Evaluating information flow in medication management process in Australian acute care facilities: A multi-professional perspective

Over the years, various interventions have been introduced to improve the medication management process. While these interventions have addressed some aspects predisposing the process to inefficiencies, significant gaps are still prevalent across the process. Studies have suggested that the goal of optimal medication therapy is achievable when information flow integrates across the various medication management process phases, stakeholders and departments involved as the patient moves through the process. To provide a cross-sectional view of the process, this study utilised a systemic philosophy to evaluate the information flow integration across the process. The research approach adopted for this study takes a positivist paradigm, which is guided by the cause and effect (causality) belief. It explored numeric measures to evaluate the relationship between constructs that assessed information flow principles (accessibility, timeliness, granularity and transparency) within the medication process and the information integration. The research design was cross-sectional and analytical, and this ensures that findings are relevant to current situations across the Australian healthcare system. Data for this research was collected using an online self-administered survey and the data assessed information flow principles and technologies used in the medication management process. There were 88 participants in this study, including doctors, nurses and pharmacists. The questions and responses were coded for analysis and data analysis techniques used were frequency analysis, Pearson’s chi-square test and multivariate analysis. Findings from this study indicates that the constructs evaluating accessibility, transparency and granularity had moderate associations with the information integration in the medication management process. Further analysis highlighted accessibility as a significant principle in explaining an increase or decrease in information integration in the medication management process. The accessibility construct referring to information retrieval was significant across the two tests conducted. Accessibility is directly related to information sharing and the assessment and monitoring and evaluation phases in the medication management process were identified as having the highest challenges with information sharing. Furthermore, the hybrid (electronic and paper) channel was preferred to support information integration in the medication management process by the participants. Among the technologies evaluated for the medication process, computer-provider-order-entry was found to be statistically significant in explaining an increase in information integration. Overall, results from this study suggest that interventions for the medication management process in Australian acute care facilities should be directed towards improving accessibility, specifically information retrieval and the sharing of information with emphasis on the assessment and monitoring phases. Implementing strategies to address the gaps identified from this research can improve information integration across the process and thereby reducing medication errors, and improving patient care management. Furthermore, the technology adoption across the process highlights that technology adoption across participants’ facilities remains a challenge in Australia

Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

Language Design for Reactive Systems: On Modal Models, Time, and Object Orientation in Lingua Franca and SCCharts

Reactive systems play a crucial role in the embedded domain. They continuously interact with their environment, handle concurrent operations, and are commonly expected to provide deterministic behavior to enable application in safety-critical systems. In this context, language design is a key aspect, since carefully tailored language constructs can aid in addressing the challenges faced in this domain, as illustrated by the various concurrency models that prevent the known pitfalls of regular threads. Today, many languages exist in this domain and often provide unique characteristics that make them specifically fit for certain use cases. This thesis evolves around two distinctive languages: the actor-oriented polyglot coordination language Lingua Franca and the synchronous statecharts dialect SCCharts. While they take different approaches in providing reactive modeling capabilities, they share clear similarities in their semantics and complement each other in design principles. This thesis analyzes and compares key design aspects in the context of these two languages. For three particularly relevant concepts, it provides and evaluates lean and seamless language extensions that are carefully aligned with the fundamental principles of the underlying language. Specifically, Lingua Franca is extended toward coordinating modal behavior, while SCCharts receives a timed automaton notation with an efficient execution model using dynamic ticks and an extension toward the object-oriented modeling paradigm