bluuebunny/crossref_metadata_2025 huggingface dataset:
Europe gets serious about minimizing needlestick injuries
Authors: Bowis John
Published: May 2014

More than one million needlestick injuries are suffered in Europe each year. New legislation was recently passed by the EU to protect Europe's healthcare workers from potentially fatal blood-borne infections such as HIV and hepatitis B and C, resulting from injuries with used needles. Here, John Bowis, Health First Europe (HFE) Honorary President and former UK Minister of Health and MEP, comments on the new directive and its significance to paramedic practice.
Prehospital induction techniques: mild hypothermia during advanced life support
Authors: Stefano Bernardelli , Elisa Rebesan , Alessandra Culoma Luciana , Rita Riolfi , Elena Colombaroli
Published: May 2014

The use of therapeutic hypothermia has been proposed as a potential treatment for a number of medical conditions including head injury and cerebral vascular accidents. This article aims to explore the different techniques used to induce hypothermia during prehospital cardiovascular arrest.

The review of the necessary literature has been made in order to answer the question ‘What are the possible cooling methods to reach therapeutic hypothermia in out-of-hospital cardiac arrest?’. The research took place between May–November 2008.

Ovid database was examined/questioned initially and the research was carried out simultaneously using Ovid Medline, Pubmed and CINAHL. The research showed that inclusion and exclusion criteria were similar in all the analysed studies. The chosen patients were aged 18–70 years. Only one article included patients older than 70 years who were affected by extra-hospital cardiocirculatory arrest and were treated with therapeutic hypothermia with infusion of cold liquids or use of correspondent remedies.

A total of 627 620 articles were found during the search term research. Boolean operators were used to review the research. ‘AND’ was used to combine to the operator limit. ‘OR’ was used to include orthographic alternatives.

All this reduced the research to four articles. Cutting off and mesh researches were used in ‘include relative terms’ within the Ovid control panel.

The analysis of the four studies showed the effectiveness of introducing hypothermia in prehospital treatment dealing with the reduction of the oesophageal temperature. In all studies, the temperature reduction is relevant, presenting values of −1–4°C. The infusion of cold solutions is a technique that is easy to apply and has low costs. Infusion with cold pads, on the other hand, proves more difficult and requires greater attention and daily maintenance.
The paediatric assessment triangle: a powerful tool for the prehospital provider
Authors: Horeczko Timothy , Gausche-Hill Marianne
Published: May 2014

The paediatric assessment triangle (PAT) is an internationally accepted tool in paediatric life support for the initial emergency assessment of infants and children. It is a rapid, global assessment using only visual and auditory clues, and takes only seconds to perform. The PAT has three components: appearance, work of breathing and circulation to skin. It is the first step in answering three critical questions: (1) How severe is the child's illness or injury? (2) What is the most likely physiologic abnormality? and (3) What is the urgency for treatment? The combination of abnormalities observed by the three components defines one of six categories of clinical status: stable, respiratory distress, respiratory failure, shock, central nervous system (CNS)/metabolic disorder, or cardiopulmonary failure. The category of illness and its severity drives management priorities and determines the initial treatment. In addition, the PAT provides a common vernacular for emergency clinicians and may be applied repeatedly to track clinical status. This article will furnish the prehospital provider with an approach to the recognition and treatment of the acutely ill or injured child.
A case of heat-related illness
Authors: Sheng Chew keng , Latif Abdul kursi abdul
Published: May 2014

Although heat-related illnesses are relatively uncommon in the UK, nonetheless, this can pose serious dangers to military personnel posted to the Middle East as well as tourists who are not acclimatised to the hot weather of a tropical country. This article illustrates some common presentations of heat-related illnesses by highlighting the case of a man who suffered from heat exhaustion after he lost consciousness in his car. This case happened in the authors' home country, Malaysia.
Epinephrine and its use in acute life-threatening asthma in adults
Authors: Bhullar Jaswin , Mellor Katherine , Hill Stephen
Published: May 2014

Epinephrine (adrenaline) is commonly used by paramedics in a range of clinical scenarios. Its role in cardiac arrest scenarios is well established, but the indications for use in acute severe or life-threatening asthma are less well defined. This article reviews the evidence for the use of epinephrine in acute severe asthma and uses a case study to highlight some of the potential side-effects that clinicians need to be aware of.
Sickle cell disease: acute complications and management
Authors: Hodges Ross
Published: May 2014

Sickle cell disease is a genetic blood disorder resulting in the sickling of red blood cells (RBC) when exposed to certain conditions. Historically, sickle cell care has been poor and often delayed, but in recent years, several key publications have helped provide guidance and uniformity on how to manage acute crises, ensuring all patients receive a high level of care. The sickling of RBC can lead to acute complications, some of which are potentially life-threatening. The sickling can occur anywhere in the body, producing a wide array of symptoms. For this reason, it is paramount that prehospital clinicians conduct a thorough assessment and, where appropriate, initiate treatment prior to arrival at the hospital. The most common symptom that clinicians will need to manage is severe pain. Many patients will have an individualized treatment plan detailing how they are best managed following an acute crisis and where possible it should be followed.
Rapid sequence airway not rapid sequence intubation
Authors: Sherlock Susannah
Published: May 2014

There has been a focus when managing traumatic brain injury patients on achieving the gold standard of airway management in the field. This has been often quoted as being rapid sequence intubation. This article looks at the evidence to support this notion and attempts to justify consideration to maintaining an adequate airway with the use of a drug assisted (paralysis) supraglottic airway device insertion (intubating laryngeal mask (ILMA). The focus being on adequate ventilation rather than intubation at all costs. Avoidance of hypoxaemia and hypotension, causing secondary brain injury, should be paramount. The article is of relevance to paramedic services considering the introduction of paralysis assisted intubations. In Australia, the remoteness of locations had originally led to upskilling of retrieval paramedics in some regions which has now been transferred to non–rural paramedics. The introduction of paralysis assisted intubation in paramedics has raised the issue of competencies and continuing maintenance of skills programmes. There are, in addition, many training issues and cost implications to maintain paramedic competency in a skill seldom performed. Australia, like many nations, is suffering from an under supply of medical graduates.
Automated external defibrillators: everywhere?
Authors: Gregory Anna , McAloon Christopher
Published: May 2014

Cardiac arrest is one of the biggest causes of death in the UK. There is an abundance of evidence showing that defibrillation is the most effective treatment in cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia, providing there is a support network to ensure installation, maintenance and training for users of the automated external defibrillator (AED). This article uses the authors' personal experience to review and discuss AED use in the workplace and in public access defibrillation programmes, as well as reviewing current guidelines.
Prehospital continuous positive airway pressure ventilation in ACPO: part 2
Authors: Rees Nigel
Published: May 2014

Acute cardiogenic pulmonary oedema (ACPO) is a common medical emergency facing UK paramedics. While swift management can delay progression of ACPO, a significant portion of patients spiral into deteriorating respiratory and cardiac function, leading to respiratory failure requiring endotracheal intubation (ETI). Continuous pulmonary airway pressure (CPAP) is increasingly being adopted into treatment regimens for ACPO in hospital. This is the second part of a paper seeking to critique the literature surrounding CPAP. Part one found how CPAP can provide early improvement in respiratory distress, metabolic abnormalities and need to ETI in hospital, yet these are not transferred into improved survival (Rees, 2011). Adherence and maximisation of medical therapy within JRCALC, and future potential of intravenous nitrates should also be explored by paramedics wishing to introduce CPAP into their practice. Methods: A comprehensive literature search of MEDLINE and CINAHL from 2000 to November 2010 was conducted using ‘CPAP’ as a subject heading combined with the subheadings: ‘pulmonary oedema’, ‘pulmonary edema’ ‘ACPO’, ‘heart failure’ ‘pre hospital’ and ‘paramedic’ as key words. A second search was conducted using ‘non invasive ventilation’ as a subject heading along all subheadings above. Results: A total of 253 papers were retrieved. These were manually scanned for relevance and eligibility, leaving a total of 53 papers for review. Given the relative scarcity in prehospital care literature all articles were reviewed, with nine finally selected for inclusion. No high quality UK prehospital studies were found. Application of CPAP resulted in significant improvements in physiological variables, need to ETI and relief of breathlessness. Despite these benefits, they are not transferred into improved mortality. Conclusion: The use of CPAP patients in ACPO can provide early improvement in respiratory distress, metabolic abnormalities and need to ETI in hospital. However, these are yet to be robustly transferred into improved survival. Despite this, many UK paramedics currently have limited options in supporting ventilation for ACPO. Adoption of CPAP into UK paramedic practice may offer options of a non–invasive means of supporting ventilation prior to ETI, with the potential of improving mortality by intervening early in ACPO. However, the limited number of quality prehospital studies presents many questions over its potential. Quality UK based studies are urgently needed.
Falls in the prehospital environment
Authors: Flavell Emma , Boyle Malcolm
Published: May 2014

Falls contribute significantly to the workload of ambulance paramedics. Falls can range dramatically in severity, with no injuries to considerable morbidity and mortality. The objective of this study was to identify the incidence of falls and the outcome from an ambulance perspective. Method: A literature search was conducted using electronic databases: Ovid Medline, EMBASE and Scopus. These databases were searched from their beginning to the end of July 2010. All references from the articles retrieved were also reviewed. Articles were included if they reported on falls attended by ambulance crews, or fall related injuries in the prehospital environment. Results: A total of 405 articles were identified with 21 articles meeting the inclusion criteria. There was one randomized trial, seven retrospective studies, two prospective studies, and one combined prospective retrospective study. Of the remaining studies, one was an epidemiological study, one a literature review, one clinical observation study, one pilot study and one case study. Five articles were excluded due to a lack of prehospital specific data. None of the studies reported a definition of a fall. Conclusion: Despite the relative frequency of falls, there is a substantial gap in the prehospital literature covering the implications for paramedic practice.
Trauma: just another statistic?
Authors: Griffin Dylan
Published: May 2014

This article explores the clinical assessment, diagnosis and current management of tension pneumothoraces in the prehospital arena by UK ambulance service paramedics. Using a case study from clinical practice, the signs and symptoms, aetiology and clinical manifestations of tension pneumothoraces are examined, with the specific aim of achieving an accurate diagnosis and effective pleural decompression. This article explores the effectiveness of needle thoracocentesis: the sole method of pleural decompression currently available to UK paramedics. It aims to compare the effectiveness of this procedure with other, and considered more reliable, methods of pleural decompression. Inherent risks and associated complications are examined and conclusions are drawn, including the proposal that critical care helicopter emergency medical services (HEMS) paramedics who have completed additional educational programmes, operating under strict clinical governance systems, and who are frequently exposed to seriously injured patients, be afforded the autonomy to practice incision thoracostomies in traumatic cardiac arrest patients in the absence of their medical colleagues.
Diagnosis and management of minor head injury in the UK
Authors: Pickering Alastair , Goodacre Steve , Pandor Abdullah , Harnan Susan , Holmes Michael , Fitzgerald Patrick
Published: May 2014

Head injury accounts for a large amount of emergency services work in the UK. We performed a review of current practice in the management of minor head injured patients (GCS 13-15) by way of a survey of UK emergency departments. Nearly all departments (∼95%) reported unrestricted access to computer tomography (CT) scans. Admission rates for minor head injured patients were 18% for adults and 9% for children. From our systematic review, we identified the most accurate clinical decision rule for adults (Canadian CT Head Rule) and children (Pediatric Emergency Care and Research Network) and commented on the applicability of these in the UK population. We also identified the most significant clinical findings that increase the likelihood of intracranial and neurosurgical injury, following minor head injury in adults, children and infants. Finally, we have highlighted where these findings may be relevant to UK paramedic practice, in particular in influencing the decision to transfer patients to the emergency department. This article summarizes the findings of studies undertaken for the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme examining the available evidence regarding the diagnostic management of minor head injuries. It will be published in a number of articles and a full report for the HTA programme.
The effect of a heart failure training intervention assessed via clinical simulation
Authors: Edwards Tim
Published: May 2014

Prehospital differential diagnosis of heart failure (HF) by paramedics is sometimes unreliable ( Schaider et al, 1995 ) and may lead to therapeutic interventions being withheld ( Jenkinson et al, 2008 ) or the initiation of inappropriate and potentially harmful treatment ( Wuerz and Meador, 1992 ). To date, no studies have evaluated the effect of participation in a HF training intervention on diagnostic accuracy among undergraduate UK paramedics assessed through clinical simulation. In this study, 17 paramedics were exposed to three mannequin based scenarios designed to simulate HF, pneumonia and chronic obstructive pulmonary disease (COPD). Participants were given up to 10 minutes to examine each mannequin and scrutinize clinical data before recording a diagnosis. Participant demographics and self reported confidence relating to assessment and management of HF were collected via a questionnaire. Two weeks later, participants attended a 90 minute targeted HF training intervention. Two weeks post training, the paramedics repeated the clinical simulation exercise and questionnaire. Initial diagnostic sensitivity and specificity for HF were higher than that reported in a previous UK clinical study, and improved following participation in a training intervention, although this failed to reach significance (83% vs 100% and 91.67 vs 100%, P>0.05). A significant improvement in self reported confidence relating to use of ECG findings in assessment of HF patients was noted (z=-2.309, P=0.021). In this study, paramedic differential diagnosis of HF assessed through clinical simulation demonstrated a non-significant trend towards improved sensitivity and specificity following participation in a targeted training intervention.
Support for self-care in Scotland: how can paramedics advocate the self-care agenda?
Authors: Haly Tony
Published: May 2014

Paramedics work very much on an episodic basis and this is entirely expected as they see patients when there has been a traumatic incident, acute onset of symptoms or acute exacerbation of an existing condition. This means that their work, although involving assessment and treatment planning, tends to be focused on the current complaint. In the UK, paramedics work to guidelines drawn up by the Joint Royal Collages Ambulance Liaison Committee (JRCALC). These focus on managing the specific condition or complaint. As a result, it may seem that supporting self-care is not congruous with the work of paramedics, but self-care support is becoming increasingly supported within the wider NHS and there is significant research around this subject. The purpose of this article is to describe what self-care is, its origins, and underpinning theories. It will also describe the drivers promoting it in the current health care context in Scotland, what is missing from current research, what implications exist for healthcare practitioners and provides an example of how paramedics can deliver effective support for self-care.
Right ventricular infarction in the pre-hospital setting: A hidden complication
Authors: Taylor Samantha
Published: May 2014

Right ventricular infarction (RVI) can occur in isolation but is more commonly associated with inferior myocardial infarction (IMI). It has a higher mortality rate compared to isolated left ventricular infarction and often presents with complications. Early recognition of RVI in paramedic practice is key to decreasing patient mortality. This article focuses on RVI within the pre-hospital environment. Particular emphasis is placed on right precordial electrocardiogram (ECG) lead placement, judicious administration of intravenous fluids in the hypotensive patient, and specific complications associated with vasodilatory drugs in RVI.
Endotracheal adrenaline in cardiac arrest due to near-fatal asthma: a case study
Authors: Smart Gary
Published: May 2014

A case report of respiratory arrest in a patient with an out-of-hospital, near fatal asthma (NFA) attack; successfully resuscitated with treatment that included endotracheal adrenaline is described.

This report demonstrates that endotracheal epinephrine (adrenaline may have a role in the resuscitation of asphyxic asthma. Adrenaline is a recognised β2 agonist and its smooth muscle relaxation properties are known to reverse bronchospasm. Ventilating patients with severe bronchospasm resulting from asphyxic asthma is known to be difficult. This report shows that instilling adrenaline via the endotracheal tube to a patient in cardio-respiratory arrest, resulted in relief of bronchospasm, reduction in airways resistance and a subsequent improvement of the operator's ability to ventilate.
Paramedics' experiences with death notification: a qualitative study
Authors: Douglas LeeAnne , Cheskes Sheldon , Feldman Michael , Ratnapalan Savithiri
Published: May 2014

Objective

To explore paramedics’ experiences and coping strategies with death notification in the field.

Methods

Urban and urban/rural paramedics participated in four focus groups across Ontario, Canada.They were asked about their experiences communicating death notifications and the support they received. Transcripts were analysed using the constant comparative method. Themes were generated inductively.

Results

Twenty-eight paramedics participated. Four themes emerged: the practical aspects of deathnotification, how paramedics acknowledge the emotional toll, how they manage the emotional toll, and the support mechanisms they used. Communicating a death notification is stressful and paramedics’ personal attitudes to death influence how they communicate a notification. Switching roles from clinician to supporter is challenging. Deaths that are unexpected, traumatic, obvious, involve children, with which the paramedic identifies, or are the paramedic’s first experience are especiallystressful. Paramedics receive support by talking to peers and using informal support networks. They prefer support from people who have had similar experiences.

Conclusion

Paramedics’ experiences with death notification are stressful, challenging, andrewarding. More formal support for paramedics is necessary, especially when the nature of the death is distressing. Our study suggests that further training is required to increase paramedics’ comfort with this challenging communication.
The introduction of the intubating laryngeal mask into paramedic practice
Authors: McCall Michael , Bull Rosalind , Dalton Lisa
Published: May 2014

Objective:

To ascertain key paramedic-reported factors affecting the implementation of the Intubating Laryngeal Mask Airway (ILMA) into paramedic practice with specific focus on educational practices.

Methods:

A sequenced exploratory descriptive research design incorporating a questionnaire and semi-structured interviews was employed. Quantitative data collected through the questionnaire was analysed using frequency distribution and Chi Square analysis. Qualitative data from both the questionnaire and the interviews was thematically analysed using a coding and cross comparative analysis technique within a conceptual framework based on Roger’s Diffusion of Innovation model.

Results:

The results show an educational programme, which departed from the traditional in-theatre model of training, can successfully prepare paramedics for using the new ILMA device for advanced airway management (AAM). Paramedics reported the educational program increased their confidence in using the ILMA for tracheal intubation for AAM, and that they achieved tracheal intubation success rates using the ILMA that were similar to those achieved using the laryngoscope. A blended educational approach of manikin and in-service training is required to be effective for improving their confidence and competence in ILMA tracheal intubation.

Conclusions:

The successful introduction of an innovation such as the ILMA into paramedic practice requires an education program that is blended and supports an effortless and sustainable change to practice. The results show simulation based ILMA tracheal intubation education can increase paramedics’ confidence and competence as a suitable alternative to the laryngoscope for paramedic tracheal intubation.
Examining current trends and research in pre-hospital hypotensive resuscitation
Authors: Bruce Che
Published: May 2014

The main purpose of trauma care is to reverse shock or reduce its deleterious effects, and in so doing, saving life. The use of aggressive fluid resuscitation may be harmful, as the resulting increased blood pressure and circulating volume could lead to clot disruption, dilution of clotting factors as well as an alteration in the body’s natural response to haemorrhage. The concept of hypotensive resuscitation and how it has evolved is discussed in this article.

This article looks at the current trends in hypotensive resuscitation, examining research into the use of such strategies and whether evidence exists to support the implementaion of these strategies into UK paramedic practice.

A number of sources were used to assess and access the literature. Primary and secondary sources were located that incorporated seminal and classical studies, permitting a broad overview of the subject.

The paramedic has a duty and a responsibiility to provide care that is safe and effective, and this includes the use of fluids to aid resuscitation.
The evidence base for the use of blanket antibiotic therapy for the control of footrot in sheep
Authors: Groenevelt Margit , Grogono-Thomas Rose
Published: May 2014

In recent years whole flock antibiotic treatment has been applied in practice in order to eradicate footrot from individual flocks. If footrot can be eradicated by a one-off whole flock treatment, this could result in lower usages of antibiotics overall and would improve welfare on these farms. This review article aims to summarise the results that are being reported by both research papers and case reports and includes data from various other European countries as well as the UK.
Supplementary prescribing: a review of current policy
Authors: Baird Anne
Published: May 2014

The concept of the independent prescriber (with responsibility for initial diagnosis and assessment), and the dependent prescriber (with responsibility for ongoing care), was first put forward in the Crown Report in 1999. This concept has been refined and is now accepted by the Department of Health as a significant way of expanding the roles of non-medical prescribers, initially nurses and pharmacists. This article will outline the proposals as they stand at the time of writing, and analyse briefly their impact upon both patient care and professional roles.
Treating and preventing influenza: epidemiology and vaccination
Authors: Purssell Edward
Published: May 2014

Influenza is a common winter infection of the respiratory tract. In most people it is unpleasant but rarely dangerous. In some groups of people, however,it can cause excess morbidity or mortality. This article looks at current policies on the prevention and treatment of influenza, and the need for Streptococcus pneumoniae vaccination to run alongside that for influenza. The nurse’s role in administering vaccines, under patient group directions or as independent prescribers, is also considered.
Selecting and developing extended and supplementary nurse prescribers
Authors: Brookes Dawn
Published: May 2014

Extended and Supplementary Nurse Prescribing offers some of the greatest challenges facing nurses today. Selecting and developing nurses to take on these roles is of great importance in order to protect patients and improve service delivery. Nurse managers and nurses need to consider how to support and maintain competency in prescribing and to put procedures in place to select and develop the right people for the roles.
Prescribing in palliative care and family planning
Authors: Griffin Shirley , Kinley Julie , Mahaffey Wendy , Fores Jo
Published: May 2014

Having completed the nurse prescribing course and qualified as an extended and supplementary prescriber, I am experiencing some problems implementing nurse prescribing in my practice. I am a Macmillan palliative care nurse at a large independent hospital, working mainly on an oncology ward and oncology day centre.
OSCEs as a means of assessment for the practice of nurse prescribing
Authors: Franklin Penny
Published: May 2014

The objective structured clinical examination (OSCE) is used in some higher educational institutions as part of the assessment process for extended nurse prescribing. An ethnographic study using a small focus group of nurse prescribing students was conducted with the aim of gaining deeper insight into students’ attitudes towards and anxieties about their OSCE assessment. Findings of the study were collated and compared to those of previous studies. Recommendations were made as to how the OSCE can be best used to assess the competencies of students of nurse prescribing, while at the same time supporting a positive learning experience.
Prescribing for patients where English is not a first language: a pilot study
Authors: Otway Chris , Bowskill Dianne
Published: May 2014

This small pilot study explores the issues related to prescribing for patients where there may be difficulties relating to differences of language and/or culture between the nurse and the patient. Limitations were recognized following the piloting of the draft questionnaire. The study, however, highlights significant findings worthy of further research and raises awareness of barriers to prescribing in this important area of practice.
Access to the whole BNF: a long-awaited triumph or the wrong decision?
Authors: Crown June , Miller Paul
Published: May 2014

For many, the news that nurses and pharmacists would have access to the whole of the British National Formulary was a cause for celebration. But was the government's decision really the right step forward for non-medical prescribing= Nurse Prescribing looks at both sides of this controversial issue.
Inpatients, insulin, prescribing and partnerships in a hospital setting
Authors: James June
Published: May 2014

Changes in legislation have enabled nurses among others to prescribe through the process of extended nurse prescribing. The most common drug for diabetes specialist nurses to prescribe is insulin treatment. This article explores insulin prescribing in acute care and how such prescribing affects the patient experience. It highlights insulin errors, why they occur and what can be done to reduce such occurrences which inevitably lead to increases in length of stay and therefore additional cost to the NHS. It outlines the benefits to the person with diabetes, the nurse prescriber and hospital trusts of diabetes nurse prescribing.
Nurse prescribing for patients with coronary heart disease
Authors: Keenan Jan
Published: May 2014

Nurse-led services in the acute sector have an increasing contribution to patient care. Despite this, it is only recently that nurse prescribing has become an attractive option for nurses in the acute sector, and therefore very little has been written in regard to this. Less still has been written about the introduction of nurse prescribing into cardiac medicine. This paper outlines the current position of nurse prescribing in relation to management of patients with coronary heart disease in the acute sector.
Identifying future prescribers: taking an organizational approach
Authors: Bramley Ian
Published: May 2014

Historically, non-medical prescribers have been self-nominating innovators. This article proposes that a more strategic approach be taken where managers identify future prescribers by taking an organizational approach. Three interrelated areas for consideration are discussed: the characteristics of the proposed prescriber, the services to be supported and developed by prescribing roles and the readiness of the organization to support prescribers in practice. Finally it is suggested that these areas are combined in an iterative way to ensure that an organization takes a strategic approach, therefore maximizing the benefit of developing new prescribers.
Running a clozapine clinic: considerations and challenges
Authors: Leppard Jill
Published: May 2014

This article looks at the role of the nurse prescriber in a community mental health setting, leading a clozapine clinic and ensuring that the rigorous safety standards required are coordinated effectively. Drawing on a real life situation, it demonstrates the role of a nurse prescriber, within mental health, facilitating a nurse-led prescribing clinic.
Prescription writing for diabetes: compliance with good practice
Authors: Carey Nicola , Stenner Karen , Courtenay Molly
Published: May 2014

This study aimed to explore the prescriptions issued to patients with diabetes by nurse independent and nurse supplementary prescribers working in general practice. A total of 19 prescriptions were collected and assessed from four case-study sites based in general practice between October 2007 and September 2008. Prescriptions were collected from patients with diabetes whose consultations were video recorded for the purposes of research. Prescriptions were consistently issued on an appropriate computer-generated prescription form, written legibly in ink, used the correct terminology, generic prescribing and contained an accurate/appropriate product dose and preparation. They were less consistent in stating the number of days, quantity of medicine to be supplied, and providing clear and accurate instructions on frequency and timing of treatment. Nurses in general practice are using computer based repeat prescribing systems to issue prescriptions to patients for the management of diabetes and its common complications, such as hypertension, hyperlipidaemia and cardiovascular disease. Whilst nurse prescribers were generally compliant with good practice in prescription writing, they need to ensure that they include ongoing information with respect to the number of days of treatment, quantity of medicine to be supplied, and clear and accurate instructions regarding the frequency and timing of medicines.
Nurse prescribing and the need for CPD: an Irish perspective
Authors: Creedon Rena
Published: May 2014

This article outlines the importance of continuing professional development (CPD) to nurse prescribing in Ireland, and emphasizes the current associated issues. Nurse prescribing is generating an ever-increasing amount of data that needs additional management and analysis in order to expand beyond the limited utilization of the minimum data set that produces reports and lists on prescriptions only. Redirecting some of the ring-fenced funding from just training nurse prescribers to the development of a comprehensive CPD programme might address the cost-effectiveness and continued safety of the nurse prescribing initiative that is expected on a national level.
Maintenance of INR consistency during the initiation of warfarin
Authors: Ala Les , Bird Diane , Barry Rose , Rathbone Nia
Published: May 2014

Background

Safe anticoagulation management requires competent prescribers. Pharmacist-led anticoagulation clinics are effective, but data on specialist nurse-led services in the acute setting are scarce.

Methods

Twenty-eight ambulatory care patients who were referred to our medical day unit for warfarin commencement and stabilisation therapy were enrolled over two separate 1-month periods. One group of patients was treated by a trained nurse practitioner; the other group was treated by different caches of junior doctors. The patients were observed until their INR was stable enough for transfer to the pharmacist-led anticoagulation clinic. INR control in the two groups was compared.

Findings

There were a total of 195 INR measurements, and the mean number of INR measurements per patient was similar in both groups. The patients treated by the junior doctors were kept in the medical day unit for a longer period, but the mean INR over time in this group was more variable. Conversely, the patients treated by the nurse practitioner group had more consistency and less variation in INR measurements.

Interpretation

The better INR consistency and minimal variation reported for the nurse-practitioner group implies better control. If we assume that a poorly controlled INR poses a higher clinical risk, then the nurse practitioner dosing regime is a safer option. The current working patterns of junior doctors are not conducive to providing such continuity of care; therefore, in the ambulatory care setting, clinical risks may be reduced if anticoagulation is initiated and stabilised by a designated health-care practitioners with the required competencies and experience.
The management of hypertension: the impact of nurse-led clinics
Authors: Chummun Harry
Published: May 2014

The number of people with hypertension continues to rise in the UK and worldwide, placing enormous social, economical and health burden on the sufferers, their dependants and statutory health care providers. Disorders of the cardiovascular and renal systems are primary sources of hypertension. In the early stages of hypertension, the British Hypertension Society and the National Institute of Health and Clinical Excellence (NICE) advise lifestyle changes in order to arrest progression to more severe hypertension and avoid more serious complications. They propose a drug algorithm, in addition to the lifestyle changes, for the safe and effective management of antihypertensive medication. Specialist nurses appropriately trained in drug prescribing and working in hypertension nurse-led clinics could be an effective alternative to conventional approaches in the management of patients with hypertension.
Aesthetic nursing: the case for safe prescribing
Authors: Ford Karen , Bentley Mai and Chris Worth , Worth Chris
Published: May 2014

Aesthetic nursing is a growing and complex area of independent practice. There is much confusion and misunderstanding, within the industry and professional organizations, both around the role of nurses in this particular setting, and around what is acceptable practice. This article intends to unravel some of the issues that practitioners encounter on a regular basis in this field. Controversial legal issues are discussed and the professional accountability of the practitioner is explored. Misunderstandings can lead to compromising patient safety and could potentially lead to the nurse or midwife facing fitness to practice challenges. The way forward is clear: aesthetic practitioners must obtain their independent and supplementary prescribing qualification to comply with the law, and NMC standards and guidance.
Students’ perceptions of learning in practice for NMPs
Authors: McCormick E , Downer F
Published: May 2014

Non medical prescribing (NMP) is integral to the modernisation of the NHS. Strong educational preparation of students in theory and practice is required to ensure patient and practitioner safety. This study takes an interpretive phenomenological approach to explore students’ perceptions of learning in practice and the effect of mentorship by their designated medical practitioner. A purposive sample of ten students from diverse clinical backgrounds, who had completed the NMP course from one HEI took part. The interviews explored specific themes including the time that students had with their mentors and the approach they took to learning and teaching. Students were asked if they perceived their mentor able and willing to give them the support they required to meet the prescribing competencies, as defined by the Nursing and Midwifery Council. Content analysis of the data was undertaken and presented using excerpts of transcriptions. The findings suggested that mentors and students had difficulties in getting quality time together, and mentors were not fully prepared in the course learning outcomes. Learning and teaching was largely directed by written course work, and mentors had limited knowledge of the prescribing competencies by which to assess the students. The study identified the need for further research into the difficulties of learning and teaching in practice for NMP students and their mentors. There is a need for greater collaboration between education, health care managers and medical practitioners to improve the standards of learning and teaching in practice for students in the future. It suggests that mentorship within the NMP course should be given greater recognition and that prescribing competencies should be generic to all prescribers.
Pharmacological management of erectile dysfunction
Authors: Steggall Martin
Published: May 2014

Erectile dysfunction is a common sexual dysfunction, with an estimated prevalence of 8% among men aged 40 years and 40% among men aged 60 years. It is associated with cardiovascular risk factors. Treatment is commonly with ‘as required’ or daily phosphodiesterase type 5 inhibitors: sildenafil citrate, tadalafil, or vardenafil, although other options are available. The selection of treatment is dependent on accurate assessment, estimation of cardiovascular risk, and patient choice. In this article, treatment choices are considered and strategies for optimizing treatment are recommended.
Pharmacology in neonatal care: Prescribing considerations
Authors: Bennett Stephen
Published: May 2014

There are many differences between prescribing for adults and children, particularly neonates. Children and neonates are not simply ‘small adults’, as their bodies have different physiologies and they may absorb, distribute, metabolise and excrete drugs in different ways. While oral administration of medication tends to be preferred in adults and older children, in neonates this route may not be preferable or possible. Other methods of drug administration are considered in this article. Babies have a higher proportion of body water, and a lower proportion of body fat, than adults or children, which is an important factor to take into account with certain drugs. Neonates usually also have a reduced ability to metabolise many drugs at birth. This article provides an overview of the pharmacological considerations that need to be taken into account when prescribing for children, and neonates in particular.
The diabetic foot: a guide for care staff
Authors: Bradshaw Terry
Published: May 2014

It is vital that nursing and residential home staff understand the essentials of foot care. Terry Bradshaw highlights what could affect the diabetic foot and what should be done if a problem is suspected.
How to… Handwash
Authors: Elizabeth Griffiths
Published: May 2014

Semmelweis established the association between hand hygiene and reduced risk of cross infection during the 19th century, studying the causes of maternal mortality from childhood fever (Newsom, 1993) and conducting trials to test his hypothesis. In May 1847 he made all staff and students wash their hands in ‘clorina liquid’. For the rest of the year the mortality was 3.04% compared with 11.4% for the previous year.
Multisensory environments
Authors: Lloyd Nicola
Published: May 2014

Multisensory environments (MSEs) are being used increasingly in establishments for clients with learning disabilities and also in the care of confused elderly people, as a means of both relaxation and education. MSEs consist of sensory experiences which are delivered to stimulate the primary senses, e.g. sight, hearing, touch and smell, with few demands placed on cognitive ability. MSEs also facilitate relaxation and help to build trust between the client and carer.
Health & Safety
Authors: Bassett David
Published: May 2014

David Bassett outlines the implications of fire regulations which impact on all British businesses.
Parkinson's disease: aetiology and treatment
Authors: Hope Simon
Published: May 2014

Simon Hope outlines that 1 in 500 people in the UK have Parkinson's disease and that each one must be treated individually with the range of drug treatments available and surgery if appropriate.
Advocacy Guaranteed?
Authors: Ashurst Adrian
Published: May 2014

In this article, Adrian Ashurst discusses the importance of offering residents an independent advocate to speak on their behalf, ensuring that their rights of choice are protected.
NSF: the views of organizations for older people
Authors: Fermoy Peter
Published: May 2014

The National Service Framework for Older People will affect many different services for older people. Representatives from the Independent Healthcare Association, Social Care Association and Age Concern give their views on the good and bad parts of the framework.
Your profit altitude will be decided by your profit attitude
Authors: Ogilvie Michael
Published: May 2014

Despite the current uncertainty affecting care homes, Michael Ogilvie argues that improved profitability is still readily achievable by involving all your team in creating a profit culture in your home.
Care Standards Act: effects on staff training and developments
Authors: Barham Bob
Published: May 2014

Bob Barham discusses the potential effects that the Care Standards Act will have on staff training and development.
What is diabetes? An update for care staff
Authors: Dunne Sinead
Published: May 2014

Diabetes is a common condition, suffered by about 3% of the population. This article outlines what causes diabetes, the symptoms that may be seen and some longer term problems.
Social and recreational activities
Authors: Ashurst Adrian
Published: May 2014

In accordance with the new minimum standards for care homes, Adrian Ashurst points out the importance of providing good social and recreational activities.
Hiding medicines or hiding problems?
Authors: Bending Angela
Published: May 2014

Hiding medicines in patients' food or drink appears to be a common practice in care and nursing homes, but few carers are aware of the pharmacological dangers or legal implications, writes Angela Bending.
Disability law and employment: what does it mean for staff?
Authors: Brothers Michael , Eathorne Victoria , Scullion Philip
Published: May 2014

This article examines employment issues related to disabled people and stresses the importance, both for employers and employees, of some knowledge of the law in this area.
The new arbitration scheme for unfair dismissal issues: 1
Authors: Richardson Barbara
Published: May 2014

Barbara Richardson looks at the framework for resolving unfair dismissal disputes under the new arbitration scheme.
Incontinence-induced pressure ulcers
Authors: Cooper Pam
Published: May 2014

In this article, Pam Cooper discusses various treatments and interventions which can be utilized to limit the detrimental effects of incontinence on skin.
Education, training and management development
Authors: Makinson Geoff
Published: May 2014

Geoff Makinson highlights the importance of educating and training staff to ensure a better service to patients.
An ideal protocol for dealing with complaints in social care
Authors: Johnson Nick
Published: May 2014

Complaints are everyday occurrences in all walks of life. In a positive sense, they enliven and inspire a business to be better. Here is a good practice guide for social care professionals.
Developing dementia services for an Asian community
Authors: Seabrooke Viniti , Milne Alisoun
Published: May 2014

In a project funded by the Mental Health Foundation, Viniti Seabrooke and Alisoun Milne investigate the need for dementia services for an Asian community in Kent.
Why nutrition is an essential part of wound care
Authors: Schols JMGA
Published: May 2014

Clients with or without chronic wounds often have a poor nutritional status, JMGA Schols explains why staff should ensure the implementation of a clear nutrition policy.
Water works: hydrotherapy for people with dementia
Authors: Smith Penny
Published: May 2014

This case study discusses the award-winning Waterworks project, which uses hydrotherapy with this client group to promote enjoyment and provide stimulation.
Building rapport through non-verbal communication
Authors: May Andrée le
Published: May 2014

Andrée le May discusses ways in which signs and signals, such as touch and facial expression, can strengthen relationships with older people and improve their quality of life.
The use of anaesthetic gel for catheterization
Authors: Pomfret Ian
Published: May 2014

Urinary catheterization may cause discomfort or pain to residents in nursing and residential care. This article considers the use of lubricating, anaesthetic and antiseptic gels in the procedure.
Managing different experiences of place and space
Authors: Peace Sheila , Reynolds Jill
Published: May 2014

How do staff in residential care homes think about the environment in which they work? This article explores the different meanings the care setting has for residents, staff and visitors.
Efficient management of clinical practice
Authors: Weaver Dawn
Published: May 2014

Dawn Weaver discusses the importance of basic hygiene measures on current best practice in clinical activity.
Assisting in the administration of residents' medication
Authors: Weaver Dawn
Published: May 2014

Dawn Weaver explains how supporting others in this practice requires sensitivity to individual needs and an understanding of protocols and procedure within the workplace.
Part five: A preferred way of life
Authors: Johnson Nick
Published: May 2014

Nick Johnson considers the ways in which social care providers and their staff can help service users to achieve a preferred way of life for themselves.