Quality and Patient Safety

Translations of evidence into pain management

an image of a patient and doctor

The problem of uncontrolled postoperative pain is well documented. Worldwide prevalence studies have shown up to 80% of patients experience significant pain after surgery and they receive less than 50% of the analgesics they are prescribed. Similar Australian studies have shown that over 40% of patients experience unnecessary pain after surgery.

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In 2010 Professor Mari Botti and her team were awarded an ARC Development grant to collate the best available evidence to inform the development of standard care processes to address the problem of ineffective pain management in postoperative care. To progress this innovative study the investigators have partnered with clinicians involved in medication prescribing, pain assessment and clinical management to address the complex problem of postoperative pain management through two fundamental components:

  • the development of a management algorithm for postoperative pain (MAPP) based on best available evidence to support for clinical decision making.
  • the implementation of the MAPP into clinical practice in a way that ensures uptake, integration and sustainability.

Evidence shows that interventions to improve postoperative pain management often fail because they are not sustained in the clinical environment once the initial implementation period is over. To avoid this problem, the Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide the clinical implementation of the MAPP, as it has been successfully used previously in improving postoperative pain management. The intervention will be tested in three sites across public and private hospitals to assess applicability in different healthcare contexts.

This project has potential economic and social benefits for Australia through improving care processes related to the management of postoperative pain, therefore minimising the adverse outcomes associated with unrelieved pain. The project will provide guidance for the formulation of educational programs and practice protocols and will inform policy development locally, nationally and internationally.

The research team includes: Prof Mari Botti, Prof Tracey Bucknall, Prof Maxine Duke, Prof Megan-Jane Johnstone, Prof Bridie Kent, Dr Rosemary Watts, Richard Steiger, Dr Bernice Redley, Julie Considine.

For more information, please contact: Professor Mari Botti

'Listen to me, I really am sick!' Understanding patient perspectives in triggering responses to medical emergencies

an image of a patient and doctor/nurse

Patients entering hospital expect that the care they receive is safe and unlikely to cause harm. Yet hospital systems may fail deteriorating patients, with detailed descriptions of suboptimal care requiring patient admissions to intensive care and high rates of serious adverse events (SAEs) resulting in death and severe disability. Many SAEs that occur in hospitals are often preceded by warning signs that are not always acted upon. Significant research has focused on the clinician detecting and responding to patient deterioration. However there has been no research that explores the patient's perspective and role in initiating clinician and service responses to critical illness. A recent priority in healthcare is to improve the safety and quality of health care by placing patients at the centre of care; by providing respect for, and response to, patient preferences, needs and immediate treatment requirements.

In 2012 Professor Tracey Bucknall and her team received funding from the Australian Research Council (Linkage Grant) and Australian Commission of Safety and Quality in Health Care (ACSQHC) to investigate patients' perceptions and role in detecting and communicating their deteriorating status and the impact on prevention of SAEs. Using a qualitative design involving patient and family member interviews, and medical record reviews, the results from this study will provide unique insights into patient and family member interpretations of events during medical emergencies. It will also inform the development of strategies to improve health service planning and delivery, thereby reducing preventable SAEs. The stories will be used to develop case-based scenarios for medical and nursing students to develop their clinical reasoning skills in detecting and managing deteriorating patients.

The research team includes: Co-chief investigator - Prof Alison Hutchinson; Partner Investigators - Prof Michael Buist, Prof Brendan McCormack, Dr Nicola Dunbar, Dr Suellen Allen, A/Prof Daryl Jones; Partner Organisations - University of Ulster (UK), Australian Commission of Safety and Quality in Health Care, Austin Hospital (Melbourne), Cabrini Health (Melbourne), North West Area Health Service (Tasmania); and PhD Candidate - Jessica Guinane.

For more information please contact: Professor Tracey Bucknall

The first reported ZUMBA GOLD dialysis program

an image of dialysis patients doing zumba gold

People requiring dialysis three times per week have only limited exercise leading to muscle deconditioning, a reduced quality of life and increased risk of injury. Low-impact exercise programs during dialysis have been found to be safe and beneficial for this group. Exercise can alleviate the boredom of receiving dialysis, creating an exercise-focused positive environment in the dialysis centre. A popular exercise program designed for people with physical limitations and inactive older people is Zumba Gold®. This is a program in which the Latin and international dance rhythms created in the original Zumba® program are adapted for older populations.

This project explored the feasibility of implementing a modified Zumba Gold program for patients in Moorabbin Dialysis Centre. Twenty, 30-minute sessions were completed in the unit over a two week period. Choreographed to music the exercises included various shoulder, arm, and leg movements, including shoulder squeezes, arm lifts, knee lifts and toe taps. Participants became increasingly active and engaged as the sessions progressed, and the instructor adjusted movements accordingly. Several staff and other dialysis patients spontaneously participated in the exercises.

The study has found that an intradialytic modified form of ZUMBA GOLD is a safe and feasible exercise program for people receiving hemodialysis. The intervention was acceptable to patients, was inexpensive, and did not adversely impact on the hemodialysis treatment. It was fun and encouraged staff and other patients to join in the exercises.

The research team includes: A/Prof Paul Bennett, Ann Marie Corradini, Cherene Ockerby, Tania Cossich

For more information please contact: Associate Professor Paul Bennett

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