Rapid response: a multiprofessional approach to hospital at home.

The provision of 'hospital at home' is not new to the 21st century but pressure from the reduction in the number of hospital beds, population growth, an ageing population and subsequent extended time living with long-term conditions means such services are increasingly necessary. However, research by the authors found services that already exist do not operate 24 hours a day or provide a single multiprofessional approach. Gloucestershire's rapid response (RR) service provides specialist, coordinated, comprehensive and supportive assessment and treatment 24 hours a day in the patient's own home. Data were collected over a 5-month period detailing the number of patients admitted to the service and its impact on hospital admission avoidance and patient outcome. The cost savings and reduction in length of hospital stay is considerable (to almost a quarter of the cost and number of bed days of an acute hospital admission). The position of the hospital as the main provider of urgent/acute care is shifting. The RR service demonstrates its position as a provider of an innovative service that breaks down the boundaries between acute, primary and social care.

Milk allergy in adults and children.

Cow's milk allergy is common in children and rare in adults. The clinical features of cow's milk allergy are varied and they include anaphylaxis, gastrointestinal symptoms and atopic dermatitis. The prevalence of cow's milk allergy is difficult to ascertain, based on self-reported symptoms that are not subsequently confirmed by diagnostic testing. The gold-standard diagnostic test is the double-blind placebo-controlled food challenge. Avoidance of milk and milk products is the main therapy. Nutritional considerations are important in both children and adults, as is recognising the potential for resolution of cow's milk allergy. Providing evidence-based advice and support to individuals and their families and carers is central to managing cow's milk allergy.

Chlorhexidine: an unrecognised cause of anaphylaxis.

Chlorhexidine is a highly effective antiseptic and disinfectant. In the past 20 years there has been a substantial increase in the number of chlorhexidine containing products used in healthcare. Anaphylaxis to chlorhexidine was first reported in 1984 and was almost always seen in men. However, in the last 4 years we have observed a surge in confirmed cases of anaphylaxis to chlorhexidine, with increasing numbers of female patients recently diagnosed. Yet, awareness of chlorhexidine as a cause of anaphylaxis is low because it is not a drug but a 'hidden' allergen, for example as a coating on medical devices such as central lines and urinary catheters. Patients will often have more than one allergic/anaphylactic reaction before the diagnosis is suspected. We have observed that there is poor recognition of an initial allergic reaction to chlorhexidine, which is well described. This, alongside poor labelling of chlorhexidine containing products, has resulted in further inadvertent exposure resulting in severe anaphylaxis. Prompt referral to a specialist allergy centre ensures appropriate investigations, diagnosis and management. Increasing awareness of the potential risk of life-threatening anaphylaxis associated with chlorhexidine use is vital, particularly in perioperative procedures. Healthcare workers are fundamental in avoiding and preventing further reactions to chlorhexidine containing products in patients diagnosed with anaphylaxis to chlorhexidine.

Treatment of rhinitis in pregnancy.

Rhinitis, a condition involving inflammation and irritation of the nasal membranes, is a common condition that can be allergic or non-allergic in origin. Pre-existing rhinitis can worsen during pregnancy, and new rhinitis can occur. Rhinitis has a significant effect on quality of life. Where rhinitis co-exists with asthma, it is a major risk factor for poor asthma control, which can have adverse effects on fetal development during pregnancy. Prescribing any drug treatment during pregnancy carries risks that must balance the benefits of symptom control with pregnancy outcome. Attaining control of rhinitis during pregnancy requires appropriate drug treatment, alongside careful patient education, monitoring and support. This article outlines the safety profile of common treatments used for rhinitis in women who are pregnant and/or breastfeeding. The aim is to aid the nurse in providing safe, effective treatment and information, thereby allowing patients to make informed decisions.

Current clinical practice in atopic dermatitis.

Atopic dermatitis affects both children and adults, and often presents in early life as itchy, dry skin primarily located on the face, trunk and limbs. There is usually a history of family or personal atopic disease and an increased blood level of the allergic antibody immunoglobulin E. The mainstays of treatment are emollients and corticosteroid ointments and/or creams. Other therapies include immunomodulators and management of any associated infections. Caring for a patient with atopic dermatitis requires skilled assessment, effective education and the ability to involve and support patients and carers in the management of this condition.

Implementation of nursing grand rounds at a large acute hospital trust.

This article outlines the implementation of nursing grand rounds (NGRs) in one of the largest NHS teaching hospitals in the UK, to share clinical and professional expertise in providing quality and evidence-based care to registered nurses and allied health professionals. A pilot was successfully trialled on one hospital site for 3 months, which was then rolled out across the organization. The objectives of the programme encouraged participation from clinical nurse specialist colleagues to promote their role and present their work, including evidenced-based care, service improvement and research. A variety of multidisciplinary team members attended and highly evaluated the 3-month pilot NGRs. The criticism of having an inappropriately sized venue was addressed, and this coupled with offering food before lectures has encouraged greater participation and networking.