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Patient Safety Learning

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  1. Patient Safety Learning
    Nearly 90% of hospital beds in England are full as hospitals try to cope with the demands of Covid in addition to normal winter pressures.
    Ambulances queuing to offload patients, staff sickness and a lack of beds mean hospitals are "at a really dangerous point", say emergency doctors. This could result in some trusts facing the decision to stop non-Covid work.
    Rises in hospital admissions are particularly affecting areas in the south.
    The percentage of NHS hospital beds which are occupied is increasing and has reached almost 89% in England for the week ending December 13.
    This is the highest occupancy rate so far this year - it's still lower than the same time last year, although the extra burden of Covid is likely to make hospitals feel they are much busier.
    A safe level for bed occupancy is below 90% but nearly half of NHS trusts report a figure currently higher than this - the largest proportion this season.
    Read full story
    Source: BBC News, 19 December 2020
  2. Patient Safety Learning
    Layla Moran, Lib Dem MP for Oxford West and Abingdon and Chair of the APPG on Coronavirus, has secured the first Commons debate on Long Covid on Thursday 7 January following cross-party support.
    The Backbench Business Committee granted the application by Layla Moran, co-sponsored by Dr Dan Poulter MP (Con) and Andrew Gwynne MP (Lab) and supported by many others.  Layla said that the debate “is long overdue” and called on “those with lived experience and clinical experience to tell us your stories” in advance of the debate.
    Layla Moran said: “I’m pleased that we’ve been able to secure this important debate on Long Covid, which is long overdue. The APPG on Coronavirus, which I chair, has submitted recommendations to the Government on this, and the debate will give us the opportunity to hold them to account and represent our constituents suffering from it."
    “What’s really important now is that as many MPs as possible take part in the debate, so we can give this the profile it deserves and give the Government the opportunity to listen and respond to our concerns. Thank you to my cross-party colleagues for supporting this. I’m calling on those with lived experience and clinical experience to tell us your stories between now and the 7 January. This is a crucial opportunity.”
    Read full story
    Source: Liberal Democrats, 19 December 2020
  3. Patient Safety Learning
    The number of people likely to have caught COVID-19 in NHS hospitals in England has risen by more than a third in the last week.
    The 35% rise in probable hospital-acquired COVID-19 from 6 to 13 December is the highest weekly increase since 30 October, HSJ analysis of NHS England data reveals.
    Hospital-acquired infections are rising across areas such as London, the South East, and South West, and also at some hospitals in the North East, Yorkshire and the Midlands.
    At some trusts, the weekly total of likely hospital-acquired COVID-19 infections has more than doubled since last week.
    Read full story (paywalled)
    Source: HSJ, 18 December 2020
  4. Patient Safety Learning
    Staff shortages and a lack of equipment are affecting the day-to-day decisions about patient care by doctors and nurses, a new YouGov survey has revealed.
    The representative survey of NHS clinicians revealed more than half, 54%, admitted that factors such as a lack of staff played a role in their decisions about patients beyond what was in their best interests.
    Almost a third of staff, 31%, said staffing levels were the top factor affecting decisions about patients. A fifth said the availability of services such as key tests were a significant factor; 16% cited a lack of equipment; and 12% cited beds. 10% of clinicians said a fear of being sued was part of their decision-making.
    YouGov carried out the research for JMW Solicitors and weighted the responses to be representative of the NHS workforce population.
    It also revealed more than two-fifths of clinicians, 42%, believe a “blame culture” in the NHS plays a top role in preventing staff admitting to mistakes in care.
    In maternity services specifically, 68% of nurses and midwives said at least one factor other than what was in patients’ best interest played a role in their decisions.
    Read full story
    Source: The Independent, 20 December 2020
  5. Patient Safety Learning
    Patients in hospital with coronavirus should be offered a follow-up six weeks later to check for "long Covid" symptoms, doctors are being advised.
    The guidance, drawn up by health officials across the UK, says the long-term effects can be "significant". They identified 28 of the most common symptoms, from breathlessness and dizziness to chest pain.
    Mental health problems including depression, anxiety and struggling to think clearly, have also been reported.
    "Because this is a new condition, there is still much that we don't know about it," said Paul Chrisp of the National Institute for Health and Care Excellence, which produces health guidance.
    The NHS has opened 69 specialist clinics across England to offer rehabilitation to people recovering from the disease.
    Read full story
    Source: BBC News, 18 December 2020
  6. Patient Safety Learning
    An independent children’s and adolescents’ mental health service has been taken out of special measures after cutting beds by two-thirds.
    The Care Quality Commission has rated St Andrew’s Healthcare’s CAMHS unit in Northamptonshire “requires improvement” but removed it from special measures. Among improvements noticed were a major change in the service’s leadership and staff raising concerns openly and honestly.
    The unit was rated “inadequate” and served with a section 31 notice following inspections in June and December last year. 
    After its December inspection, the charity reduced the number of beds within its CAMHS offering from 90 to 30. Around the same time, St Andrew’s Healthcare chief executive Katie Fisher also revealed plans to shrink its services by half to address the serious quality issues.
    Speaking to HSJ, St Andrew’s Healthcare chief executive, Kate Fisher, who was appointed in 2018, said: “this isn’t just words, we are absolutely walking the walk and seeing through the strategy we set ourselves.”
    Read full story (paywalled)
    Source: HSJ, 18 December 2020
  7. Patient Safety Learning
    Thousands of patients suffering with the long term symptoms of coronavirus can now access specialist help at more than 60 sites, NHS England announced today.
    The assessment centres are taking referrals from GPs for people experiencing brain fog, anxiety, depression, breathlessness, fatigue and other debilitating symptoms.
    NHS England has provided £10 million for the network of clinics, which started opening last month. There are now 69 operating across the country with hundreds of patients already getting help.
    The new centres bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.
    Ten sites are now operational in London, seven in the East of England, eight in the Midlands, South East and South West respectively, nine in the North West and a further 18 across the North East and Yorkshire.
    A further 12 sites are earmarked to launch in January in the East Midlands, Lancashire, Cornwall and Isle of Wight.
    The National Institute for Clinical Excellence (NICE) has today also issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID.
    Patients can access services if they are referred by a GP or another healthcare professional, so that doctors can first rule out other possible underlying causes for symptoms.
    Read full story
    Source: NHS England, 18 December 2020
  8. Patient Safety Learning
    More needs to be done to tackle safe staffing levels in Northern Ireland's health service, according to the Royal College of Nursing (RCN).
    A year on from the nurses' strike, the union has warned that problems caused by poor workforce planning and chronic underfunding have not been addressed.
    Instead they have been exacerbated by the CoOVID-19 pandemic, said the RCN.
    The Department of Health said dealing with staff shortfalls was a "key priority" for the health minister.
    Pat Cullen, the Northern Ireland director of the RCN, said "very little has actually changed" since about 15,000 healthcare workers took to the picket line in December last year for a series of protests over pay and safe staffing levels.
    "We need to remind the government that many of these issues have sadly not gone away," she added.
    Read full story
    Source: BBC News, 18 December 2020
  9. Patient Safety Learning
    London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned.
    The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity.
    More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice.
    On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before. But the numbers of coronavirus patients in critical care beds jumped 8.6% in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen.
    Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with COVID-19. This meant the capital’s total critical care bed occupancy rate was almost 95%.
    Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running.
    A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.”
    Read full story
    Source: The Independent, 17 December 2020
  10. Patient Safety Learning
    All NHS trusts in England have been given a deadline of Monday to enact safety improvements in maternity care amid Shropshire's baby deaths scandal.
    Heath chiefs have told hospitals they must have the 12 "urgent clinical priorities" in place by 17:00 GMT. The move is to address "too much variation" in outcomes for families.
    It comes during a probe into the maternity care of more than 1,800 families in Shropshire.
    The inquiry, launched amid concerns of repeated failings at Shrewsbury and Telford Hospital NHS Trust (SaTH), focuses on the experience of 1,862 in total, and includes instances of infant fatality.
    An interim report published last week found poor care over nearly two decades had harmed dozens of women and their babies.
    The report called for seven "essential actions" to be implemented at maternity units across England. But that has since been transformed into 12 clinical tasks, including giving women with complex pregnancies a named consultant, ensuring regular training of fetal heart rate monitoring, and developing a proper process to gather the views of families.
    The directions are revealed in a letter in which NHS England says there is "too much variation in experience and outcomes for women and their families".
    Read full story
    Source: BBC News, 15 December 2020
  11. Patient Safety Learning
    One in 10 people infected with the coronavirus experience symptoms that last for three months or longer, the Office for National Statistics (ONS) has said.
    A new analysis aimed at determining the extent of the “long Covid” problem among infected patients also found that one in five reported having symptoms that lasted for five weeks or longer.
    The ONS said it estimated that during the week ending on 28 November, there were about 186,000 people in England living with COVID-19 symptoms that had lasted between five and 12 weeks.
    This number could be as high as 221,000, the ONS warned. It said the data was experimental and based on the findings from its infection survey of households.
    Read full story
    Source: The Independent, 16 December 2020
  12. Patient Safety Learning
    An Independent Patients' Commissioner is set to be appointed to act as champion for people who have been harmed by medicines or medical devices.   
    Baroness Cumberlege, who recommended the new role in a landmark report earlier this year, announced that the government had budged on the issue after initial resistance.
    She welcomed the move saying: "Had there been a patient safety commissioner before now, much of the suffering we have witnessed could have been avoided."
    But she added "the risk still remains" and further urgent action is needed to protect patients from potentially harmful drugs."
    At an online meeting of parliamentarians, the baroness described the testimony of a victim of the medical device vaginal mesh, which has left some patients in chronic pain.
    The woman had told her review team: "This device took everything from me. My health, my life, my job, my dignity, my marriage, my freedom."
    Reflecting on this the baroness added: "The scale of suffering we witnessed means nothing short of profound change is necessary. Not necessary in a couple or three years, but necessary now."
    Read full story
    Source: Sky News, 16 December 2020
  13. Patient Safety Learning
    NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients.
    The Healthcare Safety Investigation Branch (HSIB) revealed some NHS staff had admitted not reading official guidance on how to avoid the ‘never event’ error as part of a new report identifying deeper systemic problems that it said left patients at an increased risk.
    The independent body warned patients across the NHS remained vulnerable to being injured or even killed by the error that keeps happening in hospitals despite warnings and safety alerts over the last 15 years.
    HSIB launched a national investigation into the problem of misplaced nasogastric (NG) tubes after a 26-year-old man had 1,450ml of liquid feed fed into his lungs in December 2018 after a bike accident.
    The patient recovered but the error was not spotted, even after an X-ray.
    Read full story
    Source: The Independent, 17 December 2020
  14. Patient Safety Learning
    One of England’s largest hospital trusts has been forced to divert ambulances and cancel operations, after seeing a very steep increase in covid-19 admissions over the past week.
    Whipps Cross Hospital in north east London, part of Barts Health Trust, declared a critical incident over the weekend, the trust has confirmed. The trust has also declared a “high pressure phase” of covid response.
    A well placed source said Whipps Cross had been forced to divert ambulances in recent days, because of pressure on its emergency services, while a message to staff said it was deferring some planned operations, along with other steps aimed at protecting safety.
    It is also understood to be attempting to further speed up discharges from hospital.
    Read full story (paywalled)
    Source: HSJ, 16 December 2020
  15. Patient Safety Learning
    Patients needing complex dental work might have to wait longer under new NHS targets, dentists warn.
    The British Dental Association (BDA) fears NHS England will impose penalties on practices that fail to reach 45% of their normal activity level, after negotiations broke down.
    And practices may have to prioritise routine check-ups over more time-consuming treatments.
    An NHS official said: "The NHS and the government are working to determine a safe and reasonable contractual arrangement with dentists, which recognises the constraints on practices and the need to maximise access for patients to see their dentist."
    The waiting list for NHS dentistry could reach eight million by New Year's Eve, according to the Association of Dental Groups.
    Dave Cottam, who chairs the BDA's General Dental Practice Committee, said: "This move will actively undermine patient care.
    "Ministers are instructing dentists to churn through routine appointments against the clock, rather than deal with a huge backlog of urgent cases. Dentists wanting to do the right thing by their patients will now be punished for it."
    Read full story
    Source: BBC News, 16 December 2020
  16. Patient Safety Learning
    A lack of face-to-face appointments during the coronavirus pandemic has significantly worsened the palliative care being provided to people at the end of their life, according to a survey of specialists.
    The research, which the Association of Palliative Medicine and end of life charity Marie Curie shared exclusively with HSJ, found 95% of respondents said their ability to provide good quality end-of-life care had been affected because patients had not received their “usual contact” such as visits from GPs or social care staff. Three-quarters said this had a “great” or “massive” impact.
    Significantly higher numbers of people have died at home since the start of the coronavirus pandemic, compared to previous years.
    Two-thirds of respondents said health professionals had missed opportunities to refer patients into palliative care and, once they had done, four fifths thought they had not done so in a “timely manner.”
    Dr Iain Lawrie, president of APM, said a lack of face-to-face appointments meant “red flags” about patients’ conditions were missed, as these clues are easier to gather in person.
    Read full story (paywalled)
    Source: HSJ, 16 December 2020
  17. Patient Safety Learning
    Pregnant women should be allowed to have one person alongside them during scans, appointments, labour and birth, under new NHS guidance sent to trusts in England.
    The chosen person should be regarded as "an integral part of both the woman and baby's care" - not just a visitor.
    Previously, individual hospitals could draw up their own rules on partners being present.
    This meant many women were left to give birth alone.
    The guidance says pregnant women "value the support from a partner, relative, friend or other person through pregnancy and childbirth, as it facilitates emotional wellbeing".
    Women should therefore have access to support "at all times during their maternity journey".
    And trusts should make it easy for this to happen, while keeping the risk of coronavirus transmission within NHS maternity services as low as possible.
    Read full story
    Source: BBC News, 16 December 2020
  18. Patient Safety Learning
    The waiting list for cancer patients has almost doubled over the last seven months, according to internal NHS data which has never been made public.
    A slide set seen by HSJ suggests the total number of patients waiting for cancer treatment on the 62-day pathway has increased from around 90,000 in mid-May, to around 160,000 at the start of December.
    However, the data suggests the NHS has made good progress in treating patients waiting the longest.
    Read full story (paywalled)
    Source: HSJ, 15 December 2020
  19. Patient Safety Learning
    The government’s plan to allow up to three households to mix at Christmas is a “major error that will cost many lives” and should be stopped, the editors of two leading medical journals have said.
    In a rare joint editorial, the editors of the British Medical Journal and Health Service Journal have said the government’s plan to relax coronavirus restrictions for five days between 23 and 27 December is a serious “blunder” that will put more pressure on the NHS and cause thousands of operations to be cancelled.
    The article published jointly on Tuesday says: “The government was too slow to introduce restrictions in the spring and again in the autumn. It should now reverse its rash decision to allow household mixing and instead extend the tiers over the five-day Christmas period in order to bring numbers down in the advance of a likely third wave.”
    Read full story
    Source: The Independent, 15 December 2020
  20. Patient Safety Learning
    England’s test and trace service is being sub-contracted to a myriad of private companies employing inexperienced contact tracers under pressure to meet targets, a Guardian investigation has found.
    Under a complex system, firms are being paid to carry out work under the government’s £22bn test and trace programme. Serco, the outsourcing firm, is being paid up to £400m for its work on test and trace, but it has subcontracted a bulk of contact tracing to 21 other companies.
    Contact tracers working for these companies told the Guardian they had received little training, with one saying they were doing sensitive work while sitting beside colleagues making sales calls for gambling websites.
    One contact-tracer, earning £8.72 an hour, said he was having to interview extremely vulnerable people in a “target driven” office that encouraged staff to make 20 calls a day, despite NHS guidance saying each call should take 45 to 60 minutes.
    Another call centre worker, who had no experience in healthcare or emotional support, said she suffered a nervous breakdown during an online tutorial about phoning the loved ones of coronavirus victims in order to trace their final movements.
    Read full story
    Source: The Guardian, 14 December 2020
  21. Patient Safety Learning
    In honor and recognition of the 20th anniversary of Lewis Blackman’s death on 6 November 2000, an award has been established with the goal of recognising outstanding leadership in patient safety by students pursuing a health profession and residents in training. Lewis Blackman was an outstanding student himself and because his mother, Helen Haskell, has dedicated her life to improving patient safety, especially through education, the Lewis Blackman Leadership Award has been created.

    You can find all the details and nomination requirements here. Application submissions will be accepted starting 15 December 15 and will close on 31 January.

    If you have any additional questions, please email [email protected]
  22. Patient Safety Learning
    There are not enough nurses to safely care for patients in the UK, according to the body that represents the profession, and many of those who are working are suffering from anxiety and burnout after a gruelling nine months treating Covid patients.
    A year after the prime minister pledged during the 2019 election campaign to add 50,000 nurses to the NHS, the Royal College of Nursing has accused Boris Johnson of being “disingenuous” for claiming the government is meeting this 2025 target.
    Johnson claimed last week that the government had “14,800 of the 50,000 nurses already” during prime minister’s questions in the Commons.
    Yet the latest NHS figures show there were 36,655 vacancies for nursing staff in England in September, with the worst shortages affecting mental health care and acute hospitals. Staff in some intensive care units (ICUs) have quit since the pandemic, with those whom the Observer spoke to choosing to work instead in supermarkets or as dog-walkers.
    Dame Donna Kinnair, the RCN’s chief executive and general secretary, said: “The simple, inescapable truth is that we do not have enough nursing staff in the UK to safely care for patients in hospitals, clinics, their own homes or anywhere else.”
    She said that even before the pandemic, “heavy demand” was rising faster than the “modest increases” in staff numbers.
    Read full story
    Source: The Guardian, 12 December 2020
  23. Patient Safety Learning
    The number of women involved in an investigation into a consultant gynaecologist who "unnecessarily harmed" patients has risen to 382.
    University Hospitals of Derby and Burton NHS Foundation Trust has written to another 110 women who were treated by Daniel Hay.
    Mr Hay is under investigation after eight women treated by him were found to have been "unnecessarily harmed". The latest women have been told there are "no concerns" for their health.
    Staff at the Royal Derby Hospital raised concerns about the consultant's care in late 2018. An initial review of 58 cases involving Mr Hay identified the eight lapses of care for which he and the trust have apologised.
    A broader investigation was launched and another 135 women, who had undergone surgery, were contacted to say their care was being reviewed.
    In September the trust wrote to a further 79 women who had received intermediate care.
    It has now said 110 more women, all outpatients at Ripley Hospital between April 2017 and July 2018, have now been contacted.
    Dr Magnus Harrison, executive medical director, said: "We have widened the review to a specific outpatient clinic... to understand the care being provided there. We are doing this proactively, rather than in response to any specific concerns, so that the review is as thorough as possible."
    "Each of the women have been informed that there are no concerns regarding their current health."
    Read full story
    Source: BBC News, 11 December 2020
  24. Patient Safety Learning
    Coronavirus vaccinations at GP practices will now take ‘twice as long’ after regulators announced new rules just days before the jabs are rolled out across primary care.
    The Medicines and Healthcare products Regulatory Agency announced patients would have to be observed for 15 minutes after they received the vaccine. This came after two people had severe allergic reactions to the Pfizer/BioNTech vaccine.
    Primary care directors told HSJ the change means they have had to overhaul plans in their primary care networks and, in some areas, the vaccine programme will be “unfeasibly challenging” to deliver.
    Sources told HSJ workforce plans are being overhauled, while vaccines risk being wasted because of the additional time constraints. There have been claims some practices may drop the vaccination programme altogether, as they lack capacity to carry out 15-minute observations for each patient.
    One primary care director, who spoke to HSJ anonymously, said: “For us, we now need additional space for an observation area. It also makes it more difficult to efficiently flow through the vaccines as the actual vaccination process might take a few minutes, but the through flow of patients will be limited by the 15-minute wait.”
    They added: “The vaccine now taking at least twice as long to do creates logistical problems. Not insurmountable but there nonetheless."
    Read full story (paywalled)
    Source: HSJ, 11 December 2020
  25. Patient Safety Learning
    The number of COVID-19 infections likely to have been acquired in hospital are rising again for the first time in three weeks and their proportion of all cases has reached record levels for the second wave, HSJ can reveal.
    NHS England data covering the week to 6 December (the latest available) shows 1,787 COVID-19 cases were acquired in-hospital – a rise of almost 14% on the week before. The number of hospital-acquired, or “nosocomial”, infections had been falling since the week to 15 November, when 1,794 were recorded.
    This week, hospital acquired covid infections amounted to 21% of the 8,337 new cases which were recorded in hospitals – the highest proportion in the second wave. On 6 December alone, 24% of infections had probably been acquired in hospital rather than the community.
    Read full story (paywalled)
    Source: HSJ, 11 December 2020

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