- Email: [email protected]
Meeting the paediatric education needs of mixed emergency departments: SCH ED experience
Conference Abstracts recieved an analgesic in the pre-hospital/community setting. Pre-hospital/community analgesics ranged from simple over the counter medicine to prescribed Schedule 4 and Schedule 8 drugs by ambulance or general practitioners. More than half of the group reporting pain or presenting with a painful condition or injury, 54% (n = 362) did not self administer or receive any analgesia in the pre hospital setting. Patients provided a variety of reasons for not self administering an analgesic. The majority of patients were discharged (57%). Conclusion: Emergency departments continue to encounter inadequate patient pre-hospital/community analgesic management. Unnecessary suffering and distress may be avoided if patients had a better understanding of the benefits for self administration of analgesics. Increased community education programs are needed to improve awareness about safe analgesic administration options prior to ED arrival. Patient education of prehospital/community analgesic management requires further research. Keywords: Pain management; Analgesics; Survey; Prehospital pain management doi:10.1016/j.aenj.2010.08.312 Intranasal fentanyl—–Standard IV concentration (50 mcg/ml) effective analgesia for children in ED Dianne Crellin, Rong Xiu Ling c , Franz Babl a,b,c a
Emergency Department, Royal Children’s Hospital, Melbourne, Flemington Road, Parkville 3052, Australia b Murdoch Children’s Research Institute, Flemington Road, Parkville 3052, Australia c The University of Melbourne, Level 5, 234 Queensberry Street, Carlton 3010, Australia E-mail address: [email protected] (D. Crellin).
Background: Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the emergency department (ED). A concentrated solution of fentanyl (300 g/ml) has been used in prior trials, yet many EDs use the standard solution at a concentration of 50 g/ml which is widely available and low cost. There are currently no data supporting the efficacy of IN fentanyl when using a lower concentration (50 g/ml), than that used in previous efficacy studies. We aimed to investigate if the standard IV fentanyl solution (50 g/ml) administered intranasally has analgesic efficacy in children with upper limb injuries. Methods: Prospective audit in children aged 5—18 years presenting with upper limb injuries. Patients received IN fentanyl (50 g/ml) at 1.5 g/kg. Patient assessed pain scores were collected 5, 10, 20, 30, and 60 min following IN fentanyl administration using a visual analogue scale (VAS) or Bieri Faces — Revised scale. Parental scores were used if patients were unable to provide a score. Results: Thirty-six of 59 eligible patients were enrolled; median age was 6.8 years (range 5—15 years). 89% (32/36) ultimately required fracture reduction. Mean first dose of IN fentanyl was 1.4 g /kg. Median pain scores dropped from 7 (IQR 5—10) pre-fentanyl to 5 (IQR 4—8) at 5 min and 2 (IQR 1—4) at 30 and 60 min. Twenty-one (58%) children did not
157 require further analgesia in the ED. There were no adverse events. Conclusions: Standard IV concentration IN fentanyl (50 g/ml) appears to have analgesic efficacy in children with upper limb injuries. Keywords: Child; Pain; Analgesia; Intranasal fentanyl; Upper limb injuries doi:10.1016/j.aenj.2010.08.313 Paediatrics 5A Concurrent Session 5 Meeting the paediatric education needs of mixed emergency departments: SCH ED experience Catherine Sumsky, Kylie Cichero, Paul Hunstead
Stark, Glenda
Mullen, Jane
Sydney Children’s Hospital, High St., Randwick 2031, Australia E-mail addresses: [email protected]. gov.au (C. Sumsky), [email protected] (K. Stark), [email protected] (G. Mullen), [email protected] (J. Cichero), [email protected] (P. Hunstead). Sydney Children’s Hospital Emergency Department (SCH ED) has been in the fortunate position of being able to provide paediatric emergency education to emergency nurses’ throughout NSW and the ACT working in mixed emergency departments. In 2003/2004 the existing paediatric emergency nursing education programs were adapted into formal study days and a more defined professional development pathway for nurses working within the department was developed. Initially, non-paediatric nursing staff from mixed emergency departments within SESIAHS, were invited to participate in the study days. The participation soon moved to outside the Area and by 2006 GESCHN and NSCCAHS were sending staff to attend the SCH ED Education Program. In 2008, SCH ED held an inaugural Paediatric Emergency Care Conference which further highlighted a need to offer paediatric emergency education opportunities to a broader audience. An estimated 500,000 children are seen in emergency departments across NSW with over 80% of these children treated in mixed emergency departments. Last year the department developed and coordinated a targeted Clinical Nurse Initiative and Triage (Paediatric skills Acquisition) program for registered nurses working in mixed emergency departments. This paper will discuss the needs analysis performed prior to commencement of the Clinical Nurse Initiative and Triage (Paediatric skills Acquisition) program, program development and the evaluation and follow up of the participants with regard to change process and the adaptation of paediatric tools to their department.
158 Establishing and maintaining paediatric nursing competency in a mixed ED is a challenge. This paper will demonstrate one option that SCH has explored. Keywords: Paediatric emergency care; Paediatric tertiary education; Competence doi:10.1016/j.aenj.2010.08.314 When opportunity knocks. . .give it your best shot!—– Opportunistic immunising in the Paediatric Emergency Department Leanne Philips, Alison Williams, Jeanine Young Royal Children’s Hospital, Herston Road, Herston, QLD 4029, Australia E-mail addresses: leanne [email protected] (L. Philips), alison [email protected] (A. Williams), jeanine [email protected] (J. Young). Immunisation has been identified by World Health Organisation as one of the most cost beneficial health prevention strategies. Opportunistic immunising within the Paediatric Emergency Department (PED) gives healthcare professionals access to a hard to reach population. This study which used a cross-sectional survey design aimed to benchmark staffs’ knowledge, opinions and practices to opportunistic immunising in the PED, identifying if barriers exist. The study evaluated five main areas: Knowledge regarding vaccine contraindications.Beliefs and attitudes about safety and necessity of vaccines.Practices in communicating with parents.Resources utilised.Current immunisation practices. A total of 86 surveys were distributed to health care workers in the PED, with a response rate of 87% (n = 75) achieved. The results showed an overall consensus that healthcare professionals believed that immunisations were safe, necessary and effective. Analysis of specific areas within knowledge, attitude and practices identified some barriers to immunising in the PED. Approximately 19% (n = 14) of staff were uncomfortable prescribing and/or giving more than two injections at the one visit. Only 5% (n = 4) always felt confident and 9% (n = 7) stated that they never felt confident answering parent questions or concerns in relation to vaccination. Although 72% (n = 54) advocated for opportunistic immunising in the PED, 72% (n = 54) identified time as a barrier, while being too difficult/extra work was also identified as a barrier by 35% (n = 26) of staff. Addressing barriers that exist for the health professional within the PED will facilitate optimal immunisation uptake, especially for the hard to reach populations. Keywords: Immunisation; Paediatric Emergency Department; Paediatric; Vaccines; Opportunistic; Health promotion; Education doi:10.1016/j.aenj.2010.08.315
Conference Abstracts The ‘‘Practise Partnership Model’’; changing the way we deliver care to our paediatric emergency patients Therese Oates, Stephen Leahy Royal Children’s Hospital, Herston Road, Herston, Brisbane, Australia E-mail addresses: Therese [email protected] (T. Oates), Stephen [email protected] (S. Leahy). Aim: The aim of the project was to explore an alternative model for delivering emergency nursing care to the paediatric population. Abstract: The number and acuity of paediatric patients who are presenting to the emergency department at the Royal Children’s Hospital in Brisbane is increasing. In addition, the emergency nursing workforce is undergoing significant change widely documented to be due to contributing factors such as a worldwide nursing shortage and an ageing workforce. As a result, this has lead to a dilution of emergency nursing skills which has implications on the delivery of safe nursing care. Subsequently, a need to increase the number of appropriately skilled emergency nurses to safely care for these children is required. Traditionally a Primary Nursing Model has been used; however, to address the issue of the changing workforce the Royal Children’s Hospital developed and implemented the Practice Partnership Model. Keywords: Paediatric emergency; Models of care; Accident and emergency; Team nursing; Nurse patient ratio doi:10.1016/j.aenj.2010.08.316 Mass Casualty 5B Exploring the disaster content in Australian postgraduate emergency nursing programs Jamie Ranse, Paul Arbon a , Ramon Shaban b , Julie c d e Considine , Belinda Mitchell , Shane Lenson a
School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia b Griffith Institute for Health and Medical Research and Princess Alexandra Hospital, Logan campus, Griffith University, Meadowbrook, QLD 4131, Australia c Deakin University — Northern Health Partnership, Emergency Department, The Northern Hospital, 185 Cooper St., Epping, VIC 3076, Australia d Northern Health, Quality, Safety & Risk Unit, 185 Cooper St., Epping, VIC 3076, Australia e Emergency Department, Calvary Health Care, PO Box 254, Jamison, ACT 2614, Australia E-mail addresses: jamie.ranse@flinders.edu.au (J. Ranse), r.shaban@griffith.edu.au (R. Shaban), [email protected] (J. Considine), [email protected] (B. Mitchell), [email protected] (S. Lenson). Disasters are global phenomena. Emergency nurses have key roles in responding to health care disasters which is extensive and ranges across the disaster continuum, from initial impact through to disaster recovery, spanning both
Emergency Department, Royal Children’s Hospital, Melbourne, Flemington Road, Parkville 3052, Australia b Murdoch Children’s Research Institute, Flemington Road, Parkville 3052, Australia c The University of Melbourne, Level 5, 234 Queensberry Street, Carlton 3010, Australia E-mail address: [email protected] (D. Crellin).
Background: Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the emergency department (ED). A concentrated solution of fentanyl (300 g/ml) has been used in prior trials, yet many EDs use the standard solution at a concentration of 50 g/ml which is widely available and low cost. There are currently no data supporting the efficacy of IN fentanyl when using a lower concentration (50 g/ml), than that used in previous efficacy studies. We aimed to investigate if the standard IV fentanyl solution (50 g/ml) administered intranasally has analgesic efficacy in children with upper limb injuries. Methods: Prospective audit in children aged 5—18 years presenting with upper limb injuries. Patients received IN fentanyl (50 g/ml) at 1.5 g/kg. Patient assessed pain scores were collected 5, 10, 20, 30, and 60 min following IN fentanyl administration using a visual analogue scale (VAS) or Bieri Faces — Revised scale. Parental scores were used if patients were unable to provide a score. Results: Thirty-six of 59 eligible patients were enrolled; median age was 6.8 years (range 5—15 years). 89% (32/36) ultimately required fracture reduction. Mean first dose of IN fentanyl was 1.4 g /kg. Median pain scores dropped from 7 (IQR 5—10) pre-fentanyl to 5 (IQR 4—8) at 5 min and 2 (IQR 1—4) at 30 and 60 min. Twenty-one (58%) children did not
157 require further analgesia in the ED. There were no adverse events. Conclusions: Standard IV concentration IN fentanyl (50 g/ml) appears to have analgesic efficacy in children with upper limb injuries. Keywords: Child; Pain; Analgesia; Intranasal fentanyl; Upper limb injuries doi:10.1016/j.aenj.2010.08.313 Paediatrics 5A Concurrent Session 5 Meeting the paediatric education needs of mixed emergency departments: SCH ED experience Catherine Sumsky, Kylie Cichero, Paul Hunstead
Stark, Glenda
Mullen, Jane
Sydney Children’s Hospital, High St., Randwick 2031, Australia E-mail addresses: [email protected]. gov.au (C. Sumsky), [email protected] (K. Stark), [email protected] (G. Mullen), [email protected] (J. Cichero), [email protected] (P. Hunstead). Sydney Children’s Hospital Emergency Department (SCH ED) has been in the fortunate position of being able to provide paediatric emergency education to emergency nurses’ throughout NSW and the ACT working in mixed emergency departments. In 2003/2004 the existing paediatric emergency nursing education programs were adapted into formal study days and a more defined professional development pathway for nurses working within the department was developed. Initially, non-paediatric nursing staff from mixed emergency departments within SESIAHS, were invited to participate in the study days. The participation soon moved to outside the Area and by 2006 GESCHN and NSCCAHS were sending staff to attend the SCH ED Education Program. In 2008, SCH ED held an inaugural Paediatric Emergency Care Conference which further highlighted a need to offer paediatric emergency education opportunities to a broader audience. An estimated 500,000 children are seen in emergency departments across NSW with over 80% of these children treated in mixed emergency departments. Last year the department developed and coordinated a targeted Clinical Nurse Initiative and Triage (Paediatric skills Acquisition) program for registered nurses working in mixed emergency departments. This paper will discuss the needs analysis performed prior to commencement of the Clinical Nurse Initiative and Triage (Paediatric skills Acquisition) program, program development and the evaluation and follow up of the participants with regard to change process and the adaptation of paediatric tools to their department.
158 Establishing and maintaining paediatric nursing competency in a mixed ED is a challenge. This paper will demonstrate one option that SCH has explored. Keywords: Paediatric emergency care; Paediatric tertiary education; Competence doi:10.1016/j.aenj.2010.08.314 When opportunity knocks. . .give it your best shot!—– Opportunistic immunising in the Paediatric Emergency Department Leanne Philips, Alison Williams, Jeanine Young Royal Children’s Hospital, Herston Road, Herston, QLD 4029, Australia E-mail addresses: leanne [email protected] (L. Philips), alison [email protected] (A. Williams), jeanine [email protected] (J. Young). Immunisation has been identified by World Health Organisation as one of the most cost beneficial health prevention strategies. Opportunistic immunising within the Paediatric Emergency Department (PED) gives healthcare professionals access to a hard to reach population. This study which used a cross-sectional survey design aimed to benchmark staffs’ knowledge, opinions and practices to opportunistic immunising in the PED, identifying if barriers exist. The study evaluated five main areas: Knowledge regarding vaccine contraindications.Beliefs and attitudes about safety and necessity of vaccines.Practices in communicating with parents.Resources utilised.Current immunisation practices. A total of 86 surveys were distributed to health care workers in the PED, with a response rate of 87% (n = 75) achieved. The results showed an overall consensus that healthcare professionals believed that immunisations were safe, necessary and effective. Analysis of specific areas within knowledge, attitude and practices identified some barriers to immunising in the PED. Approximately 19% (n = 14) of staff were uncomfortable prescribing and/or giving more than two injections at the one visit. Only 5% (n = 4) always felt confident and 9% (n = 7) stated that they never felt confident answering parent questions or concerns in relation to vaccination. Although 72% (n = 54) advocated for opportunistic immunising in the PED, 72% (n = 54) identified time as a barrier, while being too difficult/extra work was also identified as a barrier by 35% (n = 26) of staff. Addressing barriers that exist for the health professional within the PED will facilitate optimal immunisation uptake, especially for the hard to reach populations. Keywords: Immunisation; Paediatric Emergency Department; Paediatric; Vaccines; Opportunistic; Health promotion; Education doi:10.1016/j.aenj.2010.08.315
Conference Abstracts The ‘‘Practise Partnership Model’’; changing the way we deliver care to our paediatric emergency patients Therese Oates, Stephen Leahy Royal Children’s Hospital, Herston Road, Herston, Brisbane, Australia E-mail addresses: Therese [email protected] (T. Oates), Stephen [email protected] (S. Leahy). Aim: The aim of the project was to explore an alternative model for delivering emergency nursing care to the paediatric population. Abstract: The number and acuity of paediatric patients who are presenting to the emergency department at the Royal Children’s Hospital in Brisbane is increasing. In addition, the emergency nursing workforce is undergoing significant change widely documented to be due to contributing factors such as a worldwide nursing shortage and an ageing workforce. As a result, this has lead to a dilution of emergency nursing skills which has implications on the delivery of safe nursing care. Subsequently, a need to increase the number of appropriately skilled emergency nurses to safely care for these children is required. Traditionally a Primary Nursing Model has been used; however, to address the issue of the changing workforce the Royal Children’s Hospital developed and implemented the Practice Partnership Model. Keywords: Paediatric emergency; Models of care; Accident and emergency; Team nursing; Nurse patient ratio doi:10.1016/j.aenj.2010.08.316 Mass Casualty 5B Exploring the disaster content in Australian postgraduate emergency nursing programs Jamie Ranse, Paul Arbon a , Ramon Shaban b , Julie c d e Considine , Belinda Mitchell , Shane Lenson a
School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia b Griffith Institute for Health and Medical Research and Princess Alexandra Hospital, Logan campus, Griffith University, Meadowbrook, QLD 4131, Australia c Deakin University — Northern Health Partnership, Emergency Department, The Northern Hospital, 185 Cooper St., Epping, VIC 3076, Australia d Northern Health, Quality, Safety & Risk Unit, 185 Cooper St., Epping, VIC 3076, Australia e Emergency Department, Calvary Health Care, PO Box 254, Jamison, ACT 2614, Australia E-mail addresses: jamie.ranse@flinders.edu.au (J. Ranse), r.shaban@griffith.edu.au (R. Shaban), [email protected] (J. Considine), [email protected] (B. Mitchell), [email protected] (S. Lenson). Disasters are global phenomena. Emergency nurses have key roles in responding to health care disasters which is extensive and ranges across the disaster continuum, from initial impact through to disaster recovery, spanning both