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Content ArticleResilience matters now more than ever in healthcare, with the COVID-19 pandemic putting healthcare providers and systems under unprecedented strain. In popular culture and everyday conversation, resilience is often framed as an individual character trait where some people are better able to cope with and bounce back from adversity than others. Research in the management literature highlights that resilience is more complicated than that – it’s not just something you have, it’s something you do. Drawing on research on managing unexpected events, coordinating under challenging conditions, and learning in teams, Barton et al. distill some counter-intuitive findings about resilience into actionable lessons for healthcare leaders.
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Content ArticleWatch as Dr Donna Prosser is joined by a panel of experts to discuss how the COVID-19 pandemic is affecting mental health across the globe and share some tips for effectively managing these challenges.
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Content ArticleFor a child, coming in to hospital can be pretty scary at the best of times, but it's especially daunting at the moment with all the doctors and nurses wearing their special personal protective equipment (PPE) for coronavirus. Edinburgh Children's Hospital Charity has created a video that explains, with help of some big and small superheroes, why various outfits – such as an astronaut's helmet or a firefighter's uniform – protect workers from different types of hazards. The idea is to help children in hospital feel more at ease while staff wearing PPE are caring for them.
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Content ArticleDr Susan Whalley-Lloyd, Senior Lecturer in Human Factors/Ergonomics at Staffordshire University, discusses how the learning and research opportunities evolving from the coronavirus pandemic will add to our human factors knowledge base and gives us a unique opportunity to achieve new research in human factors and patient safety.
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Content ArticleTrisha Greenhalgh and colleagues argue that it is time to apply the precautionary principle. The precautionary principle is, according to Wikipedia, “a strategy for approaching issues of potential harm when extensive scientific knowledge on the matter is lacking.” The evidence base on the efficacy and acceptability of the different types of face mask in preventing respiratory infections during epidemics is sparse and contested. But COVID-19 is a serious illness that currently has no known treatment or vaccine and is spreading in an immune naive population. Deaths are rising steeply, and health systems are under strain. This raises an ethical question: should policy makers apply the precautionary principle now and encourage people to wear face masks on the grounds that we have little to lose and potentially something to gain from this measure? Greenhalgh and colleagues believe we should. However, there are criticisms of this view. Read the original analysis published in the BMJ and Tricia Greenhalgh's follow up paper in the Journal of Evaluation in Clinical Practice where she rebutts the criticisms received.
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Content ArticleIn this commentary published in the Journal of Patient Safety and Risk Management, Gurses et al. describe how human factors and ergonomics (HFE) can contribute to the COVID-19 pandemic response. Specifically, the authors provide an example of how HFE methodologies informed workflow redesigns implemented as part of COVID-19 pandemic preparations in an academic paediatric ambulatory clinic. They identify key mechanisms and areas where HFE can contribute to and improve the effectiveness of a pandemic response: Just-in-time (JIT) training development, adapting workflows and processes, restructuring teams and tasks, developing effective mechanisms and tools for communication, engaging patient and families to follow the recommended practices (e.g., social distancing, revised hospital visitation policies), identifying and mitigating barriers to implementation of plans, and learning from failures and successes to improve both the current and future pandemic responses.
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Content ArticleCancer diagnostics and surgery have been disrupted by the response of healthcare services to the COVID-19 pandemic. Progression of cancers during delay will impact on patient long-term survival. Sud et al., in a paper published in Annals of Oncology, found: Lockdown and re-deployment due to the COVID-19 pandemic is causing significant disruption to cancer diagnosis and management. 3-month delay to surgery across all Stage 1-3 cancers is estimated to cause >4,700 attributable deaths per year in England. The impact on life years lost of 3-6 month to surgery for Stage 1-3 disease varies widely between tumour types. Strategic prioritisation of patients for diagnostics and surgery has potential to mitigate deaths attributable to delays. The resource-adjusted benefit in avoiding delay in cancer management compares favourably to admission for COVID-19 infection.
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Content ArticleA medical student describes his experiences of working in the ICU of his local hospital during coronavirus in this Independent blog. "I was one of the first medical students at my university to be recruited to help out in local hospitals as fears grew about the NHS being overwhelmed by COVID-19."
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Content ArticleAs the death toll from COVID-19 rapidly increases, the need to make a timely and accurate diagnosis has never been greater. Even before the pandemic, diagnostic errors (i.e., missed, delayed, and incorrect diagnoses) had been one of the leading contributors to harm in health care. The COVID-19 pandemic is likely to increase the risk of such errors. Based on emerging literature and collaborative discussions across the globe, Gandhi and Singh propose a new typology of diagnostic errors of concern in the COVID-19 era. These errors span the entire continuum of care and have both systems-based and cognitive origins. While some errors arise from previously described clinical reasoning fallacies, others are unique to the pandemic. We provide a user-friendly nomenclature while describing eight types of diagnostic errors and highlight mitigation strategies to reduce potential preventable harm caused by those errors.
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Content ArticleThe Royal College of Midwives has put together an infographic of some of the common stresses that mothers and those working in maternity services may be experiencing and some strategies to help you cope.
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Content Article
NHS Employers: Risk assessments for staff – COVID-19
PatientSafetyLearning Team posted an article in Staff safety
This page contains guidance for employers on how to carry out risk assessments particularly for vulnerable groups, to understand the specific risks staff members face from exposure to COVID-19 and actions which employers can take to keep staff safe. This includes staff returning to work for the NHS, and existing staff who are potentially more at risk due to their race, age, disability or pregnancy. -
Content ArticlePaul Garner is Professor at the Liverpool School of Tropical Medicine. He is Director of the Centre for Evidence Synthesis in Global Health and Co-ordinating Editor of the Cochrane Infectious Diseases Group. In this blog for BMJ Opinion, Paul describes how he has struggled in the weeks following his COVID-19 infection and the relapses in fatigues that have occurred after any exertion.
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Content Article
COVID-19 tests: The safety implications of false negatives
PatientSafetyLearning Team posted an article in Blogs
The number of people accessing COVID-19 testing in the UK continues to increase. Health Secretary, Matt Hancock recently announced, that anyone over the age of five years old who is showing symptoms is eligible for a test [1]. However, there are concerns that the rate of ‘false negative’ test results could be as high as 30% and a significant number of people are wrongly being told they do not have the virus [2]. This could be due to the particularly difficult nature of obtaining the swab, which requires someone to take a sample from the very back of the mouth or deep from inside the nose. “Swabbing patients using the correct technique is paramount in ensuring an accurate result. Nasal swabs need to be taken from far back in the nasal pharynx and is often uncomfortable for the patient. By simply swabbing the inside of the nasal passage is not deep enough to verify that the virus is present. I am unsure that all clinical staff have been taught the correct way to swab patients.” Claire Cox, Intensive Care Outreach Nurse. Members of the public are now able to request self-testing kits to do at home if they are experiencing symptoms. If clinicians like Claire are finding the test challenging to perform on others, it is likely that patients could struggle to swab deep enough into their own nasal pharynx (7-8cm). There is a risk that as the number of people testing themselves increases, so too will the rate of false negative results. Testing is a key element of the UK’s COVID-19 infection control strategy [3]. A high, and potentially rising, rate of false negative results means that a significant number of people could be carrying the virus, wrongly reassured they are not infectious. In this blog, we look at some of the associated safety risks. -
Content ArticleRehabilitation is fast becoming the new priority in dealing with the impact of this pandemic and is crucial for people recovering from COVID-19 infection.The Royal College of Occupational Therapists (RCOT) have published three guides to support people to manage post-viral fatigue and conserve their energy as they recover from COVID-19. These guides are endorsed by the Intensive Care Society.Practical advice for people who have been treated in hospitalPractical advice for people who have recovered at home’Practical advice for people during and after having COVID-19.You can download the guides via the link below.
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Content Article
'False negative' and the impact on my mental health
Anonymous posted an article in Blogs
The following blog was shared by a patient who wished to remain anonymous. In this account, they explain why they felt they were treated differently when they presented with symptoms of Covid-19 due to their mental health difficulties. They also describe how receiving a false negative test result caused further harm to their mental health. -
Content ArticleOur NHS staff are doing fantastic work to tackle the COVID-19 pandemic and keep essential services going – their hard work and dedication during this difficult time is remarkable. As the NHS Chief Executive Sir Simon Stevens made clear in his letter of 29 April 2020 to NHS chief executives, it is important to remind everyone of the duty – and right – of those who work in the NHS to speak up about anything which gets in the way of patient care and worker wellbeing. Hear what Prerana Issar, the first NHS Chief People Officer, has to say in her blog. See also our hub resources on Whistleblowing and Speak Up Guardians.
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Content ArticleHow will the coronavirus pandemic affect the nation’s mental health? Covid-19 and the nation’s mental health: Forecasting needs and risks in the UK is the first assessment from the Centre for Mental Health of the likely impacts of COVID-19 on mental health in Britain. It uses evidence from previous epidemics internationally and from the aftermath of the 2008 banking crisis to estimate what effect COVID-19 will have on mental health at population level in the UK.
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Content ArticleDraft resolution proposed by Albania, Australia, Bangladesh, Belarus, Bhutan, Botswana, Brazil, Canada, Chile, Colombia, El Salvador, Guatemala, Iceland, India, Indonesia, Japan, Mexico, Monaco, Montenegro, Mozambique, New Zealand, North Macedonia, Norway, Paraguay, Peru, Republic of Korea, Republic of Moldova, Russian Federation, San Marino, Sierra Leone, South Africa, the European Union and its Member States, Turkey, Ukraine, United Kingdom of Great Britain and Northern Ireland and Zambia following the 73rd World Health Assembly.
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Content Article
Coronavirus: 'I didn't want her dying on her own'
Patient Safety Learning posted an article in Blogs
Siobhan Brammeld is a care worker at Massereene Manor care home in County Antrim and leads the social care team. She has sat with several residents as they passed away having contracted COVID-19. In this interview with BBC News NI she says she was convinced some residents had "died before their time". "I feel as though I am on autopilot - it never leaves my head. Sometimes I worry that I could have done more," she said. "These are sad times, scary times too," she added. Siobhan told BBC News that staff felt not enough was done to prepare them for the pandemic and that workers like her were left to the side. "I feel we were left on our own. We as workers were forgotten about as well as the wee residents," she said. "At the start of all this I just wanted to scream at somebody - could someone please come and help these wee residents? I just didn't want them to die before their time." "I watched what was happening in other countries and you knew it was coming, but there didn't seem to be an awful lot happening to prepare us." -
Content ArticleThe Care Quality Commission (CQC) has published the first of what will be a regular series of insight documents intended to highlight COVID-19 related pressures on the sectors that CQC regulates. This document draws on information gathered through direct feedback from staff and people receiving care, regular data collection from services who provide care for people in their own homes, and insight from providers and partners. The information collected from these sources is being used to understand the wider impact of COVID-19, to share regular updates with local, regional, and national system partners and the Department of Health and Social Care, and to highlight any emerging trends and issues.
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Content Article
Rethink Mental Illness: COVID-19 and mental illness
Patient Safety Learning posted an article in Mental health
The charity Rethink Mental Illness have set up an online hub to provide practical support and information that is useful for people living with, or supporting people with mental illness during the coronavirus pandemic. -
Content ArticleThe results of this US study are consistent with findings from China and Italy, which suggest that patients with underlying health conditions and risk factors, including, but not limited to, diabetes mellitus, hypertension, COPD, coronary artery disease, cerebrovascular disease, chronic renal disease, and smoking, might be at higher risk for severe disease or death from COVID-19. This analysis was limited by small numbers and missing data because of the burden placed on reporting health departments with rapidly rising case counts, and these findings might change as additional data become available.
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Content Article
Dirty Dozen and COVID-19 (webinar, May 2020)
Claire Cox posted an article in Coronavirus (COVID-19)
There are fears around maintaining personal safety whilst ensuring patient safety. Staff need to protect both themselves and their families at home. Equally, it is essential that staff feel supported in identifying risks and the potential for errors with a robust mechanism in place to reduce, eliminate or mitigate such risks. The Human Factors 'Dirty Dozen' is a concept developed by Gordon DuPont. He described elements that can act as precursors to accidents or incidents, or influence people to make mistakes. This webinar, from the Clinical Excellence Commission, looks at ways you can identify risks or 'hot spots' in your area of work and then discuss with your team at handover and huddles and plan strategies to reduce, eliminate or mitigate the risks -
Content ArticleThe COVID‐19 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use in intubation. The authors of this paper, published in Anaesthesia, evaluated the impact of two aerosol boxes (an early‐generation box and a latest‐generation box) on intubations in patients with severe COVID‐19 with an in‐situ simulation crossover study.
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Content ArticleAround 6.5 million carers in the UK are propping up the NHS by keeping loved ones safe at home. Where is their recognition? For the past eight years, Sheena and her brother have been caring for their mother, who has early onset dementia, diabetes and other health issues. In her blog to the Guardian, Sheena discusses why she wants to see affirmative action for carers, why government needs to take responsibility and why the carers themselves need to be involved in these discussions.
