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

New PPE allows us to perform surgery on deaf children

With so many operations put on hold when the pandemic started in March, surgeon Douglas Hartley and a team of medical veterans got to work pioneering new types of protective equipment.
When the coronavirus pandemic first hit the UK, thousands of surgical procedures were put on hold. For surgeons like Douglas, who performs operations on deaf children to restore their hearing, this created a significant moral dilemma – he wanted to get back into surgery to provide this vital care, but didn’t want to inadvertently catch or pass on COVID-19 in the process.
Douglas regularly carries out cochlear implant surgery, a process in which a surgeon embeds an electronic device which stimulates the hearing nerve in the ear. The scientific evidence is clear that this surgery needs to be performed at the earliest opportunity so that these children can benefit from being able to hear at a vital stage in their development.
But performing the surgery as normal would have put both children and surgical teams in danger. They needed to come up with another way of doing things. The team in Nottingham had to combine creativity and science to develop a novel and safe way to restart cochlear implant surgery in a matter of just a few weeks.
The team used a systematic evidence-based approach to evaluate a variety of PPE for its usability and effectiveness. During simulated cochlear implant surgery, they evaluated each type of PPE across several parameters, including its effect on a surgeon’s ability to communicate, their field of vision, and their comfort.
Many of the PPE options were found to substantially restrict the surgeon’s vision during operating. That rendered them unsafe for performing this sort of surgery. Instead, they found that the combination of “spoggles” and a half-face respirator mask had consistently superior performance across all aspects of clinical usability compared with all other options.
During their studies, Douglas and his team also worked with a surgical product manufacturer to develop a novel drape, basically a tent, that was designed to be suspended from a microscope covering the patient’s head and torso to provide a physical barrier between the site of drilling and the rest of the team.
They found that the operating tent significantly contained the droplets and prevented them from spreading around the theatre environment. They are the first – and are currently only – group in the world to develop an operating tent design that is marked for medical use. After completing our studies, we now had appropriate PPE and a protective operating tent to permit the safe restarting of cochlear implant surgery during the pandemic.
These recommendations were rapidly disseminated internationally via webinars and journal publications and quickly adopted as standard patient care by Nottingham University NHS Foundation Trust and, subsequently, embraced in other departments in the UK and across the world.
Read full story
Source: The Independent, 22 October 2020
Sam

HealthUnlocked moves to Corrona’s HealthiVibe to establish an innovative and holistic snapshot of the patient

London-based HealthUnlocked has been acquired by worldwide leader Corrona. 
HealthUnlocked is a social network of 1.3 million patients across hundreds of condition-specific communities. Moderated by over 500 patient advocacy groups, it captures insights to better understand what matters most to these patients.  
Corrona, based in Massachusetts, US, describes itself as a built-for-purpose source of gold-standard real-world evidence. 
“By combining with HealthUnlocked, we are expanding our broad set of capabilities–ranging from highly granular and longitudinal structured data across our eight registries, to broader patient insights from HealthUnlocked,” said Abbe Steel, Chief Patient Officer of Corrona.  
“The HealthUnlocked communities provide access to engaged patients across the globe, allowing us to better understand the patient experience and what matters most to patients."
Read full story
Source: Business Cloud, 22 October 2020
Sam

Twenty-two junior doctors under investigation after covid outbreak

A trust is investigating after two junior doctors developed covid following an offsite event attended by 22 juniors where social distancing rules were allegedly ignored.
The cases, involving doctors from the Royal Surrey Foundation Trust in Guildford, have been declared an outbreak by Public Health England and police have investigated the incident.
But HSJ understands that contact tracing has concluded no patients needed to be tested because staff had worn appropriate PPE at all times and those involved had swiftly self-isolated once they realised they might have covid or had been at risk of exposure to it.
It is not known whether any of the doctors had returned to work after the event before realising they might have been exposed to covid.
Dr Mark Evans, deputy medical director, said: “Protecting our patients is our priority and we are committed to ensuring that all of our staff follow government guidance. This incident took place outside of work and has been reported appropriately, and there was no disruption to our services for patients.”
Read full story
Source: HSJ, 22 October 2020
Sam

Full picture of how covid is hitting hospitals in the north

The most comprehensive picture so far of how covid’s second wave has hit the NHS in the north of England is revealed in new figures obtained by HSJ.
The latest data confirms that parts of the North West region now have more coronavirus patients in hospital beds than they did in the spring. It comes amid intense public debate about the best way to fight covid, and whether or not it is close to swamping the NHS.
Collected from local NHS sources in a joint HSJ and Independent investigation, the information shows for example that:
Lancashire and South Cumbria had 544 confirmed covid hospital patients yesterday (around 15-18% of the bed base), about 20 more than during the April peak. Liverpool University Hospitals – which remains the most severely affected trust – had 408 confirmed covid patients yesterday (20-25% of bed base), whereas it never topped 400 in the spring. The data is sent routinely by trusts to NHS England but most of it is not published – something some politicians are now calling for.
As of yesterday, there were nearly 6,100 confirmed-covid patients across England, about 650 of whom were in critical care, and 560 receiving mechanical ventilation, according to information shared with HSJ.
The number of “unoccupied” hospital beds is much lower now than in the spring, when they were cleared out in anticipation of a major hit. In the North West, up to 5,500 acute beds were reported as “unoccupied” in the spring, whereas the figure now is about 2,500 (around 14-18% of the bed base).
However, critical care is the major pinch point in the most affected areas, with nearly half of the mechanical ventilation beds open at Liverpool’s hospitals (29 of 62) occupied by confirmed covid patients; and a third of those across the North West (178 of 556).
However, hospitals in the area have opened very few extra critical care “surge” beds so far. The total numbers of mechanical ventilation (a subset of critical care) beds open in LUH and the rest of the region has not increased much in recent weeks, and falls well short of what they have declared they could open as potential surge capacity, if they cancelled large amounts of non-urgent care and reorganised staffing and wards.
Read full story
Source: HSJ, 23 October 2020
Sam

'I couldn't hold my baby': how Covid hit the families of very ill children

Parents and professionals have been devastated by the impact of the pandemic on some of the UK’s most vulnerable patients
Kelly Stoor gave birth to her daughter, Kaia, 14 weeks early. On 12 March, the midwife held her up for Kelly to see before whisking Kaia off to the neonatal unit for critical care. Kaia became seriously ill and was transferred to a hospital in Southampton, 50 miles away from home, for specialist treatment just before lockdown was imposed on 23 March. While there, she teetered on the edge of life and death for weeks and underwent life-saving surgery twice.
The impact on Kelly, her husband, Max, and their other three children has been enormous. Hospital restrictions in April dictated that only one parent was allowed to visit. Both parents were not able not hold their daughter for the first time until 88 days after she was born.
“It was extremely difficult,” says Kelly. “I wasn’t allowed to hold her because of Covid. I had to wear gloves if I was going to touch her. We didn’t know if she was going to make it, and Max and I weren’t allowed in together to be with her. There was one time I was with her for three hours and I couldn’t cope any more. I wanted to break.”
Kelly is not alone. In the UK, at least 25,000 children are living with conditions that require palliative care support and their lives, along with those of their families, have been upended by the coronavirus pandemic and accompanying restrictions.
A report by Rainbow Trust found that lockdown was a distressing experience for many; 80% of those surveyed by the charity in April said their situation was worse or much worse than before lockdown. Nearly 60% of parents, meanwhile, say that their mental health is worse than before the pandemic.
Families have had to take on the strain of caring full-time for a child with a life-limiting illness, such as cancer or neurological conditions, with little to no support. There has been no respite, explains Dr Jon Rabbs, a consultant paediatrician and trustee for Rainbow Trust. When lockdown was announced, many community healthcare services had to stop face to face contact and special schools which supported children were also closed. “One of my families is at breaking point, they are so exhausted and worried,” he says.
In child healthcare there have been delays, he says. Urgent treatment is always available but follow-up care has been cancelled or delayed in some places. “In my practice we have not missed any significant relapses,” he adds. “But imagine the worry not knowing whether things were going to be OK or not.”
Read full story
Source: The Guardian, 22 October 2020
 
Sam

Alfreton's Field House mental health unit in special measures

A mental health unit where a patient was found dead has been placed into special measures over concerns about safety and cleanliness.
Field House, in Alfreton, Derbyshire, was rated "inadequate" by the Care Quality Commission (CQC) following a visit in August. A patient died "following use of a ligature" shortly after its inspection, the CQC said.
Elysium, which runs the unit for women, said it was "swiftly" making changes.
The inspectors' verdict comes after the unit was ordered to make improvements, in January 2019.
Dr Kevin Cleary, the CQC's mental health lead, said: "There were issues with observation of patients, a lack of cleanliness at the service and with staffing.
"There were insufficient nursing staff and they did not have the skills and experience to keep patients safe from avoidable harm. Bank and agency staff were not always familiar with the observation policy."
"It was also worrying that not all staff received a COVID-19 risk assessment, infection control standards were poor, and hand sanitiser was not available in the service's apartments."
The CQC said a follow-up inspection on Monday had showed "areas of improvement" but it would continue to monitor the service.
Read full story
Source: BBC News, 22 October 2020
   
Patient Safety Learning

CQC launches criminal investigation into medication incidents at major acute trust

A major acute trust has confirmed the health service inspectorate has begun a criminal investigation into three incidents at its hospitals.
University Hospitals Birmingham FT told HSJ the Care Quality Commission (CQC) has started a criminal investigation into incidents involving potential errors around the provision of anti-coagulant medication.
The trust received a letter from the CQC this month informing it that the regulator has begun the investigation under regulation 22 of the Health and Social Care Act 2008 (regulated activities) regulations 2014. The incidents happened at Queen Elizabeth Hospital in Birmingham and Good Hope Hospital — the trust’s two main sites.
Regulation 22 says: “In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.”
The CQC launched a prosecution into East Kent Hospitals University FT this month for failing to meet fundamental standards of care. The regulator also successfully prosecuted University Hospitals Plymouth Trust in September after it pleaded guilty to breaching the duty of candour. 
Read full story (paywalled)
Source: HSJ, 23 October 2020
Patient Safety Learning

Women aged 50-60 at greatest risk of ‘long Covid’, experts suggest

Women aged 50-60 are at greatest risk of developing “long Covid”, analysis suggests. Older age and experiencing five or more symptoms within the first week of illness were also associated with a heightened risk of lasting health problems.
The study, led by Dr Claire Steves and Prof Tim Spector at King’s College London, analysed data from 4,182 COVID Symptom Study app users who had been consistently logging their health and had tested positive for the virus.
In general, women were twice as likely to suffer from Covid symptoms that lasted longer than a month, compared with men – but only until around the age of 60, when their risk level became more similar.
Covid vaccine tracker: when will a cor
Increasing age was also associated with a heightened risk of long Covid, with about 22% of people aged over 70 suffering for four weeks or more, compared with 10% of people aged between 18 and 49.
For women in the 50-60 age bracket, these two risk factors appeared to combine: They were eight times more likely to experience lasting symptoms of Covid-19 compared with 18- to 30-year-olds. However, the greatest difference between men and women was seen among those aged between 40 and 50, where women’s risk of developing long Covid was double that of men’s.
“This is a similar pattern to what you see in autoimmune diseases,” said Spector. “Things like rheumatoid arthritis, thyroid disease and lupus are two to three times more common in women until just before menopause, and then it becomes more similar.” His guess is that gender differences in the way the immune system responds to coronavirus may account for this difference."
Read full story
Source: The Guardian, 21 September 2020
Patient Safety Learning

Mass cancellations of NHS operations inevitable this winter, say doctors

Mass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care, doctors’ leaders have said.
Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped.
"Things are very, very difficult at the moment, very challenging at the moment. It feels like a juggling act every day,” said one official in the South Yorkshire NHS. “The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating.”
Read full story
Source: The Guardian, 23 October 2020
Sam

On the edge of exhaustion in the NHS

"I still have nightmares most nights about being completely out of my depth."
Gemma, a ward nurse in Northern Ireland, was redeployed to a critical care unit at the end of March when the first wave of coronavirus struck.
"I had never looked after a critically ill intensive care patient in my life," she says.
"I just thought, I'm coming in here and I'm going to die. I'm going to catch Covid and I'm going to be one of those patients in the beds."
As the second wave of the pandemic takes deep root across parts of the UK, thousands of NHS workers are struggling to recover from what they have already been through.
"We were all in PPE all the time," recalls Nathan, a senior intensive care nurse at a hospital in the Midlands. "All you can see is people's eyes, you can't see anything else."
He describes trying to help junior members of staff survive long and difficult days.
"And I'd see these eyes as big as saucers saying help me, do something. Make this right. Fix this."
"The pressure was insane, and the anxiety just got me," he says. "I couldn't sleep, and I couldn't eat, I was sick before work, I was shaking before I got into my car in the morning."
Nathan ended up having time off with severe anxiety, but he is now back at the hospital, waiting for the beds to fill up again.
The BBC has spoken to a number of nurses and doctors across the UK who are deeply apprehensive about what lies ahead this winter.
Read full story
Source: BBC News, 24 October 2020
Sam

How the elderly paid the price of protecting NHS from COVID-19

n the day Boris Johnson was admitted to hospital with COVID-19, Vivien Morrison received a phone call from a doctor at East Surrey Hospital in Redhill. Stricken by the virus, her father, Raymond Austin, had taken a decisive turn for the worse. The spritely grandfather, who still worked as a computer analyst at the age of 82, was not expected to survive the day. His oxygen levels had fallen to 70% rather than the normally healthy levels of at least 94%.
Vivien says she was told by the doctor that her father would not be given intensive care treatment or mechanical ventilation because he “ticked too many boxes” under the guidelines the hospital was using.
While ministers delayed lockdown, soaring cases were putting immense pressure on hospitals. This investigation from The Times shows officials devised a brutal ‘triage tool’ to keep the elderly and frail away.
Read full story (paywalled)
Source: The Sunday Times, 25 October 2020)
Sam

Partners still banned from UK maternity wards despite rule change

When Jess and Patrick discovered they were expecting their first baby in the new year, they looked forward to an early glimpse of their unborn child via an ultrasound scan.
But the couple, who live in the north-west of England, were soon told that Patrick would not be able to attend any antenatal appointments, including routine scans at 12 and 20 weeks. When their baby begins its journey into the world, Patrick will be permitted to join Jess only when labour is fully established, and he must leave an hour after delivery. He will not be able to visit his new family in hospital again.
“It’s taken the shine off the pregnancy,” said Jess, a junior doctor. “Patrick hasn’t been able to come to a single appointment. It’s making me very anxious and stressed – I’ve had actual nightmares about things going wrong and Patrick not being with me. He’s had to wait at home when I’ve gone for appointments, worrying and waiting for me to call to say everything’s OK.”
The hospital where Jess will give birth is among 43% of NHS trusts that – despite official guidance – have not eased restrictions imposed during lockdown on partners attending antenatal appointments, being present throughout labour, and staying with new mothers and babies after the birth. And as Covid transmissions rise across the UK, almost a quarter of NHS trusts have said they expect to reimpose such restrictions.
Read full story
Source: The Guardian, 24 October 2020
Sam

Misery of the COVID-19 long-haulers: ‘We’re all guinea pigs, we don’t know what’s around the corner’

It has a plethora of symptoms, strikes the young and old, and lasts for months – maybe much longer. It’s also so new that scientists aren’t sure what they’re dealing with. For those whose lives have been deeply affected by long-term repercussions of Covid, the battle to be recognised is just the start.
There are thousands of people in the UK dealing with the long-term effects of COVID-19, experiencing debilitating symptoms that last for weeks and months beyond the initial infection.
One of the most commonly reported is fatigue, along with breathlessness, joint pain and muscle aches. Neurological issues are common, particularly brain ‘fog’ and a loss of memory and concentration. Some have chest pain or heart palpitations, skin rashes, diarrhoea, headaches, hearing or eyesight problems, or hair loss. Others have lost their senses of taste and smell. In online support groups, people are sharing stories of bone-crippling exhaustion, constant pain in their chest or heart, or the inability to remember a name or follow a conversation.
These people don’t fit the binary model of the virus we thought we knew – that if you’re in the small minority who are seriously affected you might be hospitalised, end up in ICU or worse; otherwise you’ll likely be better after two weeks. Many only had mild cases originally and were not deemed to be in vulnerable categories.
Widely varying symptoms have added to the confusion and fear surrounding the condition, which currently has no formal definition. For months, people with Long Covid had no one to turn to but each other. It’s only recently – through increasing research emerging, and sufferers publicly sharing their stories – that it has started to be taken more seriously. Earlier this month, NHS England announced a £10 million investment to set up one-stop services for physical and mental health issues caused by Covid alongside a Long Covid task force and, crucially, research on 10,000 patients.
Not much is known about what causes Long Covid and there is little firm consensus. There are theories it occurs when a patient’s immune system overreacts to the infection, which can lead to widespread inflammation that theoretically affects any organ. Last week, a study by the National Institute for Health Research (NIHR) suggested Long Covid symptoms could actually be caused by four separate syndromes: post-intensive-care syndrome, post-viral fatigue syndrome, permanent organ damage to the lungs and heart, or lingering COVID-19 symptoms.
Read full story
Source: The Telegraph, 24 October 2020
Sam

NHS denies elderly people were refused care during early Covid

NHS bosses have denied claims that thousands of frail elderly people were denied potentially life-saving care at the peak of the pandemic in order to stop the health service being overrun.
NHS England took the unusual step on Sunday of issuing a 12-page rebuttal to allegations in the Sunday Times that patients deemed unlikely to survive were “written off” by being refused intensive care.
Prof Stephen Powis, NHS England’s national medical director, said: “These untrue claims will be deeply offensive to NHS doctors, nurses, therapists and paramedics, who have together cared for more than 110,000 severely ill hospitalised Covid-19 patients during the first wave of the pandemic, as they continue to do today."
“The Sunday Times’ assertions are simply not borne out by the facts. It was older patients who disproportionately received NHS care. Over two-thirds of our COVID-19 inpatients were aged over 65. “The NHS repeatedly instructed staff that no patient who could benefit from treatment should be denied it and, thanks to people following government guidance, even at the height of the pandemic there was no shortage of ventilators and intensive care.”
The newspaper claimed the high coronavirus infection rate in the UK before lockdown began on 23 March and the NHS’s limited supply of mechanical ventilators going into the pandemic meant that “the government, the NHS and many doctors were forced into taking controversial decisions – choosing which lives to save, which patients to treat and who to prioritise – in order to protect hospitals”.
The Sunday Times said its claims were the result of a three-month investigation that involved speaking to more than 50 sources in the NHS and the government about the health service’s response to the pandemic.
Read full story
Source: The Guardian, 25 October 2020
Sam

Baby death prompts new maternity concerns at Morecambe Bay hospital trust

A hospital that was at the centre of a major inquiry into unsafe maternity care five years ago is facing new questions over its safety after bosses admitted a baby boy would have survived if not for mistakes by hospital staff.
Jenny Feasey, from Heysham in Lancashire, is still coming to terms with the loss of her son Toby who was stillborn at the Royal Lancaster Infirmary, part of the University Hospitals of Morecambe Bay Foundation Trust in January 2017 after a series of mistakes by staff who did not act on signs she had pre-eclampsia.
Jenny, 33, has backed The Independent’s campaign for improved maternity safety and called on midwives to learn lessons after what happened to her family.
She added: “This was an easily avoidable situation. They just didn’t piece it together, all they had to do was carry out a test and I lost my son because of it."
Read full story
Source: The Independent, 25 October 2020
Sam

Endometriosis: Urgent action required to stop women with this excruciatingly painful condition being let down for years

In ‘Invisible Women: Exposing Data Bias in a World Designed For Men’ author Caroline Criado Perez writes about Rachael, a woman who suffered years of severe and incapacitating pain during her period. 
It takes, on average, eight years for women in the UK to obtain a diagnoses of endometriosis. In fact, for over a decade, there has been no improvement in diagnostic times for women living with the debilitating condition. You might think, given the difficulty so many women experience in having their symptoms translated into a diagnosis, that endometriosis is a rare condition that doctors perhaps don’t encounter all that often. Yet it is something that affects one in ten women – so what is going wrong?
Read the full article here in The Scotsman
Clive Flashman
Registered address: Patient Safety Learning, China Works SB203, 100 Black Prince Road Vauxhall, London, SE1 7SJ

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