There are more than one million people living with chronic obstructive pulmonary disease (COPD) in the UK. COPD does not follow a predictable course and differs from person to person. It is often difficult to determine the stage that a person has reached in the condition: while some patients will present with a gradual decline, others may remain stable for years, and some will require hospital admission for respiratory support. The uncertainties around the nature and progression of COPD make decisions about end-of-life (EOL) and starting EOL care challenging. This article explores some of the indicators of decline in a person with COPD, including exacerbations, cognitive dysfunction, sarcopenia, depression and anxiety. It also discusses the importance of starting appropriate EOL discussion with patients, as well as the many benefits of multidisciplinary team working when it comes to recognising care needs and enhancing patients’ quality of life.
Dysphagia is a term used to describe difficulty or discomfort in swallowing food, fluids and even saliva. It is usually caused by another health condition, such as stroke, head injury or dementia, and can affect people of all ages. Nurses play a key role in identifying and managing dysphagia and screening for malnutrition. A multidisciplinary approach is required to guide appropriate interventions and achieve the best outcomes. This article discusses the prevalence of dysphagia, as well as the signs and risk factors, before taking a closer look at management strategies to help ensure good nutritional status.
Indwelling urinary catheters are still one of the most commonly used invasive devices in health care, with recognised significant risk factors, including catheter-associated urinary tract infection (CaUTI) and sepsis. Timely and successful removal of the catheter often falls to the responsibility of community nurses. There has been much debate about the optimum timing and circumstances for a successful trial without catheter (TWOC). This article looks at best practice guidelines and relevant clinical evidence to support healthcare professionals in making choices around TWOC procedures.
Currently, within the NHS there is a need to improve efficiency to maximise quality of care, patient experience and outcomes, within the constraints of a limited budget. At the Royal Wolverhampton NHS Trust, the cost of wound care was increasing year on year, and in order to drive efficiency, procurement of dressings was switched from supply chain to ONPOS. Over a 12-month period, the use of ONPOS has resulted in 100% formulary compliance for adult community services. The number of brands of products used by the service has almost been halved, and the number of individual dressing units purchased has reduced by 36,000. Finally, cost savings are predicted for the adult community service in 19/20, after a five-year growth in costs year on year.
