Patient safety and clinical governance

Clinical effectiveness

This can be achieved by ensuring that the care provided is, where possible, based on sound evidence from research and subsequently improved through audit and performance review. The National Institute for Health and Care Excellence (NICE) provides national guidance on the prevention and treatment of many conditions after reviewing all available evidence. All published information is reviewed and updated at regular intervals.

Multidisciplinary teams

High-quality patient care requires the skills, experience and training of many individuals. This is best achieved by incorporating staff into multidisciplinary teams and ensuring that all members communicate effectively on behalf of the patient.

Clinical audit

This is part of the process of reviewing the clinical performance of a team and is now well-established in clinical care. Audit requires the identification of important standards of excellent practice, review of the practice of the team against those standards, the presentation of results to the relevant teams and introducing a change in practice to ensure all meet the standards.

Near misses and mistakes

Clinical practice is complex and difficult and sadly mistakes do occur. The impact of any mistake can be devastating for the patients and families and can also impact on clinicians involved. It behooves all clinicians to strive to avoid mistakes in their practice but if they do occur, it is then the responsibility of the clinicians and the institution to help understand and explain the issue. There is no place for hiding, disguising or obfuscating the events. Being open and honest is hard to do but it does benefit all involved. The law on Duty of Candour has already been presented ( Chapter 32 Ethics and Law) and clearly indicates that any attempts to hide the truth constitutes a criminal offence.

The term ‘clinical incidents’ is used to describe any event relating to the patient and his or her clinical care which results in harm, or which could have led to harm had the events been allowed to progress. Clinical incidents—actual or potential—must be reported to the institution for assessment so that clinical risks can be identified and reduced. Such clinical incident reporting is not part of a disciplinary process and team members are encouraged to view it as part of a reflective system that supports improvement.

All institutions provide opportunities for patients and families to submit comments and complaints on any aspect of the care they receive. Although complaints can be difficult to receive by the individual or team, it is important to recognise that they may highlight an aspect of care which does not meet the needs of patients and which is not recognised by team members. They should be seen as an opportunity to learn about the impact of practice on the care provided. All hospitals have a Patient Advice and Liaison Service (PALS) which offers confidential advice, support and information on health-related matters to patients and families and can often act as an intermediary in some situations.

Risk management

The process which looks at clinical situations and tries to identify possible problems before they occur. It recognises that in complex care, there are many areas where errors are made and a review of practice aims to break down the process to component elements and identify potential problems. Having identified any areas where the safety of the patient—or staff—could be compromised, it is then possible to introduce checks of, and changes to, practice so as to minimise or remove risks in care.