Current awareness suts feb 2016 by Musgrove Park Hospital Library

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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 3 February 2016

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

Books

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.

FALLS Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial JAMA Intern Med. Published online January 04, 2016. doi:10.1001/jamainternmed.2015.7148 Abstract: http://archinte.jamanetwork.com/article.aspx?articleid=2478897 ________________________________________________________________________________ Vitamin D Supplementation and Increased Risk of Falling: A Cautionary Tale of Vitamin Supplements Retold JAMA Intern Med. Published online January 04, 2016. doi:10.1001/jamainternmed.2015.7568 Abstract: http://archinte.jamanetwork.com/article.aspx?articleid=2478893 ________________________________________________________________________________ Title: Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial. Citation: Clinical Journal of Oncology Nursing, 2016, vol./is. 20/1(84-89) Author(s): Kuhlenschmidt, Megan L., Reeber, Christina, Wallace, Christine, Mazanec, Susan R. ________________________________________________________________________________ Title: Development of an Automated Self-assessment of Fall Risk Questionnaire for Hospitalized Patients. Citation: Journal of Nursing Care Quality, 2016, vol./is. 31/1(46-53) Author(s): Sitzer, Verna ________________________________________________________________________________ Title: Influence of urinary urgency and other urinary disturbances on falls in Parkinson's disease. Citation: Journal of the neurological sciences, Jan 2016, vol. 360, p. 153-157 Author(s): Sakushima, Ken, Yamazaki, Shin, Fukuma, Shingo, Hayashino, Yasuaki, Yabe, Ichiro, Fukuhara, Shunichi, Sasaki, Hidenao

Abstract: Falling is one of the most common and serious public health problems. It can cause injuries such as sprains and fractures, and hospitalization may be required for serious injuries. Patients with Parkinson's disease have a higher risk of falls, and urinary incontinence is a known risk factor for falls in the elderly. However, whether other urinary disturbances contribute to the risk of falling remains unclear. The purpose of this study was to identify the association between falls and urinary disturbances in Parkinson's disease. A prospective cohort study was conducted at a single institution with a 6-month observation period. Subjects were ambulatory patients with Parkinson's disease. Assessments included patient demographics, disease severity measured by the Hoehn and Yahr scale, and urinary disturbances measured using the overactive bladder symptom score (OABSS). Falls were reported using a self-documented fall record. A total of 97 patients were included. Fortyfour subjects experienced one or more falls during the observation period. The frequency of urination was not related to falling; however, mild urinary urgency, but not severe urinary urgency, increased the risk of falls by an odds ratio of 5.14 (95% confidence interval: 1.51-17.48). Mild urinary urgency was also associated with the time to the first fall and the frequency of falls. One third of falls occurred in the living room, and 13.8% of falls occurred on the way to/from the toilet. Falls in patients with Parkinson's disease might be associated with urinary urgency, but not with the frequency of urination. Copyright ÂŠ 2015 Elsevier B.V. All rights reserved. ________________________________________________________________________________ Title: 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. Citation: BMJ (Clinical research ed.), Jan 2016, vol. 352, p. h6781. Author(s): Barker, Anna L, Morello, Renata T, Wolfe, Rory, Brand, Caroline A, Haines, Terry P, Hill, Keith D, Brauer, Sandra G, Botti, Mari, Cumming, Robert G, Livingston, Patricia M, Sherrington, Catherine, Zavarsek, Silva, Lindley, Richard I, Kamar, Jeannette Abstract: To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Cluster randomised controlled trial. Six Australian hospitals. All patients admitted to 24 acute wards during the trial period. Participating wards were randomly assigned to receive either the nurse led 6PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: "falls alert" sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. Australian New Zealand Clinical Trials Registry ACTRN12611000332921. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. ________________________________________________________________________________ Title: Nursing Staff Develop a Video to Prevent Falls: A Quality Improvement Project. Citation: Journal of nursing care quality, Jan 2016, vol. 31, no. 1, p. 40-45 Author(s): Silkworth, Amelia L, Baker, Jennifer, Ferrara, Joseph, Wagner, Molly, Gevaart, Melinda, Morin, Karen Abstract: Many fall prevention strategies exist with some degree of effectiveness. Evidence to support 1 unique bundling of strategies is limited. The purpose of this article is to describe a staffdriven quality improvement initiative to develop a video in partnership with patients and families to

prevent falls when hospitalized. Since the video's release, the fall rate has decreased by 29.4%. ________________________________________________________________________________ Title: Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices. Citation: Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, Jan 2016, vol. 41, no. 1, p. 5-15, Author(s): Quigley, Patricia A Abstract: Rehabilitation nurses know the impact of injury on function, independence, and quality of life, complicated by age-related changes associated with decreased strength, endurance, reserve, frailty, and social and financial resources. Multidisciplinary teams are essential to provide expert, age specific health care delivery to this vulnerable population across settings of care. The purpose of this article is to apply level of evidence rating scales to identify the best practice interventions to prevent falls on rehabilitation units. The evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units. ÂŠ 2015 Association of Rehabilitation Nurses. ________________________________________________________________________________

PRESSURE ULCERS Title: What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit? Citation: Dimensions of critical care nursing : DCCN, Jan 2016, vol. 35, no. 1, p. 37-41 Author(s): Smit, Inge, Harrison, Lisa, Letzkus, Lisa, Quatrara, Beth Abstract: Instruments used to determine the risk of pressure ulcer development are universally applied to adult patients. These instruments do not differentiate between intensive and acute care patients. Pressure ulcers contribute to negative outcomes such as increases in pain and discomfort, risk of infection, hospital length of stay and costs, and a decrease in quality of life. Appropriately identifying risk factors is paramount to implementing a targeted care plan to avoid pressure ulcer development as well as pinpointing appropriate treatments if an ulcer develops. The purpose of this nursing research study was to identify factors associated with pressure ulcer development in a medical intensive care unit. A 15-month retrospective chart review of patients with pressure ulcers in a medical intensive care unit was performed. Statistics were computed on demographics and variables of interest including: pressure ulcer stage, vasopressor infusion, oxygen requirement, comorbidities, primary diagnosis, length of stay, mortality, age, gender, weight, Braden scores, and albumin level. The characteristics of 76 patients who developed pressure ulcers were evaluated. An equal number of men (n = 38) and women (n = 38) were included. Forty-seven percent had a stage II pressure ulcer. The presence of hemodynamic support with vasopressor administration (P = .016) and the length of stay (P = .021) were noted as the most significant factors in pressure ulcer development in this study. Vasopressor use and length of stay are not factors that are accounted for in current pressure ulcer risk assessment instruments. The administration of vasopressor support and patient length of stay are potential contributory factors that need to be considered when assessing patients. Instruments specific to intensive care unit pressure ulcer risk stratification are warranted and should include the unique characteristics of a critically ill patient. ________________________________________________________________________________ Title: Two Methods for Turning and Positioning and the Effect on Pressure Ulcer Development: A Comparison Cohort Study. Citation: Journal of wound, ostomy, and continence nursing : official publication of The Wound,

Ostomy and Continence Nurses Society / WOCN, Jan 2016, vol. 43, no. 1, p. 46-50 Author(s): Powers, Jan Abstract: We evaluated 2 methods for patient positioning on the development of pressure ulcers; specifically, standard of care (SOC) using pillows versus a patient positioning system (PPS). The study also compared turning effectiveness as well as nursing resources related to patient positioning and nursing injuries. A nonrandomized comparison design was used for the study. Sixty patients from a trauma/neurointensive care unit were included in the study. Patients were randomly assigned to 1 of 2 teams per standard bed placement practices at the institution. Patients were identified for enrollment in the study if they were immobile and mechanically ventilated with anticipation of 3 days or more on mechanical ventilation. Patients were excluded if they had a preexisting pressure ulcer. Patients were evaluated daily for the presence of pressure ulcers. Data were collected on the number of personnel required to turn patients. Once completed, the angle of the turn was measured. The occupational health database was reviewed to determine nurse injuries. The final sample size was 59 (SOC = 29; PPS = 30); there were no statistical differences between groups for age (P = .10), body mass index (P = .65), gender (P = .43), Braden Scale score (P = .46), or mobility score (P = .10). There was a statistically significant difference in the number of hospital-acquired pressure ulcers between turning methods (6 in the SOC group vs 1 in the PPS group; P = .042). The number of nurses needed for the SOC method was significantly higher than the PPS (P ≤ 0.001). The average turn angle achieved using the PPS was 31.03°, while the average turn angle achieved using SOC was 22.39°. The difference in turn angle from initial turn to 1 hour after turning in the SOC group was statistically significant (P < .0001). No nurse injuries were reported for either group during the study. Findings suggest that assistive devices such as a PPS can be effective in achieving proper positioning of patients to prevent development of pressure ulcers. ________________________________________________________________________________ Title: Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial. Citation: Clinical Journal of Oncology Nursing, 2016, vol./is. 20/1(84-89) Author(s): Kuhlenschmidt, Megan L., Reeber, Christina, Wallace, Christine, Mazanec, Susan R. ________________________________________________________________________________ Title: Pressure Ulcer Incidence: The Development and Benefits of 10 Year's-experience with an Electronic Monitoring Tool (PUNT) in a UK Hospital Trust. Citation: EWMA Journal, 2015, vol./is. 15/2(15-20), 16092759 Full text: Available EBSCOhost at EWMA Journal ________________________________________________________________________________ Title: Development of an Automated Self-assessment of Fall Risk Questionnaire for Hospitalized Patients. Citation: Journal of Nursing Care Quality, 2016, vol./is. 31/1(46-53), 10573631 Author(s): Sitzer, Verna ________________________________________________________________________________ Title: Nurse Continuity and Hospital-Acquired Pressure Ulcers. Citation: Nursing Research, 2015, vol./is. 64/5(361-371), 00296562 Full text: Available Ovid online collection at Nursing Research ________________________________________________________________________________

SEPSIS Sepsis Sepsis 6 guideline BMJ Best Practice January 2016

Send me a copy of this guidance Title: A Severe Sepsis Mortality Prediction Model and Score for Use With Administrative Data. Citation: Critical Care Medicine, 2016, vol./is. 44/2(319-327) Abstract: Objective: Administrative data are used for research, quality improvement, and health policy in severe sepsis. However, there is not a sepsis-specific tool applicable to administrative data with which to adjust for illness severity. Our objective was to develop, internally validate, and externally validate a severe sepsis mortality prediction model and associated mortality prediction score.Design: Retrospective cohort study using 2012 administrative data from five U.S. states. Three cohorts of patients with severe sepsis were created: 1) International Classification of Diseases, 9th Revision, Clinical Modification codes for severe sepsis/septic shock, 2) Martin approach, and 3) Angus approach. The model was developed and internally validated in International Classification of Diseases, 9th Revision, Clinical Modification, cohort and externally validated in other cohorts. Integer point values for each predictor variable were generated to create a sepsis severity score.Setting: Acute care, nonfederal hospitals in New York, Maryland, Florida, Michigan, and Washington.Subjects: Patients in one of three severe sepsis cohorts: 1) explicitly coded (n = 108,448), 2) Martin cohort (n = 139,094), and 3) Angus cohort (n = 523,637) INTERVENTIONS:: None.Measurements and Main Results: Maximum likelihood estimation logistic regression to develop a predictive model for inhospital mortality. Model calibration and discrimination assessed via Hosmer-Lemeshow goodness-offit and C-statistics, respectively. Primary cohort subset into risk deciles and observed versus predicted mortality plotted. Goodness-of-fit demonstrated p value of more than 0.05 for each cohort demonstrating sound calibration. C-statistic ranged from low of 0.709 (sepsis severity score) to high of 0.838 (Angus cohort), suggesting good to excellent model discrimination. Comparison of observed versus expected mortality was robust although accuracy decreased in highest risk decile.Conclusions: Our sepsis severity model and score is a tool that provides reliable risk adjustment for administrative data. Full text: Available Ovid fulltext collection at Critical Care Medicine ________________________________________________________________________________ Title: Improving Outcomes in Patients With Sepsis. Citation: American Journal of Medical Quality, 2016, vol./is. 31/1(56-63) Abstract: Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function. ________________________________________________________________________________ Title: Quantifying the improvement in sepsis diagnosis, documentation, and coding: the marginal causal effect of year of hospitalization on sepsis diagnosis. Citation: Annals of Epidemiology, 2016, vol./is. 26/1(66-70) Abstract: Purpose: To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records, and subsequent medical coding of sepsis for billing purposes in recent years.Methods: We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome criteria at a tertiary care center from 2008 to 2012. We

used g-computation to estimate the causal effect of the year of hospitalization on receiving an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period.Results: When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization, and intensive care unit admission, the causal risk difference for receiving a discharge code for sepsis per 100 hospitalizations with systemic inflammatory response syndrome, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval [CI], 3.8%-4.0%), 3.4% (95% CI, 3.3%-3.5%), 2.2% (95% CI, 2.1%-2.3%), and 0.9% (95% CI, 0.8%-1.1%) from 2008 to 2011, respectively.Conclusions: Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented, and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence. ________________________________________________________________________________ Title: National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study. Citation: Emergency Medicine Journal, 2016, vol./is. 33/1(37-41) Abstract: Introduction: Severe sepsis and septic shock (SS) are time-critical medical emergencies that affect millions of people in the world. Earlier administration of antibiotics has been shown to reduce mortality from SS; however, the initiation of early resuscitation requires recognition that a patient may have sepsis. Early warning scores (EWS) are broadly used to detect patient deterioration, but to date have not been evaluated to detect patients at risk for SS. The purpose of our study was to look at the relationship between the initial national EWS (NEWS) in the emergency department (ED) and the diagnosis of SS.Methods: We performed a retrospective, single-centre, observational study in the ED of an urban university hospital with an annual attendance of 140 000 patients. We aimed to include 500 consecutive non-trauma adult patients presenting to the ED with Manchester Triage System (MTS) category 1-3. The final diagnosis was taken from either the ED medical records or the hospital discharge summary. For all NEWS, the sensitivity and specificity to detect patients with SS was calculated.Results: A total of 500 patients were included, 27 patients (5.4%) met the criteria for SS. The area under the curve (AUC) for NEWS to identify patient at risk for SS is 0.89 (95% CI 0.84 to 0.94). A NEWS of 3 or more at ED triage has a sensitivity of 92.6% (95% CI 74.2% to 98.7%) and a specificity of 77% (95% CI 72.8% to 80.6%) to detect patients at risk for SS at ED triage.Conclusions: A NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for SS, which may ultimately lead to early recognition and treatment. Full text: Available Highwire Press at Emergency Medicine Journal ________________________________________________________________________________ Title: Systemic symptoms predict presence or development of severe sepsis and septic shock. Citation: Infectious diseases (London, England), Mar 2016, vol. 48, no. 3, p. 209-214 Author(s): Edman-WallĂŠr, Jon, LjungstrĂśm, Lars, Jacobsson, Gunnar, Andersson, Rune, Werner, Maria Abstract: Severe sepsis is a major cause of mortality and morbidity globally. As the time to adequate treatment is directly linked to outcome, early recognition is of critical importance. Early, accessible markers for severe sepsis are desirable. The systemic inflammatory response in sepsis leads to changes in vital signs and biomarkers and to symptoms unrelated to the focus of infection. This study investigated whether the occurrence of any of six systemic symptoms could predict severe sepsis in a cohort of patients admitted to hospital for suspected bacterial infections. A retrospective, consecutive study was conducted. All adult patients admitted during 1 month to a 550-bed secondary care hospital in western Sweden and given intravenous antibiotics for suspected community-acquired infection were included (n = 289). Symptoms (fever/chills, muscle weakness, localised pain, dyspnea, altered mental status and gastrointestinal symptoms) were registered along with age, sex, vital signs and laboratory values. Patients who fulfilled criteria of severe sepsis within 48 h were compared with patients who did not. Odds ratios for severe sepsis were calculated, adjusted for age, sex and comorbidities. Criteria for severe sepsis were fulfilled by 90/289 patients (31.1%). Altered mental status (OR = 4.29, 95% CI = 2.03-9.08), dyspnea (OR = 2.92, 95% CI = 1.69-5.02), gastrointestinal symptoms (OR = 2.31, 95% CI = 1.14-4.69) and muscle weakness (OR = 2.24, 95% CI = 1.06-4.75)

were more common in patients who had or later developed severe sepsis. Systemic symptoms in combination with other signs of infection should be considered warning signs of severe sepsis. ________________________________________________________________________________ Title: Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality. Citation: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, Feb 2016, vol. 73, no. 3, p. 143-149 Author(s): Beardsley, James R, Jones, Catherine M, Williamson, John, Chou, Jason, Currie-Coyoy, Margaret, Jackson, Teresa Abstract: Pharmacy department contributions to a medical center's broad initiative to improve sepsis care outcomes are described. Timely and appropriate antimicrobial therapy is a key factor in optimizing treatment outcomes in patients with severe sepsis or septic shock. The inpatient pharmacy at Wake Forest Baptist Health implemented standardized processes to reduce order turnaround time and facilitate prompt antibiotic administration as part of the hospital's multidisciplinary "Code Sepsis" initiative. The program includes (1) nurse-conducted screening for sepsis using a standard assessment instrument, (2) pager alerts notifying rapid-response, pharmacy, and other personnel of cases of suspected sepsis, (3) activation of an electronic order set including guideline-based antibiotic therapy recommendations based on local pathogen patterns, and (4) a protocol allowing pharmacists to select an antibiotic regimen if providers are busy with other patient care duties. Assessments conducted during and after implementation of the Code Sepsis initiative showed improvements in key program metrics. The mean Âą S.D. time from receipt of a Code Sepsis page to antibiotic delivery was reduced to 14.1 Âą 13.7 minutes, the mean time from identification of suspected sepsis to antibiotic administration was reduced to 31 minutes in the hospital's intensive care units and to 51 minutes in non-critical care units, and the institution's performance on a widely used measure of sepsis-related mortality improved dramatically. Implementation of the Code Sepsis initiative was associated with reductions in order turnaround time, time to antibiotic administration, and sepsis-related mortality. Copyright ÂŠ 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved. ________________________________________________________________________________ Title: A Severe Sepsis Mortality Prediction Model and Score for Use With Administrative Data. Citation: Critical care medicine, Feb 2016, vol. 44, no. 2, p. 319-327 Author(s): Ford, Dee W, Goodwin, Andrew J, Simpson, Annie N, Johnson, Emily, Nadig, Nandita, Simpson, Kit N Abstract: Administrative data are used for research, quality improvement, and health policy in severe sepsis. However, there is not a sepsis-specific tool applicable to administrative data with which to adjust for illness severity. Our objective was to develop, internally validate, and externally validate a severe sepsis mortality prediction model and associated mortality prediction score. Retrospective cohort study using 2012 administrative data from five U.S. states. Three cohorts of patients with severe sepsis were created: 1) International Classification of Diseases, 9th Revision, Clinical Modification codes for severe sepsis/septic shock, 2) Martin approach, and 3) Angus approach. The model was developed and internally validated in International Classification of Diseases, 9th Revision, Clinical Modification, cohort and externally validated in other cohorts. Integer point values for each predictor variable were generated to create a sepsis severity score. Acute care, nonfederal hospitals in New York, Maryland, Florida, Michigan, and Washington. Patients in one of three severe sepsis cohorts: 1) explicitly coded (n = 108,448), 2) Martin cohort (n = 139,094), and 3) Angus cohort (n = 523,637) INTERVENTIONS:: None. Maximum likelihood estimation logistic regression to develop a predictive model for in-hospital mortality. Model calibration and discrimination assessed via HosmerLemeshow goodness-of-fit and C-statistics, respectively. Primary cohort subset into risk deciles and observed versus predicted mortality plotted. Goodness-of-fit demonstrated p value of more than 0.05 for each cohort demonstrating sound calibration. C-statistic ranged from low of 0.709 (sepsis severity score) to high of 0.838 (Angus cohort), suggesting good to excellent model discrimination. Comparison of observed versus expected mortality was robust although accuracy decreased in highest risk decile. Our sepsis severity model and score is a tool that provides reliable risk adjustment for administrative data. Full text: Available Ovid fulltext collection at Critical Care Medicine ________________________________________________________________________________

Title: Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. Citation: Journal of critical care, Feb 2016, vol. 31, no. 1, p. 13-20 Author(s): Drumheller, Byron C, Agarwal, Anish, Mikkelsen, Mark E, Sante, S Cham, Weber, Anita L, Goyal, Munish, Gaieski, David F Abstract: The purpose was to identify risk factors associated with in-hospital mortality among emergency department (ED) patients with severe sepsis and septic shock managed with early protocolized resuscitation. This was a retrospective, observational cohort study in an academic, tertiary care ED. We enrolled 411 adult patients with severe sepsis and lactate ≥4.0 mmol/L (n = 203) or septic shock (n = 208) who received protocolized resuscitation from 2005 to 2009. Emergency department variables, microbial cultures, and in-hospital outcomes were obtained from the medical record. Multivariable regression was used to identify factors independently associated with in-hospital mortality. Mean age was 59.5 ± 16.3 years; 57% were male. Mean lactate was 4.8 mmol/L (3.5-6.7), 54% had positive cultures, and 27% received vasopressors in the ED. One hundred and five (26%) patients died in-hospital. Age, active cancer, do-not-resuscitate status on ED arrival, lack of fever, hypoglycemia, and intubation were independently associated with increased in-hospital mortality. Lactate clearance and diabetes were associated with a decreased risk of in-hospital death. We identified a number of factors that were associated with in-hospital mortality among ED patients with severe sepsis or septic shock despite treatment with early protocolized resuscitation. These findings provide insights into aspects of early sepsis care that can be targets for future intervention. Copyright © 2015 Elsevier Inc. All rights reserved. ________________________________________________________________________________ Title: Early alterations in platelet mitochondrial function are associated with survival and organ failure in patients with septic shock. Citation: Journal of critical care, Feb 2016, vol. 31, no. 1, p. 63-67 Author(s): Puskarich, Michael A, Kline, Jeffrey A, Watts, John A, Shirey, Kristin, Hosler, Jonathan, Jones, Alan E Abstract: The objective of the study is to determine if changes in platelet mitochondrial function in patients with sepsis are present early after presentation and the association of these changes with clinical outcomes and systemic metabolic function. This is a prospective observational cohort study of a convenience sample of patients with severe sepsis. Mitochondrial function of intact, nonpermeabilized platelets suspended in their own plasma was estimated using high-resolution respirometry. Unstimulated basal respiration, oligomycin-induced state 4, and maximal respiratory rate after serial titrations of carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone were measured. Organ failure was estimated using Sequential Organ Failure Assessment score, and patients were followed up until 28 days to determine survival. Lactate levels were measured in all patients, and a subset of patients had lactate/pyruvate (L/P) ratios measured. Twenty-eight patients were enrolled, 21 of whom survived. Initial Sequential Organ Failure Assessment score and lactate levels were 8.5 (interquartile range [IQR], 6-10) and 2.3 (IQR, 1.2-3.5) respectively, whereas the median L/P ratio was 23.4 (IQR, 15.2-38). Basal and maximal respiratory rates were significantly higher among nonsurvivors compared to survivors (P = .02 and P = .04), whereas oligomycin-induced state 4 respiration was not statistically different between groups (P = .15). We found a significant association between maximal respiration and organ failure (P = .03) and both basal and maximal rates with initial lactate level (P = .04, P = .02), but not with L/P ratio. Differences in platelet mitochondrial function between survivors and nonsurvivors are present very early in the hospital course and are associated with organ failure and lactate. Copyright © 2015 Elsevier Inc. All rights reserved. ________________________________________________________________________________ Title: Improving Outcomes in Patients With Sepsis. Citation: American journal of medical quality : the official journal of the American College of Medical Quality, Jan 2016, vol. 31, no. 1, p. 56-63 Author(s): Armen, Scott B, Freer, Carol V, Showalter, John W, Crook, Tonya, Whitener, Cynthia J, West, Cheri, Terndrup, Thomas E, Grifasi, Marissa, DeFlitch, Christopher J, Hollenbeak, Christopher Abstract: Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of

sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function. ÂŠ The Author(s) 2014. ________________________________________________________________________________ Title: Day 3 versus Day 1 disseminated intravascular coagulation score among sepsis patients: a prospective observational study. Citation: Anaesthesia and intensive care, Jan 2016, vol. 44, no. 1, p. 57-64) Author(s): Park, J Y, Park, S, Park, S Y, Sim, Y S, Kim, J H, Hwang, Y I, Jang, S H, Jung, K S Abstract: The role of disseminated intravascular coagulation (DIC) has not been extensively studied in patients with sepsis. A prospective study was performed in a single university hospital. The incidences of DIC at day 1 (<24 hours post-sepsis diagnosis) and day 3 (48 to 72 hours) were investigated among patients with sepsis. The International Society of Thrombosis and Haemostasis criteria for DIC were used. Among 381 patients initially screened, 219 were enrolled in this study and the incidences of overt DIC were 27.9% and 30.1% on day 1 and day 3, respectively. Patients with pneumonia had a lower incidence of DIC on day 1, but a higher hospital mortality rate compared to those with non-pneumonia sepsis. In multivariate models, although day 1 and day 3 DIC scores were not associated with hospital mortality after adjusting for existing severity scores, the change in DIC scores (odds ratio 1.862; 95% confidence interval 1.061 to 3.266) exhibited a significant association. Day 3 DIC scores were more accurate in predicting hospital mortality than day 1 DIC scores (P <0.001), especially in patients with non-pneumonia sepsis. However, DIC scores did not give additional discriminative power to the existing prognostic scores in predicting mortality of patients with sepsis. In conclusion, the change in DIC score was significantly associated with hospital mortality. Patients with pneumonia sepsis had a lower incidence of DIC on day 1, despite their higher disease severity and mortality rate, compared to those with other sources of sepsis. ________________________________________________________________________________ Title: Financial Implications of Sepsis Prevention, Early Identification, and Treatment: A Population Health Perspective. Citation: Critical care nursing quarterly, Jan 2016, vol. 39, no. 1, p. 51-57 Author(s): Angelelli, Joseph Abstract: Each day an estimated 2000 to 3000 new cases of sepsis are identified and treated in US hospitals. Despite the enormity of the problem, less than one-half of all US adults have heard of sepsis. This article reviews the financial costs of sepsis in the United States, examining the evidence for its economic impact across both hospitals and nursing homes. A brief description of payment models and government programs to promote more coordinated care between hospitals and nursing homes is provided to highlight areas where advances in sepsis care may be incentivized and sustained in new systems emerging in response to the Affordable Care Act. Finally, the costs of sepsis care to the Medicare program in a specific health care market (Pittsburgh) are estimated to highlight the challenges and opportunities for interorganizational collaborative strategies in valuebased models of care delivery. ________________________________________________________________________________ Title: National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study. Citation: Emergency medicine journal : EMJ, Jan 2016, vol. 33, no. 1, p. 37-41 Author(s): Keep, J W, Messmer, A S, Sladden, R, Burrell, N, Pinate, R, Tunnicliff, M, Glucksman, E Abstract: Severe sepsis and septic shock (SS) are time-critical medical emergencies that affect millions of people in the world. Earlier administration of antibiotics has been shown to reduce mortality

from SS; however, the initiation of early resuscitation requires recognition that a patient may have sepsis. Early warning scores (EWS) are broadly used to detect patient deterioration, but to date have not been evaluated to detect patients at risk for SS. The purpose of our study was to look at the relationship between the initial national EWS (NEWS) in the emergency department (ED) and the diagnosis of SS. We performed a retrospective, single-centre, observational study in the ED of an urban university hospital with an annual attendance of 140 000 patients. We aimed to include 500 consecutive non-trauma adult patients presenting to the ED with Manchester Triage System (MTS) category 1-3. The final diagnosis was taken from either the ED medical records or the hospital discharge summary. For all NEWS, the sensitivity and specificity to detect patients with SS was calculated. A total of 500 patients were included, 27 patients (5.4%) met the criteria for SS. The area under the curve (AUC) for NEWS to identify patient at risk for SS is 0.89 (95% CI 0.84 to 0.94). A NEWS of 3 or more at ED triage has a sensitivity of 92.6% (95% CI 74.2% to 98.7%) and a specificity of 77% (95% CI 72.8% to 80.6%) to detect patients at risk for SS at ED triage. A NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for SS, which may ultimately lead to early recognition and treatment. 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/productsservices/rights-and-licensing/ ________________________________________________________________________________ Title: Predictors of Severe Sepsis among Patients Hospitalized for Community-Acquired Pneumonia. Citation: PloS one, Jan 2016, vol. 11, no. 1, p. e0145929. Author(s): Montull, Beatriz, Menéndez, Rosario, Torres, Antoni, Reyes, Soledad, Méndez, Raúl, Zalacaín, Rafael, Capelastegui, Alberto, Rajas, Olga, Borderías, Luis, Martin-Villasclaras, Juan, Bello, Salvador, Alfageme, Inmaculada, Rodríguez de Castro, Felipe, Rello, Jordi, Molinos, Luis, RuizManzano, Juan, NAC Calidad Group Abstract: Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP). To determine the host characteristics and microorganisms associated with severe sepsis in patients hospitalized with CAP. We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07-1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50-2.04) and renal disease (OR, 1.57; 95% CI, 1.21-2.03), whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52-0.73). Bacteremia (OR, 1.37; 95% CI, 1.05-1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31-1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10-2.49) were associated with severe sepsis CAP. CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis. Full text: Available ProQuest at PLoS ONE _______________________________________________________________________________ Title: Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery. Citation: The British journal of surgery, Jan 2016, vol. 103, no. 2, p. e73. Author(s): Bouza, C, López-Cuadrado, T, Amate-Blanco, J M Abstract: Despite increasing rates of surgery in the elderly, there is limited population-based information on sepsis in this age group. This study aimed to characterize the epidemiology and national trends of sepsis among elderly patients undergoing surgery in Spain. This population-based longitudinal study of patients aged 65 years or older, undergoing surgery between 2006 and 2011, used data from the national hospital discharge database. Patients were identified by ICD coding. Primary endpoints were incidence and case-fatality rates of sepsis. Predefined age groups were examined. In-hospital mortality-related factors were assessed by means of exploratory logistic regression. Trends were assessed for annual percentage change in rates using Joinpoint regression analysis. A total of 44 342 episodes of sepsis were identified, representing 1·5 per cent of all 2 871 199 surgical hospital admissions of patients aged 65 years or older. The rates varied with age and sex. The in-hospital case-fatality rate was 43·9 per cent (19 482 patients), and associated with age,

co-morbidity and organ dysfunction. Standardized rates of sepsis increased over time, with an annual change of 4·7 (95 per cent c.i. 1·4 to 8·5) per cent, whereas the case-fatality rate declined, with an overall annual change of -3·6 (-4·3 to -2·8) per cent. The decrease in mortality was more limited in patients with organ dysfunction and in the oldest age group. Rates of sepsis are increasing among elderly patients undergoing surgery, whereas in-hospital case fatality, although common, is showing a decreasing trend. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

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DETERIORATING PATIENT Title: Analysis of a data-fusion system for continuous vital sign monitoring in an emergency department. Citation: European journal of emergency medicine : official journal of the European Society for Emergency Medicine, Feb 2016, vol. 23, no. 1, p. 28-32 Author(s): Wilson, Sarah J, Wong, David, Pullinger, Richard M, Way, Rob, Clifton, David A, Tarassenko, Lionel Abstract: The aim of the study was to evaluate the ability of a data-fusion patient status index (PSI) to detect patient deterioration in the emergency department (ED) in comparison with track-and-trigger (T&T). A single-centre observational cohort study was conducted in a medium-sized teaching hospital ED. Vital sign data and any documented T&T scores (paper T&T) were collected from adults attending the resuscitation room, majors or observation ward. For each set of vital signs, we retrospectively calculated T&T (eT&T). PSI was calculated retrospectively from the continuous vital sign data using a statistical model of normality. Clinical notes were examined to identify 'escalation' events, and the numbers of these escalations identified by paper T&T, eT&T and PSI were retrospectively calculated. Data from 472 patient episodes were examined. A total of 20 patients had PSI data at the time of an escalation related to vital sign abnormalities that occurred during their ED stay (vs. on arrival). Only four patient events were detected at the time by paper T&T. In all, 17 were detected retrospectively by eT&T and 15 by PSI. PSI had a calculated false-alert rate of 1.13 alerts/bed-day. Electronic data capture offers opportunities for increased detection of deteriorating patients in a busy clinical environment compared with paper charts. Sample size in this study is insufficient to determine which electronic method (eT&T or PSI) offers superior detection of the need for escalation. ________________________________________________________________________________ Title: Activities of a Medical Emergency Team: a prospective observational study of 795 calls. Citation: Anaesthesia and intensive care, Jan 2016, vol. 44, no. 1, p. 34-43 Author(s): Mullins, C F, Psirides, A Abstract: Relatively few papers have examined specific causes for Medical Emergency Team (MET) review and the assessment and management undertaken by the MET. The aim of our study was to describe the type of patients who require MET review, the reasons such reviews are requested and the subsequent immediate management of these patients. Our prospective single-centre observational study was conducted in a university-affiliated tertiary hospital in New Zealand between October 2012 and September 2013. Each trigger for MET review was assessed separately to allow analysis of the main associated underlying conditions and interventions. Seven hundred and ninetyfive MET calls were generated for 630 patients. Mean patient age was 64 years. Sixty percent of all calls involved medical patients. There was a marked diurnal variation in the incidence of MET calls, with MET calls more likely during the daytime and evening compared to the night. The most common triggers for MET calls were an unresponsive or fitting patient (25.2%), tachycardia (24.2%), and an Early Warning Score of 8 or more (22.8%). Neurological causes (30.7%), cardiovascular failure (hypotension, pulmonary oedema) (26.7%), respiratory failure (22.6%), and sepsis (19.2%) were the most common underlying conditions. One of these top four conditions was present in nearly all patients (99.2%). The majority of MET calls were made for a relatively small number of underlying conditions and triggers, supporting the concept of 'MET syndromes'. The pattern of interventions is

predictable from the triggering condition. This may guide education and training of ward staff to improve detection of deteriorating patients and prevent or pre-emptively manage causes of such deterioration prior to MET criteria being reached. The association between time of day and crisis recognition suggests the hospital system does not reliably detect deteriorating patients. This questions the adequacy of monitoring of deteriorating patients on hospital wards. ________________________________________________________________________________ Title: Consumer participation in early detection of the deteriorating patient and call activation to rapid response systems: a literature review. Citation: Journal of clinical nursing, Jan 2016, vol. 25, no. 1-2, p. 38-52 Author(s): Vorwerk, Jane, King, Lindy Abstract: This review investigated the impact of consumer participation in recognition of patient deterioration and response through call activation in rapid response systems. Nurses and doctors have taken the main role in recognition and response to patient deterioration through hospital rapid response systems. Yet patients and visitors (consumers) have appeared well placed to notice early signs of deterioration. In response, many hospitals have sought to partner health professionals with consumers in detection and response to early deterioration. However, to date, there have been no published research-based reviews to establish the impact of introducing consumer involvement into rapid response systems. A critical research-based review was undertaken. A comprehensive search of databases from 2006-2014 identified 11 studies. Critical appraisal of these studies was undertaken and thematic analysis of the findings revealed four major themes. Following implementation of the consumer activation programmes, the number of calls made by the consumers following detection of deterioration increased. Interestingly, the number of staff calls also increased. Importantly, mortality numbers were found to decrease in one major study following the introduction of consumer call activation. Consumer and staff knowledge and satisfaction with the new programmes indicated mixed results. Initial concerns of the staff over consumer involvement overwhelming the rapid response systems did not eventuate. Evaluation of successful consumer-activated programmes indicated the importance of: effective staff education and training; ongoing consumer education by nurses and clear educational materials. Findings indicated positive patient outcomes following introduction of consumer call activation programmes within rapid response systems. Effective consumer programmes included information that was readily accessible, easy-to-understand and available in a range of multimedia materials accompanied by the explanation and support of health professionals. Introduction of consumer-activated programmes within rapid response systems appears likely to improve outcomes for patients experiencing deterioration. © 2015 John Wiley & Sons Ltd. ________________________________________________________________________________ Title: Nurses' documentation of physiological observations in three acute care settings. Citation: Journal of clinical nursing, Jan 2016, vol. 25, no. 1-2, p. 134-143 Author(s): Considine, Julie, Trotter, Carissa, Currey, Judy Abstract: To explore nurses' documentation of physiological observations in acute care; emergency department, medical and surgical units. In Australia, physiological observations include respiratory rate, oxygen saturation, heart rate, blood pressure, temperature and level of consciousness. There is a clear relationship between abnormal physiological observations and adverse events. Nurses have highest level of responsibility for accurate measurement, interpretation and documentation of physiological observations. A descriptive exploratory design was used and the study data were collected using a prospective point prevalence approach between 25 July 2012-22 August 2012. The study was conducted in the emergency department, two 30-bed medical units and one 30-bed surgical unit of a 578 bed public health service in Melbourne, Australia. All adult patients aged ≥18 years present during data collection periods were eligible for inclusion. Patients in the emergency department resuscitation area were excluded. Patient characteristics and physiological observations for the preceding 24 hours in ward patients or eight hours in emergency department patients were collected. One hundred and seventy-eight patients were included; 38 emergency department patients, 84 medical patients and 56 surgical patients. The median age was 72·5 years and 43·8% were males. The most frequently documented physiological observations were respiratory rate, oxygen saturation, heart rate and systolic blood pressure. The least frequently recorded physiological observations were

temperature and conscious state. One or more abnormal physiological parameters was documented in 79路8% (n = 142) patients; evidence of reporting abnormalities was documented in 19路7% of patients (n = 28/142). When controlled for length of stay, physiological observations were more frequently documented in the emergency department. There was variability in the number of parameters documented and frequency of physiological observations documented by nurses. Physiological abnormalities that do not necessarily fulfil rapid response team activation criteria are common in acute care patients and provide nurses with an opportunity for early recognition of deteriorating patients. 漏 2015 John Wiley & Sons Ltd. ________________________________________________________________________________ Title: Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study. Citation: Journal of clinical nursing, Jan 2016, vol. 25, no. 1-2, p. 175-185 Author(s): Smith, Duncan J, Aitken, Leanne Abstract: To investigate nurses' use of a single parameter track and trigger chart to inform implementation of the National Early Warning Scoring tool. To report the characteristics of patients with triggers, the frequency of different triggers, and the time taken to repeat observations. To explore the barriers and facilitators perceived by nursing staff relating to patient monitoring. Sub-optimal care of the deteriorating patient has been described for almost two decades. Organisations have responded by implementing strategies that improve monitoring and facilitate a timely response to patient deterioration. While these systems have been widely adopted the evidence-base to support their use is inconsistent. A mixed method service evaluation was carried out in an acute University hospital. Physiological triggers (n = 263) and characteristics of triggering patients (n = 74) were recorded from surgical and medical wards. Descriptive statistics were displayed. Questionnaires were distributed (n = 105) to student nurses, health care assistants and registered nurses. Themes and sub-themes were identified from content analysis. Hypotension was the most frequent abnormality. There was variability in the time to repeat observations following a trigger. A high proportion of triggers were identified in older patients, as was a trend of longer time intervals between trigger and repeat observations. Nurses reported a number of barriers and facilitators to monitoring patients including: 'workload', 'equipment', 'interactions between staff' and 'interactions with patients'. This study identified a number of barriers and facilitators to monitoring and escalation of abnormal vital signs, highlighting the complexity of the process and the need for a system-wide approach to a deteriorating patient. The trend of longer delays following a trigger in older patients has not been identified previously and could reflect a knowledge gap of the physiological changes and response to acute illness in older people. 漏 2015 John Wiley & Sons Ltd.

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MEDICATION Title: Correlates of major medication side effects interfering with daily performance: results from a cross-sectional cohort study of older psychiatric patients. Citation: International Psychogeriatrics, 2016, vol./is. 28/2(331-340) Abstract: Background: Polypharmacy is common among older persons who are also vulnerable to side effects. We aimed to characterize patients who on admission to a geriatric psychiatric hospital had major medication side effects interfering with daily performance.Methods: Cross-sectional cohort study of patients consecutively admitted to a geriatric psychiatric hospital from 2006, 06 December to 2008, 24 October. The UKU side effect rating scale was performed, and patients were divided into those with no/minor side effects versus those with major side effects. Blood levels of 56 psychotropic drugs and 27 safety laboratory tests were measured upon admission.Results: Of 206 patients included in the analysis, 70 (34%) had major side effects related to drug treatment. The most frequent side effects were asthenia (31%), reduced salivation (31%), concentration difficulties (28%), memory impairment (24%), and orthostatic dizziness (18%). The significant characteristics predicting major side effects were female gender (OR = 2.4, 95% confidence interval (CI) = 1.1-5.5), main diagnosis of

affective disorder (OR = 4.3, 95% CI = 1.5-12.3), unreported use of psychotropic medications (OR = 2.0, 95% CI = 1.0-4.1), a higher number of reported psychotropic medications (OR = 1.7, 95% CI = 1.2-2.3), a higher number of reported medications for somatic disorders (OR = 1.2, 95% CI = 1.1-1.5), and a higher score on the Charlson comorbidity index (OR = 1.2, 95% CI = 1.0-1.4) (r 2 = 0.238, p < 0.001).Conclusions: Clinicians should be especially aware of side effects related to drug treatment in geriatric psychiatric female patients with a high use of psychotropic and other medications and somatic comorbidity. Unreported use of psychotropic medications was also related to the risk for side effects, and clinicians should make an effort to ascertain all medications taken by geriatric psychiatric patients. ________________________________________________________________________________ Title: Medication administration errors from a nursing viewpoint: a formal consensus of definition and scenarios using a Delphi technique. Citation: Journal of Clinical Nursing, 2016, vol./is. 25/3/4(412-423) ________________________________________________________________________________ Title: Nurses' attitude and intention of medication administration error reporting. Citation: Journal of Clinical Nursing, 2016, vol./is. 25/3/4(445-453) ________________________________________________________________________________ Title: Evaluation of Perioperative Medication Errors and Adverse Drug Events. Citation: Anesthesiology, 2016, vol./is. 124/1(25-34) Abstract: Background: The purpose of this study is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, to evaluate their root causes, and to formulate targeted solutions to prevent them.Methods: In this prospective observational study, anesthesia-trained study staff (anesthesiologists/nurse anesthetists) observed randomly selected operations at a 1,046-bed tertiary care academic medical center to identify MEs and ADEs over 8 months. Retrospective chart abstraction was performed to flag events that were missed by observation. All events subsequently underwent review by two independent reviewers. Primary outcomes were the incidence of MEs and ADEs.Results: A total of 277 operations were observed with 3,671 medication administrations of which 193 (5.3%; 95% CI, 4.5 to 6.0) involved a ME and/or ADE. Of these, 153 (79.3%) were preventable and 40 (20.7%) were nonpreventable. The events included 153 (79.3%) errors and 91 (47.2%) ADEs. Although 32 (20.9%) of the errors had little potential for harm, 51 (33.3%) led to an observed ADE and an additional 70 (45.8%) had the potential for patient harm. Of the 153 errors, 99 (64.7%) were serious, 51 (33.3%) were significant, and 3 (2.0%) were life-threatening.Conclusions: One in 20 perioperative medication administrations included an ME and/or ADE. More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. These rates are markedly higher than those reported by retrospective surveys. Specific solutions exist that have the potential to decrease the incidence of perioperative MEs. Full text: Available Ovid fulltext collection at Anesthesiology ________________________________________________________________________________ Title: Medicines reconciliation: do we know which medicines children are taking? Citation: Archives of Disease in Childhood, 2016, vol./is. 101/1(65-66) Abstract: The article focuses on Medicines reconciliation, a process of creating list of all the drugs prescribed to patients and healthcare professionals who help patients to deal with medication information. Topics discussed include origination of Medicines reconciliation as part of World Health Organization (WHO) program me, WHO's suggestion to perform medicines reconciliation earlier to reduce prescribing errors, and making recondition mandatory for pediatric patients as well as adult patients. Full text: Available Highwire Press at Archives of disease in childhood

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Title: Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration Citation: Journal of Clinical Nursing, Nov 2015, vol. 24, no. 21-22, p. 3063-3076 Author(s): Hayes, Carolyn, Jackson, Debra, Davidson, Patricia M, Power, Tamara Abstract: The purpose of this review was to explore what is known about interruptions and distractions on medication administration in the context of undergraduate nurse education. Incidents and errors during the process of medication administration continue to be a substantial patient safety issue in health care settings internationally. Interruptions to the medication administration process have been identified as a leading cause of medication error. Literature recognises that some interruptions are unavoidable; therefore in an effort to reduce errors, it is essential understand how undergraduate nurses learn to manage interruptions to the medication administration process. Systematic, critical literature review. Utilising the electronic databases, of Medline, Scopus, PubMed and CINAHL, and recognised quality assessment guidelines, 19 articles met the inclusion criteria. Search terms included: nurses, medication incidents or errors, interruptions, disruption, distractions and multitasking. Researchers have responded to the impact of interruptions and distractions on the medication administration by attempting to eliminate them. Despite the introduction of quality improvements, little is known about how nurses manage interruptions and distractions during medication administration or how they learn to do so. A significant gap in the literature exists in relation to innovative sustainable strategies that assist undergraduate nurses to learn how to safely and confidently manage interruptions in the clinical environment. Study findings highlight the need for further exploration into the way nurses learn to manage interruptions and distractions during medication administration. This is essential given the critical relationship between interruptions and medication error rates. Better preparing nurses to safely fulfil the task of medication administration in the clinical environment, with increased confidence in the face of interruptions, could lead to a reduction in errors and concomitant improvements to patient safety. [PUBLICATION] 35 references

________________________________________________________________________________ Title: Minimising harm from missed drug doses Citation: Nursing Times, Oct 2015, vol. 111, no. 44, p. 12-15 Author(s): O'Grady, Isobel, Gerrett, David Abstract: Background: The National Patient Safety Agency reported that more than 21,000 patientsafety incidents, including death, occurred between September 2006 and June 2009 as a result of missed or delayed medication doses. Aim: To identify the number of incidents reported between 2005 and 2013 associated with the oral route not being available. Find ways to improve practice. Method: The National Reporting and Learning System was searched for medication incidents categorised as omitted and delayed from 1 January 2005 until 31 December 2013. Search terms were used to filter for incidents associated with the oral route not being available. Qualitative analysis of 200 incident reports identified common themes. Results: In total 1,882 incidents met the search criteria, the majority in hospitals. There were six deaths and 581 harms. The largest number of reports concerned patients who were nil by mouth. Analysis of the medicines described found that the most commonly omitted medicine (17%) was anti-epileptic medication. Discussion: It is estimated that the actual prevalence of omitted doses where the oral route was not available is greater than this paper describes. Conclusion: Positive intervention is needed in this area to reduce harm to patients. [PUBLICATION] 6 references

________________________________________________________________________________ Title: Improving Medication Administration Safety in a Community Hospital Setting Using Lean Methodology Citation: Journal of Nursing Care Quality, Oct 2015, vol. 30, no. 4, p. 345-351 Author(s): Critchley, Sandy Abstract: Virtually all health care organizations have goals of improving patient safety, but despite clear goals and considerable investments, gains have been limited. This article explores a community

hospital's resounding success using Lean methodology to improve medication administration safety with process changes designed by engaged employees and leaders with the knowledge and skill to effect improvements. This article inspires an interdisciplinary approach to quality improvement using reproducible strategies. [PUBLICATION] 17 references

________________________________________________________________________________ Title: The 10 'R's of safe multidisciplinary drug administration. Citation: Nurse Prescribing, 2015, vol./is. 13/8(398-406) Author(s): Edwards, Sharon, Axe, Sue Abstract: Nurses are responsible for medication administration, and, as with many other nursing interventions, some risk is involved. If an error occurs, a patient may suffer harm or injury, which may lead to a permanent disability or a fatality. To ensure safe drug administration, nurses are encouraged to follow the five rights ('R's; patient, drug, route, time and dose) of medication administration to prevent errors in administration. The five 'R's do not consider all causes of drug errors; instead, they focus on medication administration at the bedside so they relate only to this stage of a drug prescription. A drug's journey is more than what happens at the bedside; therefore, the reduction of errors requires more than just the five 'R's. This article proposes a multi-professional, evidence-based approach to medicines management, which all clinicians can work towards, together. Clinicians can achieve this approach by considering the National Patients Safety Agency's definition of a medication error and the values set out by the National Prescribing Centre. The approach utilizes 10 'R's, which provide a benchmark for good practice. The 10 'Rs' advocate the need for the knowledge of the causes of drug errors, how to implement strategies to reduce drug errors, how to ensure safe practice throughout the medication journey, from chemical preparation, to monitoring outcomes, to response.

________________________________________________________________________________ Title: A safe practice standard for barcode technology. Citation: Journal of patient safety, Jun 2015, vol. 11, no. 2, p. 89-99 Author(s): Leung, Alexander A, Denham, Charles R, Gandhi, Tejal K, Bane, Anne, Churchill, William W, Bates, David W, Poon, Eric G Abstract: Safety advocates have identified barcode verification technology as an important tool to improve health-care practices. We evaluated the evidence for the role of barcode technology in improving a wide range of medication safety outcomes across a broad range of settings. Important implementation issues were highlighted to guide standards for the safe adoption of barcode technology. Adverse drug events are common, occurring frequently in both inpatient and outpatient settings. Although approximately half of all preventable adverse drug events in inpatients result from medication errors arising from transcription, dispensing, and administration, these errors are far less likely to be caught than in any of the earlier stages of the medication use process and are therefore most amenable to improvement. When integrated with electronic medication administration records, barcode systems are associated with complete elimination of transcription errors. Furthermore, barcode-assisted dispensing systems are associated with 93% to 96% reductions in dispensing errors, and 85% reductions in potential adverse drug events in dispensing. Most studies have reported large and significant reductions in administration errors by up to 80% after implementation of barcode medication administration systems. Although most studies of barcode technology have been conducted in the adult inpatient setting, the limited data available also support their benefit in pediatric and outpatient settings. There is growing evidence for the efficacy of barcode solutions in improving overall medication safety. Standards for the implementation of barcode technology are proposed.

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RESTRICTIVE PRACTICE (restraint) Title: Applying ethical principles to restraint practice. Citation: Learning Disability Practice, 2016, vol./is. 19/1(23-26), 14658712 Full text: Available RCN Publishing at Learning Disability Practice ________________________________________________________________________________ Title: Treatment of older people with dementia in surgical wards from the viewpoints of the patients and close relatives Citation: Journal of Clinical Nursing, Dec 2015, vol. 24, no. 23-24, p. 3691-3699 Author(s): Hynninen, Nina, Saarnio, Reetta, Isola, Arja Abstract: The aim of this study was to describe the treatment of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives. Little is known about the impact of the increasing number of older people with dementia on the treatment of patients in acute care. A qualitative, descriptive design was used. The data were collected using unstructured interviews, which were then subjected to inductive content analysis. Support from close relatives was significant for the mental and social wellbeing of older dementia patients during their hospital stay. People with dementia felt insecure in their relatives' absence, and missed them. For the relatives, the patients' hospital stay was emotionally heavy. The relatives desired more emotional support from the nursing staff. The participating patients hoped that the nursing staff would spend more time discussing their cases with them. One of the factors that hindered good care of an older person with dementia was use of restraint. Relatives felt that use of restraints violated patients' dignity. To improve the treatment of the people with dementia, the close relatives need to participate in planning the nature of care for the patients. [PUBLICATION] 28 references ________________________________________________________________________________ Title: Restraint Reduction, Restraint Elimination, and Best Practice: Role of the Clinical Nurse Specialist in Patient Safety Citation: Clinical Nurse Specialist, Nov 2015, vol. 29, no. 6, p. 321-328 Author(s): Kirk, Anna Purcell, McGlinsey, Andrea, Beckett, Alanna, Rudd, Patricia, Arbour, Richard Abstract: Pursuit of best practice dictates directed evidence-based practice initiatives for restraint reduction and elimination. Here, Kirk et al describe effective, evidence-based, multidisciplinary approaches to patient safety. These approaches focus on real-time individualized critical appraisal of restraint use and evaluation of potentially treatable causes of agitation. Successful strategies for sustained critical evaluation of restraint utilization through unit enculturation, nurse champions, and effective multidisciplinary care are demonstrated. [PUBLICATION] ________________________________________________________________________________ Title: Restraint Reduction, Restraint Elimination, and Best Practice: Role of the Clinical Nurse Specialist in Patient Safety Citation: Clinical Nurse Specialist, Nov 2015, vol. 29, no. 6, p. 321-328 Author(s): Kirk, Anna Purcell, McGlinsey, Andrea, Beckett, Alanna, Rudd, Patricia, Arbour, Richard Abstract: Pursuit of best practice dictates directed evidence-based practice initiatives for restraint reduction and elimination. Here, Kirk et al describe effective, evidence-based, multidisciplinary approaches to patient safety. These approaches focus on real-time individualized critical appraisal of restraint use and evaluation of potentially treatable causes of agitation. Successful strategies for sustained critical evaluation of restraint utilization through unit enculturation, nurse champions, and effective multidisciplinary care are demonstrated. [PUBLICATION]

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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

Launching and leading change initiatives in health care organisations : managing successful projects / David A. Shore (2014) Implementing change that fosters sustainable growth and better patient care in health care projects depends on astute management of change. But more than anything else, it depend on leaders who pay attention, who understand the importance of starting right, and who know how to launch projects that succeed. If leaders can increase the percentage of successful projects, patients, and practitioners everywhere will be better off and so will the organizations that depend on these projects for innovation. Read more at http://www.swims.nhs.uk/webview/?infile=details.glu&loid=681176&rs=570399&hitno=1

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Corticosteroids for treating sepsis Djillali Annane , Eric Bellissant , Pierre Edouard Bollaert , Josef Briegel , Didier Keh and Yizhak Kupfer Online Publication Date: December 2015 Bed rest for pressure ulcer healing in wheelchair users (New Protocol) Zena EH Moore , Menno T van Etten and Jo C Dumville Online Publication Date: December 2015 Reconstructive surgery for treating pressure ulcers(New Protocol) Jason KF Wong , Kavit Amin and Jo C Dumville Online Publication Date: January 2016

Dressings and topical agents for treating pressure ulcers (New Protocol) Maggie J Westby , Jo C Dumville , Marta O Soares , Nikki Stubbs , Gill Norman and Christopher N Foley Online Publication Date: November 2015 Interventions for preventing and reducing the use of physical restraints in long-term geriatric care Ralph Möhler , Tanja Richter , Sascha Köpke and Gabriele Meyer Online Publication Date: February 2011

Seclusion and restraint for people with serious mental illnesses Eila ES Sailas and Mark Fenton Online Publication Date: January 2000 (still used as current evidence)

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 21

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Assessment and emergency management of the acutely agitated or violent adult

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Prevention of adverse drug events in hospitals

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

NICE SURVEILLANCE REPORTS JANUARY 2016

Surveillance reports are a new service from NICE. Surveillance reports contain important new evidence relating to NICE guidelines. They contain: 

a summary of new evidence related to the guideline

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an in-depth commentary on a selection of this evidence

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a decision on whether the relevant guideline should be updated.

January’s edition includes: Falls: assessment and prevention of falls in older people. -surveillance report -decision matrix BACK TO TOP

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.