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Is this the profile of a healthcare radical or a troublemaker?

October 12, 2017 By Steve Turner

Steve Turner career and experience:

I began my professional career as a nurse in 1984, eventually specialising in mental health.

I spent a decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the U.S. arm of the company.

In 1999 I returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger. A spell in consultancy for a large Cancer Network followed, by leading two highly successful multi-organisational projects.

More recently I have led a successful interdisciplinary, multi-organisational prescribing project and the development of a parent held medicines record for children with complex conditions. My Associates and I have also developed, and successfully piloted, ‘patient led clinical medicines reviews’.

In 2015, after a difficult whistleblowing experience, I founded the Turn Up The Volume! movement and speak out for patient safety through transparency, values based leadership and a just culture. (www.tutv.org.uk).

We have held two successful national events, bringing together people from all areas in an atmosphere of trust and learning.


Steve is a nurse prescriber, Head of Medicines and Prescribing for @MedicineGov , Associate Lecturer at Plymouth University  and former NICE Medicines and Prescribing Programme Associate.

You can follow Steve’s tweets @MedicineGovSte  


 

  • Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator

Steve Turner  RGN; RMN; Ba (Hons); P.G. Dip. Ed.

 

steve@carerightnow.co.uk

Date: 18.11.2019

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Filed Under: Care Right Now, Children Health, Elderly care, Leadership in Health, Medicines Optimisation, NHS, NICE, Organisational Culture, Prescribing, Substance Misuse, Transparency, Uncategorized, whistleblowing, Workshops

Changing mindsets and delivering safe care in Cornwall together. #devocornwall

March 20, 2017 By Steve Turner

We want the best health care system in the world, & the most efficient and effective system …

We have an opportunity to do things differently in Cornwall

How do we achieve this?

 

The challenges in Cornwall

There’s a huge amount going on with health and social care in Cornwall. Including the Sustainability and Transformation Plan [STP]; exposure of abuse and neglect in care homes; concerns over hospital closures, delayed discharges taking up hospital beds, and devolution of services on the way.

Although I have worked in health and care for over 30 years, I struggle to keep up with the issues and understand how services are organised.  This isn’t helped by the current polarisation of views.

On the one hand we have a big dose of NHS and Council ‘spin’, excessive bureaucracy and even bullying. On the other hand we have public concern, often expressed around specific issues, and sometimes based on unfounded rumours.

Neither of these positions are helpful, and neither represent the vast majority of people (public, staff and patients) who just want good services delivered by kind people who are open, accountable and transparent.

#devocornwall

We have a great opportunity now with the devolution of health and care services. This will be realised if we all build bridges, and transcend the usual hierarchical boundaries. We all need to listen and learn. Everyone, to coin an overused phrase, needs to step out of their comfort zones.

Why we need to think differently?

Several community hospitals are under threat of closure, leading to anger and dominating the headlines. Less attention is given to identifying and measuring the benefits, and any disadvantages of community hospitals. For example, can they be staffed adequately, bearing in mind this means Doctors, Nurses, Physiotherapists, Radiographers, Dieticians, Speech and Language Therapists, Social Workers etc.? Is home care a viable option for patients and carers?  Are there any creative options such as bringing back the old style ‘convalescence’? Is rural isolation and lack of public transport the major issue?

It’s becoming increasingly difficult to book a timely GP consultation. This has led to several inaccurate scare stories in the press about ‘cuts’ to face to face GP contacts. This needs deep thought as there are times when easy access to a GP on the ‘phone, or on-line, may actually be a better option. Access to health information from Community Pharmacies or in NHS run clinics in shopping centres, or better health information and advice available locally, may be more effective approach. Leaving GPs free to spend more time with those who need their help and expertise most.

It’s now widely accepted that the NHS and Social Care is underfunded. Despite this there is still a great deal of duplication and waste in the system. How many times have you been asked to repeat information to Health Professionals which others already have? Do some services overlap, and are there gaps? Do different organisations link seamlessly with other organisations? Are all services accessible to all? Many people have important stories to tell on these areas of inefficiency.

Now’s the time to talk about this, find out what’s planned, and take action together. ‘Patient engagement’ key component of the STP and #devcornwall.

Patients and public need to take the lead on this. It’s not the NHS or Cornwall Council’s plan it’s ours.

Personal views of Steve Turner. MD Care Right Now CIC, a Cornish Company

Version 2

Date: 30/03/2017

This article is adapted from a letter which fist appeared in the St Austell Voice

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Filed Under: Care Homes, Care Right Now, Children Health, CIC, Elderly care, Human Factors, Jargon Buster, Leadership in Health, Medicines Optimisation, NHS, Organisational Culture, Transparency, Uncategorized, whistleblowing

Meds Information UK

February 22, 2016 By Steve Turner

Engagement at Care Right Now

Some sources of information on medicines

This resource page is to help you to find helpful information on diagnosis, treatments and the medicines that you are prescribed, from trusted sources. (Don’t forget your health practitioner and Pharmacist will be able to recommend information, particularly for specific conditions such as diabetes or asthma). This is a guide only, not a definitive list.

patient.co.uk (symptom checker) Electronic Medicines Compendium
Medicines for Children Head Meds (mental helath medication)
Choice and Medication (mental health) to access this in your area  see below.
NHS App

You can also download the British National Formulary [BNF] App for free:

Google play link: https://play.google.com/store/apps/details?id=com.pharmpress.bnf&hl=en_GB

iTunes link: https://itunes.apple.com/gb/app/bnf-publications/id1045514038?mt=8


Some notes on these links:

  • *Choice and medication (mental health medicines)  Really helpful information on mental health medicines. Used by doctors and patients. Trusts who have signed up to this are listed on the right hand side. Usually their web site will give you the link, Click here for the Cornwall Link.          Click here for the Lanarkshire Link (Scotland)
  • Electronic medicines compendium  Look for the Patient information leaflets [PILs], they give you an idea how common the side effects are.

Other useful sites:

  • NAM aidsmap ‘HIV & AIDS sharing knowledge changing lives’

Want to keep a record of all your medicines?

  • My Medication Passport

Author: Steve Turner Head of Medicines & Prescribing @MedicineGov 

Steve tweets as @MedicineGovSte

Last updated: 15.08.2019


External content:

This page includes external websites. We do not link to external sites in return for cash, services or any other consideration in kind.

These links are being provided as a convenience and for informational purposes only. The author bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.


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Filed Under: 'QuickKLINKS', Children Health, Medicines, MEDSINFO

Children’s medicines – how listening to parents led to safer care

August 22, 2015 By Steve Turner

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Case Study:

Background:
From 2008 to 2014 my company ran education sessions on managing medicines in a mental health trust. In common with some other mental health trusts the provider also looked after paediatric community services. This is not a mental health service. It covers children with complex health needs including enteral feeding tubes, ventilation; epilepsy and rapidly changing medicines. Children under the care of this service may be taking in excess of 15 different medicines per day, have complex titration regimes, emergency drugs with associated care plans, plus numerous ‘as required’ (prn) medicines.
It is not unusual for children with complex conditions to be under the care of up to five different providers, and to move between three different providers in one day. For example, from a Home Care Service to the Special School, to a Short Break House, maybe also being seen in an Outpatient Clinic on the same day too. As a result parents frequently have to repeat the information on their child’s medicines every time they move to another service, or a new person is involved.

Where to start?
The idea for change came about because of concerns that the staff in Children’s Short Break Houses were not learning what they needed about children’s medicines, as the learning was geared to the majority of staff who worked in mental health. So a new learning package for children’s staff was commissioned.
Part of the work to design the learning package included a baseline assessment which was conducted with parents and staff. This soon revealed that training alone was not the answer. It showed delays in medicines information reaching GPs, workarounds for obtaining information in order to administer medicines in the houses and a general lack of confidence in the whole process.
As a result we looked at the whole system starting with the area where most concerns had been raised, which was having an up to date complete list of a child’s medicines available at all times (medicines reconciliation). The system in place for Short Break Houses involved paying a local GP (not usually from the child’s GP Practice) to write up a medicines chart for each child. The process was fraught with difficulties and delays and widely disliked by everyone directly involved.
So we set about looking for a new way to manage the lists of medicines with more training and more input for the staff in the services involved. We came up with a new (and much more robust) process for medicines reconciliation in the Short Break Houses. This was fully documented in a new policy, and involved cross checking by both the staff and the parents.
Just before this went live, we asked the parents to review and comment on it and they said
‘If you’re producing an accurate and up-to-date list of my child’s medicines, why keep it the Short Break House, can’t it go with my child?’
So the My Medicines chart, which travels with the child, was born.

What was involved?
The My Medicines process led to the design and production of a new chart which has to be signed and checked by the parents.
It resulted in 40 children with complex conditions being offered a hand held paper record of their medicines (produced and validated by clinicians), which they take around with them wherever they go.

Benefits:
The new process, which continues to evolve, means that the child’s GP is now directly involved in day to day medicines reconciliation (they weren’t before); the parents are always asked to check and sign the charts (they weren’t before); verbal messages about medicines are never taken, and incomplete (or missing) directions are rapidly rectified (never worked around).
Some specific benefits of the new process include:
• It has reduced the risks of error, by providing full and accurate information on children’s medicine across their entire pathway.
• It cuts out the need for parents to keep having to repeat what medicines their child is taking to different professionals and care agencies.
• It frees up medical and clinical time which was previously spent chasing missing information.
• It has reduced the number of third part handovers and transcribing of prescription information.
Looking back it’s hard to believe that the old ways of working, which caused so many difficulties (especially for front line staff), were carried out for so long. These risky practices, or similar, are believed to still be commonplace in England.

Revealing hidden incidents and near misses:

In the first month of the project we raised 17 medicines or near misses. Of these 11 related to problems with communication of information across the child’s pathway.
Resolving these has resulted in improved communication and engagement between different clinical groups and providers, and a desire from all quarters to take the project further. Previously many of these incidents were not logged or tracked across organisations. In some cases it was only due to the vigilance of the staff and parents that they were spotted and errors avoided.

Accepting the changes:

The project was well received by parents and staff, and resulted in improved communication and engagement between different clinical groups and providers. This included the Consultant Paediatricians (working for the secondary care provider), who were initially sceptical.
The project was less well received by the relevant medicines and prescribing committees, who were understandably concerned about who owned the My Medicines chart and had agreed its content. Explaining this was made more difficult because it is hard to get across the complexity of the arrangements, due to the critical nature of the children’s illnesses, in a committee setting.
I make no apologies for ensuring from the outset that it was the parents who owned the charts, which were designed by the project team (not a committee) to meet all best practice standards. It always worries me that when it comes to cross- organisational working the formal committees and systems in place can inadvertently act as a barrier to safety rather than promoting it. There is no doubt we had designed a safer process and my company was happy to take accountability for any associated risks.
As a legacy of the project, a Community Paediatric Pharmacist was appointed specifically to work with this group of children. So whatever evolves will now be based on inter-disciplinary thinking and working and will have clear safety parameters. I am grateful to the enlightened thinking of the leaders who commissioned this work and supported this novel approach.

Steve Turner

Managing Director Care Right Now (CIC)

This example is incuded in the NICE Shared Learning resource and was  highly commended in 2015.

Click here for the poster.

Last updated: 15.08.2019

CRNAnimationTestFor more information contact: info@carerightnow.co.uk

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Filed Under: Care Right Now, Children Health, Leadership in Health, Medicines, Medicines Optimisation, NHS, Organisational Culture, Prescribing, Transparency, Uncategorized, Workshops

Pushing the boundaries

May 11, 2015 By Steve Turner

Pushing the boundaries

TwitterProfile

At Care Right Now we love pushing the boundaries. If someone, especially someone in ‘authority’, tells us it’s not possible it just makes us more determined.


 

For info there the latest on our work with people with long term conditions:
https://www.carerightnow.co.uk/condition-management/

…what do attendees on our course say?

‘You should listen to those guys. You will learn something’ April Attendee 2015.

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It’s the power of patients and the public which will drive forward safer and more cost effective care, and this doesn’t need complex jargon or rules, or to be stage managed by existing bodies.

Here’s another example of a successful project which pushed the boundaries:
https://www.carerightnow.co.uk/parent-held-medicine-records/

Oarent Hel record


 

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Author: Steve Turner 11/5/15

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Filed Under: Care Right Now, Children Health, CIC, Human Factors, Jargon Buster, Leadership in Health, Medicines, MEDSINFO, NHS, Organisational Culture, Transparency, whistleblowing

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Looking for reliable sources of information on #medicines (UK)? Includes #Children & #mentalhealth resources & link to download BNF app. carerightnow.co.uk/5… #TeamPatient 💚 #TeamNHS 💙 #MedLearn #prescribing #patients #patientcare #patientsafety #PatientEngagement

About 5 hours ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

👍A 'CLOSED TWITTER GROUP to share/discuss/read all things PATIENT related?'👍 #TeamPatient 💚#patients #patient #patiente #TeamNHS 💙#NMPPU #SOMNMPCPD #share4safety twitter.com/NusratMe…

Yesterday from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

Steve & Sam discuss what they learned as #nurse & service user: spreaker.com/user/ap… #assertive #care #change #collaborative #community #health #holistic #illness #mental #nhs #nursing, #outreach #prescribing #psychiatry, #psychology #respect #MedLearn TY @apospodcast

About 4 days ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

Fantastic to run our first pilot 'My #Medicines' session with @TheFlourishing8 yesterday. Thank you for this opportunity to develop our #patient led work. #MedLearn #TeamPatient 💚 #patients pic.twitter.com/8iDH…

About 5 days ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

Follow @MedicineGovSte

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Sign up here to share best practice tips, and receive short messages, key information and links to help prevent re-inventing the wheel.

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Care Right Now

Company number: 07587531

Registered Office,

Bennett Jones & Co.,

Unit 22, Callywith Gate Industrial Estate,

Launceston Road,

Bodmin, Cornwall,

England, PL31 2RQ

M:07931 919 330

E: info@carerightnow.co.uk

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