Warning issued over chest drain incidents

Concerns have been raised over a number of incidents that have led to patient harm, prompting the publication of a National safety alert.

A review of the National Reporting and

Learning System (NRLS) over a three-year period identified 16 incidents where patients experienced acute and significant deterioration after uncontrolled or unmonitored drainage of a pleural effusion; two of these patients died and a cardiac arrest call was made for one patient although the outcome was not reported. The incident reports suggested: l Staff did not expect large quantities of pleural fluid to drain;

l Observations and monitoring of patients after chest drain insertion were either not timely or not done;

l Plans to manage the rate of fluid drainage were not documented or not followed.

Following these findings, a joint National Patient Safety Alert has been issued by the NHS England and NHS Improvement National Patient Safety Team, British Thoracic Society (BTS) and Association of Respiratory Nurse Specialists (ARNS), on the risk of deterioration due to rapid offload of pleural effusion fluid from chest drains. Pleural effusions are the accumulation of fluid between the lung and chest wall, which may cause breathlessness, low oxygen saturation and can lead to collapsed lung(s). Large effusions, such as those caused by pleural malignancy, may require insertion of

Calls to tackle health inequalities

a chest drain and controlled drainage of fluid to allow the lung to inflate.

If large volumes of pleural fluid are drained too quickly, patients can rapidly deteriorate. Their blood pressure drops, and they can become increasingly breathless from the potentially life-threatening complication of re-expansion pulmonary oedema. The rate at which fluid is drained must be controlled in order to prevent cardiovascular instability and collapse. The alert asks providers to review local chest drain clinical procedures to ensure they follow BTS and ARNS guidelines and standards; and to ensure clear instruction on frequency of observation, red flag triggers and local escalation procedures for patient deterioration are available to staff at the patient’s bedside. Failure to take the actions required under any National Patient Safety Alert may lead to CQC taking regulatory action. Visit: content/uploads/2020/12/NatPSA-Pleural- Effusion-FINAL-v3.pdf

gains momentum The movement to tackle health inequalities in the wake of the COVID pandemic is now an “unstoppable force” with the same momentum as tackling climate change, according to Professor Sir Michael Marmot. The lead author of the landmark report, ‘Health Equity in England: The Marmot Review 10 Years On’, was speaking at the BMA North East regional council’s Health Inequalities webinar. The North East has some of the widest inequalities in the country and, along with other areas of the North of England, has suffered disproportionately during the pandemic with some of the highest infection rates in the country, which have led to a higher COVID death rate. Professor Marmot said: “I can’t help

but make a link between our miserable health situation at the beginning of the pandemic… something was going very wrong and perhaps it’s that ‘something’ that led to our gross mismanagement of the pandemic.” Speaking after the event, Dr. George

Rae, chair of the BMA North East regional council, added: “The North East is among the hardest hit with our deep- rooted inequalities in health. It is crucial that we continue to highlight these unjust differences and put pressure on the Government to act.”



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