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Found 8 results
  1. Content Article
    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.
  2. Content Article
    BAPEN recognises that resources will be limited and often patchy depending on availability of appropriately trained staff – doctors, nurses, dietitians and pharmacists. The demands posed by large numbers of COVID -19 patients with pneumonia, especially on CPAP or ventilators in critical care and intensive care settings will test the capacity of all involved. It follows that special care still needs to be taken to ensure nutritional support is given where indicated whilst avoiding complications associated with tube misplacement in the lungs or oesophagus followed by infusion of nutrients, drugs or water – so called “Never Events”. BAPEN has provided the following advice: An overview of opinions on nasogastric tubes as aerosol generating procedures during the Covid-19 crisis COVID-19 & enteral tube feeding safety
  3. Content Article
    The study used quality improvement methods to develop and test interventions to extend drinking opportunities and choice in two care homes. Initial activity included observation of the systems for delivering fluids and involving staff, residents and carers in describing and mapping the organisation of care. An interactive training programme was indicated by staff as an important priority and was therefore introduced as a first step to improve hydration care. Subsequent interventions were co-designed with care staff and tested using Plan Do Study Act (PDSA) cycles. Their efficacy was measured through data captured on the amount of fluids served and consumed, and staff and resident feedback. The long-term impact of the interventions was assessed by measuring daily laxative and antibiotic consumption, weekly incidence of adverse health events, and average fluid intake of a random sample of six residents captured monthly. The link below shows the I-Hydrate presentation which summarises the project and its findings.
  4. News Article
    It has been revealed that three patients a day are dying from starvation or thirst or choking on NHS wards. In 2017, 936 hospital deaths were attributed to one of those factors, with starvation the primary cause of death in 74 cases.The Office for National Statistics data reveals malnutrition deaths are 34% higher than in 2013. Over-stretched nurses are simply too busy to check if the sick and elderly are getting nourishment. However, Myer Glickman from the ONS says the data is not conclusive proof of poor NHS care. He said:“There has been an increase over time in the number of patients admitted to hospital while already malnourished. This may suggest that malnutrition is increasingly prevalent in the community, possibly associated with the ageing of the population and an increase in long-term chronic diseases.” Yet campaigners say too many vulnerable people are being “forgotten to death” in NHS hospitals and urgent action is needed to identify and treat malnutrition. In a recent pilot scheme the number of deaths among elderly patients with a fractured hip was halved by simply having someone to feed them. Six NHS trusts employed a junior staff member for each ward tasked with getting 500 extra calories a day into them. More survived and the patients spent an average five days less in hospital, unblocking beds and saving more than £1,400 each. It wasn’t just the calories though – it helped keep their morale up. Because, as one consultant said: “Food is a very, very cheap drug that’s extremely powerful.” Read full story Source: Mirror, 4 February 2020
  5. News Article
    Hundreds of patients have been warned supply problems with the specially made IV feed they need to stay alive is likely to continue for months. NHS England, which declared a national emergency incident in the summer because of the delays in production of intravenous nutrition, has written to patients warning the problems are far from resolved. Dozens of patients have been admitted to hospital in the past six months because of the supply shortage, which was sparked in June when the main manufacturer, Calea, based in Runcorn, was hit by overnight restrictions by the Medicines and Healthcare products Regulatory Agency (MHRA). Since the shortages started the NHS has been forced to fly in feed from other European countries, while some patients have had to switch from their bespoke feed to so-called off-the-shelf bags which don’t contain everything they need in the right quantities. Some hospitals have admitted patients to hospital to make sure they receive what they need because of fears for their health or lack of supplies in the community. Initially it had been hoped the delays in production would be improved by the end of the year, but in a letter sent to some patients, seen by The Independent, NHS bosses warn patients could be facing many more months of delays. Read full story Source: The Independent, 1 January 2020
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