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Paisley, United Kingdom

Waldie J.,Intensive Care
Journal of Advanced Perioperative Care | Year: 2010

Aim: The aim of this literature review was to examine the role of the healthcare assistant. Background: Within the United Kingdom the healthcare assistant role has been pivotal for ensuring that patient care is provided. Due to ongoing changes in nursing practice, healthcare assistants are now taking on caring roles formerly undertaken by registered nurses. Prior to determining what roles healthcare assistants can undertake, it is important to ascertain whether training for a particular role in practice is required. Method: A review of the literature was undertaken to define the key topics concerning healthcare assistant development. Findings: A review of the literature revealed that the main topics associated with the role of the HCA are: government policy, nursing skill mix, healthcare assistant education, method of training, professional boundaries, role clarification, interdisciplinary working, patient safety, accountability, role allocation and patient satisfaction. Results: This review identifies that the healthcare assistant role can be effectively developed to meet the ever-changing needs of the patient and that this development is not only achievable but desirable. Conclusion: The literature review suggests that the role of the healthcare assistant can be developed. Nonetheless, careful consideration of specific healthcare assistant roles in practice is necessary to ensure competence alongside the acknowledgement of role limitations and professional integrity. Recommendations: The healthcare assistant role can be significantly developed by encouraging appropriate training with programmes such as National Vocational Qualifications in line with local policy. Healthcare assistant development might also have wider benefits such as enhancing formalised training within the clinical area and recruitment for preregistration training and education. © AfPP 2010.

Smith R.J.,Intensive Care
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine | Year: 2010

To evaluate the effect of fluid therapy using Accusol (Baxter Healthcare, McGaw Park, Ill, USA), a crystalloid solution containing sodium bicarbonate and other electrolytes and having a strong ion difference of 35 mEq/L, on acid-base stability after cardiac surgery. Retrospective per-protocol comparison. Intensive care unit of St Vincent's Hospital, a teaching hospital in Melbourne, Australia. Consecutive adult patients admitted in daytime hours after elective on-pump coronary artery bypass graft surgery between May and October 2008 constituted the "pre-Accusol group" (n=40), and those admitted between May and October 2009 and who were treated with Accusol constituted the "Accusol group" (n=51). The fluids and their component electrolytes administered; change in standard base excess (SBE) between the time of intensive care admission and 04:00 h the next day. The Accusol group received a median Accusol dose of 1.86 mL/kg/h (interquartile range, 1.51-2.20 mL/ kg/h), which accounted for 38% (SD, 10%) of the total volume of fluid administered. The change in SBE was +0.03mmol/L (95% CI, -0.57 to 0.64 mmol/L; P = 0.91) in the Accusol group compared with -2.05mmol/L (95% CI, -2.64 to -1.45; P < 0.01) in the pre-Accusol group. The strong ion difference of the electrolytes administered as components of fluid therapies was higher in the Accusol group by 55.5mEq (95% CI, 40.0 to 71.0mEq; P < 0.01). Only 8% of the Accusol group received albumin compared with 48% of the pre-Accusol group (P < 0.01). SBE was more stable in patients treated with Accusol. Further studies are needed to determine whether use of solutions such as Accusol influences important patient outcomes.

Coventry C.,University of Adelaide | Flabouris A.,University of Adelaide | Sundararajan K.,University of Adelaide | Cramey T.,Intensive Care
Resuscitation | Year: 2013

Objective: Compare and contrast rapid response team (RRT) calls to patients with, and those without, a pre-existing not for resuscitation (NFR) order. Methods: Retrospective medical record and database review of adult inpatients with a hospital stay greater than 24. h. Results: 198 (15.7%) of 1258 patients with a RRT call, had a pre-existing NFR order. Patients with, compared to those without a pre-existing NFR, were older (median years, 81 vs 70, p<. 0.01), similar gender (males, 56.6% vs 54.3%, p= 0.55), the trigger be the worried criterion (48.5% vs 33.9%, p<. 0.01) and have had a prior RRT call (30.8% vs 18.0%, p<. 0.01).At time of RRT attendance, NFR patients had a higher respiratory rate (24 vs 20, p<. 0.01), lower SaO2 (93% vs 97%, p= 0.02) and just as likely to receive a critical care (24.2% vs 25.8%, p= 0.63) or ward type (88.9% vs 90.1%, p= 0.61) intervention. NFR patients were less likely to be admitted to an ICU (2.0% vs 9.4%, p<. 0.01), more likely to be left on the ward (92.4% vs 80.3%, p<. 0.01), and be documented not for further RRT calls (2.5% vs 0.9%, p= 0.06), but have a similar mortality (5.6% vs 3.5%, p= 0.16), at time of RRT call. Conclusions: RRT calls to patients with pre-existing NFR orders are not uncommon. The worried criterion is more often the trigger, they have abnormal respiratory observations at time of call, a similar level of intervention, less likely to be admitted to the ICU and more likely to be documented not for further RRT calls. © 2013 .

Trinkle R.M.,Royal Adelaide Hospital | Trinkle R.M.,University of Adelaide | Flabouris A.,Intensive Care | Flabouris A.,University of Adelaide
Resuscitation | Year: 2011

Objective: Describe afferent limb failure (ALF), defined as documented Rapid Response System (RRS) calling criteria, but no associated call, in the 24. h prior to an event. Methods: Retrospective medical record and database review. Adult in-patients whose hospital length of stay (LOS) was greater than 24. h, an event being a cardiac arrest, Medical Emergency Team (MET) call or unanticipated Intensive Care Unit (ICU) admission. Results: Over 6 months, there were 443 patients with 575 events, of which 35 (6.1%) were cardiac arrests, 395 (68.7%) MET calls, and 145 (25.2%) ICU admissions. 131 (22.8%) events had documented ALF, of which 47/131 (35.9%) had documented criteria across more than one time period. Patients with ALF, compared to those without ALF, were significantly more likely to have an unanticipated ICU admission (45/131 (34.4%) vs 100/443 (22.5%), p= 0.01), but be of similar age (71 years vs 72 years, p= 0.44), male gender (51.1% vs 53.2%, p= 0.38), APACHE 2 score (22.8 vs 21.4, p= 0.67), predicted risk of death (0.394 vs 0.367, p= 0.55), ICU LOS (2 days vs 2 days, p= 0.56), likelihood of not-for-resuscitation order during an event (4/131 (3.4%) vs 22/444 (5.0%), p= 0.34), and hospital mortality (42/107 (39.3%) vs 125/236 (37.2%), p= 0.70). Hospital mortality for patients with ALF across multiple, compared to single time periods was higher, 21/40 (52.5%) vs 22/69 (31.9%), p= 0.03. Conclusions: RRS ALF is a useful performance measure for a mature RRS, and is associated with unanticipated ICU admissions. The duration of, and not timing of, ALF criterion occurrence may affect hospital mortality. © 2011 Elsevier Ireland Ltd.

Background: This literature review on nursing journal clubs evaluates the efficacy of the teaching strategy within the clinical setting. Method: Peer-reviewed articles were retrieved using an online journal database. Inclusion criteria incorporated information on efficacy of the teaching strategy, evidence-based practices, and continuing education as they related to nursing journal club initiatives. Results: The literature cited numerous benefits and proved to be in favor of nursing journal clubs. The most common benefits found were nurses remaining abreast of current research, skill development in reading and critically appraising research, and incorporation of evidence-based practices to patient care. Due to the self-motivated and voluntary nature of this teaching strategy, a limitation commonly identified was lack of participation, and further research on this limitation often was suggested. Conclusion: Nursing journal clubs proved to be an effective teaching strategy, a finding that remains consistent with the medical pioneers of the movement. © SLACK Incorporated.

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