Evidence-Based Recommendations: Action 7.07 Strengthen
Concurrent with Action 7.07 of the NSQHS Blood Management Standard, three national and international best-practice recommendations are suggested.
Recommendation 1 is the nationally standardised implementation of an electronic reporting tool in all health care facilities that perform transfusions. The updated ANZSBT Guidelines for the Administration of Blood Products (2025) unequivocally stress the importance of standard documentation and simultaneous adverse event collection using electronic tools. Local paper-based system variability can lead to late or underreporting trends. A centralised computerised system allows accurate information keeping, analysis in real-time, and enables benchmarking between services.
Recommendation 2 is to standardise Australian hemovigilance reporting procedures according to the WHO’s Framework for Adverse Event Reporting and Learning Systems (WHO, 2005). WHO recommends an iterative cycle of reporting-learning systems. This global standard can complement our current reactive systems with learning loops in practice. WHO guidance supports the use of overt definition, robust classification, and feedback loops so that reports lead to change rather than documentation.
Recommendation 3 includes competency-based education and training of clinicians in detecting and reporting transfusion-related adverse events. The Australian Hemovigilance Report (NBA, 2010) makes a conclusion that there is significant variation in what staff believe ought to be reported. Similarly, ARCBS (2025) also brings to attention clinicians’ vigilance, which would reduce avoidable transfusion-related complications. Standardised training modules would reduce subjectivity and enhance early recognition.
Collectively, these suggestions aim to complement Action 7.07 by improving data dependability, reporting uniformity, and clinician responsibility, ultimately better transfusion safety at the national level.
Slide 1: Introduction
Welcome everyone, in today’s presentation, I aimed to discuss a prevailing issue of ‘Discharge Education’ that is significantly affecting patients’ outcomes as well as increasing hospital readmissions. In my clinical placement in the previous semester, I had observed a worsening case of heart failure readmission that would have been prevented if the registered nurse had provided proper guidance during discharge. Focusing on this aspect, I have also proposed my PICO questions and discussed possible methods for a study that can contribute to remedying this condition. Let us begin.
Slide 2: Clinical Experience
The experience was unsettling for me. I witnessed a preventable loss of quality patient care. Discharge is a risk-prone transition time, and patients who have just been diagnosed with heart failure require special education to be able to safely care for their disease. The experience led me to question whether systematic, nurse-initiated discharge education improves patient outcomes. It also led me to recognise the imperative for the integration of EBP to close clinical practice gaps.
Slide 3: Rationale for Improvement
Heart failure accounts for a large proportion of morbidity and healthcare costs globally. Studies found that almost 25% of rehospitalised heart failure patients are readmitted within 30 days, for usually avoidable reasons such as nonadherence or fluid balance. Time deficits and nurse-to-patient ratios contribute to insufficient discharge education. Current practices emphasise that organised, nurse-conducted sessions to provide individualised information according to patients’ needs are crucial. Such interventions could improve knowledge, reduce levels of anxiety, and reduce hospital readmission. Unfortunately, actual practice continues to differ from best practice guidelines, posting enough evidence for a stark gap and a call for change.
Slide 4: PICO Question & Making a Case for Change
My PICO question is: In adult inpatients with new-onset heart failure, does nurse-led discharge education compared to normal care enhance patient knowledge, self-care behaviour, and 30-day readmissions?
This is a direct articulation of my clinical practice and is underpinned by Australian policy and research priorities. Improved discharge education also aligns with quality and safety standards, for example, NSQHS Standard 6: Communicating for Safety. It is also encompassing of patient-centred care and national efforts to reduce unnecessary hospital admissions.
Slide 5: Research Methods
With ethical and pragmatic constraints against randomising at discharge, the quasi-experimental design is most appropriate. The study would involve comparing outcomes before and after the implementation of a nurse-education protocol. Behaviour change could be measured by scores such as the Self-Care of Heart Failure Index (SCHFI), whereas readmissions could be tracked using EMR data. It is a balance between rigour and feasibility in a hectic clinical setting.
Slide 6: Ethical Considerations
Written informed consent would be obtained from the participants. Data privacy will be maintained by de-identification and secure systems. It is a low-risk study focusing on education only. Cultural sensitivity will be adhered to. Materials will be translated for non-English patients to create equity of care and inclusion.
Slide 7: Conclusion
To conclude, my experience revealed an entrenched issue: a lack of proper discharge education that threatens patient safety and the cost of care. There is strong evidence to support that nurse-led education is the most effective intervention for this, yet it is not yet driving day-to-day practice. Through investigating this problem, we can close the evidence-practice gap and facilitate true change.
1. The new catalogue of chronic conditions introduced by the AIHW is represented by COPD, endometriosis and dementia due to their increasing burden on people and the healthcare system (AIHW, 2024). These disorders result in long-term disability and costly management, and also affect the quality of life is highly affected, and for this reason, it is recommended to make an effort to include them in the national health agendas on a strategic basis.
2. Nurses can assist families in a palliative care environment at home by providing culturally sensitive emotional support, contacting respite services and specialist services, and discussing advanced care planning (Becqué et al., 2021). Such artistic interventions as the use of memory boxes, music therapy, or legacy letters help families in bereavement and bond.
3. Since chronic disease is very common in Australia, nurses are in a central position to prevent and manage it. They offer early learning, symptom observation, self-management support and inter-health services communication (Field, 2023). Their convenience and their comprehensive patient-centred care approach minimise emergency presentations and give patients the power to have control over their health.
4. In the case of Peter, collaborative goal-setting can be based on motivational interviewing. A nurse could enquire about his values, such as time with his grandchildren, and refer to them when making healthier decisions, such as drinking less alcohol or taking better care of wounds. This is a person-centred approach that makes sure that goals are realistic, respectful and partnership-based with trust.
5. In the case of Jane, empowerment would entail guiding her in making time-saving, healthy meals. Through partnership, we would develop some loose goals following her habit. Autonomy would be facilitated by self-management measures such as keeping a food diary or including walking activities during working hours (Sallay et al., 2021). This also commends beneficence and non-maleficence since it is concerned more with her well-being and not causing harm.
References
AIHW. (2024). Chronic Conditions. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/australias-health/chronic-conditions
Becqué, Y. N., Rietjens, J. A. C., van der Heide, A., & Witkamp, E. (2021). How nurses support family caregivers in the complex context of end-of-life home care: A qualitative study. BMC Palliative Care, 20(1). https://doi.org/10.1186/s12904-021-00854-8
Field, P. E. (2023). How can access to cardiac rehabilitation in rural and remote areas of North Queensland be improved? Jcu.edu.au. https://doi.org/10.25903/q56x-d441
Sallay, V., Klinovszky, A., Csuka, S. I., Buzás, N., & Papp-Zipernovszky, O. (2021). Striving for autonomy in everyday diabetes self-management—qualitative exploration via grounded theory approach. BMJ Open, 11(12), e058885. https://doi.org/10.1136/bmjopen-2021-058885
