What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study.

INTRODUCTION: To explore the impact of a three-week downtime to an electronic pathology system on patient safety and experience. METHODS: Qualitative study consisting of semi-structured interviews and a focus group at a large NHS teaching hospital in England. Participants included NHS staff (n = 16) who represented a variety of staff groups (doctors, nurses, healthcare assistants) and board members. Data were collected 2-5 months after the outage and were analysed thematically. RESULTS: We present the implications which the IT breakdown had for both patient safety and patient experience. Whilst there was no actual recorded harm to patients during the crisis, there was strong and divided opinion regarding the potential for a major safety incident to have occurred. Formal guidance existed to assist staff to navigate the outage but there was predominantly a reliance on informal workarounds. Junior clinicians seemed to struggle without access to routine blood test results whilst senior clinicians seemed largely unperturbed. Patient experience was negatively affected due to the extensive wait time for manually processed diagnostic tests, increasing logistical problems for patients. CONCLUSION: The potential negative consequences on patient safety and experience relating to IT failures cannot be underestimated. To minimise risks during times of crisis, clear communication involving all relevant stakeholders, and guidance and management strategies that are agreed upon and communicated to all staff are recommended. To improve patient experience flexible approaches to patient management are suggested.

Exploring prison buprenorphine misuse in the United Kingdom: a qualitative study of former prisoners.

The United Kingdom Ministry of Justice recently highlighted the extent of buprenorphine (Subutex) misuse in English andWelsh prisons, naming it the third most misused drug overall. Yet little is known regarding how illicit buprenorphine is obtained in prison and what influences prisoners to use it. Qualitative research was used to explore prison drug using practices. Thirty men who were former prisoners with a history of injecting drug use were interviewed in depth about their illicit prison drug use, including buprenorphine. Interviews were conducted over 18 months, from August 2006 to January 2008 and were analysed using Framework. The misuse of Subutex by snorting emerged as a significant theme. Accounts suggested that the diversion of prison prescribed Subutex was widespread and prisoners used various tactics to obtain the medication. Various complex and interlinked reasons were given to explain why Subutex was snorted in prison. The main motivation for snorting was to experience a prolonged euphoric opiate effect, believed to help to combat the boredom of being in prison. The price of illicit Subutex in prison was linked to its availability, but it was generally cheaper than heroin, thus contributing to its use. Participants'narratives identified the belief that snorting Subutex in prison was not risk free, but risks were lower than continuing to use other drugs, particularly injecting illicit opiates. The implications of prison Subutex misuse for prisoners, prison medical services, commissioners, and prescribing policy and practice are discussed.

Non-commercial clinical trials of a medicinal product: can they survive the current process of research approvals in the UK?

Over recent years, considerable attention has been paid to the National Health Service (NHS) research governance and ethics approvals process in the UK. New regulations mean that approval from the Medicines and Healthcare Products Regulatory Agency (MHRA) is now also needed for conducting all clinical trials. Practical experience of gaining MHRA and sponsorship approval has yet to be described and critically explored in the literature. Our experience, from start to finish, of applying for these four approvals for a multicentre randomised controlled trial of two licensed drugs for opiate detoxification in the prison setting is described here. In addition, the implications of the approvals process for research projects, particularly clinical trials, in terms of time and funding, and also indirect implications for NHS patients are discussed. Inconsistencies are discussed and suggestions that could improve and streamline the overall process are made. The current approvals process could now be hindering non-commercial clinical trials, leading to a loss of important evidence-based medical information.

A comparison of the diagnostic utility of two image receptors for panoramic radiography.

OBJECTIVE: To compare the diagnostic utility of two screen-film systems for panoramic radiography, one based on green and the other on ultraviolet light. MATERIALS AND METHODS: Two hundred consecutive adult patients with teeth in all four quadrants requiring panoramic radiographs were randomly allocated to one of two groups. One group was imaged with OGA L (CEA AB, Strängnäs, Sweden) film using Lanex Regular (Eastman Kodak, Rochester, NY, USA) screens (the Lanex group). The other group was imaged using Ultra-Vision (Dupont UK Limited, Hertfordshire, UK) film and screens (the Ultra-vision group). Two different panoramic machines were used, a Planmeca (Planmeca OY, Helsinki, Finland) and Cranex (Soredex Orion Corporation, Helsinki, Finland). The radiographs were evaluated by two radiographers for overall quality and any faults recorded. Two dental radiologists evaluated the crestal and apical areas of every standing tooth on a 4-point scale. The likelihood of getting a high-quality image with the different films was modelled using logistic regression, adjusting for the radiologist and the area of the tooth being examined. Inter- and intra-examiner agreement was calculated using Kappa and weighted Kappa where appropriate. RESULTS: The radiographers recorded no significant differences in positioning errors between the two groups of film. However, the films produced on the Cranex were less likely to be recorded as excellent. The radiologists' interexaminer agreement for the lower molars and upper incisors was only moderate at best (kappa = 0.56). No significant differences were found between the likelihood of the two types of film providing a high-quality image. Crestal areas were more likely to be scored well than apical areas. CONCLUSION: There were no differences in ease of discerning apical and crestal areas between the two screen-film systems. There was only poor to moderate agreement between the two radiologists. Ultra-Vision can be recommended as an alternative to existing rare earth systems for panoramic radiography.