Thesis (MVoeding)--University of Stellenbosch, 2006. / Bibliography.

Objective: Medication safety is always having great concern in healthcare. Giving oral medication through enteral feeding tubes is not uncommon and is a well-known area that prone to error happening. These errors may lead to inadequate treatment or adverse drug reaction resulting in unnecessary health care cost and wastage of public health resources. This systematic review aims to identify contributing factors on medication errors associated with administration of oral medication via enteral feeding tubes. With better understanding of the factors, improvement measures applicable to Hong Kong situations will be suggested. Methods: Pubmed, Medline and Embase databases were searched up to February 2014 by using relevant keywords. Prospective studies with researcher analyzing the drug administration process to observe the occurrence of errors and evaluate the contributing factors and case reports on medical error with review of the place of errors and their potential root causes were considered to be potential relevant literature. Studies meeting the inclusion criteria were included and evaluated in this review. Studies were excluded based on the exclusion criteria. Results and Discussion: An initial search of medical literature by searching engines identified 682 references. After appraisal for inclusion, 11 of them were included in this systematic review. For the findings, lack of knowledge, lack of the presence or the awareness of protocol, environmental factors, inter-disciplinary communication among healthcare professionals and the ability of inadvertent connection of both IV catheter and enteral feeding system had been identified to be key contributing factors to drug administration error. Taken account with the findings, measures to improve the existing local practice through educational reinforcement, establishing guideline and inter-disciplinary communication were suggested. Conclusion: With consideration of the local situation in Hong Kong and the findings identified in this review, suggestions of improvement measures on different aspects have been made in this review. Involvement of government policy, institutional management and the collaboration of multi-disciplinary healthcare professional are essential for the success of these improvement measures. Besides, this review also revealed the lack of research on medication safety issue concerning feeding tube, further research in this area is required. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (Ph. D.)--University of Western Sydney, Hawkesbury, 1995. / Includes bibliographical references.

Thesis (Mnutr)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: INTRODUCTION Many patients seen by dietitians in Tygerberg Academic Hospital require feeding via the enteral route. Prior to this study all enteral feeds were mixed individually by hand, and production was time consuming and very labour intensive. The purpose of this study was, therefore, to compare the current method of production, with mechanised bulk production (MP) and "Ready to hang" (RTH) products, taking time, safety and cost effectiveness into consideration. MATERIALS AND METHODS A machine was designed and built to produce and decant bulk volumes of enteral feed. Production methods were evaluated and data was obtained regarding the time taken to produce a feed, and the true cost of the feeds produced. Microbiological samples were collected and the safety of all the three systems was determined and compared. RESULTS MP production time was significantly longer than hand production (HP), but MP decanting was significantly more accurate. RTH feeds cost 152% more than HP feeds, and MP feeds cost 95% of HP feeds. Seventy-one per cent of HP feeds, 74% of MP feeds and 34% of RTH feeds were contaminated just after administration had began. CONCLUSIONS Mechanisation is less labour intensive than HP and helps to decrease total costs. RTH feeds quickly become contaminated after administration decreasing their other advantages. / AFRIKAANSE OPSOMMING: IN L E ID IN G Baie van die pasiente wat deur dieetkundiges in Tygerberg hospitaal gesien word, benodig buisvoedings. Vo or hierdie studie geloots was, was alle buisvoedings by Tygerberg hospitaal met die hand gemaak. Hierdie metode is baie tydsaam en arbeidsintensief. Die doel van hierdie studie was, om die voorlopige sisteem van produksie te vergelyk met gemeganiseerde grootmaat produksie en "ready to hang" (RTH). Die studie het die volgende in ag geneenv produksietyd, mikrobiologiese veiligheid en koste effektieweteit. METODE 'n Masjien was ontwerp en gebou om grootmaat buisvoedings aan te maak en aftegiet. Produksie metodes was geevalueer en inligting bymekaar gemaak met betrekking tot produksietyd, en die ware koste van die voedings. Mikrobiologiese monsters was versamel en die mikrobiologiese veiligheid van al drie sisteme is bepaal en vergelyk. RESULTATE Produksie met die masjien was betekenisvol longer as die voedings wat met die hand gemaak was, maar die masjien het betekenisvol meer akkuraat afgemeet met afgiet. RTH voedings se koste beloop 152% meer as voedings wat met die hand gemaak word, en voedings wat deur die masjien gemaak word kos 95% van die wat met die hand gemaak is. Een en sewentig persent van die voedings wat met die hand gemaak was, 74% van die masjiengemaakte voedings en 34% van die RTH voedings was besmet net na toediening begin was. GEVOLGTREKKINGS Meganisasie is minder arbeidsintensief as voedings wat met die hand gemaak is en help om die kostes af te bring. RTH voedings word vinnig besmet met organismes na die begin van toediening en dit verminder hulle ander voordele.

Doctor of Philosophy (PhD) / Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.

Enteral feeding is commonly used in paedaitric patients. It helps to improve the digestive, absorptive, immunologic and nutrition status. However, poor handling in enteral feeding can lead to bacterial contaminations and severe consequences resulting in significant morbidity and mortality. At present, there are no definite guidelines on the handling of enteral feeding in local setting, therefore developing evidence based guideline on enteral feeding is critically important to eliminate inconsistent practices and prevent nosocomial infections related to enteral feeding. This dissertation is a translational nursing research that aims at developing evidence based guideline on enteral feeding in infants. The objectives of this thesis are to search for existing literatures on enteral feeding; perform a critical appraisal on the literatures; develop guideline on enteral feeding in infants; assess the implementation potential of the proposed guidelines, and develop the implementation and evaluation plans. The ultimate goal is to reduce the nosocomial infections in infants with enteral feeding in an acute hospital. A systemic search for relevant and valid evidence was performed using three electronic databases and nine relevant studies were retrieved. Critical appraisals on the nine studies were performed and the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN). By synthesizing the data from nine studies, it is concluded that optimal hang time and proper hand hygiene appeared to have significant effect in reducing nosocomial infections related to enteral feeding. The implementation potential of the innovation was assessed in terms of the transferability, feasibility and cost benefit ratio. After assessing the implementation potential, it is found that the evidence is transferable and feasible to implement the proposed guideline in the target paeditaric setting. An evidence based guideline on enteral feeding in infants was developed. An implementation plan of the new guideline included a comprehensive communication plan with both administration and nurses and a pilot test were developed to ensure a smooth implementation and optimize the transferability and effectiveness of the evidence based guideline in the target population. A systematic evaluation plan on patient outcomes, health care provider outcomes and systemic outcomes was developed. The evidence based guideline on enteral feeding was expected to be implemented in the long run to reduce the risk of nosocomial infections in infants with enteral feeding. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Doctor of Philosophy (PhD) / Although registered nurses have a plethora of information sources available to assist them in making clinical decisions, how this information informs such decisions is not well understood. Through the work undertaken in this thesis a deeper understanding of information use in clinical practice is developed. Information use in clinical uncertainty is explored, specifically in the context of making decisions about enteral feeding practices within critical care environments. Instrumental case studies were used to access the information use processes of registered nurses working in an intensive care unit. Two case sites (a Level III intensive care unit in metropolitan teaching hospital and a Level II intensive care unit in a district hospital) were selected for the purpose of theoretical replication. Data were collected to inform specific issues. Concurrent verbal protocols (think aloud), observation and retrospective probing were used to explore documented clinical decisions and the information used to inform those decisions. Q sorting was used to determine the accessibility and usefulness of information available to participants and focus groups were used to explore senior nurse clinician’s perceptions of the authority of the identified information sources. A synthesis of findings from the two case sites highlighted three key issues. First, natural testimony (the use of personal communication to obtain information) was privileged over other, more formal sources of information however the veracity of the information obtained through natural testimony was not explicitly assessed. Registered nurses relied on the credibility of the person providing the information, leaving the information itself unchallenged. The clear reliance on information accessed through natural testimony, but the evident lack of critical evaluation of information obtained in this way, indicates a need for the development of strategies for the critical assessment of the accuracy of this clinical information. Second, the findings highlighted nurses’ use of clinical inquiry. Nurses used clinical inquiry to resolve clinical uncertainty as well as for logistic reasons. Participant’s use of inquiry was influenced by their approach to work, the impact of both organisational and personal perspectives on the perceived value of their work; and by models of clinical leadership where an investment in relational capital was considered a strategy to positively influence a culture of inquiry. Although organisational documents which are designed to ensure quality and consistency of patient care as required by current clinical governance strategies were considered useful, these document were not widely used as a primary source of information. The use of organisational documents, as well as the need to practice in concert with such documents, was identified as a factor negatively impacting on the development and support of nurses’ use of clinical inquiry. Third, findings addressed the usefulness of information for clinical decisions and the resolution of clinical uncertainty. The usefulness of information was influenced by its relevance to a clinical question or information deficit, and by the media used to convey the information. In general, print based media was considered more useful than other forms such as electronic documents. While original research was not considered useful, nurses valued research-based practice and responded positively to incorporating research into practice, particularly if research was pre-appraised by colleagues who were able to disseminate research findings to the clinical area and facilitate its use in clinical practice. This case study indicates that information use is less about individuals and the clinical context in which they are making decisions, and more about the social, cultural and organisational influences that shape decision making, and the information selected to support those decisions. The preference for natural testimony as information in decision making may, on first consideration, be viewed as undesirable in a work context that relies on accurate and consistent documentation. Determining the credibility of the information provider and the accuracy of the information itself is also challenging in an environment where this type of information and the approach to accessing it is selected for its ease of accessibility and the speed at which it can be applied. Yet, the pervasiveness with which nurses rely on others for information suggests verbal testimony is important in the context of clinical practice and highlights the need to develop a clearer understanding of why nurses privilege this information. Therefore verbal testimony must be considered carefully as a strategy for providing information, particularly research-based information and this study therefore highlights the need to develop strategies that enable those providing information to convey their expertise as a clinician as well as a user and provider of information. The organisational culture and work structures currently in place in Australia are unlikely to undergo significant change in the coming years, therefore their impact on information use warrants careful consideration. The nursing profession and the higher education sector aim to foster through inquiry, the independent, evidence-based practice of registered nurses. Health care organisations also highly value independent, evidence-based practice but also promote patient safety through use of current clinical governance strategies. While these two goals can be complimentary they also create tension when clinical governance strategies stifle inquiry and independent decision making of registered nurses. Ultimately, the current health care system in Australia and the wider community expect an evidence base for practice together with clinical governance strategies that promote safe practice. Nurses, as part, of this system must be accountable for both in the context of their clinical practice. We therefore need with some urgency to determine how to best balance these complementary and simultaneously competing ideals.

Thesis (Ph. D.)--University of Sydney, 2008. / Title from title screen (viewed 11 February 2009). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Nursing And Midwifery. Includes bibliographical references. Also available in print form.

Made available in DSpace on 2015-06-17T19:34:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-12-03. Added 1 bitstream(s) on 2015-06-18T12:48:47Z : No. of bitstreams: 1 000830352.pdf: 1542887 bytes, checksum: 87f1a3d2a9d0941778faff708704bc13 (MD5) / Introdução: O estudo surgiu em razão da necessidade de compreender o desperdício de dieta enteral na unidade de terapia intensiva. Diversos fatores contribuem para o desperdício de dieta enteral, podendo ser intrínsecos (intolerância gastrointestinal) ou extrínsecos ao paciente (exames, cirurgias), desde a prescrição da dieta até o final da sua administração. Duas formas de verificação do desperdício foram comparadas e testadas como hipóteses: a anotação de enfermagem e a medida direta do volume residual do frasco. A utilização da metodologia de Modo de Falhas e Análise de Efeitos na terapia nutricional e o estudo do desperdício da dieta trouxe pioneirismo ao estudo. Metodologia: O desperdício foi verificado por metodologia quantitativa, o volume anotado pela enfermagem e o volume medido no frasco. Foram avaliados também índices de gravidade dos pacientes e comparados com variáveis relacionadas à dieta enteral. As causas do desperdício poderiam ser encontradas em todas as etapas do processo de dieta enteral. Optou-se nesse trabalho, também, pela metodologia da análise do modo de falhas e efeitos (FMEA), mapeando as etapas, identificando os riscos potenciais e avaliando possíveis danos com pontuação acima de oito através da análise de causa raiz. Resultados/ Discussão: Houve diferença significativa em relação aos volumes de dieta desperdiçados segundo a anotação de enfermagem e o volume medido no frasco. O volume anotado pela enfermagem era maior que o medido. Esse fato pode levar a consequências importantes referentes à anotação inadequada por se tratar de um grande volume desperdiçado, segundo a anotação de enfermagem. Quanto aos índices de gravidade do paciente e variáveis referentes à dieta enteral, houve diferença significativa relacionada às variáveis sexo, idade, uso de droga vasoativa e tempo de internação. Assim, o desperdício foi maior entre os homens, não idosos, internados ... / Introduction: This study arose from the need to understand the waste of enteral nutrition in the intensive care unit. Several factors contributed to the waste of enteral feeding and may be intrinsic (gastrointestinal intolerance) or extrinsic to the patient (tests, surgeries), since the diet prescription moment until the end of its administration. Two ways of checking the waste were compared and tested as hypotheses: nurse diary and direct measurement of the residual volume of the bottle. The use of Failure Mode and Effects Analysis methodology in nutritional therapy and the study of diet waste brought originality to the work. Methodology: The waste was verified by quantitative methodology, the volume recorded by the nursing staff and the volume measured on the bottle. Severity scores of patients were also evaluated and compared with enteral nutrition-related variables. The causes of waste could be found at all stages of enteral feeding process, and in this study it was decided by the Failure Mode and Effect Analysis (FMEA) methodology, mapping process, identifying potential risks and evaluating probable damage with score above eight through root cause analysis. Results / Discussion: there was a significant difference between volumes of diet waste according to the nurse diaries and the volume measured on the bottle. The volume registered by the nursing staff was higher than the measured one. This fact may lead to important consequences regarding inappropriate notes once it's about a big volume wasted, according to the records of the nursing staff. As for patient severity scores and variables related to enteral feeding, there were meaningful differences related to sex, age, use of vasoactive drugs and hospitalization time. Thus, the waste was higher among men, not elderly, hospitalized for less than a week (waste per day), without the use of vasoactive drugs. Regarding process failures, most occurred in the period of suspension of the ...

Made available in DSpace on 2014-12-02T11:16:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-16Bitstream added on 2014-12-02T11:21:14Z : No. of bitstreams: 1 000609546.pdf: 1464260 bytes, checksum: 34305688869576b88d9034d68dc81109 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / As técnicas biomagnéticas vêm sendo empregadas com sucesso no estudo do trato gastrintestinal (TGI). Elas podem medir o campo magnético originado pela atividade elétrica dos órgãos, o campo de marcadores magnetizados ou a resposta de marcadores ou traçadores a um campo magnético de excitação. Este trabalho apresenta uma coletânea de instrumentações desenvolvidas para aplicações no trato gastrintestinal. Os equipamentos desenvolvidos utilizaram sensor anisotrópico magnetorresistivo (AMR) para medir campo magnético e conversores de tensão true rms-to-dc objetivando a redução de custo das técnicas que empregam excitação magnética alternada (AC). Foram desenvolvidos um método de localização magnética de sonda nasoenteral, uma solução para substituição dos amplificadores lock-in’s por conversores true rms, uma instrumentação com sensor AMR com um eixo de detecção para avaliar o trânsito faringiano, uma instrumentação com sensor AMR com três eixos de detecção para avaliar o trânsito esofagiano e uma instrumentação com 36 sensores que foi aplicada para obter imagens magnéticas de diferentes fantomas e para avaliar a atividade de contração gástrica em um modelo in vivo – ratos. As instrumentações foram avaliadas em testes in vitro e in vivo e apresentaram sensibilidade para o emprego no trato gastrintestinal. Os equipamentos desenvolvidos são de baixo custo, livre de radiação ionizante, portáteis e que possibilitam aplicações em gastroenterologia, farmacologia, farmacotécnica e na clínica médica. / Biomagnetic techniques have been employed successfully to study gastrointestinal (GI) tract. They are enable to measure the magnetic field of magnetized markers, the markers and tracers responses to applied magnetic field excitation, and the magnetic field occurred by GI electrical activity. This work presents some instrumentation developed to evaluate different parameters of GI tract. The equipment built uses anisotropic magnetoresistive (AMR) sensor to measure magnetic field and true rms-to-dc voltage converter in order to reduce the cost of techniques that employ alternate (AC) magnetic excitation. In this work were developed: a magnetic method for localization of enteral feeding tube, a solution to replace lock-in amplifier for true rms converter, an instrumentation using AMR sensor (one axis-sensing) to evaluate the pharyngeal transit time, another instrumentation using AMR sensor (three axis-sensing) to evaluate esophageal transit time and finally, a equipment consisted of 36 AMR sensors to evaluate the gastric motor activity from rats and in order to obtain magnetic images from different kinds of phantoms. All equipments were tested and showed sensitivity to be employed in GI studies. The equipments developed are low cost, radiation free, portable and enable to applications in gastroenterology, pharmacology, pharmaceutical and medical clinic.