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News Article
Baby died after deadly bowel condition was mistaken for cow’s milk allergy
Patient Safety Learning posted a news article in News
A two-month-old baby died after doctors mistook symptoms of a suspected perforated bowel for a cow’s milk intolerance. Nailah Ally was diagnosed with a hole in the heart before she was born and necrotising enterocolitis (NEC) shortly after her birth in October 2019. Nailah died from multiple organ failure after she was sent home from hospital and went into septic shock A consultant believed Nailah might have an intolerance to cow’s milk and changed the formula she was being fed. A spokesman for the family said: “Nailah’s case not only vividly highlights the dangers of sepsis, but the potential consequences of poor communication between doctors as well as between doctors and families.” Read full story (paywalled) Source: The Telegraph, 7 March 2023- Posted
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Actions Identify if the accidental ingestion of dry thickening powder has occurred, or could occur, in your organisation. Consider if immediate action needs to be taken locally, and ensure that an action plan is underway if required, to reduce the risk of further incidents occurring. Distribute this alert to all relevant staff who care for children or adults in primary care, emergency care, and inpatient care settings, including mental health and learning disability units. Share any learning from local investigations or locally developed good practice resources by emailing patientsafety.enquiries@nhs.net.- Posted
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Blog - Food allergies: Unproven diagnostic tests
Patient-Safety-Learning posted an article in Allergies
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News Article
Inquest finds neglect contributed to woman’s hospital death
Patient Safety Learning posted a news article in News
The death of a young disabled woman following a routine eye operation was partly caused by malnutrition as a result of neglect, a coroner has ruled. Laura Booth, 21, was admitted to the Royal Hallamshire hospital in Sheffield in September 2016 for a routine eye operation. She died the next month, on 19 October. Booth had a number of learning difficulties and life-limiting complications, having been diagnosed with partial trisomy 13, a rare genetic disorder, shortly after she was born. Her mother, Patricia Booth, told the inquest that her daughter stopped eating shortly after she was admitted to hospital, and that doctors ignored Laura’s attempts to communicate with them. She said her daughter consumed only rice milk and blackcurrant juice in hospital, and she kept telling doctors: “This isn’t right, she can’t survive on no food.” The coroner, Abigail Combes, concluded that Laura Booth became unwell while a patient at the hospital and, among other illnesses, “developed malnutrition due to inadequate management for her nutritional needs”. Combes said that Booth’s death “was contributed to by neglect”. Read full story Source: The Guardian, 26 April 2021- Posted
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Having a child with a food allergy can have a devastating effect on all of the family. Research by the University of East Anglia last month (March) revealed that almost half (42%) of parents of children living with food allergies have suffered trauma that meets the criteria for post-traumatic stress symptoms.[1] It’s a shocking figure, but perhaps not surprising. Between 6 and 8% of children have a food allergy, with the most common being eggs, milk and peanuts. The number of people admitted to hospital for severe food allergies has tripled over the past two decades according to research published in the BMJ this year.[2] Deaths are thankfully rare but watching your child have a potentially life-threatening reaction to a food is harrowing. Then there is the day-to-day constant vigilance to try to avoid the allergen that could cause a reaction, the anxiety of not knowing when the next allergic reaction will occur and whether the prescribed EpiPen to counter a reaction will work. The uncertainty is huge. Yet there is surprisingly little support for these parents who spend their lives trying to keep either themselves (if they have a food allergy) or their children safe. The Natasha Allergy Research Foundation was formed in 2019 to improve the lives of the 2 to 3 million people in the UK who have a food allergy and their families. It was set up by the parents of Natasha Ednan-Laperouse who died aged 15 in 2016 after having an allergic reaction to an ingredient hidden in a baguette. The charity focuses on medical research as well as education and raising awareness of food allergies. Natasha’s parents, Tanya and Nadim, have also successfully campaigned for Natasha’s Law, which requires businesses to provide a full list of ingredients on pre-packaged food made and sold on the same premises, such as salads and sandwiches, from this October. They know only too well the challenges of caring for a child with a severe food allergy and are alarmed at the lack of support available to families. Natasha had her first allergic reaction when she was six months old, when she ate a small amount of banana which caused her lips to swell until they split. "She was screaming, it was just awful," recalls Tanya. "The second time, when she had formula milk, she looked like she’d been dropped into a vat of hot oil. Her skin was raised and bright red and she was in complete distress." Even if you’re an adult or a child who hasn’t had an anaphylactic reaction, knowing it is a possibility causes huge amounts of stress. "Worrying about something can often be worse than actually having to deal with it because it never leaves your side," adds Tanya. "You’re in a constant state of hypervigilance but trying to lead a normal life because the last thing you ever want to do is to actually become someone who micromanages everything as that’s no way to live either." Part of the problem is that there are not enough trained allergists in this country, the charity says. GP training in allergies is also patchy, so while some patients and their families get the support they need, others are left to cope on their own. "We know from our supporters that many people with food allergies feel they are forgotten and alone," says Tanya. "They find it hard to get the care and support they need and, in some cases, to have their condition taken seriously. This has to change." Despite the growing number of people with a food allergy, allergy remains a Cinderella service in the NHS; there has been little attention, importance and investment given to NHS allergy services despite a number of reports since 2003 by allergy experts and MPs calling for better care for people with allergic disease. "Many GPs receive no training in allergies which can be complex conditions. There is also a shortage of allergy specialists in the UK and allergy training. As a result, the care people with allergies receive is at best patchy, and at worst has led to avoidable deaths. Without greater priority given to allergies, these problems will continue and sadly more lives will be lost unnecessarily," adds Tanya. To find out more about Natasha’s Army (to receive regular updates on the work of the Foundation) go to www.narf.org.uk. References Roberts K, Meiser-Stedman R, Brightwell A, Young J. Parental Anxiety and Posttraumatic Stress Symptoms in Pediatric Food Allergy. J Pediatr Psych 2021; https://doi.org/10.1093/jpepsy/jsab012. Baseggio Conrado A, Ierodiakonou D, Gowland MH, et al. Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018. BMJ 2021;372. R -
News Article
York eating disorder clinic served unsafe food
Patient Safety Learning posted a news article in News
A hospital for adults with eating disorders has been rated inadequate after inspectors found the provision of food was "unsafe and unacceptable". A Care Quality Commission (CQC) report of the Schoen Clinic in York said some patients were given mouldy bread and one was served food containing plastic. Concerns were also raised around lack of staff and patient safety, though wards were clean and well-equipped. Schoen Clinic Group said issues raised in the report "were quickly addressed". Following the inspection in January the hospital has been placed in special measures and will be visited again in six months. Brian Cranna, CQC's head of hospital inspection, said: "The standards of care we found at Schoen Clinic York were putting patients at risk and so we have taken urgent enforcement action, which means the service must improve if it's to retain its registration." According to the report patients were put at risk of "physical and psychological harm due to unsafe and unacceptable food provision". Read full story Source: BBC News, 21 April 2022- Posted
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Self-isolation may be a pipe dream
Anonymous posted an article in Blogs
We knew what would be coming at us several weeks ago. Our daughter is a bit of a doomsday prepper and she had been warning us for a while. We had slowly stocked up on a few essentials, nothing ridiculous. We'd also made sure that we had supplies of our medications, and switched away from Boots to a small local pharmacy who promised to do deliveries. We had corded phones, candles, lanterns and lots of batteries in case of power outages. We had some bottled water. We had stocked up the freezer. We hadn't thought the panic buying would start so quickly, or last so long. Toilet paper was a surprise. We hadn't bought any extra of that, so that was an issue, but our daughter managed to find some for us. We are used to working from home. We have done it off and on for over a decade, so this situation is not new for us. We are tech savvy and able to use digital tools to meet our work needs. However, as freelancers, we have been hit hard by work just being cancelled and having much less to do than normal. Less money coming in too, soon. The hardest thing of all has been that while we want to heed the Government's call to stay at home as reasonably high-risk individuals, we cannot book any food deliveries. Tesco, Ocado and Morrisons have no slots available at all. Thankfully we had two already booked with Tesco before the end of this month. After that, the food will start to run out here. With rationing etc already in place, our family who do visit the shops cannot buy extra for us. At some point, regardless of the risk, we may have to leave the house. Wish us luck!!- Posted
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