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John Tingle discusses an NCEPOD report which reveals serious failings in the care of hospital patients receiving parenteral nutrition.

An audit tool to undertake a baseline assessment of NHS trust compliance with contemporary healthcare polices was designed collaboratively by senior children's nurses across one English strategic health authority (SHA). Children's units in hospitals across the SHA were benchmarked against the audit tool standards throughout 2009. The aim was to identify good and less optimum compliance with best practice policy-driven benchmarks of care, using a 1-5 scale. Each NHS trust within the SHA was contacted to make arrangements with members of the interprofessional team to complete the baseline benchmarking exercise. The audit was conducted over 1 or 2 days. The majority of the evidence sourced comprised documented evidence and verbal affirmation of the individual perceptions of key informants with regard to how the range of clinical areas scored against the best practice benchmarks. Scores of policy compliance in some trusts audited ranged from 1 (non-compliant) to 5 (full compliance). The results demonstrate that many trusts are making good efforts to ensure full compliance to policy guidelines and mandates. However, there are some aspects of policy standards that trusts have yet to fully embrace. This initial benchmarking exercise on behalf of an English SHA has revealed many areas of outstanding and good practice which have the potential to be shared.

A recent report by the Department of Health, Clostridium Difficile Infection: How to deal with the problem - a board to ward approach, is a revised set of guidelines based on best practice and key recommendations for the NHS to ensure the control of Clostridium difficile infection (CDI). It takes into account a national framework for clinical governance which did not previously exist, a framework that gives significant weight to infection control as a matter of patient safety, and highlights that all clinicians have a personal responsibility for infection prevention and control. It puts the onus on Trust management and PCTs to ensure that measures are in place to prevent and manage CDI according to best evidence. However, the report fails to explain how these measures will have an impact on finance and resources on an already burdened system. The author explains how much of the report is comparable with the one published in 1994, and highlights many of its limitations within the busy hospital setting. Reducing CDI is achievable, as many hospitals are showing large reductions in their CDI rates. Healthcare workers must be applauded for their success in reducing CDI, but there is more to be done.

This article discusses the practical skills and underpinning knowledge needed when manually taking a patients blood pressure. The author defines blood pressure and the terms systolic and diastolic and explores the purpose of manual measurement. The article also goes on to examine what is meant by normal blood pressure, hypertension and hypotension, as well as factors that may influence blood pressure measurement. There is a brief outline of the equipment used for manually measuring blood pressure, followed by some factors that may affect the accuracy of the final reading. The author also highlights the different positions used for taking blood pressure and the arguments surrounding their respective merits. Finally, the article includes a practical step-by-step guide to manual blood pressure measurement.

A clinical needs assessment (CNA) consulting programme was initiated with the NHS Healthcare Purchasing Consortium to improve safety and reduce risk in intravenous (IV) therapy through standardization, best practice guideline adherence and ensuring adequate training. The results of CNAs conducted at two acute NHS Trusts (A and B) are summarized. Fifteen-minute 'pump needs assessment' and 'clinical practice review' interviews were conducted with junior and senior staff members, and recommendations were made to a multidisciplinary Trust-steering committee. Post-assessment recommendations included: standardizing to one pump type with activated medication error reduction software, purchasing optimal numbers of IV pumps, implementing best practice guidelines and protocols to minimize unnecessary IV set tear-down (removing and replacing IV set), the use of standardized accessories and ensuring adequate training. Both assessments showed that streamlining, best practice adherence and training could result in pronounced cost savings and improve patient safety. Importantly, the cost savings could facilitate implementation of CNA recommendations. The Trusts have since prioritized standardizing IV pumps and accessories and future implementation of medication error software. The CNA is a valuable tool for Trusts that positively impacts on patient safety.

This article provides an overview of the principles of good practice that underpin intravenous (IV) therapy. The indications for choosing the IV route and selecting an appropriate vascular access device (VAD) are explained. Common insertion sites for VAD placement and the care and management of VADs are reviewed. Infection control aspects of IV therapy are be highlighted, including the management of IV equipment and the importance of the nurse's role in the prevention of infection associated with IV therapy. Common complications of IV therapy are explained and strategies suggested for their prevention. The article addresses the issues associated with general IV therapy, it does not address specialist subjects such as parenteral nutrition, chemotherapy or blood transfusion.

This article reviews the literature on patients' privacy and dignity and concludes that interest in the topic goes back to psychiatric patients in the 1960s, with the 1990s seeing a shift to all hospitals. A number of databases were used to obtain information for the literature review. Findings revealed United Kingdom (UK) government policies designed to raise the profile of patients' privacy and dignity. UK research on patients' privacy/dignity is limited, although there is universal interest. While a variety of methodologies have been used in previous research, and there is consistency in findings, more research is indicated. Previous research spanned topics such as elderly patients, medical and surgical patients, palliative care, rehabilitative settings and child-bearing women. A conceptual framework and definitions of privacy and dignity were examined. Although healthcare professionals and patients attach importance to patients' privacy, there is insufficient understanding of the problem. Limitations of previous research have been discussed.

Sepsis kills more people than lung cancer, and more people than bowel and breast cancer put together. The costs to the NHS are significant; it is estimated that in Europe, patients with severe sepsis cost healthcare funders around 7.6 billion euros per year (Daniels et al, 2007). Costs in the United States are estimated at $16 billion annually (Angus et al, 2001), and in the United Kingdom up to 46% of intensive care unit (ICU) bed days are used by patients with severe sepsis (Padkin et al, 2003), with each ICU bed costing around pounds sterling1700 per day. In 2002 an international campaign was launched: the Surviving Sepsis Campaign. The main aim of this campaign is to reduce mortality from sepsis by 25% by 2009. A lot of the early work has concentrated on improving sepsis care in intensive care units, but many patients on general wards develop sepsis, and the need to educate nurses throughout all areas of the hospital has been recognized. In September 2007 a new part of the campaign was launched called Survive Sepsis, which aims to deliver sepsis education to ward nurses and junior doctors. This article discusses how to recognize severe sepsis and explains how nurses can dramatically improve a patient's chance of survival by ensuring that six simple things (Sepsis Six) are done in the first hour.

The implementation of a housekeeper induction competency programme demonstrates the innovative way that the clinical standards facilitator has led the development of the housekeeping service at one NHS Trust. This service has been developed to ensure that there is sufficient training, support and opportunity to share best practice for the housekeepers. A Trust-wide approach using the multidisciplinary team (including dieticians, catering and facilities managers) has contributed to the raising of standards in meeting the patients' nutritional needs, as well as improving the ward environment. NHS Estates guidance (DH, 2001b) relating to the housekeeping service and the Essence of Care benchmarks for nutrition (DH, 2001a) were used to provide this framework for continuous quality improvement.

Evidence from the US shows that integrated treatment programmes for dually diagnosed patients are more successful than parallel treatment programmes. In the UK the Dual Diagnosis Good Practice Guide (DDGPG, 2002a), advocates a move towards an integrated system of care delivery. However, the paucity of evidence in the UK and the entrenched nature of the established mental health and addictions services means that current policy is derived from limited information and is struggling to address the process of change. By definition, dual diagnosis is a complex interaction between a range of mental health and substance misuse problems leading to difficulties in allocating appropriate skill mixes to teams. Ethical and legal issues in the mental health services cause conflict with the treatment concepts for substance misuse. The advent of the DDGPG is positive, but there is a clear need for further work in this area.

Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause for concern to health boards and trusts through the UK and the rest of the world. A review of literature sourced via Cinahl, Medline and Pubmed examines the discussions for and against screening patients for MRSA and isolating MRSA-positive patients as a means of managing MRSA within the hospital setting. The research evidence available on the ability of MRSA strains to spread within the healthcare setting and how this influences the opposing arguments is explored. Other factors considered when examining the arguments for and against screening and isolation are: the implications both in cost and resources; the effect of MRSA infection on patient morbidity and mortality; and the need for individual risk assessment of MRSA colonized or infected patients to prevent the transmission of MRSA isolates. The arguments raised lead to the conclusion that screening and isolation should be universal to decelerate the rate of transmission of MRSA.

This article reports on the development of a web-based interactive database that was designed to facilitate the dissemination of practice development, research and audit projects across a large NHS trust. A multidisciplinary team worked collaboratively to design the database in order to ensure that it incorporated features which made it easy for the end user. Concise structured information on each project was recorded and search facilities incorporated to facilitate access to information. Hyperlinks to other web pages on the Internet and the Trust intranet were created and full reports/publications of projects were included for those who wanted more information. The subsequent implementation across the organization involved promoting the database, helping practitioners develop skills to access information, setting up quality review procedures for projects and evaluating its use. The development of the database has highlighted that time, the availability of computers in clinical areas and skills development are important considerations when taking forward information technology (IT) initiatives.

Best practice guidelines and multidisciplinary pathways of care are becoming an established and essential feature of clinical practice. They can be seen in a wide variety of clinical settings ranging right across the primary, secondary and tertiary health and social care spectrums. The 1997 White Paper places strong emphasis on quality and consistency of care delivery and gives assurances of performance measurements, integrated care (Wilson, 1996) and clinical governance. It suggests making healthcare delivery against national standards a local responsibility and quality of care the driving force for decision making at every level of the service to ensure excellence for patients no matter where the care is provided. A number of controversial issues surround the use of guidelines. Some argue that they are a fetter on clinical discretion, clinical freedom and can lead to the practice of 'cookbook medicine'. Others maintain that they are an essential aid to providing safe and appropriate medical and nursing care.