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Found 107 results
  1. Content Article
    Latest case studies: Urgent/emergency care Delayed oxygenation of neonate during resuscitation when oxygen not ‘flicked’ on Equipment falling onto critically ill patients during intrahospital transfers Misapplication of spinal collars resulting in harm from unsecured spinal injury Ensuring compatibility between defibrillators and associated defibrillator pads Ensuring pregnant women with COVID-19 symptoms access appropriate care General medicine Harm from catheterisation in patients with implanted artificial urinary sphincters Confusion between different strength preparations of alfentanil Ensuring compatibility between defibrillators and associated defibrillator pads Distinguishing between haemofilters and plasma filters to reduce mis-selection Variation in use of cardiac telemetry Ceftazidime as a 24-hour infusion Tacrolimus – risk of overdose when converting from oral to intravenous route Haloperidol prescribing for confused/agitated/delirious patients Ensuring oxygen delivery when using two step humification systems Intensive care Ventilator left in standby mode Equipment falling onto critically ill patients during intrahospital transfers Ensuring compatibility between defibrillators and associated defibrillator pads Distinguishing between haemofilters and plasma filters to reduce mis-selection Sudden patient deterioration due to secretions blocking heat and moisture exchanger filters Anaesthetic machines used as ventilators: issues with circuit set up Importance of ‘tug test’ for checking oxygen hose when transferring a patient to a portable ventilator Ensuring oxygen delivery when using two step humification systems Obstetrics and gynaecology/midwifery Harm from prescribing and administering Syntometrine when contraindicated to woman with significantly raised BP Delayed oxygenation of neonate during resuscitation when oxygen not ‘flicked’ on Unnecessary caesarean section for breech presentation if not scanned on the day HIV prophylaxis in women and new-borns Ensuring compatibility between defibrillators and associated defibrillator pads Ensuring the safe use of plastic cord clamps at caesarean section Warning on the use of ethyl chloride during fetal blood sampling Ensuring pregnant women with COVID-19 symptoms access appropriate care Risk of babies becoming unwell following move to virtual home midwifery visits Paediatrics and child health Ensuring compatibility between defibrillators and associated defibrillator pads Risk of babies becoming unwell following move to virtual home midwifery visits Unintentional perforation of oesophagus in neonates from invasive procedures Chemical burn to a neonate from use of chlorhexidine Other Ensuring compatibility between defibrillators and associated defibrillator pads Infrared temperature screening to detect COVID-19
  2. Content Article
    The guidelines recommend a number of changes to training and preparation, including: Clinical staff of all grades should receive multidisciplinary training in their place of work as part of annual mandatory training, covering the management of a fire and evacuation of their work area. Nominated clinical staff should be trained to select and use fire extinguishers. Designing new and refurbished ICUs and operating theatres is an opportunity to incorporate mandatory fire safety features. New strategies covered in these guidelines include modern sprinkler systems, emergency low level lighting and oxygen pipelines designed so that the oxygen supply to an ICU area affected by a fire to be cut off without interrupting the oxygen supply to the whole ICU. Ventilation of ICUs and clinical areas where high-flow nasal oxygen and non-invasive respiratory support are in use should be good enough to prevent oxygen enrichment of the ambient atmosphere: the recommended minimum ventilation rate of these areas is 10 air changes per hour. Laminated fire and emergency evacuation action cards, specific for that clinical area, should be placed next to all manual fire call points so that they can be followed in the event of a fire or if an emergency evacuation is required for another reason.. Cylinders should be stored, handled and used according to the gas supplier’s instructions, using the correct sequence of actions when administering oxygen and using an oxygen cylinder bed bracket at all times. Major incident planning should include plans for internal incidents, where the staff themselves are victims and unable to work and where ICU and theatre suites become unusable for patient care. All staff involved in a fire or similar emergency should be supported following the event and assessed by their occupational health team before restarting work.
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    Adult critical care provides specialised care for patients who are seriously ill, or who are at risk of becoming seriously ill. About 200,000 people per year in the UK require critical care for may different reasons including medical emergencies, major trauma or following complications after surgery. The GIRFT national report for adult critical care contains 19 recommendations for improving services in England, within the context of COVID-19. These recommendations aim to ensure equal access to critical care services. You will need a FutureNHS account to view this report, or you can watch a short video summarising the report's recommendations
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    The outcome is that the RCP released a statement on its website relating to revised guidance on the use of early warning scores for COVID-19 inpatients. The RCP suggest that all staff should be aware that any increase in oxygen requirements should be an indicator of clinical deterioration as the early warning score might not significantly increase.
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    This guide does not override the responsibility of the healthcare provider to use professional judgement and make decisions appropriate to the circumstances of each patient in consultation with the patient and/or guardian. Whilst this document is aimed primarily at staff working in secondary care, much of the material is applicable to primary care (GPs, community care homes and carers). It is designed to help you provide consistent, high quality care for your patients with a tracheostomy.
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    This easy reference guide has been produced because: Some aspects of COVID-19 presentation and treatment present special challenges for safely confirming nasogastric tube position. The dense ground-glass x-ray images can make x-ray interpretation more difficult, and the increasing use of proning manoeuvres in conscious patients increases the risk of regurgitation of gastric contents into the oesophagus and aspiration into the lungs which will render pH checks less reliable. This aide-memoire is not designed to replace existing, established, NHSI compliant practice of NG confirmation. If a critical care provider is in the fortunate situation of having nursing and medical staff who have all completed local competency-based training in nasogastric tube placement confirmation aligned to local policy, they would be able to continue more complex local policies. Such policies might include specific advice indicating which critical care patients could have pH checks for initial placement confirmation, and which require x-tray confirmation, and how second-line checks should be used if first-line checks are inconclusive. However, staff returning to practice, or redeployed to critical care environments, including in Nightingale hospitals, will be helped by reminders of established safety steps in a form that can be used for all critical care patients, rather than requiring different processes for different patients. This is version 2 of the aide memoire, which includes additional advice on situations where providers can continue to safely use more complex local polices. Other changes were minor refinements of language and use of capital letters to emphasise application to checks before first use.
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