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Showing results for tags 'Obstetrics and gynaecology/ Maternity'.
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Content ArticleWe’ve come to the final instalment of our 2020 blog series, where we’ve reflected on key patient safety issues we’ve seen this year and our work in those areas. First, our Chief Executive, Helen Hughes, introduced the series, giving an overview of the year. We then looked at: The impact of the COVID19 pandemic on patient safety Advice and support for people living with Long COVID Painful hysteroscopies Staff safety. Lastly, we turn our attention to one of the most significant reports we’ve responded to this year, First Do No Harm – also known as the Cumberlege Review – by the Independent Medicines and Medical Devices Safety Review.
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News Article
Royal Derby Hospital: Gynaecologist investigation affects 382 women
Patient Safety Learning posted a news article in News
The number of women involved in an investigation into a consultant gynaecologist who "unnecessarily harmed" patients has risen to 382. University Hospitals of Derby and Burton NHS Foundation Trust has written to another 110 women who were treated by Daniel Hay. Mr Hay is under investigation after eight women treated by him were found to have been "unnecessarily harmed". The latest women have been told there are "no concerns" for their health. Staff at the Royal Derby Hospital raised concerns about the consultant's care in late 2018. An initial review of 58 cases involving Mr Hay identified the eight lapses of care for which he and the trust have apologised. A broader investigation was launched and another 135 women, who had undergone surgery, were contacted to say their care was being reviewed. In September the trust wrote to a further 79 women who had received intermediate care. It has now said 110 more women, all outpatients at Ripley Hospital between April 2017 and July 2018, have now been contacted. Dr Magnus Harrison, executive medical director, said: "We have widened the review to a specific outpatient clinic... to understand the care being provided there. We are doing this proactively, rather than in response to any specific concerns, so that the review is as thorough as possible." "Each of the women have been informed that there are no concerns regarding their current health." Read full story Source: BBC News, 11 December 2020 -
Content ArticleThis month, we’ve been looking back over 2020 and highlighting some of the key areas of health and care that Patient Safety Learning has worked in this year. First, Chief Executive, Helen Hughes, gave an overview, detailing some of the main ways we’ve been achieving our aims as an organisation. Following that, we looked at the impact of the COVID-19 pandemic on patient safety, and, earlier this week, we focused on advice and support for people living with Long COVID. In this blog, Patient Safety Learning reflect on the work we’ve been doing to highlight serious patient safety concerns relating to hysteroscopy procedures in the NHS and how we’ve been making the case for change.
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Content Article
The normalisation of women’s pain
LiSaRa posted an article in Women's health
In this wonderfully personal reflection, Junior Doctor and Clinical Fellow, Lisa Rampersad, argues that women are taught to apologise for their pain from an early age. Lisa draws on her own experiences, including those as a patient herself, to highlight a need for a better understanding of the female anatomy. She concludes by sharing her own approach as a clinician, encouraging others to listen and believe their patients when they talk about pain.- Posted
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Content ArticleThis webinar from the British Intrapartum Care Society, asks whether the medicalisation of childbirth gone too far. UK maternity services have become medicalised in an attempt to reduce pregnancy risks. But what are the risks that we use to justify these interventions and how well do we communicate these to women? How do we provide care for those who request alternative or non-recommended pathways of care? Speakers include Andrew Weeks, Jim Thornton, Maria Booker and Kemi Johnson and the webinar is Chaired by Natalie Carter from the British Intrapartum Care Society.
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Content Article
COVID-19: managing an obstetric emergency (November 2020)
PatientSafetyLearning Team posted an article in Maternity
The COVID-19 pandemic provides new challenges for the safety of people receiving and providing maternity care. This project, conducted in collaboration with the PROMPT Maternity Foundation and THIS.institute, involved a rapid-response consultation exercise to understand what good looks like for managing obstetric emergencies in women with suspected or confirmed COVID-19. -
Content Article
Continuity of Carer in Worcestershire
PatientSafetyLearning Team posted an article in Midwifery Continuity of Carer
More and more women in Worcestershire are benefiting from having an individual named midwife throughout their maternity journey. In this short video, new Continuity of Carer (CoC) midwives from Worcestershire Acute Hospitals NHS Trust, and some local mums explain what it's like to be part of a CoC model. -
Content ArticleThe Patient Safety Authority has put together information and tips for patients on a range of topics.
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Content ArticleThis is a guest post for the Hysterical Women website, by Kath Sansom, founder of the Sling the Mesh campaign. Content warning: mention of self-harm.
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Content Article
Continuity of Carer (CoC) is a way of working within maternity services. It aims to provide a consistency in the care given to people before, during and after birth, limiting the number of clinicians involved in their journey. Evidence shows this approach improves safety, leads to better outcomes and is preferred by patients. In this blog, Samantha Phillis, Community Midwife, uses powerful examples to illustrate how the CoC model has helped her look after her patients.- Posted
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Content ArticleIn this short video produced by Endometriosis Explained, retired gynaecologist, MJ Quinn, talks about the neuropathic causes of painful hysteroscopy. This includes seven recommendations for how to avoid severe pain outpatient hysteroscopy.
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Content ArticleAs with all aspects of the NHS, a number of changes have been enacted in the operation of maternity services as a result of the COVID-19 pandemic. While many of these changes are important and justifiable in order to protect the safety of pregnant people, maternity staff and newborns, it is vital that any (incidental) adverse implications to these policies be addressed. This blog, published by the BMJ, examines one such change; the policy which has been implemented by many NHS Trusts which provides that pregnant persons will only be admitted to the labour ward once labour has been “confirmed as established”.
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News Article
Essure: Women in England take legal action against sterilising-device maker
Patient Safety Learning posted a news article in News
Lawyers have begun legal action on behalf of 200 UK women against the makers of a sterilisation device, after claims of illness and pain. The device, a small coil called Essure, was implanted to prevent pregnancies. Manufacturer Bayer has already set aside more than $1.6bn (£1.2bn) to settle claims from almost 40,000 women in the US. It has withdrawn the device from the market for commercial reasons but says it stands by its safety and efficacy. The metal coil was inserted into the fallopian tube to cause scarring, blocking the tube and preventing pregnancy. Introduced in 2002, it was promoted as an easy, non-surgical procedure - a new era in sterilisation. But many women who had the device fitted have now either had hysterectomies or are waiting for procedures to remove the device. Tracey Pitcher, who lives in Hampshire, felt she had completed her family and did not want any more children. Her doctor strongly encouraged her to have an Essure device fitted, she says. But after it had been, she began to feel very unwell. "I just started to have heavy periods, migraines, which I had only ever had when I was pregnant so they were hormonal," she says. "My back was so painful I'd wake up crying in the middle of the night with pains in my hips and my back." Tracey says she battled to persuade doctors to take her symptoms seriously. But the only information she received was from a Facebook group. "... there's nobody there, there's no support apart from people that we've found ourselves, no-one will listen, because it's just 'women's things'." Read full story Source: BBC News, 15 November 2020 -
News Article
Trusts offering controversial trauma ‘treatment’ to new mums
Patient Safety Learning posted a news article in News
Several NHS trusts are offering a ‘treatment’ for birth trauma which uses a technique which lies outside national guidelines and which is criticised by specialists as potentially causing ‘more harm than good’. The ‘Rewind’ technique is promoted as a fast treatment for post-natal post-traumatic stress disorder (PTSD) – also known as birth trauma - which involves the “reprocessing” of painful memories. HSJ has learned of several trusts, including East and North Herts Trust, Chelsea and Westminster Hospital Foundation Trust and James Paget University Hospital FT, where the therapy is being offered. It is thought there are other trusts which are providing it or have explored it. Typically, it is provided by midwives who have undergone training in the technique. But Nick Grey, a clinical psychologist who was on the National Institute for Health and Care Excellence panel which looked at PTSD, said it was “absolutely clear cut” that it was bad practice to offer the technique as a branded therapy for PTSD, although he said it could be embedded as part of other treatments. He told HSJ: “It should not be offered to mothers with PTSD… they are being done a disservice if they are not given evidence-based treatment. There is no evidence that this [provides] treatment for sub-clinical PTSD or trauma,” he said. Read full story (paywalled) Source: HSJ, 11 November 2020 -
Content ArticleHysteroscopy is a diagnostic gynaecological procedure traditionally requiring administration of general anaesthesia, but more frequently completed using local anaesthesia within a day-case (ambulatory) setting. Advantages associated with this transition include decreased completion times, fewer risks, and lower clinical costs. Numerous services advertise the procedure as being either pain free or low pain; however, it is estimated that 25% of patients report experiencing intense or intolerable pain. For severe pain, local anaesthetic can be administered, but this does not guarantee effective pain management. This research, published in the British Journal of Anaesthesia, found that very few patients feel no pain and a significant number felt pain of greater than 7/10. It also found a disconnect between the patient's experience of pain and the clinician's perception of it. This research paper is paywalled, but can be purchased via the link below.
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Content ArticleObstetric quality of care measures have largely focused on severe maternal morbidity (SMM), with little consensus about measures of less severe but more prevalent delivery and neonatal complications. This study, published in The Joint Commission Journal of Quality and Safety, analyses risk-adjusted maternal and neonatal outcomes using both ICD-10 coding and electronic health record (EHR) data.
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Content ArticleIn this blog, Stephanie O'Donohue, Content and Engagement Manger for Patient Safety Learning, discusses some of the patient safety issues that specifically impact on women. Drawing on recent inquiries, patient testimonials and research, Stephanie focuses on three main issues; consent, patient engagement and bias. She highlights the need for people to work in partnership to understand the barriers to safe care for women and to prevent future harm.
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Content ArticleHysteroscopy is a procedure used as a diagnostic tool, to identify the cause of common problems such as abnormal bleeding, unexplained pain or unusually heavy periods in women. It involves a long, thin tube being passed into the womb, often with little or no anaesthesia. In recent years, there has been an increased focus on these procedures being performed within outpatient services. The availability of pain relief is much reduced in these settings. There are financial incentives in place to support this move to day surgery.[1] Reflecting on activity to date, Patient Safety Learning discusses the important role that consent, patient engagement and collaborative action is playing in highlighting a serious patient safety concern and in driving the change needed for safe hysteroscopy.
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Content ArticleThe Campaign Against Painful Hysteroscopy is a campaign group raising awareness of the safety flaws that exist within the processes surrounding hysteroscopy procedures for women. On 20 October 2020, they wrote to Matt Hancock MP, Secretary of State for Health and Social Care and Nadine Dorries MP, Minister for Patient Safety, Suicide Prevention and Mental Health. In their letter they used both empirical data and the personal stories of women to illustrate the prevalence and seriousness of the issue.
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Content ArticleDr Richard Harrison is a pain researcher employed at the University of Reading and affiliated with the School of Psychology and Clinical Language Sciences (SPCLS) and Centre for Integrative Neuroscience and Neurodynamics (CINN). His research focuses predominately on pain, examining psychological processes underlying how pain is processed, as well as individual differences in the ability to modulate (or control) the experience of pain. In this blog, Richard reflects on his recent research on pain experience and assessment during hysteroscopy procedures, published recently in the British Journal of Anaesthesia. "The dangers of advertising hysteroscopy as a mildly painful procedure are many. Firstly, this stands to put women off engaging with a very useful diagnostic test for the identification of serious medical conditions, such as ovarian cancer or endometriosis. But secondly, it is highly plausible that the resulting prediction error stands to make the experience even more painful than if patients were appropriately warned."
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Content ArticleThis review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care. Further research is needed to explore findings of fewer preterm births and fewer foetal deaths less than 24 weeks, and all foetal loss/neonatal death associated with midwife-led continuity models of care.
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Content ArticleOur 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.
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Content ArticleEndometriosis 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.
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Content ArticleDiagnostic 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.
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Content ArticleLearning about healthcare safety often focuses on understanding what has gone wrong, but it is just as important to examine what good looks for safety in maternity units. In this blog, Elisa Liberati describes how she worked with a team and several collaborators to develop a framework describing 7 key features of safety in maternity units. To ensure the study was as rigorous as possible, they combined several different methods and worked in a highly collaborative way across the system. Follow the link below to read the full blog, published by THIS.Institute.
