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News ArticleAfter receiving more than 12,000 complaints about Australia's Victorian mental health services, the state’s regulator has not taken compliance action against a single mental healthcare provider in seven years. This is despite the royal commission into the Victorian mental health sector last year finding systemic breaches of the law and human rights across the system. Annual reports from Victoria’s mental health complaints commissioner (MHCC) showed that in the seven years since it was first established in July 2014, it received 14,160 inquiries, of which 12,470 were complaints. Yet no compliance notices were issued, despite the MHCC having regulatory powers to compel providers to improve. The MHCC is an independent body that resolves complaints about Victoria’s public mental health services and makes recommendations for improvements. The MHCC’s service provider complaint reports, obtained under freedom of information, show that some mental health services do not hand over data on the outcomes of complaints, in breach of the state’s Mental Health Act (2014). The chief executive of Mind Australia – a community-based mental health provider, Gill Callister, said it was vital people with mental health concerns, their families and carers had access to “information about the performance and approach” of the mental health services they access. “For a lot of people, a lack of transparency reinforces the view that they’re sitting at the bottom of the pile in terms of priority even when seeking information about their own care,” she said. Read full story Source: The Guardian, 25 May 2022
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Content ArticleEZDrugID is a campaign to improve the distinctiveness of medication packaging set up by a group of healthcare workers. Inadequate standards around medication packaging mean that medications with very different actions are sometimes packaged in a very similar way causing "look-alike drugs”. This can lead to errors and serious harm to patients if the wrong drug is mistakenly used. The EZDrugID website contains information about their campaigns to maximise distinctiveness of different medications as well as a "lookalikes" gallery. See also: the hub's error traps gallery The medication safety area of the hub
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News Article
Australia: National cosmetic surgery standards needed for patient safety
Patient Safety Learning posted a news article in News
More than 100,000 doctors in Australia hold the right to call themselves cosmetic surgeons, without having undergone the specific training to be competent and safe. President of the Australasian College of Cosmetic Surgery and Medicine Dr Patrick Tansley says cosmetic surgery does not form part of the traditional medical training undertaken in Australia, due to the practice being relatively new. “Society has moved faster than legislation has followed it,” he told Sky News Australia. Dr Tansley said he is advocating for the introduction of a national standard to endorse this area of practice in Australia, where doctors would be placed on a public register for patients to review their accreditation. “Once they had met those standards and then were endorsed, they could be placed on a public register, independently administered by the regulator AHPRA. “And the public would then be able to see, with clarity and transparency, which of those doctors have been trained and accredited in cosmetic surgery.” Read full story Source: Sky News, 23 April 2022 -
Content ArticleThis study in JAMA Network Open aimed to investigate whether attention-deficit/hyperactivity disorder (ADHD) is over diagnosed in children and adolescents. The authors reviewed 334 published studies and found convincing evidence that ADHD is over diagnosed. They highlight that the harms associated with ADHD diagnosis may outweigh the benefits, particularly in children and young people with milder symptoms.
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Content ArticleThe Australian health care system includes a national organisation representing health care consumers and equivalent organisations in most states and territories. There are several disease-specific patient organisations, as well as formalised networks advocating for greater patient involvement in health technology assessment and research. This signals a system that sees a place for consumer insights: a system that is on a journey of maturing the way in which it seeks to involve consumers in decision-making. This article explores patient leadership, recognising it as the next level of engagement, highlighting the value and impact of incorporating the experience of patients at all levels of the health system and policy decision-making, and recognising the opportunity for consumers to become leaders.
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News ArticleThe carer who admitted the manslaughter of Adelaide woman Ann Marie Smith, who had cerebral palsy, has been jailed for at least five years and three months for her criminal neglect. Sentencing Rosa Maria Maione in the Supreme Court, Justice Anne Bampton said the 70-year-old was grossly negligent, with her care for Smith falling well short of the standard expected. “You did not mobilise her from the chair in which she was found. You did not toilet her properly and you did not clean her properly,” she told Maione on Friday. “You did not feed her a nutritional diet or monitor her intake. You knew you were not capable of properly supporting her and you did not seek assistance in providing for Ms Smith’s needs." “Despite the deterioration in Ms Smith’s health, you did not seek assistance from your supervisor or medical professionals until it was too late.” Justice Bampton said Maione had absolutely no insight into Smith’s physical condition leading up to her death. “Your incompetence, lack of training, lack of assertiveness and lack of supervision produced an environment where you failed to provide appropriate care,” she said. “Every person living with a disability, every person who requires support, every parent, carer and support worker of persons living with a disability, I have no doubt shudders with fear when they hear of the utter lack of care and human dignity afforded to Ms Smith in those last months of her life.” Read full story Source: The Guardian, 18 March 2022
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Content ArticleSkin cancer is one of the most common cancers worldwide, with one in five people in the US expected to receive a skin cancer diagnosis during their lifetime. Detecting and treating skin cancers early is key to improving survival rates. This blog for The Medical Futurist looks at the emergence of skin-checking algorithms and how they will assist dermatologists in swift diagnosis. It reviews research into the effectiveness of algorithms in detecting cancer, and examines the issues of regulation, accessibility and the accuracy of smartphone apps.
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News Article
Australia: New guidelines helping stem the tide of serious allergies in children
Patient Safety Learning posted a news article in News
The rising rate at which Australian children are being admitted to hospital for serious food allergies has flattened since infant feeding guidelines were changed, new research shows. The rate of hospitalisation for food anaphylaxis has increased in Australia in recent decades – but data suggests that changes to allergy prevention and infant feeding guidelines in 2008 and 2016 have helped to stem the rise in young children and teenagers. In 2008, the Australasian Society of Clinical Immunology and Allergy guidelines were changed to recommend that allergenic solid foods should no longer be delayed, and in 2016 they were again updated to suggest such foods should be introduced in the first year of life. Study co-author Prof Mimi Tang, an immunologist at the Murdoch Children’s Research Institute, said the greatest benefit of the updated guidelines was in children aged one to four. Tang said there had been important changes to allergy prevention advice in the last 15 years. “Prior to 2008, all of the food allergy … prevention guidelines around the world were advising to delay the introduction of allergenic foods such as egg, milk and peanut until the ages of somewhere between two and four, depending on the food,” she said. “The reason these recommendations were in place was based on theoretical concerns that the gut barrier was perhaps not as strong in young babies.” But a growing body of evidence showed that delaying allergenic foods was associated with an increased risk of developing food allergies. In the new study, published in the Journal of Allergy and Clinical Immunology, Tang and her colleagues noted an ongoing increase in anaphylaxis hospitalisation rates in teenagers aged 15 and older at the time the research was completed. People in this age group were born before the 2008 changes to the Australian guidelines. Read full story Source: The Guardian, 24 February 2022 -
Content Article
Queensland Health: Fatigue risk management systems
Patient Safety Learning posted an article in Good practice
This guideline has been developed to support all Australia's Queensland Health workplaces to identify and manage fatigue risks. It draws on lessons learnt from over a decade of implementing fatigue risk management systems (FRMSs) in Queensland Hospital and Health Services (HHSs) and from proven approaches to safety risk management. -
News ArticleTwo years of the pandemic have meant drops in essential screening and detection in Australia, while cancer patients undergo treatments alone and isolate to avoid Covid risks. When Claire Simpson turned 50 in early 2020, she received a letter telling her to get a mammogram. Then the pandemic hit, and Victoria went into lockdown. “Like many people, I put it off until we were coming out of that lockdown, but by then it was September and I couldn’t get an appointment until December,” she says. In February 2021 she was diagnosed with breast cancer and had a mastectomy. Tests showed she was positive for the aggressive HER2 receptor, so she began 12 weeks of chemotherapy as well as a treatment called Herceptin, which she received an IV infusion of every three weeks. Simpson says the delay in screening “really, really delayed diagnosis for me, by a good six months”. “I can’t help but feel that [an earlier screening] could have probably saved me from having to have chemotherapy and this Herceptin infusion therapy that I’m having,” she says. Her last Herceptin treatment was last Wednesday. She has been living in self-imposed lockdown, terrified as the Omicron wave built that she would have to isolate due to Covid and disrupt her treatment. That self-imposed isolation will continue until her final surgery, an elective operation scheduled for mid-year. Cancer screening dropped by 10% in Victoria alone in the first year of the pandemic. In 2021, referrals to the Peter MacCallum Cancer Centre, a leading treatment and research facility in Melbourne, were down 40%. “That is certainly going to bounce back at some point,” says Prof Sherene Loi, an oncologist and researcher at Peter MacCallum. “It is potentially going to be a real problem in a few years’ time. At the moment we have a lot of very young cancer diagnoses, a lot of breast cancer … we are just flat chat.” Read full Source: The Guardian, 13 February 2022
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Content ArticleThis is the recording of a webinar given on 19 January 2022 for the International Shared Decision Making Society by Professor Kirsten McCaffery from the University of Sydney and Marie Anne Durand from the University of Lausanne. It covers the following topics: What is health literacy and why does it matter Conceptualising health literacy and shared decision making Findings from recent health literacy and shared decision making reserach What can we do better?
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Content Article
Australian Atlas of Healthcare Variation Series
Patient Safety Learning posted an article in Data and insight
Mapping variation is an invaluable tool for understanding how our healthcare system is providing care. Maps of variation in care, derived from information routinely gathered by the health system, show how healthcare use differs across the country and raise important questions about why this variation might be occurring. The aim is to prompt further investigation into whether the observed variation reflects differences in people’s healthcare needs, in the informed choices they make about their treatment options, or in other factors. Each Atlas includes data, maps, graphs, clinical commentaries and recommendations for each chapter. These can be viewed or downloaded from links on the Atlas website. -
Content ArticleThe General Practice: Health of the Nation report gives a unique overview of Australian general practice. The report reflects the experience of more than 1300 RACGP Fellows from across Australia, and incorporates information from the Australian Bureau of Statistics (ABS), Medicare, the Australian Institute of Health and Welfare (AIHW) and various government publications. The report provides information at a specific point in time and identifies longer-term trends across the general practice sector. The 2021 Health of the Nation report also highlights a number of critical issues affecting GPs and their patients, including: treatment of multimorbidities in general practice the increasing mental health burden on general practice restrictions to GP involvement in aged care barriers to the use of video telehealth services the COVID-19 vaccine rollout.
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News ArticleAlmost three out of five GPs reported managing patient expectations about vaccinations to be one of the most challenging issues of the pandemic, with multiple changes to vaccine eligibility requirements leaving many people confused and overwhelmed, the president of the Royal Australian College of General Practitioners, Dr Karen Price, said. In her foreword to the college’s Health of the Nation report, published on Thursday, Price said: “Unfortunately, some of these patients took their frustrations out on general practice staff”. “Differing eligibility requirements across jurisdictions added to the strain.” Schools should stay open as greatest risk of Covid transmission is in households, research finds The report is published annually and provides an insight into the state of general practice in Australia. It includes the findings of a survey of 1,386 GPs between April and May, of which 70% were in major cities, 20% inner-regional, 8% outer‐regional, and 2% remote and very remote. Read full story Source: Guardian, 21 October 2021
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News ArticleOn Tuesday, there were 356 COVID-19 patients being treated in intensive care wards throughout Australia. Of those, 25 were fully vaccinated. While the data points to the extraordinary efficacy of COVID-19 vaccines in preventing people from becoming severely unwell, being hospitalised and dying, it does raise the question: why do a small number of people become seriously ill and, in rare cases, die, despite being fully vaccinated? An intensive care unit staff specialist at Nepean hospital in Sydney, Dr Nhi Nguyen, said those who are fully vaccinated and die tend to have significant underlying health conditions. Being treated in intensive care, where people may be on a ventilator and unable to move, added to any existing frailty, especially in elderly people, she said. “If we think about intensive care patients in general, whether they are there due to COVID-19, pneumonia or any other infection, we know that those who have underlying disorders, those who are frail, and those with co-morbidities will have a higher risk of dying from whatever the cause of being in intensive care is,” she said. “Being fully vaccinated against Covid protects you from getting severe disease, yes, but it doesn’t completely protect you from getting Covid. So if you are someone with chronic health conditions, what might be a mild disease or mild infection in a young person or a person who is in good health, will have a greater impact on you.” She said this was why the Australian Technical Advisory Group for Immunisation (Atagi) had recommended boosters for those people who are severely immunocompromised. On Wednesday the government said it intended booster shots to be rolled out to the aged care sector within weeks, and to be available to the whole population by the end of the year. Read full story Source: The Guardian, 20 October 2021
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Content ArticleThe aim of this study was to determine the distribution of formal patient complaints across Australia's medical workforce and to identify characteristics of doctors at high risk of incurring recurrent complaints. It found that a small group of doctors accounts for half of all patient complaints lodged with Australian Commissions. It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems.
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Content ArticleWhen healthcare worker infections at The Royal Melbourne Hospital in Australia seemed to be spiralling out of control despite strict protocols being adhered to by expertly trained staff, Professor Kirsty Buising and her colleagues took action. To inform future responses in the Australian setting, Kirsty and her colleagues present in this paper a description of healthcare worker infections at their institution and the suite of interventions they used to control the outbreak.
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EventWe live in a world marked by massive global changes, moving us rapidly into rather unprecedented and unknown directions. It has never been so vital for us to understand the interactions among humans and other system elements. This necessitates the creation and adoption of theories, principles, data, and methods of design, as well as new capabilities, technologies, skills, procedures, policies, strategies to find new ways of engaging with a rapidly changing world and optimise wellbeing and performance. Find out more at the Human Factors & Ergonomics Society of Australia (HFESA) virtual conference. Register
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Community PostAbout 1000 angry nurses and doctors have rallied outside Perth Children’s Hospital in Australia following the death of seven-year-old Aishwarya Aswath, demanding vital improvements to the state’s struggling health system. The Australian Nurses Federation was joined by the Australian Medical Association for the rally, with staff from hospitals across Perth attending. Many people held signs that read “We care about Aishwarya”, “Listen to frontline staff”, “Report the executive — not us” and “Please don’t throw me under the bus”. Aishwarya developed a fever on Good Friday and was taken to Perth Children’s Hospital the next day, but had to wait about two hours in the emergency department before she received treatment. She died soon after from a bacterial infection. An internal report into the tragedy made 11 recommendations — including improvement to the triage process, a clear way for parents to escalate concerns and a review of cultural awareness for staff — but Aishwarya’s parents said the report raised more questions than it answered. The family wants a broader independent inquiry to look at all 21 near-misses in the past 15 months – not just their daughter’s case. Some people have been referred to medical authorities, while Child and Adolescent Health Service chair Debbie Karasinski resigned after the report.' I am encouraged to see the way healthcare staff reacted to this tragedy. Imagine a similar event in England, would nurses protest outside the hospital and stand up to authority like this? I doubt it very much, which is very sad reflection on the prevailing culture and health leadership in England. What do others think? Source: The Australian. 9 July 2021 Picture: Picture: 9 News
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Content ArticleSubstantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. In a study published in the Lancet, McHugh et al. aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.
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News ArticleDeborah Stanford is one of many women who have received a Boston Scientific implant and suffered complications. She has joined Shine Lawyers’ class action, which was filed today in the Australian Federal Court, to hold the manufacturers to account for the continuous pain she has endured since the Obtryx sling was implanted on 12 September 2012. Ms Stanford’s bladder was sitting in the birth canal and the sling was placed, on medical advice, to reposition her bladder. “It has been 9 years of suffering." “If I knew how hard this was going to be, I never would have gone through it,” said Ms. Stanford. Boston Scientific is the third pelvic mesh manufacturer to face a class action over their range of prolapse mesh and incontinence sling implants. Shine Lawyers has filed all three actions against Johnson & Johnson, Ethicon and American Medical Systems (AMS). Read full story Source: Shine Lawyers, 22 March 2021
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Content ArticleThis charter published by the Australian Commission on Safety and Quality in Healthcare describes the rights that consumers, or someone they care for, can expect when receiving health care. These rights apply to all people in all places where healthcare is provided in Australia. This includes public and private hospitals, day procedure services, general practice and other community health services. Topics covered include access, safety, respect, partnership, information, privacy and feedback.
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Content ArticleThis survey tool from the Australian Commission on Safety and Quality in Health Care provides Australian health service organisations with a set of 14 principles supported by a variety of risk reduction strategies. The tool is intended for use in hospitals by all clinicians involved in the medication management pathway, including those with governance responsibilities within the health service. The survey tool is also intended to be applied within pharmacy and ward storage environments.
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Content ArticleDo patients’ and families’ experiences with communication-and-resolution programmes suggest aspects of institutional responses to injury that could better promote reconciliation after medical injuries? This interview study of 40 patients, family members, and hospital staff in Australia found that patients have a strong need to be heard after medical injury that is often unmet. Although 18 of 30 patient and family participants (60%) reported positive experiences with communication-and-resolution programmes overall and continued to receive care at the hospital, they reported that hospitals rarely communicated information about efforts to prevent recurrences. Opportunities are available to provide institutional responses to medical injuries that are more patient centred.
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Content ArticleThe aim of this study from Bismark et al. was to identify characteristics of doctors in Victoria, Australia, who are repeated subjects of complaints by patients.
