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

Reviews of hospital-acquired covid deaths as ‘basic’ breaches found

Senior doctors are leading a programme of work to review deaths caused by hospital-acquired covid in the North West, which has had disproportionately high rates of nosocomial infections over the last three months.
According to internal NHS England papers seen by HSJ, a number of common themes have been identified as driving the infections in the region, including “breaches in the basic tenets of infection prevention control”, insufficient numbers of cleaning staff at some trusts, and a lack of consistent testing.
The papers say there is also evidence that covid occupancy rates above 20 per cent drives nosocomial transmission. Occupancy rates in the North West have been near or above this level since the start of December, but have still been significantly lower than other areas, such as London.
Read full story (paywalled)
Source: HSJ, 24 February 2021
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MHRA warns of pregabalin ‘breathing difficulties’

Pregabalin may be associated with serious breathing problems in patients with compromised respiratory systems, according to a drug safety alert from the medicines regulator.
Elderly patients, patients with neurological disease, renal impairment and those who are taking antidepressant medication are also at increased risk of breathing problems from the drug, the Medicines Healthcare Regulatory Agency (MHRA) said (18 February).
Pregabalin is a medication that has increasingly been prescribed to treat chronic pain, however, it is also used to treat epilepsy, fibromyalgia, restless leg syndrome, and generalised anxiety disorder.
The use of pregabalin combined with central nervous system depressants such as opioids has been associated with an increased risk of respiratory failure, coma, and deaths since 2018, said the MHRA. However, a recent review of the safety of the drug has found that the use of pregabalin alone can also cause ‘severe’ respiratory depression.
"The review identified a small number of worldwide cases of respiratory depression without an alternative cause or underlying medical conditions. In these cases, respiratory depression had a temporal relationship with the initiation of pregabalin or dose increase. Other cases were noted in patients with risk factors or underlying medical history. The majority of cases reviewed were reported in elderly patients," the alert said.
Health professionals have been advised to consider adjustments in dose or dosing regimen are necessary for patients at higher risk of respiratory depression.
The alert also told them to report suspected adverse drug reactions associated with the use of pregabalin via the Yellow Card website.
Existing advice asks healthcare professionals to check the patient for a history of drug abuse before prescribing pregabalin and to observe patients who have been prescribed the drug for signs of drug abuse and dependence.
Read full story
Source: Pulse, 23 February 2021
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Covid: Half with cancer signs didn't contact GP in first wave

Almost half of people with potential cancer symptoms did not contact their GP during the first wave of the pandemic, a survey suggests.
Symptoms left unchecked included coughing up blood, lumps and changes to the appearance of moles.
NHS figures showed a fall in referrals to cancer services last spring. However, this study, of almost 8,000 people, captures the fall in people contacting their GP in the first place.
The team that carried out the study, from Cardiff University and Cancer Research UK, said this raised concerns that people could be diagnosed later - and so be less likely to be treated successfully and recover.
They surveyed a representative sample of people across the UK and found that of 3,025 people who said they had experienced at least one symptom which could be a warning sign of cancer, 45% did not seek help.
They also found that:
31% did not seek help after coughing up blood 41% did not seek help for an unexplained lump or swelling 59% did not seek help after noticing changes to the appearance of a mole. Some of the reasons given by people who did not contact their GP were not wanting to waste doctors' time or put extra strain on the NHS; not wanting to be seen as someone who made a fuss; and fear of catching Covid at appointments.
But people who did contact their GP reported feeling "safe" and "secure" when attending face-to-face appointments.
Read full story
Source: BBC News, 25 February 2021
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Jeremy Hunt’s safety programme has stalled, say bereaved families

Bereaved families have been left feeling like their efforts to improve patient safety have been ‘in vain’ as progress of a government programme instigated by Jeremy Hunt appears to have ‘stalled’.
The Learning from Deaths programme board, which was set up in 2017 to develop guidance for trusts working with families on investigations of deaths, has not met since June 2019.
Josephine Ocloo and David Smith, two bereaved family members who were on the board, have written to HSJ, saying the programme’s progress has “stalled”.
They added many of the issues it was set up to consider have not yet been addressed, including the need for a national inquiry into unresolved historical cases, the independence of the NHS’ investigatory systems, lack of effectiveness of the duty of candour, and the disproportionate impact on ethnic minorities and those with mental ill-health or learning disabilities.
They said: “We now have serious concerns that what these families went through [in November 2017] in recalling — and effectively reliving — their experiences, in order to ensure the terrible things that happened to them could not happen to others, was in vain…
“If [the issues] are not to be addressed by the new board, the families will have every right to feel betrayed and to feel as if they have been used as pawns in a political game. Once again, harmed and let down by a system that has used us and then cast us aside.”
Read full story (paywalled)
Source: HSJ, 26 February 2021
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Oxygen shortages endangering half a million Covid patients every day in poorest countries, research shows

Shortages of oxygen are endangering the lives of more than half a million COVID-19 patients every day in the world’s poorest nations, new research has shown.
Despite being vital for the effective treatment of people admitted to hospital with coronavirus, sustained access to oxygen has proven difficult in low- and middle-income countries (LMICs) due to cost, infrastructure and logistical barriers.
According to Unitaid, a global health agency, more than half a million people in LMICs currently need 1.1 million cylinders of oxygen per day, with 25 countries currently reporting surges in demand, the majority in Africa.
Supplies of oxygen were already constrained prior to COVID-19 and have been exacerbated by the pandemic, Unitaid says.
Read full story
Source: The Independent, 25 February 2021
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Thousands of urgent operations building up across London as Covid pressures continue

Hospitals across London are racing to tackle a backlog of tens of thousands of urgent operations that need to be carried out in the coming weeks to prevent patients dying or losing limbs, The Independent has learnt.
The slow decline in Covid patient numbers means many hospitals across the capital are warning they will still be relying on extra staff, and “surge” beds opened at the height of the crisis, well into March.
NHS bosses have been briefed that across the city there are about 15,000 priority two (P2) patients. These are classed as needing urgent surgery, including for cancer, within 28 days, or they could die or be at risk of losing a limb.
But the lack of available operating theatres, nurses and anaesthetists mean the city has a shortfall of more than 500 half-day surgical lists a week.
The Independent has spoken with multiple NHS insiders and seen briefing documents detailing the challenges facing the capital’s hospitals, which are expected to last up to 21 March in some areas.
One briefing warned: “Hospitals have insufficient capacity to meet urgent elective demand for P2. P2 demand is intended to be seen within 28 days, the surge has occurred for over 28 days. Patients who would normally have been seen are waiting longer than clinically advisable."
Read full story
Source: The Independent, 25 February 2021
Sam

Pandemic’s role blamed for trust’s 1,955 mixed-sex ward breaches

East Kent University Hospitals Foundation Trust reported 1,955 mixed sex accommodation breaches in November, the month before the new variant of the virus caused a huge increase in covid admissions across the county.
Such breaches occur when patients share sleeping accommodation with the opposite sex.
The trust, which struggled last summer to prevent COVID-19 outbreaks in its wards, has recorded 7,249 such breaches in the last 12 months. This is a year-on-year increase of 1,112 per cent – according to the trust’s latest board papers.
East Kent FT’s board papers stated COVID-19 had “contributed” to the high number of breaches, and that it was “imperative that we review and act on this”.
According to the papers, the trust’s interim chief nurse and chief operating officer have a “plan to address” the problem.
In a statement to HSJ the trust said: “Our hospitals are very busy as a result of increased patients with COVID-19.
“To keep covid and non-covid patients separate and as safe as possible we have sometimes needed to care for both male and female patients in a bay. This is always done in discussion with the patients affected.”
Rachel Power, chief executive of the Patients Association, told HSJ they had “long supported” moves to abolish mixed sex accommodation breaches, which she described as “an affront to patients’ dignity”.
But she said she understood why NHS providers might choose mixed sex accommodation if it was a “viable route to saving lives, whether of COVID-19 patients or others urgently needing treatment”.
Read full story (paywalled)
Source: HSJ, 27 January 2021
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Patient-friendly tuberculosis preventive treatment to be rolled out in five high-burden TB countries at affordable price

A new fixed-dose combination (FDC) of “3HP”, a short-course tuberculosis (TB) preventive treatment (TPT) combining two drugs, rifapentine and isoniazid, is starting to be rolled out in five TB high burden countries in Africa. This will reduce the number of pills that people who need the treatment have to take every week from nine to three. Enough treatments for up to 3 million patients are expected to be made available for eligible countries this year.
Ethiopia, Ghana, Kenya, Mozambique, and Zimbabwe will be the first countries out of a total of 12 to provide the new regimen at a US$15 price thanks to funding from Unitaid, PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Read full story
Source: Unitaid, 3 February 2021
Patient Safety Learning

Critical care beds shortage prompts calls for review

The NHS's "insufficient" critical care capacity has been laid bare by the pandemic, with the UK having one of the lowest number of beds per head in Europe, NHS Providers has said.
The group, which represents trusts in England, is calling for a review of the health service's capacity.
The UK has 7.3 critical care beds per 100,000 people, compared to Germany's 33.8 and the US's 34.3, analysis found.
The government said it was investing £72bn in the next two years in the NHS. 
"The UK is towards the bottom of the European League table for critical care beds per head of population," NHS Providers said.
The group added that the UK had comparatively fewer critical care beds than France, Italy, Australia and Spain.
"It's neither safe nor sensible to rely on NHS hospital trusts being able to double or triple their capacity at the drop of a hat as they've had to over the last two months, with all the disruption to other care and impossible burdens on staff that involves."
Seeking a review into critical care capacity in England, the organisation said it wanted the government to commit to providing additional finances in areas where it was needed.
"There have been too many reviews of NHS capacity in the past where huge amounts of time have been wasted because the government has not been willing to fund the results of what's been found," the group said.
Read full story
Source: BBC News, 1 March 2021
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Annual payments for contaminated blood bereaved

People whose spouse or partner died as a result of the contaminated blood scandal are to receive financial help. Annual payments of up to £33,500 will be given to those whose loved one died after contracting HIV or hepatitis C having been given infected blood.
About 5,000 people, including 99 from Northern Ireland, were infected by what has been described as "the worst scandal in the history of the NHS".
The health minister said those who had been bereaved had not been forgotten.
Robin Swann added: "I have listened to their experiences of how contaminated blood has impacted on their lives and the sacrifices they have had to make.
"I sincerely hope this annual financial support will provide some long-term financial certainty as well as recognition for those bereaved through contaminated blood."
The contaminated blood scandal resulted in people who had haemophilia being treated with blood infected with hepatitis C or HIV in the 1970s and 1980s. 
At the time the UK was struggling to keep up with demand for the Factor VIII blood clotting treatment, so supplies were imported from the US. But much of the human blood plasma used to make it came from donors such as prison inmates and drug-users who sold their blood. Those groups were at higher risk of blood-borne viruses.
Victims have campaigned for decades, saying the risks were never explained to them and the scandal was covered up.
An ongoing public inquiry has been hearing harrowing stories from people across the UK about how lives had been destroyed by the blood.
Read full story
Source: BBC News, 1 March 2021
Patient Safety Learning

NHS may ‘never catch up’ with ophthalmology surgery backlog caused by covid

Delays due to the COVID-19 crisis have created tens of thousands of year-long waiters for ophthalmology treatment, and a surgery backlog which experts say may never be recovered.
NHS England provisional data shows the number of people waiting 52 weeks or longer for ophthalmology treatment increased to more than 23,000 in December, up 57,580% on just 40 the year before. 
Experts say ophthalmology procedures have been hit particularly hard by the cancellation of elective work due to COVID-19 pressures. On average, roughly 130,000 ophthalmology patients completed treatment per month in England in 2019, most of which would likely have been cataract surgeries.
Royal College of Ophthalmologists professional standards chair Melanie Hingorani told HSJ that many in the discipline feared “traditional” ways of working were too “fragmented” to address the size of the challenge. She said that without a “much more innovative” approach it would be “really difficult” to deal with the surgery backlog on ophthalmology and that clearing it could take “two years, maybe longer”.
There remained a danger, however, she added that: “Maybe we never catch up”. 
Read full story (paywalled)
Source: HSJ, 1 March 2021
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‘Substandard care’ for over-70s with ovarian cancer as 1 in 5 patients ‘gets no treatment’

Women aged 70 or over are receiving substandard care to tackle ovarian cancer with one in five patients in their seventies getting no treatment whatsoever, a new study has found.
A report from Ovarian Cancer Action revealed almost half of patients in their 70s do not undergo surgery to treat the disease, even though it provides the best long-term prognosis for one of the most common types of cancer in women.
In total, around one in five (22%) of ovarian cancer patients aged 70 to 79  and three in five women with ovarian cancer who were over 80 years old were given no treatment for the disease.
The inadequate healthcare given to older ovarian cancer patients causes a disproportionately high short term death rate for them, the study found.
The study found older patients are substantially less likely to be referred by their GP for diagnostic tests such as ultrasounds when ovarian cancer symptoms surface.
Dr Susana Banerjee, a consultant medical oncologist at The Royal Marsden, said: “With an ageing population, many more patients with ovarian cancer are over the age of 70, so there is an urgent need to understand the best way to effectively treat older women."
“Optimising patients for treatment through frailty assessments and interventions, sharing best practice across cancer centres and representing older patients in clinical trials are important steps towards ensuring equal access to effective and tolerable treatment that could help more women live beyond their diagnosis, with a good quality of life, no matter their age.”
Patient Safety Learning

34,000 people with dementia thought to have died of Covid in UK

More than 34,000 people with dementia are estimated to have died from coronavirus in the UK since the start of the pandemic, according to new figures.
The condition has been identified in just over a quarter of all deaths due to COVID-19, partly due to the large number of deaths in care homes. Nearly 12,000 care home residents have died since January alone.
A coalition of charities, including Alzheimer's Society, Dementia UK, John's Campaign and Together in Dementia Every Day (tide), are now calling for introduction of universal social care – free at the point of use like the NHS – as a legacy of COVID-19.
It comes as new figures from the Office for National Statistics revealed that deaths of care home residents, where around 70% of people have dementia, are 30%t higher than previously thought. Nearly 12,000 have died since January alone.
The charities also revealed the result of a survey of 1,001 people who care for someone close to them with dementia, demonstrating that the toll of the pandemic reaches further than simply deaths from the virus. More than nine in ten (92%) said the pandemic had accelerated their loved one's dementia symptoms, with a third (31%) reported a more rapid increase in difficulty speaking and holding a conversation, and a quarter (25%) in eating by themselves.
Nearly a third (32%) of those who lost a loved one during the pandemic thought that isolation/lack of social contact was a significant factor in that loss.
The Alzheimer Society and Dementia UK said their helplines had been flooded with calls from relatives reporting how quickly their loved ones were deteriorating.
Read full story
Source: The Independent, 1 March 2021
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Suicide inquest sparks warning on 'nine month wait' for treatment

The government has been called on to take action over the national “backlog” for a specialist mental health service after a woman died after a substantial wait to access treatment. 
Carole Mitchell, who died by suicide on 22 November 2019, waited almost seven months for a first appointment after being referred to Greater Manchester Mental Health Foundation Trust for psychology services.
In a prevention of future deaths report, published earlier this month, coroner Alison Mutch said the inquest was told waits had since increased and “someone in Mrs Mitchell’s position today would be more likely to wait nine months”. 
The coroner added evidence heard suggested the delay experienced was “reflective of both the regional and national backlog for appointments”. The report has been sent to both the Department of Health and Social Care and Greater Manchester Health and Social Care Partnership.
Read full story (paywalled)
Source: HSJ, 1 March 2021
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Covid vaccines cut risk of serious illness by 80% in over-80s

A single shot of either the Oxford-AstraZeneca or the Pfizer-BioNTech Covid jab reduces the chance of needing hospital treatment by more than 80%, an analysis in England shows.
The Public Health England (PHE) data showed the effect kicked in three to four weeks after vaccination. It was based on people aged over 80 who were the first to receive the jab.
Government scientists hailed the result, but stressed that two doses were needed for the best protection.
It comes after similar findings were published by Scottish health authorities last week, which they hailed as "spectacular".
The PHE data, which has not been peer reviewed, also suggested the Pfizer vaccine, which started being rolled out a month before the AstraZeneca vaccine, leads to an 83% reduction in deaths from Covid. This was based on people over the age of 80 who had died.
The data also showed vaccination cuts the risk of people over 70 developing any Covid symptoms by around 60%, three weeks after an initial dose.
Prof Van-Tam, England's deputy chief medical officer, said the decision to give the AstraZeneca vaccine to older people was "clearly vindicated".
Read full story
Source: BBC News, 1 March 2021
Patient Safety Learning

Surgery delays left dementia patient housebound

A woman with dementia was effectively left housebound for the last eight years of her life due to surgical delays, an investigation found.
The Public Services Ombudsman for Wales said the individual worried about being "caught short" due to incontinence and it affected her family relationships.
Her son complained about the care she received at Glan Clwyd Hospital in Denbighshire, in particular. Betsi Cadwaladr University Health Board has since apologised to the family.
Ombudsman Nick Bennett said it was clear there was "significant injustice" in the case of the individual, who was identified in the report findings as Mrs B.
The patient's son complained there had been surgical delays for a rectal prolapse issue dating back to 2011, concerns over inpatient medical care provided by an elderly care consultant, and a delayed diagnosis of terminal ovarian cancer during a hospital stay.
The ombudsman found that clinical decision-making by colorectal surgeons "was not in keeping with accepted clinical practice".
Read full story
Source: BBC News, 2 March 2021
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