Examining emergency departments practices on advance care directives and medical treatment decision making using the victorian emergency minimum dataset.

INTRODUCTION: Existence of Advance Care Planning (ACP) documents including contact details of Medical Treatment Decision Makers (MTDM), are essential patient care records that support Emergency Department (ED) clinicians in implementing treatment concordant with patients' expressed wishes. Based upon previous findings, we conducted a statewide study to evaluate the performance of Victorian public hospital emergency departments on reporting of availability of records for ACP. METHOD: The study is a quantitative retrospective observational comparative design based upon ED tier levels as defined by the Australasian College for Emergency Medicine (ACEM) for the calendar year 2021. RESULTS: Of 1.8 million total Victorian ED attendances, 15,222 patients had an ACP alert status recorded. Of these, 7296 were aged ≥ 65 years (study group). Of the thirty-one public EDs that submitted data, 65 % were accredited and assigned a level of service tier. The presence of ACP alerts positively correlated to location, tier level, age and gender (MANOVA wilk's; p < 0.001, value=.981, F = (12, 15,300), partial ƞ2 = .006, observed power = 1.0 = 95.919). CONCLUSION: The identified rate of ACP reporting is low. Strategies to improve the result include synchronising ACP (generated at different points) electronically, staff education, training and further validation of the data at the sending and receiving agencies.

Assessment of emergency department staff awareness, access and utilisation of advance care directives and goals of care: A cross-sectional survey.

BACKGROUND: Emergency department staff awareness, access and implementation of advance care directives and goals of care documents and the related patient consent processes are important but not well understood. METHODS: A cross-sectional survey using purposive sampling was undertaken at a tertiary hospital's Emergency Department from 15th March to 26th April 2021. Participants were recruited through online platforms. Pre-validated questionnaires were distributed by email or as QR codes on bulletin boards. Data collected included staff: demographics, knowledge, access and implementation of advance care directives and goals of care documentation. RESULTS: One hundred thirty-four (28%) of 476 targeted participants responded with nursing forming largest group. Results showed that previous attendance of advance care planning education was low at 20%. Familiarity with advance care directive documentations was only 19% while with goals of care document was average. 61 (48%) respondents reported ease of accessing electronic documents and 21 (19%) reported feeling very comfortable discussing and setting goals of care with patients (p = <0.01). CONCLUSIONS: Staff awareness of advance care directive was poor, while awareness of goals of care was average. There was no association between advance care directives awareness and staff age group, gender, length of: - professional practice, practice at the study site.

High-visibility warning labels on paracetamol-containing products do not prevent supratherapeutic ingestion in a simulated scenario.

CONTEXT: In Australia, legislation requires medication containing paracetamol display warning of co-administration with other paracetamol products, and safe maximum daily dosing (4 g). Labelling style, size and visibility differ, potentially leading possible supratherapeutic misadventure. OBJECTIVE: We studied the likelihood of participants exceeding the recommended dose of paracetamol using products with standard packaging versus products labelled with one of two additional warning labels. METHODS: This was a pilot prospective, observational study, conducted from May 2013 to July 2014. Participants undertook a structured interview to create a simulated 24-h scenario in which they chose from a range of labelled lone paracetamol- and compound paracetamol-containing medications to treat dental pain on six occasions. Participants were randomized to choose from one of three groups of analgesic medications with different package labelling: (1) standard packaging alone, (2) standard packaging + a pre-existing warning label and (3) standard packaging + large customized warning label. The primary outcome was to determine if participants would administer >4 g in 24 h, exceeding the recommended daily dose. RESULTS: One hundred eighteen surveys were completed (response rate 100%, 56% females). Forty-one (35% of total) participants took >4 g within the 24-h scenario period. About 24% (10/42) of the standard packaging group, 37% (13/35) of the standard packaging + pre-existing warning label group and 48% (19/40) of the SP + large customized warning label group ingested >4 g of paracetamol. There were no significant differences between the three groups (p > 0.05). CONCLUSION: In this small, simulated dental pain scenario, use of customized warning labels did not reduce the likelihood of supratherapeutic misadventure.