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Community PostTwo vaccines for COVID-19 have now been approved. Health organisations are doing their upmost to workout how best to store and administer the vaccines safely and avoiding errors. The Chartered Institute of Ergonomics and Human Factors (CIEHF) are preparing strategic guidance for health authorities and operational guidance for people setting up vaccine programmes applicable internationally. In a recent LinkedIn post, Chief Executive Noorzaman Rashid asks: "What are the Human Factors and Ergonomic issues that should be considered?" And asks you to share your ideas: https://www.linkedin.com/posts/noorzamanrashid_the-economist-on-twitter-activity-6750290388721926144-h8XV/ #ciehf #covid #patientsafety
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Content ArticleThe report presents a varied picture across the UK, with evidence that: “Hidden harms” of the Spring lockdown on 0-2s were broad and significant, and experienced unevenly depending on family circumstances and background. Historically inadequate or insecure funding, and a rising tide of need, has inhibited the ability of some services and areas to respond to the coronavirus crisis. There were often ‘baby blind-spots’ where babies’ needs were overlooked in policy, planning and funding. The report also draws on a survey of 235 senior leaders of pregnancy and 0-2 services across the UK. The survey findings showed that: Almost all (98%) of the survey respondents said babies their organisation works with had been impacted by parental anxiety, stress or depression which was affecting bonding and responsive care. 78% of respondents were clear that the government in their nation had not done enough for the under 2s, creating this ‘baby blind-spot’. The majority (80%) said that some babies they work with had experienced increased exposure to domestic conflict, child abuse or neglect, with 29% saying many babies they work with had been impacted. It is now calling for governments across the UK to focus on ensuring all babies live in a ‘baby-positive’ local system.
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News ArticleOne of the mysteries of COVID-19 is why oxygen levels in the blood can drop to dangerously low levels without the patient noticing. It is known as "silent hypoxia" and as a result, patients have been arriving in hospital in far worse health than they realised and, in some cases, too late to treat effectively. But a potentially life-saving solution, in the form of a pulse oximeter, allows patients to monitor their oxygen levels at home, and costs about £20. They are being rolled out for high-risk Covid patients in the UK, and the doctor leading the scheme thinks everyone should consider buying one. A normal oxygen level in the blood is between 95% and 100%. "With Covid, we were admitting patients with oxygen levels in the 70s or low-or-middle 80s," said Dr Matt Inada-Kim, a consultant in acute medicine at Hampshire Hospitals. He told BBC Radio 4's Inside Health: "It was a really curious and scary presentation and really made us rethink what we were doing." Read full story Source: BBC News, 21 January 2021 See hub resource on the 'Covid Oximetry @home' project
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News ArticleJust a third of people aged 80 and over have received the covid vaccine in one part of England, compared to four out of five in the area with the highest rate, new NHS England figures have revealed. Gloucestershire delivered at least one dose of the vaccine to 85% of its over 80s population between 8 December and 17 January. Three other STPs — Northamptonshire, Herefordshire and Worcestershire, and Lancashire and South Cumbria — have all delivered at least one dose to at least three-quarters of over 80s in the area. By contrast, Suffolk and North East Essex has vaccinated just 36% of its over 80s population. A further seven of England’s 42 STP/Integrated Care Systems had vaccinated under half of their over 80s population. The mixture of reasons for the differences are not known — it may be due to supply, delivery issues, the nature of the area, or the size of the over-80s population. NHS England has maintained that the vaccine is being used nearly as quickly as it is available each week, with supply the main constraint. NHSE decides when sites are able to open and when they have supply. Read full story (paywalled) Source: HSJ, 21 January 2021
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News Article
Ambulance service facing 'terrifying' levels of risk, says trust chief
Patient Safety Learning posted a news article in News
The chief executive of a small acute trust has described the “terrifying situation” faced by ambulance crews and hospital staff in trying to provide adequate emergency care as coronavirus threatens to overwhelm the local NHS services. Susan Gilby, of Countess of Chester Hospital Foundation Trust, told HSJ staff are seeing “tragic and potentially avoidable” instances where patients with COVID-19 have reached the emergency department too late. She suggested this is due to a combination of patients waiting too long to call 999, and then having to wait long periods for an ambulance to arrive. Cheshire has been among the hardest hit areas in England during this third wave of coronavirus, with all four of its acute hospitals having very high covid occupancy rates. Dr Gilby, a former critical care consultant, said her trust has been at around 60 per cent covid occupancy for the last fortnight, which has made her increasingly fearful of the difficulties in admitting patients through the emergency department due to a lack of beds. This can then cause knock-on delays for patients arriving in ambulances, and ties those ambulance crews up for long periods, preventing them from responding to further 999 calls. She said ambulance turnaround times had been relatively good at the Countess of Chester, but she had spoken to paramedics handing over patients who were “really struggling” to get to people quickly enough. Read full story (paywalled) Source: HSJ, 22 January 2021 -
News Article
More than 400 care homes investigated over deaths
Patient Safety Learning posted a news article in News
A special Crown Office unit set up to probe Covid-linked deaths is investigating cases at 474 care homes in Scotland, the BBC can reveal. The unit was set up in May to gather information on the circumstances of all deaths in care homes. Prosecutors will eventually decide if the deaths should be the subject of a fatal accident inquiry or prosecution. Care homes say the investigation is "disproportionate" and placing a huge burden on overstretched staff. The COVID-19 Deaths Investigation Team (CDIT) had received 3,385 death reports as of Thursday. The majority of them relate to people who lived in care homes. Behind the Crown Office statistics are hundreds of families grieving for loved ones who died in Scotland's care homes. Alan Wightman's 88-year-old mother Helen died in May last year during a Covid outbreak at Scoonie House in Fife Helen's death is part of the Crown Office probe and Mr Wightman's hopes for the investigation are that it looks "at the bigger picture and appreciates that on the ground people were doing the best they could". He added: "I thought that Scoonie House did the best they could in a very difficult situation, sourcing their own PPE and stopping people coming from hospital." "My own view is that care homes were put in an impossible situation because we had successive governments which did not properly prepare for a pandemic, you only have to look at the lack of PPE at the beginning of the pandemic to see that." Read full story Source: BBC News, 22 January 2021 -
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The NHS ICU Virtual Summit: Future-proofing critical care
Sam posted a calendar event in Community Calendar
The countries focus on critical care services in England has increased because of COVID-19. A significant proportion of hospitalised patients with COVID-19 require help with breathing, including mechanical ventilation and other services critical care staff and units provide. Delivering sufficient critical care capacity goes beyond physical infrastructures – such as having more beds and equipment – and requires sufficient numbers of trained and available staff. The NHS ICU Virtual Summit: Future-Proofing Critical Care conference aims to celebrate the current efforts of ICU staff, in this time of unprecedented strain, via best practice and practical insight. We will also take a look at some key areas of potential improvement including: Understanding intensive care staffing, occupancy and capacity. Infection control. Crisis management and emergency preparedness. Clinical Information Systems. NHS staff and services will continue to be tested to their limits over the coming months, this short but high-value session aims to bring peers together from across the UK to share best practice and outcomes. Register -
News ArticleOnly a little over half of British Indians say they would get a coronavirus vaccine, according to research. Some 56% of British Indians said they would take up a vaccine when asked by the 1928 Institute, a new think tank led by academics from the University of Oxford. However, 31% per cent were unsure, while 13% said they would decline a jab, the online poll of 510 respondents found. The think tank said much of this stemmed from people feeling they were not informed enough about the vaccines, while a significant proportion felt other people deserved to receive a vaccine more. The researchers are calling for an urgent public health campaign and funding, with messaging in different languages and co-produced with community leaders to assuage doubts. The government should also widely share information on how it is helping poorer countries distribute vaccines, given that several participants said vulnerable people and those in poorer countries should take priority, they said in their report. Read full story Source: The Independent, 21 January 2021
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News Article‘Surge’ clauses allowing the NHS to again take over private hospitals — as it did in the spring — have been triggered in some areas, HSJ has learned. An email from NHS England to private hospitals in London, seen by HSJ, was sent last week, triggered a seven-day notice period under NHSE’ covid contracts with the providers. The letter said the London region had requested the move after taking into account “critical care capacity, the doubling rate [and the] forecast acute admission rate related to local prevalence.” The letter refers to the north central London health system, but HSJ understands similar arrangements have been triggered for north east London. The two areas have a combined population of 3.9m people and have been some of the hardest hit by covid admissions. The clause is also thought to have been triggered in other parts of south east England, but it is not known which ones. The letter listed six hospitals, five owned by BMI Healthcare and one by Aspen Healthcare, which would, from Friday, commit “100 per cent” of their capacity to NHS use. Read full story (paywalled) Source: HSJ, 20 January 2021
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News ArticleSmear-test delays during lockdown have prompted calls for home-screening kits. Cervical cancer screening has restarted across the UK - but some women say they will not attend their appointments for fear of catching Covid. Jo's Cervical Cancer Trust is urging "faster action" on home tests for HPV, which causes 99% of cervical cancers. An NHS official said GP practices should continue screening throughout lockdown, and "anyone invited for a cervical smear test should attend". Cancer Research UK said it was not yet known how effective and accurate self-sampling could be in cervical screening. A survey by gynaecological cancer charity the Eve Appeal indicates nearly one in three missed smear tests are the result of people being "put off" by coronavirus. And a Jo's Cervical Cancer Trust survey during the pandemic suggests the same proportion would prefer to take their own human-papillomavirus (HPV) test rather than go to a GP. Acting chief executive Rebecca Shoosmith said coronavirus had added "more barriers" to going for a smear test. "Sadly those who found it difficult before are likely to be no closer to getting tested," she said. "Self-sampling would be a game-changer." Both charities emphasise smear tests are for "women and anyone with a cervix" and transgender and non-binary people may have additional barriers to going. Jo's Cervical Cancer Trust said DIY tests could also help people who had been sexually assaulted and those with disabilities or from backgrounds where smear tests were taboo. Read full story Source: BBC News, 21 January 2021
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News Article
Trusts told to treat more COVID-19 patients at home
Patient Safety Learning posted a news article in News
Hospitals should ramp up their treatment of COVID-19 patients at home to free up more beds during the peak of the pandemic, under plans announced by NHS England/Improvement. All NHS trusts will receive up to 300 oximeters, which measure oxygen saturation levels and can be used to monitor COVID-19 patients in their own homes, rather than in hospital beds. NHSE has “recommended” that all areas of England “pursue immediate roll-out” given the “intense pressure on hospital beds right now”, according to a letter from medical director Steve Powis and two other national directors. Currently, nearly 60 trusts have COVID-19 patients in at least a third or more of their beds, and the total number of COVID-19 patients is peaking at around 37,000. There have been particular strains on hospital discharge, particularly of covid patients, whom many care homes are unable or unwilling to receive. The scheme, dubbed “covid virtual wards”, has been used at some trusts since the pandemic’s first wave. Read full story (paywalled) Source: HSJ, 19 January 2021 -
News Article
Covid: 'Sharp drop' in heart-attack hospital admissions
Patient Safety Learning posted a news article in News
There has been a sharp drop in the number of patients admitted to hospitals in England with heart attacks or heart failure in recent months, research reveals. Experts are worried that people who need urgent medical help are not seeking it. This was also the case during the first wave of the pandemic. The researchers included 66 hospitals in the study and compared daily admission rates in the year before the pandemic with those during the first and second waves in England, up to 17 November. During the first lockdown, daily admissions for heart attacks or heart failure decreased by more than 50%. They went up again in the summer, as coronavirus rates decreased in the UK and the NHS became less busy with the virus. From October, when coronavirus cases were rising again, heart admissions began to drop - by between 35% and 41% compared with pre-pandemic data, according to the study published in the Journal of the American College of Cardiology. Researcher Prof Chris Gale, from Leeds University, said: "Medical emergencies do not stop in a pandemic. I am afraid that we are seeing a re-run of one of the preventable tragedies of the first wave - people were either too afraid to go to hospital for fear of contracting COVIDd-19 or were not referred for treatment." "The message to patients needs to be clear. If they experience symptoms of a heart attack or acute heart failure, they need to attend hospital." Read full story Source: BBC News, 20 January 2021 -
News ArticleNearly a third of people who were discharged from hospitals in England after being treated for COVID-19 were readmitted within five months – and almost one in eight died, a study suggests. The research, which is still to be peer-reviewed, also found a higher risk of problems developing in a range of organs after hospital discharge in those younger than 70 and ethnic minority individuals. “There’s been so much talk about all these people dying from Covid … but death is not the only outcome that matters,” said Dr Charlotte Summers, a lecturer in intensive care medicine at the University of Cambridge who was not involved in this study. “The idea that we have that level of increased risk in people – particularly young people – it means we’ve got a lot of work to do.” There is no consensus on the scale and impact of “long Covid”, but scientists have described emerging evidence as concerning. According to recent figures provided by the Office for National Statistics (ONS), a fifth of people in England still have coronavirus symptoms five weeks after being infected, half of whom continue to experience problems for at least 12 weeks. Read full story Source: The Guardian, 18 January 2021
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News ArticleFor the last 10 months, everyone in healthcare has lived their lives as if they were trapped in a burning building without a fire escape. No matter how much water we throw on the fire or how many firefighters (healthcare providers in this instance) we send in, we cannot gain control of the flames. The catastrophic loss of life has been insurmountable, and we often haven’t had enough physicians to take care of everyone. This is not new for a healthcare system. For years prior to this pandemic, there has been a physician shortage in the United States that is expected to worsen over the coming years. The Association of Medical Colleges (AAMC) predicts that the US could see a shortage between 54,000 and 139,000 physicians in both primary and specialty care by 2033. Although the total physician supply is expected to grow, it won’t be at a fast enough rate to outpace demand. This is where physician assistants (PAs) and advanced practice nurses (APRNs) come in. Many people don’t realise that PAs and APRNs have been around for over 50 years. For 50 years, a plethora of research has shown that PAs and APRNs are safe, reliable, high quality healthcare providers and essential members of the healthcare team. But too often critics claim that because they have not gone through physician training, they cannot provide exceptional medical and surgical care. In fact, they already do. A recent comprehensive review of PA and APRN outcomes from 2008 to 2018 found that PAs and APRNs had similar outcomes compared to physicians including hospital length of stay, readmission rates, quality and safety and patient and staff satisfaction. Read full story Source: The Hill, 16 January 2021
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News ArticlePeople in high-risk minority ethnic groups must be prioritised for Covid immunisations, alongside a targeted publicity campaign, experts and politicians have said amid growing concerns over vaccine scepticism. With figures on Monday recording more than 4m Covid vaccine doses now administered across the UK, and the rollout being expanded to all over-70s, public health experts and MPs called for black, Asian and minority ethnic (BAME) communities to be better protected. The Scientific Advisory Group for Emergencies (Sage) has also raised concerns after research showed up to 72% of black people said they were unlikely or very unlikely to have the jab. Prof Martin Marshall, chair of the Royal College of GPs, urged Whitehall to begin a public health campaign. “We are concerned that recent reports show that people within BAME communities are not only more likely to be adversely affected by the virus but also less likely to accept the Covid vaccine, when offered it,” he said. “As such, where appropriate, we’re calling for public health communications to be tailored to patients in BAME communities, to reassure them about the efficacy and safety of the vaccine and ultimately encourage them to come forward for their vaccination when they are invited for it.” His remarks came as the vaccines minister, Nadhim Zahawi, admitted he feared some BAME communities could remain exposed to coronavirus despite high expected uptake of the jabs. Read full story Source: The Guardian, 18 January 2021
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News ArticleNHS bosses have instructed hospitals to keep performing urgent cancer surgery despite Covid pressures, after a growing number cancelled procedures because they did not have enough intensive care beds or available staff. They have told England’s regional directors of cancer to ensure treatment of people who need cancer surgery within four weeks gets the same priority as care of patients who have Covid. The move was unveiled in a letter, obtained by HSJ, sent last Friday by Amanda Pritchard, the chief operating officer at NHS England and NHS Improvement. It was also signed by Cally Palmer, the NHS’s national cancer director, and Prof Peter Johnson, a highly respected specialist who is the NHS’s national clinical director for cancer. They have acted after unease among cancer specialists that growing numbers of hospitals, including all those in London, had cancelled urgent operations. Hospitals have felt obliged to do so either because they did not have enough intensive care beds for patients who might need one after their cancer procedure or because surgical staff had been repurposed to help care for Covid patients. Doctors voiced alarm at the scale of recent postponements of what the NHS classes as “priority two” operations. That means they should be done within 28 days to ensure that someone with cancer does not see their disease spread or become inoperable because it was delayed. More than 1,000 cancer patients in London are now waiting to have “priority two” or “P2” urgent surgery, but none have been given a new date for when it will happen, HSJ reported last week. Read full story Source: The Guardian, 18 January 2021
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News Article
Patients ‘treated in ambulances as there was no space in A&E’
Patient Safety Learning posted a news article in News
A London hospital is being forced to send patients back to ambulances for treatment due to an ‘overwhelming’ number of Covid patients on ICU wards, according to a frontline doctor. The medic, who asked to remain anonymous, said A&E staff are "running" into waiting ambulances to treat patients there until space becomes available. He said: "It’s not the fault of the staff, but the sheer numbers are so unprecedented and being full like this means that you just have to do your best to adapt. But it’s not the standard (of care) I signed up to." "It’s extremely stressful for us to be doing our best but knowing that significant patient harm is happening because there isn’t space and the patient load is too high." He raised concerns that "significant patient harm" was occurring due to a lack of beds available and the emergency system means medics are limited in the care they can provide. Read full story Source: The Metro, 14 January 2021 -
News Article
Growth in covid hospital patients slows across the country as peak approaches
Patient Safety Learning posted a news article in News
The growth in covid positive hospital patients is rapidly slowing in every English region and appears to have stopped in the south east. The weekly increase in covid inpatients across England fell to 8% yesterday, the first time it had dropped to single figures since 12 December. A week earlier, on 10 January, the growth rate stood at 23%. There are now 33,352 covid hospital patients in English hospitals, an increase of 2,594 in the last seven days. The previous week had seen a rise of 5,801. The weekly growth rate of covid positive hospital patients in the seven English regions currently ranges from 26% in the south west to zero in the south east. In every region, the growth rate is seven to 20 percentage points lower than recorded on 10 January. London’s weekly growth rate is now three per cent and the east’s is 2%. There has been no substantive change in the south east total in the past week. It is likely covid patients will be seen to have peaked in these three regions between 13 to 15 January. The slowing in the growth of national covid patient numbers means the total is likely to peak during the next seven days at a level lower than many had feared and expected. HSJ has seen internal NHS England projections from last week that saw growth continuing into February and total covid patient numbers rising well above 40,000, this now seem very unlikely. Read full story Source: HSJ, 18 January 2021 -
News Article
Doctors and nurses 'need more legal protection amid pandemic pressures'
Patient Safety Learning posted a news article in News
Emergency legislation is needed to protect doctors and nurses from “inappropriate” legal action over critical Covid treatment decisions made amid the pressures of the pandemic, health organisations have argued. A coalition of health bodies has written to Matt Hancock, the health secretary, calling for the law to be updated so medical workers do not feel “vulnerable to the risk of prosecution for unlawful killing” when treating coronavirus patients “in circumstances beyond their control”. The letter, coordinated by the Medical Protection Society (MPS), states there are no legal safeguards for coronavirus-related issues such as when there are “surges in demand for resources that temporarily exceed supply”. The coalition, which includes the British Medical Association and Doctors’ Association UK, wrote: “With the chief medical officers now determining that there is a material risk of the NHS being overwhelmed within weeks, our members are worried that not only do they face being put in this position but also that they could subsequently be vulnerable to a criminal investigation by the police. “There is no national guidance, backed up by a clear statement of law, on when life-sustaining treatment can be lawfully withheld or withdrawn from a patient in order for it to benefit a different patient, and if so under what conditions. The first concern of a doctor is their patients and providing the highest standard of care at all times.” Read full story Source: The Guardian, 16 January 2021 -
News Article
Covid vaccine: 72% of black people unlikely to have jab, UK survey finds
Patient Safety Learning posted a news article in News
Advisers from the Scientific Advisory Group for Emergencies (Sage) have raised fresh concerns over Covid vaccine uptake among black, Asian and minority ethnic communities (BAME) as research showed up to 72% of black people said they were unlikely to have the jab. Historical issues of unethical healthcare research, and structural and institutional racism and discrimination, are key reasons for lower levels of trust in the vaccination programme, a report from Sage said. The figures come from the UK Household Longitudinal Study, which conducts annual interviews to gain a long-term perspective on British people’s lives. In late November, the researchers contacted 12,035 participants to investigate the prevalence of coronavirus vaccine hesitancy in the UK, and whether certain subgroups were more likely to be affected by it. Overall, the study found high levels of willingness to be vaccinated, with 82% of people saying they were likely or very likely to have the jab – rising to 96% among people over the age of 75. Women, younger people and those with lower levels of education were less willing, but hesitancy was particularly high among people from black groups, where 72% said they were unlikely or very unlikely to be vaccinated. Among Pakistani and Bangladeshi groups this figure was 42%. Eastern European groups were also less willing. “Trust is particularly important for black communities that have low trust in healthcare organisations and research findings due to historical issues of unethical healthcare research,” said the Sage experts. “Trust is also undermined by structural and institutional racism and discrimination. Minority ethnic groups have historically been underrepresented within health research, including vaccines trials, which can influence trust in a particular vaccine being perceived as appropriate and safe, and concerns that immunisation research is not ethnically heterogenous.” Read full story Source: The Guardian, 16 January 2021 -
News ArticleCovid outbreaks in care homes have more than trebled in a month. Figures show that infection levels are now similar to the peak of the first wave, with last week having the second highest weekly total since records began in April. Senior figures said the numbers were "shocking" and warned: "Care homes cannot be neglected again". Ministers have pledged that all care home residents would be vaccinated by the end of this month. But The Telegraph has been told the care home rollout was taking longer than officials had anticipated. The new figures come after The Telegraph revealed the Government is proposing to send hospital patients into care homes without tests, despite being warned that was responsible for driving up cases in the first wave. Read full story Source: The Telegraph, 14 January 2021
