Citation: Acute Medicine. 2018, 17(3), 168
Author: Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A
Abstract: Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.
Link to PubMed record
Thursday, 23 August 2018
WUTH publication: Focused Acute Medicine Ultrasound (FAMUS)
Citation: Acute Medicine. 2018, 17(3), 164-7
Author: Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A
Abstract: Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.
Link to PubMed record
Author: Alber KF, Dachsel M, Gilmore A, Lawrenson P, Matsa R, Smallwood N, Stephens J, Tabiowo E, Walden A
Abstract: Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.
Link to PubMed record
Thursday, 9 August 2018
WUTH publication: Advancing quality in sepsis management: a large-scale programme for improving sepsis recognition and management in the North West region of England
Citation: Postgraduate Medical Journal. 2018, 94(1114), 463-468
Author: Nsutebu EF, Ibarz-Pavón AB, Kanwar E, Prospero N, French N, McGrath C
Abstract: OBJECTIVE: To evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England.
SETTING: 14 hospitals in the northwest of England.
INTERVENTION: A quality improvement programme (Advancing Quality (AQ) Sepsis) that promoted a sepsis care bundle including time-based recording of early warning scores, documenting systemic inflammatory response syndrome criteria and suspected source of infection, taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, administration of oxygen, fluid resuscitation, measurement of fluid balance and senior review.
MAIN OUTCOME MEASURES: Inpatient mortality, 30-day readmission rates and duration of hospital ≥10 days.
RESULTS: Data for 7776 patients were included in this study between 1 July 2014 and 29 December 2015. Participation in the AQ Sepsis programme was associated with a reduction in readmissions within 30 days (OR 0.81 (0.69-0.95)) and hospital stays over 10 days (OR 0.69 (0.60-0.78)). However, there was no reduction in mortality. Administration of a second litre of intravenous fluid within 2 hours, oxygen therapy and review by a senior clinician were associated with increased mortality. Starting a fluid balance chart within 4 hours was the only clinical process measure that did not affect mortality. Taking a blood culture sample, administering antibiotic therapy and measuring serum lactate within 3 hours of hospital arrival were all associated with reduced mortality (OR 0.69 (0.59-0.81), OR 0.77 (0.67-0.89) and OR 0.64 (0.54-0.77), respectively) and shorter hospitalisations (OR 0.58 (0.49-0.69), OR0.81 (0.70-0.94) and OR 0.54 (0.45-0.66), respectively). However, none of these measures had an impact on the risk of readmission to hospital within 30 days.
CONCLUSIONS: The AQ Sepsis collaborative in northwest of England improved readmission and length of stay for patients admitted with sepsis but did not affect mortality. Further cost-effectiveness evaluation of the programme is needed.
© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: infectious diseases
Link to PubMed record
Author: Nsutebu EF, Ibarz-Pavón AB, Kanwar E, Prospero N, French N, McGrath C
Abstract: OBJECTIVE: To evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England.
SETTING: 14 hospitals in the northwest of England.
INTERVENTION: A quality improvement programme (Advancing Quality (AQ) Sepsis) that promoted a sepsis care bundle including time-based recording of early warning scores, documenting systemic inflammatory response syndrome criteria and suspected source of infection, taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, administration of oxygen, fluid resuscitation, measurement of fluid balance and senior review.
MAIN OUTCOME MEASURES: Inpatient mortality, 30-day readmission rates and duration of hospital ≥10 days.
RESULTS: Data for 7776 patients were included in this study between 1 July 2014 and 29 December 2015. Participation in the AQ Sepsis programme was associated with a reduction in readmissions within 30 days (OR 0.81 (0.69-0.95)) and hospital stays over 10 days (OR 0.69 (0.60-0.78)). However, there was no reduction in mortality. Administration of a second litre of intravenous fluid within 2 hours, oxygen therapy and review by a senior clinician were associated with increased mortality. Starting a fluid balance chart within 4 hours was the only clinical process measure that did not affect mortality. Taking a blood culture sample, administering antibiotic therapy and measuring serum lactate within 3 hours of hospital arrival were all associated with reduced mortality (OR 0.69 (0.59-0.81), OR 0.77 (0.67-0.89) and OR 0.64 (0.54-0.77), respectively) and shorter hospitalisations (OR 0.58 (0.49-0.69), OR0.81 (0.70-0.94) and OR 0.54 (0.45-0.66), respectively). However, none of these measures had an impact on the risk of readmission to hospital within 30 days.
CONCLUSIONS: The AQ Sepsis collaborative in northwest of England improved readmission and length of stay for patients admitted with sepsis but did not affect mortality. Further cost-effectiveness evaluation of the programme is needed.
© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: infectious diseases
Link to PubMed record
Patient Risk and Safety
Relevant articles from MA Healthcare
journals to support your staff’s education and practice
August 2018
We have provided a list of relevant articles from MA Healthcare
journals dealing with this area, thereby providing your NHS staff with
research, information and tips that will support both their work and the care
of their patients
(Access to links via OpenAthens
authentication currently only work on the desktop version of the MAG Online
Library platform)
African Journal of Midwifery and
Women’s Health
·
Bugs, babies and birthing: midwifery
management of sepsis
Published Online: February 07, 2017
British Journal of Community
Nursing:
·
ENFit: a major patient safety
breakthrough http://www.magonlinelibrary.com/doi/10.12968/bjcn.2016.21.Sup7.S7
Published
Online: February 10, 2017
·
Implications of case managers'
perceptions and attitude on safety of home-delivered care http://www.magonlinelibrary.com/doi/10.12968/bjcn.2015.20.12.602
Published Online: December
04, 2015
British Journal of Healthcare
Assistants
· Septic shock — and the role the HCA and AP can play
Published Online: February 18, 2014
·
Care Certificate Standard 15: infection
prevention and control
Published Online: June 10, 2016
·
Hazards and risk: the support worker's role
Published Online: October 18, 2016
·
Hand hygiene 2017—it's up to you
Published Online: May 11, 2017
·
Falls: reducing risks and improving quality
of life
Published Online: October 16, 2017
British Journal of Healthcare
Management
·
Maintaining hand hygiene to prevent the
transmission of infection
Published Online: May 09, 2017
·
Supporting infection control and patient
safety
Published Online: May 16, 2016
·
Essential practice for infection prevention
and control: RCN guidance for nursing staff
Published Online: December 09, 2017
·
Patient safety: reducing harm and saving
lives http://www.magonlinelibrary.com/doi/10.12968/bjhc.2014.20.5.220
Published Online: June 24,
2014
·
Ensuring patient safety during the
development of ambulatory emergency care http://www.magonlinelibrary.com/doi/10.12968/bjhc.2014.20.7.324
Published Online: July 10,
2014
British Journal of Midwifery:
·
Better Births: A platform for innovation
and transformation http://www.magonlinelibrary.com/doi/10.12968/bjom.2016.24.5.310
Published Online: May 02, 2016
·
More rigorous investigating needed to improve
maternity safety
Published Online: January 31, 2018
British Journal of Neuroscience
Nursing
·
Neutropenic sepsis: assessment,
pathophysiology and nursing care
Published Online: April 27, 2015
·
Preconception to postpartum care: the need to
maximise the safety of women with epilepsy
Published Online: June 27, 2016
British Journal of Nursing:
Published Online: May 12,
2016
·
Medication governance: preventing errors
and promoting patient safety http://www.magonlinelibrary.com/doi/10.12968/bjon.2017.26.3.159
Published Online: February
10, 2017
·
Ensuring the safe discharge of older patients
from hospital
Published Online: July 28, 2016
·
Reducing harm to patients caused by avoidable
adverse drug reactions
Published Online: April 23, 2018
·
Guidelines not tramlines: the WHO safe
childbirth checklist
Published Online: March 28, 2016
·
Improving the National Reporting and Learning
System and responses to it
Published Online: March 08, 2018
·
A collaborative approach to reduce
healthcare-associated infections
Published Online: June 09, 2016
·
Does a checklist reduce the number of errors
made in nurse-assembled discharge prescriptions?
Published Online: April 28, 2017
·
Patient safety perspectives from other
countries: reflecting on reporting
Published Online: April 29, 2016
·
Barriers to implementing the Sepsis Six
guidelines in an acute hospital setting
Published Online: May 11, 2018
·
Assessment and management of the septic
patient: part 1
Published Online: September 24, 2016
·
Assessment and management of the septic
patient: part 2
Published Online: November 24, 2016
·
Children's nursing: patient safety and
clinical risk in neonatal care
Published Online: September
24, 2016
·
Written communication: from staff nurse to
nurse consultant; Part 7: Incident Reports
Published Online: November 26, 2014
British Journal of Hospital
Medicine:
·
Supporting the engagement of doctors in
training in quality improvement and patient safety http://www.magonlinelibrary.com/doi/10.12968/hmed.2015.76.3.166
Published Online: March 11,
2015
·
Improving communication with primary care
to ensure patient safety post-hospital discharge http://www.magonlinelibrary.com/doi/10.12968/hmed.2015.76.1.46
Published Online: January 13, 2015
·
The risk of surgical never events
Published Online: February 13, 2016
·
Understanding safe discharge of patients with
dementia from the acute hospital
Published Online: March 10, 2016
·
Improving safety of care for older people
Published Online: February 12, 2018
Journal of Aesthetic Nursing
·
Key pointers on patient safety and prescribing
practice http://www.magonlinelibrary.com/doi/10.12968/joan.2017.6.1.42
Published Online: February
07, 2017
·
Infection control and environmental
cleanliness in aesthetic practice
Published Online: June 07, 2016
Journal of Kidney Care
·
Improving patient safety and avoiding
incidents in renal units
Published Online: February 18, 2014
·
Improving patient safety and avoiding
incidents in renal units http://www.magonlinelibrary.com/doi/10.12968/jorn.2014.6.1.24
Published Online: February
18, 2014
·
ANSA conference: patient safety in
anaemia management http://www.magonlinelibrary.com/doi/10.12968/jorn.2014.6.2.102
Published Online: March 30,
2014
Journal of Paramedic Practice
·
Patient confidentiality and safety: a
classic conundrum http://www.magonlinelibrary.com/doi/10.12968/jpar.2017.9.5.214
Published Online: May 13,
2017
·
Can multi-disciplinary simulation-based
training improve patient safety? http://www.magonlinelibrary.com/doi/10.12968/jpar.2014.6.2.98
Published Online: March 05,
2014
Journal of Wound Care
·
An assessment of key risk factors for
surgical site infection in patients undergoing surgery for spinal metastases
Published Online: September 09, 2016
Nurse Prescribing
·
Patient safety comes first
Published Online: August 13,
2015
·
Effective safety-netting in prescribing
practice http://www.magonlinelibrary.com/doi/10.12968/npre.2014.12.7.349
Published Online: July 08,
2014
·
Prescribing safely: Top 10 tips for
non-medical prescribers
Published Online: August 13, 2016
Practice Management:
·
Managing health and safety in practice http://www.magonlinelibrary.com/doi/10.12968/prma.2016.26.9.12
Published Online: January
17, 2017
·
Legal aspects of patient data-sharing http://www.magonlinelibrary.com/doi/10.12968/prma.2017.27.7.42
Published Online:
July 27, 2017
·
Getting to the point of infection control
Published Online: January 16, 2017
Nursing and Residential Care:
·
Preserving safety within the care home
environment http://www.magonlinelibrary.com/doi/10.12968/nrec.2017.19.10.594
Published Online: September
18, 2017
·
The growing importance of health and
safety for care homes http://www.magonlinelibrary.com/doi/10.12968/nrec.2015.17.6.352
Published Online: May 19, 2015
·
Reporting medication errors: residents with
diabetes
Published Online: October 16, 2014
· Infection prevention and control: steps to take in your home
Published Online: August 17, 2016
·
Making a difference: optimising medication
management
Published Online: July 18, 2016
Monday, 6 August 2018
WUTH publication: A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in the UK: Paediatric early warning system - utilisation and mortality avoidance- the PUMA study protocol
Citation: BMJ pediatrics. 2018, 18(1), 244
Author: Thomas-Jones E, Lloyd A, Roland D, Sefton G, Tume L, Hood K, Huang C, Edwards D, Oliver A, Skone R, Lacy D, Sinha I, Preston J, Mason B, Jacob N, Trubey R, Strange H, Moriarty Y, Grant A, Allen D, Powell C
Abstract: BACKGROUND: In hospital, staff need to routinely monitor patients to identify those who are seriously ill, so that they receive timely treatment to improve their condition. A Paediatric Early Warning System is a multi-faceted socio-technical system to detect deterioration in children, which may or may not include a track and trigger tool. It functions to monitor, detect and prompt an urgent response to signs of deterioration, with the aim of preventing morbidity and mortality. The purpose of this study is to develop an evidence-based improvement programme to optimise the effectiveness of Paediatric Early Warning Systems in different inpatient contexts, and to evaluate the feasibility and potential effectiveness of the programme in predicting deterioration and triggering timely interventions.
METHODS: This study will be conducted in two district and two specialist children's hospitals. It deploys an Interrupted Time Series (ITS) design in conjunction with ethnographic cases studies with embedded process evaluation. Informed by Translational Mobilisation Theory and Normalisation Process Theory, the study is underpinned by a functions based approach to improvement. Workstream (1) will develop an evidence-based improvement programme to optimise Paediatric Early Warning System based on systematic reviews. Workstream (2) consists of observation and recording outcomes in current practice in the four sites, implementation of the improvement programme and concurrent process evaluation, and evaluation of the impact of the programme. Outcomes will be mortality and critical events, unplanned admission to Paediatric Intensive Care (PICU) or Paediatric High Dependency Unit (PHDU), cardiac arrest, respiratory arrest, medical emergencies requiring immediate assistance, reviews by PICU staff, and critical deterioration, with qualitative evidence of the impact of the intervention on Paediatric Early Warning System and learning from the implementation process.
DISCUSSION: This paper presents the background, rationale and design for this mixed methods study. This will be the most comprehensive study of Paediatric Early Warning Systems and the first to deploy a functions-based approach to improvement in the UK with the aim to improve paediatric patient safety and reduce mortality. Our findings will inform recommendations about the safety processes for every hospital treating paediatric in-patients across the NHS.
TRIAL REGISTRATION: Sponsor: Cardiff University, 30-36 Newport Road, Cardiff, CF24 0DE Sponsor ref.: SPON1362-14. Funder: National Institute for Health Research, Health Services & Delivery Research Programme (NIHR HS&DR) Funder reference: 12/178/17. Research Ethics Committee reference: 15/SW/0084 [13/04/2015]. PROSPERO reference: CRD42015015326 [23/01/2015].
ISRCTN: 94228292 https://doi.org/10.1186/ISRCTN94228292 [date of application 13/05/2015; date of registration: 18/08/2015]. Prospective registration prior to data collection and participant consent commencing in September 2014.
KEYWORDS: And quality improvement; Mortality; Paediatric-early warning systems; Patient safety; Track-and-trigger tools
Link to PubMed record
Author: Thomas-Jones E, Lloyd A, Roland D, Sefton G, Tume L, Hood K, Huang C, Edwards D, Oliver A, Skone R, Lacy D, Sinha I, Preston J, Mason B, Jacob N, Trubey R, Strange H, Moriarty Y, Grant A, Allen D, Powell C
Abstract: BACKGROUND: In hospital, staff need to routinely monitor patients to identify those who are seriously ill, so that they receive timely treatment to improve their condition. A Paediatric Early Warning System is a multi-faceted socio-technical system to detect deterioration in children, which may or may not include a track and trigger tool. It functions to monitor, detect and prompt an urgent response to signs of deterioration, with the aim of preventing morbidity and mortality. The purpose of this study is to develop an evidence-based improvement programme to optimise the effectiveness of Paediatric Early Warning Systems in different inpatient contexts, and to evaluate the feasibility and potential effectiveness of the programme in predicting deterioration and triggering timely interventions.
METHODS: This study will be conducted in two district and two specialist children's hospitals. It deploys an Interrupted Time Series (ITS) design in conjunction with ethnographic cases studies with embedded process evaluation. Informed by Translational Mobilisation Theory and Normalisation Process Theory, the study is underpinned by a functions based approach to improvement. Workstream (1) will develop an evidence-based improvement programme to optimise Paediatric Early Warning System based on systematic reviews. Workstream (2) consists of observation and recording outcomes in current practice in the four sites, implementation of the improvement programme and concurrent process evaluation, and evaluation of the impact of the programme. Outcomes will be mortality and critical events, unplanned admission to Paediatric Intensive Care (PICU) or Paediatric High Dependency Unit (PHDU), cardiac arrest, respiratory arrest, medical emergencies requiring immediate assistance, reviews by PICU staff, and critical deterioration, with qualitative evidence of the impact of the intervention on Paediatric Early Warning System and learning from the implementation process.
DISCUSSION: This paper presents the background, rationale and design for this mixed methods study. This will be the most comprehensive study of Paediatric Early Warning Systems and the first to deploy a functions-based approach to improvement in the UK with the aim to improve paediatric patient safety and reduce mortality. Our findings will inform recommendations about the safety processes for every hospital treating paediatric in-patients across the NHS.
TRIAL REGISTRATION: Sponsor: Cardiff University, 30-36 Newport Road, Cardiff, CF24 0DE Sponsor ref.: SPON1362-14. Funder: National Institute for Health Research, Health Services & Delivery Research Programme (NIHR HS&DR) Funder reference: 12/178/17. Research Ethics Committee reference: 15/SW/0084 [13/04/2015]. PROSPERO reference: CRD42015015326 [23/01/2015].
ISRCTN: 94228292 https://doi.org/10.1186/ISRCTN94228292 [date of application 13/05/2015; date of registration: 18/08/2015]. Prospective registration prior to data collection and participant consent commencing in September 2014.
KEYWORDS: And quality improvement; Mortality; Paediatric-early warning systems; Patient safety; Track-and-trigger tools
Link to PubMed record
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