Current awareness suts jan 2016 by Musgrove Park Hospital Library

Library Services Musgrove Park and Somerset Partnership

Current Awareness Sign Up To Safety This monthly Current Awareness Bulletin is produced by the Library, 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 January 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 Title: Orthopedic Injuries: Protocols to Prevent and Manage Patient Falls Citation: Nursing Clinics of North America, Dec 2015, vol. 50, no. 4, p. 645-661 Author(s): Parsons, Lynn C., Revell, Maria A. Abstract: Health care organizations must adopt a culture of safety and implement effective fall prevention protocols. The teach-back method is a useful strategy for health providers to determine patient understanding of information taught to maintain a safe environment and prevent falls. Purposeful rounding is a proactive approach to ensure that patient assessments are accurate and research supports that patients use the call light less when nurses participate in hourly rounding. This article provides the reader with evidence-based fall prevention interventions, tips for using the teachback method, and fall prevention tools to safely care for patients of all ages. [PUBLICATION] 24 references

Title: Recommendations for assessing and preventing falls in adults of all ages with rheumatoid arthritis Citation: British Journal of Community Nursing, Nov 2015, vol. 20, no. 11, p. 529-533 Author(s): Stanmore, Emma K Abstract: Rheumatoid arthritis (RA) is a debilitating disease that affects younger as well as older adults. It is associated with a high risk of injurious falls due to problems such as lower-limb muscle weakness, balance impairment, swollen and tender joints, pain, and fatigue. Falls are typically associated with older people; hence, many professionals do not recognise the risks for younger persons with diseases such as RA. Falls can lead to devastating consequences, such as fatalities, hip fractures (with 50% of those affected never regaining their previous level of mobility and 30% dying within 1 year), or loss of independence and confidence. Research has shown that many people are either unaware or deny their risk of falling. Therefore, it is important that health professionals, such as community nurses, are aware of the risk factors, methods of assessment, and evidence-based preventative measures, so that falls can be avoided in this population. This article presents research and practice implications for community nurses to enable them to assess, treat, and appropriately refer adults with RA who are also at risk of falls. [PUBLICATION] 32 references Full Text: Available from EBSCOhost in British Journal of Community Nursing

Title: Moving forward in fall prevention: an intervention to improve balance among patients in a quasiexperimental study of hospitalized patients. Citation: International Journal of Rehabilitation Research, 2015, vol./is. 38/4(313-319) Author(s): VillafaĂąe JH1, Pirali C, Buraschi R, Arienti C, Corbellini C, Negrini S. Abstract: We investigated the effectiveness of three different rehabilitative programs: group exercise, individual core stability or balance training intervention with a stabilometric platform to improve balance ability in elderly hospitalized patients. We used a prospective quasi-experimental study design. Twenty-eight patients, 39.3% women [age (meanÂąSD) 72.4Âą6.5 years], known to have had at least a fall in the last 12 months, were consecutively assigned to one of the following three groups: group exercise intervention, individual core stability or balance training with a stabilometric platform (five sessions a week for 3 weeks in each group). Outcomes were collected at baseline and immediately following the intervention period. In each intervention group, patients showed improvement in balance and mobility, shown as an improvement in the three functional tests score (the Tinetti scale, the Berg Balance Scale, and the Time Up and Go test) (all, P<0.05), whereas, generally, the changes in the score of the test of the stabilometric platform (Postural Stability Test and Fall Risk Test) were not significant for all the interventions. No significant group-by-time interaction was detected for any of the intervention groups, which suggests that the groups improved in the same way. These findings indicate that participation in an exercise program can improve balance and functional mobility, which might contribute toward the reductions of the falls of elderly hospitalized patients and the subsequent fall-related costs. Functional scales might be more appropriate than an instrumental test (Postural Stability Test and Fall Risk Test of the Biodex Balance System) in detecting the functional improvement because of a rehabilitative intervention.

Title: Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial. Citation: Aging Clinical & Experimental Research, 2015, vol./is. 27/5(681-688) Author(s): Efraim Aizen, Galina Lutsyk, Lea Wainer, Sarit Carmeli Abstract: Background and aims: There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital. Methods: This was a twostage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay. Results: In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage. Conclusion: These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls

PRESSURE ULCERS Title: The home front on pressure ulcers Citation: Nursing Standard, Dec 2015, vol. 30, no. 14, p. 22-23. Author(s): Trueland, Jennifer Abstract: Tissue viability specialist nurses at Guy's and St Thomas' Trust in London are training care home staff and community carers to prevent and manage pressure ulcers. The successful Zero Pressure campaign stresses immediate response to any sign of skin reddening. [PUBLICATION] 0 references Full Text: Available from NURSING STANDARD in Library MPH Title: The use of smart technology to deliver efficient and effective pressure-damage education Citation: British Journal of Nursing, Nov 2015, vol. 24, no. 20, p. S4. Author(s): Rajpaul, Kumal, Acton, Claire Abstract: This article outlines an innovative joint working strategy, as well as a partnership project, between two NHS Foundation Trusts - a community trust and industry partner - to develop a mobile training app to deliver pressure ulcer prevention and management for clinical staff. The aim of the innovation was to enable a new way of delivering education to large numbers of staff by moving away from traditional classroom-based training. The process included development of the app, along with testing and implementation, followed by a review of the qualitative data after the app's implementation. The review takes into account the key outcomes that have had an impact on this method of delivering education, its challenges and how it has been received by clinical staff and patients. [PUBLICATION] 18 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: Part 1: Pressure ulcer assessment - the development of Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE) Citation: Nursing in Critical Care, Nov 2015, vol. 20, no. 6, p. 308-314. Author(s): Richardson, Annette, Barrow, Isabel Abstract: Introduction: Critically ill patients are at high risk of developing pressure ulcers resulting in serious untoward patient and health care system outcomes. Pressure ulcer prevention is therefore an important patient safety priority and establishing a structured approach to pressure ulcer risk assessment to identify patients at risk is a critical first step. Methods: The literature was searched using three electronic databases from 2000 to 2011 to identify papers reporting on pressure ulcer risk factors and assessment in adult critical care. The review and appraisal of papers were conducted by two critical care nurses. Papers underwent detailed review if they met inclusion criteria where they identified pressure ulcer assessment scores, scales or risk factors and related to adult critical care patients. Findings: Seven papers were reviewed. No single assessment tool was sufficiently validated for critically ill patients and seven key critical care risk factors were identified. These risk factors were: mechanical ventilation, impaired circulation, dialysis, long surgery, low protein and too unstable to turn. Tool development: The tool Critical Care Pressure Ulcer Assessment Tool made Easy (CALCULATE) was developed utilizing the risk factors from the literature and expert critical care nursing consensus decision-making. Discussion: In the absence of current consensus, valid

assessment scales and limited evidence for the most appropriate pressure ulcer assessment for critically ill patients, this assessment tool offers an easy, appropriate alternative for critically ill patients than existing tools primarily validated for acute care wards. Conclusions: 'CALCULATE' offers an important contribution towards the advancement and development of critical care pressure ulcer risk assessment. Future research is needed to further enhance and inform pressure ulcer risk assessment of the critically ill patients. Implications for practice: The identification of critical care risk factors may be an indicative method of assessing pressure ulcer risk in the critically ill patients. [PUBLICATION] 19 references

Title: Part 2: pressure ulcer assessment: implementation and revision of CALCULATE Citation: Nursing in Critical Care, Nov 2015, vol. 20, no. 6, p. 315-321. Author(s): Richardson, Annette, Straughan, Christine Abstract: Introduction: Critically ill patients are a vulnerable group at very high risk of developing pressure ulcers, and the incidence varies within critical care. Methods: A number of strategies were used to implement the pressure ulcer assessment tool CALCULATE across four adult critical care units. Strategies included, nursing leadership, the provision of definitions for each risk factor, information laid out on posters at each patient's bedside, changes to pre-printed nursing documentation and a 30-min focused training package. Two local audits were conducted to measure the number and types of risk factors occurring in patients with pressure ulcers, and to assess the frequency of assessments and gain feedback on the usability of the tool in practice. Findings: Critical care acquired pressure ulcer incidence was 3.4%. The two most commonly occurring risk factors were impaired circulation (82%) and mechanical ventilation (75%). Patients had a mean score of 4, and 65% had 4 or more reported risk factors. Feedback on the usability of the tool was mainly positive. Discussion: The tool CALCULATE was relatively straightforward to implement and was likely to be due to the design and the various change strategies used to implement the new approach. The seven point tool was revised to an eight point score based on nurses' clinical feedback. Conclusions: Research is required to further enhance and develop pressure ulcer assessment. Meanwhile CALCULATE offers an easy to use and appropriate tool to assist in the identification of patients at an elevated risk of pressure ulcer damage. Implications for Practice: Careful choice of change management strategies are needed when implementing a new assessment tool. CALCULATE should be considered for use in critical care for pressure ulcer assessment, but used alongside nurses' clinical judgement and observations of skin. [PUBLICATION] 16 references

Title: The role of innovation in heel pressure ulcer prevention Citation: Wounds U K, Nov 2015, vol. 11, no. 4, p. 106-110, 1746-6814 (November 2015) Author(s): Stang, Duncan, Ballard-Wilson, Anna Abstract: The scale and the cost of pressure ulcers (PUs) means that prevention has become a key quality of care indicator in the UK, with a zero tolerance approach adopted by the NHS. This places increased pressures on clinicians to implement PU prevention strategies that aim to reduce the number of avoidable PUs. However the provision of high-quality care is often challenged by financial and time constraints, as well as access to and selection of the right pressure-redistributing equipment. The recent recommendations for PU prevention from NICE (2014a) include methods for identification and risk assessment and the appropriate preventative measures that should be applied. Innovation in product design, along with the adoption of standard protocols, can play a key role in helping clinicians deliver these recommendations, ensuring high standards of care. [PUBLICATION] 27 references

SEPSIS Title: A quality improvement project to improve early sepsis care in the emergency department. Citation: BMJ quality & safety, Dec 2015, vol. 24, no. 12, p. 787-795 Author(s): Gatewood, Medley O'Keefe, Wemple, Matthew, Greco, Sheryl, Kritek, Patricia A, Durvasula, Raghu Abstract: Sepsis causes substantial morbidity and mortality in hospitalised patients. Although many studies describe the use of protocols in the management of patients with severe sepsis and septic shock, few have addressed emergency department (ED) screening and management for patients initially presenting with uncomplicated sepsis (ie, patients without organ failure or hypotension). A quality improvement task force at a large, quaternary care referral hospital sought to develop a protocol focusing on early identification of patients with uncomplicated sepsis, in addition to severe sepsis and septic shock. The three-tiered intervention consisted of (1) a nurse-driven screening tool and management protocol to identify and initiate early treatment of patients with sepsis, (2) a computer-assisted screening algorithm that generated a 'Sepsis Alert' pop-up screen in the electronic medical record for treating clinical healthcare providers and (3) automated suggested sepsis-specific order sets for initial workup and resuscitation, antibiotic selection and goal-directed therapy. A before and after retrospective cohort study was undertaken to determine the intervention's impact on compliance with recommended sepsis management, including serum lactate measured in the ED, 2 L of intravenous fluid administered within 2 h of triage, antibiotics administered within 3 h of triage and blood cultures drawn before antibiotic administration. Mortality rates for patients in the ED with a sepsis-designated ICD-9 code present on admission were also analysed. Overall bundle compliance increased by 154%, from 28% at baseline to 71% in the last quarter of the study (p<0.001). Bundle, antibiotic and intravenous fluid compliance all increased significantly after launch of the sepsis initiative (eg, bundle and intravenous fluid compliance increased by 74% and 54%, respectively; p<0.001). Bundle and antibiotic compliance both showed further significant increases after implementation of suggested order sets (31% and 25% increases, respectively; p<0.001). The mortality rate for patients in the ED admitted with sepsis was 13.3% before implementation and fell to 11.1% after (p=0.230); mortality in the last two quarters of the study was 9.3% (p=0.107). The new protocol demonstrates that early screening interventions can lead to expedited delivery of care to patients with sepsis in the ED and could serve as a model for other facilities. Mortality was not significantly improved by our intervention, which included patients with uncomplicated sepsis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ Full Text: Available from Highwire Press in BMJ Quality and Safety Title: A Review of GM-CSF Therapy in Sepsis. Citation: Medicine, Dec 2015, vol. 94, no. 50, p. e2044. Author(s): Mathias, Brittany, Szpila, Benjamin E, Moore, Frederick A, Efron, Philip A, Moldawer, Lyle L Abstract: Determine what clinical role, if any, GM-CSF may have in the clinical treatment of sepsis in the adult patient. Advancements in the management of sepsis have led to significant decreases in early mortality; however, sepsis remains a significant source of long-term mortality and disability which places strain on healthcare resources with a substantial growing economic impact. Historically, early multiple organ failure (MOF) and death in patients with severe sepsis was thought to result from an exaggerated proinflammatory response called the systemic inflammatory response syndrome (SIRS).Numerous prospective randomized controlled trials (PRCTs) tested therapies aimed at decreasing the organ injury associated with an exaggerated inflammatory response. With few exceptions, the results from these PRCTs have been disappointing, and currently no specific therapeutic agent is approved to counteract the early SIRS response in patients with severe sepsis. It has long been recognized that there is a delayed immunosuppressive state that contributes to long-

term morbidity. However, recent findings now support a concurrent proinflammatory and antiinflammatory response present throughout sepsis. Multiple immunomodulating agents have been studied to combat the immunosuppressive phase of sepsis with the goal of decreasing secondary infection, reducing organ dysfunction, decreasing ICU stays, and improving survival. Granulocytemacrophage colony stimulating factor (GM-CSF), a myelopoietic growth factor currently used in patients with neutropenia secondary to chemotherapy-induced myelosuppression, has been studied as a potential immune-activating agent.The applicability of GM-CSF as a standard therapy for generalized sepsis is still largely understudied; however, small-scale studies available have demonstrated some improved recovery from infection, decreased hospital length of stay, decreased days requiring mechanical ventilation, and decreased medical costs.

Title: A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis. Citation: Journal of medical economics, Nov 2015, vol. 18, no. 11, p. 944-953. Author(s): Kip, Michelle M A, Kusters, Ron, IJzerman, Maarten J, Steuten, Lotte M G Abstract: Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice. A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided. The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa â&#x201A;Ź3503 per patient, indicating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs. Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistance.

Title: Preventing sepsis Citation: The Lancet Infectious Diseases15.11 (Nov 2015): 1259-1260. Author(s): Bermejo-Martin, JesĂşs F; Andaluz-Ojeda, David; Almansa, Raquel; Eiros, Jose MarĂa; Tamayo, Eduardo Abstract: As highlighted by Jonathan Cohen and colleagues in their Commission,1 mortality remains high in severe forms of sepsis.1 The authors provided an extensive review of the key issues to be addressed in future research to develop better treatment strategies that can improve the present scenario. In our view, in the absence of effective treatments, prevention of sepsis is the best way to diminish morbidity and mortality associated with this complication. Most patients with sepsis are elderly individuals with comorbidities.

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

ABC of sepsis. Chichester: edited by Ron Daniels and Tim Nutbeam (2010). Wiley-Blackwell. ISBN 9781405181945 The importance of early prevention and treatment of sepsis has never been greater. In the UK alone sepsis contributes to more deaths than lung cancer, from bowel cancer and breast cancer combined, and approximately one third of patients who suffer from severe sepsis die. The ABC of Sepsis provides a much needed introduction and an invaluable aid in the increasing efforts to reduce hospital infection and improve patient safety.

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

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

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

New NHS England action plan to help tackle ‘silent killer’ sepsis rd

A new action plan has been published 23 December to help support healthcare professionals to recognise and treat sepsis promptly. https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf

UK Sepsis Trust This site includes a number of clinical toolkits http://sepsistrust.org/clinical-toolkit/

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.