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Patient Safety Learning

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  1. Patient Safety Learning
    A Covid-19 test can deliver results in less than an hour has been approved under an FDA emergency authorization, marking the first test that clinicians can use at the bedside.
    Cepheid, a Silicon Valley molecular diagnostics company that’s a unit of Danaher Corp., announced Saturday it received an emergency authorisation from the U.S. Food and Drug Administration to use the test, making it the 13th Covid-19 test the agency has allowed on the market as long as the public health emergency exists.
    But it’s the first one that can be used at the point of care, meaning providers don’t have to send patient samples to a separate lab to be processed and then come back to the hospital or provider’s office. Cepheid said it expects to start shipping tests next week.
    “An accurate test delivered close to the patient can be transformative — and help alleviate the pressure that the emergence of the 2019-nCoV outbreak has put on healthcare facilities that need to properly allocate their respiratory isolation resources,” said David Persing, Cepheid Chief Medical and Technology Officer.
    Read full story
    Source: Bloomberg, 21 March 2020
  2. Patient Safety Learning
    WHO has launched a messaging service with partners WhatsApp and Facebook to keep people safe from coronavirus.
    This easy-to-use messaging service has the potential to reach 2 billion people and enables WHO to get information directly into the hands of the people that need it.
    From government leaders to health workers and family and friends, this messaging service will provide the latest news and information on coronavirus including details on symptoms and how people can protect themselves and others. It also provides the latest situation reports and numbers in real time to help government decision-makers protect the health of their populations.
    The service can be accessed through a link that opens a conversation on WhatsApp. Users can simply type “hi” to activate the conversation, prompting a menu of options that can help answer their questions about COVID-19.
    The WHO Health Alert was developed in collaboration with Praekelt.Org, using Turn machine learning technology.
    Read full story
    Source: World Health Organization, 20 March 2020
  3. Patient Safety Learning
    A mental health charity has branded as “irresponsible” the Government’s coronavirus bill which would grant single doctors the power to detain the mentally ill.
    The Government wants to relax legal safeguards in the Mental Health Act in order to free up medical staff to deal with the COVID-19 pandemic. If passed, the bill would reduce the number of doctors needed to approve detaining individuals from the current minimum of two, to just one.
    In addition, it would temporarily allow time limits in the Mental Health Act to be extended or removed altogether. This would mean patients currently detained in mental health facilities could be released into the community early, or be detained for longer.
    Akiko Hart, Chief of National Survivor User Network (NSUN), a UK mental health charity, said: “Whilst we understand that these are unprecedented times, any legislative change must be proportionate and thought through, and should protect all of us. Minimising some of the safeguards in the Mental Health Act and extending its powers, is a step in the wrong direction.”
    Read full story
    Source: The London Economic, 19 March 2020
  4. Patient Safety Learning
    New guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic.
    The advice from the National Institute for Health and Care Excellence (NICE) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators.
    The three new NICE guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment.
    They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”.
    Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”.
    Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care.
    Read full story
    Source: Independent, 22 March 2020
  5. Patient Safety Learning
    The number of heart and lung transplants could quadruple thanks to a "reanimation" machine used in a pioneering operation, a hospital says.
    The device, developed at Royal Papworth Hospital in Cambridge, managed to pump oxygenated blood into both organs in a world-first procedure. The machine can revitalise deteriorating organs allowing "donation after circulatory death" (DCD).
    Hospital surgeon Pedro Catarino said it was like "recharging the batteries".
    "It is reanimation and then it replenishes the energy stores of the heart, what we call reconditioning, which allows it be transplanted," he said. "We think it could at least double and perhaps quadruple the number of [heart and lungs] available for transplant."
    He said it was desperately needed, adding: "Patients die on the waiting list every day."
    Read full story
    Source: BBC News, 23 March 2020
  6. Patient Safety Learning
    The health secretary has acknowledged there have been "challenges" with the supply of personal protective equipment to NHS staff in England - but added he is determined to rise to them.
    Last week, NHS staff said the lack of protective gear was putting them at risk during the coronavirus outbreak.
    Matt Hancock said a million face masks had been bought over the weekend and he was taking the issue "very seriously".
    From this week, the Army will play a part in helping to distribute supplies.
    "I am determined to ensure that the right kit gets to the right hospital, the right ambulance service, the right doctors' surgery, right across the country," said Mr Hancock.
    "There have been challenges and I can see that. We're on it and trying to solve all the problems."
    Read full story
    Source: BBC News, 23 March 2020
  7. Patient Safety Learning
    Nurses caring for patients in the community have been spat at and called ‘disease spreaders’ by members of the public, according to England’s chief nurse and the Royal College of Nursing (RCN).
    The nursing union urged members of the public to support the UK’s “socially critical” nursing workforce during the coronavirus outbreak.
    The RCN said it had received anecdotal reports of community nurses receiving abuse while working in uniform. Separately, England’s Chief Nurse Ruth May said she had heard reports of nurses being spat at.
    Susan Masters, the RCN’s director of policy, said abuse of nurses was “abhorrent behaviour”. She said a number of nurses had raised concerns about abuse on forums used by members to talk confidentially.
    Describing one incident she told The Independent: “These were community nurses who had to go into people’s homes and were in uniform. Members of the public who saw them called out to them and said they were ‘disease spreaders’.”
    She added: “We don’t know how big this problem is, it is anecdotal, but it is absolutely unacceptable.
    Read full story
    Source: The Independent, 21 March 2020
  8. Patient Safety Learning
    Palliative care doctors are urging people to have a conversation about what they would want if they, or their loved ones, became seriously unwell with coronavirus.
    We should discuss all possible scenarios - even those we are not "comfortable to talk about", they said. Medics said the virus underlined the importance of these conversations.
    New guidelines are being produced for palliative care for Covid-19 patients, the BBC understands.
    Read full story
    Source: BBC News, 21 March 2020
  9. Patient Safety Learning
    A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”.
    In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites.
    The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19.
    “This means that we currently do not have enough space for patients requiring critical care.
    “As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site”
    Read full story (paywalled)
    Source: HSJ, 20 March 2020
  10. Patient Safety Learning
    A campaign to reduce stillbirths, brain injury, and avoidable deaths in babies has failed to have any effect in the past three years, findings from the Royal College of Obstetricians and Gynaecologists show.
    The president of the college, Edward Morris, has urged maternity units across the UK to learn from the latest report and act on its recommendations. “We owe it to each and every person affected to find out why these deaths and harms occur in order to prevent future cases where possible,” he said.
    Read full story (paywalled)
    Source: BMJ, 19 March 2020
  11. Patient Safety Learning
    Several trust procurement leads have expressed frustration with the government’s response to covid-19, with HSJ being told of shortages of crucial personal protective equipment, unpredictable deliveries and a lack of clarity from the centre
    NHS Supply Chain, which procures common consumables and medical devices for trusts, has been “managing demand” for an increasing number of PPE and infection control products for since the end of February to ensure “continuity of supply”. Some products, like certain polymer aprons, are unavailable altogether because of the increased demand and disrupted supply caused by the covid-19 outbreak. 
    One procurement lead told HSJ: “They aren’t supplying enough, they aren’t fulfilling orders. It’s completely chaotic.” Another said his trust had “just enough to manage for the time being.”
    Read full story (paywalled)
    Source: HSJ, 20 March 2020
  12. Patient Safety Learning
    Social care has a vital part to play in the fight against Covid-19, but without proper support more lives will be put at risk, says Vic Rayner, Executive Director of the National Care Forum.
    "We are working round the clock to keep the people we care for safe and happy and to protect our staff. We know the COVID-19 situation is moving fast – but the care sector can only effectively play its part with more direct support from the government."
    Social care providers, like many across the country, are working hard to prepare for the escalation of COVID-19. This includes refresher training on infection control, robust measures to ensure any visitors to care services are safe to enter, planning for how to keep going in the face of significant workforce shortages, and ensuring the people they care for and their staff are kept safe and well.
    However, it is clear that social care is in urgent need of help, more directly and more quickly, to meet the needs of the most vulnerable, or to ensure that their staff are adequately protected.
    The issue of protection is never far from care providers’ minds, and the lack of personal protective equipment (PPE) for care staff remains a pressing problem.
    Read full story
    Source: The Guardian, 20 March 2020 
  13. Patient Safety Learning
    COVID-19 is stable for several hours to days in aerosols and on surfaces, according to a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine.
    The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. The results provide key information about the stability of SARS-CoV-2, which causes COVID-19 disease, and suggests that people may acquire the virus through the air and after touching contaminated objects.
    The findings affirm the guidance from public health professionals to use precautions similar to those for influenza and other respiratory viruses to prevent the spread of SARS-CoV-2:
    Avoid close contact with people who are sick. Avoid touching your eyes, nose, and mouth. Stay home when you are sick. Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. Read full story
    Source: National Institutes of Health, 17 March 2020
  14. Patient Safety Learning
    A “collective failure” to appreciate the enormity of the coronavirus pandemic and enact swift measures to protect the public will lead to unnecessary deaths, according to a leading doctor who says the UK ignored clear warning signs from China.
    Richard Horton, the Editor-in-Chief of the Lancet, rounded on politicians and their expert advisers for failing to act when Chinese researchers first warned about a devastating new virus that was killing people in Hubei eight weeks ago.
    The team from Wuhan and Beijing reported in January that the number of deaths was rising quickly as the virus spread in China. They urged the global community to launch “careful surveillance” in view of the pathogen’s “pandemic potential”.
    Horton said nothing in the science had changed since January. “The UK’s best scientists have known since that first report from China that Covid-19 was a lethal illness. Yet they did too little, too late,” he said.
    While the UK was now taking the right actions to quell the outbreak, Horton said, in due course “there must be a reckoning” where difficult questions would have to be asked and answered. “We have lost valuable time. There will be deaths that were preventable. The system failed,” he said.
    Read full story
    Source: The Guardian, 18 March 2020
  15. Patient Safety Learning
    A doctor who worked at the same private healthcare firm as rogue breast surgeon Ian Paterson has been suspended, it has emerged.
    Spire Healthcare said Mike Walsh – a specialist in trauma and orthopaedic surgery – was suspended in April 2018 over concerns about patient treatment. Almost 50 of his patients from its Leeds hospital had been recalled.
    The details emerged following an independent inquiry into Paterson, who is serving a 20-year jail sentence.
    Earlier this month, an inquiry into the breast surgeon found that a culture of "avoidance and denial" had allowed him to perform botched and unnecessary operations on hundreds of women.
    Spire said in a statement that it acted after concerns were raised about Mr Walsh's work at its hospital in Leeds in 2018. The company, which contacted the Royal College of Surgeons to assist with its investigation, said it had reviewed the notes of fewer than 200 patients, of which "fewer than 50" had been invited back for a follow-up appointment.
    "Where we have identified concerns about the care a patient received, we have invited the patient to an appointment with an independent surgeon to review their treatment," a spokesman for Spire Healthcare said. "This is a complex case and the review is ongoing."
    It said that Mr Walsh, who was immediately suspended after the concerns were raised, was no longer working with Spire Healthcare. The company said any patients at its Spire Leeds Hospital who had concerns about their treatment under Mr Walsh should contact the hospital. It said its findings had also been shared with the Care Quality Commission and the General Medical Council (GMC).
    Read full story
    Source: BBC News, 17 February 2020
  16. Patient Safety Learning
    St Bartholomew’s Hospital is to be the emergency electives centre for the London region as part of a major reorganisation to cope with the coronavirus outbreak.
    Senior sources told HSJ the London tertiary hospital, which is run by Barts Health Trust, will be a “clean” site providing emergency elective care as part of the capital’s covid-19 plan.
    It is understood the specialist Royal Brompton and Harefield Foundation Trust will also be taking some emergency cardiac patients.
    The news follows NHS England chief executive Sir Simon Stevens telling MPs on Tuesday that all systems were working out how best to optimise resources and some hospitals could be used to exclusively treat coronavirus patients in the coming months.
    Read full story (paywalled)
    Source: HSJ, 18 March 2020
  17. Patient Safety Learning
    Draper & Dash, a leading predictive patient flow provider, has launched a COVID-19 live hospital planning and demand impact assessment tool.
    The company said it has been working around the clock to deliver its vital tool to support impact assessment. It allows trusts to view and analyse national Hospital Episode Statistics (HES) data, alongside a number of live data sources on COVID-19 cases by the minute, as they emerge across the globe.
    The system models the impact of increased volume and complexity at a local and system level, providing visibility of ICU, theatres, and overall bed impact, and connects this live information to each trust’s clinical workforce. The tool shows immediate impacts on beds and staff under a range of selected scenarios.
    Read full story
    Source: Health Tech Newspaper, 18 March 2020
  18. Patient Safety Learning
    The rapid spread of coronavirus has given the NHS a “kick forward” in the need to accelerate technology and ensure staff are digitally prepared, a GP has said.
    Neil Paul, a Digital Health columnist and GP in Ashfields, said the need to reduce face-to-face appointments to prevent the potential transmission of Covid-19 has forced the NHS, particularly in primary care, to adopt already available technologies.
    He said practices “still in the stone ages” and “technophobes” were less prepared for the current situation, but that it would force them to move into the digital age.
    “It’s absolutely made my surgery go ‘right, how do we do online consults’. I think it actually has given people a real kick forward,” he told Digital Health News.
    “I think in six months’ time my surgery might be very different in that actually we will be doing a lot of online and telephone consults where previously we may have been a bit reluctant."
    GP practices across the country have been advised to assess patients online or via telephone and video appointments to mitigate the potential spread of coronavirus.
    In a letter to GPs last week, NHS England urged Britain’s 7,000 GP surgeries to reduce face-to-face appoints for patients displaying symptoms of Covid-19. The preemptive move means millions of patients will now be triaged online, via telephone or video and contacted via text messaging services.
    Read full story
    Source: Digital Health News, 13 March 2020
  19. Patient Safety Learning
    Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of COVID-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.
    The minister, Oliver Veran, tweeted on Saturday 14 March that people with suspected COVID-19 should avoid anti-inflammatory drugs. “Taking anti-inflammatory drugs (ibuprofen, cortisone . . .) could be an aggravating factor for the infection. If you have a fever, take paracetamol,” he said.
    Jean-Louis Montastruc, Professor of Medical and Clinical Pharmacology at the Central University Hospital in Toulouse, said that such deleterious effects from NSAIDS would not be a surprise given that since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen.
    Experts in the UK backed this sentiment. Paul Little, Professor of Primary Care Research at the University of Southampton, said that there was good evidence “that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used—both respiratory or septic complications and cardiovascular complications.”
    Read full story
    Source: BMJ, 17 March 2020
  20. Patient Safety Learning
    Who is being tested for coronavirus in the UK? 
    As of last week, when the Prime Minister announced Britain was no longer in the “contain” phase of the pandemic, most testing outside of hospitals stopped. People with symptoms are expected to self-isolate but will not know whether they have COVID-19. That means they will not know if they are immune or still at risk – and a risk to other people.
    Testing now mostly takes place in hospital. People in intensive care units and those with respiratory illness, especially if it is pneumonia, will get tested for COVID-19. When there is a cluster of infections, such as an outbreak in a care home, those people will also be tested.
    But the World Health Organization has criticised the approach of countries that are not prioritising testing, with its director general saying “you cannot fight a fire blindfolded … test, test, test”.
    So why are people with symptoms not being tested?
    It appears to be a capacity issue, although the Department of Health and Social Care failed to respond to repeated requests for explanation. So far there have been about 44,000 tests in England, which the government’s chief scientific adviser, Sir Patrick Vallance, told the health select committee put it in “the top three or four countries in terms of testing”.
    Read full story
    Source: BBC News, 17 March 2020
  21. Patient Safety Learning
    Scientists in Australia say they have identified how the body's immune system fights the Covid-19 virus.
    Their research, published in Nature Medicine journal on Tuesday, shows people are recovering from the new virus like they would from the flu.
    Determining which immune cells are appearing should also help with vaccine development, experts say.
    "This [discovery] is important because it is the first time where we are really understanding how our immune system fights novel coronavirus," said study co-author Prof Katherine Kedzierska.
    The research by Melbourne's Peter Doherty Institute for Infection and Immunity has been praised by other experts, with one calling it "a breakthrough".
    Read full story
    Source: BBC News, 17 March 2020
  22. Patient Safety Learning
    Change course or a quarter of a million people will die in a "catastrophic epidemic" of coronavirus – warnings do not come much starker than that.
    The message came from researchers modelling how the disease will spread, how the NHS would be overwhelmed and how many would die. The situation has shifted dramatically and as a result we are now facing the most profound changes to our daily lives in peacetime.
    This realisation has happened only in the past few days.
    However, it is long after other scientists and the World Health Organization had warned of the risks of not going all-out to stop the virus.
    Read full story 
    Source: BBC News, 18 March 2020
  23. Patient Safety Learning
    NHS staff are to be given access to testing for covid-19, the government said this morning, but it remains unclear how the policy will be applied.
    A Department of Health and Social Care spokesman said at lunchtime: “Our testing regime is set up to provide for those who need tests the most. This includes key workers, such as NHS staff. We will set out more details shortly.”
    It remains unclear how this will be applied.
    The announcement follows concerns from healthcare professionals they are not being tested for the virus, even if they had been exposed to infected patients.
    Read full story (paywalled)
    Source: HSJ, 17 March 2020
  24. Patient Safety Learning
    NHS hospitals have been told to cancel operations in an effort to free up 30,000 beds to create space for an expected surge in coronavirus patients.
    In a letter to NHS bosses today, NHS England said hospitals should look to cancel all non-urgent surgeries for at least three months starting from 15 April. 
    Hospitals were given discretion to begin winding down activity immediately to help train staff and begin work setting up makeshift intensive care wards. Any cancer operations and patients needing emergency treatment will not be affected.
    The letter from NHS England Chief Executive Simon Stevens said: “The operational aim is to expand critical care capacity to the maximum; free up 30,000 (or more) of the English NHS’s 100,000 general and acute beds."
    In the meantime hospitals were told to do as much elective surgery, such as hip operations and knee replacements, as possible and to use private sector hospitals which it said could free up 12 to 15,000 beds across England.
    Sir Simon also said patients who did not need to be in hospital should be discharged as quickly as possible adding: “Community health providers must take immediate full responsibility for urgent discharge of all eligible patients identified by acute providers on a discharge list. For those needing social care, emergency legislation before Parliament this week will ensure that eligibility assessments do not delay discharge.
    Read full story
    Source: The Independent, 17 March 2020
  25. Patient Safety Learning
    Great Ormond Street Hospital (GOSH) failed to properly investigate child deaths, suggests evidence uncovered by the BBC.
    The source of one fatal infection was never examined and in another case GOSH concealed internal doubts over care. Amid claims GOSH put reputation above patient care, former Health Secretary Jeremy Hunt urged it to consider a possible "profound cultural problem".
    Responding, the central London hospital said it rejected all suggestions that it treated any child's death lightly.
    BBC Radio 4's File on 4 programme has spoken to several families whose children were treated at the world-famous hospital. All said that while care at one point had been excellent, when things went wrong GOSH appeared to have little interest in fully understanding what had happened.
    The concerns over how Great Ormond Street is run are shared by staff. A staff survey, published last month, made grim reading for management.
    On two aspects, including whether there is a safety culture, it received the lowest score of all trusts in its category, while on three other questions, including how bad bullying and harassment were, and how good the quality of care was, its own staff rated it as among the worst.
    "If we want the NHS to offer the highest quality care in the world, then we have to change a blame culture and sometimes a bullying culture, for a learning and an improvement culture," the former Health Secretary Jeremy Hunt told File on 4.
    "That staff survey would indicate they don't have that culture at Great Ormond Street."
    Read full story
    Source: BBC News, 17 March 2020
    Read Joanne Hughes' response to this news in her blog shared on the hub.
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