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(2) STUDY
HIGHLIGHTS DISCRIMINATION IN NHS
AWARD SCHEME
(3) DOCTORS
SHOW HIGHER LEVELS OF
PSYCHOLOGICAL
PROBLEMS THAN OTHER
PROFESSIONS
(4) NHS PERFORMANCE INDICATORS IGNORE
(1) ERRORS OCCUR
IN HALF OF INTRAVENOUS
DRUG DOSES
(Ethnographic study of incidence
and severity of
intravenous drug errors)
http://bmj.com/cgi/content/full/326/7391/684
Errors in preparing and administering intravenous
drugs
remain a concern in the United Kingdom,
say
researchers in this week's BMJ.
Data were collected on the number, type,
and clinical
importance of errors in the preparation
and
administration of intravenous drugs over
6-10
consecutive days on 10 wards in two UK
hospitals. A
total of 1,042 doses were prescribed for
106 patients
during the study.
Errors occurred in almost half of the intravenous
drug
doses. Preparation errors occurred in
32 doses (7%),
administration errors in 155 doses (36%),
and both
types of error in 25 doses (6%). Errors
were potentially
harmful in about a third of cases.
The most common errors were giving concentrated
(bolus) doses too quickly and mistakes
in preparing
drugs that required multiple steps.
A combination of reducing the amount of
preparation on
the ward, staff training, and technology
to administer
slow bolus doses would probably have the
greatest
effect on error rates, conclude the authors.
Contacts:
Katja Taxis, Assistant Professor in Pharmacy,
Pharmaceutical Institute, University of
Tübingen,
Germany
Email: katja.taxis@uni-tuebingen.de
Nick Barber, Professor of the Practice
of Pharmacy,
The School of Pharmacy, University of
London, UK
Email: nick.barber@ams1.ulsop.ac.uk
(2) STUDY HIGHLIGHTS
DISCRIMINATION IN NHS
AWARD SCHEME
(Discrimination in the discretionary
points award scheme:
comparison of white and non-white
consultants and men
with women)
http://bmj.com/cgi/content/full/326/7391/687
Non-white and female consultants may be
disadvantaged
under the discretionary points award scheme
? one of
the main mechanisms for rewarding consultants
beyond
their basic salaries in England, Wales,
and Scotland,
finds a study in this week's BMJ.
Using data from the Advisory Committee
on Distinction
Awards for England and Wales and the Scottish
Advisory Committee on Distinction Awards,
researchers
compared the proportion of consultants
with
discretionary points between white and
non-white
consultants and between men and women.
In England and Wales, white consultants
had 1.37 times
as many awards as non-white consultants,
and men had
1.25 times as many as women. In Scotland
the ratios
were 1.34 and 1.36. The ratios increased
with increasing
level of award.
Non-white consultants are older when appointed,
so
their period of eligibility for discretionary
awards is less
than for white consultants. Non-white
consultants may
also be concentrated in specialties which
are less likely
to receive awards, explain the authors.
The reason for differences in the number
of points
awarded to men and women is unclear, but
differences
could be due to discrimination, they add.
Points are awarded by local decision making
groups
whose deliberations are not usually open
to scrutiny.
Without effective monitoring, it is impossible
to judge
whether the scheme is operated fairly
and without
discrimination, they conclude.
Having accepted that "institutional racism"
exists in the
NHS, the government has committed itself
to eliminating
bias and outmoded working practices as
part of its
modernisation programme, writes James
Raftery in an
accompanying editorial. As a result, distinction
awards
and discretionary points are to be replaced
by a new
NHS Clinical Excellence Awards scheme.
Contacts:
Paper: Aneez Esmail, President, Medical
Practitioners
Union, London, UK
Email: aneez.esmail@man.ac.uk
Editorial: James Raftery, Director, Health
Services
Management Centre, Birmingham, UK
Email: j.p.raftery@bham.ac.uk
(3) DOCTORS SHOW
HIGHER LEVELS OF
PSYCHOLOGICAL PROBLEMS THAN OTHER
PROFESSIONS
(BMJ Careers: How many doctors are
sick?)
http://bmj.com/cgi/content/full/326/7391/s97
Doctors exhibit higher levels of psychological
disturbance than people in equivalent
professional
occupations, finds a study in this week's
BMJ Careers.
Researchers tried to establish the size
and nature of
mental ill health among UK doctors using
several
methods, such as performing a literature
review on sick
doctors, reviewing policy documents from
the
Department of Health and the General Medical
Council,
reviewing evidence, and attending conferences.
They found that health problems ranged
from anxiety
through emotional exhaustion to clinical
depression,
substance misuse, and suicide. Depression,
alcoholism,
and anxiety disorders were the most common.
Furthermore, a poor organisational culture
within heath
services means that doctors are often
reluctant to seek
help.
Studies by the Nuffield Trust have identified
the major
factors for psychological disturbance
in junior to senior
grades as the long hours worked, the high
workload, the
pressure of work, and their effect on
doctors' personal
lives.
A mental health needs assessment should
be conducted
urgently across the profession, not just
those doctors
who are already seeking help, say the
authors. A health
impact assessment should also be undertaken
to build an
evidence base for acceptable, responsive,
and effective
services.
"We owe a duty of care to our colleagues.
At present
we are letting them down," they conclude.
Contacts:
Judith Stanton, Consultant in Public Health
Medicine,
Brent Primary Care Trust, Wembley Centre
for Health
and Care, Wembley, UK
Email: judith.stanton@brentpct.nhs.uk
Woody Caan, Professor of Public Health,
Public and
Family Health, Anglia Polytechnic University,
Chelmsford, UK
Email: a.w.caan@apu.ac.uk
(4) NHS PERFORMANCE
INDICATORS IGNORE
PATIENT OPINION
(Letter: Empowerment of patients±fact
or fiction?)
http://bmj.com/cgi/content/full/326/7391/710
The current obsession with improving performance,
such
as waiting times, could result in changes
that are
unpopular with patients, according to
a letter in this
week's BMJ.
Doctors at Bristol Royal Infirmary were
asked to
reorganise their busy orthopaedic clinic
to minimise
waiting room times and maximise patient
throughput.
Before the reorganisation, 172 patients
were asked
whether they preferred a clinic that allowed
a longer
consultation, even if this meant longer
waiting times
(option a) or they preferred a clinic
that ran to time, even
if this meant their consultation was strictly
limited to the
allocated time (option b).
More than two-thirds (68%) of patients
preferred option
a, whereas 28% preferred option b and
4% did not
know. During the survey, only 38% of patients
were
seen within 30 minutes of their appointment
time; the
average wait was 55 minutes.
This survey shows that the desire to influence
performance indicators could result in
changes that are
unpopular with patients, say the authors.
Being slaves to
crude measures of performance, such as
waiting times,
risks a negative effect on what is not
measured, such as
the quality of the consultation.
"We as doctors must defend attempts to
erode aspects
of clinical services that are important
to patients but do
not feature on hospital league tables.
Empowerment of
patients, while laudable in principle,
seems to be nothing
more than hot air when hospital performance
stars are at
stake," they conclude.
Contact:
Ian Learmonth, Professor of Orthopaedic
Surgery,
Bristol Royal Infirmary, Bristol, UK
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