Factors Influencing Acute Paediatric Burn Care in Western Australia

Ms Tania McWilliams1

1Perth Children’s Hospital, Nedlands, Australia, 2Edith Cowan University, Perth, Australia

Abstract:

Introduction

Paediatric burn patients receive their initial acute assessment and management in a variety of clinical settings by clinicians who have varying levels of experience and knowledge in caring for these patients. In providing this care, clinicians experience both barriers and supports which can affect the treatment provided and the patient’s outcome.

Aim

This qualitative study aimed to explore the perceived factors influencing the implementation of best practice in the acute assessment and management of paediatric burn patients in Western Australia.

Method

Interviews of nineteen referring clinicians using open-ended questions were conducted and analysed, utilising the Gilbert Behaviour Engineering Model as a framework to explore the factors influencing clinical practice.

Results

The interviews highlighted a number of factors which influenced non-burn specialist clinician practice when providing the acute assessment and management of paediatric burn patients in Western Australia. Whilst some factors were perceived as barriers, other factors were supportive in providing optimal patient care.

Conclusion

Referring clinicians work in a variety of environments and face various barriers and supports when a paediatric burn patient first presents to their healthcare facility. By exploring the factors which hinder and help these clinicians, we can assist in overcoming barriers and expanding supports in the future to optimise patient care state-wide.


Biography:

Clinical Nurse Consultant for Burns at Perth Children’s Hospital.

Worked in burns for over 20 years.

Special interests: rural/remote clinician education, telehealth, infection control, paediatric burns.

Parent and caregiver preparedness for their child’s first burns outpatient clinic visit

Ms Nicole Alexander1, Ms Ioanna Coutsouvelis1, Associate Professor  Warwick  Teague1,2,3

1The Royal Children’s Hospital, Melbourne, Parkville, Australia, 2Murdoch Children’s Research Institute, Parkville, Australia, 3Department of Paediatrics, University of Melbourne, Parkville, Australia

Abstract:

Introduction:

An outpatient paediatric burns clinic can be a busy, fast paced and overwhelming environment. Preparing children, parents and caregivers prior to attending their first appointment provides knowledge, some predictability and control over their experience (Bell et al. 2009). Referrals to clinic are received from a range of sources, therefore the information provided may be variable. This project aims to determine the preparedness of parents and caregivers in our multidisciplinary clinic. Secondary aims include exploring factors that may identify those requiring additional supports in burns clinic.

Methodology: Following ethics approval, a survey is to be conducted to assess preparedness for first burns clinic appointment. Data to be collected includes source, format and details of information provided to parents and caregivers. Specifically, the focus will be on their awareness of staff present in clinic, pain relief options, sedation, comfort positioning and parental role. Based on the information provided by the referrer, parent and caregiver preparedness will be evaluated. Demographics and mechanism of burn will be reviewed to identify any factors indicating that additional support may be required.

Results: The data collected from the survey will be used to evaluate parent and caregiver preparedness for clinic and highlight any areas of improvement for future service provision. Results will be conveyed using descriptive statistics, augmented by examples of free text responses.

References:

Bell, J., Johnson, B., Desai, P., McLeod, S. 2009, ‘Psychological Preparation and Coping’ in Thompson, R.H (eds), The Handbook of Child Life: A Guide for Pediatric Psychosocial Care, Charles C Thomas, Springfield, Illinois pp160-198.


Biography:

Nicole Alexander is a paediatric Physiotherapist at the Royal Children’s Hospital in the Burns and Plastics team.

Ioanna Coutsouvelis is an Occupational Therapist who works with the Burns and Plastics team at The Royal Children’s hospital in the area of hand therapy.

Lithium ion button battery causing a full-thickness cutaneous burn while trapped under an occlusive burns dressing.

Ms Kelly  Wardell1, Dr Anthony Penna1, Dr  Tim T  Wang1, Dr  John Vandervord1, A/Prof Damian D Marucci1,2

1The Childrens Hospital Westmead,  Westmead , Australia, 2Department of Surgery, The University of Sydney, Camperdown, Australia

Abstract:

Introduction: Alkaline or lithium-ion button batteries can cause significant chemical burns in children who ingest or insert them into orifices. We present a rare and unusual case of a full thickness cutaneous burn related to a non-exploding Lithium ion button battery.

Case: A three-year-old male presented with a 5% TBSA oil scald burn to the neck and torso He underwent hydrosurgical debridement and application of an occlusive dressing. Dressing change on Day 13 revealed a lithium button battery under his dressings in direct contact with skin. This had caused a full thickness burn to the central chest with a significant circular cavity into the subcutaneous tissue. His burns were debrided and reconstructed with layered dermal matrix and split skin grafting.

Conclusion: Only a handful of cutaneous burns from button batteries exist in the literature. It is theorised that moist environments provide a conductive medium in which electrolysis and subsequent liquefactive necrosis of tissue can occur. Education regarding the potential for this injury is important. Battery redesign to prevent activation when not in a device may be beneficial.


Biography:

This paper was authored through the Children’sHospital Westmead burns department. Kelly Wardell, a nurse practitioner from the unit will be presenting the case.

A retrospective review of the management and functional outcomes of patients who developed Heterotopic Ossification in one or bilateral upper limbs post severe burn injury at Royal Brisbane and Women’s Hospital (RBWH) between 2006 and 2016

Miss Andrea Mc Kittrick1, Mrs Amber Jones1, Dr Jason Brown2

1Department of Occupational Therapy, Royal Brisbane and Women’s Hospital, Herston, Australia, 2.  Professor Stuart Pegg Adult Burns Centre, Royal Brisbane and Women’s Hospital, Herston, Australia

Abstract:

Background:

Heterotopic ossification (HO) is defined as the presence of calcium bone deposits in soft tissue and connective tissue where bone is not normally found. It is found in patients who have sustained trauma including spinal, brain and severe burn injuries and it can be classified as a complication of trauma injuries. The aims of this study were:

  • To review the surgical and occupational therapy (OT) management of all patients presenting to RBWH for a 10-year period who sustained a severe burn injury greater than 30% TBSA to the upper extremities
  • To review the long-term management plan for patients who developed HO

Methods:

This study was a retrospective review. Ethics: LNR/2018/QRBW/45689

 

Results:

n= 20 for inclusion. Mean TBSA = 59.5%. Bilateral upper limb involvement n= 20. Average surgical procedures per patient =3. Biobrane® and allograft were the most frequent temporising procedures with sandwich grafting preferred for definitive surgery. OT interventions commenced day 2 (range 1-4) post admission. Elbow splints were in situ 24/24 average 14.8 days. Occupational therapy interventions involved provision of adaptive ADL equipment, ADL retraining and upper limb group therapy. Chronic pain team were involved in all cases: Indomethcain and Entonox most often prescribed for joint pain and stiffness. >10% underwent surgery for removal of HO.

Discussion:

The presence of HO can result in increased pain, decreased range of motion and a decrease in participation in activities of daily living.

Conclusion:

Our study found that early surgical intervention, strong links with pain services and an intensive rehabilitation programme promotes long term return to ADL’s, work and driving post development of HO which is in line with current evidence based literature.


Biography:

Andrea is the Advanced Specialist Occupational Therapist in Severe Burn Injuries at the Royal Brisbane and Women’s Hospital in Brisbane, Queensland. She graduated from Trinity College Dublin, Ireland in 2004.  She a Masters in Hand Therapy via University of Derby, United Kingdom in 2015. Andrea is currently enrolled in a PhD through The University of Queensland. She is the current chair of the ANZBA Allied Health committee, and is a casual academic at The University of Queensland and a session lecturer at Australian Catholic University.  Her special interests include hand burn injuries, critical care polyneuropathy and long term outcomes post burn injury.

 

Pilot project: Thinking Outside the Square. Low Frequency Ultrasound Debridement in Slow Healing Burn Wounds.

Mrs Sharon Rowe1

1Fiona Stanley Hospital, Murdoch Perth, Australia, 2Fiona Stanley Hospital, Murdoch Perth, Australia

Abstract:

Introduction

Chronic wounds cost the Australian healthcare system $2.85 billion each year. The personal cost to the individual with a chronic wound is much harder to measure. Biofilms within chronic wounds create an inefficient inflammatory process leading to a cycle of increased exudate and delay in healing. Scar severity is linked to time to healing of a burn wound. Every day over 21 days after a burn that a wound is not healed, increases the risk of a hypertrophic scar. Scarring, along with long term treatment for a chronic wound, impacts on a person’s life, financially, emotionally and physically.

Aim

The aim of this pilot project is to contribute to the discussion on the use of Low Frequency Ultrasound Debridement (LFUD) in slow to heal wounds, in this instance burn wounds.

Method

Small wounds within scar tissue over 3 weeks post injury and not healed were assessed for suitability for treatment with LFUD. Routine wound assessment determined a non-progressive wound. Patients included were considered not suitable for further surgery to facilitate healing.

Conclusion

LFUD treatment of small wounds within scar tissue facilitated wound progression and helped reduce repeated buildup of slough. When used in conjunction with appropriate evidence based wound care products, healing was achieved.


Biography:

Sharon is the Clinical Nurse Consultant for adult burns in WA. She has Post Graduate Diploma’s in Clinical Education and Burns Nursing and a Master of Clinical Nursing. Sharon is particularly interested in building relationships with rural and remote clinicians through education, as well as the treatment of chronic wounds within the burns population.

A new age of rehabilitation: experiences of an Occupational Therapy led telehealth review clinic

Ms Debra Phillips1, Miss Lauren Matheson1, Dr  Tilley Pain1,2, Dr Gail Kingston1,2

1The Townsville Hospital, Townsville, Australia, 2James Cook University, Townsville, Australia

Abstract:

Introduction

Rural and remote children post burn injuries are geographically disadvantaged compared to their regional and metropolitan counterparts. Studies have shown rural and remote children are more likely to have complications following a burn injury thereby increasing the disadvantage. Specialist services for burn rehabilitation are located in tertiary hospitals and rarely available in rural and remote areas.

The North Queensland Paediatric Burns Service (NQBPS) at the Townsville Hospital established the Occupational Therapy Led Paediatric Burns Telehealth Clinic (OTPBTC) to reduce rural disadvantage. In our model, the occupational therapist takes the responsibility of monitoring children undergoing active burn rehabilitation rather than a Paediatric Surgeon. Clinical indicators have been written as part of the new model of care to guide the re-engagement of the surgeon when a review is indicated.

Aim

The aim of this research was to gain an understanding of the experiences had by families and clinicians utilising the OTPBTC.

Methods

This qualitative research was undertaken to explore family’s and clinician’s experience of OTPBTC. Families and rural clinicians involved in telehealth reviews were purposefully selected for interview.

Results

Four major themes were derived through thematic analysis: continuity of care; family centred care; technology; and building of rural capacity.

Conclusion

Perspectives obtained from this study confirm the benefits of a telehealth for rural and remote children post burn injury.  It demonstrates that this telehealth model provides quality patient centred care and expert clinical advice within local communities. This telehealth model can be translated to other areas of health care across Australia.


Biography:

Debra is a senior Occupational Therapist at The Townsville Hospital in North Queensland.  She has over 15 years experiencing in providing rehabilitation to children post burn injury living in regional, remote and very remote communities.  The Occupational Therapy Led telehealth review clinic, developed in conjunction with the Paediatric Surgeons at The Townsville Hospital,  was awarded the 2019 Queensland Health Excellence Award for delivering health care.

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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