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Patient Safety Learning

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  1. Patient Safety Learning
    Doctors at an east London hospital say they are seeing so many risky cases of laughing gas misuse that they have drawn up treatment guidelines for colleagues in the UK.
    Nitrous oxide, sold in metal canisters, is one of the most commonly used drugs by 16 to 24-year-olds.
    Heavy use can lead to a vitamin deficiency that damages nerves in the spinal cord.
    The Royal London Hospital team say medics need to be on alert.
    They have been seeing a new case almost every week.
    The guidelines, endorsed by the Association of British Neurologists and written with experts from Manchester, Birmingham, Nottingham and the Queen Mary University of London, warn doctors what to look for and how to treat.
    Read full story
    Source: BBC News, 23 February 2023
  2. Patient Safety Learning
    A US government watchdog called for greater federal oversight of ethics boards that sign off on scientific studies, finding that for-profit companies have taken an outsize role in approving certain research and questioning whether financial motivations could put human subjects at risk.
    Federal regulations require that certain research on human subjects — including those testing the safety of new drugs — first get approval from a registered institutional research board. These boards, which are made up of at least five members and can include researchers and academics, are designed to make sure that a study poses as little risk as possible and that participants have enough information to give consent.
    While the majority of these boards are affiliated with universities, a small number have no affiliation with institutions conducting research. But according to a new report from the U.S. Government Accountability Office (GAO), these independent boards now account for the largest share of reviews of studies involving new drugs and biologics.
    The GAO found that federal agencies overseeing the ethics panels inspect relatively few of them and lack ways to evaluate how well they protect people participating in research.
    Read full story (paywalled)
    Source: The Washington Post, 16 February 2023
     
  3. Patient Safety Learning
    NHS England has lost an employment tribunal case against a senior black nurse on grounds of race discrimination and whistleblowing, and has been criticised for serious flaws in its own investigations.
    A judgement published today found Michelle Cox, a black woman who was an NHS continuing healthcare manager based in NHSE’s North West regional team, was excluded by her manager “at every opportunity”.
    The case centres on problems between Ms Cox and her line manager, then regional head of continuing healthcare, which took place from around April 2019 to November 2020.
    The tribunal ruled Ms Cox's line manager– who is now an associate director of nursing in the West Yorkshire integrated care system – had created an “intimidating and hostile and humiliating environment” for Ms Cox, which had the purpose and effect of unlawful harassment.
    The tribunal also upheld Ms Cox’s complaint of detriment for whistleblowing, including for raising concerns that members of her team were sitting on continuing healthcare “independent review panels”, which she pointed out was a breach of independence and legal obligations.
    Read full story
    Source: HSJ, 22 February 2023
  4. Patient Safety Learning
    Three women who died under the care of a hospital's maternity unit may have survived if earlier recommendations had been implemented, a report has said.
    The cases occurred at University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust over 16 months.
    A review by the Healthcare Safety Investigation Branch (HSIB) also found a culture of intimidation and bullying.
    The report found that although there was no common theme to the deaths - and four other life-threatening cases that occurred in the same period - processes and leadership had been inconsistent and fragmented.
    HSIB said "robust action planning and prompt addressing of the learning" from previous recommendations from other investigations "may have had an impact on the outcome for the women who received care during the seven events included in this thematic review".
    Read full story
    Source: BBC News, 22 February 2023
  5. Patient Safety Learning
    Suicidal NHS staff will be left in “dangerous” situations without support when national funding for mental health hubs ends next month, health leaders have warned.
    The hubs, set up with £15 million of government funding for NHS workers following Covid, are being forced to close or reduce services as neither the Department for Health and Social Care nor the NHS has confirmed ongoing funding for 2023-24.
    This will leave thousands of NHS staff, some of whom are described as “suicidal” in “complete limbo”, The Independent has been told.
    The British Psychological Society (BPS) and the Association of Clinical Psychologists (ACP) said the failure to continue the funding was an “irresponsible” way to treat vulnerable health and care workers.
    Professor Mike Wang, chair of ACP, said: “There is a clinical responsibility, not to remove a service from individuals who are vulnerable, and in difficulty … the problem with that is that the funding ceases at the end of March and that’s absolutely no time at all to make any [future] provision. So, it’s clinically irresponsible to simply halt a service. Some of these individuals are, you know, carrying suicide risk.”
    He said it was “dangerous” and “astonishing” that funding for the hubs was ending “given the present circumstances of continuing effects of the pandemic, clear evidence of underfunding of health care in this country”.
    Read full story
    Source: The Independent, 22 February 2023
  6. Patient Safety Learning
    The London Ambulance Service (LAS) failing on diversity and must implement specific targets for improvements, its leadership has been warned.
    According to LAS data, just 20% of the workforce is from a Black, Asian or from a minority ethnic background despite almost half of the capital’s population (46.2%) being made up of non-white communities.
    Of that 20%, 40.9% are in the lowest paid roles, compared to 15.9% who are in the highest wage bands, according to the LAS’ Integrated Performance report.
    The LAS is in the process of developing a new strategy to help attract more diverse staff, which will be published early next year.
    Research shows that ethnic minority groups suffer disproportionately higher levels of inadequate ambulance care due to a combination of issues such as a lack of cultural awareness among professionals, language and communication difficulties and a limited understanding of how the healthcare system operates for some minority groups.
    Read full story
    Source: The Independent, 21 February 2023
  7. Patient Safety Learning
    Health Secretary Stephen Barclay is to meet Royal College of Nursing bosses for pay talks later, after the union suspended next week's planned strike.
    In a joint statement, after months of bitter dispute, the two sides said they would begin "intensive talks" on "pay, terms and conditions" and "reforms to enhance productivity".
    Next week's walkout in England, from 1 to 3 March, was set to be the biggest strike of this winter's pay dispute, with half of frontline services affected.
    The action would have included nursing staff from intensive care units, cancer care and other services that were previously exempted.
    RCN general secretary Pat Cullen said: "We will put our plans on the table, they can put their plans on the table - but I'm confident that we will come out with a fair pay settlement for our nursing staff."
    She added they would make sure no stone was left unturned and a fair pay deal was reached as quickly as possible so they could end the strikes.
    Read full story 
    Source: BBC News, 22 February 2023
  8. Patient Safety Learning
    Doctors have warned that patient safety is being put at risk by the state of crumbling NHS hospitals which have fallen into potentially dangerous disrepair, an ITV News investigation has found. 
    Year-long leaks, collapsing floors, ageing roofs and potential for falling stone are among the issues exposed in the investigation - which have caused whole wards to be closed down. 
    One doctor told ITV News conditions are so poor in hospitals she has worked in that “we are always just hoping that the next time something happens it does not cause something catastrophic.”Half of the 87 hospital trusts in England that responded to our Freedom of Information requests had at least one unresolved structural or maintenance issue, as of October 2022.
    Footage shared with ITV News by staff working in NHS hospitals lays bare some of the appalling conditions doctors are forced to treat patients in every day.
    Some leaks have been so severe they flood and close entire corridors, while some wards have become so unsafe they have been permanently shut.
    Read full story
    Source: ITV News, 22 February 2023
  9. Patient Safety Learning
    A new report has condemned ‘serious issues’ with NHS referral processes, amid findings that one in five patient referrals made by GPs went into a ‘black hole’.
    Healthwatch England said that 21% of people they spoke to with a GP referral to another NHS service were rejected, not followed up on or sent back to general practice.
    The watchdog said that more support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to ‘communication failures’ following a referral.
    According to the findings, the failures were due to GP teams not sending referrals, referrals going missing between services, or being either booked or rejected by hospitals without any communication.
    Louise Ansari, Healthwatch England’s national director, said that thousands of people told the watchdog that the process is ‘far from straightforward.’
    She said: "Falling into this “referrals black hole” is not just frustrating for patients but ultimately means people end up going back to their GP or visiting crowded A&E departments to get the help they need.
    "This adds more burden to already stretched services, making things even harder for the doctors and nurses trying to provide care."
    Read full story
    Source: Pulse, 20 February 2023
  10. Patient Safety Learning
    Hundreds of thousands of women could benefit from cheaper hormone replacement therapy (HRT) as part of a scheme to cut prescription costs.
    The Department of Health said that from April, women prescribed HRT as part of menopause treatment will be able to access a new scheme to enable access to a year’s worth of treatment for just under £20.
    The announcement follows the publication of the government’s women’s health strategy for England last summer.
    Minister for Women Maria Caulfield said: “Around three-quarters of women will experience menopause symptoms, with one-quarter experiencing severe symptoms, which can seriously impact their quality of life.
    “Reducing the cost of HRT is a huge moment for improving women’s health in this country, and I am proud to be announcing this momentous step forward.
    “In our Women’s Health Strategy, we made menopause a top priority – by making HRT more accessible, we’re delivering on our commitment to women.”
    Read full story
    Source: The Independent, 21 February 2023
  11. Patient Safety Learning
    Donor organs should no longer go to the nearest in-need patient, an official report has recommended. 
    Instead, specialised organ centres across the country will be responsible for preserving, repairing and matching an organ with the most needy individual on the transplant register, irrespective of location.
    An official report commissioned by the Department for Health and Social Care and headed up by Prof Stephen Powis, the national medical director for England, has recommended 12 changes to further improve donation. 
    Among the recommendations – which have been backed by the Government and are expected to be implemented in the coming weeks – is equal access to organ donation services “irrespective of personal circumstances, including ethnicity, geography, socio-economic status or sex”.
    Read full story (paywalled)
    Source: The Telegraph, 21 February 2023
  12. Patient Safety Learning
    Hundreds of thousands of children are waiting for surgery as new figures show the backlog has spiralled by almost 50 per cent in two years.
    The latest NHS data for December lays bare the parlous state of paediatric medicine, with NHS leaders and doctors warning that adult care is being prioritised over children’s.
    In December 2022, 364,000 children were waiting for treatment, from neurosurgery to ear, nose and throat operations, while a further 200,000 needed community services such as speech and language therapy.
    The surgery figure is up by 48%t since April 2021 – a far bigger increase than was seen in the overall NHS waiting list, which grew by 36% over the same period.
    Mike McKean, vice-president of policy at the Royal College of Paediatrics and Child Health, said “Lengthy waits are unacceptable for any patient, but for children and young people, waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage. It is not the same as for adults. If you miss the right window to treat a child, or wait too long, the consequences can be irrevocable.”
    Read full story
    Source: The Independent, 19 February 2023
  13. Patient Safety Learning
    Healthcare workers are “absolutely shattered” and unless something is done to address the crisis in morale, staffing and training then “they won’t be there when you need them”, one of the world’s leading scientists has warned.
    Speaking to the Guardian, Prof Jeremy Farrar, the director of Wellcome and soon to be chief scientist of the World Health Organization, warned that healthcare workers would not be ready should another crisis hit.
    “This is a global issue, which I think is hugely concerning. It’s certainly true in this country,” he said. “The resilience of healthcare workers, broadly defined from ambulance drivers to nurses to doctors, to care workers in social care, etc. They’re shattered. They are absolutely shattered."
    Farrar said: “I think we have to address the morale, staffing, the training, everything from public health physicians to care workers, to doctors and nurses and physios and everybody in between because there’s very little spare capacity in any system globally. It’s particularly true in the UK. As you can see from the strikes, morale and resilience is very thin.”
    Read full story
    Source: The Guardian, 20 February 2023
  14. Patient Safety Learning
    The trust at the centre of a maternity scandal has been ordered to report on urgent improvements in services for women and babies, amid ‘significant concerns’ about the risk of harm.
    The Care Quality Commission (CQC) used its enforcement powers to issue the conditions on East Kent Hospitals University Foundation Trust, after it carried out an unannounced inspection last month.
    However, the “section 31” warning letter has just been made public, and the first deadline for the trust to report back to the CQC is Monday (20 February).
    The CQC said some of the problems it found were due to the labour ward environment – but others involved monitoring of women and babies whose conditions deteriorate and the risk of cross-infection due to poor cleanliness standards.
    “We have significant concerns about the ongoing wider risk of harm to patients and a need for greater recognition by the trust of the steps that can be taken in the interim to ensure safety and an improved quality of care,” Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said in a statement today.
    Read full story (paywalled)
    Source: HSJ, 17 February 2023
  15. Patient Safety Learning
    The British Medical Association has accused the government of "reckless" behaviour ahead of the results of a strike ballot by junior doctors.
    The BMA's Professor Philip Banfield said the prime minister and health secretary were refusing to enter meaningful negotiations with unions.
    The Department of Health and Social Care said it had met with the BMA and other unions to discuss pay.
    Professor Banfield, the BMA's chair of council, said that Rishi Sunak and Health Secretary Steve Barclay were "standing on the precipice of an historic mistake".
    He accused the government of "guaranteeing escalation", adding that officials were "reckless" for thinking they could stay silent and wait it out.
    Professor Banfield also accused the government of "letting patients down", adding: "All NHS staff are standing up for our patients in a system that seems to have forgotten that valuing staff and their well-being is directly linked to patient safety and better outcomes of care."
    Read full story
    Source: BBC News, 19 February 2023
  16. Patient Safety Learning
    While some people avoided seeking medical care during the worst of the pandemic, worried about the risk of infection or unable to get an appointment because hospitals and doctors were overwhelmed, now many in the USA are finding that inflation and the uncertain economy have thrown up another barrier.
    “We are starting to see some individuals who are putting off some care, especially preventive care, due to the costs,” said Dr. Tochi Iroku-Malize, the president of the American Academy of Family Physicians and the chair of family medicine for Northwell Health in New York. Choosing between going to the doctor or paying for rent and food, “the health issue is no longer the priority,” she said.
    With the prices of prescription drugs, hospital stays and other treatments expected to increase significantly this year and next, some doctors expect families to have an even harder time affording medical care. 
    When Margaret Bell, 71, found that her cancer had returned four years ago, she hesitated to resume her chemotherapy because she could not afford it, and higher prices have made it even harder. She would regularly skip appointments.
    About one-fourth of respondents in a recent Gallup poll said they put off care last year for what they considered a “serious” condition.
    Read full story (paywalled)
    Source: New York Times, 16 February 2023
  17. Patient Safety Learning
    The National Institute for Health and Care Excellence (NICE) has decided not to recommend Evusheld for adults who are unlikely to have an adequate immune response or cannot have the vaccine against Covid-19, citing a lack of evidence that it is effective against circulating variants.
    However, it is still reviewing whether the antibody drug could be used to prevent covid-19 infection in adults at the highest risk of severe illness, including people with immunodeficiency, people who have had a solid organ transplant, and people with cancer.
    NICE’s director of medicines evaluation, Helen Knight, acknowledged that the decision would be “disappointing for the many thousands” of vulnerable people who “continue to significantly modify their behaviour to avoid infection.
    Commenting on NICE’s decision, Lennard Lee, senior clinical research fellow at the University of Birmingham, said, “While it’s right for NICE to ensure that treatment options are based on the best possible evidence for their safety, efficacy, and cost effectiveness, it must be recognised that those who remain extremely vulnerable to covid need to be prioritised in trials akin to those early days of the pandemic to find treatments fit for them.
    “Otherwise, we run the risk of consigning half a million people to continue to live in 2020, stuck in their homes, not able to see their families and friends for fear of infection with no protection.”
    Read full story
    Source: The BMJ, 16 February 2023
  18. Patient Safety Learning
    One in three prisoners in Europe suffer from mental health disorders, the World Health Organization (WHO) has said in a new report.
    While European prisons managed adequate COVID-19 pandemic responses for inmates, concerns remain about poor mental health services, overcrowding and suicide rates, the report stated.
    “Prisons are embedded in communities and investments made in the health of people in prison becomes a community dividend,” said Dr. Hans Henri P. Kluge, regional director of the WHO regional office for Europe. “Incarceration should never become a sentence to poorer health. All citizens are entitled to good-quality health care regardless of their legal status.”
    The second status report on prison health in the WHO European region provides an overview of the performance of prisons in the region based on survey data from 36 countries, where more than 600,000 people are incarcerated. Findings showed that the most prevalent condition among people in prison was mental health disorders, affecting 32.8% of the prison population.
    The report drew attention to several areas of concern, including overcrowding and a lack of services for mental health, which represents the greatest health need among people in prison across the region.
    The most common cause of death in prisons was suicide, with a much higher rate than in the wider community, the report found.
    Read full story
    Source: United Nations, 14 February 2023
  19. Patient Safety Learning
    Pradeep Gill can see very little of the intense activity around him. He is leaning back in a reclining chair inside one of Heatherwood Hospital's operating theatres.
    Buzzing around him is the operating team, led by consultant orthopaedic surgeon Jeremy Granville-Chapman.
    For the surgeon and his team, this procedure is the very definition of routine. They have carried out more than 1,000 joint operations in the past 10 months.
    Heatherwood Hospital, part of the Frimley Health NHS Foundation Trust, is a specialist elective hub where patients can come in for routine but life-changing surgery at a super-charged pace with theatres working at full tilt, six days a week.
    It is busy. But it is a good-busy, not the bad-busy we have come to associate with the NHS during this winter crisis.
    The site opened in March last year and Frimley's hospital executives are keen to stress the impact it has made.
    "As a specialist planned care facility, Heatherwood has been able to perform surgery six days a week with four out of its six state-of-the-art theatres dedicated to orthopaedic procedures," it said in a press release.
    "The hospital has also successfully reduced the length of time patients stay in hospital, with 40% of patients safely discharged within 24 hours."
    This is the practice the NHS wants to adopt as it battles a record seven-million-strong waiting list.
    Heatherwood can do that because the hospital is ring-fenced from acute pressures that affect other hospitals, as one its most senior orthopaedic surgeons, Mr Rakesh Kucheira, explained.
    "We have now realised that winter pressures are 12 months not just three months, which means the acute sites are not going to be able to do planned activity that they planned for, so we've got to create more space," he said.
    Read full story
    Source: Sky News, 9 March 2023
  20. Patient Safety Learning
    The chief executive of pharma group Novo Nordisk has apologised for breaking the UK industry code by failing to disclose its sponsorship of obesity and weight management training courses for healthcare professionals that also promoted its weight loss drug.
    The webinars, which were viewed by thousands of healthcare professionals, preferentially included positive information about Novo’s weight loss drug Saxenda, which the self-regulatory watchdog deemed a “disguised” large-scale promotional campaign. 
    The industry self-regulatory body published a strongly worded reprimand last year, saying it was “concerned about the company’s compliance culture . . . internal governance systems and processes, and a perceived naivety and lack of accountability from Novo Nordisk”.
    It also said it was concerned about “the potential impact on patient safety” because the webinars, which were run by a third-party provider but sponsored by Novo, showed a “lack of balance” in how they compared the side effects of Saxenda and its competitors.
    Read full story (paywalled)
    Source: The Financial Times, 12 February 2023
  21. Patient Safety Learning
    A coroner has urged the health secretary to take action to prevent needless deaths after a woman died of heart failure following a four-hour wait in the back of an ambulance.
    Lyn Brind, 61, was taken to the Queen Elizabeth Hospital (QEH) in King’s Lynn, Norfolk, with chest pains and low blood oxygen levels but could not be admitted because the hospital had “no space”. Instead she remained in a queue of ambulances outside A&E without a timely diagnosis or treatment and where warning signs about her condition were missed.
    It was only after four hours and 25 minutes of waiting that she was transferred to a ward, by which time she was “agitated and short of breath”. She was placed on life support but died 22 minutes later.
    Brind’s family believe the grandmother of four, a former dinner lady from the town, “might still be alive today” had she been admitted more swiftly. “She wasn’t given a chance,” her partner of 38 years, Richard Bunton, said.
    After an inquest earlier this month into Brind’s death in May 2022, the senior coroner for Norfolk, Jacqueline Lake, took the unusual step of writing to England’s health secretary, Steve Barclay, to raise concerns about the NHS and social care.
    She warned that others could die in similar circumstances unless action was taken. “I believe you have the power to take such action,” Lake wrote in a prevention of future deaths report.
    Read full story
    Source: The Guardian, 29 January 2023
  22. Patient Safety Learning
    Hundreds of thousands of older people in England are having to endure chronic pain, anxiety and unmet support needs owing to the worsening shortage of social care staff and care home beds.
    Age UK has said older people with chronic conditions such as diabetes, high blood pressure and heart failure are increasingly struggling with living in their own homes because of a lack of help with everyday tasks such as getting out of bed, dressing and eating.
    The decline in the amount of support and care provided to older people is piling pressure on families and carers and leaving the NHS in constant crisis mode, contributing heavily to ambulance queues outside A&E departments, the charity said in a new report
    It warned that there would be a repeat of the NHS crisis this winter – in which rising numbers of elderly people have been unnecessarily stuck in hospital because of an acute lack of social care – without a shift to preventing unnecessary admissions.
    Read full story
    Source: The Guardian, 17 February 2023
  23. Patient Safety Learning
    Two health watchdogs have issued safety warnings after junior staff were left to work unsupervised on maternity wards previously criticised after a baby’s death.
    Training regulator, Health Education England (HEE), criticised the “unacceptable” behaviour of consultants who left junior doctors to work without any superiors at South Devon and Torbay Hospital Foundation Trust’s wards.
    The maternity safety watchdog Healthcare Safety Investigation Branch (HSIB) also raised “urgent concerns” over student midwives and “unregistered midwives” providing care without supervision.
    The latest criticism comes after the trust was condemned over the death of Arabella Sparkes, who lived just 17 days in May 2020 after she was starved of oxygen.
    According to a report from December 2022, seen by The Independent, the HEE was forced to review how trainees were working at the trust’s maternity department after concerns were raised to the regulator. It was the second visit carried out following concerns about the department, and reviewers found there had been “slow progress” against concerns raised a year earlier.
    Read full story
    Source: The Independent, 16 February 2023
  24. Patient Safety Learning
    Nurses will walk out of emergency departments, intensive care units and cancer care services for the first time in the next wave of strike action.
    The Royal College of Nursing (RCN) has announced its members will strike for 48 hours, from 6am on 1 March until 6am on 3 March and that a range of derogations will be removed, including emergency care cover. 
    More than 120 NHS organisations — covering all types of providers, integrated care systems and national organisations (see map below) — will be affected by the RCN’s walkout next month as it represents the most significant escalation of strike action yet by nurses.
    Previously, quite extensive exemptions (known as “derogations”) have been agreed, but the RCN has this time indicated they will be much more limited. 
    HSJ asked the RCN what services will remain subject to national derogations, but a spokesman said discussions are continuing at a national level as part of a commitment to “life and limb care”.
    He added services will be reduced to an “absolute minimum” and hospitals will be asked to rely on members of other unions and clinical professions instead.
    Read full story (paywalled)
    Source: HSJ, 16 February 2023
  25. Patient Safety Learning
    A training programme is providing people with the skills to care for loved ones suffering from serious conditions at home in their final days.
    Sarah Bow's partner Gary White, from Somerset, was 55 when he was diagnosed with motor neurone disease in 2021.
    A team from NHS Somerset provided personalised training to Ms Bow which allowed the couple to spend the final 13 months of his life together at home.
    The Somerset NHS Foundation Trust social care training team made visits to the couple's home as Mr White's condition progressed, to provide advice and guidance to Ms Bow.
    The service was set up in November 2021 to provide free NHS standardised training and competency assessments in clinical skills to people involved in social care.
    Ms Bow said the scheme had helped them spend more time together doing the things Mr White enjoyed.
    "Being able to care for him meant we could have so many precious moments before he died," she said.
    The training in a variety of skills including like catheters and injections, aims to reduce hospital admissions and improve patient discharge times.
    Read full story
    Source: BBC News, 17 February 2023
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