Staff Publication

End of Life Care Swan Rooms making a real difference (2017)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
Jules Lewis

Abstract:
The staff at Shrewsbury and Telford Hospital NHS Trust have been working hard to provide Swan Rooms in three areas.

This important work was facilitated by Jules Lewis End of Life Care Facilitator and Jules Lock End of Life Care Volunteer.

However, there was a real team approach in making it happen.

Thank you to all staff involved from staff & public who donatated pictures & CD players, to the painters, carpenter, communications team and ward staff including some fabulous End of Life Care Champions.

The Swan Rooms are side rooms that are used for people who are at end of life, they allow families to spend quality and special time with their loved one in a calming environment.

The side room is freshly painted, beautiful pictures are placed on the wall, a CD player and mood light are available when wanted and a swan recliner chair for relatives to rest when spending long periods of time with their loved one.

Jules Lock also donated lovely mugs / glasses and biscuits in a clear tub to encourage / support staff to make relatives drinks.

It’s the little things that make the biggest difference.

This work is part of the swan scheme for End of Life & Bereavement care which was adopted by the Trust in November 2015.

The end of life care team are planning more swan rooms for 2017 they are making a real difference to the care / support staff give to end of life patients and their family/friends and carers at the most difficult time.

It’s a privilege to care for people at end of life & support the family, we have one chance to get it right for every person every time.

Thank you everyone who was involved, together we achieve wonderful things #onechance #TeamSaTH Jules Lewis and Jules Lock from SaTH Proud to care, together we achieve, make it happen, some of our trust values

Link to full-text

Improving Oxygen Delivery on Wards (2017)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
*Nawaid Ahmad

Full text:
Oxygen (O2) is a drug and should be prescribed if administered to a patient. The British Thoracic Society has published guidelines on emergency oxygen delivery and a recent audit showed that out of 100 patients on O2, 42 did not have a written order.

Cycle 1: 2 FY1s collected data on O2 prescription and delivery on the respiratory ward at the Princess Royal Hospital, a part of the Shrewsbury and Telford Hospital NHS trust. At our trust, O2 is prescribed on the patient’s drug chart and saturation targets are mentioned on the prescription. 61% patients on O2 had a written order and 58% had the target mentioned along with the prescription.

 

Cycle 2: After the data collection, we started doing face to face education about O2 prescription in the acute medical unit and the respiratory ward. We targeted the Drs, nurses and the health care assistants. This was done for a week. A prompt card was developed (Pic 1) which was attached next to the O2 delivery system on the wall to prompt nurses to get the O2 prescribed. A card mentioning O2 targets was attached to the board above the patients bed. Another data collection was done a month later which showed that O2 prescription rates had gone up to 79% and 77% had a target mentioned.

Cycle 3: This involved forming an O2 team comprising the 2FY1s, one staff nurse and one healthcare assistant from the ward. They are called ‘O2 Ninjas’ and wear a badge (Pic 2). Their main role now will be to continue the education of all staff, each at their own level. We plan to roll out an educational programme through the trust staff education department and teach using scenarios. The idea is to spread this process to other specialties within the trust. Work is on going.

Our Motto: “ An idea needs to become a movement, for change to happen”

Link to more details or full-text: http://fabnhsstuff.net/2017/05/27/improving-oxygen-delivery-wards/

Comparison of cure rates in women treated with cold-coagulation versus LLETZ cervical treatment for CIN2-3 on pretreatment cervical punch biopsies: a retrospective cohort study (2017)

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Type of publication:
Journal article

Author(s):
*Papoutsis D, *Underwood M , *Parry-Smith W, *Panikkar J.

Citation:
Archives of Gynecology and Obstetrics. 2017 Apr;295(4):979-986

Abstract:
PURPOSE:
To compare the cure rates between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia grade 2 (CIN2) or 3 (CIN3) on pretreatment cervical punch biopsies.
METHODS:
This was a retrospective cohort study of women having had a single cervical treatment for CIN2 or CIN3 on pretreatment cervical punch biopsies between 2010 and 2011. The cure rates were defined as the absence of any dyskaryosis (mild/moderate/severe) on cytology tests during follow-up and were determined at 6 and 12 months after treatment.
RESULTS:
We identified 411 women having had cervical treatment with 178 cases of cold-coagulation and 233 cases of LLETZ. The cure rates at 6 months following cold-coagulation and LLETZ treatment were 91.6 versus 97.1% (p = 0.02), whereas at 12 months, they were 96.5 versus 97.3% (p = 0.76). Multivariable analysis showed that after adjusting for confounding factors, there was a fourfold higher cure rate with LLETZ in comparison with cold-coagulation at 6 months after treatment (adjusted OR 4.50, 95% CI 1.20-16.83; p = 0.026), with this difference disappearing at 12 months. The lower cure rates with cold-coagulation were due to its higher rates of mild dyskaryosis cytology tests at 6 months. The rates of moderate/severe dyskaryosis cytology tests were similar between the two treatment methods at 6 and 12 months.
CONCLUSION:
We found that women with CIN2 or CIN3 on pretreatment cervical punch biopsies, after adjusting for multiple confounding factors, had higher cure rates when treated with LLETZ versus cold-coagulation at 6 months, with this difference disappearing at 12 months.

Incidence of postoperative nausea and vomiting following gynecological laparoscopy: A comparison of standard anesthetic technique and propofol infusion (2016)

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Type of publication:
Journal article

Author(s):
Bhakta P., Ghosh B.R., Singh U., Govind P.S., Gupta A., Kapoor K.S., *Jain R.K., Nag T., Mitra D., Ray M., Singh V., Mukherjee G.

Citation:
Acta Anaesthesiologica Taiwanica, March 2016(no pagination)

Abstract:
Objective: To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane. Design: Randomized single-blind (for anesthesia techniques used) and double-blind (for postoperative assessment) controlled trial. Setting: Operation theater, postanesthesia recovery room, teaching hospital. Patients: Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20-60 years) scheduled for gynecological laparoscopy were included in the study. Interventions: Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane-fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting. Measurements: Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours. Main Results: Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (p . <. 0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (p . <. 0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications. Conclusion: Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.

Link to full-text: http://www.sciencedirect.com/science/article/pii/S1875459716300145/pdfft?md5=23ae5cc15830c8a727672ad3ea135958&pid=1-s2.0-S1875459716300145-main.pdf

The SaTH risk-assessment tool for the prediction of emergency cesarean section in women having induction of labor for all indications: a large-cohort based study. (2017)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios, Antonakou, Angeliki, *Gornall, Adam, Tzavara, Chara, *Mohajer, Michelle

Citation:
Archives of Gynecology and Obstetrics, Jan 2017, vol. 295, no. 1, p. 59-66

Abstract:
To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL). This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool. 6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and post-date pregnancies were 32.4 %. Risk factors for CS were: age >30 years, BMI >25 kg/m2, primiparity, black-ethnicity, non post-date pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score <11, while for a score ≥11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively. We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.