Master of Nursing Science Research Projects

THE ROYAL CHILDREN’S HOSPITAL

Evaluating the preparedness of Advanced Practice Nurses to implement Evidence-Based Practice within a tertiary Paediatric setting.

Mentor: Professor Fiona Newall
Group 1: Georgia Borrack, Georgina Cocklin, Rachel Powell, Zahir Saldin, Rachel Nheu, Bin Li, Arvinder Kaur

All nurses are expected to use principles of Evidence Based Practice (EBP) when performing their nursing roles. The expectation holds that nurses performing more advanced roles ought to have more advanced skills in EBP principles, however this has never been evaluated within a tertiary paediatric setting. Literature suggests that improved patient outcomes can be achieved through the implementation of EBP. This study determined the baseline level of confidence RCH Advanced Practice Nurses have in utilising principles of EBP. Data from this survey supported the development and implementation of targeted strategies to support these nurses to delivery optimal patient care.

Parental preference for the location in which painful procedures are performed on their hospitalised child – a survey based study.

Mentor: Dr Sally Lima
Group 2: Viet Bui, Shannen McGrath, Maria Soetjipto, Sharan Kaur, Elly Pondeljak, Giovanni The, Huyen Nguyen, Jessica Smith

A study conducted in one ward at RCH across 2014-15 demonstrated that parents have a strong preference for painful procedures to be performed on their child in the child’s hospital room, rather than in a Treatment Room. Prior evidence suggested that patients (and families) would prefer to have these procedures performed in a place other than their room, in order to keep their room “safe”. Given this information from one ward, this study determined parent preference for location of painful procedures across all inpatient units of RCH (excluding PICU, NICU and Banksia wards). This information was used to generate a clear Clinical Guideline regarding recommendations for performing procedures within this hospital.

Prospective audit of unfractionated heparin exposure across inpatient units at the RCH

Mentor: Professor Fiona Newall
Group 3: Felicity Smith, Shalini Veloosamy, Sherome Dias, Ilham Aden, Kasuni Punchi- Wedikkarage, Aditi Rao, Anita Chan, Sylvan Tour

Unfractionated heparin (UFH) is one of the top 5 medications associated with drug errors in tertiary hospitals. Within paediatric practice, the use of UFH remains common, as it is the only anticoagulant available that is short acting and fully reversible. This audit investigated the daily exposure of inpatients at RCH to UFH administered for primary thromboprophylaxis or the treatment of thrombosis in children. Using a purpose designed data collection tool, students visited all inpatient units (except Banksia) each day for 5-7 days to determine how many children received UFH, what dose was given, was a valid order present, was the UFH administered via Guardrails, and did the UFH use comply with the UFH Clinical Practice Guideline. Information from this audit determined the daily exposure of UFH to inpatients at RCH, and the level of adherence of current practice to our hospital Clinical Practice Guideline.

Prospective audit of hospitalised children requiring High Dependency care at RCH

Mentor: Dr Sharon Kinney
Group 4: Sue Naidu, Yang Gao, Erin Williams, Stacey Meek, Benju Gnawali, Lucy White, Tahlia Lam, Sangita Dhungana

Each day approximately 25 children on the wards at RCH are classified as requiring High Dependency care. These children require closer observation and monitoring and are staffed with an increased ratio of 1 nurse: 2 patients. To ensure patient complexity and workload are captured, each shift, Nurse Managers are required to review the child’s allocation to High Dependency care utilising the recently revised high dependency admission and discharge criteria. This prospective audit required students to review daily children admitted to High Dependency care over a period of at least 7 days. Data was collected about the timing of admission and discharge from High Dependency care, the specific criteria that determined High Dependency status and the planning of nursing care. Outcomes of this audit provided a better understanding of current practice and determined how well the criteria identify children requiring High Dependency care.

Paediatric assessment and clinical deterioration: State-wide survey of nurses’ education needs

Mentor: Jen Sloane
Group 5: Feina Guan, Sharni Stevens, Jessica Majewski, Jennifer Hohn, Ka Tsui, Kittiya Eldridge, Rosemary Morgan

Recently, a set of standardised observation and response charts for hospitalised children have been implemented in Victorian hospitals with paediatric patients. The observation charts known as ViCTOR (Victorian Children’s Tool for Observation and Response) assist clinicians to detect and respond to paediatric deterioration. Throughout the implementation of ViCTOR, it has become apparent that nurses, especially those who care for children in non- tertiary settings, would like more education about assessment of paediatric patients. Anecdotal feedback indicates that nurses would like education that not only supports the performance of paediatric observations, but greater emphasis should be given to the interpretation of observations and how to perform a more comprehensive paediatric assessment. This project identified the education needs of nurses working with hospitalised children regarding paediatric assessment in a range of metropolitan, regional and rural settings, using an electronic survey. Data from the survey was used by the ViCTOR team to inform the development of standardised education resources for nurses across the state, irrespective of location.

THE ROYAL MELBOURNE HOSPITAL

An observational audit of blood component administration practices within Melbourne Health.

Mentors: Ms Kaylene Bastin & Dr Rochelle Wynne
Group 6: Elizabeth Cooke, Chanel Christall, Ben Metherall, Sundar Adhikari, Priska Sunaryo, Natasha Snijders, Flavia Bezerra,

Melbourne Health transfuses on average 1000 red cells units each month. The procedure for transfusing blood components is covered by procedure 2.9.6 Blood and Blood Product Transfusion, which is consistent with ANZSBT guidelines. The Australian Patient Safety Bulletin, Newsletter of the NHMRC Centre of Research Excellence in Patient Safety states “Failure to perform appropriate checks is reported as the most common error leading to incorrect blood transfusion” (March 2009; 11). Patient safety is of paramount importance and completing the appropriate pre-transfusion checking in accordance with the MH procedure is vital in ensuring the right patient receives the right blood component.

This audit aimed to ensure safe and appropriate blood transfusion administration practices. Specific audit objectives were:

  1. To determine if the correct patient identification process occured at the bedside in accordance with the MH procedure prior to blood component administration.
  2. To determine if all documentation was checked to ensure the correct component was administered to the correct patient in accordance with the MH procedure prior to blood component administration.
  3. To determine the extent to which the patients were provided with information relating the blood component transfusion and how satisfied they were with the information provided.

Blood component administration practices; documentation of the decision to transfuse.

Mentors: Ms Kaylene Bastin & Dr Rochelle Wynne
Group 7: Katelyn Fabri, Chloe England, Justine Chan, Loo Hoo, Ashish Chaturvedi, Jedd Splatt, Urmila Rangou

Melbourne Health transfuses on average 1000 red cells units each month. The decision to transfuse should be consistent with the National Blood Authority Patient Blood Management Guidelines (NBAPMG) to ensure that blood and blood products are used appropriately. Previous auditing has shown lower rates of appropriate usage than would be expected, as the documentation of the transfusion has not reflected the NBAPMG. An audit of the documentation in conjunction with a brief questionnaire of medical staff within 24 hours of a transfusion was proposed to determine if the decision to transfuse is aligned with the NBAPBMG. Specific audit objectives were:

  1. To determine if transfusion documentation supported the decision to transfuse, and
  2. To determine if red cells and platelets were being used appropriately according to NBA Patient Blood Management Guidelines.

Healthcare associated pneumonia: a point prevalence survey of indicators for pneumonia in the acute setting and adherence to treatment guidelines.

Mentors: Louise Hobbs (Manager of RMH Infection Prevention & Surveillance), Dr Rochelle Wynne
Group 8: Hazen Clough, Grace Allan, Sarah Chapman, Keoung Yeon, Kristian Mitev, Joshua Heyman, Thi Nguyen

There are a number of nurse sensitive indicators that have been associated with a reduction in healthcare associated infections (HAI), where a nurse sensitive indicator relates to the quality of care that is influenced by nursing. Healthcare associated pneumonia (HAP) develops in patients who have recently had contact with nosocomial and/or drug resistant pathogens because of a history of hospitalisation, the need for dialysis or home wound care or residence in a nursing home. A point prevalence audit was conducted to determine whether in- patients with pneumonia had HAP. This audit involved undertaking a literature review to identify nurse sensitive indicators associated with a reduction in HAP, development of an audit tool, conducting an audit at both the Royal Melbourne Hospital City and Royal Park Campuses and analysing and reporting the data.

A non-participant observational audit of hand hygiene in the context of caring for isolated patients with communicable disease.

Mentors: Louise Hobbs (Manager of RMH Infection Prevention & Surveillance), Dr Rochelle Wynne
Group 9: Sophie Vitesnik, Shannon Everett, Anna Flanagan, Tasha Mendes, Amrita Sran, Sefronia Oakes, Kimberly Lam

There are a number of nurse sensitive indicators that have been associated with a reduction in healthcare associated infections (HAI), where a nurse sensitive indicator relates to the quality of care that is influenced by nursing. Many patients require isolated nursing care and transmission based precautions to prevent the transmission of communicable infections. Wearing personal protective equipment may inhibit the ability of the healthcare worker to perform hand hygiene according to the five moments. In addition, the number of times a healthcare worker may attend to a patients needs may be limited. This audit involved undertaking a literature review; development of an observational audit tool; conducting an non-participant observations of hand hygiene at the Royal Melbourne Hospital, and analysing and reporting the data.

Measurement and documentation of physiological observations after cardiac surgery.

Mentors: Adam Bonser, Carolyn Baker & Dr Rochelle Wynne
Group 10: Stephanie Berry, Thomas Kitt-Thompson, Alexandra Hinchcliff, Ellie Saari, Dinh Trinh, Sam Podbury

Appropriate measurement and documentation of physiological observations is vital to assist with the early detection of patient deterioration. As a component of the Royal Melbourne Hospitals RAPID/MET call response system, specific parameters trigger an interventional response. In the context of cardiac surgery, significant fluctuations in heart rate are an expected component of the recovery trajectory. Consistent with Standard 9 of the National Safety and Quality Health Service standards, the overall aim of this prospective audit of observation charts was to evaluate the frequency and duration of aberrations in physiological observation parameters. Secondary aims were to establish compliance with RAPID/MET monitoring plans and to identify relevant procedures and clinical guidelines appropriate to the care of cardiac surgical candidates.

Secondary prevention measures in patients undergoing surgery for coronary artery disease.

Mentor: Dr Rochelle Wynne
Group 11: Rachel Mrhar, Caroline Tran, Margaret Yeboah, Memori Taala, Melony Bilbrough, Ee Ling Chee, Eliza Wyatt, Mahek Brar

Each year at the Royal Melbourne Hospital approximately 350 patients undergo coronary artery bypass grafting surgery (CABGS) for coronary artery disease (CAD). Established guidelines for secondary prevention of CAD include the administration of medications such as aspirin, beta-blockers, statins and angiotensin receptor blockers. Evidence suggests  patients undergoing CABGS may be less likely to receive these medications than patients who do not have CABGS (percutaneous coronary intervention or no intervention). The aim of this audit was to determine whether there are in fact differences in the types of secondary prevention discharge medications prescribed to patients with CAD in the Department of Cardiac Services.

CANCER COUNCIL VICTORIA

An evaluation of Cancer Council Victoria’s wig service: what role does it have for service users now and into the future?

Mentors: Katherine Lane (CCV Helpline Manager), Clem Byard & Dr Anna Boltong
Group 12: Shenna Langenbach, Tara Kirkland, Annie-Rose Willis, Mauricio Cacador, Emily Oliver, Brigette Barson-Cole, Katrina Camiling

Cancer Council Victoria’s (CCV) Wig Service was formally established in 2012 to assist people experiencing hair loss as a result of cancer treatment to be provided with a wig or head covering. Offered as part of CCV’s suite of cancer information and support programs, this service can be accessed by calling Cancer Council 13 11 20. Experienced oncology nurses assist patients during the wig fitting and conduct follow up calls around six weeks after a person has had their appointment. The follow up call is used as an opportunity to provide additional support and is framed around satisfaction with the wig provided and to assess whether the person has further practical, emotional or informational support needs. Practical services such as this have been shown to improve a person’s self-esteem and sense of control at what can often be a very confronting and uncertain time. While similar services exist in other state Cancer Councils, to date, no formal evaluations of these programs have been conducted. Using both quantitative and qualitative methods, the aim of this project was to examine the user profile of the people who use this service, what it means to them and to develop a better understanding of the role of this service in supporting people experiencing hair loss as a result of cancer treatment. This analysis will help inform program development, sustainability and improvement strategies and will provide a platform for further evaluation of similar services around the country.

PETER MACCALLUM CANCER CENTRE

Value based healthcare: Understanding patient need to inform contemporary models of care delivery

Mentors: Matiu Bush & Professor Mei Krishnasamy
Group 13: Madison Sharp, Shane Maher, Yi Zhang, Jodi Acornley, Barbara Katusabe, Freya Lance, Patience Chingara

This audit proposed an opportunity to explore who is best positioned to meet the informational, emotional and supportive care needs of patients attending ambulatory care services at the Peter MacCallum Cancer Centre (PeterMac) in East Melbourne. As the incidence and prevalence of cancer grows in the context of diminishing resources and a reduction in the professional nursing workforce, understanding how the needs of patients can be met in timely, safe and appropriate ways increasingly urgent. Students were supported to develop and undertake an audit of all Nurse Coordinators telephone and pager calls to ascertain what types of enquiries are they responding to (informational, logistical, emotional, clinical ) and consider whether the introduction of volunteers into the tumour streams could safety and effectively respond to and triage informational enquiries.

Models of patient concierge/navigator care in leading international cancer centres already successfully utilise volunteer capability. PeterMac wants to explore the feasibility, acceptability and safety of implementing multiple workforce capabilities to best meet the needs of our patients, but to do this we need to explore and understand the nature of need patients present with.

Value based healthcare: Understanding patient need to inform contemporary models of care delivery

Mentors: Matiu Bush & Professor Mei Krishnasamy
Group 14: Jo Bastow, Rebecca Park, Fiona Sherwood, Son Hoang, Briallen Davies, Brittany MacDougall, Bridgette McEvoy

This audit proposed an exploration of the number of patients who present to the Peter MacCallum Cancer Centre (PeterMac) in East Melbourne for review appointments in Specialist Clinics to ascertain the percentage that could have been candidates for tele-health consults. As the incidence and prevalence of cancer grows in the context of diminishing resources understanding optimal ways to deliver safe, responsive patient-centred care is urgent. Students were supported to undertake an audit of nurse coordinator and medical records to explore the reason for review, content and outcome of visits (consultations - as recorded in the medical record) across two tumour streams at PeterMac and present preliminary recommendations for the percent/number of review appointments that could be done over the phone. The data post completion of the audit would be used to establish criteria for tele-health consultations; make recommendations of which professional is best placed to undertake the tele-health consultation (based on the audit data); and provide a framework to calculate cost savings of nurse or allied health led, criteria driven tele-health consultations versus traditional clinic appointments.