sábado, 10 de julio de 2010

Take Care Now


Take Care Now
Our enquiry into Take Care Now was triggered by the tragic case of Mr David Gray, a patient who died after he was administered 100mg of diamorphine by Dr Ubani, a locum doctor from Germany.


We announced the scope of our enquiries in June 2009, outlining that we would look at Take Care Now's out-of-hours service.

Download the terms of reference for the Take Care Now enquiry (PDF, 35KB, opens in new window)

Progress statement
Over the first three months, since our enquiry began in June, Take Care Now has:

•significantly reduced the chance of the original mistake happening again, by withdrawing 100mg doses of diamorphine;
•made sure schedule 2 controlled drugs, such as opiate-based drugs used in acute and palliative care, are stored and dispensed securely.
But there are some areas that need further improvement. Take Care Now needs to address:

•Unfilled shifts. The provider sometimes has difficulty filling doctors' shifts, which puts pressure on other staff and could affect the quality of the service.
•The policy on what action to take for people with a suspected stroke, which is inconsistent across the areas in which Take Care Now provides out-of-hours services. It must ensure that all patients with symptoms of stroke are transferred without delay to the 999 service.
•Its policy for managing medicines, as it includes some information that is currently too generic or not appropriate for out-of-hours services. It should be tailored to the actual out-of-hours services that the organisation provides.
Download our progress statement on the Take Care Now enquiry (DOC, 169KB, opens in new window)

Next steps
In the second phase of our enquiries, we will carry out:

•visits to remaining Take Care Now facilities;
•an audit of call handling, triaging and face-to-face assessment to establish the quality of interactions and decision-making;
•a survey of staff to hear their views on issues such as training;
•closer examination of arrangements for managing medicines;
•ongoing examination of the original incident to establish whether all lessons have been learned;
•further consideration of how doctors are admitted to performers' lists and arrangements to monitor and maintain these lists.
We expect to publish our final report early in 2010 and may provide further updates in the interim if there are important lessons to be learned for Take Care Now or PCTs.


open here please:
Take Care Now

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