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This exploratory, descriptive study aimed to identify and describe the pressure injury preventative interventions prescribed by nurses following the assessment of a patient's pressure injury risk and to compare the prescribed interventions relative to the assessed risk level. A total of 200 inpatients in a tertiary Australian hospital were included. Patients' charts were audited within 24 hours of admission. Data collected included patient characteristics, pressure injury risk assessment score and level, and preventative interventions prescribed. Most patients were assessed as not being at risk, with the largest group of at‐risk patients assessed as being at high risk. Some not‐at‐risk patients were prescribed interventions intended for those at risk, while prescription rates of preventative interventions recommended for those at any level of risk were variable (6%–64%). Significant associations were found between assessed pressure injury risk and preventative intervention prescription. Preventative intervention prescription was inadequate, potentially exposing some patients to pressure injury. However, the association between intervention prescription and risk level suggests that nurses are prescribing interventions relative to risk. A more structured approach to intervention prescription according to risk level, such as a care bundle, may help to improve nurses' preventative intervention prescription and ensure that all at‐risk patients receive appropriate preventative interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the experiences of high‐risk respiratory patients undergoing bronchoscopy with conscious sedation. Background: Due to possible complications, high‐risk respiratory patients are usually given smaller, cautious doses of sedation and analgesia for bronchoscopy. Described as “conscious sedation,” this facilitates depression of the patient's consciousness without causing respiratory compromise. Previously, studies have investigated patient experience using quantitative methods. This is the first study that has explored the patient experience during bronchoscopy from a qualitative perspective. Design: Qualitative, phenomenological approach as described by Van Manen. Methods: The setting was an endoscopy unit within an Australian tertiary hospital. Unstructured interviews were conducted with 13 patients with chronic obstructive pulmonary disease who underwent day‐case bronchoscopy. All participants received conscious sedation. They were interviewed twice, within a week, postprocedure. Interviews were transcribed verbatim and analysed using Van Manen's interpretive approach. Findings: Participants had varying experiences. Five themes emerged from the analysis: Frustration and fear; Comfort and safety; Choking and coughing; Being aware; and Consequences. Whilst not all participants experienced procedural awareness or remembered it, for those who did it was a significant event. Overall, experiences were found to be negative; however, participants accepted and tolerated them, perceiving them as necessary to obtain a diagnostic result. Conclusion: The findings demonstrate that often patients are aware during the procedure and their experience may be uncomfortable and distressing. Relevance to clinical practice: These findings have implications for patient preparation pre‐ and post‐bronchoscopy in terms of what they might expect, and to discuss what has happened after the procedure. Some practices of the bronchoscopy team during the procedure may need modification. For example, in anticipation of the possibility that the patient may be aware, healthcare professionals should provide patient‐focused explanations of what is happening during the procedure, as well as providing ongoing reassurance that everything is going as planned. [ABSTRACT FROM AUTHOR]

Background Emergency department overcrowding impacts patients, staff, and quality of care, and there is government pressure to optimize throughput and reduce waiting times. One solution for improving patient flow is the emerging ‘navigator’ role: a nurse that supports staff in care delivery; facilitating efficient and timely patient movement through the emergency department. Methods A 20-week project was implemented to evaluate an emergency department nurse navigator role. A controlled trial was used. The navigator worked on a week-on-week-off basis, eight hours per day, seven days per week. Time-based and cost-associated outcomes were compared. Results Data from nearly 20,000 presentations during the trial period were analysed. All outcomes were improved during the ten weeks the Navigator was working. A slight improvement in National Emergency Access Target compliance was shown, with an average of 4.5 min per presentation saved. The labour cost associated with the time saved was estimated to be $170,000. Conclusions The results from this study indicate that for a relatively small investment, complementary nursing roles such as the navigator can impact emergency department patient flow. However, further studies are required to determine optimisation of the role. Relevance to practice This study provides rigorous evidence of the effects of a nurse navigator role on emergency department throughput. Whilst positive outcomes were demonstrated, suggesting a whole-of-system benefit, the magnitude of effect on a per-presentation basis was relatively small. Further studies are required to demonstrate the clinical relevance of such roles. [ABSTRACT FROM AUTHOR]

Characterizing how physical and psychological symptoms interact in heart transplant recipients may lead to advances in therapeutic options. This study examined associations between pain and major depression. Method: A cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants meeting the criteria for major depression. Hierarchical linear regression was used to determine if there was an association between pain and major depression, controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics including immunosuppression medication which may induce pain as a side effect. Results: Average pain score of the 48 heart transplant recipients was 43 (SD ± 10, range 0–100, lower scores indicate worse pain), with moderate pain reported by 39% (n = 19). Major depression was associated with worse pain (R2 change = 36%, β = −16, 95% confidence interval [CI] = [−30, −4], p = .012). Pharmacological treatment for depression was associated with better pain scores (R2 change = 1.5%, β = 13, 95% CI [4, 23], p = .006). Conclusions: Heart transplant recipients with major depression had worse pain after controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics. Thus, it is imperative that clinicians devising a treatment regimen for pain in heart transplant recipients take into account co-occurring depression and vice versa. [ABSTRACT FROM AUTHOR]

Aim To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory. Background Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory. Methods A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations. Implications for nursing The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring. Conclusion These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting. [ABSTRACT FROM AUTHOR]

Background: Indigenous Australians carry a greater burden of cardiovascular disease than other Australians. A variety of programs has been implemented with the broad aim of improving Indigenous cardiovascular health, however, relatively few have been evaluated rigorously. In terms of effectiveness, understanding how to best manage cardiovascular disease among this population is an important priority. The review aimed to examine the evidence relating to the effectiveness of cardiovascular programs for Indigenous Australians. Methods: PubMed, CINAHL, PsycINFO, Scopus and Web of Science databases were systematically searched for relevant studies, limited to those published in English between 2008 and 2017. All studies that used experimental designs and reported interventions or programs explicitly aimed at improving Indigenous cardiovascular health were considered for inclusion. Methodological quality of included studies was appraised using design-specific Joanna Briggs Institute critical appraisal checklists. Data were extracted using the Joanna Briggs Institute data extraction form and synthesised narratively. Results: Eight studies met the inclusion criteria and were assessed to be of varying methodological quality. Common features of effectiveness of programs were integration of programs within existing services, provision of culturally appropriate delivery models with a central role for Indigenous health workers, and provision of support processes for communities such as transportation. It was noted however, that the programs modelled the interventions based on mainstream views and lacked strategies that integrated traditional knowledge and delivery of health care. Conclusions: Very few cardiovascular healthcare programs designed specifically for Indigenous Australians, which had undergone rigorous study, were identified. Whilst the majority of included articles were assessed to be of satisfactory methodological quality, the nature of interventions was diverse, and they were implemented in a variety of healthcare settings. The limited evidence available demonstrated that interventions targeted at Indigenous cardiovascular health and related risk factors can be effective. The results indicate that there are opportunities to improve cardiovascular health of Indigenous people at all stages of the disease continuum. There is a need for further research into evidence-based interventions that are sensitive to Indigenous culture and needs. Trial registration: Registered with PROSPERO International: CRD2016046688. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks., Objective: To determine if a structured assessment and decision tool (I-DECIDED®) improves daily peripheral intravenous catheter assessment and care decisions., Design: Prospective, interrupted time-series study., Settings: Seven adult inpatient wards in three Australian hospitals., Participants: 825 adults with 867 peripheral intravenous catheters., Methods: Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2-weekly measures), the I-DECIDED® tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections., Results: Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention)., Conclusions: Implementation of a comprehensive device assessment and decision tool (I-DECIDED®) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter., Anzctr Trial Registration: ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017., Tweetable Abstract: #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications., Competing Interests: Declaration of Competing Interest GRB reports investigator-initiated research grants, speaker fees and consultancy payments provided to her employer (Griffith University or The University of Queensland) by product manufacturers (3M, BBraun, BD-Bard) and education providers (Ausmed, Wolters Kluwer, Continulus), unrelated to this project. CMR discloses that her employer (Griffith University or The University of Queensland) has received on her behalf: investigator-initiated research grants from BD-Bard, Cardinal Health and Eloquest; and consultancy payments for lectures or opinion from 3M, BBraun, BD-Bard, ITL Biomedical; unrelated to current project. VC receives funding from the National Institutes of Health, Bethesda, MD, and royalties for books published with Oxford University Press and Wolters Kluwer publishers. PF: None. JL: None. GM: None. MW: None. MC: None. MM: None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Pressure injury (PI) is an ongoing problem for patients in intensive care units (ICUs). The aim of this study was to explore the nature and extent of PI prevention practices in Australian adult ICUs., Materials and Methods: An Australian multicentre, cross-sectional study was conducted via telephone interview using a structured survey instrument comprising six categories: workplace demographics, patient assessment, PI prevention strategies, medical devices, skin hygiene, and other health service strategies. Publicly funded adult ICUs, accredited with the College of Intensive Care Medicine, were surveyed. Data were analysed using descriptive statistics and chi-square tests for independence to explore associations according to geographical location., Results: Of the 75 eligible ICUs, 70 responded (93% response rate). PI was considered problematic in two-thirds (68%) of all ICUs. Common PI prevention strategies included risk assessment and visual skin assessment conducted within at least 6 h of admission (70% and 73%, respectively), a structured repositioning regimen (90%), use of barrier products to protect the skin (94%), sacrum or heel prophylactic multilayered silicone foam dressings (88%), regular PI chart audits (96%), and PI quality improvement projects (90%). PI prevention rounding and safety huddles were used in 37% of ICUs, and 31% undertook PI research. Although most ICUs were supported by a facility-wide skin integrity service, it was more common in metropolitan ICUs than in rural and regional ICUs (p < 0.001). Conversely, there was greater involvement of occupational therapists in PI prevention in rural or regional ICUs than in metropolitan ICUs (p = 0.026)., Discussion and Conclusion: This is the first study to provide a comprehensive description of PI prevention practices in Australian ICUs. Findings demonstrate that PI prevention practices, although nuanced in some areas to geographical location, are used in multiple and varied ways across ICUs., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Hospital-acquired skin tear prevalence is under-reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10-year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whether it was documented as hospital- or community-acquired were recorded. Eleven prevalence audits were analysed with a total sample of 3626 patients. An overall pooled prevalence of 8.9% (95% confidence interval [CI] 7.5-10.4) with an associated hospital-acquired pooled prevalence of 5.5% (95% CI 4.5-6.7) was found. In total, 616 skin tears were reported, of which 374 (60.7%) were hospital-acquired. Over a third of patients (38.7%) had multiple skin tears and most patients (84.8%) with at least one skin tear were aged ≥70 years. The largest proportion of skin tears (40.1%) was those with no skin flap. Of those documented, most were caused by falls or collisions, suggesting combined skin tear and falls prevention strategies may be effective. Over a decade, there was a downward trend in hospital-acquired skin tear, which is encouraging. Skin tear prevalence is recommended as a measure of care quality with an emphasis on good quality documentation., (© 2021 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.)

Background: Pressure injuries are a ubiquitous, yet largely preventable, hospital acquired complication commonly seen in critically ill patients in the intensive care unit., Objectives: The objectives of this study were to implement targeted evidence-based pressure injury prevention strategies and evaluate their effect through measurement of patient pressure injury observations., Methods: A prospective multiphased design was used in the intensive care unit of an Australian tertiary referral hospital using three study periods (period 1, weeks 1-18; period 2, weeks 19-28; and period 3, weeks 29-52). The interventions included staff-focused interventions and patient-focused interventions, with the latter defined in a work unit guideline. Weekly visual observations of critically ill patients' skin integrity were conducted by trained research nurses over 52 weeks from November 2015 to November 2016. The primary outcome measure was a pressure injury of any stage, identified at the weekly observation, and the effect of the intervention was evaluated through logistic regression. Reporting rigour has been demonstrated using the Standards for Quality Improvement Reporting Excellence checklist., Results: Over the whole study, 15.4% (95% confidence interval [CI] = 12.6, 18.2%, 97/631) of patients developed a pressure injury, with the majority of these injuries (73.2%, 95% CI = 64.4%, 82.0%, 71/97) caused by medical devices. After adjustment for covariates known to influence hospital-acquired pressure injury development, pressure injury rates for period 3 compared with period 1 were reduced (odds ratio = 0.41, 95% CI = 0.20-0.97, p = 0.0126)., Conclusions: We found the use of defined pressure injury prevention strategies targeted at both staff and patients reduced pressure injury prevalence., Competing Interests: Conflict of interest None., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Hospital-acquired pressure injuries cause significant harm to afflicted individuals, and financially burden hospitals. Most pressure injuries are avoidable with the use of preventative interventions. However, within acute hospital settings the effectiveness of pressure injury preventative interventions, as demonstrated by high-level evidence, requires examination., Objective: Analyse the effectiveness of interventions to prevent pressure injury in adults admitted to acute hospital settings., Design: Systematic review and meta-analysis of randomised controlled trials., Data Sources: CINAHL, MEDLINE, Scopus, Web of Science and Embase were searched in May/June 2019. In April 2020, searches were updated to the end of 2019., Methods: Randomised controlled trials which investigated the effectiveness of pressure injury preventative interventions on pressure injury incidence, within adults admitted to acute hospital settings, were included. Trials limited to pressure injury treatment or specialty areas, and non-English reports, were excluded. Screening, extraction and risk-of-bias assessment were undertaken independently by two reviewers, with a third as arbitrator. Included studies were grouped by intervention type. Studies were synthesised narratively, and meta-analysis was undertaken where study interventions were similar. Using a random-effects model, primary meta-analyses were undertaken using intention-to-treat data., Results: Of 2000 records, 45 studies were included in the systematic review which investigated nine different intervention types: continence management, heel protection devices, medication, nutrition, positioning, prophylactic dressings, support surfaces, topical preparations and bundled interventions. All studies were judged to be at unclear or high risk-of-bias. Several meta-analyses were undertaken, pooled by intervention type. Most pooled samples were heterogeneous. Based on intention-to-treat data, only one intervention demonstrated a statistically significant effect: Australian medical sheepskin surfaces compared to other standard care surfaces (risk ratio 0.42, p = 0.006, I 2  = 36%), but included studies were limited by bias and age. Following per protocol meta-analyses, only two intervention types demonstrated a significant effect: support surfaces (active versus other comparison [risk ratio = 0.54, p = 0.005, I 2  = 43%] and standard surfaces [risk ratio = 0.31, p < 0.001, I 2 = 0%]; and reactive versus other comparison surfaces [risk ratio = 0.53, p = 0.03, I 2  = 64%]) and heel protection devices versus standard care (risk ratio = 0.38, p < 0.001, I 2 = 36%)., Conclusions: Only one intervention was supported by intention-to-treat meta-analysis. Significantly, all trials were at unclear or high risk-of-bias; and there were several limitations regarding heterogeneity across trials and trial outcomes. Further large-scale, high-quality trials testing pressure injury preventative interventions are required to establish effectiveness within acute hospital settings. Attention should be paid to true intention-to-treat analysis, and acute and intensive care settings should be reported separately. PROSPERO registration number:CRD42019129556., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction: Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED)., Methods: An observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the EDs of two Australian tertiary hospitals. Full skin inspection and pressure injury risk assessment, using Braden and Waterlow scores, were undertaken within 1 h of presentation., Results: Pressure injuries were identified in 11 of 212 participants, giving a prevalence of 5.2% at presentation. Nearly all were admitted to hospital, giving a prevalence of 7.8% at this entry point. Participants with pressure injury and those at high risk of injury were found to have spent longer in the ambulance and within the ED. During ambulance transport and in the first hour of presentation to the ED, it was rare that pressure-relieving interventions were implemented, even for those with an identified pressure injury and those at high risk., Conclusions: The results indicate that early pressure injury surveillance and risk assessment are merited at the point of presentation to the ED, so that prevention and treatment can be implemented at the earliest possible opportunity. Although it is more challenging to manage pressure injuries within the ambulance and ED, the use of pressure-relieving devices should be considered for those at greatest risk. Further research is recommended., (Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The intensive care nursing workforce plays an essential role in the achievement of positive healthcare outcomes. A growing body of evidence indicates that inadequate nurse staffing and poor skill mix are associated with negative outcomes for patients, and potentially compromises nurses' ability to maintain the safety of those in their care. In Australia, the Australian College of Critical Care Nurses (ACCCN) has previously published a position statement on intensive care staffing. There was a need for a stronger more evidence based document to support the intensive nursing workforce., Objectives: To undertake a systematic and evidence review of the evidence related to intensive care nurse staffing and quality of care, and determine evidence-based professional standards for the intensive care nursing workforce in Australia., Methods: The National Health and Medical Research Council standard for clinical practice guidelines methodology was employed. The English language literature, for the years 2000-2015 was searched. Draft standards were developed and then peer- and consumer-reviewed., Results: A total of 553 articles was retrieved from the initial searches. Following evaluation, 231 articles met the inclusion criteria and were assessed for quality using established criteria. This evidence was used as the basis for the development of ten workforce standards, and to establish the overall level of evidence in support of each standard. All draft standards and their subsections were supported multi-professionally (median score >6) and by consumers (85-100% agreement). Following minor revisions, independent appraisal using the AGREE II tool indicated that the standards were developed with a high degree of rigour., Conclusion: The ACCCN intensive care nursing nurse workforce standards are the first to be developed using a robust, evidence-based process. The standards represent the optimal nurse workforce to achieve the best patient outcomes and to maintain a sustainable intensive care nursing workforce for Australia., (Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.)

Aims and Objectives: To explore Indigenous people's experiences of hospitalisation for acute cardiac care., Background: Indigenous Australians suffer a higher burden of cardiovascular ill health and hospitalisation rates in comparison with other Australians, but there is little research that explores their perspectives of hospitalisation., Design: Narrative inquiry., Methods: Interviews were undertaken using storytelling to facilitate participants' descriptions of their hospital experience. Data were collected during 2014-2015. A purposive sample of Indigenous cardiac patients that were admitted to hospital and their relatives participated., Findings: The narrative revealed three linked themes that characterised Indigenous people's hospitalisation experiences: The impact of the past; The reality of the present; and Anticipating the future. Hospitalisation was challenging for participants due to their sense of dislocation and disorientation, a lack of cultural and spiritual aspects to care practices, and the poor interpersonal relationships they experienced., Conclusions: Findings revealed that there were many unmet needs during hospitalisation for Indigenous people. Past experiences and future expectations were connected in a way that impacted on participants' current hospitalisation experience. Understanding this context, with incorporation of cultural and spiritual aspects of care may help nurses and other healthcare professionals to provide more positive interactions that in turn may contribute to improved cardiac care experiences of Indigenous people during hospitalisation. Healthcare professionals need to be aware and focused on person-specific and contextualised aspects of Indigenous people's experience of hospitalisation for cardiac care in order to impact outcomes., Relevance to Clinical Practice: Healthcare professionals need to understand Indigenous people's perspectives that contribute to improved health outcomes. Stories of participants' experiences may assist in the identification of aspects which might further the development of culturally appropriate continuity models that could effectively provide support throughout Indigenous people's hospital journeys, and beyond the hospital, and help improve associated health outcomes., (© 2017 John Wiley & Sons Ltd.)

Aim: To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index., Background: Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients., Design: Instrument development., Methods: A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales., Results: Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales., Conclusion: Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs., (© 2015 John Wiley & Sons Ltd.)

Aim: The aim of this study was to validate a modified version of the Paddington Alcohol Test for use in the Australian emergency department (ED) setting., Methods: A cross sectional survey was used to screen patients attending an Australian tertiary hospital ED. Data were collected over a three-month period at randomly allocated time periods and days. Consenting participants were screened using the Alcohol Use Disorders Identification Test (AUDIT) and a modified-for-Australia version of the Paddington Alcohol Test (AusPAT). The association between the two tools was investigated, as well as the sensitivity and specificity of AusPAT at various AUDIT cut-off scores and by gender and age group., Results: The sample comprised 637 ED attendees. Their mean age was 49.9 (SD 20.0) years with a mean AUDIT score of 5.21 (SD 6.58). Most (73.2%) consumed alcohol, and a quarter was AusPAT-positive (n = 153, 24.0%). AusPAT demonstrated a moderate fit with AUDIT at a cut-off score of 8 (Kappa = 0.63, P < 0.001). At this cut-off 23.4% (n = 149) were identified by AUDIT as problematic drinkers. AusPAT sensitivity was 72.5% (95% CI 65.3-79.7) with a specificity of 90.8% (95% CI 88.3-93.4)., Conclusion: Our results indicate that AusPAT was moderately well associated with AUDIT. When used universally in the ED setting, its sensitivity and specificity were moderate., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice., Objective: To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs., Design: A quantitative, cross-sectional, descriptive survey design was used., Methods: Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data., Results: A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n=58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n=58). One respondent indicated that propofol was also used. 20% (n=12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n=18) indicated that comprehensive education about PSA is provided. 45% (n=26) indicated that nurses who administer PSA should undergo competency assessment., Conclusion: By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand., (Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aims and Objectives: To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses., Background: Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present., Design: A qualitative exploratory design was employed., Methods: Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes., Results: Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements., Conclusions: The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory., Relevance to Clinical Practice: Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential., (© 2013 Blackwell Publishing Ltd.)