Background: The anaesthetic nurse is a key assistant to the anaesthetist and integral to the provision of safe anaesthesia. Inadequate undergraduate training in South Africa necessitates anaesthetic nurses to acquire the requisite skills and knowledge in the workplace. Few studies explore the challenges faced by practising nurses to acquire such skills. This study sought to explore the experiences of working anaesthetic nurses to gain their perspectives on workplace-based learning, skills acquisition and how to improve anaesthetic nurse training. Methods: We used qualitative methodology comprising an English-medium, self-administered, anonymous questionnaire. A purposive sampling method was used, and 73 anaesthetic nurses working in five government hospitals in eThekwini, KwaZulu-Natal were recruited. Questionnaires were thematically analysed, and simple statistical analysis was used for quantitative data. Results: Most anaesthetic nurses received little or no undergraduate anaesthesia training and participants identified subsequent workplace-based training as inconsistent, and insufficient. Despite most participants’ arbitrary allocation to the position of anaesthetic nurse, the majority found their work stimulating and identified themselves as team-players, adaptable, and willing to learn. Further training and hands-on skills acquisition were keenly sought. Factors impacting positively on their learning and job satisfaction included a confident anaesthetist who was willing to teach and collaborate on learning, provide positive feedback, and include the anaesthetic nurse in case planning. Participants identified crucial areas for further development. In theatre teaching and practical group tutorials led by anaesthetists were suggested as preferred training modalities. Responses to hypothetical case scenarios demonstrated qualities in the participants that are valued in the anaesthetists’ non-technical skills framework. Conclusion: It is evident that there is insufficient formal training and inconsistent training methods of the current anaesthetic nurses in the five study hospitals. The workplace-based learning experiences of our study participants has given us a unique perspective from practising anaesthetic nurses and may be used to inform the formulation of appropriate training curricula and improve the learning partnership with anaesthetists. This should ultimately improve anaesthetic nurse job satisfaction and the theatre team experience.
Aims and objective: To evaluate the pre-spinal risk factors for hypotension associated with spinal anaesthesia in elderly surgical patients. Summary of background data: Hypotension is associated with morbidity and mortality following noncardiac surgery. Reducing the incidence of hypotension associated with spinal anaesthesia may be associated with improved postoperative outcomes. Methods: This was a prospective, observational study, using convenience sampling. All patients over 55 years of age scheduled to receive spinal anaesthesia for lower limb surgery were eligible. Exclusion criteria included the need for resuscitation and/or the need for vasopressors prior to anaesthesia and surgery, and patients who declined spinal anaesthesia. The dosage of spinal anaesthesia and the use of intraoperative sedation were left to the attending anaesthesiologist. The primary outcome was hypotension, which was defined as a decrease in the systolic blood pressure by 25% from the baseline, or a systolic blood pressure below 100 mmHg. The following pre-spinal risk factors were assessed in a multivariable logistic regression for their association with spinal hypotension: age, American Society of Anaesthesiologists-Physical September 2019 Status, sex, dose of local anaesthetic, isobaric bupivacaine or bupivacaine with dextrose, baseline blood pressure, baseline heart rate and fluid preloading prior to spinal anaesthesia. Results: Three hundred and eighty-nine patients were recruited. The primary outcome of spinal hypotension was independently associated with female sex (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.19–3.28), increasing dosage of bupivacaine (OR 1.14, CI 1.01–1.29), and the use of isobaric bupivacaine (OR 1.50, CI 0.95–2.36). Conclusion: Spinal hypotension was associated with female sex, increasing dosage of bupivacaine, and the use of isobaric bupivacaine.
Background: A key element of paediatric pain management is prescribing and dispensing analgesia. This process differs in children, putting them at greater risk of drug error. Methods: This study was a retrospective postoperative analgesia prescription chart review of children who had orthopaedic surgery in a tertiary hospital in Durban, South Africa. Patient records of 202 children, aged 6 months to 12 years, with 232 theatre visits were reviewed. Prescription charts were inspected for patient characteristics, evidence of good prescribing practice and data regarding the prescribing and administration of analgesia. Results: Of the 257 analysed charts 254 (99%) had paracetamol, 208 (81%) had an opioid and 49 (19%) had a nonsteroidal antiinflammatory drug (NSAID) prescribed. Underdosing was evident in all groups of analgesics prescribed. Opioids were more often prescribed with a pro-re-nata caveat and were the least correctly dispensed. There were no prescription charts in which all the requirements for good prescribing practice were complete. Conclusions: This study demonstrates a high rate of paediatric drug error in both the prescribing and dispensing of analgesia. Potential under-utilisation of NSAIDs in this orthopaedic population is also noted. Lack of knowledge or confidence needed by clinicians to adhere to principles of paediatric dosing and multimodal analgesia may be contributing factors. Issues pertaining to paediatric analgesia prescribing and dispensing are highlighted and should be targeted by institution and population specific interventions.
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