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This protocol relates to the first phase, which will comprise a point prevalence study of intravenous infusion administration and qualitative focus groups and interviews with key hospital staff. Subsequent phases will comprise in-depth observational studies from a human factors perspective, to situate the findings of the first phase within a broader context, and a synthesis of the findings to make recommendations for safer administration of intravenous medication. Objectives of the first phase are to document the prevalence, types and clinical importance of errors involving the infusion of intravenous medication in a sample of English hospitals, and compare findings with data from a US study.

Explore potential sources of variation in the rates, types and clinical importance of errors in relation to mode of infusion delivery (gravity administration, standard infusion pumps and syringe drivers, and smart infusion pumps and syringe drivers) and clinical area (critical care, general surgery, general medicine, paediatrics and oncology).

Explore staff perspectives on potential explanatory factors behind the findings.

Describe, based on interviews with hospital staff, how intravenous infusions are administered in a sample of English hospitals, focusing on differences in practices, equipment, policies and processes, within and between hospitals.

View this table:
Table1

The three different phases of the ECLIPSE study

Study design

The study will employ a mixed-methods approach bringing together complementary quantitative and qualitative methods to address these objectives. A quantitative point prevalence study, using observational methods, will be used to document the prevalence, types and clinical importance of errors associated with the infusion of intravenous medication. Qualitative focus groups and interviews with relevant hospital staff will help explain the findings. 18 The design of the point prevalence study is based closely on that used in a similar US multicentre study which studied general medical, general surgical, medical intensive care and surgical intensive care units (K Schnock and DW Bates, personal communication, 2013). This approach, originally developed by Husch , 10 involves trained staff systematically comparing details of each intravenous infusion in progress at the time of observation with the medication prescribed, to identify any discrepancies. Within ECLIPSE, once quantitative data have been analysed, interviews with key staff will also be conducted to reflect on the point prevalence results and details of hospital intravenous practices.

Study setting, recruitment and sample selection

The study will take place within acute hospitals across England. Expressions of interest were sought from English National Health Service (NHS) hospital trusts through the National Institute for Health Research (NIHR) Clinical Research Network, the UK National Association of Medical Device Educators and Trainers (NAMDET) and contacts from a previous study. Womens Prescot Striped CottonLinen Blouse Rag amp; Bone Discount Purchase XIKV4DMVfp
Interested parties were then invited to complete an online survey to provide an overview of their hospital, capacity to take part, infusion pumps and practices. Eighteen NHS trusts responded to the survey, providing information about 26 potential hospital sites. We are inviting 14 acute hospitals and 2 specialist children's hospitals to take part in the first phase of ECLIPSE. Hospitals are being chosen purposively, with the aim of representing maximum variation in terms of type, size, geographic location, potential indicators of patient safety such as being a Bruce Keogh Trust, Peter Pilotto Woman Offtheshoulder Jacquard Crop Top Navy Size 12 Peter Pilotto Sale Discounts Big Sale Cheap Price Fast Express fmiBUpB
hospital mortality indexes Antik Batik Woman Ruffled Tiedye Woven Cotton Top Pink Size 40 Antik Batik Sexy Sport EWa4MEAUW
and media reports, and their self-reported use of infusion devices and smart pump technology. We aim to include a mixture of hospitals that use smart pumps with dose error reduction software, and those who do not. If any particular gaps are identified, additional hospital sites will be approached to ensure a wide range of practices are included.

In each participating hospital, we will study a minimum of three clinical areas (critical care, general medicine and general surgery). This set has been chosen to represent a range of clinical areas while also mirroring as closely as possible the US study, recognising that UK hospitals do not typically have separate medical and surgical intensive care units. However, in contrast to the US study, we will also include paediatric and oncology, since these are areas where, at least anecdotally, different types of errors may be more likely to occur and/or have greater consequences. In each hospital, each clinical area may include just one, or more than one, individual ward as needed.

We aim to include observation of 2100 infusions in total across all study sites. Using nQuery Advisor (Statistical Solutions, V.7.0), this sample will give a CI around a 10% overall error rate across hospitals and clinical areas of 8.7–11.3%. Free Shipping Genuine Womens Strap V Neck Dress Quiz Safe Payment HCgRV9
, 10

Medication infusions will be taken to include any medication, fluids, blood products and nutrition administered via intravenous infusion, including patient-controlled analgesia.

Here are nine suggestions that can help you to work through your disappointments in optimal ways.

Calm Yourself Down

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You can’t, however, solve a problem while indulging in this state-of-mind.

With that in mind, take a moment to calm yourself down. You can, for instance, do this by focusing on the present moment. Or, simply, step away from the situation to clear your thoughts. The key is to give yourself the space you need to clear your mind.

The key is to give yourself the space you need to clear your mind.

Other suggestions that may work for you include taking a nap, getting a massage, or indulging in a steam room or sauna.

Once you’re in a more relaxed and calmer state-of-mind, you can begin thinking about things somewhat differently. This can help trigger new insights and perspectives that could help you modify your approach moving forward.

Distract Yourself

If calming your mind doesn’t seem to be work, then immediately distract yourself from your disappointment.

Distract yourself by listening to music, by watching a movie, by talking with someone, or through reading a book. These distractions will help settle you down.

Then when you’re ready, you can get back to the situation at hand with a fresh perspective at your disposal.

There’s not much point trying to deal with something if you’re obsessing about disappointment.

Transform Your Physiology

The moment disappointment hits you like a ton of bricks, your physiology instantly changes.

Think for a moment about a time you were extremely excited about something. How did you move your body during those moments? How did you stand, breathe, and gesture? This is what I would call a resourceful state-of-mind.

Now think about a time where you experienced incredible disappointment. I bet your body was moving somewhat differently, right? Your posture was probably slumped, your breath was shallow, and your gestures were subdued. This is what I would call an unresourceful state-of-mind.

Understanding the difference between a resourceful and unresourceful state-of-mind — as it relates back to your physiology — is paramount when it comes to snapping yourself out of disappointment.

While experiencing disappointment, pay attention to your physiology and immediately make some adjustments.

For instance, think about how you would use your body while feeling excited and confident. Once you have a clear picture of what this would look like, make the necessary adjustments to how you move, talk, gesture, and breathe.

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