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Community PostTwo vaccines for COVID-19 have now been approved. Health organisations are doing their upmost to workout how best to store and administer the vaccines safely and avoiding errors. The Chartered Institute of Ergonomics and Human Factors (CIEHF) are preparing strategic guidance for health authorities and operational guidance for people setting up vaccine programmes applicable internationally. In a recent LinkedIn post, Chief Executive Noorzaman Rashid asks: "What are the Human Factors and Ergonomic issues that should be considered?" And asks you to share your ideas: https://www.linkedin.com/posts/noorzamanrashid_the-economist-on-twitter-activity-6750290388721926144-h8XV/ #ciehf #covid #patientsafety
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News ArticleOnly a third of local authorities that are rolling out lateral flow testing have made the test’s limitations clear to the public—including that it does not pick up all cases and that people testing negative could still be infected, an investigation by The BMJ has found. A search of the websites of the 114 local authorities rolling out lateral flow testing found that 81 provided information for the public on rapid COVID-19 testing. Of these, nearly half (47%; 38) did not explain the limitations of the tests or make it clear that people needed to continue following the restrictions or safety measures even if they tested negative, as they could still be infected. Although 53% (43) did advise people to continue to follow the current measures after a negative result, only 32% (26) were clear about the test’s limitations or its potential for false negatives. The advice the websites gave to the public about a negative test result ranged from “A single negative test is not a passport to carrying on your daily life ‘virus-free’... don’t let a negative COVID-19 test give you a false sense of security” to “It is good news that you don’t have the coronavirus.” On 10 January England’s health secretary, Matt Hancock, launched the drive for local authorities to test asymptomatic people who cannot work from home, to try to halt the spread of the virus. But many public health experts are concerned about false reassurance from mass testing. Read full story Source: BMJ, 26 January 2021
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News ArticleNew advice on how to treat coronavirus has been issued by the World Health Organisation (WHO) as it also begins a wide-reaching study into the effects of so-called "long COVID". For COVID-19 patients at home, WHO is now suggesting the use of a pulse oximetry machine to measure oxygen levels in the blood - but warns that this should only be done after full patient education and with medical follow-up support if necessary. For hospitalised patients, WHO is recommending the use of low-dose anticoagulants to prevent clots forming in blood vessels, known as thrombosis. And for sufferers who are already using supplemental oxygen, the organisation is officially endorsing the positioning of patients on their stomachs to increase oxygen flow. This is known as "awake prone positioning". The new guidelines also include a recommendation that healthcare professionals favour "clinical judgement over models" in making decisions for individual patients. Read full story Source: Sky News, 26 January 2021
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News ArticleA trust has warned it may reach a ‘tipping point’ where it is ‘impossible’ to separate covid positive and negative patients. Surrey and Sussex Healthcare Trust also revealed in papers published ahead of its Thursday board meeting that it planned to distribute a “duty of candour” leaflet for patients, warning them of the risk of contracting covid in hospital. The papers noted covid patients at the trust increased from 80 pre-Christmas to 230 by January, filling half its beds. HSJ’s figures suggest covid patients at the trust continued to rise until around 14 January before dropping back slightly. The report from the trust’s safety and quality committee — which met on 7 January — said: “It is becoming more difficult to separate the covid+ and covid- patients. In an increasing number of instances, patients are admitted to cold areas for non-covid treatment and without symptoms but then test positive. These patients then need to be admitted to hot areas and any contacts (including patients from the same bay) isolated. “At some point a tipping point could be reached where it may be impossible to retain hot and cold areas.” Read full story (paywalled) Source: HSJ, 27 January 2021
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News ArticleRotating clinicians and keeping ventilation running are among Public Health England’s (PHE) recommendations for how to avoid spreading covid while looking after patients in the back of ambulances outside emergency departments. The suggestions are made in unprecedented new guidance issued by PHE amid sky-high rates of very long ambulance handovers outside hospitals. This is because emergency departments (EDs) are struggling with attempts to maintain distancing for infection control, along with high occupancy and severe operational pressures elsewhere in hospitals. It has led over the past two months to large numbers of patients being looked after in ambulances for extended times while they wait for space in ED. The PHE guidance, added last week to existing covid guidance for ambulance services, says it should only happen in “exceptional circumstances”. But it says staff in this situation should adopt infection prevention and control procedures including: if more than one clinician is available, rotating them regularly, so allowing them time to change PPE and have a drink; keeping ventilation systems running which may require the engine to be kept running; ensuring patients and any essential escorts wear surgical masks, as long as patient care is not compromised; minimising the number of people within the patient compartment and avoiding sitting face-to-face with patients; and decontaminating contact surfaces more frequently and during the delay if possible. Read full story (paywalled) Source: HSJ, 25 January 2021
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News ArticleLondon’s largest acute trust has been accused of ‘emotional blackmail’ by suggesting junior doctors could do voluntary shifts in its ‘really short staffed’ critical care unit. In an email cascaded to all junior doctors at Whipps Cross Hospital, run by Barts Health Trust, hospital medical director Heather Noble said day and night shifts at another trust site, the Royal London Hospital, “really need cover”. She said doctors could work overtime through a “voluntary or paid shift”, and that if they made contact, should “state whether or not they want to be paid”. Doctors working at the trust who received the email, who wished to remain anonymous, described the email as “tone deaf” and “not the right way to incentivise anyone to do what they want”. One medic said: “There has been a lot of anger generated by this correspondence amongst junior doctors. People already working antisocial and demanding rotas are very unhappy about being asked to work more hours for free.” Read full story (paywalled) Source: HSJ, 26 January 2021
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News ArticleMen working in low-skilled jobs or care, leisure and service roles are more than three times as likely to die from Covid as professionals, according to new data. Office for National Statistics (ONS) figures show there were 7,961 coronavirus-related deaths registered among the working-age population (those aged 20 to 64 years) in England and Wales between 9 March and 28 December last year. Nearly two-thirds of those deaths were among men (5,128 fatalities). Analysis by the ONS shows men who worked in low-skilled occupations (699 deaths) or care, leisure and other service occupations (258 deaths) had the highest rates of death involving Covid-19, with 66.3 and 64.1 deaths per 100,000 males, respectively. Men working in process plants, as security guards or as chefs, had some of the highest COVID-19 death rates. Plant workers recorded a rate of 143.2 deaths per 100,000 males, while for security guards and related occupations, the figure stood at 100.7 deaths per 100,000 males. Ben Humberstone, ONS head of health analysis and life events, said: “Jobs with regular exposure to Covid-19 and those working in close proximity to others continue to have higher COVID-19 death rates when compared with the rest of the working-age population.” However, the figures do not prove that rates of death are caused directly by differences in employment. “There are a complex combination of factors that influence the risk of death, from your age and your ethnicity, where you live and who you live with, to pre-existing health conditions,” Mr Humberstone said. Read full story Source: The Independent, 25 January 2021
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Content ArticleThe report presents a varied picture across the UK, with evidence that: “Hidden harms” of the Spring lockdown on 0-2s were broad and significant, and experienced unevenly depending on family circumstances and background. Historically inadequate or insecure funding, and a rising tide of need, has inhibited the ability of some services and areas to respond to the coronavirus crisis. There were often ‘baby blind-spots’ where babies’ needs were overlooked in policy, planning and funding. The report also draws on a survey of 235 senior leaders of pregnancy and 0-2 services across the UK. The survey findings showed that: Almost all (98%) of the survey respondents said babies their organisation works with had been impacted by parental anxiety, stress or depression which was affecting bonding and responsive care. 78% of respondents were clear that the government in their nation had not done enough for the under 2s, creating this ‘baby blind-spot’. The majority (80%) said that some babies they work with had experienced increased exposure to domestic conflict, child abuse or neglect, with 29% saying many babies they work with had been impacted. It is now calling for governments across the UK to focus on ensuring all babies live in a ‘baby-positive’ local system.
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Cancer operations down 800 in first two weeks of January
Patient Safety Learning posted a news article in News
There were 800 fewer cancer surgeries in the first two weeks of January than usually take place during the period, according to provisional data seen by HSJ. The bulk of this reduction came in London and the surrounding counties such as Essex, Bedfordshire, and Surrey. London and the south east have been severely hit by coronavirus pressures, causing widely reported mass cancellations of non-urgent elective surgery. However, the impact on cancer cases has, so far, been less clear. NHS England has insisted in the last week that urgent cancer cases should be given the same priority as coronavirus patients. Read full story (paywalled) Source: HSJ, 25 January 2021 -
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Record ethnicity of those getting covid vaccine to fight stigma, NHSE told
Patient Safety Learning posted a news article in News
NHS England has been urged to introduce routine recording of race and ethnicity data when people are given their covid vaccination. Documents seen by HSJ show Pinnacle, the IT system being used by GPs and mass vaccination centres to record jabs, does not directly require ethnicity to be recorded. Jabeer Butt, chief executive of the Race Equality Foundation, which promotes race equality in public services, told HSJ that making it a requirement would help establish the facts on uptake among different groups, more quickly. It is understood the NHS is able to ascertain data on vaccine uptake by ethnicity by connecting it with GP records, through the national immunisation management service, and potentially with other healthcare data. However, Mr Butt said this would provide only limited insight and take more time. He believes the absence of data may allow ”misconceptions” to take hold about lower uptake among some minorities, which can lead to stigma, when in fact, he said, the trend may so far simply be due to there being fewer black and Asian people in the oldest age groups, who are the first eligible for vaccination. Read full story (paywalled) Source: HSJ, 24 January 2021 -
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My ‘Long Covid’ nightmare: Still sick after 6 months
Patient Safety Learning posted a news article in News
A Times reporter caught the coronavirus during the New York City outbreak last April. But the acute phase of the illness was just the beginning. Laura recounts her experience of Covid nearly 3 months after first being diagnosed. "I remember the second time I thought I would die." Read full story Source: The New York Times, 21 January 2021 -
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We're about to see a wave of long Covid. When will ministers take it seriously?
Patient Safety Learning posted a news article in News
Long Covid is no respecter of youth, health or fitness. It afflicts more women than men but it can strike anyone down, including people whose initial infection seemed mild, or even asymptomatic. In some cases, long Covid could mean lifelong Covid. The effects can be horrible. Among them are lung damage, heart damage and brain damage that can cause memory loss and brain fog, kidney damage, severe headaches, muscle and joint pain, loss of taste and smell, anxiety, depression and, above all, fatigue. We should all fear the lasting consequences of this pandemic. Long Covid is shorthand for a range of conditions. Some scientists divide them into three broad categories, others into four. Of these, one seems to ring a bell. It’s a cluster of symptoms that bear a strong similarity to myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). This is a devastating condition that affects roughly a quarter of a million people in the UK, and is often caused, like long Covid, by viral infection. Among the common symptoms of ME/CFS are extreme fatigue that is not relieved by rest, and “post-exertional malaise”: even mild physical or mental effort can make patients extremely unwell. Many sufferers are confined to their home or even their bed, with their working life, social life and family life truncated. There is, so far, no diagnostic test and no cure. Yet ME/CFS has been disgracefully neglected by science and medicine. The NHS is now setting up specialist clinics to treat long Covid. But already, apparent mistakes are being made. Without the necessary caveats, the NHS recommends steadily increasing levels of exercise for people suffering from post-Covid fatigue. But as ME/CFS patients with post-exertional malaise know, this prescription, though it sounds intuitive, could be highly damaging. We need massive research programmes into both long Covid and ME/CFS, coupled with better information for doctors. Read full story Source: The Guardian, 21 January 2021 -
News ArticleNew research has suggested there are specific molecular responses found in some COVID-19 patients which could be used to determine their likelihood of suffering from severe or long Covid symptoms, very early on following infection. Researchers, supported by NIHR Cambridge Biomedical Research Centre, had set out to increase our understanding of the relationship between the immune response and COVID-19 symptoms by recruiting individuals who tested positive for the virus into a cohort of the NIHR BioResource. Studying 207 people who had tested positive for COVID-19 over a three-month period, taking blood samples and measuring their symptoms, then comparing to samples taken from 45 healthy people, the researchers were able to uncover a number of interesting new findings. Their research showed that people with either an asymptomatic or mild case of COVID-19 mounted a robust immune response to the virus soon after getting infected. These individuals produced a greater number of T cells, B cells and antibodies than patients with more severe COVID-19 infections and within the first week of infection - after which these numbers rapidly returned to normal. The study also showed there was no evidence in these patients of widespread inflammation which can lead to damage in multiple organs. In contrast, people with severe COVID-19 who required hospitalisation showed an impaired immune response, which led to a delayed and weakened attempt to fight the virus and widespread inflammation from the time of symptom onset. In patients requiring admission to hospital, the early immune response was delayed, and profound abnormalities were present in a number of immune cells. Read full story Source: NHE, 22 January 2021
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News ArticleOne of the mysteries of COVID-19 is why oxygen levels in the blood can drop to dangerously low levels without the patient noticing. It is known as "silent hypoxia" and as a result, patients have been arriving in hospital in far worse health than they realised and, in some cases, too late to treat effectively. But a potentially life-saving solution, in the form of a pulse oximeter, allows patients to monitor their oxygen levels at home, and costs about £20. They are being rolled out for high-risk Covid patients in the UK, and the doctor leading the scheme thinks everyone should consider buying one. A normal oxygen level in the blood is between 95% and 100%. "With Covid, we were admitting patients with oxygen levels in the 70s or low-or-middle 80s," said Dr Matt Inada-Kim, a consultant in acute medicine at Hampshire Hospitals. He told BBC Radio 4's Inside Health: "It was a really curious and scary presentation and really made us rethink what we were doing." Read full story Source: BBC News, 21 January 2021 See hub resource on the 'Covid Oximetry @home' project
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News ArticleThe second wave of COVID-19 has put doctors under huge pressure, the Royal College of Physicians has warned, as two thirds of physicians report feeling tired or exhausted. A survey of 25 500 members of the college from across the UK, conducted on 2 November, received 1890 responses. It found that two thirds (64%, 931) felt tired or exhausted, 48% (687) felt worried, and just under a third (29%, 424) felt demoralised. Almost a fifth (19%, 280) said they have sought informal mental health support, such as speaking to colleagues or friends, during the pandemic. Just 10% (155) said they had sought formal mental health support from either their employer, GP, or external services. College president Andrew Goddard said he was concerned about the mental health of doctors, “There is no way to dress it up—it is pretty awful at the moment in the world of medicine. Hospital admissions are at the highest ever level, staff are exhausted, and although there is light at the end of the tunnel, it seems a long way away.” He said that before the pandemic, few physicians would have expected to need formal mental health support during their career. After the pandemic, staff will be in desperate need of a break, Goddard said, and will need specific time away if they’re to be at their best. “Doctors have demonstrated remarkable resilience throughout the pandemic, working under the most challenging conditions the NHS has ever faced, but they can’t continue working this way forever,” he said. Read full story Source: The BMJ, 21 January 2021
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News ArticleJust a third of people aged 80 and over have received the covid vaccine in one part of England, compared to four out of five in the area with the highest rate, new NHS England figures have revealed. Gloucestershire delivered at least one dose of the vaccine to 85% of its over 80s population between 8 December and 17 January. Three other STPs — Northamptonshire, Herefordshire and Worcestershire, and Lancashire and South Cumbria — have all delivered at least one dose to at least three-quarters of over 80s in the area. By contrast, Suffolk and North East Essex has vaccinated just 36% of its over 80s population. A further seven of England’s 42 STP/Integrated Care Systems had vaccinated under half of their over 80s population. The mixture of reasons for the differences are not known — it may be due to supply, delivery issues, the nature of the area, or the size of the over-80s population. NHS England has maintained that the vaccine is being used nearly as quickly as it is available each week, with supply the main constraint. NHSE decides when sites are able to open and when they have supply. Read full story (paywalled) Source: HSJ, 21 January 2021
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Ambulance service facing 'terrifying' levels of risk, says trust chief
Patient Safety Learning posted a news article in News
The chief executive of a small acute trust has described the “terrifying situation” faced by ambulance crews and hospital staff in trying to provide adequate emergency care as coronavirus threatens to overwhelm the local NHS services. Susan Gilby, of Countess of Chester Hospital Foundation Trust, told HSJ staff are seeing “tragic and potentially avoidable” instances where patients with COVID-19 have reached the emergency department too late. She suggested this is due to a combination of patients waiting too long to call 999, and then having to wait long periods for an ambulance to arrive. Cheshire has been among the hardest hit areas in England during this third wave of coronavirus, with all four of its acute hospitals having very high covid occupancy rates. Dr Gilby, a former critical care consultant, said her trust has been at around 60 per cent covid occupancy for the last fortnight, which has made her increasingly fearful of the difficulties in admitting patients through the emergency department due to a lack of beds. This can then cause knock-on delays for patients arriving in ambulances, and ties those ambulance crews up for long periods, preventing them from responding to further 999 calls. She said ambulance turnaround times had been relatively good at the Countess of Chester, but she had spoken to paramedics handing over patients who were “really struggling” to get to people quickly enough. Read full story (paywalled) Source: HSJ, 22 January 2021 -
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More than 400 care homes investigated over deaths
Patient Safety Learning posted a news article in News
A special Crown Office unit set up to probe Covid-linked deaths is investigating cases at 474 care homes in Scotland, the BBC can reveal. The unit was set up in May to gather information on the circumstances of all deaths in care homes. Prosecutors will eventually decide if the deaths should be the subject of a fatal accident inquiry or prosecution. Care homes say the investigation is "disproportionate" and placing a huge burden on overstretched staff. The COVID-19 Deaths Investigation Team (CDIT) had received 3,385 death reports as of Thursday. The majority of them relate to people who lived in care homes. Behind the Crown Office statistics are hundreds of families grieving for loved ones who died in Scotland's care homes. Alan Wightman's 88-year-old mother Helen died in May last year during a Covid outbreak at Scoonie House in Fife Helen's death is part of the Crown Office probe and Mr Wightman's hopes for the investigation are that it looks "at the bigger picture and appreciates that on the ground people were doing the best they could". He added: "I thought that Scoonie House did the best they could in a very difficult situation, sourcing their own PPE and stopping people coming from hospital." "My own view is that care homes were put in an impossible situation because we had successive governments which did not properly prepare for a pandemic, you only have to look at the lack of PPE at the beginning of the pandemic to see that." Read full story Source: BBC News, 22 January 2021 -
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The NHS ICU Virtual Summit: Future-proofing critical care
Sam posted a calendar event in Community Calendar
The countries focus on critical care services in England has increased because of COVID-19. A significant proportion of hospitalised patients with COVID-19 require help with breathing, including mechanical ventilation and other services critical care staff and units provide. Delivering sufficient critical care capacity goes beyond physical infrastructures – such as having more beds and equipment – and requires sufficient numbers of trained and available staff. The NHS ICU Virtual Summit: Future-Proofing Critical Care conference aims to celebrate the current efforts of ICU staff, in this time of unprecedented strain, via best practice and practical insight. We will also take a look at some key areas of potential improvement including: Understanding intensive care staffing, occupancy and capacity. Infection control. Crisis management and emergency preparedness. Clinical Information Systems. NHS staff and services will continue to be tested to their limits over the coming months, this short but high-value session aims to bring peers together from across the UK to share best practice and outcomes. Register -
News ArticleOnly a little over half of British Indians say they would get a coronavirus vaccine, according to research. Some 56% of British Indians said they would take up a vaccine when asked by the 1928 Institute, a new think tank led by academics from the University of Oxford. However, 31% per cent were unsure, while 13% said they would decline a jab, the online poll of 510 respondents found. The think tank said much of this stemmed from people feeling they were not informed enough about the vaccines, while a significant proportion felt other people deserved to receive a vaccine more. The researchers are calling for an urgent public health campaign and funding, with messaging in different languages and co-produced with community leaders to assuage doubts. The government should also widely share information on how it is helping poorer countries distribute vaccines, given that several participants said vulnerable people and those in poorer countries should take priority, they said in their report. Read full story Source: The Independent, 21 January 2021
