A benchmark too far: findings from a national survey of surgical site infection surveillance.

BACKGROUND: The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. AIM: To audit SSI definitions and data collection methods used by hospital trusts in England. METHOD: All 156 hospital trusts in England were sent questionnaires that focused on aspects of SSI definitions and data collection methods. FINDINGS: Completed questionnaires were received from 106 hospital trusts. There were considerable differences in data collection methods and data quality that caused wide variation in reported SSI rates. For example, the SSI rate for knee replacement surgery was 4.1% for trusts that used high-quality postdischarge surveillance (PDS) and 1.5% for trusts that used low-quality PDS. Contrary to national protocols and definitions, 10% of trusts did not provide data on superficial infections, 15% of trusts did not use the recommended SSI definition, and 8% of trusts used inpatient data alone. Thirty trusts did not submit a complete set of their data to the national surveillance service. Unsubmitted data included non-mandatory data, PDS data and continuous data. CONCLUSION: The national surveillance service underestimates the prevalence of SSIs and is not appropriate for benchmarking. Hospitals that conduct high-quality SSI surveillance will be penalized within the current surveillance service.

Constructing a financial case for a computerized patient data management system (PDMS) in a cardiothoracic intensive care unit.

A number of claims are made for computerized patient data management systems (PDMS) which make them of interest to medical and nursing staff who wish to optimize patient care. Comparatively little has been published concerning cost effectiveness of these systems. In this article a financial case is put forward based on the premise that a PDMS can save nursing time, and this saving can then be translated into employing a smaller nursing workforce. An analysis of the relevant costs suggests that over an 8-year period these systems can show substantial profits, but it is also suggested that more research is required to substantiate this finding.

The parameters that cardiothoracic intensive care nurses use to assess the progress or deterioration of their patients.

Intensive care nurses spend approximately 17% of their time recording patient observations. There is little published evidence that investigates how nurses prioritize their observations within cardiothoracic intensive care. This study used a questionnaire to identify which parameters would be used by nurses working within a cardiothoracic intensive care unit to monitor the progress or deterioration of patients postoperatively. Comparison with two pieces of medical research identified a number of parameters which both nursing and medical staff saw as important in establishing the status of a patient. These were: arterial blood gases, cardiac index, central venous pressure, chest drainage, fluid balance total, heart and rhythm, pulmonary artery pressures, pulse oximetry, pupil reaction, urea and electrolytes, urine output, and ventilator observations. It is suggested that these parameters could be given priority in the development of future computerised or paper documentation.

MJA practice essentials. Managing schizophrenia in the community.

There is an increasing expectation that general practitioners will be more involved in treating people with schizophrenia. Newer drugs are associated with better clinical outcomes, especially in relation to negative symptoms (ie, apathy, under activity, slowness, social withdrawal). Some patients make a full recovery or are quite functional between episodes. Identifying early warning signs will lead to reduction of disability. Side effects of medication must be treated vigorously and expediently to enhance compliance. Secondary symptoms of dysphoria and depression must be treated to prevent suicide. Issues of alcoholism and substance abuse must be addressed, providing education on their implications for the course of the illness. People with schizophrenia need continuity of care, which the general practitioner may be best placed to provide because of a long-term commitment to the patient. Involvement with the family (education, support and a collaborative approach in monitoring and supporting the patient's well-being) is vital.

Ethical decision-making in intensive care: are nurses suitable patient advocates?

According to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) code of conduct (1992), nurses in Britain are expected to act as patient advocates. An advocate is someone who 'pleads for another' (Concise Oxford Dictionary 1982). However, it has been shown that advocacy is a complex issue and it is debatable as to whether or not it is a legitimate attribute of the role of the nurse (Gates 1995). Mallik (1997) also finds that advocacy can be a risky career option. Professional codes of conduct spell out duties, but do not give moral guidance. Phrases such as 'promote and safeguard the well-being of the patient' (UKCC 1992) are used, but although undoubtedly well-intentioned, this is platitudinous and these codes commonly shed little light on how to define an action that is to the patient's benefit or detriment. It is tempting to suggest that they are used as a drunken man uses a street lamp; more for support than illumination. Castledine (1981) identified a number of factors that would make a nurse an inappropriate advocate and these will be discussed within the context of intensive care units (ICUs).

Nurses' time management in intensive care.

During the 1980s, interest was shown in North America as to how Intensive Care Nurses use their work time, in response to a shortage of trained nurses. These studies were developed to investigate the amount of nursing time that could be saved by computerised recording systems. Similar pressures are now present in the United Kingdom, but there are no published work load studies of Intensive Care Nurses. This study used a five category tool to examine the work load of nurses in a cardiothoracic ICU. The methodology was designed so that comparison could be made with the earlier American studies. The 36 nurses studied spent 41% of their time in direct nursing care, 22% in patient assessment, 19% in clerical duties, 11% in time outside the unit and 7% in non-nursing duties. These findings were compared with the North American studies. Similarities were found which give some support to the reliability and validity of the tool.