Mohd Idzwan Zakaria

Ten year mortality in older patients attending the emergency department after a fall.

To determine the dependency scores, long‐term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall.

A study on the medication errors in the administration of N-acetylcysteine for paracetamol overdose patients in Malaysia

Introduction N-Acetylcysteine (NAC) has been used to treat paracetamol overdose for four decades. But the administration of NAC regimens is complicated. Therefore, medication errors are an ongoing issue in the acute-care setting and directly impact the safety of patients. Objective To evaluate the rate of NAC-related medication errors during the management of paracetamol overdose at a teaching hospital in Malaysia. Methods This clinical audit study was performed retrospectively between June 2008 and June 2011. Patients who presented to the adult emergency department with paracetamol overdose and had received at least the loading dose of intravenous NAC were eligible. Children below the age of 12 years old were not included. Also, patients displaying chronic excessive paracetamol usage or recurrent paracetamol overdose were excluded. We determined the type and frequency of medication errors during intravenous NAC administration. Results The study population ranged from 13 to 87 years old (mean age: 25.06; median: 23) and was predominantly female. The overall prevalence of intravenous NAC-related medication errors was found to be 84.3%. Moreover, the following frequencies were observed based on error type: 5.9% wrong dose, 37.3% incorrect infusion rate, 8.5% interruption during treatment, and 66.5% unnecessary administration. Conclusion We observe a surprisingly high prevalence of medication errors related to the administration of intravenous NAC. Thus, this emerging issue needs be addressed in order to ensure patient safety as well as to prevent unnecessary hospital admissions and/or burdening treatment costs. (Hong Kong j.emerg.med. 2014;21: 361-367)

Utilization of the emergency department by older residents in Kuala Lumpur, Malaysia

To determine the pattern of utilization of emergency department (ED) services by older patients in Kuala Lumpur, Malaysia, compared with younger patients in the same setting.

Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial

Objective To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia. Design Pragmatic, randomized-controlled trial. Setting Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia. Participants Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months. Intervention Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment. Primary and secondary outcome measures The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall. Results Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613–1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846–1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782–1.522)] and mortality rate [RR = 0.896 (95% CI 0.335–2.400)] did not differ between groups. Conclusion Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations. Trial registration ISRCTN Registry no. ISRCTN11674947

Assessing Nurses Knowledge of Glasgow Coma Scale in Emergency and Outpatient Department

Assessment of level of consciousness using the Glasgow Coma Scale (GCS) is a tool requiring knowledge that is important in detecting early deterioration in a patients level of consciousness. Critical thinking used with the skill and knowledge in assessing the GCS is the foundation of all nursing practice. This study aims to explore the knowledge and competence in assessing the GCS among staff nurses working in the Emergency and Outpatient Departments. This is a quantitative descriptive cross-sectional study design using the GCS Knowledge Questionnaire. Convenience sampling method was used. Nurses in these Departments were asked to partake in the survey. Data collected was analyzed using the Statistical Package of Social Sciences (SPSS) version 20. Descriptive and Pearsons chi square was used. Result showed that 55.56% of nurses had poor knowledge followed by 41.48% and 2.96% with satisfactory knowledge and good knowledge, respectively. The result on the association between knowledge and education level showed a significant association between the two variables (X 2 = 18.412, df = 3, n = 135, and p < 0.05). There was also a significant correlation between knowledge and age group (X 2 = 11.085, df = 2, n = 135, and p < 0.05). Overall, this study supports that good knowledge and skill are important in assessing GCS level.