Emerging of human factor in risk analysis of home care service

Risk management in healthcare represents a group of various complex actions, implemented to improve the quality of healthcare services and guarantee the patients safety. Risks cannot be eliminated, but it can be controlled with different risk assessment methods derived from industrial applications and among these the Failure Mode Effect and Criticality Analysis (FMECA) is a largely used methodology. The main purpose of this work is the analysis of failure modes of the Home Care (HC) service provided by local healthcare unit of Naples (ASL NA1) to focus attention on human and non human factors according to the organization framework selected by WHO. © Springer International Publishing Switzerland 2014.

The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams

Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role. © 2004 Elsevier Ltd. All rights reserved.

Care-less spaces and identity construction:transition to secondary school for disabled children

There is a growing body of literature which marks out a feminist ethics of care and it is within this framework we understand transitions from primary to secondary school education can be challenging and care-less, especially for disabled children. By exploring the narratives of parents and professionals, we investigate transitions and self-identity, as a meaningful transition depends on the care-full spaces pupils inhabit. These education narratives are all in the context of privileging academic attainment and a culture of testing and examinations. Parents and professionals, as well as children are also surveyed. Until there are care-full education processes, marginalisation will remain, impacting on disabled children’s transition to secondary school and healthy identity construction. Moreover, if educational challenges are not addressed, their life chances are increasingly limited. Interdependent caring work enables engagement in a meaningful education and positive identity formation. In school and at home, care-full spaces are key in this process.

One-stop health centres:What co-location means for pharmacy

This paper examines the potential for the development of patient services that could arise from the co-location of pharmacies with medical practices in the new "one-stop" centres. A review of the pharmacy-specific literature shows limited understanding of influence of location upon service development and highlights a tension between the professional and commercial drives. The aim of the survey of health centre pharmacists was to describe the current patterns of integration in the primary health care team. The study demonstrates that co-location offers opportunities but that there are barriers linked to the loss of traditional commercial activity. © 2003 Elsevier Science Ltd. All rights reserved.

Influences on general practitioner prescribing with particular reference to community pharmacy

Influences on general practitioner prescribing of drugs continue to be of interest and importance as cost containment becomes central to Government health policy. This thesis employs a plurality of research methods including quantitative and qualitative survey techniques for example, questionnaires, interviews and prescription analyses to investigate some of the factors which may influence GP prescribing such as information sources, hospital consultants and in particular the community pharmacist. When the use and influence of drug information sources by GPs was examined, the community pharmacist was given a relatively low rating as a source but a high rating, similar to that of the consultant, for helpfulness. Influences are needed to improve prescribing and reduce the incidence of iatrogenic disease for the benefit of the patient. The education and expertise of pharmacists and their familiarity with local prescribing habits places them in a unique position to meet the needs of local GPs. As 96.5% of the public always or nearly always take their prescriptions to the same pharmacy, patient medication records, now kept by 77.5% of pharmacies, provide a valuable check on the appropriateness and safety of patients' medication. The barriers to the pharmacist's greater involvement were shown to be suspicion by GPs of pharmacists' motivation, isolation of many community pharmacists, difficulties in leaving the pharmacy for domiciliary visits, residential home care and GP practice meetings. These barriers must be lowered if the pharmacist is to have a greater influence and involvement. It was concluded that changes are necessary in pharmaceutical education, staff training, organisation and remuneration. Some changes in the targeting of remuneration to the pharmaceutical care services provided and registration of patients with pharmacies would contribute greatly to these aims.

Free to publish - free to read

Full Text: August 2001 saw the birth of the British Journal of Diabetes & Vascular Disease (Figure 1): an open-access peer review journal.1 Free to publish and free to read. The founding editorial board and publisher (MediNews Diabetes) aimed to deliver a free journal to the diabetes team and vascular professionals with a special interest in diabetes. Despite the shifting sands of time and a change of publisher (SAGE) the journal has remained true to its founding philosophy - publication is on merit, not on ability to pay and free online access remains available worldwide (www.bjdvd.com) plus an extensive – mainly UK - print circulation. Evolution- The journal attracted much attention and was soon receiving good quality experimental and clinical science manuscripts. However it was felt that these articles, especially experimental and pre-clinical studies, were not within the focus of the British Journal of Diabetes & Vascular Disease, thus Diabetes & Vascular Disease Research was conceived –and is now also a SAGE journal and has an impact factor of 2.59. Over the years the organisation of topics has changed, for example the Healthcare management, The diabetes care team and Trans-cultural medicine sections have been absorbed into the Achieving Best Practice and Current Topics sections which better reflect the broader-based content of submitted material. Landmark Studies was a regular highly popular section – but how many truly Landmark Studies are undertaken? Not enough to warrant special attention 6 times a year for 12 years. Interestingly one of the studies reviewed is consistently amongst the top ten of our most read online articles.2 The British Journal of Diabetes & Vascular Disease has also challenged convention with the production of two Jubilee issues.3,4 The celebrations for the golden and diamond jubilees of Her Majesty Queen Elizabeth II afforded opportunities to reflect on changes in the understanding and treatment of diabetes during her reign. Most of the articles in these issues were written by authors who had first hand experience of the changing face of diabetes and vascular disease care. The increased costs of print and post – both financially and environmentally mean that digital communications are likely to become more popular (assuming that these approaches have a smaller ecological footprint). The British Journal of Diabetes & Vascular Disease is pleased to be able to celebrate its 12th birthday as an original open-access journal, with an ongoing commitment to support authors to publish free of charge whilst providing free reader access. As for what the future holds: tomorrow is another day. References 1.British Journal of Diabetes & Vascular Disease 2001; 1: 1-92. 2.Levy J. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Br J Diabetes Vasc Dis 2002; 2: 278-80. 3.British Journal of Diabetes & Vascular Disease. (Golden Jubilee Issue) 2002; 2: 415-480. 4.British Journal of Diabetes & Vascular Disease. (Diamond Jubilee Issue) 2012; 12: 266-380.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

Paediatric 'care closer to home':stake-holder views and barriers to implementation

In this study we explore the views of NHS stakeholders on providing paediatric ‘care closer to home’ (CCTH), in community-based outpatient clinics delivered by consultants. Design: Semi-structured interviews and thematic framework analysis. Setting: UK specialist children's hospital and surrounding primary care trusts. Participants: 37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members. Results: Participants acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. Participants supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice. Conclusions: The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.