West Midlands Evidence Repository

WMER is an online repository that is managed by a consortium of West Midlands NHS Library and Knowledge Services. Our aim is to collate, store and make available research and other non-traditional publications by our NHS organisations.

Please see below for the full list of WMER organisations. If you wish to engage with us as we develop the repository, please contact us via email: wmnhskr@gmail.com

Please note deposit of items within WMER does not mean endorsement of the research or any opinions expressed within it by the consortium organisations.

Communities in WMER

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Now showing 1 - 10 of 10

Recent Submissions

Open Access
Adult annual reviews at the WM Adult Cystic Fibrosis Centre (WMACFC) : a service improvement project
(University Hospitals Birmingham NHS Foundation Trust, 2025-08-28) Choyce, J; Jones, L; Patel, N; Holden, A.; Brown, C; Whitehouse, J L; University Hospitals Birmingham NHS Foundation Trust; West Midlands Adult Cystic Fibrosis Centre; Physiotherapy; Intensive Care Medicine; Respiratory Medicine; Allied Health Professional; Medical and Dental; Choyce, Jocelyn; Patel, Neil; Holden, Angela; Brown, Catherine; Whitehouse, Joanna
Service improvement project aimed to evaluate the impact of an ARV at the WMACFC.
Open Access
Implementation of a new pathway supporting vulnerable patients on haemodialysis
(University Hospitals Birmingham NHS Foundation Trust, 2024-06-17) Dodds, Annette; University Hospitals Birmingham NHS Foundation Trust; Renal Medicine; Nursing and Midwifery Registered; Dodds, Annette
It is recognised that the patients attending for dialysis are increasingly co-morbid and complex, however little has been discussed about the increasing numbers of vulnerable patients. This abstract, outlines the implementation of a pathway to support these vulnerable dialysis patients. In June 2018, NHS improvement produced Learning Disability Improvement Standards to improve access to services. Further documents were also published including, • Improvements in care of patients with a Learning Disability recognised in the NHS Long Term Plan (Jan 2019) • ‘Right to be heard’: The Government’s response to the consultation on learning disability and autism training for health and care staff (Mandated - Nov 2019) In July 2020, the Vulnerabilities team within this NHS Trust, launched the Trust Learning Disability and Autism strategy. The strategy incorporated training, raising awareness and development of standards and implementation of an in-patient pathway. Due to the significant numbers of vulnerable patients being identified amongst the dialysis population, this author decided to adapt this inpatient pathway for the chronic outpatient haemodialysis programme. This process was completed with the support of the vulnerabilities team and launched in the dialysis units in July 2021. The pathway involved all patients with a diagnosis of LD being identified, passports being completed and uploaded to the main Trust IT system so available if these patients were admitted to hospital. A monthly risk assessment form was also completed to ensure patients were receiving the care they required and were fully supported, carers identified, adaptations made as required, mental capacity assessments completed and best interest meetings arranged. Quarterly meetings were initiated across the HD service with the link nurses on each unit attending to feedback on progress and to seek advice from the vulnerabilities team. In these meetings it was identified that there were other vulnerable patients suffering with dementia, mental health problems and young adults between the ages of 16 and 25 who also required support. As the Trust developed inpatient pathways for these other vulnerable patients, the pathways were again adapted for dialysis. Staff have received education and training and feel much more confident in raising concerns and supporting their vulnerable patient population. 1500 patients attend regular Haemodialysis sessions within this author’s NHS Trust, across 15 dialysis centres (2 being in acute Hospital settings). A recent audit has identified 31 patients with LD and Autism, 16 patients with dementia, 33 with diagnosed mental health problems and 10 young adults. 75% of our vulnerable patients are cared for within the 13 satellite units utilising the vulnerabilities pathway. Implementation of this pathway has enabled the dialysis nursing teams to be able to identify vulnerable patients and confidently ensure that they are supported and cared for appropriately as outpatients.
Open Access
Maintaining high arteriovenous fistula prevalence rate; a single haemodialysis unit experience
(University Hospitals Birmingham NHS Foundation Trust, 2024-09-09) Barrios, Bernard; University Hospitals Birmingham NHS Foundation Trust; Renal Unit; Nursing and Midwifery Registered; Barrios, Bernard
INTRODUCTION: Arteriovenous Fistula (AVF), the standard for haemodialysis vascular access, minimizes infections risk. Inadequate AVF function is the leading cause of renal patient hospitalization, resulting to high-cost hospital admissions and severe morbidity and mortality consequences. METHODS: BRS Pre-Cannulation Assessment Tool was used for AVF monitoring. The New AVF Assessment and Cannulation Tool ensures thorough evaluation of new AVFs. Enhanced surveillance includes Access Flow (Qa) Measurements and Referral Algorithm, with nurses utilizing an in-centre ultrasound machine for AVF scanning. Education is a critical component. 20.8% of staff attended ultrasound workshops, 41.7% engaged in ultrasound training with the Vascular Access Nurse, and 37.5% participated in the Vascular Access Study Day. Qa measurement training was provided to all staff and peer-to-peer ultrasound training further enhanced patient experience and safety. Nurse Link Role improves the collaborative framework for effective communication. RESULTS: Starting in 2007 with 70 patients and a 79.8% AVF rate, our haemodialysis unit achieved an 89.6% AVF rate with 107 patients in 2023. From 2007 to 2023, the AVF prevalence rate has averaged 90.4%. National guidelines recommend at least 80% of haemodialysis recipients use AVF or AVG (53% national average, Renal Registry Report 2021). This strategic focus on AVF utilization demonstrates sustained success and a strong commitment to optimal patient care. DISCUSSIONS: Achieving optimal AVF prevalence requires systematic monitoring, surveillance, and nurse education. Overcoming challenges like low staffing and maintaining continuity is crucial for improving AVF outcomes and patient care.
Metadata only
Extended roles in healthcare delivery: what Is the role of the laboratory in addressing ethnicity-related healthcare disparities?
(MDPI AG, 2025-11-19) More, Aman Kaur; Lorde, Nathan; Kalaria, Tejas; Gama, Rousseau; Pathology; Medical and Dental; Lorde, Nathan
No abstract available.
Open Access
Optimising renal replacement therapy: evaluating the impact of a formalised prescription chart on fluid balance management in critical care
(University Hospitals Birmingham NHS Foundation Trust, 2024-10-10) Ali, Muzzamil; Mewse, Lorna; Park, Stevie; Bhalla, Harry; Kouka, Athanasia; Ramchandani, Priyanka; Panchumarthy, Pragna; Arshad, Mohammed; Patel, Jaimin; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Renal Medicine; Critical Care; Anaesethetics; Medical and Dental; Nursing and Midwifery Registered; Kouka, Athanasia; Ali, Muzzammil; Mewse, Lorna; Park, Stevie; Bhalla, Harry; Ramchandani, Priyanka; Arshad, Mohammed; Patel, Jaimin
Background A previous audit within our tertiary centre's critical care units highlighted significant issues with suboptimal dosing of renal replacement therapy (RRT), particularly at weight extremes, and fluid balance ambiguities. These issues were largely attributed to the lack of dedicated prescription charts, raising concerns about the consistency and safety of RRT delivery. A subsequent staff survey revealed consistent discrepancies between RRT prescription and actual delivery, further underscoring the need for improvement in clinical practice. Aim In response to these findings, a formalised RRT paper prescription chart was developed and trialled over four months in one of the four critical care units (Unit A). The trial aimed to assess whether the formalised chart could effectively reduce discrepancies between RRT prescription and delivery. Objectives The study aimed to determine if the correct dose of RRT was prescribed based on patients' ideal body weight, to evaluate whether the prescribed fluid balance was achieved or if there were statistically significant discrepancies between prescribed and achieved fluid balances, to identify and quantify clinical reasons contributing to any discrepancies, to assess the completeness of the formalised prescription charts across all units, and to evaluate the completion rate of the night shift section of these charts for patients on continuous therapy. Methods This prospective observational study was conducted over one month, eight months after the formalised RRT paper prescription chart was implemented across all four critical care units (Units A, B, C, and D). Data were collected from 89 patients receiving RRT, with 53 patients having completed formalised prescription charts. Statistical analyses included Chi-square tests for categorical variables and paired t-tests for continuous variables to assess discrepancies in fluid balance. Results Of the 53 patients with completed charts, 69.81% received the correct RRT dose based on their ideal body weight. However, 30.19% received incorrect doses, with 22.64% under-dosed and 7.55% over-dosed for valid clinical reasons. Fluid balance analysis revealed a significant median discrepancy of -767.0 ml (p = 0.00206) between prescribed and achieved balances across all patients. After excluding patients with valid clinical reasons, the median discrepancy remained significant at -600.0 ml (p = 0.0064). The completeness of prescription charts varied, with 40.45% of charts missing or incomplete, and 58.00% of night shift sections for continuous therapy patients were not completed. Conclusion This study underscores the ongoing challenges in RRT dosing and fluid balance management in critical care, even with a formalised paper prescription chart. Significant discrepancies, particularly underdosing, continue to pose risks to patient outcomes, while vague fluid balance targets like "2L negative" lead to inconsistencies in achieving intended results. To enhance patient care, it is essential to standardise fluid prescriptions into clear categories, improve documentation through targeted staff training, address night shift challenges with focused interventions, and consider transitioning to electronic charts with automated alerts for discrepancies.