CCU Nurses Research Articles

Stress and Coping Strategies Among CCU and Non CCU Nurses in Selected Hospital, Kolkata

Stress and Coping Strategies Among CCU and Non CCU Nurses in Selected Hospital, Kolkata

KAP ANALYSIS AND DECISION-MAKING OF NURSES REGARDING SEPSIS ASSESSMENT AND MANAGEMENT IN CRITICALLY ILL PATIENTS

Sepsis is a life-threatening condition that requires prompt identification and management, particularly in critically ill patients. Nurses play a pivotal role in sepsis management, and their knowledge, attitudes, and practices directly impact patient outcomes. However, there is limited data on the awareness and competency of nurses regarding sepsis assessment and management, especially in low-resource settings. Objective: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of nurses towards the assessment and management of sepsis in critically ill patients. Methods: A cross-sectional study was conducted in the Intensive Care Unit (ICU) and emergency department of DHQ Hospital, Narowal, from July 2023 to July 2024. A total of 100 ICU and CCU nurses were selected using convenience sampling. Data were collected through a 32-item questionnaire that assessed knowledge, attitudes, and practices related to sepsis. Additionally, the 24-item Nursing Decision-Making Instrument (NDMI) was used to evaluate decision-making skills. Descriptive statistics were calculated, and relationships between variables were analyzed using t-tests and ANOVA. Results: The mean knowledge score was 5.1 ± 1.8, with 83% of nurses demonstrating poor awareness of sepsis. The mean attitude score was 2.0 ± 0.9, with 85% of nurses displaying negative attitudes toward sepsis management. The mean practice score was 79 ± 17.8, with 72% of nurses showing poor practice skills. The mean decision-making score on the NDMI was 63.3 ± 19.6. Qualifications (p=0.010, p=0.00) and work experience (p=0.005, p=0.050) significantly influenced knowledge and practice scores. Moreover, knowledge and practice scores varied significantly with different modes of decision-making (p<0.001, p=0.020). Conclusion: The study revealed that ICU and emergency department nurses had insufficient knowledge, negative attitudes, and inadequate practices concerning sepsis assessment and management. Training programs, targeted educational interventions, and policy reforms are urgently required to improve nurses' competency and decision-making skills in sepsis management, ultimately enhancing patient outcomes.

Effect of Educational Program on Nurses' Skill Regarding Electrocardiogram Interpretation in Critical Care Units : A Quasi-Experimental Study

Background: Electrocardiograms non-invasively assess cardiac rhythm and electrical activity. It was the first heart disease diagnosis tool that helped reduce heart disease morbidity and death. ECGs are monitored and interpreted by nurses. The study aimed to determine the effectiveness of an educational program on nurses' skills regarding electrocardiogram interpretation among critical care nurses. Methods: A quasi-experimental study was conducted on 68 nurses as a non-probability purposive sample working in critical care units at Azadi Teaching Hospital, Kirkuk City, Iraq. This study starts from 20th October 2023 to April 10, 2024. The study tool consists of two parts. Part I is concerned with nurses` socio-demographic characteristics, and Part II (the structured skill questionnaire) was developed by the researcher after reviewing the literature. For validity, the previous study restated topics and submitted them to 12 experts from various specialists. The education program was implemented with group teaching technique-based sessions, and hands-on training was provided. The collected data were analysed using SPSS version 26.0. Results: The results showed that most participants (73.5%) were aged between 24 and 28 years old and were female with 1-3 years of experience. Only 14.7% of participants had taken previous ECG training courses. Also, it showed that there is a high significant difference (Z = -7.153) at P<0.01 between nurses' total skills pre-test and post-test responses and found that nurses in CCU had high skills compared to other units. Conclusion: The overall level of nurses' skills in electrocardiography interpretation is low in the pre-test after implementation of the education program enhances their skills with high statistical significance. The study's findings prove that structured educational programs enhance nurses' skillfulness in ECG interpretation.

Knowledge of pulse oximetry among emergency and critical care nurses.

The pulse oximeter is a simple, cost-effective and reliable device for estimating arterial blood oxygen saturation. Nurses are required to be knowledgeable in pulse oximeter use. Little is known about nurses' knowledge of pulse oximetry in the Middle East region. To assess nurses' knowledge of pulse oximetry among emergency and critical care nurses and to explore predictors of nurses' knowledge of pulse oximetry. This is the second part of data analysis that was first presented in the 'proficiency in ECG' study conducted in Jordan. The original data used for both parts of analysis included a questionnaire with two tests; a knowledge of pulse oximeter test and an ECG proficiency test. Participants were asked to take, alone without receiving assistance, both tests. In this study, the second part of analysis, the focus is on the pulse oximeter test. The test consisted of 21 items that emphasize knowledge of basic physiological principles as well as device limitations; whether technical or interpretation. The test administration procedure also included asking participants to provide socio-demographic variables. In the original data collected in both parts of analysis, nurses working in the emergency department, cardiac care units or intensive care units from nine different hospitals (1 governmental, 6 private and 2 educational) and holding a bachelor degree or higher were asked to participate. The total number of participating nurses was 210; out of 247 approached (response rate, 85%). The mean score in the nurses' knowledge of pulse oximetry test was 12.33 out of 21, corresponding to 58.7%. The clinical area currently working in predicted the knowledge of pulse oximetry test score after controlling for all other variables. Emergency department and intensive care unit nurses scored higher than cardiac care unit nurses by 1.86 and 1.63 points respectively (58.2% and 60% respectively). Nurses consistently report inadequate education and training concerning pulse oximeter use and interpretation. A revision to hospital in-service education seminars and undergraduate nurses' curriculum to assure adequate preparation is needed. Knowledge of pulse oximetry among emergency and critical care nurses is modest. This is a challenge worldwide. Predictors of nurses' knowledge of pulse oximetery are the clinical area currently working in (ICU and ED nurses are more knowledgeable than CCU nurses), proficiency in electrocardiography and taking an advanced cardiac life support course.

Correlation between job burnout and Fear of COVID-19 among ICU and CCU Nurses (Case study: Shahid Madani Cardiac Hospital, Tabriz, Iran)

Background: Occupational burnout among nurses is one of the major factors which affect the quality of nursing care. Assessing the relationship between burnout and its associated factors is one of the most basic things that should be done so that later, actions can be taken to reduce burnout. Fear of COVID-19 is one of the factors that can increase the burnout of nurses during the Coronavirus Disease 2019(COVID-19) pandemic. Aim: To investigate the relationship between job burnout and fear of COVID-19 among ICU and CCU nurses. Methods: The Maslach Burnout Inventory (MBI) and the Fear of COVID-19 Scale (FCV-19S) were distributed to ICU and CCU nurses (n = 170) at Shahid Madani Cardiac Hospital, Tabriz, Iran, and the correlation between job burnout and fear of COVID-19 was calculated. Results: The results show that the level of emotional exhaustion and reduced personal accomplishment among participants of this study is average, and depersonalization is at a low level. Also, the level of fear of coronavirus is below average among the respondents. The research showed that emotional exhaustion and fear of COVID-19 were positively correlated (p < 0.05), but there was not any significant correlation between depersonalization and fear of Coronavirus; as the relationship between reduced personal accomplishment and fear of COVID-19. In addition, there were significant correlations between age and reduced personal accomplishment, as well as marital status and reduced personal accomplishment (p < 0.05). On the other hand, the results showed that there were not any significant correlations between gender and burnout dimensions, nor between educational degree and burnout dimensions. Conclusion: As job burnout reduces the quality of nursing care, managers must take strategies that reduce job burnout. One of the strategies that they can take is to reduce the fear of COVID-19 by taking wise strategies.

Knowledge, Attitude, and Performance of ICU, CCU, and Emergency Wards Nurses in Kermanshah, Iran, regarding Organ Donation.

Background Providing an organ for donation is a major problem worldwide and nurses play an important role in facilitating the process of organ donation. This study is aimed at investigating the knowledge, attitude, and performance of nurses working in the ICU, CCU, and emergency wards regarding organ donation. Methods In this descriptive-analytical study, 185 nurses working in ICU, CCU, and emergency wards were studied through systematic random sampling. The data collection was done by a self-administered questionnaire. Results The mean knowledge of nurses was 8.9 ± 1.4 out of 10. There was a significant relationship between knowledge of nurses regarding donation and religion and having organ donation card (P < 0.001). The mean attitude of nurses was 7.8 ± 2.2 out of 8. The variables, including “having a donation card and marriage,” were associated with attitude of nurses toward organ donation. The mean performance of nurses was 0.4 ± 0.7 out of 3. There was a significant relationship between performance of nurses and having a donation card (P < 0.001). Knowledge was the strongest predictor of nurses' performance (P < 0.01). Conclusion The studied nurses showed sufficient knowledge and favorable attitude toward organ donation; however, they had poor performance. It is suggested to hold training courses to improve performance of nurses. The revision of the nursing students' curriculum as future nurses should also be considered.

CROSS-SECTIONAL SURVEY ASSESSING A CULTURE OF SAFETY AT A LARGE PUBLIC HOSPITAL

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: High-risk industries with a narrow tolerance for errors such as healthcare pay considerable attention to studying safety. Such research has expanded from focus on morbidity and mortality to recognition of ways in which organizational structure, team dynamic, and working conditions impact a climate of patient safety within an institution. The Safety Assessment Questionnaire (SAQ) solicits employee perceptions of teamwork, safety, job satisfaction, stress recognition, management, and working conditions. Validation studies suggest this tool is reliable and responsive to interventions. This study was designed to identify baseline gaps in safety culture among various provider disciplines within our institution. METHODS: The study was conducted in a large public teaching hospital. We used the abbreviated Short Safety Assessment Questionnaire (sSAQ), which explores the same domains as the SAQ via 36 questions graded on a 5-point Likert scale. The survey was distributed over a month-long period to all housestaff rotating on the inpatient medicine floor and in the medical and cardiac intensive care units (MICU and CCU respectively), as well as to medicine floor attendings, MICU and CCU nurses, and inpatient respiratory therapists. Response to the survey was voluntary and anonymous. RESULTS: Responses were obtained from 86% of the rotating housestaff, 91% of floor attendings, 41% of MICU nurses, 24% of CCU nurses, and 33% of respiratory therapists. Housestaff overall responded positively to job satisfaction, stress recognition, and working conditions, while ICU-based housestaff were additionally positive regarding teamwork and patient safety climate. Attendings answered favorably to job satisfaction and stress recognition. CCU nurses scored highest in the domains of safety climate and job satisfaction, while MICU nurses were most satisfied with stress recognition. Nursing units also differed in negative perceptions; CCU nurses expressed that communication breakdown commonly interfered with delivery of patient care, and MICU nurses felt burdened by insufficient staffing for patient volume. Respiratory therapists scored low in stress recognition, perception of management, and working condition domains. They looked favorably on collaboration with nurses but were neutral toward collaboration with physicians. CONCLUSIONS: Responses to the sSAQ revealed discrepancies between provider disciplines regarding perception of safety culture across six different domains. CLINICAL IMPLICATIONS: Improvement in scores across domains in the SAQ has shown association with shorter ICU stays, decreased rates of ventilator-associated pneumonias and blood-stream infections, and lower mortality. Our survey demonstrates a clear opportunity within our institution for targeted quality improvement initiatives which can be tailored to different provider disciplines in order to improve safety culture and optimize patient outcomes. DISCLOSURES: My spouse/partner as a Advisory Committee Member relationship with CORECEPT Please note: $1001 - $5000 Added 03/15/2019 by Vikramjit Mukherjee, source=Web Response, value=Consulting fee No relevant relationships by Maria Sunseri, source=Web Response No relevant relationships by Amit Uppal, source=Web Response No relevant relationships by Brandon Walsh, source=Web Response

Factors Influencing Job Satisfaction and Turnover Intention among Coronary Care Unit Nurses in Bahrain

Background: At a time of worldwide nursing shortage, is raising questions about the issue of increasing nurses' turnover. The literatures have shown that stronger intention to leave as a consequence of job dissatisfaction may lead to actual turnover. Therefore, it may be a crucial to understand nurses' job satisfaction issue, as this is a key factor in nurses' intention to leave the working place and low job commitment. Aim and Objective: This study examined the factors that determine job satisfaction which are personal, environmental and organizational components and the relation of those factors on Coronary Care Unit nurses' intention to leave their working place. Methodology/ Design: Across sectional, quantitative and correlation design was selected at a fixed point in time. Method: Data was drawn from analysis of self reported questionnaire which included three sections of; demographic data, McClosky Mueller Satisfaction Scale and Anticipated Turnover Scale. The questionnaires were distributed to 60 accessible nurses in CCU. A total of 42 respondents completed the questionnaires with an70 percent response rate. Finding: Nationality and work scheduling were significantly influencing job satisfaction, but marital status and work experience were more influencing the turnover intention. The study finding showed an evidence of considerable highly negative relation between job satisfaction and turnover intention, which was manifested by 78.6% those nurses reporting to be dissatisfied or in neutral responds with their overall job. Moreover, 72.8% of nurses were more likely to hold an intention to leave working place. The most statistically significant predictor of dissatisfaction and lead to leave intention was external reward. Job satisfaction subscale connected to social support was identified as an important factor which may decrease leave intention. Conclusion: The study findings suggested increase nurses' satisfaction through improving benefit package such as health insurance, retirement profits and salary is a key for possible strategy to decrease turnover intention among Coronary Care Unit nurses in Bahrain. Implication for Practice: The study findings have ramifications for nurses' manages to develop strategies aimed at improving the job satisfaction in order to decrease turnover intention.

‘How would you feel …?’: a reflective case study

‘How would you feel …?’: a reflective case study

Exploring Requirements of the ‘Would Be’ Expert Cardiac Care Nurse

&lt;p&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;Cardiovascular interventions have experienced extraordinary progress in the past decades. But it seems that preparation of cardiovascular nurses has not been in pace with the changes. This is while these nurses have a prominent role in the care and management of life-threatening diseases in these wards which can lead to reduced mortality. The present study aimed to explore the effective factors on training a cardiac care nurse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;METHODS&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;This research is qualitative and applies inductive content analysis. Participants included 7 matrons and 50 nurses selected through purposive sampling method. Data was collected using semi-structured interviews and open questionnaires. Also, conventional approach to content analysis was used to analyze data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;To have a qualified CCU nurse, the findings cover four main themes including specialist nurses (having appropriate personal and professional characteristics), acquiring comprehensive educational content (acquiring specialized cardiac, basic nursing, and general educational content), integrated educational approach (group education, individual education and special education methods), and administrative and organizational requirements (the necessity of recognizing the position of CCU nurses, allocation of material and intellectual benefits, educational and managerial monitoring of supervisors).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSION&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;Since cardiac care nurses play an important role in ensuring nursing care quality in cardiovascular wards and can improve the care delivered to the patients, it is necessary for nurses to have appropriate professional and personal qualities. Therefore, nurses should have training on general, basic nursing, and specialist cardiac content through integrated educational approach. At the same time, managerial and organizational requirements should be established to maintain and improve their competencies and capabilities.&lt;/p&gt;

Death Anxiety and Meaning of Life in the Three Groups of Nurses: Obstetrics and Gynecology and CCU Nurses and Housewives

The aim of this study is to compare the anxiety of death and the meaning of life in three groups of nurses: obstetrics and gynecology and CCU nurses and housewives. Documentary and survey methodologies were used. The purpose of this research was applied in terms of objective and used a descriptive-comparative research design. 30 nurses of CCU ward, 30 nurses in the maternity ward, as well as 30 housewives were analyzed in three groups on a scale of meaning of life and death anxiety. For data analysis, two-way ANOVA was used, and the results of the study showed that there was a significant difference between ICU nurses, maternity nurses and housewives in terms of death anxiety and meaning of life. DOI: 10.5901/mjss.2016.v7n2s2p18

6 Appropriateness and outcomes of patients turned down by a primary percutaneous coronary intervention service: Abstract 6 Table 1

Background Primary PCI (PPCI) is the preferred treatment for patients presenting with ST-elevation myocardial infarction (STEMI). Strategies to minimise PCI-related delayinclude bringing patients directly to the cath lab following ECG transmission. The aim of this study was to assess the frequency, appropriateness and clinical outcomes of patients turned down for PPCI by this process. Methods The Belfast PPCI pathway is activated by CCU nurses according to a regionally agreed protocol. Electrocardiograms (ECG) are faxed to a central hub in conjunction with a focussed telephone conversation. If a decision is made not to activate the PPCI team, the referral is deemed a turn-down and the clinical data are retained. All primary PCI turn-downs from the end of September 2013 until the end of March 2014 were reviewed retrospectively with analysis of electronic care records, laboratory results, referral ECG and angiographic images and procedural reports where relevant. A turn-down was deemed inappropriate if retrospective review demonstrated diagnostic ECG criteria with either a culprit lesion at subsequent angiography or significant troponin rise or new regional wall motion abnormalities at echocardiography. Results Between 30th September 2013 and 31stMarch 2014, 945 cases were referred to the PPCI service (about 5 per day). The majority (556/945: 59%) were turned down. Of the remainder, 315 (33%) patients underwent primary PCI and 74 (8%) activated the PPCI team but did not proceed to PCI. The Northern Ireland Ambulance Service (NIAS) was the commonest source of referrals (667 cases) the majority of which were turned down ([Table 1][1]). View this table: Abstract 6 Table 1 Sources of referral to PPCI service and frequency of turn-down Three percent of turn-downs (17 patients) were deemed inappropriate. 3 were due to logistical problems whilst 14 were due to inaccurate reading of the ECG or interpretation of clinical history. 28 cases were re-referred from emergency departments, having been initially turned down; 7 of these were subsequently categorised as inappropriate turn-downs. Within the group deemed inappropriate turndowns 53% (9 cases) had been reviewed by the medical team compared with 12% overall. Six-month mortality among the patients appropriately turned down was 13.5% (73 patients) compared with 11.8% (2 patients) among the inappropriate turndowns. Conclusion In this PPCI service, the majority of patients referred are turned down appropriately, largely due to a high rate of turn-down from the ambulance service. Clinical outcomes were similar among patients turned down appropriately and inappropriately. [1]: #T1

Three dimensional interesting electrocardiogram teaching to strengthen its comprehensive application ability for young nurses in CCU

Objective To explore the three-dimensional interesting electrocardiogram (3D-IECG) teaching to strengthen ECG comprehensive application ability for young nurses in CCU. Methods A total of 40 young nurses, who took part in rotary internship in 2013, had been chosen and randomly divided into experimental group and control group on average. The nurses of control group received traditional method of ECG training while the nurses of the experimental group underwent 3D-IECG teaching, and the satisfaction of teaching methods and ECG comprehensive ability were compared. Results The examination of comprehensive ability in the experimental group acquired basic ECG theory (83.02±10.01) score, operation (92.38±4.23) score, ECG documentation ability (89.18±9.32) score, current ECG analysis (90.01±7.03), nursing plan making (93.23±5.61), personnel nursing round of arhythmia (91.29±8.78) score higher those of control group (t=2.13, 2.41, 2.03, 1.95, 2.32, 1.83; P<0.05). The satisfaction of ECG teaching method in young nurses were 85.0% of experimental group and 50.0% of control group with statistical significance between two groups (χ2=4.103, P<0.05). Conclusions The application of 3D-IECG teaching can effectively improve young nurses ECG comprehensive application ability and satisfaction of teaching method, and is worthy of clinical application. Key words: Electrocardiogram documentation; Three-dimensional; Interesting electrocardiogram; Coronary care unit; Young nurses

How Do Nurses Spend Their Time in The Hospital?

Purpose: The current study investigated the productivity of nurses in emergency department, ICU and CCU of Shahid-Madani hospital in Tabriz. Methods: A two-stage time and motion study was conducted; the observational work sampling study was undertaken by 15 nurses, followed by self-reporting work sampling study by 42 nurses over a period of five weeks. Descriptive and analytical statistics were used to analyze the data. Results: Fifty-seven work sampling data were collected, 15 through the observational study and 42 in self-reporting. Considerable differences were found in the nurses’ time distribution between two techniques. Percentage of direct, indirect and personal activities in observational versus self-reporting were observed (32.74% versus 40.52%), (24.09% versus 28.84%) and (42.30% versus 30.41%) respectively. Conclusion: A considerable proportion of nurses’ time in each shift was spent on their personal activities, which would affect their productivity as well as their direct and indirect delivered cares for patients. Identifying the percentage of spent time on nurses’ personal activities would be a useful measure for improving patient care protocols in the hospitals.

Correlation between components of tolerance caregivers in Jahrom hospitals using factor analysis

AbstractBackground and aim: Nurses have an important role in caring of clients. So, determine the component of identifying structure of components and correlation between them can effective in determine the new component and identifying the effective factors of burden. The aim of current study is to determine the correlations between CBI components among nurses in Jahrom hospitols by using factor analysis.Materials and methods: In this research, 158 of nurses in Jahrom hospitals with stratified sampling enrolled to study. by using car-giver ills questionnaire, five burden’s components that involve dependence burden, Developmental burden, burden, Social burden and burden were assessed. Data were analyzed by Pierson correlation coefficient, regression models and factor analysis.Results: Time dependence Developmental Physical Social and Emotional of women were significantly higher than men (p<0.05). There was a significant difference between workplace and different components (p<0.05). Time dependence of CCU nurses and triage nurses were in a high and low level, respectively. There was a significant correlation between Emotional and Social (P=0.000). Factor analysis showed that nurse's contains two main factors, that these two factors predicting 64% of total data variance. According to factor analysis physical burdens and Developmental and Physical were an independent factor, social and emotional burdens were another independent factor.Conclusion: There was a significant difference between gender and workplace with components of Burden. Women’s Burden in caring of patients was more than men which can related to physical and emotional characteristics of women.Key words: Time dependence Developmental Physical Social Emotional Factor Analysis

Study on the standardized training model for nurses in CCU

Objective To explore the establishment and effects of standardized training model for nurses in CCU.Methods Standardized training plan for nurses in CCU was formulated,and the training time was 3 to 5 years which was divided into two stages (low qualification and high qualification).Training included five aspects such as basic skill,professional skill,personal comprehensive ability,team cooperation ability and interpersonal communication ability.Results Nurses' scores of theories in cardiopulmonary resuscitation,defibrillation technology,electrocardiogram knowledge,respirator and pacemaker were respectively (8.0 ±0.9),(8.0 ±0.6),(8.0±0.8),(8.0 ±0.9),(8.0 ± 0.7) after training and (7.0 ±0.4),(5.0 ±0.6),(5.0 ± 1.4),(6.0 ± 0.9),(4.0 ± 0.9) before training,and the differences were statistically significant (t =-6.61,-23.15,-12.20,-10.29,-22.98,respectively; P ＜ 0.01).Nurses' scores of practicing skills in cardiopulmonary resuscitation,defibrillation technology,electrocardiogram knowledge and respirator were respectively (8.0 ±0.8),(8.0 ±0.5),(7.0 ± 1.4),8.0 ±0.4) after training and (7.0 ±0.4),(6.0 ±0.4),(2.0 ± 0.4),(3.0 ± 1.0) before training,and the differences were statistically significant (t =-7.29,-20.44,-22.44,-79.34,respectively ; P ＜ 0.01).Conclusions Standardized training of nursing talents in CCU can enhance nursing quality,improve health care environment,and comply with the requirements of the modern monitoring. Key words: Coronary care unit; Nursing management research; Nurse; Standardized training

Improved Intervention Rates in a Smoking Cessation Programme Offered by Nurses in CCU—An Audit of 2008 and 2010 at Auckland City Hospital

Improved Intervention Rates in a Smoking Cessation Programme Offered by Nurses in CCU—An Audit of 2008 and 2010 at Auckland City Hospital

10 Evaluating a nurse led triage process in treating patients with left bundle branch block (LBBB) referred for primary percutaneous coronary intervention (pPCI)

Background The Freeman Hospital (FRH) performs over 900 pPCI a year. Patients with suspected Acute Myocardial Infarction (AMI) are referred either by paramedics or networked hospitals for consideration of pPCI via a Telmed system, which is triaged by experienced CCU nurses. The pPCI Pathway can be activated in patients with LBBB suspected of having an AMI. However, there remains considerable variation in the clinical utility of new or presumed new LBBB as a ST-elevation myocardial infarction (STEMI)-equivalent ECG diagnostic criterion. The major discriminators the triage staff use in this population are ECG findings and symptoms suggestive of AMI. Our aim was to evaluate outcomes in patients with LBBB accepted to FRH or referred to local hospitals for assessment. Methods Consecutive patients referred to FRH with LBBB and suspected AMI from 1st August 2009 to 30th November 2009 were analysed by recording: 1) Peak Troponin Level 2) Angiographic findings 3) Revascularisation rates. Results 1069 patients were referred for consideration of pPCI. 177 (16.6%) of patients had new or presumed new LBBB. 33 (18.6%) patients were accepted by FRH and 144 patients (81.4%) were declined and referred to their local hospitals for assessment. Abstract 10 Table 1 Troponin levels in patients with LBBB referred for consideration of pPCI. 26.5% of patients with LBBB referred for consideration of pPCI had moderately to highly raised troponin. Of the 33 patients admitted to FRH, 13 underwent inpatient angiography and 9 patients had significant coronary disease (coronary stenosis 70%–100% in at least one coronary artery). Of those, 5 had PCI and 1 required urgent CABG. Only one patient had a 100% coronary occlusion believed to be an acute occlusion. 4 patients had unobstructed coronaries and were managed medically. Of the 132 patients declined for pPCI only 2 (1.5%) were referred back to FRH for PCI. Neither of these patients was found to have a 100% acute occlusion of a coronary artery. Conclusion Revascularisation was performed in only 6/33 (18.2%) accepted for assessment and only 2/132 (1.5%) were referred back to the centre for PCI. The sensitivity of the triage process in detecting patients with LBBB requiring urgent revascularisation is 75% and the specificity is 83%. The sensitivity of detecting patients with an acutely occluded artery diagnosed at angiography is 100% with a specificity of 81%. In a high volume Heart Attack Centre a nurse led triage is effective at discriminating patients with LBBB requiring immediate coronary intervention.

Improved Intervention Rates in a Smoking Cessation Programme Offered by Nurses in CCU—An Audit of 2008 and 2010 at Auckland City Hospital

Improved Intervention Rates in a Smoking Cessation Programme Offered by Nurses in CCU—An Audit of 2008 and 2010 at Auckland City Hospital

Impact of simulation-based learning on medication error rates in critically ill patients

To compare medication administration error rates before and after the provision of educational sessions using either traditional didactic lecture or simulation-based training. A single-center, parallel, controlled, prospective study conducted in adult coronary critical care (CCU) and medical intensive care units (MICU). Twenty-four nurses were observed administering medications. Documentation included drug name, dose, route, time and technique during observation and active medication orders in the patient's chart. A direct observation method was completed at baseline and repeated twice after the interventions. Data obtained during observation were analyzed for medication administration error rates. Interventions were two types of educational sessions with content developed from baseline medication administration error data: simulation-based training for CCU nurses and a didactic lecture for MICU nurses. Quizzes completed before and after the interventions were used to assess knowledge. A total of 880 doses (402 CCU, 478 MICU) were observed. After the simulation-based educational intervention in the CCU, medication administration error rates decreased from 30.8 to 4.0% (p < 0.001) in the initial post-intervention observation and were sustained in the final post-intervention observation (30.8 to 6.2%; p < 0.001). The error rate in the MICU after the didactic lecture intervention was not significantly different from the baseline and increased in the final post-intervention observation from 20.8 to 36.7% (p = 0.002). Mean quiz scores were significantly improved after education sessions in both ICUs. Simulation-based learning provides a significant advantage to patient care through the reduction of medication administration errors compared to lecture style education.