Duong Thuy Tran

Classifying nursing errors in clinical management within an Australian hospital

BACKGROUND Although many classification systems relating to patient safety exist, no taxonomy was identified that classified nursing errors in clinical management. AIMS To develop a classification system for nursing errors relating to clinical management (NECM taxonomy) and to describe contributing factors and patient consequences. METHODS We analysed 241 (11%) self-reported incidents relating to clinical management in nursing in a metropolitan hospital. Descriptive analysis of numeric data and content analysis of text data were undertaken to derive the NECM taxonomy, contributing factors and consequences for patients. RESULTS Clinical management incidents represented 1.63 incidents per 1000 occupied bed days. The four themes of the NECM taxonomy were nursing care process (67%), communication (22%), administrative process (5%), and knowledge and skill (6%). Half of the incidents did not cause any patient harm. Contributing factors (n=111) included the following: patient clinical, social conditions and behaviours (27%); resources (22%); environment and workload (18%); other health professionals (15%); communication (13%); and nurses knowledge and experience (5%). CONCLUSION The NECM taxonomy provides direction to clinicians and managers on areas in clinical management that are most vulnerable to error, and therefore, priorities for system change management. Any nurses who wish to classify nursing errors relating to clinical management could use these types of errors. This study informs further research into risk management behaviour, and self-assessment tools for clinicians. Globally, nurses need to continue to monitor and act upon patient safety issues.

Validating self-report of diabetes use by participants in the 45 and up study: a record linkage study

BackgroundPrevalence studies usually depend on self-report of disease status in survey data or administrative data collections and may over- or under-estimate disease prevalence. The establishment of a linked data collection provided an opportunity to explore the accuracy and completeness of capture of information about diabetes in survey and administrative data collections.MethodsBaseline questionnaire data at recruitment to the 45 and Up Study was obtained for 266,848 adults aged 45 years and over sampled from New South Wales, Australia in 2006–2009, and linked to administrative data about hospitalisation from the Admitted Patient Data Collection (APDC) for 2000–2009, claims for medical services (MBS) and pharmaceuticals (PBS) from Medicare Australia data for 2004–2009. Diabetes status was determined from response to a question ‘Has a doctor EVER told you that you have diabetes’ (n = 23,981) and augmented by examination of free text fields about diagnosis (n = 119) or use of insulin (n = 58). These data were used to identify the sub-group with type 1 diabetes. We explored the agreement between self-report of diabetes, identification of diabetes diagnostic codes in APDC data, claims for glycosylated haemoglobin (HbA1c) in MBS data, and claims for dispensed medication (oral hyperglycaemic agents and insulin) in PBS data.ResultsMost participants with diabetes were identified in APDC data if admitted to hospital (79.3%), in MBS data with at least one claim for HbA1c testing (84.7%; 73.4% if 2 tests claimed) or in PBS data through claim for diabetes medication (71.4%). Using these alternate data collections as an imperfect ‘gold standard’ we calculated sensitivities of 83.7% for APDC, 63.9% (80.5% for two tests) for MBS, and 96.6% for PBS data and specificities of 97.7%, 98.4% and 97.1% respectively. The lower sensitivity for HbA1c may reflect the use of this test to screen for diabetes suggesting that it is less useful in identifying people with diabetes without additional information. Kappa values were 0.80, 0.70 and 0.80 for APDC, MBS and PBS respectively reflecting the large population sample under consideration. Compared to APDC, there was poor agreement about identifying type 1 diabetes status.ConclusionsSelf-report of diagnosis augmented with free text data indicating diabetes as a chronic condition and/or use of insulin among medications used was able to identify participants with diabetes with high sensitivity and specificity compared to available administrative data collections.

Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study

BackgroundThe increased prevalence of diabetes and its significant impact on use of health care services, particularly hospitals, is a concern for health planners. This paper explores the risk factors for all-cause hospitalisation and the excess risk due to diabetes in a large sample of older Australians.MethodsThe study population was 263,482 participants in the 45 and Up Study. The data assessed were linked records of hospital admissions in the 12 months following completion of a baseline questionnaire. All cause and ambulatory care sensitive admission rates and length of stay were examined. The associations between demographic characteristics, socioeconomic status, lifestyle factors, and health and wellbeing and risk of hospitalisation were explored using zero inflated Poisson (ZIP) regression models adjusting for age and gender. The ratios of adjusted relative rates and 95% confidence intervals were calculated to determine the excess risk due to diabetes.ResultsPrevalence of diabetes was 9.0% (n = 23,779). Age adjusted admission rates for all-cause hospitalisation were 631.3 and 454.8 per 1,000 participant years and the mean length of stay was 8.2 and 7.1 days respectively for participants with and without diabetes. In people with and without diabetes, the risk of hospitalisation was associated with age, gender, household income, smoking, BMI, physical activity, and health and wellbeing. However, the increased risk of hospitalisation was attenuated for participants with diabetes who were older, obese, or had hypertension or hyperlipidaemia and enhanced for those participants with diabetes who were male, on low income, current smokers or who had anxiety or depression.ConclusionsThis study is one of the few studies published to explore the impact of diabetes on hospitalisation in a large non-clinical population, the 45 and Up Study. The attenuation of risk associated with some factors is likely to be due to correlation between diabetes and factors such as age and obesity. The increased risk in association with other factors such as gender and low income in participants with diabetes is likely to be due to their synergistic influence on health status and the way services are accessed.

Models of care in nursing: a systematic review

OBJECTIVE This review investigated the effect of the various models of nursing care delivery using the diverse levels of nurses on patient and nursing outcomes. METHODS All published studies that investigated patient and nursing outcomes were considered. Studies were included if the nursing delivery models only included nurses with varying skill levels. A literature search was performed using the following databases: Medline (1985-2011), CINAHL (1985-2011), EMBASE (1985 to current) and the Cochrane Controlled Studies Register (Issue 3, 2011 of Cochrane Library). In addition, the reference lists of relevant studies and conference proceedings were also scrutinised. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and extracted details of eligible studies. Data were analysed using the RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark). RESULTS Fourteen studies were included in this review. The results reveal that implementation of the team nursing model of care resulted in significantly decreased incidence of medication errors and adverse intravenous outcomes, as well as lower pain scores among patients; however, there was no effect of this model of care on the incidence of falls. Wards that used a hybrid model demonstrated significant improvement in quality of patient care, but no difference in incidence of pressure areas or infection rates. There were no significant differences in nursing outcomes relating to role clarity, job satisfaction and nurse absenteeism rates between any of the models of care. CONCLUSIONS Based on the available evidence, a predominance of team nursing within the comparisons is suggestive of its popularity. Patient outcomes, nurse satisfaction, absenteeism and role clarity/confusion did not differ across model comparisons. Little benefit was found within primary nursing comparisons and the cost effectiveness of team nursing over other models remains debatable. Nonetheless, team nursing does present a better model for inexperienced staff to develop, a key aspect in units where skill mix or experience is diverse.

The Smoking MUMS (Maternal Use of Medications and Safety) Study: protocol for a population-based cohort study using linked administrative data

Introduction Approximately 14% of Australian women smoke during pregnancy. Although the risk of adverse outcomes is reduced by smoking cessation, less than 35% of Australian women quit smoking spontaneously during pregnancy. Evidence for the efficacy of bupropion, varenicline or nicotine replacement therapy as smoking cessation aids in the non-pregnant population suggest that pharmacotherapy for smoking cessation is worth exploring in women of childbearing age. Currently, little is known about the utilisation, effectiveness and safety of pharmacotherapies for smoking cessation during pregnancy; neither the extent to which they are used prior to pregnancy nor whether their use has changed in response to related policy reforms. The Smoking MUMS (Maternal Use of Medications and Safety) Study will explore these issues using linked person-level data for a population-based cohort of Australian mothers. Methods and analysis The cohort will be assembled by linking administrative health records for all women who gave birth in New South Wales or Western Australia since 2003 and their children, including records relating to childbirth, use of pharmaceuticals, hospital admissions, emergency department presentations and deaths. These longitudinal linked data will be used to identify utilisation of smoking cessation pharmacotherapies during and between pregnancies and to explore the associated smoking cessation rates and maternal and child health outcomes. Subgroup and temporal analyses will identify potential differences between population groups including indigenous mothers and social security recipients and track changes associated with policy reforms that have made alternative smoking cessation pharmacotherapies available. Ethics and dissemination Ethical approval has been obtained for this study. To enhance the translation of the projects findings into policy and practice, policy and clinical stakeholders will be engaged through a reference group and a policy forum will be held. Outputs from the project will include scientific papers and summary reports designed for policy audiences.

Hygiene Behaviour of Adolescents in the Pacific: Associations with Socio-demographic, Health behaviour and School Environment:

This study presents findings on health-related hygiene behaviours of 9,013 adolescents from Vanuatu, Tonga and Pohnpei in the Federal States of Micronesia as part of the Health Behaviour of Pacific Youth Life surveys. We examined the prevalence of and relationship between tooth brushing, hand washing before eating, hand washing after toileting and a range of psychosocial factors such as sociodemographic charac-teristics, health behaviour and school affiliation. The results showed that patterns of prevalence and relationships were consistent for all countries, with weaker associations observed in Pohnpei. In general, adolescents reported moderate levels of optimal hygiene practice. Girls reported significantly more frequent optimal hygiene practice than boys. Logistic regression analysis confirmed that frequent hygiene behaviours were significantly associated with gender, parental occupations and high levels of school affiliation. These findings suggest the need to consider psycho-social and economic factors when examining potential influences on hygiene behaviour to ensure effective interventions.

Drink a little; take a few drugs: do nurses have knowledge to identify and manage in-patients at risk of drugs and alcohol?

INTRODUCTION AND AIMS The widespread use of alcohol and other drugs poses particular problems during hospitalisation. Although nurses have been identified as an appropriate group to screen patients and provide acute and ongoing management to people with drug and alcohol-related problems, rates of screening are low. The aims of this study were to identify current practices for screening by nurses working in medical and surgical wards, determine their knowledge relating to problems associated with substance use and identify their self-reported skills in managing patients with drug- and alcohol-related problems. DESIGN AND METHODS A chart audit of medical records was completed and a survey was distributed to nurses working in the study wards. RESULTS Screening for alcohol and drug use was documented on only 22/79 medical records, and detailed information about quantity and duration of use was recorded in only nine. Overall, the nurses reported that they had little knowledge about substance use problems, and felt that they lacked skills to care adequately for these patients. DISCUSSION AND CONCLUSIONS The results of this study suggest a need for a comprehensive training and education to ensure that nurses are familiar with policies and protocols for management of patients and to assist nurses to provide evidence-based care and make appropriate referrals to specialist services.

Country of birth recording in Australian hospital morbidity data: accuracy and predictors

Objective: Country of birth (COB) is an important determinant of health risks and outcomes. Despite the widespread use of hospital morbidity data for research, little is known about the quality of COB recording in these data. This study validated the recording of 40 COBs in Australian hospital morbidity data and identified factors associated with the recording accuracy.

Association of processes of primary care and hospitalisation for people with diabetes: A record linkage study

AIMS To explore the association of primary care and hospitalisation for people with diabetes. METHODS The study comprised 20,433 diabetic participants in the Sax Institutes 45 and Up Study. Data on processes of care at recruitment (15 months) were extracted from the Department of Human Services Medicare database. Processes included continuity of primary care (47.1%), and claims for completion of an annual cycle of care (25.0%), GP management plan/team care arrangement (GPMP/TCA, 41.3%), review of GPMP/TCA (24.0%), and monitoring including HbA1c (62.7%). Hospitalisation (12 months) following recruitment was extracted from administrative data held by NSW Ministry of Health. Adjusted incidence rate ratios (aIRR) with 95% confidence interval were calculated. RESULTS A hospital admission was reported for 33.0% of participants. Continuity of care (aIRR: 0.92 (95%CI: 0.89-0.96)), or claims for an annual cycle of care (aIRR: 0.77 (0.74-0.80)) or HbA1c testing (aIRR: 0.92 (0.89-0.96) were associated with a reduced likelihood of hospitalisation. While claims for preparation of GPMP/TCA were not associated with hospitalisation, a claim for review of GPMP/TCA was associated with a reduced likelihood of hospitalisation (aIRR: 0.92 (95%CI: 0.89 0.96)). CONCLUSIONS This study has implications for hospital avoidance programmes suggesting that strengthening primary care may be more important than care coordination for this group of patients.

Comparison of four teaching methods on Evidence-based Practice skills of postgraduate nursing students.

The aim of this study was to compare four teaching methods on the evidence-based practice knowledge and skills of postgraduate nursing students. Students enrolled in the Evidence-based Nursing (EBN) unit in Australia and Hong Kong in 2010 and 2011 received education via either the standard distance teaching method, computer laboratory teaching method, Evidence-based Practice-Digital Video Disc (EBP-DVD) teaching method or the didactic classroom teaching method. Evidence-based Practice (EBP) knowledge and skills were evaluated using student assignments that comprised validated instruments. One-way analysis of covariance was implemented to assess group differences on outcomes after controlling for the effects of age and grade point average (GPA). Data were obtained from 187 students. The crude mean score among students receiving the standard+DVD method of instruction was higher for developing a precise clinical question (8.1±0.8) and identifying the level of evidence (4.6±0.7) compared to those receiving other teaching methods. These differences were statistically significant after controlling for age and grade point average. Significant improvement in cognitive and technical EBP skills can be achieved for postgraduate nursing students by integrating a DVD as part of the EBP teaching resources. The EBP-DVD is an easy teaching method to improve student learning outcomes and ensure that external students receive equivalent and quality learning experiences.