Practitioner Development UK
Provides ongoing (because healthcare professionals never stop learning) continued professional development for advanced nurse practitioners, GPs, junior doctors, practice nurses, health visitors, school nurses, district nurses, radiologists, paramedics, pharmacists and other healthcare providers.
Being good at your job isn’t good enough. You need to prove you’re committed to developing your competence as a healthcare professional and set goals for further advancement. Our training courses help you address your continuing development needs and build your CPD portfolio.
Access all areas
Ready to become more proficient today? Start now by completing one of our innovative online eLearning courses. It only takes two hours to whiz through the questions, move forward in your career and enhance your standards of patient care. We offer a wide range of online courses, including:
The first steps in recognising the acutely ill child – a free taster
An introduction to the assessment of minor head injuries
An introduction to paediatric minor injuries
Essential ophthalmic assessment in primary care
An introduction to skin infections
Dementia – understanding and dealing with challenging behaviour
PDUK’s in-house events set the CPD bar high by providing a tailor-made and cost-effective way to train your team. Our expert tutors will help your workforce keep abreast of current practice and fill any gaps in their knowledge and skills.
Following their training, besides deriving a sense of fulfilment from the course, staff will feel empowered in their ability to deliver the best healthcare service they possibly can to patients. Programmes include:
Sepsis; early recognition and management
Telephone triage for HCAs and receptionists
Medicines optimisation and reducing polypharmacy
Palliative and end-of-life care: what you need to know
An introduction to travel health
Immunisation training for community pharmacists
Pain management in 8-18 year olds
Contraception and sexual health workshop for staff working with sexually active young people
Red dot training for radiographers
IV therapy workshop
PDUK’s scheduled courses for Spring/Summer 2019
Hone skills and make high standards standard practice with our tried-and-tested scheduled courses:
Five-day patient assessment skills workshop CPD SO Accredited
Minor injury essentials RCN Accredited
Minor surgical procedures
Minor ailments essentials RCN Accredited
NMP essentials for common long-term conditions CPD SO Accredited
Annual NMP V300 update course CPD SO Accredited
Paediatric examination made easy CPD SO Accredited
IH79 Examination of the new born RCN Accredited
Under the microscope:
Post-hospital problems for older people
It costs the NHS around £396 million every year. It causes distress and harm to recently discharged older patients but the damage it wreaks is potentially preventable in 50 per cent of cases. What is it? Medication.
According to a new study by Brighton and Sussex Medical School (BSMS) and King’s College London, published in the Journal of Clinical Pharmacology, more than one in three (37 per cent) of older patients experience medication-related harm (MRH) within the first eight weeks after being discharged from hospital.
The PRIME study involved five hospitals and 1,280 patients with an average age of 82 years, in the south of England. Patients and their carers were interviewed by senior pharmacists, who also reviewed GP records and analysed hospital readmissions. The senior geriatricians and pharmacist who scrutinised the results found that MRH most commonly occurred as a result of the toxicity of the medicine itself. In a quarter of cases, non-adherence caused the harm. Opiates, antibiotics and benzodiazepines were found to pose the highest risk.
The importance of monitoring medication regimens
The most common MRH events were gastrointestinal (25 per cent) or neurological (18 per cent). Conditions suffered by the patients included serious kidney injury, irregular heart rhythms, psychological disturbance, dizziness, confusion, constipation, falls and bleeding.
The study’s senior author, Professor Chakravarthi Rajkumar, chair of Geriatrics and Stroke Medicine at BSMS, said: ‘As the use of medicines in the ageing population is rapidly increasing, it is vital that we improve awareness among clinicians of the harm that medicines commonly cause. The risk-to-benefit analysis is particularly complex in the older population. Once medicine is initiated, there should be a tentative stop date, monitoring of correct usage and vigilance for adverse reactions.’
Professor Graham Davies, professor of Clinical Pharmacy and Therapeutics at the Institute of Pharmaceutical Science, Kings College London and senior author, said: ‘In order to reduce the number of older people being harmed by their medicines, it’s important that their medication regimens are closely monitored within the community. Pharmacists should work in close collaboration with prescribers to support the safe use of medicines.’
Read the full study here.
On the case:
Recovering from a fall
A sociable chap, 79-year-old Burt has always been very active in the community and is renowned for his comedy routines on stage. In the summer, he enjoys playing outdoor bowls.
Since his wife died and he moved to a flat six months ago, Burt has found life difficult. He’s had a couple of falls at night, the last requiring an ambulance response team to help him up off the floor. Since then he hasn’t been out much, has lost weight and spends much of his time asleep in a chair. His fridge contains out-of-date food and his flat smells of urine.
Having been fit and healthy all his life, Burt has no significant medical history. He walks with a slight limp, the result of being shot in his right leg while in service, aged 22.
Burt is alert and answering questions although he frequently turns to his daughter for reassurance. He recalls falling but denies feeling dizzy, breathless or having chest pain.
Pulse: 80 bpm regular; BP: 140/80 sitting; 130/70 standing. Temp: 37.0. Chest clear.
Burt has a slight tremor in his hand as it rests on the chair arm. As he gets up from the chair his movement is stiff, and he takes a second to take his first step. His right leg is weaker. He says he feels low and has lost his appetite, reporting that nothing tastes right.
What would your diagnosis be? (One or more may be correct):
A – Parkinson’s disease (PD)
B – depression
C – urinary tract infection (UTI)
D – dehydration/malnutrition.
Answer: Each one of these diagnoses – or a combination of them – is possible. Each one will need to be ruled out or clarified and treated to ensure that Burt is given the best chance to improve.
A – Parkinson’s disease often first presents with non-specific symptoms. Initial symptoms are one sided. Burt was noted to have a tremor in his hand at rest and increased stiffness in his leg and arm movements.
B – Depression is also a symptom of PD. Alternatively, Burt could be experiencing reactive depression following his bereavement, house move, lifestyle changes and subsequent loneliness.
C – The prevalence of UTI in men increases with age. It can also be related to abnormalities in the urinary tract such as prostate enlargement or a urethral stricture, so needs further investigation. Parkinson’s disease can affect nerve supply to the bladder, so it doesn’t empty properly, which may cause Burt to wake up at night more frequently.
D – Burt says he’s lost his appetite and the out-of-date food in the fridge bears this out. A reduced sense of smell (also associated with PD) and taste can affect appetite. Elderly people are also not always aware when they are thirsty. Eating and drinking is also a social activity and loneliness can reduce our drive to eat and drink. Poor nutrition and hydration will affect Bert’s immune system and kidney function, hinder healing and contribute to his lack of energy and feelings of depression.
Assessment of older people is often complex. The initial consultation (in this case for a fall) provides the opportunity to proactively review using a comprehensive geriatric assessment and to maximise opportunities to build an older person’s resilience. While specialist referral for a Parkinson’s diagnosis to a neurologist or geriatrician is required, prompt multifactorial assessment and support can do much to reduce the impact of Burt’s issues.
Initially, take a good history of urinary and bowel symptoms and obtain a mid-stream urine (MSU) sample to identify infection. As Burt is not unwell, it’s best to do the MSU test first and find out sensitivities before treating. You should also examine Burt’s abdomen, palpating his bladder for signs of retention. Encourage fluids and give safety advice in case his symptoms increase before the urine result is obtained. If Burt is able, get him to keep a bladder diary including fluid intake, to support decision making at the follow-up consultation.
Burt should be referred for an outpatient appointment for specialist diagnosis for PD. Meanwhile, his needs must be addressed without delay. Many new community services are in place to respond promptly when an older person starts to display frailties in their health and well-being.
The best action would be to refer immediately to a one-stop rapid assessment clinic for older people (RACOP), available in many areas now. Burt should receive a comprehensive geriatric assessment by a multidisciplinary team, including a full medical review and assessment. They can devise a proactive plan to build resilience against increasing frailty and slow deterioration.
If this is not available in your area, occupational and physiotherapy assessment can provide treatment plans and equipment to prevent further falls and rebuild confidence post fall. This should start in general practice with regular monitoring, preferably by the same person. There are many tools available to support assessment and monitoring in primary care available in The BGS toolkit for comprehensive geriatric assessment in primary care settings.
Want to get better at your role?
The best way to develop your expertise while boosting your continuous professional development is to complete one (or more) of Practitioner Development UK’s continuing professional development (CPD) courses.
Whether you want to gain specialist knowledge of a particular subject, improve your clinical skills or work on your personal attributes, we can help.
Our new brochure offers myriad opportunities for meaningful CPD, including:
1 Scheduled events: centrally located workshops where you can build on your knowledge and engage with like-minded contemporaries;
2 eLearning courses: a super-convenient resource that enables you to learn online, whenever and wherever you like;
3 In-house programmes: the flexible option, these are tailored for your staff’s needs and run by us at a location of your choice.
Try our Helping older people live well for longer in-house event. Or take advantage of a quiet hour or two to whiz through our online Dementia- understanding and dealing with challenging behaviour course.
• PDUK. We help everyone get better.
Soline Jerram answers your questions.
Q1 I have noted that some of our older patients are confused after surgery. Can you explain what factors contribute to postoperative confusion?
A1 Confusion following surgery can be caused by a condition called delirium. Factors that increase risk are age, hip fracture, severe illness and pre-existing cognitive impairment/dementia1. There are many reversible causes of delirium which need prompt attention. For example, it can be caused by a reaction to drugs (anaesthetic and or pain medication), dehydration, infection, or could indicate potential cardiac problems. If a patient has hearing or sight problems, extra care is needed to prevent them becoming confused by the busy hospital environment.
It is important to recognise signs of delirium as it can indicate a serious underlying problem. The symptoms of delirium can vary greatly from one individual to another and can be quite subtle so input from those who know the patient is essential.
Q2 Older people are frequently on multiple medications. What issues should the health professional consider when dealing with polypharmacy?
A2 It is not unusual for older people to have several conditions which need treatment with medication. Medications are added when a new symptom occurs, or illness is diagnosed. As we get older, the risks associated with multiple medication and side effects increase as our body systems become less efficient; for example, our kidneys at excretion, or our gut at absorption.
Health professionals must ensure that:
A: They understand what the medication is for;
B: They know what adverse side effects to look for and report;
C: The patient takes the correct dose of medication at the right time.
It is also important that the patient’s full medication history including over-the-counter drugs is considered whenever a new medication is started. This must be reviewed by a prescribing practitioner at least yearly and more frequently if there are high-risk medications. Regular appropriate blood tests must be taken to check kidney and liver function. Review of medication should also include discussion to stop medication when it is no longer required or the burden of taking it outweighs the benefits. Use of the STOPP/START medication review tool2 can support the decision making.
- Delirium: prevention, diagnosis and management (2010) https://www.nice.org.uk/guidance/cg103
STOPP/START Toolkit: Supporting Medication Review https://www.networks.nhs.uk/nhs-networks/nhs-cumbria-ccg/medicines-management/guidelines-and-other-publications/Stop%20start%20pdf%20final%20Feb%202013%20version.pdf/view
About our expert Soline Jerram
During her 40-year nursing career, Soline Jerram has held posts as an advanced nurse practitioner and consultant nurse for older people and has also been a director of quality and safety. She is now a hospice trustee and an independent best interest assessor and reviewer for the LeDeR programme.