INVITATION FOR CONSULTATION STANDARDS OF PROSTHETIC AND ORTHOTIC PRACTICE

As you may know, HCPC have recently launched consultations on the profession-specific standards of proficiency for a number of the Allied Health Professions including ours and this has prompted a review and revision of our own Standards.
 
We are committed to engaging with our members, taking account of their views and input in the way that we carry out our work.

It is the intention of BAPO that these standards will form the baseline of practice for Prosthetists, Orthotists and Assistant Practitioners in the UK by providing more detailed information and guidance for both day to day practice and service planning. As such they sit alongside all other regulatory documents by which the profession is guided.
 
We expect the revised standards to be useful not only for Prosthetists and Orthotists, but for all healthcare commissioners and providers, Service Heads and managers, other healthcare professionals and interested members of the public.
 
When fully approved, the Standards will be freely available to all stakeholders.
 
Please review the draft standards which can be found under these links or on the member only section of the BAPO website under Downloads & Documents/Guidelines:

NHS Commissioning Support Bulletin – Issue 4

• Welcome from Dr Joe Rafferty
• Commissioning support appointments
• Configuration of 'scale' services finalised
• Checkpoint 3 update
• CCG authorisation: commissioning support supplement
• HR update
• Finance director appointments process
• Branding and identity
• Ready Reckoner 2
• Scenario report helps shape CCG development
• News in brief

A COMPARISON BETWEEN ISIS2 AND PLAIN X-RAY IN THE MEASUREMENT OF CURVE PROGRESSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

R.T. Benson, F. Berryman, C. Nnadi, J. Reynolds, C. Lavy, G. Bowden, J. Macdonald and J. Fairbank

Author Affiliations

Abstract

Plain radiography has traditionally been used to investigate and monitor patients with adolescent idiopathic scoliosis. The X-ray allows a calculation of the Cobb angle which measures the degree of lateral curvature in the coronal plane. ISIS2 is a surface topography system which has evolved from ISIS, but with much higher precision and speed. It measures the three dimensional shape of the back using structured light and digital photography. This system has the benefit of not requiring any radiation. Lateral asymmetry is the ISIS clinical parameter estimating the curve of the spine in the coronal plane. The aim of this study was to compare this parameter to the Cobb angle measured on plain X-ray.

Twelve patients with idiopathic adolescent scoliosis underwent both a standing AP spine X-ray and an ISIS2 scan on multiple occasions. Both scan and X-ray were done within one month of each other. No patient underwent surgery during the study period. The Cobb angle and the degree of lateral asymmetry were calculated.

Twelve patients mean age 12.5 years (range 10-16) were investigated using both ISIS2 and X-ray. They had a mean 2.3 (1-5) combined investigations allowing for 30 comparisons. The correlation between the two measurements was r =0.63 (p=0.0002). The Cobb angle measured on ISIS2 was less than that measured by radiograph in 27 out of 30 comparisons. The mean difference between the measurements was mean 6.4° with a standard deviation of 8.2° and 95% confidence interval of 3.3° to 9.4°.

In adolescent idiopathic scoliosis, curve severity and rib hump severity are related but measure different aspects of spinal deformity. As expected, these relate closely but not precisely. ISIS2 offers the promise of monitoring scoliosis precisely, without adverse effects from radiation. The small numbers in this series focus on the group of patients with mild to moderate curves at risk of progression. In this group, ISIS2 was able to identify curve stability or progression, without exposing the subjects to radiation.

http://www.bjjprocs.boneandjoint.org.uk/content/94-B/SUPP_X/149.abstract

Education outcomes framework

The Department of Health (DH) has responsibility for setting the education and training outcomes for the system as a whole.

Health Education England is responsible for setting up a new system that can produce the flexible workforce we need to address future challenges, that aspires to excellence in training as well as a better educational experience for all staff (including trainees and students), and is supported by a fair and responsive funding system.

The Education Outcomes Framework and HEE's approach to quality will directly link education and learning to improvements in patients' outcomes. By providing a clear line of sight and improvement to patient outcomes, it will help address variation in standards and ensure excellence in innovation through high quality education and training.

Work is currently underway to develop indicators which will help measure delivery against these outcomes.

The five high level domains of the Education Outcomes Framework are identified in the guidance document From Design to Delivery published in January 2012, and outlined below:

Excellent education: Education and training is commissioned and provided to the highest standards, ensuring learners have an excellent experience and that all elements of education and training are delivered in a safe environement for patients, staff and learners.

Competent and capable staff: There are sufficient health staff educated and trained, aligned to service and changing care needs, to ensure that people are cared for by staff who are properly indcuted, trained and qualified, who have the required knowledge and skills to do the jobs the service needs, whilst working effectively in a team.

Adaptable and flexible workforce: The workforce is educated to be responsive to innovation and new technologies with knowledge about best practice, research and innovation, that promotes adoption and dissemination of better quality service delivery to reduce variability and poor practice.

NHS values and behaviours: Healthcare staff have the necessary compassion, values and behaviours to provide person centred care and enhance the quality of the patient experience through education, training and regular Continuing Personal and Professional Development (CPPD), that instils respect for patients.

Widening participation: Talent and leadership flourishes free from discrimination with fair opportunities to progress and everyone can participate to fulfil their potential, recognising individual as well as group differences, treating people as individuals, and placing positive value on diversity in the workforce and there are opportunities to progress across the five leadership framework domains.

Consultation launched on proposals for commissioners to deliver best value

Proposals for regulations to protect patients' interests by ensuring that commissioners always deliver best value are being consulted on by the Department of Health.

The consultation sets out proposals for requirements to:

• ensure good procurement practice by commissioners including requirements to act transparently, avoid discrimination and purchase services from the providers best placed to meet patients' needs
• ensure that commissioners enable patients to exercise their rights to choose as set out in the NHS Constitution
• prohibit commissioners from taking actions that restrict competition where this is against patients' interests
• ensure that commissioners manage conflicts of interest and that particular interests do not influence their decision-making.

Responding to the consultation

• Respond to the consultation online
• Read Securing best value for NHS patients: Requirements for commissioners to adhere to good procurement practice and protect patient choice
• Download consultation response form

The closing date for responses is 26 October 2012.

If you have any questions on this consultation, please emailpccr.consultation@dh.gsi.gov.uk

The regulations for commissioners will be made under Section 75 of the Health and Social Care Act 2012.  The Department will take account of responses before developing regulations based on these proposals to be laid in Parliament in January 2013 and to come into force in April 2013.

Spare Parts exhibition turns prosthetic limbs into works of art

http://www.bbc.co.uk/news/entertainment-arts-19162750

Adaptive changes of foot pressure in hallux valgus patients

Jianmin Wen, Qicheng Ding, Zhiyong Yu, Weidong Sun, Qining Wang, Kunlin Wei

Abstract 

Background

Hallux valgus (HV) is one of the most common deformities in podiatric and orthopedic practice. Plantar pressure technology has been widely used in studying the pressure distribution in HV patients for better assessment to plan interventions. However, previous studies produced an array of controversial findings and most of them only focused on the forefoot.

Methods

We examined the dynamic changes of foot pressure of the whole foot with a large-sample investigation (229 patients and 35 controls). Foot pain, which has been largely neglected previously, was used to group the participants.

Results

Compared to healthy controls, patients had significantly higher loading of the first and second metatarsals, where the transverse arch usually collapses, and significantly less loading of the hallux. Moreover, forces in most regions reached their maximum late, indicating a slow build-up of loading. Patients shortened the loading duration on their forefoot, loaded more on the medial foot starting from early foot contact, and delayed the medial-to-lateral load transition. Notably, nearly all these changes were more pronounced in patients with pain.

Conclusions

Biomechanical changes in HV patients are not only caused by physical deformity but also by modified neural control strategies, possibly to alleviate discomfort and to accommodate the foot deformity. Our results suggest that dynamic evaluation of the whole foot and consideration of foot pain are necessary for the functional assessment of foot pressure in HV patients. The foot balance changes have important clinical implications.

source: http://www.gaitposture.com/article/S0966-6362(12)00124-5/abstract?elsca1=etoc&elsca2=email&elsca3=0966-6362_201207_36_3&elsca4=elsevier

Diabetic Foot Ulcerations: Biomechanics, Charcot Foot, and Total Contact Cast

Sabina Malhotra, DPM, Eunis Bello, DPM, Stephen Kominsky

Diabetes is the seventh leading cause of death in the United States; approximately 6% of the US population has been diagnosed with diabetes. Fifteen percent of all people with diabetes will develop a foot ulceration, and 14% to 20% of them will require an amputation. During the past 25 years, much has been learned and written about lower extremity complications associated with diabetes. The single most significant discovery relative to diabetic foot ulceration is the role of peripheral sensory neuropathy. Once the correlation between the absence of sensation and foot breakdown was made, treatment algorithms began to develop. For the first time, the concept of biomechanics and the role of weight-bearing stress were considered when applying different treatments to the patient with a diabetic foot ulcer. Wound classification systems developed to aid the physician in treating what had been a very frustrating group of patients; those with diabetic foot ulcerations. From that, a myriad of treatments developed. In fact, the technology of wound management became a billion dollar business and, to this day, continues to present the clinician with unending options to effectively manage and heal wounds on the diabetic lower extremity.

Source: http://www.semvascsurg.com/article/S0895-7967(12)00040-3/abstract

Comparison of the efficacy of laterally wedged insoles and bespoke unloader knee orthoses in treating medial compartment knee osteoarthritis

Mokhtar Arazpour, Monireh Ahmadi Bani, Maryam Maleki, Farhad Tabatabai Ghomshe, Reza Vahab Kashani, Stephen W Hutchins

Abstract

Background: Patients suffering from medial compartment knee osteoarthritis (OA) may be treated with unloader knee orthoses or laterally wedged insoles.

Objectives: The aim of this study was to identify and compare the effects of them on the gait parameters and pain in these patients.

Study Design: Quasi-experimental.

Methods: Volunteer subjects with medial compartment knee OA (n = 24, mean age 59.29 ± 2.23 years) were randomly assigned to two separate groups and evaluated when wearing an unloader knee orthosis or insoles incorporating a 6° lateral wedge. Testing was performed at baseline and after six weeks of each orthosis use. A visual analog scale score was used to assess pain and gait analysis was utilized to determine gait parameters.

Results: Both orthoses improved all parameters compared to the baseline condition (p= 0.000). However, no significant differences in pain (p = 0.649), adduction moment (p= 0.205), speed of walking (p = 0. 056) or step length (p = 0.687) were demonstrated between them. The knee range of motion (p = 0.000) were significantly different between the two interventions.

Conclusion: Both orthoses reduced knee pain. Maximum knee range of motion was increased by both interventions although it was 3 degrees less when wearing the knee orthosis.

http://poi.sagepub.com/content/early/2012/08/02/0309364612447094.abstract

Help for Heroes and MoD criticised by injured troops

Has anyone watched tonight's Newsnight on bbc2?

http://www.bbc.co.uk/news/uk-19112550

Effectiveness of different orthoses on joint moments in patients with early knee osteoarthritis: Lateral wedge versus valgus knee bracing

Min Zhang, Pei-yu Qu, Mei-lan Feng, Lan Jiang, Xiao-yan Shen, Yan-hong Ma and Yue-hong Bai 

JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (SCIENCE)

Volume 17, Number 4 (2012), 505-510, DOI: 10.1007/s12204-012-1313-x

Abstract

The purpose of the study was to test the biomechanical differences between a lateral wedge and a valgus knee bracing on the knee joint moment during walking in patients with early stage of medial compartment knee osteoarthritis (OA). We conducted a crossover randomized design to compare gait parameters of 32 patients (with early stage medial compartment knee OA) in three different conditions during walking: with a custom-made lateral wedge of 5° (in standard shoes), with a valgus knee bracing (in standard shoes), and with control condition (in standard shoes). Both two-orthose conditions showed decreased loading patterns (knee adduction moment and knee adduction angular impulse) on the knee joint in dynamic condition (statistic probability P < 0.05). The decreased loading on OA knee in wedge condition was associated with a laterally shifted location of centre of pressure and increased ankle valgus degree and moment at the same foot (P < 0.05). It was not found significant differences in loading of the knee between these two-orthose conditions. These results indicated that, under dynamic condition, patients wearing lateral wedge and valgus knee bracing showed changes of moments on knee joints. Lateral wedge was as effective as valgus knee bracing in the treatment of early stage of knee OA

Source: http://www.springerlink.com/content/rg3391676830x156/

First Commissioning Outcomes Framework indicators revealed

Care for those recovering from stroke, tackling diabetes, and improving maternal health are among topics covered in the first set of Commissioning Outcomes Framework (COF) indicators published by NICE.

The COF has been developed by the NHS Commissioning Board, with support from NICE and groups of patients and experts, to improve the quality of healthcare provided at a local level.

From April 2013, it will be used to measure the quality and outcomes of healthcare commissioned by Clinical Commissioning Groups.

A set of 44 indicators have been recommended by the COF Advisory Committee and are published today. A selection of final indicators will be considered by the NHS Commissioning Board in autumn 2012 for inclusion in the 2013/14 COF.

Among the areas covered are enhancing the quality of life for those with long-term conditions, and care for those immediately after stroke and following hospital discharge.

Studies show that more can be done improve the care of those who suffered stroke, with research from 2011 suggesting less than half of stroke survivors had received an assessment of their health and social care needs.

The new indicator for stroke aims to tackle this with a measure for people who have had an acute stroke receive treatment for dissolving blood clots, known as thrombolysis.

This measures a key component of high-quality care defined in NICE's quality standard stroke; namely that patients with suspected stroke should be admitted directly to a specialist acute stroke unit and assessed for thrombolysis, receiving it if clinically indicated.

Further indicators measure whether people with diabetes have received all nine of their care processes.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: "By setting out the aspects of care that are essential in facilitating the best health outcomes, such as the need for people who have had an acute stroke to receive thrombolysis, the quality of care being commissioned for local populations can be measured.

"This will enable the groups responsible for commissioning NHS care to be held to account, and will ultimately drive up the standards of health care delivered."

Professor Danny Keenan, COF Advisory Committee Chair, said: "The broad range of clinical expertise within the independent committee, including GPs, hospital doctors, patients and commissioners, ensures that the menu of COF indicators recommended are workable, and can help improve the quality of commissioning to benefit patient care.

"We're pleased to recommend this robust set of indicators for potential inclusion in the first COF, and hope that they will help the new commissioning groups to secure NHS services for their populations that will lead to improved health outcomes."

The set of 44 proposed new indicators have been identified from NICE quality standards, the NHS Outcomes Framework and other existing indicator collections such as national audits.

Source: http://www.nice.org.uk/newsroom/news/FirstCommissioningOutcomesFrameworkIndicatorsRevealed.jsp

CURVE PATTERN CHANGES IN IDIOPATHIC SCOLIOSIS

Jacobus Arts, Joris Hermus, F. Van De Berg, Nick Guldemond and Lodewijk Van Rhijn

Abstract

Introduction: Ponseti and Friedman suggest that curve type is genetically determined and that curve types do not change throughout its course. In current clinical practice scoliosis is seen as a more dynamic process. Therefore we like to postulate that the natural history of idiopathic scoliosis can change during growth when left untreated.

Aim of the Study: This study focused on the shift of curve patterns as result of age, especially in patients younger than ten years. It was assessed whether age is a factor in the dynamic progression of idiopathic scoliosis. We evaluated patients records as well as radiographic images and clinical measures.

Materials and Methods: 48 Patients with idiopathic scoliosis who visited the scoliosis team between 1990 and 2007 were included. The criteria for inclusion were a curve less than 30° and not treated with brace or operative procedures. Curve pattern changes were classified according to the Scoliosis Research Society classification and the Lenke classification.

Results: The forty-eight patient records demographics consisted of eleven males and thirty-seven females. Their mean age at the start of follow-up was 11,2 years (range 4–17). Mean follow-up lasted 3,4 years (range 1–11,2). Thirteen patients were diagnosed with juvenile idiopathic scoliosis and thirty-five patients were diagnosed with an adolescent idiopathic scoliosis. Eight from the forty-eight patients, showed curve pattern changes according the SRS classification: six females and two males. Six of the thirtteen patients with juvenile scoliosis showed a shift of the scoliosis curves (46%). Two of the thirty-five patients with the adolescent scoliosis showed a shift of the scoliosis curves (6%; p<0,05).

In eleven patients with juvenile scoliosis(84,6%) there was a shift in the Lenke classification, while this only occurred in eighttteen patients with adolescent scoliosis(51,4%) (p<0,05). No curve pattern changes occurred in two patients with juvenile idiopathic scoliosis(15,4%) and in twelve patients of the adolescent idiopathic scoliosis(34,3%) (p<0,05).

Conclusion: There is evidence that idiopathic scoliosis has an genetic origin, but not all elements of the scoliosis formation can be explained. We found changes in curve patterns which suggest that idiopathic scoliosis is not a fixed deformity, but a dynamic process especially in patients younger than 10 years.

http://www.bjjprocs.boneandjoint.org.uk/content/93-B/SUPP_II/166.2.abstract

LONG-TERM EVALUATION OF THE QUALITY OF LIFE OF SUBJECTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS)

G. Grimard 1 , G. Lacroix, H. Labelle and B. Poitras
Author Affiliations
Abstract
The aim of this study is to compare the adulthood quality of life of subjects with adolescent idiopathic scoliosis who have had surgery to subjects without. Inclusion criteria were being operated or having not operated but having a scoliosis with a Cobb angle ≥ 35° at the last visit. Self-administered questionnaires (five) were sent to all eligible patients. A total of two hundred and four had surgery. The mean Rolland score for subjects was significantly higher for the group who had surgery. The only variable affecting physical component of the SF-36 was the alcohol consumption. The EuroQol score was predicted by the marital status, people being married having a better score. In conclusion, there is not significant difference in the quality of life in adulthood between the subjects with AIS whether they had surgery or not. Subjects who had surgery tend to be less in pain than people not operated on.
The aim of this study is to compare adulthood quality of life of patients with AIS who have had surgery to subjects without.
Overall, there is not significant difference in the quality of life in adulthood between the subjects with AIS whether they had surgery or not. Subjects who had surgery tend to be less in pain than people not operated on.
This preliminary study will help the health professionals involved with the management of patients with AIS make clinical decisions and better understand the long-term quality of life in idiopathic scoliosis.
Among the two hundred and ninety-nine AIS responding, two hundred and four had surgery and ninety-five none and their mean Cobb angle was respectively fifty-eight and forty-four degrees. All patients had a follow up more than twenty years. There was no significant difference as for sex, life status, education, working areas, alcoholism, smoking habits, chronic illness and reproductive health between the two groups. Same proportion of subjects in both groups had no back pain (≅30%); but more non-operated subjects had physiotherapy and/or chiropractic treatments (p< 0.001). The mean Rolland score for subjects was significantly higher for the group who had surgery (p = 0.02). Using multiple regression analysis, the only variable affecting physical component of the quality of life measured with the SF-36 was the alcohol consumption whereas the psychological of the SF-36 was predicted by alcohol consumption as well and the gender. The quality of life measured by the EuroQol was predicted mainly by the marital status, people being married having a better score.
The study was designed as a comparative retrospective cohort study. Subjects referred for Adolescent Idiopathic Scoliosis between 1960 and 1979 to Sainte-Justine Hospital were entered into the cohort. Inclusion criteria were being operated or having not operated but having a scoliosis with a Cobb angle ≥ 35° at the last visit.
A self-administered questionnaire was sent to all eligible patients. The questionnaires that were used were all reliable and valid. More specifically the instruments used were the Oswestry, Roland, SF-36, Quebec Back Pain Disability Scale, Scoliosis Research Society and the EuroQol-5D.
http://www.bjjprocs.boneandjoint.org.uk/content/90-B/SUPP_I/36.1.abstract

Abnormal Skeletal Growth Patterns in Adolescent Idiopathic Scoliosis - A Longitudinal Study Until Skeletal Maturity

Yim, Annie P. Y. MPhil; YEUNG, Hiu-Yan PhD; HUNG, Vivian W. Y. MPhil; LEE, Kwong-Man PhD; LAM, Tsz-Ping FRCS; NG, Bobby K. W. FRCS; QIU, Yong MD; CHENG, Jack C. Y. MD
Abstract
Study Design. A cross-sectional and prospective longitudinal study on the anthropometric parameters and growth pattern of adolescent idiopathic scoliosis (AIS) girls.
Objective. To investigate the growth pattern of AIS girls with different severities using cross-sectional and prospective longitudinal data set in comparison with age-matched healthy controls.
Summary of Background Data. AIS occurs in children during their pubertal growth spurt. Although there is no clear consensus on the difference in body height between AIS girls and healthy controls, it is generally believed that the development and curve progression in AIS girls is closely associated with their growth rate. There is no concrete prospective longitudinal study to document clearly the growth pattern and growth rate of AIS subjects.
Methods. 611 AIS girls and 296 healthy age-matched controls were included in the study and among them, 194 AIS girls and 116 healthy controls were followed up until skeletal maturity. The AIS girls were grouped into moderate (AIS20) and severe curve (AIS40) groups based on maximum curve magnitude at skeletal maturity. Clinical data and detailed anthropometric parameters were recorded. In the cross-sectional analysis, the groups of subjects were compared within different age groups (from age 12 to 16). In the longitudinal study, linear mixed modeling with respect to age or years since menarche was employed to formulate the growth trajectory of different anthropometric parameters.
Results. In the cross-sectional analysis, the AIS girls were generally taller, with longer arm span, and lower BMI than the healthy controls. The AIS40 girls were found to be significantly shorter in height (p = 0.006) and arm span (p = 0.025) at age 12 but caught up and overtook the control group at age 14 to 16. In the longitudinal study, the average growth rate of arm span in AIS40 girls were significantly higher than AIS20 girls (>30%) (p = 0.004) and controls (>70%) (p = 0.0004). The age of menarche of AIS40 girls was significantly delayed by 5.9 months and 3.8 months when compared with the control group and AIS20 girls respectively (p<0.05).
Conclusion. The growth patterns of AIS girls with confirmed curve severities were significantly different from healthy age-matched controls. Severe AIS girls had delayed menarche with faster skeletal growth rate during age 12-16. Monitoring the rate of change of arm span of AIS girls could be an important additional clinical parameter in helping to predict curve severity in AIS girls.
http://journals.lww.com/spinejournal/Abstract/publishahead/Abnormal_Skeletal_Growth_Patterns_in_Adolescent.98282.aspx

NHS strategic clinical networks

The NHS Commissioning Board Authority has set out its plans for a small number of national networks to improve health services for specific patient groups or conditions.

Called strategic clinical networks these organisations will build on the success of network activity in the NHS which, over the last 10 years, has led to significant improvements in the delivery of patient care.

The conditions or patient groups chosen for the first strategic clinical networks are:

Cancer
Cardiovascular disease (including cardiac, stroke, diabetes and renal disease) Maternity and children's services
Mental health, dementia and neurological conditions

These networks will exist for up to five years and will be managed by 12 locally based support teams. These teams will build and oversee effective network arrangements for their area and help networks develop an annual programme of quality improvement in local services. The support teams, funded by the NHS CB, will be located in local area teams' offices.

Read full details of the new strategic clinical networks in the document called The Way Forward, along with answers to frequently asked questions. You can find these published documents on the NHS Commissioning Board Authority website.

Improved NHS Services Through New Perspectives – A Toolkit

Improved NHS Services Through New Perspectives – a toolkit for Doctors and Managers to improve quality for patients

Where doctors are engaged in management, quality improves for patients. Moreover, it is the partnership between doctors and managers that makes the difference – where they have a productive working relationship. The Centre for Innovation in Health Management (CIHM) at Leeds University Business School has devised an online toolkit to help implement positive change in NHS Trusts.

The toolkit is laid out in a simple, well thought out manner utilising a workshop sessions guide. It offers a way of improving productive working between doctors and managers in a series of steps that requires conversations between all parties and identifies any development required. There are a  series of questions for people to answer in the Trust. The process of answering the questions will develop a better shared agenda, a better understanding of how to work together and a better working relationship between doctors and managers.

The National Inquiry into Management and Medicine, conducted by CIHM, found that doctors and managers work best together when the following conditions exist:

A clear focus on the clinical businessspace is created for local innovation by managing upwards decisions are devolved to the right levelthere is continuity over time complacency is avoided by seeking internal and external challengeinterests are aligned through rewards, information, and performance management.doctors and managers make sense of the external environment together there is frequent dialogue to build a shared purposedifferences are seen as an asset – conflict is used positively managers and doctors understand each otherthere is investment in organisational change, doctors and managers learn together, and locally relevant performance management systems are developed.

The Toolkit is free to use and is available once you have registered. Your registration gives you access to more detailed information on each stage of the process and also enables us to provide you with additional support should you require it.

To find out more about how this could work for you and your Trust please follow www.cihm.leeds.ac.uk/drmgrtoolkit

For a copy of the National Inquiry into Management and Medicine please visit: http://www.cihm.leeds.ac.uk/document_downloads/CIHM_NIMM_short_report.pdf

Source: http://www.cihm.leeds.ac.uk/new/2012/07/improved-nhs-services-through-new-perspectives-%E2%80%93-a-toolkit/ 

FallSafe project

The FallSafe project involved educating, inspiring and supporting acute, rehabilitation and mental health nurses to deliver multifactorial assessments and interventions through a care bundle approach. The care bundle, the FallSafe project final report, and How to… guides for implementation comprise the Falls Prevention Resource pack.

Access the Falls Prevention Resource.

Over 280,000 patient falls are reported from hospitals and mental health units annually, costing approximately £15 million per annum. Most hospital fallers are aged over 75 years and have multiple long term and acute illnesses. Although in purely financial terms the healthcare costs of falls are only a small fraction of a percentage of trust income and expenditure, the costs to a trusts' reputation, patient and carer confidence, and social care costs can be significant.

The FallSafe project was delivered by the Royal College of Physicians (RCP) as part of the Health Foundation's Closing the Gap Programme, which aimed to reduce the gap between best practice and routine delivery of care. Although all falls cannot be prevented without unacceptable restrictions to patients' independence, dignity and privacy, research has shown that falls can be reduced by 20-30% through multifactorial assessments and interventions.

The main mechanism of improvement was supporting a designated nurse – a FallSafe lead - to lead local improvement on their own wards, influencing not only the ward nurses and healthcare support workers but also their physiotherapist, occupational therapist, pharmacist, and medical colleagues.

Dr Frances Healey, a registered nurse who was clinical co-lead of the fallsafe project, and associate director, RCP's Clinical Effectiveness and Evaluation Unit, said:

'The FallSafe project is a great illustration of how quality improvement can empower and inspire nurses to lead and drive change on their wards, influence a multidisciplinary team, and deliver better patient care.

'The 16 nurses, who rose to the challenge of FallSafe lead within their wards, demonstrated that they can be effective change agents. This is an important finding given more senior staff may not have the capacity to lead quality improvements in the areas where it is needed. The FallSafe leads grew in confidence, knowledge and skills and, by the end of the project, felt that attitudes to falls prevention on their wards had been 'transformed' from passive acceptance to active engagement in falls prevention.'

Dr Adam Darowski, consultant geriatrician, and clinical co-lead for FallSafe said:

'Avoiding medication that can increase the risk of falling is a vital part of falls prevention. FallSafe proved how much nursing staff can influence doctors' prescribing practice – the FallSafe leads provided educational materials to the doctors on their wards, requested medication reviews for hundreds of patients, and by the end of the project the number of patients being given night sedation had reduced by 41%.'

Jill Phipps, clinical specialist physiotherapist & falls prevention coordinator at Southern Health NHS Foundation Trust said:

'Many hospitals don't have a process for issuing mobility aids to new patients except on weekdays when physiotherapists are on duty; but by the end of the project most of the FallSafe wards had arranged for mobility aids to be provided by trained nursing staff  on a temporary basis  as soon as they were needed. This was a great example of how nurses and physiotherapists can work together on sharing skills and experience to improve patient's mobility and reduce the risk of falls.'

The report indicates FallSafe wards and their hospitals have benefited through substantial improvements in the proportion of patients receiving multifactorial assessments, changes to policy, attitude to and awareness of falls, and better team working. FallSafe delivered a 25% reduction in falls for the South Central area and it is anticipated there will be further reductions as the project is rolled out to other hospitals. The costs of delivering the FallSafe project were kept low enough for its replication on a wide scale to be feasible, and the mix of ward types involved demonstrate that it could be replicated in most hospital settings.

Access the Falls Prevention Resource.

FallSafe

FallSafe is a two year multidisciplinary quality improvement project funded by The Health Foundation's Closing the Gap Programme. It has been delivered by the Royal College of Physicians' (RCP) Clinical Effectiveness and Evaluation Unit  and was overseen by a stakeholder steering group including the Royal College of Nursing, the National Patient Safety Agency and Action against Medical Accidents.

FallSafe is promoted by 'Harm free' care, the national roll out of the pilot Safety Express Quality, Innovation, Productivity and Prevention (QIPP) programme implemented by the national QIPP Safe Care work stream.  

A care bundle is a structured way of improving of care. It a specific measureable set of multifactorial assessments and interventions.

Multifactorial assessment

Multifactorial assessment refers to a process of assessing patients for a range of risk factors that can lead to falls, such as impaired mobility, cognitive impairment, medication with sedating effects, cardiovascular problems, etc. Interventions are changes made to care or treatment that can modify the risk factor or manage it in such a way as to reduce the risk of it leading to falls.

Access the Falls Prevention Resource.

Source: http://www.rcplondon.ac.uk/press-releases/educating-and-empowering-nurses-prevent-falls-hospital-wards 

 

Paralympic Schedule - Paralympic Results - All Events | London 2012

Paralympic Schedule - Paralympic Results - All Events | London 2012

Project Manager - Prosthetics & Orthotics Workforce and Education Project

The Department of Health is looking to recruit a Project manager for their Prosthetics and Orthotics Workforce and Education Project.  This position will be key in working with key stakeholders and delivering a workforce and education strategy for Prosthetics and Orthotics to meet current and future service priorities.  This job position has been advertised across the AHPs.  As our professions are very specialised, BAPO would prefer that a person with significant knowledge of our services is selected for this role.  The person specification is attached.

Further information  and application can be be made here.