Simple signature/countersignature shared-accountability quality improvement initiative to improve reliability of blood sample collection: an essential clinical task.

BACKGROUND: Timely lab results are important to clinical decision-making and hospital flow. However, at our institution, unreliable blood sample collection for patients with central venous access jeopardised this outcome and created staff dissatisfaction. METHODS: A multidisciplinary team of nurses including a specialist clinical nurse leader (CNL), the hospital intravenous team and quality improvement (QI) consultants aimed to achieve >80% blood sample collection reliability among patients with central venous access by employing a simple signature/countersignature form coupled with audit-feedback and behavioural economics strategies. The form was piloted on one 25-bed unit. Data were collected for 60 weeks and interpreted per standard run chart rules. RESULTS: Blood sample collection reliability exceeded the 80% goal by week 22. The practice was sustained on the pilot unit and spread successfully to other wards despite significant operational threats including the COVID-19 pandemic. CONCLUSIONS: At our institution, a simple signature/countersignature form supplemented by audit-feedback and behavioural economics strategies led to sustained practice change among staff. The pairing of CNL to QI consultant enhanced change potency and durability.

An Indigenous perspective on ecosystem accounting: Challenges and opportunities revealed by an Australian case study.

The System of Environmental-Economic Accounting Ecosystem Accounting (SEEA-EA) is widely promoted in environmental and economic policy and management. Unfortunately, the SEEA-EA has not substantively addressed the aspects of accounting that may be of interest to, or used by, Indigenous peoples. We investigate an Indigenous perspective on the potential of the SEEA-EA to support cultural and environmental management through collaborative workshops with managers of Nyamba Buru Yawuru, the Prescribed Body Corporate representing the Yawuru Traditional Owners in Western Australia. Our discussions highlight that while the SEEA-EA may be a valuable tool for empowering Indigenous people and supporting the management of their lands and seas, there are areas where the SEEA-EA needs to be broadened to better reflect cultural values, and the services to ecosystems provided by Indigenous peoples. Embedding Indigenous perspectives into the SEEA-EA would mean that it is of greater use to Indigenous peoples and their representative organisations and ensure that these values are better recognised in the policymaking of government.

Land cover and fire accounts to support Indigenous land management: A pilot study of Yawuru Country.

Ecosystem accounting is emerging as a promising tool for environmental management by offering consistent information about ecosystem change over time. Via a United Nations process, ecosystem accounting has been standardised in the System of Environmental-Economic Accounting (SEEA). However, there are currently no examples of ecosystem accounts developed specifically to support Indigenous people's management of land or sea. More than 40% (3 million square kilometres) of Australia's land and sea territory has Indigenous Title. If Indigenous managers are to use ecosystem accounting, then it is essential for them to be involved in its development. We assessed how ecosystem accounts can be developed and applied in a manner that supports the management objectives of Indigenous owners and managers. Working collaboratively with the Yawuru Traditional Owners of the land and sea country around Broome, Western Australia, we constructed and assessed experimental ecosystem accounts for land cover and fire for the period 2000-2020. Three key benefits of ecosystem accounts for supporting the priorities of Yawuru managers were identified: (1) flexibility in the units used for the analysis; (2) the extended time scale of the accounts; and (3) the emphasis on consistent capturing and reporting of data. We also identified the need for further work to incorporate cultural knowledge and values within the broader SEEA, with implications for the recognition of Indigenous people, knowledge and values within accounting systems globally.