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Showing results for tags 'Equipment shortages'.
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Content ArticleThe UK has fewer acute hospital beds relative to its population than many comparable health systems, and the Covid-19 pandemic has had a significant impact on their availability and use. This article by The King's Fund illustrates long-term trends in hospital beds, using 2019-20 data from before the pandemic as the most recent comparator. However, where data is available for 2020/21, the authors have included this for information and to show the impact of the pandemic.
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News Article
‘Challenged’ trust plans to move patients to chairs to free up beds
Patient Safety Learning posted a news article in News
An acute trust in the Midlands is planning to move patients to chairs on wards to free up beds for people waiting in its emergency department, following one of its “most challenged” days. In an email sent to staff at Nottingham University Hospitals on Tuesday, interim chief operating officer Rachel Eddie and chief medical officer Keith Girling wrote: “We are asking wards to transfer [patients confirmed as ready for discharge] to the discharge lounge, or if that isn’t possible, move them to a chair on the ward so that a patient waiting for a bed in ED or in an emergency pathway assessment area can be brought up.” “This is referred to as going ‘one over’,” the email added. “We will ensure that on each ward that has been designated as being able to go ‘one over’, a chair has been added to their Nervecentre ward layout so patients are all visible.” The email describes how Monday was one of the “most challenged Mondays we have seen” and confirmed the trust remains in ‘Opel 4’, the most severe level of operational pressure. It also said nursing staff have “shared concerns” about the amount of time they are able to spend with their patients. “This does mean that at times you will be asked to work at a higher patient to nurse ratio than we would like,” the email said. “We know this isn’t where any of us want to be, but it is unfortunately the reality of balancing risk.” Read full story (paywalled) Source: HSJ, 1 December 2021 -
News Article
NHSE tells trusts to ‘immediately stop all ambulance handover delays’
Clive Flashman posted a news article in News
· Trusts told to identify actions to “immediately stop all delays” · Letter calls for issue to be discussed at every board meeting · It follows concern over harm to patients from delays Trusts and integrated care systems are being told by NHS England and Improvement to take urgent action to ”immediately stop all delays” to ambulance handovers, which will require “difficult choices”. A letter yesterday from NHS England’s medical director, director for emergency and elective care, and its regional directors was sent to all local chief executives and chairs yesterday. It also says they should discuss the issue of ambulance handovers at every board meeting they hold, warns that “corridor care” is “unacceptable as a solution”, and says ambulances should not be used as “additional ED cubicles”. The move comes amid signs of large numbers of very long handover delays, and concern about the risk to patients from this and the knock-on damage to ambulance response times. Read the full article here (paywalled) Original source: Health Service Journal -
News Article
UK faces medicine shortages
Clive Flashman posted a news article in News
Many feared that the UK leaving the EU would cause shortages and limitations to the medicine supply throughout England, Scotland, Wales and Northern Ireland. Now ten months on from Brexit are we finally seeing the short fallings? Ninety percent of the UK's medicines are imported from abroad meaning disruptions caused by the outcomes of Brexit and a lack of HGV drivers has caused a significant problem in transporting drugs into the country. Leaked Department of Health and Social Care documents revealed two hundred and nine medicines had supply “issues” in 2019, more than half of these remained in short supply for over three months. Drugs such as hepatitis vaccines and anti-epileptic drugs, faced “extended” problems. A document published by the NHS Nottinghamshire Shared Medicines Management Team compiled a list of shortages and disruptions to supply due to COVID. The following 5 products had long-term manufacturing issues: AstraZeneca’s Zyban (bupropion, anti-smoking drug) Par’s Questran (colestyramine, a bile acid sequestrant) Diamorphine (a painkiller, used for cancer patients) Metoprolol (used for high blood pressure) Co-Careldopa (given to people with Parkinson’s disease) A further thirty medicines had short-term manufacturing issues, including end of life medicines such as morphine and anti-vomiting drug, levomepromazine. NHS Scotland and NHS Wales have published lists of drugs in low supply which are available to view on their NHS websites. NHS England consider this to be ‘sensitive information’ and have not published any shortfalls. An amendment to The Human Medicines Regulations 2019 legislation has added a ‘Serious Shortage Protocol’ (SSP). This allows for pharmacists and contractors to supply patients with a ‘reasonable and appropriate substitute’ if their prescription has an active SSP. Currently, shortages on Fluxoetine, (anti-depressive drug) and Estradot patches, (hormonal replacement therapy) have active SSP’s according to the NHS Business Service Authority. Original source: National Health Executive -
News ArticleA hospital in the South East today declared a level of critical care alert meaning that it may be forced into ‘refusal or withdrawal of critical care due to resource limitation’ because it has been ‘overwhelmed’ — but later claimed it was an ”administrative error”. Data from an internal NHS dashboard for critical care, seen by HSJ, showed today Darent Valley Hospital, near Dartford in Kent, declared it was at “CRITCON level four”. CRITCON level four declarations are extremely rare. In guidance they are known as “Triage - emergency” and defined as: “Resources overwhelmed. Possibility of triage by resource (non-clinical refusal or withdrawal of critical care due to resource limitation).” The definition continues: “This must only be implemented on national directive from [NHS England] and in accordance with national guidance.” Dartford and Gravesham Trust, which runs the hospital, replied to HSJ more than five hours after it was contacted, and after publication of the story, to say: “This was a purely administrative error which was quickly rectified.” The level has not however been changed so far on the live dashboard, HSJ has confirmed. Read full story (paywalled) Source: HSJ, 7 January 2021
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News ArticleConcerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies. On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms. The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out. It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver. Read full story Source: The Independent, 30 December 2020
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News ArticleA major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services. The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings. On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert. All of Essex is in tier four and the south of the county has some of the worst-affected districts in England. Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under". The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days". The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments". Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency. Read full story Source: BBC News, 30 December 2020
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News Article
Major trust diverts ambulances and cancels electives after covid surge
Patient Safety Learning posted a news article in News
One of England’s largest hospital trusts has been forced to divert ambulances and cancel operations, after seeing a very steep increase in covid-19 admissions over the past week. Whipps Cross Hospital in north east London, part of Barts Health Trust, declared a critical incident over the weekend, the trust has confirmed. The trust has also declared a “high pressure phase” of covid response. A well placed source said Whipps Cross had been forced to divert ambulances in recent days, because of pressure on its emergency services, while a message to staff said it was deferring some planned operations, along with other steps aimed at protecting safety. It is also understood to be attempting to further speed up discharges from hospital. Read full story (paywalled) Source: HSJ, 16 December 2020 -
News ArticleThe most comprehensive picture so far of how covid’s second wave has hit the NHS in the north of England is revealed in new figures obtained by HSJ. The latest data confirms that parts of the North West region now have more coronavirus patients in hospital beds than they did in the spring. It comes amid intense public debate about the best way to fight covid, and whether or not it is close to swamping the NHS. Collected from local NHS sources in a joint HSJ and Independent investigation, the information shows for example that: Lancashire and South Cumbria had 544 confirmed covid hospital patients yesterday (around 15-18% of the bed base), about 20 more than during the April peak. Liverpool University Hospitals – which remains the most severely affected trust – had 408 confirmed covid patients yesterday (20-25% of bed base), whereas it never topped 400 in the spring. The data is sent routinely by trusts to NHS England but most of it is not published – something some politicians are now calling for. As of yesterday, there were nearly 6,100 confirmed-covid patients across England, about 650 of whom were in critical care, and 560 receiving mechanical ventilation, according to information shared with HSJ. The number of “unoccupied” hospital beds is much lower now than in the spring, when they were cleared out in anticipation of a major hit. In the North West, up to 5,500 acute beds were reported as “unoccupied” in the spring, whereas the figure now is about 2,500 (around 14-18% of the bed base). However, critical care is the major pinch point in the most affected areas, with nearly half of the mechanical ventilation beds open at Liverpool’s hospitals (29 of 62) occupied by confirmed covid patients; and a third of those across the North West (178 of 556). However, hospitals in the area have opened very few extra critical care “surge” beds so far. The total numbers of mechanical ventilation (a subset of critical care) beds open in LUH and the rest of the region has not increased much in recent weeks, and falls well short of what they have declared they could open as potential surge capacity, if they cancelled large amounts of non-urgent care and reorganised staffing and wards. Read full story Source: HSJ, 23 October 2020
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News ArticleA lack of coronavirus tests for NHS staff is leading to staff absences and services being put at risk, hospital bosses have warned. NHS Providers, which represents hospital trusts in England, said staff are having to self-isolate rather than work because they cannot get tests for themselves or family members. It comes after widespread reports of people struggling to get tested. The home secretary defended the system, saying capacity was increasing. The government's testing system - part of its test, track and trace operation which Prime Minister Boris Johnson promised would be "world-beating" - has faced criticism in recent weeks. An increase in demand for coronavirus tests has led to local shortages - with some people being directed to test sites hundreds of miles from their homes. One doctor working in a coronavirus hotspot said she applied for a test for herself and her partner after they developed coughs and fevers. After refreshing the website for five hours, she managed to get an appointment but on arrival was told no booking had been made. She had taken screenshots of a confirmation code but was not sent a QR code to scan. "I showed the screenshots but I was told that the appointments weren't happening," she said. "I have to say I burst into tears. I was meant to be seeing patients and I feel guilty." Dr Rachel Ward, a GP in Newbury, told BBC Breakfast she was seeing a lot of patients who were struggling to get tests, saying a lot of families were "at the end of their tether" as it was "very stressful when you are faced with two weeks off work". She said if the staff at her practice were unable to get tests and had to self-isolate it would have a "huge impact" on patients as some of their healthcare workers are booked in to administer 100 flu jabs in a day. Read full story Source: BBC News, 14 September 2020
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News Article
‘Nightmare’ fuel shortages hit care of vulnerable patients
Patient Safety Learning posted a news article in News
Community and mental health service providers have warned the ongoing fuel crisis and other traffic disruption is starting to impact the care of vulnerable patients. Warnings about a HGV drivers shortage have prompted the panic-buying of fuel, with many petrol stations running out or heavily congested. Julia Winkless, a senior social worker and approved mental health professional in Suffolk, told HSJ clinical visits had to be cancelled as people were unable to get to work. Ms Winkless said: “We work over a very rural area, none of these petrol stations where [staff] live have got any fuel and we don’t know when there is going to be deliveries. Today, there were four mental capacity assessments cancelled.” There is also disruption to patient transport. A senior source at a West Midlands patient transport provider which often conveys people to mental health services told HSJ: “It’s been a bit of a nightmare in all honesty. We turned down a request this morning for a patient going to London because of the fuel and because of the [climate protesters disrupting motorways]… ultimately those patients are either at home and distressed carrying a big risk in the community or [accident and emergency] departments which [are not] the right settings.” Read full story (paywalled) Source: HSJ, 28 September 2021 -
News Article
GP staff facing abuse from patients over cancelled blood tests
Patient Safety Learning posted a news article in News
GP surgery staff are facing abuse from patients who are “angry and upset” that their blood test has been cancelled because of the NHS-wide chronic shortage of sample bottles. “Patients are angry when we ring them up and say, ‘Sorry we can’t do your blood test after all’. A lot of people are quite angry and concerned about their own health,” Dr David Wrigley, the deputy chair of council at the British Medical Association, said. “Patients are quite rightly upset and some get quite aggressive as well. They are worried because they don’t know what the implications of their cancelled test are for their health.” GP practices in England had begun cancelling appointments because the NHS’s main supplier could not deliver stocks as planned for one to two weeks because of “unforeseen road freight challenges”. NHS England has responded to the shortage of blood sample bottles by telling GPs to cancel all but clinically urgent blood tests and hospitals to cut back the tests they do by at least 25%. Read full story Source: The Guardian, 6 September 2021 -
News ArticleBecton Dickinson (BD), which manufactures most of the blood tubes used by the NHS, has alerted NHS England and NHS Improvement (NHSE/I) to a global shortage of some of its products, including two types of blood tubes: those with a yellow or purple top. BD says that the COVID-19 pandemic created the most unpredictable demand it has seen in the past 70 years. The company says that it has also been difficult for customers to predict the types and quantities of blood tubes they will be using from month to month, which affects manufacturers’ abilities to meet demand. “Adding to the issue are global transportation delays that have resulted in more products being tied up in transportation than is normal, creating additional delays in deliveries,” BD said in a statement. “Raw material suppliers are also challenged to keep up with demand for materials and components.” In the UK, BD has been authorised to import blood tubes that are approved for use in other regions of the world, including the United States. It plans to deliver nine million of these additional blood tubes to the NHS for immediate distribution. Read full story (paywalled) Source: BMJ, 3 September 2021
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News Article
‘Borderline critical’ stock leads to new blood test restrictions
Patient-Safety-Learning posted a news article in News
Local NHS organisations are increasing their efforts to conserve ubiquitous blood collection products amid concerns current measures are not working and stocks may run even lower. There is also a concern in east London that the message to reduce routine tests is not being heeded, with GPs not cutting back enough. However, this week the British Medical Association raised concerns over suspending routine tests, including “NHS Health Checks, monitoring of quality of care, and medication reviews”. The union said: “It would also be unreasonable to ask healthcare staff to simply delay these tests until a later date — not only for the sake of our patients, but also the entire system, which is already tackling an enormous backlog of care.” Read full story. Source: HSJ, 25 August 2021 -
News Article
NHSE steps up action on blood test tube shortage
Patient-Safety-Learning posted a news article in News
According to NHSE guidance today, non-essential blood tests should be stopped and GPs should prioritise genomic tests over others. Vitamin D testing should also be stopped in all, but "exceptional circumstances" amid shortages in the blood collection tube stocks. The guidance, issued by the NHSE has advised genomics for testing of unwell neonates, prenatal screening and cancer diagnoses are “a high priority". NHSE have also said changes to testing “should be made in consultation with individual patients” and that “it is important to make clear that routine tests will be deferred only where it is clinically safe to do so”. Read full story (paywalled). Source: HSJ, 10 August 2021 -
News Article
Blood tests rationed amid equipment shortage
Patient-Safety-Learning posted a news article in News
A national shortage in blood collection tubes has meant trusts are having to limit blood tests, with some trusts advising doctors to only order blood tests if they deem it absolutely necessary or using the same tubes for different tests rather than using a different tube of blood for each test. It has also been reported that the global disruption to the supply chain may mean shortages could continue before the supply lines recover. The NHS Supply Chain, has said there was “some improvement in the supply position in September” but that controls on the products "are likely to continue to be applied beyond this until supply stabilises”. Read full story (paywalled). Source: HSJ, 9 August 2021 -
Content ArticleSince 2010/11, the NHS has lost almost 25,000 beds across the UK. The evolving nature of healthcare provision means that the role of hospital admission has changed, but hospital beds still represent an essential part of healthcare, and the number available to the NHS should be carefully considered. A broad consensus has developed in recent years that the reduction in beds has happened too quickly. The outcome is that the NHS is now under-bedded. This has important consequences; patients must now endure long waits to be admitted with emergency department staff providing care normally provided in wards even as they continue to care for new arrivals; ambulance handover delays increase and there are delays to calls for an ambulance; planned operations are cancelled. Reducing long stays in emergency departments requires adequate staffing, space, efficient processes, and sufficient inpatient bed capacity. This report from the Royal College of Emergency Medicine (RCEM) focuses on inpatient bed capacity. While the unit of measurement is a bed, it must be remembered that a bed requires medical, nursing and other staff to safely function.
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Content ArticleThis interview is part of the hub's 'Frontline insights during the pandemic' series where Martin Hogan interviews healthcare professionals from various specialties to capture their experience and insights during the coronavirus pandemic. Here Martin interviews an advanced specialist paramedic working in central London with four years' experience of working on the frontline.
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Content ArticleSingle-use N95 respirators are critical to protect staff and patients from airborne infections, but shortages may occur during disease outbreaks and other crisis situations. Wearing an N95 respirator for hours at a time (i.e. extended wear) or reusing a respirator several times (i.e., donning and doffing between uses) are practices used to ease shortages. The potential risks and benefits of these practices may vary greatly across locations and may evolve rapidly during a crisis. This report’s conclusions are not intended as a practice endorsement or call to action. Rather, this report is intended to provide practical guidance on the potential risks and benefits that clinical centers should consider during decision making about N95 respirator reuse or extended use. ECRI is a US-based organisation.
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Content ArticleAhead of the Health and Social Care Select Committee’s next oral evidence session, Patient Safety Learning have raised several urgent safety issues with the Chair, Jeremy Hunt MP. Below is a blog summarising our submission to the Committee.
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Content ArticleIn this letter, published by the International Society for Quality Health Care, Dr Francesco Venneri shares his experience of the response to COVID-19 in Italy from the perspective of his involvement as both a clinical risk manager and as an emergency front line worker.
