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Patient Safety Learning

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  1. Patient Safety Learning
    Many media stories about ketamine as a treatment for psychiatric disorders such as depression “go well beyond the evidence base” by exaggerating the efficacy, safety and longevity of the drug or by overstating the risks, an analysis has found.
    Researchers examined 119 articles about ketamine and mental illness published by major print media in Australia, the US and UK over a five-year period. They found articles peaked in 2019, when the US Food and Drug Administration approved a ketamine-derived nasal spray known as esketamine for treatment-resistant depression.
    Researchers found 37% of articles contained inaccurate information, largely related to efficacy, safety information and the longevity of the effect of the treatment. Ketamine treatment was portrayed in an “extremely positive light” in 69% of articles, the review found.
    “Overly optimistic statements from medical professionals regarding efficacy or safety may encourage patients to seek treatments that may not be clinically appropriate,” says the paper, published  in the journal BJPsych Open.
    “Disconcertingly, some articles included strong statements about treatment efficacy that went well beyond the evidence base. Conversely, exaggeration of the risks may discourage patients from pursuing a treatment that may be suitable for them.”
    Read full story
    Source: The Guardian, 8 June 2023
  2. Patient Safety Learning
    Many people with Long Covid have a lower health-related quality of life than people with some advanced cancers, research suggests.
    Fatigue is the symptom with the greatest impact on the daily lives of Long Covid patients, according to a study led by researchers at University College London (UCL) and the University of Exeter. They found that many were seriously ill and had fatigue scores worse than or similar to people with cancer-related anaemia or severe kidney disease.
    Their health-related quality of life scores were also lower than those of people with advanced metastatic cancers, such as stage 4 lung cancer. Overall, the impact of long Covid on the daily activities of patients was worse than that for stroke patients and comparable to people with Parkinson’s disease.
    The study co-author Prof William Henley, of Exeter University medical school, said: “Long Covid is an invisible condition, and many people are left trying to manage significant changes to how they can function.
    “Shockingly, our research has revealed that Long Covid can leave people with worse fatigue and quality of life than some cancers, yet the support and understanding is not at the same level. We urgently need more research to enable the development of evidence-based services to support people trying to manage this debilitating new condition.”
    Read full story
    Source: The Guardian, 8 June 2023
  3. Patient Safety Learning
    The government has failed to change ‘restrictive’ legislation which would enable primary care reform – despite repeated announcements – a pharmacy leader has said.
    Currently, pharmacy technicians cannot take on dispensing tasks without supervision from a pharmacist but the government promised in 2019 to look at how legislation can be updated to allow pharmacy technicians to take more of a role in dispensing, as part of the current five-year Community Pharmacy Contractual Framework, which ends next year.
    The government has repeatedly announced and reannounced over the past five years that it wants to remove restrictions to give community pharmacy an expanded role.
    But in a new report shared exclusively with HSJ, the Company Chemists’ Association – the trade body with members including Asda, Boots, Lloyds Pharmacy and Superdrug – highlights that government has failed to make progress.
    Read full story (paywalled)
    Source: HSJ, 7 June 2023
  4. Patient Safety Learning
    The Royal College of Radiologists is warning that all four UK nations are facing "chronic staff shortages", with cancer patients waiting too long for vital tests and treatments.
    Half of all cancer units are now reporting frequent delays for both radiotherapy and chemotherapy.
    Ministers say a workforce strategy for the NHS in England is due shortly.
    The plan, which is meant to spell out how the government will plug staffing gaps over the next 15 years, has been repeatedly delayed, to the frustration of some in the health service.
    In June 2022, Carol Fletcher, from South Wales, finally had her routine screening appointment for breast cancer, which was itself overdue.
    "It took another eight weeks after my mammogram before I was told there might be something wrong," she said.
    Since her cancer diagnosis, there have been more waits - for scans, tests, surgery and then chemo.
    "I was told that I might not get results back [quickly] after my mastectomy because they haven't got enough pathologists, so there was another eight-week delay for chemotherapy," she said.
    "I can't plan for the future and it's had a huge impact on my family."
    Read full story
    Source: BBC News, 8 June 2023
  5. Patient Safety Learning
    Health ministers are to recruit a new volunteer army for social care to ferry medical equipment and drugs to people’s homes in a bid to free up congested hospital wards.
    Under the plan, members of the public will be able to sign up on the GoodSam app for roles such as “check in and chat”, which involves support over the phone for people struggling with loneliness.
    There will also be the chance to “pick up and deliver”, helping to transport medicines or small items of medical equipment to people’s homes from NHS sites so they can be discharged from hospital, and “community response” roles will involve collecting and delivering shopping and prescriptions.
    The joint NHS and social care volunteers responders programme for England is being launched on Wednesday amid a social care staffing crisis with 165,000 vacancies and millions of hours of care needs not being met. At the end of April, 49,000 people every day had to stay in NHS hospitals in England despite no longer meeting the criteria to be there.
    News of the planned announcement from the care minister, Helen Whately, has sparked concern among workers in the sector, who warned that volunteering could not solve the social care recruitment and retention crisis. Helen Wildbore, director of Care Rights UK, which represents relatives and residents, said it “feels like a desperate measure to try and save a system that is crumbling”.
    Read full story
    Source: The Guardian, 6 June 2023
  6. Patient Safety Learning
    The NHS in England is "failing women", the government's women's health ambassador has said.
    Prof Dame Lesley Regan, appointed to support the Women's Health Strategy implementation, was speaking to BBC Radio 5 Live's Naga Munchetty.
    Last month, Munchetty, 48, revealed she had been diagnosed with the womb condition adenomyosis, after waiting years in severe pain.
    Dame Lesley said she wanted women to be able to self-refer to specialists.
    Women and girls should not have to seek "permission [to] go and have your crippling menstrual pain sorted out", she said.
    Read full story
    Source: BBC News, 6 June 2023
  7. Patient Safety Learning
    GPs in England may start offering weight-loss jabs to some patients to reduce obesity-related illnesses and resultant pressure on hospitals.
    Wegovy was approved for NHS use after research suggested users could shed over 10% of their body weight.
    The drug blunts appetite, so users feel full and eat less.
    Rishi Sunak said it could be a "game-changer" as he announced a £40 million pilot scheme to increase access to specialist weight management services.
    But experts warn "skinny jabs" - widely used in the US and endorsed by many celebrities - are not a quick fix or a substitute for a healthy diet and exercise.
    NHS drugs watchdog, the National Institute for Health and Care Excellence (NICE), says patients can access Wegovy for a maximum of two years via specialist weight-management services.
    The new scheme will test how GPs could safely prescribe such drugs and the NHS provide support in the community or digitally, contributing to the government's wider ambition to reduce pressure on hospitals and give patients access to the care they need where it is most convenient for them.
    Read full story
    Source: BBC News, 7 June 2023
  8. Patient Safety Learning
    Seven integrated care systems and one ambulance trust have been placed in ‘intensive support’ because of their performance against urgent and emergency care metrics.
    NHS England launched the new intervention regime for emergency care earlier this year to measure progress against the urgent and emergency care recovery plan.
    The most troubled systems and organisations are now placed in a first “tier” and will receive central support from NHSE. Other systems requiring support from NHSE regional teams are placed in a secondary tier. This tiered approach is already in place for cancer and elective performance.
    Support will include help with analytical and delivery capacity, “buddying” with leading systems and “targeted executive leadership”.
    Read full story (paywalled)
    Source: HSJ, 7 June 2023
  9. Patient Safety Learning
    Gonorrhoea cases hit record levels last year, while syphilis diagnosis reached the highest level since just after the Second World War, new figures show.
    New data from the UK Health Security Agency (UKSA) shows 8,692 cases of syphilis were recorded in 2022, the largest annual figures since 1948.
    Gonorrhoea cases hit a high of 82,592 last year - a 50% increase compared to 2021. This is the highest number in any one year since records began in 1918, according to the UKHSA.
    The public health authority said gonorrhoea cases are becoming “increasingly resistant” to antibiotics and are “at risk of becoming untreatable in the future.”
    Overall there was a 24% increase in sexually transmitted infection diagnoses in 2022 and local council leaders warned sexual health services are “at risk of breaking point” as demand rises alongside real-term cuts to funding.
    Read full story
    Source: The Independent, 7 June 2023
  10. Patient Safety Learning
    A ground-breaking, mandatory national medical device outcome registry has been launched to collate detailed information on all procedures involving high-risk (Class III/IIb) devices, including pacemakers, hip joint replacements and breast implants.
    Led by NHS England’s Outcomes and Registries programme, and developed in partnership with NEC Software Solutions (NEC), the Medical Device Outcome Registry platform (MDOR) will capture data on over two million medical device procedures and more than 10 million unique devices used on patients each year across the NHS and independent healthcare sector, addressing recommendations from the Cumberlege review and Patterson inquiry.  
    Collecting key details of the procedure, the clinicians involved and devices used, the registry will include clinical observational and patient outcome data, providing a single, comprehensive repository to improve patient safety and outcomes.  
    Scott Pryde, delivery director for the Outcomes and Registries Programme, NHS England, said: “Millions of people receive high-risk medical devices and implants every year. Whereas most procedures are a complete success, when things go wrong it can result in serious harm for the patients affected. The Medical Device Outcome Registry will be responsive to concerns about the safety and outcomes of patients who receive high-risk medical devices, such as implants, and will use the data to actively detect, predict and prevent patient harm, and improve outcomes for patients".  
    “The result will be in a step change in improving patient safety in these procedures, providing clinicians and healthcare teams with secure access to critical information they can use to inform clinical decisions and improve the experience of patients before, during and after their procedures.”  
    Read full story
    Source: Clinical Services Journal, 31 May 2023
  11. Patient Safety Learning
    A group of doctors, including some GPs, has begun legal proceedings against the GMC based on what they say is a failure to act on Covid-19 vaccine misinformation.
    On Friday, the group, whose members wish to remain anonymous, sent a formal pre-action protocol letter to the GMC, which is a warning that legal action is imminent. 
    In January, these doctors called on the regulator to investigate Dr Aseem Malhotra’s fitness to practise due to what they claim is his ‘high-profile promotion of misinformation about Covid-19 mRNA vaccines’.
    Dr Malhotra, a consultant cardiologist, campaigner and author, has over half a million followers on Twitter, with most recent posts focusing on the Covid vaccine.
    The upcoming action, which is led by lawyers from the Good Law Project, is based on the GMC’s refusal to carry out an investigation.
    Professor Trish Greenhalgh, a GP and academic in primary care at the University of Oxford who has been in touch with the group, told Pulse the ‘scandal is that the GMC do not think it’s their job to investigate doctors who have massive, massive followings on social media and who fan the flames of disinformation’. 
    Read full story
    Source: Pulse, 5 June 2023
  12. Patient Safety Learning
    Dentists across Britain have been given 'falsified' oxygen supplies. 'Several' practices have been told to immediately stop using a batch of tanks and replace them with 'legitimate stock'.
    Tricodent Limited, the Sussex-based firm which supplied the oxygen, is now under criminal investigation. 
    The Medicines and Healthcare products Regulatory Agency (MHRA) has not said how the oxygen was falsified, and they stated that the risk to public health and patient safety was 'low'.
    The MHRA alert urged affected practices to check their oxygen cylinders. If any are labelled 'Medical Oxygen B.P PL No 04280/0001 MEDIGAS OXYGEN', they should be replaced with legitimate stock immediately, the MHRA said.
    All remaining stock must be quarantined, the agency added.
    The MHRA did not, however, confirm the number or locations of impacted practices.
    Read full story
    Source: Mail Online, 6 June 2023
  13. Patient Safety Learning
    Grail, a company that developed blood tests to detect cancer, mistakenly sent approximately 400 customers letters saying they might be positive for the disease, The New York Times has reported.
    Grail's Galleri test uses blood to detect cancer signals shared by 50 types of cancers and is available only by prescription, according to the report. Grail said in a statement that one of its vendors sent hundreds of letters with incorrect test results due to a "software configuration issue." 
    "No patient health information has been disclosed or breached due to this issue, and no patient harm or adverse events have been reported," Grail's statement said.
    The issue was not caused by incorrect test results, according to the company. More than half of people who received the erroneous letter had not yet had their blood drawn for the test. PWNHealth said in a statement that the system it uses to send template messages to people had a "misconfiguration." 
    Read full story
    Source: Becker's Hospital Review, 4 June 2023
  14. Patient Safety Learning
    Two new healthcare workforce surveys outline widespread reports of discrimination, racism and workplace violence in the USA perpetuated by patients and coworkers alike.
    Among the findings were acknowledgments from respondents that incidents of discrimination are rarely reported to management or law enforcement.
    Additionally, more than half of the respondents to one survey said that they believed that incidents of workplace violence have increased over the course of their tenure, while nearly half of the nurses who responded to the other survey said they believe “a culture of racism/discrimination” was present as early as in nursing school.
    “If we are to truly provide just and equitable care to our patients, we as nurses must hold ourselves accountable for our own behavior and work to change the systems that perpetuate racism and other forms of discrimination,” said Beth Toner, RN, director of program communications at the Robert Wood Johnson Foundation (RWJF).
    Read full story
    Source: Fierce Healthcare, 2 June 2023
  15. Patient Safety Learning
    A woman was “fobbed off” by her doctors who failed to diagnose her colon cancer for a year, an investigation revealed.
    In May 2019, Charlie Puplett, 45, expressed concern at her GP surgery in Yeovil, Somerset, about unexplained weight loss, lack of appetite and a change in bowel habits.
    But the surgery did not test her for colon cancer – with one doctor suggesting she had anorexia and was “in denial”, she said.
    She was not diagnosed until almost a year later when she was rushed to hospital after vomiting blood.
    Ms Puplett’s experience was detailed in an investigation by the Parliamentary and Health Service Ombudsman (PHSO), which found that her symptoms should have been “red flags” leading to urgent testing within two weeks, and said she had been “failed” by her doctors.
    Read full story
    Source: The Independent, 4 June 2023
  16. Patient Safety Learning
    Paramedics are being told to take a police escort to more than 1,200 addresses for fear of attack, The Times has revealed.
    The College of Paramedics said the figure was outrageous and called on courts to implement tougher sentences for assaults on paramedics.
    Ambulance services have marked hundreds of addresses after violence towards crew. Notes on addresses include “patient keeps axe under pillow — serrated knife hidden round the house and is known to be a risk”, “shoots/throws acid”, and “patient is anti-ambulance”.
    Read full story (paywalled)
    Source: The Times, 4 June 2023
  17. Patient Safety Learning
    Some women are being left “traumatised” following a routine gynaecological procedure that is often carried out with minimal pain relief, with one pain expert warning there is an “apathy” within the NHS in changing how it is done.
    There are various pain relief options for the procedure, including general anaesthetic. However, campaigners say it is common for women to be told just to take paracetamol before they arrive at the hospital.
    Doctors claim this is sufficient pain relief for most patients, however a significant number of women have reported pain so severe that it has left them feeling “traumatised” and “violated”.
    Jenny Wade, 51, had a hysteroscopy carried out this year after her GP referred her to Leicester General Hospital to investigate her postmenopausal bleeding.
    Ms Wade said she asked if she could have the procedure under general anaesthetic and was told she could, but there would be a wait.
    She decided to go ahead with the procedure without the anaesthetic, as she was worried she could have cancer and did not want to delay a diagnosis.
    “I’ve never known pain like it. I had tears flooding down my face,” she said describing the procedure.
    “It was so traumatic. The only way I can describe the pain is similar to childbirth. I’d say it could have even been worse because I had an epidural during childbirth.”
    According to a best practice paper published by the Royal College of Obstetricians and Gynaecologists this year, women should be given accurate written and verbal information about hysteroscopies ahead of their appointment, including the various pain control options.
    Read full story
    Source: iNews, 4 June 2023
    Further reading on the hub:
    My experience of an outpatient hysteroscopy procedure - Patient stories Hysteroscopy: 6 calls for action to prevent avoidable harm Painful hysteroscopy - hub Community thread)  
  18. Patient Safety Learning
    Most GP practices in England are still using ‘archaic’ Lloyd George paper records despite a commitment to digitise them, HSJ has found.
    NHS England’s 2019 GP contract included a commitment to do away with the so-called “Lloyd George envelopes” – named after the early 20th century prime minister who introduced a pre-NHS health insurance scheme – and digitise them by 2022-23. The NHS stopped issuing new envelopes for first-time registrations in January 2021.
    But Freedom of Information requests submitted by HSJ have revealed that the famous brown paper records, some of them many decades old, are still widely used in England.
    Where they are still used, staff typically use electronic records for new information, but have to find and consult the paper records occasionally, when they need older information. This is less efficient than if the records had been digitised, and storing the paper records takes up several rooms in many practices.
    Read full story (paywalled)
    Source: HSJ, 5 June 2023
  19. Patient Safety Learning
    Women are finding it harder to access contraception than they did a decade ago, resulting in more unplanned pregnancies, the women’s health ambassador has said.
    They have been discouraged by bad experiences, a confusingly disjointed system and long delays for procedures such as the coil or implant insertion, according to Prof Lesley Regan, a leading gynaecologist who was appointed women’s health ambassador for England last year.
    She said that “destructive” changes made to the NHS commissioning system in England in 2012, which siloed GP surgeries from hospitals, were failing women. “If you’re not commissioned to deal with the problem, there’s no incentive to do a job properly … Contraception has got to be everybody’s business and up until this moment it’s been nobody’s responsibility and no one’s been accountable for it.”
    She added that the NHS preoccupation with cost was counterproductive as “contraception is the single most cost-effective intervention in healthcare”. She is pushing to get the progesterone-only pill, which took a decade to become available over the counter, made free in pharmacies so fewer women “fall through the cracks”.
    Read full story
    Source: The Guardian, 5 June 2023
  20. Patient Safety Learning
    A trust is carrying out a review after hundreds of patients were wrongly removed from the waiting list and potentially missed out on treatment.
    York and Scarborough Teaching Hospitals Foundation Trust told HSJ that roughly 800 patients of its referral to treatment waiting list, were affected.
    A serious incident was declared after it emerged some patients “had their referral to treat clocks stopped erroneously, resulting in patients not receiving treatment”, according to a report to the trust board.
    The trust said reviews were under way but had not yet identified any cases of “moderate or significant clinical harm”, although it admitted some patients had been significantly delayed.
    Read full story (paywalled)
    Source: HSJ, 2 June 2023
  21. Patient Safety Learning
    A controversial new Florida bill will allow physicians to opt out of performing certain services because of "sincerely held" religious, moral, or ethical beliefs.
    The bill, part of a "medical freedom" legislative package signed last week, permits healthcare providers to make conscience-based objections to providing medical care and protects them from getting sued or losing their licenses.
    Critics say the new law could exacerbate health disparities and lead to discrimination against certain groups of patients, including LGBTQ+ individuals and women seeking reproductive healthcare.
    Psychologists could refuse to treat someone for gender dysphoria, for example. Doctors could refuse to prescribe birth control, administer childhood vaccines, or accept patients with state insurance.
    Kenneth W. Goodman, professor and director of the University of Miami's Institute for Bioethics and Health Policy, told Medscape Medical News the legislation could upset a longstanding precedent.
    "To deny care based on unspecified and unarticulated 'moral, ethical, or religious reasons' opens the door to neglect, abandonment, and suspicion," Goodman said. "It undermines two millennia of a cornerstone of medical ethics: take care of your patients — no matter who they are."
    Read full story
    Source: Medscape, 18 May 2023
  22. Patient Safety Learning
    The NHS in England faces an uphill struggle to improve productivity as it confronts record waiting lists, with data suggesting that an increase in staff numbers alone will not transform its performance.
    Creaking infrastructure, a sicker population and a reliance on less experienced staff are hampering the health service’s attempts to treat people in greater numbers than before the pandemic, according to health experts.
    This difficult context is casting a shadow over the government’s goal that hospital waiting lists should be falling by the next election.
    Read full story (paywalled)
    Source: Financial Times, 1 June 2023
  23. Patient Safety Learning
    A trust director has stepped down after a row with consultants about the leadership culture within her department, HSJ  has learned.
    Pratima Gupta quit as director of women’s services at University Hospitals Birmingham Foundation Trust last week after a group of consultants expressed “no confidence” in her leadership. They claimed there was “intimidating and bullying behaviour” by individual managers.
    However, Ms Gupta said the allegations are untrue, and said she has faced “obstruction at almost every step” from some consultants when trying to improve training and culture within the department.
    Trainee doctors in obstetrics and gynaecology have previously expressed concerns around a lack of support from consultants, with the trust recently receiving a further warning around this from the General Medical Council and Health Education England.
    Read full story (paywalled)
    Source: HSJ, 1 June 2023
  24. Patient Safety Learning
    Failing mental health services that do not improve, whether run by private firms or the NHS, could be shut, a Care Quality Commission (CQC) chief has said.
    It follows the watchdog judging as "inadequate" three child wards at the Priory Group's biggest hospital.
    The wards at Cheadle Royal, near Manchester, "did not always provide safe care", the CQC found.
    The unannounced inspection of Cheadle Royal took place earlier this year "in response to concerns about safety". BBC News first reported in January three women had died at the hospital last year, although not in the wards inspected for this report.
    The CQC's new director of mental health services, Chris Dzikiti, said he was determined to drive up standards in all units and warned he will close services who fail to improve.
    Read full story
    Source: BBC News, 31 May 2023
  25. Patient Safety Learning
    A chief executive has compared a lack of investment into mental health estate to ‘institutionalised discrimination’, after no new schemes were accepted on to the ‘40 new hospitals’ programme.
    HSJ revealed that almost 50 capital projects from mental health trusts attempted to win one of the final places on the “new hospitals programme”, but all were taken by new acute schemes.
    Some of the trusts that submitted unsuccessful bids are using buildings which are more than 100 years old and were constructed without modern care practices in mind. Many of the bids raised safety concerns about the current estates.
    Joe Rafferty, chief executive of Mersey Care Foundation Trust, told HSJ: “If there’s been a priority order, mental health has been at the back of the queue.
    “It’s almost a sort of institutionalised discrimination in a way… there is a risk that the system itself is stigmatised or discriminated against mental health patients.
    Read full story (paywalled)
    Source: HSJ, 31 May 2023
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