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Patient Safety Learning

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  1. News Article
    A planned Amazon-style delivery system for personal protective equipment to care workers will not be nationally available for at least another fortnight, the housing and communities secretary has told MPs, before weekly figures for deaths in care and nursing homes which are on course to rise by more than 2,000. Robert Jenrick told the housing, communities and local government select committee on Monday that the logistics system for PPE could take three more weeks to launch. Clipper Logistics was contracted by the government at the end of March and care home operators have been increasingly outspoken in their warnings that a lack of masks, aprons, gloves, gowns and face shields is causing the spread of the virus in their facilities and putting workers’ lives at risk. About 340 people a day have been dying in care homes of COVID-19, according to official figures. The largest private care home provider, HC-One, said on Monday that 703 of its residents had died across the UK while last week, Sam Monaghan, the chief executive of MHA, the largest charitable provider, warned: “Our residents and staff have not received the enhanced level of protection they need. The government will be held to account for this.” Read full story Source: The Guardian, 4 May 2020
  2. News Article
    Local authorities must be at the heart of contact tracing because COVID-19 is best understood as a pattern of local outbreaks rather than a national pandemic, says Sir Chris Ham and Robin Tuddenham in an HSJ article. Community testing and contact tracing represent our greatest hope for managing the risks to health of COVID-19 until a vaccine and effective treatments become available. Experts in infectious disease base their understanding of this on previous pandemics, and the experience of countries like South Korea and Germany. Work is underway at pace to resume contact tracking and tracing in England. It is understood that this programme will begin in earnest from 18 May following a pilot on the Isle of Wight. This work is a core part of Matt Hancock’s five-point plan for combating COVID-19, in support of some relaxation of lockdown anticipated soon. Whilst the pace is understandable, the methods and approach taken are top down, lack an effective role for key regional co-ordination through the Integrated Care Systems/Sustainability and Transformation Partnerships and Local Resilience Forums, and risk marginalising the essential skills of local authorities, GPs and the voluntary and community sector in place, according to Ham amd Tuddenham. Read full story Source: HSJ, 5 May 2020
  3. Content Article
    In the summer of 2019, following a televised Panorama programme showing abusive care of people with learning disabilities and/or autism in Whorlton Hall (an independent hospital in the north of England), the Care Quality Commission (CQC) requested an independent review of its inspections of Whorlton Hall. Professor Glynis Murphy was appointed to conduct the review.
  4. Content Article
    On Thursday 28 April, Q’s Organisational Resilience & Safety-II group organised a special zoom session to explore how practice is changing in the light of our COVID-19 response. Follow a virtual meeting discussing Safety-II in action during COVID-19, hosts Simon Gill, Suzette Woodward and Paul Stretton share a summary of insights from the session.
  5. Content Article
    Is a focus on wellbeing a ‘nice thing to do’ in organisations, or are there more fundamental arguments? In this article in Hindsight, Suzanne Shale outlines ethical arguments for making wellbeing a priority.
  6. News Article
    More than 170 carers have called a whistleblowing helpline since the start of the COVID-19 outbreak, according to a report that highlights the voices of frontline workers and lays bare a catalogue of safety concerns. Compassion in Care, which operates the helpline for care workers, says it is seeing the whistleblowing process move at “unprecedented speed” as the coronavirus crisis unfolds, with many concerns being ignored. With the coronavirus death toll mounting in care homes, the charity’s report flags the “horrendous” unsafe conditions workers are facing amid concerns over lack of personal protective equipment (PPE), as well as the impact on carers’ mental health. One whistleblower likens the situation to a “war zone” with people struggling to breathe, while another describes the pain of not having the time, because of the overwhelming workload, to even hold distressed residents’ hands. In a new report, titled When the Silence Wins, Compassion in Care’s founder, Eileen Chubb, who is herself a former care whistleblower, writes: “During this crisis I have experienced the whistleblowing process moving at unprecedented speed, at such a high-volume and involving whistleblowing issues that are without exception extremely serious." “What is emerging from these cases is a lack of action by employers in response to genuine concerns." Read full story Source: The Guardian, 6 May 2020
  7. News Article
    Hospitals are continuing to discharge patients infected with Covid-19 into Britain’s struggling care homes, despite new figures showing deaths in the care sector still rising while those in hospitals are falling. Deputy chief scientific adviser Dame Angela McLean revealed the government was now seriously concerned about the scale of the outbreak in care homes. She said the number of deaths was now almost half of those in hospitals adding: “There is a real issue that we need to get to grips with.” In March care homes were told they had to accept thousands of patients discharged from hospitals to help hospitals free up 33,000 beds ahead of the coronavirus surge. But due to a lack of community testing it was not possible to test all patients, meaning the virus may have been able to spread without detection. Public Health England data last week showed the virus has now established itself in more than 4,500 care homes across the country. Sarah Scobie from the Nuffield Trust health think tank said: “The vulnerable social care sector is now becoming the epicentre of the COVID-19 pandemic in this country. Despite a very small decrease in overall deaths from the previous week, the numbers in care homes are still growing." Read full story Source: The Independent, 6 May 2020
  8. News Article
    The NHS faces a new set of wide-ranging requirements as part of a comprehensive plan to mitigate the impact of COVID-19 on black, Asian and minority ethnic staff, HSJ has discovered. A draft NHS England/NHS Improvement document, seen by HSJ, proposes trusts ensure every staff member has “a risk assessment to keep them safe”. It says the centre will provide: “Guidance and support to employers on creating proactive approaches to risk assessment for BAME staff, including physical and mental health.” The document, Addressing Impact of Covid-19 on BAME Staff in the NHS, will call for five actions: 1. Every member of staff, current and returning, will have a risk assessment to keep them safe. 2. Every organisation with a CEO, and for primary care CCGs and ICSs, needs a BAME co-leader. 3. Diversity at every level of the health and care system starts with the podium, through our senior decision-making forums and across all organisations and at all levels of the workforce. 4. A bespoke health and wellbeing (including rehab and recovery) offer for BAME staff will be developed and rolled out for the system. 5. Every part of the system will use guidance on increasing diversity and inclusion in communications will be produced, led by the system. Read full story Source: HSJ, 6 April 2020
  9. Content Article
    A blog published in the Metro from a London hospital cleaner on how he is trying to keep himself safe during the coronavirus. "There are always fears you're going to get coronavirus but I try not to overthink it too much".
  10. News Article
    A Nottingham mum recovering from breast cancer surgery said she 'hates to think' what could have happened, if she had let the cancer go undetected. Claire Knee, 45 of Beeston, was diagnosed with breast cancer in March shortly before lockdown measures were introduced. Having felt slightly off and noticing lumps in her breast, she was encouraged to contact her GP who referred her for tests. After a serious of diagnostic tests at Nottingham City Hospital's Breast Institute, specialists confirmed the presence of a tumour in the early stages. Surgeons successfully removed the tumour from her right breast amid the pandemic and Claire has been recommended some follow up treatment. She now wants to share her experience of seeking help and getting treatment to advise others who may be showing signs of cancer but are too scared to contact their GP. "Looking back I just think that if I hadn’t made the call to my GP I would be walking around with undetected breast cancer, which could still be growing now. I would urge anyone in similar circumstances to contact their GP and get checked - even if it’s just for peace of mind.” Read full story Source: Nottinghamshire Live, 4 May
  11. Content Article
    Calum McGregor shares with the Q Community practical tips and tools to help with team-working and staff wellbeing during the COVID-19 pandemic. Calum highlights some principles and examples which have helped with team-working in his Acute Medical Unit recently and in the past.
  12. News Article
    The health secretary Matt Hancock has been threatened with a judicial review amid fears patients’ human rights are at risk from the incorrect use of controversial do not resuscitate orders during the coronavirus pandemic. Ministers have been told they should use emergency powers to issue a direction to doctors and nurses in the NHS requiring them to comply with the law on do not attempt resuscitation orders (DNARS) and to ensure patients are properly consulted. In recent weeks there have been a number of reports of patients having DNARs put in place without their knowledge or in GPs imposing blanket decisions, prompting a warning letter from NHS England’s chief nurse last month. The legal action is being brought by Kate Masters, the daughter of Janet Tracey, who died at Addenbrooke's hospital in 2011 after a DNAR was put in place without her knowledge. In 2014, Tracey's husband David won a landmark victory at the Court of Appeal which gave patients a new legal right to be consulted by doctors when DNARS were being considered. Not consulting a patient was a breach of their human rights, the court ruled. Read full story Source: The Independent, 6 May 2020
  13. Content Article
    Perioperative care is the Integrated care across the full patient pathway before, during and after surgery. Perioperative care, also referred to as perioperative medicine, is the practice of patient-centered, multidisciplinary, and integrated medical care of patients from the moment of contemplation of surgery until full recovery. The Centre for Perioperative Care has produced a video on what good perioperative care looks like and a number or resources and advice on the perioperative journey.
  14. News Article
    Pregnancy support helplines are experiencing a massive spike in distressed pregnant women asking for urgent help as charities warn coronavirus upheaval is placing pregnant women at risk. Frontline service providers warn mothers-to-be are anxious about whether they will be denied pain relief options and be separated from their newborn babies due to them being put in neonatal units. Birthrights, a maternity care charity, found enquiries to its advice line in March were up by 464 per cent in comparison to March last year. Women getting in touch also raised concerns about home birth services being withdrawn, midwifery-led birth centres shutting their doors and elective caesareans being discontinued due to the COVID-19 crisis. Baby charity Tommy’s experienced a 71% surge in demand for advice from midwives on its pregnancy helpline last month. The organisation warned coronavirus turmoil is placing pregnant women at risk after their midwives answered 514 urgent calls for help in April which is a sizeable rise from the 300 enquiries they would generally get. Jane Brewin, the charity’s chief executive, said: “Antenatal care is vital for the wellbeing of mother and baby – but the coronavirus outbreak means that many don’t know who they can ask for help, or don’t want to bother our busy and beloved NHS." “Although services are adapting, they are still running, so pregnant women should not hesitate to raise concerns with their midwife and go to appointments when invited. The large increase in people contacting us demonstrates that coronavirus is creating extra confusion and anxiety for parents-to-be, making midwives’ expert advice and support even more important at this time.” Read full story Source: The Independent, 5 May 2020
  15. News Article
    Today is International Day of the Midwife. Each year since 1992, the International Confederation of Midwives leads global recognition and celebration of the great work midwives do. Take a look at some of the resources and blogs we have recently published on the hub highlighting the work midwives are doing to support mothers and families during the coronavirus pandemic and the challenges services face. Home births, fears and patient safety amid COVID-19 Midwifery during COVID-19: A personal account Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic Birthrights: COVID-19
  16. News Article
    Isolation during lockdown is exacerbating psychosis in some patients, a consultant psychiatrist at a leading mental-health trust warns. Steve Church said the South London and Maudsley NHS Trust had now had to shift its focus to crisis management. He leads the psychosis recovery team, one of the trust's five teams helping patients struggling with their mental health during the coronavirus pandemic. Some have had to move homes to isolate and many no longer visit the clinic. Dr Church, who has been working in the field for almost three decades, said: "In normal times, and we're not in normal times, the whole treatment is about trying to help people not self-isolate, trying to help people to re-engage with society. "Self-isolation is one of the red flag-hallmarks of somebody becoming unwell in the first place, where they take themselves into a psychosis-induced lockdown." One of his patients, Tracey, told Dr Church, in a phone consultation, staying at home had increased her hallucinations. "It's been quite daunting," she said. "I do hear the voices a little bit more now. They're domineering - they tell me to run across the road and they're following me and they say horrible and nasty things." Read full story Source: BBC News, 5 May 2020
  17. News Article
    A leading doctor has called on the government to address regional health inequalities surrounding coronavirus. Dr George Rae, the British Medical Association's regional chairman for the North East, has written an open letter saying the area is "suffering disproportionately". He said it was "time to ask why" and wanted action to "close the gap". A government spokesman said it was working "incredibly hard" to protect the nation's public health. "This is gravely disconcerting," Dr Rae wrote. "Not only does this mean that we're suffering from a disproportionate amount of serious cases and deaths but also that, as a consequence, gradual lockdown measures may be affected - prolonging the hurt caused to our local economy. Covid-19 has shone a light on the health inequalities in the North East". "What we need now is action from the government to close this gap and reduce the vulnerability of people in the North East to many medical conditions and, indeed, any future viruses." Read full story Source: BBC News, 5 May 2020
  18. News Article
    An NHS app that aims to track the spread of coronavirus is being rolled out for the first time, as part of a trial on the Isle of Wight. Council and healthcare workers will be the first to try the contact-tracing app, with the rest of the island able to download it from Thursday. The app aims to quickly trace recent contacts of anyone who tests positive for the virus. However, the new NHS coronavirus app will have “unintended consequences”, according to the head of the unit developing it. Officials do not know “exactly how it will work”, Matthew Gould, chief executive of NHSX, told a parliamentary committee. “There will be unintended consequences, there will for sure be some things we have to evolve,” he said. Privacy campaigners have raised concern over the potential for “mission creep” with the data that will be gathered on people’s movements and contact with others. The Health Service Journal reported that it has not yet passed tests on cyber security, performance and clinical safety needed to be included in the NHS app library. Read full story Source: The Independent, 4 May 2020
  19. Content Article
    Philip Anderson’s able-bodied daughter, Lucy, joins Philip in sharing their perspectives of positive developments during the coronavirus lockdown, and their hopes for the future. Philip acquired a debilitating rare disease and has had to learn to live with remorseless erosion of his physical capacity, and increasing dependency. "I confess that when I was able-bodied, I was not aware of the extent of restrictions imposed by organisations on those with physical impairments. I’m only as disabled by the choices others make, rather than by loss of my motivation to live life ‘normally'. I hope that many who are experiencing some of our restrictions for the first time, will be passionate advocates for those with disability," says Philip in this thought-provoking article published in Independent Living.
  20. Content Article
    We can use what we’ve learned from the crisis to make a 21st-century service fit for patients and staff alike, says Joel Schamroth in a blog to the Guardian. This pandemic is forcing us to rethink how we deliver healthcare. For too long patients have experienced fragmented services, administrative hurdles and unreliable lines of communication. The “patient experience” often remains an afterthought in the NHS, leading to worse health outcomes, and costing the NHS dearly. The lesson the public is learning is that money can be made available when it’s deemed to be important. In a matter of weeks COVID-19 has shown us that change is possible. 
  21. News Article
    Public Health England PHE) has made new changes to its guidance on the use of face masks as “a pragmatic approach for times of severe shortage”. The update came as trust procurement leads reported receiving substandard face masks from national stocks over the weekend, although a PHE spokesman told HSJ that this had not caused the change to guidance. PHE on Sunday updated its guidance on the use of certain facemasks facing “acute shortages”. The new advice states that FFP2 respirators can be worn without fit testing in lieu of surgical masks in non-surgical settings. The new guidance says: “This is a pragmatic approach for times of severe shortage of respiratory protective equipment, FFP2 respirators being used in this way will not be carrying out the function they were designed to perform.” However, FFP2 respirators must still be properly fit-tested in situations where this level of protection is required, the new PHE advice states. Read full story Source: 4 May 2020
  22. Content Article
    Good quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. McInnes et al. used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan.
  23. Content Article
    The Florence Nightingale Foundation has launched an NHS leadership support service, Nightingale Frontline.
  24. Content Article
    Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitisers or irritants, including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review from Mazurek and Weissman focuses on allergic occupational respiratory diseases in HCWs.
  25. News Article
    Doctors should reassure parents and carers of children who are immunocompromised that immunosuppression does not seem to increase the risk of severe COVID-19, the UK National Institute for Health and Care Excellence (NICE) advises in a rapid guideline. “Covid-19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised,” NICE says. Children and teenagers who are immunocompromised and their carers may be feeling particularly anxious and fearful about covid-19, so it is important they are involved in decision making as much as possible, NICE advises. Doctors should also support patients’ and carers’ mental wellbeing through communication and by signposting to charities and support groups. The guideline says that patients should not avoid their usual appointments unless they have been told to and should continue with their usual treatment. However, face-to-face contact should be reduced where safely possible and alternative approaches such as telephone, video, or email consultations used instead. When deciding whether to start treatments that affect the immune system, doctors should discuss the risks and benefits with the patient and their carers. If it is safe to delay treatment then watchful waiting should be undertaken. Read full story Source: BMJ, 1 May 2020
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