Aim: To investigate the natural history of peripheral intravenous cannulas (PIVCs) in patients admitted to The Royal Children's Hospital (RCH). The essential role of PIVCs in the delivery of medications, hydration and blood products is well recognised. However, data relating to their lifespan in paediatrics is poorly described. Establishing baseline characteristics of prevalence, clinical characteristics and removal circumstances may identify strategies to improve clinical management of PIVCs in children. Methods: This prospective observational audit collected predetermined data relating to PIVCs in patients admitted to RCH across five consecutive days. A customised data collection tool was used to record data on each cannula. Data was obtained from daily physical and visual observations, patient charts, medication records and nursing staff. A three-day pilot study tested the interrater reliability of the collection tool, auditor documentation, study protocols and procedures to achieve acceptable consistency (>=80%). Auditors received clinical education on vascular anatomy related to PIVC siting, securement methods and components. Results: Day 1 of the audit identified 56 PIVCs across six wards at RCH. Twenty-four removals were documented on day 2 (42%); 19 on day 3 (33%); 8 removals on day 4 (14%) and 4 removals on day 5 (7%). The dorsal aspect of the hand was the most prevalent PIVC site (62.5%), followed by forearm (16%) and cubital fossa (16%). The primary method of cannulation utilised a 22 gauge cannula (66%), delivered via the dorsal venous network (60%), with no splinting present (64%). Typical securement methods included Tegaderm IV Tubifast,Leukoplast Elastic, Hypafix, Elastolite bandage and white standard tape. The study documented 18 unplanned removals (32%) over the five audit days. Conclusion: This study details the natural history of PIVCs in a tertiary paediatric hospital setting not previously described. The key finding demonstrates that unplanned PIVC removal is a frequent event within a tertiary paediatric setting. Implications for clinical practice This audit has identified areas where further research should be conducted to improve clinical outcomes related to PIVCs in paediatric populations.
Many children taking warfarin perform their international normalized ratio (INR) at home, with results phoned to a clinician who instructs warfarin dosing. Data suggest that parents can be supported to make warfarin dosing decisions themselves, a process known as patient self-management (PSM).This study aimed to determine the suitability and acceptability of warfarin PSM in children using the Epic Patient Portal.Children currently performing INR patient self-testing were eligible. Participation involved an individualized education session, adherence to the PSM program, and participation in phone interviews. Clinical outcomes (INR time in therapeutic range and safety outcomes), patient portal functionality, and family experience were assessed. The hospital human research ethics committee approved the study and consent was obtained from parents/guardians.Twenty-four families undertook PSM. The median age of children was 11 years and all children had congenital heart disease. A median of 13 INRs was uploaded to the portal per family (range, 8-47) across a 10-month period. Before PSM, the mean time the INR was in therapeutic range was 71%; this increased to 79.9% during PSM (difference: P < .001). No adverse events were encountered. Eight families participated in a phone interview. The major theme identified was empowerment; minor themes that emerged included "gaining knowledge," "trust and responsibility builds confidence," "saving time," and "resources as a safety net."This study demonstrates that communication via the Epic Patient Portal is satisfactory to families and offers a suitable option for PSM for children. Importantly, PSM empowers and builds confidence in families to facilitate management of their child's health.
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Abstract Background Clinical aggression episodes, that is aggression and externalising behaviours that create risk, in acute care hospitals are increasing. Acute care staff are often not confident or trained in the management of aggression. Various aggression management training formats have been described in practice including face to face training, written learning resources, web- and media-based training resources, and simulation training. The aim of this systematic review is to assess whether simulation-based training is effective in increasing de-escalation knowledge, skills, and behaviour of staff working in the acute care setting. Methods We designed and registered a study protocol for a systematic review of studies evaluating simulation-based training for the management of patients with aggression. We will include randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies including health care professionals and trainees in acute health care settings. Comprehensive searches will be conducted in the following databases (from January 1980 onwards): PubMed, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library. The reference lists of selected studies, trial registers, and leading journals will also be searched. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential discrepancies will be resolved through discussion. The primary outcomes will include patient outcomes (e.g. frequency of clinical aggression), quality of care (e.g. frequency of emergency situations, physical/chemical/mechanical restraint), and adverse effects (e.g. patient/family complaints, patient harms, staff harms). Secondary outcomes will include workplace resource use, health care provider-related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. The study methodological risk of bias will be appraised using appropriate tools. A narrative synthesis will be performed for included studies. If feasible, we will conduct random-effects meta-analysis of data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. participant characteristics, interventions, and follow-up). Discussion This systematic review will identify, evaluate, and integrate the evidence on simulation-based training programmes for acute care health professionals on managing clinical aggression. The results of this study will inform the implementation of effective training strategies. Implications for future research will be discussed. Systematic review registration PROSPERO registration number CRD42020151002
Aim Sleep problems are common in school‐aged children with cerebral palsy (CP). Despite the significant impact of sleep disturbance and deprivation, there is a paucity of research in the area. The aims of this study were to (i) investigate the frequency of sleep problems in children with CP and their parents and (ii) understand what happens when parents ask for help with sleep problems from their health‐care professionals. Methods This was a prospective cohort study using an online survey sent to parents/primary care givers of children with CP aged 6–12 years recruited through the Victorian Cerebral Palsy Register. The following sleep assessment tools: The Children's Sleep Habits Questionnaire, the Pittsburgh Sleep Quality Index and the Gross Motor Function Classification System Parent Rating Tool were administered along with custom‐designed questions that were informed by a preceding qualitative scoping study. Results Complete data sets were received from 126 parents/care givers. Almost half (46%) of the parents reported their child had sleep problems. Of the 64 parents who reported seeking help for a child's sleep problem, only 21 indicated that their attempt was successful. If a child had poor sleep, the parent was more likely to have a sleep problem than parents who did not report poor child sleeping. Conclusion Sleep problems are common in children with CP and their parents. Parents do not always seek help, and those who do may not find an effective solution. Future research should explore how sleep problems can be effectively prioritised for children with CP and their parents/care givers.
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