165 results for Merry, Alan, Journal article

  • Acid Aspiration Risk-Factors

    Hutchinson, BR; Merry, Alan (1986-02-01)

    Journal article
    The University of Auckland Library

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  • Improving patients' safety by gathering information.

    Runciman, WB; Merry, Alan; Mccall, SA (2001-08-11)

    Journal article
    The University of Auckland Library

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  • Managing treatment injury—and response

    Merry, Alan; Seddon, Mary (2006)

    Journal article
    The University of Auckland Library

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  • Medication administration in anesthesia - time for a paradigm shift

    Stabile, M; Webster, Craig; Merry, Alan (2007)

    Journal article
    The University of Auckland Library

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  • Safety in Anaesthesia: promoting sustainable change for the future

    Merry, Alan (2008)

    Journal article
    The University of Auckland Library

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  • Hard lessons for pain researchers

    Merry, Alan; Frampton, CM; Anderson, Brian (2010)

    Journal article
    The University of Auckland Library

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  • Role of anesthesiologists in WHO safe surgery programs

    Merry, Alan (2010)

    Journal article
    The University of Auckland Library

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  • The challenges of technological intensification

    Webster, Craig; Stabile, M; Merry, Alan (2009)

    Journal article
    The University of Auckland Library

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  • Improved compliance with the World Health Organization Surgical Safety Checklist is associated with reduced surgical specimen labelling errors

    Martis, WR; Sturge, Jacqueline; Lee, T; Merry, Alan; Mitchell, Simon (2016-09-09)

    Journal article
    The University of Auckland Library

    AIMS: A new approach to administering the surgical safety checklist (SSC) at our institution using wall-mounted charts for each SSC domain coupled with migrated leadership among operating room (OR) sub-teams, led to improved compliance with the Sign Out domain. Since surgical specimens are reviewed at Sign Out, we aimed to quantify any related change in surgical specimen labelling errors. METHODS: Prospectively maintained error logs for surgical specimens sent to pathology were examined for the six months before and after introduction of the new SSC administration paradigm. We recorded errors made in the labelling or completion of the specimen pot and on the specimen laboratory request form. Total error rates were calculated from the number of errors divided by total number of specimens. Rates from the two periods were compared using a chi square test. RESULTS: There were 19 errors in 4,760 specimens (rate 3.99/1,000) and eight errors in 5,065 specimens (rate 1.58/1,000) before and after the change in SSC administration paradigm (P=0.0225). CONCLUSIONS: Improved compliance with administering the Sign Out domain of the SSC can reduce surgical specimen errors. This finding provides further evidence that OR teams should optimise compliance with the SSC.

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  • Perspective on Cerebral Microemboli in Cardiac Surgery: Significant Problem or Much Ado About Nothing?

    Mitchell, Simon; Merry, Alan (2015-03)

    Journal article
    The University of Auckland Library

    From the time an association was perceived between cardiac surgery and post-operative cognitive dysfunction (POCD), there has been interest in arterial microemboli as one explanation. A succession of studies in the mid-1990s reported a correlation between microemboli exposure and POCD and there followed a focus on microemboli reduction (along with other strategies) in pursuit of peri-operative neuroprotection. There is some evidence that the initiatives developed during this period were successful in reducing neurologic morbidity in cardiac surgery. More recently, however, there is increasing awareness of similar rates of POCD following on and off pump cardiac operations, and following many other types of surgery in elderly patients. This has led some to suggest that cardiopulmonary bypass (CPB) and microemboli exposure by implication are non-contributory. Although the risk factors for POCD may be more patient-centered and multifactorial than previously appreciated, it would be unwise to assume that CPB and exposure to microemboli are unimportant. Improvements in CPB safety (including emboli reduction) achieved over the last 20 years may be partly responsible for difficulty demonstrating higher rates of POCD after cardiac surgery involving CPB in contemporary comparisons with other operations. Moreover, microemboli (including bubbles) have been proven harmful in experimental and clinical situations uncontaminated by other confounding factors. It remains important to continue to minimize patient exposure to microemboli as far as is practicable.

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  • Can team training make surgery safer? Lessons for national implementation of a simulation-based programme

    Weller, Jennifer; Civil, Ian; Torrie, Jocelyn; Cumin, David; Garden, A; Corter, A; Merry, Alan (2016-10-14)

    Journal article
    The University of Auckland Library

    AIM: Unintended patient harm is a major contributor to poor outcomes for surgical patients and often reflects failures in teamwork. To address this we developed a Multidisciplinary Operating Room Simulation (MORSim) intervention to improve teamwork in the operating room (OR) and piloted it with 20 OR teams in two of the 20 District Health Boards in New Zealand prior to national implementation. In this study, we describe the experience of those exposed to the intervention, challenges to implementing changes in clinical practice and suggestions for successful implementation of the programme at a regional or national level. METHODS: We undertook semi-structured interviews of a stratified random sample of MORSim participants 3-6 months after they attended the course. We explored their experiences of changes in clinical practice following MORSim. Interviews were recorded, transcribed and analysed using a general inductive approach to develop themes into which interview data were coded. Interviews continued to the point of thematic saturation. RESULTS: Interviewees described adopting into practice many of the elements of the MORSim intervention and reported positive experiences of change in communication, culture and collaboration. They described sharing MORSim concepts with colleagues and using them in teaching and orientation of new staff. Reported barriers to uptake included uninterested colleagues, limited team orientation, communication hierarchies, insufficient numbers of staff exposed to MORSim and failure to prioritise time for team information sharing such as pre-case briefings. CONCLUSION: MORSim appears to have had lasting effects on reported attitudes and behaviours in clinical practice consistent with more effective teamwork and communication. This study adds to the accumulating body of evidence on the value of simulation-based team training and offers suggestions for implementing widespread, regular team training for OR teams.

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  • Extending the WHO 'Safe Surgery Saves Lives' Project through Global Oximetry

    Merry, Alan; Eichhorn, JH; Wilson, IH (2009-10)

    Journal article
    The University of Auckland Library

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  • Reducing harm from falls

    Jones, S; Blake, S; Hamblin, R; Petagna, C; Shuker, C; Merry, Alan (2016-12-02)

    Journal article
    The University of Auckland Library

    Serious adverse event reporting from district health boards (DHBs) brought in-hospital falls to the attention of the Health Quality & Safety Commission (the Commission) when it was incepted in 2010. In 2012, responding to the large numbers reported, the Commission began planning for a three-year programme to reduce harm from falls, initially to run 2013-2015. In this article we discuss the serious consequences of falls, and the challenges and practical considerations involved in reducing the risk of falling and the rate of falls. We explore the Commission's choice of an adaptive approach in its programme, and show how a targeted measurement framework and national action has led to a nationwide statistically significant reduction in fractured neck of femur (hip fracture) and associated costs resulting from in-hospital falls, from a median of 12 per 100,000 admissions to eight per 100,000 admissions, sustained as at June 2016 for six quarters. This reduction reflects nationwide implementation of two key care processes: 1.) the percentage of patients 75 and over provided with an assessment of their risk of falling upon admission to hospital has risen from 77% in the first quarter of 2013 to 91% nationally in June 2016, 2.) the percentage of those with identified risk who were provided with an individualised care plan that addressed those risks has risen from 77% of older patients in the first quarter of 2013 to 95% nationally in June 2016. (These results are also reflected in a 14% decrease to 30 June 2016 in numbers of falls reported by DHBs as serious adverse events). Finally, we give a call to arms to the disparate health practitioners and services across all settings for individualised responses to prevent falls one patient at a time, and for leadership responses that promote an integrated approach to falls in older people.

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  • Ethics, Industry and Outcomes

    Merry, Alan (2008-03)

    Journal article
    The University of Auckland Library

    Evidence-based medicine depends on research that is reliable, well conducted, and free of influence from interest groups (which are not confined to industry). There are many ways to influence the outcome of clinical research, and the history of influence in research related to tobacco is illuminating in this regard. Health care depends on industry, and if properly managed, the relationship between industry and medical academia can be symbiotic. Achieving positive outcomes from such relationships depends on ensuring the presence of the elements needed for reasonable independence on the part of investigators, and on understanding the ways in which influence can be exerted over the production and publication of evidence. Regulation cannot substitute for integrity, particularly the integrity of the investigators. Pushing the limits of ethics in research threatens to undermine not only the reputation of those conducting the research but also the standing of science itself.

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  • Development of an 'Equipment to manage a difficult airway during anaesthesia' professional document using a new evidence-based approach

    Scott, DA; Merry, Alan (2010-01)

    Journal article
    The University of Auckland Library

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  • Effective labelling is difficult, but safety really does matter

    Webster, Craig; Mathew, DJ; Merry, Alan (2002-02)

    Journal article
    The University of Auckland Library

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  • The Bare Minimum Requires Caution

    Gelb, AW; Enright, A; Merry, Alan; Morriss, W (2015-10-19)

    Journal article
    The University of Auckland Library

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  • Safety, cost and predrawn emergency drugs

    Webster, Craig; Merry, Alan; Ducat, CM (2001)

    Journal article
    The University of Auckland Library

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  • Reducing perioperative harm in New Zealand: the WHO Surgical Safety Checklist, briefings and debriefings, and venous thrombembolism prophylaxis

    Perry, W; Civil, Ian; Mitchell, S; Shuker, C; Merry, Alan (2015-10-30)

    Journal article
    The University of Auckland Library

    New Zealand appears to have a relatively high rate of perioperative adverse events. The Health Quality & Safety Commission???s Safe Surgery NZ programme was introduced to address the rates of perioperative harm in New Zealand by promoting proper and effective use of the World Health Organization (WHO) Surgical Safety Checklist, and by encouraging use of operating room (OR) team briefings and debriefings. Venous thromboembolism prophylaxis is a key part of the checklist as deployed in New Zealand ORs, but it remains underused or variably used as well. Communication and teamwork are critical to improving patient safety and efficiency in the OR, and these interventions have demonstrated effectiveness in building and melding effective teams.

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  • Use of a new task-relevant test to assess the effects of shift work and drug labelling formats on anesthesia trainees' drug recognition and confirmation.

    Cheeseman, James; Webster, Craig; Pawley, Matthew; Francis, Margaret; Warman, Guy; Merry, Alan (2011-01)

    Journal article
    The University of Auckland Library

    Background Drug administration errors occur in every aspect of clinical practice. Using a novel task-relevant Medication Recognition and Confirmation Test (MRCT), we investigated the effects on performance of working night and day shifts and labelling different drug formats. Methods Anesthesia trainees (n = 18) participated in one of two experiments during an 8-12 hr day shift and an 8-12 hr night shift. In Experiment-1 (n = 10), we compared standardized colour-coded labels with pictures of ampoules. In Experiment-2 (n = 8), we compared colourcoded labels with black and white labels. Sleep was measured with wrist actigraphy during both day and night shift runs over seven to eight days. The MRCT outcome measures were reaction times and drug errors. Results In the two experiments, colour-coded labels were recognized (and therefore selected) more quickly than pictures of conventional ampoules (mean difference 332 msec, 95% confidence interval (CI) 242-422 msec; P\0.0001) and faster than black and white labels (mean difference 96 msec, 95% CI 46-146 msec; P\0.0001). Participants obtained less sleep while working night shifts than while working day shifts (mean difference 57 min, 95% CI 0:15-1:39 hr; P = 0.013). Mean confirmation reaction times were slower during night shifts than during day shifts (mean difference 60 msec, 95% CI 1-120 msec; P = 0.048). No differences in error rates were observed between shifts or among drug label types. Conclusions Label format influenced recognition and confirmation reaction times to representations of drugs in this study, and we found some evidence to suggest that performance is better during day shifts than during night shifts. The task-relevant test evaluated here may have further application in measuring performance in the wider clinical setting.aspect of clinical practice. Using a novel task-relevant Medication Recognition and Confirmation Test (MRCT), we investigated the effects on performance of working night and day shifts and labelling different drug formats. Methods Anesthesia trainees (n = 18) participated in one of two experiments during an 8-12 hr day shift and an 8-12 hr night shift. In Experiment-1 (n = 10), we compared standardized colour-coded labels with pictures of ampoules. In Experiment-2 (n = 8), we compared colourcoded labels with black and white labels. Sleep was measured with wrist actigraphy during both day and night shift runs over seven to eight days. The MRCT outcome measures were reaction times and drug errors. Results In the two experiments, colour-coded labels were recognized (and therefore selected) more quickly than pictures of conventional ampoules (mean difference 332 msec, 95% confidence interval (CI) 242-422 msec; P\0.0001) and faster than black and white labels (mean difference 96 msec, 95% CI 46-146 msec; P\0.0001). Participants obtained less sleep while working night shifts than while working day shifts (mean difference 57 min, 95% CI 0:15-1:39 hr; P = 0.013). Mean confirmation reaction times were slower during night shifts than during day shifts (mean difference 60 msec, 95% CI 1-120 msec; P = 0.048). No differences in error rates were observed between shifts or among drug label types. Conclusions Label format influenced recognition and confirmation reaction times to representations of drugs in this study, and we found some evidence to suggest that performance is better during day shifts than during night shifts. The task-relevant test evaluated here may have further application in measuring performance in the wider clinical setting.

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