Karen Elcock

Using care bundles to reduce in-hospital mortality: quantitative survey

Problem To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage. Design Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardised mortality ratio (HSMR) diagnoses covering 80% of hospital deaths. Setting Acute hospital trust in north west London. Strategies for change Use of clinical guidelines in care bundles in eight targeted clinical areas. Interventions Use of care bundles in treatment areas for the diagnoses leading to most deaths in the trust in 2006-7. Key measures for improvement Change in adjusted mortality in targeted and non-targeted diagnostic groups; hospital standardised mortality ratio (HSMR) during the intervention year compared with the preceding year. Effect of the change The standardised mortality ratio (SMR) of the targeted diagnoses and the HSMR both showed significant reductions, and the non-targeted diagnoses showed a slight reduction. Cumulative sum charts showed significant reductions of SMRs in 11 of the 13 diagnoses targeted in the year of the quality improvements, compared with the preceding year The HSMR of the trust fell from 89.6 in 2006-7 to 71.1 in 2007-8 to become the lowest among acute trusts in England. 255 fewer deaths occurred in the trust (174 of these in the targeted diagnoses) in 2007-8 for the HSMR diagnoses than if the 2006-7 HSMR had been applicable. From 2006-7 to 2007-8 there was a 5.7% increase in admissions, 7.9% increase in expected deaths, and 14.5% decrease in actual deaths. Lessons learnt Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate.

Supporting students with disabilities: good progress, but must try harder

© 2 01 4 M A H ea lth ca re L td T he introduction of the Equality Act in 2010 has had a significant impact on policies and procedures in all organisations. Within health care, it has required creative thinking to ensure that the rights of individuals are balanced against the needs of patients and service users. However, implementing the requirements set out in the Act still provokes considerable discussion and debate. For universities delivering healthcare programmes, adjustments are often required for students with disabilities, which requires partnership working through consultation and effective communication to ensure that the students’ needs are met. This includes involving academic staff, support staff, practitioners who support students and the students themselves in the development of policies and procedures, and in the processes to identify and implement adjustments needed, to ensure that students are not disadvantaged. Equality and diversity training is a requirement for all academic and healthcare staff. Students are taught the importance of not making assumptions and being respectful of an individual’s beliefs and values. Sadly, despite this training, the response to students with disabilities from some students and academic and healthcare staff, still poses challenges that suggests that further education is required. Part of the problem is that the numbers of students with a disability remain relatively low (around 10% of students declared disabilities on entry to university in 2012 according to the Higher Education Statistics Agency (HESA) (2014)), which means that direct contact is relatively limited. While training and education are important, actually working with students with a disability is probably the most effective means to break down barriers and dispel misconceptions. The introduction of the Disability Discrimination Act in 1995, which later became subsumed into the Equality Act in 2010, has removed many barriers to higher education and led to an increase in the number of applicants with a disability entering nursing. Often the decision to enter nursing has been Karen Elcock

Student life-no barriers to nursing: Karen Elcock presents some helpful tips for nursing students with a disability

Having a disability is no longer a barrier to becoming a nurse. Todays universities are accustomed to supporting students with a wide range of disabilities, including dyslexia, diabetes, mental health difficulties, hearing or visual impairments and mobility difficulties.

Tips for preceptorship.

Applying for and gaining your first post can be an anxious time. While getting the job is essential, it is also important to consider what an employer can offer that will ease the transition from student to registered nurse.

Importance of being flexible in nurse education

British Journal of Nursing, 2014, Vol 23, No 15 847

It is not out of reach – your stepping stones to success Christiana de-Sammy It is not out of reach – your stepping stones to success Sunflower Press 219pp £9.99 978 0 9567 5820 0 9780956758200

Written by a former nurse and midwife who is now a life coach, this life-improvement book offers a range of strategies to manage the challenges of modern life.

Time for a rethink if we want to improve standards of mentoring

Bob Prices learning zone article (August 8) highlights the complexity of assessing students in practice.

Lack of support from a mentor while on a placement is something that, unfortunately, many of us will recognise (reflections May 25): High-quality mentorship will help us build a strong future workforce

The Nursing and Midwifery Council code of conduct requires all nurses to support learners and expects all nurses to aspire to be a mentor. While this is great in theory, not everyone makes a good mentor and many nurses who attend mentorship programmes openly admit that they are doing it to aid their career progression.

What is Nursing? Exploring Theory and Practice Carol Hall What is Nursing? Exploring Theory and PracticeandDawnRitchie Learning Matters186pp£18978 1 84445 158 61844451585

This sixth book in the Transforming Nursing Practice series is a quick and easy read aimed at pre-registration nursing students. It will also prove useful for students on overseas nursing programmes and access-to-nursing courses as it gives an excellent overview of nursing in the UK today.

Educating Professionals – Practice Learning in Health and Social Care Mark Doel Educating Professionals – Practice Learning in Health and Social CareandSteven MShardlow (Eds)Ashgate322pp|£19.99978 0 7546 4811 60754648117

This is an original book which gives a synopsis of the practice education component for each of the main health and social care professions. The initial chapters introduce the context for healthcare programmes and describe a typical community in which healthcare students will gain their practice experience.