bluuebunny/crossref_metadata_2025_split huggingface dataset:
A STUDY OF THE EFFECT OF HYPOTONIC HYPER-HYDRATION FLUIDS ON SODIUM BALANCE IN PAEDIATRIC HAEMATOLOGY/ONCOLOGY PATIENTS RECEIVING CHEMOTHERAPY
Authors: Keane Sinead , Butler Eileen 
Published: August 2016

AimsTo determine the effect, if any, that hyper-hydration with hypotonic fluids has on sodium balance in paediatric haematology/oncology patients receiving cytotoxic chemotherapy treatment for malignancies.MethodsA literature review was carried out and a snapshot of current practice across paediatric haematology/oncology centres in the UK was obtained. A prospective study was carried out in a tertiary paediatric haematology/oncology centre. A total of 98 patient episodes involved hyper-hydration with isotonic 0.9% NaCl, almost isotonic 0.45% NaCl+2.5% glucose with added sodium bicarbonate or hypotonic 0.45% NaCl+2.5% glucose. Serum sodium was monitored before and during hyper-hydration. Results were analysed according to whether children experienced a drop in serum sodium.ResultsPatients who were hyper-hydrated with hypotonic 0.45% NaCl & 2.5% Glucose experienced the greatest mean drop in serum sodium. The mean drop in sodium was 2.11 mmol/L in the group receiving the hypotonic 0.45% NaCl & 2.5% Glucose compared to 0.47 mmol/L in the group who received isotonic 0.9% NaCl or 0.45% NaCl & 2.5% Glucose with added sodium bicarbonate. During the course of the study five patients who received 0.45% NaCl & 2.5% Glucose dropped their sodium to 130 mmol/L or less constituting hyponatraemia. No patient dropped their serum sodium to 130 mmol/L or less in the other two groups. During the course of the study no patient experienced clinical manifestations of hyponatraemia. No child became hypernatraemic.ConclusionsIn paediatric haematology/oncology patients receiving hyper-hydration with concurrent chemotherapy isotonic fluids are preferable.
RATES AND TYPES OF PRESCRIBING ERRORS AND RELATED INTERVENTIONS IN PAEDIATRIC ONCOLOGY
Authors: Fosbrook Claire 
Published: August 2016

AimThe aim of the pharmacy intervention audit was to prospectively record the number and type of interventions made to paediatric oncology chemotherapy prescriptions. This baseline data will be used in the future to assess the impact of electronic prescribing (EP) on prescribing error or intervention rates.Independently from the EP project research, I interrogated the data to establish if there was a correlation between prescribing workload and rate of errors or interventions. I predicted that an ‘overworked’ prescriber would make more mistakes due to the volume of the workload and a less frequent prescriber would make more mistakes due to scarce use of these skills.Intervention rates have been found to be as high as 66% for chemotherapy prescriptions, including interventions for missed information, wrong doses and protocol breach1. This intervention rate demonstrates the importance of pharmacy verification. Another source demonstrated that 80% of errors were due to poor prescription writing.2
MethodAn audit tool was created to collect the data, included fields for date, prescriber type, number of drugs prescribed, number of interventions made and intervention type. Data was collected from 5 Jan 2015 to 12 Jun 15.ResultsThe most common interventions required were addition of diluent volume, addition of start date and dose amendments to ensure doses could be accurately measured.The staff grade doctor prescribed on average 75% of the prescriptions each week, with an intervention rate of 19%. The registrar was responsible for 23% each week and had an error rate pf 24%. Consultants were responsible for only 2% of the weekly prescription workload and had the lowest rate of interventions at 7%. There was no clear correlation between percentage of chemotherapy prescribed per week and rate of errors.ConclusionThe most common types of errors expected from the background reading are demonstrated by this audit, as the three common interventions are related to poor prescribing. EP should eliminate all three of these interventions as all these are either mandatory fields for a prescription to be ordered or measurable dose rounding will be in inbuilt into each drug field, and therefore calculated automatically by our prescribing system.There was no clear correlation between error rate and proportion of prescribing. Errors are therefore independent of prescribing workload. Alternative reasons for errors could include external factors such as environment or bad habits of the prescriber. I believe the low rate of errors from the consultants is due to the types of prescriptions they often prescribe. Which were more frequently for single agents such as intrathecals. This suggests further data interrogation could identify whether there is a relationship between prescription complexity (or length) and error rate.
ASSESSING PHARMACEUTICAL CARE NEEDS OF PAEDIATRIC IN-PATIENTS: A TEAM BASED APPROACH
Authors: Mott Adele , Kafka Susan , Sutherland Adam 
Published: August 2016

AimsTo pilot a novel approach to providing pharmaceutical care to paediatric inpatients using structured referral and assessment tools. Using standardised referral criteria to ensure patients are assessed by appropriately skilled pharmacists.MethodThree wards of varying acuity and specialism were selected in a tertiary children's hospital in England - General Paediatric Ward (GPW), High Dependency Unit (HDU) and Haematology/Oncology Ward (HOW). The project ran for three months.Three levels of pharmacist were involved: Band 8 (“Level 3”), Paediatric Band 7 (“Level 2”) and rotational band 6/7 (“Level 1”). All patients were initially triaged by an appropriate pharmacist using criteria: Early Warning Scores (EWS), reason for admission, Level 1 Medicines Reconciliation. Patients were then graded according to level of acuity: Level 1: EWS 0–2 AND no significant medication history; Level 2: EWS 2–4 OR significant medication history; level 3: EWS >4.After initial triage patients were handed over using SBAR1 in a structured group “huddle”, and acuity levels validated. Pharmaceutical care plans were formulated and patients allocated to appropriate pharmacists.On the GPW patients were triaged by a level 3 pharmacist (“Refer Down”) for the first 2 weeks. On review of data generated and acuity levels triage was changed to be carried out by a level 1 pharmacist (“Refer Up.”) In the HDU and HOW the Refer Down system was used. All patients in the pilot were reassessed and acuity re-evaluated daily ensuring appropriate pharmacist review.Data was collected on initial acuity level and any change in level following the huddle; (1) to identify those patients in need of a higher level of pharmaceutical input; (2) to identify the level of pharmacist most appropriate to a given clinical area.Results245 patients were assessed. 148 (83%) patients on GPW were triaged as level 1. Using a “refer down” model there was no change in patient acuity. Using “refer up” only 5 patients were reclassified to a higher level of care post-huddle.18 (64%) patients in HOW were triaged as level 3. Eight patients were reduced to level 2 after the huddle. 53% of patients were classified as level 2 post-huddle. There were very few level 1 patients in HOW. PHDU demonstrated similar demographics, though with more level 1 patients.ConclusionThis study demonstrates the potential benefits of a team based approach in optimising pharmaceutical care by directing patients to the most appropriate pharmacist. The huddle facilitates clinical supervision of patients and pharmacists. There may be benefits in efficiency using this system in a resource-constrained environment. This study does not present longitudinal changes in acuity. More research is needed.
CAN THE '4 P'S OF PN' IMPROVE NEONATAL NUTRIENT INTAKE?
Authors: Lansdowne Zoe , Griffiths Elizabeth 
Published: August 2016

AimsELBW infants on NICU were found to have poor growth compared to network data. Previous audit work1 showed that the time from birth to PN did not meet unit guideline targets and did not achieve optimal protein intake. Intensive work was done to publicise this and to decrease the time from birth to PN. Stock PN recipes were also reformulated to concentrate nutrition. The aim of audits 2 and 3 was to analyse whether publicising the 4 P's of PN (prompt, protein, protected and peripheral) could improve protein intake and ultimately increase growth velocity.MethodsThe details of all infants born <28 weeks or <1 kg from 1st September to 30th November 2014 (audit 2) and from 1st April to 30th June 2015 (audit 3) were analysed retrospectively. Data was collected from the patients' medical notes, including parenteral nutrition (PN) prescriptions, fluid prescriptions and observation charts.ResultsOver both 3 month audit cycles, data from a further 52 patients were analysed. It was found that the mean time from birth to PN for inborn infants was reduced from 10 hrs 59 mins to 7 hrs 14 mins, and then again further to 4 hrs 16 mins. On average all patients received more protein in the first 24 hrs of life in audit 3 compared to audits 2 and 1, 0.92 g/kg/day, 0.86 g/kg/day and 0.66 g/kg/day respectively. Just under 1/3 of patients achieved the target protein intake of 1.25 g/kg/day for day 1 of life in audit 3. For inborn patients only, protein intake increased from 0.83 g/kg/day to 1.09 g/kg/day to 1.38 g/kg/day over the audit cycle period. Inborn infants <750 g receiving PN within 6 hrs of birth increased from 17%, to 67%, and finally to 83% in audit 3.Of the infants still on the unit at day 14 of life, the mean daily protein intake increased from 2.15 g/kg/day to 2.35 g/kg/day and then to 2.46 g/kg/day, although the maximum achieved on a single day for a single infant was 3.87 g/kg/day, in audit 2.Average weight gain was 2.97 g/kg/day in audit 1 but this increased to over 7 g/kg/day in audits 2 and 3. All of the infants exceeded their birth weight by day 14 of life in audits 2 and 3, compared to only 71% in audit 1.The percentage of PN quantities prescribed but never administered remained constant between 13% and 16%.ConclusionPublicising the 4 P's of PN ensured that PN was started promptly after birth resulting in increased protein intake on day 1 of life. Reformulating the stock PN bags to a more concentrated recipe, and protecting the PN volume infused, also increased protein intake. The results of these actions were improved growth velocity and all infants regained at least their birth weight by day 14 of life. Work still needs to be done to increase the mean daily protein intake.Peripheral PN was not actioned.
MEDICATION MANAGEMENT OF THE EXTREMELY PREMATURE NEONATE – THE IMPACT OF A SPECIALIST PHARMACIST
Authors: Whitfield Karen , Barkeij Claudia , North Angela 
Published: August 2016

AimTo present a case of an extremely premature infant and the role that the specialist neonatal pharmacist has on the quality of care of these patients.MethodInterventions and recommendations made by the pharmacists over the admission of a triplet born at 23 weeks and 5 days gestation were recorded. The type of interventions were categorised and classified for risk using a consequence/probability matrix.1
ResultsThe patient required admission to the intensive care unit and subsequently the special care unit for a period of 163 days before discharge home. Over the period of admission the patient had a history of a large patent ductus arteriosus, pulmonary hypertension, bilateral grade two intraventricular haemorrhages, neonatal jaundice, hyponatraemia, hyperglycaemia, anaemia of prematurity, retinopathy of prematurity and chronic neonatal lung disease. A pleural effusion developed at day 10 requiring high frequency ventilation. At the age of 3 weeks a pseudomonas sepsis developed together with feed intolerance and abdominal distention. Milk curd syndrome was diagnosed requiring the removal of 30 cm of bowel and placement of a temporary stoma. Long term Parenteral Nutrition was prescribedSixteen interventions were recorded – low risk (3), moderate risk (9) and high risk (4).Clinical advice was provided regarding appropriate dose, therapeutic drug monitoring and administration of antibiotics including gentamicin, meropenem and flucloxacillin to enhance safety and improve efficacy. Owing to the complexity of the medication regimen at times, drug compatibility queries were common. Close liaison with the neonatal consultant, dietician and gastroenterologists was undertaken during long term Parenteral Nutrition and included discussions relating to, administration of additional electrolytes, trace elements and liver function tests. Advice was sought on the dose and administration of loperamide for short gut syndrome and control of diarrhoea. Pharmaceutical advice was provided to ensure medications were optimised for issues associated with drug administration via transpyloric tube to avoid blockage. Calculation of total daily phosphate was undertaken whilst the patient was receiving fortified feeds, to ensure adequate supplementation, to assist normal bone development. Prior to discharge palivizumab prophylaxis was recommended for respiratory syncytial virus Infection. The pharmacist provided advice on administration to the nursing staff and ensured required documentation was completed.ConclusionThe care of the extremely premature neonate involves numerous medication related challenges. This case not only demonstrates the specialist knowledge, skills and attitudes required by a pharmacist working in this complex field but the impact that can be achieved working closely with the neonatal team.
A NATIONAL SURVEY TO IDENTIFY HOW DISPLACEMENT VALUE INFORMATION IS USED AND PRESENTED TO CLINICAL STAFF IN NHS HOSPITALS
Authors: Christiansen Nanna , Kehk Zinab , Keeling Susan , Dean Bryony 
Published: August 2016

AimThe use of displacement values (DVs) when preparing intravenous (IV) medication for children enables accurate doses to be given1 and is assumed to be common paediatric practice. This survey aimed to assess views of UK paediatric pharmacists on DVs in practice to explore:▸ How prevalent is DV use in the paediatric hospital setting▸ Which type of IV administration guidelines were being used▸ Which form of DV presentation is perceived to be most practical▸ Which method of calculation is preferredMethodA national cross-sectional survey study was undertaken. The questionnaire comprised of 13 closed and open questions as well as samples of how DVs are currently displayed on the Medusa Injectable Medicines Guide2. After piloting the questionnaire the survey was sent to 365 paediatric pharmacists across 120 UK hospitals utilising Qualtrics Survey Software.ResultsFifty-five completed questionnaires covering 52 (43%) United Kingdom (UK) hospital trusts were received. Of 55 respondents, 52 (95%) reported the clinical significance of DVs in paediatric care. This was reflected in the fact that all local guides provided information on DVs. The majority (32;59%) used locally produced guides, while 15 (27%) of respondents used Medusa as a resource. All respondents commented on methods of presentation and calculation of DV information. Of four methods presented, the method involving presentation of reconstitution information in a brand-specific table was ranked as most practical (46;84% respondents). This method was viewed as being clear and concise. Respondents also expressed the importance of having this tabulated method visually embedded in the monograph to allow easy access to information on the wards. This concurs with suggested information presentation to aid error reduction in the literature.3 National standardisation of DV information was viewed as ‘very useful' or ‘preferred' by 52 (95%) of respondents; reasons for this preference were risk reduction due to errors or misinterpretation.ConclusionThe use of DVs in paediatrics is commonplace in the UK; this is reflected in local IV guides used by the majority of centres. Improving visual presentation of DVs is important and tabulated expression of DVs is preferred by pharmacists and a national standard presentation of DVs is encouraged. The results from the survey will inform the monograph layout for the Medusa. Prior to implementation nurse feedback should also be sought.
IDENTIFYING PRE-HOSPITAL FACTORS WHICH INFLUENCE OUTCOME FOR MAJOR TRAUMA PATIENTS IN A REGIONAL TRAUMA NETWORK: AN EXPLORATORY STUDY
Authors: Thompson Lee , Hill Michael , Davies Caroline , Shaw Gary 
Published: August 2016

BackgroundMajor trauma is often life threatening or life changing and is the leading cause of death in the United Kingdom for adults aged≤45 years. The aim of this exploratory study was to identify pre-hospital factors influencing patient outcomes for major trauma within the Northern Trauma Network.MethodSecondary data analysis of a combined data set of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (n=1033) was undertaken. Variables included mechanism of injury, age, physiological indices, timings and skill mix. Principle outcome measures included Mortality data and Glasgow Outcome Scales.ResultsGlasgow Coma Scores proved a significant predictor of mortality in major trauma (p<0.00). Amongst other physiological indices, systolic blood pressure ≤90 mm Hg. was associated with both increased mortality (p≤0.004) and poorer morbidity (p≤0.021). Respiration rate <14/minute was also significantly predictive of morbidity (p≤0.03) and mortality (p<0.00). Prolonged response times to the most critically injured patients (p<0.031), and increasing casualty age were significantly associated with poorer outcomes. The attendance of a Doctor was significantly associated with increased mortality (p≤0.036) perhaps validating existing resource despatching practices.Predictors of positive outcomes included the presence of a Doctor when on-scene time ≤50 minutes (p≤0.015), crew arrival on-scene ≤10 minutes (p<0.046) and on-scene time ≤50 minutes (p<0.015).ConclusionThese findings validate GCS, BP and Respiratory Rate values as valid triggers for transport to a Major Trauma Centre. Analysis of the interactions between arrival time, time-on-scene, skill mix and age demand further exploration but tentatively validate the concept of a ‘Golden Hour’ and suggest the potential value of a ‘load and go and play on the way’ approach.
REFINING QUESTIONNAIRE ITEMS IN A PATIENT REPORTED EXPERIENCE MEASURE (PREM) DESIGNED FOR USERS OF NHS AMBULANCE SERVICES: QUESTION APPRAISAL STUDY
Authors: Togher Fiona , Siriwardena A Niroshan , Windle Karen 
Published: August 2016

BackgroundService users' experience of ambulance services is important as a measure of quality in addition to effectiveness and safety of care.This doctoral study focuses on the development of a Patient Reported Experience Measure (PREM), a questionnaire used to assess people's experiences of health care provision.The draft PREM had been piloted with a sample of patients to explore their views of the content and format of the questionnaire. In this next stage we aimed to use experts (including ambulance care providers and academics) to evaluate the quality of the PREM.MethodsThis evaluation involved the use of the Question Appraisal System (QAS-99), originally developed to assist questionnaire designers identify problems with questionnaire items.Participants' were asked to review 20 items from a draft PREM of 60 items, completing a QAS-99 coding form for each questionnaire item they were assigned to evaluate. The form directed their attention to the type of flaws that may be found, for example, problems with question instructions, clarity of wording, potential for bias and response options.ResultsTen participants completed the study. Overall refinements were suggested for 46 of 60 questionnaire items reviewed. Amendments suggested included wording of questionnaire items to improve responders' understanding and interpretation, appropriateness of response options, and decisions on inclusion/exclusion, of specific questionnaire items. The PREM was revised in accordance with these recommendations.ConclusionThe QAS-99 approach to questionnaire evaluation facilitated refinement of the PREM. The final stage of this doctorate will involve further testing of the PREM using cognitive interviews with patients that have recently used the ambulance service to investigate how they interpret and respond to the refined version of the tool.
PREHOSPITAL USE OF KETAMINE AND MIDAZOLAM IN AN URBAN ADVANCED PARAMEDIC PRACTITIONER SERVICE: A RETROSPECTIVE REVIEW
Authors: Edwards Tim , Shaw Joanna , Gray Danielle , Thomson Neil , Faulkner Mark 
Published: August 2016

BackgroundThe use of ketamine and midazolam in physician-led prehospital care teams within the UK is well established. Although both agents are in use by paramedics within emergency medical systems in North America and Australasia, there is a paucity of data relating to administration by UK paramedics.MethodsA panel of clinicians utilised a standardised data extraction form to review patient report forms for all cases where an Advanced Paramedic Practitioner (APP) administered ketamine or midazolam from 1st May to 30th September 2015. Reviewers assessed indications for and appropriateness of administration, and identification and management of adverse events.ResultsA total of 21 patients received ketamine for analgesia (n=20, 95%) or to facilitate rapid extrication (n=1, 5%). Pain scores were recorded in 18 patients (90%), the majority of whom experienced a reduction in pain post administration (n=17, 94%). No adverse events occurred following ketamine use. Midazolam was administered to a total of 80 cases. The most common indications for administration were maintenance of an advanced airway in patients with return of spontaneous circulation post cardiac arrest (n=37, 46%), management of acute behavioural disturbance (n=28, 35%) and prolonged seizures (n=15, 18%). Transient airway compromise occurred in 10% (n=8) of cases, all of which were managed appropriately. No other adverse events occurred. The administration of ketamine and midazolam was judged to be appropriate in all cases.ConclusionsThe use of ketamine and midazolam in the context of an urban APP service with high levels of additional education, procedural experience and selective targeting to emergency calls appears safe and effective. Further prospective studies are warranted to confirm these findings.