Your Committee 3

Advertise with ASPAAN 3

Stay in Touch 3

President’s Note 5

Disclaimer 5

ASPAAN Seminar: Bariatric Surgery 6

Increasing the Use of an Existing Medical Emergency Team in a Teaching Hospital JONES, MITRA, BARBETTI, CHOATE, LEONG, & BELLOMO

7

Grants 12

Professional Changes or Challenges? HUMPHREY

13

Case Study Notes WONG

14

ASPAAN Membership 4

w w w . a s p a a n . o r g . a uw w w . a s p a a n . o r g . a u

CCONTENTSONTENTS

20072007

Volume 11Volume 11

Issue 1Issue 1

ANAESTHESIA & POST ANAESTHESIA NURSING (4 DAYS) 18th to 21st June or 13th to 16th November 2007

This 4 day course covers in depth Anaesthetic principles and practice course covers in depth Anaesthetic principles and practice.

CLINICAL PACU PRACTICE (RECOVERY) (1 DAY) 20th & 21st June or 15th & 16th November 2007

This course is aimed at those nurses who are Beginner Practitioners / or are anticipating working in this area of practice.

DAY SURGERY CLINICAL PRACTICE (2 DAYS) 23rd June or 17th November 2007

This course has been designed to inform you as a nurse of the principles & current practice issues to enable you to meet your patients needs in this dynamic area of nursing practice

An overview of anaesthesia, post anaesthesia care, anaesthetic drugs, and infection control will be provided.

DAY SURGERY MANAGEMENT (INCLUDING RISK MANAGEMENT) (1 DAY) 22nd June or 16th November 2007

The complexity of complying with new legislation and regulations continues to challenge the management of all the Health Sectors. Delivering a safe and appropriate service which is clinically and financially successful is a challenge to all managers.

This course will address strategies to manage these risks.

To be held at :To be held at : The Australian & New Zealand College of Anaesthetists

630 St Kilda Road, MELBOURNE VIC

PPOSTOST G GRADUATERADUATE EEDUCATIONDUCATION S SERVICESERVICES

• PGES is pleased to offer these short courses in Peri-Anaesthetic Nursing Care.

• 2007 is the 13th year of this course, which has led and continues to lead and support Nurses as Practitioners in the delivery of Anaesthetic Nursing Care in a variety of clinical settings.

• This program offers an update in providing knowledgeable support to Anaesthetists and the delivery of Nursing Care to patients.

• Over 1000 Nurses have attended these courses to further their clinical and practical knowledge in Anaesthetic Nursing Practice.

Comments from previous courses:

“Very professional & friendly approach”

“I’ve found the course extremely inspiring.

Before the course I was thinking of changing

jobs, and now feel I want to improve my unit.”

“I will recommend this course to my col-

leagues.”

Limited Places Available

To avoid being disappointed phone 03 9419 9322 Fax 03 9419 9399 or e-mail debbie2@ihc.com.au

and reserve your place NOW! Further information on courses is available at www.ihc.com.au

POST GRADUATE EDUCATION SERVICE 18 CAMBRIDGE STREET

COLLINGWOOD VIC 3066

It is very important that you keep us informed of your address. All correspondence such as upcoming seminars, conferences, including the newsletter are sent to the last known address. Our membership database is updated quarterly. Any communication from you regarding a change of address is updated at this time. If you are planning on moving or have moved recently, please complete a new membership form.

Advertise with ASPAAN

For Advertising space in this newsletter, or trade display

opportunities at our conferences and seminars,

please contact either Catherine Humphrey, Brent Law, or Chris Vanderstock

Number of Members: 400

The annual subscription date for all ASPAAN

members runs from July 1 to June 30. If you have not renewed for the 2006 / 2007

year, please do so now.

Any queries about the current state of your

membership, please email one of our committee

members.

President & Newsletter Editor Christopher Vanderstock vanderc@svhm.org.au Vice-President Jane Anthony janeanth@bigpond.com Secretary Catherine Humphrey catherine@kozka.com Treasurer & Memberships TBA Corporate Relations Brent Law blaw@bigpond.net.au Website Administrator Gary Martin Gary.Martin@austin.org.au Education Chooi Wong w008ho@yahoo.com.au Kath Fraser k.fraser@alfred.org.au

Committee Members Louise Alexander Wendy Tibballs

ASPAAN Newsletter 3

2007 (11) 1

Stay in Touch

Your Committee

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ASPAAN Newsletter 4

2007 (11) 1

ASPAAN Membership

I hope you had a safe and prosperous Christmas and New Year. If you made any new years resolutions, how are they going? Broken any yet? Me, plenty. That’s why there is always next year!

ASPAAN is currently involved in examining the role and responsibilities of peri-anaesthesia nursing and we would like your input as to the key attributes of this challenging domain of nursing.

From the top of my head, I can think of a few aspects of perianaesthesia nursing to include:

• knowledge of anaesthetic drugs,

• principles of anaesthesia,

• advanced patient assessment skills, and

• airway management,

All the while balancing the multiple pressures of timely patient centred care.

This list is of course only the tip of the iceberg and perhaps a starting point to begin a dialogue between ASPAAN and you, our members, to help shape what will become a statement about the qualities, knowledge, behaviours, et cetera, which constitute a perianaesthesia nurse. Catherine Humphrey has written up ASPAAN’s involvement in a new initiative from DHS. Please ensure that you read this and ensure that our high standard of care to patients, doctors, and your fellow staff members is not put be at risk.

In this issue, I have selected an article which details a recent study performed at The Alfred regarding the impact of revisiting the MET call criteria and personnel involved. Does your PACU have a written policy which specifies when/if you can call a MET call?

Opinions and views expressed within the newsletter are those of the author, not necessarily those of the Australian Society of Post Anaesthesia and Anaesthesia Nurses (herein know as ASPAAN). Nor are the opinions of the editor, or advertisements given official backing of the Society. The Society cannot accept any responsibility for the accuracy of any of the opinions, information, errors or omissions in this newsletter. Articles are published in the ASPAAN newsletter are copyright, and the copyright remains with the author.

ASPAAN Newsletter 5

2007 (11) 1

President’s Note

Disclaimer

What is your out of hours cover like? Do you feel comfortable saying to the anaesthetist, “yes I’m fine, you can go now”. I think it very important that if you do not have the necessary support in PACU for patients experiencing difficulty, then perhaps the inclusion of PACU in the MET call system should be tabled at your next OR/Anaesthetics meeting. ASPAAN would like to invite all members to attend a free education session. The topic covers the growing speciality of bariatric surgery. We have got a great line up of specialists, including our own, Brent Law who will be discussing the peri-anaesthesia nurses perspective. See page 7 for more information. And finally, I would like to make brief mention of the revised layout / design of the newsletter. It has been more than two years since I last adjusted the look of the newsletter. I hope you like it. If you have any suggestions, please email me. Look forward to seeing you in April,

Chris Vanderstock

ASPAAN President / Newsletter Editor

ASPAAN is proud to announce yet another free half day seminar to our members.

BARIATRIC SURGERY

Saturday 21st of April, 2007

St Vincent’s Public Hospital Mortuary Theatre

Main In-Patient Services Building Ground Floor

ASPAAN Newsletter 6

2007 (11) 1

ASPAAN Seminar

This seminar is FREE to all ASPAAN Members.

Cost to non-members is $35.00 for the seminar,

or join ASPAAN on the day for $50 per year.

Please Register prior to Friday the 20th of April, 2007.

RSVP to:

Kath Fraser (k.fraser@alfred.org.au)

09:00am Registration

09:15am Welcome Address Chris Vanderstock ASPAAN President

09:20am Post Operative Care of Bariatric Patients Brent Law, ANUM Alfred Hospital

09:50am Free Morning Tea

10:15am Anaesthesia for the morbidly obese TBA

11:00am Lap Banding Surgery, a surgical perspective Dr Wendy Brown Surgeon

11:45 Question Time

TIME PROGRAM

D. A. JONES*, B. MITRA†, J. BARBETTI‡, K. CHOATE§, T. LEONG**, R. BELLOMO†† Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, The Alfred Emergency and Trauma Centre, Department of Intensive Care, Alfred Hospital and the Departments of Intensive Care and Surgery, Melbourne University, Austin Hospital, Melbourne, Victoria, Australia

SUMMARY Cultural barriers in hospital ward staff may limit the use of a Medical Emergency Team (MET) service. In December2000 the role of the existing Code Blue team in our hospital was expanded to incorporate review of patients fulfillingcommonly employed MET criteria. Between January 2001 and June 2003, the average call rate was only 9.8 calls/1000 admissions. Anecdotal feedback and a group-administered questionnaire conducted in July 2003 demonstrated a number of obstacles to initiating calls and the system was modified in October 2004. Specifically, emergency response calls were separated into Code Blue calls (for cardiorespiratory arrests) and MET calls (with physiological and worried criteria). Further, loud overhead chimes as well as anaesthetist and cardiologist attendance were used only in the case of Code Blue calls (suspected arrests). Finally, the heart rate and respiratory rate criteria for MET service activation were modified. In the 12 months before the intervention (October 2003 to September 2004) there were 817 emergency response calls and 51,963 admissions (15.7 calls/1000 admissions). In the 12 months after the intervention there were 1349 emergency response calls (Code Blue plus MET calls) and 54,593 admissions (24.7 calls/1000 admissions [OR 1.59; 95% CI=1.45-1.73; P<0.0001]). Our findings suggest that increasing the use of an existing service to review patients fulfilling MET criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization. Key Words: medical emergency team, cardiac arrest, emergency response call, quality improvement

ASPAAN Newsletter 7

2007 (11) 1

Increasing the Use of an Existing Medical Emergency Team in a Teaching Hospital

The hospital The Alfred Hospital is a 350-bed tertiary

referral centre affiliated with Monash

University in Melbourne, Victoria. The hospital

provides a wide variety of medical and surgical

services including cardiothoracic and

neurosurgery. Moreover, it contains the

primary trauma and burns units for the state of

Victoria, as well as units for bone marrow, lung

and heart transplantation. The ICU contains

on average 30 beds and operates according to

a closed model, where only intensive care

staff can prescribe therapy.

Overview of hospital emergency call systems Formal data collection on medical emergency

response calls commenced in January 1999.

At that time a single form of medical

emergency response call (“Code Blue” call)

operated to review patients suffering

suspected cardiac arrest. Members of theteam

were notified via the hospital switchboard

* B.Sc.(Hons), M.B., B.S., Department of Epidemiology and

Preventive Medicine, Australian and New Zealand Intensive Care

Research Centre,

Monash University.

†M.B., B.S., The Alfred Emergency and Trauma Centre. ‡ R.N.,

Crit Care Cert, B.Ed., Department of Intensive Care, Alfred

Hospital.

§ Dip App Science (Nursing), Grad Dip Crit Care, Grad Cert,

Trauma Counselling, Masters of Clinical Nursing, Department of

Intensive Care, Alfred Hospital.

** M.B., B.S., F.J.F.I.C.M., Department of Intensive Care, Alfred

Hospital. †† M.B., B.S., M.D., F.R.A.C.P., F.J.F.I.C.M., Depart-

ments of Intensive

Care and Surgery, Melbourne University, Austin Hospital.

This article originally appeared in Anaesthesia and Intensive Care, Vol. 34, No. 6, December 2006, Dr Tim Leong kindly allowed ASPAAN to reprint the article. CV.

using a series of individual pages. In

December 2000, the role of the existing “Code

Blue” team was expanded to include review of

unwell ward patients that had not suffered

cardiac arrest, but who fulfilled predefined

MET criteria. This approach is similar to that

described by Lee and co-workers11. The team

was notified by a paging system as well as an

announcement and loud “chimes” over the

hospital PA system. The criteria for MET

activation were similar to those described

elsewhere6 and were based on perturbations

of heart rate (HR>130 beats/min), respiratory

ASPAAN Newsletter 8

2007 (11) 1

rate (8< RR >30 breaths/min), pulse oximetry

(SaO2<90% despite oxygen therapy) and

acute alterations in conscious state. In

addition, there existed a “staff member

worried” criterion to permit activation of the

service for any other reason.

Between January 2001 and September 2004 a single type of emergency response call (termed “Code Blue” call) continued to operate for both cardiac arrests and patients fulfilling MET crtiteria, and the team comprised ICU, anaesthetic, cardiology and medical registrars, an ICU nurse and the parent unit doctors. As part of a detailed intervention, from October 2004 two types of emergency response call operated and calls were separated into Code Blue calls (for cardiorespiratory arrests) and MET calls (with physiological and “worried” criteria).

Study design The study is a prospective before-and-after interventional trial. All patients admitted to the hospital were considered as participants to the study. A group-administered questionnaire was executed in July 2003. During August and September 2004 an intensive program of nursing and medical staff education was performed by a key group of nurses and an intensivist to reinforce the principles of the MET and to explain the changes to the emergency response calling system. To assess the change in utilisation of the MET, the proportion of hospital admissions subject to an emergency response call (Code Blue plus MET call) after the intervention was compared with the period of MET use in the period January 2001 to July 2003 (commencement of the questionnaire). In addition, we assessed use of the MET in the 12 months after the intervention (October 2004) and compared this to use in the prior 12 months (October 2003 to September 2004), as well as the period that included and preceded administration of the questionnaire (January 2001 to September 2003).

Details of the questionnaire In July 2003 we distributed a questionnaire containing 13 questions to 1900 staff to assess attitudes to the MET service and potential barriers to its use. In particular, we asked whether the staff member had been involved in a MET call, whether they knew and accepted the MET call criteria and the reasons for not initiating a MET call in the presence of MET criteria. The response rate to the survey

was only 29%. The major reasons for not initiating a MET call in the presence of MET criteria included reluctance to go against senior medical and nursing staff, confidcne in the staff members’ own ability to manage the patient and lack of acceptance of the limits for the MET calling criteria. An additional barrier appeared to be the use of the overhead chimes and the large size of the team that arrived to manage MET calls.

Details of the education and intervention The intervention consisted of modifications in four key areas (Table 1, p.10). First, the single Code Blue calling system was separated into a two-tier calling system. Code Blue calls were reserved for patients who were thought to have suffered a cardiorespiratory arrest. A separate MET call was introduced to cater for patients fulfilling objective criteria of physiological instability but not suffering a cardiac arrest. The second modification involved using the overhead chimes only for code blue calls. The chimes are loud and were thought to be acting as a disincentive to staff calling the Met, particularly overnight. After the intervention, activation of the MET service involved an announcement and paging notification of the ward where the MET had occurred. The third modification entailed modifying the heart rate and respiratory necessary to achieve MET criteria, in concordance with those published previously (Table 1)12. Finally, the composition of the two teams was modified. The code blue team retained input from both the anaesthetic and cardiology departments, whereas the MET service comprised only the ICU registrar and nurse and the receiving medical registrar of the day. The parent unit doctors were notified for all medical emergency response calls (Table 1). During August and September 2004 a

detailed program of education was delivered

by an intensivist (TL) and a key group of

nurses (including JB and KC) to all hospital

nursing and medical staff. The presentations

highlighted the theory and evidence behind

the MET, reinforced the MET as a hospital

policy, and outlined the pending changes to

the composition, triggers and methods of

activation of the MET and Code Blue teams. In

the period following October 2004, ongoing

informal education was provided to nursing

staff by the ICU liaison nurses (JB, KC) and

information sessions were provided for all new

ASPAAN Newsletter 9

2007 (11) 1

TABLE 1 Details of intervention aimed at improving the use of the MET service

SaO2, pulse oximetry oxygen saturation; bpm, beats per minute; ICU, intensive care unit.

Variable Before intervention After intervention

Nature of calls Code Blue call for all medical emergency response calls

Emergency response calls sepa-rated into Code Blue calls emergency response calls (for suspected cardiorespiratory ar-rests) and MET calls (with physiological and worried criteria).

Method of calling emergency re-sponse team

Loud overhead chimes and an-nouncement for all calls

Overhead chimes used for Code Blue calls only

Criteria for activation of calls other than cardiac arrest

HR >130 bpm Upper limit of HR increased to >140 bpm BP <90 mmHg systolic Lower limit of HR <40 bpm added RR <8 or >30 breaths / min Upper limit of respiratory rate >36 breaths per minute SaO2 <90% despite oxygen ther-apy Alterations in conscious state

Upper limit of HR increased to >140 bpm Lower limit of HR <40 added Upper limit of respiratory rate >36 breaths per minute

Composition of team attending call

Anaesthetic registrar and/or con-sultant ICU registrar and nurse Coronary care registrar General medical registrar Parent unit doctors

For code blue call Anaesthetic registrar and/or con-sultant ICU registrar and nurse Coronary care registrar General medical registrar Parent unit doctors For MET call ICU registrar and nurse General medical registrar Parent unit doctors

(from page 9)...hospital staff during hospital orientation. Data on admissions and emergency response calls Data on the number of monthly hospital admissions was obtained from the hospital computer system. Data on all emergency response calls is maintained in a detailed logbook by the hospital switchboard operators. The log contains details of the date and time of call and the parent unit of the patient subject to the call. From November 2004, the nature of the call (MET or Code Blue) has also been documented. Data on 3,722 calls between January 2001 and September 2005 were manually entered into a Microsoft

Windows Excel™ spreadsheet by two operators (BM and DJ) who worked concurrently and cross checked entries to minimise errors.

Outcome measures and statistical analysis The number of emergency response calls was quantified and compared with the number of admissions for the same period. Data on the proportion of admissions receiving emergency calls before and after the intervention were compared using the chi-square test and analysed using Stat-view for Windows (Abacus Concepts, Berkeley, CA, D. A. JONES, B. MITRA ET AL U.S.A.). A P value of <0.05 was considered statiscally significant. After the intervention, the

In the subsequent 12-month period

(October 2003 to September 2004) there were

817 emergency calls and 51,963 admissions

(15.7 calls/1000 admissions), giving an odds

ratio (OR) for risk of emergency medical call of

1.36 (95% CI=1.25-1.47, P<0.0001) when

compared with the period preceding and

including the survey (Figure 2).

Change in emergency response calling after the intervention The modifications to the composistion, triggers, and method of activation of emergency response calls in our hospital (Table 1) were associated with a marked increase in the frequency of calls (multiple ..2, P<0.0001) (Figure 2). Thus, there were 1,349 calls for 54,593 admissions (24.7 calls/1000 admissions) in the period October 2004 to September 2005, giving an OR for risk of emergency call after the intervention of 2.16 (95% CI=2.02-2.31, P<0.0001) when compared with the period January 2001 to September 2003. Further, the OR for risk of emergency called was 1.59 (95% CI=1.45-1.73, P<0.0001) when compared with the 12-month period before the intervention (October 2003 to September 2004).

Composition of calls after the intervention Analysis of the nature of the call (MET call or Code Blue call) was possible from November 2004. The majority of calls after this period were MET calls and there was a trend for reduction in the use of Code Blue calls. Thus, there were 24 Code Blue calls from a total of 120 calls in November 2004 and 17 Code Blue calls from a total of 127 calls in September 2005 (OR for Code Blue call=0.62; 95% CI=0.31-1.22; P=0.16).

DISCUSSION We conducted a study to assess the effect of a detailed intervention on the frequency and pattern of use of medical emergency response calling for acutely unwell ward patients in our hospital. We found that modification of the staff composition, triggers and method of activation of emergency response calls in our hospital was associated with a marked increase in our hospital was associated with a marked increase in use for patients fulfilling MET criteria. Previous studies have shown that the uptake of a MET service in a hospital may take time5. Similar observations have been made for trauma systems9. At least two studies have shown that use of a MET service

frequency of Code Blue and MET calls were assessed independently.

RESULTS Pattern of emergency response calling before intervention The emergency response call rate was essentially unchanged at an average of 9.8 calls/1000 admissions until administration of the survey in July 2003 (Figure 1). Between January 2001 and September 2003 there were 2,373 emergency calls for 204,326 admissions (11.6 calls / 1000 admissions).

FIGURE 1: Line diagram showing number of emergency calls per thousand admissions before the administration of the group administered questionnaire. The average call rate between January 2001 and July 2003 was 9.8 calls / 1000 admissions.

FIGURE 2: Histogram showing the frequency

of emergency admission calls for three time

intervals. The questionnaire was conducted in

July 2003 and the detailed intervention to

increase use of the MET commenced in

October 2004. Shown is the frequency of

emergency calls for the year before and after

the detailed intervention, as well as the period

January 2001 to September 2003. Odds ratios

ASPAAN Newsletter 10

2007 (11) 1

In addition, it does not exclude an increase in the use of the service due to other factors such as the passage of time and word of mouth following the administration of the survey. However, use of the MET service was markedly higher than the period before the intervention and was also higher than the 12-month period that followed the survey. Finally, our study does not assess the effect of the increased MET use on changes in outcomes such as unexpected ICU admission and cardiac arrest. These questions will require subsequent studies. In summary, we have demonstrated that it is possible to increase the use of an existing system to review unwell wward patient fulfilling MET criteria. Although the specific barriers identified in our study may not apply to other hospitals, the generalities of our approach do. Achieving behaviour change requires 1) a period of “information and diagnosis analysis” (e.g. assessment of barriers using a questionnaire or focus groups), 2) development of strategies to address these barriers, 3) implementation of these strategies (e.g. education and focus groups) and 4) maintenance of behaviour change through constant reminding and positive feedback13.

REFERENCES 1. Franklin C, Mathew J. Developing strategies to prevent in hospital cardiac arret: analysing responses of physicians and nurses in the hours before the event. Cri Cre Med 1994; 22:244-247. 2. Schin RMH, Hazday, N Pena M et al. Clinical antecedents to in hospital cardiopulmonary arrests. Chest 1990; 98:1388-1392. 3. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman KM. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom—The ACADEMIA study. Resuscitation 2004; 62:275-82. 4. Buist MD, Moore GE, Bernard SA et al. Effects of a medical emergency team on reduction in incidence of and mortality from unexpected cardiac arrest in hospital: preliminary study. BMJ 2002; 324:387-390. 5. Kenward G, Castle N, Hodgetts T, Shaikh L. Evaluation of a Medical Emergency Team one year after implementation. Resuscitation 2004; 61:257-263. 6. Bellomo R, Goldsmith D, Uchino S, Buckmaster J et al. A prospective before-and-after trial of a medical emergency team. Med J Aust 2003; 179:283-287.

(from page 11)...by hospital staff may be impeded by cultural barriers in the hospital4,10. Specifically it has been suggested that medical and nursing staff are reluctant to breach the “traditional” hierarchical system of patient management that usually involves notification of the most junior member of medical staff first4. In both of these studies a detailed education program was required to increase use of the existing MET service. In our hospital, the major barrier to initiating review of unwell ward patients appeared to be reluctance to use the traditional Code Blue team to review patients fulfilling Met criteria who had not suffered a cardiorespiratory arrest. The two major concerns related to the size of the attending team and the use of the loud overhead chimes to initiate the call. The introduction of a two-tier calling system and provision of a MET service with a more discrete activation mechanism was associated with a marked increase in the use of the system. Additional barriers to calling the MET may have included a lack of acceptance of the limits of the existing MET criteria, as some patients had baseline vital signs that were always approximating MET criteria. Furthermore, some ward staff indicated that they felt comfortable in managing the patient themselves. Finally, on some occasions ward staff indicated a reluctance to call the MET either because they felt disempowered, or because they feared criticism from the MET regarding their management. Our study has several strengths and limitations. It is the second to formally report that a detailed intervention can produce increased use of a MET. DeVita and co-workers presented a retrospective analysis of 3,269 MET calls (Condition C responses) in a 622-bed university hospital7. Over 6.8 years, the use of the MET at this hospital rose from 13.7 MET calls/1000 admissions to 25.8 calls/1000 admissions. In the current study we were able to increase the call rate in our hospital from 15.7 to 24.7 calls/1000 admissions in just one year following the intervention. Importantly, our current call rate is three times that of the call rate seen in the first ix months of the recently completed MERIT study (8.3 calls/ 1000 admissions)8. This observation emphasises the fact that time may be required for a system change such as the MET service to become established in a hospital. Despite these strengths, our study reveals the experience of only a single centre.

ASPAAN Newsletter 11

2007 (11) 1

ASPAAN was formed with the idea of providing continuing education, research and professional development opportunities for nurses in the specialty of Anaesthesia and PACU nursing. Study days, combined group seminars and conferences have all contributed to furthering education and providing the networking opportunities so important in this area. All of these events contribute to the ideals of the group and therefore to optimal patient care. With all of this in mind, the committee is keen to encourage members to make use of grants available through ASPAAN. An education and research fund has been established and the ASPAAN committee extends to members an invitation to apply for these grants. We would like to see an enthusiastic response to the research challenge. There must be a lot of questions out there, and you may be able to solve some problems or at least give us your educated (and well researched) opinion. For more information about our education and research grants, please either write to us for an application form, or go to: www.aspaan.org.au/grants.html

7. DeVita MA, Braithwaite S, Mahidhara R et al. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 2004; 13:251-425. 8. MERIT study investigators. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005; 365:2091-2097. 9. Jurkovich GJ. Strengthening of the case for organised trauma care systems. Lancet 2000; 335:1740-1741. 10. Foraida MI, DeVita MA, Braithwaite S et al. Improving the utilisation of medical crisis teams (Condition C) at an Urgban Tertiary CCare Hospital. J Crit Care 2003;19:87-94. 11. Lee A, Bishop G, Hillman KM, Daffurn K. The Medical Emergency Team. Anaesth Intensive Care 1995; 23:183-186. 12. Bristow PJ, Hillman KM, Chey T et al. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 2000; 173:236-240. 13. Grol R, Wensing M. What drives change?

Barriers to and incentives for achieving

evidence-based practice. Med J Aust 2004;

180:S57-S60.

ASPAAN Newsletter 12

2007 (11) 1

CORRESPONDENCE: Dr T. Leong

Department of Intensive Care

The Alfred Hospital Commercial Rd, Melbourne

Vic. 3004.

Grants

delivering sedation in theatre for less complex

procedures and “off the floor procedures” such as

burns dressings and

radiology procedures. 4 The Clinical Assistant in

Recovery is a nursing support role involving

cleaning, restocking, data collection and organising

patient belongings etc.

ASPAAN have been actively contributing to the discussions

and our primary focus is on ensuring that patient care is

delivered by knowledgeable, skilled and educated individuals

as well as protecting the interests

of our members.

Catherine Humphrey Secretary ASPAAN.

The Better Skills, Best Care strategy has been initiated by the

Department of Human Services (DHS) and seeks to encourage

health services to explore new

and redesigned work roles and provide support to pilot and roll

out initiatives. Perianaesthesia is one area

which has been identified as an area for workforce redesign.

ASPAAN has been invited to participate in the reference and

advisory groups as one of the key stakeholders. The project is being

undertaken at the Alfred hospital in Melbourne.

There are four new roles proposed: Anaesthetic Assistant,

Anaesthetic Clinician, Delivery of

Sedation (Theatre/Off the floor procedures) and Clinical Assistant

(Recovery). 1 The Anaesthetic

Assistant role is aimed at Division 2 Registered

Nurses and appropriately trained theatre technicians.

The role involves assisting the Anaesthetist with the

delivery of anaesthetic care.

2 The Anaesthetic Clinician is an advanced practice role

for Registered Nurses

providing resource support to assist with more complex

cases in theatre and an extended scope of practice

in Recovery. 3 Delivery of Sedation is

an advanced practice role for Registered Nurses

ASPAAN Newsletter 13

2007 (11) 1

BETTER SKILLS, BEST CARE PROJECT

Professional Changes or Challenges?

• 1900hrs: Total blood loss 1700mls. prepare for O.T. for EUA.

• Blds taken for Hb, U&E, FBC, coag studies. Xmatch 4 units

ANAESTHETIST ASSESSMENT

• ASA 3 • HELLP: platelets 127 L. Hb 114

@1300hrs • High BMI ratio • Abnormal LFT • Anxiety/ Depression • Investigation: Hb 100 on Haemacue • Blood gases done. • Main IV • Art. Line.-blood taken for arterial gases. • (Ph7.39: pCO2 32L, pO2 94, HCO3 19L, • Base excess 5.3L) • Crash induction with suxmethonium.

• Dexa. Max., aramine, morphine 3mg, kytril, clonidine, cephalothine.

• Haemacue - Hb 90 after induction, 2 units Red cells

• Patient still bleeding +++. 2 units RBC • Further bld tests: FBC, Coag., DIC screen.

• 22.30hrs pt transferred to ICU. Operation Record

• Diagnosis: Uterine Atony • Patient had EUA. • Findings:

• No retained products. No cervical tears. No vaginal lacerations.

• Intramyometrial PG F2 alpha via 22g spinal needle.

• Well contracted uterus. ICU

• Stayed over night in ICU • B/P initially hypertensive – 180/100- • B/P Stabilised with hydrallazine 5mg I.V. x

2 • Magnesium sulphate infusion @4mmol/hr. • Urine output > 30ml • SaO2 97% @ 6 L O2

• Husband stayed overnight. Baby in SCN POSTNATAL WARD

• 25/9/06 Returned to P/N ward • Daily P/N check • On oral aldomet and PRN analgesia.

• Infant feeding: on expressed EBM and nursed in SCN intially.

• Parentcraft: encouraged rooming in.

Late last year, Chooi from our ASPAAN committee presented a case study on obstetric emergency. Members requested the reprint of her power point overheads, and finally, here they are! CV

• 28 yr old female, G3P2 • Past Obstetrics History: • 1995 vaginal delivery(VD) – pre eclampsia

– live infant. • 1997 VD Normal - live infant. • On both occasions, patient had mastitis in

the postnatal period. • Family history: father has high B/P • Medication: on Exfor for depression.

Suffers from depression for 2 yrs. Antenatal

• LMP 17/1/2006 • EDD 23/10/2006 • Obstetrics complication this pregnancy :

Pre eclampsia . Has proteinuria. • Bloods tests revealed abnormal LFTS

and low platelets and suggested history of HELLP syndrome. (Haemolysis Elevated Liver Low Platelets)

• Weight of patient on 8/3/06: 68.3kg • Weight of patient on 11/9/06: 100kg Delivery Record

• Labour : 23/9/06 13.00 - induced @ 35 wks –A.R.M. and syntocinon. Proteinuria 3+ in labour

• B/P systolic bet. 165-140 mmHg: diastolic : 90-100mm Hg.

• Bloods taken for U/E, Uric acid, FBE, LFTs

• Duration of labour: vertex presentation, less than 4 hrs.

• Live infant @ 1500hrs. 3.110kg. Apgar7@1 min, 8@5min.

• Analgesia: pethidine 150mg and maxolon. @14.30

• Third stage: complete. • Perineum: 1’ tear sutured. • 1545hrs: uterus relaxed – massaged-

700mls blood expelled. • Cytotec 1000mcg inserted pr. • I.V. Syntocinon 40 units in 1 litre

commenced.

ASPAAN Newsletter 14

2007 (11) 1

Chooi Wong

Case Study Notes

• Assist and supervise PRN • Observe parent/infant interaction -

BONDING • Debrief mother about birth experience. • Discharge planning • Both mother and baby were discharged on

28/9/06

ASPAAN Newsletter 15

2007 (11) 1

Acknowledgement: • To Dr. Pillay for his permission to use the case study.

• Thanks to Colleen Flanders for her I.T. skills.