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Content ArticlePaediatric drug optimization (PADO) exercises aim to identify key priority products and their preferred product characteristics for research and development. These have been successfully undertaken for HIV, hepatitis C, tuberculosis and antibiotics, demonstrating their potential and impact to accelerate access to optimal formulations in the context of fragmented, small markets for medicines for children. WHO convened and facilitated a paediatric exercise for neglected tropical diseases to ensure that more targeted research and development efforts can address the specific needs of infants and children. These are schistosomiasis, human African trypanosomiasis (HAT), scabies, onchocerciasis and visceral leishmaniasis (VL).
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News ArticleTwo young people facing mental health crises were left on paediatric wards for months while different agencies across a health system struggled to find appropriate placements. The patients – who were both autistic and had learning disabilities, with special educational needs – were admitted to Maidstone and Tunbridge Wells Trust (MTW) last year after attending emergency departments more than 10 times within a two-month period. They were left on a paediatric ward – one of the patients for four months – as this was the “only available place of safety as opposed to the optimum setting to meet their needs,” according to Kent and Medway Integrated Care Board’s “learning review” of children and young people with complex needs, which the two cases prompted. The review, which HSJ obtained under a Freedom of Information request, revealed several problems with joint working, despite a multidisciplinary team meeting regularly to discuss the young patients’ needs. Since the review, a new escalation process has been introduced, urgent mental health risk assessments in the community have been enhanced and a three-month pilot of a self-harm service has been implemented at Tunbridge Wells Hospital, part of MTW. Read full story (paywalled) Source: HSJ, 17 November 2023
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News Article
Record number of child deaths last year with hundreds more dying since pandemic
Patient Safety Learning posted a news article in News
The number of child deaths has hit record levels, with hundreds more children dying since the pandemic, shocking new figures show. More than 3,700 children died in England between April 2022 and March 2023, including those who died as a result of abuse and neglect, suicide, perinatal and neonatal events and surgery, new data from the National Child Mortality Database has revealed – with more than a third of the deaths considered avoidable. Children in poorer areas were twice as likely to die as those in the richest, while 15 per cent of those who died were known to social services. The UK’s top children’s doctor, Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, hit out at the government for failing to act to tackle child poverty, which she said was driving the “unforgivable” and “avoidable” deaths. The report said: “Whilst the death rate in the least deprived neighbourhoods decreased slightly from the previous year, the death rate for the most deprived areas continued to rise, demonstrating widening inequalities.” Read full story Source: The Independent, 11 November 2023- Posted
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Content ArticleThe National Child Mortality Database (NCMD) was launched on 1 April 2019 and collates data collected by Child Death Overview Panels (CDOPs) in England from reviews of all children who die at any time after birth and before their 18th birthday. There is a statutory requirement for CDOPs to collect this data and to provide it to NCMD, as outlined in the Child Death Review statutory and operational guidance. The guidance requires all Child Death Review (CDR) Partners to gather information from every agency that has had contact with the child, during their life and after their death, including health and social care services, law enforcement, and education services. This is done using a set of statutory CDR forms and the information is then submitted to NCMD. The data in this report summarise the number of child deaths up to 31 March 2023 and the number of reviews of children whose death was reviewed by a CDOP before 31 March 2023.
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- Children and Young People
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EventuntilOn the NHS75 anniversary, NHSE announced that paediatrics will be the next priority pathway for the rollout of virtual wards. With over 350,000 children in the queue for treatment, capacity pressures continue to mount for paediatric teams. The stage is set for paediatric virtual wards to address these pressures head-on, and emerging evidence is promising. Pilot sites have demonstrated paediatric virtual wards can: Reduce a child’s length of stay in hospital by an average of 3 days Decrease hospital readmission by 38% for children with chronic conditions. So what is needed to build paediatric virtual wards that work for both children and their caregivers? This webinar will dive into the nuanced approach required when caring for children at home, bringing in insights and learnings from leading UK paediatric clinicians and experts working in the field. In this webinar you will learn: The need for a fresh approach: the huge potential for paediatric virtual wards to reduce pressure in paediatric departments and why these pathways require teams to think differently Lessons from the front-line: the key take-aways from one of the first NHS sites to trial paediatric virtual wards How to build a successful paediatric virtual ward: what is needed to set up a paediatric virtual ward pathway and team for success Speakers: Zoe Tribble, Children's Nurse Jim McDonald, Black Country ICB Juliana Faleti, Paediatric Nurse Register for the webinar
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Content ArticleThe transition from hospital to home is a vulnerable time as patients may have changes in medications or care needs, or difficulties accessing follow up with an outpatient provider. Authors conducted a prospective intervention study of children with medical complexity discharged at a children’s hospital from April 2018 to March 2020. To reduce adverse events (AE), rehospitalizations, and emergency department visits, this hospital developed a structured discharge bundle based on the I-PASS tool used for inpatient handoffs. AE, rehospitalisations, and emergency department visits were all reduced following implementation of the I-PASS bundle.
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Content ArticleThese charts have been collaboratively developed by clinical teams across England to standardise how the deterioration of children in hospital is tracked. There are four charts for children of different ages, designed to be used on general children’s wards. PEWS observation and escalation chart: 0 to 11 months PEWS observation and escalation chart: 1-4 years PEWS observation and escalation chart: 5-12 years PEWS observation and escalation chart: ≥13 years
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News Article
Sick children’s health worsening as record numbers wait for NHS care in England
Patient Safety Learning posted a news article in News
Sick children’s health problems are getting worse as record numbers wait up to 18 months for NHS care, doctors treating them have warned. The number of under-18s on the waiting list for paediatric care in England has soared to 423,500, the highest on record. Of those, 23,396 have been forced to wait over a year for their appointment. Delays facing children and young people are now so common that Dr Jeanette Dickson, the chair of the Academy of Medical Royal Colleges, the body representing all UK doctors professionally, warned that children are “the forgotten casualties of the NHS’s waiting list crisis”. “As a paediatrician, I’ve seen first hand the damaging impact that long waiting times have on children, on their education and overall wellbeing, and of course on their families,” said Dr Camilla Kingdon, the president of the Royal College of Paediatrics and Child Health (RCPCH). The figures came from the RCPCH’s analysis of official performance data recently published by NHS England. The health of some children was deteriorating while they languished on the waiting list because their illness and age meant they needed to have their treatment fast, Kingdon added. “Many treatments and interventions must be administered within specific age or developmental stages. No one wants to wait for treatment, but children’s care is frequently time-critical.” Read full story Source: The Guardian, 17 September 2023- Posted
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- Children and Young People
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News Article
Trusts admit ‘severe’ harm to children
Patient Safety Learning posted a news article in News
Children have suffered severe harm at two further hospital trusts as a result of failures in paediatric audiology, HSJ has revealed. HSJ reported in July that three children at Croydon Health Service Trust may have come to “severe harm” – meaning they may have suffered permanent damage – following failures in the trust’s processes in audiology. Now East and North Hertfordshire Trust and North West Anglia Foundation Trust have also confirmed a small number of cases of severe or serious harm; while some trusts have yet to confirm findings from case reviews they have carried out. Major problems emerged earlier this year, initially in Scotland, of poor quality checks missing children with hearing problems who should have received support, and of a failure to inspect the services. NHS England ordered a review of data from the national newborn screening programme which, alongside other review work, identified six English trusts as having likely failures in their service: Croydon, East and North Herts, North West Anglia, Warrington and Halton Hospitals, North Lincolnshire and Goole, and Worcestershire Acute Hospitals. Read full story (paywalled) Source: HSJ, 14 September 2023- Posted
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- Patient harmed
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Content ArticleA new issue brief from the Agency for Healthcare Research and Quality (AHRQ) examines the unique challenges of studying and improving diagnostic safety for children in respect to their overall health, access to care and unique aspects of diagnostic testing limitations for multiple paediatric conditions. The issue brief features approaches to address these challenges cross the care-delivery spectrum, including in primary care offices, emergency departments, inpatient wards and intensive care units. It also provides recommendations for building capacity to advance paediatric diagnostic safety.
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News Article
Trust apologises to dozens of families after harm to children
Patient_Safety_Learning posted a news article in News
A hospital trust has apologised to families after dozens of children suffered hearing loss following failures in their care. Croydon Health Services Trust had already revealed three children “may have been at risk of serious hearing loss or a delay to their speech development”, but it has now confirmed to HSJ that a further 49 “incurred mild to moderate hearing loss or impairment”. The south London trust would not disclose the results of its internal review that begun after it declared a serious incident in March 2021, saying it was “ongoing”, but said it had acted on all the “immediate recommendations”. The incident was declared after more than 1,400 children were found not to have been followed up by the trust. There was also an external review carried out by an audiologist from Guy’s and St Thomas’ Foundation Trust. It is unclear which review uncovered the incidents of harm. Read full story Source: HSJ 1 August 2023 -
Content ArticleTests that indicate the health of newborns, moments after birth, are limited and not fit-for-purpose for Black, Asian and ethnic minority babies, and need immediate revision according to the NHS Race and Health Observatory.
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- Baby
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News Article
Tens of thousands of children to be treated in ‘virtual wards’ at home
Patient Safety Learning posted a news article in News
Tens of thousands of children will be treated in “virtual wards” to free hospital beds for more critically ill patients under new NHS plans. The Hospital at Home service will be expanded to include paediatric care in every region of England this month, the health service announced. As part of the service, clinical teams review patients daily and can provide treatments including blood tests, prescribe medicines or administer fluids through a drip. Ward rounds can include home visits or a video call, and many services use technology such as apps and wearable devices to monitor recovery. Professor Simon Kenny, the NHS’s national clinical director for children and young people, said: “The introduction of paediatric virtual wards means children can receive clinical care from home, surrounded by family and an environment they and their parents would rather they be — with nurses and doctors just a call away.” Read full story (paywalled) Source: The Times. 5 July 2023- Posted
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News Article
U.S. News & World Report's best children's hospitals 2023-24 honor roll
Patient Safety Learning posted a news article in News
U.S. News & World Report's Best Children's Hospital list for 2023-2024, released 21 June, said 11 children's hospitals are at the top of their game when it comes to 10 pediatric specialties. This year, 11 children's hospitals are included on this list due to a tie in the diabetes and endocrinology category. U.S. News gathered subjective data from more than 15,000 pediatric specialists and clinical data from close to 200 children's hospitals to develop its Best Children's Hospitals 2023-2024 listings. For the first time, Cincinnati Children's Hospital Medical Center took the top spot on the list. The hospital has the only level 4 neonatal intensive care unit, which offers care to infants at all level 3 NICUs in the area. The hospital discovered a "super antibody" it believes will inform new vaccines and offered a specialized approach to reduce stays in the NICU for opioid-exposed newborns. Steve Davis, MD, president and CEO: "This distinction only confirms what we have always known — that we have outstanding, talented team members who are unmatched in their dedication to ensuring that all children have access to exceptional care." Read full story Source: Becker's Hospital Review, 23 June 2023- Posted
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News ArticleNHS trusts across England are scrambling to trace thousands of children for urgent hearing tests amid fears that cases of infant deafness may have been missed for years. An internal NHS report has exposed poor-quality testing within paediatric audiology departments at five hospitals and warned of systemic failings. At another NHS trust, almost 1,500 children were found to have missed out on appointments dating back to 2012. Vital quality inspections of departments checking infants for hearing loss were stopped ten years ago. Whistleblowers who previously worked for the NHS’s newborn hearing screening programme have revealed that concerns were raised shortly before they were told to stop carrying out checks. They say that thousands of children may have been mistreated for deafness and hearing loss in the past decade. Read full story (paywalled) Source: The Times, 25 June 2023
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Content ArticleIntrahospital transport is a common occurrence for many hospitalised patients. Critically ill children are an especially vulnerable population who experience preventable adverse events at least once a week, on average. Transporting these patients throughout the hospital introduces additional hazards and increases the risk of adverse events. The transport process can be decomposed into a series of steps, each incurring specific risk. These risks are numerous and few of these risks are specific to the transport process. There is a paucity of literature available on paediatric intrahospital transport and related adverse events. Elliot et al. recently reviewed the Wake Up Safe database, a paediatric anesthesia quality improvement initiative across member institutions to disseminate information on best practices, for paediatric perioperative adverse events associated with anaesthesia-directed transport. The authors present several examples of airway and respiratory events taken from the database and discuss the complexity of the transport process.
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News ArticleForty children were hospitalised for vaping last year, prompting NHS bosses to warn we risk “sleep-walking into a crisis”. Amanda Pritchard, NHS England boss, said it was "right" for paediatricians to call for action on vaping among young people, as the Royal College of Paediatrics and Child Health called for an outright ban on disposable vapes. She said the 40 children admitted to hospital in England in 2022 due to “vaping-related disorders” was up from 11 two years before. The RCPCH’s call for action comes as NHS data revealed one in five 15-year-olds said they used e-cigarettes in 2021, while charity Action on Smoking (ASH) reported the experimental use of e-cigarettes among 11 to 17-year-olds had risen by 50 per cent compared to last year. The college warned: “Youth vaping is fast becoming an epidemic among children, and I fear that if action is not taken, we will find ourselves sleep-walking into a crisis.” Read full story Source: The Independent, 16 June 2023
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Content ArticleThe Child Health Clinical Outcome Review Programme has produced this review of the barriers and facilitators in transitioning children and young people with complex chronic health conditions into adult health services. Based on data on children and young people with one of 12 complex conditions identified from a sample period between 1st October 2019 and 31st March 2021, the report concludes that there is no clear pathway for the transition from healthcare services for children and young people to adult healthcare services. The report finds that the process of transition and subsequent transfer is often fragmented, both within and across specialties, and that adult services often sit only with primary care. It argues that developmentally appropriate healthcare should be everyone’s responsibility, with adequate resources needed to allow this to happen. The Inbetweeners also calls for services to: involve young people and parent/carers in transition planning and transition to adult services improve communication and coordination between all specialties be organised to enable young people to transfer to adult services effectively, and provide strong leadership at Board and specialty level at all stages of transition and transfer. The report’s recommendations highlight areas that are suitable for regular local clinical audit and quality improvement initiatives by those providing care to this group of patients. It suggests that the results of such work should be presented at quality or governance meetings, and action plans to improve care should be shared with executive boards.
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- Transfer of care
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News ArticleThe mayor of London is independently reviewing NHS England plans to reconfigure children’s cancer services in the capital, which were triggered when the commissioner finally accepted the current arrangements are unsafe. In a letter to NHSE London director Caroline Clarke, Sadiq Khan’s health adviser said the mayor would apply his six tests for major reconfigurations to both the options proposed for the “principal treatment centre” for paediatric cancer in south London. NHSE London is currently running a process to decide the principal treatment centre's location. An earlier assessment put the bid from the Evelina Hospital, part of Guy’s and St Thomas’ Foundation Trust, ahead of the other bidder, St George’s University Hospitals FT. Read full story (paywalled) Source: HSJ, 5 June 2023
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News Article
Paediatric wards may not be safe for patients with 'high-risk' behaviours
Patient-Safety-Learning posted a news article in News
Children presenting with 'high-risk' behaviours are being cared for in NHS paediatric wards that may put them and others at risk of harm, according to a new report from the Healthcare Safety Investigation Branch (HSIB). HSIB's interim report warns that the placement of children and young people with complex mental health issues on NHS paediatric wards can impact on the wellbeing of these patients and their families, and pose a risk to other patients and staff. The report emphasises that paediatric wards are designed to care for patients who only have physical health needs and not for those who are exhibiting high-risk behaviours, which include attempts to die by suicide, self-harm, attempts to leave the hospital without permission, and episodes of violence and aggression. Examples of children and young people being restrained or sedated in front of other sick and vulnerable patients, families feeling concerned for their and their children's safety during incidents, rooms being stripped down to remove any risk of self-harm or death by suicide, and paediatric staff being physically assaulted are cited in the report. Saskia Fursland, HSIB national Investigator, said,"We know that NHS staff are trying to provide a safe environment for their patients, but they are facing difficult choices in wards that are not designed to support children and young people displaying high-risk behaviours. Our ongoing investigation will take a longer-term look at effective design, adaptations and risk management in the wards. A whole system response is now needed to ensure we can keep children and young people safe." Read full story Source: Medscape, 25 May 2023- Posted
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- Paediatrics
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News Article
Young mental health patients 'at risk' in child wards
Patient Safety Learning posted a news article in News
A safety investigation has warned that young people with complex mental health needs are being put at significant risk, by being placed on general children's wards in England. The findings come from the Healthcare Safety Investigation Branch (HSIB). BBC News recently highlighted the plight of a 16-year-old autistic girl, who spent several months in a children's ward. Other families have since contacted the BBC describing similar situations. The majority had faced similar difficulties getting appropriate support. HSIB says that paediatric wards are designed to care for patients who only have physical health needs and not for those with mental health needs. It describes the situation in 18 hospitals it visited as "challenging", and 13 were described as "not safe" for children who were suicidal or at risk of harming themselves to be on their paediatric wards. Read full story Source: BBC News, 25 May 2023- Posted
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Content ArticlePaediatric wards in acute hospitals are increasingly caring for children and young people (CYP) who have mental health needs. Paediatric wards are primarily designed to accommodate children with physical health needs and are not specifically designed to help keep children and young people with mental health needs safe. This national investigation looks at the risk factors associated with the design of paediatric wards in acute hospitals for children and young people with mental health needs.
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Content ArticleThis report by the National Paediatric Diabetes Audit (NPDA) is based on data from 33,251 children and young people receiving care from a paediatric diabetes unit (PDU) in 2021/22 in England and Wales. It found that the increase in incidence of Type 1 diabetes observed in the first year of the Covid-19 pandemic was followed by a continuing increase in the numbers of children newly diagnosed with the condition in 2021/22. Other key findings include: Almost all of those with Type 2 diabetes were overweight or obese, and almost half had a diastolic or systolic blood pressure in the hypertensive range. Despite reductions in the percentages recorded as requiring additional support between 2020/21 and 2021/22, over a third of children and young people were assessed as requiring additional psychological support outside of multidisciplinary meetings. Inequalities persist in terms of the use of diabetes related technologies in relation to ethnicity and deprivation.
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Content ArticleBased on data from January 2019 to December 2021, this report by the Paediatric Intensive Care Audit Network (PICANet) catalogues comprehensive information on referral, transport and admission events. This enables the monitoring of delivery and quality of care in relation to agreed standards, and the evaluation of clinical outcomes to inform national policy in paediatric critical care. It reports on five key metrics relevant to Paediatric Intensive Care services: case ascertainment including timeliness of data submission retrieval mobilisation times emergency readmissions within 48 hours of discharge unplanned extubation in PICU mortality in PICU
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- Paediatrics
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Content Article
ERIC: The children's bowel and bladder charity
Patient_Safety_Learning posted an article in Paediatrics
ERIC is the national charity dedicated to improving children’s bowel and bladder health. Their mission is to reduce the impact of continence problems on children and their families. The ERIC website includes: advice and resources for professionals advice and resources for parents and young people training and events information about bowel and bladder health for children with additional needs. To speak to an ERIC advisor you can call 0808 1699 949. The Helpline is open Monday - Thursday, 10am to 2pm and is free to call from landline and mobile numbers. To visit the ERIC website, click on the link below.