Behind the Rituals
Fewer than two registered nurses present on a ward during any shift, day or night, represents a patient safety “red-flag”, according to major guidelines for the NHS.
In addition, nurse managers must check staffing levels are safe on hospital wards where each registered nurse is caring for more than eight patients during day shifts.
The guidelines state that nurses in charge of shifts should monitor for the occurrence of “nursing red-flag events” during each 24-hour period. Where one occurs, it should “prompt an immediate escalation response”, such as allocating additional nursing staff to the ward.
- Is an “immediate escalation response” realistic for every red-flag event?
- How often do “red-flag” incidents occur in your place of work?
- Will the guidelines be effective in improving patient safety?
This week we reported that more people with type 2 diabetes are likely to become eligible for weight-loss surgery.
NICE’s new draft guidance suggests people with a BMI score of 30 to 35 should be considered for an assessment for weight-loss operations if they have been diagnosed with diabetes within the last 10 years.
This could mean hundreds of thousands more patients could be considered for treatment.
What do you think of this story?
- Should more patients with diabetes be offered weight loss surgery?
- Is there a risk that this option may be seen as a “quick fix”?
- With 10% of the NHS budget currently spent on diabetes, could this save the NHS money in the long run?
Staff at Worthing Hospital in Sussex “pulled out all the stops” to ensure a couple’s wedding went ahead on their planned day, despite the bride having to stay in hospital for care.
Joann Howells, 46, from East Preston, who was receiving cancer treatment revealed to a nurse how disappointed she was to have to cancel her wedding planned for 21 June.
Hospital staff worked together to give the couple a wedding ceremony and reception.
It’s not always possible to do what Ms Howells’ nurses did and opportunities don’t always present themselves, but when you’re been able to, how have you gone the extra mile for your patients?
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The British Heart Foundation suggested that patients with heart conditions and their GPs should talk openly about sex issues.
Doireann Maddock, senior cardiac nurse at the BHF, said: “Sex is a hugely important part of life, but isn’t getting the attention it deserves in the consultation room”.
- Are you comfortable talking to patients about the effect their health is having on their sex life?
- Would you be able to respond if a patient raised a concern about sex?
- Do we make assumptions about whether people are sexually active based on age or health?
I was at Nottingham University Hospital Research conference last week and listened to an interesting paper about washing sedated patients on intensive care units at night (between 9pm and 11pm). The aim is to reduce the interruptions that occur when someone is being washed during the day. The team are in the process of evaluating the change.
- Are we still tied to routine and rituals around washing patients in the morning?
- If so, why?
- Is it possible to be more flexible?
Last week our #SNTtwitchat highlighted some anxieties about raising spiritual issues with patients and what we mean by spiritual needs.
How do you define spirituality?
What is the role of the nurse in meeting spiritual needs?
Should nurses ever discuss their religious beliefs with patients?
Last week, #nttwitchat discussed a national initiative aimed at ensuring agency nurses are high quality and up to the job. One nurse commented that 12 hour shift were inflexible and resulted in more agency staff being used in the NHS.
What do you think?
- Do you agree?
- Should shifts be more flexible to cover variations in workload?
A recent news story in Nursing Times highlighted the views of the ethicist Dr Anthony Wrigley who suggested that axing the Liverpool Care Pathway (LCP) was “too extreme”. He said scrapping the measure on the basis of some poor use was like prohibiting the use of morphine.
It is generally accepted that there were problems with its implementation, but what will fill the gap when the pathway is phased out?
What do you think?
- Does your organisation have plans to replace it?
- Have you had training and education to manage palliative care without the LCP?
- What help do you need to provide effective palliative care?
Last week we reported claims that some nurses are not able to pass numeracy and literacy tests as part of the recruitment processes.
Central and North West London Foundation Trust tests nursing applicants for numeracy and literacy, and regularly sees failure rates of 50-80%.
Health Education England has now appealed for evidence of the “anecdotal” problem amid greater focus on the education and training of qualified nurses following the Francis Report into care failings at Mid Staffordshire Foundation Trust.
What do you think?
- Do you feel confident calculating drug doses?
- Are you confident that your colleagues have adequate numeracy skills?
- Should greater emphasis be placed on numeracy skills in nurse training?
Last week, we hosted a twitter discussion on NICE’s ground-breaking new guidelines on safe staffing levels in the NHS. The draft recommendation states that if nurses are looking after more than eight patients on adult, hospital wards, the risk of harm to patients is increased.
On individual wards, the draft guideline highlights the importance of the nursing team’s awareness of patient needs and “red flag events”, which signal that an immediate response is needed, such as an urgent need for additional nurses.
What do you think of this announcement?
- Should NICE have gone further and formally recommended a minimum staffing level?
- Are there enough nurses working in the UK to fulfil a one nurse to eight patients ratio?
- Could trusts use this guidance as an excuse to not bring in additional nurses when needed if they are already below 1:8?