The concurrent use of 5 or more medications by one individual – is becoming increasingly a challenging phenomenon that demands attention at clinical policy and practice level. In the past decade, the average number of items prescribed for each person per year in England has increased by 53.8% from 11.9 to 18.3. It is 35-50% of community older people aged 65 years and above take 5 or more medications. The King’s fund ¹ published in November 2018 a report “Polypharmacy and medicines optimisation: Making it safe and sound” where they distinguished between the terms ‘appropriate’ and ‘problematic’ polypharmacy.
Appropriate polypharmacy: means prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and the medicines are prescribed according to best evidence.
Problematic polypharmacy where multiple medications are prescribed inappropriately, or where the intended benefit of the medication is not realised.
Here at NIHR CLAHRC Wessex we have had the privilege to work with some very talented and determined people who have signed up to become an NIHR Trainee. It’s a demanding process where you are supported to carry out research, normally for a PhD, while continuing often in your day job, be that in the NHS or University. The NIHR has now set up an Academy to support trainees.
More than twenty have made it through the process and we wanted to capture their experience to help others who may be considering the idea. We asked them four questions:
What have I got from being a trainee?
What advice would you give to someone who’s thinking about applying?
Dr Kate Lyle is a Research Fellow based in Health Sciences at the University of Southampton
Professor Catherine Pope is Deputy Director NIHR CLAHRC Wessex
Dr Kate Lyle is a Research Fellow in Health Sciences at the University of Southampton and Professor Catherine Pope (right) is Deputy Director of NIHR CLAHRC Wessex
As academics, practitioners, and users of healthcare services we are all used to hearing about examples of successful interventions that have improved health services and care. Indeed one of the core aims of the NIHR CLARHC programme is to improve patient outcomes locally and across the wider NHS. Here in Wessex we have been working hard over the past 5 years to do just that, spreading best practice and evidence based research throughout the NHS.
But what about the things that don’t work? Attempts at service improvement or innovation that went nowhere? Often these are the things we don’t hear about. Yet, arguably there is as much to learn from our failures, as there is from successful innovations.
Not so long ago CLAHRC East of England Research Capacity in Dementia Care Programme (RCDCP) joined forces with the University of Southampton Alzheimer’s Society Doctoral Training Centre to provide a European Summer School for 17 dementia care doctoral students. Hosted by the University of Linköping in Sweden, the programme enabled participants to share ideas, build international partnerships, and learn from leaders in dementia care research.
Professor Jackie Bridges explains some of the lessons we can learn about caring for people with dementia.
She was particularly struck by the approach of a day centre she visited whilst on the trip.
One of the great things about being involved with CLAHRC Wessex has been the opportunity to engage with other research teams around the country doing similar work. A group of us have been part of a network of people across England, Scotland and Wales who are interested in acute kidney injury (AKI). A challenge with AKI research is that it can be misleading if you don’t use the same methods and definitions to define the condition.
Dr Melinda Taylor, Senior Research Fellow in Organisational Behaviour, NIHR CLAHRC Wessex Data Science Hub
The first blog in this series described how health professionals in our study found it difficult to define ‘frailty’ but agreed that it was an extremely broad concept with no defined boundaries. This has an impact on training in frailty care. This second blog outlines our participants’ views on frailty care training.
Our study evaluated particular aspects of four initiatives intended to enhance the care provided to people regarded as frail. The diverse nature of the initiatives further demonstrates the complex nature of frailty.
I remember being asked in my interview for nursing why I wasn’t applying to be a doctor. There’s no simple answer to ‘what nursing is’ or ‘what it means to me’ but the answer I gave then is probably as close as I’ll ever get.
I’m not that interested in disease but I am interested in people. Nursing is about supporting and helping people, often through their most difficult times. While it’s hard to distinguish this from many other caring professions the key (to me) is that the focus is on the person comes first and the rest follows.
We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.
The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.
Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.
Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.
National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1). It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).
When people talk about managing mental health the most frequent thing to do is to recourse to self help or looking to services to help. There is less recognition of the power of social networks for help and support based on connections and reciprocity around us.
Separating out the individual from their need for other people and ability to mobilise resources in order to manage effectively, has meant that the notion of a personal community of support (the array of personal ties with which people are located and embedded) has not tended to be included in understanding or responding to mental health need.
Now there’s a nascent social movement about networks.
This site promotes independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Funding Scheme. The views expressed in this blog are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health