Critical illness in children is a life changing event for the child, their parents, caregivers and wider family. There is a need to design and evaluate models of care that aim to implement family-centred care to support more positive outcomes for critically ill children and their families. Due to a gap in knowledge on the impact of such models, the present review was conducted. Primary research articles written in English that focused on children hospitalised for an acute, unexpected, sudden critical illness, such as that requiring an intensive care admission; and addressed the implementation of a model of care in a paediatric acute care hospital setting. Thirteen studies met the inclusion criteria. The models of care implemented were associated with positive changes such as reduced parental anxiety and improved communication between parents/caregivers and health professionals. However, no model provided intervention throughout each phase of care to (or post) hospital discharge. Models of care applying family-centred care principles targeting critically ill children and their families can create positive changes in care delivery for the family. However a model which provides continuity across the span of care is required. There is need to describe how best to design, implement and sustain models of care for critically ill children and their families. The success of any intervention implementation will be dependent on the comprehensiveness of the strategy for implementation, the relevance to the context and setting, and engagement with key stakeholders.

Timely recognition and treatment of acutely ill patients at appropriate levels of the health system are fundamental to the quality and safety of healthcare. This study determines if the implementation of an emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves patient safety. A quasi-experimental cohort study was conducted in two emergency departments in [Anonymised], Australia. HIRAID was implemented using a multi-pronged behaviour change intervention. Data of 920 patients (374 pre and 546 post) who deteriorated within 72-hours of ED departure were collected. Statistical tests were conducted as two-sided, with a 95% confidence interval to determine pre/post cohort association. Patients in the post group had more comorbidities, but experienced less deterioration associated with care delivered in the ED (27% to 13%). There was a reduction in treatment delays [ 28.3% to 15.1%, p = 0.041, 95% CI (1.1%-25.3%)], and delay or failure to escalate care when abnormal vital signs were identified [20.2% to6.9%, p = 0.014, 95% CI (3.5%-23.1%)]. Isolated nursing-related causal factors decreased from 20 (21%) to 6 (8%). Implementing a standardised emergency nursing framework is associated with a reduction in clinical deterioration related to emergency care.

The psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury. Semi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time. Three parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child's injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time; recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months; and distressed trajectory where parents experienced significant psychosocial disruption due to their child's injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented. This is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families' psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child's admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.

Purpose: Adverse drug reaction (ADR) underreporting is highly prevalent across the world. This study aimed to identify factors associated with ADR reporting and map these to a behavioural change framework to help inform future interventions designed to improve ADR underreporting. Methods: A mixed methods survey was distributed to healthcare professionals at a tertiary hospital in Sydney, Australia. Quantitative data was analysed using logistic regression to identify factors that predict ADR reporting. Qualitative data was evaluated using content analysis. These were then integrated and mapped to the 14 domains within the Theoretical Domains Framework (TDF) to identify target areas relevant for improving ADR reporting. Results: One hundred thirty-three healthcare professionals completed the survey. Knowing how to report ADRs (OR 4.56, 95%CI 1.95–10.7), having been trained on ADR reporting (OR 2.72, 95%CI 1.29–5.77), and encountering ADRs as part of clinical practice (OR 10.3, 95%CI 3.59–29.4) were significant predictors of reporting an ADR. Content analysis identified three categories: modifying the ADR reporting process, enabling clinicians to report ADRs, and creating a positive ADR reporting culture. After data integration, the three target TDF domains were knowledge, environmental context/resources, and beliefs about consequences. Conclusion: Future interventions designed to improve ADR reporting should address these target domains to instigate behaviour change in healthcare professionals’ reporting of ADRs.

Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term ‘care bundle’ (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.

Background: Adverse drug reaction (ADR) related hospitalisations is a major cause of morbidity and mortality in Australia. This study investigated the prevalence, characteristics and reporting of ADR related hospitalisations at a tertiary hospital in Australia. Research design and methods: A retrospective review of all ADR related hospitalisations from October to December 2019 was conducted using eMedical Records. They were classified by medicine class, ADR type, preventability, and the strength of causal relationship. ADRs were searched within the regulator’s safety database to verify whether it was reported. Results: A total of 496 ADR related hospitalisations were identified from 5521 records (9.0%). Nervous system agents (32.3%) were responsible for most ADR hospitalisations and were more likely to cause psychiatric disorders (RR 9.71, 95%CI 4.98-18.87) than other types of ADRs. They were also more likely to cause preventable ADRs (HR 1.62, 95%CI 1.46-1.81). Patient age (OR 1.04, 95%CI 1.03-1.05) and the number of medicines (OR 1.13, 95%CI 1.11-1.15) were significantly associated with ADR related hospitalisations. Under-reporting to the national regulator was over 99%. Conclusions: ADR under-reporting is highly prevalent in Australian hospitals. Further research into identifying specific barriers towards reporting ADRs are needed to inform strategies with a focus on healthcare professionals involved in prescribing, dispensing and administrating nervous system agents.