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Found 54 results
  1. Content Article
    Due to the scale of the pandemic, despite being in a healthcare setting, patients in hospital and other in-patient settings faced an increased risk of hospital acquired COVID-19. In its first year, the programme has supported NHS Wales organisations to assess and investigate over 5,000 cases of nosocomial COVID-19, where they meet the definition of a patient safety incident and is on track to have successfully investigated all cases of hospital-acquired COVID-19 by March 2024. Findings in the report include; The value of bereavement support and care-after-death services have for people experiencing grief and signposting to support at the earliest opportunity. The benefits of a single point of contact and support for people navigating the concerns process. The impact of visiting restrictions and visiting considerations should continue to be carefully balanced with risk. Inequities in the concerns process for people who receive healthcare via independent providers. Inconsistent approaches to the management and reporting of health care acquired infections across Wales.The need for improved application and improvement of DNACPR (Do Not Attempt Cardio-Pulmonary Resuscitation. The need for improvement in how Infection prevention and control (IP&C) guidance, is reviewed and communicated to staff. Better communication with families and carers around ward movements.
  2. News Article
    Thousands of 999 calls are being transferred to the Welsh Ambulance Service because they are taking more than five minutes to answer in England, HSJ can reveal. More than 50,000 calls – 1.2% of all made – were sent to a different ambulance service than the one intended between October and the middle of February, under a new system of routing unanswered calls was introduced. It automatically diverts calls which have not been answered after five minutes, rerouting them to services with current capacity, while a BT operator remains on the line until the call is answered. The Welsh Ambulance Service explained it records details from the transferred caller, prioritises the response level and provides lifesaving instructions if required, including having access to a national database of defibrillators. However, it is unable to despatch ambulances outside its area and does not provide clinical assessment. Instead the details are transferred electronically into the “home” trust’s computer-aided despatch system. Read full story (paywalled) Source: HSJ, 21 March 2023
  3. Content Article
    Key findings Adult asthma: 0.4% died within 30 days of admission to hospital, 0.8% within 90 days COPD: 6.1% died within 30 days of admission, 11.9% within 90 days.
  4. Content Article
    Key findings National Hip Fracture Database (NHFD) The number of hip fractures changed very little during the pandemic, so this is an ideal marker of the pandemic’s impact on the care of frail and older people and shows how successive waves of Covid-19 affected outcomes (mobility, return home, length of stay and mortality) in Wales. National Audit of Inpatient Falls (NAIF) There were approximately 12,500 inpatient falls in 2021. These led to: over 195 hip fractures loss of confidence and slower recovery distress to families and staff litigation against health boards. Fracture Liaison Service Database (FLS-DB) Based on 1,956 fragility fractures in 2020 and 2,033 fragility fractures in 2021, the number receiving FLS assessment within 12 weeks was similar in 2020 and 2021 (64% and 65% respectively). Recommendations Local health boards should ensure that they have appointed an orthogeriatrician and that they actively support their leadership of multidisciplinary care in each trauma unit. Local health boards should ensure that falls teams in acute, community and mental health hospitals are included in quality improvement activities and are using the data from the National Audit of Inpatient Falls. With falls teams reviewing health board level data and implementing focused quality improvement interventions should help improve the quality and safety of care in hospitals. Health boards without an FLS should contact the Royal Osteoporosis Society and use their implementation toolkit to support them in preparing a business case. Health boards that already have an FLS should ensure it is actively participating in the FLS-DB, and meeting its expected outcomes as defined by the FLS-DB’s set of KPIs.
  5. Content Article
    Key findings The increase in incidence of Type 1 diabetes observed in the first year of the Covid-19 pandemic was followed by a continuing increase in the numbers newly diagnosed with the condition in 2021/22. Almost all of those with Type 2 diabetes were overweight or obese, and almost half had a diastolic or systolic blood pressure in the hypertensive range Despite reductions in the percentages recorded as requiring additional support between 2020/21 and 2021/22, over a third of children and young people were assessed as requiring additional psychological support outside of multidisciplinary meetings Inequalities persist in terms of the use of diabetes related technologies in relation to ethnicity and deprivation. Recommendations Commissioners should ensure adequate staffing of full multidisciplinary diabetes teams to manage the increasing numbers of cases of Type 1 and Type 2 diabetes observed since 2020, who are trained to facilitate the optimal use of new diabetes-related technologies. Children and young people with Type 1 diabetes should have equitable access to diabetes care, irrespective of social deprivation, ethnicity or geography. They should be offered a choice of diabetes technology that is appropriate for their individual needs with families being made aware of the potential differences in outcome with different modalities of insulin delivery and blood glucose monitoring. Health checks for children and young people with diabetes are essential for early recognition of complications. The need for tests and the results should be clearly communicated to families as part of their individual care package, and completion rates of checks should be monitored through the year. Awareness of diabetes symptomatology amongst the public should be enhanced to avoid newly diagnosed children and young people presenting with Diabetic ketoacidosis (DKA). Studies should be funded to derive evidence for interventions supporting pre-diabetic children young people to avoid progression to Type 2 diabetes.
  6. News Article
    A new scheme in Wales to help people who have suffered falls has prevented 50 ambulances being unnecessarily sent this year. St John Ambulance works with Hywel Dda health board in Pembrokeshire to send its people when someone calls 999. The pilot has been used 96 times since January but it needs more health board funding to continue after March. Ageing Well in Wales estimates that between 230,000 and 460,000 over 60s fall each year. When people dial 999, it can be directed to the St John Ambulance falls response team, who are sent to perform an assessment and identify whether the person can stay home or needs an ambulance to take them to hospital. St John Ambulance operational team leader Robert James said in 60% of cases, the person was well enough to stay at home. "You can imagine if you were sending an ambulance crew out and it has wasted 60% of the crew's time, well it's a big saving towards the NHS and the ambulance service in itself," he added. "Provided there are no injuries, or reason for them to go to hospital, they can be discharged on the scene." Read full story Source: BBC News, 10 March 2023
  7. Content Article
    Key findingsPatients experienced long delays from time of arrival at hospital to time of surgery, including those with sepsis suspected at arrival in hospital (median 15.6 hours to theatre)Many patients (77.7%) with suspected sepsis on arrival did not receive antibiotics within an hour of arrival in hospitalOne in five high-risk patients did not receive postoperative care in a critical care unit.Frailty doubled the risk of mortality of patients aged 65 and over (13.0% vs 5.9%), but review by a member of the elderly care team was associated with a significant reduction in mortality (5.9% vs 9.5% amongst non-frail patients, and 13.0% vs 22.3% amongst frail patients). However, this is not routine practice in many hospitals.
  8. Content Article
    Recommendations Technology that is obsolete should be replaced with up-to-date models by employers. The cost of using obsolete devices in terms of lost time and efficiency is likely to far outweigh the cost of purchasing new hardware. Nurses should be consulted at an early stage in the choice of hardware for use in community settings to ensure that it is appropriate and safe for its designated use. Companies that design mobile devices should be called upon to improve future designs of those used by the community nursing workforce, actively seeking nursing feedback. Nurses should be involved at an early stage in the design and development of software programmes that they will use as part of their everyday work. Healthcare provider organisations, commissioners and policy makers should undertake national, regional and local reviews of WiFi internet connectivity in all areas where their services are delivered and understand how this is directly impacting on the work of nurses delivering care in people’s homes and communities. Healthcare services and supporting organisations could usefully campaign for improved internet connectivity and ask for increased investment by mobile phone operators and government. Scheduling tools and related apps should always be designed, developed and used in a manner that is consistent with the nursing process, professional judgement and autonomy, personalised care and patient need. All healthcare providers should have a nurse who is appropriately experienced and skilled to lead on the use of digital technology within the organisation.
  9. 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
  10. News Article
    The Covid-19 pandemic cannot continue being blamed for poor cancer care, a charity boss has said. Judi Rhys, of Tenovus Cancer Care, said urgent action was needed to save lives when more people than ever are living with cancer in Wales. It comes as the Wales Cancer Network publishes a three-year plan to improve cancer outcomes and patient experience. But the group's clinical director warned the immediate priority would be maintaining current services. Prof Tom Crosby, clinical director for Wales Cancer Network, which was tasked by Wales' health minister to draw up the improvement plan, said the biggest pinch point at the moment was access to diagnostics. "We're absolutely trying to shorten overall times for patients coming into the system being diagnosed and then being treated," he said. On average in November, people suspected of having cancer had to wait 17 days for a first appointment and 23 days for a first test. It was an average 31 days from point of suspicion to being told if they had cancer or not and an average 24 days from point of diagnosis to treatment starting. "We hope that this year we will develop the first regional diagnostic centre and that is likely to be in south-east Wales," Prof Crosby said. Read full story Source: BBC News, 31 January 2023
  11. Content Article
    The census had responses from all 12 major Emergency Departments in Wales and found: There is one WTE Consultant per 7784 annual attendances, considerably less than the RCEM recommended figure of 1:4000. Of these 101 consultants, 19 are planning to retire in the next six years – a fifth of the consultant workforce. There were 90 gaps in the consultant rota, 33 in the middle grade rota and eight in the junior rota. Inability to recruit was the primary reason for rota gaps. This is leading to departments in Wales not meeting RCEM best practice recommendations of having an EM consultant presence for at least 16 hours a day in all medium and large systems. When asked for future staffing needs, departments across Wales reported needing an increase of 75% consultants, 120% increase in the ACP/ANP/PA workforce, 44% increase in the ENP workforce, 30% increase in the Higher Specialist Trainees/ Non-consultant Senior Decision Maker and a 50% increase in Junior Doctors in the next six years. The census also found that junior doctors were also being overstretched: At the time of collection there were 52 trainees in the ST1-6 programme as well as 95 non- Emergency Medicine trainees working in EDs across Wales Junior doctors work one weekend every three weekends, consultants work one weekend every 6.2 weekends. Junior doctors in training also do the most night shifts with an average of 52 per year.
  12. News Article
    Being placed on immunotherapy to treat Stage 4 cancer was a life-saver for Imogen Llewellyn. Three years on, the 34-year-old is currently cancer-free, but said if it was not for specialist doctors, the side effects could have killed her. The Royal College of Physicians (RCP) claims Wales needs more oncology experts in A&E to recognise and treat emergencies. The Welsh government said all acute hospitals were expected to have an acute oncology service. The RCP report wants investment in emergency cancer care because of the sheer volume of patients who need urgent care during their treatment. With about a fifth of acute hospital beds occupied by people who have a cancer-related problems, they add that about a third of admissions could be avoided if same-day care were more widely available in Wales - which in turn would relieve pressure on hospitals. Dr Hilary Williams, consultant oncologist and Wales Cancer Network lead for acute oncology, said: "Wherever a patient lives in Wales, they should be able to access excellent acute oncology services. "When people think about cancer treatment, they might think about undergoing surgery or receiving chemotherapy, radiotherapy or immunotherapy in an organised way, perhaps during weekday hours in a specialist centre. But what happens when an emergency arises?" Read full story Source: BBC News, 24 January 2023
  13. Content Article
    The report contains a number of findings related to: patterns of care at diagnosis staging and treatment planning waiting times along the care pathway curative surgery non-curative treatments. It also includes findings relating to the impact of the Covid-19 pandemic, including: In April 2020, the number of patients diagnosed with OG cancer was 43.6% of the 2019/20 monthly average, falling from 837 to 365 cases per month. The numbers diagnosed soon returned to normal levels, and in the period from June 2020 to March 2021, the number of monthly cases was 97.8% of 2019/20 levels. The percentage of patients diagnosed with stage 4 disease (advanced cancer) increased from 41.6% in 2019/20 to 44.9% in 2020/21. The report also contains recommendations for healthcare professionals, among which is including a call to review patients diagnosed after emergency admission and undertake root cause analysis to identify opportunities to reduce rates of emergency diagnosis.
  14. News Article
    The deaths of two nurses from Covid-19 in the early days of the pandemic have been ruled as industrial disease. Gareth Roberts, 65, of Aberdare, and Domingo David, 63, of Penarth, were found to have been most likely to have contracted the virus from colleagues or patients while working for hospitals under the Cardiff and Vale University Health Board. The senior coroner Graeme Hughes concluded on Friday that although they were given appropriate personal protective equipment (PPE), Roberts and David were “exposed to Covid-19 infection at work, became infected and that infection caused” their deaths. He made a finding of industrial disease. Roberts’ family had argued for a conclusion of industrial disease, while the health board had made the case for ruling that both deaths were from natural causes. Unions are campaigning for Covid-19 to be considered an industrial disease by the UK government so workers affected by it would receive greater financial support. Read full story Source: The Guardian, 13 January 2023
  15. Content Article
    Recommendations Every person to receive an early and accurate diagnosis based on a guideline-defined approach and a plan for their care Care to be provided to people with asthma and COPD within the recommended timeframe after hospital admission, to support optimal outcomes People with asthma and COPD to receive care by appropriately trained healthcare professionals, at each stage of their care pathway, and Primary, secondary and community services to implement ways to work together, offering people with asthma and COPD a seamless pathway of care.
  16. Content Article
    Key findings More patients were recommended anti-osteoporosis medication in 2021 than in 2019 (56% vs 52%), and The percentage of patients who were followed up within 16 weeks of their fragility fracture has increased from 41% in 2019 to 47% in 2021. This report also contains a number of recommendations for patients and carers, and for senior executive decision makers. This includes a call for the latter to hold a key stakeholder meeting to explore how local needs for fragility fracture patients can be met.
  17. News Article
    The NHS is on the verge of collapse due to demand for healthcare rising significantly faster than funding levels, a consultant has warned. Peter Neville, a consultant for NHS Wales, took to social media to explain why, in his view, the system is failing. The consultant physician, who has been working in the NHS in Yorkshire and Wales for 32 years, set out the challenges facing the health service in a Twitter thread. He said he had experienced the NHS at its best, in 2008, and its worst, in 2022. He wrote: "Over at least the past 15 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer. "Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer. (Immigrants, by the way, use much less care). "Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it." Read full story Source: Wales Online, 3 January 2023
  18. News Article
    Patients discharged from hospital without social care packages could die at home, doctors have warned. They said Welsh government advice to do this showed a system at breaking point. The British Medical Association (BMA) said it rejects the guidance to "change the risk threshold" for releasing people from hospital. The Welsh government said discharging patients could help them get better "by reducing the risk of infection and muscle wastage". Royal College of General Practitioners Wales chairwoman, Rowena Christmas, said the NHS was "unbelievably stretched". "A frail, elderly person coming home, who can't really safely get from their bed or their chair to the bathroom without risk of falling over, they're not going to be able to survive at home," Dr Christmas said. "I completely understand we need more beds, but that feels like a bad move." Read full story Source: BBC News, 6 January 2023
  19. News Article
    Senior NHS staff have been advised by the Welsh government to discharge people who are well enough to leave, even without a package of care. But one GP called the announcement "terrifying" and warned that patients could deteriorate and end up back in hospital. The seven health boards in Wales have nearly 1,800 patients medically well enough to leave hospital. The Welsh government has called the NHS situation "unprecedented". The message comes after one health leader said the NHS was on a "knife-edge" in terms of its ability to cope. The letter from the chief nursing officer and the deputy chief medical officer to the health boards offered "support and advice to ensure patients are kept as safe as possible, and services are kept as effective as possible over the next period". Read full story Source; BBC News, 4 January 2023
  20. News Article
    The NHS in Wales could move to a model in which most or all nursing care is outsourced to private companies, if its increasing reliance on agency staff continues, a union report has claimed. According to the Royal College of Nursing, the Welsh health service risks moving to a situation where it no longer directly employs staff to provide patient care. NHS Wales spent between £133m and £140m on agency nursing during 2021-22, based on different freedom of information (FOI) requests and official figures, the RCN’s report suggested. RCN Wales said, “If this trend continues, Wales will move to a situation where NHS Wales no longer directly employs staff to provide patient care and instead moves to a model in which most or all nursing care is outsourced to private companies.” Read more Source: Nursing Times, 4 December 2022
  21. Content Article
    Key messages Fall-related fractures can happen on any ward There is only one chance to get it right High quality multi-factorial risk assessment (MFRA) is necessary to ensure important fall risk factors are addressed Accurate post-fall checks support effective care All inpatients should have access to flat lifting equipment to move patients from the floor Inpatients who sustain a femoral fracture should have immediate access to analgesia Improvement activities should focus on fall prevention and post-fall management processes