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 Temporal Landscape of Residential Aged Care Facilities – Implications for Context-Sensitive Health Technology

Health information technology (IT) can have a profound effect on the temporal flow and organisation of work. Yet research into the context, meaning and significance of temporal factors remains limited, most likely because of its complexity. This study outlines the role of communications in the context of the temporal and organizational landscape of seven Australian residential aged care facilities displaying a range of information exchange practices and health IT capacity. The study used qualitative and observational methods to identify temporal factors associated with internal and external modes of communication across the facilities and to explore the use of artifacts. The study concludes with a depiction of the temporal landscape of residential aged care particularly in regards to the way that work is allocated, prioritized, sequenced and coordinated. We argue that the temporal landscape involves key context-sensitive factors that are critical to understanding the way that humans accommodate to, and deal with health technologies, and which are therefore important for the delivery of safe and effective care.

Evaluating the Feasibility of Implementing a Green Roof Retrofit on Pitched Residential Roofs

Green roofs are one solution to stormwater runoff which is a major environmental problem. However, the majority of green roofs are primarily implemented on flat roofed commercial buildings and not residential homes with sloped roofs. Team SO GREEN designed a light-weight green roof system retrofit for residential homes. Between June and November 2014, green roof performance data was collected and compared between the designed sloped roofs and a non-sloped control. The sloped design performed well and one test slope was improved with a recirculating irrigation system. An economic analysis was made and a focus group determined preliminary consumer interest, aesthetic preferences, and barriers. This study enriches the body of knowledge regarding bringing green roof systems to the residential home market.

Modernity, the new republic and Sing Sing: The creation of a disciplined workforce and citizenry

[Author's description] Bringing together new research on punishment and control in the 19th and 20th centuries, this collection begins by examining the development of the modern prison, gender, social control and punishment, and psychiatry and the criminal justice system. Further, it explores penal olicy, prison practice, and discourses on offenders, providing case studies of: the 'respectable' criminal, the female inebriate and the juvenile offender. The final part examines the experiences of confinement, discipline and resistance, through prisoner memoirs, prison riots and resistance and identity in residential institutions.

A Census-based longitudinal study of variations in survival amongst residents of nursing and residential homes in Northern Ireland

Background: despite the intensive services provided to residents of care homes, information on death rates is not routinely available for this population in the UK. Objective: to quantify mortality rates across the care home population of Northern Ireland, and assess variation by type of care home and resident characteristics. Design: a prospective, Census-based cohort study, with 5-year follow-up. Participants: all 9,072 residents of care homes for people aged 65 and over at the time of the 2001 census with a special emphasis on the 2,112 residents admitted during the year preceding census day. Measurements: age, sex, self-reported health, marital status, residence (not in care home, residential home, dual registered home, nursing home), elderly mentally infirm care provision. Results: the median survival among nursing home residents was 2.33 years (95% CI 2.25–2.59), for dual registered homes 2.75 (95% CI 2.42–3.17) and for residential homes 4.51 (95% CI 3.92–4.92) years. Age, sex and self-reported health showed weaker associations in the sicker populations in nursing homes compared to those in residential care or among the non-institutionalised. Conclusions: the high mortality in care homes indicates that places in care homes are reserved for the most severely ill and dependent. Death rates may not be an appropriate care quality measure for this population, but may serve as a useful adjunct for clinical staff and the planning of care home provision.

The Advancing MOOCs for Development Initiative: An examination of MOOC usage for professional workforce development outcomes in Colombia, the Philippines, & South Africa

The potential of online learning has long afforded the hope of providing quality education to anyone, anywhere in the world. The recent development of Massive Open Online Courses (MOOCs) heralded an exciting new breakthrough by providing free academic instruction and professional skills development from the world’s leading universities to anyone with the sufficient resources to access the internet. The research in Advancing MOOCs for Development Initiative study was designed to analyze the MOOC landscape in developing countries and to better understand the motivations of MOOC users and afford insights on the advantages and limitations of MOOCs for workforce development outcomes. The key findings of this study challenge commonly held beliefs about MOOC usage in developing countries, defying typical characterizations of how people in resource constrained settings use technology for learning and employment. In fact, some of the findings are so contrary to what has been reported in the U.S. and other developed environments that they raise new questions for further investigation.

A qualitative study of inclusion at a residential summer camp

The purpose of this qualitative case study was to understand the inclusion process at a Project Rainbow affiliated camp. Project Rainbow is a non-profit organization which promotes inclusion into children's camps in Ontario. This study was completed in order to provide stakeholders of the camping industry insight on how inclusive techniques can be implemented in residential camps. The researcher observed one camp's inclusion techniques for six days. The researcher observed three campers with disabilities and the camp staff and campers that interacted with them on a daily basis. While the researcher was at the camp, she interviewed nine staff members. The staff members consisted of the camp director, the inclusion coordinator, four camp counsellors, and three inclusion counsellors. An additional interview was conducted after arriving home from camp with the manager from Project Rainbow. The qualitative analysis program NVivo was used to help organize the analyzed data. The researcher found that in attempting to build a culture of inclusion, two important concepts are necessary. First, mutual leadership involved the camp director and Project Rainbow working together as a team to facilitate the inclusion process. Second, power of supportive relationships focused on inclusion being the responsibility of everyone, teamwork, and creating a welcoming environment. Hints at some potentially serious problems related to staff training, teamwork, and attitudes of non-disabled campers pointed to future research and policies which focus on the Ontario and Canadian Camping Associations' role in inclusion, in addition to camp in this study and Project Rainbow.

Field study on thermal comfort and adaptive strategies in residential buildings in China

This paper fully describes a nation-wide field study on building thermal environment and thermal comfort of occupant, which was carried out in summer 2005 and in winter 2006 respectively in China, illustrating the adaptive strategies adopted by occupants in domestic buildings in China. According to the climate division in China, the buildings in Beijing (BJ), Shanghai (SH), Wuhan (WH) and Chongqing (CQ), Guangzhou (GZ), Kunming (KM), were selected as targets which are corresponding to cold zone, hot summer and cold winter zone (SWC-SH, WH, CQ), hot summer and warm winter zone and temperate zone, respectively. The methodology used in the field study is the combination of subjective questionnaire regarding thermal sensation and adaptive approaches and physical environmental monitoring including indoor air temperature and relative humidity. A total of 1671 subjects participate in this investigation with more than 80% response rate in all surveyed cities. Both physiological and non-physiological factors (behavioural and psychological adaptations) have been analysed.

The significance of occupancy steadiness in residential consumer response to Time of Use pricing: Evidence from a stochastic adjustment model

The recent roll-out of smart metering technologies in several developed countries has intensified research on the impacts of Time-of-Use (TOU) pricing on consumption. This paper analyses a TOU dataset from the Province of Trento in Northern Italy using a stochastic adjustment model. Findings highlight the non-steadiness of the relationship between consumption and TOU price. Weather and active occupancy can partly explain future consumption in relation to price.

Characterization of residential chimney conditions for flue gas flow measurements

A literature survey and a theoretical study were performed to characterize residential chimney conditions for flue gas flow measurements. The focus is on Pitot-static probes to give sufficient basis for the development and calibration of a velocity pressure averaging probe suitable for the continuous dynamic (i.e. non steady state) measurement of the low flow velocities present in residential chimneys. The flow conditions do not meet the requirements set in ISO 10780 and ISO 3966 for Pitot-static probe measurements, and the methods and their uncertainties are not valid. The flow velocities in residential chimneys from a heating boiler under normal operating condi-tions are shown to be so low that they in some conditions result in voiding the assumptions of non-viscous fluid justifying the use of the quadratic Bernoulli equation. A non-linear Reynolds number dependent calibration coefficient that is correcting for the viscous effects is needed to avoid significant measurement errors. The wide range of flow velocity during normal boiler operation also results in the flow type changing from laminar, across the laminar to turbulent transition region, to fully turbulent flow, resulting in significant changes of the velocity profile during dynamic measurements. In addition, the short duct lengths (and changes of flow direction and duct shape) used in practice are shown to result in that the measurements are done in the hydrodynamic entrance region where the flow velocity profiles most likely are neither symmetrical nor fully developed. A measurement method insensitive to velocity profile changes is thus needed, if the flow velocity profile cannot otherwise be determined or predicted with reasonable accuracy for the whole measurement range. Because of particulate matter and condensing fluids in the flue gas it is beneficial if the probe can be constructed so that it can easily be taken out for cleaning, and equipped with a locking mechanism to always ensure the same alignment in the duct without affecting the calibration. The literature implies that there may be a significant time lag in the measurements of low flow rates due to viscous effects in the internal impact pressure passages of Pitot probes, and the significance in the discussed application should be studied experimentally. The measured differential pressures from Pitot-static probes in residential chimney flows are so low that the calibration and given uncertainties of commercially available pressure transducers are not adequate. The pressure transducers should be calibrated specifically for the application, preferably in combination with the probe, and the significance of all different error sources should be investigated carefully. Care should be taken also with the temperature measurement, e.g. with averaging of several sensors, as significant temperature gradients may be present in flue gas ducts.

Comparison Of Demand Pattern Calibration In Water Distribution Networks With Geographic And Non-Geographic Parameterization

Demands are one of the most uncertain parameters in a water distribution network model. A good calibration of the model demands leads to better solutions when using the model for any purpose. A demand pattern calibration methodology that uses a priori information has been developed for calibrating the behaviour of demand groups. Generally, the behaviours of demands in cities are mixed all over the network, contrary to smaller villages where demands are clearly sectorised in residential neighbourhoods, commercial zones and industrial sectors. Demand pattern calibration has a final use for leakage detection and isolation. Detecting a leakage in a pattern that covers nodes spread all over the network makes the isolation unfeasible. Besides, demands in the same zone may be more similar due to the common pressure of the area rather than for the type of contract. For this reason, the demand pattern calibration methodology is applied to a real network with synthetic non-geographic demands for calibrating geographic demand patterns. The results are compared with a previous work where the calibrated patterns were also non-geographic.

Treatment outcomes of an integrated residential programme for patients with schizophrenia and substance use disorder

About half of all schizophrenic patients have a co-occurring substance use disorder, leading to poorer social and functional outcomes than obtained in non-abusing patients. To improve outcomes, integrated treatments have been designed that address the two conditions simultaneously. Results are, however, conflicting because the available effect studies are hampered by various methodological issues, among which are heterogeneous patient samples.