Pulse Oximetery
Using pulse Oximetery probes correctly is critical and important for patient safety.
Cervical cancer awareness
Read Sarah Graham's brilliant and timely article(link below), highlighting the importance of having your smear test but also raising awareness about having a smear test not being a full gynaecological MOT as erroneously believed by 1 in 3 women in a research study carried out by The Eve Appeal. #knowyourbody
Where do broken hearts go? A midnight reflection on mental health and mental health services within hospitals.
Patient in a hospital bed.
Everywhere you turn, you are reminded that we are living in unusual times, with words like “unprecedented” banded around often. We are also reminded of self care and mental well-being due to the effects of the pandemic and lock-down changing our way of lives for the foreseeable future if not forever- whats being called “the new normal”.
So there i was in the middle of the night, sleep having escaped me and Whitney Houston’s song ‘where do broken hearts go?’ playing over and over in my head, wondering where patients who presented with mental health problems went after coming into A&E? Or why , in my all my years in nursing, the only times i came across a mental health nurse was at university and when a psych consult was ordered on the unit/ward. Typically, when patients presented in A&E, and need admission, there are two routes normally followed- admission to the Medical assessment unit(MAU) or to the Surgical assessment unit(SAU). Most mental health patients end up in MAU or poisons unit( if admitted due to overdose and where such a unit is available and has empty beds).
Most of the time i have been involved in looking after a patient with mental health issues, it has been on an acute medical ward. This has been usually in the bays closest to the nurses patients reserved for patients who are acutely ill and need constant nursing supervision, which often involves bright lights, regular vital sign monitoring and other checks as per care plan with a hive of activity going on around due to the nature of varying acutely ill patients around. This got me wondering if an acute medical ward really is the right setting for someone going through a mental health crisis, given that they are being looked after by nurses, not mental health nurses, who yes might be doing a brilliant job and are good at what they do but are not aware of triggers or care pathways for someone going through a mental health crisis as a trained mental health nurse would with the patient in the right setting.
With a little help………
According to Mind¹, a leading mental health charity, mental health problems are common in England with 1 in 4 people experiencing some sort of mental health problem each year and 1 in 6 reporting having experienced a common mental health problem like anxiety or depression in any given week.
A study by The Nuffield Trust² looking at hospital use by people with mental health illness, makes for an interesting and sober reading and highlights a number of key points that need addressing. With almost every NHS hospital trust having a Medical assessment unit or a Surgical one, maybe it is time there was also a Mental health assessment unit where those coming into hospital with a mental health illness can get the care they deserve, looked after by trained mental health staff under conducive conditions designed with them in mind. I would certainly welcome a unit like that, where me and my fellow healthcare workers can pop into just for a chat or to make sense of life and all its challenges especially after a hard and emotionally draining day at work given the pressures we are constantly under with the added effect that this pandemic adds to it and i would be happy to know that mental health just like physical health, matters and that those going through any sort of mental health illness can come into hospital knowing that they have a dedicated area that’s ready to to help them in anyway possible.
Dr. Chisholm - the first Director-General of the World Health Organisation (WHO)
Focus on Informed Consent
Great Blog post below on the Patient Safety Learning site about Findings in the Cumberlege Review with a focus on Informed Consent. This is very relevant and important especially now that NHS Improvement England are looking into putting patients at the heart of patient safety.
Do Not Resuscitate- what do your family know?
14 years ago today my very patient better half almost killed me( it’s not what you are thinking).......well it could be argued that I was dead anyway but that's a story for another day ( when i almost became a Never Event statistic!).
A bag valve mask
14 years ago today my very patient better half almost killed me( it’s not what you are thinking).......well it could be argued that I was dead anyway but that's a story for another day ( when i almost became a Never Event statistic!).
It all started after an emotional episode of Greys’ anatomy where I declared I never want to be resuscitated but never got to really explain under what circumstances (I thought I had!). Well the day comes when I'm lying there being resuscitated x 3, himself in shock, resus successful, emergency surgery..... surgeon comes out to inform himself that they have managed to save me and that’s when he informs the surgeon that I'm against being resuscitated! We are all glad he failed to mention that while i was being resuscitated prior to surgery. I have now clarified the circumstances under which i would not want to resuscitated .
Have you talked to and explained to your loved ones your wishes when it comes to #resuscitation #endoflifecare
Nursing Standard on Instagram 16th March 2020
Nursing standard¹ have a great article about Marie Curie’s Talkabout campaign, that encourages people to openly talk about death and dying. They also had a feature on nursing and DNACPR orders², that clarifies the Nursing and Midwifery councils position on nurses who don’t start CPR where a DNACPR order is in place.
Links to the articles can be found below.
Nursing Standard( Linkedin): https://rcni.com/nursing-standard/opinion/comment/talking-about-death-and-dying-covid-19-has-taught-us-not-to-wait-161456 [Accessed June 2020]
Nursing Standard: https://rcni.com/nursing-standard/newsroom/news/nursing-and-midwifery-council-clarifies-its-position-nurses-who-do-not-start-cpr-159536 [Accessed June 2020]
Lets talk about Allergy!
Lets talk about Allergy!
Looking at allergy and some of the most common allergens.
If like me you are constantly sneezing, almost gorging your eyes out and constantly apologising ( especially in this Covid-19 era!), or have to mind where you get your take out, or are constantly reading ingredients at the supermarket or shops when buying packaged food or skincare products, then you understand the frustrations having an allergy can bring.
Allergies are caused by allergens - which is defined as “a substance that causes an allergic reaction” ¹, and can be roughly broken down into 5 categories: Eczema, Rhinitis, Asthma, Food and Anaphylaxis. We will look at briefly, a list of the most common allergens for each category, and what services and help are available ( some will be UK specific) to help identify what is causing your allergy and how to manage it.
Gathering at a Barbecue
So what are the most common allergens?
ALLERGIC RHINITIS ²
Furry animals like cats and dogs, Mould, Pollen and House dust mite.
ASTHMA ³
Furry animals like cats and dogs, Mould, Pollen and House dust mite.
ECZEMA ⁴
Milk, Wheat, Soya, Peanut, Eggs, Mould, Pollen, Furry animals like cats and dogs and House dust mite.
FOOD ⁵
Children: Tree nuts and peanut, Wheat, Soya, Milk, Eggs.
Adults: Tree nuts and peanut, Shellfish and Fish.
ANAPHYLAXIS ⁶
Latex, Drugs, Fruits, Milk, Fish, Shellfish, Eggs, Tree nuts and peanut and Insect stings.
IS IT ALLERGY? What happens next!
Most mild allergic reactions can be treated with a dose of antihistamine, bought over the counter like Cetirizine, loratadine or if the allergen is know, for example if its a food stuff then avoidance measures can be used, life threatening allergies with likely hood of causing anaphylaxis may require one to carry a precribed adrenaline auto-injector( Epi-pen, Jext pen, Emmerade). Best practice is always a referral to an allergy clinic, where detailed clinical history is taken, and a range of tests can be carried out like Skin prick tests(amongst others) of suspected allergens, specific IgE blood tests for suspected allergens combined with exposure reduction advice to all sensitised allergens, like removing carpets and replacing them with wooden floors to reduce prevalence of house dust mite for house dust mite allergy or avoiding all shellfish for shellfish allergy. The severity of the allergy and potential risk is also accessed and advice and treatment is prescribed accordingly. It is especially important to attended an allergy clinic if there is increased risk of ANAPHYLAXIS or a suspected case of ANAPHYLAXIS has occured. This is because anaphylaxis is a medical emergency that can end in death and the sooner the causative allergen is found or not and preventative measures are put into place, the chances of not dying from anaphylaxis are improved.
REMEMBER: Use your adrenaline auto-injector as instructed ( if you have one) and call an ambulance or rush to the hospital if you experience any of the following symptoms immediately or within an hour of coming into contact with a suspected allergen.
feeling lightheaded/dizzy/ collapse
throat closing up
shortness of breath
facial swelling( eyes, tongue, lips etc)
All over body itch with hives
REFERENCES:
Lexico online dictionary: https://www.lexico.com/en/definition/allergen [Accessed June 2020]
NHS Rhinitis: www.nhs.uk/conditions/allergic-rhinitis/causes [Accessed June 2020]
NHS Asthma: https://www.nhs.uk/conditions/asthma/causes/ [Accessed June 2020]
NHS Eczema: https://www.nhs.uk/conditions/atopic-eczema/ [Accessed June 2020]
NHS Food: https://www.nhs.uk/conditions/food-allergy/causes/ [Accessed June 2020]
NHS Anaphylaxis: https://www.nhs.uk/conditions/anaphylaxis/ [Accessed June 2020]
USEFUL LINKS:
Anaphylaxis Campaign: https://www.anaphylaxis.org.uk/
Resuscitation UK: https://www.resus.org.uk/anaphylaxis/
EAACI: https://www.eaaci.org/
The British Society for Allergy and Clinical Immunology: https://www.bsaci.org/index.htm
Allergy and Immunology West Midlands: https://allergyandimmunology.heartofengland.nhs.uk/
Thermo Fisher Scientific: https://www.thermofisher.com/diagnostic-education/hcp/wo/en/allergy-autoimmune-diseases.html
Allergy Society of Kenya: https://www.allergysociety.or.ke/
Allergy tests- Kenya Paediatric Assosiation: http://www.kenyapaediatric.org/wp-content/uploads/2017/05/Allergy-test-their-Application-in-Clinical-management-Dr.-Priya-Bowry.pdf
DISCLAIMER: This article is not a substitute to seeking professional medical advice nor should it be used in place of medical advice.
WORLD ALLERGY WEEK 13th - 19th JUNE 2021.
This year’s focus is on Anaphylaxis: how to Spot. Treat. Prevent. A handy info graphic has been produced by World Allergy Week Organisation and you can learn more at:
https://www.worldallergy.org/
The NHS is returning to ‘normal’. Backlog and patient safety
Putting patientsafety at the front ,back and center of every decision as the NHS tries to deal with the huge backlog of cases as it tries to return to 'normal' #effectsofcovid19 #patientcare #covid19uk #healthcare
Click on the link below to read a brilliant piece by Patient Safety Learning on concerns about patient safety and the backlog of cases that face the NHS as it tries to return to normal post Covid-19
Telemedicine in Kenya - 5 years on!
Telemedicine was meant to revolutionise primary health care delivery in Kenya. Five years on, has it?
Technology can play an important part in healthcare, as is currently evident in the role it has played in the fight against Covid-19. Indeed early this year in March, Kenyatta National Hospital (KNH), launched a telemedicine technology center for the detection of Coronavirus, touted as the first of its kind in Africa. Telemedicine allows healthcare professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology.
A quick google search on telemedicine in Kenya, shows that its not a new concept in Kenya. In fact 2015 saw the launch of two telemedicine schemes, that were meant to revolutionise healthcare delivery to Kenya’s rural poor and marginalised communities. The first scheme was a collaborative venture between German based Merck group and the Ministry of Health, that provided a platform which enabled both patients and healthcare providers in rural areas to interact with Kenyatta National Hospital health experts via video conferencing. The second scheme, Sema-Doc was launched by the First Lady Margaret Kenyatta and for monthly fee of 300 Kenyan shillings you would get access to medical doctor plus a whole range of other services by dialing *220# on ones safaricom line. There also exists a whole host of privately run telemedicine schemes like Connect Med (mDaktari) by Access Afya, which aim to offer affordable convenient access to primary care.
Five years on and with the devolution of healthcare coupled with little or no change in primary healthcare delivery services especially in rural and marginalised areas, we would like to know of your experience of telemedicine and if it has truly revolutionised primary healthcare delivery for the rural poor and marginalised communities as envisioned. Have you heard of these schemes or even used any of them or any other form of telemedicine? If so, what has been your experience and what if anything can be improved upon?
Please let us know via the ‘your health matters’ page on the website.
Useful reading:
Nakweya,G(2015) Kenya launches telemedicine initiative for the poor- https://www.scidev.net/sub-saharan-africa/medicine/news/kenya-launches-telemedicine-initiative-poor.html
2. Wanyonyi,P(2015), Telemedicine is here ,but more needs to be done . Nairobi business monthly https://www.nairobibusinessmonthly.com/telemedicine-is-here-but-more-needs-to-be-done/
4. Kabia, J (2018), Technology expert says Kenya is the ‘promised land’ of telemedicine. Health Business- http://www.healthbusiness.co.ke/2015/technology-expert-says-kenya-is-the-promised-land-of-telemedicine/
Is patient feedback relevant and/or necessary?
Importance of feedback and how it can be used.
We all get some sort of feedback while going about our daily lives. It can be positive, critical, negative, unsolicited or at times asked for.
This also applies to institutions we interact with. We might give feedback whether asked for or not as pertaining to their services. Healthcare is big business and as a business, feedback from your service users in essential and should be incorporated into daily practice. Feedback is a great tool that can be used to evaluate how you are doing as an individual( useful for staff appraisals etc) or as a corporation ( improve or maintain high ranking, and increase revenue), and can be used to improve services or used to highlight strengths.
The National Institute for Health Research ( NIHR ) in the U.K has published an interesting piece of research looking at patient feedback and how it can be used to improve care. Please have a read below.:
https://content.nihr.ac.uk/nihrdc/themedreview-04327-PE/Patient-Feedback-WEB.pdf
Care, consent and patients rights
Obtaining consent is vital in all aspects of healthcare provision. A patient should have access to information and be able to ask questions and make an informed choice about the care they recieve. Care without consent is ASSAULT.
Working in partnership with SIRRO and the nurse in charge at a local healthcare facility, we have developed a patient information leaflet and informed consent form for those using the facilities cervical cancer screening program. This will provide consistent and vital information about the service provided and encourage dialogue between patient and healthcare professionals as well encourage good clinical practice.
