Behind the Rituals
All posts from: October 2011
Is it necessary to record the batch numbers for IV fluids on prescription sheets?
Recording batch numbers for IV fluids is an outdated procedure. The burden of risk of giving an IV fluid is no greater than any other IV medicine where batch numbers are not recorded.
Martin Shepherd is head of medicines management, Chesterfield Royal Hospital NHS Foundation Trust.
Should cooling methods such as fanning and tepid sponging be used to manage pyrexia? What do you think?
The routine use of physical cooling methods such as tepid sponging and fanning are controversial. If the body’s natural defence mechanism to combat infection is to increase body temperature, why try to reduce it? Physical cooling methods may actually increase body temperature: they can stimulate a compensatory response by resulting in heat-generating activities such as shivering, which can compromise unstable patients by depleting their metabolic reserve.
There is no evidence to support the routine use of tepid sponging in temperate climates such as the UK and it does not produce a sustained drop in temperature. It can cause vasoconstriction, which can result in a further rise in patients’ temperature. If it is performed too quickly, it can cause them to shiver, which will increase metabolic rate and subsequently core body temperature. It is also time-consuming.
However, some authors recommend that physical cooling methods should be used if patients have potentially life threatening hyperpyrexia, heat stroke or malignant hyperthermia.
There is no doubt that a cool fan (not directly on patients) or cool flannel on the face can be very welcome when feeling hot. Reducing the amount of clothing and bedding can also help.
Phil Jevon is resuscitation officer and clinical skills lead at Manor Hospital, Walsall, West Midlands.
Does massage help to prevent pressure ulcers? What do you think?
The simple answer is there is no evidence to suggest massage helps prevent pressure ulcers. In fact, there is limited evidence to suggest it actually causes harm, and several national guideline groups advise against it.
Key points are:
- There is no evidence to suggest massage helps to prevent pressure ulcers
- The potential for interpreting what constitutes a massage could mean there is no standard approach
- Massage on patients at risk of developing pressure ulcers who have inflamed skin could exacerbate existing damage
Heidi Guy is a tissue viability clinical nurse specialist, East and North Hertfordshire Trust, and an honorary fellow, University of Hertfordshire.
Does increasing fluids really help constipation? What do you think?
There is conflicting evidence regarding the adequate quantities of fluid required for health, let alone for the management of constipation. Inadequate fluid intake is a risk factor for constipation. Older people drink less in an attempt to avoid nocturnal urinary incontinence and are at greater risk of dehydration due to an impaired thirst mechanism, especially those with severe cognitive impairment. Dehydration causes dry hard faeces resulting in a slow bowel transit time. Consequently encouraging patients to increase their fluid consumption is widely recommended in the treatment for constipation based on the assumption that additional fluid leads to an increase in bowel transit time by bulking up faecal matter. Yet there is no clinical evidence that increasing fluids can successfully treat constipationunless dehydration is diagnosed. However, there is a need to increase fluid intake in excessively hot weather, following alcohol consumption and if pyrexia is present.
Gaye Kyle is the chair of the ACA education committee
Should you always change plastic aprons between patients? What do you think?
Several studies show that healthcare workers clothing can become contaminated with potentially pathogenic microorganisms e.g. Staphylococcus aureus.
Aprons are also included as part of healthcare workers personal protective equipment regulations. (Personal Protective Equipment at Work Regulations, 1992).
Therefore, plastic aprons are part of universally accepted evidence based standards, guidance and regulations for infection prevention and control. They recommend that single use disposable aprons, or gowns, must be worn based on risk assessment when there is a risk that healthcare workers clothing may become exposed to blood, body fluids, secretions and excretions.
Such guidance also recommends that aprons must be changed and removed carefully between care provided for each patient to prevent transmission of microorganisms and when cleaning different areas e.g. bedrooms, bays, toilets, kitchens and clinical areas.
Many policies also advice different colour coded aprons to help ensure that they have been changed between patients and procedures e.g. different colours for patient care, isolation, food service, bathroom and kitchen areas. Some studies have indicated that plastic may acquire static electric charge which can attract airborne bacteria. Although there are various opinions regarding this it also helps support the need to change aprons between patients.
Julie Hughes is a Nurse Consultant Infection Control/Lecturer, 5 Boroughs Partnership NHS Foundation Trust/University of Chester.