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ItemMedication communication between nurses and doctors for paediatric acute care: An ethnographic studyBorrott, N ; Kinney, S ; Newall, F ; Williams, A ; Cranswick, N ; Wong, I ; Manias, E (WILEY, 2017-07-01)AIMS AND OBJECTIVES: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. BACKGROUND: Communication between health professionals influences medication incidents' occurrence and safe care. DESIGN: An ethnographic study was undertaken. METHODS: Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. RESULTS: The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. CONCLUSIONS: Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. RELEVANCE TO CLINICAL PRACTICE: Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands. Interdisciplinary education delivered in healthcare organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management.
ItemPain assessment and management in paediatric oncology: a cross-sectional auditPlummer, K ; McCarthy, M ; McKenzie, I ; Newall, F ; Manias, E (WILEY, 2017-10-01)AIMS AND OBJECTIVES: To describe the pain assessment and management practices documented by health professionals within a tertiary-level Children's Cancer Centre and to evaluate how these practices were compared with international recommendations. BACKGROUND: Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology inpatients are of a high quality. DESIGN: A single-site cross-sectional audit. METHODS: A 24-hour period of documented pain-related care in randomly selected inpatients of an Australian tertiary-level Children's Cancer Centre was examined. The current pain management practices were audited over a two-month period resulting in 258 episodes of pain-related care being reviewed. RESULTS: Pain related to medical treatment for cancer was common (n = 146/258, 57%) and persistent. The presence of pain was not consistently recorded by health professionals (n = 75/146, 51%). Pain was mild (n = 26/75, 35%) and opioids were the mainstay of pain management interventions (n = 63/112, 56%). Adjuvants were an important component of pain management (n = 47/112, 42%), and nonpharmacological methods of managing pain were under-represented in this audit (n = 38/146, 26%). According to the Pain Management Index, pain was appropriately managed for the majority of children (n = 65/76, 87%). CONCLUSIONS: Pain management practices did not fully reflect the recommendations of contemporary paediatric pain management. Due to limitations in the documentation of children's pain, it was difficult to determine the effectiveness of pain management interventions. RELEVANCE TO CLINICAL PRACTICE: This study highlights the ongoing problem of pain for children receiving antineoplastic therapy. It is recommended that health professionals routinely screen for the presence of pain during hospitalisation and assess the efficacy of pain-related care.
ItemMedication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospitalManias, E ; Cranswick, N ; Newall, F ; Rosenfeld, E ; Weiner, C ; Williams, A ; Wong, ICK ; Borrott, N ; Lai, J ; Kinney, S (WILEY, 2019-03-01)AIM: This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors. METHODS: A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included. RESULTS: A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors. CONCLUSION: Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors.
ItemDifficulties with assessment and management of an infant's distress in the postoperative period: Optimising opportunities for interdisciplinary information-sharingWeiner, C ; Penrose, S ; Manias, E ; Cranswick, N ; Rosenfeld, E ; Newall, F ; Williams, A ; Borrott, N ; Kinney, S (SAGE PUBLICATIONS INC, 2016-01-01)OBJECTIVES: The importance of accurate paediatric patient assessment is well established but under-utilised in managing postoperative medication regimens. METHODS: Data for this case report were collected through observations of clinical practice, conduct of interviews, and retrieval of information from the medical record. This case report involving a hospitalised 1-year-old boy demonstrates the difficulties associated with assessing and managing postoperative distress, including pain and other clinical conditions related to the surgical procedure. RESULTS: Postoperatively, there were difficulties in managing pain and an episode of over-sedation, occasioning opiate reversal with naloxone. In addition, he had decreasing oxygen saturation and increased work of breathing. X-ray showed changes consistent with either atelectasis or aspiration, and he was commenced on antibiotics. The patient experienced respiratory distress and required intervention from the medical emergency team. CONCLUSION: This case demonstrated the importance of comprehensive assessment and careful consideration of alternative causes of an infant's distress using the results of assessment tools to aid decision-making. Communication moderates effective patient care, and more favourable outcomes could be achieved by optimising interdisciplinary information-sharing.