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This study focuses on acute home-based care. Data wasollected over an 18-month period. The sample populationncluded patients admitted to Hospital in the Home eitherirectly from their General Practitioner or the emergencyepartment requiring intravenous antibiotics (N = 196). Forhe purpose of this study the outcome measure was theate of phlebitis per 100 catheter days. The researcherlso explored relationships between other variables iden-ified in the literature, thought to affect the developmentf phlebitis.

Final results indicated a satisfactory randomisation pro-ess with no statistical demographic difference betweenhe control and experimental population. The results werexplored using the Kaplan—Meier survival curve to assesshe equivalence of survival times until events (in this casehlebitis). The Log rank (Mantel—Cox) test of equivalencehowed no significant difference in the rates of phlebitisver time between the control and experimental groupsp = 0.987). Furthermore comparing the ratio of phlebitisvents to the total number of dwell time hours between thewo groups indicate that the rate of phlebitis occurred at aimilar rate for experimental and control group catheters.

The majority of catheters were either 20 or 22 gauge andnserted by either the HITH nurse or emergency departmenturses. The data was further extrapolated to determinef either of these factors affected the development ofhlebitis. The inserting clinician data suggests that intra-enous catheters inserted in the emergency department areot statistically more likely to develop phlebitis than thosenserted by HITH staff.

This presentation will give an overview of the study andts findings with focus on the fact that ED inserted periph-ral intravenous catheters are not more likely to develophlebitis, suggesting that earlier routine re-site at 48 h isnnecessary.

eywords: Peripheral intravenous catheters; Dwell time;hlebitis

oi:10.1016/j.aenj.2007.09.070

he effect of a rapid rehydration guideline on ED manage-ent of gastroenteritis in children

anielle Waddell 1,∗, Julie Considine1,2

Emergency Department, The Northern Hospital, Epping,IC, AustraliaDeakin University, Melbourne, VIC, Australia

This project will examine the effect of rapid rehydra-ion guideline on emergency department (ED) managementf gastroenteritis in small children (aged <4 years) with aocus on decreasing need for admission and reducing EDength of stay. The ED at TNH manages approximately 1000mall children with gastroenteritis per year. Of these, 19.5%equired admission. Dehydration secondary to gastroenteri-is is a common reason for parents of small children toeek emergency care. Observations of current practice sug-

est wide variability in the management of this patientroup and unnecessary delays in definitive management.he aim of this study is to evaluate the effect of a rapidehydration guideline for the emergency department (ED)

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anagement of gastroenteritis in children aged under 4ears. Primary outcomes of this project will be need for inpa-ient admission and ED length of stay. Secondary outcomesill be assessment of physiological recovery and consistencyf rehydration regimes used. This project is of importance tohe Northern Hospital as gastroenteritis in children is a com-on ED presentation and efficient ED management of theseatients will ensure positive patient outcomes and optimumse of ED resources.

Early evidence-based intervention for children with gas-roenteritis may reduce complications such as increasedeverity of dehydration and decrease use of intravenous flu-ds. This paper will present the study findings and examinehe implications of evidence-based practice for the manage-ent of paediatric gastroenteritis.

eywords: Emergency department; Paediatric; Gastroen-eritis; Evidence-based practice

oi:10.1016/j.aenj.2007.09.071

oes it hurt? The challenges of pain assessment and man-gement in paediatric emergency

uzanne Williams

Practice Development, Paediatric Emergency, Mater Chil-ren’s, South Brisbane, QLD, Australia

According to Simons and Macdonald1 current knowledgen the assessment and management of pain in children isnder-utilised leading to inadequate treatment of paediatricain. The use of pain assessment tools is strongly supportedn the literature as a routine and integral part of paediatricanagement1 and there are a number of paediatric pain

core tools in practice. However, the majority of these toolsncluding the Wong—Baker faces2 focus on self-assessmentnd require preparation of the child and caregiver prioro use. This presents a challenge to accurate pain assess-ent in the Paediatric Emergency Department because of

he unplanned nature of the presentation. The Alder Heyriage paediatric pain score (AHTS)3 is a validated observa-ional pain score tool which can be easily utilised by triageurses to assess children’s pain on presentation. The AHTSas developed for use at triage and utilises nursing observa-

ion of the child’s response to pain. The advantages of thisool include:

Validation as a paediatric pain management tool.Designed for use in the emergency department setting.Observational model which can used for ALL ages.Assists in assessing the level of pain and correlation withthe level of analgesia required.High level of inter-rata reliability which enhances appli-cation in an ED with multiple users.Staff can be trained in approximately 10 min (with supportat triage during initial use).

In the spirit of evidence-based practice a project wasndertaken to trial the AHTS as a pain assessment tool inaediatric emergency.4 The ultimate goal of the projectas to facilitate the development of definitive guidelines

n administration of analgesia in line with pain assessment.

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Subsequently the AHTS was integrated into a pain man-agement pathway and trialled in the emergency paediatricsetting. This paper describes the challenges nurses experi-enced in implementing a pain management pathway utilisingthe AHTS as the primary assessment tool. Outcomes of thistrial will guide future practice in determining appropriateanalgesia for the paediatric patient.

Keywords: Pain assessment tool; Pain management; Paedi-atric emergency

Reference

1. Simons J, Macdonald L. Changing practice: implementing val-idated paediatric pain assessment tools. J Child Health Care2006;10(2):160—176.

2. Wong D, Baker C. Pain in children: comparison of assessmentscales. Paediatr Nurs 1988;14(1):9—17.

3. Stewart B, Lancaster G, Lawson J, Williams K, Daly J. Validationof the Alder Hey Triage Score. Arch Dis Child 2004;89:625—630.

4. Beyea S, Slattery M. Evidence-based practice in nursing. Mar-blehead: HCPro Inc.; 2006.

doi:10.1016/j.aenj.2007.09.072

Nursing as a political force

Frances Hughes1,2

1 University of Technology Sydney, Sydney, NSW, Australia2 WHO Pacific Islands Mental Health Network, New Zealand

There are challenges in health care which nursing hasthe enormous and unrealised potential to contribute toaddressing. Workforce issues, public health challenges suchas poverty, HIV/AIDs, and ageing populations for exampleare all issues that health care systems worldwide are grap-pling with.

Opportunity for nurses to connect with policy will makethem more effective with the ultimate goal being to improvethe health of our nations. Nurses inherently have a vastamount of skill and experience which can be brought to thepolicy arena. However, many of these opportunities havebeen missed. Nurses need to realise the importance of theirinvolvement in engaging with policy. To do so will give nursesthe power to really change things, ultimate goal of courseis to contribute to strategies that improve the health of ournations.

The author will outline her own doctoral research intothe political development of nursing and provide a frame-

work for nursing to develop into a greater political force.It is through nursing developing in this area that the keychallenges can be addressed.

doi:10.1016/j.aenj.2007.09.073

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We’re just gonna give your dad a trakky”: Turning com-laints about emergency nurses into quality changes

eth Wilson

Victorian Health Services Commissioner, Melbourne, VIC,ustralia

Every state and territory of Australia and New Zealandow has a health complaints commissioner. The primary rolef the commissioner is to receive and resolve complaintsbout health providers. Most people who make complaintsant to know what went wrong and why, and they want

o ensure that what happened to them does not happeno someone else. In other words, if they take the troubleo lodge a complaint they are hoping to achieve qual-ty changes. Complaints about nursing staff in emergencyervices are few in number but all contain failures of commu-ication. This paper explores the reasons for communicationailures in emergency settings. It does so using story, humournd music to communicate a serious message in a light-earted way. It invites the delegates to view complaints,ot in a negative way, but as an opportunity to improve theervices they provide.

oi:10.1016/j.aenj.2007.09.074

linical risk management and the ethics of open disclo-ure when things go wrong: Implications for the nursingrofession

egan-Jane Johnstone

RMIT University, Melbourne, VIC, Australia

There is now widespread acknowledgement in the inter-ational patient safety literature that human error andreventable adverse events in health care are inevitable. Its also generally agreed that while it is impossible to eradi-ate human error and preventable adverse events in healthare, it is nonetheless possible to design and implement sys-ems and processes that will help reduce their incidence andarmful impact in clinical domains. Critical to the success-ul development and implementation of effective patientafety systems and processes in health care is the devel-pment and operationalisation of an organisational processalled clinical governance. A key driver of patient safetyrocesses within a clinical governance structure is clini-al risk management (CRM)—–the primary focus of which ishe prevention, monitoring, early identification, and earlyanagement of clinical incidents. And linchpin to the effec-

iveness of early identification processes in CRM programs isncident reporting. This is because, as has been famouslyrgued in the patient safety literature, ‘you can’t fix whatou don’t know about’.

The next (and in several respects, logical) step in inci-ent reporting is the ‘open disclosure’ of adverse events.pen disclosure (now guided by a national standard in Aus-ralia) refers to a multifaceted and complex process of ‘openommunication’ with patients and their carers ‘when things

o wrong’. Open disclosure, in such instances, includesn immediate and candid discussion about what has hap-ened, why it has happened, and what is being done toelp prevent it from happening again. It also includes an