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Found 11 results
  1. News Article
    A health board has apologised to the family of a patient after medical staff failed to consult with them over a decision not to resuscitate her. While the decision was clinically justified, the public services ombudsman for Wales said Betsi Cadwaladr health board did not discuss it with the patient and her family. The ombudsman, Michelle Morris, also upheld a complaint by the patient's daughter, identified only as Miss A, that her mother's discharge from Ysbyty Gwynedd in Bangor was "inappropriate" and that insufficient steps were taken to ensure her needs could be safely met at home. The final complaint, which was also upheld, was that medics failed to communicate with the family about the deteriorating condition of the patient, identified as Mrs B, which meant a family visit was not arranged before she died. In her report she said the Covid pandemic had contributed to the failings, but added "this was a serious injustice to the family". As well as apologising to the family, she asked that all medical staff at Ysbyty Gwynedd and Ysbyty Penrhos Stanley be reminded of the importance of following the proper procedure when deciding when a patient should not be resuscitated. Read full story Source: BBC News, 6 February 2023
  2. Content Article
    This research from Benjamin Kah Wai Chang and Pia Matthews was conducted between May and August 2021, during which COVID-19 hospital cases were relatively low and pressures on NHS resources were near normal levels. Data were collected via online survey sent to doctors of all levels and specialties, who have worked in the NHS during the pandemic. In total, 231 participants completed the survey. The research found that over half of participants reported making more patients DNACPR than prepandemic, and this was due, at least in part, to an increased focus on factors including patient age, Clinical Frailty Scores and resource limitations. In addition, a sizeable minority of participants reported that they now had a higher threshold for escalating patients to ITU and a lower threshold for palliating patients, with many attributing these changes to formative experiences gained during the pandemic. The study found that there has not been a statistically significant change in the views of clinicians on the legalisation of euthanasia or physician-assisted suicide since the start of the pandemic. The authors concluded that the COVID-19 pandemic appears to have altered several aspects of end-of-life decision making, and many of these changes have remained even as COVID-19 hospital cases have declined.
  3. Content Article
    The authors found that the four most frequent tracheostomy-related complications were: unplanned decannulations, 71.4% uncontrolled bleeding/hemorrhage, 9.2% partial/total occlusion, 6.9% mucus plug/thick secretions, 6.9%. They concluded that in order to manage patient airways safely, staff need to be knowledgeable, confident and equipped with appropriate skills and equipment to respond promptly when there are complications. They discuss potential safety strategies to reduce the risk of complications and issues related to equipment, knowledge and communication.
  4. News Article
    Doctors are less likely to resuscitate the most seriously ill patients in the wake of the pandemic, a survey suggests. Covid-19 may have changed doctors’ decision-making regarding end of life, making them more willing not to resuscitate very sick or frail patients and raising the threshold for referral to intensive care, according to the results of the research published in the Journal of Medical Ethics. However, the pandemic has not changed their views on euthanasia and doctor-assisted dying, with about a third of respondents still strongly opposed to these policies, the survey responses reveal. The Covid-19 pandemic transformed many aspects of clinical medicine, including end-of-life care, prompted by millions more patients than usual requiring it around the world, say the researchers. In respect of DNACPR, the decision not to attempt to restart a patient’s heart when it or breathing stops, more than half the respondents were more willing to do this than they had been previously. Asked about the contributory factors, the most frequently cited were: “likely futility of CPR” (88% pre-pandemic, 91% now); coexisting conditions (89% both pre-pandemic and now); and patient wishes (83.5% pre-pandemic, 80.5% now). Advance care plans and “quality of life” after resuscitation were also commonly cited. Read full story Source: The Guardian, 25 July 2022
  5. News Article
    When Susan Sullivan died from Covid-19, her parents’ world fell quiet. But as John and Ida Sullivan battled the pain of losing their eldest, they were comforted by doctors’ assurance that they had done all they could. It was not until more than a year later, when they received her medical records, that the family made a crushing discovery. These suggested that, despite Susan being in good health and responding well to initial treatments, doctors at Barnet hospital had concluded she wouldn’t pull through. When Susan was first admitted on 27 March 2020, a doctor had written in her treatment plan: “ITU (Intensive therapy unit) review if not improving”, indicating he believed she might benefit from a higher level of care. But as her oxygen levels fell and her condition deteriorated, the 56-year-old was not admitted to the intensive unit. Instead she died in her bed on the ward without access to potentially life-saving treatment others received. In the hospital records, seen by the Observer, the reason Susan was excluded is spelled out: “ITU declined in view of Down’s syndrome and cardiac comorbidities.” A treatment plan stating she was not to be resuscitated also cites her disability. For John, 79, a retired builder, that realisation was “like Susan dying all over again”. “The reality is that doctors gave her a bed to die in because she had Down’s syndrome,” he said. “To me it couldn’t be clearer: they didn’t even try.” Susan is one of thousands of disabled people in Britain killed by Covid-19. Last year, a report by the Learning Disabilities Mortality Review Programme found that almost half those who died from Covid-19 did not receive good enough treatment, including problems accessing care. Of those who died from Covid-19, 81% had a do-not-resuscitate decision, compared with 72% of those who died from other causes. Read full story Source: The Guardian, 10 July 2022
  6. Content Article
    Findings Findings of this investigation included: The administration of a blood transfusion as part of resuscitation requires a number of preparatory steps, including collecting the blood and undertaking various checks before using it. Inclusion in resuscitation training of a prompt for clinicians to consider the need for a transfusion, and to prepare for it if appropriate, may help reduce any delay. Involving members of neonatal teams (staff who specialise in the care of newborn babies) in multidisciplinary training in maternity units is not routine. Standardising their inclusion in such training would promote a shared understanding of relevant clinical information and ways of working. Recommendations The report makes the following safety recommendations: HSIB recommends that NHS Resolution, working with relevant specialities through the clinical advisory group, amends the maternity incentive scheme guidance for year five to include the neonatal team as one of the professions required to attend multi-professional training. HSIB recommends that the Resuscitation Council (UK)’s Newborn Life Support training course highlights that neonatal resuscitation teams should consider fetal blood loss in the event of neonatal resuscitation that includes chest compressions. In addition, this consideration should be included in the guidance to support the newborn life support algorithm.
  7. Content Article
    Latest case studies: Urgent/emergency care Delayed oxygenation of neonate during resuscitation when oxygen not ‘flicked’ on Equipment falling onto critically ill patients during intrahospital transfers Misapplication of spinal collars resulting in harm from unsecured spinal injury Ensuring compatibility between defibrillators and associated defibrillator pads Ensuring pregnant women with COVID-19 symptoms access appropriate care General medicine Harm from catheterisation in patients with implanted artificial urinary sphincters Confusion between different strength preparations of alfentanil Ensuring compatibility between defibrillators and associated defibrillator pads Distinguishing between haemofilters and plasma filters to reduce mis-selection Variation in use of cardiac telemetry Ceftazidime as a 24-hour infusion Tacrolimus – risk of overdose when converting from oral to intravenous route Haloperidol prescribing for confused/agitated/delirious patients Ensuring oxygen delivery when using two step humification systems Intensive care Ventilator left in standby mode Equipment falling onto critically ill patients during intrahospital transfers Ensuring compatibility between defibrillators and associated defibrillator pads Distinguishing between haemofilters and plasma filters to reduce mis-selection Sudden patient deterioration due to secretions blocking heat and moisture exchanger filters Anaesthetic machines used as ventilators: issues with circuit set up Importance of ‘tug test’ for checking oxygen hose when transferring a patient to a portable ventilator Ensuring oxygen delivery when using two step humification systems Obstetrics and gynaecology/midwifery Harm from prescribing and administering Syntometrine when contraindicated to woman with significantly raised BP Delayed oxygenation of neonate during resuscitation when oxygen not ‘flicked’ on Unnecessary caesarean section for breech presentation if not scanned on the day HIV prophylaxis in women and new-borns Ensuring compatibility between defibrillators and associated defibrillator pads Ensuring the safe use of plastic cord clamps at caesarean section Warning on the use of ethyl chloride during fetal blood sampling Ensuring pregnant women with COVID-19 symptoms access appropriate care Risk of babies becoming unwell following move to virtual home midwifery visits Paediatrics and child health Ensuring compatibility between defibrillators and associated defibrillator pads Risk of babies becoming unwell following move to virtual home midwifery visits Unintentional perforation of oesophagus in neonates from invasive procedures Chemical burn to a neonate from use of chlorhexidine Other Ensuring compatibility between defibrillators and associated defibrillator pads Infrared temperature screening to detect COVID-19
  8. Content Article
    Executive summary of the main changes since the 2015 GuidelinesGuidelines ProcessEducationEpidemiology of cardiac arrestEthicsSystems saving livesAdult basic life supportAdult advanced life supportSpecial circumstancesPost-resuscitation carePaediatric basic life supportPaediatric advanced life supportNewborn resuscitation and support of transition of infants at birthContributors and Conflict of InterestReferences