Objective: Postnatal follow-up care (PNFC) is important to promote maternal and newborn health an... more Objective: Postnatal follow-up care (PNFC) is important to promote maternal and newborn health and wellbeing. In Oman, women’s utilisation of postnatal follow-up services has declined with rates as low as 0.29 (mean visits) in some Governorates; well below the recommended postnatal follow up visits at two- and six-weeks for assessment of mother and newborn. The reasons for low utilisation are not well understood. The aim of this study is to explore women’s views and identify factors that influence their utilisation of postnatal follow-up services. Methods: Purposive sampling and semi-structured telephone interviews with 15 women aged 20 to 39 years at six to eight weeks post childbirth between May 2021 to August 2022. Data were analysed using Erlingsson and Brysiewicz content analysis approach. Results: Six categories were identified as influencing PNFC utilisation: 1) need for information; 2) experiences and expectations; 3) family support, expectations and customs; 4) sociocultura...
Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vasc... more Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vascular access device insertion and management practices, and describe the incidence and risk factors for complication development. This is a prospective cohort study of neonates requiring vascular access devices over 3 months in an Australian quaternary-referral neonatal intensive care unit. In addition to describing current practices, primary outcomes were device failure, complications, and skin complications. Results are reported using descriptive statistics and with risk factors calculated via Cox proportional hazards regression. A total of 104 neonates required 302 vascular access devices, over 1375 catheter days. Peripheral intravenous catheters (PIVCs) were most used (n = 186; 62%), followed by umbilical venous catheters (n = 52; 17%). Insertion attempts were often undocumented; but for those recorded, 5% of devices (n = 15) required 4 attempts or more. Device failure occurred in 28%...
Focus on Health Professional Education: A Multi-Professional Journal
Introduction: Evidence-based teaching and learning strategies should underpin any educational act... more Introduction: Evidence-based teaching and learning strategies should underpin any educational activity. This is particularly important for interprofessional education (IPE) activities, where there is an expectation that healthcare professions are taught using best available evidence. There is a research–practice gap that this review aims to address by using the current evidence to develop recommendations regarding optimal design components to better inform faculty who design IPE. Methods: A five-stage scoping review was conducted. Methodological characteristics and IPE design components of primary and review studies were extracted. Three important components of design—participants (level and stage of progression, discipline type and number, group size and ratios), learning constructs (theories, frameworks, learning objectives) and learning approaches (exchange, observation, action, simulation and practice)—were reviewed to develop recommendations regarding effective design. Results:...
Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care conti... more Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care continuum. This review explores women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephonecall and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and notbeing provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisatio...
Introduction Implementation of interprofessional education (IPE) is recognised as challenging, an... more Introduction Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. Methods Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. Results Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro ...
an overview of the 2013 neonatal skin care guideline neonatal skin care: clinical outcomes of the... more an overview of the 2013 neonatal skin care guideline neonatal skin care: clinical outcomes of the jognn neonatal skin care evidence based clinical practice guideline carolyn lund rn, ms, faan improving care for infants and aarc clinical practice guideline rcjournal what’s unique about baby skin? disclosures an evidence-based approach to newborn skin cleansing skin integrity in the neonate tools for assessment medtronic neonatal skin care evidence based clinical practice guideline neonatal skin-care and flammability of neonate topical neonatal skin care guidelines women western australia skincare time to review newborn skincare the hierarchy of evidence royal children's hospital delayed newborn bathing awhonnwa evidence-based product selection criteria for diaper rash care practical approaches to baby skin care recommendations awhonn promoting the archive publications and newborns neonatal skin care: understanding unique differences in validity and reliability of the neonatal ski...
Background: Medical adhesive-related skin injuries (MARSI) are common in hospitalised neonates. A... more Background: Medical adhesive-related skin injuries (MARSI) are common in hospitalised neonates. Aims: To (i) identify adhesives and removal techniques, (ii) develop and distribute neonatal MARSI resources, and (iii) evaluate the resources. Methods: A participatory action research cycle was conducted from 2017 to 2019 to identify practices and recommendations, establish MARSI elements, develop and evaluate resources with Australian Neonatal Nurses. Results: Twenty-three different adhesives, six peer-reviewed publications and 18 product information sources were reviewed. A poster with adhesive base and top layers, application and removal recommendations outlined, and 10 video tutorials were produced. Survey responses from 223 nurses revealed the definition of MARSI and risks were poorly known. Resource awareness was limited despite widespread promotion but were reported as useful. Conclusions: To address neonatal MARSI, nursing clinicians need to understand adhesive base layers. Quick reference resources are now available but further evaluation is needed on MARSI and evidence utilisation in neonatal practice.
Peripheral intravenous catheters (PIVCs) are important tools for the provision of treatment for u... more Peripheral intravenous catheters (PIVCs) are important tools for the provision of treatment for unwell and premature neonates. This study aimed to explore current PIVC practices (i.e. insertion, product selection, complications and management priorities) within Australian and New Zealand neonatal units, to identify areas for innovation and practice change. The survey was distributed via Australian and New Zealand neonatal nursing associations, with 180 respondents (54% Australia; 46% New Zealand). Respondents reported an average of 2-3 insertion attempts were required per PIVC, with variability in cleansing agents, decontamination techniques, skin barrier films and PIVC dressing products used. The large majority of respondents reported seeing skin complications associated with PIVCs within their practice (94%). Infection prevention was the highest management priority, and skin complication prevention, the lowest priority. High quality research is necessary to inform neonatal PIVC insertion and management practices, to improve patient safety and treatment provision.
Background: Advanced cancer patients' end-of-life care preferences in oncology units, medical-sur... more Background: Advanced cancer patients' end-of-life care preferences in oncology units, medical-surgical units, nursing homes and palliative care services have been established. However, less is known about end-of-life care preferences of patients with advanced cancer in intensive care units and their families. Aim: To explore end-of-life care preferences of patients with advanced cancer and their families in intensive care units and if these align with essential elements for end-of-life care. Design: Electronic databases were searched up to February 2018. Reference lists of retrieved articles were screened for potential studies. Results: A total of 112 full text articles were retrieved. Of these, 12 articles reporting outcomes from 10 studies were eligible for inclusion. The majority were retrospective chart reviews (n=7) and conducted in developed countries (n=9). Care preferences change over time with deteriorating physical condition. Ongoing patient-centred communication and shared decision-making are critical as is teamwork and involvement of a palliative care team. Marital status, gender and ethnicity appear to influence care preferences. Of those studies examining patient preferences and/or the receiving of their preferences these could be aligned with approximately half of the Australian essential elements for end-of-life care. Conclusions: Providing end-of-life care for patients with advanced cancer in intensive care units is challenging. No studies have investigated prospectively the end-of-life care preferences of patients and their families in this acute setting. Further research is required to determine the elements of care preferences for patients with advanced cancer and their families in Intensive care units in developing countries.
Supporting healthy weight gain and management in pregnancy: Does a mandatory training education s... more Supporting healthy weight gain and management in pregnancy: Does a mandatory training education session improve knowledge and confidence of midwives? Midwifery, 65, pp. 1-7.
International journal of nursing studies, Jan 9, 2017
The birth process and the moments thereafter are a crucial time for newborns as they adapt to ext... more The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on 'Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools. To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age. Systematic Review. Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary stud...
Objective The aim of the present study was to investigate the incidence of and patient outcomes a... more Objective The aim of the present study was to investigate the incidence of and patient outcomes associated with frequent patient moves. Methods In a prospective cohort study, any bed move and the reason for the move were documented. Patients were assessed on admission for anxiety, social support and delirium. Adverse events, length of stay and satisfaction were recorded. Patients moved three or more times were compared with those moved less than three times. Results In all, 566 patients admitted to a tertiary referral hospital were included in the study. Of these, 156 patients (27.6%) were moved once, 46 (8.1%) were moved twice and 28 (4.9%) were moved at least three times. Those moved three or more times were almost threefold more likely to have an adverse event recorded compared with those moved fewer times (relative risk (RR) 2.75; 95% confidence interval (CI) 1.18, 6.42; P = 0.02) and to have a hospital stay twice as long (RR 7.10; 95% CI 2.60, 11.60; P = 0.002). Levels of satis...
Low birth weight Weight of less than 2 500 g, irrespective of gestational age Newborn death The d... more Low birth weight Weight of less than 2 500 g, irrespective of gestational age Newborn death The death within 28 days of birth of any live-born baby regardless of weight or gestational age Preterm birth A baby born < 37 completed weeks gestation Small for gestational age Infant below the 10th percentile of birth weight for gestational age. An SGA baby may be preterm or full-term. Stillbirth A baby born with no signs of life, weighing more than 1 000 g or with more than 28 completed weeks of gestation (for international comparison purposes)
Background: Anaemia is common in critically ill patients, and has a significant negative impact o... more Background: Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by sampling for diagnostic testing. Objectives: Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood sampling and conservation strategies. Methods: Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane. Data were collected on diagnostic blood samples obtained during the study period, including demographic and acuity data of patients. Institutional blood conservation practice and guidelines were compared against seven evidence-based recommendations. Results: A total of 940 blood sampling episodes from 96 patients were examined across three sites. Arterial blood gas was the predominant reason for blood sampling in each unit, accounting for 82% of adult, 80% of paediatric and 47% of neonatal samples taken (p < 0.001). Adult patients had significantly more median [IQR] samples per day in comparison to paediatrics and neonates (adults 5.0 [2.4]; paediatrics 2.3 [2.9]; neonatal 0.7 [2.7]), which significantly increased median [IQR] blood sampling costs per day (adults AUD$101.11 [54.71]; paediatrics AUD$41.55 [56.74]; neonatal AUD$8.13 [14.95]; p < 0.001). The total volume of samples per day (median [IQR]) was also highest in adults (adults 22.3 mL [16.8]; paediatrics 5.0 mL [1.0]; neonates 0.16 mL [0.4]). There was little information about blood conservation strategies in the local clinical practice guidelines, with the adult and neonatal sites including none of the seven recommendations. Conclusions: There was significant variation in blood sampling practice and conservation strategies between critical care settings. This has implications not only for anaemia but also infection control and healthcare costs.
Objective To examine the use, management, documentation and complications for intravascular devic... more Objective To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. Methods A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Results Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8 h for 25% of the devices in situ. Conclusions The present study identified several problems and highlighted areas for improvement in the management and documen...
To compare the available dressings and securement devices for CVCs, in terms of catheter-related ... more To compare the available dressings and securement devices for CVCs, in terms of catheter-related bloodstream infection (CR-BSI), catheter colonisation, entry and exit site infection, skin colonisation, skin irritation, accidental catheter removal (complete or partial), dressing condition and mortality. 1 Dressings and securement devices for central venous catheters (CVC) (Protocol)
Objective: Postnatal follow-up care (PNFC) is important to promote maternal and newborn health an... more Objective: Postnatal follow-up care (PNFC) is important to promote maternal and newborn health and wellbeing. In Oman, women’s utilisation of postnatal follow-up services has declined with rates as low as 0.29 (mean visits) in some Governorates; well below the recommended postnatal follow up visits at two- and six-weeks for assessment of mother and newborn. The reasons for low utilisation are not well understood. The aim of this study is to explore women’s views and identify factors that influence their utilisation of postnatal follow-up services. Methods: Purposive sampling and semi-structured telephone interviews with 15 women aged 20 to 39 years at six to eight weeks post childbirth between May 2021 to August 2022. Data were analysed using Erlingsson and Brysiewicz content analysis approach. Results: Six categories were identified as influencing PNFC utilisation: 1) need for information; 2) experiences and expectations; 3) family support, expectations and customs; 4) sociocultura...
Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vasc... more Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vascular access device insertion and management practices, and describe the incidence and risk factors for complication development. This is a prospective cohort study of neonates requiring vascular access devices over 3 months in an Australian quaternary-referral neonatal intensive care unit. In addition to describing current practices, primary outcomes were device failure, complications, and skin complications. Results are reported using descriptive statistics and with risk factors calculated via Cox proportional hazards regression. A total of 104 neonates required 302 vascular access devices, over 1375 catheter days. Peripheral intravenous catheters (PIVCs) were most used (n = 186; 62%), followed by umbilical venous catheters (n = 52; 17%). Insertion attempts were often undocumented; but for those recorded, 5% of devices (n = 15) required 4 attempts or more. Device failure occurred in 28%...
Focus on Health Professional Education: A Multi-Professional Journal
Introduction: Evidence-based teaching and learning strategies should underpin any educational act... more Introduction: Evidence-based teaching and learning strategies should underpin any educational activity. This is particularly important for interprofessional education (IPE) activities, where there is an expectation that healthcare professions are taught using best available evidence. There is a research–practice gap that this review aims to address by using the current evidence to develop recommendations regarding optimal design components to better inform faculty who design IPE. Methods: A five-stage scoping review was conducted. Methodological characteristics and IPE design components of primary and review studies were extracted. Three important components of design—participants (level and stage of progression, discipline type and number, group size and ratios), learning constructs (theories, frameworks, learning objectives) and learning approaches (exchange, observation, action, simulation and practice)—were reviewed to develop recommendations regarding effective design. Results:...
Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care conti... more Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care continuum. This review explores women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephonecall and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and notbeing provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisatio...
Introduction Implementation of interprofessional education (IPE) is recognised as challenging, an... more Introduction Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. Methods Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. Results Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro ...
an overview of the 2013 neonatal skin care guideline neonatal skin care: clinical outcomes of the... more an overview of the 2013 neonatal skin care guideline neonatal skin care: clinical outcomes of the jognn neonatal skin care evidence based clinical practice guideline carolyn lund rn, ms, faan improving care for infants and aarc clinical practice guideline rcjournal what’s unique about baby skin? disclosures an evidence-based approach to newborn skin cleansing skin integrity in the neonate tools for assessment medtronic neonatal skin care evidence based clinical practice guideline neonatal skin-care and flammability of neonate topical neonatal skin care guidelines women western australia skincare time to review newborn skincare the hierarchy of evidence royal children's hospital delayed newborn bathing awhonnwa evidence-based product selection criteria for diaper rash care practical approaches to baby skin care recommendations awhonn promoting the archive publications and newborns neonatal skin care: understanding unique differences in validity and reliability of the neonatal ski...
Background: Medical adhesive-related skin injuries (MARSI) are common in hospitalised neonates. A... more Background: Medical adhesive-related skin injuries (MARSI) are common in hospitalised neonates. Aims: To (i) identify adhesives and removal techniques, (ii) develop and distribute neonatal MARSI resources, and (iii) evaluate the resources. Methods: A participatory action research cycle was conducted from 2017 to 2019 to identify practices and recommendations, establish MARSI elements, develop and evaluate resources with Australian Neonatal Nurses. Results: Twenty-three different adhesives, six peer-reviewed publications and 18 product information sources were reviewed. A poster with adhesive base and top layers, application and removal recommendations outlined, and 10 video tutorials were produced. Survey responses from 223 nurses revealed the definition of MARSI and risks were poorly known. Resource awareness was limited despite widespread promotion but were reported as useful. Conclusions: To address neonatal MARSI, nursing clinicians need to understand adhesive base layers. Quick reference resources are now available but further evaluation is needed on MARSI and evidence utilisation in neonatal practice.
Peripheral intravenous catheters (PIVCs) are important tools for the provision of treatment for u... more Peripheral intravenous catheters (PIVCs) are important tools for the provision of treatment for unwell and premature neonates. This study aimed to explore current PIVC practices (i.e. insertion, product selection, complications and management priorities) within Australian and New Zealand neonatal units, to identify areas for innovation and practice change. The survey was distributed via Australian and New Zealand neonatal nursing associations, with 180 respondents (54% Australia; 46% New Zealand). Respondents reported an average of 2-3 insertion attempts were required per PIVC, with variability in cleansing agents, decontamination techniques, skin barrier films and PIVC dressing products used. The large majority of respondents reported seeing skin complications associated with PIVCs within their practice (94%). Infection prevention was the highest management priority, and skin complication prevention, the lowest priority. High quality research is necessary to inform neonatal PIVC insertion and management practices, to improve patient safety and treatment provision.
Background: Advanced cancer patients' end-of-life care preferences in oncology units, medical-sur... more Background: Advanced cancer patients' end-of-life care preferences in oncology units, medical-surgical units, nursing homes and palliative care services have been established. However, less is known about end-of-life care preferences of patients with advanced cancer in intensive care units and their families. Aim: To explore end-of-life care preferences of patients with advanced cancer and their families in intensive care units and if these align with essential elements for end-of-life care. Design: Electronic databases were searched up to February 2018. Reference lists of retrieved articles were screened for potential studies. Results: A total of 112 full text articles were retrieved. Of these, 12 articles reporting outcomes from 10 studies were eligible for inclusion. The majority were retrospective chart reviews (n=7) and conducted in developed countries (n=9). Care preferences change over time with deteriorating physical condition. Ongoing patient-centred communication and shared decision-making are critical as is teamwork and involvement of a palliative care team. Marital status, gender and ethnicity appear to influence care preferences. Of those studies examining patient preferences and/or the receiving of their preferences these could be aligned with approximately half of the Australian essential elements for end-of-life care. Conclusions: Providing end-of-life care for patients with advanced cancer in intensive care units is challenging. No studies have investigated prospectively the end-of-life care preferences of patients and their families in this acute setting. Further research is required to determine the elements of care preferences for patients with advanced cancer and their families in Intensive care units in developing countries.
Supporting healthy weight gain and management in pregnancy: Does a mandatory training education s... more Supporting healthy weight gain and management in pregnancy: Does a mandatory training education session improve knowledge and confidence of midwives? Midwifery, 65, pp. 1-7.
International journal of nursing studies, Jan 9, 2017
The birth process and the moments thereafter are a crucial time for newborns as they adapt to ext... more The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on 'Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools. To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age. Systematic Review. Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary stud...
Objective The aim of the present study was to investigate the incidence of and patient outcomes a... more Objective The aim of the present study was to investigate the incidence of and patient outcomes associated with frequent patient moves. Methods In a prospective cohort study, any bed move and the reason for the move were documented. Patients were assessed on admission for anxiety, social support and delirium. Adverse events, length of stay and satisfaction were recorded. Patients moved three or more times were compared with those moved less than three times. Results In all, 566 patients admitted to a tertiary referral hospital were included in the study. Of these, 156 patients (27.6%) were moved once, 46 (8.1%) were moved twice and 28 (4.9%) were moved at least three times. Those moved three or more times were almost threefold more likely to have an adverse event recorded compared with those moved fewer times (relative risk (RR) 2.75; 95% confidence interval (CI) 1.18, 6.42; P = 0.02) and to have a hospital stay twice as long (RR 7.10; 95% CI 2.60, 11.60; P = 0.002). Levels of satis...
Low birth weight Weight of less than 2 500 g, irrespective of gestational age Newborn death The d... more Low birth weight Weight of less than 2 500 g, irrespective of gestational age Newborn death The death within 28 days of birth of any live-born baby regardless of weight or gestational age Preterm birth A baby born < 37 completed weeks gestation Small for gestational age Infant below the 10th percentile of birth weight for gestational age. An SGA baby may be preterm or full-term. Stillbirth A baby born with no signs of life, weighing more than 1 000 g or with more than 28 completed weeks of gestation (for international comparison purposes)
Background: Anaemia is common in critically ill patients, and has a significant negative impact o... more Background: Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by sampling for diagnostic testing. Objectives: Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood sampling and conservation strategies. Methods: Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane. Data were collected on diagnostic blood samples obtained during the study period, including demographic and acuity data of patients. Institutional blood conservation practice and guidelines were compared against seven evidence-based recommendations. Results: A total of 940 blood sampling episodes from 96 patients were examined across three sites. Arterial blood gas was the predominant reason for blood sampling in each unit, accounting for 82% of adult, 80% of paediatric and 47% of neonatal samples taken (p < 0.001). Adult patients had significantly more median [IQR] samples per day in comparison to paediatrics and neonates (adults 5.0 [2.4]; paediatrics 2.3 [2.9]; neonatal 0.7 [2.7]), which significantly increased median [IQR] blood sampling costs per day (adults AUD$101.11 [54.71]; paediatrics AUD$41.55 [56.74]; neonatal AUD$8.13 [14.95]; p < 0.001). The total volume of samples per day (median [IQR]) was also highest in adults (adults 22.3 mL [16.8]; paediatrics 5.0 mL [1.0]; neonates 0.16 mL [0.4]). There was little information about blood conservation strategies in the local clinical practice guidelines, with the adult and neonatal sites including none of the seven recommendations. Conclusions: There was significant variation in blood sampling practice and conservation strategies between critical care settings. This has implications not only for anaemia but also infection control and healthcare costs.
Objective To examine the use, management, documentation and complications for intravascular devic... more Objective To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. Methods A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Results Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8 h for 25% of the devices in situ. Conclusions The present study identified several problems and highlighted areas for improvement in the management and documen...
To compare the available dressings and securement devices for CVCs, in terms of catheter-related ... more To compare the available dressings and securement devices for CVCs, in terms of catheter-related bloodstream infection (CR-BSI), catheter colonisation, entry and exit site infection, skin colonisation, skin irritation, accidental catheter removal (complete or partial), dressing condition and mortality. 1 Dressings and securement devices for central venous catheters (CVC) (Protocol)
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Papers by Karen New