Three venepuncture techniques in babies: a comparative study

Modifying hyodermic needles for blood sampling in babies is common. However, such techniques mean that medical devices are not always used as manufacturers intend and potential and actual risks associated with their use occur. A number of new devices have recently been designed to overcome safety issues. However, whether new devices are any more effective than existing modified methods is unknown. Through a randomoised controlled trial, this study attempted to compare the safety and efficacy of three blood sampling techniques in babies: (i) the 'broken' needle, (ii) the 'modified' buttrefly' and (iii) a new 'single winged' needle designed specifically for venepuncture in babies and young children. Eligibility criteria for inclusion to the study comprised: babies twelve months of age and under, weighing over 1500 grams, requiring at least three routine blood samples to monitor their condition, six hours apart. Informed, written parental consent was also required. The sample was drawn from a neonatal intensive care unit and achildren's unit in a large teaching hospital. Ethical approval for the study was gained form the local research ethics committee. Babies recruited into the study were randomised according to the order in which the three blood sampling techniques were used. Data were collected in terms of: (1) whether the blood sample had been obtained after one, two or more than two attempts; (2) whether there was clotting in the sample and (3) whether there was bruising and the extent of the bruising measured at the largest diamter of the bruise. Fourteen babies completed the study reulting in the trail being severely underpowered. Recruitment to the study was disappointing and was, in part, attributed to a number of adverse incidents that had occurred in clinical and research practices involving babies and children, that had gained much media attention, both before and during the study period

Health needs assessment in the contemporary NHS

Working for Patients, published in January 1989 and the subsequent NHS and Community Care Act 1990, Introduced the most major and complex reorganisation of the NHS since its inception. One of the outcomes of this re-organisation has been the separation of the purchasing and providing functions and the creation of an internal market in health care in Great Britain. District Health Authorities shed their responsibility for providing health care (this responsibility passing to acute and community NHS Trusts) enabling them to concentrate on their wider role of purchasing health care services which maximise the health of their local population. The thesis is about health needs assessment for the planning and purchasing of health services, where decisions about priorities and the allocation of resources are based on an assessment of health need. At the inception of the NHS, 'need' was purely medically defined. In the 1970s formal planning systems and a formula for allocating resources were the mechanisms through which 'need' was identified. The post 1990 reform of the NHS is the focus of the thesis, where health need assessment is undertaken within an internal market in health care

Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial

Objective To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers. Design Randomised controlled equivalence/non-inferiority trial. Setting Four NHS hospitals in three trusts. Three of the four were teaching hospitals. Participants All patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999. Intervention Assessment by one of three appropriately trained nurses or by one of several preregistration house officers. Main outcome measures History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome). Results 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%). Conclusions There is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment

Medical audit and total quality management in health care: a sociological assessment

Changes in the organization, funding and delivery of health care are affecting health systems in all societies in the search for greater economy, efficiency and effectiveness. The issue of quality is at the forefront of these changes and has been largely addressed by the implementation of the Medical Audit initiative. Medical Audit is the review of clinical practice, a process largely designed by doctors, led by doctors and, described as an issue that is essentially a matter for the medical profession. Nevertheless, since its formal introduction, the initiative has largely failed to meet expectations. Some argue that the problem is technical in character, that audit methods are inadequately researched. Others believe that the philosophy of Total Quality Management, designed to effect continuous improvement in all aspects of health service delivery, is more appropriate. However, this study, conducted through participation and observation of both the audit process and implementation of Total Quality Management in health care, will argue that, in their current form, neither is adequate for fulfilling its stated objectives. It will suggest that Medical Audit is conceptually rather than technically inadequate, because little account is taken of the complex social and technical systems that exist within hospital settings. Similarly, the industrial model of 'total quality' presupposes conditions that do not exist within provider organizations. Nevertheless, this is not to say that Medical Audit and Total Quality Management are inappropriate for health care. Audit has demonstrated only limited success and, though many of aspects of the 'total quality' approach are clearly relevant, it will require modification and further testing prior to full implementation. Both audit and 'total quality’ require fundamental changes in behaviour, and if they fail, they may not get a second chance - health care quality is much to important for that to be allowed to happen

An examination of information systems and technology maturity and it’s relationship to methods of contributing information to the information systems planning process in National Health Service acute trust hospitals

As a result of the use of Nolan's six Stage model of IS and IT maturity in a number of consultancy studies in the early 1980s, managers felt they could maximise the contribution of the IS and IT portfolios to the achievement of business strategy by becoming more IS and IT mature. Despite the development of a further eight models since 1979, empirical tests exist only of the Nolan model and one other, McFarlan, McKenney and Pyburn's model ofIT assimilation. This research has sought further empirical evidence of IS and IT maturity in National Health Service (NHS) acute Trust hospitals. Survey method was used to collect data from over seventy top and middle managers representing four Trust hospitals. Statistical analysis of these data provided evidence that six of twenty-three maturity characteristics identified in existing models can currently be used to differentiate the maturity of NHS acute Trust hospitals. These six characteristics had been identified both in models which considered a range of IS and IT issues and in models which had concentrated on a single aspect of IS and IT management. This indicated that further insight is gained by combining these approaches when modelling IS and IT maturity. Managers also placed different emphasis on the use of specific methods of contributing information to the IS planning process in hospitals which exhibited greater IS and IT maturity than in hospitals which exhibited lesser IS and IT maturity. This indicates the existence ,of a further IS maturity characteristic, further evidence of which can now be sought in other industry sectors

Promoting health

By introducing the theories and practices of health promotion, emergency nurses can become strategic practitioners

A study of nurses in management within the NHS in Scotland 1994-1995

Abstract available : p.

Computer deployment in the health services of developed and developing countries : a comparative case study of the UK and Oman

Organisations are increasingly deploying and using computer technology in various ways, involving the allocation of large amounts of capital and human resources. However, in many cases, computer deployment has been accompanied by failure, particularly in health care services. Therefore, information technology has raised grave questions, misunderstanding, fears, and hostility.This study emphasises the importance of computer deployment and development in developed and developing countries' health care services with examples from advanced and less advanced nations. It describes strategy development for IT/ISs using information system methodologies and explores the development of ISs strategy in the NHS in the light of fundholding and the internal market. A number of problems that commonly influence the success or failure of computer deployment and development are identified. These issues are explained through two case studies: the Omani health system and General Practices (GPRs) in the UK, which have introduced computers.The research focuses on five main sets of issues related to computer deployment and utilisation in health care: strategic planning; computer utilisation; computer fears; computer impact; and computer technical problems and performance. Users' overall satisfaction with systems in use is also considered.Data collection was carried out using two surveys. One survey was conducted in GPRs in Humberside and the other conducted in Royal Hospital and Sultan Qaboos University Hospital in Oman. Data sources included observations, review of relevant documents, such as reports, research papers and manuals, structured and non-structured interviews with selected users and a questionnaire.A number of conclusions can been drawn from this study: firstly, computer deployment, utilisation and development still faces problems in both the systems studied, more especially the Omani system. Secondly, GPRs have carried out strategic planning for computer deployment and utilisation and are prepared to use information system methodology for IT/IS strategy and there is a plan to use this for competitive advantage but Omani hospitals did not set a constructive strategic plan for their systems. Thirdly, the main problems of computer failure are related to human issues rather technical issues. The most important of these human issues are the style of the leadership planning, poor utilisation of computer applications, lack of skills and poor training. Finally, the results of the survey suggested that though the respondents were aware of the potential of computer technology, the problems of computer fears, training and lack of skills were experienced, and often, few individuals possessed computingknowledge.The author suggests several points to be considered: 1) that any thinking about computer deployment and development should employ appropriate information system development methodologies; 2) the decisions on computer deployment, use and development should be made by a special committee that has expertise in IT matters; 3) good strategic planning for computer deployment, use and development; should be connected to the organisation's overall strategy and 4) there is a need of mandate review for such development and planning. With these points in mind the researcher presents a diagram to help improving strategic planning and development of IT/IS methods with particular emphasis on the Omani environment