Looking forward to a safer future: The new WHO guidelines for safe surgery

Each year in Australia there are approximately 2 million hospital admissions for surgical services (Australia’s Health, 2008) and this number is set to grow significantly, with forecasts of at least a 22% increase by 2021 (Birrell, Hawthorne & Rapson, 2003). Surprisingly, for such a high-risk high-volume specialty, we have very little data on perioperative adverse events. This lack of even basic data means that we are unable to track event rates, leaving us oblivious to the full extent of the problem. Research on intraoperative adverse events tells us that the rate of major complications is between 3-16%, with a mortality rate of 0.4-0.8%. (Kable, Gibbered & Spigelman, 2002; Gawande et al, 1999). Applying the lowest of these rates (3% & 0.4%) to Australia’s surgical population reveals that a staggering 60,000 patients annually suffer significant complications, with 8000 patients dieing during or immediately after surgery as a result of adverse events. This is indeed a significant number, and given that the research indicates that nearly half of these events are preventable (Kable, Gibbered & Spigelman, 2002; Gawande et al, 1999), one that clearly needs addressing. This paper will review the research on perioperative safety and adverse events and examine some of the safety strategies put forward in the new World Health Organizations (WHO) Guidelines for Safe Surgery. These guidelines were developed for the WHO by renowned perioperative safety champion Dr Atul Gawande and contain recommendations for ‘safer surgery practices’ that have been demonstrated to reduce adverse events

Utilising the Clinical Excellence Commission’s Performance Indicators for Quality Use of Medicines

Like other aspects of health care, Quality Use of Medicine (QUM) can be considered in terms of structures, processes and outcomes. These components of QUM can be measured with performance indicators. This poster describes the Clinical Excellence Commissions (CEC) new performance indicators and their use in a warfarin practice improvement project. Aim: - To measure performance indicators in order to; Comprehensively audit warfarin therapy. - Benchmarking current practices. - Identify opportunities for practice improvement. - Measure practice change\u3e Method: Auditing structures, processes, and outcomes requires different tools and methods. For this project, the following tools were utilised; - The CEC Medication Safety Self Assessment for Antithrombotic Therapy in Australian Hospitals tool (MSSA-AT) was selected to provide qualitative data on hospital structure, culture, systems, policies, procedures and activities. - The CEC and NSW TAG Indicators for Quality Use of Medicines in Australian Hospitals were used to review processes. These indicators provided quantitative data regarding the impact and effectiveness of systems, policies and procedures. Indicators from Australia Council of Health Care Standards (ACHS) provided quantitative data related to patient outcomes. Results: Together, the tools provided a comprehensive evaluation of warfarin therapy at St Vincents Private Hospital. The MSSA-AT provided a baseline measure of performance, a benchmark of practices, and numerous areas for practice improvement. The CEC’s process indicators provided a picture of current practices. This data, when benchmarked, identified strengths and opportunities and the ongoing measurement of these indicators will provide ongoing evidence of practice change. The ACHS outcomes date provided evidence that, although room for improvement, outcomes remained comparable with national data. Conclusion: Using performance indicators enabled a comprehensive review of clinical practice by providing information from a variety of sources about different aspects of therapy. This information can then facilitate the practice improvement process

Web 2.0: Experiences in teaching Quality Use of Medicines (QUM) to undergraduate nurses.

Quality Use of Medicine (QUM) means selecting management options wisely; choosing suitable medicines if a medicine is considered necessary; and using medicines safely and effectively. Even though QUM has been a key component of the national medicines policy since 1992, there is much concern that it is not widely known or understood by nurses, one of the professional groups responsible for its implementation. The challenge for nurse educators is to try and incorporate QUM into the nursing curriculum. Unfortunately, lecturers are already pressured by the insufficient time allocated for teaching pharmacology. These time pressures force students to memorise long lists of drugs, rather than allowing them to develop a framework of QUM principles that would facilitate life-long learning. Notre Dame School of Nursing Sydney has worked with the National Prescribing Service to adapt their online QUM module for use with undergraduate students. The module enables students to explore the principles of QUM in a moderated online environment, maximising valuable teaching time. The module uses LAMS (learning activity management system) a new Web 2.0 tool for designing, managing and delivering online collaborative learning activities. The module uses vignettes; forums; discussions; and student reflection to foster an environment that promotes concept construction. QUM as a concept, rather than a discreet set of knowledge or skills, benefits from this social constructivist learning approach. The online environment is not without its challenges but with planning, can be a useful adjunct for the teaching of Quality Use of Medicine

Heart failure patients' experiences of non-pharmacological self-care

Background:Heart failure self-care is important yet often sub-optimal. This literature review identifies and analyses the literature on heart failure patients' experiences of non-pharmacological self-care.Methods:The literature was searched in April 2015 using EBSCO Host. The World Health Organization (WHO) (2003) dimensions of adherence framework was used for data analysis.Results:The identified literature (14 primary articles; 4 literature reviews) was heavily weighted towards patient-related factors, namely acceptance of diagnosis, bio-behavioural variables and decision-making characteristics. Poor symptom recognition/management and the presence of comorbidities (specifically depression) were common condition-related factors highlighted as barriers to self-care. Lifestyle factors (therapy-related dimension) and professional support (health system/team dimension) were briefly described.Conclusions:This narrative literature review highlighted that heart failure self-care regimes are complex and often challenging to maintain. Further qualitative research regarding the therapy-related and health system-related factors would shed light on individual variations of and barriers to self-care

Perioperative nursing shines! Magnet designation reflected in staff engagement, empowerment and excellence

Magnet designation is the 'gold standard' recognising excellence in nursing care and outcomes. It is granted on the basis of empirical evidence across 88 criteria organised into four model components, namely: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; and New Knowledge, Innovations and Improvement. This article reports on the results from the perioperative services of the Practice Environment Scale (PES-AUS) which was conducted as part of the preparation for Magnet designation at St Vincent's Private Hospital, Sydney (SVPH), New South Wales, Australia. Results demonstrate high levels of staff engagement and satisfaction and are comparable to results from Magnet hospitals in the USA. Four brief narratives from staff provide evidence of the excellent work being done to improve patient care outcomes as well as staff safety and staff satisfaction in the perioperative services of this newly designated Magnet facility