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Found 1,169 results
  1. News Article
    The British Dental Association (BDA) has criticised NHS England for “dragging its feet” in setting up an urgent care system for dental patients, putting further strain on already overstretched GPs. At the end of March, dental practices were ordered to suspend all routine treatment, as part of plans to prevent the spread of coronavirus. NHS regions were instructed to set up local urgent dental care centres. However, GPs have told HSJ they have been experiencing a rise in calls from patients with dental problems, but when they direct them to the urgent care centres, appointments appear to be limited. The BDA has said, in some regions, there is “nowhere” to send patients in need of urgent dental care. Sources working in primary care and tech said GPs were dealing with a spike in demand from dental patients who did not know where to go. Read full story Source: HSJ, 17 April 2020
  2. News Article
    Doctors have been warned that crucial drugs used to help sedate and ventilate patients in intensive care are running out due to the demand caused by coronavirus. An alert to hospitals from NHS England today said there were “limited supplies” of muscle relaxant drugs atracurium, cisatracurium and rocuronium, which are used during intubation when patients are sedated and paralysed with a ventilator used to help them breathe. As a result of the shortages, and to help maintain supplies, NHS England said it would now manage existing supplies “centrally”. Its said supplies of atracurium and cisatracurium were likely to be exhausted in coming days, and hospitals would need to switch to alternatives that were still available. A critical care nurse working in ICU in the south of England told The Independent they were already using alternatives but that this had to be used at different concentrations and run for longer to achieve the same sedation. She said changes like this with staff overstretched could increase the likelihood of drug errors. Read full story Source: The Independent, 17 April 2020
  3. Content Article
    Patient Safety Learning works with experts on guidance around ventilator safety As part of the Government’s fast track approach to the development of ventilators, the Medicines & Healthcare products Regulatory Agency (MHRA) issued guidance for clinical requirements based on ‘minimally acceptable’ performance. [2] Patient Safety Learning approached a range of human factors/ergonomics experts, asking for their input on the procurement of these new ventilators due to the involvement of new manufacturers, flexing of established guidelines and ‘safety in use’ issues. We asked them what they believed the key issues were in ensuring that these ventilators are safe in use. Experts did express concerns, identifying several risks: By moving at speed and developing non-standard ventilators (with some manufacturers with no prior experience in this area), we may unintentionally be designing a system than has numerous points of failure, increasing risk for patients. How ventilators can be used safely, particularly for staff redeployed in the pandemic who may be inexperienced or untrained in using them. How safe will ventilators be to operate for staff wearing full Personal Protective Equipment (PPE)? Should patients die as a result of safety problems with ventilators, their deaths may not be identified as such, instead being attributed to Covid-19. There are already known safety issues relating to the use of ventilators. For example, there are currently multiple designs of machines used by the NHS, with different training requirements for different devices. We worked with this expert group, who provided detailed advice and guidance to address these risks. Patient Safety Learning then immediately developed proposals for urgent action to ensure that ventilators are safe for use with patients. We called for the healthcare system to work at a pace, together with manufacturers and experts in human factors/ergonomics, in order to minimise the usability safety risks. With our proposals, we provided details of what is required to ensure ventilator safety in use. Experts called for the MPV (Minimum Viable Product) specification to be revised to reflect ‘safety in use’ requirements with an immediate design, development and test sprint approach with human engineering user trials, task analysis and hazard analysis. NHS and Chartered Institute of Ergonomics and Human Factors (CIEHF) work quickly to design new guidance So, what happened next? Initially there was a swift response. NHS England and NHS Improvement asked the CIEHF to provide designers and manufacturers with guidance aiding the rapid production of new ventilators. CIEHF subsequently designed guidance, sending it to NHS England within 48 hours. The guide, Human Factors in the Design and Operation of Ventilators for Covid-19, was then to be sent to manufacturers of ventilators in the UK.[3] Soon after CIEHF also developed a ‘rapid and easy to use’ testing protocol to assist manufacturers with testing. CIEHF have developed overarching advice and guidance and testing protocol. To support this, a detailed set of user requirements has been developed by Dr Sue Whalley Lloyd and Karen Priestly. They have worked with, and adapted, Yorkshire Water’s general human factors guidance and have produced a detailed Engineering Specification: Ventilator HF Design guidance. We need to address the risk to patient safety We’ve seen an enormous amount of activity these past few weeks towards the design and production of new ventilators; something that would usually take months or even years. However, there are still serious concerns about the process to date and outstanding safety issues. It’s vital that we meet the urgent need for additional ventilators in the UK, however it cannot be at the cost of patient safety. Concerns about the Government’s response The Government has come under increasing pressure in recent weeks over its handling of this issue. This has been, in part, because it decided not to order ventilators through the EU’s procurement scheme. This has resulted in a more urgent need for scaling up production within the UK.[4] There have also been questions raised around the number of ventilators required. Initial estimates of 30,000 have since been cut down by more than a third to 18,000. [5] [6] [7] Efforts to engage more UK manufacturers in the production of new ventilators have also proved to be complicated, with only one new model to date, Penlon’s ESO2 device, receiving approval from the MHRA.[8] While this covers a provisional order for 5,000 ventilators, there are a significant number of other applications still waiting the regulatory clearance that will be needed to meet the revised 18,000 target. Meanwhile, another provisional order has been forced to withdraw, as a model from the Renault and Red Bull Formula 1 teams was found to not be suitable for treating patients with Covid-19. [9] “Don’t bother, you’re wasting your time” There has been increasing clinical concern about the Government’s decision to move away from standard specification and known manufacturers. Some of these concerns have related to the minimum specification for the ventilator programme set out by the MHRA, suggesting that it will not lead to the production of machines that are suitable for treating Covid-19 patients. Dr Alison Pittard, Dean of the Faculty of Intensive Care Medicine, has raised concerns about the minimum specifications.[10] The MHRA guidance states that “it is proposed these ventilators would be for short-term stabilisation for a few hours”.[11] Dr Pittard has said that the group of medical professionals that advised the Government on this in March suggested that these machines should be capable of working for the a patient’s full time in intensive care.[12] She noted that: “If we had been told that that was the case, that the ventilators were only to treat a patient for a few hours, we’d have said: “don’t bother, you’re wasting your time. That’s of no use whatsoever.”[13] Compounding this issue, the standards that currently exist in this area are not formal regulatory requirements. The MHRA state that: “They are not formal regulatory requirements, but many are harmonised against regulatory requirements. Consider them as helpful advisory standards for now. MHRA will lead an exercise to define which can be ‘safely’ relaxed for this emergency situation.”[14] This is not simply a technical issue. If we can’t ensure ventilators are being produced to the right standards, to deliver the right care and to be used safely, then it will inevitably result in errors and could ultimately cost lives. Critical safety questions for the Government Considering these concerns, Patient Safety Learning believes that it is vital that the Government responds to the following critical ventilator safety questions: Safety standards Are the standards for ventilators issued to manufacturers fit for purpose? Are MHRA ensuring that these standards are being applied? These standards are not currently formal regulatory requirements. Should they be? Utilising expertise Has the expert guidance on ventilator safety in use, developed by CIEHF and others, been issued to manufacturers by NHS England and NHS Improvement or the MHRA? If yes, are manufacturers required to apply this guidance? Is it advisory or is it mandatory? Are manufacturers who comply with the guidance and usability protocols given an advantage in the procurement process? Are regulators signing off new ventilators against this guidance? Delivery, communication and timescales Currently only one of the manufacturers of new ventilators has received approval. What is the timescale for delivery of the new ventilators and how does this match estimated demand? How are the NHS and MHRA communicating with patients, staff and the public to assure them that the new ventilators will be safe in use? Monitoring performance How will ventilator ‘safety in use’ be monitored and reported on? Are NHS providers and clinicians being asked to strengthen their incident reporting, particularly where manufacturers have developed novel approaches? References Gov.uk, Call for business to help make NHS ventilators, Last Accessed 15 April 2020. Medicines & Healthcare products Regulatory Agency, Rapidly Manufactured Ventilator System, 10 April 2020. Chartered Institute of Ergonomics & Human Factors, Human Factors in the Design and Operation of Ventilators for Covid-19, Last Accessed 1 April 2020. The Guardian, UK missed three chances to join EU scheme to bulk-buy PPE, 13 April 2020. The Guardian, How the UK plans to source 30,000 ventilators for the NHS, 26 March 2020. The Guardian, How close is the NHS to getting the 18,000 ventilators it needs? 14 April 2020. Health Service Journal, NHS needs a third fewer ventilators than forecast, says Hancock, 5 April 2020. Gov.uk, Regulator approves first Ventilator Challenge device, 16 April 2020. The Guardian, UK scraps plans to buy thousands of ventilators from Formula One group, 14 April 2020. Financial Times, Ventilator standards set out for UK makers ‘of no use’ to Covid patients, 15 April 2020. Medicines & Healthcare products Regulatory Agency, Rapidly Manufactured Ventilator System, 10 April 2020. Financial Times, Ventilator standards set out for UK makers ‘of no use’ to Covid patients, 15 April 2020. Ibid. Medicines & Healthcare products Regulatory Agency, Rapidly Manufactured CPAP System (RMCPAPS), 29 March 2020.
  4. News Article
    The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned. Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them. And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden. “People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.” Read full story Source: The Guardian, 16 April 2020
  5. News Article
    A leaked letter seen by the BBC has revealed an extensive list of concerns about how the social care sector is coping with the coronavirus crisis. The letter raises fears about funding, testing, personal protective equipment (PPE) and the shielding scheme for vulnerable people. Written on Saturday, to a senior official at the Department of Health and Social Care by the Association of Directors of Adult Social Services (Adass), it says mixed messages from the government have created "confusion and additional workload". On protective equipment for care workers, the letter says the national handling has been "shambolic". Early drops of equipment have been "paltry" and more recent deliveries have been "haphazard", with some even being confiscated by border control for the NHS. And while the rollout of testing for care workers has been generally welcomed, the letter states "testing for care workers appears to be being rolled out without being given thought to who is going to be tested and what we are going to do with the result". Read full story Source: BBC News, 16 April 2020
  6. News Article
    Close family members will be able to see dying relatives to say goodbye under new coronavirus guidelines, Health Secretary Matt Hancock has said. He said the UK would introduce new steps to "limit the risk of infection" and allow goodbyes "wherever possible". Many loved ones have been unable to say goodbye to family and friends since stringent restrictions were introduced on life in the UK on 23 March. Mr Hancock highlighted the death of Ismail Mohamed Abdulwahab, 13, from Brixton, south London. Ismail died alone in hospital last month and his close family were then unable to attend his funeral because they were self-isolating. Speaking at Wednesday's briefing, Mr Hancock said the reports made him "weep". "Wanting to be with someone at the end of their life is one of the deepest human instincts," he said. New government guidelines for social care providers, published shortly after the briefing, say that care homes should still "limit unnecessary visits" but advises that "visits at the end of life... should continue" Read full story Source: BBC News, 16 April 2020
  7. News Article
    The world is likely to face a global crisis in poor mental health after the coronavirus pandemic has passed, experts have warned. Two dozen mental health scientists including neuroscientists, psychiatrists, psychologists, and public health experts have warned of the long-term impact of the virus on people’s mental health and demanded governments prioritise research to come up with evidence-based treatments. They also called for real-time monitoring of mental health in the UK and across the world in order to gauge the severity of the expected increase in poor mental wellbeing. Their warning, in the journal Lancet Psychiatry, comes as a new Ipsos Mori survey carried out at the end of March revealed people’s mental health was already being affected by the UK lockdown and self-isolation policy. Read full story Source: The Independent, 16 April 2020
  8. News Article
    Millions of patients face being left without a dentist as one in five practices are on the brink of collapse this month. A sharp loss of income since the government banned all routine dental care during the coronavirus crisis has crippled practices, with many poised to close permanently. Some have already been forced out of business. A British Dental Association (BDA) survey of 2,800 practices found 71.5% said they could stay “financially sustainable” for only three months at the most. More than one in five, 20.4%, said they would not survive beyond April. Mick Armstrong, who chairs the association, said: “Practices are weeks from a cliff edge. Without meaningful support, the nation’s dental services face decimation.” Read full story (paywalled) Source: The Times, 12 Aril 2020
  9. News Article
    In March, while the UK delayed, Ireland acted. For many this may prove to have been the difference between life and death. The choices our governments have made in the last month have profoundly shaped what risks we, as citizens, are exposed to during the course of this pandemic. Those choices have, to a large extent, determined how many of us will die. At the time of writing, 365 people have died in Ireland of COVID-19 and 11,329 have died in the UK. Adjusted for population, there have been 7.4 deaths in Ireland for every 100,000 people. In the UK, there have been 17 deaths per 100,000. In other words, people are dying of coronavirus in the UK at more than twice the rate they are dying in Ireland. In her article, Elaine Doyle explores why this might be. Read full story Source: The Guardian, 14 April 2020
  10. News Article
    None of the new life-saving mechanical ventilators ordered last month to cope with the increase in coronavirus patients has so far been awarded safety approval. Models by manufacturers such as Dyson have yet to get the green light from the Medicines and Healthcare products Regulatory Agency, the Financial Times reported. It comes a month after the Government issued a rallying cry to put non-medical manufacturers such as Dyson on a "war footing" to make additional machines. The lag is thought to be due in part to changing clinical understanding of how best to manage the virus. Read full story (paywalled) Source: The Times, 14 April 2020
  11. News Article
    Nurses at a hospital run by a major private healthcare provider have been threatened with disciplinary action after apparently refusing to treat coronavirus patients, according to a leaked email seen by HSJ. The email was sent on Sunday by a senior matron at Nuffield Health’s Cheltenham Hospital, which has been made available to the NHS during the COVID-19 outbreak. She said: “I’m hoping to get another undisturbed day as I’m going to have to formally take on everyone who won’t help on the C19 side." “Unfortunately, it will be a disciplinary matter and referral to the [Nursing and Midwifery Council]. I really don’t want to go down that route but they’re giving me little choice.” It is not clear why staff had refused to help with COVID-19 work, but one staff member who spoke with HSJ said nurses had objected to working without personal protective equipment. A spokesman for Nuffield Health said: “We can categorically state that we have been provided with a full supply of PPE from the local NHS trust so that all members of the team are protected when they treat COVID-19 patients. The team has also been given the appropriate training to ensure they can carry out their roles safely.” Read full story Source: HSJ, 14 April 2020
  12. News Article
    All care home residents and staff with COVID-19 symptoms will be tested for coronavirus as laboratory capacity increases, the government has promised. Health Secretary Matt Hancock said he was "determined" to ensure everyone who needed a test had access to one. Care providers have been calling for more testing for weeks, with charities saying the virus is "running wild" amid outbreaks at more than 2,000 homes. At the moment only the first five residents who show symptoms in a care home are tested, to determine whether there is an outbreak of the virus. Providers have also complained that deaths among residents were being "airbrushed" out of official figures and demanded greater support for the industry. Read full story Source: BBC News, 15 April 2020
  13. Content Article
    BAPEN recognises that resources will be limited and often patchy depending on availability of appropriately trained staff – doctors, nurses, dietitians and pharmacists. The demands posed by large numbers of COVID -19 patients with pneumonia, especially on CPAP or ventilators in critical care and intensive care settings will test the capacity of all involved. It follows that special care still needs to be taken to ensure nutritional support is given where indicated whilst avoiding complications associated with tube misplacement in the lungs or oesophagus followed by infusion of nutrients, drugs or water – so called “Never Events”. BAPEN has provided the following advice: An overview of opinions on nasogastric tubes as aerosol generating procedures during the Covid-19 crisis COVID-19 & enteral tube feeding safety
  14. Content Article
    The rheumatology community has created a global, coordinated and timely response to the COVID-19 pandemic. The alliance aims to harness the breadth of expertise and knowledge in the rheumatology physician and patient communities to advance knowledge about COVID-19 for the benefit of all patients with rheumatic diseases.
  15. Content Article
    This guidance is produced during the COVID-19 outbreak in order to support the care in the community of patients and those important to them, at the end of their lives or who are unwell as the result of COVID-19 or other life-limiting illnesses. This document will be updated and adapted as further contributions are received and in line with changing national guidance. The most current version of the guidance document will be available on the public-facing pages of the RCGP COVID-19 Resource Hub and Association for Palliative Medicine website. Please check that you are referring to the most current version.
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