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Take a look at a selection of our recent media coverage:

Research grants for patient safety and workforce wellbeing topics open for applications

2nd April 2024

The MPS Foundation is inviting healthcare professionals to register their interest and submit proposals for research grants focusing on patient safety and the wellbeing of healthcare professionals and teams, both medical and dental.

Applications for the grants – which are worth £5,000 to £200,000, or equivalent in local currency, depending on the scale, focus and duration of the proposal – are open to both Medical Protection Society members and non-members from countries including the UK and Ireland.

To be eligible, the research projects must be academically robust, evidence-based and address the MPS Foundation’s key research priorities, including:

  • The impact of human factors on patient safety, outcomes and risk
  • The impact of processes and delivery modes on patient safety, outcomes and risk
  • The personal and professional wellbeing of healthcare professionals and teams
  • The impact of digital integration and technology on patient safety, outcomes and risk
  • The impact of the effectiveness of teaching and learning innovations upon patient safety, outcomes and risk.

Dr Graham Stokes, MPS Foundation chair, said: ‘We are delighted to launch our third grant programme to support research projects on patient safety and the wellbeing of healthcare professionals. Funding for research in this area has been limited but our grant programmes have been changing that. Projects that we have supported in previous years have shown great success in promoting best practise and wellbeing across several countries.‘

He added: ‘Our aim is simple: to fund research that improves safety for patients and the wellbeing of healthcare teams.

‘If you have a research project that you think is suitable, register your interest and join our growing community of grant recipients. I strongly encourage healthcare professionals to consider applying for support whatever the scale of the proposal and to make the most of the additional resources available to support applicants this year.’

Applicants can register interest for the grants and apply via the MPS Foundation online grant portal, which also includes a guide for applicants, frequently asked questions and tips on creating a good application.

Calls for expressions of interest are open until 5pm BST on 3 May 2024.

Projects awarded MPS Foundation funding in 2023 included a study aimed at improving safety in gastrointestinal endoscopy, research examining the effects of patient suicide on clinicians, and a project to better understand the role patients’ relatives play in ICU decisions and how the Mental Capacity Act can lead to better outcomes for patients, families and healthcare professionals.

The MPS Foundation is part of the Medical Protection Society – an organisation that aims to protect and support the professional interests of more than 300,000 doctors, dentists and healthcare professionals across the UK, Ireland, South Africa, New Zealand, Australia, Hong Kong, Singapore, Malaysia, the Caribbean and Bermuda.

Patient misidentification interventions outlined in new HSSIB report

16th February 2024

Current controls are unable to prevent all patient misidentification and a proactive approach should be adopted to support staff in safety management, according to a new report by the Health Services Safety Investigations Body (HSSIB).

Its ‘Positive patient identification’ report states that patient misidentification is an under-recognised, under-researched and persistent safety risk that can result in significant harm.

The report is therefore aimed at supporting national learning and influencing action across England to reduce the risk of patient misidentification.

And it offers a series of safety interventions for healthcare organisations and policy makers to consider when updating safety processes.

‘A complicated array of interacting factors’

The report analysed evidence from six completed Healthcare Safety Investigation Branch (HSIB) investigations alongside research literature and national policy documents.

These misidentification investigations included a patient who received an invasive procedure not meant for them, a patient who bled after receiving anticoagulation medication not meant for them and a patient who did not undergo a resuscitation attempt because it was thought he was a different patient.

‘HSIB investigations identified a complicated array of interacting factors in different healthcare systems that contribute to misidentifying patients,’ the report said.

Positive patient identification is complex and ‘relies on staff following instructions described in policies and procedures, which might not always be fully appropriate to the circumstances within which staff are identifying patients,’ it added.

Indeed, despite national direction to use the NHS number as the unique patient identifier, the report found that local policies varied in their descriptions of how patient identification should be undertaken. This included what identifiers should be used and the role of the NHS number.

Reactive approach to preventing misidentification

The report concluded that current controls are unable to prevent all misidentifications, and the traditional reactive approach to safety management is ineffective.

The HSSIB recommends a move towards proactively understanding systems and assuring the safety of processes, as well as targeting opportunities to better support staff by improving working conditions.

‘It is not yet possible to eliminate the risk of patient misidentification. However, a series of interventions – including using new technologies and optimising workplaces – may help to reduce the risk,’ the report said.

Prioritising high-risk situations and settings, such as handovers and transfers of patient care, is an area that the HSSIB encourages healthcare organisations particularly focus on to improve patient safety.

And it also championed the effective use of technology such as electronic patient records, electronic prescribing and administration systems, and barcode and QR code scanning, but warned that currently ‘it is not clear which technology is most effective at controlling the risk in different settings’.

As part of its report, HSSIB recommended that ‘NHS England reviews and identifies system-wide requirements for scanning in positive patient identification. This is to support local organisations to use scanning technology to reduce misidentification incidents’.

Effective solutions

Commenting on the report, Nick Woodier, senior safety investigator at the Health Services Safety Investigations Body, said: ‘The six HSIB investigations considered misidentification across different areas of NHS care – from outpatient procedures and emergency departments to ambulance services and care homes.

‘The evidence we have collected aligns with research literature and data from national incident databases and emphasises that despite national improvement efforts, misidentification remains a persistent safety risk.

‘Our report offers insight into where effective solutions could be implemented but we recognise that there is difficulty in allocating resources when healthcare organisations tell us that the scale of the problem is not known.’

He added: ‘Our safety recommendations and findings are aimed at influencing national action to better understand the risk and consider how resources can be allocated to drive improvement across England.’

NHS England and BMA clash over patient safety risks during ongoing strike action

4th October 2023

The ‘cumulative’ impact of doctor strikes is now causing ‘significant disruption’ and risk to patient safety, NHS England has told the British Medical Association (BMA) in a formal warning letter.

However the BMA argued that patient safety is being put at risk due to strike planning failures by NHS England.

Following months of walkouts, consultants and junior doctors are jointly striking for three full days this week, with ‘Christmas Day’-level cover.

NHS England noted doctors are taking ‘lawful industrial action in line with their respective mandates’, but added that it is ‘increasingly concerned that the cumulative impact of this action is causing significant disruption and risk to patients’.

It said: ‘In writing to you, we recognise the stated aim of the BMA to protect urgent and emergency care during industrial action and to maintain patient safety.’

NHS England is ‘extremely concerned’ that Christmas Day cover is ‘insufficient’ to ensure appropriate levels of patient safety are being maintained.

‘This is particularly the case in the current period of industrial action, with three consecutive Christmas Day levels of service.

‘The reasons for this are two-fold: we are not experiencing Christmas Day levels of pressure, when demand falls by around a third, nor are we seeing the drop in bed occupancy levels that occurs immediately prior to Christmas.

‘In addition, successive days of Christmas Day cover are significantly impacting on the ability of systems to maintain flow throughout our emergency pathways, which in turn is resulting in delayed ambulance handovers, deteriorating ambulance response times and long waits for patients in Emergency Departments.’

The letter, signed by workforce chief Dr Navina Evans and national medical director Professor Sir Stephen Powis and others, noted these issues were already raised in regular industrial action operational meetings.

But, it added: ’However, in light of our responsibility to support the NHS and maintain patient safety we feel it is important these concerns are also now raised formally.’

Responding, BMA council chair Professor Phil Banfield said: ‘We have always been open to discussing ways in which together we can maintain patient safety during industrial action, and we communicated this directly to colleagues at NHS England, most recently in a meeting just yesterday.’

He also detailed several ‘planning failures’ including that some NHS trusts ‘had not appropriately rescheduled’ non-urgent elective activity in the days leading up to strikes which has directly impacted the ability to prioritise more urgent care needs, according to the union.

He added: ‘I do not agree that the Christmas and Boxing Day model of industrial action is unsafe or that it is the reason for the issues you have detailed in your letter.

‘This model only applies to consultants and junior doctors eligible to strike. Consequently, actual staffing is higher than Christmas and Boxing Day, given SAS doctors, various non-striking consultant and junior doctors, as well as allied health professionals continue to work as normal.

‘Instead, there is clear evidence of the failure by some trusts to adequately prepare for industrial action.

‘In particular the BMA is aware that some trusts have continued with significant amounts of elective activity during industrial action and have failed to reschedule non-urgent elective care in an attempt to meet political targets. This is causing unnecessary risk of harm.’

He added: ‘As you know, no further industrial action has been called, and it is now incumbent upon the Government to come to the table, drop their refusal to negotiate on pay and settle its dispute with doctors.’

Yesterday the BMA offered to involve reconciliation service ACAS in resolving the dispute over consultants’ pay.

This story was originally published by our sister publication Pulse.

Image credit: Anna Colivicchi.

EU safety committee recommends measures to avoid topiramate exposure in pregnancy

14th September 2023

New measures recommending the avoidance of all medicines containing topiramate during pregnancy have been published by the European Medicines Agency‘s Pharmacovigilance Risk Assessment Committee (PRAC).

While it is well known that topiramate can cause major congenital malformations and foetal growth restriction if used during pregnancy, recent data also suggest a potential increased risk of neurodevelopmental disorders after exposure in the womb.

Topiramate-containing medicines are used for the treatment of epilepsy and the prevention of migraine, with some EU countries also using the drug in a fixed-dose combination with phentermine for weight reduction.

For patients using topiramate for the treatment of epilepsy, the latest PRAC recommendations state that the drug should not be used during pregnancy unless there is no other suitable treatment available. This builds on existing advice that topiramate is contraindicated during pregnancy when used for the prevention of migraine or for weight management.

Additional recommendations involve the establishment of a pregnancy prevention programme. This means that healthcare professionals should ensure any woman or girl who is able to have children has been made fully aware of and has understood the risks of taking topiramate during pregnancy, as well as the measures that must be taken.

This includes taking a pregnancy test before starting treatment and the need to avoid becoming pregnant during topiramate treatment by using effective birth control for the treatment duration and for at least four weeks after its cessation.

Alternative treatment options should be considered and the need for topiramate treatment should be reassessed at least annually using a risk awareness form.

The product information for topiramate-containing medicines will be updated to further highlight the risks and the measures to be taken and a visible warning added to the outer packaging of the medicines.

In addition, patients and healthcare professionals in Europe will be provided with educational materials regarding the risks of using topiramate during pregnancy, and a patient card will be provided to the patient with each medicine package.

In spring 2018, the UK’s Medicines and Healthcare products Regulatory Agency banned the use of valproate for epilepsy during pregnancy without a pregnancy prevention programme.

Topiramate and neurodevelopmental disorders

These recommendations from the PRAC were based on the findings from three recent observational studies. In the first, prenatal exposure to topiramate was associated with increased risk of neuro-developmental disorders. The second study showed prenatal topiramate was linked to a greater risk of attention deficit hyperactivity disorder.

The third demonstrated that topiramate use late in pregnancy was associated with twice the risk of neurodevelopmental diagnoses in children compared to unexposed pregnancies.

In its review, the PRAC confirmed the known increased risk of birth defects and reduced growth of the unborn child when mothers receive topiramate during pregnancy. It estimated that birth defects will occur in between four and nine out of every 100 children born to women who take the drug during pregnancy, compared with one to three out of every 100 children to women who do not take topiramate.

In further analysis, the PRAC estimates that 18 in every 100 children were smaller and weighed less than expected at birth to mothers taking topiramate compared to only five in every 100 children born to mothers without epilepsy and not taking anti-epileptic medication.

Also triggered by the first study outlined above, the UK’s Medicines and Healthcare products Regulatory Agency announced in July 2023 that it had started a safety review of topiramate in relation to the potential for neurodevelopmental disorders.

Patient safety alert issued in the UK over risk of death relating to medical beds

31st August 2023

A national patient safety alert has been issued in the UK over the risk of death from entrapment or falls relating to medical beds, with a call for all relevant staff to have appropriate training within the next 12 months.

In an alert issued on Wednesday 30 August, the Medicines and Healthcare products Regulatory Agency (MHRA) said it continues to receive reports of death and serious injuries relating to medical beds and trolleys.

Between 1 January 2018 and 31 December 2022, the MHRA received 18 reports of death and 54 reports of serious injuries related to medical beds, bed rails, trolleys, bariatric beds, lateral turning devices and bed grab handles.

The MHRA confirmed to Nursing in Practice that these incidents included medical beds used outside of a hospital setting.

And it said the ‘majority’ of the reported incidents were because of entrapment or falls.

Investigations into incidents that involved falls ‘often found the likely cause to be worn or broken parts, which should have been replaced during regular maintenance and servicing, but which were either not carried out or were carried out improperly’, the MHRA said in its alert.

Meanwhile, those incidents involving entrapment were due to factors including: a lack of risk assessment or risk assessments not being updated following a change in equipment or patient’s condition, a lack of maintenance and servicing, incompatibility issues and children and adults with ‘atypical anatomy using inappropriate equipment’.

As part of its patient safety alert, the MHRA outlined several actions to be taken by all those responsible for the use, purchase, prescription and maintenance of medical beds, including acute and community organisations, care homes, equipment providers, occupational therapists and early intervention teams, to begin and complete by March 2024.

One action called for role-specific training for staff that covered, where appropriate, the ‘risks and operation of these devices, the provision of training to carers/patients, reporting issues, servicing and maintenance and risk assessments’.

And it said that organisations should develop a plan for all staff to be appropriately trained within the next 12 months.

Other actions asked providers to review their medical device management systems, to implement maintenance and servicing schedules and to implement systems to update risk assessments.

Organisations were also urged to update their polices and procedures on procurement, provision, prescribing, servicing and maintenance of such devices in line with updated MHRA guidance.

In addition, it called for patients currently provided with bed rails or bed grab handles to be reviewed ‘to ensure there is a documented up-to-date risk assessment’.

Patients who are children or adults with atypical anatomy should be reviewed ‘as a priority’, it noted.

A version of this story was originally published by our sister publication Nursing in Practice.

Discharge medication errors in England could be cut by up to 40%

28th July 2023

Medication errors when people go into or are discharged from hospital in England could be reduced by nearly 40% with the introduction of new digital information standards being rolled out this year, say researchers.

Analysis by a team at the University of Manchester found that medication errors would be cut from 1.8 million to 1.1 million (39%) by the easier sharing of information across hospital and GP systems.

They also calculated that there could be around 12,000 fewer people experiencing harm from their medicines, with 14,000 fewer days spent in hospital at a saving to the NHS of £6.6m.

But they stressed, there still needs to be a healthcare professional, usually a pharmacist, doing medicines reconciliation.

The standards, which first came into effect in October 2021 with NHS organisations having to show compliance by this year, should make that work easier and quicker so more patients can have their medicines checked properly, they added.

A report commissioned by NHS England looked at published research on medication errors in the UK as well as evidence from other countries where similar changes to digital information standards have been made.

Overall, they estimated that around 31,000 people experience harm from a transition medication error, with over half of these happening to mistakes made at hospital admission.

They also estimated that such errors lead to 45 deaths a year, 20 of which could be prevented when the standards are introduced.

This is not just a UK issue, the researchers said. Errors relating to medicines missed off the list, extra ones added, or wrong doses written down are common worldwide, and the World Health Organization has made it a priority for health services to find ways to reduce them, they added.

Speaking to Hospital Pharmacy Europe‘s sister publication Pulse, study lead Professor Rachel Elliott, professor of health economics, said the standards were being rolled out this year but it was a very complex process with lots of different stakeholders.

She added: ‘Medicines reconciliation done at admission and discharge has been shown to reduce medication errors. This is not about replacing that process but it is about making it easier to access the information which at the moment is all over the place and all the different systems can’t talk to each other. It is enabling the human element to be done more quickly.’

This article was originally published by our sister publication Pulse.

Electronic prescribing system in ICU requires less pharmacist input to maintain patient safety

22nd June 2023

An electronic prescribing (EP) system within an intensive care unit (ICU) requires a lower level of clinical pharmacist input compared to a paper-based system, according to a recent prospective, longitudinal UK study.

Although EP systems are designed to reduce medication errors, the quality of evidence on their effectiveness is variable. Nevertheless, within an ICU setting, the use of commercial computerised provider order entry systems led to an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. However, few studies have focused on whether EP systems optimise medication therapy, reduce costs, improve the quality of prescribing and patient outcomes.

In the current study, published in the International Journal of Medical Informatics, researchers compared the clinical significance of pharmacist contributions in two ICU departments to understand the impact of an EP system on the quality of patient care.

The team chose one department that used an EP system and compared the extent of pharmacist input with a second department using a paper-based prescribing (PBP) system. The primary outcome was the distribution of clinical significance levels of pharmacist contributions. This was assessed using a tool that assigned a clinical significance rating to pharmacists’ contributions based on the mitigation of risk or negative outcome for the patient and ranged from I (low level) to V (high level).

Impact of electronic prescribing on pharmacist input

A total of 303 patients were included, with EP used in 171 patients. Overall, 1,658 contributions were analysed.

The median number of patient reviews in both groups was similar, as was the proportion of reviews with no change (49.3% vs 48.5%, PBP vs EP). In addition, there were 14.9% highly clinically significant pharmacist contributions (levels III and above) with EP compared to 44.6% with PBP.

The EP group had a lower odds for a higher clinical significance contribution compared to the PBP group (Odds ratio, OR = 0.05, 95% CI 0.02-0.12). However, over time, there was a lower odds of a higher level contribution from the PBP group (OR = 0.57, 95% CI 0.42 – 0.78, p < 0.001).

Based on these findings, the researchers concluded that the clinical significance of pharmacist contributions remained both low and stable in over time in the EP group. Moreover, while initially higher, pharmacists in an ICU using a PBP system actually reduced over time.

Taken together, the study suggests that the use of an EP system required significantly less pharmacist input to maintain patient safety, possibly because the EP system enables access to data to improve decision-making at the point of prescribing.

Review suggests biologics safe for pregnant women with psoriasis

The use of biologics in women with psoriasis who are either pregnant or planning to conceive is not associated with an increased risk of miscarriage, abortion or congenital malformations, according to the findings of a recent study.

The available literature suggests that psoriasis improves during pregnancy although there is a slight risk of a disease flare following delivery. Although biologics are used for patients with moderate to severe psoriasis, the continued use of biologic therapy in pregnancy is a difficult decision to make because of the lack of safety data. Moreover, these decisions are further hampered by the fact that pregnant women are invariably excluded from clinical trials using biologics.

With uncertainty over the safety of biologics in pregnancy, in the current study, published in Journal of the European Academy of Dermatology and Venereology, Spanish researchers conducted a systematic review and meta-analysis to examine examine pregnancy outcomes in women with psoriasis exposed to biologics within three months before or during pregnancy. The team also included studies where women were planning to conceive and who were exposed to biologics.

Biologics and outcomes

A total of 51 observational studies in women with a mean age of 30.3 years and with 739 pregnancies exposed to approved biologics were included in the analysis. In most cases (70.4%) the biologics were administered during the first trimester, with the most common agent being ustekinumab (36.0%), followed by etanercept (19.3%). However, there were no studies with newer agents such as brodalumab, risankizumab or bimekizumab.

The estimated prevalence of miscarriage was 15.3% (95% CI 12.7 – 18.0) and elective abortions, 10.8% (95% CI 7.7 – 14.3). Congenital malformations occurred in about 3.0% (95% CI 1.6 – 4.8) of live births. These estimates were similar to those reported in the general population.

The researchers concluded that biologics used in psoriasis are safe and pose an acceptable risk to foetuses and neonates.

Fresh calls for talks as NHS strike action risks becoming ‘business as usual’

20th June 2023

Urgent action must be taken to avoid strikes becoming ‘business as usual’ for NHS trusts and patients, NHS Providers has warned.

Highlighting the already overstretched hospital, ambulance, mental health and community services, along with record waiting lists, the membership organisation is urging the Government and the British Medical Association to reopen talks to ‘break the deadlock’.

Following the junior doctors’ strike in England on 14-17 June, Miriam Deakin, director of policy and strategy at NHS Providers, said: ‘Trust leaders and their staff continue to pull out all the stops to cushion the impact of strikes with patient safety the top priority. But they are worried about the long-term effects on patients who have their care delayed at a time when waiting lists are already at record levels, the impact on staff morale and the rising cost of paying to provide cover.’

Some 108,602 procedures and appointments were rescheduled as a result of the most recent junior doctors’ strike, bringing the total of strike-affected appointments in England to 651,232 since December 2022.

With radiographers, nurses and consultants currently being balloted about industrial action, July may see the eighth consecutive month of strikes in the NHS.

No sign of resolve over strikes

‘While ministers and the doctors’ union aren’t talking, patients pay the price of the stand-off,’ Ms Deakin continued. ‘The longer that industrial action goes on and trusts have to keep coping with the fall-out from the most significant period of industrial action in the history of the NHS, the less they can focus all of their energy on patients and help to meet the Government’s pledge to cut waiting lists.’

NHS Providers chief executive Sir Julian Hartley highlighted strike action resolution as ‘the elephant in the room’ at last week’s NHS ConfedExpo. The topic remained absent from health secretary Steve Barclay’s speech, in which he focused instead on tackling waiting lists, greater patient choice, investment in technology in the NHS and greater support for mental health patients.

Junior doctors in Scotland voted decisively last week that three days of strikes will take place on 12-15 July unless an improved pay offer is put forward by the Scottish Government.

Large study confirms safety of Covid-19 mRNA vaccine in under fives

12th June 2023

The safety of Covid-19 mRNA vaccines when used in children under five years of age has been reassured following a recent analysis of nearly a quarter of million doses.

Published in the journal Pediatrics, US researchers analysed information contained within the Vaccine Safety Datalink (VSD) on the use of mRNA vaccines in children aged five years of age and younger.

The VSD is a collaborative effort between the Centers for Disease Control and Prevention and eight data-contributing health systems. It maintains comprehensive electronic medical records for members, including Covid-19 vaccination data from retail pharmacies and state immunisation registries.

The researchers examined a total of 23 pre-specified safety outcomes including myocarditis, pericarditis and seizures. The primary analyses compared the incidence of these safety outcomes during a pre-specified risk interval (one to 21 days post-vaccination) with outcomes among primary series vaccinated comparators who were less recently vaccinated at 22-42 days post-vaccination.

Incidence of mRNA vaccine safety outcomes

In total, 135,005 doses of the Pfizer-BioNTech Covid-19 vaccine and 112,006 doses of the Moderna Covid-19 vaccine (i.e. mRNA vaccines) were given to children aged six months to five years in the VSD population. The risk ratios were not elevated for any of the pre-specified safety outcomes following any dose of either mRNA vaccine. As an example, the risk ratios for convulsions and seizures in zero to seven days post-vaccination were 0.64 (95% CI 0.25 – 1.51, p = 0.89) for Pfizer-BioNTech and 0.85 (95% CI, 0.27 – 2.32, p = .70) after Moderna.

The researchers concluded that these ongoing surveillance data should provide reassurance to clinicians, parents and policymakers.

Reassuring results

A previous interim analysis concluded that the incidence of selected serious outcomes was not significantly higher one to 21 days post-vaccination compared with 22-42 days post-vaccination for mRNA Covid-19 vaccines. Moreover, a further analysis indicated a low incidence of myocarditis and pericarditis among individuals persons aged five to 39 years. While these data are reassuring, further safety monitoring data are needed for mRNA doses, particularly when administered to children aged six months to five years of age, hence the current study.