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Drug and Therapeutics Bulletin (DTB): July–December 2014
Nicotine and health
Nicotine, an alkaloid derived from the leaves of tobacco plants (Nicotiana tabacum and Nicotiana rustica), is the primary addictive agent in tobacco products. There are different ways of administering the various products including smoking cigarettes, chewing tobacco, holding moist snuff in the mouth, inhaling dry snuff through the nose, inhaling smoke from a waterpipe and inhaling vapour from an electronic cigarette. It can be difficult to differentiate the effects of nicotine from the many other toxic substances these products also contain. We review the pharmacological effects of nicotine, but we will not review the well-known harmful effects of cigarettes, where it is primarily the toxins and carcinogens in tobacco smoke rather than the nicotine that cause illness and death. A future article will consider the use of electronic cigarettes (DTB 2014;52:78–81).
Zoely: a new combined oral contraceptive
Zoely is the second estradiol-containing oral contraceptive formulated as an ‘extended regimen’ (pill-free interval <7 days) to be licensed in the UK. However, unlike the quadraphasic estradiol-containing contraceptive Qlaira, it is a monophasic preparation. The company considers Zoely an option for women ‘who want a contraceptive with hormones similar to her own’, and claims that it has a high level of contraceptive efficacy, produces shorter, lighter periods compared with a 21-day regimen of drospirenone 3 mg/ethinylestradiol 30 µg (Yasmin) and that most women report no negative impact on weight and skin. In this article, we review the effectiveness and place of Zoely (DTB 2014;52:90–3).
Relvar Ellipta for asthma
Relvar Ellipta (GlaxoSmithKline) is a dry powder inhaler that contains a corticosteroid (fluticasone furoate) and a long-acting β2 agonist (vilanterol trifenatate). It is licensed for once-daily use as maintenance therapy for chronic obstructive pulmonary disease (COPD) and asthma. In a previous article, we considered its use in the management of COPD. In this article, we review the evidence for Relvar Ellipta in the treatment of patients with asthma (DTB 2014;52:93–6).
Potassium hydroxide 5% for the treatment of molluscum contagiosum
Molluscum contagiosum is a common reason for consultation in primary care. The condition is normally benign and self-limiting and the standard advice is to wait for the lesions to resolve spontaneously. Recently, potassium hydroxide 5% (MolluDab—Alliance Pharmaceuticals Limited) has been marketed in the UK for the treatment of the condition. It is sold as a medical device rather than as a licensed medicinal product. In this article, we consider the evidence for potassium hydroxide 5% in the management of molluscum contagiosum (DTB 2014;52:118–20).
Do electronic cigarettes help with smoking cessation?
Smoking causes around 100 000 deaths each year in the UK, and is the leading cause of preventable disease and early mortality. Smoking cessation remains difficult and existing licensed treatments have limited success. Nicotine addiction is thought to be one of the primary reasons that smokers find it so hard to give up, and earlier this year DTB reviewed the effects of nicotine on health. Electronic cigarettes (e-cigarettes) are nicotine delivery devices that aim to mimic the process of smoking but avoid exposing the user to some of the harmful components of traditional cigarettes. However, the increase in the use of e-cigarettes and their potential use as an aid to smoking cessation has been subject to much debate. In this article, we consider the regulatory and safety issues associated with the use of e-cigarettes, and their efficacy in smoking cessation and reduction (DTB 2014;52:126–9).
Faecal microbiota transplantation
The use of faeces for the treatment of gastrointestinal diseases was described in fourth century Chinese medicine for the treatment of severe diarrhoea. Recently, there has been renewed interest in this unconventional biological therapy, particularly for the treatment of recurrent Clostridium difficile infection (CDI) and, to a lesser extent, inflammatory bowel diseases (IBD). Faecal microbiota transplantation (FMT) involves the introduction of enteric bacteria from the faeces of healthy donors in order to restore a healthy balance of bacteria in the gut. In March 2014, the National Institute for Health and Care Excellence issued guidance on the use of FMT for the treatment of recurrent CDI that has failed to respond to antibiotics and other treatments. In this article, we review the use of FMT in CDI and IBD (DTB 2014;52:141–4).
Articles are accompanied by an MCQ-based CME/CPD module.
BLOG and slideshow
The unknown unknowns: crowdsourcing research through social media
In this guest post blog and associated slideshow, Marie Ennis-O'Connor argues that patients are the most under-utilised resource in healthcare and challenges researchers to start filling the knowledge gaps and working towards better health outcomes by involving patients.
Clinical guideline publications
RNAO Clinical Best Practice Guideline
Person-centred and family-centred care: (May 2015)
http://rnao.ca/bpg/guidelines/person-and-family-centred-care
This Best Practice Guideline (BPGs; formerly Client Centred Care) was developed to promote evidence-based practices associated with person-centred and family-centred care to assist nurses and other healthcare providers acquire the knowledge and skills necessary to practise person-centred and family-centred care. Person-centred and family-centred practices should be used by nurses and other members of the interprofessional healthcare team to enhance the quality of their partnerships with the person to ultimately improve their clinical outcomes and experience of care through use of the evidence-based practices, which formed the basis of this guideline's recommendations.
Canadian Association of Wound Care and RNAO
Diabetic Foot Canada e-journal
http://www.diabeticfootcanadajournal.ca/
This online, peer-reviewed publication is a quarterly journal that provides readers with current, practical information related to the care of persons with diabetes and how to prevent and treat foot complications. It is targeted at interdisciplinary healthcare professionals to support their practice and to improve patient outcomes.
RNAO Clinical Best Practice Guideline
Engaging clients who use substances (March 2015)
http://www.rnao.ca/substanceuse
This guideline has been developed to address the question of how to assess and manage people with substance use disorders. It provides evidence-based recommendations to all nurses and the interprofessional team who provide care in all healthcare settings to individuals related to Mental Health and Addictions.
The intent of this document is to assist all nurses and the interprofessional team to focus on evidence-based strategies, within the context of the healthcare professional–client relationship. It is further acknowledged that individual competencies of nurses may vary among nurses and across categories of nursing professionals. These competencies are based on knowledge, skills, attitudes and judgement enhanced over time by experience and education.
National Institute for Health and Care Guidance
Safe staffing for nursing in adult inpatient wards in acute hospitals (July 2014)
https://www.nice.org.uk/guidance/sg1
This guideline covers safe staffing for nursing in adult inpatient wards in acute hospitals. It recommends a systematic approach at ward level to ensure that patients receive the nursing care they need, regardless of the ward to which they are allocated, the time of the day or the day of the week.
The guideline identifies organisational and managerial factors that are required to support safe staffing for nursing, and makes recommendations for monitoring and taking action if there are not enough nursing staff available to meet the nursing needs of patients on the ward.
Skin cancer prevention: information, resources and environmental changes
http://www.nice.org.uk/guidance/ph32
This guidance is for National Health Services and other commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, preventing skin cancer. This includes, for example, general practitioners, local authority planners, pharmacists, practice nurses, public health practitioners, school nurses and skin cancer specialists. It also includes those involved in, or responsible for, employee health and well-being. In addition, it may be of interest to those working in the wider public, private, voluntary and community sectors and to members of the public.
The six recommendations aim to raise and maintain awareness—and increase knowledge—of the risks of exposure to natural and artificial ultraviolet. They also aim to influence attitudes and prompt people to change their behaviour to protect themselves against skin cancer. They focus on:
National mass media campaigns and the provision of local information (including verbal advice and printed and visual material);
Developing and evaluating information campaigns and interventions;
The factual content of information;
The tone of messages and how to tailor them for specific audiences;
The workplace—to help protect children, young people and outdoor workers;
The provision of shade as part of the design of new buildings.
Implementation and evaluation resources
RNAO Clinical Best Practice Guideline
Preventing and addressing abuse and neglect of older adults: person-centred, collaborative, system-wide approaches and Best Practice Success Kit: tools to support implementation of the guideline
http://www.rnao.ca/elder-abuse
A Best Practice Success Kit (below) contains easy-to-use resources to support uptake of the guideline at practice, education and policy, organisation and system levels.
Brochure: 10 strategies to help you address abuse and neglect of older adults for nurses and other healthcare providers.
Self-assessment tool for healthcare organisations.
Health Education Fact Sheet for Older Adults: Five Measures You Can Take to Protect Yourself (From Abuse and Neglect—to be used where best practices occur).
Political action toolkit for individuals and organisations advocating for change in the workplace/community.
Best Practice Guideline Pocket Guide.
Poster: ‘Role Models are Vital’.
RNAO eLearning course: preventing and addressing abuse and neglect of older adults
This online course is designed to increase awareness of the forms, signs and risk factors of abuse and neglect of older adults; encourage reflection on attitudes and approaches to caring for older adults; outline responsibilities for responding to situations of abuse and neglect; and explore complex challenges related to this issue. The course is available in English and French (coming soon) and is comprised of four modules, a knowledge check (quiz) and supplementary resources. The material presented builds throughout the four modules—the first module covers introductory concepts and is suitable for anyone who works with older adults; the second, third and fourth modules cover material that is suitable for nurses, other healthcare providers and supervisors who work with older adults and families. Each module contains learning activities that contain reflection and other relevant exercises to help support the core content. We encourage people to use the course for independent learning (eg, to build foundational knowledge, enhance professional development and reflective practice), for learning in small groups with colleagues or as a component of classroom or workplace education. Funding to develop this course was provided by the Government of Canada's Employment and Social Development Canada—New Horizons for Seniors Program.
RNAO and RPNAO
Primary care toolkit (August 2014)
http://rnao.ca/resources/toolkits/primary-care-toolkit
The Registered Nurses’ Association of Ontario (RNAO) and Registered Practical Nurses Association of Ontario, through funding from the Ontario Ministry of Health and Long-Term Care, partnered on the development of an online toolkit for primary care employers and their teams on maximising the scope of practice for registered nurses and registered practical nurses in primary care settings. The purpose of the toolkit is to assist employers and their teams in developing and reinforcing structures and processes to enable primary care registered nurses (RNs) and registered practical nurses (RPNs) to practise to their full scope, as per the Primary solutions for primary care: maximising and expanding the role of the primary care nurse in Ontario report. Anyone wishing to maximise nurses’ full scope of practice in primary care settings can benefit immensely from this evidence-based and practical toolkit.
Speakers bureau: mental health and addictions archived webinar series
http://www.rnao.ca/mentalhealth
The RNAO in partnership with Opioid Awareness Treatment & Education through the Centre for Addiction and Mental Health hosts a monthly webinar series on pertinent Mental Health and Addictions topics for nurses and other healthcare professionals. All webinars are achieved online and made available for future viewing. Webinars available include:
Nursing and Methadone Maintenance Therapy—13 May 2013
Opioids 101: Laying the Foundation—24 October 2013
Pregnancy and Substance Use—11 December 2013
First Nations and Aboriginal Youth and Substance Use—15 January 2014
Substance Use and Alcohol—Women, Pregnancy and After Birth—10 June 2014
Screening and Brief Intervention for Substance-Related Problems in Later Life—16 September 2014
Older Adults and Opioid Replacement Therapy Within Clinical and Community Settings—23 October 2014
Examining Substance Use in Older Adults–An Interactive Webinar—27 November 2014
Youth and Opioids: Sharpening Our Focus—8 December 2014
Laying the Groundwork: Engaging Substance Using Youth for the Long-Term—25 February 2015
Spotlight on Mindyourmind: Innovative Practices in Youth Substance Use Prevention—12 March 2015
Youth Mental Health Promotion @ School: Conditions, Capacity, Collaboration—8 May 2015
Back to basics: chronic disease management webinar series (October–November 2014)
http://rnao.ca/events/back-basics-chronic-disease-management-series-1
This repeat webinar series (previously offered in May 2014) was for healthcare providers and organisations looking to improve the use of evidence-based practices to prevent and manage chronic disease. This webinar learning series presented one learning module a week for five consecutive weeks. Each session lasted 2 h, with each module presenting a basic concept, model or theory known to be effective in practice to prevent and manage chronic diseases in clients at risk for the first hour, and in the second hour participants were introduced to leaders from various healthcare settings who have applied the concept, model or theory in practice.
Mental Health and Addictions eLearning Modules (August 2014)
The RNAO Mental Health and Addictions initiative has three eLearning resources that provide healthcare professionals with evidence-based concepts and tools to assist individuals who use substances. Topics include:
Engaging Youth Who Use Substances eLearning Module
Engaging Clients Who Use Substances
Addictions ELearning Series
RNAO Nursing Best Practice Smoking Cessation Initiative: webpage
The TobaccoFreeRNAO.ca website is an online resource that reflects current information related to best practices in tobacco and nicotine interventions, as well as provincial and initiative updates. This website hosts resources for free download including the Smoking Cessation Best Practice Guideline, Nursing Faculty Education Guide (NFEG) and the Implementation Toolkit. Past webinars can be accessed through this site along with four Smoking Cessation eLearning modules and the RNAO online community.
The Smoking Cessation Program launched a webinar series related to the RNAO NFEG. This 3-part webinar series features topics related to: an overview of the NFEG; utilising the guide to incorporate smoking cessation best practices into the nursing curriculum; and young adult smoking cessation engagement. All three webinars are available for review on the tobaccofreernao.ca website.
RNAO also hosted a Webinar series on smoking cessation best practices, which are available on the website, including:
Working with Pregnant and Postpartum Tobacco Users: The Smokers’ Helpline Experience (July 2014)
Respiratory Effects Across the Lifespan (August 2014)
Smoking and Smoking Cessation Therapies—The Evidence (September 2014)
Smoking and Smoking Cessation Therapies: The Evidence Mother Risk Program (September 2014)
E-Cigarettes: Navigating the Minefield (Melodie Tilson, Non-Smokers’ Rights Association (October 2014)
Impact of Nicotine Exposure on Maternal Health and the Developing Fetus and Child (November 2014)
Pregnets: A Tool on Quitting Smoking and Pregnancy (November 2014)
Pregnets: How to Help Women Quit or Reduce Smoking in Pregnancy and the Postpartum Period (February 2015)
Pharmacology and Smoking Cessation (March 2015)
Harm Reduction Approaches for prenatal and postnatal women and their families (March 2015)
RNAOs newest Smoking Cessation eLearning course: Supporting prenatal and postnatal women and their families who use tobacco is now available online.
RNAO Mental Health and Addiction Initiative: webpage
http://www.rnao.ca/mentalhealth
The Mental Health and Addictions Initiative is funded through the Ontario Ministry of Health and Long-Term Care to strengthen nurses’ capacity to integrate and sustain Mental Health and Addictions Best Practices in daily nursing practice. The Mental Health and Addiction Initiative webpage aims to bring awareness to the multicomponent strategies of the RNAO initiative and engage nurses in the uptake of best practices across clinical settings.
RNAO Communities Online knowledge exchange forum
RNAO Communities is the RNAO's professional networking website. It has been designed to be directly linked to the various guideline implementation projects within the IABPG portfolio. This site is a forum for debate and sharing among nurses locally, nationally and internationally as a way to gain knowledge related to guideline implementation.
There are six active communities:
Smoking Cessation Communities (three in total for Champions, Educators and SC Facilitators)
Best Practice Spotlight Organizations (BPSO) Community
Addictions and Mental Health Community
Nursing and eHealth Community
Long-Term Care Best Practice Coordinator's Community
Wound Care Community for Long-Term Care
The RNAO Communities site design has currently been updated to offer streamlined operation and enhanced navigation.
Nursing order sets
http://rnao.ca/bpg/initiatives/nursing-order-sets
The RNAO is developing vendor-neutral nursing order sets derived from its BPGs. The nursing order sets are comprised of clinically relevant evidence-informed nursing assessments, interventions and patient/client outcomes for a variety of topics related to women and children, addiction and mental health, skin and wound care, chronic diseases and functional care. The individual assessment and intervention statements are organised within the context of the nursing process and reflect nursing care at different phases along the health continuum: health promotion, primary care, acute care, home healthcare, long-term care (LTC) and end-of-life care. Each nursing order set is being mapped to the International Classification for Nursing Practice (ICNP)—a standardised terminology language with global application. Once integrated within an eHealth system, ICNP-encoded nursing order sets expedite knowledge translation, engender evidence-based practice and facilitate data retrieval for research and quality improvement. As of September 2014, 31 nursing order sets have been developed to complement 19 of the existing 41 clinical BPGs. Many of these address global health priorities identified by the WHO.
Nursing Quality Indicators for Reporting and Evaluation
RNAO continues to develop and deploy its international data system, Nursing Quality Indicators for Reporting and Evaluation (NQuIRE). NQuIRE collects, compares and reports data on nursing-sensitive indicators reflecting the structures, processes and outcomes of nursing care resulting from RNAO BPG implementation in national and international BPSO. NQuIRE currently offers indicator sets for 19 clinical nursing BPGs.
Nursing Orientation e-Resource for Long-Term Care
http://ltcorientationeresource.rnao.ca
The Nursing Orientation e-Resource for Long-Term Care (e-Resource) is designed for registered nurses, registered practical nurses, nurses in management positions and nurse consultants who practise in Ontario LTC homes. The e-Resource is organised into four knowledge domains: professional, role, clinical and organisational. Each knowledge domain contains up to five learning modules which include an introduction to the topic and practical activities to engage in, including eLearning modules, specific learning module resources to read and review and websites to explore. Links to information in the learning modules include regulatory, legislative and professional sources such as the College of Nurses of Ontario, Ministry of Health and Long-Term Care, RNAO Clinical and Healthy Work Environment Best Practice Guidelines and other leading provincial and national organisations. Content is regularly updated to reflect RNAO guideline content and other relevant resources.
Evidence-based policy resources
Rural, remote and northern area nursing task force
http://www.rnao.ca/ruralremote
This evidence-based policy document serves as the final report for a provincial task force which identified the enablers and barriers towards the retention and recruitment of nurses in rural, remote and northern communities. The task force's report also includes a set of 23 recommendations that, if fully implemented, will enable the sustainability of this workforce for generations to come.
A 70% full-time employment for nurses survey report
This report provides the findings of a provincial survey of nursing employers in the hospital and LTC home settings. The purpose was to get a snapshot of progress towards 70% full-time employment for nurses, and to identify opportunities and barriers from the perspective of employers. The report contributes to the expansion of the evidence base around nursing employment status and also includes a synthesis of the evidence accumulated to date.