170 results for Merry, Alan

  • Acid Aspiration Risk-Factors

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

    Journal article
    The University of Auckland Library

    View record details
  • Improving patients' safety by gathering information.

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

    Journal article
    The University of Auckland Library

    View record details
  • Managing treatment injury—and response

    Merry, Alan; Seddon, Mary (2006)

    Journal article
    The University of Auckland Library

    View record details
  • Medication administration in anesthesia - time for a paradigm shift

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

    Journal article
    The University of Auckland Library

    View record details
  • Safety in Anaesthesia: promoting sustainable change for the future

    Merry, Alan (2008)

    Journal article
    The University of Auckland Library

    View record details
  • Hard lessons for pain researchers

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

    Journal article
    The University of Auckland Library

    View record details
  • Role of anesthesiologists in WHO safe surgery programs

    Merry, Alan (2010)

    Journal article
    The University of Auckland Library

    View record details
  • Prospective assessment of a new anesthestic drug administration system designed to improve safety

    Merry, Alan; Webster, Craig; Larsson, L; Weller, Jennifer; Frampton, CM (2006)

    Conference item
    The University of Auckland Library

    View record details
  • Medical students, patients, and the process of consent

    Malpas, Phillipa; Merry, Alan; Bagg, Warwick (2014)

    Conference item
    The University of Auckland Library

    The issue of informing patients and gaining their consent (or refusal to consent) for various medical interventions was formally recognised in the development of the Code of Health and Disability Consumers’ Rights in 1996. Rights 6 and 7 specifically set out the rights consumers have to be fully informed, to make an informed choice, and the right to give informed consent. Alongside the HDC rights based focus were changes in the doctor-patient relationship – changes that promoted a more patient centred focus - which also supported a paradigm that advocated patients being more involved in the decision-making process concerning their own medical treatment and care. The involvement of medical students in the treatment and care of patients and the obligations students have with respect to the informed consent process has received little academic attention. Yet there is evidence that medical students have troubling ethical experiences with patients regarding the issue of consent. In this discussion I will consider some of the ethical challenges that arose when senior medical students at the University of Auckland identified and discussed their experiences with patients (within the context of consent) as part of their ethics teaching. I will also discuss the consensus document being developed by Auckland and Otago Schools’ of Medicine that arose as a consequence of the consent issues discussed by students.

    View record details
  • The challenges of technological intensification

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

    Journal article
    The University of Auckland Library

    View record details
  • Improving quality and safety in healthcare: an interprofessional learning programme for medical, pharmacy and nursing undergraduates

    Sheridan, Jane; Seddon, M; Warman, Guy; Marshall, Dianne; Merry, Alan (2008)

    Conference item
    The University of Auckland Library

    View record details
  • 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

    View record details
  • Incorrect representation of aseptic techniques

    Merry, Alan; Gargiulo, Derryn; Sheridan, Jane; Webster, Craig; Swift, Simon; Torrie, Jocelyn; Weller, Jennifer; Henderson, K; Sturge, Jacqueline (2017-05)

    Journal article
    The University of Auckland Library

    View record details
  • 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.

    View record details
  • 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.

    View record details
  • 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.

    View record details
  • In Reply

    Gargiulo, Derryn; Mitchell, Simon; Sheridan, Jane; Short, TG; Swift, Simon; Torrie, Jocelyn; Webster, Craig; Merry, Alan (2016-10)

    Journal article
    The University of Auckland Library

    We thank Tafelski et al. for making some interesting points about our recent study1 and asking for clarification of some issues. We agree that for various reasons, our results may be an underestimate, and we discussed these in some length in our article. With respect to the Hawthorne effect, we agree that our findings may reflect an underestimation of the actual rate of syringe contamination. Indeed, in the article, we indicated that ???anesthesiologists were encouraged to behave ???normally??? in respect of their aseptic practice,??? but that ???the open-label nature of the study may have influenced them to be more fastidious.???

    View record details
  • Improving the safety of pediatric sedation? Human error, technology, and clinical microsystems

    Webster, Craig; Anderson, Brian; Stabile, MJ; Merry, Alan (2015)

    Book item
    The University of Auckland Library

    Recent years have seen significant improvements in the safety of a number of areas of health care. However, evidence would suggest that the practice of pediatric sedation outside of the operating room is an area where unaddressed complexities and risks in care remain. In addition, the number of children receiving sedation outside of the operating room is on the increase, emphasizing the need to realize opportunities to improve safety. We outline the risks inherent in sedating children in the context of both the human factors and system factors perspectives. We incorporate examples from other high-technology industries such as aviation and nuclear power generation to allow a better understanding of why things go wrong during sedation. The value of prior risk assessment, communication, checklists, and formalized recovery pathways are discussed, and new directions for the development of safety initiatives are identified. Finally a number of practical steps based on existing successful safety approaches are given, with an emphasis on the demonstration of efficacy and the sharing of successful safety solutions.

    View record details
  • Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study

    Nakarada-Kordic, Ivana; Weller, Jennifer; Webster, Craig; Cumin, David; Frampton, C; Boyd, M; Merry, Alan (2016)

    Journal article
    The University of Auckland Library

    BACKGROUND: Patient safety depends on effective teamwork. The similarity of team members' mental models - or their shared understanding-regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams. METHODS: We developed a computer-based card sorting tool (Momento) to capture the information on mental models in 20 six-person surgical teams, each comprised of three subteams (anaesthesia, surgery, and nursing) for two simulated laparotomies. Team members sorted 20 cards depicting key tasks according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. Within each OR team and subteam, we conducted pairwise comparisons of scores to arrive at mean similarity scores for each task. RESULTS: Mean similarity score for task sequence was 87??% (range 57-97??%). Mean score for responsibility for task was 70??% (range???=???38-100??%), but for half of the tasks was only 51??% (range???=???38-69??%). Participants believed their own subteam was primarily responsible for approximately half the tasks in each procedure. CONCLUSIONS: We found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients.

    View record details
  • A framework of comfort for practice: an integrative review identifying the multiple influences on patients??? experience of comfort in healthcare settings.

    Wensley, Cynthia; Botti, M; McKillop, Ann; Merry, Alan (2017)

    Journal article
    The University of Auckland Library

    Comfort is central to patient experience but the concept of comfort is poorly defined. This review aims to develop a framework representing patients' complex perspective of comfort to inform practice and guide initiatives to improve the quality of healthcare.CINAHL, MEDLINE Complete, PsycINFO and Google Scholar (November 2016); reference lists of included publications.Qualitative and theoretical studies advancing knowledge about the concept of comfort in healthcare settings. Studies rated for methodological quality and relevance to patients' perspectives.Data on design, methods, features of the concept of comfort, influences on patients' comfort. Data were systematically coded and categorized using Framework method.Sixty-two studies (14 theoretical and 48 qualitative) were included. Qualitative studies explored patient and staff perspectives in varying healthcare settings including hospice, emergency departments, paediatric, medical and surgical wards and residential care for the elderly. From patients' perspective, comfort is multidimensional, characterized by relief from physical discomfort and feeling positive and strengthened in one's ability to cope with the challenges of illness, injury and disability. Different factors are important to different individuals. We identified 10 areas of influence within four interrelated levels: patients' use of self-comforting strategies; family presence; staff actions and behaviours; and environmental factors.Our data provide new insights into the nature of comfort as a highly personal and contextual experience influenced in different individuals by different factors that we have classified into a framework to guide practice and quality improvement initiatives.

    View record details