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Mandatory sepsis training needed so healthcare staff can spot and treat faster

Sepsis kills five people every hour in the UK.

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More training needed to spot and act on sepsis, say nurses.

Delegates at the Royal College of Nursing’s annual Congress in Liverpool alongside sepsis survivor Tom Ray will today call for better training for health care staff on recognising the signs of sepsis and understanding the need for prompt treatment.

They will call for mandatory sepsis training for all members of the nursing and midwifery professions and ask frontline nurses to take inspiration from their campaign to improve patient care.

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According to the Sepsis Trust, sepsis kills five people every hour in the UK and affects 25,000 children each year.

The union will also call for a nationally standardised Paediatric Early Warning Sign Score (PEWS) mirroring the National Early Warning Score (NEWS) rolled out since last year.

Overstretched and unsupported

Speaking ahead of the speech and debate, Tom Ray – a quadruple amputee as a result of delayed diagnosis and treatment of sepsis, said: “Poor outcomes for patients are equally dramatic for staff, friends and family and they will continue to happen if nursing staff are overstretched, under trained and unsupported.

“My own experience has placed huge strain on myself, my family and my carers – and it should never have happened.

“Damage and even death from sepsis will continue until there is a commitment to educate all staff to give every patient the care and attention that is needed to spot and treat sepsis as fast as possible.”

Better public awareness

Rose Gallagher, professional lead for infection prevention and control at the RCN said: “Without the right number of nurses with the right training, we will struggle to identify and manage potential cases of sepsis – and we must have better public awareness to help people recognise the potential symptoms of sepsis and seek help quickly.

Fiona Smith, professional lead for children and young people at the RCN said: “Nurses have been calling for a national standardised PEWS system for children for over ten years now. Progress on delivering this has been too slow.”

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Mental health and learning disability services are deteriorating, says CQC

Growing pressure on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients.

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Nearly one in ten acute mental health and learning disability services are now rated as ‘inadequate’.

The quality of care provided by mental health and learning disability services has deteriorated in past last year, a report by the Care Quality Commission (CQC) has warned.

In the CQC’s annual assessment of the state of health and social care in England, the regulator warns that growing pressures on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients using mental health and learning disability services.

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The report reveals that 10% of learning disability inpatient services and 8% of acute mental health units and psychiatric intensive care units are now rated as ‘inadequate’, compared with just 1% and 2% respectively last year.

Fourteen independent mental health hospitals were placed into special measures since last October and three were closed permanently.

The number of child and adolescent mental health inpatient services rated inadequate has also risen to 8%, up on just 3% last year.

‘A perfect storm’.

Ian Trenholm, Chief Executive of the Care Quality Commission (CQC) said: “In this year’s State of Care, we have highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people.

“There has been a deterioration in ratings in these services – and our inspection reports highlight staff shortages, or care delivered by staff who aren’t trained or supported to look after people with complex needs, as a reason for this.

“Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.

‘Immediate and firm action is needed’.

Commenting on the report, Patricia Marquis, Director for RCN England, said:  “With this report, the official inspectors are putting England’s nursing shortage front and centre as a key reason for poor care – no area of care appears safe from the engulfing workforce crisis. Now that their concern is on record, it leaves Ministers with nowhere to turn – they must take immediate and firm action to address the 40,000 unfilled nurse jobs.

“The CQC is painting a picture of too many nurses reaching burnout or breaking point with patients paying the price. In A&E in particular, nursing staff and their colleagues are left trying to treat patients as best they can in a system without enough capacity or boots on the ground.

“The independent inspection body backs calls made by the RCN and others for a coherent workforce plan and also puts on record its view that the removal of the bursary for nursing students led to a decline in people able to train. Now that it has been recognised here, the Government must act to put at least £1 billion extra per year into nursing education if it hopes to recover lost ground and fill these vital jobs.”

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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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