Articles from Anaesthesia and intensive care 2015 November

Anaesth Intensive Care · Nov 2015

Case Reports

Anaphylaxis following intravenous paracetamol: the problem is the solution.

Paracetamol is a ubiquitous analgesic and antipyretic that is widely administered, including by anaesthetists. Immediate hypersensitivity reactions to intravenous paracetamol are particularly rare. ⋯ The allergological investigations are described, during which it became evident that both patients were allergic to an excipient (mannitol) present in the formulation and that neither was allergic to the principal agent (paracetamol). The importance of referral and investigation of perioperative drug reactions is underscored by these two cases.

A survey of educator needs to support the implementation of the intrinsic ANZCA Roles in Practice.

The 'Roles in Practice' framework was introduced into the revised ANZCA curriculum in 2013. We conducted an online survey of Supervisors of Training in Australia and New Zealand to assess understanding of this framework, and teaching and perceived value of the non-scholar intrinsic roles within the framework. One hundred and forty-three survey responses were received (response rate 60.8%). ⋯ The Communicator Role was perceived as being the role for which the development of resources would be most valuable. Respondents overwhelmingly nominated small group teaching as the preferred medium for resource development of all intrinsic roles. Our survey indicates that there is a need to increase both the understanding of the Roles in Practice framework and the teaching resources available in the ANZCA Supervisor of Training community.

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Anaesth Intensive Care · Nov 2015

Overcoming barriers to the mobilisation of patients in an intensive care unit.

We conducted a quality improvement project aimed at increasing the frequency of mobilisation in our ICU. We designed a four-part quality improvement project comprising: an audit documenting the baseline frequency of mobilisation; a staff survey evaluating perceptions of the barriers to mobilisation; identification of barriers that were amenable to change and implementation of strategies to address these; and a follow-up audit to determine their effectiveness. The setting was a tertiary care, urban, public hospital ICU in South Australia. ⋯ Multivariable analyses showed that three out of four mobility outcomes did not significantly change between the baseline and follow-up audits, with a significant difference in favour of the baseline audit found for the fourth mobility outcome (maximum level of mobility). We concluded that implementing relatively simple measures to improve staff education, interdisciplinary communication and leadership regarding early progressive mobilisation was ineffective at improving mobility outcomes for patients in a large tertiary-level Australian ICU. Other strategies, such as changing sedation practices and/or increasing staffing, may be required to improve mobility outcomes of these patients.