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

Coronavirus: Refuse Covid patients if you can’t stop spread of virus, care homes told

Care homes should refuse to take coronavirus patients from hospitals if they cannot prevent the spread of the disease, the care watchdog has told The Independent.
Staff should admit these patients only if care homes are equipped with the right personal protective equipment (PPE) and infection prevention measures, the Care Quality Commission (CQC) said.
During the first wave of the pandemic, care homes saw widespread outbreaks of the virus with 16,000 deaths. Homes struggled to access protective clothing for staff and were forced to take 25,000 untested patients discharged from hospitals.
In an in-depth interview, Kate Terroni, the CQC’s chief inspector of social care, said care homes should not be put under pressure during a second wave to take infected patients they could not properly look after.
She said any home that refused to admit patients would have her support.
“Care home providers should only admit a resident when they are confident they can meet their care needs, so where they are confident they’ve got good infection prevention control, they’ve got the right PPE, they’ve got the right workforce."
“We will absolutely support a provider to say they cannot admit someone if those ingredients aren’t in place.”
Read full story
Source: The Independent, 12 October 2020, 
Sam

Maternity scandal hospital fined for not triaging A&E patients fast enough

An NHS hospital which has faced repeated criticism by regulators for poor standards of care has been fined £4,000 for failing to assess A&E patients quickly enough.
The Shrewsbury and Telford Hospitals Trust has been fined by the Care Quality Commission (CQC) after patients were not triaged within 15 mimutes of arrival in A&E – in breach of conditions set by the regulator last year and a national target.
The care of emergency patients at the hospital trust, which is also facing an inquiry into poor maternity care, has been a long running concern for the watchdog which has rated the trust inadequate and put it in special measures in 2018.
Earlier this year the CQC’s chief inspector of hospitals, Professor Ted Baker, wrote to NHS England warning of a “worsening picture" at the Midlands hospital and demanding action be taken.
The CQC said it had issued the fixed penalty notice to the trust because it failed to comply with national clinical guidance that all children and adults must be assessed within 15 minutes of arrival. It also failed to implement a system that ensured all children who left the emergency department without being seen were followed up.
After inspections in April 2019 and November 29 the CQC imposed seven conditions on the hospital over emergency care. The regulator said it was now clear the trust had not stuck to the conditions and had breached them both at Royal Shrewsbury Hospital and Princess Royal Hospital.
Professor Baker said: "The trust has not responded satisfactorily to previous enforcement action regarding how quickly patients are assessed upon entering the urgent and emergency department."
“We have issued a penalty notice due to the severity of the situation and to ensure the necessary, urgent improvements are made. It is essential that patients are seen in a timely way when they arrive at an emergency department; failure to do so could result in deteriorating health, harm, or even death, which is why national guidelines exist and must be followed."
Read full story
Source: The Independent, 12 October 2020
Patient Safety Learning

Pregnant women must have flu jab this winter, warn health bodies

All pregnant women have been urged by doctors to get a free flu vaccination this winter to ensure they and their babies are protected.
People can get infected with flu and coronavirus at the same time - with Public Health England finding if you get both simultaneously you may get more seriously ill.
Researchers previously said those who have been infected with both viruses face a serious increase to their risk of death and warned the public “not to be complacent” in the wake of fears flu could circulate around the country alongside COVID-19.
The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives note while getting flu is not a big deal for most people, getting the virus while you are pregnant can be serious for a small proportion of women and their babies. Flu can occasionally lead to stillbirth, maternal death and raise the chances of having a miscarriage.
Dr Edward Morris, president of RCOG, said: “We are keen to reassure pregnant women that flu vaccination is safe for women to have at any stage in pregnancy - from the first few weeks right up to their due date, and while breastfeeding."
"Over the last 10 years, the flu vaccine has been routinely and safely offered to pregnant women in the UK. The vaccine can also pass some protection to babies, which lasts for the first months of their lives."
Read full story
Source: The Independent, 12 October 2020
 
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Covid reinfection: Man gets Covid twice and second hit 'more severe'

A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report.
The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body.
Reinfections remain rare and he has now recovered. However, the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.
The man from Nevada had no known health problems or immune defects that would make him particularly vulnerable to Covid.
Scientists say the patient caught coronavirus twice, rather than the original infection becoming dormant and then bouncing back. A comparison of the genetic codes of the virus taken during each bout of symptoms showed they were too distinct to be caused by the same infection.
"Our findings signal that a previous infection may not necessarily protect against future infection," said Dr Mark Pandori, from the University of Nevada.
"The possibility of reinfections could have significant implications for our understanding of COVID-19 immunity."
Read full story
Source: BBC News, 13 October 2020
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NHS England at loggerheads with Test and Trace over staff testing

The introduction of weekly covid tests for NHS staff in ‘high risk areas’ will mean other groups missing out or waiting longer, well-placed sources have told HSJ.
There is also understood to be a standoff between NHS England and Test and Trace over the regular testing of asymptomatic staff, which was announced for the North of England on Monday.
NHS trust labs don’t have enough capacity to test all their staff; and there is not enough spare in “pillar two” commercial labs to carry out hundreds of thousands of additional tests. National bodies are said to be in disagreement over who should do it.
NHSE believes they should be provided by T&T, and T&T says NHS labs should expand their capacity to carry them out themselves, HSJ has been told.
A senior source involved in the testing programme said there would have to be “trade-offs” for T&T to meet the new NHS demand, with supply having to be cut for others who want tests — mostly the general population, or care home staff.
At present the NHS has agreed to carry out 100,000 daily tests by the end of the month, as part of the T&T’s overall 500,000 target. It has been encouraged to do more by T&T, but any expansions may face shortages of equipment and supplies such as reagents, as well as staff and space.
Read full story (paywalled)
Source: HSJ, 13 October 2020
Patient Safety Learning

‘Babies are still being damaged’ Tory peer warns ‘evasive’ ministers

The government has been told it is ‘not sustainable’ to continue to delay its response to a major review on patient safety as ‘babies are still being damaged’.
The Independent Medicines and Medical Devices Safety Review spoke to more than 700 people, mostly women who suffered avoidable harm from surgical mesh implants, pregnancy tests and an anti-epileptic drug, and criticised “a culture of dismissive and arrogant attitudes” including the “unacceptable labelling of many symptoms as “attributable to ‘women’s problems’”.
The review’s author Baroness Julia Cumberlege told HSJ that “time is marching on” for the Department of Health and Social Care to implement the recommendations of her July report, which include setting up a new independent patient safety commissioner.
The Conservative peer said pressure was building on government to adopt the findings of the review, since it had been endorsed by Royal Colleges and has already been adopted by the Scottish government. She said the government had given “evasive” answers in parliament on the issue.
In an exclusive interview with HSJ, Baroness Cumberlege said:
There is a crowded field of regulators but “there’s a void” for a service that listens and responds to patients’ safety concerns. She feels “diminished” that women’s concerns are still being dismissed by clinicians, but said young doctors are a cause for hope. She is “very optimistic” report will be implemented – but the NHS has to have the will to make changes. Read full story (paywalled) 
Source: HSJ, 13 October 2020
Patient Safety Learning

Coronavirus: Patient has sudden permanent hearing loss

A 45-year-old British man has been left with permanent hearing loss after developing COVID-19.
UK doctors say it is the first such case they have seen linked to the pandemic coronavirus. Although rare, sudden hearing loss can follow other viral infections, such as flu.
The ear-nose-and-throat experts told BMJ Case Reports journal steroid drugs could help avoid this damage if given early enough.
The patient, who has asthma, had been admitted to a London hospital with COVID-19 symptoms and transferred to intensive care after struggling to breathe. Tests confirmed he had coronavirus and he was put on a ventilator machine. He also needed various drugs and a blood transfusion before beginning to recover and coming off the ventilator 30 days later.
A week after the breathing tube was removed and he left intensive care, he noticed tinnitus (a ringing or buzzing noise) followed by sudden hearing loss in his left ear. A hearing test suggested the loss was linked to damage to the hearing nerve, the middle ear, or both, rather than inflammation or a blockage to the ear canal.
Doctors could find no explanations for his hearing problem, other than his recent COVID-19 illness.
They gave him steroid tablets as well as injections into the ear, which helped a little, but he has some irreversible hearing loss.
Read full story
Source: BBC News, 14 October 2020
Sam

Rising covid absences will have ‘significant impact’ on NHS recovery

Increasing staff absence due to COVID-19 will have a ‘significant impact’ on the ability of the NHS to deliver critical care services and routine operations, leading intensive care doctors have said.
The latest NHS England data has shown the number of COVID-19 related absences of staff, either through sickness or self-isolation, has risen from 11,952 on 1 September to 19,493 on 1 October. Staff absence has almost doubled in the North West in this time as well – from 2,664 to 5,142 during the same period.
It peaked at 17,628 in the region on 11 April and means the October total accounts for nearly a third of that amount already (29%). 
Alison Pittard, dean of the Faculty of Intensive Care Medicine, confirmed increasing numbers of NHS critical care staff were absent from work. “I suspect this is due to having to be at home with children asked to isolate and therefore the parent needing to isolate, as was the case in the first wave," she told HSJ.
 “This will have an impact on our ability to deliver critical care services. We know that staff numbers are inadequate at the best of times, with a significant vacancy rate especially for critical care nurses.”
Royal College of Anaesthetists council member Helgi Johannsson said the rising absence rate was “likely to have a significant impact”, particularly on routine operations.
Dr Johannsson, a consultant anaesthetist at Imperial College Healthcare Trust, said: “In my hospitals, I have been aware of several doctors and nurses having to isolate due to their children being asked to self-isolate. These healthcare staff were otherwise well and would have been at work."
Read full story (paywalled)
Source: HSJ, 14 October 2020
Sam

Midlands trust fights to ‘preserve' elective work amid covid bed closures

Covid’s second surge has begun disrupting elective care at hospitals outside the north west, HSJ has learned.
At Nottingham University Hospitals Trust, the number of patients with COVID-19 is “rising fast”, causing ward closures and elective care disruption, according to an internal memo seen by HSJ.
The memo, sent by the trust’s divisional director for surgery Simon Parsons, said covid admissions to the trust “are way past 100 and rising fast”.
“There are also outbreaks of covid on certain wards, which have resulted in closures of beds,” Mr Parsons said.
“I am afraid the elective programme is going to be disrupted and we are doing everything we can to preserve as much elective work as possible,” said the memo to staff at the major teaching hospital.
Mr Parsons called on clinicians to concentrate on “getting patients discharged in a timely way” and for them to escalate instances where patients were fit for discharge but not leaving the trust.
“We are not asking you to make unsafe discharges but to keep length of stay as short as possible,” Mr Parsons said.
Read full story (paywalled)
Source: HSJ, 14 October 2020
Sam

NHS trust apologises after staff accused of restraining elderly man 19 times

An NHS trust has offered an unreserved apology to an elderly patient and his family after they accused hospital staff of restraining him 19 times in order to forcibly administer treatment.
East Kent Hospitals University NHS Foundation Trust admitted that care for the man, who has dementia, “fell far short” of what patients should expect.
The 77-year-old had been admitted to the William Harvey Hospital last November for urinary retention problems, according to a recent BBC investigation.
In February, The Independent revealed that a police investigation had been launched into an alleged assault against an elderly man at the hospital after nurses and carers were filmed by hospital security staff holding the man’s arms, legs and face down while they inserted a catheter.
A whistleblower told The Independent that the incident was being covered up by the trust and staff were told: “Don’t discuss it, don’t refer to it at all.”
On Wednesday, the trust said its investigation had found a failure to alert senior medics to the difficulties being experienced in caring for the patient.
Changes to dementia care including ward reorganisation, training and recruitment are underway, said a spokesperson, who added: “We apologise unreservedly to the patient and his family for the failings in his care, this fell far short of what patients should expect.”
Read full story
Source: The Independent, 14 October 2020
Sam

Liverpool intensive care units '90% full' as city braces for second wave

Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections.
Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus.
"Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme.
"The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days."
Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive."
He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid."
Read full story
Source: The Independent, 14 October 2020
Patient Safety Learning

Coronavirus: 'Long Covid could be four different syndromes'

"Long Covid" – the long-lasting impact of coronavirus infection – may be affecting people in four different ways, according to a review, and this could explain why some of those with continuing symptoms are not being believed or treated.
There could be a huge psychological impact on people living with long-term COVID-19, the National Institute for Health Research report says.
They need more support – and healthcare staff require better information.
Most people are told they will recover from mild coronavirus infections within two weeks and from more serious disease within three. But the report says thousands could be living with "ongoing Covid".
Based on interviews with 14 members of a long-Covid support group on Facebook and the most recent published research, the review found recurring symptoms affecting everything from breathing, the brain, the heart and cardiovascular system to the kidneys, the gut, the liver and the skin.
These symptoms may be due to four different syndromes:
permanent organ damage to the lungs and heart post-intensive-care syndrome post-viral fatigue syndrome continuing COVID-19 symptoms Some of those affected have had a long stay in hospital with severe Covid-19 - but others, who have had a mild infection, have never even been tested or diagnosed.
The review says coming up with a "working diagnosis for ongoing COVID-19" would help people access support.
Read full story
Source: BBC News, 15 October 2020
Sam

'I fear being a forgotten casualty of pandemic'

At the age of 49, Sarah Fisher feels her life is on a knife-edge. She had a heart attack during lockdown and has subsequently been diagnosed with heart failure.
In July, she was told she needed to have an implantable cardioverter defibrillator (ICD) fitted, which can shock the heart back into rhythm when it detects a potential cardiac arrest. But 12 weeks on, she is still waiting. "I could have a cardiac arrest at any point," Sarah says.
"It is awful not knowing what is going to happen. "I am on the urgent list – but the infection rates are rising and the clinics are closing."
"I don't know when I will get it.
"There are so many people in my position – we don't have Covid but our lives are at risk too. We are the forgotten victims of this pandemic."
British Heart Foundation analysis of Office for National Statistics data for England and Wales found almost 800 extra deaths from heart disease among under-65s from March to July - 15% more than would be expected.
The rate of death was highest during the full lockdown - but, worryingly, the trend continued afterwards. The charity blames delays in people seeking care, as well as reduced access to routine tests and treatments.
And NHS England figures show a sharp rise in the numbers waiting over six weeks for a whole range of key tests, including echocardiograms for hearts.
Read full story
Source: BBC News, 15 October 2020
Sam

NHS staff in northern England 'exhausted' amid second wave fears

Doctors and nurses in areas of northern England with some of the highest Covid infection rates have described being “physically and emotionally” exhausted, as the NHS braces itself for the second wave of the pandemic.
Most of the north has been put into the tier 2 “high risk” category, with Merseyside in the highest – tier 3 – bracket. While politicians debate whether a nationwide circuit breaker would be a more effective instrument to curb spread of the virus, frontline staff – still scarred from the first wave – are under no illusions as to what lies in store.
Carmel O’Boyle, a nurse in Liverpool, who is also chair of the Royal College of Nursing’s Greater Liverpool and Knowsley branch, said members of the public had used A&E and primary care sparingly during the first national lockdown but mixed messages and a lack of trust in the government had led to people throwing caution to the wind and attendances were rising accordingly.
“The nurses across my branch are frightened and exhausted – physically and emotionally,” she said. “They’ve been dealing with this for months and now there are more people in hospitals than there were in March. Although we know a little bit more about how to treat people and the kind of path of the disease process, it’s still frightening. It’s just so demanding and so draining to be nursing people in this manner without any family involvement and with the complications that there are.”
A consultant in Manchester, who did not want to be named, said her hospital coped with the first wave but “the difference this time is that we’re trying to continue all of the elective activity and that’s going to be challenging.
“I do think that we will manage the Covid cases. I just now worry about whether we will be able to continue to keep the normal care for people who need their operations [and] need care for cancer."
Read full story
Source: The Guardian, 15 October 2020
Sam

Leaked emails raise flag on ‘extremely concerning’ bed shortage

‘Systemic’ problems within mental health services in Birmingham have caused the number of people waiting for an inpatient bed to reach ‘extremely concerning’ levels, according to documents leaked to HSJ.
There are currently 41 people waiting to be admitted to a bed by Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) , according to internal documents, while 36 people have already had to be sent to private sector facilities up to 150 miles away.
The NHS in the area has indicated to HSJ  that it is due to need for “intensive levels of care” now growing because of the impact of the COVID-19 pandemic.
In an email thread, sent to 60 people in the trust including senior executives, one senior clinician wrote in response to the bed figures: “The number of patients with Mental Health Act assessments completed is extremely concerning. This needs to be escalated to commissioners. The problem is systemic.”
It comes after an HSJ investigation earlier this year into the deaths of 12 patients under BSMHFT’s services. It revealed senior medics had repeatedly warned the trust about severe bed shortages and a lack of capacity within home treatment services.
The trust said it was addressing the issues raised, but senior clinicians told HSJ this week the trust is still short of at least 80 adult mental health beds.
Read full story (paywalled)
Source: HSJ, 15 October 2020
Sam

Lockdown patients ‘put off’ GP visits after warnings about restricted care

GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said.
The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”.
Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital.
Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.”
Read full story (paywalled)
Source: The Times, 16 October 2020
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