Coronavirus warning signs MISSED by scoring system used across the NHS, investigation finds

WARNING signs that some hospital patients had contracted coronavirus may have been missed by a scoring system used across the NHS.

A new investigation has claimed that patients with severe symptoms may have also had treatment delayed because of the system.

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The Healthcare Safety Investigation Branch (HSIB) found that some NHS staff members had developed an “over reliance” on the scoring system.

The system is used to determine how ill a patient is and how their needs should be met.

Medical professionals look for early warning signs such as pulse, blood pressure, breathing and temperature, in order to determine a patient’s progress.

But some patients had suffered with “happy hypoxia” a condition which means that the patient isn’t getting the right amount of oxygen levels – but shows no symptoms or signs that they are struggling.

This means that their warning score would not change.

What is happy hypoxia?

Patients with the condition known as “happy hypoxia” will display oxygen levels low enough to cause death or unconsciousness.

Patients are not likely to feel uncomfortable at this level, which is why the condition often goes undetected.

As they won't have symptoms, in many cases patients will continue to behave normally before passing out or collasping.

It is dangerous for Covid-19 patients as the body is deprived of oxygen, and the conditon could lead to further complications.

Signs and symptoms:

  • cough
  • wheezing
  • confusion
  • rapid breathing
  • shortess of breath
  • sweating
  • changes of colour in the skin
  • unusally slow/fast heart rate

If you think you're suffering signs of hypoxia you should call NHS 111 where an operator will be able to advise on your symptoms, or in an emergency dial 999

The HSIB said there was a risk that patients who were suffering from this may not have had their care needs escalated fast enough if staff had already been reassured with their other symptoms.

The investigation also found that inexperienced staff were deployed to care for Covid patients and were reliant on the scoring system.

The Independent reported that a previous investigation by the HSIB last year found that staff can rely on such scores when working in a busy environment.

It did however state that the use of the score depends on the judgement of the staff on duty at that time.

Dr Kevin Stewart, HSIB’s medical director and a consultant physician at Hampshire Hospitals Trust, said: “In one report that we received, a patient’s oxygen saturation significantly reduced within a period of half an hour, but this did not change their score, and escalation didn’t happen in a timely way.

 

 

“The virus meant that we had to completely reorganise the way we worked in a short space of time.”

He said that this brought new risks to the fore and that many staff found themselves working in unfamiliar environments with patients that they wouldn’t usually care for.

Dr Stewart added: “They did a fantastic job in the circumstances but this sort of working can introduce new risks, especially when dealing with a new disease.”

The report highlights that some NHS trusts across England had been using warning scores to “track deterioration” in Covid patients.

It stated that the availability of clinicians with the prerequisite “clinical judgement” and the correct expertise was limited.

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“Staff who were less familiar with managing acute medical patients were sometimes falsely reassured by no change or additional change in early warning score", it added.

While some hospitals were using the warning scores to analyse the risk patients posed when being admitted – others were using it in isolation from other indicators.

In April the Royal College of Physicians warned staff that any increase in oxygen requirements should be referred to a senior doctor.

An NHS England spokesperson said: “The NHS has been clear throughout the pandemic that clinical teams should not solely rely on national early warning scores for clinical decision making.”

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