There will be an upgrade to Medicus Outreach on Monday 1st December 2025 at 10am

Our team day is on the 23rd December 2026

Time: 0900 to 1300

Venue: Common Room - Post Grad Centre/Education Centre

I will send the agenda nearer the time.

We will exchange secret Santa and please bring some food - nearer the time we can organise a food list and drinks.

Gentle reminder - ops meeting on the 4th Dec @9:30 x

15/12/2025 to 21/12/2025 and 22/12/25 to 28/12/2025 will be 02/01/2026

Call 4 Concern (C4C), which was initially launched by the hospital in January 2023 for adult inpatients, has been rolled out across the two other services after the hospital was chosen as one of 143 hospitals in England to fully implement the system in both adult and children’s inpatient settings.

It enables inpatients staying with us, and their friends and family, to call a dedicated number, 24/7, for immediate help and advice, directly from a member of the Trust’s Acute Response Team, if they still have ongoing concerns about their own, or their loved ones changing condition despite raising their concerns with the nurse in charge or doctor.

A member of the team will then visit the patient on the ward to discuss any concerns with them or their family or friends, and assess the situation before liaising with the patient’s medical team, and other healthcare professionals, to discuss further treatment options, if needed. A note of the C4C intervention will then be logged in the patient’s notes summarising the concern raised and any actions taken.

The system was developed in response to the death of Martha Mills who died in 2021 due to developing sepsis in hospital after she was admitted with a pancreatic injury following a fall from her bike. Martha’s family’s concerns about her deteriorating condition were not listened to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.

In response to this, and other cases related to the management of clinical deterioration, the then Secretary of State for Health and Social Care and NHS England committed to implementing the system, which is also known as ‘Martha’s Rule’, across the NHS.

Central to Martha’s Rule is the right for patients, families and carers to request a rapid review if they are worried that they or their loved one’s condition is getting worse and their concerns are not being responded to.

Jonathan Wade, Interim Chief Executive, said: “While our staff work extremely hard to provide the very best of care to our patients, we also recognise that at times patients, and their loved ones, may notice small changes that could be early warning signs of deterioration before they show up in routine health measurements.

“We already have robust systems and processes in place to detect when a patient’s condition worsens, but Call 4 Concern provides another layer of reassurance for our patients and their families and shows our commitment to providing safe, compassionate and joined up care.”

Patients, family and friends who have ongoing concerns about their own or their loved ones changing condition, despite raising their concerns with the nurse in charge or doctor, can call the dedicated Call 4 Concern phone number, 24/7, on 07799 348608.

1.1.1.     Metaraminol tartrate 10mg in 1ml vial standard concentration

1.2.  Preparation of infusion and dose regimen

1.2.1.     Normal Preparation

·       60 mg in 500 ml of Sodium Chloride 0.9%.

·       Resulting concentration is 120 microgram / ml.

·       Usual flow rate is 30 – 250 ml/ hr (ie 3.6 – 30 mg/hr)

1.2.1.1.         Infusion MUST be titrated to effect via VOLUMETRIC PUMP

·       Start infusion at 30 ml/hour.

·       Change infusion rate in 5 to 10 ml steps every 5 minutes till MAP of 70 mmHg is reached.

·       Document Metaraminol dose in microgram / min (this is double the hourly infusion rate)

·       The upper limit of infusion is 250 ml/hour to avoid fluid overloading patients on long term infusions.

1.1.1.1.         Infusion MUST be titrated to effect via SYRINGE PUMP

·       Start infusion at 1 ml/ hr (0.5mg/hr)

·       Change infusion rate in 1-2 ml/hr increments every 10 minutes to achieve target MAP up to a maximum of 60ml/hr (30 mg/hr)

·       On discontinuation, wean infusion. Avoid abrupt withdrawal

1.1.  Bolusing metaraminol injection

·       In an emergency a dose of 0.5 mg – 5mg may be given into a large peripheral vein, as a slow IV bolus, over 1-2 minutes. This may be followed by a continuous infusion. The bolus is given either by diluting a 10mg in 1ml ampoule to 20ml NaCL 0.9% (0.5mg/ml) or a pre-diluted ampoule of 2.5mg in 5ml (0.5mg/ml). However, in an emergency metaraminol 10mg in 1ml can be given undiluted. This MUST be given by a Critical Care or Anaesthetic Medical Staff. Outside theatres metaraminol must not be bolused by anyone except an anaesthetist or consultant familiar with the drug as it can cause marked hypertension and bradycardia. Following a single injection the onset of action is within 1-2 minutes with an approximate duration of action of around 20-60 minutes.

1.1.  Monitoring

·       Continuous heart rate, SpO2 and Non-Invasive BP:

o   BP measurements every 3 to 5 min till steady state is reached.

o   Followed by measurements every 15 minutes once stable blood pressure is reached.

o   The infusion rate can be changed and titrated to a MAP of 65mm Hg or higher if specified by the consultant/anaesthetist.

o   The cannula should be checked HOURLY to ensure blanching/extravasation does not occur as this can result in skin necrosis.

1.1.  Side effects

·       Severe and prolonged hypertension if infused in an uncontrolled manner.

o   This is the reason why Metaraminol must be administered via VOLUMETRIC PUMP or SYRINGE DRIVER.

·       Bradycardia, arrhythmia, decreased cardiac output, headache, excitability, dizziness.

·       If the blood pressure is significantly high and not coming down quickly – contact an anaesthetist urgently. Hypertension can result in reflex bradycardia. If this occurs and does not resolve following discontinuation of the infusion it can be treated by a bolus of 200 micrograms of glycopyrrolate or 600 micrograms of atropine.

·       For a full list of side effects and drug interactions please refer to Summary of product Characteristics (SPC) via www.medicines.org.uk

Patients remaining hypotensive on infusions running at a rate over 125 ml/hr need to be escalated to be reviewed by senior doctor from anaesthesia/critical care:

o   Need for further fluid challenge?

o   Is this patient bleeding?

Be aware of intra-abdominal bleeding!

o   Need for central access and noradrenaline infusion?

·       The decision to initiate metaraminol infusion therapy is restricted to the Anaesthesia and Critical Care Doctors and ART/critical care senior nurses.

·       Metaraminol can only be administered by registered nurses with the relevant experience and competence.

1.1.  There is data to suggest that peripheral administration is safe.

1.1.1.     The decision to use a peripheral line for noradrenaline must be assessed and approved

by the consultant in Critical Care, must be documented in the patient’s notes and communicated to the nursing staff prior to administration. Do not use peripheral noradrenaline if access is difficult or unreliable.

1.2.  Contraindications:

1.2.1.     Treatment escalation plan states that vasopressors, high dependency/ICU treatment

would be inappropriate

1.2.2.     Acute heart failure or cardiogenic shock

1.1.  Peripheral administration for noradrenaline is indicated for a maximum of 48 hours and under the discretion of the consultant therapy may be extended to a maximum of 72 hours. Administration must not extend beyond 72 hours.

1.2.  Patient should have continuous BP monitoring via an arterial line.

1.3.  Peripheral access may be used for one vasopressor only. If multiple vasopressors are required then central access is required.

1.4.  The peripheral access must be placed in the forearm, upper arm or upper leg. Peripheral access cannot be within the antecubital fossa, hand, wrist, lower leg or foot. The access/line site must be visible. Avoid sites of flexion in awake patients.

1.5.  The insertion must be contralateral to the blood pressure cuff.

1.6.  The peripheral catheter must be 20G or larger.

1.1.    A second peripheral cannula should be sited as a contingency in case of a primary site failure.

1.2.    The line must be labelled appropriately so the line does not get flushed.

The catheter site must be assessed at least every 2 hours and check that blood can be aspirated from the line (noradrenaline will need to stop for a few seconds)

1.1.    Double pumping should not be required.

1.2.    The concentration to be used must be 4mg noradrenaline made up to 250mL with Sodium Chloride 0.9% (or 0.8mg noradrenaline made up to 50mL with Sodium Chloride 0.9% for syringe drivers for theatres only) to give a resulting concentration of 16micrograms/mL6. Noradrenaline concentrate kept at the Trust is 4mg/4mL i.e. 1mg/mL. Make sure the infusion is well mixed before administration.

1.1.1.      4mg in 250mL – remove 4mL of Sodium Chloride from a 250mL bag, draw up 4mL noradrenaline (1mg/mL) and add to 250mL bag of Sodium Chloride 0.9%

1.1.2.      0.8mg in 50mL – draw up 0.8mL noradrenaline (1mg/mL) and make up to 50mL in a syringe with Sodium Chloride 0.9% (Only Theatres to use this volume).

1.1.    Infusion rates

1.1.1.     Use ideal body weight (IBW)

1.1.2.     Female: 45.5kg + (2.3kg x inch over 5ft)

1.1.3.     Male: 50kg + (2.3kg x inch over 5ft)

1.1.4.     Administer via an infusion pump at a starting dose of 0.05microgram/kg/min (see

appendix 1 for table).

1.1.5.     Increase rate every 5 – 15 minutes depending on urgency of the situation, degree of

hypotension and underlying condition causing shock. Increase by 0.05microgram/kg/min increments until target MAP is reached.

1.1.6.     If patient is on or approaching maximum rate discuss with responsible consultant.

1.1.7.     Maximal rate of infusion is 0.2microgram/kg/min. Higher infusion rates require central

access.

1.1.  Non-Core Members

The Following are Non-Core members of the Team who will be present if on site and available to attend:

·       ART Nurses

o   Bleeps 723/724/725 are handed over and carried by the ART Nurses on duty

Diabetics Nurse Bleep Number: 573

Any queries, please message Amy.

If you have got a busy shift, work until late and have not had a break - please let me know. I’m happy to receive any PM xx

The current S25 Cohort in CCCU would be using a new curriculum, it is would be a combined first year learning regardless of their individual pathways( Child Nursing, Mental Health Nursing and Adult Nursing),  They would be sent to different  placement areas to learn for example  if you are an adult nursing placement area, you  might have a student who is on the child nursing pathway.  I would encourage you to print this out and put on your student board for your colleagues.

(From Ijeoma)

Six reasons to apply for The Mary Seacole programme:

1. It’s highly relevant to actual situations and can be applied in the workplace

2. Feel more confident in your leadership skills

3. Increase your self-awareness and be more aware of your colleagues

4. Develop your leadership skills as well as your technical skills

5. Learn how to overcome cultural barriers

6. Make a real difference

Please check the link:

Overview

Staff Training Materials

Amy will discuss on Team day on the 23rd December 2025.

BW

Yushreen

NHS England Patient Safety Incident Response Framework info:
https://www.england.nhs.uk/patient-safety/patient-safety-insight/incident-response-framework/ NHS England

The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety.

Patient safety incidents are unintended or unexpected events (including omissions) in healthcare that could have or did harm one or more patients.

The PSIRF replaces the Serious Incident Framework (SIF) (2015) and makes no distinction between ‘patient safety incidents’ and ‘Serious Incidents’. As such it removes the ‘Serious Incidents’ classification and the threshold for it. Instead, the PSIRF promotes a proportionate approach to responding to patient safety incidents by ensuring resources allocated to learning are balanced with those needed to deliver improvement.

The PSIRF is not a different way of describing what came before – it fundamentally shifts how the NHS responds to patient safety incidents for learning and improvement. Unlike the SIF, the PSIRF is not an investigation framework that prescribes what to investigate. Instead it:

• advocates a co-ordinated and data-driven approach to patient safety incident response that prioritises compassionate engagement with those affected by patient safety incidents

• embeds patient safety incident response within a wider system of improvement and prompts a significant cultural shift towards systematic patient safety management

Organisations are required to develop a thorough understanding of their patient safety incident profile, ongoing safety actions (in response to recommendations from investigations) and established improvement programmes. To do so, information is collected and synthesised from a wide variety of sources, including wide stakeholder engagement.

A patient safety incident response planning exercise is used to inform what the organisation’s proportionate response to patient safety incidents should be. The PSIRF approach is flexible and adapts as organisations learn and improve, so they explore patient safety incidents relevant to their context and the populations they serve. 

• Levels 1 and 2 of the patient safety syllabus are available to access, and NHS staff often can complete these without cost. NHS England

How to access:

• Go to the e‑LFH website and search for “Patient Safety Syllabus” to enrol in free modules relevant to PSIRF fundamentals.

The Healthcare Safety Investigations Body (HSSIB) offers a suite of CPD‑certified courses free of charge to NHS staff in England, including short courses such as:

• Patient Safety Incident Response Framework oversight

• Involving those affected in learning responses

• Investigative interviewing

• After action review

• Demystifying thematic analysis

• Writing effective learning reports
  These are directly aligned with PSIRF requirements. HSSIB

How to enrol / find dates

• Visit the HSSIB course catalogue and browse or search available PSIRF‑related short courses.

• If a course you want isn’t showing dates currently, subscribe to the HSSIB mailing list so you receive notifications when new dates are released. HSSIB

Link to HSSIB courses:
https://www.hssib.org.uk/education/courses/ HSSIB

Example webinar:

• PSIRF webinar: Patient Safety Incident Response Plan template review – a session that has been offered virtually via Microsoft Teams. NHS England Events

How to register:
Search the NHS England events portal for “PSIRF webinar” and register for upcoming sessions. Attendance is free. NHS England

• Search for “Patient Safety Syllabus” on the e‑LFH platform to enrol in relevant modules. NHS England

How to join:
Email NHSps‑manager@future.nhs.uk to request access. NHS England

CCCU has launched a new range of resources to support you in your PA/PS roles. This includes ePAD practice and examples, FAQs, and links to PA/PS refresher activities.  

Please go to our webpage to see what is on offer: https://www.canterbury.ac.uk/about-us/our-schools/school-of-nursing-midwifery-allied-and-public-health/practice-learning-unit/information-to-support-practitioners  

• 8th Jan 2026

• 29th Jan 2026

• 5th Feb 2026

• 12th Feb 2026

• 27th Feb 2026

• 5th March 2026

• 26th March 2026

The rota has already been completed; however, your hours will be added to HealthRoster.

The Awake prone study:

The above is a study of proning awake patients with hypoxemic respiratory failure needing 40% or more oxygen. They are supposed to be proned for up to 8 hours a day (in a single episode or in minimum of multiple  one hour episodes).

This is now open at our site - the expectation is that this will primarily be done in RSU. However, there will be a few that might be in HDU and ICU (vapotherm / CPAP etc). Nurses are supposed to keep a log of when the patient is proned and supine.

Please access the links below with a short video (9 minutes) about this.

https://warwick.ac.uk/fac/sci/med/research/ctu/trials/awakeprone/health/training/materials/

Dr Sanctuary is the P.I.

Thanks

Rahul

Time: 14:00 -15:00

MS Teams - Online

Suitable for all levels

Practice Assessors: Brooke and Sam

Wednesday only.

Erato Markantoni - 20th and 22nd Jan

Rachel Attakora - 3rd and 5th Feb 2026

Kapishan Shanmugathasan - 10th and 12th Feb 2026

Arnav Umranikar - 17th and 19th Feb 2026

Please read the KSS network minutes. It is interesting to know that other Trusts have the same issues and some of CCOT are seeing patients in ED etc.

Next steps

Please delete The Green Book app from your personal devices immediately.

Using outdated clinical guidelines can compromise patient safety. While we recognise that The Green Book has been a valued resource for many years, we cannot continue to support an app that no longer provides current information.

What you must use instead

Q-Pulse remains our official source for accessing the latest Trust policies and guidelines. However, we recognise this isn't always accessible at the point of need, which is why we're making local guidelines available through BMJ Best Practice for clinical staff, alongside its comprehensive national guidance and evidence base. Key benefits include:

• Available as an app or webpage.

• Can be accessed using your NHS OpenAthens login.

• Guidelines are updated live - when we update a guideline, you immediately have access to the latest version.

• No need to download or save documents locally.

• Contains national clinical guidelines and evidence-based information on a wide range of conditions.

  
  

To set up NHS OpenAthens access or for questions about BMJ Best Practice, contact the Library team, trust.library@nhs.net or visit the Library Team in the Education Centre.

If you're promoting clinical guidelines to colleagues or trainees, please direct them to BMJ Best Practice, not The Green Book.

Just to let you know that we will be having 2 Nursing students in their second year starting next week (2nd Feb 2026) for 5 weeks with us.

Anna - Packiam and Laura

Caitlin - Lucy and Claire.

Thank you all for the support with the students.

NICE has updated its adult sepsis guidance. The previous NG51 guideline has now been replaced for adults by NG253: Suspected sepsis in people aged 16 and over – recognition, assessment and early management.

Key updates include:

• Revised risk stratification criteria

• Updated recommendations on IV fluid management and vasopressor use

• Strengthened antimicrobial stewardship principles

• Improved guidance for patients with communication needs and in mental health settings

Our Trust adult sepsis pathway and supporting documentation have been updated in line with NG253 and are now available to print from Q-PULSE on the intranet [https://qpulse.medway.nhs.uk/QPulseDocumentServiceCorporateLive/Documents.svc/documents/active/attachment?number=THAN-FOR-41].

From 25 February, the updated Sepsis Toolkits and Sepsis 6 bundles (attached) will be available within EPR, replacing previous versions currently in use.

Further communications, including additional guidance and supporting information, will be shared in the coming week.

All clinical teams are asked to familiarise themselves with the revised pathway and ensure local practice reflects these changes.  Ongoing updates on SEPSIS management can also be accessed on the Padlet using the below QR Code

https://padlet.com/MFTKnowledgeandlibraryservice/sepsis-6b8g68jru8ra2tgj

•  Updated guidance on Suspected Sepsis in Pregnant or Recently pregnant people can be found at: Overview | Suspected sepsis in pregnant or recently pregnant people: recognition, diagnosis and early management | Guidance | NICE

• Updated guidance for Suspected in under 16’s can be found at: Overview | Suspected sepsis in under 16s: recognition, diagnosis and early management | Guidance | NICE

If you have any questions, please contact @SHARP, Sara (MEDWAY NHS FOUNDATION TRUST), @HAYES, Amy (MEDWAY NHS FOUNDATION TRUST), @VADAMOOTOO, Yushreen (MEDWAY NHS FOUNDATION TRUST), or a member of the Acute Response Team on Bleep 725. 

Thank you for your continued support in improving early recognition and management of sepsis.

Amy, Sara, Yushreen