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

NHS backlog disproportionately affecting England’s most deprived

The NHS backlog is being disproportionately shouldered by people in poorer areas, according to new research, amid a stark warning that waiting lists are likely to “grow significantly” because millions of people did not seek help during the pandemic.
Waiting lists for routine treatments have grown by 50% in the most deprived parts of England, compared with nearly 35% in the most affluent areas. Those in deprived areas were also nearly twice as likely as those in the wealthiest to wait more than a year for treatment, according an analysis by the King’s Fund.
Jonathan Ashworth, the shadow health secretary, warned that the long waiting lists were in danger of leading to privatisation of the NHS.
“Waiting times have got so bad that you’ve got people taking out payday loans, sometimes even remortgaging their homes, because they cannot bear the pain, or the disruption to their lives, or fear they will lose their lives,” he said. “That is eroding the fundamental universal system that we created.”
Read full story
Source: The Guardian, 27 September 2021
Patient Safety Learning

Hospitals in England can relax Covid rules to treat more patients

Hospitals in England have been given the green light to ease some of the Covid infection-control measures that have been in place during the pandemic.
The changes, recommended by the UK Health Security Agency (UKHSA), are aimed at easing pressure on the NHS.
It says testing and isolating patients before planned operations can be dropped and hospitals can return to normal cleaning procedures.
Social distancing can also be reduced from 2m (6ft) to 1m in some areas.
UKHSA chief executive Dr Jenny Harries said the new recommendations would help local hospitals plan more elective care.
"This is a first step to help the NHS treat more patients more quickly, while ensuring their safety and balancing their different needs for care," she said.
Health and Social Care Secretary Sajid Javid said: "As ever more people benefit from the protection of our phenomenal vaccination campaign, we can now safely begin to relieve some of the most stringent infection controls where they are no longer necessary, to benefit patients and ease the burden on hardworking NHS staff."
Read full story
Source: BBC News, 28 September 2021
Patient Safety Learning

‘The system is broken’: Patients told to sit on chairs outside A&E

Sick patients have been forced to wait outside a hospital A&E department on chairs and wrapped only in blankets while being treated by nurses in shocking photographs and videos captured by one worried relative.
The situation, at Addenbrooke's Hospital in Cambridge, is a regular occurrence, workers have told The Independent.
Footage shared with The Independent by a concerned member of the public shows one patient being cannulated, where a needle and intravenous line is inserted into a vein, while another patient has a monitor attached to track their vital signs.
Patients waiting outside the A&E were said to be extremely sick, with some vomiting and complaining of worsening symptoms.
“It was like something out of a horror movie,” said Maria, who has asked for her surname not to be used. “The system is completely broken from the beginning to the end..."
Addenbrooke’s Hospital has been under severe pressure for months with patients queuing out the door earlier this year and patients waiting over 24 hours for a bed. One mental health patient was detained in the back of an ambulance for over 12 hours.
It is just one symptom of a nationwide summer crisis in the NHS, with the military called in to support ambulance services that have reported their busiest months ever. A&E units are also witnessing record levels of attendance.
Patients are being made to wait so regularly outside Addenbrooke’s A&E that heat lamps have been installed on the walls outside one entrance, used by non-Covid patients. The hospital has also built a marquee as a permanent space for waiting patients.
Read full story
Source: The Independent, 28 September 2021
Patient Safety Learning

Tennessee Board of Nursing’s unjust decision to revoke nurse’s license

The US Institute for Safe Medication Practices (ISMP) has expressed its shock that the Tennessee (TN) Board of Nursing has recently revoked RaDonda Vaught’s professional nursing license indefinitely, fining her $3,000, and stipulating that she pay up to $60,000 in prosecution costs.
RaDonda was involved in a fatal medication error after entering “ve” in an automated dispensing cabinet (ADC) search field, accidentally removing a vial of vecuronium instead of VERSED (midazolam) from the cabinet via override, and unknowingly administering the neuromuscular blocking agent to the patient.
While the Board accepted the state prosecutor’s recommendation to revoke RaDonda’s nursing license, ISMP doubts that the Board’s action was just, and believe that it has set patient safety back by 25 years.
On September 27, 2019, in a stark reversal of a 2018 decision to take no licensing action against the nurse, the TN Board of Nursing filed disciplinary action against RaDonda that focused on three violations:
Unprofessional conduct related to nursing practice and the five rights of medication administration Abandoning or neglecting a patient requiring nursing care Failure to maintain a record of interventions. During the hearing, RaDonda was given an opportunity to testify and defend herself; however, she never shrank from admitting her mistake. According to her defense attorney, her acceptance of responsibility for the error was immediate, extraordinary, and continuing. However, RaDonda also testified that the error was made because of flawed procedures at the hospital, particularly the lack of timely communication between the pharmacy computer system and the ADC, which led to significant delays in accessing medications and the hospital’s permission to temporarily override the ADC to obtain prescribed medications that were not yet linked to the patient’s profile in the ADC.
Although many questions regarding RaDonda’s alleged failures and the event remain unanswered, the Board still voted unanimously to strip RaDonda of her nursing license and levy the full monetary penalties allowed, noting that there were just too many red flags that RaDonda “ignored” when administering the medication.
The ISMP has asked whether the Board’s action was fair and just in this situation? 
Read full story
Source: ISMP, 12 August 2021
 
Patient Safety Learning

Digital Clinical Safety Strategy a ‘vote of confidence’ in technology

One week ago NHSX published the first of its kind Digital Clinical Safety Strategy – but what do industry leaders  think of the framework?
The strategy aims to help the NHS provide a safer service when using digital technology, including through training and better use of data.
Speaking to Digital Health News, Natasha Phillips, CNIO and director of patient safety at NHSX, said there was a clear demand for training in digital clinical safety in the NHS and that frontline staff were “excited” about learning more on using technology to improve safety.
The strategy aims to set out a “clear vision” and recommendations on how to use digital to improve safety, as well as expanding staff access to digital safety.
Sarah Hanbridge, chair of the Digital Health chief nursing information officer (CNIO) Network, welcomed the strategy but warned not to “underestimate” organisational changes it will require.
“Patient safety is all our responsibilities, as nurses and AHP’s [allied health professionals] delivering safe care is at the heart of what we do every day, proactively taking steps to prevent avoidable harm,” she told Digital Health News. “The Digital Clinical Safety Strategy has been welcomed by our [Digital Health] CNIO Network, as we know the benefits of how digital technologies can enhance patient safety in delivering care."
Reaction from suppliers has followed a similar pattern, with a recognition that safety needs to be embedded in the heart of digital.
Dr Constantin Jabarin, chief clinical information officer (CCIO) at Allscripts, said the strategy was a “vote of confidence” for digital health tools.
“As a clinician who also works for a technology company, I see the Digital Clinical Safety Strategy as a vote of confidence for digital solutions, rather than an obstacle, for improving patient safety issues,” he told Digital Health News.
“As a clinical user I can’t stress how important it is to design systems with the user and the patient in mind to ensure they contribute towards safer clinical practice.”
Read full story
Source: Digital Health News, 24 September 2021
Patient Safety Learning

NHS Highland pays out millions to bullied staff

NHS Highland says it expects to pay £3.4m in settlements to current and former staff who have complained of bullying.
Whistleblowers exposed a "culture of bullying" at NHS Highland in 2018. 
A Scottish government-commissioned review suggested hundreds of health workers may have experienced inappropriate behaviour. So far 150 cases have been settled since the start of a "healing process", costing the health board more than £2m.
Whistleblower Brian Devlin told BBC Scotland the scale of settlements made so far was "heartening", but he added that he continued to have concerns about bullying at the health board.
A group of Highlands GPs first complained of a culture of bullying at NHS Highland in September 2018.
Staff said they had not felt valued, respected or supported in carrying out "very stressful work". Others told of not being listened to when raising matters regarding patient safety concerns and decisions being made "behind closed doors".
The review also said that "many described a culture of fear and of protecting the organisation when issues are raised".
Read full story
Source: BBC News, 28 September 2021
Patient Safety Learning

‘Nightmare’ fuel shortages hit care of vulnerable patients

Community and mental health service providers have warned the ongoing fuel crisis and other traffic disruption is starting to impact the care of vulnerable patients.
Warnings about a HGV drivers shortage have prompted the panic-buying of fuel, with many petrol stations running out or heavily congested.
Julia Winkless, a senior social worker and approved mental health professional in Suffolk, told HSJ clinical visits had to be cancelled as people were unable to get to work. 
Ms Winkless said: “We work over a very rural area, none of these petrol stations where [staff] live have got any fuel and we don’t know when there is going to be deliveries. Today, there were four mental capacity assessments cancelled.”
There is also disruption to patient transport. A senior source at a West Midlands patient transport provider which often conveys people to mental health services told HSJ: “It’s been a bit of a nightmare in all honesty. We turned down a request this morning for a patient going to London because of the fuel and because of the [climate protesters disrupting motorways]… ultimately those patients are either at home and distressed carrying a big risk in the community or [accident and emergency] departments which [are not] the right settings.”
Read full story (paywalled)
Source: HSJ, 28 September 2021
Patient Safety Learning

Abuse became ‘normal’ at Birmingham care home, finds watchdog

A care home in Birmingham has been heavily criticised by the care watchdog after it found physical and verbal abuse of residents with learning disabilities and autism had become “normal”.
The Care Quality Commission (CQC) said it had put urgent restrictions on Summerfield House, in Birmingham, to stop any more people being admitted there.
The home was looking after four residents with disabilities in August when CQC inspectors found a string of concerns. Records revealed episodes of physical, verbal and emotional abuse of the residents with staff making threats to cancel activities or threatening to call the police.
The CQC found staff were not able to recognise abuse, citing an example where inspectors saw a person being hit on the head by another person with no action being taken.
The watchdog’s report said abuse was happening between residents and staff.
Debbie Ivanova, CQC deputy chief inspector for people with a learning disability and autistic people, said: “Our latest inspection of Summerfield House found a truly unacceptable service with a poor culture where abuse and people being placed at harm had become normal, with no action taken to prevent incidents from happening or reoccurring."
Read full story
Source: The Independent, 28 September 2021
Patient Safety Learning

Woman with agonising burns sent away from two hospitals: new rules mean people have to get urgent care at unit closest to home

Patients needing urgent care may be sent to the unit closest to their homes under new rules, the Manchester Evening News revealed.
Hospital bosses admitted the ‘protocol’ after one patient, suffering horrific burns, reported being sent away from two hospitals before receiving any care.
The Northern Care Alliance NHS Group has introduced the directive as part of a ‘reconfiguration of services across Greater Manchester’, saying that patients will be sent to the 'most appropriate place for their needs', 'closest to their home', in the 'quickest time possible'.
However, anyone needing care for emergency and life-threatening conditions can still go to their nearest A&E department for treatment, hospital chiefs have stressed.
The group operates Salford Royal Hospital, the Royal Oldham Hospital, Fairfield General Hospital, and Rochdale Infirmary, among other local care services.
The instructions come as a 64-year-old woman from Norden in Rochdale suffered with severe burns after accidentally tipping scalding water on herself while on holiday in Northumberland.
The woman - a former nurse of more than 30 years - was unable to treat the burns alone, and she returned home with her husband, immediately attending Rochdale Infirmary's Urgent Care Centre.
Noting that there would be a 'five-and-a-half hour wait' for urgent care, a staff member sent the patient to Fairfield General's Accident and Emergency Department in Bury, she says.
Read full story
Source: Evening Manchester News, 29 September 2021
Patient Safety Learning

Canada's nurses want national hiring and retention strategy amid staffing 'crisis' widespread burnout

Logan Giesbrecht left his dream job as an emergency room nurse when the mental health strain of an understaffed department became unbearable, even before the pandemic's fourth wave hit and anti-vaccination protesters began gathering outside hospitals.
“The biggest frustration, and what I'm taking home from work, was basically doing the job of more than one nurse,” said Giesbrecht, who feared low staffing levels would risk patient safety.
He quit working at Royal Inland Hospital in Kamloops, Canada, last April.
Representatives for nurses around the country are calling on the federal government to come up with a national plan to attract and retain nurses during a “crisis” they say needed action long before the uptick in cases from the Delta variant.
Statistics Canada released data this week from the second quarter of 2021 showing a steep rise in job vacancies for both registered nurses and registered psychiatric nurses, which are part of a single category in its analysis.
Those professions had the largest increase in vacancies of all occupations over a two-year period, up by 10,400 to 22,400 - a hike of nearly 86 per cent, the agency said, adding nearly half of the vacancies had been open for 90 days or more, compared with 24 days across all occupations.
Linda Silas, president of the Canadian Federation of Nurses Unions, said it's not uncommon for some registered nursing positions to be vacant for a couple of weeks, as workers switch jobs within a hospital or health region, but having vacancies unfilled for 90 days or longer is unsustainable.
Read full story
Source: CP24 News, 24 September 2021
Patient Safety Learning

NHS needs to ‘radically simplify’ data sharing rules, says tech chief

A national tech chief has called for a ‘radical simplification’ of the way in which NHS patients can opt out of having their data shared.
NHSX chief executive Matthew Gould today said the current system was “overly complicated” with “too many different opt out mechanisms” and it needs to be made “super simple” for the public.
His comments come as NHSX, NHS Digital and the Department of Health and Social Care are working on the much-delayed and controversial GP data-sharing programme. The scheme was paused indefinitely this summer after backlash from GPs and campaigners.
Speaking at the Healthcare Excellence Through Technology conference, Mr Gould said the NHS had a “rich history of misfiring” on getting the public’s trust for data-sharing projects, which included the recent furore around the paused General Practice Data for Planning and Research.
He said: “Where we are at the moment is an overcomplicated overlap of too many different opt out mechanisms and we’re trying to work out how to radically simplify this."
Read full story (paywalled)
Source: HSJ, 28 September 2021
Patient Safety Learning

Smokers up to 80% more likely to be admitted to hospital with Covid, study says

Smokers are 60%-80% more likely to be admitted to hospital with COVID-19 and also more likely to die from the disease, data suggests.
A study, which pooled observational and genetic data on smoking and COVID-19 to strengthen the evidence base, contradicts research published at the start of the pandemic suggesting that smoking might help to protect against the virus. This was later retracted after it was discovered that some of the paper’s authors had financial links to the tobacco industry.
Dr Ashley Clift at the University of Oxford and colleagues drew on GP health records, COVID-19 test results, hospital admissions data and death certificates to identify associations between smoking and Covid-19 severity from January to August 2020 in 421,469 participants of the UK Biobank study – all of whom had also previously had their genetic makeup analysed.
Compared with those who had never smoked, current smokers were 80% more likely to be admitted to hospital and significantly more likely to die from Covid-19 if they became infected.
Clift said: “Our results strongly suggest that smoking is related to your risk of getting severe Covid, and just as smoking affects your risk of heart disease, different cancers, and all those other conditions we know smoking is linked to, it appears that it’s the same for Covid. So now might be as good a time as any to quit cigarettes and quit smoking.”
Read full story
Source: The Guardian, 28 September 2021
Patient Safety Learning

US news publishes new list of best hospitals in the USA

U.S. News has just released its list of the best hospitals with associated rankings and ratings.
Scores are based on several factors, including survival, patient safety, nurse staffing and more. U.S. News reviews hospitals performance in 15 adult specialties, 10 pediatric specialties and 17 surgical procedures and medical conditions affecting millions of people across the country.
Find all of the rankings and ratings here
 
Clive Flashman

GPs to fall under remit of new patient safety watchdog from 2023

GP practices will be included in the remit of a new patient safety watchdog, due to come in from 2023 under the new Health and Care Bill, the Department of Health and Social Care (DHSC) has said. DHSC said that it expects the new Health Services Safety Investigations Body (HSSIB) to be ‘fully operational’ in England from April 2023 – ‘subject to parliamentary clearances’. 
It confirmed that the statutory independent body will investigate NHS care in GP practices, although it said that the HSSIB’s ‘focus is likely to be predominantly on investigating patient safety incidents in NHS trusts’. The body will also investigate care provided by the independent healthcare sector.
RCGP vice-chair Dr Gary Howsam said: ‘It is important that we have further details about how this regulator will interact with general practice, and the expectations it will have of GPs and our teams, including ensuring GPs are not implicated for systemic issues out of their control.’
Read the full article here
Clive Flashman

The NHS is hiding delays to care for millions of patients

Covid has created an urgent need, and a unique opportunity, to get the true waiting list out in the open.
The English waiting list continues to break new records in the aftermath of Covid, and even the Secretary of State says it could reach 13 million patients. But the referral-to-treatment data – bad as it is – doesn’t reveal the full scale of the backlog, partly because not all waiting lists fall under RTT rules, but also because the RTT waiting list data is inaccurate and incomplete.
The scale of these hidden delays could be vast - millions of patients. Some could wait for years, some indefinitely, always taking second place to the swelling RTT waiting list and the targets that surround it. Some patients who need urgent care will end up with disability or death. Others are already in terrible pain. All deserve better.
Read full article here
Source: HSJ (Paywalled). 20 September 2021
Clive Flashman
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