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Patient Safety Learning

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  1. Patient Safety Learning
    The coroner investigating the botched birth of a baby boy who died from hypoxia has strongly criticised the Healthcare Service Investigation Branch (HSIB) over its report on his death.
    Karen Henderson, who conducted the inquest into the death of baby Theo Young in May 2018 at East Surrey Hospital said that the HSIB had asked Surrey and Sussex Healthcare NHS Trust not to undertake its own investigation, “effectively preventing the recognition of causes of concern and therefore being unable to undertake any immediate and necessary remedial action at the earliest opportunity to prevent future deaths.”
    Read full story (paywalled)
    Source: BMJ, 19 May 2020
  2. Patient Safety Learning
    European countries should brace themselves for a deadly second wave of coronavirus infections because the pandemic is not over, the World Health Organization’s top official in Europe has said. 
    In an exclusive interview with The Telegraph, Dr Hans Kluge, director for the WHO European region, delivered a stark warning to countries beginning to ease their lockdown restrictions, saying that now is the "time for preparation, not celebration".
    Dr Kluge stressed that, as the number of cases of COVID-19 in countries such as the UK, France and Italy was beginning to fall, it did not mean the pandemic was coming to an end. The epicentre of the European outbreak is now in the east, with the number of cases rising in Russia, Ukraine, Belarus and Kazakhstan, he warned.
    Read full story (paywalled)
    Source: The Telegraph, 20 May 2020
  3. Patient Safety Learning
    More than 460 people with a learning disability have died from coronavirus in just eight weeks since the start of the outbreak in England.
    New data shows between the 16 March and 10 May 1,029 people with a learning disability died in England, with 45 per cent, 467, linked to coronavirus.Overall the number of deaths during the eight weeks is 550 more than would be expected when compared to the same period last year.
    The charity Mencap warned people with a learning disability were “being forgotten in this crisis” and called for action to tackle what it said could be “potentially discriminatory practice.”
    It highlighted the percentage of Covid-19 related deaths among learning disabled people was higher than those in care homes, where the proportion of Covid-19 deaths was 31 per cent for the same period.
    The data has been published after an outcry over the lack of transparency about the impact of Covid-19 on mental health patients and people with a learning disability or autism.
    Read full story
    Source: The Independent, 19 May 2020
  4. Patient Safety Learning
    More than half a million people have accessed online training that aims to prevent suicide in the last three weeks alone, a charity has said.
    The Zero Suicide Alliance said 503,000 users completed its online course during lockdown. It aims to help spot the signs that a person may need help.
    It comes as health leaders warned front-line workers tackling coronavirus could suffer from mental ill health.
    NHS England launched a mental health hotline to support staff last month.
    The alliance's Joe Rafferty said the true impact of the coronavirus on mental health will not be known until the pandemic ends, but he said "the stress and worry of the coronavirus is bound to have impacted people's mental health".
    Read full story
    Source: BBC News, 18 May 2020
  5. Patient Safety Learning
    People carrying Emerade 500 microgram adrenaline auto-injector pens should return them and get hold of a prescription for a different brand.
    A fault has been detected in the pens, meaning the dose of adrenaline may not be delivered when needed for people with severe allergies.
    The official advice comes from the Medicines and Healthcare products Regulatory Agency (MHRA).
    Alternative brands - EpiPen and Jext - are available up to 300 micrograms.
    "Action has been taken to protect patients, following detection of a fault in one component of the Emerade adrenaline auto-injector pens," an MHRA spokesperson said.
    "Patients should return all Emerade 500 microgram pens to their local pharmacy once they have a new prescription and have been supplied with pens of an alternative brand."
    If an Emerade pen does need to be used before a patient can get hold an alternative pen, the advice is that it should be pressed very firmly against the thigh. If this does not work, the patient should immediately use their second pen.
    Read full story
    Source: BBC News, 19 May 2020
  6. Patient Safety Learning
    Delirium and confusion may be common among some seriously-ill hospital patients with COVID-19, a study in The Lancet suggests.
    Long stays in intensive care and being ventilated are thought to increase the risk, the researchers say. 
    Doctors should look out for depression, anxiety and post-traumatic stress disorder (PTSD) after recovery, although most patients, particularly those with mild symptoms, will not be affected by mental health problems.
    The evidence is based on studies of patients with severe acute respiratory syndrome (Sars) and Middle-East respiratory syndrome (Mers), as well early data on COVID-19 patients.
    Read full story
    Source: BBC News, 19 May 2020
  7. Patient Safety Learning
    Global efforts to vaccinate children against fatal diseases such as measles and polio could be set back a decade due to the disruption caused by the coronavirus pandemic, Unicef has warned.
    Immunisation campaigns and routine vaccine services have been suspended across the world to limit the transmission of COVID-19, leaving countries with weak health systems susceptible to a resurgence in preventable illnesses once lockdown restrictions are lifted and societies reopen.
    More than 25 vulnerable countries have placed their immunisation programmes for measles on hold, while the delivery of Ebola vaccinations across central Africa, in countries such as the Democratic Republic of the Congo (DRC) and Central African Republic (CAR), has similarly been suspended or curtailed.
    “Our immediate concern is with disruption to currently available vaccines,” Dr Robin Nandy, global chief of immunisation at Unicef, told The Independent. “We expect to go back maybe five to 10 years. The longer the disruptions continue, the more concerned we are as it builds the number of susceptible kids in populations.
    “What we’re trying to avoid is countries recovering from the current Covid pandemic then being hit by another outbreak of a vaccine-preventable disease.”
    Read full story
    Source: The Independent, 18 May 2020
  8. Patient Safety Learning
    Tens of thousands of cases of COCID-19 may have been missed because of delays in warning the public that loss of taste and smell is a key symptom that should lead to self-isolation or testing, experts say.
    The four chief medical officers of the UK have finally made official what many scientists had been saying for weeks: that anosmia, or loss of smell, should be added to the other two main warning symptoms, a continuous cough and high temperature. Those who experience any of the three symptoms should isolate for seven days and their families for 14 days.
    Prof Tim Spector from King’s College London and his team said data from 1.5 million people who downloaded their symptom-reporting app suggested 50,000 to 70,000 people in the UK had been missed. As early as 1 April, they warned that people with anosmia should self-isolate.
    They were joined by ear, nose and throat surgeons, who said loss of taste and smell could be one of the few markers for people who were otherwise asymptomatic and potentially able to infect other people without realising they were a risk.
    Their professional body, ENT-UK, said they had been calling for eight weeks for anosmia to be listed as a marker for asymptomatic carriers. It issued a joint statement with the British Rhinology Society (BRS) on 20 March, it said. “We estimate that many hundreds of thousands of patients in the UK have developed anosmia as a result of COVID-19,” said Prof Claire Hopkins, the BRS president.
    Read full story
    Source: Guardian, 18 May 2020
  9. Patient Safety Learning
    Suspected cancer patients are being refused hospital appointments despite being referred by GPs, it has emerged.
    Family doctors working for one NHS trust in north east London claimed that hundreds of referrals had been rejected in recent weeks.
    Many were for ultrasounds and chest X-rays and were sent via the two-week wait system, in which suspected cancer patients referred by GPs are seen within a fortnight.
    A rejection letter sent from Whipps Cross hospital seen by Pulse magazine, said the referral had been “due to the Covid-19 pandemic”. 
    It added: “Following triage by a consultant radiologist, your imaging request has been assessed as non-urgent and cancelled.”
    Read full story
    Source: The Telegraph (18 May 202)
  10. Patient Safety Learning
    The leader of the NHS’ pandemic testing programme has highlighted concerns about the rate of COVID-19 transmissions in hospitals, HSJ can reveal.
    NHS England’s patient safety director Dr Aidan Fowler told an industry webinar that he and his team “are concerned about the rates of nosocomial spread within our hospitals”.
    Dr Fowler leads the NHS and Public Heath England testing programme (know as “pillar one”). He said the concerns had led to a focus on discovering where transmissions of covid-19 are occurring in hospitals, and how the NHS can reduce the rate of staff and patients becoming infected while on the NHS estate.
    His comments come as the NHS attempts to restart the provision of routine elective care and prepares for a significant increase in emergency admissions. The NHS has been told to create separate areas for covid positive and negative patients where possible, regardless of what they are being treated for. Patients are being to self-isolate at home for two weeks before attending hospital for treatment.
    Read full story
    Source: HSJ, 18 March 2020
  11. Patient Safety Learning
    Hospitals have been refusing requests for caesarean sections during the COVID-19 outbreak despite official guidance and NHS England advice that they should go ahead.
    Multiple NHS trusts have told women preparing to give birth since March that requests for a caesarean section will not be granted due to the viral pandemic.
    It has led to accusations from the charity Birthrights that the coronavirus outbreak is being used as an excuse to promote an ideology that more women should have a natural birth.
    Maria Booker, from Birthrights, told The Independent: “We continue to be contacted by women being told they cannot have a maternal request caesarean and we are concerned that in some places coronavirus is being used as an excuse to dictate to women how they should give birth, which contravenes NICE (National Institute for Health and Care Excellence) guidance.
    Official guidance from NICE says women should be offered a caesarean section where they insist it is what they want.
    NHS England has warned hospitals they need to “make every effort” to avoid cancelling caesarean sections and work with neighbouring trusts to transfer women if necessary. It said surgery should only be suspended in “extreme circumstances” where there is a shortage of obstetricians or anaesthetists.
    Read full story
    Source: The Independent, 17 May 2020
  12. Patient Safety Learning
    The government needs to make sure its coronavirus testing strategy is fit for purpose instead of focusing on hitting targets, says the Royal College of GPs (RCGP).
    In a letter to Health Secretary Matt Hancock, chairman Prof Martin Marshall said long wait times were "undermining confidence" in the results. Health professionals were also concerned about the accuracy of some test results, he said.
    The government said "95% of tests" were processed "in less than 48 hours". 
    Ensuring there are enough tests to meet demand is part of the government's five tests it says must be met before easing lockdown restrictions. However, the absence of a clear strategy had left patients vulnerable, according to Prof Marshall.
    He said the RCGP did not currently believe the testing strategy was capable of working to prevent a second wave of infections and "secure the overall health of the population".
    Read full story
    Source: BBC News, 16 May 2020
  13. Patient Safety Learning
    Up to a fifth of patients with COVID-19 in several hospitals contracted the disease over the course of the pandemic while already being treated there for another illness, NHS bosses have told senior doctors and nurses.
    Some of the infections were passed on by hospital staff who were unaware they had the virus and were displaying no symptoms, while patients with coronavirus were responsible for the others.
    The figures represent NHS England’s first estimate of the size of the problem of hospital-acquired COVID-19, which Boris Johnson last week said was causing an “epidemic” of deaths. In a national briefing last month on infection control and COVID-19, NHS England told the medical directors and chief nurses of all acute hospitals in England that it had found that 10%-20% of people in hospital with the disease had got it while they were inpatients.
    Senior doctors and hospital managers say that doctors, nurses and other staff have inadvertently passed on the virus to patients because they did not have adequate personal protective equipment (PPE) or could not get tested for the virus.
    Doctors say that hospital-acquired COVID-19 is a significant problem and that patients have died after becoming infected that way. One surgeon, who did not want to be named, said: “Multiple patients my department treated who were inpatients pre lockdown got the bug and died. Obviously the timeline supports that they acquired it from staff and other patients.”
    Read full story
    Source: The Guardian, 17 May 2020
  14. Patient Safety Learning
    A joint letter from the Health Foundation, The King’s Fund and Nuffield Trust has been delivered to the Health and Social Care Select Committee identifying five key aspects which need addressed ahead of their evidence session on delivering core NHS and care services during and beyond the coronavirus pandemic.
    Health and Social Care Secretary Matt Hancock told the House of Commons on 22 April 2020 that the pandemic had reached its peak and talked of his intention to ‘gradually reopen’ the NHS as soon as it was safe to do so.
    For the joint authors of the letter, before any services look to begin being restarted key areas need addressed including a reliable supply of PPE to protect staff and a clear understanding within the system of the full extent of unmet need – particularly important as at present, from a big picture view, it is not clear how many services have been suspended.
    The joint letter puts five key questions to the Select Committee to address:
    How and when will appropriate infection prevention and control measures be available for all settings delivering care, and what impact will these have on capacity to reopen? How will the system understand the full extent of unmet need? How will the public’s fear of using NHS and social care services be reduced? What is the strategy for looking after and growing the workforce? Can the system improve as it recovers? Read full story
    Source: National Health Executive, 14 May 2020
  15. Patient Safety Learning
    NHS staff are at risk of high rates of post-traumatic stress disorder (PTSD) if they don't get the right support as the coronavirus outbreak subsides, health service adviser Prof Neil Greenberg has said.
    For now there's a national focus on health and care workers. Public billboards praise them, millions turn out on the street for a weekly round of applause and volunteers have been rushing to help in any way they can. But the height of the crisis is when many staff will be in coping mode. It's when things slow down - and the clapping stops - that, psychologists believe, the real risk of difficulties will arise.
    People may need months or even years of "active monitoring" of their mental health after things return to some semblance of normality, according to Prof Greenberg, a world-leading expert in trauma at King's College London.
    The NHS in England is providing crisis support to its staff. But it hasn't produced a formal long-term plan to offer extra psychological services in the aftermath of the pandemic.
    It's what happens after the trauma that is "most predictive of what people will be like in terms of their mental health", according to Prof Greenberg. How well people are supported and how much stress they're put under as they try to recover can make or break whether someone manages well or develops far more serious difficulties including PTSD.
    "If we muck it up then that's going to make the trauma they've already had much more difficult to deal with," he says.
    Read full story
    Source: BBC News, 15 May 2020
  16. Patient Safety Learning
    More than 22,000 care home residents in England and Wales may have died as a direct or indirect result of COVID-19, academics have calculated – more than double the number stated as passing away from the disease in official figures.
    Academics at the London School of Economics (LSE) found that data on deaths in care homes directly attributed to the virus published by the Office for National Statistics significantly underestimated the impact of the pandemic on care home residents and accounted for only about 4 out of 10 of the excess deaths in care settings recorded in recent weeks in England and Wales.
    The figures suggest the impact of the virus in care homes is finally reducing. They are based on reports filed directly from care home operators to the regulator, the Care Quality Commission. Care Inspectorate Wales has said Covid was confirmed or suspected in a further 504 cases in homes up to the 8 May in Wales.
    But academics at the care policy and evaluation centre at the LSE found that when excess deaths of other care residents and the deaths of care home residents from Covid-19 in hospitals are taken into account, the toll that can be directly and indirectly linked to the virus pandemic is likely to be more than double the current official count.
    Read full story
    Source: The Guardian, 13 May 2020
  17. Patient Safety Learning
    More than a quarter of all NHS patients who have died after being infected with COVID-19 had diabetes, according to new statistics from NHS England.
    Between 31 March and 12 May, a total of 5,873 patients with diabetes died in hospital from COVID-19, 26% of all coronavirus deaths.
    It is the first time data on hospital deaths and underlying health conditions has been revealed by the NHS.
    People with diabetes have previously been described as being at moderate risk from the virus and were not part of the groups told to shield themselves in their homes due to fears they were at extreme risk.
    The NHS England data does not specifically say whether type 1 or type 2 was more prevalent among deaths. It said work was underway to understand the deaths data to include examining the type of diabetes, ethnicity and weight of those who died.
    NHS England said it was working with Diabetes UK to provide support and advice to patients via its helpline which will include volunteer clinical advisers.
    Read full story
    Source: Independent, 15 May 2020
  18. Patient Safety Learning
    Rapid testing and an adequate supply of protective equipment must be in place when the NHS reopens services cancelled during the peak of the coronavirus oubreak, health unions have said.
    The unions have put forward a nine-point plan for the NHS to reopen safely as lockdown restrictions ease.
    NHS England has told hospitals to restart routine and non-urgent operations and procedures which were put on hold to create more capacity for COVID-19 patients. But 16 unions, including Unison, the Royal College of Nursing, Unite and GMB, said they wanted the NHS to continue to operate a "safety-first" approach as outpatient clinics and operations resume.
    They said they wanted to avoid a repeat of the PPE supply problems which "sapped" staff confidence and "caused widespread and unnecessary anxiety".
    Unison's Sara Gorton, who also chairs the NHS group of unions, said the health sector faced another "crucial test" after handling the outbreak. 
    She added: "As hospitals get busier, and clinics and other services begin to reopen, the safety of staff and patients is paramount. But this can't happen without plentiful and constant PPE supplies."
    Read full story
    Source: BBC News, 15 May 2020
  19. Patient Safety Learning
    A&E admissions in the UK have fallen to the lowest on record, with a 57% year-on-year drop in attendances in England, new NHS data shows.
    The latest figures show a dramatic fall in demand for emergency treatment, falling below one million attendances per month for the first time since records began in 2010.
    The coronavirus crisis has placed additional strain on NHS resources, but is thought to have had the opposite effect on A&E, with the public staying at home and avoiding hospitals where possible.
    Read full story (paywalled)
    Source: The Telegraph, 14 May 2020
  20. Patient Safety Learning
    With all care home staff and residents now eligible for testing, with a priority given to those in homes looking after residents over 65 years of age, a new online portal has been launched to streamline the process of arranging coronavirus test kit deliveries.
    As national testing capacity continues to increase, the government is prioritising testing for care homes and other areas identified as having the greatest need. As such, across England, all symptomatic and asymptomatic care home staff and residents can be tested for coronavirus.
    The Department of Health and Social Care (DHSC) is working alongside local authority Directors of Public Health, Directors of Adult Social Services and local NHS providers to deliver this testing programme for care homes.
    Tens of thousands of care home workers and residents have already been tested, either by Public Health England or at drive through testing sites, mobile testing units and via satellite testing kits – packages of tests sent to care homes for staff to use on residents.
    Secretary of State for Health and Social Care Matt Hancock said: “The additional testing capacity we have achieved delivers many thousands of tests a day for residents and staff in care homes. This new portal allows those who book tests for staff and residents to do so even more easily, and it also offers a route for the prioritisation of care homes with the greatest need."
    Read full story
    Source: National Health Executive, 12 May 2020
  21. Patient Safety Learning
    Ministers faced fresh allegations on Wednesday of failing to prepare care homes for a pandemic, as it emerged that COVID-19 may have killed 22,000 residents in England and Wales – more than twice the official toll.
    Council social care directors in England warned the government two years ago, in a series of detailed reports, about care homes’ exposure to a pandemic, the Guardian has learned.
    They called for better supply plans for personal protective equipment (PPE) – warning that “demand for PPE could rapidly outstrip supply” – plus improved infection control and a system to enlist volunteers to help services expected to be stretched to breaking point.
    The Association of Directors of Adult Social Services (Adass), which represents directors of adult social services in England, told the Guardian it carried out the work to improve government planning for a flu pandemic at the request of the Department of Health and Social Care. But it said: “We are not aware of whether government departments picked up on any of the recommendations set out.”
    A Department for Health and Social Care spokesperson said: “As the public would expect, we regularly test our pandemic plans – allowing us to rapidly respond to this unprecedented crisis. Our planning helped prevent the NHS being overwhelmed and means we are past the peak of the virus.”
    Read full story
    Source: Guardian, 13 May 2020
  22. Patient Safety Learning
    NHS England has set up an advisory group to look at how physical and mental health services can be delivered to patients who are most vulnerable to COVID-19 and have been asked to shield themselves from the pandemic.
    There are now around 2.5 million patients on the list of people considered to be at the highest clinical risk, including solid organ transplant recipients and patients on chemotherapy, who have been told to cut themselves off from society as far as possible.
    They are going to have to stay that way beyond the end of June, with suggestions that their isolation could continue for many more months hence, and there is significant concern about the impact of this on their ongoing physical and mental health.
    The NHS has therefore set up an advisory group to examine how care can be provided to these patients.
    Read full story
    Source: HSJ, 13 May 2020
  23. Patient Safety Learning
    Restarting NHS services will be an even greater challenge than coping with the first coronavirus infections, health think tanks and hospital chiefs have warned.
    Since March, the NHS has freed up more than 33,000 beds to prepare for an influx of COVID-19 patients needing intensive care, but since the peak of infection health chiefs have worried that delays to care were harming patients.
    Around 46,000 so-called excess deaths have been recorded during the pandemic, as compared against a five-year average. Around a quarter of these are believed to be unrelated to COVID-19.
    In a joint statement, the Health Foundation, Nuffield Trust and King’s Fund think tanks have said it could take months before the NHS and social care are able to fully restart. All three bodies will be giving evidence to the Commons health committee on Thursday, where they will warn about the impact on the health service’s “exhausted staff” and demand action to help care homes – which are now at the frontline in the fight against coronavirus.
    The experts will stress the need for the NHS to begin planning for a second peak of infections, especially if it comes in winter – when the service is usually overwhelmed by seasonal flu.
    They will warn about concerns over how the NHS manages the risk of infection, with the need for more protective equipment, social distancing and increased testing. This will “severely limit capacity for many months”, they said.
    Read full story
    Soruce: The Independent, 14 May 2020
  24. Patient Safety Learning
    The NHS in London is planning to “fundamentally shift the way we deliver health and care” in the wake of coronavirus, according to documents obtained by HSJ.
    The plans from NHS England and Improvement’s London office say leaders should:
    Plan for elective waiting times to be measured at integrated care system level, rather than trust level. Accept “a different kind of risk appetite than the one we are used to”. Expect decisions from the centre on the location of cancer, paediatric, renal, cardiac, and neurosurgical services. Plan for a permanent increase in critical care capacity. Transform to a “provider system able to be commissioned and funded on a population health basis”. Work towards “a radical shift away from hospital care”. Expect “governance and regulatory landscape implications” plus “streamlined decision-making”. The document, titled Journey to a New Health and Care System, says there are three “likely” phases, with the final new system in place “from November 2021”.
    The preceding two phases are “action programmes” over the next 12 to 15 months which will be about reconfiguring services to deal with “immediate covid, non-covid and elective need”, and “transition” when the move to new configurations is evaluated and “public consent” sought.
    Read full story
    Source: HSJ, 11 May 2020
  25. Patient Safety Learning
    Measures to ease the lockdown in the UK could lead to tens of thousands of extra deaths if vulnerable people are not sufficiently protected and health care systems are put under strain, a study has suggested.
    Boris Johnson announced the first step towards normalcy — allowing unlimited exercise, one on one outdoor social meetings and a return to work for those who cannot do so at home — against a background of flattening infection numbers and fatalities caused by the virus.
    However in a study published in medical journal The Lancet, research led by University College London (UCL) has warned between 37,000 and 730,000 excess deaths could take place due to the direct and indirect effects of the virus within a year.
    Lead author Dr Amitava Banerjee said: “Older people, those with one or more underlying conditions and their carers are asking what easing the lockdown might mean for their health. Using data modelling on a number of different scenarios, our findings show the mortality risk for these vulnerable groups increases significantly, and could lead to thousands of avoidable deaths.”
    Read full story
    Source: The Independent, 13 May 2020
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