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Patient-Safety-Learning

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  1. Patient-Safety-Learning
    A former nursing home manager has been fined £40,000 after pleading guilty to two offences of failing to provide safe care and treatment to two residents at Rossendale Nursing Home in Lancashire.
    Caroline Taylforth, who established her first residential care home in 1997, was prosecuted by the CQC. She was the registered manager at Rossendale Nursing Home at the time of the incidents, and admitted mistakes she had made that meant two residents did not receive safe care and treatment, and resulted in "avoidable harm" while in her care, said a CQC spokesperson.
    The first offence was for failures in the care of resident Patricia Sutton, aged 77, who was admitted to the home on 11 October 2018 and had a significant medical history. On 6 November 2019, Patricia Sutton was eating dinner in the dining room and started choking. She was taken to hospital and died later that day. Ms Sutton had previously been involved in three other choking incidents and should have been referred to a speech and language therapist after the second one occurred to properly assess the risks, said the CQC. However, Ms Taylforth "did not safely assess, monitor or manage the risk or make this referral", the CQC concluded.
    The CQC also prosecuted Ms Taylforth for another incident concerning Dereck John Chapman, aged 82, who was admitted to the home on 22 October 2019 with multiple health issues and was also prone to having falls. Following admission to the home, Mr Chapman suffered at least 14 falls. Ms Taylforth "failed to mitigate" the risk of falls and "failed to ensure" Mr Chapman was promptly referred to appropriate services, such as the falls team, GP, and local authority following known incidents, particularly those resulting in injuries, criticised the CQC.
    Read full story
    Source: Medscape, 6 April 2023
  2. Patient-Safety-Learning
    Nurses and physiotherapists can now provide ill patients with “fit-notes” to stay off work in an attempt to ease pressure on GP services. A range of health staff including pharmacists and occupational therapists are certifying illness sign-offs under moves to free up doctors to tackle the treatment backlog.
    NHS Grampian has successfully completed a pilot scheme at a GP practice which staff described as “really positive” and a step in the right direction.
    David Cooper, a GP from Old Machar Medical Practice in Aberdeen, said: “It is a more efficient way for us to work as a practice. For the nurses, physiotherapists and others who are working closely with a patient, it makes sense for them to be able to work on fit-notes without having to refer back to a GP for sign off. “We have found it works particularly well for those with chronic, long-term conditions or illness and the process behind the scenes is also now electronic so it saves paper, time and energy.”
    Paul Gray, a physiotherapist at Old Machar, said: “It makes the patient’s journey easier and it is better for people to access them from those who are assessing your physical capabilities."
    Read full story (paywalled)
    Source: The Times, 6 April 2023
  3. Patient-Safety-Learning
    Just three years of breathing polluted air can increase a person’s risk of lung cancer, a study has found.
    Scientists have found, for the first time, the mechanism that proves air pollution causes lung cancer to develop.
    Research funded by Cancer Research UK and conducted by the Francis Crick Institute showed that small pieces of carbon particulates, known as PM2.5, enter deep into the lungs and lead to tumour development. A key gene, known as EGFR, mutates and then the presence of the air pollution exacerbates the growth and expansion of these mutated cells, the study found.
    The scientists are hopeful that by shedding light on how lung cancer develops they can help to prevent it. Prof Charles Swanton, the chief clinician for Cancer Research UK and lead investigator on the study, said a statin-like drug to protect against lung cancer and ensure the inflammation that can lead to the disease is kept under control could be developed in as little as 10 years.
    Prof Swanton said: “Our study has fundamentally changed how we view lung cancer in people who have never smoked."
    Read full story (paywalled)
    Source: The Telegraph, 5 April 2023
  4. Patient-Safety-Learning
    Lives could be saved by a new tool that identifies those most at risk of developing lung cancer, according to researchers.
    The CanPredict tool can spot those most at risk of developing the disease over the next decade and put them forward for screening tests earlier, researchers from the University of Oxford and the University of Nottingham said. They created and tested CanPredict using the anonymised health records of more than 19 million adults from across the UK and hope it can save “time, money and, most importantly, lives”.
    Lung cancer is the leading cause of cancer deaths worldwide and the second most common form of the disease, but early diagnosis has been shown to improve survival rates.
    Professor Julia Hippisley-Cox, senior author and professor of clinical epidemiology and general practice at the Nuffield Department of Primary Care Health Sciences, University of Oxford, said: “We hope that this new validated risk tool will help better prioritise patients for screening and ultimately help spot lung cancer earlier when treatments are more likely to help. We’d like to thank the many thousands of GPs who have shared anonymised data for research without whom this would not have been possible.”
    Read full story
    Source: The Independent, 6 April 2023
  5. Patient-Safety-Learning
    An independent group overseeing the reviews into a toxic culture at University Hospitals Birmingham have raised concerns over a possible ‘cover up’ of key reports.
    The cross-party reference group, which includes MPs, council and Healthwatch officials, has demanded transparency over key decisions, and says there are continuing concerns over the trust’s leadership. It has been scrutinising a review into patient safety concerns at UHB, which found the trust’s executive had become “overzealous and coercive”.
    On the day this review was released, it was revealed that UHB’s former CEO David Rosser had decided to retire.
    The group, chaired by MP Preet Gill, said in a statement: “The allegations made by whistleblowers were not isolated incidents, but the result of a deep-seated and toxic culture. While Dr Rosser has recently announced his retirement, one member of staff, albeit a chief executive, cannot be responsible for this alone. Feedback from staff has made it clear that there must be collective accountability by the senior leadership for the distressing culture afflicting the trust."
    Read full story (paywalled)
    Source: HSJ, 5 April 2023
  6. Patient-Safety-Learning
    Some of the most vulnerable patients could risk missing out on covid treatment because new rules will place the onus on them to access antiviral medication themselves instead of the NHS contacting them directly, senior figures have warned.
    The warnings follow NHS England’s national medical director Sir Stephen Powis writing to local leaders last week advising them the national commissioner will no longer identify patients who are eligible for covid treatment.
    This means eligible patients will need to contact local services themselves, rather than being approached proactively by a covid medicines delivery unit.
    Patients Association chief executive Rachel Power said: “Expecting patients ill with covid to know they’re eligible for these treatments and ask for them is unreasonable. How will they know they’re eligible or who to contact?”
    Read full story (paywalled)
    Source: HSJ, 6 April 2023
  7. Patient-Safety-Learning
    The parents and children of victims of the contaminated blood scandal should receive government compensation, a judge has said.
    The chairman of the infected blood public inquiry, Sir Brian Langstaff, said it was time to "recognise deaths which have so far gone unrecognised". More than 3,000 people died after contracting HIV or hepatitis C via NHS treatments in the 1970s and 80s.
    The government must now respond to the recommendations.
    In August 2022, the government agreed to make the first interim compensation payments of £100,000 each to about 4,000 surviving victims, and bereaved widows. 
    Sir Brian said, "It is a fact that around 380 children with bleeding disorders were infected with HIV. Some of them died in childhood. But their parents have never received compensation. Children who were orphaned as a result of infections transmitted by blood transfusions and blood products have never had their losses recognised. It's time to put that right."
    Read full story
    Source: BBC News
  8. Patient-Safety-Learning
    Delays in people leaving hospital in England could be costing an average of £395 per night, according to researchers at a health think tank.
    The direct costs of delayed discharges, where patients are considered medically fit to leave hospital, is estimated to be around £1.89 billion for the past financial year, the King's Fund said. This estimate does not count extra costs, including cancelled operations or staff time spent arranging care packages. Ambulance handover delays are often linked to a shortage of space caused by people who no longer need to be in hospital beds.
    The most recent PA analysis of NHS figures showed an average of 13,300 beds per day in the week to March 26 were filled by people ready to be discharged, compared with 12,643 at that point last year. Overall, 42% of medically fit patients in England were discharged, though the rate varied between regions, from 31% in the North West to 52% in eastern England.
    Read full story
    Source: Medscape, April 2023
  9. Patient-Safety-Learning
    A virus carried by ticks, which is common in many parts of the world, is now present in the UK and health officials are reminding the public how to avoid bites from the tiny bugs.
    They say the risk of tick-borne encephalitis is very low—only one person is confirmed to have been infected in England so far, last year. But the tick species which carries the virus is widespread in the UK. Most people do not develop symptoms but swelling to the brain is possible.
    The UK Health Security Agency has recommended changes to testing in hospital so that any new cases can be picked up quickly. 
    Health officials say anyone who becomes unwell after a tick bite should see a GP. More serious symptoms to look out for include severe headache, stiff neck, unexplained seizure, sudden confusion and weakness in arms and legs.
    Read full story
    Source: BBC News, 5 April 2023
  10. Patient-Safety-Learning
    A new non-invasive diagnostic test for oral cancer test developed by researchers at the University of Surrey is said to be over 92% accurate at detecting oral squamous cell carcinoma (OSCC) and more than 80% accurate at identifying pre-cancerous oral epithelial dysplasia (OED), according to a proof-of-concept study. 
    The news comes in the wake of a recent report showing that cases of oral cancer in the UK increased by 34% over the last decade and have more than doubled compared with 20 years ago. The State of mouth cancer UK report 2022, released last November by the Oral Health Foundation, showed that there were 8846 new cases of mouth cancer diagnosed in the UK over the previous year, with 3034 deaths from the disease.
    The test could pave the way for better oral cancer detection, the researchers said. The samples were collected in dental surgeries and mailed to their laboratory for analysis, which demonstrated that the test could be "used in primary care to identify patients in need of specialist care".
    Study co-author Dr Fatima Labeed, senior lecturer in human biology from the University of Surrey, said: "Over 300,000 people are diagnosed with oral cancer worldwide–a disease with an alarming mortality rate of around 50%. This suggests that the scientific community doesn't have the tools available to identify oral cancer early enough, and we hope that PANDORA paves the way for more effective clinical diagnostic tools for this terrible disease."
    Read full story
    Source: Medscape, 5 April 2023
  11. Patient-Safety-Learning
    Critically ill patients “will inevitably die” because hospitals are having to cancel surgery as a direct result of next week’s junior doctors’ strike in England, leading heart experts have warned.
    There were bound to be fatalities among people with serious heart problems whose precarious health meant they were “a ticking timebomb” and needed surgery as soon as possible, they said. They added that patients would face an even greater risk than usual of being harmed or dying if their time-sensitive operation was delayed because NHS heart units would have too few medics available during the four-day stoppage by junior doctors to run normal operating lists.
    The trio of cardiac experts are senior doctors at the Royal Brompton and Harefield specialist heart and lung hospitals in London. Those facilities, plus the cardiac unit at St Thomas’ hospital in the capital, have between them postponed between 30 and 40 operations they were due to conduct next week on “P2” patients, whose fragile health means they need surgery within 28 days.
    “It is no exaggeration to say that delaying surgery for this group [P2s] will result in harm. For some, this may be life-changing. For others, it may mean premature death,” said Dr Richard Grocott-Mason, a cardiologist who is also the chief executive of the Royal Brompton and Harefield hospitals.
    Read full story
    Source: The Guardian, 4 April 2023
  12. Patient-Safety-Learning
    Two concurrent outbreaks of the Marburg virus, a close cousin of Ebola that can kill as many as 90 percent of the people it infects, are raising critical questions about the behaviour of this mysterious bat-borne pathogen and global efforts to prepare for potential pandemics.
    Marburg causes high fever, vomiting, diarrhoea and bleeding from orifices. It spreads between people via direct contact with the blood or other bodily fluids of infected people and with surfaces and materials such as clothing contaminated with these fluids.
    One of the two outbreaks, in Tanzania in East Africa, seems to have been brought under control, with just two people left in quarantine. But in the other, in Equatorial Guinea on the west coast, spread of the virus is ongoing, and the World Health Organization (WHO) said last week that the country was not being transparent in reporting cases.
    The WHO said both outbreaks pose regional risks: Equatorial Guinea has porous borders with Cameroon and Gabon, and so far the cases have appeared in geographically diffuse parts of the country. In Tanzania, the Kagera region has busy borders with Uganda, Rwanda and Burundi.
    Read full story (paywalled)
    New York Times, 5 April 2023
  13. Patient-Safety-Learning
    Federal regulators have decided to authorise a second omicron-specific coronavirus vaccine booster shot for people who are at least 65 or have weak immune systems in an effort to provide additional protection to high-risk individuals, according to several officials familiar with the plan. 
    The Food and Drug Administration is expected to announce the step in the next few weeks, and the Centers for Disease Control and Prevention is expected to move quickly to endorse it, said the officials, who spoke on the condition of anonymity because they were not authorised to publicly discuss internal discussions. Eligible individuals will be able to receive the dose as long as it has been at least four months since their first shot of what’s known as the bivalent booster, which targets omicron subvariants BA.4 and BA.5 as well as the original novel coronavirus. The expectation is that consumers will consult with their health-care providers about whether to get the extra booster, the officials said.
    John P. Moore, a professor of microbiology and immunology at Weill Cornell Medicine in New York, said an extra booster could benefit people who are in poor health or have an impaired immune system. But he was skeptical everyone older than 65 needs it. Boosters lead to “a short-term boost against mild infection but protection against severe disease is still pretty robust” because of previous shots, he said.
    Read full story (paywalled)
    Source: Washington Post, 3 April 2023
  14. Patient-Safety-Learning
    Confirmation the government has cut hundreds of millions from budgets partly designed to boost health and care integration has been met with fury, with the decision described as leaving the social care reform agenda in ‘tatters’.
    It was revealed last month that the £1.7bn promised in 2021’s social care white paper to strengthen the sector, and especially its contribution to more integrated services, was set to be drastically cut by ministers.
    Today’s announcement has confirmed the investment originally ear-marked for “investment in knowledge, skills, health and wellbeing, and recruitment policies [to] improve social care as a long-term career choice” has been cut from £500m to £250m, the £300m promised to “integrate housing into local health and care strategies" cut to zero. The white paper also promised “at least £150m” for investment in digital and technology, but today’s government announcement has capped this at £100m. Overall cuts to the series of reform programme are in the region of £600m. Only £520m has been allocated, and it is unclear where the rest of the original £1.7bn will be spent.
    Sarah McClinton, president of the Association of Directors of Adult Social Services, said the plan “takes us backwards” and “leaves the government’s vision for reform in tatters”, adding that it “ducks the hard decisions and kicks the can down the road again until after the next election.”
    Read full story (paywalled)
    Source: HSJ, 4 April 2023
  15. Patient-Safety-Learning
    The number of new ambulances in England will be far less than the hundreds promised by the government, a Freedom of Information request has revealed.
    In January, 800 new ambulances were announced, with a 10% fleet increase. But vehicles being ordered by trusts are mostly replacements they were prevented from purchasing because of procurement changes and the pandemic.
    In response to a written question in February, DHSC said the "over 800 new ambulances" advertised equated to about 350 extra vehicles, plus 100 mental health ambulances. However, the FOI responses from England's ambulance trusts suggest the number of extra vehicles will be far fewer.
    Read full story
    Source: BBC News, 4 April 2023
  16. Patient-Safety-Learning
    NHS England have issued a safety alert on the risk of inappropriate anticoagulation of patients with a mechanical heart valve.
    Published guidance supported clinical teams in reviewing patients being treated with a vitamin K antagonist (VKA) early on in the pandemic and change their medication to an alternative anticoagulant where needed. 
    However, there have been reports that those with a mechanical heart valve have been prescribed a molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC) which the guidance lists as an exception to its use in such patients.  
    The alert asks GPs and other NHS providers to urgently identify patients with a mechanical heart valve and ensure they are on the most appropriate anticoagulant. 
    Read full story.
    Source: NHS England, 14 July 2021
  17. Patient-Safety-Learning
    Thousands of patients are being forced to wait more than 18 months for treatments such as knee and brain surgery as the health service is set to miss its flagship target because of NHS strikes.
    NHS England last week claimed it was “on track” to hit the mandated target, but senior sources have warned that the impact of prolonged walkouts combined with unprecedented demand for emergency care means that this is now unlikely.
    The sources say it is probable that up to 10,000 patients will still be waiting for 18 months or more by the end of March, as a knock-on effect of the cancellation of 140,000 appointments because of strike action. More walkouts are planned over the coming weeks.
    Patricia Marquis, RCN director for England, said the backlog was “yet even more evidence of what happens when you fail to invest in the workforce. If ministers are serious about preventing a further exodus and cutting the backlog, they need to hear the calls of NHS leaders and come to the table and talk about pay. Only then will patients receive the care they need and waiting lists start to come down.”
    Read full story
    Source: The Independent, 15 February 2023
  18. Patient-Safety-Learning
    GPs are attempting to deal with up to 3,000 patients each, amid worsening staff shortages, according to new analysis commissioned by the Liberal Democrats.
    The research shows that the number of patients per GP has risen sharply, as rising numbers of doctors reduce their hours, or opt for early retirement. The figures, which track the number of “full-time equivalent” fully qualified GPs, show the number has fallen from 29,320 in 2016 to 27,372 last year. The trend follows a rise in part-time work, with the average GP now working a three-day week. 
    On average, there are now 2,273 patients per fully qualified doctor, up from 1,981 in 2016, the research commissioned by the Liberal Democrats shows. While the total number of GPs fell by almost 2,000, the number of registered patients grew from 58 million to 62.2 million, according to the House of Commons Library.
    Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said the research “shows yet again how GPs and our teams are working above and beyond to deliver care to an ever-growing patient population, with falling numbers of fully qualified, full-time equivalent GPs.”
    Read full story (paywalled)
    Source: The Telegraph, 14 February 2023
  19. Patient-Safety-Learning
    A health board has been fined £180,000 for failing to protect a vulnerable pensioner who died after repeatedly falling in hospital. Colin Lloyd, 78, was assessed as posing a high risk of falling and required one-to-one care after being admitted to Raigmore Hospital in Inverness.
    Despite repeated requests for more nursing staff none were made available and the pensioner suffered falls on the ward, which caused fatal injuries.
    Fiona Hogg, NHS Highland’s director of people and culture, said: “We are deeply sorry for the failures identified in our care. Our internal review following the incident identified several areas of improvement and we have made a number of changes to our practice.”
    Read full story (paywalled)
    Source: The Times, 15 February 2023
  20. Patient-Safety-Learning
    The number of GPs seeing patients outside standard surgery hours in Scotland has dropped by almost a quarter in three years.
    Nurses and paramedics have had to fill in for doctors in the out-of-hours urgent care centres because GPs could not be found to cover the shifts. Some health boards have had to close their centres and send patients to overstretched A&Es instead because of the GP shortage.
    Dr Andrew Buist, chairman of the British Medical Association’s Scottish GP committee, said, “Patient demand is outstripping GP capacity across the whole service, including out-of-hours. We simply do not have enough GPs in Scotland. Those who are working in out-of-hours may be doing more hours now than they perhaps did in 2019 which comes as no surprise if there are fewer GPs to go around but it is unsustainable and puts those working in the service at risk of exhaustion and burnout.”
    Read full story (paywalled)
    Source: The Times, 15 February 2023
  21. Patient-Safety-Learning
    Healthcare leaders have been warned by nearly 200 doctors that plans to give more work to private hospitals will “drain” money and staff away from NHS services, leaving the most ill patients at risk.
    In a letter seen by The Independent, almost 200 ophthalmologists urged NHS leaders to rethink plans to contract cataract services to private sector hospitals, as to do so “drains money away from patient care into private pockets as well as poaching staff trained in the NHS”. The doctors have called for “urgent action” to stop a new contract from being released, which would allow private sector hospitals to take over more cataract services.
    Professor Ben Burton, consultant ophthalmologist and one of the lead signatories of the letter, said, “What is needed is a long-term sustainable solution rather than a knee-jerk reaction which risks the future of ophthalmology as an NHS service. The long-term solution will be achieved by investing in NHS providers to deliver modern, efficient care, and the private sector only used as a last resort.”
    Read full story
    Source: The Independent, 10 February 2023
  22. Patient-Safety-Learning
    Some doctors say that however reasonable guidelines may seem, their cumulative burden causes “constant frustration” to medical practice.
    A team of doctors wrote a study last year for the Journal of General Internal Medicine which suggested that if an American doctor followed all of the guidelines for preventive, chronic and acute disease care issued by well-known medical groups, it would require nearly 27 hours per day.
    Guidelines have become “a constant frustration,” said Dr. Minna Johansson, a general practitioner in Uddevalla, Sweden, who also directs the Global Center for Sustainable Healthcare at the University of Gothenburg. “A lot of guidelines may seem reasonable when considered in isolation, but the cumulative burden of all guideline recommendations combined is absurd.”
    Read full story (paywalled)
    Source: New York Times, 14 February 2022
  23. Patient-Safety-Learning
    Around half of the largest trusts are not buying all their electricity from renewable sources despite a national requirement to do so, as prices of this type of energy rocket.
    NHS England previously committed to the service purchasing only renewable energy from April 2021, as part of efforts to meet its target to be net zero for emissions it can control–including electricity–by 2040.
    However, NHSE information seen by HSJ shows that nine of the largest 20 trusts have not been buying 100 per cent renewable electricity this financial year, amid soaring costs. Several trusts told HSJ they had abandoned previous decisions to only use electricity which was “guaranteed” to be renewable.
    Read full story (paywalled)
    Source: HSJ, 15 February 2023
  24. Patient-Safety-Learning
    A Conservative MP has blamed “far too many overpaid and utterly useless senior managers” for what he described as the “shambles of the NHS.”
    Philip Davies, MP for Shipley in Yorkshire, said in an email that the NHS is “appallingly run”, with many senior managers “who wouldn’t be able to get a similar job in the private sector.”
    He claimed the NHS “shambles” “is not a problem created by the government,” as “the government’s job is to fund that NHS,” while running the services is done by NHS England and individual trusts.
    However, recent analysis indicates that managers make up just 2 per cent of the NHS workforce, compared with 9.5 per cent of the UK workforce. NHS Confederation has said the NHS is “as a whole under, not over, managed,” despite “persistent and misleading media headlines.”
    Read full story (paywalled)
    Source: HSJ, 16 January 2023
  25. Patient-Safety-Learning
    Prostate cancer patients across the UK face a “postcode lottery” of care, a charity has warned, with men in Scotland almost three times more likely to be diagnosed at a late stage compared with men in London.
    Prostate Cancer UK said the proportion diagnosed when the disease may be too advanced to treat varied hugely depending on where patients lived. Health leaders called the findings “shocking”. In Scotland, more than a third (35%) of men are only diagnosed when the disease is classed as stage 4, meaning the cancer has spread to another part of the body – known as metastatic cancer. In London, the figure is 12.5%.
    Chiara De Biase, director of support and influencing at Prostate Cancer UK, said, "We can’t say for sure what’s behind this gap in diagnosis, but it’s clear that men are more likely to be diagnosed at an earlier stage in areas with higher rates of PSA blood testing. That means the key way to tackle this is by raising awareness – especially in places like Scotland which are worst-affected."
    Read full story
    Source: The Guardian, 12 January 2023

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