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Journal: British journal of community nursing

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Chronic obstructive pulmonary disease (COPD) is a common long-term condition involving restricted airflow, which reduces quality of life. Treatments include lifestyle changes (smoking cessation), pulmonary rehabilitation and medication with inhaled therapies. However, medication adherence is often suboptimal, resulting in poor health outcomes. A pilot project assessed the impact of medicines management support from a community pharmacy team for people with COPD, delivered in their own homes. Individuals were given a medication review and an assessment of their inhaler technique and were followed up at 3 and 6 months. The COPD Assessment Test (CAT) score was administered before and after the intervention. A change in score of 2 or more suggests a significant difference; the average score was 19.2 at the first assessment and 16.7 at the six month follow-up. Seventeen patients had improved CAT scores, 10 patients had a reduced score and three remained unchanged. Most patients evaluated the project positively as it helped them to improve their inhaler technique. Medicines optimisation was also achieved as a person-centred approach was taken; suboptimal practice had not been picked up by health professionals previously. Community pharmacists working in integrated care teams provide invaluable support to patients with COPD. This project will be rolled out across the community team, and training on medicines management and inhaler technique provided to other health professionals involved in the care of these patients.

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Adults ≥65 are more susceptible to influenza infection and its associated complications. This paper critically reviews the literature, identifying the need for and priorities of a public health strategy to improve vaccination awareness and uptake among older adults. Four electronic databases were searched for peer-reviewed articles in English published between 2001 and 2016. Twelve studies were included. Three themes were identified on analysis: impact on healthcare services; barriers and motivators influencing influenza vaccination uptake; and health promotion interventions. Studies suggest vaccination may reduce the health-care costs of influenza-associated infection. Socioeconomic factors, information about vaccination and cultural beliefs may influence an individual’s decision. Multicomponent interventions, such as home visits combined with reminders, support increased uptake. Interventions are identified that could be adopted at the community level in Singapore and other countries to improve influenza vaccination uptake among older adults.

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District Nursing (DN) caseloads are increasingly unwieldy. ( Queen’s Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient’s needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

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This article looks at practical ways to support patients with oral medication compliance in their own homes. It addresses the importance of assessing why the patient needs support, the importance of a medication review and strategies and tools to aid patient compliance, alongside instances where a nurse can aid patient’s relatives and carers can provide medication instead of a nurse.

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A Do Not Attempt Resuscitation notice (DNACPR) is an important mechanism for avoiding inappropriate CRP attempts, and protects district nurses and others from allegations of ill treatment or wilful neglect. The DNACPR notice must be discussed with the patient or their relatives, before placed on file ( Tracey v Cambridge Uni Hospital NHS Foundation Trust and others [2014] ; Winspear v City Hospitals Sunderland NHSFT [2015] ). In this article Richard Griffith set out the steps district nurses must take to ensure that a DNACPR notice is lawful.

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Adults ≥65 are more susceptible to influenza infection and its associated complications. This paper critically reviews the literature, identifying the need for and priorities of a public health strategy to improve vaccination awareness and uptake among older adults. Four electronic databases were searched for peer-reviewed articles in English published between 2001 and 2016. Twelve studies were included. Three themes were identified on analysis: impact on healthcare services; barriers and motivators influencing influenza vaccination uptake; and health promotion interventions. Studies suggest vaccination may reduce the health-care costs of influenza-associated infection. Socioeconomic factors, information about vaccination and cultural beliefs may influence an individual’s decision. Multicomponent interventions, such as home visits combined with reminders, support increased uptake. Interventions are identified that could be adopted at the community level in Singapore and other countries to improve influenza vaccination uptake among older adults.

0

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen’s Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient’s needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

0

A Do Not Attempt Resuscitation notice (DNACPR) is an important mechanism for avoiding inappropriate CRP attempts, and protects district nurses and others from allegations of ill treatment or wilful neglect. The DNACPR notice must be discussed with the patient or their relatives, before placed on file ( Tracey v Cambridge Uni Hospital NHS Foundation Trust and others [2014] ; Winspear v City Hospitals Sunderland NHSFT [2015] ). In this article Richard Griffith set out the steps district nurses must take to ensure that a DNACPR notice is lawful.

0

This article looks at practical ways to support patients with oral medication compliance in their own homes. It addresses the importance of assessing why the patient needs support, the importance of a medication review and strategies and tools to aid patient compliance, alongside instances where a nurse can aid patient’s relatives and carers can provide medication instead of a nurse.

0

Chronic obstructive pulmonary disease (COPD) is a common long-term condition involving restricted airflow, which reduces quality of life. Treatments include lifestyle changes (smoking cessation), pulmonary rehabilitation and medication with inhaled therapies. However, medication adherence is often suboptimal, resulting in poor health outcomes. A pilot project assessed the impact of medicines management support from a community pharmacy team for people with COPD, delivered in their own homes. Individuals were given a medication review and an assessment of their inhaler technique and were followed up at 3 and 6 months. The COPD Assessment Test (CAT) score was administered before and after the intervention. A change in score of 2 or more suggests a significant difference; the average score was 19.2 at the first assessment and 16.7 at the six month follow-up. Seventeen patients had improved CAT scores, 10 patients had a reduced score and three remained unchanged. Most patients evaluated the project positively as it helped them to improve their inhaler technique. Medicines optimisation was also achieved as a person-centred approach was taken; suboptimal practice had not been picked up by health professionals previously. Community pharmacists working in integrated care teams provide invaluable support to patients with COPD. This project will be rolled out across the community team, and training on medicines management and inhaler technique provided to other health professionals involved in the care of these patients.