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Found 20 results
  1. News Article
    The NHS has launched an investigation after it sent “priority” letters to people who died years ago, in some cases decades, urging them to book flu and Covid-19 jabs to reduce their risk of serious illness. The health service is asking eligible patients to arrange appointments for both vaccines to avoid a potential “twindemic” of flu and coronavirus this winter, which would pile further pressure on hospitals and GP surgeries. “You are a priority for seasonal flu and Covid-19 vaccinations,” the two-page letter tells recipients. “This is because you are aged 65 or over (by 31 March 2024). However, some of the letters, which contain personal information such as NHS numbers, have been sent to people who died years ago. Others have been sent to people who are not eligible for the vaccines, with no connection to the addressee. In a statement, NHS England told the Guardian it was investigating. It declined to answer questions about when the error was first discovered, what had caused it and how many people had been affected. “We have been made aware of some letters sent in error and appreciate this may have been upsetting for those who received it – we are working as quickly as possible to investigate this,” a spokesperson for NHS England said. Read full story Source: The Guardian, 24 October 2023
  2. News Article
    A trust has been reprimanded by the Information Commissioner’s Office (ICO) for exposing a domestic abuse victim to risk by disclosing their address to an ex-partner. University Hospitals Dorset Foundation Trust is one of only seven organisations in the UK – and the only NHS organisation – to have received a reprimand since July 2022 for a data breach involving a victim of domestic abuse. According to new details released by the ICO, University Hospitals Dorset received a reprimand in April this year over a procedure it had in place that, when sending correspondence by letter, would include the full addresses of all recipients of that letter without their consent to do so. In the case that was referred to the ICO, the subject of the data breach had their full address revealed to their ex-partner despite previous allegations of abuse, which has created a “risk of unwanted contact which will remain”. The ICO concluded that, while the subject did not request their address be withheld, it would not be a reasonable expectation that personal information would be shared without prior consent. The report raised concerns that UHD did not have a clear policy in place for managing situations where there are parental disputes and that no formal training was provided to administrative staff for dealing with such circumstances. Read full story (paywalled) Source: HSJ, 2 October 2023
  3. News Article
    A director at a major acute trust said it needs to stop “caving in” to demand pressures by opening extra escalation beds. Board members at Mid and South Essex were discussing a recent report from the Care Quality Commission (CQC), which rated medical services as “inadequate”. The CQC flagged significant staffing shortages and repeated failures to maintain patient records, among other issues. Deputy chair Alan Tobias told yesterday’s public board meeting: “We have just got to hold the line on these [escalation] beds. We never do. Every year we cave in… “We have just got to hold the line with this… Do what some other hospitals do, they shut the doors then. We have never had the bottle to do that.” Barbara Stuttle, another non-executive director, said: “Our staff are exhausted… We don’t have the staff to give the appropriate care to our patients when we have got extra beds. To have extra beds on wards, I know we have had to do it and I know why, [but] you are expecting an already stretched workforce to stretch even further. “And when that happens, something gives. Record keeping, that’s usually the last thing that gets done because they’d much rather give the care to patients.” Read full story (paywalled) Source: HSJ, 28 July 2023
  4. Content Article
    Failure to be aware of and to follow clinical guidelines and protocols could constitute clinical negligence, but not in all cases, and much will depend on the facts of each case. John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses aspects of the law on clinical guidelines and other care management tools.
  5. News Article
    The confidentiality of NHS medical records has been thrown into doubt after a “stalker” hospital doctor accessed and shared highly sensitive information about a woman who had started dating her ex-boyfriend, despite not being involved in her care. The victim was left in “fear, shock and horror” when she learned that the doctor had used her hospital’s medical records system to look at the woman’s GP records and read – and share – intimate details, known only to a few people, about her and her children. “I felt violated when I learned that this woman, who I didn’t know, had managed to access on a number of occasions details of my life that I had shared with my GP and only my family and very closest friends. It was about something sensitive involving myself and my children, about a family tragedy,” the woman said. The case has prompted warnings that any doctor in England could abuse their privileged access to private medical records for personal rather than clinical reasons. Sam Smith, of the health data privacy group MedConfidential, said: “This is an utterly appalling case. It’s an individual problem that the doctor did this. But it’s a systemic problem that they could do it, and that flaws in the way the NHS’s data management systems work meant that any doctor can do something like this to any patient. Read full story Source: The Guardian, 14 May 2023
  6. Content Article
    Hospital command and control centres (CCCs) are central locations within a hospital where staff can coordinate and manage the response to emergencies, disasters and other critical events. They are also often used to track and monitor the location and status of hospital staff and resources, such as beds, equipment and supplies, in order to ensure that they are used efficiently and effectively. This blog by Sukhmeet Panesar, Chief Health Officer at Monstar Labs, acts as an introduction to CCCs in healthcare. It includes information on the different types of CCC, the benefits of CCCs and the challenges they may face.
  7. Content Article
    The NHS is in a state of crisis, with increasingly long delays for ambulances and emergency care. Often people believe that hospital delays and bottlenecks are caused entirely by the difficulty of discharging patients to social care. But there is another factor which is just as much of a problem, and which should be far easier to fix: the masses of unnecessary paperwork doctors and nurses have to fill out every day. Gordon Caldwell explores this issue in an article in the Spectator.
  8. News Article
    A son has accepted a settlement and an apology from the north Wales health board nearly 10 years after his mother was a patient in a mental health unit. Jean Graves spent nine weeks at the Hergest unit in Ysbyty Gwynedd in Bangor in 2013 after struggling with anxiety and depression. Her son David said she was left "severely malnourished" and fell. He previously said his mother - who was 78 when she was treated at the unit - collapsed six times and, over the course of six weeks, lost 25% of her body mass. The health board also apologised for the "distress" the family experienced while seeking answers "over many years" and said it hopes to "learn and improve" from Mr Graves's experience. In a letter to him, executives said: "It is very clear to us that we have failed your mother and that she should have had a better care whilst in our services." It said her records were incomplete or were "amended without proper evidence" and she was placed on a ward with a mix of patients with both psychiatric illness and older organic mental illness, which was not "best practice". Read full story Source: BBC News, 26 March 2023
  9. News Article
    Hospital staff have to complete 50 separate steps on average to discharge a patient, it has emerged, as the NHS grapples with a bed-blocking crisis. On average, around 14,000 patients deemed fit to leave hospital are stuck in beds every day, according to the latest official figures. The congestion is helping to fuel the backlog in accident and emergency (A&E) departments, where more than 55,000 patients waited 12 hours or longer last month. Steve Barclay, Health Secretary, announced an additional £250 million in funding last week to buy up care beds to help discharge thousands of patients. But doctors, social care experts and families have warned discharges are being delayed by NHS “bureaucracy” and excessive form filling. Dr Matt Kneale, co-chair of the Doctors’ Association UK and a junior doctor in Manchester, said patients are held up by “numerous bottlenecks” before being sent home. “While social care shortages are the predominant issue, smaller factors stack up to create a big problem,” he told The Telegraph. Many hospitals have limits on the times their pharmacies are open, he explained, meaning patients can often be stuck on the ward all day, or an extra night, waiting for their medication. Read full story (paywalled) Source: The Telegraph, 15 January 2023
  10. Content Article
    Research undertaken by digital health platform, CAREFUL shows that handover in hospitals is the cause of frequent and severe harm to patients.
  11. News Article
    A trust has discovered 1,800 patients who were removed by mistake from its elective waiting list. Barking, Havering and Redbridge University Hospitals Trust chief executive Matthew Trainer wrote to colleagues in the east London health system today to “apologise for the stress this will have caused those experiencing a delay”. Of the 1,800 patients involved, 600 have been waiting more than a year and roughly 200 have been waiting for more than two years. Mr Trainer’s note explained: “The patients have been waiting to see our specialists in routine clinics in gynaecology, neurology, neurosurgery and ophthalmology.” It continued: “As we have been working through our waiting lists, we have discovered a problem with one of them that was used to deal with the backlog created by the pandemic. “It contained routine referrals that were submitted by GPs who wanted their patients to be seen by a specialist, but for whom there were no appointments available due to covid-19. Unfortunately, these patients were removed automatically from this list before they had been seen.” Read full story (paywalled) Source: HSJ, 26 April 2022
  12. Content Article
    In this blog for Patient Safety Movement, Pranjal Bora, Head of Product Management at Digital Authority Partners, looks at the ways in which digital technologies improve outcomes and safety in healthcare. The blog examines areas in which digital technologies are currently being used, and looks at the potential future uses of AI and other digital technologies.
  13. Event
    until
    Be a part of history and join leading minds to explore clinical documentation's impact on patient safety, financial sustainability, and data integrity, in Australia's inaugural CDI conference. Targeting a broad array of health care stakeholders including CEOs, CFOs, Quality Managers, clinical staff, HIMs, Coders, and Clinical Documentation Specialists in Australia, New Zealand, and the Middle East. The conference will provide invaluable networking opportunities both in person and virtually with industry experts and like-minded individuals. Register
  14. News Article
    The NHS has erroneously written to thousands of patients who have had glandular fever in the past asking them to get a flu jab from their GP. The error left some GPs with practice phone lines blocked last week while reception staff have had to explain to patients they are not actually eligible for free flu vaccination. Nearly 40,000 letters were sent out to patients with a past history indicating glandular fever because of a coding error at NHS Digital. This was meant to identify patients with suppressed immune systems which would include those who currently have glandular fever and encourage them to contact their GP practice to arrange vaccination. However, the historical cases were not excluded, leading to the letters being automatically generated even when the glandular fever diagnosis was decades old. When NHS Digital realised the error, it contacted NHS England – which was responsible for posting out the letters – and managed to stop others being sent out. An NHS Digital spokesman said: “During a process to identify patients eligible for a flu vaccination, glandular fever was incorrectly included in a complex list of conditions that cause persistent immunosuppression. This led to some patients incorrectly receiving a letter encouraging them to seek a flu vaccination. “There has been no adverse clinical impact for patients and the issue was quickly resolved before the majority of letters were sent.” NHSD said patients who had received the letter would receive another one to explain and to reassure them." Read full story (paywalled) Source: HSJ, 4 November 2020
  15. News Article
    A technical glitch that meant nearly 16,000 cases of coronavirus went unreported has delayed efforts to trace contacts of people who tested positive. Public Health England (PHE) said 15,841 cases between 25 September and 2 October were left out of the UK daily case figures. They were then added in to reach Saturday's figure of 12,872 new cases and Sunday's 22,961 figure. PHE said all those who tested positive had been informed. But it means others in close contact with them were not. The issue has been resolved, PHE said, with outstanding cases passed on to tracers by 01:00 BST on Saturday. The technical issue also means that the daily case totals reported on the government's coronavirus dashboard over the past week have been lower than the true number. Read full story Source: BBC News, 5 October 2020
  16. Content Article
    Administrative data systems are used to identify hospital-based patient safety events; few studies evaluate their accuracy. McIsaac assessed the accuracy of a new set of patient safety indicators (designed to identify in hospital complications).
  17. Content Article
    Referrals to hospital are increasing as more people continue to live longer with a range of complex conditions. The Professional Records Standards Body (PRSB) recognise that good information sharing is integral to ensuring that patients can receive the ongoing care that they need. Currently there are differences between GP systems and GP practices in the clinical content of referrals, with multiple templates in use. The clinical referral information standard is designed to improve the exchange of referral information from GPs to hospital consultants and other health care professionals providing outpatient services.
  18. News Article
    The Healthcare and Safety Investigation Branch (HSIB) started a new national investigation looking into a safety risk involving outpatient follow-up appointments which are intended but not booked after an inpatient hospital stay. If a patient does not receive their intended follow-up appointment, it could lead to patient harm owing to delayed or absent clinical care and treatment. The investigation was launched after HSIB identified an event where a patient was discharged from hospital on two separate occasions with a plan to follow-up in outpatient clinics. Neither of the outpatient appointments were made. Read full story Source: HSIB, 20 December 2019
  19. Content Article
    A great  initiative by East Sussex Healthcare NHS Trust to reinforce the importance of basic checks to keep patients from harm when administering medicines.
  20. Content Article
    The Institute for Safe Medication Practices (ISMP) is the only US nonprofit organisation devoted entirely to preventing medication errors.  In this short video, produced by ISMP in partnership with the Temple University School of Pharmacy, experts discuss current medication safety concerns and offer practical error prevention recommendations.
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