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Patient Safety Learning

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  1. Patient Safety Learning
    A large-scale trial of a new treatment it is hoped will help stop COVID-19 patients from developing severe illness has begun in the UK.
    The first patient received the treatment at Hull Royal Infirmary on Tuesday afternoon. It involves inhaling a protein called interferon beta which the body produces when it gets a viral infection.
    The hope is it will stimulate the immune system, priming cells to be ready to fight off viruses.
    Early findings suggested the treatment cut the odds of a COVID-19 patient in hospital developing severe disease - such as requiring ventilation - by almost 80%.
    It was developed at Southampton University Hospital and is being produced by the Southampton-based biotech company, Synairgen.
    Read full story
    Source: BBC News, 13 January 2021
  2. Patient Safety Learning
    More women may suffer pain due to being conscious while undergoing caesareans or other pregnancy-related surgery under general anaesthetic than realised, a troubling new study has found.
    The report, conducted by medical journal Anaesthesia, found being awake while having a caesarean is far more common than it is with other types of surgery. 
    Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit.
    If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said.
    While the experiences generally only last for a few seconds or minutes, anaesthetists remain highly concerned.
    Women also felt tugging, stitching, feelings of dissociation and not being able to breathe - with some suffering long-term psychological damage that often involved characteristics of post-traumatic stress disorder.
    Read full story
    Source: The Independent, 13 January 2021
  3. Patient Safety Learning
    Many hospital staff treating the sickest patients during the first wave of the pandemic were left traumatised by the experience, a study suggests.
    Researchers at King's College London asked 709 workers at nine intensive care units in England about how they were coping as the first wave eased. Nearly half reported symptoms of severe anxiety, depression, post-traumatic stress disorder or problem drinking. One in seven had thoughts of self-harming or being "better off dead".
    Nursing staff were more likely to report feelings of distress than doctors or other clinical staff in the anonymous web-based survey, which was carried out in June and July last year. Just over half reported good well-being.
    Victoria Sullivan, an intensive care nurse at Queen's Hospital in Romford, said she often can't sleep because she's thinking about what is happening at the hospital.
    Her worst moment was breaking the news of a death on the phone, she said, adding that the screams from the patient's relatives "will honestly stay with me forever".
    "Telling someone over the phone and all you can say is 'I'm really sorry', whilst they're crying their heart out, is quite traumatising," she said. "Although you're saying how sorry you are, in the back of your mind, you're also thinking: 'I've got three other patients I've got to go and see, the infusions need drawing up, and meds need to be given and a nurse needs support'.
    "The guilt is just too much."
    Lead researcher Prof Neil Greenberg said the findings should be a "wake-up call" for NHS managers. He said: "The severity of symptoms we identified are highly likely to impair some ICU staff's ability to provide high-quality care as well as negatively impacting on their quality of life."
    Read full story
    Source: BBC News, 13 January 2021
  4. Patient Safety Learning
    There is a considerable human and healthcare cost that could have been avoided at the onset of COVID-19 had more been done to ameliorate eventual racial health disparities, amounting to thousands of lives lost and billions of dollars spent, according to analysis from Altarum on behalf of Episcopal Health Foundation.
    Using figures up until the end of September 2020, the researchers found that had Black and Hispanic people in Texas been hospitalised at the same rate as their White counterparts, the state would have seen 24,000 fewer hospitalisations. That would have amounted to $550 million in healthcare cost savings, the analysis showed.
    That is not to mention the human costs associated with racial health disparities during the pandemic. Had Black and Hispanic patients had the same COVID-19 mortality rates as White people, the state of Texas would have seen about 5,000 fewer deaths, cutting the total number of COVID-19 deaths in the state by 30%.
    “These numbers are a glaring reminder of how non-medical factors like economic status and living conditions impact health and how COVID-19 is highlighting that in the worst way,” Elena Marks, president and CEO of the Episcopal Health Foundation, said in a statement. “The human and economic costs of health disparities continue to grow during the pandemic and we’re learning why we can’t address them through medicine alone. Something has to change in Texas.”
    Read full story
    Source: Patient Engagement HIT, 13 January 2021
  5. Patient Safety Learning
    More than a third of critical care units in the East of England are either at or have exceeded their maximum surge capacity, information leaked to HSJ reveals, and all but one are above their normal capacity.
    Data from the region’s critical care network shows that as of 11 January, seven of the region’s 19 critical care units were either at 100% of, or had exceeded, what is known as ”maximum safe surge” capacity. This represents the limit of safe care, mostly based on available staffing levels. The units have opened more beds, but they require dilution of normal staffing levels.
    Across the East of England, 482 of the region’s current 491 intensive care beds, after the opening of surge capacity, were occupied. This included 390 patients in intensive care with confirmed covid-19, six with suspected covid and 86 non-covid patients.
    It gives a regional occupancy rate of 91 per cent against total “safe surge” capacity.
    Published government figures show the rapid increase in demand for intensive care in the East of England in the last two weeks — the number of patients with covid in mechanical ventilation beds is more than double what it was just after Christmas.
    Read full story (paywalled)
    Source: HSJ, 11 January 2021
  6. Patient Safety Learning
    Thousands of women have had abortions after falling pregnant while having difficulties accessing contraception during the pandemic, healthcare providers have warned.
    Sexual health clinics have been forced to shut or run reduced services while staff are transferred to work with Covid patients or have to self-isolate – with the profound disruption leaving many women unable to access their usual methods of contraception.
    Many women are struggling to get the most effective long-acting contraceptive choices of a coil or an implant due to these requiring face-to-face appointments which have largely been suspended as consultations are carried out remotely via phone or video call to curb the spread of COVID-19.
    British Pregnancy Advisory Service, the UK's largest abortion provider, told The Independent they provided the progestogen-only contraceptive pill to almost 10,000 women undergoing an abortion between May and October last year.
    Katherine O’Brien, a spokesperson for the service, said: “Many of these women will have fallen pregnant after struggling to access contraception, so there really is a huge unmet need for contraceptive services which will only worsen as lockdown and Covid continues.
    “We routinely hear from women during the pandemic who simply can’t access their regular method of contraception because of clinics closing or staff being deployed elsewhere or staff self-isolating.”
    Read full story
    Source: The Independent, 9 January 2021
  7. Patient Safety Learning
    A coronavirus patient's gut bacteria may influence the length and severity of their infection and their immune response to it, a new study suggests. A team of researchers at The Chinese University of Hong Kong examined whether the variety and quantity of microbiome played a role in COVID-19 infections.
    Researchers found that patients with COVID-19 were depleted in gut bacteria known to modify a person's immune response, and that this depletion appeared to persist 30 days after the virus had gone.
    Gut bacteria — or gut microbiome — help to digest food. But research increasingly shows that gut bacteria also affect our health.
    The study, published in the journal Gut, found that the composition of gut microbiome had changed in COVID-19 patients, compared to those who did not have the infection.
    It said that gut microbiome could be involved in the "magnitude of COVID-19 severity possibly via modulating host immune responses".
    Read full story
    Source: The Independent, 12 January 2021
     
  8. Patient Safety Learning
    UK residents can apply for a Global Health Insurance Card (GHIC) to access emergency medical care in the EU when their current EHIC card runs out.
    Under a new agreement with the EU, both cards will offer equivalent healthcare protection when people are on holiday, studying or travelling for business. This includes emergency treatment as well as treatment needed for a pre-existing condition.
    The new GHIC card is free and can be obtained via the official GHIC website.
    Current European Health Insurance Cards (EHIC) are valid as long as they are in date, and can continue to be used when travelling to the EU. 
    You don't need to apply for a GHIC until your current EHIC expires. People should apply at least two weeks before they plan to travel to ensure their card arrives on time.
    Read full story
    Source: BBC News, 11 January 2021
  9. Patient Safety Learning
    GPs are being paid £1,000 to cancel second dose appointments for Covid jabs and given a script to follow to deal with angry patients amid growing chaos in the roll-out of the vaccine programme.
    Practices have been offered the payments to cover the workload of postponing hundreds of patients who were set to have their second dose and booking new ones in their place.
    NHS sources said the shift has contributed to delays in rolling out the programme. Some GPs have refused to postpone the appointments, with practice managers saying it was "too cruel" to dash the hopes of those who were booked for a second jab.
    In December, everyone given a first vaccine by Pfizer was told to come back for their second dose three weeks later. But the strategy was changed 10 days ago in a bid to get a first dose to more of the population more quickly.
    Patients are now being told they will have to wait 12 weeks for the second dose, with a reassurance from health officials that the longer gap could strengthen its effectiveness.
    By the time the plan was changed, around one million people had already been booked in for their second dose. GPs are now under orders to postpone such appointments and instead give the slots to those awaiting a first dose. 
    Read full story
    Source: The Telegraph, 8 January 2021
  10. Patient Safety Learning
    NHS England has told hospitals in the Midlands to further dilute their staffing ratios so critical care capacity can be doubled, HSJ has learned.
    In a letter sent on 9 January to the boards of all trusts in the region, national leaders said they needed to “dilute nursing ratios beyond the current ask of 1:2” to achieve the significant increase in capacity.
    In November, all trusts in England were told they could dilute staffing ratios in critical care from the standard one nurse to one patient ratio, to one nurse to two patients. Informal reports from around the country suggest some trusts have already had to move beyond these ratios.
    The letter said trusts had already been asked to surge capacity to 150% cent of the normal baseline on 6 January, and were expected to be at 175% today. But it said some units were still not achieving this and the region was “transferring patients to other regions.”
    It added: “In addition to this, you need to have well developed plans in place that can be rapidly activated to surge to 200% of baseline, which may need to be enacted in the coming days.
    Read full story (paywalled)
    Source: HSJ, 11 January 2021
  12. Patient Safety Learning
    Rachel Hardeman has dedicated her career to fighting racism and the harm it has inflicted on the health of Black Americans. As a reproductive health equity researcher, she has been especially disturbed by the disproportionately high mortality rates for Black babies.
    In an effort to find some of the reasons behind the high death rates, Hardeman, an associate professor at the University of Minnesota School of Public Health, and three other researchers combed through the records of 1.8 million Florida hospital births between 1992 and 2015 looking for clues.
    They found a tantalising statistic. Although Black newborns are three times as likely to die as White newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half.
    "Strikingly, these effects appear to manifest more strongly in more complicated cases," the researchers wrote, "and when hospitals deliver more Black newborns." They found no similar relationship between White doctors and White births. Nor did they find a difference in maternal death rates when the doctor's race was the same as the patient's.
    Read full story
    Research paper
    Source: The Washington Post, 9 January 2021
  13. Patient Safety Learning
    People waiting to receive the COVID-19 vaccine say they are confused by NHS letters inviting them to travel to centres miles away from their homes.
    The first 130,000 letters have been sent to people aged 80 or older who live about 30 to 45 minutes' drive away from one of seven new regional centres.
    But patients, many of whom are shielding, questioned why they had to travel so far in a pandemic.
    Local jabs are available to people if they wait, the NHS said.
    The seven centres include Ashton Gate in Bristol, Epsom racecourse in Surrey, London's Nightingale hospital, Newcastle's Centre for Life, the Manchester Tennis and Football Centre, Robertson House in Stevenage and Birmingham's Millennium Point.
    Mary McGarry from Leamington Spa in Warwickshire told BBC News that her letter points to an NHS online booking page which suggests she would have to take her husband, who has cancer and a lung disease, 20 miles to Birmingham.
    "We're very reluctant to go into Birmingham city centre," she said.
    "If we can't get somebody to take us, we'd have to go on the train but we're shielding because my husband's got poor health.... we want to know why we've got to travel that far?"
    People will not miss out on their vaccination if they do not use the letters to make an appointment at one of the centres, the NHS said.
    Read full story
    Source: BBC News, 11 January 2021
  14. Patient Safety Learning
    A hospital's oxygen supply has "reached a critical situation" due to rising numbers of COVID-19 infections.
    A document shared with the BBC showed Southend Hospital has had to reduce the amount it uses to treat patients. It said the target range for oxygen levels that should be in patients' blood had been cut from 92% to a baseline of 88-92%.
    Hospital managing director, Yvonne Blucher, said it was "working to manage" the situation.
    "We are experiencing high demand for oxygen because of rising numbers of inpatients with Covid-19 and we are working to manage this," she said.
    Read full story
    Source: BBC News, 11 January 2021
  15. Patient Safety Learning
    The government is being pressed to urgently pay care homes to take on thousands of patients from hospitals, many of which are on course to be overwhelmed by COVID-19 patients.
    Hospitals, particularly in London and the surrounding areas, are seeing very high and rapidly growing numbers of covid-19 admissions, and are running out of options to free up beds. Multiple senior NHS leaders said they need to discharge more patients to care homes, but that this had become increasingly difficult.
    Beds in many care homes are lying empty, but many care providers are refusing to accept residents where there is a risk of introducing covid-19 and fear of repeating the disaster of the spring in the sector.
    Part of the problem is some care providers which would otherwise become covid-designated homes say they are not insured for the risk of doing so.
    HSJ understands national officials in the NHS and government are now considering options to try to alleviate the problem, amid urgent requests from local NHS leaders, including paying for the additional insurance cost. However, sources said the Treasury had not yet been willing to foot the bill.
    Read full story
    Source: HSJ, 7 January 2021
  16. Patient Safety Learning
    The government has confirmed plans to open seven new mass vaccination centres across England next week.
    The seven centres opening are:
    ExCel Centre (Nightingale), London Etihad Tennis and Football Centre, Manchester Centre for Life, Newcastle Robertson House, Stevenage Epsom Downs racecourse, Surrey Ashton Gate Stadium, Bristol Millennium Point, Birmingham The exact opening dates for each site have yet to be established, however the prime minister’s official spokesperson said they would be opening “next week”. More details on how the vaccination sites will operate are expected to be revealed over the coming days. 
    Read full story
    Source: The Independent, 6 January 2021
  17. Patient Safety Learning
    In a bid to fight against misinformation about the coronavirus vaccines, a group of scientists from all over the world have created an online guide to building a ‘truth sandwich’.
    The guide serves to arm people with practical tips, up-to-date information and evidence to talk reliably about the vaccines, and enable them to constructively challenge associated myths.
    The scientists, led by the University of Bristol, are appealing to everyone to understand the facts set out in the 'COVID-19 Vaccine Communication Handbook', follow the guidance and spread the word.
    Professor Stephan Lewandowsky, the lead author of the guide, said: “Vaccines are our ticket to freedom and communication about them should be our passport to getting everyone on board."
    “The way all of us refer to and discuss the COVID-19 vaccines can literally help win the battle against this devastating virus by tackling misinformation and improving uptake, which is crucial."
    Read full story
    Source: The Independent, 7 January 2021
  18. Patient Safety Learning
    Some trusts in London and the South East are closing standalone birth centres and warning they cannot support home births because of high levels of demand for ambulance services from covid patients.
    Women in East Sussex who planned to give birth at Eastbourne District General Hospital and Crowborough Birth Centre have been told they need to go to other units. Both Eastbourne and Crowborough have standalone midwife-led units and women who have a difficult labour would need to be transferred by ambulance to another hospital.
    Both East Sussex Healthcare Trust and Maidstone and Tunbridge Wells Trust, which run the services, cited pressure on the ambulance services as the reason for the closures. The trusts, both of which are served by South East Coast Ambulance Service Foundation Trust, have also suspended support for home births.
    Services are continuing at a similar birthing unit at Maidstone Hospital, with private ambulances transferring women to Tunbridge Wells Hospital if needed. However, Maidstone and Tunbridge Wells Trust has posted on Facebook to warn women the situation may change and it is monitoring ambulance response times to determine “the safety of our out of hospital birthing choices”.
    Read full story (paywalled)
    Source: HSJ, 6 January 2021
  19. Patient Safety Learning
    For the first since April the UK has recorded more than 1,000 daily Covid-related deaths – one of the highest figures of the pandemic.
    Right now, London is at the epicentre of this crisis. Hospitals now have more Covid patients being admitted every day than they did at the peak in April. Many doctors and nurses say they're reaching breaking point.
    The BBC's medical editor Fergus Walsh filmed inside the intensive care unit at London's University College Hospital, which is one of the busiest in the capital.
    View video
    Source: BBC News, 6 January 2021
  20. Patient Safety Learning
    London’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon.
    NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call.
    The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January.
    The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity.
    Read full story (paywalled)
    Source: HSJ, 6 January 2021
  21. Patient Safety Learning
    Many people suffering from “long Covid” are still unable to work at full capacity six months after infection, a large-scale survey of confirmed and suspected patients has found.
    While COVID-19 was initially understood to be a largely respiratory illness from which most people would recover within two or three weeks, as the pandemic wore on increasing numbers reported experiencing symptoms for months on end.
    These long haulers – with symptoms affecting organs ranging from the heart to the brain – have no real explanation and no standardised treatment plan for their long-term condition. There is no consensus on the scale and impact of long Covid but emerging data is concerning.
    In one of the largest studies yet, which has not been peer reviewed, Patient Led Research for COVID-19 (a group of long Covid patients who are also researchers) surveyed 3,762 people aged 18 to 80-plus from 56 countries who responded in nine different languages to 257 different questions
    Two-hundred and five symptoms across 10 organ systems were recorded, with 66 symptoms traced over seven months. On average, respondents experienced symptoms from nine organ systems.
    Read full story
    Source: The Guardian, 5 January 2021
  22. Patient Safety Learning
    NHS leaders are holding fresh talks with private healthcare groups to try to secure surgery for urgent cancer patients in London, as the covid-19 second wave causes hospitals in the capital to make widespread cancellations, HSJ understands.
    In recent weeks, pivotal independent sector providers have declined to do the procedures for the payments on offer.
    In the spring covid peak, the NHS block-booked private capacity in London, but now only small, spot contracts are in place for this work. Under the previous deal, rules meant low-priority private patients could not be treated ahead of NHS patients who needed surgery urgently.
    But now providers can prioritise their private patients as they see fit. HSJ understands NHS England, under pressure from the Treasury, was not willing to pay the prices asked by the three private providers.
    As London NHS hospitals continue to fill with covid patients, particularly in critical care, they are able to do few cancer procedures beyond the most urgent category, P1, and are suspending many procedures in the lower categories, including P2, sources said. P2 is defined as patients who need treatment within four weeks.
    One senior clinical manager in the city told HSJ on Monday: “Cancellations [are] rife. We have stopped almost all operating in our elective hub apart from P1 [patients assessed as needing surgery within three days].
    “The independent sector has not opened up capacity and lifestyle operations [are] still planned [in private hospitals].”
    Read full story (paywalled) 
    Source: HSJ, 5 January 2021
  23. Patient Safety Learning
    Doctors on the front line of the UK’s vaccine programme have said they are “ready to go” and will be able to administer doses “very quickly” in the months ahead, amid questions over whether or not the NHS can inoculate 2 million people a week.
    After suggestions that staffing constraints could hinder the roll-out of the Oxford/AstraZeneca vaccine, which was approved for use last week, NHS officials and GPs have insisted that the health service is primed to deliver doses as soon “as supply becomes available”.
    On Monday, Professor Stephen Powis, national medical director of NHS England, said 100 hospital hubs and 700 vaccination centres – based in GP practices and other community settings – would have access to the vaccine by the end of the week, with plans in place to expand the programme.
    “We aim to get it into people’s arms as quickly as it is supplied to us,” Prof Powis said. “If we get 2 million doses a week, our aim is to get 2 million doses into the arms of those priority groups."
    Read full story
    Source: The Guardian, 4 January 2021
  24. Patient Safety Learning
    A thousand health professionals have backed an appeal for hospital staff to be given improved personal protective equipment.
    In an open letter to UK political leaders, they say there is growing evidence that tiny coronavirus particles can spread through the air.
    The group want general ward staff to be given the type of high-quality masks usually only worn in intensive care.
    Nurses' leaders said higher level PPE should be provided as a "precaution".
    Read full story
    Source: BBC News, 5 January 2021
  25. Patient Safety Learning
    Nine months ago, Boris Johnson praised staff at St Thomas’ for saving his life. Now, a senior intensive care nurse at the London hospital has warned that patient care is being compromised because of staff shortages and a failure to plan for the second Covid wave.
    Dave Carr, an intensive care charge nurse, is one of many NHS workers desperate for the public to know what is going on inside their hospitals at a time when misinformation and scepticism about the virus are rife.
    “The public needs to be aware of what’s happening. This is worse than the first wave; we have more patients than we had in the first wave and these patients are as sick as they were in the first wave. Obviously, we’ve got additional treatments that we can use now, but patients are still dying, and they will die,” said Carr.
    As a representative for the union Unite, Carr feels emboldened to speak out. But across the NHS, many more staff claim they have been threatened with disciplinary action or even dismissal if they put their head above the parapet.
    In Devon, one nurse working on a Covid ward said safety standards had slipped at her hospital, but she feared for her job if she was identified by name. “The infection control restrictions are more relaxed. Before, we had to use a separate entrance but now we don’t, and some doctors feel they don’t have to obey the infection control protocols and are still unsure of how to properly remove the PPE,” she said.
    Read full story
    Source: The Guardian, 1 January 2021
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