Patient Safety Watch: Antibiotics and valproate put prescribing in the spotlight

Good afternoon!

Welcome to the relaunch of the Patient Safety Newsletter that was previously brought to you by Patient Safety Watch and Jeremy Hunt. For obvious reasons, Jeremy has had to take a step back so, from now on, this newsletter will arrive in your inbox every two weeks and will come from Patient Safety Watch trustee, James Titcombe, published in collaboration with HSJ. We hope that it will continue to provide a useful source of patient safety related news and information.

National State of Patient Safety 2022 – new research report to be published next week

A new major research report – National State of Patient Safety 2022, produced by the Institute of Global Health Innovation and Patient Safety Watch – will be published on Tuesday next week. The report explores progress and identifies areas for improvement in patient safety nationally, based on analysis of publicly available data over the past 15 years. Please look out for the report and news coverage next week.

A spotlight on maternity safety

Earlier this month saw the publication of the latest report from MBRRACE-UK, Saving Lives, Improving Mothers’ Care. The report looks at lessons learned from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity between 2018 and 2020. Key messages from the report include:

• 229 women died during or up to six weeks after the end of pregnancy in 2018-20. That’s 10.9 women per 100,000 giving birth and worryingly, 24 per cent higher than 2017-19; 
• Black women were 3.7 times more likely to die than white women (34 women per 100,000 giving birth) and Asian women were 1.8 times more likely to die than white women (16 women per 100,000 giving birth); and
• In 2020, women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy compared to 2017-19.

A helpful summary of the findings, themes and recommendations from the charity Baby Lifeline can be read here.

Promoting patients’ voices

Henrietta Hughes, England’s new patient safety commissioner, has wasted no time since taking on this crucial new role earlier this year. In this blog written for the Healthcare Safety Investigation Branch, she sets out her vision for how this new role will be a champion for patients’ voices, promoting their safety within the health system and “ensuring their views are collated, listened to, and visibly included”.

Wishing Henrietta the best in her new role, which has huge potential to make a difference.

In other patient safety news:

World Antimicrobial Awareness Week

In a letter to integrated care system, trust and primary care leaders late last week, NHS England urged prescribers to use the shortest effective course of antibiotics appropriate. It added patients “should be advised to take antibiotics as directed, not to save for later or share with others, and to return any unused antibiotics to community pharmacies for safe disposal”.

The letter also encouraged organisations to ensure they were switching from intravenous to oral antibiotics in a timely manner, and to reduce inpatient exposure to antibiotics on the World Health Organisation’s “watch” and ”reserve” lists.

Meanwhile, the annual English Surveillance Programme for Antimicrobial Utilisation and Resistance report has revealed the estimated total number of severe antibiotic resistant infections in England rose to the equivalent of 148 a day in 2021, a 2.2 per cent rise compared to 2020. This is despite antibiotic use falling by 15.1 per cent between 2017 and 2021.

However, despite the year-on-year increase, antibiotic resistant diseases are at a lower level than before the covid-19 pandemic.

This year’s report also highlighted disparities among different demographic groups, with those in the most deprived parts of the country more likely to contract particularly serious forms of antibiotic resistant illnesses compared with the least deprived parts.

Action on valproate

NHSE and the Pharmaceutical Services Negotiating Committee have told community pharmacy contractors this year’s national clinical audit will focus on reducing harm from valproate prescribing for patients who could become pregnant.

Valproate, which is used to treat epilepsy, has been associated with increased risk of babies being born with congenital abnormalities and developmental delay when taken during pregnancy. However, a Sunday Times investigation earlier this year discovered many patients had continued to receive their prescriptions without being made aware of such warnings.

Meanwhile, campaigners are continuing to call for compensation for the babies, children and adults disabled as a consequence of valproate use – a key recommendation of the First Do No Harm report, published more than two years ago (July 2022).

Treatments for covid-19

The National Institute for Health and Care Excellence has recommended three medications for treating covid-19 in adults – Pfizer’s Paxlovid, Roche’s RoActemra, and Eli Lilly’s Olumiant. Paxlovid was recommended for non-hospital settings, while RoActemra and Olumiant were recommended for those who were in hospital and receiving oxygen.

It also examined five other medications which it chose not to recommend. This includes AstraZeneca’s Evusheld, which the committee was uncertain would be effective against the Omicron variant.

Developing a safety culture

Based on feedback from trusts rated “outstanding” or “good” in the Care Quality Commission’s safe domain, NHSE has drawn up a best practice guide for developing a safety culture. Ideas for embedding a safety culture include: creating senior patient safety roles (potentially at director level); allowing people to take time for safety even in busy periods; providing prompt feedback after incidents; creating direct escalation mechanisms for patients and their families to raise concerns; and talking constantly about key culture issues such as “psychological safety, civility, diversity of thinking and humility”.

Upgrading face masks could save NHS millions

A study by The York Economic Health Consortium has found the NHS could save up to £360m each year swapping surgical masks for correctly-fitted FFP3 masks in hospitals. It said the switch would help reduce the number of hospital-acquired covid infections and lower absence rates among NHS staff to levels similar to the general population.

That brings the first of the re-launched Patient Safety Newsletters to an end. For future editions, I’d love to hear from anyone with suggestions for items that we should include – my DMs are always open (assuming Twitter is still around that is!).

James Titcombe, Patient Safety Watch Trustee

@JamesTitcombe