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Evans J, Morrison Z, Thomas-Turner R, Bouamra O, Mullen S, Morgan J. Smartphone use for Paediatric Calculations in Emergencies (SPaCE). Arch Dis Child 2024; 109:282-286. [PMID: 38050000 DOI: 10.1136/archdischild-2023-326180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The preparation for critically ill children involves calculating drug and fluid volumes using the commonly taught WETFLAG (weight, energy, endotracheal tube, fluids, lorazepam, adrenaline, glucose) acronym. While smartphone applications (apps) are increasingly used for these calculations in clinical practice, limited studies have explored their accuracy and safety. AIM To assess the accuracy of three calculation methods for paediatric emergency drug doses and fluid volumes: a smartphone app, reference charts and traditional calculation methods. The secondary aims were to investigate the effect on the time taken and self-reported stress levels. METHODS A convenience sample of healthcare professionals from four hospitals contributed. Participants calculated drug and fluid doses for fictional patients using the three different methods. The method and case order were randomised centrally. The study recorded the number of errors made during the calculations, healthcare professionals' self-reported stress levels on a scale of 0 (no stress) to 10 (maximum stress) and the time taken for each case. The app was developed at the direct request of the study team. RESULTS Ninety-six participants calculated values for six fictional cases, resulting in 576 calculations. Traditional calculation methods showed a statistically significant higher rate of error compared with the use of a smartphone app or reference charts (mean=1, 0, 0, respectively). The smartphone app outperformed both traditional calculation methods and reference charts for time taken and user-reported stress levels. CONCLUSIONS Traditional methods of 'WETFLAG' drug and fluid calculations are associated with a statistically significant increased risk of error compared with the use of reference charts or smartphone app. The smartphone app proved significantly faster and less stressful to use compared with traditional calculation methods or reference charts.
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Affiliation(s)
- Jordan Evans
- Paediatric Emergency Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Zoe Morrison
- Children and Young Adults Research Unit, Noah's Ark Children's Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rhian Thomas-Turner
- Children and Young Adults Research Unit, Noah's Ark Children's Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Stephen Mullen
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Jeff Morgan
- Paediatric Emergency Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
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Turner R, Hart J, Ashiru-Oredope D, Atkins L, Eades C, Felton T, Howlett E, Rice S, Shallcross L, Lorencatto F, Byrne-Davis L. A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care. BMC Health Serv Res 2023; 23:770. [PMID: 37468860 DOI: 10.1186/s12913-023-09559-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals. METHODS Semi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework. RESULTS A total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals' roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation). CONCLUSION This study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change.
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Affiliation(s)
- Rebecca Turner
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK.
| | - Jo Hart
- Division of Medical Education, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK
| | | | - Lou Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Christopher Eades
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Felton
- Department of Critical Care Medicine, Wythenshawe Hospital, Manchester University NHS Foundation, Manchester, UK
| | - Emily Howlett
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen Rice
- Population Health Sciences Institute, Faculty of Medical Sciences, the University of Newcastle Upon, Tyne, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | | | - Lucie Byrne-Davis
- Division of Medical Education, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK
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John B, McCreary C, Roberts A. Smartphone technology for communications between clinicians - A scoping review. J Dent 2022; 122:104112. [PMID: 35413411 DOI: 10.1016/j.jdent.2022.104112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This scoping review aims to review explore, assess, and map the literature to inform clinical practice regarding communication between clinicians. Specific Apps/channels used were identified and assessed with a focus on data security with key concepts and knowledge gaps identified. DATA The Joanna Briggs Institute framework is followed, with search results reported as per the PRISMA ScR for scoping reviews guidelines. SOURCES A systematic search strategy encompassing EBSCO and OneSearch databases was conducted - two identical searches, (June and October 2020) limited to English language articles published 2016-2020. A narrative synthesis was used to integrate and report the findings. STUDY SELECTION Sixty-six publications were selected. Twelve from EBSCO, thirty-five from OneSearch, nineteen were hand searched. Sixteen of the publications were research studies, nine were literature reviews, twenty-six were editorial, one was a newspaper article and fourteen were grey literature. Instant Messaging (40%, n = 23), image sharing (41%, n = 24), and video conferencing (19%, n = 11) were functions most popular with clinicians. WhatsApp, generic instant messaging, Facebook messenger, ZOOM, and Skype are evidenced as channels for communication between clinicians within the EU. A sizeable proportion of the publications (38%; n = 25) failed to identify or adequately address technical security concerns and requirements around privacy and data protection. CONCLUSIONS Clinicians use smartphones /Apps to communicate clinical information with each other. The security and privacy issues arising from their communication of sensitive data is absent or only superficially acknowledged within the literature. CLINICAL SIGNIFICANCE Clinician's need clearer guidance on the use of smartphone technology for clinical communications.
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Affiliation(s)
- Bernadette John
- Cork University Dental School & Hospital, University College Cork, Wilton, Cork, Ireland.
| | - Christine McCreary
- Cork University Dental School & Hospital, University College Cork, Wilton, Cork, Ireland
| | - Anthony Roberts
- Cork University Dental School & Hospital, University College Cork, Wilton, Cork, Ireland
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Hand KS, Clancy B, Allen M, Mayes A, Patel Y, Latter SM. 'It makes life so much easier'-experiences of users of the MicroGuide™ smartphone app for improving antibiotic prescribing behaviour in UK hospitals: an interview study. JAC Antimicrob Resist 2021; 3:dlab111. [PMID: 34632385 PMCID: PMC8496772 DOI: 10.1093/jacamr/dlab111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives To understand the impact on prescribing behaviour of an antimicrobial therapy
guidelines smartphone app, in widespread use in hospitals in the UK. Methods Twenty-eight doctors and five nurse prescribers from four purposively
selected hospitals in the UK participated in behavioural theory-informed
semi-structured interviews about their experiences of using the
MicroGuide™ smartphone app. Data were analysed using a thematic
content analysis. Results Five themes emerged from the interview data: convenience and accessibility;
validation of prescribing decisions; trust in app content; promotion of
antimicrobial stewardship; and limitations and concerns. Participants
appreciated the perceived convenience, accessibility and timesaving
attributes of the app, potentially contributing to more prompt treatment of
patients with time-critical illness. The interviewees also reported finding
it reassuring to use the app to support decision-making and to validate
existing knowledge. They trusted the app content authored by local experts
and considered it to be evidence-based and up-to-date. This was believed to
result in fewer telephone calls to the microbiology department for advice.
Participants recognized the value of the app for supporting the goals of
antimicrobial stewardship by promoting the responsible and proportionate use
of antimicrobials. Finally, a number of limitations of the app were
reported, including the risk of de-skilling trainees, cultural problems with
using smartphones in clinical environments and software technical
problems. Conclusions The MicroGuide app was valued as a means of addressing an unmet need for
updated, concise, trustworthy specialist information in an accessible format
at the bedside to support safe and effective antimicrobial prescribing.
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Affiliation(s)
- Kieran S Hand
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Bridget Clancy
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Mike Allen
- Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, UK
| | - Amazigom Mayes
- Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, UK
| | - Yash Patel
- Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, UK
| | - Susan M Latter
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Rowe-Setz G, Behringer W, Roland D, Lyttle MD, Jahn HK. Fifteen minute consultation: When can I use a medical app? Arch Dis Child Educ Pract Ed 2021; 106:258-263. [PMID: 32948634 DOI: 10.1136/archdischild-2020-319448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022]
Abstract
Advances in mobile device technology and internet connectivity have created powerful new mobile health (mHealth) and telemedicine capabilities. The guidelines regarding mHealth use in the clinical environment can be conflicting, which has resulted in some reluctance by institutions and medical staff to fully embrace these advances due to privacy and patient confidentiality concerns among others. The COVID-19 response has led to departments to reconfigurate care and revisit mHealth as a tool to allow social distancing and remote care. This article reviews mHealth guidance in practice and describes its use and interpretation as rapid decision-making aid and in telehealth.
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Affiliation(s)
- Gala Rowe-Setz
- Children's Emergency Department, The Royal Belfast Hospital for Sick Children, 274 Grosvenor Rd, Belfast BT12 6BA, Northern Ireland, UK
| | - Wilhelm Behringer
- Faculty of Medicine, Center of Emergency Medicine, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Damian Roland
- Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, England
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Academic Department of Emergency Care, University of the West of England, Bristol, UK
| | - Haiko Kurt Jahn
- Faculty of Medicine, Center of Emergency Medicine, Friedrich-Schiller-Universität Jena, Jena, Germany .,Children's Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
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Jahn HK, Jahn IHJ, Behringer W, Lyttle MD, Roland D. A survey of mHealth use from a physician perspective in paediatric emergency care in the UK and Ireland. Eur J Pediatr 2021; 180:2409-2418. [PMID: 33763717 PMCID: PMC8285308 DOI: 10.1007/s00431-021-04023-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/04/2022]
Abstract
There has been a drive towards increased digitalisation in healthcare. The aim was to provide a snapshot of current apps, instant messaging, and smartphone photography use in paediatric emergency care. A web-based self-report questionnaire was performed. Individual physicians working in paediatric emergency care recorded their personal practice. One hundred ninety-eight medical doctors completed the survey. Eight percent of respondents had access to institutional mobile devices to run medical apps. Eighty-six percent of respondents used medical apps on their personal mobile device, with 78% using Apple iOS devices. Forty-seven percent of respondents used formulary apps daily. Forty-nine percent of respondents had between 1-5 medical apps on their personal mobile device. Respondents who used medical apps had a total of 845 medical apps installed on their personal device, accounted for by 56 specific apps. The British National Formulary (BNF/BNFc) app was installed on the personal mobile device of 96% of respondents that use medical apps. Forty percent of respondents had patient confidentiality concerns when using medical apps. Thirty-eight percent of respondents have used consumer instant messaging services, 6% secure specialist messaging services, and 29% smartphone photography when seeking patient management advice. CONCLUSION: App use on the personal mobile devices, in the absence of access to institutional devices, was widespread, especially the use of a national formulary app. Instant messaging and smartphone photography were less common. A strategic decision has to be made to either provide staff with institutional devices or use software solutions to address data governance concerns when using personal devices. What is Known: • mHealth use by junior doctors and medical students is widespread. • Clinicians' use of instant messaging apps such as WhatsApp is the widespread in the UK and Ireland, in the absence of alternatives. What is New: • Personal mobile device use was widespread in the absence of alternatives, with the British National Formulary nearly universally downloaded to physicians' personal mobile devices. • A third of respondents used instant messaging and smartphone photography on their personal mobile device when seeking patient management advice from other teams in the absence of alternatives.
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Affiliation(s)
- Haiko Kurt Jahn
- Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
- Children’s Emergency Department, Royal Belfast Hospital for Sick Children, 274 Grosvenor Rd, Belfast, BT12 6BA UK
| | - Ingo Henry Johannes Jahn
- School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Wilhelm Behringer
- Faculty of Medicine, Center of Emergency Medicine, Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK
- Academic Department of Emergency Care, University of the West of England, Blackberry Hill, Avon, Bristol, BS16 1DD UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, LE1 6TP UK
- Children’s Emergency Department, Royal Infirmary, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, LE1 5WW UK
| | - On behalf of Paediatric Emergency Research United Kingdom and Ireland (PERUKI)
- Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
- Children’s Emergency Department, Royal Belfast Hospital for Sick Children, 274 Grosvenor Rd, Belfast, BT12 6BA UK
- School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, QLD 4072 Australia
- Faculty of Medicine, Center of Emergency Medicine, Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
- Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK
- Academic Department of Emergency Care, University of the West of England, Blackberry Hill, Avon, Bristol, BS16 1DD UK
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, LE1 6TP UK
- Children’s Emergency Department, Royal Infirmary, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, LE1 5WW UK
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Jahn HK, Jahn IHJ, Roland D, Behringer W, Lyttle M. Prescribing in a paediatric emergency: A PERUKI survey of prescribing and resuscitation aids. Acta Paediatr 2021; 110:1038-1045. [PMID: 32869877 DOI: 10.1111/apa.15551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim was to investigate the use of paper-based and electronic prescribing and resuscitation aids in paediatric emergency care from a departmental and individual physician perspective. METHODS A two-stage web-based self-report questionnaire was performed. In stage (i), a lead investigator at PERUKI sites completed a department-level survey; in stage (ii), individual physicians recorded their personal practice. RESULTS The site survey was completed by 46/54 (85%) of PERUKI sites. 198 physicians completed the individual physicians' survey. Individual physicians selected the use of formulary apps for checking of medication dosages nearly as often as hardcopy formularies. The APLS WETFLAG calculation and hardcopy aids were widely accepted in both surveys. A third of sites accepted and half of the individual physicians selected resuscitation apps on the personal mobile device as paediatric resuscitation aids. CONCLUSION Our survey shows a high penetrance of the British National Formulary app, a success of NHS digital policy and strategy. Despite potential advantages, many physicians in our survey do not use resuscitation apps. Reluctance to engage with apps is likely to be multifactorial and includes human factors. These obstacles need to be overcome to create a digital healthcare culture.
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Affiliation(s)
- Haiko Kurt Jahn
- Emergency Department Royal Belfast Hospital for Sick Children Belfast UK
- Friedrich Schiller University Jena Jena Germany
| | | | - Damian Roland
- Emergency Department Leicester Royal Infirmary University of Leicester Leicester UK
| | | | - Mark Lyttle
- Emergency Department Bristol Royal Hospital for Children Bristol UK
- Faculty of Health and Applied Sciences University of the West of England Bristol UK
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