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  1. Patient Safety Learning
    Once COVID-19 seeps into care homes, it is a monumentally difficult job to protect the residents, writes Sky's Alex Crawford.
    We will look back at this appalling, tragic episode in our global history, and our children and grandchildren will ask us: "Did that really happen? Did you really leave the most vulnerable of our society - the elderly, the infirm, the defenceless, the muddled, sick and weak - in care homes, shut away from their closest relatives? Did you leave them to be ravaged by a deadly virus, and do very little to help them?"
    Because that is what's happening right now. There are elderly people - many with Alzheimer's, many with dementia, many frail - in thousands of residential homes up and down Britain, and they are very much at risk.
    Read full story
    Source: Sky News, 11 Aril 2020
  2. Patient Safety Learning
    Eight in ten coronavirus patients placed on ventilators in New York City have died, according to officials.
    New York state has recorded more cases than any country other than America itself. The tally rose by 10,000 in 24 hours to 159,937, ahead of Spain and Italy, which at different times have reported the most infections in the world. The US, which now holds the position, had 463,433 confirmed cases yesterday and the national death toll was 16,504.
    Read full story
    Source: The Times. 10 April 2020
  3. Patient Safety Learning
    London trusts have been warned not to expect deliveries of gowns from the national supply chain for at least the next few days, HSJ understands.
    Without central deliveries, providers risk running out of gowns ahead of the Easter weekend. Trusts will have to rely on existing supplies and any new stock they procure independently. 
    Staff performing or assisting aerosol-generating procedures on confirmed or suspected covid-19 patients should wear gowns, according to the latest guidance from Public Health England.
    But supplies have been an issue for weeks, with trust procurement leads raising concerns about dwindling gown stocks last month. It recently emerged that gowns were not included in national pandemic stockpiles, unlike other forms of personal protective equipment like masks and gloves.
    Read full story
    Source: HSJ, 9 April 2020
  4. Patient Safety Learning
    Medical leaders have warned sick patients not to avoid getting help from the NHS after a huge drop in the numbers of people attending A&E departments sparked fears some could die without care.
    In March, the number of people going to their local emergency department fell by 600,000, or 29 per cent, compared to same month last year, the lowest number of attendances since 2010.
    While the NHS has battled for years to reduce the number of people going to A&E for unnecessary reasons, the sudden fall during the coronavirus epidemic has worried officials that the pandemic could be deterring people who have genuine need and who could become sicker or even die as a result of staying away.
    Read full story
    Source: HSJ, 9 April 2020
  5. Patient Safety Learning
    Hospitals are turning to the veterinary workforce to fill staffing gaps on intensive care wards ahead of an expected peak of COVID-19 patients, HSJ can reveal.
    Torbay and South Devon Foundation Trust has recruited 150 vets to enrol as “respiratory assistants”, amid preparations for a 10-fold increase of intensive care patients.
    Another trust, Hampshire Hospitals FT, has asked vets and dentists to become “bedside support workers” as part of its response to COVID-19 pressures.
    Read full story
    Source: HSJ, 9 March 2020
  6. Patient Safety Learning
    A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris.
    A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity.
    While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection.
    One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available.
    Read full story
    Source: HSJ, 9 April 2020
  7. Patient Safety Learning
    The UK's organ transplant network could be forced to shut down as a result of the coronavirus outbreak, the body that runs the scheme is warning.
    One factor is the pressure on intensive care beds, according to NHS Blood and Transplant (NHSBT). But there is also the risk to transplant patients, who have their immune systems suppressed so their bodies don't reject new organs.
    This is a dilemma for those like Ana-Rose Thorpe, from Manchester, who is waiting for a liver transplant.
    Now aged 29, Ana-Rose has lived with hepatitis almost her entire life after contracting it as a baby. The disease has taken its toll and now her liver is failing and she is in desperate need of a transplant.
    "Having to go into hospital while there are coronavirus patients there is very worrying," she says.
    "Whilst my body could withstand the transplant, the longer I'm not being monitored, not being seen as often as I was, the longer I leave it, I could just get sicker and sicker.
    "I feel like it's patients that are already on the transplant list, patients waiting for other operations, we have just been swept aside."
    "It's my life - it is a matter of life and death," Ana-Rose says.
    Read full story
    Source: BBC News, 9 April 2020
  8. Patient Safety Learning
    Some Welsh NHS staff with Covid-19 have been given wrong test results and were told they did not have coronavirus, BBC Wales has learned.
    They are among a group of ten who have been given incorrect results - including eight from Aneurin Bevan Health Board and two from elsewhere.
    It is not clear how many of the ten had Covid-19 and were told they did not, or vice versa.
    The Gwent-based heath board said the staff were contacted "immediately".
    It happened when a small number of test samples from a batch of 96 were attributed to the wrong patients.
    Read full story
    Source: BBC Wales, 7 April 2020
  9. Patient Safety Learning
    The designs of a new breathing aid developed by engineers at the Mercedes F1 team, University College London (UCL), and clinicians at UCL Hospital have been made freely available to support the global response to COVID-19. It's the latest development in Formula 1’s Project Pitlane effort to help fight coronavirus.
    The Continuous Positive Airway Pressure (CPAP) devices, which help coronavirus patients with lung infections to breathe more easily, were developed by engineers at the Mercedes team and University College London (UCL), and clinicians at UCL Hospital after a round-the-clock effort to reverse engineer a device that could be manufactured rapidly by the thousands.
    After patient evaluations at UCLH and across sister hospitals in the London area, the device received regulatory approval last week. An order for up to 10,000 has now been placed by the British National Health Service, and the Mercedes AMG High Performance Powertrains technology centre in Brixworth – the facility where the F1 team’s highly successful power units are developed and built – is now building 1,000 devices per day.
    Read full story
    Source: F1, 7 April 2020
  10. Patient Safety Learning
    “Recurrent safety risks” around clinical care at an embattled NHS trust’s maternity service have been identified in a report published on Tuesday.
    The Healthcare Safety Investigation Branch (HSIB) has been investigating East Kent hospitals university NHS foundation trust since July 2018 after a series of baby deaths.
    Among those treated at the trust was Harry Richford, whose death was “wholly avoidable”, seven days after his emergency delivery in November 2017, an inquest found.
    Speaking on Tuesday, Harry’s grandfather Derek Richford said it is clear that sufficient lessons were not learned from his death.
    The independent report, published on Tuesday by the Department of Health and Social Care, discusses 24 maternity investigations undertaken since July 2018, including the deaths of three babies and two mothers.
    It said: “These investigations have enabled HSIB to identify recurrent safety risks around several key themes of clinical care in the trust’s maternity services.”
    Read full story
    Source: The Guardian, 8 April 2020
  11. Patient Safety Learning
    Sending coronavirus patients to hospital can dramatically increase death rates, the experience of two hard-hit Italian regions suggests.
    Veneto and Lombardy are neighbouring regions but have seen sharply differing fatality rates since the contagion broke out in northern Italy in late February. Despite having equally well-equipped hospitals and similar levels of wealth, Lombardy’s death rate is around 17% while that of Veneto is around 5%.
    One reason for the disparity is that Veneto has tested many more people – the more tests that are carried out, the more positive cases are found, and that brings down the overall death rate among those infected.
    But another key factor, experts believe, is that Lombardy admitted more patients to hospital, whereas Veneto urged them to stay at home or treated them in local health clinics.
    Read full story (paywalled)
    Source: The Telegraph, 6 April 2020
  12. Patient Safety Learning
    Nick has terminal bowel cancer. He’s been told he won't receive chemotherapy for three months because it would put him more at risk of the coronavirus.
    He fears having the treatment taken away would shorten his life.
    Current NHS guidelines say cancer specialists should discuss with their patients whether it is riskier for them to undergo or to delay treatment at this time.
    Read full story
    Source: BBC News, 6 April 2020
  13. Patient Safety Learning
    Health apps have grown enormously in popularity, even more so during the COVID-19 Pandemic. Since early March, more than 500 health apps contain coronavirus-related keywords in their description.
    People are taking advice from these apps, often using them to share sensitive information. Yet, in a time of fake reviews, scams and personal data breaches, not all health apps can be trusted. 
    The Organisation for the Review of Care and Health Apps (ORCHA) has launched a health app formulary to help healthcare professionals and consumers know which health apps they can trust. 
    As a free to use resource, the site includes reviews of health apps across a range of health conditions relevant to the COVID-19 pandemic, including reviews of COVID-19 apps launched to date.
    Read full story
    Source: ORCHA, 6 April 2020
  14. Patient Safety Learning
    The NHS is launching a hotline to support and advise healthcare staff during the coronavirus pandemic.
    Volunteers from charities including Hospice UK, the Samaritans and Shout, will listen to concerns and offer psychological support.
    The phone line will be open between 07:00 and 23:00 every day, while the text service will be available around the clock.
    The phone number is 0300 131 7000 or staff can text FRONTLINE to 85258.
    It comes as staff face increasing pressure to care for rising numbers of patients who are seriously ill with the virus.
    Read full story
    Source: BBC News, 8 April 2020
  15. Patient Safety Learning
    Ambulance staff are being put at risk by a lack of protective equipment to guard them against coronavirus, according to a trade union.
    GMB says its members are "scared" about their own safety and their families. The union claims one in five ambulance staff in London are off sick with coronavirus-related sickness.
    The government says hundreds of millions of protective items have been delivered to NHS staff around the country.
    According to the GMB Union, 679 frontline ambulance crew in the London Ambulance Service are off sick due to Covid-19-related sickness.
    Among those at work, some say they feel unprotected either because of a lack of or inadequate personal protective equipment (PPE).
    Read full story
    Source: BBC News, 8 April 2020
  16. Patient Safety Learning
    The Government will look for a refund for millions of coronavirus tests ordered from China after scientists found they were too unreliable to be used by the public.
    Ministers will attempt to recoup taxpayers' money spent on the fingerprick tests after an Oxford University trial found they returned inaccurate results.
    The failure is a significant setback because it had been hoped the antibody tests would show who had already built up immunity, therefore offering a swifter route out of lockdown.
    Read full story
    Source: The Telegraph, 6 April 2020
  17. Patient Safety Learning
    Doctors in Britain are being “bullied and shamed” into treating patients with COVID-19 despite not having the masks, gowns and eyewear they need to protect themselves from the virus, frontline medics have said.
    Others are being told to hold their breath to avoid getting infected because of persistent shortages of personal protective equipment (PPE) .
    The findings raise questions about how far a huge effort by NHS bosses, ministers and the military has succeeded in banishing previously widespread supply problems with PPE.
    “Lack of personal protective equipment continues to be a critical issue. It is heartbreaking to hear that some staff have been told to simply ‘hold their breath’ due to lack of masks,” said Dr Samantha Batt-Rawden, the president of the Doctors’ Association UK (DAUK).
    “Doctors are dying. Nurses are dying. We are devastated, and can no longer stand by and watch as more dedicated colleagues lose their life,” she said.
    Read full story
    Source: The Guardian, 7 April 2020
  18. Patient Safety Learning
    The government could be significantly underestimating the number of medics going off work due to the coronavirus, according to a survey by the Royal College of Physicians (RCP).
    The health secretary, Matt Hancock, said on Sunday that 5.7% of hospital doctors were off sick or absent because of Covid-19, but a doctors’ survey of more than 2,500 medics found the rate was almost three times that – 14.6%.
    In recent weeks in London, nearly a third of hospital doctors said they were off work for Covid-19 and non-Covid-19 reasons, according to the RCP’s poll of members, conducted on Wednesday and Thursday.
    Prof Andrew Goddard, the president of the RCP, said the number who had been off work in London “should be a sobering wake-up call” for the rest of the country, with the largest rises in confirmed cases now being outside the capital including in the West Midlands.
    Read full story
    Source: The Guardian, 5 April 2020
  19. Patient Safety Learning
    Plaid Cymru Leader Adam Price has argued that the Welsh Government should appoint a procurement tsar to get to grips with Wales's serious shortage of COVID-19 testing kits, personal protective equipment (PPE) for frontline health and care staff and medical devices for patients.
    Wales is currently only testing 1,100 people a day when it was planning to test 6,000. This follows the collapse of an alleged deal between the Welsh Government and private company Roche which would have provided for 5,000 of those tests.
    Adam Price made the case for the appointment of a tsar whose "sole responsibility" would be the procurement and supply of COVID-19 tests, PPE, and oxygen and medical devices for Wales.
    He cited cases of care homes with just one or two boxes of surgical masks - each enough to last just two days for one patient, as well as hospital staff being forced to wear paper underwear over their hair due to the lack of any other protection.
    Read full story
    Source: Plaid Cymru Party of Wales, 6 April 2020
  20. Patient Safety Learning
    The first two coronavirus deaths among care workers in England were announced, as industry leaders hit out at chronic shortages of protective equipment and urged the government to start treating social care as “a second front line”.
    Carol Jamabo, 56, a community carer for Cherish Elderly Care in Bury in Greater Manchester, died last Wednesday.
    Another carer died in a home run by MHA, the UK’s largest charitable social care provider, which said it was unclear where she contracted the virus. The death of a West Dumbartonshire care worker that emerged on Sunday was also confirmed by the Scottish first minister, Nicola Sturgeon.
    The fatalities came amid rising concern that those working in social care still do not have the protection they need amid the Covid-19 pandemic and that, without testing for the virus, staff risk contaminating care homes where elderly people are supposed to be “shielded”.
    Read full story
    Source: The Guardian, 6 April 2020
  21. Patient Safety Learning
    Doctors and nurses will need treatment for post-traumatic stress disorder after working in harrowing conditions on wards during the coronavirus crisis, health leaders warn.
    The strain on their mental and physical health is already unprecedented and the virus has not yet reached its expected peak, they say.
    NHS staffing is at levels that were previously unthinkable as workers – forced to spend hours in hot conditions while wearing full protective gear – try to keep up with demand amid a lack of equipment.
    It comes as the head of intensive care at London’s Royal Free Hospital described in a memo how most units had already shifted from the usual one nurse to one patient ratio to one to six and were running out of key machines and equipment.
    Dr Alison Pittard, dean of the Faculty of Intensive Care Medicine, told The Independent: “I am really concerned about the toll this is taking and will continue to take on staff."
    “We are used to dealing with emergencies, but we have never been exposed to this sort of demand. We know staff are already struggling physically and mentally and that this will only continue."
    Read full story
    Source: The Independent, 6 April 2020
  22. Patient Safety Learning
    Doctors, nurses and paramedics have been given conflicting advice about when to start resuscitation for coronavirus patients, amid fears the procedure could put them at risk of infection.
    While Public Health England has said it does not believe CPR creates a risk, the UK’s Resuscitation Council – which is responsible for setting standards for resuscitation in the NHS – has said it believes there is a risk and staff should wear full equipment.
    The Independent has seen several examples of different messages being sent out to hospital staff and ambulance workers, and some NHS trusts were forced to change their guidance within a matter of days after PHE changed its stance.
    One set of guidance could mean a delay in starting CPR for patients while staff put on protective equipment, while the other means staff could be at risk of being infected with coronavirus.
    Ken Spearpoint, a former consultant nurse and resuscitation officer at Imperial College Healthcare Trust, said the situation had led to confusion and created an “ethical dilemma” for some staff who were being forced to choose between the Resus UK’s position and their trust’s guidance.
    Read full story
    Source: The Independent, 6 April 2020
  23. Patient Safety Learning
    Thousands of people have been missed off the government's high risk list for Covid-19 despite meeting the criteria.
    Among them have been transplant patients, people with asthma and some with rare lung diseases.
    Many are worried it will affect their ability to access food and medical supplies as they shield from the virus, unable to leave their homes for at least 12 weeks.
    "It's like she's been forgotten," said Bev Pearson, mother of 20-year-old heart transplant patient Lucy Pearson.
    Miss Pearson, from Whitsbury in Fordingbridge, Hampshire, had her transplant 14 years ago and still visits hospital for regular check-ups. She has been shielding in the home she shares with her mother, brother and sister - none of whom have been venturing out in an attempt to protect her.
    Despite registering her daughter on the government list herself, she said she had received no confirmation.
    When she asked her GP she was told it had "nothing to do with the surgery", she added.
    Read full story
    Source: BBC News, 7 April 2020
  24. Patient Safety Learning
    Oxygen supplies at a Hertfordshire hospital inundated with coronavirus patients became so precarious last week that officials considered how to decide who should receive the gas and who should miss out and likely die, the Guardian understands.
    The oxygen system at Watford general hospital came close to breaking point on Saturday, when a critical incident was declared and staff had to tell the public not to come to the hospital. Some patients were moved out to prevent the vital system failing.
    A senior clinician said: “They were [consulting] the hospital ethics committee every day and considering who they were not going to oxygenate and ventilate if they needed it, and making decisions about who would be triaged to not have oxygen and die.”
    Read full story
    Source: Guardian, 5 April 2020
  25. Patient Safety Learning
    Adult social care services are to receive millions of personal protective equipment products following a national audit of personal protective equipment (PPE), HSJ can reveal.
    The government will deliver more than 30 million items to local resilience forums in the coming days, for distribution among social care and other front-line services, according to a letter seen by HSJ.
    The stock should not be sent to acute trusts or ambulance services, the letter, from health and social care secretary Matt Hancock and housing, communities and local government secretary Robert Jenrick, stated.
    Describing an “urgent need” for PPE in front-line services, Mr Hancock and Mr Jenrick asked local planners to distribute this latest batch of stock “only where there is a clear and pressing need”.
    Read full story
    Source: HSJ, 6 April 2020

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