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Found 1,338 results
  1. News Article
    A joint letter from the Health Foundation, The King’s Fund and Nuffield Trust has been delivered to the Health and Social Care Select Committee identifying five key aspects which need addressed ahead of their evidence session on delivering core NHS and care services during and beyond the coronavirus pandemic. Health and Social Care Secretary Matt Hancock told the House of Commons on 22 April 2020 that the pandemic had reached its peak and talked of his intention to ‘gradually reopen’ the NHS as soon as it was safe to do so. For the joint authors of the letter, before any services look to begin being restarted key areas need addressed including a reliable supply of PPE to protect staff and a clear understanding within the system of the full extent of unmet need – particularly important as at present, from a big picture view, it is not clear how many services have been suspended. The joint letter puts five key questions to the Select Committee to address: How and when will appropriate infection prevention and control measures be available for all settings delivering care, and what impact will these have on capacity to reopen? How will the system understand the full extent of unmet need? How will the public’s fear of using NHS and social care services be reduced? What is the strategy for looking after and growing the workforce? Can the system improve as it recovers? Read full story Source: National Health Executive, 14 May 2020
  2. News Article
    Up to a fifth of patients with COVID-19 in several hospitals contracted the disease over the course of the pandemic while already being treated there for another illness, NHS bosses have told senior doctors and nurses. Some of the infections were passed on by hospital staff who were unaware they had the virus and were displaying no symptoms, while patients with coronavirus were responsible for the others. The figures represent NHS England’s first estimate of the size of the problem of hospital-acquired COVID-19, which Boris Johnson last week said was causing an “epidemic” of deaths. In a national briefing last month on infection control and COVID-19, NHS England told the medical directors and chief nurses of all acute hospitals in England that it had found that 10%-20% of people in hospital with the disease had got it while they were inpatients. Senior doctors and hospital managers say that doctors, nurses and other staff have inadvertently passed on the virus to patients because they did not have adequate personal protective equipment (PPE) or could not get tested for the virus. Doctors say that hospital-acquired COVID-19 is a significant problem and that patients have died after becoming infected that way. One surgeon, who did not want to be named, said: “Multiple patients my department treated who were inpatients pre lockdown got the bug and died. Obviously the timeline supports that they acquired it from staff and other patients.” Read full story Source: The Guardian, 17 May 2020
  3. News Article
    The government needs to make sure its coronavirus testing strategy is fit for purpose instead of focusing on hitting targets, says the Royal College of GPs (RCGP). In a letter to Health Secretary Matt Hancock, chairman Prof Martin Marshall said long wait times were "undermining confidence" in the results. Health professionals were also concerned about the accuracy of some test results, he said. The government said "95% of tests" were processed "in less than 48 hours". Ensuring there are enough tests to meet demand is part of the government's five tests it says must be met before easing lockdown restrictions. However, the absence of a clear strategy had left patients vulnerable, according to Prof Marshall. He said the RCGP did not currently believe the testing strategy was capable of working to prevent a second wave of infections and "secure the overall health of the population". Read full story Source: BBC News, 16 May 2020
  4. News Article
    Problems with dispensing drugs during the COVID-19 crisis may be contributing to an “apparent increase” in deaths of patients receiving treatment for opiate addiction, the Care Quality Commission (CQC) has said. The regulator has said the increase in deaths “may be a result of some services stopping all daily dispensing of opiates” and has taken enforcement action against a “large national provider of substance misuse services” which ”stopped all daily dispensing”. The provider has not been named by the CQC as it is “entitled to an appeal period,” but the regulator told HSJ the provider had not recorded their risk assessments for their clients in relation to changes in drug dispensing. The CQC said the provider had now “assured us” individualised risk assessments were in place. The CQC is now reviewing all deaths of people which have been reported by substance misuse services since 1 March due to concerns about the apparent increase and “that some of these deaths may be related to changes in prescribing practices in response to COVID-19”. Read full story Source: HSJ, 27 May 2020
  5. News Article
    A team of 25,000 contact tracers are making their first phone calls to track down people who will be told to self-isolate under a new scheme in England. Tracers will text, email or call people who test positive with coronavirus and ask who they have had contact with. Any of those contacts deemed at risk of infection will be told to isolate for 14 days, even if they are not sick. A test and trace system is also launching in Scotland, where an easing of the lockdown is expected later. The aim of England's NHS Test and Trace system is to lift national lockdown restrictions and move towards more localised, targeted measures. The team will start by contacting the 2,013 people who tested positive for the virus on Wednesday. Read full story Source: BBC News, 28 May 2020
  6. News Article
    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
  7. 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.
  8. Content Article
    My symptoms began towards the end of April. I started to cough and feel really cold. I developed a severe headache, was bothered by light and started to hurt in my kidney area and my neck. I stopped being able to complete a sentence without breathing in between words and felt like I had a tight chest. I found it hard to stay awake. I struggled to breathe if I even stood up. We started to isolate as a family of six. My GP tried to call but I was too breathless to speak on the phone so she asked me to take my blood pressure. It was 130/95 with a pulse of 38. She told my husband to take me to the hospital in case I needed oxygen. I was taken to a ward specifically for those showing signs of COVID-19. Three nurses treated me while I was crying and coughing and unable to breathe. They had a mask and gloves and had put a mask on me but the masks were not great and I didn't think it would be sufficient protection. One swabbed my throat and up my nose. I knew I had COVID-19 and didn't want them touching me as I thought they would get it. Two hours later was told I was fine and should go home. The doctor said my blood results were clear, my chest X-ray was clear I didn't have COVID, just anxiety. On my way out I was distressed as my husband and I were sure I had it. We continued to isolate as a family, despite what I was told in hospital. I haven't had anyone contact me with my swab results. At home, my symptoms got worse. I was freezing and coughing, headache, diarrhoea, aches, foggy, couldn't taste or smell, craved sugar to keep me awake. My fever came on and off. I had three teenagers and a five year old at home. I had extreme exhaustion and was unable to walk or complete sentences. A week or so later, following a phone call, the GP sent a Healthcare Assistant (HCA) to take my blood pressure and SATS. The HCA said that I had tested negative for COVID but I told her that I didn't believe it to be accurate. She gave me the SATS monitor to use myself while she watched from the doorway. My SATS went down to 80percent when I lifted my arms so the HCA called the GP who called an ambulance. The paramedics said that I should be in a coma according to my obs. He was only wearing gloves and a mask so I was upset as I was sure I had COVID. He commented that it was in my notes, COVID negative. The paramedics were with me for over an hour in my house. My daughter was in the room and husband who were not wearing masks and my other three children not wearing masks came to say goodbye to me. It would have been quite possible for them to be spreading it to the paramedics too. Upon walking to the ambulance, my SATS went down to 68% with a blood sugar of 2, so I was given sugar and given oxygen in the ambulance. I started to shake. The paramedic then changed into a hazmat suit. The other paramedic carried on treating me as he wanted to put a cannula into me. Acknowledging my concerns, they reassured me that they would speak to the staff to say that I may have had a false negative as I was showing signs of COVID. The staff in the resuss part of the hospital were wearing full PPE with plastic over their faces. A few hours later the doctor made me walk round the ward with a SATS monitor attached to my ear. My SATS went down to 96 then 94 then 92 and then 90 and then I went back to my bed. The doctor told me that I did have COVID-19, that it had been a false negative and that I needed to rest. My biggest concerns are for the safety of the paramedics, who were seriously at risk thinking I was a negative for COVID-19 because of my initial test results. I'm interested to know if anyone else had a similar experience.
  9. Content Article
    Key points This report provides a road map for navigating through the current COVID-19 pandemic in the United States. It outlines specific directions for adapting our public-health approach away from sweeping mitigation strategies as we limit the epidemic spread of COVID-19, such that we can transition to new tools and approaches to prevent further spread of the disease. The authors outline the steps that can be taken as epidemic transmission is brought under control in different regions. They also suggest measurable milestones for identifying when we can make these transitions and start reopening America for businesses and families. In each phase, the authors outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time, but planning for each phase should begin now so the infrastructure is in place when it is time to transition.
  10. Content Article
    In this Institute for Healthcare Improvement (IHI) webinar discusses what it might look like to embed and center equity in the response to the pandemic going forward. This Virtual Learning Hour: Examines the latest data on the disproportionate COVID-19 death and infection rates among African Americans. Considers immediate actions to improve outcomes. Addresses inequities when it comes to testing, treatment, and prevention. Strategises long-lasting solutions.
  11. News Article
    The staff-to-patient ratios for intensive care are being dramatically reduced as the NHS seeks to rapidly expand its capacity to treat severely ill covid-19 patients, HSJ has learned. Acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”. Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally. She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough." “It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.” Read full story (paywalled) Source: HSJ, 24 March 2020
  12. News Article
    A new ventilator, a virus-killing snood and a hands-free door pull are just some of the innovations coming out of Wales to tackle coronavirus. Since the outbreak, doctors, scientists and designers have been working on ideas to stop the virus spreading. The ventilator has already successfully treated a Covid-19 patient and has been backed by the Welsh Government. Mass production of the snood-type mask is under way while a 3D design of the handle has been widely circulated. Plaid Cymru leader Adam Price, who was part of the impetus to get the ventilator into mass production, said the innovations put Wales "on the front foot" in the battle against the pandemic. "It shows that Wales, as a small nation, can get things done quickly as we face the biggest challenge of our generation," he said. Read full story Source: BBC News, 24 March 2020
  13. Content Article
    “Our emotions they say, guide us into facing predicaments and tasks to important to leave to intellect alone”. Daniel Goleman. Such an interesting concept, yet emotions are the things we so often suppress, don’t always know how to handle, don’t always talk about, are so very complex, yet feed into our behaviour, actions, our wellbeing and outcomes. So, guess what my blog is going to be about? We are going to be diving into emotions. Whether I am working with healthcare professionals, coroner’s officers, legal teams or any number of other professionals, I start off every training session I deliver on empathy and emotional awareness, saying this. It resonates every time. The reason it resonates, despite professional skills, is because we are all human beings first and foremost. And for us human beings, our emotions are a key player. I doubt if there is one person in this country that is having just an intellectual reaction to the COVID-19 pandemic. They will be having an emotional one too. And I am no exception, as we all battle with the threat nationally to our way of life, to our safety and the threat to our own personal world. If ever we needed empathy for each other, it is now. Let me paint a picture for you. I am sat at home (lucky that I have one) working. Nothing new there. When I am not delivering training, I am often at home running my business supporting organisations to incorporate an empathic and an emotionally aware approach to their practices, leadership and wellbeing of client group and staff. But instead of being able to go and work for a couple of hours down my local hotel, while enjoying a coffee, and connect with others, something vitally important to me (there is a reason I am very comfortable up on a stage in front of a hundred plus people – I am a people person). Or I may even have popped over the road to my mum who is now in complete isolation because of her vulnerabilities, go to the gym, or meet my bestie for an early evening drink and catch up with her in her family pub. It is now me, just me, all day, all evening. A ‘me’, in fact, that has gone from celebrating just a few days ago that I was off to Amsterdam to do a closing keynote address (yep, I had gone international!). A ‘me’ that was in discussions with the Ministry of Justice to potentially train 1000 people. A ‘me’ that was travelling all over the country and meeting amazing people. To now everything being on hold. Plus, like everyone else, absorbing the fact that we are facing a global and nationwide crisis. Now I consider myself to be a resilient person. I know overcoming adversity after losing my 15 year old daughter in hospital in patient safety circumstances and going through a brutal serious incident and inquest system. Yet, still needing to bring up three young children, when emotionally I was on my knees. But overcome I did and created a happy life. Once more, created a business that is not only embedded in my counselling background but my lived experience of empathy, or lack of it in challenging situations, indeed in my whole adult life. So yes, the impact, as for many these last few days, was indeed emotional, as well as intellectual, as I went from a euphoria and excitement, to shock, fear and worry. Compassion for others is such a crucial human attribute to have and use but is underpinned by empathy and emotional awareness. To be able to think, ‘what might it be like for that person?’ What I have found, doing the work that I do, is that people are so much better at this when they feel that someone is considering the very same about them too. Whenever I do my training, whether in leadership, investigations, or communication, it is not about giving a toolkit of magic words or phrases. Oh if only it was that easy. But it isn’t. It is about helping people firstly feel and understand their own empathic response. Taking empathy out of the textbook and into their real life application. It is to help them understand and feel proud and confident of what they do well already. To challenge their thinking, perspective and biases (yep, we all have them!!). And, very importantly, how to care for themselves, colleagues and teams, so that empathy is kept strong and apathy kept in check. And resilience is optimised. This always has been important, but even more so now. Nurses, doctors, executive teams, paramedics, cleaners, health support workers, receptionists, to name but a few, all have their own emotional felt experiences. Their own deep-routed triggers, saturation points in their real everyday lives too. They face their own fears as their own internal personal world is under threat too. Empathy for others when overwhelmed is not always easy. I don’t always get it right either, I can promise you that. Managers, take a second or two to ask how your team are? Team, in return, ask how your manager is? Nurses, ask how your patient and loved ones are? But patient, have you asked how your nurse is? In a time when human connection, touch, closeness, social activities are so restricted, our words, our tone, our empathic attitude, our emotional awareness, our care and interest in others does not have to be restricted. We have power still. All of us. To make someone else’s day a little worse, or a little better. We connect on an emotional level; it is a felt experience. I started off this blog with how I start a session and so I will finish with how I often end and with this quote, because it transcends whatever job title you hold, whatever profession you work in. It transcends race, age, culture and gender. Because our one commonality is that we are human beings, with our own real life and story and our own emotional experience. "People hear your words, but they feel your attitude". C Maxwell.
  14. News Article
    Medical students who are employed in the NHS as part of efforts to swell staff numbers to tackle covid-19 should not be expected to “step up” and act outside of their competency, says the BMA in new guidance. This is the first set of guidance released by the BMA specifically for medical students, who have had placements and exams cancelled and are uncertain about how they might be employed in the NHS in the current crisis. It says that any employment should be voluntary and within the competency of the student, who should have adequate access to personal protective equipment. The BMA refers to General Medical Council guidance that states that plans are not currently in place to move provisional registration forward from the normal August date. It warns that there are concerns around the boundaries of practice and the level of supervision that students who take on roles in the NHS would have, which could lead to unsafe working practices. The BMA is in talks to negotiate a safe national contract for such roles. Read full story Source: BMJ, 24 March 2020
  15. News Article
    A GP has criticised the practice of giving doctors surgical masks with expiry dates that have passed. Dr Kate Jack said doctors felt "like cannon fodder" after discovering the paper masks had expired in 2016. A box delivered to her Nottingham surgery had a 2021 label placed over the original date of 2016. The Department of Health and Social Care (DHSC) said equipment underwent "stringent tests" and was given a "new shelf-life" where appropriate. "I don't feel protected at the moment," said Dr Jack, a GP of 22 years. "They are really not designed for prevention of infection and are practically useless." Read full story Source: BBC News, 25 March 2020
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