Comparison of medication policies to guide nursing practice across seven Victorian health services

2016 ◽  
Vol 40 (5) ◽  
pp. 526 ◽  
Author(s):  
Mariann Fossum ◽  
Lee Hughes ◽  
Elizabeth Manias ◽  
Paul Bennett ◽  
Trisha Dunning ◽  
...  

Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to individual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals’ responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice; however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth Manias ◽  
Maryann Street ◽  
Grainne Lowe ◽  
Jac Kee Low ◽  
Kathleen Gray ◽  
...  

Abstract Background Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services. Methods A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken. Results There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618–0.771), or by pharmacists (OR 0.327, 95% CI 0.267–0.401), or by patients or families (OR 0.641, 95% CI 0.472–0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826–0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480–0.705) and dispensing (OR 0.350, 95% CI 0.199–0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512–4.908), movement across transitions of care (OR 1.461, 95% CI 1.190–1.793), presence of interruptions (OR 1.432, 95% CI 1.012–2.027), presence of covering personnel (OR 1.490, 95% 1.113–1.995), misread or unread orders (OR 2.411, 95% CI 2.162–2.690), informal bedside conversations (OR 1.221, 95% CI 1.085–1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136–2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors. Conclusions Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm.


2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Tatiana Varela Madureira ◽  
Maria Cristina Quintas Antunes

Background: The integration of mental health in primary health care, throughout its various functional units and with effective articulation between primary health care and mental health services, has been considered an essential objective of the legislative documents produced in the last three decades in Portugal, among them the National Health Plan 2011-2016.Goals: This study aimed to inquire health professionals’ perceptions about mental health care provided by public primary health care units, namely their perceptions about the mental health of their patients. It also intended to explore the difficulties perceived by the health professionals in their daily activity about the mental health problems of their patients and about the need of clinical psychologists’ activity in the public primary health care.Methods: This is an observational cross-sectional study with two non-probabilistic samples: health professionals (doctors, nurses and psychologists) and patients from two public health care units. Health professionals were interviewed (individual structured face-to-face interviews) about their perceptions of needs for improving their capacity to provide mental healthcare and about patients’ mental health conditions. Patients responded (by self-administration) to the Depression, Anxiety and Stress Scale (DASS-21), providing a characterization of patients’ stress, anxiety and symptoms of depression.Results: Health professionals in their daily practice often identify in their patients symptoms of stress, anxiety and depression (most particularly in adults),. Several issues were identified as problematic, such as: poor access of the referral system for psychiatric and clinical psychological specialized care, insufficient number of health professionals, particularly of psychologists, and lack of appropriate mental health care specialization. The results also revealed relevant levels of stress, anxiety and depression in primary health care patients (both genders), which seem to increase with age. Discussion: Difficulties identified by health professionals may relate to the centralisation of resources, resistance to change from human resources management, lack of consensus among the various decision groups linked to mental health and, at institutional level, insufficient and inadequate funding. These factors may contribute to a failure in early diagnosis of symptoms of depression, anxiety and stress. It is expected that articulation between primary health services and differentiated health services will improve, with improvement in teamwork among professionals and increase of the quality of life of users, satisfaction with work, from health professionals,  and reduction of health costs.


2016 ◽  
Vol 40 (4) ◽  
pp. 431 ◽  
Author(s):  
Sandra G. Leggat ◽  
Bev Phillips ◽  
Philippa Pearce ◽  
Margaret Dawson ◽  
Debbie Schulz ◽  
...  

Objectives The aim of the present study was to explore the perspectives of allied health professionals on appropriate content for effective clinical supervision of staff. Methods A set of statements regarding clinical supervision was identified from the literature and confirmed through a Q-sort process. The final set was administered as an online survey to 437 allied health professionals working in two Australian health services. Results Of the 120 respondents, 82 had experienced six or more clinical supervision sessions and were included in the analysis. Respondents suggested that clinical supervision was beneficial to both staff and patients, and was distinct from line management performance monitoring and development. Curiously, some of the respondents did not agree that observation of the supervisee’s clinical practice was an aspect of clinical supervision. Conclusions Although clinical supervision is included as a pillar of clinical governance, current practice may not be effective in addressing clinical risk. Australian health services need clear organisational policies that outline the relationship between supervisor and supervisee, the role and responsibilities of managers, the involvement of patients and the types of situations to be communicated to the line managers. What is known about the topic? Clinical supervision for allied health professionals is an essential component of clinical governance and is aimed at ensuring safe and high-quality care. However, there is varied understanding of the relationship between clinical supervision and performance management. What does this paper add? This paper provides the perspectives of allied health professionals who are experienced as supervisors or who have experienced supervision. The findings suggest a clear role for clinical supervision that needs to be better recognised within organisational policy and procedure. What are the implications for practitioners? Supervisors and supervisees must remember their duty of care and ensure compliance with organisational policies in their clinical supervisory practices.


2018 ◽  
Vol 13 (2) ◽  
pp. ii35
Author(s):  
Sarah Neil ◽  
Kylie Murphy ◽  
Glenda Chapman

The term ‘health literacy’ refers to the knowledge and skills used by an individual to make decisions about his or her own health. However, the environment in which health decisions are made is increasingly recognised as a critical component of health literacy. The health literacy environment can help to moderate the typical relationship between low individual health literacy and poor health. Becoming a more health literate healthcare organisation may require only meager financial investment for relatively large effectiveness gains. In this article, a review of Australian government health policies identifies three major foci relevant to the health literacy environment: the complexity of health services, the content of health information, and the physical environment. An overarching theme identified in this review is the importance of consumer input in evaluating all aspects of the health literacy environment. Despite major policy imperatives and the ongoing need to ensure health investments are socially equitable and cost-effective, there is little published evidence of Australian healthcare services evaluating their own health literacy environment. This article establishes the importance of evaluating the health literacy of Australian healthcare services and reviews four potentially useful evaluation tools.


2015 ◽  
Vol 5 (4) ◽  
pp. 520-521 ◽  
Author(s):  
Kiran Thapa

For two decades, Government of Nepal has made efforts to develop and maintain mental health professionals in all areas; however, much has to be done. This could be an opportunity for Nepal to redesign mental healthcare services at the community level. Primary mental health services integrated with community mental health could help children and families cope with and recover from mental illnesses in the long run.


2014 ◽  
Vol 38 (1) ◽  
pp. 93 ◽  
Author(s):  
Bruce F. Walker ◽  
Norman J. Stomski ◽  
Anne Price ◽  
Elizabeth Jackson-Barrett

Aim To identify Indigenous people’s views about gaps and practical solutions for the delivery of healthcare services in the Pilbara. Methods A structured guide was used to interview three Indigenous language groups from the Pilbara region of Western Australia. The responses were analysed with the use of content analysis. In the first stage, codes were developed by assigning names to small sections of the interview transcripts. Next, the most salient incisive codes were identified and developed into themes that captured the most important issues. Results Many respondents said that there were insufficient health professionals near country, which was compounded by a lack of adequate transport to reach healthcare services. Moreover, respondents commonly indicated that they would be unable to secure adequate accommodation for themselves and any carer when needing to leave country to undergo medical care. The importance of secondary healthcare interventions was highlighted, particularly health promotion initiatives that improved diet and exercise levels and reduced substance abuse. Assuming responsibility for one’s own health was seen as integral to improving the overall health of communities. The respondents saw role models as the most important influence in leading people to take responsibility for improving their own health. Conclusion This study provides Indigenous perspectives about gaps and solutions in healthcare service delivery in the Pilbara region of Western Australia. Although initiatives have commenced to address the shortfall in health professionals and inadequate transport to healthcare, there are still gaps in service provision. Mobile health services were strongly supported as an integral measure to address these gaps. What is known about this topic? About two out of every three Indigenous adults in the Pilbara experience a chronic health condition. Moreover, compared with non-Indigenous people in the region, Indigenous people experience a significantly higher mortality rate for numerous chronic health conditions. Although some information is available about the provision of health services for Indigenous people in the Pilbara, little is known about Indigenous people’s perspectives about its adequacy or how it should be delivered. What does this paper add? This study details three local language groups’ views about the gaps and solutions to delivery of healthcare for Indigenous people in the Pilbara. It highlights the need for secondary healthcare interventions given difficulties around providing adequate primary care in remote settings. What are the implications for practitioners? Health promotion initiatives need to be prioritised to improve the health of Australian Indigenous people in the Pilbara and the initiatives should be delivered with the involvement of the local communities. Innovative solutions are required to improve the continuity of healthcare in the Pilbara, including increased use of mobile services.


2017 ◽  
Vol 12 (1) ◽  
pp. 47-61 ◽  
Author(s):  
Maryam Sassoli ◽  
Gary Day

Objective: To better understand the inter-professional clinical communication between pharmacists, other health professionals and medication errors. Methods: This research study used a systematic literature review approach by searching online databases including Medline, PubMed and CINHAL to understand the relationship between pharmacist clinical communication and medication errors. The results of this study show that from 1158 studies that were screened and assessed, only 454 studies were initially selected after the application of inclusion and exclusion criteria. A PRISMA chart and descriptive analysis was used to present the result. Results: The results concluded that of the 18 studies, 17 showed a relationship between communication and medication errors, while only one study indicated no relationship. Thematic synthesis was used to classifythe result of the 17 studies. The result was classified into five general themes based on the literature review and similarity among the studies. Conclusions: This systematic literature review investigated the interrelationship between communication and medication errors. In regards to patient safety, the research highlights that structured communication iseffective in preventing medication errors. These errors can occur within the medication management cycle at any point of the drug distribution chain. This is due to the involvement of different health professionals, anddifferent steps in the cycle from the correct prescription through to correct administration. Thus, to effectively prevent medication errors and reduce the rate of patient harm, structured communication (verbally andnon-verbally) is highly recommended. Abbreviations: GP – General Practitioner; SLR – Systematic Literature Review


2011 ◽  
Vol 35 (3) ◽  
pp. 284 ◽  
Author(s):  
Amee Morgans ◽  
Stephen J. Burgess

Background. Investigations into ‘inappropriate’ use of emergency health services are limited by the lack of definition of what constitutes a health emergency. Position papers from Australian and international sources emphasise the patient’s right to access emergency healthcare, and the responsibility of emergency health care workers to provide treatment to all patients. However, discordance between the two perspectives remain, with literature labelling patient use of emergency health services as ‘inappropriate’. Objective. To define a ‘health emergency’ and compare patient and health professionals perspectives. Method. A sample of 600 emergency department (ED) patients were surveyed about a recent health experience and asked to rate their perceived urgency. This rating was compared to their triage score allocated at the hospital ED. Results. No significant relationship was found between the two ratings of urgency (P = 0.51). Conclusions. Differing definitions of a ‘health emergency’ may explain patient help-seeking behaviour when accessing emergency health resources including hospital ED and ambulance services. A new definition of health emergency that encapsulates the health professional and patient perspectives is proposed. An agreed definition of when emergency health resources should be used has the potential to improve emergency health services demand and patient flow issues, and optimise emergency health resource allocation. What is known about the topic? Although many patients’ access emergency healthcare services in an emergency, many patients’ access emergency healthcare services when their condition is non-urgent, and avoid using emergency health care when their condition requires. What does this paper add? This paper identifies that health professionals and patients have different perspectives on what constitutes an emergency and when emergency health resources should be used.This paper also provides a review of literature and triage policy papers that identify key differences in the assessment of a health event, and shows that health professionals base their assessment on knowledge and physiological measures, whereas patients used socio-emotional cues to identify medical urgency. What are the implications for practitioners? Practitioners cannot expect their patients to be able to accurately evaluate the urgency of a health event. An emergency is difficult to define as health conditions are dynamic, and may change in urgency over time, and relative urgency is a continuous variable, rather than a dichotomous ‘health emergency’ v. ‘not a health emergency’.


2020 ◽  
Vol 2 (2) ◽  
pp. 4
Author(s):  
Bernadett Mária Varga

Background. The rising number of the EU Roma citizens from the CEE countries, non-EU Roma citizens from the Western-Balkans, and of undocumented migrants in the European Union makes it interesting to see that most of them face barriers when accessing health services [with a European Health Insurance Card (EHIC)] or have no health coverage at all [no legal entitlement]. European migrant health policies are seemingly well structured and responsive to the needs of migrants, however, results of recent studies raise the question whether the legislations are responsive enough to the needs of the Roma and undocumented migrants when accessing health services. Given the circumstances of the Covid-19 pandemic these groups are now at an increased risk and they might not be able to understand how the virus transmits and how they can protect themselves from it.  Methods. Literature review focusing on the access to health services and migrant health policies in the EU and the UK was carried out. The target groups of this research were Roma citizens and third-country national undocumented migrants residing in the European Union. Results. In theory the legal entitlement for accessing healthcare for migrants in general is satisfactory, while in practice these groups face difficulties, such as prejudice, discrimination and other barriers (language, logistical) when approaching health services. Migrants lack trust in the health system and the healthcare professionals, and are not aware of their fundamental rights to healthcare either.  Conclusions. Legal entitlements for EU migrant citizens do not differ within EU countries but they significantly vary for undocumented migrants Europe-wide and there seems to be a mismatch between the legal entitlements for undocumented migrants in theory and their implementation in practice. Given the circumstances of the pandemic these groups are at an increased risk and therefore their health inclusion through health literacy programs should take place, as well as health workers should be trained on diversity in order to establish diversity adapted EU health systems. Seeking adaptive practices to establish cultural diversity within the healthcare settings, and introducing the universal health coverage scheme Europe-wide in order for undocumented migrants and EU citizens without employment to benefit from proper healthcare services is encouraged and necessary. 


2018 ◽  
Vol 2 (1) ◽  
pp. 56-64
Author(s):  
Hamna Rao

Today’s health workforce is constantly engaged to enhance the standards of healthcare services and ensuring comprehensive healthcare standards to the community. Queensland’s health workforce is Australia’s second largest health workforce (1) and serving proportionately in all areas of QLD, making efforts to make health better by making research, surveys and developmental planning in rural and regional areas. Aged Care is currently the most concerned health issue among OECD countries (2) as aged population continues to grow and it’s challenging for Australian health sector to meet the standards of quality care in provision of aged care health services. As per Australian Institute of Health and Welfare statistics it is projected that Australia will constitute 22% of aged population in next 30 years (AIHW).


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