World Patient Safety Day 2026, observed on 17 September, highlighted the importance of safe care for people living with noncommunicable diseases. This article explores the community nurse's role in promoting patient safety, examining how the NHS Patient Safety Incident Response Framework supports compassionate engagement, systems-based learning and continuous improvement.
Background Fear of falling among older adults can trigger physical deconditioning because of activity avoidance and is associated with an increased risk of recurrent falls. Aims This study aimed to determine whether multicomponent interventions combining physical activity with psychologically informed components reduce fear of falling more than interventions without psychological components in community-dwelling adults aged ≥65 years. Methods: A literature search for empirical studies focused on interventions to treat fear of falling in community-dwelling adults >65 years was conducted on Ovid SP, Embase, PubMed and CINAHL. The search yielded six randomised-controlled trials and one pre-post study. Studies were critically appraised using the Critical Appraisal Skills Programme analysis tools and findings were synthesised narratively and organised into themes. Findings: Seven empirical studies were identified, encompassing six multicomponent programmes. Each programme combined physical exercise with psychologically informed strategies. The analysis of the studies found significant reductions in fear of falling in patients undergoing the programme. One trial found no additional benefit from combining cognitive behavioural therapy with tai chi compared with tai chi alone. Conclusions: Multicomponent programmes involving physical and psychological component are associated with reductions in fear of falling, although implementation may be constrained by resources. A two-tier approach may support proportionate care, with lower-resource interventions offered initially and escalation to Otago exercise combined with formal cognitive behavioural therapy for individuals identified as having severe fear of falling following assessment. Implications for practice Community nurses should assess fear of falling alongside physical fall risks and provide individualised interventions. A stepped approach combining exercise and psychologically informed strategies may support proportionate fear of falling management.
Background An increasingly frail and ageing population has resulted in an unsustainable demand on district nurse teams in terms of insulin administration. Aims This quality improvement initiative aimed to reduce district nursing team visits by adjusting the insulin regimens of people with type 2 diabetes from twice to once daily, where possible. Methods The integrated community care team audited all people receiving district nursing visits for insulin administration. Community diabetes specialist nurses provided personalised insulin adjustment guides. HbA1c levels before and after the intervention were assessed over a 3-year follow-up period. Findings Twice daily visits were reduced by 77%. Mean HbA1c significantly decreased by 16.3 mmol/mol (1.5%) (from 94.9 [10.8%] to 78.6 [9.3%]) at 12 months. The mortality rate was 30%, and median follow up was 18 months. Conclusions This innovative way of working and change of insulin regimens lessened the burden of insulin administration on district nursing teams, while improving glycaemia and yielding estimated savings of approximately £839 500 annually.
Background Pain and reduced mobility are common among people living with lipoedema. While well-fitting compression garments can help alleviate these symptoms, poorly fitting garments may be ineffective and contribute to significant material waste. Aims This survey explored compression prescription experiences of healthcare practitioners and compared them with those of people living with lipoedema. Methods Online surveys were completed by 373 people living with lipoedema in 2024 and 24 healthcare practitioners in 2025. Follow-up interviews were conducted with two healthcare practitioners in 2025 and one brand. Results Chronic oedema/lymphoedema nurses normally measure for, and prescribe, compression to people with lipoedema. Lower compression classes (RAL CCL1/CCL2, 18-32mmHg) were most prescribed or used. Three specialist practitioners recommended that people with lipoedema could try compressive sportswear as a first step to ascertain tolerance to compression, and the usefulness of non-medical support before prescribing. Conclusions Greater awareness of lipoedema and access to appropriate resources are needed among general practitioners. Specialists reported confidence in measuring and prescribing compression garments, but patient satisfaction with prescribed garments was mixed. People with lipoedema similarly reported mixed satisfaction with their compression garments. Improved compression garments, designed specifically for people with lipoedema, are needed. Implications for practice Patients suspected to have lipoedema should be referred to specialist lymphoedema clinics where available. As fitting compression garments often involves trial and error, keeping a range of sample garments in the clinic allows patients to explore fabrics, fit and comfort to determine the most appropriate option.
