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The Department of Health (DH) proposes that 75% of elective surgery should be performed as a day case procedure (NHS Plan 2000). To achieve this some modification of the traditional selection criteria may be required and careful thought given to the patient pathway, including the anaesthetic technique. Successful anaesthesia for day case surgery requires a balanced anaesthetic technique and multidisciplinary input which commences at booking, runs through preoperative assessment and continues to a nurse-led discharge. Suitable patients need to be selected (Digner 2007), prepared both physically and psychologically, undergo minimally invasive surgery with a suitable anaesthetic technique encompassing good pain relief and the avoidance of postoperative nausea and vomiting (PONV). Pain and PONV are the most common causes for a patient to require unplanned admission (Junger 2001).
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PMID:Anaesthesia for day surgery. 1770 2

Patients with pressure ulcers suffer pain and distress from wounds that can require treatment for many months following discharge from hospital (Havard, 2007). This initial and ongoing treatment accounts for around four per cent of the NHS annual budget (Bennett et al, 2004), therefore pressure ulcer prevention and management is beneficial not only to patients but also the NHS. Education for healthcare professionals is an important factor in the prevention and management of pressure ulcers; however, in the current climate releasing staff to attend study days is becoming difficult. In some locations staff have to travel long distances in order to attend while locally-based study days are poorly attended. Developing e-based learning was seen as a realistic option for nurses working in Trust within a large geographical area.
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PMID:E-learning in wound care: developing pressure ulcer prevention education. 1785 69

The use of general anaesthesia for dental treatment in the NHS outside hospitals has changed over time. Although deaths are uncommon during or immediately after general anaesthesia for dental treatment, they are more likely to occur than with other methods of pain and anxiety reduction, such as local anaesthesia and conscious sedation. Inquiries into recent anaesthetic deaths in dental practice have been critical of the standard of care provided in areas such as pre-operative assessment, monitoring, resuscitation and transfer to specialist critical care facilities.
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PMID:Intravenous conscious sedation in children for outpatient dentistry. 1850 Feb 72

Nurses working in the field of tissue viability constantly strive to improve pressure ulcer prevention and management in their clinical areas, knowing that pressure ulcers cause pain and suffering to patients while costing the NHS millions of pounds to treat. The aim of this initiative was for the tissue viability team to develop an audit tool based on recently devised performance indicators. The purpose of the audit was to provide the mechanism for reviewing the quality of everyday care. The tool utilizes the 'traffic light' system to categorize the results. The initiative has improved clinical outcomes for patients and increased the awareness, education, knowledge and confidence of nurses in pressure ulcer prevention and management across a combined primary and secondary care Trust.
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PMID:Performance indicators--a quest to improve patient care. 1807 96

Background In order to comply with clinical governance requirements and receive payments under the Qualities and Outcomes Framework, GPs are required to undertake an annual survey of patient experience using a validated assessment tool. Dentists, in contrast, have embryonic clinical governance structures. The provision of quality dental services was identified in NHS Dentistry: Options for Change as a priority for the future. In anticipation of the PCT role in commissioning quality NHS dental care, Croydon PCT has developed an instrument to examine various aspects of the patient experience. Methods A review of existing literature identified five generic dimensions of patient satisfaction with dental care: technical competence, interpersonal factors, convenience, costs and facilities. The dental practice assessment questionnaire was developed to cover all of these dimensions using a number of validated measures and modified questions. A small scale pilot was undertaken before the questionnaire was sent to a 10% random stratified sample of the PCT population. Results Validation analyses were undertaken in conjunction with the GKT Dental Institute. Cronbach's alpha demonstrated very high levels of internal consistency, and factor analysis and correlation coefficients demonstrated high levels of factorial and concurrent validity respectively. Subgroup analysis revealed differences in reported satisfaction by age and ethnic group, and that those who attend because of pain or a dental emergency are generally less satisfied with the care they receive. These results are consistent with previous research findings. Conclusion The dental practice assessment questionnaire is a valid and consistent measurement tool. Its use could be extended across the NHS without difficulty.
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PMID:What do you think of your dentist? A dental practice assessment questionnaire. 1809 9

This article describes the development, introduction and implementation of'Guidelines for Pain Management in the Opioid-Dependent Patient' in Yeovil District Hospital NHS Foundation Trust, Somerset. It incorporates the relevant background experiences within the organization and establishes the rationale for the development of the guidelines. An outline of the consultation processes with the different professional groups involved is given, together with the strategy for implementation across the Trust. This project challenged old ways of working and embraced new expanding roles. Indications are that both the quality of care and the patient experience have improved as a direct result of the implementation of these guidelines.
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PMID:Pain management for the opioid-dependent patient. 1839 97

Reprinted with permission from the British Medical Journal 300:1431-1437.1990. Objective - To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.Design - Randomized controlled trial. Allocation to chiropractic or hospital management by minimization to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up to two years.Setting - Chiropractic and hospital outpatient clinics in 11 centers.Patients - 741 patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.Interventions - Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilization or manipulation, or both.Main outcome measures - Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion.Results - Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7 percent points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow-up period. Secondary outcome measures also showed that chiropractic was more beneficial.Conclusions - For patients with low back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.J Orthop Sports Phys Ther 1991;13(6):278-287.
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PMID:Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. 1878 99

Back pain affects a large proportion of the population. It can impact on an individual's ability to function and on their quality of life, and can also incur significant economic, NHS and personal costs. The approach to the treatment of back pain has undergone significant changes in the past 10 years. Current guidelines emphasize the importance of maintaining activity and support the role of analgesics in facilitating active rehabilitation. There is evidence that many patients with chronic conditions do not use medication in the way they were prescribed. Fears associated with analgesics may compound this in those experiencing pain. There is limited research into the attitudes and experiences of sufferers of low back pain who have been prescribed analgesics. This qualitative study explored, through interviews, the attitudes to analgesic use of 16 patients referred to a community-based back pain programme. A thematic analysis was conducted and identified five key themes. The findings suggest that patients are generally confused about the value of complying with their analgesic regime as healthcare professionals do not give them sufficient explanation when the prescriptions are issued.
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PMID:Experiences of analgesic use in patients with low back pain. 1897 89

The importance of evaluating systematically the effectiveness of hospice care has been noted for at least 20 years. There is, however, limited evidence about whether and how the care provided to terminally ill patients by in-patient hospices in the UK differs from that provided in NHS hospitals. In this article, we, therefore, present a comparison of hospice in-patient care and hospital care for cancer patients in the UK, from the perspective of bereaved relatives who had experienced both types of care during the last 3 months of the patient's life. The Office of National Statistics drew a random sample of 800 deaths in South London in 2002, and sent the person who registered the death (the informant) a Views of Informal Carers - Evaluation of Services (VOICES) questionnaire 3-9 months after the death, with up to two reminders. There was a response rate of 48%. For this analysis, 40 cancer patients whose informant reported both a hospice in-patient admission and a hospital admission in the last 3 months of life were identified. Informants answered the same questions about each admission and responses on these were compared. There were statistically significant differences between respondents' views of hospice and hospital care on eight out of 13 variables measuring aspects of satisfaction with care, with a trend towards statistical significance on a further two: in all cases respondents rated hospice care more positively than hospital care. There were no differences in the experience of pain and breathlessness in the two settings, but respondents rated pain control by the hospice as more effective. In comparison to hospital care, from the perspective of bereaved relatives, hospice in-patient care provided better pain control, better communication with patients and families, and better medical, nursing and personal care, which treated the patient with more dignity. Further research is needed to confirm these findings using a wider sample of in-patient hospices in the UK and including the perspectives of patients. Providing high quality care for terminally ill patients in acute hospitals remains an important challenge.
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PMID:A comparison of the quality of care provided to cancer patients in the UK in the last three months of life in in-patient hospices compared with hospitals, from the perspective of bereaved relatives: results from a survey using the VOICES questionnaire. 2012 46

Patients coming into hospital can suffer a great deal of anxiety--Mathews et al (1981) suggested patients who undergo surgery experience acute psychological distress in the pre-operative period. These fears manifest themselves as uncertainty, loss of control and decreased self-esteem, anticipation of postoperative pain, and fear of separation from family (Egan et al, 1992; Asilioglu and Celik, 2004). As technical advances and improved anaesthetic techniques become available to the NHS, the ability to offer day surgery to a wider patient population is increasing. In fact Bernier et al (2003) and Elliott et al (2003) have suggested that 60% of future operations will be day procedures. This means as health-care professionals, nurses will have shorter time available not only to identify patients who may be experiencing anxiety, but also to offer them the support they need to cope with the surgery. Anxiety can have a profound effect on patients--it affects them in a variety of ways, from ignoring the illness, which could have a serious impact on the patient's life, to the constant demand for attention which can take the nurse away from the care of other patients on the ward (Thomas et al, 1995). Recently, there has been increasing interest in the possible influences of properative anxiety on the course and outcome of surgical procedures and the potential benefits of anxiety-reducing interventions (Markland et al, 1993). Caumo et al (2001) suggested that pre-operative management of a patients anxiety would be improved if health-care professionals had more knowledge about the potential predictors of pre-operative anxiety.
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PMID:Managing anxiety in the elective surgical patient. 1937 85


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