Patient safety and the RCA: A document analysis

This research examined the function of Queensland Health's Root Cause Analysis (RCA) to improve patient safety through an investigation of patient harm events where permanent harm and preventable death, Severity Assessment Code 1, were the outcome of healthcare. Unedited and highly legislated RCAs from across Queensland Health public hospitals from 2009, 2010 and 2011 comprised the data. A document analysis revealed the RCAs opposed organisational policy and dominant theoretical directives. If we accept the prevailing assumption that patient harm is a systemic issue, then the RCA is failing to address harm events in healthcare.

Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: Preliminary feasibility, safety and sample size considerations

Objective The Nintendo Wii Fit integrates virtual gaming with body movement, and may be suitable as an adjunct to conventional physiotherapy following lower limb fractures. This study examined the feasibility and safety of using the Wii Fit as an adjunct to outpatient physiotherapy following lower limb fractures, and reports sample size considerations for an appropriately powered randomised trial. Methodology Ambulatory patients receiving physiotherapy following a lower limb fracture participated in this study (n = 18). All participants received usual care (individual physiotherapy). The first nine participants also used the Wii Fit under the supervision of their treating clinician as an adjunct to usual care. Adverse events, fracture malunion or exacerbation of symptoms were recorded. Pain, balance and patient-reported function were assessed at baseline and discharge from physiotherapy. Results No adverse events were attributed to either the usual care physiotherapy or Wii Fit intervention for any patient. Overall, 15 (83%) participants completed both assessments and interventions as scheduled. For 80% power in a clinical trial, the number of complete datasets required in each group to detect a small, medium or large effect of the Wii Fit at a post-intervention assessment was calculated at 175, 63 and 25, respectively. Conclusions The Nintendo Wii Fit was safe and feasible as an adjunct to ambulatory physiotherapy in this sample. When considering a likely small effect size and the 17% dropout rate observed in this study, 211 participants would be required in each clinical trial group. A larger effect size or multiple repeated measures design would require fewer participants.

Facing the wave of change: Stakeholder perspectives on climate adaptation for Australian seafood supply chains

Climate change is one of the most important issues confronting the sustainable supply of seafood, with projections suggesting major effects on wild and farmed fisheries worldwide. While climate change has been a consideration for Australian fisheries and aquaculture management, emphasis in both research and adaptation effort has been at the production end of supply chains—impacts further along the chain have been overlooked to date. A holistic biophysical and socio-economic system view of seafood industries, as represented by end-to-end supply chains, may lead to an additional set of options in the face of climate change, thus maximizing opportunities for improved fishery profitability, while also reducing the potential for maladaptation. In this paper, we explore Australian seafood industry stakeholder perspectives on potential options for adaptation along seafood supply chains based on future potential scenarios. Stakeholders, representing wild capture and aquaculture industries, provided a range of actions targeting different stages of the supply chain. Overall, proposed strategies were predominantly related to the production end of the supply chain, suggesting that greater attention in developing adaptation options is needed at post-production stages. However, there are chain-wide adaptation strategies that can present win–win scenarios, where commercial objectives beyond adaptation can also be addressed alongside direct or indirect impacts of climate. Likewise, certain adaptation strategies in place at one stage of the chain may have varying implications on other stages of the chain. These findings represent an important step in understanding the role of supply chains in effective adaptation of fisheries and aquaculture industries to climate change.

A quantitative metric to identify critical elements within seafood supply networks

A theoretical basis is required for comparing key features and critical elements in wild fisheries and aquaculture supply chains under a changing climate. Here we develop a new quantitative metric that is analogous to indices used to analyse food-webs and identify key species. The Supply Chain Index (SCI) identifies critical elements as those elements with large throughput rates, as well as greater connectivity. The sum of the scores for a supply chain provides a single metric that roughly captures both the resilience and connectedness of a supply chain. Standardised scores can facilitate cross-comparisons both under current conditions as well as under a changing climate. Identification of key elements along the supply chain may assist in informing adaptation strategies to reduce anticipated future risks posed by climate change. The SCI also provides information on the relative stability of different supply chains based on whether there is a fairly even spread in the individual scores of the top few key elements, compared with a more critical dependence on a few key individual supply chain elements. We use as a case study the Australian southern rock lobster Jasus edwardsii fishery, which is challenged by a number of climate change drivers such as impacts on recruitment and growth due to changes in large-scale and local oceanographic features. The SCI identifies airports, processors and Chinese consumers as the key elements in the lobster supply chain that merit attention to enhance stability and potentially enable growth. We also apply the index to an additional four real-world Australian commercial fishery and two aquaculture industry supply chains to highlight the utility of a systematic method for describing supply chains. Overall, our simple methodological approach to empirically-based supply chain research provides an objective method for comparing the resilience of supply chains and highlighting components that may be critical.

Using smartphones for cycling safety: A survey of riders preferences and interest in new technologies

Cyclists are among the most vulnerable road users. Many recent interventions have aimed at improving their safety on the road, such as the minimum overtaking distance rule introduced in Queensland in 2014. Smartphones offer excellent opportunities for technical intervention for road safety at a limited cost. Indeed, they have a lot of available processing power and many embedded sensors that allow analysing a rider's (or driver's) motion, behaviour, and environment; this is especially relevant for cyclists, as they do not have the space or power allowance that can be found in most motor vehicles. The aim of the study presented in this paper is to assess cyclists’ support for a range of new smartphone-based safety technologies. The preliminary results for an online survey with cyclists recruited from Bicycle Queensland and Triathlon Queensland, with N=191, are presented. A number of innovative safety systems such as automatic logging of incidents without injuries, reporting of dangerous area via a website/app, automatic notification of emergency services in case of crash or fall, and advanced navigation apps were assessed. A significant part of the survey is dedicated to GoSafeCycle, a cooperative collision prevention app based on motion tracking and Wi-Fi communications developed at CARRS-Q. Results show a marked preference toward automatic detection and notification of emergencies (62-70% positive assessment) and GoSafeCycle (61.7% positive assessment), as well as reporting apps (59.1% positive assessment). Such findings are important in the context of current promotion of active transports and highlight the need for further development of system supported by the general public.

Policing of road safety in Oman: Perceptions and beliefs of traffic police officers

With increasing motorisation, road safety has become a major concern within Oman. Internationally, traffic policing plays a major role in improving road safety. Within Oman, the Royal Oman Police's (ROP) Directorate General of Traffic is responsible for policing traffic laws. Many common enforcement approaches originate from culturally different jurisdictions. The ROP is a relatively young policing force and may have different operational practices. Prior to applying practices from other jurisdictions it is important to understand the beliefs and expectations within the Directorate General of Traffic. Further, there is a need for individuals to understand their role and what is expected of them. Therefore, it is important to explore the agreement between levels of the ROP to determine how strategies and expectations transfer within the organisation. Interviews were conducted with 19 police officers from various levels of the ROP. A number of themes and findings emerged. Individuals at the upper level of the traffic police had a clear knowledge of the role of the ROP, believed that traffic police know what is expected of them, are well trained in their role and can have a very positive influence on road safety. These beliefs were less certain lower within the organisations with traffic officers having little knowledge of the role of the ROP or what was expected of them, felt undertrained, and believed their peers have little positive impact on road safety. There is a need to address barriers within the ROP in order to positively impact road safety.

Safety culture and speeding in the Australian heavy vehicle industry

Inappropriate speed and speeding are among the highest causes of crashes in the heavy vehicle industry. Truck drivers are subjected to a broad range of influences on their behaviour including industrial pressures, company monitoring and police enforcement. Further, drivers have a high level of autonomy over their own behaviour. As such it is important to understand how these external influences interact with commonly shared beliefs, attitudes and values of heavy vehicle drivers to influence their behaviour. The present study uses a re-conceptualisation of safety culture to explore the behaviours of driving at an inappropriate speed and speeding in the heavy vehicle industry. A series of case studies, consisting of interviews and ride-along observations, were conducted with three transport organisations to explore the effect of culture on safety in the heavy vehicle industry. Results relevant to inappropriate speed are reported and discussed. It was found that organisational management through monitoring, enforcement and payment, police enforcement, customer standards and vehicle design factors could all reduce the likelihood of driving at inappropriate speeds under some circumstances. However, due to weaknesses in the ability to accurately monitor appropriate speed, this behaviour was primarily influenced by cultural beliefs, attitudes and values. Truck drivers had a tendency to view speeding as relatively safe, had a desire to speed to save time and increase personal income, and thus often attempted to speed without detection. When drivers saw speeding as dangerous, however, they were more likely to drive safely. Implications for intervention are discussed.

Colonoscopy preparation in children: Safety, efficacy, and tolerance of high- versus low-volume cleansing methods

Background: The use of large-volume electrolyte balanced solutions as preparation for colonoscopy often results in poor patient compliance and acceptance. The tolerance, safety, and efficacy of high-versus low volume colon-cleansing methods as preparation for colonoscopy in children were compared by randomized operator-blinded trial. Methods: Twenty-nine children ages 3.6-14.6 years had either high-volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/h) until the effluent was clear (n = 15), or two oral doses of sodium phosphate solution (22.5-45 ml) separated by oral fluid intake (n = 14). Results: Both preparations were equally effective. The low-volume preparation was better tolerated and caused less discomfort that the high-volume preparation, judging by serial nurse observations. The incidence of abdominal symptoms, diarrhea, sleep disturbance, and vomiting was not significantly different between the two groups. Both groups had a small reduction in mean hematocrit and serum calcium levels. The sodium phosphate preparation caused increases in mean serum sodium concentrations from 140 to 145 mmol/L and serum phosphate concentrations from 1.41 to 2.53 mmol/L. Ten hours after the commencement of the preanesthetic fast, these concentrations had returned to normal. Conclusions: There are advantages in terms of tolerance, discomfort, and case of administration with acceptable colonic cleansing with the use of the less-invasive oral sodium phosphate low-volume colon-cleansing preparation in children. Safe use requires ensuring an adequate oral fluid intake during the preparation time and avoidance of use in patients with renal insufficiency.

Driver views on safety at roadworks

Poor compliance with temporary speed limits is a common contributing factor in roadway work zone crashes. Despite the wide range of measures used to encourage compliance, speeding remains a major challenge in work zone traffic control. As part of the major study into safety at Queensland roadworks conducted by CARRS-Q and industry partners, an online survey was conducted to study the perceptions and experiences of drivers regarding roadworks, speed choice and related safety concerns. Survey participants (N=410) were asked to view photographs of 12 roadwork sites (shot from a drivers’ perspective without revealing the speed limits), to nominate the speed they thought they would drive at through work zones, and to rate from 1 to 5 separate levels of perceived risk to workers and to their own vehicles. The survey sought further information on topics including recall and effectiveness of public safety messages, perceived effectiveness of common roadwork safety measures, and demographic characteristics. Participants were also invited to express their concerns regarding any general or specific issue related to driving through roadworks. The current paper provides a descriptive summary of key findings from the survey, drawn from preliminary analyses of both quantitative and qualitative data, demonstrating the depth of data and its value for improving knowledge on driver perceptions and speed choice at roadworks. The survey is the first study of driver perceptions of roadwork risks and hazards to include an assessment of self-nominated speeds which can be compared with actual observed speeds at the same roadwork sites.

Perceptions of the prevalence of self-organising amongst Australian road safety stakeholders: A comparative perspective

The Australian road traffic fatality rate is slowing down at a much lower rate than that of comparable high income countries. This slow rate of reduction may be attributable to a wide range of causes such as deficits in coordination and low community engagement. However, it may also be due to the absence of understanding of systems thinking in road safety in Australia. This exploratory study aimed to investigate the perceptions of Australian stakeholders about the prevalence of a principle of the Dynamic Systems Theory, namely: self-organising. The results pointed to a need to decentralize the road traffic injury prevention efforts in Australia through a range of self-organising principles and the adoption of emergent rather than deliberate strategies.

Worker views on safety at roadworks

Roadworks in live traffic environments are hazardous to workers and road users alike. In an increasing body of international research literature, roadwork risks and hazards have been comprehensively examined. As in the broader field of road safety research, much of the work rightly takes a quantitative approach to assessing risk and related issues and to addressing the identified risks appropriately. In Australia, however, limited official data constrains the ability of researchers to achieve an in-depth understanding of the situation at state/territory and national levels based on traditional quantitative analyses. One way to enhance and supplement the limited available data is to consult those who are directly involved in roadworks for qualitative information, although such an approach is rarely reported in the roadwork safety arena. As part of the major study focusing on safety at roadworks in Queensland, 66 workers were interviewed about their perceptions and experiences regarding roadwork safety. This paper thus outlines a qualitative examination of workers' perceptions of the causes of roadwork incidents and the effectiveness of hazard mitigation measures. Consistent with findings reported in the literature is the view among workers that speeding is a major hazard and that police enforcement is the most effective countermeasure. Other hazards commonly observed by workers but less frequently reported elsewhere include driver distraction and aggression toward workers, working in poor weather and working at night. Workers mostly suggested educational measures to address distraction and aggression issues, though such measures are only tentatively supported in the literature.

The Role of the Law in Communicating Patient Safety

This chapter considers the role of the law in communicating patient safety. Downie, Lahey, Ford, et al’s (2006) preventing, knowing and responding theoretical framework is adopted to classify the different elements of patient safety law. Rather than setting out all relevant patient safety laws in detail, this chapter highlights key legal strategies which are employed to: prevent the occurrence of patient safety incidents (preventing); support the discovery and open discussion of patient safety incidents when they do occur (knowing),; and guide responses after they occur (responding) (Downie, Lahey, Ford, et al 2006). The law is increasingly being invoked to facilitate open discussion of and communication surrounding patient safety. After highlighting some legal strategies used to communicate patient safety, two practice examples are presented. The practice examples highlight different aspects of patient safety law and are indicative of communication issues commonly faced in practice. The first practice example focuses on the role of the Ccoroner in communicating patient safety. This example highlights the investigative role of the law in relation to patient safety (knowing). It also showcases the preventing responding and preventing elements in respect of the significant number of communication errors that can occur in a multi-disciplinary, networked health system. The main focus of the second practice example is responding example illustrates how the law responds to health service providers’ and professionals’ miscommunication (and subsequent incidents) during treatment, however it also touches upon knowing and preventing.

From gearstick to joystick – Challenges in designing new interventions for the safety-critical driving context

Consumer electronics increasingly find their way into cars and are often portrayed as unwanted distractions. As part of our endeavour to capitalise on these technologies as safety tools rather than safety threats, we suggest to use smartphones, head-up displays, vehicle interfaces, and other digital gadgets: a) as readily available and lightweight sensing devices, and b) as platforms for engaging interventions that provide safe stimuli in real- time while driving. In our effort to make safe driving behaviours more fun, we explore ways to apply gamification to driving. In this paper, we illustrate the need for a careful balance between fun and safety and reveal ethical issues that arise when introducing new technology interventions into this complex and safety- critical design space.

Evaluation of safety treatments at roadwork zones

A major 3-year research project to improve safety at roadworks has recently been completed by the Centre for Accident Research and Road Safety – Queensland (CARRS-Q) and industry partners. This project involved developing strategies to mitigate roadwork hazards including speeding. This paper presents three on-road evaluation studies on the effectiveness of some current and new safety treatments: use of pilot vehicles, variable message signage (VMS), police enforcement with and without VMS, and remote-controlled traffic control devices. The speed reduction potential of pilot vehicles was evaluated at a highway site. Results showed that pilot vehicles reduced average speeds within the work area, but not at a downstream location. Combinations of VMS and police enforcement were evaluated at a motorway site and results showed that police enforcement accompanied with VMS had greater effects on reducing speeds than either of these treatments alone. Three new remote-controlled traffic control devices—red and amber lights, red light and amber arrow, and a robotic stop/slow sign—were evaluated at a highway site. Results showed that the red light and amber arrow option produced consistent effects on the speeds at the approach to traffic controls and at a location inside the work area. This paper presents the first rigorous evaluations of these roadwork safety treatments in Queensland.

A road safety strategy for Norfolk Island, an Australian external territory

Norfolk Island is an Australian external territory in Oceania. The significant road safety reforms in Australia from the 1970s onward bypassed the island, and most road safety ‘silver bullets’ adopted in other Australian jurisdictions were not introduced. While legislative amendments in 2010 introduced mandatory seat belt wearing for vehicle occupants on Norfolk Island, other critical issues face the community including drink driving by residents and visitors, occupant protection for vehicle passengers, and the provision of a more protective road environment. The release of the first Norfolk Island road safety strategy 2014-2016 proposed, inter alia: • a lower BAC of 0.05 and the introduction of compulsory driver alcohol and drug testing by police; • targeted enforcement of occupant protection for vehicle passengers, particularly for passengers riding on vehicle tray backs; • education interventions to challenge values held by some members of the community that support unsafe road use; • ensuring that driver information, training and testing is adequate for all drivers; • identification and rectification of hazardous roadside infrastructure, particularly barrier protection at “high drop locations” within the road network; and • developing a specification for vehicle standards for vehicles imported into Norfolk Island. Norfolk Island is engaging in a process of integration with the Australian community, and wider issues relating to funding and resources have impacted on the implementation of the road safety strategy. The response to the strategy will be discussed, particularly in terms of current attempts to address drink driving and the provision of a safer road environment.