scholarly journals EP.FRI.510 The Management of Hyperkalaemia in Acute General Surgical Inpatients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rezhaw Karadaghi ◽  
Joseph Sagar ◽  
Roberta Bullingham ◽  
Pawan Mathur
Keyword(s):  
Educational Intervention ◽  
Clinical Management ◽  
Emergency Treatment ◽  
Junior Doctors ◽  
Inpatient Stay ◽  
National Guidelines ◽  
High Potassium ◽  
Hospitalised Patients ◽  
Data Record ◽  
Current Guidelines

Abstract Aims Hyperkalaemia is very common in hospitalised patients especially in peri-operative settings. It is associated with increased length of stay, morbidity and mortality. Here we review the management of hyperkalaemia in emergency surgery inpatients compared to the recommended national guidelines. With the identification of any gaps, we will introduce a new protocol to standardize practice as the basis of our educational intervention. Methods A retrospective observational study of adult surgical inpatients between July and December 2020. 20 patients with a K+ >5.5 during their inpatient stay were identified. Data on their clinical management was extracted from their electronic data record and handover database and analysed. Results Of the 20 patients identified, 13 had mild (5.5-6), 3 moderate (6-6.5) and 4 severe (>6.5) hyperkalaemia. Mortality was 0 and 100% of patients with K + ≥6.5 received timely emergency treatment in line with guidelines. However, there was a wide variation in the type of treatment given with 100% of cases not aligning with current guidelines. Additionally, in only 40% of cases was the hyperkalaemia documented and only 20% of patients received an ECG; a recommendation even in mild cases.  Conclusions There is a need to standardise practice in the clinical management of hyperkalaemia and align with recent, validated guidance. A clear and easily accessible algorithm reinforced by an educational intervention to junior doctors may improve the management of high potassium in surgical inpatients and improve outcomes. Following this intervention, the standard will be re-audited.

REVIEW OF INDEPENDENT NURSE PRESCRIBING IN A PAEDIATRIC CYSTIC FIBROSIS (CF) AND RESPIRATORY POPULATION

2016 ◽  
Vol 101 (9) ◽  
pp. e2.6-e2
Author(s):  
Gabis Chana ◽  
Michelle Tabberner ◽  
Wendy Nixon ◽  
Sue Frost ◽  
Leslie Barrett ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Medical Condition ◽  
Junior Doctors ◽  
Positive Contribution ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Exclusion Criteria ◽  
Patient Journey ◽  
Telephone Advice

AimWith pressures on junior doctors' availability in the NHS, non-medical prescribing is topical. Independent Nurse Prescribers (INPs) can prescribe any licensed medicine for any medical condition within their level of competence.1 An audit was undertaken of the four INPs employed by the Respiratory Department evaluating current prescribing practices.MethodThe requirement for this audit was identified by the multidisciplinary team (MDT) and Trust approval was obtained. A data collection form was designed capturing patient demographics and full details of prescribed items.Over a 3 month period (August to October 2014) outpatient cystic fibrosis (CF) and respiratory prescriptions were studied using cluster sampling. Over a 6 week period prescription requests by CF INPs faxed to General Practitioners (GPs) were reviewed. INPs also prescribe via telephone, documenting advice on trust forms; these were preliminarily audited. All data was analysed using Microsoft Excel. Legality of prescriptions and adherence to national and local guidelines were evaluated. Reference keys were used to designate non-adherence post-application of exclusion criteria.ResultsA total of 77 outpatient prescriptions (45 CF and 32 respiratory) were completed by the 4 INPs, containing 122 items (72 CF and 50 respiratory). Of the CF prescribed items 21 were oral antibiotics (29%). Respiratory INPs mainly prescribed 14 inhaler devices (28%) and 12 inhaled bronchodilators (24%).All INP prescriptions met legal requirements. Basic details of medicinal products (drug name and dose) were documented for all items. A key finding was that duration/quantity was not indicated for 27 (54%) respiratory items.After applying exclusion criteria, of the CF prescribed items, 56/59 (95%) adhered to national guidelines and 47/66 (71%) followed local guidelines. The leading reason for not following local guidelines was not documenting allergy status. Of the respiratory prescribed items, 34 (100%) adhered to national guidelines and 31/32 (97%) followed local guidelines.A total of 33 faxes (with 38 items) were completed and 35 items (92%) were oral antibiotics. Drug name, dose and frequency were stated for all items. From the faxed items, 38 (100%) adhered to national guidelines and 32/33 (97%) followed local guidelines.Over 5 days, CF INPs provided telephone advice for 12 patients. Of these, 6 patients had respiratory exacerbation. Telephone advice led to faxes being sent to GPs for 9 patients. This was preliminary data with a re-audit planned after amendment of trust form.ConclusionOverall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed.

scholarly journals ISMAR-study presentation: in-hospital epidemiology and clinical management of respiratory and cardiac comorbidities in cardiac and respiratory disease units

2014 ◽  
Vol 9 ◽  
Author(s):  
Roberto Tramarin ◽  
Mario Polverino ◽  
Maurizio Volterrani ◽  
Bruna Girardi ◽  
Claudio Chimini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Management ◽  
Real Life ◽  
Length Of Hospital Stay ◽  
Relevant Information ◽  
Hospital Epidemiology ◽  
Discharge Data ◽  
Definition Of ◽  
Current Guidelines

Background: Cardiovascular and respiratory diseases are leading causes of morbidity and their co-occurrence has important implications in mortality and other outcomes. Even the most recent guidelines do not reliably address clinical, prognostic, and therapeutic concerns due to the overlap of respiratory and cardiac diseases. Study objectives and design: In order to evaluate in the reality of clinical practice the epidemiology and the reciprocal impact of cardio-pulmonary comorbidity on the clinical management, diagnostic workup and treatment, 1,500 cardiac and 1,500 respiratory inpatients, admitted in acute and rehabilitation units, will be enrolled in a multicenter, nationwide, prospective observational study. For this purpose, each center will enroll at least 50 consecutive patients. At discharge, data analysis will be aimed at the definition of cardiac and pulmonary inpatient comorbidity prevalence, demographic characteristics, length of hospital stay, and risk factors, taking into account also procedures, pharmacological and non-pharmacological treatment, and follow up in patients with cardio-respiratory comorbidity. Conclusions: The purely observational design of the study aims to give new relevant information on the assessment and management of overlapping patients in real life clinical practice, and new insight for improvement and implementation of current guidelines on the management of individual diseases.

scholarly journals Focused educational intervention improves but may not sustain knowledge regarding falls management

2018 ◽  
Vol 7 (3) ◽  
pp. e000222 ◽  
Author(s):  
Punith Kempegowda ◽  
Joht Singh Chandan ◽  
Richard Hutton ◽  
Lauren Brown ◽  
Wendy Madden ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Educational Intervention ◽  
Educational Interventions ◽  
Alternative Methods ◽  
Junior Doctors ◽  
Improvement Project ◽  
Preventative Measures ◽  
Before And After ◽  
Hospital Stays ◽  
Falls Management

BackgroundThe number of falls in hospital ranges from 3.8 to 8.6 falls per 1000 bed days. 1 Around 30% of falls as inpatients are injurious, and 4%–6% can result in serious and life-threatening injury. 2 3 This results in significant health burdens and economic burdens due to increased hospital stays following a fall. Junior doctors are usually the first point of contact for managing patients who fall in hospital. It is therefore important they understand the preventative measures and postfalls management.AimTo assess the retention of knowledge regarding falls management in foundation year 1 (FY1) doctors before and after a short educational intervention.MethodsA 3-stage quality improvement project was conducted at a West Midlands teaching hospital to highlight issues regarding falls management. A questionnaire assessing areas of knowledge regarding assessment and management of falls was delivered to 31 F1s. This was followed by a short presentation regarding falls management. The change in knowledge was assessed at 6 and 16 weeks postintervention. The questionnaire results were analysed using unpaired t-tests on STATA (V.14.2).ResultsThe mean score for knowledge regarding falls management in the preintervention, early postintervention and late postintervention were 73.7%, 85.2% and 76.4%, respectively. Although there was an improvement in the knowledge at 6 weeks’ postintervention, this returned to almost baseline at 16 weeks. The improvement in knowledge did not translate to clinical practice of falls management during this period.ConclusionAlthough educational interventions improve knowledge, the intervention failed to sustain over period of time or translate in clinical practice. Further work is needed to identify alternative methods to improve sustainability of the knowledge of falls and bring in the change in clinical practice.

Resuscitation status conversations: a short education session improves junior doctors’ confidence

2020 ◽  
pp. bmjspcare-2020-002479
Author(s):  
Lana Ferguson ◽  
Helen Clark ◽  
Wayne de Beer
Keyword(s):  
Educational Intervention ◽  
Postgraduate Education ◽  
Tertiary Hospital ◽  
Perceived Barriers ◽  
Junior Doctors ◽  
Education Session ◽  
Level Of Confidence ◽  
Significant Difference ◽  
Short Education ◽  
Resuscitation Status

AimJunior doctors are frequently required to discuss resuscitation status with patients. They generally lack experience, confidence and skill in having these conversations. However, there is currently no formal postgraduate education requirement to improve or develop in this area. The aim of this educational intervention was to improve junior doctors’ level of confidence and skill in having resuscitation status conversations with patients.MethodAn educational intervention for 27 prevocational postgraduate second and third-year house officers at a tertiary hospital in Hamilton, New Zealand was conducted. A self-administered survey was completed preintervention and postintervention.ResultsFour factors were assessed in the survey (level of confidence having conversations regarding resuscitation status, ability to prognosticate, content of conversations and perceived barriers to having conversations), with a statistically significant difference found with respect to level of confidence having conversations regarding resuscitation status (p=0.001).ConclusionThis study demonstrated that a short education session improves confidence in discussing resuscitation status. It has also identified the need for further postgraduate training in complex communication skills.

Testing for pharyngeal gonorrhoea in heterosexual men: should we revisit national guidelines?

2020 ◽  
pp. 095646242091344
Author(s):  
Melissa Dresser ◽  
Jane Hussey
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Persistent Infection ◽  
Service Evaluation ◽  
Heterosexual Men ◽  
National Guidelines ◽  
North East ◽  
The North ◽  
Current Guidelines

Pharyngeal testing for Neisseria gonorrhoeae (gonorrhoea) in heterosexual men is not currently recommended in UK guidelines; however, it was being undertaken in a service in the North East of England for those presenting with urethral infection or as contacts of gonorrhoea. This service evaluation was performed to see if this practice should continue, or cease in line with national recommendations. The results revealed that 10% of contacts were positive in the pharynx only. Had this test not been performed, it would have left these patients without any treatment, as the current guidelines now discourage epidemiological treatment of contacts. Twenty-seven per cent of all heterosexual men diagnosed with urethral infection also had oropharyngeal gonorrhoea, with implications for persistent infection, had testing not been performed followed by a test of cure.

scholarly journals What Factors Are Important in Increasing Junior Doctors' Willingness To Provide Palliative Care in Taiwan? An Educational Intervention Study

2010 ◽  
Vol 13 (10) ◽  
pp. 1245-1251 ◽  
Author(s):  
Chih-Yuan Shih ◽  
Tai-Yuan Chiu ◽  
Long-Teng Lee ◽  
Chien-An Yao ◽  
Ching-Yu Chen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Educational Intervention ◽  
Intervention Study ◽  
Junior Doctors

scholarly journals How Well Equipped are ENT Wards for Airway Emergencies?

2006 ◽  
Vol 88 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Rupan Banga ◽  
Andrea Thirlwall ◽  
Rogan Corbridge
Keyword(s):  
Airway Management ◽  
Response Rate ◽  
Telephone Survey ◽  
Junior Doctors ◽  
National Guidelines ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Airway Equipment ◽  
Adequate Provision ◽  
And Training

INTRODUCTION With increased cross cover of specialities at night and more direct triaging of casualty patients to ENT wards, there is an increased need to ensure that there is adequate provision of emergency airway management. There are currently no national guidelines on what equipment should be available on ENT wards, and the authors have devised a portable airway box with all equipment deemed necessary to manage an acute airway. We believe that all junior doctors covering ENT should have airway training and access to an airway box. The aim of this study was to determine the provision of on-ward airway equipment and training on ENT wards in England. MATERIALS AND METHODS A telephone survey of all English hospitals with in-patient ENT services. RESULTS A total of 103 departments were contacted with 98% response rate. Most wards were covered by a combination of ENT and other specialties. Results indicated that only 18% of departments had an airway box and 28% had some training in airway management. CONCLUSIONS Results suggest poor provision of emergency airway equipment and training on wards. We recommend the use of an airway box, and list of minimal equipment required.

95 Goals-Of-Care and Advance Care Planning Discussions with Hospitalised Frail Older People: What is the Evidence?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i30-i32
Author(s):  
S A Hopkins ◽  
A Bentley ◽  
V Phillips ◽  
S Barclay
Keyword(s):  
Literature Review ◽  
Older People ◽  
Advance Care Planning ◽  
Controlled Trial ◽  
Care Planning ◽  
Frail Older People ◽  
National Guidelines ◽  
Goals Of Care ◽  
Hospitalised Patients ◽  
Advance Care

Abstract Introduction National guidelines suggest that patients in the last year of life should be identified, their prognosis and future care options discussed, with advance care planning (ACP) recorded. Goals-of-care should be discussed with hospitalised patients at risk of deteriorating or with life-limiting conditions. The stated purpose of ACP and goals-of-care discussions is to increase goal-concordant care (i.e. patients receiving treatments they would wish to receive, and not receiving those they would not want). This literature review investigates the evidence-base for these policies and outcomes. Review question What is the evidence for goals-of-care and ACP discussions with hospitalised frail older people? Methods Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO, and Embase databases from January 1990 to September 2017. An updated search until May 2019 is currently underway. Results Of 8077 unique articles identified, 17 met inclusion criteria. There is no evidence that goals-of-care discussions lead to increased goal-concordant care; there is observational evidence that they increase the accuracy of documented preferences. Currently, rates of goals-of-care discussions are variable (38-72%), and there is poor concordance between patients’ actual and documented preferences, with agreement in only 31-33% of cases. Present rates of ACP are very low (0-3%), with mixed evidence for benefits of ACP. One single-centre randomised controlled trial suggests ACP improves outcomes for patients who die within 6 months of discharge, including increased goal-concordant care and reduced family distress. There is very limited evidence concerning patients’ and family members’ experiences of these discussions, their reasons for wishing (or not) to participate in discussions, or their perceptions of the important outcomes. Most (80%) patients would like to be involved in decisions about their care; 48% consider these conversations very important. The views and experiences of healthcare professionals have been little studied. Conclusions The asserted aim of goals-of-care and ACP discussions is to increase goal-concordant care; the extent to which this reflects patients’ priorities is unknown. In younger patient populations, while 40% of patients consider goal-concordant care the most important outcome, one third of patients consider family-related outcomes to be more important. Further research is needed to understand the perspectives of frail older patients, their families and clinicians, in order to make these discussions and subsequent care truly patient-centred.

Oxford Handbook of Oral and Maxillofacial Surgery

2018 ◽  
Author(s):  
Luke Cascarini ◽  
Clare Schilling ◽  
Ben Gurney ◽  
Peter Brennan
Keyword(s):  
Maxillofacial Surgery ◽  
Dental Materials ◽  
Training Programme ◽  
Dental Students ◽  
Oral And Maxillofacial Surgery ◽  
Junior Doctors ◽  
Reference Guide ◽  
Surgical Trainees ◽  
Specialist Nurses ◽  
Current Guidelines

This new edition of Oxford Handbook of Oral and Maxillofacial Surgery has been fully updated to cover the current guidelines and research in the field of OMFS. Splitting vital knowledge into sections based on clinical areas, this handbook uses bulleted lists and summary boxes to make the information easily searchable. Chapters on ‘in the clinic’, ‘in the theatre’, and ‘on the ward’ cover all common complaints and presentations that the reader can expect to encounter in their daily activities, and a dedicated section to emergencies provides clear advice. Common drugs and dental materials are covered as a quick reference guide. With OMFS now part of the Core Training programme for surgical trainees, the handbook ensures a solid grasp of the basics and fundamentals to help support decision making for junior doctors, dental foundation trainees, specialist nurses, and medical and dental students.

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