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

Regulator steps in after staff claim trust ignored concerns

Staff at a Midlands hospital trust told regulators they had repeatedly raised safety concerns internally without action being taken.
The Care Quality Commission (CQC) has downgraded maternity services at Worcestershire Acute Hospital from “good” to “requires improvement” following an inspection prompted by the whistleblowers’ concerns.
Staff had reported “continuously escalating” staffing level concerns to senior managers, but said they got “no response”. Some said they were fearful of raising concerns internally.
Whistleblowers also reported delays to induction of labour, with examples of women waiting up to a week to be induced instead of one to two days. Managers said women who suffered delays were risk assessed.
The CQC also identified a risk women might not be informed of significant harm caused to them or their babies following an incident, due to the way the trust was grading some babies who were admitted to the neonatal unit. However, it added: “When things went wrong, staff apologised and gave patients honest information and suitable support.”
The report added the trust’s leaders were aware of the challenges in maternity, but “timely” action was not always taken to address the concerns.
Read full story (paywalled)
Source: HSJ, 19 February 2021
Sam

Covid: Three in 10 care home staff in England not vaccinated

Three in 10 care home staff have not been vaccinated against COVID-19 despite being in the top four priority groups, according to data from NHS England.
More than 435,000 workers in care homes for older adults are eligible in England, but only 304,600 have received a first dose.
In London, only 52% of staff have had a jab, rising to 75% in the South West.
The UK target of vaccinating 15 million people was met at the weekend. However, these figures, up to 14 February, suggest there are large groups of care workers, who are in the top four priority groups, who have still not come forward.
Some care home staff have previously said they refused the vaccine because of "cultural issues", but organisations representing care providers say they must be convinced to have one - to protect them and the services they work in.
Read full story
Source: BBC News, 18 February 2021
Patient Safety Learning

Calls to make at home early abortions permanent as major study finds they pose no greater risk

At home early abortions pose no greater risk and allow women to have the procedure much earlier on in their pregnancy, research has found.
The findings have sparked calls from leading healthcare providers for the option, which was rolled out in the wake of lockdown measures last spring, to be made permanent.
Researchers, who conducted the UK’s largest study into abortions, discovered there were no cases of significant infection which necessitated the woman to go to hospital or have major surgery.
The study, conducted by the British Pregnancy Advisory Service and MSI Reproductive Choices, drew attention to the fact that despite misinformation to the contrary, not one individual died from having an at home early abortion.
Eight in ten women said at home abortions were their preferred choice and they would opt for it in the future, while waiting times from when the woman has her consultation to treatment improved from 11 days to 7 days.
Dr Jonathan Lord, medical director for MSI Reproductive Choices UK, said: “Being able to access abortion care earlier in pregnancy has also reduced the low complication rate even further.”
Dr Lord added: “Telemedicine has provided a lifeline for vulnerable women and girls who cannot attend consultations in-person. We have seen a major increase in safeguarding disclosures, including from survivors of domestic and sexual violence, as they can talk more freely about distressing and intimate details from the privacy of their own home at the beginning of the Covid emergency."
Read full story
Source: The Independent, 19 February 2021
Sam

Covid: Health workers appeal to PM for better personal protection

Nearly 20 major healthcare bodies are appealing to the Prime Minister for better personal protection against coronavirus.
They say at least 930 health and care workers have died of COVID-19 and more are experiencing long-term effects.
In a letter, they say measures to stop airborne spreading are "inadequate" and call for urgent improvement in masks and other defences against variants.
The government said it was monitoring evidence on airborne transmission and would update advice "where necessary".
The organisations involved represent a wide range of health professionals, from doctors and nurses to dieticians and physiotherapists. Their approach to Downing Street follows repeated efforts to raise the issue with others in government.
With health and care workers at three to four times greater risk of becoming infected than the general public, the plea to Boris Johnson is to make an "urgent intervention to prevent further loss of life". It says current policies focus on contaminated surfaces and droplets - for which the best defences are hand hygiene and social distancing - but not on airborne transmission by tiny infectious aerosols.
The groups are demanding:
ventilation is improved better respiratory protection, such as FFP3 masks, are provided healthcare guidance reflects the evidence of airborne transmission. Read full story
Source: BBC News, 19 February 2021
Sam

COVID-19: New study reveals how effective Pfizer's vaccine is after the first dose

A new COVID vaccine efficacy study from Israel has concluded that Pfizer/BioNTech's jab is up to 85% effective after the first dose.
The research, conducted by the Sheba Medical Centre, the country's largest hospital, has been published in the Lancet medical journal.
The hospital assessed the effectiveness of the first dose of the Pfizer/BioNTech vaccine among 7,000 of its healthcare employees. The workers each received their first dose in January and the research team observed an 85% reduction of clinical (symptomatic) COVID-19 between 15 and 28 days after the jab.
But critically, they also observed efficacy in asymptomatic patients.
The study found that all infections, including asymptomatic, were reduced by 75% after the first dose.
Professor Eyal Leshem, an infectious disease expert and director of Sheba's Institute for Travel and Tropical Medicine, told Sky News: "This is first real-world evidence of effectiveness that shows up after the first dose of the vaccine."
Read full story
Source: Sky News, 19 February 2021
Patient Safety Learning

'Classic triad' of symptoms misses positive COVID-19 cases, study finds

New research led by researchers at King’s College London suggests that restricting testing to the ‘classic triad’ of cough, fever and loss of smell which is required for eligibility for a PCR test through the NHS may have missed cases. Extending the list to include fatigue, sore throat, headache and diarrhoea would have detected 96% of symptomatic cases.
A team of researchers at King’s and the Coalition for Epidemic Preparedness Innovations (CEPI) analysed data from more than 122,000 UK adult users of the ZOE COVID Symptom Study app. These users reported experiencing any potential COVID-19 symptoms, and 1,202 of those reported a positive PCR test within a week of first feeling ill.
While PCR swab testing is the most reliable way to tell whether someone is infected with the SARS-CoV-2 coronavirus that causes COVID-19, the analysis suggests the limited list of three does not catch all positive cases of COVID-19.
Testing people with any of the three ‘classic’ symptoms would have spotted 69% of symptomatic cases, with 46 people testing negative for every person testing positive. However, testing people with any of seven key symptoms - cough, fever, anosmia, fatigue, headache, sore throat and diarrhoea - in the first three days of illness would have detected 96% of symptomatic cases. In this case, for every person with the disease identified, 95 would test negative.
Researchers also found users of the Symptom Study App were more likely to select headache and diarrhoea within the first three days of symptoms, and fever during the first seven days, which reflects different timings of symptoms in the disease course. Data from the ZOE app shows that 31% of people who are ill with COVID-19 don’t have any of the triad of symptoms in the early stages of the disease when most infectious.
Read full story
Source: King's College London, 17 February 2021
Sam

1 in 10 Covid patients die within months of leaving hospital, study reveals

More than 1 in 10 Covid patients died within five months of being discharged from hospital, while almost a third of those who survived the virus had to be readmitted, new research has warned.
Papers released by the governments Scientific Advisory Group for Emergencies (Sage) also revealed half of patients in hospital with the virus suffered complications, with one in four struggling when they got back home.
Younger patients under the age of 50 were more likely to suffer complications.
The reports present the first substantial evidence that Covid could be the cause of significant long term ill-health, with the virus attacking the body’s organs and causing diseases of the liver, heart, lungs and kidneys.
Read full story
Source: The Independent, 20 February 2021
Sam

Covid: Confusion over gestational diabetes advice

Some pregnant women who have had gestational diabetes say a change to shielding advice in England has caused confusion. 
Some have been told to stay at home while others have not, based on a new algorithm which calculates an individual's risk from Covid. It identified an extra 1.7 million people as extremely clinically vulnerable in England this week. They will now be prioritised for a Covid vaccine.
NHS England says not everyone with the same condition will be advised to shield but suggests people contact their GP to discuss their individual case.
Heather Davis Mahoney, from Hertfordshire, had gestational diabetes while carrying her second child, and was monitored closely during her third pregnancy. She has not been told to shield, but says it's worrying when others from similar backgrounds have been told they should.
"There's been an explosion of confusion. People don't know what's going on and are worried about putting themselves and their babies at risk," she says.
But GP Dr David Triska said just because someone has gestational diabetes or had it in the past, doesn't mean they should be shielding. "I think the major point of confusion is that people are expecting that this is a binary 'yes' or 'no' per condition algorithm - and it is not," he said.
"The reason why people are getting different answers from various sources is because this is an individual risk assessment."
Read full story
Source: BBC News, 20 February 2021
 
Patient Safety Learning

Staff seeking second vaccination early threatened with ‘regulatory action’

Staff at one of England’s largest hospital trusts have been threatened with disciplinary and regulatory action if they attempt to get their second COVID-19 vaccine dose early, HSJ has learned
In an all staff email today, University Hospitals Birmingham Foundation Trust said: “Any staff trying to obtain a second dose ahead of their booked sessions could be considered deliberately attempting to deceive the NHS in order to obtain medicines and, as such will be a professional conduct issue which may result in disciplinary action and/or regulatory action being taken against you.
The new note indicates the FT may have had a particular problem with staff seeking and/or getting second doses.
The email said that if they attended vaccination centres, staff would be refused a second dose, and be asked to leave. Staff were also asked not to try and book another appointment at a different vaccination centre or “re-enter” the system through over means.
The email added: “The current supply of vaccines is allocated to us to ensure all priority groups can receive their first dose and provide protection to as many as possible.”
In December the trust’s executives were heavily criticised by unions for getting their first vaccine doses, after patients didn’t show up for appointments. The trust, which has been dealing with very large numbers of covid patients especially in intensive care, has also been the subject of concerns over culture and management in recent months.
Read full story (paywalled)
Source: HSJ, 20 February 2021
Patient Safety Learning

UK’s Covid vaccines cut hospital admissions by around 90%, study shows

The COVID-19 vaccines deployed in the UK substantially reduce the risk of hospital admission, real-world data from Scotland has shown.
Four weeks after receiving a first dose, both the Pfizer/BioNTech and Oxford/AstraZeneca jabs cut hospitalisation with the disease by up to 85 and 94%, respectively.
Among those aged 80 years and over – one of the most vulnerable groups – the two vaccines were associated with a combined 81% reduction in hospitalisation risk.
Scientists from the University of Edinburgh, the University of Strathclyde, and Public Health Scotland gathered vaccine data between 8 December and 15 February, during which 1.14 million doses were administered among the Scottish population.
Researchers analysed data for every week during the study – including GP records on vaccination, hospital admissions, death registrations and laboratory test results – and compared the outcomes of those who had received their first jab with those who had not.
Lead researcher Professor Aziz Sheikh said: "These results are very encouraging and have given us great reasons to be optimistic for the future. We now have national evidence – across an entire country – that vaccination provides protection against Covid-19 hospitalisations."
Read full story
Source: The Independent, 22 February 2021
Patient Safety Learning

NHS sets up mental health hubs for staff traumatised by Covid

The NHS is setting up dozens of mental health hubs to help staff who have been left traumatised by treating Covid patients during the pandemic.
There is mounting concern that large numbers of frontline workers have experienced mental health problems such as anxiety, depression and post-traumatic stress disorder over the last year.
NHS personnel will be able to ring one of the 40 new hubs in England, receive advice and be referred for support from psychologists, mental health nurses, therapists and recovery workers.
Frontline workers who are struggling with their mental health will be encouraged to use the service, and hub staff will call workers deemed at highest risk directly to offer their help. Higher-risk groups are likely to include those who work in intensive care, on Covid wards and in A&E units.
Almost half of doctors, nurses and other ICU staff have reported symptoms of PTSD, severe depression or anxiety, according to research published last month. Of these, about 40% had probable PTSD – far higher than the rates seen among military veterans.
Sir Simon Stevens, NHS England’s chief executive, announced the hubs in an interview with the House magazine. They are being set up at locations across England including Bedfordshire, Lancashire and north-east London. A handful are already in operation.
Read full story
Source: The Guardian, 22 February 2021
Patient Safety Learning

Infected Blood Inquiry: Man 'not told of Aids diagnosis for 18 months'

A man who was treated with imported blood products in the 1980s became the first haemophiliac in the UK to test HIV positive and die of Aids, an inquiry has heard.
Kevin Slater, from Cwmbran, was 20 when he developed Aids in 1983 the Infected Blood Inquiry has been told. He was not informed that he had been diagnosed with the condition for at least 18 months and died in 1985. Records show it was recommended that the diagnosis be kept from him.
The UK-wide inquiry is looking into what has been described as the worst treatment disaster in the history of the NHS.
Haemophilia is a blood condition which affects the clotting of blood in those affected. In the 1980s some of the blood products used to treat the condition were infected with HIV.
The inquiry heard there were about 100 haemophiliac patients in Wales at the time.
Mr Slater's sister-in-law Lynda Maule said she does not believe he was ever told he had Aids.
"He was treated disgustingly," she told the inquiry. "There was no care, nothing.
Read full story
Source: BBC News, 2 February 2021
Patient Safety Learning

Long Covid: ‘It’s a year since I’ve felt like myself’

Today is an anniversary that George Hencken never imagined. It is exactly one year since she caught COVID-19. But unlike most people who have suffered from the disease, she remains ill.
“It’s a year since I’ve felt like myself,” she said. “It’s a year since my life as I knew it came to an end. And I don’t know if I’m going to get it back again.”
Long Covid doesn’t quite describe the depths of her fatigue. “It’s not tiredness. It’s like having jet lag and a hangover. It feels like I’ve been poisoned,” she said.
The problem for Hencken and the thousands still suffering from the virus months later is that long Covid doesn’t describe much at all.
The umbrella term covers people who are breathless and fatigued, or who have brain fog, headaches and tingling arms, or who have chest pains and heart palpitations, or all of those and dozens more symptoms besides.
Support groups such as LongCovidSOS have been fighting hard for the condition to be recognised and taken seriously – sufferers say they feel disbelieved, and doctors initially had little information, support or even funding.
Last week the government announced £18.5m through the National Institute for Health Research to fund four major studies attempting to understand exactly what long Covid means, why it affects so many apparently healthy people, and how they can be helped. Research by University College London will track the health of 60,000 people, including people with long Covid and a control group who will wear a Fitbit-style wristband to measure heart rate, breathing and exercise levels.
The aim is to chart and identify clusters of symptoms, Professor Nishi Chaturvedi said. “My sense is that the multiplicity of symptoms that people are reporting suggests to me and many others that it’s not one thing, but several syndromes. We’re not even at the starting point yet of knowing what it is,” she said.
Read full story
Source: The Guardian, 20 February 2021
Patient Safety Learning

The NHS rose to the challenge of Covid, but its next test may be even harder

Over the past year, our NHS has risen to the challenges of the pandemic. But it’s been a very close-run thing. There have been well-publicised difficulties such as the shortage of ventilators, ICU beds and PPE, and the physical and staffing capacity of the health service has been strained to breaking point.
GPs have managed the risks to patients who have been unable to receive specialist care. We now face a growing backlog of postponed treatments and emerging mental health issues. So if we were to imagine a post-Covid NHS, toughened by the challenges of the pandemic but better prepared for the future, what would it look like?
To ensure the health service is capable of meeting the challenges it will face in the next decade and beyond, it will require both structural and local reforms. The word “reform” triggers unease among many NHS professionals, who have been subject to numerous reorganisations over the years and have witnessed efforts being diverted into reforms at the expense of improving patient care. While some of the changes in the recent NHS white paper seem sensible, their effectiveness will depend on the final detail.
To ensure the focus remains on patients, all policy reforms and local changes should convincingly pass at least one of these six tests:
Will they reduce demand on the NHS by preventing disease or improving wellbeing? Will they speed up the time between a patient seeking help and receiving treatment? Will they enhance patient safety before, during or after treatment? Will they enable better clinical outcomes? Will they provide better taxpayer value? And will they reduce the inequality of access that has resulted in some groups receiving less care than others? Read full story
Source: The Guardian, 18 February 2021
Patient Safety Learning

Genetic test predicts likelihood of developing common type of leukaemia

Scientists have developed a genetic test to predict whether someone will develop a common type of blood cancer.
The breakthrough could lead to potential patients being warned about the risk of progressive Chronic Lymphocytic Leukaemia (CLL) and boost their chances of survival.
CLL affects the white blood cells and tends to develop slowly over many years, mostly affecting those aged over 60. By studying blood samples of people with CLL, researchers found they often had the same "genetic tendency" to develop progressive forms of the illness.
The team, from eight UK universities and the Institute for Cancer Research, said their work would help doctors "move towards a more personalised diagnosis of leukaemia".
Haematology consultant Dr David Allsup, who is also a senior lecturer at Hull York Medical School, said: "Not only does the research inform us if patients have the genetic tendency to develop progressive CLL, but it also enables us to determine whether or not a patient's CLL will require treatment in the future or not."
"That way, we are able to keep a close eye on the patients with a high risk, and have treatment options available as soon as they are required."
Professor James Allan, from Newcastle University's Centre for Cancer, said: "Emerging evidence suggests that early treatment for patients at high risk of developing progressive CLL could significantly delay the onset of symptomatic leukaemia and improve survival."
Read full story
Source: The Independent, February 9 F2021
Patient Safety Learning

Sharp drop in patient goodwill towards NHS since autumn

Patient positivity about NHS hospital services suffered a sharp drop during the autumn, and satisfaction with access is now well below pre-pandemic levels, according to analysis exclusively shared with HSJ.
The analysis of social media and online sentiment by PEP Health appears to show that a surge of goodwill towards the health service during the first covid peak last spring dissipated last autumn.
At that time, the first-wave peak had passed, but hospitals were getting a lot busier — with more emergency attendances, and efforts to get planned appointments and procedures back close to normal levels. Emergency departments were coming under strain, coping with infection control measures, and large numbers of very long waits for elective care had built up. 
The drop in positive feeling towards NHS hospitals was particularly felt between October and January, especially with concerns over the speed of access to health services. The work only covers acute hospital services. 
One hospital chief executive told HSJ the change in patient sentiment was palpable at the frontline. “There is quite a lot of chippiness from patients and relatives. The ‘we love the NHS’ feels a very long lost memory.
“We see a lot of chippiness to staff, and aggression and irritability — which is understandable because everyone’s been waiting a long time — but is really unhelpful because everyone [staff are] knackered and trying to do their best.”
Read full story (paywalled)
Source: HSJ, 22 February 2021
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