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This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes. [ABSTRACT FROM AUTHOR]

What is known and objective: The purpose of this paper is to discuss the limitations of the evidence supporting the SIS recommendations for antibiotic prescribing in patients with traumatic facial fractures and to provide suggestions for clinical decision‐making and further research in this area given the wide variation in prescribing practices. Comment: The Surgical Infection Society (SIS) recently published guidelines on antibiotic use in patients with traumatic facial fractures. The guidelines recommend against the use of prophylactic antibiotics for all adult patients with mandibular or non‐mandibular facial fractures undergoing non‐operative or operative procedures. Despite the available evidence, surveys conducted in the United States and the United Kingdom prior to the publication of the SIS guidelines demonstrate substantial preoperative, intraoperative and postoperative prophylactic prescribing of antibiotics for patients with facial fractures undergoing surgery. What is new and conclusion: With the exception of strong recommendations based on moderate‐quality evidence to avoid prolonged postoperative antibiotic prophylaxis, the weak recommendations in the guidelines are a function of low‐quality evidence. A logical choice for a narrow‐spectrum antibiotic is cefazolin administered within 1 h of surgery and no longer than 24 h after surgery, since it is the gold standard of comparison based on clinical practice guidelines concerning antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Aim To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects. Background Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys. Results Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. [ABSTRACT FROM AUTHOR]

Presently, there are a range of evidence-based staffing tools that have been used to inform nursing, midwifery and health care capacity. These tools are designed to be used with professional judgement and include frameworks such as Rhys Hearn, the National Services Scotland Care Home Staffing Project, a variety of Royal College of Nursing Tool Kits including the Older People in Hospital's tool and the only National Institute of Clinical Excellence approved safe-staffing tool, Shelford's Safer Nursing Tool. These safe-staffing tools are used to score a patient's or resident's level of dependency across a number of domains, for example a patient/resident's ability to wash, dress, mobilise or fulfil their own elimination needs. While these tools have been beneficial with regards to informing staff levels there are a number of limitations that are important to highlight. Succinctly, most are not readily applicable to care home settings nor do they focus on more person-centred aspects of care. [ABSTRACT FROM AUTHOR]