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Patient Safety Learning

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  1. Patient Safety Learning
    Coronavirus vaccinations at GP practices will now take ‘twice as long’ after regulators announced new rules just days before the jabs are rolled out across primary care.
    The Medicines and Healthcare products Regulatory Agency announced patients would have to be observed for 15 minutes after they received the vaccine. This came after two people had severe allergic reactions to the Pfizer/BioNTech vaccine.
    Primary care directors told HSJ the change means they have had to overhaul plans in their primary care networks and, in some areas, the vaccine programme will be “unfeasibly challenging” to deliver.
    Sources told HSJ workforce plans are being overhauled, while vaccines risk being wasted because of the additional time constraints. There have been claims some practices may drop the vaccination programme altogether, as they lack capacity to carry out 15-minute observations for each patient.
    One primary care director, who spoke to HSJ anonymously, said: “For us, we now need additional space for an observation area. It also makes it more difficult to efficiently flow through the vaccines as the actual vaccination process might take a few minutes, but the through flow of patients will be limited by the 15-minute wait.”
    They added: “The vaccine now taking at least twice as long to do creates logistical problems. Not insurmountable but there nonetheless."
    Read full story (paywalled)
    Source: HSJ, 11 December 2020
  2. Patient Safety Learning
    The number of COVID-19 infections likely to have been acquired in hospital are rising again for the first time in three weeks and their proportion of all cases has reached record levels for the second wave, HSJ can reveal.
    NHS England data covering the week to 6 December (the latest available) shows 1,787 COVID-19 cases were acquired in-hospital – a rise of almost 14% on the week before. The number of hospital-acquired, or “nosocomial”, infections had been falling since the week to 15 November, when 1,794 were recorded.
    This week, hospital acquired covid infections amounted to 21% of the 8,337 new cases which were recorded in hospitals – the highest proportion in the second wave. On 6 December alone, 24% of infections had probably been acquired in hospital rather than the community.
    Read full story (paywalled)
    Source: HSJ, 11 December 2020
  3. Patient Safety Learning
    The NHS is under pressure to publish a delayed review into a bullying scandal at Matt Hancock’s local hospital that involved senior clinicians being asked to provide fingerprint samples in a “witch-hunt” for a whistleblower.
    The “rapid review” into West Suffolk hospital, which Hancock had to recuse himself from because of his friendship with the boss at the trust, was ordered in January and had been due for completion in April. Its publication was put back to this month because of the coronavirus pandemic. But it is now not expected until spring.
    The Doctors’ Association UK suspects the conclusions are being sat on because they make embarrassing reading for the trust’s chief executive, Steve Dunn, described by Hanock as a “brilliant leader”.
    A consultant who chairs the hospital’s medical staff committee wrote to the NHS’s regional director for the east of England, Ann Radmore, last week warning that senior medics felt the hospital could not move on until the review was published.
    The NHS East insists the review will be published as soon as possible, but a source confirmed this is likely to be “spring next year”.
  4. Patient Safety Learning
    A prominent feminist campaigner and writer has described in devastating detail how she was left feeling “humiliated and alone” as she was forced to deal with a miscarriage without her partner.
    Caroline Criado Perez, the author of Invisible Women, called on NHS trusts to allow partners to attend medical appointments, scans and emergencies in maternity services, because the refusal to do so was “traumatising an already traumatised woman”. She added: “It needs to stop, now.”
    At the start of the coronavirus crisis, the majority of NHS trusts began preventing partners from accompanying pregnant women to the majority of maternity appointments, and reports suggest this is still the case in many areas.
    In September the Guardian revealed that three-quarters of NHS trusts were not allowing birth partners to support women throughout their whole labour, despite being told by the NHS and Boris Johnson to urgently change the rules on visiting.
    According to a November survey by the campaign group Pregnant Then Screwed (PTS), 82% of respondents said their local hospital had restrictions in place (for labour or scans), while 90% said that these restrictions were having a negative impact on their mental health.
    Read full story
    Source: The Guardian, 9 December 2020
  5. Patient Safety Learning
    At least 162,000 patients are waiting more than a year for routine NHS operations, the highest number for more than 12 years.
    Latest statistics from NHS England show 162,888 people were waiting over 52 weeks for hospital treatment in October this year.
    The total NHS waiting list for routine treatments at the end of October had reached 4.4 million with more than a third of patients waiting over 18 weeks – the NHS target for waiting times from referral to treatment.
    Earlier this year health think tanks had predicted the waiting list could hit 10 million, but NHS England said this had not come to pass because of the work of hospitals and NHS staff to keel waiting lists lower than they were last year.
    The median waiting time was just over 11 weeks, NHS England said 
    Some experts have warned of hidden demand for NHS surgeries with many patients yet to be referred to treatment because of the covid pandemic.
    A spokesperson for NHS England, said: “Although Covid hospitalisations almost doubled during November, for every Covid inpatient the NHS treated, hospitals managed to treat five other inpatients for other health conditions. With cancer referrals and treatments now back above usual levels, our message remains that people should continue to come forward for care when they need it."
    Read full story
    Source: The Independent, 10 December 2020
  6. Patient Safety Learning
    A hospital has apologised after an elderly cancer patient tested positive for coronavirus, having been left in a ward with another patient suffering from COVID-19 for several days.
    The Aneurin Bevan University Health Board, which serves the Royal Gwent Hospital in Newport, Wales, has confirmed that it is dealing with an outbreak of the virus at the hospital.
    It comes after Lesley Pook accused the hospital of “locking” her father James ‘Jim’ Pook and others in a ward with a coronavirus patient and “waiting for them all to develop symptoms”.
    Read full story
    Source: The Independent, 9 December 2020
  7. Patient Safety Learning
    Coronavirus has not caused an increase in stillbirths despite fears it could do so, Government data suggests.
    The Office for National Statistics (ONS) published data on Monday showing that the stillbirth rate decreased from 4.0 stillbirths per 1,000 total births in 2019, to 3.9 in the first three quarters (January to September) of 2020, in line with the long-term trend.
    The data comes amid fears that coronavirus can impact pregnancy and the stillbirth rate.
    Read full story
    Source: The Telegraph, 8 December 2020
  8. Patient Safety Learning
    The UK’s drug regulator has warned that people with have a history of “significant” allergic reactions should not receive the Pfizer-BioNTech vaccine.
    The Medicines and Healthcare products Regulatory Agency (MHRA) issued the warning after two NHS staff members who were administered with doses on Tuesday both suffered an allergic reaction.
    NHS England said all trusts involved with the vaccination programme have been informed.
    Dr June Raine, chief executive of the MHRA, said the regulatory body was examining the cases.
    “We know from the very extensive clinical trials this wasn’t a feature," she told a parliamentary committee on Wednesday. 
    "But if we need to strengthen our advice now that we’ve had this experience in the vulnerable populations - the groups that have been selected as a priority - we get that advice to the field immediately.”
    Read full story
    Source: The Independent, 8 December 2020
  9. Patient Safety Learning
    Dialysis patients who must travel to hospital are nearly four times as likely to die of covid than those aged over 80, but so far have not been prioritised for receiving vaccination, HSJ has learned. 
    UK Renal Registry data shows that, from March to November 2020, 3.3% of all in-centre haemodialysis patients have died from covid (662 deaths out of a population of 20,000). This figure compares to a death rate of approximately 0.7% in all those aged over 80 and 1.8% in over 90s.
    Although the government classifies dialysis patients as clinically extremely vulnerable to COVID-19, not all patients are able to receive dialysis at home and those receiving inpatient treatment still need to travel to dialysis clinics, either in main hospital buildings or smaller satellite clinics, three times a week.
    At present the Joint Committee on Vaccine and Immunisation COVID-19 vaccine prioritisation list ranks all dialysis patients at priority level four, alongside all other shielding patients and those aged over 70. Priority one covers all care home residents and staff, while priority two covers all over 80s and frontline health workers.
    The Renal Association wrote to Public Health England and JCVI over the weekend to ask for a change in vaccine prioritisation but, at the time of writing, has not received a response. 
    Read full story (paywalled)
    Source: HSJ, 9 December 2020
  10. Patient Safety Learning
    All non-urgent elective operations are being postponed for at least two weeks in a health system still seeing significant and growing pressure from coronavirus.
    The four acute trusts in Kent and Medway will still carry out cancer and urgent electives, but other work is being postponed. Relatively few elective operations are usually carried out around Christmas and New Year, meaning the county is likely to see little or no elective work for the next four weeks.
    In a covid update bulletin issued last night, the Kent and Medway Clinical Commissioning Group acknowledged the pressure hospitals across its area were under but stressed cancer and other urgent operations would go ahead.
    It added: “However, we are now pausing non-urgent elective services. This will allow staff to move to support the increased number of covid-19 patients.
    “Initially this will be for a two-week period. We will keep this under weekly review and will contact individual patients where appointments need to be rescheduled.”
    Read full story (paywalled)
    Source: HSJ, 8 December 2020
  11. Patient Safety Learning
    The increase in the number of remote GP consultations during the COVID-19 pandemic has not appeared to increase A&E attendances, according to the Care Quality Commission (CQC).
    The regulatory body discussed concerns about access to GP services during its September meeting, including the suggestion that the increase in remote consultations and a perceived lack of face-to-face appointments were potentially leading to ‘increased attendance at A&E’.
    However, chief inspector Rosie Benneyworth has confirmed that – having looked into this – the organisation has ‘not seen evidence’ to suggest a link between the two.
    Despite this, she noted ‘anecdotal concern’ about people attending A&E departments if they ‘feel their needs are not being met elsewhere’.
    GPs have faced media criticism in the past few months for the perception that they have are failing to provide face-to-face appointments, with some believing that patients attend A&E as a result.
    Minutes from the September CQC board meeting said: ‘Concerns about access to GP services were… discussed, including the suggestion that digital appointments were not meeting the needs of some patients and how this could potentially lead to increased attendance at A&E. Work to quantify the extent of the problem and to monitor it was underway.’
    But Dr Benneyworth told Pulse this week: ‘While there may be some anecdotal concern about people attending Emergency Department (ED) if they feel their needs are not being met elsewhere, we have not seen evidence to suggest a link between digital appointments and ED attendance. The latest figures also show there has not been a sharp rise in online/video appointments (according to NHS Digital they are not currently at pre-COVID-19 levels).
    Read full story
    Source: Pulse, 7 December 2020
  12. Patient Safety Learning
    A 90-year-old woman has become the first patient in the world to receive the Pfizer Covid-19 vaccine after its approval in the UK, where the NHS has launched its biggest vaccine campaign.
    Margaret Keenan received the jab at about 6.45am in Coventry, marking the start of a historic mass vaccination programme.
    The vaccines will be administered at 50 hospital hubs around the country, with patients aged 80 and over who are either already attending hospital as an outpatient or are being discharged home after a hospital stay, being first in line.
    Read full story
    Source: The Guardian, 8 November 2020
  13. Patient Safety Learning
    Great Ormond Street Hospital may have broken the law by failing to share information with parents that showed its errors had contributed to their son’s death, The Independent understands.
    The care watchdog is speaking to Great Ormond Street about its handling of an expert report into five-year-old Walif Yafi in 2017.
    It showed that the hospital’s failure to share results that showed a deadly infection had played a role in Walif’s death. But the boy’s parents were only told about the findings after inquiries by The Independent – months after settling a lawsuit with Great Ormond Street in which the trust denied responsibility.
    The Care Quality Commission is looking at concerns relating to duty of candour regulations, which require hospitals to be open and honest with families about mistakes made that result in serious harm to patients. Breaching the regulations is a criminal offence and can lead to prosecution.
    Read full story
    Source: The Independent, 7 December 2020
  14. Patient Safety Learning
    The lateral flow devices used in the community testing pilot in Liverpool only picked up half the COVID-19 cases detected by polymerase chain reaction (PCR) tests and missed 3 out of 10 cases with higher viral loads, according to the government’s own policy paper.
    Given the low sensitivity of the Innova lateral flow devices when used in the field, experts are questioning how they can be used to allow care home residents to have contact with relatives over Christmas safely or for students to know for certain that they are not infected before returning home.
    The information can only be found by looking in annex B of the document, Community testing: a guide for local delivery, which was published on 30 November. This is the first publicly available information about the field evaluation of the Innova tests in Liverpool which has been criticised for its lack of transparency, accuracy of the tests used, and costs and potential harms.
    Read full story
    Source: BMJ, 4 December 2020
  15. Patient Safety Learning
    Concern is growing that NHS hospitals may face a third wave of the coronavirus pandemic with a much higher level of covid-positive inpatients than at the beginning of the second wave.
    This raises the prospect of the service being overwhelmed during the January-February “winter pressures” period and having to once again halt elective and non-urgent work in many areas.
    HSJ understands national NHS leaders are concerned that anything over 5,000 covid patients in hospital by the year end would leave the service vulnerable to being overwhelmed.
    Their concerns are based on the fact that the second wave added 13,000 hospitalised covid patients at peak. During the first wave, covid hospitalisation peaked at just over 17,000, and in order to prepare for it the NHS cancelled most elective and non-urgent work.
    Read full story
    Source: HSJ, 7 December 2020
  16. Patient Safety Learning
    More people signed off sick with mental health problems during lockdown, analysis reveals. Millions of people expected to need help after effect of coronavirus on UK
    A GP fit note is issued after the first seven days of sickness absence if a doctor agrees the patient is too ill to work
    The proportion of people applying for fit notes from their GP for mental health reasons jumped 6% during lockdown in England, according to new research.
    It adds to growing concern the UK will see a surge in mental health problems as a result of the pandemic and the impact on society and the economy.
    It could be the first signs of increasing mental health illnesses since the pandemic started.
    The Centre for Mental Health think tank has warned the government needs to prepare for the aftermath of COVID-19.
    Its analysis, based on research into COVID-19 and the effects of other epidemics on mental health, predicts 8.5 million adults and 1.5 million children in England will need support for depression, anxiety, post-traumatic stress disorders and other mental health difficulties in the coming months and years. That is the equivalent of 20 per cent of all adults and 15 per cent of all children. A third of patients would need help for the first time.
    Read full story
    Source: Independent, 6 December 2020
  17. Patient Safety Learning
    The coronavirus vaccine is the "beginning of the end" of the epidemic in the UK, Prof Stephen Powis has said, as vaccinations begin on Tuesday.
    But the NHS England medical director warned the distribution of the Pfizer/BioNTech vaccine would be a "marathon not a sprint". It will take "many months" to vaccinate everybody who needs it, he said.
    Frontline health staff, those over 80, and care home workers will be first to get the COVID-19 vaccine.
    In England, 50 hospitals have been initially chosen to serve as hubs for administering the vaccine. Scotland, Wales, and Northern Ireland will also begin their vaccination programmes from hospitals on Tuesday.
    Prof Powis was speaking outside Croydon University Hospital in south London, which became one of the first hospitals in the UK to take delivery of the vaccine on Sunday.
    Read full story
    Source: BBC News, 6 December 2020
  18. Patient Safety Learning
    Women in a newly opened psychiatric intensive care unit (PICU) had concerns for their sexual safety, a Care Quality Commission (CQC) report has revealed.
    Inspectors found women in the PICU at Cygnet Health Care’s Godden Green Hospital, in Kent, were afraid to shower because male staff did not always knock before entering bedrooms and staff entered bathrooms without permission. Patients were often looked after by male staff despite having asked for a female staff member and, in some cases, had an all-male care team.
    Most patients the inspectors spoke to had concerns about their sexual safety.
    The CQC carried out an unannounced inspection of the PICU in October, following concerns raised by members of the public and to check concerns identified in an earlier inspection of the hospital’s child and adolescent mental health services were not organisational. 
    The PICU opened in November 2019. Since the summer, Kent and Medway NHS and Social Care Partnership Trust has commissioned some of the beds, but HSJ understands it stopped admissions for a time to review the care being provided. 
    Inspectors found records referred to PICU patients as “difficult” and “troublemakers” and warned a ”culture of negativity towards patients had developed among some staff”.
    Read full story (paywalled)
    Source: HSJ, 4 December 2020
  19. Patient Safety Learning
    Healthcare practitioners who committed child sexual abuse commonly did so under the guise of medical treatment, which went unchallenged by other staff even when unnecessary or inappropriate because of their position of trust, research has found.
    An independent inquiry into child sexual abuse report into abuse in healthcare settings between the 1960s and 2000s found that perpetrators were most commonly male GPs or healthcare practitioners with routine clinical access to children. As a result their behaviour was not questioned by colleagues, the children or their parents.
    In many cases patients’ healthcare needs related to physical, psychological and sexual abuse they suffered at home. They spoke of attending health institutions seeking treatment, care and recovery, but were instead subjected to sexual abuse. This included fondling, exposing children to adult sexuality, and violations of privacy. More than half who shared their experiences described suffering sexual abuse by penetration.
    Read full story
    Source: The Guardian, 4 December 2020
  20. Patient Safety Learning
    A new mother has spoken of her distress after wrongly-imposed Covid rules led to her being separated from her six-week-old baby for almost a week while she received treatment in hospital.
    Charlotte Jones, 29, was taken to Princess Royal University hospital in Kent by ambulance last Wednesday, after complications following the birth of her son, Leo. When she arrived, she asked whether she would be able to see her baby, whom she is breastfeeding, while in hospital, but was told it would not be allowed because of the threat of coronavirus. She did not see him until her release six days later.
    The restrictions as applied in Jones’s case, appear to contravene official guidance and go against the advice of NHS England, which specifies that mothers and babies should be kept together unless it is absolutely necessary to separate them. Separation at such a critical time can have an adverse impact on the physical and mental health of the mother, baby and wider family, say healthcare professionals and charities.
    King’s College NHS foundation trust, which manages the hospital, has admitted that although it is limiting the number of visitors during the pandemic, there is no policy stopping babies to be brought in to be breastfed. The trust has pledged to ensure staff are aware of its policies.
    Read full story
    Source: The Guardian, 4 December 2020
  21. Patient Safety Learning
    NHS staff will no longer get the coronavirus vaccine first after a drastic rethink about who should be given priority, it emerged last night.
    The new immunisation strategy is likely to disappoint and worry thousands of frontline staff – and comes amid urgent warnings from NHS chiefs that hospitals could be “overwhelmed” in January by a third wave of COVID-19 caused by mingling over Christmas.
    Chris Hopson, the chief executive of NHS Providers, said: “If we get a prolonged cold snap in January the NHS risks being overwhelmed. The Covid-19 restrictions should remain appropriately tough.
    “Trust leaders are worried about the impact of looser regulations over Christmas.”
    Frontline personnel were due to have the Pfizer/BioNTech vaccine when the NHS starts its rollout, which is expected to be next Tuesday after the Medicines and Healthcare products Regulatory Agency (MHRA) approved it on Wednesday.
    However, hospitals will instead begin by immunising care home staff, and hospital inpatients and outpatients aged over 80. The new UK-wide guidance on priority groups was issued by the joint committee on vaccination and immunisation (JCVI) amid uncertainty over when the rest of the 5m-strong initial batch of doses that ministers ordered will reach the UK.
    Read full story
    Source: The Guardian, 4 December 2020
  22. Patient Safety Learning
    More than 60,000 people in the UK have now died within 28 days of a positive COVID-19 test, official figures show.
    A further 414 were recorded on Thursday, taking the total to 60,113.
    Two other ways of measuring deaths - where Covid is mentioned on the death certificate, and the number of "excess deaths" for this time of year - give higher total figures.
    Only the US, Brazil, India and Mexico have recorded more deaths than the UK, according to Johns Hopkins University.
    However, the UK has had more deaths per 100,000 people than any of those nations. In terms of deaths per 100,000 people, the UK is the seventh-highest country globally, behind Belgium, San Marino, Peru, Andorra, Spain and Italy.
    Read full story
    Source: BBC News, 
  23. Patient Safety Learning
    A hospital serving the prime minister’s constituency has been issued a warning notice by inspectors over poor infection control, including staff having to share two small toilet cubicles for changing.
    The Care Quality Commission (CQC) announced it has issued the notice to The Hillingdon Hospitals FT today following an unannounced inspection in September.
    It comes after the watchdog placed urgent conditions on the provider following a coronavirus outbreak among staff at Hillingdon Hospital in August. At least 70 members of staff had to isolate, some of whom had tested positive for covid.
    The watchdog said it found there had been improvements, but that “further work is needed”.
    The CQC’s inspection report, published today, said there were no staff changing rooms available for people to change in and out of their scrubs, and that they were sharing two small toilet cubicles at the start and end of shifts.
    These were not cleaned with an “enhanced” cleaning schedule, it added, and the lack of separate changing rooms “caused a risk of cross-contamination”. However, senior leaders were aware of the risk and were seeking ways to improve access to changing areas for staff.
    Read full story (paywalled)
    Source: HSJ, 4 December 2020
  24. Patient Safety Learning
    Thirteen trusts are facing billions of pounds of maintenance — in some cases, making it more cost-effective to rebuild the hospital — over ‘significant safety issues’ stemming from outdated construction methods. 
    Reinforced autoclaved aerated concrete planks were used when constructing public sector buildings in the 1960s, 70s and 80s, including a group of prefabricated hospitals under the government’s “Best Buy” building programme. However, RAAC planks used in buildings constructed prior to 1980 have now exceeded their shelf life, meaning affected trusts need to carry out frequent inspections and expensive maintenance.
    For at least three of the affected trusts — Mid Cheshire Hospitals FT, Airedale FT and The Queen Elizabeth Hospital King’s Lynn FT — it would be more cost-effective to build new hospitals than replace the planks in their existing facilities.
    Victoria Pickles, director of corporate affairs at Airedale FT, told HSJ 85% of the trust’s buildings’ floors, roofs and walls comprised RAAC planks, with one ward closing due to the risk.
    Read full story (paywalled)
    Source: HSJ, 3 December 2020
     
  25. Patient Safety Learning
    Staff at a mental health unit missed "multiple opportunities" to realise a woman had become unwell before she died, a coroner has said.
    Sian Hewitt, 25, died at Milton Keynes Hospital last year after collapsing at the nearby Campbell Centre. Coroner Tom Osborne said there was "a failure to start effective CPR".
    A spokesman for the centre said changes have been made to how care is delivered.
    Ms Hewitt, who had Asperger's syndrome and bipolar disorder, was admitted to the inpatient unit on 13 March 2019.
    She died less than a month later on 6 April 2019 at Milton Keynes Hospital, where she was taken after collapsing on Willow Ward at the centre.
    An inquest concluded she died of a pulmonary embolism, caused when a blood clot travels to the lungs.
    In a Prevention of Future Deaths Report, Mr Osborne said the centre failed to carry out a risk assessment and there was a delay in administering a drug resulting in "her mania not being brought under control".
    His report said the "failure to recognise how seriously ill she had become" had "resulted in lost opportunities to treat her appropriately that may have prevented her death".
    He said her death suggested the NHS was "unable to provide a place of safety for those who are suffering from Asperger's syndrome" or other forms of autism "when they are also suffering additional mental health problems such as bipolar".
    Read full story
    Source: BBC News, 4 December 2020
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