The process and impact of implementing injury prevention projects in smaller communities in New Zealand.

It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10 000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.

Shopping trolley-related injuries to children in New Zealand, 1988-97.

OBJECTIVE: To describe the epidemiology of shopping trolley related injuries (fatalities and hospitalizations) to children in New Zealand prior to the introduction of a voluntary standard for shopping trolleys. METHODOLOGY: To identify cases, a key word search was conducted of national mortality and hospitalization databases for the years 1988-97. Cases were limited to children under 15 years of age. RESULTS: For the 10 year period investigated, 282 hospitalizations and no fatalities were identified. A significant increasing trend for hospitalizations was detected (chi2 = 17.6, 1 d.f.; P < 0.001). Ninety-two per cent of children hospitalized were aged under 5 years and two-thirds were aged 2 years or younger. Ninety per cent of injuries resulted from falls from trolleys, 84% of injuries were to the head or face and 22% were rated serious (AIS-3) on the Abbreviated Injury Scale. CONCLUSIONS: The incidence of injuries associated with shopping trolleys increased between 1988 and 1997. Following the introduction of a voluntary standard for shopping trolleys in 1999, which included specifications for child harnesses, trends in injury should be monitored.

A unitary patient record improves admission documentation in a medical assessment unit in a major teaching hospital.

OBJECTIVE: To ascertain the impact of the introduction of a unitary patient record (UPR) on clerking documentation of emergency medical admissions. DESIGN: Retrospective casenote audit. SUBJECTS AND SETTING: Random sample of 100 unselected admissions to the medical assessment unit of a major teaching hospital, comprising two groups pre- and post-introduction of the UPR. RESULTS: Statistically significant improvements in the documentation of several items were achieved; function before episode, ethnic origin, chest pain, breathlessness, ankle oedema, cough, bowel habit and locomotor symptoms and recording of blood pressure and peripheral pulses. There were trends towards improvement in other areas and there were no areas in which the UPR performed less well than standard documentation. CONCLUSIONS: Introduction of the UPR represents the successful application of multidisciplinary principles to over 10,000 acute general medical admissions. It has improved some, but not all, aspects of documentation. Revision of the design of the UPR should lead to further progress, as part of an ongoing process of development and re-audit.