Karlee is an advanced practice critical care pharmacist with more than 15 years’ experience. Having stepped away from regular full-time clinical work, Karlee has moved into academia to focus on teaching and research, although still enjoys working clinically on a casual basis. Karlee primarily teaches pharmacology and prescribing as well as professionalism and leadership to the Medical Students.  She has recently completed a PhD at the Australian National University School of Medicine and Psychology.  Karlee’s research has focused on investigating pharmacist burnout, particularly during COVID-19, and finding solutions to burnout with the aim of improving healthcare workers wellbeing. 

Social work has a unique voice in health care. Social workers work with both the person and their environment within which the social determinants of health are paramount. This voice isn’t often heard due to barriers in combining clinical practice and research.

 

What are the barriers and enablers/motivators for social workers at Canberra Health Services in undertaking research? Would implementing the enablers/motivators support research activities?

 

This was a mixed methods study. A senior social work lecturer/researcher from Charles Sturt University ran eight co-operative inquiry workshops embodying the identified enablers/motivators A Research Capacity in Context (RCC) tool captured quantitative data and qualitative with free text boxes.  A streams of consciousness evaluation further added to the qualitative results.

 

There were significant increases in the RCC scores across the domains of individual, team, and organisation. This was further reflected in qualitative feedback such as the workshops created a safe place and time to think leading to statements” I can do research” The study led to a growth in confidence and renewed interest in social work research. To date two projects are close to being submitted for publication and several other research areas are being steadily progressed.

 

It has shown the importance of listening to what social workers need in order to conduct research and highlighted the benefits of coming alongside each other and working together to both tackle the barriers and create research growth.

 

Significance 

This study is replicable for all disciplines to combine clinical practice and research.

 

Alison McDonald1, Monica Short2, Nick Brown3,4, Rosemary (Rosy) Winter5, Charmaine Nicoll5, Mary Woodcock6, Catherine Spence7
 
 

1.     Canberra Health Services, Garran, ACT, 2605

2.     School of Social Work and Arts, Charles Sturt University, Wagga Wagga, NSW, 2678

3.     Faculty of Health, University of Canberra Hospital, Bruce, ACT, 2617

4.     UC Clinical School, Canberra Health Services, Garran, ACT, 2605

5.     Office of the Director of Allied Health, MHJHADS, Canberra Health Services, Canberra, 2601

6.     Division of Cancer and Ambulatory Support, Canberra Health Services, Garran, ACT, 2605

7.     Australian Catholic University, Watson, ACT, 2602 

Introduction: Strengthening of the breathing muscles can improve patients' quality of life in ICU. Electronic trainers could allow training of a broader range of very weak patients, but safety and acceptability needs to be established. 

Aim: To evaluate the safety, feasibility, and acceptability of an electronic device to facilitate inspiratory muscle training (IMT) with critically ill patients requiring prolonged mechanical ventilation (≥5 days). 

Methods: Prospective observational cohort study, with convenience sampling in 2 tertiary ICUs. Daily training supervised by ICU physiotherapists was completed with the electronic IMT device. Feasibility was defined a priori as ≥ 80% of planned sessions completed. Patient-perceived acceptability was evaluated with a bespoke survey. 

Results: Forty participants completed 197 electronic IMT treatment sessions. Electronic IMT was feasible with 81% of planned sessions completed. There were 19 minor adverse events in 11 participants (10% sessions) and no major adverse events. All minor events were transient without clinical consequences (e.g. rise in systolic blood pressure >20mmHg). All participants that recalled completing electronic IMT sessions reported that the training was acceptable, with over 85% reporting electronic IMT was helpful or beneficial.

Conclusion: Electronic IMT is feasible and acceptable with ICU patients who require prolonged mechanical ventilation. As all minor adverse events were transient without clinical consequences, electronic IMT can be considered a relatively safe intervention in this cohort. 

• Electronic IMT is safe, feasible and acceptable in ICU patients undergoing prolonged mechanical ventilation (>5 days) and can be incorporated into clinical practice.

• The efficacy of electronic IMT in ICU patients should be explored in a randomised trial.

 

Bernie Bissett1, Marc Nickels2, Grant McMurray3, Katie Erwin4, Richie Talbot1, Mark Strong3, Anand Krishnan5, Frank Van Haren6

 

1.     Discipline of Physiotherapy, University of Canberra, Canberra ACT, 2617

2.     Physiotherapy Department, Ipswich Hospital, Brisbane, QLD, 

3.     Physiotherapy Department, Princess Alexandra Hospital, Brisbane, QLD

4.     Physiotherapy Department, Canberra Health Services, Garran ACT, 2606

5.     Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD,

6.     College of Health and Medicine, ANU, Canberra, ACT, 2600

Adequate nurse staffing and manageable workload are foundations upon which nurses can undertake timely, safe patient care, including infection control practices (ICP).. Staffing models such as nurse-to-patient ratios (NPR) are a commonly applied approach to ensure safe staffing but their impact on ICP has not been explored. 

To understand nurses’ perceptions of the impact of ratios on ICP

Cross-sectional online survey of nurses on 12 units in Canberra Health Services where a 1:4 NPR had been introduced. Questions were drawn from previous research and reviewed by a panel of infection control experts. Analysis was descriptive.

Nurses who cared for four or fewer patients on their most recent shift completed most ICP tasks in a timely manner, were more likely to provide patient education, and had more time to communicate with the treating team. Some ICP such as hand hygiene or PPE use were not impacted by NPR staffing.

Many ICP were strengthened by staffing that was consistent with the ratio framework. This suggests that NPR staffing had an early and important impact on practice. Contrasting findings for some activities may be explained by priorities developed during the COVID-19 pandemic. Future research will be enhanced with longitudinal or observational approaches. 

This study adds to the limited evidence on NPR, particularly regarding ICP. It used end-user experiences to help understand impacts of early policy implementation within Canberra Health Services. It provides a foundation for future exploration of the specific impact of NPR staffing.

 

Monika Tencic1, Michael A Roche2
 
 

1.     Canberra Health Services, Garran, ACT 2605

University of Canberra, Bruce, ACT, 2617 

Central line-associated bloodstream infections (CLABSI) and major vascular injuries (MVI) are serious but preventable complications in patients requiring central venous access devices (CVADs).

 

To determine the effectiveness of a comprehensive care bundle (CCB) in adult patients with CVAD in reducing the rate of CLABSI and MVI in a major tertiary hospital.

 

Pre-and-post intervention study using ICU-CLABSI data reported to the Australia and New Zealand Intensive Care Society (ANZICS) and MVI-data from CVAD audit in patients admitted to The Canberra Hospital between February 1, 2018, to January 31, 2022. The pre-intervention (February 1, 2018, to January 31, 2020) review of CVAD complications indicated significantly higher CLABSI and MVI than peer hospitals.

 

At the institutional level, we introduced an evidence-based CCB, checklist, policy, and education package through a literature review and multi-disciplinary collaboration addressing system and operator-focused changes on February 1, 2020.

 

The post-intervention cohort had a significantly lower CLABSI rate than the pre-intervention (0.32 vs.1.1 per 1000-line days, 3 incidences per 9283-line days vs. 10 incidences per 9079-line days, P<0.001) despite significantly higher risk factors in the form of CVAD line days (387vs378, P<0.001), number of patients on mechanical ventilation (1739 Vs. 1687, P=0.005), immunosuppressive diseases (318 vs.119, P<0.001), leukaemia (99 Vs. 81, P=0.038) and hepatic diseases (97 Vs. 71, P=0.006). No MVI was reported post-intervention compared to four in the pre-intervention cohort.

 

The CCB decreased the incidence of CLABSI and MVI in patients in a tertiary ICU.

 

Introducing a multi-disciplinary CCB for CVAD insertion and maintenance decreased CVAD-related preventable complications and healthcare costs.

 

Harshel G. Parikh1,2, Andrew Deacon3, Kiran Gudivada1, Mary Nourse1, Kelvin Grove1
 
 

1.     Intensive Care Unit, Canberra Health Services, Garran, ACT 2605

2.     Medical School, The Australian National University, Acton, ACT 2600

3.     Department of Anaesthesia, Canberra Health Services, Garran, ACT 2605

Hysterectomy is a common surgical procedure that has a post-operative complication rate of 20%. Enhanced Recovery After Surgery (ERAS) protocols reduce complications, hospital length of stay, and healthcare costs for patients undergoing hysterectomy. Compliance is crucial for ERAS success but challenging to achieve in clinical practice. The impact of ERAS protocol compliance on hospital length of stay is unclear for hysterectomy patients at the Canberra Hospital.

The aim of this study is to investigate the effect of compliance with the ERAS protocol on hospital length of stay for patients undergoing elective hysterectomy. 

This prospective cohort study recruited 160 hysterectomy patients since February 2021. Compliance is measured as the percentage adherence to 15 key ERAS protocol elements, with a targeted average monthly compliance of ≥80%. Hospital length of stay is the difference between actual and predicted length of stay in days, as calculated by the American College of Surgeons Surgical Risk Calculator.

Protocol compliance ranged from 46% to 100%, with a mean of 77% (SD 10.55%), which includes the targeted average monthly compliance of ≥80%. The mean difference between actual and predicted length of stay was 0.97 days (SD 1.37). Pearson’s correlation coefficient showed a weak but significant correlation between increased ERAS protocol compliance and reduced hospital length of stay (r= -0.16, p= 0.027).

This study emphasises that ERAS protocol compliance is crucial for optimising the care of patients undergoing hysterectomy at the Canberra Hospital. 

This research paves the way for targeted studies to identify potential barriers to protocol adherence and interventions to increase compliance.


Sanduni Pathiratna1, Kimberly McNeice2, Craig Boutlis3, Andrew Deacon4
 
 

1.     Critical Care Senior Resident Medical Officer, Canberra Health Services, Garran, ACT, 2605

2.     ERAS Nursing Coordinator, Canberra Health Services, Garran, ACT, 2605

3.     Department of Infectious Diseases, Calvary Public Hospital, Bruce, ACT, 2617 

4.     Department of Anaesthesia, Perioperative Medicine and Pain Management, Canberra Health Services, Garran, ACT, 2605