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Background: Pain is a leading cause of disability worldwide. Pain assessments are an essential part of evidence-based care and management. Among comparable care providers, there is variation in how nurses document assessments as well as the content in them, and there is a notable associated administrative burden. Aims: This study evaluated the impact and significance of a new, structured, digitised pain assessment form from quality, safety and efficiency standpoints. Methods: Samples of pain assessments were examined at three consecutive stages: first, the pre-existing form was used, then the new structured form was introduced and, finally, the structured form was taken away and nurses went back to completing the original form. Assessments were scored by two clinical analysts against 18 clinically defined pain-related characteristics and factors. The time taken to extract and interpret the assessments was also recorded. Statistically significant changes were assessed using Welch's t-tests and Fisher's exact tests. Findings: There was a significant improvement in data quality using the new structured form compared with the pre-existing template, including an increase in the capture of five safety-related variables. Less time was needed to extract and interpret data with the new form. Conclusion: Intelligent structured forms are highly effective for documenting pain assessments, and offer notable benefits in quality, safety, and efficiency.

To address measurement of patient safety, the NHS in England has introduced the NHS Safety Thermometer using the Commissioning for Quality and Innovation (CQUIN) scheme. The scheme offers a financial reward to all providers of NHS care measuring four common harms using the NHS Safety Thermometer on one day each month, with further incentives to achieve improvement goals in subsequent years of the scheme. This article discusses the background to the scheme and a rationale for the focus on pressure ulcers, falls in care, catheter use and urinary tract infection, and venous thromboembolism. The implementation process for this scheme in a large NHS foundation trust is detailed together with its effect within the authors' organisation on harm-free care for their patients.

Icodextrin is a new peritoneal dialysis fluid, with maltose polymers providing the osmotic drive, that may extend time on peritoneal dialysis in situations in which use of conventional glucose-based peritoneal dialysis fluid (Dianeal) has led to loss of ultrafiltration. Although cutaneous reactions have been reported, we report a new phenomenon of aseptic peritonitis that has arisen in our unit associated with icodextrin use.Icodextrin was first introduced in our unit in 1997 and was used extensively beginning in late 1999. From a combination of an observational study of 141 patients in our unit in whom icodextrin was used over 3.5 years and our unit 2000 and 2001 peritonitis audits, we identified an increase in the incidence of culture-negative peritonitis (CNP).The rate in 2000 of 12.3% rose to 17% in 2001, but this increase was seen only in patients on icodextrin (Percentage changes 2000 audit2001 audit: icodextrin patients, 14%--31% increase; Dianeal alone, 12%--10% increase; P0.05). Six patients were affected in the period 2000 to 2001 out of a total of 141 patients exposed to icodextrin (4.3%). Two index cases of relapsing CNP responded after withdrawal of the icodextrin. We then adopted a protocol of cessation and rechallenge with icodextrin when dealing with CNP, which successfully confirmed the phenomenon and led to resolution of relapsing CNP after icodextrin withdrawal. All these patients had been on icodextrin for some time, and none had had an immediate reaction or any skin reaction. Eosinophils were reported in the peritoneal effluent from two patients. All patients continued Dianeal without further CNP episodes.Icodextrin use carries the risk of CNP, and we suggest a cessation and rechallenge protocol in all patients on icodextrin who have CNP.

A new glucoee polymer, icodextrin, related to maltose, is in increasing use as a peritoneal dialysis fluid. We report on adverse events seen in our unit during a 12-month period after the introduction of this reagent.