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Introduction: During 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings. Methods: A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality. Results: During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates. Conclusion: These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents' care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research. [ABSTRACT FROM AUTHOR]

Aims: The potential harm associated with medication errors is widely reported, but data on actual harm are limited. When actual harm has been measured, assessment processes are often poorly described, limiting their ability to be reproduced by other studies. Our aim was to design and implement a new process to assess actual harm resulting from medication errors in paediatric inpatient care. Methods: Prescribing errors were identified through retrospective medical record reviews (n = 26 369 orders) and medication administration errors through direct observation (n = 5137 administrations) in a tertiary paediatric hospital. All errors were assigned potential harm severity ratings on a 5‐point scale. Multidisciplinary panels reviewed case studies for patients assigned the highest three potential severity ratings and determined the following: actual harm occurrence and severity level, plausibility of a link between the error(s) and identified harm(s) and a confidence rating if no harm had occurred. Results: Multidisciplinary harm panels (n = 28) reviewed 566 case studies (173 prescribing related and 393 administration related) and found evidence of actual harm in 89 (prescribing = 22, administration = 67). Eight cases of serious harm cases were found (prescribing = 1, administration = 7) and no cases of severe harm. The panels were very confident in 65% of cases (n = 302) where no harm was found. Potential and actual harm ratings varied. Conclusions: This harm assessment process provides a systematic method for determining actual harm from medication errors. The multidisciplinary nature of the panels was critical in evaluating specific clinical, therapeutic and contextual considerations including care delivery pathways, therapeutic dose ranges and drug–drug and drug–disease interactions. [ABSTRACT FROM AUTHOR]

Objectives. Industry reports suggest that routine and essential care in Australian residential aged care (RAC), including allied health (AH) services, were disrupted during the coronavirus diseas 2019 (COVID-19) pandemic. This study aimed to explore whether AH services in RAC were paused during the pandemic, factors associated with a pause in care delivery, and qualitative details on how COVID-19 impacted AH service delivery. Methods. A 26-question survey was distributed via social media, health service providers, and AH networks between February and April 2022. Participation was restricted to AH professionals and assistants with experience in RAC during the pandemic. A mix of closed and open-ended response questions was used to collect demographic data and experiences of delivering care during the pandemic. Quantitative responses were analysed with descriptive statistics and a probit model. Content analysis was performed on open-ended questions. Results. One hundred and four AH professionals and assistants responded to the survey. Fifty-five percent of participants (n = 51) were contractually or casually employed. AH services were negatively impacted by the pandemic with 52% of respondents experiencing a pause in service delivery and 78% reporting poorer AH care quality. In a probit model, contracted/casually employed respondents were more likely to experience a pause in care delivery (1.03, P < 0.05) compared to permanently employed AH professionals. Conclusion. Insecure work arrangements may have exacerbated inconsistent care during the pandemic (impacting residents) and may have negative implications on the RAC AH workforce. In the future, an AH inclusive workforce policy including data collection and research is required to monitor and plan the RAC workforce. [ABSTRACT FROM AUTHOR]

In the residential aged care sector medication management has been identified as a major area of concern contributing to poor outcomes and quality of life for residents. Monitoring medication management in residential aged care in Australia has been highly reliant on small, internal audits. The introduction of electronic medication administration systems provides new opportunities to establish improved methods for ongoing, timely and efficient monitoring of a range of medication indicators, made more meaningful by linking medication data with resident characteristics and outcomes. Benchmarking contemporary medication indicators provides a further opportunity for improvement and is most effective when indicator data are adjusted to take account of confounding factors, such as residents' characteristics and health conditions. Roundtables provide a structure for sharing and discussing indicator data in a trusted and supportive environment and encourage the identification of strategies which may be effective in improving medication management. This paper describes a new project to establish, implement and evaluate a National Aged Care Medication Roundtable. [ABSTRACT FROM AUTHOR]

Medication errors are a leading cause of preventable harm in hospitals. Electronic medication systems (EMS) have shown success in reducing the risk of prescribing errors, but considerable less evidence is available about whether these systems support a reduction in medication administration errors in paediatrics. Using a stepped wedge cluster randomized controlled trial we investigated changes in medication administration error rates following the introduction of an EMS in a paediatric referral hospital in Sydney, Australia. Direct observations of 284 nurses as they prepared and administered 4555 medication doses was undertaken and observational data compared against patient records to identify administration errors. We found no significant change in administration errors post EMS (adjusted Odds Ratio [aOR] 1.09; 95% CI 0.89-1.32) and no change in rates of potentially serious administration errors (aOR 1.18; 95%CI 0.9-1.56), or those resulting in actual harm (aOR 0.92; 95%CI 0.34-2.46). Errors in administration of medications by some routes increased post EMS. In the first 70 days of EMS use medication administration error rates were largely unchanged. [ABSTRACT FROM AUTHOR]

Electronic medication systems (EMS) improve medication safety in hospitals; however require modifications to optimize their performance. Drawing on a five-year program of research, we developed the Health Innovation Series to disseminate recommendations arising from our research to a wide audience. Each issue contains EMS optimization tips that can be actioned by EMS managers and system vendors, as well as user tips for health professionals including nurses, doctors and pharmacists. Five issues were released by 30 Nov 2022, via two email campaigns, with further issues planned. The five issues had 2,035 downloads by March 2023. The most recent email campaign open and click rates indicate very good audience engagement. [ABSTRACT FROM AUTHOR]

Consumers and providers have long been advocating for increased access to and delivery of allied health services in Australian residential aged care (RAC). There is significant evidence that allied health interventions are effective; however, there is limited evidence on the benefit of routine day‐to‐day allied health service delivery in RAC. This information is critical to effectively inform funders and policy advisors of the necessity of allied health in RAC. To improve arguments for future funding opportunities, providers, facilities and consumers need to partner together to use routinely collected, yet disparate, data, in electronic health and billing records, to improve data collection practices and evidence generation on allied health in aged care. [ABSTRACT FROM AUTHOR]

Objective To assess the comparability of out-of-pocket (OOP) payment and catastrophic health expenditure (CHE) estimates from different household surveys in India. Methods Data on CHE, outpatient and inpatient OOP payments and other expenditure from all major national or multi-state surveys since 2000 were compared. These included two consumer expenditure surveys (the National Sample Survey for 2004-05 [NSS 2004- 05] and 2009-10 [NSS 2009-10]) and three health-focused surveys (the World Health Survey 2003 [WHS 2003]; the National Sample Survey on Morbidity, Health Care and the Condition of the Aged 2004 [NSS 2004]; and the Study on Global Ageing and Adult Health 2007-08 [SAGE 2007-08]). All but the NSS 2004-05 and the NSS 2009-10 used different questionnaires. Findings CHE estimates from WHS 2003 and SAGE 2007-08 were twice as high as those from NSS 2004-05, NSS 2009-10 and NSS 2004. Inpatient OOP payment estimates were twice as high in WHS 2003 and SAGE 2007-08 because in these surveys a much higher proportion of households reported such payments. However, estimates of expenditures on other items were half as high in WHS 2003 as in the other surveys because a very small number of items was used to capture these expenditures. Conclusion The wide variations observed in CHE and OOP payment estimates resulted from methodological differences. Survey methods used to assess CHE in India need to be standardized and validated to accurately track CHE and assess the impact of recent policies to reduce it. Objectif Evaluer la comparabilite des paiements directs (PD) et estimer les depenses de sante catastrophiques (DSC) a partir de differentes enquetes menees aupres des menages en Inde. Methocles Les donnees recueillies dans toutes les grandes enquetes nationales ou multi-regionales depuis 2000 et portant sur les DSC, les paiements directs pour hospitalisation interne et externe et autres depenses, ont ete comparees. Parmi ces etudes, figurent notamment deux enquetes portant sur les depenses des consommateurs (l'enquete nationale pour 2004-2005 [NSS 2004-05] et pour 20092010 [NSS 2009-10]), et trois enquetes axees sur la sante (l'enquete sur la sante dans le monde 2003 [WHS 2003]; l'enquete nationale sur la morbidite, les soins de sante et la condition des personnes agees 2004 [NSS 2004]; et l'etude sur le vieillissement et la sante des adultes 2007-2008 [SAGE 2007-08]).Toutes ces enquetes, a l'exception de la NSS 2004-05 et de la NSS 2009-10, ont utilise des questionnaires differents. Resultats Dans les enquetes WHS 2003 et SAGE 2007-08, les DSC etaient deux fois plus elevees que celles relevees dans les enquetes NSS 2004-05, NSS 2009-10 et NSS 2004. Les paiements directs pour une hospitalisation interne etaient deux fois plus eleves dans les enquetes WHS 2003 et SAGE 2007-08, car, dans ces enquetes, une proportion beaucoup plus elevee de menages ont declare ces paiements. Cependant, d'autres depenses estimees etaient deux fois moins elevees dans l'enquete WHS 2003 que dans les autres enquetes, car un tres petit nombre de questions ont ete utilisees pour rendre compte de ces depenses. Conclusion Les grandes variations observees dans les DSC et les estimations de paiements directs resultent de differences methodologiques. Les methodes d'enquete utilisees pour evaluer les DSC en Inde doivent etre standardisees et validees pour evaluer les DCS avec precision et mesurer l'impact des politiques recentes pour les reduire. Objetivo Evaluar la comparabilidad de las estimaciones del pago por el propio paciente (OOP) y los gastos sanitarios catastroficos (CHE) a partir de distintas encuestas a hogares de la India. Metodos Se compararon los datos sobre los gastos sanitarios catastroficos (CHE), los pagos por el propio paciente (OOP) por el cuidado sanitario ambulatorio y hospitalario, asi como otros gastos de las principales encuestas nacionales o plurinacionales desde 2000. Estos incluyen dos encuestas sobre los gastos de consumo (la Encuesta Nacional por Muestreo de 2004-05 [ENM 2004-05] y 2009-10 [ENM 2009-10]) y tres encuestas sobre salud (la Encuesta Mundial de Salud de 2003 [EMS 2003], la Encuesta Nacional por Muestreo de morbilidad, cuidado sanitario y de las condiciones de la tercera edad de 2004 [ENM 2004], y el Estudio sobre el Envejecimiento mundial de la poblacion y la salud de los adultos de 2007-08 [SAGE 2007-08]). Se emplearon cuestionarios diferentes en cada una de ellas, excepto para la ENM 2004-05 y la ENM 2009-10. Resultados Las estimaciones de los gastos sanitarios catastroficos (CHE) de la EMS 2003 y del Estudio sobre el Envejecimiento mundial de la poblacion y la salud de los adultos (SAGE) de 2007-08 fueron dos veces mas altas que las de la ENM 2004-05, ENM 2009-10 y ENM 2004. Las estimaciones del pago por el propio paciente (OOP) fueron dos veces mas altas en la EMS 2003 y el SAGE 2007-08 debido a que en estos estudios una proporcion mucho mayor de los hogares informo acerca de dichos pagos. Sin embargo, otros gastos estimados fueron la mitad en la EMS 2003 y en las otras encuestas porque se utilizo un numero muy pequeno de elementos para captar dichos gastos. Conclusion Las grandes variaciones observadas en las estimaciones de los gastos sanitarios catastroficos (CHE) y los pagos por el propio paciente (OOP) se debieron a diferencias metodologicas. Es necesario estandarizar y validar los metodos de encuesta utilizados para evaluar los gastos sanitarios catastroficos (CHE) en la India a fin de realizar un seguimiento preciso sobre dichos gastos y evaluar el impacto de las politicas recientes para reducirlos., Introduction Out-of-pocket (OOP) payments are the primary source of health-care financing in many countries. (1) In 2004-05, OOP payments in India were estimated to account for approximately two thirds of [...]