Use of an educational, audiovisual podcast to maximise safety with variable rate intravenous insulin infusions
WHERE THIS HAPPENED: Nottingham University Hospitals NHS Trust
There have been several patient safety alerts from NHS England reporting serious incidents of harm due to inappropriate handling of insulin.1 From direct observation on the wards at a large, local, acute hospital Trust, practice suggested that some patients might be receiving insufficient supplementary fluid with their variable rate intravenous insulin infusion (VRIII), or no fluids at all.
To understand the problems with local intravenous insulin usage, an audit was carried out in January 2015 for patients on VRIII considering ‘safe use of insulin’. This audit showed that 48% of patients were prescribed the appropriate fluid with their VRIII.
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How critical cost analysis can save money in today’s NHS: a review of carpal tunnel surgery in a district general hospital
WHERE THIS HAPPENED: Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust
With today’s National Health Service (NHS) facing huge financial pressures the healthcare profession cannot afford to carry on spending at the current rate. Individual clinicians should be encouraged to critically appraise their own practices to bring about a more efficient and costeffective service.
The purpose of this project was to analyse the way that carpal tunnel surgery was being performed within our institution and bring about safe changes to practice that reduce expenditure. By critiquing our practices and applying simple changes based around sound evidence an annual saving of over £15 500 to the department was made.
The changes instigated are simple, sustainable and safe to implement while providing improved patient satisfaction. They are also easily transferrable across institutions and to other minor hand surgical procedures to afford even greater ongoing savings to the NHS.
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WHERE THIS HAPPENED: University Hospitals Birmingham NHS Foundation Trust, Birmingham, Heart of England NHS Foundation Trust, Birmingham
Oxygen is one of the most frequently prescribed inpatient drugs, but accurate prescription still poses a nationwide problem.1 The British Thoracic Society (BTS) 2015 audit showed 14% of hospital inpatients were on oxygen, with 42.5% of these not having a valid prescription.2 Patients who retain carbon dioxide due to underlying conditions, such as chronic obstructive pulmonary disease (COPD), bronchiectasis and some neuromuscular disorders, require a level of hypoxia to stimulate respiratory drive. Obliteration of that drive from iatrogenic overoxygenation can cause hypercapnia and its related complications.3
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