Timeliness and Clinical Impact of Hospital-Initiated Medication Reviews

Background: Medication-related problems often occur in the immediate post-discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients' medicines in their homes. Aim: To determine if hospital-initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity-specific questions on the quality of reports. Method: Eligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post-discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance. Results: HIMRs were conducted within 11.6 6.6 days postdischarge. 36 HIMR reports were evaluated and 1442 issues identified - information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised. Conclusion: HIMRs can be facilitated in a more timely manner than post-discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports.

Designing university, government and industry community engagement to build informed and effective interventions in the area of road safety

Individuals, community organisations and industry have always been involved to varying degrees in efforts to address the Queensland road toll. Traditionally, road crash prevention efforts have been led by state and local government organisations. While community and industry groups have sometimes become involved (e.g. Driver Reviver campaign), their efforts have largely been uncoordinated and under-resourced. A common strength of these initiatives lies in the energy, enthusiasm and persistence of community-based efforts. Conversely, a weakness has sometimes been the lack of knowledge, awareness or prioritisation of evidence-based interventions or their capacity to build on collaborative efforts. In 2000, the Queensland University of Technology’s Centre for Accident Research and Road Safety – Queensland (CARRS-Q) identified this issue as an opportunity to bridge practice and research and began acknowledging a selection of these initiatives, in partnership with the RACQ, through the Queensland Road Safety Awards program. After nine years it became apparent there was need to strengthen this connection, with the Centre establishing a Community Engagement Workshop in 2009 as part of the overall Awards program. With an aim of providing community participants opportunities to see, hear and discuss the experiences of others, this event was further developed in 2010, and with the collaboration of the Queensland Department of Transport and Main Roads, the RACQ, Queensland Police Service and Leighton Contractors Pty Ltd, a stand-alone Queensland Road Safety Awards Community Engagement Workshop was held in 2010. Each collaborating organisation recognised a need to mobilise the community through effective information and knowledge sharing, and recognised that learning and discussion can influence lasting behaviour change and action in this often emotive, yet not always evidence-based, area. This free event featured a number of speakers representing successful projects from around Australia and overseas. Attendees were encouraged to interact with the speakers, to ask questions, and most importantly, build connections with other attendees to build a ‘community road safety army’ all working throughout Australia on projects underpinned by evaluated research. The workshop facilitated the integration of research, policy and grass-roots action enhancing the success of community road safety initiatives. For collaboration partners, the event enabled them to transfer their knowledge in an engaged approach, working within a more personal communication process. An analysis of the success factors for this event identified openness to community groups and individuals, relevance of content to local initiatives, generous support with the provision of online materials and ongoing communication with key staff members as critical and supports the view that the university can directly provide both the leadership and the research needed for effective and credible community-based initiatives to address injury and death on the roads.

Moral and social development : teachers’ knowledge of learning and teaching strategies in the early years

The intention of the analysis in this paper was to determine, from interviews with eleven early years’ teachers, what knowledge guided their teaching of moral behaviour. Six of the teachers defined moral behaviour in terms of social conventions only. Children’s learning was attributed by five of the teachers to incidental/contextual issues. Nine of the teachers used discussion of issues, in various contexts, as a way of teaching about social and moral issues. The majority of the teachers (n=7) gave the source of their knowledge of pedagogy as practical as opposed to theoretically informed. There was no clear relationship between their definitions, understanding of children’s learning, pedagogy or source of knowledge. Most of the teachers were using discussion, negotiation and reflection to develop the children’s moral and social behaviour. This is probably effective; however, it suggests a strong need for teaching of moral development to be given more prominence and addressed directly in in-service courses so that teachers are clear about their intentions and the most effective ways of achieving them.

Principles for use of ball projection machines in elite and developmental sport programmes

Use of ball projection machines in the acquisition of interceptive skill has recently been questioned. The use of projection machines in developmental and elite fast ball sports programmes is not a trivial issue, since they play a crucial role in reducing injury incidence in players and coaches. A compelling challenge for sports science is to provide theoretical principles to guide how and when projection machines might be used for acquisition of ball skills and preparation for competition in developmental and elite sport performance programmes. Here, we propose how principles from an ecological dynamics theoretical framework could be adopted by sports scientists, pedagogues and coaches to underpin the design of interventions, practice and training tasks, including the use of hybrid video-projection technologies. The assessment of representative learning design during practice may provide ways to optimize developmental programmes in fast ball sports and inform the principled use of ball projection machines.

Health Librarianship Workforce and Education : Research to plan the future. Final Report.

In late 2009, Health Libraries Australia (HLA) received a small grant to undertake a national research project to determine the future requirements for health librarians in the workforce in Australia and develop a structured, modular education framework (post-graduate qualification and continuing professional development structure) to meet these requirements. The main objective was to consider the education and professional development framework that would ensure that health librarians have a clearly defined scope of practice and the specific competency based knowledge and skills that enable them to contribute to the design and delivery of high quality health services in this country. The final report presents a detailed discussion of the changing Australian healthcare environment and the resulting impact on the health library sector, as well as an overview of international trends in health libraries and the implications for Australian health librarianship education. The research methodology is outlined, followed by an analysis of the findings from the two surveys with health librarians and health library managers and the semi-structured interviews conducted with employers. The Medical Library Association (MLA) in the United States had developed a policy document detailing the competencies required by health librarians. It was found that the MLA competencies represented an accepted professional framework of skills which could be used objectively in the survey instrument to measure the areas of professional knowledge and responsibilities that were relevant in the current workplace, and to identify how these requirements might change in the next three to five years. The research results underscore the imperative for health librarians to engage in regular, relevant professional development activities that will enable them to stay abreast with the rapid contextual changes impacting on their practice. In order to be accepted as key members of the multi-disciplinary health professional team, it is strongly believed that health librarians should commit to establishing the mechanisms for specialist certification maintained through compulsory CPD in an ongoing three-year cycle of revalidation. This development would align ALIA and health librarians with other health sector professional associations which are responsible for the self regulation of entry to and continuation in their profession.

Occupational Therapy and Clinical Research in Mental Health Rehabilitation

Practitioners working in Australian mental health services are faced with the challenge of providing appropriate evidence-based interventions that lead to measurable improvement and good outcomes. Current government policy is committed to the development of strategic mental health research. One focus has been on under-researched practice areas, which include the development of psychosocial rehabilitation systems and models that facilitate recovery. To meet this challenge, an Australian rehabilitation service formed a collaborative partnership with a university. The purposes of the collaboration were to implement new forms of service delivery based on consumer need and evidence and to design research projects to evaluate components of the rehabilitation programme. This article examines the process of developing the collaboration and provides examples of how research projects have been used to inform practice and improve the effectiveness of service delivery. Challenges to the sustainability of this kind of collaboration are considered.

Developing a social justice framework to ensure good practice in higher education

The concept of student engagement is a key factor in student achievement and retention and Australasian universities have a range of initiatives aimed at monitoring and intervening with students who are at risk of disengaging. Given the aspirations about widening participation, it is absolutely critical that these initiatives are designed to enable success for all students, particularly those for whom social and cultural disadvantage have been a barrier. Consequently, these types of initiatives must be consistent with the concept of social justice and a set of principles would provide this philosophical foundation for the sector. An Australian Learning and Teaching Council (ALTC) project that involves ten Australasian universities, is designing of a suite of resources for the sector which will include: (1) a set of principles for good practice in MSLE, (2) a good practice guide for the design and implementation of institutional MSLE policy and practice, and (3) a collection of resources for and exemplars of good practice to be taken up by the sector. This workshop session will provide an opportunity for participants to examine the draft set of principles and to discuss their potential value for the participants’ institutional contexts. Australian Learning and Teaching Council Competitive Grant CG10-1730 2010-2012: Good practice for safeguarding student learning engagement in higher education institutions.

Improving patient privacy and confidentiality in one regional Emergency Department – a quality project

Background: Patient privacy and confidentiality (PPaC) is an important consideration for nurses and other members of the health care team. Can a patient expect to have confidentiality and in particular privacy in the current climate of emergency health care? Do staff who work in the Emergency Department (ED) see confidentiality as an important factor when providing emergency care? These questions are important to consider. Methods: This is a two phased quality improvement project, developed and implemented over a six month period in a busy regional, tertiary referral ED. Results: Issues identified for this department included department design and layout, overcrowding due to patient flow and access block, staff practices and department policies which were also impacted upon by culture of the team, and use of space. Conclusions: Changes successful in improving this issue include increased staff awareness about PPaC, intercom paging prior to nursing handover to remove visitors during handover, one visitor per patient policy, designated places for handover, allocated bed space for patient reviews/assessment and a strategy to temporarily move the patient if procedures would have been undertaken in shared bed space. These are important issues when considering policy, practice and department design in the ED.

Private supervisors of learner drivers and Queensland's graduated driver licensing system : how important are they?

Background: A key element of graduated driver licensing systems is the level of support provided by parents. In mid-2007 changes were made to Queensland’s graduated driver licensing system, including amendments to the learner licence with one of the more significant changes requiring learners to record 100 hours of supervised driving practice in a logbook. Prior to mid-2007, there was no minimum supervision requirement. Aims: The aim of this study was to document the experiences of the supervisors of Queensland learner drivers after the changes made to the graduated driver licensing system in mid-2007. Methods: The sample of 552 supervisors of learner drivers was recruited using a combination of convenience and snowball sampling techniques. The internet survey was open for completion between July 2009 and May 2010 and took approximately 15 to 20 minutes for participants to complete. Results: For 59.7 per cent of the participants, this was the first time that they had supervised a learner driver. For 63.2 per cent, they classified themselves as the main supervisor for the learner driver. Participants provided an average of 79.62 hours of supervision (sd = 92.38), while other private supervisors provided 34.89 hours of supervision (sd = 41.74) to the same learner and professional driving instructors 18.55 hours of supervision (sd = 27.54). The vast majority of supervisors recorded all or most of the practice that they provided their learner driver in their log book with most supervisors indicating that they believed that the hours recorded in the learner’s logbook were either accurate or very accurate. While many supervisors stated that they did not receive any advice regarding the supervision of learner drivers, some had received advice from others such as friends or through discussions with a professional driving instructor. Discussion and conclusions: While graduated driver licensing systems implicitly encourage the involvement of parents and other private supervisors, these people tend not to be systematically involved. As demonstrated in this study, private supervisors provide a significant amount of supervised practice and seek to record this practice accurately and honestly in the learner’s logbook. However, even though a significant number of participants reported that this was the first time that they had supervised a learner driver, they accessed little support or guidance for their role. This suggests a need to more overtly encourage and support the role of private supervisors for learner drivers.

Training clinical psychologists : The current situation and a way forward [Guest Editorial]

In the past, training in clinical psychology in Australia and overseas has been dominated by definitions of input— hours of classes or supervision and of specific components. While prospective practitioners have been required to demonstrate the acquisition of generic competencies, satisfaction of these input driven criteria has been required for both accreditation and registration. Ironically, for a discipline that prides itself on requiring empirical bases for practice and communicating those to students (Calhoun, Moras, Pilkonis, & Rehm, 1998), training criteria have been primarily derived from accepted wisdom, rather than from a sound body of data. The situation has been remarkably like that of a treatment establishing standards of fidelity before its effective components are known—an action our profession has correctly criticised in the past (Herbert & Mueser, 1992).

The collaborative push : pushing beyond rhetoric and gaining evidence

Collaboration has been enacted as a core strategy by both the government and nongovernment sectors to address many of the intractable issues confronting contemporary society. The cult of collaboration has become so pervasive that it is now an elastic term referring generally to any form of ‘working together’. The lack of specificity about collaboration and its practice means that it risks being reduced to mere rhetoric without sustained practice or action. Drawing on an extensive data set (qualitative, quantitative) of broadly collaborative endeavours gathered over ten years in Queensland, Australia, this paper aims to fill out the black box of collaboration. Specifically it examines the drivers for collaboration, dominant structures and mechanisms adopted, what has worked and unintended consequences. In particular it investigates the skills and competencies required in an embeded collaborative endeavour within and across organisations. Social network analysis is applied to isolate the structural properties of collaborations over other forms of integration as well as highlighting key roles and tasks. Collaboration is found to be a distinctive form of working together, characterised by intense and interdependent relationships and exchanges, higher levels of cohesion (density) and requiring new ways of behaving, working, managing and leading. These elements are configured into a practice framework. Developing an empirical evidence base for collaboration structure, practice and strategy provides a useful foundation for theory extension. The paper concludes that for collaboration, to be successfully employed as a management strategy it must move beyond rhetoric and develop a coherent model for action.

Understanding business process models : the costs and benefits of structuredness

Previous research has put forward a number of properties of business process models that have an impact on their understandability. Two such properties are compactness and(block-)structuredness. What has not been sufficiently appreciated at this point is that these desirable properties may be at odds with one another. This paper presents the results of a two-pronged study aimed at exploring the trade-off between compactness and structuredness of process models. The first prong of the study is a comparative analysis of the complexity of a set of unstructured process models from industrial practice and of their corresponding structured versions. The second prong is an experiment wherein a cohort of students was exposed to semantically equivalent unstructured and structured process models. The key finding is that structuredness is not an absolute desideratum vis-a-vis for process model understandability. Instead, subtle trade-offs between structuredness and other model properties are at play.

Good Practice Report : Blended Learning

In early 2011, the Australian Learning and Teaching Council Ltd (ALTC) commissioned a series of Good Practice Reports on completed ALTC projects and fellowships. This report will: • Provide a summative evaluation of the good practices and key outcomes for teaching and learning from completed ALTC projects and fellowships relating to blended learning • Include a literature review of the good practices and key outcomes for teaching and learning from national and international research • Identify areas in which further work or development are appropriate. The literature abounds with definitions; it can be argued that the various definitions incorporate different perspectives, but there is no single, collectively accepted definition. Blended learning courses in higher education can be placed somewhere on a continuum, between fully online and fully face-to-face courses. Consideration must therefore be given to the different definitions for blended learning presented in the literature and by users and stakeholders. The application of this term in these various projects and fellowships is dependent on the particular focus of the team and the conditions and situations under investigation. One of the key challenges for projects wishing to develop good practice in blended learning is the lack of a universally accepted definition. The findings from these projects and fellowships reveal the potential of blended learning programs to improve both student outcomes and levels of satisfaction. It is clear that this environment can help teaching and learning engage students more effectively and allow greater participation than traditional models. Just as there are many definitions, there are many models and frameworks that can be successfully applied to the design and implementation of such courses. Each academic discipline has different learning objectives and in consequence there can’t be only one correct approach. This is illustrated by the diversity of definitions and applications in the ALTC funded projects and fellowships. A review of the literature found no universally accepted guidelines for good practice in higher education. To inform this evaluation and literature review, the Seven Principles for Good Practice in Undergraduate Education, as outlined by Chickering and Gamson (1987), were adopted: 1. encourages contacts between students and faculty 2. develops reciprocity and cooperation among students 3. uses active learning techniques 4. gives prompt feedback 5. emphasises time on task 6. communicates high expectations 7. respects diverse talents and ways of learning. These blended learning projects have produced a wide range of resources that can be used in many and varied settings. These resources include: books, DVDs, online repositories, pedagogical frameworks, teaching modules. In addition there is valuable information contained in the published research data and literature reviews that inform good practice and can assist in the development of courses that can enrich and improve teaching and learning.

Frantic fashion and Australia’s invisible designers : conversations on sustainability in the mass market

The majority of Australians will work, sleep and die in the garments of the mass market. Yet, as Ian Griffiths has termed it, the designers of these garments are ‘invisible’ (2000). To the general public, the values, opinions and individual design processes of these designers are as unknown as their names. However, the designer’s role is crucial in making decisions which will have impacts throughout the life of the garment. The high product volume within the mass market ensures that even a small decision in the design process to source a particular fabric, or to use a certain trim or textile finish, can have a profound environmental or social effect. While big companies in Australia have implemented some visible strategies for sustainability, it is uncertain how these may have flowed through to design practices. To explore this question, this presentation will discuss preliminary findings from in-depth semi-structured interviews with Australian mass market fashion designers and product developers. The aim of the interviews was to hear the voice of the insider – to listen to mass market designers describe their design process, discuss the Australian fashion industry and its future challenges and opportunities, and to comment on what a ‘sustainability’ for their industry could look like. These interviews will be discussed within the framework of design philosopher Tony Fry’s writing on design redirection for sustainability.