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NHS hospitals ignore patient safety orders

The Guardian - 16th February 2010 10:03 am

Hospitals were accused of putting patients’ lives at unnecessary risk after research revealed they were failing to comply with NHS orders designed to prevent deaths from mistakes involving drugs, surgery or equipment.

Information released by the Department of Health after a freedom of information request showed that hospitals were not complying with safety alerts issued by the National Patient Safety Agency (NPSA).

The NPSA’s chairman, Lord Patel of Dunkeld, said that the behaviour of the trusts was unacceptable and endangered the health of patients.

“It’s not good enough,” he said. “What’s the point of us developing these alerts if they don’t pay any attention to them? Alerts are produced to reduce risk and hopefully avoid many deaths, so not to implement them to me is alarming. If they aren’t implemented then they run the risk of harm occurring and the danger will continue.”

The findings were from a FOI request submitted by patient safety charity Action Against Medical Accidents (AvMA). It revealed that:

• 104 hospitals and other providers of NHS care in England have not confirmed they have implemented an NPSA alert issued in March 2007 to ensure that injectable medicines are used more safely - even though new systems are meant to be in place by March 2010. The alert came after 25 patients died and 28 others experienced serious harm in 18 months.

• 81 hospitals and other care providers had not taken the “required actions” outlined in patient safety alerts covering opioid (painkilling) medicines. The alert was originally issued in July 2008 with a deadline of January 2009; the 81 had not complied by 29 December 2009.

Andy Burnham defends NHS targets after failings

HSJ - 2nd December 2009 5:53 pm

The health secretary has defended the government’s targets for the NHS in the wake of failings at several hospitals.

Andy Burnham told the Commons the best hospitals were providing “high quality, safe care” as well as meeting performance targets, such as seeing accident and emergency patients within four hours.

He was responding to criticisms from the Tories that clinical priorities were being “distorted” by targets, with waiting times put above patient care.

Burnham said patient safety was his “highest priority” as he made a statement to MPs following revelations about high death rates at Colchester Hospital University Foundation Trust and poor hygiene and standards of care at Basildon and Thurrock University Hospitals Foundation Trust.

A report by Dr Foster Intelligence rated a dozen hospitals as “significantly underperforming”, despite nine of them being rated good or excellent by official regulator the Care Quality Commission.

Seven hospitals were also found to have considerably higher mortality rates for the past five years.

Surgeons say quality of care worse with WTD

By Mike Broad - 11th October 2009 9:28 pm

Patients are more at risk since the European Working Time Directive was introduced in August, a survey of surgeons reveals.

The research, by the Royal College of Surgeons, shows that 64% of surgeons thought quality of care had worsened due to the 48-hour week.

A third say handover arrangements are inadequate in their hospital and 23% say they cannot stay involved in all stages of individual patients clinical care that require their expertise. With so many shift changeovers, the WTD has compromised the time available for handovers and damaged continuity of care.

Furthermore, 62% of surgeons said they were not working a truly compliant 48-hour week with 70% estimating they worked more than 48 hours, averaging between 55 and 60 hours a week.

Trainee surgeons in particular are staying on unpaid after the hours limit because they want to see through care for patients. Some are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week.

A quarter of respondents say other professionals in the healthcare team are acting up to cover tasks previously done by surgeons and 43% say they are covering rota gaps in other areas of their own hospital to keep services running.

The Royal College of Surgeons says hospitals are relying on this goodwill because they know they couldn’t stay open without them. As a result, there is an emerging ‘grey’ market in hospital cover with doctors true working hours being kept off the books.

The college has also learned that more than 100 further hospital rotas have applied for a ‘derogation’ from the government because they cannot meet the legislation.

The government set an original deadline of 28 May for trusts to request the derogation, which is a two-year delay to WTD implementation during which time juniors can work a 52-hour week. It claims all but 200 rotas are compliant.

Mr John Black, president of the Royal College of Surgeons, said: “Throughout this affair the call from the Department of Health has been that this legislation is about making patients safer. We now have a clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services.

“We now have the ridiculous situation where the Department of Health in public moralises over fears that trainees are being coerced into working over 48 hours while privately relying on these doctors to stay longer or cover additional dead-end shifts as locums because there is no way the service could keep running otherwise.”

Earlier this year, surgical trainee organisations called for a 65-hour week and the college called for a sectoral opt-out of the European legislation to achieve this.

Nine hundred surgeons responded to the survey.

A spokesman for the DoH said there is no evidence of harm being caused to patients.

A recent survey by Remedy showed that 47% of juniors claimed their rotas were non-compliant.

Tags: Derogation, Patient safety, WTD
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Patient safety incidents in NHS increase by 12%

HSJ - 8th October 2009 11:15 am

The number of patients who have been involved in safety incidents while undergoing NHS treatment has risen by 12% in six months.

The National Patient Safety Agency released new figuresrevealing that 459,500 people were affected between 1 October 2008 and 31 March 2009 in England.

The data also showed that 5,700 patients experienced serious harm or died because of mistakes and near misses.

The NPSA said the rise was due to improved reporting. Overall, in 303,016 (66%) of the cases no harm came to the patient and in 122,246 (27%) there was low harm.

A further breakdown showed 28,521 (6%) of incidents ended in moderate harm and 5,717 (1%) resulted in severe harm or death.

Thirty two per cent of reports were accidents involving patients that could have been avoided, followed by errors or near misses with treatments or procedures (10.1%) and medication (9.4%).

Trusts to review safety of out-of-hours GP services

The Guardian - 2nd October 2009 9:53 am

All 152 NHS organisations responsible for out-of-hours GP services in England have been ordered to review patient safety following the case of a German doctor who accidentally killed a patient on his first shift in Britain.

PCTs, which commission emergency overnight and weekend care for millions of people, will receive letters today from the Department of Health telling them to re-examine induction and training for foreign doctors, call-handling and prioritising of cases, clinical decisions made by GPs and other staff and the management of powerful drugs.

The instruction reinforces a warning from the NHS watchdog the Care Quality Commission that shortcomings so far identified in its investigation of the incident may be repeated elsewhere.

Government officials and Steve Field, chairman of the Royal College of GPs, have been asked by ministers to consider whether further changes are needed nationally to the system under which local trusts check that doctors are fit to practise and speak and understand English.

The government response reflects concern within the NHS over the case in which Daniel Ubani killed David Gray at his home in Cambridgeshire by administering a tenfold overdose of a painkiller. There are fears that Gray’s death highlights systemic failures.

Killing season can’t be as bad as the old days

By Katherine Teale - 25th September 2009 3:33 pm

We northern provincials always get excited when we come up to London for the day: as well as gawping at the posh people and hoping to absorb some culture, I could even pop into the City to see how those bankers are enjoying my taxation.

The journey does present challenges, though. First and foremost, what on earth to wear (our northern wardrobes not being adapted for the sweltering London micro-climate). Then there’s the whole Underground experience. And lastly the trust’s decision to ban first class travel, even for managers. Great.

Not only do I have to get up in the middle of the night to get to the station with my three alternative outfits, but I have to go second class without a Virgin Trains vegetarian cooked breakfast to prepare myself for the inevitable hour going the wrong way round the Circle Line.

The official reason for my visit is to attend a course on Improving Patient Safety (because nobody’s ever thought of this before, obviously). I’m quite looking forward to it really, as the alternative is an all-day orthopaedic list.

Just to show how enthusiastic I am about the course, I’m going armed with a couple of cracking ideas of my own which should reduce our mortality rate by at least 6%. The first is not to allow patients into hospital in the first place as it’s just far too dangerous: a hypothesis which is amply supported by the harrowing ‘patient stories’ related during the course; the second, for those patients who absolutely insist on admission, is to ban trainee doctors from the wards. Even those who’ve managed to actually pass their finals are apparently a danger to the public.

I know this will come as a shock, but a significant increase in deaths during August has been identified, which coincides suspiciously with the changeover of new doctors. Of course for generations no doctor in their right mind would have dreamed of allowing any family member to be admitted until at least the end of September.

When I was a new house-officer, we were all too knackered anyway after working a million hours a week to get too worked up about a couple of extra deaths every August. When a patient took a turn for the worse, there was a well-developed system to follow: a junior (usually me) told the relatives that their loved one had “passed away”. The relatives, obligingly keeping a stiff upper lip, said something along the lines of “it’s just one of those things, doc”, before cups of tea were handed round and nothing more was heard. No Critical Incident forms were filled in, and no-one from the trust risk management unit appeared to take statements.

We just carried on, no doubt making the same mistakes.

If it’s any consolation to our new trainees, I’m pretty sure that this year’s increased mortality pales into insignificance beside previous Augusts, especially the year I started when the changeover day was a Saturday so there was nobody in the hospital who could to site a venflon for two whole days. Fortunately the Standardised Hospital Mortality Ratio hadn’t been invented, so nobody took any notice.

I suppose some things really have changed for the better.

Tags: Juniors, Patient safety
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Research suggests ‘killing season’ exists in August

BBC Health - 23rd September 2009 8:16 am

A small but statistically significant number of patients die each year when junior doctors start work in August, an Imperial College London study suggests.

Researchers looked at 300,000 patients admitted as emergencies to English hospitals between 2000 and 2008.

They compared death rates between the first week of August, when new doctors arrive, and the previous week in July.

After adjusting for various factors, they report in PLoS One that the August patients were 6% more likely to die.

The period when an influx of newly qualified doctors enter the wards has sometimes been dubbed the “killing season”, but studies to establish whether there is any truth to this have been inconclusive.

The researchers from Imperial College London stressed they were unable to draw firm conclusions about the reasons for the increase, but that it was significant, if small.

Comparisons of the raw figures showed little difference, but when factors including age, sex, socio-economic deprivation and existing medical problems were taken into account, a discrepancy began to emerge.

Repair work 20 times more likely for patients at ISTC

The Times - 22nd September 2009 3:11 pm

Patients having hip replacements at independent sector treatment centres are up to 20 times more likely to need repair work.

Many operations are having to be redone in NHS hospitals, at great cost and with serious staffing implications for the health service.

A study by orthopaedic surgeons in Cardiff found that of 113 hip operations on patients sent from their NHS trust to Weston-super-Mare NHS Treatment Centre between 2004 and 2006, two thirds showed clear evidence of poor surgical technique, such as poor cementing of the hip.

In the three years since the operation, 18% had undergone revision or were awaiting an operation - 20 times the 0.9% NHS-wide revision rate at three years. A study on knee operations at the unit, conducted earlier this year, recorded a tenfold increase in revision rates.

Since the ISTC programme was introduced in 2003, dozens of centres have been set up, mainly conducting orthopaedic surgery, cataracts and diagnostic screening. A total of 44 are described as NHS centres - though they are often staffed by independent sector contracts - and 23 are provided by private companies.

Leading surgeons said that this new data underlined the need for a significant overhaul of the multimillion-pound programme, which was introduced with great fanfare by the government to reduce waiting times and increase patient choice.

They said a total lack of supervision of the sector and its clinical outcomes was a dereliction of duty by the government, which had put a premium on reducing numbers rather than patient care. Early concerns about poorly vetted overseas doctors carrying out the work had not been addressed, they said.

The Cardiff study, published in the Journal of Bone and Joint Surgery, offers the most compelling evidence to date of problems with care in the sector, and the lack of proper auditing. Surgeons said that the data backed anecdotal reports from elsewhere in the country, although it was likely to be at the high end.

They said that NHS trusts were being left to manage the extra workload created.

Safety fears as European doctor numbers revealed

The Telegraph - 7th September 2009 12:30 pm

Of more than 20,000 EU doctors registered to practice in this country, 4,061 have arrived since safety checks were removed five years ago.

The figure comes amid increasing concerns about the lack of scrutiny of medics who migrate to this country.

Figures from the General Medical Register show that among the foreign doctors registered to work in the UK, more than 5,000 are from former Eastern bloc countries.

Of those, the greatest exporter was Poland, which trained 1,800 medics now on the British register, followed by Hungary, which sent more than 1,000. More than 700 came from the Czech Republic and almost 800 from Romania.

Under an EU directive passed in 2004, doctors who qualify in any EU state can move to work in any other member state without tests of their language skills or clinical competence - even though experts last night warned that there is little consistency in the medical training, treatments and medications used across Europe.

Aviation analogies need work before they will fly

By Dr Richard Marks, head of policy at Remedy - 18th June 2009 9:16 am

We are constantly being told that medicine could learn a thing or two from aviation, and that the aircraft industry has managed to solve all the problems around working in teams. If only this were true.

The airline industry works with a rigid structure of authority and responsibility. All the crew work for the same company and follow the same procedures. When an aircraft is in flight the captain has complete authority over every member of his or her team.

Now contrast that with work in an operating theatre, where there are anaesthetists, surgeons, nurses, ODPs and support staff. Each of them is a member of a separate department, and each of them works within their own professional and other rules of engagement. To say that all of them are working together for the good of the patient is a slight simplification, since they are each working to their own rules with different priorities.

When there is conflict between the members of this ‘team’ there are no clear lines of authority or responsibility. The surgeon naturally assumes that he is the leader of the team. The anaesthetist does too (and is probably correct). The nurses have written a ‘Philosophy of Care’ on the wall of the theatre claiming responsibility for everything that goes on within it.

The lesson we should learn from aviation, but haven’t done yet, is how that team should function. Each member of the team has their own individual role – navigator/pilot and surgeon/anaesthetist. But the interrelationships between these roles needs to be made much clearer. If anything these relationships have got less clearly defined, and when things go wrong it becomes critical.

We are also less familiar with the colleagues with whom we are working. Shift patterns and management efficiencies sometimes result in us working with people who we don’t really know. We don’t know their capabilities and we don’t know the difficulties they are having.

The WHO checklist requires each member of the theatre team to introduce themselves to one another at the beginning of a case. With true British reserve we find this excruciatingly embarrassing, but it could go a long way to helping. It would be especially useful in the emergency situation, where not everyone knows each other.

The concept of a ‘team’ is a complex one and many teams are more realistically a collection of representatives from separate independent teams. Once we understand this concept we can move forward.

Tags: Patient safety
Posted in Remedy | No Comments »