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Urinary Tract infection: diagnostic tools for primary care from PHE flowcharts (updated Apr 2019) describes when to send for urine cultures and when to consider a UTI in adults >65 years, women <65 years and in children. The flow chart for adults >65 has been updated to reflect NICE guidance on managing catheter-associated UTIs.
The form to complete and send to the GP if an older resident has a suspected urinary tract infection will be updated once national guidance has been updated.
Out of hospital management of UTIs in elderly patients
Good hydration in six parts:
Part 1 – The Urinary System
Part 2 – Spotting the sign of dehydration
Part 3 – Improving Hydration
Part 4 – Medicines, kidneys and urine
Part 5 – Urinary tract infection (UTI)
Part 6 – Improving hydration through structured drinks rounds
‘To Dip Or Not To Dip’ has a network of health and social care professionals who are improving the management of UTI in older people in care settings throughout the UK. To join this community email Elizabeth Beech (National Project Lead Healthcare Acquired Infection and Antimicrobial Resistance NHS Patient Safety Team, NHS Improvement)
See also the Antimicrobial Guidelines for Primary Care .
Public Health England has issued ‘Guidelines on the management of outbreaks of influenza-like illness in care homes’ Influenza-like_illness_in_care_home_2018
Public Health England has issued guidance about infection control in residents with Candida auris.
Preparations for dry skin (emollients) and other skin preparations
West Yorkshire Fire & Rescue Service – Essential Information for Health Care Professionals
Following a number of local deaths, West Yorkshire Fire & Rescue Service has produced a YouTube Video for healthcare professionals about emollients, which can increase the risk of a fire developing. Please watch it and discuss it within your team.
Watch Commander, Chris Bell, has also highlighted the risks on his Twitter account @WYFRSChrisBell and there is also information on the Fire Service’s website, including a leaflet about caring for people who use certain products, creams, airflow or oxygen equipment.
West Yorkshire Fire and Rescue Service would like you to consider:
. Skin products, such as emollients are safe to use. The danger exists when residue of the products gets onto fabrics, bedding, clothing, chairs and bandages. This dried residue will make the fabric more flammable.
. In line with reports from Coroner’s, those that apply these products to people in their care should speak to their patients about the fire risks. This is in addition to the warnings that will appear on these products.
. Some patients have been switched to a lower paraffin product or a paraffin-free alternative. This will not reduce the risk. Initial tests indicate the risk is similar to paraffin-based emollients.
. People using products should not go near to naked flames, smoking materials, cookers and heaters.
. Keep away from anyone else that is smoking if there is any risk of fabric contamination.
. Washing fabrics at the highest temperature recommended on the fabric care label will reduce the emollient residue but may not totally remove it. Therefore remain cautious and stay away from fire.
. Advise people not to place heated appliances such as electric blankets, hairdryers, heated rollers and tongs on or near their airflow mattresses and cushions.
. If anyone has concerns that someone is displaying high risk behaviours around fire and the use of skin products, a referral is made to their local fire service, so that they can try to mitigate the risk through information, advice and appropriate interventions. The fire service can undertake home fire safety checks. If you have concerns, also tell health and social care professionals looking after the patient.
We have updated our poster Sept 2019 v1 which includes advice for both healthcare professionals and patients when using such products.
Medicines and Healthcare products Regulatory Agency (MHRA)
The MHRA has also highlighted the risks in a press release.
It was previously thought the risk occurred with emollients which contain more than 50% paraffins. However, evidence now points to a risk with emollients which contain lower levels of paraffin and with paraffin-free emollients. This advice therefore applies to all emollients whether they contain paraffin or not.
It is important people caring for someone who uses an emollient, are aware of the potential fire risks and take appropriate action.
Further details are available here Press Release MHRA 181218
BBC News Health has again highlighted the dangers of using preparations for dry skin whilst smoking or using naked flames.
The wound management formulary has been developed by the Joint Wound Management Formulary Group.
Please click the link to navigate to the relevant sections of the wound formulary.
Newsletter about concern regarding high strength insulin:
A patient safety alert has been issued about the risk of severe harm and death resulting from withdrawing insulin from pen devices. This notes that
56 incidents have been reported which were associated with withdrawing insulin from insulin pens or refill cartridges.
Extracting insulin from pen devices or cartridges is dangerous and should not happen.
Safer administration of insulins is included in the key therapeutic topic from NICE on Safer Insulin Prescribing.
Managing Medicines in Care Homes
From NICE: Guideline on Managing Medicines in Care Homes.
Quality standard – Medicines Management in Care Homes.
Flow chart – Managing Medicines in Care Homes.
Some things to think about when considering covert administration of medicine
Some things to consider when crushing tablets or opening capsules.
Therapeutic Options for patients unable to take solid oral dosage forms
Some useful websites
Advice on diamorphine and Intrasite gel
The CD Accountable Officer is aware of the unlicensed use of Intrasite gel and diamorphine injection in certain settings.
The decision to use this would be a clinical judgement for the individual prescriber.
In all cases, if this is the chosen treatment, both the person administering the treatment, and the patient, must be aware of its unlicensed status. There must also be a full audit trail for the use of the diamorphine (including destruction details of any part ampoules that may have been discarded).