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NS526 Lankshear et al (2010) Safe practice for patients receiving anticoagulant therapy. Nursing Standard. 24, 20, 47-55. Date of acceptance: August 4 2009. Summary Venous thrombolembolism, although largely preventable, continues [...]

Abstract Background There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy. Methods Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression. Results Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so. Conclusions The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.

By the time a child in the UK reaches 13 months of age he or she should have received nine vaccinations. Therefore, it is important to look at interventions to decrease pain associated with receiving vaccines and to examine the evidence base for current clinical practice. This study (sample 72 babies randomly allocated to one or other treatment) was a small randomised, controlled trial to determine whether, when immunising babies aged two to six months, there is any difference in the perceived level of pain and distress experienced by babies when given two injections at the same time (simultaneous technique) as compared to giving them one injection after the other (sequential technique). Both practices are currently widespread. The study has shown that there is no difference in parents' perceptions of the distress experienced by babies receiving either simultaneous or sequential vaccinations. Preliminary findings of the observed measure of pain behaviour in babies report statistically significant differences in distress behaviours at four time points after vaccination between the sequential and simultaneous vaccinations, further research in a larger study is required to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the management of the safety alert broadcast system (SABS) in England. Design/methodology/approach – This survey was part of a multi-method study which was undertaken over an 18-month period. The questionnaire was sent to every trust SABS liaison officer (SLO) (n=561) in England using the DH database. In total, 343 completed questionnaires were electronically returned, a response rate of 62 per cent. Findings – SABS is the means by which safety alerts from key agencies are electronically distributed to the NHS in England. Each organisation is required to have a named SLO who is required to acknowledge receipt on the Department of Health web site, indicate whether action is under way and finally confirm that action is complete. It offers a profile of this important segment of the workforce, over half of whom work in risk management, and 65 per cent of whom have no clinical background. Most spend very little of their working week managing the system itself, and are entirely dependent on the word of other managers to indicate that the trust has completed all action. Whilst the system is liked by the SLOs, concerns are expressed about the level of responsibility they are expected to assume. Practical implications – Trusts may wish to consider the role in the light of the increasing number and complexity of the alerts being managed. Originality/value – The paper offers a unique insight into the role and profile of those managing the interface between trusts and the patient safety team at the Department of Health. [ABSTRACT FROM AUTHOR]

Objectives: To assess the quality and impact of medication safety outputs issued by the National Patient Safety Agency (NPSA) to the NHS in England and Wales., Methods: A multi-method study comprising (1) focus groups and interviews with NHS Chief Pharmacists and (2) an electronic survey of medical, nursing and clinical governance directors., Results: Acute sector respondents agreed that the medication outputs had a major impact on patient safety. Pharmacists welcomed national support for medication safety improvement, despite the resulting workload. Medical Directors were much less likely to be aware of alerts and Rapid Response Reports (RRRs) than their nursing and clinical governance colleagues. One key finding was the inability of around half of NHS trusts to communicate effectively and reliably with their junior doctors., Conclusion: Medication alerts issued by the NPSA have stimulated significant work to improve medication safety and are believed to have had an important impact on patient safety.

The relationship between quality of care and the cost of the nursing workforce is of concern to policymakers. This study assesses the evidence for a relationship between the nursing workforce and patient outcomes in the acute sector through a systematic review of international research produced since 1990 involving acute hospitals and adjusting for case mix. Twenty-two large studies of variable quality were included. They strongly suggest that higher nurse staffing and richer skill mix (especially of registered nurses) are associated with improved patient outcomes, although the effect size cannot be estimated reliably. The association appears to show diminishing marginal returns.

Objectives: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE)., Design: Interrupted time series analysis, review of case notes, survey, and interviews., Setting: Acute and primary care trusts in England and Wales., Participants: All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts., Main Outcome Measures: Rates of prescribing and use of procedures and medical devices relative to evidence based guidance., Results: 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued., Conclusions: Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context.