In this issue of BMJ Quality & Safety, Hampton and colleagues report a process evaluation of an intervention trial intended to encourage older patients’ involvement in their hospital care.1

The logic of the intervention, Your Care Needs You (YCNY), was that more patient involvement in aspects of care in hospital will carry over to home after discharge, preventing avoidable repeat admissions. YCNY was described as a ‘hybrid’ intervention. Ward-level staff were obliged to deliver ‘fixed’ components—a booklet, and advice sheet and a video. But they were also invited to design and deliver ‘flexible’ components, that is, any other components that the ward team thought would also encourage patients to take part in the selected aspects of their care (some examples were offered by the investigators). One of their eight wards went all in, embracing the challenge of designing flexible components. But the others chose differently, keeping with...

The last 5 years have seen a rapid growth in research applying artificial intelligence or machine learning to improve the quality and safety of healthcare. This coincides with the release of web interfaces (such as ChatGPT from OpenAI and Copilot from Microsoft) that have enabled the general public (including health professionals and researchers) to easily access the latest generation of large language models (LLMs).

LLMs have fundamentally changed how machine learning is used across domains. Unlike previous generation systems that required careful data curation for specific tasks before training, modern LLMs work well with just a few examples or a simple problem description. This progress is mainly due to training on large volumes of web data that allows them to develop an ‘understanding’ of both language and general knowledge which they can then apply to a wide range of tasks.1

To fully comprehend the capabilities and associated...

Performance problems among healthcare professionals can have significant implications for patient safety. Estimates suggest approximately 6–12% of physicians experience performance issues,1 while about one in three healthcare professionals report encountering a poorly performing colleague within the past year.2 Performance problems can arise from individual-level causes including physical illness, substance use disorders, cognitive impairment, mood or personality disorders, and failure to acquire or maintain the knowledge and skills necessary to safely carry out their responsibilities.3 Furthermore, broader systemic issues, including excessive workloads, inadequate resources, lack of institutional support and poor workplace culture, can contribute to or exacerbate performance problems.4 The performance of healthcare professionals is generally evaluated against a set of standards or core competencies of a particular profession that commonly require health professionals to maintain the knowledge, procedural proficiencies, communication skills and professionalism to effectively care for patients. Deficiencies in any...

Background

Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing practical and coordinated strategies for managing under pressure.

Methods

We conducted qualitative semi-structured interviews with 20 senior multidisciplinary healthcare professionals from intensive care units (ICUs) in 4 major hospitals in the UK. The interviews explored the everyday pressures faced by intensive care staff and the strategies they use to adapt. A thematic template analysis approach was used to analyse the data based on our previously empirically developed taxonomy of pressures and strategies.

Results

The principal source of pressure described was a shortage of staff with the necessary skills and experience to care for the increased numbers and complexity of patients which, in turn, increased staff workload and reduced patient flow. Strategies were categorised into anticipatory (in advance of anticipated pressures) and on the day. The dynamic and unpredictable demands on ICUs meant that strategies were mostly deployed on the day, most commonly by flexing staff, prioritisation of patients and tasks and increasing modes of communication and support.

Conclusions

ICU staff use a wide variety of adaptive strategies at times of pressure to minimise risk and maintain a reasonable standard of care for patients. These findings provide the foundation for a portfolio of strategies, which can be flexibly employed when under pressure. There is considerable potential for training clinical leaders and teams in the effective use of adaptive strategies.

Collegeville, Pennsylvania, Provepharm Inc. is voluntarily recalling lot number 24020027; Expiry Date December 2025 of Phenylephrine hydrochloride Injection, USP, 10 mg/ mL (Pharmacy Bulk Package) at the hospital/institutional level. This recall was initiated based on a customer complaint from a pha

The FDA is warning about the risk of a rare but serious allergic reaction with the medicine glatiramer acetate (Copaxone, Glatopa), which is used to treat patients with multiple sclerosis (MS). This serious allergic reaction, called anaphylaxis, can occur at any time while on treatment, after the fi

Max Mobility/Permobil has initiated a nationwide recall of the Speed Control Dial component used with the SmartDrive MX2+ Power Assist Device due to potential safety and performance concerns.

This communication is part of the Communications Pilot to Enhance the Medical Device Recall Program

The FDA issued an update on the recommendations about the potential for exposure to airborne chemicals from neonatal incubators.

HemoPro EVH Systems have updated instructions related to bent/detached heater wires and peeling/detaching silicone during minimally invasive surgery.

Philips Monitoring Service Application processes mobile cardiac telemetry data but failed to send critical data for review by healthcare professionals.

FDA Requires Guillain-Barré Syndrome (GBS) Warning in the Prescribing Information for RSV Vaccines Abrysvo and Arexvy: FDA Safety Communication

This communication is part of the Communications Pilot to Enhance the Medical Device Recall Program

This communication is part of the Communications Pilot to Enhance the Medical Device Recall Program

This communication is part of the Communications Pilot to Enhance the Medical Device Recall Program

Astellas Pharma US, Inc. (Head of US Commercial: Michael Petroutsas, "Astellas") is voluntarily recalling one lot of PROGRAF® 0.5mg (tacrolimus) and one lot of ASTAGRAF XL® 0.5mg (tacrolimus extended-release) capsules to the consumer level. These products are being recalled because bottles may conta

This communication is part of the Communications Pilot to Enhance the Medical Device Recall Program

Fort Worth, Texas. Alcon Laboratories is voluntarily recalling one (1) lot of Systane Lubricant Eye Drops Ultra PF, Single Vials On-the-Go, 25 count (Lot 10101) to the consumer level. Alcon evaluated a consumer complaint of foreign material observed inside a sealed single use vial and determined th

Some CSB batteries intended for use with Plum 360, A+ or A+3 infusion pumps may be counterfeit and are not validated for use in these pumps.

Endo, Inc (OTCQX: NDOI) (“Endo”), announced today that one of its operating subsidiaries, Endo USA, Inc., is voluntarily recalling all lots within expiry of Adrenalin® Chloride Solution (EPINEPHrine nasal solution, USP) 30mg/30mL (1mg/mL) 30 mL vials, to the consumer level. This product, which pre-d