British journal of nursing (Mark Allen Publishing)最新文献

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses several recent patient safety reports and what they show about the development of an effective NHS patient safety culture.

Peripheral intravenous catheter (PIVC) insertion is a critical component of patient care in out-of-hospital settings, with its use becoming routine for a wide array of therapies. However, repeated failed attempts at catheter insertion are both a source of patient distress and a contributing factor to suboptimal clinical and economic outcomes. This study examined the challenges associated with PIVC placement in out-of-hospital settings, specifically within the Lloyds Clinical service, where a diverse group of patients receives intravenous therapies, including oncology medications, antibiotics, and treatments for rare disorders. The study retrospectively analysed 16 241 nursing visits, identifying cases of failed initial PIVC insertion and exploring the causes behind these instances. Findings suggest that patient-related anatomical and physiological factors, such as vein visibility and previous medical interventions, account for the majority of failed insertions. A review of current literature highlighted the importance of addressing variability in nursing practices, enhancing educational frameworks, and adopting evidence-based guidelines to optimise PIVC insertion and management. Strategies such as patient education, localised warming techniques, and targeted nurse retraining were identified as potential ways to improve outcomes. The implementation of these strategies aims to enhance the overall patient experience and ensure optimal venous access success rates in out-of-hospital settings.

Health professionals continue to be under pressure to reduce costs while providing efficient care and ensuring patient safety. As the number of vascular access devices (VADs) used in health care continues to increase, there is a need to reduce the complications, such as infection and occlusion, associated with them. Needle-free devices (NFDs) first became available in the early 1990s with the aim of reducing the number of needles in clinical practice. Since then different designs have been developed. As well as the original aim of NFDs to maintain a closed system and to reduce the risk of needlestick injuries and blood spillage, NFDs are now designed with the aim of improving clinical outcomes by reducing the common complications of infection and catheter occlusion. Due to the increasing number of NFDs with various specific designs available, it is imperative that health professionals have an understanding of the different types and functions. This article provides an explanation of NFD design and functions, guidance and information about their benefits when used correctly, as well as advice on preventing possible complications associated with their use.

Background: Peripheral intravenous catheter (PIVC) failures remain common, hindering patient care. Ultrasound-guided PIVC (USG-PIVC) placement offers improved first-time and overall insertion success rates, reduced complications, and enhanced patient satisfaction. Yet, in our adult intensive care unit (ICU), most USG-PIVCs were placed by physicians, a skill that nursing staff could also benefit from acquiring.

Purpose: Our aim was to select the most appropriate handheld ultrasound device and develop a comprehensive USG-PIVC nursing education program to improve PIVC success rates and enhance patient care.

Methods: This quality improvement initiative's literature review guided development of an education model and evaluation of three handheld ultrasound devices. Nurses received two hours of didactic training, two hours of classroom simulation, and supervised clinical practice. Outcomes were analyzed by the lead ICU clinical educator.

Results: Five ICU nurses performed 76 USG-PIVC placements with 70%-90% overall insertion success rates, ie within two attempts. The preferred of three ultrasound devices was selected for its highest success rate, portability, transducer probe, and screen integration lending to ease of use, quick start-up, and clinical support. Nurses were overwhelmingly positive about the education program, as evidenced by informal qualitative feedback collected at each end of session.

Conclusion: Our comprehensive USG-PIVC insertion program empowers nurses to improve vascular access through a structured approach, combining online learning, simulation, and supervised clinical practice, with effective ultrasound technology selection. This approach provides other organizations with insight to equip nurses and leverage ultrasound technology toward meeting the 2024 Canadian Vascular Access Association guidelines' (in press) recommendations for ultrasound guidance and product selection.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the impact on practice of the UK Supreme Court's decision in Montgomery v Lanarkshire Health Board [2015], 10 years on from the judgment.

Background: Normal saline instillation into tracheostomy or endotracheal tubes, collectively known as altered airways, is often indicated when airway secretions become difficult to manage. Internationally, a clear gap exists between scientific evidence and the practice of normal saline instillation before suctioning the altered airway.

Aim: The objective of this review is to appraise and synthesise the evidence as to whether normal saline instillation before suctioning causes adverse effects on adult patients with altered airways.

Method: A mixed-method review was undertaken to appraise hierarchical quantitative-designed studies available in literature, and critical appraisal skill programme tools were used to judge trustworthiness of studies. A systematic search disclosed 828 potentially eligible studies, of which 6 hierarchical relevant studies were chosen for appraisal.

Findings: Collaboratively, findings established that normal saline instillation before suctioning caused adverse effects on adult patients with altered airway.

Conclusion: The evidence synthesis does not support the practice of normal saline instillation into the adult altered airway before suctioning for management of airway secretions.

Sam Foster reflects on the problem of aggression directed at nurses, why it needs to be taken as seriously as a patient safety event, and the role of leadership in reducing it.