RSS 1.0East of England Ambulance Service [EastAmb]
Publications from the East of England Ambulance Service. To find out more about EastAmb visit their website at https://www.eastamb.nhs.uk
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When 999 gets called at the end of life: equipping ambulance clinicians to promote a dignified death (hospices and ambulance service working together)Background End of life care is an emergent aspect of ambulance clinicians’ work. They are often called to an emergency or crisis in an individual’s last days of life and have to make complex decisions with limited information. However they receive limited formal palliative care education. Two hospices were approached by a local paramedic to see if they could help address this educational need. Aim of the Collaborative Work For ambulance clinicians to gain confidence in recognising end of life needs of patients and their families and delivering appropriate care. For hospice professionals to understand the role and abilities of ambulance clinicians in delivering end of life care. What have we achieved? Two hospices and their local Ambulance NHS Trust worked collaboratively to devise a one-day workshop for paramedics to explore palliative and end of life care. The workshop included communication skills, symptom control, recognising dying, promoting patient wishes and accessing local palliative care services. Feedback from 70+clinicians was good and their confidence scores increased ‘Helps make a grey area of our work more understood.’ Two paramedics completed the European Certificate in Essential Palliative Care and are recognised locally as palliative care champions within their work in the community and control room. Links established with local university; end of life care sessions delivered to third-year paramedic students and palliative care student placements arranged. Additional Benefits Increased mutual understanding of practitioners’ roles – informing practice and education. Paramedics accessing ongoing communication skills training. Paramedics delivering teaching to hospice staff highlighting end of life care challenges. Improved communication between ambulance crews and local hospices. Joint hospice and ambulance end of life care Facebook discussion delivered as part of the Ambulance’s service End of Life Care Awareness month Joint end of life care strategy working. https://spcare.bmj.com/content/bmjspcare/7/Suppl_2/A8.1.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/openhrt-2015-000281
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Wristwatches in bare-below-the-elbows out-of-hospital policies: time for a reviewBackground: Bare-below-the-elbows (BBE) policies are common in infection prevention and control strategies but the evidence relating to wristwatch prohibition is slim and varied in quality. No dispensation is considered for those working outside hospital, which poses unique infection prevention and control challenges. Blanket approaches may be putting patients at further risk of healthcare-acquired infections (HCAIs). Aims: This review aimed to collate evidence and bring clarity to the ongoing debate surrounding mandated BBE policy, specifically relating to wristwatches worn within the prehospital setting. Methods: Three searches were undertaken, and results refined against an inclusion criterion to ensure relevance. Findings: Wristwatches can be considered a vector for HCAI; however, most data on this are confounded by other known risk factors. No studies were conducted outside a hospital environment. Alternative time sources used by clinicians such as touchscreen phones are a significant pathogen vector. Conclusion: Four policy evidence-based recommendations are made in relation to this topic. The National Institute for Health and Care Excellence (NICE) should review this topic as the evidence base underpinning its guidance is inadequate. Abstract published with permission.
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Factors that influence child conveyance decisions made by prehospital cliniciansAbstract Introduction: The decision to convey children to emergency departments is complex. This study aimed to identify barriers and enablers to making appropriate decisions, along with areas of disparity in this decision-making process by ambulance clinicians. Methods: A rapid evidence review was conducted. MEDLINE, CINAHL and PubMed were searched from 2012 to July 2023. Critical appraisal and thematic synthesis were performed. Results: Three studies were identified, which highlights the lack of research in this area. Five themes were identified: provision of care; equipment and protocols; exposure, experience and confidence; emotional and social circumstances; and education or skill set. Findings: Enhanced paediatric education is required before and after registration to ensure appropriate conveyance and address clinicians' lack of exposure, experience and confidence. Protocols and guidelines should be drawn up to support decision-making for lower-acuity child patients. Specialist paediatric roles are required in ambulance services to support clinicians and provide advanced patient-centred care. Conclusions: The findings of this review provide a basis for discussion and clinical practice improvement. Research to determine the clinical and cost effectiveness of implementing prehospital specialist paediatric roles is required. Abstract published with permission
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A scoping review exploring the confidence of healthcare professionals in assessing all skin tonesBackground: Health inequalities and poorer outcomes have been identified for patients with dark skin tones. The reasons are multi-factorial, but may include delayed treatment due to a lack of recognition of early clinical signs of physiological deterioration. Within the medical literature there is a light skin tone bias, leading to healthcare professionals having insufficient knowledge regarding the assessment of patients with different skin tones, which may result in reduced confidence and create patient safety issues. The aim of this scoping review was to explore the confidence levels of healthcare professionals when assessing patients of different skin tones. Methods: The methodology followed scoping review frameworks set out by Arksey and O’Malley (2005), the Joanna Briggs Institute (Peters et al., 2020) and the PRISMA extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018). Searches for literature were performed between February and June 2022 using electronic databases EBSCO (Academic Search Complete, the Allied Complementary Medicine Database, e-journals, MEDLINE, CINAHL), British Nursing Index (ProQuest), Scopus, Web of Science, Zetoc, UpToDate, Google Scholar, NICE Evidence, ResearchGate, Opengrey and the British Association of Dermatologists. No date range was specified, expanders were left on and the findings were screened using inclusion and exclusion criteria. Included papers were synthesised using narrative synthesis. Results: Thirteen papers were identified, and the extracted data charted by the paper’s origin, sample size, profession and confidence levels. Our synthesis revealed reduced confidence in assessing, managing and diagnosing skin conditions in dark skin tones. A lack of training was cited by different health professionals, but undertaking tailored training and experiential learning increased confidence. Conclusions: There is a safety issue for patients with dark skin tones, as healthcare professionals lack clinical confidence in managing and treating all ethnicities equally. Tangible diversity within healthcare training is required, supported by inclusive skin tone imagery and appropriate terminology within medical literature. Abstract published with permission.
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'Every day was a learning curve': Implementing Covid-19 triage protocolsBackground TRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic's first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols. Method Research paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants' accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together. Results We identified the following themes: Constantly changing guidelines - at some points, updated several times a day. The ambulance service as part of the wider healthcare system - changes elsewhere in the system left ambulance services as the default. Peaks and troughs of demand - fluctuating greatly over time, and varying across the staff groups. A stretched system - resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED. Emotional load of responding to the pandemic - including call centre staff. Doing the best they can in the face of uncertainty - a rapidly evolving situation unlike any which ambulance services had faced before. Conclusion Implementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load. https://bmjopen.bmj.com/content/12/Suppl_1/A16.1 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/openhrt-2015-000281
