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Behind the Rituals

Can patients be accurately assessed using Skype and email?

21 April, 2014 Posted by: -

Last week David Cameron said more than 7.5 million people will be offered increased access to GP services through extended opening times and new consultation methods using video-phone services, email and phone. But can Skype and email replace face-to-face contact?

Nurses are already using this technology successfully in their practice. An article published in Nursing Times this week describes an innovative continence service where young people with spina bifida were happy to access specialist continence service from home via Skype.


What do you think?

  • Could your patients manage to use email or Skype to consult with nursing and medical staff?
  • What are the benefits and limitations?
  • Would you be happy to have a consultation with your GP over the phone?


If you want to know more about telehealth visit our Health IT specialist section.

Comments (4)

Should we have a standard prescription chart across the NHS?

14 April, 2014 Posted by: -

A trial in Scotland is working on developing a new standardised prescribing and administration chart to cut out errors in prescribing wrong doses or the wrong drug by clinical staff.

The new standardised chart, designed by the Royal College of Physicians of Edinburgh and approved by doctors, pharmacists and nurses, will provide a simpler and more uniform document to be used across all hospitals and wards.

It is hoped that if the trial is successful then the chart will be rolled out nationally across Scotland.

What do you think?

  • Do you think a standard prescription chart would reduce error?
  • What are the benefits of locally designed charts?
  • What are the major causes of drug error in your trust?
  • How do you think drug errors could be reduced?


Read the report at Nursing Times.

Comments (12)

Do we give enough positive feedback to people we work with?

7 April, 2014 Posted by: -

This question was posed by Natalie Silvey @silv24 on Twitter last weekend and it caught my eye:

When I visit hospitals I am struck by the number of charts and graphs giving visual feedback on quality of care but how often do we tell the people we work with that they have done a good job?

What do you think?

Do we ever tell the domestic team that the ward looks clean and fresh or thank the pharmacy when TTOs arrive on time?

Does it make a difference when you get informal feedback from your team?

Comments (2)

Do we underestimate the dangers of infectious childhood diseases?

31 March, 2014 Posted by: -

A recent article published in Nursing Times explored a case study of a children with chicken pox and no rash. Chickenpox is usually self-limiting, but complications can occur. In healthy children these include secondary bacterial infections of the chickenpox lesions, otitis media, secondary pneumonia, necrotising fasciitis, subclinical hepatitis and cerebellar ataxia. Most childhood infectious diseases can have serious complications.

What do you think?

  • Are you aware of the unusual presentations and potential complications of childhood infectious diseases?
  • Are you confident to explain potential complications of infectious diseases to parents?
  • Do you have appropriate knowledge to discuss vaccinations with parents?

Are we failing to identify patients nearing the end of life?

24 March, 2014 Posted by: -

A study reported in the news last week suggested that the “core business” of hospitals is caring for people who are nearing the end of their lives.

The research team studied 10,000 people in 25 Scottish hospitals on 31 March, 2010.

In total 3,098 patients – almost 31% – died within 12 months and 9% died during their admission.

The authors said, “Our findings provide a platform to invest more energy in identifying patients on admission to hospital who are likely to die within a year and then to develop appropriate care plans for them.”


What do you think?

  • Do hospitals focus on treatment and fail to identify patients nearing the end of life?
  • When is it appropriate to start end-of-life discussions with patients and relatives?
  • Do you have access to a palliative care team in your hospital?
  • Do hospital nurses have appropriate end-of-life training?

Does two-hourly pressure area care affect sleep?

10 March, 2014 Posted by: -

This week’s Behind the Rituals is from Liz Charalambous, staff nurse at Nottingham University Hospital

We have had a discussion on our ward about how two-hourly pressure area care affects sleep. The tissue viability team has introduced a skin bundle, which prescribes care for patients depending on whether they are classed as red, amber or green.

The latest meta-analysis from the Cochrane Collaboration finds no difference in pressure ulcer prevention when a risk assessment tool is used compared with clinical judgement. However, the current scheme does not allow for clinical judgement to supersede the tool.

What do you think?

I am doing a research study into prevention of delirium, and part of the criteria for preventing delirium is sleep hygiene. This involves ensuring patients get enough sleep.

  • Should clinical judgement override policies in this situation?
  • Is there any evidence to support a decision to do this?

Comments (21)

How can you prevent patients losing dentures in hospital?

3 March, 2014 Posted by: -

One day a ward sister asked a student nurse to clean all the patients’ dentures. The student got a bowl, collected the dentures and cleaned them. The rest of the shift was spent trying to find which dentures belonged to which patients.

I love these old nursing tales but this one illustrates the problem associated with keeping patients and their dentures together. How many patients wrap their dentures in tissues which are then thrown away?


What do you think?

  • How can we prevent the loss of dentures and hearing aids?
  • Do you have any tips?
  • Does loss of dentures and hearing aids impact on patient recovery? Is there any evidence?

Comments (18)

What would prevent a nurse from talking to patients about FGM?

17 February, 2014 Posted by: -

The government has announced that NHS hospitals will have to submit data on the number of girls and women who have suffered female genital mutilation (FGM).

Among a range of measures aimed at targeting the illegal practice, it will be mandatory for hospitals to tell the Department of Health on a monthly basis of any cases they see of FGM.

The data will be held centrally and shared with other government departments and the police to build up a picture of the extent of FGM across the UK.

The announcement comes after a senior Scotland Yard officer said young girls who have suffered FGM were being failed by doctors who do not report cases to the police.


  • What do you think of this announcement?
  • What would prevent a nurse from talking to patients about FGM?
  • Are you confident to talk to patients about female genital mutation?


Read the full story: NHS hospitals told to submit FGM data




Comments (4)

Should nurses have indemnity insurance?

10 February, 2014 Posted by: -

Members of the Royal College of Nursing who work for the NHS, private sector or independently in aesthetics will no longer be covered by the union’s indemnity scheme from July. The RCN described the change as “small” and said it was in order to close a loophole that allowed employers to shift the costs of cover onto the college.

Under NHS indemnity arrangements for clinical negligence claims, health service bodies are vicariously liable for their employees. But the RCN argued that some employers were passing on claims relating to its members to the college, rather than meeting them themselves.

What do you think?

  • Do you have indemnity cover?
  • Are you concerned about the RCN policy change?
  • Do you feel confident to work without indemnity cover?

Comments (3)

What activities do older people want in care homes?

3 February, 2014 Posted by: -

Last week we reported that residents at a Gloucestershire care home can now enjoy a game of darts or their favourite drink, thanks to the introduction of a pop-up pub.

The pub is a pop-up “pod”, meaning the whole room can be taken down quickly and new themed areas introduced in its place at little additional cost.

The College of Occupational Therapists has recently published Living Well through Activity in Care Homes Toolkit which illustrated how activity is possible, even with few resources.


Let’s discuss…

  • How do you define activities? Do they have to be a communal events, such as tea parties or film clubs?
  • What is the purpose of activities?
  • What activities should we provide for older people in care homes?

Comments (9)

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