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Patient Safety Learning

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  1. Patient Safety Learning
    Although community-based treatment can improve outcomes for people with eating disorders, it must not be at the expense of vital inpatient services, says Lorna Collins in an article today in the Guardian supporting Eating Disorders Awareness Week.
    No single treatment or approach works for every patient experiencing an eating disorder and it is extremely hard to get help;  there is too little money in the system to provide enough care.
    "Speaking to patients, carers and clinicians, I am struck by the sheer desperation of so many people saying the system has failed them. Too many find that nothing is done until they are at death’s door. Others say no one talks about binge-eating disorder, which is still too often seen as a weakness or a problem that dieting can fix, rather than a real eating disorder," says Lorna.
    Clinicians, too, paint a gloomy picture of the state of services. Oxford-based eating disorder consultant Agnes Ayton, who chairs the faculty of eating disorders at the Royal College of Psychiatrists, is frank about the problems. She believes NHS eating disorder services are on their knees and desperately need more money after years of austerity.
    However, there are some encouraging signs. In West Yorkshire and Harrogate, consultant psychiatrist William Rhys Jones, who works for the Connect community and inpatient eating disorders service, says he is seeing real change. Connect’s community outreach teams deliver home-based treatment for people with severe and enduring eating disorders.
    This is one of the NHSE new care models and Jones says results so far have been very positive. Clinical community services and early intervention result in a good prognosis, he says – and it is cost effective. While inpatient treatment costs about £434 a day, community treatment costs about £20 to £35 a day, with similar or even improved clinical outcomes.
    While there are concerns about limiting inpatient treatment and prioritising community treatment simply because it may be cheaper, positive examples like this can help hold the NHS to its promise to make treatment truly open to all who need it.
    Read full story
    Source: The Guardian, 2 March 2020
  2. Patient Safety Learning
    The NHS is currently rolling out services on NHS sites to test people for coronavirus, including a new service now in action in west London, offering ‘drive through’ coronavirus testing.
    The new service, provided by Central London Community Healthcare NHS Trust in Parsons Green, is only accessed through a referral from NHS 111, and means people worried about the virus can safely and quickly get checked close to home.
    The model is one of the ways in which community testing and home testing are being rolled out nationwide, with the NHS’ strategic incident director for coronavirus, asking health services in every part of England to set up home and community testing.
    After being referred through NHS 111, people are invited to an appointment in their car, during which two community nurses carry out a swab in the nose and mouth, which are checked and assessed within 72 hours.
    People are asked to self-isolate while checks are completed, to prevent any potential onward transmission of the virus.
    Dr Joanne Medhurst, medical director for Central London Community Healthcare NHS Trust, said: “Anyone who is worried about coronavirus should call NHS 111 for up to date advice. We’ve set up the ‘drive through’ service to make sure people in our community can get safe, convenient and quick checks for coronavirus, as part of NHS efforts to keep everyone safe."
    “It’s crucial that, as a community service, we help residents in our area to get accurate, timely advice while managing extra pressure on the NHS, and so far this week we’ve had good feedback from people that the swabbing service offers reassurance at what can be a difficult time.”
    Read full story
    Source: NHS England, 28 February 2020
  3. Patient Safety Learning
    Prime Minister Boris Johnson will say there is “little doubt” the coronavirus will present a “significant challenge” for the UK as he chairs a Cobra meeting to discuss the government’s response to the outbreak.
    The health secretary, Matt Hancock, has warned it was now “inevitable” the deadly virus would “become endemic” in the UK as 13 more cases of Covid-19 were announced, bringing the total number to 36. The Cobra meeting will bring together senior ministers and the Chief Medical Officer, Professor Chris Whitty and Chief Scientific Adviser Sir Patrick Vallance.
    Meanwhile the worldwide death toll from the disease has passed 3,000, with more than 80,000 cases worldwide. Several countries in Europe, the Middle East and the Americas have banned large gatherings and imposed stricter travel restrictions in an attempt to limit infections.the Americas have banned large gatherings and imposed stricter travel restrictions in an attempt to limit infections.
    Read full story
    Source: The Indpendent, 2 March 2020
  5. Patient Safety Learning
    An 87-year-old woman died after her carers gave her the wrong medication, a coroner was told.
    Heather Planner, from Butler's Cross in Buckinghamshire, died at Wycombe Hospital on 1 April from a stroke. Senior coroner Crispin Butler heard three staff from Carewatch Mid Bucks had failed to spot tablets handed over by the pharmacy were for a male patient.
    Mr Butler said action should be taken to prevent similar deaths.
    A hearing in Beaconsfield on Thursday, where he issued a Prevention of Future Deaths report, followed an inquest in November. In the report he said he was told at the inquest that the carers from Carewatch Mid Bucks gave widow Mrs Planner the wrong medication four times a day for two and a half days. She suffered a fatal stroke because she did not receive her proper apixaban anticoagulation medication.
    Mr Butler said he would send his concerns to the chief coroner and the Care Quality Commission. He said there was no procedure in place to ensure individual carers read and specifically acknowledged any medication changes.
    Read full story
    Source: BBC News, 27 February 2020
  6. Patient Safety Learning
    There is a “strong association” between staff experience of senior management and whether an organisation acts on error reporting, exclusive analysis for HSJ of the staff survey data suggests.
    Analysis by health and social care charity Picker Institute examined statistical relationships between responses to staff survey questions regarding staff communication with managers and those relating to error reporting.
    The analysis, which included all trust types, looked at the relationships between statements such as “communication between senior managers and staff is effective” and “I know who the senior managers are here” to “When errors, near misses or incidents are reported, my organisation takes action to ensure they do not happen again” and other similar indicators.
    A high correlation to the questions does not categorically prove a direct causal relationship but the data suggested “strong associations”, Picker Institute chief statistician Steve Sizmur told HSJ.
    He said: “There are a number of strong associations in the latest staff survey data, to the extent that there is likely to be a link between staff experiences of senior management and their views about error reporting and whether the organisation addresses their concerns.”
    Read full story (paywalled)
    Source: HSJ, 27 February 2020
  7. Patient Safety Learning
    NHS patients could be denied lifesaving care during a severe coronavirus outbreak in Britain if intensive care units are struggling to cope, senior doctors have warned.
    Under a so-called “three wise men” protocol, three senior consultants in each hospital would be forced to make decisions on rationing care such as ventilators and beds, in the event hospitals were overwhelmed with patients.
    The medics spoke out amid frustration over what one said was the government’s “dishonest spin” that the health service was well prepared for a major pandemic outbreak.
    The doctors, from hospitals across England, said the health service’s existing critical care capacity was already overstretched and “would crumble” under the demands of a pandemic surge in patients who may all need ventilation to help them breathe.
    Those denied intensive care beds could be those suffering with coronavirus or other seriously ill patients, with priority given to those most likely to survive and recover.
    Doctors said this would lead to “tough decisions” needing to be made about the wholesale cancellation of operations to free-up beds.
    Read full story
    Source: Independent, 28 February 2020
  8. Patient Safety Learning
    From July, hospitals will be able to refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy. Patients will be digitally referred to their pharmacy after discharge from hospital.
    The NHS Discharge Medicines Service will help patients get the maximum benefits from new medicines they’ve been prescribed by giving them the opportunity to ask questions to pharmacists and ensuring any concerns are identified as early as possible.
    This is part of the Health Secretary’s ‘Pharmacy First’ approach to ease wider pressures on A&Es and general practice.
    Read full story
    Source: Department of Health and Social Care, 23 February 2020
  9. Patient Safety Learning
    Controversial healthcare app maker Babylon Health has criticised the doctor who first raised concerns about the safety of their AI chatbot.
    Babylon Health’s chatbot is available in the company’s GP at Hand app, a digital healthcare solution championed by health secretary Matt Hancock. The chatbot aims to reduce the burden on GPs and A&E departments by automating the triage process to determine whether someone can treat themselves at home, should book an online or in-person GP appointment, or go straight to a hospital.
    A Twitter user under the pseudonym of Dr Murphy first reached out to us back in 2018 alleging that Babylon Health’s chatbot was giving unsafe advice. Dr Murphy recently unveiled himself as Dr David Watkins and went public with his findings at The Royal Society of Medicine’s “Recent developments in AI and digital health 2020“ event.

    Over the past couple of years, Dr Watkins has provided countless examples of the chatbot giving dangerous advice.
    In a press release (PDF) on Monday, Babylon Health calls Dr Watkins a “troll” who has “targeted members of our staff, partners, clients, regulators and journalists and tweeted defamatory content about us”.
    Read full story
    Source: AI News, 26 February 2020
  10. Patient Safety Learning
    Just six of the English NHS’s more than 200 private patient units (PPUs) are signed up to the independent complaints adjudicator, HSJ has learned.
    The figures follow the publication of the Paterson Inquiry earlier this month. The inquiry’s report warned patients treated in private units, including PPUs, which are not regulated by the Independent Sector Complaints Adjudication Service (ISCAS) “will not have access to independent investigation or adjudication of their complaint”.
    ISCAS is the main independent adjudicator for the private healthcare sector and takes on approximately 125 adjudications each year on unresolved patient complaints. Most standalone independent providers have signed up to the watchdog. However, ISCAS membership is not mandatory and it is concerned patients wishing to complain about care at PPUs will have little choice but to pursue costly legal action. 
    The government is now considering the inquiry’s recommendation that all private patients are given the right to a mandatory independent resolution of their complaint.
    Read full story
    Source: HSJ, 26 February 2020 
  11. Patient Safety Learning
    Hundreds of elderly and vulnerable social care residents have allegedly been sexually assaulted in just three months, a shock new report from the care regulator has revealed.
    According to the Care Quality Commission there were 899 sexual incidents reported by social care homes between March and May 2018. Almost half were categorised as sexual assault. In 16% of the cases members of staff or visiting workers were accused of carrying out the abuse.
    The watchdog said it was notified of 47 cases of rape and told The Independent local authorities were informed and 37 cases were referred to police for investigation.
    Kate Terroni, Chief Inspector of adult social care at the regulator, said: “Supporting people as individuals means considering all aspects of a person’s needs, including sexuality and relationships. However, our report also shows all too starkly the other side of this – the times when people are harmed in the very place they should be kept safe. This is utterly devastating, both for the people directly affected and their loved ones."
    “It is not good enough to put this issue in a ‘too difficult to discuss’ box. It is particularly because these topics are sensitive and complex that they should not be ignored.”
    Read full story
    Source: The Independent, 27 February 2020
  13. Patient Safety Learning
    More than 70 children and young people have been put at risk by long delays in treatment by mental health services in Kent and Medway, HSJ has learned.
    According to a response to a Freedom of Information request submitted by HSJ, 205 harm reviews have been carried out for patients waiting for treatment following a referral to the North East London Foundation Trust, which runs the child and adolescent mental health services in Kent and Medway.
    Of those, 76 patients, who had all waited longer than the 18 week target time for treatment, were found to be at risk of harm. One patient had to be seen immediately as they were judged to be at “severe” risk. Seven were found to be at “moderate” risk and 68 at “low” risk. 
    The trust said “risk” meant a risk of harm to themselves or others. But it said none of the 76 patients had come to actual harm. 
    Read full story (paywalled)
    Source: HSJ, 25 February 2020
  14. Patient Safety Learning
    Prisoners in Britain frequently have hospital appointments cancelled and receive less healthcare than the general public, a new study has found.
    As many as 4 in 10 hospital appointments made for a prisoner were cancelled or missed in 2017–18, with missed appointments costing the NHS £2 million.
    The in-depth analysis of prison healthcare by the Nuffield Trust think tank examined 110,000 hospital records from 112 prisons in England. It revealed 56 prisoners gave birth during their prison stay, with six prisoners giving birth either in prison or on their way to hospital.
    The Nuffield Trust said its findings raised concerns about how prisoners are able to access hospital care after a cut in the number of frontline prison staff and a rising prison population.
    Lead author Dr Miranda Davies, a senior fellow at the Nuffield Trust, said: “The punishment of being in prison should not extend to curbing people’s rights to healthcare. Yet our analysis suggests that prisoners are missing out on potentially vital treatment and are experiencing many more cancelled appointments than non-prisoners.”
    Read full story
    Source: The Independent, 26 February 2020
  15. Patient Safety Learning
    A&E units are so overcrowded that growing numbers of patients have to be looked after in hospital corridors, warn nurses and doctors.
    There are rising concerns that the “shameful” trend means people stuck in corridors are not getting the care they need, or they may be even coming to harm. A&E health professionals say “corridor nursing” is becoming increasingly widespread as emergency departments become too full to look after the sheer number of people seeking treatment.
    In a survey of 1,174 A&E nurses in the Royal College of Nursing’s (RCN) Emergency Care Association, 73% of those polled said they looked after patients in a “non-designated area” such as corridors every day and another 16% said they did so at least once a week, while 90% said they feared patient safety was being put at risk by those needing care having to spend time in areas of hospitals which did not have medical equipment or call bells.
    Staff have had difficulty administering urgent doses of intravenous antibiotics to such patients, some of whom have been denied privacy and found it harder to use a toilet or been left in distress, nurses said.
    Read full story
    Source: The Guardian, 26 February 2020
  16. Patient Safety Learning
    Tests for coronavirus are being increased to include people displaying flu-like symptoms at 11 hospitals and 100 GP surgeries across the UK.
    The tests will provide an "early warning" if the virus is spreading, Public Health England Medical Director Prof Paul Cosford said.
    Up to now, people were tested only if they displayed symptoms having recently returned from one of the countries where there has been an outbreak, including China, South Korea and northern Italy. However, Prof Cosford said Public Health England was now working with hospitals and GP surgeries to conduct "random" tests.
    These will target some patients with coughs, fevers or shortness of breath, regardless of whether they have travelled to a place where the virus is spreading.
    "If we do get to the position of a more widespread infection across the country, then it will give us early warning that's happening," said Prof Cosford.
    Read full story
    Source: BBC News, 26 February 2020
  17. Patient Safety Learning
    The British Medical Association (BMA) should not allow itself to become a campaign tool for vested interest groups seeking a dangerous change in the law, writes Dr Matthew Davis in the Guardian.
    "Doctors have a responsibility to first do no harm... Even when it may feel uncomfortable, doctors must continue to exercise their Hippocratic duty", says Dr Davies.
    "The BMA must remain opposed to assisted suicide if the medical profession it claims to represent is to have any credibility in safe, caring and trustworthy expertise. It must not allow itself to become a campaign tool for vested interest groups seeking an extreme and dangerous change in the law that has, even very recently, been rejected by parliament."
    Read full story
    Source: The Guardian, 25 February 2020
  18. Patient Safety Learning
    Doctors need to stop moaning and take responsibility for improving the NHS, the leader of Britain’s medics has said.
    Ministers have given the NHS a “substantial sum” of money and doctors must now stop blaming the government for all its problems, Carrie MacEwen, Chairwoman of the Academy of Medical Royal Colleges, told The Times.
    Britain’s 220,000 doctors have a professional duty to make the health service’s ten-year plan work and can no longer “sit on their hands”, Professor MacEwen said.
    After years in which the loudest medical voices have tended to complain about government funding and staffing levels, she said that doctors should take advantage of a “golden opportunity”.
    Read full story (paywalled)
    Source: The Times, 25 February 2020
  19. Patient Safety Learning
    Hospitals in the UK will be among 60 across Europe that will be supported to redesign their systems and ways of working to tackle nurse burnout and stress, under a ground-breaking four-year study.
    The first-of-its-kind project will see chosen hospitals implement the principles of the Magnet Recognition Programme, an international accreditation scheme that recognises nursing excellence in healthcare organisations.
    Run by the accreditation wing of the American Nurses Association, the scheme is based on research showing that creating positive work environments for nurses leads to happier and healthier staff and the delivery of safer patient care, in turn improving recruitment and retention.
    Among the key pillars of Magnet are transformational leadership, shared governance and staff empowerment, exemplary professional practice within nursing, strong interdisciplinary relationships and a focus on innovation.
    The new study – called Magnet4Europe – is being directed by world-renowned nursing professor Linda Aiken, from the University of Pennsylvania in the US, and Walter Sermeus, professor of healthcare management at Katholieke Universiteit Leuven in Belgium.
    Read full story
    Source: Nursing Times, 24 February 2020
  20. Patient Safety Learning
    The number of nurses in schools has fallen in recent years, prompting fears that pupils’ lives are being put “at risk”. 
    Teaching assistants are being asked to carry out medical interventions, such as injections, without adequate training or support, the GMB union, which represents school staff, has said. 
    Data, obtained by the GMB union through a Freedom of Information request, shows the number of school nurses has fallen by 11 per cent in four years – from 472 in 2015 to 420 in 2018.
    Karen Leonard, National Schools Officer at the GMB union, said: “The uncomfortable truth is that in too many schools children are not getting the medical support they need.”
    Ms Leonard added: “School staff should not administer medicine unless they feel fully confident in their training and lines of accountability, but often they are placed in uncomfortable situations."
    “This is a highly stressful state of affairs for children, parents, and staff, who fear they will be blamed if something goes wrong. It is not alarmist to say that lives are at risk.”
    Read full story
    Source: The Independent, 23 February 2020
  21. Patient Safety Learning
    Mediators want more clinicians to come forward – and lawyers to enable them – to speak directly to patients bringing medical negligence claims against the NHS.
    Alan Jacobs, mediator at the Centre for Effective Dispute Resolution, told a conference of lawyers that they should do more to encourage discussions between injured people and those allegedly responsible. His call came as figures show record numbers of clinical claims against the NHS went to mediation in 2018/19 – with the majority of mediations resulting in damages being agreed on the day.
    Jacobs, speaking at the Claims Media conference in Manchester, said the challenge now is to ensure medical professionals volunteer to take part in the process.
    "It allows an apology to be given face to face and allows explanations to be given," he said. "It is also an opportunity for the clinician to have a discussion, sit down with the claimant and answer questions and concerns. It can be tremendously important for a claimant to vent and express their frustrations and for the trust to hear that."
    Both claimant and defendant lawyers agreed on the merits of bringing doctors in to the room, but stressed this was not always a realistic aim.
    Barrister Daniel Frieze, head of the personal injury team at St Johns Buildings, said: "Often it is too late and there is too much water under the bridge. Claimants are very stressed and it may be counter-productive for them to face the other side. I know the idea is of being collaborative but I’m not sure that’s necessarily always true."
    Read full story
    Source: 21 February 2020, The Law Society Gazette
  22. Patient Safety Learning
    Nurses will be trained to perform surgery under new NHS measures to cut waiting times.
    Nursing staff will be urged to undertake a two year course to become “surgical care practitioners” as part of the drive to slash waiting times but critics have warned it will worsen the nursing shortage. Nurses who qualify will be tasked with removing hernias, benign cysts and some skin cancers, according to the Daily Mail.
    They will also assist during major surgeries such as heart bypasses and hip and knee replacements. The re-trained nurses will be tasked with closing up incisions after operations. 
    The proposals are contained within the NHS’s People Plan, due to be unveiled next month. 
    Lib Dem health spokesman Munira Wilson said: "This is a sticking plaster solution to very serious staffing crisis across our NHS workforce.'"
    However the proposals were backed by Professor Michael Griffin, president of the Royal College of Surgeons of Edinburgh. He said: "We are totally supportive of this. We have very little anxiety about this.”
    Read full story
    Source: 24 February 2020
  23. Patient Safety Learning
    Today, Sir Liam Donaldson is chairing a patient safety meeting at the World Health Organization (WHO) 'A Global Consultation – A decade of Patient Safety 2020–2030' to formulate a Global Patient Safety Action Plan. His introductory address this morning focused on the task ahead – to maintain the World Health Assembly resolution momentum and patient safety as a global movement. 
    "Patients are not empowered to prevent their own harm", Donaldson said, as he highlighted patient stories of unsafe care and the alarming parallels of patient and family experiences across the world. 
    So where is the power? Donaldson went on to to highlight how the six current power blocks are not doing enough to improve safety and that we need to engage and motivate these power blocks to achieve change:
    Designing of health systems – we have not seen much evidence of systems being designed for safety. Health leaders are not using their power to lead for reduced harm. Educational institutions – these have to happen faster to train staff in. Research community – has patient safety research led to sustainable reduction in risk? Data and information – how has this improved patient safety? Industry – pharma doing very little on medication packaging and labelling; medical devices industry also could do more.
  24. Patient Safety Learning
    Patients in need of a new hip or knee are increasingly being left in agony for more than a year, an investigation reveals.
    The number of patients forced to endure such waits has risen by more than 50% in 12 months, NHS data shows.
    Charities said that the findings were "devastating", with thousands of people left in pain and misery, with some left house-bound, and younger patients unable to work, as they waited for NHS help. 
    The figures show that in 2018/19, 55,251 patients waited at least 18 weeks for hip and knee surgery – a more than doubling from 25,704 such cases in 2013/14.  In total, 2,889 patients were left waiting at least 12 months, up from 1,863 a year before, and 780 cases five years ago. 
    Experts warned that even these figures from NHS Digital are an underestimate, as they only measure the wait from the point a hospital doctor decides that surgery is required, not from point of GP referral. 
    Read full story
    Source: The Telegraph, 22 February 2020
  25. Patient Safety Learning
    The number of patients stuck in hospitals because they could not be transferred is at its highest quarterly level since 2017, reversing years of progress amid ongoing crises in health and care services.
    “Delayed transfers of care” – often known as “bed blocking” – rose in the mid-2010s as austerity hit council-run adult-care services, meaning hospitals were unable to discharge patients into the community.
    The number of “delayed days” in the NHS increased from an average of 114,000 a month in 2012 to more than 200,000 in October 2016, before extra funding and higher council taxes brought the numbers back down.
    But the latest NHS figures show the problem is returning. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years.
    Read full story
    Source: The Guardian, 23 February 2020
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