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  1. Patient Safety Learning
    Some hospitals are washing single-use protective gowns at 60C so they can be used several times by frontline staff because of the ongoing shortage, according to a senior NHS official.
    Chris Hopson, the chief executive of NHS Providers, also said hospitals could not rely on government promises that more personal protective equipment (PPE) was on the way – saying there was “relatively low confidence” a shipment of 400,000 gowns would arrive from Turkey on Monday.
    The head of the membership organisation for NHS trusts in England said some trusts had taken to “hand-to mouth” arrangements, with one discovering that some types of gowns remained fluid-repellent if washed at high temperatures.
    “There is no doubt that at the moment, we have now got trusts who have definitely got shortages of gowns,” Mr Hopson told BBC Radio 4’s Today programme. “Trust leaders are doing absolutely everything they can to try and address that problem.”
    Read full story
    Source: The Independent, 20 April 2020
     
  2. Patient Safety Learning
    The government’s chief scientific adviser has cautioned against banking on a OVID-19 jab, warning that new vaccines are “long shots”.
    Oxford University researchers are planning to begin human trials of a vaccine this week and believe that they could have results showing whether it works as early as September.
    However, Sir Patrick Vallance, the chief scientific adviser, has cautioned that even if a vaccine shows signs of protecting against the virus, ensuring that it is safe could take much longer.
    “All new vaccines that come into development are long shots. Only some end up being successful,” he said yesterday. “Coronavirus will be no different and presents new challenges for vaccine development. This will take time.”
    Read full story (paywalled)
    Source: The Times, 20 April 2020
  3. Patient Safety Learning
    Having access to a ventilator can mean the difference between life and death for patients who are seriously ill with COVID-19, but sometimes even these breathing machines cannot save someone's life.
    Juanita Nittla is a chief nurse in the intensive care unit (ICU) at London's Royal Free Hospital, and has been working for the NHS as an intensive care specialist nurse for the past 16 years. Switching off ventilators is part of Juanita's job.
    The work is traumatic and painful, the 42-year-old says. "Sometimes I feel like I am somewhat responsible for someone's death."
    Medical teams face tough decisions about when to stop treatment for patients who aren't getting better. The decision is made after careful consideration, analysing factors such as the age of the patient, underlying health conditions, their response to the virus and likelihood of recovery.
    Read full story
    Source: BBC News, 20 April 2020
  4. Patient Safety Learning
    The UK is gearing up to use the blood of coronavirus survivors to treat hospital patients ill with the disease.
    NHS Blood and Transplant is asking some people who recovered from COVID-19 to donate blood so they can potentially assess the therapy in trials. The hope is that the antibodies they have built up will help to clear the virus in others.
    The US has already started a major project to study this, involving more than 1,500 hospitals.
    A statement from the organisation said: "We envisage that this will be initially used in trials as a possible treatment for Covid-19. If fully approved, the trials will investigate whether convalescent plasma transfusions could improve a Covid-19 patient's speed of recovery and chances of survival."
    "All clinical trials have to follow a rigorous approval process to protect patients and to ensure robust results are generated. We are working closely with the government and all relevant bodies to move through the approvals process as quickly as possible."
    Read full story
    Source: BBC News, 20 April 2020
  5. Patient Safety Learning
    Concerns have been raised that updated government guidance on personal protective equipment (PPE) could put hospital staff and patients at risk.
    Healthcare workers have been advised to reuse gowns or wear different kit if stocks in England run low.
    Unions representing doctors and nurses have expressed concerns about the updated Public Health England guidance.
    Healthcare staff treating patients with Covid-19 have previously been advised to wear long-sleeved disposable fluid-repellent gowns.
    But Public Health England changed its guidance on Friday, outlining three options if the gowns are not available as "some compromise is needed to optimise the supply of PPE in times of extreme shortages".
    Read full story
    Source: BBC News, 18 April 2020
  6. Patient Safety Learning
    An “unprecedented” national suicide prevention plan has been launched by a government advisory group amid concerns suicides could increase during the covid-19 pandemic, HSJ can reveal.
    The government’s national suicide prevention advisory group has developed the plan to address risks covid-19 could present to vulnerable people.
    Chair of the group and the national adviser to the government on suicide prevention, Louis Appleby, told HSJ the plan was centred on getting far quicker access to data on suicides and self-harm episodes, which is the strongest indicator of suicide risk.
    He said: “We are in unprecedented times, we haven’t got a lot of evidence on what happens to suicides rates during pandemics, so we’re having to infer from what we know generally to see where the risk might lie.
    “This is a serious attempt, in some senses an unprecedented attempt to prevent a [physical health] crisis turning into a mental health crisis."
    Read full story
    Source: HSJ, 17 April 2020
  8. Patient Safety Learning
    Dozens of NHS trusts fear running out of disposable gowns this weekend if they do not receive more supplies, while national officials have issued guidance on alternatives to use in extreme circumstances, HSJ has learned. 
    Several well-placed sources in procurement reported widespread concerns, more severe than so far in the COVID-19 outbreak. One had information that at least 60 trusts would run out this weekend without supplies, and that it was likely the large majority of NHS providers were affected.
    One well-placed source told HSJ the situation today was “not normal even during this pandemic”. Another described the “critical” shortage as “a dire situation for everyone”.
    Read full story
    Source: HSJ, 17 April 2020
  9. Patient Safety Learning
    More than 9 in 10 people dying with coronavirus have an underlying health condition, figures from the Office for National Statistics (ONS) show.
    The ONS looked at nearly 4,000 deaths during March in England and Wales where coronavirus was mentioned on the death certificate. In 91% of cases the individuals had other health problems.
    The most common was heart disease, followed by dementia and respiratory illness. On average, people dying also had roughly three other health conditions.
    The ONS has also looked at the differences in death rates by age and sex, with men twice as likely to die with coronavirus. Unsurprisingly, the risk of dying increases with age, rising sharply from age 60 years onwards.
    Read full story
    Source: BBC News, 17 April 2020
  10. Patient Safety Learning
    A three-year-old child died after its desperate mother spent more than an hour on hold to the NHS 111 helpline.
    The ill child suffered a cardiac arrest at its home and died in hospital, according to details of critical incidents affecting children in London amid the coronavirus crisis. 
    Another case saw a six-month-old die from sepsis and liver failure because the parents feared the child could catch Covid-19 in hospital, the Evening Standard reports. 
    Doctors have raised concerns that parents are not seeking treatment for their children amid the outbreak.
    Read full story
    Source: 16 April 2020, Mail Online
  11. Patient Safety Learning
    Experts have warned giving the public coronavirus antibody tests to be carried out at home could lead to “disastrous results”.
    A testing manager at an NHS trust told HSJ they feared the public may take the tests too soon for antibodies to appear, which could produce misleading results, while a leading virologist at the British Society for Immunology called for antibody tests to be carried out in GP surgeries.
    Public Health England has previously said it wants to distribute antibody tests via Amazon and Boots and make them available to the general public. Health secretary Matt Hancock has also promised increased antibody tests will form part of 100,000 of all types of daily COVID-19 tests by the end of April.
    Read full story
    Source: HSJ, 17 April 2020
  12. Patient Safety Learning
    The British Dental Association (BDA) has criticised NHS England for “dragging its feet” in setting up an urgent care system for dental patients, putting further strain on already overstretched GPs.
    At the end of March, dental practices were ordered to suspend all routine treatment, as part of plans to prevent the spread of coronavirus. NHS regions were instructed to set up local urgent dental care centres.
    However, GPs have told HSJ they have been experiencing a rise in calls from patients with dental problems, but when they direct them to the urgent care centres, appointments appear to be limited. The BDA has said, in some regions, there is “nowhere” to send patients in need of urgent dental care.
    Sources working in primary care and tech said GPs were dealing with a spike in demand from dental patients who did not know where to go.
    Read full story
    Source: HSJ, 17 April 2020
  13. Patient Safety Learning
    Doctors have been warned that crucial drugs used to help sedate and ventilate patients in intensive care are running out due to the demand caused by coronavirus.
    An alert to hospitals from NHS England today said there were “limited supplies” of muscle relaxant drugs atracurium, cisatracurium and rocuronium, which are used during intubation when patients are sedated and paralysed with a ventilator used to help them breathe.
    As a result of the shortages, and to help maintain supplies, NHS England said it would now manage existing supplies “centrally”.
    Its said supplies of atracurium and cisatracurium were likely to be exhausted in coming days, and hospitals would need to switch to alternatives that were still available.
    A critical care nurse working in ICU in the south of England told The Independent they were already using alternatives but that this had to be used at different concentrations and run for longer to achieve the same sedation.
    She said changes like this with staff overstretched could increase the likelihood of drug errors.
    Read full story
    Source: The Independent, 17 April 2020
  14. Patient Safety Learning
    The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned.
    Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them.
    And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived.
    The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden.
    “People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.”
    Read full story
    Source: The Guardian, 16 April 2020
  15. Patient Safety Learning
    A leaked letter seen by the BBC has revealed an extensive list of concerns about how the social care sector is coping with the coronavirus crisis.
    The letter raises fears about funding, testing, personal protective equipment (PPE) and the shielding scheme for vulnerable people.
    Written on Saturday, to a senior official at the Department of Health and Social Care by the Association of Directors of Adult Social Services (Adass), it says mixed messages from the government have created "confusion and additional workload".
    On protective equipment for care workers, the letter says the national handling has been "shambolic". Early drops of equipment have been "paltry" and more recent deliveries have been "haphazard", with some even being confiscated by border control for the NHS.
    And while the rollout of testing for care workers has been generally welcomed, the letter states "testing for care workers appears to be being rolled out without being given thought to who is going to be tested and what we are going to do with the result".
    Read full story
    Source: BBC News, 16 April 2020
  16. Patient Safety Learning
    Close family members will be able to see dying relatives to say goodbye under new coronavirus guidelines, Health Secretary Matt Hancock has said.
    He said the UK would introduce new steps to "limit the risk of infection" and allow goodbyes "wherever possible".
    Many loved ones have been unable to say goodbye to family and friends since stringent restrictions were introduced on life in the UK on 23 March.
    Mr Hancock highlighted the death of Ismail Mohamed Abdulwahab, 13, from Brixton, south London. Ismail died alone in hospital last month and his close family were then unable to attend his funeral because they were self-isolating.
    Speaking at Wednesday's briefing, Mr Hancock said the reports made him "weep". "Wanting to be with someone at the end of their life is one of the deepest human instincts," he said.
    New government guidelines for social care providers, published shortly after the briefing, say that care homes should still "limit unnecessary visits" but advises that "visits at the end of life... should continue"
    Read full story
    Source: BBC News, 16 April 2020
  17. Patient Safety Learning
    The world is likely to face a global crisis in poor mental health after the coronavirus pandemic has passed, experts have warned.
    Two dozen mental health scientists including neuroscientists, psychiatrists, psychologists, and public health experts have warned of the long-term impact of the virus on people’s mental health and demanded governments prioritise research to come up with evidence-based treatments.
    They also called for real-time monitoring of mental health in the UK and across the world in order to gauge the severity of the expected increase in poor mental wellbeing.
    Their warning, in the journal Lancet Psychiatry, comes as a new Ipsos Mori survey carried out at the end of March revealed people’s mental health was already being affected by the UK lockdown and self-isolation policy.
    Read full story
    Source: The Independent, 16 April 2020
  18. Patient Safety Learning
    Millions of patients face being left without a dentist as one in five practices are on the brink of collapse this month.
    A sharp loss of income since the government banned all routine dental care during the coronavirus crisis has crippled practices, with many poised to close permanently. Some have already been forced out of business.
    A British Dental Association (BDA) survey of 2,800 practices found 71.5% said they could stay “financially sustainable” for only three months at the most. More than one in five, 20.4%, said they would not survive beyond April. Mick Armstrong, who chairs the association, said: “Practices are weeks from a cliff edge. Without meaningful support, the nation’s dental services face decimation.”
    Read full story (paywalled)
    Source: The Times, 12 Aril 2020
  19. Patient Safety Learning
    In March, while the UK delayed, Ireland acted. For many this may prove to have been the difference between life and death.
    The choices our governments have made in the last month have profoundly shaped what risks we, as citizens, are exposed to during the course of this pandemic. Those choices have, to a large extent, determined how many of us will die.
    At the time of writing, 365 people have died in Ireland of COVID-19 and 11,329 have died in the UK. Adjusted for population, there have been 7.4 deaths in Ireland for every 100,000 people. In the UK, there have been 17 deaths per 100,000. In other words, people are dying of coronavirus in the UK at more than twice the rate they are dying in Ireland.
    In her article, Elaine Doyle explores why this might be.
    Read full story
    Source: The Guardian, 14 April 2020
  20. Patient Safety Learning
    None of the new life-saving mechanical ventilators ordered last month to cope with the increase in coronavirus patients has so far been awarded safety approval.
    Models by manufacturers such as Dyson have yet to get the green light from the Medicines and Healthcare products Regulatory Agency, the Financial Times reported.
    It comes a month after the Government issued a rallying cry to put non-medical manufacturers such as Dyson on a "war footing" to make additional machines.
    The lag is thought to be due in part to changing clinical understanding of how best to manage the virus.
    Read full story (paywalled)
    Source: The Times, 14 April 2020
  21. Patient Safety Learning
    Nurses at a hospital run by a major private healthcare provider have been threatened with disciplinary action after apparently refusing to treat coronavirus patients, according to a leaked email seen by HSJ.
    The email was sent on Sunday by a senior matron at Nuffield Health’s Cheltenham Hospital, which has been made available to the NHS during the COVID-19 outbreak.
    She said: “I’m hoping to get another undisturbed day as I’m going to have to formally take on everyone who won’t help on the C19 side."
    “Unfortunately, it will be a disciplinary matter and referral to the [Nursing and Midwifery Council]. I really don’t want to go down that route but they’re giving me little choice.”
    It is not clear why staff had refused to help with COVID-19 work, but one staff member who spoke with HSJ said nurses had objected to working without personal protective equipment.
    A spokesman for Nuffield Health said: “We can categorically state that we have been provided with a full supply of PPE from the local NHS trust so that all members of the team are protected when they treat COVID-19 patients. The team has also been given the appropriate training to ensure they can carry out their roles safely.”
    Read full story
    Source: HSJ, 14 April 2020
  22. Patient Safety Learning
    All care home residents and staff with COVID-19 symptoms will be tested for coronavirus as laboratory capacity increases, the government has promised.
    Health Secretary Matt Hancock said he was "determined" to ensure everyone who needed a test had access to one. 
    Care providers have been calling for more testing for weeks, with charities saying the virus is "running wild" amid outbreaks at more than 2,000 homes. At the moment only the first five residents who show symptoms in a care home are tested, to determine whether there is an outbreak of the virus.
    Providers have also complained that deaths among residents were being "airbrushed" out of official figures and demanded greater support for the industry.
    Read full story
    Source: BBC News, 15 April 2020
  23. Patient Safety Learning
    GPs are advising patients with respiratory diseases to buy oxygen privately amid shortages of the gas across the NHS.
    Last week hospitals were warned to urgently consider limiting how many patients were given oxygen simultaneously.
    Hospitals usually have a pipeline to pump liquid oxygen from a central store to the wards, but most do not have the capacity to meet the demand from the number of patients they are treating with COVID-19.
    Read full story (paywalled)
    Source: The Times, 12 April 2020
  24. Patient Safety Learning
    One in 10 nurses working in acute hospitals are off work due to coronavirus, according to internal NHS figures seen by HSJ.
    Internal NHS figures from the COVID-19 national operational dashboard state that, on Saturday, English acute trusts reported that 41,038 nurses and midwives were absent . 28,063 (68%) were COVID-19 related. The total nursing and midwifery headcount in acute trusts is about 280,000 — meaning roughly 10% are off on covid-related absence.
    There are ongoing complaints from staff about their access to COVID-19 tests — which, it is hoped, will hope reduce the absence rates from suspected cases — while national officials say these are now being made available.
    Read full story
    Source: HSJ, 14 April 2020
  25. Patient Safety Learning
    Cancer doctors say difficult decisions are having to be made to postpone some patients' care during the coronavirus crisis.
    Some treatments such as chemotherapy can weaken the immune system, and potentially put patients at greater risk from COVID-19. Some of those affected have been expressing concern.
    Roisin Pelan is 38 and lives in Lancashire. She has incurable breast cancer and had been taking chemotherapy tablets every day. Every three months she also visits the hospital to receive the drug intravenously. Last month she was told her chemotherapy treatment would be stopped for 12 weeks.
    "It's terrifying they've stopped treatment that I know is keeping me alive," she says.
    "To have that taken away is just unbearable. How do we know it's only going to be 12 weeks? This pandemic could go on a lot longer."
    NHS England has told trusts that all essential and urgent cancer treatments must continue but specialists should discuss with patients whether it is riskier for them to undergo it or delay.
    Read full story
    Source: BBC News, 13 April 2020

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