Biomedical subjects

Margaret Fry

Publications and source records attributed to Margaret Fry.

6 recordsLinked to original sources

PubMed2006

Factors associated with delay to opiate analgesia in emergency departments.

UNLABELLED: Patients presenting to an emergency department (ED) with painful conditions continue to experience significant delay to analgesia. It remains unclear whether demographic and clinical factors are associated with this outcome. The objectives of this study were to determine 1) the proportion of patients that require parenteral opiate analgesia for pain in an ED and who receive the opiate in less than 60 minutes; and 2) whether any factors are predictive for the first dose of analgesia being delayed beyond 60 minutes. A retrospective cohort study with descriptive and comparative data analysis was conducted. Over a 3-month period, the medical record of every patient receiving parenteral opiates in a tertiary emergency department was reviewed and analyzed. Of 857 patients, 451 (52.6%) received analgesia in less then 60 minutes. Multiple demographic and clinical factors are associated with statistically significant delay to analgesia, including age, triage code, seniority of treating doctor, diagnosis, and disposition from the ED. PERSPECTIVE: A considerable proportion of patients suffer delay to analgesia. Identifiable factors associated with a delay to analgesia exist. There is potential for clinicians to develop strategies to address the population in emergency departments at risk for delay to analgesia.

Adolescent↗

PubMed2005

An educational framework for triage nursing based on gatekeeping, timekeeping and decision-making processes.

INTRODUCTION: The role of the triage nurse has emerged in response to growing community demand for a more accessible and efficient emergency department (ED) service. The focus of triage research has been on measuring outcomes and improving the delivery of emergency care. This has meant that the context of care, and triage processes and practices have remained concealed. Thus, little evidence about the role and ways to prepare nurses for this role is available. The aim of this study was to provide insight and understanding needed to educate and support the triage nursing role in Australian EDs. METHODS: A 12-month ethnographic study of triage nursing practice was conducted in Sydney metropolitan EDs. Data were then collected from participant observation in four EDs and interviews with 10 triage nurses. Analysis used standard content and thematic analysis techniques. FINDINGS: Findings reveal that notions of timeliness, efficiency and equity are embedded in a culture of ED care. This sustains a particular cadence of care to which triage nurses are culturally oriented. Triage nurses maintain, negotiate and restore this cadence of emergency care by using gatekeeping, timekeeping and decision-making processes. CONCLUSION: The comprehensive study of triage nursing has led to the development of an educational framework based on the processes of gatekeeping, timekeeping and decision-making.

Anthropology, Cultural↗

PubMed2005

A retrospective chart review of adult mortality characteristics of patients presenting to a principal tertiary emergency department.

AIM: To determine the incidence of death after arrival to one metropolitan emergency department (ED) for each triage code, day of arrival, diagnosis and length of stay. METHOD: A 12-month retrospective chart review was conducted in a 550 bed principal referral hospital of all patients that presented to the ED and subsequently died. The ED annual attendance rate for the study year was 46,017 patients. The data collected included patient demographics, diagnosis, triage code, length of stay and ward disposition. The data are expressed as proportions, percentages, frequencies or the statistic chi-square (chi(2)). The proportion of ED deaths also examined included those patients admitted through the ED to a ward area. RESULTS: The ED mortality rate for the study period was 1.3% (n=595). One hundred and twenty-three patients (21%) died in the unit, while 472 (79%) were admitted through the ED to a ward area. The total annual hospital mortality rate was 1.7% (n=790). The mean age of patients that died was 76 years. Of ED deaths, 329 (55%) were male and 266 (45%) female. Triage code 1 (60%) was allocated more commonly to patients that died in the ED compared with triage code 3 (46%) for ED-Ward deaths. CONCLUSIONS: Examination of ED mortality rate provides a deeper understanding of service utilisation and nursing staff work performance. Triage codes are beneficial in evaluating ED services, casemix, policies and quality assurance activities, but the application of this indicator to in-patient services appears limited.

Adult↗

PubMed2004

A prospective study of nurse initiated panadeine forte: expanding pain management in the ED.

INTRODUCTION: This study describes an innovative pain management strategy that aimed to improve the efficiency and effectiveness of timely analgesia for those patients in moderate pain and who experienced significant delay prior to medical assessment. METHOD: A 12-week prospective exploratory study was conducted to evaluate the introduction of a triage nurse initiated schedule 4 drug. A panadeine forte policy was developed and a data tool formulated to evaluate the effectiveness and frequency of nurse initiated panadeine forte. RESULTS: The average pre-pain score reported by patients was 68 mm and the median was 70 mm. The average post-pain score was 37 mm and the median was 35 mm. The average post-pain score reduced by 31 mm demonstrating a clinically significant change. A statistically significant (Wilcoxon signed rank test < 0.001) reduction in post-pain scores was also identified. CONCLUSION: We identified a statistically and clinically significant reduction in post-analgesic pain scores for patients. Improving pain management can have a positive impact on patients in moderate pain who experience extended waiting times prior to medical assessment.

Acetaminophen↗

PubMed2002

Nurse-initiated intravenous morphine in the emergency department: efficacy, rate of adverse events and impact on time to analgesia.

OBJECTIVES: The objectives of this study were: (i) to measure the analgesic efficacy and frequency of adverse events following autonomous nurse-initiated intravenous morphine in patients presenting with acute pain, awaiting medical assessment; and (ii) to determine whether such a process would improve the time to analgesia. METHODS: A prospective convenience sample of patients presenting in acute pain received titrated intravenous morphine by experienced emergency nurses. Pain scores on a 10.0 cm visual analogue scale and predetermined adverse events defined by physiological parameters were measured at regular intervals over the following 60 min. Demographic, diagnostic and waiting time data were also recorded. RESULTS: Three hundred and forty nine patients were enrolled over a 12-month period. The median initial pain score was 8.5 cm, with a reduction to 4.0 cm at 1 h. Respiratory rate, oxygen saturation, heart rate and blood pressure all showed small but statistically significant reductions over 60 min. There were 15 predefined adverse events, 10 episodes of hypotension and five episodes of oxygen desaturation. No intervention other than supplemental oxygen was required. There were no episodes of bradycardia, bradypnoea or reduced level of consciousness. The median time to narcotic was 18 min and the median time to be seen by a doctor was 52 min. CONCLUSION: Experienced emergency nurses can initiate effective intravenous narcotic analgesia for patients in acute pain awaiting medical assessment, with minimal change in physiological parameters. This process can improve the time to analgesia for patients in acute pain.

Emergency Service, Hospital↗

PubMedDate not supplied

Randomized, single blinded control trial comparing haemolysis rate between two cannula aspiration techniques.

OBJECTIVE: Blood aspiration through i.v. cannulae is a common ED sampling method. It is, however, associated with increased haemolysis rates when compared with direct venipuncture. Our ED utilizes two common methods of sampling through cannulae. The aim of the present study was to examine the haemolysis rates for these two techniques. METHODS: A randomized, single blinded prospective study was performed. From a convenience sample patients were randomized to either 'Method one' (blood taken directly from cannula hub) or 'Method two' (blood taken using an Interlink device through cannula cap). For each group patient demographics, clinical information and haemolysis were analysed. chi(2)-analysis and a multivariate logistic regression model were applied to determine significant relationships. RESULTS: A total of 1390 patients were enrolled, 694 had blood collected by 'Method one' and 696 by 'Method two', with haemolysis rates of 6.5% and 7.2%, respectively. Univariate analysis showed ease of aspiration to be the only variable to have a strong association with haemolysis (P < 0.0001). After allowing for ease of aspiration the technique used did not significantly affect haemolysis rate (P = 0.7). CONCLUSIONS: The rate of haemolysis is unrelated to the technique of blood aspiration. However, haemolysis rates increase significantly with perceived difficulty of blood draw.

Adolescent↗