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Content ArticleThis document should be used to guide clinicians on the appropriate use of continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), here referring to bilevel positive airway pressure (BiPAP) and high flow nasal oxygen (HFNO, such as OptiflowTM) in patients with confirmed or suspected COVID-19. Published evidence, clinical guidelines and personal communications with colleagues in China and Italy have informed this document. The guidance is not designed to be prescriptive but to provide a useful aid to use alongside clinical judgement. It can be adjusted to suit individual clinical environments. Decisions relating to the escalation of ventilatory support (whether as a trial of treatment, as a ceiling of care, or as a possible bridge to ongoing invasive ventilation) need to be made early and by experienced clinical decision-makers.
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News Article
Coronavirus: Cancer patient's chemotherapy put on hold
Patient Safety Learning posted a news article in News
A woman with brain cancer has been told her chemotherapy has stopped because of the coronavirus outbreak. Nancy Carter-Bradley, 44, from Hampshire, said the health secretary should ring-fence cancer treatment. She said her treatment at a London hospital had paused as it was at full capacity and oncologists were helping with the response to coronavirus. Imperial College Healthcare NHS Trust said it was "exploring use of private healthcare facilities". Mrs Carter-Bradley, from Penwood, said she had been dealing with "unbelievable stress" since she was informed her chemotherapy at Charing Cross Hospital for stage three brain cancer would be paused. Read full story Source: BBC News, 26 March 2020 -
Community PostDo you usually access services, receive treatment or take medication for mental health difficulties? How is this being impacted by the coronavirus outbreak? We’re asking for patients, carers, family members and friends to share their stories, highlight weaknesses or safety issues that need to be addressed and share solutions that are working. We will be identifying themes and reporting to healthcare leaders with your insights. We want to help close the gaps that might emerge as everyone focuses on the pandemic. Please share your stories in the comments below. You’ll need to sign up (for free) to join the conversation. Register here - it's quick and easy.
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Content ArticleThe information contained in this evidence table is emerging and rapidly evolving because of ongoing research and is subject to the professional judgment and interpretation of the practitioner due to the uniqueness of each medical facility’s approach to the care of patients with COVID-19 and the needs of individual patients. It has been rpoduced by the US-based organisation, the American Society of Health-System Pharmacists (ASHP). ASHP provides this evidence table to help practitioners better understand current approaches related to treatment and care. ASHP has made reasonable efforts to ensure the accuracy and appropriateness of the information presented. However, any reader of this information is advised ASHP is not responsible for the continued currency of the information, for any errors or omissions, and/or for any consequences arising from the use of the information in the evidence table in any and all practice settings. Any reader of this document is cautioned that ASHP makes no representation, guarantee, or warranty, express or implied, as to the accuracy and appropriateness of the information contained in this evidence table and will bear no responsibility or liability for the results or consequences of its use. Public access to AHFS Drug Information® (https://www.ahfscdi.com/login) is available for the next 60 days with the username "ahfs@ashp.org" and password "covid19." ASHP's patient medication information is available at http://www.safemedication.com/.
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Content Article
Video: Intubation in the ICU – COVID-19
Claire Cox posted an article in Good practice and useful resources
This video demonstrates how to perform an intubation safely on a patient with coronavirus. -
News Article
Cancer treatment delayed as patient priority lists drawn up
Patient Safety Learning posted a news article in News
Delays have begun to cancer treatments, as patients are reprioritised ahead of capacity becoming overwhelmed by the coronavirus crisis. In three separate developments: A London trust announced it was cancelling chemotherapy and routine cancer operations for a fortnight due to coronavirus pressure; An NHS England covid-19 guidance document indicated palliative care cancer patients will be less likely to receive appropriate treatment; and Cancer waiting times guidance has been changed to provide for some urgent referrals for suspected cancer to be sent back to GPs without diagnosis. Read full story (paywalled) Source: HSJ, 23 March 2020 -
Content ArticleThis American Society for Reproductive Medicine (ASRM) guidance is in response to the coronavirus (COVID-19) global pandemic. Their goal is to provide practices with recommendations that guard the health and safety of their patients and staff, and recognise our social responsibility, as an organisation and as a community of providers and experts, to comply with national public health recommendations.
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News ArticleSouthampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk. The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part. Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days. The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic. Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and to help patients recover quickly as the pressure on health systems mounts." Read full story Source: University of Southampton, 18 March 2020
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Content ArticleNovel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 threatens healthcare resources throughout the world. This is particularly true for the patients who develop moderate to severe respiratory failure and require oxygen supplementation devices such as high-flow nasal cannula (HFNC). The HFNC uses humidification to allow the delivery of up to 100% oxygen at flow rates of up to 60 Lmin-1 ; however, there is a concern this may aerosolize respiratory tract pathogens. This report states that patient requiring HFNC are at least used in single occupancy rooms or negative pressure airborne isolation rooms. Healthcare workers caring for those using HFNC should be wearing full airborne personal protective equipment (i.e., N95 mask or equivalent, gown, gloves, goggles, hair covers, and face shield or hoods).
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News Article
Health experts criticise NHS advice to take ibuprofen for Covid-19
Patient Safety Learning posted a news article in News
Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition. The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.” NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen. “I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.” Read full story Source: The Guardian, 16 March 2020 -
Content Article
Seeking treatment for an eating disorder: GP leaflet
Patient Safety Learning posted an article in Eating disorders
This leaflet has guidance for the person who has or may have an eating disorder, anyone supporting them, and their GP. It’s based on the guideline on eating disorders from the National Institute for Health and Care Excellence (NICE), which the GP should use when making decisions about patients’ healthcare. -
News ArticleAlthough community-based treatment can improve outcomes for people with eating disorders, it must not be at the expense of vital inpatient services, says Lorna Collins in an article today in the Guardian supporting Eating Disorders Awareness Week. No single treatment or approach works for every patient experiencing an eating disorder and it is extremely hard to get help; there is too little money in the system to provide enough care. "Speaking to patients, carers and clinicians, I am struck by the sheer desperation of so many people saying the system has failed them. Too many find that nothing is done until they are at death’s door. Others say no one talks about binge-eating disorder, which is still too often seen as a weakness or a problem that dieting can fix, rather than a real eating disorder," says Lorna. Clinicians, too, paint a gloomy picture of the state of services. Oxford-based eating disorder consultant Agnes Ayton, who chairs the faculty of eating disorders at the Royal College of Psychiatrists, is frank about the problems. She believes NHS eating disorder services are on their knees and desperately need more money after years of austerity. However, there are some encouraging signs. In West Yorkshire and Harrogate, consultant psychiatrist William Rhys Jones, who works for the Connect community and inpatient eating disorders service, says he is seeing real change. Connect’s community outreach teams deliver home-based treatment for people with severe and enduring eating disorders. This is one of the NHSE new care models and Jones says results so far have been very positive. Clinical community services and early intervention result in a good prognosis, he says – and it is cost effective. While inpatient treatment costs about £434 a day, community treatment costs about £20 to £35 a day, with similar or even improved clinical outcomes. While there are concerns about limiting inpatient treatment and prioritising community treatment simply because it may be cheaper, positive examples like this can help hold the NHS to its promise to make treatment truly open to all who need it. Read full story Source: The Guardian, 2 March 2020
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News Article
Young people put at risk by delays for treatment
Patient Safety Learning posted a news article in News
More than 70 children and young people have been put at risk by long delays in treatment by mental health services in Kent and Medway, HSJ has learned. According to a response to a Freedom of Information request submitted by HSJ, 205 harm reviews have been carried out for patients waiting for treatment following a referral to the North East London Foundation Trust, which runs the child and adolescent mental health services in Kent and Medway. Of those, 76 patients, who had all waited longer than the 18 week target time for treatment, were found to be at risk of harm. One patient had to be seen immediately as they were judged to be at “severe” risk. Seven were found to be at “moderate” risk and 68 at “low” risk. The trust said “risk” meant a risk of harm to themselves or others. But it said none of the 76 patients had come to actual harm. Read full story (paywalled) Source: HSJ, 25 February 2020 -
Content ArticleThe National Organization for Rare Disorders (NORD)’s Rare Disease Database provides brief introductions for patients and caregivers to specific rare diseases.
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News Article
Fast response to terror attacks saves lives. UK medics should not be held back
Patient Safety Learning posted a news article in News
The Streatham terrorist attack has again highlighted one of the most difficult decisions the emergency services face – deciding when it is safe to treat wounded people. In the aftermath of the stabbings by Sudesh Amman, a passer-by who helped a man lying on the pavement bleeding claimed ambulance crews took 30 minutes to arrive. The London Ambulance Service (LAS) said the first medics arrived in four minutes, but waited at the assigned rendezvous point until the Metropolitan police confirmed it was safe to move in. Last summer, the inquest into the London Bridge attack heard it took three hours for paramedics to reach some of the wounded. Prompt treatment might have saved the life of French chef Sebastian Belanger, who received CPR from members of the public and police officers for half an hour. A LAS debriefing revealed paramedics’ frustration at not being deployed sooner. A group of UK and international experts in delivering medical care during terrorist attacks have highlighted alternative approaches in the BMJ. In Paris in 2015, the integration of doctors with specialist police teams enabled about 100 wounded people in the Bataclan concert hall to be triaged and evacuated 30 minutes before the terrorists were killed. The experts writing in the BMJ believe the UK approach would have delayed any medical care reaching these victims for three hours. These are perilously hard judgment calls. Policymakers and commanders on the scene have to balance the likelihood that long delays in intervening will lead to more victims dying from their injuries against the increased risk to the lives of medical staff who are potentially putting themselves in the line of fire by entering the so-called 'hot zone'. First responders themselves need to be at the forefront of this debate. As the people who have the experience, face the risks and want more than anyone to save as many lives as possible, their leadership and insights are vital. In the wake of the Streatham attack the government is looking at everything from sentencing policy to deradicalisation. Deciding how best to save the wounded needs equal priority in the response to terrorism. Read full story Source: The Guardian, 7 February 2020 -
Content ArticleThis document records the findings of an online survey sent to 7,106 members of the RCN’s Emergency Care Association network exploring their experiences of corridor care.
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Content ArticleThere are few validated tools to identify treatment‐related adverse events across cancer care settings. This study seeks to develop oncology‐specific 'triggers' to flag potential adverse events among cancer patients using claims data.
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Content ArticleThe location of care for many brain-injured patients has changed since 2012, following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, the Association of Anaesthetists have included an expanded section on paediatric transfers. This guideline has also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of the recommendations. These guidelines remain a mix of evidence-based and consensus-based statements.
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News Article
Cancer care backlog may cost 30,000 lives, Boris Johnson told
Patient Safety Learning posted a news article in News
Scores of MPs and former ministers have urged the prime minister to tackle a backlog in NHS cancer care that threatens to lead to thousands of early deaths over the next decade. More than 100 MPs have written to Boris Johnson after the coronavirus lockdown caused severe disruption to cancer diagnoses and treatments. They have called on him to deliver an emergency boost to treatment capacity. One senior oncologist has claimed that in a worst-case scenario the effects of the pandemic could result in 30,000 excess cancer deaths over the next decade. Read full story (paywalled) Source: The Times, 22 August 2020 -
Content ArticleEditor of the award-winning site Feministing.com, Maya Dusenbery brings together scientific and sociological research, interviews with experts within and outside the medical establishment, and personal stories from women across the country to provide the first comprehensive, accessible look at how sexism in medicine harms women today.
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Content ArticlePatient safety has been increasingly recognised as an issue of global importance. To overcome this issue,Ministry of Health and Family Welfare, Government of India, has taken an initiative for patient safety by introducing a National Patient Safety Implementation Framework (NPSIF), which positions patient safety as fundamental element of healthcare. NPSIF is intended to be adopted by both, public and private, sectors to address the various issues arising while providing qualitative healthcare services.
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Content Article
Primary care cancer toolkit
Claire Cox posted an article in Cancers
This Primary Care Cancer Toolkit provides a collection of key resources about cancer prevention, diagnosis and care relevant for the primary care setting. It provides links to current guidance, continuing professional development resources, patient information, and information for those involved in commissioning. -
Content ArticleThe South Thames Paediatric Network's aim is to enable children within the South Thames region (South London, Kent, Surrey and Sussex) to have access to high-quality specialist paediatric care in the place most suitable to their needs, at the appropriate time with a focus on surgery in children, critical care, long term ventilation and gastroenterology.
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News Article
Surgeons withdraw support for heart disease advice
Patient Safety Learning posted a news article in News
European clinical guidelines on how to treat a major form of heart disease are under review following a BBC Newsnight investigation. Europe's professional body for heart surgeons has withdrawn support for the guidelines, saying it was "a matter of serious concern" that some patients may have had the wrong advice. Guidelines recommended both stents and heart surgery for low-risk patients, but trial data leaked to Newsnight raises doubts about this conclusion. Thousands of people in the UK and hundreds of thousands worldwide will be treated for left main coronary artery disease each year. This is a narrowing of one of the main arteries in the heart. The guidelines on how to treat it were largely based on a three-year trial to compare whether heart surgery or stents – a tiny tube inserted into a blocked blood vessel to keep it open – was more effective. The trial called Excel started in 2010 and was sponsored by big US stent maker, Abbott. Led by US doctor Gregg Stone, the study and aimed to recruit 2,000 patients. Half were given stents and the other half open heart surgery. Success of the treatments was measured by adding together the number of patients that had heart attacks, strokes, or had died. The research team used an unusual definition of a heart attack, but had said that they would also publish data for the more common "Universal" definition of a heart attack alongside it. There is debate around which is a better measure and the investigators stand by their choice. In 2016, the results of the trial for patients three years after their treatments were published in the New England Journal of Medicine. The article concluded stents and heart surgery were equally effective for people with left main coronary artery disease. But researchers had failed to publish data for the common, "Universal" definition of a heart attack. Newsnight has seen that unpublished data and it shows that under the universal definition, patients in the trial that had received stents had 80% more heart attacks than those who had open heart surgery. The lead researchers on the trial have told Newsnight that this is "fake information". But Newsnight has spoken to experts who say they believe the data is credible. Read full story Source: BBC News, 9 December 2019 -
Content ArticleI have worked in the UK NHS as a hospital pharmacist for 13 years, experiencing a variety of specialities before specialising in cancer and education and, more recently, gastroenterology. I am also an avid traveller and have witnessed that, while we are globally connected, populations around the world are not as fortunate as we are in the UK for medicine and healthcare access and as a result are dying of very treatable diseases. This fuelled me to enrol on the Global Health Policy post-graduate masters (MSc). On completing my MSc, an opportunity arose to take part in the Global Health Fellowship and so I began working with Zambian colleagues at the University Teaching Hospital (UTH) and University of Zambia (UNZA), Lusaka, via the Brighton-Lusaka health link. This fellowship is a collaborative project between Commonwealth Pharmacists Association (CPA), Tropical Health and Education Trust (THET) and the Fleming Fund and is an avenue for pharmacists to become more involved in global health and improve medicine usage.
