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Patient Safety Learning

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  1. Patient Safety Learning
    Doctors in Britain are being “bullied and shamed” into treating patients with COVID-19 despite not having the masks, gowns and eyewear they need to protect themselves from the virus, frontline medics have said.
    Others are being told to hold their breath to avoid getting infected because of persistent shortages of personal protective equipment (PPE) .
    The findings raise questions about how far a huge effort by NHS bosses, ministers and the military has succeeded in banishing previously widespread supply problems with PPE.
    “Lack of personal protective equipment continues to be a critical issue. It is heartbreaking to hear that some staff have been told to simply ‘hold their breath’ due to lack of masks,” said Dr Samantha Batt-Rawden, the president of the Doctors’ Association UK (DAUK).
    “Doctors are dying. Nurses are dying. We are devastated, and can no longer stand by and watch as more dedicated colleagues lose their life,” she said.
    Read full story
    Source: The Guardian, 7 April 2020
  2. Patient Safety Learning
    The government could be significantly underestimating the number of medics going off work due to the coronavirus, according to a survey by the Royal College of Physicians (RCP).
    The health secretary, Matt Hancock, said on Sunday that 5.7% of hospital doctors were off sick or absent because of Covid-19, but a doctors’ survey of more than 2,500 medics found the rate was almost three times that – 14.6%.
    In recent weeks in London, nearly a third of hospital doctors said they were off work for Covid-19 and non-Covid-19 reasons, according to the RCP’s poll of members, conducted on Wednesday and Thursday.
    Prof Andrew Goddard, the president of the RCP, said the number who had been off work in London “should be a sobering wake-up call” for the rest of the country, with the largest rises in confirmed cases now being outside the capital including in the West Midlands.
    Read full story
    Source: The Guardian, 5 April 2020
  3. Patient Safety Learning
    Plaid Cymru Leader Adam Price has argued that the Welsh Government should appoint a procurement tsar to get to grips with Wales's serious shortage of COVID-19 testing kits, personal protective equipment (PPE) for frontline health and care staff and medical devices for patients.
    Wales is currently only testing 1,100 people a day when it was planning to test 6,000. This follows the collapse of an alleged deal between the Welsh Government and private company Roche which would have provided for 5,000 of those tests.
    Adam Price made the case for the appointment of a tsar whose "sole responsibility" would be the procurement and supply of COVID-19 tests, PPE, and oxygen and medical devices for Wales.
    He cited cases of care homes with just one or two boxes of surgical masks - each enough to last just two days for one patient, as well as hospital staff being forced to wear paper underwear over their hair due to the lack of any other protection.
    Read full story
    Source: Plaid Cymru Party of Wales, 6 April 2020
  4. Patient Safety Learning
    The first two coronavirus deaths among care workers in England were announced, as industry leaders hit out at chronic shortages of protective equipment and urged the government to start treating social care as “a second front line”.
    Carol Jamabo, 56, a community carer for Cherish Elderly Care in Bury in Greater Manchester, died last Wednesday.
    Another carer died in a home run by MHA, the UK’s largest charitable social care provider, which said it was unclear where she contracted the virus. The death of a West Dumbartonshire care worker that emerged on Sunday was also confirmed by the Scottish first minister, Nicola Sturgeon.
    The fatalities came amid rising concern that those working in social care still do not have the protection they need amid the Covid-19 pandemic and that, without testing for the virus, staff risk contaminating care homes where elderly people are supposed to be “shielded”.
    Read full story
    Source: The Guardian, 6 April 2020
  5. Patient Safety Learning
    Doctors and nurses will need treatment for post-traumatic stress disorder after working in harrowing conditions on wards during the coronavirus crisis, health leaders warn.
    The strain on their mental and physical health is already unprecedented and the virus has not yet reached its expected peak, they say.
    NHS staffing is at levels that were previously unthinkable as workers – forced to spend hours in hot conditions while wearing full protective gear – try to keep up with demand amid a lack of equipment.
    It comes as the head of intensive care at London’s Royal Free Hospital described in a memo how most units had already shifted from the usual one nurse to one patient ratio to one to six and were running out of key machines and equipment.
    Dr Alison Pittard, dean of the Faculty of Intensive Care Medicine, told The Independent: “I am really concerned about the toll this is taking and will continue to take on staff."
    “We are used to dealing with emergencies, but we have never been exposed to this sort of demand. We know staff are already struggling physically and mentally and that this will only continue."
    Read full story
    Source: The Independent, 6 April 2020
  6. Patient Safety Learning
    Doctors, nurses and paramedics have been given conflicting advice about when to start resuscitation for coronavirus patients, amid fears the procedure could put them at risk of infection.
    While Public Health England has said it does not believe CPR creates a risk, the UK’s Resuscitation Council – which is responsible for setting standards for resuscitation in the NHS – has said it believes there is a risk and staff should wear full equipment.
    The Independent has seen several examples of different messages being sent out to hospital staff and ambulance workers, and some NHS trusts were forced to change their guidance within a matter of days after PHE changed its stance.
    One set of guidance could mean a delay in starting CPR for patients while staff put on protective equipment, while the other means staff could be at risk of being infected with coronavirus.
    Ken Spearpoint, a former consultant nurse and resuscitation officer at Imperial College Healthcare Trust, said the situation had led to confusion and created an “ethical dilemma” for some staff who were being forced to choose between the Resus UK’s position and their trust’s guidance.
    Read full story
    Source: The Independent, 6 April 2020
  7. Patient Safety Learning
    Thousands of people have been missed off the government's high risk list for Covid-19 despite meeting the criteria.
    Among them have been transplant patients, people with asthma and some with rare lung diseases.
    Many are worried it will affect their ability to access food and medical supplies as they shield from the virus, unable to leave their homes for at least 12 weeks.
    "It's like she's been forgotten," said Bev Pearson, mother of 20-year-old heart transplant patient Lucy Pearson.
    Miss Pearson, from Whitsbury in Fordingbridge, Hampshire, had her transplant 14 years ago and still visits hospital for regular check-ups. She has been shielding in the home she shares with her mother, brother and sister - none of whom have been venturing out in an attempt to protect her.
    Despite registering her daughter on the government list herself, she said she had received no confirmation.
    When she asked her GP she was told it had "nothing to do with the surgery", she added.
    Read full story
    Source: BBC News, 7 April 2020
  8. Patient Safety Learning
    Oxygen supplies at a Hertfordshire hospital inundated with coronavirus patients became so precarious last week that officials considered how to decide who should receive the gas and who should miss out and likely die, the Guardian understands.
    The oxygen system at Watford general hospital came close to breaking point on Saturday, when a critical incident was declared and staff had to tell the public not to come to the hospital. Some patients were moved out to prevent the vital system failing.
    A senior clinician said: “They were [consulting] the hospital ethics committee every day and considering who they were not going to oxygenate and ventilate if they needed it, and making decisions about who would be triaged to not have oxygen and die.”
    Read full story
    Source: Guardian, 5 April 2020
  9. Patient Safety Learning
    Adult social care services are to receive millions of personal protective equipment products following a national audit of personal protective equipment (PPE), HSJ can reveal.
    The government will deliver more than 30 million items to local resilience forums in the coming days, for distribution among social care and other front-line services, according to a letter seen by HSJ.
    The stock should not be sent to acute trusts or ambulance services, the letter, from health and social care secretary Matt Hancock and housing, communities and local government secretary Robert Jenrick, stated.
    Describing an “urgent need” for PPE in front-line services, Mr Hancock and Mr Jenrick asked local planners to distribute this latest batch of stock “only where there is a clear and pressing need”.
    Read full story
    Source: HSJ, 6 April 2020
  10. Patient Safety Learning
    New figures reveal that what we think we know about the Covid-19 death toll in the UK is wrong. Here’s why.
    Every day we get one big figure for deaths occurring in the UK. Everyone jumps on this number, taking it to be the latest toll. However NHS England figures – which currently make up the bulk of UK deaths – in fact reflect the day on which the death was reported, not the actual date of death, which is usually days, sometimes weeks, before it appears in the figures.
    The truth is we don’t know how many deaths have taken place the previous day. In fact the headline figure is likely to under-report the number of deaths that actually happened the previous day.
    The number we hear about usually counts deaths which took place at an earlier date. The difference matters because by undercounting the number of deaths we are skewing the curve.
    Read full story
    Source: Guardian, 4 April 2020
  11. Patient Safety Learning
    A healthcare worker in north-west London quit her job after she was refused permission to wear a protective face mask, the Guardian has learned.
    In her resignation letter, Tracy Brennan chastised her superiors at Hillingdon Hospitals NHS foundation trust for forbidding her from wearing a surgical mask she had bought to protect herself – and the patients she was caring for – from contracting the deadly virus.
    Brennan, a healthcare assistant, said she had returned to work after self-isolating for 14 days because her daughter had shown symptoms of Covid-19. She said that patients in the ward where she was working, which was not a coronavirus treatment ward, felt comfortable with her wearing the surgical mask and some positively encouraged her to do so.
    Brennan wrote: “With a heavy heart and sadness, I feel I have no alternative but to hand this letter in as my formal resignation and will be unable to work my notice due to not being allowed to wear sufficient personal protective equipment (PPE) for the duties I perform.”
    Read full story
    Source: Guardian, 4 April 2020
  12. Patient Safety Learning
    When Victoria Gianopoulos-Johnson got a call from her midwife to say her home birth would be cancelled, panic took hold. She says she “lost it” for two days, crying constantly, gripped by uncertainty and then anger. Now she has reached the decision to have a free birth, also known as unassisted childbirth.
    Maternity rights groups say there has been a rise in the number of women seeking advice about freebirthing owing to pressures on hospitals and new restrictions around birth partners.
    More than a fifth of birthing centres and more than a third of homebirth services have closed due to a shortage of midwives and concerns about ambulance response times.
    Alison Edwards, of Doula UK, whose 700 members advocate for expectant mothers, says she has seen a threefold increase in calls about freebirthing in the last fortnight.
    “Initially women were concerned about staff shortages,” says Edwards. “Now they don’t want to go to hospital at all, it’s about infection. It is inevitable that some who should not be freebirthing because they are in a high-risk category will give birth at home because they fear the alternative – infection from [coronavirus] or spending time in hospital without their partner’s support.”
    Read full story
    Source: Guardian, 5 April 2020
  13. Patient Safety Learning
    People who may be having a stroke should still call 999 for emergency medical care, even during the coronavirus pandemic, say UK experts.
    They are concerned that many are not seeking urgent help when they most need it, possibly due to fear of the virus or not wanting to burden the NHS.
    Any delay in seeking help can lead to disability or even death, warns the Stroke Association. Prompt assessment and treatment saves lives, it says.
    Data suggest people are currently staying away from hospitals, which is fine unless you really need care.
    Latest figures for England and Scotland suggest attendance to Emergency Departments has dropped by over a third on the same week last year. Those who need urgent medical help should still attend, say experts.
    Read full story
    Source: BBC News, 6 April 2020
  14. Patient Safety Learning
    Almost 400 care companies which provide home support across the UK have told the BBC they still do not have enough personal protective equipment (PPE).
    Without protection, providers say they may not be able to care for people awaiting hospital discharge.
    Of 481 providers, 381 (80%) said they did not have enough PPE to be able to support older and vulnerable people.
    The government said it was working "around the clock" to give the sector the equipment it needs.
    The BBC sent questions to the nearly 3,000 members of the UK Homecare Association.
    About a quarter of respondents said they have either run out of masks or have less than a week's supply left.
    Read full story
    Source: BBC News, 6 April 2020
  15. Patient Safety Learning
    City and Hackney Clinical Commissioning Group might have the fifth highest prevalence of serious mental illness in England, but last year it achieved the highest physical health check coverage in the country.
    This was down to a collaborative approach by the CCG, local trust, GPs, heath informatics, a voluntary sector exercise and diet specialist organisation, and service users themselves.
    This alliance model for primary care SMI physical health was named mental health innovation of the year at the HSJ awards.
    Find out more
    Source: HSJ, 20 March 2020
  16. Patient Safety Learning
    Children may have died from non-coronavirus illnesses because they are not coming to hospital quickly enough, amid concerns NHS 111 may be giving flawed advice to stay away, according to senior paediatricians.
    HSJ understands the concern about 111 giving the wrong advice to parents who should travel to hospital had been “escalated” to national leaders.
    Several senior paediatric leaders in London raised serious concerns to HSJ. They said several children in the past week had been admitted to intensive care in London, and had been harmed — and, in some cases, died — because of the issue, though they did not want to identify particular hospitals or cases. The sources said it was a national problem.
    Read full story
    Source: HSJ, 3 April 2020
  17. Patient Safety Learning
    Royal Wolverhampton Trust (RWT) has become the first provider to sign a deal with Babylon Health for citywide coverage of a new COVID-19 app, HSJ has learned.
    Digital health provider Babylon announced earlier this month the creation of a “covid-19 care assistant” app, which provides patients with digital triage, a live chat service, a symptom tracker and video consultation.
    RWT’s deal covers around 300,000 patients registered to a Wolverhampton GP, and all trust staff regardless of where they live. Earlier this year, RWT announced a 10-year deal with Babylon to develop a “digital-first integrated care” model.
    The new COVID-19 app will be made available to staff today and will then be rolled out to the general public next week.
    Read full story
    Source: HSJ, 3 April 2020
  18. Patient Safety Learning
    Elderly care home residents have been categorised “en masse” as not requiring resuscitation, in a strategy branded unacceptable by the healthcare regulator.
    People in care homes in Hove, East Sussex and south Wales are among those who have had “do not attempt resuscitation” (DNAR) notices applied to their care plans during the coronavirus outbreak without proper consultation with them or their families, MPs and medical unions fear.
    Care homes in Leeds have reported that district nurses have been asking them to “revisit do not resuscitate conversations with people who said they didn’t want them” and a care worker in Wales told the Guardian that after a visit from a GP, all 20 of their residents had DNAR notices attached to their plans.
    DNAR notices are a common part of care plans and many people wish to have them in place because, in the event of cardiac arrest, attempts to resuscitate can cause serious trauma, including broken bones. But the Care Quality Commission and other medical bodies are so concerned about the blanket application of the notices that it has issued a warning to stop.
    “It is unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description,” the notice states. “These decisions must continue to be made on an individual basis according to need.”
    Read full story
    Source: The Guardian, 1 April 2020
  20. Patient Safety Learning
    On any normal day the Oak Springs Care home in Liverpool is a hive of activity, laughter ringing out as its elderly residents enjoy dancing, creative crafts and bingo.
    Yesterday it was quiet, the inhabitants confined to their bedrooms and stark notices on the door warning visitors against entering, as word spread that a third resident had died in hospital that morning after a corona-virus diagnosis. Of the 66 remaining residents, 52 are exhibiting symptoms.
    Four were put on end-of-life care plans this week, a situation described by Andrea Lyons, the general manager, as “our absolute worst nightmare”.
    She said: “These are people who we love, who we spend more time with than our families. It has been difficult beyond the worst you can imagine”.
    Read full story
    Source: The Times, 2 April 2020
  21. Patient Safety Learning
    Boris Johnson has been forced to shift strategy on the government’s testing regime for coronavirus after criticism of the slow pace of checks being carried out on frontline NHS staff.
    Private laboratories are now being drafted in to do the tests where before these were being performed through a centralised process.
    The prime minister accepted last night that mass testing was the way out of the crisis and said in a tweet that it would “eventually unlock the puzzle of coronavirus”.
    Read full story (paywalled)
    Source: The Times, 2 April 2020
  22. Patient Safety Learning
    A father has described the "huge impact" of losing respite care for his young daughter who has complex special needs.
    Tim Clarke and his wife Ana look after their six-year-old daughter Molly at home in Worcester. The family normally receives a few hours of outside care and educational help a week, but that ended with the coronavirus pandemic.
    Molly has been diagnosed with autism and also has medical issues including a cyst on her brain.
    One charity worker from the Pathological Demand Avoidance (PDA) Society, a condition which is on the autism spectrum, described parents of children with special needs as being in "survival mode".
    Watch video
    Source: BBC News, 1 April 2020
  23. Patient Safety Learning
    The procurement of digital tools to support online primary care services during the coronavirus outbreak are to be fast-tracked for providers who don’t have the resources.
    In a letter sent to primary care providers and commissioners, GP surgeries were told to move to a triage-first model of care as soon as possible as the NHS bolsters its response to COVID-19.
    The letter, sent by medical director for primary care, Nikita Kanani, and director of primary care strategy and NHS contracts, Ed Waller, states practices and commissioners should promote online consultation services where they are in place or “rapidly procure” them.
    “Rapid procurement for those practices that do not currently have an online consultation solution will be supported through a national bundled procurement,” wrote in the letter.
    Read full story
    Source: Digital Health, 30 March 2020
  24. Patient Safety Learning
    Doctors have been reminded not to prioritise coronavirus patients at the expense of others in new ethical guidance backed by royal colleges.
    There are increasing concerns that patients are not getting treatment for serious problems, including strokes or heart attacks, because they are afraid to go to hospitals.
    The guidelines were drawn up by the Royal College of Physicians (RCP) amid worries that a shortage of ventilators and beds could force doctors to make difficult decisions on which patients get lifesaving treatment.
    Read full story (paywalled)
    Source: The Times, 2 April 2020
  25. Patient Safety Learning
    GPs are having end of life conversations with their patients because of concerns over a lack of intensive care beds during the coronavirus crisis.
    Multiple GPs have told HSJ they are talking to patients who are older or in very high risk groups about signing “do not attempt to resuscitate” forms in case these patients were to go on to contract the virus.
    Some practices have also sent letters to patients requesting they complete the forms, it is understood.
    One leader of a primary care network, who asked not to be named, told HSJ: “Those in the severe at-risk group and those over 80 are being told they won’t necessarily be admitted to hospital if they catch coronavirus.”
    Read full story 
    Source: HSJ, 1 April 2020
     
     
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