Preventing and managing device-related pressure ulcers in oncology

2021 ◽  
Vol 30 (1) ◽  
pp. 48-53
Author(s):  
Susy Pramod
Keyword(s):  
Case Studies ◽  
Medical Device ◽  
Best Practice ◽  
Pressure Ulcers ◽  
High Standard ◽  
Standard Of Care ◽  
Care Plan ◽  
Tissue Viability ◽  
Prophylactic Devices ◽  
Individualised Care

There is growing evidence that medical device-related pressure ulcers (MDRPUs) are an increasing healthcare concern in all aspects of care. It is especially important to develop an individualised care plan for people at the end of life to prevent pressure ulceration and to treat this if it occurs. Tissue viability nurses have a responsibility to review and assess new prophylactic devices and dressings, to ensure a high standard of care is provided. This article describes the use of a soft silicone dressing, Kliniderm foam silicone lite, in combination with best practice, to prevent MDRPUs in the oncology setting. Three case studies show that the dressing helped avoid the occurrence of ulceration on the ears and nose in patients receiving oxygen through a nasal cannula.

Improving Diabetes Care in an Urban Aboriginal Medical Centre

2005 ◽  
Vol 11 (3) ◽  
pp. 25 ◽  
Author(s):  
Diane A Longstreet ◽  
Marlene M Griffiths ◽  
Deanne Heath ◽  
Gauwada Emily G Marshall ◽  
Paolo Morisco ◽  
...  
Keyword(s):  
Best Practice ◽  
Service Providers ◽  
Standard Of Care ◽  
Holistic Health ◽  
Medical Centre ◽  
Care Plan ◽  
Care Plans ◽  
Patients With Diabetes ◽  
Care Approach ◽  
Design And Methods

The aim of this project was to improve the detection, monitoring, and medical care of Indigenous patients with diabetes in an urban Aboriginal medical centre. The research design and methods entailed the diabetes register being cleaned and updated. A pre- and post-project non-random sample audit of medical records of patients diagnosed with diabetes evaluated the level of care received compared to best practice standard of care. A multi-disciplinary Diabetes Team established procedures to improve the patient care provided. Additional service providers, including a dietitian, podiatrist, ophthalmologist, and endocrinologist, joined the team. A holistic health care approach was implemented with an emphasis on opportunistic care. The percentage of patients having a care plan completed increased from 18% in the 2002 audit to 72% in the 2003 audit. There were significant trends between increased completion of all cycle of care activities and frequency of GP review. Doctors prepared care plans for 50% of patients who attended less than two review visits in 2003, but increased to 89% if receiving six visits or more (p = 0.000). No significant improvement in health outcome was noted. The project showed significantly improved care planning and medical management of urban Aboriginal and Torres Strait Islander patients with diabetes.

scholarly journals POS1478-HPR NURSE LED REMOTE MANAGEMENT OF OSTEOPOROSIS – DO PATIENTS APPROVE?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1024.1-1024
Author(s):  
J. Begum ◽  
J. Fourmy ◽  
M. K. Nisar
Keyword(s):  
Quality Care ◽  
High Standard ◽  
Standard Of Care ◽  
Osteoporosis Treatment ◽  
Physical Review ◽  
Care Plan ◽  
Telephone Consultation ◽  
Clinical Nurse Specialists ◽  
Related Information ◽  
Innovative Solution

Background:Specialist services are heavily reliant on consultant delivered models however lack of sufficient consultant appointments pose a significant operational challenge. Clinical nurse specialists (CNSs) are highly trained and can fill this gap whilst maintaining a high standard of care.Objectives:We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver high-quality care.Methods:A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. We surveyed 100 consecutive patients to gain their feedback regarding the service using a ten-item questionnaire employing binary and Likert scale options.Results:The questionnaire was posted to 100 patients. Mean age of participants was 77.2 years (65-92). 75 returned the survey. 67 (89%) were happy with the waiting time and seventy (93%) found thirty-minute appointment acceptable. 66 (88%) were happy with the phone consultation and agreed that the care plan was adequately explained. 73 (97%) were happy for the CNS review in future and would recommend the service. 67 (89%) were satisfied with the overall service. Though most (95%) were able to take the call maintaining privacy, eleven (15%) participants would’ve found physical appointment more convenient. When asked which medium they would prefer for future reviews, only fifty (66%) patients would keep telephone as their choice. Sixteen (21%) would prefer face to face consultation, seven (9%) a combination of the two and only two would choose online option.Conclusion:To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs. Most patients were satisfied with this model of care and would highly recommend it. They were happy to be reviewed by CNS in the future. However a significant minority did not like the remote element and a higher proportion would choose physical review in future if offered. Interestingly, telephone consultation still scored substantially higher than online platform despite being physically visible in the latter. This is intriguing as most remote services strive for online consultations assuming its preference to phone. Our study suggests against this notion certainly in older patient group. Overall, a nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution though remote consultations may not be the optimal delivery model.Disclosure of Interests:None declared

Best practice for chronic oedema in community settings: what can we learn?

2020 ◽  
Vol 25 (12) ◽  
pp. 610-614
Author(s):  
Garry Cooper-Stanton
Keyword(s):  
Service Provision ◽  
Best Practice ◽  
Evidence Base ◽  
Community Services ◽  
Guidance Document ◽  
Community Settings ◽  
Tissue Viability ◽  
Delivery Of Care ◽  
Specialist Nurses ◽  
The Uk

There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.

Managing Public Services Innovation

2001 ◽  
Author(s):  
Richard M. Walker ◽  
Emma L. Jeanes ◽  
Robert O. Rowlands
Keyword(s):  
Case Studies ◽  
Best Practice ◽  
Public Services ◽  
Housing Association ◽  
Evidence Based ◽  
Data Sets ◽  
Evidence Based Policy ◽  
Services Innovation ◽  
Longitudinal Case Studies

<i>Managing Public Services Innovation</i> provides an in-depth exploration of innovation and its management in the housing association sector. Drawing on longitudinal case studies and data sets, it explores techniques to develop evidence-based policy in the housing association sector, and makes recommendations for best practice.

scholarly journals P094 CPAP Service Patient Experience Survey

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A51-A52
Author(s):  
R Mihai ◽  
K Ellis ◽  
N Verginis ◽  
M Davey ◽  
G Nixon
Keyword(s):  
Support Groups ◽  
Online Survey ◽  
Positive Airway Pressure ◽  
High Standard ◽  
Standard Of Care ◽  
Sleep Apnoea ◽  
Information Support ◽  
Obstructive Sleep ◽  
Experience Survey

Abstract Introduction Increasing numbers of children with obstructive sleep apnoea require continuous positive airway pressure (CPAP) treatment. We aimed to collect feedback from parents/carers about our CPAP education and follow-up programme. Methods An online survey link was texted to families of children starting outpatient CPAP from Jan 2019 -Feb 2021. Questions assessed satisfaction with the CPAP initiation process, including education by our nurse educator (NE), mask fitting, using equipment, accessing help, confidence using CPAP and follow up. Open-ended feedback was invited. Results 17/55 (31%) of eligible families responded. “Very satisfied” responses regarding CPAP education ranged from 76% (discussion of costs) to 94% (machine use and maintenance). All families felt confident starting CPAP at home. Two reported issues starting CPAP, but reported feeling fully supported by staff remotely to troubleshoot. All families were “somewhat” or “very satisfied” with NE follow-up, with 2 families more neutral about physician follow-up. Two families reported lower satisfaction (“somewhat dissatisfied” or neutral) with the range of paediatric masks, rather than with the mask fitting process itself. Of 14 general comments, 64% were positive (most common theme was high standard of care from the NE); 21% negative (lack of mask choices, location of consulting suites); and 15% neutral. Suggestions for improvement included financial support information, support groups and online consumable ordering. Discussion Families feel confident and well supported to commence outpatient CPAP, highlighting the care, knowledge and support provided by our team. Findings emphasize the importance of a dedicated NE. Suggestions provided will inform future service improvements.

scholarly journals Case Studies: A Brief Introduction and Suggested Guidelines for the Field

2021 ◽  
Vol 3 (1) ◽  
pp. 4-11
Author(s):  
Emma Fleck
Keyword(s):  
Case Studies ◽  
Teaching And Learning ◽  
Best Practice ◽  
Entrepreneurship Education ◽  
Special Issue ◽  
Good Case ◽  
Traditional Research ◽  
Teaching Cases ◽  
Parent Discipline

Case studies are a common teaching and learning tool within entrepreneurship and its parent discipline, business, as a method of bringing the nuances of realism to complex theoretical problems. However, within the arts entrepreneurship field, they are used less frequently for pedagogical purposes and often with hesitation. Consequently, in this guide to the Case Study Edition, I aim to briefly: provide a rationale for using case studies in arts entrepreneurship education; illustrate what makes a good case study; highlight the mechanics of writing case studies by clearly outlining the expectations of a submission to JAEE for both traditional research cases and teaching cases; summarize the cases within this special issue and highlight why they demonstrate best practice example cases.

scholarly journals Considerations in Management for Trans and Gender Diverse Patients with Inherited Cancer Risk

2021 ◽  
Author(s):  
Beth Coad ◽  
Josephine Giblin ◽  
Reubs J. Walsh ◽  
Oliwia Kuczkowska ◽  
Alexander M. von Vaupel-Klein ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Best Practice ◽  
Cancer Genetics ◽  
National Guidelines ◽  
Inherited Cancer ◽  
Gender Diverse ◽  
Individualised Care ◽  
And Gender ◽  
The Impact ◽  
Risk Reducing

Abstract Purpose of Review To best support all patients with inherited cancer risk, we must broaden our scope of practice to consider the needs of the transgender and gender diverse (trans) community. We considered best practice for supporting trans patients including tailored risk assessments and management recommendations. Recent Findings There is limited literature considering trans patient care in cancer genetics. Small case studies have highlighted how medical transition and cancer risk–reducing options intersect with the need for individualised care. Studies have also shown that cancer genetics professionals do not feel prepared to support trans patients. Summary Patient-centred care for trans patients relies on a multidisciplinary team (MDT) engaged in shared decision-making. National guidelines are needed to standardise access to appropriate discussions around risk-reducing options and screening. International collaborative research is required to provide empiric data on the impact of gender-affirming treatments on cancer risk, and more experiential data is needed from trans patients accessing cancer genetics services. Finally, education and training in this area should be formally embedded for all cancer genetics professionals.

Complex Subsurface Well Abandonments Using Relief Well Methodologies

2021 ◽  
Author(s):  
Jamie Dorey ◽  
Georgy Rassadkin ◽  
Douglas Ridgway
Keyword(s):  
Case Studies ◽  
Best Practice ◽  
Oil And Gas ◽  
Oil And Gas Industry ◽  
Gas Industry ◽  
Gas Seepage ◽  
Cost Efficient ◽  
Well Abandonment ◽  
Efficient Option ◽  
Practice Methods

Abstract The field experience in the continental US suggests that approximately 33% of plug and abandonment operations are non-routine, and 5% require re-entry (Greer C.R., 2018). In some scenarios, the most cost-efficient option for the intervention is drilling an intercept well to re-enter the target well or multiple wells externally using advanced survey management and magnetic ranging techniques. This paper presents the methods applied of relief well methodologies from the planning to execution of a complex multiple-well abandonment project. Improvements in Active Magnetic Ranging sensor design and applications have improved the availability of highly precise tools for the purpose of locating and intercepting wellbores where access is not possible. These instruments were commonplace on relief well interventions, however, have found a new application in solving one of the major issues facing the oil and gas industry. Subsurface abandonments are a complex task that requires a robust methodology. In this paper, we describe the techniques that have been built upon the best practices from industry experience (ISCWSA WISC eBook). This paper also illustrates how the combination of advanced survey management, gyro surveying, and magnetic ranging can be used following the best industry practices for fast and cost-efficient non-routine plug and abandonment. Case studies of several abandonment projects are presented showing the various technical challenges which are common on idle and legacy wells. The projects include wells that are currently under the ownership of an operator and orphaned wells that have been insufficiently abandoned and left idle over many decades. The case studies outline how the application of relief well methodologies to the execution of complex sub surface interventions led to the successful outcomes of meeting environmental and government regulations for wellbore abandonment. This includes performing multiple zonal isolations between reservoirs, water zones and preventing oil and gas seepage to the surface. The projects and their outcomes prove economically viable strategies for tackling the growing issue of idle and orphaned wells globally in a fiscally responsible manner. Combining industry best practice methods for relief well drilling, along with the technological advancements in magnetic ranging systems is a solution for one of the largest dilemmas facing the oil and gas industry in relation to idle and orphaned wellbores. These applications allow previously considered impossible abandonments to be completed with a high probability of long-term success in permanent abandonment.

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