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Patient Safety Learning

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Everything posted by Patient Safety Learning

  1. Content Article
    Implementation of high reliability principles in healthcare delivery is recognized as an effective strategy for reducing harm to patients and healthcare workers. With the coronavirus disease 2019 (COVID-19) pandemic upon us, our emergency departments (EDs) are facing an unprecedented safety threat. How does a high reliability ED function during a pandemic, and what are the most important strategies for keeping ourselves and our patients safe? Thull-Freedman et al. discuss this in a commentary in the Canadian Journal of Emergency Medicine.
  2. Content Article
    According to experts, older adults with or without pre-existing chronic conditions are at higher risk of COVID-19 infection and are also more likely to have severe cases requiring intubation, ventilator support, and intensive care. In fact, the CDC reports that about 8 of 10 COVID-19 deaths in the U.S. have been adults over the age of 65 years, with the majority over 85 years of age. The risk of contracting and dying from COVID-19 is an even greater problem in the almost 16,000 U.S. nursing homes, where there are concentrated numbers of older adults with chronic disease and frailty. This PSNet Patient Safety Primer looks at the patient safety problems for older adults.
  3. Content Article
    RADIO Meso (Receiving a diagnosis of mesothelioma) is a research project, funded by Mesothelioma UK and being carried out by researchers at the University of Sheffield. The project aims to identify ways to improve the patient and family carer experience of receiving a diagnosis of mesothelioma. The researchers carried out interviews with people with mesothelioma and their family members. Additional consultation was conducted with health professionals involved in communicating a mesothelioma diagnosis. People attending a group event at the Mesothelioma UK Patient and Carer Day also contributed their experiences and views regarding diagnosis communication. They were asked to recall their own experience and to tell the team ‘what went well?’ and ‘what could have been better?’. Following analysis the researchers identified key themes and developed ‘ten Top Tips’ for communicating a mesothelioma diagnosis.
  4. News Article
    NHS trusts could be asked to create shared waiting lists for elective care under plans being considered by national leaders. HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running. Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example, by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch. In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements. Read more Source: HSJ, 19 June 2020
  5. News Article
    The UK’s failure to report how many people have recovered from COVID-19 has been criticised by public health experts, who say a huge proportion of cases have remained “invisible” to the health service. Britain is an outlier internationally in not reporting the number of people who have recovered from COVID-19 alongside statistics on deaths and numbers of identified cases. Chile is the only other nation not to share this information out of the 25 countries with the highest reported incidence. A failure to monitor those who test positive for COVID-19 outside of hospital has left people feeling unsupported and alienated from the health system, the experts say. There is concern that because the majority of community cases have not been logged in patient records, it will be more challenging to research the long-term consequences of the disease. Prof Devi Sridhar, the chair of global public health at the University of Edinburgh, said: “Not tracking people in the community, for me, [is] so astonishing. These people are completely invisible in the health system.” Read full story Source: The Guardian, 18 June 2020
  6. Content Article
    After the COVID-19 pandemic is over, a key issue remains for the UK’s NHS: Will there be less avoidable patient harm, fewer occurrences of “never events,” and fewer headline grabbing patient safety crises? John Tingle explores this further in his blog for the Bill of Health. John Tingle is a regular contributor to the Bill of Health blog and is a Lecturer in Law at Birmingham Law School in the UK and a Visiting Professor of Law, Loyola University Chicago, School of Law.
  7. Content Article
    Six years ago The Snowy White Peaks of the NHS highlighted the scale of race discrimination in the NHS, the UK’s biggest employer of Black and Minority Ethnic (BME) staff. COVID-19 has shown so much more needs to be done. 300 health and social care staff have died so far from COVID-19, a disproportionate number of BME heritage. We know NHS staff infection was overwhelmingly due to occupational exposure whose causes are varied but include the disproportionate BME staff role in patient-facing services, their poorer access to appropriate PPE, the greater reluctance of BME staff to raise concerns, disproportionate deployment into “hotter” roles, and the greater presence of BME colleagues amongst agency staff. BME staff have been largely absent from decision-making. The COVID-19 impact on BME staff, and Black Lives Matter, has prompted promises to tackle racism more resolutely. So what should NHS leaders do to ensure faster progress to tackle workforce race discrimination? Roger Kline, in this BMJ Leader blog, has ten suggestions for Boards and Integrated Care System system leaders.
  8. News Article
    Low dose dexamethasone reduces deaths in patients hospitalised with COVID-19 who need ventilation, according to preliminary results from the RECOVERY trial. The drug was also found to reduce deaths by one-fifth in other hospitalised patients receiving oxygen only, but no benefit was seen among COVID-19 patients who did not need respiratory support. The chief investigators from the University of Oxford trial said that the findings represent a “major breakthrough” which is “globally applicable” as the drug is cheap and readily available. Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford and a chief investigator on the trial, added, “This is the only drug that has so far been shown to reduce mortality, and it reduces it significantly. It is a major breakthrough.” Read full story Source: BMJ, 16 June 2020
  9. News Article
    Doctors fear a rise in stillbirths and babies with impaired growth because pregnant women were too scared to seek help during the pandemic. At a Royal Society of Medicine webinar on pregnancy and Covid, medics expressed concern that women in need of urgent attention had kept away from maternity services, for fear of catching the infection. In other cases, those with worrying symptoms which could mean their baby was at risk may have stayed away because they feared putting pressure on services, doctors said. Dr Maggie Blott, head of obstetrics at the Royal Free London Foundation trust, said: “A lot of the work that we do is is prevention, and a lot of women that we see, turn up for hospital as an emergency - have concerns around abdominal pain, reduced foetal movements, all sorts of things.” Read full story (paywalled) Source: The Telegraph, 18 June 2020
  10. News Article
    The COVID-19 pandemic could entrench and exacerbate inequalities in mental health for a generation unless action is taken, the Centre for Mental Health has warned. In a report published on Thursday, the charity warned that the lockdown would put greater pressure on groups whose mental health was already poor beforeCOVID-19 hit, such as women and children experiencing violence and abuse, and ethnic minority communities. The pandemic will leave an “unequal legacy of complicated bereavement, trauma, and economic repercussions which will push more people towards financial insecurity and poverty, significant risk factors for poor mental health,” the report said. “Unequal experiences of grief, loss, trauma, injustice, and abandonment all add to the psychological damage caused by COVID-19.” The report, backed by 12 mental health charities and the Royal College of Psychiatrists, said that the government must prioritise race equality and support “trauma informed” approaches for all people whose lives had been affected by COVID-19. Read full story Source: BMJ, 19 June 2020
  11. Content Article
    The COVID-19 pandemic has brought health inequalities into sharp focus. The unequal impacts of the virus are also extending inequalities in mental health. This briefing paper, produced by Centre for Mental Health and supported by 13 other national mental health charities, explores the mental health inequalities that are associated with the pandemic in the UK. It finds that the virus and the lockdown are putting greater pressure on groups and communities whose mental health was already poorer and more precarious. Groups of people whose mental health is at greatest risk include those with existing mental health problems, people with long-term physical conditions, women and children experiencing violence and abuse, and Black, Asian and minority ethnic communities. The combination of existing structural inequalities and the unequal impacts of the pandemic mean that people whose mental health was at greatest risk prior to COVID-19 are likely to bear the brunt of the emergency longer term.
  12. News Article
    Nurses' leaders want all healthcare employers - including the NHS - to "care for those who have been caring" during the coronavirus crisis. The Royal College of Nursing (RCN) is calling for better risk assessments; working patterns and mental health care for those on the front line. It warns many may be suffering from exhaustion, anxiety and other psychological problems. The Department of Health and Social Care said support was a "top priority". The RCN has released an eight-point plan of commitments it wants to see enforced to mark the 100 days since the World Health Organization (WHO) declared a pandemic. Amongst its suggestions are a better COVID-19 testing regime for healthcare workers and more attention paid to the risks posed to ethnic minority nurses. It says employers and ministers "must tackle the underlying causes which have contributed to worse outcomes for Bame staff". Read full story Source: BBC News, 19 June 2020
  13. Content Article
    The pandemic has shown us health service transformation needs to go hand in hand with more beds and resources. The big challenge for all of us now is to to stand back and say: what has this taught us about the strengths and weaknesses of our healthcare system? What did we get right and wrong? The NHS has done an amazing job, proving itself very agile, very productive and very flexible. It’s been a process of constant learning. But there’s a very big backlog of people needing care, because we had this huge emptying out of hospitals and many NHS services were paused, notably elective surgery. Sir Jim Mackey, Chief Executive of Northumbria Healthcare NHS foundation trust and former Chief Executive of NHS Improvement, thinks private hospitals can help the NHS get on top of the backlog, to agreed standards and with the NHS paying. He tells the Guardian that it’s wrong that patients have to wait too long to get treatment and the public won’t care who provides that care.
  14. Content Article
    University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) is setting out its priorities for the remainder of the coronavirus (COVID-19) pandemic and into the future. The pandemic has meant that certain plans have had to be put temporarily on hold but the Trust says there are important areas that can and will be developed over the next few months and into 2021. Quality and safety of care remain the main priorities so the Trust is now focusing on four key areas to ensure that services recover and improve as the country emerges from the pandemic. 
  15. News Article
    In a major U-turn, the UK is ditching the way its current coronavirus-tracing app works and shifting to a model based on technology provided by Apple and Google. The Apple-Google design has been promoted as being more privacy-focused. However, it means epidemiologists will have access to less data. The government now intends to launch an app in the autumn, but it says the product may not involve contact tracing at that point. Instead the software may be limited to enabling users to report their symptoms and order a test. Baroness Dido Harding - who heads up the wider Test and Trace programme - will only give the green light to actually deploying the Apple-Google technology if she judges it to be fit for purpose, which she does not believe is the case at present. It is possible this may never happen. Read full story Source: BBC News, 18 June 2020
  16. News Article
    Frontline staff and volunteers at the forefront of the national coronavirus response across England will be able to access a new Psychological First Aid (PFA) training course, the Minister for Mental Health Nadine Dorries has announced. The course, which has been developed by Public Health England, will be available to frontline workers and volunteers dealing with the public during the coronavirus pandemic. The free online course enables responders to develop their skills and confidence in providing key psychological support to people affected by coronavirus, including on issues such as job worries, bereavement or isolation as they carry out their vital work as part of the ongoing coronavirus response. It will also help to develop understanding of how emergencies like the coronavirus pandemic can affect us all, how to recognise people who may be at increased risk of distress, and how to offer practical and emotional support. Minister for Mental Health Nadine Dorries said: “Supporting each other’s mental health and wellbeing is more important than ever during these challenging and uncertain times. Staff and volunteers in many different roles are working tirelessly to provide crucial support at this time and are often a critical touchpoint in identifying those who may be affected. “This new training course will help to support the incredible work of frontline workers to support those most in need both through the coronavirus outbreak and beyond, equipping them with vital tools to deliver psychological first aid.” Read press release Source: GOV.UK, 15 June 2020
  17. Content Article
    The NIHR-funded and supported study RECOVERY (Randomised Evaluation of COVid-19 thERapY) has announced that the steroid dexamethasone has been identified as the first drug to improve survival rates in certain coronavirus patients.
  18. Content Article
    More Inclusive Healthcare helps healthcare organisations in the United States do the good work of making healthcare more inclusive and equitable so that everyone will have the opportunity to achieve their full health potential.
  19. Content Article
    The National Guardian's Office (NGO) published a summary of speaking up learning and actions in response to its review into the handling of speaking up cases at Whittington Health NHS Trust. The review, carried out at the end of last year, revealed encouraging areas of good practice. There were also areas of improvement recommended by the review that highlighted issues with the wording and application of the trust policy relating to speaking up, support and feedback to those who speak up, and the way in which the trust manages grievances. The review summary details the NGO’s findings and actions of the trust.
  20. News Article
    At least another 130,000 people worldwide have died during the coronavirus pandemic on top of 440,000 officially recorded deaths from the virus, according to BBC research. A review of preliminary mortality data from 27 countries shows that in many places the number of overall deaths during the pandemic has been higher than normal, even when accounting for the virus. These so-called "excess deaths", the number of deaths above the average, suggest the human impact of the pandemic far exceeds the official figures reported by governments around the world. Some will be unrecorded COVID-19 victims, but others may be the result of the strain on healthcare systems and a variety of other factors. Read full story Source: BBC News, 18 June 2020
  21. News Article
    The NHS contact-tracing app will not be ready before winter, a health minister has said, despite initially being promised in mid-May. Lord Bethell said the Department of Health was "seeking to get something going for the winter". But, he told a committee of MPs, the app wasn't "the priority at the moment". Lord Bethell confirmed the government still planned to introduce a contact-tracing app, describing it as "a really important option for the future". The app has been the subject of a trial on the Isle of Wight, where the Department of Health says it has been downloaded by 54,000 people. Lord Bethell said the trial had been a success, but admitted that one of its principal lessons had been that greater emphasis needed to be placed on manual contact tracing. Asked why the app had taken so long to release, Lord Bethell told the Science and Technology Committee the Isle of Wight trial had shown that people "weren't frightened of it, as we were worried that they might be" - and had also provided "concrete examples" of successes in breaking transmission chains. But he admitted there had been "technical challenges", as well as an "ongoing battle" to persuade people the system was safe and privacy-protecting. Read full story Source: Sky News, 18 June 2020
  22. News Article
    Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls". Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. "The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that." Read full story (paywalled) Source: The Telegraph, 16 June 2020
  23. News Article
    The Care Quality Commission (CQC) has issued a plan for re-starting routine inspections — but has been warned by the NHS Confederation that the health service needs this “like a hole in the head”. The organisation said there would be a “managed return” of “routine inspections” in the autumn. It also stated in a statement today: ”Inspectors are now scheduling inspections of higher risk services to take place over the summer.” But the CQC later insisted to HSJ that this was not a change to its current policy, in place since the beginning of the UK COVID-19 peak, as it would only be inspecting in response to information it receives which raises “serious concerns”. The CQC suspended its routine inspections in March – and has instead been calling healthcare providers and only physically attending where there are serious concerns about harm, abuse or human rights breaches. The new approach to regulation, which the CQC called its “emergency support framework”, was criticised by 11 older people’s and disabled groups, which said the decision not to carry out routine inspections broke human rights and equalities laws. Read full story Source: HSJ, 17 June 2020
  24. Content Article
    Report from the Saudi Patient Safety Center on: 1. Hospital Survey on Patient Safety Culture National Recommendations Cycle 2: (2019), and 2. National Supplementary Recommendations related to COVID-19.
  25. News Article
    The chief inspector of hospitals has warned that patient safety is at risk if the NHS winter crisis is worsened by coronavirus – and ministers must act now in emergency departments to prevent a catastrophe. Professor Ted Baker, speaking to The Independent in his first interview since the COVID-19 outbreak hit Britain, warned that the NHS could not carry on as before as hospitals across the country struggle to return to normal care while the crisis continues. “If we are going to do something about it, we need to act now, not at the beginning of winter,” he warned, adding the Care Quality Commission (CQC) was also worried about patients being “forgotten” as NHS waiting lists surge to an expected 10 million later this year. "We will be going into winter and all the difficulties of the winter viruses that we normally face, together with Covid. I think next winter is going to be very difficult, unless emergency departments and the whole system supporting emergency departments do things very differently.” He warned providing care in the NHS under the shadow of coronavirus was “a formidable challenge … probably bigger than the challenge we faced at the height of the pandemic”. Prof Baker also told The Independent that the CQC was investigating a number of reports that some hospital patients were discharged unsafely to care homes following a staggering 55% rise in whistleblowing complaints, particularly in care homes, with 2,612 calls between March and May. Read full story Source: The Independent, 17 June 2020
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