Fall incidence and fall prevention practices at acute care hospitals in Singapore : a retrospective audit

Objective To investigate the incidence of falls and explore fall prevention practices at acute care hospitals in Singapore.

Design A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five acute care hospitals in Singapore from December 2004 to March 2005.

Study participants Medical record data (n = 6000) of patients admitted into the medical, surgical and geriatric units in the five hospitals.

Outcome measures Fall incidence was obtained from the hospital's fall databases and incident reports for the period of June 2003 to May 2004. In total, 6000 medical records from five hospitals were randomly selected, retrieved and reviewed to determine whether falls, fall assessments and interventions were being initiated and documented.

Results The number of fallers for all hospitals was 825. Analysis showed that patient fall rates ranged from 0.68 to 1.44 per 1000 patient days, and the proportion of falls associated with injury ranged from 27.4% to 71.7%. The use of a fall risk assessment tool by nurses was recorded in 77% of all the nursing records.

Conclusion This study has laid the foundation for further research for fall prevention in Singapore by describing current fall rates, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results will be used to inform the development of a tailored multifaceted strategy to facilitate the implementation of Fall Prevention Clinical Practice Guidelines to reduce the burden of falls and fall injuries in hospitals in Singapore.

Internal audit independence and objectivity : emerging research opportunities

Purpose – The purpose of this paper is to provide a review of the recent literature on internal audit independence and objectivity and discuss opportunities for future research. The topics examined are the organizational status of internal audit, the internal auditor's dual role as a provider of assurance and consulting activities, internal audit's involvement in risk management, outsourcing and co-sourcing of internal audit activities, and the use of internal audit as a training ground for managers.
Design/methodology/approach – The approach used in this paper is a review of the literature followed by an identification of further research opportunities.
Findings – The paper summarizes the existing body of knowledge relating to internal audit independence and objectivity and identifies gaps in the literature where further research is needed.
Originality/value – The paper provides researchers with a useful summary of the literature on internal audit independence and objectivity and stimulates them to engage in further research in the area.

An audit of local government planning tools for their potential use in addressing community food and nutrition issues

Issues addressed: This project aimed to identify how local government planning tools could be used to influence physical and policy environments to support healthy eating behaviours in communities.
Methods: An audit of Queensland's legislative and non-legislative local government planning tools was conducted by a public health nutritionist to assess their potential use in addressing strategies to achieve positive nutrition outcomes. Ten strategies were identified and covered the following themes: improving access to healthy foods and drinks; increasing access to breastfeeding facilities; decreasing fast food outlet density; and unhealthy food advertising. 
Results: The audit found that all of the 10 strategies to achieve positive nutrition outcomes could be considered through three or more of the planning tools.
Conclusion: Based on the findings of this audit, local government planning tools provide opportunities to address food and nutrition issues and contribute toward creating physical and policy environments that support healthy eating behaviours.

The Civic School : Australian-Indonesian professional collaboration to model and audit the development of democratic primary classrooms and teacher language using the index for inclusion

The study is a pilot project in Australian-Indonesian institutional collaboration for the professional development of primary school teachers in West Sumatra in citizenship education. Senior staff in the department of Pancasila and Citizenship Education at the State University of Padang (UNP), West Sumatra initiated the project. UNP staff sought the collaboration of the Faculty of Education at the University of Tasmania for bringing about and sustaining changes in teacher practice needed to implement the new civic goals in the 1999 Suplemen. The Index for Inclusion was used to model and audit the development of democratic primary classrooms and language use in a cluster of Padang schools in West Sumatra. The paper describes the background to the project and how the Index for Inclusion was understood during the initial two-week implementation phase by teachers and school principals. The significance of the study lies in the potential of the Index for Inclusion internationally to citizenship education, a field of education that was not considered in the initial development of the Index project and the contribution of the multiple fields of inquiry to the evolving theoretical understandings of inclusive education.

An audit of clinical outcomes and client and referrer satisfaction with a mood and anxiety Disorders unit

Objective To evaluate outcome and client and referrer satisfaction with the service provided by a Mood and Anxiety Disorders Unit (MADU).

Method MADU was a specialized clinical service for the assessment and management of individuals suffering with affective and anxiety disorders. Clients were referred to MADU from a variety of health service providers. A telephone survey of 30 clients and 20 referrers who have used the services of MADU was conducted, investigating outcome satisfaction with the service provided by MADU.

Results Clients and referrers reported a high level of satisfaction with the service provided by MADU. There was a high degree of adherence to treatment recommendations. The mean Patient Global Impression of Improvement (PGI) rating by the clients before the MADU assessment was 2.74 (SD = 1.27). In comparison the mean PGI rating at the time of follow-up was 6.64 (SD = 1.91).

Conclusions Specialist mood disorders units are a useful and potentially cost-effective additional service included as a part of a mental health service.