Clinical deterioration

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

A Comparison of Scoring Systems for Predicting Short- and Long-term Survival After Trauma in Older Adults.
Meagher AD. Academic Emergency Medicine 2019;26(6):621-630.
[Conclusions: Older, injured adults transported by emergency medical services to a large variety of trauma and nontrauma hospitals were more likely to die within 30 days if they required emergent airway management or had a higher comorbidity burden...Using geriatric trauma outcome score II or the geriatric trauma risk indicator may better identify high‐risk older adults than traditional scores, such as Injury Severity Score , but identification of an ideal prognostic tool remains elusive.
]

A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people.
Baxter R. BMJ Quality & Safety 2019;28(8):618-626.
[Conclusion: This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.]

Advancing the status of nursing: reconstructing professional nursing identity through patient safety work.
Heldal F. BMC Health Services Research 2019;19(1):418.
[We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses' practices and values. The patient safety programme involved activities that were more in accordance with the 'cure' discourse than traditional 'care' work within nursing. As a result, this implied a heightened perceived professional status among the nurses.]

Adverse side effects of dexamethasone in surgical patients.
Polderman JA. Cochrane Database of Systematic Reviews 2018;11:CD011940.
[Dexamethasone is widely used for prophylaxis of postoperative nausea and vomiting, for pain management, and to facilitate early discharge after ambulatory surgery.Long-term treatment with steroids has many side effects, such as adrenal insufficiency, increased infection risk, hyperglycaemia, high blood pressure, osteoporosis, and development of diabetes mellitus. However, whether a single steroid load during surgery has negative effects during the postoperative period has not yet been studied.]

Managing deterioration in older adults in care homes: a quality improvement project to introduce an early warning tool.
Little S. British Journal of Community Nursing 2019;24(2):58-66.
[The plan, do, study, act (PDSA) method was used, and process mapping informed a tailored intervention. Introducing the tool had positive outcomes for residents and care staff. There was a reduction in the incidence of pressure ulcers and falls, and care staff were more confident in recognising resident deterioration.]

Reports

The following report(s) may be of interest:

Better care of deteriorating patients has reduced US mortality after surgery.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000764/better-care-of-deteriorating-surgical-patients-reduced-us-mortality
[NIHR Signal. Improved management of deteriorating patients with surgical complications has reduced the number of deaths in US hospitals rather than it being due to fewer complications. Over the past 10 years, complication rates have remained fairly similar. It is the reduction in 'failure to rescue' that has made the main difference in mortality. These US findings support the recently introduced early warning system in the NHS called NEWS2.]
Freely available online

Having more registered nurses on general wards is linked to lower mortality.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000753/having-more-registered-nurses-on-general-wards-is-linked-to-lower-mortality
[NIHR Signal. Higher registered nurse staffing levels are associated with lower mortality, and the fact that fewer vital sign observations are missed is the most likely explanation for this. Increasing registered nursing staff by an hour for each patient per day could reduce the risk of death by 3%.]
Freely available online

Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation, England, March 2018 - February 2019.
NHS Digital; 2019.
https://digital.nhs.uk/data-and-information/publications/clinical-indicators/shmi/current
[The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. It covers patients admitted to hospitals in England who died either while in hospital or within 30 days of being discharged.]
Freely available online

Falls Prevention

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review.
Martínez-Carbonell Guillamón E. BMC Geriatrics 2019;19(1):52 .
[There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.]
Freely available online

Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations.
Winser SJ. Annals of Physical and Rehabilitation Medicine 2019;:doi: 10.1016/j.rehab.2019.06.012.
[There is evidence to support exercise-based interventions as cost-effective treatment for preventing falls. Further research is needed to fully establish the cost-effectiveness of such programs, especially in both developing and underdeveloped countries.]
Contact the library for a copy of this article

Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial.
Liu-Ambrose T. JAMA 2019;321(21):2092-2100 .
[Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.]

Effectiveness of cognitive behavior therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: A systematic review and meta-analysis.
Chua CHM. Journal of Advanced Nursing 2019;:doi: 10.1111/jan.14150.
[This review included 15 randomized controlled trials involving 3165 community-dwelling adults aged 60 years and older. The pooled results showed that the intervention effects, including immediate, short-term (i.e., ≤ 6 months postintervention) and long-term (i.e., > 6 months postintervention) effects, favored the intervention group.]
Available with an NHS OpenAthens password for eligible users

Engagement of general practitioners in falls prevention and referral to occupational therapists.
McIntyre A. British Journal of Occupational Therapy 2019;82(2):71-79.
[Falls prevention is a key activity for general practitioners, occupational therapists and other allied health professionals...General practitioners are crucial in identifying older people at risk of falls and referring for intervention.
This research aims to identify the current practice of general practitioners in falls prevention and to identify opportunities for occupational therapists in particular to extend their role in falls prevention in primary care.
]
Contact the library for a copy of this article

Evaluating falls prevention strategies in community settings: marginal reduction on rate of falls with individual risk-based multifactorial interventions compared to ‘usual care’.
Lee A. Evidence-Based Nursing 2019;22(1):20.
[Authors conclude a marginal reduction on rate of falls with individual risk-based multifactorial interventions compared with ‘usual care’, but no reductions in other outcome measures. There is limited evidence to support whether multifactorial interventions are better than exercise alone. Moderate quality evidence supports that multiple component interventions may reduce risk and rates of falls. However, there is limited evidence on whether this impacts other outcome measures.]
Available with an NHS OpenAthens password

Exercise for preventing falls in older people living in the community.
Sherrington C. Cochrane Database of Systematic Reviews 2019;1:CD012424.
[At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community.]

Fear of falling: a hidden burden with or without a history of falls.
Hill K D. Evidence-Based Nursing 2019;22(1):21.
[Fear of falling (FOF) is common, even in the absence of recent falls. Health professionals should assess older people who present with falls, near falls or unsteady gait for the presence of FOF, and if identified, exercise or cognitive–behavioural intervention should be considered. Future research should evaluate the effectiveness of interventions to address FOF on preventing or minimising development of incident disability.

]
Available with an NHS OpenAthens password

Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis.
Hamed A. Sports Medicine - Open 2018;4(1):56 .
[The present review and meta-analysis provide evidence that physical exercise interventions have the potential to significantly reduce fall rate and risk in healthy older adults. Posture-challenging exercises might be particularly considered when designing fall prevention interventions.]
Freely available online

Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis.
Finnegan S. Physiotherapy 2019;105(2):187-199 .
[Falls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention.]
Freely available online

Managing deterioration in older adults in care homes: a quality improvement project to introduce an early warning tool.
Little S. British Journal of Community Nursing 2019;24(2):58-66.
[The plan, do, study, act (PDSA) method was used, and process mapping informed a tailored intervention. Introducing the tool had positive outcomes for residents and care staff. There was a reduction in the incidence of pressure ulcers and falls, and care staff were more confident in recognising resident deterioration.]

Physical activity programs for balance and fall prevention in elderly: A systematic review.
Thomas E. Medicine 2019;98(27):e16218.
[Eight articles were considered eligible and included in the quantitative synthesis. The articles investigated the effects of resistance and aerobic exercise, balance training, T-bow© and wobble board training, aerobic step and stability ball training, adapted physical activity and Wii Fit training on balance outcomes. Balance measures of the studies showed improvements between 16% and 42% compared to baseline assessments.]
Freely available online

Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis.
Wylie G. Age and Ageing 2019;:doi: 10.1093/ageing/afy189.
[Conclusions: multifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant reductions in falls rate. The effect of multi-component podiatry interventions and of podiatry within multifactorial interventions in care homes is unknown and requires further trial data.]
Contact the library for a copy of this article

Policies and strategies to prevent patient falls in hospital.
Glasper A. British Journal of Nursing 2019;28(12):806-807.
[The author discusses polices and strategies used by nurses to minimise patient falls in hospital.]
Available with an NHS OpenAthens password for eligible users

Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis.
Tricco AC. Age and Ageing 2019;:doi: 10.1093/ageing/afy219.
[Conclusions: Team changes may reduce risk of injurious falls and a combination of case management, patient reminders, and staff education, as well as case management and patient reminders may reduce risk of falls.]
Contact the library for a copy of this article

The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review.
Lima CA. Physiotherapy 2018;104(4):383-394.
[The Berg Balance Scale (BBS) is often used in clinical practice to predict falls in the older adults. However, there is no consensus in research regarding its ability to predict falls.]

Reports

The following report(s) may be of interest:

Long-term exercise programmes reduce falls and injuries in older adults.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000749/long-term-exercise-programmes-reduce-falls-and-injuries-in-older-adults
[NIHR Signal. Older people who participate in year-long exercise programmes fall less and are less likely to be injured if they do fall. Exercise does not increase or decrease their risk of hospitalisation.]
Freely available online

Raising the bar on strength and balance: The importance of community-based provision.
Centre for Ageing Better; 2019.
https://www.ageing-better.org.uk/publications/raising-bar-strength-balance
[Despite common misconceptions, falls are not an inevitable part of ageing and can be prevented. Although there are some NHS rehabilitation services that provide strength and balance programmes, these are often of limited length, making it essential that there are effective community-based strength and balance programmes in their local areas to move on to.]
Freely available online

Websites

The following website(s) may be of interest:

Falls prevention resources.
https://improvement.nhs.uk/resources/falls-prevention-resources/
[Resources to reduce the instances of falls in hospitals, collected by NHS Improvement. ]
Freely available online

Human Factors

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

An empirical investigation into the role of values in occupational therapy decision-making.
Thomas Y. British Journal of Occupational Therapy 2019;82(6):357-366.
[The importance of values in occupational therapy is generally agreed; however, there is no consensus about their nature or their influence on practice. It is widely assumed that occupational therapists hold and act on a body of shared values, yet there is a lack of evidence to support this.
The research tested the hypothesis that occupational therapists’ responses to ethically challenging situations would reveal common values specific to the occupational therapy profession.]
Freely available online

An organisational participatory research study of the feasibility of the behaviour change wheel to support clinical teams implementing new models of care.
Bull ER. BMC Health Services Research 2019;19(1):97.
[An Organisational Participatory Research study was conducted with health organisations from North West England, health psychologists and health workforce education commissioners. The Behaviour Change Wheel (BCW) was applied with teams of professionals seeking help to overcome barriers to practice change. Pre-post quantitative data collected suggested some positive changes in staff practice behaviours and psychological determinants following the intervention.]

Are more experienced clinicians better able to tolerate uncertainty and manage risks? A vignette study of doctors in three NHS emergency departments in England.
Lawton R. BMJ Quality & Safety 2019;28(5):382-388.
[Conclusion: While we might be tempted to conclude from this research that experience and the ability to tolerate uncertainty lead to positive outcomes for patients (less risk-averse management strategies and higher levels of safety netting), what we are unable to conclude from this design is that these less risk-averse strategies improve patient safety.]

Attitudes of mental health providers towards adoption of evidence-based interventions: relationship to workplace, staff roles and social and psychological factors at work.
Rye M. BMC Health Services Research 2019;19(1):110.
[Gaining insight into factors influencing the adoption of evidence-based interventions (EBI) is essential to ensuring their sustainability in the mental healthcare setting. The findings suggest that implementation efforts may benefit from being tailored to the different needs and values of the affected professionals, including the role of the context they operate within.]

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis.
Karimi-Shahanjarini A. Cochrane Database of Systematic Reviews 2019;4:CD010412.
[Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. ]

Changing the nursing handover.
Laugher H. British Journal of Nursing 2019;28(1):60-61.
[The article discusses efforts to improve the nursing handover process which deals with the transfer of patient care between registered nurses (RNs) and healthcare assistants (HCAs) in Great Britain, and it mentions communication breakdowns and patient care-related mistakes on clinical decision units (CDUs) at British hospitals. Questionnaires are addressed, along with patient safety and the Plan, Do Study, Act (PDSA) handover methodology.]
Available with an NHS OpenAthens password for eligible users

Characterising ICU-ward handoffs at three academic medical centres: process and perceptions.
Santhosh L. BMJ Quality & Safety 2019;28(8):627-634.
[Conclusion: In this multisite study, despite significant process variation across sites, almost all resident physicians recalled an adverse event related to the ICU–ward handoff. Future work is needed to determine best practices for ICU–ward handoffs at academic medical centres.]

Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study.
Tørring B. BMC Health Services Research 2019;19(1):528.
[The findings complement previous research on interdisciplinary teamwork in surgical teams and contribute to the theory of relational coordination. The findings offer a new typology of teams that goes beyond weak or strong relational coordination to capture four distinct patterns of relational coordination. In particular, the study highlights the central role of mutual respect and presents proposals for improving relational coordination in surgical teams.]

Critical Review, Development, and Testing of a Taxonomy for Adverse Events and Near Misses in the Emergency Department.
Griffey RT. Academic Emergency Medicine 2019;26(6):670-679.
[Conclusions: We developed a taxonomy of AEs and near misses for the ED, modified from an existing framework. Testing of the tool with minimal training yielded high performance and good inter‐rater reliability. This taxonomy can be adapted and modified by EDs seeking to enhance their quality and safety reviews and characterize harm occurring in their EDs for quality improvement purposes.
]

Evaluation of a toolkit resource package to support positive workplace behaviours in relation to quality end-of-life care in Australian hospitals.
Hutchinson C. BMJ Open Quality 2018;7(4):doi.org/10.1136/bmjoq-2017-000286.
[The study aimed to determine the effectiveness of an action-orientated toolkit in supporting behaviour change in relation to quality end-of-life care in acute hospital settings. A toolkit was developed from an international review of peer-reviewed literature on end of life. The toolkit was well received by users who reported increased confidence in communication around end-of-life matters. 59.3% of users reported making a behaviour change over the previous 4 weeks. ]
Freely available online

Healthy working time arrangements for healthcare personnel and patients: a systematic literature review.
Bernstrøm VH. BMC Health Services Research 2019;19(1):193.
[Results suggest that employee health partially (but not completely) mediates the relationship between working time arrangements and patient safety. However, there is a lack of studies directly investigating employee health as a mediator between working time arrangements and patient safety. Future studies should address this research gap.]

Human factors, cognitive bias and the paramedic.
Allen J. Journal of Paramedic Practice 2019;11(1):14.
[The consequences of human factors and cognitive bias can be catastrophic if unrecognised. Errors can lead to loss of life because of the flawed nature of human cognition and the way we interact with our environment. The College of Paramedics now recommends the teaching of human factors. Using a problem-based approach, this article aims to inform prehospital clinicians about how human factors and cognitive bias can affect them and their practice, and how these can be mitigated.]
Available with an NHS OpenAthens password for eligible users

Implications for reflective practice and safer care in paramedicine: The Bawa-Garba case.
Delport S. Journal of Paramedic Practice 2018;10(11):462.
[[Opinion] Comment on the case of Hadiza Bawa-Garba, a paediatrics trainee (resident) who was convicted of gross negligence manslaughter in 2015 after the death of a 6-year-old boy from sepsis. In January 2018, the High Court ruled that Bawa-Garba was to be struck off the General Medical Council (GMC) register in the UK. The authors argue that, in addition to Bawa-Garba's 'very serious errors', there were also system failings that should be considered. Impact on role of reflection in practice.]
Available with an NHS OpenAthens password for eligible users

Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety.
Zaheer S. BMJ Open Quality 2018;7(4):doi.org/10.1136/bmjoq-2018-000433.
[Results of the study suggest leadership support at supervisory level can substitute for the absence of leadership support for safety at senior level. Organisations should recruit into leadership roles those who prioritise safety and possess relational competencies. The field would benefit from evidence on how to build leadership support for patient safety. It is important to provide on-site workshops on topics that can strengthen working relationships across professional and unit boundaries.]
Freely available online

Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room.
Joseph A. BMJ Quality & Safety 2019;28(4):276-283.
[Conclusion: Room design and layout issues may create barriers to task performance, potentially contributing to the escalation of flow disruptions (FD) in the operating rooms (OR).]

Nurses need to be aware of their professional responsibilities when engaging with social media.
Barrett D. Evidence-Based Nursing 2019;22(1):28.
[Approximately 37% of the nurses identified as part of the study were judged to have posted inappropriate messages; of the 8934 tweets analysed, 4.6% were categorised as uncivil. The most prevalent types of incivility within tweets were the use of profanity, ‘product promotion’ (defined as disseminating health or medical information about a particular brand without proper evidence), sexual content or being demeaning towards patients.]
Available with an NHS OpenAthens password

Provider interruptions and patient perceptions of care: an observational study in the emergency department.
Schneider A. BMJ Quality & Safety 2019;28(4):296-304.
[Conclusions: Provider interruptions were differentially associated with patient perceptions of care. Whereas coordination-related and patient-initiated interruptions were beneficial to patient-perceived efficiency of emergency department (ED) operations, interruptions due to case-irrelevant communication were related to inferior patient ratings of ED organisation...]

Quality and safety of in-hospital care for acute medical patients at weekends: a qualitative study.
Sutton E. BMC Health Services Research 2018;18(1):1015.
[At weekends patients and staff are well aware of suboptimal staffing numbers, skill mix and access to resources at weekends, and identify that emergency admissions are prioritised over those already hospitalised. The consequences in terms of quality and safety and patient experience of care are undesirable. Our findings suggest the value of focusing on care processes and systems resilience over the weekends, and how these can be better supported.]

Reviewing and responding to patient safety incidents in the NHS.
Tingle J. British Journal of Nursing 2019;28(8):530-531.
[The author discusses several recent reports on patient safety incidents in the NHS and the urgent need for action to deal with the problems identified.]
Available with an NHS OpenAthens password for eligible users

Safe, sustainable and productive staffing. An improvement resource for the deployment of nursing associates in secondary care.
National Quality Board. British Journal of Healthcare Assistants 2019;13(2):61–65.
[The National Quality Board (NQB) publication, Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time: safe, sustainable and productive staffing (NQB, 2019), outlines the expectations and framework within which decisions on safe and sustainable staffing should be made to support the delivery of safe, effective, caring, responsive and well-led care on a sustainable basis. ]
Available with an NHS OpenAthens password for eligible users

The origins and implementation of an intervention to support healthcare staff to deliver compassionate care: exploring fidelity and adaptation in the transfer of Schwartz Center Rounds® from the United States to the United Kingdom.
Leamy M. BMC Health Services Research 2019;19(1):457.
[Schwartz Center Rounds® were adopted in the United Kingdom (UK) in 2009 and have been subsequently implemented in over 180 healthcare organisations. Using Rounds as a case study, we aim to inform current debates around maintaining fidelity when an intervention developed in one country is transferred and implemented in another.]

Guidelines

The following new guidance has recently been published:

Being fair: supporting a just and learning culture for staff and patients following incidents in the NHS.
NHS Resolution;2019.
https://resolution.nhs.uk/resources/being-fair-report/
[This guidance highlights the need for the NHS to involve users of care services and staff in safety investigations. It aims to help the NHS to create an environment to better support staff when things go wrong and to encourage learning from incidents. Key challenges include fear, equity and fairness, and bullying and harassment.]
Freely available online

Reports

The following report(s) may be of interest:

Learning from Deaths - A review of the first year of NHS trusts implementing the national guidance
Care Quality Commission (CQC); 2019.
https://www.cqc.org.uk/sites/default/files/20190315-LfD-Driving-Improvement-report-FINAL.pdf
[This report provides a very first look at observations from our inspection teams, as well as an indication of the types of enablers and barriers that we have seen trusts face in implementing the guidance, and is not necessarily representative of all trusts’ experiences... To help encourage improvement we have included examples of good practice to inspire NHS trust staff to continue to improve how they review and learn from deaths.]
Freely available online

Public Administration and Constitutional Affairs Committee: Inquiry to explore the findings of "Ignoring the Alarms" by the Parliamentary and Health Services Ombudsman: Written Evidence by the Patient Experience Library April 2019.
The Patient Experience Library; 2019.
https://www.patientlibrary.net/tempgen/194234.pdf
[(From Executive summary)
"We will draw on evidence to show that the failures of investigation and learning highlighted by the PHSO are not unique to Averil Hart's case. Nor are they unique to eating disorder services. They are systemic, and extend right across the NHS."
This report looks to highlight that there is a double standard in the treatment of patient experience evidence as opposed to medical evidence, that the flaws are persistent. They go on to recommend steps for improvement.]
Freely available online

Infection Prevention

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

Antibacterial Envelope to Prevent Cardiac Implantable Device Infection.
Tarakji KG. New England Journal of Medicine 2019;:doi: 10.1056/NEJMoa1901111.
[Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. ]
Contact the library for a copy of this article

Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial.
Gilbert R. Lancet Child Adolesc Health 2019;3(6):381-390 .
[Central venous catheters (CVCs) impregnated with antimicrobial agents are no better than standard CVCs for avoiding bloodstream infection in pre-term babies.

Researchers reported no evidence of clinical benefit or harm from the antimicrobial-impregnated CVCs.

They noted these antimicrobial-impregnated CVCs are rarely used in the UK and are more expensive than standard alternatives.]

Antipyretic drugs in patients with fever and infection: literature review.
Ludwig J. British Journal of Nursing 2019;28(10):610-618.
[Antipyretic drugs are routinely administered to febrile patients with infection in secondary care. However, the use of antipyretics to suppress fever during infection remains a controversial topic within the literature. It is argued that fever suppression may interfere with the body's natural defence mechanisms, and may worsen patient outcomes. The evidence does not currently support routine antipyretic administration.]
Available with an NHS OpenAthens password for eligible users

Catheter-associated urinary tract infection: signs, diagnosis, prevention.
Davis C. British Journal of Nursing 2019;28(2):96-100.
[Catheter-associated urinary tract infection (CAUTI) is one of the most prevalent healthcare-associated infections (HAIs) in the UK and can have implications for both the patient and the health service. This article highlights those at risk, the signs and symptoms of CAUTI, diagnosis, methods of prevention and treatment. It highlights current guidance available to nurses to help ensure they are following the most recent recommendations for best practice.]
Available with an NHS OpenAthens password for eligible users

Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis.
Wang MY. American Journal of Infection Control 2019;47(7):755-760.
[CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.]
Contact the library for a copy of this article

Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial.
Huang SS. The Lancet 2019;:doi: 10.1016/S0140-6736(18)32593-5.
[Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients.]
Contact the library for a copy of this article

Clinical experience of a subcutaneously anchored sutureless system for securing central venous catheters.
Pittiruti M. British Journal of Nursing 2019;28(2):S4-S14.
[This article reports the results of three prospective clinical studies conducted in a university hospital regarding the efficacy, safety and cost effectiveness of a subcutaneously anchored sutureless system for securing central venous catheters. The results were favourable to the adoption of such a device, and the analysis of the data allowed the authors to define those categories of patients where the device should have the most benefit.]
Available with an NHS OpenAthens password for eligible users

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.
Webster J. Cochrane Database of Systematic Reviews 2019;1:CD007798.
[US Centers for Disease Control guidelines recommend replacement of peripheral intravenous catheters (PIVC) no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation or infection. Costs associated with routine replacement may be considerable. ]

Control of a multidrug-resistant Acinetobacter baumannii outbreak.
Warde E. British Journal of Nursing 2019;28(4):242-248.
[This article describes the management of an outbreak of multidrug-resistant Acinetobacter baumannii (MDR-Ab) at an acute NHS Foundation Trust. The outbreak affected two respiratory wards and the initial outbreak lasted 9 months, with the first patient (index case) being identified in April 2015 and the final, tenth case, in September 2015. It is hoped that this article will increase awareness among healthcare providers and infection prevention and control (IPC) teams .]
Available with an NHS OpenAthens password for eligible users

Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?
Jackson L. British Journal of Nursing 2019;28(11):682-689.
[Oral colonisation by pathogens contributes to contracting ventilator-associated pneumonia (VAP). The aim of this review was to determine whether the use of the antiseptic chlorhexidine in the intra-oral cavity reduced its incidence in the critically ill, mechanically ventilated adult. The findings from this review led to the conclusion that chlorhexidine reduced the occurrence of VAP.]
Available with an NHS OpenAthens password for eligible users

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial.
ELFIN trial investigators group. The Lancet 2019;393(10170):423-433 .
[Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants.]
Contact the library for a copy of this article

Enteral lactoferrin to prevent infection for very preterm infants: the ELFIN RCT.
Griffiths J. Health Technology Assessment 2018;22(74):https://doi.org/10.3310/hta22740.
[Enteral supplementation with bovine lactoferrin did not reduce the risk of late onset infection in very preterm infants.]
Freely available online

Getting the basics right: reflections on infection prevention and control.
Weston D. British Journal of Nursing 2019;28(1):8-10.
[The article discusses various aspects of infection prevention and control (IPC) in Great Britain as of 2019, and it mentions concerns about pathogens such as carbapenem-resistant Enterobacteriaceae (CRE) and Candida auris. Healthcare associated infection (HCAI) reduction and meticillin-resistant Staphylococcus aureus (MRSA) infections are examined, along with the use of hand hygiene, personal protective equipment, and urinary catheter management to prevent infections.]
Available with an NHS OpenAthens password for eligible users

Guide to the safe use of needlefree connectors.
Harrold K. British Journal of Nursing 2019;28(Sup14b):1-6.
[Needlefree connectors (NFCs) are routinely used to access peripheral and central intravenous devices. However, improper use can result in catheter dysfunction and life-threatening catheter-related blood stream infection ). This guide provides guidance on best practice for the use of NFCs. The need for this was highlighted by an online survey which found health professionals had limited knowledge about the types of needlefree devices available and required further education on best practice.]
Available with an NHS OpenAthens password for eligible users

International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units.
van Puffelen E. BMC Health Services Research 2019;19(1):379.
[Initiating parenteral nutrition (PN) within 24 h in critically ill children is inferior to withholding PN during the first week, as was found in the PEPaNIC study. The aims of this study were to investigate de-implementation of early initiation of PN at PICUs worldwide, and to identify factors influencing de-implementation.]

Intrasite Antibiotic Powder for the Prevention of Surgical Site Infection in Extremity Surgery: A Systematic Review.
Fernicola SD. Journal of the American Academy of Orthopaedic Surgeons 2019;:doi: 10.5435/JAAOS-D-18-00475.
[There are no current guidelines for the use of intrasite antibiotic powder for the prevention of SSIs in orthopaedic procedures. Despite the lack of high-quality evidence available in the literature, published smaller studies do suggest a significant protective effect. However, recommendations with regard to this technique after common orthopaedic procedures cannot yet be made.]
Available with an NHS OpenAthens password for eligible users

Intravenous infusion drug administration: flushing guidance.
Barton A. British Journal of Nursing 2019;28(8):S16-S17.
[The author and NIVAS board colleagues have produced evidence-based guidelines for health profesionals on how to avoid under-dosing in IV therapy. These guidelines, in association with NIVAS, are presented here.
This guidance has been produced in response to recently published concerns about the discarded amount of intravenous medication which is left remaining in an intravenous giving set at the end of an IV Infusion.]
Available with an NHS OpenAthens password for eligible users

Network meta-analysis and pharmacoeconomic evaluation of antibiotics for the treatment of patients infected with complicated skin and soft structure infection and hospital-acquired or ventilator-associated penumonia.
Zhang Y. Antimicrobial Resistance and Infection Control 2019;8:72 .
[In these clinical trials, considering efficacy, safety, and cost-effectivenes, linezolid and tedizolid showed their superiority in MRSA cSSSI; while linezolid might be recommended to treat MRSA pneumonia. Although vancomycin was not cost-effective in pharmacoeconomic evaluation, it is still the first-line treatment for MRSA infection in the clinical practice.]
Freely available online

Nurses' knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study.
Hammerschmidt J. BMC Health Services Research 2019;19(1):547.
[Results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.]

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection.
Parks Taylor S. Critical Care Medicine 2019;47(8):1081-1088.
[The accuracy of quick Sequential Organ Failure Assessment to predict hospital mortality diminishes with increasing comorbidity burden. Patients with comorbidities may have baseline abnormalities in quick SOFA variables that reduce predictive accuracy. Additional research is needed to better understand quick SOFA performance across different comorbid conditions with modification that incorporates the context of changes to baseline variables.]

Preventing infection in surgical patients.
Parry A. British Journal of Nursing 2018;27(21):1218-1220.
[The article presents the author’s views on the question of preventing infection in surgical patients. Topics discussed include patient’s risk of developing a surgical site infection (SSI), preoperative patient preparation, intraoperative practices and postoperative care.]
Available with an NHS OpenAthens password for eligible users

Rapid Detection of Methicillin-Resistant Staphylococcus aureus in BAL: A Pilot Randomized Controlled Trial.
Paonessa JR. Chest 2019;155(5):999-1007 .
[A highly sensitive BAL RDT for MRSA significantly reduced use of vancomycin and linezolid in ventilated patients with suspected pneumonia. Management made on the basis of RDT had no adverse effects, with a trend to lower hospital mortality.]

The case for using a disinfecting cap for needlefree connectors.
Barton A. British Journal of Nursing 2019;28(14):S22-S27.
[Catheter-related bloodstream infections (CRBSIs) are a signification cause of infection. When CRBSI rates are high, the cost to the patient and the organisation can be significant. More than ever before, there is a high demand for vascular access. Advances in treatment often entail extended indwell times for central vascular access devices. The care and maintenance of these devices is crucial in avoiding complications such as infection.]

The Common Missed Handwashing Instances and Areas after 15 Years of Hand-Hygiene Education.
Wong JSW. Journal of Environmental and Public Health 2019;:5928924.
[The results show that the majority of participants only wash their hands after using the toilet (87%) or handling vomitus or faecal matter (91%). The areas of the hand most neglected during handwashing were the fingertips (48.1%), medial area (30.5%), and back of the hand (28%). Participants aged 30 and above tend to neglect 5 more areas of the hand than those aged below 30.]
Freely available online

The efficacy of topical gentamycin application on prophylaxis and treatment of wound infection: A systematic review and meta-analysis.
Wang P. International Journal of Clinical Practice 2019;73(5):e13334 .
[Studies to date show that topical gentamycin application significantly increases the rate of clinical efficacy and decreases the duration of wound healing in patients with local wound infection or infective risk.]

The importance of infection control in tackling the antimicrobial resistance crisis.
Wyeth J. British Journal of Nursing 2019;28(5):284-286.
[The article discusses the importance of infection control in tackling the antimicrobial resistance crisis, actions plans in development of new antimicrobial agents, and infection prevention and control guidelines. According to the author, effective antimicrobial treatments such as chemotherapy, organ transplantation and elective surgical procedures, may no longer be possible due to the associated risks of infection.]
Available with an NHS OpenAthens password for eligible users

Guidelines

The following new guidance has recently been published:

Catheter Care: RCN Guidance for Health Care Professionals.
Royal College of Nursing (RCN);2019.
https://www.rcn.org.uk/professional-development/publications/007-313
[Publication aiming to encourage widespread adoption of the National Occupational Standards across all NHS and independent health care sectors, by enabling a full understanding of the standards and providing quality care for patients.]
Freely available online

Curos for preventing infections when using needleless connectors.
National Institute for Health and Care Excellence (NICE);2019.
https://www.nice.org.uk/guidance/mtg44
[1 Recommendations. 1.1 Curos disinfecting cap shows promise for preventing infections when using needleless connectors, but there is currently insufficient evidence to support the case for routine adoption in the NHS. 1.2 Research is therefore recommended to address uncertainties about the clinical benefits of using Curos...]
Freely available online

Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects.
Medicines and Healthcare Products Regulatory Agency (MHRA);2019.
https://www.gov.uk/drug-safety-update/fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects
[Drug Safety Update. Disabling, long-lasting or potentially irreversible adverse reactions affecting musculoskeletal and nervous systems have been reported very rarely with fluoroquinolone antibiotics. Fluoroquinolone treatment should be discontinued at the first signs of a serious adverse reaction, including tendon pain or inflammation.]
Freely available online

Nodau gwella heintiau sy'n gysylltiedig â gofal iechyd ac ymwrthedd gwrthficrobaidd (WHC/2019/019) / Healthcare associated infections and antimicrobial resistance improvement goals (WHC/2019/019).
Llywodraeth Cymru / Welsh Government;2019.
https://gov.wales/healthcare-associated-infections-and-antimicrobial-resistance-improvement-goals-whc2019019-0
[Yr hyn rydym yn disgwyl i fyrddau iechyd ac ymddiriedolaethau ei wneud i leihau heintiau sy'n gysylltiedig â gofal iechyd ac ymwrthedd gwrthficrobaidd. / What we expect health boards and trusts to do to reduce healthcare associated infections and antimicrobial resistance.]
Freely available online

Standard infection control precautions: national hand hygiene and personal protective equipment policy.
NHS England & NHS Improvement;2019.
https://improvement.nhs.uk/resources/national-hand-hygiene-and-personal-protective-equipment-policy/
[This national policy is a practice guide for NHS healthcare staff of all disciplines in all care settings. It covers responsibilities for organisations, staff and infection prevention and control teams. It also sets out how and when to decontaminate hands.]
Freely available online

Surgical site infections: prevention and treatment.
National Institute for Health and Care Excellence (NICE);2019.
https://www.nice.org.uk/guidance/ng125
[This guideline covers preventing and treating surgical site infections in adults, young people and children who are having a surgical procedure involving a cut through the skin. It focuses on methods used before, during and after surgery to minimise the risk of infection.]
Freely available online

Urinary catheter tools.
NHS Improvement;2019.
https://improvement.nhs.uk/resources/urinary-catheter-tools/
[The urinary catheter tools have been developed collaboratively with national experts to support providers in delivering consistent evidence based catheter care. The use of the tools needs to be supported by strong leadership and education.]
Freely available online

Reports

The following report(s) may be of interest:

Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI) annual report, 2017 to 2018.
Department of Health and Social Care; 2019.
https://www.gov.uk/government/publications/aprhai-annual-report-2017-to-2018/aprhai-9th-annual-report
[This report describes the Committee’s work which has mainly focused on supporting the implementation of the ambitions of the UK 5-year antimicrobial resistance strategy 2013 to 2018.]
Freely available online

Antimicrobial central venous catheters do not reduce infections in pre-term babies.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000782/antimicrobial-central-venous-catheters-for-pre-term-babies-do-not-reduce-infections
[NIHR Signal. This NIHR-funded trial compared peripherally inserted CVCs that had been impregnated with a combination of the antifungal miconazole and the broad-spectrum antibiotic rifampicin, against standard non-antimicrobial-impregnated CVCs for preterm babies in intensive care. Rates of bloodstream infections were similar in both groups, and no differences in other clinical outcomes were found.]
Freely available online

Decontamination of the mouth or digestive tract was not linked to reductions in drug-resistant bloodstream infections in the intensive care unit.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000727/decontamination-strategies-not-linked-to-reductions-in-drug-resistant-bloodstream-infections-in-icu
[NIHR Signal. Decontamination strategies to remove potentially harmful bacteria from the mouth, throat and gut of critically ill patients don’t reduce the risk of intensive care unit-acquired bloodstream infections or deaths from bacteria that were resistant to antibiotics. The study was carried out in 13 intensive care units across Europe, including the UK, with moderate to high levels of antibiotic resistance (extended resistance in more than 5% of all bloodstream infections).]
Freely available online

Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000760/early-switch-to-oral-antibiotics-for-bone-and-joint-infection
[NIHR Signal. For adults with bone or joint infection, many of whom had metal implants, beginning six weeks of oral antibiotics within seven days of intravenous treatment, was no worse than a regimen delivered wholly intravenously (IV). After one year, around 14% of both groups still had an infection, showing the difficulty of treatment, irrespective of the route of administration.]
Freely available online

The Next Decade of Vaccines: Addressing the challenges that remain towards achieving vaccinations for all.
UK All-Party Parliamentary Group on Vaccines for All; 2019.
http://www.appg-vfa.org.uk/reports-articles/
[Throughout 2018, the APPG conducted an inquiry into the reasons for stalling global immunisation rates, taking written and oral evidence from a variety of stakeholders across the sector. The subsequent report highlights the key challenges that remain and provides recommendations for all immunisation actors and donors for progress in the next decade of vaccines.]
Freely available online

Treating asymptomatic MRSA on discharge from hospital reduces risk of later infection.
NIHR Dissemination Centre; 2019.
https://discover.dc.nihr.ac.uk/content/signal-000766/treating-symptomless-mrsa-at-hospital-discharge-reduces-infection-risk
[NIHR Signal. Use of medicated creams, mouthwash and body wash for six months after discharge from hospital led to a 30% lower risk of MRSA infection, compared with basic hygiene education. This study was carried out in the USA using 2,121 adults who had tested positive for MRSA in hospital, but who had no symptoms. Rates of MRSA are higher in the USA, and therapy regimens may differ, but this study found that the intervention was effective and this should be relevant to practice here.]
Freely available online

Malnutrition & Dehydration

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

Association of vitamin D and vitamin B12 with cognitive impairment in elderly aged 80 years or older: a cross‐sectional study.
da Rosa M I. Journal of Human Nutrition and Dietetics 2019;32(4):518-524.
[The present study showed that individuals aged ≥80 years who had vitamin D levels of ≤18 ng mL−1 had a higher prevalence of cognitive decline even after adjustment for potential confounders. A cross‐sectional analysis does not enable the inference of a cause–effect relationship and additional studies are needed to understand these relationships. ]
Available with an NHS OpenAthens password for eligible users

Community-based supplementary feeding for food insecure, vulnerable and malnourished populations - an overview of systematic reviews.
Visser J. Cochrane Database of Systematic Reviews 2018;11:CD010578.
[Supplementary feeding may help food insecure and vulnerable people by optimising the nutritional value and adequacy of the diet, improving quality of life and improving various health parameters of disadvantaged families. In low- and middle-income countries (LMIC), the problems supplementary feeding aims to address are entangled with poverty and deprivation, the programmes are expensive and delivery is complicated.]

Dehydration and cognition: an understated relation.
Merhej R. International Journal of Health Governance 2019;24(1):19-30.
[Dehydration, even at mild levels, is associated with impairments in basic and higher order cognitive functions. Websites from international authoritative nutrition sources understate the role of water in healthy nutrition, and omit the discussion of the impact of dehydration on cognitive functioning.]
Contact the library for a copy of this article

Deterioration of nutritional status of patients with locally advanced cervical cancer during treatment with concomitant chemoradiotherapy.
Sanchez M. Journal of Human Nutrition and Dietetics 2019;32(4):480-491.
[The nutritional status of cervical cancer patients deteriorates during treatment with concomitant chemoradiotherapy and, most importantly, muscle loss impacts the clinical outcome of patients.]
Available with an NHS OpenAthens password for eligible users

Drinking vessel preferences in older nursing home residents: optimal design and potential for increasing fluid intake.
Bak A. British Journal of Nursing 2018;27(22):1298-1304.
[Residents in nursing and residential care homes are at risk of dehydration due to both resident and institutional factors. Previous studies have focused on improving fluid intakes by concentrating on types of fluids offered and assisting residents to drink. The aim of this study was to determine resident opinion of the optimal features of drinking vessels and evaluate the impact of improving vessel design on fluid consumption. Design improvements have the potential to increase fluid intakes.]
Available with an NHS OpenAthens password for eligible users

Dysphagia and malnutrition in older adults.
Taylor C. British Journal of Community Nursing 2019;24(Sup7):S26-S28.
[Dysphagia and the need for texture-modified food and fluids has a life-changing impact on the enjoyment of food and fluids. A multi-disciplinary approach is vital to ensuring that patients, family and carers are provided with the support they require to allow compliance with the recommendations. It is important to try to ensure people get suffient nutrients from their food intake first, if this is not possible, advice on supplements should be sought.]

Educating registered nurses and healthcare support workers on nutrition and tissue viability.
Royall D. British Journal of Community Nursing 2019;24(Sup7):S29-S31.
[Key points: Effective wound healing is dependent on adequate nutrition and protein intake; In-service training directly benefits patients by empowering nurses and healthcare support workers to take an active role in ensuring optimum nutrition, especially when patients have a wound or are at risk of developing one; The success of the ANTs (Agents for Nutrition and Tissue Viability) programme has contributed to a 78% retention rate of staff across the author's organisation.]

Effect of a novel supplementary porridge on the nutritional status of infants and young children diagnosed with moderate acute malnutrition in Uganda: a cluster randomised control trial.
Kajjura K B. Journal of Human Nutrition and Dietetics 2019;32(3):295-302.
[Moderate acute malnutrition and anaemia are prevalent among infants/children in Uganda. A lack of consensus regarding the most effective strategy for managing MAM among IYC resulted in the present study comparing the effect of malted sorghum‐based porridge (an active malt, extruded maize and soy sorghum supplementary porridge developed for the purpose of the present study) as an intervention versus an extruded maize and soy micronutrient fortified blend as a control and current standard care. ]
Available with an NHS OpenAthens password for eligible users

Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations.
Garcia-Casal MN. Cochrane Database of Systematic Reviews 2018;12:CD010187.
[Approximately 800 million women and children have anaemia, a condition thought to cause almost 9% of the global burden of years lived with disability. Around half this burden could be amenable to interventions that involve the provision of iron. Several programmes around the world have fortified maize flour and other maize-derived foodstuffs with iron and other vitamins and minerals to combat anaemia and iron deficiency.]

Fortification of staple foods with vitamin A for vitamin A deficiency.
Hombali AS. Cochrane Database of Systematic Reviews 2019;5:CD010068.
[Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups.]

Improving the nutritional intake of hospital patients: how far have we come? A re‐audit.
Beavan S. Journal of Human Nutrition and Dietetics 2019;32(3):3782-384.
[The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein‐dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice. ]
Available with an NHS OpenAthens password for eligible users

In critically ill children, fluid overload is consistently associated with worse outcomes .
Barbaro R. BMJ Evidence-Based Medicine 2019;24(1):41-42.
[This meta-analysis of predominantly observational studies should raise awareness among clinicians about the potential risks of avoidable fluid overload. Importantly, we need a consensus definition for fluid overload and to rigorously study approaches that will reduce mortality and morbidity among critically ill children at risk of, or with, fluid overload.]
Available with an NHS OpenAthens password

Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial.
Schuetz P. The Lancet 2019;:doi: 10.1016/S0140-6736(18)32776-4.
[In medical inpatients at nutritional risk, the use of individualised nutritional support during the hospital stay improved important clinical outcomes, including survival, compared with standard hospital food. These findings strongly support systematically screening medical inpatients on hospital admission regarding nutritional risk, independent of their medical condition, followed by a nutritional assessment and introduction of individualised nutritional support in patients at risk.]
Contact the library for a copy of this article

International survey of De-implementation of initiating parenteral nutrition early in Paediatric intensive care units.
van Puffelen E. BMC Health Services Research 2019;19(1):379.
[Initiating parenteral nutrition (PN) within 24 h in critically ill children is inferior to withholding PN during the first week, as was found in the PEPaNIC study. The aims of this study were to investigate de-implementation of early initiation of PN at PICUs worldwide, and to identify factors influencing de-implementation.]

Investigating vitamin B12 deficiency.
Sukumar N. BMJ 2019;365:l1865.

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders.
Santos JAR. Cochrane Database of Systematic Reviews 2019;2:CD010734.
[Among children, iodine deficiency is the main cause of potentially preventable deficits of central nervous system development and impairment of cognitive function, as well as goitre and hypothyroidism in people of all ages. Salt iodisation is the preferred strategy for IDD prevention and control, however, in some instances where salt is not the major condiment, alternate vehicles for iodine fortification have been considered.]

Malnutrition: evaluating the effectiveness of supplements.
Collins AJ. British Journal of Community Nursing 2019;24(Sup7):S18-S25.
[Key Points: A reduction in body mass index (BMI) is part of the normal ageing process; however, reduced energy requirements do not dictate a reduced need for micronutrients or protein; A systematic literature search yielded an article for critical appraisal; The selected literature shows that energy-dense supplements are effective at increasing BMI; Further research is needed to fully ensure that the needs of those at risk of malnutrition, or who are malnourished, are met.]

Maternal socio‐demographic characteristics and associated complementary feeding practices of children aged 6–18 months with moderate acute malnutrition in Arua, Uganda.
Kajjura R B. Journal of Human Nutrition and Dietetics 2019;32(3):303-310.
[There is a paucity of published data regarding maternal socio‐demographic characteristics and associated complementary feeding practices of moderately malnourished infants and young children (IYC) in sub‐Saharan Africa. In the present study, this association was investigated in Arua, Uganda.]
Available with an NHS OpenAthens password for eligible users

Nutritional interventions for preventing stunting in children (birth to 59 months) living in urban slums in low- and middle-income countries (LMIC).
Goudet SM. Cochrane Database of Systematic Reviews 2019;6:CD011695.
[Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas in low- and middle-income countries (LMIC). Few interventions are focused on urban slums. The literature needs a systematic assessment, as infants and children living in slums are at high risk of stunting. ]

Oral nutritional support with or without exercise in the management of malnutrition in nutritionally vulnerable older people: A systematic review and meta-analysis.
Wright J. Clinical Nutrition 2018;37:1879-1891 .
[Combining exercise with ONS may provide additional improvements to muscle strength but had no effect on other measures of physical functioning, nutritional status or morbidity in nutritionally vulnerable older adults.]
Contact the library for a copy of this article

Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age.
Schoonees A. Cochrane Database of Systematic Reviews 2019;5:CD009000.
[In-hospital rehabilitation of children with severe acute malnutrition is not always desirable or practical - especially in rural settings - and home-based care can offer a better solution. Ready-to-use therapeutic food (RUTF) is a widely used option for home-based rehabilitation, but the findings of our previous review were inconclusive.]

Use of a Probiotic to Enhance Iron Absorption in a Randomized Trial of Pediatric Patients Presenting with Iron Deficiency.
Rosen G M. The Journal of Pediatrics 2019;207:192-197.
[Treatment with low-dose ferrous sulfate is well-tolerated and effective in correcting iron deficiency in children. However, the probiotic LP299v did not enhance treatment. Further attention should examine the dose–response effect in children, including an alternate day dosing schedule]
Contact the library for a copy of this article

What more can community nurses do to manage adult malnutrition.
Holdoway A. British Journal of Community Nursing 2019;24(Sup7):S6-S10.
[Key Points: Over 3 million people in the UK are malnourished or at risk of malnutrition; In order to tackle malnutrition in an increasingly ageing population, screening, treatment and prevention need to be improved; Nutritional deficiencies, unintentional weight loss and frailty are not inevitable consequences of ageing and disease; Dietary advice and oral nutritional support are important first-line treatments for patients at risk of malnutrition.]

Books

New book(s) from the Library and Knowledge Service. Call into your nearest library or contact me for more information.

Overcoming anxiety; Kennerley H
Kennerley H. 2nd. Robinson. 2014. Library Shelf Location: WM 172.
[This self-help guide shows you how to use cognitive behavioural therapy (CBT) techniques to manage your anxieties.]
Contact the library for a password

Guidelines

The following new guidance has recently been published:

Iron Deficiency and Anaemia in Adults.
Royal College of Nursing (RCN);2019.
https://www.rcn.org.uk/professional-development/publications/007-460
[Iron deficiency anaemia (IDA) is a widespread problem affecting an estimated two billion people worldwide and is the most common cause of anaemia seen in primary care. This guidance has been developed by expert nurses from several specialties and is for the use of nurses, health care assistants (HCAs), midwives, and health visitors from all specialties and backgrounds.]
Freely available online

Reports

The following report(s) may be of interest:

Bwyd a maeth yng nghartrefi gofal pobl hŷn / Food and nutrition in older people care homes.
Llywodraeth Cymru / Welsh Government; 2019.
https://gov.wales/food-and-nutrition-older-people-care-homes
[Ymgynghoriad ar agor. Hoffem glywed eich barn ynghylch canllawiau drafft ar ddarparu bwyd a diod o safon uchel sy’n diwallu gwahanol anghenion preswylwyr o safbwynt maeth. Ymgynghoriad yn cau: 11 Hydref 2019. / Open consultation. We want your views on draft guidance to support good quality food and drink provision in care home settings for older people. Consultation ends: 11 October 2019.]
Freely available online

Dietary supplements 'do not help improve health outcomes'.
NHS Behind the Headlines; 2019.
https://www.nhs.uk/news/food-and-diet/dietary-supplements-do-not-help-improve-health-outcomes/
[A US study reports that vitamin and mineral supplements do not reduce the risk of death. And there's a suggestion that high-dose calcium supplements could actually increase the risk. But the study is hampered by numerous limitations, so the results are not clear-cut.]
Freely available online

Kids on the breadline: solutions to holiday hunger.
Bevan Foundation; 2019.
https://www.bevanfoundation.org/publications/kids-on-the-breadline-solutions-to-holiday-hunger/
[School holidays put severe pressure on low income families. Losing free school meals and the high costs of food, childcare and holiday treats mean many families struggle to make ends meet. This report outlines how the Welsh Government, local authorities, social landlords and others can provide immediate help to low-income families as well as pointing to longer-term solutions that would put more cash in families’ pockets.]
Freely available online

National Diet and Nutrition Survey: Years 1 to 9 of the Rolling Programme (2008/2009 – 2016/2017): Time trend and income analyses.
Public Health England (PHE); 2019.
https://www.gov.uk/government/statistics/ndns-time-trend-and-income-analyses-for-years-1-to-9
[National Diet and Nutrition Survey results from 2008 to 2017 assessing time and income trends for diet, nutrient intake and nutritional status for the UK. Carried out on behalf of Public Health England and the Food Standards Agency.]
Freely available online

Medical Errors & Never Events

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people.
Baxter R. BMJ Quality & Safety 2019;28(8):618-626.
[Conclusion: This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.]

Barriers and facilitators with medication use during the transition from hospital to home: a qualitative study among patients.
Daliri S. BMC Health Services Research 2019;19(1):204.
[During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home.]

Barriers to nurses reporting errors and adverse events.
Mansouri SF. British Journal of Nursing 2019;28(11):690-695.
[This study aimed to assess nurses' views about major barriers to reporting errors and adverse events in intensive care units. A descriptive analytical study was used to examine barriers to reporting such events. A questionnaire was completed by 251 nurses across seven hospitals in Iran to elicit information about their views on reporting errors and adverse events.]
Available with an NHS OpenAthens password for eligible users

Critical Review, Development, and Testing of a Taxonomy for Adverse Events and Near Misses in the Emergency Department.
Griffey RT. Academic Emergency Medicine 2019;26(6):670-679.
[Conclusions: We developed a taxonomy of AEs and near misses for the ED, modified from an existing framework. Testing of the tool with minimal training yielded high performance and good inter‐rater reliability. This taxonomy can be adapted and modified by EDs seeking to enhance their quality and safety reviews and characterize harm occurring in their EDs for quality improvement purposes.
]

Development and performance evaluation of the Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to prevent medication-related problems.
Geeson C. BMJ Quality & Safety 2019;28(8):645-656.
[Conclusion: The Medicines Optimisation Assessment Tool (MOAT) has potential to predict those patients most at risk of moderate or severe preventable medication-related problems (MRPs), experienced by 41% of admissions. External validation is now required to establish predictive accuracy in a new group of patients.]

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study.
Seston EM. BMC Health Services Research 2019;19(1):325.
[The findings of this study suggest that the implementation of a pharmacy technician-supported medicines administration scheme to reduce omitted doses may be acceptable to staff in an NHS hospital, and that issues with service fidelity, staff resource/capacity and perceived interventions to avoid dose omissions have important implications for the feasibility of extending the service.]

Evaluation of Medication Errors at the Transition of Care From an ICU to Non-ICU Location.
Tully AP. Critical Care Medicine 2019;47(4):543-549.
[To determine the point prevalence of medication errors at the time of transition of care from an ICU to non-ICU location and assess error types and risk factors for medication errors during transition of care.]

Guilt, forgiveness and medical error.
Wiinter GF. British Journal of Midwifery 2019;27(3):145-145.
[Is the greater emphasis on no-blame working cultures at odds with health professionals' responsibility to recognise and learn from errors? the author debates the issues at stake.]
Available with an NHS OpenAthens password for eligible users

Lawfully admitting a person who lacks decision-making capacity to hospital.
Griffith R. British Journal of Nursing 2019;28(3):202-203.
[The author considers the legal options available to a nurse who believes their patient should be moved from home to hospital for treatment when the person lacks decision-making capacity to consent to the move.]
Available with an NHS OpenAthens password for eligible users

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.
Panagioti M. BMJ 2019;366:l4185.
[To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.]

Professional, structural and organisational interventions in primary care for reducing medication errors.
Rowan-Robinson K. British Journal of Community Nursing 2019;24(2):77-79.
[Recommendations for practice: Nurses play an important role in the management and quality use of medications within primary care. Clinics and other facilities that store medications for patient use require robust systems to ensure medications are stored appropriately and securely onsite. Clinics must provide nurses with access to pharmacology reference guides as well as regularly updated policies and procedures to reflect current practice.]

Rationalising medications through deprescribing.
Avery AJ. BMJ 2019;364:l570.

Reviewing and responding to patient safety incidents in the NHS.
Tingle J. British Journal of Nursing 2019;28(8):530-531.
[The author discusses several recent reports on patient safety incidents in the NHS and the urgent need for action to deal with the problems identified.]
Available with an NHS OpenAthens password for eligible users

Using the HALT model in an exploratory quality improvement initiative to reduce medication errors.
Ragau S. British Journal of Nursing 2018;27(22):1330-1335.
[Medication errors can have deleterious effects on patient safety and care. Interruptions, patient acuity and time pressures have all been cited as contributing factors in the incidence of medication errors. The aim of this quality improvement initiative was to reduce medication errors by 25% on a medical ward, through the introduction of the hunger, angry, lonely, tired (HALT) model to address the human factors associated with medication errors.]
Available with an NHS OpenAthens password for eligible users

We want to know: patient comfort speaking up about breakdowns in care and patient experience.
Fisher KA. BMJ Quality & Safety 2019;28(3):190-197.
[Conclusions: Patients frequently experience problems in care during hospitalisation and many do not feel comfortable speaking up. Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience. Such efforts should consider the impact of health literacy and mental health on patient engagement in patient-safety activities.]
Available with an NHS OpenAthens password for eligible users

Guidelines

The following new guidance has recently been published:

Emergency Department Out of Hours Discharge Medications
Royal College of Emergency Medicine (RCEM);2019 .
https://www.rcem.ac.uk//docs/RCEM%20Guidance/RCEM_16-04-2019_Emergency%20Department%20Out%20of%20Hours%20Discharge%20Medications_Final.pdf
[Hospital Episode Statistics (HES) data shows that up to 40% of attendances to EDs occur
outside of normal working hours. Despite this few trusts provide a comprehensive out of hours pharmacy service.
Managing discharge medication effectively will likely lead to greater patient (and carer)
satisfaction, increased concordance, increased likelihood of right drug at the right time
and potentially cost benefits to the Hospital.]
Freely available online

Reports

The following report(s) may be of interest:

Getting medicines right.
NHS Improvement; 2019.
https://improvement.nhs.uk/resources/getting-medicines-right/
[A case study describing action by North Devon Healthcare NHS Trust to improve the medicines management pathway for patients receiving acute unplanned episodes of care.]
Freely available online

Medication errors: where do they happen?
Royal Pharmaceutical Society (RPS); 2019.
https://www.pharmaceutical-journal.com/news-and-analysis/infographics/medication-errors-where-do-they-happen/20206204.article
[Reducing medicines-related harm requires a clear understanding of where and when errors occur. This visual summary shows the latest estimates in England per year.]
Freely available online

Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation, England, March 2018 - February 2019.
NHS Digital; 2019.
https://digital.nhs.uk/data-and-information/publications/clinical-indicators/shmi/current
[The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. It covers patients admitted to hospitals in England who died either while in hospital or within 30 days of being discharged.]
Freely available online

Pressure Ulcers

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative.
Goodman L. BMJ Open Quality 2018;7(4):doi.org/10.1136/bmjoq-2018-000425.
[We aimed to reduce the prevalence of HAPI within the ICU and non-ICU setting. We implemented a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention and treatment strategies. Our prevalence of HAPI reduced from 27.6% in 2015 to10% in 2017 for non-ICU patients however in ICU patients the prevalence has risen from 30% to 45% in the same period suggesting critically ill patients represent a unique challenge for reducing HAPI.]
Freely available online

An overview of 'Pressure ulcers: revised definition and measurement'.
Lumbers M. British Journal of Community Nursing 2019;24(5):216-223.
[The ‘Pressure ulcers: revised definition and measurement’ document has been produced to effectively address key issues, remove blame and ensure that best practice is implemented in a timely manner in pressure ulcer management. Learning how and why damage has occurred, whether from a bony prominence, a medical device or moisture, allows full and transparent investigations and understanding into how to address issues, while preventing future damage]

Body sensor providing feedback to bedside staff reduced the prevalence of pressure ulcers in patients with critical illness.
Swift A. Evidence-Based Nursing 2019;22(2):48.
[There were 1312 patients randomised in the study with similar ages, sex, risk of pressure ulceration profiles and ethnicity. During the study, 20 patients developed an HAPI on the ICU; 15 of these were in the control group and 5 in the active sensor group. This suggests that use of the active device has a protective effect against pressure injury. Patients without the device are almost three times more likely to develop an HAPI.]
Available with an NHS OpenAthens password

Dressings and topical agents for preventing pressure ulcers.
Moore ZE. Cochrane Database of Systematic Reviews 2018;12:CD009362.
[Pressure ulcers, localised injuries to the skin or underlying tissue, or both, occur when people cannot reposition themselves to relieve pressure on bony prominences. These wounds are difficult to heal, painful, expensive to manage and have a negative impact on quality of life. Prevention strategies include nutritional support and pressure redistribution. Dressing and topical agents aimed at prevention are also widely used, however, it remains unclear which, if any, are most effective. ]

Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review.
Gaspar S. International Wound Journal 2019;: doi: 10.1111/iwj.13147 .
[The review included 26 studies. Studies related to prophylactic dressings applied in the sacrum, trochanters, and/or heels, education for health care professionals, and preventive skin care and system reminders on-screen inpatient care plan were effective in decreasing PUs. Most of the studies related to multiple intervention programmes were effective in decreasing PU occurrence. Single interventions, namely support surfaces and repositioning, were not always effective in preventing PUs.]
Available with an NHS OpenAthens password for eligible users

Non-blanchable erythema for predicting pressure ulcer development: a systematic review with an individual participant data meta-analysis.
Shi C. British Journal of Dermatology 2019;:doi: 10.1111/bjd.18154.
[The first prognostic factor review with individual-level data analysis in pressure ulcers suggests people with non-blanchable erythema are more likely to develop new pressure ulcers of Stage 2 or above within 28 days than people without non-blanchable erythema. It is important to identify non-blanchable erythema in practice and intervene appropriately to prevent pressure ulceration.]
Available with an NHS OpenAthens password for eligible users

Predictive efficacy of the Braden Q Scale for pediatric pressure ulcer risk assessment in the PICU: a meta-analysis.
Chun X. Pediatric Research 2019;:doi: 10.1038/s41390-019-0465-x.
[The Braden Q Scale predicted pressure ulcer risk in the PICU with moderate accuracy. More testing for the Braden QD Scale's performance is needed, taking into account the impact of the interventions. In the future, it will be necessary to look for and improve pediatric pressure ulcer risk assessment tools.]
Contact the library for a copy of this article

Pressure ulcer prevention in hospitals: a successful nurse-led clinical quality improvement intervention.
Fremmelevholm A. British Journal of Nursing 2019;28(6):S6-S11.
[A pressure ulcer prevalence of 17.3% at Odense University Hospital in Denmark in 2010 prompted action and a quality improvement project was planned. This had two aims: to reduce pressure ulcers at the hospital by 50% and to have no pressure ulcers at or above category 3. A project was established with a steering committee, a pressure ulcer specialist nurse, local dedicated nurses and nurse assistants to implement a pressure ulcer bundle in clinical practice at all departments at the hospital.]
Available with an NHS OpenAthens password for eligible users

Pressure ulcers in patients receiving palliative care: A systematic review.
Ferris A. Palliative Medicine 2019;:doi: 10.1177/0269216319846023.
[The prevalence of pressure ulcers is higher in patients receiving palliative care than the general population. While this should not be an excuse for poor care, it does not necessarily mean that inadequate care has been provided. Skin failure, as with other organ failures, may be an inevitable part of the dying process for some patients.]
Available with an NHS OpenAthens password for eligible users

Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies.
Martinengo L. Annals of Epidemiology 2018;:doi: 10.1016/j.annepidem.2018.10.005.
[Chronic wounds of mixed etiologies (n = 3) showed a pooled prevalence of 2.21 per 1000 population, and for chronic leg ulcers (n = 9), the prevalence was estimated at 1.51 per 1000 population.]
Contact the library for a copy of this article

Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review.
Mäki-Turja-Rostedt S. Journal of Clinical Nursing 2018;:doi: 10.1111/jocn.14767.
[PU incidence in LOPC-facilities decreased by using computerized decision-making support systems, PU prevention programs, repositioning, or advanced cushions. PU prevalence decreased with PU prevention programs, by using advanced mattresses and overlays, or by adding protein and energy supplements to diet. One third of the preventive interventions in LOPC- facilities were effective.]
Available with an NHS OpenAthens password for eligible users

Risk assessment tools for the prevention of pressure ulcers.
Moore ZE. Cochrane Database of Systematic Reviews 2019;1:CD006471.
[Use of pressure ulcer risk assessment tools is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. We conducted a review to provide a summary of the evidence pertaining to pressure ulcer risk assessment in clinical practice. This is the third update of this review.]

Skin considerations for older adults with wounds.
Holloway S. British Journal of Community Nursing 2019;24(Sup6):S15-S19.
[Key Points: Older age effects the skin, causing problems with wound healing and increasing the risk of skin damage; In those at risk of pressure ulcers, moisture increases the risk of tissue injury, as it alters skin resilience; Lipodermatosclerosis, hyperkeratosis and eczema are common in those with venous disease; Autonomic neuropathy in individuals with diabetic foot disease makes the skin dry and prone to cracking and infection.]

The relationship between pressure ulcer risk assessment and preventative interventions: a systematic review.
Lovegrove J. Journal of Wound Care 2018;27(12):862-875 .
[The aim of this review was to identify and evaluate primary research which links pressure ulcer risk assessment with prescription and implementation of preventative interventions for hospitalised adults.]
Available with an NHS OpenAthens password for eligible users

Guidelines

The following new guidance has recently been published:

Mepilex Border Heel and Sacrum dressings for preventing pressure ulcers.
National Institute for Health and Care Excellence (NICE);2019.
https://www.nice.org.uk/guidance/mtg40
[1 Recommendations. 1.1 Mepilex Border Heel and Sacrum dressings show promise for preventing pressure ulcers in people who are considered to be at risk in acute care settings. However, there is currently insufficient evidence to support the case for routine adoption in the NHS...]
Freely available online

Stop the Pressure programme: nutrition and hydration.
NHS Improvement;2018.
https://improvement.nhs.uk/resources/nutrition-and-hydration/
[Improvement guide. Supporting providers to follow best practice in nutrition and hydration to reduce the incidence of pressure ulcers and promote good wound healing.]
Freely available online

The Debrisoft monofilament debridement pad for use in acute or chronic wounds.
National Institute for Health and Care Excellence (NICE);2019.
https://www.nice.org.uk/guidance/mtg17
[Evidence-based recommendations on the Debrisoft monofilament debridement pad for use in acute or chronic wounds. This guidance has been updated to include a review of the cost model using more recent values. New evidence and updated costs identified during the guidance review are denoted as [2019].]

Root Cause Analysis

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people.
Baxter R. BMJ Quality & Safety 2019;28(8):618-626.
[Conclusion: This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.]

Advancing the status of nursing: reconstructing professional nursing identity through patient safety work.
Heldal F. BMC Health Services Research 2019;19(1):418.
[We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses' practices and values. The patient safety programme involved activities that were more in accordance with the 'cure' discourse than traditional 'care' work within nursing. As a result, this implied a heightened perceived professional status among the nurses.]

Patient safety: the need for global sharing and learning.
Tingle J. British Journal of Nursing 2019;28(10):656-657.
[Patient safety is a worldwide problem with many countries grappling with the issue. A vast number of stakeholders, NGOs and organisations also exist to offer professional advice, services and publications. In resource-constrained healthcare environments, it is important to try not to waste time and money reinventing the wheel when proven solutions are already in place in other countries. Global knowledge sharing and learning helps all countries and this needs to be encouraged.]
Available with an NHS OpenAthens password for eligible users

Guidelines

The following new guidance has recently been published:

Surgical Innovation, New Techniques and Technologies
Royal College of Surgeons (RCS);2019.
https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/standards-and-policy/good-practice-guides/surgical-innovation-new-techniques-and-technologies.pdf
[This guide follows the RCS' work on the Commission on the Future of Surgery, and aims to provide a guiding framework for introducing new procedures, techniques and technologies into the service in a way that provides robust oversight and protects patient safety while at the same time encouraging and providing support to surgical innovators.]
Freely available online

Safeguarding

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

Attending a best interests meeting.
Griffith R. British Journal of Nursing 2019;28(7):476-477.
[The author considers the conduct of a best interests meeting and the role nurses play in those meetings.]
Available with an NHS OpenAthens password for eligible users

Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection.
Truong C. Journal of Elder Abuse and Neglect 2019;31(2):181-190.
[Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.]

Lawfully admitting a person who lacks decision-making capacity to hospital.
Griffith R. British Journal of Nursing 2019;28(3):202-203.
[The author considers the legal options available to a nurse who believes their patient should be moved from home to hospital for treatment when the person lacks decision-making capacity to consent to the move.]
Available with an NHS OpenAthens password for eligible users

The "appropriate adult": What they do and what they should do in police interviews with mentally disordered suspects.
Farrugia L. Criminal Behaviour and Mental Health 2019;29(3):134-141.
[Conclusions/implications for practice: In our sample, appropriate adults were not fulfilling their role as outlined in the Police and Criminal Evidence Act (PACE) 1984 and accompanying Codes of Practice; specifically, they appeared to know what to do but not when to do it. There is a heightened risk of a miscarriage of justice in such circumstances without improvements.
]

Books

New book(s) from the Library and Knowledge Service. Call into your nearest library or contact me for more information.

The straightforward guide to safeguarding adults : from getting the basics right to applying the Care Act and criminal investigations.
Jessica Kingsley. 2019.
[The Care Act 2014 sets out a legal framework for how local authorities should protect adults at risk of abuse and neglect. However, the law can be complex and difficult to interpret. This straightforward manual aims to help managers, practitioners and trainers to work through the whole safeguarding process, from the very basics to the complexities of multi-agency collaboration and criminal investigation.]
Available with free registration

Evidence Searches

Types and effectiveness of predictive models in adolescent safeguarding.
Carried out by Lisa Burscheidt from Aubrey Keep on 19/7/2019
https://www.knowledgeshare.nhs.uk/index.php?PageID=literature_search_request_download&RequestID=17318
[Results include examples of how predicitive modelling or predictive analytics have been used, or are currently being used, in public services.
They have been used in the Troubled Families programme.
The University of Essex Catalyst programme uses the expertise and knowledge of the scientists working at the university's data archive to help with predictive modelling in Suffolk and Essex County Councils. Have a look at University of Essex Catalyst programme and their reports on the website.]
Available with an NHS OpenAthens password

Guidelines

The following new guidance has recently been published:

Advocacy for children: Children and young people’s advocacy in England.
The Children’s Commissioner;2019.
https://www.childrenscommissioner.gov.uk/publication/advocacy-for-children/
[This report takes stock of advocacy provided by local authorities and highlights ongoing issues observed by the Children’s Commissioner’s Help at Hand service, which provides advice and help to children in care. This research is intended to contribute to ongoing work to promote support for effective advocacy and to ensure that children and young people receive a good service wherever they are.]
Freely available online

BSUH Mental Capacity Act Policy (Incorporating Deprivation of Liberty Safeguards).
Brighton and Sussex University Hospitals NHS Trust (BSUH);2019.
https://nww.bsuh.nhs.uk/clinical/clinical-policies-and-guidelines/clinical-and-medicines-management-policies/?assetdet946769=447420&p=4
[This policy sets out the standards and procedures required to ensure that staff in Brighton and Sussex University Hospitals NHS Trust (BSUH) comply with the legal requirements of the MCA.]
Only available via the Trust Intranet

BSUH Policy for the Use of Hand Control Mittens in Adult Patients.
Brighton and Sussex University Hospitals NHS Trust (BSUH);2019.
https://nww.bsuh.nhs.uk/clinical/clinical-policies-and-guidelines/clinical-and-medicines-management-policies/?assetdet946769=447422&p=5
[The purpose of this policy is to ensure a consistent Trust wide approach to
managing the use of hand control mittens in adult patients. It should be used
to support healthcare professionals in making an informed decision regarding
the use of hand control mittens.]
Only available via the Trust Intranet

BSUH Safeguarding Children and Young People Policy.
Brighton and Sussex University Hospitals NHS Trust (BSUH);2019.
https://nww.bsuh.nhs.uk/clinical/clinical-policies-and-guidelines/clinical-and-medicines-management-policies/?assetdet946769=449910&p=4
[The purpose of this policy is to ensure that all employees of BSUH are aware of their statutory duties to promote and safeguard the welfare of children under the Children Act 2004.]
Only available via the Trust Intranet

Rhannu gwybodaeth er mwyn diogelu plant: canllawiau / Information sharing to safeguard children: guidance.
Llywodraeth Cymru / Welsh Government;2019.
https://gov.wales/information-sharing-safeguard-children-guidance
[Canllawiau i sefydliadau ar eu dyletswyddau a'u cyfrifoldebau i ddiogelu plant. / Guidance for organisations on their duties and responsibilities to safeguard children.]
Freely available online

Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff.
Royal College of Nursing (RCN);2019.
https://www.rcn.org.uk/professional-development/publications/007-366
[To protect children and young people from harm, and help improve their wellbeing, all healthcare staff must have the competencies to recognise child maltreatment, opportunities to improve childhood wellbeing, and to take effective action as appropriate to their role. This intercollegiate document provides a clear framework which identifies the competencies required for all healthcare staff.]
Freely available online

Teaching online safety in school: Guidance supporting schools to teach their pupils how to stay safe online, with in new and existing school subjects.
Department for Education (DfE);2019.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/811796/Teaching_online_safety_in_school.pdf
Freely available online

Reports

The following report(s) may be of interest:

Keeping kids safe: improving safeguarding responses to gang violence and criminal exploitation.
Children's Commissioner for England; 2019.
https://www.childrenscommissioner.gov.uk/2019/02/28/childrens-commissioner-for-england-warns-the-same-mistakes-that-led-to-child-sexual-exploitation-failings-are-being-repeated-with-gangs/
[This report estimates there are 27,000 children in England who identify as a gang member, only a fraction of whom are known to children’s services. It recommends that the government needs to make child criminal exploitation a national priority, and lay out clear expectations about the role of all organisations working with children – including the police, schools, children’s services and NHS bodies.]
Freely available online

Reducing restrictive intervention of children and young people.
Challenging Behaviour Foundation (CBF); 2019.
https://www.challengingbehaviour.org.uk/driving-change/restraintandseclusion.html
[This report looks at the use of restrictive interventions on disabled children and young people aged 0-25 in schools. Restrictive interventions can include: physical restraint, mechanical restraint, seclusion, blanket restrictions, and chemical restraint. It includes accounts of family carers' children’s experiences of restrictive intervention, shared through a survey and case studies.]
Freely available online

Taming the Wild West Web: How to regulate social networks and keep children safe from abuse.
National Society for the Prevention of Cruelty to Children (NSPCC); 2019.
https://www.nspcc.org.uk/what-we-do/news-opinion/9-in-10-parents-back-social-network-regulation/
[The report sets out the NSPCC's proposals for a new regulatory approach, including: strong and independent statutory regulation; platforms subject to a legally enforceable duty of care; platforms subject to a legally enforceable duty of care; platforms required to proactively tackle harms; a regulator to have wide-ranging powers of information disclosure and compliance and enforcement powers.]
Freely available online

Sepsis

Articles

The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into your nearest library.

Antibiotic- and Fluid-Focused Bundles Potentially Improve Sepsis Management, but High-Quality Evidence Is Lacking for the Specificity Required in the Centers for Medicare and Medicaid Service's Sepsis Bundle (SEP-1).
Pepper DJ. Critical Care Medicine 2019;:0.1097/CCM.0000000000003892.
[Available studies support the notion that antibiotic- and fluid-focused sepsis bundles like SEP-1 improve survival but do not demonstrate the superiority of any specific antibiotic time or fluid volume or of serial lactate measurements. Until strong reproducible evidence demonstrates the safety and benefit of any fixed requirement for these interventions, the present findings support the revision of SEP-1 to allow flexibility in treatment according to physician judgment.]
Available with an NHS OpenAthens password

Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis.
Fang F. JAMA Internal Medicine 2018;:doi:10.1001/jamainternmed.2018.5849.
[In this systematic review and meta-analysis of 37 randomized clinical trials that included 9564 patients with sepsis, administration of corticosteroids was associated with reduced 28-day mortality. Corticosteroids were also significantly associated with increased shock reversal at day 7 and vasopressor-free days and with decreased intensive care unit length of stay, the Sequential Organ Failure Assessment score at day 7, and time to resolution of shock.]
Available with an NHS OpenAthens password for eligible users

Clinical experience of a subcutaneously anchored sutureless system for securing central venous catheters.
Pittiruti M. British Journal of Nursing 2019;28(2):S4-S14.
[This article reports the results of three prospective clinical studies conducted in a university hospital regarding the efficacy, safety and cost effectiveness of a subcutaneously anchored sutureless system for securing central venous catheters. The results were favourable to the adoption of such a device, and the analysis of the data allowed the authors to define those categories of patients where the device should have the most benefit.]
Available with an NHS OpenAthens password for eligible users

Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database.
Lindell RB. Critical Care Medicine 2019;47(2):e129-e135.
[To compare the performance of three methods of identifying children with severe sepsis and septic shock from the Virtual Pediatric Systems database to prospective screening using consensus criteria.]

Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department.
Usman OA. American Journal of Emergency Medicine 2018;:doi: 10.1016/j.ajem.2018.10.058.
[NEWS was the most accurate scoring system for the detection of all sepsis endpoints. Furthermore, NEWS was more specific with similar sensitivity relative to SIRS, improves with disease severity, and is immediately available as it does not require laboratories. However, scoring NEWS is more involved and may be better suited for automated computation. QSOFA had the lowest sensitivity and is a poor tool for ED sepsis screening.]
Contact the library for a copy of this article

Corticosteroids for septic arthritis in children.
Delgado-Noguera MF. Cochrane Database of Systematic Reviews 2018;11:CD012125.
[Septic arthritis is an acute infection of the joints characterised by erosive disruption of the articular space. It is the most common non-degenerative articular disease in developing countries. The most vulnerable population for septic arthritis includes infants, especially boys. Systemic corticosteroids and antibiotic therapy may be beneficial. Even if the joint infection is eradicated by antibiotic treatment, the inflammatory process may produce residual joint damage and sequelae.]

Does Obesity Protect Against Death in Sepsis? A Retrospective Cohort Study of 55,038 Adult Patients.
Pepper DJ. Critical Care Medicine 2019;47(5):643-650.
[Observational studies suggest obesity is associated with sepsis survival, but these studies are small, fail to adjust for key confounders, measure body mass index at inconsistent time points, and/or use administrative data to define sepsis. To estimate the relationship between body mass index and sepsis mortality using detailed clinical data for case detection and risk adjustment.]

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial.
Hernàndez G. JAMA 2019;321(7):654-664 .
[Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality.]
Available with an NHS OpenAthens password for eligible users

Effect of Antihypertensive Medications on Sepsis-Related Outcomes: A Population-Based Cohort Study.
Kim J. Critical Care Medicine 2019;47(5):e386-e393.
[Although the effect of antihypertensive agents on sepsis has been studied, evidence for survival benefit was limited in the literature. We investigated differences in sepsis-related outcomes depending on the antihypertensive drugs given prior to sepsis in patients with hypertension.]

Enteral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates.
Pammi M. Cochrane Database of Systematic Reviews 2019;5:CD007138.
[Neonatal sepsis and necrotizing enterocolitis (NEC) cause significant neonatal mortality and morbidity despite appropriate antibiotic therapy. Enhancing host defense and modulating inflammation by using lactoferrin as an adjunct to antibiotics in the treatment of sepsis, NEC, or both, may improve clinical outcomes.]

Extracorporeal Membrane Oxygenation for Septic Shock.
Falk L. Critical Care Medicine 2019;47(8):1097-1105.
[Septic shock carries a high mortality risk. Studies have indicated that patients with septic shock may benefit from extracorporeal membrane oxygenation. In most studies, patients exhibited shock due to myocardial dysfunction rather than distributive/vasoplegic shock. One proposed theory is that venoarterial extracorporeal membrane oxygenation alleviates a failing myocardial function.]

Hypertonic Saline in Human Sepsis: A Systematic Review of Randomized Controlled Trials.
Orbegozo D. Anesthesia & Analgesia 2019;128(6):1175-1184 .
[In patients with sepsis, hypertonic saline reduced the volume of fluid needed to achieve the same hemodynamic targets but did not affect survival.]

Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study.
Kushimoto S. Critical Care Medicine 2019;47(5):691-699.
[To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.]

Importance of vitamin D in acute and critically ill children with subgroup analyses of sepsis and respiratory tract infections: a systematic review and meta-analysis.
Cariolou M. BMJ Open 2019;9:e027666.
[Our results suggest that 25(OH)D deficiency in acute and critically ill children is high and associated with increased mortality. Small-study effects, reverse causation and other biases may have confounded results. Larger, carefully designed studies in homogeneous populations with confounder adjustment are needed to clarify the association between 25(OH)D levels with mortality and other outcomes.]
Freely available online

Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock.
Li D. Cochrane Database of Systematic Reviews 2018;12:CD010593.
[Sepsis and septic shock are potentially life-threatening complications of infection that are associated with high morbidity and mortality in adults and children. Fluid therapy is regarded as a crucial intervention during initial treatment of sepsis. Whether conservative or liberal fluid therapy can improve clinical outcomes in patients with sepsis and septic shock remains unclear.]

Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients.
Crouser ED. Critical Care Medicine 2019;47(8):1018-1025.
[Most septic patients are initially encountered in the emergency department where sepsis recognition is often delayed, in part due to the lack of effective biomarkers. This study evaluated the diagnostic accuracy of peripheral blood monocyte distribution width alone and in combination with WBC count for early sepsis detection in the emergency department.]

Plasma interleukin-6 concentration for the diagnosis of sepsis in critically ill adults.
Molano Franco D. Cochrane Database of Systematic Reviews 2019;4:CD011811.
[Even though sepsis is one of the leading causes of mortality in critically ill patients it still lacks an accurate diagnostic test. Determining the accuracy of interleukin-6 (IL-6) concentrations in plasma, which is proposed as a new biomarker for the diagnosis of sepsis, might be helpful to provide adequate and timely management of critically ill patients, and thus reduce the morbidity and mortality associated with this condition.]

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection.
Parks Taylor S. Critical Care Medicine 2019;47(8):1081-1088.
[Evaluate the accuracy of the quick Sequential Organ Failure Assessment tool to predict mortality across increasing levels of comorbidity burden.]

Predictive Accuracy of Quick Sequential Organ Failure Assessment for Hospital Mortality Decreases With Increasing Comorbidity Burden Among Patients Admitted for Suspected Infection.
Parks Taylor S. Critical Care Medicine 2019;47(8):1081-1088.
[The accuracy of quick Sequential Organ Failure Assessment to predict hospital mortality diminishes with increasing comorbidity burden. Patients with comorbidities may have baseline abnormalities in quick SOFA variables that reduce predictive accuracy. Additional research is needed to better understand quick SOFA performance across different comorbid conditions with modification that incorporates the context of changes to baseline variables.]

Quality of Life and 1-Year Survival in Patients With Early Septic Shock: Long-Term Follow-Up of the Australasian Resuscitation in Sepsis Evaluation Trial.
Higgins AM. Critical Care Medicine 2019;47(6):765-773.
[To examine long-term survival and quality of life of patients with early septic shock.]

Recombinant Human Soluble Thrombomodulin in Sepsis-Induced Coagulopathy: An Updated Systematic Review and Meta-Analysis.
Yamakawa K. Thrombosis and Haemostasis 2019;119(1):56-65 .
[Even in this updated review including the latest SCARLET trial, we currently cannot make any declarative judgments about the beneficial effects of rhTM in sepsis-induced coagulopathy, although some favourable effects were suggested.]

Reporting of Organ Support Outcomes in Septic Shock Randomized Controlled Trials: A Methodologic Review-The Sepsis Organ Support Study.
Bourcier S. Critical Care Medicine 2019;47(7):984-992.
[Many recent randomized controlled trials in the field of septic shock failed to demonstrate a benefit on mortality. Randomized controlled trials increasingly report organ support duration and organ support-free days as primary or secondary outcomes. We conducted a methodologic systematic review to assess how organ support outcomes were defined and reported in septic shock randomized controlled trials.]

Risk Factors for New-Onset Atrial Fibrillation in Patients With Sepsis: A Systematic Review and Meta-Analysis.
Bosch NA. Critical Care Medicine 2019;47(2):280-287.
[Atrial fibrillation frequently develops in patients with sepsis and is associated with increased morbidity and mortality. Unfortunately, risk factors for new-onset atrial fibrillation in sepsis have not been clearly elucidated. Clarification of the risk factors for atrial fibrillation during sepsis may improve our understanding of the mechanisms of arrhythmia development and help guide clinical practice.]

Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage.
Cornelissen L. International Journal of Gynaecology and Obstetrics 2019;146(2):231-237 .
[In this secondary data analysis, certain invasive treatments for postpartum hemorrhage appear to increase the risk of sepsis. Further research is needed to confirm this finding and investigate the role of prophylactic antibiotics during these procedures. The harms and benefits of such interventions must be carefully weighed, both in treatment guidelines and during individual patient management.]
Available with an NHS OpenAthens password for eligible users

Sepsis associated acute kidney injury.
Poston JT. BMJ 2019;364:k4891.
[This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. ]

Subduing the killer - sepsis; through simulation.
Herron J B T. BMJ Evidence-Based Medicine 2019;24(1):26-29.
[Provision of sepsis training to all staff who take patient’s observational measurements is vital. The training needs to be tailored to learners’ current knowledge base and experiences. This significantly reduces time to treatment of sepsis and will improve clinical outcomes and allow for financial saving.]
Available with an NHS OpenAthens password

The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study.
Corl KA. Critical Care Medicine 2019;: doi: 10.1097/CCM.0000000000003779.
[This pilot study demonstrates that a restrictive resuscitation strategy can successfully reduce the amount of IV fluid administered to patients with severe sepsis and septic shock compared with usual care. Although limited by the sample size, we observed no increase in mortality, organ failure, or adverse events. These findings further support that a restrictive IV fluid strategy should be explored in a larger multicenter trial.]
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Trends and Outcomes in Sepsis Hospitalizations With and Without Atrial Fibrillation: A Nationwide Inpatient Analysis.
Desai R. Critical Care Medicine 2019;47(8):e630-e638.
[Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fibrillation and its impact on outcomes of sepsis-related hospitalizations.]

Guidelines

The following new guidance has recently been published:

Good Practice Points - Recognising Sepsis in a child.
Institute of Health Visiting;2019.
https://ihv.org.uk/news-and-views/news/new-good-practice-points-recognising-sepsis-in-a-child/
[These iHV Good Practice Points set out what health visitors need to know about recognising Sepsis in a child. They outline some practical measures along with up-to-date evidence and references.]
Available with appropriate registration or membership