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Keep up to date with the latest news, research and activity in patient safety.

Hundreds of ventilators UK bought from China 'are wrong type and could kill patients if used'

Hundreds of ventilators the UK government bought from China to relieve a major shortage are the wrong type and could kill patients, senior doctors have warned in a newly uncovered letter.
The medical staff behind the letter say the devices were designed for use in ambulances rather than hospitals, had an "unreliable" oxygen supply and were of "basic" quality.
Seen by Sky News' partner organisation NBC, the document also claims the ventilators cannot be cleaned properly, are an unfamiliar design and come with a confusing instruction manual.
Cabinet Office minister Michael Gove triumphantly announced the arrival of "300 ventilators from China" to help treat COVID-19 patients on 4 April. But the letter of warning from doctors was issued just nine days later.
"We believe that if used, significant patient harm, including death, is likely," it says.
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Source: Sky News, 30 April 2020
Patient Safety Learning

Deaths in care homes: what do the numbers tell us?

The Chief Scientific Adviser reportedly warned the government in January that the care homes sector in the UK was particularly vulnerable to COVID-19 – and that has unfortunately proved to be the case.
With care home deaths now being reported daily, what do the numbers tell us about this group? Have care home residents been disproportionately affected? And is there a chance the crisis could belatedly mark the start of better times for a sector in danger of collapse?
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Source: Nuffield Trust, 1 May 2020
 
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Britons will suffer health problems from COVID-19 for years, warn doctors

Many people in Britain are likely to suffer from physical and mental problems for several years after the COVID-19 epidemic has subsided. That is the grim message from doctors and psychologists who last week warned that even after lockdown measures had been lifted thousands of individuals would still be suffering.
Some of these problems will be due directly to the impact that the virus has had on those it has infected, especially those who went through life-saving interventions in intensive care units (ICUs) in hospital. In addition there will be a considerable impact on vulnerable people affected by the lockdown and isolation.
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Source: The Observer, 2 May 2020
Sam

Healthcare workers outside of NHS finding it harder to access testing, survey suggests

Healthcare workers providing support outside of the NHS are finding it harder to access coronavirus tests than their colleagues inside the service, a survey of nurses has suggested.
A poll of 22,000 health and care workers conducted by the Royal College of Nursing found 44% of respondents did not know how to access testing – while 76% said they had not been offered a test.
The problem was also particularly pronounced among the temporary workers, with four in five not offered testing compared to three-quarters of full time workers.
Meanwhile the survey found 79% of those working outside of the NHS had not been offered a test, compared with 75% in the health service.
Dame Donna Kinnair, chief executive and general secretary of the RCN, said: “It is concerning to see that some nursing staff, particularly those outside the NHS, are still having issues accessing COVID-19 testing.
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Source: The Independent, 4 May 2020
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A ‘tsunami’ of coronavirus survivors could overwhelm NHS rehabilitation services, experts warn

The health service will face a “tsunami” of coronavirus survivors discharged from hospitals needing long-term physical and mental support that the NHS will struggle to provide, The Independent has been told.
Coronavirus can leave patients with lasting physical damage and scarring to their lungs, meaning many could struggle to breathe and move around as well as they did before – in some cases permanently.
Patients admitted to intensive care can also suffer physical effects of being paralysed weeks and almost half who are ventilated with a tube in their windpipe will experience a form of delirium that can include terrifying hallucinations and leave survivors with lasting mental problems including post-traumatic stress.
Experts have warned a long-term lack of funding of NHS rehabilitation services and post-discharge care for ITU patients means the health service will struggle to help the thousands of patients who beat the virus but face a long road to recovery.
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Source: 3 May 2020
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Coronavirus: 'Many said goodbye to loved ones in an ambulance'

As a medical examiner at St George's Hospital, in south London, Dr Nigel Kennea's job is to advise clinical teams on completing death certificates, then support relatives through their grief. But like so much during this pandemic, none of that is straightforward.
"The most harrowing thing is knowing that many said goodbye to their loved ones in an ambulance," he says.
Despite staff "going above and beyond" to support patients in desperate times, using mobile phones and iPads to connect seriously ill patients and their families, contact is just not always possible. Even after a patient's death, social distancing has meant grieving relatives are left in limbo.
"Normally, registering a death is done face-to-face with relatives," Dr Kennea says. "They come in, talk through the admin and how to plan for after death. Now, it's all done on the phone."
Dr Kennea's job is to take an overview of all deaths at the hospital. It's a relatively new role in the UK, introduced last year, which is independent of trusts. Dr Kennea discusses each death at the hospital with the doctors and nurses involved in that patient's care, making sure death certificates are completed correctly and consistently. But with COVID-19 deaths so closely scrutinised, there is added pressure and "some are complicated", he says.
There are also challenges with communicating with patients. When Dr Kennea goes into COVID-19 areas, he has to wear full PPE which has its limits when communicating with patients.
"It's hard to share a smile behind a mask and goggles," he says.
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Source: 1 May 2020
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COVID-19 is no worse in immunocompromised children, says NICE

Doctors should reassure parents and carers of children who are immunocompromised that immunosuppression does not seem to increase the risk of severe COVID-19, the UK National Institute for Health and Care Excellence (NICE) advises in a rapid guideline.
“Covid-19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised,” NICE says.
Children and teenagers who are immunocompromised and their carers may be feeling particularly anxious and fearful about covid-19, so it is important they are involved in decision making as much as possible, NICE advises. Doctors should also support patients’ and carers’ mental wellbeing through communication and by signposting to charities and support groups.
The guideline says that patients should not avoid their usual appointments unless they have been told to and should continue with their usual treatment. However, face-to-face contact should be reduced where safely possible and alternative approaches such as telephone, video, or email consultations used instead.
When deciding whether to start treatments that affect the immune system, doctors should discuss the risks and benefits with the patient and their carers. If it is safe to delay treatment then watchful waiting should be undertaken.
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Source: BMJ, 1 May 2020
 
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Mask guidance downgraded amid reports of failing stock

Public Health England PHE) has made new changes to its guidance on the use of face masks as “a pragmatic approach for times of severe shortage”.
The update came as trust procurement leads reported receiving substandard face masks from national stocks over the weekend, although a PHE spokesman told HSJ that this had not caused the change to guidance.
PHE on Sunday updated its guidance on the use of certain facemasks facing “acute shortages”. The new advice states that FFP2 respirators can be worn without fit testing in lieu of surgical masks in non-surgical settings.
The new guidance says: “This is a pragmatic approach for times of severe shortage of respiratory protective equipment, FFP2 respirators being used in this way will not be carrying out the function they were designed to perform.”
However, FFP2 respirators must still be properly fit-tested in situations where this level of protection is required, the new PHE advice states.
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Source: 4 May 2020
Patient Safety Learning

NHS coronavirus tracing app ‘will have unintended consequences’, senior official says

An NHS app that aims to track the spread of coronavirus is being rolled out for the first time, as part of a trial on the Isle of Wight.
Council and healthcare workers will be the first to try the contact-tracing app, with the rest of the island able to download it from Thursday. The app aims to quickly trace recent contacts of anyone who tests positive for the virus.
However, the new NHS coronavirus app will have “unintended consequences”, according to the head of the unit developing it.
Officials do not know “exactly how it will work”, Matthew Gould, chief executive of NHSX, told a parliamentary committee. “There will be unintended consequences, there will for sure be some things we have to evolve,” he said.
Privacy campaigners have raised concern over the potential for “mission creep” with the data that will be gathered on people’s movements and contact with others.
The Health Service Journal reported that it has not yet passed tests on cyber security, performance and clinical safety needed to be included in the NHS app library.
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Source: The Independent, 4 May 2020
Patient Safety Learning

COVID-19 'sheds light on health inequalities in North East'

A leading doctor has called on the government to address regional health inequalities surrounding coronavirus.
Dr George Rae, the British Medical Association's regional chairman for the North East, has written an open letter saying the area is "suffering disproportionately". He said it was "time to ask why" and wanted action to "close the gap".
A government spokesman said it was working "incredibly hard" to protect the nation's public health.
"This is gravely disconcerting," Dr Rae wrote.
"Not only does this mean that we're suffering from a disproportionate amount of serious cases and deaths but also that, as a consequence, gradual lockdown measures may be affected - prolonging the hurt caused to our local economy. Covid-19 has shone a light on the health inequalities in the North East".
"What we need now is action from the government to close this gap and reduce the vulnerability of people in the North East to many medical conditions and, indeed, any future viruses."
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Source: BBC News, 5 May 2020
 
Patient Safety Learning

Coronavirus: Lockdown psychiatric care 'severely disrupted'

Isolation during lockdown is exacerbating psychosis in some patients, a consultant psychiatrist at a leading mental-health trust warns.
Steve Church said the South London and Maudsley NHS Trust had now had to shift its focus to crisis management.
He leads the psychosis recovery team, one of the trust's five teams helping patients struggling with their mental health during the coronavirus pandemic. Some have had to move homes to isolate and many no longer visit the clinic.
Dr Church, who has been working in the field for almost three decades, said: "In normal times, and we're not in normal times, the whole treatment is about trying to help people not self-isolate, trying to help people to re-engage with society.
"Self-isolation is one of the red flag-hallmarks of somebody becoming unwell in the first place, where they take themselves into a psychosis-induced lockdown."
One of his patients, Tracey, told Dr Church, in a phone consultation, staying at home had increased her hallucinations. "It's been quite daunting," she said. "I do hear the voices a little bit more now. They're domineering - they tell me to run across the road and they're following me and they say horrible and nasty things."
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Source: BBC News, 5 May 2020
Patient Safety Learning

International Day of the Midwife 2020

Today is International Day of the Midwife. Each year since 1992, the International Confederation of Midwives leads global recognition and celebration of the great work midwives do. 
Take a look at some of the resources and blogs we have recently published on the hub highlighting the work midwives are doing to support mothers and families during the coronavirus pandemic and the challenges services face.
Home births, fears and patient safety amid COVID-19
Midwifery during COVID-19: A personal account
Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic
Birthrights: COVID-19
Patient Safety Learning

Pregnancy support helplines report dramatic spike in urgent enquiries as coronavirus turmoil puts mothers at risk

Pregnancy support helplines are experiencing a massive spike in distressed pregnant women asking for urgent help as charities warn coronavirus upheaval is placing pregnant women at risk.
Frontline service providers warn mothers-to-be are anxious about whether they will be denied pain relief options and be separated from their newborn babies due to them being put in neonatal units.
Birthrights, a maternity care charity, found enquiries to its advice line in March were up by 464 per cent in comparison to March last year. Women getting in touch also raised concerns about home birth services being withdrawn, midwifery-led birth centres shutting their doors and elective caesareans being discontinued due to the COVID-19 crisis.
Baby charity Tommy’s experienced a 71% surge in demand for advice from midwives on its pregnancy helpline last month. The organisation warned coronavirus turmoil is placing pregnant women at risk after their midwives answered 514 urgent calls for help in April which is a sizeable rise from the 300 enquiries they would generally get.
Jane Brewin, the charity’s chief executive, said: “Antenatal care is vital for the wellbeing of mother and baby – but the coronavirus outbreak means that many don’t know who they can ask for help, or don’t want to bother our busy and beloved NHS."
“Although services are adapting, they are still running, so pregnant women should not hesitate to raise concerns with their midwife and go to appointments when invited. The large increase in people contacting us demonstrates that coronavirus is creating extra confusion and anxiety for parents-to-be, making midwives’ expert advice and support even more important at this time.”
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Source: The Independent, 5 May 2020
Patient Safety Learning

Matt Hancock faces judicial review threat over 'do not resuscitate' orders

The health secretary Matt Hancock has been threatened with a judicial review amid fears patients’ human rights are at risk from the incorrect use of controversial do not resuscitate orders during the coronavirus pandemic.
Ministers have been told they should use emergency powers to issue a direction to doctors and nurses in the NHS requiring them to comply with the law on do not attempt resuscitation orders (DNARS) and to ensure patients are properly consulted.
In recent weeks there have been a number of reports of patients having DNARs put in place without their knowledge or in GPs imposing blanket decisions, prompting a warning letter from NHS England’s chief nurse last month.
The legal action is being brought by Kate Masters, the daughter of Janet Tracey, who died at Addenbrooke's hospital in 2011 after a DNAR was put in place without her knowledge.
In 2014, Tracey's husband David won a landmark victory at the Court of Appeal which gave patients a new legal right to be consulted by doctors when DNARS were being considered. Not consulting a patient was a breach of their human rights, the court ruled.
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Source: The Independent, 6 May 2020
Patient Safety Learning

Cancer survivor urges people not to ignore symptoms and get checked by GP

A Nottingham mum recovering from breast cancer surgery said she 'hates to think' what could have happened, if she had let the cancer go undetected.
Claire Knee, 45 of Beeston, was diagnosed with breast cancer in March shortly before lockdown measures were introduced.
Having felt slightly off and noticing lumps in her breast, she was encouraged to contact her GP who referred her for tests. After a serious of diagnostic tests at Nottingham City Hospital's Breast Institute, specialists confirmed the presence of a tumour in the early stages. Surgeons successfully removed the tumour from her right breast amid the pandemic and Claire has been recommended some follow up treatment.
She now wants to share her experience of seeking help and getting treatment to advise others who may be showing signs of cancer but are too scared to contact their GP.  
"Looking back I just think that if I hadn’t made the call to my GP I would be walking around with undetected breast cancer, which could still be growing now. I would urge anyone in similar circumstances to contact their GP and get checked - even if it’s just for peace of mind.”
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Source: Nottinghamshire Live, 4 May
Patient Safety Learning

Revealed: the NHS’s plan to protect BAME staff from COVID-19

The NHS faces a new set of wide-ranging requirements as part of a comprehensive plan to mitigate the impact of COVID-19 on black, Asian and minority ethnic staff, HSJ has discovered.
A draft NHS England/NHS Improvement document, seen by HSJ, proposes trusts ensure every staff member has “a risk assessment to keep them safe”. It says the centre will provide: “Guidance and support to employers on creating proactive approaches to risk assessment for BAME staff, including physical and mental health.”
The document, Addressing Impact of Covid-19 on BAME Staff in the NHS, will call for five actions:
1. Every member of staff, current and returning, will have a risk assessment to keep them safe.
2. Every organisation with a CEO, and for primary care CCGs and ICSs, needs a BAME co-leader.
3. Diversity at every level of the health and care system starts with the podium, through our senior decision-making forums and across all organisations and at all levels of the workforce.
4. A bespoke health and wellbeing (including rehab and recovery) offer for BAME staff will be developed and rolled out for the system.
5. Every part of the system will use guidance on increasing diversity and inclusion in communications will be produced, led by the system.
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Source: HSJ, 6 April 2020
 
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