Authors:  Aude Fahrer, George Cavic, Christina Carroll, Andrew Almonte, Birhanu Jemere, Yada Kanjanapan, Laeeq Malik, Desmond Yip

Our team previously initiated the first ever investigator-led phase I oncology trial in the ACT.

Our novel, slow-release cancer immunotherapy is injected into a tumour to initiate a strong immune response.  The objective is to convert the tumour into a personalised anti-cancer vaccine.  

The objectives of our current project are to improve our formulation, and to see if our drug acts synergistically with checkpoint inhibitor cancer therapies.  Our ultimate aim is to improve response rates to treatment for cancer patients.

The difficulty differentiating the symptoms of a mild transfusion reaction from early symptoms of serious reactions leads to unnecessary cessation of blood transfusions, blood product wastage and over utilisation of laboratory resources in investigating suspected reactions. Creating a direct cost burden on the health care system.

 

To determine the cost associated with investigating minor transfusion reactions and identify opportunities to improve the management of blood transfusion reactions through application of current national guidelines. 

 

This study retrospectively reviewed all suspected transfusion reactions reported to the laboratory at The Canberra hospital (TCH) between 2015 and 2020. TCH has mandatory training on recognition, clinical management, and reporting of suspected transfusion reactions. Suspected reactions were assessed for appropriateness of clinical management and associated investigations. Cost of inappropriate investigations and associated blood product discard was calculated using current national tariffs. 

 

A total of 274 suspected reactions were reported in the 6-year period under review. 148 cases were considered unnecessarily investigated for transfusion reactions, either because they lacked signs or symptoms of a transfusion-related event, or these were minor with the transfusion potentially able to be continued under national guidelines. The costs of unnecessary investigation for suspected transfusion reactions totalled AU $ 32,427.00. In addition, the costs of partially discarded blood products were AU$55,656.00. 12% of blood products cultured returned a positive result with microbes of low pathogenicity isolated.

 

The study demonstrated that unnecessary investigation of minor transfusion reactions adds a significant financial burden to the health care system. 

Significance: Improved guidance for clinicians at the point of care is required.

 

Cliford Joel1, Philip Crispin2,3, Maria Burgess4
 
 

1.     ACT pathology, Canberra Health Services, Garran, ACT 2605

2.     ACT Pathology – Haematology, Canberra Health Services, Garran, ACT 2605

3.     Medicine, The Australian National University, Acton, ACT, 2601

4.     ACT blood program, Canberra Health Services, Garran, ACT, 2605

D-dimer has high sensitivity for acute pulmonary embolism (PE) diagnosis, but poor specificity – resulting in unnecessary imaging and costs. Age-adjusted (AADD), clinical probability-adjusted (CPADD) and YEARS-algorithm-adjusted (YDD) D-dimer approaches increase specificity, but their relative effectiveness is unclear.

To assess the diagnostic effectiveness of AADD, CPADD, YDD, clinician judgement and novel approaches, and estimate potential cost-savings from the best-performing approach.

Retrospective cross-sectional analysis of consecutive patients attending Canberra Hospital Emergency Department from December 2019–March 2020 with Computerised Tomography Pulmonary Angiography (CTPA) and D-dimer performed for suspected PE. Sensitivities/specificities of approaches were compared. Proportion of avoidable CTPAs and annual cost-savings were calculated using the best-performing approach. 

226 patients (mean age 59.1 years; 61.1% female) were included, with PE diagnosed in 10.6% on CTPA. CPADD (95.8% sensitivity; 62.9% specificity) and YDD (100% sensitivity; 57.4% specificity) were superior to AADD (95.8% sensitivity; 28.7% specificity) and 0.5 mg/L cut-off (100% sensitivity; 16.8% specificity). Clinician judgement had high specificity (79.2%) but poor sensitivity (58.3%). Novel combined approaches using YDD and CPADD with 0.75 mg/L and 1.40 mg/L optimised cut-offs (YDD 0.75/1.40 and CPADD 0.75/1.40) had highest sensitivity and specificity (YDD 0.75/1.40 100% sensitivity, 74.8% specificity; CPADD 0.75/1.40 95.8% sensitivity, 78.7% specificity). YDD 0.75/1.40 approach would have avoided 45.8% of all CTPAs – equating to AUD$253,405 annual cost-savings, with zero missed PEs.

YDD, CPADD and the novel approaches are most effective – potentially avoiding half the CTPAs and saving a quarter-million dollars annually at Canberra Hospital.

Utilising novel D-dimer approaches can potentially improve PE diagnosis and reduce healthcare resource utilisation.

 

Yi Tong Vincent Aw1,2,3, Jessica YH Aw3, Priyaah Sekar4, Teisa Holani5, Craig Wayling4, Hsien Cheun Soo4, Denesh Selvarajah4, Stuart Schembri6,3
 
 

1.     General Medicine Department, Canberra Health Services, Garran, ACT 2605

2.     College of Health and Medicine, The Australian National University, ACT, 2601

3.     ANU Medical School, The Australian National University, Acton, ACT, 2605

4.     Canberra Health Services, Garran, ACT, 2605

5.     Emergency Department, Calvary Public Hospital, Bruce, ACT, 2617

Department of Respiratory and Sleep Medicine, Canberra Health Services, ACT, 2605 

Older people in residential aged care facilities (RACFs) are at risk of medication related harm due to high rates of co-morbidities and inappropriate medication use. There is a need for new models of care using inter-disciplinary collaboration. 

 

This cluster randomised controlled trial (cRCT) was conducted to examine the effectiveness and implementation of employing on-site pharmacists in RACFs. 

 

The cRCT and implementation study was conducted in 20 facilities in the ACT and assessed the effect of having an on-site pharmacists in RACFs on:

• Medication-related outcomes – Potentially Inappropriate Medications (PIM) per Beers criteria (2019), use of psychotropics, poly-pharmacy and Anti-Cholinergic Burden

• Non-medication related outcomes – Emergency Department visits and unplanned hospitalisations, falls, medication incidents and economic cost-effectiveness

• Implementation outcomes – collaboration, normalisation, adherence. 

 

There was a significant reduction in the use of PIM, Anti-Cholinergic Burden scale and a smaller reduction in inappropriate antipsychotic medicines dosage. There were no significant changes in other outcomes. No statistically significant difference was identified between control and intervention group in health care resource usage. Positive working relationships between on-site pharmacists, RACF staff, families and GPs were developed and maintained. 

 

The on-site pharmacist model improved medication management. Employment by the RACF and onsite location facilitated the pharmacist embedding into the RACF team and clinical governance processes. 

 

The Commonwealth Department of Health announced funding for on-site pharmacists in RACFs (2022 Budget), roll out commencing 2023. Findings from our study helped informed this and the training, education, promotion resources and toolkits from this study can be adapted for national scale-up.

 
Jane Koerner1, Sam Kosari2, Mark Naunton2, Rachel Davey1, Ibrahim Haider1, Miranda Batten1, Michael J Dale1
 
 

1.     Health Research Institute, University of Canberra, Canberra, ACT, 2617

2.     Discipline of Pharmacy, Faculty of Health, University of Canberra, Canberra, ACT, 2617

While recent literature has suggested that ambiguity of patient outcomes may contribute to the occupational distress of emergency nurses, data to substantiate this is lacking.

This research explores if ambiguity about patient outcomes negatively impacts emergency nurses, and if ambiguity is demonstrated to cause this, the study will explore the frequency and scope of the impact on the personal and professional lives of emergency nurses

Emergency nurse participants were invited to complete a 17-item survey tool exploring their experience of ambiguity relating to patient outcomes and potential impact on their professional or personal life. Analysis of data collected from January – April 2023 was undertaken using descriptive statistical analysis.

176 (93.1%) of participants responded that they sometimes, often or always experienced ambiguity related to the clinical, social or personal outcomes for a patient or their significant others after presentation to the emergency department. Similarly, a strong majority reported negative impacts of this ambiguity on their professional practice (n = 158, 85.4%) and/or personal life (n= 141, 75.8%)

A large majority of the study sample report ambiguity relating to the clinical, social or personal outcomes of patients and/or their families after presenting to the emergency department (93.1%). Further, this ambiguity has a negative impact on the professional and personal lives of emergency nurses.

Ambiguity of patient outcomes has a significant impact on emergency nurses. Further study into this phenomena should be a priority of health services.

 

 
Rebecca, A, Caulfield1,2, Taneal, Wiseman1, Janice, Gullick1, Rebekah Ogilvie4

 
 

1.     Susan Wakil School of Nursing and Midwifery, University of Sydney, NSW, 2620

2.     Emergency Department, Canberra Health Services, Garran, ACT, 2605 

3.     Canberra Health Service, Garran, ACT, 2605

Introduction: Mental health clinical placements can reduce fear, stigma, and discrimination, yet mental health clinical placements are not mandatory nor sufficient to meet the needs of the growing number of students enrolled in nursing courses. It is important to understand the impact of professional learning and motivation for nursing students when attending clinical placement and identify how these can be adapted universally. 

  

Aims: An examination of the influence that the provision of structure had on the motivation and professional skills of nursing students working within a mental health clinical placement. 

  

Methods: This study used a quasi-experimental study design to examine the nursing clinical placement experience of nursing students enrolled in the Bachelor of Nursing degree. 114 nursing students completed a battery of pre and post-test surveys examining their perceptions of the social context, motivational responses, and levels of professional learning. 

  

Results: The provision of structure positively impacted on the motivation and professional learning of nursing students. 

  

Conclusions: Mental health clinical placements are key professional learning opportunities for nursing students. This research demonstrated the need to enhance knowledge and awareness of mental health nursing to all registered nurses working within any field of health. Autonomy-supportive clinical placements are more likely to enhance the learning opportunities and outcomes of nursing students and enhance clinical placement competencies to meet the needs of consumers. 

  

Significance: This research provided crucial insight into the learning outcomes of students engaged in clinical placements and highlights that provision of structure and social context significantly impacts on the professional learning of nursing students. 

 

Anita Cregan

 

School of Education and School of Nursing, University of Wollongong, NSW, 2522