Do high-risk medicines alerts influence practice?

Background: Medicine-related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three highrisk medicines alerts – wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin – and accompanying audit tools in 2008 and 2009.
Aims: To determine the impact of the three high-risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.
Method: A cross-sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).
Results: Most of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high-risk medicines alerts – 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions for
improving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine-related tools.
Conclusion: High-risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.

The projected impact of population and high-risk strategies for risk-factor control on coronary heart disease and stroke events

Objective: To model the impact of both population and high-risk strategies on cardiovascular disease (CVD) outcomes.

Design, setting and participants: A CVD risk-factor survey was carried out in rural south-eastern Australia from 2004 to 2006. Using a stratified random sample, data for 1116 participants aged 35–74 years were analysed. Applying the Framingham risk equations to risk-factor data, 5-year probabilities of a coronary heart disease event, stroke and cardiovascular event were calculated. The effect of different changes in risk factors were modelled to assess the extent to which cardiovascular diseases can be prevented by changing the risk factors at a population level (population strategy), among the high-risk individuals (high-risk strategy) or both.

Results: Among men, a population strategy could reduce cardiovascular events by 19.3% (193 per 1000 per 5 years), the high-risk strategy by 12.6% (126 per 1000) and a combined strategy by 24.1% (241 per 1000); and among women, by 21.9% (219 per 1000), 19.0% (190 per 1000) and 28.7% (287 per 1000), respectively.

Conclusions: For prevention of CVD in Australia, it is important both to treat high-risk individuals and to reduce the mean risk-factor levels in the population. We show how risk-factor survey data can be used to set targets for prevention and to monitor progress in line with the recommendations of the National Preventative Health Taskforce.

Time for a change : applying the Good Lives Model of rehabilitation to a high-risk violent offender

In this article we operationalise the theoretical concepts of the Good Lives Model (GLM) of offender rehabilitation by providing a step-by-step framework for assessment, formulation, treatment planning, and monitoring with a high-risk violent offender residing in the community. The case study illustrates how the GLM can be applied to complement and enhance traditional Risk-Management interventions and shows how the GLM's clinical relevance extends from sex offending to broader offending typologies.

The dance of trust in high risk multi-partner collaborations : an exploration of the antecedents of trust in cross-sector R&D projects

This paper explores the dance of trust in cross-sector R&D collaborations, and does so by drawing on a multi-method study (involving qualitative research, case studies and a survey of project leaders) of the Australian Cooperative Research Centre (CRC) Program. R&D collaborations formed under this Program involve two main types of risk, venture or performance-related and relational, and these are problematic given power, information and risk impact asymmetries among the partners. Within the CRCs these risks are addressed through formalisation, employing the “right people”, and through relationship building. Trust (theorised following Sako as a multi-dimensional construct) is central to these processes. Where trust is formed among CRC participants, and is reinforced over repeated interactions, then relational and performance risks cease to become a major concern for CRC managers. In the CRCs, trust is formed and sustained as a multi-level process. Engagement and relationship commitment is achieved at an organizational level, and partner reputation, credible commitments and the institutional context are important factors here. At the project level, trust, in conjunction with a task focus, leads to a positive collaboration experience and this is associated with positive project outcomes. Within CRC projects, capabilities for communication and cross-sector management are important for the formation and maintenance of trust. The paper concludes by discussing the managerial implications of the study’s findings and by identifying areas for further research and conceptual development.