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dc.contributor.authorMilligan, Franken
dc.contributor.authorGadsby, Rogeren
dc.contributor.authorGhaleb, Maisoonen
dc.contributor.authorIvory, Philipen
dc.contributor.authorMcKeaveney, Coletteen
dc.contributor.authorNewton, Kathrynen
dc.contributor.authorSmith, Jackieen
dc.contributor.authorRandhawa, Gurchen
dc.date.accessioned2018-10-02T13:28:09Z
dc.date.available2018-10-02T13:28:09Z
dc.date.issued2015-07-01
dc.identifier.citationMilligan F., Gadsby R., Ghaleb M., Ivory P., McKeaveney C., Newton K., Smith J., Randhawa G. (2015) 'Going beyond blame: reporting NHS medication errors in nursing home residents with diabetes', British Journal of General Practice, 65 (636), pp.372-373.en
dc.identifier.issn0960-1643
dc.identifier.pmid26120130
dc.identifier.doi10.3399/bjgp15X685897
dc.identifier.urihttp://hdl.handle.net/10547/622910
dc.description.abstractIt is widely accepted in literature on patient safety that an open culture — one that seeks to understand the multiple reasons for error — is required to promote incident reporting and maximise learning for system improvement.1 In the attempt to deliver the research described here we encountered a culture of blame. Such a culture leads to low levels of medication error reporting with regard to NHS systems supplying the nursing home setting. This article explores the problem of this low level of reporting being detrimental to future learning on NHS medication errors.2 The study we undertook, ‘Root causes of medication errors in nursing home residents with diabetes: enhancing safety in NHS medicines management’, was funded by the Research for Patient Benefit (RfPB) programme. It focused on residents with diabetes in nursing homes, as defined by the Care Quality Commission (CQC),3 and involved consenting homes in Bedfordshire and Hertfordshire. Nursing homes were selected because medication delivery processes are slightly different from residential care home provision, although the incident reporting systems are similar. The aim of the study was to gather data on NHS errors, and report on and analyse them for learning purposes and solution development. The comments made here relate to the data collection process. The final research findings will be summarised in future publications.
dc.language.isoenen
dc.publisherRoyal College of General Practitionersen
dc.relation.urlhttps://bjgp.org/content/65/636/372.longen
dc.rightsWhite - archiving not formally supported
dc.subjectpatient safetyen
dc.subjectdiabetesen
dc.subjectmedication errorsen
dc.subjectnursing homesen
dc.subjectL510 Health & Welfareen
dc.titleGoing beyond blame: reporting NHS medication errors in nursing home residents with diabetesen
dc.typeArticleen
dc.identifier.eissn0960-1643
dc.contributor.departmentUniversity of Bedfordshireen
dc.contributor.departmentWarwick Medical Schoolen
dc.contributor.departmentUniversity of Hertfordshireen
dc.contributor.departmentAge Concern Lutonen
dc.contributor.departmentNHS Bedfordshireen
dc.identifier.journalBritish Journal of General Practiceen
dc.identifier.pmcidPMC4484938
dc.date.updated2018-10-02T12:39:04Z
html.description.abstractIt is widely accepted in literature on patient safety that an open culture — one that seeks to understand the multiple reasons for error — is required to promote incident reporting and maximise learning for system improvement.1 In the attempt to deliver the research described here we encountered a culture of blame. Such a culture leads to low levels of medication error reporting with regard to NHS systems supplying the nursing home setting. This article explores the problem of this low level of reporting being detrimental to future learning on NHS medication errors.2 The study we undertook, ‘Root causes of medication errors in nursing home residents with diabetes: enhancing safety in NHS medicines management’, was funded by the Research for Patient Benefit (RfPB) programme. It focused on residents with diabetes in nursing homes, as defined by the Care Quality Commission (CQC),3 and involved consenting homes in Bedfordshire and Hertfordshire. Nursing homes were selected because medication delivery processes are slightly different from residential care home provision, although the incident reporting systems are similar. The aim of the study was to gather data on NHS errors, and report on and analyse them for learning purposes and solution development. The comments made here relate to the data collection process. The final research findings will be summarised in future publications.


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