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Clinical Updates

Number of children vaccinated against life-threatening illnesses falls

Leading doctors have blamed “false and misleading information on vaccinations”.

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Vaccine
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Only two local authorities met global vaccination targets.

The number of children vaccinated against a range of life-threatening illnesses in England and Wales has fallen, a new report has revealed.

NHS Digital’s Childhood Vaccination Coverage Statistics, published today, shows that just two of the 149 local authorities in England and Wales met the global targets for the second dose of vaccines for measles, mumps and rubella.

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Hackney and the City of London had the lowest uptake at just 73.2% – a stark contrast to the recommended 95% by the World Health Organisation (WHO).

In 2018-19, 90.3% of children received their first dose of the measles, mumps, rubella (MMR) vaccine, compared to 91.2% in 2017-18.

For the combined diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib) vaccine, coverage at 12 months was 92.1%, its lowest level since 2008-09.

False and misleading information on vaccinations.

The British Medical Association (BMA) has blamed the fall in vaccine uptake on “false and misleading information on vaccinations” particularly on social media.

Responding to NHS Digital figures showing a fall in coverage for all routine childhood vaccinations in England, BMA public health medicine committee chair, Dr Peter English, said: “Childhood immunisation remains the most effective way to prevent a range of life-threatening illnesses and it is therefore extremely concerning to see a decrease in vaccination uptake given this is largely avoidable.

“There is a clear need to curb the damaging spread of false and misleading information on vaccinations by enforcing standards and placing legal obligations on social media corporations.

“More importantly still, the Government must implement an effective vaccination strategy that addresses the wide-ranging factors behind this decline and deliver adequate resources to ensure targeted, comprehensive vaccination programmes that reach those most in need.”

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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Nurse with patient in bed

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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