Staffordshire and Stoke on Trent

Noted (AI summary) West Midlands Ambulance Service acknowledges the concerns and explains that they use NHS Pathways for triage, as required by Department of Health guidelines. They also describe their clinical validation team's review of category 3 and 4 patients and regular clinical audits.

Noted (AI summary) The trust has developed a Cardiac Implantable Electronic Device Lead Infection Microbiology Hospital Guideline to aid in detection and treatment of Subacute Bacterial Endocarditis (SBE) related to cardiac rhythm devices and will link it to existing guidance for Pyrexia of Unknown Origin (PUO). The learning board has been shared and will be further supported at the Trust-wide Quality Summit and in a monthly 'Patient Safety Brief' newsletter. The practice discussed the case and reviewed the patient's medical record, concluding that the diagnosis was difficult to make in primary care due to the unusual nature of the infection and non-specific symptoms. They now recognise this as a possible cause of malaise in similar future scenarios. The Trust is undertaking a programme of education for acute physicians via grand rounds and a 'Lesson of the Month' email to raise awareness of pacemaker related endocarditis. They will also update patient information leaflets to include additional instructions regarding fever and device related endocarditis, aiming to complete this by November 2019.

Noted (AI summary) Stoke on Trent Council details its involvement with Mrs Kaiser's care, noting that Staffordshire County Council had primary responsibility. They state that concerns about SSOTP TVN staff actions were raised with the Safeguarding Lead Nurse for the Stoke on Trent CCG, and that learning from the investigation has been shared with the home.