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Patient Safety Learning

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  1. Patient Safety Learning
    Tens of thousands of nurses across the UK have not had their first coronavirus vaccine, sparking fears that they could contract COVID-19 or infect patients.
    A Royal College of Nursing (RCN) survey of 24,370 nurses found that 85% had had at least one dose, with the remaining 15% unvaccinated.
    The findings show that the government is in danger of failing to deliver one of the main elements of its pledge that all 15 million Britons in the top four priority groups for immunisation – which includes all health and social care staff – should have been offered a first shot by next Monday, 15 February.
    “It is extremely worrying that, as our survey suggests, many thousands of nursing staff have yet to be given their COVID-19 vaccine less than a week before the government’s deadline,” said Dame Donna Kinnair, the RCN’s chief executive and general secretary.
    “With only days to go, every effort must be made to reach all nursing staff to ensure their protection and that of the patients and vulnerable people they care for.”
    Read full story
    Source: The Guardian, 9 February 2021
  2. Patient Safety Learning
    One in three Covid patients put on a ventilator experience extensive symptoms of post-traumatic stress disorder (PTSD), according to research, which adds to mounting evidence of the virus’s impact on mental health.
    The study of 13,049 patients with confirmed or suspected coronavirus, by Imperial College London and the University of Southampton, found that one in five who were admitted to hospital but did not require a ventilator also experienced extensive symptoms of PTSD.
    The most common PTSD symptom experienced by COVID-19 patients was intrusive images, sometimes known as flashbacks. Examples of these could be images of the intensive care unit (ICU) environment, ICU doctors wearing full personal protective equipment or other patients in the ICU.
    The study, published in the Royal College of Psychiatrists’ BJPsych Open, on Tuesday, found lower levels of extensive symptoms of PTSD for patients given medical help at home (approximately one in six) and patients who required no help at home but experienced breathing problems (one in ten).
    Dr Adam Hampshire, from Imperial College London, said: “We can see that the pandemic is likely to be having an acute and lasting impact, including for a significant proportion of patients who remained at home with respiratory problems and received no medical help. This evidence could be important for informing future therapy and reducing the long-term health burden of this disease.”
    Read full story
    Source: The Guardian, 9 February 2021
  3. Patient Safety Learning
    People aged 70 or older in England who have not yet had their coronavirus vaccine but would like to are being asked to contact the NHS.
    A national booking system can be accessed online or people can call 119 free of change between 7am and 11pm.
    At a Downing Street news briefing, deputy chief medical officer Prof Jonathan Van-Tam urged people to get the vaccine "without delay".
    "Protect yourself against the clear and present danger," he said.
    He said the vaccines worked very well against the "immediate threat" of the Kent variant of coronavirus circulating in the UK.
    Read full story
    Source: BBC News, 8 February 2021
  4. Patient Safety Learning
    The use of ten million surgical gowns, bought by the UK government, has been suspended for frontline NHS staff because of how the items were packaged.
    Sterile gowns were bought for £70m from a US firm last year, but safety concerns were raised when they arrived in one layer of protective packaging.
    The contract had not requested double packaging, as used in sterile settings.
    The government says all personal protective equipment (PPE) is quality assured, but Labour has called for an inquiry into the awarding of contracts.
    The BBC has been investigating the purchase of PPE - or personal protective equipment - for NHS staff since the beginning of the pandemic. It has already been revealed how millions of face masks bought by the UK government cannot be used in the NHS as intended.
    Read full story
    Source: BBC News, 8 February 2021
  5. Patient Safety Learning
    The NHS bill due to land in Parliament before the summer break will be the first for nearly 10 years, so will address various overdue changes and is certain to be significant.
    The bill’s thrust has become clear from the draft of the government’s white paper leaked on Friday, though some important details might change before a final version is published in the next few weeks. Many of the white paper proposals are what NHS England has been asking for in formal proposals over the last 18 months, and reflect the direction the NHS has been moving slowly but inexorably towards for several years.
    NHSE’s central aim of clearing up the NHS landscape by turning integrated care systems into statutory agencies, but without overdoing the central specification of how they will work, is largely intact. Clinical commissioning groups are reconstituted as ICSs, a move unpopular with some but accepted by most. There is a formal role for local authorities planned in the shape of “partnership councils”. This creates a little extra bureaucracy but does not give them real power in the NHS. NHSE and ICSs are given a bit more sway over foundation trusts, but probably not enough to set off a huge row with NHS Providers.
    The leaked version of the white paper also includes proposals which NHSE will not be happy about, including giving the health secretary a sweeping “general power to direct NHS England on its functions”, another to transfer functions between all arm’s length bodies and even abolish them, and ability to intervene at any stage in NHS service reconfigurations.
    If pursued, these risk bringing even more toxic politics back into the NHS, both in the process of putting through the legislation itself, and beyond that, in the day to day running of the service.
    Read full story (paywalled)
    Source: HSJ, 6 February 2021
  6. Patient Safety Learning
    NHS hospitals are defying official rules to give nurses and doctors masks with greater protection amid fears over the spread of coronavirus within hospital wards.
    An analysis of the latest NHS data by The Independent shows more than 35,000 patients were likely to have been infected with coronavirus while already in hospital between 1 August and 31 January.
    NHS England has estimated as many as 20% of infections could be due to spread within hospitals. Outbreaks at some hospitals have seen whole teams of doctors or nurses affected, in some cases leading to wards having to be closed.
    The Independent has learnt several hospitals are now supplying higher grade masks to staff working in general wards, despite Public Health England saying only surgical masks are needed. Research this week suggested staff exposed to coughing were at greatest risk of infection from the virus.
    Read full story
    Source: The Independent, 7 February 2021
  7. Patient Safety Learning
    An urgent inquiry to investigate how alleged systemic racism in the NHS manifests itself in maternity care will be launched on Tuesday with support from the UK charity Birthrights.
    The inquiry will apply a human rights lens to examine how claimed racial injustice – from explicit racism to bias – is leading to poorer health outcomes in maternity care for ethnic minority groups.
    Data published last month by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the country) showed black women were four times more likely than white women to die in pregnancy or childbirth in the UK while women from Asian ethnic backgrounds face twice the risk.
    Barrister Shaheen Rahman QC, who will lead the inquiry, said: “In addition to these stark statistics there are concerns about higher rates of maternal illness, worse experiences of maternity care and the fact black and Asian pregnant women are far more likely to be admitted to hospital with COVID-19.
    “We want to understand the stories behind the statistics, to examine how people can be discriminated against due to their race and to identify ways this inequity can be redressed.”
    Read full story
    Source: The Guardian, 7 February 2021
     
  9. Patient Safety Learning
    Toronto, Canada, will launch a pilot programme that will see civilians, not police officers, dispatched to 911 calls involving mental health crises — as long as violence is not being threatened.
    Council also approved a motion by Mayor John Tory to fast-track parts of the plan and review 911 call services in 2021 to determine how best to dispatch help through the proposed new service.
    The plan calls for four crisis support teams in different parts of the city, to respond to some of the roughly 30,000 calls for people in crisis that go through 911 each year. 
    Pilot programmes are to be launched in early 2022, and were scheduled to be fully implemented in 2026 if proven successful. Tory’s motion called for full implementation by 2025.
    “Putting something else in place is not a simple task. It is necessary that we do it properly,” said Tory, in bringing forward the motion. Nonetheless, the mayor said, he believes it can be done more quickly.
    Asante Haughton, a mental health advocate and co-founder of the Reach Out Response Network, focused on transformational change in mental-health crisis response, said the move is another rung on the ladder to a more equitable society.
    “I really see this as an opportunity to transform the way that we think about mental health and transform the way that we think about social service and community building in general,” he said.
    Read full story
    Source: Toronto Star, 2 February 2021
  10. Patient Safety Learning
    Relatives of patients who died after receiving "dangerous" levels of painkillers at Gosport War Memorial Hospital have called for new inquests. 
    An inquiry found 456 patients died after being given opiate drugs at the hospital between 1987 and 2001, but no charges have ever been brought.
    Four families told the BBC they have requested judge-led "Hillsborough-style" hearings with a jury. The Attorney General's Office said it was reviewing the application.
    Police began a fresh inquiry in 2019 into 700 deaths after the Gosport Independent Review Panel found there was a "disregard for human life" at the hospital in Hampshire.
    Coroner-led inquests in 2009 found drugs administered at the hospital contributed to five deaths.
    However, lawyers representing some of the families told the BBC more wide-ranging inquests similar to those that examined the events of the Hillsborough disaster should be undertaken.
    Read full story
    Source: BBC News, 5 February 2021
  11. Patient Safety Learning
    Hospitals across the country are preparing for a significant increase in children needing treatment for a rare disease triggered by coronavirus.
    Paediatric departments across the NHS are recalling children’s nurses who have been redeployed to help care for adult patients as well as freeing up specialist intensive care beds to be ready for more cases of the rare condition first identified after the first wave last year.
    Because of how widespread COVID-19 infections have become in the last month, with the numbers of patients in hospital peaking at almost 40,000, experts believe they will see a larger number of children affected by the disease called Paediatric Multisystem Inflammatory Syndrome (PIMS).
    Modelling by London’s Evelina Children’s Hospital, which treated around 110 children with PIMS during the first wave of the virus, suggested for every 200 adults admitted to hospital across London, there was one child admitted with PIMS at the Evelina.
    This modelling cannot be used to predict admissions across the country, but paediatric experts believe they will begin to see a larger number of children with the condition with a peak expected in the next three weeks.
    It is thought COVID-19 triggers an inflammatory response among a very small minority of children – of all children infected with COVID-19, less than half of one per cent went on to develop PIMS.
    Those that do suffer severe inflammation in their blood vessels and can have damage to their heart. Symptoms of PIMS include a rash, fever and abdominal pain.
    Read full story
    Source: The Independent, 4 February 2021
  12. Patient Safety Learning
    About one in three people recently given a Covid vaccine by the NHS report some side-effects.
    None was serious - a common one was some soreness around the injection site, the UK researchers who gathered the feedback found.
    Experts say the findings, from about 40,000 people - mostly healthcare workers - are reassuring for the millions having the vaccines now.
    The Zoe app team from King's College London found:
    37% experienced some local "after-effects", such as pain or swelling near the site of the injection, after their first dose, rising to about 45% of the 10,000 who had received two doses 14% had at least one whole-body (systemic) after-effect - such as fever, aches or chills - within seven days of the first dose, rising to about 22% after the second dose These after-effects get better within a few days. All of the medical trials and real-world experiences so far suggest the vaccines are safe and effective.
    Read full story
    Source: BBC News, 4 February 2021
  13. Patient Safety Learning
    To be successful digital health technology must be accessible to all while still maintaining the human aspects of healthcare, a new report has said.
    ‘Digital Health during the Covid-19 Pandemic: Learning Lessons to Maintain Momentum’ draws on research and case studies of good practice in digital health during the pandemic.
    The aim of the report is to offer policy recommendations to help ensure the UK capitalises on the potential of digital health to the benefit of patients, the NHS and the UK, after the crisis subsides.
    The report, launched by the Patient Coalition for AI, Data and Digital Tech in Health, with support from patient organisations and the Royal Colleges of Nursing and Radiologists, highlights that uptake of digital health technologies has been limited, while patient experience of technologies including video conferencing and mobile apps has been mixed.
    While patients strongly believe in the value of digital health, there are still significant concerns about using it, particularly around data collection and sharing.
    A number of key organisations gave their support to the report. This included the likes of the British Heart Foundation, Patient Safety Learning and the Royal College of Nursing.
    Read full story
    Source: Digital Health, 3 February 2021
  14. Patient Safety Learning
    Within a few months of joining Great Ormond Street Hospital Foundation Trust as medical director, Mat Shaw became its chief executive. Heading up the organisation clearly brought with it new responsibilities and challenges, yet he says on one important issue there was little difference between the two roles – namely, the focus on patient safety and enabling clinicians to offer the best possible care for patients.
    “I lived through the time when all notes were on paper, when you had five, six volumes of thousands of pages. I lived through that time when it was very difficult to actually know what information to collect, and from where you should collect it, to make decisions around patients. And I recognise we don’t always do the right thing based on those systems.
    “So for me it’s been tremendously important to try and bring a system in, and the digital tools which are needed, to make care kinder and also safer, with better outcomes for patients. In our new strategy, digital is front and centre in a way that it’s never been before, because I consider this agenda so important to how we treat patients.”
    Read full story
    Source: HSJ (paywalled), 3 February 2021
     
  15. Patient Safety Learning
    Care homes in England operated by profitable chains have been branded unsafe by inspectors, who found serious failures in efforts to control the spread of coronavirus in its latest wave.
    In the last month 40% of care homes inspected by the Care Quality Commission in England were judged to be inadequate or in need of improvement. Several handling fatal coronavirus outbreaks were revealed to have broken laws meant to keep residents safe.
    Some of the worst failings uncovered in reports filed in the last month include CCTV showing PPE being used wrongly on 63 occasions in one home, infected residents mixing in communal areas with Covid-free residents, chronic staff shortages, and a care home manager continuing to work after showing Covid symptoms.
    The spate of problems relates to a small minority of care homes but coincides with a tripling of fatalities linked to the virus among care residents in England and Wales.
    Read full story
    Source: 4 February 2021
  16. Patient Safety Learning
    The NHS has been urged to rethink safety for thousands of frontline staff after new research suggested that Covid patients’ coughing is putting them at far greater risk of catching the virus than previously thought.
    The study found that coughing generated at least 10 times more infectious “aerosol” particles than speaking or breathing – which could explain why so many NHS staff have fallen ill during the pandemic.
    The research has led to fresh demands that anyone caring for someone with Covid-19, or suspected Covid-19, should be provided with the most protective equipment – including FFP3 respirator masks – and that hospital ventilation should be improved.
    Health workers are up to four times more likely to contract coronavirus than the general population, with infection rates among those on general hospital wards approximately double those of intensive care unit (ICU) staff – who do have access to the most protective PPE.
    Read full story
    Source: The Guardian, 3 January 2021
  17. Patient Safety Learning
    People with a learning disability must be urgently prioritised for the coronavirus vaccine, charities have warned as new data shows they are almost twice as likely to die from the virus than the general population.
    The latest data for learning disability deaths shows 80% of deaths in the week to 22 January were linked to COVID-19. This compares to just 45% in the general population.
    The charity Mencap said everyone with a learning disability should be prioritised for the vaccine.
    According to its analysis of deaths reported to the Office for National Statistics and the national Learning Disabilities Mortality Review programme, the proportion of deaths among the learning disabled has been increasing every week since November when it was just above 35%.
    Harry Roche, an ambassador at Mencap who has a learning disability, said: “The death rate for 18- to 34-year-olds with a learning disability is 30 times higher than the rest of the population. I’m 32 years old and have a learning disability – this statistic scares me. I’m calling on Boris Johnson and Matt Hancock to rethink and prioritise everyone with a learning disability. We are too often forgotten, don’t ignore us now.”
    Read full story
    Source: The Independent, 3 February 2021
  18. Patient Safety Learning
    With the first phase of the UK’s vaccination programme now fully under way, the government’s self-congratulatory tone suggests all clinically vulnerable groups are soon in line for protection. There’s certainly reason to be positive: millions of people are on their way to safety. But look a little closer and many high-risk people are struggling to access the vaccine.
    When the vaccine was first introduced last year, the Joint Committee on Vaccination and Immunisation (JCVI) put shielders – or the “clinically extremely vulnerable” (CEV) – as low as sixth on the priority list, behind older people with no underlying health conditions. It resulted in the baffling situation where a marathon-running 65-year-old was given priority for the vaccine over a 20-year-old with lung disease who needs oxygen support. The government U-turned after pressure, moving CEV people up to fourth spot behind healthy over-75s.
    These are complex calculations, but there are still fears some will miss out. Some young disabled people who don’t meet the government’s narrow criteria of CEV and are worried they won’t be prioritised at all.
    Shielders – many of whom are of working age and live with children – also have extra risk factors compared with older people. As the British Medical Association said this month, we need a more sophisticated vaccine delivery that takes into account circumstantial factors such as race, health inequality and employment. I’ve received many messages from shielders who are terrified of being forced out to work, or of schools reopening before they get their vaccine.
    There are also those with learning disabilities to consider. Currently, only older people with a learning disability, those who have Down’s syndrome or people who are judged as having a severe learning disability are on the priority list. This means that people with a mild or moderate learning disability aren’t prioritised at all. This is despite the fact all people with learning disabilities have a death rate six times higher than the general population. Young adults with a learning disability are 30 times more likely to die of Covid than young adults in the general population.
    Read full story
    Source: The Guardian, 3 February 2021
  19. Patient Safety Learning
    Clinicians within a major teaching hospital’s cancer services have raised multiple concerns over patient safety, which they believe have resulted from badly planned service changes in response to the covid crisis.
    HSJ has spoken to several staff members who have worked in the haematology speciality at University Hospitals Birmingham Foundation Trust since last June, when the services underwent significant changes to free up capacity for coronavirus patients.
    This involved most haematology services at Heartlands Hospital in east Birmingham moving to the trust’s main Queen Elizabeth Hospital site in Edgbaston.
    The staff, who all wished to remain anonymous, told HSJ the transfer happened at just one week’s notice and was poorly planned. Once implemented, they said QEH’s newly enlarged service suffered from extreme staffing shortages, leading to several “never events”, such as patients being given the wrong blood type.
    In one resignation letter, a nurse who had transferred to QEH told managers patients’ “basic care needs are not being met”.
    The nurse said most shifts were understaffed, with examples of three nurses looking after 30 patients and added in the resignation letter: “I am witnessing strong and knowledgeable colleagues breaking down on each shift.
    “Furthermore, never events are happening at an alarming rate, necessary resources are commonly unavailable and communication between all levels of seniority is poor…"
    Read full story (paywalled)
    Source: HSJ, 2 February 2021
  20. Patient Safety Learning
    Coronavirus patients who call an ambulance but are not yet sick enough to go to hospital are being given new home oxygen monitoring kits to help spot those who may deteriorate earlier.
    Across the Thames Valley region, thousands of patients will be given the kits which include a pulse oximeter device to monitor blood oxygen levels, a diary to track their symptoms and advice on what to do if they become sicker.
    South Central Ambulance Service Trust (SCAS) has become the first ambulance service in the country to launch the scheme after research showed a small drop in oxygen levels among some patients could be an early warning sign of serious complications.
    Patients with pneumonia and non-Covid lung conditions often experience shortness of breath before a drop in oxygen levels. But with coronavirus, patients can suffer what has been called ‘silent hypoxia’ where their oxygen levels can fall before the patient becomes breathless and calls for help.
    Read full story
    Source: The Independent, 2 February 2021
  21. Patient Safety Learning
    The Oxford-AstraZeneca vaccine could lead to a "substantial" fall in the spread of the virus, say scientists.
    The impact of Covid vaccines on transmission has been a crucial unknown that will dramatically shape the future of the pandemic.
    The study, which has not been formally published, also showed the vaccine remained effective while people waited for a second dose. It was 76% effective during the three months after the first shot. 
    The UK, amid global debate and in sharp contrast to other countries, is prioritising giving the first dose to as many people as possible. The idea is to save more lives by giving more people some protection, but it means people will have to wait around three months for the booster instead of three weeks.
    This study - on 17,000 people in the UK, South Africa and Brazil - showed protection remained at 76% during the three months after the first dose. This rose to 82% after people were given the second dose.
    Prof Andrew Pollard, from the Oxford Vaccine Trial, said: "These new data provide an important verification of the interim data that was used by more than 25 regulators including the MHRA and EMA to grant the vaccine emergency use authorisation."
    "It also supports the policy recommendation made by the Joint Committee on Vaccination and Immunisation for a 12-week prime-boost interval, as they look for the optimal approach to rollout."
    The report does not tackle the impact of the new variants on how well the vaccines work.
    Read full story
    Source: BBC News, 2 February 2021
     
     
  22. Patient Safety Learning
    The NHS’s London regional team has told its integrated care systems (ICS) to draw up plans for ‘another possible [covid-19] surge later in 2021’, HSJ has learned.
    The guidance, dated February 2021 says: “Later in March/early April we will ask for systems to begin to plan for a possible wave 3 covid surge.”
    The NHS England and Improvement London presentation adds: “[The] purpose of the critical care de-surge plan [is to] ensure that the… bed base can expand safely in the event of a 3rd covid surge and/or other major incident/event.”
    Any surge in covid cases is likely to be caused by new variants of the virus, such as those originating in Brazil and South Africa, which are more resistant to vaccines, becoming dominant in the UK. At present government advisers think this is unlikely and that even if this scenario did arise, it will be possible to modify vaccines to combat the new strain.
    The guidance sets out three other “strategic goals” the ICSs should address. But it has “surprised” senior figures from outside London who were waiting for the national framework for tackling the NHS’ growing elective waiting list expected later this month.
    The presentation said the other key goals were to: ensure “staff get… immediate rest and respite”; set out plans to “desurge critical care”; and plan for elective recovery.
    Read full story (paywalled)
    Source: HSJ, 3 March 2021
  23. Patient Safety Learning
    Failures to follow national guidelines to prevent group B Strep infections in newborn babies is leading to a postcode lottery of care and opportunities to stop deadly infections being missed, a new report has found. Nearly 90% of hospitals in the UK are not using the recommended test for GBS carriage – which costs around £11- despite clear guidance issued by the Royal College of Obstetricians and Gynaecologists (RCOG) and Public Health England (PHE) that the test can significantly decrease false-negative results.
    Group B Strep is the UK’s most common cause of severe infection in newborn babies, causing sepsis, pneumonia, and meningitis. Approximately 800 babies a year in the UK develop group B Strep infection in their first 3 months of life, 50 babies will die, with another 70 survivors left with life-changing disabilities. Most of these infections could be prevented.
    Only a tiny number of NHS Trusts are following the key new recommendations around giving pregnant women information on group B Strep, offering testing to some pregnant women, and following Public Health England guidelines on testing for group B Strep. As a result, pregnant women face a postcode lottery, potentially receiving significantly different care from recommended practice.
    Read full story
    Source: Group B Strep Support, 1 February 2021
  24. Patient Safety Learning
    The pandemic has had a deep impact on children, who are arriving in A&E in greater numbers and at younger ages after self-harming or taking overdoses, writes Dr John Wright of Bradford Royal Infirmary.
    Children are a lost tribe in the pandemic. While they remain (for the most part) perplexingly immune to the health consequences of COVID-19, their lives and daily routines have been turned upside down.
    From surveys and interviews carried out for the Born in Bradford study, we know that they are anxious, isolated and bored, and we see the tip of this iceberg of mental ill health in the hospital.
    Children in mental health crisis used to be brought to A&E about twice a week. Since the summer it's been more like once or twice a day. Some as young as 10 have cut themselves, taken overdoses, or tried to asphyxiate themselves.
    There was even one child aged eight.
    Lockdown "massively exacerbates any pre-existing mental health issues - fears, anxieties, feelings of disconnection and isolation," says A&E consultant Dave Greenhorn.
    Read full story
    Source: BBC News, 2 February 2021
  25. Patient Safety Learning
    A newborn baby died after doctors caring for him failed to realise that the umbilical venous catheter (UVC) through which he was being fed and medicated was wrongly positioned, a coroner has found.
    Anna Crawford, assistant coroner for Surrey, called for guidelines from the National Institute for Health and Care Excellence (NICE) on the use of the catheters after hearing that none currently exist.
    Yo Li was born extremely prematurely at St Peter’s Hospital in Chertsey on 11 January 2019 and transferred to the neonatal intensive care unit, where he was put on mechanical ventilation. A UVC was inserted but it was wrongly positioned within his liver tissue and he died four days later.
    Read full story (paywalled)
    Source: BMJ, 29 January 2021

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