Hospital Guidelines (hospital + guideline)

Distribution by Scientific Domains

Selected Abstracts

Using the worldwide web to improve children's pain care

E. Bruce msc, bschons
Aim:, This paper describes a three-year project, the aims of which were to disseminate information regarding the assessment and management of children's pain, to reach consensus on the essential elements of pain assessment for children and to track nurses' perceived changes in pain assessment and management practices in hospital settings over time. Background:, Despite the availability of research, guidelines and standards, paediatric nurses inconsistently practice evidence-based pain management. Project methods:, Nurses attending the 5th International Symposium on Paediatric Pain were invited to a workshop to discuss best practices and consider ways to share information regarding the assessment and management of children's pain. A website was designed and participants provided hospital guidelines, exchanged information via the Internet and completed periodic surveys. Conclusion:, Web-based resources were positively received. Consensus regarding the essential elements of pain management was achieved, but nurses identified organizational and resource restraints as barriers to achieving best practices. Surveys identified perceived increases in some hospital and ward level resources and activities to improve children's pain care. Sharing of information related to children's pain management and benchmarking of practice should be encouraged. Consensus building and networking may facilitate change, but organizational commitment is also required for successful implementation of new practices. [source]

Clinical guidelines and off-license recombinant activated factor VII: content, use, and association with patient outcomes

Summary.,Background: Recombinant activated factor VII (rFVIIa) is increasingly being used off-license for treating critical bleeding. Guidelines may therefore be useful for improving processes and outcomes. Little is known regarding guidelines for off-license rFVIIa or their association with patient outcomes. Objectives: To investigate the availability of hospital guidelines for off-license rFVIIa use and the association between these guidelines and mortality. Methods: Data were extracted from the Haemostasis Registry, which collects all cases of off-license rFVIIa use in participating institutions in Australia and New Zealand. Contributing hospitals were requested to supply a copy of the institutional guideline relating to off-license rFVIIa administration. The characteristics of patients treated in accordance with all elements of the guidelines were compared with those of patients for who one or more guideline elements had been violated. The relationship between guideline-directed treatment and 28-day mortality was investigated using stepwise logistic regression. Results: Two thousand five hundred and fifty-one patients in 75 hospitals were available for analysis. Of these hospitals, 58 provided a guideline for analysis. Patients complying with all guideline elements (n = 530) did not differ from patients receiving care that violated guidelines (n = 1035) regarding age, size of dose, or gender. Guideline-directed treatment was not found to have an association with 28-day mortality following logistic regression. Conclusions: Few patients are treated in accordance with the criteria of rFVIIa guidelines, despite their availability in the majority of hospitals. Moreover, 28-day mortality does not appear to be associated with the use of guidelines in this patient group. Refinement of guidelines relating to the off-license use of rFVIIa is therefore required. [source]

Safely treating hypokalaemia in high dependency cardiac surgical patients

Claire Sladdin
Abstract In Australia, there were national issues on the use of potassium ampoules (resulting in patient deaths), which led to the removal of the ampoules from clinical areas. A decision was made by the Medication Safety Committee at a metropolitan Melbourne hospital to remove potassium ampoules from ward areas as part of the establishment of a hospital-wide potassium guideline. As a result, the nurses in the cardiothoracic ward Practice Review Committee identified the need to review the proposed practice of treating hypokalaemia with 30 mmol of potassium chloride (KCL) in 1000 mL over an extended period in postoperative cardiothoracic patients. The challenge was to develop a practice to safely administer intravenous KCL in fluid restricted patients in addition to the hospital guidelines to prevent hypokalaemic-induced cardiac dysrhythmias. A literature search revealed there were no clear or uniform approaches to guide our practice in addressing this clinical problem. The Practice Review Committee developed a KCL administration guideline based on a review of the available literature. The Practice Review Committee developed a ward-based guideline that addressed infusion concentration, duration of administration, responsiveness of nurses to severity of hypokalaemia and the evaluation of treatment by measuring serum potassium after replacement. This ward-based guideline was based on benchmarking from similar institutions and relevant literature. The review process provided an opportunity for the staff to critique their practice to improve patient care and allowed regular evaluation of the implemented practice guideline. The ward-based guideline required a revision as patients' renal function was not being taken into consideration prior to potassium infusions being administered. The implementation of the ward-based guideline into practice has been well received by the staff as it has allowed consistent practice and timely treatment of hypokalaemia. [source]

Antibiotic prophylaxis in elective colorectal surgery

Yunus A. Gul
Background: Antibiotics are often administered in elective colorectal surgery to prevent wound infection. The tendency for surgeons to prolong the administration of prophylactic antibiotic therapy in the postoperative period is a well-known fact. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilization in elective colorectal surgery and to determine if evidence-based medicine is employed in relation to this practice. Methods: A cross-sectional study encompassing general surgeons performing elective colorectal surgery was performed. Questionnaires were distributed to 144 surgeons (national, academic and private health care). Questions pertaining to the type, timing and duration of antibiotic administration were asked. The prevalence of wound infection audit rate and whether or not there were specific guidelines related to antibiotic administration were also determined. Results: The response rate obtained was 67% (n = 96). Although evidence from the current medical literature and recommended national guidelines support the use of single-dose prophylactic antibiotics, 72% of the respondents used more than a single dose. Forty surgeons (42%) claimed that their prescribing practice was supported by the medical literature, 31 respondents (32%) based their practice on hospital guidelines and personal preference was cited as a reason by 21 surgeons (22%). The remaining four respondents (4%) used a similar scheduling policy to that practiced by their colleagues in relation to antibiotic administration. There was no significant difference in antibiotic dose scheduling between national, private and university academic institutions (P = 0.85). Conclusions: These results suggest that a significant proportion of surgeons administer excessive and unnecessary doses of antibiotics in elective colorectal surgery. Further studies are required to uncover the reasons but lack of appropriate guidelines and failure to exercise evidence-based medicine are major factors that account for this practice. [source]