IntroductionEpidural analgesia is useful for some patients with refractory cancer pain. However delivering a continuous epidural infusion can raise some challenges regarding safety and practicality. We present our experience of using the Accufuser Elastomeric Vacuum pump.Aims▶To identify a delivery method for continuous epidural infusion for ambulatory patients in the Hospice and Community setting.▶To develop policies and procedures and facilitate staff training.▶To facilitate discharge of ambulatory patients with continuous epidural infusions.MethodsThe Integrated Pain service performs joint consultations and has monthly meetings to develop Policies and Procedures and discuss complex cases. In response to patient need we performed a literature review to select a device that was portable, light, easy to fill, has long duration of action and was safe. We met with the manufacturer to evaluate it fully prior to use.ResultThe Accufuser is an elastomeric device delivering a near linear infusion with a patented piston preventing under or over dosing. It has variable infusion rates and volumes. It is filled aseptically in the hospital pharmacy in the aseptic unit and we used a device which lasts 5.7 days. It was used for a patient with severe perineal pain despite maximal tolerated oral therapy who had benefitted from bolus epidural analgesia. Following titration of diamorphine, clonidine and levobupivacaine the patient was discharged and returned to the hospice for renewal.DiscussionIntroduction of the accufuser required an integrated approach from the Pain team, Pharmacy and the Specialist Palliative Care Team. Development of a policy and patient leaflets alongside intensive staff training was required. We feel this is innovative practice and opens up the choices for Units and Pain teams dealing with Epidural infusions. This device is unique in its mechanism and patented technology and offers a better patient experience.
are Doing. The project commenced in 2014 and continues to develop. There have been significant changes in the way the Unit operates alongside increased staff morale, enthusiasm, ownership and pride in the environment and maintaining and improving standards Aims The ultimate aim of the Productive Ward foundation modules is to release time to care by ensuring efficient systems are in place in a well organised environment Methods A project lead planned and trained three groups to lead each module. Each group nominated a group lead who reported back to the project manager quarterly. Quarterly reports were included in the annual audit plan for Dorothy House. A ward vision was produced and clearly displayed outlining out core values. A project board was introduced to demonstrate progress and maintain momentum. Before and after photographs were taken to demonstrate improvements. Once an area was completed standards were set and regular audits commenced to ensure compliance and sustainability. Conclusions Patient Status at a Glance: An electronic whiteboard has been introduced that informs handovers and MDT meetings. This can be accessed via the desk top for all clinical teams connected with IPU. It records a variety of patient information and has the ability to aid in reporting and audit Well Organised Ward: Each clinical area was assessed using the 5S tool involving to sort, set, shine, standardise and sustain. We worked with the three second rule where any item needed could be found within three seconds of entering the room.Knowing How we are Doing: Friends and family feedback, suggestion boxes and safety crosses were introduced. The safety crosses monitor any incidences or near misses related to pressure ulcers, falls or medication errors
The Chairman, Mr. E. B. Uvarov, Head of the Technical Information Bureau of Courtaulds, Ltd., Coventry, introduced the first speaker, Miss H. Thornton, of T.M.M. (Research), Ltd. He said that she was a welcome newcomer to the ranks of Aslib speakers, but no stranger to the members of the Aslib Textile Group, who knew her as the Group's very efficient and persistent Secretary, who prodded them into activity with skill and tact, and with a great measure of success. One of the more valuable results of such activity was the Group's work on translations, which present rather special problems in the textile field. The Chairman then invited Miss Thornton to speak on this subject.
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