Nhs Guidelines, Procedures And IssuesPresentation Transcript
Grzegorz Chodkowski (MD)
Riga, Radisson SAS
NHS Guidlines, Procedures and Issues
• Waiting Times
• Copying Letters to Patients
• Hospital at Night (HAN)
• Hospital Hygiene & Infection Control: MRSA & Clostridium
• National Institute for Health & Clinical Excellence (NICE)
• National Patient Safety Agency (NPSA)
• Clinical Governance
• Swine Flu
• Continence Care
• Chaperone persons
• NHS Cuts
• Staff assault
Source: Department of Health Quarter Report
Copying Letters to Patients
• In response to Government guidelines, this Trust is giving patients the option to
receive copies of letters sent to their doctor after an outpatient appointment or
inpatient/day case admission.
• The policy concerning Copy Letters to Patients (CLTP) was first set out in the NHS
Plan (2000) which made a commitment that patients should be able to receive
copies of clinicians’ letters about them as of right. Detailed information and
guidance is also available on the Department of Health website,
• Our patient information leaflet explains some of the benefits of receiving copies of
letters and how to arrange to receive these. Copies can be obtained in a variety of
formats including Braille, large print, audio or translated into another language.
• Once a patient/carer has indicated that they wish to receive copies of letters, these
will continue to be provided for all attendances/admissions until the patient/carer
tells us that they no longer wish to receive copies of clinical letters.
• It is important for patients and carers to be aware that the purpose of the letter is to
give the patient’s General Practitioner (GP) medical information about the patient’s
illness, care and treatment.
Hospital at Night
Hospital at Night
The Hospital at Night project began in various pilot sites around the country
in April 2003, with aim of enabling the European Working Time Directive
(EWTD) and reducing the hours worked by junior doctors.
Medical cover provided in hospitals during the out-of-hours period has been
Medical cover requirements are no longer defined by professional
demarcation and grade. Cover is now based on the competence of staff in
The project aims to enable and possibly enhance care for patients given the
changes in permitted working hours of doctors in training.
Hospital at Night
• The HAN project offers a method of preserving, and even
enhancing, doctors' training by reduced hours available.
• The HAN model consists of a multidisciplinary night team,
which has the competences to cover a wide range of
interventions. It also has the capacity to call in senior and
specialist expertise when necessary.
• This model contrasts the traditional model of junior doctors
working in isolation.
National Institute for
Health and Clinical
National Institute for Health
and Clinical Excellence (NICE)
NICE is the independent organisation responsible for providing
national guidance on the promotion of good health and the
prevention and treatment of ill health.
On April 2005 NICE joined with the Health Development Agency to
become the new National Institute for Health and Clinical
Excellence (also known as NICE).
Head injuries (June 2003)
Preoperative tests (June 2003)
Referral for suspected cancer (June 2005)
Laparoscopic surgery for inguinal hernia (September 2004)
Laparoscopic surgery for colorectal cancer ( December 2002)
Gemcitabine for pancreatic cancer (May 2001)
Herceptin for advanced breast cancer (March 2002)
Tension-free vaginal tape for stress-incontinence (February 2003)
Infliximab for Crohn’s disease
Benefits of Implementation
NICE guidance can help patients and Carers:
• Receive care in line with the best available evidence of clinical an
• Empower patients to be accountable for their care, knowing how they
will be cared for in a consistent evidence-based approach, thus
building patients confidence in NHS services
• Improve their own health and prevent disease
• Help put NICE guidance into practice
Benefits of Implementation
NICE guidance can help healthcare professionals:
• Ensure care provided is based on the best evidence available
• Ensure clinicians meet the standards set by regulatory bodies and that
they consider NICE guidance when exercising their clinical judgement
• Enable all staff dealing with patient queries to have confidence in
the approaches to care
• Effectively target resources and efforts at the areas that offer the
most significant health improvement.
Benefits of Implementation
NICE guidance can help organisations:
• Meet the Standards for better health
• Core standards – technology appraisals and IP
• Developmental standards – nationally agreed guidance
• Enable organisations to meet the requirements in the
government’s standards-based planning framework National
standards, local action, health and social care standards and
planning framework, 2005-2008
• Benefit from any identified disinvestment opportunities, cost savings
or opportunities for re-directing resources
• Meet government indicators and targets for health improvement
and reducing health inequalities
• Help local government fulfil its remit to promote the economic and
social well-being of its communities.
• Provide a focus for multi-sector partnership working on health,
involving patients and the public in implementing NICE guidance
Infection control is a key concern for any professional involved with patients
that are subject to our duty of care. Any contact with the healthcare
environment and care professionals should have a positive outcome for the
individual and not result in a worsening of their circumstances.
Universal precautions is an approach to the unknown risk presented by
the handling of products and provides a safe system for the healthcare
This is done while maintaining a consistent approach to the patient in
order that confidential information of infection is not identified by the
behaviour of the healthcare professional.
Universal precautions is a method of care delivery that recognises all
body products from all patients constituting a risk, and therefore
stipulates the use of a barrier between healthcare professionals and
Caution should therefore be taken with all blood and body products.
The following is a list of less common body products that still
constitute a risk:
• Blood and wound excaudate
• Breast milk
• Vaginal secretions
• Cerebral spinal fluid
• Synovial fluid
• Pleural fluid
• Peritoneal fluid
• Amniotic fluid
• Unfixed organs and tissue
The most effective barrier is the disposable glove.
• Patients in hospital can be very vulnerable to picking up infections because they
are already ill or may be undergoing surgery, and their ability to fight infection is
• We are very keen to protect you and your family from acquiring an infection
during your stay in hospital.
• It cannot be stressed too highly that effective handwashing is one of the effective
ways to prevent the spread of infection.
• You can help us prevent the spread of infection by paying particular attention to
washing your hands before and after visiting the hospital.
• Remember that if you are suffering from a heavy cold, flu-like symptoms, vomiting
or diarrhoea YOU SHOULD NOT visit the hospital. Please inform the relevant
ward/dept. If you have symptoms of diarrhoea or vomiting, you must not visit
until you have been free of symptoms for 48 hours.
staphylococcal aureus (MRSA)
MRSA is the identified organism in 20% of
all staphylococcal aureus cultures in the UK.
Its incidence seems to be growing in number
and is increasingly responsible for major
Managing MRSA is a significant responsibility
of all healthcare workers in every
Consider every source contaminated
Isolate all new admissions until proven negative of MRSA carriage
If at all possible manage patients away from healthcare environment
if known positive.
Have robust process of screening :
Three consecutive negative screens
Each swab taken on different days
Swabs to be from more than one site on each screening
When MRSA has been identified in an environment:
Identify the source
Isolate with barrier nursing
Treat infected patients and staff
Close ward or hospital
Health and Safety
Health and Safety is both the responsibility of both the employer and the employee,
stated within the Health an Safety at Work Act 1974.
Employers have a duty to maintain Health and Safety standards and have to take
reasonable steps to ensure the health safety and welfare of their employees at work.
Health and Safety Obligations
As an employee, you have a duty to take reasonable care of your own and other’s
health an safety. Employees must read and be familiar with :
Health and Safety manual
Infection control policy and procedure
Employers must conduct regular risk assessments in the areas of work
In the year 2004/05, the Health and Safety Executive reported that in the UK, 220
workers and 361 members of the public were killed, and 363,000 people suffered an
injury due to accidents at work.
A needlestick injury is any injury where the skin has been breeched with an
infected sharp. This can include grazes as well as puncture wounds.
Similarly, splashes of blood or blood stained fluid into the eye is considered as
carrying the same risk but of a different order.
Following a mucocutaneous exposure, via the mucous membrane, the average
risk is estimated to be less than one in one thousand.
Where intact skin is exposed to HIV infected blood, no risk of HIV transmission
With HIV/AIDS, the chance of contracting the infection from a needlestick injury
is one in 300, whereas with hepatitis C it is one in 30 and hepatitis B it is one in
More than a third of all incidents happen after the completion of procedures
such as cannulation and phlebotomy, often as a result of resheathing needles.
Health professionals should not under any circumstances resheath needles.
The Occupational Health Department has a vital function in maintaining the
well being of staff. The department also responds to issues of health and
risk that have an impact on the individual employee in the workplace.
The chronology of care provided by Occupational Health Departments
begins with the pre-employment interview, which is both surveillance and
*Advice and guidance
Vaccinations, for example Hepatitis B
Subsequently Occupational Health manage issues that can arise, including:
Work related injury or stress.
Confidential advice on any health problem
A Needlestick Injury is an Emergency
Stop what you are doing immediately
Force the wound to bleed
Wash under running water
Report immediately to your immediate manager
Report to Ocuppational Health/ Accident and Emergency (as per protocol)
Needlestick Injury and Post Exposure Prophylaxis (PEP)
Consider with the Accident and Emergency clinician/Occupational Health
clinician whether or not to take PEP.
This is a short course, generally around three months, of anti-retroviral triple
therapy which is thought to be of value in preventing seroconversion when an
individual has been expose to the HIV infection.
The most usual regime offered is a three drug combination of:
* Indinavir or Nelfinavir
These drugs are started immediately. A case control study amongst
healthcare workers exposed to HIV has found that the administration of AZT
for four weeks after exposure was associated with an 80% reduced risk of
AZT treatment at this stage is believed to block the infection of immune
system cells by HIV, so prompt AZT treatment is likely to block the
establishment of HIV infection in an individual who has been exposed to the
It is assumed that a combination of two or three drugs may be even more
effective than AZT alone at blocking HIV infection.
The Decision to commence PEP
Was the donor patient HIV positive?
Was the patient known to have a high viral load at the time of inoculation?
Was the injury received a deep injury from a large diameter needle?
Despite the benefits of PEP, there is evidence that the standard regime of AZT,
3TC and Indinavir is poorly tolerated.
Nine out of 18 healthcare workers at three London hospitals who commenced this
regime stopped or changed therapy due to side effects within four weeks.
Six of the nine who started Indinavir required more than two weeks off work.
Among the other 9, only one required more than 7 days leave. There were no
discontinuations among the five people who received saquinavir.
PEP – Department of Health guidance
If exposed in the course of your work you may well have access to triple therapy
on site which could save time.
Local policy will include instructions to inform occupational health in the instance o
Training on prevention of needlestick injuries and post exposure procedures,
including AZT treatment, should also be included.
Ideally administration of PEP, should commence within1hour of exposure. If
not at least within 24 hours of exposure.
All NHS Trusts should have a post-exposure policy. Starter packs of triple
therapy should be available on site for use following occupational exposure.
Source: NHS Annual Audit 2007/008
• All patients in the hospital with bladder or bowel problems will be offered
appropriate assessment, treatment and management if they wish. This
will be done sensitively with respect to their privacy and dignity.
• Nursing and medical staff will be trained to carry out baseline
assessments on patients with bladder and bowel problems and will know
when to refer to appropriate specialists.
• Regular training of staff will be provided and will be based on recognised
best practice statements and national guidelines. Patients will have access
to health care professionals with knowledge of treating and managing
bladder and bowel conditions; treatment and management will be
evidence based, in line with best practice statements and national
• Products available to manage incontinence will be used as necessary
after initial assessment. These products will be recognised as being
effective and staff will be trained and competent in their use.
• Regular audit of continence assessment and treatment will be done in
order to monitor and improve the service. This will also apply to
continence management products used within the Trust.
• Patient will be discharged with adequate supplies of continence
products to meet their immediate post-discharge needs; they will be
referred to appropriate community services for further assessment and