Patient education has been considered as an integral component of care for patient after myocardial infarction. Post myocardial infarction patients require information and knowledge related to their conditions to reduce anxiety and aid recovery. The objective of this study was to identify nurses’ perception on information needs of post MI patients of UKMMC. A cross sectional study using Cardiac Patient Learning Needs Inventory (CPLNI) adopted from Timmins and Kalizer (2002) was used. It comprises seven cate-gories: related to anatomy and physiology, psychological factor, life style factor, medi-cation information, dietary information, physical activity, and symptom management. This study was conducted in coronary care unit (CCU), coronary rehabilitation ward (CRW), medical ward 1 and medical ward 2 from January 2007 to March 2007. 56 res-pondents (96%) who fulfilled the inclusion criteria were recruited in this study. Results showed that CCU and CRW respondents ranked symptom management as their first ranking followed by medication, life style factor, anatomy and physiology, dietary in-formation, physical activity and psychological factor. However, respondents in Medical Ward 1 and 2 reported and ranked medication information as their top priorities fol-lowed by symptom management, psychological factors, dietary information, physical activity, anatomy and physiology and life style factor. There were significant differ-ences between ward nurses’ responses with their perception related to anatomy and physiology, psychology factor, life style factor, physical activity, and symptom man-agement with p value
Critical incident monitoring in anaesthesia is an important tool for quality improvement and maintenance of high safety standards in anaesthetic services. It is now widely accepted as a useful quality improvement technique for reducing morbidity and mortality in anaesthesia and has become part of the many quality assurance programmes of many general hospitals under the Ministry of Health. Despite wide-spread reservations about its value, critical incident monitoring is a classical qualitative research technique which is particularly useful where problems are complex, contextual and influenced by the interaction of physical, psychological and social factors. Thus, it is well suited to be used in probing the complex factors behind human error and system failure. Human error has significant contributions to morbidities and mortalities in anaesthesia. Understanding the relationships between, errors, incidents and accidents is important for prevention and risk management to reduce harm to patients. Cardiac arrests in the operating theatre (OT) and prolonged stay in recovery, constituted the bulk of reported incidents. Cardiac arrests in OT resulted in significant mortality and involved mostly de-compensated patients and those with unstable cardiovascular functions, presenting for emergency operations. Prolonged-stay in the recovery extended period of observation for ill patients. Prolonged stay in recovery was justifiable in some cases, as these patients needed a longer period of post-operative observation until they were stable enough to return to the ward. The advantages of the relatively low cost, and the ability to provide a comprehensive body of detailed qualitative information, which can be used to develop strategies to prevent and manage existing problems and to plan further initiatives for patient safety makes critical incident monitoring a valuable tool in ensuring patient safety. The contribution of critical incident reporting to the issue of patient safety is far from clear and very difficult to study. Efforts to do so have tended to rely on incident reporting, the only practical approach when funding is limited. The heterogeneity of critically ill patients as a group means that huge study populations would be required if other research techniques were to be used. In the era of evidence-based medicine, anaesthetists are looking for alternative evidence-based solutions to problems that we have accepted traditionally when we cannot quantify for good practical reasons. In the quest for patient safety, investment should be made in reliable audit, detection and reporting systems. The growing recognition that human error usually result from a failure of a system rather than an individual should be fostered to allow more lessons to be learnt, an approach that has been successful in other, safety-critical industries. New technology has a great deal to offer and investment is warranted in novel fail-safe drug administration systems. Last but not the least the importance of simple and sensible changes and better education should be remembered.
BACKGROUND: This was a double-blinded, prospective randomized controlled trial to compare the postoperative analgesia, side effects profile and overall satisfaction in patients who received intrathecal fentanyl with or without morphine for elective Caesarean.
METHODS: Sixty ASA I and II parturients were randomized into two groups. Group I received intrathecal fentanyl with 0.1 mg morphine and Group II received intrathecal fentanyl only. Postoperatively, all patients were provided with oral analgesics. The degree of post-operative pain score was assessed by verbal pain score. The incidence of side effects was assessed every 4 hours for 24 hours, which included incidence of nausea, vomiting, pruritus, sedation and evidence of respiratory depression. Patient's overall satisfaction was also recorded.
RESULTS: The verbal pain score was significantly lower in morphine group up to 20 hours postoperative period. The incidence of pruritus, nausea and vomiting were statistically significant up to 12 hours postoperative. There was no incidence of severe side effects in all the patients. There was significant difference between the morphine and no morphine group in terms of overall patient satisfaction.
CONCLUSION: There was significant difference in terms of lower pain score, higher incidence of side effects with better patients' overall satisfaction in morphine group.
A prospective randomized double-blind study was conducted which involved, 60 ASA 1-2, aged 18-65 years patients, who had elective or emergency orthopaedic surgeries of the upper limbs. They were randomly divided into two groups: Group I received 30 mls of 0.5% ropivacaine; and Group II received 0.5% levobupivacaine for infraclavicular brachial plexus block based on the coracoid approach. The onset time required for sensory block of all required dermatomes (C5-T1) and the onset time of motor block were documented. Based on the Visual Analogue Score, pain scores were recorded every 30 minutes during surgery and at the 6th hour. The mean onset time (SD) for sensory block with ropivacaine was 13.5 +/- 2.9 minutes compared to levobupivacaine at 11.1 +/- 2.6 minutes (p = 0.003). The onset time for motor block was 19.0 +/- 2.7 minutes in Group I compared to 17.1 +/- 2.6 minutes (p = 0.013) in Group II. Patients in both groups experienced both mild to moderate pain at the 6th hour. In conclusion, there were statistically significant differences in the onset-time for sensory and motor block. However, there was no statistically significant difference in terms of effectiveness of analgesia at the 6th hour. Although the clinical advantage of levobupivacine is not substantial, its safety profile becomes a major consideration in the choice of local anaesthetic for brachial plexus block where a large volume is required for an effective result.
This study to evaluate the relationship between end-tidal carbon dioxide pressure (ETCO2) and arterial partial pressure of carbon dioxide (PaCO2) included 35 patients between the ages of 18 and 65 years, ASA grade 1 and 2, who had elective craniotomies. Measurements of PaCO2 and ETCO2 were taken simultaneously: 1) 10 minutes after induction of general anaesthesia, 2) after cranium opening prior to dural incision, 3) start of dural closure. There was significant correlation between ETCO2 and PaCO2 (correlation coefficient: 0.571, 0.559 and 0.629 respectively). The mean (SD) difference for PaCO2 and ETCO2 were: 3.84 (2.13), 4.85 (5.78) and 3.91 (2.33) mmHg respectively. Although there was agreement, the bias is of significant clinical importance. In conclusion, we find that ETCO2 consistently underestimated the value of PaCO2 during craniotomy.
This was a prospective randomised, controlled, single-blind study done to determine the effect of intrathecal morphine 0.1 mg as compared with intrathecal fentanyl 25 microg in terms of analgesia and duration for postoperative pain relief after Caesarean section. Sixty ASA I or II parturients were randomised into two groups. Group 1 (n=33) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 0.1 mg morphine while Group 2 (n=27) received 1.8 ml of 0.5% hyperbaric bupivacaine combined with 25 microg fentanyl for spinal anaesthesia. Postoperatively, all patients were provided with patient controlled analgesia (PCA) morphine. Pain was assessed using visual analogue score (VAS) at 6, 12, 18 and 24 hours. Time to first demand of PCA morphine, cumulative PCA morphine requirement and opioid side effects were documented. The VAS for pain and the cumulative PCA morphine requirement were both significantly lower in Group 1 (p < 0.05) during the 24 hours study period. The time to first demand was also significantly longer in Group 1 (p < 0.05). Overall, there were no significant difference between the two groups in side effects, except for a high incidence of nausea and vomiting requiring treatment in Group B in the first six hours. In conclusion the addition of 0.1 mg morphine for spinal anaesthesia provided superior and longer postoperative analgesia after Caesarean section.
Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.
This prospective, randomized, study was designed to compare the effect of two different preloading volumes of Ringer's lactate for prevention of maternal hypotension induced by spinal anaesthesia for Caesarean section. Eighty ASA I or II obstetric patients were randomized to two groups. Group 1 (n = 40) received 20 ml/kg of Ringer's lactate and Group 2 (n = 40) 10 ml/kg of Ringer's lactate over 20 minutes before spinal anaesthesia. The lowest mean arterial pressure (MAP) for both groups were recorded at 15 minutes after giving spinal anaesthesia, This difference in the drop of MAP from base-line at 15 minutes (mean decrease of 12.5 mmHg from baseline), between preloading with 10 ml/kg and 20 ml/kg of Ringer's was statistically significant. Twelve patients from Group 1 required bolus doses of ephedrine and 15% of these needed additional crystalloid whereas two patients from Group 2 needed ephedrine boluses and 22% of these required additional crystalloid. The difference in frequency of requirement for treatment of hypotension was not statistically significant. There were five patients in Group 1 and six patients in Group 2 who experienced nausea and vomiting, the frequency of occurrence did not show any statistically significant difference between the two groups. In conclusion, for prevention of hypotension during spinal anaesthesia for Caesarean section, infusing 20 ml/kg or 10 ml/kg of Ringer's Lactate gave similar results and we do not recommend the use of a larger volume of crystalloid for preloading before spinal anaesthesia.
Coronary Artery Bypass Grafting (CABG) surgery has increased the survival rate for individuals suffering from myocardial infarction or coronary ischemia. The present study aimed to examine the perception of quality of life amongst post CABG patients at the National Heart Institute Malaysia. A total of 69 post CABG patients, were studied using the Medical Outcomes Short Form 36 (SF-36). The findings showed that post CABG respondents possessed good level of quality of life (SF-36) physically and mentally. There were significant differences between the role physical in the physical functioning domains of quality of life with gender (t=0.286, p
The main goal of perioperative transfusion is to reduce the morbidity and mortality associated with inadequate delivery of oxygen to the tissues during surgery. In this audit, the primary trigger for transfusion was clinical anaemia assessed by examination of a patient's conjunctiva [40.7%] followed by estimation of blood loss of greater 20% of total blood volume [29.3%]. Haemoglobin estimation in the operation theater was not done in 45.9% of studied patients and only 7.8% patients had transfusion based on this criteria. A common practice is to transfuse blood for hypovolaemia. This was the indication for blood transfusion in 96 patients (7.8%). Inappropriate use of blood in this way has led to wastage of a valuable resource and exposed patients to potential risks of unwanted side effects. Analysis of haemoglobin estimation at recovery room showed 32% of patient with co-morbidities had Hb > 10 gm% while 65% and 29.5% of patients without co-morbidities had Hb > 8 gm% and 10 gm% respectively. This reflects the practice of anaesthetists in maintaining a target of Hb of 10 gm% for both groups of patients while a target of 8 gm% is still relatively safe for patients with good cardiovascular reserves. This has resulted in signifant use of homologous blood which will certainly burden the blood bank and increase the cost of healthcare.
Critical incident reporting is a useful quality improvement technique for reducing morbidity and mortality in anaesthesia. This study analyses 93 cases in Kuala Lumpur Hospital from July 1995 to January 1997. The main incidents during anaesthesia in this study were airway incidents. While human error was identified as the main factor contributing to the occurrence of adverse incidents. Critical incident monitoring plays an important role in identifying potential problems, which may lead to disaster. The findings from this report of the anaesthesia incident monitoring study continued to indicate the occurrence of similar problems seen in an earlier report. The identification of common incidents can be used to identify risk factors and minimise repetition of such incidents.
Post operative pain is an expected adverse outcome following surgery and it often delays mobilization and overall recovery. Acute post operative pain is subjective and cannot be measured directly. The objective of this study was to determine nurses’ knowledge and attitude towards post operative pain management. A cross sectional study was conducted in surgical wards and the Intensive Care Unit of Universiti Kebangsaan Malaysia Medical Centre from February to April 2008. A 28 item questionnaire which comprised of two domains: knowledge and attitude towards post operative pain management was used. Eighty four respondents successfully responded to the study. Twenty respondents (25%) possessed high level, 58 respondents (69%) possessed moderate level and 5 respondents (6%) had low knowledge level of post operative pain management. Positive attitude towards post operative pain management was reported by 66 respondents (78.5%). There was a significant relationship between nurses’ academic qualifications and attitude towards post operative pain management (χ² =29.96, p
BACKGROUND AND AIMS: Nurses play a pivotal role in pain management. Unrelieved pain significantly interferes with patient's quality of life and is of great concern to nurses. The aim of this study was to determine the knowledge level and attitudes of nurses related to pain management.
MATERIALS AND METHODS: This descriptive study was conducted in an urban hospital. A total of 84 registered nurses were recruited using a modified version of questionnaire of Knowledge and Attitudes Survey Regarding Pain.
RESULTS: The findings showed that respondents possessed good knowledge (99.12±14.810) and attitude (66.00 ±10.415) towards pain management. Fifty five respondents (66%) responded as positive to cultural beliefs affecting their pain management and 65 respondents (77%) viewed that their personal experiences had influenced their practice in pain management. Another 45 respondents (54%) reported they have attended pain course. There was no significant difference in pain management between respondents' year of service, cultural belief and personal experiences (p=>0.05). In terms of knowledge towards to pain management, respondents' age groups of more than 40 years were noted to possess better knowledge (p=0.046), unmarried respondents (p=0.018), and attended pain course (p=0.001) were significant. Attitude towards to pain management was not significant (p≤0.05).
CONCLUSION: Nurses' knowledge and attitudes scores were impressive but there is room for further improvement to pain management. Continuing education organized by the hospital had significant impact on the nurses. However, this education course has to be reinforced from time to time in order to improve patients' pain experiences.
BACKGROUND AND AIMS. The experience in intensive care unit (ICU) has created an intense emotional situation both to patients and their family members. The aim of this study was to determine the family members information needs of critically ill patients in ICU.
MATERIALS AND METHODS:
A descriptive cross-sectional study was conducted on 200 family members of patients admitted in ICU. A face to face interview was conducted and a self-report questionnaire of the Critical Care Family Needs Inventory (CCFNI) was used.
RESULTS:
Findings reported CCFNI five sub-attributes that ranked from highest to lowest included: support (mean 39.13 ± 6.189); proximity (mean 27.17 ± 3.384); information (mean 24.25 ± 3.093); assurance (mean 22.67 ± 1.862) and comfort (mean 16.24 ± 2.776). There were no significant differences in needs between family members with different gender (p >0.05). However, there were significant differences in support needs between family members with admission to ICU with (t=-2.111; p <0.05). There were significant differences in assurance needs (F=3.542; p <0.05) and information needs (F=3.681; p <0.05) between family members with age. There were no significant differences in needs between family members with different education level (p >0.05) whereas assurance needs were significant differences with education level of (F=3.542; p <0.05).
CONCLUSION:
The results suggest that family members perceived support and proximity as the most crucial need. Comfort need was viewed as least important. Although this study was conducted in a tertiary hospital, the findings could still provide insight for nurses to improve the delivery of care to patients and family members.