7,174 research outputs found
iCARE: an Integrated Translational Model of Effective Clinical Handover Communication
No full textOur final example of a handover event brings together many of the challenges with clinical handover identified in earlier chapters. Early one weekday evening, Sartaj1, a tall, strong man who speaks English as a second language, brought his wife Indira to hospital B’s emergency department. Indira was 33-weeks pregnant and had suffered a miscarriage in the past. The couple were of Indian background. Sartaj told the triage nurse that Indira was complaining of nausea and vomiting and had headaches. Sartaj explained that he had taken Indira to the other major public hospital in the city earlier in the day, but that she had been discharged home after a few hours in their emergency department. Several hours later, hospital B’s emergency department night registrar examined Indira. He found her unwell – still nauseous and complaining of severe headaches. He was unable to reach a diagnosis but wanted to admit Indira for observation and tests. However, no beds were available in the antenatal ward. He made several phone calls to consultants and other wards, looking for a bed where Indira could be cared for while she waited for a bed in antenatal. At around 3 am Indira was admitted to Ward M, the hospital’s general medical ward, where she stayed for 10 hours before being transferred to a bed in the antenatal ward. Throughout her admission and handover, Indira was accompanied by Sartaj. With the consent of Sartaj and Indira, an ECCHo researcher observed and audiorecorded the transfer from Ward M to the antenatal ward
Clinical Handover in Context: Risks and Protections Across a Hospital Patient’s Journey
No full textOne weekday afternoon an 18-year-old patient, we’ll call her Belinda Page,1 arrives at the emergency department of a busy tertiary teaching hospital, complaining of shortness of breath and chest pain due to a flare-up of her asthma. During the six hours Belinda spends in the emergency department she develops additional symptoms – weakness and numbness, particularly down her left side. She undergoes an emergency MRI, x-rays and other tests but the emergency department night registrar, Dr Ken Lee – a relatively junior non-English speaking background doctor – cannot reach a diagnosis. Under pressure to move patients out of the emergency department as quickly as possible, during the night he calls the senior neurology consultant, Dr Richard Lancer, who declines to admit Belinda before reviewing her. Dr Lee then calls the Ward M consultant, Dr Allenanda, who reluctantly agrees to admit Belinda to a general medical assessment ward, until the neurology staff can review her the next day. Over the next day we observed and recorded as many of the interactions with and about Belinda as we could, including consultations and examinations, formal and informal discussions about her case and nursing and medical handovers. The first occurred at 8 am the next morning when, after working a 12-hour shift, Dr Lee fronted up to a large auditorium to give the whole-of-hospital medical handover of all the patients he had admitted overnight. He sat on a solitary chair placed front and center of the auditorium, almost as if he were to be interrogated. In the tiered rows of seats facing him sat those members of the hospital’s day shift medical staff who had the time and motivation to attend (attendance is not compulsory). On this morning, about 25 doctors were present, ranging from interns to senior consultants. They included the two female registrars from Ward M (Dr Pantani and Dr Lingren) and a male cardiology consultant (Dr Davidson). The neurology consultant Dr Lancer arrived about five minutes into this handover. While Dr Lee delivered his handover, referring to a sheet of handwritten notes, another doctor stood at the computer console, front right of the auditorium, and projected the patient’s x-ray, test results and scans on the front screen. Below we reproduce a transcript of this five-minute handover
Communication in Bedside Nursing Handovers
No full textThe previous chapters have described the challenges of emergency department clinical handovers when medical staff change. In this chapter the focus shifts to nursing staff shift changes in a general medical ward. We describe and analyze the practice of bedside handovers in a metropolitan teaching hospital, hospital B, acknowledging the challenges but also the benefits of this semi-public clinical handover mode for nurses and patients. In chapter 7 we then suggest strategies and resources to improve patient safety and to increase nurse and patient satisfaction with the practice
Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system
No full textBACKGROUND: Rapid response systems (RRSs) are considered an important tool for improving patient safety. We studied the effect of an RRS on the incidence of cardiac arrests and unexpected deaths.METHODS: Retrospective before- after study in a university medical centre. We included 1376 surgical patients before (period 1) and 2410 patients after introduction of the RRS (period 2). Outcome measures were corrected for the baseline covariates age, gender and ASA.RESULTS: The number of patients who experienced a cardiac arrest and/or who died unexpectedly decreased non significantly from 0.50% (7/1376) in period 1 to 0.25% (6/2410) in period 2 (odds ratio (OR) 0.43, CI 0.14-1.30). The individual number of cardiac arrests decreased non-significantly from 0.29% (4/1367) to 0.12% (3/2410) (OR 0.38, CI 0.09-1.73) and the number of unexpected deaths decreased non-significantly from 0.36% (5/1376) to 0.17% (4/2410) (OR 0.42, CI 0.11-1.59). In contrast, the number of unplanned ICU admissions increased from 2.47% (34/1376) in period 1 to 4.15% (100/2400) in period 2 (OR 1.66, CI 1.07-2.55). Median APACHE ll score at unplanned ICU admissions was 16 in period 1 versus 16 in period 2 (NS). Adherence to RRS procedures. Observed abnormal early warning scores ?72 h preceding a cardiac arrest, unexpected death or an unplanned ICU admission increased from 65% (24/37 events) in period 1 to 91% (91/101 events) in period 2 (p?<?0.001). Related ward physician interventions increased from 38% (9/24 events) to 89% (81/91 events) (p?<?0.001). In period 2, ward physicians activated the medical emergency team in 65% of the events (59/91), although in 16% (15/91 events) activation was delayed for one or two days. The overall medical emergency team dose was 56/1000 admissions.CONCLUSIONS: Introduction of an RRS resulted in a 50% reduction in cardiac arrest rates and/or unexpected death. However, this decrease was not statistically significant partly due to the low base-line incidence. Moreover, delayed activation due to the two-tiered medical emergency team activation procedure and suboptimal adherence of the ward staff to the RRS procedures may have further abated the positive results
Enhancing Water Use Efficiency on Irrigated Dairy Pastures with Nitrogen Fertiliser
No full textLow summer rainfall in southwest Victoria, Australia, restricts pasture growth and limits milk production. One fifth of dairy farmers in the region have some capacity to irrigate during summer. Irrigated dairy pastures are relatively poor utilisers of water with water use efficiencies (WUE) of about 1 t DM/ML water (Ward et al. 1998). Using nitrogen (N) fertiliser may increase dry matter (DM) yields for a given amount of water. Data on N response efficiencies from irrigated pasture in southwest Victoria are lacking. Two experiments determined the potential of N fertiliser to maximise the conversion of irrigated water to pasture DM
Effects of cromakalim (BRL 34915) on potassium conductances in CA3 neurons of the guinea-pig hippocampus in vitro
No full textThe action of the potassium channel activator, cromakalim (BRL 34915), on membrane potential, input resistance and current-voltage-relationship of CA3 neurons in a slice preparation of the guinea-pig hippocampus was investigated by means of intracellular recordings. In the presence of tetrodotoxin, cromakalim (30–100 mol/l) produced a hyperpolarization up to 4 mV associated with a decrease in input resistance up to 10 MOhms. Determination of the equilibrium potential of the cromakalim action revealed that the hyperpolarization is due to the activation of a potassium conductance. This cromakalim-activated potassium conductance was voltage-dependent, i.e. it increased with hyperpolarization. Among a number of potassium channel blockers tested, only Cs+ (2 mmol/l) and Ba2+ (0.5 mmol/1) were able to inhibit the cromakalim-induced effects. Simultaneously, both cations suppressed the hyperpolarizing inward rectification (anomalous rectification) in these neurons, indicating that cromakalim activated or potentiated an inwardly rectifying potassium conductance. In addition, cromakalim slightly enhanced both amplitude and duration of afterhyperpolarizations following single calcium-dependent action potentials, suggesting that cromakalim might have a weak facilitatory effect on calcium-dependent potassium conductances
Fluorescence characterization of clinically-important bacteria
No full textHealthcare-associated infections (HCAI/HAI) represent a substantial threat to patient health during hospitalization and incur billions of dollars additional cost for subsequent treatment. One promising method for the detection of bacterial contamination in a clinical setting before an HAI outbreak occurs is to exploit native fluorescence of cellular molecules for a hand-held, rapid-sweep surveillance instrument. Previous studies have shown fluorescence-based detection to be sensitive and effective for food-borne and environmental microorganisms, and even to be able to distinguish between cell types, but this powerful technique has not yet been deployed on the macroscale for the primary surveillance of contamination in healthcare facilities to prevent HAI. Here we report experimental data for the specification and design of such a fluorescence-based detection instrument. We have characterized the complete fluorescence response of eleven clinically-relevant bacteria by generating excitation-emission matrices (EEMs) over broad wavelength ranges. Furthermore, a number of surfaces and items of equipment commonly present on a ward, and potentially responsible for pathogen transfer, have been analyzed for potential issues of background fluorescence masking the signal from contaminant bacteria. These include bedside handrails, nurse call button, blood pressure cuff and ward computer keyboard, as well as disinfectant cleaning products and microfiber cloth. All examined bacterial strains exhibited a distinctive double-peak fluorescence feature associated with tryptophan with no other cellular fluorophore detected. Thus, this fluorescence survey found that an emission peak of 340nm, from an excitation source at 280nm, was the cellular fluorescence signal to target for detection of bacterial contamination. The majority of materials analysed offer a spectral window through which bacterial contamination could indeed be detected. A few instances were found of potential problems of background fluorescence masking that of bacteria, but in the case of the microfiber cleaning cloth, imaging techniques could morphologically distinguish between stray strands and bacterial contamination
Psychiatric assessment wards for older adults : a qualitative evaluation of two ward models.
No full textThis study was requested to investigate the relative strengths of two different ward arrangements. Both wards were psychiatric assessment wards for people over the age of 65 and both were mixed sex wards. The major focus was to examine if the separation of cognitively impaired (CI) and functional clients on an elderly assessment ward had benefits in terms of client and staff satisfaction. The study involved 192 hours of observation, following four clients on each ward for 24-hours. Results indicate that the split ward and the mixed ward differ qualitatively and that in terms of user and staff satisfaction the split model is preferable. Implications for service development and future research are also discussed
The Effectiveness of Family Support on Drug Compliance in Type II DM Patients In RSU Mitra Medika Medan 2022
No full textType II DM is a disease with special symptoms, namely hyperglycemia. Poor adherence to medication is problematic when managing DM. An aspect that can improve medication discipline in Type II DM sufferers is family support. The family is a component that influences Type II DM sufferers in supporting patients to fulfill their medication. The research aims to assess the effectiveness of family support for medication discipline in Type II DM sufferers at Mitra Medika RSU. This research method uses an analytical survey with a cross sectional approach. The population in this study were all Type II DM patients in the internal medicine ward at Mitra Medika RSU in 2022 with a total of 308 patients. Samples were taken using a side purposive technique of 75 respondents. This study used a questionnaire instrument on family support and medication adherence for Type II DM patients. This study used a questionnaire instrument on family support and medication adherence in Type II DM patients. Based on analysis using the chi-square test, the p-value = 0.000 (<0.05). The conclusion was drawn that there is a significant relationship between family support and medication adherence in Type II DM patients at Mitra Medika General Hospital in 2022. It is hoped that families of Type II DM patients will maximize family support for treatment for family members who experience Type II DM
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