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

Hormone replacement therapy: Northern Ireland shortage 'distressing' for women

The shortage of hormone replacement therapy (HRT) in Northern Ireland is distressing for women and challenging for pharmacies trying to access it, according to a community pharmacist.
Loretto McManus advised women to leave plenty of time for ordering their prescriptions.
The Health and Social Care Board said there were "some treatments which are currently experiencing supply issues".
HRT helps many women control their often difficult menopausal symptoms. There is a national shortage of HRT with officials citing several reasons including manufacturing delays, an increase in demand and possibly Brexit.
Ms McManus said certain products were out of stock in pharmacies across Northern Ireland and that this was "distressing" for women who have become used to particular treatments.
"As a community pharmacist the utmost care of our patients is premium to us," she said. "Trying to source the prescribed product in a timely manner for the patient can be challenging."
Several women have told BBC News NI that they were being offered substitutes or had to source the medication themselves.
Kathryn Schreuder, part of a Northern Ireland menopause support group, said: "For a lot of women, their concern is, if their medication isn't available and they have just maybe spent six months to a year getting the right level of what they need, for that suddenly to be changed because of the limitation of what is available is very distressing."
Read full story
Source: BBC News, 7 November 2021
Patient Safety Learning

In-person GP appointments save lives and must return

Last week a receptionist saved a patient’s life. She put him straight into a face-to-face appointment early in the day. The doctor saw him and sent him to A&E urgently. He was operated on the same day.
Receptionists are are given an impossible task, to fit a large number of patients into a small number of slots, and they have to stay calm. When the slots run out – which sometimes happens by 9am – they then have to persuade one of the doctors, already at the end of their tether, to add any patient they are especially worried about to their list.
So it’s not surprising that when during the early part of the pandemic demand for appointments dropped by 30%, some very stressed and overworked GPs found their lives were a lot nicer without patients. And now that appointment levels have finally (as of May 2021) gone back to normal levels, some are finding the demand very difficult to cope with.
This could explain GPs’ persistence at keeping patients at arms length. Telephone consultations are less intense somehow, less tiring. Some GPs feel they can control the day better by using telephone consultations and only bringing in some patients. But patients are experiencing this persistent distancing as rejection. And these rejections are hurtful. Some people have held on to problems for six months or more and then finally felt free to book an appointment when the restrictions ended in August.
Except the restrictions haven’t ended, not in general practice. GPs seem unable to let the remote triage go. GPs say: “We are seeing patients face-to-face. We’ve been seeing them throughout the pandemic,” which is true. But only some patients. Plenty of patients who would have benefitted from a face-to-face appointment or an examination have not been seen. Patients are not idiots. They know telephone consultations are not as good. They know, especially older patients, that proper doctoring involves an examination. They know that the rapport and connection with a doctor can only come from a face-to-face appointments. And they wish to book an appointment with their GP themselves, without facing multiple barriers.
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Source: The Independent, 6 November 2021
Patient Safety Learning

Springfield Village - new community-based mental health facility

A new community-based mental health facility is under construction in South West London.
Set to open during 2022, the new facilities will provide high quality inpatient services that are designed to deliver the most modern mental health care in the country. The service will give people the best chance to recover in the best environment and will support Trust staff to deliver outstanding care. The new buildings will form part of the new ‘Springfield Village’, which will include a new 32-acre park at Springfield Hospital, as well as hundreds of new homes. 
Ian Garlington, Director for South West London and St George’s Mental Health NHS Trust’s Integrated Programme, which is delivering investments in NHS mental health services in South West London, said: “We are proud to be leading the way in breaking stigma by developing facilities that will sit at the heart of our Springfield Village, alongside a fantastic new 32-acre park, supporting the health and wellbeing of our whole community.”
hub topic lead, Steve Turner, said: As a nurse who completed my registered nurse training at St George's Hospital and mental health nurse training at Springfield Hospital in the 1980s, I am very pleased to see this development on the site where I once worked and will be following progress with interest."
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Source: NHS South West London and St George's Mental Health NHS Trust
Patient Safety Learning

Long waits at A&E becoming normal, warn doctors’ groups

Long waiting times in emergency departments are becoming normal, with some patients spending days in A&E wards before they can be moved into other hospital beds, emergency physicians have warned.
Leaders of the Royal College of Emergency Medicine (RCEM) and the Society for Acute Medicine (SAM) said that some hospitals had effectively run out of space, meaning patients could not receive the right care until a bed became free.
NHS figures for September show that 5,025 patients waited for more than 12 hours to be admitted to hospital in England. That is only 1% of the 506,916 admitted via A&Es, but it is more than 10 times as many as the 458 waiting more than 12 hours in September 2019 and nearly twice as many as the January peak of 2,847.
Scientists at the Zoe Covid study said last week that UK cases of coronavirus may have peaked. But the React study at Imperial College found that the R number was between 0.9 and 1.1 with Covid cases at their highest levels.
Pressures on hospitals have prompted the Royal College of Nursing to call for a return to compulsory mask-wearing, while Sadiq Khan, the mayor of London, said that ministers should reimpose a legal obligation to wear masks on public transport, allowing police to enforce the law.
Read full story
Source: The Guardian, 7 November 2021
Sam

California couple sue clinic for alleged IVF swap 'horror'

A California couple gave birth to a stranger's child after being given the wrong embryo by a fertility clinic during in vitro fertilisation (IVF), says a lawsuit.
Daphna and Alexander Cardinale say they gave birth in September 2019 to a girl that looked nothing like them. After a DNA test, they found the couple that carried their daughter to term, and together decided to swap the girls.
This is not the first alleged mix-up during an IVF procedure.
IVF is a procedure during which a woman's eggs are fertilised by man's sperm in a laboratory before the embryos are implanted into a woman's uterus.
The Cardinales are suing the Los Angeles-based fertility centre, the California Center for Reproductive Health (CCRH), as well as In VitroTech Labs, an embryology lab.
The lawsuit alleges medical malpractice, negligence and fraudulent concealment. Neither company responded to a BBC News request for comment.
In an emotional news conference on Monday, Mrs Cardinale said her family's "heartbreak and confusion can't be understated".
"Our memories of childbirth will always be tainted by the sick reality that our biological child was given to someone else, and the baby that I fought to bring into this world was not mine to keep."
Read full story
Source: BBC News, 9 November 2021
Patient Safety Learning

East of England Ambulance Service warns of 999 call delays

An NHS ambulance service boss has urged 999 callers to not hang up as "there may be a delay before we pick up".
The East of England Ambulance Service (EEAS) said demands on the health service meant it was extremely busy.
Marcus Bailey, EEAS chief operating officer, said delays were due to a "combination" of Covid, winter pressures and recruitment.
He said the service planned to recruit 100 call-handlers over the next few months to help ease pressure.
The EEAS has published posters online telling emergency callers to be patient.
The service covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk.
Mr Bailey told BBC Look East: "It's about us warning people who are phoning 999 that it's really busy and at some points there may be a delay before we pick up the 999 call.
"Remain on the line, don't hang up, and we will get to you as soon as possible."
Read full story
Source: BBC News, 9 November 2021
Patient Safety Learning

‘It’s going to get worse’: view from inside the NHS as winter approaches

Bed occupancy in England’s hospitals has already reached normal peak winter levels, NHS leaders have warned.
While modelling suggests that the rise in Covid infection levels appears to have stalled for now, the chief executive of NHS Providers has stressed that bed occupancy levels at acute hospitals are already at 94-96%, an “unprecedented” situation not normally seen until the middle of winter.
It comes as long waiting times in England’s emergency departments are becoming normal, with the number of patients waiting for more than 12 hours increasing tenfold since 2019. Meanwhile, the NHS is undergoing a mounting workforce crisis and an enormous backlog of routine treatments that have built up over the pandemic.
Six healthcare workers describe to the The Guardian the pressures they are facing at the moment, highlighting staff shortages, rising wait times and abuse toward NHS workers.
Read full story
Source: The Guardian, 8 November 2021
Patient Safety Learning

Derriford Hospital trials routine pregnancy Group B Strep tests

A trial testing for Group B Strep during pregnancies has been welcomed by a mum who lost her son to the bacterial infection.
The trial at Derriford Hospital will see routine testing for the bacteria that can put newborns at risk.
Dawn Byly lost her third child Leo to the infection a day after he was born in Truro in 2003. "I would love to think this might help prevent other families going through such a traumatic loss," she said.
About one in four pregnant women are carriers of Group B Strep. Most do not have any symptoms, but it can spread to their child during labour and in a small number of cases the infection can be life-threatening.
Currently only women identified as being at risk are tested and if positive are offered antibiotics during labour and birth.
Tests are available privately and involve a late swab in pregnancy.
"Suffering the loss of a child is a tragedy and we are committed to making sure all women get the right support and best possible maternity care," said the Department of Health and Social Care.
"The UK National Screening Committee reviewed the evidence to screen for Group B Strep at 35 to 37 weeks of pregnancy in 2017 and concluded there was insufficient evidence to introduce a national screening programme," it added.
Dr Alexander Taylor, from Derriford Hospital in Plymouth, said: "It's felt uncomfortable as an obstetrician in the UK knowing America, Canada and many of our European neighbours have been routinely screening for Group B Strep.
"This large trial aims to uncover both the clinical effectiveness but also the cost effectiveness of instituting a programme like this."
Read full story
Source: BBC News, 9 November 2021
Patient Safety Learning

11,600 people caught Covid in hospital and died

More than 11,000 people who died from Covid probably caught the deadly virus while in hospital for other reasons, it has emerged.
Freedom of information requests to NHS trusts across England has revealed as many as one in eight people who have died in hospital from coronavirus during the pandemic actually arrived free of the virus.
An investigation by the Daily Telegraph has revealed 11,688 people are listed by the NHS as either probably or definitely catching the virus which killed them while in hospital.
Probable cases are those who tested positive at least eight days after admission, while definite cases require the patient to not have tested positive until they had been on the wards for at least 15 days.
The figures emerged as the government was expected to announce it will be mandatory for all NHS staff to be vaccinated against Covid by next spring.
Read full story
Source: The Independent, 9 November 2021
Patient Safety Learning

COVID-19: Vaccines to be compulsory for frontline NHS staff in England

Frontline NHS staff in England will have to be fully vaccinated against Covid, the health secretary has announced.
A deadline is expected to be set for 1 April next year to give unvaccinated staff time to get both doses, Sajid Javid told the Commons.
Between 80,000 and 100,000 NHS workers in England were unvaccinated, said Chris Hopson, head of NHS Providers.
Thursday is the deadline for care home workers in England to get vaccinated.
The government's decision follows a consultation which began in September and considered whether both the Covid and flu jabs should be compulsory for frontline NHS and care workers. Mr Javid said the flu vaccine would not be made mandatory.
There will be exemptions for the Covid vaccine requirement for medical reasons, and for those who do not have face-to-face contact with patients in their work, he added.
In a statement to MPs, Mr Javid said: "Having considered the consultation responses, the advice of my officials and NHS leaders including the chief executive of the NHS, I have concluded that all those working in the NHS and social care will have to be vaccinated."
"We must avoid preventable harm and protect patients in the NHS, protect colleagues in the NHS and of course protect the NHS itself."
Read full story
Source: BBC News, 9 November 2021
Patient Safety Learning

Patient kills herself on Glasgow hospital ward after 'failure in communication'

A woman took her own life on a ward after her move to a mental health hospital was not facilitated.
Anne Clelland was found unconscious in the toilet of her room in Glasgow's Queen Elizabeth University Hospital and later died of a brain injury.
Anne - who had a history of self-harm - was admitted following an overdose. She was due to be moved to a psychiatric hospital three days before her death but this did not take place because of a "failure of communication."
NHS Greater Glasgow and Clyde pled guilty today to failing to conduct their undertaking in a way that a person would not be exposed to risks to their health and safety.
Glasgow Sheriff Court heard Anne was admitted to Ward 5A at the hospital after overdosing on 7 May 2015. A specialist met with Ann on 11 and 12 May with a plan put in place for her to be transferred to Leverndale hospital once she was medically fit.
A psychiatry team was to be contacted at that time for a further review to facilitate the transfer.
Prosecutor Catriona Dow said: “There was no suggestion at this time that despite her ongoing treatment following her suicide attempt, that she was at risk of suicide and required special requirements such as the removal of her possessions and enhanced observations such as constant observations.”
“There appears there was a breakdown in communication regarding the intention of the psychiatrist that Anne would be transferred that evening due to her assessed risk of self-harm.”
Other witnesses recalled a plan for a transfer to Leverndale but it was understood that until a bed was to become available, she would be able to remain at Ward 5A.
Other staff appeared not to have been aware of the assessed risk of self-harm and her transfer to Leverndale that evening.
Read full story
Source: Glasgow Live, 8 November 2021
Patient Safety Learning

WHO’s 10 calls for climate action to assure sustained recovery from COVID-19

Countries must set ambitious national climate commitments if they are to sustain a healthy and green recovery from the COVID-19 pandemic.
The WHO COP26 Special Report on Climate Change and Health, spells out the global health community’s prescription for climate action based on a growing body of research that establishes the many and inseparable links between climate and health.
“The COVID-19 pandemic has shone a light on the intimate and delicate links between humans, animals and our environment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The same unsustainable choices that are killing our planet are killing people. WHO calls on all countries to commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests. WHO’s new report highlights 10 priorities for safeguarding the health of people and the planet that sustains us.”
The WHO report was launched at the same time as an open letter, signed by over two thirds of the global health workforce - 300 organisations representing at least 45 million doctors and health professionals worldwide, calling for national leaders and COP26 country delegations to step up climate action.
“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change,” the letter from health professionals reads. “We call on the leaders of every country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions.”
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Source: World Health Organization, 11 October 2021
Sam

COVID-19: Pfizer’s paxlovid is 89% effective in patients at risk of serious illness, company reports

Pfizer’s oral antiviral drug paxlovid significantly reduces hospital admissions and deaths among people with COVID-19 who are at high risk of severe illness, when compared with placebo, the company has reported.
The interim analysis of the phase II-III data, outlined in a press release, included 1219 adults who were enrolled by 29 September 2021. It found that, among participants who received treatments within three days of COVID-19 symptoms starting, the risk of covid related hospital admission or death from any cause was 89% lower in the paxlovid group than the placebo group.
Commenting on the announcement, England’s health and social care secretary, Sajid Javid, said, “If approved, this could be another significant weapon in our armoury to fight the virus alongside our vaccines and other treatments, including molnupiravir, which the UK was the first country in the world to approve this week.”
Read full story
Source: BMJ, 8 November 2021
Sam

AI skin cancer diagnoses risk being less accurate for dark skin – study

Artificial intelligence (AI) systems being developed to diagnose skin cancer run the risk of being less accurate for people with dark skin, research suggests.
The potential of AI has led to developments in healthcare, with some studies suggesting image recognition technology based on machine learning algorithms can classify skin cancers as successfully as human experts.
NHS trusts have begun exploring AI to help dermatologists triage patients with skin lesions. But researchers say more needs to be done to ensure the technology benefits all patients, after finding that few freely available image databases that could be used to develop or “train” AI systems for skin cancer diagnosis contain information on ethnicity or skin type. Those that do have very few images of people with dark skin.
Dr David Wen, first author of the study from the University of Oxford, said: “You could have a situation where the regulatory authorities say that because this algorithm has only been trained on images in fair-skinned people, you’re only allowed to use it for fair-skinned individuals, and therefore that could lead to certain populations being excluded from algorithms that are approved for clinical use."
“Alternatively, if the regulators are a bit more relaxed and say: ‘OK, you can use it [on all patients]’, the algorithms may not perform as accurately on populations who don’t have that many images involved in training.”
That could bring other problems including risking avoidable surgery, missing treatable cancers and causing unnecessary anxiety, the team said.
Read full story
Source: The Guardian, 9 November 2021
Patient Safety Learning

Thousands missed from breast implant registry

Thousands of women are being missed off the breast implant registry, new figures suggest.
Data from NHS Digital, which manages the register, implies that around 8500 women across England and Scotland have not been added to the register after they were fitted with an implant last year.
The register was recommended as a result of the breast implant scandal which saw some women fitted with faulty implants. 
It records the details of every person who has breast implant surgery in case of a product recall or another safety concern.
But the latest figures suggest that many are being missed off the register and NHS Digital has asked women undergoing such treatment to ensure their surgeon has registered their details.
The figures show that operations on 10,500 people were recorded in 2020. But officials have estimated this represents around 55% of the total number of cases. This means that approximately 8485 people were not added.
Lee Martin, NHS breast surgeon and chairman of the Breast and Cosmetic Implant Registry steering group, said: "We want all patients, past and present, to be aware that the registry exists and ensure they are included by speaking to their surgeons."
"As a surgeon, I know first-hand the importance of patient information being included on the registry, it's crucial in providing good patient care and provides patients with assurance that they will be followed up with if there are issues with their breast implants in the future."
Read full story
Source: Medscape, 10 November 2021
Patient Safety Learning

Epilepsy mortality in Scotland 'not reducing' as study finds hundreds of avoidable deaths

Campaigners have called for a change in how epilepsy services are delivered after "alarming" new research revealed that nearly 80% cent of deaths in young adults could have been avoided.
It comes as researchers behind the first ever national review into deaths linked to the condition warned that "little has improved in epilepsy care" despite previous findings of premature mortality.
They describe the situation as a "major public health problem in Scotland", adding that deaths "are not reducing, people are dying young, and many deaths are potentially avoidable”.
In particular, the Edinburgh University team found that adults aged 16 to 24 were five times more likely to die compared to the general population, a problem they said may be linked to the "vulnerable period of transition from paediatric to adult care".
Overall, for adults with epilepsy aged 16 to 54, the mortality rate was more than double that for the age group as a whole, with as many as 76% of these deaths potentially preventable and the majority occurring among patients from the most deprived areas.
Read full story
Source: The Herald, 11 November 2021
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