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Patient Safety Learning

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  1. Patient Safety Learning
    Raw sewage flooding wards, power failures, and rat infestations were just some of more than 1,200 critical incidents at NHS trusts in the past year caused by ageing equipment and crumbling infrastructure.
    NHS leaders have said more investment is needed to reverse a backlog in buildings maintenance across the health service which has now reached an unprecedented £9bn. The situation is getting worse, with the backlog costs rising by 60 per cent in four years.
    In some hospitals the problems have become so severe they are affecting patient care leading to wards being closed, operations delayed and in some cases posing genuine risks to safety.
    Hampshire Hospitals was forced to suspend some services because of an uncontrollable rat infestation, while at East Cheshire NHS trust a power failure led to a back-up generator causing a fire triggering a second blackout. Patients had to be transferred to neighbouring hospitals and given blankets while others were given blankets to keep them warm.
    In another incident at Great Western Hospitals Trust, a patient having a hip operation was left under anaesthetic “open and exposed” while staff struggled to find a vital part needed for the operation which was in a storeroom that couldn’t be opened.
    Read full story
    Source: The Independent, 20 April 2021
  2. Patient Safety Learning
    The mother of a man who died after suffering neglect said she felt "extreme distress and anger" at a critical new report into his care home.
    James Delaney, 37, died while he was a resident at Sapphire House in Bradwell, Norfolk, in July 2018. After an inadequate rating by the Care Quality Commission (CQC), Mr Delaney's mother said she felt lessons had not been learned from her son's death.
    A spokeswoman for operator Crystal Care said it had "addressed all concerns".
    Mr Delaney, who died of a diabetes-related illness, was required to take insulin twice a day, but, despite staff noting he had not taken insulin for three days, they failed to take action.
    Jacqueline Lake, senior coroner for Norfolk, said at his inquest in 2019 there had been "a gross failure" by the care home to provide "basic medical attention".
    The home, which houses up to five people who have a learning disability or autistic spectrum disorder, was inspected in January and February 2021 after two whistleblowers alleged that abusive practices were taking place - a claim which is being investigated by the local safeguarding team.
    CQC inspectors found "people were not safe and were at risk of avoidable harm", and while risk assessments for diabetes, medicines and behaviour management existed, information was often "lacking or inaccurate".
    After reading the report, Mr Delaney's mother, Roberta Conway, said her reaction was one of "extreme distress and anger". She said the coroner had "pointed out what needed to be done, and it hasn't been done".
    "It cost my son his life and I don't want to see anybody else's life being wasted," she added.
    Read full story
    Source: BBC News, 21 April 2021
  3. Patient Safety Learning
    Almost 20% of patients seen by neurology consultant Dr Michael Watt were given a wrong diagnosis, a report has found.
    A review of 927 of Dr Watt's high-risk patients found 181 people received a diagnosis described as "not secure", Health Minister Robin Swann said.
    He was speaking as the Belfast Trust announced the recall of a further 209 neurology patients seen and discharged by Dr Watt between 1996 and 2012.
    This is the third such recall.
    Dr Watt was at the centre of Northern Ireland's biggest patient recall linked to his work at Belfast's Royal Victoria Hospital.
    Mr Swann said he had met patients and families affected by the recall in October last year.
    "While this report is statistical in nature, it deals with individuals, their families and their experiences," he said.
    "I know that many will have had their confidence in our health service shaken and I remain committed to helping restore it."
    Read full story
    Source: BBC News, 20 April 2021
     
  4. Patient Safety Learning
    A child was twice given double the "safe" dose of a rapid tranquilizer at a hospital run by a troubled NHS trust.
    The child was put at "significant risk of harm" at Telford's Princess Royal Hospital, said inspectors.
    Rating children's services inadequate, they said Shrewsbury and Telford Hospital NHS Trust (SaTH) must halt seeing under 18s for acute mental health needs. The trust, in special measures, was working to "urgently address concerns".
    The Care Quality Commission (CQC) carried out a targeted inspection on 24 February prompted by "concerning information" about treatment at the service run by SaTH.
    The trust is currently at the centre of the largest ever inquiry into NHS maternity care.
    Staff told inspectors they had seen an increase in the number of young people with "significant mental health issues" and learning disabilities over the past year.
    But the services, which were rated as "requiring improvement" in November 2019, were deemed "inadequate" in four of five areas tested - for being safe, effective, responsive and well-led.
    Read full story
    Source: BBC News. 19 April 2021
  5. Patient Safety Learning
    Patients have been significantly harmed, including suffering permanent damage to their liver, after being given accidental overdoses of paracetamol in hospital.
    The NHS safety watchdog the Healthcare Safety Investigation Branch (HSIB) has now launched a national investigation after a number of incidents where adults with a low bodyweight were given too much paracetamol through an infusion, or IV drip, directly into their bloodstream.
    The Independent understands there were three incidents reported by NHS staff in 2020 but there have been others in earlier years including the trigger event which sparked HSIB’s probe.
    Overdoses of IV paracetamol in both adults and children is a recurring problem. Safety alerts have been repeatedly issued to NHS hospitals over the problem, with one alert in 2010 highlighting more than 200 previous incidents of overdoses.
    In 2011 an inquiry into the death of 19-year-old Danielle Welsh, who died from liver failure due to a sustained paracetamol overdose in June 2008, found a junior doctor who prescribed the drug did not know she weighed only 35kg. The inquiry found: “There was a prevailing culture of assumed familiarity with the administration of IV paracetamol, a familiarity derived from the common use of oral paracetamol.”
    Now the independent Healthcare Safety Investigation Branch believes the problem of prescribing paracetamol without considering a patients’ weight is still going on.
    Read full story
    Source: The Independent, 19 April 2021
  6. Patient Safety Learning
    A London-wide operation has launched known as Operation Cavell, to improve the safety of NHS staff. The initiative will see a senior officer review all reports of assaults and hate crime against NHS staff.
    Following a three-month pilot, the NHS, Metropolitan Police Service (MPS) and Crown Prosecution Service (CPS) have been working in partnership to launch the scheme, which aims to protect NHS staff on the frontline.
    As well as senior police officer involvement, senior welfare and support staff within the NHS will be brought on board to help those who have been the victim of such crimes feel safer.
    Martin Machray, Joint Regional Chief Nurse for NHS England & Improvement in London, said: “The last year of the pandemic has shone a light on the selflessness and dedication of NHS staff. All our staff should be able to come into work without fear of violence, injury or abuse. We therefore welcome the rollout of this important initiative across mental health services in London and we hope it will help protect and support our wonderful colleagues.”
    Read full story
    Source: National Health Executive, 16 April 2021
  7. Patient Safety Learning
    Regulators have sent an improvement director into a North West acute trust amid multiple allegations of poor care and ‘cover up’ across different specialties.
    University Hospitals of Morecambe Bay Foundation Trust, which spent 18 months in special measures midway through the last decade, is again now the subject of significant regulatory intervention from NHS England.
    The regulator has appointed Simon Bennett as a board-level improvement director, which comes after he undertook a similar assignment at the struggling Stockport FT.
    It comes amid ongoing external investigations into the trust’s urology and trauma and orthopaedics specialties, where serious allegations have been made about attempts to cover up poor care.
    The trust has a troubled history of care failings and regulatory intervention, including a major maternity scandal which culminated in the Kirkup Inquiry in the first half of the 2010s, and being placed in special measures in 2014.
    It was widely recognised that positive progress was subsequently made to implement the inquiry recommendations and improve services, which culminated in the trust exiting special measures in late 2015, and being rated “good” by the CQC in early 2017. However, the recent allegations and investigations have again brought regulatory intervention.
    Read full story (paywalled)
    Source: HSJ, 20 April 2021
  8. Patient Safety Learning
    An NHS trust has admitted failing to provide safe care and treatment for a mother and her baby boy, who died seven days after an emergency delivery.
    Mother Sarah Richford said it brought "some level of justice" for baby Harry's death in 2017.
    Lawyers for the East Kent Hospitals Trust pleaded guilty to the charge at Folkestone Magistrates Court.  The trust said it had made "significant changes" and would "do everything we can to learn from this tragedy".
    Mrs Richford said: "Although Harry's life was short, hopefully it's made a difference and that other babies won't die".
    She added: "If somebody had done this before Harry was born he may be alive today."
    The prosecution by the Care Quality Commission followed an inquest in 2020, which found Harry's death was wholly avoidable and contributed to by neglect at Margate's Queen Elizabeth the Queen Mother Hospital.
    The inquest found more than a dozen areas of concern in the care of Harry and his mother, including failings in the way an "inexperienced" doctor carried out the delivery, followed by delays in resuscitation.
    Coroner Christopher Sutton-Mattocks criticised the trust for initially saying the death was "expected", adding that an inquest was only ordered due to the family's persistence.
    Read full story
    Source: BBC News, 19 April 2021
  9. Patient Safety Learning
    Seven individuals face prosecution for alleged ill-treatment and wilful neglect of patients at a hospital for people with severe learning disabilities.
    The alleged offences took place at the psychiatric intensive care unit at Muckamore Abbey Hospital in County Antrim, Northern Ireland.
    Prosecution follows ongoing police inquiries
    A police investigation into claims of abuse at the hospital has been ongoing since 2018, following reports of inappropriate behaviour and alleged physical abuse of service users by staff.
    Read full story
    Source: Nursing Standard, 19 April 2021
  10. Patient Safety Learning
    A nurse of the year finalist who faced being struck off after she saved a woman's life has been cleared by an official inquiry, the Mail can reveal.
    Leona Harris, 48, who gave a blood transfusion in a speeding ambulance to a woman who was haemorrhaging after losing her baby, has faced a four-year nightmare, including the potential loss of her 24-year career and home to pay legal costs.
    Through no fault of Mrs Harris's, the required prescription for the use of the blood had not been taken on to the ambulance with the patient.
    Now, four years on, the Nursing and Midwifery Council (NMC) has concluded Mrs Harris 'undoubtedly acted in the best interests of the patient' and has 'no case to answer'.
    The ruling raises major concerns about the conduct of the East Lancashire Hospitals Trust, which used inexplicably altered statements about Mrs Harris's conduct.
    The 600-page report will heap new pressure on Health Secretary Matt Hancock, who pledged that 'eradicating the curse' of NHS bullying would be one of his 'top priorities'.
    Read full story
    Source: Mail Online, 20 April 2021
  11. Patient Safety Learning
    The Labour Party will call on the government to commit to a target of ending the Black maternal mortality gap during a landmark debate about the topic later on Monday.
    This comes as shocking figures show Black women are over four times more likely than white women to die during or after pregnancy or childbirth in the UK.    
    MPs will debate a petition relating to Black maternal healthcare and mortality.
    Scheduled to take place at 6.15pm this evening, the session will be led by Petitions Committee Chair Catherine McKinnell MP.
    Read full story
    Source: The Independent, 19 April 2021
  12. Patient Safety Learning
    Pregnant women should be offered a Covid jab when other people their age get one, the UK's vaccine advisers say.
    They say the Pfizer and Moderna vaccines are preferable because data from the US in 90,000 pregnant women has not raised any safety concerns.
    Up until now, only women with underlying health conditions or those whose risk of exposure to the virus was high were eligible.
    The shift in advice brings the UK into line with other countries.
    The Joint Committee on Vaccination and Immunisation now advises that pregnant women should all be offered the Pfizer-BioNTech or Moderna vaccines where available, at the same time as the rest of the population.
    They are encouraged to discuss the risks and benefits of the vaccines with their doctor before making the appointment, but it is not a requirement.
    "There is no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed," it added.
    Currently, there is a lack of data on the AstraZeneca vaccine in pregnancy because pregnant women were not included in trials, but the JCVI says more evidence may be forthcoming in the near future.
    Read full story
    Source: BBC News, 17 April 2021
  13. Patient Safety Learning
    Sarah Spoor and her two adult sons have spent the past 14 months shielding in a one-bedroom apartment, with no garden, in west London. Her youngest sleeps in the bedroom, his brother has a pull-out bed in the kitchen, while Spoor takes the living room in another fold-out bed.
    All three have complex medical conditions that leave them vulnerable to Covid, and despite the strain of living in such close quarters, they don’t feel safe leaving home any time soon.
    “If we catch it, we die; it’s that simple. In the 14 months, I have probably been out about four times, and that’s usually in some dire emergency,” said Spoor, who provides round-the-clock care for her sons, 20 and 24, after their medical team decided it was too risky for their usual carers to continue visiting.
    The family has yet to be vaccinated as their medical conditions, which include type 1 diabetes, adrenal insufficiency, pernicious anemia and thyroid failure, mean they are likely to experience a severe reaction leading to hospital admission, and they are concerned about the risk of catching Covid in hospital when cases are still prevalent.
    Spoor is not alone in fearing a return to life after lockdown, with disability charity Scope estimating 75% of disabled people plan to continue shielding until after their second vaccine dose, and some for longer.
    “I think there is a potential long-term impact that groups of people become squirrelled away and it’s potentially easy for governments and local authorities to forget about them,” said James Taylor, executive director of strategy and social change at Scope. “We’re really worried that, in the long-term, lots of the rights that disabled people have fought for, the visibility, the recognition of disabled people as equal, that all falling away and going backwards.”
    Read full story
    Source: The Guardian, 19 April 2021
  14. Patient Safety Learning
    As a teenager, Kelly Moran was incredibly sporty: she loved to run and went to dancing lessons four times a week. But by the time she hit 29, she could barely walk or even drive, no longer able to do all the activities she once enjoyed. She had pain radiating into her legs.
    Her pain was repeatedly dismissed by doctors, who told her it was in her head. She moved back to her parents’ house in Manchester and left her job. She decided to seek treatment privately and was told she had endometriosis. Soon, with the right treatment, her life improved.
    Kelly is among dozens of women who got in touch to share their stories with the Guardian on the topic of women’s pain. Women are almost twice as likely to be prescribed powerful and potentially addictive opiate painkillers than men, a Guardian analysis shows. Data from the NHS Business Services Authority, which deals with prescription services in England, shows a large disparity in the number of women being given these drugs compared with men, with 761,641 women receiving painkiller prescriptions compared with 443,414 men, or 1.7 times, and the pattern is similar across broad age categories.
    The women who reached out said they felt that they were often “fobbed off” with painkillers when their problems required medical investigation.
    Read full story
    Source: The Guardian, 16 February 2021
  15. Patient Safety Learning
    WHO/Europe and the Hellenic Republic of Greece today open a new sub-office in the country focusing on quality of care and patient safety. Acting as a centre of excellence, the sub-office will work towards achieving the highest level of well-being, health and health protection in the WHO European Region, in line with the Sustainable Development Goals (SDGs).
    Speaking at its opening, WHO Regional Director for Europe Dr Hans Henri P. Kluge said, “Better quality of care relies on a strong primary health care system, where most preventive activities, diagnostics, consultations and treatments occur. Let us make no mistake – the quality of care encompasses all levels of a health system, hence the need to integrate quality policies across the board.”
    Read full story
    Source: WHO, 15 April 2021
  16. Patient Safety Learning
    The NHS in England is required by legislation to ensure that at least 92 per cent of patients on the waiting list have been waiting no longer than 18 weeks from referral to treatment. At the end of February, following a year of covid restrictions, that waiting time measure exceeded 52 weeks.
    How much longer than 52 weeks? We don’t know, because the data stops at “52 plus”. But there is good news, because this is about to change.
    Guidance was issued during March requiring two major improvements to the published RTT data.
    Firstly, instead of stopping at 52 weeks plus, the weekly waiting time cohorts will continue up to 104 weeks plus.
    Secondly, we are going to get a lot more information about mental health and other RTT waiting times, because the catch-all “Other” specialty is going to be broken down into medical, surgical, mental health, paediatric and the rest.
    Read full story (paywalled)
    Source: HSJ, 16 April 2021
  17. Patient Safety Learning
    Hundreds of senior NHS managers have voiced their fears for the future of the health service amid the ongoing coronavirus crisis without a significant pay rise to help retain staff on the frontline.
    A survey of more than 800 senior NHS managers has revealed the extreme pressure some have been working under, with many working 20 or more hours of unpaid extra hours each week.
    More than 90 per cent backed a significant pay rise for NHS staff to try and head off a feared exodus of nurses, doctors and other staff leaving the NHS after the pandemic. This would help shore up the service as it faces the daunting task of tackling record waiting lists now totalling 4.7 million patients.
    Some managers said that the government’s planned 1 per cent pay rise was an “insult” and made them feel “worthless”, in responses to the survey, run by the Managers in Partnership union.
    Another described NHS staff as being treated like “cannon fodder” during the crisis.
    Read full story
    Source: The Independent, 16 April 2021
  18. Patient Safety Learning
    Nearly 200 families have now reported experiences of poor maternity and neonatal care in East Kent, according to the family whose baby’s death sparked both an independent investigation and a court case against the trust.
    Baby Harry Richford died seven days after his birth at the Queen Elizabeth, the Queen Mother, Hospital in Thanet in 2017.
    Next week, the Care Quality Commission is taking East Kent Hospitals University Foundation Trust to court, alleging it failed to meet fundamental standards of care in the treatment of both Harry and his mother Sarah.
    An independent investigation, led by Bill Kirkup, is also looking into maternity and neonatal services at the trust.
    In a statement, the Richford family told HSJ  they had had numerous contacts from other families who had had bad experiences of maternity and neonatal care at the trust. “We have encouraged such families to come forward to the Kirkup Inquiry and now believe that the number of families is approaching 200,” they said.
    Read full story (paywalled)
    Source: HSJ, 16 April 2021
  19. Patient Safety Learning
    A group of royal colleges has produced guidance for doctors seeing patients who have concerns about symptoms after receiving the Oxford AstraZeneca COVID-19 vaccine.
    The Royal College of Emergency Medicine, the Society for Acute Medicine, and the Royal College of Physicians say that anyone who presents with symptoms suggestive of COVID-19 vaccine induced thrombosis and thrombocytopenia (VITT)1 should have a full blood count to check their platelet level. Symptoms of concern include persistent or severe headaches, seizures, or focal neurology; shortness of breath, persistent chest, or abdominal pain; and swelling, redness, pallor, or cold lower limbs.
    The advice comes after the HSJ reported that emergency clinicians had raised concerns over a surge in patients attending emergency departments as a result of anxiety over the safety of the AstraZeneca vaccine. Investigations by EU and UK regulators into reports of unusual blood clots after receiving the vaccine concluded that these are a “possible” and “extremely rare” side effect.
    Katherine Henderson, president of the Royal College of Emergency Medicine, said that following the announcements, patients had been attending emergency departments after receiving the AstraZeneca vaccine. “I saw 21 patients with concerns in an eight hour shift, so we have to have a way of dealing with this. It was important for us to have a strategy for managing those patients that didn’t mean that they were getting over-investigated but they were getting reassurance. We also need to be aware that if somebody has significant symptoms it is always possible, given the rarity of VITT, that it is something else,” she said.
    Read full story
    Source: BMJ, 13 April 2021
  20. Patient Safety Learning
    Coronavirus death rates are twice as high in insecure jobs as in other professions, new research suggests.
    The TUC said workers on a contract that does not guarantee regular hours or income, such as zero-hours contracts or casual work, and those in low-paid self-employment, have been more at risk of infection.
    It’s thought that key workers such as those in social care and delivery driving, which cannot be done from home and require people to come into contact with others, are more insecure.
    The COVID-19 mortality rate among men in insecure occupations was 51 per 100,000 people aged 20-64, compared with 24 per 100,000 in more secure work, said the union organisation.
    The mortality rate among women in insecure jobs was 25 per 100,000 people, compared with 13 per 100,000 in more secure occupations.
    The TUC, which called the figures stark, said more research was needed to understand the links between precarious work and risk of infection and death.
    Read full story
    Source: The Independent, 16 April 2021
  21. Patient Safety Learning
    Senior government officials have raised “urgent” concerns about the mass expansion of rapid coronavirus testing, estimating that as few as 2% to 10% of positive results may be accurate in places with low Covid rates, such as London.
    Boris Johnson last week urged everyone in England to take two rapid-turnaround tests a week in the biggest expansion of the multibillion-pound testing programme to date.
    However, leaked emails seen by the Guardian show that senior officials are now considering scaling back the widespread testing of people without symptoms, due to a growing number of false positives.
    In one email, Ben Dyson, an executive director of strategy at the health department and one of health secretary Matt Hancock’s advisers, stressed the “fairly urgent need for decisions” on “the point at which we stop offering asymptomatic testing”.
    On 9 April, the day everyone in England was able to order twice-weekly lateral flow device (LFD) tests, Dyson wrote: “As of today, someone who gets a positive LFD result in (say) London has at best a 25% chance of it being a true positive, but if it is a self-reported test potentially as low as 10% (on an optimistic assumption about specificity) or as low as 2% (on a more pessimistic assumption).”
    He added that the department’s executive committee, which includes Hancock and the NHS test and trace chief, Dido Harding, would soon need to decide whether requiring people to self-isolate before a confirmatory PCR test “ceases to be reasonable” in low infection areas where there is a high likelihood of a positive result being wrong.
    Read full story
    Source: The Guardian, 15 April 2021
  22. Patient Safety Learning
    Around 4.7 million people were waiting for routine operations and procedures in England in February - the most since 2007, NHS England figures show.
    Nearly 388,000 people were waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began.
    During January and February, the pressure on hospitals caused by COVID-19 was particularly acute.
    NHS England said two million operations took place despite the winter peak.
    However, surgeons said hospitals were still under huge pressure due to the second wave of Covid, which had led to "a year of uncertainty, pain and isolation" for patients waiting for planned treatment.
    Speaking on a visit to Dartmouth, Prime Minister Boris Johnson said the government would "make sure that we give the NHS all the funding that it needs... to beat the backlog".
    He said the situation had been "made worse by Covid", and added: "We do need people to take up their appointments and to get the treatment that they need."
    Read full story
    Source: BBC News, 15 April 2021
  23. Patient Safety Learning
    A care home under investigation over a resident's death has been rated inadequate for the second time.
    Merseyside Police began investigating Prescot's Griffin House after the death of a 90-year-old man in June 2020.
    The Care Quality Commission (CQC) rated it inadequate in September, highlighting safety concerns and a report from February, released on 9 April, found it had not improved.
    The inspection on 24 February found management had failed to adequately address the problems previously identified by the CQC and there were new concerns relating to staff recruitment.
    Inspectors found medicines were not always administered safely, COVID-19 guidance was not always followed and there was not always enough staff on duty.
    They also noted some staff had not had proper background checks before starting work, but added that since the inspection, a new system had been introduced to ensure checks were carried out.
    The report said the home's management "refused to follow government guidelines and participate in lateral flow testing for visitors to the home as they did not believe these tests were accurate".
    Read full story
    Source: BBC News, 13 April 2021
  24. Patient Safety Learning
    Relatives of elderly patients have set up a families action group to investigate allegations of “poor level of care” at the Royal London Hospital.  
    The Royal London Hospital Patients and Families Group says it is in talks with lawyers this week after setting up a Facebook page to share their experiences of the east London hospital. 
    Anger erupted after relatives were refused visits to wards during strict lockdown periods and there were claims elderly family members were not receiving attentive care on the wards.
    Barts Health NHS Trust, which runs the hospital, said the pandemic has been an "extremely busy" time but insisted patient safety is its top priority, while promising to listen to any feedback and concerns.
    The families' group is calling for changes and suggesting how standards "should be improved" by involving families with patient care. 
    “Many don’t speak English,” the group’s chair Abdul Doyas explained. “They are unable to communicate with medical staff. Allowing a family member to be present during agreed hours will improve care."
    "Vulnerable people are admitted to hospital in an unfamiliar environment, which is a frightening experience that causes anxiety. But having a family member by their side can improve chances of recovering.” 
    Read full story
    Source: East London Advertiser, 13 April 2021
  25. Patient Safety Learning
    NHS maternity units have been told they have until next April to increase the numbers of midwives on wards to expected levels after a near £100 million investment.
    NHS England has told hospitals they must bring staffing levels for midwives up the levels needed to meet their planned demand from mothers and to ensure women get safe care.
    In a letter to NHS trusts, England’s chief nurse Ruth May said she expected hospitals to use their share of a recent £96 million investment by NHS England to boost staffing levels along with extra spending from local budgets.
    NHS England has carried out an analysis of demand and supply with Health Education England as part of a four year plan to boost the number of midwives.
    Hospitals are expected to set the level of midwives needed to deliver more one-to-one care and to try and ensure more than half of women see the same midwife throughout their pregnancy.
    Read full story
    Source: The Independent, 13 April 2021

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