Australasian Emergency Nursing Journal RSS feed: Articles in Press. As the official journal of the College of Emergency Nursing Australasia (CENA), the The Australasian Emergency Nursing Journal (AENJ) serves the professional practice needs of emergency nurses by providing them with high-quality information directly relevant to their contemporary practice. As an international peer-reviewed journal, the AENJ is a conduit for clinical, applied, and theoretical research and scholarship in emergency nursing that is original and innovative. The Journal is published four times a year. ERA Ranking: A (as at December, 2010) Peer-Review Process: Double-blind, external peer review Nursing Consult Visit our nursing resource, Nursing Consult To purchase books on Emergency Nursing or to browse our comprehensive range of Nursing titles, please visit us at shop.elsevier.com.au. Go to: Shop.elsevier.com.au/Emergency http://www.aenj.org.au//inpress?rss=yesElsevier Inc.en Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved. Australasian Emergency Nursing Journal1574-62672012-02-10 Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.aenj.org.au/article/PIIS1574626711002771/abstract?rss=yesSummary: Objectives: Every health service presentation of a child should be considered an opportunity to ensure optimal immunisation. Measures to limit missed opportunities for vaccination in local emergency departments (ED) should reflect the scale of opportunity and parental support of immunisation service delivery strategies.Methods: The vaccination status of every child aged less than seven years that presented to a tertiary hospital ED over a three month period was identified using the Australian Childhood Immunisation Register (ACIR). Contra-indications to vaccination were determined from medical records. A telephone survey or posted survey was conducted with parents of eligible children to confirm ACIR status and whether they would have consented to receiving vaccinations during their presentation. ED records were reviewed for vaccination history recording and ACIR records were reviewed, after interview, to confirm parental reports that initial ACIR status was incorrect.Results: Nine per cent (215/2399) of children were identified as incompletely vaccinated according to ACIR. Forty-seven children were excluded. Of the remaining 168 children, 95 parents (57%) participated. Thirty-eight children had no contra-indications and their parents would have consented to vaccination during their ED presentation. The vaccination status of 82% (78/95) was recorded in ED records, but was incorrect in 35 cases. Forty parents indicated that the ACIR record was incorrect and this was confirmed in 36 cases (90%).Conclusions: There were missed opportunities to vaccinate a small proportion of children in ED. Parents provided a more accurate timely history of immunisation status than ACIR and thus ED staff should ensure that parents are always asked whether their child is fully vaccinated and provide or encourage vaccination.Opportunistic childhood vaccinations in emergency—Are we really missing anyone? - Corrected ProofIngrid Berling, Jody Stephenson, Patrick Cashman, Conrad Loten, Michelle Butler, David Durrheim10.1016/j.aenj.2011.12.002Australasian Emergency Nursing Journal (2012)2012-02-10Australasian Emergency Nursing Journal2012-02-10RESEARCH PAPERhttp://www.aenj.org.au/article/PIIS157462671200002X/abstract?rss=yesThe Prince of Wales Audit Project team would like to thank Associate Professor Gerdtz for her comments regarding our presentation at this year's 9th International Conference for Emergency Nurses.Letter to the Editor - Corrected ProofAlister Hodge, Andrew Hugman, Wayne Varndell10.1016/j.aenj.2012.01.001Australasian Emergency Nursing Journal (2012)2012-02-10Australasian Emergency Nursing Journal2012-02-10http://www.aenj.org.au/article/PIIS1574626711002722/abstract?rss=yesSummary: According to the World Health Organization lung cancer was the leading cause of cancer deaths in 2008. Patients with lung cancer present frequently to the emergency department. This article will outline Non-Small Cell Lung Cancer (NSCLC), patient presentation, and how to care for the patient with lung cancer in the emergency department (ED).Lung cancer in the emergency department - Corrected ProofAndrew D. Harding, Catherine C. Simmons10.1016/j.aenj.2011.10.001Australasian Emergency Nursing Journal (2012)2012-02-01Australasian Emergency Nursing Journal2012-02-01DISCUSSION AND DEBATEhttp://www.aenj.org.au/article/PIIS1574626711002734/abstract?rss=yesSummary: Haemolysed blood samples are an unnecessary burden on Emergency Departments (ED) as they increase workloads and drive down efficiencies. Little empirical data exists that demonstrates the effectiveness of educational posters displayed in staff toilet cubicles. This study explored the impact educational toilet posters have on reducing haemolysis rates within the ED.Methods: A time series study of the clinical effect of educational toilet posters on reducing haemolysis rates throughout a 12 month period at the Gold Coast Hospital ED was undertaken. The GCH ED is a tertiary emergency service that has approximately 66,000 patient presentations per year. Data was collected prospectively. Analysis was undertaken to investigate the effects on total number of haemolysed samples and those clinically significant samples with a haemolytic index >3. Further investigation explored the specific effects on medical and nursing staff.Results: Analysis undertaken using an independent t-test found that the pre-intervention data demonstrates a medium haemolysis rate of 4.92% (SD=1.04). This is a statistically significantly different (t=3.56, df=50, p=0.001) from the median post intervention data of 3.95% (SD=0.84). The difference of 0.97% (95%CI=0.42, 1.52) represents a 19.72% reduction in clinically significant haemolysed samples over the study period.Conclusion: This study reveals that the use of educational toilet posters had a positive impact on reducing the rates of haemolysed samples collected within the ED. This simple and cost effective educational initiative changed the behaviour of clinical staff. Further investigation is warranted to examine the impact of educational toilet posters on additional clinical scenarios.Testing the effects of educational toilet posters: A novel way of reducing haemolysis of blood samples within ED - Corrected ProofDavid Corkill10.1016/j.aenj.2011.11.001Australasian Emergency Nursing Journal (2012)2012-02-01Australasian Emergency Nursing Journal2012-02-01RESEARCH PAPERhttp://www.aenj.org.au/article/PIIS157462671100276X/abstract?rss=yesSummary: Injury is a leading cause of mortality, hospitalised morbidity and disability in Australia and New Zealand. Of the many public health challenges facing clinicians on a daily basis, traumatic injury is one of the most significant. A large spectrum of injury severity may result, ranging from minor injuries which require little medical intervention through to severe multisystem trauma, requiring definitive management by an experienced multidisciplinary team. An improved understanding of the incidence and prevalence of trauma can empower clinicians of all levels of experience to contribute to improving the trauma system they work in at a local level. This paper provides an overview of the history and epidemiology of traumatic injury in Australia and New Zealand. The reading of this article and completion of revision questions is equivalent to 2h of self-directed learning.Traumatic injury in Australia and New Zealand - Corrected ProofKate Curtis, Erica Caldwell, Andrea Delprado, Belinda Munroe10.1016/j.aenj.2011.12.001Australasian Emergency Nursing Journal (2012)2012-02-01Australasian Emergency Nursing Journal2012-02-01PRACTICE DEVELOPMENT PAPERhttp://www.aenj.org.au/article/PIIS1574626711002783/abstract?rss=yesSummary: Background: Management of dental emergencies is a clinical problem facing many primary care providers who have often received little training in this area.Aim: This study evaluated the impact of a four-hour interactive workshop on clinicians’ self reported proficiency in managing common dental emergencies.Method: A descriptive study design using a questionnaire type survey instrument was used to evaluate the effectiveness of a brief interactive workshop.Results: The workshop positively impacted proficiency, especially in oral local anaesthesia, management of avulsed teeth and dental trauma. Open comments from participants focused on the lack of dental topics in professional training.Recommendations: Further education is required in the management of dental emergencies such as odontogenic infections, dental local anaesthesia, trauma, intra-oral haemorrhage and in dental nomenclature.Conclusions: An effective interactive workshop intervention employing blended instructional techniques may help improve the management of dental emergencies and patient outcomes.Can a four-hour interactive workshop on the management of dental emergencies be effective in improving self reported levels of clinician proficiency? - Corrected ProofTony Skapetis, Tania Gerzina, Wendy Hu10.1016/j.aenj.2011.12.003Australasian Emergency Nursing Journal (2012)2012-02-01Australasian Emergency Nursing Journal2012-02-01RESEARCH PAPERhttp://www.aenj.org.au/article/PIIS1574626711002795/abstract?rss=yesSummary: Objective: To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department.Methods: A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios.Results: Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92–0.99) sensitivity and 66% (CI, 0.57–0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2–3.7) and the negative likelihood ratio was 0.03 (CI, 0.01–0.13).Conclusion: The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral.Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department - Corrected ProofGaye Moore, Graham Hepworth, Tracey Weiland, Elizabeth Manias, Marie Frances Gerdtz, Margaret Kelaher, David Dunt10.1016/j.aenj.2011.12.004Australasian Emergency Nursing Journal (2012)2012-02-01Australasian Emergency Nursing Journal2012-02-01RESEARCH PAPERhttp://www.aenj.org.au/article/PIIS1574626711002746/abstract?rss=yesThe publisher wishes to apologize for the error in the figure legend of . The correct figure legend of is reproduced below. The publisher apologizes for this error and any confusion it may have caused.Erratum to: “Gunshot wounds to the leg causing neurovascular compromise—A case study” [Aust. Emerg. Nurs. J. 14 (2011) 264–269] - Corrected ProofTaneal Wiseman, Kate Curtis10.1016/j.aenj.2011.11.002Australasian Emergency Nursing Journal (2012)2012-01-31Australasian Emergency Nursing Journal2012-01-31ERRATUMhttp://www.aenj.org.au/article/PIIS1574626711002758/abstract?rss=yesSummary: Background: It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management.Methods: A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken.Findings: Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients’ pain level and attitudes toward pain assessment and pain management were identified as barriers.Conclusion: This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED.Characteristics of effective interventions supporting quality pain management in Australian emergency departments: An exploratory study - Corrected ProofRamon Z. Shaban, Kerri Holzhauser, Kerri Gillespie, Sue Huckson, Scott Bennetts10.1016/j.aenj.2011.11.003Australasian Emergency Nursing Journal (2012)2012-01-24Australasian Emergency Nursing Journal2012-01-24RESEARCH PAPER