CHHC Health Services Library April 2019 Newsletter

5 ways to re-energise on a night shift

For many nurses and midwives working night shifts, it can be challenging to keep energy levels up and remain mentally alert. The ANMJ suggest five ways to re-energise and combat night shift fatigue here.

                                                          source: ANMJ

Recent article from Critical Care Medicine on the dangers of medication errors in the transition of care

Evaluation of medication errors at the transition of care from an ICU to non-ICU location

Tully AP, Hammond DA, Li C, Jarrell AS, Kruer RM 

Critical Care Medicine. 2019;47(4):543-9.

Transitions of care are a known source of risk. These are points where there can be a failure to communicate important information, failure to adequately transfer or hand over care of a patient between individuals, teams, units or services. This study looked at the specific issue of medication errors for patients transferred from intensive care units (ICUs). The study was a 7-day point prevalence study that encompassed 958 patients who were transferred from an ICU to a non-ICU location in a group of hospitals (34 in the USA and 2 in the Netherlands).

Source: Waitemata District Health Board website

The authors report that 450 patients (45.7%) had a medication error occur during transition of care. Further, among those patients who experienced a medication error, an average of 1.88 errors per patient occurred. The most common types of errors were continuation of medication with ICU-only indication (28.4%), untreated condition (19.4%), and pharmacotherapy without indication (11.9%). Seventy-five percent of errors reached the patient but did not cause harm. Renal replacement therapy during ICU stay and number of medications ordered following transfer were identified as factors associated with occurrence of error. Orders for anti-infective, hematologic agents, and IV fluids, electrolytes, or diuretics at transition of care were associated with an increased odds of error. Factors associated with decreased odds of error included daily patient care rounds in the ICU and orders discontinued and rewritten at the time of transfer from the ICU.

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Have you checked your immunisation history?

Australians are being encouraged to check their immunisation history as the country reaches a five year high in measles cases.

Australia was declared measles-free just five years ago, with due diligence and high vaccination rates holding the virus at bay. There have been 92 confirmed cases of measles nationally this year in early April, compared to an annual total of 103 for 2018, and 81 for 2017.

Because measles is so highly infectious, outbreaks occasionally happen when people travelling overseas catch the virus and bring it back into Australia. Globally there are hundreds of thousand of cases of measles and tens of thousand of deaths.

The measles virus is so contagious that in areas where vaccination rates are not very high - over 90%, there is a high risk of measles once more becoming a threat to the Australian community. Currently that is what is now happening around the world.

(Centres for Disease Control)

A sharp increase in measles cases has prompted Government immunisation warnings. On Monday, Health Minister Greg Hunt urged all Australians to check their measles immunisation history and book in for a catch-up vaccination if necessary. "In particular, any individual planning to go overseas and those born between 1966 and 1994 are at higher risk and should be take action to protect themselves and their community," Mr Hunt said.

For more on this serious health issue you can read more on ABC News

Chlorhexidine bathing: No benefit in non-critical care units

No benefit of chlorhexidine bathing in non-critical care units
Mimoz O, Guenezan J
The Lancet. 2019;393(10177):1179-80.

Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial
Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Heim L, et al
The Lancet. 2019;393(10177):1205-15.

Mimoz and Guenezan's commentary on the article by Huang, observes that universal decolonisation has been advocated as a way to reduce health-care-associated infections and limit the transmission of multidrug-resistant organisms. The commonplace strategy has been bathing patients with chlorhexidine (a broad-spectrum antiseptic). This practice has been increasingly used in intensive care units (ICUs) globally. The efficacy of chlorhexidine baths has varied across different trials, with the greatest benefit seen among patients with the greatest risk of infection and few studies have examined the effect of this practice outside ICUs, in lower infection risk venues, and the findings have not been consistent.

Source: Critical Care stock

Huang et al report on the ABATE Infection trial that endeavored to evaluate the use of chlorhexidine bathing in non-critical-care settings. This trial was a cluster-randomised trial involving 53 hospitals and had a 12-month baseline period, a 2-month phase-in period, and a 21-month intervention period. The trial found little difference across the three periods, leading them to find that ‘Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients.’

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