DSpace Collection:
https://hdl.handle.net/2440/84545
2024-03-19T02:21:00ZA retrospective cohort Study Exploring Existing Sedation, Analgesia and Withdrawal management in a Paediatric Intensive Care Unit (PICU): The SEESAW study
https://hdl.handle.net/2440/126655
Title: A retrospective cohort Study Exploring Existing Sedation, Analgesia and Withdrawal management in a Paediatric Intensive Care Unit (PICU): The SEESAW study
Author: Welbing, Katrina
Abstract: PURPOSE Paediatric Intensive Care Unit (PICU) patients are at risk of developing withdrawal when high doses of opioid analgesics and sedatives are stopped or tapered too rapidly. The primary aim of the study was to explore the factors associated with the increased incidence of withdrawal in order to better understand the extent of the problem. The secondary aim was to analyse if the presence of withdrawal syndrome was associated with clinical complications or delayed recovery. METHODS The retrospective chart audit examined the medical records of 120 mechanically ventilated infants and children that were admitted to the PICU within a tertiary children’s hospital from 2015 to 2017. The patients were selected if exposed to at least 24 hours of continuous opioid or sedative infusion. The presence of withdrawal syndrome was assessed retrospectively using the Sophia Observation of withdrawal Symptoms (SOS) scale. The retrospective cohort study provided a means to report on the natural course of untreated and under-treated withdrawal. A multivariate regression model analysed variables associated with withdrawal. RESULTS Overall, the incidence of withdrawal in the study cohort was 61% (73/120). This included 45 patients that had been diagnosed with withdrawal by the clinical team and 28 that were undiagnosed. Patients that received fentanyl were more likely to develop withdrawal compared to patients that received morphine (RR 1.5, 95% CI 0.96-2.20). However, the mean infusion rate was significantly (3.4 times) higher for fentanyl, accounting for the difference. The mean opioid infusion rate and infusion duration were both associated with withdrawal to varying degrees. High mean infusion rates of 3 mcg/kg/hr fentanyl and 80 mcg/kg/hr morphine were 80% predictive of precipitating withdrawal. Dose tapering characteristics were analysed and demonstrated that the patients that developed withdrawal were typically tapered from a dose of 3 mcg/kg/hr fentanyl over 0-24 hours. Patients with withdrawal symptoms had significantly higher rates (24/73 vs 4/47) of severe clinical deterioration within 72 hours of opioid dose tapering (OR 5.8, 95% CI 1.8-18.5, p = 0.003). Severe clinical deterioration included seizures, aspiration events, life-threatening arrhythmias, hypoglycaemia, and respiratory failure that required intubation or mechanical ventilation. Comparing outcomes, patients with withdrawal had prolonged PICU (8.0 vs 4.7 days, p = 0.001) and hospital (23 vs 14 days, p = 0.003) length of stay. CONCLUSION The SEESAW study demonstrated that significantly higher mean infusion rates of fentanyl were administered to patients in PICU, compared to morphine. The incidence of withdrawal was predominantly fentanyl dose-driven. Using the retrospective SOS scale results, the presence of withdrawal was associated with increased clinical complications and delayed recovery.
Description: Master of Nursing Science by coursework. This item is only available electronically.2019-01-01T00:00:00ZThe Effect of a Breath Alcohol Level Measurement on Length of Stay and Clinical Management of Acutely Intoxicated Patients in an Emergency Department
https://hdl.handle.net/2440/117758
Title: The Effect of a Breath Alcohol Level Measurement on Length of Stay and Clinical Management of Acutely Intoxicated Patients in an Emergency Department
Author: Mooney, Kelly Jane
Abstract: Background Alcohol use and misuse is a common occurrence in Australian society with one in seven Emergency Department Presentations being alcohol related. Despite substantial literature on the treatment and management of acute alcohol intoxication there is no consistency in the approach to treatment and diagnosis. With a lack of literature on the use of breath alcohol level measurement as a diagnostic tool and the focus of Australian Emergency Departments being length of stay, this study compares them alongside the additional interventions provided throughout the patient journey in the Emergency Department. Method A retrospective study of patient case notes from the calendar year 2016 was conducted. Five hundred and ninety episodes of care met the inclusion criteria and data was collected from the patient case notes and the Emergency Department computer system. This data included identifying treatment provided, breath alcohol levels, length of stay and demographic data. The data was analysed and then interpreted. Results Results revealed that having a breath alcohol level measurement affected length of stay and interventions in the Emergency Department but the value of that breath alcohol level did not influence length of stay or the interventions provided. This indicates that utilising a breath alcohol measurement for determining whether a person is intoxicated affects patient journey through the Emergency Department, however utilising it to determine how intoxicated a patient is, is unlikely to change their Emergency Department journey.Conclusion This study provides evidence on current practice in an Australian Emergency Department. It showed there was a lack of consistency in approach to treatment of acute alcohol intoxication and suggests some implications to clinical practice for Emergency Department clinicians, and examples of where future research would be beneficial.2018-01-01T00:00:00ZNurses’ lived experience of delivering temporary epicardial cardiac pacing care: an Australian cardiothoracic intensive care finding
https://hdl.handle.net/2440/111325
Title: Nurses’ lived experience of delivering temporary epicardial cardiac pacing care: an Australian cardiothoracic intensive care finding
Author: Han, Matilda Kyungsook
Abstract: There are many examples in literature concerning the effectiveness or complications associated with temporary epicardial pacing practice. While surrounding literature identifies elements essential to safe care and challenges faced by clinicians managing temporary epicardial pacing systems, no literature was identified about nurses’ experience in managing this practice. This study contributes to understanding of nurses’ experiences of managing temporary epicardial pacing.
An interpretive phenomenological framework articulated by Heidegger was used to generate rich and descriptive data of this little known phenomenon. In-depth interviews were conducted with eight registered nurses who work in the specialist cardiothoracic intensive care and had responsibility for delivering temporary epicardial pacing care. The transcripts from the interviews were analysed using Smith’s Interpretive Phenomenology Analysis (IPA) method and to gain deeper interpretation, consideration of Benner’s five-stage skill acquisition theory was used as a lens to further examine the findings. The participants’ shared experiences revealed three major themes; ‘Risky business’, ‘Take time to own’ and ‘Zeroing in’. These themes were experienced in a variety of ways depending on the skill level of each participant. Furthermore, the interpretation of the study recognized that an internal motivation to use pacing at its optimal best, is characteristic of an expert.
Strengths and limitations and implications for both clinical practice and education are discussed, and suggestions for future research are included.2017-01-01T00:00:00ZA randomised controlled trial pilot study assessing use of clinical digital photography for specialist referral process: can its use reduce length of stay of patients with minor burns within an Emergency Department
https://hdl.handle.net/2440/110385
Title: A randomised controlled trial pilot study assessing use of clinical digital photography for specialist referral process: can its use reduce length of stay of patients with minor burns within an Emergency Department
Author: McLeay, Kate Jane
Abstract: Emergency departments around Australia are facing increasing demands. Significant
contributing factors for growing emergency department (ED) attendances are an aging
population, increased occurrence of chronic disease and insufficient hospital, aged
care and rehabilitation beds. Other factors include a lack of access to community
services and low socio-economic conditions. The increasing demand on ED resources
primarily because of increasing presentations increases patient length of stay and
leads to overcrowding, this has a negative effect on patient outcomes and decrease in
the quality of care. Despite a national focus on improving all Australian EDs, there
continues to be limited interventional research that highlights successful strategies to
reduce length of stay and thereby reduce overcrowding. There is a wealth of literature
on the positive outcomes resulting from clinical photography being utilised within
healthcare settings and in remote specialist referrals. Limited research exists on
referral practices of ED practitioners and the use of clinical photography within an ED
setting. By identifying the research gaps, reviewing findings and analysing current
health care demands, the aim of this study was to trial an alternative referral method -
clinical photography. The study was conducted by an emergency nurse practitioner
candidate, who used clinical photographs of bum injuries as part of the referral
process to the bums specialist. This study hoped to assist with decreasing length of
stay in ED and therefore adds a plausible way to reduce overcrowding. Additionally,
it piloted a study in preparation for a randomised control trial. To the researcher's
knowledge, there has been no study to date trialling the effectiveness of this
intervention.2013-01-01T00:00:00Z