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Found 75 results
  1. News Article
    An emergency unit at a Norwich hospital has reduced ward admissions and is helping shield urgent non-COVID-19 patients. The older people’s emergency department (Oped) – a special unit at the Norfolk and Norwich university hospital – is providing emergency care for patients over 80. Launched in 2017, the unit, just down the corridor from A&E, has six beds, two in side rooms and no waiting room. Normally, it admits patients identified as frail and usually with multiple conditions that need a lot of care (such as cognitive impairment, incontinence or reduced mobility). They are brought straight in by ambulance or trolley from other parts of the hospital and seen by a consultant geriatrician within two hours. A team of nurses with experience in both emergency care and care of the elderly, pharmacists and physiotherapists are on hand to support patients much more quickly than A&E to get patients out of hospital and back home within the same day wherever possible. For patients who need to stay longer after treatment there is an adjacent ambulatory ward. This unique model is showing results. The proportion of the specialist department’s patients admitted to the hospital is 50% compared with 68% for the same age group of emergency patients coming to the hospital five years ago, when they were treated at the normal A&E. When Oped patients are admitted, their average length of stay is 1.2 days less. “It’s just what we want for old people,” says Dr Sarah Bailey, the department’s lead consultant geriatrician. “We get the experts in straight away because we recognised that’s the best thing for [them]”. During the pandemic, the unit is helping to keep those who do not have coronavirus symptoms, such as those with injuries from falls and some stroke patients, away from the main A&E ward, providing a degree of shielding not normally possible. But for most NHS trusts, providing a separate unit like Oped is not feasible. “Hospitals are working to separate emergency patients with respiratory problems from those with other conditions,” says Dr Jay Banerjee, who leads the Royal College of Emergency Medicine’s work on emergency care for the elderly. “But most just do not have the capacity to also try to separate elderly patients with other conditions from younger patients.” Read full story Source: The Guardian, 27 May 2020
  2. News Article
    Once COVID-19 seeps into care homes, it is a monumentally difficult job to protect the residents, writes Sky's Alex Crawford. We will look back at this appalling, tragic episode in our global history, and our children and grandchildren will ask us: "Did that really happen? Did you really leave the most vulnerable of our society - the elderly, the infirm, the defenceless, the muddled, sick and weak - in care homes, shut away from their closest relatives? Did you leave them to be ravaged by a deadly virus, and do very little to help them?" Because that is what's happening right now. There are elderly people - many with Alzheimer's, many with dementia, many frail - in thousands of residential homes up and down Britain, and they are very much at risk. Read full story Source: Sky News, 11 Aril 2020
  3. News Article
    Hundreds of people are dying in care homes from confirmed or suspected coronavirus without yet being officially counted, the Guardian has learned. More than 120 residents of the UK’s largest charitable provider of care homes are thought to have died from the virus in the last three weeks, while another network of care homes is reported to have recorded 88 deaths. Care England, the industry body, estimated that the death toll is likely to be close to 1,000, despite the only available official figure for care home fatalities being dramatically lower. The gulf in the figures has prompted warnings that ministers are underestimating the impact of Covid-19 on society’s most frail, and are failing to sufficiently help besieged care homes and workers. Read full story Source: The Guardian, 7 April 2020
  4. News Article
    Elderly care home residents have been categorised “en masse” as not requiring resuscitation, in a strategy branded unacceptable by the healthcare regulator. People in care homes in Hove, East Sussex and south Wales are among those who have had “do not attempt resuscitation” (DNAR) notices applied to their care plans during the coronavirus outbreak without proper consultation with them or their families, MPs and medical unions fear. Care homes in Leeds have reported that district nurses have been asking them to “revisit do not resuscitate conversations with people who said they didn’t want them” and a care worker in Wales told the Guardian that after a visit from a GP, all 20 of their residents had DNAR notices attached to their plans. DNAR notices are a common part of care plans and many people wish to have them in place because, in the event of cardiac arrest, attempts to resuscitate can cause serious trauma, including broken bones. But the Care Quality Commission and other medical bodies are so concerned about the blanket application of the notices that it has issued a warning to stop. “It is unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description,” the notice states. “These decisions must continue to be made on an individual basis according to need.” Read full story Source: The Guardian, 1 April 2020
  5. News Article
    Healthcare professionals have been told to consider not treating patients with the COVID-19 coronavirus if they themselves would be put at risk, part of new ethical guidance that calls on doctors to prioritise some ailments over the pandemic. The new recommendations for healthcare professionals over 70 years, or with pre-existing conditions, to put themselves first when tackling the pandemic comes following the death of a doctor who returned to the frontlines as a volunteer following a call to arms from the government. The guidance from the Royal College of Physicians (RCP) makes up part of a sweeping list of ethical considerations faced by healthcare workers in the face of the global pandemic. Read full story Source: The Independent, 2 April 2020
  6. Content Article
    Background and scope of guidanceWhat do we mean by extremely vulnerable?What you need to knowSymptomsWhat is shielding?What should you do if you have someone else living with you?Handwashing and respiratory hygieneWhat should you do if you develop symptoms of coronavirus (COVID-19)?How can you get assistance with foods and medicines if you are shielding?What should you do if you have hospital and GP appointments during this period?What is the advice for visitors, including those who are providing care for you?What is the advice for informal carers who provide care for someone who is extremely vulnerable?How do you look after your mental well-being?What steps can you take to stay connected with family and friends during this time?What is the advice for people living in long-term care facilities, either for the elderly or persons with special needs?What is the advice for parents and schools with extremely vulnerable children?
  7. Content Article
    This regulation 28 is around testing of patient call bells in care homes. Questions: Have you got a system for checking call bells where you work? Are the call bells always in reach of the patient?
  8. Content Article
    RESTORE2 was co-produced by West Hampshire CCG and Wessex Patient Safety Collaborative. It is designed to support homes and health professionals to: Recognise when a resident may be deteriorating or at risk of physical deterioration Act appropriately according to the residents care plan to protect and manage the resident Obtain a complete set of physical observations to inform escalation and conversations with health professionals Speak with the most appropriate health professional in a timely way to get the right support Provide a concise escalation history to health professionals to support their professional decision making. The full series of six videos about implementing and using RESTORE2 in care home settings, together with some case study based scenarios can be viewed below.
  9. News Article
    Hundreds of elderly and vulnerable social care residents have allegedly been sexually assaulted in just three months, a shock new report from the care regulator has revealed. According to the Care Quality Commission there were 899 sexual incidents reported by social care homes between March and May 2018. Almost half were categorised as sexual assault. In 16% of the cases members of staff or visiting workers were accused of carrying out the abuse. The watchdog said it was notified of 47 cases of rape and told The Independent local authorities were informed and 37 cases were referred to police for investigation. Kate Terroni, Chief Inspector of adult social care at the regulator, said: “Supporting people as individuals means considering all aspects of a person’s needs, including sexuality and relationships. However, our report also shows all too starkly the other side of this – the times when people are harmed in the very place they should be kept safe. This is utterly devastating, both for the people directly affected and their loved ones." “It is not good enough to put this issue in a ‘too difficult to discuss’ box. It is particularly because these topics are sensitive and complex that they should not be ignored.” Read full story Source: The Independent, 27 February 2020
  10. Content Article
    These guidelines by the Association of Anaesthetists are a concise document designed to help peri-operative physicians and allied health professionals provide multidisciplinary, peri-operative care for people with dementia and mild cognitive impairment. They include information on: involving carers and relatives in all stages of the peri-operative process administering anaesthesia with the aim of minimising peri-operative cognitive changes training in the assessment and treatment of pain in people with cognitive impairment.
  11. Content Article
    So, what does it feel like working in chronically depleted staffing levels? "We are down three nurses today" – this is what I usually hear when I turn up for a shift. It has become the norm. We work below our template, usually daily, so much so that when we are fully staffed, we are expected to work on other wards that are ‘three nurses down’. Not an uncommon occurrence to hear at handover on a busy 50-bedded medical ward. No one seems to bat an eyelid; you may see people sink into their seat, roll their eyes or sigh, but this is work as usual. ‘Three nurses down’ has been the norm for months here, staff here have adapted to taking up the slack. Instead of taking a bay of six patients, the side rooms are added on making the ratio 1:9 or sometimes 1:10, especially at night. This splitting up the workload has become common practice on many wards. "That was a good shift" – no one died when they were not supposed to, I gave the medications, I documented care that we gave, I filled out all the paperwork that I am supposed to, I completed the safety checklists. Sounds a good shift? Thinking of Erik Hollnagel’s ‘work as done, work as imagined’ (Wears, Hollnagel & Braithwaite, 2015) – this shift on paper looks as if it was a ‘good shift’ but in fact: Medications were given late; some were not given at all as the pharmacy order went out late because we had a patient that fell. Care that was given was documented – most of the personal care is undertaken by the healthcare assistants (HCA) now and verbally handed over during the day – bowel movements, mobility, hygiene, mouth care, nutrition and hydration. As a nurse, I should be involved in these important aspects of my patients’ care, but I am on the phone sorting out Bed 3’s discharge home, calling the bank office to cover sickness, attending to a complaint by a relative. It’s being attended to by the HCA – so it's sorted? I have documented, probably over documented which has made me late home. I’m fearful of being reprimanded for the fall my patient had earlier on. This will be investigated and they will find out using my documentation what happened. The safety checklists have been completed for all my patients; comfort rounds, mouth care, falls proforma, bed rails assessment, nutritional score, cannular care plan, catheter care plan, delirium score, swallow test, capacity test, pre op assessments, pre op checklists, safe ward round checklist, NEWS charting, fluid balance charting and stool charting… the list is endless. Management have made things easier with the checklist ‘if it’s not written down it didn’t happen’ so now we can ‘tick’ against the check list rather than writing copious notes. However, I cut corners to enable me to complete all my tasks, some ticks are just ‘ticks’ when no work has been completed. No one would know this shift would they? What looks as if it has been a ‘good shift’ for the nurse, has often been the opposite for the patients and their family. There is a large body of research showing that low nurse staffing levels are associated with a range of adverse outcomes, notably mortality (Griffiths et al, 2018; Recio-Saucedo et al, 2018). What is the safest level of staff to care for patients? Safe staffing levels have been a long-standing mission of the Nursing and Midwifery Council (NMC)/Royal College of Nursing (RCN) in recent years. In the UK at present, nurse staffing levels are set locally by individual health providers. The Department of Health and professional organisations such as the RCN have recommended staffing levels for some care settings but there is currently no compliance regime or compulsion for providers to follow these when planning services (Royal College of Nursing 2019). I was surprised to find that there are no current guidelines on safe staffing within our healthcare system. It left me wondering… is patient safety a priority within our healthcare system? It seems not. While the debate and fight continues for safe staffing levels, healthcare staff continue to nurse patients without knowing what is and isn’t safe. Not only are the patients at risk and the quality of care given, but the registration of that nurse is also at risk. What impact does low staffing have on patients and families? ‘What matters to them’ does not get addressed. I shall never forget the time a relative asked me to get a fresh sheet for their elderly mother as there was a small spillage of soup on it. I said yes, but soon forgot. In the throes of medication and ward rounds, being called to the phone for various reasons, answering call buzzers, writing my documentation, making sure Doris doesn't climb out of bed again, escorting patients to and from the CT scanner, transferring patients to other wards – I forgot. My elderly patients’ daughter was annoyed, I remember she kept asking and I kept saying "in a minute", this made matters worse. She got annoyed, so that I ended up avoiding her altogether. How long does it take to give her the sheet? Five minutes tops, so why not get the sheet? MY priority was the tasks for the whole ward, tasks that are measured and audited on how well the ward performs by the Trust; filling out the observations correctly, adhering to the escalation policy, completing the 20 page safety booklet, completing the admission paperwork, ensuring everyone had their medication on time, making sure no one fell – changing a sheet with a small spot of soup on it was not on my priority list. It was a priority for my patients’ family. My patient was elderly, frail and probably wouldn’t get out of hospital alive this time. Her daughter was the only family she had left. It’s no wonder families feel that they are not listened to, are invisible, are getting in the way and not valued. These feelings do not encourage a healthy relationship between patients/families and healthcare workers. Studies have shown that involving patients and families in care is vital to ensure patient safety. Patients and their relatives have the greatest knowledge of patients and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems (O’dell et al, 2011). If our relationship is strained, how can we, as nurses, advocate for the safety of our patients? So, what impact does low staffing have on the staff member? "Fully staffed today!" The mood lifts at handover. People are sat up, smiling, quiet excitable chatter is heard. This uplifting sentence is quickly followed by either: "Let’s keep this quiet" or "someone will be moved" or "someone will have to move to XX ward as they are down three nurses". Morale is higher when wards are fully staffed. The mood is different. There are people to help with patient care, staff can take their breaks at reasonable times, staff may be able to get home on time and there is emotional support given by staff to other staff – a camaraderie. The feeling does not last long. Another department is ‘three nurses down’. Someone must move to cover the shortfall. No one wants to go When you get moved, you often get given the ‘heavy’ or ‘confused’ patients. Not only that, you are working with a different team with different dynamics – you are an outsider. This makes speaking up difficult, asking for help difficult, everything is difficult: the ward layout, where equipment is stored, where to find documentation, drugs are laid out differently in the cupboard, the clinical room layout is not the same. The risk of you getting something wrong has increased; this is a human factors nightmare, the perfect storm. I am in fear of losing my PIN (NMC registration) at times. At some point I am going to make a mistake. I can’t do the job I have been trained to do safely. The processes that have been designed to keep me and my patients safe are not robust. If anything, it is to protect the safety and reputation of the Trust, that’s what it feels like. Being fully staffed is a rarity. Being moved to a different department happens, on some wards more than others. Staff dread coming to work for threat of being moved into a different specialty. Just because you trained to work on a respiratory, doesn’t mean you can now work on a gynae ward. We are not robots you can move from one place to another. I can see that moving staff is the best option to ensure efficiency; but at what cost? Another problem in being chronically short staffed is that it becomes the norm. We have been ‘coping’ with three nurses down for so long, that ‘management’ look at our template. Is the template correct, we could save money here? If we had written guidance on safe staffing levels, we still have the problem of recruitment and retention of staff; there are not enough of us to go around. Thoughts please... Does this resonate with you? Has anyone felt that they feel ‘unsafe’ giving care? What power do we have as a group to address this issue of safe staffing levels? References 1. Wears RL, Hollnagel E, Braithwaite J, eds. The Resilience of Everyday Clinical Work. 2015. Farnham, UK: Ashgate. 2. Griffiths P et al. The association between nurse staffing and omissions in nursing care: a systematic review. Journal of Advanced Nursing 2018: 74 (7): 1474-1487. 3. Recio-Saucedo A et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing 2018; 27(11-12): 2248-2259. 4. O’dell M et al. Call 4 Concern: patient and relative activated critical care outreach. British Journal of Nursing 2001; 19 (22): 1390-1395.
  12. News Article
    A double amputee suffered fatal pressure sores caused by "gross and obvious failings" in her hospital treatment. Janet Prince, from Nottingham, developed the sores after being admitted to Queen's Medical Centre (QMC) in July 2017. The 80-year-old died in January 2019. Assistant Coroner Gordon Clow issued a prevention of future deaths report to Nottingham University Hospitals NHS Trust (NUH). Nottingham Coroner's Court had heard Ms Prince was taken to QMC in Nottingham with internal bleeding on 15 July 2017. The patient was left on a trolley in the emergency department for nine hours and even though she and daughter Emma Thirlwall said she needed to be given a specialist mattress, she was not given one. "No specific measures of any kind were implemented during that period of more than nine hours to reduce the risk of pressure damage, even though it should have been easily apparent to those treating her that [she] needed such measures to be in place," Mr Clow said. Ms Prince was later transferred to different wards, but a specialist mattress was only provided for her a few days before she was discharged on 9 August, by which time Mr Clow said her wounds "had progressed to the most serious form of pressure ulcer (stage four) including a wound with exposed bone". Mr Clow said there were "serious failings" over finding an appropriate mattress and other aspects of her care while at the QMC, including "a gross failure" to prevent Ms Prince's open wounds coming into contact with faeces. Mr Clow said the immediate cause of her death was "severe pressure ulcers", with bronchopneumonia a contributory factor. Recording a death by "natural causes, contributed to by neglect", he said he was "troubled by the lack of evidence" of any changes to wound management at NUH. NUH medical director Keith Girling apologised for the failings in Ms Prince's care, claiming the trust had "learnt a number of significant lessons from this very tragic case". Read full story Source: BBC News, 14 February 2020
  13. Content Article
    To use the tool, you just need to enter your height and weight into the online calculator, along with your height and weight 3-6 months ago. You will be given a rating that will tell you if you are at high, medium or low risk of malnutrition. You will then be able to download a dietary advice sheet that gives basic information and suggestions for improving nutritional intake. If you are worried about your weight or having difficulty eating, make sure you talk to your GP or a healthcare professional. The dietary advice sheet was developed in partnership with a number of professional organisations. NB this site is intended for adult self-screening only.
  14. 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.
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