Assoc Prof Jed Duff

Background: Although cardiac rehabilitation (CR) is an effective secondary prevention strategy, it remains underutilized worldwide. Barriers to accessibility and adherence to traditional hospital-based programs have led to the development of alternative models, such as home-based CR, to improve healthcare delivery and patient outcomes. Objective: In this study, we aimed to map and synthesize evidence of effective home-based CR models for promoting secondary prevention in patients with coronary heart disease after percutaneous coronary intervention. Methods: Following the Joanna Briggs Institute methodology, we conducted a scoping review across 7 databases: Cochrane, CINAHL, Scopus, MEDLINE, Embase, PubMed, and Web of Science, and gray literature sources. The search included primary English-language articles published in the last decade, with an update extending to October 2024. Reviewers independently assessed eligibility, and data extraction followed the Template for Intervention Description and Replication and PRISMA guidelines. Results: Among the 3296 initially identified articles, 23 met the inclusion criteria. The identified home-based CR models varied in duration (6 weeks to 6 months) and used a range of technological tools, such as Internet platforms and telecommunication, for exercise supervision and patient communication. These programs include supplementary equipment and educational resources to enhance patient self-efficacy and cardiovascular disease awareness. Conclusions: All identified home-based CR models showed positive patient outcomes, with high program enrollment and adherence to secondary prevention measures. Further research is needed to compare different home-based CR models and assess their feasibility in diverse settings.

Aim: To investigate self-reported health literacy levels, learning preferences and knowledge resource needs of Australian elective surgery patients. Background: Surgery contributes significantly to global health care, but surgical waitlists, cancellations and delay remain major challenges for health care systems. Pre-operative preparation and patient education about the surgical journey are essential to reducing these disruptions. Unfortunately, preparation and education are limited by short timeframes and one-size-fits-all approaches. Limited information exists about Australian surgical patients' health literacy levels, learning preferences and knowledge resource needs. Design and methods: This cross-sectional waiting room survey investigated patient health literacy, preferred education mode and learning styles among elective surgery patients. Data were collected from patients using existing validated questionnaires and open-text questions. Quantitative data were analysed descriptively, and qualitative data were themed using an iterative open-coding approach. The study is reported using the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) guidelines. Results: The study had 100 participants, 68 living in metropolitan areas, 93 having access to a smartphone and 62 possessing adequate health literacy levels. The top surgical challenge was understanding preparation and recovery instructions. Most participants were visual learners preferring face-to-face, digital formats, booklets or leaflets to receive educational information. Half of the participants sought additional surgical preparation information; of those, 60 per cent used the internet. Conclusion: This study found that many Australian surgical patients have limited health literacy, prefer visual learning and seek information outside of hospital resources. These findings suggest that clinicians should engage with patients to tailor education, provide different forms of learning materials and explore digital formats for education. Patient or public contribution: This study was designed using insights from a patient representative during intervention development.

Objectives: This study aimed to evaluate adherence to secondary prevention measures and to identify barriers to cardiac rehabilitation enrolment among patients with coronary heart disease after percutaneous coronary intervention. Methods: An observational cross-sectional survey was conducted through computer-assisted telephone interviews to assess recently treated percutaneous coronary intervention patients at the Prince Sultan Cardiac Center in Saudi Arabia. Results: Out of 104 surveyed patients with coronary heart disease, 85 (82%) were male, with an average age of 59.5 years. The obesity rate was 28% (n = 29), with a high prevalence of comorbidities: 82 (79%), 63 (61%), and 62 (60%) patients had hyperlipidemia, diabetes, and hypertension, respectively. Despite high medication compliance (97%), adherence to secondary prevention measures was low (21%). Adherence to physical exercise and weight monitoring for fluid body build-up was notably poor at 35% and 9%, respectively. Only 11 (10.6%) patients were referred for cardiac rehabilitation, of whom only four (36.4%) attended. Significant barriers such as a lack of staff contact, insufficient physician support, and distance to cardiac rehabilitation facilities were particularly noted by 69% of rural patients. Conclusions: This study underscores the significant cardiac risk factors and low adherence to secondary prevention measures among post revascularization patients with coronary heart disease in Saudi Arabia. Low referral and other organizational barriers, as well as the travel distance to hospital-based cardiac rehabilitation, hinder program enrolment. To improve cardiac rehabilitation accessibility, it is crucial to revise the discharge plans, implement automated referral systems, expand the services across all regions, and utilize alternative delivery models.

In the perioperative environment, the safety and wellbeing of nursing staff are paramount for ensuring the delivery of high-quality, safe and sustainable health care services. Various factors contribute to the wellbeing of perioperative nurses, and significantly influence their decisions to stay in their current roles or seek employment elsewhere. The implications of high turnover rates among perioperative nurses extend beyond individual job satisfaction to encompass broader consequences for hospital systems, including compromised quality of patient care and increased operational costs. While the existing body of research on the wellbeing of perioperative nurses is relatively limited, available findings underscore the critical importance of staff wellbeing within the health care sector. These findings highlight the urgent need for proactive initiatives to promote the wellbeing of perioperative nursing professionals. This discussion paper aims to comprehensively explore wellbeing within the context of perioperative nursing. It will delve into the various domains and characteristics of wellbeing related to perioperative nurses, shedding light on the intricate relationship between wellbeing and turnover intentions in this specialised nursing setting. Furthermore, the paper will discuss current interventions designed to promote the wellbeing of nurses.

Aim: To explore the barriers and facilitators influencing emergency department clinicians' adherence to the Australian Peripheral Intravenous Catheter (PIVC) Clinical Care Standard, using the Behaviour Change Wheel (BCW). Background: Suboptimal PIVC practices are frequently linked to a range of patient-important adverse outcomes. The first Australian Peripheral Intravenous Catheter Clinical Care Standard was introduced in 2021, aiming to standardize practice. However, a recent national survey revealed a lack of adherence to the Standard among emergency department clinicians. Design: A qualitative descriptive study. Method: The study was conducted across two Australian emergency departments in 2023. Utilizing purposive sampling, semi-structured interviews were conducted. The analysis incorporated both deductive and inductive approaches, mapping the findings to the BCW. Findings: Interviews with 25 nurses and doctors revealed nine key subthemes. The main barriers were the stressful environment, insufficient education and training, and the absence of a feedback mechanism. The main facilitators were recognition of suboptimal practice, belief in the importance of patient engagement, and the desire to improve practice. Conclusion: Multiple complex factors have an impact on clinicians' adherence to the Standard. The identified interventions will serve as a guide for future implementation of the Standard. Implications for the Profession and Patient Care: The findings inform healthcare organizations of the significance of implementing strategies to enhance clinicians' acceptance of the Standard. Clinicians should consider incorporating the multifaceted interventions developed in accordance with the BCW for future implementation projects. Impact: Promoting adherence to standards opens avenues to challenge suboptimal practice and has the potential to instigate a culture shift in the fundamental skills of frontline clinicians. Reporting Method: The study is designed and reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: No patient or public contribution.

Background: Surgery accounts for 30 % of the global disease burden, but healthcare systems struggle with managing surgical waitlists, optimising operations, and minimising cancellations, leading to poor patient outcomes and financial strain. E-health technologies offer promising solutions to enhance perioperative care and improve surgical outcomes, yet their integration faces significant organisational and structural challenges. This paper aims to explore and analyse the perspectives of decision-making personnel regarding the challenges and opportunities of implementing a surgery support e-health application. Methods: This study utilised an explorative qualitative approach, employing a rapid cycle qualitative evaluation informed by the NASSS framework. Data were collected through individual semi-structured interviews with decision-making personnel conducted. Framework analysis guided by the NASSS framework was used to analyse the interview transcripts. Results: A total of 15 participants from public health and external organisations participated in the study. The analysis, framed by the seven domains of the NASSS framework, critical challenges in integrating new health technologies, emphasising the need for compatibility, cybersecurity, and demonstrating clear benefits. Key factors for successful adoption included early and continuous stakeholder engagement, organisational readiness, and ongoing support. Additionally, participants highlighted the importance of centralised information systems and continuous adaptation of health IT solutions to meet evolving needs. Conclusion: This paper reveals that implementing surgical e-health interventions is a complex process fraught with organisational, technical, financial, and political challenges, particularly due to insufficient end-user involvement and the intricate healthcare landscape. Despite the recognised benefits, successful implementation necessitates comprehensive stakeholder engagement and co-design approaches. Additionally, while a partnership between commercial vendors and public health developers presents an attractive solution, significant obstacles such as intellectual property disputes and resource allocation must be overcome.

Objective: This study aimed to investigate the prevalence of pre-operative anxiety in elective surgical patients at a major metropolitan hospital in Australia. Background: Globally, 310 million people are admitted for surgery every year. It is estimated that up to 80 per cent of these patients experience clinically relevant anxiety in the pre-operative period. Pre-operative anxiety can result in post-operative complications such as pain, delayed wound healing, surgical site infection, prolonged recovery and extended hospital stays. While preoperative anxiety has many negative consequences, this anxiety has often been overlooked in clinical practice. Methods: A prospective study was conducted between November 2021 and June 2022, involving 308 adult patients scheduled for elective surgery. Preoperative anxiety levels were measured using the Amsterdam pre-operative anxiety and information scale (APAIS), and age, sex and surgery type were collected. Results: In total, 308 patients were enrolled, more than half (58%, n=279) were women. The mean (± SD) APAIS score out of 20 was 8.69 (± 4.08). Almost one-third (32.4%, n=100) of patients had significant pre-operative anxiety (APAIS score > 11/20). Women were three times more likely to experience anxiety than men (OR=3.39, 95% CI 1.97¿5.82). Conversely, older patients were less likely to experience anxiety, with a reduction in anxiety of two per cent for each year above 18 years (OR=0.98, 95%CI 0.97¿0.99). Patients reported higher anxiety levels related to the surgery itself compared to the anaesthesia, with mean scores of 5.04 (± 2.48) and 3.65 (± 2.07) out of 10, respectively. More than half the patients (54.9%, n=169) reported needing more information about anaesthesia and surgery. Conclusions: Findings suggest that clinically relevant anxiety is common yet underdiagnosed. A higher prevalence is observed among females and those under the age of 30. The surgical procedure more than the anaesthesia was reported to cause higher anxiety. Relevance to clinical practice: Identifying the prevalence of high preoperative anxiety highlights the importance of routine screening and the use of a standardised assessment tool for accurate evaluation in clinical practice. Prioritising interventions for at-risk groups, such as women and younger patients, is imperative to mitigate the risks of post-operative pain, delayed wound healing, surgical site infection, prolonged recovery and extended hospital stays.

Background. Occupational violence (OV) is a significant workplace issue that affects 62% of healthcare workers globally. An Ambassador is a new role that focuses on preventing OV in healthcare settings. They proactively engage with patients and visitors, using behavioural strategies to redirect or de-escalate people who may be of concern. This pilot study evaluated the introduction of an Ambassador in an acute inpatient hospital setting. Methods. A cross-sectional multiple-method evaluation was conducted in three surgical wards in a major metropolitan hospital in Australia from December 2020 to February 2021. Data from security records, incident reports and staff surveys were collected before and during the pilot. The survey included multiple-choice and open-ended questions. Quantitative data were analysed in SPSS, and qualitative data were analysed using thematic analysis. Results. After the 3 month pilot, a significant decrease was seen in security calls (from 111 to 44, a decrease of 60%, ¿2 = 28.96, P < 0.001) and incident reports (from 20 to 6, a decrease of 70%, ¿2 = 7.54, P = 0.006). Staff surveys showed an increased awareness of OV as a workplace issue (from 60% to 82%, ¿2 = 7.65, P = 0.005). The qualitative analysis identified three main themes: professional roles and functions, key personnel characteristics, and suggestions for future implementation. Conclusions. An improvement was seen in the staff perception of safety and a reduction in organisational metrics related to OV. Future research is required to evaluate program effectiveness across different wards and settings. Application to practice. The success of the Ambassador program relies on selecting the right candidates, providing clear role descriptions, offering appropriate training and ensuring adequate support resources.

Introduction: Surgery plays a critical role in global health, often facing significant quality challenges such as high rates of postoperative complications, variability in patient outcomes, and inconsistencies in care pathways, due to the complex nature of the perioperative journey. The My Surgical Pathway (MSP) app is an e-health intervention designed to address these challenges by supporting self-management and integrated care throughout the entire perioperative journey. This study aims to describe the features and functions of MSP and report on the results of usability testing from both patients and healthcare workers. Methods: This mixed-methods study evaluated the usability of the My Surgical Pathway (MSP) app using quantitative surveys, qualitative feedback, and observation data from patients and healthcare workers. Structured 2-hour user testing sessions included interaction with the MSP app, completion of the User Version of the Mobile Application Rating Scale (uMARS), and think-aloud activities. Data analysis combined quantitative and qualitative insights to identify usability issues and inform potential improvements. Results: The mixed-method user-testing evaluation of the co-designed e-health intervention revealed high overall app quality scores, with an average of 4.50 out of 5. All user-type interfaces received mean scores above the minimum acceptability threshold of 3.0, demonstrating the intervention's efficacy in supporting patient surgery journeys, enhancing healthcare worker coordination, and meeting diverse user needs. Notably, the highest individual item scores were for credibility of source (4.92) and interactivity (4.85), highlighting the application's reliability and engaging nature. Conclusions: The study evaluated the 'My Surgical Pathway' (MSP) e-health intervention, co-designed with consumers and healthcare workers to support self-management of surgical care. Results indicate high user satisfaction, with an overall app quality score of 4.50 out of 5 on the uMARS tool. Users praised MSP's engagement, education, and responsiveness, highlighting its potential to improve patient experiences and clinician workflows. Recommendations for future research include expanding participant diversity and hospital settings, and employing longitudinal designs for a comprehensive evaluation.

Background: Defective, incorrect or missing procedural devices from the surgical set-up contribute to delay, interruption, cancellation and patient harm in the perioperative environment. Objective: This scoping review aims to identify evidence to guide approaches to surgical set-up used by perioperative health service personnel, organisations or teams. In addition, the review aims to describe factors that hinder or support the surgical set-up, identify gaps in the literature and determine any issues impacting the quality of available evidence. Methods: Empirical research and grey literature were retrieved from seven electronic databases. Titles and abstracts were screened before full text screening. A mixed method appraisal tool (MMAT) and quality improvement minimum quality criteria set (QI-MQCS) were used for critical appraisal. After data extraction from included studies, key concepts were synthesised, thematically analysed and reported. Results: Forty-nine full texts were included. Evidence generated by nurses responsible for the surgical set-up is limited. The majority of studies were quality improvement studies to reduce inefficiencies through optimisation or mathematical modelling with outcomes measured in cost and time saved. There is limited evidence exploring how optimisation or mathematical modelling impacts the work of perioperative staff. Conclusion: Technology will continue to influence work systems and processes of the surgical set-up. Implementing surgical set-up quality indicators within policy may aid waste and cost reduction of organisations. The impact of human factors upon the surgical set-up is relatively unaddressed. Nurse-led research on the surgical set-up would be valuable as nurses are key professionals contributing to delivery of, management of and policy about surgical set up.

Purpose: Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. Methods: A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. Results: Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. Conclusion: Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. Trial registration: Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.

Objective: This scoping review aimed to identify and synthesise existing literature on patient-facing e-health interventions to support self-management and preparation for or recovery from surgery for adult patients. Introduction: Patients waiting for surgery often experience distress and uncertainty, which can lead to suboptimal surgical preparation and recovery. E-health interventions may provide new models of care to address these issues and maximise value-based healthcare. Inclusion criteria: Studies were included if adult patients utilised an e-health intervention to support self-management in preparation for and recovery from their surgery, with interventions targeting any perioperative phase. Methods: The review followed Joanna Briggs Institute methodology and included sources from 2010 onwards in MEDLINE, Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, Google Scholar and ProQuest. Four reviewers undertook screening and data was presented in tabular and diagrammatic form with a narrative summary. Results: From 2293 records, 48 papers with a total of 41 unique studies from 15 countries were included. Most interventions supported patients in the postoperative phase only for bowel/colorectal cancer surgery and total hip arthroplasty Quality was generally good to average, with limitations including small sample sizes, single-centre studies, and a failure to include a comparison group. Just 35 % of interventions were codesigned with input from patients during the development process. Development and evaluation methods were workshops (17 %) and unvalidated attitudinal studies (65 %), respectively. E-health interventions showed positive impacts on clinical outcomes (54 %), user satisfaction (65 %), utilisation of the interventions (46 %), and health system outcomes (24 %). Conclusions: E-health interventions for self-management of surgery preparation and recovery were prevalent in 15 countries, but mostly focused on postoperative support and lacked input from end-users during development. Future studies should address these limitations by creating applications that support patients from all surgical specialities and involving patients and families in the development process.

Opioid analgesics prescribed for the management of acute pain following orthopaedic surgery may lead to unintended long-term opioid use and associated patient harms. This study aimed to examine the prevalence of opioid use at 90 days after elective orthopaedic surgery across major city, regional and rural locations in New South Wales, Australia. We conducted a prospective, observational cohort study of patients undergoing elective orthopaedic surgery at five hospitals from major city, regional, rural, public and private settings between April 2017 and February 2020. Data were collected by patient questionnaire at the pre-admission clinic 2¿6 weeks before surgery and by telephone call after 90 days following surgery. Of the 361 participants recruited, 54% (195/361) were women and the mean age was 67.7 years (standard deviation 10.1 years). Opioid use at 90 or more days after orthopaedic surgery was reported by 15.8% (57/361; 95% confidence interval (CI) 12.2¿20%) of all participants and ranged from 3.5% (2/57) at a major city location to 37.8% (14/37) at an inner regional location. Predictors of long-term postoperative opioid use in the multivariable analysis were surgery performed at an inner regional location (adjusted odds ratio 12.26; 95% CI 2.2¿68.24) and outer regional location (adjusted odds ratio 5.46; 95% CI 1.09¿27.50) after adjusting for known covariates. Long-term opioid use was reported in over 15% of patients following orthopaedic surgery and appears to be more prevalent in regional locations in Australia.

Objectives To develop a consensus on evidence-based principles and recommendations for perioperative hypothermia prevention in the Australian context. Design This study was informed by CAN-IMPLEMENT using the ADAPTE process: (1) formation of a multidisciplinary development team; (2) systematic search process identifying existing guidance for perioperative hypothermia prevention; (3) appraisal using the AGREE II Rigor of Development domain; (4) extraction of recommendations from guidelines meeting a quality threshold using the AGREE-REX tool; (5) review of draft principles and recommendations by multidisciplinary clinicians nationally and (6) subsequent round of discussion, drafting, reflection and revision by the original panel member team. Setting Australian perioperative departments. Participants Registered nurses, anaesthetists, surgeons and anaesthetic allied health practitioners. Results A total of 23 papers (12 guidelines, 6 evidence summaries, 3 standards, 1 best practice sheet and 1 evidence-based bundle) formed the evidence base. After evidence synthesis and development of draft recommendations, 219 perioperative clinicians provided feedback. Following refinement, three simple principles for perioperative hypothermia prevention were developed with supporting practice recommendations: (1) actively monitor core temperature for all patients at all times; (2) warm actively to keep body temperature above 36°C and patients comfortable and (3) minimise exposure to cold at all stages of perioperative care. Conclusion This consensus process has generated principles and practice recommendations for hypothermia prevention that are ready for implementation with local adaptation. Further evaluation will be undertaken in a large-scale implementation trial across Australian hospitals.

Objectives: Clinical research continues to build knowledge that can potentially improve clinical and health service outcomes; however, integrating evidence into routine care is challenging, resulting in a knowledge practice gap. The field of implementation science is a resource available for nurses to translate evidence into their practice. This article aims to provide nurses with an overview of implementation science, illustrate its value integrating evidence into practice, and show how it can be applied with high rigor in nursing research practice. Data Sources: A narrative synthesis of the implementation science literature was conducted. A series of case studies were purposively selected to demonstrate the application of commonly used implementation theories, models, and frameworks across health care settings relevant to nursing. These case studies demonstrate how the theoretical framework was applied and how the outcomes of the work reduced the knowledge practice gap. Conclusion: Implementation science theoretical approaches have been used by nurses and multidisciplinary teams to better understand the gap between knowledge and practice for better informed implementation. These can be used to understand the processes involved, identify the determinants at play, and undertake an effective evaluation. Implications for Nursing Practice: By using implementation science research practice, nurses can also build a strong foundation of evidence about nursing clinical practice. As an approach, implementation science is practical and can optimize the valuable nursing resource.

Aims: To examine the effectiveness of nonpharmacological interventions for the reduction of post-operative pain in patients undergoing ambulatory surgery (also known as day surgery). Background: Post-surgical pain remains prevalent, especially in day surgery cases. When poorly managed, this acute pain can lead to chronic pain and delayed recovery. Nowadays, several nonpharmacological regimens are available for reducing pain after ambulatory surgery. Further investigation is required to assess the quality of these alternatives. Design: Systematic review Methods: An electronic search of PubMed, CINAHL (via EBSCOhost), Embase, and Cochrane library was undertaken to screen and assess the studies of nonpharmacological intervention in reducing post-operative pain in ambulatory surgery. Inclusion criteria covered randomised controlled trials (RCTs) on patients undergoing day surgery in which the patients received nonpharmacological intervention for post-operative pain management. This review excluded studies published more than 25 years ago, studies using languages other than English and Bahasa Indonesia, and case reports, conference abstracts and review articles. Results: Four eligible studies provided drug-free interventions for reducing pain after day surgery; the interventions included foot massage, acupuncture, audio¿visual relaxation tools delivered by mobile technology and digital video discs (DVDs). There were varying respondents and tool assessment characteristics, especially in pain level instruments and pain outcome indicators across the studies. The risk of bias found in the studies was mainly associated with incomplete data and selective reporting. Although some studies showed less significant statistical results, the mean difference in the intervention arms showed meaningful effectiveness. Conclusion: The appropriate application of nonpharmacological interventions might reduce patient pain levels after day surgery. High-quality RCTs and specific follow-up studies are needed to investigate the effectiveness of each intervention for post-operative pain reduction.

Background: The surgical count process is currently the recommended strategy for preventing unintentionally retained surgical items (RSIs) in Australia. Despite this, RSIs still occur and remain an internationally recognised issue and sentinel event associated with morbidity and mortality. There are numerous new and emerging strategies to prevent inadvertent RSIs, apart from the surgical count, and many involve the use of technology. These strategies are not currently specified in Standards for Perioperative Nursing in Australia (the ACORN Standards). Aim: To provide an integrative synthesis of the literature to identify current and emerging strategies for preventing RSIs during surgical procedures. Design: An integrative review process was undertaken. Method: The literature search was conducted in the CINAHL, ClinicalKey and Medline databases and included primary research papers of any design about RSIs and prevention strategies in humans that were published in English between 2008 and 2022. Data was extracted and developed into a table. Quality assessment was undertaken using the Mixed Method Assessment Tool (MMAT). Findings: Based on the inclusion and exclusion criteria, 186 articles were screened and 18 studies were included following quality assessment. Data were grouped into categories according to the prevention strategies of surgical count, radiography, radiofrequency technology, barcode technology and other technologies. Conclusions: RSIs occur despite the mandated use of the surgical count, a human-based process. The use of adjunct, technological prevention strategies is not yet feasible as more research is needed into efficacy and cost-effectiveness.

Background: Surgical Conscience is a unique concept that is central to the clinical practice of perioperative nurses. It is an abstract phenomenon that explains a nurse's moral obligation to safeguard surgical asepsis and patient safety. Despite being deeply rooted in perioperative tradition, the phenomenon is poorly understood and inadequately described. Aim: To generate insight into the phenomenon of Surgical Conscience by interpreting the experiences and perceptions of perioperative nurses. Methods: Semistructured in-depth interviews were conducted with 15 Australian perioperative nurses. Interview transcripts were reviewed to identify themes and patterns within the experiences and perceptions of the participants. These were then synthesised into a conceptual model of Surgical Conscience. Findings: Surgical Conscience was defined as 'the moral obligation to uphold and defend surgical asepsis and perioperative safety no matter the cost or consequence'. The conceptual model illustrates that a Surgical Conscience is dependent on the presence of three constructs: consciousness (knowing), conscience (feeling), and agency (acting) and is moderated by contextual factors such as education, training, mentorship, environment, culture, and support. Discussion: New insight into this phenomenon makes it evident that nurturing a Surgical Conscience requires a multifaceted approach that targets each of the constructs (knowing, feeling, acting) and the contextual factors. Conclusion: To optimise surgical asepsis and patient safety, perioperative leaders should evaluate their staff and department against the conceptual model and develop an evidence-informed program to address identified deficits.

Background: In the context of performing resuscitation, research has demonstrated that provider confidence and stress levels are related to patient survival outcomes. Virtual reality (VR) offers innovative simulation training opportunities to improve confidence and reduce stress. Method: Whittemore and Knafl's (2005) integrative review method was used. An electronic database literature search and evaluation of studies using the BEME critical appraisal tool yielded five papers for this review. Results: Four studies examined confidence and one stress. Identified themes included: Variation in virtual reality intervention; Timing of measurement outcome; and variation in VR interactivity. Conclusion: Confidence was noted to generally increase through the use of VR across the studies reviewed, with no significant impact on stress outcomes. Differences in study heterogeneity reflects that further research is required to determine if the use of VR technologies impacts on confidence and stress in resuscitation training.

Background: Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective: The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods: The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the "following a thread" approach. Results: For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions: Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program.

Background: A definitive cost analysis of preventing inadvertent perioperative hypothermia (IPH) in surgical patients in Australia is lacking. Preventing IPH is a common nurse-led initiative in surgery and cost savings represent the value of nursing care. Aim: The study aims are twofold. First, we aim to estimate the cost of the current prevalence of IPH in Australian hospitals. Second, is to estimate the potential cost reductions that could be realised by reducing IPH prevalence by using a thermal care bundle. Methods: Cost-of-illness analysis measures the economic burden of illness to society. It does so by identifying and measuring all costs of a disease or illness such as IPH. It was undertaken using a prevalence approach and a one-year time horizon. Findings: The annual costs of IPH to the Australian health system can be estimated to be $1,259,725,856. The annual net benefit of IPH prevention to the Australian health system is $602 million. Using a thermal care bundle to reduce IPH by actively warming 80% of the patients that are not warmed yet could save $657.1 million per year at the expense of $18.4 million. Discussion: Preventing IPH using active warming is estimated to lead to significant cost savings across the Australian health system. It is recommended that a national policy for preventing IPH is needed and guidelines must reflect up-to-date strategies for preventing IPH including active prewarming. Conclusion: The Thermal Care Bundle should be adopted to lower IPH incidence and associated costs in Australia.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Background: More than 300,000 babies are born in Australia each year, with almost 20% of newborns requiring some form of neonatal resuscitation at birth. The most common first responders to a neonatal resuscitation emergency are midwives. While the Australian and New Zealand Council on Resuscitation guides midwives' practice during a neonatal resuscitation, each state and territory uses varying strategies to train and assess midwives proficiency in neonatal resuscitation. Aim: To examine the neonatal resuscitation training requirements for midwives and raise awareness for the lack of consistency in training in Australia. Discussion: A significant variation was found in the teaching methods and frequency of training for neonatal resuscitation across Australia. Neonatal resuscitation is mandated through a state-wide guideline or policy in only four of the states with seven formal neonatal resuscitation training programs used across seven states and territories. Although a multi-modal approach to learning is present in all of the programs, the combination of teaching methods differ. Conclusion and Recommendations: A standardised, evidence-based training program is required to ensure consistency in training for midwives in Australia. Multi-modal learning is common across all current training programs; however, the best combination of multi-modal teaching methods needs to be determined. Neonatal resuscitation training needs to occur at least annually, as recommended by the Australian and New Zealand Council on Resuscitation.

Background: Surgical patients with preoperative anemia are more likely to experience adverse outcomes. Patient blood management (PBM) guidelines recommend screening and treating patients for anemia preoperatively to enable optimisation before surgery. This study investigates compliance with PBM guidelines and reports the association between length of stay and transfusion risk in patients with preoperative anemia. Study Design and Methods: A retrospective, observational, chart audit that included all patients having primary, total hip and knee replacement surgery between July¿ December 2018 at a tertiary, metropolitan healthcare facility. Results: Six hundred and seven patients patients were included, 96% (n = 583) patients had blood tests available (full blood count), and 8.1% (n = 49) had iron studies. Most patients 53% (n = 324) were screened between 2 and 6 days before surgery; 14.6% (n = 85) were anaemic preoperatively and only 5.9% (n = 5) of anaemic patients received treatment. Patients who had anemia preoperatively were more likely to receive a blood transfusion (odds ratio 8.65 [95% CI 3.98¿18.76]) and stayed longer in hospital (median difference = 1, ¿2LR = 17.2, df=1, p<0.007). Conclusion: Tests ordered for patients having major surgery should include iron studies, renal function, CRP and full blood count to enable detection and classification of preoperative anemia. Timing of screening relative to surgery needs to be sufficient to allow patient optimisation to occur. Appropriate treatment should be provided to anaemic patients to prevent unnecessary blood transfusions and reduce the length of stay. A standardised preoperative anemia pathway may assist in improving practice.

Introduction and aims: Patients undergoing major surgery risk significant blood loss and transfusion, which increases substantially if they have pre-existing anemia. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P) outline recommended blood tests and treatment to optimize patients before surgery. Documented success using PAIDSEM-P to reduce transfusions and improve patient outcomes exists, but the reporting quality of such studies is suboptimal. It remains unclear what implementation strategies best support the implementation of PAIDSEM-P. Method: Maximum variation, purposive sampling was used to recruit a total of 15 partici-pants, including a range of health professionals and patients for semi-structured interviews. Data analysis utilized a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. A modified version of the Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection. Results: The analysis revealed five barriers: access to knowledge and information, patient needs and resources, knowledge and beliefs about the intervention, available resources, and networks and communications, which had strong ERIC recommendations, including conduct educational meetings, develop educational materials, distribute educational materials, obtain and use patients/consumers family feedback, involve patients/consumers/family members, conduct a local needs assessment, access new funding, promote network weaving, and organize clinician implementation team meetings. Conclusions: Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAIDSEM-P and other evidence-based healthcare implementation problems more broadly.

Innovative, patient-centered mHealth interventions have the potential to help with the burden of chronic conditions. This review aims to describe the development of consumer mHealth interventions for chronic condition self-management. A scoping review methodology was used to search medical databases for eligible reports, published between January 1, 2010, and December 31, 2017, that provided information on consumer mHealth interventions for respiratory disease, cancer, diabetes, and cardiovascular disease. Twenty-one reports were included, representing the development of 14 mHealth interventions. Most were developed collaboratively, using user-centered and participatory design processes. Predesign work involved a thorough needs assessment, and redesign processes were described as iterative, engaging with usability testing and design improvements. Tensions from competing priorities between patients and healthcare professionals were uncovered, with the intention to develop a useful product for the patient while ensuring clinical relevance. This review provides clear evidence that consumer mHealth interventions are developed inconsistently even when engaging with participatory or user-centered design principles, sometimes without direct involvement of patients themselves. Further, the incomplete description of the development processes presents challenges to furthering the knowledge base as healthcare professionals need timely access to quality information on mHealth products in order to recommend safe, effective consumer mHealth interventions.

An interactive action research workshop was offered during the ACORN & ASIORNA Conference which was held in Adelaide in 2018. The purpose of the workshop was to explore the research evidence supporting ACORN's Standards for Perioperative Nursing in Australia, to identify gaps in the evidence related to standards and to explore challenges associated with the implementation of standards in clinical practice. The workshop also provided perioperative nurses with the opportunity to discuss their research interests and ask questions about undertaking research-focused degrees. Workshop participants provided an eclectic and credible range of issues related to the development and implementation of standards, underpinned by their concern for patient safety. In addition, the workshop outcomes have since provided the basis for the Research Committee to develop a research priorities survey to be distributed to the membership in the next 12 months.

Introduction In 2012 the Patient Blood Management (PBM) guidelines were published by the National Blood Authority1, providing a standard of practice for clinicians across Australia. The Australian Commission on Safety and Quality in Health Care (ACSQHC) standards were recently updated in 20172 and the adoption of the PBM guidelines will now be nationally mandated for hospitals in 2019. In this article, we answer three questions: 1.Why were the PBM guidelines developed? 2.What do the PBM guidelines recommend? 3.How can we implement the PBM guidelines successfully?.

Objective This paper seeks to stimulate discussion and debate about the future of doctoral education for nurses in Australia. Setting A large Magnet recognised acute care private hospital in New South Wales and a large regional university in Australia. Primary argument Healthcare today and into the future is increasingly more complex and requires ever more highly skilled healthcare professionals to meet the challenges of providing safe, quality care. Doctoral research and education based in the workplace and designed to improve healthcare while skilling up nurses and other professionals in research methods has never been more relevant and appropriate. Conclusion Nurses have generally not seen the PhD as the best fit for their higher professional development. The professional doctorate offers a compelling and dynamic alternative to the more academic focus of the PhD and prepares 'inquiry-driven leaders' for tomorrow's challenges.

Background: A porous tantalum glenoid component for total shoulder replacements was introduced in 2003 to promote biologic ingrowth. However, reports of component failure prompted design modifications. The purpose of this study is to present the largest series to date, of TSR with the second-generation Trabecular Metal¿ glenoid component. Method: A radiologic and clinical evaluation of the second-generation TM glenoid was conducted in consecutive cases of 76 shoulders (66 patients) with a mean follow-up of 43.2¿months (range 24¿72¿months). Pre-operative VAS score, patient self-assessed ASES score, active shoulder range of motion, and radiologic assessment were recorded. Patients were recalled for latest follow-up clinical and radiologic evaluation. Results: On latest follow-up, the mean VAS scores (pre-op: 6.4¿latest: 0.9) and ASES scores (pre-op: 36.9¿latest: 88.5) improved. Active range of motion improved in all planes. There was no report of glenoid component migration, loosening, or humeral stem subsidence. The incidence of non-progressive radiolucency in the glenoid was 6.6¿% (Franklin 1: 3 cases, Franklin 2: 2 cases). Post-operative complications involved dislocation (n¿=¿2) which were reduced in ED, post-operative stiffness (n¿=¿1), transient axillary nerve neuropraxia (n¿=¿1), and supraspinatus tear which underwent arthroscopic repair at 16¿months post-op. There were no revision surgeries for implant loosening nor glenoid component fracture at the peg¿base plate junction. Conclusions: The modifications established in the second-generation TM glenoid resulted to improve early to mid-term survivorship and clinical outcomes in TSR, with promise of long-term implant stability through bony ingrowth. Level of evidence: Level IV, case series, treatment study.

A qualitative-descriptive study of four patients with prostate cancer used the Cognitive-Social Health Information Processing framework to understand how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. In accordance with the literature, it was found that the surgeon or general practitioner's recommendation was the most influential factor when patients are making a treatment decision.

The aim of this study was to identify which items should be included in a pre-operative checklist based on recommendations by nurse experts in order to promote patient safety and effective communication in the perioperative environment. Method: Thirty-five nurses participated in this e-Delphi study, which was conducted online via SurveyMonkey®. Each survey presented participants with a list of potential items for inclusion in a pre-operative checklist. Participants were asked to identify items they felt should be included in the checklist with the option to include comments. Comments were de-identified and shared with other participants to allow confidential interaction. The surveys were analysed for consensus, determined as agreement between at least 70% of participants. Results: Three survey rounds were completed. Forty-six items achieved consensus for inclusion in a pre-operative checklist. Conclusion: The 46 items which achieved consensus were condensed to a list of 25 items categorised as: 1. Patient and procedure verification; 2. Preparation; and 3. Assessments. The findings of this study provide an evidence base for development of pre-operative checklists, to promote patient safety and effective communication in the perioperative environment.

Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician-patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients' experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects and safety of active and passive perioperative warming interventions for the prevention of SSI, when compared with standard care and other interventions.

'Rounding' is reported to be an effective intervention to enhance patient-centred care; nurses make frequent calls on their patients to ensure their needs are met and reassure them they are the focus of their care. In our hospital, two clinical units implemented rounding as improvement projects and asked the research unit to evaluate the effectiveness of implementation. A qualitative descriptive study using focus groups and in-depth interviews revealed that although the idea of rounding was well intended, it was not as effectively implemented as it might have been. Consequently, lessons have been learnt about the difficulties of changing clinician behaviour and will inform a new attempt at implementation.

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effects and safety of active and passive perioperative warming interventions for the prevention of SSI, when compared with standard care and other interventions.

The Magnet Recognition Program A requires evidence that nursing practice environments support staff to provide optimal care, access professional development opportunities, and participate in hospital affairs. The research presented in this article aimed to assess clinical nurses' work environment at a recently designated, private Magnet A hospital in Sydney, Australia. Authors compare results with baseline data collected for a gap analysis before application for recognition. The outcomes challenge previously reported data suggesting that hospitals on the journey to Magnet recognition outperform already designated hospitals in this respect.

Perioperative inadvertent hypothermia (PIH) significantly increases a patient's risk of adverse complications such as surgical site infection; morbid cardiac events; and surgical bleeding. A retrospective chart audit of 400 patients was conducted to identify the incidence of PIH and compliance with evidence-based recommendations at four Australian hospitals. Patients were excluded from the audit if they were pregnant, under 18 years of age, had impaired thermoregulation, therapeutic hypothermia, or local anaesthesia only. Trained auditors extracted data on the incidence of PIH, compliance with evidence-based recommendations, and patient characteristics. Of the 350 patients who met the inclusion criteria, the mean age was 56 (SD 19). The majority (74%, n=260) had elective surgery with orthopaedic procedures, the most common surgical type (28%, n=98). The incidence of PIH in the population was 32% (n=101) and the lowest recorded temperature was 34.0°C. Eighty per cent (n=280) of patients did not have a temperature documented intraoperatively and only 8.8% (n=29) had at least one documented temperature for each perioperative phase (pre-, intra-, and postoperative). Forty five per cent (n=133) of intraoperative patients and 77% (n=97) of postoperative patients did not receive active warming when indicated. Contrary to recommended practice, 47% (n=137) of patients were hypothermic at discharge from the post-anaesthetic recovery unit (PARU). This audit revealed poor compliance with evidence-based recommendations, which may have contributed to the significant number of patients who experienced PIH. Further research must be undertaken to identify the potential barriers to appropriate PIH prevention and identify strategy to translate the evidence into clinical practice.

Despite the wide acceptance of evidence-based practice as the foundation for professional health care delivery, there still remains a considerable gap between research evidence and current perioperative nursing practice. The aim of this study was to describe the self-reported knowledge, practice, attitudes and perceived barriers to evidence-based practice among perioperative nurses from nine metropolitan hospitals. Eight hundred nurses were sent a survey comprising two validated tools, the Barriers to Research Utilisation Scale (BARRIERS Scale) and the Evidence-Based Practice Questionnaire (EBPQ). Four hundred and ninety-three participants completed the returned the survey (60%). On the seven-point EBPQ, participants rated their evidence-based practice knowledge as 4-65 (l=poor to 7=excellent); their use of evidence-based practice as 4.12 (1=never to 7=frequently); and their attitude to evidence-based practice as 5.23 (l=negative to 7=positive). On the BARRIERS Scale (l=no barrier to 4=great barrier) issues related to the organisation were identified as the most significant barrier (2.66); followed by research communication issues (2.76); individual adopter-related issues (2.65); and issues about the innovation (2.52). These results indicate that this sample of Australian perioperative nurses have a positive attitude to evidence-based practice and reasonable knowledge of the topic; but this has not resulted in extensive use of evidence in the clinical setting.

Background: 'Patient experience is both recognised and solicited as a means of assessing healthcare delivery and a method for gauging patient centredness. Research comparing healthcare recipient and provider perceptions regarding the same episode of care is lacking. Aim: To identify what mattered to a patient and family member (healthcare recipients) during the patient's hospital experience and to examine the healthcare provider's awareness of what mattered. Methods: A qualitative descriptive investigation was undertaken using semi-structured interviews designed to compare multiple perceptions of one patient's hospital experience. Interviews were undertaken with the patient, family member, and healthcare providers. A definition of hospital experience was sought from each participant. Additional phrases as presented by the patient and family member were coded and grouped into categories and then salient themes. Phrases as presented by the healthcare providers were coded and then allocated to the previously identified themes. Findings: One patient, his wife and seven healthcare providers (doctors (2), registered nurses (4) and a patient care orderly (J)) were interviewed. Definitions of 'hospital experience' differ between participants. Recipients include pre and post hospital admission periods, whereas providers limit hospital experience to admission. Three salient themes emerged from recipient data suggesting; medication management, physical comfort and emotional security are what mattered to the recipients. Awareness was dependent upon theme and differed between the providers. Conclusion: Hospital experience as a term is poorly defined, and definitions differ between recipients and providers of care. Healthcare providers are not always aware of what matters to the patient and family during their hospital admission.

The impact of implementing a guideline on venous thromboembolism (VTE) prophylaxis was evaluated in a metropolitan private hospital with a before- and after-intervention study. This subsequent study aimed to identify if improved prophylaxis rates translated into cost savings and improved clinical outcomes. A conceptual decision-tree analytical model incorporating local treatment algorithms and clinical trial data was used to compare prophylaxis costs and clinical outcomes before and after the guideline implementation. The study analyzed data from 21,942 medical and surgical patients admitted to a 250-bed acute-care private hospital in Sydney, Australia. The modeled simulation estimated the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as adverse events such as heparin-induced thrombocytopenia (HIT), post-thrombotic syndrome (PTS), major bleeding, and mortality. The costs of prophylaxis therapy and treating adverse events were also calculated. The improvement in prophylaxis rates following the implementation of the guideline was estimated to result in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. Improved adherence to evidence-based prophylaxis regimens was associated with overall cost savings of $245,439 over 12 months. We conclude that improved adherence to evidence-based guidelines for VTE prophylaxis is achievable and is likely to result in fewer deaths, fewer VTE events, and a significant overall cost saving. © 2013 Society for Vascular Nursing, Inc..

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized medical patients. Evidence-based guidelines exist for preventing VTE; unfortunately, these guidelines are not always adhered to by clinicians. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on nurses' provision of mechanical prophylaxis to hospitalized medical patients using a prospective, uncontrolled, before-and-after design. Nurses received a 1-to-1 educational session on mechanical VTE prevention by a trained nurse facilitator. The EOV intervention was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Eighty-five of the 120 eligible nurses (71%) attended the EOV. The median length of each visit was 11.5minutes (interquartile range [IQR], 10-15) and the median time spent arranging and conducting each visit was 63minutes (IQR, 49-85). Eighty-four (99%) of the 85 participants gave a verbal commitment to trial the new evidence-based mechanical VTE prevention practices. However, there were no measurable improvements in the proportion of patients risk assessed (-1.7% improvement; 95% confidence interval [CI], -7.0 to 10.3; P = .68) or provided appropriate mechanical prophylaxis (-0.3% improvement; 95% CI, -13.4 to 14; P = .96). Researchers conclude that EOV should not be used to improve nurses' use of mechanical VTE prevention because it has no measurable impact on clinical practice and is resource intensive, requiring 4.5 minutes of preparation for every minute spent face to face with participants. Further research into the specific mechanism of action is required to explain the variability in clinical effect seen with this intervention. © 2013 Society for Vascular Nursing, Inc.

Background: Despite the availability of evidence-based guidelines on venous thromboembolism (VTE) prevention clinical audit and research reveals that hospitalised medical patients frequently receive suboptimal prophylaxis. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on the provision of VTE prophylaxis to hospitalised medical patients in a 270 bed acute care private hospital in metropolitan Australia. Methods. The study used an uncontrolled before-and-after design with accompanying process evaluation. The acceptability of the intervention to participants was measured with a post intervention survey; descriptive data on resource use was collected as a measure of utility; and clinical impact (prophylaxis rate) was assessed by pre and post intervention clinical audits. Doctors who admit >40 medical patients each year were targeted to receive the intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Results: Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15 to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004). Conclusions: EOV is effective at improving doctors' provision of pharmacological VTE prophylaxis to hospitalised medical patients. It was also found to be an acceptable implementation strategy by the majority of participants; however, it was resource intensive requiring on average 92 minutes per visit. © 2013 Duff et al.; licensee BioMed Central Ltd.