tag:blogger.com,1999:blog-79932511366417344352024-02-20T09:47:07.617-08:00Leeds Respiratory NetworkAnonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.comBlogger38125tag:blogger.com,1999:blog-7993251136641734435.post-56659838566686206072018-11-25T13:37:00.001-08:002018-11-25T13:37:19.705-08:00Things are constantly changing
<br />
<div align="center" style="margin: 0px 0px 10.66px; text-align: center;">
<u><span style="font-family: Calibri;"></span></u><br /></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<span style="font-family: Calibri;">As we come to the end of another year, I felt it was time to
write a blog, at first, I thought I haven’t even done anything, nothing has
changed. Then I looked back since the last blog and thought quite a few things
have changed! Where do I even start? Well our business is slowly but surely
growing Sarah has been amazing! Stepping into the business role she has secured
us another grant to grow our business, so we now have our first new employees. We have employed an administrator and we have recently took on a nurse who will work on a
research program in Hull for us. We also have our own little office in an
office block! We have helped a few more areas around the country set up
respiratory networks, with our support it makes it easier for them and we also
invest in developing the nurses too. In March someone kindly nominated us for
the general practice nurse awards and we were humbled to have been finalists!</span></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<br /></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<span style="font-family: Calibri;">My contract has been extended until next June, but my remit
has grown to 12 practices. As the NHS is changing with the development of the
new local care partnerships in Leeds, I have also found myself in the position
of the locality lead nurse for Leeds 8&9. This was not in the plan, but at
the moment there is no one else to do it so I agreed to do it. Sarah is also one
of the locality lead nurses in her locality too. I think it is quite an
exciting opportunity, that we have a blank canvass to try and make some
changes. I have enjoyed getting out more into the community and working with
the different organisations. Although it has been a bit a of a balancing act as I only
work four days a week and could be at meetings all day every day!</span></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<br /></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<span style="font-family: Calibri;">I don’t feel like I have had many challenges or stress
thrown my way this year except for when I’m travelling. I have had some
wonderful karma ripening that has enabled me to travel a lot this year and I
feel very thankful for the experiences. However, things have always been made
difficult, planes have been cancelled, then I nearly missed a plane, trains
have been cancelled, I’ve had flat tyres and taxis haven’t turned up! I
managed to get myself to the monastery last month for a needed retreat to
recharge ready for the year ahead but not without problems! I arrived at the
airport and they wouldn’t let me fly because I had four months on my passport
instead of six! I had to pay a lot of money to change it to the Sunday and hope
that I could get a new passport. After another adventure straight to Liverpool
they kindly made me one in two hours for a nice little charge. The only
adventure that went smooth this year was when I took the children to Thailand
and I was so thankful nothing went wrong while I had them with me. I don’t think
Id have handled it quite the same and may have got a little stressed to say the
least! But I used the other experiences to put my teachings into practice by
practicing patience and not getting angry or upset etc like I would have done
in the past.</span></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<br /></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<span style="font-family: Calibri;">I said this year I was focusing on my spiritual development
and I think I’m just getting weirder and weirder as time goes by! I completed the
first level reiki course and booked on to do the second level in the new year.
I’ve been doing the Buddhist course and I also signed myself up for an eight-week
spiritual development course. I’ve been working on becoming a Buddhist chaplain
in the prisons but hasn’t been too easy so in the new year I will be starting
in the hospitals. Hopefully the prison work should follow. As if I didn’t already
have enough on, I have managed to get myself involved with a group of people
and we are trying to organise a compassion festival in Leeds for 2020. <span style="margin: 0px;"> </span>I think this is quite exciting as we have been
organising events to get people to come on board with us. <span style="margin: 0px;"> </span>We are thinking of setting up a social
enterprise to do this work, so we shall see how that turns out next year. I
told myself I wasn’t going to do any more work-related courses for a while but
of course I signed myself up for one, so I also completed the talent management
course from the NHS leadership academy this year too.</span></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<br /></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<span style="font-family: Calibri;">So when I look back we’ve done quite a bit in a short space
of time but it has gone so fast! On Friday this week we will be in London as we
have been shortlisted for the general practice awards! We are delighted to have
been shortlisted and looking forward to having a night to celebrate our hard
work. I have no plans for the new year I’m just going to see how it turns out. The last few years have taught us a lot. We have grown and I think I have almost grown out of imposter syndrome! I said to Sarah that I feel like we’ve gone through a transition period and this
is the start of a new life for us! I’m under no illusion and know that we have
difficult times ahead with more and more nurses leaving our localities and all
the other challenge, but I am really looking forward to 2019!</span></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<br /></div>
<br />
<div style="margin: 0px 0px 10.66px;">
<br /></div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><span style="font-family: Calibri;"></span>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-11174151433780295282018-01-16T01:10:00.000-08:002018-01-16T01:10:23.266-08:00Living the dream......
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">So I start 2018 living the dream, how exciting! But what
does it feel like living the dream? It doesn’t feel any different to normal! I
started my new job in September, working for our social enterprise, so I am now
my own boss! People ask me, do you feel pressure having your own business, do
you feel stressed with the responsibility?<span style="mso-spacerun: yes;">
</span>I feel less stressed now than I have ever felt, I feel at peace and I’m
just going with the flow. At first after a week or two I did feel a bit
overwhelmed thinking OMG there is so much work to do! But I took 3 deep breaths
and let that worry float away. I decided to write some lists of actions I
needed to take and told myself I had to do it step by step and I couldn’t do
everything at once. <span style="mso-spacerun: yes;"> </span>I never really wrote
lists before just kept everything in my head. Previously if I would have had
all these ideas in my mind I wouldn’t have been able to settle until they were
all actioned and completed. But these days I’m realistic with what I can
achieve and manage my expectations.<span style="mso-spacerun: yes;">
</span>(This is the best piece of advice a Dr gave me a few years ago, manage
your expectations Melissa! It was hard, but I think I’m getting there now)</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;"> </span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">So, I’m working with a collaboration of 8 GP practices that
all have different dynamics and different ways of working. This has been quite
interesting and has brought one or two challenges with it, but so far so good.
I guess it is quite exciting when I think about it and the freedom I’ve been
given. I have been doing training sessions, joint clinics, mentoring and
building relationships. But after a month or two I started to get itchy feet
thinking now what? Not that I was not happy, but I had achieved what I wanted
so what should I focus on now. Why couldn’t I just be satisfied with that? I
could rest now, just BE for a while! But oh no, inside of me I feel like I need
to do more. I go through phases like this every so often, a feeling of itchy feet
that a change is coming but I just need to be patient and my next path will be
shown. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>I’m in middle of the teaching course and this
is for my career, but it will also link with my spiritual path.<span style="mso-spacerun: yes;"> </span>I feel like this year instead of focusing on
my career the focus has shifted to my personal development. I’ve signed up
learn reiki and signed up to do a deeper course in Buddhism as I’m starting to
teach that at a basic level this year. I wouldn’t have dared do anything like
this before, but feel I must do it to benefit others.</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;"> </span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">My mum is already quite anxious because my contract expires
in September and she keeps telling me I need to save money in case I’m left without
a job. Mother relax, it will all be fine! She says booking her next flight to
New York! I went to New York as planned at the end of last year but of course
it didn’t go to plan. Our flight was cancelled in Dublin and we were offered a
refund and basically that was it. So, I used my negotiating and leadership
skills I have been learning over the years and manged to get us a flight. We
were the only ones to get a flight, I felt so lucky. But our trip was cut short
so it’s only right I should make it back up! I won’t mention to her yet that I
have my eyes on going back to the monastery in Nepal at the end of the year to
do a course. It might tip her over the edge haha. <span style="mso-spacerun: yes;"> </span>I’ve had a lot of pressure and stress over the
years and it hasn’t been easy bringing up two kids on my own. They are getting
older now, so I think I’ll be a bit crazy for a year or two and have some fun.
Then I’ll think about being sensible and settling down. </span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;"> </span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">But for now, it’s the start of another year and another
chapter to write. I don’t know where I’ll end up or what I will be doing this
time next year but I’m excited by what this year will bring. <span style="mso-spacerun: yes;"> </span>I have a feeling that 2018 is going to be even
better than 2017 and that will be hard to beat!</span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-69938685631019254722017-08-18T12:03:00.001-07:002017-08-18T12:03:13.313-07:00Learning to let go...Well I can’t believe it’s been 8 months since I wrote my last blog! I’ve blinked and the year has nearly gone. So I started 2017 in the crazy country that is India. WOW is all I can say, I had a very special time but I don’t think I would have coped there without my mind training. I had already decided that 2017 I was going with the flow, I had no plans at all and I was going to trust in the universe and see where it would take me. This is something I would never have been able to do before I always had to have a plan! (Which never went to plan) So I arrived in Delhi 2.5 hours later than expected, then I queued for 1.5 hours in immigration, to get to the front to be told I was in the wrong queue. I just laughed but I was a little worried as my friend from Nepal was meeting me, his phone was not connecting but I knew he would be waiting for me. So I joined another long queue and a hippie looking guy from London started chatting to me. He said he had been to India 9 times but the first time he came it was too much for him and he had to leave. He said the best piece of advice he could give me for India was that I had to let go and that’s where the magic would happen. <br />
My phone finally rung and it was my friend, I met him 4.5 hours later than originally planned. India was a good place to practice patience and learn to let go! <br />
<br />
I came back from India on a massive high. I needed that break so I could start 2017 fresh and ready for whatever the year would bring. The year seemed quite slow to get going, but now I look back it has gone so fast. I feel this has been a year of resting and relaxing preparing me for the future. In March we were invited to London by NHS England to talk about our social enterprise at the GP forward view conference. We couldn’t believe they had asked us, we were a bit nervous but so excited! <br />
<br />
At the end of 2016 two nurses from Wakefield got in touch with us to see if we would help them set up a respiratory network. They came under our social enterprise and had their second meeting this year. It has been nice to watch them grow quite quickly into a successful network. In April we had a joint conference with them which was our biggest and best yet. <br />
<br />
Over the summer I had the wonderful opportunity to join the primary care respiratory academy for the second year running presenting with them. I can tell how much I have grown in the past year as I actually enjoyed it this year rather than being held back by fear. I have also got back in the saddle and I'm back at uni for a teaching course, then I’m not studying ever again! haha<br />
<br />
So last September I gave up my job as a practice nurse for a 12 month contract at the hospital as a Respiratory Nurse Specialist. With the aim, that in the year we would secure a contract for our social enterprise. A few people were a bit worried especially my mum, I told her not to worry and that it would be fine. By June she was like Mel what are you going to do? Previously I would have been very worried by now and jumped at the first opportunity that came along. The hospital also offered me the opportunity to stay permanently so that was a nice back up plan. <br />
<br />
But my patience paid off as we have just secured a contract with a collaboration of GP practices to standardise respiratory care and improve outcomes. We have been given a blank canvass to be as creative and innovative as we like, we are so excited for the future! I have really enjoyed my time working at the hospital with such a lovely team. I would love to have stayed but I feel like Santiago from the Alchemist and I have to continue on my journey. It has been a hard few years in lots of different ways but it has all been worth it to make me grow stronger. I feel like a caterpillar that has gone through the changes to become a butterfly, as this year has past I have felt lighter every day. Learning to let go is the best thing I could have ever done. Letting go everything; control, plans, fear, expectations and just trying to live in the present moment. Being happy to accept whatever comes my way, but this is turning out to be a great year where all my dreams are coming true. In 2 weeks I will be having a girly break in Ibiza before I start my new job. Then in October for my birthday I will be visiting New York a place where I have always dreamt of going. There’s still four months of this year left and I can’t wait to see what happens next…….<br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-27215769150121062082016-12-22T12:36:00.001-08:002016-12-22T12:36:21.653-08:002016 a year of growth
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">2016 a year of growth…..</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<br /></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">I started January 2016 the way I left 2015, feeling
emotionally and physically drained but I knew I had to give it all I had. Just
3 more months and it would all be over! Looking back I can admit that I took on
too much in 2015. After a very busy start to the year, setting up the social
enterprise, working, completing the spirometry course, completing the frontline
programme from the NHS Leadership academy and numerous other projects. I started
the prescribing course in September and by the end of the year I had nothing
left, I wanted to give up but then I had a wakeup call. I failed the numeracy
exam. Me fail? I couldn’t believe I had failed! I always had a fear of failing.
That was my drive, the fear of failing was an energy that spurred me on. I felt
like it happened for a reason as I don’t think I would have had the energy or
motivation to complete the work in the New Year.</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">Oooh but my ego took a beating. The first thing I thought
was well how many others failed? I didn’t want to be a failure on my own. I
could feel embarrassment and disappointment in my heart. I was in shock I couldn’t
believe it. But it was OK I wasn’t too worried as I only got one question wrong
and I could re-sit it and I always get 100% any other time. Like I said
everything happens for a reason and this was to help me deal with my fear of
failing and help me focus.</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">So for those next few months I worked hard. January I had to
go to court as a witness, as a patient assaulted a colleague. That was quite a
stressful time being cross examined. It makes you realise that documentation
really is important and that things that seem insignificant can be really big
things.</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">In February I attended a training event to become a trainer
for education for health. I don’t know what they must have thought of me, by
this point I was almost ready to give up again. I don’t think I have ever felt
so drained in my life.</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">I don’t know where I found the energy from but by Easter I managed
to complete my essays, portfolio and exam for the prescribing course and was
thankful that I passed them!</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">My resit for the numeracy exam was due in the summer, just
before this stress had been building at work and then we had 2 very serious
incidents. I can’t discuss here but the stress of that and an incident at home
led to one of the worst things that could have ever happened to me. I thought I
was going to lose my mind!</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">I attended BLS with my colleague when all of a sudden “boom”
I can only try and explain what happened to me that day because I have never
experienced anything like that before. I felt like my mind had become detached
from my body that I was not in control anymore. My heart started racing and all
I felt was fear and I didn’t know why. I was trying to reassure myself that
everything was ok but I was panicking and I had to get out of there. I was
trying to act “normal” and went to the toilet to try and bring myself round but
it was no good. What was I going to do? I’ve never felt so scared in my life, I
felt really hot and nauseous. </span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">I finally decided
to try and go back in the room, as I got there, they were coming out for a break.
Luckily I’m very close to my colleague she asked me what was wrong with me I
told her I didn’t know. I said there was something really wrong with me and I
was trying to hold it together. I told her I had to leave, that I was really
sorry but I couldn’t go back in there and I would call her later. Wow what was
I doing? </span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">But there was no way I could go
back in there I felt like I was about to go crazy. I set off walking from the
university through town I felt so scared my hands were trembling. I felt really
nervous and anxious it was really overwhelming. I walked all the way home but didn’t
really know what to do with myself. I was pacing up and down trying to work out
what was wrong with me. A few hours later after the course finished she called
to my house, by this point I had brought myself round. I couldn’t believe what
had happened I felt so stupid! I apologised for leaving but thanked her for not
thinking I was silly. </span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">I was OK but it
had shook me up a bit. Later that night I went to bed and boom!!! There it was
again I couldn’t believe it my heart was beating so fast and hard I thought it
was going to explode. I was really panicking wondering what I could do. I tried
to lie on the bed but I was so restless and fidgety I had to keep getting up, I
was so tired but couldn’t sleep. I felt sick, I could hardly breathe I felt
like I was going to die, it was the most frightening feeling. I am a regular
meditator but I couldn’t focus and I couldn’t relax my mind there was nothing I
could do. Why was I feeling like this? What was wrong with me? Would I feel
like this forever? I’ve been through some really bad times in my life and suffered
with depression before I started meditating a few years ago. I’ve felt stressed
and anxious but never experienced anything so scary in my life.</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">I went to work the next day exhausted, with everything that
had been going on at work I didn’t dare tell anyone at work that I had walked
out of BLS. I was trying my best to act normal even though I felt like I was
going to die. I am so glad I had my colleague to confide in, who didn’t judge
me and supported me. I saw a Dr and got some medication to help my symptoms,
but even with diazepam I didn’t get any sleep the next night. Even though I had
this dread and fear and full of negative energy. I was trying to stay positive,
telling myself that nothing is permanent and it won’t last forever. That it is
happening for some reason and I will be ok once I get through it. I don’t think
I truly understood prior to this, how patients actually felt when they have
told me they suffer with anxiety and panic attacks. I didn’t appreciate how it
actually made them feel. I really </span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">don’t </span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">know how I got through those next 2 weeks and
I don’t think I’d have made it without the beta blockers and diazepam. I’ve
never needed medication like that before and I still had insomnia for a week. I
had to send my children to my mums for a short time I was just about
functioning myself. I couldn’t look after them. I felt so ashamed and guilty and
a bit of a failure. Sometime in this crazy state I went and retook the numeracy
exam because I daren’t not go to that after walking out of BLS.</span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">Just after that episode when I was coming back to “normal” Sarah
saw a job advertised at the hospital for Respiratory Nurse Specialist. She told
me to apply for it, that it was meant to be because she never looks on NHS jobs
and something had told her to. So I applied for the job even though it was only
a 12 month contract covering maternity leave. </span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">The good news was I got the job! The bad news was I failed
the numeracy again by one question so that meant I had failed the course! So
here it was my biggest fear staring me right in the face. But it was ok I was
alive! I still had my job, I still had my mind! I was lucky and only felt like
that for a short time. To think that some of my patients have to live with it
for a long time and often have long term conditions as well. I can see why some
people find things too much and sadly take their own lives. Your mind can either
be your best friend or your worst enemy and you are stuck with those thoughts
24/7. After all that work I had done I thought I should try so I put in for
extenuating circumstances to see if I could have one more try being of sane
mind. It was refused even though I had a Drs letter as it did not provide
evidence that I would have been unable to engage with the University’s
extenuating circumstances procedure at the time of the assessment.</span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">They advised me that if I was not happy I could contact the Office
of the Independent Adjudicator for Higher Education. I decided I should do that
as I feel I give 110% to my job I’m never off the sick. The amount of money the
NHS spent on the course and the time of the Dr to support me. The one time I
needed some support and understanding and I didn’t feel I was getting it. So I
took it to OIA and asked my GP to write me another supporting letter. I was
caught up in emotion I felt they didn’t understand! Like I didn’t understand
before this happened to me so I asked her to write my symptoms and how I had
felt at the time. To try and express what I was going through at that time.
Around this time I started my new job. Even though it can be scary starting a
new job I was so excited and felt like a huge weight had been lifted. As these
last three months have passed I can feel myself coming back to normal my energy
has returned and I’m feeling better than ever. </span></div>
<br />
<div style="margin: 0px 0px 11px;">
<span style="font-family: Calibri;">Last week I received an email to say even though it is disappointing
the university followed their guidelines and procedures and my new letter still
didn’t specifically say that I was unable to engage with the University’s
extenuating circumstances procedure at the time of the assessment. So
unfortunately there is nothing more I can do. So there it is I failed. But that
was just the way it was meant to be, I have faced my fears now and let it go.
There is no point stressing over things you can’t change. I have no more fears
now, I have been on a journey for the past few years pushing myself and overcoming
my fears. </span><span style="margin: 0px;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">I have had so many ups and
downs but now I feel ready for 2017. I feel like everything I have been through
has been preparing me for what is going to be the best year of my life! I don’t
know what will happen yet my contract will end and I have no plans but I feel more confident and I am so
excited for the future! So 29</span><sup><span style="font-family: Calibri; font-size: x-small;">th</span></sup><span style="font-family: Calibri;"> December I will be saying goodbye
England, goodbye 2016. I started the year on a low and ending it on high. I
will be celebrating the new year in India receiving special teachings from HH
Dalai Lama having some R&R before the fun of 2017 begins ;)</span></div>
#self development #growth #journeyAnonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-79637701503162863652016-07-17T03:23:00.001-07:002016-07-17T03:23:10.225-07:00Laying the foundations and building relationships
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">Friday night was Leeds Respiratory Network (LRN) 3<sup><span style="font-size: x-small;">rd</span></sup>
educational committee meeting.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">First of all let’s rewind and remind ourselves how we got to
this point.<span style="mso-spacerun: yes;"> </span>Two nurses initially set up LRN
to try and reduce variation in respiratory care through education. This was achieved by organising evening meetings and developing a mailing list of interested
people. This mailing list was used to send out respiratory updates and guidance
but also a way to communicate progress of the network and articulate the vision
as it developed. The mailing list keeps growing and hundreds of people have
come along on our journey with us as we have progressed. (</span><a href="mailto:leedsrespiratory.network@nhs.net"><span style="color: #0563c1; font-family: Calibri;">leedsrespiratory.network@nhs.net</span></a><span style="font-family: Calibri;">)
<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">In April 2015 our social enterprise Respiratory Care Solutions
was born! Since then, as well as being full time mothers, running our homes,
keeping down the day job, studying at university and meditating with monks in
Asia we have been laying the foundations for our social enterprise. We decided
that LRN would be the educational arm of our business and we needed help. We
decided the best way forward would be to set up an education committee to help
us plan our education meetings etc.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">So we were starting to get an idea of interested people and
we sent an email asking people who would like to come on board to get in
contact. We also contacted secondary care and community to see if they would
like to get involved. So in October 2015 we had our first educational committee
meeting explaining our intentions and asked if they would like to join us on our mission. There was an air of excitement but also apprehension and nervousness.
We were open and honest that we didn’t have a clue how it would turn out and
that we could just try it. So where are we now?</span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<o:p><span style="font-family: Calibri;"> </span></o:p></div>
<span style="font-family: Calibri;">Nine months down the line we have organised two evening meetings
and our upcoming conference on Friday 30<sup><span style="font-size: x-small;">th</span></sup> September. (</span><a href="http://www.eventbrite.co.uk/e/leeds-respiratory-network-conference-tickets-25601327259"><span style="color: #0563c1; font-family: Calibri;">http://www.eventbrite.co.uk/e/leeds-respiratory-network-conference-tickets-25601327259</span></a><span style="font-family: Calibri;">)
. The social enterprise paid for a few of our committee members to attend the
PCRS leadership course in June and we are also taking 7 committee members to
the PCRS annual conference in October. (</span><a href="https://www.pcrs-uk.org/clinical-leadership-programme"><span style="color: #0563c1; font-family: Calibri;">https://www.pcrs-uk.org/clinical-leadership-programme</span></a><span style="font-family: Calibri;">)
The buzz in that room on Friday night was amazing! We nearly lost one amazing
nurse after the first meeting due to fear but we maintained contact with her
and encouraged her to go on the leadership course. We agreed that after she
attended the course if she didn’t want to be apart of the committee we would leave
her alone and never bother her again. <span style="mso-spacerun: yes;"> </span>Thankfully after that she attended the meeting
on Friday and has decided to come to the next leaders event in November.<span style="mso-spacerun: yes;"> </span>They were all very courageous to get in a car
with strangers and travel across the country together to go and do something
that would take them out of their comfort zones! <o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<o:p><span style="font-family: Calibri;"> </span></o:p><span style="font-family: Calibri;">We have all bonded now and we feel safe and comfortable to
be open and honest. In these hard and difficult times the NHS is facing there
was so much hope and positive energy in that room planning for a brighter
future. I felt honoured to be in a room full of passionate, enthusiastic,
inspiring professionals that give their own time to do this. I don’t know if
they have realised it yet, but their job now is to find other leaders and
develop them. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">It hasn’t taken up too much of our time to organise and
develop these meetings. The only down side to having meetings on a Friday night
is that your feet hurt from dancing into the early hours of Saturday morning ;)<o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-670864148659488012016-01-08T10:35:00.000-08:002016-01-08T10:35:11.660-08:00Journal of General Practice Nursing, Volume 1, Number 4, November/December 2015 pg 66<u><span style="color: #444444;"></span></u><br />
<u><span style="color: #444444;"></span></u><br />
<u><span style="color: #444444;">What is a typical day for you?</span></u><br />
<u></u><br /><span style="color: #444444;">A typical day for us is just like any other general practice nurse (GPN). We have a variety of clinics that consist of treatment room duties such as baby immunisations, ear irrigation, smears, dressings and also chronic disease management. Sarah also holds minor illness clinics. We also have admin time where we organise visits and complete tasks sent regarding patient queries. </span><br />
<u><span style="color: #444444;">Do you have one practice experience that has taught you something valuable?</span></u><br />
<u></u><br /><span style="color: #444444;">Not one experience in particular, but I would suggest to question everything! Primary care funding is being reduced and this will have an impact on staffing levels so we need to do things differently. When I first started in general practice there were systems in place where the patient would come back several times, now we try to have more time allocated to each patient so that the patient doesn’t have to keep returning. Think about the procedures and systems that are taking place in a GP practice — is that just the way it has always been? Could work be delegated to admin or HCAs to free up nurse time? </span><br />
<span style="color: #444444;"></span><br />
<u><span style="color: #444444;">Where did your passion for respiratory care come from?</span></u><br />
<u></u><br /><span style="color: #444444;">I started as a nursing cadet when I was 18 and my first placement was an assessment unit. I couldn’t believe that too much oxygen could kill someone. I became fascinated with chronic obstructive pulmonary disease (COPD) and my love of respiratory grew from there. Sarah had a placement as a student nurse on a respiratory ward and this is where she developed her passion. Then, we later completed respiratory diplomas when we moved into primary care nursing.</span><br />
<span style="color: #444444;"><br /><u>What were the main drivers for setting up the Leeds respiratory network?</u></span><br />
<u></u><br /><span style="color: #444444;">We decided to set up the Leeds Respiratory Network for two reasons. First, working as a GPN can be quite isolating and lonely. I work in a small practice and there is no one to discuss patients or share ideas with. Second, we found from looking at data that Leeds was one of the worst places in the country for respiratory outcomes. From discussions, we realised that there was a great deal of variation in general practice, for example, training given, time allowed for reviews, etc. So, we wanted to try and reduce some of this variation through education. We organise evening educational meetings and also a full respiratory event with inspirational national speakers. We use social media to disseminate information, with twitter, facebook and blog accounts. We also send out emails to people, as new guidance and resources become available. We have tried to create a sense of community with our mailing list, and people email questions that we send out to the rest of the network. </span><br />
<span style="color: #444444;"></span><br />
<u><span style="color: #444444;">What are your plans for the future?</span></u><br />
<u></u><br /><span style="color: #444444;">Setting up the network has led to us forming a social enterprise called ‘Respiratory Care Solutions’. From discussion we were having at grass roots to commissioning level, we realised that there was a gap in the market. There is already a shortage of nurses and this will become worse over the next few years as more GPNs retire. We would like to become a kind of nursing agency that only provides respiratory care, for example, if a practice needs extra help with reviewing their respiratory patients. In addition, we can provide support to GPNs by shadowing their clinics. We hope that in the future, clinical commissioning groups (CCGs) will commission our service. </span><br />
<br /><u><span style="color: #444444;">What advice would you give a GPN Who Was considering setting up a network?</span></u><br />
<u></u><br /><span style="color: #444444;">Just do it! It hasn’t taken up too much of our time, but it has really helped us to establish links at both local and national level. We are fortunate that we are affiliated with the Primary Care Respiratory Society UK (PCRSUK), which has put us in touch with appropriate people from its groups throughout the country. PCRS-UK also has an excellent leadership programme that members of the society can attend for free twice a year. We have developed personally and grown in confidence from attending these events. At the leaders event we have also learnt non-clinical skills that we have used to set up the social enterprise, such as project management, business knowledge and how to obtain data to make the case for change. If someone wanted to set up a diabetes network, for instance, find a colleague to work with so you can share the workload and bounce ideas off each other. </span><br />
<span style="color: #444444;"></span><br />
<u><span style="color: #444444;">How do you see primary care developing in the next five years?</span></u><br />
<u></u><br /><span style="color: blue;"><span style="color: #444444;">I think primary care will look totally different in five years with co-commissioning and the new federations. The Five Year Forward View will also change the look of primary care with the integration of services. These are exciting times for nurses to be innovative and use their knowledge to fill the gaps in service. Setting up the social enterprise has not been too difficult, and we have received grants and business support from UnLtd (a provider of support to social entrepreneurs in the UK) and Leeds Community Foundation, so it has not been financially taxing on us as individuals.</span> </span>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-20600375965093530972015-11-19T11:45:00.001-08:002015-11-19T11:45:53.859-08:00Improving End of Life Care by using PCRS EQUIP Worksheets
THIS WAS A POSTER SUBMITTED TO PCRS ANNUAL CONFERENCE 2015<br />
<br />
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 12pt;">
<b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 16pt; mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Aims:</span></b><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 16pt; mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Times New Roman";"><br />
The Practice Lincoln Green is situated in inner city Leeds and we have high
levels of deprivation. Our practice prevalence for COPD is 3.9% with the
national prevalence at 1.7%. </span><b style="mso-bidi-font-weight: normal;"><span style="color: #365f91; font-family: "Century Gothic",sans-serif; font-size: 18pt; mso-bidi-font-family: Tahoma; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent1; mso-themeshade: 191;"><o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 16pt;">14.2%
of patients on our practice COPD register have severe to very severe COPD. COPD
life expectancy is very difficult to predict due to the disease trajectory and
often doctors over-estimate survival.<span style="mso-spacerun: yes;">
</span>There is reluctance to discuss respiratory patients at gold standards
meeting. Our aim was to improve the end of life care for our patients by using
the EQUIP worksheets. <br />
<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><b><span style="color: #31849b; mso-themecolor: accent5; mso-themeshade: 191;"><o:p></o:p></span></b></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 16pt; mso-themecolor: accent5; mso-themeshade: 191;"><o:p> </o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 16pt; mso-themecolor: accent5; mso-themeshade: 191;">Methods: </span></b><span style="font-family: "Century Gothic",sans-serif; font-size: 16pt;"><br />
We used the PCRS EQUIP worksheets to help us identify patients approaching
terminal stages of disease. The worksheets ensured we provided holistic reviews
focusing on symptom management, medicines optimisation and referring to
external agencies such as social services and palliative setting.<span style="mso-spacerun: yes;"> </span><br />
<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><b><span style="color: #31849b; mso-themecolor: accent5; mso-themeshade: 191;"><o:p></o:p></span></b></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 16pt; mso-themecolor: accent5; mso-themeshade: 191;"><o:p> </o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 16pt; mso-themecolor: accent5; mso-themeshade: 191;">Results: </span></b><span style="font-family: "Century Gothic",sans-serif; font-size: 16pt;"><br />
Every quarter the practice receives an MOT report from the CCG, highlighting
smoking cessation rates and hospital admissions. Currently we have the highest
levels of smoking cessation within the CCG and also have the lowest levels of
hospital admissions.<span style="mso-spacerun: yes;"> </span>The number of
people with respiratory disease discussed at gold standards meeting has
increased, as has the number of patients with advance care plans and on the
EPACCS template. We have also increased referrals to social services and third
sector organisations. A small number of patients have also used the local
hospice and one patient has moved to a nursing home, both of which have
prevented admissions.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 10pt; mso-no-proof: yes;"><o:p> </o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 10pt; mso-no-proof: yes;"><o:p> </o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 10pt; mso-no-proof: yes;"><o:p> </o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 16pt;"><br />
<b><span style="color: #31849b; mso-themecolor: accent5; mso-themeshade: 191;">Conclusions:</span></b><br />
The EQUIP worksheets are very quick and easy to use ensuring that patients
receive the highest standards of care. Historically, resistance to discuss
respiratory patients at GSF meetings has resulted in patients suffering with
symptoms and struggling for longer. It is hard trying to change practice, but
the worksheets have been invaluable at persuading clinicians without a special
interest in respiratory care, that this is how patients should be managed.<span style="mso-spacerun: yes;"> </span>There is still some reluctance to prescribe
opioids for breathlessness and in Leeds we do not have a dedicated palliative
care team for respiratory. The worksheets have also made us realise there is a
cohort of patients that would benefit from a breathlessness service such as the
Cambridge Breathlessness Service, so we have contacted the commissioners to try
and make the case for change.<span style="mso-spacerun: yes;"> </span><br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 14pt;"><o:p> </o:p></span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-70614915407639853612015-11-19T11:43:00.001-08:002016-01-08T09:51:48.839-08:00Q&A with Respiratory FuturesSee our interview with Respiratory Futures <a href="http://www.respiratoryfutures.org.uk/regions-and-nations/yorkshire-and-humber/announcements/qa-with-leeds-respiratory-network/">http://www.respiratoryfutures.org.uk/regions-and-nations/yorkshire-and-humber/announcements/qa-with-leeds-respiratory-network/</a><br />
<br />
<h1>
Q&A with Melissa Canavan, Leeds Respiratory Network</h1>
<h4>
posted 16 Feb 2015</h4>
<ul>
<li>Leeds Respiratory Network was set up in October 2013 by Melissa Canavan and Sarah Anderson, practice nurses at Leeds South and East CCG</li>
<li>The network provides practice nurses in Leeds with guidance and support on respiratory care</li>
<li>Social media has played an important role its development so far</li>
</ul>
<strong>RF: What motivated you to start up Leeds Respiratory Network?</strong><br />
<strong>Melissa: </strong>I work as a practice nurse in Leeds and I have always been interested in respiratory. But as a practice nurse, it can be quite lonely – I’m the only one in my practice, for example. There was no one really to ask for advice or ideas, to check if you were doing things right.<br />
So in 2013 after attending the Primary Care Respiratory Society [PCRS] leaders workshop, I had this idea to set up a network of likeminded people to support practice nurses in their respiratory work – there wasn’t anything like this in Leeds. I asked Sarah [Anderson], a friend and a fellow practice nurse with an interest in respiratory, to get involved and we just took it from there.<br />
<br />
<strong>So what sort of support does it offer to practice nurses?</strong><br />
<strong>Melissa: </strong>As a practice nurse, the list of things you have to deal with is endless: baby injections, travel injections, dressings, blood, ECGs, diabetes, etc. There can be a bit of information overload. So one of the key reasons we set up the network was to help nurses stay up to date with all the relevant information that they need to know.<br />
On a very practical level, we send out an email nearly every week where we share any new information we get with the network – guidance, resources, things like that. It’s just a really easy way for people to keep in touch with new developments or fill any gaps in their knowledge.<br />
Through our emails we’re trying to encourage nurses to think outside the box. If they see changes that can be made, we encourage them to be brave and start making them – don't wait to be told. We’re trying to inspire and motivate the practice nurses in Leeds to become leaders.<br />
<br />
<strong>RF: Are you only working with practice nurses?</strong><br />
<strong>Melissa: </strong>That’s the main audience for our emailing list but the actual network spreads much wider than that: we’ve also got GPs, community matrons, CCG pharmacists, school nurses, prison nurses, secondary care nurses and respiratory consultants. And because of Twitter, we’ve got contacts right across the country and even internationally.<br />
It means we’ve got a really wide range of people we can turn to for information. We often schedule evening meetings with or email respiratory consultants to find out what’s new and what that means for practice nurses. Recently, for example, we did a leadership programme within the CCGs and focused it on the review of asthma deaths. So as part of that project, because of our network, we were easily able to meet with the respiratory and A&E consultants to see what was happening and how we could improve things.<br />
<br />
<strong>RF: What made you focus on respiratory?</strong><br />
<strong>Melissa: </strong>I just love respiratory. I’m really interested in it but I was also shocked when I looked at the atlas of variation and saw that that Leeds was one of the worst performing areas in the country in terms of respiratory care. When I looked at the INHALE [Interactive Health Atlas for Lung conditions in England] report, I saw that our area was significantly worse for a lot of things: COPD admissions, emergency admissions, recording FEV1s.<br />
So it makes you want to do something about it. Because here in primary care, this is where the majority of patients are seen – we’ve got all these people, but not necessarily enough healthcare practitioners with the right training to treat them properly. But if we can learn to manage patients better in primary care, there won’t be as much demand on hospitals, there won’t be as many unplanned admissions. In the long term, these are the sorts the things we’d like to help change.<br />
<br />
<strong>RF: Do you think the network can really reduce this variance in your area?</strong><br />
<strong>Melissa: </strong>We set up the network to try and improve things through education. We felt that if we improved the education of the nurses – particularly in relation to respiratory reviews – hopefully in the longer term that would have better outcomes for patients in Leeds. So that’s why we originally started with the educational meetings in the evening and then we set up the emailing list.<br />
<br />
<strong>RF: Do you think this is filtering down to impact patient care already?</strong><br />
<strong>Melissa: </strong>Yes I think so. We get emails from nurses in the network asking questions and we try and find out the answers and send it out to the group as a whole so they’re all learning from each other. Some people might want to ask a question but they daren’t, or someone else has asked it, so we just share the answers out to everyone. People are saying to us that they’ve learned a lot.<br />
We’ve also got the CCG pharmacists and the lead nurses from the CCGs on our network, so we’re sending out all the messages and information we get to them as well – we think it is influencing what CCGs prioritise.<br />
For example, one of the CCGs is now focussing on their medicines management for respiratory, stepping down high dose steroids in asthma and COPD. They have also just employed an asthma specialist now – we hope we’ve been a positive influence in decisions like that.<br />
<br />
<strong>RF: You’ve been going more than 15 months – what do you think are your key achievements?</strong><br />
<strong>Melissa: </strong>Organising the event in October 2014 with PCRS, our joint conference day. I think that was our biggest achievement because we wanted to do it and we managed to pull it off exactly year after we first started. Because of the speakers that we had like Professor Mike Morgan [Respiratory National Clinical Director] and others, we just feel like it was a real achievement to get people like that to come along.<br />
I also think that it was a turning point as well for the people who attended the event, especially the practice nurses; I think they understood at that point why we set up the network and why it is important. I feel like they really got on board with us after that.<br />
<br />
<strong>RF: You’ve been very proactive in using social media – what sort of difference has that made?</strong><br />
<strong>Melissa: </strong>We’ve got about 80 people we contact directly on our emailing list, but our social media network is much broader than that – we’ve got a lot of contacts on Facebook and on Twitter we’ve got more than 800 followers.<br />
In particular I think it’s helped us network nationally. We’ve met people through Twitter that we wouldn’t have met otherwise – we would never have been aware of them. They’re very knowledgeable and they’ve helped us, we can get advice from them and they support us as well.<br />
<br />
<strong>RF: What advice would you give to anyone else thinking of setting up their own network?</strong><br />
<strong>Melissa: </strong>Just do it. It’s easy. It doesn’t cost anything – well it hasn’t cost us anything. It doesn’t take up a lot of time. And you get a lot of satisfaction – especially when the nurses tell us we’re making a difference and they can trust us with their queries.<br />
<strong> </strong><br />
<strong>RF: You’re working in a relatively new health landscape – has your role change since the introduction of CCGs?</strong><br />
<strong>Melissa: </strong>My role as a practice nurse has not changed since the introduction of CCGs. But it’s because of the way that CCGs work that we had the idea of setting up Leeds Respiratory Network and now we are developing further to set up a social enterprise. We’ve realised that there is a gap in the market.<br />
When I first heard about the setting up of CCGs, I thought it could be a bad thing, fragmenting care due to opening up to private providers. But now we can actually use this to our advantage.<br />
I’ve been attending the CCG meetings for quite a while now. It’s good to hear what’s going on, what the plans are and have a little bit of a voice. And that influence could be growing as commissioners are starting to become more aware of our network. For example, I’ve got a meeting arranged next week with a commissioning GP to discuss end-of-life care for respiratory patients in Leeds.<br />
<strong> </strong><br />
<strong>RF: What are your plans going forward?</strong><br />
<strong>Melissa: </strong>We would like to evaluate the progress of our network formally. But this year we will be focusing on setting up our social enterprise. We’ve secured funding now from two grants so we’re just waiting for some legal advice on which structure to use before we formally establish it.<br />
The idea of the social enterprise will be to go to GP clinics and do their asthma and COPD reviews, basically because there’s a shortage of qualified practice nurses in these areas. You could say it’s going to be like a nursing agency but only providing respiratory care. All profits will go back into the business.<br />
Who knows how far it could go? The idea to start with is to offer standard respiratory reviews to GP practices. But we might move on to offer cost-saving exercises – reducing the costs and improving the quality of your respiratory services – at a practice level or even at a CCG level.<br />
<br />
<strong>RF: And do you think Respiratory Futures can support you to achieve your goals?</strong><br />
<strong>Melissa: </strong>Yes definitely! Just having the support and backing of Respiratory Futures gives us more confidence to go knocking on the CCG doors with ideas of how we think respiratory services can be improved in Leeds. We learn so much about respiratory commissioning from professional workshops, these are another support mechanism to make us stronger and get our voice heard.<br />
<br />
We would like to thank PCRS and Respiratory Futures for the support and guidance you give us!<br />
<br />
<strong>RF: Thanks very much. This all sounds really interesting – good luck and keep us updated!</strong><br />
<strong>Melissa: </strong>Thanks – we will do!<br /><br /><br />
<a href="http://www.respiratoryfutures.org.uk/umbraco/@RespNetwork"> </a><br />
<br />
<h3>
Email: leedsrespiratory.network@nhs.net Web: respiratorynetworkleeds.blogspot.co.uk Twitter: @RespNetwork</h3>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-46341342025597219892015-10-18T14:12:00.000-07:002015-10-18T14:12:47.064-07:00
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 12pt;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #365f91; font-family: "Century Gothic",sans-serif; font-size: 22pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent1; mso-themeshade: 191;">Stepping Down Inhaled Therapy in COPD Patients</span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 12pt;">
<span style="color: #333333; font-family: "Century Gothic",sans-serif; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">POSTER SUBMITTED TO PCRS-UK ANNUAL CONFERENCE (2014)</span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 12pt;">
<b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Authors:</span></b><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Canavan M<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Affiliation of first author:</span></b><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
The Practice Lincoln Green, Leeds<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Brief outline of context</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
There is an increased risk of serious but non-fatal pneumonia in COPD patients
prescribed ICS . Kew et al (2014). Patients are often over treated with
ICS the aim was to identify those patients and step down inhaled
therapy.<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Brief outline of problem</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Many patients with COPD are over treated with ICS, this could be
due to a lack of awareness of other causes for respiratory symptoms.<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Assessment of problem and analysis of its causes</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Airway reflux is an unrecognised agent provoking the symptoms of respiratory
disease. Airway reflux is unlike gastro-oesophageal reflux disease
(GORD). GORD is liquid acid reflux causing heartburn and indigestion. Airway
reflux consists of mainly gaseous non-acid mist which, when deposited in the
airways leads to inflammation, fibrosis, bronchoconstriction and cough.
(Morice, 2013)<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Strategy for change</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
We began to use the Hull cough questionnaire in practice with COPD patients
complaining of cough to identify patients with airway reflux. Patients
identified as having reflux were treated as per protocol from</span><a href="http://www.issc.info/" target="_blank"><b><span style="color: #660000; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">http://www.issc.info/</span></b></a><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">. Once the symptoms improved we proceeded to stop combined
inhalers in favour of LABA and/or LAMA.<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Measurement of improvement</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Exacerbations were reduced and symptoms improved as demonstrated by improved
CAT scores. A CAT score of minus 2 is significant, CAT scores
improved by up to 10 once reflux was managed. Using the GSK POINTS audit we
found that in the 12 month period 17 COPD patients had stopped the combined
inhaler in patients who had FEV1 above 50%. GOLD 2014 recommended that
COPD is not managed solely on FEV1 as this is a poor descriptor of disease
status. This was also taken into account when discontinuing combined inhaler.<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Effects of changes</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Addressing airway reflux improved quality of life and also reduced costs. For 2
consecutive years The practice made the most savings relating to respiratory
care within the CCG resulting in an underspend. Lincoln Green saved £12,071 on
respiratory medicines, whereas most practices within the CCG increased spending
on average £6,680<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Lessons learnt</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Rather than increasing inhaled therapy in the first instance,
other conditions such as airway reflux and rhinitis should be
assessed.<br />
<br />
</span><b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">Message for others</span></b><span style="color: #31849b; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent5; mso-themeshade: 191;">:</span><span style="color: #333333; font-family: "Century Gothic",sans-serif; font-size: 14pt; mso-bidi-font-family: Tahoma; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><br />
The Hull cough questionnaire is quick and easy tool that can
be implemented in practice for respiratory patients with a cough.
Addressing airway reflux improves quality of life, reduces cost and also side
effects from potent steroids. This can help with the GRASP tool for COPD to
reduce the number of patients with FEV1 above 50% on combination inhalers.<br />
<br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 0pt;">
<span style="font-family: "Century Gothic",sans-serif; font-size: 11pt; mso-bidi-font-size: 10.0pt;"><o:p> </o:p></span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-80396695716382281112015-06-16T12:21:00.000-07:002015-06-16T12:21:01.457-07:00NRAD report - Delivering Excellence Locally - What changes have you made?
<br />
<div class="page" title="Page 33">
<div class="section">
<div class="layoutArea">
<div class="column">
<span style="font-family: 'FoundrySans'; font-size: 20.000000pt; font-weight: 700;">Delivering Excellence Locally
</span><br />
<span style="color: rgb(0.000000%, 29.249998%, 64.999998%); font-family: 'FoundrySans'; font-size: 18.000000pt; font-weight: 700;">Practice Nurse is inspired to improve asthma care
after reading NRAD report
</span><br />
<span style="font-family: 'FoundrySans'; font-size: 12.000000pt; font-weight: 700;">Francesca Robinson </span><span style="font-family: 'FoundrySans'; font-size: 12.000000pt;">talks to </span><span style="font-family: 'FoundrySans'; font-size: 12.000000pt; font-weight: 700;">Sarah Anderson, </span><span style="font-family: 'FoundrySans'; font-size: 12.000000pt; font-style: italic;">Respiratory Leader,
Yorkshire
</span><br />
</div>
</div>
<div class="section" style="background-color: rgb(80.580002%, 87.026401%, 94.800001%);">
<div class="layoutArea">
<div class="column">
<span style="font-family: FoundrySans; font-size: 11pt;">Featuring initiatives led by PCRS-UK members around the UK, supported by PCRS-UK programmes
and tools
</span><br />
</div>
</div>
</div>
<br /><div class="layoutArea">
<div class="column">
<span style="font-family: FoundrySans; font-size: 9pt;">A practice nurse, who recently joined the PCRS-UK Clinical Leadership
Programme, has launched a series of changes to improve asthma care
in her practice after reading the National Review of Asthma Deaths
(NRAD) report.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">“You can't read a report like that and then not do anything about it, I
would not have been able to sleep at night,” says Sarah Anderson, who
is respiratory lead for her Leeds practice.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">“When the report came out a year ago I realised it needed action. I
started to question my own practice and started thinking about the
wider picture and what we could do to improve the care we provide
for over 800 people with asthma in this practice.”
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">First Sarah gave a presentation to her GPs who were surprised when
they heard about the findings and recommendations of the report.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">Then she printed out a list of patients who had received more than 12
prescriptions of salbutamol in a 12 month period – some had had more
than 36 inhaler issues in that time. She called in the patients on this
list that she felt were having problems with their asthma control. She
reviewed them and educated them on using their inhalers after finding
that many were unsure how they worked.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">“If the patient’s compliance is poor I explain to them about the NRAD
report and its findings. Often they are quite surprised and tell me they
didn’t realise people still died as a result of having asthma. I’ve noticed
this knowledge has increased their compliance. Some patients are now
coming in more regularly if they are not feeling so well – before they
just used to wait until their annual review,” says Sarah.
</span><br />
</div>
<div class="column">
<span style="font-family: FoundrySans; font-size: 9pt;">Nurses in the practice were using different asthma action plans so
Sarah has now standardised this, recommending that everyone uses
the Asthma UK Action Plan. She has inserted a link to the plan into
the asthma template.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">Sarah has also worked to improve communications between the prac-
tice and secondary care to speed up the process of receiving docu-
ments after patients have been to accident and emergency (A&E) and
have been admitted to hospital following an exacerbation. Now the
practice admin team sends her a note informing her when a patient
has been discharged so they can be followed up within 48 hours.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">Sarah has also disseminated information about the NRAD report and
shared the changes she has made in her own practice with the PCRS-
UK affiliated Leeds Respiratory Network, she set up in 2013 with
colleague Melissa Canavan.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">She works only three days a week in her practice and has had to find
the time to make these changes mainly by snatching ten minutes here
and there in between patient appointments.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">“You could spend all day every day sorting out respiratory issues but
unfortunately as a practice nurse I can’t spend all my time doing this.
It is very rewarding to be able to make the changes and see the care of
patients improve. In time we will need to audit the process”.
</span><br />
<span style="font-family: FoundrySans; font-size: 9pt;">“It has also been exciting to see the enthusiasm and passion for im-
proving asthma care that has been rubbing off among colleagues in
the Respiratory Network which has been expanding rapidly since we
set it up in October 2013,” says Sarah. </span><br />
</div>
</div>
</div>
</div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-70469678193308772652015-06-14T11:19:00.000-07:002015-06-14T11:19:42.500-07:00The Fear of Death<span style="font-family: Arial, Helvetica, sans-serif;">On 19th May 2015 I was in Manchester airport about to leave England for a
trip of a lifetime to Kathmandu. It was 3 weeks since the first devastating
earthquake hit Nepal. I had already planned the trip before the earthquakes, to
stay at Kopan Monastery ( </span><a href="https://web.nhs.net/OWA/redir.aspx?SURL=Y_EnWID1KvfZ4ilZ_euVykmRFIdMOufSG7-qkqSrBmFmkqLg43TSCGgAdAB0AHAAOgAvAC8AdwB3AHcALgBrAG8AcABhAG4AbQBvAG4AYQBzAHQAZQByAHkALgBjAG8AbQAvAA..&URL=http%3a%2f%2fwww.kopanmonastery.com%2f" target="_blank"><u><span style="color: blue;"><span style="color: blue; font-family: Arial, Helvetica, sans-serif;">http://www.kopanmonastery.com/</span></span></u></a><span style="font-family: Arial, Helvetica, sans-serif;">) for Buddhist teachings on death and dying. The trip was for my
personal spiritual development but also to see if I could transfer anything I
had learnt into my daily practice. I am on a bit of mission at the moment to try
and improve the end of life care for respiratory patients in Leeds. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Waiting to board the plane was one of the weirdest experiences I have ever
felt. I was truly living in the moment, something I had never been able to
achieve before. I wasn't looking back and I could see no future. I really didn't
know what to expect, except I thought I was going to a place like hell. I also
wondered if I would ever walk back through these gates again. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">When the first earthquake hit all my friends and family asked if I was still
going, of course I was! They accepted it but when the second earthquake hit they
obviously all became very worried. No one wanted me to go, everyone was asking
me to cancel. Before the earthquake came I had said to my mum there was a deeper
meaning for me to go to Nepal I didn't know what it was but I had to go. Maybe
if I hadn't had that feeling I would have possibly cancelled, who knows? But I
just knew I had to go and that I would be ok. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">It was quite an emotional time with people saying negative things, that I
shouldn't go, that I was selfish. I was trying to reassure them that it would be
ok. My new mantra for this year has been "it will be fine!" Then suddenly I had
a thought! How ignorant I had been! I was feeling like nothing could happen to
me and that I will live forever. But in reality something could happen to me,
after all I was going for teachings on death and dying, and that we are not as
permanent as we seem to think. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">So I thought I should plan for the worst just in case. Trying to talk about
death and planning things with family and friends was like talking to a brick
wall! No one wanted to discuss things with me and they wouldn't listen to my
wishes, some even started to get a little angry! So I decided to write some
letters with my wishes instead, I got quite emotional writing them. Not for
myself but for my family I would be leaving behind. They would be upset and
angry with me and maybe I was selfish. I hoped they would understand if anything
did happen. Previously I was very scared of death, but I'm not scared to die
now. If I would have died I would have been quite happy with the life I have
lived, I don't have any regrets. If I didn't go to Nepal I would have regretted
it for the rest of my life and I really don't want to die with any regrets! </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">When I arrived in Nepal I was so shocked at how normal everything seemed, it
was like nothing had happened, life goes on! I really hadn't expected that. As
we left the airport in the taxi all the roads were manic, then a random cow
would cross the road and slow all the traffic down. We drove past tent cities,
and places where buildings had collapsed in between busy shops. I had never
experienced anything like it. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">During my time there we experienced a few aftershock tremors and earthquakes
that were quite scary at times. One night I was laid in my tent and all I could
hear was the sound of heavy rain, thunder and lightening. At the same time I
could feel the earth moving underneath me I started to feel the fear rise in me
I really thought I might die. What could I do? The aim for Buddhists and
everyone else for that matter is to have a peaceful death. I decided to say some
mantras in my head to pacify the thoughts which seemed to work as the fear
disappeared and I felt at peace. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Another time I was in the library on the first floor when an earthquake came,
the whole building started shaking but I just panicked and froze! I didn't know
what to do or what to think, about 1000 thoughts raced through my mind all at
once. There was a monk with me and I just looked at him for guidance, we didn't
say anything to each other we just stayed still and then it eased off. We both
kind of relaxed a bit and I must have had the look of relief but then it came
back again! Come on let's go! He shouted and we both ran out of the room, down
the stairs and into the courtyard. My heart was beating, my legs were shaking
and I was scared! </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">The night before we came home, we were laid in the tent and an earthquake
came. It was awful because we could hear the people down below in the valleys
screaming then shouting at each other. I guess to see if they were all ok. I
felt lucky because I would be out of there this time tomorrow, but felt sad at
the same time these people could not escape it. There was no where to run or no
where to hide.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">The whole experience did make me realise how we take this life for granted.
Obviously I thought a lot about death and how we deal with it in western
society. We don't like to talk about death do we? As a nurse I had felt
uncomfortable talking about death up until about two years ago. I was at the
PCRS annual conference and there was a session on palliative care. I was sat
next to a doctor and we had a little discussion. I said oh I don't talk about
end of life!! That's not my job, I leave it to the district nurses or community
matrons etc. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><span style="font-family: Arial, Helvetica, sans-serif;">Why not? She asked, do you not think it would be nice for you to have those
kind of conversations as they know you and you have a relationship with them.
Why did I not have these kind of conversations with people? I was scared! I
didn't know what to say to them, I didn't want to upset them by saying the wrong
thing. I didn't know what I was doing, I haven't had any training on this kind
of thing. I was full of negative excuses, that were all fear based but it did
get me thinking! </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">After that I slowly pushed myself to start to overcome my fears. If a patient
made a comment like "I'm going to die anyway" when discussing things like
smoking cessation, I didn't dismiss it. I started to ask questions, well have
you thought about when you die? What would you like? Do you have a will?
Gradually over time my conversations are getting better and patients have been
thankful for the conversations. I still have a long way to go but I will keep
trying! As clinicians we are lucky now, PCRS have developed some tools to help
us with end of life care. </span><a href="https://web.nhs.net/OWA/redir.aspx?SURL=ffT67jqVjYimnM4j4YUu5ZtCoaU3RHnlJjReE8zG9p1mkqLg43TSCGgAdAB0AHAAcwA6AC8ALwB3AHcAdwAuAHAAYwByAHMALQB1AGsALgBvAHIAZwAvAGUAcQB1AGkAcAA.&URL=https%3a%2f%2fwww.pcrs-uk.org%2fequip" target="_blank"><span style="font-family: Arial, Helvetica, sans-serif;">https://www.pcrs-uk.org/equip</span></a><span style="font-family: Arial, Helvetica, sans-serif;"> hopefully they will help more people receive better end of life
care.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Mel</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"> </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">P.S If people like to fundraise for
charities or would like to donate to a children's home that we found please
contact </span><a href="https://web.nhs.net/OWA/redir.aspx?SURL=45Rl0Xa_qyGq56-IURBBArhNEO2Rpx3UNgJUGbvnQx1mkqLg43TSCG0AYQBpAGwAdABvADoAbABlAGUAZABzAHIAZQBzAHAAaQByAGEAdABvAHIAeQAuAG4AZQB0AHcAbwByAGsAQABuAGgAcwAuAG4AZQB0AA..&URL=mailto%3aleedsrespiratory.network%40nhs.net"><span style="font-family: Arial, Helvetica, sans-serif;">leedsrespiratory.network@nhs.net</span></a><span style="font-family: Arial, Helvetica, sans-serif;">
. This home rescues children
who are trafficked, abandoned and sold by their parents. The home has been
totally destroyed by the earthquakes and they are quite
desperate.</span><br />
<span style="font-family: Arial;"></span><br />
<span style="font-family: Arial;">#RespEd #COPD #EOL #Nursing #compassion </span>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-38219600110249081762015-05-09T11:28:00.002-07:002015-05-09T11:28:28.135-07:00NHS Change DayLeeds Respiratory Network featured as story 79 for #NHS Change Day 100 days of change (2014 )read the story here <a href="http://changeday.nhs.uk/story79/">http://changeday.nhs.uk/story79/</a>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-32260792277578756902015-04-19T11:37:00.003-07:002015-04-19T11:37:38.324-07:00Leadership & Ice Skating <div dir="ltr" style="-webkit-text-size-adjust: auto; font-family: Tahoma;">
<span style="color: black; font-family: Tahoma; font-size: x-small;"><div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">When it was suggested I write a blog yesterday, I was on my way to the ice rink with my children. Whilst skating on the ice, I was thinking about the uncomfortable situations I have been finding myself in lately on this leadership journey. I got to thinking that actually leadership is just like ice skating. Some people just sit at the edge and watch while others step on the ice. Some people walk and talk on the ice, while others bump, fall, slip and trip, slide, glide and skate and some……. just dance.</span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<br /></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">Some people will get on the ice fall over and never go back on, due to reasons such as fear, embarrassment and hurt. Other people will fall but get back up and keep on trying. Others will keep pushing themselves because they want to be the best they can. To become the best takes practice and patience. In this time they will fall and stumble lots of times, they will get tired, angry, frustrated. They may feel like they are not good enough a fake and a fraud. But they don’t give up, they keep on trying and then one day, they can dance!</span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<br /></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">The good thing about ice skating is that anyone can do it! Young, old, rich or poor. Same as leadership you can be a cleaner or a consultant, student or nurse. It doesn’t matter how qualified or unqualified you are. You just have to have the patient’s best interest at heart. To be able to dance on the ice, you have to lose your ego! Stop thinking, what others will think. Stop thinking that you’re not good enough, that you haven’t done it for long enough. </span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">The NHS needs YOU and your patients also need YOU to …….. just dance!</span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">Be creative and innovative, take risks, and be brave because remember the problems we face cannot be solved at the same level of thinking they were at when they were created. </span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">So thank you to all the people who have taught us how to ice skate and now helping us to dance! The people who have supported, inspired, encouraged and believed in us. Too many individuals to mention but from organisations such as PCRS, School of Health Care Radicals, NHS Changeday, ARNS, Education for Health, Respiratory Futures, NHS leadership Academy, Leeds CCG’s, The Practice PLC, Leeds Respiratory Network, Leeds Teaching Hospital Staff, UnLtd, Leeds Community Foundation, SEE ahead.</span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">Mel</span></div>
<div class="x_MsoNormal" style="margin: 0cm 0cm 8pt;">
<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 17px;">#RespEd #Respiratory #Leadership </span></div>
</span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-83015107792135251712015-04-19T00:07:00.001-07:002015-04-19T00:07:28.836-07:00Follow us on Twitter<br style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;" /><span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;">Follow us on </span><a class="ot-hashtag aaTEdf" href="https://plus.google.com/u/0/s/%23Twitter" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #417fec; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px; text-decoration: none;">#Twitter</a><span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;"> @RespNetwork </span><a class="ot-hashtag aaTEdf" href="https://plus.google.com/u/0/s/%23Nurses" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #417fec; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px; text-decoration: none;">#Nurses</a><span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;"> </span><a class="ot-hashtag aaTEdf" href="https://plus.google.com/u/0/s/%23Nursing" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #417fec; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px; text-decoration: none;">#Nursing</a><span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;"> </span><a class="ot-hashtag aaTEdf" href="https://plus.google.com/u/0/s/%23Asthma" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #417fec; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px; text-decoration: none;">#Asthma</a><span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;"> </span><a class="ot-hashtag aaTEdf" href="https://plus.google.com/u/0/s/%23COPD" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #417fec; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px; text-decoration: none;">#COPD</a> <span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;"></span><a class="ot-hashtag aaTEdf" href="https://plus.google.com/u/0/s/%23Respiratory" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; color: #417fec; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px; text-decoration: none;">#Respiratory</a><span style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: auto; background-color: #fefefe; color: #212121; font-family: Roboto, Arial, Helvetica, sans-serif; font-size: 14px; line-height: 20px;"> Disease :)</span>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-64393108202489325362015-04-18T13:26:00.002-07:002015-04-18T13:26:29.471-07:00The Power of Storytelling <div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">This afternoon it was suggested that I write a blog on the power of storytelling. The first thought that went through my mind, is the same thought that usually does when someone suggests I do something new. “OMG I can’t do that!” But this year I promised myself that I will face my fears, do everything that scares me and push myself to do the things that I don’t want to do! It must be getting easier now because I didn’t have all the usual fear and panic that goes with that thought, today it was just the thought.</span></span></div>
<div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<br /></div>
<div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">So storytelling, well some of you might know that recently I have been on a journey. I felt the next phase on the journey was story telling as I kept reading articles about this. But I was scared who would want to hear my stories? What stories could I tell? As I said I have been pushing my boundaries and this week I have presented for the first time solo. I don’t like I presentations, I don’t like standing in front of people talking, I would much prefer that someone else does it but I pushed myself to do it when the opportunity arose. On the first night we had some technical errors and I had to present without slides. But I was ok, I survived they said they had enjoyed it and learnt new things. Wow people actually enjoyed it, how could I make it better next time I thought to myself.</span></span></div>
<div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<br /></div>
<div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">I have just started the NHS leadership frontline program and that night I decided to do some of the online learning. I had to think of a leader that had inspired me and what was it about them that had inspired me. When I thought about the person I had in mind, she was a great story teller, she brought her presentations to life. Instead of just telling us what she wanted us to know she gave great examples of how this had benefited the patients. I thought this is how I can make my presentation better I had briefly told some stories but I had been too nervous in case they didn’t like them, they needed more depth.</span></span></div>
<div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<br /></div>
<div class="x_MsoNormal" style="-webkit-text-size-adjust: auto; font-family: Tahoma; margin: 0cm 0cm 8pt;">
<span style="font-size: small;"><span style="font-family: Calibri;">So the next night for my second presentation I told more story’s and in more depth! I spoke about my 36 year old patient with severe COPD who is now a grandma. Another female patient who previously had lots of hospital admissions, but when she stopped smoking and started swimming she hasn’t been in hospital since. I gave lots of examples of success stories as we went through the presentation and the feedback was excellent! The delegates had loved it, they were definitely going to make changes and I really enjoyed the night too.</span></span></div>
<span style="-webkit-text-size-adjust: auto; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16px;"></span><br />
<div class="x_MsoNormal" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; color: black; font-family: Tahoma; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; margin: 0cm 0cm 8pt; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">
<span style="font-family: Calibri; font-size: small;">Mel </span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-39168191960019652192014-11-05T12:20:00.000-08:002014-11-05T12:20:35.003-08:00Follow us on Twitter<br />
<div class="post-footer" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; color: #999999; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 1.6; margin: 0.5em 0px 0px; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">
</div>
<br />
<div class="post-body entry-content" id="post-body-2874850296431083015" itemprop="description articleBody" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 1.4; orphans: auto; position: relative; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; width: 578px; word-spacing: 0px;">
Follow us on #Twitter @RespNetwork #Nurses #Nursing #Asthma #COPD #Respiratory Disease :)<br />
<div style="clear: both;">
</div>
</div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-43525137624546916532014-09-28T03:15:00.000-07:002014-09-28T03:15:29.216-07:00UK launch for Teva's COPD/asthma inhaler<a href="http://www.pharmatimes.com/Article/14-09-03/UK_launch_for_Teva_s_COPD_asthma_inhaler.aspx?utm_source=HCP+E-Newsletter&utm_campaign=45d967ec8b-HCP_Newsletter_September_2014&utm_medium=email&utm_term=0_7109f09163-45d967ec8b-341103549" target="_blank">http://www.pharmatimes.com/Article/14-09-03/UK_launch_for_Teva_s_COPD_asthma_inhaler.aspx?utm_source=HCP+E-Newsletter&utm_campaign=45d967ec8b-HCP_Newsletter_September_2014&utm_medium=email&utm_term=0_7109f09163-45d967ec8b-341103549</a> #Asthma #COPD #RespiratoryAnonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-33746107796131494232014-09-27T05:41:00.002-07:002014-09-27T05:43:46.694-07:00Emergency Salbutamol Inhalers in Schools<span style="background-color: rgba(255, 255, 255, 0);">From 1 October 2014 UK schools will be allowed to purchase a salbutamol inhaler without a prescription for use in emergencies when a child with asthma cannot access their own inhaler.</span><br>
<span style="background-color: rgba(255, 255, 255, 0);"><br></span>
<span style="background-color: rgba(255, 255, 255, 0);">This guidance is for schools who CHOOSE to purchase emergency Salbutamol inhalers stating </span><span style="background-color: rgba(255, 255, 255, 0);">that this is a </span><span style="font-family: ArialMT; font-size: 12pt;">discretionary</span><span style="font-family: ArialMT; font-size: 12pt;"> </span><span style="background-color: rgba(255, 255, 255, 0);">power enabeling schools to purchase only if they wish. </span><br>
<span style="background-color: rgba(255, 255, 255, 0);"><br></span>
<span style="background-color: rgba(255, 255, 255, 0);">Included in this guidance is information on how to recognise an Asthma attack and what to do during an Asthma attack.</span><br>
<span style="background-color: rgba(255, 255, 255, 0);"><br></span>
We feel that this should be compulsary and not left up to the individual school to decide. It will be interesting to see how many schools follow this guidance... Watch this space!<br>
<br>
Alongside this we believe that schools who do purchase emergency inhalers should have training from a qualified healthcare professional with respiratory qualifications. <a href="https://www.gov.uk/government/publications/emergency-asthma-inhalers-for-use-in-schools?utm_source=HCP+E-Newsletter&utm_campaign=45d967ec8b-HCP_Newsletter_September_2014&utm_medium=email&utm_term=0_7109f09163-45d967ec8b-341103549" target="_blank">https://www.gov.uk/government/publications/emergency-asthma-inhalers-for-use-in-schools?utm_source=HCP+E-Newsletter&utm_campaign=45d967ec8b-HCP_Newsletter_September_2014&utm_medium=email&utm_term=0_7109f09163-45d967ec8b-341103549</a>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-90042719833260701282014-09-24T13:34:00.000-07:002014-09-24T13:34:02.563-07:00Practice Nurse Peer Review in General Practice <h2 style="font-weight: normal; max-width: 100%;">
<span style="background-color: rgba(255, 255, 255, 0);">Interesting discussions today regarding practice nursing peer review of COPD patients during the CCG locality/Lead nurse meeting.</span></h2>
<span style="background-color: rgba(255, 255, 255, 0);"><br />How can we improve the care we provide, has been and always will be the million dollar question!<br /><br />How do we address the variation in Practice..... This is something Leeds Respiratory Network has been trying to achieve for a long time! This question is music to our ears!<br /><br />Out thoughts....<br /><br />Every Practice should have a clinical lead for respiratory care.<br /><br />Minimun standards of education for Practice Nurses who perform Respiratory reviews moving away from see one do one.<br /><br />Educational standards during training should include mentorshp, secondary and community care involvement.<br /><br />Standardisation of review requirements - Templates & Care Plans.<br /><br />FEV1 for annual review obtained by full spirometry and not COPD6 used for screening.<br /><br />Implementation of current up to date evidenced based guidelines. Not following the guidelines that were around when if at all respiratory qualifications were recieved.<br /><br />Enocrporate the QIPP agenda through appropriate prescribing and minimising waste. This is your responsibility not someone else's. We all have a duty to reduce cost in the NHS wheather we like it or not.<br /><br />Holistic review of the COPD patient to encoporate social assessment.<br /><br />Referral onto external agencies such as smoking cessation and pulmonary rehabilitation - influence patients with passion and excitement about these services in order to achieve improve outcomes.<br /><br />Don't be afraid of talking about end of life care!<br /><br />Just to name a few #COPD #Leadership #Respiratory #Education #PalliativeCare<br /><br /></span>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-54594890299732235202014-09-23T12:17:00.000-07:002014-10-12T14:02:13.010-07:00Leeds Respiratory Network Conference<br>
<div class="post-footer" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; color: #999999; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 1.6; margin: 0.5em 0px 0px; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">
</div>
<br>
<div class="post-body entry-content" id="post-body-8027028910823599592" itemprop="description articleBody" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.301961); -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: white; color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 1.4; orphans: auto; position: relative; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; width: 578px; word-spacing: 0px;">
<div class="tlAboveUnit" style="margin-top: 10px;">
<span class="tlActorText" style="background-color: rgba(255, 255, 255, 0);">Limited places available for the first Leeds Respiratory Network Conference in conjunction with PCRS on 22nd October 2014 Leeds England. Check out our exciting agenda #COPD #Asthma #Respiratory #Nursing #Palliativecare </span></div>
<br><div class="tlBelowUnit" style="margin: 14px -8px -9px;">
<div class="_5k8f" style="padding: 4px 10px 6px;">
<a href="https://www.pcrs-uk.org/civicrm/event/info?id=36&reset=1" style="color: #6699cc; text-decoration: none;" target="_blank">https://www.pcrs-uk.org/civicrm/event/info?id=36&reset=1</a><div class="_5ibf" style="-webkit-box-orient: horizontal; -webkit-box-pack: justify; box-sizing: border-box; display: -webkit-box;">
<div class="_5ibi" style="-webkit-box-flex: 1; display: -webkit-box; max-width: 300px;">
<a data-mustcapture="1" href="https://m.facebook.com/pages/boosted_post/?pid=174522746084339&sid=290775694459043&refid=17" style="-webkit-touch-callout: none; color: #576b95; cursor: pointer; text-decoration: none;"></a></div>
</div>
</div>
</div>
<br><div class="tlUnitContent" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: none; -webkit-text-stroke-width: 0px; color: black; font-family: 'Helvetica Neue', Helvetica, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; margin-top: 10px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">
<div class="mhideout" data-sigil="m-hide-outside">
</div>
</div>
<div style="clear: both;">
</div>
</div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-42544956513289193442014-09-23T11:36:00.002-07:002014-09-23T11:39:28.594-07:00Chronic obstructive pulmonary disease: beclometasone/formoterol
(Fostair)<div style="text-align: start;">
<span style="background-color: rgba(255, 255, 255, 0);"><b>Evidence summary: new </b><b>medicine </b> </span></div>
<div>
<span style="font-size: 12pt;"><span style="font-family: arial, sans-serif;"><br></span></span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">'Evidence summaries: new medicines' provide summaries of key evidence for selected new medicines, or for existing medicines with new indications or formulations, that are considered to be of significance to the NHS. The strengths and weaknesses of the relevant evidence are critically reviewed within this summary to provide useful information for those working on the managed entry of new medicines for the NHS, <span style="font-weight: 700;">but this summary is not NICE guidance</span>.</span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);"><br></span></div>
<div>
<span style="background-color: rgba(255, 255, 255, 0);">From the published data, beclometasone/formoterol appears to work as well in COPD as the 2 commonly used ICS/LABA combinations, its constituent ingredients have been available for many years so their safety profile is known, it costs less than most alternatives and it can be used with a spacer, which many people with COPD need.<a href="http://www.nice.org.uk/Advice/ESNM47" target="_blank">http://www.nice.org.uk/Advice/ESNM47</a></span></div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-28748502964310830152014-09-22T13:59:00.001-07:002014-09-22T13:59:35.664-07:00TwitterFollow us on #Twitter @RespNetwork #Nurses #Nursing #Asthma #COPD #Respiratory Disease :)Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-3681362292745379722014-09-22T12:23:00.005-07:002014-09-22T13:32:31.484-07:00National Review of Asthma DeathsWhat changes have you made to your current practice following the publication of the National Review of Asthma Deaths in May 2014? #Asthma <a href="http://www.educationforhealth.org/news.php?id=272" target="_blank">http://www.educationforhealth.org/news.php?id=272</a>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-33486079080912480272014-09-22T12:12:00.000-07:002014-09-22T13:29:17.106-07:00Palliative Care Training Directory Leeds have launched a palliative care directory to provide access to educational resources for patients carers and healthcare professionals in order to promote end of life choices #palliativecare <a href="http://www.leedspalliativecare.co.uk/staff/training-directory/" target="_blank">http://www.leedspalliativecare.co.uk/staff/training-directory/http://www.educationforhealth.org/news.php?id=272</a>Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0tag:blogger.com,1999:blog-7993251136641734435.post-80270289108235995922014-09-21T08:53:00.001-07:002014-09-21T08:53:19.609-07:00Leeds Respiratory Network Conference <div class="tlAboveUnit" style="margin-top: 10px;">
<span class="tlActorText" style="background-color: rgba(255, 255, 255, 0);">Register today for the first Leeds Respiratory Conference in conjunction with PCRS on 22nd October 2014 Leeds England </span></div>
<br />
<div class="tlBelowUnit" style="margin: 14px -8px -9px;">
<div class="_5k8f" style="padding: 4px 10px 6px;">
<a href="https://www.pcrs-uk.org/civicrm/event/info?id=36&reset=1" target="_blank">https://www.pcrs-uk.org/civicrm/event/info?id=36&reset=1</a><div class="_5ibf" style="-webkit-box-orient: horizontal; -webkit-box-pack: justify; box-sizing: border-box; display: -webkit-box;">
<div class="_5ibi" style="-webkit-box-flex: 1; display: -webkit-box; max-width: 300px;">
<a data-mustcapture="1" href="https://m.facebook.com/pages/boosted_post/?pid=174522746084339&sid=290775694459043&refid=17" style="-webkit-touch-callout: none; color: #576b95; cursor: pointer; text-decoration: none;"></a></div>
</div>
</div>
</div>
<br />
<div class="tlUnitContent" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.235294); -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: none; -webkit-text-stroke-width: 0px; color: black; font-family: 'Helvetica Neue', Helvetica, sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; margin-top: 10px; orphans: auto; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">
<div class="mhideout" data-sigil="m-hide-outside">
</div>
</div>
Anonymoushttp://www.blogger.com/profile/03113980109074372525noreply@blogger.com0