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Patient Safety Learning

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  1. Patient Safety Learning
    New figures reveal that what we think we know about the Covid-19 death toll in the UK is wrong. Here’s why.
    Every day we get one big figure for deaths occurring in the UK. Everyone jumps on this number, taking it to be the latest toll. However NHS England figures – which currently make up the bulk of UK deaths – in fact reflect the day on which the death was reported, not the actual date of death, which is usually days, sometimes weeks, before it appears in the figures.
    The truth is we don’t know how many deaths have taken place the previous day. In fact the headline figure is likely to under-report the number of deaths that actually happened the previous day.
    The number we hear about usually counts deaths which took place at an earlier date. The difference matters because by undercounting the number of deaths we are skewing the curve.
    Read full story
    Source: Guardian, 4 April 2020
  2. Patient Safety Learning
    A healthcare worker in north-west London quit her job after she was refused permission to wear a protective face mask, the Guardian has learned.
    In her resignation letter, Tracy Brennan chastised her superiors at Hillingdon Hospitals NHS foundation trust for forbidding her from wearing a surgical mask she had bought to protect herself – and the patients she was caring for – from contracting the deadly virus.
    Brennan, a healthcare assistant, said she had returned to work after self-isolating for 14 days because her daughter had shown symptoms of Covid-19. She said that patients in the ward where she was working, which was not a coronavirus treatment ward, felt comfortable with her wearing the surgical mask and some positively encouraged her to do so.
    Brennan wrote: “With a heavy heart and sadness, I feel I have no alternative but to hand this letter in as my formal resignation and will be unable to work my notice due to not being allowed to wear sufficient personal protective equipment (PPE) for the duties I perform.”
    Read full story
    Source: Guardian, 4 April 2020
  3. Patient Safety Learning
    When Victoria Gianopoulos-Johnson got a call from her midwife to say her home birth would be cancelled, panic took hold. She says she “lost it” for two days, crying constantly, gripped by uncertainty and then anger. Now she has reached the decision to have a free birth, also known as unassisted childbirth.
    Maternity rights groups say there has been a rise in the number of women seeking advice about freebirthing owing to pressures on hospitals and new restrictions around birth partners.
    More than a fifth of birthing centres and more than a third of homebirth services have closed due to a shortage of midwives and concerns about ambulance response times.
    Alison Edwards, of Doula UK, whose 700 members advocate for expectant mothers, says she has seen a threefold increase in calls about freebirthing in the last fortnight.
    “Initially women were concerned about staff shortages,” says Edwards. “Now they don’t want to go to hospital at all, it’s about infection. It is inevitable that some who should not be freebirthing because they are in a high-risk category will give birth at home because they fear the alternative – infection from [coronavirus] or spending time in hospital without their partner’s support.”
    Read full story
    Source: Guardian, 5 April 2020
  4. Patient Safety Learning
    People who may be having a stroke should still call 999 for emergency medical care, even during the coronavirus pandemic, say UK experts.
    They are concerned that many are not seeking urgent help when they most need it, possibly due to fear of the virus or not wanting to burden the NHS.
    Any delay in seeking help can lead to disability or even death, warns the Stroke Association. Prompt assessment and treatment saves lives, it says.
    Data suggest people are currently staying away from hospitals, which is fine unless you really need care.
    Latest figures for England and Scotland suggest attendance to Emergency Departments has dropped by over a third on the same week last year. Those who need urgent medical help should still attend, say experts.
    Read full story
    Source: BBC News, 6 April 2020
  5. Patient Safety Learning
    Almost 400 care companies which provide home support across the UK have told the BBC they still do not have enough personal protective equipment (PPE).
    Without protection, providers say they may not be able to care for people awaiting hospital discharge.
    Of 481 providers, 381 (80%) said they did not have enough PPE to be able to support older and vulnerable people.
    The government said it was working "around the clock" to give the sector the equipment it needs.
    The BBC sent questions to the nearly 3,000 members of the UK Homecare Association.
    About a quarter of respondents said they have either run out of masks or have less than a week's supply left.
    Read full story
    Source: BBC News, 6 April 2020
  6. Patient Safety Learning
    City and Hackney Clinical Commissioning Group might have the fifth highest prevalence of serious mental illness in England, but last year it achieved the highest physical health check coverage in the country.
    This was down to a collaborative approach by the CCG, local trust, GPs, heath informatics, a voluntary sector exercise and diet specialist organisation, and service users themselves.
    This alliance model for primary care SMI physical health was named mental health innovation of the year at the HSJ awards.
    Find out more
    Source: HSJ, 20 March 2020
  7. Patient Safety Learning
    Children may have died from non-coronavirus illnesses because they are not coming to hospital quickly enough, amid concerns NHS 111 may be giving flawed advice to stay away, according to senior paediatricians.
    HSJ understands the concern about 111 giving the wrong advice to parents who should travel to hospital had been “escalated” to national leaders.
    Several senior paediatric leaders in London raised serious concerns to HSJ. They said several children in the past week had been admitted to intensive care in London, and had been harmed — and, in some cases, died — because of the issue, though they did not want to identify particular hospitals or cases. The sources said it was a national problem.
    Read full story
    Source: HSJ, 3 April 2020
  8. Patient Safety Learning
    Royal Wolverhampton Trust (RWT) has become the first provider to sign a deal with Babylon Health for citywide coverage of a new COVID-19 app, HSJ has learned.
    Digital health provider Babylon announced earlier this month the creation of a “covid-19 care assistant” app, which provides patients with digital triage, a live chat service, a symptom tracker and video consultation.
    RWT’s deal covers around 300,000 patients registered to a Wolverhampton GP, and all trust staff regardless of where they live. Earlier this year, RWT announced a 10-year deal with Babylon to develop a “digital-first integrated care” model.
    The new COVID-19 app will be made available to staff today and will then be rolled out to the general public next week.
    Read full story
    Source: HSJ, 3 April 2020
  9. Patient Safety Learning
    Elderly care home residents have been categorised “en masse” as not requiring resuscitation, in a strategy branded unacceptable by the healthcare regulator.
    People in care homes in Hove, East Sussex and south Wales are among those who have had “do not attempt resuscitation” (DNAR) notices applied to their care plans during the coronavirus outbreak without proper consultation with them or their families, MPs and medical unions fear.
    Care homes in Leeds have reported that district nurses have been asking them to “revisit do not resuscitate conversations with people who said they didn’t want them” and a care worker in Wales told the Guardian that after a visit from a GP, all 20 of their residents had DNAR notices attached to their plans.
    DNAR notices are a common part of care plans and many people wish to have them in place because, in the event of cardiac arrest, attempts to resuscitate can cause serious trauma, including broken bones. But the Care Quality Commission and other medical bodies are so concerned about the blanket application of the notices that it has issued a warning to stop.
    “It is unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description,” the notice states. “These decisions must continue to be made on an individual basis according to need.”
    Read full story
    Source: The Guardian, 1 April 2020
  11. Patient Safety Learning
    On any normal day the Oak Springs Care home in Liverpool is a hive of activity, laughter ringing out as its elderly residents enjoy dancing, creative crafts and bingo.
    Yesterday it was quiet, the inhabitants confined to their bedrooms and stark notices on the door warning visitors against entering, as word spread that a third resident had died in hospital that morning after a corona-virus diagnosis. Of the 66 remaining residents, 52 are exhibiting symptoms.
    Four were put on end-of-life care plans this week, a situation described by Andrea Lyons, the general manager, as “our absolute worst nightmare”.
    She said: “These are people who we love, who we spend more time with than our families. It has been difficult beyond the worst you can imagine”.
    Read full story
    Source: The Times, 2 April 2020
  12. Patient Safety Learning
    Boris Johnson has been forced to shift strategy on the government’s testing regime for coronavirus after criticism of the slow pace of checks being carried out on frontline NHS staff.
    Private laboratories are now being drafted in to do the tests where before these were being performed through a centralised process.
    The prime minister accepted last night that mass testing was the way out of the crisis and said in a tweet that it would “eventually unlock the puzzle of coronavirus”.
    Read full story (paywalled)
    Source: The Times, 2 April 2020
  13. Patient Safety Learning
    A father has described the "huge impact" of losing respite care for his young daughter who has complex special needs.
    Tim Clarke and his wife Ana look after their six-year-old daughter Molly at home in Worcester. The family normally receives a few hours of outside care and educational help a week, but that ended with the coronavirus pandemic.
    Molly has been diagnosed with autism and also has medical issues including a cyst on her brain.
    One charity worker from the Pathological Demand Avoidance (PDA) Society, a condition which is on the autism spectrum, described parents of children with special needs as being in "survival mode".
    Watch video
    Source: BBC News, 1 April 2020
  14. Patient Safety Learning
    The procurement of digital tools to support online primary care services during the coronavirus outbreak are to be fast-tracked for providers who don’t have the resources.
    In a letter sent to primary care providers and commissioners, GP surgeries were told to move to a triage-first model of care as soon as possible as the NHS bolsters its response to COVID-19.
    The letter, sent by medical director for primary care, Nikita Kanani, and director of primary care strategy and NHS contracts, Ed Waller, states practices and commissioners should promote online consultation services where they are in place or “rapidly procure” them.
    “Rapid procurement for those practices that do not currently have an online consultation solution will be supported through a national bundled procurement,” wrote in the letter.
    Read full story
    Source: Digital Health, 30 March 2020
  15. Patient Safety Learning
    Doctors have been reminded not to prioritise coronavirus patients at the expense of others in new ethical guidance backed by royal colleges.
    There are increasing concerns that patients are not getting treatment for serious problems, including strokes or heart attacks, because they are afraid to go to hospitals.
    The guidelines were drawn up by the Royal College of Physicians (RCP) amid worries that a shortage of ventilators and beds could force doctors to make difficult decisions on which patients get lifesaving treatment.
    Read full story (paywalled)
    Source: The Times, 2 April 2020
  16. Patient Safety Learning
    GPs are having end of life conversations with their patients because of concerns over a lack of intensive care beds during the coronavirus crisis.
    Multiple GPs have told HSJ they are talking to patients who are older or in very high risk groups about signing “do not attempt to resuscitate” forms in case these patients were to go on to contract the virus.
    Some practices have also sent letters to patients requesting they complete the forms, it is understood.
    One leader of a primary care network, who asked not to be named, told HSJ: “Those in the severe at-risk group and those over 80 are being told they won’t necessarily be admitted to hospital if they catch coronavirus.”
    Read full story 
    Source: HSJ, 1 April 2020
     
     
  17. Patient Safety Learning
    Healthcare professionals have been told to consider not treating patients with the COVID-19 coronavirus if they themselves would be put at risk, part of new ethical guidance that calls on doctors to prioritise some ailments over the pandemic.
    The new recommendations for healthcare professionals over 70 years, or with pre-existing conditions, to put themselves first when tackling the pandemic comes following the death of a doctor who returned to the frontlines as a volunteer following a call to arms from the government.
    The guidance from the Royal College of Physicians (RCP) makes up part of a sweeping list of ethical considerations faced by healthcare workers in the face of the global pandemic.
    Read full story
    Source: The Independent, 2 April 2020
  18. Patient Safety Learning
    Stable coronavirus patients could be taken off ventilators in favour of those more likely to survive, it emerged on Wednesday, as another sharp rise in deaths left the UK braced for the outbreak to reach up to 1,000 deaths a day by the end of the week.
    In a stark new document issued by the British Medical Association (BMA), doctors set out guidelines to ration care if the NHS becomes overwhelmed with new cases as the outbreak moves towards its peak.
    Under the proposals, designed to provide doctors with ethical guidance on how to decide who should get life-saving care when resources are overstretched, hospitals would have to impose severe limits on who is put on a ventilator. Large numbers of patients could be denied care, with those facing a poor prognosis losing the potentially life-saving equipment even if their condition is improving.
    The BMA suggested that younger, healthier people could be given priority over older people and that those with an underlying illness may not get treatment that could save them, with healthier patients given priority instead.
    Read full story
    Source: The Guardian, 1 April 2020
  19. Patient Safety Learning
    A major hospital trust has told staff they should attend work even if a household member is showing covid-19 symptoms, contrary to national guidance.
    Newcastle Upon Tyne Hospitals Foundation Trust’s occupational health department has told staff who had reported having family members with covid-19 symptoms they were still expected to attend work.
    In the email exchanges seen by HSJ, some as recently as a couple of days ago, the trust’s occupational health department was clear there was an NUTH policy agreement with Public Health England.
    Read full story
    Source: HSJ, 1 April 2020
  20. Patient Safety Learning
    Hospitals should allow parents to be with children who are being treated for the coronavirus, NHS England has confirmed, after a 13-year-old boy died without any family members beside him.
    Under its national guidance to hospitals, parents are considered essential visitors, but hospitals do have discretion to suspend visitors if it is “considered appropriate”. Anyone who has symptoms of COVID-19 should not be allowed to visit a hospital.
    NHS England confirmed the position after 13-year-old Ismail Mohamed Abdulwahab died at King’s College Hospital in south London in the early hours of Monday without any family members present. A statement by his family suggested he was alone because of the risk of infection.
    On its website the hospital repeated the guidance sent to trusts by NHS England that states children are allowed one parent or carer as a visitor, but declined to explain why his family were not with him.
    The end-of-life charity Marie Curie has also called on doctors to allow families to be with their loved ones, describing it as an “important part of their duty of care”.
    Read full story
    Source: The Independent, 2 April 2020
  21. Patient Safety Learning
    The government has ordered an urgent national audit of personal protective equipment (PPE), body bags, swabs and infection control products, HSJ can reveal. 
    Local resilience forum planners were earlier this week asked to share stock levels and daily consumption rates of the items at ambulance, acute trusts and in primary care and other services by 9pm on Tuesday.
    They were asked to indicate whether each figure represented a “major” or “minor” supply problem, or no problem at all, in an email seen by HSJ.
    As well as trusts, resilience forum staff were asked to share stock levels among adult social care services, numbers of mortuary staff, other local authority staff, police, prisons, fire and rescue services and funeral directors.
    The email also asked planners if local services had access to PPE supplies above their immediate need and whether local authorities were in discussions with any private PPE suppliers.
    The email noted the Department of Health and Social Care wanted to develop a “systematic days of supply picture” for all PPE at all providers.
    Read full story (paywalled) 
    Source: HSJ, 1 April 2020
  22. Patient Safety Learning
    Special body recovery teams have begun work to deal with suspected coronavirus victims who die in their homes.
    Small units of police, fire and health service staff will confirm death and the identity of the dead and remove their bodies to a mortuary.
    Known as Pandemic Multi-Agency Response Teams, or PMART, they will be dispatched when victims die outside hospitals and there is a high probability they had COVID-19.
    The teams have been set up, initially in London, to relieve pressure on hospitals overwhelmed with coronavirus emergency cases.
    Read full story
    Source: Sky News, 1 April 2020
  23. Patient Safety Learning
    Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are in the emergency department and staff are wearing full personal protective equipment (PPE).
    The guidance from the University Hospitals Birmingham NHS Foundation Trust says that patients in cardiac arrest outside the emergency department can be given defibrillator treatment if they have a “shockable” rhythm. But if this fails to restart the heart “further resuscitation is futile,” it says.
    If a patient with suspected covid-19 is in cardiac arrest they should be given cardiac compressions and be ventilated only if they are in the emergency department and the person attending them is wearing aerosol generating procedures (AGP) PPE. That means wearing an FFP3 mask, full gown with long sleeves, gloves, and eye protection.
    The advice rests on the premise that performing cardiac compressions risks virus particles being released into the air that could infect staff.
    Read full story
    Source: BMJ, 29 March 2020
  24. Patient Safety Learning
    Frontline doctors have told the Independent they have been gagged from speaking out about shortages of protective equipment as they treat coronavirus patients – with some claiming managers have threatened their careers.
    Staff have been warned not to make any comments about shortages on social media, as well as avoiding talking to journalists, while NHS England has taken over the media operations for many NHS hospitals and staff.
    The Independent has seen a series of emails and messages warning staff not to speak to the media during the coronavirus outbreak.
    One GP has been barred from working in a community hospital in Ludlow after making comments about the lack of equipment, while another in London said they were told to remove protective equipment they had purchased themselves.
    NHS England confirmed it was controlling media communications, which it said was part of its national emergency incident planning to ensure the public received “clear and consistent information”. 
    Read full story
    Source: The Independent, 1 April 2020
  25. Patient Safety Learning
    Amid growing shortages of vital protective equipment in New York hospitals, healthcare workers are desperately scrounging to find facemasks, hiding supplies from colleagues in other departments, and sometimes even pilfering for themselves.
    The novel coronavirus has infected nearly 45,000 across New York, and more than 550,000 globally. Nurses in New York City were shaken on Tuesday, when Kious Kelly, a nurse manager at a Mount Sinai Health System hospital, died after being infected.
    Nurses who would normally use masks and other protective gear only once are keeping them for entire shifts or longer to conserve supplies.
    "Masks disappear," said Diana Torres, a Mount Sinai nurse. "We hide it all in drawers in front of the nurses' station. We hide masks, we have to hide chucks for beds," she said, referring to incontinence pads.
    Read full story
    Source: MedScape Nurses, 30 March 2020

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