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SIGN Apps for iPhone and iPad,

The SIGN app has recently been updated and now contains quick reference guides (QRGs) for:

  • SIGN 136 Management of chronic pain

  • SIGN 135 Management of epithelial ovarian cancer

  • SIGN 134 Treatment of primary breast cancer

  • SIGN 133 Management of hepatitis C

The SIGN app has also had a complete re-design and now features:

  • Optimisation for the latest operating systems

  • Re-designed for improved legibility

  • Send pdf button feature

  • Split screen feature (ipad)

Prevention of stroke in patients with atrial fibrillation: a guide for primary care

This guide summarises the current evidence available to support the management of atrial fibrillation in primary care. The guide was developed by Healthcare Improvement Scotland by collating existing recent advice and guidance, including evidence-based guidelines and consensus recommendations for practice in NHS Scotland.

SIGN 137: management of lung cancer

This guideline replaces SIGN 80. It covers all aspects of the management of patients with small-cell lung cancer and non-small cell lung cancer, and reflects the most recent evidence on diagnostic and staging investigations, surgery, radiotherapy and systemic anticancer therapy.

Cochrane Nursing Care Field Trials Register

The Cochrane Nursing Care Field Trials Register contains randomised controlled trials and other relevant trial reports. The studies considered relate to interventions that are considered to be integral to, or associated with, the delivery of nursing care and delivered across a wide range of specialties and settings.

Drug and Therapeutics Bulletin (DTB): September 2013—January 2014

Dapagliflozin (Forxiga) for type 2 diabetes?

Dapagliflozin belongs to a new class of oral glucose-lowering drugs that inhibit renal glucose reabsorption and promote glycosuria. It is licensed in the UK in adults with type 2 diabetes as monotherapy when diet and exercise alone do not provide adequate glycaemic control and who are unable to tolerate metformin; or, as add-on therapy, with other glucose-lowering agents including insulin, when these, with diet and exercise, do not provide adequate glycaemic control. The company’s advertising materials claim that dapagliflozin provides a ‘novel method of controlling excess glucose’ with ‘secondary benefit of weight loss’. In this article we review the evidence for the use of dapagliflozin in the management of type 2 diabetes mellitus (DTB 2013; 51:105–8).

Management of hyperemesis gravidarum

Nausea and vomiting in pregnancy are common symptoms and vary considerably in duration and severity. Hyperemesis gravidarum represents the extreme end of the spectrum associated with dehydration and weight loss. As embryonic organogenesis occurs during the first trimester, pharmacological intervention for any condition during this period poses a significant clinical dilemma requiring careful assessment of risks and benefits. In the UK, there are no formal national guidelines for the management of hyperemesis gravidarum. In this article, we review the evidence for the efficacy and safety of different management options for hyperemesis gravidarum (DTB 2013; 51:126–9).

Drug assessment: UK style

Before medicines can be marketed in the UK, they are subject to a system of licensing and the granting of a marketing authorisation that describes the conditions and patient groups for which the medicinal product can be used within the terms of its licence. The licensing process involves an assessment of data relating to the efficacy, safety and quality of the product. However, the marketing authorisation does not determine whether, or how, it will be used in clinical practice. In the UK, the National Institute for Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC) and the All Wales Medicines Strategy Group (AWMSG) publish recommendations on the use of medicines for health services in the UK. In this article we review their remit, work processes and the status of guidance published in England, Scotland, Wales and Northern Ireland (DTB 2013; 51:141–4).

UK immunisation schedule update

Several important changes were made to the UK vaccination schedule for 2013/2014. These include three new vaccines (intranasal influenza, oral rotavirus and subcutaneous shingles), a change to the schedule for meningitis C vaccination, and an extension of the temporary programme for pertussis vaccination of pregnant women. In this article we provide a reminder of the changes to the vaccination schedule in the UK, highlight the importance in offering the vaccines and outline some practical considerations (DTB 2014; 52:10–2).

Articles are accompanied by an MCQ-based CME/CPD module.

Learning nurse

The Learning Nurse Resources Network is about informal nurse learning, continuing education and professional development. The learning resources are suitable for nursing students, nursing assistants/aides, licensed practical nurses (LPN), registered nurses (RN), and registered psychiatric nurses (RPN), as well as nurse educators, trainers and instructors. The Learning Nurse website is divided into three major sections—(1) the assessment resources designed to help nurses determine what they know, and in what areas/topics they need to refresh or enhance their nursing competence, knowledge and skills; (2) e-Learning where nursing resources are designed to provide convenient online learning opportunities that are available at anytime and anyplace. The nursing e-learning section includes e-Courses, narrated learning modules, nuggets (common nursing mistakes and errors) and nursing simulations. In addition, we have links to podcasts, medical videos and other online nursing resources; (3) The Library where there are links to useful nursing resources, the Learning Nurse newsletters, and numbers of nurses world-wide and research reports and papers.

Canadian Association of Wound Care and Registered Nurses’ Association of Ontario: Diabetic Foot Canada online journal

This online, peer-reviewed publication is a quarterly journal that provides readers with current, practical information related to the care of persons with diabetes and how to prevent and treat foot complications. It is targeted to interdisciplinary healthcare professionals, to support their practice and to improve patient outcomes.

Highlights of the current issue include:

  • An overview of registered Nurses’ Association of Ontario (RNAO)'s nursing order sets for clinical nursing practice and decision support;

  • The impact and results of quality improvement initiatives to improve diabetic foot care;

  • Using evidence to support wound care programmes in long-term care (LTC).

RNAO Clinical Best Practice Guideline: Assessment and Management of Pain (3rd edition) (December 2013)

RNAO has revised the best practice guideline Assessment and Management of Pain. Two health education fact sheets have been produced:

  • Helping people manage their pain,

  • Helping you manage your pain.

RNAO Healthy Work Environment Best Practice Guideline

Developing and Sustaining Interprofessional Health Care: Optimising patient, organisational and system outcomes, Best Practice Guideline (December 2013).

This best practice guideline is intended to foster healthy work environments. The focus in developing this guideline was identifying attributes of interprofessional care that will optimise quality outcomes for patients/clients, providers, teams, the organisation and the system.

This guideline identifies best practices to enable, enhance and sustain teamwork and interprofessional collaboration, and to enhance positive outcomes for patients/clients, systems and organisations.

RNAO Clinical Best Practice Guideline: Working with Families to Promote Safe Sleep for Infants 0–12 Months of Age (February 2014)

This guideline has been developed to address the question of how healthcare providers can partner with parents and families to promote safe sleep for infants 0–12 months of age to reduce known risk factors for injury and death. It provides evidence-based recommendations for nurses and the interprofessional team who provide care, in all healthcare settings, to parents/caregivers and families of infants. This guideline is intended to be applicable to all nursing domains, including clinical, administration and education.

RNAO Clinical Best Practice Guideline: Care Transitions (March 2014)

RNAO has published a new best practice guideline: Care Transitions that focuses on building on the core competencies and concepts known to facilitate safe and effective care transitions. Recommendations support best practices to support the client, their family and caregivers through transitions in care and in any environment across all healthcare and community settings. A health education fact sheet has been produced called Care Transitions to assist persons undergoing care transitions.

RNAO Clinical Best Practice Guideline: Primary Prevention of Childhood Obesity, Second Edition (May 2014)

This best practice guideline provides nurses across all practice settings with evidence-based practice, education, system, organisation and policy recommendations for the primary prevention of obesity in infants, preschool and elementary-school-aged children. In this Guideline, practice recommendations refer to comprehensive interventions in settings where children gather (such as schools and childcare centres), whereas education recommendations support the development and maintenance of nursing competency in the primary prevention of childhood obesity. Finally, system-level, organisation and policy recommendations address the importance of supportive practice environments for the implementation and evaluation of high-quality, evidence-based nursing care targeting the prevention of obesity in childhood.

RNAO Clinical Best Practice Guideline: Abuse and Neglect of Older Adults—Person-centred, Collaborative, System-wide Approaches (June 2014)

This best practice guideline is focused on recognising, managing and preventing the abuse and neglect of older adults throughout various healthcare organisations and community settings in Canada. The guideline provides evidence-based recommendations for clinical practice, education and for organisations/systems across the spectrum of care.

Nursing order sets

RNAO has developed nursing order sets for each clinical best practice guideline. The RNAO nursing order sets are designed to be incorporated into an electronic health record, and may also be used in a paper-based or hybrid order-entry system. They are intended to optimise patient safety by ensuring that patients receive the right evidence-based care, at the right time and translate into significant time and cost savings benefits for healthcare organisations. RNAO Nursing Order Sets are applicable to clinicians in all healthcare sectors including: acute care, LTC, community care and palliative care.

RNAO has partnered with (POS) to disseminate the nursing order sets through the addition of a nursing order set module to POS's existing library of medical order sets. currently supplies medical order sets to a large percentage of Canadian healthcare agencies and also has a growing international presence. There are currently 31 nursing order sets available for purchase via the POS website.

Tips and tools guides for nurses

  • Developing and Sustaining Nursing Leadership (Spring 2013)

  • Managing and Mitigating Fatigue (Spring 2013)

  • Managing and Mitigating Conflict in Healthcare Teams (November 2013)

  • Preventing and Managing Violence in the Workplace (November 2013)

  • Developing and Sustaining Interprofessional HealthCare: optimizing patient, organizational and systems outcomes (January 2014),,,,

RNAO Healthy Work Environment (HWE) ‘Tips and Tools’ pamphlets are now available for Nurses. These quick view pamphlets provide another alternative to share the important components of the, HWE Best Practice Guidelines. The purpose of the Tips and Tools pamphlets is to provide a quick overview of the healthy work environment guideline to assist nurses to better understand and learn how to create healthy work environments. Currently available are Tips and Tools on ‘Leadership’, ‘Fatigue’, ‘Conflict’, ‘Violence’ and ‘Interprofessional Health Care’. The information is customised based on the RNAO Healthy Work Environment, Best Practice Guidelines.

Coming soon are the Tips and Tools for Nurses on:

  • Leadership at the Point-of-care Tips and Tools for Nurses.

Working to reduce commercial tobacco use in First Nations, Inuit and Métis Communities in Ontario: New eLearning Module

The new eLearning module, ‘Working to reduce commercial tobacco use in First Nations, Inuit and Métis Communities in Ontario’ will teach culturally appropriate smoking-cessation interventions in First Nations, Inuit and Métis populations, keeping in mind the special considerations of working with these populations. The learning module aims to build capacity and skill among healthcare-professionals by providing culturally appropriate smoking cessation interventions that can be used with clients who smoke.

Engaging Adults with Substance Use Disorders: New eLearning Module

The new eLearning programme ‘Engaging Adults with Substance Use Disorders’ is designed to educate nurses and other healthcare professionals regarding identification and treatment of clients with Substance Use Disorders. This eLearning module aims to build capacity in nurses and other healthcare professionals to understand issues pertaining to stigma, learn how to identify a substance use disorder, be able to screen clients who have potential substance use disorders, understand harm reduction techniques to care and engage clients in a brief intervention.

Addictions eLearning Series (content updated)

This eLearning programme ‘Addiction eLearning series’ is a 10 module series that provides support to nurses working with clients with opioids addictions and interested and/or using methadone maintenance therapy. This eLearning module aims to build capacity in nurses and other healthcare professionals around areas pertaining to establishing therapeutic relationships, client centred care, principles of opioid addictions, methadone maintenance treatment and harm reduction.

Mental Health and Addictions: Speaker Bureau

The ‘Mental Health and Addictions Speaker Bureau’ is a new addition to the RNAO Speaker Bureau series, aimed to increase capacity among nurses and other healthcare professionals to support clients with substance use disorders.

Mental Health and Addiction Initiative: Webpage

The Mental Health and Addictions Initiative is funded through the Ontario Ministry of Health and Long-Term Care to strengthen nurses’ capacity to integrate and sustain Mental Health and Addictions Best Practices in daily nursing practice.

RNAO Communities: On-line knowledge exchange forum

RNAO Communities is the RNAO's professional networking website. It has been designed to be directly linked to the various guideline implementation projects within the IABPG portfolio.

There are 6 active communities:

  • Smoking Cessation Communities (three in total for Champions, Educators and SC Facilitators)

  • Best Practice Spotlight Organization (BPSO) Community

  • Addictions and Mental Health Community

  • Nursing and eHealth Community

  • Long-Term Care Best Practice Coordinator's Community

  • Wound Care Community for Long-Term Care

BPG APP: Condensed Versions of All Clinical and Healthy Work Environment Best Practice Guideline for Mobile Technology (Apple and Blackberry)

RNAO's Nursing Best Practice Guidelines APP (BPG APP) consists of adapted content from each of RNAO's clinical and healthy work environment guidelines. The BPG APP makes all of the knowledge of the RNAO BPGs readily available at your fingertips when and where you are. The APP is available for Blackberry, and Apple smart phones. The content of the APP is updated regularly, as new guidelines are published and/or revised. Access to these updates is included with the BPG APP.

Nursing Quality Indicators for Reporting and Evaluation (NQuIRE)

The RNAO has developed an international BPSO indicator database, Nursing Quality Indicators for Reporting and Evaluation (NQuIRE). The data base collects, compares and reports data on nursing-sensitive indicators reflecting the process and outcomes of nursing care resulting from RNAO best practice guideline implementation in national and international BPSO©s. Indicators have been developed for 15 clinical BPGs.

Nursing Orientation e-Resource for Long-Term Care

The Nursing Orientation e-Resource for Long-Term Care (e-Resource) is designed for registered nurses, registered practical nurses, nurses in management positions and nurse consultants who practice in Ontario LTC homes. The e-Resource is organised into four knowledge domains: professional, role, clinical and organisational. Each knowledge domain contains up to five learning modules which include an introduction to the topic and practical activities to engage in including—e-learning modules, specific learning modules resources to read and review and websites to explore.