Paediatric nursing
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Needle phobia is very common in children, particularly in those with chronic illness who may have to endure many painful procedures. A programme developed to educate paediatric healthcare professionals working with children undergoing painful procedures was evaluated to identify: (1) whether the education programme led to an increase in participating clinicians' knowledge and confidence; and (2) the effectiveness of the education programme in changing practice for patient care. ⋯ There are useful pain control techniques that can be taught relatively quickly by nursing staff to paediatric healthcare professionals that do make a substantial difference to the care of children.
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Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. ⋯ It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit.
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The use of sedation and analgesia in critically ill children is necessary for clinical management but can result in undesirable side effects such as physical dependence, tolerance and withdrawal symptoms. Weaning from sedation aims to prevent such unpleasant effects. ⋯ This variation may be the result of high workload, other external pressures, traditional ways of working or other factors. Strategies such as an easily accessible scoring flow chart, a poster display, improved staff induction or other measures could help to improve safety and quality in sedation management.
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Infants in the neonatal intensive care unit are at particular risk from clinical errors because of their fragility and vulnerability, as well as the complex nature of medication and other treatment regimes. Wrong route errors have been well documented, particularly related to enteral nutrition and medication. Published guidance for preventing such errors should inform changes in practice at the local level. ⋯ A routine revision of departmental policy resulted in a review of available evidence to inform the practice changes. Colour-coded enteral/oral syringes with a new style nasogastric tube were introduced. By promoting best practice through networking with other colleagues, staff have worked towards standardising the delivery of care in order to minimise the risk wrong route errors.