Malcolm Elliott

Readmission to intensive care: A review of the literature

Acutely ill patients are commonly found on general hospital wards; some of these are patients who have been recently discharged from an intensive care unit (ICU). These patients may require a higher level of care than other ward patients and, due to the acuity of their illness, are at risk of readmission to ICU. Research has indicated that patients readmitted to ICU have mortality rates up to six times higher than those not readmitted and are eleven times more likely to die in hospital. Numerous studies have retrospectively examined these readmissions but, despite this, there is still no clear indication of why ICU readmissions occur or what the common characteristics of readmitted patients are. This literature review examines the published studies on patients who have been readmitted to ICU. Further research is needed to explore why readmissions to ICU occur and the type of patient who is at greatest risk for readmission.

Mapping drug calculation skills in an undergraduate nursing curriculum

The ability to calculate drug dosages correctly is an essential skill for registered nurses to possess. Performing drug calculations accurately is not a skill that new graduates have the luxury of developing over time. Drug errors are in many instances directly related to either the administration of an incorrect dose or incorrect infusion rate caused by calculation errors. A strategy for implementing drug calculation skills into our new under graduate nursing curriculum was initiated to assist students in developing proficiency in drug calculations. The aim of this program is to promote the development of calculation skills in undergraduate nursing students, rather than simply assessing their skills.

Clinical education : a challenging component of undergraduate nursing education

Abstract Clinical education is an essential part of every undergraduate nursing curriculum. The main benefits are that it allows students to put theory into practice and experience the realities of the practice-based nursing profession. Limitations include the unstable nature of the clinical area as a learning environment and the challenges this produces with students’ assessments. This article reviews the literature and concludes there is room for significant improvement in the area of clinical education and numerous strategies can be implemented to do so.

Intensive care readmission: a contemporary review of the literature.

ICU readmissions are a commonly used quality measure but despite decades of research, these adverse events continue to occur. Of particular concern is that readmitted patients have much worse prognoses than those not readmitted. In recent years new clinical service roles have evolved to assist ward staff with the care of acutely ill patients, such as those discharged from ICU. Given the recent emergence of these service roles, a review of contemporary ICU readmission studies was warranted to determine their impact on this adverse event. Reviewed studies indicated the incidence of readmissions and outcomes of these patients have changed little in recent years. Few studies mentioned whether clinical service roles existed to support ward staff caring for patients recently discharged from ICU. Future research needs to focus on identifying modifiable factors in care processes to reduce the incidence and outcomes of this adverse event and to determine how clinical service roles can best help prevent its occurrence.

Factors contributing to adverse events after ICU discharge: a survey of liaison nurses.

BACKGROUND A significant number of patients experience an adverse event when discharged from intensive care to a ward. More than half of these events may be preventable with better standards of care. AIM To explore the opinions of an expert group of clinicians around factors contributing to adverse events in patients discharged from ICU. METHOD Online survey of Australian ICU Liaison Nurses (n=39) using a validated questionnaire of 25 items. RESULTS The response rate was 92.8%. Key contributing factors included a lack of experienced ward staff, patient co-morbidities and the clinically challenging nature of many patients. CONCLUSION Modifying processes of care may decrease the risk or impact of adverse events in this high risk patient population.

Reason's accident causation model: Application to adverse events in acute care

Abstract Adverse events are unintended harm to a patient caused by the health care provided; more than half of all these events have been deemed avoidable. Adverse events are a common problem in acute care and represent a breach in care quality and safety. They are generally not caused by a single mistake or error and although safety barriers exist in health care, patients today are still harmed. Using an accident causation model is a constructive way of identifying the underlying causes of adverse events and to strengthen a study’s theoretical underpinnings. Reason’s model is recommended as a useful framework for adverse event analysis as it promotes a focus on the conditions or situation in which the clinician was trying to perform, rather than apportioning blame.

Why is respiratory rate the neglected vital sign? A narrative review

C l i n M e d International Library Citation: Elliott M (2016) Why is Respiratory Rate the Neglected Vital Sign? A Narrative Review. Int Arch Nurs Health Care 2:050 Received: May 12, 2016: Accepted: June 23, 2016: Published: June 26, 2016 Copyright:

Inadvertent intracranial insertion of nasogastric tubes: An overview and nursing implications

Abstract Nasogastric tubes are a commonly used medical device. There are numerous complications associated with their use, one of the most significant is when they are inadvertently inserted into the cranium. Clinicians need to be aware of this complication and the type of patient who is most susceptible.

The effects of a catheter clamping protocol on bladder function in neurosurgical patients: A controlled trial

There is scant evidence-based literature on the best strategies for short-term urinary catheter removal. This clinical trial explored the effects of an early urinary catheter clamping protocol on bladder function in neurosurgical patients. Eligible patients were divided into observation and control groups. Those in the observation group had their catheter clamped postoperatively on return to the ward and unclamped at dedicated intervals. The control group received standard care; the catheter was on free drainage during the entire time in situ. The mean catheter indwelling time was 2.6 days. Compared with the control group, the observation group experienced shorter time to first postoperative urination, less residual urine volume and better subjective perception during their first postoperative urination. For patients undergoing neurosurgery and associated short-term indwelling urinary catheterization, an early catheter clamping protocol is effective in facilitating bladder function, reducing the rate of dysuria and making patients feel more comfortable after catheter removal.

A Modified Supine Position Facilitates Bladder Function in Patients Undergoing Percutaneous Coronary Intervention: A Randomized Controlled Clinical Trial

Background:Percutaneous coronary intervention (PCI) is currently the most common intervention for cardiovascular disease. Standard care after PCI typically involves a period of bed rest in the supine position, but this position creates voiding difficulties. Objective:This study aimed to determine whether a modified supine position could facilitate bladder emptying after PCI. Method:A randomized controlled trial involving 300 patients was conducted. Patients in the intervention group were nursed in the supine position with the bed tilted 20° upright and with a pillow between their feet and the end of the bed. Patients in the control group received standard care, which was supine positioning. Results:One hundred fifty patients were allocated to the intervention group (100 men, 50 women), and 150 were allocated to the control group (103 men, 47 women). Baseline data did not differ between the 2 groups. Patients in the intervention group had significantly better bladder function as evidenced by a shorter time to the first void (5 vs 15 minutes) and fewer patients requiring voiding assistance (8.6% vs 35.3%). Residual urinary volumes were also much lower in the intervention group (88.71 vs 248.22 mL, P < .001). Conclusions:This study demonstrates that a modified supine position can reduce the incidence of impaired micturition and the preservation of normal bladder function after PCI.