Background: In Australia, telehealth services were used as an alternative method of health care delivery during the COVID-19 pandemic. Through a realist analysis of a survey of health professionals, we have sought to identify the underlying mechanisms that have assisted Australian health services adapt to the physical separation between clinicians and patients.Methods: Using a critical realist ontology and epistemology, we undertook an online survey of health professionals subscribing to the Australian Telehealth Society newsletter. The survey had close- and open-ended questions, constructed to identify contextual changes in the operating environment for telehealth services, and assess the mechanisms which had contributed to these changes. We applied descriptive and McNemar's Chi-square analysis for the close-ended component of the survey, and a reflexive thematic analysis approach for the open-ended questions which were framed within the activity based funding system which had previously limited telehealth services to regional Australia.Results: Of the 91 respondents most (73%) reported a higher volume of telephone-based care since COVID and an increase in use of video consultations (60% of respondents). Respondents felt that the move to provide care using telehealth services had been a “forced adoption” where clinicians began to use telehealth services (often for the first time) to maintain health care. Respondents noted significant changes in managerial and medical culture which supported the legitimisation of telehealth services as a mode of access to care. The support of leaders and the use personal and organisational networks to facilitate the operation of telehealth service were felt to be particularly valuable. Access to, and reliability of, the technology were considered extremely important for services. Respondents also welcomed the increased availability of more human and financial resources.Conclusions: During the pandemic, mechanisms that legitimise practise, build confidence, support relationships and supply resources have fostered the use of telehealth. This ongoing interaction between telehealth services, contexts and mechanisms is complex. The adoption of telehealth access to enable physically separated care, may mark a “new context;” or it could be that once the pandemic passes, previous policies and practises will re-assert themselves and curb support for telehealth-enabled care.

Interprofessional collaboration improving hospital-wide processes can have significant benefits for the release of nursing time.

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Background Incorrect use of transdermal patches can and has resulted in significant patient harm, including death. Multidisciplinary guidelines to ensure their safe use have been developed in-house and disseminated to all hospitals in the country. Purpose To produce easy-to-use guidance for staff that would promote safe practice in all aspects of patch use, including prescribing, application, documentation, removal and disposal. Materials and methods A patient-focused group addressed all safety concerns around transdermal patch use and subsequently developed guidelines based on best practice points cited in the literature as well as innovative practice-based elements developed by the group. The processes identified the roles of each healthcare professional in their patients’ safety and care. Results Guidance has been developed to inform all healthcare staff of the potential dangers and necessary safety procedures required each time a transdermal patch is used. The implementation of these new processes throughout our hospital serves to improve patient safety. This is likely to lead to a long-term, sustained improvement in patient safety in the MMUH. This information is now available throughout Ireland via the Irish Medication Safety Network. Consistent implementation will optimise transdermal drug delivery and improve all aspects of patient safety associated with its use. Conclusions No such guidance exists in any other healthcare facility, either in Ireland or internationally, therefore the requirement for this work went beyond the needs of the MMUH. It was envisaged that by using a multidisciplinary approach for development of guidance, the work could be tailored to have relevance for, and benefit patients, beyond the environs of the MMUH and therefore would be suitable for national dissemination and implementation. No conflict of interest.

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