Bibek Chauhan

Medication errors remain a major concern in healthcare, with look-alike and sound-alike (LASA) medications contributing to a significant proportion of these incidents. LASA medications can be defined as medications with similar packaging, drug name, appearance, or label. These visual similarities contribute to increasing the risk of medication errors being made. Despite the requirement for two registered nurses to dispense controlled drugs, LASA medications have the potential to create confusion, especially when staff are under time pressure, fatigued or distracted. Confusion between similar-sounding or similar-appearing medicines can lead to incorrect doses or drug administration, with the potential for serious patient harm.

This poster presents local data and practical strategies aimed at reducing LASA-related errors at the Royal Brisbane and Women’s Hospital (RBWH). LASA medications continue to pose a substantial risk to patient safety. In Australian hospitals, 18.7% of reported medication incidents are associated with LASA confusion (Ryan et al., 2025). At the RBWH, 32 Tapentadol–Tramadol errors were reported over a six-month period (April–September 2025), with 81% attributed to LASA confusion. Within the Cancer Care ward, commonly confused medications include Oxynorm and Ordine (look-alike), Tramadol and Tapentadol (sound-alike), and MS Contin and OxyContin (sound-alike). Four Oxynorm–Ordine errors were recorded between 2022 and 2024; however, no further incidents have occurred since the introduction of colour-coded LASA stickers in early 2025 (RBWH Safety & Quality team).

To address this issue, a structured LASA safety initiative was implemented. A key strategy involved placing an “Is this Tramadol or Tapentadol?” reminder card on top of each medication box to prompt staff to double-check and correctly identify high-risk medicines. In addition, colour-coded stickers were applied to Oxynorm and Ordine bottles and matched to the medication book to enhance visual differentiation and reduce confusion during preparation and administration. These interventions reinforce the importance of adhering to medication safety standards, including the six rights of medication administration (right patient, medication, dose, route, time, and documentation), reading labels twice, and completing an independent two-nurse check for high-risk medicines. This poster was recognised as the winner of the 2025 Metro North Medication Safety Awareness Poster Competition, reflecting its innovation, practical applicability, and contribution to improving medication safety within the organisation.

Overall, this poster aims to increase awareness of the high rate of medication errors associated with LASA medications and recommend strategies to implement in order to reduce this risk. The evident decrease in medication errors following the implementation of this initiative at the RBWH Cancer Care ward is clearly demonstrated, highlighting the importance of medication safety and awareness. 

Background: Domestic and family violence (DFV) is a pervasive issue in Australia, often presenting in primary healthcare settings where doctors, nurses, and administrative staff play crucial roles in patient care. Administrative staff, such as receptionists and practice managers, frequently act as the first point of contact for DFV-affected patients. However, they are less likely to receive training or participate in policy. This knowledge gap can have a significant impact on patient care, practice processes and workforce wellbeing.

Contribution: Informed by our study findings, the aim of the project training activities is to transition general practice and allied health professionals from a reflective to an agentive position. Part of this agency-building includes the opportunity to participate in capacity-building sessions led by local DFV crisis and response specialists. Further resource material and guidance will be provided based on identified needs collected from participants, to assist stakeholders with the development of organisation- and system-level DFV policies and procedures. As of June 2025, the project has directly benefited 77 frontline healthcare workers, providing foundational DFV knowledge and fostering interdisciplinary collaboration. By including administrative staff in these efforts, the research ensures a comprehensive, inclusive 20 approach to DFV response, which can improve patient safety, support workforce wellbeing, and strengthen organisational resilience. Future training sessions are scheduled for later in the year.

Significance: The concurrent industry implementation of scholarly findings into practice with academic outputs creates a broader impact, in its potential to transform primary care practices into proactive, informed spaces that not only respond to DFV but also contribute to breaking systemic cycles of violence through improved care pathways and policy development. Shared training also increases the opportunity for interprofessional collaboration between administrators and the clinical workforce to support a culture of collaborative team-based care.

Vascular access devices are essential for inpatient care, with approximately 70% of hospitalised patients requiring intravenous therapy during their admission. Adherence to current evidence-based practice (EBP) is critical to optimising vascular health, improving patient outcomes and reducing healthcare-associated infections. Nurses play a key role in applying EBP to minimise complications associated with vascular devices. This poster aims to raise awareness and promote EBP recommendations on vascular access devices with a focus on maintaining device patency, reduce infection risk and improving patient comfort.

Contemporary evidence and Metro North Health guidelines support the replacement of peripheral intravenous catheters (PIVCs) when clinically indicated such as if the device displays signs of infection, blockage, or is no longer functioning instead of the routine 72-hour replacement. This approach has been shown to reduce unnecessary cannulations, enhance patient comfort, and decrease healthcare resource use without increasing infection risk. Infection prevention strategies such as the aseptic non-touch technique, Five Moments for Hand Hygiene, and scrubbing the hub for at least five seconds followed by drying can reduce catheter-related bloodstream infections by 48–86%. Minimising device manipulation, such as using "to keep vein open" (TKVO) maintenance fluids for antibiotics further contributes to lowered infection risks. For central venous access devices (CVADs), patency is best maintained using appropriate syringe sizing (min 10ml) and pulsatile flushing (20 ml before/after medication administration) with positive pressure technique to prevent 99% of blood reflux, occlusion and catheter-related complications.

By aligning clinical practice with current evidence available, this research supports the delivery of patient-centred and evidence-based care, improves vascular health outcomes and enhances safety and quality in hospital settings. Importantly, ongoing education, supervision, and training for clinicians is essential to ensure consistent adherence to EBP, helping create a skilled workforce capable of delivering safe and effective vascular access management. This poster was selected as the winner of the Royal Brisbane and Women Hospital Vascular Access Devices Awareness Week 2025 Poster Competition for its clarity, creativity and strong focus on promoting safe and effective vascular access practices

Background: Vascular access devices (VADs) are essential in modern clinical practice but are associated with significant risks including catheter-related bloodstream infections (CRBSIs). The use of continuous intravenous infusion through a closed system like TKVO (To Keep Vein Open) has been proposed as a strategy to reduce these risks.

Aim: This case study explores the effectiveness of continuous intravenous infusion using a burette compared to intermittent infusion for reducing bloodstream infections among adult patients, based on clinical experiences across two Australian healthcare systems supported by high-level evidence.

Methods: This study applied the 6S evidence hierarchy to evaluate evidence from systematic reviews, randomized controlled trials, and expert guidelines. Personal clinical observations from Northern Territory and Queensland Health settings provided contextual background.

Results: Evidence indicates that continuous infusion helps maintain catheter patency, reduces manipulation of VADs, and may lower infection rates. However, high-level statistical data directly comparing infection rates between continuous and intermittent methods remain limited. Implementation barriers include equipment availability, reduced patient mobility, and contraindications in certain patient populations.

Conclusion: Continuous infusion using TKVO may reduce infection risk and improve patient safety when appropriately implemented. More rigorous research is required to strengthen the evidence base and policy guidelines development across Australian healthcare settings.