Aust Crit Care
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In order to develop strategies to improve high-dependency (HD) patient care, a continuous quality improvement (CQI) study was initiated in August 1994. It sought to establish a system for the collection and evaluation of relevant information concerning medical and nursing management of HD patients. ⋯ The study revealed a low HD bed occupancy rate, inadequate documentation by medical staff of the need for monitoring, and insufficient numbers of nursing personnel specifically educated to care for HD patients. Recommendations include increased consultants surveillance, immediate assessment of HD patients by a medical officer on the ward, a documented plan for monitoring, avoidance of after-hours discharge from operating theatres or intensive care, and the implementation of an education program for HD area nurses.
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Snake bite envenomation demands a high level of knowledge and skill on the part of the critical care nurse. The following paper examines a case study of one patient who presented on two separate occasions, with snake bites from a taipan and then, 6 months later, from a death adder. ⋯ This paper seeks to examine the different management required for each specific episode of envenomation. It compares the characteristics of the two snakes and examines the different effects of envenomation in both cases.
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The transfer of the critically ill patient is often complex and difficult, and may contribute to increased morbidity. It is therefore valuable to have an understanding of the practical problems relating to patient transfer, and common management strategies, in order to minimise adverse outcomes. Key issues in the process of transporting the critically ill patient in metropolitan Sydney include: (i) particular problems and pitfalls during the transfer process; (ii) risk factors in transferring patients and the appropriateness of escorts and transfer procedures; (iii) procedures for arranging a patient transfer; (iv) the role of the NSW Medical Retrieval Co-ordination Centre (MRCC); (v) preparation of the patient for transfer, (vi) education of staff on the concept of safe matching of patient needs to appropriate escorts; and (vii) the need for a co-ordinated patient transfer system to Sydney metropolitan hospitals. An understanding of these issues, and an appropriate response to them from hospital staff will ensure safe and efficient transportation of critically ill patients in metropolitan Sydney.