Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks

BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

ePortfolios and eGovernment : from technology to the entrepreneurial self

We analyse the electronic portfolio (ePortfolio) in higher education policy and practice. While evangelical accounts of the ePortfolio celebrate its power as a new eLearning technology, we argue that it allows the mutually-reinforcing couple of neoliberalism and the enterprising self to function in ways in which individual difference can be presented, cultured and grown, all the time within a standardised framework which relentlessly polices the limits of the acceptable and unacceptable. We point to the ePortfolio as a practice of (self-) government, arguing that grander policy coalesces out of a halting, experimental set of technological instruments for thinking about how life should be lived.

Registration of clinical trials: Challenges for global regulation

In 2004 the International Committee of Medical Journal Editors (ICMJE) issued a statement indicating that from 1 July 2005 registration in a publicly accessible trials registry would be a condition of publication in an ICMJE member journal. The World Health Organisation is coordinating the International Clinical Trials Registry Platform (ICTRP) as a means of providing a standardised framework for registration. This article considers the practical challenges and opportunities that arise from these developments and considers the relevance of trial registration for women and minorities and for developing countries.

Demonstration reaches: Looking back whilst moving forward with river rehabilitation under the Native Fish Strategy

‘Demonstration reaches’ are sections of river where multiple threats to native fish are addressed through river rehabilitation and strong community participation. They are an important way of promoting the key driving actions of the Murray-Darling Basin Authority's Native Fish Strategy (NFS) by using on-ground community-driven rehabilitation. Measuring rehabilitation success against well-defined targets and using this information to adaptively mange activities is fundamental to the demonstration reach philosophy. Seven years on from the establishment of the first demonstration reach, there are now seven throughout the Murray-Darling Basin (MDB), all in differing states of maturation and but all applying a standardised framework for monitoring native fish outcomes. In this study, we reflect on the role that demonstration reaches have played within the NFS, synthesise some key findings from 32 monitoring and evaluation outputs, and highlight some of the successes and barriers to success. We make recommendations as to how to strengthen the demonstration reach model to ensure it remains a relevant approach for fish habitat rehabilitation beyond the NFS and MDB.

The nature of emotional support and counselling provision for people with sight loss in the United Kingdom

People with sight loss in the United Kingdom are known to have lower levels of emotional wellbeing and to be at higher risk of depression. Consequently ‘having someone to talk to’ is an important priority for people with visual impairment. An on-line survey of the provision of emotional support and counselling for people affected by sight loss across the UK was undertaken. The survey was distributed widely and received 182 responses. There were more services offering ‘emotional support’, in the form of listening and information and advice giving, than offered ‘counselling’. Services were delivered by providers with differing qualifications in a variety of formats. Waiting times were fairly short and clients presented with a wide range of issues. Funding came from a range of sources, but many felt their funding was vulnerable. Conclusions have been drawn about the need for a national standardised framework for the provision of emotional support and counselling services for blind and partially sighted people in the UK

MOLES3: implementing an ISO standards driven data catalogue

ISO19156 Observations and Measurements (O&M) provides a standardised framework for organising information about the collection of information about the environment. Here we describe the implementation of a specialisation of O&M for environmental data, the Metadata Objects for Linking Environmental Sciences (MOLES3). MOLES3 provides support for organising information about data, and for user navigation around data holdings. The implementation described here, “CEDA-MOLES”, also supports data management functions for the Centre for Environmental Data Archival, CEDA. The previous iteration of MOLES (MOLES2) saw active use over five years, being replaced by CEDA-MOLES in late 2014. During that period important lessons were learnt both about the information needed, as well as how to design and maintain the necessary information systems. In this paper we review the problems encountered in MOLES2; how and why CEDA-MOLES was developed and engineered; the migration of information holdings from MOLES2 to CEDA-MOLES; and, finally, provide an early assessment of MOLES3 (as implemented in CEDA-MOLES) and its limitations. Key drivers for the MOLES3 development included the necessity for improved data provenance, for further structured information to support ISO19115 discovery metadata export (for EU INSPIRE compliance), and to provide appropriate fixed landing pages for Digital Object Identifiers (DOIs) in the presence of evolving datasets. Key lessons learned included the importance of minimising information structure in free text fields, and the necessity to support as much agility in the information infrastructure as possible without compromising on maintainability both by those using the systems internally and externally (e.g. citing in to the information infrastructure), and those responsible for the systems themselves. The migration itself needed to ensure continuity of service and traceability of archived assets.

Social media in disaster response : Queensland Police Service - public engagement during the 2011 floods

Social Media, particularly Microblogging services, are now being adopted as an additional tool for emergency service agencies to be able to interact with the community at all stages of a disaster. Unfortunately, no standard framework for Social Media adoption for disaster management exists and emergency service agencies are adopting Social Media in an ad-hoc fashion. This paper seeks to provide a general understanding of how Social Media is being used by emergency service agencies during disasters, to better understand how we might develop a standardised framework of adoption. In this study of the 2010/11 Queensland Flood event, Facebook broadcast messages from the Queensland Police Service to the general public, were analysed by genre. Findings show that these Microblogging activities were mostly about information distribution and warning broadcasts and that the strength of Social Media for two-way communication and collaboration with the general public, was under-utilised during this event.

The National Safety and Quality Health Service Standards requirements for orientation and induction within Australian healthcare: a review of the literature

Introduction: A workplace orientation program is a core requirement of the National Safety and Quality Health Service (NSQHS) Standards in Australia. This is particularly important within healthcare as patient safety and the patient experience are at risk if the healthcare workforce is not supported with an effective orientation and induction program. Aim: This study aimed to review the literature and map the requirements of the NSQHS Standards in relation to orientation and induction. Method: This study utilised online databases to search for literature pertaining to orientation and induction within healthcare. Inclusion criteria included relevance to research questions, and originating in a country with a comparative health system to Australia. Results: The search identified a total of 202 articles of potential relevance with 42 articles meeting the inclusion criteria. Articles were ranked according to hierarchy of evidence criteria for both qualitative and quantitative studies. The importance of using orientation to detail safety and quality roles, the organisations' risk management system, governance structure, operational processes and procedures was highlighted. Patient-centred care, antimicrobial stewardship, clinical handover and mechanisms for escalation of care and emergency assistance should also be covered within the orientation process. Conclusion: There is a dearth of studies in relation to orientation and induction in the healthcare literature. Orientation content is now clearly prescribed, what is lacking within healthcare is a standardised framework. Concept mapping, educational theory and adult learning methods have been shown to enhance workforce problem solving and engagement with orientation, however further research is needed to enhance practice

Rail incident investigator training: Is there support for a standardised Australasian training framework?

Background: Historically rail organisations have been operating in silos and devising their own training agendas. However with the harmonisation of the Australian workplace health and safety legislation and the appointment of a national rail safety regulator in 2013, rail incident investigator experts are exploring the possibility of developing a unified approach to investigator training. Objectives: The Australian CRC for Rail Innovation commissioned a training needs analysis to identify if common training needs existed between organisations and to assess support for the development of a national competency framework for rail incident investigations. Method: Fifty-two industry experts were consulted to explore the possibility of the development of a standardised training framework. These experts were sourced from within 19 Australasian organisations, comprising Rail Operators and Regulators in Queensland, New South Wales, Victoria, Western Australia, South Australia and New Zealand. Results: Although some competency requirements appear to be organisation specific, the vast majority of reported training requirements were generic across the Australasian rail operators and regulators. Industry experts consistently reported strong support for the development of a national training framework. Significance: The identification of both generic training requirements across organisations and strong support for standardised training indicates that the rail industry is receptive to the development of a structured training framework. The development of an Australasian learning framework could: increase efficiency in course development and reduce costs; establish recognised career pathways; and facilitate consistency with regards to investigator training.

Training needs research applied to the development of a standardised incident investigator training framework

In response to the rail industry lacking a consistently accepted standard of minimal training to perform incident investigations, the Australasian rail industry requested the development of a unified approach to investigator training. This paper details how the findings from a training needs analysis were applied to inform the development of a standardised training package for rail incident investigators. Data from job descriptions, training documents and subject matter experts sourced from 17 Australasian organisations were analysed and refined to yield a draft set of 10 critical competencies. Finally the draft of critical competencies was reviewed by industry experts to verify the accuracy and completeness of the competency list and to consider the most appropriate level of qualification for training development. The competencies identified and the processes described to translate research into an applied training framework in this paper, can be generalised to assist practitioners and researchers in developing industry approved standardised training packages.

Creating a standardised teaching and learning framework for social work field placements

Mapping and evaluating a student's progress on placement is a core element of social work education but there has been scant attention to indicate how to effectively create and assess student learning and performance. This paper outlines a project undertaken by the Combined Schools of Social Work to develop a common learning and assessment tool that is being used by all social work schools in Victoria. The paper describes how the Common Assessment Tool (CAT) was developed, drawing on the Australian Association of Social Work Practice Standards, leading to seven key learning areas that form the basis of the assessment of a student's readiness for practice. An evaluation of the usefulness of the CAT was completed by field educators, liaison staff, and students, which confirmed that the CAT was a useful framework for evaluating students' learning goals. The feedback also identified a number of problematic features that were addressed in a revised CAT and rating scale.

Creating a standardised teaching and learning framework for social work field placements

© 2014, © 2014 Australian Association of Social Workers. Abstract: Mapping and evaluating a student's progress on placement is a core element of social work education but there has been scant attention to indicate how to effectively create and assess student learning and performance. This paper outlines a project undertaken by the Combined Schools of Social Work to develop a common learning and assessment tool that is being used by all social work schools in Victoria. The paper describes how the Common Assessment Tool (CAT) was developed, drawing on the Australian Association of Social Work Practice Standards, leading to seven key learning areas that form the basis of the assessment of a student's readiness for practice. An evaluation of the usefulness of the CAT was completed by field educators, liaison staff, and students, which confirmed that the CAT was a useful framework for evaluating students' learning goals. The feedback also identified a number of problematic features that were addressed in a revised CAT and rating scale.

Incident investigation : on a collision course towards a national standardised approach

The investigation of rail incidents is a highly specialised and important area within the rail industry. Historically training for investigators has been disjointed, with no standard approach being applied consistently. Currently in Australia, rail incidents are investigated by the various rail operators and regulators of each State, with the more serious incidents investigated by the Australian Transport Safety Bureau (ATSB). However, it is hoped with the introduction of a National Safety Regulator for the industry, a standardised competency framework for rail incident investigators can be developed. Consequently, this will also lead to more standardised training across the industry for these specialised career paths. A previous scoping report published by the CRC for Rail Innovation highlighted a need within the industry for a standardised competency framework and training package. Based on the results of the scoping report, a comprehensive Training Needs Analysis for the rail industry was undertaken. This paper will examine potential barriers and facilitators that the industry may face when implementing this national training. Furthermore, based on the results of the Training Needs Analysis, differences and similarities in the needs of rail organisations as well as between operators and regulators will be examined.

iMarNet: an ocean biogeochemistry model intercomparison project within a common physical ocean modelling framework

Ocean biogeochemistry (OBGC) models span a wide variety of complexities, including highly simplified nutrient-restoring schemes, nutrient–phytoplankton–zooplankton–detritus (NPZD) models that crudely represent the marine biota, models that represent a broader trophic structure by grouping organisms as plankton functional types (PFTs) based on their biogeochemical role (dynamic green ocean models) and ecosystem models that group organisms by ecological function and trait. OBGC models are now integral components of Earth system models (ESMs), but they compete for computing resources with higher resolution dynamical setups and with other components such as atmospheric chemistry and terrestrial vegetation schemes. As such, the choice of OBGC in ESMs needs to balance model complexity and realism alongside relative computing cost. Here we present an intercomparison of six OBGC models that were candidates for implementation within the next UK Earth system model (UKESM1). The models cover a large range of biological complexity (from 7 to 57 tracers) but all include representations of at least the nitrogen, carbon, alkalinity and oxygen cycles. Each OBGC model was coupled to the ocean general circulation model Nucleus for European Modelling of the Ocean (NEMO) and results from physically identical hindcast simulations were compared. Model skill was evaluated for biogeochemical metrics of global-scale bulk properties using conventional statistical techniques. The computing cost of each model was also measured in standardised tests run at two resource levels. No model is shown to consistently outperform all other models across all metrics. Nonetheless, the simpler models are broadly closer to observations across a number of fields and thus offer a high-efficiency option for ESMs that prioritise high-resolution climate dynamics. However, simpler models provide limited insight into more complex marine biogeochemical processes and ecosystem pathways, and a parallel approach of low-resolution climate dynamics and high-complexity biogeochemistry is desirable in order to provide additional insights into biogeochemistry–climate interactions.

Keeping it real! Enhancing realism in standardised patient OSCE stations

Background: Objective structured clinical examinations (OSCEs) are a
commonly used method of assessing clinical competency in healthcare education. They can providean opportunity to observe candidates interacting with patients.
There are many challenges in using real patients in OSCEs, and increasingly standardised patients are being used as a preference. However, by using standardised patients there is a risk of making the encounter arti?cial and removed from actual clinical practice.
Context: Efforts made in terms of cognitive, auditory, visual, tactile, psychological and emotional cues can minimise the differences between a simulated
and real clinical scenario. However, a number of factors, including feasibility, cost and usability, need to be considered if such techniques are to be practicable
within an OSCE framework.
Innovation: This article describes a series of techniques that have been used in our institution to enhance the realism of a standardised patient encounter in an
OSCE. Efforts in preparing standardised patient roles, and how they portray these roles, will be considered. A wide variety of equipment can also be used in
combination with a patient and the surrounding environment, which can further enhance the authenticity of the simulated scenario.
Implications: By enhancing the realism in simulated patient OSCE encounters, there is potential to trigger more authentic conscious responses from candidates and implicit reactions that the candidates themselves may be less
aware of. Furthermore, using such techniques may allow faculty members to select scenarios that were previously not thought possible in an OSCE