Evidence and Practice
Report on a service improvement project aiming to determine accuracy of hand injury referrals
Why you should read this article: • To recognise the potential causes of behaviour that challenges among people with dementia in the emergency department (ED) setting • To understand the issues that may occur as a result of behaviour that challenges in the ED • To be aware of strategies to manage dementia-related behaviour that challenges that you can use in your practice Dementia symptoms can manifest in a variety of ways, such as anxiety, agitation and an inability to communicate unmet needs. In emergency departments (EDs), these symptoms, as well as various environmental factors, can lead to behaviour that challenges in people with dementia. Therefore, ED staff must be skilled in screening, assessing and managing this patient group effectively. This article details a literature review that was conducted to explore the evidence on managing behaviour that challenges in people with dementia in the ED and what de-escalation strategies may be useful. A literature search of eight databases was undertaken, resulting in 11 articles that were included in this literature review. Four main themes were identified: violence and aggression towards staff; manual and chemical restraint in the ED; identifying delirium and dementia; and environment and person-centred care. Strategies identified to de-escalate and reduce the risk of behaviour that challenges include: making environmental modifications to the ED; providing person-centred care; excluding or evaluating pain and unmet needs; using various tools and strategies to improve communication; and using distraction techniques.
Why you should read this article: • To understand the role of the sepsis six care bundle in managing patients with sepsis • To recognise the effectiveness of performing all six actions from the sepsis six care bundle within one hour of patient admission • To learn about potential barriers to clinician compliance with the sepsis six care bundle There are up to 11 million sepsis-related deaths worldwide each year. Management of sepsis requires early recognition, appropriate antibiotic treatment and careful management of haemodynamic status. In 2006, the UK Sepsis Trust introduced the sepsis six care bundle to simplify the guidelines for managing sepsis and identify actions for management that were more accessible to junior clinicians. This article reports findings from a literature review that explored the effectiveness of the sepsis six bundle in the management of adult sepsis patients in the UK and assessed the level of clinician compliance in UK clinical settings. The effectiveness of sepsis six was based on patient mortality during hospital stay, rate of intensive care unit admissions and length of hospital stay, all of which were found to have improved since the introduction of the tool.
The knowledge and skills required to care for patients with cancer
Care of patients who present with symptoms arising from a combination of severe mental illness and substance misuse
To get care and treatment right it is essential to ‘ask and engage’ people
The care needs of homeless people attending EDs are frequently misunderstood
CPD article on the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries
Sepsis is a medical emergency that should always be considered in acutely unwell patients
This article aims to increase emergency nurses’ knowledge of acute aortic dissection
Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines ( BTS/SIGN) (2016) .
Mistakes made in healthcare settings and the challenges to staff that arise from them can harm service users, consume time and money, and often receive bad publicity. However, by learning from these mistakes and meeting these challenges, practitioners can improve the quality of the care they provide. This article explores what is meant by mistakes and challenges in the context of health care. It suggests that front line managers are best placed to prevent and learn from mistakes, and thereby improve care for patients.