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SOP for IV Administration of Diuretics to Heart Failure Patients in DCHS North Community Hospitals and CRH Same Day ECU (S89)

The Aim of this SOP is to provide heart failure patients across Derbyshire access to IV drug treatments without the need for attendance at an acute hospital

Temperature Monitoring of Medicines Storage Rooms SOP (S74)

Aim of SOP; to reduce risk to patient safety by monitoring exposure of medicines to high temperatures. DCHS accepts that the storage of medicines may exceed 25°C in exceptionally hot weather. However, all staff must follow the actions outlined in this SOP to reduce this risk.

Safe Use of Bed Rails and Bed Area Equipment Within Inpatient Areas Policy (P22)

Some people in hospital may be at risk of falling from bed for many reasons including poor mobility, cognitive impairment, e.g. dementia, brain damage, visual impairment, and the effects of their treatment or medication. The National Audit of Inpatient Falls 2015 reported that twenty two per cent of patients who fall in hospital do so from their bed. The use of bed rails can be challenging. This is because bed rails are not appropriate for all patients and can create a barrier to independence that can create a greater risk of falls to mobile but confused patients who may attempt to climb over the rails. However a review of literature indicates that falls from beds with bed rails are usually associated with lower rates of injury (NRSL 2015). Bed rails and other pieces of bed equipment are not appropriate for all people, and using bedrails, bed levers etc. involves risks. National data suggests around 1,250 people injure themselves on bed rails each year. This is usually scrapes and bruises to their lower legs. Based on reports to the MHRA and the HSE, deaths from bed rail entrapment could probably have been avoided if MHRA advice had been followed. Staff should continue to take great care to avoid bed rail entrapment, but need to be aware that in hospital settings there is a greater risk of harm to people falling from beds.

Interim Standard Operating procedure for delivering intravenous (IV) diuretics within a patient’s home (S106)

An Ambulatory Heart Failure (AHF) service has been delivered by DCHS, in partnership with UHDB, on a day case basis at the Royal Derby Hospital site since 2016. Treatment is given using Intravenous (IV) diuretics which can be given daily either following discharge from the acute hospital or referral from the community setting. The development of a Cardiology Virtual Ward has been discussed during 2022 which once implemented will see intravenous diuretics being administered to patients in their own home in addition to the existing AHF service. As an interim step and to support the transition away from hospital and to home delivery along with assisting University Hospitals Derby and Burton (UHDB) with current bed pressures; it has been proposed that one of 3 rooms currently used for AHF on CCU be converted back to a bedroom and a small number of patients receive their treatment at home instead. This will also help assess the process prior to commencing the virtual ward on a larger scale.

A2 - Advice for manual handling when working at low level (S96)

Advice for manual handling when working at low level

APPENDIX 11a - Issues which require further investigation (unrelated to this case).docx

HRP APPENDIX 11a - Issues which require further investigation (unrelated to this case)

A4 - Patient next appointment information slip (S107)

Patient next appointment information slip

Service Level Clinical Harms Standard Operating Procedure (S139)

This document should be read in conjunction with the overarching DCHS patient access and safe waiting policy which outlines the processes to be followed in order to deliver a consistent approach to. • Utilising a proactive method of risk stratification to minimise clinical harm as a result of delays in care. • Embedding systems which take into account health inequalities. • Monitoring waiting times against defined thresholds across pathways of care. • Delivering personalised, patient-centred communications to patients who are waiting for care. • Implementing Harm Reviews for the that support the Trusts governance and assurance processes and maintains practice in line with national expectations.

Appendix 6b- Communication Agreement for Formal Investigations.docx

HRP24 Disciplinary Policy Communication Agreement for Formal Investigations

Appendix 3 - Work Practice Placement/Experience Confidential Pre-placement Health Declaration.docx

Appendix 3 – Work Practice Placement/Work Experience Confidential Pre-Placement Health Declaration

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