The Essential Steps of Medication Administration Practices Project medication administration improvement practices among acute inpatients in a tertiary hospital: a best practice implementation project.

OBJECTIVES: The current project aimed to conduct an audit of nursing medication administration practices, to implement evidence-based best practice recommendations and assess the effectiveness of these changes in maximizing medication administration safety and reducing the risks of adverse incidents across 10 wards/units in a large tertiary hospital. INTRODUCTION: Medications are the most common treatment used in healthcare. Because they are so commonly used, medications are associated with a higher incidence of errors and adverse events than other healthcare interventions. Nurses are primarily involved in the administration of medications to patients and this duty is an important aspect of professional practice. The Australian Commission on Safety and Quality in Healthcare has recognized medication safety as a National Standard, thus reinforcing its importance. METHODS: The project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 200 observations of medication administration was conducted and measured against eight best practice recommendations, followed by the implementation of targeted strategies and follow-up audits. RESULTS: The baseline audit revealed deficits between current practice and best practice in three of the eight criteria. Identification of barriers for implementation of medication administration best practice criteria were made by the project team and reflective practice and ward/unit led strategies were implemented. There were improved or sustained outcomes across all best practice criteria in the follow-up audits. CONCLUSION: The findings showed how audit may be used to promote best practice in healthcare and that reflective practice and front-line led strategies can have a positive impact on clinical practice. Some of the measured criteria did not reach 100%, leaving room for improvement; however, by the end of the project attitudes towards medication administration had been 'transformed' from a passive, routine 'must do' task, to an active process with a focus on safety and patient/carer engagement. Future audits are planned to ensure sustainability.

Nursing clinical handover improvement practices among acute inpatients in a tertiary hospital in Sydney: a best practice implementation project.

BACKGROUND: The nursing handover normally occurs at the beginning of a nurse's shift and is considered essential for continuity of care. Nursing handovers have the potential to communicate accurate information about a patient's condition, treatment and anticipated needs but also to be ineffective or even harmful if information is incomplete or omitted. The Australian Commission on Safety and Quality in Health Care has recognized clinical handover as a National Standard, thus reinforcing its importance. OBJECTIVES: This project aimed to conduct an audit of nursing clinical handover practices to implement evidence-based best practice recommendations to assess the effectiveness of these strategies to maximize the effectiveness of clinical handover across 11 units in a large tertiary hospital. METHODS: The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 330 observations of nursing clinical handover was conducted and measured against seven best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit. RESULTS: The baseline audit revealed significant deficits between current practice and best practice in all but one criterion. Barriers for implementation of nursing clinical handover best practice criteria were identified by the project team, and a bundled education strategy was implemented. There were significantly improved outcomes across all best practice criteria in the follow-up audit. CONCLUSIONS: The findings showed how audits may be used to promote best practice in healthcare and that focused education and provision of relevant resources can have an immediate and positive impact on clinical practice. Some of the measured criteria improved to a moderate degree, leaving room for improvement; however, by the end of the project attitudes toward nursing clinical handover had been "transformed" from a passive routine "must do" task to an active process with a focus on safety and patient/carer engagement. Future audits are planned to ensure sustainability.

Implementing a Primary Healthcare Framework: The Importance of Nursing Leadership in Developing and Maintaining a Brain Tumor Support Group.

BACKGROUND: Although brain tumor support groups have been available internationally for many years, Liverpool Hospital in Australia has not traditionally provided this service. As a leadership initiative, the development of a brain tumor support group that incorporates a primary healthcare framework is a sustainable approach that showcases the role of nursing leaders in changing attitudes and improving outcomes. OBJECTIVES: The purpose of this review of the literature and reflection of clinical experience is to explore nursing leadership within brain tumor-specific support groups. METHODS: This article will showcase a nurse-led group that incorporated a coordinated approach to delivering patient-centered care. FINDINGS: The initiation of activities and interventions that reflected the five tenets of primary health care resulted in improved outcomes for individuals and their family caregivers throughout the trajectory of their illness. Vital to the success of this project was moving from a standalone leader to building collective and collaborative leadership more conducive to facilitating change. The support group successfully demonstrated that individuals and family caregivers may see ongoing and long-term improvements during and following treatment.

Frequency, clinical correlates, and ratings of behavioral changes in primary brain tumor patients: a preliminary investigation.

PURPOSE: Few studies have addressed the specific behavioral changes associated with primary brain tumor (PBT). This paper will report on the frequency and demographic/clinical correlates of such behaviors, and the reliability of rating such behaviors among people with PBT, family informants, and clinicians. The association of behavioral changes and patient functional status will also be discussed. METHODS: A total of 57 patients with 37 family informants were recruited from two large Australian metropolitan hospitals. Each completed three neuro-behavioral self-report measures; the Emotional and Social Dysfunction Questionnaire, the Frontal Systems Behavior Scale, and the Overt Behavior Scale. Patients also completed a depression symptom measure. Functional status was defined by clinician-rated Karnofsky performance status. RESULTS: Patients were on average 52 years old, a median of 4 months (range 1-82) post-diagnosis, with high grade (39%), low grade (22%), or benign tumors (39%). Patients reported frequency rates of 7-40% across various behavioral domains including anger, inappropriate behavior, apathy, inertia, and executive impairment. The presence of epileptic seizures was associated with significantly higher levels of behavioral changes. Notably, behavior did not correlate with tumor grade or treatment modality. There was moderate agreement between patients and relatives on the presence or absence of behavioral changes, and substantial agreement between relative and clinician ratings. Depressed patients did not generally report more changes than non-depressed patients. Increases in the relative and clinician-rated behavior scores were significantly correlated with decreasing functional status in the patient. CONCLUSION: Behavioral changes were a common sequela of both benign and malignant PBT. Larger scale studies are required to confirm these results. The results suggest the importance of including behavior in brain cancer psychosocial assessments and the need to develop interventions to treat these patients and reduce the burden of care on families.

Development and evaluation of information resources for patients, families, and healthcare providers addressing behavioral and cognitive sequelae among adults with a primary brain tumor.

Behavioral and cognitive changes in patients with primary brain tumor (PBT) are common and may be distressing to patients and their family members. Healthcare professionals report a strong need for information, practical strategies, and training to assist consumers and better address management issues. A literature review by the current project found that 53% of the information resources currently available to consumers and health professionals contained minimal or no information about cognitive/behavioral changes after PBT, and 71% of the resources contained minimal or no information on associated strategies to manage these changes. This project aimed to develop an information resource for patients, carers, and health professionals addressing the behavioral and cognitive sequelae of PBT, including strategies to minimize the disabling impact of such behaviors. In consultation with staff and patient groups, 16 key information topics were identified covering cognitive and communication changes and challenging behaviors including executive impairment, behavioral disturbance, and social/emotional dysfunction. Sixteen fact sheets and 11 additional resource sheets were developed and evaluated according to established consumer communication guidelines. Preliminary data show that these resources have been positively received and well utilized. These sheets are the first of their kind addressing challenging behaviors in the neuro-oncology patient group and are a practical and useful information resource for health professionals working with these patients and their families. The new resource assists in reinforcing interventions provided to individual patients and their relatives who are experiencing difficulties in managing challenging behaviors after PBT.

Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

OBJECT: Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. METHODS: Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay. RESULTS: Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively. CONCLUSIONS: Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.