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Takashima M, Gibson V, Borello E, Galluzzo L, Gill FJ, Kinney S, Newall F, Ullman AJ. Pediatric invasive device utility and harm: a multi-site point prevalence survey. Pediatr Res 2024:10.1038/s41390-023-03014-1. [PMID: 38200324 DOI: 10.1038/s41390-023-03014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND AIMS Invasive devices are widely used in healthcare settings; however, pediatric patients are especially vulnerable to invasive device-associated harm. This study aimed to explore invasive device utility, prevalence, harm, and clinical practice across three Australian pediatric tertiary hospitals. METHODS In 2022-2023, a multi-center, observational, rolling-point-prevalence survey was conducted. Fifty-per-cent of inpatients were systemically sampled by random allocation. Patients with devices were then followed for up to 3-days for device-related complications/failures and management/removal characteristics. RESULTS Of the 285 patients audited, 78.2% had an invasive device (n = 412 devices), with a median of 1 device-per-patient (interquartile range 1-2), with a maximum of 13 devices-per-patient. Over half of devices were vascular access devices (n = 223; 54.1%), followed by gastrointestinal devices (n = 112; 27.2%). The point-prevalence of all device complications on Day 0 was 10.7% (44/412 devices) and period-prevalence throughout the audit period was 27.7% (114/412 devices). The period-prevalence of device failure was 13.4% (55/412 devices). CONCLUSIONS The study highlighted a high prevalence of invasive devices among hospitalized patients. One-in-ten devices failed during the audit period. These findings underscore the need for vigilant monitoring and improved strategies to minimize complications and enhance the safety of invasive devices in pediatric hospital settings. IMPACT A high prevalence of invasive devices among hospitalized patients was reported. Of the 285 patients audited, almost 80% had an invasive device (total 412 devices), with a median of 1 device-per-patient and a maximum of 13 devices-per-patient. The most common devices used in pediatric healthcare are vascular access devices (n = 223; 54.1%), however, 16% (n = 36) of these devices failed, and one-third had complications. The point prevalence of all device complications at day 0 was 10.7% (44 out of 412 devices), with a period prevalence of 27.7% (114 out of 412 devices) throughout the audit period.
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Affiliation(s)
- Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia.
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Eloise Borello
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lily Galluzzo
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
| | - Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Perth, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Sharon Kinney
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Newall
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
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Jeffs EL, Delany C, Newall F, Kinney S. Goals of the Morbidity and Mortality meeting in acute care: A scoping review. Aust Crit Care 2024; 37:185-192. [PMID: 38016842 DOI: 10.1016/j.aucc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe what is known about understandings of the goals of the Morbidity and Mortality meeting. REVIEW METHODS USED The study utilised scoping review methodology. DATA SOURCES Papers in English presenting empirical data published in academic journals with Morbidity and Mortality meetings as the central concept of study. Included papers presented data about the perception of stakeholders about goals of the Morbidity and Mortality meeting. Medline, Embase, and CINAHL databases were search conducted from earliest record - October 20th 2021. A manual search of the reference lists of all included papers identified further eligible papers. REVIEW METHODS Data about the location, participant type, and methods/ methodology were extracted and entered onto a database. Content analysis of the results and discussion sections of qualitative papers yielded broad categories of meeting goal. This provided a framework for the organisation of the quantitative findings, which were subsequently extracted and charted under these categories. RESULTS Twenty-five papers were included in the review, and six main categories were identified in the qualitative synthesis of findings. These included meeting goals related to quality and safety, education, legal and reputational risk management, professional culture, family/caregivers, and peer support. CONCLUSIONS There are heterogeneous understandings of key terminologies used to describe Morbidity and Mortality meeting goals, particularly evident within understandings of educational and quality and safety meeting goals. This paper defines and unravels this complexity in a way that researchers and clinicians can define, compare and evaluate their own department's meeting goals.
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Affiliation(s)
- Emma Louise Jeffs
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Clare Delany
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Fiona Newall
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Sharon Kinney
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3010, Australia; The University of Melbourne, Parkville, Victoria, 3010, Australia
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Thompson J, Bujalka H, McKeever S, Lipscomb A, Moore S, Hill N, Kinney S, Cham KM, Martin J, Bowers P, Gerdtz M. Educational strategies in the health professions to mitigate cognitive and implicit bias impact on decision making: a scoping review. BMC Med Educ 2023; 23:455. [PMID: 37340395 DOI: 10.1186/s12909-023-04371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cognitive and implicit biases negatively impact clinicians' decision-making capacity and can have devastating consequences for safe, effective, and equitable healthcare provision. Internationally, health care clinicians play a critical role in identifying and overcoming these biases. To be workforce ready, it is important that educators proactively prepare all pre-registration healthcare students for real world practice. However, it is unknown how and to what extent health professional educators incorporate bias training into curricula. To address this gap, this scoping review aims to explore what approaches to teaching cognitive and implicit bias, for entry to practice students, have been studied, and what are the evidence gaps that remain. METHODS This scoping review was guided by the Joanna Briggs Institute (JBI) methodology. Databases were searched in May 2022 and included CINAHL, Cochrane, JBI, Medline, ERIC, Embase, and PsycINFO. The Population, Concept and Context framework was used to guide keyword and index terms used for search criteria and data extraction by two independent reviewers. Quantitative and qualitative studies published in English exploring pedagogical approaches and/or educational techniques, strategies, teaching tools to reduce the influence of bias in health clinicians' decision making were sought to be included in this review. Results are presented numerically and thematically in a table accompanied by a narrative summary. RESULTS Of the 732 articles identified, 13 met the aim of this study. Most publications originated from the United States (n=9). Educational practice in medicine accounted for most studies (n=8), followed by nursing and midwifery (n=2). A guiding philosophy or conceptual framework for content development was not indicated in most papers. Educational content was mainly provided via face-to-face (lecture/tutorial) delivery (n=10). Reflection was the most common strategy used for assessment of learning (n=6). Cognitive biases were mainly taught in a single session (n=5); implicit biases were taught via a mix of single (n=4) and multiple sessions (n=4). CONCLUSIONS A range of pedagogical strategies were employed; most commonly, these were face-to-face, class-based activities such as lectures and tutorials. Assessments of student learning were primarily based on tests and personal reflection. There was limited use of real-world settings to educate students about or build skills in biases and their mitigation. There may be a valuable opportunity in exploring approaches to building these skills in the real-world settings that will be the workplaces of our future healthcare workers.
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Affiliation(s)
- John Thompson
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia.
| | - Helena Bujalka
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Stephen McKeever
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Adrienne Lipscomb
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Sonya Moore
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Nicole Hill
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sharon Kinney
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Martin
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Patrick Bowers
- Department of Audiology and Speech Pathology, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
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O'Neill J, Devsam B, Kinney S, Hawley M, Richards S, Newall F. Exploring the impact of the COVID-19 environment on nursing delivery of family-centred care in a paediatric hospital. J Adv Nurs 2023; 79:320-331. [PMID: 36253941 PMCID: PMC9874628 DOI: 10.1111/jan.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES To understand how the pandemic environment impacted the delivery of FCC of children and families from a nursing perspective in a major tertiary paediatric hospital. BACKGROUND Family-centred care (FCC) is a well-established framework to promote parental involvement in every aspect of a child's hospitalization, however, rules and restrictions in place during the COVID-19 pandemic affected the ways in which Family-centred Care could be delivered in practice. DESIGN This is a qualitative exploratory descriptive study to elicit the perspective of paediatric nurses delivering care to children in a hospital during the COVID-19 pandemic in Victoria, Australia. METHODS Nurses from all subspecialties in a tertiary paediatric hospital were invited to participate in virtual focus groups to discuss their experience of delivering FCC during the COVID-19 pandemic. Focus groups were recorded and transcribed, then analysed using Framework Analysis. RESULTS Nineteen nurses participated across seven focus groups during June and July 2020. The four themes-Advocating with empathy, Enabling communication, Responding with flexibility, and Balancing competing considerations-and the eight subthemes that were generated, outline how nurses deliver FCC, and how these FCC actions were impacted by the COVID-19 environment and the related hospital restrictions. CONCLUSION This study documents the experiences, resilience and resourcefulness of paediatric nurses in Australia during the COVID-19 pandemic as well as moving Family-centred Care from a theoretical framework into a practical reality. IMPACT The findings from this study should inform consideration of the impacts of public health policies during infectious disease outbreaks moving forward. In addition by describing the core actions of Family-centred Care, this study has implications for educational interventions on how to translate FCC theory into practice. No public or patient contribution as this study explored nursing perceptions only.
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Affiliation(s)
- Jenny O'Neill
- Department of Nursing ResearchThe Royal Children's HospitalMelbourneVictoriaAustralia,Department of Nursing, Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Bianca Devsam
- Department of Nursing ResearchThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Sharon Kinney
- Department of Nursing ResearchThe Royal Children's HospitalMelbourneVictoriaAustralia,Department of Nursing, Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Meaghan Hawley
- Department of Nursing ResearchThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Stacey Richards
- Department of Nursing ResearchThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Fiona Newall
- Department of Nursing ResearchThe Royal Children's HospitalMelbourneVictoriaAustralia,Department of Nursing, Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
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Murni IK, Duke T, Kinney S, Daley AJ, Wirawan MT, Soenarto Y. Risk factors for healthcare-associated infection among children in a low-and middle-income country. BMC Infect Dis 2022; 22:406. [PMID: 35473658 PMCID: PMC9040216 DOI: 10.1186/s12879-022-07387-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAI) are one of significant causes of morbidity and mortality. Evaluating risk factors associated with HAI are important to improve clinical outcomes. We aimed to evaluate the risk factors of HAI in children in a low-to middle-income country. METHODS A prospective cohort study was conducted during 43 months at a teaching hospital in Yogyakarta, Indonesia. All consecutive patients admitted to pediatric ICU and pediatric wards > 48 h were eligible. Those eligible patients were observed daily to identify the presence of HAI based on CDC criteria. The risk factors of HAI were identified. Multivariable logistic regression was used to identify independent risk factors. RESULTS Total of 2612 patients were recruited. Of 467 were diagnosed as HAI. The cumulative incidence of HAI was 17.9%. In the multivariable analysis; length of stay > 7 days, severe sepsis, use of urine catheter, central venous catheter (CVC), non-standardized antibiotics, and aged < 1 year were independently associated with increased risk of HAI with adjusted OR (95%CI): 5.6 (4.3-7.3), 1.9 (1.3-2.9), 1.9 (1.3-2.6), 1.8 (1.1-2.9), 1.6 (1.2-2.0), and 1.4 (1.1-1.8), respectively. CONCLUSIONS This study found that length of stay > 7 days, use of urine catheter and CVC, non-standardized antibiotic use, aged < 1 year, and had a diagnosis of severe sepsis increased risk of HAI.
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Affiliation(s)
- Indah K Murni
- Department of Child Health, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia. .,Centre for Child Health-Pediatric Research Office (CCH-PRO), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI, Melbourne, VIC, Australia.,Pediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Kinney
- Department of Pediatrics and Nursing, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Andrew J Daley
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Laboratory Services, Infection Prevention and Control, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Muhammad Taufik Wirawan
- Department of Child Health, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Yati Soenarto
- Department of Child Health, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia.,Centre for Child Health-Pediatric Research Office (CCH-PRO), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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6
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Jarden R, Scanlon A, Bridge N, McKeever S, Turner R, Prescott H, Thompson J, Cambridge P, Kinney S, Leong N, Gerdtz M. Coronavirus disease 2019 Critical Care Essentials course for nurses: development and implementation of an education program for healthcare professionals. AUST J ADV NURS 2022. [DOI: 10.37464/2020.391.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Devsam BU, Kinney S. The clinical utility of the pain assessment tool in ventilated, sedated, and muscle-relaxed neonates. Aust Crit Care 2020; 34:333-339. [PMID: 33223388 DOI: 10.1016/j.aucc.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The neonatal Pain Assessment Tool (PAT) is considered a reliable and valid tool for assessing neonatal pain. No research has been conducted on the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates. OBJECTIVE The objective of the study was to determine the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates. METHODS Neonatal nurses from the Royal Children's Hospital completed online surveys to assess the clinical utility of the PAT. Three focus groups were then conducted to further explore the variation of pain scores from the survey and clarify the challenges in interpreting the pain score. RESULTS Nurses perceived the PAT clinically useful in neonates who were ventilated and minimally sedated. However, the PAT was not clinically useful in neonates who were ventilated and heavily sedated or muscle-relaxed. Further exploration via focus groups highlighted two themes related to the 'variation in the timing of the pain score' and the 'integration of critical thinking and judgement' used when assessing pain in neonates. CONCLUSIONS The clinical utility of the PAT is acceptable for minimally sedated neonates; however, it decreases the more sedated a neonate becomes, and the PAT's usefulness is extremely poor in the muscle-relaxed neonate. A better understanding of the timing and interpretation of the pain score in relation to the neonate's clinical status may enable improved decision-making and pain management. The PAT requires further validity, reliability, and clinical utility research, particularly in critically ill and muscle-relaxed neonates.
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Affiliation(s)
- Bianca U Devsam
- Neonatal Intensive Care Unit (Butterfly Ward), The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Nursing Research Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, 3010, Australia.
| | - Sharon Kinney
- Nursing Research Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, 3010, Australia
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Yi Goh MZ, Hutchinson A, Gelbart B, Kinney S. Challenging routine hourly vital sign documentation in the paediatric intensive care unit. Aust Crit Care 2020. [DOI: 10.1016/j.aucc.2020.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Yi Goh MZ, Hutchinson A, Gelbart B, Kinney S. Establishing a suitable frequency of vital sign documentation in the paediatric intensive care unit. Aust Crit Care 2020. [DOI: 10.1016/j.aucc.2020.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Background: Nosocomial bloodstream infection (BSI) is associated with high mortality rates. Evaluating factors to predict mortality is important for prevention and improving clinical outcomes. Aim: To evaluate the clinical predictors of mortality in paediatric nosocomial bloodstream infection. Methods: A prospective cohort study was conducted from 1 December 2010 until 28 February 2013 in a teaching hospital in Yogyakarta, Indonesia. All patients admitted consecutively to the paediatric ICU (PICU) and paediatric wards after > 48 h of hospitalisation were eligible. Patients were observed daily to identify the presence of nosocomial BSI based on Centers for Disease Control and Prevention (CDC) criteria. Patients were followed up until they were discharged or died, and predictors of mortality were identified. Logistic regression was used to identify independent predictors. Results: A total of 2646 patients were recruited, 170 developed nosocomial BSI (6.4%) and 70 of these children died (case fatality rate 41%). Nosocomial BSI was associated with increased mortality with an adjusted OR of 8.5 (95% CI 6.0-12.1). In multivariate analysis, malnutrition, admission to the PICU and use of a central line catheter were independently associated with an increased risk of death with adjusted ORs (95% CI), respectively, of 6.0 (1.6-22.6), 3.2 (1.6-6.7) and 3.1 (1.1-8.7). Conclusion: The study demonstrates that significant mortality is attributable to nosocomial bloodstream infection. An increased risk of death in children with nosocomial BSI can be identified by simple clinical predictors including malnutrition, admission to the PICU and use of a central line catheter.
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Affiliation(s)
- Indah K Murni
- a Department of Paediatrics, Dr Sardjito Hospital/Faculty of Medicine , Universitas Gadjah Mada , Yogyakarta , Indonesia
| | - Trevor Duke
- b Centre for International Child Health, Department of Paediatrics, University of Melbourne, MCRI, and Paediatric Intensive Care Unit , Royal Children's Hospital , Melbourne , Victoria
| | - Andrew J Daley
- c Laboratory Services, Infection Prevention and Control, Royal Children's Hospital, Melbourne and Department of Paediatrics , University of Melbourne , Victoria
| | - Sharon Kinney
- d Department of Paediatrics and Nursing, University of Melbourne , Royal Children's Hospital , Melbourne , Victoria
| | - Yati Soenarto
- a Department of Paediatrics, Dr Sardjito Hospital/Faculty of Medicine , Universitas Gadjah Mada , Yogyakarta , Indonesia
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Manias E, Cranswick N, Newall F, Rosenfeld E, Weiner C, Williams A, Wong ICK, Borrott N, Lai J, Kinney S. Medication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospital. J Paediatr Child Health 2019; 55:320-326. [PMID: 30168236 PMCID: PMC7379618 DOI: 10.1111/jpc.14193] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 06/07/2018] [Accepted: 07/22/2018] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors. METHODS A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included. RESULTS A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors. CONCLUSION Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversitySydneyNew South WalesAustralia,Department of MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia,Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Noel Cranswick
- Department of MedicineClinical Pharmacology UnitMelbourneVictoriaAustralia,Murdoch Childrens Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Fiona Newall
- Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia,Murdoch Childrens Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Paediatrics, Royal Children's HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ellie Rosenfeld
- Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Carlye Weiner
- Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Allison Williams
- School of Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Ian CK Wong
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUnited Kingdom
| | - Narelle Borrott
- Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Jerry Lai
- eResearchDeakin UniversityGeelongVictoriaAustralia
| | - Sharon Kinney
- Melbourne School of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia,Department of Paediatrics, Royal Children's HospitalUniversity of MelbourneMelbourneVictoriaAustralia
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12
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Morris K, Morris N, Kinney S. Nurses New to Paediatric Intensive Care: Knowledge Outcomes of a 12-week Transition to Specialty Practice Program. Aust Crit Care 2019. [DOI: 10.1016/j.aucc.2018.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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Murni IK, Duke T, Daley AJ, Kinney S, Soenarto Y. True Pathogen or Contamination: Validation of Blood Cultures for the Diagnosis of Nosocomial Infections in a Developing Country. J Trop Pediatr 2018; 64:389-394. [PMID: 29177467 DOI: 10.1093/tropej/fmx081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Blood culture results are frequently used to guide antibiotic decision-making, but culture contaminants need to be distinguished from true pathogens. AIMS To assess the contamination rate of blood cultures and validate a method to distinguish between true bacteraemia and contamination. METHODS We analysed blood culture results from children who were admitted to the paediatric ICU and paediatric wards at the Sardjito Hospital, Yogyakarta, Indonesia between December 2010 and February 2013. For each positive culture result, the type of isolated organism, time to positivity, and the number of positive culture sites were considered to classify the isolate as representing a true bacteraemia or contaminant. RESULTS There were 1293 cultures obtained from blood and 308 (23.8%) were positive for bacterial growth. Fifty-three (4.1%) of the total cultures drawn fulfilled criteria for contaminants. The most common blood culture contaminants were coagulase-negative staphylococci. CONCLUSION Using standardized criteria, it is possible to implement a working method to identify true nosocomial infection from blood culture contaminant, and thus limit the effect of contaminated blood culture on irrational antibiotic use.
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Affiliation(s)
- Indah K Murni
- Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Trevor Duke
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, MCRI, Parkville, Victoria, Australia.,Paediatric Intensive Care Unit, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Andrew J Daley
- Laboratory Services, Infection Prevention and Control, Royal Children's Hospital, Melbourne and Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Sharon Kinney
- Department of Paediatrics and Nursing, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Yati Soenarto
- Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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McKittrick JT, Kinney S, Lima S, Allen M. The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session. Nurse Educ Pract 2017; 28:115-120. [PMID: 29078106 DOI: 10.1016/j.nepr.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 04/01/2017] [Accepted: 10/16/2017] [Indexed: 12/01/2022]
Abstract
Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation.
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Affiliation(s)
- Joanne T McKittrick
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia; The University of Melbourne, Melbourne, Victoria, 3010, Australia.
| | - Sharon Kinney
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia; The University of Melbourne, Melbourne, Victoria, 3010, Australia.
| | - Sally Lima
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
| | - Meredith Allen
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
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15
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Gorlin J, Kinney S, Fung MK, Tinmouth A. Prothrombin complex concentrate for emergent reversal of warfarin: an international survey of hospital protocols. Vox Sang 2017. [DOI: 10.1111/vox.12539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- J. Gorlin
- Innovative Blood Resources/Memorial Blood Centers; St. Paul MN USA
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - S. Kinney
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - M. K. Fung
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington VT USA
| | - A. Tinmouth
- Ottawa Hospital Centre for Transfusion Research; Ottawa Hospital Research Institute; Ottawa ON Canada
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16
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Borrott N, Kinney S, Newall F, Williams A, Cranswick N, Wong I, Manias E. Medication communication between nurses and doctors for paediatric acute care: An ethnographic study. J Clin Nurs 2017; 26:1978-1992. [DOI: 10.1111/jocn.13606] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Narelle Borrott
- Melbourne School of Health Sciences The University of Melbourne Parkville VIC Australia
| | - Sharon Kinney
- Nursing Research The Royal Children's Hospital Melbourne Parkville VIC Australia
- Departments of Nursing and Paediatrics The University of Melbourne Parkville VIC Australia
| | - Fiona Newall
- Nursing Research The Royal Children's Hospital Melbourne Parkville VIC Australia
- Departments of Nursing and Paediatrics The University of Melbourne Parkville VIC Australia
- Murdoch Childrens Research Institute Parkville VIC Australia
- Clinical Haematology Royal Children's Hospital Parkville VIC Australia
| | - Allison Williams
- School of Nursing and Midwifery Monash University Clayton VIC Australia
| | - Noel Cranswick
- Clinical Pharmacology Unit Department of Medicine Royal Children's Hospital Parkville VIC Australia
- Australian Paediatric Pharmacology Research Unit (APPRU) Murdoch Childrens Research Institute & The Royal Children's Hospital Parkville VIC Australia
- The University of Melbourne Parkville VIC Australia
| | - Ian Wong
- School of Pharmacy University College London London UK
| | - Elizabeth Manias
- School of Nursing and Midwifery Faculty of Health Deakin University Burwood VIC Australia
- The Royal Melbourne Hospital The University of Melbourne Parkville VIC Australia
- Melbourne School of Health Sciences The University of Melbourne Burwood VIC Australia
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17
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Weiner C, Penrose S, Manias E, Cranswick N, Rosenfeld E, Newall F, Williams A, Borrott N, Kinney S. Difficulties with assessment and management of an infant's distress in the postoperative period: Optimising opportunities for interdisciplinary information-sharing. SAGE Open Med Case Rep 2017; 4:2050313X16683628. [PMID: 28228956 PMCID: PMC5308436 DOI: 10.1177/2050313x16683628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/16/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The importance of accurate paediatric patient assessment is well established but under-utilised in managing postoperative medication regimens. METHODS Data for this case report were collected through observations of clinical practice, conduct of interviews, and retrieval of information from the medical record. This case report involving a hospitalised 1-year-old boy demonstrates the difficulties associated with assessing and managing postoperative distress, including pain and other clinical conditions related to the surgical procedure. RESULTS Postoperatively, there were difficulties in managing pain and an episode of over-sedation, occasioning opiate reversal with naloxone. In addition, he had decreasing oxygen saturation and increased work of breathing. X-ray showed changes consistent with either atelectasis or aspiration, and he was commenced on antibiotics. The patient experienced respiratory distress and required intervention from the medical emergency team. CONCLUSION This case demonstrated the importance of comprehensive assessment and careful consideration of alternative causes of an infant's distress using the results of assessment tools to aid decision-making. Communication moderates effective patient care, and more favourable outcomes could be achieved by optimising interdisciplinary information-sharing.
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Affiliation(s)
- Carlye Weiner
- Melbourne School of Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Sueann Penrose
- Children’s Pain Management Service, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Elizabeth Manias
- Melbourne School of Health Sciences, The University of Melbourne, Carlton, VIC, Australia
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- The Royal Melbourne Hospital and The University of Melbourne, Parkville, VIC, Australia
- Elizabeth Manias, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | - Noel Cranswick
- Clinical Pharmacology Unit, Department of Medicine, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Australian Paediatric Pharmacology Research Unit (APPRU), Murdoch Childrens Research Institute and The Royal Children’s Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Ellie Rosenfeld
- Melbourne School of Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Fiona Newall
- Nursing Research, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Clinical Haematology, Departments of Nursing and Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Allison Williams
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Narelle Borrott
- Melbourne School of Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Sharon Kinney
- Nursing Research, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Departments of Nursing and Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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Murni IK, Duke T, Daley AJ, Kinney S, Soenarto Y. ANTIBIOTIC RESISTANCE AND MORTALITY IN CHILDREN WITH NOSOCOMIAL BLOODSTREAM INFECTION IN A TEACHING HOSPITAL IN INDONESIA. Southeast Asian J Trop Med Public Health 2016; 47:983-993. [PMID: 29620805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Nosocomial infection is a major problem in hospitals worldwide. Understanding patterns of bacterial etiology and antibiotic susceptibility are important factors to combating nosocomial infection. Among children with nosocomial bloodstream infection (BSI), we identified pathogens and determined antibiotics resistance patterns and mortality rates for antibiotic-susceptible and multidrugresistant (MDR) infection in patients with nosocomial BSI in pediatric wards and PICU at Dr Sardjito Hospital, Indonesia during December 2010 to February 2013. Of 174 isolates from 170 patients, 168 pathogens were bacteria, of which 148 were gram-negative. Pseudomonas aeruginosa, Klebsiella spp, Enterobacteriaceae, Acinetobacter baumanii, and Escherichia coli was found in 55%, 6%, 4%, 1%, and <1%, respectively of the isolates. Imipenem, amikacin, ciprofloxacin, and ceftazadime had the highest sensitivity to nosocomial pathogens at 86%, 84%, 84%, and 75%, respectively. Eleven patients had MDR-infections, 7 of whom died. Among 153 patients infected with bacteria resistant to <3 classes of antibiotics (non-MDR), mortality was 40%, and among 4 patients with fully drug-susceptible sepsis only one died. Thus, substantial mortality was observed in children with nosocomial-BSI, particularly with MDR pathogens. Given the further high risk of resistance with wider use of carbapenems, third generation cephalosporins and flouroquinolones, prevention should be given highest priority in combating hospital-acquired infection.
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McKeever S, Kinney S, Lima S, Newall F. Creating a journal club competition improves paediatric nurses' participation and engagement. Nurse Educ Today 2016; 37:173-177. [PMID: 26763208 DOI: 10.1016/j.nedt.2015.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/10/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND To improve journal club participation, innovative approaches are required but few have been described. It was unknown if adding an element of competition, to an established journal club, would increase nurses' participation. OBJECTIVE To explore the impact on attendance and participation in a hospital-wide nursing journal club through the introduction of an element of competition. DESIGN A descriptive exploratory study. SETTING AND PARTICIPANTS An Australian specialist tertiary paediatric hospital with over 1600 nurses. METHODS In 2013, 12 hospital wards/departments were randomly assigned a month each to present journal club. Nurses were supported to evaluate an article according to a published framework. A predetermined rubric guided marking. Post competition, all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and qualitative data were collected. Questions elicited attitudes and perceived barriers or facilitators to participation in the journal club. RESULTS Compared to 2012, there was a statistically significant increase in journal club attendance (2013 median=20.5 [IQR=18.2, 27.7] vs. 2012 median=9 [IQR=6.5, 12.5], Mann-Whitney U test, p<0.01). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (Non-Attendees n=224, Attendees n=65 (including 18 presenters). Overall, Attendees reported journal club had a positive impact on their professional engagement. Presenters rated the journal club format highly as it developed skills and increased their confidence in journal club presentation. Emergent themes were time and location, engagement, topics and content. CONCLUSION A competition format can increase nurses' journal club attendance and participation. Further work is required to establish applicability of this format to other settings.
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Affiliation(s)
- Stephen McKeever
- Nursing Research and Education Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, VIC 3010, Australia; Department of Children's Nursing, School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
| | - Sharon Kinney
- Nursing Research and Education Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, VIC 3010, Australia.
| | - Sally Lima
- Nursing Research and Education Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, VIC 3010, Australia; Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
| | - Fiona Newall
- Nursing Research and Education Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, VIC 3010, Australia; Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
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Lima S, Newall F, Jordan HL, Hamilton B, Kinney S. Development of competence in the first year of graduate nursing practice: a longitudinal study. J Adv Nurs 2016; 72:878-88. [DOI: 10.1111/jan.12874] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sally Lima
- The Royal Children's Hospital Melbourne; Parkville Victoria Australia
- The University of Melbourne; Parkville Victoria Australia
- Murdoch Children's Research Institute Melbourne; Parkville Victoria Australia
| | - Fiona Newall
- The Royal Children's Hospital Melbourne; Parkville Victoria Australia
- The University of Melbourne; Parkville Victoria Australia
- Murdoch Children's Research Institute Melbourne; Parkville Victoria Australia
| | | | | | - Sharon Kinney
- The Royal Children's Hospital Melbourne; Parkville Victoria Australia
- The University of Melbourne; Parkville Victoria Australia
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21
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Lima S, Jordan HL, Kinney S, Hamilton B, Newall F. Empirical evolution of a framework that supports the development of nursing competence. J Adv Nurs 2015; 72:889-99. [DOI: 10.1111/jan.12872] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sally Lima
- The Royal Children's Hospital Melbourne; Parkville Victoria Australia
- The University of Melbourne; Parkville Victoria Australia
- Murdoch Children's Research Institute Melbourne; Parkville Victoria Australia
| | | | - Sharon Kinney
- The Royal Children's Hospital Melbourne; Parkville Victoria Australia
- The University of Melbourne; Parkville Victoria Australia
| | | | - Fiona Newall
- The Royal Children's Hospital Melbourne; Parkville Victoria Australia
- The University of Melbourne; Parkville Victoria Australia
- Murdoch Children's Research Institute Melbourne; Parkville Victoria Australia
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22
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Goldsworthy M, Franich-Ray C, Kinney S, Shekerdemian L, Beca J, Gunn J. Relationship between Social-Emotional and Neurodevelopment of 2-Year-Old Children with Congenital Heart Disease. CONGENIT HEART DIS 2015; 11:378-385. [PMID: 26680016 DOI: 10.1111/chd.12320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to describe social-emotional outcomes and the relationship with neurodevelopmental outcomes in a cohort of 2-year-old children who underwent surgery for congenital heart disease (CHD) in infancy, and explore the relationship between the outcomes and parental and surgical factors. DESIGN A two-center prospective cross-sectional cohort study. PATIENTS A cohort of 105 2-year-olds who underwent surgery in infancy for severe CHD MEASURES: Social-emotional and neurodevelopment was evaluated with the Infant and Toddler Social and Emotional Assessment tool (ITSEA), and the Bayley Scales of Infant Toddler Development, Third Edition. RESULTS Neurodevelopment was delayed in the CHD cohort with significantly worse results compared to published Australian-based norms in all domains (P < .001) and in the Cognitive (P < .001) and Language (P < .001) domains with respect to the reported American norms. Social-emotional outcome was similar to Australian norms in all domains but better than the American based norms in the Internalizing domain (P < .05). Higher maternal education was associated to better neurodevelopmental outcome in all domains and better scores in the internalizing and externalizing domains of the ITSEA. There was a moderate correlation (r = 0.43, P < .001) between Language and social-emotional competence. Motor development was influenced by the need for a significant cardiac reoperation. CONCLUSIONS The influences of social factors may be underestimated in the outcome of children with CHD. Language development in those with CHD may be improved with intervention targeting social-emotional competence; further research is needed in this area.
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Affiliation(s)
- Michelle Goldsworthy
- The University of Melbourne, Melbourne, Australia.,Baylor College of Medicine, Houston, Tex, USA
| | - Candice Franich-Ray
- The Royal Children's Hospital, Melbourne, Australia, New Zealand.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sharon Kinney
- The University of Melbourne, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia, New Zealand
| | | | - John Beca
- Starship Children's Health, Auckland, New Zealand
| | - Julia Gunn
- The University of Melbourne, Melbourne, Australia. .,The Royal Children's Hospital, Melbourne, Australia, New Zealand. .,Murdoch Childrens Research Institute, Melbourne, Australia.
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McKeever S, Twomey B, Hawley M, Lima S, Kinney S, Newall F. Engaging a Nursing Workforce in Evidence-Based Practice: Introduction of a Nursing Clinical Effectiveness Committee. Worldviews Evid Based Nurs 2015; 13:85-8. [DOI: 10.1111/wvn.12119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen McKeever
- Senior Lecturer in Children's Nursing, Department of Children's Nursing, School of Health and Social Care; London South Bank University; London UK
| | | | - Meaghan Hawley
- Administrative Assistant; Royal Children's Hospital; Parkville Victoria Australia
| | - Sally Lima
- Nurse Consultant, Research, Royal Children's Hospital; The University of Melbourne; Parkville Victoria Australia
| | - Sharon Kinney
- Nurse Consultant, Research, Royal Children's Hospital; The University of Melbourne; Parkville Victoria Australia
| | - Fiona Newall
- Director, Nursing Research, Royal Children's Hospital; The University of Melbourne, Parkville, Victoria, Australia, and London South Bank University; London UK
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24
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Murni IK, Duke T, Kinney S, Daley AJ, Soenarto Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child 2015; 100:454-9. [PMID: 25503715 PMCID: PMC4413864 DOI: 10.1136/archdischild-2014-307297] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 11/21/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. AIMS To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use. METHODS A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods. RESULTS We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)). CONCLUSIONS Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries.
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Affiliation(s)
- Indah K Murni
- Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia,Department of Paediatrics, Centre for International Child Health, University of Melbourne, MCRI, Melbourne, Victoria, Australia,Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, MCRI, Melbourne, Victoria, Australia,Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sharon Kinney
- Department of Paediatrics and Nursing, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew J Daley
- Laboratory Services, Infection Prevention and Control, Royal Children's Hospital, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Yati Soenarto
- Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, Indonesia
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Kinney S, Moulden A, Sloane J. Evaluation of the statewide paediatric observation and response charts in Victoria. Aust Crit Care 2015. [DOI: 10.1016/j.aucc.2014.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lima S, Newall F, Kinney S, Jordan HL, Hamilton B. How competent are they? Graduate nurses self-assessment of competence at the start of their careers. Collegian 2014; 21:353-8. [DOI: 10.1016/j.colegn.2013.09.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. DATA SOURCES Databases were searched from inception to April 2014. STUDY SELECTION AND DATA EXTRACTION Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. DATA SYNTHESIS In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ(2)(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). CONCLUSIONS Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions.
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Affiliation(s)
- Elizabeth Manias
- Deakin University, Burwood, VIC, Australia The University of Melbourne, Parkville, VIC, Australia
| | - Sharon Kinney
- The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia
| | - Noel Cranswick
- The University of Melbourne, Parkville, VIC, Australia Royal Children's Hospital, Parkville, VIC, Australia
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Evans J, Syddall S, Butt W, Kinney S. Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric intensive care unit. Aust Crit Care 2014; 27:70-4; quiz 75-6. [PMID: 24636425 DOI: 10.1016/j.aucc.2014.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/07/2014] [Accepted: 01/29/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Endotracheal suctioning (ETS) is one of the most common procedures performed in the paediatric intensive care. The two methods of endotracheal suctioning used are known as open and closed suction, but neither method has been shown to be the superior suction method in the Paediatric Intensive Care Unit (PICU). PURPOSE The primary purpose was to compare open and closed suction methods from a physiological, safety and staff resource perspective. METHODS All paediatric intensive care patients with an endotracheal tube were included. Between June and September 2011 alternative months were nominated as open or closed suction months. Data were prospectively collected including suction events, staff involved, time taken, use of saline, and change from pre-suction baseline in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2). Blocked or dislodged ETTs were recorded as adverse events. FINDINGS Closed suction was performed more often per day (7.2 vs 6.0, p<0.01), used significantly less nursing time (23 vs 38 min, p<0.01) and had equivalent rates of adverse events compared to open suction (5 vs 3, p<0.23). Saline lavage usage was significantly higher in the open suction group (18% vs 40%). Open suction demonstrated a greater reduction in SpO2 and nearly three times the incidence of increases in HR and MAP compared to closed suction. Reductions in MAP or HR were comparable across the two methods. CONCLUSIONS In conclusion, CS could be performed with less staffing time and number of nurses, less physiological disturbances to our patients and no significant increases in adverse events.
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Affiliation(s)
- Janine Evans
- Paediatric Intensive Care Unit, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 VIC, Australia.
| | | | - Warwick Butt
- Paediatric Intensive Care Unit, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 VIC, Australia.
| | - Sharon Kinney
- Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 VIC, Australia; Department of Nursing, The University of Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia.
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Abstract
AIM This study aims to explore the characteristics of reported medication errors occurring among children in an Australian children's hospital, and to examine the types, causes and contributing factors of medication errors. METHODS A retrospective clinical audit was undertaken of medication errors reported to an online incident facility at an Australian children's hospital over a 4-year period. RESULTS A total of 2753 medication errors were reported over the 4-year period, with an overall medication error rate of 0.31% per combined admission and presentation, or 6.58 medication errors per 1000 bed days. The two most common severity outcomes were: the medication error occurred before it reached the child (n = 749, 27.2%); and the medication error reached the child who required monitoring to confirm that it resulted in no harm (n = 1519, 55.2%). Common types of medication errors included overdose (n = 579, 21.0%) and dose omission (n = 341, 12.4%). The most common cause relating to communication involved misreading or not reading medication orders (n = 804, 29.2%). Key contributing factors involved communication relating to children's transfer across different clinical settings (n = 929, 33.7%) and the lack of following policies and procedures (n = 617, 22.4%). More than half of the reports (72.5%) were made by nurses. CONCLUSION Future research should focus on implementing and evaluating strategies aimed at reducing medication errors relating to analgesics, anti-infectives, cardiovascular agents, fluids and electrolytes and anticlotting agents, as they are consistently represented in the types of medication errors that occur. Greater attention needs to be placed on supporting health professionals in managing these medications.
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Affiliation(s)
- Elizabeth Manias
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Abstract
BACKGROUND Prevention of nosocomial infection is key to providing good quality, safe healthcare. Infection control programmes (hand-hygiene campaigns and antibiotic stewardship) are effective in reducing nosocomial infections in developed countries. However, the effectiveness of these programmes in developing countries is uncertain. OBJECTIVE To evaluate the effectiveness of interventions for preventing nosocomial infections in developing countries. METHODS A systematic search for studies which evaluated interventions to prevent nosocomial infection in both adults and children in developing countries was undertaken using PubMed. Only intervention trials with a randomized controlled, quasi-experimental or sequential design were included. Where there was adequate homogeneity, a meta-analysis of specific interventions was performed using the Mantel-Haenzel fixed effects method to estimate the pooled risk difference. RESULTS Thirty-four studies were found. Most studies were from South America and Asia. Most were before-and-after intervention studies from tertiary urban hospitals. Hand-hygiene campaigns that were a major component of multifaceted interventions (18 studies) showed the strongest effectiveness for reducing nosocomial infection rates (median effect 49%, effect range 12.7-100%). Hand-hygiene campaigns alone and studies of antibiotic stewardship to improve rational antibiotic use reduced nosocomial infection rates in three studies [risk difference (RD) of -0.09 (95%CI -0.12 to -0.07) and RD of -0.02 (95% CI -0.02 to -0.01), respectively]. CONCLUSIONS Multifaceted interventions including hand-hygiene campaigns, antibiotic stewardship and other elementary infection control practices are effective in developing countries. The modest effect size of hand-hygiene campaigns alone and negligible effect size of antibiotic stewardship reflect the limited number of studies with sufficient homogeneity to conduct meta-analyses.
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Affiliation(s)
- Indah Murni
- Department of Pediatrics, Dr Sardjito Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Kinney S, Lima S, McKeever S, Twomey B, Newall F. Employing a Clinical Governance Framework to Engage Nurses in Research. J Nurs Care Qual 2012; 27:226-31. [DOI: 10.1097/ncq.0b013e318249290f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Azzopardi P, Kinney S, Moulden A, Tibballs J. Attitudes and barriers to a Medical Emergency Team system at a tertiary paediatric hospital. Resuscitation 2011; 82:167-74. [DOI: 10.1016/j.resuscitation.2010.10.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/28/2010] [Accepted: 10/08/2010] [Indexed: 11/16/2022]
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Jolic M, Lim Y, Hamblin S, Kinney S. A Retrospective Audit of Screening Practices Used to Detect Abnormal Glucose Regulation in a Cohort of AMI Patients Admitted to a Coronary Care Unit—An Australian Study. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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McKinley D, Kinney S. The challenges of completing a randomised controlled trial evaluating the use of saline during endotracheal suction in the paediatric intensive care unit. Aust Crit Care 2009. [DOI: 10.1016/j.aucc.2008.12.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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35
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Kinney S, Tibballs J, Johnston L, Duke T. Clinical profile of hospitalized children provided with urgent assistance from a medical emergency team. Pediatrics 2008; 121:e1577-84. [PMID: 18519463 DOI: 10.1542/peds.2007-1584] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review. PATIENTS AND METHODS We conducted an audit of prospectively collected medical emergency team forms and a retrospective review of medical charts during an 18-month period at a tertiary pediatric hospital in Australia. Critical events were defined as cardiac arrest, endotracheal intubation on the ward, reversal of analgesia or sedation, fluid resuscitation at >/=40 mL/kg, hyponatremia (serum sodium level of </=125 mmol/L), hypernatremia (serum sodium level of >/=155 mmol/L), hypoglycemia (glucose level of </=2 mmol/L), or severe metabolic acidosis (pH </= 7.1). RESULTS A total of 172 children had 225 medical emergency team calls (10.6 calls per 1000 hospital admissions and 2.0 calls per 1000 patient-days). Forty-two percent of calls were for infants <1 year old. Preexisting chronic disease was common, with 20% having a chronic underlying neurologic disorder. Forty-four percent of the children were postoperative. The mortality rate of the 172 children was 7.6% in the hospital and 13.4% within 1 year. Thirty-three children had a critical event, with reversal of analgesia being the most common event (n = 11). Postoperative children were more frequently seen in the critical-event group (64% vs 40%). Hospital and 1-year mortality rates were higher for children who had a critical event (16.1% vs 22.6%, respectively) than those who did not (5.7% vs 11.3%). CONCLUSIONS Chronic and complex illnesses were prevalent among children provided with urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.
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Affiliation(s)
- Sharon Kinney
- Clinical Quality Safety Unit, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
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36
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Tibballs J, Kinney S. Evaluation of a paediatric early warning tool--claims unsubstantiated. Intensive Crit Care Nurs 2006; 22:315-6; author reply 317. [PMID: 17084084 DOI: 10.1016/j.iccn.2006.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 10/17/2006] [Indexed: 11/18/2022]
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Tibballs J, Kinney S. A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. Resuscitation 2006; 71:310-8. [PMID: 17069956 DOI: 10.1016/j.resuscitation.2006.05.009] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 05/15/2006] [Accepted: 05/21/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few prospective studies of the incidence and outcome of paediatric in-hospital cardiopulmonary arrest have been reported to enable quality assurance comparisons within and between institutions. METHODS All cardiac and respiratory arrests and their management over a 41-month period in children not subject to palliative treatment or to a 'do not resuscitate' order were recorded and analysed using the Utstein template. RESULTS Cardiac arrest occurred in a total of 111 of 104,780 admissions (1.06/1000) while respiratory arrest alone occurred in 36 (0.34/1000). Return of spontaneous circulation (ROSC) was achieved in 81 patients (73%) in cardiac arrest but only 40 (36%) were discharged from hospital and 38 (34%) survived for 1 year. The 1-year survival from respiratory arrest alone was 97%. Cardiac arrest was four times more common (89 versus 22) and approximately 90 times the incidence in the intensive care unit compared with wards but 1-year survival was similar (34% versus 36%). The initial heart rhythms were hypotensive-bradycardia in 73 (66%) with 38% survival; asystole in 17 (15%) with 12% survival; ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in 10 (9%) with 40% survival; pulseless electrical activity (PEA) in 10 (9%) with 30% survival and SVT in 1 with survival. Secondary ventricular fibrillation occurred in 15 children given adrenaline (epinephrine) for treatment of asystole, hypotensive-bradycardia or PEA of whom 11 had received adrenaline in an initial dose of > 15 mcg/kg and 4 had < 15 mcg/kg (P = 0.0013). Eleven of 15 patients (73%) in secondary VF never achieved ROSC. CONCLUSIONS In-patient paediatric cardiac arrest has a mediocre outcome with a better outlook if the initial rhythm is hypotensive-bradycardia, VF or pulsatile VT. Doses of adrenaline greater than 15 mcg/kg given for non-shockable rhythms may cause secondary VF which has a worse outcome than primary VF.
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Affiliation(s)
- James Tibballs
- Intensive Care Unit, Royal Children's Hospital and Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, 3052 Australia.
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38
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Affiliation(s)
- T Duke
- Intensive Care Unit, University Department of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Tibballs J, Kinney S, Duke T, Oakley E, Hennessy M. Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child 2005; 90:1148-52. [PMID: 16243869 PMCID: PMC1720176 DOI: 10.1136/adc.2004.069401] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the impact of a paediatric medical emergency team (MET) on cardiac arrest, mortality, and unplanned admission to intensive care in a paediatric tertiary care hospital. METHODS Comparison of the retrospective incidence of cardiac arrest and death during 41 months before introduction of a MET service with the prospective incidence of these events during 12 months after its introduction. Comparison of transgression of MET call criteria in patients who arrested and died before and after introduction of MET. RESULTS Cardiac arrest decreased from 20 among 104 780 admissions (0.19/1000) to 4 among 35 892 admissions (0.11/1000) (risk ratio 1.71, 95% CI 0.59 to 5.01), while death decreased from 13 (0.12/1000) to 2 (0.06/1000) during these periods (risk ratio 2.22, 95% CI 0.50 to 9.87). Unplanned admissions to intensive care increased from 20 (SD 6) to 24 (SD 9) per month. The incidence of transgression of MET call criteria in patients who arrested decreased from 17 to 0 (risk difference 0.16/1000, 95% CI 0.09 to 0.24), and in those who died, decreased from 12 to 0 (risk difference 0.11/1000, 95% CI 0.05 to 0.18) after introduction of MET. CONCLUSIONS Introduction of a medical emergency team service was coincident with a reduction of cardiac arrest and mortality and a slight increase in admissions to intensive care.
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Affiliation(s)
- J Tibballs
- Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.
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40
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Tibballs J, Kinney S. A prospective before‐and‐after trial of a medical emergency team. Med J Aust 2004; 180:308, 310; author reply 310. [PMID: 15012573 DOI: 10.5694/j.1326-5377.2004.tb05936.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2003] [Accepted: 12/22/2003] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE The purpose of this study was to determine whether disposable suction catheters can be reused in the same patient for a 24-hour period without affecting the incidence of pneumonia. DESIGN The study design was a randomized controlled trial. SETTING The study was conducted in the pediatric intensive care unit of a tertiary pediatric center. SAMPLE Subjects included 486 children with an endotracheal tube in place. OUTCOME MEASURES The development of pneumonia, diagnosed with radiographic and clinical evidence, was the measure. Cost analysis was also undertaken. METHOD Subjects in the study group (n = 241) were suctioned using the same catheter for a 24-hour period. Those in the control group (n = 245) had a new catheter for each episode of suctioning. RESULTS Pneumonia developed in 14 members (5.71%) of the control group and in 12 members (4.98%) of the study group, a difference of 0.7% (95% CI, -3.3% to 4.7%). Cost analysis indicated a saving of Aust $4.14 per patient per day. CONCLUSION Reusing suction catheters for up to 24 hours is both safe and cost-effective.
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Affiliation(s)
- M K Scoble
- Royal Children's Hospital, Melbourne, Australia
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42
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Liesenfeld O, Montoya JG, Kinney S, Press C, Remington JS. Effect of testing for IgG avidity in the diagnosis of Toxoplasma gondii infection in pregnant women: experience in a US reference laboratory. J Infect Dis 2001; 183:1248-53. [PMID: 11262207 DOI: 10.1086/319672] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2000] [Revised: 01/10/2001] [Indexed: 11/03/2022] Open
Abstract
The usefulness of testing for IgG avidity in association with Toxoplasma gondii was evaluated in a US reference laboratory. European investigators have reported that high-avidity IgG toxoplasma antibodies exclude acute infection in the preceding 3 months. In this US study, 125 serum samples taken from 125 pregnant women in the first trimester were chosen retrospectively, because either the IgM or differential agglutination (AC/HS) test in the Toxoplasma serologic profile suggested or was equivocal for a recently acquired infection. Of 93 (74.4%) serum samples with either positive or equivocal results in the IgM ELISA, 52 (55.9%) had high-avidity antibodies, which suggests that the infection probably was acquired before gestation. Of 87 (69.6%) serum samples with an acute or equivocal result in the AC/HS test, 35 (40.2%) had high-avidity antibodies. Forty women were given spiramycin, to prevent congenital transmission, and 7 (17.5%) had high-avidity antibodies. These findings highlight the value of testing a single serum sample obtained in the first trimester of pregnancy for IgG avidity.
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Affiliation(s)
- O Liesenfeld
- Department of Immunology and Infectious Diseases, Research Institute, Palo Alto Medical Foundation, Ames Bldg., 795 El Camino Real, Palo Alto, CA 94301, USA
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Berg RA, Cobb LA, Doherty A, Ewy GA, Gerardi MJ, Handley AJ, Kinney S, Phillips B, Sanders A, Wyllie J. Chest compressions and basic life support-defibrillation. Ann Emerg Med 2001; 37:S26-35. [PMID: 11290967 DOI: 10.1067/mem.2001.114173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R A Berg
- Department of Pediatrics, University of Arizona, Tucson, AZ 85724-0001, USA.
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Kinney S. An analysis of effective chest compression and bag-valve-mask ventilation with different compression-ventilation ratios in paediatric cardiopulmonary resuscitation. Aust Crit Care 1999. [DOI: 10.1016/s1036-7314(99)70529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Some investigators suggest that placental thrombosis and infarction can cause recurrent miscarriage. We have shown that the common missense mutation in the factor V gene, the Leiden mutation, which renders factor Va resistant to cleavage inactivation by activated protein C, predisposes to placental thrombosis and spontaneous miscarriage. Our objective was to determine the frequency of the Leiden mutation in a population with well-characterized idiopathic recurrent miscarriage. DNA was extracted from whole blood of 40 couples with a history of idiopathic recurrent miscarriage and 25 couples with a history of proven fertility (seven or more live births). The polymerase chain reaction was used to amplify exon 10 of the factor V gene followed by allele-specific restriction with Mnl1 for mutation detection. Results were analyzed with a chi 2 contingency table. None of the 40 women with idiopathic recurrent miscarriage carried the mutation and only one of their reproductive partners was heterozygous for the mutation. Similarly, none of the control women carried the mutation, and only one of the 25 control male partners was heterozygous for the mutation. In our referral population, the factor V Leiden mutation which predisposes to thrombosis is not a common cause of recurrent miscarriage.
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Affiliation(s)
- D S Dizon-Townson
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City 84132, USA.
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Therrell BL, Hannon WH, Pass KA, Lorey F, Brokopp C, Eckman J, Glass M, Heidenreich R, Kinney S, Kling S, Landenburger G, Meaney FJ, McCabe ER, Panny S, Schwartz M, Shapira E. Guidelines for the retention, storage, and use of residual dried blood spot samples after newborn screening analysis: statement of the Council of Regional Networks for Genetic Services. Biochem Mol Med 1996; 57:116-24. [PMID: 8733889 DOI: 10.1006/bmme.1996.0017] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
These guidelines provide scientific information for policy development by state health departments considering appropriate use of newborn screening specimens after screening tests are finished. Information was collected, debated, and formulated into a policy statement by the Newborn Screening Committee of the Council of Regional Networks for Genetic Services (CORN), a federally funded national consortium of representatives from 10 regional genetics networks. Newborn screening programs vary widely in approaches and policies concerning residual dried blood spot samples (DBS) collected for newborn screening. Recognition of the epidemiological utility of DBS samples for HIV seroprevalence surveys and a growing interest in DBSs for DNA analysis has intensified consideration of issues regarding retention, storage, and use of residual DBS samples. Potentially these samples provide a genetic material "bank" for all newborns nationwide. Their values as a resource for other uses has already been recognized by scientists, administrators, and judicial officials. Programs should promulgate rules for retention and use of residual newborn screening DBS samples based on scientifically valid information. Banking of newborn samples as sources of genetic material should be considered in light of potential benefit or harm to society.
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Affiliation(s)
- B L Therrell
- Bureau of Laboratories, Texas Department of Health, Austin 78756, USA.
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Tibballs J, Kinney S. Adult advanced life support. Med J Aust 1994; 160:455-6. [PMID: 8007889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Affiliation(s)
- James Tibballs
- Intensive Care UnitRoyal Children's HospitalMelbourne Flemington RoadParkvilleVIC3052
| | - Sharon Kinney
- Intensive Care UnitRoyal Children's HospitalMelbourne Flemington RoadParkvilleVIC3052
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Kinney S. 'Care of the donor family'. Confed Aust Crit Care Nurses J 1990; 3:2. [PMID: 2129920 DOI: 10.1016/s1033-3355(11)80084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Poinar GO, Hess RT, Lanier W, Kinney S, White JH. Preliminary observations of a bacteriophage infecting Xenorhabdus luminescens (Enterobacteriaceae). Experientia 1989; 45:191-2. [PMID: 2920806 DOI: 10.1007/bf01954872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A bacteriophage infective to Xenorhabdus luminescens, a bacterial symbiont of heterorhabditid nematodes, was recovered from insects that supported poor nematode development. Plaque tests showed the phage particles to be infective only to primary and not secondary colonies of X. luminescens. The phage was not infective to X. nematophilus primaries or secondaries. The bacteriophage particles ranged 80-90 nm in length, with the head ranging from 40 to 50 nm in diameter. Restriction analysis was performed on isolated bacteriophage DNA. This first report of a bacteriophage from Xenorhabdus species has practical implications since it could be detrimental to cultures of Heterorhabditis nematodes that are being produced throughout the world for the biological control of insects.
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Affiliation(s)
- G O Poinar
- Division of Entomology and Parasitology, University of California, Berkeley 94720
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