CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
271
NURSING SCIENCE
Results
: Ninety-four children’s detailed postoperative information
was collected, 76 children survived and 18 died. In-hospital mortality
was 19.1%. The postoperative S
P
O
2
of the survivors increased, which
was significantly improved when compared with pre-operative S
P
O
2
(
p
=
0.000). Fifteen children have already had the radical (definitive)
operation and their postoperative condition is good.
Conclusion:
MBTs is a good palliative treatment for children with
CHD, as it can improve their hypoxic situation and increase pulmo-
nary blood flow so as to improve the success rate of surgery. Rational
use of oxygen, early use of prostaglandin E
1
, improved monitoring of
postoperative cardiac function, implementing effective respiratory
management, early use of peritoneal dialysis, accurate application
of anticoagulant drugs, and comprehensive training of parents could
significantly increase the surgical success and survival rate and
improve the quality of life of the patients.
863: PAEDIATRIC CARDIOTHORACIC SURGICAL SITE
INFECTION PREVENTION: A MULTIDISCIPLINARY
APPROACH
Ashley Nadine Hurford, Julie Plumridge, Di Robertshaw
Great Ormond Street Children’s Hospital, NHS Foundation Trust, UK
Background:
Surgical site infection prevention (SSIP) is a vital part
of ensuring that all patients experience a complication-free journey
throughout their healthcare experience. A great deal of research has
been done in the adult healthcare setting on how to prevent surgi-
cal site infection but there remains little evidence of SSIP within
paediatrics.
Method:
Great Ormond Street Children’s Hospital initiated an inde-
pendent SSI team in 2010. The aim was to independently review
in-patient’s wounds on alternate days and follow them for 30 days
post procedure. The cardiothoracic unit multidisciplinary team
worked together with the department of infection prevention to estab-
lish a care bundle that would be suitable for cardiothoracic patients,
from pre-admission to discharge. All patients now follow a specific
care bundle that includes the following elements:
• improved MRSA screening compliance
• patient information on SSI and surveillance
• pre-operative washing
• patient skin preparation
• information post discharge
• unit protocol development on visitors, chest closure procedures
on CICU, and wound care
• timely investigations into all surgical site infections.
Essential to our work is the ability to follow our patient’s journey
through his/her recovery up to 30 days post-surgery. We believe we
have extended our wound-care program into the community.
Results:
The cardiothoracic unit has been able to follow up 80% of
all surgical patients. Our results show we have had a 10% reduction
in SSI and we currently have a 1% infection rate for deep and organ-
space infections. We feel this is due to the multidisciplinary approach
to the SSIP.
Conclusions:
Since the monitoring process has been in place, we can
demonstrate a reduction in infection rates, which ultimately improves
our patient experience in their healthcare journey. We’re now looking
at extending and developing our methods further to continue our rate
reduction.
930: RESEARCHING THE OUTCOMES OF AN EDUCA-
TIONAL INTERVENTION WITHIN THE WORKPLACE: A
FLEXIBLEWORKFORCE FIT FOR PRACTICE?
Angie Johnson, Sheila McQueen
Northumbria University, Newcastle, UK
Background:
High-dependency nursing of seriously ill cardiac
children is fast paced and requires a high level of attention to detail,
400: PARENT EDUCATION DISCHARGE INSTRUCTIONS:A
PILOT STUDY, HYDERABAD, INDIA
Sandra Staveski
1
, Reena Paul
2
, Rosalind Conway
2
, Susan Kools
1
,
Linda Franck
1
1
San Francisco School of Nursing, University of California, USA
2
Innova Heart Hospital, India
Background
: Every day nurses worldwide assist patients and fami-
lies in the transition from hospital to home. Currently, in economi-
cally developing countries, children with complex cardiac defects
are receiving treatment for their chronic illnesses and are requiring
more expanded parental education programmes to manage care after
discharge. The aim of this study was to test the feasibility of training
Indian nurses to conduct discharge teaching for parents. The study
team developed a sustainable computer-based nurse training, the
PEDI programme, to increase nurses’ knowledge and support role
expansion. Our secondary goal was to validate culturally relevant
training materials for parents and nurses.
Methods
: Institutional review board and ethics committee approvals
were obtained. This investigation used a pre-/post-study design to
evaluate user satisfaction, nurses’ knowledge of discharge teaching
content, and documentation of discharge teaching conducted with
parents. After nurse training throughout a tertiary Indian paediatric
heart hospital, individualised and group parent teaching post-opera-
tive training sessions were implemented on the ward. Convenience
samples of 40 nurses, 25 parents, and 25 patient charts were obtained
pre- and six months post-implementation of the PEDI programme.
Focus testing of parents and nurses and retrospective patient chart
audits were performed.
Results
: There was a 15-point increase in nurses’ discharge knowl-
edge, from a mean of 80.6 to 95.7% (
p
=
0.0005) after participation
in the training. Nurses’ and parents’ reported high levels of satisfac-
tion with the parent education material (3.75–4 on a four-point scale).
Evidence of discharge teaching in patient medical records improved
from 60% (15/25 charts) to 96% (24/25 charts) after implementation
of the PEDI programme.
Conclusions
: Nurses can play an integral role in educating parents
about postoperative care at home for children with complex cardiac
defects. Future studies are needed to examine nurse, child, parent
and organisational outcomes related to this expanded nursing role in
developing countries.
420: EFFECT ANALYSIS AND NURSING METHODS STUDY
OF THE MODIFIED BLALOCK-TAUSSIG SHUNTS OPERA-
TION IN CHILDRENWITH CONGENITAL HEART DISEASE
Lijuan Fu
Shanghai Children’s Medical Centre, China
Objective
: Through summarising the therapeutic efficacy of the
modified Blalock-Taussig shunts (MBTs) used on children with
congenital heart disease (CHD), we aimed to study the methods of
peri-operative nursing care and the reasons for complications, and
to use the appropriate care counter-measures to increase children’s
survival rate and improve their quality of life.
Methods:
A retrospective study was performed to summarise the
peri-operative treatment and nursing process and the subsequent
complications of the 94 children undergoing MBTs operation. The
peri-operative monitoring and nursing methods included: (1) All
the children underwent pre-operative examinations, and low-flow
oxygen inhalation and prostaglandin E
1
was administered to them
to prevent the closure of the ductus arteriosus. (2) We continuously
monitored the children’s postoperative cardiac function. (3) We kept
a balance of intake and output, electrolytes and acid–base ratios. (4)
We used peritoneal dialysis early on. (5) We implemented effective
respiratory management. (6) We strengthened the anticoagulant drug
application and venous access management to prevent postoperative
catheter embolisation.
