How to ensure safe and effective resuscitation for patients with Covid-19 #covid19rftlks

Jevon P et al (2020). How to ensure safe and effective resuscitation for patients with Covid-19. Nursing Times [online]; 116| 7 | 26-30.

Resuscitation of patients with Covid-19 presents a number of challenges to health professionals in hospitals and the community. This article discusses recent guidance and the controversy surrounding the use of PPE

Abstract

Caring for patients who are critically ill with Covid-19 presents a number of complex challenges including decisions regarding resuscitation and concerns about use of personal protective equipment while undertaking chest compressions. This article explores these issues, summarises recent guidance and provides an overview of what nurses should do when patients with confirmed or suspected Covid-19 require resuscitation.

Key points

  • The coronavirus pandemic poses serious health risks to health workers when resuscitating patients with Covid-19
  • Health professionals must discuss Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) decisions with the patient, or those close to the patient if the patient lacks mental capacity
  • Care for people with Covid-19 should aim to identify those who are deteriorating, treat them effectively and prevent
    cardiac arrest
  • There is confusion around guidance on personal protective equipment for the resuscitation of patients with Covid-19
  • The Resuscitation Council (UK) advises that chest compressions are an aerosol-generating procedure requiring level 3 PPE

Full article is available from Nursing Times

NHS England: NHS Roadmap To Safely Bring Back Routine Operations #covid19rftlks

NHS England | May 2020| NHS Roadmap To Safely Bring Back Routine Operations

Health leaders have set out a series of measures to help local hospitals plan to increase routine operations and treatment, while keeping the necessary capacity and capability to treat future coronavirus patients.

Over the coming weeks patients who need important planned procedures – including surgery – will begin to be scheduled for that care, with specialists prioritising those with the most urgent clinical need.

But, in line with measures currently in place to protect staff and patients who have been receiving urgent treatment during the pandemic, they will be required to isolate themselves for 14 days and be clear of any symptoms before being admitted.

Testing will also be increasingly offered to those waiting to be admitted to provide further certainty for patients and staff that they are COVID-free.

This approach will help to protect patients from potentially catching the virus in hospital, and help staff to ensure they are using the correct infection control measures and protective equipment.

Those requiring urgent and emergency care will continue to be tested on arrival and streamed accordingly, with services split to make the risk of picking up the virus in hospital as low as possible.

Those attending emergency departments and other ‘walk-in’ services will be required to maintain social distancing, with trusts expected to make any adjustments necessary to allow this.

As well as the requirements for those needing operations, as many outpatient appointments as possible will be conducted remotely, and those who do need a face to face consultation will be asked not to attend if they have COVID symptoms.

Those requiring a long hospital stay will be continuously monitored for symptoms and re-tested between 5 and 7 days after admission, and those who are due to be discharged to a care home will be tested up to 48 hours before they are due to leave.

Read the full piece from NHS England 

Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’

Royal College of General Practice | January 2020 | Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’ 

Responding to a feature that ran in The Sunday Times (in last Sunday’s edition, 5 January 2019), Professor Martin Marshall, Chair of the Royal College of GPs, said: “It is totally unacceptable to expect patients to wait weeks for a GP appointment. Patients -and GPs – deserve better. 

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“However, the situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years.

Over 1m patients are seen in general practice every day, and GPs are doing their best but the service cannot keep stretching. There are limits beyond which GPs can no longer guarantee safe care to patients and the potential for error or misdiagnosis increases.

“There is also the risk that long waiting times for a GP appointment will deter some patients from seeing a GP at all, which could mean they seek help at a much later stage when the problem is much more serious.

“Pressure of workload is taking its toll on the health and wellbeing of GPs themselves. For too many, the job has become untenable, with the result that they are burning out and leaving the profession before their time.

“It is extremely encouraging that we have more GPs in training than ever before, but it takes a long time to qualify and we need urgent action to retain existing GPs and ensure they are supported to remain in the profession and that the job of a frontline GP becomes ‘do-able’ again.” (Source: RCGP)

Related:

The Times Eleven million patients wait more than three weeks to see GP

Story also reported in:

BBC News GP shortages cause ‘unacceptable’ patient waits

National Hip Fracture Database – 2019 Annual Report

Health Quality Improvement Partnership | December  2019| National Hip Fracture Database – 2019 Annual Report

The National Hip Fracture Database measures the quality of care for patients with hip fracture; it also functions as a clinical governance and quality improvement platform. 

This report describes the data from all 175 trauma unites of the care provided to 66,313 people who presented with hip fracture in 2018, representing over 95% of patients in the UK.

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Image source: hqip.org.uk

The HQIP publication examines the quality of patient care using six key performance indicators along with analysis on using the NHFD to support quality improvement, understanding variation in performance and statistics on mortality and secondary prevention (Source: Health Quality Improvement Partnership)

National Hip Fracture Database – 2019 Annual Report Data from January to December 2018 

Infographic 

Better care for patients and service users

This report demonstrates how – in difficult circumstances – trust leaders and staff are coming up with ideas and solutions to deliver better care | NHS Providers

This is the first in a new publication series to promote the work of NHS trusts and foundation trusts in improving care.  This briefing focuses on how trusts have responded to feedback from the Care Quality Commission in a positive and systematic way, encouraging ideas that have made a difference for patients and service users.

The report Providers deliver: better care for patients considers both the leadership approaches and frontline initiatives that underpin improvements in quality. Through 11 case study conversations, it considers some of the frontline work that has contributed to trusts’ improvements in CQC ratings, as well as exploring the role of trust leaders in providing an enabling, supportive environment in which this work has been possible.

Full report: Providers deliver: better care for patients 

See also: NHS Providers blog

National Cardiac Audit Programme

Health Quality Improvement Partnership | October 2019 | National Cardiac Audit Programme 

The Health Quality Improvement Partnership (HQIP)  has published the National Cardiac Audit Programme 2019 Annual Report. The report covers over 300,000 records across five clinical areas: Congenital Heart Disease, Heart Attack, Percutaneous Coronary Interventions (PCI), Adult Surgery and Heart Failure. It highlights quality improvement opportunities under the themes of the need for timely care, the need for specialised care and the need for evidence-based care delivered equitably.

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This report focuses on three broad quality improvement (QI) themes:

  • Timely care
  • Specialist care
  • Evidence-based care delivered to a uniformly high standard

There are also five audit specific reports that are also available from HQIP

Full details are available from HQIP

 

Patient report

Annual report 

NIHR study: Physician associates appear to make a positive contribution to inpatient care

NIHR | August 2019 | Physician associates appear to make a positive contribution to inpatient care

One of the latest Signals from the National Institute of Health Research (NIHR),  looks at the role of physician associate, albeit a  relatively new profession in the UK, but n with over 3,000 students expected to qualify by 2020. Physician associates have to undergo two years’ intensive postgraduate training based upon a medical, rather than nursing, model.  Consequently, upon qualification, they can undertake a range of diagnostic and clinical duties that would otherwise be done by doctors.

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Now an NIHR funded study considers the way that physician associates are deployed and the appropriateness as well as the effectiveness of their work in relation to other team members.

A national survey shows that a small but growing number of hospitals are now using physician associates. It concludes that the profession is being restrained by a lack of autonomy, preventing the role from fulfilling its potential. Statutory regulation and prescribing or X-ray ordering rights may help ease the pressure on doctors and strengthen physician associate roles within the team. Evaluation of the impact of these positions as they become more common will be useful (Source: NIHR).

The full study is available from the NIHR

Abstract 

Background Increasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.

Objectives (1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.

Methods This was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.

Results The surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors. In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.

Limitations PAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team. Conclusions PAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice. Future research Comparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners. Funding The National Institute for Health Research Health Services and Delivery Research programme (Source: NIHR).

The full journal article is available from the Health Services and Delivery Research

Where best next? New NHS plan to help patients avoid long hospital stays

NHS England & NHS Improvement | August 2019 | Where best next?

A new campaign is encouraging NHS doctors, nurses and other staff a to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness.  ‘Where Best Next?’  aims to reduce the hospital stay of  140,000 people every year spared a hospital stay of three weeks or longer.

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As well as being better for those individuals who get home with the right support quicker, the drive could also free up more than 7,000 beds for other patients – the equivalent of building an extra 15 large hospitals.

The campaign, launched on Monday, will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community (Source: NHS England).

Full details from NHS England 

See also:

NHS England [blog] Valuing 350,000 patients’ time

 

Helping doctors and nurses to improve care for patients with a learning disability

NHS Digital | August 2019 | Helping doctors and nurses to improve care for patients with a learning disability

NHS Digital have produced Helping doctors and nurses to improve care for patients with a learning disability to help  public health, health professionals, paid social care staff and family members to prevent falls in people with learning disabilities (Source: NHS Digital).

The full document is available from NHS Digital

 

The Healthcare Safety Investigation Branch launch online feedback form

Healthcare Safety Investigation Branch | August 2019 | Online feedback form launched so you can ‘tell us what you think’

The Healthcare Safety Investigation Branch (HSIB) have launched an online feedback form so that anyone involved in their healthcare safety investigations can tell HSIB what they think.

  • National investigations in general
  • Specific national investigations
  • Maternity investigations
  • HSIB in general

Full details from HSIB