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Patient Safety Learning

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  1. Patient Safety Learning
    The UK’s failure to report how many people have recovered from COVID-19 has been criticised by public health experts, who say a huge proportion of cases have remained “invisible” to the health service.
    Britain is an outlier internationally in not reporting the number of people who have recovered from COVID-19 alongside statistics on deaths and numbers of identified cases. Chile is the only other nation not to share this information out of the 25 countries with the highest reported incidence.
    A failure to monitor those who test positive for COVID-19 outside of hospital has left people feeling unsupported and alienated from the health system, the experts say. There is concern that because the majority of community cases have not been logged in patient records, it will be more challenging to research the long-term consequences of the disease.
    Prof Devi Sridhar, the chair of global public health at the University of Edinburgh, said: “Not tracking people in the community, for me, [is] so astonishing. These people are completely invisible in the health system.”
    Read full story
    Source: The Guardian, 18 June 2020 
  2. Patient Safety Learning
    Doctors have warned that a “culture of fear” in the NHS may prevent life-saving lessons being learned about COVID-19 after a leading hospital consultant emailed scores of staff saying those responsible for “leaks” would be found and fired.
    Dr Daniel Martin OBE, head of intensive care for serious infectious diseases at the Royal Free hospital, emailed a report to colleagues at the peak of the pandemic with a note claiming that the trust would “track any leaks to the media” and then “offer you the chance to post your P45 on Facebook for all to see.”
    The email, which described journalists at one respected newspaper as “parasites”, was sent to dozens of nurses and junior doctors. It has been examined by Liberty Investigates, the investigative journalism unit of the civil rights group Liberty, and the Guardian, after being shared by a recipient who said they found the language “intimidating”.
     Whistleblowers UK, the non-profit group, said it had been made aware of the email by a separate individual who was also concerned about its contents.
    The Royal Free London trust said the email was “badly worded” and did not reflect trust policy. However, the trust said it was an open and transparent organisation that “does everything it can to encourage our staff to raise concerns and, if necessary, whistleblow”.
    Read full story
    Source: The Guardian, 22 June 2020
  3. Patient Safety Learning
    Leading clinicians have written to Boris Johnson warning the UK faces a "second health catastrophe" because so many non-Covid patients are missing out on treatment as a result of the pandemic.
    The letter warns that “lives are being put at risk” and that action is needed immediately. It comes as new figures show as many as one in six (10 million) people will be on the NHS waiting list by the end of the year.
    The letter, signed by ten specialists, including cancer doctors, patient safety experts, CQCs and medical negligence lawyers, states: “We are increasingly concerned about the impact, including avoidable harm and death caused by the continuing unavailability of urgent diagnostics and treatment for thousands of non-COVID patients. 
    “The backlog of such cases is now significant and worsening. We implore the central and devolved Governments of the UK to take urgent strategic action, including in co-ordination and co-operation with each other, to prevent this becoming a second and perhaps even more serious health catastrophe arising from the pandemic in the UK.”
    The letter was also signed by barrister Theo Huckle QC, Professor John Fairclough of Swansea and Cardiff Met Universities, Nick Brown of Doughty Street Chambers and Helen Hughes, Chief Executive, Patient Safety Learning.
    Cases which have come to the attention of the signatories include Sherwin Hall, 27, a father of one from Leeds, who made 13 visits to hospital during the COVID-19 lockdown before getting a cancer diagnosis for the pain in his groin.
    He said of his case: “I am very angry at the way I have been treated due to COVID-19 and the delay on my cancer treatment and now I am fighting for my life.
    Read full story
    Source: Express, 21 June 2020
     
  4. Patient Safety Learning
    A new coronavirus test which could replace the existing a nose and throat swab is being piloted in Southampton.
    People will be able to simply spit into a pot at home before the sample is sent off to check whether they have COVID-19.
    If successful, the saliva test could become an alternative to the existing swab which some people find uncomfortable and can provoke coughing and spluttering.
    Read full story
    Source: The Independent, 22 June 2020
  5. Patient Safety Learning
    NHS trusts could be asked to create shared waiting lists for elective care under plans being considered by national leaders.
    HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running.
    Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example, by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch.
    In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements.
    Read more
    Source: HSJ, 19 June 2020
  6. Patient Safety Learning
    Low dose dexamethasone reduces deaths in patients hospitalised with COVID-19 who need ventilation, according to preliminary results from the RECOVERY trial.
    The drug was also found to reduce deaths by one-fifth in other hospitalised patients receiving oxygen only, but no benefit was seen among COVID-19 patients who did not need respiratory support.
    The chief investigators from the University of Oxford trial said that the findings represent a “major breakthrough” which is “globally applicable” as the drug is cheap and readily available.
    Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford and a chief investigator on the trial, added, “This is the only drug that has so far been shown to reduce mortality, and it reduces it significantly. It is a major breakthrough.”
    Read full story
    Source: BMJ, 16 June 2020
  7. Patient Safety Learning
    Doctors fear a rise in stillbirths and babies with impaired growth because pregnant women were too scared to seek help during the pandemic.
    At a Royal Society of Medicine webinar on pregnancy and Covid, medics expressed concern that women in need of urgent attention had kept away from maternity services, for fear of catching the infection.
    In other cases, those with worrying symptoms which could mean their baby was at risk may have stayed away because they feared putting pressure on services, doctors said.
    Dr Maggie Blott, head of obstetrics at the Royal Free London Foundation trust, said: “A lot of the work that we do is is prevention, and a lot of women that we see, turn up for hospital as an emergency - have concerns around abdominal pain, reduced foetal movements, all sorts of things.”
    Read full story (paywalled)
    Source: The Telegraph, 18 June 2020
  8. Patient Safety Learning
    The COVID-19 pandemic could entrench and exacerbate inequalities in mental health for a generation unless action is taken, the Centre for Mental Health has warned.
    In a report published on Thursday, the charity warned that the lockdown would put greater pressure on groups whose mental health was already poor beforeCOVID-19 hit, such as women and children experiencing violence and abuse, and ethnic minority communities.
    The pandemic will leave an “unequal legacy of complicated bereavement, trauma, and economic repercussions which will push more people towards financial insecurity and poverty, significant risk factors for poor mental health,” the report said.
    “Unequal experiences of grief, loss, trauma, injustice, and abandonment all add to the psychological damage caused by COVID-19.”
    The report, backed by 12 mental health charities and the Royal College of Psychiatrists, said that the government must prioritise race equality and support “trauma informed” approaches for all people whose lives had been affected by COVID-19.
    Read full story
    Source: BMJ, 19 June 2020
  9. Patient Safety Learning
    Nurses' leaders want all healthcare employers - including the NHS - to "care for those who have been caring" during the coronavirus crisis.
    The Royal College of Nursing (RCN) is calling for better risk assessments; working patterns and mental health care for those on the front line. It warns many may be suffering from exhaustion, anxiety and other psychological problems.
    The Department of Health and Social Care said support was a "top priority".
    The RCN has released an eight-point plan of commitments it wants to see enforced to mark the 100 days since the World Health Organization (WHO) declared a pandemic.
    Amongst its suggestions are a better COVID-19 testing regime for healthcare workers and more attention paid to the risks posed to ethnic minority nurses.
    It says employers and ministers "must tackle the underlying causes which have contributed to worse outcomes for Bame staff".
    Read full story
    Source: BBC News, 19 June 2020
  10. Patient Safety Learning
    Frontline staff and volunteers at the forefront of the national coronavirus response across England will be able to access a new Psychological First Aid (PFA) training course, the Minister for Mental Health Nadine Dorries has announced.
    The course, which has been developed by Public Health England, will be available to frontline workers and volunteers dealing with the public during the coronavirus pandemic.
    The free online course enables responders to develop their skills and confidence in providing key psychological support to people affected by coronavirus, including on issues such as job worries, bereavement or isolation as they carry out their vital work as part of the ongoing coronavirus response.
    It will also help to develop understanding of how emergencies like the coronavirus pandemic can affect us all, how to recognise people who may be at increased risk of distress, and how to offer practical and emotional support.
    Minister for Mental Health Nadine Dorries said:
    “Supporting each other’s mental health and wellbeing is more important than ever during these challenging and uncertain times. Staff and volunteers in many different roles are working tirelessly to provide crucial support at this time and are often a critical touchpoint in identifying those who may be affected.
    “This new training course will help to support the incredible work of frontline workers to support those most in need both through the coronavirus outbreak and beyond, equipping them with vital tools to deliver psychological first aid.”
    Read press release
    Source: GOV.UK, 15 June 2020
     
  11. Patient Safety Learning
    The chief inspector of hospitals has warned that patient safety is at risk if the NHS winter crisis is worsened by coronavirus – and ministers must act now in emergency departments to prevent a catastrophe.
    Professor Ted Baker, speaking to The Independent in his first interview since the COVID-19 outbreak hit Britain, warned that the NHS could not carry on as before as hospitals across the country struggle to return to normal care while the crisis continues.
    “If we are going to do something about it, we need to act now, not at the beginning of winter,” he warned, adding the Care Quality Commission (CQC) was also worried about patients being “forgotten” as NHS waiting lists surge to an expected 10 million later this year.
    "We will be going into winter and all the difficulties of the winter viruses that we normally face, together with Covid. I think next winter is going to be very difficult, unless emergency departments and the whole system supporting emergency departments do things very differently.”
    He warned providing care in the NHS under the shadow of coronavirus was “a formidable challenge … probably bigger than the challenge we faced at the height of the pandemic”.
    Prof Baker also told The Independent that the CQC was investigating a number of reports that some hospital patients were discharged unsafely to care homes following a staggering 55% rise in whistleblowing complaints, particularly in care homes, with 2,612 calls between March and May.
    Read full story
    Source:  The Independent, 17 June 2020
  12. Patient Safety Learning
    At least another 130,000 people worldwide have died during the coronavirus pandemic on top of 440,000 officially recorded deaths from the virus, according to BBC research.
    A review of preliminary mortality data from 27 countries shows that in many places the number of overall deaths during the pandemic has been higher than normal, even when accounting for the virus.
    These so-called "excess deaths", the number of deaths above the average, suggest the human impact of the pandemic far exceeds the official figures reported by governments around the world.
    Some will be unrecorded COVID-19 victims, but others may be the result of the strain on healthcare systems and a variety of other factors.
    Read full story
    Source: BBC News, 18 June 2020
  13. Patient Safety Learning
    Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. 
    Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls".
    Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. 
    "The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that."
    Read full story (paywalled)
    Source: The Telegraph, 16 June 2020
  14. Patient Safety Learning
    The Care Quality Commission (CQC) has issued a plan for re-starting routine inspections — but has been warned by the NHS Confederation that the health service needs this “like a hole in the head”.
    The organisation said there would be a “managed return” of “routine inspections” in the autumn.
    It also stated in a statement today: ”Inspectors are now scheduling inspections of higher risk services to take place over the summer.” But the CQC later insisted to HSJ that this was not a change to its current policy, in place since the beginning of the UK COVID-19 peak, as it would only be inspecting in response to information it receives which raises “serious concerns”.
    The CQC suspended its routine inspections in March – and has instead been calling healthcare providers and only physically attending where there are serious concerns about harm, abuse or human rights breaches.
    The new approach to regulation, which the CQC called its “emergency support framework”, was criticised by 11 older people’s and disabled groups, which said the decision not to carry out routine inspections broke human rights and equalities laws.
    Read full story
    Source: HSJ, 17 June 2020
  15. Patient Safety Learning
    There should be independent reviews of the NHS’ readiness for a potential second major outbreak of coronavirus in the UK, senior doctors are arguing.
    The Royal College of Anaesthetists said a series of reviews should be carried out, overseen by an independent group formed from clinical royal college representatives, independent scientists and academics.
    It would encompass investigation of what happened to care quality during the peak of infection and demand through March, April and May — there are major concerns that harm and death was caused by knock of effects, with some health services closed and people being afraid to use others.
    Hospitals were unable to provide many other services as staff, including most anaesthetists, were redeployed to help with critical care.
    Ravi Mahajan, president of the Royal College of Anaesthetists, told HSJ areas such as capacity, workforce and protective equipment were key issues to be reviewed. He said: “We can’t wait for [the pandemic] to finish and then review. [The reviews] have to be dynamic, ongoing, and the sooner they start the better.
    Read full story
    Source: HSJ, 17 June 2020
  16. Patient Safety Learning
    A leading surgeon has said NHS staff must be routinely tested for coronavirus up to twice a week.
    Prof Derek Alderson, president of the Royal College of Surgeons, said it was vital, to reassure patients staff were not unwittingly carrying the virus. 
    But hospital trust bosses say they are still waiting for clarity on plans for regular testing. The Department for Health and Social Care (DHSC) said it was focusing on routine testing in care homes.
    Prof Alderson was speaking at a Health Select Committee meeting about the necessary steps to get all NHS services back up and running. He said: "It's absolutely essential to regain public confidence that we are able to test our staff regularly."
    It would be "pragmatic" for testing to take place "about twice weekly", he added, because it was known that the available tests were not perfect.
    Read full story
    Source: BBC News, 17 June 2020
  17. Patient Safety Learning
    A patient almost died after being misdiagnosed and sent home from hospital on the first day of the lockdown as the NHS curtailed many normal services to focus on COVID-19.
    The NHS trust involved has admitted that its failings led to the man suffering excruciating pain, developing life-threatening blood poisoning, and contracting the flesh-eating bug necrotising fasciitis. He needed eight operations to remedy the damage caused by his misdiagnosis.
    The man, his wife and his GP spent three weeks after his discharge trying to get him urgent medical care. However, St Mary’s hospital on the Isle of Wight rejected repeated pleas by them for doctors to help him, even though his health was deteriorating sharply.
    The man, who does not want to be named, said his experience of seeking NHS care for something other than COVID-19 during the pandemic had been “debilitating and exhausting” and that feeling the NHS “was not there” for him had been “very distressing” for him and his wife.
    Mary Smith, of the solicitors Novum Law, who are representing the man in his complaint against the trust, said his plight highlighted the growing number of cases that were emerging of people whose health had suffered because they could not access normal NHS care in recent months.
    Read full story
    Source: The Guardian, 16 June 2020
  18. Patient Safety Learning
    A woman whose father died in a care home has launched a judicial review case in the High Court over the government’s “litany of failures” in protecting the vulnerable elderly residents who were most at risk from COVID-19.
    Cathy Gardner accuses England’s health and social care secretary, Matt Hancock, NHS England, and Public Health England of acting unlawfully in breaching statutory duties to safeguard health and obligations under the European Convention on Human Rights, including the right to life.
    Her father, Michael Gibson, who had Alzheimer’s disease, died aged 88 of probable COVID-19 related causes on 3 April at Cherwood House Care Centre, near Bicester, Oxfordshire. She claims that before his death the care home had been pressured into taking a hospital patient who had tested positive for the virus but had not had a raised temperature for about 72 hours.
    “I am appalled that Matt Hancock can give the impression that the government has sought to cast a protective ring over elderly residents of care homes, and right from the start,” Gardner said. “The truth is that there has been at best a casual approach to protecting the residents of care homes. At worst the government has adopted a policy that has caused the death of the most vulnerable in our society.”
    Read full story
    Source: BMJ, 15 June 2020
  19. Patient Safety Learning
    Care homes have been ordered to destroy a batch of faulty COVID-19 test kits after it was discovered that the swabs could break off while being used to gather samples from residents’ tonsils and noses.
    Care home managers were told on Sunday not to use the tests because they had “brittle stems at risk of snapping”. The kits were manufactured by Citotest, a company based in China, and were distributed by the government’s COVID-19 care home testing programme. It is tasked with providing tests for all staff and residents in care settings, not just people displaying symptoms.
    The affected batch should be destroyed or kept in a safe area clearly marked with warnings not to use them, officials said, adding that the problem emerged on Saturday and they were working as quickly as possible to resolve it.
    The Department of Health and Social Care (DHSC) said the batch could have contained tens of thousands of tests and that a complaint had been raised with the manufacturer, with whom discussions were ongoing.
    “We are aware of an issue with one batch of swab sticks which are being replaced where needed but this does not affect any tests, or the results of tests, previously taken,” a DHSC spokesperson said. “Testing is unaffected and people should still arrive for their booked tests.”
    Read full story
    Source: The Guardian, 15 June 2020
  20. Patient Safety Learning
    Demand for oxygen from COVID-19 patients recovering at home is set to place the NHS under strain, the health service has warned.
    NHS England has issued guidance to out-of-hospital health providers on the extra demands likely to be placed on them given the number of people recovering after a hospital stay with the coronavirus. It warns that the provision from its home oxygen services and community respiratory teams across the NHS is expected to be an issue as the scale of demand increases.
    Andrew Whittamore, a practising GP and clinical lead for the Asthma UK and British Lung Foundation partnership, said concerns about the potential for hospitals to be overwhelmed in the early part of the pandemic had led to community oxygen teams being primed to take on more patients – but he described that ramping up as “a short-term fix”.
    “We don’t know how long people are going to need oxygen or other services for,” he said. “There are definitely going to be extra patients added on to our community teams’ workloads.”
    The Taskforce for Lung Health – of which the British Lung Foundation is a member – has raised particular concerns about access to pulmonary rehabilitation. An education- and exercise-based treatment, which is proven to be more effective for lung patients than many drug-based treatments, and face-to-face classes have been suspended during the pandemic. It may be that such treatment would also be helpful for some patients recovering from COVID-19.
    Jackie Eagleton, policy officer at the British Lung Foundation, said there had been issues with access to pulmonary rehabilitation for a long time, but the need to offer this form of support to people with lung conditions “has never been more pressing than it is now”.
    Read full story
    Source: The Independent, 16 June 2020
  21. Patient Safety Learning
    The architects behind the new NHS Race and Health Observatory have vowed that it will deliver actionable recommendations within months to tackle the structural racism that exists throughout healthcare.
    Victor Adebowale and Mala Rao called for an observatory to tackle the ethnic health inequalities in the UK in a special issue of The BMJ that they co-edited in February (bmj.com/racism-in-medicine) and NHS England confirmed at the end of the May that the centre would go ahead.
    Speaking at a meeting to discuss the aims of the observatory on 12 June, Adebowlae told more than 20 assembled stakeholders that he wanted the new centre “to fire on all cylinders,” making recommendations for changes to services that are likely to affect the health outcomes of people from black and ethnic minority backgrounds “within a couple of months.”
    Read full story
    Source: BMJ, 15 June 2020
  22. Patient Safety Learning
    When Dan Scoble came down with the coronavirus in March, all the classic symptoms landed in one fell swoop. “I had everything under the sun: a fever, temperature, fatigue and chest pain,” he said. “My head felt like a balloon.”
    The 22-year-old, a personal trainer from Oxford who normally breezed through 10-mile runs, suddenly found himself bed-bound. He presumed it would soon blow over, but 12 weeks after falling ill as the country went into lockdown, he is still not back to normal.
    Dan has left his house just five times in three months — twice to see his GP and three times to hospital. He still suffers from crippling fatigue, recurrent migraines and a persistent sore throat, as well as abdominal and musculoskeletal pain.
    Read full story (paywalled)
    Source: The Times, 14 June 2020
  23. Patient Safety Learning
    Unlawful 'do not resuscitate' orders are being placed on patients with a learning disability during the coronavirus pandemic without families being consulted.
    National charities have successfully challenged more than a dozen unlawful do not resuscitate orders (DNRs) that were put in place because of the patient’s disability rather than due to any serious underlying health risk.
    Turning Point said it had learned of 19 inappropriate DNRs from families while Learning Disability England said almost one-fifth of its members had reported DNRs placed in people’s medical records without consultation during March and April.
    In one example, a man in his fifties with sight loss was admitted to hospital after a choking episode and was incorrectly diagnosed with coronavirus. He was discharged the next day with a DNR form giving the reason as his “blindness and severe learning disabilities”.
    Marie-Anne Peters, whose brother Alistair has epilepsy but no other health conditions, overturned a DNR on her brother which included instructions for him not to be taken to hospital.
    Both charities fear other people with learning disabilities who are vulnerable could be wrongly denied life-saving treatment. They have now launched a new checklist for families and care workers to challenge illegal DNRs.
    Read full story
    Source: The Independent, 13 June 2020
  24. Patient Safety Learning
    Dozens of hospitals are running short of scrubs in the latest problem to hit the NHS over the supply of personal protective equipment (PPE) during the coronavirus pandemic.
    The shortages are revealed in a survey of UK doctors undertaken by the Doctors’ Association UK (DAUK), which found that 61% said that the hospital where they worked was facing a shortage of scrubs.
    In recent months, many more NHS staff have begun wearing scrubs, which are usually used mainly by surgical staff, to protect themselves against COVID-19. The prevalence of coronavirus in hospitals has prompted many to switch from wearing their own clothes at work to using scrubs, and handing them in to be washed at the end of their shift. However, the big increase in demand for scrubs from doctors, nurses, physiotherapists and occupational therapists has left many hospitals unable to keep up and also put unprecedented pressure on hospital cleaning services.
    Some staff have even worn pyjamas intended for patients when scrubs have run out.
    “Protective clothing must be considered to be at a par with other PPE by Public Health England and must be provided to staff by the NHS," said said Dr Samantha Batt-Rawden, the president of the DAUK.
    She added: “A failure to adequately supply scrubs to staff may risk further community spread of Covid-19.”
    Read full story
    Source: The Guardian, 15 June 2020
  25. Patient Safety Learning
    Ambulance services have been urged to look at how suspected overdose and poisoning cases are prioritised after paramedics took 45 minutes to reach a woman with known mental health problems.
    Helen Sheath, 33, had been discharged from a mental health unit in early July last year and was still waiting for an outpatient appointment with a psychological assessment and treatment service when she took a fatal dose of sodium nitrate on 20 August.
    Her father called an ambulance at 6.20pm when she had locked herself in a bathroom and was threatening to take the sodium nitrate. But Bedfordshire and Luton senior coroner Emma Whitting said her father could not tell whether or not she had taken it, and that in view of her history of suicidal ideation, the call should have been treated as a category two – with an 18 minutes response target – rather than a category three incident.
    The first ambulance which was sent to her was diverted on route and it was only after a second call to the East of England Ambulance Service at 6.48pm, that the call was upgraded to category two – when the call handler selected a different set of questions, after being told she had ingested the chemical. A rapid response vehicle arrived at 7.05pm and the mental health street triage team attended six minutes later. Shortly afterwards she became acutely unwell and was taken to Bedford Hospital, where she received treatment but died shortly afterwards.
    In a prevention of future deaths report Ms Whitting said: “If the first call had been coded as a category two, it seems likely that the rapid response vehicle, mental health street triage team (and even possibly the double staffed ambulance) would have arrived on scene much earlier (potentially just before or just after Helen had ingested the sodium nitrate) which could potentially have altered the outcome.” 
    The case comes just months after two other ambulance trusts were criticised in cases involving suspected or threatened overdoses.
    The prevention of future deaths report was sent to the Association of Ambulance Chief Executives and the emergency call prioritisation advisory group, which is run by NHS England. Neither would comment other than saying they would respond to the coroner.
    Read full story
    Source: HSJ, 15 June 2020

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