Nursing pioneers benefit thousands of Victorians

The team from Deakin’s Centre for Quality and Patient Safety (QPS) trail-blazed a model of seamless co-operation between nursing research and clinical practice almost two decades ago. They have achieved outstanding healthcare results for Victoria – and now offer a best practice model to health service providers and academics around the world.

Led by QPS Director Alfred Deakin Professor Maxine Duke along with six Nursing Chairs – each based at a different healthcare provider – QPS is at the centre of an intricate network that collaborates effectively to identify and address gaps in health care.

This approach has seen improved practices and developed guidelines in a wide range of areas, including pain management, complex, critical and emergency care, midwifery, aged care and dementia, amongst many others.

“QPS is based on a hub and spoke model, where each Chair and her team works with a partner organisation and across a network,” said Professor Duke.

“This gives us access to over 30,000 nurses in Victoria (almost half the practicing nurses in the state) and about one million hospital patients and aged care residents each year.

“It may not have a high public profile, but the quality of nursing research and practice plays a fundamental role in our nation’s health.”

The group’s first partnership with a health service provider was established over 18 years ago – breaking new ground for nursing research. The approach was based on the fundamental understanding that this research must be applied if it is to make a real difference.

“All the Nursing Chairs are experts as both practitioners and researchers – often a unique mix in academia,” said Professor Duke.

“There is a seamlessness between the Chairs’ academic and clinical roles. We generate and translate knowledge, which is the antithesis of the traditional ‘ivory tower’ approach.”

As one example of how this stance directly translates into better outcomes for patients in Australia and beyond, a major study led by Nursing Chair, Alfred Deakin Professor Mari Botti AM, led to the recognition of the need for an integrated approach to pain management in acute care.

Based at Epworth Healthcare, Professor Botti is collaborating with other QPS Chairs from networks including Alfred, Barwon, Eastern, Monash and Western Health to gain a comprehensive understanding of the issues affecting pain management and identify the best ways to address them.

Professor Botti was named a Member of the Order of Australia in 2016 in recognition of her pain management research and her bro

ader services to nursing and medical education as an academic and author. “We are striving to make sure patients receive the best possible pain management in acute care all the time,” Professor Botti said.

“The Australian Commission for Quality and Safety developed national standards in 2011. Now, researchers are trying to find the best ways to ensure these standards are met in health care.

“We have made good progress and raised awareness amongst the profession, but we still have some way to go.

"Pain management has been a long-standing problem that needs a multi-dimensional solution, through strategies such as improved communication in multidisciplinary teams, finding ways to help patients participate in their own care and ensuring that policies and practices support clinicians to deliver optimal care.”

A new QPS-led major partnership study is targeting another long-standing issue that, once completed, could save the lives of hundreds of Australians. The three-year project is investigating ways to improve first line management of patient deterioration in hospitals – focusing on identifying at-risk patients in the first hours to minutes before critical events, in order to intervene before symptoms escalate.

“The identification of abnormal vital signs is paramount to ensuring patient safety and care,” said project leader and Nursing Chair, Professor Tracey Bucknall.

“This project, Prioritising Responses of Nurses to Deteriorating Patient Observations” (PRONTO) is funded by the National Health and Medical Research Council (NHMRC).

“Despite a growing body of evidence that shows the benefit of early recognition and management of patients, there is a gap between what the research is telling us we need to do and what happens in the clinical setting. With this study we are looking at ways to close that gap.”

The researchers are conducting a randomised trial in four Victorian hospitals, with the goal of improving the uptake of clinical practice guidelines for identifying and managing deteriorating patients. Alfred Health, Monash Health, Eastern Health, The Australian Commission on Safety and Quality in Health Care, and SA Health are all involved.

“The collaboration will provide a large, rich data source,” said Professor Duke. “We expect the resulting guidelines will be translated across the Victorian health sector and provide a model for other states.”

In fact, the Centre’s reputation has already reached well into the international arena. In late 2016, Canadian researchers Professors Ian Graham and Dawn Stacey visited QPS to explore the unique partnership network. The visit was part of a multimillion dollar Canadian Government research grant supporting translating health knowledge. The visit is one example of a number of collaborations QPS is undertaking with international colleagues.

The QPS team has every reason to feel proud of their achievements. They pioneered Deakin University-health care partnerships long before other health alliances began to emerge. These networks now represent a mature, self-sustaining nursing research “tour de force.”

Leaders such as Alfred Deakin Professor Maxine Duke and the six outstanding Nursing Chairs have developed relationships with clinicians, patients and the industry more broadly to understand the problems facing health care and find research solutions to improve the quality of care for many patients.

The six Chairs of Nursing at QPS:

  • Professor Julie Considine, Eastern Health.
  • Professor Alison Hutchinson, Monash Health.
  • Alfred Deakin Professor Mari Botti, Epworth HealthCare.
  • Professor Trisha Dunning, Barwon Health.
  • Professor Bodil Rasmussen, Western Health.
  • Professor Tracey Bucknall, Alfred Health.

Multimedia tool activates surgical patients

Technology is helping to empower surgical patients – and achieving outstanding results – thanks to an innovative tool tested and evaluated by a QPS PhD student.

Working with Alfred Deakin Professor Mari Botti and Professor Richard de Steiger, PhD student Jo McDonall assisted in the development and led the testing of an innovative patient activation support tool. The tool can be easily accessed on an iPad and guides patients on the most effective ways to achieve the best possible recovery after surgery, allowing them to return home earlier.

Trialled at Epworth Healthcare, the tool is showing strong promise for improved patient outcomes. It has the potential to be used across the country, initially for patients receiving knee surgery, but is modifiable for patients having all types of surgery.

“The trial group experienced less pain, and went home a day earlier than the control group,” said Professor Botti.