RESUMO
BACKGROUND: Alarms in the critical areas are an important component of most of the machines as they alert nurses on the change in the patients' condition. Most patients in the critical care units cannot speak for themselves hence cannot pinpoint when their condition changes. It is therefore important to assess the nurses' interventions when managing clinical alarms. The purpose of this study was to assess interventions employed by nurses in the management of clinical alarms in the care of patients in the Critical Care Unit (CCU), Kenyatta National Hospital (KNH). METHODS: A descriptive cross sectional study was carried out in the month of June 2014 where 87 nurses were recruited as study respondents. KNH/ University of Nairobi (UoN) Ethics and Research committee approved the research. A structured self administered questionnaire was used to collect data. The questionnaire contained some questions in a Likert scale in relation to the actions the nurses would take in the management of clinical alarms and some on whether policies on alarm management existed in the hospital, if they filled alarm checklists and how often and the types of alarms they would respond to first. RESULTS: The respondents' responses were scored and from the results it was clear that there were some gaps in the management of clinical alarms. Majority of the nurses reported that they respond to alarms of all durations and do not fill alarm checklists as neither alarm checklists nor protocols are provided. From the findings there was a statistically significant association (p = 0.06) between age and whether the respondents assessed the cause of the alarm beep. DISCUSSION: Respondents in this study respond to alarms of all durations in contrast to other studies where the findings indicate that nurses respond to alarms for different reasons, not just that the alarm sounds. Majority of the respondents scored averagely on the questions on whether they carry out most of the interventions or actions. This is inline with previous studies which have shown that healthcare personnel respond to alarms depending on the patient's physiological status. CONCLUSIONS: Nurses in the unit carry out the standard nursing interventions on clinical alarms and, respond to alarms of all durations and do not fill alarm checklists. Alarm protocols should therefore be developed in the hospital, the nurses should be trained on management of clinical alarms and more nurses employed.
RESUMO
BACKGROUND: Private sector medicine outlets are an important provider of health services across the developing world, and are an untapped means of distributing and selling vaccines outside of childhood immunization programs. The present study assessed the viability of medicine outlets (chemists and pharmacies) as potential channels for sale of vaccines. METHODS: To evaluate the viability of the medicine outlet model, we partnered with nine outlets across urban and rural communities in western Kenya to sell a nurse-administered typhoid vaccine. Purchasers were surveyed to reveal market demographic characteristics, reasons for vaccine purchase, and sources of information about the program. Key informant interviews and focus group discussions defined acceptability, demand, and additional suggestions for improving this mechanism of selling and distributing vaccines. RESULTS: There was a higher than expected demand for the vaccine that resulted in stock-outs. Previous instance of typhoid, desire to prevent disease, affordable price and convenience were cited by most participants as main reasons for purchase of vaccine at the local outlet. The most common source of information on the vaccine sale was word-of-mouth and referral from friends. Longer vaccine sale duration, adequate stocking of vaccines and extended hours of administration in the evening to allow working individuals to buy vaccines were cited by participants as ways for improved participation in the future. CONCLUSIONS: This study demonstrated a high demand for vaccines at community medicine outlets. Important insights on how to improve and sustain such a program included extension of distribution time, education of outlet keepers, and minimizing vaccine stockouts. With improved social marketing, infrastructure mapping, education and pricing schemes, medicine outlets could become a sustainable avenue for selling adult vaccines in emerging markets for both routine and pandemic vaccines.
