Outpatient parenteral antimicrobial therapy: its delivery in the community

Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services (Wiselka and Nicholson, 1997). Now almost 70% of those treated with intravenous antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). In total, 38-53% percent of those requiring OPAT are able to self-administer (Hills et al, 2012). The demand for intravenous antimicrobial therapy is increasing and the way it is being delivered is changing. This article examines service models, setting up services and developing staff to enable them to deliver OPAT services.

Catheters: a guide to selecting appropriate products

When a catheter is inserted as a comfort measure at the end of life, it is important to ensure that the patient receives a catheter of the correct size, length and material. This will minimise trauma, reduce catheter changes and improve quality of life.

Urinary incontinence: providing respectful, dignified care

People are living longer than ever before and ageing and illness associated with ageing can affect a person's ability to remain continent. In many cases, the older person can benefit from rehabilitation and continence promotion. In some cases, this is not possible and the nurse's role is to work with the older person to help the person manage continence problems. It is vital that nurses work with individuals to provide person-centred continence care. This paper examines some of the difficulties older people can experience and how the nurse can enable the individual to have the best possible quality of life.

Intermittent self-catheterisation: past, present and future

In the past, the only way to drain a bladder was to use intermittent catheterisation. For four millennia, intermittent self-catheterisation (ISC) was used to treat bladder dysfunction. That changed in the 20th century when Foley redesigned and improved on 19th century designs for an indwelling urethral catheter. While some patients benefit from indwelling catheters, long- and short-term indwelling catheters can increase infection risks and contribute to bladder dysfunction. NICE guidance on infection control recommends that intermittent catheterisation should be used in preference to an indwelling catheter if it is a clinically appropriate and practical option for the patient. NICE also recommends that patients should be offered a choice of either single-use hydrophilic or gel reservoir catheters for intermittent self-catheterisation. Voiding problems increase the risks of infection, bladder and renal dysfunction, and can impair quality of life. Individuals who have reasonable bladder capacity and sufficient dexterity and motivation can regain bladder control using ISC, which can make a huge difference to their health and wellbeing.

An NHS fit for purpose?

When I first started looking after older people, the average patient was 30 or 40 years older than I was. Almost 30 years later, the average patient is still 30-40 years older than I am. Have I discovered the fountain of eternal youth? No, but perhaps I should ask my patients where it is.

Turning back time

I've spent an hour with Paula giving her much-needed support. She feels burnt out and utterly demoralised. She's counting the days towards retirement, and then she drops the bombshell. She's six younger than I am. She leaves, thanking me for listening, and saying: 'If I had my life over again I'd do it do differently. Wouldn't you?'

An evidence-based approach to diagnosis and management of cellulitis

Community nurses are involved in caring for people who are at risk of cellulitis. The community nurse may be involved in dressing leg ulcers and may refer a patient with suspected cellulitis for appropriate treatment. Community nurses are also increasingly involved in delivery of outpatient antibiotic therapy (OPAT). As the role of the community nurse expands to encompass diagnosis, prescribing, delivery of OPAT and in some cases the decision on when to switch from IV to oral antibiotics, it is essential that the nurse is aware of the evidence base for diagnosis and treatment of lower leg cellulitis. This paper discusses the reasons for the increasing incidence of lower leg cellulitis and explores the evidence base for treatment.

Kind enough to care, clever enough to cope

In my lifetime the human race has reached out to the stars and walked on the surface of the moon. Now I can hold a computer more powerful than the one used to control the moon landing in the palm of my hand. Diseases that once signalled death have been reduced to the status of long-term conditions, the number of people aged 85 and over has more than tripled.

Preventing catheter-related urinary tract infection: focus on Proteus mirabilis

Urinary tract infectious caused by Proteus are uncommon, and account for only 1-2% of community-acquired infectious. However, it is important that staff are able to recognise the features of a Proteus infection. Proteus infections, if unrecognised, can become established and cause major health problems. Proteus is more common in people who have or have had a urinary catheter. Minimizing the incidence and duration of urinary catheterization is an important part of preventing infection. Community staff who are alert to the possibility of this infection can make a huge difference to their patient's quality of life.

Holding the line

When problems occur in healthcare nurses are often blamed. Press and public may consider that the nurse should have done more or that nurses should have spoken out. Do problems occur because of staff who are not fit to be nurses, or is the situation more complex?

Should antibiotics be prescribed when urinary catheters are removed?

Each year around one million urinary catheters are inserted in NHS hospitals. In around 60% of cases prophylactic antibiotics are prescribed prior to removal. This practice aims to reduce infection risks, but is not supported by evidence. Inappropriate prescribing increases antibiotic resistance, already a serious and worsening problem, and exposes patients to the hazards of antibiotic prescribing. This practice also costs an estimated £1.35-£2.7 million pounds annually. Nurses at all levels can have a huge influence on catherterization rates and catheter management. This can reduce the risks of harm and infection and improve quality of care.