Reduction in preventable time-critical dose omissions: impact of electronic medication management systems on in-patients.

: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose.

Evaluation of Smart Pump Interoperability with an Electronic Medical Record System to Improve Infusion Safety.

Medications administered via intravenous (IV) infusions have high potential for patient harm. Evaluation of the rate of variances between the medication order on the Electronic Medical Record (EMR) and IV infusion details in the smart pump was performed pre and post- implementation of smart pump and EMR interoperability. Introduction of smart pumps with EMR interoperability resulted in a statistically significant reduction in frequency of variances.

Medication-related Medical Emergency Team activations: a case review study of frequency and preventability.

Objectives: Despite recognition of clinical deterioration and medication-related harm as patient safety risks, the frequency of medication-related Rapid Response System activations is undefined. We aimed to estimate the incidence and preventability of medication-related Medical Emergency Team (MET) activations and describe the associated adverse medication events.

Methods: A case review study of consecutive MET activations at two acute, academic teaching hospitals in Melbourne, Australia with mature Rapid Response Systems was conducted.

Bringing the Nurse Back to the Bedside.

As digitisation continues to increase across Australian health services, the nursing profession has focused on analysing and measuring the way care is provided to the patients. Focus on optimising nursing workflows and improved care delivery has presented challenges but this is now demonstrating improvements in patient care outcomes and time for care.

Feasibility of Bluetooth Low Energy wearable tags to quantify healthcare worker proximity networks and patient close contact: A pilot study.

Background: The hospital environment is characterised by a dense network of interactions between healthcare workers (HCWs) and patients. As highlighted by the coronavirus pandemic, this represents a risk for disease transmission and a challenge for contact tracing. We aimed to develop and pilot an automated system to address this challenge and describe contacts between HCWs and patients.

Redundancy within hospital-related harm prediction tools.

The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted.

A longitudinal time and motion study quantifying how implementation of an electronic medical record influences hospital nurses' care delivery.

Aim Background: Many health care services are implementing or planning to undergo digital transformation to keep pace with increasing Electronic Medical Record (EMR) functionality. The aim of this study was to objectively measure nursing care delivery before and following introduction of an EMR.

Design And Methods: An extensive program of work to expand an EMR across our health service using a 'big bang' methodology was undertaken.

Evaluation of medical emergency team medication management practices in acute hospitals: A multicentre study.

Background: Medical emergency teams use medications to rescue deteriorating patients. Medication management is the system of steps and processes, including prescribing, distribution, administration, and monitoring, to achieve the best outcomes from medication use. Systems or standards for medication management by medical emergency teams have not been defined.

The pre-Medical Emergency Team response: Nurses' decision-making escalating deterioration to treating teams using urgent review criteria.

Aim: To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria.

Design: A qualitative design comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital.

Method: A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews.

Improving sepsis care for hospital inpatients using existing medical emergency response systems.

Background: Sepsis is a medical emergency; timely management has been shown to reduce mortality. We aimed to improve the care of inpatients who developed sepsis after hospital admission by integrating a sepsis bundle with an existing medical emergency team (MET).

Methods: We performed a before-and-after study at an Australian institution.

The frequency and nature of clinician identified medication-related rapid response system calls.

Aim: The contribution of adverse medication events to clinical deterioration is unknown. This study aimed to determine the frequency and nature of rapid response system (RRS) calls that clinicians perceived were medication-related using RRS quality arm data.

Methods: Analysis of routine data prospectively collected by clinicians responding to RRS calls in an Australian acute tertiary academic hospital.

An Observational Analysis of Medication Use During 5,727 Medical Emergency Team Activations at a Tertiary Referral Hospital.

Background: Medical emergency teams (METs) rescue deteriorating patients as the response arm of hospital rapid response systems. This study aimed to (1) investigate medication use during MET activations by describing the type, frequency and access sources of medications; and (2) assess associations between patient characteristics, MET activation criteria, and outcomes and MET medication use.

Methods: A single-center, retrospective study from a prospective database of MET activations in an Australian tertiary referral hospital was undertaken.

Understanding how medications contribute to clinical deterioration and are used in rapid response systems: A comprehensive scoping review.

Background: In hospitals, rapid response systems (RRSs) identify patients who deteriorate and provide critical care at their bedsides to stabilise and escalate care. Medications, including oral and parenteral pharmaceutical preparations, are the most common intervention for hospitalised patients and the most common cause of harm. This connection between clinical deterioration and medication safety is poorly understood.

Avoiding adult in-hospital cardiac arrest: A retrospective cohort study to determine preventability.

Introduction: This study had three main aims. Develop a methodology for reviewing in-hospital cardiac arrests (IHCA). Assess appropriateness and potential preventability of IHCAs.

Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system.

Objectives: To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values.

Design, Setting And Participants: A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013.

Changes in oxygenation in mechanically ventilated critically ill patients following hyperbaric treatment.

Background: Some ventilated intensive care unit (ICU) patients may experience reduced oxygenation following hyperbaric oxygen treatment (HBOT).

Methods: In a prospective, single-centre, observational study, we documented changes in oxygenation and the need for associated changes in ventilator settings in 25 consecutive, mechanically ventilated ICU patients immediately post-treatment and 1, 2, 3 and 6 hours following 61 HBOT sessions. The primary outcome measure of oxygenation was the ratio of arterial partial pressure of oxygen (P(a)O2) against the level of inspired oxygen (F(i)O2), P(a)O2/F(i)O2.