ORCID Profile
0000-0002-5829-2216
Current Organisation
Royal Brisbane and Women's Hospital
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Publisher: Wiley
Date: 22-12-2017
DOI: 10.1111/AJO.12759
Abstract: Insertion of a 16 or 18 gauge peripheral intravenous catheter is a potentially painful intervention but one frequently experienced by pregnant women when admitted to hospital. Although the rationale for this practice is 'in case of an emergency bleed', evidence for using large-bore catheters in this population is absent. (i) To identify the proportion of 18 gauge or larger peripheral catheters inserted into maternity patients and (ii) to investigate the proportion of women who require blood products during their perinatal period. Data from a sub-set of maternity patients who were included in a study of risk factors for peripheral intravenous access failure were analysed using descriptive statistics. One hundred and fourteen catheters were inserted in 95 women. Of the 95 first-inserted catheters, 84 (88.4%) were 16 or 18 gauge and 69 (82.1%) of these were placed in the hand or wrist. Four women (4%) received blood products, all were for non-urgent transfusions. Postpartum haemorrhage requiring a blood transfusion remains a relatively rare event. Comprehensive risk assessment should be undertaken before inserting large-bore catheters in perinatal women. Small veins in the hand and wrist should not be used for large bore catheters.
Publisher: Cambridge University Press (CUP)
Date: 31-07-2019
DOI: 10.1017/ICE.2019.205
Abstract: To establish the reliability of the application of National Health and Safety Network (NHSN) central-line–associated bloodstream infection (CLABSI) criteria within established reporting systems internationally. Diagnostic-test accuracy systematic review. We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed. A systematic search identified 1,259 publications 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58–0.81) to 0.99 (95% CI, 0.99–1.00) and sensitivity ranged from 0.42 (95% CI, 0.15–0.72) to 0.88 (95% CI, 0.77–0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%–4.4%. The risk of bias was low to moderate in most included studies. Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time. Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989 June 7, 2015). www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.AUCC.2018.08.004
Abstract: Controversy remains about the impact of 12-h shift patterns on staff satisfaction and health and on patient outcomes. Consequently, the objective of the study was to investigate the effect on nurses and patients of 8-h rostering compared with 12-h rostering. We conducted a two-phase survey. Intensive care nurses completed a purposefully designed 49-item questionnaire, which included open- and closed-ended questions. Phase 1 was conducted during 2015, while the 8-h shift pattern was in place. Data for phase 2 were collected in 2017, approximately 6 months after the trial of 12-h shifts began. We extracted data from the hospital's adverse event register to compare patient outcomes between the two phases. A total of 152/193 (78.8%) surveys were returned in phase 1. In phase 2, the response rate was 114/188 (60.6%). The proportion of nurses satisfied with the roster increased 3-fold after the introduction of 12-h shifts risk ratios 3.36 (95% confidence intervals 2.62 to 4.28). Communication with all levels of senior staff improved, and the number of hours of professional development leave increased with the 12-h roster phase 1, 358 h versus 538 h in phase 2 (p = <0.0001). Most respondents believed that 12-h shifts would be beneficial for their health, and this belief was validated by official leave records there was a reduction of 69 days for sick leave and 216 days for family leave. Adverse outcomes for patients were similar in the two periods. Twelve-hour shifts are popular with ICU nurses, days lost to sick and family leave are reduced, and patient outcomes are not compromised.
No related grants have been discovered for Joan Webster.