Chief Executive Bulletin
13 - 19 April 2001
Issue 62
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Chief Executive Bulletin
13 - 19 April 2001 |
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Hard copy versions of these publications can be ordered from the NHS Responseline 08701 555 455. Contents: NHS interest 1. Implementing An Organisation With A Memory and The Prevention of Intrathecal Error 3. Surveillance of Healthcare Associated Infections NHS and Social Care interest 4. Seminars on 'Managing the Consequences of a Deliberate Release of Chemical or Biological Agents NHS interest 1. Implementing An Organisation With A Memory and The Prevention of Intrathecal Error The report An organisation with a memory (OWAM), published in June 2000, drew attention to the scale of potentially avoidable events that result in unintended harm to patients. A new report entitled Building a Safer NHS for Patients, published on 17 April 2001, describes progress in implementing the OWAM recommendations, the next steps and further action which is planned. This report is available on the Department of Health website at www.doh.gov.uk/buildsafenhs It is accompanied by two further reports, published on 19 April 2001. The first, the report of an independent investigation into the death of a teenager from an intrathecal injection error at the Queen's Medical Centre, Nottingham, produced by Professor Brian Toft, is available on the Department of Health website at www.doh.gov.uk/qmcinquiry. The second is a report on the prevention of intrathecal medication errors, produced by Professor Kent Woods. This is available at www.doh.gov.uk/imeprevent Chief Executives of NHS organisations and their senior management teams are asked to read these reports and to take immediate action as set out in the letter from the Chief Medical Officer (CMO) which accompanies them. This is a matter of patient safety and Chief Executives must take personal responsibility to ensure that the necessary action on intrathecal medication is taken urgently. Ref(s). Building a Safer NHS for Patients 23720, Adverse Incident at Queens Medical Centre 23722 and the Prevention of Intrathecal Medication Errors 23721. Will be mailed to Chief Executives of Health Authorities, Special Health Authorities and NHS Trusts, Regional Directors and Nurse Directors and Health Authority Directors of Public Health. Hard copies will be available w/c 23/4/01. Issue 60 of this Bulletin drew your attention to the Director of Research and Development's (Professor Sir John Pattison) letter of 2 April 2001, setting out the details of an assessment for complying with research governance. This was placed on the Department's R&D web site at www.doh.gov.uk/research. An electronic version of the assessment form is now available on the same site. To access this document please click on either the "What's New" or "Research Governance" heading in the list under "NHS R&D". All research active NHS organisations must complete the assessment form for return to their regional contact listed under Sir John Pattison's letter no later than 31 May 2001. NHS bodies that are not research active should simply complete the preliminary question on the form and return it to their regional contact by the same date. Health Authority chief executives should ensure that primary care practitioners are aware of this exercise with the aim of ensuring that research active practitioners return the form on time. 3. Surveillance of Healthcare Associated Infections From 1 April all acute Trusts are required to collect data on healthcare associated infections. This will focus on Staphylococcus aureus bacteraemias in the first instance. Data will be submitted to Regional Offices on a quarterly basis, and will be published from April 2002. Responsibility for collection lies with the Chief Executive of the Trust. Discussions will be needed with Regional Offices to agree the format for submission that best suits local needs. Regional Epidemiologists have been informed of this data collection requirement and may already have been in touch with Trusts. Chief Executives should, however, ensure that their infection control teams are aware of the requirement. Further information, including the data that needs to be collected, can be found at www.doh.gov.uk/hai For further details contact David.Howell@doh.gsi.gov.uk NHS / Social Care interest 4. Seminars on 'Managing the Consequences of a Deliberate Release of Chemical or Biological Agents A series of seminars are being jointly held by the Department of Health and the Home Office on the management of the consequences of a deliberate release of a chemical or biological agent (CB). Central Government departments, emergency services, local authorities, health providers, military and others are all working together to develop a response to such an incident. The Department of Health and the Home Office are therefore arranging three seminars to be held at the Home Office Emergency Planning College. The purpose of the seminars is to raise awareness of issues that will have to be addressed following a deliberate release, and to encourage those who would be involved in the management of the response to think about their potential roles. The documents in this bulletin are Crown copyright but may be reproduced by NHS and Local Authority staff without formal permission or charge for personal or in-house use - ©2001 Back to Chief Executive's Bulletin Home Page |
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