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Patient Safety Learning

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  1. Patient Safety Learning
    Singapore plans to open source a smartphone app its digital government team has developed to track citizens' encounters with coronavirus carriers.
    The app, named TraceTogether, and its government is urging citizens to run so that if they encounter a Coronavirus carrier, it’s easier to trace who else may have been exposed to the virus. With that info in hand, health authorities are better-informed about who needs to go into quarantine and can focus their resources on those who most need assistance.
    The app is opt-in and doesn’t track users through space, instead recording who you have encountered. To do so, it requires Bluetooth and location services to be turned on when another phone running the app comes into range exchanges four nuggets of information - a timestamp, Bluetooth signal strength, the phone’s model, and a temporary identifier or device nickname. While location services are required, the app doesn't track users, instead helping to calculate distances between them.
    Read full story
    Source: The Register, 26 March 2020
  2. Patient Safety Learning
    Local authorities must be at the heart of contact tracing because COVID-19 is best understood as a pattern of local outbreaks rather than a national pandemic, says Sir Chris Ham and Robin Tuddenham in an HSJ article.
    Community testing and contact tracing represent our greatest hope for managing the risks to health of COVID-19 until a vaccine and effective treatments become available. Experts in infectious disease base their understanding of this on previous pandemics, and the experience of countries like South Korea and Germany.
    Work is underway at pace to resume contact tracking and tracing in England. It is understood that this programme will begin in earnest from 18 May following a pilot on the Isle of Wight. This work is a core part of Matt Hancock’s five-point plan for combating COVID-19, in support of some relaxation of lockdown anticipated soon.
    Whilst the pace is understandable, the methods and approach taken are top down, lack an effective role for key regional co-ordination through the Integrated Care Systems/Sustainability and Transformation Partnerships and Local Resilience Forums, and risk marginalising the essential skills of local authorities, GPs and the voluntary and community sector in place, according to Ham amd Tuddenham.
    Read full story
    Source: HSJ, 5 May 2020
  3. Patient Safety Learning
    The NHS contact-tracing app will not be ready before winter, a health minister has said, despite initially being promised in mid-May.
    Lord Bethell said the Department of Health was "seeking to get something going for the winter". But, he told a committee of MPs, the app wasn't "the priority at the moment".
    Lord Bethell confirmed the government still planned to introduce a contact-tracing app, describing it as "a really important option for the future".
    The app has been the subject of a trial on the Isle of Wight, where the Department of Health says it has been downloaded by 54,000 people.
    Lord Bethell said the trial had been a success, but admitted that one of its principal lessons had been that greater emphasis needed to be placed on manual contact tracing.
    Asked why the app had taken so long to release, Lord Bethell told the Science and Technology Committee the Isle of Wight trial had shown that people "weren't frightened of it, as we were worried that they might be" - and had also provided "concrete examples" of successes in breaking transmission chains. But he admitted there had been "technical challenges", as well as an "ongoing battle" to persuade people the system was safe and privacy-protecting.
    Read full story
    Source: Sky News, 18 June 2020
  4. Patient Safety Learning
    A contact tracing system has this week been launched in Wales, initially a telephone based process, followed by an online system next week.
    Anyone who has a positive coronavirus test result will be contacted by a team of contact tracers and asked for details of everyone they have had close contact with while they have had symptoms.
    From Monday 8th June, a new online system will be used to support the process. People will have the option to use the system to provide details of their close contacts electronically.
    The system has been trialled in four health board areas over the last two weeks and more than 600 contact tracers have so far been employed, with more to be employed.
    Health Minister,  Vaughan Gething said “Today’s roll-out of the contact tracing element of our Test, Trace, Protect strategy is a significant step forward in the gradual move out of lockdown.”
    Read full story
    Source: HTN, 2 June 2020
  5. Patient Safety Learning
    In a major U-turn, the UK is ditching the way its current coronavirus-tracing app works and shifting to a model based on technology provided by Apple and Google.
    The Apple-Google design has been promoted as being more privacy-focused. However, it means epidemiologists will have access to less data.
    The government now intends to launch an app in the autumn, but it says the product may not involve contact tracing at that point. Instead the software may be limited to enabling users to report their symptoms and order a test.
    Baroness Dido Harding - who heads up the wider Test and Trace programme - will only give the green light to actually deploying the Apple-Google technology if she judges it to be fit for purpose, which she does not believe is the case at present. It is possible this may never happen.
    Read full story
    Source: BBC News, 18 June 2020
  6. Patient Safety Learning
    NHSX is working on a contact tracking app to trace the spread of coronavirus through the population.
    Contact tracking is already in limited use for people who have tested positive and the discipline has a long history in tuberculosis outbreaks.
    In a statement sent to HSJ, Matthew Gould, Chief Executive of NHSX, said : “NHSX are looking at whether app-based solutions might be helpful in tracking and managing coronavirus, and we have assembled expertise from inside and outside the organisation to do this as rapidly as possible.”
    Read full story (paywalled)
    Source: HSJ, 18 March 2020
  7. Patient Safety Learning
    Time is running out to finalise a track and trace strategy that would avoid a potential second surge in coronavirus cases, NHS leaders have said.
    The NHS Confederation warned of "severe" consequences to staff and patients if the right system was not established quickly and that lockdown measures should not be eased until a clear plan was in place.
    Contact tracing identifies those who may have come into contact with an infected person, either through an app or by phone and email, so they can avoid potentially passing the disease on.
    It follows the Prime Minister's pledge to introduce a "world-beating" contact tracing system in England from June.
    Niall Dickson, chief executive of the confederation, which represents health and care leaders, welcomed Boris Johnson's pledge made at Prime Minister's Questions on Wednesday. But in a letter to Health Secretary Matt Hancock, Mr Dickson said without a clear strategy the UK was at greater risk of a second peak of the virus.
    He said a strategy should have been in place sooner and if the right system was not instigated rapidly the ramifications for the NHS "could be severe".
    Speaking on the Today programme, Mr Dickson said: "We are absolutely clear that contact tracing is the right thing to do, it is absolutely critical, it has got to be in place to prevent any notion of a second surge if the lockdown is being further released."
    Read full story
    Source: 21 May 2020
  8. Patient Safety Learning
    The UK’s failure to report how many people have recovered from COVID-19 has been criticised by public health experts, who say a huge proportion of cases have remained “invisible” to the health service.
    Britain is an outlier internationally in not reporting the number of people who have recovered from COVID-19 alongside statistics on deaths and numbers of identified cases. Chile is the only other nation not to share this information out of the 25 countries with the highest reported incidence.
    A failure to monitor those who test positive for COVID-19 outside of hospital has left people feeling unsupported and alienated from the health system, the experts say. There is concern that because the majority of community cases have not been logged in patient records, it will be more challenging to research the long-term consequences of the disease.
    Prof Devi Sridhar, the chair of global public health at the University of Edinburgh, said: “Not tracking people in the community, for me, [is] so astonishing. These people are completely invisible in the health system.”
    Read full story
    Source: The Guardian, 18 June 2020 
  9. Patient Safety Learning
    Doctors have warned that a “culture of fear” in the NHS may prevent life-saving lessons being learned about COVID-19 after a leading hospital consultant emailed scores of staff saying those responsible for “leaks” would be found and fired.
    Dr Daniel Martin OBE, head of intensive care for serious infectious diseases at the Royal Free hospital, emailed a report to colleagues at the peak of the pandemic with a note claiming that the trust would “track any leaks to the media” and then “offer you the chance to post your P45 on Facebook for all to see.”
    The email, which described journalists at one respected newspaper as “parasites”, was sent to dozens of nurses and junior doctors. It has been examined by Liberty Investigates, the investigative journalism unit of the civil rights group Liberty, and the Guardian, after being shared by a recipient who said they found the language “intimidating”.
     Whistleblowers UK, the non-profit group, said it had been made aware of the email by a separate individual who was also concerned about its contents.
    The Royal Free London trust said the email was “badly worded” and did not reflect trust policy. However, the trust said it was an open and transparent organisation that “does everything it can to encourage our staff to raise concerns and, if necessary, whistleblow”.
    Read full story
    Source: The Guardian, 22 June 2020
  10. Patient Safety Learning
    Leading clinicians have written to Boris Johnson warning the UK faces a "second health catastrophe" because so many non-Covid patients are missing out on treatment as a result of the pandemic.
    The letter warns that “lives are being put at risk” and that action is needed immediately. It comes as new figures show as many as one in six (10 million) people will be on the NHS waiting list by the end of the year.
    The letter, signed by ten specialists, including cancer doctors, patient safety experts, CQCs and medical negligence lawyers, states: “We are increasingly concerned about the impact, including avoidable harm and death caused by the continuing unavailability of urgent diagnostics and treatment for thousands of non-COVID patients. 
    “The backlog of such cases is now significant and worsening. We implore the central and devolved Governments of the UK to take urgent strategic action, including in co-ordination and co-operation with each other, to prevent this becoming a second and perhaps even more serious health catastrophe arising from the pandemic in the UK.”
    The letter was also signed by barrister Theo Huckle QC, Professor John Fairclough of Swansea and Cardiff Met Universities, Nick Brown of Doughty Street Chambers and Helen Hughes, Chief Executive, Patient Safety Learning.
    Cases which have come to the attention of the signatories include Sherwin Hall, 27, a father of one from Leeds, who made 13 visits to hospital during the COVID-19 lockdown before getting a cancer diagnosis for the pain in his groin.
    He said of his case: “I am very angry at the way I have been treated due to COVID-19 and the delay on my cancer treatment and now I am fighting for my life.
    Read full story
    Source: Express, 21 June 2020
     
  11. Patient Safety Learning
    A new coronavirus test which could replace the existing a nose and throat swab is being piloted in Southampton.
    People will be able to simply spit into a pot at home before the sample is sent off to check whether they have COVID-19.
    If successful, the saliva test could become an alternative to the existing swab which some people find uncomfortable and can provoke coughing and spluttering.
    Read full story
    Source: The Independent, 22 June 2020
  12. Patient Safety Learning
    NHS trusts could be asked to create shared waiting lists for elective care under plans being considered by national leaders.
    HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running.
    Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example, by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch.
    In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements.
    Read more
    Source: HSJ, 19 June 2020
  13. Patient Safety Learning
    Low dose dexamethasone reduces deaths in patients hospitalised with COVID-19 who need ventilation, according to preliminary results from the RECOVERY trial.
    The drug was also found to reduce deaths by one-fifth in other hospitalised patients receiving oxygen only, but no benefit was seen among COVID-19 patients who did not need respiratory support.
    The chief investigators from the University of Oxford trial said that the findings represent a “major breakthrough” which is “globally applicable” as the drug is cheap and readily available.
    Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford and a chief investigator on the trial, added, “This is the only drug that has so far been shown to reduce mortality, and it reduces it significantly. It is a major breakthrough.”
    Read full story
    Source: BMJ, 16 June 2020
  14. Patient Safety Learning
    Doctors fear a rise in stillbirths and babies with impaired growth because pregnant women were too scared to seek help during the pandemic.
    At a Royal Society of Medicine webinar on pregnancy and Covid, medics expressed concern that women in need of urgent attention had kept away from maternity services, for fear of catching the infection.
    In other cases, those with worrying symptoms which could mean their baby was at risk may have stayed away because they feared putting pressure on services, doctors said.
    Dr Maggie Blott, head of obstetrics at the Royal Free London Foundation trust, said: “A lot of the work that we do is is prevention, and a lot of women that we see, turn up for hospital as an emergency - have concerns around abdominal pain, reduced foetal movements, all sorts of things.”
    Read full story (paywalled)
    Source: The Telegraph, 18 June 2020
  15. Patient Safety Learning
    The COVID-19 pandemic could entrench and exacerbate inequalities in mental health for a generation unless action is taken, the Centre for Mental Health has warned.
    In a report published on Thursday, the charity warned that the lockdown would put greater pressure on groups whose mental health was already poor beforeCOVID-19 hit, such as women and children experiencing violence and abuse, and ethnic minority communities.
    The pandemic will leave an “unequal legacy of complicated bereavement, trauma, and economic repercussions which will push more people towards financial insecurity and poverty, significant risk factors for poor mental health,” the report said.
    “Unequal experiences of grief, loss, trauma, injustice, and abandonment all add to the psychological damage caused by COVID-19.”
    The report, backed by 12 mental health charities and the Royal College of Psychiatrists, said that the government must prioritise race equality and support “trauma informed” approaches for all people whose lives had been affected by COVID-19.
    Read full story
    Source: BMJ, 19 June 2020
  16. Patient Safety Learning
    Nurses' leaders want all healthcare employers - including the NHS - to "care for those who have been caring" during the coronavirus crisis.
    The Royal College of Nursing (RCN) is calling for better risk assessments; working patterns and mental health care for those on the front line. It warns many may be suffering from exhaustion, anxiety and other psychological problems.
    The Department of Health and Social Care said support was a "top priority".
    The RCN has released an eight-point plan of commitments it wants to see enforced to mark the 100 days since the World Health Organization (WHO) declared a pandemic.
    Amongst its suggestions are a better COVID-19 testing regime for healthcare workers and more attention paid to the risks posed to ethnic minority nurses.
    It says employers and ministers "must tackle the underlying causes which have contributed to worse outcomes for Bame staff".
    Read full story
    Source: BBC News, 19 June 2020
  17. Patient Safety Learning
    Frontline staff and volunteers at the forefront of the national coronavirus response across England will be able to access a new Psychological First Aid (PFA) training course, the Minister for Mental Health Nadine Dorries has announced.
    The course, which has been developed by Public Health England, will be available to frontline workers and volunteers dealing with the public during the coronavirus pandemic.
    The free online course enables responders to develop their skills and confidence in providing key psychological support to people affected by coronavirus, including on issues such as job worries, bereavement or isolation as they carry out their vital work as part of the ongoing coronavirus response.
    It will also help to develop understanding of how emergencies like the coronavirus pandemic can affect us all, how to recognise people who may be at increased risk of distress, and how to offer practical and emotional support.
    Minister for Mental Health Nadine Dorries said:
    “Supporting each other’s mental health and wellbeing is more important than ever during these challenging and uncertain times. Staff and volunteers in many different roles are working tirelessly to provide crucial support at this time and are often a critical touchpoint in identifying those who may be affected.
    “This new training course will help to support the incredible work of frontline workers to support those most in need both through the coronavirus outbreak and beyond, equipping them with vital tools to deliver psychological first aid.”
    Read press release
    Source: GOV.UK, 15 June 2020
     
  18. Patient Safety Learning
    The chief inspector of hospitals has warned that patient safety is at risk if the NHS winter crisis is worsened by coronavirus – and ministers must act now in emergency departments to prevent a catastrophe.
    Professor Ted Baker, speaking to The Independent in his first interview since the COVID-19 outbreak hit Britain, warned that the NHS could not carry on as before as hospitals across the country struggle to return to normal care while the crisis continues.
    “If we are going to do something about it, we need to act now, not at the beginning of winter,” he warned, adding the Care Quality Commission (CQC) was also worried about patients being “forgotten” as NHS waiting lists surge to an expected 10 million later this year.
    "We will be going into winter and all the difficulties of the winter viruses that we normally face, together with Covid. I think next winter is going to be very difficult, unless emergency departments and the whole system supporting emergency departments do things very differently.”
    He warned providing care in the NHS under the shadow of coronavirus was “a formidable challenge … probably bigger than the challenge we faced at the height of the pandemic”.
    Prof Baker also told The Independent that the CQC was investigating a number of reports that some hospital patients were discharged unsafely to care homes following a staggering 55% rise in whistleblowing complaints, particularly in care homes, with 2,612 calls between March and May.
    Read full story
    Source:  The Independent, 17 June 2020
  19. Patient Safety Learning
    At least another 130,000 people worldwide have died during the coronavirus pandemic on top of 440,000 officially recorded deaths from the virus, according to BBC research.
    A review of preliminary mortality data from 27 countries shows that in many places the number of overall deaths during the pandemic has been higher than normal, even when accounting for the virus.
    These so-called "excess deaths", the number of deaths above the average, suggest the human impact of the pandemic far exceeds the official figures reported by governments around the world.
    Some will be unrecorded COVID-19 victims, but others may be the result of the strain on healthcare systems and a variety of other factors.
    Read full story
    Source: BBC News, 18 June 2020
  20. Patient Safety Learning
    Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. 
    Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls".
    Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. 
    "The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that."
    Read full story (paywalled)
    Source: The Telegraph, 16 June 2020
  21. Patient Safety Learning
    The Care Quality Commission (CQC) has issued a plan for re-starting routine inspections — but has been warned by the NHS Confederation that the health service needs this “like a hole in the head”.
    The organisation said there would be a “managed return” of “routine inspections” in the autumn.
    It also stated in a statement today: ”Inspectors are now scheduling inspections of higher risk services to take place over the summer.” But the CQC later insisted to HSJ that this was not a change to its current policy, in place since the beginning of the UK COVID-19 peak, as it would only be inspecting in response to information it receives which raises “serious concerns”.
    The CQC suspended its routine inspections in March – and has instead been calling healthcare providers and only physically attending where there are serious concerns about harm, abuse or human rights breaches.
    The new approach to regulation, which the CQC called its “emergency support framework”, was criticised by 11 older people’s and disabled groups, which said the decision not to carry out routine inspections broke human rights and equalities laws.
    Read full story
    Source: HSJ, 17 June 2020
  22. Patient Safety Learning
    There should be independent reviews of the NHS’ readiness for a potential second major outbreak of coronavirus in the UK, senior doctors are arguing.
    The Royal College of Anaesthetists said a series of reviews should be carried out, overseen by an independent group formed from clinical royal college representatives, independent scientists and academics.
    It would encompass investigation of what happened to care quality during the peak of infection and demand through March, April and May — there are major concerns that harm and death was caused by knock of effects, with some health services closed and people being afraid to use others.
    Hospitals were unable to provide many other services as staff, including most anaesthetists, were redeployed to help with critical care.
    Ravi Mahajan, president of the Royal College of Anaesthetists, told HSJ areas such as capacity, workforce and protective equipment were key issues to be reviewed. He said: “We can’t wait for [the pandemic] to finish and then review. [The reviews] have to be dynamic, ongoing, and the sooner they start the better.
    Read full story
    Source: HSJ, 17 June 2020
  23. Patient Safety Learning
    A leading surgeon has said NHS staff must be routinely tested for coronavirus up to twice a week.
    Prof Derek Alderson, president of the Royal College of Surgeons, said it was vital, to reassure patients staff were not unwittingly carrying the virus. 
    But hospital trust bosses say they are still waiting for clarity on plans for regular testing. The Department for Health and Social Care (DHSC) said it was focusing on routine testing in care homes.
    Prof Alderson was speaking at a Health Select Committee meeting about the necessary steps to get all NHS services back up and running. He said: "It's absolutely essential to regain public confidence that we are able to test our staff regularly."
    It would be "pragmatic" for testing to take place "about twice weekly", he added, because it was known that the available tests were not perfect.
    Read full story
    Source: BBC News, 17 June 2020
  24. Patient Safety Learning
    A patient almost died after being misdiagnosed and sent home from hospital on the first day of the lockdown as the NHS curtailed many normal services to focus on COVID-19.
    The NHS trust involved has admitted that its failings led to the man suffering excruciating pain, developing life-threatening blood poisoning, and contracting the flesh-eating bug necrotising fasciitis. He needed eight operations to remedy the damage caused by his misdiagnosis.
    The man, his wife and his GP spent three weeks after his discharge trying to get him urgent medical care. However, St Mary’s hospital on the Isle of Wight rejected repeated pleas by them for doctors to help him, even though his health was deteriorating sharply.
    The man, who does not want to be named, said his experience of seeking NHS care for something other than COVID-19 during the pandemic had been “debilitating and exhausting” and that feeling the NHS “was not there” for him had been “very distressing” for him and his wife.
    Mary Smith, of the solicitors Novum Law, who are representing the man in his complaint against the trust, said his plight highlighted the growing number of cases that were emerging of people whose health had suffered because they could not access normal NHS care in recent months.
    Read full story
    Source: The Guardian, 16 June 2020
  25. Patient Safety Learning
    A woman whose father died in a care home has launched a judicial review case in the High Court over the government’s “litany of failures” in protecting the vulnerable elderly residents who were most at risk from COVID-19.
    Cathy Gardner accuses England’s health and social care secretary, Matt Hancock, NHS England, and Public Health England of acting unlawfully in breaching statutory duties to safeguard health and obligations under the European Convention on Human Rights, including the right to life.
    Her father, Michael Gibson, who had Alzheimer’s disease, died aged 88 of probable COVID-19 related causes on 3 April at Cherwood House Care Centre, near Bicester, Oxfordshire. She claims that before his death the care home had been pressured into taking a hospital patient who had tested positive for the virus but had not had a raised temperature for about 72 hours.
    “I am appalled that Matt Hancock can give the impression that the government has sought to cast a protective ring over elderly residents of care homes, and right from the start,” Gardner said. “The truth is that there has been at best a casual approach to protecting the residents of care homes. At worst the government has adopted a policy that has caused the death of the most vulnerable in our society.”
    Read full story
    Source: BMJ, 15 June 2020
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