Jump to content
 View Profile  See their activity

  • Posts

    11,906

  • Joined

  • Last visited

Patient Safety Learning

Administrators

 Content Type 

News posted by Patient Safety Learning

  1. Patient Safety Learning
    The health secretary Matt Hancock has been threatened with a judicial review amid fears patients’ human rights are at risk from the incorrect use of controversial do not resuscitate orders during the coronavirus pandemic.
    Ministers have been told they should use emergency powers to issue a direction to doctors and nurses in the NHS requiring them to comply with the law on do not attempt resuscitation orders (DNARS) and to ensure patients are properly consulted.
    In recent weeks there have been a number of reports of patients having DNARs put in place without their knowledge or in GPs imposing blanket decisions, prompting a warning letter from NHS England’s chief nurse last month.
    The legal action is being brought by Kate Masters, the daughter of Janet Tracey, who died at Addenbrooke's hospital in 2011 after a DNAR was put in place without her knowledge.
    In 2014, Tracey's husband David won a landmark victory at the Court of Appeal which gave patients a new legal right to be consulted by doctors when DNARS were being considered. Not consulting a patient was a breach of their human rights, the court ruled.
    Read full story
    Source: The Independent, 6 May 2020
  2. Patient Safety Learning
    Pregnancy support helplines are experiencing a massive spike in distressed pregnant women asking for urgent help as charities warn coronavirus upheaval is placing pregnant women at risk.
    Frontline service providers warn mothers-to-be are anxious about whether they will be denied pain relief options and be separated from their newborn babies due to them being put in neonatal units.
    Birthrights, a maternity care charity, found enquiries to its advice line in March were up by 464 per cent in comparison to March last year. Women getting in touch also raised concerns about home birth services being withdrawn, midwifery-led birth centres shutting their doors and elective caesareans being discontinued due to the COVID-19 crisis.
    Baby charity Tommy’s experienced a 71% surge in demand for advice from midwives on its pregnancy helpline last month. The organisation warned coronavirus turmoil is placing pregnant women at risk after their midwives answered 514 urgent calls for help in April which is a sizeable rise from the 300 enquiries they would generally get.
    Jane Brewin, the charity’s chief executive, said: “Antenatal care is vital for the wellbeing of mother and baby – but the coronavirus outbreak means that many don’t know who they can ask for help, or don’t want to bother our busy and beloved NHS."
    “Although services are adapting, they are still running, so pregnant women should not hesitate to raise concerns with their midwife and go to appointments when invited. The large increase in people contacting us demonstrates that coronavirus is creating extra confusion and anxiety for parents-to-be, making midwives’ expert advice and support even more important at this time.”
    Read full story
    Source: The Independent, 5 May 2020
  3. Patient Safety Learning
    Today is International Day of the Midwife. Each year since 1992, the International Confederation of Midwives leads global recognition and celebration of the great work midwives do. 
    Take a look at some of the resources and blogs we have recently published on the hub highlighting the work midwives are doing to support mothers and families during the coronavirus pandemic and the challenges services face.
    Home births, fears and patient safety amid COVID-19
    Midwifery during COVID-19: A personal account
    Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic
    Birthrights: COVID-19
  4. Patient Safety Learning
    Isolation during lockdown is exacerbating psychosis in some patients, a consultant psychiatrist at a leading mental-health trust warns.
    Steve Church said the South London and Maudsley NHS Trust had now had to shift its focus to crisis management.
    He leads the psychosis recovery team, one of the trust's five teams helping patients struggling with their mental health during the coronavirus pandemic. Some have had to move homes to isolate and many no longer visit the clinic.
    Dr Church, who has been working in the field for almost three decades, said: "In normal times, and we're not in normal times, the whole treatment is about trying to help people not self-isolate, trying to help people to re-engage with society.
    "Self-isolation is one of the red flag-hallmarks of somebody becoming unwell in the first place, where they take themselves into a psychosis-induced lockdown."
    One of his patients, Tracey, told Dr Church, in a phone consultation, staying at home had increased her hallucinations. "It's been quite daunting," she said. "I do hear the voices a little bit more now. They're domineering - they tell me to run across the road and they're following me and they say horrible and nasty things."
    Read full story
    Source: BBC News, 5 May 2020
  5. Patient Safety Learning
    A leading doctor has called on the government to address regional health inequalities surrounding coronavirus.
    Dr George Rae, the British Medical Association's regional chairman for the North East, has written an open letter saying the area is "suffering disproportionately". He said it was "time to ask why" and wanted action to "close the gap".
    A government spokesman said it was working "incredibly hard" to protect the nation's public health.
    "This is gravely disconcerting," Dr Rae wrote.
    "Not only does this mean that we're suffering from a disproportionate amount of serious cases and deaths but also that, as a consequence, gradual lockdown measures may be affected - prolonging the hurt caused to our local economy. Covid-19 has shone a light on the health inequalities in the North East".
    "What we need now is action from the government to close this gap and reduce the vulnerability of people in the North East to many medical conditions and, indeed, any future viruses."
    Read full story
    Source: BBC News, 5 May 2020
     
  6. Patient Safety Learning
    An NHS app that aims to track the spread of coronavirus is being rolled out for the first time, as part of a trial on the Isle of Wight.
    Council and healthcare workers will be the first to try the contact-tracing app, with the rest of the island able to download it from Thursday. The app aims to quickly trace recent contacts of anyone who tests positive for the virus.
    However, the new NHS coronavirus app will have “unintended consequences”, according to the head of the unit developing it.
    Officials do not know “exactly how it will work”, Matthew Gould, chief executive of NHSX, told a parliamentary committee. “There will be unintended consequences, there will for sure be some things we have to evolve,” he said.
    Privacy campaigners have raised concern over the potential for “mission creep” with the data that will be gathered on people’s movements and contact with others.
    The Health Service Journal reported that it has not yet passed tests on cyber security, performance and clinical safety needed to be included in the NHS app library.
    Read full story
    Source: The Independent, 4 May 2020
  7. Patient Safety Learning
    Public Health England PHE) has made new changes to its guidance on the use of face masks as “a pragmatic approach for times of severe shortage”.
    The update came as trust procurement leads reported receiving substandard face masks from national stocks over the weekend, although a PHE spokesman told HSJ that this had not caused the change to guidance.
    PHE on Sunday updated its guidance on the use of certain facemasks facing “acute shortages”. The new advice states that FFP2 respirators can be worn without fit testing in lieu of surgical masks in non-surgical settings.
    The new guidance says: “This is a pragmatic approach for times of severe shortage of respiratory protective equipment, FFP2 respirators being used in this way will not be carrying out the function they were designed to perform.”
    However, FFP2 respirators must still be properly fit-tested in situations where this level of protection is required, the new PHE advice states.
    Read full story
    Source: 4 May 2020
  8. Patient Safety Learning
    Doctors should reassure parents and carers of children who are immunocompromised that immunosuppression does not seem to increase the risk of severe COVID-19, the UK National Institute for Health and Care Excellence (NICE) advises in a rapid guideline.
    “Covid-19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised,” NICE says.
    Children and teenagers who are immunocompromised and their carers may be feeling particularly anxious and fearful about covid-19, so it is important they are involved in decision making as much as possible, NICE advises. Doctors should also support patients’ and carers’ mental wellbeing through communication and by signposting to charities and support groups.
    The guideline says that patients should not avoid their usual appointments unless they have been told to and should continue with their usual treatment. However, face-to-face contact should be reduced where safely possible and alternative approaches such as telephone, video, or email consultations used instead.
    When deciding whether to start treatments that affect the immune system, doctors should discuss the risks and benefits with the patient and their carers. If it is safe to delay treatment then watchful waiting should be undertaken.
    Read full story
    Source: BMJ, 1 May 2020
     
  9. Patient Safety Learning
    As a medical examiner at St George's Hospital, in south London, Dr Nigel Kennea's job is to advise clinical teams on completing death certificates, then support relatives through their grief. But like so much during this pandemic, none of that is straightforward.
    "The most harrowing thing is knowing that many said goodbye to their loved ones in an ambulance," he says.
    Despite staff "going above and beyond" to support patients in desperate times, using mobile phones and iPads to connect seriously ill patients and their families, contact is just not always possible. Even after a patient's death, social distancing has meant grieving relatives are left in limbo.
    "Normally, registering a death is done face-to-face with relatives," Dr Kennea says. "They come in, talk through the admin and how to plan for after death. Now, it's all done on the phone."
    Dr Kennea's job is to take an overview of all deaths at the hospital. It's a relatively new role in the UK, introduced last year, which is independent of trusts. Dr Kennea discusses each death at the hospital with the doctors and nurses involved in that patient's care, making sure death certificates are completed correctly and consistently. But with COVID-19 deaths so closely scrutinised, there is added pressure and "some are complicated", he says.
    There are also challenges with communicating with patients. When Dr Kennea goes into COVID-19 areas, he has to wear full PPE which has its limits when communicating with patients.
    "It's hard to share a smile behind a mask and goggles," he says.
    Read full story
    Source: 1 May 2020
  10. Patient Safety Learning
    The health service will face a “tsunami” of coronavirus survivors discharged from hospitals needing long-term physical and mental support that the NHS will struggle to provide, The Independent has been told.
    Coronavirus can leave patients with lasting physical damage and scarring to their lungs, meaning many could struggle to breathe and move around as well as they did before – in some cases permanently.
    Patients admitted to intensive care can also suffer physical effects of being paralysed weeks and almost half who are ventilated with a tube in their windpipe will experience a form of delirium that can include terrifying hallucinations and leave survivors with lasting mental problems including post-traumatic stress.
    Experts have warned a long-term lack of funding of NHS rehabilitation services and post-discharge care for ITU patients means the health service will struggle to help the thousands of patients who beat the virus but face a long road to recovery.
    Read full story
    Source: 3 May 2020
  11. Patient Safety Learning
    Healthcare workers providing support outside of the NHS are finding it harder to access coronavirus tests than their colleagues inside the service, a survey of nurses has suggested.
    A poll of 22,000 health and care workers conducted by the Royal College of Nursing found 44% of respondents did not know how to access testing – while 76% said they had not been offered a test.
    The problem was also particularly pronounced among the temporary workers, with four in five not offered testing compared to three-quarters of full time workers.
    Meanwhile the survey found 79% of those working outside of the NHS had not been offered a test, compared with 75% in the health service.
    Dame Donna Kinnair, chief executive and general secretary of the RCN, said: “It is concerning to see that some nursing staff, particularly those outside the NHS, are still having issues accessing COVID-19 testing.
    Read full story
    Source: The Independent, 4 May 2020
  12. Patient Safety Learning
    Inquests into coronavirus deaths among NHS workers should avoid examining systemic failures in provision of personal protective equipment (PPE), coroners have been told, in a move described by Labour as “very worrying”.
    The chief coroner for England and Wales, Mark Lucraft QC, has issued guidance that “an inquest would not be a satisfactory means of deciding whether adequate general policies and arrangements were in place for provision of PPE to healthcare workers”.
    Lucraft said that “if there were reason to suspect that some human failure contributed to the person being infected with the virus”, an inquest may be required. The coroner “may need to consider whether any failures of precautions in a particular workplace caused the deceased to contract the virus and so contributed to death”.
    But he added: “An inquest is not the right forum for addressing concerns about high-level government or public policy.”
    Labour warned the advice could limit the scope of investigations into the impact of PPE shortages on frontline staff who have died from COVID-19.
    “I am very worried that an impression is being given that coroners will never investigate whether a failure to provide PPE led to the death of a key worker,” said Lord Falconer, the shadow attorney general. “This guidance may have an unduly restricting effect on the width of inquests arising out of Covid-19-related deaths.”
    Read full story
    Source: The Guardian, 29 April 2020
  13. Patient Safety Learning
    The Chief Scientific Adviser reportedly warned the government in January that the care homes sector in the UK was particularly vulnerable to COVID-19 – and that has unfortunately proved to be the case.
    With care home deaths now being reported daily, what do the numbers tell us about this group? Have care home residents been disproportionately affected? And is there a chance the crisis could belatedly mark the start of better times for a sector in danger of collapse?
    Read full story
    Source: Nuffield Trust, 1 May 2020
     
  14. Patient Safety Learning
    Hundreds of ventilators the UK government bought from China to relieve a major shortage are the wrong type and could kill patients, senior doctors have warned in a newly uncovered letter.
    The medical staff behind the letter say the devices were designed for use in ambulances rather than hospitals, had an "unreliable" oxygen supply and were of "basic" quality.
    Seen by Sky News' partner organisation NBC, the document also claims the ventilators cannot be cleaned properly, are an unfamiliar design and come with a confusing instruction manual.
    Cabinet Office minister Michael Gove triumphantly announced the arrival of "300 ventilators from China" to help treat COVID-19 patients on 4 April. But the letter of warning from doctors was issued just nine days later.
    "We believe that if used, significant patient harm, including death, is likely," it says.
    Read full story
    Source: Sky News, 30 April 2020
  15. Patient Safety Learning
    Hospital leaders have launched a strident attack on the government’s coronavirus testing strategy, as it became clear that the target of 100,000 daily tests by 30 April would be comprehensively missed.
    NHS Providers, which represents foundation trusts in England, rounded on ministers for “a series of frequent tactical announcements” to expand testing criteria, and dismissed the 100,000 target as a “red herring” that distracted from their failures.
    Just 33,000 people were tested for COVID-19 in the latest 24-hour period – a record high for a single day – according to official figures. Dominic Raab, the first secretary of state, said that more than 52,000 tests were carried out, but this total is apparently bolstered by 19,000 retests.
    Test capacity was now more than 73,000 a day, he said – still considerably below the target set by the health secretary, Matt Hancock, at the start of April.
    Read full story
    Source: The Guardian, 30 April 2020
  16. Patient Safety Learning
    Patients with the most severe eating disorders have received the least support during the COVID-19 pandemic, a leading expert has warned.
    Dr Agnes Ayton, chair of the Royal College of Psychiatrists eating disorder faculty, told HSJ that although it was an achievement that services had implemented digital consultations so quickly, for the most severe and high-risk patients this would not work as well.
    She also warned that some specialist eating disorder units across the country have had to limit admissions and run below full capacity. 
    Her warning comes after a leading charity for eating disorders, Beat, said it has seen a 35% increase in calls to its national helpline since the pandemic began.
    Read full story
    Source: HSJ, 1 May 2020
  17. Patient Safety Learning
    Experts have raised fears that high-risk pregnancies may be missed due to the coronavirus pandemic, leading to a potential rise in stillbirths and neonatal deaths.
    During a session of Westminster’s Health and Social Care Committee, Gill Walton, the Chief Executive of the Royal College of Midwives, said there was a “fear” among pregnant women presenting themselves to maternity services during the COVID-19 outbreak.
    Former health secretary Jeremy Hunt, who chairs the committee, said one of the most important elements of maternity safety was to identify higher-risk pregnancies early “so that interventions can be made to prevent stillbirths, complications, or even the death of a baby”.
    Mr Hunt added the President of the Royal College of Obstetricians, Dr Edward Morris, had told him he is “worried that some higher-risk pregnancies may be being missed” because of fewer face-to-face appointments and missed scans.
    Asked whether she shared that concern, Ms Walton told MPs: “I do share that concern. Some of that is related to the fear of the pregnant population and presenting to maternity services during the pandemic."
    "That fear then prevents them sometimes just picking up the phone to call their midwife to say that may be concerned about not feeling well, or that they’ve got reduced foetal movements.”
    Read full story
    Source: The Independent, 1 May 2020
  18. Patient Safety Learning
    Death rates from coronavirus in the most deprived parts of England are more than double than in less deprived areas, according to new figures that show London is the worst-hit part of the country.
    The mortality rate for the most deprived areas for March and early April was 55.1 deaths per 100,000 population – compared with 25.3 deaths per 100,000 in the least deprived areas, according to the Office for National Statistics (ONS).
    The statistics show London has by far the highest mortality rate, with 85.7 deaths per 100,000 persons. This was found to be “statistically significantly higher” than any other region – almost double the next highest rate.
    Read full story
    Source: The Independent, 1 May 2020
  19. Patient Safety Learning
    The government is under pressure to go further on measures to relax rules on powerful painkillers such as morphine to prevent patients suffering “unnecessary pain and distress in the last days of their lives”.
    On Tuesday the health secretary, Matt Hancock, announced staff in care homes and hospices would be allowed to “re-use” controlled drugs such as morphine and midazolam, with medication prescribed for one patient used for another where there is an immediate need.
    But the Home Office today confirmed to The Independent that it had no plans to extend the rules to the care of patients in their own homes – a restriction experts and charities have warned could leave people suffering at the end of their lives.
    The government announced the changes following concerns over the supply of drugs. 
    The Royal College of GPs (RCGP) welcomed the changes announced by Mr Hancock, calling them “a significant step forward”, but added: “This only applies to patients living in care home and hospice settings, so there is still work to be done to ensure patients living in their own homes have appropriate access to necessary medication in a timely way.”
    Last week the RCGP wrote to home secretary Priti Patel warning that people were suffering unnecessarily due to problems accessing drugs.
    Read full story
    Source: The Independent, 30 April 2020
  20. Patient Safety Learning
    There is growing concern that standard personal protective equipment (PPE), which often has a unisex design, doesn't always fit women properly.
    The Department of Health said the kit is designed to protect "both genders". However, healthcare workers are saying that even the smallest sizes are too big for some women - who make up 77% of the NHS workforce, according to NHS Digital figures from 2018.
    If it is too big it can be less effective in providing a complete barrier to the virus.
    "PPE is designed to be unisex and offer protection for both genders, although some products are available in different sizes to enable fit to both small and larger frames," said the Department of Health, in a statement.
    But the Royal College of Nursing has described "one-size-fits-all" personal protective equipment as "problematic" and "restrictive" when it can be worn for up to 12 hours during shifts. PPE includes gloves, masks, gowns and face shields.
    "Nurses can find it very difficult to treat patients if this equipment is so uncomfortable it makes them hot and unwell," said Rose Gallagher, professional lead for infection prevention and control.
    Read full story
    Source: BBC News, 29 April 2020
  21. Patient Safety Learning
    People needing hospital treatment for coronavirus are as likely to die as those with Ebola, claim UK researchers. The warning comes as the largest study in Europe showed at least a third of hospital patients with COVID-19 die.
    The disease is mild for most and can be treated at home, but scientists said people needed to realise how dangerous the infection could be. Obesity, ageing and being male greatly increase the risk of death, according to the data from 166 British hospitals.
    Medical details on nearly 17,000 coronavirus patients in England, Wales and Scotland have been analysed and it shows that 49% survived and were discharged, 33% have died and 17% were still being treated.
    "Some people persist in believing that Covid-19 is no worse than a bad dose of flu - they are gravely mistaken," said Calum Semple, the Chief Investigator on the trial, and a Professor in Child Health and Outbreak Medicine at the University of Liverpool.
    "The crude case fatality rate for people who are admitted to hospital with severe Covid-19 is 35% to 40%, which is similar to that for people admitted to hospital with Ebola. People need to hear this and get it into their heads... this is an incredibly dangerous disease."
    Read full story
    Source: BBC News, 29 April 2020
  22. Patient Safety Learning
    The rising death toll from coronavirus is never far from the headlines, but hidden behind the daily figures is what public health experts refer to as the "parallel epidemic". This is the wider impact on people's health that is the result of dealing with a pandemic.
    UK chief medical adviser Prof Chris Witty has been referring to this with increasing frequency during the daily briefings, speaking about the "indirect" costs of coronavirus.
    But what is it, and how significant could it be?
    Routine treatments, such as hip and knee replacements, were cancelled across the UK. This alone will have a significant impact on people's lives, though it is unlikely to kill anyone. However, the pandemic has also had a knock-on effect on emergency care. Data collected by Public Health England from a sample of A&E departments in England shows attendances have halved since the pandemic started. The trend has prompted NHS leaders to urge patients to come forward for treatment.
    Cancer screening has been suspended in Wales, Scotland and Northern Ireland and drastically cut back in England. But it is not only an issue for cancer patients, people with chronic conditions like diabetes or kidney disease may face trying to manage their conditions remotely without the regular face-to-face contact they would have with health professionals. 
    The pandemic is also the 'perfect storm' for mental health.
    The full impact could take years to unravel.
    Read full story
    Source: BBC News, 29 April 2020
     
  23. Patient Safety Learning
    An overflow system has been added to NHS 111 to help deal with the “huge increase” in calls during the coronavirus pandemic.
    People displaying coronavirus symptoms who are contacting 111 either via telephone or online are now being diverted to the overspill system, freeing up space for non-covid related enquiries.
    The tool has been developed by software company Advanced — alongside NHSX, NHS England and NHS Improvement — for its patient management system Adastra, which is used by 80% of NHS 111 providers in England.
    The overspill add on, which started being rolled out earlier this month, can be accessed by clinicians who are working from home, including those who have been redeployed in the NHS, as well as those in 111 call centres. 
    Ric Thompson, managing director of health and care at Advanced, said the new queuing extension was developed to handle the “huge increase in the number of calls to 111 but also the need to bring back many thousands of retired clinicians”.
    Read full story
    Source: HSJ, 29 April 2020
  24. Patient Safety Learning
    Intensive care capacity in London must be doubled on a permanent basis following the coronavirus pandemic, according to the chief executive of the city’s temporary Nightingale hospital.
    Speaking to an online webinar hosted by the Royal Society of Medicine, Professor Charles Knight said London had around 800 critical care beds under normal operations but “there’s a clear plan to double intensive care unit capacity on a permanent basis”.
    He added: “We must have a system of healthcare in this country that means, if this ever happened again, that we wouldn’t have to do this, that we wouldn’t have to build an intensive care unit in a conference centre because we had enough capacity under usual operating so that we could cope with surge.”
    It would also mean the NHS would no longer be in a position “where lots of patients, as we all know, get cancelled every year for lack of an ITU bed,” he said.
    Read full story
    Source: HSJ, 28 April 2020
  25. Patient Safety Learning
    The coronavirus pandemic could lead to almost 18,000 more deaths from cancer in England over the next year and there could also be a 20% spike in fatalities of newly diagnosed cancer patients, according to research by University College London (UCL) and DATA-CAN, the Health Data Research Hub for Cancer.
    The figures stem from real-time hospital data for urgent cancer referrals and chemotherapy attendances, which have experienced a 76% and 60% fall, respectively.
    Professor Peter Johnson, the NHS Clinical Director for Cancer, has urged people to not hesitate in seeking help or being checked after worrying research showed nearly half of the public have concerns about seeking help.
    Moreover, the poll by Portland revealed 1 in 10 people would not contact their GP even if they discovered a lump or a new mole that remained for a week or more.
    Read full story
    Source: BBC News, 28 April 2020
×
×
  • Create New...