There is another way: empowering frontline staff caring for acutely unwell adults.

QUALITY PROBLEM OR ISSUE: It is estimated that only 17% of patients survive an in-hospital cardiac arrest. Medical evidence indicates that many patients show signs of deterioration during the 24 h period prior to their cardiac arrest. INITIAL ASSESSMENT: At Salford Royal NHS Foundation Trust (SRFT) 135 patients (outside critical care areas) suffered a cardiac arrest between March 2007 and April 2008. CHOICE OF SOLUTION: Quality improvement method-The breakthrough series (BTS) collaborative approach, change package-reliable manual vital signs, nurse-led response to the deteriorating patient, code red, structured ward round, ceilings of care, nurse-led do not attempt cardiopulmonary resuscitation (DNA-CPR) protocol and allocated roles. IMPLEMENTATION: The project was delivered over two phases with a total of 23 wards (12 wards in Phase One and 11 wards in Phase Two). Frontline teams worked to develop changes with the aim of reducing cardiac arrests by 50%. EVALUATION: The primary outcome measure was the number of cardiac arrests per 1000 admissions outside of critical care areas. Process and balancing measures were also used to evaluate the impact of the intervention. LESSONS LEARNED: The results showed a positive relationship between the change package and a reduction of 41% in cardiac arrests outside of critical care areas from the baseline period (April 2007-March 2008) to December 2012. The BTS model has the potential to reduce cardiac arrests without the need for initial large-scale financial investment.

An initial evaluation of stable isotopic characterisation of post-blast plastic debris from improvised explosive devices.

A number of two-way radios, similar to those which have been employed to initiate Improvised Explosive Devices (IEDs), were acquired from a commercial supplier and grouped into four pairs. Samples of plastic material were collected from five distinct regions of each radio and analysed by Infrared and Raman spectroscopy to identify the nature of the material. One radio of each pair was then subjected to detonation with a commercially available plastic explosive. The combination of radio and explosive was considered to be representative of the components of an IED. Following detonation, fragments were recovered and, where possible, identified as specific sampling points of the radio. A combination of delta2H and delta13C stable isotopic analysis of material from each of the five sampling points was found to provide a pattern which was characteristic of a given radio and provided a means to associate pairs of radios. When few fragments were recovered, no positive association could be made between the fragments and the paired, undamaged radio. This was attributed, in part, to manufacturing variation in the radios. However, when three or more post-blast fragments were recovered it was possible to associate these with the paired, undamaged radio with a high degree of certainty.