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Risk assessment tool for falls in an acute neuroscience unit
VOL 6 NO 3 1993
AUSTRALIAN CRITICAL CARE
'AL 4"ARI I
(Hospal24 hours, EVAL 17 hours), with no statistical significance being demonstrated. Reasons for cessation of the filter were different with both groups. No statistical significance was demonstrated in mean urea and creatinine clearance rates of both filters. We believe that the results of this study are sufficiently encouraging to justify a larger randomised trial comparing non-anticoagulant CVVHF with conventional CVVHF using systemic heparinization in the Intensive Care Unit.
THE DYNAMICS OF INHOSPITAL CARDIAC ARREST ISSUES AND IMPLICATIONS
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Colleen &, Kevin Davey, Stan Woodhouse, Colin Case, Moira Weber Princess Alexandra Hospital Brisbane This study examines aspects of primary inhospital cardiac arrests that affect survival. 272 ventricular fibrillation (VF) and asystole cardiac arrests from The Coronary Care Unit (CCU), Emergency Department (ED), and general wards were analysed. 75 (27.5%) of resuscitations were excluded due to age of patient, multiple organ disease, inappropriate resuscitations and prolonged period with no cardiopulmonary resuscitation (CPR). Features examined were origin, primary rhythm (VF-CCU 30 (64%), ED 21 (78%), Wards 46 (38%) p=0.002), delay to CPR or defibrillation, duration of resuscitation, immediate survival and discharge status. 84 (43%) of patients were alive immediately following resuscitation (CCU - 40 (83%), ED 14 (52%), Wards 31 (25%) p = 0.0004. Of these patients 40 (20%) survived to be discharged from Hospital (CCU - 20 (42%), ED 9 (33%), Wards 11 (9%) p = 0.0008). This study highlights the
L,
features which contribute to the diversity of outcomes across specialty and ward areas with regard to resuscitation.
RISK ASSESSMENT TOOL FOR FALLS IN AN ACUTE NEUROSCIENCE UNIT Karen R Kerr Clinical Nurse Consultant Princess Alexandra Hospital Brisbane During the period January 1st to June 30th 1992 a total of 61 incidents were recorded in the Neuroscience Unit at Princess Alexandra Hospital. Forty three of these incidents were patient falls. This is double the average number of falls recorded in all other areas of the hospital. Consequently a retrospective chart audit was undertaken to identify predisposing factors with the view of implementing strategies to reduce the number of patient falls in the unit. STUDY OBJECTIVES To identify predisposing factors in relation to patient falls. Use this information to develop and implement a risk assessment form. Evaluate the effectiveness of this risk assessment form to minimise falls in Neuroscience patients. Potential strategies to minirnise the number of falls were developed and implemented. From the common predisposing factors identified a risk assessment form was developed. All patients were assessed on admission. Patients identified as a high risk of falling had their charting documents and bed card 'flagged' with a coloured dot. A follow up study of patient incidents between January 1993 and June 1993 was conducted to identify the effectiveness of the risk assessment tool in reducing
patient falls. Methodology included a correlation between the identified risk of falling and the actual fall incidence. During this time there was a 37.5% reduction in patient falls (in comparison with the previous six months). The falls risk assessment tool identified that patients who fell were categorised as moderate risk of falling, rather than high risk. All patients that fell scored 9 to 14 (total risk = 15) on the risk assessment tool. 32% of patients in the neuroscience unit scored a falls risk of 9 to 14. The falls risk assessment tool has improved staff awareness of patient's risk of falling (this may have heightened awareness in staff, thus contributing to reduction in patient falls). Following the trial, the tool has been modified. It is anticipated that this will further contribute to falls prevention in the neuroscience unit.
ECONOMIC RATIONALISM AND COSTING NURSING SERVICES Jan Andrews Director, Educational Services, NSW College of Nursing Sydney Over recent years, the Australian Health Care System has undergone significant change, particularly in the area of economic reform, in an effort to match limited resources to the inevitable growth in demand for services. Micro economic reform has resulted in a significant erosion of nursing resource allocation relative to workload. Picone (1) suggests that while a range of factors such as previous nursing shortages, effects of underfunding of award variations, inadequate provision for inflation and repeated rounds of productivity cuts have all contributed to the changes, the main issue of the profession has been its limited ability to model these variations because of crude descriptions of workloads and outputs. 19.
AUSTRALIAN CRITICAL CARE
'AL 4"ARI I
(Hospal24 hours, EVAL 17 hours), with no statistical significance being demonstrated. Reasons for cessation of the filter were different with both groups. No statistical significance was demonstrated in mean urea and creatinine clearance rates of both filters. We believe that the results of this study are sufficiently encouraging to justify a larger randomised trial comparing non-anticoagulant CVVHF with conventional CVVHF using systemic heparinization in the Intensive Care Unit.
THE DYNAMICS OF INHOSPITAL CARDIAC ARREST ISSUES AND IMPLICATIONS
-
Colleen &, Kevin Davey, Stan Woodhouse, Colin Case, Moira Weber Princess Alexandra Hospital Brisbane This study examines aspects of primary inhospital cardiac arrests that affect survival. 272 ventricular fibrillation (VF) and asystole cardiac arrests from The Coronary Care Unit (CCU), Emergency Department (ED), and general wards were analysed. 75 (27.5%) of resuscitations were excluded due to age of patient, multiple organ disease, inappropriate resuscitations and prolonged period with no cardiopulmonary resuscitation (CPR). Features examined were origin, primary rhythm (VF-CCU 30 (64%), ED 21 (78%), Wards 46 (38%) p=0.002), delay to CPR or defibrillation, duration of resuscitation, immediate survival and discharge status. 84 (43%) of patients were alive immediately following resuscitation (CCU - 40 (83%), ED 14 (52%), Wards 31 (25%) p = 0.0004. Of these patients 40 (20%) survived to be discharged from Hospital (CCU - 20 (42%), ED 9 (33%), Wards 11 (9%) p = 0.0008). This study highlights the
L,
features which contribute to the diversity of outcomes across specialty and ward areas with regard to resuscitation.
RISK ASSESSMENT TOOL FOR FALLS IN AN ACUTE NEUROSCIENCE UNIT Karen R Kerr Clinical Nurse Consultant Princess Alexandra Hospital Brisbane During the period January 1st to June 30th 1992 a total of 61 incidents were recorded in the Neuroscience Unit at Princess Alexandra Hospital. Forty three of these incidents were patient falls. This is double the average number of falls recorded in all other areas of the hospital. Consequently a retrospective chart audit was undertaken to identify predisposing factors with the view of implementing strategies to reduce the number of patient falls in the unit. STUDY OBJECTIVES To identify predisposing factors in relation to patient falls. Use this information to develop and implement a risk assessment form. Evaluate the effectiveness of this risk assessment form to minimise falls in Neuroscience patients. Potential strategies to minirnise the number of falls were developed and implemented. From the common predisposing factors identified a risk assessment form was developed. All patients were assessed on admission. Patients identified as a high risk of falling had their charting documents and bed card 'flagged' with a coloured dot. A follow up study of patient incidents between January 1993 and June 1993 was conducted to identify the effectiveness of the risk assessment tool in reducing
patient falls. Methodology included a correlation between the identified risk of falling and the actual fall incidence. During this time there was a 37.5% reduction in patient falls (in comparison with the previous six months). The falls risk assessment tool identified that patients who fell were categorised as moderate risk of falling, rather than high risk. All patients that fell scored 9 to 14 (total risk = 15) on the risk assessment tool. 32% of patients in the neuroscience unit scored a falls risk of 9 to 14. The falls risk assessment tool has improved staff awareness of patient's risk of falling (this may have heightened awareness in staff, thus contributing to reduction in patient falls). Following the trial, the tool has been modified. It is anticipated that this will further contribute to falls prevention in the neuroscience unit.
ECONOMIC RATIONALISM AND COSTING NURSING SERVICES Jan Andrews Director, Educational Services, NSW College of Nursing Sydney Over recent years, the Australian Health Care System has undergone significant change, particularly in the area of economic reform, in an effort to match limited resources to the inevitable growth in demand for services. Micro economic reform has resulted in a significant erosion of nursing resource allocation relative to workload. Picone (1) suggests that while a range of factors such as previous nursing shortages, effects of underfunding of award variations, inadequate provision for inflation and repeated rounds of productivity cuts have all contributed to the changes, the main issue of the profession has been its limited ability to model these variations because of crude descriptions of workloads and outputs. 19.