Introduction Dental caries is entirely preventable, yet remains the most common chronic disease of childhood- affecting 50% of children under five in Wales. It is caused by acid produced by the bacterial metabolism of dietary carbohydrates, particularly refined sugars. Frequent squeal include: pain, infection, poor aesthetics and permanent teeth damage. Basic standards of advice to prevent dental caries exist.1 Ensuring medical staff have the knowledge to advocate appropriate oral care, and know when to refer to dental colleagues could reduce the burden of dental disease. Aims To audit knowledge of staff regarding dental health care in children against basic dental guidelines1. Methods Structured questionnaires were designed by paediatricians and dentists and administered to healthcare staff. These were based upon: dietary advice including limitation of fruit juices, toothpaste fluoride concentrations, brushing techniques, and frequency of dental visits. Results 50 staff members were approached; 30 doctors and 20 nurses. 38% had more than 10 years’ experience. Abstract G137(P) Table 1 Question Correct Answer % Correct Tooth decay: most common chronic childhood disease Yes 52 Age child should drink from a cup 12months 52 Erosion occurs brushing teeth <30mins after drinking juice Yes 72 Eating a piece of cheese is tooth protective Yes 46 Begin tooth brushing as soon as teeth appear through gums Yes 96 Tooth brushing frequency 2 per day 90 Age requiring tooth brushing assistance <7 Years 76 Toothpaste's fluoride strengthens enamel Yes 86 Optimal Fluoride concentration in childhood's toothpaste (parts per million) 1350-1500 54 Advisable frequency of dental visits per year 2 90 Conclusions Our data demonstrates the current knowledge gap regarding basic dental advice. In response we have initiated training sessions for healthcare staff, provided space for dental examination in our admission proforma and developed a family/staff information leaflet, making these widely available. Reference Prevention and management of dental decay in the preschool child. SIGN Nov 2005.
Background Anaphylaxis is a severe life threatening allergic reaction. Prompt administration of epinephrine(adrenaline) is the first line treatment. There are currently three epinephrine auto-injector devices available in the UK; original Anapen, new EpiPen and Jext, each of which differ in their advised method of use. International standards recommend training for all patients prescribed epinephrine auto-injectors, we meet these. If families can more successfully use a particular trainer device, this may have important clinical effects. Aims To assess the effectiveness of the training by evaluating “epinephrine naive” families’ ability to successfully use an auto-injector trainer device. Methods Adults and children over 12, with no experience of auto-injector use were invited to participate in this service evaluation. They were randomly allocated to be trained in the use of one of the available auto-injectors. Their performance was assessed using a ten point marking sheet based on the correct method of administration of epinephrine for the individual device. Six marks were for procedures identical to all three devices (e.g. massage the site of injection) and four were device specific to reflect the differences in administration technique. Success rates were analysed by Chi-square with p < 0.05 being deemed significant (). Results There were 120 participants. Abstract G86 Table 1 Anapen(n = 40) EpiPen(n = 40) Jext(n = 40) Chi squared p valueEpipen: Jext Chi squared p valueEpipen: Anapen All participants(n = 120) Scoring 6/6 for identical procedures 16(40%) 13(33%) 16(40%) ns ns 45(38%) Scoring 4/4 for device specific procedures 36(90%) 18(45%) 22(55%) ns 0.0001 76(63%) Performing all procedures correctly 10/10 16(40%) 8(20%) 10(25%) ns ns 34(28%) Successfully firing auto-injector trainer pens 39(98%) 28(70%) 39(98%) 0.0024 0.0024 106(88%) Conclusions Only 28% of participants were able to perform the individual device’s 10 steps correctly. Overall the trainer devices fired in 88%, with a failure rate of 2 to 30%; a clinically and statistically significant result. The Epipen’s swing and hit delivery method may affect its successful delivery compared to the Jext and Anapen’s methods.
Objective To evaluate prescribing errors made during induction training and evaluate these for any common themes. Methods Four basic questions requiring five or six drugs to be prescribed were administered at the end of the Child Health Induction session for junior doctors. These focused on commonly used medications including analgesics and antibiotics. The doctors were given the BNF for Children (BNFC) and were allowed to use calculators. Answers were derived from the BNFC. We analysed errors by the following parameters: Route of administration, Dosage, Frequency and Dated and signed. Results 96 junior doctors participated between August 2007 and December 2009. 537 individual drug prescriptions were analysed revealing 114 errors (21.2%). Type of error Frequency Percentage of errors Dosage 58 50.8 Frequency 18 15.7 Dose and frequency 14 12.2 Not attempted 13 11.4 Dose mentioned as a range 9 7.8 Route of administration 1 0.9 Not dated and/or signed 1 0.9 Total 114 100 The 58 dosage errors included; underdose-47 (antibiotics), overdose-11 (antibiotics-5, analgesics-6). Conclusion Prescribing errors occur frequently in paediatric admissions with a small proportion causing harm.1 Suggestions to reduce medication errors in children include a recommendation that staff should have sufficient training and continuous education in the use of paediatric medications.2 The GMC emphasises the importance of safe prescribing by all doctors.3 Over recent years routine training and evaluation of junior doctors prescribing ability has been performed as part of Child Health induction training in Cardiff. A significant proportion of prescriptions had an error; around two thirds relating to incorrect dosage or frequency. Future teaching will try to target these mistakes. Mandatory prescription training and evaluation seems valuable.
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