REGISTRAR RESEARCH PRIZE ABSTRACTS



Peninsula Health Research Week 2007

Saturday 17 November 2007 – Friday 23 November 2007

ABSTRACT BOOKLET

Poster Display

Registrar Research Prize

Allied Health Research Prize

Nursing Research Prize

Table of contents

Poster Display Competition

HIGH 5 ON HAND HYGIENE 3

DEATH AND END OF LIFE MANAGEMENT IN A METROPOLITAN ICU 4

ACADEMIC DETAILING TO MEDICAL OFFICERS ON COMPLETING DISCHARGE SUMMARY 5

SCREENING STROKE PATIENTS FOR A VERY EARLY REHABILITATION TRIAL (AVERT) 6

USING THE QUALITY CYCLE TO DEVELOP MENU NUTRITION STANDARDS FOR THE PENINSULA HEALTH PATIENT MENU 7

IS THE PROGRESSION THROUGH CLEAR FLUID AND THIN FLUID DIETS NECESSARY POST-OPERATIVELY? 8

EVALUATING LONG BONE FRACTURES IN THE EMERGENCY DEPARTMENT FOR CHILDREN UNDER 5 YEARS: MEETING THE CHALLENGE OF CHILD PROTECTION 9

WHAT A WONDERFUL WORLD 10

TESTING THE RELIABILITY OF MEASURING MUSCLE STRENGTH WITH A HAND HELD DYNAMOMETER FOLLOWING A BRIEF TRAINING PROTOCOL 11

CIRCUIT TRAINING FOR STROKE PATIENTS 12

A COMPARISON OF HIGH FLOW NASAL OXYGEN TO HIGH FLOW FACE MASK OXYGEN IN EXTUBATED PATIENTS. 13

INTENSIVE CARE NURSES’S KNOWLEDGE OF ARTERIAL PRESSURE MONITORING 14

POST-CAESAREAN PAIN RELIEF 15

PHYSIOTHERAPIST IN ORTHOPAEDIC OUTPATIENT CLINIC 16

ACUTE STROKE THROMBOLYSIS WITH INTRAVENOUS TISSUE PLASMINOGEN ACTIVATOR IN AN AUSTRALIAN OUTER METROPOLITAN HOSPITAL 17

OUTPATIENT MANAGEMENT OF TRANSIENT ISCHAEMIC ATTACKS BY THE GENERAL PRACTITIONER IN AN AUSTRALIAN OUTER METROPOLITAN REGION. 18

DYSPHAGIA SCREENING IN AUSTRALIA 19

NUTRITION RISK MANAGEMENT USING A PRE-ASSESSMENT PRIORITY TOOL 20

THE RELATIONSHIP BETWEEN PSYCHOLOGICAL PARAMETERS AND GLYCAEMIC CONTROL IN A DIABETIC CLINIC SETTING. 21

EARLY PREDICTORS OF MORTALITY IN ELDERLY PATIENTS WITH SEPSIS 22

PUTTING EVIDENCE INTO PRACTICE: EVALUATION OF TRAINING CLINICIANS TO PRACTICE CBT AS PART OF ROUTINE CARE IN AN AREA MENTAL HEALTH SERVICE 23

Registrar Research Prize

THE SPLIT THICKNESS SKIN GRAFT DONOR SITE: A comparative study of Tegaderm Absorbent and Kaltostat alginate dressings 27

Anterior fontanelle morphology in unilateral coronal synostosis: implications for clinical diagnosis of frontal plagiocephaly 28

Long term outcomes of surgical tongue reduction in Beckwith-Wiedemann syndrome 29

CHANGE OF PATTERN OF ORAL GLUCOSE TOLERANCE TEST (OGTT) IN PREGNANT WOMEN WITH GESTATIONAL DIABETES MELLITUS (GDM) IN MORNINGTON PENINSULA OVER 10 YEAR PERIOD 30

MYTH BUSTERS: THE INDWELLING CATHETER 31

A SYSTEMATIC EVALUATION OF EMERGENCY MANAGEMENT OF SUSPECTED TRANSIENT ISCHAEMIC ATTACKS (TIA) AND MINOR ISCHAEMIC STROKES (MIS) IN AN AUSTRALIAN OUTER METROPOLITAN HOSPITAL 32

PREDICTORS OF INTENSIVE CARE UNIT MORTALITY IN PATIENTS WITH SEPSIS 33

HIGH FLOW NASAL OXYGEN VERSUS HIGH FLOW FACE MASK OXYGEN IN EXTUBATED PATIENTS; A RANDOMISED CROSSOVER TRIAL 34

OUTCOME OF EXTERNAL CEPHALIC VERSION AT THE WOMEN’S CHILDREN’S AND ADOLESCENTS HEALTH (WCAH) DEPARTMENT, FRANKSTON HOSPITAL (2005 -07) 35

COMPARISON OF OUTCOMES BETWEEN OBESE AND NON-OBESE PATIENTS FOLLOWING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY AT PENINSULA HEALTH 36

DEATH AND END OF LIFE MANAGEMENT IN A METROPOLITAN INTENSIVE CARE UNIT 37

PRE-OPERATIVE MANAGEMENT OF DIABETES – AN AUDIT OF CURRENT PRACTICE 38

THE RELATIONSHIP BETWEEN PSYCHOLOGICAL PARAMETERS AND GLYCAEMIC CONTROL IN A DIABETIC CLINIC SETTING 39

OPTIMISING PATIENT CARE THROUGH THE DEVELOPMENT OF AN OSTEOPOROSIS SERVICE 40

Allied Health Research Prize and Nursing Research Prize

EVALUATING LONG BONE FRACTURES IN THE EMERGENCY DEPARTMENT FOR CHILDREN UNDER 5 YEARS: MEETING THE CHALLENGE OF CHILD PROTECTION 43

NUTRITION RISK MANAGEMENT USING A PRE-ASSESSMENT PRIORITY TOOL 44

THE EFFECTIVENESS OF HAND THERAPY INTERVENTIONS FOR SCAR MANAGEMENT: A SYSTEMATIC REVIEW 45

EARLY MEDICATION RECONCILIATION – THE EARLY BIRD CATCHES THE WORM 46

TESTING THE RELIABILITY OF MEASURING MUSCLE STRENGTH WITH A HAND HELD DYNAMOMETER FOLLOWING A BRIEF TRAINING PROTOCOL 47

A COMPARISON OF HIGH FLOW NASAL OXYGEN TO HIGH FLOW FACE MASK OXYGEN IN EXTUBATED PATIENTS. 48

‘WELL FOR LIFE’ A HEALTH PROMOTION PROJECT IN A RESIDENTIAL AGED CARE SETTING 49

DEVELOPMENT OF A MENTORING PROGRAM FOR NEW GRADUATE OCCUPATIONAL THERAPISTS 50

DEATH AND END OF LIFE MANAGEMENT IN A METROPOLITAN ICU 51

SOCIAL DIMENSIONS OF ADHERENCE TO A PHYSICAL ACTIVITY PROGRAM FOR OLDER VICTORIANS 52

IS THE PROGRESSION THROUGH CLEAR FLUID AND THIN FLUID DIETS NECESSARY POST-OPERATIVELY? 53

SPONSORS 54

HIGH 5 ON HAND HYGIENE

Kaye Bellis

Infection Control Consultant

Hand Hygiene Nurse

Purpose

Following on from Peninsula Health’s participation in Victorian Quality Council’s Hand Hygiene Project, Infection Prevention and Control decided the next phase for us was not only to continue to educate all health care workers but also to include the public. By educating the general public in our catchment area on the whys and wherefores of Hand Hygiene it is hoped to develop good habits in school children early in life and to prompt adult members of the community on what they may have forgotten over time.

Method

To visit external sites and educate via demonstration and power point (at an appropriate level) on the values and reasons why Hand Hygiene is so important. The development of a public brochure on Hand Hygiene for distribution both within the hospital settings and outside has helped.

Conclusions

Its difficult to measure a result but subjectively we aim to raise the public awareness to the reasons why Hand Hygiene is important thus we hope to be able to help reduce the number of sick days to local schools, industry and businesses, the numbers of public outbreaks of infections spread via the hands and the number of hospital admissions as well as empower the public to remind not only health care workers but others such as food handlers, to perform appropriate and timely Hand Hygiene.

DEATH AND END OF LIFE MANAGEMENT IN A METROPOLITAN ICU

Michael Tsiripillis, John Botha, Ravi Tiruvoipati, Diana Hanna,

Melissa Bloomer, Laurel Walker

Intensive Care Unit, Frankston Hospital

Introduction

Death in ICU is often predictable and end of life management is essential when futility of care appears evident. Respect for patients wishes and involvement of the family in the decision making process is essential.

Aim

The aim of this study was to look at aspects of end of life management within our ICU to determine whether the care we provide is optimal.

Method

A retrospective audit was done, of the deaths in our ICU over 12-months. It reviewed patient demographics, reason for ICU admission, expectation of death and Not For Resuscitation status. Family discussions, withdrawal/withholding of treatment, and the presence of family at the time of death were also recorded.

Results

The results showed that the mean age of this population was 69 years, with an expectation of death at 85.7%. This correlated to our NFR status of 84.5%, where the main reason was ‘futility of care’. 62% of this population had at least two organ systems in failure at time of admission. Treatments were not withheld in 69% of cases, and 66% of patients were receiving analgesia at the time of death. Family discussions were held in 90% of cases and family were present at death in 66% of cases.

Conclusion

This data suggest that death in our ICU was often predictable, with treatment strategies in place to ensure patient comfort and minimise distress to patients and their families.

ACADEMIC DETAILING TO MEDICAL OFFICERS ON COMPLETING DISCHARGE SUMMARY

Denis Chang

Pharmacy Department, Frankston Hospital

Aim

To improve accuracy and timeliness of medication information on discharge summaries via the use of academic detailing methodology. The goal was to ensure a comprehensive discharge medication summary which included any alteration to medications during the hospital stay and completed within 48 hours of discharge.

Method

A pharmaceutical company’s trainer was enlisted to educate clinical pharmacists on academic detailing methodology and to assist in developing our goals and detailing materials. A total of 50 patients were recruited for the baseline audit, 1-2 patients were randomly selected from each junior medical officer. Medical staff then received individual academic detailing session, subsequently 50 patients were recruited for a first post-audit and a second post audit will follow.

Results

Based on preliminary data from the first post audit, 87.4% of discharge summaries were documented accurately in the pre-audit and 98.4% post-audit. A high level of efficiency in complete discharge summary was achieved within 48 hours in both the pre and the first post-audit, 97% versus 100% respectively. A significant improvement in documenting alterations of medications in discharge summaries, from 23% (39/166, pre-audit) to 79% (95/120, first post-audit) and there was 62% increase in patients who received a complete and accurate discharge summaries at the first post-audit.

Conclusion

This project demonstrates successful use of academic detailing methodology to educate medical staff to improve the accuracy and efficiency in recording medication information in discharge summaries. It vastly reduces the risk of medication misadventures in the transition between the hospital and the community setting.

SCREENING STROKE PATIENTS FOR A VERY EARLY REHABILITATION TRIAL (AVERT)

Michael Davis

Physiotherapy, Frankston Hospital

Introduction

Frankston Hospital has been asked to participate in a randomised controlled trial to investigate the efficacy and cost effectiveness of very early rehabilitation of stroke patients (AVERT). In keeping with the trial protocol, eligible subjects would need to be admitted under Neurology and transferred to Ward 5GS within 24 hours of stroke onset.

Aim

The aim of this study was to establish whether sufficient eligible cases of stroke are admitted to Frankston Hospital in order to meet the site target set by AVERT (30-60 subjects per annum).

Methods

Data was retrieved on stroke cases (DRG codes B70A-D) admitted in 2006-7, and admission details relevant to basic AVERT eligibility criteria were analysed. A subsequent short-term prospective study was conducted to determine the impact of other organisational factors on patient eligibility for the trial.

Results

Analysis of DRG data showed a strong relationship between short-term outcomes and admitting medical unit (χ2=201, p ................
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