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Acute Trusts (acute + trust)
Selected AbstractsDriving towards an improved research and development cultureJOURNAL OF NURSING MANAGEMENT, Issue 3 2008MARY P. McNICHOLL BSc (Hons) Background, This study examined the research and development culture and capacity within one NHS Trust in Northern Ireland. Strengths and challenges were identified and opportunities for further research and development expansion were sought. Methods, This is a two-stage project incorporating a baseline survey (n = 379) followed by consultation with key stakeholders across the Trust (n = 11). Findings, In the survey, over half of the respondents (n = 194) stated they had participated in a research project and a significant number (n = 313) read health care journals. Identification of barriers to research resulted in findings similar to other published work. Staff responded positively about using research in practice (n = 328) and that practice should be influenced by research (n = 312). Nurse Managers indicated support for research and development activity. Conclusion, The study provides a starting point from which to develop a positive research and development culture within this Trust. Implications for nursing management, After establishing a baseline of research and development activity across a large acute Trust, the strengths and weaknesses of such activity were identified with a view to informing a strategy to develop this aspect of professional activity. A change in an organizational culture cannot be made without full support of both the clinicians and their managers. [source] The benefit of geriatric intervention in surgery,increased throughput does not necessarily need more bedsCOLORECTAL DISEASE, Issue 6 2000R. B. Dunn Objective Three years ago a consultant geriatrician began regular visits to the coloproctology and general surgery wards of an acute Trust every weekday, to assist staff with the medical management, rehabilitation and discharge planning of patients aged 65 years and above. The length of stay of these patients in the first 10 months of the appointment was compared with younger concurrent controls and with historical controls in the preceding 10 months. Results The mean length of stay for the 4146 patients aged 16 years and above in a 10-month intervention period was 1.3 days shorter (95% confidence interval (CI) 0.86,1.74 days) than for the 4002 patients in the 10-month control period. This pattern was consistent across all ages and types of surgery, including major colorectal resection. Conclusion There was an important benefit to the availability of coloproctology and general surgical beds in this acute Trust. More efficient rehabilitation of elderly patients reduces ,bed blockage' post-operatively, and allows more effective use of available resources. Co-ordination of the geriatric service with the specialized stoma support service allows earlier discharge of the elderly, and their relocation to appropriate premises where long-term changes in bowel habit and problems with stoma care can be managed away from the acute surgical unit. [source] A national survey of pharmacist transcribing of discharge prescriptionsINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2003Mrs Rachel J. Hobson teacher-practitioner pharmacist Objective To provide quantitative data on pharmacist discharge prescription transcription service (PDPTS) provision in UK hospitals. Method Postal questionnaire survey of clinical pharmacy managers. Setting Selection criteria included one hospital in each acute trust in the UK. Key findings The response rate was 66% (135/206). In mid-2001, a PDPTS was provided by 49 hospital pharmacy departments (36%). PDPTS was the most common prescribing activity undertaken by pharmacists, followed by a prescription amendment policy (29%), prescribing in pre-admission clinics (18%) and re-writing drug charts (15%). 59 departments (44%) did not undertake any prescribing activity. Of the 86 non-transcribing hospitals, 69% undertook no prescribing activity (range = 0 to 3 prescribing activities). Transcribing hospitals offered a wider range of prescribing activities (range = 1 to 8 prescribing activities). A weak relationship was found between the number of pharmacists employed per hospital and the number of prescribing activities undertaken (correlation coefficient = 0.208, P = 0.018). The most frequently used PDPTS model (78%) involved pharmacists transcribing the discharge prescriptions for their own wards. The number of pharmacists transcribing discharge prescriptions per hospital ranged from 1 to 89 (mean = 8, mode = 2, median = 5, 25% percentile = 2, 75% percentile = 10). The majority of pharmacists (52%) reported writing less than five prescriptions per day; 35% were writing 5,10 prescriptions per day. The most common training requirement for pharmacists to start transcribing was an in-house training programme (55%). The majority of departments (80%) did not re-assess the ability of their pharmacists to transcribe. Conclusion Hospital pharmacy departments in the UK have started to take on prescribing roles, especially transcribing discharge prescriptions. However, it would appear that the majority of the PDPTS schemes are not being run extensively throughout the hospitals. It is of concern that the principles of clinical governance are not being met in terms of training and re-assessment of the pharmacists who are undertaking this service. The reasons why the service has developed in some hospitals and not others are not known. In order to extend this service, funding, resources and skill-mix maximisation need to be considered. This will enable patients to gain the maximum benefit from this service development. [source] The Audit Commission review of diabetes services in England and Wales, 1998,2001DIABETIC MEDICINE, Issue 2002B. Fitzsimons Abstract Aims of the Audit Commission The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies. Methods Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self-nomination. Results Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self-management. Conclusion As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs. [source] Locally targeted initiatives to recruit and retain nurses in EnglandJOURNAL OF NURSING MANAGEMENT, Issue 4 2006DINAH GOULD BSc MPhil PhD RGN RNT Aim, The aim of this study is to provide a detailed account of the locally targeted strategies to improve staffing levels by senior nurses responsible for recruitment and retention in acute trusts in the National Health Service in England. Background, There is a shortfall in nursing numbers throughout England. Some trusts have employed senior nurses with a specific remit to improve recruitment and retention, but little has been published about their work or its success. Methods, Data were collected by telephone using semi-structured interviews with standard probes. The tape-recorded interview data were transcribed verbatim and analysed by content. Results, Of the 156 acute trusts in England, 36 employed a senior nurse to deal with recruitment and retention. Twenty-nine were interviewed. All were using a range of locally targeted initiatives to attract and retain health-care assistants, newly qualified and more experienced practitioners. They also worked closely with university staff to attract and retain student nurses who would later seek employment locally. Different approaches were used to secure the services of different types of staff. Conclusion, This exploratory study has revealed a wealth of valuable data concerning locally targeted recruitment and retention strategies. Further research is needed to examine the effectiveness and cost-effectiveness of the initiatives described. [source] Local and marginal control charts applied to methicillin resistant Staphylococcus aureus bacteraemia reports in UK acute National Health Service trustsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2009O. A. Grigg Summary., We consider the general problem of simultaneously monitoring multiple series of counts, applied in this case to methicillin resistant Staphylococcus aureus (MRSA) reports in 173 UK National Health Service acute trusts. Both within-trust changes from baseline (,local monitors') and overall divergence from the bulk of trusts (,relative monitors') are considered. After standardizing for type of trust and overall trend, a transformation to approximate normality is adopted and empirical Bayes shrinkage methods are used for estimating an appropriate baseline for each trust. Shewhart, exponentially weighted moving average and cumulative sum charts are then set up for both local and relative monitors: the current state of each is summarized by a p -value, which is processed by a signalling procedure that controls the false discovery rate. The performance of these methods is illustrated by using 4.5 years of MRSA data, and the appropriate use of such methods in practice is discussed. [source] Latest news and product developmentsPRESCRIBER, Issue 3 2007Article first published online: 14 MAR 200 PPIs and hip fracture Treatment with a PPI may increase the risk of hip fracture, with longer use associated with higher risk according to a study in UK patients (J Am Med Assoc 2006;297:2947-53). The case control study compared use of PPIs by 13 556 patients with hip fracture and 135 386 controls in the UK General Practice Research Database. Use of a PPI for more than one year was associated with an increase of 44 per cent in the odds of hip fracture. The risk was higher for longer- term use (59 per cent after four years) and at higher doses (more than doubled with long-term high doses). The mechanism for this possible effect may be impaired calcium absorption associated with hypochlorhydria and reduced bone resorption. CHD NSF Statin prescribing has increased by 30 per cent every year since the publication of the Coronary Heart Disease NSF, the Department of Health says. The estimated number of lives saved attributable to statins had risen to 9700 in 2005. The proportion of patients with acute MI who were given thrombolysis within 30 minutes of admission has increased to 83 per cent. Flu jabs cut pneumonia deaths A US study suggests that flu vaccine protects against death during the flu season in patients admitted with community-acquired pneumonia (Arch Intern Med 2007;167:53-9). Nineteen per cent of patients admitted with pneumonia during the winters of 1999-2003 were known to have been vaccinated against flu. Their risk of death during their hospital stay was 70 per cent lower than that of nonvaccinated individuals. After adjustment for antipneumococcal vaccination and comorbidity, the odds of death were still 39 per cent lower. Model to predict admissions The King's Fund, together with New York University and Health Dialog, has published a model that predicts the risk of emergency hospital admission (see www.kingsfund.org.uk). The model is intended for use by PCTs and draws on data from secondary and primary care to define clinical profiles, allowing patients whose condition is deteriorating to be identified before they need admission. Problem drinking The National Treatment Agency for Substance Misuse (NTA), a special authority within the NHS, has published a critical appraisal of the evidence for various treatments for alcohol problems (www.nta.nhs.uk). The 212-page document estimates that over seven million hazardous or harmful drinkers may benefit from brief interventions by any health workers, and over one million dependent drinkers may benefit from specialist intervention. It concludes that cognitive behavioural approaches to specialist treatment are most effective and that treatment probably accounts for about one-third of improvements made in problem drinking. of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. Stopping anti-TNFs Discontinuation of treatment with anti-TNF agents is more common in clinical practice than in clinical trial populations, a French study has found (J Rheumatol 2006;33:2372-5). The retrospective analysis of a single centre's experience of treating 770 patients with etanercept (Enbrel), infliximab (Remicade) or adalimumab (Humira) found that fewer than two-thirds of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. There were no statistically significant differences between the three agents but there was a trend for infliximab to be least well tolerated. Generic statin savings The Department of Health has estimated that prescribing simvastatin and pravastatin generically would save £85 million per year. Its analysis of the ,Better care, better value' indicators (see www.productivity.nhs.uk) shows that statin prescribing has increased by 150 per cent in the past five years, with costs totalling £600 million in 2005. The Department says that if every PCT prescribed pravastatin and simvastatin by generic name in only 69 per cent of cases ,the level achieved by the top quarter of trusts ,the savings would be over £85 million a year. Herceptin reporting Press reports of a two-year trial of trastuzumab (Herceptin) were generally accurate in reporting its effectiveness but few reported an increased risk of adverse effects, according to the NHS National Library for Health (www.library.nhs.uk). The Herceptin Adjuvant (HERA) trial (Lancet 2007;369:29-36) found that, after an average follow-up of two years, 3 per cent of women treated with trastuzumab died compared with 5 per cent of controls; estimated three-year survival rates were 92.4 and 89.7 per cent respectively. All four press articles reported these findings accurately, but only two mentioned the increased risk of adverse effects. Updated guidance on CDs The Department of Health has published updated guidance on the strengthened governance requirements for managing controlled drugs, taking into account new regulations that came into force on 1 January (seewww.dh.gov.uk/asset Root/04/14/16/67/04141667.pdf). Statin adherence lowers MI mortality Patients with acute myocar- dial infarction (MI) who take their statins as prescribed are significantly more likely to survive for two to three years than those with low adherence (J Am Med Assoc 2007;297: 177-86). The four-year observational study of 31 455 patients with acute MI found that, compared with those who had taken at least 80 per cent of prescribed daily doses, the risk of death in those with less than 40 per cent adherence was 25 per cent greater over 2.4 years. For individuals with intermediate adherence (40-79 per cent), the risk was 12 per cent greater. Both differences were statistically significant after adjustment for potential confounding factors. The authors believe their finding is explained by differences in adherence rather than healthier behaviour because the excess risk of low adherence was less marked with beta-blockers and not significant for calcium-channel blockers. Improving community medicines management Mental health trusts need to improve medicines management by their community teams and improve information sharing with GPs, the Healthcare Commission has found (www.healthcare commission.org.uk). Its national report revealed limited evidence of pharmacist involvement in community mental health teams, even though 90 per cent of patients were cared for in the community. Only 11 per cent of assertive outreach patients had the tests necessary to ensure safe use of their medicines. Medication reviews found that 46 per cent of patients in mental health trusts and 12 per cent of those in acute trusts were not taking their medication appropriately. The Commission also reported that acute trusts received a complete drug history from GPs for fewer than half of audited patients when they were admitted to hospital, and only 30 per cent of PCTs reported that GPs received adequate information on patients' medicines on discharge. Copyright © 2007 Wiley Interface Ltd [source] | ||||||||||