Royal College of Physicians: National care of the dying audit of hospitals

National care of the dying audit of hospitals

Holding Hands with Elderly PatientThis report has found significant variations in care across hospitals in England.  The audit shows that major improvements need to be made to ensure better care for dying people, and better support for their families, carers, friends and those important to them. While previous audits had been based on the goals of care within the Liverpool Care Pathway for the Dying Patient (LCP), the new audit sampled the care of dying people in hospital, regardless of whether they were supported by the LCP or other care pathways or frameworks, and included more hospitals than the previous audits.

Acute oncology on the acute medical unit

Royal College of Physicians (RCP)

Acute oncology on the acute medical unit
This toolkit aims to improve the care of cancer patients admitted to hospital as an emergency with medical problems due to their cancer or their treatment. It stresses the importance of patients having access to cancer specialists as soon as possible, and suggests that NHS trusts set up acute oncology services, which can work with the team in the acute medical unit to help in the management of patients with acute oncology problems.

The King’s Fund: Hospital workforce: fit for the future?

Royal College of Physicians (RCP)

Hospital workforce: fit for the future?
This report brings together findings from the medical registrar report and the 2011 RCP consultant census and looks at the key challenges that are facing the medical workforce. It concludes that there needs to be a rethink of the skills in which doctors are trained, in order to better meet patients’ needs; while the role of the medical registrar and the esteem in which it is held must be reassessed and better valued.

Map of Medicine – how can it help your practice?

Respiratory viruses during winter can strain the NHS with an influx of patients, as well as more staff illness. In most cases, rest, increased fluid intake, and paracetamol are sufficient. However, winter can be much more serious for people with pre-existing conditions, such as COPD.  Total excess winter mortality is between 20,000 and 50,000 annually in England and Wales, principally from respiratory, cardiovascular or cerebrovascular diseases.  Older age, female gender and a history of respiratory disease confer greater vulnerability.
Optimising management of chronic conditions is a process, not an event, and clinicians can be supported in this by using the Map of Medicine.   The following care maps are accredited by the Royal College of Physicians (RCP) and offer evidence-based, practice-informed guidance for the on-going management of chronic conditions:

  • ‘Chronic obstructive pulmonary disease (COPD)’ – covers management in both primary and secondary care, and includes treatment of acute exacerbations of breathlessness, which can occur in response to viral infection
  • ‘Cardiovascular disease (CVD) risk management’ – gives information on primary and secondary prevention of cardiac disease
  • ‘Stroke and transient ischaemic attack (TIA)’ – includes information on the secondary prevention of cerebrovascular events

The Map and the RCP bring together evidence and practice to support clinical decisions at the point of care. The Map can be customised to reflect local needs by clinicians looking to support clinical decision-making. Over 150 organisations have ‘localised’ more than 1,300 care pathways. Local additions to the care maps for these chronic conditions range from signposting services, for example local telehealth initiatives and social care packages, to providing information on topics such as factors to consider when deciding where exacerbations of COPD should be managed, and which teams are responsible for delivering care.

Click here to see how the Map could help your organisation.

NEWS system to provide a ‘step-change’ in patient safety

Extract courtesy of http://www.nationalhealthexecutive.com/

The Royal College of Physicians (RCP) has launched a new National Early Warning Score (NEWS), to recognise very sick patients

A report on NEWS was produced by a multidisciplinary working group and clinical observation charts and e-learning materials have been provided by the NEWS educational programme, funded by the RCP, Royal College of Nurses (RCN), National Outreach Forum and NHS Training for Innovation.

On each acute hospital bed, a chart records patients’ pulse rate, blood pressure and temperature, but different NHS trusts use different types of chart, leading to a lack of consistency in the detection and response to acutely ill patients.

The NEWS system allocates a score to six physiological measurements; respiratory rate, oxygen saturations, temperature, systolic blood pressure, pulse rate and level of consciousness.

The more measurements vary from what would be expected, the higher the resultant score. These six scores are then aggregated into one overall score which, if high, will alert the medical or nursing team of the need to escalate a patient’s care.

RCP believes this provides the basis for a unified approach to assessment and continuous tracking of patients’ clinical care, standardised training of all staff and standardised data on regional variations in illness severity.

NEWS also provides detailed recommendations on actions for each score, and the e-learning materials aim to help trusts with implementation. NEWS has been evaluated against existing systems and proved to be as good as, or better, with greater sensitivity when triggering alerts.

A recent study of 1,000 adults dying in acute hospitals in England estimated that around one in 20 deaths in hospital, or 11,859, were preventable by improved clinical monitoring, fewer diagnostic errors and good drug or fluid management. Professor Bryan Williams, chair of the working party, estimated that around 50% of these deaths, 6,000, could have been prevented by using NEWS.

He said: “This new National Early Warning Score has the potential to transform patient safety in our hospitals and improve patient outcomes, it is hugely important.”

Professor Derek Bell, chair of the NEWS educational subgroup, said adopting NEWS would be “one of the most significant developments in health care in the next decade”.

And RCN director of nursing and service delivery, Janet Davies said: “There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care.

“I hope that every Trust will read this report and adopt this system as soon as possible, as countless lives could be saved in the future by adopting this simple process.”

www.rcplondon.ac.uk/sites/default/files/documents/national-early-warning-score-standardising-assessment-acute-illness-severity-nhs.pdf

Acute care toolkit 2: high quality acute care from RCP

Royal College of Physicians (RCP)

Acute care toolkit 2: high quality acute care
This toolkit focuses on the delivery of high-quality acute care, looking at current problem areas and factors threatening care delivery, and suggesting a range of recommendations for improving quality.The toolkit is accompanied by two appendices: the RCP position statement on out-of-hours care, and guidance notes on the provision of 12-hours-per-day, 7-days-per-week consultant care.