing safety science {a term adopted by the authors which incorporates both patient safety and human factors (Sherwood, G. (2011). Integrating quality and safety science in nursing education and practice. Journal of Research in Nursing, 16(3), 226-240. doi: 10.1177/1744987111400960)} into healthcare programmes is a major challenge facing healthcare educators worldwide (National Advisory Group on the Safety of Patients in England, 2013; World Health Organisation, 2009). Patient safety concerns relating to human factors have been well-documented over the years, and the root cause(s) of as many as 65-80 % of these events are linked to human error (Dunn et al., 2007; Reason, 2005). This paper will describe how safety science education was embedded into a pre-registration nursing programme at a large UK university. The authors argue that the processes described in this paper, may be successfully applied to other pre-registration healthcare programmes in addition to nursing.

Teaching patient safety and human factors in undergraduate nursing curricula in England: a pilot survey.

Patient safety is a key priority for all healthcare systems, and there is growing recognition for the need to educate tomorrow's nurses about the role of human factors in reducing avoidable harm to patients. A pilot survey was sent to 20 schools of nursing in England to explore the teaching of patient safety and human factors. All 13 schools that responded (65% response rate) stated that patient safety was covered in their curricula and was allocated more than 4 hours; all the classes included human factors. Only two respondents indicated their teaching to be multi-professional. Awareness of the World Health Organization's multiprofessional patient safety curriculum guide was poor. Faculties also seemed unaware that the Institute for Healthcare Improvement provides free online patient safety modules for students and that there is a global network of student patient safety chapters.

Nursing considerations to complement the Surviving Sepsis Campaign guidelines.

OBJECTIVES: To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis. DESIGN: Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus. METHODS: We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding. RESULTS: Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points. CONCLUSION: Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.

Patient safety is improved by early training.

Making care safer for patients is currently a top priority for the NHS. Nurses, as the biggest group of health-care workers, have countless opportunities each day to contribute to this aim. One of the first challenges that arises is: how do we ensure that all nurses are aware of the size and extent of the problem? We must also ask what is being done locally to reduce avoidable harm and deaths.

The Sepsis Six: helping patients to survive sepsis.

Sepsis kills more people than lung cancer, and more people than bowel and breast cancer put together. The costs to the NHS are significant; it is estimated that in Europe, patients with severe sepsis cost healthcare funders around 7.6 billion euros per year (Daniels et al, 2007). Costs in the United States are estimated at $16 billion annually (Angus et al, 2001), and in the United Kingdom up to 46% of intensive care unit (ICU) bed days are used by patients with severe sepsis (Padkin et al, 2003), with each ICU bed costing around pounds sterling1700 per day. In 2002 an international campaign was launched: the Surviving Sepsis Campaign. The main aim of this campaign is to reduce mortality from sepsis by 25% by 2009. A lot of the early work has concentrated on improving sepsis care in intensive care units, but many patients on general wards develop sepsis, and the need to educate nurses throughout all areas of the hospital has been recognized. In September 2007 a new part of the campaign was launched called Survive Sepsis, which aims to deliver sepsis education to ward nurses and junior doctors. This article discusses how to recognize severe sepsis and explains how nurses can dramatically improve a patient's chance of survival by ensuring that six simple things (Sepsis Six) are done in the first hour.

An audit of ward nurses' knowledge of sepsis.

Many of the patients with sepsis admitted to intensive care and high dependency units develop severe sepsis/septic shock in general hospital wards. If the Surviving Sepsis Campaign's aim of a 25% reduction in mortality from sepsis is to be achieved by 2009, then it is essential that registered nurses are aware of the standard definitions of sepsis, and the recommendations for its initial management. The aim of this study was to audit ward nurses' knowledge of sepsis against standard definitions and evidence-based management guidelines. An audit was carried out in one acute hospital to assess ward nurses' knowledge of sepsis. Seventy-three registered nurses from medical, surgical and orthopaedic wards completed a questionnaire about the signs and symptoms of sepsis and its initial management. The results showed that some ward nurses appeared to have a poor knowledge of the signs and symptoms of sepsis, severe sepsis/septic shock and some aspects of its initial management. Following the results of the audit, a variety of educational initiatives were introduced to raise awareness of the standard definitions and the surviving sepsis management guidelines. In conclusion, targeted education must be provided for nurses working in general wards if the Surviving Sepsis Campaign is to achieve its aim of a 25% reduction in mortality by 2009.

Assessing, treating and managing patients with sepsis.

This article outlines the causes, signs and symptoms of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock, the implications and available treatments. The article also highlights a campaign to reduce the incidence of sepsis and reflects on efforts to reduce healthcare-associated infections.

Severe sepsis in A&E.

In this article, the author clarifies the definition of sepsis, severe sepsis and septic shock, describes the physiological changes that occur and the initial treatment used to improve patient outcome, and examines the concept of early goal directed therapy (EGDT).

An evaluation of the evidence base related to critical care outreach teams--2 years on from Comprehensive Critical Care.

It is now 2 years since the publication of Department of Health [Comprehensive Critical Care: A Review of Adult Critical Care Services (2000a)] document 'Comprehensive Critical Care'. One of its' main recommendations was the introduction of critical care outreach services. Many hospitals have since established such services and are providing education for ward nurses and house officers, and follow-up for patients discharged from intensive care when they return to a general ward. Early Warning Scoring (EWS) systems have also been introduced onto the wards to improve the identification of patients deteriorating into critical illness. However, as yet there appears to be little evidence that this investment has been worthwhile in terms of improving patient outcomes, such as reduction in cardiac arrests on the wards, reduction in unplanned admissions to critical care or earlier referrals to critical care. With many outreach teams hoping to expand their services in the future there is a pressing need to demonstrate an impact. We must remember however that some outreach teams have only been in post for 12 months and so it may therefore be far too early to reliably demonstrate any effect.

The physiological after-effects of critical care.

After a stay in intensive care, patients may suffer physiological after effects, such as muscle wasting, polyneuropathies, disturbed sleep, itching and poor mobility. The care that patients receive whilst on intensive care may contribute to the severity of some of these physical problems. Raising awareness amongst critical care nurses may help reduce the severity of some of the physiological after effects. Increased awareness amongst nurses on the wards about the physical impact of intensive care may lead to a greater understanding of the needs of this group of patients and may improve discharge planning.

British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units.

Critical care nurses in the United Kingdom have become increasingly concerned about the use, potential abuse and risks associated with physical restraint of patients. Restraint in critical care is not only confined to physical restraint but can also encompass chemical and psychological methods. There are concerns regarding the legal and ethical issues relating to the (ab)use of physical restraint techniques in critical care. The aim of this article was to present the British Association of Critical Care Nurses (BACCN) position statement on the use of restraint in adult critical care units and to provide supporting evidence to assist clinical staff in managing this process.