Clinical

Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.

The provision of emergency healthcare for women who experience intimate partner violence

The provision of emergency healthcare for women who experience intimate partner...

Strategies to address knowledge deficits and negative attitudes

Exploring medicines reconciliation in the emergency assessment unit: staff perceptions and actual waiting times

Exploring medicines reconciliation in the emergency assessment unit: staff perceptions...

Why you should read this article: • To recognise why timely medicines reconciliation is important in the emergency assessment unit (EAU) • To understand the barriers to timely medicines reconciliation in the EAU • To identify potential methods of improving medicines reconciliation in the EAU Background Medicines reconciliation is the process of creating and maintaining the most accurate list possible of all medicines a patient is taking. If medicines reconciliation cannot be completed in a timely manner in hospital emergency assessment units (EAUs), delays in treatment can occur, potentially leading to deterioration of long-term and acute conditions, patient distress and complaints. Aim To obtain the perspectives of staff working on an EAU regarding the time patients wait for their medicines to be prescribed, including their awareness of practice and protocols. To determine the time from admission to the EAU until medicines reconciliation, and to identify if there was any time difference in medicines reconciliation according to the day of admission. Method This was a service evaluation in which staff working in one EAU in a teaching hospital in the north east of England were asked to complete a survey in December 2017. The staff survey aimed to ascertain: whether staff were aware of any guidance relating to medicines reconciliation times; how long they thought the average waiting time was for medicines reconciliation; and if they thought there were implications for patients or staff as a result of time spent waiting for medicines reconciliation. In addition, an audit was performed analysing medicines reconciliation times for all patients admitted to the EAU during the month of December 2017. Results A total of 30 staff members responded to the survey. While 40% (n=12) of respondents believed that the EAU had an efficient system in place for timely medicines reconciliation, 90% (n=27) believed the unit could still improve. Almost half the respondents (47%, n=14) perceived a delay in medicines reconciliation could result in exacerbation of patients’ physical conditions. The clinical audit identified considerable variation in medicines reconciliation times, ranging from seven minutes to almost 24 hours. However, most medicines (82%) were reconciled within six hours. Conclusion This service evaluation found that the median time after arrival in the EAU until completion of medicines reconciliation was two hours 48 minutes. However, almost one fifth of patients had to wait for more than six hours, and in one instance almost 24 hours. One potential solution could be increasing the involvement of hospital pharmacists or pharmacy technicians in medicines reconciliation.

Managing the needs of frequent attenders of urgent care services: a case management approach

Managing the needs of frequent attenders of urgent care services

A case management approach of a new frequent service user manager service

Barriers to effective nurse-patient communication in the emergency department

Barriers to effective nurse-patient communication in the emergency department

Identifying what emergency nurses perceive as barriers to nurse-patient communication

Charcot’s foot: a clinical update for emergency nurses

Charcot’s foot: a clinical update for emergency nurses

Emergency nurses in the UK have an important role in recognising patients with this condition

Rhabdomyolysis: a case-based critical reflection on its causes and diagnosis

Rhabdomyolysis: a case-based critical reflection on its causes and diagnosis

Rhabdomyolysis is a complex condition that can have traumatic and non-traumatic causes

Trauma-informed care for people presenting to the emergency department with mental health issues

Trauma-informed care for people presenting to the ED with mental health issues

EDs can be challenging environments for people experiencing mental health issues

Assessment and treatment of cutaneous leishmaniasis in the emergency department

Assessment and treatment of cutaneous leishmaniasis in the emergency department

Healthcare staff have a vital role in the assessment and treatment of cutaneous leishmaniasis

Prescribing

Exploring the common prescribing errors that occur in the emergency department

Identifying common prescribing errors in one large inner-city ED in South Wales

Using problem-based learning to improve patient safety in the emergency department

Two elements are vital to patient safety in emergency care – work culture and staff training

Recognition and management of autonomic dysreflexia in patients with a spinal cord injury

Recognition and management of autonomic dysreflexia in patients with spinal cord injury

It is important that ENs are aware of the symptoms and management of autonomic dysreflexia

How safe staffing can improve emergency nursing: time to cut the Gordian knot

How safe staffing can improve emergency nursing: time to cut the Gordian knot

Exploring the effects of fatigue, workplace bullying, moral distress and inadequate staffing

Decompression sickness: a guide for emergency nurses

ENs have an essential role in recognising and initially treating patients experiencing DCS

Screening for sepsis: SIRS or qSOFA? A literature review

Evidence from this article led to the creation of a screening tool developed by the author

Assessment and management of patients with tibial plateau fractures in EDs

Such fractures are a common presentation in EDs, yet diagnosis is not always obvious

Emergency healthcare for women who experience intimate partner violence: part 1

This integrative review is the first of a two-part series about intimate partner violence

A comparison of two interventions in the treatment of severe ankle sprains and lateral...

Aim Stable ankle injuries are highly prevalent in the UK. Prevention of complications and...
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Awareness of secondary traumatic stress in emergency nursing

How nurses can safeguard against secondary traumatic stress

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