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Found 101 results
  1. News Article
    Frontline doctors have told the Independent they have been gagged from speaking out about shortages of protective equipment as they treat coronavirus patients – with some claiming managers have threatened their careers. Staff have been warned not to make any comments about shortages on social media, as well as avoiding talking to journalists, while NHS England has taken over the media operations for many NHS hospitals and staff. The Independent has seen a series of emails and messages warning staff not to speak to the media during the coronavirus outbreak. One GP has been barred from working in a community hospital in Ludlow after making comments about the lack of equipment, while another in London said they were told to remove protective equipment they had purchased themselves. NHS England confirmed it was controlling media communications, which it said was part of its national emergency incident planning to ensure the public received “clear and consistent information”. Read full story Source: The Independent, 1 April 2020
  2. Content Article
    This guidance document seeks to provide a framework to help your local simulation-based endeavours achieve the most benefit for the needs in your organisation and department. Further resources and examples of practice to support each domain of the framework are currently being collated for sharing nationally in the immediate future. Working in collaboration, The Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists have developed this website to provide the UK intensive care and anaesthetic community with information, guidance and resources required to support their understanding of and management of COVID-19. Intensive care practitioners and anaesthetists are integral to the safe and effective care of patients diagnosed with COVID-19, and play a role in informing and reassuring the public about this viral outbreak.
  3. Content Article
    Key recommendations Ask the patient if they would like to have the conversation and how much information they would want. All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences. Conversations about the future can and should be initiated at any point. The conversation is a process not a tick-box, and does not have to reach a conclusion at one sitting. Be aware of the language you use with patients and those they have identified as being important to them, and try to involve all the relevant people in agreement with the patient.
  4. News Article
    NHS national leaders are set to reassure doctors they should not fear regulatory reprisals, within reason, if they end up working outside their areas of expertise during the coronavirus outbreak. HSJ understands the UK’s four chief medical officers and the General Medical Council are drafting a letter to be sent to all UK doctors, which will contain the reassurances, as the system braces for a sharp rise in covid-19 cases. The letter will also urge doctors to be flexible and not to resist new ways of working, with senior figures expecting many clinicians working in other specialities or locations during the outbreak. The letter will say doctors, while still expected to follow good medical practice, should not fear reprimand from their employers or national bodies such as the GMC, NHS England or other regulators. Read full story (paywalled) Source: HSJ, 11 March 2020
  5. News Article
    The British Medical Association (BMA) should not allow itself to become a campaign tool for vested interest groups seeking a dangerous change in the law, writes Dr Matthew Davis in the Guardian. "Doctors have a responsibility to first do no harm... Even when it may feel uncomfortable, doctors must continue to exercise their Hippocratic duty", says Dr Davies. "The BMA must remain opposed to assisted suicide if the medical profession it claims to represent is to have any credibility in safe, caring and trustworthy expertise. It must not allow itself to become a campaign tool for vested interest groups seeking an extreme and dangerous change in the law that has, even very recently, been rejected by parliament." Read full story Source: The Guardian, 25 February 2020
  6. News Article
    Doctors need to stop moaning and take responsibility for improving the NHS, the leader of Britain’s medics has said. Ministers have given the NHS a “substantial sum” of money and doctors must now stop blaming the government for all its problems, Carrie MacEwen, Chairwoman of the Academy of Medical Royal Colleges, told The Times. Britain’s 220,000 doctors have a professional duty to make the health service’s ten-year plan work and can no longer “sit on their hands”, Professor MacEwen said. After years in which the loudest medical voices have tended to complain about government funding and staffing levels, she said that doctors should take advantage of a “golden opportunity”. Read full story (paywalled) Source: The Times, 25 February 2020
  7. Content Article
    The evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.
  8. News Article
    Lives may be at risk unless the NHS reviews how stand-in doctors are recruited, a coroner has warned. Harry Richford's death after a series of failings at a hospital in Margate, Kent, was ruled "wholly avoidable". An inquest heard he was delivered by an "inexperienced" locum doctor who was new to the hospital. A national review into the recruitment, assessment and supervision of locums should be carried out, Christopher Sutton-Mattocks said in a report. The coroner wrote that particular emphasis should be considered upon the scope of locums' activities before they are left responsible for out-of-hours labour care. He issued 19 recommendations to prevent future deaths, including a request that NHS England and the Royal College of Obstetricians and Gynaecologists consider such a review, warning "there may be a risk to other lives both at this trust and at other trusts in the future". Read full story Source: BBC News, 19 February 2020
  9. News Article
    The Doctors’ Association UK has compiled stories from 602 frontline doctors which expose a startling culture of bullying and overwork in the NHS. The stories include: a pregnant doctor who fainted after being forced to stand up for 15 hours straight and being denied water. The junior doctor was subsequently shouted at in front of colleagues and patients on regaining consciousness and told it was her choice to be pregnant and that ‘no allowances would be made’. a doctor who told us that a junior doctor hung themselves in a cupboard whilst on shift and was not found for 3 days as no-one had looked for them. His junior doctor colleagues were not allowed to talk about his suicide and it was all ‘hushed up’. a doctor who was denied a change of clothes into scrubs after having a miscarriage at work despite her trousers being soaked in blood. Full press release
  10. News Article
    London doctors are using artificial intelligence to predict which patients with chest pains are at greatest risk of death. A trial at Barts Heart Centre, in Smithfield, and the Royal Free Hospital, in Hampstead, found that poor blood flow was a “strong predictor” of heart attack, stroke and heart failure. Doctors used computer programmes to analyse images of the heart from more than 1,000 patients and cross-referenced the scans with their health over the next two years. The computers were “taught” to search for indicators of future “adverse cardiovascular outcomes” and are now used in a real-time basis to help doctors identify who is most at risk. Read full story Source: Evening Standard, 15 February 2020
  11. News Article
    Leaving the EU means the UK has greater control over the training of healthcare professionals. The Department of Health and Social Care (DHSC) has announced that nurses and other allied healthcare professionals will be able to retrain as doctors ‘more quickly’ now the UK has left the EU. Under training standards set by the EU, existing healthcare professionals wishing to move into another area would have to complete a set standard of training, regardless of any existing health background or qualifications. Under the potential new system, a nurse who has been in the job for 10 years could benefit from training standards based upon experience and qualifications, rather than strict time-frames. Health Secretary Matt Hancock said: “Our incredible NHS is full of highly-qualified and dedicated professionals – and I want to do everything I can to help them fulfil their ambitions and provide the best possible care for patients. Without being bound by EU regulations, we can focus on ensuring our workforce has the necessary training which is best suited to them and their experience, without ever compromising on our high standards of care or on patient safety. The plans we are setting out today mean that we can retrain healthcare workers and get them back to the frontline faster. This is good for patients, and good for our NHS." Nursing leaders warn that the move needs to come without compromising patient care. Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) said: “Having enough health and care professionals with the right knowledge, skills and values is vital to meet the individual needs of people across all four countries of the UK now and in the future." “The NMC supports the wish to explore how education and training for registered nurses and midwives may be achieved in more flexible ways while ensuring our high standards are maintained and not compromised. Every nursing and midwifery professional must be safe and competent to provide the best care and support possible." Read full story Source: Nursing Notes, 9 February 2020
  12. Content Article
    Managing neuropenic sepsis My role as an acute oncology CNS is to improve cancer services. Part of my role is the treatment and management of neutropenic sepsis. Neutropenic sepsis is an oncological emergency following chemotherapy, whereby the patient’s immune system has been depleted by the treatment for their cancer. The body’s natural defense system has been wiped out from the cytotoxic drug, making the patient more susceptible to infections and, therefore, sepsis. The national standards for treatment of neutropenic sepsis are: Early warning symptoms: call the chemotherapy 24-hour hotline, manned during the day by the chemotherapy nurses and out of hours by the oncology ward nurses who are trained in giving advice to patients on chemotherapy. A high or low temperature is normally the worrying symptom. The UKONS 24 Hour Triage Tool: an algorithm used to support the nurses' advice. The patient is then advised to attend A&E or, if acutely unwell, call an ambulance. Once the patient arrives in the emergency department, the national standard 'door-to-needle time' is to receive antibiotics for suspected infection within 1 hour. How we improved cancer patient safety Monthly audits showed that for 65% of all patient's suspected to have neutropenic sepsis, none received appropriate treatment. This was usually because of contra-indicating admission i.e., came in with left flank pain, or poor triage. An alert card is given to every patient receiving cancer treatment for them to present to the emergency department, alerting everyone that the patient is receiving cytotoxic drugs and advice on how to manage this. The audits I performed highlighted that the patients who presented to the emergency department out of hours did not receive appropriate antibiotics in time. This correlated to no acute oncology nurse present. These findings led to us changing our practice to a nurse-led service. We asked the chemotherapy hotline to alert us to anyone they had advised to attend the emergency department. This allowed us to meet the patient at the front door, and to support and arrange for doctors and nursing staff to give the correct management in time, expediting and eliminating error. The errors I speak of were never incompetence; they were human error. One nurse to 20 unwell patients in the emergency department is unsafe. The emergency department is the frontline in all acute trusts. In the trenches, fantastically skilled but overworked and under-valued. This was noticed by the acute oncology team. I derived that we as a team needed to change our working hours. 10 hours days, 4 days a week. Excluding weekends, where the oncology registration would stand in for the acute oncology service. This worked on days where neutropenic sepsis admissions were many, but still did not support the out of hours admissions. Teaching and training were my next focus. I set up a trust-wide acute oncology conference where I invited all trust staff to attend, inviting guest speakers, experts in their field, to teach and train nurses, doctors, the receptionist, anyone who would meet a patient on cancer treatment. We trained emergency department nurses to be able to prescribe and administer the first dose of antibiotics to ensure the door-to-needle time less than 1 hour was adhered to. Training empowered the emergency staff. Training is investing not scolding. Following these changes, our monthly audit numbers went from 65% to 80–90% over the course of 3 months, which showed a huge success. However, then January came, ambulances queuing down the hill from the emergency department. 345 admissions with only two beds within the trust. 25 staff shortage. Door-to-needle times became 3 hour rather than 1 hour. Our team consisted of three CNS to cover the acute hospitals with emergency departments. 50 referrals a day predominately for new diagnosis of cancer. Door-to-needle times on audit were at an all-time low of 25%. The worst I had seen it. Look at the contributing factors: 25 staff nurses down, huge demand on admissions and beds, limited capacity to review patients. During this month, acute oncology CNS predominantly lived in the emergency department, prescribing and administering the antibiotics ourselves to ensure safe practice. This did not come at a cost to the rest of our service and ensured patient safety. It dramatically improved our door-to-needle times. Acute oncology CNS are a necessity and, I personally think, the unsung heroes of an acute trust. We can prevent hospital admissions and avoid delayed discharges, freeing up beds and supporting and advising doctors to investigate patients appropriately and safely. Why I love my role I enjoy my role. It is a rewarding role. I have had the privilege to meet and work with the most beautiful people in the most harrowing of times. The worst times. But it is worth it. Meeting someone who has been in pain and suffering for 3 months at home who has come into hospital because the pain had got to much. They are aware something is wrong but isn’t sure what. Breaking the bad news that this is a cancer and having the time and resources to support that patient and their family. Knowing I am making a difference. Even when the outcome is that this person is not fit enough for further investigations or would not be safe enough to have chemotherapy, but advising them that the main focus of care should be symptom management and palliative care to ensure quality of life. To feel that I have made a difference and, more importantly, to hear that I have. Ensuring patient safety through diagnosis to treatment and to the end of life care. Something we must not overlook the importance of. Although acute oncology CNS is not as well-known as critical outreach nurses or heart failure nurse specialists, it is equally important and necessary. A case study I would like to end this blog with a case study of a patient named Brendan*. Brendan was a 24-year-old man who presented with a 3-day history of right upper quadrant pain. Clinically jaundice. 10/10 pain. Unable to move. He had an ultrasound in the emergency department on Wednesday pm. He was referred to acute oncology in light of suspicious radiological diagnosis of cancer. Within 48 hours, acute oncology had reviewed him and broken the bad news to him that he had cancer. Cancer of unknown primary. The young man was discharged from hospital. We ensured a support service in system (given him our CNS number), managed his pain, arranged further investigations and discussed in a multidisciplinary meeting the best site for biopsy. We booked the biopsy and arranged a clinical appointment 1 week later with our acute oncology consultants. We called this young man every day for symptom reviews and holistic support for him and his family. He received chemotherapy within 3 weeks of diagnosis and is alive to this day, with a cancer that is rare and difficult to treat. Having only had six hospital admissions. This is why acute oncology are a necessity to any hospital and community service. *Name has been change to ensure confidentiality.
  13. Content Article
    Clare Wade and Professor Allen Hutchinson discuss the National Mortality Case Record Review (NMCRR) and the structured judgement review process at the RCP's Patient Safety Seminar:
  14. Content Article
    The Primary Care Cancer Toolkit has been developed by the Royal College of General Practitioners (RCGP) in collaboration with Cancer Research UK as part of our partnership to raise awareness and knowledge of the role of primary care in cancer control. It is designed for use by primary healthcare professionals in the UK. If you are accessing these resources from outside the UK, bear in mind that guidelines and systems may be different. Resources are split into professional and patient sections. Professional resources consist of guidelines, information and tools aimed at those working in primary healthcare. Those within the patient section are websites, information leaflets and other resources aimed at a public audience which a healthcare professional can signpost patients to during or post consultation.