Clinical Skills Ltd

Verification of expected death – updated guide https://lnkd.in/eCpyreJT   This guide has been reviewed and updated by Diane Laverty, Macmillan Nurse Consultant, London Ambulance Service NHS Trust. The guide has also been double-blind peer-reviewed.   The Academy of Medical Royal Colleges (AoMRC, 2008) describes death as “the irreversible loss of essential characteristics which are necessary to the existence of a living human person”.   The process of verifying a death involves carrying out a set of practices to confirm that a person’s life has ended. This may also be known as ‘confirmation of death’ or ‘recognition of life extinct’ (Hospice UK, 2024a; 2024b),   While the verification of death is usually performed by medical staff, "any competent person" can carry out the procedure (BMA, 2020). The national consensus is that nurses should only verify expected deaths (Hospice UK, 2024a).   Nurses should be given adequate education and training on how to verify an expected death and provide bereavement support to the deceased person’s family. While national guidance is available (Hospice UK, 2024a) an organisation may have its own local policies.   This guide covers the steps used in verifying an expected death, including:   • Recording the verification request; • Confirming the identity of the deceased; • Checking for a response to stimuli; • Assessing the pupils; • Checking for a pulse; • Listening for breath and heart sounds; • Maintaining the person's dignity; • Documenting the findings. #nursing #clinical #death #elearning

Disposal of clinical waste and sharps – updated guide https://lnkd.in/eWxnUqzx   This fully illustrated guide has been updated by Satu Hakala, Senior Lecturer in Simulated Learning and Clinical Skills at Kingston University London. It has also been double-blind peer reviewed.   The guide explains how to safely dispose of clinical waste and sharps, according to NHS regulations. It now also incorporates the NHS Scotland guidance on waste management.   Healthcare professionals who handle and manage waste must be trained in the safe disposal of clinical waste and sharps and know which items should go into which container (NHSE, 2023a). They should dispose of healthcare waste in a way that protects their own health, their patients and the environment.   The incorrect disposal of clinical waste and sharps can lead to sharps injuries, toxic exposure, air pollution and thermal injuries. Healthcare organisations must have robust strategies and systems in place to ensure the safe disposal of both hazardous (also known as “special”) waste and non-hazardous waste (NHSE, 2023a; NHSS, 2023; WHO, 2018). Each waste stream must have a designated, labelled and colour-coded waste receptacle. Whoever generates the waste should correctly segregate it immediately after use.   This guide covers:   ·      A summary of waste categories; ·      An overview of the recommended colour-coded clinical waste system; ·      The correct labelling of waste containers; ·      The safe storage of clinical waste; ·      How to safely tie up clinical waste bags; ·      Safe use of sharps bins. #nursing #clinical #elearning

Updates to two guides from our category Pre- and Postoperative Care in Children and Young People:   ·      Preoperative care of children and young people https://lnkd.in/ebEa6C32   ·      Postoperative care of children and young people https://lnkd.in/eFGzvbjv   These fully illustrated guides have been updated by Catherine Hewitt, Senior Lecturer at London South Bank University.   Children and young people undergoing surgery have different emotional, psychological and physiological needs to adults (RCN, 2020). It is important to understand the general principles of pre- and postoperative care for all children/young people. – Preoperative care of children and young people   The goal of preoperative assessment is to ensure an excellent patient- and family-centred experience, with shared decision-making embedded throughout the process (RCoA, 2023a).   This guide supports this goal and includes details of: ·      Preoperative assessment; ·      Psychological preparation; ·      Admission to the ward; ·      Identification and consent; ·      Fasting guidelines; ·      Recording preoperative vital signs; ·      Fluid balance; ·      Preparation of the incision site; ·      Transfer to theatre. – Postoperative care of children and young people   The length of the postoperative phase depends on the type of surgery and the child/young person’s medical condition (RCoA, 2023b). Following minor surgeries, most patients can be discharged on the same day as the procedure. Major surgeries require longer recovery times and may even warrant a stay in intensive care.   This guide covers postoperative care, including: ·      Ward preparation and the handover process; ·      Initial assessment; ·      Observation of any infusions; ·      Postoperative care plan; ·      Recording vital signs; ·      Fluid balance; ·      Pain assessment; ·      Wound care; ·      Mobilisation; ·      Emotional wellbeing. #paediatric #nursing #elearning

A–E assessment in infants and children – NEW GUIDE https://lnkd.in/evVD8g8w   The author of this new, fully illustrated guide is Liesje André, who is a senior resuscitation practitioner. The guide has been double-blind peer-reviewed. The A–E approach is a standardised tool for clinically assessing a patient. The approach is designed to rapidly assess and manage potential respiratory, circulatory or neurological failure. A structured A–E assessment helps to ensure that potentially life-threatening problems are identified and managed in order of priority. The five components of the assessment are airway, breathing, circulation, disability and exposure.   This guide summarises each component of the A–E assessment for infants, children and young people. Each stage involves assessment, investigation and intervention.   It is important to address life-threatening problems as they arise, and to reassess after each intervention before moving on to the next stage of the assessment.   Observations should be recorded on a suitable Paediatric Early Warning System (PEWS) chart. To ensure the effective handover of information, use a recognised tool that allows for concise and clear communication, such as SBAR (situation, background, assessment and recommendation). #paediatrics #nursing #elearning

Abdominal examination – updated guide https://lnkd.in/eQbYStQB   This fully illustrated guide has been revised and updated by the author, Anthony McGrath, Head of Nursing at the University of Essex. It has been double-blind peer-reviewed. An updated competency checklist accompanies this guide, which can be used to assist with staff development and assessment. An abdominal examination identifies possible diagnoses in conjunction with the patient’s history and physical symptoms. The guide provides a comprehensive overview of each of the four key stages of abdominal examination:   ·      Inspection; ·      Palpation; ·      Percussion; ·      Auscultation. Before carrying out a physical clinical examination, it is important to conduct a preliminary general assessment of the patient. This should include an initial general inspection, which may find evidence of liver disease or cachexia, for example. This initial assessment is followed by a more detailed inspection of the patient’s face, chest, abdominal and pelvic areas.   The author has expanded on details of patient positioning, inspection of the hands and eyes, and added content on how to palpate for lymphadenopathy in the supraclavicular fossae. Additional illustrations have also been added. #nursing #medicine #elearning

Updates to two guides in our Infection Control Measures category: To coincide with International Infection Prevention Week 2024, we have news of updates to two guides in our Infection Control Measures category:   ·      Aseptic technique in the community: Key principles ·      Aseptic technique in a hospital setting: Key principles   These guides have been updated by Satu Hakala, Senior Lecturer in Simulated Learning and Clinical Skills at Kingston University London. They have been double-blind peer-reviewed.   The term ‘aseptic technique’ can be defined as a set of practices and procedures for ensuring asepsis and for preventing the transfer of potentially pathogenic microorganisms to a susceptible site on the body, or to sterile equipment/devices.   An aseptic technique ensures that susceptible body sites and sterile instruments are not contaminated during procedures such as wound dressing, urethral catheterisation or intravenous cannulation. This includes open wounds or insertion sites for invasive medical devices. An effective aseptic technique requires the strict application of the appropriate guidance on hand hygiene, and the correct use of personal protective equipment.   Undertaking an aseptic technique in the community can be challenging. The environment must be safe and clean before carrying out any procedure.   These fully illustrated guides demonstrate how to carry out an effective aseptic technique in both community and hospital settings, including:   ·      Selecting and gathering equipment; ·      Preparing the patient and the environment ·      Putting on sterile gloves; ·      Disposing of waste. They have been updated to reflect the latest guidance from NHS England (2024; 2021) and NHS Scotland (2023; 2022). The equipment and cleaning methods used in the guides have also been updated in line with national guidelines. APIC #IIPW #iipw2024 #nursing #aseptic

Updates to two guides from our Nutrition in Adults category:   ·      Care of a percutaneous endoscopic gastrostomy (PEG) tube https://lnkd.in/eUH9ejcQ ·      Nutrition screening in adults https://lnkd.in/eK3fWgN5  These guides have been updated by Jane Fletcher, Lead Nurse for Nutrition at Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust. The guides have been double-blind peer reviewed.   Competency checklists accompany these guides. These can be used to assist with staff development and assessment, and can be downloaded using a button above the respective guide, or viewed on screen immediately below the guide. – Care of a percutaneous endoscopic gastrostomy (PEG) tube   This guide describes the components of a PEG tube and lists indications and contraindications for the use of these tubes. It also describes each of the key steps in caring for a PEG tube. The guide also includes a troubleshooting section that identifies some common problems and appropriate actions. ­– Nutrition screening in adults   People in care settings are often at an increased risk of malnutrition, making it important to screen for malnutrition in all patients admitted to hospital. Identifying patients at risk of malnutrition allows the care team to develop a suitable care plan, which should allow for any special dietary requirements and cultural/social dietary preferences.   Various screening tools are available. This guide describes the use of the Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition (BAPEN).   The guide also includes some alternative measurements that can be used to estimate the patient’s BMI if height and weight cannot be obtained. This includes measuring ulnar length to estimate height, and using mid upper arm circumference (MUAC) to estimate the BMI. There may be other indications of malnutrition, such as the patient’s appearance, appetite, food intake and signs of muscle wasting. The guide highlights risk factors that can contribute to malnutrition including surgery, poor mouth care, environmental factors, infection and nutritional loss caused by vomiting or diarrhoea. #nutrition #nursing #elearning

Measuring blood pressure in infants, children and young people – updated guide https://lnkd.in/eBY5c_QD This fully illustrated guide focuses on the indirect measurement of blood pressure using a manual sphygmomanometer and a stethoscope It has been updated by Lucy Williams, Advanced Paediatric Nurse Practitioner, Royal Cornwall Hospitals NHS Trust. It has been double-blind peer-reviewed.   Blood pressure is the pressure that the blood exerts against the inner walls of the blood vessels and it is the force that keeps blood circulating continuously, even between heartbeats. It varies throughout the vascular system and alters with age and weight; however, blood pressure can also vary between children of the same age.    Arterial blood pressure is measured frequently throughout clinical practice as part of an overall assessment of the patient’s condition. The blood pressure reflects a patient’s perfusion and fluid status, as well as their cardiac and endocrine function, which can indicate their overall level of illness.   High blood pressure readings in children and young people are often dismissed (e.g., if the patient is mobile/unsettled), resulting in healthcare professionals failing to initiate the correct follow-up and monitoring.   Blood pressure can be measured directly or indirectly. Direct measurement gives an accurate reading, but is an invasive procedure involving cannulation of an artery and connection of a pressure transducer. Indirect measurement is performed using oscillometry via an automated electronic device, or manually using a sphygmomanometer and a Doppler device or a stethoscope. #nursing #medicine #paediatrics #elearning

Subcutaneous infusion of fluids or medications – updated guide   This fully illustrated guide has been updated by Marie Woodley, IV CNS/OPAT Lead at Buckinghamshire Healthcare NHS Trust. It has been double-blind peer-reviewed.   Subcutaneous infusion of fluids via a needle placed under the skin into the subcutaneous tissue is a method of administering fluids and medications to patients who cannot take these in adequate amounts via the oral route.    Fluids administered via the subcutaneous route are absorbed more slowly than if given intravenously. However, this route is also less painful or distressing than the intramuscular route and is therefore often the route of choice for palliative care.   Subcutaneous infusions are relatively straightforward and can be carried out in a community setting.   This guide describes:   • The anatomy of the skin; • The sites for subcutaneous infusions; • How to insert a subcutaneous needle/infusion set; • Administering the prescribed fluid or medication via a gravity flow infusion. A competency checklist accompanies this guide, which can be used to assist with staff development and assessment. #nursing #clinical #elearning

Oxygen delivery systems for infants, children and young people – updated guide. This fully illustrated, updated guide describes the following methods of oxygen delivery that are used to treat infants, children and young people who have a patent airway: • Nasal cannula; • High-flow nasal cannula; • Venturi mask; • Simple mask; • High-concentration reservoir (non-rebreathing) mask. The advantages and disadvantages of each method are listed for each device. It is important to select the oxygen delivery system that is most appropriate for the individual patient and their clinical condition. The guide also considers practices such as ‘wafting’ oxygen, the use of hydrocolloid dressings to prevent pressure injuries from occurring during the use of medical devices and the importance of oral hygiene and the prevention of dehydration of the exposed membranes in the mouth. It has been updated by the authors Helen Reddy, Louise Clarke and Laura Holliday (Assistant Professors), and Abby Sanders (Teaching Associate), at the School of Health Sciences, University of Nottingham. The guide has been double-blind peer-reviewed. #nursing #paediatrics #elearning