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I met with the nurse from the Community Reablement Service. She works along side a physio, OT and support workers. They receive referrals from the MRHT and MRHP for patients who were independent post hospital admission who need some support on discharge following surgery or a medical problem. The referral is discussed among the team to determine if they are suitable for the service. If they are accepted they are seen usually the day after discharge by one of the team members, to set what goals they would like to achieve. The following day another team member will go out with the support worker and introduce them. Patients are seen daily Mon-Fri by the support worker and reviewed by the other team members regularly depending on their needs. On average patients are with the service for about 6 weeks. Some patients need less time and some more. If the patient needs more follow up or home help after this time they are referred to the local PHN service.

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Community Guards available in every County

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Community Guards are available to support Clients in their own homes. This was a new initiative brought in during COVID 19 and is still available. They visit clients in their homes to prevent isolation, to give support with social activities, give advice and transport to appointments or shopping. A phone number is given to clients as a contact if required. Clients can self refer or be referred by the Nurse or any health care professional. Community Guards can be made aware of Mobile Dementia clients and will support them and their families. Community Guards will attend MDT is required, regarding the people they support in the Community

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I met with the ICPOP team in Meath. They are a new team, only working together since the middle of last year. The team lead is from a physiotherapy background. There are 2 nurses, one OT, a dietician and a community link person on the team. They are awaiting a Geriatrician, a Speech and Language therapist, a physio and a multi-task attendant to join the team but with the current embargo, they are unsure when this will start. They are accepting referrals from 2 GP practices in a small rural area at present, they have had great success with their clients so far and have gotten great results with their interventions, supporting people back to their baseline and ensuring they continue to live in their community. They follow ICPOP guidelines. The nursing staff are limited in the interventions they can do as there is no Geriatrician on the team, e.g. bloods, bladder scanning, etc. At present the nurses are completing the CGA (Comprehensive geriatric assessment) which is a very thorough assessment.  Although the team are still waiting on team members, they are not dwelling on it and are working hard and making a great impact in their community. 

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Integrated Care Programme for Older Persons | ICPOP

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The Integrated Care Programme (ICPOP) in Ireland aims to implement integrated services and pathways for Older People.

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Get the help and support you need to quit smoking. Sign up to a Quit Plan for free to get a personalised plan and double your chances of success with quitting.

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I met with Dr Mary Costello who is our Tissue Viability Specialised. She along with Maree ANP in Vascular have started a new Legs @ 11 club for patients who have finished their treatment for leg ulcers and are now going into compression wear. During the session Mary discussed who the circulation system works and showed the attendees some gentle exercises that they can do at home. She also went through the different types of compression wear such as open or closed too stockings and farrow wraps. This allows people to see the different products available and what might suit them best. She went on to demonstrate different methods on who to put on the compression wear. The session ended with a talk from the Aveeno rep who went discussed the importance of good skin care in preventing further breaks to the skin. Mary hopes to run these sessions every 4-6 weeks.

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Patient is encouraged to maintain a 3 day bladder and bowel record diary to identify their intake and how this impacts their output. Education provided by nursing team to patient re diet/fluid intake i.e. caffeine intake, reducing near bed time. Identifying contributing factors and come up with treatment plan 

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HSE National Guidelines (2019) for continence care and management

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Continence advisory team for bladder scan, GP review for possible change of medications i.e diuretics, Mirabegon for overactive bladder. Phyio for pelvic floor and bladder retraining, CRGN for coordination of above care and assessment for continence products if required. 

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Diabetes Ireland, HSE Discover Diabetes, CODE, and DESMOND online courses are excellent resources for digitally literate clients. In-person courses are also available in local primary care centers. By engaging, educating, and empowering clients on the importance of self-managing, healthcare professionals can help clients live a healthy and productive life, in areas such as foot care, eye care,  lifestyle choices, medication management, home glucose readings, and home blood pressure monitoring, along with attending scheduled appointments for diabetic retina screen program, podiatry, and other allied health care appointments as per guidelines. 

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HSE Guidelines for the Management of Type 2 Diabetes,  American Diabetic Association guidelines. 

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I observed motivational interviewing and patient-centered care in operation when I attended a Diabetic Nurse Clinic in community primary care.  This service is an example of communication between secondary care (the hospital), and primary care (the general practitioner) as this particular diabetic nurse works with our local Endocrine consultant, our clients in primary care, and attends clinics in local General Practitioner surgeries.  This service facilitates flow of information from secondary care to client to primary care and vice versa,

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We are fortunate to have Irish Guidelines for the Integrated Management of Type 2 Diabetes. Each aspect of care is outlined to include screening for diabetes and its complications and management of hyperglycaemia with drug therapy. You may find Clinical Standards from the American Diabetes Association specific to Primary Care Providers, useful to refer to also.

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Guidelines for the Management of Type 2 Diabetes - HSE.ie

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We are fortunate to have Irish Guidelines for the Integrated Management of Type 2 Diabetes. Each aspect of care is outlined to include screening for diabetes and its complications and management of hyperglycaemia with drug therapy. You may find Clinical Standards from the American Diabetes Association specific to Primary Care Providers, useful to refer to also.

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Meditation and breathing exercises, yoga

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The smoking cessation officer is a essential service for trying to get individual to quit smoking, They are trained to provide support, guidance and resources to help individual to overcome their addiction. She provided the following in her service:  Counselling, behaviour therapy, setting quitting goals, education and information on smoking cessation, Follow up sessions and access to NRT ( nicotine replacement therapy

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You must be signed into your quit plan in order to request a callback or you can text QUIT to 50100.

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Patients are given an opportunity to engage in activites that promote physical, mental and emotional well-being. Examples at Killarney caycentre include exercise classes, mindfulness sessions, art therapy and music therapy. Patients also get to enjoy nutritious meals provided, and connect with other people to enhance social interaction. These activities collectively empower indivduals to gain knowledge and skills to prioritise their health-goals. 

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I was given the opportunity to spend time @ Killarney Daycentre. I have always been a strong advocate for these centers which offer a structured environment with activities, social interaction, and assistance to enhance well-being and independence. However having experienced the daily routine offered, I believe it will enhance my role of a community RGN. 

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Services often include meals, healthcare, conselling and recreational activities, which contribute to the overall quality of life for those in need

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Falls prevention (SAS seniors alert scheme)

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Falls prevention (SAS seniors alert scheme)

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Over 65s can get a personal alarm under the scheme if they are living alone, living with another person who is age-eligible or living alone for significant periods during the day.

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SAS - Seniors alert scheme administered by POBAL

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The scheme is no longer means-tested and available to cardholders and private clients alike. Pendants or wrist bands are available (preference for wrist bands) which are waterproof and can be worn in the shower or bath and the face is recessed so no accidental pressing when sleeping with it. Costs: Installation and 1st year free under the government scheme. Subsequently, the cost is 66 euros per year (if a phone or modem/router is in the house). An additional cost of 72 euros if a wireless system is needed (no landline or router in the home). How to refer: Applications have to be made via the community scheme and cannot be done by the clients themselves. Margaret and Tony Mc Carthy are covering all areas for Dublin 4, 6, 6W, 14, 16, 18, 24, South County Dublin and Wicklow. (for all other areas check  (Details for areas available on https://www.pobal.ie/programmes/seniors-alert-scheme-sas/)Patients/clients can phone 01 2897213 or email cartaigh@hotmail.com. Still, alternatively, we can refer patients ourselves to them via the same phone number or email. Just get consent for the referral and email with Name, Address, and phone number. Explain that this is run voluntarily and phones may not always be answered. Messages can be left and phone calls will be returned within a few days usually.

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encourage community support, use asthma action carepland and copd self care plan. inhaler technique

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GOLD and GINA guideline, Nurses keep very close to guidelines, anything deviating will be consultant led.

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Smoking cessation - community tobacco project, QUIT.ie and ASH, referral via healthlink but can also refer from any other email address. Taking referrals from Nurses as well as Dr. Can independently assess and recommend treatments to GP. Refer to pulm rehab - can be done by nurse, dr or hub. current wait time 8/52. Can do spirometry and refer for CT/CXR/Echo and PFTs if needed. Links with COPD.ie sports group - recommend for all COPD patients. 

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1 in 2 women and 1 i 5 men over the age of 50 will break a bone so Bone health is really important. i met with CANP for local injury unit in mallow where there they treat many fractures related to this silent disease of Osteoporosis. Physical exercise 30 minutes a day 5 days a week is recommended-A physio would give more tailored advice www.iscp.ie.www.getirelandactive.ie,www.irishosteoporosis.ie,www.getirelandwalking.ie 

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Irish Osteoporosis Society - Irish Osteoporosis Society

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Osteoporosis is a condition that causes bones to become brittle and weak. If you have osteoporosis, your bones can break more easily than expected. Everyday tasks like bending down, even coughing, or sneezing can lead to a life-changing break. Medications are available for those with osteoporosis and aid the strengthening of bones.

The most suitable course of medication for you will depend on your DXA scan results of your spine and hips, the causes of your bone loss, the risk of a break or if you have already broken bones (fractured), your age, gender, and most importantly your medical history.

Some people are more at risk of developing or having undiagnosed osteoporosis than others. Older women who have gone through menopause are the highest risk group.

For you to get the most benefit from your Osteoporosis medication, it is very important that you follow the instructions on how and when to have your treatment.
NOTE; It is essential during Covid that you continue with your Osteoporosis treatment, as high-stress levels cause bone loss. If for whatever reason you do not continue with your Osteoporosis treatment, you are placing yourself at high risk to break bones and possibly lose your independence.

Vitamin D supplements & Calcium

To ensure you get enough calcium, your Doctor may prescribe calcium or calcium and vitamin D supplements or just a vitamin D supplement, if you cannot get the recommended amounts from food. Most people can get their calcium from food, very few foods contain Vitamin d and due to the lack of sunshine in Ireland, there are not many days, a person will get their recommended vitamin D from being outside in the sunlight. If you are frail or housebound and cannot get enough from food, speak to your doctor regarding the possibility of a vitamin D supplement.
Some of these medications include:
There are always possible side effects from medications/treatments. Please ask whoever is treating your bone loss, any queries you have regarding this topic. You can also look them up on the Irish Medicines board website.

The following are some of the many bisphosphonates available:

Boniva® Can be given in tablet monthly

Boniva® Can be given by IV four times a year

Fosamax® - Can be given in tablet which is taken once weekly

Fosamax® plus D - Fosamax is a tablet which is taken weekly and has Vitamin D in it.

Fosavance 5600 tablet which is taken once weekly

Actonel® - This is a tablet that can be daily /weekly

Actonel® with Calcium. Actonel Combi- Actonel is a tablet is taken weekly and Calcium is taken the other 6 days

Actonel plus Calcium & vitamin D, Actonel tablet is taken once weekly and a sachet the other 6 days

Aclasta ® is a once-a-year IV Osteoporosis treatment.

Parathyroid Hormone - (PTH)

This is a bone forming agent, that stimulates the formation of new bone.

Forsteo is the most common brand name, and it is given as a daily injection for up to 24 months

Kyphoplasty

This is a surgical treatment that involves a balloon being placed within the fractured vertebrae (Broken bone in the back), followed by a "bone cement" being injected into the balloon. It should only be done to help to reduce pain, not to restore height.

Vertebroplasty

This is a non-surgical treatment that involves a needle with "bone cement" in it, inserted through the skin into the fractured body of the vertebrae. It should only be done to help to reduce pain, not to restore height.

If you are concerned about your risk of developing osteoporosis, please contact us today.

Irish Osteoporosis Society
1B Clonskeagh Square
Clonskeagh, Dublin 14
D14 A0K8

Reg Charity No. (RCN) : 20034191

CharityReference: CHY11987

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies.

Irish Osteoporosis Charter

The Irish Osteoporosis Society is calling on you to support the Irish Osteoporosis Society, by signing our Irish Osteoporosis Charter.

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Prescribed medication for Osteoporosis - Irish Osteoporosis Society

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Osteoporosis is a condition that causes bones to become brittle and weak. If you have osteoporosis, your bones can break more easily than expected. Everyday tasks like bending down, even coughing, or sneezing can lead to a life-changing break. Medications are available for those with osteoporosis and aid the strengthening of bones.

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 Mallow Local Injury Unit and Osteoporosis

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 Mallow Local Injury Unit and Osteoporosis

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NICE guidelines on Osteoporosis, FRAX score,

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Irish Osteoporosis Society - Irish Osteoporosis Society

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The Irish Osteoporosis Society would like everyone to make their Bone Health their top priority. Click below to see how Kay at 83 has improved her bone health.

We help people across Ireland look after their bones and appreciate the importance of bone health for everybody.

Prof. Mary O'Brien tells Brendan O'Connor how Osteoporosis is preventable and treatable and gives her top tips for how to maintain good bone health.

The Charity is dedicated to reducing the incidence of Osteoporosis and promoting good bone health.

About Osteoporosis

Osteoporosis is a condition that affects the inside of bones. It causes bones to become fragile, so they break more easily. It is called the silent disease because there are no signs or symptoms prior to a person breaking (fracturing) bones. The effects of undiagnosed/untreated osteoporosis can be devastating, and therefore the prevention and early detection of this disease is so important.

Become a member

Join the Irish Osteoporosis Society. By becoming a member of the Irish Osteoporosis Society Charity, you are helping the Charity to keep its services running.

You Can Help

There are many ways in which you can help the Irish Osteoporosis Society. Together we can build a future without osteoporosis.

Irish Osteoporosis Charter

The Irish Osteoporosis Society is calling on you to support the Irish Osteoporosis Society, by signing our Irish Osteoporosis Charter.

The aims of this charter are the following;

1. To prioritise the prevention of osteoporosis throughout Ireland, starting from childhood

2. The diagnosis rate be significantly increased, in order that less people lose their independence, from a disease that is preventable and treatable in the majority of people.

3. That medical treatments are made available to patients with bone loss or who are at high risk of fractures, in a timely manner.

Irish Osteoporosis Society
1B Clonskeagh Square
Clonskeagh, Dublin 14
D14 A0K8

Reg Charity No. (RCN) : 20034191

CharityReference: CHY11987

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies.

Irish Osteoporosis Charter

The Irish Osteoporosis Society is calling on you to support the Irish Osteoporosis Society, by signing our Irish Osteoporosis Charter.

X

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The Irish Osteoporosis Society are the National Experts regarding Bone health.

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I met with Lauren, one of the founders of the Women’s Shed in Bray. It was set up to reconnect women of all ages and to find themselves again,especially post Covid. The shed is a safe place where women can come altogether and take part in various activities. What struck me the most was, they hold educational meetings on how to save money, manage finances at home, domestic abuse. They do painting and art, cake decorating demos as well as practicing mindfulness and yoga. A small donation of a few euro each day or evening class. It is on in Bray on a Tuesday morning and Thursday evening but unfortunately the group in Bray are actually full at the moment and they cannot take any more members. Every week, they place an orange shoe somewhere around the town in a shop window maybe and the ladies can come in and they will receive help if they are experiencing domestic abuse at home. Women from all walks of life and all ages are welcome. There are various nights out and day trips planned. It’s a great service for the women in this area to come together for a chat and a bit of fun.

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Patients were educated on skin hygiene and the necessity of skin moisturization. All patients had family members in attendance with them who were all involved in their care and they also had necessary information reinforced. Information leaflets on skin care products and application of compression bandages was also shared.

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I met with Mary Costello RANP TVN in the Primary Care setting over the last 2 days. There she reinforced the information and learning that I gained at our face-to-face lecture in UCD on February 21st with Karen Warwick. We discussed compression dressings for venous ulceration, dressings and I carried out Doppler studies on several patients. As I work in General practice we discussed several wound issues that I am more likely to be exposed to such as wound infection and burns management. We also discussed nutrition and red flags to wound healing. She talked me through the wound assessment form and allowed me to complete them with the patients also.

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All patients were referred from PHN who in turn had initially received referral from GP and secondary care such as hospitals. 

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Patients are counselled & educated on self-care & management of their chronic condition. – Diagnosis is key for management of these conditions. 1.)SVI- Once arterial system confirmed intact – positive pedal pulses. Compression Class 2 (European) socks -graduated compression.If ulceration present – wound management then compression bandaging over dressing delivering class 2 compression until healed then lifelong socks. Consider surgical treatment of underlying cause -i.e truncal incompetence with EVTA (Endovenous thermal ablation) to reduce the incidence of recurrent ulceration. 2.)Lymphoedema: Skin care. Compression. MLD (Manual lymph drainage by qualified therapist). Exercise. 3.)Lipoedema: Skin care. Exercise. Compression. +/- Liposuction. Self-care is key to the management of these chronic conditions, to prevent deterioration of condition. Ensuring the patient understands the diagnosis and is signposted to the various supports to assist with management of their condition. 

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I met with the Clinical Nurse Specialist (CNS) in Venous Disease. She works as part of a consultant-led team in the assessment, counseling, surveillance & support of patients with venous disease, lymphoedema & Lipoedema. Her practice is guided by the 5 core competencies as set out by NMBI 1. Clinical Focus, 2. Patient/Client Advocate, 3. Education and Training, 4. Audit and Research, 5. Consultant including leadership in clinical practice. Her role involves the management of Superficial Venous Insufficiency (SVI) and associated sequela: Varicose Veins, lower limb swelling, skin staining/skin damage, and resultant venous leg ulcers. The CNS also manages Lymphoedema and Lipodema. Definitions of 1.)SVI - affects lower limbs, involves saphenous truncal incompetence, and signs and symptoms include varicose veins, itch, leg swelling, skin staining, and ulceration in advanced stages. 2.)Lymphoedema - falls under the umbrella of chronic oedema and has traditionally been used to describe oedema resulting from the failure of the lymphatics, due to cancer, lymphatic malformation and filariasis. 3.)Lipoedema - is a chronic condition characterised by a disproportionate increase in adipose tissue and pain in the legs and sometimes the arms of women.  1.)Guidelines followed for SVI: NICE guidelines 2013 – Varicose veins diagnosis and management, HSE National Wound Care guidelines 2018, European Society of Vascular Surgery 2022, Wounds UK Best Practice Documents (new documents every 2 years). 2.)Guidelines followed for Lymphoedema: All Ireland Lymphoedema Guidelines 2022, 3.) Guidelines for Lipoedema: Best Practice Guidelines: The Management of Lipoedema, Wounds UK 2017

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The Vascular CNS acts as a link to acute services if needed and also as a signpost to other services in the community, i.e. GP, public health nursing team, but most importantly is the ‘constant’ for the patient. Patients who attend the vascular service with the above conditions have an easy route from primary care back to the hospital once referred back in. The CNS liaises with the public health nursing team frequently re. patients with chronic venous ulcers. Lymphoedema patients- New Model of Care of Lymphoedema in Ireland is ‘slowly’ being rolled out,  this includes -Physio and nursing.  Aware of clinic in Summerhill Meath and one in Ennis Co Clare so far. A referral to weight-loss clinics by GP’s is often recommended. Manual Lymph drainage therapists in the community are usually private. Smoking cessation is key to promoting wound healing (ulcers) and overall health. Weight management is key in this patient cohort as obesity puts extra strain on lower limbs. Physical activity especially walking and swimming promotes circulation and improves venous return. Social prescribing – to join groups that promote physical activity – walking/hiking. Some Lympoedema patients are referred to a clinic in the Black Forest in Germany for treatment & self-care education of their condition.

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Encorages patient to carry out 3 day Output chart prior to assessment which helps to clarify what kind of incontinence she is dealing with. Importance of recording stool and urinary output very important. Constipation may be the leading contributory factor. Important to get bowel pattern right first. Educate patient re importance of fluid intake, diet, include fresh fruit and veg, fibre. Advise re importance of regular exercise and pelvic floor exercises.  Advised re importance ofDecaf tea/ coffee- caffeine can irritate the bladder ++. By educating the patient they are therefore more empowered to takebetter care of their overall health and well being.

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I attended 1 hour webinar with CNM2 on incontinence care. She follows the HSE National Guidelines 2019  on incontinence care- link attached- see same. It is a clear framworke to follow and supports the assessment of incontinence in patients. 3 steps involved : Assess, Diagnose and source Treatment Options.

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Refer to physio for pelvic floor if required. Refer urology fr botox / further intervention if required. Liaise with PHN re continence wear/ pads etc

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The course enables patients get up-to-date information on type 2 diabetes and learn practical skills self-manage your their diabetes. Other conditions that effect  diabetes treatment like food choices, being active, managing weight, medicines, smoking, alcohol, check-ups, eye care, foot care are discussed. 

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Integrated care framework was used to guide the diabetes reform. Guidelines from ESC, AHA, NICE were used. Patients are then enrolled if they agree to the DISCOVER  programme. The courses are run over 4 weeks. Each session is 2.5 hours, at the end of the course patients are invited to attend a follow-up session at 6 months and 12 months . A self management approach focusing on diet, weight management  lifestyle and food choices to improve overall diabetes and prevent complications.

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This programme instills the integrated care framework in T2DM. The patient can either self refer or when they see the dietitian on the first consultation they will be invited to enrol.

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advice re elevation of legs when resting Regular exercise Use of compression stockings when prescribed

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onward referral from GP to vascular specialist duplex scans TVNS

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Varicose veins are swollen and enlarged veins visible under the skin that usually occur on the legs and feet. They may be blue or dark purple and are often lumpy, bulging or twisted in appearance.

Varicose veins usually cause no symptoms but may be associated with:

aching, heavy and uncomfortable legs

swollen feet and ankles

burning or throbbing in your legs

muscle cramp in your legs, particularly at night

dry, itchy and thin skin over the affected vein

eczema

The symptoms are usually worse during warm weather or if you've been standing up for long periods of time. They may improve when you walk around or raise your legs when resting.

Types of varicose veins

There are several types of varicose veins, such as:

trunk varicose veins

reticular varicose veins

telangiectasia varicose veins

Trunk varicose veins

These are near to the surface of the skin and are thick and knobbly. They're often long and can look unsightly.

Reticular varicose veins

These are red and sometimes grouped close together.

Telangiectasia varicose veins

These are also known as thread veins or spider veins. They are small clusters of blue or red veins. They mostly appear on your legs but may also be found on your face.

They're harmless. Unlike trunk varicose veins, they do not bulge underneath the skin.

Complications from varicose veins

Most people who have varicose veins will not develop complications. If they do, it's usually years after varicose veins first appear.

Possible complications include:

bleeding

blood clots in the varicose veins

chronic venous insufficiency

Bleeding

Varicose veins near the surface of your skin can sometimes bleed if you cut or bump your leg. The bleeding may be difficult to stop.

If this happens, you should:

lie down

raise your leg - this is usually enough to stop bleeding

apply direct pressure to the wound

See your GP immediately if this does not stop the bleeding

Blood clots

Blood clots can form in varicose veins

Blood clots could lead to conditions such as:

thrombophlebitis - swelling (inflammation) of the veins in your leg

deep vein thrombosis (DVT) - this can cause pain and swelling in the leg. It may lead to serious complications like pulmonary embolism

Blood clots rarely extend to the deep veins causing a DVT.

Chronic venous insufficiency

A small number of people with varicose veins may develop chronic venous insufficiency. Poor blood flow and drainage from your skin can damage the skin. Prolonged poor blood drainage from the skin on the lower leg can lead to skin injury or damage.

Your skin and blood exchange oxygen, nutrients and waste products. If this stops for a long time, it's known as chronic venous insufficiency.

Chronic venous insufficiency can cause other conditions.

These include:

varicose eczema - a condition that causes your skin to become red, scaly and flaky

lipodermatosclerosis - this is where your skin on the inside calf above the ankle becomes hardened and tight. You may find it turns a red or brown colour

venous leg ulcers - usually happens as a result of advanced lipodermatosclerosis

Read about the causes of varicose veins

Content supplied by the NHS and adapted for Ireland by the HSE

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Find out how to recognise the symptoms of varicose veins, the different types of varicose veins and the complications that can often be brought on by symptoms.

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If you are unable to make certain decisions even with someone else's support, the court may appoint a decision-making representative to you. The decision-making representative is appointed by the court to make certain decisions on your behalf, taking into account your wishes.

If possible, the court will appoint someone you know and trust as your decision-making representative. However, if there is no-one willing or able to act on your behalf, the court may appoint someone from our panel of trained experts.

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If you are unable to make certain decisions even with someone else's support, the court may appoint a decision-making representative to you. The decision-making representative is appointed by the court to make certain decisions on your behalf, taking into account your wishes. If possible, the court will appoint someone you know and trust as your decision-making representative.

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  Encouraging independence.Encourage people to be open about their diagnosis to their friends and family. plan for the future. Advanced Care Planning,  advising on Registration with Assisted Decision making service

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National Dementia Strategy, Alzheimers Association of ireland

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 patient assessed and diagnosed at Memory clinic by Consultant Geriatrician, consultant psychologist or consultant 

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Patients have a lot of education and lifestyle modification needs. The CNS will educate on medication administration, storage, compliance, management of side effects including hypo and hyperglycemia. She will advise on blood glucose monitoring and the interpretation of results. She will advise on driving and diabetes, she will educate family members on what to do in emergencies and initial first line treatments. Sick day rules will also be discussed and information on lifestyle habits including diet and exercise, foot care and regular retinal screening will be discussed. Information sharing whether through leaflets, booklets, websites and apps will all be provided along with contact numbers for diabetes services locally and nationally. Websites such as Diabetes.ie, HSE.ie and Apps such as DIGIBETE Self management app and Diabetes SMART a free online course covering emotional, health and well being are all good sources for patients.

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I spent a day with a Diabetes Nurse Specialist who visits our GP Practice and holds clinics for people with Diabetes who have poor glycaemic control, Type 2 Diabetes patients requiring insulin/GLP1 initiation, all patients who are not meeting HbA1c targets who are on insulin,Steroid induced Hyperglycemia, recurrent hypoglycemia,and unresolved issues with self monitoring of blood glucose.The CNS will have been referred the patient by the Practice Nurse or GP usually through their work in the Diabetes CDM Programme. The referral will have included Type of Diabetes, length of time Diabetes has been diagnosed, current medications, current blood work, other co-morbidities, Physical Assessment including recent Foot Evaluation and Retinal Screening.Also the referral will include medication compliance and lifestyle habits of the patient. If patient has been referred to DESMOND programme or dietitian this will also be highlighted.The CNS I spent time with works within the Local Policy, Procedure and Guidelines , her NMBI Scope of Practice Framework and she is also guided clinically by American Diabetes Association Guidelines. The management and initiation of medications is multifactorial but usually the patient commences on Metformin,or GLP1 eg Ozempic or SGLT2 eg Jardin or Insulin.

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The CNS  in Secondary Care works as part of a MDT,liaising with the patient,GP, GPN,and Consultant Endocrinologist. The CNS provides care to patients with type 1 and 2 Diabetes to ensure clinical skills are maintained in the management of more complex cases who are seen in secondary care. The CNS also assists with the development of integrated care pathways with hospital and primary care staff.

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There are may self care measures that patients can employ such as ensuring adequate hydration, avoiding constipation(taking increased fibre) and reducing bladder stimulants such as caffeine. Also if overweight or obese reducing weight, and doing regular exercise to include daily pelvic floor exercises. Using bladder retraining techniques.

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On Friday 23rd February 2024, I joined a webinar in which CNM2 Sinead Grogan talked about incontinence.  Sinead referred to the Guideline for the assessment, promotion and management of continence in adults by registered nurses 2019 which is available along side plenty of additional information which I have linked to above. Sinead highlighted the importance of assessing patient to include a 3 day bowel and bladder record, the patients intake and output, the level of incontinence (whether small, moderate or large). A comprehensive medical history is also necessary to identify factors which may influence continence daibetes, cardiac disease, previous TIA, menopause, vaginal deliveries, constipation and a list of medications as some may effect bladder control.

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Referrals to physiotherapists that specialize in pelvic floor exercises. Referral to urology services if Botox or surgical interventions appropriate. Referral to gynecologic services to address menopause issues or for treatment of uterine prolapse. Liaise with community and public health colleagues to ensure the appropriate continence wear is sourced.

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The Alzheimer Society of Ireland is the leading dementia-specific service provider in Ireland.

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Chronic illness loneliness and isolation

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Chronic illness loneliness and isolation

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Walking, running, games, tea, coffee, and treats are organised every Sunday and attendees are encouraged to contribute in whatever way they can, by bringing home-baked goods, arranging a game to play on the day, or organising a day trip. 

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This is a community, voluntary-run group for anyone in the area to drop in and meet new friends, particularly aimed at Ukrainian refugees, international protection applicants, and anyone lonely in our area. Run every Sunday by volunteers who wish to contribute to our community positively and proactively. Many of the people attending are living with chronic illnesses. I recently attended a day trip to Operation Transformation 5k and then a zoo visit.

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This group improves communication between all nationalities, and there are multiple attending, ages ranging from six months old to eighty-nine years old. Many friendships have been formed, language barriers overcome, accommodation and employment secured for people through the group network. 

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Smoking Cessation Officer self referral or HCW referral supports patients in their quit journey .Its Free and all the Nicotine replacement products are free ! You do not need a medical card . i met with Smoking cessation officer for Cork South Lee  on zoom. Based in Chronic Disease hub Ballincollig.She runs a 6 week standard tx programme. Using Combination of CBT and Nicotine Repalcement therepy. Follow up suppoer with client for 1 year. A pre Quit assessment is done preferably face to face . Small achievable goals SMART eg homes and car smoke free first. Abrupt stop to smoking 7-10 days after seeing officer.

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Get the help and support you need to quit smoking. Sign up to a Quit Plan for free to get a personalised plan and double your chances of success with quitting.

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"The majority of people with asthma are prescribed a daily preventer inhaler to protect against an asthma attack and a reliever inhaler to use when symptoms occur."  

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What is Asthma?

Asthma is a condition that affects the airways- the small tubes that carry air in and out of the lungs. In asthma, the airways become over-sensitive; meaning that they react to things that wouldn't usually cause a problem, such as cold air or dust.

When the airways react to a substance, the muscles of the tube walls tighten up, making them narrow and leaving little room for air to flow in and out. The lining of the airways then gets swollen (just like your nose during a cold) and sticky mucus is produced which clogs up the breathing passages.

With so little space in the airways, it becomes difficult for air to move in and out and the chest has to work much harder to breathe. Tightening of the muscles around the airways can happen quickly; this is the most common cause of mild asthma symptoms.

Thankfully, this tightness can be relieved quickly with a reliever inhaler (usually blue). However, the swelling and mucus happen more slowly and need a different treatment. This usually is usually a preventer inhaler which is taken daily to allow the effect to build up over time.

The majority of people with asthma are prescribed a daily preventer inhaler to protect against an asthma attack and a reliever inhaler to use when symptoms occur. It is extremely important that preventer medication is taken regularly, as prescribed and even when asthma symptoms are not present.

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Asthma is a condition that affects the airways- the small tubes that carry air in and out of the lungs. In asthma, the airways become over-sensitive; meaning that they react to things that wouldn't usually cause a problem, such as cold air or dust.

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I attended a zoom on February 12th Webinar: “Assessment Tools for Asthma Management” facilitated by Ruth Morrow and supported by Orion Pharma Ireland.  Signs and Symptoms of pre-diagnosis must include x2 of the following - Wheeze/cough/chest tightness/SOB . 

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NICE Guidelines are followed and also an American Guideline - Asthma Control Test.ie 

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A wonderful place for men to meet and chat ,do a little woodwork,art ,gardening something for everyone

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Douglas / Frankfield Men's Shed | Irish Men's Sheds Association

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I met with the Ballyphehane Social Prescriber in the Ballyphehane Community Development Project. A wonderful service . Clients can be referred by Health care professional or self refer or family member refer with consent. No age limit .The social prescriber meets with the client on their terms whether on phone ,video call or face to face . They will discuss their interests ,what holds them back from achieving health goals .She will then link clients in with  the Community Garden, Local Mens shed,Friendship Club,Walking Group,Local Library,Keep Fit ,cookery group,day centre depending on what client goals and preferences . Noone is forced to do anything . It works well if there is a level of readiness within the client.I went to local Mens Shed (frankfield/Douglas) recently on RTE Nationwide

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Ballyphehane/Togher Community Development Project is a community anchor project linking residents, groups and public services. It is managed by a local voluntary committee. It offers programmes in community childcare, health, development, arts, education, administration and support.

What is Health and Wellbeing Community Referral?

This is a free service we are offering to those living in the area who wish to become part of the community around them. The focus is on improving the overall health and wellbeing of individuals.

We do this by encouraging and supporting people to make connections with local resources, supports and services and to participate in activities, courses, education or training programmes.

The Community Link Worker will work closely with you to help you to identify an area of interest. It is important to us that we find something that fits in with your needs and your priorities. The Link Worker role is to bridge the gap between you and your chosen activity or service and to help you make a step towards it.

Who is this for?

This is available to anybody over the age of 18 and living in the Ballyphehane, Togher, Greenmount, Glasheen, Lough area of Cork City

It is for adults who are ready to try something new, those who are lonely, or isolated, or would enjoy spending time with people, or wish to become more involved in the community they live in.

How can Community Referral help you?

This is an opportunity to learn a new skill, to try a new activity, to make a connection in your neighbourhood or to meet new people, with the support of the Link Worker encouraging you along the way. You will find resources within your community you may have been unaware and make new connections. This is something positive you can do to improve your own health and wellbeing.

Community Walking Group

The Community Walking Group has started up for the month of October at the St. Finbarr's Hurling & Football club. Every Tuesday night at 7pm. Everyone is welcome!

Their is a newly evolving Togher Community Garden based at the Clashduv park also.

They have a Facebook, Instagram and Twitter accounts. Volunteers are always welcome!

Ballyphehane has a newly formed tidy towns committee that has all those social media accounts aswell full of up to date information. The tidy towns committee is also seeking volunteers.
Twitter- @btcdp Facebook - BallyphehaneTogherCDP

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Ballyphehane/Togher Community Development Project is a community anchor project linking residents, groups and public services. It is managed by a local voluntary committee. It offers programmes in community childcare, health, development, arts, education, administration and support. This is a free service we are offering to those living in the area who wish to become part of the community around them.

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Lets Wear Denim for Dementia Awareness Day 1st March 2024!!

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This  is an important document supporting standards of care in Ireland  there are 5 principles in planning of care 1.Citizenship(equal fair access to supports and services)2. Person centred approach 3.Integration 4.Personal Outcome focused 5.Timeliness

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Hello Debbie It was lovely to meet you today & to discuss the SMILE project. Please find attached patient consent form, referral criteria and information leaflet .Please share this information with the rest of the staff in the practice.We look forward to receiving referrals from you now.  Please contact me at the email above, or the SMILE service Smile@caredoc.ie with any queries The SMILE 2 project centres on integrated virtual case management of patients with multi-morbid chronic disease in the community. It is a 2 year Slaintecare funded project between the HSE Enhanced Community Care programme and the chronic disease hubs partnering with Caredoc. The virtual case management is provided by trained triage nurses combined with remote patient monitoring, to support patients with multi-morbidity to live more independently and reduce their episodes of deterioration. We accept referrals from the Chronic Disease hubs, GP practices and acute services.   Additional information (recordings)For more information on SMILE, please see the full 1 hour Slaintecare webinar (Nov 2023) about the SMILE project: https://vimeo.com/revolutionaries/review/880934168/c6fe299c1a Click here to view Niamh-Ann, one of the SMILE nurses, talking about the kinds of patients that the SMILE nurses see in the service. This may support you when you are considering appropriateness of referrals https://youtu.be/ZpEzC0SSSx8?si=_T9N1womSiccP8TS&t=2592  (5 mins recording from Slaintecare webinar Nov 2023) Please view the recording here with two participants talking about their experience of the service (6 mins recording from Slaintecare webinar Nov 2023)   RTE also featured the SMILE 1 project in 2020 with short video included https://www.rte.ie/news/2020/0925/1167409-slaintecare-health-smile/ Please don’t hesitate to contact me with any queries Kind regards Agatha Agatha Lawless, Project Manager: SMILE 2                       Integrated Virtual Case Management of Patients with Multimorbid Chronic Disease in the CommunityPrimary Care Strategy and Planning|HSE|Waterford Vaccination Centre|Ballytruckle Road|Waterford|X91 XFC9 Tel:  087 7988363  Email: agatha.lawless@hse.ie 

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Diabetes Type 1 ∧ Type 2o COPD/Chronic Bronchitis/Emphysema/Asthmao Heart Failureo Coronary Artery Diseaseo Cerebrovascular Diseaseo Hypertensiono Arrythmia

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Diabetes Type 1 ∧ Type 2o COPD/Chronic Bronchitis/Emphysema/Asthmao Heart Failureo Coronary Artery Diseaseo Cerebrovascular Diseaseo Hypertensiono Arrythmia

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It was lovely to meet you today & to discuss the SMILE project. Please find attached patient consent form, referral criteria and patient information leaflet.

Please share this information with the rest of the staff in the practice.

We look forward to receiving referrals from you now. Please contact me at the email above, or the SMILE service Smile@caredoc.ie with any queries

The SMILE 2 project centres on integrated virtual case management of patients with multi-morbid chronic disease in the community. It is a 2 year Slaintecare funded project between the HSE Enhanced Community Care programme and the chronic disease hubs partnering with Caredoc. The virtual case management is provided by trained triage nurses combined with remote patient monitoring, to support patients with multi-morbidity to live more independently and reduce their episodes of deterioration. We accept referrals from the Chronic Disease hubs, GP practices and acute services.

Additional information (recordings)

For more information on SMILE, please see the full 1 hour Slaintecare webinar (Nov 2023) about the SMILE project: https://vimeo.com/revolutionaries/review/880934168/c6fe299c1a

Click here to view Niamh-Ann, one of the SMILE nurses, talking about the kinds of patients that the SMILE nurses see in the service. This may support you when you are considering appropriateness of referrals https://youtu.be/ZpEzC0SSSx8?si=_T9N1womSiccP8TS&t=2592 (5 mins recording from Slaintecare webinar Nov 2023)

Please view the recording here with two participants talking about their experience of the service (6 mins recording from Slaintecare webinar Nov 2023)

RTE also featured the SMILE 1 project in 2020 with short video included https://www.rte.ie/news/2020/0925/1167409-slaintecare-health-smile/

Please don’t hesitate to contact me with any queries

Kind regards

Agatha

Agatha Lawless, Project Manager: SMILE 2

Integrated Virtual Case Management of Patients with Multimorbid Chronic Disease in the Community

Primary Care Strategy and Planning|HSE|Waterford Vaccination Centre|Ballytruckle Road|Waterford|X91 XFC9

Tel: 087 7988363 Email: agatha.lawless@hse.ie

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SMILE Information Leaflet for Patients Version 2.0 Aug 2023

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Includes inhaler technique, spacer use, maintenance treatment and having an action plan. 

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Attended a webinar by Ruth Morrow on the assessment tools for asthma management. Use of asthma leaflets - Take control of your asthma. Use of peak flow and spirometry.

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Register for our 'Take a Breath Challenge' to Raise Funds for our Essential Work

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Our Asthma Education Inclusion Project consists of culturally appropriate, literacy-friendly asthma resources and materials for the Roma, Refugees, People Seeking International Protection and the Traveller community.

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Bipolar disorder is a serious mental illness and is considered to be a mood disorder. Early diagnosis is important so you can decide on the best form of treatment.

If you have bipolar disorder you will have extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).

Episodes of mania and depression often last for several weeks or months.

Depression

During a period of depression, your symptoms may include:

feeling sad, hopeless or irritable most of the time

lacking energy

difficulty concentrating and remembering things

loss of interest in everyday activities

feelings of emptiness or worthlessness

feelings of guilt and despair

feeling pessimistic about everything

self-doubt

being delusional, having hallucinations and disturbed or illogical thinking

lack of appetite

difficulty sleeping

waking up early

suicidal thoughts

Mania

The manic phase may include:

feeling very happy, elated or overjoyed

talking very quickly

feeling full of energy

feeling self-important

feeling full of great new ideas and having important plans

being easily distracted

being easily irritated or agitated

being delusional, having hallucinations and disturbed or irrational thinking

not feeling like sleeping

not eating

saying things that are out of character, often risky or harmful

During a manic phase, extreme positive feelings about yourself or your life could lead to risky actions or unwise decisions. These could have negative consequences for your finances, work or relationships.

Patterns of depression and mania

Patterns of depression and mania are not always the same.

For example, you may have episodes of depression more often than episodes of mania.

You may also have periods of 'normal' mood between episodes.

Some people may experience:

rapid cycling - quick and repeated swings from a high to a low without having a 'normal' period in between

mixed state - symptoms of depression and mania together, for example overactivity with a depressed mood

If your mood swings last a long time but are not severe, you may have cyclothymia. This is a mild form of bipolar disorder.

If you have an elevated mood or marked irritability without changes in thinking or sleep, this could be hypomania (less severe mania).

Living with bipolar disorder

Bipolar disorder can be a condition of extremes. You may be unaware of changes in your mood and behaviour during phases of mania or hypomania.

After the episode is over, you may be upset by your out-of-character behaviour. But at the time, you may believe other people are being negative or unhelpful.

Some people with bipolar disorder have more frequent and severe episodes than others. Staying in a job may be difficult. Relationships may also become strained. There's also an increased risk of suicide.

During episodes of mania and depression, you may have strange sensations. For example, hearing or smelling things that aren't there (hallucinations). There are treatments that can help with these experiences.

People with bipolar disorder may also believe things that seem irrational to other people (delusions). These are symptoms of psychosis or a psychotic episode.

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Bipolar disorder is a serious mental illness. It is considered to be a mood disorder. Find out more about the symptoms of bipolar disorder.

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Asthma Society of Ireland 42-43 Amiens Street, Dublin 1 Tel: 01 8178886 reception@asthmasociety.ie nurse@asthmasociety.ie

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Regular self testing with spirometry, monitoring inhaler use and reporting any changes to GP, Specialist or PCT.

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Zoom call talk with Ruth Marrow 12/02/24 19.30-21.30 Nurse Educator and Consultant with Asthma Society of Ireland. Ruth demonstrated spirometry and peak flow technique, rationale and interpretation with the aid of online videos. She also discussed ICS therapy, Mart inhaler and Salbutamol inhaler indications and dosing. Relevant signs and symptoms of over use and red flags. Websites such as asthmacontroltest.com, geeky medics and ipcrg.org were shared, discussed and highlighted as useful resources in primary care. Further videos regarding Feno testing, respiratory physical exam, inhaler technique and inspiration measurement with the 'In Check Dial Meter' were viewed and discussed. There was an open Q&A at the end which covered numerous medications and real life experiences, with techniques that help asthma sufferers avoid complications and progression of serious disease. Overall a very interesting and practical presentation.

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Attendance to Physiotherapy for chest physio and regular physio exercises as required. Weight management and sleep study to assess for sleep apnoea and contributory factors affecting breathing function. ENT and cardiac assessment if needed.

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Our inhaler technique videos are suitable for both patients and health care professionals. You will find demonstrations for the majority of inhalers available on the market.

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Asthma action plan for every patient with asthma https://www.asthma.ie/about-asthma/learn-about-asthma/managing-your-asthma/asthma-action-plan. Inhaler technique  https://www.asthma.ie/taxonomy/term/285. Importance of adherence to preventor inhaler emphasized.  Using a spacer device with MDI's highlighted as very important. Living well with asthma booklet. https://www.asthma.ie/about-asthma/living-well-with-asthma.

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Many of us attended an online zoom talk with Respiratory CNS. Asthma assessment tools was discussed. She gave us a list of assessment tools we could use to assess how well controlled our patients asthma is at CDM appointments.1/ https://www.pcrs-uk.org/resource/current/online-asthma-slide-rule  2/ https://www.asthmacontroltest.com/en-gb/welcome/ 3/ https://www.ipcrg.org/sites/ipcrg/files/content/attachments/2023-12-04/Reliever%20Reliance%20Test%20-%20English.pdf. If asthma not well controlled check inhaler technique. Patients should have their own peak flows at home and set targets.  https://www.youtube.com/watch?v=UQa74XtQXf8 Gina Guidlines best practice https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Full-report-23_07_06-WMS.pdf

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Referal pathways to Hubs available. For asthma advice from an experienced asthma nurse, call our free Asthma Adviceline on 1800 44 54 64 or send a WhatsApp message to 086 059 0132

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Asthma Action Plan | Asthma Society of Ireland

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An Asthma Action Plan is a document that contains all the information you need to keep you asthma under control. All children and adults with asthma should fill in an Asthma Action Plan with their GP or asthma nurse.

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I met virtually with an asthma nurse specialist who works for the asthma society of Ireland. Asthma assessment was discussed. She discussed how spirometer yshould be used for diagnosis then every 1-2 years or of a deterioration was queried. She suggested using a peak flow at every assessments. She suggested the use of the GINA assessment of asthma control and the asthma control test to assess how well controlled the asthma is. She suggested the use of the asthma slide rule and the reliever reliance test to assess the overuse of SABA’s.  https://www.asthmacontroltest.com/en-gb/welcome/

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She also discussed the use of FeNO testing which can help to decipher if the asthma is related to allergic inflammation in the airways and can help dictate treatment. 

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I met with one of the CNS's in Older Persons Care who is temporarily working in the Frailty in the ED. She sees any patient over 75 who attends the ED department along with the physios to assess patients to see if they need and support services set up for when they go home.

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Learn How to Inject | Lantus® (insulin glargine injection) 100 Units/mL

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Patient Leaflets

What is a Patient Information Leaflet and why is it useful?

A Patient Information Leaflet (PIL) is the leaflet for patients containing information on taking a medicine, that is included with the medicine packaging. It is written by pharmaceutical companies as a patient version of the Summary of Product Characteristics (SPC). Changes to the PIL after your medicine was packed may mean that the version on medicines.ie may differ from the version found with your medicine. You can compare the "Leaflet prepared or revised date" towards the end of the leaflet in the pack with the version that is on the website to find out if there have been any changes to the information since your medicine was packed.

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Lantus 100 units/ml solution for injection in a cartridge | PIL | Medicines.ie

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When the patients wounds are healed hoisery will be discussed and a suitable option (that the patient can manage to apply) will be described for the management of odemea. Also, methods of mantaining skin integrity are discussed i.e. hygiene and applying emoillent lotion. 

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Working Closlely with the CNS in my local area, I have gained an insight into the management of leg ulcers. I understand when to refer my patients to them for their input and assessment (APBIs +/- compression therapy). They adhere to the wound management guidelines. 

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The TVNs work in partnership with the MDT. By providing information relating to the patients diet which is integral to wound care. They refer patients to the MDT as required. In our local area the TVNs are involved in follwoing up with the clients. The patient will return to the TVNs in 4 weeks and an assessment to determine whether the patient is managing their hoisery. 6 months later they will contact the patient and arrange assessment. They are also closely linked with the patients and their family to promote their independence with the application of hosiery. 

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An Alternate Pathway- I met with the Pathfinder team last week. The Pathfinder team is made up of an Advanced Paramedic, Physio and Occupational therapist. Originally set up in 2019 following a trial and then Slaitecare funded a vehicle and 7 staff. It is a pre-hospital service that aims to treat patients over 65 yrs in their own home and therefore avoiding admission to ED. Calls to Pathfinder are triaged through NEOC (National Emergency Operation Centre), and given codes such as Alpha and Omega- low acuity or no-life threatening, such as falls and non-traumatic back pain and blocked urinary catheters. Initially set up in Beaumont Hospital, Dublin but there are now 9 centres across Ireland- Limerick, Waterford. Tallaght (2022), Cork, Letterkenny, Carlow, Galway and Kerry in 2023. They respond by visiting the patient to assess them, they will decide if they need to go to ED. If not, they will do a follow-up visit to assess any Physio, OT needs as well as any other possible services they may need. They don't visit Nursing Homes or attend to patients who are already linked in with a specialist team such as oncology, Fantastic service but more training needs to be given to staff who triage the calls as it can be underutilised at times.

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I have performed a home visit with a CNS TVN for assessment of a chronic wound. In this situation we were dealing with a chronic leg ulcer, which was considered chronic since it was present for more than 6 months without healing. On observation it was identified that the leg was swollen and oozing in large amount, presenting hyperpigmentation, clear signs of venous insufficiency. Ankle-brachial Pressure Index (ABPI) assessed in order to discard possible Peripheral Arterial Disease. ABPI score within Mild Peripheral Disease range (0.8-1). TVN advised that best treatment plan in this situation would be to start with full compression, monitor tolerance and ABPI in 3/12. Client provided with education about Peripheral Disease and compression therapy.  
In this case, client was a heavy smoker, overweight and with reduced mobility, each of this an important risk factor f r the development of Peripheral Disease. It was also discussed with the client the necessity of changing behaviours and provided information about support services to assist with same. Client agreed to be linked with Dietitian and smoking cessation services. 
According to TVN, main concerns in this situation is related to early identification and long life care. Firstly, an early identification of this cases would facilitate early action, decreasing healing times by ensuring appropriate treatment plans. Additionally it is important to highlight with clients that compression therapy will be something that they would require even after the wound is healed, which usually the clients tend to stop after a few months past healing, resulting in high levels or ulcer recurrence.  

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'how to check your skin' information available on Irish Cancer Society

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Zoom meeting with ANP Plastic Surgery Roscommon Hospital. The topics discussed included conditions for optimal wound healing, reducing the risk of scarring, types of wound dressings, and managing wound infections.  Types of skin cancers including the most common basal cell cancer, squamous cell cancer, and melanoma were described.

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Referral pathways were highlighted including plastic surgery day service in Roscommon Hospital. 

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Symptoms and diagnosis of non-melanoma skin cancer

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Learn about the symptoms and diagnosis of non-melanoma skin cancer

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This is a picture of a poster displayed on the wall. Information from the Nice guidelines which the BMJ has created this image.

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This is a picture of a poster displayed on the wall. Information from the Nice guidelines which the BMJ has created this image.

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This guideline covers the diagnosis, assessment and non-surgical management of osteoarthritis. It aims to improve management of osteoarthritis and the quality of life for people with osteoarthritis.

Recommendations

This guideline includes recommendations on:

Who is it for?

Healthcare professionals

Commissioners of health and social care services

People with osteoarthritis, their families and carers

Researchers with an interest in osteoarthritis

Guideline development process
How we develop NICE guidelines
This guideline updates and replaces NICE guideline CG177 (published February 2014).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Osteoarthritis in over 16s: diagnosis and management

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This guideline covers the diagnosis, assessment and non-surgical management of osteoarthritis. It aims to improve management of osteoarthritis and the quality of life for people with osteoarthritis

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The wound specialist if appropriate access is available will direct clients to the HSE website alongside providing leaflets with education to clients. She wound educate clients and gauge there level of understanding. There is hope of trialling a 4-6 week return clinic for healed wounds to ensure they are maintaining self care management to try reduce risk of wounds returning. This gives clients an opportunity to ask questions and discuss issues that may be difficult to maintain ( eg wearing compression stockings).

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The wound specialist explained how she follows policies such as the National wound care guideline 2018, wounds international best practice guidelines and the European pressure ulcer advisory board. The wound specialist is very dedicated in her work to ensuring evidence based care is delivered. In Dublin North West we have 1 yearly wound education study days. The specialist arranges lunch and learning workshops, compression days and new staff wound care education days where deemed appropriate. Her aim is for staff to have the same knowledge and education regarding wound care and make our informed decisions based on expertise knowledge/support.

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There is a tissue viability association of Ireland where experienced wound specialists meet to discuss new wound management in there area once a year. This allows for knowledge and expansion of care wound management. The wound specialist in our area has a good repour with many experienced teams such as vascular consultants, podiatry and wound specialist in the hospital.( Mater most appropriate for my case load). She has mentioned looking at ways to ensure clients in community and hospital visa versa provide the same standard of care to clients in relation to wound care. A shared system re ABPI information, dressings and relevant issues known in relation to wound care management that should be shared across care providers. 

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When carrying out routine foot screens, the use of the 5 A's of making every contact count is a useful tool, ask, assess, advise, agree, and assist.  Education and information regarding self care is essential. 

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F2F attendance at podiatry clinic: The current diabetic foot model of care requires a foot screen for clients newly diagnosed with diabetes in the first part, an annual review for low-risk clients although the chronic disease management program requires a six-monthly foot exam.  Foot disease is a serious complication of diabetes as clients living with diabetes are twenty-two times more likely to have a non-traumatic foot amputation (Buckley et al., 2012).  Clients with moderate or severe risk are referred to podiatry clinics, specialised diabetic foot clinics, vascular clinics and hospital care as appropriate. 

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Caring for foot care in clients living with diabetes requires a multidisciplinary approach, as timely intervention is often required, therefore a good rapport with both clients and appropriate health professionals is  key.                                                                                 Buckley, C.M. et al. (2012) Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland, PLOS ONE. Available at: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0041492 (Accessed: 11 February 2024).   

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I met with a respiratory ANP, she went through the care of patients with asthma and COPD.  She advised that GP surgery should be referring patients for spirometry testing for asthma diagnosis. She follows GINA guidelines for asthma and GOLD guidelines for COPD. She takes a thorough history of the patient, reinforcing the importance of active listening. Care plans are devised for the patient with an Asthma Action Plan for each patient with asthma. She went through various inhalers and advised the importance of displaying a poster of in surgery of the different types, as there as so many options. The inhaler technique and the use of a  volumatic spacer device/ aero chamber were discussed. She advised that no patient should leave a consultation without education on the inhaler technique , following the GINA and GOLD guidelines. She reported that poor inhaler technique in asthma and COPD  is associated with poor disease control and increased GP/A/E visits/ increased costs and also inappropriate escalation of treatment.

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I visited pulmonary rehab in Thurles as detailed above. The patients do a circuit of exercises under the supervision of two physios and two nurses twice weekly. Their o2 sats are checked before and after. They also have a presentation after the circuit on various topics, when I attended it was on mental health and promoted meditation and gratitude. It is such an excellent service, all patients I spoke with really enjoyed it and found it beneficial. Unfortunately funding is an issue and the class can only take fourteen people.

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I have organised to visit pulmonary rehab for my local area on the 12/02/24 in conjunction with the CNS there so I can get a better understanding of the service and how it benefits my patients.

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I had a phonecall linking in with our CNS in the DM hub. She is not prescribing yet despite being a nurse prescriber as they are waiting for a permanent consultant to take over for oversight. I have organised a date in April to come visit for a more in depth discussion of their service.

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The courses available to you will depend on your location. Courses vary in length and when and where they are delivered.

Book your place on a free course

You can book a place online for the course that is available near you.

Places are given on a first come basis. You will be contacted with details of what is available as soon as possible after registering.

Do not worry if you need to arrive a little late to sessions. If you miss a session you can attend another on a future course.

Book your place on a course or call HSE Live on 1800 700 700 to get your local course booking telephone number. HSE Live are available Monday to Friday 8am to 8pm and Saturday and Sunday 10am to 5pm.

Going online

If you are taking part in an online diabetes course that uses the 'webex' video call platform, watch this short video where dietitian Didi de Zwarte will describe how to use it.
How to prepare for your online course
If you want some help with working online, Age Action give free tutoring over the phone for those 55 years and over. You can call them on 01-4756989.

They will go through things like:

setting up and using an email address

using your smartphone

downloading and using apps

use of internet

whatsapp

zoom

Course details

Courses are:

free of charge - even if you do not have a medical card

suitable for people who are newly diagnosed or living with diabetes for many years

delivered by trained healthcare professionals

an opportunity to learn, freely ask questions and make plans to look after your diabetes

open for you to bring a family member, carer or friend for support

Courses are available in the morning, afternoon and some evenings. You can attend a course in any town or county. You do not have to go to your local one if you prefer not to.

All venues are accessible with:

parking

wheelchair access

toilet facilities

What to expect

Friendly dietitians and nurses will create a safe place for you to learn.

You will also meet other people with the condition. You can share experiences and learn from each other in a relaxed and enjoyable environment.

You are welcome to ask any questions you have or you can just sit and listen if you prefer.

You'll receive a free helpful guide for you to refer to at home.
Book your free place on a course
Free online education course

While you are waiting to complete a diabetes support course you can also take the 'Diabetes Smart' course. This is a free short online course you can complete yourself. It is offered by Diabetes Ireland and is available at diabeteseducation.ie

The Diabetes Smart course can help you start learning about how you can treat and manage type 2 diabetes.

It is 55 minutes long and consists of a series of short videos on topics such as:

What is diabetes

Healthy eating

Physical activity

Medicines

Diabetes complications

It is a useful way to start understanding the condition and your key role in treating it.

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diabetes education and self-management for ongoing and newly diagnosed people

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DESMOND courses are free and will help you manage the changes that type 2 diabetes brings to your life. Find out how you can book your free course.

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Coping strategies for living with cancer would include developing a good nurse-patient relationship. These relationships provide continuity of care, enhanced patient support and education, and assist the CNS to become an advocate for their patient. Physical self-care would include information on smoking cessation, balanced dietary intake, exercising as tolerated, sleep hygiene, skin care and establishing of family and friends as support. Patients can also avail of counselling services, and support groups either locally or nationwide. Apps that patients can download include Mindful Cancer App, Irish Cancer Society ¬EmotionSpace- App for metastatic breast cancer patients. Useful websites include Cancer.ie, HSE.ie, Marie Keating Foundation, St Vincent de Paul for financial issues associated with cancer care. The Cancer Thriving and Surviving programme is also a valuable resource for some patients as this is being currently rolled out nationwide. ARC Cancer Support Services also provides various therapies and services free of charge to support the patient and family in challenging times.

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After spending time with Acute Oncology and Hematology CNS, she shared some of the common themes associated with people receiving chemotherapy whether IV or oral and care associated with same. The CNS is guided by Local Standing Operating Procedures and Policies, NCCP-National Cancer Control Programme and NCCN-National Cancer Strategy Guidelines. She is also guided by a UK Cancer Nursing Society Tool for assessment of acute deterioration in a patient receiving chemotherapy. This is a green/amber/red alert system for triage purposes. Most patients receiving chemotherapy will have been allocated and consented to a standard or modified treatment plan.  Education and excellent Nurse-Patient relationships are key to supporting the patient in cancer care. Education should also involve family members and topics that can be discussed include drug compliance, common side effects (nausea and vomiting, constipation, diarrhoea, mucositis, stomatitis, skin reactions, flare-ups)and management of same, recognition of Neutropenic Sepsis when and who to contact within the hospital (inpatient oncology day ward, CNS or Emergency dept)and the importance of early recognition are discussed.

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MDTs are integral to cancer management for delivering best practice and patient-centred care. The teams can consist of the CNS, an oncology consultant, a registrar, palliative care, pharmacist, and a psychologist. The CNS can coordinate referrals to Physio, OT and Dietician as required. The CNS also acts for the patient in their absence and provides an opportunity for communication between the team and the patient. Good communication between the MDT and Primary Care is also essential for ongoing supportive cancer care. Palliative care teams are also integral to Cancer Care. They are often brought on board late in the patient's journey but early engagement with the patient and families can provide a wealth of support in areas such as chronic pain and nausea management, psychological care, patient withdrawal care and end-of-life care. Finally, the National Cancer Control Programme is a valuable resource for GPs and HCPs providing guidelines and support.

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https://www.gov.ie/en/publication/62d6a5-national-dementia-strategy/ I met with Advanced Nurse Practitioner for Dementia in the ICPOP ATC . This is a rapid access clinic lead by Consultant Geriatrician ,with ANP,OT,Physio,SALT and Dementia advisors .This is an excellent service for patients whereby their Gps  can make an urgent referral if concerned  regarding cognitive decline. The patient will have a holistic and  comprehensive assessment  and diagnosis . Treatments vary . whether linking in with the memory gym , Memory Resource technology ,cognitive stimulation such as games and puzzles ,increasing social interaction . There is also a place for pharmacological  therepy . Depends on the persons level of decline , progression rate ,other co morbidities . Patients will get the name and contact details of the Dementia Support Advisor and an opportunity to meet with them.https://www.understandtogether.ie/get-support/service-finder/?c=Cork&s=Day%20Care#:~:text=Cork%20Day%20Care,support%20and%20stimulation.a

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Integrated Care Programme for Older Persons | ICPOP

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The Integrated Care Programme (ICPOP) in Ireland aims to implement integrated services and pathways for Older People.

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Virtual clinics for heart failure patients are now available. These clinics aim to help patients take charge of their own care. Patients are expected to weigh themselves at a specific time each day and record their weight in a logbook. Additionally, patients are encouraged to educate themselves about the various stages and classifications of heart failure.

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The ANP discussed the importance of the four essential medications for HF and emphasized the need for patients to take them. She also highlighted the significance of blood tests such as NTP and BNP and the importance of monitoring them regularly.

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I recently attended a Zoom talk by an ANP HF nurse who had previously worked at St. Michael's Hospital in Dun Laoghaire. During the talk, she emphasized the significance of integrated care between the GP, patient, and HF specialist nurse, and the crucial role of open communication in facilitating this care.

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Self care includes maintenance, monitoring and management. Nursing care facilitates this though education of reducing salt in diet checking food labels and avoiding processed foods, there are no fluid restrictions in the community setting. Exercise as tolerated reassuring that it is safe to exercise and can increase frequency and intensity as tolerated. Smoking cessation. Providing easy to follow instructions for medications, explaining the importance of taking all tablets as they work in different ways. Patients should be reminded to weigh themselves every day at the same time every day (dry weight). An increase of 2kg in 48 hours should be directed to the Doctor. Other signs to monitor are reduced appetite, cough, palpitations, chest pain, low energy, dizziness.

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Presentation given by ANP in GP with a background in Heart Failure. Presentation was attended virtually. Heart failure is a complex clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump. Diagnosis and treatment follows ESC 2021 guidlines however a 2023 focusd update of 2021 guidlines updated its guidlines on treatment of acute and chronic HF. Symptoms of HF Breathlessness, Orthopnoea, Paroxysmal nocturnal dyspnoea, Reduced exercise tolerance, Fatigue, tiredness, Increased time to recover after exercise, Ankle swelling. Less typical symptoms include weight gain, loss of appetite, noctural cough, palpitations. Treatment for HF with reduced EF: diuretics, dapagliflozin, ACEi, MRA, Beta blocker, treatment for preserved EF: diuretics, dapagilflozin, treatment for aetielogy CV and non CV co morbidities. Risk factors include Ischaemia, CAD, Diabetes, Alcohol and CKD.

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Patients with HF should be enrolled in the CDM programme with 6 monthly reviews

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Foundation - The National Heart and Stroke Charity

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The Irish Heart Foundation supports and campaigns for people who have been affected by heart and strokes throughout their lives

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Ferns Diocese Youth Service Francis Street Wexford053 9123262 Carmel.obrien@fdys.ieFDYS is a local  Youth outreach Centre. I met with Carmel OBrien who described the service as a Charity offering free confidential services from 11 to 25 year olds . It is Health Care Worker, parent/guardian or self-referral and offers advice, support, education, or just a 'safe place' . They deal with topics such as health and wellbeing, family support, sexual health, mental health and substance misuse, and offer family support. There is a free Counselling service available mariead.duffy@hse.ie 085 881 4259 for those who require it. Johnpaul.oneil@fdys.ie is based there and he runs the community drug initiative at the charity. An amazing service and team available to the youth of Wexford. 

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I met with Amy one of the Wexford Suicide Crisis Assessment Nurses (SCAN )Service in our practice 8/2/24 . She provides a crisis intervention service for patients 18 years old and over GP referral only however as a GPN I can identify/triage patients for GP to refer in my practice. Wexford service running for last 15 years and is for a 1:1 for nurse and patient and /or patient and family with --Suicide Ideation- (not active suicide thoughts). -Passive Death wish or Thoughts of Self harm. Patients will be seen within 1 week of referral or 24 hours if necessary. They attend the GP practice for the meeting but can be seen in their own home if they wish. The nurse will then liaise with GP for further care/treatment plan or refer them to Behavioral Family Therapists, Community Mental Health team (based in Summer Hill Community Mental Health Centre Wexford), or ED if necessary. There are specialist nurses providing this service to the people of Wexford and their aim is to see all patients in a timely manner, treat them in the community, so reducing unnecessary hospital admissions. GP or GPN can contact them anytime for advice regarding medication management and ongoing treatment plans. SCAN provides a Monday to Friday 9-4pm service however if a patient presents outside of these hours there is  and ED liaison nurse in Wexford General and on call psychiatrist in  University Hospital Waterford who can be contacted for advice and  support. 