The procedure manual as a document represents the practice of nursing care. Analysis of such manuals allows us to explore discourses of nursing and the ways in which they frame nursing practice. A critical analysis of a hospital procedure manual using discourse analysis was undertaken. A specific excerpt concerning 'Last offices' is used as an example of the institutionalisation of organisational values and beliefs as these influence nursing care. 'Last offices' directs nursing practices related to the death of a patient, and the laying out as preparation for the funeral director or coroner. The analysis shows that procedure manuals reproduce hegemonic ideologies of nursing. The analysis also shows how nursing practices are constituted by intersecting forces of differing locations such as the hospital as an organisation, the healthcare system and the wider society within which these function.

Transfusion safety coordinators (TSCs) are an integral part of the transfusion process, which involves many interlinking chains of events and a multidisciplinary group of health professionals. In Australia, individual hospital‐based TSCs have been in place for several decades, with state‐based collaboratives commencing in 2002. The role has expanded across the country and currently there are 113 dedicated TSC positions and many more staff involved as blood/transfusion champions. There are also 12 transfusion nurse (TN) positions within the Australian Red Cross Blood Service. Over time both TSC and TN roles have evolved to meet the changes within the Australian blood sector. The primary focus of safety and appropriateness has now evolved to be more patient‐centred by incorporating patient blood management (PBM) initiatives. National PBM guidelines, statements, strategies, criteria and healthcare standards specifically focused on all aspects of transfusion have influenced this evolution. TSCs undertake diverse roles and activities that vary significantly between health services and within each jurisdiction. Effective communication and change management skills are integral to the success of the role. Conclusion: The TSCs are highly recognised within the transfusion team and the role continues to evolve with the changes in the Australian blood sector. The term Transfusion Safety Coordinators (TSCs) has been used to describe roles such as transfusion nurse/trainer/practitioner/safety officer/clinical nurse consultant and PBM nurses.

There is a need for improved education to ensure best transfusion practice and patient outcomes. Australian junior doctors want immediate, practical, reliable transfusion information from credible sources to support them in practicing safely and confidently. Their educational needs are driven by real-time patient management. Promotion of the available resources and tools provided by the blood sector is important.

Audits of clinical transfusion practice have consistently demonstrated deficiencies in knowledge and practice that impact on patient safety and in some cases result in death. These deficiencies include transfusion being prescribed inappropriately, administration of blood components using poor processes, documentation deficiencies and inadequate identification of potential transfusion recipients. Improvement needs to be driven by a multifaceted approach that includes robust systems and mechanisms to ensure compliance combined with education of staff. However, education of medical, nursing and other staff involved in the transfusion chain can be difficult. Large numbers of staff, shiftwork, varying levels of background knowledge and limited resources create significant challenges. Consideration of these problems and informal needs analysis defined a web‐based or on‐line learning tool (e‐learning) as being a suitable mechanism to assist hospitals to increase knowledge of staff. An effective e‐learning tool must be engaging, replicate an authentic learning environment, cater for various learning styles and engage the learner in the learning process. This requires knowledge of on‐line learning best‐practice, learner profiles, learning styles and the learning environment, as well as consideration of interface design, motivational tools and knowledge retention strategies. Funding was provided by the South Australian Department of Health, under the BloodSafe programme, to develop an e‐learning tool. This has resulted in a multimedia‐rich programme utilizing video, audio, animations, and case studies and didactic instruction in order to create an authentic learning environment. Learning content includes expert and peer education, case studies, interactive games and puzzles and modelling of best‐practice processes. A flexible learning pathway gives learners control over learning sequence, content viewed and assessment. Learner demographics, progress and assessment tools and records are stored in an SQL database. This tool is available for use by hospitals and healthcare institutions and professionals. Initial use has demonstrated a high degree of acceptance with participants providing strong feedback on the content, learning pathway and ease of use. Further development is being undertaken to add additional modules offering advanced content and/or a broader audience base. The initial implementation of this e‐learning tool is directed at an Australian audience, however, the content is relevant to the wider transfusion scene in the Asia‐Pacific region (and beyond) as a mechanism for educating staff involved in all steps of the transfusion chain.

In 2007, new criteria covering the clinical aspects of blood transfusion were introduced into hospital accreditation schemes in Australia. One of the components of this was a requirement for appropriate staff to be ' ... trained and credentialed in (i) blood sample collection, (ii) blood component therapy prescription and administration, [and] (iii) the storage and transportation of blood components. ' In response to this, BloodSafe developed an online education (e-learning) package (www.bloodsafelearning.org.au). Initial implementation occurred in South Australia, with demand from other states and territories resulting in a plan to implement in all areas of Australia. The programme has seen significant uptake and ready acceptance by users, with very strong positive feedback on the content, educational design and delivery. This e-learning tool incorporates a range of media and activities designed to engage the learner emotionally, psychologically and physically. It has also been designed to cater for different learning styles and to further engage and support the learner through the use of video, audio, interactive animations and best practice examples in an authentic learning environment. The success of this project has been due to a number of factors including: (i) input from a wide range of transfusion experts across medical, nursing and laboratory disciplines, (ii) involvement of qualified and experienced educators with a clear understanding of e-learning, and (iii) the use of professionals from other disciplines including graphic design, photography, video production, computer programming, acting and production. During the production of this tool, many lessons were learnt that can be applied to other e-learning projects and resources. These include the time required to produce a quality product, budget and production time estimation, personnel resources required, the value of storyboarding and review of content and learning materials, governance structure and project management. e-Learning is a cost-effective delivery mechanism for provision of educational materials and resources. If well designed, it can be as effective as traditional forms of teaching and is readily accepted by users. It has the potential to standardize policies and procedures and improve clinical practice, resulting in improved patient outcomes and better use of a scarce resource. If made freely available, via the world-wide web, it is also a way that the developed world can assist disadvantaged regions and countries at little or no additional cost.The safest thing for a patient is to be in the hands of a [person] engaged in teaching medicine. In order to be a teacher of medicine the doctor must always be a student [1].It has long been recognized that continuing education of health professionals is crucial to the improvement of health care. Some have suggested that it is as critical as research and new discoveries [2] and in transfusion medicine it is seen as a mechanism for improving patient outcomes and ensuring best use of a scarce an...