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

Thousands still being denied PPE for procedures with ‘high covid risk’

Thousands of frontline workers delivering treatments where the risk of transmitting coronavirus is heightened are still being denied personal protective equipment (PPE), according to multiple unions and professional bodies.
Eleven organisations, including Unison and the British Association of Stroke Physicians, believe numerous procedures have been “wrongly excluded” from the list of 13 “aerosol generating procedures” that require PPE, despite the NHS now having adequate supplies.
They say their members are “facing illness and even death” while performing procedures such as chest physiotherapy, introducing feeding tubes, and assessing whether a patient can swallow safely.
The unions have formed an alliance to lobby on the issue, and its chair Dr Barry Jones told HSJ: “We’ve asked ministers and the Department of Health and Social Care again and again to take action and provide PPE to frontline NHS staff carrying out procedures which are not currently listed as AGPs but which the scientific evidence shows should be.
Read full story
Source: HSJ, 13 November 2020
Patient Safety Learning

Wall Street Journal: How the Swiss Cheese Model can help us beat COVID-19

No single solution will stop the virus’s spread, but combining different layers of public measures and personal actions can make a big difference.
It’s im­por­tant to un­der­stand that a vac­cine, on its own, won’t be enough to rapidly ex­tin­guish a pan­demic as per­ni­cious as Covid-19. The pan­demic can­not be stopped through just one in­ter­ven­tion, be­cause even vac­cines are im­per­fect. Once in­tro­duced into the hu­man pop­u­la­tion, viruses con­tinue to cir­cu­late among us for a long time. Fur­ther­more, it’s likely to be as long as a year be­fore a Covid-19 vac­cine is in wide-spread use, given in­evitable dif­fi­cul­ties with man­u­fac­tur­ing, dis­tri­b­u­tion and pub­lic ac­ceptance.
 Con­trol­ling Covid-19 will take a good deal more than a vac­cine. For at least an­other year, the world will have to rely on a mul­ti­pronged ap­proach, one that goes be­yond sim­plis­tic bro­mides and all-or-noth­ing re­sponses. In­di­vid­u­als, work-places and gov­ern­ments will need to con­sider a di­verse and some­times dis­rup­tive range of in­ter­ven­tions. It helps to think of these in terms of lay­ers of de­fence, with each layer pro­vid­ing a bar­rier that isn’t fully im­per­vi­ous, like slices of Swiss cheese in a stack.
 The ‘Swiss cheese model’ is a clas­sic way to con­cep­tu­al­ize deal­ing with a haz­ard that in­volves a mix­ture of hu­man, tech­no­log­i­cal and nat­ural el­e­ments.
This article can be read in full on the WSJ website, but is paywalled. 
The illustration showing the swiss cheese pandemic model is hyperlinked to this hub Learn post.
Clive Flashman

Essure: Women in England take legal action against sterilising-device maker

Lawyers have begun legal action on behalf of 200 UK women against the makers of a sterilisation device, after claims of illness and pain.
The device, a small coil called Essure, was implanted to prevent pregnancies.
Manufacturer Bayer has already set aside more than $1.6bn (£1.2bn) to settle claims from almost 40,000 women in the US. It has withdrawn the device from the market for commercial reasons but says it stands by its safety and efficacy.
The metal coil was inserted into the fallopian tube to cause scarring, blocking the tube and preventing pregnancy. 
Introduced in 2002, it was promoted as an easy, non-surgical procedure - a new era in sterilisation. But many women who had the device fitted have now either had hysterectomies or are waiting for procedures to remove the device.
Tracey Pitcher, who lives in Hampshire, felt she had completed her family and did not want any more children.
Her doctor strongly encouraged her to have an Essure device fitted, she says. But after it had been, she began to feel very unwell.
"I just started to have heavy periods, migraines, which I had only ever had when I was pregnant so they were hormonal," she says. "My back was so painful I'd wake up crying in the middle of the night with pains in my hips and my back."
Tracey says she battled to persuade doctors to take her symptoms seriously. But the only information she received was from a Facebook group.
"... there's nobody there, there's no support apart from people that we've found ourselves, no-one will listen, because it's just 'women's things'."
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Source: BBC News, 15 November 2020
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Damage to multiple organs recorded in 'long Covid' cases

Young and previously healthy people with ongoing symptoms of COVID-19 are showing signs of damage to multiple organs four months after the initial infection, a study suggests.
The findings are a step towards unpicking the physical underpinnings and developing treatments for some of the strange and extensive symptoms experienced by people with “long Covid”, which is thought to affect more than 60,000 people in the UK. Fatigue, brain fog, breathlessness and pain are among the most frequently reported effects.
On Sunday, the NHS announced it would launch a network of more than 40 long Covid specialist clinics where doctors, nurses and therapists will assess patients’ physical and psychological symptoms.
The Coverscan study aims to assess the long-term impact of COVID-19 on organ health in around 500 “low-risk” individuals – those who are relatively young and without any major underlying health complaints – with ongoing Covid symptoms, through a combination of MRI scans, blood tests, physical measurements and online questionnaires.
Preliminary data from the first 200 patients to undergo screening suggests that almost 70% have impairments in one or more organs, including the heart, lungs, liver and pancreas, four months after their initial illness.
“The good news is that the impairment is mild, but even with a conservative lens, there is some impairment, and in 25% of people it affects two or more organs,” said Amitava Banerjee, a cardiologist and associate professor of clinical data science at University College London.
Read full story
Source: The Guardian, 15 November 2020
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NHS launches 40 ‘long COVID’ clinics to tackle persistent symptoms

The NHS will launch a network of more than 40 ‘long COVID’ specialist clinics within weeks to help thousands of patients suffering debilitating effects of the virus months after being infected.
The clinics, due to start opening at the end of November, will bring together doctors, nurses, therapist and other NHS staff to physical and psychological assessments of those experiencing enduring symptoms.
NHS England has provided £10 million to fund the pioneering clinics, which will see patients who have been hospitalised, officially diagnosed after a test or reasonably believe they had COVID-19.
Ten sites have been earmarked for the Midlands, seven in the North East, six in the East of England, South West and South East respectively, five in London and three in the North West.
Patients will be able to access services through a GP referral or referral from other healthcare professional, allowing doctors an opportunity to rule out any other possible underlying causes for symptoms, such as suspected stroke, lung cancers or respiratory conditions.
The NHS has also launched a new taskforce, with patients, charities, researchers and clinicians, to help manage the NHS approach to ‘long COVID’ and produce information and support materials for patients and healthcare professionals to develop a wider understanding of the condition.
NHS Chief Executive Sir Simon Stevens said: “Long COVID is already having a very serious impact on many people’s lives and could well go on to affect hundreds of thousands.
“That is why, while treating rising numbers of patients who are sick with the virus and many more who do not have it, the NHS is taking action to address those suffering ongoing health issues."
“These pioneering ‘long COVID’ clinics will help address the very real problems being faced by patients today while the taskforce will help the NHS develop a greater understanding of the lasting effects of coronavirus.”
Read full press release
Source: NHS England, 15 November 2020
Patient Safety Learning

Leaked government review plans new law to push data sharing

An official review carried out for the health secretary, leaked to HSJ,  reveals plans to bolster the law to require greater sharing of patient data, saying it would help improve safety for those wrongly prescribed drugs.
A draft of the report on overprescribing, carried out for Matt Hancock by NHS England, says a major problem is that clinicians in different parts of the system can’t see what’s been prescribed and dispensed elsewhere. It says “wider access” should be given, which would also ensure “many eyes” are looking at the data to detect patterns or problems.
This should include making it a requirement that prescribing apps make their data openly available, according to the report by chief pharmaceutical officer Keith Ridge.
Read full story (paywalled)
Source: HSJ, 16 November 2020
Patient Safety Learning

How to overcome COVID-19 fatigue

Eight months after phrases such as “stay at home,” “flatten the curve” and “social distancing” started to become part of our daily vocabulary, people are experiencing a type of burnout experts call COVID-19 fatigue.
“By this point, we know people are tired — tired of missing family and friends, tired of not having a routine, of not going into the office,” said Jeanne Marrazzo, M.D., director of the University of Alabama at Birmingham (UAB) Division of Infectious Diseases. “Whatever disruptions to a person’s normal life have occurred, there is no denying the mental, physical and emotional toll people are experiencing. What we’ve learned — and what we keep learning — is how to combat burnout in safe ways that minimize the spread of the virus and enable us to feel some sense of normalcy.”
Figuring out how to safely navigate the new normal is more important than ever, explain UAB experts, particularly heading into more vulnerable and trying winter months that present unique challenges.
Read full story
Source: University of Alabama at Birmingham, USA, 6 November 2020
Patient Safety Learning

More than 75% of NHS midwives think staffing levels unsafe, says RCM

More than three-quarters of midwives think staffing levels in their NHS trust or board are unsafe, according to a survey by the Royal College of Midwives (RCM).
The RCM said services were at breaking point, with 42% of midwives reporting that shifts were understaffed and a third saying there were “very significant gaps” in most shifts.
Midwives were under enormous pressure and had been “pushed to the edge” by the failure of successive governments to invest in maternity services, said Gill Walton, the chief executive of the RCM.
“Maternity staff are exhausted, they’re demoralised and some of them are looking for the door. For the safety of every pregnant woman and every baby, this cannot be allowed to continue,” she said.
“Midwives and maternity support workers come into the profession to provide safe, high-quality care. The legacy of underfunding and underinvestment is robbing them of that – and worse still, it’s putting those women and families at risk.”
RCM press release
Read full story
Source: The Guardian, 16 November 2020
Patient Safety Learning

Major delays for new NHS England covid service

A key expansion of services for patients recovering from coronavirus has been delayed by several months, HSJ has learned.
In July, NHS England hailed a “ground breaking” new service with the launch of a website with information for patients on how to recover from covid following hospital discharge. It promised a second phase of the service would allow patients to be connected with health professionals for more tailored support, to be launched “later this summer”.
But in a memo sent to professional bodies on 30 October, NHSE said the national roll-out was delayed until at least January 2021, with no date confirmed for the launch beyond that.
Documents on the website itself said a “first cohort of patients from Leicester will begin to work through the programme” in November, with a further rollout scheduled for early December, followed by a “refresh” in January 2021 and a “full national rollout accessible across the country” at an unspecified date beyond that.
The second phase is seen as vital for ensuring that people with covid receive personalised support to help them recover from its debilitating effects, especially as a separate face-to-face rehabilitation programme was scrapped due to costs.
Read full story (paywalled)
Source: HSJ, 16 November 2020
Patient Safety Learning

Patients harmed amid ‘internecine squabbles’ and cover-up claims

Several patients were harmed after leaders at an acute trust failed to act on multiple concerns being raised about a surgeon, documents obtained by HSJ suggest.
The documents reveal a catalogue of governance and safety concerns over the trauma and orthopaedics department at University Hospitals of Morecambe Bay Foundation Trust in the last three years.
They include an external review which described the process for investigating clinical incidents as akin to “marking your own homework” and found the T&O department at Royal Lancaster Infirmary driven by “internecine squabbles”.
It comes as the trust, which is widely known for a patient safety scandal within its maternity department, also faces a major investigation into whistleblowing concerns over its urology services.
Read full story (paywalled)
Source: HSJ, 17 November 2020
Patient Safety Learning

CQC to inspect hospitals on food standards after patient deaths

Hospital food standards are set to be put on a statutory footing, with trusts held to account by the Care Quality Commission, according to the chair of a government-commissioned review.
Philip Shelley, who led the review into hospital food following seven patient deaths from listeria last year, told HSJ the incident was an “absolute condemnation” and that trusts must use the review to improve food standards.
The review, published last month, also calls for capital investment to refurbish hospital kitchens and replace old and inefficient equipment, which is likely to cost several hundreds of millions of pounds.
The government has accepted the recommendations and Mr Shelley will lead a group of experts to oversee the review’s implementation across the NHS during the next three years.
Among the review’s recommendations is the “enhanced role” for the CQC when it inspects NHS trusts.
The review states there is currently “very little evidence to prove that food and drink standards are being monitored closely enough” and it therefore recommends placing the standards on a statutory footing from which the CQC can hold trusts to account.
Read full story (paywalled)
Source: HSJ, 17 November 2020
Patient Safety Learning

'Diabetes burnout': The mental health impact of diagnosis

"It's a full-time job that you can't quit. It's a massive burden that you didn't ask for, didn't expect."
Diagnosed with type 1 diabetes at the age of 19, Naomi, now 33, says she reached a point where she simply could not handle "the physical or mental challenges of diabetes any more", a condition known as "diabetes burnout".
About 250,000 people in England have type 1 diabetes, which means the body cannot produce insulin, the hormone that controls blood sugar levels. It can lead to organ damage, eyesight problems and - in extreme cases - limb amputation. But for many there is also a significant psychological impact of learning to manage the condition.
Naomi felt she could no longer bear testing her blood sugar levels many times each day to calculate how much insulin she needed to inject, even though she knew she was risking her long-term health and putting herself in extreme danger, at risk of developing diabetic ketoacidosis (DKA), which can lead to a coma. She became so ill she was admitted to an eating disorder unit even though she was not struggling to eat.
The head of the unit, Dr Carla Figueirdo, says of her diabetes patients: "These people are seriously unwell, seriously unwell. They are putting themselves at harm every day of their lives if they don't take their insulin."
Naomi's consultant at the Royal Bournemouth Hospital, Dr Helen Partridge, says the psychological impact of a diabetes diagnosis should not be underestimated. 
The hospital is hosting one of two NHS England pilot projects looking at how to treat type 1 diabetes patients whose chronic illness affects their mental health.
NHS England diabetes lead Prof Partha Kar says: "The NHS long-term plan commits strongly on getting mental and physical health together. If we do tackle these two together, it will help improve outcomes."
Read full story
Source: BBC News, 16 November 2020
 
Patient Safety Learning

Labour demands new NHS investment as patients wait longer for surgery

Labour is demanding new investment for the NHS as part of the government’s spending review next week, after analysis shows hundreds of thousands of patients are waiting for life-changing operations.
The party’s shadow health secretary, Jonathan Ashworth, will challenge Matt Hancock in Parliament on today over the latest NHS data, which reveal almost 500,000 patients are waiting for surgery on their hips, knees and other bones.
Last week, NHS England published new data showing more than 1.7 million people were waiting longer than the NHS target of 18-weeks for treatment. The target was last met in February 2016.
An analysis of NHS England data reveal which specialities have been hardest hit by the growing backlog of operations, which has soared since the first wave of coronavirus caused widespread hospital cancellations earlier this year.
There were 4.3 million patients on NHS waiting lists for hospital treatments in September. Labour said this included 477,250 waiting for trauma and orthopaedic surgery, with 252,247 patients waiting over 18 weeks.
The next worst specialty was ophthalmology, which treats eye disorders, with 444,828 patients on waiting lists, 233,425 of whom have waited more than 18 weeks.
There were six figure waiting lists over 18 weeks for other specialties including gynaecology, urology, general surgery, and ear, nose and throat patients.
Read full story
Source: 17 November 2020
Patient Safety Learning

Mothers needlessly separated from babies under UK hospital Covid rules

Mothers are being needlessly separated from their babies under strict hospital restrictions introduced to stop the spread of COVID-19, doctors and charities have warned.
The measures preventing UK parents from staying with their babies when one or both require hospital treatment are causing trauma and increasing the risk of physical and mental health problems, it is claimed.
Some parents of sick babies are also being barred from seeing their child in neonatal units, which is causing distress and preventing bonding.
Campaigners have written to the health secretary, Matt Hancock, to raise their concerns. They want hospitals to review these policies urgently and have called for a working group to draw up national standards to meet families’ needs during pregnancy, birth and breastfeeding.
Read full story
Source: The Guardian, 16 November 2020
Patient Safety Learning

Physician predicts 'unprecedented surge' in US COVID-19 cases after Thanksgiving

Coronavirus cases in the US will spike after Thanksgiving, further stressing health care systems and prompting new restrictions, an emergency physician said Saturday, as states continued to report soaring numbers of new cases, hospitalizations and deaths.
Dr. James Phillips, chief of disaster medicine at George Washington University Hospital, told CNN's Erica Hill he is "terrified" about what's going to happen this holiday season.
"We're going to see an unprecedented surge of cases following Thanksgiving this year, and if people don't learn from Thanksgiving, we're going to see it after Christmas as well," Phillips said.
Already, grim indicators offer a glimpse of what's to come. A little more than a week after the US first topped 100,000 daily infections, it reported a record of more than 184,000 new cases Friday. Hospitalisations also hit a new high – for the fourth consecutive day – with more than 68,500 COVID-19 patients nationwide, according to the COVID Tracking Project. And the country's daily death toll has topped 1,300 at least three times this week.
"Things are going to get much, much worse," said Dr. Leana Wen, a CNN medical analyst and former Baltimore Health Commissioner. She expressed concern over the impact on the already-strained health care system when the new cases added in recent days are reflected in hospitalisations.
Read full story
Source: CNN, 15 November 2020
Patient Safety Learning

Energy drinks increase stillbirth risk but pregnant women’s caffeine guidance is confusing

Expectant mothers are being warned about potentially confusing guidance on consuming caffeine while pregnant, as research suggests energy drinks could have potentially deadly consequences for their babies.
A new report by Tommy’s Maternal and Fetal Health Research Centre claims to have established a 27 per cent rise in the risk of stillbirth for each 100mg of caffeine consumed.
Researchers compared stillbirths to ongoing pregnancies among 1,000 women across 41 hospitals from 2014 to 2016 as well as interviewing women about their consumption of caffeinated drinks. They adjusted for demographic and behavioural factors, such as age and alcohol consumption, to determine whether stillbirth was linked to caffeine.
One in 20 women were found to have increased their caffeine intake while pregnant in spite of evidence some caffeinated drinks put babies lives at risk. However, experts say that calculating precise intake can be difficult, and guidance on limiting caffeine is not consistent
The NHS recommends pregnant women keep their daily caffeine intake below 200mg whereas the World Health Organization stipulates 300mg as the safe amount to consume.
Tommy’s, a leading baby charity, called for both the NHS and the World Health Organisation to rethink such guidelines, but refused to outline a specific limit - saying it was the NHS and World Health Organisation’s responsibility to decide the recommendations in light of their new study.
Professor Alexander Heazell, an author of the study, said: “Caffeine has been in our diets for a long time, and, as with many things we like to eat and drink, large amounts can be harmful – especially during pregnancy. It’s a relatively small risk, so people shouldn’t be worried about the occasional cup of coffee, but it’s a risk this research suggests many aren’t aware of."
Read full story
Source: The Independent, 18 November 2020
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