Medication incident reporting in residential aged care facilities: Limitations and risks to residents' safety

Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

Understanding the information dynamics of medication administration in residential aged care facilities (RACFs): A prerequisite for design of effective ICT systems

Medication information is a critical part of the information required to ensure residents' safety in the highly collaborative care context of RACFs. Studies report poor medication information as a barrier to improve medication management in RACFs. Research exploring medication work practices in aged care settings remains limited. This study aimed to identify contextual and work practice factors contributing to breakdowns in medication information exchange in RACFs in relation to the medication administration process. We employed non-participant observations and semi-structured interviews to explore information practices in three Australian RACFs. Findings identified inefficiencies due to lack of information timeliness, manual stock management, multiple data transcriptions, inadequate design of essential documents such as administration sheets and a reliance on manual auditing procedures. Technological solutions such as electronic medication administration records offer opportunities to overcome some of the identified problems. However these interventions need to be designed to align with the collaborative team based processes they intend to support.

Coping with information silos: An examination of the medication management process in residential aged care facilities (RACFs)

The aim of this study was to examine the actions of geographically dispersed process stakeholders (doctors, community pharmacists and RACFs) in order to cope with the information silos that exist within and across different settings. The study setting involved three metropolitan RACFs in Sydney, Australia and employed a qualitative approach using semi-structured interviews, non-participant observations and artefact analysis. Findings showed that medication information was stored in silos which required specific actions by each setting to translate this information to fit their local requirements. A salient example of this was the way in which community pharmacists used the RACF medication charts to prepare residents' pharmaceutical records. This translation of medication information across settings was often accompanied by telephone or face-to-face conversations to cross-check, validate or obtain new information. Findings highlighted that technological interventions that work in silos can negatively impact the quality of medication management processes in RACF settings. The implementation of commercial software applications like electronic medication charts need to be appropriately integrated to satisfy the collaborative information requirements of the RACF medication process.

The long-run impact of Information and Communication Technology on economic output: The case of Australia

This paper investigates the cointegration and causal relationships between Information and Communication Technology (ICT) and economic output in Australia using data for about five decades. The framework used in this paper is the single-sector aggregate production function, which is the first comprehensive approach of this kind to include ICT and non-ICT capital and other factors to examine long-run Granger causality. The empirical evidence points to a cointegration relationship between ICT capital and output, and implies that ICT capital Granger causes economic output and multifactor productivity, as does non-ICT capital.

On the contribution of information and communication technology to productivity growth in Australia

This paper revisits the so-called ‘ICT-productivity paradox’ from a long-run perspective by using annual Australian data for 1965–2013. It provides estimates of long-run and short-run elasticities of labour productivity with respect to ICT capital deepening, and explores the nature of long-run causality among productivity growth and ICT and non-ICT capital deepening. The estimates of long-run elasticities are derived by employing both time-series and panel data econometric techniques. The empirical results provide strong confirmatory evidence of the long-run impact of ICT capital deepening on labour productivity in Australia.

Location of concentrators in a computer communication network: a stochastic automation search method

The following problem is considered. Given the locations of the Central Processing Unit (ar;the terminals which have to communicate with it, to determine the number and locations of the concentrators and to assign the terminals to the concentrators in such a way that the total cost is minimized. There is alao a fixed cost associated with each concentrator. There is ail upper limit to the number of terminals which can be connected to a concentrator. The terminals can be connected directly to the CPU also In this paper it is assumed that the concentrators can bo located anywhere in the area A containing the CPU and the terminals. Then this becomes a multimodal optimization problem. In the proposed algorithm a stochastic automaton is used as a search device to locate the minimum of the multimodal cost function . The proposed algorithm involves the following. The area A containing the CPU and the terminals is divided into an arbitrary number of regions (say K). An approximate value for the number of concentrators is assumed (say m). The optimum number is determined by iteration later The m concentrators can be assigned to the K regions in (mk) ways (m > K) or (km) ways (K>m).(All possible assignments are feasible, i.e. a region can contain 0,1,…, to concentrators). Each possible assignment is assumed to represent a state of the stochastic variable structure automaton. To start with, all the states are assigned equal probabilities. At each stage of the search the automaton visits a state according to the current probability distribution. At each visit the automaton selects a 'point' inside that state with uniform probability. The cost associated with that point is calculated and the average cost of that state is updated. Then the probabilities of all the states are updated. The probabilities are taken to bo inversely proportional to the average cost of the states After a certain number of searches the search probabilities become stationary and the automaton visits a particular state again and again. Then the automaton is said to have converged to that state Then by conducting a local gradient search within that state the exact locations of the concentrators are determined This algorithm was applied to a set of test problems and the results were compared with those given by Cooper's (1964, 1967) EAC algorithm and on the average it was found that the proposed algorithm performs better.

A pilot RCT of a multi-component nutrition intervention for nursing home residents with dementia

Background Malnutrition and unintentional weight loss are major clinical issues in people with dementia living in residential aged care facilities (RACFs) and are associated with serious adverse outcomes. However, evidence regarding effective interventions is limited and strategies to improve the nutritional status of this population are required. This presentation describes the implementation and results of a pilot randomised controlled trial of a multi-component intervention for improving the nutritional status of RACF residents with dementia. Method Fifteen residents with moderate-severe dementia living in a secure long-term RACF participated in a five week pilot study. Participants were randomly allocated to either an Intervention (n=8) or Control group (n=7). The intervention comprised four elements delivered in a separate dining room at lunch and dinner: the systematic reinforcement of residents’ eating behaviors using a specific communication protocol; family-style dining; high ambiance table presentation; and routine Dietary-Nutrition Champion supervision. Control group participants ate their meals according to the facility’s standard practice. Baseline and follow-up assessments of nutritional status, food consumption, and body mass index were obtained by qualified nutritionists. Additional assessments included measures of cognitive functioning, mealtime agitation, depression, wandering status and multiple measures of intervention fidelity. Results No participant was malnourished at study commencement and participants in both groups gained weight from follow-up to baseline which was not significantly different between groups (t=0.43; p=0.67). A high degree of treatment fidelity was evident throughout the intervention. Qualitative data from staff indicate the intervention was perceived to be beneficial for residents. Conclusions This multi-component nutritional intervention was well received and was feasible in the RACF setting. Participants’ sound nutritional status at baseline likely accounts for the lack of an intervention effect. Further research using this protocol in malnourished residents is recommended. For success, a collaborative approach between researchers and facility staff, particularly dietary staff, is essential.

Psychiatric design : Using a salutogenic model for the development and management of mental health facilities

The prevailing model of psychiatric facility design does not fulfil its potential in supporting the healing process. A salutogenic approach can improve coherence and foster meaning, will actually improve mental health outcomes, not only manage patient behaviour.

Queuing Models for Estimating Aircraft Fleet Availability

The availability of a small fleet of aircraft in a flying-base, repair-depot combination is modeled and studied. First, a deterministic flow model relates parameters of interest and represents the state-of-the art in the planning of such systems. Second, a cyclic queue model shows the effect of the principal uncertainties in operation and repair and shows the consequent decrease in the availability of aircraft at the flying-base. Several options such as increasing fleet size, investments in additional repair facilities, or building reliability and maintainability into the individual aircraft during its life-cycle are open for increasing the availability. A life-cycle cost criterion brings out some of these features. Numerical results confirm Rose's prediction that there exists a minimal cost combination of end products and repair-depot capability to achieve a prescribed operational availability.

Output feedback control of networked systems with a stochastic communication protocol

This paper addresses an output feedback control problem for a class of networked control systems (NCSs) with a stochastic communication protocol. Under the scenario that only one sensor is allowed to obtain the communication access at each transmission instant, a stochastic communication protocol is first defined, where the communication access is modelled by a discrete-time Markov chain with partly unknown transition probabilities. Secondly, by use of a network-based output feedback control strategy and a time-delay division method, the closed-loop system is modeled as a stochastic system with multi time-varying delays, where the inherent characteristic of the network delay is well considered to improve the control performance. Then, based on the above constructed stochastic model, two sufficient conditions are derived for ensuring the mean-square stability and stabilization of the system under consideration. Finally, two examples are given to show the effectiveness of the proposed method.

Cochannel Interference in Partially Coherent Communication

Effects of cochannel interference and synchronization error of the carrier phase on the probability of error in binary communications are considered. Several bounds on the probability of error are proposed. The bounds are easy to compute and do not require complete statistical characterization of the errors. They turn out to be simple linear combinations of error probabilities with no cochannel interferences and no phase errors. Several illustrative examples are given which show that the bounds can be tight.