- Email: [email protected]
Pre-operative eGFR predicts hospital length of stay post-coronary bypass surgery
Abstracts
53
PaO2 /FiO2 ratio. The algorithm was readily available to clinicians, and user friendly due to its design and clarity. Implementation was supported via ongoing nursing/medical education. Data from 56 patients transplanted between October 2005 and January 2007 were analysed. Fifty-three patients who received transplants between March 2004 and September 2005 formed the historical control group. Lung preservation and graft preparation techniques were standardised in March 2004. The proportion of patients with PaO2 /FiO2 ratios >300 at 48 h after transplantation was higher in patients managed after implementation of the guideline (p = 0.03). Significantly less positive fluid balances (p = 0.01) and lower noradrenaline doses (p = 0.01) were recorded up to 72 h in the postintervention group. Findings suggest the implementation of a guideline for haemodynamic and respiratory management may improve respiratory function after lung transplantation.
Statistical analysis demonstrated that the groups were comparable. Significant differences were detected in median Morhpine infusion duration (3.63 days vs. 2.83 days, p = 0.05) and maximum doses (120 mcg/(kg h) vs. 97.5 mcg/(kg h)). There was also a significant difference in the number of adjunctive medications used (p = 0.001), in particular Methadone (pre 3% vs. post 63%). Chart audit revealed generally poor adherence to guidelines but good use of tools. Staffs were positive about the trial and the perceived impact the guidelines had on practice. The sedation guidelines in this study appear to have impacted on the duration and dosage of agents without adversely impacting on ventilation time or length of stay. Increased awareness and use of adjunctive medication also occurred. Full adoption is yet to be fully realised. Ongoing staff consultation and education are vital to support the acceptance of practice change. doi:10.1016/j.aucc.2007.12.006
doi:10.1016/j.aucc.2007.12.005
Adult Free Papers
Best Paediatric Nursing Presentation Guiding sedation practice in the paediatric intensive care Samantha Keogh1* , Debbie Long1 , Desley Horn1 , Jennifer Eggins2 , Tanya Cienfuegos1 1
Royal Children’s Hospital, Brisbane, Australia; Mater Children’s Hospital, Brisbane, Australia
2
Sponsored by Mayo
Administration and management of sedative agents is a necessary component in the care of the critically ill child. Sedation reduces anxiety and agitation, and facilitates critical care therapies. However, there are adverse consequences of prolonged and/or inappropriate use of sedation, agents including tolerance and withdrawal syndrome. The aim of this study was to develop, implement and evaluate guidelines for sedation management in the PICU. The study employed a pre and post-test design with a total of 138 patients studied (75 pre and 63 post). Patient characteristics and outcome variables were compared to detect for significant differences. Guideline adherence was examined through a chart audit and staff were surveyed for the merit and use of the guidelines.
Pre-operative eGFR predicts hospital length of stay post-coronary bypass surgery Moore Elizabeth1* , Julie Simpson2 , Antony Tobin11 St Vincent’s Hospital, Melbourne, Australia; 2 University of Melbourne, Australia The association between severe pre-operative renal dysfunction and adverse outcomes, such as prolonged LOS after CABGS, is well known. A growing body of knowledge indicates milder degrees of renal dysfunction also adversely influence outcomes of cardiac surgery, implying greater resource use. There are few published Australian studies. This HREC approved study uses data from four hospital departments to test these findings locally. For 3000 consecutive patients who underwent CABGS (June 1997—January 2007) eGFR was calculated and categorised (normal, mild, moderate and severe), and post-operative hospital LOS determined. The cumulative percentage still in hospital at 7 days (using the Kaplan—Meier method) was 37% for those with normal renal function and increased with renal dysfunction: mild (42%), mod (59%), severe (83%), P trend <0.001. Univariable Cox regression analysis showed decreasing hazard ratio (HR) for probability of discharge within 1 month, across renal dysfunction categories when compared to those with normal renal function: mild (0.88, P = 0.03), mod (0.61, P < 0.001), severe (0.36, P < 0.001). On adjusting for age, diabetes and APACHEII score, HRs were mild 0.98 (P = 0.69), mod 0.77 (P < 0.001), severe 0.51 (P < 0.001).
54 The cumulative percentage still in ICU at 2 days was 8% for those with normal renal function and also increased with renal dysfunction: mild (10%), mod (17%), severe (32%), P trend <0.001. Progressively poorer pre-operative renal function is associated with longer length of stay after CABGS. Pre-operative eGFR should be considered in assessing surgical risk, obtaining informed consent and in intensive care resource allocation and treatment plans.
Abstracts considered such as; improving the relationship between the MET and non-critical care nurses; the need for resuscitation education to be contextualised and mimic the realities of a resuscitation event; and providing non-critical care nurses with the confidence and competence to remain involved in a resuscitation event, firstly to provide support for less experienced staff and secondly to participate in the ongoing management of the patient.
doi:10.1016/j.aucc.2007.12.007
Acknowledgements Medical emergency teams: Graduate nurses interactions, attitudes and perceptions during resuscitation events in the non-critical care environment
This research was supported by an ACT Health, Nursing and Midwifery Office, Postgraduate Scholarship and access to Sabbatical Leave.
Jamie Ranse
doi:10.1016/j.aucc.2007.12.008
The Canberra Hospital, Australia When a patient has a sudden cardiac arrest within the non-critical care hospital environment, nurses are predominately the first healthcare professionals to provide any intervention. It is not unrealistic to expect that a graduate (junior) nurse may be an active participant of such an event. The purpose of this research was to explore, describe and interpret the lived experience of graduate nurses who have participated in an in-hospital resuscitation event within the non-critical care environment. Using a hermeneutic phenomenological design, a convenience sample was recruited from a population of graduate Registered Nurses with less than twelve months experience. Focus groups were employed as a means of data collection. Thematic analysis of the focus group narrative was undertaken using a well-established human science approach. Responses from participants were analysed and grouped into four main themes: needing to decide, having to act, feeling connected and being supported. The narrative discussed participant interactions, attitudes and perceptions of the medical emergency team (MET) response. This included the decision-making of participants to activate the MET, the resuscitation environment being turned from calm to chaos upon arrival of the MET and the departure of ward nurses from the resuscitation event to return to other activities within their ward environment. Strategies to improve the resuscitation experience for healthcare participants should be
An exploration of the transition of patients from intensive care to the ward environment: A ward nursing perspective Sandra Bunn Middlemore Hospital, New Zealand The transition of patients from the intensive care unit (ICU) to the ward is a regular occurrence in the intensive care environment. Due to the demands for intensive care beds patients are often transferred earlier and sicker. This results in higher acuity patients on the wards where ward nurses have to meet the ongoing complex needs of the critically ill patient. This research aimed to explore the experiences of ward nurses receiving patients from ICU, to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent upon patient transfer. A qualitative descriptive methodology using focus groups explored the experiences of ward nurses receiving patients from intensive care. Three focus groups were held with nurses from wards with the greatest contact with our intensive care. The resulting data indicated that correct information was essential, in that, on arrival, the patient’s condition was as ICU stated on referral. Time to prepare was important for ward nurses to be organised sufficiently to receive an ICU patient. Comprehensive documentation was essential as a continuation of patient care especially fluid bal-
53
PaO2 /FiO2 ratio. The algorithm was readily available to clinicians, and user friendly due to its design and clarity. Implementation was supported via ongoing nursing/medical education. Data from 56 patients transplanted between October 2005 and January 2007 were analysed. Fifty-three patients who received transplants between March 2004 and September 2005 formed the historical control group. Lung preservation and graft preparation techniques were standardised in March 2004. The proportion of patients with PaO2 /FiO2 ratios >300 at 48 h after transplantation was higher in patients managed after implementation of the guideline (p = 0.03). Significantly less positive fluid balances (p = 0.01) and lower noradrenaline doses (p = 0.01) were recorded up to 72 h in the postintervention group. Findings suggest the implementation of a guideline for haemodynamic and respiratory management may improve respiratory function after lung transplantation.
Statistical analysis demonstrated that the groups were comparable. Significant differences were detected in median Morhpine infusion duration (3.63 days vs. 2.83 days, p = 0.05) and maximum doses (120 mcg/(kg h) vs. 97.5 mcg/(kg h)). There was also a significant difference in the number of adjunctive medications used (p = 0.001), in particular Methadone (pre 3% vs. post 63%). Chart audit revealed generally poor adherence to guidelines but good use of tools. Staffs were positive about the trial and the perceived impact the guidelines had on practice. The sedation guidelines in this study appear to have impacted on the duration and dosage of agents without adversely impacting on ventilation time or length of stay. Increased awareness and use of adjunctive medication also occurred. Full adoption is yet to be fully realised. Ongoing staff consultation and education are vital to support the acceptance of practice change. doi:10.1016/j.aucc.2007.12.006
doi:10.1016/j.aucc.2007.12.005
Adult Free Papers
Best Paediatric Nursing Presentation Guiding sedation practice in the paediatric intensive care Samantha Keogh1* , Debbie Long1 , Desley Horn1 , Jennifer Eggins2 , Tanya Cienfuegos1 1
Royal Children’s Hospital, Brisbane, Australia; Mater Children’s Hospital, Brisbane, Australia
2
Sponsored by Mayo
Administration and management of sedative agents is a necessary component in the care of the critically ill child. Sedation reduces anxiety and agitation, and facilitates critical care therapies. However, there are adverse consequences of prolonged and/or inappropriate use of sedation, agents including tolerance and withdrawal syndrome. The aim of this study was to develop, implement and evaluate guidelines for sedation management in the PICU. The study employed a pre and post-test design with a total of 138 patients studied (75 pre and 63 post). Patient characteristics and outcome variables were compared to detect for significant differences. Guideline adherence was examined through a chart audit and staff were surveyed for the merit and use of the guidelines.
Pre-operative eGFR predicts hospital length of stay post-coronary bypass surgery Moore Elizabeth1* , Julie Simpson2 , Antony Tobin11 St Vincent’s Hospital, Melbourne, Australia; 2 University of Melbourne, Australia The association between severe pre-operative renal dysfunction and adverse outcomes, such as prolonged LOS after CABGS, is well known. A growing body of knowledge indicates milder degrees of renal dysfunction also adversely influence outcomes of cardiac surgery, implying greater resource use. There are few published Australian studies. This HREC approved study uses data from four hospital departments to test these findings locally. For 3000 consecutive patients who underwent CABGS (June 1997—January 2007) eGFR was calculated and categorised (normal, mild, moderate and severe), and post-operative hospital LOS determined. The cumulative percentage still in hospital at 7 days (using the Kaplan—Meier method) was 37% for those with normal renal function and increased with renal dysfunction: mild (42%), mod (59%), severe (83%), P trend <0.001. Univariable Cox regression analysis showed decreasing hazard ratio (HR) for probability of discharge within 1 month, across renal dysfunction categories when compared to those with normal renal function: mild (0.88, P = 0.03), mod (0.61, P < 0.001), severe (0.36, P < 0.001). On adjusting for age, diabetes and APACHEII score, HRs were mild 0.98 (P = 0.69), mod 0.77 (P < 0.001), severe 0.51 (P < 0.001).
54 The cumulative percentage still in ICU at 2 days was 8% for those with normal renal function and also increased with renal dysfunction: mild (10%), mod (17%), severe (32%), P trend <0.001. Progressively poorer pre-operative renal function is associated with longer length of stay after CABGS. Pre-operative eGFR should be considered in assessing surgical risk, obtaining informed consent and in intensive care resource allocation and treatment plans.
Abstracts considered such as; improving the relationship between the MET and non-critical care nurses; the need for resuscitation education to be contextualised and mimic the realities of a resuscitation event; and providing non-critical care nurses with the confidence and competence to remain involved in a resuscitation event, firstly to provide support for less experienced staff and secondly to participate in the ongoing management of the patient.
doi:10.1016/j.aucc.2007.12.007
Acknowledgements Medical emergency teams: Graduate nurses interactions, attitudes and perceptions during resuscitation events in the non-critical care environment
This research was supported by an ACT Health, Nursing and Midwifery Office, Postgraduate Scholarship and access to Sabbatical Leave.
Jamie Ranse
doi:10.1016/j.aucc.2007.12.008
The Canberra Hospital, Australia When a patient has a sudden cardiac arrest within the non-critical care hospital environment, nurses are predominately the first healthcare professionals to provide any intervention. It is not unrealistic to expect that a graduate (junior) nurse may be an active participant of such an event. The purpose of this research was to explore, describe and interpret the lived experience of graduate nurses who have participated in an in-hospital resuscitation event within the non-critical care environment. Using a hermeneutic phenomenological design, a convenience sample was recruited from a population of graduate Registered Nurses with less than twelve months experience. Focus groups were employed as a means of data collection. Thematic analysis of the focus group narrative was undertaken using a well-established human science approach. Responses from participants were analysed and grouped into four main themes: needing to decide, having to act, feeling connected and being supported. The narrative discussed participant interactions, attitudes and perceptions of the medical emergency team (MET) response. This included the decision-making of participants to activate the MET, the resuscitation environment being turned from calm to chaos upon arrival of the MET and the departure of ward nurses from the resuscitation event to return to other activities within their ward environment. Strategies to improve the resuscitation experience for healthcare participants should be
An exploration of the transition of patients from intensive care to the ward environment: A ward nursing perspective Sandra Bunn Middlemore Hospital, New Zealand The transition of patients from the intensive care unit (ICU) to the ward is a regular occurrence in the intensive care environment. Due to the demands for intensive care beds patients are often transferred earlier and sicker. This results in higher acuity patients on the wards where ward nurses have to meet the ongoing complex needs of the critically ill patient. This research aimed to explore the experiences of ward nurses receiving patients from ICU, to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent upon patient transfer. A qualitative descriptive methodology using focus groups explored the experiences of ward nurses receiving patients from intensive care. Three focus groups were held with nurses from wards with the greatest contact with our intensive care. The resulting data indicated that correct information was essential, in that, on arrival, the patient’s condition was as ICU stated on referral. Time to prepare was important for ward nurses to be organised sufficiently to receive an ICU patient. Comprehensive documentation was essential as a continuation of patient care especially fluid bal-