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The downside of young people learning about ADHD on TikTok
Patient Safety Learning posted a news article in News
Less than half of the claims made about symptoms of attention deficit hyperactivity disorder (ADHD) in the most popular videos on TikTok align with clinical guidelines, a new study has found. Two clinical psychologists with expertise in ADHD also found that the more ADHD-related TikTok content a young adult consumes, the more likely they are to overestimate both the prevalence and severity of symptoms in the general population. People with ADHD are known to suffer inattention, hyperactivity and impulsivity – and may struggle to concentrate on a given task, or suffer extreme fidgeting. Prescriptions for drugs for ADHD have jumped 18% year-on-year in England since the pandemic, which underscores the need for accurate and reliable information, particularly on platforms popular with young people. In this latest study, published in the journal Plos One, the two psychologists evaluated the accuracy, nuance, and overall quality in the top 100 #ADHD videos on TikTok. They found the videos have immense popularity (collectively amassing nearly half a billion views), but fewer than 50 per cent of the claims made were robust. Read full story Source: The Independent, 31 March 2025- Posted
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Vaping is increasingly common among young people. It is less harmful than smoking, but not without risk, particularly for people who have never smoked. Researchers surveyed 39,214 young people and found that: those who vaped were more likely to have breathing issues than those who did not the more they vaped, the higher their chance of breathing issues. The researchers call for more research on the overall safety of vaping in young people, and on the effects of different types of nicotine and vapes and the various flavours. They say that improved labelling would allow thorough investigation of ingredients.- Posted
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A consultant paediatrician warned medical colleagues treating her son that they had failed to give him life-saving antibiotics hours before he died from sepsis, an inquest has heard. William Hewes, 22, a history and politics student, died on 21 January 2023 of meningococcal septicaemia at east London’s Homerton hospital, where his mother, Dr Deborah Burns, worked. Burns brought her “very ill” son into the A&E at the hospital just after midnight and told her colleagues he was seriously ill and needed treating for meningitis, the inquest into his death heard on Thursday. A doctor prescribed 2 grams of the antibiotic ceftriaxone within minutes of Hewes’s arrival and the medical team knew the drug had to be given as soon as possible. But due to a communication mix-up between the duty emergency registrar, Dr Rebecca McMillan, and nurses, the “life-saving” drug was not administered within the vital first hour of treatment, the inquest heard. Burns said her son only got the antibiotics after she warned Dr Luke Lake, the acting medical registrar on duty at the time, about the failure to administer the drug. In written evidence read to the court, she said: “I told him I didn’t think William had the antibiotics. Luke reassured me, that they had been written up earlier. I replied: ‘Yes, but they have not been given.’” Earlier, Dr McMillan recounted her distress when she realised at about 1.17am that the drug had not been administered by nurses as she requested. She said: “I do recall standing outside the resus room with [nurse Marianela Balatico] where she asked if I was OK and said that I looked really upset when I realised that antibiotics had not been given. “We had a conversation along the lines of we didn’t understand how this had happened. We were both upset when we realised that this hadn’t happened.” Fighting back tears, McMillan said one of the “learning points” from Hewes’s death was the need “to be clearer who I’m giving instruction to”. She added: “I obviously thought that my instructions had been clear enough. I have thought about that moment over and over.” Read full story Source: The Guardian, 13 February 2025- Posted
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Harry’s story: Acute Behavioural Disturbance
Patient_Safety_Learning posted an article in Mental health
In December 2022, Harry Vass died after experiencing Acute Behavioural Disturbance (ABD) and a complex disturbance in normal physiology. Harry’s death was found to be avoidable as carers were not fully aware of this condition associated with acute psychosis. In this blog, Harry’s mother Julie tells us more about Harry and the years that proceeded his death, during which he suffered with anxiety, addiction and psychosis. Julie describes the barriers they faced in getting the right support and care for Harry before he died and highlights the need for healthcare staff to have a greater awareness of ABD and the associated risks of a medical emergency. You can also read a second blog by Julie, where she explains more about Acute Behavioural Disturbance and the changes she believes are needed to make sure patients like Harry are cared for appropriately. Harry Harry was born in Bristol in 1998, a second child with an older sister, to working parents. He had a good childhood attending a local school and did well with good educational achievements. He was a happy boy, had friends and hobbies with football and music being his greatest loves. He had a great sense of humour and when Harry was around, we laughed a lot, often until our sides split! There had been clear symptoms of ADHD earlier in his childhood, but they were manageable. A change of school and friendship groups at 16 years old brought his struggles to a head. Ultimately this led to a formal diagnosis of ADHD and access to supporting medication, both of which helped us all (including Harry) to understand him better and manage his day-to-day anxieties. When addiction entered his life In the sixth form, Harry was introduced to cannabis smoking, and we often reflect that addiction started here for him. He still managed to get good exam results and went on to become a chef. He worked at a local pub, running the kitchen for over 2 years before Covid brought furloughing into play. Harry was at home throughout the Covid period, and it was during this time that cocaine was introduced into his life. We now know that ADHD and cocaine are a “match” and Harry suffered with addiction, which resulted in him leaving his job in December 2021. He became extremely ill for two months, suffering from psychosis. He was prescribed medication, and the mental health crisis team oversaw his treatment at home on a daily basis during that period. As this illness was linked to his addiction, Harry decided to go to rehab, with good results. He had a good period over the spring and summer of 2022 - he went to the gym, played sport, got a job working in the kitchen of a local care home and began to make plans for the future. He wanted to travel America, and he was starting to make career plans. Struggling to access the right support That Autumn, Harry became depressed, he disengaged with the world, took time off sick and occasionally took cocaine and other illicit drugs to self-medicate with the hope of improving his mood. He was given antidepressant medication which had little effect. He engaged with mental health teams but was not able to see a psychiatrist at that time, which he felt was important. He was convinced that his problems were not all about ADHD and anxiety. A psychiatric assessment was scheduled for January 2023, which would end up being the month after Harry died. I remember several frustrations at the time that felt like barriers to Harry getting the care he needed: The ADHD team would not see Harry when he was taking illicit drugs, so he had a long period without their support. The Mental Health Crisis team would not see Harry when he was taking drugs even when feeling suicidal as they felt his symptoms were induced by illicit drugs. We attended the Emergency Department twice in December 2022 with drug related problems, but there was no link to agencies offering help with the reduction of illicit drug taking. Harry was discharged home without support. Access to a clinical psychiatric review seemed very restricted and it was “only to be kind “that Harry did receive an appointment to see a psychiatrist, an appointment that was to be a month after his death. Signs of psychosis Over the Christmas period of 2022, Harry began showing signs of psychosis, he had taken cocaine on Christmas Eve and on Christmas Day. We recognised the same symptoms from the year before. He was hyper anxious and extremely agitated; he believed that people were after him and would kill him. He felt unsafe at home and left the house around 3.40am on 26th December, despite our endeavours to keep him there. We called the Police as we were so concerned for his safety and felt he should be detained. Unfortunately, they returned him home thinking that he might settle and feel safe in his home environment. Once home they lost their powers to detain him. We spent the day trying to get him to sleep as he had not slept for a while, and we had learnt from previous experience how this could resolve the psychosis. This was not possible and by 3pm Harry was deteriorating. The Emergency Department We took him to the Emergency Department at our local Hospital. Harry was seen quickly and triaged as a high-risk mental health patient. In a quiet single room, he had physical observations taken, ECGs and blood taken. He was assessed by two mental health liaison nurses who felt that he had drug induced psychosis. They were very caring in their approach and planned to discharge Harry with medication to induce sleep. The department was very busy at the time. At about 9pm Harry went to the toilet, and on return told us he had taken cocaine. After this, his condition escalated considerably, and he was moved to the main department where he could be better observed. He was given Lorazepam twice. Despite this, he remained extremely agitated, frightened and active, although he had short periods where he was calmer and even appeared lucid. He was sweating profusely and began to look physically unwell. Transferred to a mental health unit Because of the agreed diagnosis of psychosis and the level of agitation, the medical staff felt that Harry was not safe to be cared for in the department and posed a threat to others. The police were called to use the Mental Act section 136 to detain Harry at the secure Mental health unit on the Hospital campus. It was explained to us that Harry would be safe there and fully assessed by a psychiatrist in the morning. The policeman asked the medical team if Harry might have “ABD”. We didn’t know what this was but we heard the discussion, and their response, “no, this is psychosis “. Harry was taken by two policemen to the mental health unit at 10.45pm. We returned home thankful that Harry was safe and would receive proper care and an assessment of his mental health. The day Harry died The telephone woke us at 05.45am the following morning, 27th December. The nurse from the mental health unit informed us that Harry had not settled until about 3am, had then began to vomit and become ill. They had called an ambulance, but Harry continued to deteriorate. Another call for an ambulance was made and before this arrived, Harry’s heart had stopped. They asked us to come as quickly as possible to the Emergency Department as Harry was being transferred back there with an ongoing resuscitation. We arrived there about 06.10am and the Consultant in charge of Harry explained to us that he was very seriously ill and that they were doing everything they could to reverse the drugs he had ‘on board’. We were allowed to be with him whilst the resuscitation was ongoing, but his blood gases were found to be ‘incompatible with life’ and he was pronounced dead at 06.36am. The information we were given at the time about why Harry had died seemed to be around drug overdose. My last words to Harry had been about his choices around drugs, and that we were not angry with him. I now regret this deeply as he didn’t die as a direct result of drugs. Reflecting back on that night, I remember we asked ourselves: Should the Police have taken him to the Emergency Department in the early hourly hours of 26th December instead of bringing him home? Should we have taken him earlier in the day? What was ABD and why was this raised by the policeman? The inquest We waited for 18 months for the Inquest to be held. It was an article 2 Inquest with a full Jury. It was painful to hear the detail leading up to, and at, Harry’s death from the professionals involved and to hear the expert witness opinion. We heard that no physical observations were undertaken in the Emergency Department after the first ones taken on arrival at approximately 5pm, discharge was at 10.45pm when he was taken to the mental health unit. He was restrained in different ways on a few occasions. He did have some short periods of being lucid and was able to apologise to staff for his presentation, they said he appeared kind with a nice sense of humour. At around 3.30am he appeared to settle on a mattress on the floor; they thought he was sleeping. He then began to vomit around 04.10am and at this point his temperature was 39.9c (hyperthermic) pulse in excess of 186 (very rapid) blood pressure unreadable and blood oxygen saturation was 80% (very low). No physical observations were taken on unit until Harry became unwell at around 04.15am. He had escalated in behaviour, was uncontainable in the room, was sweating profusely, hitting walls and himself, scratching at his skin and eyes, responding to unseen stimuli. Aside from not having taken physical observations on the mental health unit, we were disappointed to hear that the duty psychiatrist did not examine Harry other than view him through a glass window. When his heart stopped, this clinician was not skilled enough to insert the tube required to inflate the lungs during the resuscitation. This meant that a nurse had to take this action. Cause of death The expert witness was an experienced pathologist who was clear that Harry had died of ABD (Acute Behavioural Disturbance) - “sudden death, most likely as a result of terminal cardiac arrhythmia on a background of psychosis and recent cocaine use leading to an acute disturbance in behaviour and complex disturbance in normal physiology.” We heard that almost none of the professionals and staff that had cared for Harry in the Emergency Department knew of Acute Behavioural Disturbance. The one that had, thought he had seen it before, but Harry didn’t fit that picture. We also heard that Acute Behavioural Disturbance, and the associated risks of medical emergency, were not known by the mental health staff. Included in the conclusion of the jury: “Given the evidence regarding his treatment in the Mason Unit, it is probable that the failure to perform adequate observations, both physical and non-contact, contributed to Harry’s death as, by failing to prioritise the accurate monitoring of his physical condition and therefore identify it’s deterioration, an opportunity to transfer him promptly back into the Emergency Department was missed.” Included in the ‘Coroner’s Matters of Concern’: “Due to Harry’s level of agitation, he did not undergo the level of observations that would and should have happened either in the emergency department or once on the Mason Unit which may have assisted in assessing his physical health. It was clear that none of the mental health nursing staff were aware of ABD and the fact it is a medical emergency. The decision as to whether a person has ABD is important, Dr Delaney said that” this group are vulnerable to cardiac arrest”, that “deaths are multifactorial”, that “normally in the background a body is maintaining safe limits for e.g. pulse rate, blood pressure, temperature, but with acute disturbance in behaviour the body loses control of these safe parameters.” Life after the unthinkable I was terrified that I would lose the memory of Harry’s face so we gathered together all our photos of him. Silly really as his face, voice, smell and laughter are still with me clearly even now, nearly two years on. You’ll think we’re mad but each of us talk to him as though he is still here. We still lay four places at the table without thinking, we still go to pull over in the car to offer a lift home when we think we see him out. I don’t know how long that takes to go away. Our lives have changed for ever now. We try not to be angry as we know that no one intended for this to happen. We do want learning to be taken away from this unthinkable event in the hope that something similar will not happen to other families. Read Julie ’s second blog, where she explains more about Acute Behavioural Disturbance and the changes she believes are needed to make sure patients like Harry are cared for appropriately. Share your insights Do you have insights to share around patient safety? Could your experiences help guide improvements? Or perhaps you're a healthcare professional making changes to reduce risk to patient safety? If you would like to contribute, please comment below (you'll need to sign up here first for free) or contact the editorial team at [email protected]. Related reading Acute Behavioural Disturbance: preventing future deaths (Julie's second blog) Mental Health improvements and initiatives implemented in Avon & Somerset Constabulary Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed (9 May 2023) INQUEST: Skills and support toolkit Acute behavioural disturbance: a physical emergency psychiatrists need to understand (14 October 2020)- Posted
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Nurses at psychiatric unit called teens 'pathetic'
Patient Safety Learning posted a news article in News
Former patients at Scotland's biggest children's psychiatric hospital have spoken out about a culture of cruelty among nursing staff. Patients who were teenagers when they were admitted to Skye House, a specialist NHS unit in Glasgow, told BBC Disclosure some nurses called them "pathetic" and "disgusting" - and even mocked their suicide attempts. "It was almost as if I was getting treated like an animal," one young patient, being treated for anorexia, said. NHS Greater Glasgow and Clyde said it was "incredibly sorry" and has launched two inquiries into the allegations uncovered by the BBC's investigation. Programme-makers spoke to 28 former patients while making BBC Disclosure's Kids on The Psychiatric Ward documentary. One said the 24-bed psychiatric hospital, which sits in the grounds of Glasgow's Stobhill hospital, was like "hell". "I'd say the culture of the nursing team was quite toxic. A lot of them, to be honest, were quite cruel a lot of the time," she added. Read full story Source: BBC News, 10 February 2025- Posted
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US hospitals suspend healthcare for transgender youth after Trump order
Patient Safety Learning posted a news article in News
In the wake of Donald Trump’s executive order threatening to withhold federal funding from hospitals that offer gender-affirming care to individuals under the age of 19, several major hospitals across the US have stopped providing such treatments. The 28 January executive order directed federal departments and agencies to ensure that hospitals and medical institutions receiving federal research or education grants stop providing puberty blockers, hormone therapy or surgical procedures to transgender youth under the age of 19. “It is the policy of the United States that it will not fund, sponsor, promote, assist or support the so-called ‘transition’ of a child from one sex to another and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” the order reads. In response, several hospitals around the country have stopped providing gender-affirming care procedures for those under 19 while they evaluate and assess the order. A spokesperson for Denver Health in Colorado told the Associated Press that the hospital had stopped providing gender-affirming surgeries for individuals under the age of 19, to comply with the executive order and continue receiving federal funding. In a statement posted to its website, Denver Health said that it was “working to understand and comply with the full implications of the broadly worded order” and that “guidance on changes to medical care is being handled privately so that we can best support our patients and their families”. The Denver hospital said it was “deeply concerned for the health and safety of our gender diverse patients under the age of 19”. “We recognize this order will impact gender-diverse youth, including increased risk of depression, anxiety and suicidality,” the hospital stated. Read full story Source: The Guardian, 3 February 2025 -
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Acute Behavioural Disturbance: preventing future deaths
Patient_Safety_Learning posted an article in Mental health
In December 2022, Harry Vass died after experiencing Acute Behavioural Disturbance (ABD) and a complex disturbance in normal physiology. In her first blog, Harry’s mother Julie told us about Harry and the events that preceded his death, during which he suffered with anxiety, addiction and psychosis. She talked about the inquest and how they learned of gaps in Harry’s care, that led the coroner to deem it an avoidable death. In this second blog, Julie explains more about Acute Behavioural Disturbance and the changes she believes are needed to make sure patients like Harry are cared for appropriately. Right after Harry was pronounced dead, a paramedic presented us with his belongings in a plastic hospital bag and we were sent home. We were told to ring the hospital bereavement office the following morning. We did so to be told that they didn’t have anything to do with coroner cases, so we knew then that Harry had been referred to the coroner. Our inquest was an article 2 inquest as Harry had died whilst detained under section 136 of the Mental Health Act and his liberty had been taken away for his own, and others, safety. This allows for the scope of the inquest to be slightly wider in exploring the issues prior to, and the cause, of death. The jury concluded that Harry had died of: “…sudden death, most likely as a result of terminal cardiac arrhythmia on a background of psychosis and recent cocaine use leading to an acute disturbance in behaviour and complex disturbance in normal physiology.” Acute Behavioural Disturbance is not a condition in its own right, so the term cannot be used on the death certificate as a standalone cause of death. As the coroner felt that this death was avoidable, a Prevention of Future Deaths Report was written and later a response was received from the Royal College of Nursing. What is Acute Behavioural Disturbance? Acute behavioural disturbance is an umbrella term used to describe a presentation which can include abnormal physiology and/or behaviour. Acute Behavioural Disturbance has previously been called excited delirium, acute behavioural disorder, or agitated delirium. The below represent signs which may be present in Acute Behavioural Disturbance - one or more may be present. Agitation Constant physical activity Bizarre behaviour (incl. paranoia, hypervigilance) Fear, panic Unusual or unexpected strength Sustained non-compliance with police or ambulance staff Pain tolerance, impervious to pain Hot to touch, sweating Rapid breathing Tachycardia.[1] Although the term Acute Behavioural Disturbance has been used over a long period, it is still not consistently known, used or understood across different professional groups. Seven key areas for change Throughout the last two years we have become more aware of the gaps in Harry’s care and support in the lead up to his death. I believe focusing on the seven areas below would help to prevent future deaths. 1. Raising awareness and understanding Making sure that healthcare professionals working in emergency departments and mental health units (especially those caring for acutely ill patients) receive training and education in Acute Behavioural Disturbance. This must include nurses who are the professionals most likely to detect physical changes in a patient’s condition. 2. Consistent terminology Although much has been published since Harry’s death, there is procrastination over terminology used to describe this presentation. There should be collaboration on immediate actions needed, using agreed reference terms, for example; “physiological disarray with psychosis, particularly following the use of illicit drugs”. The simple addition of a few words to training policies and packages could be very powerful in saving lives. 3. Collaborative guidance The National Institute for Health and Care Excellence, the Royal College of Nursing, Royal college of Psychiatrists and Royal College of Emergency Medicine need to agree on the wording of appropriate policies to guide and educate professionals facing this presentation. It is essential to bring nurses to this forum as they have previously been excluded. 4. Post-mortem training The Royal College of Pathologists/ Forensic Pathologists could think about training and education for those undertaking post-mortems for these patients. Knowing what to look for and finding evidence is extremely difficult. In our case, we were told that Harry had previously damaged heart muscle caused by illicit drugs which was not the opinion of the expert witness. 5. Data collection and coding NHS England should have the coding reviewed/ adjusted. “Psychosis with physiological disarray with or without illicit drug use“ (or similar wording) should be available as a coding choice for clinicians and coders. This would allow for proper data capture for these presentations in the NHS. 6. Monitoring of prevention of future deaths reports I believe there should be an overarching body to monitor prevention of future deaths reports, and the responses to these. This body should support any learning and the required remedial actions within appropriate timeframes. It should hold organisations accountable for investment and implementation of remedial plans and ongoing measurement of agreed set outcomes. 7. Research and early intervention We need more research to fully understand those at risk of the presentation of Acute Behavioural Disturbance and why. Early warning signs would then be identified and recommendations made for care pathway interventions for better outcomes. What else can healthcare professionals do? Simply be aware of patients presenting with psychosis, particularly with a history of illicit drug use and previous mental health difficulties. Patients with extreme and prolonged agitation can become physically unwell leading to the medical emergency of cardiac arrhythmia and arrest. Take frequent basic physical observations to be alerted to any changes in physical condition. Healthcare professionals already have training and policies on dealing with a deteriorating patient should a change be detected. What else can Trusts do? Make sure relevant staff receive training, education and support in Acute Behavioural Disturbance. Patients taking illicit drugs who may have mental health issues already should be offered support at the earliest possible opportunity to avoid an escalating situation. Drug and alcohol liaison teams working in emergency departments is good practise and can offer clear pathways to support for these patients. Consider partnership working with wider public services to improve mental health support – Avon and Somerset Constabulary have made changes including working with the ambulance service. Trusts should be proactive in providing an appropriate environment for the care and safety of the patient, staff and other patients. An appropriate environment also avoids the potentially discriminatory actions of removing a patient from a busy emergency department because they are disruptive, without proper examination and care. There is a conflict of interest in offering a family a duty of candour when care doesn’t go to plan, and the need to protect the Trust from potential litigation. We found this so frustrating as it meant that what happened to Harry was not fully shared and understood until the inquest some 18 months after his death. I’m not sure how this could be addressed but it’s a wider issue for Trusts to consider. Our family would have felt far less stressed and emotionally exhausted if we had been told more of the facts and what had not gone to plan at an earlier point. Support and advice for other families Over the weeks and months leading up to the inquest there were periods of so much activity that I found it helpful to write a journal. Journal keeping allowed for thoughts to be put down on paper and “parked” but it has also proved to be good for checking back on dates and events. I would recommend keeping a journal to anyone in a similar position. On the good side, there were people and organisations that we were so grateful for and would highly recommend having their support and input. We would not have made it through this period without them. The Mental Health NHS Trust had a Family Liaison Officer who was able to field our questions, update us on issues such as the serious incident investigation and organise meetings with professionals at which she would support us. I don’t know if this is common practice, but we had clear benefit from this role. We found our way to INQUEST, a charitable organisation which supports families like us through the inquest process. We had our own case worker who was amazing at supporting us in both practical ways as well as giving us valuable information and guidance. We really felt we were not alone as she checked on us regularly. She assisted in the appointment of lawyers and a barrister for the inquest and was able to respond to our questions which were many given we had never been in this situation before. We still have contact now. Final thoughts Since Harry’s death there have been further deaths in hospitals with very similar stories to Harry’s. There is a general feeling that there has been an increase of cases. Use of cocaine and illicit drugs, increase of poor mental health in the population and a developing awareness of this presentation are possible associated factors. We have looked at other recent prevention of future deaths reports to find that Acute Behavioural Disturbance is mentioned fairly consistently. Our concern is that these reports are either not responded to, or are responded to inadequately and no effective action is taken. There is no body responsible for the oversight of these reports and to hold those organisations who can effect change to account. Our lives have changed for ever now. We try not to be angry as we know that no one intended for this to happen. We do want learning to be taken away from this unthinkable event in the hope that something similar will not happen to other families, this is so important to us. [1] Royal College of Emergency Medicine, October 2023. Acute Behavioural Disturbance in Emergency Departments (version 2). Share your insights Do you have insights to share around patient safety? Could your experiences help guide improvements? Or perhaps you're a healthcare professional making changes to reduce risk to patient safety? If you would like to contribute, please comment below (you'll need to sign up here first for free) or contact the editorial team at [email protected]. Related reading Harry’s story: Acute Behavioural Disturbance Prevention of future deaths report: Harry Vass (13 June 2024) Mental Health improvements and initiatives implemented in Avon & Somerset Constabulary Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed (9 May 2023) INQUEST: Skills and support toolkit Acute behavioural disturbance: a physical emergency psychiatrists need to understand (14 October 2020)- Posted
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Harry Vass was a 24yr old, he had a history of ADHD, poor mental health, psychosis, paranoia secondary to recreational drug use and illicit drug dependency including cocaine. Harry attended the A&E department of Southmead Hospital on 26th December 2022 at 16.42hrs, with the reason recorded as “mental health”, he was expressing paranoid thoughts. He had a high heart rate and was sweating. He underwent a physical assessment and was assessed by the Mental Health Team. At some point he took cocaine in the toilet of the hospital after which he became more agitated and there were concerns being raised that others in the department felt threatened. At one point he absconded from the unit but was brought back, a doctor in the emergency department gave him medication to calm him down. The police were called but when they attended Harry was calm from the effects of the medication. The police were called and attended again when Harry’s agitation increased. It was during this discussion that the police officer raised the possibility of Harry having ABD (acute behavioural disturbance). The police officer said that he’d seen close to a dozen cases, that Harry had similar symptoms. The two mental health practitioners said that they knew very little about ABD. After some discussions with the police officer, the two mental health practitioners and the consultant in emergency medicine Harry was deemed medically fit and he was admitted under s136 Mental Health Act to The Mason Unit (a place of safety) within the hospital at around 23.00hrs. Once on the Mason Unit Harry continued to be distressed and agitated, he was given further medication to calm him. Harry remained disturbed but had periods of calm, he became fearful of isolation, he became sleepy and at around 3.30hrs on 27th December 2022, he vomited. Observations were carried out confirming that Harry had low oxygen saturations and a high temperature. At 4.45hrs his extremities were discolouring, and he became unresponsive, an ambulance was called. He was transferred back to the A&E department but died at 06.36hrs. The coroner's report included the following matters of concern: Due to Harry’s level of agitation, he did not undergo the level of observations that would and should have happened either in the emergency department or once on the Mason Unit which may have assisted in assessing his physical health. It was clear that none of the mental health nursing staff were aware of ABD and the fact it is a medical emergency. The decision as to whether a person has ABD is important, Dr Delaney said that” this group are vulnerable to cardiac arrest”, that “deaths are multifactorial”, that “normally in the background a body is maintaining safe limits for e.g. pulse rate, blood pressure, temperature, but with acute disturbance in behaviour the body loses control of these safe parameters.” The full report can be found via the link below. You can also read the Royal College of Nursing response here.- Posted
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This study in the Journal of Medical Virology aimed to assess the extent and the disparity in excess acute myocardial infarction (AMI)-associated mortality during the pandemic, focusing on the outbreak of the Omicron strain. Using data from the US Centers for Disease Control and Prevention's (CDC's) National Vital Statistics System, the authors found that excess death, defined as the difference between the observed and the predicted mortality rates, was most pronounced for the 25–44 years age group. Excess deaths ranged from 23%–34% for the youngest compared to 13%–18% for the oldest age groups. The trend of mortality suggests that age and sex disparities have persisted even through the Omicron surge, with excess AMI-associated mortality being most pronounced in younger-aged adults.- Posted
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The Child Health Clinical Outcome Review Programme has produced this review of the barriers and facilitators in transitioning children and young people with complex chronic health conditions into adult health services. Based on data on children and young people with one of 12 complex conditions identified from a sample period between 1st October 2019 and 31st March 2021, the report concludes that there is no clear pathway for the transition from healthcare services for children and young people to adult healthcare services. The report finds that the process of transition and subsequent transfer is often fragmented, both within and across specialties, and that adult services often sit only with primary care. It argues that developmentally appropriate healthcare should be everyone’s responsibility, with adequate resources needed to allow this to happen. The Inbetweeners also calls for services to: involve young people and parent/carers in transition planning and transition to adult services improve communication and coordination between all specialties be organised to enable young people to transfer to adult services effectively, and provide strong leadership at Board and specialty level at all stages of transition and transfer. The report’s recommendations highlight areas that are suitable for regular local clinical audit and quality improvement initiatives by those providing care to this group of patients. It suggests that the results of such work should be presented at quality or governance meetings, and action plans to improve care should be shared with executive boards.- Posted
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The Children and Young People’s Mental Health Coalition (CYPMHC) and the Maternal Mental Health Alliance have launched ‘The Maternal Mental Health Experiences of Young Mums’ report, which includes both a literature review and first-hand insights from young mums impacted by maternal mental health problems. This collaboration began from a shared desire to spotlight the needs of young mums and their mental health and how to improve perinatal mental health provision in an inclusive way. The reality is: postnatal depression is up to twice as prevalent in teenage mothers compared to those over 20 1 in 4 births in England and Wales were to young people aged 16-24 there has been a tragic rise in teenage maternal suicides. This report shines a light on the urgent needs of young mums and how across the UK, we must make the report’s recommendations a positive reality. Based on the experiences and insights received from young mothers and the evidence collated in the literature review, the briefing identifies four priority areas for action to better support the needs of young mothers: Listen and respond to the needs of young mothers in national and local systems Resource and invest in universal and preventative services Ensure access to specialist mental health services Research and listen to the voices of young mums.- Posted
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Suicide prevention drive launched in England amid concern for young people
Patient Safety Learning posted a news article in News
Ministers have vowed to reduce suicide rates in England with the launch of more than 100 new initiatives amid particular concerns over rising deaths and self-harm among children and young people. The pledge to reverse the trends within two and a half years came as the government launched its first prevention strategy in more than a decade. In 2022, there were 5,275 suicides in England, equivalent to 10.6 suicides per 100,000 people, according to the Office for National Statistics. “While overall the current suicide rate is not significantly higher than in 2012, the rate is not falling,” a new government document says. “We must do all we can to prevent more suicides, save many more lives and ultimately reduce suicide rates.” It highlights how rates of suicide among children and young people have increased in recent years, despite being low overall, adding: “Urgent attention is needed to address and reverse these trends.” The new measures being launched will also aid other specific groups at risk of suicide, including middle-aged men, autistic people, pregnant women and new mothers. Steve Barclay, the health secretary, said: “Too many people are still affected by the tragedy of suicide, which is so often preventable. This national cross-government strategy details over 100 actions we’ll take to ensure anyone experiencing the turmoil of a crisis has access to the urgent support they need.” Read full story Source: The Guardian, 11 September 2023- Posted
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Samuel Howes was 17 when he died by suicide in September 2020. Samuel had ongoing mental health issues including anxiety and depression. This led to his use of drugs and dependency on alcohol, which in turn further worsened his mental health. This blog by his mother Suzanne details her experience of the final day of the inquest into her son's death, which found multiple failings on the part of Child and Adolescent Mental Health Services (CAMHS), social services and the police.- Posted
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Woman with anorexia 'faced delays' before death
Patient Safety Learning posted a news article in News
A woman described as a "high risk" anorexia patient faced delays in treatment after moving to university, an inquest has heard. Madeline Wallace, 18, from Cambridgeshire, was told there could be a six-week delay in her seeing a specialist after moving to Edinburgh. The student "struggled" while at university and a coroner said there appeared to be a "gap" in her care. Ms Wallace died on 9 January 2018 due to complications from sepsis. A parliamentary health service ombudsman report into her death was being written at the time of Ms Wallace's treatment in 2017 and issues raised included moving from one provider to another and higher education. Coroner Sean Horstead said Ms Wallace only had one dietician meeting in three months, despite meal preparation and planning being an area of anxiety she had raised. Dr Hazel said she had tried to make arrangements with the Cullen Centre in Edinburgh in April 2017 but had been told to call back in August. The Cullen Centre said it could only accept her as a patient after she registered with a GP and that an appointment could take up to six weeks from that point. Read full story Source: BBC News, 10 February 2020- Posted
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Coroner and friends criticise NHS treatment of 24-year-old anorexia victim
Patient Safety Learning posted a news article in News
A coroner has criticised health professionals for failing to give a young woman who died after suffering severe anorexia the support and care she needed. Maria Jakes, 24, died of multiple organ failure in September 2018 after struggling for years with the eating disorder. Coroner Sean Horstead last week concluded that the agencies involved in the Peterborough waitress’s care missed several key opportunities to monitor her illness properly. Mr Horstead said that there had been insufficient record-keeping and a failure to notify eating disorder specialists in the weeks before her death, following treatment at Addenbrooke’s and Peterborough City Hospital. He also criticised the lack of specialist eating disorder dieticians at Addenbrookes and Peterborough hospitals, “together with a nursing team insufficiently trained and knowledgeable of eating disorder patients”, both of which had contributed to the lack of monitoring of Maria. Despite the criticism the father of another anorexia victim, whose death was described in a Parliamentary and Health Service Ombudsman’s report as an “avoidable tragedy”, has said the inquest failed to properly address or challenge the “lack of care” that Maria received from the NHS. Nic Hart, whose daughter Averil died in 2012 at the age of 19, criticised the inquest as “a very one sided process”. He told The Telegraph: “No real challengers were made of the clinical evidence or indeed of the lack of care that poor Maria received.” Read full story Source: The Telegraph, 21 December 2019- Posted
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England appoints ambassador to shake up women's health
Patient Safety Learning posted a news article in News
England's first women's health ambassador is calling for "one-stop shops" where women can sort out their health needs. Dame Lesley Regan, also a practising doctor, wants to make it easier for women and girls to access care such as contraception and smear tests in the community. Her new role aims to close the "gender health gap". She will also support the upcoming government-led women's-health strategy. "At the moment, we waste a lot of resource in telling girls and women that they cannot have things," she told BBC News. "So you might go off to your doctor or gynaecologist or heart specialist and get told, well, you cannot have a smear here, even if it is due, or you need to go somewhere else for this, that and the other. "We should make it very, very easy for people to access this out in the community - why do you need to go to a secondary or tertiary facility for things that are very easy to provide?" Instead, she wants health hubs where women could "go for half a day and get all these things sorted out" and then get on with their lives. "A one-stop shop is what I want for myself and what I want for my daughters and I'm sure it is what every other girl and woman wants and what every man and boy wants for the women in their lives, to be looked after that way," Dame Lesley said. Read full story Source: BBC News, 17 June 2022- Posted
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Understanding the needs of youth during the COVID-19 crisis
Claire Cox posted an article in Blogs
While COVID-19 coverage has been saturated with news of clinical cases, deaths, hospital shortages, and financial losses, it seems as though a key population has been excluded from the concern. The youth and young adult population, of all ethnicities and backgrounds, have not had the proper attention to their needs as other groups impacted by COVID-19 have. Particularly, these populations are at risk of severe mental health distress due to COVID-19 related financial, academic, and housing instability. The team at Imperial College London describes their approach understanding these barriers for youth in the launch of CCopeY, a study around “Young People’s Mental Health and Their Coping Strategies During and After the COVID-19 Lockdown”.- Posted
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Tips, advice and guidance on where you can get support for your mental health during the coronavirus (COVID-19) pandemic. If you’re worried about the impact of coronavirus on your mental health, you are not alone. The COVID-19 pandemic is a new and uncertain time for all of us and will affect our mental health in different ways. However you are feeling right now is valid. With the right help and support, we can get through this. Here is you will find advice from Young Minds on things you can do to keep mentally healthy during this time.- Posted
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As college students return, a crisis in campus care awaits
lzipperer posted an article in Coronavirus (COVID-19)
Health services in college and university campuses are under pressure to respond to COVID-19 with patient safety in mind. This article from Abelson et al. in The Seattle Times discusses weakness in university health services that undermine their ability to do so. It shares interviews with students that discuss misdiagnosis and diagnostic delays due to the impact of the pandemic.- Posted
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What is orthorexia?
Claire Cox posted an article in Social care
Although not formally recognised in the Diagnostic and Statistical Manual, awareness about orthorexia is on the rise. The term ‘orthorexia’ was coined in 1998 and means an obsession with proper or ‘healthful’ eating. Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being. Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia, and whether it’s a stand-alone eating disorder, a type of existing eating disorder like anorexia, or a form of obsessive-compulsive disorder. Studies have shown that many individuals with orthorexia also have obsessive-compulsive disorder. This web page describes: The signs and symptoms of orthorexia Health implications Treatment- Posted
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Our son’s final days
Claire Cox posted an article in Patient stories
NHS investigators are to meet the family of a young, autistic man - left starving and desperately thirsty in hospital while waiting for a delayed operation. Mark Stuart spent five days in agony and died following a catalogue of failings by NHS staff. His parents say they have been battling for answers for four years. These are the harrowing events that came days before the needless, avoidable death of Mark Stuart. Mark was a young man with autism.- Posted
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Homerton University Hospital describes how they have embedded the Redthread Youth Violence Intervention Programme into their A&E department. What is Redthread? Redthread, a Youth Violence Intervention Programme, runs in hospital emergency departments in partnership with the major trauma network. The innovative service aims to reduce serious youth violence and has revolutionised the support available to young victims of violence. Every year thousands of young people aged 11–24 come through hospital doors as victims of assault and exploitation. It is then, at this time of crisis, that our youth workers use their unique position embedded in the emergency departments alongside clinical staff to engage these young victims. Redthreads extensive experience tells us that this moment of vulnerability, the ‘Teachable Moment’, when young people are out of their comfort zone, alienated from their peers, and often coming to terms with the effects of injury, is a time of change. In this moment many are more able than ever to question what behaviour and choices have led them to this hospital bed and, with specialist youth worker support, pursue change they haven’t felt able to before. Redthread workers focus on this moment and encourage and support young people in making healthy choices and positive plans to disrupt the cruel cycle of violence that can too easily lead to re-attendance, re-injury, and devastated communities. Redthread and the Homerton Redthread is embedded within Homerton’s A&E department. The Redthread youth work team work hand in hand with the emergency department team to safeguard young people between the ages of 11-24 who are at risk of violence or exploitation. Emergency department clinicians send referrals for at-risk young people to the Redthread team, who work on an individual basis with the young people to support them and endeavour to alleviate the risk in their environment. Redthread achieves this by liaising with statutory services such as CAMHS, Children’s Social Care and Housing to ensure that the young person is being placed first. By linking up services, Redthread ensures that the young person is the focal point and that help is being given, without duplicating existing services. Redthread works in several major trauma centres across the UK; however, the Homerton practice is the first community hospital based service. The Redthread service would not be possible without the support of the emergency department staff. Not only is the clinical and non-clinical body supportive of the service and actively referring young people, the emergency department as a whole takes an active interest in Redthread’s work – talking to Redthread staff about their work, fundraising and attending training sessions. Thanks to the initial efforts of emergency department doctors and nurses in gaining funding and support for this project at Homerton, and the continued work and collaboration by the emergency department and Redthread, the service has excellent track record after its 1 year of service. The Redthread youth workers work closely with young people in a way that clinicians do not have time to. This means that patients are cared for both medically and holistically. Though difficult to quantify results, a strong qualitative difference to the service is that there is a caring external presence within the emergency department. For young people in crisis, being seen one-to-one by someone in a non-clinical role means that there is someone solely on their side. In a lot of cases, a Redthread worker might be the first person in a long time to ask if they are ok, and to see them for who they are as opposed to the trauma that they have suffered. For the emergency department team, having a constant youth work presence acts as a reassurance that when a safeguarding issue does arise, this will be followed up and the young person will continue to be cared for. The emergency department safeguarding has improved as awareness has grown among staff members of safeguarding procedures. The Redthread collaboration has also prompted staff to be more inquisitive with the patients they see, and to consider how that patient’s behaviour may be a manifestation of underlying problems. As such, young people coming into the emergency department are safer as they are more likely to be seen and understood by clinicians, as well as receiving long term assistance as part of the emergency department care package. As the first community hospital in the Redthread network, the Homerton Redthread team have tailored and changed their service to best fit the community it serves. The team spend longer working with young people, in addition to working more closely with them than in other hospitals – taking on a constant role in our young people's lives. The breadth of presentations seen at Homerton has also resulted in a broader case-load. The result is a service which is ready to adapt to individual cases to best serve young people both in hospital and out in the community. Redthread at Homerton are also innovating and adding value structurally by meeting young people at the earliest opportunity – the statistic is that young people present to hospitals like Homerton four to five times on average before they are injured to the extent that they have to be taken to a major trauma centre. By being embedded in a local hospital such as this, we have an opportunity to engage people and help them to change their trajectories and avoid escalating harm. We’re also pioneering work around contextual safeguarding, by listening to young people and feeding back to local authorities when for example unsafe spaces in the community are identified.- Posted
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NHS England published an independent report into the deaths of people with a learning disability or mental health problem at Southern Health NHS Foundation Trust and highlighted a system-wide response. The report was commissioned by NHS England (South) following the death of Connor Sparrowhawk in July 2013 in a unit in Oxford run by Southern Health NHS Foundation Trust. Both Southern Health NHS Foundation Trust and the clinical commissioning groups (CCGs) that commission services from them have accepted the recommendations. Main findings: Many investigations were of poor quality and took too long to complete. There was a lack of leadership, focus and sufficient time spent in the Trust on carefully reporting and investigating deaths. There was a lack of family involvement in investigations after a death. Opportunities for the Trust to learn and improve were missed. Of the 1,454 deaths recorded at the Trust during this period, 722 were categorised as unexpected by the Trust. Of these 540 were reviewed and 272 unexpected deaths received a significant investigation.- Posted
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A Parliamentary and Health Service Ombudsman (PHSO) report of an investigation that found that Averil Hart's tragic death from anorexia would have been avoided if the NHS had cared for her appropriately. Ignoring the alarms: How NHS eating disorder services are failing patients highlights five areas of focus to improve eating disorder services.- Posted
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Hitting the target, missing the point
Anonymous posted an article in Florence in the Machine
A thought-provoking blog about what it's like nursing in the emergency department (ED) when there are no beds. What’s the worst thing you have ever seen? For those that work on the frontline in healthcare you may have heard this question asked many times… usually by friends or people you meet when you are trying to relax outside of work. They often want to hear some awful blood and guts story, something unusual being stuck in an unfortunate person’s orifice or a heroic story of a dramatic rescue. We all have something to tell along these lines. Especially when you work in ED, like me. Yep, they are awful episodes, especially for those involved, these awful stories often happen in ED. Car crashes, trauma, cardiac arrests, injured, sick children… you name it, I’ve probably seen it. When tragic things happen, we have support to get us through them. We have support from our wonderful work colleagues who understand – most of the time black humour gets us through. I want to tell you about the worst thing I ever saw, I still see, we all still see. It wasn’t a one off, I didn’t get any support, we didn’t get any support. In fact, it went unnoticed and it happened multiple times and often for hours on end. It’s like being in a recurrent bad dream, the trouble is that it isn’t a dream. It’s real and it's probably happening in hospitals up and down the country today. Rose tinted spectacles… It’s a Tuesday afternoon. It’s a warm, sunny day. I have had 2 whole days off. I’m rested and ready for the day ahead. I drive to work in a good mood. Today is going to be a great day. I walk up to the ED entrance. My hopes of a good day are dashed. There are already eight ambulances outside. I hear the sirens of another in the distance coming up the road. Perhaps the department was already empty… it might not be that bad? I step inside. Two paramedics wheel an elderly man up to the desk. He looks frail, he has a bruised face and blood running from his nose. He looks frightened. He has fallen in his rest home. "… you will have to park him in the corridor, love..." The corridor is now an ‘area’ in our ED. It’s not a walkway between two clinical areas, it’s now clinical area itself. We even have allocated a ‘corridor nurse’ to care for this group of patients. The corridor is full. Each side of the corridor there are people. People on trollies, in chairs, in wheelchairs. I feel their eyes staring at me. Someone is calling out for water, someone has vomited on the floor, an elderly lady is wandering around with her hospital gown on, it's not done up properly and everyone can see her bottom. Every few steps I take I hear someone ask when they are going to be seen. I see a couple crying, trying to console each other in full view of the onlooking people who have nothing else to do but wait. I must walk down to get to the staff room to start my shift. I feel like I am running the gauntlet. I need to get changed and get on with moving people out of the department. I hear staff members muttering "thank god the day staff are here" and "good luck, you’re going to need it". Ok, If I was able to nurse the way I have been taught; ensuring patients are listened to, made comfortable, had medication on time, are given food and water, turned if required, clean… basic nursing care, maybe I wouldn’t feel as crap as I do when I go home. Maybe I’m in the wrong job? But… this type of nursing takes time. Time is forever ticking, especially in ED. It's all about flow. Get them seen, treated and moved – within 12 hours. Sounds a long time 12 hours, doesn’t it? It’s not in healthcare. Blink, 12 hours have gone in a flash. Site managers constantly circle the nurses’ station with their clip boards, trying to strategically place patients on appropriate wards. Single sexed bays, side room, isolation rooms, monitored beds, surgical, medical, trauma, elective, the list goes on. It must be like playing one of those online strategy games, but it never ends. I’m now waiting for handover. The noise is deafening. White noise. I try and block out other people’s instructions, conversations, phones ringing, doors banging. My senses are overloaded. Not only is it too loud, the smell of stale alcohol and vomit is left in the air from an overdose that came in earlier, the irony smell of blood left by lady with a bleeding ulcer, the heat of the corridor and a hint of pseudomonas from a leaking leg ulcer – there are no windows here to give us any relief. This is my next 12 hours. People who are wearing lanyards appear. I see them when things go ‘tits up’. No idea who they are, what they do or where they come from. Never have they spoken to me and I have never seen them speak to a patient. They arrive in immaculate clothing and smell fresh, whereas I have been here a few hours and already blended in with the current smells. They are obsessed with how long people have stayed in the department. I see them frown and start talking to the site managers, who then speak to our nurse in charge, who then will speak to me. "We need to move X number of patients out of here in the next 2 hours." So, if I choose to help a man who may have soiled himself – this may take up to 40 minutes. That’s too long. I should have been preparing my patients to move off. But then if I don’t help him, the ward he moves onto will report me. Notes to prepare, IV antibiotics to give with in 1 hour, comfort rounds every 2 hours, mouth care, turn charts, feeding regimes, safety documentation to be completed, toileting, venepuncture, sepsis pathways, NEWS charting, escalation protocols… so many targets to be met. I can’t do this. It’s impossible. ‘The standard you walk past is the standard you accept’ Every time I walk down that corridor – I say this in my head. I have failed. We have failed our patients. That is the worst thing I have ever seen.- Posted
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