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Army of NHS experts brought in to tackle over-medication in care homes

The project aims to improve quality of life, reduce over-medication and reduce the number of hospital admissions.

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Charities are concerned that care home residents are being given a ‘chemical cosh’.

An army of experts has been recruited to help prevent care home residents being given too many medicines.

According to NHS England, care home residents are prescribed an average of seven medicines a day, with many taking 10 or more, costing the NHS an estimated £250 million each year.

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Charities have voiced fears that a generation of older people is being subjected to a ‘chemical cosh’.

Clinical experts, including pharmacists and pharmacy technicians, will review the medication of thousands of residents with the aim of improving quality of life, reducing the number of hospital admissions and reduce over-medication.

GPs are also being encouraged to reduce long-term prescribing and ensure patients get regular medication reviews.

‘Reducing avoidable drug’.

Professor Alistair Burns, National Clinical Director for Dementia and Older People’s Mental Health at NHS England, said: “Older people deserve the best possible support and with many care home residents living with complex conditions, bringing in extra expert health advice will mean the NHS can reduce avoidable drug use, improve care and free up vital funding for better treatment.

“People want to know their mum or grandad is being properly looked after and helping them to live well and with the best possible quality of life is key to that.

“Strengthening the ties between GPs and care homes made a huge difference to residents’ health when we tested the scheme and the NHS Long Term Plan will mean older people in every part of the country soon will benefit from tailored, specialist support in their care home.”

‘A better quality of life, for longer’.

England’s Chief Pharmaceutical Officer Keith Ridge said: “Too many patients are prescribed medicines they may no longer need or may need adjusting, which is why the NHS Long Term Plan is funding expert pharmacy teams across the country to give tailored advice to care home residents and extra support to staff to increase the safety and quality of older people’s care.

“Rather than assuming there’s a pill for every ill, increasing the availability of specialist health advice in care homes will mean residents get more personalised treatment, reduced chances of being admitted to hospital and people will have a better quality of life, for longer.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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