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Patient Safety Learning

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  1. Patient Safety Learning
    Frontline NHS staff are at risk of dying from Covid-19 after the protective gear requirements for health workers treating those infected were downgraded last week, doctors and nurses have warned.
    Hospital staff caring for the growing number of those seriously ill with the disease also fear that they could pass the infection on to other patients after catching it at work because of poor protection.
    Doctors who are dealing most closely with Covid-19 patients – A&E medics, anaesthetists and specialists in acute medicine and intensive care – are most worried.
    A doctor in an infectious diseases ward of a major UK hospital, who is treating patients with Covid-19, said: “I am terrified. I am seriously considering whether I can keep working as a doctor.”
    Read full story
    Source: The Guardian, 16 March 2020
  2. Patient Safety Learning
    Italy has rapidly become the country hit second hardest in the world by the coronavirus pandemic. Marta Paterlini reports in the BMJ on the front lines of a country in total lockdown.
    The resulting government imposed state of emergency lockdown, which started in northern Italy and has expanded to the whole country, will last until at least 3 April in an attempt to contain a contagion that has, at the time of writing, infected over 24 747 people (including at least 2026 healthcare staff) and killed 1809. The fatality rate of 7.2 is now higher than in China (3.8).
    Italian doctors describe a warlike scenario in hospitals, with fewer places available than there are patients in critical condition. Lombardy, the region around Milan and the most affected in the country, has around 1000 beds available for patients in need of intensive care, but they are near to saturation.
    Italy is experiencing a chronic shortage of healthcare workers. On 9 March the government announced a plan to add 20 000 new doctors, nurses, and hospital employees to meet demand.567 Retired doctors may be called on, as well as students who have completed their medical degree and are in the final year of specialist training.
    Meanwhile, medical authorities are trying to avoid quarantining doctors who have come into contact with coronavirus patients. They are encouraged to work unless they show symptoms of the infection or test positive. Specialist physicians such as gastroenterologists and cardiologists have been asked to work outside of their fields.
    Read full story
    Source: BMJ, 16 March 2020
  3. Patient Safety Learning
    The Prime Minister has said everyone in the UK should avoid "non-essential" travel and contact with others to curb coronavirus as the country's death toll hit 55.
    Boris Johnson said people should work from home where possible as part of a range of stringent new measures, which include:
    1. Everyone of every age should avoid any non-essential social contact and travel.
    2. Everyone to avoid pubs, clubs, cinemas, theatres and restaurants etc.
    3. Everyone to avoid large gatherings - including sports events.
    4. Everyone should work from home where possible.
    5. If anyone in a house has CV19 symptoms, everyone in that house has to isolate for at least 14 days
    6. Over 70s and those at risk (including pregnant women) to stay home for 12 weeks, which means no going out to shops or collect anything etc., unless there is no other option.
    Schools will not close for the moment. 
    Read full story
    Source: BBC News, 16 March 2020
  4. Patient Safety Learning
    Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition.
    The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”
    NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen.
    “I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.”
    Read full story
    Source: The Guardian, 16 March 2020
  5. Patient Safety Learning
    Channel 4 News says they have seen a Public Health England document indicating that not all healthcare and other essential workers with symptoms will be tested because there simply isn’t the capacity to do so – with testing prioritised in order of clinical need.
    Public Health England say they won’t comment on the contents of a leaked document and it is still subject to ongoing discussions.
    View full story
    Source: Channel 4 News, 15 March 2020
  6. Patient Safety Learning
    The Care Quality Commission (CQC) has suspended its routine inspections due to the coronavirus outbreak following pressure from system leaders and NHS bosses.
    The decision to suspend inspections where there are no immediate safety concerns is understood to have been taken by the CQC’s executive team this morning, senior sources told HSJ. Both the NHS Confederation and The Royal College of GPs said the decision had been made.
    NHS Confederation called the move a “sigh of relief” for front-line staff, while the RCGPs said it would enable GPs to dedicate their time to providing care. 
    NHS Confederation chief executive Niall Dickson said: “Front-line staff will breathe a sigh of relief that CQC has responded to our concerns and will now postpone its inspections where there is no immediate safety concern so that they can gear themselves up to prepare for the huge task ahead in dealing with the coronavirus pandemic.”
    Read full story
    Source: HSJ, 16 March 2020
  7. Patient Safety Learning
    Matt Morgan, an intensive care doctor, describes in this Guardian article how his ICU are preparing for the coronavirus crisis.
    "ICUs are as prepared as they can be. Locally business as usual has made way for preparations for caring for high numbers of patients. We are finding every ventilator we may have and identifying every suitably qualified member of staff. We will work together to fill gaps as best we can.
    There’s a sense of anticipation about what the next eight, 10, 12 weeks are going to bring in terms of work. Anyone who works in healthcare is also a mum, dad, daughter, brother, son. We want to give everything to saving lives and work and care, but equally we’re thinking about the logistics of personal lives and elderly relatives too."
    Matt says his worst nightmare is having insufficient workforce and equipment to meet patient needs. Whether or not that will come to fruition is tough to predict. 
    He also says that his ICU has a psychologist who’s doing a huge amount of thinking about putting in place wellbeing resources for staff who might be in moral distress after having to prioritise one patient over another.
    "If there are 500 patients and only 200 ventilators then that’s when we need national guidance from the government and other bodies. It can’t be up to individual doctors. The age of playing God is long behind us. The question is who should we be making decisions with: the public, government or within the profession?"
    Read full story
    Source: The Guardian, 13 March 2020
  8. Patient Safety Learning
    At least 20 maternity deaths or serious harm cases have been linked to a Devon hospital since 2008, according to NHS reports obtained by the BBC.
    A 2017 review which was never released raised "serious questions" about maternity care at North Devon District Hospital. The BBC spent two years trying to obtain the report and won access to it at a tribunal earlier this year.
    Northern Devon Healthcare NHS Trust (NDHT) said the unit was "completely different" after recommended reforms.
    A 2013 review by the Royal College of Obstetricians and Gynaecologists (RCOG) investigated 11 serious clinical incidents at the unit, dating back as far as 2008.
    The report identified failings in the working relationships at the unit, finding some midwives were working autonomously and some senior doctors failed to give guidance to junior colleagues.
    Despite the identified problems with "morale", the subsequent investigation by RCOG in 2017 expressed concerns with the "decision-making and clinical competency" of senior doctors and their co-operation with midwives. 
    An independent review into midwifery in October 2017 noted "poor communication" between medical staff on the ward for more than a decade. The report identified a "lack of trust and respect" between staff and "anxiety" among senior midwives at the quality of care.
    Read full story
    Source: BBC News, 16 March 2020
  9. Patient Safety Learning
    As coronavirus spreads widely across the UK, many of those who fall sick may seek treatment at their GP's surgery. But are family doctors ready to deal with a wave of patients, prevent the spread of the disease and protect the most vulnerable?
    "This is a massive crisis, probably the biggest crisis the NHS has ever had to face," says Prof Martin Marshall, an east London GP who is also chair of the Royal College of General Practitioners' council.
    He says not enough has been done yet to prepare family doctors for the epidemic, although he adds: "We need to be a little bit understanding of the pressures that the whole system is under."
    As the virus circulates in the community, he says we need "urgent action" to protect healthcare workers, give them the information they need and provide technology to allow for more consultations by phone or the internet.
    Given the pressures the NHS will be under, Prof Marshall says it is vital that doctors and nurses are not taken out of action for seven days of isolation unnecessarily.
    "We're not saying that health professionals are more important than patients, we're saying that health professionals have a responsibility," he says.
    "We therefore need to keep them as healthy as possible and we need to get them back into the workforce as quickly as possible. So we're asking that health professionals are tested early."
    Read full story
    Source: BBC News, 16 March 2020
     
     
  10. Patient Safety Learning
    Two out of five GPs have still not received any personal protective equipment (PPE) against coronavirus, a Pulse survey suggests.
    The poll of over 400 GPs saw 41% of respondents say they have not received any PPE, while a further 32% said they had not received enough. Just 15% of GPs said they have sufficient PPE, with the remainder unsure.
    This comes despite NHS England promising last week that it would ship PPE free of charge to practices.
    The Welsh Government made the same announcement this week, while in Scotland health boards should be distributing PPE.
    A GP who has received no proper equipment, Dr Kate Digby, in Cirencester, said she feels "woefully underprepared".
    She told Pulse: "I'm becoming increasingly concerned at the lack of resources being provided for frontline primary care".
    Read full story
    Source: Pulse, 2 March 2020
  11. Patient Safety Learning
    Frontline medics are juggling fears about a lack of beds, a crisis in staffing and worries about their own personal safety as the threat of a large-scale coronavirus outbreak looms, HuffPost UK has learned.
    With public health officials warning that, in the worst-case scenario, up to 80% of the UK population could be infected with coronavirus, NHS staff said such a scenario would be a “disaster” for the health service. 
    Meanwhile, medics working in the community have warned they are not getting consistent advice on how to protect their own health.
    Dr Punam Krishan, a GP in Glasgow, told HuffPost UK that while the NHS deals with thousands of cases of cold, flu and norovirus each year, the threat of Covid-19 is still worrying. 
    “Obviously as frontline workers we are most at risk,” she said. “So I’m not going to lie, yes – it does provoke anxiety. Particularly because the signs don’t show immediately – there’s an incubation period that’s up to 14 days.” 
    This means that someone who has unknowingly been in contact with a coronavirus patient and is not yet showing symptoms of the virus could come into the practice. That thought “can trigger a bit of panic”, Krishan said. 
    Read full story
    Source: HuffPost UK, 11 March 2020
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  12. Patient Safety Learning
    MedStar Health launched a new tool that automatically calculates a patient's risk of having a heart attack or stroke within 10 years. The tool enables doctors to more easily show patients their personal risk for heart disease, stroke and other cardiovascular diseases over time using easy-to-read graphics. 
    "Seeing their risk on a visual display is more powerful than me telling them their risk,” said Ankit Shah, Director, Sports and Performance Cardiology for the MedStar Heart & Vascular Institute at Union Memorial Hospital in Baltimore.
    The tool is embedded in MedStar's Cerner electronic health record (EHR), making it easier for physicians to use it during patient visits, health system officials said. The project highlights how MedStar Health National Center for Human Factors focuses on human factor design to improve technology for patients as well as providers. 
    Final rules from the US Department of Health and Human Services (HHS) will make it easier in the future for patients to share their health data with third-party apps.
    Read full story
    Source: FierceHealthcare, 9 March 2020
  13. Patient Safety Learning
    The trusts which are likely to face the fiercest struggle to deliver quality care in the immediate future have been identified through an analysis carried out exclusively for HSJ.
    Analyst company Listening into Action has taken data from the NHS Staff Survey 2019 to produce “a set of ‘workforce at risk’ numbers that point to the likelihood (or not) of workforce stability and continuity challenges adversely affecting the care a trust’s key assets are able to deliver in the year ahead”.
    The analysis shows a strong correlation between staffs’ perceptions of how well they are supported, and care quality — and therefore reveals which trusts face the toughest challenge to improve performance.
    Read full story (paywalled)
    Source: HSJ, 9 March 2020
  14. Patient Safety Learning
    A leading public health expert has launched a devastating critique of the government’s handling of the coronavirus outbreak in the UK, saying it is too little too late, lacks transparency and fails to mobilise the public.
    Prof John Ashton, a former regional director of public health for north-west England, lambasted a lack of preparation and openness from the government and contrasted Britain’s response to that of Hong Kong.
    “Right at the beginning of February, they [Hong Kong] adopted a total approach to this, which is what we should have done five weeks ago ourselves. They took a decision to work to three principles – of responding promptly, staying alert, working in an open and transparent manner,” he told the Guardian.
    “Our lot haven’t been working openly and transparently. They’ve been doing it in a (non) smoke-filled room and just dribbling out stuff. The chief medical officer only appeared in public after about two weeks. Then they have had a succession of people bobbing up and disappearing. Public Health England’s been almost invisible."
    Read full story
    Source: The Guardian, 12 March 2020
  15. Patient Safety Learning
    NHS England is commissioning a “COVID-19 home treatment service” of primary and community healthcare for self-secluding patients.
    It is introducing “urgent primary care services to patients diagnosed with COVID-19” who are self-secluded at home. The service will care for patients’ symptoms relating to COVID-19 as well as other conditions until they are discharged from home isolation and referred back to their GP.
    “There is likely to be a gradual handover of patients to CHMS providers as they come onstream to provide the service,” according to a letter from NHSE’s primary care directors sent to GPs today.
    “As soon as the new service is up and running in your area, your clinical commissioning group will be able to tell you who will be providing care for patients in your locality.”
    Read full story (paywalled)
    Source: HSJ, 11 March 2020
  16. Patient Safety Learning
    System leaders are telling hospitals to prepare for a potential suspension of all non-emergency elective procedures which could last for months, as they get ready for a surge in coronavirus patients.
    Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity.
    HSJ understands trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment.
    An announcement is expected soon, with patients affected given at least 48 hours notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But HSJ has been told it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations.
    Read full story (paywalled)
    Source: HSJ, 12 March 2020
  17. Patient Safety Learning
    NHS national leaders are set to reassure doctors they should not fear regulatory reprisals, within reason, if they end up working outside their areas of expertise during the coronavirus outbreak.
    HSJ understands the UK’s four chief medical officers and the General Medical Council are drafting a letter to be sent to all UK doctors, which will contain the reassurances, as the system braces for a sharp rise in covid-19 cases. The letter will also urge doctors to be flexible and not to resist new ways of working, with senior figures expecting many clinicians working in other specialities or locations during the outbreak.
    The letter will say doctors, while still expected to follow good medical practice, should not fear reprimand from their employers or national bodies such as the GMC, NHS England or other regulators.
    Read full story (paywalled)
    Source: HSJ, 11 March 2020
  18. Patient Safety Learning
    A London NHS trust has been ordered to pay a leading heart doctor more than £870,000 after he was sacked for whistleblowing about safety concerns following a patient’s death.
    Dr Kevin Beatt, one of the UK’s most respected consultant cardiologists, was fired from Croydon Health Services in 2012 after reporting staff shortages, inadequate equipment and workplace bullying at the trust.  
    The tribunal heard Dr Beatt’s dismissal “had a devastating effect on his career and his wellbeing”.
    He told the Evening Standard: “I was forced into a position where I lost my career for trying to highlight dangerous practices in the NHS. It has taken seven years to get to this point, which is just appalling. It has been a huge ordeal and I have the greatest sympathy for any whistleblower who has to go through something like this.”
    Read full story
    Source: Evening Standard, 11 March 2020
  19. Patient Safety Learning
    NHS Confederation has called on the Care Quality Commission (CQC) to suspend planned inspections of front-line services so busy staff can focus on the coronavirus outbreak.
    NHS Confederation told HSJ it will write to CQC chief executive Ian Trenholm, asking for the regulator to immediately call off inspections over fears the visits could pull staff’s focus from the covid-19 outbreak.
    NHS Confederation Chief Executive Niall Dickson told HSJ: “Our members recognise the value of regulation but given the current and future impact of covid-19 infections on front-line services, a temporary suspension of planned inspections would be the right move."
    “Front-line staff and managers do not need any distraction as they confront one of the greatest challenges the NHS has faced in its history.”
    Read full story (paywalled)
    Source: HSJ, 11 March 2020
  20. Patient Safety Learning
    NHS hospitals have been told to expect a “several-fold” increase in demand for intensive care beds during a serious coronavirus outbreak.
    Professor Keith Willett, NHS England’s incident director for the coronavirus outbreak, told a secret briefing of chief nurses from across the NHS that they needed to prepare now for the unprecedented demand which could overwhelm existing critical care services.
    Sources who were in the briefing told The Independent Prof Willett warned the demand was likely to be not just double but “several fold” the existing 4,000 intensive care beds in the NHS.
    Prof Willett said the NHS will also be holding large-scale simulations next week for an expected coronavirus surge in an effort to “stress test the system” ahead of rising cases of infection.
    If the predictions are right the NHS will likely be forced to cancel large numbers of operations and re-deploy nurses and doctors.
    Read full story
    Source: The Independent, 12 March 2020
  21. Patient Safety Learning
    The coronavirus outbreak has been labelled a pandemic by the World Health Organization (WHO).
    WHO chief Dr Tedros Adhanom Ghebreyesus said the number of cases outside China had increased 13-fold in two weeks. He said he was "deeply concerned" by "alarming levels of inaction".
    A pandemic is a disease that is spreading in multiple countries around the world at the same time.
    Dr Tedros said that calling the outbreak a pandemic did not mean the WHO was changing its advice about what countries should do. He called on governments to change the course of the outbreak by taking "urgent and aggressive action".
    "Several countries have demonstrated that this virus can be suppressed and controlled," he said.
    "The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same - it's whether they will."
    Read full story
    Source: BBC News, 11 March 2020
     
  22. Patient Safety Learning
    Third year undergraduate trainee nurses will be invited into clinical practice to support the coronavirus effort, while routine care quality inspections are “going to need to be suspended”, the Chief Executive of NHS England has said.
    Speaking at the Chief Nursing Officer’s summit event in Birmingham this morning, Sir Simon Stevens told delegates NHSE was working with the Nursing and Midwifery Council to “see how many of the 18,000 [relevant] undergraduates are available”.
    It is understood they would be paid, and follows government moves to pass emergency legislation to relax rules around working in healthcare. 
    Asked about Care Quality Commission inspections during the outbreak, Sir Simon said: “There will be a small number of cases where it would be sensible to continue for safety related reasons… but the bulk of their routine inspection programmes is clearly going to need to be suspended and many of the staff who are working as inspectors need to come back and help with clinical practice.” 
    Read full story (paywalled)
    Source: HSJ, 11 March 2020
  23. Patient Safety Learning
    Incorrect use of menstrual cups could be resulting in some women suffering pelvic organ prolapse, the Victoria Derbyshire programme has been told. The Chartered Society of Physiotherapy wants some manufacturers to include better safety advice.
    Menstrual cups fit into the vagina and collect period blood. They are not currently regulated in the UK, and there is no safety testing. Menstrual cups, which can last up to 10 years, have grown in popularity as a more sustainable alternative to single-use tampons and pads. But there are claims that more education is needed before women decide to use them.
    There is limited research on the products, but in a report by the Lancet Public Health journal last year – which looked at 43 studies involving 3,300 women and girls living in rich and poor countries – the authors concluded menstrual cups were a "safe option".
    But the Chartered Society of Physiotherapy is calling for the cups, which are produced by a growing number of manufacturers worldwide, to be better regulated. Currently they are not safety-tested, and there is no industry standard or body responsible for collating complaints.
    Read full story
    Source: BBC News, 11 March 2020
  24. Patient Safety Learning
    With the number of UK coronavirus cases set to rise, NHS England says it is scaling up its capacity for testing people for the infection.
    It means 10,000 tests a day can be done – 8,000 more than the 1,500 being carried out currently.
    Confirmation of any positive test results will be accelerated, helping people take the right action to recover or quickly get treatment. Most of the people tested should get a result back within 24 hours.
    Scotland, Wales and Northern Ireland will be expected to roll out their own testing services, but there will be some shared capacity between nations, depending on need.
    Read full story
    Source: BBC News, 11 March 2020
  25. Patient Safety Learning
    On January 2020, Patient Safety will be on the G20 agenda (among other five health key priorities), but Abdulelah M. Alhawsawi, Saudi Patient Safety Center, asks "what is patient safety doing on an economic forum like the G20?"
    Patient harm is estimated to be the 14th leading cause of the global disease burden. This is comparable to medical conditions such as tuberculosis and malaria. In both US and Canada, patient safety adverse events represent the 3rd leading cause of death, preceded only by cancer and heart disease. In the US alone, 440,000 patients die annually from healthcare associated infections. In Canada, there are more than 28,000 deaths a year due to patient safety adverse events. In low-middle income countries,  134 million adverse events take place every year, resulting in 2.6 million deaths annually. 
    In addition to lives lost and harm inflicted, unsafe medical practice results in money loss. Nearly, 15 % of the health expenditure across Organization of Economic Cooperative Development countries is attributed to patient safety failures each year, but if we add the indirect and opportunity cost (economic and social), the cost of harm could amount to trillions of dollars globally.
    When a patient is harmed, the country loses twice. The individual will be lost as a revenue generating source for society and the individual will become a burden on the healthcare system because he or she will require more treatment. Unless we do something different about patient safety, we would risk the sustainability of healthcare systems and the overall economies. 
    Alhawsaw proposed establishing a G20 Patient Safety Network (Group) that will combine Safety experts from healthcare and other leading industries (like aviation, nuclear, oil and gas, other), and economy and fFinancial experts
    This will function as a platform to prioritise and come up with innovative patient safety solutions to solve global challenges while highlighting the return on investment (ROI) aspects. 
    This multidisciplinary group of experts can work with each state that adopts the addressed global challenge to ensure correct implementation of proposed solution.
    Read full story
    Source: The G20 Health & Development Partnersip, 10 February 2020
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