The effect of combined training on the safety culture of the treatment team in the neonatal and intensive neonatal care departments of the choosen hospitals in Iran

Prof. Shayesteh Salehi1, Miss maryam alibac1

1Nursing And Midwifery School, community research center, islamic azad university, isfahan branch, Isfahan, Iran

The purpose of this study was to determine the effect of combined training on the safety culture of the treatment team in the neonatal and intensive neonatal care departments of the hospitals in Isfahan.

The present study was carried out in a clinical trial in two stages before and after the intervention on some personnel(32 members) of neonatal and intensive neonatal care departments of the mentioned hospital. The sampling method was a census. Data was collected by questionnaire. The combined training included film show and group round. First, the patient safety culture survey questionnaire was completed by the personnel.then they were grouped. At first, the educational video was displayed for 45 minutes and then, using a checklist in the neonatal intensive and neonatal care department, the participants observed and recorded the performance of their colleagues on the check list. After one month, the patient safety culture survey questionnaire was completed by the treatment team members.

The results of the analysis showed that the translated questionnaire with 12 given domains is a suitable tool for assessing the patient’s safety status in our country. The results showed that in the 12 dimensions of the patient safety culture, the highest average score in the group work dimension of the units, before the intervention, was 3/95±0/57, after the intervention, 3/88±0/55, and in the non- reproval dimension of the mean score before the intervention was 2/59±74/2 and after the intervention 2/34±0/70. The average of the safety culture of the patient before the intervention was 3.40 ± 0.33 and after the intervention 3.39±0/32  .

After evaluating the status of the safety culture in the hospitals, it is necessary to take steps to plan the patient’s safety culture through appropriate planning and intervention.


Biography:

shayesteh salehi has been nursing teacher for 40 years and nursing education is her most interest during these years.

Raise the bar; a strategy to facilitate optimal patient safety through staff self-care

Mrs Louise Veitch1

1Calvary Public Hospital Bruce, Bruce, Australia

The Emergency Department is a dynamic, high tempo and challenging healthcare setting, presenting obstacles and opportunities that can influence patient safety through communication, leadership and workplace culture.

Introducing a distinctive evidenced-based initiative into the Emergency Department at Calvary Bruce Public Hospital aims ultimately to improve patient safety by utilising multimodal clinical education, accompanied by an uptake of accountability and self-awareness from all levels of nursing staff, precipitated uniquely through increased engagement of self-care amongst nursing staff.

From the commencement of an undergraduate nursing degree, students are taught to approach patients and patient care in a holistic manner; it makes sense then that nurses be encouraged to look after themselves and each other in the same manner. Self-awareness enables the identification and discussion of barriers and enablers to practice change and when combined with self-care, leadership and communication training, organisational culture and patient safety improve.

When staff have a voice, in addition to feeling valued and appreciated, an improved workplace performance is inevitable. Raise the Bar is an initiative that enables staff of all levels and experience to be actively involved in quality improvement within the Emergency Department and celebrates the differing perspectives, expertise, backgrounds and dynamics of staff in a respectful and genuine manner, leaving no room for the ‘eat your young’ mentality.

It is known that patient safety has three primary contributors; leadership, communication and organisational culture and by engaging staff on these contributors, improvement across all areas will be seen. As staff become further engaged, a prospect will exist to optimise patient safety and workplace culture through teaching and learning opportunities both horizontally and vertically within the Emergency Department hierarchy. The increased engagement of clinical education will result in optimal patient safety as the link between learning strategy and self-efficacy is established.


Biography:

Louise is an Emergency Nurse and member of the MET, Advanced Practice Nursing and Clinical Manager teams at Calvary Public Hospital Bruce, and has a particular interest in workplace culture, patient safety and quality improvement in the Emergency Department. Louise is has completed a Master of Clinical Nursing (Emergency) through the University of Tasmania and is currently studying a Graduate Certificate in Clinical Education through Australian Catholic University.

Multidisciplinary communication to support nurse-to-nurse handover at patient transfer from the Emergency Department to acute medical ward

Mr Darcy O’Connor1, Dr  Bernice  Redley1,2, Dr Helen Rawson1,2

1Deakin University, Burwood, Australia, 2Monash Health, Clayton, Australia

Background

Little is known about how goals for multidisciplinary team communication, as specified by Australian national safety standards, are operationalised during clinical handover when complex patient care is transferred from the Emergency Department (ED) to an acute medical ward. This research examined nurses’ communication of multidisciplinary care during the transfer of complex patients from the ED to acute medical wards.

Methods

The naturalistic, mixed-methods design used observation, audit and interview data collected from a convenience sample of 38 nurses involved in transfer of care for 19 complex patients from the ED to medical wards at a single tertiary hospital, and a focus group with 17 multidisciplinary clinicians.

Results

Each complex medical patient was seen by 3 to 6 different health professionals in the ED, but this was seldom communicated between nurses during the transfer of ongoing responsibility for patient care to the ward. Observations identified over 90% of handovers included at least three of the four Connect, Observe, Listen and Delegate (COLD) steps in the patient transfer processes. However, inconsistent practices, duplication and gaps in handover communication negatively impacted the efficiency of transfers and effective delegation of responsibility for ongoing care. Practices known to increase patient risk were observed in over half (53%) of the patient transfers.

Conclusions

Gaps in communication of multidisciplinary care and behaviours inconsistent with best practice recommendations contributed to safety risks for complex patients during transfer of their care from the ED to acute medical wards. Organisational policies, interdepartmental relationships and tensions between meeting demands for efficiency and quality also contributed to risk.


Biography:

Darcy completed his Bachelor of Nursing with Federation University in  2016. In 2017 he completed a graduate program with Monash Health working in geriatrics and rehabilitation, and the Emergency Department. His passion for emergency care lead him to complete a Bachelor of Nursing (Honours) with Deakin University in the field of communication of multidisciplinary during transitional phases of  ED care.

Implementation of Safewards into 3 Victorian Emergency Departments: What we adapted and how

Ms Monique Rosenbauer1, Ms  Ashleigh Ryan2, Dr Cathy Daniels3, Prof Marie Gerdtz3, Ms Marisol Corrales4

1Bendigo Health, Bendigo, Australia, 2Peninsula Health , Frankston, Australia, 3University of Melbourne, Carlton, Australia, 4Department of Health and Human Services, Melbourne, Australia

Safewards is an internationally acclaimed model aimed at reducing harm (conflict) and reducing the restrictive response to events that can lead to harm (containment),  while promoting safety. The Safewards model originated in the UK, and following a successful trial was rolled out to all mental health services in Victoria, Australia. Staff and patients reported increased engagement, safety and confidence in preventing conflict, or reducing its impact. The results also demonstrated a reduction in the use restrictive interventions, which are known to cause harm to patients and staff.  The need for a similar change in Emergency Departments (ED) was highlighted, and in July 2018, the Safewards in the ED trial commenced.

The Safewards ED pilot focuses on improving outcomes and experiences for patients presenting to ED and staff.  The model also aims to address increasing rates of occupational violence in an environment where patients are often acutely unwell on arrival, length of stay is short, turnover is rapid, and time to build rapport is limited.  The ten ED Safewards interventions have been adapted to reflect this unique environment.  Each intervention is designed to reduce ‘flashpoints’, or situations that may lead to conflict.  Using an exploratory model, staff and patients in the ED have been challenged to look for ways of improving their interactions and enhancing their environment, using creative and simple measures.

This paper will outline how an evidence based and adaptable model is being implemented to a new environment, with a new patient population.   The model’s potential impact on staff culture, de-escalation skills, collaboration, and language will also be explored.  The 10 interventions and exploring the impact of Safewards in ED has not been previously reported. This paper will describe the 10 skill based interventions, challenges, opportunities and the innovative nature of this intervention in the ED setting.


Biography:

Monique Rosenbauer and Ashleigh Ryan are project leads for the two sites undertaking the Safewards in Emergency Department (ED) pilot project. Monique is a Mental Health Nurse and Social Worker in the Bendigo Health ED and Ashleigh a Clinical Nurse Specialist in the Frankston ED at Peninsula Health. Together they have many years of working with and supporting patients and their families who have complex health and/or safety needs, high risk concerns and vulnerability. They are currently working together to creatively adapt the success of Safewards in mental health inpatient units to the ED environment.

The Academic and Professional features of Australian post-graduate emergency nursing programs

Ms Tamsin Jones1, Professor Ramon Shaban1,2, Professor Kate Curtis1

1Sydney Nursing School, University of Sydney, Sydney, Australia, 2Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, Westmead Institute for Medical Research, Australia

Background: Emergency nursing is unique. Patients of any age present to emergency care environments, generally undiagnosed, and thus there is gross need for suitably trained emergency nurses to safely and efficiently assess and manage care. Staff working in rural and remote areas are further challenged with limited staff and facilities, yet are still required to assess and manage undiagnosed and potentially life-threatening patient complaints. Specialist education in emergency nursing contributes to the skilled workforce, that ultimately improves patient outcomes however preliminary studies indicate there is variability in Australian graduate programs.

Method: A document analysis of all Australian post-graduate emergency programs was conducted in September 2017. These findings informed the development of semi-structured interviews. All Australian post-graduate emergency nursing course conveyors (n=14) were identified and semi-structured interviews were conducted with 13 key informants in 2018. Interview data was analysed using a five-step framework approach.

Results: Eight key characteristics were identified and aligned to academic or professional features. Five academic features were determined: course entry, funding sources, mode of program delivery, volume of learning and clinical assessments. Three professional characteristics were found: employment requirements, expectations of the graduate and influence of industry and professional engagement

Discussion: The findings are the first documented academic and professional characteristics of graduate emergency nursing programs across Australia. In the absence of nationally defined graduate emergency nursing outcomes and attributes, it is plausible that the effect of these variances could impact workforce and patient safety.

Conclusion: The findings further support the need for the establishment of minimum practice standards for Australian graduate emergency nursing programs.


Biography:

Tamsin is a PhD Candidate at the Sydney Nursing School, University of Sydney. Her PhD is seeking to develop minimum practice standards for students who complete their post-graduate studies in emergency nursing. When not working on her PhD, Tamsin works as an academic in a Victorian university and casually in a Melbourne ED. Tamsin is also kept very busy with her three three young children, husband and fur child.

The characteristics and attributes of waiting room nurses

Kelli Innes1,2, Professor Doug Elliott1, Professor Debra Jackson1, Associate Professor Virginia Plummer2,3

1University of Technology Sydney, Faculty of Health, Ultimo, Australia, 2Monash Nursing and Midwifery, Monash University , Frankston, Australia, 3Peninsula Health, Frankston, Australia

Introduction

The emergency department waiting room has long been a challenging environment for patients and staff. In response to these challenges, care of patients has expanded to incorporate the waiting room. Key aims of the role are to decrease waiting times by commencing early interventions, monitor patients for clinical deterioration and enhance communication. There is a paucity of literature and research exploring the role.

Method

A mixed methods, multi-phase study explored the implementation of the emergency department waiting room nurse. In Phase One nursing key informants who implemented the role were interviewed; Phase Two observed waiting room nurses in clinical practice and Phase Three surveyed emergency nurses about the role and their perceptions.

Results

The integrated results of the study identified five essential characteristics that waiting room nurse should possess to effectively perform the role – experience and preparation; communication; assessment and monitoring; being a clinical decision-maker; and patient focused.

From these characteristics, nine key attributes were identified as being important for the waiting room nurse to be effective and efficient in the role – competent; confident; knowledgeable; proficient in assessment skills; autonomous; patient advocate; clinical decision-maker; highly developed communication skills; focus on patient safety, care quality and patient-centred care.

Conclusion

By possessing these essential characteristics and attributes the waiting room nurse can effectively and efficiently perform the role contributing to the delivery of safe, quality care and patient safety.


Biography:

Kelli is an experienced emergency nurse and nurse educator. She is currently employed as a Senior Lecturer at Monash Nursing and Midwifery teaching in both the undergraduate program and the postgraduate emergency nursing stream. She has recently completed her PhD from which this presentation arises.

Improving the knowledge and skills of emergency department and mental health nurses to work therapeutically with patients who self-injure

Dr Irene Ngune1, Mrs Carrie Janerka1, Prof Diane Wynaden1, A/Prof Penelope Hasking1, Prof Clare Rees1, A/Prof Karen Heslop1, Dr Shirley McGough1

1Curtin University, Bentley, Australia

Non-suicidal self-injury (NSSI) falls within the spectrum of self-harm and includes behaviours such as cutting the skin and self-battery. NSSI generally begins around 14 years of age, with representations to hospital common. Increased frequency of self-injury has been linked to an increased risk for accidental death. Nurses who are skilled to work with people who self-injure can provide compassionate and professional care, hence reducing the person’s potential for future self-injury admissions.

Aim: The purpose of this study was to explore emergency department (ED) and mental health nurses’ understanding and experiences of working with people who present because of self-injury, and identify strategies that can enhance care for this group of patients.

Method: An online survey of emergency and mental health nurses across Australia. Participants’ knowledge, attitude and confidence in managing people who self-injure were measured.

Findings: A sample of 101 nurses (78% female; mean age = 41.96, SD = 11.42), including 54 ED nurses and 47 mental health nurses completed the survey. There was no significant difference in knowledge of NSSI between mental health and ED nurses (81.1% vs. 79.5%). Both groups of nurses had low negative attitude and high positive empathy however, mental health nurses perceived to have a less negative attitude (p=0.034), more confidence (p=0.000) and higher empathy (p=0.000) in caring for patients who self-injure than ED nurses. Knowledge was positively correlated with empathy (r=0.366, n=92, p=0.000) and confidence (r=0.373, n=92, p=0.000), but was negatively correlated with attitude (r=-0.539, n=92, p=0.000). Nurses with 6-10 years of specialty nursing experience were shown to have the highest levels of knowledge, attitude and confidence.

Conclusion: Further exploration of factors which impact nurses’ attitudes towards NSSI, particularly those with >10 years experience is required. Results of this study could inform future training for ED and mental health nurses.


Biography:

Carrie is a Lecturer at Curtin University for the Graduate Certificate in Critical Care Nursing, and a Clinical Nurse at Fiona Stanley Hospital ED. She has over 15 years of emergency nursing experience in tertiary, rural and remote settings, and specialises in emergency nursing education. Carrie has completed a Master of Clinical Nursing (Emergency) and is currently embarking on a PhD. She is involved in emergency nursing research, instructs on a trauma course and is a member of various CENA Committees.

Patient education in the Emergency Department: What’s going on?

Mrs Nicole Coombs1

1Federation University Australia, Churchill, Australia

Patient education is paramount in professional nursing practice as well as ensuring patient safety and empowerment. Much research has occurred in the field of patient education regarding practices and techniques as well as patient comprehension and compliance, but limited studies have been conducted specifically in the Emergency Department (ED) setting. A scoping review of the literature was conducted to explore a generalised view of the existing barriers to effective patient education in this unique healthcare environment. Despite some progress being made in patient education techniques and technologies, evidence suggests health promotion and patient education practices in general may be stagnating within the ED.

Many new education practices and delivery techniques have been explored and tested, yet current study outcomes still highlight issues regarding poor patient comprehension and compliance. Findings from this review of the literature identified three important factors, each contributing to the challenges both patients and staff experience in either receiving or providing health information and discharge instructions. Various perspectives including, the patient (recipient), the staff (provider) and the organisation (environment) have been used to demonstrate the barriers to effective education and ultimately, how they influence patient safety outcomes.

The recommendations from this review include using a broader, collective lens to explore this area of nursing practice, and that solutions cannot come from one perspective alone. An increased recognition for the value of patient education is also needed within this critical care environment, not only in progressing practice, but in order to improve patient safety and health outcomes.


Biography:

Nicole has been employed as a lecturer at Federation University Australia – Gippsland campus since 2015 and is passionate about Teaching and Learning. By sharing her knowledge and clinical experience as an emergency nurse, she is able to highlight the connections of both critical care and Primary Health, aiming to reduce the perception of a ‘great divide’ between the two. Teaching future nurses the importance of preventative practice rather than curative practice, is where her strengths lie.  Having already obtained a Masters in Nursing, she is now undertaking her PhD studies in the field of patient education in the emergency department. She has several publications in the areas of nurse and patient education in both Primary Health and Emergency fields.

Escalating deteriorating patients’ care in the Emergency Department: Characteristics and safety culture

Mr Cliff Connell1, Professor Ruth Endacott1, Professor Simon Cooper2

1Monash University, Frankston, Australia, 2Federation University, Churchill, Australia

Background: Physiological deterioration in patients is often heralded by clinical features such as abnormal vital signs and declining conscious state. Rapid Response Systems (RRS) have evolved to help recognise and stabilise patients experiencing clinical instability in general acute medical and surgical wards. More recently, there has been an increasing uptake of emergency department (ED) specific responses to patient deterioration. The prevalence of deterioration and the effectiveness of ward based RRS are well documented in the ‘Failure to Rescue’ (FTR) literature. However, the characteristics affecting FTR in ED specific RSS is are largely unknown.

Aim: To describe the relationships between dynamic ED characteristics (workload, skillmix and casemix), organisational culture (safety climate) and the care of the deteriorating ED patient.

Methods: Mixed methods comprising a safety climate survey, retrospective medical record review and staff interviews.

Results: Failure to rescue deteriorating ED patients is influenced by i) the safety culture within the ED, ii) the experience and expertise of the person documenting signs of deterioration, iii) staff self-confidence and confidence in others, iv) communication and team interaction, v) the ED area in which the patient is being cared for, vi) the interpretation and implementation of care based on the health services and national performance indicators, vii) education which is provided to support ED staff efforts to recognise and manage deteriorating patients, and viii) the vital sign which indicates physiological deterioration.

Conclusion: This study provides key recommendations for emergency practice and research priorities for recognising and managing deteriorating ED patients. These recommendations include i) site specific cultural evaluation and change, ii) educational strategies which include regular interprofessional in situ simulation based on ED specific deterioration scenarios, and iii) recommendations for the roles and responsibilities of ED response teams, and an ED specific track and trigger system befitting the ED patient profile.


Biography:

With more than 30 years nursing experience, Cliff Connell has spent the last 20 years as an emergency nurse, ED clinical nurse educator, university lecturer and researcher. Currently a Monash Nursing and Midwifery lecturer and PhD candidate, Cliff’s research interests focus on patient safety, deteriorating patient outcomes, emergency care and evidence-based education.

Know the flow: A mixed-method analysis of patient flow through a regional ED

Alex Pryce1,2, Maria Unwin1,2, Leigh Kinsman1,2, Damhnat McCann2

1Tasmanian Health Service, 2University of Tasmania

Introduction

The equivalent of one in three Australians present to an Emergency Department (ED) in a single 12-month period. The increasing demand for ED care and ED crowding has heightened focus on the movement of patients through the ED (ED patient flow). We set out to map the patient flow through a regional ED in a 300-bed hospital with the aim of recording the movement of patients through the input, throughput, and output phases, and identifying factors contributing to extended ED length of stay.

Methods

We undertook a mixed methods study based on retrospective presentation data, prospective observational data and a subsequent focus group with the observers based in a regional Tasmanian hospital ED.

Results

Key findings identified from the retrospective analysis of 89,013 ED presentations and observational data from 382 patient journeys included: arrival numbers were not a predictor of ED crowding; waiting times at triage and in the waiting room created significant risks to patient safety; ED crowding triggers the use of ‘makeshift’ space to assess and treat patients; and access block is the major contributor to crowding. Analysis from the focus group identified four key themes: coping under pressure, compromising care and safety, makeshift spaces, and makeshift roles.

Discussion

Our mixed methods observational study revealed an environment of crowding and chaos that impacted patient flow and compromised patient and staff safety. Despite this, ED staff maintained outstanding standards of care.

This presentation will highlight key findings and stimulate discussion regarding the need for strategies to address ED crowding that address contributing factors external to ED.


Biography:

Alex Pryce is a Associate Nurse Unit Manager (ANUM) at the LGH ED. Alex lives in Launceston and enjoys camping with her young family, lego building, mountain biking and running. In her spare time she dabbles in tutoring for the University of Tasmania School of Nursing and assisting in the high fidelity simulation lab for the Launceston Clinical School.