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Differences in Documented and Actual Medication Administration Time in the Emergency Department: A Prospective, Observational, Time-Motion Study

Introduction: Retrospective studies suggest that a rapid initiation of treatment results in a better prognosis for patients in the emergency department. There could be a difference between the actual medication administration time and the documented time in the electronic health record. In this study, the difference between the observed medication administration time and documentation time was investigated. Patient and nurse characteristics were also tested for associations with observed time differences. Methods: In this prospective study, emergency nurses were followed by observers for a total of 3 months. Patient inclusion was divided over 2 time periods. The difference in the observed medication administration time and the corresponding electronic health record documentation time was measured. The association between patient/nurse characteristics and the difference in medication administration and documentation time was tested with a Spearman correlation or biserial correlation test. Results: In 34 observed patients, the median difference in administration and documentation time was 6.0 minutes (interquartile range 2.0-16.0). In 9 (26.5%) patients, the actual time of medication administration differed more than 15 minutes with the electronic health record documentation time. High temperature, lower saturation, oxygen-dependency, and high Modified Early Warning Score were all correlated with an increasing difference between administration and documentation times. Discussion: A difference between administration and documentation times of medication in the emergency department may be common, especially for more acute patients. This could bias, in part, previously reported time-to-treatment measurements from retrospective research designs, which should be kept in mind when outcomes of retrospective time-to-treatment studies are evaluated.

Clinical Relevance of Routinely Measured Vital Signs in Hospitalized Patients: A Systematic Review

BACKGROUND: Conflicting evidence exists on the effectiveness of routinely measured vital signs on the early detection of increased probability of adverse events.PURPOSE: To assess the clinical relevance of routinely measured vital signs in medically and surgically hospitalized patients through a systematic review.DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature, and Meta-analysen van diagnostisch onderzoek (in Dutch; MEDION) were searched to January 2013.STUDY SELECTION: Prospective studies evaluating routine vital sign measurements of hospitalized patients, in relation to mortality, septic or circulatory shock, intensive care unit admission, bleeding, reoperation, or infection.DATA EXTRACTION: Two reviewers independently assessed potential bias and extracted data to calculate likelihood ratios (LRs) and predictive values.DATA SYNTHESIS: Fifteen studies were performed in medical (n = 7), surgical (n = 4), or combined patient populations (n = 4; totaling 42,565 participants). Only three studies were relatively free from potential bias. For temperature, the positive LR (LR+) ranged from 0 to 9.88 (median 1.78; n = 9 studies); heart rate 0.82 to 6.79 (median 1.51; n = 5 studies); blood pressure 0.72 to 4.7 (median 2.97; n = 4 studies); oxygen saturation 0.65 to 6.35 (median 1.74; n = 2 studies); and respiratory rate 1.27 to 1.89 (n = 3 studies). Overall, three studies reported area under the Receiver Operator Characteristic (ROC) curve (AUC) data, ranging from 0.59 to 0.76. Two studies reported on combined vital signs, in which one study found an LR+ of 47.0, but in the other the AUC was not influenced.CONCLUSIONS: Some discriminative LR+ were found, suggesting the clinical relevance of routine vital sign measurements. However, the subject is poorly studied, and many studies have methodological flaws. Further rigorous research is needed specifically intended to investigate the clinical relevance of routinely measured vital signs.CLINICAL RELEVANCE: The results of this research are important for clinical nurses to underpin daily routine practices and clinical decision making.

The incidence of traumatic brain injury in young people in the catchment area of the University Hospital Rotterdam,The Netherlands

Background: Traumatic brain injury (TBI) is in the developed countries the most common cause of death and disability in childhood. Aim: The purpose of this study is to estimate the incidence of TBI for children and young people in an urbanised region of the Netherlands and to describe relevant characteristics of this group. Methods: Patients, aged 1 month - 24 years who presented with traumatic brain injury at the Erasmus University Hospital (including the Sophia Children's Hospital) in 2007 and 2008 were included in a retrospective study. Data were collected by means of diagnosis codes and search terms for TBI in patient records. The incidence of TBI in the different referral areas of the hospital for standard, specialised and intensive patient care was estimated. Results: 472 patients met the inclusion criteria. The severity of the Injury was classified as mild in 342 patients, moderate in 50 patients and severe in 80 patients. The total incidence of traumatic brain injury in the referral area of the Erasmus University Hospital was estimated at 113.9 young people per 100.000. The incidence for mild traumatic brain injury was estimated at 104.4 young people, for moderate 6.1 and for severe 3.4 young people per 100.000. Conclusion: The ratio for mild, moderate and severe traumatic brain injury in children and young people was 33.7e1.8e1.In the mild TBI group almost 17% of the patients reported sequelae. The finding that 42% of them had a normal brain CT scan at admission underwrites the necessity of careful follow up of children and young people with mild TBI.

Sanitary systems

Global society is confronted with various challenges: climate change should be mitigated, and society should adapt to the impacts of climate change, resources will become scarcer and hence resources should be used more efficiently and recovered after use, the growing world population and its growing wealth create unprecedented emissions of pollutants, threatening public health, wildlife and biodiversity. This paper provides an overview of the challenges and risks for sewage systems, next to some opportunities and chances that these developments pose. Some of the challenges are emerging from climate change and resource scarcity, others come from the challenges emerging from stricter regulation of emissions. It also presents risks and threats from within the system, next to external influences which may affect the surroundings of the sewage systems. It finally reflects on barriers to respond to these challenges. http://dx.doi.org/10.13044/j.sdewes.d6.0231 LinkedIn: https://www.linkedin.com/in/sabineeijlander/ https://www.linkedin.com/in/karel-mulder-163aa96/

Correlation between Mottling score and peripheral skin temperature compared to the hemodynamic component of the SOFA score

Increasing value and reducing waste by optimizing the development of complex interventions

In recent years there has been much emphasis on 'research waste' caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial. We therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practice METHODS: Based on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design.