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Patient Safety Learning

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  1. Event
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    Using psychological theory and research-based techniques, this session will demonstrate how to enhance recovery and build resilience for healthcare professionals. In this interactive webinar, Dr Anne-Marie Doyle, consultant clinical psychologist and Dr Elizabeth Haxby, immediate Past President of the RSM Patient Safety Section, will offer strategies to protect the wellbeing of healthcare professionals by helping to anticipate and manage stress, recovery and build resilience. Register
  2. Event
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    Explore the link between healthcare staff wellbeing and patient safety in the first episode of the Royal Society of Medicine's Patient Safety Section's webinar series, Optimising Strength and Resilience. The wellbeing of healthcare professionals is fundamental to the delivery of high-quality, safe patient care. It has become a major focus of attention during the COVID-19 pandemic, especially in relation to physical and mental health, resilience and potential for burnout. In contrast to existing resources and support initiatives, this series is designed to be proactive and help healthcare staff anticipate and prepare for stressful events. It will offer knowledge and tools to help staff to manage stressful events in both their professional and personal lives. Join Dr Anne-Marie Doyle, consultant clinical psychologist and Dr Elizabeth Haxby, immediate Past President of the RSM Patient Safety Section, for this interactive webinar which will help healthcare professionals to identify sources of stress, acknowledge its impact on individuals and teams and understand how they respond to stresses. Using systems theory and strengths-based positive psychology, this session will examine the concept of integrated health and psychological resilience. Register
  3. News Article
    Trusts in more than half English local authorities still do not have an agreed safe place to discharge recovering covid patients to, despite the government asking councils to identify at least one such ‘designated setting’ by the end of October. The situation is leading to an increase in delayed discharges from hospital just as the service comes under increased pressure from the second covid wave and returning elective and emergency demand. In a letter last month, the government told local authorities to identify at least one “designated setting” – typically a care home – which hospitals could discharge covid positive patients to when they no longer need secondary care. The designated setting would also take discharged patients who had not received a negative covid test. The plan is designed to protect residents in other homes, after thousands of care home residents died due to outbreaks of the virus in the spring. But a well-placed source in the care sector told HSJ less than half of the 151 upper tier councils met the 31 October deadline, due to a range of reasons including insurance costs, fear of high mortality rates and reputational damage to the designated homes. It means that in many parts of the country, there are a lack of options when it comes to discharging patients, which is causing a rise in delayed discharges. Read full story (paywalled) Source: HSJ, 5 November 2020
  4. News Article
    The NHS has been returned to the highest level of risk on its emergency preparedness framework, a move which allows national leaders tighter control over local resources and decision making. NHS England chief executive Sir Simon Stevens announced the decision at a press conference this morning. He said: “Unfortunately, again we are facing a serious situation [due to rising coronavirus infections and hospital admissions]. That is the reason why at midnight tonight the health service in England will be returning to its highest level of emergency preparedness, EPPR level 4, which of course we had to be at from the end of January to the end of July.” Placing the NHS on level 4 of Emergency Preparedness Reslience and Response framework allows system leaders to take control of decisions over mutual aid and other local priorities. Sir Simon was joined by NHSE/I medical director Steve Powis and Alison Pittard, dean of the Faculty of Intensive Care Medicine. They used the press conference to stress the threat the NHS faced from the second covid peak, but also set out more positive news on the covid vaccine programme. Read full story Source: HSJ, 4 November 2020
  5. News Article
    A woman has been arrested after attempting to take her 97-year-old mother out of a care home for lockdown. Qualified nurse Ylenia Angeli, 73, wanted to care for her mother, who has dementia, at home. But when she told staff at the care home, they called the police who then briefly arrested Ms Angeli. The family have not been able to see their elderly relative for nine months, and decided to act ahead of the second national lockdown. Assistant Chief Constable Chris Noble, from Humberside Police, said: "These are incredibly difficult circumstances and we sympathise with all families who are in this position." "We responded to a report of an assault at the care home, who are legally responsible for the woman's care and were concerned for her wellbeing. We understand that this is an emotional and difficult situation for all those involved and will continue to provide whatever support we can to both parties." The incident came to light on the day the government announced new rules for families wishing to visit their loved ones in care homes. Under the guidance, issued hours before lockdown, families can meet relatives through a window or in a secure outdoor setting. Visits will need to be booked in advance, but the Department of Health and Social Care advice said care homes "will be encouraged and supported to provide safe visiting opportunities". All care home residents are allowed to receive visits from friends and family during the second national lockdown. Read full story Source: Sky News, 5 November 2020
  6. News Article
    The Medicines and Healthcare products Regulatory Agency (MHRA) has received its one millionth Yellow Card. The Yellow Card scheme is the UK’s system for reporting suspected side effects to medicines and adverse events with medical devices. This major milestone coincides with the launch of the 5th annual #MedSafetyWeek (2-8 November), which highlights the value of the Yellow Card scheme to the nation’s health, and the importance of reporting suspected side effects from medicines. The MHRA has seen an increased rate of Yellow Card reports and would like to continue to encourage more reporting this #MedSafetyWeek. MedSafetyWeek is a global campaign, with over 70 countries participating, worldwide. This year, the theme is ‘every report counts’. The MHRA will be calling upon patients and carers, as well as healthcare professionals and their organisations to report suspected side effects from medicines. Reporting helps to identify new side effects, as well as unexpected and serious safety problems. It also adds to existing information about known effects. By reporting, patients and the public can help the safe use of medicines for everyone. Read press release Source: GOV.UK, 2 November 2020
  7. News Article
    Vulnerable patients at a major NHS hospital at the centre of England’s coronavirus second wave have been left without help to eat or drink because wards are so dangerously understaffed, The Independent can reveal. Dozens of safety incidents have been reported by doctors and nurses at the Liverpool University Hospitals Trust since April, citing the lack of nurses as a key patient safety risk. Across several wards, just two registered nurses per ward were being expected to look after dozens of sick patients – a ratio of nurses to patients far below recommended safe levels. On one ward there were 36 patients to two registered nurses – with the nurse in charge of the ward having only qualified six months earlier. The safety concerns also include a diabetic patient – where there was no evidence nurses had monitored their blood glucose levels and insulin medication, which if left unchecked could prove fatal. Other patients have been forced to eat food and drink which has gone cold by the time staff are ready to help them. The hospital is among the worst affected by the surge in coronavirus cases in the north of England. It’s medical director warned on Friday that it was at 100 per cent capacity and unable to maintain standards of care. Read full story Source: The Independent, 5 November 2020
  8. Content Article
    Our understanding of race and human genetics has advanced considerably, yet these insights have not led to clear guidelines on the use of race in medicine. The result is ongoing conflict between the latest insights from population genetics and the clinical implementation of race. For example, despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice. One subtle insertion of race into medicine involves diagnostic algorithms and practice guidelines that adjust or “correct” their outputs on the basis of a patient’s race or ethnicity. Physicians use these algorithms to individualise risk assessment and guide clinical decisions. By embedding race into the basic data and decisions of health care, these algorithms propagate race-based medicine. Many of these race-adjusted algorithms guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities. To illustrate the potential dangers of such practices, Vyas et al. have compiled a partial list of race-adjusted algorithms.
  9. Content Article
    COVID-19 survivors Fiona Lowenstein and Nikki Brueggeman share their experiences with the disease and how they navigated the healthcare system during the pandemic, and how they were inspired to become advocates for others.
  10. Content Article
    PEP Health is a social media listening tool which offers a radical new approach to collecting and analysing the views of patients on the health services they encounter. The platform delivers comprehensive real-time reporting of what patients really think about their care and provide actionable insights that can function as a board assurance tool and provide feedback to inform operational decisions. This report explores some of the key findings from PEP Health data on trends and variation in patient experiences across hospitals in England and derives insights and recommendations that can lead to improvement in care.
  11. News Article
    Over a third (35%) of healthcare professionals say they have suffered verbal or physical abuse from patients, or patients’ relatives during COVID-19, according to a survey by Medical Protection. The Medical Protection survey of 1250 doctors in the UK, also showed that a further 7% have experienced verbal or physical abuse from a member of the public outside of a medical setting, with some saying they have been sworn at for using the NHS queue at the supermarket. This follows reports that GP’s are facing abuse and complaints from patient’s who believe they aren’t offering enough face-to-face appointments, despite face-to-face appointments increasing in recent months. Medical Protection said the abuse presents yet another source of anxiety for doctors at the worst possible time. In the same survey, 2 in 5 doctors say their mental wellbeing is worse compared to the start of the pandemic. “I have been sworn at for using the NHS queue at the supermarket.” “I have had more unpleasantness from patients in the last 6 months than in all my previous 50 years in healthcare.I am almost at the point of stopping all clinical practice.” “There is too much verbal abuse to mention but the most upsetting is patients believing that we haven`t been open – we are all on our knees.” Read full story Source: Medical Protection, 31 October 2020
  12. Content Article
    Endometriosis is a chronic disease affecting approximately 10% of fertile women. These women often have negative health care experiences. This study from Bach et al. adds new knowledge about endometriosis care in a hospital setting and nurses’ attitudes toward the disease. To explore how the personal attitudes of gynaecological nurses, their specialised knowledge, and their clinical experiences influenced the way they conceptualised and cared for women with endometriosis, participant observations and semi-structured interviews were conducted. Categorisation of patients into certain kinds, with more or less legitimate needs, provided an important framework for practice. Specialised knowledge qualified the nurses’ views of their patients and seemed to be conducive to sustained patient involvement. However, the organisation of care based solely on medical specialisation restricted a holistic approach. An important goal is, therefore, to investigate patients’ perspectives of health and illness and to create participatory relationships with patients, regardless of their diagnosis.
  13. Content Article
    Diagnostic delays for endometriosis can occur as many of the symptoms are very similar to other common medical conditions. During 2018 and 2019, there were 24 incidents reported to the MDU (a medical defence organisation) which involved endometriosis. A common factor in these incidents involved a complaint or claim following an allegation of a missed or delayed diagnosis. A delayed diagnosis can lead to prolonged pain and suffering and may cause other physical and psychological problems for the patient, such as infertility, anxiety and depression.  Failure to diagnose endometriosis or a delay in diagnosis is not necessarily negligent, but a claimant may have a case if they can demonstrate that a doctor's management fell below the expected standard - for example, by not adequately examining the patient, or by not considering the diagnosis when a patient presents with those signs and symptoms as described in the NICE guidance. MDU offers advice in this blog to help reduce the risk of a delayed or missed diagnosis of endometriosis.
  14. Content Article
    The hierarchy of control is a system for controlling risks in the workplace. Guidance on this page explains the hierarchy of control and can help employers understand and use the hierarchy of control to eliminate or reduce risks at work.
  15. Content Article
    Risks should be reduced to the lowest reasonably practicable level by taking preventative measures, in order of priority. This table from the was developed by the construction industry’s Leadership and Worker Engagement Forum and sets out an ideal order to follow when planning to reduce risk from construction activities. This could be adapted for healthcare.
  16. News Article
    An NHS hospital where a woman bled to death in childbirth has been given an "urgent" deadline to keep patients at its maternity unit safe. A letter seen by the BBC reveals the Care Quality Commission (CQC) found unsafe staffing levels at the unit at Basildon Hospital throughout August. The CQC said the trust that runs it had until next Monday to implement appropriate measures. The trust said it had a "robust improvement plan in place". The seven-page document, sent by the CQC on 7 October, puts the Mid and South Essex NHS Foundation Trust on notice that it has to "implement an effective governance system", among other measures. Consequences for missing the deadline were not stated, but the CQC said it was using its powers under the Health and Social Care Act to impose conditions on the trust's registration. The Act does allow the CQC to temporarily close health services. Read full story Source: BBC News, 3 November 2020
  17. Content Article
    As the race to develop a vaccine for COVID-19 has reached phase 3 clinical trials, concerns are increasing about the low rates of trial participation in important subgroups, including Black communities. Recent data show that although Black people make up 13% of the US population, they account for 21% of deaths from COVID-19 but only 3% of enrollees in vaccine trials. This problem threatens both the validity and the generalisability of the trial results and is of particular concern in vaccine trials, in which differences in lifetime environmental exposures can result in differences in immunologic responses that could affect both safety and efficacy. Despite long-standing calls from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) to improve the participation of underrepresented subgroups in drug trials, the problem persists. Warren et al., in an article in the New England Journal of Medicine, explore what the barriers are to greater participation of Black people in COVID-19 trials.
  18. News Article
    A senior judge has said friends and family can legally visit their loved ones in care homes, in an apparent challenge to recent government policy that has in effect banned routine visits in areas of high COVID-19 infection. Mr Justice Hayden, vice-president of the court of protection which makes decisions for people who lack mental capacity, said courts are concerned about the impact on elderly people of lockdowns. He has circulated a memo that sets out his analysis that regulations do “permit contact with relatives” and friends and visits are “lawful”. He was responding to guidance from the Department of Health and Social Care (DHSC) last month telling thousands of care homes in England that visiting should be stopped in areas with tier 2 and tier 3 lock down restrictions, apart from in exceptional circumstances such as the end of life. It triggered blanket prohibitions by some councils and sparked anguish from relatives who warn a lack of contact is leading to misery and early death in some cases. Within a week, Gloucestershire county council told care homes in its area to stop visits until next spring. With the England-wide lockdown starting on Thursday, care home providers, families and groups including Age UK and Alzheimer’s Society, have called on ministers to this time make clearer provisions for visiting. Hayden said exceptions in the existing regulations mean contact with residents staying in care homes is lawful for close family members and friends. He said the court of protection was concerned about “the impact the present arrangements may have on elderly people living in care homes,” citing their suffering. Read full story Source: The Guardian, 2 November 2020
  19. Content Article
    Disparities in healthcare exist because of socioeconomic factors, structural racism and implicit bias. The panelists in this video identify the problems and discuss what solutions are in place that could improve health disparities such as medical education, more training for underrepresented minority physicians, more funding for research, and fast-tracking publication of research. Furthermore, the panelists explore how the field of dermatology and other medical specialties can address these issues.
  20. Event
    Westminster Health Forum policy conference. The agenda: Assessing the impact of COVID-19 on the ethnic minority community, and priorities for improving health outcomes. The health and social care response to inequality through the pandemic and taking forward new initiatives. Understanding the data and risk factors for COVID-19 in ethnic minority groups. Wider health inequalities faced by people in ethnic minorities - addressing underlying factors, and the role of COVID-19 recovery strategies in supporting long-term change. Priorities for providing leadership in tackling health inequalities in the workforce. Driving forward and ensuring race equality in the NHS. Providing support to the ethnic minority health workforce and taking forward key learnings from COVID-19. Next steps for action in race disparity in healthcare. Book
  21. News Article
    There are 70% more people in hospital now as when England was approaching its spring COVID-19 peak, and twice as many non-covid patients, according to official figures leaked to HSJ. In some regions, the contrast is even sharper. In the North East and Yorkshire, where COVID-19 hospitalisations are still mounting rapidly, there are now twice as many patients in acute hospitals than there were in early April. The information also shows that there are now 13% more patients than there were on 3 April in mechanical ventilation beds – which are reserved for the most seriously ill patients. These include more than double the number of non-covid patients than there were in the spring. The information — shared with HSJ and The Independent by NHS sources — also reveals that 1 in 10 hospital beds are now occupied by confirmed covid patients – up from about 6% two weeks ago. Read full story Source: HSJ, 3 November 2020
  22. News Article
    A mental health trust has been told to make ‘urgent improvements’ by regulators after a fourth inpatient death occurred with similar themes to three other patients dying within 12 months. The warning, issued by the Care Quality Commission (CQC) to Devon Partnership Trust, was made after an unannounced inspection at the trust’s Langdon Hospital – following the death of a patient who died by suspected suicide in July. Last week HSJ revealed how the death was the fourth inpatient death within the last 12 months at the trust, with each incident having recurring themes. The latest death happened at Langdon Hospital in Dawlish, on one of the trust’s medium secure wards (Ashcombe), with the patient using a ligature point. It was a similar incident to another serious incident in May on a different ward (Holcombe) at the hospital, and it prompted the inspection from the CQC in mid-August. While the death remains under investigation by the trust, early details shared with the CQC reveal that the incident happened in an area of the ward which had been changed to an “isolation area” under the trust’s COVID-19 infection prevention strategy. However, this meant there were not “good lines of sight” for staff monitoring patients – according to the CQC’s inspection report. There were also “low staffing levels on the wards”, according to staff which spoke to the CQC. The staff also told inspectors they were “stressed, exhausted and burnt out following the demands of the pandemic”. According to the CQC, some staff had concerns about areas on the ward where patients had “unrestricted access to items including sports equipment that could be used as weapons for self-harm”. Although the ward’s ligature assessment claimed those areas were always supervised by staff, this was disputed by the staff themselves, the report said. Read full story Source: HSJ, 3 November 2020
  23. News Article
    An NHS hospital at the epicentre of the coronavirus second wave is facing the threat of action by the care watchdog as it struggles to keep patients safe, The Independent has learned. Senior NHS bosses in the northwest region have been accused of putting politics ahead of patient safety and not doing enough to help the hospital to cope with the surge in Covid patients in recent weeks. The Care Quality Commission (CQC) warned the Liverpool University Hospitals Trust on Friday that it could face action after an inspection carried out last week in response to fears raised with the regulator. In a message to his colleagues on Friday, Liverpool University Hospitals (LUH) Trust medical director Tristan Cope warned the hospital had been overwhelmed by coronavirus and standards of care could no longer be maintained. He criticised NHS England and said the trust had been “abandoned” as coronavirus cases surged. He confirmed the CQC’s intention to take action against the trust but said the regulator had failed to appreciate the pressure staff in the hospital were under. Dr Cope, a consultant in anaesthesia and critical care, said: “LUH is now essentially overwhelmed by the demand. We cannot maintain patient flow and usual standards of care. We have put forward a proposal to further reduce elective [planned] activity, but maintaining capacity for the most urgent cases that would suffer from a two-four week delay." “It is a very sound plan that our divisional teams have worked up. However, NHS England are prevaricating and delaying with the usual request for more detail, more data, etc. It is clear to me that the politics is outweighing the patient safety issues of the acute crisis." Read full story Source: The Independent, 3 November 2020
  24. News Article
    North West Ambulance Service has declared a “major incident” over a high number of calls. People were warned they could be asked to make their own way to hospital if their call was not life-threatening, while some patients faced delays. There were no signs the surge in demand was linked to coronavirus, a spokesperson for the service said. “North West Ambulance Service has declared a major incident due to the high level of activity in the North West region, in particular the Greater Manchester area,” the service said on Monday evening. “If your call is not life-threatening, you may be asked if you can seek an alternative source of care or make your way to hospital by alternate means," the statement on Facebook said. The Independent understands at one point hundreds of calls were live - which triggered the major incident alert. Read full story Source: The Independent, 3 November 2020
  25. News Article
    People in Liverpool will be offered regular COVID-19 tests under the first trial of whole city testing in England. Everyone living or working in the city will be offered tests, whether or not they have symptoms, with follow-up tests every two weeks or so. Some will get new tests giving results within an hour which, if successful, could be rolled out to "millions" by Christmas, the government says. Liverpool has one of the highest rates of coronavirus deaths in England. The latest figures show the city recorded 1,754 cases in the week up to 30 October. The average area in England had 153. The pilot aims to limit spread of the virus by identifying as many infected people as possible, and taking action to break chains of transmission. It is thought around four-fifths of people who are infected with coronavirus show no symptoms. Read full story Source: BBC News, 3 November 2020
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