Non-Therapeutic Medication Omissions: Incidence and Predictors at an Australian Hospital

Background: The inconsistent definition of non-therapeutic medication omissions, under-reporting, and a poor understanding of their associated factors hamper efforts to improve medication administration practices. Aim: To examine the incidence of non-therapeutic medication omissions among acutely ill medical and surgical adult patients; and to identify the patient-, drug- and system-related predictors of these omissions. Method: A medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The sample was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review. Results: Of the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p < 0.001) and the number of medication administration episodes (p < 0.001) were statistically significant predictors of non-therapeutic medication omissions. Conclusion: The high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error. J Pharm Pract Res 2011; 41: 188-91.

Outcome evaluation framework for the Queensland Alcohol Ignition Interlock Program. Report to Queensland Department of Transport and Main Roads (TMR 3814)

The Queensland Department of Transport and Main Roads (TMR) required an evaluation framework for the Queensland Alcohol Ignition Interlock Program (AIIP). The objective of this project was to develop a framework to evaluate the AIIP in terms of its effect on road safety outcomes.

Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

Application of a Bayesian Network complex system model to a successful community electricity demand reduction program

Utilities worldwide are focused on supplying peak electricity demand reliably and cost effectively, requiring a thorough understanding of all the factors influencing residential electricity use at peak times. An electricity demand reduction project based on comprehensive residential consumer engagement was established within an Australian community in 2008, and by 2011, peak demand had decreased to below pre-intervention levels. This paper applied field data discovered through qualitative in-depth interviews of 22 residential households at the community to a Bayesian Network complex system model to examine whether the system model could explain successful peak demand reduction in the case study location. The knowledge and understanding acquired through insights into the major influential factors and the potential impact of changes to these factors on peak demand would underpin demand reduction intervention strategies for a wider target group.

Exploring physical activities in an employer-sponsored health program

This work brings a perspective from an employer-sponsored health and wellness program called Global Corporate Challenge (GCC) to the 'quantified self' research. We present preliminary findings from a study with 17 university employees who participated in the GCC. We aimed to explore how participants derived meaningfulness from their self-tracking experiences. Our findings echo the growing body of work that advocates for conceptualizing activity tracking beyond the rationalistic, data-oriented perspectives and supporting more social and lived experiences.

"It broke our hearts": Understanding parents' lived experiences of their child's admission to an acute mental health care facility

This article reports the evaluative findings of an Early Psychosis Education Program (EPEP) designed to support parents caring for their child who was recently admitted to the psychiatric intensive care unit of an inpatient mental health care facility in Australia. The EPEP offered education on mental illness, treatment options, and medication, as well as information on the recovery model of care. The EPEP was facilitated by two RNs and was evaluated for educational effectiveness using a simple pre- and postevaluation questionnaire. The evaluation revealed two themes expressed by parents: "We didn't see it coming," and "Hopelessness and helplessness." The themes highlighted the parents' lack of mental health care knowledge prior to the EPEP, which had a significant impact on the parents' experiences and well-being. The evaluative findings highlighted a need for a nurse-led EPEP within the community. A community EPEP has the potential to strengthen the partnership between parents, families, and mental health service providers and to help with the provision of a recovery framework of care.

Geography and international assessment: Opportunity or distraction

Assessments of students in primary and secondary education are debated among practitioners, policy-makers, and parents. In some countries, assessment scores serve a criterion for passage between levels of education, for example, from secondary school to post-secondary education. Those practices are often traditions and while they come under criticism, they are a long-accepted part of the educational practices within a country. In those countries, the students’ assessment and examination scores are posted in public places or published in local news media. In other countries, assessments are used for the periodic checks on individual student progress. The results of assessments may be used for rating schools, and in some cases, they are used for evaluating the performance of teachers. Assessments are used less often to analyze student performance and make judgments regarding the performance of the curriculum. Even less often, assessments serve to critically establish strategies for the improvement of student learning and educational practices. The ends on the continuum of the assessment debate often focus on the opportunities that assessments present to improve education on one end. The other end is that assessments serve as a major distraction from the important work of teachers by removing classroom room time from instruction. The debate on those issues continues.

The Yonder project: Stories of impact, change, and capacity building through engagement in arts education

This thesis examined the long-term impact of the community arts education project Yonder, a collaboration between Education Queensland and Queensland Performing Arts Centre. The findings from the data reveal that the project was still having impact twelve months after its completion and that in some instances the project served as a 'circuit-breaker', especially for special needs students and struggling students. The intervention of a rich arts project proved to be an opportunity for these students to learn in a different way and to perceive themselves in a new and reinvented light. This confidence was found to transfer into other aspects of their learning.

Identifying satisfaction factors in tertiary education: The case of an information systems program

This paper introduces a modified Kano approach to analysing and classifying quality attributes that drive student satisfaction in tertiary education. The approach provides several benefits over the traditional Kano approach. Firstly, it uses existing student evaluations of subjects in the educational institution instead of purpose-built surveys as the data source. Secondly, since the data source includes qualitative comments and feedback, it has the exploratory capability to identify emerging and unique attributes. Finally, since the quality attributes identified could be tied directly to students’ detailed feedback, the approach enables practitioners to easily translate the results into concrete action plans. In this paper, the approach is applied to analysing 26 subjects in the information systems school of an Australia university. The approach has enabled the school to uncover new quality attributes and paves the way for other institutions to use their student evaluations to continually understand and addressed students’ changing needs.

Differential segmentation responses to an alcohol social marketing program

Objective This study seeks establish whether meaningful subgroups exist within a 14-16 year old adolescent population and if these segments respond differently to the Game On: Know Alcohol (GOKA) intervention, a school-based alcohol social marketing program. Methodology This study is part of a larger cluster randomized controlled evaluation of the Game On: Know Alcohol (GOKA) program implemented in 14 schools in 2013/2014. TwoStep cluster analysis was conducted to segment 2114 high school adolescents (14-16 years old) on the basis of 22 demographic, behavioral and psychographic variables. Program effects on knowledge, attitudes, behavioral intentions, social norms, expectancies and refusal self-efficacy of identified segments was subsequently examined. Results Three segments were identified: (1) Abstainers (2) Bingers (3) Moderate Drinkers. Program effects varied significantly across segments. The strongest positive change effects post participation were observed for the Bingers, while mixed effects were evident for Moderate Drinkers and Abstainers. Conclusions These findings provide preliminary empirical evidence supporting application of social marketing segmentation in alcohol education programs. Development of targeted programs that meet the unique needs of each of the three identified segments is indicated to extend the social marketing footprint in alcohol education.

A two-arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients

Purpose This study tested the effectiveness of a pressure ulcer (PU) prevention bundle in reducing the incidence of PUs in critically ill patients in two Saudi intensive care units (ICUs). Design A two-arm cluster randomized experimental control trial. Methods Participants in the intervention group received the PU prevention bundle, while the control group received standard skin care as per the local ICU policies. Data collected included demographic variables (age, diagnosis, comorbidities, admission trajectory, length of stay) and clinical variables (Braden Scale score, severity of organ function score, mechanical ventilation, PU presence, and staging). All patients were followed every two days from admission through to discharge, death, or up to a maximum of 28 days. Data were analyzed with descriptive correlation statistics, Kaplan-Meier survival analysis, and Poisson regression. Findings The total number of participants recruited was 140: 70 control participants (with a total of 728 days of observation) and 70 intervention participants (784 days of observation). PU cumulative incidence was significantly lower in the intervention group (7.14%) compared to the control group (32.86%). Poisson regression revealed the likelihood of PU development was 70% lower in the intervention group. The intervention group had significantly less Stage I (p = 002) and Stage II PU development (p = 026). Conclusions Significant improvements were observed in PU-related outcomes with the implementation of the PU prevention bundle in the ICU; PU incidence, severity, and total number of PUs per patient were reduced. Clinical Relevance Utilizing a bundle approach and standardized nursing language through skin assessment and translation of the knowledge to practice has the potential to impact positively on the quality of care and patient outcome.

LunaRoo: A Proposal for the Google Lunar XPrize Payload Opportunity with the Part Time Scientists team

This proposal describes the innovative and competitive lunar payload solution developed at the Queensland University of Technology (QUT)–the LunaRoo: a hopping robot designed to exploit the Moon's lower gravity to leap up to 20m above the surface. It is compact enough to fit within a 10cm cube, whilst providing unique observation and mission capabilities by creating imagery during the hop. This first section is deliberately kept short and concise for web submission; additional information can be found in the second chapter.

Personas of students accessing a peer-facilitated support for learning program

STIMulate is a support for learning program at the Queensland University of Technology in Brisbane, Australia. The program provides assistance in mathematics, science and information technology for undergraduate students. This paper develops personas - archetypal users - that represent the attitudes and motivations of students that utilise STIMulate (in particular, the IT stream). Seven different personas were developed based on interviews gathered from Peer Learning Facilitators (PLF) who are experienced students that have excelled in relevant subject areas. The personas were then validated by a PLF focus group. Developing the personas enabled us to better understand the characteristics and needs of the students using the STIMulate program, enabling a more critical analysis of the quality of the service provided.

The challenge of normative influences for program design for youth in detention

Young people in detention are at greater risk of death and disability from injury sustained while not in custody. Injury prevention and mental health programs have been designed for this group but their theoretical basis is rarely discussed. The present study investigates whether the conceptual basis of the Theory of Planned Behavior (TPB) is relevant to youth in a detention center. Focus group and observational data were collected. A thematic analysis supported central theoretical constructs and emphasized “Subjective Norms.” The challenge of normative influences must be actively addressed in the design of health interventions for youth in detention.

Is Merit on the Agenda? Approaches to Recruitment and Promotion in Australian Organisations

Employment on the basis of merit is the foundation of Australia’s equal opportunity legislation, beginning with the Affirmative Action (Equal Opportunity for Women) Act 1986, and continuing through the Equal Opportunity for Women in the Workplace Act 1999 to the Workplace Gender Equality Act 2012, all of which require organisations with more than 100 employees to produce an organisational program promoting employment equity for women (WGEA 2014a; Strachan, Burgess & Henderson 2007). The issue of merit was seen as critically important to the objectives of the original 1986 Act and the Affirmative Action Agency produced two monographs in 1988 written by Clare Burton: Redefining Merit (Burton 1988a) and Gender Bias in Job Evaluation (Burton 1988b) which provided practical advice. Added to this, in 1987 the Australian Government Publishing Service published Women’s Worth: Pay Equity and Job Evaluation in Australia (Burton, Hag & Thompson 1987). The equity programs set up under the 1986 legislation aimed to ‘eliminate discriminatory employment practices and to promote equal employment opportunities for women’ and this was ‘usually understood to mean that the merit principle forms the basis of appointment to positions and for promotion’ (Burton 1988a, p. 1).