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Wendy Preston, Chair of ARNS encourages members to complete RCN Safer Staffing Survey

Wendy Preston, Chair of ARNS encourages members to complete RCN Safer Staffing Survey

As Chair of ARNS, I would urge you to complete the following RCN  Safer Staffing survey (you need not be a member to complete it). The survey aims to capture what nurse staffing levels are like across all area’s and identify relevant issues/ themes to inform recommendations. There is a section to add narrative that you may find useful. Please complete this even if your ‘last shift/ work day’ was fully staffed, you can add previous issues, such as:

  • Not taking breaks
  • Staying after work
  • Covering nurse vacancies by doing another role to yours e.g. working as a Staff Nurse on a ward
  • No time in establishment for training/ annual leave
  • No leadership time

The deadline is May 31st and it is important to get the Respiratory Nurse contribution to this survey.

Complete the survey here

Wendy Preston
Chair, ARNS

Clinicians urged to use new guidance on emergency oxygen to save lives

Clinicians urged to use new guidance on emergency oxygen to save lives

Health professionals from across the NHS and beyond are being urged to adopt the latest version of the world’s first evidence-based guideline on the use of emergency oxygen, published today (Monday 15 May).

The updated guidance is based on new evidence about how effective prescribing and delivery of emergency oxygen for patients can both improve health and save lives.

The updated British Thoracic Society (BTS) Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings, first published in 2008 and endorsed by over 20 clinical societies and colleges, advises health practitioners when prescribing oxygen to always specify a safe ‘target range’ of oxygen in the blood, which can then be monitored.   This vital action is designed to ensure that patients are not given too little, or too much, oxygen which can result in greater illness and, in rare cases, even death.

The rationale for giving emergency oxygen treatment is to treat low blood oxygen levels (hypoxaemia) where the body’s cells are starved of oxygen, which can cause damage to vital organs which can lead to death.  Oxygen can be used to help treat a number of lung diseases, such as pneumonia or deteriorations in asthma or chronic obstructive pulmonary disease (COPD). Oxygen is also used with other diseases such as heart failure and sepsis, which do not directly involve the lungs.

The updated Guideline now covers:

  • Emergency oxygen use, and most other oxygen use, in healthcare settings
  • Short-term oxygen use by healthcare workers outside of healthcare settings

The new areas included are:

  • Endoscopy (for example, gastroscopy) and other procedures requiring sedation
  • Care before, during and after operations including patient-controlled analgesia
  • Palliative care settings like hospices
  • Use of oxygen mixtures, like Entonox (‘gas and air’) – widely used in childbirth
  • Use of high-flow humidified nasal cannulae (a relatively new method for oxygen delivery)
  • Use of oxygen by healthcare professionals in patients’ homes
  • Use of oxygen by voluntary rescue organisations and other non-NHS first responders

Evidence of the Guideline’s effectiveness has been increasing since it was first launched in 2008.

Among a number of studies in support of its impact, one randomised controlled trial and two observational studies have supported decades of evidence that giving high concentration oxygen to patients with severe exacerbations of COPD can increase the likelihood of death, often associated with critically high levels of carbon dioxide in the blood. These studies support the case for the BTS Guideline’s recommendation of a lower safe ‘target range’ of 88-92% oxygen saturation for patients with COPD.

Another example of evidence spotlights the issue of patients with heart attacks with normal blood oxygen levels being given high concentration oxygen – this was common practice until very recently but probably increases the size of the heart attack due to constriction of the blood vessels in the heart in response to high doses of oxygen.  There is also mounting evidence which indicates that very high blood oxygen levels in intensive care unit (ICU) patients are also associated with increased death rates.  These recent studies support the effectiveness of the BTS Guideline-recommended ‘target range’ for improving patient outcomes.

Dr Ronan O’Driscoll, Consultant Respiratory Specialist at Salford Royal NHS Foundation Trust, and first author of the British Thoracic Society’s Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings, said:

“Oxygen is a very important drug and should always be prescribed and monitored like any other medication.  It is very beneficial to many patients, but can be harmful if misused.

We urge all clinicians to adopt the updated BTS Guideline so that emergency oxygen is always used in an optimal and safe way.

We’re delighted that a new body of evidence is confirming how effective following the Guideline can be in improving patient outcomes and reducing avoidable deaths.

The Guideline has now been extended to include more uses of oxygen ranging from procedures requiring sedation such as endoscopy, through to use of oxygen mixtures like ‘gas and air’ widely used in childbirth, to benefit an even greater number of patients.”

1 in 7 patients in UK hospitals receives oxygen therapy for their condition on any given day, according to the BTS Emergency Oxygen Audit report (2015).  Yet more than 4 in 10 of these patients (about 6,000 on an average day) are receiving oxygen with no prescription or other written order to help ensure that staff deliver and monitor oxygen use safely and effectively. Furthermore, over half of hospitals don’t provide sufficient training in oxygen provision and monitoring for doctors or nurses.

However, the 2015 audit also reflected some real progress in the UK:

  • 85% of hospitals have implemented an oxygen policy
  • 100% used pulse oximeters to measure a patient’s oxygen levels on all nursing observation rounds
  • 72% recorded the patient’s oxygen levels in a dedicated oxygen section on the monitoring chart consistent with the BTS oxygen guidelines

BTS won a National Patient Safety Award in 2011 for its campaigning work in the area of safe oxygen use, which has included the delivery of Guidelines, educational resources and audit to help hospitals provide oxygen safely and effectively.

The BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings can be downloaded here: https://www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guideline-for-emergency-oxygen-use-in-adult-patients/

The BTS Guideline for oxygen use in adults in healthcare and emergency settings has been endorsed by: Association of British Neurologists, Association of Chartered Physiotherapists in Respiratory Care, Association for Palliative Medicine, Association of Respiratory Nurse Specialists, Association for Respiratory Technology and Physiology, British Association of Stroke Physicians, British Geriatrics Society, College of Paramedics, Intensive Care Society, Joint Royal Colleges Ambulance Liaison, Primary Care Respiratory Society UK, Resuscitation Council (UK), Royal College of Anaesthetists, The Royal College of Emergency Medicine, Royal College of General Practitioners, Royal College of Nursing (endorsement granted until April 2020), Royal College of Obstetricians and Gynaecologists, Royal College of Physicians London, Royal College of Physicians of Edinburgh, Royal College of Physicians and Surgeons of Glasgow, Royal Pharmaceutical Society and The Society for Acute Medicine.

New website for Asthma UK Centre for Applied Asthma Research

New website for Asthma UK Centre for Applied Asthma Research

On World Asthma Day (2 May 2017) the Asthma UK Centre for Applied Research launched a new website – a brand new virtual home for the Centre.

The website celebrates the wealth of applied asthma research across the UK conducted by members of the Asthma UK Centre for Applied Research, as well as the supporting platforms that support and facilitate the research process.  It makes it easy to find out about recent activity, recent research publications, news and events.

People affected by asthma are at the core of all Asthma UK Centre for Applied Research work. The new website celebrates our active patient and public involvement groups and provides information for people affected by asthma on how they can get involved and provide a valuable contribution to help transform the lives of people affected by asthma across the UK.

The website contains a unique, curated catalogue of big data sets on Asthma in the UK – so researchers can see at a glance what data are available, where they are held and how to obtain data relevant to their research. This will be an invaluable resource, and will continue to grow and develop.

A fantastic postgraduate training programme supports the next generation of researchers – current PhD students form a vibrant and active group, though they are based at various locations around the UK. The new website highlights opportunities for prospective PhD students, as well as giving lots of information on current students.

The Asthma UK Centre for Applied Research Methodology Platform shares expertise in planning, executing and analysing data from trials, and is developing mechanisms to facilitate secondary uses of data.  The new website is a great resource for researchers across the UK to find out about events, workshops and more information from experts across the Centre.

Centre co-director Professor Aziz Sheikh, of the University of Edinburgh, said

“I am delighted to launch this new website on World Asthma Day. It will be a great resource for anyone interested in applied asthma research”

Visit the new website and have a look – find out what the Asthma UK Centre for Applied Research has been up to and how you can get involved:  www.aukcar.ac.uk

Key features

Fun film encourages children to use inhalers

Fun film encourages children to use inhalers

A fun short film that encourages children with asthma to use their inhalers effectively has been released by
Education for Health to mark World Asthma Day, 2 May 2017.
Jack Blows His Own Trumpet has been written by Education for Health’s Chief Executive, Monica Fletcher OBE and
Jane Scullion, Trustee and Respiratory Nurse Consultant University Hospitals of Leicester NHS Trust, to mark the
charity’s 30th anniversary.
The two-minute film can be viewed here https://www.youtube.com/watch?v=Ae5lTVJTaHw
It features a heart-warming poem that tells the story of a little boy, Jack, who longs to play the trumpet in a band but
is unable to because of his asthma. Inspired by his friend Molly, Jack learns to take his inhalers correctly and fulfils
his dream. The vibrant film includes colourful illustrations of Jack, his friend Molly and a herd of trumpeting
elephants.
Health professionals, teachers, parents and children’s activity leaders will be encouraged to share the film with
children with asthma.
Monica and Jane are passionate about improving the lives of children with asthma and ensuring inhalers are taken
correctly. Monica chairs the UK Inhaler Group (UKIG) and Jane is a professional advisor to the group, a coalition of
not-for-profit organisations and professional societies with a common interest in promoting the correct use of
inhaled therapies.
Monica said she and Jane are delighted the characters in their poem have come to life.
“Sadly, we know far too many children with asthma, a serious medical condition, are reluctant, or unable, to use
their inhalers properly and this can have a huge impact on their lives.
“Many miss out unnecessarily on enjoying important everyday activities such as sport or music. This is unacceptable
and often unnecessary if their asthma is managed properly.
“We hope this film will provide a fun way for those who care for children with asthma to get across an important
message about effective inhaler use and encourage these children to take part in a whole range of activities and
enjoy life to the full.”

UK Inhaler Group  launches new website on World Asthma Day

UK Inhaler Group launches new website on World Asthma Day

An interactive new website has been launched today, World Asthma Day (2 May), to raise awareness of the importance
of accurate inhaler technique with healthcare professionals.
The free-to-access site promotes the UK Inhaler Group’s (UKIG) Inhaler Standards and Competency Document, which
was first published in January 2017. It can be viewed here: https://ukiginhalerstandards.educationforhealth.org
UKIG developed these standards in response to its concerns that people are still unable to use their inhalers correctly
and many healthcare professionals are also unable to assist people effectively to optimise their technique. The
standards set out how healthcare professionals can work with patients to maximise the benefit of their inhaled
medication.
Education for Health developed the site in partnership with UKIG, a coalition of not-for-profit organisations and
professional societies with a common interest in promoting the correct use of inhaled therapies.
UKIG member Jane Scullion, Respiratory Nurse Consultant University Hospitals of Leicester NHS Trust and lead
author of the standards document, said: “We are excited to launch this new site on World Asthma Day.
“It is an excellent resource that will help to spread the word about UKIG’s inhaler standards and, in turn, improve
outcomes for many people with respiratory disease.
“Using an inhaler is the most common and effective way to take respiratory medications and remains the
cornerstone for treating airways diseases such as asthma and COPD.
“Correct inhaler use is fundamental to improving outcomes in asthma and COPD. Healthcare professionals need to
know it, show it, teach it and review.”
Education for Health’s Chief Executive Monica Fletcher OBE, is Chair of UKIG.
She said: “Education for Health takes great pride in delivering education and training in an innovative way that
enables healthcare professionals to increase their knowledge and understanding at a time and place to suit them.
“This new interactive site is a great example of this and will enable many professionals to support patients to
optimise their inhaler technique.”

 

NHS Hospitals fail to meet national standards on helping patients quit smoking

NHS Hospitals fail to meet national standards on helping patients quit smoking

According to a major new report launched today (Wednesday 7th December 2016), NHS hospitals across UK are falling ‘woefully short’ of national standards on helping patients who smoke to quit and enforcing smoke-free premises.

Experts presenting the findings at the British Thoracic Society (BTS) Winter Meeting, will state that many NHS hospitals are missing out on a ‘golden opportunity’ to provide what is often the most effective front-line treatment for smoking patients who are sick  –  support and medication to help them quit tobacco.

The BTS Report ‘Smoking cessation: policy and practice in NHS hospitals’ is unique in its scope and size; reviewing the smoking cessation & smoke-free policies and practices of 146 hospitals across UK between April and May 2016 – including the analysis of 14,750 patient records.

The main findings of the report are as follows:

  • Over 7 in 10 (72%) hospital patients who smoked were not asked if they’d like to stop
  • Only 1 in 13 (7.7%) hospital patients who smoked were referred for hospital-based or community treatment for their tobacco addiction
  • Over 1 in 4 (27%) hospital patients were not even asked if they smoke
  • Only 1 in 10 hospitals completely enforce their fully smoke-free premises. Rates of enforcement were even lower for hospitals which provided areas where smoking was allowed. The report highlights the importance of a smoke-free NHS – to trigger and support quit smoking attempts for patients and reduce second hand smoke exposure for children, staff and the public
  • Provision of nicotine replacement therapies and other smoking cessation treatments were ‘poor’ in hospital pharmacy formularies
  • Only 26% of hospitals had an identified consultant ‘lead’ overseeing their smoke-free and smoking cessation plans
  • 50% of frontline healthcare staff in hospitals were not offered training in smoking cessation

In the study, 25% of hospital patients were recorded as being ‘current smokers’ – which is higher than rates in the general adult population (19%)   Other studies have shown that approximately 1.1 million smokers are admitted to NHS hospitals a year.

The Society is using the report findings to call for all hospitals to deliver NICE Guidelines in this area (PH48) and that national regulators such as the Care Quality Commission (CQC) hold Hospital Boards accountable for the delivery of smoke-free and smoking cessation hospital policies.

The report also highlights a number of key activities that all NHS hospitals should deliver to help more of their patients quit smoking:

  1. Offer a prescription for Nicotine Replacement Therapy to all patients who smoke to help them cope with their tobacco dependence whilst in hospital
  1. Refer all patients who smoke in hospital to specialised stop smoking support services to explore the option of quitting smoking. Patients can opt out if they like – but the NHS should try to offer the most effective treatment and support whatever the illness – and with many smoking-related conditions such as chronic obstructive pulmonary disease (COPD), support and medication to help people quit smoking are the best front line treatments
  1. Employ an appropriately skilled senior clinician within the hospital to oversee, drive forward, and be accountable for the hospital’s smoking cessation service
  1. Employ smoking cessation practitioners in every hospital – this was recommended by NICE in 2013 but the report shows patchy delivery across the country
  1. Hospital Board involvement in delivering plans is key. Delivering smoke-free hospital grounds – as part of a wider smoking cessation policy – requires Hospital Boards to work together including the chief executive, director of human resources, director of facilities and the medical and nursing directors – in partnership with the the ‘smoking cessation lead’ at the hospital

The Society is also encouraging more health professionals to become BTS ‘Stop Smoking Champions’ in their hospital. There are over 160 at present and they deliver a range of vital activities to champion stop smoking service provision. For further information, contact stopsmokingchampions@brit-thoracic.org.uk or to see a video about the initiative go to:

https://www.brit-thoracic.org.uk/standards-of-care/quality-improvement/smoking-cessation/bts-stop-smoking-champions/

 

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