A discussion on the legal barriers in addressing sleeping disorders in aged care using wireless technology

[Abstract]: Disturbed sleep can affect personal well being. In the case of old people, disturbed sleep will impede recovery from any illness. Therefore, sleep quality is an essential ingredient for well being. While previous studies have provided a number of solutions based on clinical trials, it appears that 'technology' solutions are not yet caught up with the problems of sleeping specific to aged care. This 'research in progress' paper provides a conceptual model of how wireless technology solutions can provide answers to some of the monitoring problems of sleeping disorders. Based on the review conducted by the JBI on sleep research, this paper provides guidelines to future research. The paper also provides current status of regulatory issues that may affect the uptake of wireless solutions in this domain

Drivers for wireless handheld technology: views from Queensland nurses

[Abstract]: The use of wireless hand held devices is becoming popular in healthcare due to its flexibility and mobility. In the nursing domain, the use of handheld devices, a specific component of wireles technology appears to be beneficial for data collection and other information management functions nurses may undertake. Studies in nursing literature have indicated that handheld devices deliver advantages and benefits at the point of care. In this study a set of 30 interviews with Queensland Nursing Staff in one district health centre was conducted over a period of three months to establish the drivers for the introduction of wireless technology among nurses. The outcome of these interviews is developed into a preliminary model and reported in this paper

Digital skills in healthcare practice

The healthcare industry is rapidly evolving in tandem with a demand for increased flexibility in the delivery of education in our fast-paced society. As a result, the passive reception of content by students, delivered by an expert from the front of the class, is becoming increasingly redundant. Students are now being taught, ubiquitous connectivity allowing widespread access to online materials (Collier, Gray, & Ahn, 2011). Programs such as nursing are often offered in an external, online delivery mode (Wright, 2013). Due to an increasingly aging population, healthcare is by far one of the fastest-growing industries, and graduate job seekers choosing to enter healthcare, will need to ensure they have developed sound digital literacies, particularly as they apply to professional communication. It is imperative that students develop and leverage emerging communication technologies as part of their portfolio prior to seeking employment (Clark, 2009; Hargittai & Litt, 2013)

Assessment and non-pharmacological management among adults with a dementia diagnosis in a residential care setting: a best practice implementation project

Background This evidence implementation project reports on a project conducted in the 17 bed special care unit of Symes Thorpe Residential Facility in Queensland that focused on improving assessment and management of elderly residents diagnosed with dementia. The motivation for the project, and its value, should be understood in the context of a lack of validated tool or standardized documentation being used to assess behaviors of residents diagnosed with dementia as well as little targeted education being provided to staff on behaviour management strategies. Objectives To promote evidence based assessment and non-pharmacological management of challenging behavior in elderly adults living with dementia in a residential setting in Queensland. Methods The project design was based on the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit of care documentation in the 17 residents in the special care unit was conducted. Meetings were held with the project team to reflect on the findings of the baseline audit and plan strategies to improve practice. A validated tool, the 'Cohen-Mansfield Agitation inventory', was introduced to improve assessment of patients together with a program of staff education to inform the use of the Inventory. A staff education program was introduced to improve staff awareness and use of strategies for behaviour management of residents in the special care unit. Two follow up audits were conducted. The second audit was undertaken 3 months post introduction of the Cohen Mansfield Agitation Inventory and staff education program. Results The follow up audits demonstrated 100% compliance of usage of the Cohen Mansfield agitation inventory and 100% staff attendance at education sessions. The audit also showed significant increase and improvement in quality of related resident care documentation e.g. documenting outcomes of use of non-pharmacological therapy such as music, exercise, pets etc. Conclusions The findings show that a comprehensive education program can make an effective contribution to the understanding of challenging behaviours in dementia residents, and the associated documentation required to monitor them effectively

Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol

Introduction There is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment. Methods and analysis The review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and 'qualitised' quantitative data. Ethics and dissemination No ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations

Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol

Introduction: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that causes persistent respiratory symptoms and decline in lung function over many years. This chronic disease significantly affects health-related quality of life and is known to contribute to frequent emergency department (ED) presentations. Multidimensional management of these patients, including interconnecting health disciplinarians will allow holistic care provision in the ED. The purpose of this scoping review is to synthesise current evidence on holistic management and assessment, and referral practices stemming from acute COPD presentation in the ED. Specifically, to determine: (1) What are the known causal factors associated with COPD ED presentations and (2) Is there an identified connection with appropriate healthcare professional assessment within ED presentations and reported referral pathways? Methods and analysis The iterative stages of the Arskey and O'Malley, and Levac advanced scoping review framework informs this review. Using published and unpublished studies in English, a three-tiered search strategy will be applied. After duplicates are removed, screen 1 (title and abstract) and screen 2 (full-text) will be conducted by two independent reviewers to determine eligibility of articles. Disputes will be settled through discussion or by using a third reviewer. A data collection tool developed by the authors will inform the data extraction process. Schematic tabular format of results with a narrative summary will depict how the results link with the scoping review objectives. Categorisation of results will be narrowed down as key conceptual findings and will align with the strategic intent of this review. Ethics and dissemination Ethics approval was not required for this study. A multidisciplinary team of authors will participate in dissemination activities (publications, reports, conference presentations, framework development)

Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol

Introduction Multifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families. Methods and analysis This protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations

Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review

Background: COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency. Materials and Methods: This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations. Results: Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over-or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance. Conclusion: Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance

ACCERT: aged care community education research training

Objectives: The ACCERT project has undertaken a Clinical Risk Audit within Anglicare Southern Queensland (ASQ) with the intent of identifying gaps in client or resident care standards. Audit data was mapped across existing (ASQ) risk data resulting in a Clinical Risk Register and a Research Priorities Register. Using these 2 Registers six Evidence Utilisation Projects were prioritised using integrated risk management weightings, based on actual and potential risk. Anglicare then identified from its workforce six Research Champions (Research Fellows) that would focus on one of the six research utilisation projects. These staff were drawn from the EN-RN and Allied Health disciplines, and were selected based on two criteria – being self-motivated and having a desire for further education and learning as part of their own career development. They were selected jointly by the ASQ and USQ TRACS project team. Topics chosen for implementation will include sleep screening using wrist actigraphy, falls risk screening in the home, polypharmacy screening in the community, and nutritional risk screening in the community. Methods: During the implementation phase of the six research fellow (Evidence Utilisation Projects) the ACCERT project team will undertake qualitative research assessment on staff perceptions of research utilisation practice and evidence based practice ascertaining the facilitators and barriers to change. Concurrently a PhD candidate will undertake qualitative research assessment on clinical care staff perceptions of leadership and its influence in the clinical learning environment of aged care facilities with ASQ. Conclusion: In 2014, the ACCERT team aim to establish an Evidence Utilisation Centre, part of which will involve developing frameworks that will utilise clinical audit findings as a to prioritise future research utilisation projects. The sole aim will be to leave ASQ with a positive research utilisation culture and a central hub of skilled research staff that can champion further change