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Nursing In Australia

Yearbook

2011 edition

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Contents

Published by

executive Media Pty Ltd ABN 30 007 224 204 430 William Street Melbourne VIC 3000 Phone: +61 3 9274 4200 Fax: +61 3 9329 5295 Email: media@executivemedia.com.au Website: www.executivemedia.com.au

Contents

2011

best Practice 2

Australian Safety and Quality Framework for the healthcare team

Medication Safety 6

New robotic pharmacy to improve patient safety

8

Computerised alerts enhance medication safety

education + Training 10

Attracting new grads to aged care

12

Major research centre announced

14

Taking off the nursing glasses

16

The next generation

Complementary Medicines 18

Local complementary medicines best option

aged Care 19

Pathways in aged care

22

Hip fracture rates declining

Children’s Health

The editor, publisher, printer and their staff and agents are not responsible for the accuracy or correctness of the text of contributions contained in this publication or for the consequences of any use made of the products, and the information referred to in this publication. The editor, publisher, printer and their staff and agents expressly disclaim all liability of whatsoever nature for any consequences arising from any errors or omissions contained in this publication whether caused to a purchaser of this publication or otherwise. The views expressed in the articles and other material published herein do not necessarily reflect the views of the editor and publisher or their staff or agents. The responsibility for the accuracy of information is that of the individual contributors and neither the publisher or editor can accept responsibility for the accuracy of information which is supplied by others. It is impossible for the publisher and editors to ensure that the advertisements and other material herein comply with the Trade Practices Act 1974 (Cth). Readers should make their own inquiries in making any decisions, and where necessary, seek professional advice. © 2011 Executive Media Pty Ltd. All rights reserved. Reproduction in whole or part, without written permission is strictly prohibited.

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P.A.R.T.Y program opening young eyes

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New hope for childhood cancer

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ADHD medication safe for kids’ hearts

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Repeated stress in pregnancy linked to children’s behaviour

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Australian safety and Quality Framework for the healthcare team

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he Australian Safety and Quality Framework for Health Care describes a vision for safe and high-quality care for all Australians, and sets out the actions needed to achieve this vision. The Framework specifies three core principles for safe and high-quality care. These are that care is consumer-centred, driven by information, and organised for safety.

InCreaSe HeaLTH LITeraCY, and ParTner wITH PaTIenTS, faMILIeS and CarerS To SHare deCISIon-MakIng abouT THeIr Care Consumers have told us that it is important for them to participate in decision making processes about their health so that they can make an informed decision about their care. At the same time, members of the healthcare team are fully aware of the requirements for informed patient consent and are looking for ways to improve the involvement of patients, families and carers in decision-making.

Making decisions about treatment and screening where there are a number of options to choose from is not easy. The technical nature of this information, and concepts such as relative risk, can be unfamiliar to patients and families. In addition, the volume of information required can sometimes be overwhelming. The use of written material to provide information about particular procedures or treatments is now well-established but tends to be generally used after a decision about treatment has been made. Patient decision aids are evidence-based tools that help people become involved in decision-making by providing information about the options and outcomes and by clarifying personal values. The largest and most consistent benefits of patient decision aids, relative to usual care, are better knowledge of options and outcomes and more accurate perceptions of outcome probabilities. Patient decision aids may be videos, booklets, or websites that prepare patients for decision-making by providing them with information about treatment and screening options, and outcomes relevant to their health. They help patients consider the possible benefits and harms in an unbiased way so that they can make choices about their health care which fit with their personal values and preferences. Clinicians can use these with their patients in consultations, in addition to routine clinical counselling. as a member of a healthcare team, you should: 1. Be aware of the availability of patient decision aids relevant to your areas of practice. 2. Determine which patient decision aids you will use in your practice. 3. Make sure that you plan the timing of discussions with your patients, families and carers to make the best use of the patient decision aids. Patient decision aids can particularly help patients with low education levels and low literacy to take a more active role in their care. You should have an understanding of the education and literacy levels of your patients. This will support more effective use of patient decision aids.

ProvIde Care THaT reSPeCTS and IS SenSITIve To dIfferenT CuLTureS Consumers tell us that a fundamental aspect of consumer-centred care is their capacity to understand the information that is being given to them and the healthcare worker’s capacity to understand the questions and concerns of each patient and family member. The basic requirement for effective and respectful communication is to provide information that makes sense to a patient in the context of their cultural background in a language that they can understand. Proficiency in everyday, conversational English does not mean that a person necessarily has the capacity to understand more clinical or technical terms when English is used. Each patient’s clinical situation will vary and while pre-prepared information translated into different languages can be a valuable tool to assist with communication, the need for a dynamic, interpreter-supported conversation will remain. Although use of interpreters is straightforward in concept, it is well recognised that timely availability of interpreters to simplify this two-way communication in healthcare is difficult to achieve for a wide variety of reasons. Clinicians should use translated information about routine clinical and administrative matters as well as using interpreters for more specific discussions. In order for any clinician to communicate effectively and appropriately with their patients, it is important that they understand the cultural norms and language needs of their particular patient population. All clinicians should make use of training opportunities to understand the cultural beliefs

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of the most common cultural groups in their patient population and also be aware of their own cultural assumptions. as a member of a healthcare team, you should: 1. Regularly check with your patient that they understand the information you are providing to them, particularly where there may be technical or complex information relevant to choices about treatment. 2. Be aware of how to organise an interpreter in your service and be able to find alternatives if an interpreter is not available. 3. Be aware of and respect the cultural beliefs held by the patients you treat. In addition, you should take the opportunity to explore the underlying cultural assumptions within your healthcare team and consider how these might differ from those of your most common patient groups.

IMProve ConTInuITY of Care Health consumers are particularly conscious of the need to have continuity of care as they traverse the healthcare system. This continuity of care for patients must apply within a healthcare team as well as between any team and other health professionals. Healthcare delivery is increasingly complex and multidisciplinary and all professionals are now working within teams of their own professions as well as with colleagues from other disciplines. The recording of accurate, complete and timely information about a patient is more important than ever in ensuring that the correct treatment is continued by all health professionals. This information should be accompanied by an up-to-date plan of intended treatment that is available wherever and whenever a patient is seen by a health professional. Clinicians should be conscious of, and use, current and evolving communication mechanisms including paper-based and electronic medical records, and handover and transfer documentation, as well as working with patients to make sure they have sufficient information and understanding of their treatment to be able to effectively participate in maintaining the continuity of their own care. as a member of a healthcare team, you should: 1. Make sure that you regularly and accurately update the clinical record and intended treatment plan of all patients with whose treatment you are involved.

handover communication. This Program involved more than 30 hospitals across Australia, as well as primary health and aged care services, and has resulted in the development and piloting of a number of practical, structured tools for improving clinical handover. These include protocols and support material for improving shift change handover, tools for transfers between facilities, and materials on team communication. These tools were accepted for use in Australia’s hospitals by Health Ministers in April 2010. as a member of a healthcare team, you should: 1. Be aware of, and always use, the agreed handover protocol for your organisation. 2. Make sure that clinical handover protocols are used when patients are transferred between services. These transfers may include referrals from GPs to specialists or other primary healthcare practitioners, transfers between hospitals, and discharges from hospitals to primary health and community services. 3. Involve patients, families and carers in handover where possible and appropriate. This has the effect of increasing the involvement of patients in their care and can bring safety and quality benefits.

uSe agreed guIdeLIneS To reduCe InaPProPrIaTe varIaTIon In THe deLIverY of Care Clinical care for individual patients is ideally a product of best available evidence for the treatment of a particular diagnosis, matched and adapted to suit the clinical circumstances of a particular patient. The increasing development of clinical guidelines, standards and protocols has greatly assisted in the delineation of good, evidence-based practice, but has also created a new challenge for clinicians: that of knowing when and how to tailor this guidance for a particular individual. Inappropriate variation in care (for example, where care is based solely on clinician preference without consideration of current agreed practice) is a well-recognised cause of poor quality and increased numbers of adverse events. At the same time, the wide variety of overlapping, and occasionally contradictory, guides add further uncertainty to the choices facing clinicians in the practice of their profession. Complexity also emerges from the fact that many patients have multiple

2. Be able to effectively use the electronic and paper-based clinical systems in your organisation. 3. Work with patients to make sure they have sufficient information and understanding of their treatment to be able to participate in maintaining the continuity of their own care.

MInIMISe rISkS aT Handover For most patients, modern healthcare requires the involvement of multiple health practitioners in their care. This can be within a particular health service or across different services and sectors. Patients and consumers tell us that one of the most important things to them is that each health practitioner they see is aware of their history and their treatment plan. Lack of this information causes considerable anxiety and frustration on the part of the patient and the health practitioner as well as being a recognised cause of delays in appropriate treatment, the unnecessary duplication of investigations, and even the provision of inappropriate care. Clinical handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis. Clinical handovers occur at shift change, when patients are transferred between health services or wards, as well as during admission, referral or discharge. Millions of clinical handovers occur annually in Australia and this is therefore a high risk area for patient safety with consequences that can be serious. In 2007, the Australian Commission on Safety and Quality in Health Care established the National Clinical Handover Pilot Program to improve

diagnoses and, therefore, a number of guidelines and standards may be applicable simultaneously. Clinicians can reduce the confusion and risk associated with this complex situation by consciously choosing a set of wellconstructed clinical guidelines to use consistently within their own areas of practice, and by participating in decisions about the agreed guidelines to be used by any healthcare team in which they work. as a member of a healthcare team, you should: 1. Adopt clinical guidelines that you will use consistently within your own area of practice. These can be adapted for your practice and tailored to the needs of individual patients. 2. Make sure that these guidelines are consistent with the clinical guidelines used by any clinical team of which you are a member. 3. Feed back your own experience of using clinical guidelines into any organisational or professional review process, and adopt new nursing in AustrAliA Yearbook 2011

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information as it becomes available. Consistent application of wellevidenced clinical guidelines is a part of high-quality, safe clinical practice.

CoLLeCTIng and anaLYSIng SafeTY and quaLITY daTa To IMProve Care, and Learn froM PaTIenTS’ and CarerS’ exPerIenCeS An essential part of improving the safety and quality of care provided to patients is the gathering, analysis and use of information regarding clinical performance across the organisation. This information can be in the form of data about operational performance, clinical outcomes, and the experience of patients receiving care.

enCourage and aPPLY reSearCH THaT wILL IMProve SafeTY and quaLITY Research about safety and quality issues provides the foundation for evidence-based processes of care, identifies the changes required to improve clinical practice and health outcomes, and helps to reduce risks and harm associated with the delivery of care. Safety and quality research is a rapidly developing field, with several journals specifically focused on this topic. With the existence of improved processes for disseminating and obtaining access to research results and papers, it is getting easier for clinicians to access this information. as a member of a healthcare team, you should: 1. Be aware of, and regularly check, the key sources of safety and quality research results. 2. Discuss research findings with colleagues and reflect on how they apply to your clinical practice. You should incorporate these results not only in your own practice but also in the practices of the broader clinical teams you are involved in. 3. Include discussion of safety and quality matters in any routine continuing education and peer review activities in which you participate. You should also look for opportunities to be involved in structured processes of quality improvement, as well as research activity within and outside your organisation.

HeaLTH ProfeSSIonaLS Take aCTIon for SafeTY, and Take aCTIon To PrevenT or MInIMISe HarM froM HeaLTHCare errorS

All healthcare organisations should have a clearly defined set of safety and quality information that is gathered and consolidated into meaningful indicators for clinicians, managers and the executive. Clinicians play a vital role in this process by accurately recording information, encouraging patients and families to express their views, and participating in the process of discussion and analysis at the local level. as a member of a healthcare team, you should: 1. Participate in the gathering and analysis of safety and quality information within your organisation. This may include providing clinical or other performance data as part of routine data collection or audit processes. 2. Support and encourage patients and families to make their views and experiences known. This may include supporting them to make a comment or complaint, or encouraging them to participate in more formal feedback mechanisms such as patient surveys. 3. Review any information provided to you about the safety and quality of the care provided by you, and your healthcare team. This includes reflecting on your own performance, and identifying where changes and improvements can be made. You also need to take action to ensure that the improvements in care identified from these processes are put into practice. To facilitate your use of safety and quality data, you should develop an understanding of the ways in which this information is presented. This may require some understanding of graphical representation of data such as statistical process control charts, which have been shown to be effective in illustrating performance over time and identifying changes that are significant.

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For the majority of occasions where a patient is harmed, the harm is related to the clinical care they have received. All clinicians should act immediately to keep patients safe when they recognise that a patient safety incident has happened or is at risk of happening. It is also critical to report adverse events and the circumstances surrounding the incident so that the organisation can learn from the incident, and take steps to prevent it from happening again. Reporting ‘near misses’ is also important to help understand how to avoid future incidents from occurring. Reports of these events need to be analysed to identify actions that can be taken to change the process of care to prevent future patient harm. In the most serious cases where harm has occurred, a structured process, such as a root cause analysis, should be used to identify the key issues and remedy the causes. as a member of a healthcare team, you should: 1. Be aware of and follow the processes for reporting patient incidents and near misses in your organisation. 2. Take direct action to reduce or prevent risks of patient harm that you recognise during your clinical or other work. This may include speaking up in an operating theatre if you are unsure that the right procedure is to be performed on the right patient, or contacting a GP if you are unsure about the accuracy of a prescription you may be dispensing. 3. Participate in the ongoing analysis of adverse patient events. You should also take an active role in adopting recommendations for change that come from incident analysis and other investigations into healthcare errors. In addition, you should follow the policies, procedures and protocols that have been developed in your organisation to support the provision of safe and high-quality care. These policies and protocols may cover areas such as patient identification, hand hygiene, falls prevention, medication safety, and clinical handover.

This is an edited version of Putting the Framework into Action: Getting Started - Activities for the Healthcare Team, prepared by the Australian Commission on Safety and Quality in HealthCare. This document and other information about the Framework can be found at www.safetyandquality.com.au

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system for our centres is transferring to a single unit dose packaging system. research confirm that this mode of packaging is much incidents in aged care. 2. Deliveries from the pharmacy to the centre will occur each week and there will be no need to carry stock as the system improves stock control. As is the case now, urgent items will be handled on the day.

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MediCation safetY

new robotic pharmacy to improve patient safety by karin rush-Monroe

Robotic pill picker and plastic bags for medications

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lthough it won’t be obvious to the United States’ UCSF Medical Center patients, behind the scenes a family of giant robots now counts and processes their medications. With a new automated hospital pharmacy, believed to be the nation’s most comprehensive, UCSF is using robotic technology and electronics to prepare and track medications with the goal of improving patient safety. Not a single error has occurred in the 350,000 doses of medication prepared during the system’s recent phase-in. The robots tower over humans, both in size and ability to deliver medications accurately. Housed in a tightly secured, sterile environment, the automated system prepares oral and injectable medicines, including toxic chemotherapy drugs. In addition to providing a safer environment for pharmacy employees, the automation also frees UCSF pharmacists and nurses to focus more of their expertise on direct patient care.

InTegraTed Care The new pharmacy is the hub of UCSF’s integrated medication management system, which combines state-of-the-art technology with personalised care. ‘The automated pharmacy streamlines medication delivery from prescription to patient,’ said Lynn Paulsen, PharmD, Director of Pharmaceutical Services at UCSF Medical Center. ‘It was important to develop a system that is integrated from end to end. Each step in safe, effective medication therapy – from determining

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the most appropriate drug for an individual patient to administering it – is contingent on the other.’ The new pharmacy currently serves UCSF hospitals at Parnassus and Mount Zion and has the capacity to dispense medications for the new UCSF Medical Center at Mission Bay, San Francisco, scheduled to open in 2014. As the phase-in continues, additional steps in the process will be eliminated as doctors begin inputting prescriptions directly into computers in 2012. ‘We are intent on finding new ways to improve the quality and safety of our care, while increasing patient satisfaction,’ said Mark Laret, CEO, UCSF Medical Center and UCSF Benioff Children’s Hospital. ‘The automated pharmacy helps us achieve that and at the same time, advance our mission as a leading teaching hospital and research institution.’ Studies have shown that technology, including barcoding and computerised physician entry, as well as changes in hospital processes for medication management, can help reduce errors. The pharmacy also will enable UCSF to study new ways of medication delivery with the goal of sharing that knowledge with other hospitals across the United States.

auToMaTIon aT work Once computers at the new pharmacy electronically receive medication orders from UCSF physicians and pharmacists, the robotics pick, package, and dispense individual doses of pills. Machines assemble doses onto a thin plastic ring that contains all the medications for a patient for a 12-hour

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period, which is bar-coded. This year, nurses at UCSF Medical Center will begin to use barcode readers to scan the medication at patients’ bedsides, verifying it is the correct dosage for the patient. The automated system also compounds sterile preparations of chemotherapy and non-chemotherapy doses and fills IV syringes or bags with the medications. An automated inventory management system keeps track of all the products, and one refrigerated and two non-refrigerated automated pharmacy warehouses provide storage and retrieval of medications and supplies. By using robots instead of people for previous manual tasks, pharmacists and nurses will have more time to work with physicians to determine the best drug therapy for a patient, and to monitor patients for clinical response and adverse drug reactions.

eduCaTIng THe nexT generaTIon In addition, the new pharmacy offers a rich training ground for pharmacy students in the medication distribution systems of the future. ‘UCSF led the way in training clinical pharmacists, who focus on the patient rather than the drug product,’ said Mary Anne Koda-Kimble, PharmD, Dean of the UCSF School of Pharmacy. ‘Automated medication dispensing frees pharmacists from the mechanical aspects of the practice. This technology, with others, will allow pharmacists to use their pharmaceutical care expertise to assure that patients are treated with medicines tailored to their individual needs.’

Medications selected by the pill picker drop into a drawer.

UCSF Automated Pharmacy Streamlines Hospital Medication Path of a prescription: Standard vs. Automated Pharmaceutical Process

STANDARD PROCESS

1

Doctor writes prescription.

2

Hospital clerk scans/faxes prescription to pharmacist.

3

Pharmacist inputs into computer.

3

Pharmacist inputs into computer.

4

Technician processes and fills prescription order.

5

Pharmacist checks for correct medication.

6

Nurse checks medication and administers to patient.

5

Nurse scans barcode* and administers medication to patient. (Fall 2011)

AUTOMATED PROCESS

1

Doctor writes prescription.

2

Hospital clerk scans/faxes prescription to pharmacist.

SPRING 2012

1

4

Robots select barcoded drugs and fill prescription order.

Doctor enters prescription into computer.

Graphic by Olivia Nguyen

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MediCation safetY

Computerised alerts enhance medication safety

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he Australian Commission on Safety and Quality in Health Care makes available a range of medication safety alerts released by itself, Australian states and territories and by international medication safety organisations. The aim of alerts is to warn healthcare professionals about serious known medication risks, outline the action required to minimise risks and provide the tools to do so. A recent example is a New South Wales Health Safety Notice about a number of serious incidents involving hydromorphone. Some of the incidents

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resulted in death, and the majority involved administration errors. These include confusion between the names and preparations of hydromorphone and morphine, poor understanding that hydromorphone is five times more potent than morphine, both oral and injectable hydromorphone solutions may increase the risk of product selection error during the administration process, and the complex calculations required.

MedICaTIon aLerTS Recently, a patient was inadvertently administered 125 mg of intravenous injection (IVI) rather than the 25 mg dose intended due to the abbreviation IVI being misread as IV1. The abbreviation IVI for intravenous injection has since been listed as an error-prone abbreviation, which should be avoided. In recent months there have been at least 15 incidents involving confusion between Coumadin (5 mg) and Coversyl (5 mg and 10 mg) tablets. In each instance the patient was dispensed the wrong medication. Some of the incidents were serious, and resulted in the patient being admitted to hospital. The confusion arises because these products look very similar; both come in 5 mg strengths and have similar trade names and packaging. The risk of confusion increases when the medications are stored next to each other, such as when stored alphabetically by brand name. A change in packaging of Coversyl is currently being expedited through the Therapeutic Goods Administration, but this change may take some time to reach the point of care, highlighting the importance that nurses and health professionals are vigilant in reducing the risk of the wrong medication being supplied. Actions that can be taken to reduce this risk include: storing medications in a way that will reduce the risk of selecting the wrong product, checking the correct product has been dispensed for the correct patient by scanning with a barcode reader before dispensing, performing a final check of the product against the prescription when handing the medicine to the patient, and ensuring that caution is taken when stocking shelves – ideally a double check, or use of barcode scanning, should be used to verify that the correct product is being stocked. Overseas, researchers at the University of Pennsylvania School of Medication in the United States have found that errors are responsible for a large number of adverse drug events in patients each year, and the use of medication-related abbreviations accounts for nearly five per cent of these errors. Strategies to reduce the use of problematic abbreviations, which can lead to overdose or incorrect or missed medications because of staff misinterpretation, have largely focused on education, primarily a ‘do not use’ list of abbreviations produced by professional and regulatory bodies. However, the research found there has generally been poor compliance by hospital staff with this practice. In a study published in JAMIA, the journal of the American Medical Informatics Association, Jennifer S. Myers, MD, patient safety officer of the Hospital of the University of Pennsylvania, and her colleagues found that computerised alerts inserted within an electronic progress note program could reduce the use of these abbreviations, ultimately enhancing patient safety. Some examples of problematic abbreviations include: • IU (for international unit), possibly mistaken as IV (intravenous) or 10. • µg (for microgram), possibly mistaken for mg (milligrams), resulting

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in a one thousand-fold dosing overdose. • D/C (for discharge), possibly interpreted as ‘discontinue whatever medications follow’ (typically discharge medications). • MS, could mean either morphine sulfate or magnesium sulfate. In the study, 59 Pennsylvania School of Medicine interns were randomised to one of three groups: a forced correction alert group, an autocorrection alert group, or a group that received no alerts. In the first (or forced correction alert group) an alert identified the unapproved abbreviation, informed interns of the correct non-abbreviated notation, and forced them to correct the abbreviation before allowing them to save or print their note. For example, when the physician attempted to type in ‘QD’ (relying on a customary, but non-intuitive, abbreviation for ‘daily’), the pop-up precluded the term from being entered and instead directed the physician to ‘use “daily” instead.’ In the second (or auto-correction alert group) physicians received an alert when an unapproved abbreviation was entered, but instead of forcing the interns to make a correction, an auto-correction feature displayed the correction and automatically replaced the abbreviation with the acceptable non-abbreviated notation. Group three was a control group and received no alerts. Over time, physicians in all three groups significantly reduced their use of the problem abbreviations as measured by frequency of electronic alerts triggered and within subsequent handwritten notes. Alerts with the forced correction feature lowered the use of abbreviations to a much greater extent than alerts with an auto-correction feature.  ‘It may be that forcing physicians to correct abbreviations themselves, as opposed to having it automatically done for them, better solidifies their knowledge of these banned abbreviations,’ said Ms Myers. An unanticipated finding was that reductions in abbreviation use were observed in the control group. Even though they were not directly exposed to alerts, their behavior may have been influenced by the improving

MediCation safetY

In recent months there have been at least 15 incidents involving confusion between Coumadin (5 mg) and Coversyl (5 mg and 10 mg) tablets. In each instance the patient was dispensed the wrong medication.

documentation patterns of the interns exposed to the intervention who worked with them. ‘Eliminating error-prone medication abbreviations has been extremely challenging for hospitals, and there are few effective strategies in the literature for addressing it,’ said Myers. ‘Given the strong association between abbreviation use and medication errors, it’s vital for healthcare leaders to consider multiple strategies, including the alerts we tested, as effective additions to medical education and training.’

This textbook provides nurses with the relevant knowledge and skills that are integral to safe medication administration.

Medication Administration for Nurses $ 65.00 Julie Bowen, DÏanna King and Deborah Smith Community Services, Health, Tourism and Recreation Curriculum Centre, TAFE NSW, 2008. 245 x 170mm 368pp. Available through ITSA Bookshop itsashop@shoal.net.au ISBN 978-0-73489-028-3 316096AE_TAFE NSW | 1695.indd 1

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The user friendly text provides insight into legal responsibilities, pharmacokinetics, pharmacodynamics and factors influencing modes of medication administration. Medication use, major drug groups and relevant technology are also discussed. The text provides learning activities, key alerts and critical thinking exercises including medication calculation exercises and answers. In an easy to read format the text supports the development of competent practice in the clinical context. 3/15/11 10:07 AM

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eduCation + training

Attracting new grads to aged care

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ew grads entering the nursing profession are finding new opportunities in the aged care sector in rural areas. It’s no secret that Australia is facing a shortage of nurses in aged care and is increasingly unable to meet the needs of a rapidly ageing population. ‘Wage disparity has led to a staffing crisis. Ignoring this issue means the problem of attracting nurses and assistants in nursing to aged care will continue long into the future,’ said ANF Federal Secretary Lee Thomas. Under current policy, the demand for aged care services is unable to keep up with its supply. Cracks in the system will most likely begin to show by 2012, according to an Access Economics’ report called ‘Caring Places, Volume 2’ and the draft Productivity Commission report. The report says that dementia-related illness will become more prevalent and will begin to put a strain on the aged care sector. Aged care nurses, qualified and ready, are needed now more than ever.

the hope of attracting new blood into the sector. Aged Care Services (ACS), an industrial organisation of employers of aged care and community care providers in the not-for-profit and charitable sector, offers a one-day course for RNs designed to assist them entering into the aged care sector. There has been a growing demand for this course, particularly in rural areas. ‘We run courses in 10 regional areas from the far west to the far south coast and this course usually receives a lot of interest,’ said Margaret Bundred, Learning Centre Manager at ACS. The course looks at various components of aged care: the changing environment of aged care and how RNs need to adopt solutions to adhere to these changes; scope of practice principle - which looks at what other members of the care team, such as ENs and EENs, can do so that RNs don’t burn out; leadership supervision and delegation; responsibility and accountability; and the comprehensive assessment of an aged care client.

eMPLoYerS Look for InCenTIveS

CourSeS and InCenTIveS To aTTraCT nurSeS

Aged care employers are beginning to feel this strain with low wages and working conditions making recruitment of younger nurses and recently graduating nurses into the sector, particularly in rural areas, a challenge. ‘Aged care is not sexy. It is becoming more difficult to attract younger nurses to rural areas as they seek opportunities in big cities. It’s essential that RNs remain in aged care mainly due to our diagnostic skills,’ said Penny Temple, RN, General Manager Horton House and Warmington Lodge in Yass. Not-for-profit and for-profit aged care employers in rural areas wanting to nip this problem in the bud are offering recruitment incentives to RNs in

Lyn Jones, an aged care RN at Horton House and Warmington Lodge in Yass, said it is difficult to recruit RNs to rural facilities due to the low pay scale, but courses like the one offered by ACS do prepare RNs to meet the growing expectations of the communities they live in and the ever-increasing challenges of the sector. ‘Due to the shortage of RNs in aged care, we have to increase delegation and strong team work with ENs, AINs, and PC staff. The course was excellent in teaching us about competencies and finding the right skill mix for staff,’ said Ms Jones ‘There’s a big demand for this course in aged care, so it was also an

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opportunity for some of the newer RNs to attend this course and get a skills upgrade,’ she said. Horton House and Warmington Lodge, a community-based, not-for-profit facility, is trying to attract younger nurses, as its core group of dedicated RNs is getting older. Ms Temple said that, along with her board of directors, she decided to take matters into her own hands to address this issue. They now offer a $5000 scholarship to second-year student nurses through Australian Catholic University. The main criteria to qualify for the scholarship are having aged care as an elective and passing all subjects. Nurses, upon receiving their Bachelor’s Degree in Nursing, would work for the facility for 12 months. They would be offered a full-time appointment and accommodation. ‘Our first recipient has just gone into third year. We hope we have an ongoing supply of younger and highly qualified nurses. It’s our way of trying to promote aged care as an option for younger nurses in rural areas,’ said Ms Temple. ‘One of the problems with aged care is that we don’t have wage parity. If we had that, we would be able to attract and retain nurses,’ she said.

…dementia-related illness will become more prevalent and will begin to put a strain on the aged care sector.

deveLoPIng exISTIng STaff BUPA also offers a Graduate Nurse Program that places newly registered nurses into BUPA facilities around the country as part of their training. The program, run in conjunction with The College of Nursing, is designed to attract recent graduate nurses to the aged care industry, giving them hands-on clinical exposure as well as professional development sessions. Into its second year, the program started with 20 nurses who had just

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completed their Bachelor’s Degree in Nursing in aged care. Margaret Ryan, the Learning and Development Manager for BUPA, agrees there is a need for new blood in the sector but also saw it as an opportunity to develop existing staff. ‘About four participants in the program were existing staff members who had worked as AINs. They were looking for those opportunities in aged care to progress and develop their leadership skills.’

CoMPreHenSIve rn TraInIng

Chesalon Care Beecroft, a not-for-profit residential aged care facility, offers an informal graduate program, which manager Sharon Cumming is hoping to formalise. ‘We’ve had three recent graduates in the past 12 months we’ve been training. They’ve taken to the profession like ducks to water and are performing really well. Two out of the three have stayed on to work for us,’ she said. The program at Chesalon Beecroft consists of initially partnering up recent grads with more experienced nurses until they’re ready to work independently. Sharon considers the combination of clinical, counselling, palliative and management skills that working at an aged care facility offers as a winning combination for the comprehensive training of RNs. The program has been so successful for Chesalon Beecroft in terms of recruitment and retention of young RNs into the profession that Sharon now places in their job ads: ‘Graduates will be supported’.

This article reproduced courtesy of The Lamp magazine.

Competencies On-Line Turrell Multimedia are a provider of e-learning solutions to many Australian Hospitals via it’s Competencies OnLine Acute and Aged Care web sites. Here RN’s , EN’s and carers can complete online competency tests either from home or work in the areas of Medication Calculations, Basic Life Support, Advanced Life Support, Use of AED’s, MET, Manual Handling, Infection Control, Fire Safety, OHS. New Aged care focused topics include Falls Prevention, Infection Control, Dysphagia, Diabetes including Blood Glucose Monitoring, Safety on Home Visits and Challenging Behaviour incorporating Dementia. New acute care topics for 2011 will include ECG Interpretation and Emergency Drugs. A full on-line CPD portfolio can be kept by each nurse which can also include any face to face training they have completed in the last 12 months. Staff are challenged by the large question banks and learn from their mistakes. All tests are marked automatically by the web site with every result and answer stored for later troubleshooting. On-Line tutorials on recent BLS and ALS guideline changes and other topics are also available as additions to a standard subscription. Please email us to arrange free trials and demo videos. mturr@onwebfast.com or visit our website www.onwebfast.com 9/2/11 2:16:54 PM

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Major research centre announced

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eputy Premier and Minister for Health Paul Lucas has announced a major $60.8 million Skills, Academic and Research Centre to be co-located with the new Sunshine Coast University Hospital (SCUH) at Kawana. The new centre will operate as part of a Queensland-first collaboration between the University of Queensland (UQ), the University of the Sunshine Coast (USC) and Sunshine Coast TAFE. This significant funding boost means the SCUH will now become the biggest health infrastructure project in the country once work commences in 2013. Mr Lucas said the announcement was delivering on the Bligh Government’s commitment to deliver a university hospital for the Sunshine Coast, one of only five in the state. ‘This exciting collaboration will ensure that the next generation of our health workforce on the Sunshine Coast can be trained locally,’ Mr Lucas said. ‘It’s well known that when you receive your education and training in the community you live in, you’re more likely to continue working there. This new centre will mean that for the first time, almost every category of health worker will be able to complete the majority of their training locally. ‘Currently, medical students can only complete their third and fourth years of training on the Sunshine Coast. Under this collaboration we expect medical students to be able to undertake their full degree study right here on the Sunshine Coast. ‘Equally, nursing students will benefit from this new centre through opportunities such as enrolled nurse training at TAFE and registered nurse training with USC.’ This new initiative will also mean that nurses can begin their career as an assistant in nursing and receive the training they need locally to progress all of the way to become a registered nurse. ‘Another example of how this new centre will benefit the local workforce is that a member of our catering staff will be able to receive their certificate qualification through TAFE Queensland, as will administrative staff who can undertake IT and business-related qualifications,’ Mr Lucas said. Mr Lucas said it was important that high school graduates interested in a career in health could receive their training locally, assisting them to secure a job in their region. ‘This new Skills, Academic and Research Centre will make this a reality for more than 1300 students annually,’ he said. ‘And in a boost for local jobs, these students will be supported by up to 150 staff. This is on top of the 2500 new health workforce jobs expected to be created on the Sunshine Coast when the SCUH opens.’ The centre will also ensure these staff receive the latest training using the most up-to-date technology, including advanced life support training using hi-fidelity mannequins that can replicate a wide range of clinical circumstances. Staff and students will also contribute to important local research.

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... it will ensure that cutting edge and complex procedures can be performed for the first time on the Coast.

Early planning indicates that the centre will include three floors of dedicated teaching and research space, including classrooms, wet labs and an auditorium. Each of the collaborating partners, including Queensland Health, will also contribute to the planning, fit-out and operational costs of the centre. Mr Lucas said this new investment would create over 360 additional construction jobs over and above the 11,000 jobs already set to be created to build the SCUH. ‘A facility of this calibre will also help us attract the very best specialists to work in the new hospital,’ he said. ‘And it will ensure that cutting edge and complex procedures can be performed for the first time on the Coast.’ With additional training and education space, the collaborating partners will be able to expand the size of their health schools and offer more student placements. USC Vice-Chancellor Professor Greg Hill said the establishment of the new centre would be an exciting development for the region. ‘This centre will greatly benefit university staff and students, many of whom are likely to gain work as health professionals at the new hospital,’ Professor Hill said. ‘USC is working closely with Queensland Health to help meet the hospital’s future staffing requirements, particularly in the areas of nursing and allied health.’ Medical students will continue to undertake their degree at UQ and can do their internship at the SCUH. UQ Vice-Chancellor Professor Paul Greenfield said UQ was looking forward to collaborating with Queensland Health and the other partners. ‘The SCUH promises to be a leading teaching and research hospital providing a high standard of patient care and excellent opportunities to students and academics,’ said Professor Greenfield. Chief Operations Officer of TAFE Queensland Deb Daly said Sunshine Coast TAFE was excited about the value that will be generated through this partnership. ‘Vocational education and training is critical to the success of every hospital, not just in the core medical areas like nursing and allied health, but also in the other activities that make a hospital function,’ Ms Daly said. The new Skills, Academic and Research Centre will open in 2016 in line with the opening of the SCUH. The SCUH will open with 450 beds in 2016 growing to 738 beds by 2021.

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NursINg TOday Given the number of quality options now available in a rapidly developing discipline, choosing the right study option to further your nursing career can be quite a challenge! It’s about getting the balance between your work, your family and your study right. To achieve this, our nursing programs are offered 100% online. The result is a level of freedom to tailor a study experience to match your busy lifestyle and budget. The Faculty of Health at the University of Newcastle is the most comprehensive of its kind in Australia, offering a range of cutting edge online postgraduate nursing programs designed to suit the contemporary needs of today’s nursing professionals.

With extensive experience in the delivery of online learning, our highly skilled educators, with ‘real world’ practical experience, create an exciting and rewarding learning environment. The online courses are taught by academic staff skilled in this type of delivery, through the University of Newcastle’s highly regarded Faculty of Health. GradSchool’s student-focused programs will give you the knowledge and skills you need to reach the peak of your nursing career – wherever you practice around the world, allowing you to stay where you are needed most.

Programs currently available : • Master of Applied Management (Nursing) • Master of Midwifery • Master of Mental Health Nursing • Master of Nursing (Advanced Practice) • Master of Nursing (Nurse Practitioner) To find out more go to www.GradSchool.com.au

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taking off the nursing glasses During a midwifery professional development course, registered nurse Michelle Vujicic was reminded that patients are also real people.

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t was the first day of practicum for my maternal nursing course for professional development and as I was buddied up to my nurse midwife after morning handover, I felt a sense of excitement and anticipation as I heard the words ‘the patient we have is close to delivery’. It was the first time I would see a live birth in many years, and remembering the last time I experienced watching a birth was very vague. After reading all the information on textbooks and seeing pictures, of positions, dilations and foetal assessments, I was finally about to put all the pieces together and concrete my theoretical knowledge of the physiology of birth. When I went into the room, I grabbed a pair of gloves, shut the door and looked to my right, where there was an exhausted New Zealand lady, with her back to me, on her knees facing the wall on the bed. I could already see blood and fluid dripping from her perineum; the midwife had her hand on her lower back and another with a cloth over her buttocks. Now, for someone who has not yet had any children, I would be lying if I didn’t say I was initially shocked by what I was seeing first thing in the morning, especially with the amount of bodily fluids that were present in and around the bed. Needless to say there were many days flourishing with birthing and maternity nursing experiences such as these, some more graphic than others, some more joyful and pleasant, others rather challenging, especially watching premature infants cling onto dear life in the special care nursery. It wasn’t however, until my last day of practicum, when I was in antenatal clinic, situated outside the hospital setting, that something finally dawned on me. In this clinic, the midwives were explaining to me that every week, the community centre was a place that wasn’t just ‘an appointment and check-up’ like a doctor’s office. It was a new initiative, which was intended for women to sit together, have their blood pressures taken, watch some educational DVDs and enjoy a cup of tea while they waited for their pregnancy assessment. Appointments were open and patients were given a time frame to come in and be assessed before the morning session was over. These women were very supported and knew the midwives by name, and brought their other children along to the clinic as they went about their busy schedules. I felt by being amongst the women in the community and not in the hospital setting, allowed me to connect with them and be their friend, rather than just their ‘professional’ who will simply assess them. I was able to associate the fact that soon, these women who were pregnant will eventually end up as those ‘patients’ in the hospital giving birth where I was on day one in birth suites. My nursing glasses finally came off that day, as I truly saw who these women were. They had a real life with a family to raise, mouths to feed, and had the same fears, doubts and challenges as we all do. I realised I was so used to dealing with patients day in and day out in emergency; ‘fixing’ them up and moving on, as if they were cars. No matter what type of nursing we practice, I think it’s so important to

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remember that as nurses, we can become so engrossed in our professional routine of meeting and greeting our nursing friends, having that medical and university mindset of fixing patients that we forget that the pregnant lady in labour, or that man who complains about his sore knee, or that old woman with pressure ulcers are the same as you and I. We need to remember to connect the dots and realise that we are not just ‘working’ we are actually in the path of someone’s life, in their most vulnerable state. One example of this occurring was when a 22-year-old African woman was in the process of giving birth. During this time, I was next to her throughout the whole process holding her hand and telling her to push when necessary. She had tense eye contact with me and it felt like she was relying on me in this moment to be her rock. Once the ordeal was over and her baby was wrapped, she turned to me and in her thick African accent told me to come closer to her. So I knelt down towards her and she kissed me on the cheek and said ‘God bless you’ and ‘Thank you so much for your help’. It was then I realised the importance of letting your own guard down and humbling yourself to their position and becoming a part of their lives in the moments they need you. That to me is truly the beauty of this profession. So the next time a patient comes in to your workplace, just stop to remember that you are helping someone’s son, daughter, mother, father or brother, and some of these people are probably going through a tougher time than you think and are relying on someone to be, not just their healthcare professional, but their support and friend. Our attitude and perception towards our profession and patients, really does make all the difference.

Michelle Vujicic is a registered nurse. This article reproduced courtesy of Nursing Review

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NURSING AND MIDWIFERY PROGRAMS AT USQ Nursing and Midwifery at USQ allow you to upgrade your qualifications in an educational environment that encourages integrity, perspective, knowledge and skill. USQ’s postgraduate nursing programs are offered by distance education with intakes in March, July and November.

Bachelor of Nursing USQ’s Bachelor of Nursing (offered oncampus), prepares students for the nursing profession as a Registered Nurse. Almost 50 percent of the program is devoted to clinical practice within simulated labs or in other health settings. The Bachelor of Nursing also offers an option of accelerated progression, allowing you to be in the workforce in two calendar years by studying three semesters a year.

Graduate Certificate in Alcohol and Drug Studies The Graduate Certificate in Alcohol and Drug Studies is designed to provide relevant and specialised training in the assessment and treatment of substance misuse disorders. The program has been designed to provide graduates from medical, allied health (including psychology) and nursing degrees with core skills to respond to substance misuse in a range of health settings, including those which focus on psychological health, mental health nursing, medical practice, social work, occupational therapy, and Indigenous health settings.

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Graduate Certificate in Indigenous Mental Health and Well-Being This program is designed for qualified health practitioners (e.g. general practitioners, nurses, psychologists, social workers, counsellors, psychotherapists) wanting to develop culturally appropriate mental health skills for the challenging and socially important work in Indigenous Mental Health.

Postgraduate Certificate in Advanced Nursing Practice (Rural and Remote) This program has been developed for registered nurses wishing to further their knowledge and advance their clinical nursing skills in the area of rural and isolated practice. The four courses comprising the PCNP equip Registered Nurses to apply to the Australian Health Practitioner Regulation Authority (AHPRA) for the endorsements of Remote and Isolated Practice (RIPEN). Some courses have a compulsory clinical placement requirement and nurses who are currently employed in a rural/remote area will normally undertake clinical placement per course outside of their current health facility.

Master of Nursing The Master of Nursing is designed to allow the experienced registered nurse to develop the attitudes, skills and knowledge necessary

for leadership roles in clinical practice, nursing education or administrative health care management. This eight unit program includes a study of law and healthcare, health organisations, cultural awareness and professional studies.

Master of Mental Health Nursing This program prepares nurses to practise as Mental Health Nurses and enables them to work as clinically skilled members of mental health teams in developing and established services. Upon successful completion of this eight unit program, registered nurses will have the knowledge, skills and attitudes necessary to practise as specialist mental health nurses in primary, secondary and tertiary settings.

Master of Midwifery The Master of Midwifery is designed to prepare registered nurses to become registered midwives and has been developed in partnership with Cairns Hospital, Toowoomba Hospital, St Vincent’s Hospital Toowoomba and other nominated rural hospitals in Queensland. Students of this program seeking registration as midwives must be employed as midwifery students at a partner hospital during the clinical year of the program.

For more information on these programs please call 1800 640 678 or visit studyusq.com

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the next generation Savvy providers have realised student nurses can fill today’s assistant in nursing shifts, but can also be a source of new blood for tomorrow’s workforce. Cathy Wever reports.

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espite the sometimes low prestige associated with working as assistants in nursing (AIN), which often features some of the less glamorous care-related tasks, many student nurses opt for this work to supplement their income as they study. Savvy aged care providers are therefore looking to tap into this source of relief workers, but also to attract, develop and nurture student AINs in an effort to keep them in aged care after they graduate. At Benetas, a Victorian provider with 12 sites across the state, Executive Manager Residential Services, Jane Boag, says the organisation sees nursing students working as AINs as a valuable resource. ‘We look at them as an opportunity. Because they are studying, they are constantly in contact with new ideas and research, which they can share with their colleagues at work.’ Boag says that Benetas is currently devising ways in which they can further tap into the knowledge of student AINs. Meanwhile, the organisation has created several new positions, which aim to support and enrich the experience of AINs and other, non-tertiary qualified members of their workforce. ‘Our recently appointed dementia support advisor works with all our

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staff so that our approach to dementia patients is consistent, and we see our student AINs benefitting from such learning and interaction. ‘We also try to communicate to our AINs what a varied career they can expect from aged care nursing,’ says Boag. ‘We know that for many graduating nurses, a career in aged care is at the bottom of their list, so we try to show AINs that the sector offers them the chance to use many of their clinical skills, such as pain management and neurology,’ says Boag. At Bupa Care Services, head of learning and development, Marg Ryan, says student AINs are supported to have a career path in aged care should they wish to progress and develop. The organisation has relationships with universities in New South Wales, Victoria and South Australia, which they use to attract graduates to their ‘new graduate nursing program’ and also to encourage students to apply for AIN roles within their facilities. Emma Larkman, a graduate management intern at Bupa Care Services, started her career as a student AIN in the aged care setting and describes it as a positive experience. ‘Working as an AIN in the aged care setting took my practice to the next level. I was able to autonomously operate within my scope of practice knowing that if I was unsure about the how or why of what I was doing

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in the facility or even in my undergraduate course, there were always RNs available who were ready and willing to help me.’ Bupa Care Services encourages continual education for its staff, including an online learning option introduced in 2010, and Ryan says this culture of professional learning helps to support and develop the skills of its AINs. ‘Currently seven of our AINs from different facilities around Australia are now recruited in our new graduate purse program in 2011. Reflecting the organisation’s success in training and retaining AINs up to RN level.’ Ryan says Bupa Care Services ‘had an 80 per cent retention of RNs from this program in 2010.’ Yet, according to UTS Professor of Nursing and Health Services Management, Christine Duffield, the positive experience for nursing student AINs may be the exception rather than the rule. ‘As the aged care industry has moved to having fewer registered nurses and more unskilled workers, students who go into facilities as AINs often have little or no supervision and are left to their own devices.’ She says that while she supports the idea of providing AINs with a positive experience, the reality is this is not always the case. ‘If AINs have access to a good mentor, the experience can be fantastic and there is a real opportunity to promote aged care. It’s a sector where you can see that you’ve made a difference and you enjoy more patient continuity than in a hospital setting.’ Duffield says some aged care facilities operate with a single registered nurse overseeing up to 100 beds, leaving no time for them to effectively supervise student AINs. She says an argument she often hears that ‘elderly people aren’t sick so they don’t need a registered nurse’ is ridiculous and the health needs of older patients are very complex. ‘One of the options for aged care facilities might be to employ nurse practitioners, who would be good role models for student AINs, showing them what they can aspire to and giving them a highly skilled practitioner

to see in action, while providing an extra level of care to the facility and its residents.’ Elsewhere, at South Australia’s Helping Hand Aged Care, Director of Research and Development Megan Corlis says the organisation actively values the AIN position and its role as a stepping-stone towards a career in aged care nursing. ‘Our strategy is to actively support our existing AINs to go on to complete their nursing qualification. We provide a financial contribution to their studies and we ask that they remain with Helping Hand for a set period after they qualify.’ In addition, Helping Hand has a mentor program to help AINs make the transition to the RN role within their existing workplace, which focuses on personal leadership skills and managing others’ perceptions of your role within the organisation. Corlis says the Helping Hand approach has many benefits, including the retention of a known staff member. ‘You might advertise for an RN and get maybe one application, whereas if you can support the further education of an existing AIN, then you know their strengths and talents, and you know that they fit in with your organisational culture.’ Helping Hand has strong links with the University of South Australia, and Corlis says as part of this relationship a number of student nurses came through their facilities at the end of 2010. ‘We were surprised how few of them could envisage following a career in aged care nursing. Also, we saw they had little understanding of how they could apply their nursing expertise in an aged care environment. When such students are working as AINs there is a real opportunity to show them how nursing skills are applied in aged care and how varied and rewarding the role is.’

This article reproduced courtesy of Nursing Review

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CoMPleMentarY MediCines

local complementary medicines best option

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ollowing recent media coverage regarding the dangers associated with purchasing complementary medicines online from overseas retailers, the CHC strongly reiterates its warning on this issue. However, this warning is issued in conjunction with reassurance for consumers that the Australian Complementary Medicines industry is the most tightly regulated in the world. Dr Wendy Morrow, Executive Director of the CHC said, ‘The CHC continues to remind consumers that they need to be aware that products purchased overseas are not subject to the same regulations as those enforced in Australia. It is therefore important to ensure online or telephone purchases of complementary medicines are made only on the recommendation of a qualified healthcare professional or from a reputable retailer.’ Dr Morrow went on to say ‘it is of the utmost importance when buying complementary medicines that you consult a healthcare professional regarding any medicines you are considering taking, as well as those you may already be taking.’ The Therapeutic Goods Administration (TGA) works with the Complementary Healthcare Industry to regulate complementary medicine products on the market in Australia, ensuring they are of high quality and safety. Products sold legally in Australia must be entered on the Australian Register of Therapeutic Goods (ARTG) before they enter the market. They have therefore been subject to assessments and requirements, which ensure their quality and safety, unlike products available for purchase overseas which may not have been subjected to the same level of regulations. Isolated instances like those recently reported in the media do not mean

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Australian regulations need to be reviewed, but clearly demonstrate the need for greater education and understanding of consumers with regard to purchases being made online, particularly from overseas websites. Low quality, unsafe and unregulated products purchased online from overseas is not an issue affecting complementary medicines products alone. This is an issue affecting all products available for purchase online. With the existence of global communications and online retailing, regulating any medicines purchased online or by telephone from overseas is an unrealistic task. It is also important to note that if products are being brought into Australia from overseas for personal use, the TGA has little authority over their regulation. However, the TGA website does recommend to consumers that they ‘do not order medicines, including dietary supplements and herbal preparations, over the internet unless they know exactly what is in the preparation and have checked the legal requirements for importation and use in Australia.’ An alternative and more effective option is to educate consumers about the dangers associated with purchasing complementary medicines online from overseas. Informing consumers that products may not be of the same standard or subject to the same level of regulation applied by the TGA to those sold in Australia is something the CHC continues to promote.

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aged Care

Pathways in aged care

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nalysis of care pathways provides information that is useful to both policy planners and service providers alike. The Pathways in Aged Care (PIAC) cohort study linked aged care assessment data for a cohort of 105,100 people to data sets showing use of five main aged care programs and deaths over four years. This report presents an overview of the PIAC cohort, investigating care needs, assessment patterns, common care pathways, time to entry to permanent residential aged care and time to death after assessment for use of aged care services. Coordination of aged care services is important, both to provide services cost-effectively and to provide the appropriate care for people at the appropriate time. Using linked data from the Pathways in Aged Care (PIAC) cohort study, this report presents groundbreaking large-scale analysis of peoples’ use of aged care services. This analysis includes information on time to key events, changes in use of care programs over time and concurrent use of programs. The PIAC cohort comprises 105,000 people who had a completed assessment by an Aged Care Assessment Team (ACAT) under the Aged Care Assessment Program (ACAP) in 2003–04. Their ACAP assessment data were linked to data for five key aged care programs: Home and Community Care (HACC), Veterans’ Home Care (VHC), Community Aged Care Packages (CACPs), Extended Aged Care at Home packages (EACH) including EACH (Dementia), and residential aged care (RAC). Program use was identified for 2003–06. For analytical purposes, the PIAC cohort was divided into groups based on use of aged care programs before the first completed assessment in 2003–04: • Continuing path cohort: clients who had used ACAT-dependent services (27,640 people) • HACC and/or VHC before cohort: clients who had used only HACC or VHC services (42,974). This group consisted of three subsets: HACC only before (37,546 people) VHC only before (2471 people) HACC and VHC before (2957) • No previous care cohort: clients who had not previously used aged care services (34,463). The subset of the cohort that had not used ACAT-dependent programs before their first completed assessment of 2003–04 (i.e. the ‘HACC and/ or VHC before’ and ‘No previous care’ groups) constitute the PIAC newpathways cohort. To simplify the discussion, the first completed ACAT assessment recorded for a cohort member in 2003–04 on ACAP NMDS v2 is referred to as the reference assessment. Analysis of the characteristics of the PIAC cohort groups suggests that people in the new-pathways cohort who had already accessed HACC or VHC before their reference assessment had higher care needs than those who had had no previous care, and so were further along their ‘care needs pathway’. As expected, those in the continuing pathway group had the highest care needs. In summary: • The average age of the PIAC cohort was 81 years and four months; 15 per cent of the cohort were aged 90 or over at the reference assessment. • Just 36 per cent of the PIAC cohort were men. This varied with PIAC group: 31 per cent of the continuing path cohort were men, compared with 34 per cent of those with HACC or VHC only before the reference assessment, and 41 per cent of those with no previous care. • New-pathways cohort members who had used VHC had a different demographic profile from other cohort members as a consequence of the eligibility criteria for this program. • Across the PIAC groups, between 20 per cent and 23 per cent of

the cohort had their ACAT reference assessment in hospital. • Almost 40 per cent of the continuing path cohort were reported as already living in permanent residential care. • Among cohort members living in the community at the reference assessment, nearly 80 per cent had a carer available. Carers were most commonly a spouse (35 per cent of carers) or daughter (also 35 per cent). • On average between three and four health conditions were reported as contributing to the care needs of cohort members. The level of co-morbidity was least among cohort members who had not previously used care programs. • The most common health conditions affecting care needs were circulatory system diseases (60 per cent of the cohort), mental disorders (40 per cent, including 27 per cent with dementia), musculoskeletal diseases (42 per cent), and endocrine, nutritional and metabolic disorders (21 per cent). The first three of these were also commonly identified by ACATs as the main health condition impacting on need for assistance. • Among people recommended to live in the community, 48 per cent did not receive an ACAT approval to use any of the ACAT-dependent programs at their reference assessment. However, nearly two-thirds of those without any approvals got recommendations for community care programs.

Care PaTHwaYS People access services to suit their particular circumstances, and so patterns of service use are diverse in terms of the programs accessed and the frequency and order in which they are used. Among the full PIAC cohort, the linked data commonly identified over five program access events for a client, with a small number having over 25 distinct periods of program use over the study period. The occurrence of large numbers of events combined with the variety of care programs available means that there are many thousands of different care pathways. Examination of care pathways is simplified if a clear starting point can be identified. To achieve this, the analysis was restricted to the newpathways cohort. Different approaches can be used to examine pathways. For example, looking at the order in which people access care programs but without considering the timing or re-assessments, the 77, 400 people in the PIAC new-pathways cohort had 1003 distinct care pathways over two years, including those ending in death. While there were many different care pathways, a relatively small set nursing in AustrAliA Yearbook 2011

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aged Care

was used by a large proportion of the cohort. Looking at the first three care changes after the reference ACAT assessment, for new-pathways cohort members: • 14 path combinations were used by 82 per cent of people. • The most common path was the ‘no change’ path: 16 per cent of the cohort were still alive two years after the reference assessment and had not newly accessed any care programs in that time. However, almost half of these people were, or had already been, HACC or VHC clients. • Eight per cent of the cohort died before taking up any new program services; two-thirds of these people had been HACC or VHC clients prior to their ACAT assessment. • 22 per cent of the cohort only accessed permanent residential care after their reference assessment, with just over 40 per cent of these dying within the two-year study period. • 14 per cent only accessed HACC or VHC services within two years of their reference assessment. Analysis again shows that people were being pointed towards nonACAT-dependent community care services by ACATs: five of the top 14 care pathways began with accessing, or re-accessing, HACC or VHC services. These five paths were used by over one-quarter (29 per cent) of the newpathways cohort with no previous care. By the early 1980s there was ‘a general recognition in the aged care field that Australia had an overly large and expensive long-term institutional-care sector, and a correspondingly under-developed homebased sector’ (AIHW 2001). To address this imbalance, there has been a range of reforms that have increasingly placed emphasis on formal assessment processes and expanded the focus of care provision from residential care to providing a continuum of care, with community care being developed to both supplement and complement residential care (AIHW 2001; AIHW 2007a). This evolution reflected the wishes of older people, with assessment teams ‘finding that not only did many frail older people not need nursing home or hostel [residential] care, they did not want it either’ (Bruen 2005). In response to expressed preferences, the Australian Government developed—and continues to expand—a range of community care and information programs. By 2004 the Australian Government was funding 17 community care programs, with program initiatives still continuing (DoHA 2004, AIHW 2007a). While there has been a proliferation of programs, between 2001–02 and 2005–06 four key programs accounted for around 85 per cent of government expenditure on programs delivering community aged care (excluding assessment services): Home and Community Care (HACC), Veterans’ Home Care (VHC), Community Aged Care Packages (CACPs) and EACH packages (Extended Aged Care at Home), including EACH (Dementia) (EACHD) (AIHW 2007a). The aged care sector within Australia is very complex, with a wide range of services available to older people in need of assistance. Moreover, different programs have different access processes: an approval through the Aged Care Assessment Program (ACAP) is required before a person can access residential aged care (RAC) or the aged care package programs (CACP, EACH and EACHD), but program-specific assessment processes regulate access to other community care programs like HACC and VHC . Therefore, coordination of aged care services is important both to provide services cost-effectively and to provide the appropriate care for people at the appropriate time. However, until recently there has been no capacity to describe statistically the way in which the aged care system functions as a whole (Gray 2001). Computerised person-level administrative data have been maintained for residential aged care (RAC) and CACPs since the 1990s, and administrative data have been collected for each of VHC, EACH, EACHD and the Transition Care Program (TCP) as they became operational.

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MaIn fIndIngS • People do not need an ACAT assessment to access HACC or VHC. However, for many people their first contact with the aged care system is through an ACAT: just over 40 per cent of the cohort with no previous use of aged care programs accessed HACC or VHC following their ACAT assessment. • Although approval for program use from an ACAT assessment is valid for 12 months, re-assessment within that period is common: 30 per cent of the no previous care cohort had a re-assessment within 12 months, and two-fifths of these had no intervening program use (Table 1). • Before 1 July 2009, approval to use residential respite care had to be renewed annually to maintain access. This requirement was an important cause of re-assessment. • Assessments do not necessarily result in program use: 25 per cent of the no previous care cohort did not newly access any care programs within two years. Nearly one-quarter of these people had died. • The use of care programs by the cohort increased over time. In particular, among no previous care cohort members the proportion who were in permanent RAC more than doubled between three months and 24 months after their first assessment in 2003–04— from 17 per cent of clients still living to 34 per cent. Some care programs can be accessed simultaneously. For the no previous care cohort, six months after assessment: • One in six CACP recipients (16 per cent) were also using services from other programs. • Almost 40 per cent of people who were clients of VHC were also accessing services from the large HACC program. • Just under 10 per cent of those using HACC were also accessing other programs. • Two-fifths of the people in respite RAC were also using a community care program when they were at home. Nearly one-third of the PIAC cohort died within the two-year study period.

Sex and age Reflecting the greater longevity of women than men, nearly two-thirds (64 per cent) of the cohort was women. However, as expected, there were relatively more men among people who had used VHC prior to their reference assessment, and they constituted 60 per cent of those who only used VHC services previously (and not HACC). Overall, women were more likely than men to have previously accessed ACAT-dependent services (28 per cent versus 23 per cent). As a consequence of the differential access to VHC services, men were more likely to have used VHC services prior to accessing ACAP. Not surprisingly, older clients were more likely than younger clients to have already used ACAT-dependent services at the start of the study period.

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Almost 22 per cent of cohort members who had accessed ACAT-dependent services prior to their reference assessment were aged 90 or more compared with 11 per cent of the cohort who had not accessed any care programs before their reference assessment. Furthermore, new-pathways cohort members who had accessed HACC or VHC services before their reference ACAT assessment tended to be older than those who had not (64 per cent versus 56 per cent for people aged 80+). Overall, in the PIAC cohort women tended to be older than the men, again reflecting the greater longevity of women than men. However, among clients who had accessed VHC services before their reference ACAT assessment a larger proportion of women were aged under 80 than men.

This is explained by the tendency for men (that is, in this case usually the veteran) to marry women younger than themselves. Overall, it is estimated that 15 per cent of the PIAC cohort had either a gold or white DVA card.

This article is a summary of the report entitled ‘Pathways in Aged Care: program use after assessment’, released by the Australian Institute of Health and Welfare, Canberra. This publication is part of the Australian Institute of Health and Welfare’s Data linkage series. The full version of this report and a complete list of the Institute’s publications is available from the Institute’s website www.aihw.gov.au.

table 1: PiAC cohort with re-assessments within 12 months: first post-assessment care pathway event by PiAC group first post-assessment event

Continuing path

HaCC and/or vHC before

Per cent

no previous care

all new-pathways cohort

Total

number

Incomplete ACAT assessment Completed ACAT assessment HACC VHC CACP EACH(D) Respite RAC Permanent RAC

7.0 37.7 12.1 0.7 1.9 0.4 32.7 7.5

8.1 47.1 12.2 1.8 8.4 0.2 16.3 5.9

5.7 33.5 40.8 1.9 4.1 0.1 9.1 4.9

7.1 41.6 23.7 1.8 6.7 0.2 13.4 5.5

7.1 40.7 21.0 1.6 5.6 0.2 17.9 6.0

Total

100.0

100.0

100.0

100.0

100.0

Total (number)

7,630

15,135

10,152

25,287

..

2,335 13,395 6,912 515 1,834 67 5,890 1,969 .. 32,917

Notes 1. Table excludes 184 cases with a pathway that indicated death before receipt of care (excluding HACC). 2. The reference assessment is the first completed ACAT assessment in 2003–04. 3. An ACAT assessment may end before completion due to a number of reasons—personal or medical. 4. Components may not add to total due to rounding.

Aged care in Australia: a guide for aged care workers is a valuable resource for workers, carers, volunteers and the aged care industry. It is contextualised to the Australian aged care environment. The textbook enables integration of knowledge, with aged care issues and practice. The textbook has received widespread support from industry and training organisations since it was first published.

Aged Care in Australia: a guide for aged care workers $ 69.95 Di Dawbin and Anthony Rogers Community Services, Health, Tourism and Recreation Curriculum Centre, TAFE NSW, 2006. Size 215mm x 273mm 464pp. Available through ITSA Bookshop itsashop@shoal.net.au ISBN 1-9209-6729-X 316097AE_TAFE NSW | 1695.indd 1

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For training purposes a companion volume: Aged care in Australia: a guide for aged care workers-Learner study guide is also available. A second edition update will be available for both publications in the second half of 2011. Additional chapters will focus on dementia, a palliative approach to care services and working with cultural diversity. Chapter review activities, reflective questions for case studies and an improved glossary are just some of the features of the new edition. 3/9/11 11:53 AM

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aged Care

Hip fracture rates declining

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eakin University research has found a drop in hip fracture rates in people over 55. Researchers with Deakin’s School of Medicine based at Barwon Health analysed data from the Geelong Osteoporosis Study, a long-term study involving men and women living in the Barwon Statistical Division in south-eastern Australia, and found that hip fracture rates had decreased by eight per cent for men and 31 per cent for women from 1994 to 2007. While the rates of hip fracture had declined, the actual number of hip fractures had increased by 53 per cent for men (100 to 153) and 4.4 per cent for women (319 to 333) because of the expanding and ageing population. Deakin’s Associate Professor Julie Pasco said that even with the increase in the actual number of hip fractures, the study’s findings were an encouraging sign. ‘Hip fractures are the most debilitating and costly fractures and lead to disability, loss of independence and, sometimes, death. So it is great to see that the fracture rates are declining,’ she said. ‘Our results reflect a trend being reported by a number of other Western countries including Canada, the United States, Denmark and Switzerland.’ Associate Professor Pasco said that a number of factors could have contributed to the drop in fracture rates. ‘Improvements in osteoporosis medications and their increased use may have contributed to the decline,’ she said.

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‘We also found an increase in body weight, with consequent increases in bone mineral density at the hip that may have contributed to the decline in hip fracture rates. ‘The link between body weight and fracture risk is complex but weight gain in non-obese individuals tends to increase bone formation through mechanical loading and hormonal links between fat cells and the skeleton.’ The results of the study, ‘Changes in hip fracture rates in southeastern Australia spanning the period 1994-2007’ are published online in the Journal of Bone and Mineral Research (accepted articles section). The Geelong Osteoporosis Study (GOS) started in 1992. It is a population-based study designed to investigate osteoporosis and identify risk factors for fracture. The GOS uses radiology reports to identify all fractures that occur in the Barwon Statistical Division (a region surrounding Geelong, with a population of 259,000). The study has also recruited large cohorts of men and women (1500 men and 1700 women) who were selected at random from electoral rolls. The participants attend the study centre at Barwon Health every few years and are monitored for their overall health, diseases and lifestyle choices over time.

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Steven made the move to country Queensland Clinical Nurse Consultant Steven Dyer made a move from Brisbane’s chaotic city life in 2006 to settle in Barcaldine, in Central Western Queensland. “I was literally gridlocked in the Brisbane rat race,” Steven said. “With dropping my kids to school and day care, and the traffic jams, I was basically sitting in my car for two or three Steven D y hours a day.” Barcald er, Clinical Nurse ine, Cent Consulta ral W nt, Steven took on a six month secondment position at Health D est Queensland istrict Queensland Health’s Barcaldine Hospital and Multipurpose Health Service with some encouragement from some Brisbane colleagues who had worked in Blackall. “Barcaldine is a small community and the shops and school are close by - there’s no traffic, there’s not even a set of traffic lights,” Steven said. “I’ve now reclaimed back a few hours in my day.” Steven found the move into a close community confronting at first. “It can be a culture shock, especially if you haven’t spent any time outside the city. But we soon got over the initial shock and just began to feel a part of the community.” Steven believes the opportunities for Queensland Health nurses to grow their skills and get broader experience in rural hospitals is generally greater than in the major hospitals. “During my time here I have been provided opportunities to work in other fields, such as working as the director of nursing and I have also spent some time working as the district patient safety officer. “Working as a registered nurse within a smaller team offers many challenges, but also provides opportunities for greater autonomy. The nurses in our hospital are responsible for providing total care from triage to discharge and then follow-up in the community,” Steven said. “Nurses and healthcare workers new to the bush often worry about being given tasks that are out of their depth, but in reality it isn’t scary because you’ve got a close-knit team of professionals supporting you. The support is so good I’ve seen nurses from agencies come out for a stint, then decided to stay on and live here.” Queensland Health provides an unprecedented level of professional support to its nurses and midwives working in rural and remote communities. “We take the support of nursing staff in their transition seriously, helping them to develop and apply their skills safely,” Steven said. “We live in a safe and friendly community. As for traffic, the only gridlock you get out here is the occasional herd of cows on the road!” Whether you are searching for a career change, or want a change of pace, Queensland Health offers incentives and pathways for experienced nurses and midwives to make the move.

Visit www.health.qld.gov.au/nursing 1695_Nursing Yearbook 2011.indd 24

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“Being a midwife in a rural environment is more than just a job; you become part of the community and you can even see children that you have birthed grow up. Queensland Health provides many opportunities and resources and I enjoy being part of the community lifestyle here - it’s a great area to bring up my three active boys.” Debbie McConnel, Midwife and Clinical Nurse Educator, Proserpine and Bowen, Whitsunday Health Service.

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Recruitin Express y g now: our inter est online w it Work For h Us

Work For Us Search for jobs or submit an Expression of Interest today. www.health.qld.gov.au/nursing

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Children’s health

P.A.r.t.Y program opening young eyes

Nurse with Participants in Emergency Department

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he Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) program is an in-hospital trauma prevention initiative aimed at senior school students (15-18 years) and young offenders (18-25 years). This program is currently run through the Trauma Service at The Royal Melbourne Hospital (RMH), one of the two adult trauma hospitals in Victoria, where many young people are treated for serious injury as a result of their risktaking behaviour. P.A.R.T.Y. gives participants insight into the possible traumatic and often preventable consequences of risk-related behaviour. The program at The Royal Melbourne Hospital is coordinated by Claire McGuinness, a registered nurse with a passion for working with young people. She has a background in paediatric nursing at The Royal Children’s Hospital, and more recently, after completing her Diploma of Education, was working in the Victorian Secondary School Nursing Program to deliver programs and health promotion messages to adolescents. Claire thrives on having a positive influence on the decisions of young people and feels that P.A.R.T.Y. is the ultimate platform to illustrate the reality and consequences of risk-taking behaviour. Claire works alongside RMH trauma nurses, doctors and allied health professionals to deliver the program, which aims to reduce the rate of serious injury in Victoria’s youth.

wHY foCuS on YouTH TrauMa? Trauma and injury is the leading cause of death and disability in young Australians Participants in ICU with road trauma being the most common mechanism. Despite significant public education, Australia continues to have a high road toll. Over the last five years, The Royal Melbourne Hospital had more than 5000 patients admitted in the age range of 15-25 years and 30 per cent of these sustained life-threatening injuries with long-term consequences. The most common causes of these injuries were road trauma (48 per cent cars and pedestrians), assaults and fights

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Children’s health

Participants during rehab activities

Participants in Emergency Department cutting clothes off dummy

(28 per cent), and falls (14 per cent). Worryingly, 35 per cent involved drugs and/or alcohol in some way. Associate Professor Rodney Judson, Director of the hospital’s Trauma Service, said ‘Overall, 35 per cent of trauma cases where serious and lifethreatening injuries are sustained, involve drugs or alcohol or a combination of both.’ ‘We hope through this program young people will have a greater awareness of the consequences of risk-taking behaviour and that this will translate into fewer traumatic injuries and admissions in future,’ he said

HISTorY P.A.R.T.Y. was developed in 1986 at the Sunnybrook Health Services Centre in Toronto, Canada. Their Emergency staff created the Program in response to the high number of preventable injuries among young people they were seeing time and time again. The P.A.R.T.Y. Program is now operated by staff at established trauma hospitals in more than 100 sites around the world. In Australia these sites are The Royal Perth Hospital (WA), Royal Brisbane and Women’s Hospital (QLD), The Alfred and The Royal Melbourne Hospital (VIC).

Participants in ICU performing log roll with nurse

and other orthotic equipment. Once returning back to school, students are encouraged to further explore risk-related trauma and its effects.

benefITS Data collected via pre and post-program questionnaires at The Royal Melbourne Hospital shows an excellent response from participants. When asked if they thought the program would make them think about their actions in the future 19 per cent of participants answered ‘definitely’ preprogram compared to 76 per cent post-program. Recent research from Canada showed that over a 10-year period those students who did not participate in P.A.R.T.Y. were twice as likely to be injured than those from a similar demographic who attended the program.

For further information, please visit P.A.R.T.Y. Headquarters: www.partyprogram.com P.A.R.T.Y. Melbourne: www.partymelbourne.net.au

THe PrograM The students spend a day at The Royal Melbourne Hospital, following the patient’s journey from what happens at the scene of an accident, to the emergency department, the intensive care unit, the trauma wards, rehabilitation and beyond. The first half of the day focuses on treatment of an acute injury including the life-saving management of trauma. The students tour our emergency department, intensive care unit and the trauma wards. It is here that nursing staff deliver the facts to participants of what it would be like to be a trauma patient. An important, and sometimes confronting, part of the program is meeting and talking to trauma patients, hearing their stories and learning from their experience. The second part of the day is focused on rehabilitation and the long-term effects of injury. The participants spend time with our allied health staff, discovering what life can be like with a long-term injury or disability. They complete tasks such as being fed, dressing, and moving around with braces, splints,

Participants using a communication board

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Children’s health

new hope for childhood cancer

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world-first clinical trial for childhood cancer has received a $6 million boost. The Minister for Mental Health and Ageing, Mark Butler, announced the prestigious National Health and Medical Research Council (NHMRC) Program Grant awards for 2012. Professors Michelle Haber AM, Glenn Marshall and Murray Norris from the Children’s Cancer Institute Australia (CCIA) were awarded an NHMRC Program Grant worth $6 million over five years and commencing in 2012. The Program Grant will fund further research into childhood cancer, and specifically neuroblastoma, the most common solid tumour in children and one of the most aggressive forms of childhood cancer. Professor Michelle Haber AM, CCIA Executive Director and President of the international Advances in Neuroblastoma Research Association, has accepted the Program Grant on behalf of her co-investigators at CCIA in Melbourne today. The Program Grant is one of only nine awarded throughout the country for outstanding medical research and one of two awarded in NSW. The Grant is focused on translational research, which means doctors and scientists working side-by-side on the same problems, taking scientific discoveries from the lab bench to the patient’s bedside through new drug discovery and clinical trials, with the goal of improving the outcome for children diagnosed with neuroblastoma. Translational research has become a priority for medical research funding and has been a long-time priority for CCIA. The award of this highly competitive grant attests to the excellent partnership between researchers at CCIA and cancer experts at Sydney Children’s Hospital, Randwick, as well as

other national and international clinical partners, which has allowed CCIA to excel in its ‘bench to bedside’ approach to childhood cancer research. The Cancer Centre has been treating children with cancer and

Rebuilding Emily’s shattered life Often the lives of the parents of the children we meet have spiralled so far out of control that they have been unable to provide the nurturing home life their kids deserve. Children like seven-year-old Emily whose family has fallen apart around her, but luckily for her Barnardos is there to help pick up the pieces. When we first met Emily her family had already been known to community services for some time due to her frequent absences from school – she had been found roaming the streets alone – and her teachers had noticed that a lack of basic care meant she often smelt. Alcoholism had left both Emily’s mother and father unable to hold down a job and so the family was surviving on benefits. It was not unusual for Emily to find her father passed out, and to be woken late at night by her mother coming home, barely able to walk and relying on Emily to help her to bed. The full extent of the neglect has become immediately apparent. She is a long way behind her peers in both literacy and numeracy due to her absences from class. When she was there she was so tired she was unable to concentrate, and she had become a natural victim for bullies because she had dirty clothes and had seldom bathed. Children like Emily need someone who truly believes in them. With your support we can give them a safe and caring family environment where they will be nurtured instead of neglected. Visit www.barnardos.org.au to read more about Emily and the work of Barnardos. 316093E_Barnardos Australia | 1695.indd 1

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Children’s health

blood diseases from NSW and the ACT for nearly 50 years. During that time the cure rate for child cancer has increased from 10 per cent to 80 per cent. Many individual staff from the cancer centre have directly contributed to this modern medical miracle through work in bone marrow transplantation, clinical trials and the provision of outreach services to rural children. However, the comprehensive cancer centre created by the union of Sydney Children’s Hospital Randwick and CCIA aims to discover therapy and improve clinical care so that zero children die from cancer. Mr Butler said that the Australian Government recognises that translational bench to bedside research is an important area of funding as the outcomes are essential for the future of the health of all Australians. The success of the CCIA research team in this very competitive and prestigious Program Grant funding round is a reflection of the excellent results they have achieved over the years and their commitment to translational research. The Program Grant recognises the Institute’s world-class research capability, and will support CCIA’s multi-faceted research programs, which aim to improve the diagnosis, understanding, treatment and prevention of childhood cancer. ‘The survival rate for children with neuroblastoma is one of the lowest of all childhood cancers, with only about 50 per cent of children surviving on current treatments. New treatments are desperately needed,’ says Professor Marshall, Head of the Molecular Carcinogenesis Program at CCIA and Director of the Cancer Centre at Sydney Children’s Hospital. A specific goal of the Program Grant will be to support three world-first clinical trials for children with relapsed neuroblastoma. ‘These new treatment approaches gives hope to the families of children with neuroblastoma, specifically those children who relapse following conventional treatment,’ said Professor Marshall, who has been researching childhood cancer and treating children with cancer for more than 25 years. ‘CCIA has taken a leading role in placing Australia at the forefront of

international childhood cancer research. Our bench to bedside translational approach to research has seen a dramatic increase in the number of clinical trials planned or underway, and will make a difference to helping save the lives of all children with cancer,’ said Professor Haber. One new approach in the phase I/II clinical trial for neuroblastoma, which has recently opened, involves a combination therapy of two drugs, valproate and gamma-interferon, which work together to inhibit tumour growth by blocking tumour blood supply. Both chemicals have anti-cancer action but have not been used for the treatment of childhood cancer before. CCIA scientists have shown in the laboratory that they are much more potent when used together, rather than separately, leading directly to the design of this clinical trial. Neuroblastoma tumour growth is driven by a gene called MYCN. CCIA reseachers have shown that two genes, ODC1 and MRP1, are essential for MYCN’s cancer-causing properties and have very different levels in normal and cancer cells, allowing more effective targeting of the tumour cells. They have recently designed more effective ways of blocking the action of both these genes to combat neuroblastoma, and these approaches will form the basis of the two other clinical trials for neuroblastoma that will be supported by this Program Grant. As recently as the 1950s, childhood cancer was virtually a death sentence. Medical research has developed treatments to improve current childhood cancer survival rates to over 80 per cent. Even so, more than 600 Australian children will be diagnosed with cancer this year, and 120 will die of the disease this year. The long-term impact of child cancer on individuals, families and communities imposes a significant health, social and economic burden in Australia. The NHMRC Program Grant brings the total funds awarded to CCIA to over $17 million this year. This grant success marks a record achievement in the Institute’s 30-year history, with two other large Program Grants and a number of additional Project Grants also being funded.

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Children’s health

AdHd medication safe for kids’ hearts A new study has put to rest recent concerns that ADHD medications may increase the risk of cardiovascular events in young people.

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espite recent concerns that medications for attention deficit hyperactivity disorder (ADHD) could increase the risk of cardiovascular events in children and adolescents, an observational study conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania and HealthCore Inc, in the United States, finds they are no more likely to die from a severe cardiovascular event than those who do not take the drugs. The findings, published online in the journal Pediatrics, provide the first analysis of such events in a large population of children and adolescents receiving ADHD medications compared to non-users. ‘These data provide reassurance that the thing most concerning — death — is not any higher in users of ADHD medications than non-users,’ said senior author Sean Hennessy, PharmD, PhD, an associate professor of Epidemiology at the University of Pennsylvania. ‘For kids who will benefit from ADHD treatment, the potential risk of a cardiovascular event should not dissuade parents or caregivers from giving a child or adolescent these drugs.’ An estimated 2.7 million or 4.8 per cent of all children in the US aged four to 17 took ADHD medications in 2007, the most recent year for which data are available. After previous studies found drugs to treat ADHD can lead to increased heart rate and blood pressure in children, Hennessy’s group turned to a large database of patient records to see if patients who recently began taking ADHD medications appeared any more likely to suffer from sudden death, heart attack, or stroke. For the study, researchers sifted through patient data contained in Medicaid databases from five states and the HealthCore Integrated Research Database, which contains historical and current medical and pharmacy claims data from more than 44 million people. Hennessy’s group identified

These data provide reassurance that the thing most concerning — death — is not any higher in users of ADHD medications than non-users,’ said senior author Sean Hennessy, PharmD, PhD, an associate professor of Epidemiology at the University of Pennsylvania.

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241,417 patients ages three to 17 on ADHD medications and tracked their health records during the period they were on medication (a median of 135 days). The researchers then compared rates of sudden death, heart attack, and stroke in patients taking ADHD medications to those not taking medications who were of the same age, sex and from the same state over a median of 609 days. The researchers found 28 deaths in the group exposed to ADHD medications (incidence 1.79 per 10,000 person-years) and 607 in the control group (incidence 3.00 per 10,000 person-years). Additionally, the researchers identified no cases of heart attack or stroke in the group who received ADHD medications and 11 cases in the unexposed group. Because the group of children and adolescents receiving ADHD medications had no validated reports of stroke and heart attack, researchers were unable to rule out relative increases in the rate of such events from use of the drugs. ‘The fact that the rates of cardiovascular events that could be identified were very low is of interest because at least we can tell that we do not have an epidemic of such events in kids receiving ADHD drugs,’ Hennessy said. ‘If ADHD medications were causing an epidemic of cardiovascular events, we would expect to see it in this study. ‘This is one of first answers but it won’t be the last,’ Hennessy said, adding that since 2007, the US Food and Drug Administration (FDA) and Agency for Healthcare Research and Quality (AHRQ) has been looking into the potential cardiovascular risks of ADHD medications on children. ‘Until the results of the FDA study become public, this study should provide reassurance to parent and caregivers that ADHD drugs are safe from a cardiovascular perspective.’

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Children’s health

repeated stress in pregnancy linked to children’s behaviour

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esearch from Perth’s Telethon Institute for Child Health Research has found a link between the number of stressful events experienced during pregnancy and increased risk of behavioural problems in children. The study has just been published online in the latest edition of the top international journal Development and Psychopathology. Common stressful events included financial and relationship problems, difficult pregnancy, job loss and issues with other children and major life stresses were events such as a death in the family. Lead author, registered psychologist Dr Monique Robinson, said while previous studies have shown a link between stress and poorer outcomes, this study goes further by analysing the timing, amount and kinds of events that lead to poorer outcomes. ‘What we have found is that it is the overall number of stresses that is most related to child behaviour outcomes,’ Dr Robinson said. ‘Two or fewer stresses during pregnancy are not associated with poor child behavioural development, but as the number of stresses increase to three or more, then the risks of more difficult child behaviour increase.’ Dr Robinson said the actual type of stress experienced was of less importance than the number of stresses, and there was no specific risk associated with the timing of these stress events – early or late – in the pregnancy. The analysis was undertaken on data from Western Australia’s longterm cohort Raine Study, which recruited nearly 3000 pregnant women and recorded life stress events experienced at 18 and 34 weeks of pregnancy,

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as well as collecting sociodemographic data. The mother’s experience of life stress events and child behavioural assessments were also recorded when the children were followed-up at ages two, five, eight, 10, and 14 years using a questionnaire called ‘Child Behaviour Checklist’. The percentage of women with more than two stress events was 37.2 per cent, while the percentage with six or more was 7.6 per cent.  Dr Robinson said the study should not make pregnant women stress further about the stress in their lives. ‘These types of analyses look at overall population risk, and of course individuals can have very differing responses,’ Dr Robinson said. ‘Regardless of exposure to stress in the womb, a nurturing environment after birth can provide the child with enormous potential to change their course of development. This is known as developmental plasticity, which means that the brain can adapt and change as the child grows with a positive environment. ‘The important message here is in how we as a community support pregnant women. If we think about people who lead stressful lives, they are most often linked with socioeconomic disadvantage. This research shows we should be targeting these women with support programs to ensure the stress does not negatively affect the unborn child.’ Dr Robinson said further research is needed to understand the mechanisms behind how stress in pregnancy affects the developing baby, including the impact of maternal stress hormones, attachment and parenting issues and socioeconomic factors.

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