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Patient Safety Learning

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  1. Patient Safety Learning
    UK plastic surgeons have released new guidelines to try to make Brazilian Butt Lift (BBL) procedures safer for people who desire a bigger bottom.
    Some women have died from the operation, which involves sucking out fat from elsewhere - such as the belly - and injecting it into butt cheeks.
    The British Association of Plastic Surgeons (BAAPS) says the injections should not go very deep to help avoid complications such as dangerous clots.
    According to the NHS, it has the highest death rate of all cosmetic procedures, and the risk of death from BBL surgery is at least 10 times higher than many other procedures.
    A major concern is that the injected fat can cause a blockage in a blood vessel in the lungs - called a pulmonary embolism - which can be fatal.
    This happened to Leah Cambridge, a beautician and mother of three from Leeds.
    She suffered a massive pulmonary embolism during the operation at a private hospital in Turkey in 2018, a coroner found.
    BAAPS president Marc Pacifico told the BBC: "Unfortunately we don't know how many people have been going for these risky BBL procedures. We have been recommending against it for a number of years after seeing quite a frightening death rate associated with it. But people have been going abroad to get it done."
    "Make sure you ask if the surgeon will be using ultrasound for gluteal fat grafting. We are recommending that surgeons should only perform this with real time ultrasound guidance as the only way to ensure the procedure is performed superficially and safely."
    Read full story
    Source: BBC News, 10 October 2022
  2. Patient Safety Learning
    More than 100,000 doctors in Australia hold the right to call themselves cosmetic surgeons, without having undergone the specific training to be competent and safe.
    President of the Australasian College of Cosmetic Surgery and Medicine Dr Patrick Tansley says cosmetic surgery does not form part of the traditional medical training undertaken in Australia, due to the practice being relatively new.
    “Society has moved faster than legislation has followed it,” he told Sky News Australia.
    Dr Tansley said he is advocating for the introduction of a national standard to endorse this area of practice in Australia, where doctors would be placed on a public register for patients to review their accreditation.
    “Once they had met those standards and then were endorsed, they could be placed on a public register, independently administered by the regulator AHPRA.
    “And the public would then be able to see, with clarity and transparency, which of those doctors have been trained and accredited in cosmetic surgery.”
    Read full story
    Source: Sky News, 23 April 2022
  3. Patient Safety Learning
    People administering Botox or fillers will be required to have a licence under new laws after an “unacceptable” rise in reports of botched cosmetic procedures in the UK.
    The legislation to protect against rogue practitioners will make it an offence to perform such non-surgical work without a licence after Sajid Javid said “far too many people have been left emotionally and physically scarred” when things have gone wrong.
    The health secretary recognised that most of those in the aesthetics industry “follow good practice” when it comes to patient safety but said it was time to think about the harm botched cosmetic procedures can have.
    “We’re doing all we can to protect patients from potential harm, but I urge anyone considering a cosmetic procedure to take the time to think about the impact on both their physical and mental health and ensure they are using a reputable, safe and qualified practitioner,” he said.
    Maria Caulfield, the minister for patient safety, said the spread of images online via social media has led to a rise in demand for Botox and fillers and there had been a subsequent increase in people suffering the consequences of badly performed procedures.
    She said: “While these can be administered safely, we are seeing an unacceptable rise in people being left physically and mentally scarred from poorly performed procedures.”
    Read full story
    Source: The Guardian, 28 February 2022
  4. Patient Safety Learning
    A cosmetic surgeon who did not have adequate insurance for operations that went wrong has been struck off.
    Dr Arnaldo Paganelli worked privately for The Hospital Group in Birmingham. The Medical Practitioners' Tribunal Service ruled his actions constituted misconduct.
    Four women took their case to the body and the tribunal heard evidence about his time at Birmingham's Dolan Park Hospital where he made regular trips from Italy to work.
    Lead campaigner Dawn Knight, from Stanley, County Durham, said too much skin was removed from her eyes during an eyelift in 2012 and they became "constantly sore".
    She told BBC Radio 4's You and Yours programme she felt relieved Dr Paganelli "cannot injure anyone else on UK soil" and called for the government to tighten regulation around cosmetic procedures to protect the public.
    "The process has been long, emotional and exhausting. This situation must never be repeated. After all, when are you more vulnerable than when under aesthetic at the hands of a surgeon who has no insurance?"
    Read full story
    Source: BBC News, 12 August 2020
  5. Patient Safety Learning
    Nine in 10 beauty clinics are breaking the law by advertising Botox, new research reveals, sparking fresh concern that Britain’s booming £3.6bn cosmetic treatments industry is like the “wild west”.
    Academics at University College London (UCL) found 88% clinics in London are flouting regulations intended to protect public health banning the advertising of Botox and other forms of botulinum toxin.
    The disclosure prompted warnings the illegal advertisements could help persuade vulnerable people to undergo injections that could leave them feeling traumatised.
    Promotion of the anti-ageing substance is illegal because it is a prescription-only medicine, which cannot be advertised under the Human Medicines Regulations 2012.
    A group of beauty professionals who are seeking to rid the industry of its reputation for dubious practices said the findings showed consumers were being subjected to “a tsunami of untamed and unrestricted promotional activity that presents a threat to public protection and patient safety”.
    Read full story
    Source: The Guardian, 14 April 2023
  6. Patient Safety Learning
    The government has rejected an urgent call by MPs to bring in a new licensing regime for non-surgical procedures such as Botox injections, chemical peels, microdermabrasion and non-surgical laser interventions.
    Ministers also rejected recommendations by the House of Commons Health and Social Care Committee to make dermal fillers available as prescription only substances—as Botox is—and to bring in specific standards for premises that provide non-surgical cosmetic procedures.
    The government also rejected several recommendations aimed at tackling obesity—including a dedicated eating disorder strategy, annual health and wellbeing checks for every child and young person, and restrictions on buy-one-get-one free deals for foods and drinks high in fat, salt, or sugar.
    Read full story
    Source: BMJ, 2 February 2023
  7. Patient Safety Learning
    More than two-thirds of people who are administering cosmetic surgery injections such as Botox in the UK are not qualified medical doctors, a new study suggests.
    The study is the first survey of who is providing cosmetic injectable services, including botulinum toxin (Botox) and dermal fillers, in the country.
    Dr David Zargaran, UCL Plastic Surgery, an author of the study, said: “There are well-documented, yet to-date unaddressed challenges in the UK cosmetic injectables market.
    “Without knowledge of the professional backgrounds of practitioners, we cannot adequately regulate the industry.
    “Our research highlights that the majority of practitioners are not doctors and include other healthcare professionals, as well as non-healthcare professionals such as beauticians.
    “The range of backgrounds opens a broader question relating to competence and consent.
    Read full story
    Source: The Independent, 24 July 2023
  8. Patient Safety Learning
    A coroner has strongly criticised a mental health trust for failing to investigate serious incidents promptly.
    Tees Esk and Wear Valleys Foundation Trust has been told that delays in probing serious incidents may “compromise the quality” of these investigations and hence “their value in preventing deaths”.
    The warnings, from Jeremy Chipperfield, senior coroner for County Durham and Darlington, come amid an ongoing inquest into the death of TEWV patient Ian Darwin. Mr Darwin died aged 42 in March, and the serious incident review into his death is still ongoing.
    A recently published prevention of future deaths report relating to Mr Darwin’s death said TEWV’s serious incident death investigations, “at all levels of seriousness, are routinely (if not invariably) significantly delayed and I understand there is no expectation of immediate, or any timetable for eventual rectification”.
    “In permitting delay of ‘serious incident’ investigations, TEWV may permit lethal hazard to persist for longer than necessary, and compromise the quality of such investigations and hence their value in preventing avoidable deaths.”
  9. Patient Safety Learning
    The British Medical Association has written to trust chief executives warning of ‘concerns regarding the safety of our members and the patients they serve’ due to flawed concrete beams.
    The BMA has written to trust chiefs, copying in their medical committee leads, in the wake of a wave of publicity around reinforced autoclaved aerated concrete in recent weeks.
    The letter said: “The HSJ has reported that many NHS hospital buildings have been constructed with RAAC, which is in some cases reaching the end of safe use and causing danger to staff and patients.
    “Unfortunately, your trust may be one of the affected hospitals. We have concerns regarding the safety of our members and the patients they serve, and would appreciate answers to the following.”
    It also requested the trusts provide answers, under the Freedom of Information Act, to questions including whether they had identified RAAC, what assessments they had made, what mitigations were planned or in place, and emergency plans such as evacuation.
    It is thought the letter was sent to all or most provider trusts.
    Read full story (paywalled)
    Source: HSJ, 12 September 2023
  10. Patient Safety Learning
    Female surgeons say they are being sexually harassed, assaulted and in some cases raped by colleagues, a major analysis of NHS staff has found.
    The Royal College of Surgeons said the findings were "truly shocking".
    Sexual harassment, sexual assault and rape have been referred to as surgery's open secret.
    There is an untold story of women being fondled inside their scrubs, of male surgeons wiping their brow on their breasts and men rubbing erections against female staff. Some have been offered career opportunities for sex.
    Nearly two-thirds of women surgeons that responded to the researchers said they had been the target of sexual harassment and a third had been sexually assaulted by colleagues in the past five years.
    Women say they fear reporting incidents will damage their careers and they lack confidence the NHS will take action.
    It is widely accepted there is a culture of silence around such behaviour. Surgical training relies on learning from senior colleagues in the operating theatre and women have told us it is risky to speak out about those who have power and influence over their future careers.
    Read full story
    Source: BBC News, 12 September 2023
    Related reading on the hub:
    Breaking the silence: Addressing sexual misconduct in healthcare Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign GMC's Good medical practice 2024
  11. Patient Safety Learning
    Ministers have vowed to reduce suicide rates in England with the launch of more than 100 new initiatives amid particular concerns over rising deaths and self-harm among children and young people.
    The pledge to reverse the trends within two and a half years came as the government launched its first prevention strategy in more than a decade. In 2022, there were 5,275 suicides in England, equivalent to 10.6 suicides per 100,000 people, according to the Office for National Statistics.
    “While overall the current suicide rate is not significantly higher than in 2012, the rate is not falling,” a new government document says. “We must do all we can to prevent more suicides, save many more lives and ultimately reduce suicide rates.”
    It highlights how rates of suicide among children and young people have increased in recent years, despite being low overall, adding: “Urgent attention is needed to address and reverse these trends.”
    The new measures being launched will also aid other specific groups at risk of suicide, including middle-aged men, autistic people, pregnant women and new mothers.
    Steve Barclay, the health secretary, said: “Too many people are still affected by the tragedy of suicide, which is so often preventable. This national cross-government strategy details over 100 actions we’ll take to ensure anyone experiencing the turmoil of a crisis has access to the urgent support they need.”
    Read full story
    Source: The Guardian, 11 September 2023
  12. Patient Safety Learning
    Patients are needlessly being put at risk of dying from heart problems because they have to wait months to be fitted with lifesaving implantable defibrillators, experts have said.
    Two million people in the UK live with coronary heart disease, which is a leading cause of heart failure. Those at the highest risk of dying as a result of heart failure may be offered an implantable cardioverter defibrillator device (ICD). These can kickstart the heart and may save their life.
    Patients have to wait at least 90 days before they can be fitted with an ICD while doctors wait to see if stents and medication might improve their health. However, a large study funded by the British Heart Foundation suggests there is little or no benefit to waiting, and the charity says lives are needlessly being put at risk as a result.
    Dr Sonya Babu-Narayan, an associate medical director at the BHF, said the results had significant implications.
    “The findings suggest that the current ‘wait and see’ approach to find out whether a patient’s heart function improves with medication and stents isn’t always best, and that an unnecessary wait could even be the difference between life and death,” she said.
    “The results from this large UK-wide trial could lead to re-evaluation of how best to treat people living with severe heart failure due to coronary heart disease.”
    Read full story
    Source: The Guardian, 11 September 2023
  13. Patient Safety Learning
    A trust which hired the former chief executive of the Countess of Chester Hospital as an interim CEO has launched a review of decisions about safety and whistleblowing taken under his leadership.
    Jacqui Smith, chair-in-common at Barts Health and Barking, Havering and Redbridge University Hospitals trusts, made the announcement at a board meeting, following the nurse Lucy Letby’s conviction for murdering seven babies, and attempting to murder six more, during a year-long period between June 2015 and June 2016.
    Tony Chambers was Countess of Chester Hospital Foundation Trust CEO for six years from December 2012 to September 2018, and resigned shortly after Letby’s initial arrest. His role – and that of fellow senior managers in Chester – in responding to concerns raised by doctors, has come under intense scrutiny since the verdicts.
    Mr Chambers served as BHRUT’s interim chief from January 2020 until August 2021, and Ms Smith told BHRUT’s board: “In the light of concerns, particularly around listening to staff and patients, and given the seriousness of the events, we will undertake a look at the periods of Tony Chambers’ tenure.
    “To see whether there are, firstly, any significant decisions taken regarding quality and safety that we need to look at again, and [secondly], checking our log of whistleblowing cases and other concerns to make sure that they have been appropriately followed up."
    Read full story
    Source: HSJ, 8 September 2023
  15. Patient Safety Learning
    A public inquiry will be held into the disgraced brain surgeon Sam Eljamel, the Scottish government has confirmed.
    Eljamel harmed dozens of patients at NHS Tayside, leaving some with life-changing injuries.
    He was head of neurosurgery at Ninewells Hospital in Dundee until December 2013, when he was suspended.
    Health Secretary Michael Matheson said he was persuaded of the need for the inquiry after reading a damning due diligence review into NHS Tayside.
    It follows a long-running campaign which saw almost 150 former patients of the surgeon calling for the inquiry.
    Mr Matheson said he had concluded that a public inquiry was "the only route to get to the bottom of who knew what and when, and what contributed to the failures described by NHS Tayside".
    The health secretary said he also wanted to see individual cases reviewed independently of NHS Tayside in a "person-centred, trauma-informed" manner.
    Read full story
    Source: BBC News, 7 September 2023
     
  16. Patient Safety Learning
    YouTube has launched a verification system for healthcare workers in the UK as it battles disinformation online.
    In 2022, health videos were viewed more than three billion times in the UK alone on the video-sharing platform.
    Doctors, nurses and psychologists have been applying for the scheme since June and must meet rigorous criteria set by the tech giant to be eligible.
    Successful applicants will have a badge under their name identifying them as a genuine, licensed healthcare worker.
    But YouTubers have warned the system is only meant for education purposes, not to replace medical advice from your GP.
    Vishaal Virani, who leads health content for YouTube, said it was important simply due to the sheer number of people accessing healthcare information on the video-sharing platform.
    "Whether we like it or not, whether we want it or not, whether the health industry is pushing for it or not, people are accessing health information online," he told the BBC.
    "We need to do as good a job as possible to bring rigour to the content that they are subsequently consuming when they do start their care journey online."
    Read full story
    Source: BBC News, 8 September 2023
  17. Patient Safety Learning
    North East London Foundation Trust has been charged with corporate manslaughter – making it only the second NHS provider to be prosecuted for the crime.
    The Crown Prosecution Service has authorised the Metropolitan Police to bring a charge of corporate manslaughter against the mental health provider in regard to the death of Alice Figueiredo at the trust’s Goodmayes Hospital on 7 July 2015.
    Goodmayes ward manager Benjamin Aninakwa has also been charged with gross negligence manslaughter, and an offence under the Health and Safety at Work Act.
    The trust and Mr Aninakwa will appear at Barkingside Magistrates’ Court on Wednesday, 4 October. The prosecution follows a five year investigation by Met detectives.
    Read full story (paywalled)
    Source: HSJ, 7 September 2023
  18. Patient Safety Learning
    NHS England’s finance boss has said patient treatment areas are being closed “all the time” due to crumbling estates, fire risks and flooding.
    Julian Kelly told MPsthe health service had “examples all the time where hospitals are having to shut units, decant patients into other spaces, where we are losing theatres… which limits our capacity to treat patients”.
    It comes amid the national controversy around the government’s investment into public buildings, sparked by the sudden closure of dozens of school buildings with unsafe structures known as ‘reinforced autoclaved aerated concrete’.
    He said: “We have hospital teams which are managing these sort of issues day in and day out. And so we have examples of managing fire risk, flooding… a lot of this is because we know we’ve seen a big increase in backlog maintenance and we know there was a pause in investment in new hospital infrastructure.”
    Read full story (paywalled)
    Source: HSJ, 7 September 2023
  19. Patient Safety Learning
    A police investigation is to be launched into failings that led to dozens of baby deaths and injuries at a hospital trust.
    The maternity units at Nottingham University Hospitals (NUH) NHS Trust are already being examined in a review by senior midwife Donna Ockenden.
    The review will become the largest ever carried out in the UK, with about 1,800 families affected.
    Nottinghamshire Police said its decision to investigate followed discussions with Ms Ockenden.
    Her team is looking into failings that led to babies dying or being injured at Nottingham City Hospital and the Queen's Medical Centre.
    Chief Constable Kate Meynell said: "On Wednesday I met with Donna Ockenden to discuss her independent review into maternity cases of potentially significant concern at Nottingham University Hospitals NHS Trust (NUH) and to build up a clearer picture of the work that is taking place.
    "We want to work alongside the review but also ensure that we do not hinder its progress.
    "However, I am in a position to say we are preparing to launch a police investigation.
    "I have appointed the Assistant Chief Constable, Rob Griffin, to oversee the preparations and the subsequent investigation."
    Read full story
    Source: BBC News, 7 September 2023
  20. Patient Safety Learning
    Sharri Shaw walked out of the CVS on Vermont Avenue in South Los Angeles in 2019 believing she had a prescription for the pain reliever acetaminophen.
    Instead the bottle held a medicine to treat high blood pressure, a problem she did not have.
    Shaw began taking the pills, not learning of the mistake until six days later when a CVS employee arrived at her home, according to a lawsuit she filed last year. The employee told her not to take the tablets, the lawsuit said, before leaving the correct prescription at her door. The mistake, she said, left her stunned.
    Shaw’s experience is far from an isolated event. California pharmacies make an estimated 5 million errors every year, according to the state’s Board of Pharmacy.
    Officials at the regulatory board say they can only estimate the number of errors because pharmacies are not required to report them.
    Most of the mistakes that California officials have discovered, according to citations issued by the board and reviewed by The Times, occurred at chain pharmacies such as CVS and Walgreens, where a pharmacist may fill hundreds of prescriptions during a shift, while juggling other tasks such as giving vaccinations, calling doctors’ offices to confirm prescriptions and working the drive-through.
    Christopher Adkins, a pharmacist who worked at CVS, and then at Vons pharmacies until March, said that management policies at the big chains have resulted in understaffed stores and overworked staff.
    “At this point it’s completely unsafe,” he said.
    Read full story
    Source: Los Angeles Times, 5 September 2023
  21. Patient Safety Learning
    Rishi Sunak’s pledge to cut the NHS waiting list backlog is being threatened by the crumbling concrete crisis as affected hospitals warn they will be forced to shut wards and theatres.
    Hospitals were told they had buildings prone to collapse in 2019 but four years later they are still dealing with the issue.
    In a report last year, West Suffolk NHS Foundation Trust leaders said that work to replace reinforced autoclaved aerated concrete (Raac) in its hospitals would hit general surgery, urology, gynaecology and orthopaedic care.
    Wards have had to close, piling pressure on a crowded A&E as patients can’t be offloaded due to lack of beds, and threatening its ability to hit government targets to reduce waiting lists, it added.
    The warning comes as Sir Keir Starmer used Prime Minister’s Questions to attack Mr Sunak over the crisis. He argued that “the cowboys are running the country” and asked the PM if he was “ashamed” of the scandal caused by 13 years of “botched jobs”.
    Read full story
    Source: The Independent, 6 September 2023
  22. Patient Safety Learning
    A father whose daughter died after travelling to Turkey for weight-loss surgery has urged people to think again before doing the same.
    Shannon Meenan Browse from Londonderry was 32 when she died in August.
    The mother-of-four travelled for a gastric sleeve operation 18 months ago but, according to her father, got sick almost straight away.
    The family were told she died in Altnagelvin Hospital from "malnutrition due to gastric sleeve".
    A BBC investigation in March found that seven British patients who travelled to Turkey for weight-loss surgery died after operations there, while others returned home with serious health issues.
    One of the UK's leading bariatric surgeons, Prof David Kerrigan said people are taking a "massive risk" by travelling abroad for weight-loss surgery.
    In the UK, he said, patients undergo a rigorous preparatory process that includes a psychological assessment and there is "a proper after-care programme".
    Read full story
    Source: BBC News, 6 September 2023
  23. Patient Safety Learning
    Most women going through menopause are not receiving effective treatment for their symptoms, in part because of widespread misinformation, according to new research.
    A comprehensive literature review led by Prof Susan Davis from Monash University in Australia calls for more personalised treatment plans that address the greatly varying physical and mental symptoms of menopause.
    After adverse affects were reported from the landmark 2002 Women’s Health Initiative study into menopausal hormone therapy (MHT), Davis said there was a blanket fear that “hormones are dangerous” and as a result, “menopause [treatment] just went off the radar”.
    Read full story
    Source: The Guardian, 6 September 2023
  24. Patient Safety Learning
    Dozens of young autistic people have died after serious failings in their care despite repeated warnings from coroners, BBC News has found.
    Their investigation found issues that were flagged a decade ago are still being warned about now.
    Two bereaved mothers said lessons had not been learned by their local health authority after the deaths of their teenage sons, two years apart.
    The coroner who oversaw both cases, noted a repeated failure in care.
    After the first death, the coroner criticised NHS Kent and Medway for "inadequate support" and said a similar incident may happen if this continued.
    Two years later, the second autistic teenager died under the care of the same authority. The same coroner found that had the victim received the recommended level of care, he might have got the therapy he needed.
    In the first piece of research of its kind, the BBC combed through more than 4,000 Prevention of Future Death (PFD) notices delivered in England and Wales over the past 10 years.
    Read full story
    Source: BBC News, 7 September 2023
  25. Patient Safety Learning
    Former commissioning chiefs have been accused of presiding over a ‘culture of bullying’ at the predecessor organisation to Norfolk and Waveney Integrated Care Board, as part of a legal claim from a former employee.
    The accusations, which have been made in an employment tribunal case, relate to former chief executive Melanie Craig and other former executives at what was then Norfolk and Waveney Clinical Commissioning Group. Ms Craig now leads Suffolk Community Foundation, a local voluntary sector organisation.
    The claims have been made by a former long-standing assistant director for mental health services, Clive Rennie, who has claimed unfair dismissal. However, the integrated care board said it disputes the claims and is defending the case.
    In a witness statement to the tribunal, which began this week, Mr Rennie alleges there was an “authoritarian and dictatorial style of management” and described a “culture of bullying and misuse of power that had emerged under the leadership of Melanie Craig and which included the executive team”.
    Read full story (paywalled)
    Source: HSJ, 6 September 2023
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