This article reports on the monitoring of healing rates of fullthickness pressure ulcers at one care provider in the Midlands. This was an agreed measure that was part of the Commissioning for Quality and Innovation (CQUIN) incentive scheme for the CCG. It was an attempt to provide data to support the anecdotal reports that pressure ulcer healing rates had improved after the implementation of a pressure ulcer reduction scheme called the Midlands and East Pressure Ulcer Ambition in 2012. The healing times for full-thickness pressure ulcers were recorded at 40 and 80 days after being reported by the community care provider (a community interest company [CIC], providing NHS funded services). There were 138 patients included in the data collected over a one-year period in 2015. A total of 34% of the patients were healed or healing at 40 days. A total of 55% of patients were healed or healing at 80 days. Of the 138 patients who had a full-thickness pressure ulcer, 56 died (41%), 15% had deteriorating or static wounds at 40 days and 9% at 80 days. This demonstrates that the majority of full-thickness pressure ulcers progress to healing unless the patient is at the end of life. There should be a continued emphasis on preventing as many pressure ulcers as possible to reduce avoidable harm to patients.
This series focuses on the patient treatment pathway in managing psoriasis as laid out by the National Institute for Health and Care Excellence guidelines (NICE, 2016). This disease affects up to 1.8 million people within the UK, necessitating up to 60% of these patients requiring a form of secondary care input (Jackson, 2012). Secondary care is often required to provide further topical treatment advice, but equally this also falls within the remit of all healthcare professionals, such as community nurses, who have face-to-face contact with patients with psoriasis. As these topical treatments may not manage the symptoms of psoriasis alone, referral to dermatology departments where more specialist treatments can be prescribed may be needed. The first option is to offer a course of phototherapy. There are several forms of treatment under this umbrella, with which community nurses should be familiar.
Anxiety disorders are common amongst elderly housebound clients and are undertreated with detrimental effects to this population. Effective treatment for anxiety includes access to a talking therapy. Cognitive behavioural therapy (CBT) for anxiety is proven to be successful and has a low r elapse rate. Elderly housebound clients have poor access to talking therapies which compounds existing health inequalities. District and community nurses could be instrumental in enabling elderly housebound clients to have access to CBT approaches for the treatment of anxiety at an early stage, which could gr eatly improve outcomes.
The number of people with venous and/or lymphatic disorders who require long-term management of their condition with compression garments in a community setting is growing. Here, Professor Jackie Stephen-Haynes, professor and consultant nurse in Tissue Viability, Birmingham City University and Worcestershire Health and Care NHS Trust, outlines the problems that some patients and clinicians encounter as a result of delayed and/or inaccurate dispensing of garments, and asks if this is a problem that affects you in your practice.
Asthma is a common lung condition affecting many patients in the community. Nurses are pivotal in the diagnosis and management of people with both stable disease and during acute flare-ups. Asthma reviews offer opportunities to build therapeutic relationships and optimise treatment, helping patients to recognise and plan management of an asthma attack. On average, three people die of asthma every day in the UK - a stark statistic which should encourage nurses to be forever watchful of opportunities to regularly review the evidence base and produce patient-centred care. This article focuses on the management of chronic adult asthma, at diagnosis, management, and briefly touches on assessment of the acute exacerbation. They key differences between the asthma guidelines of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016) and the National Institute for Health and Care Excellence (NICE, 2017) guidelines, which are currently in use in the UK, are presented for reader consideration.
Imagine the scenario. You’ve arranged a special dinner for a group of friends. You’ve bought the food; picked out your ‘good’ cutlery; dressed in your best clothes. You may have even tidied up the bathroom and hidden last week’s washing under the bed. Then, they simply don’t turn up. No phone call or email, they just decide, for whatever reason, not to show. Quite apart from the wasted food and wine and the fact that you’ve spent the afternoon preparing, there’s the knowledge that if you knew they weren’t coming, you could have invited someone else. Annoying doesn’t quite cover it.
A new, practical and informative guide to bolus feeding has been launched by Nutricia in response to requests from healthcare professionals, as this form of feeding is becoming more frequently used in clinical practice.
One in ten older people in the UK are suffering from, or at risk of malnutrition. This relatively unknown, yet significant issue, costs the NHS £19.6 billion per year (Elia, 2015). Often overshadowed by obesity as a public health issue, malnutrition impacts a person’s wellbeing; leading to further problems, such as an increase in hospital admissions, increased dependency and increased risk to life.
