Patient mortality and the neglect of vital signs' assessment: An audit of a national coronial database.

BACKGROUND: Vital signs assessment is critical for patient surveillance and safety. Research has found, however, that this assessment is often neglected in clinical practice. The reasons for this are unclear as few studies have explored this issue. Those studies that have are small, single site studies and found that culture and poor understanding are contributing factors. AIM: The aim was to explore the link between the clinical neglect of vital signs assessment and patient mortality and provide a better understanding of factors influencing vital signs assessment in the context of acute patient care. Coroners' reports represent an untapped source of information regarding shortfalls in vital signs assessment. Using a framework analysis, an audit was conducted of the Australian National Coronial Information System for cases where vital signs' assessment was mentioned in coronial reports. RESULTS: Fifty-eight cases met the eligibility criteria, with deceased patients aged from 7 days to 93 years. Key themes related to absence of reassessment of vital signs, inappropriate delegation, passing responsibility to another staff member and not following policy. CONCLUSIONS: The findings reflect a combination of individual and institutional failings and suggest that vital signs assessment was not considered a priority aspect of care. RELEVANCE TO CLINICAL PRACTICE: Vital signs assessment must be considered an essential aspect of clinical care in all patients. This important aspect of care should be emphasized across all domains of patient care.

Effectiveness of an educational intervention on first-year nursing students' knowledge and confidence to perform basic life support: a quasi-experimental study.

BACKGROUND: Knowing how to respond effectively to an acutely deteriorating patient is a National Safety and Quality Health Service Standard and a requirement for nurse registration with the Australian Health Practitioner Regulatory Authority. Literature has highlighted that a lack of knowledge, skills and confidence in healthcare professionals to perform basic life support may be a contributing factor to the high mortality and morbidity rates associated with cardiac arrest in the hospital setting. AIM: To explore first-year nursing students' knowledge and confidence to perform basic life support according to the Australian Resuscitation Council guidelines before and after watching an online video lecture. METHOD: A quantitative quasi-experimental pre- and post-test design to measure changes, if any, in first-year nursing students' knowledge and confidence to perform basic life support at an Australian university in 2021. FINDINGS: The collected data were analysed using Stata, a statistical software for data sciences. Participants' mean knowledge score increased from 9.3 (SD: 2.5) in the pre-test to 13.9 (SD: 3) (p < 0.001) in the post-test (maximum possible score: 19). Participants' mean confidence score increased from 17.0 (SD: 6.3) in the pre-test to 24.5 (SD: 4.4) (p < 0.001) in the post-test (maximum possible score: 30; p < 0.001). DISCUSSION: The most significant improvement in knowledge was observed in chest compression rate, breathing/ ventilation and checking patient response. The study found that the video lecture is an effective teaching method to increase students' confidence to perform basic life support. CONCLUSION: An online video-recorded lecture can increase undergraduate student nurses' knowledge and confidence to perform basic life support. This is one educational strategy that universities can use to improve students' knowledge and confidence to perform this essential skill for practice.

The clinical neglect of vital signs' assessment: an emerging patient safety issue?

Objectives: Vital signs assessment is a critical component of acute clinical care. Despite this, research has consistently found that the assessment of these signs is often neglected in clinical practice. This paper highlights three recent cases reported in the media where the neglect of vital signs assessment resulted in patient mortality.Results: Recent media reports highlighted the potentially devastating consequences of vital signs not being rigorously assessed, including avoidable death. The public needs to be confident they will receive safe, quality health care when they are admitted to hospital.Conclusion: The neglect of vital signs assessment places patients at risk of poor outcomes. Early detection of clinical deterioration via the assessment of vital signs facilitates prompt medical intervention. Factors contributing to the neglect of vital signs assessment need to be identified and corrective action is taken to improve the safety of clinical care.

The global elements of vital signs' assessment: a guide for clinical practice.

The assessment of vital signs is critical for safe, high-quality care. Vital signs' data provide valuable insight into the patient's condition, including how they are responding to medical treatment and, importantly, whether the patient is deteriorating. Although abnormal vital signs have been associated with poor clinical outcomes, research has consistently found that vital signs' assessment is often neglected in clinical practice. Factors contributing to this include nurses' knowledge, clinical judgement, culture, tradition and workloads. To emphasise the importance of vital signs' assessment, global elements of vital signs' assessment are proposed. The elements reflect key principles underpinning vital signs' assessment and are informed by evidence-based literature.

Early identification of patients with severe COVID-19 at increased risk of in-hospital death: a multicenter case-control study in Wuhan.

BACKGROUND: Most evidence regarding the risk factors for early in-hospital mortality in patients with severe COVID-19 focused on laboratory data at the time of hospital admission without adequate adjustment for confounding variables. A multicenter, age-matched, case-control study was therefore designed to explore the dynamic changes in laboratory parameters during the first 10 days after admission and identify early risk indicators for in-hospital mortality in this patient cohort. METHODS: Demographics and clinical data were extracted from the medical records of 93 pairs of patients who had been admitted to hospital with severe COVID-19. These patients had either been discharged or were deceased by March 3, 2020. Data from days 1, 4, 7, and 10 of hospital admission were compared between survivors and non-survivors. Univariate and multivariate conditional logistic regression analyses were employed to identify early risk indicators of in-hospital death in this cohort. RESULTS: On admission, in-hospital mortality was associated with five risk indicators (ORs in descending order): aspartate aminotransferase (AST, >32 U/L) 43.20 (95% CI: 2.63, 710.04); C-reactive protein (CRP) greater than 100 mg/L 13.61 (1.78, 103.941); lymphocyte count lower than 0.6×109/L 9.95 (1.30, 76.42); oxygen index (OI) less than 200 8.23 (1.04, 65.15); and D-dimer over 1 mg/L 8.16 (1.23, 54.34). Sharp increases in D-dimer at day 4, accompanied by decreasing lymphocyte counts, deteriorating OI, and persistent remarkably high CRP concentration were observed among non-survivors during the early stages of hospital admission. CONCLUSIONS: The potential risk factors of high D-dimer, CRP, AST, low lymphocyte count and OI could help clinicians identify patients at high risk of death early in the hospital admission. This might assist with rationalization of health care resources.

Mechanism of IL-6-related spontaneous atrial fibrillation after coronary artery grafting surgery: IL-6 knockout mouse study and human observation.

Clinical observation and ex vivo studies have established a strong association between inflammation and postoperative atrial fibrillation (POAF). However, it is unclear whether the inflammatory phenotype is causally linked to this event or is an epiphenomenon, and it is not known which inflammatory meditators may increase susceptibility to POAF. The limitations of available animal models of spontaneous POAF (sPOAF) makes it difficult to select an experimental system. Here, we provide experimental and clinical evidence for mechanistic involvement of interleukin-6 (IL-6) in sPOAF. PHASE I: We established a mouse model of cardiac surgery with nonpaced sPOAF. IL-6 knockout mice were protected from sPOAF compared with wild-type mice. PHASE II: At 48 hours after surgery, the heart was separated into 6 regions and cultured. IL-6 was expressed in all regions, with highest abundance in the left atrium (LA). In PHASE III, we demonstrated that IL-6 in the LA elicited early profibrotic properties in atria via the pSTAT3/STAT3 signaling pathway and contributed to sPOAF. PHASE IV: In a translational prospective clinical study, we demonstrated that humans with POAF had a higher IL-6 concentration in pericardial drainage (PD). This study provides preliminary evidence of a causal relationship between IL-6 and POAF in a novel nonpaced sPOAF mouse model. IL-6 is a crucial prerequisite for eliciting profibrotic properties in cardiac myocytes via the pSTAT3 pathway during the early postoperative period, leading to an increased susceptibility to POAF. Measuring IL-6 in PD could be a new noninvasive biomarker for the clinical prediction of POAF.

Do nursing textbooks accurately describe pulse oximetry? An audit of current literature.

BACKGROUND: The assessment of a patient's vital signs is a critical nursing task. Despite this, research has found that many nurses have a poor understanding of pulse oximetry. AIM: As undergraduate students rely heavily on textbooks as an educational resource, an audit was conducted of nursing texts to determine the quality of pulse oximetry descriptions. METHOD: The audit was guided by questions based on the findings of research examining nurses' understanding of pulse oximetry. Two researchers used these questions to appraise textbook content. FINDINGS: A convenience sample of 32 contemporary nursing textbooks was appraised. Text descriptions of pulse oximetry varied from brief to more extensive, with the content ranging from superficial to detailed. CONCLUSION: Superficial, inconsistent or misleading information within basic nursing textbooks may be one factor associated with nurses' knowledge deficits about pulse oximetry. Academics and nurse educators should appraise core content of textbooks carefully before recommending textbooks to nursing students.

Pulse oximetry and the enduring neglect of respiratory rate assessment: a commentary on patient surveillance.

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.

A Modified Supine Position Facilitates Bladder Function in Patients Undergoing Percutaneous Coronary Intervention: A Randomized Controlled Clinical Trial.

BACKGROUND: Percutaneous coronary intervention (PCI) is currently the most common intervention for cardiovascular disease. Standard care after PCI typically involves a period of bed rest in the supine position, but this position creates voiding difficulties. OBJECTIVE: This study aimed to determine whether a modified supine position could facilitate bladder emptying after PCI. METHOD: A randomized controlled trial involving 300 patients was conducted. Patients in the intervention group were nursed in the supine position with the bed tilted 20° upright and with a pillow between their feet and the end of the bed. Patients in the control group received standard care, which was supine positioning. RESULTS: One hundred fifty patients were allocated to the intervention group (100 men, 50 women), and 150 were allocated to the control group (103 men, 47 women). Baseline data did not differ between the 2 groups. Patients in the intervention group had significantly better bladder function as evidenced by a shorter time to the first void (5 vs 15 minutes) and fewer patients requiring voiding assistance (8.6% vs 35.3%). Residual urinary volumes were also much lower in the intervention group (88.71 vs 248.22 mL, P < .001). CONCLUSIONS: This study demonstrates that a modified supine position can reduce the incidence of impaired micturition and the preservation of normal bladder function after PCI.

The effects of a catheter clamping protocol on bladder function in neurosurgical patients: a controlled trial.

There is scant evidence-based literature on the best strategies for short-term urinary catheter removal. This clinical trial explored the effects of an early urinary catheter clamping protocol on bladder function in neurosurgical patients. Eligible patients were divided into observation and control groups. Those in the observation group had their catheter clamped postoperatively on return to the ward and unclamped at dedicated intervals. The control group received standard care; the catheter was on free drainage during the entire time in situ. The mean catheter indwelling time was 2.6 days. Compared with the control group, the observation group experienced shorter time to first postoperative urination, less residual urine volume and better subjective perception during their first postoperative urination. For patients undergoing neurosurgery and associated short-term indwelling urinary catheterization, an early catheter clamping protocol is effective in facilitating bladder function, reducing the rate of dysuria and making patients feel more comfortable after catheter removal.

Factors associated with post-intensive care unit adverse events: a clinical validation study.

BACKGROUND: Many patients discharged from intensive care units (ICU) have complex care needs, placing them at risk of an adverse event in a ward environment. Currently, there is limited understanding of factors associated with these events in the post-intensive care population. A recent study explored intensive care liaison nurses' opinions on factors associated with these events; 25 factors were identified, highlighting the multifaceted nature of post-intensive care adverse events. AIM: This study aimed to clinically validate 25 factors intensive care liaison nurses believe are associated with post-intensive care adverse events, to determine the factors' relevance and importance to clinical practice. DESIGN: Prospective, clinical validation study. METHOD: Data were prospectively collected on a convenience sample of 52 patients at 4 tertiary referral hospitals in an Australian capital city. All patients had experienced an adverse event after intensive care discharge. RESULTS: Each of the 25 factors contributed to adverse events in at least 6 patients. The factors associated with the most adverse events were those that related to the patient such as illness severity and co-morbidities. CONCLUSION: Clinical care and research should focus on modifiable factors in care processes to reduce the risk of future adverse events in post-intensive care patients. RELEVANCE TO CLINICAL PRACTICE: Many patients are at risk of post-ICU adverse events due to the contribution of non-modifiable factors. However, by focusing on modifiable factors in care processes, the risk of post-ICU adverse events may be reduced.

Intensive care readmission: a contemporary review of the literature.

ICU readmissions are a commonly used quality measure but despite decades of research, these adverse events continue to occur. Of particular concern is that readmitted patients have much worse prognoses than those not readmitted. In recent years new clinical service roles have evolved to assist ward staff with the care of acutely ill patients, such as those discharged from ICU. Given the recent emergence of these service roles, a review of contemporary ICU readmission studies was warranted to determine their impact on this adverse event. Reviewed studies indicated the incidence of readmissions and outcomes of these patients have changed little in recent years. Few studies mentioned whether clinical service roles existed to support ward staff caring for patients recently discharged from ICU. Future research needs to focus on identifying modifiable factors in care processes to reduce the incidence and outcomes of this adverse event and to determine how clinical service roles can best help prevent its occurrence.

Examining adverse events after intensive care unit discharge: outcomes from a pilot questionnaire.

Adverse events are common in acute clinical settings but little is known about these events occurring after Intensive Care discharge. This study aimed to develop a reliable and valid tool for exploring clinicians' opinions of factors associated with post-Intensive Care adverse events. A convenience sample of Australian Intensive Care Liaison Nurses was invited to complete and appraise a questionnaire using structured guidelines. Content validity and internal consistency were assessed. Twelve Intensive Care Liaison Nurses completed the questionnaire. Cronbach?s alpha coefficient showed high internal consistency for the questionnaire; all 24 items on the questionnaire had coefficients greater than 0.852. The content validity index of the questionnaire overall was 0.76. The post-Intensive Care adverse events questionnaire demonstrated reliability and validity. It is a tool that can be used to explore clinicians? opinions of factors associated with these events. The tool is important as it facilitates further insight into the causes of post-Intensive Care adverse events.

A core competency model for Chinese baccalaureate nursing graduates: a descriptive correlational study in Beijing.

BACKGROUND: A review of the literature showed that the core competencies needed by newly graduated Chinese nurses were not as of yet undocumented. OBJECTIVE: To develop a psychometrically sound instrument for identifying and measuring the core competencies needed by Chinese nursing baccalaureate graduates. DESIGN: Descriptive correlational and multicentre study. SETTING: Seven major tertiary teaching hospitals and three major medical universities in Beijing. PARTICIPANTS: 790 subjects, including patients, nursing faculty members, doctors and nurses. METHOD: A reliable and valid self-report instrument, consisting of 58 items, was developed using multiple methods. It was then distributed to 790 subjects to measure nursing competency in a broader Chinese context. The psychometric characteristics of reliability and validity were supported by descriptive and inferential analyses. RESULTS: The final instrument consists of six dimensions with 47 items. The content validity index was 0.90. The overall scale reliability was 0.97 with dimensions range from 0.87 to 0.94. Six domains of core competencies were identified: professionalism; direct care; support and communication; application of professional knowledge; personal traits; and critical thinking and innovation. CONCLUSION: The findings of this study provide valuable evidence for a psychometrically sound measurement tool, as well as for competency-based nursing curriculum reform.

Factors contributing to adverse events after ICU discharge: a survey of liaison nurses.

BACKGROUND: A significant number of patients experience an adverse event when discharged from intensive care to a ward. More than half of these events may be preventable with better standards of care. AIM: To explore the opinions of an expert group of clinicians around factors contributing to adverse events in patients discharged from ICU. METHOD: Online survey of Australian ICU Liaison Nurses (n=39) using a validated questionnaire of 25 items. RESULTS: The response rate was 92.8%. Key contributing factors included a lack of experienced ward staff, patient co-morbidities and the clinically challenging nature of many patients. CONCLUSION: Modifying processes of care may decrease the risk or impact of adverse events in this high risk patient population.

Critical care: the eight vital signs of patient monitoring.

Nurses have traditionally relied on five vital signs to assess their patients: temperature, pulse, blood pressure, respiratory rate and oxygen saturation. However, as patients hospitalised today are sicker than in the past, these vital signs may not be adequate to identify those who are clinically deteriorating. This paper describes clinical issues to consider when measuring vital signs as well as proposing additional assessments of pain, level of consciousness and urine output, as part of routine patient assessment.

Reason's accident causation model: application to adverse events in acute care.

Adverse events are unintended harm to a patient caused by the health care provided; more than half of all these events have been deemed avoidable. Adverse events are a common problem in acute care and represent a breach in care quality and safety. They are generally not caused by a single mistake or error and although safety barriers exist in health care, patients today are still harmed. Using an accident causation model is a constructive way of identifying the underlying causes of adverse events and to strengthen a study's theoretical underpinnings. Reason's model is recommended as a useful framework for adverse event analysis as it promotes a focus on the conditions or situation in which the clinician was trying to perform, rather than apportioning blame.

Regeneration of Transgenic Rice with Bacterial ipt Gene Driven by Senescence Specific (SAG12) Promoter by Particle Bombardment.

Transgenic rice plants were generated using particle bombardment to introduce the Agrobacterium cytokinin biosynthesis gene driven by Arabidopsis (Arabidopsis thaliana) senescence specific promoter (SAG12) for delaying leaf senescence. Using two plasmids we co-transformed one week old embryogenic calli derived from mature Japonica rice (Oryza sativa) variety Chin Guang. The selectable marker hygromycin phosphotransferase (hph) gene and the reporter gene B-ß-glucuronidase (uidA), both under the control of cauliflower mosaic virus (CaMV) 35S promoter were placed on the same co-integrate vector whereas the cytokinin biosynthesis gene, isopentenyl transferase (ipt) driven by the SAG12 promoter is supplied in another plasmid. A total of 32 transgenic rice plants were regenerated of which 27 plants were randomly selected for histochemical ß-glucuronidase (GUS) assay, PCR and Southern blot analysis. Co-integration frequencies of 88% and 69% were obtained for two linked genes (uidA and hph) and two unlinked genes (hph and ipt gene) respectively in R0 plants. Southern blot analysis confirmed the results of histochemical GUS assay and PCR amplifications. A complex integration pattern for all the transgenes including the multiple copies integration was predominantly observed.