Associate Professor Jed Duff

© 2016 American Society of PeriAnesthesia Nurses. Background: Perioperative hypothermia significantly increases a patient's risk of adverse complications, such as surgical site infection; morbid cardiac events, and surgical bleeding. Although guideline recommendations are relatively simple and inexpensive, they are often not adhered to in clinical practice. Knowledge tools are tangible resources that assist clinicians to provide evidence-based care. Purpose: This article reports the collaborative development of a knowledge tool-a perioperative thermal care bundle. Methods: A multidisciplinary panel of experts used the online GuideLine Implementability Appraisal tool to prioritize and select recommendations for inclusion in the care bundle. Design: Collaborative, iterative design. Finding: Through a consensus process, the expert panel selected three main bundle elements: Assess patient's risk of hypothermia and contraindications to active warming; record temperature frequently preoperatively, intraoperatively, and postoperatively; and actively warm, intraoperatively, if they are at high risk, or anytime they are hypothermic. Conclusions: The GuideLine Implementability Appraisal tool was a simple yet comprehensive tool that enabled the development of a care bundle by expert clinicians.

© 2016, Australian Nursing Federation. All Rights Reserved. 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.

© 2016, Springer-Verlag Berlin Heidelberg. 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.

© 2016 Kornhaber et al. 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.

© 2014 Wiley Publishing Asia Pty Ltd. '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.

Copyright © 2014 Wolters Kluwer Health. 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.

© eContent Management Pty Ltd. Contemporary Nurse. 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 (1)) 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 emotion al 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' prov ision 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.