A completed audit to reduce hospital outpatients non-attendance rates.
An audit loop for patients failing to attend a paediatric outpatient department was completed by repeating the analysis three years after interventions were put into place. The 1995 study had shown non-attendance for clinic visits was 34%, varying from 32.5% for Europeans and 50% for Asian patients. A follow up study in 1998 showed a fall to 12.04% and 13.5%, respectively, with an overall rate of 12.3%. The Manor Hospital NHS Trust had the lowest non-attendance rate of the 30 hospitals in the West Midlands region for the year 1996-7. (+info)
Accident and emergency services for children within Trent region.
OBJECTIVES: To investigate the provision of accident and emergency (A&E) services for children within Trent region, and to compare these with published recommendations. METHODS: A postal questionnaire was sent to all A&E and minor injury units within Trent region providing services for children. Findings were compared with published recommendations including those of the Multidisciplinary Working Party into Accident and Emergency Services for Children. RESULTS: Thirty six units provided A&E services for children within Trent: 17 mixed units, 17 minor injury units and two children's units. Within mixed A&E units complete audio-visual separation from adult patients was provided by six units (35%), inpatient paediatric facilities were available at 11 units (65%) and a minimum of one registered children's nurse was always on duty in three units (18%). CONCLUSIONS: Few A&E units within Trent region currently meet the recommendations of the Multidisciplinary Working Party. The most common shortfall identified was in the provision of registered children's nurses. (+info)
Effect of an IMCI intervention on quality of care across four districts in Cape Town, South Africa.
AIMS: To measure the change in quality of care provided to sick children as a result of the routine implementation of the IMCI intervention. METHODS: Structured observations of consultations with sick children, exit interviews with caregivers, and facility reviews were conducted both before and after IMCI intervention in four health districts in Cape Town. Interventions were case management training, orientation courses for supervisors and medical officers, and some reorganisation of management systems. RESULTS: Twenty one nurses in 21 clinics were observed before and after the IMCI intervention; 90 and 70 child observations were conducted before and after IMCI intervention respectively. There was a marked improvement in assessment of danger signs in sick children (7% before versus 72% after), assessment of co-morbidity (integrated score 5.2 versus 8.2), rational prescribing (62% versus 84%), and starting treatment in the clinic (40% versus 70%). However there was no change in the treatment of anaemia or the prescribing of vitamin A or counselling of caregivers. There was no change in the knowledge of caregivers regarding medication or when to return to the health facility. Facilities were well stocked and supervision regular both before and after IMCI. CONCLUSION: This study has shown that under normal operating conditions and in a context of good facility infrastructure and management support, IMCI is associated with improvements in some important aspects of care. (+info)
Pressure ulcers in children are presumed to be relatively uncommon and have not been well studied. To better understand the occurrence of pressure ulcers in the pediatric population, two wound ostomy continence certified nurses at the University of Virginia Children's Hospital conducted prevalence studies in June 2003 and in June 2004. All five pediatric units (the neonatal intensive care unit, the pediatric intensive care unit, two general acute care units, and the rehabilitation unit) were included in the study. Each hospitalized child present on the unit at the time of the study participated and was examined. The data were tabulated and analyzed using descriptive statistics. In June 2003, two of 77 patients (3%) and a year later three of 79 patients (4%) had a pressure ulcer. These results are comparable to recent multisite study prevalence figures. Priority outcomes of the prevalence studies include implementation of a pediatric pressure ulcer risk assessment tool, education of healthcare professionals, and continuous pressure ulcer prevalence monitoring. (+info)
Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study.
PURPOSE: To compare the performance of nurse screeners with that of lay screeners in administering preschool vision screening tests. METHODS: Trained nurse and lay screeners administered the Retinomax Autorefractor (Right Manufacturing, Virginia Beach, VA), SureSight Vision Screener (Welch Allyn, Inc., Skaneateles Falls, NY), crowded Linear Lea Symbols visual acuity (VA) test at 10 ft (Precision Vision, Inc., La Salle, IL), and Stereo Smile II test (Stereo Optical, Inc., Chicago, IL) to 3- to 5-year-old Head Start participants. Lay screeners also administered a crowded Single Lea Symbols VA test at 5 ft (Good-Lite, Inc.). Screening results were compared with the classification of the children according to the presence of one or more of four conditions (amblyopia, strabismus, significant refractive error, and unexplained reduced VA) based on the results of a gold standard eye examination by study-certified optometrists and ophthalmologists. The primary outcome measure was sensitivity for detecting children with one or more targeted conditions at 0.90 specificity. RESULTS: Nurse screeners achieved slightly higher sensitivities with the Retinomax, SureSight, and Stereo Smile II tests than did lay screeners; however, most differences were small and not statistically significant. Nurse screeners achieved significantly higher sensitivity with the Linear Lea Symbols VA test than did lay screeners. Lay screeners achieved strikingly higher sensitivity with the Single Lea Symbols VA test than did nurse or lay screeners using the Linear Lea Symbols VA test. Combining the Stereo Smile II test with each of the other tests did not result in improved sensitivities for detecting one or more targeted conditions. CONCLUSIONS: Nurse and lay screeners can achieve similar sensitivity, when specificity is set at 0.90, for detecting preschool children in need of a comprehensive eye examination. (+info)
Drug administration errors and their determinants in pediatric in-patients.
OBJECTIVE: . To quantify the type and frequency of drug administration errors to pediatric in-patients and to identify associated factors. DESIGN: Prospective direct-observation study of drug administration errors from April 2002 to March 2003. SETTING: Four clinical units in a pediatric teaching hospital. STUDY PARTICIPANTS: Twelve observers accompanied nurses giving medications and witnessed the preparation and administration of all drugs to all patients on all weekday mornings. INTERVENTION: None. MAIN OUTCOME MEASURE: Discrepancies between physicians' orders and actual drug administration. RESULTS: During the 1719 observed administrations to 336 patients by 485 nurses, 538 administration errors were detected, involving timing (36%), route (19%), dosage (15%), unordered drug (10%), or form (8% form). These errors occurred for 467 (27%) of the 1719 administrations. Intravenous drugs (OR = 0.28; CI = 0.16-0.49; versus miscellaneous) were associated with fewer errors. Error rates were higher for cardiovascular (OR = 3.38; CI = 1.24-9.27; versus miscellaneous) and central nervous system drugs (OR = 2.65; CI = 1.06-6.59; versus miscellaneous); unspecified dispensing system (OR = 2.06; CI = 1.29-3.29; versus store in the unit); non-intravenous non-oral administration (OR = 4.44; CI = 1.81-10.88; versus oral administration); preparation by the pharmacy (OR = 1.66; CI = 1.10-2.51); and administration by a hospital pool nurse, temporary staffing agency nurse, or nurse intern (OR = 1.67; CI = 1.04-2.68; versus registered full-time nurse). Each additional management procedure in the patient increased the risk of error (OR = 1.22; CI = 1.01-1.48). CONCLUSIONS: The risk factors identified in our study should prove useful for designing preventive strategies, thereby improving the quality of care. (+info)
How effectively can clinical examination pick up congenital heart disease at birth?
AIMS: To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians. METHODS: A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. RESULTS: 1.2% of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography) within a year of birth. The number not suspected before discharge declined over time, and only 6% were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8, but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2% requiring cardiac referral; 54% of these babies still had a murmur when assessed one to two weeks later, and 33% had a structural defect. Parents said in independent, retrospectively conducted, interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. CONCLUSIONS: Effective screening requires experience and a clear, structured, referral pathway, but can work much better than most previous reports suggest. Whether staff bring a medical or nursing background to the task may well be of less importance. (+info)
Mapping the literature of pediatric nursing.
BACKGROUND: Pediatric nurses work in an interdisciplinary field and face ever-increasing demands on their time and knowledge. Selection tools for librarians serving this group are available, but only one bibliometric analysis has examined citations to aid collection development. METHOD: The "Mapping the Literature of Nursing Project" protocol was used. Three source journals were selected, and a citation analysis of articles from 1998 to 2000 was conducted. RESULTS: The frequency of journal citation was tabulated, and a list of the most frequently cited journals was created. Just over 1% of the cited journals produced 33% of the citations. PubMed/MEDLINE, Science Citation Index, and Social Sciences Citation Index provided the most complete indexing coverage of all types of the journals, while CINAHL providing the most complete coverage of nursing journals. Books were the second-most frequently cited format. CONCLUSIONS: Citation analysis of journal articles from pediatric nursing journals may be helpful in selecting journals for libraries serving pediatric nurses and those who conduct pediatric nursing research. Librarians should consider adding indexes to their collection in addition to PubMed/MEDLINE to access the broad range of journals useful to this specialty. (+info)