Beyond Burns Online Hub – A Co Design Approach

Mr Dale Forbes1, Mrs Anne Darton2

1Agency of Clinical Innovation Statewide Burn Injury Service Consumer Representative, , , 2Agency of Clinical Innovation Statewide Burn Injury Service,

Abstract:

The challenges facing burn survivors are numerous and can often take many years to overcome. Some of these include: anxiety, depression, altered body image and social adjustment. The Australian burns landscape features a mix of government and NGO health services offering a variety of therapeutic support models commonly used in burn survivor rehabilitation and recovery however, the availability and accessibility of burns support and services is varied and often limited.

A co-design approach has been used in the development of this project. Burn Survivors and burn clinicians across Australia and New Zealand have been partners in the development of themes, features and functions of this online space. The attributes identified through this process are to create a space that is trustworthy, safe and gives support and continued engagement.

Beyond Burns key message is to let burn survivors know they are not alone in their experience. Primarily focused on improving long term psychosocial outcomes for burn survivors, the online hub provides many different ways for burn survivors to connect to others in the community, whether it is by accessing quality burns medical resources, reading personal stories or connecting to others through chat.

The online hub will be the leading support platform for the burns community, providing a centralised and comprehensive directory of services and provide a safe space where other burn survivors can give back to support and empower the burns community.


Biography:

Dale Forbes is an Aboriginal man from Rural NSW. Dale has a lived experience as a Burn Survivor in addition to growing up in Out of Home Care. Dale has been heavily involved in volunteering and charitable work in burns sector for many years. Dale is currently finishing a Bachelor of Social Work while working as an Aboriginal Senior Project Officer with the NSW Department of Family and Community Services. Dale has been a driving force behind the Beyond Burns project from the initial conception through to the design and development and has a deep commitment to collaborative consumer centred approaches

Prevention and Management of Hypothermia in Burns Patients in the Operating Room: a Best Practice Implementation Project.

Mrs Svetlana Kolokolnikova1, Mrs Natalia Adanichkin2, Dr Sandeep  Moola3

1Clinical Nurse, Burns Theatre, Technical Suites, The Royal Adelaide Hospital, Adelaide, Australia, 22 ANZBA Nursing Chair, ANZBA SA Representative, Advanced Nurse Unit Manager, Adult Burns Centre, The Royal Adelaide Hospital,7G154, , Adelaide, Australia, 3Research Fellow, Implementation Science Team, The Joanna Briggs Institute, The University of Adelaide, Adelaide, Australia

Abstract:

Perioperative patients with burn injury are at great risk of hypothermia.
Cancellation or interruption of surgery results in a patient’s multiple additional visits back to theatre for further excisions, prolonged theatre time, excessive use of surgical time and resources.
The aim of this project was to develop and implement the best evidence based protocol on management of hypothermia in burns patients in the Operating Room and thereby improve burns patient management and outcome.
This evidence based implementation project utilises the Joanna Briggs Institute’s Practical Application of clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit and feedback tool. The PACES and GRiP framework involves three phases.
The first phase included a baseline audit on management of hypothermia in burns patients in operating theatres undertaken in the old Royal Adelaide Hospital.
The second phase involved reflection on the results of the baseline audit and designing and implementing evidence based best practice protocol on management of hypothermia in burns patients in the operating room. Findings from base line audit reflected that preventative actions such as prewarming patient prior theatre to 36°C were effective in management of intraoperative hypothermia.
The third phase involves the conducting of a follow up audit to assess the outcomes of the interventions implemented to improve practice, and identify future practice issues to be addressed in subsequent audits. The implementation process is in place.
The results of this project including the positive changes in practice, the barriers and facilitators will be presented.


Biography:

Immigrated to Australia in 2001. Have been working in Royal Adelaide Hospital Burns Unit for 15 years including 9 years in Burns Operating Theatre. Currently undertaking evidence based clinical fellowship project with JBI. Graduate Diploma in Nursing Science (Perioperative Nursing)

The Viability of Primary Human Skin Fibroblasts Exposed to Heat: The Lethal Dose for 50% Death is 48˚C.

Ms Elissa Henderson1, Ms Margit Kempf2, Ms Emily Jones1, Ms Sara Kong1, Ms Ella Pearson1, Ms Anastasia Kearns1, Dr Leila Cuttle1

1Queensland University of Technology, Brisbane, Australia, 2University of Queensland, Brisbane, Australia

Abstract:

Scald burns are common injuries that can cause lifelong suffering, particularly for children. To prevent burn injuries, attempts have been made to set maximum water temperatures from household faucets, however, there is little evidence of adherence to these guidelines and poor evidence to support them. Prior burn research has mostly focussed on new dressing or treatment methods, but more needs to be understood about the cellular mechanisms involved in heat-affected cells or injury progression. Primary normal human skin fibroblasts were cultured for a period of 6 days and then exposed to a range of temperatures from 37˚C to 54˚C for a period of 1 hour, followed by a 1 hour recovery period. An MTT assay was used to assess the relative cell viability of heat-treated and control cells. Several cell morphology changes were visible when cells were exposed to heat, including: rounding of cells, loss of adherence to cell culture flasks, and degradation of both the nuclear membrane and plasma membrane. The LD50 for 1 hour of heat exposure was determined to be 48˚C for primary fibroblasts. This study supports previous research that thermal damage to cells occurs at 43˚C. This study has provided a reproducible method that can be used to examine the effect of heat on primary human cells grown in culture and can further be used to develop burn therapies that limit heat injury and burn wound progression.


Biography:

Elissa is student in her third year of a Bachelor of Biomedical Science. Having previously completed a Bachelor of Business, her future career aspirations are to continue in the field in medical research.

A retrospective review of two years of intensive care admissions with a primary diagnosis of burns in a quaternary burns centre

Dr Juliette Mewton1, Dr  John  Gowardman1

1Royal Brisbane and Women’s Hospital , Herston , Australia

Abstract:

Introduction. Ninety-one patients were admitted to the Intensive Care Unit during 2015-2017. Admission characteristics, primary treatment, analgesia management and antimicrobial screening, infections and treatment were reviewed.

Methods. A retrospective chart review of ninety-one patients admitted to the Intensive Care Unit with a primary diagnosis of Burns.

Results. Of ninety-one admissions sixty-four were male and twenty-seven female. Median age at presentation was forty-three years (range fifteen- eighty-five). Cause of burn was deliberate self-harm in twenty-six patients (28.5%), accidental causes sixty-four (70%) and one forensic (1.5%). The mechanism of burn was electrocution four patients, accelerant thirty-three, MVA 2, House fire/blast fourteen, camp fire eight, or other causes five patients. Twenty-eight (31%) were direct admissions, fifty-nine transitioned through one facility, four via two centres and four from overseas.
The Total Body Surface Area range was eight-ninety-eight percent. The ICU length of stay was a median twenty-two days (range one – seventy-six days). Ten were palliated within twenty-four hours of admission seventeen patients died during admission (18.68%). On presentation only fifty-three (58%) were normothermic. Fifty-one had a lacticaemia (maximum 10.2 mmol/l). Forty-one had a haemoglobin below eighty or above one hundred and fifty-five grams per litre. Sixty- seven (73.6%) had more fluid resuscitation than their parkland calculation and that was despite forty-one patients having no pre-ICU fluids recorded. Forty required vasopressors and three patients required multiple agents. During their Intensive care stay fifty-seven had positive sputum microscopy, twenty-three positive blood and/or urine and twenty positive donor sites. Twelve had positive MRO screens.

Conclusions. There is still significant clinical variation in management and review of primary resuscitation. Inter-hospital transfer and geography can complicate the primary resuscitation. Early debridement is essential. A review of microbiology and multiple resistant organism screening may reduce costs and streamline care.


Biography:

Currently working as a Fellow in the Royal Brisbane and Womens Hospital, having had a significant interest in Burns management during my training in the UK as a Surgeon and in Australia as an Intensivist.

Phases of music therapy treatment in a severe paediatric burns case

Mrs Aniek Janssen1, Mrs Clare Kildea1

1Lady Cilento Children’s Hospital, South Brisbane, Australia

Abstract:

Historically, music therapy research in burns has focused on music analgesia, where music therapy interventions and techniques are used to ease the sufferings of the burns patient (Whitehead-Pleaux, 2013). However in more recent developments, the role of music therapy appears to be changing as clinical procedures such as debridement and dressing changes are conducted under a general anaesthetic.

This case study will describe the application of music therapy techniques in the acute and sub-acute care of patient ‘Jack’, during a lengthy hospital admission for severe burn injury. It will distinguish six different stages in music therapy treatment for severe burn injury, with musical interventions and goals in each phase.

During Jack’s stay in Paediatric Intensive Care Unit music therapy assisted with settling and pain management and it provided family with a sense of being included in his cares when he was sedated and intubated. Music therapy provided support and assistance while sedation was weaned and Jack emerged from his delirious state. Music therapy helped Jack deal with his lengthy admission and it helped him safely explore the trauma and grief around the loss of a sibling. Music therapy also supported in the physical rehabilitation by providing Jack with opportunity to playfully increase moments of purposeful movement to achieve an extended range of motion in his upper limbs and regain fine motor skills.

This presentation explores the changing role of music therapy in paediatric burns care and invites clinicians to consider modifying and adapting techniques in order to meet patient needs in an evolving clinical practice area.


Biography:

Aniek Janssen is music therapist at the Lady Cilento Children’s Hospital, working across a range of acute paediatric caseloads including burns care and paediatric intensive care.

Clare Kildea is Clinical Lead Music Therapy at the Lady Cilento Children’s Hospital, managing the acute care team and working predominantly in critical care.

 

 

 

Enhancing Clinical handover by using Burn External Referral form in a burn centre

Ms Tze Wing Wong1

1Hong Kong Hospital Authority, Burns Centre, Prince of Wales Hospital, Hong Kong

Abstract:

Background:Burns Centre, Prince of Wales Hospital is one of referral center for extensive burn cases in Hong Kong. It develops the coordination of burn service with their supporting network of Burn Facilities. Also, burn cases of cross-territory and cross center are consulted and transferred to the Centre for management. Therefore, a Burn External Referral form was designed to enable comprehensive clinical handover.

Objectives:

The establishment of Burn External Referral form enhances:

  1. Essential informations are received before burn patients transfer to Burns Centre.
  2. Guidance provides to healthcare professionals of other hospitals for managing acute burn stage.
  3. Referred burn patients receive acute assessment and management safely before transfer.

Methodology:A comprehensive Burn External Referral form was established. Essential and mandatory items for acute burn assessment were included, for example: Burn distribution, fluid challenge with formula, airway assessment, limbs circulation assessment, chemical burn treatment and treatment given prior transfer, etc. Briefing sessions were conducted to surgeons and nurses on the workflow of using the form. And auditing on compliance of Burn External Referral form was evaluated by using checklist.

Result:During Jun. 2016 to Jun. 2017, total 49 nos. of burn referred cases were received and 49 nos. of Burn External Referral forms were audited. Result showed only 87.8% sample forms documented the mechanism of burn injury. Only 47% sample forms showed correct assessment on area of burn injury.

Also, 98% and 93.9% indicated that burn patients’ airway and limb circulation had been examined before transferred. Only 75.5% sample forms had acknowledged the need for tetanus prophylaxis prescription.

Conclusion:The use of Burn External referral form provides guidance to healthcare professionals of referring hospitals for management and stabilization of burn patients. Essential informations are received for preparation for admission in Burns Centre. But, there still need for improvement in evaluating the area of burn injury which affects the treatment regime especially for extensive burn.

Reference:Australian Medical Association, 2006 Safe handover: safe patients. Guidance on clinical handover for clinicans and manager. Canberra ACT.


Biography:

Ms. Wong Tze Wing is Nurse Consultant in Burn and Plastic Specialty in Prince of Wales Hospital, Hong Kong Hospital Authority. She has extensive experience in burn management and regularly teaches and coaches nursing colleagues in Hong Kong. She also takes part in advances in burn care and is an EMBS course Nurse coordinator.

Expanding the army in the fight against burn scars

Ms Madeleine Jacques1, Ms Stephanie Wicks1, Mrs Claire Toose1

1The Childrens Hospital At Westmead, Westmead, Australia

Abstract:

Background:Burn injuries require specialist management to heal and prevent contractures which may lead to devastating life-long functional limitations. The Kidsburns Telehealth service enables equitable state-wide access to specialist burns expertise, allowing a large proportion of minor burn injuries to be treated closer to home. This presentation will provide an update on the Kidsburns Murrumbidgee telehealth project with specific emphasis on the important extension to include allied health.

Main body:Collaborative management of children across NSW has decreased travel time, cost and family disruption, and enabled local supported management of minor burn injuries; this is only effective if an equitable service can be provided otherwise children are treated at CHW. In 2016 >25% of children attending lived outside of Sydney.

In the Murrumbidgee LHD, a structured and supported rollout of such services is in progress, culminating in the development of a collaborative care model. This has been achievable with significant education and up-skilling of local staff. Similar investment to date has not been reciprocated in rural scar management and rehabilitation, resulting in limited capability and capacity to manage burn injury scars outside of CHW. Local allied health outreach strategies are being formulated to address not only the geographical barriers, but additional financial and social factors which impact on a family’s ability to engage in a successful therapy program.

Conclusion: Specialist expertise is required in the treatment of paediatric burn injury and scar prevention/management. The Murrumbidgee telehealth project has supported local burn management but requires more formal collaborative processes to include allied-health staff engagement to deliver ongoing scar management and join the fight against scarring.


Biography:

Madeleine has worked as a Nurse at The Children’s Hospital at Westmead since 2009. She has found a passion in the challenging and unique area of paediatric burn injury and is currently employed as a Nurse Practitioner in the outpatient burns and plastics treatment centre.

Brothers Who Burn: Two Paediatric Case Reports of para- Phenylenediamine (PPD) Sensitisation to Black Henna.

Dr Rachael  Stokes1, Dr Camille Wu1, Dr  Susan Adams1

1Sydney Children’s Hospital, Randwick, Australia

Abstract:

The addition of para-phenylenediamine (PPD) to red henna to create a cosmetically pleasing temporary black henna tattoo (TBHT) is well established in tourist industries worldwide. This molecular compound can induce severe skin sensitization.  Clinical manifestations of the type IV delayed hypersensitivity reaction vary from erythema, to allergic contact dermatitis (ACD) – most commonly, to chemical burns. Type I hypersensitivity reactions (urticaria, angioedema, or anaphylaxis) with potentially lethal reactions have also been documented, although less frequently.  This report describes two siblings presenting with suspected PPD sensitisation leading to chemical burns, and summarises the literature on this clinical problem. Case Presentation: Two brothers, aged five and eleven, presented with severe chemical burns over multiple limbs following application of TBHT whilst overseas. The reaction was mildest in areas of initial and single application – with hypopigmentation and ACD – and most severe in areas where TBHT was applied sequentially – with skin loss and pustule formation. In addition, some wounds were complicated by infection. Management consisted initially of Hydrogel and Paraffin Gauze, with oral antibiotics, followed by anti-microbial foam and Nanocrystalline silver dressings, and finally, topical steroid cream. Dermatology was consulted regarding chemicals with cross-reactivity to be avoided in addition to PPD-containing products.  Conclusion: The use of PPD is widespread throughout the world, but its presence and concentration is often unknown. Due to difficulty enforcing regulations in other jurisdictions, increasing public awareness of its potential complications, including long-term scarring risk, is likely to be the most effective means of preventing burns secondary to PPD sensitisation.


Biography:

Rachael completed her Undergraduate MBBS at the University of Western Australia in 2014.She has recently moved from Adult General Surgery to Paediatric General Surgery and is currently a resident at Sydney Children’s Hospital.

A Brief Psychosocial Screening Program- Acceptable to Both Patient and Clinician? Initial Feedback 

 Katherine A. Skinner1, Deborah Murray2, Kathryn Russell3 

 1 National Burn Centre, Middlemore Hospital, Private Bag 13 311 Otahuhu, Auckland 1640, New Zealand  

National Burn Centre, Middlemore Hospital, Private Bag 13 311 Otahuhu, Auckland 1640, New Zealand 

3 National Burn Centre, Middlemore Hospital, Private Bag 13 311 Otahuhu, Auckland 1640, New Zealand 

 People who sustain a burn injury typically come from a vulnerable sector of the population. They may have diagnosed or undiagnosed psychological conditions, or be affected by psychosocial stressors pre-injury. Post-injury adjustment to surgical and rehabilitative treatment is an additional stressor of variable duration. Psychological issues with onset pre- or post-injury are likely to impact rehabilitation and return to previous social and vocational functioning. To improve patient outcomes psychological issues require intervention. Psychological screening can identify issues that would not otherwise be disclosed, and target assessment and treatment within the service and in the community. 

Until now patients who have been discharged from the National Burn Centre, Middlemore Hospital have not been routinely offered psychosocial screening. A psychosocial screening program for all patients who attend the National Burn Centre outpatient clinic aims to improve access to psychosocial supports including psychological assessment and treatment, and community alcohol and drug treatment. A brief psychosocial screen for patient anxiety, depression, PTSD, suicidality, alcohol, and substances was adapted from a previously validated instrument and administered during outpatient appointments. As well as being acceptable to patients, the instrument needed to be easy to administer and score for clinic staff. Preliminary patient data from an audit of the psychosocial screening program and team feedback on use of the instrument is presented. 

 References 

Dhalla, S., & Kopec, J. A. (2007). The CAGE Questionnaire for Alcohol Misuse: A Review  

of Reliability and Validity Studies. Clinical & Investigative Medicine, 30(1), 33-41. doi:10.25011/cim.v30i1.447 

 Löwe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld, K., . . . Brähler, E.  

(2010). A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders, 122(1-2), 86-95. doi:10.1016/j.jad.2009.06.019 

 Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P., Hugelshofer, D. S., Shaw-Hegwer,  

J., . . . Sheikh, J. I. (2003). Primary Care PTSD Screen. Primary Care Psychiatry, 9(1), 8-14. doi:10.1037/t04709-000 

 

 

 

 

 

Burn injuries secondary to cryolipolysis: Freezing fat, burning skin.

Dr Lisa Murphy1, Mr David Read1,2, Ms Margaret Brennan1, Mrs Linda Ward2,3, Mrs Kathleen  McDermott2

1Royal Darwin Hospital, Tiwi, Australia, 2National Critical Care and Trauma Response Centre, Tiwi, Australia, 3Menzies School of Health Research, Tiwi, Australia

Abstract:

Background:The number of Australians seeking cosmetic procedures is increasing each year, particularly non-surgical or minimally invasive cosmetic procedures. One of the newer technologies used to reduce the appearance of fat deposition is cryolipolysis or ‘cool sculpting’; a process designed to cause fat cell necrosis but leave skin unharmed, by cooling soft tissues to 0 to -7 C degrees.
Methods:We present two cases of burns associated with cryolipolysis in female patients seeking fat removal treatment. Both patients received cold thermal burn injuries to their treated areas, one of which was superficial dermal and treated conservatively and one of which was deep dermal and required debridement. A review of the literature surrounding these particular types of injury was performed, which were hand searched for articles reporting complications.
ResultsThe results of the literature search revealed three cases of reported skin necrosis with cryolipolysis use; one do-it-yourself home fat-freezing abdomen skin necrosis, one beauty salon flank cryolipolysis-induced necrosis and one plastic surgery clinic lateral thigh cryolipolysis-induced necrosis.

Discussion: Burn injury or skin necrosis does not appear to be a commonly-reported complication of cryolipolysis and it was not listed among the potential complications on the device’s website in the cases we treated. However, the observation of two such injuries in two months at our unit highlights that these injuries are certainly possible and may be more common than previously thought. Complications of cosmetic procedures; their regulation, monitoring and credentialing are increasingly topical issues as the demand for such procedures increases.


Biography:

Jennifer is a Set 1 Plastic Surgical Trainee in Victoria. She is dual qualified in both medicine and dentistry. She aims to be involved in preventative programs/initiatives to plastic surgical & burns related injuries.

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About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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