Developing a policy to empower informal carers to administer subcutaneous medication in community palliative care; a feasibility project.

BACKGROUND: This article describes the development and implementation of a policy to support community professionals to train informal carers to give, 'as required ', subcutaneous medications to their relative. In a rural county, Lincolnshire, despite out of hours responsive services, patients could wait up to one hour for subcutaneous medications. Additionally there were increasing requests from carers to participate in this role. AIM: To provide a safe and effective framework via a robust policy to support informal carers to give, as required, subcutaneous medications in today's health-care environment. METHODS: A group of professionals working in adult community palliative care formed a working party to scope the literature and existing policies, and to consider risks, legalities and local infrastructure. The policy was developed and based on available literature. A consultation process on the policy was commenced before a series of educational workshops supported its roll out. RESULTS: The small number of informal carers (n=5) who undertook this role reported positive experiences and felt empowered. Professionals found the policy was able to be implemented quickly and was adhered to. CONCLUSION: From the small numbers audited it could be suggested that if the process is well managed and the informal carers feel supported they can safely and effectively administer subcutaneous injections in community palliative care. More importantly, if a policy is available, staff can respond to requests from carers in a timely manner.

Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren.

BACKGROUND: Rheumatic heart disease (RHD) is an important problem in developing countries; however, many cases are detected only when the disease has progressed to cardiac failure. Screening can detect cases earlier, but there are no screening guidelines. METHODS: We performed a cross-sectional screening study in Tonga among 5,053 primary school children, in whom auscultation followed by echocardiography of those with heart murmurs were used to identify RHD. We also analyzed whether a three-stage screening protocol of auscultation performed by a medical student to detect any heart murmur, second-stage auscultation performed by a local pediatrician to differentiate pathological from innocent murmurs and echocardiography of those with pathological murmurs altered outcomes. RESULTS: The prevalence of definite RHD was 33.2 per 1,000. The prevalence of RHD increased significantly with age, peaking at 42.6 per 1,000 in children aged 10-12 years. Most valve lesions (91 [54%] of 169) were mild. Auscultation to detect pathological murmurs was poorly sensitive (46.4%), and the finding of any murmur on auscultation did not affect the likelihood of detecting pathology on echocardiography. The finding of a pathological murmur did significantly increase the likelihood of detecting pathology on echocardiography, but still missed 54% of those with pathology (mainly RHD) detected on echocardiography. CONCLUSIONS: Screening is a useful method for detecting asymptomatic RHD in regions of high prevalence and we report a high echocardiographically confirmed prevalence. The most appropriate screening strategy remains to be confirmed, however, and implementation will depend on the availability of echocardiography and trained staff.