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Found 2,343 results
  1. Content Article
    As the death toll from COVID-19 rapidly increases, the need to make a timely and accurate diagnosis has never been greater. Even before the pandemic, diagnostic errors (i.e., missed, delayed, and incorrect diagnoses) had been one of the leading contributors to harm in health care.  The COVID-19 pandemic is likely to increase the risk of such errors. Based on emerging literature and collaborative discussions across the globe, Gandhi and Singh propose a new typology of diagnostic errors of concern in the COVID-19 era. These errors span the entire continuum of care and have both systems-based and cognitive origins. While some errors arise from previously described clinical reasoning fallacies, others are unique to the pandemic. We provide a user-friendly nomenclature while describing eight types of diagnostic errors and highlight mitigation strategies to reduce potential preventable harm caused by those errors.
  2. News Article
    Deaths resulting from COVID-19 infection account for only half of the number of excess deaths taking place in private homes, expert analysis of latest data suggests. Figures from the Office for National Statistics from the seven weeks to 15 May show that more than 40 000 COVID-19 deaths have now taken place in hospitals, care homes, and private homes in England and Wales. The figures also show 14 418 excess non-covid deaths. Although COVID-19 was mentioned on death certificates 13 500 times in care homes and private homes over the past seven weeks, some 23 500 more non-covid deaths have taken place in the community than would be expected. Discussing the data, David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said that “as soon as the pandemic started we saw a huge immediate spike in non-covid deaths in [private] homes that occurred close to the time hospitals were minimising the service they were providing." “Over the seven weeks up to 15 May, as the NHS focused on covid, around 8800 fewer non-covid deaths than normal occurred in hospitals.” He added that these had not been “exported” to care homes, since fairly few care home residents normally died in hospitals. Instead, he said, it seemed that these deaths had contributed to the huge rise in extra deaths in private homes during this period. Read full story Source: BMJ, 27 May 2020
  3. News Article
    Problems with dispensing drugs during the COVID-19 crisis may be contributing to an “apparent increase” in deaths of patients receiving treatment for opiate addiction, the Care Quality Commission (CQC) has said. The regulator has said the increase in deaths “may be a result of some services stopping all daily dispensing of opiates” and has taken enforcement action against a “large national provider of substance misuse services” which ”stopped all daily dispensing”. The provider has not been named by the CQC as it is “entitled to an appeal period,” but the regulator told HSJ the provider had not recorded their risk assessments for their clients in relation to changes in drug dispensing. The CQC said the provider had now “assured us” individualised risk assessments were in place. The CQC is now reviewing all deaths of people which have been reported by substance misuse services since 1 March due to concerns about the apparent increase and “that some of these deaths may be related to changes in prescribing practices in response to COVID-19”. Read full story Source: HSJ, 27 May 2020
  4. News Article
    Amid warnings that BAME nursing staff may be disproportionately affected by the COVID-19 pandemic, a Royal College of Nursing (RCN) survey reveals that they are more likely to struggle to secure adequate personal protective equipment (PPE) while at work. The latest RCN member-wide survey shows that for nursing staff working in high-risk environments (including intensive and critical care units), only 43% of respondents from a BAME background said they had enough eye and face protection equipment. This is in stark contrast to 66% of white British nursing staff. There were also disparities in access to fluid-repellent gowns and in cases of nursing staff being asked to re-use single-use PPE items. The survey found similar gaps for those working in non-high-risk environments. Meanwhile, staff reported differences in PPE training, with 40% of BAME respondents saying they had not had training compared with just 31% of white British respondents. Nearly a quarter of BAME nursing staff said they had no confidence that their employer is doing enough to protect them from COVID-19, compared with only 11% of white British respondents. Dame Donna Kinnair, RCN Chief Executive & General Secretary, said: “It is simply unacceptable that we are in a situation where BAME nursing staff are less protected than other nursing staff. Read full story Source: Royal College of Nursing, 27 May 2020
  5. News Article
    A team of 25,000 contact tracers are making their first phone calls to track down people who will be told to self-isolate under a new scheme in England. Tracers will text, email or call people who test positive with coronavirus and ask who they have had contact with. Any of those contacts deemed at risk of infection will be told to isolate for 14 days, even if they are not sick. A test and trace system is also launching in Scotland, where an easing of the lockdown is expected later. The aim of England's NHS Test and Trace system is to lift national lockdown restrictions and move towards more localised, targeted measures. The team will start by contacting the 2,013 people who tested positive for the virus on Wednesday. Read full story Source: BBC News, 28 May 2020
  6. News Article
    The UK's scientists have been trying to trace COVID-19's path through the population ever since the coronavirus arrived on British shores. In what is thought to be the largest study of its kind in the world, an app developed by King's College London (KCL) and technology company Zoe, which tracks symptoms of the disease, has been downloaded more than three million times in the UK. Not to be confused with the government's contact-tracing app, the COVID-19 Symptom Study app allows users to report daily whether they feel healthy, and record any symptoms. The scientists have been using the data to estimate how the virus may have travelled through the population. Read full story Source: BBC News, 23 May 2020
  7. News Article
    "I'm not sure I want to be a nurse anymore," she tells me. "I've seen more people die in the past two months than in the whole six years." Some 70% of health workers dealing with COVID-19 in Italy's hardest-hit areas are suffering from burnout, a recent study shows. "This is actually the hardest moment for doctors and nurses," says Serena Barello, the author of the study. Read story Source: BBC News, 26 May 2020
  8. News Article
    Selected NHS coronavirus patients will soon be able to access an experimental treatment to speed up their recovery, with the health secretary Matt Hancock suggesting it is probably “the biggest step forward’’ in medication since the beginning of the COVID-19 crisis. The anti-viral drug remdesivir will be made available to patients meeting certain clinical criteria to support their recovery in hospital. The drug is currently undergoing clinical trials around the world, including in the UK, and peer-reviewed data showed it can shorten the time to recovery by about four days. Treatment will initially be prioritised for patients who have the greatest likelihood of deriving the most benefit, according to the Department of Health and Social Care (DHSC). Satisfied the drug can help boost recovery, the government’s Medicines and Healthcare products Regulatory Agency (MHRA) approved the use of remdesivir through its early access to medicines scheme. The experimental anti-viral drug was granted emergency authorisation to treat Covid-19 in the US by the Food and Drug Administration earlier this month. Read full story Source: The Independent, 26 May 2020
  9. News Article
    Facial recognition has been added as a way of logging in to an NHS app that lets people order prescriptions, book appointments and find healthcare data. Initially, it will allow faster access to the services on the app, which is separate from the contact-tracing one, but its developers say it could also be used for COVID-19 "immunity passports". The NHS facial-recognition system, built by iProov and available for both Android devices and iOS, requires users to submit a photo of themselves from an official document such as their passport or driving license. They then scan their face using their phone and, following a short sequence of flashing colours, their identification will be verified and they will have access to all the services on the NHS app. Immunity passports need to link a person's identity to their coronavirus test results, so would require a robust way of allowing people to verify themselves. Those deemed clear of the virus could then prove their status via a code generated by an app. However, the idea is controversial, not least because there is no hard scientific evidence that having had the coronavirus provides people with long-lasting immunity. The World Health Organization has warned countries against implementing such passports, saying: "There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection." Dr Tom Fisher, a senior researcher at Privacy International, said the implementation of such measures needed to be "necessary, proportionate and based on the epidemiological evidence". "For the moment, immunity passports do not meet this test," he said. "We must be concerned about the broad societal impact of such immunity passports. They are essentially about limiting the rights of those who are not deemed to be immune. This is a route to exclusion and discrimination." Read full story Source: BBC News, 27 May 2020
  10. Content Article
    There are fears around maintaining personal safety whilst ensuring patient safety. Staff need to protect both themselves and their families at home. Equally, it is essential that staff feel supported in identifying risks and the potential for errors with a robust mechanism in place to reduce, eliminate or mitigate such risks. The Human Factors 'Dirty Dozen' is a concept developed by Gordon DuPont. He described elements that can act as precursors to accidents or incidents, or influence people to make mistakes. This webinar, from the Clinical Excellence Commission, looks at ways you can identify risks or 'hot spots' in your area of work and then discuss with your team at handover and huddles and plan strategies to reduce, eliminate or mitigate the risks
  11. Community Post
    This topic has been created to provide our members with a space to share COVID-19 risk assessments for BAME staff. You can share your risk assessment resources by commenting below and adding an attachment. We've kicked things off by sharing an example below. If you are not yet a member of the hub, you'll need to sign up here first - it's quick and easy to do. By collaborating and sharing learning, we hope to reduce risk. Risk ax form .doc
  12. Content Article
    The Royal College of Midwives has put together an infographic of some of the common stresses that mothers and those working in maternity services may be experiencing and some strategies to help you cope.
  13. Content Article
    The COVID‐19 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use in intubation. The authors of this paper, published in Anaesthesia, evaluated the impact of two aerosol boxes (an early‐generation box and a latest‐generation box) on intubations in patients with severe COVID‐19 with an in‐situ simulation crossover study.
  14. News Article
    Weston General Hospital has stopped admitting new patients – including to the accident and emergency department – following a spike in coronavirus cases. The hospital announced yesterday it was taking this “precautionary measure” due to the “high number of coronavirus patients” on site. MP for Weston-super-Mare John Penrose tweeted that he had spoken to local health chiefs and a deep clean is being carried out at the hospital “following a spike in infections”. He added that a temporary A&E has been set up outside the hospital, while inpatients will be re-directed to hospitals in Taunton or Bristol. Out of hours GP practices, pharmacies and walk-in services at the minor treatment unit in Clevedon and Yate have also been given as alternative options for patients seeking medical treatment. Read full story Source: HSJ, 25 May 2020
  15. News Article
    NHS England has said disabled and vulnerable patients must not be denied personalised care during the coronavirus pandemic and repeated its warning that blanket do not resuscitate orders should not be happening. In a joint statement with disabled rights campaigner and member of the House of Lords, Baroness Jane Campbell, NHS England said the COVID-19 virus and its impact on the NHS did not change the position for vulnerable patients that decisions must be made on an individualised basis. It said: “This means people making active and informed judgements about their own care and treatment, at all stages of their life, and recognises people’s autonomy, as well as their preferences, aspirations, needs and abilities. This also means ensuring reasonable adjustments are supported where necessary and reinforces that the blanket application of do not attempt resuscitation orders is totally unacceptable and must not happen.” Read full story Source: The Independent, 26 May 2020
  16. News Article
    The World Health Organization has said it will temporarily drop hydroxychloroquine — the malaria drug Donald Trump said he is taking as a precaution — from its global study into experimental coronavirus treatments after safety concerns. The WHO’s director-general Tedros Adhanom Ghebreyesus said in light of a paper published last week in the Lancet that showed people taking hydroxychloroquine were at higher risk of death and heart problems than those who were not, it would pause the hydroxychloroquine arm of its solidarity global clinical trial. “The executive group has implemented a temporary pause of the hydroxychloroquine arm within the solidarity trial while the safety data is reviewed by the data safety monitoring board,” Tedros said on Monday. “The other arms of the trial are continuing,” Read full story Source: The Guardian, 25 May 2020
  17. Content Article
    A medical student describes his experiences of working in the ICU of his local hospital during coronavirus in this Independent blog. "I was one of the first medical students at my university to be recruited to help out in local hospitals as fears grew about the NHS being overwhelmed by COVID-19."
  18. Content Article
    Trisha Greenhalgh and colleagues argue that it is time to apply the precautionary principle. The precautionary principle is, according to Wikipedia, “a strategy for approaching issues of potential harm when extensive scientific knowledge on the matter is lacking.” The evidence base on the efficacy and acceptability of the different types of face mask in preventing respiratory infections during epidemics is sparse and contested. But COVID-19 is a serious illness that currently has no known treatment or vaccine and is spreading in an immune naive population. Deaths are rising steeply, and health systems are under strain. This raises an ethical question: should policy makers apply the precautionary principle now and encourage people to wear face masks on the grounds that we have little to lose and potentially something to gain from this measure? Greenhalgh and colleagues believe we should. However, there are criticisms of this view. Read the original analysis published in the BMJ and Tricia Greenhalgh's follow up paper in the Journal of Evaluation in Clinical Practice where she rebutts the criticisms received.
  19. Content Article
    As the current coronavirus (COVID-19) continues to present significant challenges for healthcare providers both in the independent sector and the NHS, healthcare professionals who are involved in receiving patients confirmed positive for COVID-19 in the perioperative setting require the best evidence-based guidance on infection prevention control. The following published guidance seeks to ensure a consistent and resilient UK approach, as differences in operational details and organisational responsibilities may apply across the four UK countries. 
  20. Content Article
    The number of people accessing COVID-19 testing in the UK continues to increase. Health Secretary, Matt Hancock recently announced, that anyone over the age of five years old who is showing symptoms is eligible for a test [1]. However, there are concerns that the rate of ‘false negative’ test results could be as high as 30% and a significant number of people are wrongly being told they do not have the virus [2]. This could be due to the particularly difficult nature of obtaining the swab, which requires someone to take a sample from the very back of the mouth or deep from inside the nose.  “Swabbing patients using the correct technique is paramount in ensuring an accurate result.  Nasal swabs need to be taken from far back in the nasal pharynx and is often uncomfortable for the patient.  By simply swabbing the inside of the nasal passage is not deep enough to verify that the virus is present. I am unsure that all clinical staff have been taught the correct way to swab patients.” Claire Cox, Intensive Care Outreach Nurse. Members of the public are now able to request self-testing kits to do at home if they are experiencing symptoms. If clinicians like Claire are finding the test challenging to perform on others, it is likely that patients could struggle to swab deep enough into their own nasal pharynx (7-8cm). There is a risk that as the number of people testing themselves increases, so too will the rate of false negative results.  Testing is a key element of the UK’s COVID-19 infection control strategy [3]. A high, and potentially rising, rate of false negative results means that a significant number of people could be carrying the virus, wrongly reassured they are not infectious. In this blog, we look at some of the associated safety risks. 
  21. Content Article
    Rehabilitation is fast becoming the new priority in dealing with the impact of this pandemic and is crucial for people recovering from COVID-19 infection.The Royal College of Occupational Therapists (RCOT) have published three guides to support people to manage post-viral fatigue and conserve their energy as they recover from COVID-19. These guides are endorsed by the Intensive Care Society.Practical advice for people who have been treated in hospitalPractical advice for people who have recovered at home’Practical advice for people during and after having COVID-19.You can download the guides via the link below.
  22. Content Article
    The following blog was shared by a patient who wished to remain anonymous. In this account, they explain why they felt they were treated differently when they presented with symptoms of Covid-19 due to their mental health difficulties. They also describe how receiving a false negative test result caused further harm to their mental health.
  23. News Article
    The risk of dying from coronavirus is more than twice as great in the most deprived areas of England – with the disparity largest for women, analysis shows. A study by the Health Foundation of deaths from COVID-19 showed women in the most deprived parts of the country had a risk of dying that was 133% higher than those in the least deprived neighbourhoods. Between men the difference in risk was 114% higher in worse-off areas, suggesting that while deprivation is a key factor in risk of death from coronavirus for both sexes, its effect is worse for women. Experts say the evidence shows the impact of COVID-19 is falling disproportionately on the poorest in society. Mai Stafford, principal data analyst at the Health Foundation, told The Independent: “This pandemic could and should be a watershed moment in creating the social and political will to build a society that values everyone’s health now and in the long term. Without significant action, there is a real risk that those facing the most disadvantage will eventually pay the highest price.” Read full story Source: The Independent, 21 May 2020
  24. News Article
    National leaders have said healthcare workers must do better on social distancing amid growing evidence that staff-to-staff transmission is the significant factor in the spread of coronavirus throughout hospitals. NHS England national clinical director for trauma Dr Chris Moran, said: “I’ve witnessed and I’m sure you’ve all witnessed that actually healthcare workers are not necessarily been the best at managing social distancing. We know when directly managing patients that it [social distancing] is impossible, that’s what PPE is for to protect both sides of the equation. But I think in the staff-only areas we could do quite a lot better in some of the places that I’ve visited.” National director for acute care Keith Willett added: “The evidence we’ve seen coming through suggests the infection risks from staff to patients or patients to staff seems very low but the risks to staff of infection, COVID-19 infection, within hospitals is much, much, much higher between staff and staff, and patients and patients.” The warning comes after NHS England’s patient safety director Dr Aidan Fowler said he was concerned about the rates of "nosocomial spread within our hospitals”. Following national guidance designed to facilitate an increase in elective operations and other routine work, NHS trusts have been asked to set up “covid free” green zones and blue zones with a higher COVID-19 risk. Read full story Source: HSJ, 21 May 2020
  25. News Article
    People will be asked to self-isolate for two weeks even if they are asymptomatic after coming into ‘high-risk’ contact with a person who has tested positive for COVID-19 – a testing chief has told NHS executives. This marks a change from the official guidance given to users of the government’s contact tracing app – on NHS’ COVID-19 website – which states: “If you do not have symptoms, you do not need to self-isolate at this time.” John Newton, a leader of the UK’s testing programme, would be “directed towards those people at high risk” instead of the wider public. He added the government faces a “huge communications exercise” next week ahead of the launch of the test and trace programme. Giving an update on the test and trace programme – which is due to launch on 1 June – Professor Newton said: “People who are deemed high risk contact of confirmed [COVID-19] cases will be told to self-isolate for 14 days, even if they have no symptoms at the time. Professor Newton said: “The point is there will still be a requirement to contain the virus, but the impact in terms of containment will be directed towards those people at high risk so the rest of the population can enjoy more normal life." He said the programme’s success would depend on the public’s response in terms of: Presenting themselves for a test if they have symptoms; Providing the information needed to identify high risk contacts; and Those people identified as high risk contacts complying with advice to self-isolate. Read full story Source: HSJ, 21 May 2020
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