District Nursing Manual of Clinical Procedures

Elizabeth O Brien is clinical team leader for district nursing in Croydon Primary Care Trust. She is involved in writing clinical guidelines clinical audit and benchmarking in connection with Croydon Primary Care Trust s clinical governance agenda.

“Overall a good manual that gives a good overview of the key aspects of a district nurses role . . . This book is ideally placed for student nurses, nurses new into the community setting and experienced district nurses as a reference guide to base their practice on.”  (Nursing Times, 31 January 2013)“As district nursing practice requires a pragmatic approach and adaptable skills, this manual is a useful resource.”  (Primary Health Care, 1 December 2012)“It is ideal for nursing students, newly qualified staff and return-to-nursing students and wanting to work in the community.  For more experienced staff it is a good point of reference.”  (Journal of Community Nursing, 1 July 2012)

• Contributors viii Foreword xPreface xiChapter 1 Assessment and communication (general principles) 1Background evidence 1The Single Assessment Process (SAP) 2Communication 6Conclusion 15References and further reading 15Chapter 2 Blood glucose monitoring for people with diabetes mellitus 19Background evidence 19Metabolic control (physiology of blood glucose) 20Urine versus blood testing 20Capillary blood glucose testing 20Blood glucose monitoring training and education 22Types of blood glucose monitoring system 23Limitations of blood glucose meters 23Contraindications for the use of blood glucose meters 23Maintenance and care of the meter 24References and further reading 26Chapter 3 Bowel management 28Background evidence 28Constipation 30Diarrhoea 38Irritable bowel syndrome 40Faecal incontinence 40Conclusion 46References and further reading 62Chapter 4 Discharge planning 65Background evidence 65Discharge planning process 65Community Care Delayed Discharge Act 2003 76Informal carers 76Risk management 77Training 78Conclusion 78References and further reading 82Chapter 5 Ear irrigation 84Background evidence 84Purpose of ear irrigation 84Preparation of the patient prior to irrigation 85Risk management 87Training 88Conclusion 88References and further reading 92Chapter 6 Infection prevention and control 93Glossary 93Background evidence 94Healthcare-associated infection (HCAl) 96The epidemiology of infection 97Infection prevention and control in the community 97Standards 99Outbreak of infection in the community 99Health clearance for healthcare workers 99Universal/Standard precautions 100Conclusion 120References and further reading 125Chapter 7 Intravenous therapy and central vascular access devices 131Background evidence 131Referrals 132Education and training 132Quality of life issues 134Peripherally inserted central catheters (PICCs) 135Skin-tunnelled cuffed catheters 138Implantable ports 140Administration of medications and/or infusions 142CVAD insertion complications 143Complications of CVADs 143References and further reading 174Chapter 8 Medicines management 177Background evidence 177Accountability, responsibility and consent 177Risk management 178Delegation of administration 179Storage 179Transportation of medication 180Transcribing 180Changes to medication doses 180Incident reporting 180Adverse drug reaction (ADR) 180Disposal 181Non-medical prescribing 181Administration 181Intravenous (IV) drug administration 183Diagnosis and management of anaphylaxis 183Conclusion 185References and further reading 199Chapter 9 Moving and handling 201Background evidence 201The legal aspects ofmanual handling 201Manual handling equipment 204Conclusion 207References and further reading 210Chapter 10 Nutritional support 211Background evidence 211Nutritional status and health 212Malnutrition 217Identifying patients at risk of malnutrition (initial nursing assessment) 217Nutritional risk screening tools 219Anthropometric assessment 221Diagnostic tests 222Referral to the community dietetic department 222Patients with weight loss/loss of appetite 227Patients who are overweight 229Nutritional support in the home 229Conclusion 242References and further reading 253Chapter 11 Personal hygiene 256Background evidence 256Assessment 256Multicultural needs 257Manual handling and risk assessment 258Conclusion 258References and further reading 271Chapter 12 Syringe driver/pump management and symptom control in palliative care 272Background evidence 272Education and training 273Prescribing and administering drugs in the community 275Using a syringe driver/pump 275Symptom management 281Crisis box 281Pain control 281Anxiolytics 285Terminal agitation/acute confusional state 285Anti-emetics 286Drugs used for excess secretions 286Drugs used for intestinal obstruction 286Steroids 286Rescue doses of medication 286Monitoring 287Reactions at the infusion site 287Ethical issues and consent 288Risk management 288Reporting adverse incidents 290Conclusion 291References and further reading 302Chapter 13 Urinary catheterisation and management 304Background evidence 304Risk management 304Training and education 304Catheter selection 304Anaesthetic/Lubricating gel 307Suprapubic catheterisation 307Intermittent catheterisation 308Meatal hygiene 309Drainage systems 309Infection 310Catheter blockage and encrustations 310Conclusion 312References and further reading 331Chapter 14 Venepuncture 333Education and training 333Anatomy and physiology 334Selecting a vein 335Improving venous access 336Selection of equipment 338Specimen handling and transportation 338Safety of staff 340Infection control issues 340Patients’ perspective of venepuncture 340 viiReducing pain during venepuncture 341Legal and professional issues 341Problem solving 342Conclusion 343References and further reading 346Chapter 15 Wound management 349Background evidence 349Wound healing 351Wound management 358Types of wound commonly managed by community nurses 365Procedural guidelines 378References and further reading 397Index 402