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Patient Safety Learning

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  1. Patient Safety Learning
    Black women are more than four times more likely to die in pregnancy or childbirth than white women in the UK, a review of 2017-2019 deaths shows.
    The MBRRACE-UK report found women from Asian backgrounds are almost twice as likely to die as white women.
    Some 495 individuals died during pregnancy or up to a year after birth, out of 2,173,810 having a child.
    The charity Birthrights is concerned that overall "this bleak picture has not changed in over a decade".
    University of Oxford researchers say for the vast majority of people, pregnancy remains very safe in the UK. But despite slight decreases in the maternal death rate in recent years, there have been no significant improvements to these rates since the 2010 to 2012 period.
    Their current report shows heart disease, epilepsy and stroke continue to be the most common causes of death. And they say in some 37% of cases, improvements in care may have made a difference to the outcome.
    Lead researcher, Prof Marian Knight, said: "Pregnant women get inequitable care for several reasons.
    "Healthcare professionals often attribute their symptoms to pregnancy alone and they do not always end up getting the treatment they need because people can be incorrectly concerned about giving them medication.
    "On top of that is the unconscious bias that black and Asian women can experience. It all adds up.
    "We know from other studies that the disparity in death rates cannot be fully explained by socio-economic factors and other medical conditions for example. We need to look for other reasons."
    Read full story
    Source: BBC News, 11 November 2021
  2. Patient Safety Learning
    Health experts have raised the alarm over “serious” delays in diagnosing children and young people with cancer, as a study reveals the number found to have the disease during the pandemic fell by almost a fifth.
    The University of Oxford found a “substantial reduction in childhood, teenage and young adult cancer detection” in England last year. The research, being presented on Friday at the National Cancer Research Institute (NCRI) festival, showed a 17% drop in cases diagnosed in the under-25s last year compared with previous years.
    The impact of Covid on adults with cancer is well known. However, previously little has been known about the toll on younger patients.
    As well as the fall in the overall numbers of children diagnosed with cancer, researchers found that even those whose cancer was spotted last year were more likely to have been diagnosed only after being admitted to intensive care. That suggests long delays in accessing care may have made them much sicker, experts say.
    Read full story
    Source: The Guardian, 12 November 2021
  3. Patient Safety Learning
    Lives are at risk because patients are facing unacceptably long waits for a 999 response, paramedics across the UK have told a BBC investigation.
    Average waits for emergency callouts for problems such as heart attacks and strokes are taking more than twice as long as they should in England. Targets are being missed in the rest of UK too, with some seriously-ill waiting up to nine hours for an ambulance.
    There are numerous investigations ongoing into deaths linked to delays.
    The problems have forced all ambulance services to be put on their highest levels of alert - meaning patients who can make their own way to hospital are told to do so. A number of services have also brought in the military to support crews. 
    The BBC has received reports of numerous serious incidents across the UK.
    Margaret Root, 82, waited nearly six hours for an ambulance to come following a stroke, and she then waited for another three hours outside hospital. When she was finally admitted, her family was told it was too late to give her the drugs needed to reverse the effects of the stroke.
    Her granddaughter Christina White-Smith said her grandmother had been "hugely let down".
    She said she did not blame the staff because they were "amazing" when they got to her grandmother, but said she is angry the NHS is not getting the help it needs.
    "I don't think people are aware of the severity of the situation."
    Read full story
    Source: BBC News, 11 November 2021
     
     
     
  4. Patient Safety Learning
    England has the highest death rates of frail and older hospitalised patients in the western world, a landmark global study has found.
    Harvard University, the London School of Economics (LSE) and the thinktank Health Foundation, all part of the International Collaborative on Costs, Outcomes and Needs in Care (Icconic), a global network of healthcare researchers, used thousands of official medical records to compare the cost and quality of care in 10 OECD (Organisation for Economic Co-operation and Development) countries.
    Patient deaths are commonly used measures of performance in healthcare systems but until now there have been few sources of comparable death rates across countries.
    In order to assess outcomes in frail and older patients, researchers focused on two groups that represent priority areas for the NHS and other healthcare systems: those in hospital with a hip fracture and those admitted with heart failure who have diabetes.
    On both measures, England had higher mortality rates than all the other countries, which included the US, Germany, France, Sweden and Spain.
    Dr Jennifer Dixon, the chief executive of the Health Foundation, said: “The findings of the Icconic study warrant urgent further investigation, particularly the finding of higher mortality among patients with hip fracture in the year after their admission for emergency treatment."
    “That patients in England with hip fracture spend far longer in hospital after surgery than they would in other countries also highlights an opportunity to improve efficiency by reducing the avoidable use of hospital care. Less avoidably long stays would mean existing capacity could be better used to address the backlogs in hospital care as a result of the pandemic. This could contribute to both better outcomes for patients and, as hip fracture is the most common reason for emergency surgery, significantly improved productivity for hospitals across the country.”
    Read full story
    Source: The Guardian, 10 November 2021
  5. Patient Safety Learning
    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
  6. Patient Safety Learning
    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
  7. Patient Safety Learning
    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
  8. Patient Safety Learning
    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
  9. Patient Safety Learning
    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
  10. Patient Safety Learning
    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
  11. Patient Safety Learning
    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
  12. Patient Safety Learning
    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
  13. Patient Safety Learning
    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
  14. Patient Safety Learning
    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
  15. Patient Safety Learning
    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."
    Read full story
    Source: NHS South West London and St George's Mental Health NHS Trust
  16. Patient Safety Learning
    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.
    Read full story
    Source: The Independent, 6 November 2021
  17. Patient Safety Learning
    An acute trust currently rated ‘outstanding’ has been served with a warning notice by the Care Quality Commission, after senior doctors’ safety concerns prompted an inspection.
    Inspectors visited University Hospitals Sussex Foundation Trust days after HSJ reported on a letter from consultants highlighting “an extremely unsafe situation” and calling for elective work to be moved away from one of the trust’s main hospitals.
    The inspection looked at surgical areas at the Royal Sussex County Hospital, in Brighton, and maternity services at four sites – the RSCH, St Richard’s in Chichester, Worthing Hospital and the Princess Royal Hospital in Haywards Heath.
    In a letter to all staff, seen by HSJ, chief executive Dame Marianne Griffiths said the trust was “striving to improve” but that “the last four months are like nothing I have ever seen before. Like others we are facing unprecedented daily challenges”.
    She said: “High patient numbers combined with continuing to work through the pandemic with the stringent infection prevention and control processes that entails make for a challenging work environment.”
    Chief nurse Maggie Davies said: “The safety of our patients is always our number one priority. Our services remain under unprecedented pressure and our staff are working hard to provide the highest standards of care to all our patients.
    Read full story (paywalled)
    Source: HSJ, 5 November 2021
  18. Patient Safety Learning
    Saiqa Parveen was eight months pregnant and weeks from welcoming her fifth daughter to the world, but died of Covid after putting off getting the coronavirus jab. Her family have now issued an emotional plea for pregnant women to get vaccinated.
    Parveen, 37, had planned to delay having the jab until her baby was born, her family said, but she was admitted to hospital with breathing difficulties in September and put on a ventilator.
    A decision was taken by medical staff at Good Hope hospital in Sutton Coldfield, Birmingham, to deliver the baby by emergency caesarean section. Parveen died on 1 November after spending five weeks in intensive care.
    Asked what her last words were, her husband Gahfur said: “She couldn’t even talk. She couldn’t breathe properly … She couldn’t talk.”
    He added: “I’m going to pass this message to the whole world, I just beg all people to get the vaccine, otherwise it’s very hard for them. It’s a very deadly disease, you know. She planned so many things, and this disease didn’t give her a chance.”
    Covid vaccines are recommended for pregnant women. In a letter to midwives, obstetricians and GP practices in July, the chief midwife for England, Jacqueline Dunkley-Bent, said all healthcare professionals had “a responsibility to proactively encourage pregnant women” to get vaccinated.
    Parveen chose not to have the vaccine, but concerns have been raised that pregnant women are being turned away from vaccine clinics despite clinical advice.
    Members of the Joint Committee on Vaccination and Immunisation told the Guardian that they were urging ministers to focus more on pregnant women because only about 15% in the UK have been fully vaccinated. 
    Read full story
    Source: The Guardian, 7 November 2021
  19. Patient Safety Learning
    Inside the emergency department at Sparrow Hospital in Lansing, Michigan, staff members are struggling to care for patients showing up much sicker than they’ve ever seen.
    Tiffani Dusang, the ER’s nursing director, practically vibrates with pent-up anxiety, looking at patients lying on a long line of stretchers pushed up against the beige walls of the hospital hallways. “It’s hard to watch,” she said.
    But there’s nothing she can do. The ER’s 72 rooms are already filled.
    “I always feel very, very bad when I walk down the hallway and see that people are in pain, or needing to sleep, or needing quiet. But they have to be in the hallway with, as you can see, 10 or 15 people walking by every minute,” Dusang said.
    The scene is a stark contrast to where this US emergency department — and thousands of others — were at the start of the pandemic. Except for initial hot spots like New York City, in spring 2020 many ERs across the country were often eerily empty. Terrified of contracting covid-19, people who were sick with other things did their best to stay away from hospitals. Visits to emergency rooms dropped to half their typical levels, according to the Epic Health Research Network, and didn’t fully rebound until this summer.
    But now, they’re too full. Even in parts of the country where covid isn’t overwhelming the health system, patients are showing up to the ER sicker than before the pandemic, their diseases more advanced and in need of more complicated care.
    Read full story
    Source: Kaiser Health News, 29 October 2021
  20. Patient Safety Learning
    There have been more than 30 serious security breaches at NHS hospital mortuaries in the past five years, The Independent can reveal.
    The figures come as local MPs demand a public inquiry into the crimes of NHS electrician David Fuller who sexually abused 100 corpses, including three children, over a period of 12 years.
    The calls for a full inquiry have also been backed by Labour’s shadow health secretary Jonathan Ashworth who said on Friday: “It is important the secretary of state listens to the concerns of the local MP and the families of those who have been involved, and establishes a full, swift public inquiry, so that lessons can be learned from this appalling incident and ensure this is never repeated.”
    Fuller, aged 67, pleaded guilty on Thursday to the murders of two women, Wendy Knell, 25, and Caroline Pierce, 20, in two separate attacks in Tunbridge Wells, Kent, in 1987.
    Detectives searching Fuller’s home found four million images of sexual abuse he had downloaded from the internet on computer hard drives.
    They also found footage he had filmed of himself carrying out attacks on the bodies of women at the now-closed Kent and Sussex Hospital and the Tunbridge Wells Hospital, where he had worked since 1989.
    Read full story
    Source: The Independent, 5 November 2021
  21. Patient Safety Learning
    The High Court in Canberra, Australia, has ruled against big pharma giants Johnson and Johnson's application to appeal the Federal Court’s decision in favour of the survivors of their defective medical devices in November 2019.  This means the decision of the Full Federal Court, in favour of the Lead Applicant and group members, will stand.
    Shine Lawyers', which has led the class action, has launched further actions against American Medical Systems (AMS), another manufacturer of mesh and tape implants supplied in Australia. The AMS implants, which are used to treat pelvic organ prolapse and stress urinary incontinence, have left many Australian women with severe complications. The legal group has also moved against Boston Scientific for defective vaginal mesh and sling implants received by women in Australia and opened a second Ethicon / Johnson & Johnson’s on behalf of women implanted with a defective mesh product on or after 4 July 2017.  The class actions were filed in the Federal court and MIA believe other class actions, including hernia mesh, are underway.
    Kath Sansom, founder of the Sling the Mesh campaign, said "Brilliant news from Australia! Johnson & Johnson Loses High Court Appeal against the pelvic mesh verdict of 2019. This means J&J can no longer appeal the verdict! I realise compensation may still take time to be awarded to the 10,000+ mesh injured but at least the appeals are over! Congratulations to all the Australian mesh campaigners!"
    Read press release
  22. Patient Safety Learning
    The first pill designed to treat symptomatic Covid has been approved by the UK medicines regulator.
    The tablet - molnupiravir - will be given twice a day to vulnerable patients recently diagnosed with the disease.
    In clinical trials the pill, originally developed to treat flu, cut the risk of hospitalisation or death by about half.
    Health Secretary Sajid Javid said the treatment was a "gamechanger" for the most frail and immunosuppressed.
    In a statement he said: "Today is a historic day for our country, as the UK is now the first country in the world to approve an antiviral that can be taken at home for Covid."
    Read full story
    Source: BBC News, 4 November 2021
  23. Patient Safety Learning
    A man who murdered two women 34 years ago went on to sexually abuse 100 female corpses in hospital mortuaries, taking videos and images of his crimes, HSJ can reveal.
    David Fuller was employed as an electrician and later a maintenance supervisor at the now closed Kent and Sussex Hospital, in Tunbridge Wells, and later the Tunbridge Wells hospital in Kent. Over a period of 12 years from 2008 to 2020 he used his access to the hospital mortuaries to sexually abuse the bodies of women and girls.
    HSJ first learned of David Fuller’s crimes in June this year, but agreed to a request by Kent police not to publish before his trial concluded. They can now reveal all that they discovered.  
    Police have identified 80 victims – from mortuary records and name tags visible in some of the photos and videos Mr Fuller took of the abuse – but 20 are currently unidentified.
    Mr Fuller’s mortuary offences – which he admitted at a court hearing last month – only came to light when he was arrested for the 1987 murders of Caroline Pierce and Wendy Knell. Police searching his home in Heathfield, East Sussex, discovered millions of videos and photographs, some clearly showing him abusing the bodies.
    To many of his colleagues at Tunbridge Wells Hospital, David Fuller was an affable and helpful maintenance supervisor who was always willing to carry out small tasks and was the “go to” man if a problem needed sorting. His arrest on murder charges last December was greeted with shock and disbelief by those who knew him.
    Both the families of the women violated by Mr Fuller and some staff at Maidstone and Tunbridge Wells are expected to need psychological help to deal with the enormity and nature of Fuller’s crimes.
    Families will be offered a range of support, including psychiatric counselling, and will also be given a letter from Mr Scott, with a personal apology and containing an invitation for them to contact the trust if they want to.
    Read full story (paywalled)
    Source: HSJ, 4 November 2021
  24. Patient Safety Learning
    A special Crown Office unit set up to probe Covid-linked deaths is considering 827 cases in Scotland's hospitals, latest figures show.
    The unit was set up to consider the circumstances of Covid-linked deaths such as those in care homes. But the prosecution service has also received reports of hundreds of hospital-related virus deaths.
    Prosecutors will eventually decide if these deaths should be the subject of a fatal accident inquiry or prosecution.
    As of 7 October, Crown Office figures show Scotland's biggest hospital, the Queen Elizabeth University Hospital in Glasgow, has the highest number of reported Covid-linked deaths at 113.
    This was followed by the Royal Alexandra Hospital in Paisley and Glasgow Royal Infirmary which both had 71 Covid-related deaths referred to the Crown Office.
    The figures do not include deaths at home addresses or hospices, or where a care home resident died in hospital after contracting COVID-19 in a home.

    Read full story
    Source: BBC News, 4 November 2021
  25. Patient Safety Learning
    Socioeconomic inequalities account for an estimated quarter of stillbirths, fifth of preterm births, and a third of births with fetal growth restriction, according to a study published in the Lancet of over one million births in England
    The nationwide study across England’s NHS was carried out by the National Maternity and Perinatal Audit team, who analysed birth records between April 2015 and March 2017 to quantify socioeconomic and ethnic inequalities in pregnancy outcomes.
    They found that an estimated two thirds (63.7%) of stillbirths and half (55.0%) of births with fetal growth restriction in black women from the most deprived neighbourhoods could be avoided if this population had the same risks as white women living in the most affluent 20% of neighbourhoods.
    Read full story (paywalled)
    Source: BMJ, 2 November 2021

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