Carter Review Research Articles

An Economic Analysis of Critical Care Nurse Resourcing Following the Uptake of Ready-to-Administer Noradrenaline for Hypotensive Shock in Adults in England

IntroductionReady-to-administer formulations for intravenous administration of noradrenaline are now broadly recommended and predicted to reduce pressure on critical care nursing. This analysis sought to quantify the nurse resource released from national level transition.MethodsThe annual number of noradrenaline support days for hypotensive shock was determined and the administration of noradrenaline was simulated over 24 h using a decision tree. A ‘best-practice’ ready-to-administer strategy (RtA) of volumetrically pumped noradrenaline was compared to a ‘nil uptake’ strategy (AfC) of bedside prepared solution delivered either volumetrically or using a double syringe pump. A mix of noradrenaline concentrations, flow rates, product sizes, and preferences for ampoule pooling, preparation volume, and sterility were included. The consumption of nurse days and product units was then projected over 1 year for a population of adults in critical care in England.ResultsNoradrenaline was administered over 231,011 days per year across 4123 critical care beds in England. Implementing a transition from AfC to RtA strategies on this scale released 35,791 nurse days or 176 whole-time nurse equivalents at 50/50 NHS band 5 and 6, a monetised release of £11.6 million. There was an increase in drug acquisition cost of £2.1 million using the licensed commercial product Sinora®. Annual net monetary benefit was + £9.5 million, or + £65,961 per critical care unit (CCU) of 29 beds, equivalent to one nurse released per unit for patient care.ConclusionsThis modelling of ready-to-administer noradrenaline with volumetric delivery quantifies and bears out the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations for safe and resource-effective critical care.

Ambulances, outdoor air quality and health

Journal of Paramedic PracticeVol. 11, No. 7 CommentAmbulances, outdoor air quality and healthBelinda LindenBelinda LindenEmail for correspondence:E-mail Address: [email protected]Former Cardiac Nurse and Independent Consultant, DevonSearch for more papers by this authorBelinda LindenPublished Online:10 Jul 2019https://doi.org/10.12968/jpar.2019.11.7.302AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Committee on the Medical Effects of Air Pollutants. The effects of long-term exposure to ambient air pollution on cardiovascular morbidity: mechanistic evidence. 2018. https://tinyurl.com/y4fk3xvg (accessed 29 June 2019) Google ScholarDepartment for the environment, food and rural affairs. Daily air quality index. 2019. https://uk-air.defra.gov.uk (accessed 29 June 2019) Google ScholarGilkes D. Emergency services: urgent care. Transport Engineer. 2019. https://tinyurl.com/y5b7k554 (accessed 29 June 2019) Google ScholarGOV.UK. Clean air strategy. 2019: executive summary. 2019. https://www.gov.uk/government/publications/clean-air-strategy-2019/clean-air-strategy-2019-executive-summary (accessed 29 June 2019) Google ScholarNational Audit Office. NHS Ambulance Services. 2017. https://www.nao.org.uk/report/nhs-ambulance-services/ (accessed 29 June 2019) Google ScholarNational Institute for Health and Care Excellence. Air pollution: outdoor air quality and health [QS181]. 2019. https://www.nice.org.uk/guidance/qs181 (accessed 29 June 2019) Google ScholarNHS Improvement. Lord Carter's review into unwarranted variation in NHS Ambulance trust. 2018. https://tinyurl.com/y5usvyn3 (accessed 29 June 2019) Google ScholarNHS Improvement. 2019–20 Standard ambulance vehicle specification. 2019. https://tinyurl.com/yyxqg9bq (accessed 29 June 2019) Google ScholarPolicy Connect. The health effects of air pollution: time to act – briefing paper. 2018. https://tinyurl.com/y63vx296 (accessed 29 June 2019) Google ScholarSheldon A, Hill L. Scoping ambulance service emissions: A literature review and quality improvement recommendations. J Para Pract. 2019; 11(7):305–312 Abstract, Google ScholarWorld Health Organization. Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulphur dioxide. Global update. 2005. https://tinyurl.com/y54v9aux (accessed 29 June 2019) Google ScholarWorld Health Organization. Ambient (outdoor) air quality and health factsheet. 2018. https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health (accessed 29 June 2019) Google Scholar FiguresReferencesRelatedDetails 2 July 2019Volume 11Issue 7ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 10 July 2019 Published in print 2 July 2019 Information© MA Healthcare LimitedPDF download

The Carter review: how are hospitals measuring up?

The Carter review: how are hospitals measuring up?

A trigger for change? Two years on from the Carter review

A trigger for change? Two years on from the Carter review

Using the care hours per patient day tool: one hospital's experience.

This article examines one hospital's journey to improve the way in which the nursing workforce was used. A clear message in Lord Carter's review for the Department of Health ( Carter, 2016 ) was to drive efficiency and work towards being the 'model hospital'. With the introduction of the care hours per patient day, a new rota management system, and a review of the establishment tool used, the hospital has developed a way of real time tracking of nursing time against patient care needs on a ward-by-ward basis. The trust also used a newly developed establishment tool to triangulate and articulate particular patient care requirements.

Make better use of hospital pharmacists in mental health, says second Carter review

Make better use of hospital pharmacists in mental health, says second Carter review

Second Carter review will "release hospital pharmacists from paperwork"

Second Carter review will "release hospital pharmacists from paperwork"

E-Roster policy: Insights and implications of codifying nurse scheduling.

Following a decade of dissemination, particularly within the British National Health Service, electronic rostering systems were recently endorsed within the Carter Review. However, electronic rostering necessitates the formal codification of the roster process. This research investigates that codification through the lens of the 'Roster Policy', a formal document specifying the rules and procedures used to prepare staff rosters. This study is based upon analysis of 27 publicly available policies, each approved within a 4-year period from January 2010 to July 2014. This research finds that, at an executive level, codified knowledge is used as a proxy for the common language and experience otherwise acquired on a ward through everyday interaction, while at ward level, the nurse rostering problem continues to resist all efforts at simplification. Ultimately, it is imperative that executives recognise that electronic rostering is not a silver bullet and that information from such systems requires careful interpretation and circumspection.

Deconstructing the Carter Review: competing conceptions of quality in England’s ‘school-led’ system of initial teacher education

The commitment to establish a ‘school-led’ system of teacher education in England, announced by the Coalition Government in 2011 and relentlessly pursued thereafter, represented a radical departure from previous kinds of initial teacher education partnership. While it is entirely consistent with a neoliberal agenda, with its strong regulatory framework and appeal to market mechanisms, it is also underpinned by a particular conception of teaching as a craft – ‘best learnt as an apprentice observing a master craftsman or woman’. In 2014, the government established a Review of Initial Teacher Training, led by a primary school head teacher, Sir Andrew Carter. This signalled the recognition of teacher education as a ‘policy problem’, adopting Cochran-Smith’s term. The ensuing report, published in early 2015, was more nuanced than might have been anticipated, although a number of profound tensions emerge from a closer analytical reading; four of these tensions are similar to those previously defined by Cochran-Smith and two are newly emergent. This paper identifies and discusses these tensions as they appear in the Carter Review and relates them to wider debates about the links between teaching, teacher education, evidence and research and to policy-making processes in education.

The care hours metric: a useful tool?

hours’ suggested in the Carter review (2015) is another example of a national proposal that has divided the opinion of many. We all know that there is no single metric that will satisfy trusts, regulators or indeed the public. Yet, for me, the care hours metric concept is important nevertheless. The notion of measuring care hours is not new: the ‘Productive Ward’ series (NHS Institute for Innovation and Improvement, 2011) saw us measuring direct and indirect nursing care to enable the elimination of waste and maximise nursing care hours. More recently, Safer Staffing: A Guide to Care Contact Time (NHS England, 2014) explored the principles of safe staffing and shared case studies to enable senior nurses to select appropriate tools to support decision making to secure safe staffing. So what is the care hours metric? The Carter review (2015) recommended that the care hours per patient per day become the principal measure of nursing and caresupport deployment in the NHS from April this year. It is calculated by adding the hours of the registered nurses to healthcare support workers and dividing the total by every 24 hours of inpatient admissions. Lord Willis, a fellow peer of Lord Carter, has objected to this metric, viewing the monitoring of care hours as ‘too blunt a tool’ and stating that the care metric could be ‘meaningless’ for workforce planning, arguing that it does not sufficiently take into account the skills of different parts of the workforce The care hours metric: a useful tool?

Productivity still 'not good enough' says Carter review.

Productivity still 'not good enough' says Carter review.

Barriers to doctors successfully delivering leadership in the NHS

Leadership will be essential to deliver the changes outlined in the Five year forward view and to ensure that the efficiencies identified in the Carter Review are delivered. To achieve the scale of savings outlined in these papers, while maintaining the quality and safety of care, all NHS staff will need to be involved in and to take the lead in identifying wasteful practice and procurement and, more importantly, to become the agents of change and architects of innovative and high-quality practice. However, many barriers exist to successful leadership by doctors in the NHS. In this article we present qualitative data from interviews with senior NHS leaders identifying several real-word barriers that need action to maximise the success of the medical profession in leading these changes.

The Carter review through the eyes of a hospital pharmacist

The Carter review through the eyes of a hospital pharmacist

Carter review calls for more clinical pharmacists to be deployed by NHS trusts

Carter review calls for more clinical pharmacists to be deployed by NHS trusts

Apply the Carter review principles into community pharmacy

Apply the Carter review principles into community pharmacy

Use staff wisely to save NHS money.

The NHS could save up to £ 2 billion a year by improving workflow and containing workforce costs, according to Labour peer Lord Carter's review of NHS efficiency. Changes in areas such as rostering and management of annual leave must avoid increasing the pressure on staff.

What has the Coalition Government done for the development of initial teacher education?

The past five years have seen significant changes to the structures and content of routes to Qualified Teacher Status (QTS) in this country, and to the balance of contributions to these routes between schools and higher education (HE). Such developments do not always address emerging knowledge about the needs of beginner teachers; further, changes have implications for teacher further professional development as well as for the health of education research in this country. However, changes have catalysed overdue evaluation of more established routes and a priori thinking about how such needs could best be met. The Carter Review (DfE, 2014b) offers some useful ways forward that should be complemented by rigorous evaluation of the range of outcomes of initial teacher education over short, medium, and long terms, making full use of the evidence base.

Disentangling posterror and postconflict reduction of interference.

Conflict monitoring theory (CMT; Botvinick, Braver, Barch, Carter, & Cohen Psychological Review, 108, 624-652, 2001) states that response conflict, the simultaneous activation of two competing responses, increases task focus and reduces interference from irrelevant information. CMT also defines errors as conflict, and reduced interference effects have consistently been reported following errors (Ridderinkhof Psychological Research, 66, 312-323, 2002). However, previous computations of this posterror reduction of interference (PERI) have overlooked the congruency of the previous trial. This is problematic, because most errors are made on incongruent trials, creating a confound between (previous) accuracy and (previous) congruency. Therefore, it is likely that reduced interference following errors is in fact the congruency sequence effect (i.e., reduced interference following incongruent, relative to congruent, trials). Our results corroborate this idea by demonstrating that participants indeed showed significant PERI following a congruent trial, but inverse PERI following an incongruent trial. These findings are discussed in light of the adaptation-by-binding account (Verguts & Notebaert Psychological Review, 115, 518-525, 2008, Trends in Cognitive Sciences, 13, 252-257, 2009).

Managing demand for laboratory tests: a laboratory toolkit

Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, while maintaining quality. Laboratory testing has not escaped this pressure, particularly since pathology investigations cost the National...

Probation work and NOMS

With the centenary of the probation service less than a year away, it looks increasingly unlikely that probation work will continue into its second century in a shape that has any significant continuity with the past. Following the Carter Review (2003), probation is in the process of radical ‘modernisation’. The intentions are laudable: to reduce re-offending, and thus contain the burgeoning prison population. But the strategy carries big risks. The NOMS reforms have three main elements that relate to probation: