Current awareness suts august 2016 by Musgrove Park Hospital Library

Library Services Musgrove Park and Somerset Partnership

Current Awareness Sign Up To Safety This monthly Current Awareness Bulletin is produced by the Library Team, Musgrove Park Academy to provide staff with a range of resources to support Sign Up To Safety. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of relevant resources and is not intended to be a comprehensive list. All websites have been evaluated and details are correct at the time of publications. Details correct at time of going to print. Please note that resources are continuously updated. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Carol-Ann Regan Musgrove Park Hospital Library Service Carol-ann.regan@tst.nhs.uk @musgrovesompar

ď&#x20AC;şď&#x20AC; http://librarymph.wordpress.com/ Issue 9 August 2016

Contents Click on a section title to navigate contents Page Recent journal articles

Books

UpToDate and Dynamed Plus

Reports, publications and resources

Literature search service

Training and Athens

Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433) Fax: 01823 34 (2434) Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

RECENT JOURNAL ARTICLES BACK TO TOP Some articles are available in the library or on-line via an OpenAthens password by following the fulltext link. If you would like an article which is not available as full-text then please contact library staff. Please note that abstracts are not always available for articles.

FALLS 1. Problematising the problem: a critical interpretive review of the literature pertaining to older people with cognitive impairment who fall while hospitalised Source: Nursing Inquiry; Jun 2016; vol. 23 (no. 2); p. 148-157. Author(s): Rushton, Carole Abstract:This article presents a reflexive account by way of a critical interpretive review of the literature pertaining to falls of older people with cognitive impairment who have been hospitalised in an acute care setting. A key aim of this review was to use thematic analysis and problematisation to challenge assumptions underpinning the current falls literature and to bring into consideration alternate foci of research and new approaches to falls research. An innovative approach is used to generate descriptive and interpretive summaries of the literature which are presented graphically to reveal the prevailing themes and assumptions within. It is argued that currently, falls research in the context of cognitive impairment is constrained by scientism. Meta-paradigmatic approaches, which have the potential to provide a better understanding of why falls may or may not occur among this particular subgroup of older people, are proposed as an alternative. [PUBLICATION] References Database: BNI

2. Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: a systematic review Source: Emergency Medicine Journal; May 2016; vol. 33 (no. 5); p. 345-350 Author(s): Zozula, Alexander; Carpenter, Christopher R; Lipsey, Kim; Stark, Susan Abstract:Background: Falls represent an increasing source of geriatric morbidity and mortality. Prehospital emergency services may be uniquely suited to screen and refer subsets of high-risk older adults to fall prevention programmes. This systematic review assesses the effectiveness of such screening and referral programmes. Methods: We searched PubMed, Embase, CINAHL, Web of Science, Scopus, the Cochrane Library and OTseeker for English-language peer-reviewed randomised trials, non-randomised trials and cohort studies evaluating prehospital fall risk screening and referral programmes for community-dwelling adults =60 years of age. Risk of bias was assessed using the Cochrane Collaboration's tool. Primary outcomes included the risk and rate of falling. Secondary outcomes included successful follow-up to address fall risks and adverse events. Results: From 6187 unique records, 6 studies were included. Screening varied from using 3

semistructured risk assessments to recording chief complaints. All studies were at high risk of bias. One unblinded trial of a multifactorial fall prevention programme demonstrated a 14.3% (95% CI 6.1% to 22.5%) absolute reduction in annual fall risk and a relative fall incidence of 0.45 (95% CI 0.35 to 0.58). The probability of successful follow-up varied from 9.8% to 81.0%. No studies demonstrated any attributable adverse events. Conclusions: No high-quality evidence demonstrates that prehospital services reduce falls in communitydwelling older adults. Screening by prehospital personnel using semistructured risk assessments appears feasible, but it is unclear whether this is superior to referral based on fall-related chief complaints. [MEDIUM] References Database: BNI

3. Agreement between the frailty index and phenotype and their associations with falls and overnight hospitalizations. Source: Archives of Gerontology & Geriatrics; Sep 2016; vol. 66 ; p. 161-165 Author(s): Zhu, Yinsheng; Liu, Zuyun; Wang, Yong; Wang, Zhengdong; Shi, Jianming; Xie, Xuejuan; Jin, Li; Chu, Xuefeng; Wang, Xiaofeng Database: CINAHL

4. Predicting falls: considerations for screening tool selection vs. screening tool development. Source: Journal of Advanced Nursing; Sep 2016; vol. 72 (no. 9); p. 2238-2250 Author(s): McKechnie, Duncan; Pryor, Julie; Fisher, Murray J. Database: CINAHL

5. A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls Among Breast Cancer Survivors. Source: American Journal of Physical Medicine & Rehabilitation; Aug 2016; vol. 95 (no. 8); p. 561-570 Author(s): Lee, C. Ellen; Warden, Stuart J.; Szuck, Beth; Lau, Y. K. James Database: CINAHL

6. Patient perceptions and experiences with falls during hospitalization and after discharge. Source: Applied Nursing Research; Aug 2016; vol. 31 ; p. 79-85 Author(s): Shuman, Clayton; Jia Liu; Montie, Mary; Galinato, Jose Gabriel; Todd, Molly A.; Hegstad, Marcia; Titler, Marita Database: CINAHL 4

7. Continuous Monitoring of Turning Mobility and Its Association to Falls and Cognitive Function: A Pilot Study. Source: Journals of Gerontology Series A: Biological Sciences & Medical Sciences; Aug 2016; vol. 71 (no. 8); p. 1102-1108 Author(s): Mancini, Martina; Schlueter, Heather; El-Gohary, Mahmoud; Mattek, Nora; Duncan, Colette; Kaye, Jeffrey; Horak, Fay B. Abstract:Background: Difficulty turning is a major contributor to mobility disability, falls, and reduced quality of life in older people because it requires dynamic balance control that worsens with age. However, no study has quantified the quality and quantity of turning during normal daily activities in older people. The objective of this pilot study was to determine if quality of turning during daily activities is associated with falls and/or cognitive function.Methods: Thirty-five elderly participants (85 Âą 8 years) wore three Opal inertial sensors. Turning and activity rate were measured. Based on retrospective falls, participants were grouped into nonfallers (N = 16), single fallers (N = 12), and recurrent fallers (N = 7). We also determined which turning characteristic predicted falls in the 6 months following the week of monitoring.Results: Quality of turning was significantly compromised in recurrent fallers compared with nonfallers (p < .05). In contrast, activity rate and mean number of turns per hour were similar across the three groups. Also, quality of turning during a prescribed test was similar across the three groups. Visuospatial and memory functions and the Tinetti Balance Scores were associated with quality of turning. Future falls were related to an increased variability of number of steps to turn.Conclusions: Continuous monitoring of turning characteristics, while walking during daily activities, is feasible in older people. Turning characteristics during daily life appear to be more sensitive to fall risk than prescribed turning tasks. These findings suggest a slower, less variable, cautious turning strategy in elderly volunteers with a history of falls. Database: CINAHL

8. Antidepressant Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study. Source: Annals of Pharmacotherapy; Jul 2016; vol. 50 (no. 7); p. 525-533 Author(s): Marcum, Zachary A.; Perera, Subashan; Thorpe, Joshua M.; Switzer, Galen E.; Castle, Nicholas G.; Strotmeyer, Elsa S.; Simonsick, Eleanor M.; Ayonayon, Hilsa N.; Phillips, Caroline L.; Rubin, Susan; Zucker-Levin, Audrey R.; Bauer, Douglas C.; Shorr, Ronald I.; Kang, Yihuang; Gray, Shelly L.; Hanlon, Joseph T. Abstract:Background: Few studies have compared the risk of recurrent falls across various antidepressant agents-using detailed dosage and duration data-among community-dwelling older adults, including those who have a history of a fall/fracture.Objective: To examine the association of antidepressant use with recurrent falls, including among those with a history of falls/fractures, in community-dwelling elders.Methods: This was a longitudinal analysis of 2948 participants with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Any antidepressant medication use was self-reported at years 1, 2, 3, 5, and 6 and further categorized as (1) selective serotonin reuptake inhibitors (SSRIs), (2) tricyclic antidepressants, and (3) others. Dosage and duration were examined. The outcome was recurrent falls (â&#x2030;Ľ2) in the ensuing 12-month period following each medication data collection.Results: Using multivariable generalized estimating equations models, we observed a 48% greater likelihood of recurrent falls in antidepressant users compared with nonusers (adjusted odds ratio [AOR] = 1.48; 95% CI = 5

1.12-1.96). Increased likelihood was also found among those taking SSRIs (AOR = 1.62; 95% CI = 1.15-2.28), with short duration of use (AOR = 1.47; 95% CI = 1.04-2.00), and taking moderate dosages (AOR = 1.59; 95% CI = 1.15-2.18), all compared with no antidepressant use. Stratified analysis revealed an increased likelihood among users with a baseline history of falls/fractures compared with nonusers (AOR = 1.83; 95% CI = 1.282.63).Conclusion: Antidepressant use overall, SSRI use, short duration of use, and moderate dosage were associated with recurrent falls. Those with a history of falls/fractures also had an increased likelihood of recurrent falls. Database: CINAHL

9. Recurrent falls in Parkinsonâ&#x20AC;&#x2122;s disease after one year of follow-up: A nested casecontrol study. Source: Archives of Gerontology & Geriatrics; Jul 2016; vol. 65 ; p. 17-24 Author(s): Gazibara, Tatjana; Tepavcevic, Darija Kisic; Svetel, Marina; Tomic, Aleksandra; Stankovic, Iva; Kostic, Vladimir S.; Pekmezovic, Tatjana Database: CINAHL

10. Daytime sleepiness is independently associated with falls in older adults with dementia. Source: Geriatrics & Gerontology International; Jul 2016; vol. 16 (no. 7); p. 850-855 Author(s): Chen, Pin-Yuan; Chiu, Hsiao-Ting; Chiu, Hsiao-Yean Database: CINAHL

11. Activity, balance, learning, and exposure (ABLE): a new intervention for fear of falling. Source: International Journal of Geriatric Psychiatry; Jul 2016; vol. 31 (no. 7); p. 791-798 Author(s): Wetherell, Julie Loebach; Johnson, Kristen; Chang, Douglas; Ward, Samuel R.; Bower, Emily S.; Merz, Caroline; Petkus, Andrew J. Abstract:Objective: Fear of falling is an important problem among older adults, even those with relatively low rates of objective fall risk, who are often overlooked as targets for intervention.Method: We developed and pilot tested a new intervention, Activity, Balance, Learning, and Exposure (ABLE), in a sample of 10 older adults with excessive fear of falling. The ABLE intervention integrates exposure therapy and cognitive restructuring with a home safety evaluation and an exercise program and is conducted in the home. In this pilot project, ABLE was jointly conducted by a physical therapist and a psychologist with expertise in geriatric anxiety disorders.Results: The intervention was feasible and acceptable and resulted in decreases in fear and activity avoidance for most participants. One participant experienced an injurious fall.Discussion: We learned a number of important lessons resulting in modifications to the inclusion criteria, assessments, and intervention over the course of this pilot study. Results suggest that ABLE has promise for treating excessive fear of falling in the elderly and support testing the intervention in a larger randomized trial. Copyright ÂŠ 2016 John Wiley & Sons, Ltd. 6

Database: CINAHL

12. Reducing inpatient falls: Human Factors & Ergonomics offers a novel solution by designing safety from the patients’ perspective. Source: International Journal of Nursing Studies; Jul 2016; vol. 59 Author(s): Hignett, Sue; Wolf, Laurie Database: CINAHL

13. A longitudinal qualitative study of health care personnel's perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers. Source: Journal of Clinical Nursing; Jul 2016; vol. 25 (no. 13/14); p. 1912-1922 Author(s): Skytt, Bernice; Engström, Maria; Mårtensson, Gunilla; Mamhidir, Anna-Greta Database: CINAHL

14. Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson’s Disease. Source: Neurorehabilitation & Neural Repair; Jul 2016; vol. 30 (no. 6); p. 512-527 Author(s): Shen, Xia; Wong-Yu, Irene S. K.; Mak, Margaret K. Y. Database: CINAHL

15. Incidence and characteristic analysis of in-hospital falls after anesthesia. Source: Perioperative medicine (London, England); 2016; vol. 5 ; p. 11 Author(s): Lam, Chen-Fuh; Hsieh, Shiu-Ying; Wang, Jen-Hung; Pan, Hui-Shan; Liu, XiuZhu; Ho, Yu-Ching; Chen, Tsung-Ying Abstract:In-hospital falls may result in serious clinical adverse consequences, but the effects of anesthesia in the occurrence of postoperative falls are still undetermined. Anesthesia may theoretically cause postoperative falls due to the residual pharmacologic and neuromuscular blocking effects of anesthetics. We retrospectively reviewed events of inhospital falls occurred after anesthesia management to identify the incidence and risk factors of postanesthesia falls. We reviewed the postanesthesia visit of patients received anesthesia in the Hualien Buddhist Tzu Chi General Hospital from January 2009 to December 2013. Falls happened within 24 h after anesthesia were recorded. The Poisson regression model was used for simultaneous analysis of the association between incidence proportion of postanesthesia falls and the potential risk factors. A total of 60,796 inpatients received anesthesia management over the past 5 years, and ten patients fell within 24 h after anesthesia. All cases happened in the general wards. Falls occurred more often at the bedside, presence of caregivers, and during the daytime. Patients underwent regional anesthesia, and old age significantly increased the risk of postanesthesia falls, while differences in gender and ASA physical status did not affect the occurrence of 7

postanesthesia falls. The overall incidence proportion of postanesthesia falls is 1.6 cases per 10,000 patients (95 % CI 0.006 to 0.026 %) over a 24-h observation period. Falls are more commonly happened during the less expected periods after operation and are increased in the elderly and patients received regional anesthesia. This study highlights that more comprehensive clinical practice guidelines for postoperative care should be exercised to prevent the in-hospital falls. Database: Medline

16. Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial. Source: BMC geriatrics; 2016; vol. 16 ; p. 34 Author(s): Sherrington, Catherine; Fairhall, Nicola; Kirkham, Catherine; Clemson, Lindy; Howard, Kirsten; Vogler, Constance; Close, Jacqueline C T; Moseley, Anne M; Cameron, Ian D; Mak, Jenson; Sonnabend, David; Lord, Stephen R Abstract:Lasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can improve mobility after fracture and reduce falls in older people, however the optimal approach to rehabilitation after fall-related lower limb and pelvic fracture is unclear. This randomised controlled trial aims to evaluate the effects of an exercise and fall prevention selfmanagement intervention on mobility-related disability and falls in older people following fallrelated lower limb or pelvic fracture. Cost-effectiveness of the intervention will also be investigated. A randomised controlled trial with concealed allocation, assessor blinding for physical performance tests and intention-to-treat analysis will be conducted. Three hundred and fifty people aged 60 years and over with a fall-related lower limb or pelvic fracture, who are living at home or in a low care residential aged care facility and have completed active rehabilitation, will be recruited. Participants will be randomised to receive a 12-month intervention or usual care. The intervention group will receive ten home visits from a physiotherapist to prescribe an individualised exercise program with motivational interviewing, plus fall prevention education through individualised advice from the physiotherapist or attendance at the group based "Stepping On" program (seven two-hour group sessions). Participants will be followed for a 12-month period. Primary outcome measures will be mobility-related disability and falls. Secondary outcomes will include measures of balance and mobility, falls risk, physical activity, walking aid use, frailty, pain, nutrition, falls efficacy, mood, positive and negative affect, quality of life, assistance required, hospital readmission, and health-system and community-service contact. This study will determine the effect and cost-effectiveness of this exercise self management intervention on mobility-related disability and falls in older people who have recently sustained a fall-related lower limb or pelvic fracture. The results will have implications for the design and implementation of interventions for older people with fall related lower limb fractures. The findings of this study will be disseminated in peer-reviewed journals and through professional and scientific conferences. Australian New Zealand Clinical Trials Registry: ACTRN12610000805077. Database: Medline

17. Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States. Source: PloS one; 2016; vol. 11 (no. 3); p. e0150939 Author(s): Verma, Santosh K; Willetts, Joanna L; Corns, Helen L; Marucci-Wellman, Helen R; Lombardi, David A; Courtney, Theodore K Abstract:Falls are the leading cause of unintentional injuries in the U.S.; however, national estimates for all community-dwelling adults are lacking. This study estimated the national incidence of falls and fall-related injuries among community-dwelling U.S. adults by age and gender and the trends in fall-related injuries across the adult life span. Nationally representative data from the National Health Interview Survey (NHIS) 2008 Balance and Dizziness supplement was used to develop national estimates of falls, and pooled data from the NHIS was used to calculate estimates of fall-related injuries in the U.S. and related trends from 2004-2013. Costs of unintentional fall-related injuries were extracted from the CDC's Web-based Injury Statistics Query and Reporting System. Twelve percent of community-dwelling U.S. adults reported falling in the previous year for a total estimate of 80 million falls at a rate of 37.2 falls per 100 person-years. On average, 9.9 million fall-related injuries occurred each year with a rate of 4.38 fall-related injuries per 100 person-years. In the previous three months, 2.0% of older adults (65+), 1.1% of middle-aged adults (45-64) and 0.7% of young adults (18-44) reported a fall-related injury. Of all fall-related injuries among community-dwelling adults, 32.3% occurred among older adults, 35.3% among middle-aged adults and 32.3% among younger adults. The age-adjusted rate of fall-related injuries increased 4% per year among older women (95% CI 1%-7%) from 2004 to 2013. Among U.S. adults, the total lifetime cost of annual unintentional fall-related injuries that resulted in a fatality, hospitalization or treatment in an emergency department was 111 billion U.S. dollars in 2010. Falls and fall-related injuries represent a significant health and safety problem for adults of all ages. The findings suggest that adult fall prevention efforts should consider the entire adult lifespan to ensure a greater public health benefit. Database: Medline

18. A Comprehensive Initiative to Prevent Falls Among Newborns. Source: Nursing for women's health; 2016; vol. 20 (no. 3); p. 247-257 Author(s): Ainsworth, Rose Mary; Summerlin-Long, Shelley; Mog, Cathy Abstract:Our hospital experienced seven instances of newborns falling over a 7-month period. Until that time, there had been no reported newborn falls. We formed a committee to study the situation and make recommendations for change. Common factors observed were early morning hours and an exhausted parent, usually the mother, falling asleep while feeding the newborn. The committee developed a policy and procedure addressing falls among newborns, created staff education and tools, and posted signage in mothers' rooms. We also updated crib cards to include information about falls and safe sleep, and we revised newborn admission education for parents with additional information about falls. The incidence of newborns falling has decreased since we implemented these changes. ÂŠ 2016 AWHONN, the Association of Womenâ&#x20AC;&#x2122;s Health, Obstetric and Neonatal Nurses. Database: Medline

19. Protecting Patient Safety: Can Video Monitoring Prevent Falls in High-Risk Patient Populations? Source: Journal of nursing care quality; 2016; vol. 31 (no. 2); p. 131-138 Author(s): Sand-Jecklin, Kari; Johnson, Jennifer Ray; Tylka, Sharon Abstract:Despite implementation of many prevention strategies, patient falls in hospitals continue to be a significant safety problem, causing nursing staff and administrators to seek innovative means to further reduce falls among hospitalized patients. This article describes the feasibility and impact of implementing centralized video monitoring on the safety of patients identified as high risk for falls, as well as implications of video monitoring in the acute care setting. Database: Medline

20. Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke. Source: Disability and rehabilitation; Sep 2016; vol. 38 (no. 18); p. 1811-1819 Author(s): Goljar, Nika; Globokar, Daniel; PuziÄ&#x2021;, NataĹĄa; Kopitar, Natalija; VrabiÄ?, Maja; Ivanovski, Matic; Vidmar, Gaj Abstract:To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients. A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010-2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006-2014 period to evaluate effectiveness of fall-risk reduction measures. The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and nonextreme FIM score (55-101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014. The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention. Implications for Rehabilitation Recognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards. Assessing the fall risk is a team tasks and combines information from various sources. Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient. Database: Medline

PRESSURE ULCERS 1. The revised pressure ulcer staging criteria: where are we going and why? Source: Journal of Wound Care; Jul 2016; vol. 25 (no. Sup7) Author(s): Bryant, Ruth Database: CINAHL

2. From Pressure Ulcers to ''Pressure Injury'': Disambiguation and Anthropology. Source: Advances in Skin & Wound Care; Jul 2016; vol. 29 (no. 7); p. 295-295 Author(s): Salcido, Richard "Sal" Database: CINAHL

3. Is single room hospital accommodation associated with differences in healthcareassociated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls. Source: Journal of Health Services Research & Policy; Jul 2016; vol. 21 (no. 3); p. 147-155 Author(s): Simon, Michael; Maben, Jill; Murrells, Trevor; Griffiths, Peter Database: CINAHL

4. Use of the Pressure Ulcer Scale for Healing ( PUSH) in Inpatient Rehabilitation: A Case Example. Source: Rehabilitation Nursing; Jul 2016; vol. 41 (no. 4); p. 207-210 Author(s): Zeigler, Mary; Smiley, Jill; Ehrlich-Jones, Linda; Moore, Jennifer L. Database: CINAHL

5. Factors Associated With Treatment Failure of Infected Pressure Sores. Source: Annals of surgery; Aug 2016; vol. 264 (no. 2); p. 399-403 Author(s): Jugun, Kheeldass; Richard, Jean-Christophe; Lipsky, Benjamin A; Kressmann, Benjamin; Pittet-Cuenod, Brigitte; SuvĂ , Domizio; Modarressi, Ali; UĂ§kay, Ilker Abstract:In this study, we assess interdisciplinary surgical and medical parameters associated to recurrences of infected pressure ulcers. There is a little in the published literature regarding factors associated with the outcome of treatment of infected pressure ulcers. We undertook a single-center review of spinal injured adults hospitalized for an infected pressure ulcer or implant-free osteomyelitis and reviewed the literature on this topic from 1990-2015. We found 70 lesions in 31 patients (52 with osteomyelitis) who had a median follow-up of 2.7 years (range, 4 months to 19 years). The median duration of antibiotic therapy was 6 weeks, of which 1 week was parenteral. Clinical recurrence after 11

treatment was noted in 44 infected ulcers (63%), after a median interval of 1 year. In 86% of these recurrences, cultures yielded a different organism than the preceding episode. By multivariate analyses, the following factors were not significantly related to recurrence: number of surgical interventions (hazard ratio 0.9, 95% confidence interval 0.5-1.5); osteomyelitis (hazard ratio 1.5; 0.7-3.1); immune suppression; prior sacral infections, and duration of total (or just parenteral) antibiotic sue. Patients with antibiotic treatment for <6 weeks had the same failure rate as those with as >12 weeks (Ď&#x2021; test; P = 0.90). In patients with infected pressure ulcers, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogen(s). The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence, suggesting recurrences are caused by reinfections caused by other extrahospital factors. Database: Medline

6. The revised pressure ulcer staging criteria: where are we going and why? Source: Journal of wound care; Jul 2016; vol. 25 Author(s): Bryant, Ruth Database: Medline

SEPSIS 1. Sepsis and Septic Shock: Lingering Questions Source: Critical Care Nursing Quarterly; 2016; vol. 39 (no. 1); p. 3-13 Author(s): Dumont, Tiffany; Francis-Frank, Lyndave; Chong, Josebelo; Balaan, Marvin R Abstract:Sepsis and septic shock are major health conditions in the United States, with a high incidence and mortality. The Surviving Sepsis Campaign, which was formed in 2002, formulates guidelines for the management of severe sepsis and septic shock and has actually demonstrated a reduction in mortality with institution of "sepsis bundles." Despite this, some elements of the guidelines have been questioned, and recent data suggest that strict compliance with bundles and protocols may not be necessary. Still, prompt recognition and treatment of sepsis and septic shock remain of utmost importance. Database: BNI

2. Sepsis-3: What is the Meaning of a Definition? Source: Critical Care Medicine; Aug 2016; vol. 44 (no. 8); p. 1459-1460 Author(s): Marshall, John C. Abstract:The article discusses the definition of sepsis which characterized by putrefaction and a foul smell. Topics mentioned include the importance to understand the biology of infection, the role of microorganisms in disease and the efficacy and safety of medicine and therapies for treating sepsis with specific diagnostic criteria. Database: CINAHL 12

3. Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials. Source: Critical Care Medicine; Aug 2016; vol. 44 (no. 8); p. 1461-1467 Author(s): Yende, Sachin; Austin, Shamly; Rhodes, Andrew; Finfer, Simon; Opal, Steven; Thompson, Taylor; Bozza, Fernando A.; LaRosa, Steven P.; Ranieri, V. Marco; Angus, Derek C. Abstract:Objectives: To describe the quality of life among sepsis survivors.Design: Secondary analyses of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [derivation cohort] and PROWESSSHOCK [validation cohort]).Setting: ICUs in North and South America, Europe, Africa, Asia, and Australia.Patients: Adults with severe sepsis. We analyzed only patients who were functional and living at home without help before sepsis hospitalization (n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, respectively).Interventions: None.Measurements and Main Results: In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, the average age of patients living at home independently was 63 and 61 years; 400 (34.9%) and 298 (30.2%) died by 6 months. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis, 580 patients had a quality of life measured using EQ-5D at 6 months. Of these, 41.6% could not live independently (22.7% were home but required help, 5.1% were in nursing home or rehabilitation facilities, and 5.3% were in acute care hospitals). Poor quality of life at 6 months, as evidenced by problems in mobility, usual activities, and self-care domains were reported in 37.4%, 43.7%, and 20.5%, respectively, and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK. Over 45% of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year.Conclusions: Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis, one third had died and of those who survived, a further one third had not returned to independent living by 6 months. Both mortality and quality of life should be considered when designing new interventions and considering endpoints for sepsis trials. Database: CINAHL

4. Surviving Severe Sepsis: Is That Enough? Source: Critical Care Medicine; Aug 2016; vol. 44 (no. 8); p. 1603-1604 Author(s): Anderson-Shaw, Lisa Abstract:An introduction to the journal is presented in which the editor discusses the complication of sepsis with multiple acute organ dysfunction in the intensive care unit (ICU) setting. Database: CINAHL

5. Sepsis-Induced Endoplasmic Reticulum Stress: A Matter of Life and Death? Source: Critical Care Medicine; Aug 2016; vol. 44 (no. 8); p. 1626-1627 Author(s): Crouser, Elliott D. 13

Abstract:The author reflects on the advancement of resuscitative care for treating patients with sepsis wherein resuscitation was designed to optimize the timing of antibiotics and fluid resuscitation to prevent multiple organ failures. He examines the contribution of several illnesses to endoplasmic reticulum (ER) stress such as ischemia-reperfusion injury and inflammation. The author cites the use of hemodynamic indices to monitor human sepsis. Database: CINAHL

6. Community-onset sepsis and its public health burden: a systematic review. Source: Systematic reviews; 2016; vol. 5 (no. 1); p. 81 Author(s): Tsertsvadze, Alexander; Royle, Pam; Seedat, Farah; Cooper, Jennifer; Crosby, Rebecca; McCarthy, Noel Abstract:Sepsis is a life-threatening condition and major contributor to public health and economic burden in the industrialised world. The difficulties in accurate diagnosis lead to great variability in estimates of sepsis incidence. There has been even greater uncertainty regarding the incidence of and risk factors for community-onset sepsis (COS). We systematically reviewed the recent evidence on the incidence and risk factors of COS in high income countries (North America, Australasia, and North/Western Europe). Cohort and case-control studies were eligible for inclusion. Medline and Embase databases were searched from 2002 onwards. References of relevant publications were hand-searched. Two reviewers screened titles/abstracts and full-texts independently. One reviewer extracted data and appraised studies which were cross-checked by independent reviewers. Disagreements were resolved via consensus. Odds ratios (ORs) and 95 percent confidence intervals (95 % CIs) were ascertained by type of sepsis (non-severe, severe, and septic shock). Ten cohort and 4 case-control studies were included. There was a wide variation in the incidence (# cases per 100,000 per year) of non-severe sepsis (range: 64-514), severe sepsis (range: 40455), and septic shock (range: 9-31). Heterogeneity precluded statistical pooling. Two cohort and 4 case-control studies reported risk factors for sepsis. In one case-control and one cohort study, older age and diabetes were associated with increased risk of sepsis. The same case-control study showed an excess risk for sepsis in participants with clinical conditions (e.g., immunosuppression, lung disease, and peripheral artery disease). In one cohort study, higher risk of sepsis was associated with being a nursing home resident (OR = 2.60, 95 % CI: 1.20, 5.60) and in the other cohort study with being physically inactive (OR = 1.33, 95 % CI: 1.13, 1.56) and smoking tobacco (OR = 1.85, 95 % CI: 1.54, 2.22). The evidence on sex, ethnicity, statin use, and body mass index as risk factors was inconclusive. The lack of a valid standard approach for defining sepsis makes it difficult to determine the true incidence of COS. Differences in case ascertainment contribute to the variation in incidence of COS. The evidence on COS is limited in terms of the number and quality of studies. This review highlights the urgent need for an accurate and standard method for identifying sepsis. Future studies need to improve the methodological shortcomings of previous research in terms of case definition, identification, and surveillance practice. PROSPERO CRD42015023484. Database: Medline

7. Prehospital management and identification of sepsis by emergency medical services: a systematic review. Source: Emergency medicine journal : EMJ; Jun 2016; vol. 33 (no. 6); p. 408-413 14

Author(s): Lane, Daniel; Ichelson, Robbie I; Drennan, Ian R; Scales, Damon C Abstract:To identify studies describing the accuracy of prehospital sepsis identification and to summarise results of studies of prehospital management of patients with sepsis, severe sepsis or septic shock. We conducted a systematic review to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors extracted data describing the study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS provider diagnosis of sepsis. Our search identified no randomised controlled trials and 16 cohort studies. Eight studies described the identification of sepsis, seven described prehospital management or treatment of sepsis and one described both. The most common approach to the identification of sepsis involved applying systemic inflammatory response syndrome criteria or a combination of vital signs, which had sensitivity ranging from 0.43 to 0.86 when used alone or combined with provider impression. Only four studies collected information required to calculate specificity (0.47-0.87). Metaanalysis was not performed owing to significant heterogeneity and an overall low quality of evidence. A few studies described prehospital sepsis treatment-most commonly intravenous fluid resuscitation. The evidence suggests that identification of sepsis in the prehospital setting by EMS providers is carried out with varied success, depending on the strategy used; however, high-quality studies are lacking. Relying on provider impression alone had poor sensitivity, but some moderate-quality evidence supporting structured screening for sepsis with vital signs criteria demonstrated modest sensitivity and specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management is needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rightsand-licensing/ Database: Medline

8. Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes. Source: Critical care (London, England); 2016; vol. 20 ; p. 89 Author(s): Rhee, Chanu; Kadri, Sameer S; Danner, Robert L; Suffredini, Anthony F; Massaro, Anthony F; Kitch, Barrett T; Lee, Grace; Klompas, Michael Abstract:Sepsis is the focus of national quality improvement programs and a recent public reporting measure from the Centers for Medicare and Medicaid Services. However, diagnosing sepsis requires interpreting nonspecific signs and can therefore be subjective. We sought to quantify interobserver variability in diagnosing sepsis. We distributed five case vignettes of patients with suspected or confirmed infection and organ dysfunction to a sample of practicing intensivists. Respondents classified cases as systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, or none of the above. Interobserver variability was calculated using Fleiss' Îş for the five-level classification, and for answers dichotomized as severe sepsis/septic shock versus not-severe sepsis/septic shock and any sepsis category (sepsis, severe sepsis, or septic shock) versus not-sepsis. Ninetyfour physicians completed the survey. Most respondents (88%) identified as critical care specialists; other specialties included pulmonology (39%), anesthesia (19%), surgery (9%), and emergency medicine (9%). Respondents had been in practice for a median of 8 years, and 90% practiced at academic hospitals. Almost all respondents (83%) felt strongly or somewhat confident in their ability to apply the traditional consensus sepsis definitions. 15

However, overall interrater agreement in sepsis diagnoses was poor (Fleiss' κ 0.29). When responses were dichotomized into severe sepsis/septic shock versus not-severe sepsis/septic shock or any sepsis category versus not-sepsis, agreement was still poor (Fleiss' κ 0.23 and 0.18, respectively). Seventeen percent of respondents classified one of the five cases as severe sepsis/septic shock, 27.7% rated two cases, 33.0% respondents rated three cases, 19.2% rated four cases, and 3.2% rated all five cases as severe sepsis/septic shock. Among respondents who felt strongly confident in their ability to use sepsis definitions (n = 45), agreement was no better (Fleiss' κ 0.28 for the five-category classification, and Fleiss' κ 0.21 for the dichotomized severe sepsis/septic shock classification). Cases were felt to be extremely or very realistic in 74% of responses; only 3% were deemed unrealistic. Diagnosing sepsis is extremely subjective and variable. Objective criteria and standardized methodology are needed to enhance consistency and comparability in sepsis research, surveillance, benchmarking, and reporting. Database: Medline

9. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6. Source: BMJ quality improvement reports; 2016; vol. 5 (no. 1) Author(s): Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie Abstract:The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance. Database: Medline

10. Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials. Source: Critical care medicine; Aug 2016; vol. 44 (no. 8); p. 1461-1467 Author(s): Yende, Sachin; Austin, Shamly; Rhodes, Andrew; Finfer, Simon; Opal, Steven; Thompson, Taylor; Bozza, Fernando A; LaRosa, Steven P; Ranieri, V Marco; Angus, Derek C

Abstract:To describe the quality of life among sepsis survivors. Secondary analyses of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [derivation cohort] and PROWESS-SHOCK [validation cohort]). ICUs in North and South America, Europe, Africa, Asia, and Australia. Adults with severe sepsis. We analyzed only patients who were functional and living at home without help before sepsis hospitalization (n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, respectively). None. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, the average age of patients living at home independently was 63 and 61 years; 400 (34.9%) and 298 (30.2%) died by 6 months. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis, 580 patients had a quality of life measured using EQ-5D at 6 months. Of these, 41.6% could not live independently (22.7% were home but required help, 5.1% were in nursing home or rehabilitation facilities, and 5.3% were in acute care hospitals). Poor quality of life at 6 months, as evidenced by problems in mobility, usual activities, and self-care domains were reported in 37.4%, 43.7%, and 20.5%, respectively, and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK. Over 45% of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year. Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis, one third had died and of those who survived, a further one third had not returned to independent living by 6 months. Both mortality and quality of life should be considered when designing new interventions and considering endpoints for sepsis trials. Database: Medline

DETERIORATING PATIENT

1. "Deterioration to Door Time": An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients. Source: Journal of general internal medicine; Aug 2016; vol. 31 (no. 8); p. 895-900 Author(s): Sankey, Christopher B; McAvay, Gail; Siner, Jonathan M; Barsky, Carol L; Chaudhry, Sarwat I Abstract:Timely escalation of care for patients experiencing clinical deterioration in the inpatient setting is challenging. Deterioration on a general floor has been associated with an increased risk of death, and the early period of deterioration may represent a time during which admission to the intensive care unit (ICU) improves survival. Previous studies examining the association between delay from onset of clinical deterioration to ICU transfer and mortality are few in number and were conducted more than 10 years ago. We aimed to evaluate the impact of delays in the escalation of care among clinically deteriorating patients in the current era of inpatient medicine. This was a retrospective cohort study that analyzed data from 793 patients transferred from non-intensive care unit (ICU) inpatient floors to the medical intensive care unit (MICU), from 2011 to 2013 at an urban, tertiary, academic medical center. "Deterioration to door time (DTDT)" was defined as the time between onset of clinical deterioration (as evidenced by the presence of one or more vital sign indicators including respiratory rate, systolic blood pressure, and heart rate) and arrival in the MICU. In our sample, 64.6 % had delays in care escalation, defined as greater than 4 h based on 17

previous studies. Mortality was significantly increased beginning at a DTDT of 12.1 h after adjusting for age, gender, and severity of illness. Delays in the escalation of care for clinically deteriorating hospitalized patients remain frequent in the current era of inpatient medicine, and are associated with increased in-hospital mortality. Development of performance measures for the care of clinically deteriorating inpatients remains essential, and timeliness of care escalation deserves further consideration. Database: Medline

2. The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study. Source: Intensive & critical care nursing; Jun 2016; vol. 34 ; p. 25-33 Author(s): Stafseth, Siv K; GrĂ¸nbeck, Sturle; Lien, Tine; Randen, Irene; Lerdal, Anners Abstract:To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour oncall nursing support. To secure patient safety in hospital wards, nurses may increase the quality of care using a tool to detect the failure of vital functions. Possibilities for support can be provided through on-call supervision from a qualified team or nurse. This exploratory qualitative investigation used focus group interviews with nurses from two wards of a university hospital in Norway. A purposive sample of seven registered nurses was interviewed in focus groups. A semi-structured guide and an inductive thematic analysis were used to identify interview themes. Three themes emerged: (1) experiences with the early recognition of deterioration using the MEWS, (2) supportive collaboration and knowledge transfer between nurses and (3) a "new" precise language using the score for communicating with physicians. The use of scores and support were perceived as improving care for deteriorating patients and for supporting the collaboration of nurses with other professionals. In our study, nurses described increased confidence in the recognition of deteriorating patients and in the management of such situations. The non-critical attitude, supportive communication and interactive learning according to the MICN were essential elements for success. Copyright ÂŠ 2015 Elsevier Ltd. All rights reserved. Database: Medline

PATIENT SAFETY A PICU patient safety checklist: rate of utilization and impact on patient care Brianna L. Mckelvie, et al Int J Qual Health Care 2016 28: 371-375 Abstract: http://intqhc.oxfordjournals.org/content/28/3/371.abstract?etoc

A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses Paul O'connor, et al Int J Qual Health Care 2016 28: 339-345

Abstract: http://intqhc.oxfordjournals.org/content/28/3/339.abstract?etoc

Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery Joel J. Gagnier, et al Int J Qual Health Care 2016 28: 363-370 Abstract: http://intqhc.oxfordjournals.org/content/28/3/363.abstract?etoc

1. Promoting Patient Safety With Perioperative Hand-off Communication Source: Journal of PeriAnesthesia Nursing; Jun 2016; vol. 31 (no. 3); p. 245-253. Author(s): Robinson, Nancy Leighton Abstract:Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment. References Database: BNI

2. Patient safety and rocket science. Source: BMJ Quality & Safety; Aug 2016; vol. 25 (no. 8); p. 562-564 Author(s): McCulloch, Peter Database: CINAHL

3. At a crossroads? Key challenges and future opportunities for patient involvement in patient safety. Source: BMJ Quality & Safety; Aug 2016; vol. 25 (no. 8); p. 565-568 Author(s): O'Hara, Jane K.; Lawton, Rebecca J. Database: CINAHL

4. Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. Source: International Journal of Nursing Studies; Aug 2016; vol. 60 ; p. 263-271 Author(s): Cho, Eunhee; Lee, Nam-Ju; Kim, Eun-Young; Kim, Sinhye; Lee, Kyongeun; Park, Kwang-Ok; Sung, Young Hee Database: CINAHL

5. Patient safety in acute care: are we going around in circles? Source: British Journal of Nursing; Jul 2016; vol. 25 (no. 13); p. 747-751 Author(s): Waldie, James; Day, Tina; Tee, Stephen Abstract:This article provides a critical discussion examining why adult patients continue to unnecessarily deteriorate and die despite repeated healthcare policy initiatives. After considering the policy background and reviewing current trends in the data, it proposes some solutions that, if enacted, would, the authors believe, have a direct impact on survival rates. Health professionals working in hospitals are failing to recognise signs of physiological deterioration. As a result, adult patients are dying unnecessarily, estimated to be in the region of 1000 a month. This is despite international healthcare policy requiring practitioners to be appropriately trained to recognise the deteriorating adult patient and to intervene. A literature review centred on health policy for England from 1999 to 2015 was undertaken, with reference to international policy and practice. This article also draws on the authorsâ&#x20AC;&#x2122; combined clinical experience, which is underpinned by relevant research and theory. The implications for nursing could be significant. Change is urgently required otherwise people will continue to die unnecessarily. Health professionals, healthcare organisations and international governments working together can prevent unnecessary deaths from happening within acute hospitals. Database: CINAHL

6. Tip of the iceberg: patient safety incidents in primary care. Source: BMJ Quality & Safety; Jul 2016; vol. 25 (no. 7); p. 477-480 Author(s): Sarkar, Urmimala Database: CINAHL

7. Patient safety and the problem of many hands. Source: BMJ Quality & Safety; Jul 2016; vol. 25 (no. 7); p. 485-489 Author(s): Dixon-Woods, Mary; Pronovost, Peter J. Database: CINAHL

8. Patient safety in primary care: incident reporting and significant event reviews in British general practice. Source: Health & Social Care in the Community; Jul 2016; vol. 24 (no. 4); p. 411-419 Author(s): Rea, David; Griffiths, Sarah Database: CINAHL

9. Nursing physical assessment for patient safety in general wards: reaching consensus on core skills. Source: Journal of Clinical Nursing; Jul 2016; vol. 25 (no. 13/14); p. 1890-1900 Author(s): Douglas, Clint; Booker, Catriona; Fox, Robyn; Windsor, Carol; Osborne, Sonya; Gardner, Glenn Database: CINAHL

10. Handwriting and a nurse's duty of care. Source: British Journal of Nursing; Jun 2016; vol. 25 (no. 11); p. 622-623 Author(s): Griffith, Richard Abstract:The article discusses the professional duty of nurses to write clearly and highlights the financial and human cost of poor handwriting. It points out that a nurse's duty of care includes indirect elements such as information sharing, record keeping and the standard of handwriting in addition to direct care and treatment given to patients. It notes that poor handwriting is a significant risk to patient safety and nurses are duty bound to ensure the safety of their patients by writing clearly. Database: CINAHL

11. Quality Improvement, Education, Simulation and Patient Safety (EP12). Source: BJOG: An International Journal of Obstetrics & Gynaecology; Jun 2016; vol. 123 ; p. 198-220 Database: CINAHL

12. In the Name of Patient Safety, Let's Burden the Emergency Department More. Source: Annals of Emergency Medicine; Jun 2016; vol. 67 (no. 6); p. 737-740 Author(s): Kelen, Gabor; Peterson, Susan; Pronovost, Peter Database: CINAHL

13. Medication Safety Huddles in the Intensive Care Unit: A Patient Safety Initiative Led by Our Critical Care Pharmacists and Nurses. Source: Canadian Journal of Critical Care Nursing; Jun 2016; vol. 27 (no. 2); p. 43-43 Author(s): Webb-Anderson, Karen Database: CINAHL

14. Handoffs, safety culture, and practices: evidence from the hospital survey on patient safety culture. Source: BMC health services research; 2016; vol. 16 (no. 1); p. 254 Author(s): Lee, Soo-Hoon; Phan, Phillip H; Dorman, Todd; Weaver, Sallie J; Pronovost, Peter J Abstract:The context of the study is the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture (HSOPSC). The purpose of the study is to analyze how different elements of patient safety culture are associated with clinical handoffs and perceptions of patient safety. The study was performed with hierarchical multiple linear regression on data from the 2010 Survey. We examine the statistical relationships between perceptions of handoffs and transitions practices, patient safety culture, and patient safety. We statistically controlled for the systematic effects of hospital size, type, ownership, and staffing levels on perceptions of patient safety. The main findings were that the effective handoff of information, responsibility, and accountability were necessary to positive perceptions of patient safety. Feedback and communication about errors were positively related to the transfer of patient information; teamwork within units and the frequency of events reported were positively related to the transfer of personal responsibility during shift changes; and teamwork across units was positively related to the unit transfers of accountability for patients. In summary, staff views on the behavioral dimensions of handoffs influenced their perceptions of the hospital's level of patient safety. Given the known psychological links between perception, attitude, and behavior, a potential implication is that better patient safety can be achieved by a tight focus on improving handoffs through training and monitoring. Database: Medline

15. Healthcare professionals' views on feedback of a patient safety culture assessment. Source: BMC health services research; 2016; vol. 16 (no. 1); p. 199 Author(s): Zwijnenberg, Nicolien C; Hendriks, Michelle; Hoogervorst-Schilp, Janneke; Wagner, Cordula Abstract:By assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals' views on the feedback of a patient safety culture assessment. Twenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a website. In a survey, we evaluated healthcare professionals' views on this feedback and the effect of additional information about patient safety culture improvement strategies on the appraisal of the feedback. 20 hospitals 22

participated in part I (evaluation of the report), 13 hospitals participated in part II (evaluation of the website). Healthcare professionals (e.g. members of staff and department heads/managers) rated the feedback in the report and on the website positively (average mean on different aspects = 7.2 on a scale from 1 to 10). Interpreting results was sometimes difficult, and information was sometimes lacking, like specific recommendations and improvement strategies. The provision of additional general information on patient safety culture improvement strategies resulted only in a higher appraisal of the attractiveness (layout) of the report and the understandability of the feedback report. The majority (84 %) of the healthcare professionals agreed or partly agreed that the feedback on patient safety culture stimulated actions to improve patient safety culture. However, a quarter also stated that although the feedback report provided insight into the patient safety culture, they did not know how to improve patient safety culture in their hospital. Healthcare professionals seem to be positive about the feedback on patient safety culture and its effect on stimulating patient safety culture improvement. To optimally tune feedback on patient safety culture towards healthcare professionals, the following might help: 1) pay attention to the understandability of outcomes for its intended users; and 2) create feedback that is tailored towards specific hospital departments. Database: Medline

16. Putting an end to Black Wednesday: improving patient safety by achieving comprehensive trust induction and mandatory training by day 1 . Source: Clinical medicine (London, England); Apr 2016; vol. 16 (no. 2); p. 124-128 Author(s): Gaskell, Natalie; Hinton, Richard; Page, Tristan; Elvins, Tracy; Malin, Adam Abstract:The term 'Black Wednesday' has been used to describe the August national changeover day, a day when a new cohort of inexperienced doctors start work, many of whom are absent from patient care to attend organisational induction and mandatory training. In this paper, we report on the development and implementation of a novel, interactive e-learning programme for induction and mandatory training for junior doctors in a district general hospital in south-west England from August 2013. This comprehensive mandatory-training programme with summative assessment saved 19.5 hours of trust time per trainee. Since the programme's inception, the completion rate has been 100% (n = 370). Subgroup analysis of starters from August 2013 (n = 141) showed that 85.7% completed by day 1 (mean time of completion 3.0 days before day 1, standard deviation 14.2 days). Importantly, 90 minutes of induction was freed on Black Wednesday, enabling earlier, wardbased clinical orientation, thereby enhancing patient safety. We believe that this is the first programme to combine induction with fully assessed, comprehensive mandatory training in a single package. Such an approach is suitable for widespread application and is to be implemented regionally. ÂŠ 2016 Royal College of Physicians. Database: Medline

HUMAN FACTORS 1. Identifying workflow disruptions in the cardiovascular operating room. Source: Anaesthesia; Aug 2016; vol. 71 (no. 8); p. 948-954 Author(s): Cohen, T N; Cabrera, J S; Sisk, O D; Welsh, K L; Abernathy, J H; Reeves, S T; Wiegmann, D A; Shappell, S A; Boquet, A J Abstract:The objectives of this study were to identify the frequency and nature of flow disruptions in the operating room with respect to three cardiac surgical team members: anaesthetists; circulating nurses; and perfusionists. Data collected from 15 cases and coded using a human factors taxonomy identified 878 disruptions. Significant differences were identified in frequency relative to discipline type. Circulating nurses experienced more coordination disruptions (χ(2) (2, N = 110) = 7.136, p < 0.028) and interruptions (χ(2) (2, N = 427) = 29.743, p = 0.001) than anaesthetists and perfusionists, whereas anaesthetists and perfusionists experienced more layout issues than circulating nurses (χ(2) (2, N = 153) = 48.558, p = 0.001). Time to resolve disruptions also varied among disciplines (λ (12, 878) = 5.186, p = 0.000). Although most investigations take a one-size fits all approach in addressing disruptions to flow, this study demonstrates that targeted interventions must focus on differences with respect to individual role. © 2016 The Association of Anaesthetists of Great Britain and Ireland. Database: Medline

2. The human factor. Source: Practical radiation oncology; 2016; vol. 6 (no. 4); p. 215-216 Author(s): Vujovic, Olga Database: Medline

3. Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy. Source: American journal of infection control; Jul 2016; vol. 44 (no. 7); p. 758-760 Author(s): Keller, Sara C; Gurses, Ayse P; Arbaje, Alicia I; Cosgrove, Sara E Database: Medline

4. Human Factors and Human Nature in Cardiothoracic Surgery. Source: The Annals of thoracic surgery; Jun 2016; vol. 101 (no. 6); p. 2059-2066 Author(s): Fann, James I; Moffatt-Bruce, Susan D; DiMaio, J Michael; Sanchez, Juan A Database: Medline

5. Human factors in the emergency department: Is physician perception of time to intubation and desaturation rate accurate? Source: Emergency medicine Australasia : EMA; Jun 2016; vol. 28 (no. 3); p. 295-299 Author(s): Cemalovic, Nail; Scoccimarro, Anthony; Arslan, Albert; Fraser, Robert; Kanter, Marc; Caputo, Nicholas Abstract:The main objective of the present study was to examine the perceived versus actual time to intubation (TTI) as an indication to help determine the situational awareness of Emergency Physicians during rapid sequence intubation and, additionally, to determine the physician's perception of desaturation events. A timed, observation prospective cohort study was conducted. A post-intubation survey was administered to the intubating physician. Each step of the procedure was timed by an observer in order to determine actual TTI. The number of desaturation events was also recorded. One hundred individual intubations were included. The provider perceived TTI was significantly different and underestimated when compared with the actual TTI (23 s, 95% confidence interval (CI) 20.4-25.49 vs 45.5 s, 95% CI 40.2-50.7, P < 0.001, respectively). Pearson correlation coefficient of perceived TTI to actual TTI was r(2) = 0.39 (95% CI 0.21-0.54, P < 0.001). The provider perceived desaturation rate was also significantly different from actual desaturation rate (13, 95% CI 312 vs 23, 95% CI 13-29, P = 0.05, respectively). The overall time to desaturation was 65.1 s. Our findings have shown that provider's perception of TTI occurs sooner than actually observed. Also, the providers were less aware of desaturation during the procedure. ÂŠ 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. Database: Medline

6. Human factors in prehospital research: lessons from the PARAMEDIC trial. Source: Emergency Medicine Journal; Aug 2016; vol. 33 (no. 8); p. 562-568 Author(s): Pocock, Helen; Deakin, Charles D.; Quinn, Tom; Perkins, Gavin D.; Horton, Jessica; Gates, Simon Abstract:Background: There is an urgent need to develop prehospital research capability in order to improve the care of patients presenting to emergency medical services (EMS). The Prehospital Randomised Assessment of a Mechanical compression Device In Cardiac arrest trial, a pragmatic cluster randomised trial evaluating the LUCAS-2 device, represents the largest randomised controlled trial conducted by UK ambulance services to date. The aim of this study was to identify and analyse factors that may influence paramedic attitudes to, and participation in, clinical trials.Methods: Personal and organisational experience from this trial was assessed by feedback from a workshop attended by collaborators from participating EMS and a survey of EMS personnel participating in the trial. A work systems model was used to explain the impact of five interwoven themes-person, organisation, tasks, tools & technology and environment-on trial conduct including gathering of high-quality data.Results: The challenge of training a geographically diverse EMS workforce required development of multiple educational solutions. In order to operationalise the trial protocol, internal organisational relationships were perceived as essential. Staff perceptions of the normalisation of participation and ownership of the trial influenced protocol compliance rates. Undertaking research was considered less burdensome when additional tasks were minimised and more difficult when equipment was unavailable. The prehospital environment presents practical challenges for undertaking clinical trials, but our experience suggests these are not insurmountable and should not preclude conducting high-quality research in 25

this setting.Conclusions: Application of a human factors model to the implementation of a clinical trial protocol has improved understanding of the work system, which can inform the future conduct of clinical trials and foster a research culture within UK ambulance services.Trial Registration Number: ISRCTN08233942. Database: CINAHL

7. Reducing inpatient falls: Human Factors & Ergonomics offers a novel solution by designing safety from the patientsâ&#x20AC;&#x2122; perspective. Source: International Journal of Nursing Studies; Jul 2016; vol. 59. Author(s): Hignett, Sue; Wolf, Laurie Database: CINAHL

BOOKS BACK TO TOP If you are unable to find a book, or require a book that is not on this list, please ask library staff who will be able to locate the book for you using interlibrary loan.

Fast facts about pressure ulcer care for nurses : how to prevent, detect and resolve them in a nutshell / Mary Ellen Dziedzic (2014)

This "Fast Facts" will assist with improving outcomes for patients with pressure ulcers and strategies for decreasing pressure ulcer occurrence within a facility. Using the easy to read, quick-access "Fast Facts" style, the book presents guidelines for assessing, preventing, and treating pressure ulcers, for establishing an ulcer reduction program, and for increasing reimbursement. It includes tips for care in the "Fast Facts in a Nutshell" feature format.

We now have a subscription to EBL Electronic Books and would be interested to know if there are any titles you feel would be of benefit to be added to our collection. The catalogue can be browsed here; you will need your OpenAthens password to access it. You can request books either on the site itself or by emailing us on library@tst.nhs.uk

UPTODATE and DYAMED PLUS BACK TO TOP

UpToDate Access is available to MPH staff only but topics from UpTodate can be supplied to Sompar staff on request. OpenAthens password required. 

Falls in older persons: Risk factors and patient evaluation



Falls: Prevention in nursing care facilities and the hospital setting



Prevention of pressure ulcers



Evaluation and management of severe sepsis and septic shock in adults



Assessment and emergency management of the acutely agitated or violent adult



Prevention of adverse drug events in hospitals

Please contact library staff for details on how to access this resource; you will need an Athens password if accessing from home.

Dynamed Plus Access is available to Sompar staff only but topics from UpTodate can be supplied to MPH staff on request. Open Athens password required

Falls in the elderly Pressure ulcer Sepsis in adults Sepsis treatment in adults Please contact library staff for details on how to access this resource; you will need an Athens password if accessing from home.

REPORTS, PUBLICATIONS AND RESOURCES

Think Infection – stop Sepsis Northumbria Healthcare Read more at: http://fabnhsstuff.net/2016/07/03/think-infection-stop-sepsis-northumbria-healthcare/ Pressure ulcer Prevention Across Hackney In Hackney they identified that all of the patients being admitted to hospital with existing pressure ulcers had recent contact with health or social care services in the community. They hypothesised that increasing awareness and education of pressure ulcer risk and prevention for non-nursing health and social care workers has the potential to reduce the number of pressure ulcers and the severity of ulcers that do develop across the borough. Read more at: http://fabnhsstuff.net/2016/07/05/pressure-ulcer-prevention-across-hackney/ Recognising signs of sepsis in children Health Education England has announced details of a new film Think Sepsis which aims to help health care professionals to spot and respond to the warning signs of sepsis in children. The film highlights the key signs that healthcare staff should be looking out for and asks them to think, ‘could this be sepsis’ when assessing and diagnosing patients. Whilst aimed at clinical trainers the film contains valuable information for GPs and other clinicians working across both primary and secondary care

NICE guidance: sepsis NICE has published new guidance Sepsis: recognition, diagnosis and early management (NG51). This guideline covers the recognition, diagnosis and early management of sepsis for all populations. The guideline committee identified that the key issues to be included were: recognition and early assessment, diagnostic and prognostic value of blood markers for sepsis, initial treatment, escalating care, identifying the source of infection, early monitoring, information and support for patients and carers, and training and education Guidance

Patient Safety Collaboratives: making care safer for all Patient Safety Collaboratives: making care safer for all updates on the work of the 15 teams (known as Patient Safety Collaboratives) to improve patient safety, spread examples of success and influence system leaderships. The teams are led by local Academic Health 29

Science Networks (AHSNs) and made up of talented NHS, academic and healthcare experts. https://improvement.nhs.uk/news-alerts/patient-safety-collaborative-teams-reduce-harmpatients-nationwide/

Raising concerns e learning Health Education England's e-Learning for Healthcare team (HEE e-LfH) has developed a new online resource for healthcare staff to equip them with the necessary knowledge and confidence to raise public interest concerns. http://www.nhsemployers.org/news/2016/07/raising-concerns-e-learning-nowavailable?ec_as=47E84BA16F3C42ADA80A10B233BE9BEB

LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but havenâ&#x20AC;&#x2122;t got time to trawl the databases? Do you need a literature search carried out? Do you need to find evidence to support an improvement? Do you want to know how something has been done elsewhere and whether it worked?

Library staff provide a literature search service for busy clinicians who are pressed for time.

To request a search please complete and return the attached form ,providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library.

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at www.swice.nhs.uk and following the link for Athens selfregistration. Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement. The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.