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Emollient cream build-up can lead to fire deaths

There have been in excess of 50 deaths where a build-up of emollients has contributed to the speed and intensity of a fire.

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Emollient cream build-up
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Fabrics with a build up of emollient cream can lead to fire deaths – even after washing.

The Medicines and Healthcare products Regulatory Agency (MHRA) has warned that emollient creams can build up in fabrics and cause them to catch fire more easily.

The medicines regulator is asking for clearer advice to be given to patients on the risks of a severe burn or even death if clothing, bedding or dressings with a build-up of emollients are exposed to cigarettes or naked flames – even after washing.

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It was previously thought the risk occurred with emollients which contain more than 50% paraffins.  However, evidence now points to a risk with emollients which contain lower levels of paraffin and with paraffin-free emollients. This advice therefore applies to all emollients whether they contain paraffin or not.

The MHRA and the medicines industry are working together to develop suitable ways to make sure the warning is displayed prominently on products. The text will clearly warn users not to smoke or go near naked flames due to the risk of severe burns, that fabric (such as clothing, bedding and dressings) which has been in repeated contact with these products burn more easily and can be a serious fire hazard, and that washing clothing and bedding may reduce product build-up but not totally remove it.

Fifty deaths.

June Raine, Director of MHRA’s vigilance and risk management of medicines division said: “We don’t want to unduly worry people into not using these products which offer relief for what can be chronic skin conditions, but it is equally important people are aware of the risks and take steps to mitigate them.

“Our new evidence-based recommendations are intended to empower proper use of these tried and trusted treatments and we are working with industry to support delivery of prompt packaging and labelling warnings and advice.

“Patient safety is our highest priority. We strongly encourage anyone to report any issues with this product, or more generally with any medical device, to our Yellow Card Scheme.”

Watch Manager Chris Bell from West Yorkshire Fire and Rescue Service and National Fire Chiefs Council‘s lead for emollient creams, said:“We welcome this recommendation. There have now been in excess of 50 deaths in the UK where the build-up of emollients on bedding, dressings or clothing may have contributed to the speed and intensity of the fire. Many of these fires were caused by people who smoked and were unaware of the fire risks associated with emollient build-up on fabrics. 

“We have been trying to raise awareness about this issue with the public and health and care professionals. Ensuring that these products carry warnings will certainly help us as we continue to work with pharmacists, the NHS and care sector to prevent any future deaths.”

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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