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Patient Safety Learning

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  1. Patient Safety Learning
    A hospital in Yorkshire has said it is cancelling planned surgeries for at least two weeks as the number of coronavirus patients there hits levels not seen since May.
    Bradford Teaching Hospitals said it was being forced to stop non-urgent surgery and outpatient appointments for two weeks from Tuesday because of the numbers of severely ill COVID-19 patients.
    In statement the hospital said it had seen a spike in admissions in the last few days with 100 coronavirus patients now on the wards with 30 patients needing oxygen support – the highest number of any hospital in the northeast and Yorkshire region.
    It also said more patients were needing ventilators to help them breathe in intensive care.
    The trust is the latest to announce cancellations, joining the University Hospitals of Birmingham, Nottingham University Hospitals and Plymouth Hospitals as well as those in Liverpool and Manchester where hundreds of Covid patients are being looked after.
    Read full story
    Source: The Independent, 21 October 2020
  2. Patient Safety Learning
    UK researchers have developed a new risk prediction tool that estimates a person’s chance of hospitalisation and death from COVID-19.
    The algorithm, which was constructed using data from more than eight million people across England, uses key factors such as age, ethnicity and body mass index to help identify individuals in the UK at risk of developing severe illness.
    It’s hoped that the risk prediction tool, known as QCOVID, will be used to support public health policy throughout the rest of the pandemic, in shaping decisions over shielding, treatment or vaccine prioritisation.
    The research, published in The BMJ, was put together by a team of scientists across the UK, and has been praised for the depth and accuracy of its findings.
    “This study presents robust risk prediction models that could be used to stratify risk in populations for public health purposes in the event of a ‘second wave’ of the pandemic and support shared management of risk,” the researchers say.
    “We anticipate that the algorithms will be updated regularly as understanding of COVID-19 increases, as more data become available, as behaviour in the population changes, or in response to new policy interventions.”
    Read full story
    Source: The Independent, 21 October 2020
  3. Patient Safety Learning
    A man who was the last patient to leave Blackpool Victoria Hospital's intensive care unit after being treated for COVID-19 in July has died.
    Roehl Ribaya spent 60 days in intensive care in the summer but "never recovered" from the long-term effects of the virus. 
    The Filipino aerospace engineer's family said the virus had taken a heavy toll on the 47-year-old even after he was discharged from hospital on 14 August. He had a cardiac arrest on 13 October and was in a coma until he died two days later.
    His wife, Mrs Ricio-Ribaya, who lives in St Annes in Lancashire, said: "He was never the same. He was so breathless all the time.
    "Please follow the government's advice so we can stop this virus. We don't want any more to die."
    Read full story
    Source: BBC News, 20 October 2020
  4. Patient Safety Learning
    Parts of the South East saw “striking” levels of excess deaths occurring in people’s homes between July and October.
    Analysis of official data by HSJ shows the region, which excludes London, had almost 900 excess deaths in the 10 weeks to 2 October (around 10 per 100,000 population), which accounted for almost three-quarters of the national total in that period.
    Excess deaths means the number taking place above the seasonal average of previous years.
    Deaths in people’s homes — as opposed to in hospitals or care homes, for example — more than accounted for the total excess. Meanwhile, only 132 of the region’s deaths in this period mentioned COVID-19 on the death certificate.
    Experts have described the South East numbers as “very striking”, but said it is not immediately clear what was causing it to be such a significant outlier.
    Possible explanations for excess mortality during the pandemic have included disruptions to normal health services, as well as anxiety among patients about attending hospital or GP surgeries.
    Read full story (paywalled)
    Source: HSJ, 20 October 2020
  5. Patient Safety Learning
    There is growing distrust for the NHS and government in communities that are of fundamental importance to the national effort to counter covid, according to research by NHSX.
    People in so-called “hard to reach” communities are faced with stigma and racism due to the covid pandemic but have dwindling trust in the health service, the research found.
    They are worried about how their personal data will be used by the NHS and other state bodies. They are particularly concerned that their details will be passed on to the police or immigration services.
    Read full story (paywalled)
    Source: HSJ, 20 October 2020
  6. Patient Safety Learning
    The large number of COVID-19 patients being admitted to hospitals at the centre of the second wave will “devastate” care for people with other illnesses, a top doctor has said.
    Dr Tristan Cope said Liverpool’s acute hospitals would not be able to continue providing normal care because of the high number of people being treated for serious Covid symptoms. Unless the surge in coronavirus admissions slowed down it would “have a devastating effect on planned care, such as operations”, he said.
    Cope is the medical director of Liverpool university hospitals NHS trust, where almost all critical care beds are already full because the city’s high infection rate has placed intense pressure on the trust’s three hospitals: the Royal Liverpool, Broadgreen and Aintree.
    “Liverpool hospitals are under enormous pressure with admissions of sick Covid patients. We are used to pressure, but this is over and above that,” Cope tweeted last week.
    “We have the highest number of Covid patients in the UK, nearly as many now as at the peak of the first wave. We also have more Covid patients in ICU [intensive care units] than any other trust in the UK.”
    Cope said: “If we don’t reduce the rate of infection in the community and Covid admission rates continue to rise, it will inevitably have a massive effect on non-urgent care."
    “If we don’t get control of [the] spread of the virus in the community and admissions continue at the current rate, our hospitals will not be able to cope. This will have a devastating effect on planned care, such as operations.”
    Read full story
    Source: The Guardian, 15 October 2020
  7. Patient Safety Learning
    A mother of a young boy with Down's syndrome is helping to teach people about appropriate language, after being hurt by words people often used.
    Becca, from Cornwall, uses flashcards to make sure people are aware to say things like saying someone "has Down's syndrome", rather than "suffers with Down's syndrome".
    The campaign is being rolled out in hospitals for midwives and other healthcare workers to use, with many in the profession talking about it on social media.
    A children's clothing company has offered to run it, with her son Arthur as the model, and she has been asked to translate it into other languages.
    Source: BBC News, 15 October 2020
  8. Patient Safety Learning
    The offices of the World Health Organisation (WHO) for the Quality of Health Care and Patient Safety will be located in Athens, Health Minister Vassilis Kikilias and the WHO Regional Director for Europe, Hans Kluge, announced on Friday after their meeting in Copenhagen.
    "The choice of Greece is a recognition of the work by Prime Minister Kyriakos Mitsotakis, the Greek Ministry of Health and the Greek government in managing the pandemic and implementing public health policies, such as the successful implementation of the anti-smoking law, and promoting important reforms, such as passing the law for the establishment of the National Organisation for Quality Assurance in Health," the health ministry said in a statement.
    "Greece has recently led important developments in the field of health, such as legislation banning smoking in public places, the launch of the National Anti-Smoking Action Plan and reforms in the field of primary health care."
    "All the above, in combination with the excellence of the Greek health institutions and the leading researchers in the field of health and wellness, indicate a strong leadership within the European Region and beyond. In addition, they create an ideal framework for the creation of a much-needed centre of excellence in the field of quality healthcare and patient safety."
    Read full story
    Source: The National Herald, 16 October 2020
  9. Patient Safety Learning
    As hospitalisations and intensive care admissions surge around the country, new figures indicate coronavirus patients in critical care have a better survival rate now than when the pandemic first began.
    The latest report from The Intensive Care National Audit and Research Centre (ICNARC) into critical care for England, Wales and Northern Ireland looks at patients admitted to intensive care up until 31 August and those admitted from 1 September.
    The data shows that on average, 39% of critical care coronavirus patients died up until the end of August while less than 12% have died since September.
    The proportion of patients who died after being admitted to critical care fell by almost a quarter from the peak and as much as half in hospitals overall.
    However, the Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard, told the BBC that the difference may be attributed to an insufficient amount of time having passed which impedes an accurate and longterm patient assessment, as some remain in hospital.
    Meanwhile, scientific advisors continue to warn that the next few weeks are critical for regulating hospital admissions.
    Read full story
    Source: The Independent, 18 October 2020
  10. Patient Safety Learning
    A pharmacist-led, new digital intervention that improves patient safety when prescribing medication in general practice reduced rates of hazardous prescribing by more than 40%, 12 months after it had been introduced to 43 GP practices in Salford, finds a new study. Due to its success, plans are underway to roll it out across Greater Manchester.
    Prescribing and medication are one of the biggest causes of patient safety incidents and the third WHO Global Patient Safety Challenge is focussed on Medication without Harm. The SMASH intervention addresses this. It was developed by researchers at the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), which is a partnership between The University of Manchester and Salford Royal hospital in collaboration with The University of Nottingham.
    Pharmacists working in general practice use the SMASH dashboard to identify patients who are exposed to potentially hazardous prescribing. For example, patients with a history of internal bleeding may be prescribed medications such as aspirin which could increase the risk of further internal bleeds without prescribing other treatments to protect them. SMASH identifies this and warns healthcare professionals about it, who can then decide on a possible course of action.
    The intervention is unique due to its ability to provide near real time feedback to prescribers as it updates every evening.
    Professor Darren Ashcroft, Research Lead for the Medication Safety theme at the GM PSTRC, said: "We worked with the Safety Informatics theme at the GM PSTRC to develop then test SMASH. It is designed to improve patient safety in general practice by reducing potential problems made when prescribing medication and inadequate blood-test monitoring. It brings together people and data to reduce these common medication safety problems that all too often can cause serious harm."
    Read full story
    Source: EurekAlert, 14 October 2020
  11. Patient Safety Learning
    Inpatient mortality among people receiving non-invasive ventilation (NIV) has decreased for the first time since 2010, falling from 34% in 2013 to 26% in 2019, figures released by the British Thoracic Society show.
    The annual National Adult Non-Invasive Ventilation audit, which began in 2010, reported “substantial improvements in processes of care and patient outcomes” in 2019 when compared with previous years.
    “Some improvement in overall mortality may be attributed to improved patient selection,” it said. “Mortality outcomes were lower for each diagnostic category, and most notably for patients with COPD [chronic obstructive pulmonary disease] and obesity-related respiratory failure.”
    Read full story (paywalled)
    Source: BMJ, 10 July 2020
  12. Patient Safety Learning
    Greater Manchester is set to run out of beds to treat people left seriously ill by COVID-19, and some of the region’s 12 hospitals are already full, a leaked NHS document has revealed.
    It showed that by last Friday the resurgence of the disease had left hospitals in Salford, Stockport and Bolton at maximum capacity, with no spare beds to help with the growing influx. The picture it paints ratchets up the pressure on ministers to reach a deal with local leaders over the region’s planned move to the top level of coronavirus restrictions.
    It suggested that Greater Manchester’s hospitals are quickly heading towards being overwhelmed by the sheer number of people with Covid needing emergency care to save their lives, in the same way that those in Liverpool have become in recent weeks. By Friday 211 of the 257 critical care beds in Greater Manchester – 82% of the total supply – were already being used for either those with Covid or people who were critically ill because of another illness.
    Read full story
    Source: The Guardian, 18 October 2020
  13. Patient Safety Learning
    After contracting COVID-19 in March, Michael Reagan lost all memory of his 12-day vacation in Paris even though the trip was just a few weeks earlier.
    Several weeks after Erica Taylor recovered from her coronavirus symptoms of nausea and cough, she became confused and forgetful, failing to even recognise her own car, the only Toyota Prius in her apartment complex’s parking lot.
    Lisa Mizelle, a veteran nurse practitioner at an urgent care clinic who fell ill with the virus in July, finds herself forgetting routine treatments and lab tests, and has to ask colleagues about terminology she used to know automatically.
    It is becoming known as Covid “brain fog”: troubling cognitive symptoms that can include memory loss, confusion, difficulty focusing, dizziness and grasping for everyday words. Increasingly Covid survivors say brain fog is impairing their ability to work and function normally.
    “There are thousands of people who have that,” said Dr Igor Koralnik, chief of neuro-infectious disease at Northwestern Medicine in Chicago, who has already seen hundreds of survivors at a post-Covid clinic he leads. The effect on the workforce that is affected is going to be significant, he added.
    Read full story
    Source: The Irish Times, 18 October 2020
  14. Patient Safety Learning
    A wider range of healthcare workers—including midwives, paramedics, physiotherapists, and pharmacists—are now allowed to give flu and potentially COVID-19 vaccines after the introduction of new laws by the UK government.
    The changes to the Human Medicines Regulations 2012, first proposed in August1 and consulted upon last month, came into effect on 16 October.
    The Department of Health and Social Care said that the expanded workforce will have to undergo additional training to ensure patient safety. It added that government planning will “ensure this does not affect other services in hospitals and in GP and community services, by drawing on a pool of experienced NHS professionals through the NHS Bring Back Scheme.”
    Commenting on the changes, England’s deputy chief medical officer Jonathan Van-Tam said, “The measures outlined today aim to improve access and strengthen existing safeguards protecting patients.”
    Read full story
    Source: BMJ, 16 October 2020
  15. Patient Safety Learning
    More men than normal are dying at home from heart disease in England and Wales and more women are dying from dementia and Alzheimer's disease, figures show.
    More than 26,000 extra deaths occurred in private homes this year, an analysis by the Office for National Statistics found.
    In contrast, deaths in hospitals from these causes have been lower than usual.
    The Covid epidemic may have led to fewer people being treated in hospital or it may be that people in older age groups, who make up the majority of these deaths, may be choosing to stay at home – but the underlying reasons for the figures are still not clear.
    Read full story
    Source: BBC News, 19 October 2020
  16. Patient Safety Learning
    When the pain in her shoulders and weakness in her right leg started two years ago, Giovanna Ippolito thought it was just part of getting older — that's until the 46-year-old's doctor ordered an X-ray that showed a five-centimetre long, broken needle embedded in her spine.
    It was a medical error that took more than a decade to discover — after medical staff at the time failed to report it. 
    Exactly when the needle was left in Ippolito's spine is unclear, but she says she's only had something injected into her back twice — during the birth of her son in 2002 and her daughter in 2004. 
    Ippolito says she believes the needle broke off when medical staff at Mackenzie Richmond Hill Hospital in nearby Richmond Hill (called York Central Hospital at the time) administered a spinal block or an epidural during one of the births.
    She's now locked in a battle with the hospital for answers and accountability. But experts say, with a system that's stacked against Canadians harmed by medical errors, it's likely no one will have to take responsibility.
    More than 132,000 patients experienced some kind of medical harm — something both preventable and serious enough to require treatment or a longer hospital stay — in 2018-19, according to the Canadian Institute for Health Information, an independent, not-for-profit organization that collects information on the country's health systems.
    Read full story
    Source: CBC, 5 October 2020
  17. Patient Safety Learning
    The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission (CQC) has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections.
    In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”.
    Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from COVID-19 in England’s care homes.
    Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services.
    The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind.
    The regulator argued that the health system’s response to the pandemic needs to change. After focusing on protecting NHS services from being overwhelmed, health leaders must now adapt to prevent people who need help for non-Covid reasons from being left behind, it said.
    These include people whose operations were cancelled and people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from the impact of Covid.
    “Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others,” said Trenholm.
    Read full story
    Source: The Guardian, 16 October 2020
  18. Patient Safety Learning
    Leaking vials and suspected contamination were identified in a batch of more than 500,000 test tubes produced for the NHS Covid test and trace operation over the summer, whistleblowers have said.
    The test tubes were provided by a small UK-based company, Life Science Group (LSG), which produces materials for the diagnostics industry.
    According to the whistleblowers, there have been repeated problems with test tubes filled by LSG leaking. Stocks of some 600,000 test tubes were inspected in August as a result, and records seen by the Guardian describe the discovery of what looked like hair and blood contamination.
    It is understood firms in the supply chain concluded that the contamination was not hair or blood, following inspections. However, records seen by the Guardian suggested at least one bag of LSG test tubes thought to be contaminated “cannot now be found”.
    The whistleblowers said that rather than rejecting the entire potentially compromised batch, as would be normal safety protocol with NHS supplies, only part of the batch with visible problems was removed from use. They said they had blown the whistle because they were concerned for public safety.
    Read full story
    Source: The Guardian, 16 October 2020
  19. Patient Safety Learning
    A group of experts in nursing and infection prevention and control (IPC) is today warning against the use of IPC measures as a “rationale” for stopping safe and compassionate visits in care homes during the Covid-19 pandemic.
    In a new open letter published in Nursing Times, the specialists say that preventing people from visiting loved ones in social care settings in the name of IPC is a “misinterpretation and at times even abuse” of IPC principles.
    The letter is the brainchild of independent global health consultant and former Infection Prevention Society (IPS) president, Jules Storr. Among the signatories are five former IPC presidents, current president Pat Cattini as well as incoming president Jennie Wilson. Dr Ron Daniels, chief executive of the UK Sepsis Trust, is also on the list, Helen Hughes, chief executive of Patient Safety Learning, as well as leading IPC nurse specialists, nurse academics, a GP and carers.
    Ms Storr, a nurse by background, and the hub topic lead, said she was motivated to take action after hearing “the most heart-breaking” stories from health professionals and relatives of residents about restricted visits in the UK in the wake of COVID-19.
    Some had not seen relatives for weeks or months, whilst others were only allowed to see their loved one once a week for 20 minutes at a distance, she said.
    One individual had told her how when their father had died only one family member was permitted in the home and they were not allowed to sit close enough to hold his hand.
    Ms Storr said these practices were “absolutely outrageous and wrong from an infection prevention point of view”.
    Read full story
    Source: Nursing Times, 16 October 2020
  20. Patient Safety Learning
    GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said.
    The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”.
    Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital.
    Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.”
    Read full story (paywalled)
    Source: The Times, 16 October 2020
  21. Patient Safety Learning
    Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections.
    Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus.
    "Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme.
    "The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days."
    Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive."
    He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid."
    Read full story
    Source: The Independent, 14 October 2020
  22. Patient Safety Learning
    The government has been told it is ‘not sustainable’ to continue to delay its response to a major review on patient safety as ‘babies are still being damaged’.
    The Independent Medicines and Medical Devices Safety Review spoke to more than 700 people, mostly women who suffered avoidable harm from surgical mesh implants, pregnancy tests and an anti-epileptic drug, and criticised “a culture of dismissive and arrogant attitudes” including the “unacceptable labelling of many symptoms as “attributable to ‘women’s problems’”.
    The review’s author Baroness Julia Cumberlege told HSJ that “time is marching on” for the Department of Health and Social Care to implement the recommendations of her July report, which include setting up a new independent patient safety commissioner.
    The Conservative peer said pressure was building on government to adopt the findings of the review, since it had been endorsed by Royal Colleges and has already been adopted by the Scottish government. She said the government had given “evasive” answers in parliament on the issue.
    In an exclusive interview with HSJ, Baroness Cumberlege said:
    There is a crowded field of regulators but “there’s a void” for a service that listens and responds to patients’ safety concerns. She feels “diminished” that women’s concerns are still being dismissed by clinicians, but said young doctors are a cause for hope. She is “very optimistic” report will be implemented – but the NHS has to have the will to make changes. Read full story (paywalled) 
    Source: HSJ, 13 October 2020
  23. Patient Safety Learning
    The introduction of weekly covid tests for NHS staff in ‘high risk areas’ will mean other groups missing out or waiting longer, well-placed sources have told HSJ.
    There is also understood to be a standoff between NHS England and Test and Trace over the regular testing of asymptomatic staff, which was announced for the North of England on Monday.
    NHS trust labs don’t have enough capacity to test all their staff; and there is not enough spare in “pillar two” commercial labs to carry out hundreds of thousands of additional tests. National bodies are said to be in disagreement over who should do it.
    NHSE believes they should be provided by T&T, and T&T says NHS labs should expand their capacity to carry them out themselves, HSJ has been told.
    A senior source involved in the testing programme said there would have to be “trade-offs” for T&T to meet the new NHS demand, with supply having to be cut for others who want tests — mostly the general population, or care home staff.
    At present the NHS has agreed to carry out 100,000 daily tests by the end of the month, as part of the T&T’s overall 500,000 target. It has been encouraged to do more by T&T, but any expansions may face shortages of equipment and supplies such as reagents, as well as staff and space.
    Read full story (paywalled)
    Source: HSJ, 13 October 2020
  24. Patient Safety Learning
    A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report.
    The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body.
    Reinfections remain rare and he has now recovered. However, the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.
    The man from Nevada had no known health problems or immune defects that would make him particularly vulnerable to Covid.
    Scientists say the patient caught coronavirus twice, rather than the original infection becoming dormant and then bouncing back. A comparison of the genetic codes of the virus taken during each bout of symptoms showed they were too distinct to be caused by the same infection.
    "Our findings signal that a previous infection may not necessarily protect against future infection," said Dr Mark Pandori, from the University of Nevada.
    "The possibility of reinfections could have significant implications for our understanding of COVID-19 immunity."
    Read full story
    Source: BBC News, 13 October 2020
  25. Patient Safety Learning
    All pregnant women have been urged by doctors to get a free flu vaccination this winter to ensure they and their babies are protected.
    People can get infected with flu and coronavirus at the same time - with Public Health England finding if you get both simultaneously you may get more seriously ill.
    Researchers previously said those who have been infected with both viruses face a serious increase to their risk of death and warned the public “not to be complacent” in the wake of fears flu could circulate around the country alongside COVID-19.
    The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives note while getting flu is not a big deal for most people, getting the virus while you are pregnant can be serious for a small proportion of women and their babies. Flu can occasionally lead to stillbirth, maternal death and raise the chances of having a miscarriage.
    Dr Edward Morris, president of RCOG, said: “We are keen to reassure pregnant women that flu vaccination is safe for women to have at any stage in pregnancy - from the first few weeks right up to their due date, and while breastfeeding."
    "Over the last 10 years, the flu vaccine has been routinely and safely offered to pregnant women in the UK. The vaccine can also pass some protection to babies, which lasts for the first months of their lives."
    Read full story
    Source: The Independent, 12 October 2020
     
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