scholarly journals New Zealand paramedics are ready for an autonomous pre-hospital thrombolysis protocol

2017 ◽  
Vol 14 (3) ◽  
Author(s):  
Paul Davis ◽  
Graham Howie ◽  
Bridget Dicker
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Clinical Decision Making ◽  
Life Support ◽  
Advanced Life Support ◽  
Clinical Decision ◽  
Multiple Choice Questions ◽  
Common Error ◽  
Paramedic Education ◽  
Written Test

IntroductionInternationally, autonomous paramedic-delivered pre-hospital thrombolysis (PHT) administration for ST-elevation myocardial infarction patients has proven to be a highly effective strategy in facilitating expedited delivery of this treatment modality. However, current New Zealand models rely on physician authorised telemetry-based systems which have proved problematic, particularly due to technological failings. The aim of this study is to establish whether current paramedic education in New Zealand is sufficient for the introduction of an autonomous paramedic clinical decision-making model of PHT.MethodsA one-hour workshop introduced a new PHT protocol to 81 self-selected paramedic participants – both rural and metropolitan based – from New Zealand. Paramedics were then tested in protocol application through completion of a scenario-based standardised written test. Four written scenarios constructed from actual field cases assessed 12-lead electrocardiogram interpretation, understanding of protocol inclusion/exclusion criteria, and treatment rationale. Ten multiple-choice questions further tested cardiac and pharmacology knowledge as well as protocol application.Results Overall clinical decision-making showed a sensitivity of 92.0% (95% CI: 84.8–96.5), and a specificity of 95.6% (95% CI: 89.1–98.8). Electrocardiogram misinterpretation was the most common error. University educated paramedics (n=44) were significantly better at clinical decision-making than in-house industry trained paramedics (n=37) (p=0.001), as were advanced life support paramedics (n=36) compared to paramedics of lesser practice levels (n=45) (p=0.006).Conclusion Our New Zealand paramedic sample demonstrated an overall clinical decision-making capacity sufficient to support the introduction of a new autonomous paramedic PHT protocol. Recent changes in paramedic education toward university degree programs are supported.

scholarly journals Medication omission rates in New Zealand Residential Aged Care Homes: a national description

2019 ◽  
Author(s):  
Stephanie M Garratt ◽  
Ngaire M Kerse ◽  
Kathryn Peri ◽  
Monique F Jonas
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Clinical Decision Making ◽  
National Level ◽  
Clinical Decision ◽  
Medication Administration ◽  
Aged Care ◽  
Care Staff ◽  
Care Homes ◽  
Residential Aged Care

Abstract Background Medication administration is a key service offered to individuals residing in residential aged care homes (RAC homes). A medication omission is an event where a prescribed medication is not taken by a resident before the next scheduled dose. Medication omissions are typically classed as errors, they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. Studies that critically appraise or support medication omissions in healthcare settings are limited. There is uncertainty around which medication omissions are problematic and how many on average a patient should experience. There have been several hospital-based studies, with limited sample sizes, timeframes, and inconsistent reporting of omissions. As the first population-level, RAC Home-specific study of its kind, this study quantifies the incidence, prevalence, and types of medication omissions in RAC homes on a national scale. Methods A retrospective review of de-identified, medication administration e-records from December 1 st 2016 to December 31 st 2017 was conducted. Demographic details of residents, care staff competency levels, medications, and RAC ownership types were included in the review and analysis. Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire data collection period. A mean rate of 3.40 medications doses were omitted per 100 dispensed medications doses per resident (s.d. 7.27). Approximately 73% of residents had at least one dose omission. The most common selected omission category was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The mean rate of omission was found to be slightly higher in corporate operated RAC Homes (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions Compared to other studies medication omissions within RAC homes in New Zealand are not as common as previously proposed. This study sets out the first national-level rate of medication omissions per resident over a one-year timeframe. Subsequent studies will address the medications omitted, the clinical significance of omissions and the place of medication omissions within clinical decision-making.

scholarly journals Australian Familial Haematological Cancer Study - Findings from 15 Years of Aggregated Clinical, Genomic and Transcriptomic Data

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1439-1439 ◽  
Author(s):  
Christopher N Hahn ◽  
Milena Babic ◽  
Peter J Brautigan ◽  
Parvathy Venugopal ◽  
Kerry Phillips ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Haematological Cancer ◽  
Cancer Study ◽  
Lymphoid Malignancies ◽  
Familial Cases ◽  
Pathogenic Variants ◽  
Predisposition Genes

The Australian Familial Haematological Cancer Study (AFHCS) was initiated in 2004 with the aim to define genes predisposing to hematological malignancy (HM) to offer better options for clinical decision making and genetic counselling, and to identify therapeutic targets. The study is a referral centre for Australia and New Zealand, and currently has 230 families with multiple cases of myeloid and/or lymphoid malignancies or early onset cases (Figure 1), and is growing as clinical awareness of a germline genetic basis for blood cancers increases. To date, we have identified families with causal germline variants in several predisposition genes (five GATA2, ten RUNX1, one CEBPA, ten DDX41, one SAMD9L) including novel single nucleotide variants, deletions and insertions in coding and intronic sequences using traditional Sanger sequencing and now genomic and transcriptomic technologies. Of these, one GATA2 and four DDX41 germline mutations were identified during the screening of "sporadic" MDS samples. All four DDX41 mutant samples also harbored a somatic DDX41 (R525H) variant on the other allele at a low variant allele frequency. A comprehensive clinical analysis of the RUNX1 families has uncovered segregating phenotypes, in addition to thrombocytopenia and myeloid and lymphoid malignancies, including skin disorders such as psoriasis. In an increasing number of individuals in these families, important clinical decisions have been made dependent on mutation carrier status. Recently, we have identified and characterized a unique myeloproliferative neoplasm (MPN)/acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) family with a germline Chr14q duplication that overlaps with duplications in two other reported MPN/AML families. This appears to be a unique genotypic/phenotypic entity when compared to other myeloid predisposition genes and their associated phenotypes. Interestingly, we have identified several families carrying heterozygous pathogenic/likely pathogenic variants in genes representing autosomal recessive genomic instability syndromes segregating with HM. Here mutations in the genes NBN, RECQL4, DDX11 and RAD21 appear to act in an autosomal dominant manner. Further, we have found DNA damage repair gene predicted pathogenic variants in PALB2 and BARD1 in families with both solid cancers and HM, predominantly lymphomas, implicating an expansion of the major predisposition phenotype of these gene perturbations. Familial cases of chronic lymphocytic leukemia (CLL) have been well recognized, but it has been particularly difficult to identify predisposing variants. We have identified a number of strong candidate genes/variants in CLL families including PRPF8 (Y208C and N400S) and SAMHD1 (R371H) although more families are required to confirm these. An integral part of the AFHCS is the continued generation of cell and animal models to help define mechanisms of action of predicted or known pathogenic variants, and functional model systems for testing of variants of unknown significance. To facilitate the collection of patient samples, we have adopted the use of hair bulbs as the main germline sample as they are easy to collect, can be easily sent long distance by mail at room temperature, require no culture, are quickly and cheaply processed and provide good quality DNA using automated procedures. Overall, collaborative efforts within Australia and New Zealand and internationally have been highly fruitful in solving familial cases of hematopoietic malignancies over the last 15 years, and even more concerted international efforts will be required in the future to uncover the familial basis of unsolved cases, particularly in the lymphoid lineage, and to clarify best approaches for clinical decision making and treatment options. Figure 1. Summary of AFHCS families with associated hematological malignancies. Figure Disclosures Scott: Celgene: Honoraria.

scholarly journals MP40: What are the factors contributing to medico-legal risk of procedural interventions performed by physicians practicing emergency medicine?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S57-S57
Author(s):  
K. Lemay ◽  
P. Finestone ◽  
R. Liu ◽  
R. De Gorter ◽  
L. Calder
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Patient Safety ◽  
Clinical Decision Making ◽  
Life Support ◽  
Improve Patient Safety ◽  
Clinical Decision ◽  
Wound Management ◽  
Contributing Factors ◽  
Orthopedic Injury

Introduction: Physicians who practice emergency medicine (EM) often perform procedural interventions, which can occasionally result in unintended patient harm. Our study's objective was to identify and describe the interventions and contributing factors associated with medico-legal (ML) cases involving emergency physicians performing procedural interventions. Methods: The Canadian Medical Protective Association (CMPA) is a not-for-profit, ML organization which represented over 99,000 physicians at the time of this study. We extracted five years (2014-2018) of CMPA data describing closed ML cases involving procedural interventions (e.g. suturing, reducing a dislocated joint) and excluding interventions related to pharmacotherapy (e.g. injection of local anesthetic), diagnosis (electrocardiograms) and physical assessments (e.g. ear exams), performed by physicians practicing EM. We then applied an internal contributing factor framework to identify themes. We analysed the data using descriptive statistics. Results: We identified 145 cases describing 145 patients who had 205 procedures performed in the course of their EM care. The three most common interventions were orthopedic injury management (47/145, 32.4%), wound management (43/145, 29.7%), and Advanced Cardiac Life Support (24/145, 16.6%). Out of 145 patients, 93.8% (136/145) experienced a patient safety event, and 55.9% (76/136) suffered an avoidable harmful incident. One quarter of patients suffered mild harm (34/76, 25.0%), 18.4% of patients died, 14.5% suffered severe harm, and 13.2% moderate harm. Peer experts were critical of 86/145 cases (59.3%) where the following provider contributing factors were found: a lack of situational awareness (20/68, 29.4%), and deficient physician clinical decision-making (54/68, 79.7%). Clinical decision-making issues included a lack of thoroughness of assessment (33/54, 61.1%), failure to perform tests or interventions (21/54, 38.9%), and a delay or failure to seek help from another physician (17/54, 31.2%). Peer experts were also critical of 48.8% of cases containing team factors (42/86) due to deficient medical record keeping (26/42, 61.9%), and communication breakdown with patients or other team members (25/42, 59.5%). Conclusion: Both provider and team factors contributed to ML cases involving EM physicians performing procedural interventions. Addressing these factors may improve patient safety and reduce ML risk for physicians.

scholarly journals Ethnic bias and clinical decision-making among New Zealand medical students: an observational study

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Ricci Harris ◽  
Donna Cormack ◽  
James Stanley ◽  
Elana Curtis ◽  
Rhys Jones ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Medical Students ◽  
Observational Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ethnic Bias

scholarly journals Escape rooms in paramedic education

2021 ◽  
Vol 18 ◽  
Author(s):  
Shannon Delport ◽  
Anthony Weber
Keyword(s):  
Higher Education ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Teaching Methodology ◽  
Approaches To Teaching ◽  
Higher Education Curriculum ◽  
Learning And Teaching ◽  
Paramedic Education ◽  
Clinical Thinking

Introduction Even with paramedicine's evolution, clinical decision-making will always be a crucial learning and teaching requirement. As part of their learning, paramedic students need to develop critical thinking and collaborative approaches with others. The aim was to review the literature around escape room activity as a pedagogical approach for paramedic education. The intent is to contribute to the discussion around authentic and engaging approaches to teaching clinical thinking and decision making in paramedicine. Methods A systematic review was undertaken to review existing literature on using this approach in higher education. EBSCO, Medline, CINAHL, ScienceDirect, ProQuest and PubMed were used to review paramedic and health education strategies using a list of keywords. Results There were 23 scholarly papers examining the use of escape rooms in an educational context found. There was no reference to using this teaching methodology in paramedicine, but some health contexts were identified for nursing, pharmacy, radiology and medicine. Conclusion With an instructional design that addresses logistical requirements, educational escape rooms can be used effectively in paramedic higher education. This review highlights a longitudinal study is needed to assess an educational escape room's implementation into the paramedic higher education curriculum. A longitudinal, multi-university study can further explore the feasibility of using a blended online/offline escape room activity in large enrolment paramedic programs.

Emergency medicine

2020 ◽  
pp. 568-623
Author(s):  
Blair Graham
Keyword(s):  
Emergency Medicine ◽  
Clinical Decision Making ◽  
Life Support ◽  
Wound Care ◽  
Advanced Life Support ◽  
Clinical Decision ◽  
Pelvic Trauma ◽  
Limb Injuries ◽  
Bites And Stings ◽  
Exit Block

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of emergency medicine. It describes the work of a doctor in the emergency department (ED), including an overview of emergency medicine and ED teams, triage, crowding, exit block, clinical decision-making, patient expectations, and patient assessment. It investigates common procedures in depth, including advanced life support and management of pain and sedation. It discusses commonly encountered problems such as shock, the unwell child, and major trauma from brain injury to thoracic, abdominal, and pelvic trauma, as well as major burns, environmental emergencies, emergency toxicology, sepsis, loss of consciousness, stroke, acute severe headache, chest pain, acute shortness of breath, abdominal pain, atraumatic back pain, extremity problems, common limb injuries, bites and stings, foreign body ingestion, and wound care.

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