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

USA: It's not just doctors and nurses reporting burnout. Support staff are feeling stressed

The vast majority of front-line clinical support staff are reporting moderate to extreme burnout, and nearly two-thirds have considered quitting, a new US survey found.
"While much has been reported on doctor and nurse burnout, less attention has been paid to the front-line clinical support staff who have been working tirelessly throughout the COVID-19 pandemic to ensure high-quality patient care was maintained," Meg Aranow, senior vice president and platform evangelist for patient experience vendor Well Health, told Fierce Healthcare.
"We recognize the critical role clinical support staff play in provider organizations—this study further validates the cascading impact clinical support staff have on the patient experience and so many facets of our healthcare system," Aranow said.
Well Health surveyed 320 clinical support staff who are primarily responsible for communicating and coordinating with patients, mostly through phone calls, which can be time-consuming. According to the survey results, the patient-communication coordination process is overwhelming staff to the point of wanting to quit, with 82% saying that contacting and coordinating with patients about their appointments, follow-ups and health issues via phone, email, text or live chat is a direct cause of their burnout.
The survey found that 58% of clinical support staff believe their burnout has negatively affected a patient’s quality of care, and 60% report poor or ineffective patient communication has negatively affected a patient’s health outcomes.
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Source: Fierce Healthcare, 20 October 2021
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Man fitted with stoma after 'unnecessary' surgery

A patient who suffered internal bleeding from surgery following an incorrect diagnosis, said he has "nightmares" about how he was treated.
The public services ombudsman for Wales said it was "completely avoidable" and recommended health officials make a redress payment of £10,000.
The man was initially referred to Cardiff's University Hospital of Wales with appendicitis. But, after a number of tests and scans, it was wrongly determined he had Crohn's disease, and colon surgery was recommended which led to a series of complications.
The man, known as Mr D in the ombudsman's report, suffered internal bleeding from the initial surgery and required a stoma, despite being told the chances of that were "very, very slim".
He also developed a hernia which required further surgery, and a mesh to be inserted.
"I try and do things that wouldn't have been a problem for me years ago, and find I struggle," he said.
"Sometimes I wake up still in pain from some of the scars. I sometimes have nightmares."
The man, who has Asperger's syndrome, also said it was not taken into proper consideration during consultation.
"I don't think there's a lot of things where people do take into account neurodiversity," he said.
Ombudsman Nick Bennett called the case "regrettable" after investigating the man's complaint.
"Physicians responsible for Mr D's care should have employed a watch and wait approach in which his condition would probably have settled without surgical treatment," he said.
"Instead, Mr D, a vulnerable individual, faced completely avoidable trauma of unnecessary surgery and post-treatment complications - a trauma which saw him seek mental health support."
Cardiff and Vale University Health Board said it accepted the findings.
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Source: BBC News, 7 December 2021
Patient Safety Learning

Republic of Ireland: Most HSE staff felt negative change at work during pandemic

The vast majority of HSE staff in the Republic of Ireland felt supported during the COVID-19 pandemic but more than half felt there has been a negative change in their working environment, a new survey has found.
Staff across the health service were asked about their work, and responses from almost 13,000 staff showed a mixed impact since the pandemic with staff saying they were more enthusiastic about their job than in 2018 but were less optimistic about their future in the health service.
Three in 10 said they had been subject to assault from the public in the past two years. One in three felt more positively towards the HSE since before the pandemic began.
The survey found there had been an increase in the satisfaction with the level of care delivered since 2018 but almost 4 in 10 felt the service delivered was deteriorating.
There was a strong sense of job security among staff, but satisfaction levels have fallen back on the previous survey three years ago. A third said they were dissatisfied at present.
Despite the fact that an anti-bullying taskforce was set up after the previous survey, the same number of staff reported experiences of being bullied by a colleague as in 2018. Three in 10 said they had experienced bullying or harassment at work from a manager, team leader or other colleagues.
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Source: The Irish Times, 6 December 2021
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Patients face ‘inevitable rationing’ as one in four psychiatry posts not substantive

Psychiatry is facing a ‘double whammy’ of chronic consultant shortages where patient care is being rationed and under-pressure doctors are working with ‘hands tied behind their backs’, a leading clinician has warned.
As the Royal College of Psychiatrists’ official 2021 census reveals consultant vacancies are up by more than a third (35 per cent) since 2017 with nearly one in 10 posts going unfilled, current Dean Professor Subodh Dave told HSJ the current situation impacts “very adversely” on achieving NHS long-term plan goals.
In an exclusive interview, the Derbyshire-based liaison psychiatrist told HSJ one in four (24%) of the country’s 7,782 consultant posts are not substantive and are currently dominated by locums, typically on shorter-term contracts.
Professor Dave said current workforce gaps are having a knock-on effect with “inevitable rationing” of patient care to keep services running.
“If you design a service that has to meet NICE standards then clearly you need the workforce to deliver that standard of care,” he added.
“To do that with your hands tied behind your back is frankly impossible.”
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Source: HSJ, 6 November 2021
Patient Safety Learning

‘Sheer desperation’ felt by A&E staff admitted by trust

An investigation into whistleblowing claims which described patients “hanging off trolleys” and “vomiting down corridors” in a crowded emergency department has upheld most of the concerns.
It comes after a staff member at Northern Lincolnshire and Goole Foundation Trust wrote to the chief executive and trust’s commissioners after working a weekend shift within the emergency department at Diana, Princess of Wales Hospital in Grimsby.
In their original email, sent in January 2020, the anonymous whistleblower said they were writing out of “sheer desperation for the safety of patients”.
They added: “I have never in my whole career seen patients hanging off trolleys, vomiting down corridors, having [electrocardiograms] down corridors, patients desperate for the toilet, desperate for a drink. Basic human care is not being given safely or adequately…"
“Your hospital is full, your A&E department is over-flowing, you are expecting staff to manage treble the amount of patients in majors and resus than they would do normally, without breaks, this is not safe. They cannot provide that care – which is evident.”
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Source: HSJ, 7 November 2021
Patient Safety Learning

Doctors report 13,000 cancelled operations in UK over two months

UK hospitals have cancelled at least 13,000 operations over the last two months as they struggle to cope with record demand for NHS care and people sick with Covid-19.
Figures collected by A&E doctors showed that 13,061 planned surgeries had to be called off during October and November because of shortages of beds and staff.
However, the cancellations occurred at just 40 of the several hundred NHS hospitals across the four home nations, so those 13,061 are likely to be a major underestimate of the scale of the problem.
Dr Adrian Boyle, a vice-president of the Royal College of Emergency Medicine (RCEM), which published the data, said the cancellations represented “a stark warning for the months ahead”.
He also warned that A&E units across the NHS are “verging on crisis” because of their growing inability to provide timely care to the increasing numbers of patients seeking help. “Urgent and emergency care is verging on crisis and it is impacting and derailing elective care, meaning surgery for patients with serious conditions is delayed,” he added.
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Source: The Guardian, 7 December 2021
Patient Safety Learning

Female ambulance staff subjected to ‘macho and sexualised’ culture

A ‘macho’ culture within ambulance trusts is leading to widespread abuse of female staff.
HSJ has been told of multiple cases including sexual misconduct, harassment or abuse against staff in the last two and a half years. These include:
women being told that giving sexual favours would help them get on to paramedic training a woman who was told she would pass her driving course if she gave oral sex to a superior a student on placement who could not take off her jacket without comments being passed on her breasts, and therefore would wear it even on the hottest days a student given a lift by her supervisor who then proceeded to rub his hands up and down her legs during the journey. In a freedom of information request, the 10 ambulance trusts in England were asked for the number of incidents in which allegations of sexual misconduct, harassment or abuse had been made against staff.
The trusts reported 221 cases since April 2019, of which at least 27 resulted in dismissal and at least 44 resulted in other disciplinary action, with some cases still under investigation.
Read full story (paywalled)
Source: HSJ, 7 December 2021
 
Patient Safety Learning

Staff who refuse covid vaccination may see ‘impact upon their pay and pension’

NHS staff who have to be redeployed because they refuse to be vaccinated against covid may be forced to ‘compete’ for a new role and could find their pay and pensions affected if their transfer becomes permanent, according to new NHS England guidance.
Health and social care secretary Sajid Javid announced last month that all patient-facing NHS staff would need to have received two doses of the covid vaccine by 1 April 2022.
This includes non-clinical staff who may have face-to-face contact with patients, such as receptionists, porters and cleaners.
Guidance published this week urged organisations to identify options for potential redeployment to non-face-to-face roles, but advised against taking formal action until the new rules receive Parliamentary approval.
The guidance said: “Employers should consider the possibility of redeployment for staff in scope of the regulations and who remain unvaccinated on 1 April 2022.”
Read full story (paywalled)
Source: HSJ, 8 December 2021
Patient Safety Learning

Nearly 2,000 young patients left waiting a year or more for specialist mental health care in Scotland

Nearly 2,000 children and teenagers have been left waiting for specialist mental health care for at least a year in Scotland, according to official figures branded “damning” by psychiatrists.
New NHS Scotland data has revealed that, at the end of September, there were 1,978 patients who had been waiting 52 weeks or more for a Child and Adolescent Mental Health Services (CAMHS) appointment.
That is more than double the 959 young people who were waiting that long the previous September – despite efforts by Nicola Sturgeon’s government to meet its own 2023 target for 90% of young people to receive help within 18 weeks.
Ahead of the Holyrood Budget on Thursday, the figures prompted calls from service providers for a “radical transformation of our mental health services” enacted with the same zeal as the response to the coronavirus pandemic and with a focus on earlier interventions to prevent young people “giving up on their futures”.
According to the latest figures, there were a total of 11,816 young people waiting for an appointment by the end of September – just 78% of them who had been seen within 18 weeks.
Dr Helen Smith, chair of the CAMHS faculty of the Royal College of Psychiatrists in Scotland, said the long waits for help highlighted the “many problems” with these services “across the length and breadth of the country”.
“The fact that our vulnerable children and young people are still waiting to be seen is, frankly, not good enough,” Dr Smith said. “We need them to be able to access the right support at the right time, from the correct services.”
Read full story
Source: The Independent, 8 December 2021
Patient Safety Learning

Britain’s drinking deaths rose at record rate in pandemic

Britain’s lockdown drinking habits may have had fatal consequences. Deaths caused by alcohol in 2020 increased by almost 19%, marking the biggest rise since records began, according to the Office for National Statistics.
There were 8,974 deaths from alcohol specific causes registered in the 12 month period, up from 7,565 deaths in 2019 – the highest year-on-year increase since the data series began in 2001. It bucks a trend in which fatalities from alcohol remained stable for the previous seven years.
In England, the number of people drinking more than 14 units a week increased after the first national lockdown, according to surveys by Public Health England (PHE), and has remained at similar levels since. As pubs shut, drinking at home soared, with off-licence sales of beer rising 31% and spirits 26% compared with 2019.
Dr James Tucker, the head of health analysis, said: “There will be many complex factors behind the elevated risk since spring 2020."
“For instance, Public Health England analysis has shown consumption patterns have changed since the onset of the coronavirus pandemic, which could have led to hospital admissions and ultimately deaths. We’ve seen increases in loneliness, depression and anxiety during the pandemic and these could also be factors. However, it will be some time before we fully understand the impact of all of these.”
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Source: The Guardian, 7 December 2021
Patient Safety Learning

Mental health access frustration for deaf people

Deaf people are twice as likely to suffer mental health problems than those with hearing, a report has found.
The All Wales Deaf Mental Health and Wellbeing Group said help in Wales was behind the rest of the UK and it wants to see significant improvements.
It also described the inequalities faced by deaf people trying to access mental health support as "really frustrating".
The Welsh government said it would consider the findings of the report.
Ffion Griffiths, 23, from Neath, has been deaf since birth, and accessing child and adolescent mental health services in Wales has been a problem over the years. She had to travel to England to get the support she needed.
"It's really frustrating because deaf people in England have more opportunities," she said. It means they can be treated and get better quicker but for us, how can we do that?"
"How can we expect to recover if we don't have access to the services or any pathways for us to follow to get the treatment that we need in Wales?"
Read full story
Source: BBC News, 8 December 2021
Patient Safety Learning

Covid PCR test market a ‘rip-off jungle’, says ex-chair of competition regulator

The former chairman of the UK competition regulator has condemned the market for PCR tests for travellers, describing it as a “rip-off jungle”.
After the reimposition of the requirement to take the tests on return from abroad, Lord Tyrie accused the government of once again allowing the companies offering PCR tests to manipulate the system by making them available at unrealistic prices.
“For this policy to get into a mess once might be seen as a misfortune but for it to resurface again after all the warnings over the summer would have to be described as carelessness,” he told BBC Radio 4’s Today programme. “It was a scandal waiting to happen and it’s now happened and it needs very urgent action.”
Last week, the Guardian revealed that a slew of the cheapest deals on PCR tests had been removed from the government website amid concerns travellers were being misled by companies advertising the coronavirus testing service for less than a £1.
Private companies offering day two tests for travellers are listed on a government website for consumers to search. However, most of the deals were found to not be suitable for most travellers as they were often offered in only one location, on limited dates and only available to those who could attend in person.
“It appears that some of the worst practices – misleading online advertisements, overpricing, unacceptably poor service among them – are still widespread,” said Tyrie, the former head of the Competition and Markets Authority, and the ex-chair of the Treasury select committee.
Read full story
Source: The Guardian, 8 December 2021
Patient Safety Learning

USA: Safety alert issued over age-related COVID-19 vaccine mix-ups

Three pharmacy and medication safety organisations are warning clinicians about a reported increase in age-related COVID-19 vaccine mix-ups.
The Institute for Safe Medication Practice's National Vaccine Errors Reporting Program said it's seen a "steady stream" of mix-ups involving the Pfizer vaccine intended for kids ages 5-11 and formulations for people 12 and older. ISMP said the reports involved hundreds of children and included young children receiving formulations meant for those 12 and up or vice versa.

The safety organisation said some errors were linked to vial or syringe mix-ups. In other situations, healthcare providers gave young children a smaller or diluted dose of the formulation meant for people 12 and up.
"Vaccine vials formulated for individuals 12 and up (purple cap) should never be used to prepare doses for the younger age group," the organisation said.
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Source: Becker's Hospital Review, 7 December 2021
Sam

Doctors and nurses vent anger as unvaccinated Covid cases delay vital operations

The NHS has a backlog of 5.8 million waiting for surgery and specialists are increasingly frustrated at how the unvaccinated have left them unable to tackle it.
Doctors and nurses have told of their anger and frustration at not being able to treat seriously ill patients as new figures show that more than 90% of Covid sufferers requiring the most specialist care are unvaccinated.
While the success of the vaccination rollout has reduced the overall impact of COVID-19 on hospitals, intensive care clinicians from across England have spoken out over the continuing pressure they are under.
Between 20% and 30% of critical care beds in England are occupied by Covid patients and three-quarters of those have not been vaccinated, according to the latest data up to July this year.
Read full story (paywalled)
Source: The Times, 4 December 2021
Patient Safety Learning

Most adolescents dying by suicide or harming themselves known to health services

Around 80% of adolescents who died by suicide or who had self-harmed had consulted with their GP or a practice nurse in the preceding year, shows new research.
The large study of 10 to 19-year-olds between 2003 and 2018, published in the Journal of Child Psychology and Psychiatry, also puts forward a series of proposals to deal with the problem.
The study, funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust (NCA).
It showed that 85% who later took their own lives consulted with their GP or a practice nurse at least once in the preceding year; the equivalent figure was 75% for those youngsters who harmed themselves non-fatally.
Lower than expected rates of diagnosis of psychiatric illness, around a third in both groups, were probably down to a lack of contact with mental health services, rather than an absence of psychiatric illness, argue the research team. Depression was by far the commonest of the examined conditions among both groups, accounting for over 54% of all recorded diagnoses.
Also, while suicide was more common in boys, non-fatal self-harm was more common in girls. Two-thirds of adolescents who died by suicide had a history of non-fatal self-harm.
And while self-harm risk rose incrementally with increasing levels of deprivation, suicide risk did not.
Read full story
Source: The University of Manchester, 7 December 2021
Sam

NHS report reveals decade of failings in care of vulnerable man

A vulnerable man detained for 10 years was failed by a system meant to care for him, an independent NHS investigation has found.
Clive Treacey, a man who lived his life in the care of NHS and social care authorities, experienced an “unacceptably poor quality of life”, and was not kept safe from harm before his death at just 47.
The findings of the independent review, The Independent and Sky News can reveal, have concluded Mr Treacey’s death was “potentially avoidable” and comes after years of his family “fought” for answers.
His family are now pursuing a second inquest into his death after the review found a pathologist report and post-mortem used by coroners did not follow guidelines, along with new CCTV footage from the night he died.
NHS England commissioned the review, under the Learning Disability Mortality Review Programme, in January 2020 – three years after Mr Treacey’s death and after his family was initially denied a review.
In an exclusive interview with The Independent, Mr Treacey’s sister, Elaine Clark said: “We have fought on because Clive deserved nothing less. He spent his entire life being incarcerated and so did we, his entire family. He didn’t matter. His voice didn’t matter. His human rights didn’t matter. His life choices didn’t matter. The system and its people believed he did not matter and nobody in it had enough ambition to do anything differently."
“Well Clive did matter. It matters what happened to him. It matters that it’s still happening to other people. And it matters that nothing seems to be changing we are one family but there are many others like us.”
Read full story
Source: The Independent, 9 December 2021
Sam
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