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Patient Safety Learning

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  1. Patient Safety Learning
    A major British medical school is leading the drive to eliminate what it calls "inherent racism" in the way doctors are trained in the UK.
    The University of Bristol Medical School says urgent action is needed to examine why teaching predominantly focuses on how illnesses affect white people above all other sections of the population.
    It comes after students pushed for reform, saying gaps in their training left them ill-prepared to treat ethnic minority patients – potentially compromising patient safety.
    Hundreds of other UK medical students have signed petitions demanding teaching that better reflects the diversity of the country.
    The Medical School Council (led by the heads of UK medical schools) and the regulator, the General Medical Council, say they are putting plans in place to improve the situation.
    A number of diseases manifest differently depending on skin tone, but too little attention is given to this in training, according to Dr Joseph Hartland, who is helping to lead changes at the University of Bristol Medical School.
    "Historically medical education was designed and written by white middle-class men, and so there is an inherent racism in medicine that means it exists to serve white patients above all others," he said .
    "When patients are short of breath, for example, students are often taught to look out for a constellation of signs – including a blue tinge to the lips or fingertips – to help judge how severely ill someone is, but these signs can look different on darker skin."
    "Essentially we are teaching students how to recognise a life-or-death clinical sign largely in white people, and not acknowledging these differences may be dangerous," said Dr Hartland.
    Read full story
    Source: BBC News, 17 August 2020
  2. Patient Safety Learning
    Ministers have been accused of trying to cover up the findings from investigations into hundreds of health and social care worker deaths linked to coronavirus after it emerged the results will not be made public.
    The Independent revealed on Tuesday that medical examiners across England and Wales have been asked by ministers to investigate more than 620 deaths of frontline staff that occurred during the pandemic.
    The senior doctors will review the circumstances and medical cause of death in each case and attempt to determine whether the worker may have caught the virus during the course of their duties.
    But now the Department of Health and Social Care (DHSC) said the results will be kept secret with the aim of helping local hospitals to learn and improve protection for staff.
    Separately, trade unions and NHS Providers, which represents hospital trusts, have urged the government to ensure full investigations into every death and to be transparent about findings to reassure health and social care staff ahead of any second wave.
    Sir Ed Davey, acting leader of the Liberal Democrats, said: “We currently have one of the highest number of deaths of health and care workers in Europe. The government has utterly failed to protect staff in both hospitals and care homes. The fact that now they are trying to cover up how and why each tragic death occurs is a disgrace."
    Read full story
    Source: The Independent, 15 August 2020
     
  3. Patient Safety Learning
    Almost a million people waited at least half an hour for an ambulance after having a medical emergency such as a heart attack or stroke last year, NHS figures show.
    Ambulance crews responding to 999 calls in England took more than 30 minutes to reach patients needing urgent care a total of 905,086 times during 2019–20. Of those, 253,277 had to wait at least an hour, and 35,960 – the equivalent of almost 100 patients a day – waited for more than two hours.
    In addition to heart attacks and strokes, the figures cover patients who had sustained a serious injury or trauma or major burns, or had developed the potentially lethal blood-borne infection sepsis.
    Under NHS guidelines, ambulances are meant to arrive at incidents involving a medical emergency – known as category 2 calls – within 18 minutes.
    The Liberal Democrat MP Layla Moran, who obtained the figures using freedom of information laws, said: “It’s deeply shocking that such huge numbers of seriously ill patients have had to wait so long for an ambulance crew to arrive after a 999 call. It shows the incredible pressure our ambulance services were under even before this pandemic struck.
    “Patients suffering emergencies like a heart attack, stroke or serious injury need urgent medical attention, not to be left waiting for up to two hours for an ambulance to arrive. These worryingly long delays in an ambulance reaching a seriously ill or injured patient could have a major long-term impact on their health.”
    Read full story
    Source: The Guardian, 16 August 2020
  4. Patient Safety Learning
    Two hundred thousand defective gowns supplied to NHS hospitals have been recalled by the government because of fears they could leave staff at increased risk of coronavirus infection.
    Hospitals have been told to check their stocks of personal protective equipment (PPE) to identify the Flosteril non-sterile gowns and quarantine them immediately.
    The Department of Health and Social Care (DHSC) said tests carried out on the gowns, which were delivered in June, had shown that they did not meet the fluid-resistance standards originally claimed by the manufacturer.
    There may also be “inconsistencies” in the material used to make the gowns.
    An estimated 200,000 gowns are thought to be in circulation within the NHS after 600,000 were supplied by the company Vannin Healthcare Global, which is registered in the Isle of Man.
    Hospitals were told on Tuesday this week not to dispose of the gowns but to keep them for two weeks until they can be collected after 31 August.
    It is another embarrassing blow for the government over the supply of PPE to hospitals – an issue that prompted major criticism during the height of the COVID-19 crisis, when many hospitals ran out of equipment.
    Read full story
    Source: The Independent, 15 August 2020
  5. Patient Safety Learning
    Public Health England (PHE) is to be replaced by a new agency that will specifically deal with protecting the country from pandemics, according to a report.
    The Sunday Telegraph claims Health Secretary Matt Hancock will this week announce a new body modelled on Germany's Robert Koch Institute. Ministers have reportedly been unhappy with the way PHE has responded to the coronavirus crisis.
    A Department of Health and Social Care spokesperson said: "Public Health England have played an integral role in our national response to this unprecedented global pandemic."
    "We have always been clear that we must learn the right lessons from this crisis to ensure that we are in the strongest possible position, both as we continue to deal with Covid-19 and to respond to any future public health threat."
    The Telegraph reports that Mr Hancock will merge the NHS Test and Trace scheme with the pandemic response work of PHE.
    The paper said the new body could be called the National Institute for Health Protection and would become "effective" in September, but the change would not be fully completed until the spring.
    Read full story
    Source: BBC News, 16 August 2020
  6. Patient Safety Learning
    Unprecedentedly poor waiting time data for electives, diagnostics and cancer suggests the chances of NHS England’s ambitions for ‘near normal’ service levels this autumn being met are very unlikely, experts have warned.
    The statistics prompted one health think tank to urge NHS leaders to be “honest that with vital infection control measures affecting productivity, and a huge backlog, there are no shortcuts back to the way things were”.
    NHS England data published today revealed there were 50,536 patients who had been waiting over a year for elective treatment as of June – up from 1,613 in February before the covid outbreak, a number already viewed as very concerning. The number represents the highest level since 2009 and 16 times higher than they were in March.
    Nuffield Trust deputy director of research Sarah Scobie said: “These figures are a serious warning against any hope that the English NHS can get planned care back to normal before winter hits. The number of patients starting outpatient treatment is still a third lower than usual and getting back to 100 per cent by September will be a tall order.”
    “The increase in patients waiting more than a year has continued to accelerate at a shocking pace, with numbers now at their highest since 2009 and 16 times higher than they were in March. 
    “Unfortunately, despite the real determination of staff to get back on track, some of these problems are set to grow… We need to be honest that with vital infection control measures affecting productivity, and a huge backlog, there are no shortcuts back to the way things were.”
    Read full story (paywalled)
    Source: HSJ, 13 August 2020
  7. Patient Safety Learning
    GP leaders have written to NHS England to demand that an NHS hospital trust urgently restores routine referrals as it has 'closed its doors' to some patients, ‘destabilising’ practices in the process. 
    Oxfordshire LMC said local GPs are ‘concerned and angry’ about the ‘ongoing closure’ to routine referrals across multiple ‘high-demand’ specialties by Oxford University Hospital Foundation Trust, while warning GPs are also being asked to carry out tests that should be done in hospital.
    A ‘significant’ number of specialties are affected, including ENT, general gynaecology, dermatology, ophthalmology, endoscopy and urology, as well as plastics and maxillofacial, it added.
    The hospital trust said it had remained open for urgent and emergency care and was accepting clinically urgent and suspected cancer referrals, while reinstating services to support 'the vast majority' of routine referrals.
    But Oxfordshire LMC has this week written to NHS England and the council of governors at OUHFT to demand that there are ‘no further delays’ in restoring the services amid concerns of ‘patient harm’.
    It said: ‘The LMC believes the continuing closure of some specialty services to routine referrals is now so serious for patients that it has taken a decision to formally raise the concerns of Oxfordshire’s GPs with NHS England.’ 
    Read full story
    Source: Pulse, 13 August 2020
  8. Patient Safety Learning
    A damning new report has exposed numerous lapses in nursing care on wards at Shrewsbury and Telford Hospital Trust amid a culture which left patients at risk of “unsafe and uncaring” treatment, the care watchdog has said.
    Inspectors from the Care Quality Commission (CQC) cited multiple examples of nurses at the scandal-hit trust lacking the knowledge to look after patients safely and failing to record key information needed to keep patients safe during an inspection of medical wards in June this year.
    The inspectors found poorly completed nursing records, equipment unavailable and nurses not following procedures. This meant some patients developed pressure sores, fell from their beds and were injured or suffered pain at the end of their life. Other patients were at risk of suffering similar harm.
    Inspectors ruled the trust, which was rated inadequate and put into special measures in 2018, was unsafe and criticised the hospital leadership for what it said was a “collective failure” that was perpetuating the problems at the hospital.
    Read full story
    Source: The Independent, 14 August 2020
  9. Patient Safety Learning
    The new version of the government’s contact tracing app will give users a ‘risk score’ based on how many people they interact with and where they live.
    The news comes as the Department of Health and Social Care launches a trial for the latest model of the contact tracing app, two months after the initial version was scrapped. 
    According to the DHSC, the new app will tell users whether their risk of contracting coronavirus is unknown, low or high based on how many people they are in significant contact with. They will also be told what the coronavirus risk level is in their local authority area and will be alerted if it changes.
    Government guidance said the risk levels and alerts will be based on a local authority watchlist – which highlights areas that are of particular concern across the country, based on the number of coronavirus cases.
    People will also be able to check into venues – such as restaurants, pubs and leisure centres – using the app by scanning a QR code. If there is then an outbreak in a venue those who have checked in via the app will be alerted and told to isolate.
    The new NHS Test and Trace app trial was launched today for residents on the Isle of Wight and will expand to the London borough of Newham next week.
    Read full story (paywalled)
    Source: HSJ, 13 August 2020
  10. Patient Safety Learning
    NHS staff will be given “COVID-19 passports” to help hospitals redeploy workers during a feared second wave of infection.
    Bosses at NHS England say the digital passports, which are stored on workers’ phones, have been successful in pilots across the country and are being rolled out “to support the COVID-19 response”.
    The COVID-19 crisis has triggered a major reorganisation of NHS care, with hospitals now having to plan to restart routine services while at the same time maintain their readiness for any increase in coronavirus cases.
    The passports will help redeploy staff quickly to where they are needed most.
    Read full story
    Source: The Independent, 12 August 2020
  11. Patient Safety Learning
    A healthcare professional is facing a fitness to practise investigation for delaying attending to a COVID-19 positive patient because of inadequate personal protective equipment (PPE), in what may be the first case of its kind.
    The revelation came from a healthcare regulatory solicitor, Andrea James, who tweeted, “Was expecting it, but still disgusted to have received first #FitnessToPractise case arising from NHS trust disciplining healthcare professional who expressed concern about/delayed attending to a Covid+ patient without PPE (NHS Trust having failed to provide said PPE). For shame.”
    Doctors and nurses reacted with outrage to the tweet, and the Medical Protection Society issued a strong statement condemning the move. But James said that her client wanted to remain anonymous and declined to identify the profession or the regulator involved. She said that the treatment in question was expected to be an aerosol generating procedure.
    Rob Hendry, medical director at the Medical Protection Society (MPS), said, “It is appalling enough that healthcare professionals are placed in the position of having to choose between treating patients and keeping themselves and their other patients safe. The stress should not be compounded by the prospect of being brought before a regulatory or disciplinary tribunal.
    “MPS members who are faced with regulatory or employment action arising from a decision to not see a patient due to lack of PPE can come to us for advice and representation. However, it should not come to this: healthcare workers should not be held personally accountable for decisions or adverse outcomes that are ultimately the result of poor PPE provision.”
    Read full story
    Source: BMJ, 12 August 2020
  12. Patient Safety Learning
    Screening women for breast cancer from their 40s rather than their 50s could save lives without adding to the diagnosis of harmless cancers, a UK study has found.
    The research was based on 160,000 women from England, Scotland and Wales, followed up for around 23 years.
    Lowering the screening age could save one life per 1,000 women checked, the scientists say.
    But experts caution there are many other considerations, including cost.
    Cancer Research UK says it is still "not clear if reducing the breast screening age would give any additional benefit compared to the UK's existing screening programme".
    The charity says the priority should be getting cancer services "back on track" for women aged 50-70, after disruption caused by the pandemic.
    Read full story
    Source: BBC News, 13 August 2020
  13. Patient Safety Learning
    The development of separate emergency units to help acute trusts manage demand during the covid pandemic may risk increasing “discrimination” against mental health patients, a royal college has warned.
    In a report shared with HSJ, the Royal College of Psychiatrists said separate emergency assessment units being set up by mental health trusts offered a calmer environment for mental health patients and reduced pressure on emergency departments.
    But the report, based on 54 survey responses from liaison psychiatry teams, also warned there was a “potential to increase the stigmatisation of mental illness by emergency department staff”.
    It added: “Within a general hospital there is a risk that prejudicial attitudes amongst staff translate into discriminatory behaviour towards patients. The provision of a separate mental health emergency assessment facility on another site may reinforce the erroneous view that the assessment and management of mental health problems is not a role for an emergency department.”
    Read full story (paywalled)
    Source: HSJ, 11 August 2020
  14. Patient Safety Learning
    The deaths of hundreds of NHS and social care workers infected with coronavirus are under investigation by medical examiners, The Independent has learnt.
    Ministers have asked medical examiners in England and Wales to review all deaths of frontline health and social care staff infected with the virus to determine whether the infection was caught as a result of their work.
    The review, which started last month, is likely to cover more than 620 deaths including nurses, doctors and care home staff across England and Wales, since the beginning of March.
    It could trigger a number of investigations by hospitals, the Health and Safety Executive, and coroners into the protection, or lack of, for staff during the pandemic when many hospitals ran out of protective masks and clothing for staff.
    Hospitals have already been ordered to risk assess workers who may be more susceptible to the virus, such as those from a black and minority ethnic backgrounds or those with existing health conditions.
    Read full story
    Source: The Independent, 12 August 2020
  15. Patient Safety Learning
    A new study has highlighted the number of NHS staff who can be infected with coronavirus but be completely unaware they are a risk to their colleagues and patients.
    The research by doctors at University College London Hospitals (UCLH) found a third of staff working in two maternity departments at UCLH and St George’s Hospital tested positive for the virus but had no symptoms.
    Overall, one in six staff who had not previously been diagnosed with the virus were tested for COVID-19 antibodies and were found to be positive for infection.
    Prof Keith Neal, emeritus professor of epidemiology of infectious diseases at the University of Nottingham, who was not involved in the research, said: “Asymptomatic healthcare workers with COVID-19 pose a risk of spreading the virus depending on the personal protective equipment in use. We know many cases were acquired in hospital.
    “Regular testing of healthcare workers is clearly warranted.”
    Read full story
    Source: The Independent, 12 August 2020
  16. Patient Safety Learning
    Doctors are seeing a rise in people reporting severe mental health difficulties, a group of NHS leaders says.
    It follows a more than 30% drop in referrals to mental health services during the peak of the pandemic.
    But there are predictions that the recent rise will mean demand actually outstrips pre-coronavirus levels - perhaps by as much as 20%.
    The NHS Confederation said those who needed help should come forward.
    But the group, which represents health and care leaders, said in a report that mental services required "intensive support and investment" in order to continue to be able to help those who needed it.
    Read full story
    Source: BBC News, 12 August 2020
  17. Patient Safety Learning
    Over 8 out of 10 (84%) of members of the Medical Protection Society thinks a face covering should be mandatory when attending any healthcare setting.
    This was the finding of a survey including 562 of the GP indemnity providers' members, out of which 473 said masks should be mandated by law as they are on public transport and in shops.
    Effective from 13 July, PHE guidance says all clinical and non-clinical staff as well as patients should wear a face mask in areas of GP practices that cannot be made 'Covid-secure' through social distancing, optimal hand hygiene, frequent surface decontamination, ventilation and other measures.
    But NHS England has said GPs cannot refuse to treat patients who present at the practice without a face covering because they are not legally required to wear them. In response to its member survey, MPS has urged political leaders to ‘reconsider’ this decision.
    Medicolegal lead for risk prevention Dr Pallavi Bradshaw stressed that ‘it cannot be right’ for frontline healthcare workers to be put at ‘unnecessary risk by patients who refuse to wear a face mask’.
    Read full story
    Source: Pulse, 8 August 2020
  18. Patient Safety Learning
    Health Secretary Matt Hancock has announced one of the world’s largest comprehensive research studies into the long-term health impacts of coronavirus on hospitalised patients.
    Backed by an award of £8.4m in funding by the Government, through UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR), the study is expected to include around 10,000 across the UK and will support the development of new measures to treat NHS patients with coronavirus.
    The study will be led by the NIHR Leicester Biomedical Research Centre, a partnership between the University of Leicester and University Hospitals of Leicester NHS Trust and will draw on the expertise of a consortium of leading researchers and doctors from across the UK.
    They will assess and publish findings on the impact of COVIDd-19 on patient health and their recovery, including looking at potential ways to help improve the mental health of patients hospitalised with the virus and how individual characteristics such as gender and ethnicity influence recovery.
    Patients on the study from across the UK will be assessed using techniques such as advanced imaging, data collection and analysis of blood and lung samples, creating a comprehensive picture of the impact COVID-19 has on longer-term health outcomes.
    The findings will support the development of new strategies for clinical and rehabilitation care, including personalised treatments based on the particular disease characteristics that a patient shows, to improve their long-term health.
    Read full story
    Source: National Health Executive, 10 August 2020
  19. Patient Safety Learning
    Boris Johnson has said the government will allocate £300m to NHS trusts to upgrade A&E facilities ahead of a potential spike in coronavirus cases this winter.
    The funding, which will be split between 117 trusts, comes alongside attempts to reassure members of the public that it is safe to visit A&E departments during the COVID-19 pandemic.
    “Thanks to the hard work and tireless efforts of NHS staff throughout the pandemic, our A&Es have remained open for the public,” the prime minister said in a statement.
    “It is vital that those who need emergency treatment this winter access it, and for those who remain concerned about visiting hospitals, let me assure you that the NHS has measures in place to keep people safe.”
    Hospitals will be able to use the funding to expand waiting areas and increase the number of treatment cubicles to boost A&E capacity, while social distancing rules and hygiene measures are in place to protect patients from COVID-19.
    Read full story
    Source: The Independent, 10 August 2020
  20. Patient Safety Learning
    Dozens of surgeons have reported being told by the NHS employer to stop discussing shortages of personal protective equipment (PPE) during the coronavirus crisis.
    The Confederation of British Surgery (CBS) said almost 70 surgeons working in major hospitals around the country had been warned off discussing a lack of PPE by their trust.
    A third of surgeons said the supply of PPE was inadequate at their hospital, with many complaining of inconsistent guidance, rationing of supplies and poor quality PPE when it was available. When asked if their concerns were dealt with satisfactorily, nearly a third said they were not addressed, or not effectively.
    A survey of 650 surgeons by the union found many were now considering changes to the way they worked as a result of the crisis – with more than half, 380, saying they would be avoiding face-to-face meetings with patients in the future.
    More than 40 surgeons, around 7%, said they were now considering leaving surgery altogether.
    Read full story
    Source: The Independent, 10 August 2020
  21. Patient Safety Learning
    Ambulance chiefs are looking at alternative defibrillators after coroners highlighted confusion over how to correctly use their existing machines.
    London Ambulance Service (LAS) Trust has received two warnings from coroners since 2016 after the delayed use of Lifepak 15 defibrillators “significantly reduced” the chances of survival for patients, including a 15-year-old boy.
    Coroners found some paramedics were unaware the machines had to be switched from the default “manual” mode to an “automatic” setting.
    The first warning came after the death of teenager Najeeb Katende in October 2016. A report by coroner Edwin Buckett said the paramedic who arrived had started the defibrillator in manual mode and did not detect a heart rhythm that was appropriate for administering the device, so it was not used until an advanced paramedic arrived on scene 24 minutes later.
    The report stated the defibrillator had been started in manual mode but it needed to be switched to automatic to detect a shockable heart rhythm. The coroner warned LAS that further deaths could occur if action was not taken to prevent similar confusion.
    But another warning was issued to the LAS in March this year, following the death of 35-year-old Mitica Marin. Again, a coroner found the paramedic, who was on her first solo shift, had started the machine in manual mode and had not detected a shockable rhythm. It was suggested this caused a four minute delay in the shock being administered.
    Coroner Graeme Irvine said this was “not an isolated incident” for LAS and noted the trust had reviewed other cases of delayed defibrillation. They found that the defibrillator’s manual default setting was a “contributing factor” to the delays.
    Read full story (paywalled)
    Source: HSJ, 10 August 2020
  22. Patient Safety Learning
    Up to 750,000 unused coronavirus testing kits are being recalled due to safety concerns.
    The UK's medicines and healthcare products regulator (MHRA) asked Randox to recall the kits sent out to care homes and individuals.
    The government said it was a "precautionary measure" and the risk to safety was low.
    It comes weeks after the health secretary said Randox kits should not be used until further notice.
    A spokeswoman said: "We have high safety standards for all coronavirus tests. Following the pausing of Randox kits on 15 July, Randox have now recalled all test kits as a precautionary measure."
    Care home residents or staff with symptoms of coronavirus can continue to book a test, she said.
    Read full story
    Source: BBC News, 8 August 2020
  23. Patient Safety Learning
    All NHS hospitals in England have been told to destroy a powerful medicine mistakenly used by staff because its packaging looks the same as another drug.
    A national safety alert was issued following several incidents, including two deaths of babies, in which patients were inadvertently given a dose of sodium nitrite – which is used as an antidote to cyanide poisoning – rather than sodium bicarbonate.
    The errors are thought to have been caused by similarities between the labelling and drug packaging used by manufacturers. Now hospitals have been told to check all wards and medicine storage areas for sodium nitrite and to destroy any of the unlicensed product. The drug should only be available in emergency departments and may have been supplied to medical wards by mistake.
    There are an estimated 237 million medication errors in the NHS every year – with a third linked to packaging and labelling.
    Read full story
    Source: The Independent, 9 August 2020
  24. Patient Safety Learning
    Trusts are being encouraged to adopt a system in which patients initiate follow up appointments by the lastest guidance from NHS England designed to help the NHS recover from the covid crisis. 
    It is hoped the approach can reduce unnecessary demand and therefore help trusts cut waiting lists that have soared as a result of the restrictions placed on hospital activity during the pandemic.
    Under 'patient initiated follow up' (PIFU) patients decide when they require follow up appointments. They are given guidance as to what symptoms and other factors they should take into account when deciding if a follow up appointment is necessary. PIFU is already used by some trusts, but it has not yet become widely adopted. 
    The plan to increase PIFUs was set out in a guidance published today designed to underpin the “phase three letter” sent out to NHS leaders last week.
    The guidance, Implementing phase 3 of the NHS response to COVID-19 pandemic , says “individual services should develop their own guidance, criteria and protocols on when to use PIFUs”. The document also sets out some overarching principles.
    It says services will be rated against the following headline metrics: “total number and proportion of patients on the PIFU pathway; patient outcomes, e.g. recovery rates, relapse rates; waiting times; and DNA rates”.
    Read full story (paywalled)
    Source: HSJ, 7 August 2020
  25. Patient Safety Learning
    Policymakers’ failure to tackle chronically underfunded social care has resulted in a “lost decade” and a system now at breaking point, according to a new report.
    A team led by Jon Glasby, a professor of health and social care at the University of Birmingham, says that without swift government intervention including urgent funding changes England’s adult social care system could quickly become unsustainable.
    Adult social care includes residential care homes and help with eating, washing, dressing and shopping. The paper says the impact has been particularly felt in services for older people. Those for working-age people have been less affected.
    It suggests that despite the legitimate needs of other groups “it is hard to interpret this other than as the product of ageist attitudes and assumptions about the role and needs of older people”.
    Read full story
    Source: The Guardian, 9 August 2020
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