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Handling medication is a critical aspect of community nursing, demanding precision, vigilance, and adherence to stringent legal standards. This blog examines the responsibilities of community nurses in administering medication and the legal guidelines they must follow to ensure patient safety and compliance with UK laws. The Role of Community Nurses in Medication Management: Community nurses play a pivotal role in managing medications for patients in their homes or local care settings. Their responsibilities include: Administering Medications:  Ensuring patients receive the correct medications at the right times, in the correct dosages, and via the appropriate routes. Medication Reviews : Conducting regular reviews of patients' medications to assess effectiveness and identify potential issues. Education and Support:  Providing education to patients and carers about medication regimens, potential side effects, and the importance of adherence. Monitoring and Documentation:  Keeping accurate records of all medications administered and monitoring patients for any adverse reactions or interactions. Medication Prescribing:  Some community nurses are qualified as nurse prescribers, allowing them to prescribe medications within their scope of practice. Their responsibilities include assessing patients, diagnosing conditions, and prescribing appropriate medications. Nurse Prescribers: Responsibilities and Legal Framework Nurse prescribers hold additional responsibilities in medication management, including: Assessment and Diagnosis:  Conducting thorough assessments and diagnosing conditions to determine the need for medications. Prescribing Medications:  Issuing prescriptions for medications within their competency and scope of practice, ensuring compliance with relevant laws and guidelines. Monitoring and Follow-Up:  Regularly monitoring patients’ progress and adjusting prescriptions as necessary to ensure optimal therapeutic outcomes. Documentation:  Keeping detailed records of all prescribed medications, including the rationale for prescribing, dosages, and any changes made. Best Practices for Handling Medications: To ensure safe and effective medication management, community nurses should adhere to the following best practices: Double-Check Prescriptions:  Always verify the medication prescription details, including the patient’s name, dosage, and administration instructions. Cross-check with the patient's medical history for any potential contraindications. Use of Technology:  Utilise electronic health records (EHRs) to keep accurate and up-to-date medication records, ensuring easy access and better coordination of care. Patient Identification:  Confirm the patient’s identity before administering any medication to avoid errors. Proper Storage:  Store medications as per guidelines to maintain their efficacy and prevent contamination or misuse. Educate and Communicate:  Clearly explain to patients and their carers how and when to take their medications, potential side effects, and what to do in case of a missed dose. Challenges in Medication Management: Community nurses often face unique challenges when managing medications, including: Complex Medication Regimens:  Managing multiple medications for patients with chronic conditions can be complex and time-consuming. Patient Compliance:  Ensuring patients adhere to their medication regimens, especially those with cognitive impairments or low health literacy. Resource Constraints:  Limited access to resources and support in the community setting compared to a hospital environment. Legal Considerations for Medication Management: Community nurses in the UK must navigate a comprehensive legal framework to ensure their practice remains compliant and patients are protected. Key legal aspects include: Medicines Act 1968:  This act regulates the manufacture and supply of medicines, ensuring they meet safety and efficacy standards. Nurses must ensure they administer medications according to these regulations. The Misuse of Drugs Act 1971:  This act controls the use of drugs that are liable to abuse, setting out strict guidelines for their prescription, storage, and administration. The Human Medicines Regulations 2012:  These regulations provide detailed rules on the authorisation, labelling, and distribution of medicines, with which nurses must comply. Nursing and Midwifery Council (NMC) Guidelines:  The NMC sets out specific standards for medication management, including the need for proper documentation and the administration of medicines. Documentation and Record-Keeping: Accurate documentation is crucial in medication management. Community nurses must maintain detailed records of all medications administered, including: Patient Details:  Name, age, and medical history. Medication Details:  Name of the medication, dosage, route of administration, and timing. Administration Records:  Date and time of administration, and any observations or reactions noted. Signature:  The nurse’s signature to confirm that the medication was administered correctly. These records not only ensure continuity of care but also provide essential evidence in case of any legal scrutiny. Conclusion: Handling medication in community nursing is a complex and critical task that requires meticulous attention to detail and adherence to legal guidelines. By following best practices and staying informed about relevant laws and regulations, community nurses can ensure the safe and effective administration of medications, ultimately enhancing patient outcomes. At Apex Experts, we understand the intricacies involved in community nursing and medication management. Our panel includes expert witnesses who are well-versed in the legal aspects of community nursing, ensuring that the highest standards of care and legal compliance are maintained. We have provided many reports in this area for the consideration of the Court and also regulators.

Introduction:  The Supreme Court's landmark judgments in Paul v Royal Wolverhampton NHS Trust , Polmear v Royal Cornwall Hospitals NHS Trust , and Purchase v Ahmed signal a watershed moment in the legal recognition of psychiatric injury claims within medical negligence, focusing particularly on the experiences of secondary victims. These judgments arise from tragic cases that underscore the profound psychological impact of medical mismanagement on patients' families.   The Appellants' Plight: A Case-by-Case Examination: Each appellant's story is testimony to the psychiatric toll exacted by medical negligence:   In Paul v Royal Wolverhampton NHS Trust , a family grappled with a preventable death due to misdiagnosed cancer, which inflicted deep psychological scars. Polmear v Royal Cornwall Hospitals NHS Trust  involved the negligent treatment of a child, which not only led to a premature death but also left the anguished parents behind. This case probes the ethical and legal obligations of healthcare providers towards a patient's relatives. Purchase v Ahmed  presented the consequences of suboptimal surgical care that escalated to fatal complications, thereby raising questions about the legal system's acknowledgment of a family's suffering in the wake of such tragedy. Evolution of Psychiatric Illness Claims: Landmark Cases:  The historical tapestry of psychiatric injury claims is woven through several pivotal cases, each contributing a distinct thread to the legal fabric:   McLoughlin v O'Brian  first recognised the trauma inflicted on immediate family members who witness or come upon a catastrophic event. Alcock v Chief Constable of South Yorkshire Police  refined these principles, setting the proximity and relationship criteria as key factors in the pattern of claims. Frost v Chief Constable of South Yorkshire Police  stretched the boundaries, testing the fabric in the context of large-scale negligence and the plight of secondary victims.   Secondary Victims in Medical Negligence: A Legal Journey: The trajectory of legal thought regarding secondary victims in medical negligence has been critically shaped by several cases:   Taylor and Somerset laid the groundwork for proximity requirements, emphasising the spatial and temporal dimensions of witnessing harm. Sion examined the aftermath of negligent medical care, bringing into focus the immediate psychological impact on the family. Walters took a broader view of 'immediacy,' recognising the unfolding sequence of events as part of the traumatic experience. Shorter scrutinised the intimate connections that bind primary and secondary victims, acknowledging the shared emotional landscapes. Ronayne establiushed the contours of liability, underscoring the limitations and bounds of legal responsibility in psychiatric injury claims.   Taylor v Novo: A Cornerstone Case: Taylor v Novo (UK) Ltd stands as a cornerstone case, its significance emanating from the exploration of how time intersects with trauma. The Supreme Court's analysis of this case became a lens through which the current cases were viewed, particularly in discerning the intricate relationship between an act of negligence and the resultant psychiatric harm to secondary victims.   Supreme Court's Judgement: Analysis and Implications: The Supreme Court, in a nuanced judgement, affirmed that while the shock from medical negligence could indeed be profound, the legal duty of care does not extend indefinitely. Through careful consideration of legal precedents, the Court delineated the scope of duty, highlighting the importance of a direct and immediate perception of harm. The Justices emphasised that the law guards against an overextension that could make the practice of medicine untenably burdensome.   Conclusion  The rulings in Paul, Polmear, and Purchase (combined) have set pivotal legal precedents, underscoring the need for a delicate balance between the acknowledgment of psychiatric harm and the practicalities of healthcare provision.  While the general principle remains that the doctor patient relationship does not involve the doctor taking on responsibility for the health of the patient’s family, these judgments serve as pointers for future cases, guiding the legal and medical professionals alike in navigating the intricate and often emotionally charged domain of medical negligence.

Are you a nurse working in the healthcare sector within the UK? Did you know that you could become an expert witness? If you are interested in some extra income, this article contains everything you need to know about how you can become an expert witness. Expert witnesses are those at the head of their field, who have years of experience in their industry. Expert witnesses in nursing are asked to produce reports often dealing with issues of breach of duty and causation. What Does an Expert Witness Do? As an expert witness, you would primarily produce reports dealing with issues of breach of duty and causation. These reports are based on the evidence provided to you, and should offer a balanced and unbiased view of the case.  Your reports will be used as evidence, helping solicitors to decide if claims have merit. As an expert on our panel, we handle all of the admin work for you. We communicate with clients for you, allowing you to focus on writing reports. If you have any problems, or need anything at all, we are always happy to provide support and help in any way we can. You will be required to consider whether each case is within your area of expertise and ensure that you have no conflict of interest. Your report should offer a balanced view of the case, based on the evidence provided and your own experience. We will support you throughout the whole process. Will You Get Paid For Your Work As An Expert Witness? As an expert witness you will be paid not only for writing the report itself, but reviewing the records provided to you, further work that may be requested of you and for attending any teleconferences or remote meetings. At Apex Health Associates, we pride ourselves on always paying our experts within 30 days, no matter what. What Type Of Nurse Can Become An Expert Witness? Expert witnesses from all areas of healthcare are in demand, from midwives and occupational therapists to mental health nurses and tissue viability nurses. At Apex Health Associates, our current panel contains a wide variety of specialisations, but we are always looking to expand on this. Are There Any Requirements To Become An Expert Witness? To become an expert witness, you will need to meet certain criteria: You must have at least a decade of experience in your area of specialisation You must have achieved at least a band 7 in your field. If you have not previously worked as an expert witness, you may be asked to undertake some training provided by Apex Health Associates. Do You Need To Complete Any Training? If you have never worked as an expert witness before, you may be asked to undertake some training provided by Apex Health Associates. This training will help you to develop your skills and ensure that you have all the support you need to produce reports. Our training programme is completely online so you can complete the material at your own pace. Become an Expert Witness in the UK If you are interested in joining our panel of experts, or have any questions, we would love to hear from you, so please do get in touch today ! Further Information: Crown Prosecution Service  Notes on Expert Witnesses The UK Government website’s information for Expert Witnesses in Legal Aid Cases The Crown Office and Procurator Fiscal Service Expert Witness Guide Apex Health Blog

What is Clinical Negligence Law? When you visit a doctor, hospital, or any other healthcare professional, you expect to receive proper care and treatment. Most of the time, this is exactly what happens. However, there are instances where the care falls below an acceptable standard, and as a result, you suffer harm. When this occurs, it may be considered clinical negligence. Clinical negligence law (also referred to as medical negligence law ) is the area of law that deals with these situations. It allows patients who have been harmed by substandard medical care to seek compensation for their injuries and losses. The purpose of clinical negligence law is to ensure that individuals who suffer due to negligent healthcare are compensated fairly to help them recover or manage their condition and any financial losses. If you believe you have suffered due to clinical negligence, it is important to understand the legal process involved in making a claim, as well as what needs to be proven to succeed in your case. What is Clinical (or Medical) Negligence? Clinical negligence happens when a healthcare provider—whether it’s a doctor, nurse, surgeon, dentist, or another medical professional—fails to provide care that meets the expected standard, resulting in injury or worsening of the patient’s condition. Some examples of clinical negligence include: Misdiagnosis  or delayed diagnosis of a condition. Surgical errors , such as performing the wrong procedure or leaving an object inside the patient. Medication mistakes , such as prescribing the wrong drug or incorrect dosage. F ailure to obtain informed consent , where the risks of treatment were not properly explained to the patient. Inadequate follow-up care , leading to complications or delayed recovery. To successfully claim compensation, there are several elements that must be proven in a clinical negligence case. The Key Elements to Prove in a Clinical Negligence Claim To win a clinical negligence claim, you must prove (on the balance of probability) that the healthcare provider was legally responsible for your injury or condition. There are four key components that must be established: Duty of Care, Breach of Duty, Causation, and Damage . Here’s a closer look at each element: 1. Duty of Care Every healthcare professional has a duty of care towards their patients. This means they are legally obligated to provide care that meets a certain standard, which is expected of a reasonable and competent professional in their field. When you are treated by a doctor, nurse, or any medical professional, this duty of care is automatically established. 2. Breach of Duty Once a duty of care has been confirmed, the next step is to prove that the healthcare provider breached that duty. Essentially, did they fail to meet the expected standard of care? This could be through an action or a failure to act when appropriate. To establish this, expert medical evidence is typically required. Independent medical experts will review the details of your case to determine if the care you received was below the standard expected of a reasonable professional in similar circumstances. 3. Causation Even if you can show that the healthcare provider breached their duty of care, you must also prove that this breach directly caused you harm. This is known as causation . Causation can be challenging to prove because it requires demonstrating that your injury or worsened condition was a direct result of the healthcare provider’s negligence. For example, if a mistake was made during surgery, you must show that this mistake directly caused the harm you’re claiming, rather than the harm being due to the progression of your underlying condition. 4. Damage Finally, you need to show that the breach of duty caused you specific harm or damage. This could include physical injury, ment al distress, or financial losses. For instance, if you were unable to work due to the negligence or required further medical treatment, you may be entitled to claim compensation for these losses. Compensation in clinical negligence claims can cover various types of damage, including: Pain and suffering caused by the injury or illness. The cost of any additional medical treatment or rehabilitation needed. Loss of earnings if you’ve had to take time off work. The cost of care or assistance if you need support with daily tasks. Adaptations to your home if required to accommodate your injury. How the Claim Process Works If you believe you have suffered from clinical negligence, it’s essential to seek professional legal advice as soon as possible. Here’s an overview of how the claim process generally works: 1. Initial Consultation At the outset, you will have an initial consultation with a legal professional who specialises in clinical negligence. During this meeting, they will listen to your experience, review your medical records, and offer advice on whether there may be grounds for a claim. This consultation is often free, and you are under no obligation to proceed unless you wish to. 2. Investigation If the claim goes forward, the next step involves gathering evidence. This will typically include obtaining your medical records and seeking expert medical opinions. Independent medical experts will review your treatment to determine whether the care you received fell below an acceptable standard and whether it directly caused your injury. 3. Letter of Claim Once sufficient evidence has been collected, your solicitor will draft a Letter of Claim. This is a formal letter that outlines the details of your case, including what went wrong, how it has affected you, and the compensation you are seeking. This letter is sent to the healthcare provider or their legal representatives. 4. Response from the Defendant The healthcare provider or their legal team will usually respond within a set timeframe, typically around four months. They will either admit or deny responsibility. If they admit to the negligence, discussions around compensation can begin. If they deny it, further evidence may need to be gathered, and the case could proceed to court. 5. Negotiations and Settlement In many cases, clinical negligence claims are settled without the need to go to court. If liability is admitted or a settlement offer is made, negotiations will take place to ensure you receive fair compensation. However, if an agreement cannot be reached, your case may proceed to trial, where a judge will make the final decision. 6. Court Proceedings If the case does go to court, it can take some time to arrange a hearing. During this stage, your legal team will work with barristers and expert witnesses to present your case. However, it’s worth noting that most claims settle before reaching trial, and your solicitor will aim to resolve the matter as quickly and effectively as possible. Time Limits for Making a Claim In England and Wales, there are strict time limits for bringing a clinical negligence claim. Generally, you have three years  from the date of the negligent act or from when you became aware that the negligence caused your injury (known as the "date of knowledge"). There are exceptions, for example, if the patient is a child or lacks mental capacity, but it’s always advisable to seek legal advice as soon as possible. How We Can Help You Find the Right Legal Support As an expert witness practice specialising in clinical negligence, we work closely with many expert solicitors who specialise in this area of law. We understand that navigating a clinical negligence claim can be daunting, and we are here to help you find the right legal support to guide you through the process. If you believe you may have a clinical negligence claim, you can provide us with your details, and we will be more than happy to connect you with one of the highly experienced solicitors we work with. We only refer clients to solicitors who have a proven track record in handling clinical negligence claims, ensuring you receive the best possible representation. Please note that we do not charge any fees for this service, nor do we receive any payments from the solicitors we recommend. Our goal is simply to help you find the right legal assistance to pursue your claim. Final Thoughts If you or someone you care about has suffered as a result of substandard medical care, you may be entitled to compensation. Understanding your rights and exploring your options can be a key step in your recovery journey. We are here to offer expert guidance and to help you connect with solicitors who are specialists in clinical negligence law. If you would like to discuss your situation or simply find out more about the claim process, please don’t hesitate to get in touch with us. Your well-being is our priority, and we’re committed to helping you find the legal support you need.

Mr Scott Harding-Lister Head of practice at Apex Health Associates, Scott Harding-Lister is a trained Nurse, a non-practising solicitor and an experienced expert witness. In an earlier blog post, we scrutinised the intricacies of iron extravasation and provided general guidance on its avoidance. Here we direct our focus towards the injuries witnessed in our capacity as nursing experts when consulted on such cases, particularly concerning matters of liability, causation, and care (quantum). While iron extravasation may not be a commonplace injury, our extensive expertise in this domain equips us to offer insights into its ramifications. Physical Staining If the iron solution seeps into tissues beyond the vascular space, it results in the permanent staining of affected tissues. The discolouration may manifest as a discreet stain around the cannula site or extend to encompass an entire limb. Regrettably, our experience indicates that this staining tends to be irreversible, with the customary recourse being the application of camouflage makeup. It is advisable to promptly seek the opinion of plastic surgeons following such an incident for specialist support. Credit: Sage Journal, Link via Sage Journal Psychological Injury: The Long-Term Struggle Our role as expert witnesses has highlighted a significant psychological toll experienced by many patients affected by iron extravasation. The psychological aftermath of such an event constitutes an enduring struggle, affecting the mental health of those affected. Anxiety and Fear of Medical Procedures: Iron extravasation may render medical environments a source of anxiety and fear for affected individuals. The trauma associated with scarring induces a persistent fear of medical procedures, casting a shadow over future treatments. Routine medical check-ups, once benign, can undergo a transformation into anxiety-inducing experiences. Body Image Concerns: The visible staining left by iron extravasation can extend beyond physical issues to profound body image concerns. Individuals may grapple with heightened self-consciousness about their appearance, resulting in a negative impact on mental health and overall well-being. Social situations may be avoided, and participation in activities curtailed, contributing to a pervasive sense of isolation. Trust Issues: Iron extravasation incidents can fracture the trust between patients and healthcare providers, sowing seeds of doubt regarding the competence of the medical team. Rebuilding this trust becomes an intricate part of the psychological healing process, necessitating open communication and reassurance. Post-Traumatic Stress Disorder (PTSD): In severe cases, the psychological impact of iron extravasation can escalate to post-traumatic stress disorder (PTSD). Persistent flashbacks, nightmares, and heightened anxiety related to the traumatic event endure long after the physical injuries have occurred. The emotional scars may be as enduring as the physical ones, requiring specialised psychological support, counselling, and intervention. Depression and Social Withdrawal: The emotional toll of iron extravasation may precipitate depression and social withdrawal. Individuals may grapple with feelings of sadness, hopelessness and isolation, complicating their journey towards recovery. Addressing these emotional aspects is integral to holistic patient care. Conclusion Iron extravasation, often relegated to the periphery in discussions about medical complications, can bring about a lasting psychological impact on affected individuals. Recognition of potential psychological injuries, spanning from anxiety to PTSD, is indispensable for both healthcare providers and patients. By implementing preventive measures, early intervention, and offering comprehensive psychological support, we can work towards mitigating the psychological consequences of iron extravasation. In my professional opinion, it is imperative that patients are adequately informed about the risks of extravasation before receiving iron preparations (case law – Montgomery). Should an extravasation occur, routine referral to plastic surgeons for specialist advice and input is advisable, with a low threshold for involving psychological colleagues in the care pathway. Apex Health Associates has a team of general nurses who are all experienced experts at dealing with these types of cases. As Head of Practice I have personal interest in this subject and have assisted both Claimant and Defendants by providing an opinion as to the standard of care.

In our ongoing exploration of clinical risk assessment models, we now turn our attention to the PURPOSE-T framework. Arising from a major international research project initiated around 2009, PURPOSE-T has shaped the landscape of pressure ulcer risk assessment since its release in 2014. Backed by approximately £2 million in funding from the National Institute for Health and Care Research, the model is now extensively adopted across the UK.   Pressure ulcers, also known as bedsores, pose a formidable challenge within healthcare settings, necessitating unwavering diligence and strategic intervention. Far from being mere indicators of discomfort, they profoundly impact patient outcomes and healthcare economics, serving as benchmarks for care quality.   Understanding PURPOSE-T PURPOSE-T sits at the heart of a pressure ulcer risk assessment framework (PURAF), developed to identify adults susceptible to developing pressure ulcers and classify preventive measures into primary or secondary actions. This critical distinction equips healthcare professionals with the means to craft bespoke interventions, preventing ulcers in at-risk individuals and managing existing ones with greater efficacy.   The formulation of PURPOSE-T ensued from an extensive collaborative effort, including systematic reviews, consensus studies, conceptual framework creation, and comprehensive clinical evaluations. This rigorous development cycle ensures that PURPOSE-T stands on a foundation of robust evidence, tuned to the nuances of clinical practice.   It's important to note that older pressure sore risk assessments previously discussed have often faced criticism for insufficient research and evidence basis.   The Mechanics of PURPOSE-T The operationalisation of PURPOSE-T is streamlined into a three-step procedure, optimised for utmost efficiency and effectiveness: Screening: The initial phase zeroes in on at-risk patients, examining mobility status, skin condition, and employing clinical judgement to factor in any treatments or conditions that might influence risk levels. This step judiciously allocates resources, sparing comprehensive evaluations for those most in need. Full Assessment: Individuals flagged during screening undergo a detailed assessment, analysing a range of factors like independent movement, sensory perception, nutrition, and skin integrity. This creates a layered risk profile, pivotal for informed decision-making. Assessment Decision: The process culminates in establishing an apt prevention strategy, based on the assessment. A colour-coded system helps classify patients into categories for primary prevention, secondary prevention, or those not currently at risk, ensuring tailored and effective care plans.   Why PURPOSE-T Stands Out? The impact of PURPOSE-T on pressure ulcer prevention is immense. Its methodical process yields several benefits: Customised Prevention Strategies: PURPOSE-T's intricate patient risk profiles enable the creation of specific prevention strategies for individual needs. Evidence-based Foundation: Grounded in rigorous research and clinical trials, PURPOSE-T's relevance and effectiveness align with the demands of real-world healthcare. Efficient Use of Resources: By structuring the assessment process, only those who need thorough evaluations receive them, leading to optimised resource allocation. Enhanced Patient Outcomes: Focusing on targeted prevention and management, PURPOSE-T could significantly curtail the prevalence of pressure ulcers, enhancing patient experiences and reducing healthcare costs.   Implementing PURPOSE-T in Clinical Practice Integrating PURPOSE-T into daily clinical practice requires dedication to training and education. It's essential that healthcare professionals are well-versed in the tool's theoretical background, proficient in the assessment procedures, and adept at interpreting and acting on the outcomes. Interdisciplinary collaboration is key, with nurses, physicians, and other medical staff working in concert to embed the PURPOSE-T framework into the patient care continuum.   The mere introduction of PURPOSE-T is likely to spotlight pressure injury prevention, bringing it to the fore of healthcare priorities and potentially reducing the incidence of such injuries.   Looking Ahead The PURPOSE-T framework heralds a substantial leap forward in the realm of pressure ulcer prevention. Its all-encompassing, evidence-based approach not only raises the bar for patient care but also underscores the critical nature of individualised and proactive interventions. As the healthcare community embraces and hones tools like PURPOSE-T , the enhancement of patient safety and care quality seems not just achievable but imminent.Elevating Patient Care: A Comprehensive Guide to the PURPOSE-T Framework for Pressure Ulcer Prevention Author Scott Harding-Lister Scott is a qualified nurse and solicitor. He was a senior nurse within the NHS before leaving to pursue a career as a solicitor in City practices. In 2013 he set up Apex Health Associates and the expert witness practice has gone from strength to strength. Scott is a medico-legal expert, a nursing expert, and head of practice at Apex . Links to Other Blogs on Pressure Ulcer Prevention A n Examination of the Waterlow Scoring System f or Pressure Ulcer Prevention ( https://www.apexhealth.net/post/waterlow-score ) B RADEN SCALE: Identifying Risk and Prevention of Pressure Ulcers ( https://www.apexhealth.net/post/braden-scale )

The purpose of incident reporting is a key determinant in the understanding of how and why things go wrong in healthcare today. It has been evidenced that over the past decade there has been a dramatically positive change in the culture within healthcare to internally report those incidents that have either caused harm to patients, or those incidents that are classified as ‘near misses’ whereby the potentiality for harm has been identified and rectified through appropriate action (NHSE, 2014). This increase has been shown to have occurred through the transformation of incident reporting from a paper based process to the use of Information Technology systems allowing healthcare professionals to report in a more ‘real time’ manner, supported by quality standards and improvement initiatives driven by central healthcare government departments. Dr Mike Durkin, NHS England Director for Patient Safety commented in May 2014 that ‘It is hugely encouraging to see more and more incidents being reported as this demonstrates that not only doctors, nurses, midwives but all NHS staff feel increasingly comfortable with speaking openly about mistakes and learning from error. Incident reporting is our best indicator of whether an organisation’s culture is becoming more open and transparent’. It has been encouraging to note this increase in quantity; however, whilst the number of incidents reported has increased dramatically over the years, there still remains some way to go to ensure the level of quality reporting is in place to allow for rapid investigation, supported by sufficient information, ensuring immediate actions are taken to maintain patient safety and improve the quality of care delivery. This, therefore, poses the question why the quality of incidents reported has such variability within it? The proposed reasons for this are multiple in nature and include: Knowledge and skills of healthcare staff to undertake the process – this can be caused by a lack of training, lack of support in the access of electronic incident reporting systems and in developing skill sets to provide accurate and meaningful data for investigation purposes. Capacity of the workforce – in times of austerity and a shrinking healthcare workforce the operational demands on staff can potentially lead to a culture of viewing incident reporting as an ‘add on’ to clinical duties, rather than an intrinsic process of safeguarding patients. Cultural norms – predominantly (through personal experience of working across a variety of healthcare sectors and providers) it can be evidenced that the domain of incident reporting has rested squarely within the remit of particular healthcare groups (eg nurses and midwives), as this aspect of healthcare provision has been identified as ‘not a job for us’. The ability to be objective – reporting an incident can be highly emotive for staff involved, and the ability to detach from such emotion, providing an accurate and objective view of the sequence of events, subsequently identifying and categorising actual harm (or no harm), can prove challenging. The multiple agency aspect to healthcare provision – when incidents occur that have caused harm to patients, it can be difficult to identify where the incident actually originated – which can cause the reporter some challenge to classify whether this was ‘our incident’ or someone else’s. Ultimately there remains a mandated responsibility on all healthcare organisations to ensure that incident reporting is highlighted as a key action for all staff to undertake (clinical and non-clinical) within an organisation, forming a key tenet to ensure best practice in relation to clinical governance and risk management. It is key to provide all staff with the requisite knowledge and skills to undertake robust incident reporting, provide daily quality assurance of the output of reports, with appropriate systems and support provided to reporters and investigators to improve practice. Perhaps, most importantly, such support will help begin the process of changing culture, thereby providing some assurance that all professions within healthcare, and across organisations, take a personal and professional lead in ensuring that any incident involving patients, relatives or staff is identified, reported and investigated at the earliest possible opportunity. Such workstreams should be undertaken to ensure that immediate reparative actions can be taken, and that appropriate risk management can be enforced to mitigate the likelihood of any potential similar future events occurring. It can logically be postulated that the output of these actions would not only see further increases in incident reporting rates but that a concurrent level of quality of reporting would also improve, thereby requiring a reduction in any required feedback to ensure that sufficient information is provided for investigation. Furthermore, the objective identification of actual harm or no harm to patients should also improve, allowing any member of staff the opportunity to reflect and be able to provide factual evidence regarding incidents that they have witnessed or been involved in. Ultimately, incidents will occur in healthcare. By its nature, the provision of clinical services to patients has a degree of significant inherent risk in any arena it is provided in. However, it is only through thorough investigation of incidents (including those that have caused no harm), with the involvement of patients and families (thereby providing assurance in transparency and honesty in practice) can actions be undertaken to ensure patient safety and enhance patient experience. It is interesting to note this position being championed by NHS England when Dr Durkin quoted Profession Don Berwick in that ‘we need to support the NHS to become a system devoted to continual learning and improvement’. There is encouraging evidence this will become evident in the near future, and that all staff employed in healthcare will continue to seek ways in which to grow and improve, ensuring that patient safety remains at the core of all action.

Apex Experts is a specialist medico-legal practice that provides exceptional medico-legal experts. Nurses possess a wide array of expertise, which is essential for managing their demanding roles in patient care, medication administration, ward rounds, and support for relatives and colleagues. This expertise, however, extends beyond the clinical environment. With continuous advancements in clinical techniques, professional regulations, and medical knowledge, nurses maintain and enhance their skills through ongoing training and professional development. In the UK, the role of a "nurse expert" is integral to legal cases involving medical negligence. Nurse experts apply their considerable experience to evaluate and provide opinions on the treatment and care of the claimant, culminating in the drafting of an expert witness report that serves as a crucial document during legal proceedings.  These reports are vital for articulating professional opinions in a medico-legal context, ensuring accurate and informed evaluations are available during legal proceedings. This requires a distinct skill set, different from the communicative competencies typically associated with nursing, to effectively convey this expertise within a medico-legal context. The expertise of nurse experts in blending medical knowledge with legal requirements is crucial for the accurate assessment and resolution of medico-legal matters. It is somewhat unexpected that nurse experts are relatively rare in the UK. Despite many nurses having experience in producing detailed reports within their roles, few have transitioned their expertise into medico-legal services. The paucity of suitably qualified nurse experts prompted Apex Experts to establish a dedicated nurse expert witness service. Our commitment is to ensure that nurses are both experienced and adequately trained to meet our clients' needs. Our approach is to collaborate exclusively with senior practising nurses, guaranteeing that our nurse experts are not only clinically credible but also proficient in applying evidence-based practice to report preparation. Recognising that while nurses are adept at utilising their knowledge and judgment in report writing within their everyday roles, many lack specific training in medico-legal report writing. Our clients prefer reports that not only offer expert insight but also demonstrate a comprehension of the legal framework. Therefore, we offer comprehensive training for nurses to craft reports that are both informative and meticulously presented. We encourage senior nurses from diverse backgrounds to join us and provide training courses annually. Our training programme is meticulously designed to cultivate the medico-legal competencies required for nurse experts. If you are a nurse interested in exploring opportunities with us, please reach out at info@apexexperts.co.uk .