Regression Equations for Weight Estimation in Paediatric Resuscitation

Background: Weight estimation is critical in paediatric resuscitation, as stopping to weigh a child could influence their survival. Weight estimation methods used in New Zealand (NZ) are not accurate for the population, increasing the complexity of prescribing medication and selecting equipment. Aim: Develop regression equations (RE) to predict the weight of NZ children based on height, sex, age and ethnicity to be deployed in a mobile application (Weight Estimation Without Waiting). Methods: The RE was derived from retrospective regression modelling of a large existing dataset. Data were presented using descriptive statistics and calculation of means, limits of agreement and the proportion of weight estimates within a percentage of actual weight. Conclusion: The RE developed in this study outperformed existing age-based weight estimation methods while providing a method to ensure that weight estimation techniques evolve with NZ children.

Competences of polish nurses in the field of prescribing medications: A systematic review

Purpose: The purpose of the following systematic review is to present polish regulations in terms of education, acquiring competencies in the field of prescribing drugs and medical devices. Methodology: The following review can be helpful to conduct comparative meta-analyses. Internet System of Legal Acts, PubMed, Google Scholar research was used to analyze the topic. The selected keywords were used to find information sources: law, competence, nurse, prescribing, medication, medical devices. Articles were selected according to regulations in Poland in terms of education, acquiring competencies in the field of prescribing drugs and medical devices. Main findings: The increase in nurses' competencies is equivalent to a greater need for knowledge and new knowledge acquired. Nurses take part not only in care and treatment, but also takes independent actions. In such enormous responsibilities, it is crucial to focus on the development of skills. Thus, a competent nurse is interested in continuous professional and personal growth and provides patients with high-quality nursing trustees. Implications of this study: The results should be considered in health care units, especially Primary Healthcare Units. The paper indicates the regulations in terms of education, acquiring competencies in the field of prescribing drugs which should be revised by personnel and implemented to improve the work of the healthcare unit. Novelty in this study: There is a lack of systematic reviews of the regulations in Poland in terms of education, acquiring competencies in the field of prescribing drugs and medical devices. The paper is an attempt to assess the topic.

Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study

Background: Anticholinergic burden (ACB), is defined as the cumulative effect of anticholinergic medication which are widely prescribed to older adults despite increasing ACB being associated with adverse effects such as: falls, dementia and increased mortality. This research explores the views of health care professionals (HCPs) and patients on a planned trial to reduce ACB by stopping or switching anticholinergic medications. The objectives were to explore the views of key stakeholders (patients, the public, and HCPs) regarding the potential acceptability, design and conduct of an ACB reduction trial.Materials and Methods: We conducted qualitative interviews and focus groups with 25 HCPs involved in prescribing medication with anticholinergic properties and with 22 members of the public and patients who were prescribed with the medication. Topic guides for the interviews and focus groups explored aspects of feasibility including: 1) views of a trial of de-prescribing/medication switching; 2) how to best communicate information about such a trial; 3) views on who would be best placed and preferred to undertake such medication changes, e.g., pharmacists or General Practitioners (GPs)? 4) perceived barriers and facilitators to trial participation and the smooth conduct of such a trial; 5) HCP views on the future implementability of this approach to reducing ACB and 6) patients’ willingness to be contacted for participation in a future trial. Qualitative data analysis was underpinned by Normalization Process Theory.Results: The public, patients and HCPs were supportive of an ACB reduction trial. There was consensus among the different groups that key points to consider with such a trial included: 1) ensuring patient engagement throughout to enable concerns/potential pitfalls to be addressed from the beginning; 2) ensuring clear communication to minimise potential misconceptions about the reasons for ACB reduction; and 3) provision of access to a point of contact for patients throughout the life of a trial to address concerns; The HCPs in particular suggested two more key points: 4) minimise the workload implications of any trial; and 5) pharmacists may be best placed to carry out ACB reviews, though overall responsibility for patient medication should remain with GPs.Conclusion: Patients, the public and HCPs are supportive of trials to reduce ACB. Good communication and patient engagement during design and delivery of a trial are essential as well as safety netting and minimising workload.

The effect of Benson relaxation technique on fatigue of patients diagnosed with multiple sclerosis

Introduction: The previous studies showed that fatigue is a very common symptom in patients diagnosed with multiple sclerosis (MS) and has the greatest effect on their activities of daily living. Benson relaxation technique (BRT) is one of the most relaxation techniques used to decrease fatigue, improve emotional status and quality of life in patients with several chronic diseases. This study aimed to investigate the effect of BRT on fatigue level of patients diagnosed with MS in Jordan.Methods: This is a quasi-experimental repeated measure study. It involved six neurological clinics in the Ministry of Health and five neurological clinics at private hospitals. In this study, 95 patients returned the completed questionnaire and attended BRT.Results: The mean age of the patients was 33 years. Females accounted for 60% of the patients and almost half of the patients were single. All patients reported having a university degree and three-quarters of the patients were employed. Almost, two-thirds of the patients reported having not more than 1 time of relapse in the past 2 years. The majority of them reported <3 years from the confirmed diagnosis. Findings showed a statistical significant reduction in the overall level of fatigue including physical, cognitive, and psychosocial fatigue of patients with MS after BRT (p < 0.001).Conclusions: Results suggested that this technique is a very effective strategy for reducing fatigue in patients with MS. Therefore, in addition to prescribing medication, it is recommended that this method be applied in the care of patients diagnosed with MS.

Legal aspects of prescribing

Paramedic independent prescribing is in its infancy and there are limitations to the range of medicines that can be prescribed when compared with other professions undertaking independent prescribing. Medication and prescribing errors are common events within the NHS in England, resulting in a substantial number of litigation and fitness-to-practise proceedings against other professions in relation to prescribing and medicines management. It is foreseeable that paramedic independent prescribers could also find themselves subject to legal action. This article considers a fictitious scenario where a patient suffers harm as a result of a prescribing decision and the legal implications for the prescriber.

SP10.2.5 It SOCS: Surgical On-Call Simulation for final year Medical Students

Introduction Simulation is a well-known method of effectively teaching Medical students. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks. Method Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment. Results The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call. Conclusion This project demonstrates how simulation is also effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.

Iranian nurses’ attitudes towards the necessity and barriers to developing nurse prescribing roles

Background Prescribing medication by nurses as an approach to rational drug prescription has been proposed in many countries. Nursing prescribing is an effective measure in the management of critically ill patients admitted to intensive care units (ICU). This study investigated the attitude of ICU nurses towards the necessity and the barriers to developing nursing prescribing. Materials and methods In this cross-sectional study, 136 ICU nurses were included by stratified random sampling. The data collection tool was the researcher-made questionnaire. Cronbach’s alpha method was used to evaluate the reliability of the instrument. The validity of the instrument was also verified by the content validity method. To collect the data, the researcher referred to the nurses’ workplace and provided them with a questionnaire and collected it after completion.The collected data were analyzed by IBM SPSS 16 using descriptive and inferential statistics. Results It was revealed that 58.8 % of nurses were familiar with the term ‘nursing prescribing’; a majority (92.1 %) of whom considered it vital to develop this role in the ICU. Moreover, 86 % (n = 98) of the nurses assumed that it is possible to implement this role in ICU. The most potential barriers to its implementation were lack of legitimacy, disapproval of physicians, and the reluctance of nursing managers. Conclusions Most nurses maintained a positive attitude towards nursing prescribing; hence, its legitimacy seems vital in ICUs. For the development of the ‘nurse prescribing’ role, the Nursing System Organization may be helpful.

1617 SOCS: Surgical On-Call Simulation

Introduction Simulation is a well-known method of effectively teaching Medical students. The majority of the simulation scenarios are related to Medicine. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks. Method Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment. Results The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call. Conclusions This project demonstrates how simulation is effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.

MEDICATION ERROR OVERVIEW AND PREVENTION STRATEGIES

This literature review aims to highlight the overview of medication errors and strategies to avoid and decrease medication errors. Availability of various types of over-the-counter and prescribed medication has added to the risk of medication. Also, the medication chain has different steps, and different people are involved in each step, such as prescribing medication, dispensing, and administering medication. Every phase in the medication chain is prone to risks that can lead to medication errors. Medication safety is the responsibility of every healthcare professional involved in the medication chain to deliver effective and safe care to patients with an optimal outcome. A medication error can happen in every health care setting to decrease and prevent medication errors. It is critically important to have complete knowledge of the medication use chain and integrate evidence-based strategies, such as medication reconciliation, analysis of medication error, double-check, and avoiding interruption and distraction into practice. Medication errors can lead to patient harm, prevent on-time discharges, and increase care costs. Medication safety culture can shine in a setting of effectively applying strategy into practice, and everyone's collaboration and commitment to adhere to medication safety strategy can improve patient safety.

Potentially inappropriate medicines use in older adults

Background With the increase of the average life expectancy, and the increase in chronic diseases, consequently also increases the consumption of medicines. Polymedication leads to an increase in drug-related problems, particularly in the elderly. Prescription of medications potentially inappropriate, which can have a harmful impact on the quality of life of the elderly. The aims are identifying and classify potentially inappropriate medication according to the recent criteria of Beers. Methods We conducted an observational study in the nursing home. The sample consisted of 45 seniors of 65 years of age or older, take at least two different mediations at the same time. The data collection was made to a questionnaire with sociodemographic characteristics and clinical profile. Results The female sex predominates with 32 people (71.1%), with a very high average age (86.02 years ± 7.6). In the 45 respondents it appears that they take a minimum of 4 drugs (2.2%) and a maximum of 16 (4.4%), with an average of 9.7 daily drugs per individual. The most prescribed drugs are for the nervous and the cardiovascular system, and 34 drugs were considered potentially inappropriate medication use in older adults, 23 drugs of which were recommended to be avoided and the rest were recommended to be used with caution and dose reduction. Conclusions It is necessary more personalised criterion for prescription and dispensation of medication to elderly people. It is necessary to develop habits and practices that create higher prudence when prescribing medication and its rational use.