R Zaidi, A Heald, P Wai, T Patani and S Westal: Diabetic Medicine 2011

An audit on insulin prescribing errors and a survey of junior doctors on insulin prescribing

Diabetic Medicine, March 2011, vol./is. 28/(87-88), 0742-3071 (March 2011)

Authors: R Zaidi, A Heald, P Wai, T Patani and S Westal – Diabetes and Endocrine Department, East CheshireNHS Trust, Macclesfield, UK

Aims: (1) To identify errors in prescribing insulin on medical and surgical wards and compare resultswith those of the National Inpatient Diabetes Audit (NIDA) 2009. (2) A survey assessed the confidence of junior doctors in prescribing insulin.

Methods: We conducted a prospective audit, analysing 31 insulin prescription charts on medical and surgical wards, over 2 weeks following the NPSA report on safe administration of insulin. ‘Units’ written, regimen type and legitimacy, timing and signatures were checked. 48 junior doctors were questioned. This included 19 specialist registrars, 16 F2/CT trainees and 13 F1 doctors.

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Grand Round: 1 February 2012

The next Grand Round will be on Wednesday 1 February and will be a presentation by Dr.S Chandramouli, entitled ‘Clots, shots and plots – A to Z of PE’

The presentation will commence at 1:00pm in the lecture theatre and will be preceded by a buffet from 12:15pm in seminar room 4.

Future presentations

  • 8 February – A presentation given by
    Dr A Heald Consultant Diabetologist (Leighton)
  • 15 February – A presentation given by Annie Coppel – NICE

Please show support of your colleagues by attending where possible.

Margaret says ‘goodbye’ to her friends and colleagues

Margaret Perry completed her last day as Clincal Effectiveness/Research and Development Manager with a farewell buffet for friends and colleagues on January 26 2012.

Consultant Rheumatologist Susan Knight described Margaret’s long career with the Trust and thanked her on behalf of all the many staff and students she had helped over the years, recalling her work spent in PGME and the multi-professional health sciences library – now the staff library.

We wish Margaret all the very best for a long, happy and rewarding retirement and hope to see her soon.

GMC: Leadership and management for all doctors

General Medical Council (GMC)

Leadership and management for all doctors
This guidance sets out the wider management and leadership responsibilities of all doctors in the workplace, including: responsibilities relating to employment issues; teaching and training; planning, using and managing resources; raising and acting on concerns; and helping to develop and improve services. It comes into effect on 12 March 2012.

Second stage – guidance for aspirant foundation trusts

The second stage of the Board Governance Assurance Framework – the Development Modules – is available. The modules cover quality governance, organisational strategy and values, and financial governance. In December 2011, the Department published the first stage of the assurance framework, which is a mandatory Board Governance Memorandum for all aspirant Foundation Trusts.

Resource Watch: HealthKnowledge

This online learning resource is for anyone working in health, social care and well-being across the NHS, local authorities, the voluntary, and the private sector. The resource allows you to access a broad range of learning materials for personal use or for teaching purposes in order to help everyone expand their public health knowledge.

HealthKnowledge is a ‘one stop shop’ that will provide you with all the public health learning materials, whatever your current competency. The resources on this site are very useful and relate not just to public health topics. Some useful tools included on this website:

  • e-Learning modules
  • Teaching modules
  • Interactive learning modules
  • Critical Appraisal
  • RCT
  • Finding the Evidence
  • Systematic Reviews
  • Economic Evaluations

Go to http://www.healthknowledge.org.uk/interactive-learning/finding-and-appraising-the-evidence


FREE HIEC Stakeholder Event: Monday 30th January 2012

HIEC Stakeholder Event: A collaborative approach to evidence based innovation, education and implementation – Monday 30th January 2012

The Yorkshire and Humber Health Innovation and Education Cluster (HIEC) is holding a stakeholder event at the Metropole Hotel inLeeds. All senior leaders from our member organisations are invited to attend.

The event will give attendees the chance to hear from key speakers around innovation and education and the emerging landscape from the NHS transition. Attendees will also be able to share their priorities with the Yorkshire and Humber Health Innovation and Education Cluster in order to shape their future work.

The Patient Safety Theme will be showcasing work to date and talking about support across Yorkshire andHumber over the coming months in an interactive workshop session.  The event is free to attend so book your place now

Patient Safety Update: Yorkshire and Humber Health Innovation

Visit our web-site: www.yhhiec.org.uk/themes/patient-safety/

This extract was taken from “Patient Safety Update“, a new e-bulletin informing people of the emerging work and resources developed by the Yorkshire and Humber Health Innovation and Education Cluster Patient Safety Theme.

Situational Awareness Vital Insights (SAVI)

SAVI has been developed by a team of clinicians and human factors experts to help all staff working with patients to be more situationally aware. There are four films focusing on four high risk areas where good situational awareness is central to patient safety: Deteriorating Patients, Prescribing High Risk Medicine, Handover/Safety Briefing and Misdiagnosis.

The films are aimed at healthcare professionals who have direct patient contact. However the films could also be used as part of undergraduate training for nurses and doctors. The first three films are based in secondary care, whilst the last is based within primary care. The films are hosted with support materials on a training website http://www.training-pod.com/SAVI/ where you can currently view a sample film.

For an initial period while we collect user feedback we can offer SAVI free to trainers (as a DVD with supporting training materials) and to individual students and clinical practitioners via online access (which needs a password). Following this initial trial period we expect to launch the resource more widely later in the year.

To receive SAVI now please e-mail savi@bhft.nhs.uk and state whether you are a trainer or an individual.

Patient Safety Training

Help us to plan future patient safety training by filling in this short survey: https://www.surveymonkey.com/s/PatientSafetyHIEC

Introduction to Patient Safety online training module

Introduction to Patient Safety is an innovative and interactive new online training module for health care staff developed by the Yorkshire Quality & Safety Research Group and theYorkshire and Humber HIEC. The resource will help existing NHS staff to meet their continuing professional development requirements and can form part of inductions for new staff.

The Introduction to Patient Safety training module involves the completion of 5 online units:
• Unit 1: Approaches to error and patient safety incidents.
• Unit 2: The inevitability of human error.
• Unit 3: Case studies – select 3 or more.
• Unit 4: Reflection
• Unit 5: Patient safety multiple choice questionnaire.

The module is free to NHS colleagues across Yorkshire and Humber. Organisations who would like to provide access to this resource for their staff please contact carolyn.clover@bthft.nhs.uk

Quick links to …
TAPS Training and Action for Patient Safety – a practical training programme which involves online learning and multi-professional clinical team action. It engages frontline staff in developing innovative solutions and can be used to deliver results for local safety priorities.
• Emerging results of work with NHS organisations to improve implementation of Patient Safety alerts.
• Our library of patient safety case studies taken from our TAPS programme and Patient Safety Congress 2010 and 2011.



A new newsfeed: Children and Young People

Read all the latest news from the newly acquired CASH newsfeed covering Children and Young People on our Women and Children’s page.

Grateful thanks to the CASH Portal at http://www.netvibes.com/keeping-up-to-date#Home

CASH aims to keep health professionals up-to-date with new developments for the benefit of patient care and improved decision making. It is a collaborative service provided by librarians from around England who monitor and capture content from across 3 broad sectors – Primary Care, Secondary Care and Mental Health.

BMJ: Best Practice looks at Diabetes insipidus

Featured updated topic: Diabetes insipidus

Diabetes insipidus is characterised by polydipsia, polyuria, increased thirst, and formation of hypotonic urine. Two types exist: central DI, due to defective synthesis or release of arginine vasopressin (AVP) from the hypothalamo-pituitary axis; and nephrogenic DI, due to renal insensitivity to AVP. Both types of DI may be associated with hypernatremia, and this may present as a medical emergency. Treatment goals are correction of any pre-existing water deficits and reduction in ongoing excessive urinary water losses. In central DI, desmopressin is the treatment of choice. Nephrogenic DI is treated with an adequate fluid intake; salt restriction and diuretics may help reduce polyuria.

Read the full article here

Clinical Evidence systematic reviews inside Best Practice

For a full list of updated topics, please visit our website.

The Clinical Evidence systematic reviews are now available for you to access within Best Practice. The content of Best Practice is also linked to the appropriate Clinical Evidence systematic review via evidence scores. Below are some of the Clinical Evidence reviews that have been updated over the past few months:

Atrial fibrillation (chronic) New evidence found

Kidney stones  New evidence found

News from The King’s Fund: Cardiac rehab needed

Heart UK

After the event: getting care right for patients after a heart attack

This report calls on all NHS trusts to offer cardiac rehabilitation services to heart attack patients after finding that 2,100 patients across England are not being offered rehabilitation despite the clear benefits of the service in improving patient experience and outcomes from the disease.

Beating Bowel Cancer week

23-29 January is Beating Bowel Cancel week and the Staff Library will be launching the first of a series of monthly themed topics.

Working together with the Trust’s MacMillan Cancer Resource Centre, the aim is to raise awareness and signpost staff, students and visitors to a range of quality resources, where they can gain further help and knowledge.

Look out for us next week when we will be out and about.

Mastering Management in Healthcare: Improve your feedback technique

From Radcliffe Publishing


In this issue of Mastering Management in Healthcare, it looks at the second of two areas that tend to provoke anxiety in managers old and new – giving feedback to staff and colleagues.

It is worth noting that most of us actually want to know how we are doing, and we look for opportunities to have our work recognised. As long as the process is handled with respect and dignity we don’t even seem to mind being told where we might need to improve. However, recent research shows that of the 77% of NHS staff in England who have access to appraisal, just over a third of those feel it is well structured and leaves them feeling valued(1). Judging by this, there still seems to be a barrier to giving good feedback.

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Community pain staff move to a new location

Extract from The Staff Communications Bulletin

The Community Pain Service are moving on 20 January 2012
The Community Pain Service are moving from Weston Clinic on Friday 20 January 2012 to Waters Green Medical Centre on Monday 23 January 2012.

New address and contact details:
PCT Room 3, 3rd Floor, Waters Green Medical Centre
Sunderland Street, Macclesfield, Cheshire, SK11 6JL

01625 264181

Haider, S, BMJ Case Reports 2012: Images in paediatrics

BMJ Case Reports 2012; doi:10.1136/bcr.10.2011.4904

Images in paediatrics: subcutaneous fat necrosis causing radial nerve palsy

  1. Shahzad Haider Department of Paediatrics, Macclesfield District General Hospital, Cheadle, UK
  2. Correspondence to Dr Shahzad Haider, drhaider786@hotmail.com
A baby boy was born at term by forceps extraction following uneventful pregnancy. The baby did not require resuscitation at birth. On routine postnatal check, it was noticed that the baby had left-sided wrist drop. An area of palpable subcutaneous nodules with some erythema was identified over the lower part of left arm. It was thought to be subcutaneous fat necrosis which had most likely caused radial nerve palsy. There were no associated signs suggested for brachial plexus injury. There was good flexion at the elbow and normal movements at shoulder. There was no evidence of fracture in the upper limb on x-ray. He received physiotherapy in the form of splinting and passive movements to prevent secondary contractures. After 4 weeks, he started showing some minimal extension of the fingers. The skin over the area of fat necrosis was desquamated. At his 10 week follow-up, his left arm seemed completely recovered. He had full range of movements. There is limited literature available relating radial nerve palsy secondary to subcutaneous fat necrosis. It is thought to be due to intrauterine pressure effect and almost universally there is a good recovery.
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