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The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice. • Personal protective equipment (PPE) in emergency departments (EDs) can be contentious • Infection control and ED clinicians agree on the necessity of most PPE items. • ED clinicians find PPE guidance less practicable than infection control clinicians. • Infection prevention guidelines for EDs must be designed for ED contexts. [ABSTRACT FROM AUTHOR]

Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management. To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes. A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia. In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes. Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making. • Varied medication policies across settings were associated with adverse effects. • Older patients were not often given information about changes to their regular medications. • Older patients were informed about new medications after decisions were made. • Health professionals had rigid views about their own roles in medication decisions. • Shared decision-making was rarely observed during medication changes. [ABSTRACT FROM AUTHOR]

Background: Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result in medication discrepancies or incidents.Objective: The aim of this systematic review was to explore older patients' experiences and perceptions of communication about managing medications across transitions of care.Design: A systematic review.Methods: A comprehensive review was conducted of qualitative, quantitative and mixed method studies using CINAHL Complete, MEDLINE, Embase and PsycINFO, Web of Science, INFORMIT and Scopus. These databases were searched from inception to 14.12.2018. Key article cross-checking and hand searching of reference lists of included papers were also undertaken.Inclusion Criteria: studies of the medication management perspectives of people aged 65 or older who transferred between care settings. These settings comprised patients' homes, residential aged care and acute and subacute care. Only English language studies were included. Comments, case reports, systematic reviews, letters, editorials were excluded. Thematic analysis was undertaken by synthesising qualitative data, whereas quantitative data were summarised descriptively. Methodological quality was assessed with the Mixed Methods Appraisal Tool.Results: The final review comprised 33 studies: 12 qualitative, 17 quantitative and 4 mixed methods studies. Twenty studies addressed the link between communication and medication discrepancies; ten studies identified facilitators of self-care through older patient engagement; 18 studies included older patients' experiences with health professionals about their medication regimen; and, 13 studies included strategies for communication about medications with older patients. Poor communication between primary and secondary care settings was reported as a reason for medication discrepancy before discharge. Older patients expected ongoing and tailored communication with providers and timely, accurate and written information about their medications before discharge or available for the post-discharge period.Conclusions: Communication about medications was often found to be ineffective. Most emphasis was placed on older patients' perspectives at discharge and in the post-discharge period. There was little exploration of older patients' views of communication about medication management on admission, during hospitalisation, or transfer between settings. [ABSTRACT FROM AUTHOR]

With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it's important to prepare nurses with skills and knowledge necessary to manage such incidents. There are very few documented accounts of the inclusion of mass casualty education within undergraduate nursing programs. This paper is the first to describe undergraduate mass casualty nursing education in Australia. A final year Bachelor of Nursing undergraduate subject was developed. The subject focused on initial treatment and stabilisation of casualties predominantly within pre-hospital environments, and included a capstone inter-professional mass casualty simulation. Students experience of the subject was evaluated using the Satisfaction with Simulation Experience Scale (Levett-Jones et al., 2011) and a subject evaluation survey. Student satisfaction and evaluations were extremely positive. As a tool for developing clinical skills, 93% (n = 43) agreed that the simulation developed their clinical reasoning and decision making skills. In particular, the simulation enabled students to apply what they had learned (77%, n = 35, strongly agree). Due to the frequency of mass casualty events worldwide, there is a need for educational exposure in undergraduate nursing curricula. We believe that this mass casualty education could be used as a template for development in nursing curricula. [ABSTRACT FROM AUTHOR]

Keywords: Continuity of patient care; Physician-patient relations; Clinical decision-making; Aged; Quality of health care; Health communication; Patient safety; Prescribing; Informed consent EN Continuity of patient care Physician-patient relations Clinical decision-making Aged Quality of health care Health communication Patient safety Prescribing; Informed consent 176 177 2 08/17/22 20220815 NES 220815 Tailored medication communication is key to preventing patient harm across transitions of care Older patients are likely to have complex medication regimens, which need to be carefully managed as they move across and within diverse settings, including primary care, acute care, geriatric rehabilitation, and aged care facilities. Aged, Quality of health care, Patient safety, Continuity of patient care, Physician-patient relations, Clinical decision-making, Health communication, Prescribing; Informed consent. [Extracted from the article]

The article discusses a study that examined the efficacy of the Classification of Hospital Acquired Diagnoses (CHADx), a computerized tool developed by the Australian Commission on Safety and Quality in Health Care for monitoring the occurrence and extent of hospital-acquired illness and injury. It applied CHADx to analyze 126,940 inpatient episodes in acute care hospitals in Victoria from 2005 to 2006. CHADx used 4,345 codes to describe hospital-acquired conditions, which were then grouped into 144 subclasses and 17 "roll-up" groups.

The PoMS results demonstrate that medical students encounter patient sexual relationship dilemmas and are often unsure about how to manage this - a situation compounded by a lack of national guidance or codes of conduct. Keywords: Ethics; professional EN Ethics professional 487 487 1 11/17/21 20211115 NES 211115 To the Editor: "Patients often suggest a "social meeting" after you have treated them. One of the scenarios asked for respondents' opinions on how acceptable it would be for a medical student to embark on a romantic relationship with a former patient, and if student participants had encountered a similar situation. [Extracted from the article]

The article examines the benefits of the Australian government's plans for public reporting of performance data in health care. According to the authors, public reporting incorporates interpretation and comparisons that make the data meaningful for the community. The authors conclude that public performance reporting promotes strong adherence to values such as honesty and concern for the well-being of patients and should be at the core of effective health system governance.

A letter to the editor is presented in response to the article "Patient Safety: Time for A Transformational Change in Medical Education," by Joanna R. Sutherland.

The authors invite patients, consumers, clinicians, health service managers, policymakers and researchers in Australia to present their view on how the safety and quality of the country's healthcare system can be improved. They cite the topics of discussion which include the aspects of safety and quality are important, the barriers to providing optical care and suggestions for improving safety and quality.

The article presents a study according to which aged-care home (ACH) transferto- hospital envelope (the Envelope) are used in transfers of ACH residents to emergency department (EDs) and is highly valued by ACH staff, ambulance officers and ED staff.

The article discusses the importance of proper clinical handover. The definition of clinical handover is presented and the importance of accountability and responsibility as critical terms in the definition are noted. The case of an elderly Aboriginal man left to die on an airstrip in the Northern Territory in Australia is cited as an example of an inadequate handover. The need to improve clinical handover particularly in coming up with a standardized process and the importance of engaging clinicians in the improvement process are also emphasized.

An introduction to the journal is presented in which the editor discusses various reports published within the issue including a review of 3390 New South Wales prevocational progress assessment forms and an article on the Australian Medical Association's 2010 Specialists Trainees Survey.

The authors discuss the problems facing general practitioners (GP) with regard to providing medical student education. They cite the lack of the benefits of the hierarchical structure of the teaching hospital. They mention the lack of the ability to evaluate trainees' progress in the graded manner. They also introduce articles published within the issue which explores the fundamental concerns raised by GP.