BackgroundThe Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change.PurposeThis study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings.MethodsMixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used.ResultsThree main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF.ConclusionThe TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.

Background Numerous national and international authorities have advised against the use of certain prescribing abbreviations due to their risk of misinterpretation. Aim To evaluate an intervention to reduce the use of error‐prone prescribing abbreviations in the emergency department (ED). Method The intervention consisted of education sessions as part of ED medical and nursing orientation programs, distribution of name badge sized cards summarising the information and placement of posters in the ED. All medication and fluid charts present in the ED at one randomly selected time each day were screened over consecutive days. Patients with at least one medication or fluid prescribed were included. Error‐prone abbreviations were classified as of major, moderate or minor significance. Pre‐intervention data on abbreviation usage guided the content of the intervention. Results 166 patients were included pre‐intervention and a further 166 patients post‐intervention. The overall rate of error‐prone abbreviation use per 100 prescriptions declined from 31.8 pre‐intervention to 18.7 post‐intervention (difference in rates 13.1; 95%CI 8.8–17.4; p < 0.001). The rate of use of major significance error‐prone abbreviations per 100 prescriptions decreased from 5.8 pre‐intervention to 2.3 post‐intervention (difference in rates 3.5; 95%CI 1.8–5.2; p < 0.001). Conclusion The intervention resulted in a significant reduction in the use of error‐prone abbreviations in the ED. Implementing this intervention hospital‐wide should have a further impact as ward‐based doctors also prescribe medications in the ED.

Objectives:To determine whether weather conditions affect emergency department (ED) attendance and admissions from the ED. Design and setting: A retrospective observational study in a large metropolitan ED. Main outcome measures: ED attendance (total and via ambulance) and admissions to hospital from ED, as a function of weather variables. Results: On warm, dry, sunny and good weather days there were significantly more ED attendances in total than there were on cool, rainy, dull and bad weather days, respectively (P р 0.001). There were significant correlations between ED attendance and temperature (r = 0.36, P < 0.001), rainfall (r = −0.20, P < 0.001) and hours of sunshine (r = 0.17, P = 0.001). Attendance via ambulance was not affected by weather variables. Admissions from the ED were positively correlated with temperature (r = 0.15, P < 0.01) and negatively correlated with rainfall (r = −0.12, P = 0.02). Conclusions:As there is a clear relationship between weather conditions and ED attendance, incorporating meteorological forecasting into emergency medicine training may improve ED scheduling. To improve the morale of ED staff coping with an onslaught of patients on good weather days, the ED environment should simulate sunny weather, MJA 2005; 183: 675-677 with swimming pools, sun lamps, palm trees and Beach Boys music.

Background Despite the uncertainty regarding flucloxacillin's stability, flucloxacillin solutions are routinely used as 24‐hour ambulatory infusions for hospital‐in‐the‐home patients. Aim To determine the stability of flucloxacillin solutions in a simulated hospital‐in‐the‐home environment and to assess whether flucloxacillin loss can be minimised via pH control. Method Samples of flucloxacillin 5% and 12% solutions were prepared with either sodium chloride 0.9% or water for injection and with or without 5 mL phosphate buffer (0.384 M; pH 7). Flucloxacillin 5% solutions were tested in elastomeric infusion devices and the 12% solutions in polyvinyl chloride bags. All of the solutions were refrigerated for 6 days and then half of them were incubated at 37 °C for 24 hours. The remainder of the refrigerated solutions acted as controls. Incubated solutions were sampled for pH and high performance liquid chromatography analysis on Day 0, and Day 6 at 0, 12, 18 and 24 hours. Controls were sampled on Days 0, 6 and 14. Acceptable shelf life was ± 7.5% of initial flucloxacillin content. Results Refrigerated buffered controls remained stable for 14 days while the unbuffered controls were stable for 6 days. All of the buffered solutions were stable at 37 °C after 24 hours, except for flucloxacillin 12% in water for injection. Incubated unbuffered flucloxacillin 5% in water for injection lost approximately 27% flucloxacillin and all of the other incubated unbuffered solutions lost up to 60%. Incubated unbuffered solutions displayed significant yellowing and cloudiness. The pH of all solutions fell by approximately 1 unit, except for refrigerated buffered controls (fell by 0.5 units). Conclusion Unbuffered flucloxacillin 5% and 12% solutions lost up to 60% of flucloxacillin content when stored at 37 °C for 24 hours. Adjusting pH with phosphate buffer kept the incubated solutions stable for at least 24 hours (except flucloxacillin 12% in water for injection).

Aim To determine clinical staff's understanding of managing oral medications in patients with restrictions on oral intake. Method An online survey was designed consisting of 4 scenarios featuring a patient who was fasting pre‐surgery, day 1 post‐surgery, nil‐by‐mouth after stroke or had a nasogastric feeding tube in situ. The target population was clinical staff (nursing, medical, pharmacy, dietetics, speech pathology) involved in the management of oral medications and/or patients' oral intake. Medications studied were: aspirin (Cartia) 100 mg mane; gliclazide (Diamicron MR) 60 mg mane; atorvastatin (Lipitor) 40 mg mane; metoprolol (Betaloc) 50 mg bd; levodopa/carbidopa (Sinemet CR) 200/50 tds; ginkgo 7500 complex mane. Respondents could choose to give, withhold, cease, contact someone for advice, change the formulation before giving or choose ‘other’ and make a comment. Results 622 responses were received from clinical staff. When fasting, respondents would give metoprolol (65%) and levodopa (68%) but not aspirin (70%), gliclazide (63%), atorvastatin (50%) and ginkgo (65%). Approximately 10% of respondents would give oral medications to the nil‐by‐mouth patient. The consensus for the nasogastric feeding tube was to give all the medications via the tube, including modified‐ or controlled‐release medications. Conclusion There appeared to be varying understanding of managing oral medications when patients have restrictions on oral intake. This is concerning as it has the potential to result in adverse patient outcomes.