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Patient Safety Learning

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  1. Patient Safety Learning
    Hundreds of thousands of NHS patients could lose the ability to see their GP face to face because their doctors may have to protect themselves from coronavirus.
    An analysis by the Health Foundation charity has found around a third of GPs who run their practice on their own are at high risk from the virus themselves.
    If they are forced to abandon face-to-face consultations the charity warned it could deny 710,000 patients access to their doctor.
    Dr Rebecca Fisher, senior policy fellow at the Health Foundation and a GP said: “The ongoing risk of Covid-19 to the safety of both patients and GPs means hundreds of thousands of people may find it much harder to get a face-to-face GP appointment.
    “It’s particularly worrying that GPs at higher risk from Covid-19 are far more likely to be working in areas of high deprivation. Those are precisely the areas with the greatest health need, the biggest burden from Covid-19, and an existing under-supply of GPs relative to need. Unless urgent action is taken this could become another way in which poorer communities become further disadvantaged, and risks further widening health inequalities.”
    Read full story
    Source: The Independent, 6 August 2020
  2. Patient Safety Learning
    A senior coroner has demanded action by Simon Stevens, chief executive of NHS England, to ensure that GPs monitor repeat prescriptions properly, after an 84 year old man with dementia died from an overdose of tramadol.
    Peter Cole, who was found collapsed at his home in Welwyn in Hertfordshire by a neighbour, had amassed a large quantity of unused prescription drugs at his house. He had numerous drugs on repeat prescription, said Geoffrey Sullivan, chief coroner for Hertfordshire. 
    Read full story (paywalled)
    Source: BMJ, 5 August 2020
  3. Patient Safety Learning
    The NHS will be inflicting pain, misery and risk of death on tens of thousands of patients if it again shuts down normal care when a second wave of COVID-19 hits, doctors’ and surgeons’ leaders are warning.
    They are urging NHS bosses not to use the same sweeping closures of services that were introduced in March to help hospitals cope with the huge influx of patients seriously ill with Covid.
    “The NHS must never again be a Covid-only service. There is a duty to the thousands of patients waiting in need and in pain to make sure they can be treated,” said Prof Neil Mortensen, president of the Royal College of Surgeons of England.
    The leader of Britain’s doctors warned that hospitals should not leave patients “stranded” by again suspending a wide range of diagnostic and treatment services.
    “We cannot have a situation in which patients are unable to access diagnostic tests, clinic appointments and treatment which they urgently need and are simply left stranded,” said Dr Chaand Nagpaul, chair of council at the British Medical Association (BMA).
    Read full story
    Source: The Guardian, 6 August 2020
  4. Patient Safety Learning
    Fifty million face masks bought by the government in April will not be used in the NHS because of safety concerns. The government says the masks, which use ear-loop fastenings rather than head loops, may not fit tightly enough.
    They were bought for healthcare workers from supplier Ayanda Capital as part of a £252m contract.Ayanda says the masks meet the specifications the government had set out. The government says its safety standards process is "robust".
    According to legal papers seen by the BBC, the government says these masks will now not be used in the NHS because of a safety issue. The document says that there is concern about whether they would fit adequately.
    To be effective these types of face mask need to fit tightly to create a seal between the mask and the wearer's face. Anyone who wears them for work is required to undergo a face fit test.
    "The face fit is either a pass or a fail and there are more fails on products with ear loops than there are on products with head harnesses," says Alan Murray, chief executive of the British Safety Industry Federation.
    Read full story
    Source: BBC News, 6 August 2020
  5. Patient Safety Learning
    All medical students at the National University of Singapore will be taught patient safety through a virtual reality (VR) game, a move prompted by the COVID-19 social distancing rules.
    The game, called PAtient Safety aS Inter-Professional Training (PASS-IT), will use VR to get all 1,500 of them acquainted with the proper procedures in operating theatres. It was developed by the NUS Yong Loo Lin School of Medicine (NUS Medicine).
    The school has 12 such VR stations. Each has a 15-minute game with various medical scenarios that will require the students to "act out" the standard operating procedures. These range from how to check for a patient's consent and verify their identity as well as the correct ways to handle surgical tools and what must be done if a team member accidentally cuts himself.
    "This VR system is a good tool to help the students consolidate their learning despite increased clinical restrictions," said Associate Professor Alfred Kow, assistant dean of education of NUS Medicine.
    Read full story
    Source: The Straits Times, 5 August 2020
  6. Patient Safety Learning
    The parliamentary committee led by Jeremy Hunt will subject health ministers to a “CQC style ratings system”, as part of a new way of scrutinising the Department of Health and Social Care.
    The Health and Social Care Select Committee has set out plans for a new ratings system to “offer independent and objective evaluation of ministerial pledges”. This will mean the government is held to account by an evaluation process similar to that used across the NHS and social care system which gives not just an absolute score but key pointers as to how to improve that score next time round.
    “We hope it will focus attention on areas such as cancer, mental health and patient safety where a number of vital commitments have been made,” says Jeremy Hunt, committee chair and former health secretary.
    In his six year tenure as health secretary, Mr Hunt styled himself as a champion of patient safety, while his successor, Matt Hancock, has been criticised for appearing to jettison this agenda.
    Read full story (paywalled)
    Source: HSJ, 5 August 2020
  7. Patient Safety Learning
    Plans for a mass expansion of rehabilitation beds in new “Seacole centres” have been scrapped, with local leaders now told there is no capital funding to build them.
    In late May, NHS England announced the “first” Seacole Centre in Surrey, for patients recovering from coronavirus, and asked other local systems to draw up proposals for similar units ahead of a possible second peak of the virus over winter.
    The policy was designed to provide significant extra bed capacity to help get covid and other respiratory patients out of hospital more quickly, while offering effective rehab care.
    But multiple well-placed sources have now told HSJ that capital bids for new Seacole units have been rejected.
    In a statement, NHSE said: “Work with local NHS and social care providers suggests that these expanded rehab services can largely be provided in existing physical facilities as well as people’s own homes, so government has not allocated extra capital in year for this purpose.”
    However, local leaders told HSJ that some of the plans to use “existing physical facilities” still required some capital funding to make them suitable for rehab care. One trust executive in the North West said: “If there’s no capital it means we can’t go ahead.”
    Read full story (paywalled)
    Source: HSJ, 5 August 2020
  9. Patient Safety Learning
    As part of a £160m initiative, the NHS will look to roll out and expand ‘Covid-friendly’ cancer treatments which are safer for patients during the pandemic, the health service’s Chief Executive Sir Simon Stevens has announced.
    The funding will help pay for drugs which treat patients without having as significant of an impact on their immune system, or which could offer other benefits such as a reduced number of hospital visits.
    Almost 50 treatments have been approved for use as ‘swaps’ for existing drugs, with thousands of patients having already benefitted, and more are expected to be made available this week as part of deals struck between the NHS and pharmaceutical companies.
    Within these treatments include options which allow patients to take tablets at home or receive medicines with fewer side effects rather than undergoing hospital-based treatment which can leave them more susceptible to coronavirus and other infections.
    Sir Stevens said: “Since the first case of Covid in England six months ago, NHS staff have fast tracked new, innovative ways of working so that other services, including A&E, cancer and maternity could continue safely for patients and it is thanks to these incredible efforts that 65,000 people could start treatment for cancer during the pandemic.
    “We are now adopting new, kinder treatment options which are not only effective but safer for use during the Covid-19 pandemic and more convenient for thousands of patients, who can take medication at home or be given medicines with less harmful effects on their immune system.”
    Read full story
    Source: National Health Executive, 3 August 2020
  10. Patient Safety Learning
    The coronavirus lockdown has provoked a mental health crisis among the LGBTQ community, with younger people confined with bigoted relatives the most depressed, researchers found.
    A study of LGBTQ people’s experience during the pandemic, by University College London (UCL) and Sussex University, found 69% of respondents suffered depressive symptoms, rising to about 90% of those who had experienced homophobia or transphobia.
    Almost 10% of people reported they felt unsafe in their homes.
    The study called for more government support for LGBTQ charities, which have experienced significant rises in demand since the start of the pandemic. It warned: “Poor LGBTQ+ mental health may remain unchecked without a substantial policy commitment and funding directed to ameliorating health inequalities exacerbated by the pandemic.”
    Read full story
    Source: The Guardian, 5 August 2020
  11. Patient Safety Learning
    Patients suffering heart attacks during the coronavirus lockdown stayed away from hospitals with some dying as a result, a new study has found.
    In an analysis of more than 50,000 patients who suffered heart attacks and were treated in 99 NHS hospitals in England both before and after lockdown, researchers found the proportion of deaths for patients with a milder form of heart attack jumped during the first month of lockdown.
    Those suffering more severe heart attacks actually saw a lower death rate with hospitals keeping their emergency heart services running.
    Dr Jianhua Wu, associate professor in biostatistics at the University of Leeds and lead author of the study, said: “It has revealed that although patients were able to get access to high levels of care, the study suggests a lot of very ill people were not seeking emergency treatment and that may have been an unintended consequence of the ‘stay at home’ messaging.”
    Read full story
    Source: The Independent, 5 August 2020
  12. Patient Safety Learning
    MPs are to launch a new system for evaluating whether key health targets are being met in England. 
    A panel of experts reporting to the Commons health committee will assess progress made on policy commitments, starting with maternity services. They will rate performance from "outstanding" to "inadequate" and seek to drive improvements where needed.
    Panel chair Dame Jane Dacre said it would be "fair and impartial" in its findings. She said she was keen to ask recent patients and users of NHS services to contribute to the panel's work as well as specialists in chosen fields, all of whom would have no political affiliation.
    "It will be challenging, but I am committed to using available evidence to evaluate pledges, with the aim of improving patient care," she added.
    The panel will scrutinise, on behalf of the health committee, major commitments made by the Department of Health, NHS England, NHS Improvement and other public bodies. It will base its approach on the Care Quality Commission, which evaluates care homes, hospitals, GP practices and other health services.
    Read full story
    Source: BBC News, 5 August 2020
  13. Patient Safety Learning
    MPs have launched an inquiry examining workforce burnout across the NHS and social care, and the system’s ability to manage staff stress amid increased pressures during the COVID-19 pandemic. 
    The House of Commons health and social care committee said it aims to produce a report showing the levels of staff needed in health and social care to tackle exhaustion and meet future challenges. 
    The committee is calling for evidence on how workforce shortages impacted staff well-being and patient care during the pandemic and the areas that need to see recruitment most urgently. 
    Read full story
    Source: Pulse, 3 August 2020
  14. Patient Safety Learning
    People with chronic pain that can’t be explained by other conditions should not be prescribed opioids because they do more harm than good, the medicines watchdog has warned.
    The National Institute for Health and Care Excellence (NICE) has said people should instead be offered group exercise, acupuncture and psychological therapy.
    In new draft guidance, NICE said most of the common medications used for chronic primary pain has little or no evidence to support their use in patients aged over 16.
    Its latest guidance comes amid concerns over the level of opioid use. In September last year a review by Public Health England found 1 in 4 adults have been prescribed addictive medications with half of them taking the drugs for longer than 12 months.
    NICE’s new draft guidance said some antidepressants should be considered for people with chronic primary pain but it said paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, as well as benzodiazepines or opioids should not be given because of concerns they might do more harm than good.
    Read full story
    Source: The Independent, 4 August 2020
  15. Patient Safety Learning
    New guidance requires GPs to offer at least some face-to-face appointments, amid reports that some had completely eliminated them, sparking ‘significant incidents’.
    NHS England’s instructions for the third phase of the NHS response to COVID-19 were issued on Friday, including the call that “all GP practices must offer face to face appointments at their surgeries” along with remote triage and remote consultations.
    Most appointments in primary care have been carried out remotely since the NHS instituted new operating procedures in response to covid, with practices offering a mix of remote consultations over the telephone or video, with a diminished number face-to-face. 
    However, there have been reports of some GP practices not offering any face-to-face appointments at all, and continuing this approach following the peak of cases in the spring.
    A letter to GPs last month told them they must offer appointments in person “where clinically appropriate”, now reiterated in the phase three guidance.
    The letter added: “It should be clear to patients that all practice premises are open to provide care, with adjustments to the mode of delivery. No practice should be communicating to patients that their premises are closed.”
    Read full story
    Source: HSJ, 4 August 2020
  16. Patient Safety Learning
    Today, four leading global organisations dedicated to fighting preventable deaths due to medical errors announced their partnership to co-convene the #uniteforsafecare programme on World Patient Safety Day (September 17, 2020).
    In June, the Patient Safety Movement Foundation announced the wide-ranging campaign to bring attention to system-wide improvements that will ensure better health worker and patient safety outcomes, called #uniteforsafecare. Now, the organisation will be joined by the American Society of Anesthesiologists (ASA), The Leapfrog Group, and International Society for Quality in Health Care (ISQua) in co-convening the slate of programming, which includes a virtual physical challenge to raise awareness of the issue; collaboration with the National Association for Healthcare Quality’s annual conference, NEXT; an in-person demonstration in Washington, D.C. and a free virtual event for the public and those who have experienced errors, harms, or death to themselves or loved ones.
    “As the first medical specialty to advocate for patient safety, and as physicians on the front lines treating COVID-19 patients, we know firsthand how critical ensuring health worker safety is,” said ASA President Mary Dale Peterson.  “The issue is especially timely.  From having the appropriate PPE to strategies for stress management and wellness – ensuring health worker safety is patient safety and improves outcomes.  We are happy to participate in this effort to advance safety in health care.”
    Read press release
  17. Patient Safety Learning
    The mother of a former patient at a north Wales mental health unit has said she "couldn't let" her daughter "go back there" as new details about people being "neglected" there have emerged.
    ITV News has seen a leaked copy of the Robin Holden report from 2014.
    It was commissioned by Betsi Cadwaladr Health Board after staff on the Hergest mental health unit, which is situated within Ysbyty Gwynedd in Bangor, blew the whistle over management and patient safety concerns.
    It reveals details never before made public, about how staff struggled to care for patients.
    The document, which the health board has fought for six years to keep out of public view, gives an account of the death of a patient while no doctor was available because of rota gaps, another of a patient who tried to take their own life, again when no doctor was available, and inadequate staffing affecting patient care.
    Read full story
    Source: ITN News, 31 August 2020
  18. Patient Safety Learning
    Two new tests for COVID-19 that are said to deliver results within 90 minutes are to be introduced across NHS hospitals and care homes, to speed up diagnosis ahead of winter and differentiate coronavirus infection from flu, the government says.
    But some experts were surprised by the government’s decision, saying the particular tests were not well-known. No data had been published concerning their evaluation. The government had made mistakes in buying tests that turned out to be sub-standard in the past, they said.
    “Repeatedly through the pandemic the government has raced ahead purchasing tests on the basis of manufacturer’s claims, and have found later when independent studies are done that the tests do not have adequate performance for use in the NHS,” said Professor Jon Deeks from Birmingham University, part of a team who have been evaluating tests of this sort.
    “We would hope that the government would wait for proper evaluations, and consider the scientific evidence for all available tests before signing further contracts. The mistakes made in test purchasing have wasted millions of pounds as well as put lives at risk.”
    Read full story
    Source: The Guardian, 3 August 2020
  19. Patient Safety Learning
    The proportion of patients confirmed as infected with COVID-19 after admission to East Kent hospitals is running at twice the national rate, according to figures seen by HSJ.
    The discovery comes as the Care Quality Commission confirmed to HSJ that it has sought and received further information from East Kent Hospitals University Foundation Trust on the high covid death rate at the trust. It is now deciding whether to take further action over the issue.
    Read full story (paywalled)
    Source: HSJ, 31 July 2020
  20. Patient Safety Learning
    Trusts have been set a series of “very stretching” targets to recover non-covid services to nearly normal levels in the next few months, in new guidance from NHS England.
    NHS England and Improvement set out the system’s priorities for the remainder of 2020-21 in a “phase three letter” sent to local leaders.
    It said the NHS must “return to near-normal levels of non-covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”, when further emergency and covid pressures are anticipated.
    In recent weeks providers have found it very difficult to resume many services, with many running at well below normal capacity, due to infection prevention measures, staffing gaps, and other covid-related barriers.
    The targets in the new guidance for phase three of the NHS’s covid response include:
    In September trusts must deliver “at least 80 per cent of their last year’s activity for both overnight electives and for outpatient/daycase procedures, rising to 90% in October (while aiming for 70% in August)”; “This means that systems need to very swiftly return to at least 90 per cent of their last year’s levels of MRI/CT and endoscopy procedures, with an ambition to reach 100 per cent by October.” “Trusts must hit 100 per cent of their last year’s activity for first outpatient attendances and follow-ups (face to face or virtually) from September through the balance of the year (and aiming for 90 per cent in August).” Read full story (paywalled)
    Source: HSJ, 31 July 2020
  21. Patient Safety Learning
    A sponge-on-a-string pill test could transform the way oesophageal cancer is diagnosed, researchers say. The method can identify 10 times more people with Barrett’s oesophagus than the usual GP route, scientists say.
    The test, which can be carried out by a nurse in the GP surgery, is also better at picking up abnormal cells and potentially early-stage cancer.
    Barrett’s oesophagus is a condition that can lead to oesophageal cancer, cancer of the food pipe, in a small number of people. Normally it is diagnosed in hospital by endoscopy, which involves passing a camera down into the stomach, following a GP referral for long-standing heartburn symptoms.
    The cytosponge test, developed by researchers at the University of Cambridge, is a small pill with a thread attached that the patient swallows. It expands into a small sponge when it reaches the stomach, and is then quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis.
    The pill is a quick, simple and well tolerated test that can be performed in a GP surgery and helps tell doctors who needs an endoscopy. In turn, this could prevent many people from having potentially unnecessary endoscopies.
    Scientists say that as well as better detection, the test means cancer patients can benefit from kinder treatment options if their cancer is caught early enough.
    Read full story
    Source: The Independent, 1 August 2020
     
  22. Patient Safety Learning
    The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys and brain.
    The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people—including some “mild” cases—don’t quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic diseases.
    One such patient is Athena Akrami. Her early symptoms were textbook for COVID-19: a fever and cough, followed by shortness of breath, chest pain, and extreme fatigue. For weeks, she struggled to heal at home. But rather than ebb with time, Akrami’s symptoms waxed and waned without ever going away. She’s had just 3 weeks since March when her body temperature was normal.
    “Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU,” says Akrami, who falls into neither category. Thousands echo her story in online COVID-19 support groups. Outpatient clinics for survivors are springing up, and some are already overburdened. Akrami has been waiting more than 4 weeks to be seen at one of them, despite a referral from her general practitioner.
    Read full story
    Source: Science, 31 July 2020
     
  23. Patient Safety Learning
    A third of GPs believe it will take up to a year or longer for their practice to return to pre-Covid levels of capacity, even with ‘no future spikes’ of the virus.
    The data comes from the BMA’s latest COVID-19 tracker survey, which polled almost 2,000 GPs in England and Wales.
    GPs have previously warned that they are battling a backlog of referrals and patients who have been ‘overlooked’ during the coronavirus crisis.
    Around 26% of the 1,770 GP respondents said consultations would take between three and 12 months to return to normal when asked how quickly their practice will ‘return to full pre-Covid levels of capacity... assuming there are no future Covid spikes’.
    And a further 7% of GPs believed it could take ‘longer’ than a year or that consultations would ‘never’ return to pre-Covid levels.
    Read full story
    Source: Pulse, 23 July 2020
  24. Patient Safety Learning
    Healthcare staff working at the height of the covid-19 pandemic in England were not properly protected and were forced to work in an unsafe environment, MPs have been told.
    Appealing before the health and social care committee on 21 July, experts criticised the government and NHS management for their failure to provide staff with sufficient testing and personal protective equipment (PPE). The committee was gathering evidence for its inquiry into the management of the COVID-19 outbreak.
    Paul Nurse, director of the Francis Crick Institute, said he believed that the failure to implement better testing systems in the early days of the pandemic had contributed significantly to the problems.
    He said, “At the height of the pandemic, our own research—which backs up what’s been done elsewhere—found that up to 45% of healthcare workers were infected and they were infecting their colleagues and infecting patients, yet they weren’t being tested systematically.
    “In the healthcare environment we weren’t providing proper protection, and it’s important because it protects the most vulnerable in our society and it protects our healthcare workers. They deserve to work in a safe environment, and some of them are dying because of what they do. They deserve better.”
    Read full story
    Source: BMJ, 22 July 2020
  25. Patient Safety Learning
    NHS England and Improvement have launched an independent review into the care and death of a man with learning disabilities, following concerns raised by HSJ. 
    The regulator has appointed Beverley Dawkins to carry out an independent review of the case of Clive Treacy, as part of the learning disability mortality review programme.
    Clive, who died in 2017, had previously been denied a review under LeDer and, according to emails seen by HSJ, his death was never officially recorded by the programme, which is meant to record all deaths of people with a learning disability.
    NHS England and Improvement overturned the decision earlier this year after HSJ presented evidence of a series of failures in his care between 2012 and 2017.
    Today, it was confirmed to us that Ms Dawkins has been commissioned to carry out the review, and that it would review his care throughout his life, as well as his death.  
    Read full story
    Source: HSJ, 23 July 2020
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