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Patient Safety Learning

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  1. Patient Safety Learning
    A GP surgery has apologised after sending a letter asking patients with life-limiting illnesses to complete a "do not resuscitate" form.
    A letter, from Llynfi Surgery in Maesteg, asks people to sign to ensure emergency services would not be called if their condition deteriorated due to coronavirus.
    "We will not abandon you.. but we have to be frank and realistic," it said.
    Cwm Taf health board issued an apology from the surgery, the Guardian reports.
    The letter says in an "ideal situation" doctors would have had this conversation in person but had written to them due to fears they were carrying the virus and were asymptomatic.
    Read full story
    Source: BBC News, 1 April 2020
     
  2. Patient Safety Learning
    A paramedic in the London Ambulance Service (LAS) has claimed the kit workers have been given to protect them from coronavirus would be more suitable for people making sandwiches.
    The south London medic, who did not want to be identified, said the basic apron, gloves and masks were not sufficient protection from infection.
    "It feels like every day I'm exposing myself and potentially my family to this virus," he told the BBC.
    In a document seen by the BBC, LAS has told its paramedics to wear basic PPE - a plastic apron, gloves and a surgical mask - for most call-outs.
    The advanced PPE - including a white boiler suit, FFP3 mask, and goggles - is reserved only for confirmed cases of coronavirus, and in situations where paramedics have to perform invasive procedures such as full CPR.
    Read full story
    Source: BBC News, 31 March 2020
  3. Patient Safety Learning
    More than 80% of young people with a history of mental ill health have found their conditions have worsened since the coronavirus crisis began in the UK, a survey has found.
    In a study by the mental health charity YoungMinds, 2,111 people aged under 25, who had a history of mental health needs, were asked how the pandemic had affected them.
    Of the 83% who said the pandemic had made their mental health worse, 32% said it had made it “much worse” and 51% said it had made it “a bit worse”.
    Among the respondents who were accessing mental health support leading up to the crisis – including from the NHS, school and university counsellors, charities, helplines and private providers – 74% said they were still receiving support and 26% said they were unable to access support.
    Emma Thomas, the chief executive of YoungMinds, said the pandemic was a “human tragedy that will continue to alter the lives of everyone in our society. The results of this survey show just how big an impact this has had, and will continue to have, on the mental health of young people.”
    Read full story
    Source: Guardian, 31 March 2020
  4. Patient Safety Learning
    Patients in England can now have home abortions during the COVID-19 outbreak, the government in England has said.
    Abortion policy has changed several times during the current pandemic. Women and girls wanting to terminate an early pregnancy were first told the service would be available but that decision was then retracted.
    Now, the government has decided patients can take two pills at home instead of going to a clinic to avoid exposure to coronavirus.
    Charities had been worried that women who want an abortion but have underlying health conditions would put themselves at risk to have the procedure or turn to dangerous alternatives.
    Read full story
    Source: BBC News, 31 March 2020
  5. Patient Safety Learning
    Gowns for front-line staff were not included in the national pandemic stockpile of personal protective equipment, procurement chiefs have been told.
    Trust procurement leads have raised concerns over dwindling gown supplies. Health Care Supply Association chief officer Alan Hoskins tweeted he could not order the products through NHS Supply Chain, even after escalating the matter to NHS England.
    Mr Hoskins’ tweet on Sunday, which has since been deleted, said: “What a day, no gowns NHS Supply Chain. Rang every number escalated to NHS England, just got message back — no stock, can’t help, can send you a PPE pack. Losing the will to live, god help us all.”
    Read full story (paywalled)
    Source: HSJ, 30 March 2020
  6. Patient Safety Learning
    The Red Cross called Friday for increased psychological support to health workers and others fighting the COVID-19 pandemic, warning of rising suicides as a result of pressure and isolation.
    Countries around the world have taken dramatic measures to try to halt the spread of the virus, which first emerged in China late last year, with more than three billion people now living under lockdown.
    The demand for psycho-social support has "increased significantly" since the start of the crisis, said Jagan Chapagain, the Secretary-General of the International Federation of Red Cross and Red Crescent Societies (IFRC).
    In an interview with AFP, he said he understood that providing mental health support "may not be very high on the agenda as we are trying to contain the virus," but stressed that the issue is important and "impacts millions and millions of people."
    "I think that could be the big silent killer if sufficient attention is not paid to psychosocial needs and mental health needs," he said.
    Read full story
    Source: Agence France-Presse, 28 March 2020
  7. Patient Safety Learning
    Join Animah Kosai, Founder of Speak Up at Work, Roger Kline, Trustee Patients First UK, and Kernan Manion Executive Director, Center for Physician Rights as we explore essential crisis communication principles to ensure staff safety, healthcare team cohesion, and effective care delivery. 
    Few in our local and national communities have ever experienced a pandemic causing complete shutdown and emergency isolation measures.
    With such an immense and unparalleled global catastrophe, despite play-acting disaster drills,  few corporations are truly prepared for the emergency response demands and the accompanying requirement for a Crisis Response Mindset and its communication principles. 
    Fortunately, wisdom gleaned from knowledge-based science and on-the-ground experience in prior epidemics and natural catastrophes is available to guide us through this very unfamiliar turf.
    A particular focus is on intra-organisational crisis management and communication with an aim toward sharing best practices.
    Further information
  8. Patient Safety Learning
    Acute trusts have been told to set aside 15% of their daily coronavirus tests for NHS key workers who are quarantining at home with others.
    New guidance for NHS trust chief executives on covid-19 testing has been published after NHS England chief executive Sir Simon Stevens announced hundreds of frontline staff would be given antigen tests from next week.
    The guidance from NHSE said acute trusts should prioritise testing staff working in critical care, emergency departments and ambulance services, along with “any other high priority groups you determine locally”.
    Read full story (paywalled)
    Source: HSJ, 30 March 2020
  9. Patient Safety Learning
    A breathing aid that can help keep coronavirus patients out of intensive care has been created in under a week.
    University College London engineers worked with clinicians at UCLH and Mercedes Formula One to build the device, which delivers oxygen to the lungs without needing a ventilator.
    Continuous Positive Airway Pressure (CPAP) devices are already used in hospitals but are in short supply. China and Italy used them to help Covid-19 patients.
    Forty of the new devices have been delivered to ULCH and to three other London hospitals. If trials go well, up to 1,000 of the CPAP machines can be produced per day by Mercedes-AMG-HPP, beginning in a week's time.
    The Medicines and Healthcare products Regulatory Agency (MHRA) has already given its approval for their use.
    Read full story
    Source: BBC News, 30 March 2020
  10. Patient Safety Learning
    Hundreds of thousands of pregnant women face a crisis as maternity and abortion services shut their doors because of the coronavirus outbreak.
    One MP this weekend warned that pregnant women were being treated like “second-class citizens” with the closure of NHS services and a lack of government guidance for those in need of urgent care.
    The NHS faces a severe shortage of midwives with the number of unstaffed positions doubling to one in five since the virus arrived in Britain. 
    A fifth (22%) of senior midwives said their local maternity units had shut indefinitely because of staff self-isolating or being deployed elsewhere.
    Read full story (paywalled)
    Source: The Times, 29 March 2020
  11. Patient Safety Learning
    The NHS could have prevented “chaos and panic” had the system not been left wholly unprepared for the pandemic, the editor of the BMJ has said.
    Numerous warnings were issued but these were not heeded, Richard Horton wrote in the Lancet. He cited an example from his journal on 20 January, pointing to a global epidemic: “Preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.”
    Horton wrote that the government’s Contain-Delay-Mitigate-Research plan had failed. “It failed, in part, because ministers didn’t follow WHO’s advice to ‘test, test, test’ every suspected case. They didn’t isolate and quarantine. They didn’t contact trace."
    “These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The result has been chaos and panic across the NHS.”
    Read full story
    Source: Guardian, 28 March 2020
  12. Patient Safety Learning
    National and regional NHS chiefs will seek to share out scarce ventilators to ”areas with the most immediate need, on a fair share basis relative to patient ventilation need," they have told hospital chiefs, who are increasingly concerned about what they will receive and when.
    Many are expecting demand for ventilated beds to outstrip what they have as the number of patients seriously ill with covid-19 ramps up.
    Trust leaders yesterday told HSJ they were growing increasingly worried about the lack of information over when the machines would be sent to their trusts. Some are worried London, and other regions which see their demand spike first, will get more supply.
    A letter from NHS England and Improvement to trust chiefs late on Wednesday told them that as “extra ventilators become available we will coordinate distribution via regional teams who will work with local health systems”.
    Read full story (paywalled)
    Source: HSJ, 27 March 2020
  13. Patient Safety Learning
    The absence of COVID-19 testing for NHS staff is causing huge workforce shortages by forcing doctors to self-isolate even if they do not have the virus, the head of the BMA has warned.
    The government’s advice is for people with COVID-19 symptoms to stay at home for seven days, but for all other household members who remain well to isolate for 14 days. The BMA council chairman, Chaand Nagpaul, said that the lack of testing for staff was “counter-intuitive” as it was likely to be forcing more staff than necessary to stay away from hospitals and GP surgeries because they do not know if they are infected.
    Read full story (paywalled)
    Source: BMJ, 27 March 2020
  14. Patient Safety Learning
    Join the Institute for Healthcare Improvement's (IHI's) President Emeritus and Senior Fellow, Donald M. Berwick MD, MPP, FCRP and IHI President and CEO, Derek Feeley for a special Virtual Learning Hour today on Mobilizing to Respond to COVID-19. 
    In this hour-long call, Don and Derek will share key learnings, innovations, and revelations they’ve been gathering and gleaning from health care leaders and improvers across the globe.
    The call will also serve as an opportunity for listeners to share the struggles, stories, and bright spots they are seeing in this unprecedented time.
    Register
  15. Patient Safety Learning
    The government says a communications mix-up meant it missed the deadline to join an EU scheme to get extra ventilators for the coronavirus crisis.
    Ministers were earlier accused of putting Brexit before public health when Downing Street said the UK had decided to pursue its own scheme.
    But No 10 now says officials did not get emails inviting the UK to join and it could join future schemes.
    The party's shadow Health Secretary Jonathan Ashworth said: "Given the huge need for PPE, testing capacity and crucial medical equipment including ventilators, people will want to know why on Monday ministers were saying they had 'chosen other routes' over the joint EU procurement initiatives but now they are claiming that they missed the relevant emails.
    "We need an urgent explanation from ministers about how they will get crucial supplies to the frontline as a matter of urgency."
    Read full story
    Source: BBC News, 27 March 2020
  16. Patient Safety Learning
    NHS staff who have contracted coronavirus but remain at work because they show no symptoms are probably infecting patients, a public health official admitted yesterday.
    Doctors said they were worried about becoming “part of the problem” owing to a lack of testing and a shortage of protective equipment, particularly outside hospitals. Masks, gloves and visors can help stop people infecting others and stop them becoming infected.
    The British Medical Association said that staff testing was urgently needed so that doctors and nurses knew if it was safe for them to see patients.
    Read full story (paywalled)
    Source: The Times, 27 March 2020
  18. Patient Safety Learning
    Data collected via the NHS's 111 telephone service is to be mixed with other sources to help predict where ventilators, hospital beds, and medical staff will be most in need.
    The goal is to help health chiefs model the consequences of moving resources to best tackle the coronavirus pandemic.
    Three US tech firms are aiding the effort - Amazon, Microsoft and Palantir - as well as London-based Faculty AI.
    The plan is expected to be signed off by Health Secretary Matt Hancock.
    "Every hospital is going to be thinking: Have we got enough ventilators? Well we need to keep ours because who knows what's going to happen - and that might not be the optimal allocation of ventilators," explained a source in one of the tech companies involved.
    "Without a holistic understanding of how many we've got, where they are, who can use them, who is trained, where do we actually have patients who need them most urgently, we risk not making the optimal decisions."
    Read full story
    Source: BBC News, 26 March 2020
  19. Patient Safety Learning
    A family from East Sussex may have been Britain’s first coronavirus victims, catching the virus in mid-January after one of them visited an Austrian ski resort that is now under investigation for allegedly covering up the early outbreak.
    If confirmed by official tests, it would mean the outbreak in Britain started more than a month earlier than currently thought.
    As things stand, the first recorded UK case was on January 31, and the earliest documented incidence of transmission within Britain occurred on 28 February.
    Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh, said cases like this demonstrated the need for widespread antibody and viral genome sequencing testing. These tests can show who has and has not been exposed to the virus, and therefore help epidemiologists trace the history and spread of the illness.
    "A really significant unknown in this epidemic is whether or not the cases that are symptomatic are simply the tip of the iceberg," he said. "If there are hidden cases in large numbers, then it tells us that the infection is more difficult to control than we thought… but it also suggests that there is a possibility herd immunity may have built up."
    Read full story
    Source: The Telegraph, 25 March 2020
  20. Patient Safety Learning
    New guidelines for assessing people with coronavirus who go to hospital were amended after an outcry from parents of children with special needs.
    The emergency guidelines published by the National Institute for Health and Care Excellence (NICE) are designed to help determine how much treatment a patient will receive.
    Those deemed "completely dependent for personal care for whatever reason" will be offered end-of-life care rather than restorative treatment.
    This now excludes people with learning difficulties or cerebral palsy.
    In a statement NICE said the system was "not perfect" but was designed to support hospital medics "during this very difficult period of intense pressure". "We welcome the recent clarification that the Clinical Frailty Score should not be used in certain groups," it said.
    The updated guidelines now state that it "may not perform as well in people with stable long-term disability" and suggests that it is not used in those cases.
    Read full story
    Source: BBC News, 26 March 2020
  21. Patient Safety Learning
    Hundreds of healthcare professionals in Zimbabwe have refused to work without protective equipment, beginning strike action in a standoff with the government as the nation begins to see its first impacts of coronavirus.
    With the risk of an outbreak increasing day by day, industry chiefs in the country have warned doctors face inadequate supplies of gloves, masks and gowns.
    The president of the Zimbabwe Hospital Doctors Association, Tawanda Zvakada, said doctors would return to the frontlines of the battle against the virus when adequate protection was provided. 
    "Right now we are exposed and no one seems to care," he said, adding that doctors have inadequate stocks of gloves, masks and gowns.
    Read full story
    Source: Independent, 26 March 2020
  22. Patient Safety Learning
    A woman with brain cancer has been told her chemotherapy has stopped because of the coronavirus outbreak.
    Nancy Carter-Bradley, 44, from Hampshire, said the health secretary should ring-fence cancer treatment.
    She said her treatment at a London hospital had paused as it was at full capacity and oncologists were helping with the response to coronavirus. Imperial College Healthcare NHS Trust said it was "exploring use of private healthcare facilities".
    Mrs Carter-Bradley, from Penwood, said she had been dealing with "unbelievable stress" since she was informed her chemotherapy at Charing Cross Hospital for stage three brain cancer would be paused.
    Read full story
    Source: BBC News, 26 March 2020
  23. Patient Safety Learning
    GPs are demanding "urgent clarification" from the government on whether they should now wear protective equipment to examine all patients.
    Family doctors now wear it if they see a patient with suspected coronavirus. But the Royal College of General Practitioners (RCGP) has written to Health Secretary Matt Hancock to ask if GPs should wear it for all face-to-face consultations. It says patients with the virus but no symptoms could still infect staff.
    The BBC understands GPs in some surgeries have decided to wear personal protective equipment (PPE) for all face-to-face consultations, but this is not currently recommended by Public Health England.
    In the letter, Prof Martin Marshall, chairman of the RCGP, wrote: "GPs across the country have never been more concerned, not just for the safety of themselves and their teams, but for patients too. They are unsure as to whether they have enough supplies [of PPE], either now, or as the crisis deepens".
    "They are not confident that the current guidance provides the necessary clarity about whether GPs are using the right type of equipment, at the right times," he said.
    Read full story
    Source: BBC News, 26 March 2020
     
  24. Patient Safety Learning
    Criticism is mounting in Sweden of the government’s approach to Covid-19, with academics warning that its strategy of building broad immunity while protecting at-risk groups – similar to that initially adopted by the UK – amounted to “Russian roulette” and could end in disaster.
    The prime minister, Stefan Löfven, on Sunday night called on all Swedes to accept individual responsibility in stopping the rapid spread of the virus as the number of patients in intensive care in Stockholm continued to rise sharply.
    Read full story
    Source: 23 March 2020, The Guardian
  25. Patient Safety Learning
    As the world writhes in the grip of Covid-19, the epidemic has revealed something majestic and inspiring: millions of health care workers running to where they are needed, on duty, sometimes risking their own lives. In his article in the New York Times, Don Berwick says he has never before seen such an extensive, voluntary outpouring of medical help at such a global scale. Millions of health care workers are running to where they are needed, sometimes risking their lives.
    Intensive care doctors in Seattle connect with intensive care doctors in Wuhan to gather specific intelligence on what the Chinese have learned: details of diagnostic strategies, the physiology of the disease, approaches to managing lung failure, and more. 
    City by city, hospitals mobilise creatively to get ready for the possible deluge: bring in retired staff members, train nurses and doctors in real time, share data on supplies around the region, set up special isolation units and scale up capacity by a factor of 100 or 1000.
    "We are witnessing professionalism in its highest form, skilled people putting the interests of those they serve above their own interests."
    Read full article
    Source: New York Times, 23 March 2020
     

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