Challenges in translating scientific evidence into mandatory food fortification policy: an antipodean case study of the folate- neural tube defect relationship

Objective: To identify challenges in translating scientific evidence of a  nutrient and health relationship into mandatory food fortification policy.
Design: A case study approach was used in which available evidence  associated with the folate–neural tube defect relationship was reviewed against the Australia New Zealand Food Regulation Ministerial Council's Policy Guideline for mandatory food fortification. Results: Three particular challenges were identified. The first is knowing when and how to act in the face of scientific uncertainty. The second is knowing how to address the special needs of at-risk individuals without compromising the health and safety of the population as a whole. The third is to ensure that a policy is sufficiently monitored and evaluated. Conclusions: Despite the availability of compelling evidence of a relationship between a particular nutrient and a health outcome, a definitive policy response may not be apparent.  Judgement and interpretation inevitably play significant roles in influencing whether and how authorities translate scientific evidence into mandatory food fortification policy. In relation to the case study, it would be prudent to undertake a risk–benefit analysis of policy alternatives and to implement nutrition education activities to promote folic acid supplement use among the target group. Should mandatory folate fortification be implemented,  comprehensive monitoring and evaluation of this policy will be essential to know that it is implemented as planned and does more good than harm. In relation to mandatory food fortification policy-making around the world,  ongoing national nutrition surveys are required to complement national policy guidelines.

Implementation of a medication guideline to improve medication safety for patients

Although the incidence of medication error remains unknown, in Australian hospitals, they are thought to occur in 5-20 % of drug administrations 1. Not surprisingly, international debate has focused on the mechanisms to improve the safety of patients. Thus a new National Inpatient Medication Chart (NIMC) was endorsed to improve communication and reduce medication errors 2. This study aimed to investigate the documentation practices of clinicians following the implementation of a medication guideline and NIMC.
A pre and post-test design was used to evaluate the adoption of and adherence to the medication guideline at Western Health, an 850 bed healthcare network in Australia. Audits of inpatient medication charts (N=265) were conducted at 3 months prior to and repeated 4 months (N=290) after implementation. The pre-test data was used to formulate an interdisciplinary organizational strategy that included mandatory education for all clinical staff, practice reminders, decision prompts, a telephone hotline for support, an intranet information website and electronically distributed Frequently Asked Questions.
Pre and post implementation audits highlighted areas of potential medication error. The post-test showed an overall trend towards improvement in documentation. There were significant improvements in 4 critical practices: Drug name clear (p=0.0003); Drug dose clear (p=0.0002); Prescribed frequency equals documented frequency (p=0) and; No signature by administrator (p=0).
The majority of documentation errors showed poor attention to detail and would be considered a slip or lapse in skill based judgment 3. Although this study was designed to evaluate documentation practices, future research should include observation methods to increase our understanding of the context behind the judgments such as work place interruptions, skill mix and knowledge levels. While evidence based guidelines enable work, they are not the actual work or substance of patient care. Organisational systems can assist in preventing unconscious aberrations that lead to error.

Protecting legal rights when things go wrong : legal recourse if mandatory fortification of a food were to harm human health

Food laws can encompass considerations that extend beyond food safety. The recent food standard mandating the fortification of flour with folic acid in Australia illustrates the legal problems and legal risks when governments introduce food standards that aim to medicinalise the population through the food supply despite a lack of scientific consensus. Legal analysis of the process by which the folic acid fortification was introduced into flour in Australia demonstrates legal inadequacies, administrative and policy failures, as well as flaws in safety assumptions. An analysis of the restrictions on legal rights and remedies for any adversely affected consumers seeking legal redress, and the existence of statutory immunities for governments, demonstrates a need for legal reform and changes in policy development processes.

Benchmarking occupational health and safety performance of Australian construction companies.

It is mandatory for Australian construction companies to provide a safe working environment for their workers and sub-contractors. Consequently, occupational health and safety (OHS) is a major issue for construction firms mainly due to the fear of prosecution. The recent introduction of Zero Tolerance by the Victorian government WorkCover Authority provided even higher OHS safety standards for the construction industry. This has placed a increased burden on construction companies especially small firms that are not in a position of financial strength.

The size of the companies has been found to be a major contributing factor to the OHS performance of construction contractors. This research is based on benchmarking study of 44 construction companies in Victoria, Australia. The results show that the major factors influencing safety performance were; company size, and management commitment to OHS.

Measuring the occupational health and safety performance of construction companies in Australia

Many facility managers are now required to deal directly with small firms engaged in the maintenance, alteration and cleaning of physical infrastructure. Increasingly the performance of small firms reflects on the manager of the facility, and so an understanding of their operation is required. It is mandatory for all firms to provide a safe working environment for their workers and subcontractors. Consequently, occupational health and safety (OHS) is a major issue for companies mainly due to the fear of prosecution. The introduction of Zero Tolerance by the Victorian government WorkCover Authority in 1999 provided even higher OHS safety standards for the construction industry. This has placed an increased burden on construction and maintenance companies especially small firms that are not in a position of financial strength. The size of the company has been found to be a major contributing factor to the OHS performance of construction contractors. This research is based on a benchmarking study of 44 construction companies in Victoria, Australia. The results show that the major factors influencing safety performance were; company size, and management and employee commitment to OHS.

Effect of company size on occupational health and safety

It is mandatory in all Australian jurisdictions for construction companies to provide a safe working environment for their workers and sub-contractors. Consequently, occupational health and safety (OHS) is a major issue for construction companies mainly due to the fear of prosecution. The introduction of zero tolerance by the Victorian government “WorkCover Authority” in 1999 provided increased legislative OHS standards for the construction industry. This has placed an increased burden on construction companies especially small firms that are not in a position of financial strength. This research is based on benchmarking study of OHS performance of 44 construction companies in
Victoria, Australia. The results show that the size of the company is a major contributing factor to their OHS performance. Small companies employing less than 25 employees have comparatively low levels of OHS performance compared to larger firms. Company size is a limiting factor that impacts on the ability of small firms to implement comprehensive OHS plans. This research calls into question that notion that increasing legislative requirements will improve OHS outcomes.