Current awareness suts dec 2015 by Musgrove Park Hospital Library

Library Service Musgrove Park Academy

Current Awareness Sign Up To Safety This monthly Current Awareness Bulletin is produced by the Library, 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 2 December 2015

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

3 17

Cochrane Systematic Reviews

UpToDate & DynaMed 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.

SUTS Title: Improving patient safety in primary care. Citation: Nursing Times, 2015, vol./is. 111/25(20-22) Author(s): Fairlie, Susan Abstract: A national drive to improve patient safety is extending to all healthcare settings, including primary care. General practice does not have the same infrastructure to support governance and safety arrangements as large acute trusts, and there has not been the same level of national learning. However, a new system of professional regulation requires nurses in all settings to show how they promote a safety culture. This article shows how joining the Sign up to Safety campaign allows primary care organisations and individuals to access a network of support and shared learning to make improvements in their places of work. Better reporting of patient safety incidents using a new national e-form will also help to develop and spread best practice. [Summary]

Title: Do it your way. Citation: Health Service Journal, 2015, vol./is. 125/6452(15-16) Author(s): Carlisle, Daloni Abstract: Daloni Carlisle on a safety campaign [Sign up to Safety] that takes a bottom up approach asking staff to work on areas that matter to them over the next three to five years. [Introduction] Full Text: Available from Emap in HSJ: Health Service Journal, The; Note: ; Collection notes: Institutional nonAthens username and password required - contact library@tst.nhs.uk or phone ext: 2433 for details Available from HSJ: Health Service Journal, The in Library MPH

FALLS Title: Reducing the risk of inpatient falls Citation: Nursing Times 2015 111(47) pp22-3 Author(s): Oxtoby, K Read more at NT http://www.nursingtimes.net/clinical-subjects/patient-safety/a-care-bundle-approach-to-fallsprevention/5070700.article

Title: Reducing falls with a safety spotter program Citation: Nursing, Aug 2015, vol. 45, no. 8, p. 16-19, 0360-4039

Author(s): Primmer, Patricia, Borenstein, Kathleen K., Downing, Michelle T., Fochesto, Denise, Reilly, Laura, Santos, Rachael, Zepeda, Karla, O'Keefe, Trish Abstract: Despite nurses' concerted efforts, over one million falls are reported in hospitals each year. Besides the potential for bodily injury, falls are frightening, can diminish a patient's independence, and increase hospital length of stay. Keeping patients safe by preventing falls supports the goal of shorter and more patient-centered hospital stays. Primmer et al discuss an innovative program that involves educating unlicensed assistive personnel to act as Safe Patient Observation Technicians, or "spotters," for up to four patients grouped in a safety zone. [PUBLICATION] 5 references Title: Strength or power, which is more important to prevent slip-related falls? Citation: Human movement science, Dec 2015, vol. 44, p. 192-200 Author(s): Han, Longzhu, Yang, Feng Abstract: Falls are a serious health and medical concern facing older adults worldwide. Both muscle strength and power have been related to falls among older adults. The primary purpose of this study was to identify which one of these two muscular performances is more important in preventing a sliprelated fall. Twenty-six healthy young adults participated in this study. Their muscle strength (torque) and power capacities were assessed at the right knee under maximum voluntary isometric (flexion and extension) and isokinetic (concentric extension and flexion at three different contraction speeds: 60deg/s, 120deg/s, and 180deg/s) contractions, respectively. They were then subjected to an identical and unannounced slip during gait on a treadmill under the protection of a safety harness after walking regularly for five times on the treadmill. Accuracy of predicting slip outcome (fall vs. recovery) was examined for each muscle performance measurement using logistic regression. Results showed that overall the joint power capacity measurements predicted the slip outcome among these subjects with higher accuracy than did the joint torque capacity measurements. Such results suggested that muscle power could be more closely related to a fall initiated by a slip during gait. The findings from the present study could provide guidance to identify individuals at increased risk of falling using the joint power capacity measurement and to design effective fall prevention training paradigms aiming at maximizing muscle power among older adults and others with physical disabilities. Copyright ÂŠ 2015 Elsevier B.V. All rights reserved.

Title: Medications associated with falls in older people: systematic review of publications from a recent 5-year period. Citation: European journal of clinical pharmacology, Dec 2015, vol. 71, no. 12, p. 1429-1440 Author(s): Park, Hyerim, Satoh, Hiroki, Miki, Akiko, Urushihara, Hisashi, Sawada, Yasufumi Abstract: Falls are an important public health problem in older people. Medication use is considered a risk factor for falls. This study systematically reviewed recent studies to determine the medications that might be associated with the risk of falling in older people. We conducted a systematic review of prospective and retrospective studies identified through the MEDLINE and CINAHL databases that quantitatively assessed the contribution of medications to falls risk in participants â&#x2030;Ľ60 years old published in English between May 2008 and April 2013. The search identified 1,895 articles; 36 articles met the inclusion criteria. Of the 19 studies that investigated the effect of polypharmacy on the risk of falling, six studies reported that the risk of falling increased with polypharmacy. Data on the use of antihypertensive medications including calcium channel blockers, beta-blockers, and angiotensin system blocking medications were collected in 14 studies, with mixed results. Twenty-nine studies reported an association between the risk of falls and psychotropic medications including sedatives and hypnotics, antidepressants, and benzodiazepines. The use of sedatives and hypnotics and antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors appears to be related with an increased risk of falls. It is not clear if the use of antihypertensive medications is associated with the risk of falls in older people.

Title: Redesigning a falls prevention standard of practice. Citation: Nursing management, Nov 2015, vol. 46, no. 11, p. 7-9 Author(s): Eckes, Ellen J, Smith, Leslie

PRESSURE ULCERS Title: A Predictive Model for Pressure Ulcer Outcome: The Wound Healing Index. Citation: Advances in skin & wound care, Dec 2015, vol. 28, no. 12, p. 560-572 Author(s): Horn, Susan D, Barrett, Ryan S, Fife, Caroline E, Thomson, Brett Abstract: The purpose of this learning activity is to provide information regarding the creation of a risk-stratification system to predict the likelihood of the healing of body and heel pressure ulcers (PrUs). This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Explain the need for a PrU risk stratification tool.2. Describe the purpose and methodology of the study.3. Delineate the results of the study and development of the Wound Healing Index. : To create a validated system to predict the healing likelihood of patients with body and heel pressure ulcers (PrUs), incorporating only patient- and wound-specific variables. The US Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, and so on). Significant variables were identified with bivariate analyses. Multivariable logistic regression models were created based on significant factors (P < .05) and tested on a 10% randomly selected hold-out sample. Fiftysix wound clinics in 24 states : A total of 7973 body PrUs and 2350 heel PrUs were eligible for analysis. Not applicable : Healed PrU MAIN RESULTS:: Because of missing data elements, the logistic regression development model included 6640 body PrUs, of which 4300 healed (64.8%), and the 10% validation sample included 709 PrUs, of which 477 healed (67.3%). For heel PrUs, the logistic regression development model included 1909 heel PrUs, of which 1240 healed (65.0%), and the 10% validation sample included 203 PrUs, of which 133 healed (65.5%). Variables significantly predicting healing were PrU size, PrU age, number of concurrent wounds of any etiology, PrU Stage III or IV, evidence of bioburden/infection, patient age, being nonambulatory, having renal transplant, paralysis, malnutrition, and/or patient hospitalization for any reason. Body and heel PrU Wound Healing Indices are comprehensive, user-friendly, and validated predictive models for likelihood of body and heel PrU healing. They can risk-stratify patients in clinical research trials, stratify patient data for quality reporting and benchmarking activities, and identify patients most likely to require advanced therapeutics to achieve healing.

Title: Differentiating a Pressure Ulcer from Acute Skin Failure in the Adult Critical Care Patient. Citation: Advances in skin & wound care, Nov 2015, vol. 28, no. 11, p. 514-524 Author(s): Delmore, Barbara, Cox, Jill, Rolnitzky, Linda, Chu, Andy, Stolfi, Angela Abstract: The purpose of this learning activity is to provide information regarding the differentiation between pressure ulcers and acute skin failure (ASF) in critically ill patients. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Describe the purpose, methodology and impact of this research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3. Identify risk factors and diagnostic criteria for ASF. To develop a statistical model to predict the development of acute skin failure in patients admitted to the intensive care unit (ICU) and to validate this model.Retrospective case-control, logistic regression modeling552 ICU patientsIntensive care unit patients with and without pressure ulcers (PrUs) were studied and compared on key variables sorted into the following categories: (1) disease status, (2) physical conditions, and (3) conditions of hospitalization.The variables, peripheral arterial disease (odds ratio [OR], 3.8; P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001), respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically significant and independent predictors of acute skin failure in ICU patients. These variables created a predictor model for acute skin failure in the ICU.Lack of objective criteria to define acute skin failure presents a clinical conundrum for practitioners-the acknowledgment that skin failure exists, but no clear-cut diagnostic criteria in which to support its existence as a result of a paucity of empirical evidence. In certain populations, such as the critically ill patient, the phenomenon of acute skin failure may be occurring, and with the current level of evidence, these ulcers may be incorrectly identified as PrUs. Accurately distinguishing risk factors that lead to a PrU from factors that result in a lesion due to acute skin failure is crucial in the quest to provide evidencebased practice to patients.

Title: Evidence-based practices in pressure ulcer prevention: Lost in implementation? Citation: International journal of nursing studies, Nov 2015, vol. 52, no. 11, p. 1655-1658 Author(s): Balzer, Katrin, Kottner, Jan

Title: The cost of prevention and treatment of pressure ulcers: A systematic review. Citation: International journal of nursing studies, Nov 2015, vol. 52, no. 11, p. 1754-1774 Author(s): Demarré, Liesbet, Van Lancker, Aurélie, Van Hecke, Ann, Verhaeghe, Sofie, Grypdonck, Maria, Lemey, Juul, Annemans, Lieven, Beeckman, Dimitri Abstract: Pressure ulcers impose a substantial financial burden. The need for high-quality health care while expenditures are constrained entails the interest to calculate the cost of preventing and treating pressure ulcers and their impact on patients, healthcare, and society. The aim of this paper is to provide insight into the cost of pressure ulcer prevention and treatment in an adult population. A systematic literature review was performed to conform the Cochrane Collaboration guidelines for systematic reviews. The search strategy contained index terms and key words related to pressure ulcers and cost. The search was performed in Medline, CINAHL, Web of Science, The Cochrane Library, Embase, and EconLit covering articles up to September 2013. Reference lists and conference abstracts were screened. Articles were eligible if they reported on direct medical cost of pressure ulcer prevention or treatment, and provided national cost estimates, cost per patient, or cost per patient per day. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies. In total, 2542 records were retrieved. After assessing eligibility, 17 articles were included. Five articles reported on both the cost of prevention and treatment, three articles reported on cost of prevention, and nine articles reported on the cost of pressure ulcer treatment. All articles were published between 2001 and 2013. Cost of pressure ulcer prevention per patient per day varied between 2.65 € to 87.57 € across all settings. Cost of pressure ulcer treatment per patient per day ranged from 1.71 € to 470.49 € across different settings. The methodological heterogeneity among studies was considerable, and encompassed differences regarding type of health economic design, perspective, cost components, and health outcomes. Cost of pressure ulcer prevention and treatment differed considerable between studies. Although the cost to provide pressure ulcer prevention to patients at risk can importantly impact health care services' budgets, the costs to treat a severe pressure ulcer were found to be substantially higher. Methodological heterogeneity among studies identified the need to use available, and study designspecific methodological guidelines to conduct health economic studies, and the need for additional pressure ulcer specific recommendations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Title: Using the Care Dependency Scale for identifying patients at risk for pressure ulcer. Citation: Journal of advanced nursing, Nov 2015, vol. 71, no. 11, p. 2529-2539 Author(s): Dijkstra, Ate, Kazimier, Hetty, Halfens, Ruud J G Abstract: The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. Cross-sectional design. The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited. © 2015 John Wiley & Sons Ltd.

Title: Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers. Citation: Respiratory care, Nov 2015, vol. 60, no. 11, p. 1536-1547 Author(s): Visscher, Marty O, White, Cynthia C, Jones, Jennifer M, Cahill, Thomas, Jones, Donna C, Pan, Brian S Abstract: Pressure ulcers (stages III and IV) are serious safety events (ie, never events). Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. Fifty subjects age 10.4 ± 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ± 29 for sites with erythema versus 75 ± 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers. This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity. Copyright © 2015 by Daedalus Enterprises.

Title: Inter-rater reliability of three most commonly used pressure ulcer risk assessment scales in clinical practice. Citation: International wound journal, Oct 2015, vol. 12, no. 5, p. 590-594 Author(s): Wang, Li-Hua, Chen, Hong-Lin, Yan, Hong-Yan, Gao, Jian-Hua, Wang, Fang, Ming, Yue, Lu, Li, Ding, Jing-Jing Abstract: The objective of this study was to evaluate inter-rater reliability of Braden Scale, Norton Scale and Waterlow Scale for pressure ulcer risk assessment in clinical practice. The design of the study was cross-sectional. A total of 23 patients at pressure ulcer risk were included in the study, and 6 best registered nurses conducted three subsequent risk assessments for all included patients. They assessed alone and independently from each other. An intra-class correlation coefficient (ICC) was used to determine the inter-rater reliability. For the Braden Scale, the ICC values ranged between 0·603 (95% CI: 0·435-0·770) for the item 'moisture' and a maximum of 0·964 (95% CI: 0·936-0·982) for the item 'activity'; for the Norton Scale, the ICC values ranged between 0·595 (95% CI: 0·4260·764) for the item 'physical condition' and a maximum of 0·975 (95% CI: 0·955-0·988) for the item 'activity'; and for the Waterlow Scale, the ICC values ranged between 0·592 (95% CI: 0·422-0·762) for the item 'skin type' and a maximum of 0·990 (95% CI: 0·982-0·995) for the item 'activity'. The ICC values of total score for three scales of were 0·955 (95% CI: 0·922-0·978), 0·967 (95% CI: 0·9430·984), and 0·915 (95% CI: 0·855-0·958) for Braden, Norton, and Waterlow scales, respectively. Although the inter-rater reliability of Braden Scale, Norton Scale and Waterlow Scale total scores were all substantial, the reliability of some items was not so good. The items of 'moisture', 'physical condition' and 'skin type' should be paid more attention. However, some studies are needed to find out high reliable quantitative items to replace these ambiguous items in new designed scales. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

SEPSIS Title: Clinical management for patients admitted to a critical care unit with severe sepsis or septic shock. Citation: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, Dec 2015, vol. 31, no. 6, p. 359-365 Author(s): Cheung, Wai Keung, Chau, Lai Sheung, Mak, Iun Ieng Laurinda, Wong, Mei Yi, Wong, Sai Leung, Tiwari, Agnes Fung Yee Abstract: The Surviving Sepsis Campaign promotes the use of norepinephrine as the first-line inotropic support for patients presenting with severe sepsis or septic shock in cases of persistent hypotension, despite adequate fluid resuscitation. However, there is little published evidence on how much noradrenaline is administered to such patients when admitted to the intensive care unit (ICU). The authors report the clinical management of this group of patients, with a special focus on the total amount and duration of norepinephrine infusion required. A chart review of the admission records of an ICU in Hong Kong was carried out in 2013. A total of 5000 patients were screened by their diagnosis of severe sepsis or septic shock (in the admissions book) between 1 January 2011 and 31 December 2013. A total of 150 of these were identified and 100 included in the study after simultaneous in-depth reviews of their case notes by two of the investigators. The analysis covers those with severe sepsis or septic shock who required ICU admission for further care. Clinical management and outcomes were analysed. 100 patients (median age 61.6; M/F ratio 2:1) met the inclusion criteria. The mean ICU stay was 13.4 days (range=1-371). 14 patients (14%) died in the ICU, with a 28-day mortality rate of 22%. The mean period of mechanical ventilation was 6.1 days (range=0-137). 91.5% (n=43) of patients had been operated on immediately before admission to the ICU, and the majority of these operations had been of the emergency type (97.7%, n=43). The mean total volumes of crystalloid and colloid administered were 3420ml and 478ml, respectively. The mean wean-off period for norepinephrine infusion was 4234minutes (70.5hours). All patients were prescribed norepinephrine for persistent hypotension despite adequate fluid resuscitation, and the mean total amount administered was 87,211mg. Final multiple linear and logistic regression analysis showed different clinical outcomes associated with different covariates, which included: (1) total amount of crystalloid given, positively associated with the total amount and duration of norepinephrine infusion; (2) duration of mechanical ventilation, positively associated with the type of operation the patient had undergone; (3) 28-day mortality rate, positively associated with the INR. What this study adds to knowledge about patients suffering from severe sepsis or septic shock: (1) the mean duration of norepinephrine infusion for septic shock patients in an ICU is almost three days; (2) the more crystalloid is required to correct hypoperfusion, the higher the dosage and longer the duration of norepinephrine infusion will be necessary; (3) the longer the patient's INR, the higher the chances of death within 28 days. Since not all patients have their body weight measured on or after admission to the ICU, we suggest further research into indirect estimation of body weight by other means, such as anthropometric measures, to guide the use of drugs and nutritional support in the ICU. In addition, APACHE scores should be included in further studies to compare the severity of the patient's condition in other research. Furthermore, since this study does not cover university hospital ICUs, we suggest that further research concerning such patients should compare and reflect similarities and differences between public and university hospitals in the territory. Copyright ÂŠ 2015 Elsevier Ltd. All rights reserved. Title: Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department. Citation: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Nov 2015, vol. 22, no. 11, p. 1298-1306 Author(s): Balamuth, Fran, Alpern, Elizabeth R, Grundmeier, Robert W, Chilutti, Marianne, Weiss, Scott L, Fitzgerald, Julie C, Hayes, Katie, Bilker, Warren, Lautenbach, Ebbing Abstract: The objective was to compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were

determined and receiver operating characteristic (ROC) curves were compared. Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159 and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% confidence interval [CI] = 72.1% to 73.4%) and specificity of 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity of 92.1% (95% CI = 91.7% to 92.4%) and specificity of 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment versus algorithmic alert were 40.3% versus 2.5% and 99.88% versus 99.96%, respectively. The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. ÂŠ 2015 by the Society for Academic Emergency Medicine.

Title: Variation in the Contents of Sepsis Bundles and Quality Measures. A Systematic Review. Citation: Annals of the American Thoracic Society, Nov 2015, vol. 12, no. 11, p. 1676-1684 Author(s): Kramer, Rachel D, Cooke, Colin R, Liu, Vincent, Miller, Russell R, Iwashyna, Theodore J Abstract: Sepsis contributes to one in every two to three inpatient hospital deaths. Early recognition and treatment are instrumental in reducing mortality, yet there are substantial quality gaps. Sepsis bundles containing quality metrics are often used in efforts to improve outcomes. Several prominent organizations have published their own bundles, but there are few head-to-head comparisons of content. We sought to determine the degree of agreement on component elements of sepsis bundles and the associated timing goals for completion of each element. We additionally sought to evaluate the amount of variation between metrics associated with bundles. We reviewed the components of and level of agreement among several sepsis resuscitation and management bundles. We compared the individual bundle elements, together with their associated goals and metrics. We performed a systematic review (PubMed 2008-2015) and searched publically available online content, supplemented by interviews with key informants, to identify eight distinct bundles. Bundles are presented as current as of April 2015. Broadly, elements of care covered early resuscitation and short-term management. Bundles varied from 6 to 10 elements, and there were 12 distinct elements listed across all bundles. Only lactate collection and broad-spectrum antibiotics were common to all eight bundles, although there were seven elements included in at least 75% of the bundles. Timing goals for the collection of lactate and antibiotic administration varied among bundles from within 1 to 6 hours of diagnosis or admission. Notably, no bundle included metrics evaluating timeliness or completeness of sepsis recognition. There is a lack of consensus on component elements and timing goals across highly recognized sepsis bundles. These differences highlight an urgent need for comparative effectiveness research to guide future implementation and for metrics to evaluate progress. None of the widely instituted bundles include metrics to evaluate sepsis recognition or diagnostic accuracy. Full Text: Available from ProQuest in Annals of the American Thoracic Society Title: Sepsis: An update in management. Citation: Journal of hospital medicine, Nov 2015, vol. 10, no. 11, p. 746-752 Author(s): Galen, Benjamin T, Sankey, Christopher Abstract: Hospitalists are a critical link in providing evidence-based care for patients with sepsis across the disease spectrum, from early recognition to recovery. The past decade of sepsis research has led to significant findings that will change clinical practice for hospital medicine practitioners. Although the incidence of severe sepsis in the United States has continued to rise, in-hospital mortality has declined. Management of the spectrum of sepsis disorders is no longer restricted to the intensive care unit (ICU). This review article will provide an update in the management of sepsis for hospitalists based on recently published pivotal studies. The expanding evidence base in sepsis

includes early goal-directed therapy/clinical endpoints/sepsis bundles, antibiotics and source control, volume resuscitation, ICU considerations (including the use of insulin and corticosteroids), mortality/complications, and the newly recognized condition of "sepsis survivorship". Journal of Hospital Medicine 2015;10:746-752. © 2015 Society of Hospital Medicine. © 2015 Society of Hospital Medicine.

Title: Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis. Citation: BJOG : an international journal of obstetrics and gynaecology, Oct 2015, vol. 122, no. 11, p. 1506-1515 Author(s): Mohamed-Ahmed, O, Nair, M, Acosta, C, Kurinczuk, J J, Knight, M Abstract: To identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK. A population-based case-control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD). All pregnancy care and death settings in UK hospitals. All non-influenza sepsis-related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non-influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358). Cases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals. Odds ratios for socio-demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived. Four factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64-141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23-5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62-7.89). Anaemia (aOR = 13.5, 95%CI 3.17-57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93-116.9) were the two most important factors driving the association between medical comorbidities and progression to death. There must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis-related maternal deaths. Medical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Title: Appropriate Antibiotic Treatment in Severe Sepsis and Septic Shock: Timing Is Everything. Citation: Critical care medicine, Oct 2015, vol. 43, no. 10, p. 2258-2259 Author(s): Zilberberg, Marya D, Shorr, Andrew F Full Text: Available from Ovid online collection in Critical Care Medicine Title: Spotting sepsis early saves lives Citation: Independent Nurse, Sep 2015, p. 9-13 Author(s): Bhardwa, Seeta Abstract: Many conditions can be prevented or can reduce the risk of long-term harm if caught early. One of these conditions is sepsis. Yet, most healthcare professionals believe that sepsis is a condition most common in secondary care. However, if the symptoms of sepsis are spotted early by primary care healthcare professionals, sepsis can be treated by an antibiotic with no further risk to the individual. [PUBLICATION] 4 references

Title: Sepsis: contemporary issues and implications for nursing Citation: British Journal of Nursing, Sep 2015, vol. 24, no. 17, p. 864-866 Author(s): Bateson, Meghan, Patton, Andrea

Abstract: Severe sepsis and septic shock are common causes of admission and mortality within critical care (Lagu et al, 2012; Quenot et al, 2013). Reported mortality rates vary widely because of the range of measurement approaches used, making comparisons difficult (Gaieski et al, 2013). In the UK sepsis is often cited as causing 37000 deaths per year (Daniels, 2011). This is, however, a conservative estimate since it only includes patients diagnosed with severe sepsis within 24 hours of intensive care admission. The high incidence together with associated morbidity and mortality has contributed to an international focus on improving the care and outcomes for patients with sepsis (Stehr and Reinhart, 2013). This article outlines the current debates around defining and diagnosing sepsis together with sepsis-associated morbidity and implications for nurses. [PUBLICATION] 27 references Full Text: Available from Mark Allen Group in British Journal of Nursing; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option Available from EBSCOhost in British Journal of Nursing

DETERIORATING PATIENT Title: Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: A mixed methods study. Citation: Nurse education today, Dec 2015, vol. 35, no. 12, p. 1161-1168 Author(s): Ignacio, Jeanette, Dolmans, Diana, Scherpbier, Albert, Rethans, Jan-Joost, Chan, Sally, Liaw, Sok Ying Abstract: The use of standardized patients in deteriorating patient simulations adds realism that can be valuable for preparing nurse trainees for stress and enhancing their performance during actual patient deterioration. Emotional engagement resulting from increased fidelity can provide additional stress for student nurses with limited exposure to real patients. To determine the presence of increased stress with the standardized patient modality, this study compared the use of standardized patients (SP) with the use of high-fidelity simulators (HFS) during deteriorating patient simulations. Performance in managing deteriorating patients was also compared. It also explored student nurses' insights on the use of standardized patients and patient simulators in deteriorating patient simulations as preparation for clinical placement. Fifty-seven student nurses participated in a randomized controlled design study with pre- and post-tests to evaluate stress and performance in deteriorating patient simulations. Performance was assessed using the Rescuing A Patient in Deteriorating Situations (RAPIDS) rating tool. Stress was measured using salivary alpha-amylase levels. Fourteen participants who joined the randomized controlled component then participated in focus group discussions that elicited their insights on SP use in patient deterioration simulations. Analysis of covariance (ANCOVA) results showed no significant difference (p=0.744) between the performance scores of the SP and HFS groups in managing deteriorating patients. Amylase levels were also not significantly different (p=0.317) between the two groups. Stress in simulation, awareness of patient interactions, and realism were the main themes that resulted from the thematic analysis. Performance and stress in deteriorating patient simulations with standardized patients did not vary from similar simulations using high-fidelity patient simulators. Data from focus group interviews, however, suggested that the use of standardized patients was perceived to be valuable in preparing students for actual patient deterioration management. Copyright ÂŠ 2015 Elsevier Ltd. All rights reserved.

Title: How to assess deteriorating patients. Citation: Nursing standard Nov 2015, vol. 30, no. 11, p. 34-36 Author(s): Barker, Mike, Rushton, Melanie, Smith, Joyce Abstract: Rationale and key points This article aims to help practitioners to undertake the assessment of deteriorating patients using a standardised ABCDE (airway, breathing, circulation, disability, exposure) approach that allows the practitioner to assess the patient in a structured and timely manner, and to identify the specific needs of the patient using the look, listen and feel method.

▶ Systematic assessment is central to recognising a deteriorating patient and to taking timely and appropriate action to minimise the incidence of further deterioration. ▶ The ABCDE approach can be used to identify patients at risk of becoming acutely unwell and to summon appropriate assistance at an early stage. ▶ The practitioner should review obtained physiological data to develop an effective management plan and indicate future investigations. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. What you have gained from reading this article. 2. How this knowledge will influence your practice. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Title: Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students. Citation: Journal of advanced nursing, Nov 2015, vol. 71, no. 11, p. 2563-2574 Author(s): Stayt, Louise Caroline, Merriman, Clair, Ricketts, Barry, Morton, Sean, Simpson, Trevor Abstract: To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. The intervention group performed significantly better in the post-objective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and SelfReported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient. © 2015 John Wiley & Sons Ltd. Title: Early identification and management of the unstable adult patient in the emergency department. Citation: Journal of clinical nursing, Nov 2015, vol. 24, no. 21-22, p. 3138-3146 Author(s): Hudson, Paul, Ekholm, Jodie, Johnson, Maree, Langdon, Rachel Abstract: The focus of this research was to standardise an emergency observation chart, the Adult Emergency Department Flow Chart, which incorporates elements designed to allow clinicians to more readily recognise the trends of patient deterioration. Patients present to the Emergency Department with some form of instability. Core skills and principles of Emergency Department care are to rapidly and continually assess the clinical condition of the patient, prioritise their care and treat accordingly. Often, however, deterioration of these patients is missed. The incidence of missed deterioration is set within a background of increasing presentations to Emergency Departments, greater complexity of the patient health status, longer length of stay within the Emergency Department and an ageing population. This quantitative research study comprised a retrospective medical record audit. Only those records containing notes relating to an Emergency Department admission were included. An online data collection tool based on the Adult Emergency Department Flow Chart was developed. A total of 181 medical records were reviewed: 80 during the pre-implementation audit and 101 during the post-implementation audit. The Adult Emergency Department Flow Chart enabled clinicians to better identify deteriorating patients, with a higher number of abnormal vital signs being identified at the post-implementation audit. Identification of pain also dramatically increased at the postimplementation audit. Documentation of notification to Medical Officers also increased, as did documentation of the number of patients receiving medication to help treat the abnormal vital sign. The introduction of the Adult Emergency Department Flow Chart facilitated the essential role of nurses in the identification, documentation and monitoring of the unstable or deteriorating patient in

the Emergency Department. Further research is required with larger samples to determine the impact of the Adult Emergency Department Flow Chart on the timely management of abnormal vital signs. The Adult Emergency Flow Chart provides a valuable tool for the early identification and subsequent management of an unstable / deteriorating adult in the emergency department, particularly for clinicians with limited experience. ÂŠ 2015 John Wiley & Sons Ltd.

CULTURAL CHANGE AND LEADERSHIP FOR SAFETY Title: Influencing organisational culture: a leadership challenge Citation: British Journal of Nursing, Jun 2015, vol. 24, no. 12, p. 633-638 Author(s): Muls, Ann, Dougherty, Lisa, Doyle, Natalie, Shaw, Clare, Soanes, Louise, Stevens, AnnaMarie Abstract: In the wake of the Francis report, the need for NHS trusts and hospitals to adopt a culture of learning, safety and transparency has been highlighted. This article considers different aspects of culture in health care, and hones in on the link between culture and safety for patients in putting the patient first, embedding the 6Cs and considering the options to measure and influence organisational culture. The article reflects more deeply on how leadership across all levels can influence and inspire change in organisational culture, ensuring that the patient remains the focus of any changes in care delivery. [PUBLICATION] 52 references Full Text: Available from Mark Allen Group in British Journal of Nursing; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option Available from EBSCOhost in British Journal of Nursing Title: Leadership Style and Patient Safety: Implications for Nurse Managers Citation: Journal of Nursing Administration, Jun 2015, vol. 45, no. 6, p. 319-324 Author(s): Merrill, Katreena Collette Abstract: Here, Merrill explores the relationship between nurse manager leadership style and safety climate. Transformational leadership style was demonstrated as a positive contributor to safety climate, whereas laissez-faire leadership style was shown to negatively contribute to unit socialization and a culture of blame. Nursing leaders must concentrate on developing transformational leadership skills while also diminishing negative leadership styles. [PUBLICATION] 27 references

Title: Organizational Culture Changes Result in Improvement in Patient-Centered Outcomes: Implementation of an Integrated Recovery Pathway for Surgical Patients. Citation: Journal of the American College of Surgeons, Sep 2015, vol. 221, no. 3, p. 669 Author(s): Wick, Elizabeth C, Galante, Daniel J, Hobson, Deborah B, Benson, Andrew R, Lee, K H Ken, Berenholtz, Sean M, Efron, Jonathan E, Pronovost, Peter J, Wu, Christopher L Abstract: The goals of quality improvement are to partner with patients and loved ones to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste, yet few programs have successfully worked on of all these in concert. We evaluated implementation of a pathway designed to improve patient outcomes, value, and experience in colorectal surgery. The pathway expanded on pre-existing comprehensive unit-based safety program infrastructure and used trust-based accountability models at each level, from senior leaders (chief financial officer and senior vice president for patient safety and quality) to frontline staff. It included preoperative education, mechanical bowel preparation with oral antibiotics, chlorhexidine bathing, multimodal analgesia with thoracic epidurals or transversus abdominus plane blocks, a restricted intravenous fluids protocol, early mobilization, and resumption of oral intake. Eleven months of pre- and post-pathway outcomes, including length of stay (LOS), National Surgical Quality Improvement Program surgical site infection (SSI), venous thromboembolism, and urinary tract infection rates, patient experience, and variable direct costs were compared. Three hundred ten patients underwent surgery in the baseline period, the mean LOS was 7 days, and the mean SSI rate was 18.8%. There were 330 patients who underwent

surgery on the pathway, the LOS was 5 days, and the rate of SSI was 7.3%. Patient experience improved and variable direct costs decreased. Our trust-based accountability model, which included both senior hospital leadership and frontline providers, provided an enabling structure to rapidly implement an integrated recovery pathway and quickly improve outcomes, value, and experience of patients undergoing colorectal surgery. The study findings have significant implications for spreading surgical quality improvement work. Copyright ÂŠ 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved. Title: Bypass Rapid Assessment Triage: How Culture Change Improved One Emergency Department's Safety, Throughput and Patient Satisfaction. Citation: Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, May 2015, vol. 41, no. 3, p. 213-220 Author(s): Marino, Penne A, Mays, Angela C, Thompson, Elizabeth J Abstract: Emergency department waiting rooms are high risk, high liability areas for hospitals. Patients who are greeted by non-clinical personnel or who are not being placed in available beds increases wait times and prevent patients from receiving timely treatment and access to care. A multidisciplinary team was convened to review best practice literature and develop and implement an immediate bedding process. The process included placing a greeter nurse in the waiting room who performs a quick patient assessment to determine acuity. Based on that acuity, the greeter nurse then places the patient in the appropriate available bed. We established our Bypass Rapid Assessment Triage process and improved door-to-triage, door-to-bed, and door-to-physician times while enhancing patient satisfaction. A system should be in place that allows for immediate bedding wherever possible. Transitioning to immediate bedding requires a culture change. Staff engagement is essential to achieving such a culture shift. Copyright ÂŠ 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Title: Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety Authors: Charles Vincent, Susan Burnett, Jane Carthey Open Access via: http://qualitysafety.bmj.com/content/23/8/670.full

Title: Breaking the silence : determinants of voice for quality improvement in hospitals. Citation: Health Care Management Review, 2015, vol./is. 40/3(225-236) Author(s): Nembhard, Ingrid, Labao, Israel, Savage, Shantal Abstract: BACKGROUND: Research suggests that staff voice-discretionary communication of ideas, suggestions, concerns, or opinions about work-related issues with the intent to improve organizational or unit functioning-is associated with quality improvement, which most agree is needed in health care. Nevertheless, health professionals often do not voice. Little research has explored their reluctance to speak up and, relatedly, the conditions under which they voice. PURPOSE: We examine the drivers of voice for health professionals in hospitals. Specifically, we investigate the factors that influence their voice, why these factors are influential, and the purposes for which staff use their voice. METHODOLOGY: We conducted a qualitative study using data from 99 in-depth interviews with diverse staff at 12 randomly sampled hospitals in the United States. Data were collected from December 2007 to December 2008, the first year of a 4-year study of improvement. By national standards, all of the hospitals had significant room for improvement in their care of patients experiencing heart attack, suggesting that there were potentially issues and suggestions for staff to voice. FINDINGS: Factors related to individuals (e.g., tenure), work (e.g., work configuration), organizational context (e.g., culture), data (e.g., benchmarking), and the external environment (e.g., attention) influenced health professionals' voice. These factors shaped their sense of safety, efficacy, opportunity, and/or legitimacy, all of which affected their belief about the risk and benefit of voice and

willingness to voice. They voiced for three purposes: to learn for themselves, inform others, and protect patients. PRACTICE IMPLICATIONS: These findings indicate that hospitals and their leaders must attend to multiple factors (e.g., work configuration, culture, etc.) if they wish to increase staff voice in service of quality improvement. The presence of many influential factors suggests that there are several levers that leaders can use to elicit voice, noting that voice can be used in multiple ways to facilitate improvement. [Abstract] Title: First-year doctorsâ&#x20AC;&#x2122; attitudes and beliefs relating to quality improvement and patient safety. Citation: Clinical Risk, 2015, vol./is. 21/2(47-49) Author(s): Dahill, Mark, Bethune, Rob, Carson-Stevens, Andrew Abstract: In the current environment of culture change and financial pressure on the National Health Service, quality improvement initiatives are heralded as new vehicles for workplace evolution. Foundation Year One doctors encounter many of the problems impinging on quality, and their enthusiasm and number make them an indispensable resource and critical mass for improvement. In response to the increasing importance of quality improvement training, and as part of an ongoing project to embed quality improvement education in the Severn Deanery region, this paper describes the evolution of a questionnaire tool to assess the attitudes and beliefs of a cohort of new Foundation Year One doctors. An electronic survey was developed and validated to address each aim of quality care. The survey was sent by email to every Foundation Year One doctor in the Severn Deanery. New Foundation Year One doctors' attitudes are overwhelmingly positive towards quality improvement and patient safety; however, universally, they do not feel valued and listened to. In addition, they do not feel that their previous medical education has fully equipped them to improve the quality and safety of the care they deliver to their patients. Foundation Year One doctors represent a large, intelligent and enthusiastic workforce and in an environment where quality is now accepted as paramount, harnessing their potential through better quality improvement training could prove advantageous to all National Health Service stakeholders. [Abstract] Full Text: Available from EBSCOhost in Clinical Risk Title: Can staff and patient perspectives on hospital safety predict harm-free care? : an analysis of staff and patient survey data and routinely collected outcomes Citation: BMJ Quality and Safety, 2015, vol./is. 24/6(369-376) Author(s): Lawton, Rebecca, O'Hara, Jane Kathryn, Sheard, Laura Abstract: BACKGROUND: Patients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes. METHOD: Data were collected from 33 hospital wards across three acute hospital trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for 'harm-free care' on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (ie, no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes. RESULTS: The friends and family test, a single item measure of patient experience was associated with patients' perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r2=0.39) and patient perceptions (adjusted r2=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49 per cent of the variance in safety outcomes (adjusted r2=0.49), suggesting that there is overlap but some unique variance is also explained by these two measures. Based on responses to the Patient Measure of Safety it was also

possible to identify differences between the acute Hospital Trusts. DISCUSSION: The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes. These findings suggest that feedback from patients about the safety of the care that they receive can be used, in addition to data from staff to drive safety improvements in healthcare. TRIAL REGISTRATION NUMBER: ISRCTN07689702.[Abstract] Full Text: Available from Highwire Press in BMJ Quality and Safety

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. 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

Achieving high quality care : practical experience from NICE / edited by Gillian Leng, Val Moore, Sasha Abraham (2014) Drawing on the experience of the National Institute for Health and Care Excellence (NICE), Achieving High Quality Care is a practical guide on how to recognise and implement high quality evidence and guidance. This new title provides an overview of the evidence behind successful initiatives designed to change practice and improve the quality of health care. It provides an overall picture of change management, from understanding the barriers to change to how these barriers can best be overcome.

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Interventions for preventing falls in older people: an overview of Cochrane Reviews Julie E Udell , Amy Drahota , Taraneh P Dean , Ruth Sander and Heather Mackenzie Online Publication Date: January 2015

Interventions for preventing falls in older people in care facilities and hospitals Ian D Cameron , Lesley D Gillespie , M Clare Robertson , Geoff R Murray , Keith D Hill , Robert G Cumming and Ngaire Kerse Online Publication Date: December 2012 Repositioning for treating pressure ulcers Zena EH Moore and Seamus Cowman Online Publication Date: January 2015

Wound-care teams for preventing and treating pressure ulcers Zena EH Moore , Joan Webster and Ray Samuriwo Online Publication Date: September 2015

Negative pressure wound therapy for treating pressure ulcers Jo C Dumville , Joan Webster , Debra Evans and Lucy Land Online Publication Date: May 2015

UPTODATE & DYNAMED BACK TO TOP What’s new from our clinical decision-making tools on the topic of dementia.

UpToDate 

Falls in older persons: Risk factors and patient evaluation

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Falls: Prevention in nursing care facilities and the hospital setting

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Prevention of pressure ulcers

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Evaluation and management of severe sepsis and septic shock in adults

DynaMed 

Falls in the elderly

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Pressure ulcer

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Sepsis treatment in adults

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Sepsis in children

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Sepsis treatment in children

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Late-onset neonatal sepsis

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

REPORTS, PUBLICATIONS AND RESOURCES

Sepsis national patient outcome report The Healthcare Quality Improvement Partnership (HQIP) has published the latest National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report into sepsis. Just Say Sepsis! A review of the process of care received by patients with sepsis highlights that that 45% of those patients included in the study admitted to hospital with no other obvious functional problems, either suffered from a disabling condition at discharge or died with sepsis. One of the key findings from the report showed that one third of hospitals in the study had no formal sepsis protocol. Additional links: HQIP press release http://www.thetimes.co.uk/tto/health/news/article4621840.ece

E Resources NHS England: Sign up to Safety Safety Improvement Plan (SIP) Guidance plus examples can be found at: https://www.england.nhs.uk/signuptosafety/sip-resources/ NHS Improving Quality Variety of improvement resources can be accessed via: http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/improvementresources.aspx Reports

Department of Health Culture change in the NHS : Applying the lessons of the Francis Inquiries https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/403010/culturechange-nhs.pdf

A handy checklist for developing safety solutions at the front line

See more at: http://www.health.org.uk/newsletter/handy-checklist-developing-safetysolutions-frontline/?utm_source=charityemail&utm_medium=email&utm_campaign=november2015&pubid=healthfoundation&description=november2015&dm_i=4Y2,3V2K1,59C5M1,DX8JQ,1#sthash.M0O7sioD.dpuf

The Health Foundation Closing the Gap in Patient Safety programme is supporting and funding nine project teams to test large-scale, evidence-based interventions for known patient safety issues in health and social care. A snapshot of the projects and how they are planning to make care safer for patients, closing the gap between best practice and routine delivery of care can be read at: http://www.health.org.uk/newsletter/nine-projects-are-closing-gap-patientsafety/?utm_source=charityemail&utm_medium=email&utm_campaign=november2015&pubid=healthfoundation&description=november2015&dm_i=4Y2,3V2K1,59C5M1,DX8JQ,1#sthash.PteP0arH.dpuf Building skills for safety at board level This project from the Health Foundation encourages board teams to think differently about safety, and enables teams from across local health economies to work together to build capability and develop systems for improved measurement and monitoring of safety . See more at: http://www.health.org.uk/newsletter/building-skills-safety-boardlevel/?utm_source=charityemail&utm_medium=email&utm_campaign=november2015&pubid=healthfoundation&description=november2015&dm_i=4Y2,3V2K1,59C5M1,DX8JQ,1#sthash.R6k5P5dl.dpuf

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.