Chelsea PENINSULA HEALTH PO BOX 52, FRANKSTON, … · Tel: (03) 9784 8600 Fax: (03) 9784 8674 The production of this report has been supported by the Rosebud Hospital Opportunity

0 105SCALE

KILOMETRES

Chelsea

Carrum

Seaford

CranbourneFrankston

Mornington

Baxter

Dromana

RosebudSorrento

Flinders

Portsea

Hastings

Mount Eliza

PENINSULA HEALTHPO BOX 52, FRANKSTON, VICTORIA 3199PH: (03) 9784 7777For those outside the MelbourneMetropolitan Area PH: 1800 858 727

www.phcn.vic.gov.au

CARINYA RESIDENTIAL AGED CARE UNIT125 Golf Links Road Frankston Vic 3199Tel: (03) 9783 7277 Fax: (03) 9783 7515

CHELSEA COMMUNITYREHABILITATION CENTRE8 Edithvale Road Edithvale Vic 3196Tel: (03) 9772 6099 Fax: (03) 9772 3042

COMMUNITY CARE UNIT4 Spray Street Frankston Vic 3199Tel: (03) 9781 4288 Fax: (03) 9781 4393

FRANKSTON COMMUNITYREHABILITATION CENTRE125 Golf Links Road Frankston Vic 3199Tel: (03) 9783 7288 Fax: (03) 9770 5459

FRANKSTON HOSPITALHastings Road PO Box 52 Frankston Vic 3199Tel: (03) 9784 7777

FRANKSTON REHABILITATION UNIT125 Golf Links Road Frankston Vic 3199Tel: (03) 9784 8666 Fax: (03) 9784 8662

FRANKSTON INTEGRATED HEALTH CENTREHastings Road Frankston Vic 3199Tel: (03) 9784 8100

Community Health ServiceTel: (03) 9784 8100 Fax: (03) 9784 8149

MICHAEL COURT RESIDENTIAL AGED CARE UNIT32 Michael Court Seaford Vic 3198Tel: (03) 9785 3744 Tel: (03) 9785 3739Fax: (03) 9782 4434

MOUNT ELIZA CENTREJacksons Road PO Box 192 Mount Eliza Vic 3930Tel: (03) 9788 1200 Fax: (03) 9787 9954

PENINSULA COMMUNITY MENTAL HEALTH SERVICE15-17 Davey Street Frankston Vic 3199Tel: (03) 9784 6999 Fax: (03) 9784 6900

PENINSULA HEALTH PSYCHIATRIC SERVICEHastings Road PO Box 52 Frankston Vic 3199Tel: 1300 792 977 Fax: (03) 9784 7192

ROSEBUD COMMUNITY REHABILITATION SERVICE288 Eastbourne Road Rosebud Vic 3939

Community Rehabilitation CentreTel: (03) 5986 3344 Fax: (03) 5981 2267

Inpatient UnitTel: (03) 5981 2166 Fax: (03) 5982 2110

ROSEBUD HOSPITAL1527 Pt. Nepean Road Rosebud Vic 3939Tel: (03) 5986 0666 Fax: (03) 5986 7589

ROSEBUD RESIDENTIAL AGED CARE SERVICES1497 Pt. Nepean Road Rosebud Vic 3939

Jean Turner Community Nursing HomeTel: (03) 5986 2222 Fax: (03) 5982 2762

Lotus Lodge HostelTel: (03) 5986 1011 Fax: (03) 5982 2762

Rosewood HouseTel: (03) 5982 0147 Fax: (03) 5982 0378

S.H.A.R.P.S.35-39 Ross Smith Avenue Frankston Vic 3199Tel: (03) 9781 1622 Fax: (03) 9781 3669

TATTERSALLS PENINSULA PALLIATIVE CARE UNIT125 Golf Links Road Frankston Vic 3199Tel: (03) 9784 8600 Fax: (03) 9784 8674

The production of this report has been supported by the Rosebud HospitalOpportunity Shop and the Frankston Hospital Pink Ladies.

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www.phcn.vic.gov.au

Peninsula Health tallied up the following figuresduring 2004 – 2005:

ANSWERS TO QUALITY QUIZ

1.(B)A pressure ulcer is another name for a bedsore.We are vigilant in monitoring and treatingpressure ulcers because they can become veryserious.(See pg 45)

2.(A)When a health service performs well in theVictorian Quality Council’s Six Dimensions ofQuality,it is providing its community with firstrate care.(See pg 8)

3.(A)In the health industry,lifting is the mostcommon cause of workplace injuries.PeninsulaHealth has a NO LIFT policy and provides specialtraining to its staff.(See figures this page)

4.(B)Accurate discharge summaries help patients to continue recovering after leaving hospital.Thesummaries tell their GPs about the treatment andmedications they received in hospital.(See pg 37)

5.(C)Diabetes and Emphysema are examples ofchronic conditions – they are long-term healthproblems that people must learn to manage well inorder to stay as healthy as possible.(See pg 61)

58,032 the number ofinpatients we treated

16,848 the kilos of general paper

(not confidential paper) we recycled from

Frankston Hospital

112,038 kilolitres ofwater used in our facilities

$997,617.27what that electricity cost us

7,879 the total units of blood andblood products (plasma, etc) used

914,713 the number of mealsserved across Peninsula Health

14,296,819 the kilowatt hours ofelectricity we used at Peninsula Health

640 the number of medical and health relatedjournals to which our medical libraries subscribe

59,000 the approximate numberof procedures done in our MedicalImaging services (x-rays, CT scans,

ultrasounds, etc)

899 the number of new staff appointed

548 the number of staff trained in

No Lift procedures

ServiceIntegrityCompassionRespectExcellenceProfessionalism

through

1 QUALITY OF CARE REPORT 2005

The people we serve live in a 900 sq km area thatincludes the City of Frankston, the Mornington PeninsulaShire and the southern part of the City of Kingston.

Our population, especially peopleover 65, is growing fasterthan that of both MetropolitanMelbourne and Victoria.

One in ten of the people we treat comesfrom a non-English speaking background(NESB). Our NESB patients most oftenspeak Croatian, Greek or Italian.

Heart disease is the biggest cause ofdeath, disability and/or illness in our area.The next highest causes include cancer,stroke, emphysema (breathing disorderoften caused by smoking) and asthma,accidents and diabetes.

Peninsula Health

Gavin Carter, age 4,accompanies his foster mum, BeaEdwards, when she talks to groups inthe Indigenous community. Bea, who isfrom our Community Health staff, helpslocal Aboriginal families get the healthcare services they need. She often usesDreamtime stories to illustrate conceptsto her clients, using the clap sticks whileGavin performs traditional dances.(See pages 24 and 28 for more onIndigenous health services)

Peninsula Health provides public health care for 300,000 people, 50,000 of whom are over 70.

Each year 2,000 babiesbegin their lives in our hospitals.Our Emergency Departments areamong the busiest in the state.

CommunityProfile

Community Profile


Young people in our area suffer most from injuries, asthma and mental

disorders. Elderly men and women have the highest rates of heart

disease, stroke, cancer and breathing disorders compared with the rest of the

population. Men in our region are three timesmore likely to attempt suicide than women.

Tobacco continues to be the biggest disease riskfactor for both men and women. Physical

inactivity, high blood pressure and obesityare next on the list. In addition, alcohol,poor diet, high cholesterol, illicit drugs,unsafe sex and work injuries make up

the top ten risk factors.

The rate of death and disability in our service area isslightly lower than the average for Victoria. Women in ourpopulation can expect to live to almost 82 years and mento nearly 76. Sadly, Aboriginal life expectancy is between

eight and 18 years lower than the Victorian average.

SOURCES: Australian Bureau of Statistics; Burden of Disease: Victoria 1996-2016;Southern Metropolitan Burden of Disease Study

Each holiday seasonthe population grows by over

100,000 with visitors flocking to thePeninsula’s recreational attractions.

Every year some of theseholidaymakers require hospital care

and other services from Peninsula Health.

At the last census, there were1,200Indigenous people, known in Victoriaas Kooris, living in our area.


• Emergency Departments inFrankston and Rosebud

• Hospital in the Home• Hospital Care

- cancer services- cardiac (heart) services- endocrinology (diabetes)- Intensive Care (critical illness)- gastroenterology

(digestive system) services- general medical services - geriatric medicine

(aged care) services

- haematology (blooddisorders) services

- infectious diseases- neurology (brain and

nervous system) services

- respiratory (breathing)services

• Rehabilitation• Outpatient Clinics• Palliative care (for people preparing

for the end of life)

• Operating Theatre Suites atFrankston & Rosebud Hospitals

• Day surgery• Short stay surgery

• Anaesthesia and painmanagement services

• Pre-admission clinics• Lithotripsy

(for kidney stones)

• Wound therapy andstomal therapy (forpatients with surgicallycreated wasteelimination sites)

• Rehabilitation

- ear, nose and throat surgery- general surgery - orthopaedic (joint and bone)

surgery- paediatric surgery

(for children)- plastic and

reconstructive surgery

- thoracic (lung and respiratorysystem) surgery

- urology (urinary and malereproductive system) surgery

- vascular (blood vessel)surgery

Services for people who are ill or injured

Services for people whoneed surgery

Peninsula HealthHealthcare

MEDICAL SPECIALTIES

SURGICAL SPECIALTIES

Profile

Healthcare Profile


• Breast Cancer services• Birthing services including Family Birthing• Care for women and infants following birth• Childbirth education• Special services for chemically dependent and very

young pregnant women• Clinics for infant feeding and sleeping problems• Special services for post natal depression• Special Care Nursery for ill or premature newborns• Children’s Ward• Special services for children with diabetes, asthma

and eating disorders• Adolescent health services• Gynaecology (female reproductive system) services

Services for womenand children

• Crisis response• Continuing care and

outreach programs• Home and community

based services• GP liaison for mental

health issues• Counselling• Living skills programs• Consumer and Carer

consultancies

• Services for peoplewith both illness andaddiction

• Accommodation, careand rehabilitation forpeople with long termmental illness

• Hospital care for adults• Hospital care for elderly

people with a mentalillness

Services for people withmental illness

• Youth services• Family planning• Koori access services• Health promotion• Alcohol, drug and needle

exchange services

• Dental services for all ages• Programs to reduce the

need for hospitalisation• Pharmacy (medications)• Chaplaincy

Services that support patient care

• X-ray, computerised axial tomography (CAT scans),magnetic resonance imaging (MRI) and other medical imaging services

• Pathology (testing of blood, tissue, etc)• Endoscopy (internal visual examination procedures)• Sleep Laboratory

Investigative Services

• Assessment• Bed-based and home

care for the elderly• Residential care• Personal Alarm

Call Service

• Respite and carer support• Home modification, aids for

disabilities and prosthetics• Rehabilitation • Falls Prevention• Continence and Memory clinics

Services for older people

Josephine Bonnici, 81,gets help from our Complex Care Service for her Chronic Heart Failure, a condition inwhich the heart does not pump forcefullyenough. One of the services arranged for heris a regular, supervised exercise program.Her husband, Frank, sometimes joins in.

- physiotherapy- podiatry (foot care)- diabetes education- speech pathology- audiology (hearing)

- optometry (vision)- nutrition and dietetics- occupational therapy- social work

ALLIED HEALTH SERVICES


f you have a medical emergency or youneed surgery, you will most likely betreated by staff at Peninsula Health.

Your elderly relative might currently beliving in one of our aged careresidences.

Perhaps your neighbour is using ourhealth programs to manage her diabetesor your son has just had his hearingtested in our Audiology lab.

Your children were probably born in oneof our hospitals.

One of your friends might have sought ourhelp for a psychiatric problem, and youprobably know someone who is on the mendand getting stronger through one of ourrehabilitation programs.

Your tax dollars pay for our services. Yourneeds determine what we offer. You entrustyour health to our skill.

You have the right to know as much aboutPeninsula Health as possible. We have theresponsibility to provide you with honest,current, comprehensive information on whatwe do and how well we do it.

. . . because Peninsula Health is your health service.

We want to report on the things that are important to you. Please fill out the evaluation at theback of this magazine for a chance to win one of THREE GREAT PRIZES.

IThis is

your report

That is what our annual Quality of Care Report is all about!

WIN A HEALTH BONANZA BASKET

fifthQuality of Care


It includes Peninsula Health’s ‘Report Card’and contains your comments on the healthservice’s performance. It also has theopinions of a team of leading healthprofessionals who recently examined ourservices against national standards.

This report brings you the latest news onsome of the topics that have been reportedon over the last four years, showing you thetrends that have developed over this period.

It provides a clear picture of the methodsused to ensure safety and quality.

As always, the report includes performancefigures on four crucial safety concerns:medication safety, infection control, woundmanagement and falls prevention.

Peninsula Health’s current status on one ofthe most high profile issues in health care– waiting lists for elective surgery – isprovided, with an explanation on whyplanned surgery is sometimes cancelled.

This year the Peninsula Health coreservices in the spotlight are the Division ofMedicine and Critical Care, the ComplexCare Program and the Women’s, Children’sand Adolescent Health Service.

Peninsula Health recommends that you read this report in conjunction with the 2005 Annual Report, 2005 Research Reportand current Financial Statements. These are available on the Web Page,www.phcn.vic.gov.auYou may also request a printed copy.

We hope you will tell Peninsula Healthhow it can improve this report. At the endof this document the ways in which youcan send in your ideas, concerns andquestions are listed.

You will also find a current ‘fridge magnet’with updated health care telephone numbers.On this year’s magnet the information is alsoaccessible in Braille and is translated intoCroatian, Greek and Italian, our three mostspoken non-English languages.

This year, Peninsula Health considered thecost of producing this report and confirmedthat a good quality report would be useful tothe community. The total cost of producingthe report, printing 3,000 copies anduploading the document to our Website is$23,000. We are grateful for the support ofthe Rosebud Hospital Opportunity Shop andthe Frankston Pink Ladies who contributed50% of production costs.

Thank you for your interest in PeninsulaHealth and we hope you enjoy readingabout your health service.

This is Peninsula Health’s

QUALITY OFCARE REPORT

Barry NichollsChairman, Board of Directors

Dr Sherene DevanesenChief Executive


This HealthService needsto improve

. . . all the time.

So we are constantly developing newand better ways of doing our job:

• we keep a close watch oneverything we do in order to spotand solve problems quickly

• we carefully study the informationwe collect to pick up on areas wherewe can perform more efficiently

• we combine our efforts, consult ourpartners and keep up withworldwide advancements in order toproduce more effective services

• and we respond to our community’sneeds by listening to you - ourconsumers - investigating yourconcerns, considering yoursuggestions and using your ideas.

We are totally committed to theseprocesses, and we follow the guidelinesused by progressive and professionalhealth providers all over the world.

At Peninsula Health, our quality goals andsystems are based specifically on theQuality Framework developed by the

Victorian Quality Council.

Only through a commitment to continuous improvement canPeninsula Health bring you high quality health care.

123

56

4

Quality of Care


When you are sick, you don’t want the peoplecaring for you to guess.

You expect your medical test results to beaccurate, your medications to be correctlymeasured and your treatments to be based onmore than conjecture.

In trusting your health to others, you areexpecting them to use evidence instead ofassumption and to rely on facts rather thansupposition.

In health care today, as well as in education andmany other fields, there is a world-wide emphasison the need for ‘evidence-based practice’ and‘data-driven decision making’.

Buzzwords aside, this focus means that servicesrespond to measurable needs, that treatment isbased on carefully tested criteria and that goodrecord keeping is used to spot problems anddevelop solutions.

Peninsula Health collects and reviews information to better manage care and improve health services.

Carefully analysing facts, figures, observations and statistics helps to set goals, judge progressand overcome challenges.

At Peninsula Health we follow the motto

SAFETYensuring the safety of its consumersand staff

ACCESS making sure the services peopleneed are available to them

EFFECTIVENESSdelivering care that producesmeasurable, effective outcomes

ACCEPTABILITYaddressing the needs and meeting the expectations of the people it serves

EFFICIENCY using resources efficiently.

APPROPRIATENESSproviding the right treatment at theright time for the right patient.

These six Dimensions of Qualityare not slogans.They direct the processes by which Peninsula Healthcontinuously strives to improve the safety and quality of its services.

a high qualityhealth systemdemonstrates -

According to this Framework,

Don’t Speculate:INVESTIGATE

Take Effectiveness, for example.

Effectiveness, Safety, Appropriateness,Acceptability, Access and Efficiency are our guiding principles. Throughout thismagazine we will feature articles on howwe incorporate, use and meet these sixDimensions of Quality.

Word Doctorwill translate theMedical Jargon for you. Look forthis personthroughout themagazine.


Contents

p27

p72

13 Your Say Consumers comment on our care

17 Making the Grade Results fromour latest Accreditation Survey

19 Kicking Goals...and Hitting Our Targets We spotlight our progresson activities from our last four Quality ofCare Reports . . . and show how werespond when things do not go to plan

27 Trendsetters We chart the trends in our performance

29 Quality Culture Our annualaccounting of five Key Issues thatdemonstrate our commitment to Quality and Safety – Hospital InitiatedPostponements, Infection Prevention and Control, Reducing Medication Safety,Skin Integrity and Falls Prevention

Our Report Card

p63

p80

The

Contents


51 Solid Foundations A snapshot of themethods we use to keep improving our services

55 Care Close Up We give some of our coreservices a thorough examination

Good Medicine The programs, projects andpeople in our Division of Medicine and Critical CareCaring Connections Tackling chronic conditionsin the Complex Care ProgramFamily Fare Innovative care in our Women’s,Children’s and Adolescent Health Services

79 Communication . . . COMMUNITY. . . Collaboration Working with our consumersto Build a Healthy Community

Features

Snippets

p56

p73

EDITORIAL GROUPDr Peter Bradford, Executive Director Medical ServicesMs Shannon Anastasio, Community Advisory CommitteeMs Marilyn Rowe, Community Advisory CommitteeMs Elaine Bennett, Director Quality and Customer ServicesMs Elizabeth Wilson, Executive Director Nursing and Community ParticipationMr John Jukes, Director Public Relations and Marketing

2005 PROJECT GROUPDr Gary Braun, Deputy Director, Division of MedicineMr Brendon Gardner, Acting Executive Director Rehabilitation, Aged andPalliative Care; Director Health Information SystemsMs Jan James, Administrative Assistant Quality and Customer ServiceMs Melissa Lowe, Project OfficerMs Kate MacRae, Director Occupational TherapyMr Phillip Murphy, Acting Executive Director Human ResourcesMs Gayle Reid, Project Officer - Quality, Psychiatric ServicesMs Nicole Romney, Project Officer Complex CareMr Simon Ruth, Manager Peninsula Drug and Alcohol ProgramMs Fiona Turner, Manager Complex Care

Published annually in hard copy and online at www.phcn.vic.gov.au (includes MP3 audio version)

A collection of fast facts, health hints andquick quizzes throughout the magazine Quality of Care Report

EDITORIALEditor:Elizabeth AlexanderPhotography:John Lim PhotographyGraphic Design:Powerhouse DesignCartoons:George Haddon


Ashleigh and Thomas Davis have lots to look forward to as they begintheir life’s journey. Their future will be filled with wonderful advancementsin technology, medicine, science and culture.

Peninsula Health is pleased to havehelped them on their way to a healthyfuture by providing the special carethey needed at birth. As they grow,Peninsula Health will continue to planfor and offer the services they need.

Our Strategic Plan for 2005 to 2008 isbuilt on consumer input from surveys,focus groups and other feedback, aswell as data on current and futureneeds. This Plan outlines thirteen goalsto achieve by 2008.

In this Quality of Care report we arefeaturing just a few of the actionscalled for in the Strategic Plan. A fullsummary of our 2005 – 2008 StrategicPlan and the projects and developmentsemerging from it will be available at our facilities during Open Days inMarch 2006.

When the Davis twins are three yearsold, Peninsula Health will be workingfrom its 2008 – 2011 Strategic Plan.Through the years our goals willcontinue to be updated to provideAshleigh, Thomas and all ourconsumers with quality health care.

The following articles illustrate ourcommitment to the Victorian QualityCouncil’s SIX DIMENSIONS OF QUALITY

SAFETYPutting an End to Perilous Prescriptions 37Infection Protection 41Could It Happen Here? 53Battle Plans 54Smoke Out 74

ACCESSMoving Right Along 31Wait Reduction 32Theatre Performance 33Specialist Medicine at Rosebud Hospital 59Jill’s Day 65

EFFECTIVENESSInvestigation 40We have the Problem in Hand 42Glad I MET You 56Clearly Evident 58Critical Care 59

APPROPRIATENESSCaring Connections 61The Chesterfields 67All In the Family 70Gently, Gently 72Teen Trials 75Groups With Special Needs 80

ACCEPTABILITYYour Say 13Kicking Goals 19Complex Care & Partners 63Communication COMMUNITY Collaboration 79Inviting Viewpoints 81

EFFICIENCYKicking Goals 19Hitting Our Targets 25Banking On Our Doctors 60

ReferencesQUALITY

SharingtheJourney

Contents


GOALS ACTIONSProvide a quality of care to older people that is inkeeping with evidence-based practice

Provide high quality complementary services fromRosebud Hospital

Work in partnership with other health providers toenhance the health and wellbeing of the community

Provide a flexible range of responses to the increasinglevel and complexity of demand

Continue and enhance service and capital planning

Develop mutually beneficial partnerships to build ahealthier community

Build on our strong culture of quality and innovation

Establish and maintain a strong and dynamic research functionPromote the attractiveness of Peninsula Health as anemployer of choice, avoiding staff shortages in key areas

Maintain financial viability by living within our means

Plan, manage and enhance physical infrastructure

Provide timely, accurate information to improve efficiency and patient/client outcomes

Identify, analyse, treat, evaluate and monitor risks at all levels.

Read about our Centre for Excellence to be established in Mornington. See page 21.

We have set up a new General Medicine Unit atRosebud Hospital. For details see page 59.

Learn about our new Complex Care program on pages 79-82.Innovative staffing in our Rosebud Hospital EmergencyDepartment has helped us treat a record number ofpatients. See page 19.

Plans are well under way for a major redevelopment atFrankston Hospital. Details on page 21.

Read about our Community Kitchens on pages 27-28.

We are collecting ideas to improve patient flow.Please see pages 31 for details.We provide a comprehensive review of our researchactivities in the 2005 Research Report.We have established our own Medical Officers Bank.Read about it on page 60.See page 6 on volunteer support and also refer to ourAnnual Report & Financial Statements

Major redevelopment of our Radiology facilities isunderway. See page 21.We continue to expand our computer-based recordkeeping, risk alerts and prescribing. See pages 26 & 37for information about our electronic activities.Our procedures for handling risks are among the best inAustralia. See pages 52-54 & page 71 for details.


you are sometimes a patient,AT PENINSULA HEALTH

Your Say

WE VALUE YOUR VIEWSWe want you to tell us whatyou think about our services.We need to know if you havea problem with your care. Weseek your ideas, suggestions,opinions, perspectives andcomplaints.

With your input, we canimprove what we do andbetter meet your needs.

And we DO listen!

Last year we heard fromhundreds of you through yourcards and letters, complaints,survey questionnaires, phonecalls and visits.

We need you to helpus to meet your needs.Without your feedback,interest and participation in our work, we could notdeliver quality health care.

These are some of thethings you had to say –

“… we appreciated the treatment and care givento us by the nurses who work for Hospital in theHome … It is a wonderful service that made ourlife so much easier at a very difficult time….”

“I would like to dispel the myth of malfunction ofour public hospital system. I have attendedFrankston and Rosebud for over 50 years and atno time have I received or observed anything butthe most capable and courteous attention….”

“…Although the wait in emergency is sometimeslong but unavoidable, all staff have treated ourdaughter kindly and reassured my husband, myselfand our older daughter when we have been veryworried. We know how much pressure your staffare under in emergency and people in pain don’thave a lot of patience! We can only say thank youfor your help….”

“… to the staff of MEPACS (Mount Eliza PersonalAlarm Call Service) – Thank you so much for thebirthday card you sent. I was amazed to get it.How vigilant you must be if you send one to allyour clients! It is such a wonderful institution. I amvery grateful indeed….”

. . . WITH YOUR COMPLIMENTS

Your Say


but you are always a partner

Last year 610 of you filed formalcomplaints about the issues that concernedyou. We were able to identify eightgeneral categories from these issues andare investigating the ways in which we canmake improvements in these areas.

. . . AND YOUR COMPLAINTS

Many complaints resulted in our makingchanges in our services.

Examples from last year include:

A patient complained that notification of aradiology procedure booked for him by hisdoctor did not arrive by post until the daybefore the test, making it difficult to arrangeattendance. Now, if a doctor books a patientfor an x-ray or other radiology procedureand it is to be done within 48 hours, thepatient is notified by phone rather than mail.

A clinical pathway (See page 23) is beingdeveloped for women who experience thedeath of a foetus under twelve weeks. Thiswas initiated in response to a complaint froman expectant mother who was advised inRadiology that her foetus had died. Thewoman received no counselling at the time.

A patient who had surgery on her footcomplained that she unexpectedly foundblood on the cast. A rupture had occurred,the stitches had opened and the foot becamenumb and swollen when circulation wascompromised. The patient’s condition wastreated successfully, and surgical staff haverevised the instructions they give to patientsin plaster casts.

WE LISTENED


. . . in the September 2004Victorian Patient Satisfaction MonitorEach year the Government sends questionnaires to 40,000 people who have been patients in public hospitals. They get around 18,000 returned, with about 600 of those coming fromFrankston and Rosebud Hospital patients. Results of the survey are compared to hospitals ofsimilar size and makeup, and percentages indicate the level of patient satisfaction fromlowest 0% to highest 100%.

FRANKSTON HOSPITAL ROSEBUD HOSPITAL98% Help with Pain97% Helpfulness of Staff97% Cleanliness of Room96% Being treated with respect96% Courtesy of nurses89% Willingness to listen to problems86% Way information about condition

was explained83% Quality of the Food82% Given written information on how to

manage your recovery/condition at home74% Privacy in Room73% Restfulness of Hospital55% Hospital staff encouraged feedback

100%Staff attitudes before admission98% Courtesy of Nurses95% Cleanliness of toilets and showers92% Confidence in doctor in charge of care90% Convenience of time of day discharged84% Explanation of hospital routines83% Informed of what to do if had a

problem or needed help80% Temperature of hot meals72% Informed of activities should or

should not do69% Restfulness of hospital57% Hospital staff encouraged feedback57% Aware could make a formal complaint

“I could not fault the staff – they werecourteous at all times.”

“ . . . the longest night of my life; it was not possible to sleep!”

“Everything was very satisfactory in my book!”

“Admission staff good.”“Please have doctors explain in normal

English when telling you what is the matter,instead of talking in initials.”

“I was diagnosed on Sunday, admitted onMonday and sent home on Monday night.

Fantastic response.”“I was upset that, being a young woman

having a mastectomy, I had to share a roomwith an old man.”

“Provide more parking for visitors.”“I think they have it all – courtesy, nice

manners and very caring.”“Some patients have too many noisy visitors.”

“Excellent kindness from all staff!”“Doctors should communicate with patients.They should answer questions when asked,

as the patient is the one under stress.”“Toilets are a bit old. I think they

could do with more modern cisterns, but they were very clean.”

“Require a bit more privacy in theEmergency Department for a short stay.”“I was overwhelmed at how well I was

treated.”

AND SOME INDIVIDUAL COMMENTS FROM THE SURVEY

Your Say


“The print was too small.”“Some bits I did not understand”“Perhaps put a space on the fridgemagnet to write our own GP’s number.”“There was too much to read.” “Covered all areas well.”“Keep up the good work.”“The graphs were difficult to read.”“I did not understand a lot of themedical jargon.”“I liked the phone numbers at the back.”“A1 Pass”

We are using this and other Quality of CareReport feedback to improve this year’sreport by –

enlarging the type size

making graphs clearer and morestraightforward

keeping articles as short as possible

adding a Word Doctor to explain the jargon

making the fridge magnet bigger andincluding other languages and Braille

inserting a space on the fridge magnetfor phone numbers of GPs or otherhealth care professionals

WE LISTENED

We are holding communication trainingsessions with our doctors; languagetraining is provided for doctors from anon-English speaking background.

A Patient Rights and Responsibilitiescampaign was conducted across thehealth service, raising consumers’awareness of avenues for feedback andthe process for filing a formal complaint.

We are addressing the issue of therestfulness of the hospital environment byreducing the number of voice pages overthe PA system. Individual pagers areprovided for the appropriate personnel.

We are responding to issues involvingfood by reducing the size of meals (aspatients have requested) and investigatingmethods for heating smaller plates.

WE LISTENED

OTHER COMMENTS:

. . . AFTER REVIEWING OUR 2004 QUALITY OF CARE REPORT

YES NODid you find the report easy to read?

(From a focus group of 45 patients)

35 10

Did we explain issues clearly? 38 7

Were our topics interesting to you? 35 10

Did the report answer anyquestions or concerns you hadabout health care?(2 x no answer)

Do you now have a betterunderstanding of how we try tokeep you safe and providequality care? (1 x no answer)

29 14

38 6

QUESTION


This ‘Report Card’ details the results of ourrecent accreditation surveys by thesenational agencies.

Making the Grade


National agencies, recognised by governments and health providers throughout Australia,regularly conduct reviews of individual Health Services. These reviews are thorough and lookat all the functions of a healthcare organisation, including the vitality of the Quality culture.

Peninsula Health is evaluated by the Australian Council on Healthcare Standards (ACHS),which examined our entire Health Service in May. Our aged care residential services are alsoreviewed by the Aged Care Standards Accreditation Agency.

SURVEYORS’ COMMENTS:Peninsula Health works from a culture of evaluationand innovation.

The program of electronic prescribing and discharge(using computers to write prescriptions and reportswhen a patient is discharged), is the benchmark forthe health industry in Australia.

The health service uses a unique system to ensure it is complying with all legal requirements. Thatsystem, developed at Peninsula Health, is beingcommercially produced and has been recommendedby the Department of Human Services. It is nowused by other Victorian health services and its useby interstate health services is being explored.The Final Report lists this compliance system asOutstanding, making it a benchmark for Australia.

The Peninsula Health Pharmacy Department hasdeveloped numerous best practice procedures formedication safety. (Much more information on thison pages 37-40)

Peninsula Health is also a leader in falls prevention.The service-wide falls prevention program hasdeveloped strategies, training aids and evaluationtools that are in use around Australia andinternationally. (More about our Falls PreventionServices on page 48)

The Psychiatric Service provided to the community is comprehensive and of a very high quality.

Staff training in emergency procedures is thoroughand effective.

The health service does an outstanding job ofhelping consumers move between acute and sub-acute services smoothly and without delays.

The Medical Officer Bank developed by Peninsulahealth addresses medical workforce and staffingissues to ensure a safer environment.(More about this on page 60)

SUGGESTED IMPROVEMENTS:Peninsula Health should consider centralisingequipment storage for better use of resources.(We have done that with the equipment that is used for people with obesity, see page 20)

Benchmarking (comparing performance against thatof other similar organisations) should be enhancedthroughout the Health Service.

The Health Service should continue to progress itsplanning for a possible influenza pandemic.(We have – see page 54)

RECOMMENDATIONS:The Health Service should restructure its storage ofhazardous goods at Frankston Hospital. (This wasdone immediately following the Survey Summation in May)

SUMMATION AND FINAL REPORT

Makingthe Grade

Your ultimate guaranteethat we are providingsafe, high qualityservices is theaccreditation process.

Kicking Goals


We have made further progress on several topics discussedin our 2004 Quality of Care Report. These include:

HOSPITAL BYPASSHospital bypass refers to times when an Emergency Department isso full that ambulances are asked to go on to other hospitals. Thisyear we reduced bypasses from 22 a month to 4 a month at ourRosebud Hospital Emergency Department (ED). Several strategiescontributed to this result. First, we appointed additional senior medicalstaff and a Physiotherapist to the ED team. The Physiotherapist treatssoft tissue injuries( sprains, pulled ligaments, etc), freeing up otherstaff to treat more patients. We also expanded our ED Streamlineservice which fast tracks simple cases allowing more people to beseen. And we established a Team at Rosebud that identifies patientswho actually need other services such as Respite Care or AlliedHealth. This team then arranges direct admission to these services.This frees up resources for emergency patients.

With these new strategies, we are responding to increasing demandfor emergency services at Rosebud Hospital. By February 2005 theunit treated as many patients as in the entire 2003/04 financial year.Summer visitors further swell the number of patients, which inDecember and January averaged 2,075 per month compared tomonthly averages of 1,350 for the rest of the year. Total emergencypresentations to the Rosebud Emergency Department over this pastyear were 18,451.

PNEUMATIC TUBEA pneumatic tube system now connects FrankstonHospital’s ED to the Pharmacyand Pathology Departments.The ‘pipeline’ increases speed and security in thetransfer of pathology specimens and medication.

Kicking Goals


FAST FACT Although the blood type O-Negative can be given to anyoneneeding a transfusion, people with bloodtype O-Negative can only safely receive O-Negative blood.

BLOOD MATTERSWe were one of 16 hospitals toparticipate in the Blood MattersCollaborative, aimed at reducing bloodtransfusion errors. The data collected is now thebasis of guidelines set out by the Better SafeTransfusions (BeST) Committee. This is a StateGovernment program that works to improve thequality of hospital transfusion care. Two ofPeninsula Health’s Executive Directors sit on theBeST Advisory Committee along with other publicand private health providers and the Red Cross.

BARIATRIC HEALTHLast year we reported on the steps we weretaking to make our hospitals more comfortable for people with obesity. This year we are puttingall our Bariatric Health (care for conditions relatingto obesity) policies and procedures, along with alisting of special bariatric patient equipment, onthe Peninsula Health intranet. This will help staff to locate equipment more quickly and tofamiliarise themselves with methods of safelymanaging this special patient group.

DENTAL PROGRAMA $226,767 funding increase from theDepartment of Human Services has made itpossible for our in house Dental program toprovide more services by facilitating clientreferrals to private dentists. This year we alsoadopted a new system to more efficientlyschedule emergency dental patients and wecurrently have no emergency waiting list in thisservice. We are increasing capacity byconstructing an additional treatment room andrecruiting more dentists. We are treating allchildren referred by the school dental vans.Our Aged Care Dental Services can see clientsfor routine care and dentures within six months.However: our waiting list for routine adult care,including cleanings and check ups, now standsat 7,623 people. Even though the routine careis less urgent than emergency care, denturework or dentistry for children, the list is toolong. Over the next twelve months we will beinvestigating ways in which we might reducethat number.

WWW21 QUALITY OF CARE REPORT 2005

SYRINGE EXCHANGEOur Syringe Exchange program has the bestreturn rate in Victoria. Current statistics showthat for every 100 clean needles we give out,we get 94 used ones back. The state averagereturn rate is only 50%.

The service aims to minimise the harm ofintravenous drug abuse. It provides cleanneedles to drug users, helping to prevent thespread of AIDS and hepatitis and giving ourstaff an opportunity to address general healthneeds for this group. By collecting usedneedles, the program minimises the risk ofthe needles being discarded on thecommunity’s beaches and streets.

ACCESS PROGRAMOur ACCESS PROGRAM helps callers find the rightnon-hospital services for their problems. Thisincludes many services for older people such as thePersonal Alarm Call Service, Memory Clinics anddisability aids. Last year 76% of calls were referredto the appropriate services within 24 hours.

PHARMACOTHERAPYDemand for our Pharmacotherapy (Methadone)Clinic is still high. The clinic, staffed by a GeneralPractitioner, provides support and health care topeople who are struggling with addictions to illicitdrugs. Between 1st April 2004 and 30th April2005 the Clinic made 4,056 appointments.(The clinic was established in 2002 and servedjust under 3,000 clients the first year.) In addition,two people a day commonly present without anappointment. Phone calls average 30 per day,and range from script requests to crisis calls.

FAST FACT Of the 100,000 Australianswho have Parkinson’s disease, 30,000are Victorians. Every year 500 Victoriansare diagnosed with the condition.

CAPITAL IDEA - Capital Works on the GoAll last year we were planning for the development of anew aged care facility in Mornington. The ‘MorningtonCentre for Health Independence’ will help meet thedemands for aged care treatment and residential careas the 65+ population increases dramatically over thenext two decades. The first 60 bed stage, which willtake about 18 months to complete, starts at the end of2005. The State Government has committed$20million to the first stage of the project.

Work began in August 2005 on a $3.4 millionupgrade and redevelopment of our Medical Imaging(Radiology) Department at Frankston Hospital.The project, which will take 12 months to complete,is increasing the size of the facility, introducing newequipment and expanding services, such as peripheralangiography. This is a procedure used to diagnose andhelp clear blood vessel blockages.

The redevelopment of the department was madepossible through a grant from the Department ofHuman Services and a $500,000 donation from thePink Ladies Auxiliary.

Peninsula Health is in the master planning phase ofthe Frankston Hospital Redevelopment, StageTwo. Stage One included the construction of a newWomen’s Children’s and Adolescent Health facility, anew Coronary Care Unit, additional Medical Ward, a16-bed Observation Ward and a new Main Entranceand Kiosk. Stage Two will include an upgrade inOperating Theatre facilities with the inclusion of theDay Theatre in the new complex. This will increase thecapacity of our Planned Surgery Program. As part ofthe development, it is also expected our Intensive CareUnit will be enhanced.

MOVEMENT DISORDERSOur Movement Disorders Program for people withParkinson’s Disease has been so successful at theRosebud Rehabilitation Service that we expandedit to Frankston. The Frankston service is providedfrom our Golf Links Road rehabilitation complex.We also conducted a week-long Parkinson’sAwareness Campaign for staff and consumers.

WEBInformation on our Peninsula Health Website isnow available to more people. Over the year weadded MP3 audio versions of our Quality Reportand Annual Report for people with visionproblems. We also now include patient informationin Greek, Italian and Croatian, the three mostcommon non-English languages in our community.

We will keep you updated.

Kicking Goals


FAST FACT Prior to 1928, ReverendFlynn had already established fifteenhospitals in the outback.

FAST FACT In 2003 the 50,000th Cochlear implant leta three year old Japanese girl hear for the first time.

FAST FACT Marshall and Warren actually swallowed aculture of Helicobacter Pylori as part of their research

FLYING DOCTOR SERVICEIn 1928 Reverend John Flynn created theworld’s first flying medical service. In Maythat year the first official visit was made bythe first flying doctor, Dr Kenyon Welch.

1928

ULTRASOUNDThe first ultrasound scanner usingsound waves to view inside the body was built by George Kossoff andDavid Robinson at the CommonwealthDepartment of Health.

FAST FACT Penicillin was soeffective at saving lives, Nobel Prizewinner Florey was later accused ofhelping create the world’spopulation explosion. Florey, himselfa long-time contraceptiveresearcher and strong advocate ofbirth control, called overpopulation“the most devastating thing thatthe world has got to face.”

PENICILLINAustralian scientist Howard Floreyand his team extracted and refinedpenicillin from mould and put theantibiotic in production.

1941

1961

GENE SHEARSCSIRO scientists Dr Wayne Gerlach and Dr Jim Haseloffdiscovered molecules that can move and remove genes.The technology is used in genetic research.

1986

RELENZA FLU VACCINEBuilding on earlier work done at Melbourne’s Walter and Eliza HallInstitute, Australian researchers Dr Peter Coleman and Dr JoseVarghese created a vaccine that can stop flu viruses spreadingfrom cell to cell.

1996

DISCOVERY OF HELICOBACTER PYLORIDr Robin Warren and Professor Barry Marshall of the Universityof Western Australia discovered this bacterium that can causegastritis and peptic ulcers. Despite international scepticism,they were proved right and doctors can now cure these ulcers.

1980S

BIONIC EARAn artificial ear rather than a hearing aid, the Cochlearimplant was developed by Professor Graeme Clark ofthe University of Melbourne and his team.

1979

MICROSURGERYThe first microsurgery was performed by ProfessorEarl Owen from Sydney who reattached an amputatedindex finger.

1970JUST A FEW OF THE AUSTRALIANFIRSTS IN MEDICAL RESEARCH AND DEVELOPMENT ARE -

Snippets


Like pilots consulting their Flight Manuals orteachers working from curriculum guides,healthcare providers use Clinical Pathways.These pathways outline all the steps that arerecommended in caring for patients with certainconditions, such as stroke or gallstones. Seniorclinicians develop and update the pathwaysbased on current evidence-based ‘best practice’.

On the eve of 2001 we had established sixClinical Pathways. Now we have 33 and arecurrently developing four new Pathways.

Since the Pathways are developed from thelatest and best evidence, staff are expected touse them. Sometimes, changes need to be madebecause patients may respond to treatment inunexpected ways. They may develop otherproblems such as vomiting or they might recovermore slowly than most patients with the samecondition. This requires that their care plans arealtered to meet the new conditions. They might,for example, need different medications or morefrequent observations or less fluids than thePathway recommends.

These changes are called Variances, and staffare asked to record them. By keeping a closewatch on these changes we can often detectproblems at their earliest stages.

For example, some Variances are caused byproblems in the system such as delayed testresults or time constraints that prevent staff

keeping to Pathway schedules. If these situationscause many Variances, we know that there is anissue we need to address.

We employ a Quality and Clinical PathwaysCoordinator and this year she has audited all theClinical Pathways for Variances and has determinedthe causes. She found that the Variances recordedfrom January to May 2005 were for the following reasons:

All the data that has been collected is being fedback to the wards so that staff can address delay or non-compliance issues.

It was found that sometimes Variances were notbeing recorded, and her investigation showed thatthe forms for recording the changes were toonumerous and cumbersome. So The Quality &Clinical Pathways Coordinator is also redesigningthe forms that doctors and nurses fill out on eachpatient to make it quicker and easier to record Variances.

Progress we have made onissues from our first threeQuality of Care Reports

CLINICAL PATHWAYS

Kicking Goals

20012001

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Kicking Goals


20022002

Sara Fredriksen, our newAboriginal Liaison Officer

provides cross-cultural trainingas part of nurse educationprograms, other in-housetraining for staff and as part ofthe orientation program for newemployees.

We also reported on ourcampaign to increase the use ofinterpreters for patients who donot speak English. This includedinterpreters fluent in Auslan sign

language for people with hearing problems. The graphbelow shows a rising trend ininterpreter bookings,demonstrating that staff arebecoming more aware of thebarriers faced by our non-Englishspeaking consumers.

Peninsula Health is a member ofthe Victorian Hospital Languageand Culture Network.

In our 2002 Quality of CareReport we outlined our goals inhelping our local Aboriginalpopulation to more easily accesshealth services.

This year we appointed a newstaff member to support ourIndigenous health services. Ournewest Aboriginal Liaison Officer,Sara Frederiksen, will focus onaccess to inpatient services aswell as health promotion for theIndigenous community. She willwork with Peninsula Health staffto increase awareness ofAboriginal cultural traditions –and taboos – and explain howthese can be accommodated inthe health care setting.

Meanwhile our Drug and AlcoholService’s Aboriginal Liaison Officer,Bea Edwards, this year presentedat an international conference inBelfast, Ireland. Through a grantfrom the Alcohol Education andRehabilitation Foundation, she wasable to speak to healthprofessionals from many countriesabout her use of Dreamtimestories to illustrate health issuesfor our indigenous community.Recently Bea was honoured by theNational Aboriginal Islander DayObservance Committee as Elder ofthe Year for the MorningtonPeninsula.

We have also recruited a 23-yearold Aboriginal woman, ShyvonneAiello, who is training for herCertificate in Community Service.She is working with our PeninsulaDrug and Alcohol Program learningfirst hand about our drug

treatment programs. Shyvonnewas also honoured by theNational Aboriginal Islander DayObservance Committee.

20032003Australia benefits from the art,food, fashions, traditions andfestivities brought here byimmigrants from all over theworld. Our studies show that the Mornington Peninsula is a rich melting pot of cultures.(We have more than 45 differentlanguages on our interpreterrequest lists.)

In our 2003 Quality of CareReport we talked about howthese cultural differences wouldimpact on health care and howstaff needed to be sensitive toother customs and beliefs. Tohelp staff to learn about differingcultural needs, Peninsula Health


...and hittingour targetsWe are always pleased to tell you about oursuccesses. But, odd as it may seem, we are alsokeen for you to know about our shortcomings. We are anxious for you tosee that we pick up on them, learnfrom them and use that informationto improve our services.

Here are some examples:

PROBLEM:We surveyed patients to see if theyunderstood their rights and responsibilitieswhile in our care. We found that only 41% ofpatients had seen the information and thatonly 19% of those patients had a goodunderstanding of the issue.

ACTION TAKEN:We re-wrote our Rights and Responsibilitiesleaflet and provided the information in threeadditional languages. Posters were displayedthroughout the organisation. A video wascreated explaining Patient Rights andResponsibilities – it was screened in ourwaiting areas. And our ‘on-hold’ telephonemessage was enhanced to include Rightsand Responsibilities information.

OUTCOME:A subsequent survey demonstrated that76% of patients had seen the informationand, of those, 88% reported a goodunderstanding of the content.

PROBLEM:We found that our patient discharges werebeing delayed when assessments ofpatients’ homes were not completed ontime. Up to 80% of our patients needed ourOccupational Therapists to check out whatsupports might be necessary on returninghome. These could include shower chairs,handrails, Meals on Wheels, alarm callservices and so on. An examination of ourdischarge information showed us thatsome of these home assessments weretaking up to 5 days to complete, holding up the discharge process.

ACTION TAKEN:An investigation revealed that the homeassessment process was often delayedbecause hospital vehicles were notavailable. So we altered our procedures,dedicating a car to our OccupationalTherapy Service.

OUTCOME:The Therapists are now able to visitpatients’ homes on schedule, avoidingdelays in discharge due to the homeassessment process. In September 2004,there were 19 delays due to lack of caraccess for home assessments. There havebeen no more delays since the newinitiative was introduced.

Kicking Goals


PROBLEM:Writing prescriptions and patient caresummaries using computers gives betterresults. The scripts and reports are alwayslegible, important prompts such as patientallergies can be built into the software and the entire process can be much quicker thanhandwritten work. But busy doctors do nothave time to deal with sometimes confusingelements in a computer program. If nobody isavailable to explain when to double click orhow to move an entry into another field, mostdoctors will simply revert back to handwrittenreports.

ACTION TAKEN:We focused this year on providing moreInformation Technology (IT) support to ourdoctors. More training sessions in using thesoftware programs were offered to ourHospital Medical Officers. More technicianswere put on an IT Help Desk to answerdoctors’ questions. Technicians were alsoequipped with mobile phones to respondimmediately to queries. And electronic accesswas increased by adding more computers tothe Doctors’ Writing Area and purchasinglaptops for doctors to use at patient bedsides.To enhance the quality of the summaries,Peninsula Health began presenting a prizeeach month to the doctor who prepared themost complete, accurate and informativedischarge summaries.

OUTCOME:The number of Discharge Summariesrecorded electronically increased over this last year by 90%. Electronic prescribing anddischarge summaries are now used across our Rehabilitation, Aged and Palliative CareServices. We surveyed General Practitionerswho told us that they found the electronicsummaries very useful.

PROBLEM:We were concerned when we detected a rise inthe number of prescriptions being written fordrugs to which patients had a known allergy.Although these errors were identified well beforethe medications were given to patients, thepotential for harm was high – some allergicreactions could be serious or even fatal.

ACTION TAKEN:We ran a ‘Bee Alert’ campaign which we reportedon in our 2004 Quality of Care Report. Thecampaign encouraged patients to alert us to anyallergies and to ask about the medications thatwere being given to them. The staff focus of thecampaign highlighted the need to record allallergies and to check alert sheets in patientrecords before prescribing a medication. We alsoimproved our electronic Alerts Policy so thatallergies would be displayed prominently whenworking with a patient’s file.

OUTCOME:The first audit following the campaign showed a30% improvement in the error rate ofprescriptions written, from 10.5% (in a samplegroup of 133 patients) to 7.4% (in a sample of135 patients). The most recent audit of 111patients in April this year showed a furtherimprovement with only 5.4% of prescriptionscontaining an allergy-related error.


Trendsetters

Peninsula Health dietician JennyTrezise learned about a newconcept called CommunityKitchens. The kitchens broughttogether members of thecommunity to learn goodnutritional guidelines whilepreparing healthy dishes andfostering social networks.

20012001 20022002Statistics showed thatFrankston was an area inwhich people spent very littleon fruits and vegetables.Other information from theDepartment of HumanServices (DHS) indicated ahigh level of obesity in ourpopulation.

The number of schools grew to25 with 780 students involved.The number of trainedfacilitators (who could teachthe program) jumped to 66.

The program, which wasdeveloped by Rosebud Hospitalstaff in 1999, taught secondaryschool students aboutpregnancy, birth and parentingissues. The program expandedfrom five schools to eight. Datashowed that teen birth rates onthe Southern Peninsula hadbeen halved.

Public Health Forumsprovided information onDiabetes Management,Dementia, Mental Illness andDrug and Alcohol Issues.

Peninsula Health and itspartners in the Primary Careand Population Committeedeveloped a program of publichealth forums. These healthproviders, who meet withPeninsula Health on a regularbasis, wanted to keep thecommunity up to date with thelatest medical evidence ondisease prevention andtreatment. Peninsula Healthhosted two major forums onHeart Health and Breast Cancer.

Community Kitchens

Health Forums

Core of Life

Trend Setters


Jenny worked with communitygroups and found lots of interestin the idea. In SeptemberPeninsula Health and itscommunity partners launchedthe first six Community Kitchensin Australia.

Currently there are nineCommunity Kitchens in thelocal area supported by 25community groups.

Jenny was awarded the VictorianTravelling Fellowship by theDepartment of Human Services andthe Victorian Quality Council. Sheused the grant to study the Kitchensproject in Canada. On her return shedeveloped plans for local CommunityKitchens.

20032003 20042004 20052005

Nearly 18,000 students in 160schools benefited from theproject. The number of trainedfacilitators around Australiastood at 650. The project wasrecognised with a VictorianHealthcare Association Award.

School participation expandedto 250 with 25,000 students.Major funding was granted bythe CommonwealthGovernment to train facilitatorsthroughout Australia. A furthergrant of $45,000 was awardedto establish a Core of LifeProgram specifically for theIndigenous community.

The schools involved in theprogram increased to 90, with12,000 students participating.Twenty training sessions wereheld for 300 new facilitators.A program for Indigenous youthwas implemented.

Forums during the year focusedon Drugs in Sport, Type 1Diabetes, Osteoporosis andMedication Safety. Later in theyear we conducted forums onSurviving the Workplace, Men’sHealth and Wellbeing andSurvival Skills for Parents.

A second Men’s Health Forum,entitled “Men BehavingPositively II” was held in Mayand attracted more than 500people. During Patient SafetyWeek, held in June, a forumwas offered highlighting theTen Tips for Safer Health Careby the Australian Council forSafety & Quality in Health Care.

Over the five years that we have been producing this report, several projectshave continued to deliver positive outcomes. A brief summary includes:

The Health Forum Programcontinued with publiceducation sessions onMedication Management,Asthma, Road Safety andMeningococcal Disease.


Continuous qualityimprovement must bethe framework of anorganisation, not partof the framework.

At Peninsula Health everything we do isbased on, aimed at and developed from ourcommitment to quality and safety.

Making improvements is not enough. Weneed to improve on the improvements in acontinuous quality cycle – do our best,evaluate our performance, find ways towork even better and change our practices

to meet the new standards. Again and againand again.

The following issues illustrate how weconstantly seek strategies to make sure thatyou get the right care at the right time bythe right person in a safe environment.

SHORTER QUEUES AND SMALLER HIPSEllen and Louis Malanwere all ready to go to hospital for hisplanned operationwhen the call came.

QualityCulture

Read on to see our Quality Culture in action.

The operation to open ablocked blood vessel inLouis’ leg would have to

be postponed. In this procedure,originally scheduled for May 2ndat Frankston Hospital, thesurgeon would insert a finemesh cylinder called a stent tokeep the vessel open andrestore good blood flow.

The admissions clerk who rangapologised and explained thatLouis’ surgeon, operating room

Quality Culture


CRITICAL DECISIONS(Continued from previous page)

WHAT HAPPENED TO LOUIS & ELLEN MALANWAS A HIP – a Hospital Initiated Postponementin action. Last year we made several hundredof those dreaded calls to elective surgerypatients.

We hate to make them. Patients hate to get them.

HIPS are a burden for families, surgeons,hospital staff, the Government, taxpayers andthe community.

The calls are made for many reasons – theremay be no ward or Intensive Care Unit bedsavailable; another operation may have takenlonger than expected; the surgeon oranaesthetist might have been called away or,like Louis, an emergency patient may haveneeded the theatre, surgeon and surgical team.

We would, of course, have preferred to simplyadd another operation to our May 2nd surgicalschedule. But, like all public hospitals, ourfacilities sometimes do not have the capacity toadmit another patient. We must often decidewho needs our resources the most at any onetime.

Our decision ended well for Francie and Louis.Each is now recovered and getting back tonormal activities.

It distresses us, however, that there are manyothers still waiting for their turn in ourOperating Suite, some of them in pain, most ofthem anxious. To provide good outcomes forthese people as well, we continue to identifyopportunities for moving people through ourservices as smoothly, safely and quickly aspossible. We call this ‘patient flow’.

and bed were all needed for anemergency patient. Ellen and Louiswere disappointed, but only twoweeks later learned that the surgeryhad been rescheduled for May 25th.

While the Malans were unpackinghis bag, the hospital was getting 87 year old Francie ready for thesurgery that would prevent herfrom having a potentially fatalstroke. She had been brought tothe Frankston Hospital EmergencyDepartment with temporaryconfusion, slurred speech andweakness, classic symptoms of aTransient Ischemic Attack. Theseare warning signs that a strokecould occur at any time. Testsshowed that a blood vessel in herneck was almost completelyblocked.

Francie is now fully recovered andback at home. Several times a dayshe climbs the stairs to her own flatwhere, with a little help from herson and daughter, she is still ableto live independently.

Louis had his surgery on the 25thwith no complications, and he wasable to leave the following day. Hetold us that he was delighted tohave warm feet again.

The following are severalideas we have implementedduring the last year toimprove patient flow.

The friendly ladies on our Admissionsstaff who have to make the HIPs calls


THE WORST GOES FIRSTElective Surgery Categories Explained

MOVING RIGHT ALONGEmergency patients come into hospitalany hour of the day, seven days a week.Many of them need admission to a ward.

But the majority of patients in wardshave traditionally only been dischargedbetween Monday and Friday. For nearlythree days there are patients coming inbut few patients are leaving. Theproblem – and the solution – are clear.Discharge more patients on theweekend! So we put the necessaryprocedures in place to do just that.

This change is helping us to move morepatients through the system moreefficiently. We make better use of eachbed and eliminate the classic ‘MondayBed Block’ that holds up surgery andkeeps patients waiting on EmergencyTrolleys.

CHANGE is the focus of the Patient Flowproject. By minimising waitingthroughout the patient journey, we canimprove quality, safety and servicedelivery.

At Peninsula Health we have establishedfour teams who are looking for evidenceof existing obstacles to good patient flowand are developinggreat ideas on how toeliminate theobstacles.

Some projects havealready helped toimprove ourpatient flow.Some are still tobe evaluated.

All are targetedat giving you aquality healthcare service. The graph (right) tells how many people were on

our elective surgery waiting lists at 30th June foreach of the last five years. Alongside these weshow the number of elective and emergencyoperations we actually did during each year.

It is usually too risky to postpone any patients with aCategory One condition. Since the rest of the space in the surgical schedule is filled mostly with Category Twopatients, it is inevitable that these people will most oftenbe the unfortunate ones who have to be cancelled infavour of a Category One or Emergency patient.

1 CATEGORY ONEa condition liable to deteriorate quickly intoan emergency (such as a growth that maybe a cancer)

2 CATEGORY TWOa condition causing pain, dysfunction ordisability, but not likely to become anemergency (such as hip replacement) THEMAJORITY OF ELECTIVE SURGERY PATIENTSFALL INTO THIS CATEGORY

3 CATEGORY THREEa condition that is not especially painful ordisabling and is not likely to deteriorate quickly(such as varicose veins)

Quality Culture


WAIT REDUCTIONIf you go into a store to buy some knee-high boots,it is doubtful the sales staff will send you toanother shop.

But if you come to Peninsula Health for a kneereplacement, we are quite willing to refer you to St Vincent’s Hospital.

That is what the Elective Surgery Access Service(ESAS) is all about – the best use of resources tohelp the most patients. Developed by theDepartment of Human Services, ESAS fundshospitals with extra theatre capacity, such as StVincent’s, to take on patients from other healthservices.

This enables us to offer patients waiting forOrthopaedic Surgery (mainly joint replacement) anearlier operation. Last year 206 patients took upthe offer to have their surgery earlier, but fartherfrom home.

The program obviously has a good reputation. In2002 we only had 44% of patients take up theESAS offer. This year that rose to 64%. Over thethree years since 2002, we have had 610 of ourpatients treated through this program. Victoria-wideduring that period 2,770 patients were treatedthrough ESAS.

We have now further developed our ElectiveSurgery Access Service by appointing aCoordinator, Ms Jenny Abernethy, a Division OneNurse and former Surgical Associate NurseManager. Among her many duties she will:

• liaise closely with our Waiting List Manager andDirector of Surgery to eliminate avoidableobstacles to surgery schedules

• communicate with patients on the waiting listand offer support to those patients who havebeen waiting the longest

• explain and offer patients the opportunity tohave their operation at other hospitals andcoordinate their care

• coordinate services for patients who are ‘NotReady for Care’ because of issues such asobesity, pregnancy, chemical dependency, othermajor health problems and so on

• work with Coordinators from other healthservices to share good ideas

• look for ways to move patients through thesystem more efficiently.

One initiative from our Physiotherapy Department isa program to assist patients waiting for jointreplacements. Physiotherapists evaluate patients tosee if they would benefit from participation in anexercise program. Over twelve months 130patients will take up organised exercise programsthrough our Physiotherapy Services and AgestrongPrograms. This is expected to reduce pain andimprove mobility and strength in these patientsuntil they have their operations.

Another project aims to treat more Category TwoUrology (Urinary System) patients who have beenwaiting more than eight months. In May Jennyhelped to initiate Saturday sessions in our DaySurgery Unit. Seven patients from the 2003 waitinglist were treated at the first session. The weekendsurgery plus Jenny’s management of the Urologylists has resulted in 48 long-waiting patients beingtreated, including 4 patients waiting since 2002and 22 waiting since 2003. Only six patientsremain from the 2003 list, three of whom are ‘NotReady for Care’.

0 2000 4000 6000 8000 10000


THEATRE PERFORMANCEThe hub of our elective surgery services is, ofcourse, our operating theatres. We must use thesefacilities with clockwork efficiency to avoid gridlockin the rest of the system.

This year, with a DHS grant, we conducted ourOperating Room Breakthrough Project. The aim ofthe project was to analyse the systems andbooking practices in our Theatres at Frankston andRosebud Hospitals.

In January and February we collected data on awide range of issues such as surgery startingtimes, transport to and from the Theatre, length ofthe procedures and whether there were anydifficulties with equipment.

The data indicated that improvements werepossible in the following areas:

• starting time of surgery• more accurate prediction of operating times• cancellation of patients on the day of surgery

because no Intensive Care Unit beds wereavailable

• additional cancellation because of a lack ofbeds on Mondays.

A Project Team then analysed the data forpractices or systems that could be improved.A member of our Community Advisory Committeejoined the ‘think tank’ to help us to developstrategies for improvement.

Some of the recommendations that are beingconsidered or have been implemented are:

• The Intensive Care Consultants perform anassessment at 7.00 a.m. to determine howmany, if any, Intensive Care beds are available.This lets the Operating Theatre know earlier ifthey can or cannot go ahead with someoperations.

• Operating Theatre Team Leaders keep track ofall aspects of each patient’s procedure anddetermine when the next patient is required.

• The feasibility of developing a Tracker System,like the ED Tracker in the EmergencyDepartment (See ‘On the Right Track’ nextpage) is being explored. This would keep

patient status updated electronically so thatOperating Theatre and Ward Staff wouldknow at any time where the patients wereon their journey.

• Surgeons putting in an estimated time for eachprocedure on the booking form along withdetails of special equipment that will beneeded. This will assist in scheduling and instarting operations on time.

• Allocating some time in the Operating TheatreSchedule for unscheduled emergency surgery.This would permit the emergency operation togo ahead without cancelling elective patients.

We are collecting data on the initiatives already inplace and we will report back to you in next year’sQuality of Care Report on the outcomes of ourOperating Room Breakthrough Project.

Quality Culture


ON THE RIGHT TRACKWe send a big THANK YOU to Melbourne Health and the RoyalMelbourne Hospital for inviting us to study their system of trackingemergency patients.

This research helped the Peninsula Health team to develop acomputer system that allows staff to track patients while they are inthe Emergency Department. This helps to identify bottlenecks in theED. Once identified, these delay-causing issues can be resolved.

Our ED Tracker can also alert the team to the fact that a patient haspresented to the ED more than six times in a year. The team canthen arrange for the patient to be included in our Complex CareProgram for people with chronic conditions. (See page 61-68).

IN RESIDENCEA frequent scenario...an elderly person becomes illand is hospitalised for treatment. The personrecovers, but not enough to return to independentliving. The person needs to go to a nursing homebut such a placement is not readily available.

This is a LOSE/LOSE situation all round. The patienthas to stay in a busy hospital rather than in ahomelike atmosphere. That bed is unavailable for anew patient who needs to be in hospital. And thecost to the community of caring for a person inhospital is far greater than if the person was in aresidential care setting.

But things are changing.

At Peninsula Health we have a new service.Elderly Patients can receive the health care theyneed at home while they wait for a place in aresidential facility. For patients who fit the criteria –they have someone staying with them (family, friendor partner) and they do not wander at night – ourstaff can provide nursing care, respite for the carerand other home-based services. This is morecomfortable for the patient and allows us to use thebed in hospital for new patients.

This program has had a tremendous impact on theunnecessary time elderly patients spend in hospitalbeds. The graph (right) shows the dramatic reductionover 26 months in the length of stay in a hospital bedand the number of patients waiting in hospital forresidential care placement.

LENGTH OF STAYThe days spent inhospital for oneepisode of care


TIMELY TRANSFERSHospital is not the answer for everyone. Sometimespeople have health problems that can be betterhandled elsewhere or in other ways.

That fact is the basis of a new initiative in ourEmergency Departments. Older patients in ED arenow reviewed by a specially qualified team. If thepatients could be better served in one of our agedcare assessment units, and a bed is available, adirect admission to that service can be made.

The program was trialled in January this year. Therewere 31 patients deemed suitable for direct transferto our Mount Eliza Aged Care Centre. Of those, 26were able to be admitted on the same day. At MountEliza, all these patients received services tailored tothe special needs of older people.

This, of course, left 26 more beds available forpatients who needed hospitalisation.

Since January, 122 patients have been transferredthrough this process.

IT’S ON THE CARDSNew Bed Cards, with additional information, aredisplayed prominently in a Perspex holder over apatient’s bed. The A4 sized card lists the names of allthe medical and allied health staff that are involved incaring for the patient.

It also lists, for everyone to see, the Expected Date ofDischarge. This is based on the average length of stayfor a patient with that particular condition.

The card serves several purposes:

• It helps the patient remember the names of theirtreatment team.

• The patients know when they are expected to leavehospital so they can make arrangements for beingpicked up.

• The discharge date also gives the entire treatmentteam a target that they are working toward.

• The card tells team members who else is caring forthis patient, which improves communication withinthe team.

The initial trial in March 2005 was successful and theBed Cards are now being implemented acrossPeninsula Health.

A MOSTLY GOOD NEWS STORYLong hours spent in Emergency Department (ED)waiting rooms are legendary and causefrustration all over the world.

At Peninsula Health we are constantly seekingnew ways to reduce the waiting time foremergency patients. We fast-track simple cases.We train nurses to give pain relief and todetermine when patients need x-rays. Wetransfer people who do not need emergency careto other services. We monitor patients’ progressthrough the system. We even installed apneumatic tube to rush pathology samples, testresults and medications to and from the ED.

And we need these innovations – the demandfor emergency services at both our Frankstonand Rosebud Hospitals went up again this yearfrom 45,154 to 46,794 (Frankston Hospital) and17,364 to 18,451 (Rosebud Hospital).

Even with this high demand, our efforts arepaying off. The five graphs below show that for the most part we are seeing even morepatients in the specified time than the threshold recommended by the Department of Human Services.

EMERGENCY DEPARTMENT WAITINGTIMES FOR INITIAL TREATMENTIn most categories Peninsula Health exceeds the Department of Human Services (DHS) target.This means we see more patients within therecommended time frame than is expected.

Quality Culture


Category 2 - % Patients Seen in 10 Minutes

DHS TARGET ACTUAL PREV YEAR

JunMayAprMarFebJanDecNovOctSepAugJul0

20

40

60

80

100

DHS TARGET ACTUAL PREV YEAR

JunMayAprMarFebJanDecNovOctSepAugJul

We will keep you informed on ourprogress each year through this Quality of Care Report.

So much for the good news.When we move patients quickly through theEmergency Department, we must then be able totransfer the ones who need to stay in hospital to award bed. That is a bit trickier. The patients alreadyin the ward beds may need to stay longer thanexpected. Elective surgery patients are scheduledto fill those beds as they become available. Inaddition, specialised beds (Intensive Care, CoronaryCare and high-dependency monitored beds) arenearly always occupied.

So our statistics on patients waiting to be admitted(right) are not as impressive as our ED WaitingTimes for initial treatment (Graphs 1-5 below).

This is where the other initiatives in this articlecome to the fore. We are investigating everyavenue and implementing our best ideas to keeppatient flow at peak levels in order to avoidpatients being stalled at any point in their care.


People with certain heart disorders needthe drug Digoxin to improve theirsymptoms. But given to the wrong person or in the wrong dose, Digoxin cancause the heart to beat erratically. This canbe fatal.

Penicillin can save the life of a patientwith a severe infection, but some peoplewho are allergic to the drug can developserious reactions.

Medicines can save our lives, extend ourlives and improve our lives. But usedincorrectly, they can also make us verysick or even take our lives.

It is estimated that each year in Australia140,000 admissions to hospital are due toproblems with medicines. Up to 20% ofthe things that go wrong in health care areto do with medication. (Australian Council forSafety and Quality in Health Care).

Peninsula Health has systems and practicesin place to keep you safe from medicationerrors, both in hospital and at home.

endPutting an

to PerilousPrescriptions:

MEDICATION SAFETY ATPENINSULA HEALTH

COLLABORATIONSince November 2003we have been involvedin the National MedicationSafety BreakthroughCollaborative sponsored by theAustralian Council for Safety andQuality in Health Care. We are one of100 teams across Australia workingtogether to improve medication safety.

Our participation in this project sparkedseveral other Medication Safetyinitiatives by our innovative Pharmacystaff. Some of these initiatives aredetailed below.

To date we have –

• reduced the actual or potential harmfrom inaccurate Electronic DischargeSummaries by 67% (see graph right).

• included two new sections to theDischarge Summary related tomedication. These are MedicationsStarted/Stopped and High RiskMedications. These sections give apatient’s GP important information aboutchanges to pre-admission medicationsand any new medications that havebeen prescribed.

• put patient friendly labels (such as FORPAIN or FOR BLOOD PRESSURE) on74% of all discharge medications (thesoftware for this is built into our labellingsystem and is now automatic). Thisinitiative was first reported in our 2004Quality of Care Report.

VIGILANCEA swollen tongue, itching, hives, difficulty breathing andheart palpitations are all possible symptoms ofmedication allergies. Allergic reactions can be as simpleas a rash or serious enough to cause death.

We reduced medication allergy errors through our BeeAlert Campaign, which we combined with an educationprogram for staff on Penicillin reactions. The programincluded updates to clinical staff on the different kindsof penicillin, quiz competitions and lectures to interns.

(Our Bee Alert Campaign was featured inlast year’s Quality of Care Report.)

Over the last year, we reducedprescription errors related topenicillin allergies from:

3.7% (in a sample of 135 patients) to0.9% (in a sample of 111 patients) –a 76% improvement overall.

Quality Culture


FAST FACT Peninsula Healthbegan putting ‘patient friendly’labels on medicines after anincident with a patient who wasunable to remember which ofhis discharge medications wereantibiotics and which wereantacids. (Our consumerrepresentative on theMedication Safety team helpedto design the labels.)

• produced an easy to read brochuregiving details about pain medicationsand explaining how to take the drugs,how to minimise side effects andwhat to do if there are problems.

Peninsula Health attends a MedicationSafety conference – (from left) Gus deGroot, consumer representative; SkipLam, Pharmacy Director; Dr GaryBraun, Director of Clinical PracticeImprovement; Dr Peter Bradford,Executive Director Medical Services.

To gauge how much improvement Peninsula Healthmade in reducing errors regarding medications in ourElectronic Discharge Summaries, our Director ofPharmacy and Director of Clinical PracticeImprovement conducted regular, random audits onpatient records. They reviewed drug charts,prescriptions and discharge summaries. When theyfound an error, they used an algorithm from theDepartment of Human Services (called the‘Harmometer’) to rate the level of harm that could haveoccurred. (They, of course, rectified errors whereverpossible.) Their findings showed a 67% decrease inactual or potential harm from medication errors overthe six months June to November 2004.


PRECAUTIONWhenever people are confined to a seat or a bed for an unusually long period such as on aplane flight or a stay in a hospital bed, changesoccur in the body.

For one thing, blood flow becomes sluggish,allowing clots to form in deep blood vessels. If aclot breaks loose and travels to the lungs, it cancause what is called a Pulmonary Embolism,which can be fatal.

In fact, Pulmonary Embolism is the most commonpreventable cause of deaths in hospital.

Patients admitted for severe respiratory diseaseand chronic heart failure are especially at risk.

Studies show that by giving blood thinning agentsprophylactically (as a precaution) to these patients,there is a reduced incidence of clots.

Our Pharmacists and Senior Physicians areworking together to improve our pulmonaryembolism prevention rates. In February this yearthey reviewed the records of 160 patients todetermine how many of those patients would fitthe criteria for high risk. They found 62 patientswere good candidates for thromboprophylaxis(giving blood thinning agents as a precaution), butonly 35 of them were actually receiving it (56%).

So the team began an education campaign,working with doctors to stress the value of thetherapy and the guidelines for its use. A newprotocol was developed and approved by theDrugs and Therapeutics Committee. The “Don’t bea Clot” campaign was launched.

In June a repeat audit demonstrated that out of 44 patients who had an indication forthromboprophylaxis, 31 (71%) had receivedtreatment, representing a 15% improvement.Three months after the campaign a further auditshowed that all patients in the audit sample whoneeded thromboprophylaxis had received theblood thinning agent.

So far the use of thromboprophylaxis is increasing,but we will know how well the improvements aremaintained when we resurvey later this year.We will report our findings in nextyear’s Quality of Care Report.

AWARENESSWarfarin is a ‘goodnews / bad news’ kindof drug. It workswonders in preventingclots forming insideblood vessels, whichcan lead to a heartattack or stroke.

But too much Warfarincan cause uncontrolled bleeding. It is a trickybalancing act, especially in an emergencysituation.

To help medical staff manage the effects of toomuch Warfarin, our Pharmacists are running aWarfarin Awareness Campaign. Lectures,newsletters and posters are being used to helpdoctors choose the right dose of the right medicineto counter the effect of too much Warfarin.

The campaign has had good results so far.

EIGHT RIGHTS

1. Right...drug

2. Right...client

3. Right...dose

4. Right...form

5. Right...time

6. Right...route

7. Right...reason

8. Right...documentation

Quality Culture


INITIATIVESarah Turner is a Peninsula Health pharmacytechnician with a good eye for spotting problems.

She noticed that sometimes medications wereaccidentally left in the bedside drug drawers afterpatients were discharged. If this was not detectedprior to a new patient’s medicines being put in thedrawer, it became a medication error waiting tohappen.

For a month, working with nurses in one ward,Sarah recorded each time she found a leftover

drug as she was screening bedside drawers. Inaddition, Sarah checked the medications in thedrawers of patients in hospital against theprescriptions on their drug chart.

She found an overall 19.3% error rate. So shedevised an education and awareness program forward staff, including posters and lectures.

Since Sarah’s campaign, bedside drawer errorrates have dropped significantly. At the end of thecampaign the error rate had dropped to 5.7% andfour months after the campaign the rate is down to3.5%, an improvement of 82%.

PARTNERSHIPSOne special partnership has been of particular helpin our ongoing campaign to reduce medicationerrors. Two years ago Mr Gus de Groot from ourCommunity Advisory Committee registered acomplaint about communication problems he hadexperienced while in hospital. The response to hiscomplaint caught Mr de Groot’s interest, and sincethen he has been actively involved. He attendsmeetings of the Medication Safety Team, rings GPsin a survey on discharge summaries and haspresented the consumer’s perspective at nationalconferences on Reducing Medication Errors.

FAST FACT The Pharmacy Departmenthas begun sending a separate medicationdischarge update to GPs. The updateoutlines any alerts or last minute changesto discharge prescriptions.

INVESTIGATION‘Six Sigma’ sounds like the name of a Greekrock band, but it is actually a way of findingsolutions to problems.

Built on the old adage ‘Never Assume’, Six Sigmais all about defining and measuring problems anddeveloping solutions based on evidence. Thistechnique is used by companies such asMicrosoft, Sony, 3M and Ford Motor Company.Several projects this year are proving the value ofthe Six Sigma approach at Peninsula Health.

ONE EXAMPLE IS...An investigation was made into why up to 15% ofpatients admitted through our Emergency Departmentshad no drug chart when they arrived on the wards.This document lists all the drugs a patient was takingprior to admission and any medications they receivedin ED. The clinical team on the ward needs to knowthis information in order to properly care for thepatient.Again, we looked at all steps in the process, from thepatient’s presentation in ED to settling into bed on theward. We found that there was confusion about whowas responsible for ensuring the drug chart was sentwith the patient.A couple of meetings with senior doctors set up anofficial protocol for writing up the drug charts. Staffwere all briefed on the process and now only two inevery hundred charts fails to make it to the ward onadmission – an 83% improvement.

Mr Gus de Grootreceives an awardfor contributions tothe NationalMedication SafetyBreakthroughCollaborative. Withhim is the HonBronwyn Pike, theVictorian Ministerfor Health.

MRSAMulti ResistantStaphylococcusAureus;a bacterial infectionthat is becomingincreasinglyresistant toantibiotics

HOW WE PREVENT ANDCONTROL INFECTION

GERMScan hide almost anywhere. They findcountless devious ways of infectingour bodies. They can even transformthemselves to outwit our defenses.

It takes a lot to control thismicroscopic mob and prevent thedamage it can cause.

This is the challenge facingPeninsula Health’s InfectionPrevention and Control Unit.Staff in this unit keep watch 24/7 on infection risks and work in everypart of the health service to keeprisks in check.

MICROBE HUNTERSMaking infection controlEverybody’s Business

This year our team conductedextensive staff training, including a6-week Infection Prevention andControl Liaison Course for cleaners, food handlers and other non-clinical staff.

Peninsula Health is one of the onlyhealth service in Victoria offering thistraining to non-clinical staff.

To date, 48 non-clinical staff havesuccessfully completed the course.This means more eyes are scanningfor infection risks and there is extrahelp with implementing infectioncontrol measures.

InfectionProtection


FAST FACT Although many peoplecarry MRSA without developinginfections, the germ can causeinfections in almost any part of thebody. MRSA infections can rangefrom redness and discharge of awound to a potentially fatalinfection of the blood.

AIR SAFETYKeeping our facilities infection free

Peninsula Health is expanding its Medical Imaging Services (see page 21) at Frankston Hospital.

During the redevelopment our Infection Control staff will becarefully monitoring the air space around the construction site.They will be looking for infectious particles such as Aspergillusstirred up by the work. Aspergillus is a fungus that can causeinfections in some people.

Using an air monitoring device, the team will check differentareas on a regular basis. They will also ensure that barricadesaround the construction are properly sealed and that, ifnecessary, parts of the air conditioning system are shut down andcleaned.

This will protect patients, staff and visitors while our new facilitytakes shape.

Quality Culture


WE HAVE THE PROBLEM IN HANDThe benefits of hand hygiene

To help reduce the spread of germs from one patient toanother, Peninsula Health joined five other VictorianHospitals in the Hand Hygiene Project. The project islooking at ways to make it quicker and simpler for busystaff to cleanse their hands between patients.

Conventional hand washing is time consuming and,when done many times every day, tends to dry out theskin and damage the hands. This sets up the perfectbreeding ground for bacteria.

The project is promoting the latest in hand hygiene–Chlorhexidine Hand Rubs. These bottles of hand rub arepositioned at the end of each bed in the wards. A shortpump of the bottle gives a metered dose of the germkilling agent, which dries quickly when it is rubbed in. Italso contains emollients to reduce dry skin.

Hand rubs reduce the chance of staff spreading infectionand significantly decrease the time spent in handwashing.

In a busy medical environment, this safe time-saver ismost welcome. Infection Control staff have collected datato show that staff hand cleansing practices haveimproved by 27% since the hand rubs were introduced.


We put a lot of effort into making sure ourfacilities are as clean and as well maintainedas possible.

Twice a year we conduct an in-house audit(inspection) of all our facilities. We rate themfrom 0% to 100% on how well they meet ourstandards.

Then once a year we bring in cleaningexperts from outside the organisation to dothe same again.

Our results are good and getting better.

This year our Community Rehabilitation Unitin Chelsea earned a score of 100% for itsCleaning Audit result and was presented withan award for this achievement.

Our Rosebud Hospital Operating Theatre Suitealso received a score of 100%, with theauditor noting that it was “the best theatreI’ve ever seen.”

Up to April this year the Department ofHuman Services required health services toachieve an 80% score to pass. In April thatwas increased to 85%. All of PeninsulaHealth’s facilities exceed that target.

SITE 2003/04 2004/05

Frankston Hospital 90.5 91.6

Rosebud Hospital 93.8 94

Carinya Aged Residential Unit 84.5 91

Jean Turner Nursing Home 88.3 90.3

Lotus Lodge Hostel 89.3 89.8

Mount Eliza Centre 83.2 90.1

Palliative Care Unit 84.9 91

Frankston Community Rehab 94.6 99.5

Frankston Rehab Unit One 88 92.5

Frankston Rehab Unit Two 88 93.3

Rosebud Rehab Unit 82.5 92.6

Cleanliness is not healthy for germs

Percentage scores from External Cleaning Auditsfor Peninsula Health sites.

GERMS

Quality Culture


One reason infections spread more easily in winter isthat people are usually crowded together indoors,making it easier for germs to move from one personto another.

The same effect can be found year-round in nursinghomes, where residents spend great amounts of timeindoors in close proximity to others.

In Peninsula Health’s residential care units, ourInfection Control team regularly monitors forinfections, including conjunctivitis. This is an eyeinfection that causes sore eyes with redness anddischarge.

Data last year showed that our Carinya AgedResidential Unit recorded a high incidence of this

condition, with a rate of 13 infections over 12months. Many of the residents of this nursing homehave difficulty understanding and following hygieneroutines.

On investigation, one of the main causes of thisparticular problem turned out to be fairly simple. Wefound that many of the residents would bring theirpillows with them to the day room, but took someoneelse’s pillow back to their own rooms. This made iteasy for the infection to spread between residents.

The simplest answer was to label pillows withresidents’ names. Staff could then ensure that eachresident used only his or her own pillow.

This easy solution cut the rate of conjunctivitis atCarinya from 13 cases last year to only seven casesthis year.

PILLOW SLIPS A simple solution

After surgical procedures, people aremore vulnerable to infections becausethe skin and other tissue have beenbreached. Germs can more easilyenter the body through a wound site.

So we take every possible precautionto protect surgical wound sites frominfection.

To help us monitor how well we areperforming in this area, we participatein the Victorian Nosocomial InfectionSite Surveillance (VICNISS) program.Participating hospitals target specificprocedures and submit infection ratesfor these. The coordinating centre willthen establish an average rate usingall the participants’ information – thisis called the Aggregate. Comparingour rates to the Aggregate helps usjudge the effectiveness of our InfectionPrevention and Control practices.

We submit data on infection rates fortotal knee replacement surgery. TheVICNISS 2004 statistics for thisprocedure show that FrankstonHospital has a lower infection ratethan the Aggregate.

(The graphs below compare Peninsula Health’s knee replacementinfection rates with the Aggregate for each risk index. People witha Risk Index of 0 are fit and healthy compared to people with aRisk Index of 2. Patients with factors such as chronic disease [e.g.diabetes] would have a higher risk of developing an infection.)

0

1

2

3

0

1

2

3

4

0

1

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3


Skin SafeSkin Safe KEEPING BEDSORES AT BAY

Our skin is a three-kilogram powerhouse that shields us from intenseheat and cold, stops germs in their tracks, stores water, makes vitamins,sends signals that warn of danger and keeps out infections.

It is our body’s largest organ andis so important to our health thatkeeping skin in good shape is oneof a hospital’s priorities.

When people are weakened bydisease or frailty they are atgreater risk of skin problems.

Their skin does not heal as well, andlong hours spent in bed, wheelchairsand casts put continuous pressure onvarious parts of the body.

This can lead to serious wounds calledpressure ulcers. The risk of pressureulcers is increased when a patient ispoorly nourished and has lost sensationor is exposed to moisture, e.g.incontinence. Poor circulation andhaving either too much or too little fatalso contribute to this problem.

Commonly called a ‘bed sore’, a pressureulcer usually develops over bony areassuch as heels, backs, buttocks, elbowsand shoulders. Wherever constantpressure or friction restricts blood flow,the risk of ulcers is high.

Pressure ulcers can become so severethat sections of skin and tissue actuallydecay, exposing and even damagingbone. (See examples RIGHT). Thisfurther weakens a patient’s generalhealth, extends his or her hospital stayand leads to additional complications.

A pressure ulcer is much easier toprevent than to cure.

1) monitoring all patients for their risk of developingskin problems

2) initiating action to prevent ulcers developing whilepatients are in hospital

3) treating pressure ulcers that do develop or thatexisted when patients were admitted

4) working to keep pressure sores from deteriorating5) using the information we collect on pressure ulcers

to improve our care and our practices.6) using pressure reduction & relieving mattresses

Skin is reddened

AT PENINSULA HEALTH WE BATTLE BED SORES BY -

stage 1

Slight loss of skin;looks like a blisteror a graze

stage 2

Full loss of skin,exposing underlyingtissue; now an opensore

stage 3

Destruction ofunderlying fat, muscleand bone

stage 4

÷

÷

÷

÷

Pictures courtesy of the VictorianQuality Council (PUPPS Education)

Quality Culture


Patients are assessed every dayto see if they are developingpressure ulcers or if they haverisk factors that could lead toulcers. Nurses look for loss ofsensation, mobility levels,nutritional status and whetherthe skin is exposed to moistureand friction.

When patients are first admittedand then weekly after that,nursing staff record their findingson a Pressure Risk AssessmentTool. If a pressure ulcer is found,an incident report is filled out. Allthis information – as well as howconsistently reports arecompleted – is collated and thisinformation is given to theQuality and Clinical GovernanceCommittee of the Board.

This accurate and consistentrecord keeping has manybenefits. It alerts us to begin

KEEPING TRACK OF SKIN INTEGRITY

FAST FACT Actor and spinal researchcampaigner, Christopher Reeve, wastotally immobilised in a riding accidentin 1995. After years of confinement to abed and wheelchair, he died last yearfrom complications of an infectioncaused by a bed sore.

preventive measures. This helpsminimise the number of bedsores that otherwise may goundetected. It provides lots ofinformation we can use toimprove the quality of our skinprotection services. It warns usof developing problems with ourpractices and keeps us alwaysup-to-date on the extent of theproblem.

One very good indication of howwe are performing in the area ofSkin Integrity is the rate at whichstaff are completing the dailyassessment forms. We aim for90%-100% completion of theRisk Assessment Tool. Thesefigures, shown in the ‘CompletionRate’ graph below, indicate howwell staff are monitoring for risksand implementing recommendedinterventions.

Some patients come into hospitalwith an existing pressure ulcer.These can often be Stage Three

Average Target Completion Rates - for Pressure Ulcer Assessment Toolsacross Peninsula Health

% o

f pat

ient

s w

ith c

ompl

eted

PR

ATS

0%

20%

40%

60%

80%

100%

2003 2004 2005 TO DATE

or Four wounds, especially ifthey developed at home andhave not been treatedappropriately. We begintreatment immediately.

Despite preventive measures,some especially vulnerablepatients do develop pressureulcers after they are admitted.Providing top quality care forthese patients involves

- detecting the ulcer at itsearliest stage

- keeping the wound fromdeteriorating to a moreserious stage and

- healing the wound as quicklyas possible.

The graph below shows the totalnumber of pressure ulcerstreated at Peninsula Health overtwelve months. The blue barshows the ulcers existing onadmission and the orange barshows the numbers of ulcersthat developed in our hospitals.The latter category had fewerhigh-level wounds, indicatingthat we are finding ulcers earlyand keeping them frombecoming worse.


DISCHARGE DRESSINGSAfter leaving hospital, patients or their carers often have tocontinue dressing surgical ormajor injury wounds at home untilrecovery is complete. While mostpeople keep a few band-aids inthe medicine cupboard, few stockthe kinds of materials needed forwound care.

To help maintain good woundmanagement after leavinghospital, Peninsula Health nowprovides wound-care packages ondischarge for patients. Thisincludes a user-friendly pamphleton how to change dressings,problems to look out for, who tocontact if there are concerns andwhere to get wound dressingsupplies. In addition, the packagecontains three dressing changesso wounds can be coveredproperly until families canpurchase more dressings.

We are working in partnershipwith the Royal District NursingService to record theeffectiveness of the pamphlet andthe extra dressings. Thisinformation will help us to finetune our discharge procedures.

In 2001 Peninsula Health appointed a Skin Integrity ConsultantNurse, Fiona Butler, acknowledging our commitment to quality woundmanagement. As part of her job she has been surveying nursing staffwho have experienced concerns about the problems involved intreating skin tears.

Skin tear wounds are prevalent among elderly people. It does nottake much to injure their fragile, thin skin. Even a simple bump canshear away skin as if it were tissue paper.

These wounds can be difficult to treat, especially when the adhesivein most dressing products often reopens the wound or createsfurther tears when removed. So last year staff evaluated five differentdressing products. They looked at which dressings stayed in place,which could be removed with no damage to skin, the time requiredfor changing the dressings and the cost. They found that a newsilicone-based dressing gave the best over-all results, and the healthservice has this year established a new policy requiring the use ofthe new dressings for all skin tears and wounds on fragile skin

FAST FACT In 2003 and again in 2004, the StateGovernment ran surveys to count the total number ofhospital patients who on that particular day had any level of pressure ulcer. This included both patients who hadpressure ulcers when they came to hospital and those whohad developed ulcers in hospital. This gave a good picture of the problem statewide. After reviewing the data, theGovernment allocated $2 million to supply new pressure-reducing foam mattresses to public hospitals aroundVictoria. Peninsula Health received $83,973, to which weadded another $66,000 to purchase 408 new pressurereducing mattresses for our hospital and rehabilitation beds.

Best Dressed

Quality Culture


Although people over 65 havefewer injuries than other agegroups, they have the highestrate of death from injuries. Outof 100,000 people aged 65 to85, 18 will die from falls eachyear. In people over 85 yearsold, the number of those dyingfrom falls rises to 81 out of100,000.(Australian Bureau of Statistics)

STANDING UP to FallsAt Peninsula Health we do everything wecan to make sure people do not fall down.

FALLS KILLFalls cost communities millionsin health care costs and lostproductivity. Falls causesuffering, hardship and distress.Falls can create disabilities thatlimit people’s lives. Falling canbe fatal.

More people come toEmergency Departmentsbecause of falls than any othercause, and the majority ofpatient related incidents atPeninsula Health are falls.

People of all ages fall, but olderpeople are at higher risk. Theyare more susceptible to fallsbecause there has often been adecline in strength, balance,eyesight and reaction time. Aswell, older bones are usuallythinner, putting seniors more atrisk of serious injury when theydo fall. On top of that, as peopleage they heal less quickly and itis more likely that being unableto move during recovery willcreate other health problems.


PREVENTING HIP FRACTURESOur Rehabilitation, Aged and Palliative Care Service hasfocused this year on hip fractures, implementing newstrategies and staff training programs. A major component ofthe campaign has been the expanded use of hip protectors forhigh risk clients. These are special garments fitted with padsthat spread the shock if a fall occurs.

Since June 2004, 72 patients have been prescribed hipprotectors, compared to only four in the previous year.

Records at our Carinya Residential Aged Care Unit show thatthe protectors do work. Twenty residents were fitted with hipprotectors last year. Over six months the 20 high risk fallersexperienced 83 falls without a single broken hip.

So Peninsula Health is fighting falls – in its facilitiesand in the community.

GOOD SENSEStaff are trialling aspecially designedsensor thatattaches topatients’ beds andalerts nursing staffto unusualmovement. Thisimproves ourability to respondquickly to protecthigh-risk fallers.

During 2004 nursing staff testedcommercial bed sensors, providingfeedback that has led to designmodifications by the manufacturer.In January 2005 the servicepurchased 22 of the customisedsensors for patients and residents in high risk units.

MORE MUSCLEPeninsula Health has run Agestrong exercise courses for threeyears, both in our facilities and out in the community. (Wereported on this project in both our 2003 and 2004 Quality ofCare Report.) These courses give older people guidance onfitness issues and easy access to regular exercise. In April 2003we conducted three courses for 35 participants. The program hasproven to be so popular that we now run 20 groups across sevensites for 275 participants.

A survey of participants in January 2005 showed that 85%attended twice a week and that 65% reported making newfriends at their Agestrong groups. Half of those surveyed saidthey had made contact with fellow participants outside grouptimes and that they felt more a part of the community. Fifteen per cent of the participants were over 85 years old.

We have begun referring patients who are finishing rehabilitation totheir nearest Agestrong program. When people leave rehabilitationwithout some sort of follow up exercise routine, the benefits ofrehabilitation can quickly be lost. Agestrong provides a friendly socialnetwork to encourage participants to continue their fitness routines.

Our focus on maintaining fitness after rehabilitation led to oursetting up a ‘Staying Stronger for Longer’ program this year inconjunction with the Mornington Peninsula Shire.

Quality Culture


ON THE MOVEResearch done byMonash University showsthat when older peopleexercise they becomestronger, their balanceimproves and they reducetheir risk of falls. If theydo fall, people who are fitare less likely to sustainan injury So in addition toFalls Prevention Clinicsand Agestrong exerciseprograms, our staff haveintroduced optional exercise sessions for patientsin our Mount Eliza facilities and for residents inour nursing home and hostel in Rosebud.

PENINSULA HEALTH REACHES OUTThis year our Residential Outreach SupportService will work with our Falls Prevention Serviceto offer training programs for staff from nursinghomes and hostels throughout the community.These facilitators will then teach their co-workershow to assess falls risk in their residents. Theteam will also conduct falls assessments for theaged care residents they visit.

SPREADING THE WORDPeninsula Health has been a leader in FallsPrevention for nearly a decade. Our staff begandeveloping a Falls Risk Assessment Tool andstrategies to prevent falls during the 1990s. Theresulting FRAT PACK is a program that any healthservice could use to reduce falls in its facilities.And the word has spread.

With recognition by the Victorian Quality Counciland the Australian Quality Council Best PracticeGuidelines, over 500 FRAT PACKS have beendistributed nationally since 2000. Of the 50requests for falls prevention information wereceived last year, four were from overseas.

SHOPPING FOR HEALTHOur health walks at Karingal Hub ShoppingCentre, which we featured in our 2003 Report,are now five years old and going strong.Peninsula Health and the Centre Managementcoordinate an early morning walking andexercise program for the public, with facilitiesmade available before stores open. PeninsulaHealth volunteers and walk leaders ensure thatolder people and those with disabilities have asafe, supervised walking experience. Theprogram averages 220 participants each week,and 88% of participants report improvement inoverall health and fitness. The City of Caseyrecently began their own walking programmodelled on our Karingal Hub Walks.


SOLID

Through Clinical Governance we ensure thathigh standards are maintained, services arecontinually improved, resources are usedresponsibly, performance is reported openly and consumers are consulted.

The Quality and Clinical GovernanceCommittee is the central point of our ClinicalGovernance structure. The information from allaspects of our Clinical Governance Frameworkflows into this committee. Its members reviewand evaluate Peninsula Health’s overallperformance on quality and safety. Four BoardDirectors serve on this committee, along withthe Chief Executive, Executive Directors andSenior Managers. A community representative is a fulltime member of the committee.

Within the framework, we drive qualityand safety through:

• Monitoring performance against targets• Collecting and analysing data• Identifying and responding to problems

and mistakes• Taking steps to reduce risks• Making sure staff are qualified and

experienced.

Like bricks in a wall, all these aspects of Clinical Governance are joined to build a solidfoundation for our Quality and Safety Culture

At Peninsula Health we work to provideyou with – the RIGHT service at theRIGHT time by the RIGHT person in aSAFE environment.

To do this, we need a Quality and Safety Framework.

THIS FRAMEWORK IS CALLEDCLINICAL GOVERNANCE.

CONSUMER CONSULTATIONWe involve our community in review and decisionmaking processes. The members of our threeConsumer Advisory Committees and the consumerconsultants in our Psychiatric Service help us toimprove services. As well, communityrepresentatives serve on our Research and EthicsCommittee and our Quality and ClinicalGovernance Committee. Demonstrating ouremphasis on consumer consultation, we have thisyear appointed an Executive Director responsiblefor Community Participation.

CLINICAL PATHWAYSClinical Pathways are treatment plans for aparticular disease or procedure. They outline eachstep in a patient’s care from admission todischarge. The plans are developed by clinicalstaff after reviewing current worldwide researchand recommendations and are updated every oneto two years. In many cases, health consumersfrom the community provide a ‘patientperspective’ on the Pathways. Peninsula Healthmonitors the use of these pathways and analysesany deviations (Variances) from the plan.

MORTALITY REVIEWSStaff and Senior Clinicians review deaths in ourfacilities and in other health services to identifyways in which Peninsula Health can make patientcare safer. This year, for example, a seriousincident in our emergency services led to theexpansion of resuscitation training for clinical staff.During 2004/05 there were 1,076 deaths acrossPeninsula Health. Of these, 144 were declaredunexpected and were reported to the Coroner.

FOUNDATIONS

Collecting and Analysing Data

Solid Foundations


KEY PERFORMANCE INDICATORSOur Key Performance Indicators are the ‘vital signs’of our performance. Like blood pressure,temperature and oxygen levels indicate how apatient is progressing, the data we collect onquality and safety issues shows how we areperforming against targets. These issues includethe cleanliness of our facilities, how quickly werespond to complaints, how many patients havedeveloped pressure sores, how many of ourpatients suffer falls while in our care and numerousother indicators. Statistics on these and many otherissues are reviewed by the Quality and ClinicalGovernance Committee at every meeting. With thisinformation we can spot problems, identify whatworks and what does not and put safeguards inplace to minimise risks.

ACCREDITATIONIndependent national accrediting agencies arecalled on to examine healthcare organisationsand to judge performance against nationalstandards in delivering quality, safe healthservices. Peninsula Health seeks and consistentlyreceives accreditation for all its services.

BENCHMARKING It is not enough that we think we are doing well.To ensure top quality we need to compare ourperformance against established national andinternational standards and against theperformance of other health services. This iscalled ‘benchmarking’. Benchmarking helps usand the government agencies that fund us todetermine how well we are meeting goals.

LEGAL COMPLIANCETo keep the public safe, there are laws, standards andpolicies for most aspects of health care. PeninsulaHealth has a thorough, service-wide program toensure we are complying with all this legislation.Compliance against the laws is monitored by 24Compliance Officers across the system. Theymeasure and record how well we are complying withlegislative requirements and with Peninsula Health’skey policies. The system at Peninsula Health has beenadopted by other health services in Victoria and wascommended by the Australian Council on HealthcareStandards (national accrediting body).

SENTINEL EVENT MONITORINGA Sentinel Event is a very serious incident, such asgiving a patient the wrong type of blood or a fatalpatient fall. Health services throughout Victoria reportall Sentinel Events to the Department of HumanServices, which looks for common factors or trends.From this information action plans are developed tominimise the risk of the same things happeningagain. Guidelines are issued to help health providersmanage risks better. This year Peninsula Healthmade five reports to the Department of HumanServices for the Sentinel Event Program. Of these,four related to actual patient incidents and one was a‘near miss’. Investigation of these events resulted inchanges to our systems and processes such as:

• the development of guidelines for themanagement of patients taking anti-clottingmedication who experience a fall

• the systematic improvement in the waypathology results are reported electronically.

Identifying and Responding to

Problems or Mistakes

Monitoring performance against Targets


Clinical Risk Management (also called Patient Safety)Any activity in which people’s lives are at stake isinherently risky. There are countless potential hazardsin health care, covering every level of risk from minorinconvenience to life-threatening scenarios. In a Qualityand Safety Culture, staff are constantly on the look outfor risk and quick to work out ways to reduce it. To dothat, health providers must work in an environment thatemphasises prevention, not punishment. And theremust be formal processes through which risks areidentified, recorded and investigated.

CredentialingAt Peninsula Health we minimise the risk of hiringunqualified staff by thoroughly checking the skills,qualifications and experience of our doctors. Thisprocess is referred to as Credentialing. This year we have improved our credentialing andappointment process through working to a new National Standard issued in 2004.(See “Could it Happen Here? next page.)

STAGE ONE – APPLICATIONAt Peninsula Health all our senior doctors mustbe registered with the Medical Practitioners Boardof Victoria. They must also have their ProviderNumber from the Health Insurance Commission.And we expect them to be Fellows (members) inGood Standing with their respective specialistCollege (e.g. the Australian College of Surgeons).These criteria ensure that doctors’ qualificationsand training have been reviewed and that there areno unresolved complaints against them.

When a new senior doctor applies to work atPeninsula Health, our Executive Director of MedicalServices and our Clinical Directors reconfirm thesequalifications and training and contact referees andformer employers.

In addition, the doctor is requested to list the typesof procedures he or she wishes to undertake. Thedoctors’ skills and experience is matched againstthis request before the doctor is permitted toperform the listed procedures.

Media reports about medical incompetence are chilling.Everyone wonders, could my hospital let unqualifiedpeople work on me?

Since your hospital is part of Peninsula Health, thechances of that happening are extremely small.

While even the most experienced and skilled doctor canmake a mistake, the hiring of people not qualified orcompetent for their jobs should not happen here.

We are pleased to welcome new doctors to our staff, butonly after they have passed a rigorous screening process.

Could it happen here?

YEAR

2004/05

2003/04

2002/03

INCIDENTSREPORTED

3,708

3,057

2,143

% INVOLVING MINIMAL OR NO HARM

93%

94%

91%

Taking Steps to Reduce Risks

Making Sure Staff are Qualified

and Experienced

As reporting of incidents is a voluntary process, it isa good sign when the number of reports increases.This shows that staff are alert to risks, that they workin a No Blame culture and that they areencouraged to contribute to risk management.

Battle PlansHealth officials around the world are saying thata serious pandemic is inevitable. They predictthat some type of virus, probably a flu, willspread out of control and kill millions.

Many people thought SARS (Severe AcuteRespiratory Syndrome) might be the one. But asthe disease began causing deaths in Asia, healthproviders worldwide set plans in motion to stopSARS spreading. Fortunately this cooperationamong the nations contained the virus.

Peninsula Health responded to the SARSoutbreak in 2002/03 and is well into planning for a future flu pandemic. This year, working fromstate and national pandemic plans, we havedeveloped our response at the local level. Theplan specifies what we should do at each stageof a pandemic and nominates the people andteams responsible for each action.

Our plan also includes Clinical ManagementGuidelines for the medical and nursing staff who would be on the front lines. We have addeda section on resource management, addressingissues like employee immunisation, how toaccess and use protective equipment and thelocation of isolation rooms within the hospital.

Our pandemic plan also includes theappointment of a Flu Pandemic MonitoringGroup. This committee would coordinate themany elements of Peninsula Health’s role in such a scenario.

While we hope we never have to put this planinto action, we know that being prepared is thebest way that we can protect our community inthe event of a worldwide influenza outbreak.

FAST FACT The worldwide SpanishFlu pandemic of 1918/19 hit Australiain January 1919, showing up first inMelbourne. By November of that year,12,972 cases of flu had been reportedin Victoria, and 803 Victorians haddied. Overall, Australia lost 12,000people in this pandemic.

Solid Foundations


STAGE TWO – INTERVIEWIf applicants are found suitable, they are grantedan interview with our Senior Medical StaffAppointments Committee. This is chaired by ourChief Executive and includes Executive Directors,Clinical Directors and other very senior medical andnon-medical staff. Recommendations from thiscommittee go to the Board of Directors, the onlygroup that can approve appointment.

STAGE THREE – APPOINTMENTIf a doctor is offered formal appointment, he or shewill have a probationary period of employment fortwelve months in order to ensure that the doctor’sperformance is satisfactory.

CONTINUOUS MONITORINGEvery year all our doctors must be re-registered withthe Medical Practitioners Board. We ALWAYS checkwhether this has been completed.

If, for any reason a doctor begins performing poorly,our Clinical Governance systems will detect it.Substandard performance will show up in regularperformance appraisal meetings, in incident reports,risk management activity, audits of clinical pathways,mortality reviews, sentinel event monitoring,accreditation, complaints and other elements of ourvigorous Clinical Governance.

Throughout our staff appointment processes, patientsafety is our first priority.

So as a consumer served by Peninsula Health, youcan be assured that the right steps have been takento appoint the clinicians who will care for you.

Traditionally, a medical specialist – as opposed toa surgeon – cares for ill patients using non-surgicaltechniques. But today that distinction has softenedconsiderably. In fact, you could say that Physiciansand Surgeons work ‘hand in glove’.

A Physician will insert a stent, a device used to open upa blocked artery around a heart. A Surgeon will performbypass surgery if a stent is not enough.

A Physician will examine the digestive tract with aflexible tube and camera (endoscopy) to make adiagnosis. A Surgeon will remove a gallbladder.

Our Division of Medicine works in closecollaboration with our Surgical Services, as it doeswith all the services across Peninsula Health.

Last year our Division of Medicine treated 24,168patients for everything from asthma to zootoxin(snake or spider bite).

All these patients received care from highly skilledspecialists in the many fields of medicine. Ourmedical specialists, in turn, worked closely withnurses, therapists, support staff and doctors fromother services to help sick people to recover andget on with their lives.

We present for your inspection our PeninsulaHealth Medicine and Critical Care Service.

MEDICINEGood

SO GLAD IMETYOU


Keeping conditionsfrom becoming critical‘So glad I MET you’ is what patients might say ifthey have needed the services of our MedicalEmergency Team (MET).

The Team includes a doctor and nurse from theIntensive Care Unit who respond immediately toany ‘MET call’. Nurses on the wards will call theteam if one of their patients begins to deteriorateto a serious level where a cardiac arrest or otherlife threatening event is possible.

MET clinicians quickly evaluate the situation andbegin the necessary steps to prevent furtherdecline. The patient might be transferred to the ICUor Coronary Care Unit (CCU). Usually, they are ableto stay on the ward with a new care plan.

During 2004 Frankston Hospital had 220 METcalls. Many of these helped to prevent cardiacarrest and even death.

By responding to changes before they reach crisispoint, we can protect patients from cardiac arrest,heart attack or stroke while keeping more ICU bedsavailable for those who are critically ill.

Good Medicine


A few definitions first . . .People preparing to be doctors spend six yearsstudying medicine at university with some hospital-based training. During this time they are referred toas Medical Students.

When they graduate from Medical School, they aredoctors ready for supervised training in a hospital.

For their first year of training they are calledInterns. When they have finished their Interntraining, they complete two or more years ofincreasingly independent hospital work. For theseyears they are called Hospital Medical Officers.

If doctors wish to go on to a specialty rather than to take up General Practice, they continue theirhospital-based training as Registrars. This phaseof their training can continue for several yearsdepending on the specialty. On successfulcompletion of their Registrar training, they arequalified as Surgeons, Physicians, Psychiatrists,Pathologists or one of many other specialist doctors.

MATTERS OF THE HEARTSHARING CARDIAC TRAINING

Because Peninsula Health treats a very large numberof people with heart problems and performs a widerange of cardiac tests, we offer an exceptionaltraining opportunity for young doctors. Both the AlfredHospital and St Vincent’s Hospital send theirAdvanced Trainees (Registrars) to Peninsula Healthfor rotations in Cardiology.

Medical Education has ahigh profile at PeninsulaHealth. Our Medicine andCritical Care Service isactive in the educationand training of doctors.

MedicalEDUCATION

SPECIALIST STUDIESWORKING TOGETHER TO PREPARE PHYSICIANS

Peninsula Health and the Alfred Hospital share anexclusive partnership.

The two agencies collaborate in the final stages oftraining for their respective Medical Registrars. Theseadvanced trainee doctors are preparing for exams tobecome Specialist Physicians.

As part of this preparation the Registrars work ineach other’s wards and are evaluated by seniordoctors from both hospitals. As well, theyare given practice exams by eachhospital’s SpecialistPhysicians.

This alliance expands thetraining opportunities andexpert guidance that will contribute tothese doctors becoming outstandingSpecialist Physicians.


The stories that follow detail some specificactivities for medical training in our Division of Medicine:

WARD TRAININGINTERN WARD ROUNDS

Interns are brand new doctors – just graduatedfrom their medical studies at university. Up to nowtheir education has been mostly theoretical – theyhave not had much direct contact with patients.

To give our interns more opportunity to learn in award setting, our Medicine and Critical CareService has established Intern Ward Rounds.During these rounds a Senior Physician andInterns discuss conditions and treatment optionsfor medical patients on the wards. We find thatpatients are usually keen to contribute to thetraining of these new doctors.

CLEARLY EVIDENTPROMOTING SKILLS FOR EVIDENCE-BASED MEDICINE

Since the 1990s, the entire world has become our library.

With the advent of the Internet we can findinformation on virtually any topic, any time, fromanywhere. Ask Google to find you something onhigh fibre foods and you will be offered 54,300sources of information. This overwhelming arrayincludes everything from nutritionalrecommendations by the World Health Organisationto musings on Aunt Sadie’s personal relationshipwith bran.

It is not a simple task to find and use onlineinformation and to judge which material is reliable.

FINAL DECISIONS DOCTORS LEARN ABOUT END OF LIFE DECISION MAKING

Most people plan for retirement, but few of us give any thought to the decisions that often need to be madeat the end of their lives.

Who will look after your best interests if you are unable to communicate? Do you want to be resuscitated ifyou already have a terminal illness? What measures do you want used to battle a life-threatening conditionand for how long should the doctors use them?

Awareness of these and other end-of-life issues is the focus of surveys by our Director of Medicine,Associate Professor David Langton, who found that there is little understanding of these matters outside thehospital setting. So he has begun using his study results to conduct education programs for medical staffand General Practitioners.

This is an even more crucial issue for doctors, whoare accessing data that will impact on someone’shealth. Learning to use rapidly advancinginformation technology is a skill that doctors did notneed fifty years ago, because many of the tools didnot even exist.

Teaching medical students and doctors how to usethese new research opportunities is part ofPeninsula Health’s medical training programs. OurDeputy Director of Medicine teaches a regularcourse in Evidence-based Medicine to third yearmedical students. And we recently hosted a GrandRound in which Professor Don Campbell, Directorof the Monash Institute of Health ServicesResearch, worked with Hospital Medical Officersand Physicians on how to find and judge data onthe Information Superhighway.

This year Peninsula Health has successfullyrecruited 24 interns, compared with 20 last yearand 16 the year before.

Good Medicine


ICU Ward Round

CRITICAL CARESAVING MORE LIVES

Patients only come to our Intensive Care Unit (ICU) ifthey are gravely ill. They are often too sick to breatheon their own. They require 24 hour one-to-onenursing care. And their conditions are so critical andcomplex that there are always doctors stationed inthe ward.

Sadly, despite the comprehensive treatment and carethey receive, some patients are too ill to survive.

Much research has been done worldwide onIntensive Care and ICU patient outcomes. TheAustralia and New Zealand Intensive Care Society(ANZICS) maintains a massive database on survivalrates of ICU patients throughout both countries. Unitssend information on patients’ conditions when theyare admitted and when they discharged. Thisinformation can be used to identify practices andprocedures that save more lives.

ANZICS has developed research programs thatpredict patient outcomes based on their condition onadmission.

During this year the patient outcomes formetropolitan, private and rural hospitals were veryclose to those predicted by the ANZICS program. Butin our ICU, the survival rate of our critically ill patientswas much higher than statistically expected.

Mortality review figures like these contribute to ourresearch on the most effective medical interventionsfor critically ill patients.

Last year Peninsula Health, supported by theDepartment of Human Services and the Pink LadiesAuxiliary, invested $800,000 in monitors,defibrillators and other lifesaving equipment for ourIntensive Care Unit.

SPECIALIST MEDICINE MOVES IN AT ROSEBUD HOSPITALA single new service at Rosebud Hospital has had a positive impact on patient care for thecommunity on the Southern part of theMornington Peninsula.

In December 2004 we established a GeneralMedical Unit at Rosebud Hospital. SpecialistPhysicians and a senior medical officer makeregular rounds in the unit and meet with nursingand allied health staff. By having this medicalexpertise and management on site, RosebudHospital can now treat complex medicalconditions such as pancreatitis, unstable diabetes or epilepsy.

Previously these patients had to be treated atFrankston Hospital.

The new unit –

• can admit medical patients directly from theRosebud Emergency Department, eliminatingthe need to transport them to Frankston;

• reduces the demand on both admissions andemergency services at Frankston Hospital;

MedicalDEVELOPMENTS


NET RESULTS – Get the Best Results When YouUse the Internet While medical professionals need complexskills to use information technology in theirwork, there are some simple tips for those ofyou browsing the Internet for good healthideas. According to our Medicine and CriticalCare service you should –

See if the site lists its source. If not, it is apretty good indication the material could bemumbo-jumbo.

Look for information put out by governmentagencies and other respected organisations.Data put out by private companies or groupsmight be distorted to make a point or sell aproduct.

Check when the site was last updated. Theinformation on the site could be too old to be valid.

Give preference to links listed on reliablesites. Most respected organisationswould never knowingly recommend adodgy source.

Check with your GP beforeimplementing any major diet,exercise or other health programyou find on the Internet.

• enables patients who live on theSouthern Peninsula to be closer to homewhen they need hospital care for amedical condition;

• eliminates the drive to Frankston forpatients’ families;

• makes better use of RosebudHospital facilities.

By the end of June, the new unithad treated 637 patients.

BANKING ON OUR DOCTORSOUR NEW MEDICAL OFFICERS BANK

Doctors get sick...and go on vacation... and have family emergencies. Like all of us, there are days whenthey just cannot get to work.

When that happens, we have to find qualified doctors to fill in their shifts.In the past we have primarily called on commercial staffing agencies for replacement staff, but this hadseveral drawbacks, including the fact that the relief doctors were not familiar with their place of work.

So in December 2004 we created our own bank of relieving doctors, called the Medical Officers Bank. Withinsix months we had registered 125 doctors and reduced our use of agency bookings from over 1000 hours amonth to zero hours.

Figures to date indicate that not only will we have the staffing options we want, but working this way has the potential to save $270,000 a year.

Good Medicine



For most people being sick is a miserable – but short term – plight.

A week with sinuses that feel like they weigh sixkilos. . . maybe a tormenting cough that hangsaround for a month . . . but then it is over, and lifeis back to normal.

For people with chronic conditions,however, their disease IS normal life.A chronic illness is a condition that is usually not curable.It must be managed for many years or for a lifetime. Suchconditions include diabetes, serious breathing problems,certain heart conditions, some addictions and other long-term disorders.

In order to stay as healthy as possible and lead a normallife, people with these illnesses need to know how to keeptheir conditions in check. This might involve regularmonitoring, medication regimens, special diets or exerciseprograms and medical support. It can include treatmentsand routines that must be incorporated into daily activity.

If actively managed, chronic conditions can be well-controlled. Even though they may never be ‘over’ – like about of flu or an inflamed gallbladder – these conditions donot need to stop people from having productive andpleasurable lives.

But poorly managed, these chronic conditions can causedistress and debilitation, and send sufferers to hospital overand over again. Difficulty breathing, blocked circulation,altered consciousness and other painful and frightening

FAST FACT The Departmentof Human Services hasdeveloped guidelines on thedelivery of complex care for allVictorian health services.These guidelines are modelledon the type of program beingprovided by Peninsula Health.

CONNECTIONSCaring

symptoms bring these patients to theEmergency Department time after time.

Peninsula Health’s Complex Care Programis helping people to manage their chronicconditions and to reduce the need forhospitalisation. This improves the lives ofclients* and their families and reduces thedemands on healthcare resources.

*In this report, we refer to the people weserve through our Complex Care Programas clients of the service.

ROSEBUD (17 CLIENTS)

49% reduction in the number of EmergencyDepartment presentations

60% reduction in the number of Inpatientadmissions

70% reduction in the number of bed days

24% reduction in the average length of stay

Caring connections


COMPLEX CARE PROGRAM PROFILEThe Peninsula Health ComplexCare Program was establishedin April 2004 as part of thestate government’s HospitalAdmission Risk Program. Thestaff provide a hub for a widerange of services to help peoplewith chronic conditions.

THE PROGRAM HAS FIVE STREAMS –

DIABETESuncontrolled diabetes can result in blindness,amputations, heart attacks and kidney failure

CHRONIC HEART FAILUREa condition in which the heart does not pumpforcefully enough

CHRONIC RESPIRATORY CONDITIONSpeople can have breathing problems from severaldifferent disease processes, such as asthma orchronic bronchitis. The resulting shortness of breathcan severely limit activity and decrease quality of life

DRUG AND ALCOHOL PROBLEMSaddictions to and the abuse of drugs and alcoholoften affect all aspects of a person’s life, from familyto finances.

GENERAL COMPLEX NEEDSconditions that bring people into hospital over andover again can also reduce people’s ability to managetheir health and their lives. Their complex needs areaddressed by the Complex Care Team.

FAST FACT Over two years the Chronic HeartFailure stream has supported 280 clients.

The Diabetes stream has supported 128 clientsover the last two years.

Over 440 clients have been supported over twoyears by our Drug and Alcohol Hospital Liaisonstream. When reviewed after 12 months, 83%of these clients had not returned to hospitalwith drug and alcohol issues.

Through the General Complex Care and ChronicRespiratory stream, we have supported 68clients at Frankston and Rosebud Hospitals.

FRANKSTON (51 CLIENTS)

23% reduction in the number of EmergencyDepartment presentations

42% reduction in the number of Inpatientadmissions

57% reduction in the number of bed days

40% reduction in the average length of stay

IMPACT OF COMPLEX CARE ONHOSPITALISATION OF CLIENTSOf 68 Complex Care clients seen during 2004/05,the following results were achieved over a 12 monthperiod.

MORNINGTON PENINSULADIVISION OF GENERALPRACTICEInformation about the Serviceto GPs and the highlighting of key targets in chronic disease management

PENINSULA HEALTHPSYCHIATRIC SERVICEResource for clients and guidance for staff

LOCAL GOVERNMENT AGENCIES(such as the City of Frankston andthe Mornington Peninsula Shire)Services for clients including carerrespite, household help, Meals onWheels, etc

CHARITABLE ORGANISATIONS(Such as The Brotherhood of St Laurence and St Vincent dePaul) Resources for clients

DEPARTMENT OF HUMANSERVICESIdentification of service gaps,Funding

UNIVERSITIESAssessment Tools,Formal Program Evaluation

COMMUNITY REHABILITATIONCENTRESPrograms for clients such asPulmonary Rehabilitation

The following chart lists some of thepartners who help us to provide servicesfor people with complex care issues.


COMPLEX CARE & PARTNERS

Podiatryfoot care and

treatment

PulmonaryBreathing/

lungs

EMERGENCYDEPARTMENT/RESPONSEASSESSMENT AND DISCHARGE TEAMReferral of clients, Screening and Assessment

COMMUNITY HEALTHSERVICESServices for clients such asPodiatry,Counselling, Drug &Alcohol Services

GENERAL PRACTITIONERSCare planning, Medical advice

Complex Care Program Team

Identifying people with complex needsFrequent admissions to the Emergency Department alert us to a patient’s likely need for Complex Careservices. The following conditions are the primary reasons that these patients present to the ED.

Complex Care Coordinator,Jill Gurney has responsibility for 18 clients.

There is scarcely a spare minute in Jill’s day – but she wouldn’t have it any other way. “I love myjob,” she says. “I have never once wanted to leave this work.”

To learn why Jill is so passionate about her role as Complex Care Coordinator, we look at a typicalday and meet some of the people she helps (see next page).

Complex Care Clients who donot fit one of the precedingcategories can present to EDwith any of the following conditions:Abdominal painChest painBackacheEffects from toxic substancesShortness of breathSeizureBackache or joint painMigraineGeneral complex conditions

Drug and Alcohol problemscause clients to present with:IntoxicationSeizuresAbdominal painOverdoseSuicidal behaviour

Clients with Diabetes come to the Emergency Department with:Blood sugar too high(hyperglycaemia)Blood sugar too low(hypoglycaemia)Nausea and vomitingInsulin overdose

WARNING SIGNS . . .WARNING SIGNS . . .People who have ChronicHeart Failure may come tohospital with one or moreof these symptoms:Shortness of breathChest painIrregular heartbeatFalls

Those with ChronicRespiratory Conditionsusually present with:Shortness of breathAsthmaChest painChest infection

Caring Connections


Jill’s Day


Caring connections


Retinopathybleeding in blood vessels of the eyes - can lead

to blindness

COPDChronic Obstructive Pulmonary

Disease (breathing)

Lanoxin and Lasixmedications often used by patients with Chronic

Heart Failure

UR numbera patient’s medical

record number


For years Karen Chesterfield looked afterpeople with disabilities. Now she strugglesevery day with a disability of her own.

Case Study:

The Chesterfields

Caring connections


A home accidentleft Karen, 34, with a severe back injury. In the year following the accident, she was in FrankstonHospital 18 times, either in the EmergencyDepartment or in a hospital bed. After severaloperations and rehabilitation, Karen will still gothrough life with a ‘bad back’ and currentlyrequires daily medication for pain.

She had to give up the job she loved, working in aprivate nursing home as a Personal CareAttendant. Her husband Tim became her carer and,with looking after Karen seven days a week, hewas only able to work part time outside the home.He also had to give up his university studies inChristian Ministry.

Their financial situation deteriorated. They had togive up many of the activities they had alwaysenjoyed because going out was difficult bothfinancially and physically.

At home, simple activities suddenly requiredstrategic planning. Showering, getting in and out of bed, sleeping, even sitting in a chair was achallenge. Additional problems arose from themedications Karen took to cope with the constant pain.

The scope of their problems was bewildering anddepressing, and neither Karen nor Tim knew whereto find the services they now needed.

Then Jill rang.Upon learning of Karen’s numerous trips tohospital, Complex Care Coordinator Jill Gurneycontacted the couple to offer help. Since her firstassessment visit, Jill has met with Karen and Timeight times.

Jill and the Chesterfields agreed that there werethree main issues they wanted to focus on – painmanagement for Karen, counselling for thedepression Karen and Tim were both experiencingand assistance with financial difficulties.

Jill liaised with their GP, consulting him on Karen’scare plan. “He was part of our team,” says Jill.Through the GP, Karen was referred to a painmanagement specialist.

Jill arranged for a number of home modificationsand aids to help Karen reduce her pain andincrease her independence. These included railsand other supports for the bathroom and bedroom,a walker, a wheelchair and a special orthopaedicchair that would let Karen sit more comfortably.

Counselling was arranged in May for both Karenand Tim, and the couple continue to use theservice.

Jill contacted Veteran’s Affairs regarding pensionoptions for Karen and Tim. She also dealt with theMinistry of Housing regarding an application forspecial housing for people with disabilities. Bothapplications are still in the process of beingassessed.

Through the Brotherhood of St Laurence, Jillarranged for Karen’s application to Linkages, aCommonwealth program that provides packages ofcare such as housecleaning or shopping assistancefor people with disabilities.

A half price taxi voucher was organised with thehelp of Karen’s GP and she is about to begin theBetter Health Self Management Program run by theComplex Care team.

Now things are looking up for both Karen and Tim.Tim has a little more time for his church work andthe many home chores he took over from Karen.He was also invited by Jill to join the FrankstonCommunity Advocacy Project which provides thepublic with a chance to be heard on various issues.Tim is now a member and is contributing acarer/consumer perspective.

Karen is managing better at home using herwalker and wheelchair. And she has not been back to hospital even once since April.

“My outlook on life has improved a lot,” saysKaren, “especially since I can function better athome.” She hopes eventually to be able to resumeher career on light duties and in a part timecapacity.

Karen and Tim know that there are battles still tobe fought, but they are more confident they canmeet the challenges now that the Complex CareTeam is in their corner.


FAREFAMILYFAMILYWOMEN’S, CHILDREN’S AND ADOLESCENT HEALTH SERVICES

During 2004/05 Peninsula Health helped to welcome

Frankston Hospital

2,196 tiny Australians

1,023 Boys911 Girls

Rosebud Hospital

148 Boys114 Girls

Family Fare


• A comprehensive service for the care of pregnant women,birthing support and follow upcare for mums and babes, thetreatment of premature or illinfants and health care forchildren and adolescents

• Prenatal assistance to pregnantwomen with special needs,including women with chemicaldependencies

• Special mother, baby and familyservices, including breastfeedingsupport, grandparenting groups,

referral to communityagencies, home visits followingbirth and Family Birthing

• Treatment, care and educationfor families with specialproblems, including postnatal depression and infantfeeding and sleepingproblems

• Medical and surgicaltreatment of gynaecologicalconditions (health issuesaffecting women).

A snapshot

• Specially tailored educationand preparation for the wholefamily

• Focus on natural, active andintervention-free birth

• Going home within 24 hours of giving birth.

From August 2004 to June 2005,32 women had their babies usingthis option. Another 22 womenoriginally chose Family Birthing buteither decided on another birthingoption or developed medical orobstetric complications thatrequired a different kind of care.

of our Women’s, Children’s andAdolescent Health Services:

ALL IN THE FAMILYFamily Birthing gains fans

In last year’s report we introduced a new program of Family BirthingCare at Frankston Hospital. TheFamily Birthing option involved:

• Family participation in providingsupport for birth

• Midwife care

Comments by women whochose Family Birth Care –

“We had both our mothers in . .. (they) loved being a part oftheir grandson’s birth.”

“My husband was impressedwith how easygoing everyonewas and (how they) helped himto be included and at ease.”

“I enjoyed the experience of thefamily all taking part in the birth– we will always remember it asa positive experience.”

“Really appreciated the respectgiven to what I wanted.”


The risk level is the most important factor indetermining the birthing option and location for the delivery of a baby.

Low risk pregnancies can be cared for at a facilitylike our Rosebud Hospital, where midwives and/ordoctors provide women with a birthing experiencerequiring very little intervention. The criteria for thisservice were designed with the help of consumersfrom the local community. During the developmentof the Rosebud Hospital’s Obstetric Model of Care,staff also worked closely with the Victorian MaternityCoalition Advisory Board.

Women wanting epidural pain relief or those whomay need a medical intervention will be referred toFrankston Hospital. At Frankston there is a 24-hourAnaesthetic Service and a Level Two Special CareNursery.

If a woman has serious health problems such askidney failure or heart disease, she will probably bereferred to a Level Three facility, such as MonashMedical Centre or the Royal Women’s Hospital. If herlabour starts at less than 34 weeks, she also needsa Level Three facility.

The obvious ‘glitch’ in the process is when a woman with few if any risk factors suddenly findsherself in very early labour or with a seriouscomplication. She could need a more complex levelof care in a hurry!

Our Professor/Director of Women’s Children’s andAdolescent Health, Professor Bob Burrows, recentlyserved on a Department of Human Servicestaskforce on this issue. The group is establishing areferral service that can handle all the organisationaldetails when a patient needs to go to a hospital witha Level 2 or 3 obstetric service. Her care team willhave their hands full getting her stabilised and ready to transfer. The new service would make allthe appropriate phone calls, find available beds,organise receiving care teams and arrange transport.

By March 2005 all our midwives wereaccredited to do ‘well baby checks’ ondischarge. This reduces the time that afamily has to wait to leave hospital andtake the newest member home.

Gauging Birthing RisksAlthough birth is a natural process, there arethings that can go wrong.

For centuries, women who developed seriouscomplications before or during the birthing processoften died. Thankfully, a mother dying during birth isa rare occurrence these days.

Part of this is due to antenatal risk assessment.This means that the doctors and midwives who helpwomen to prepare for giving birth develop a prettygood idea of how much help and special care thewomen are going to need.

For example, a woman is considered to have a lowrisk of complications if she is between 16 and 42years old, is in general good health and has a bodymass index between 18 and 30 prior to pregnancy.(Body Mass Index BMI is a calculation of a person’sweight status, from very underweight to morbidlyobese. An average BMI for a healthy woman is 25.)

If however, the woman has diabetes, is onmedication for high blood pressure, is dependent onillicit drugs or alcohol, has malignant cancer or oneof several other problems, she cannot be consideredlow risk. The chances are just too high that she willneed medical intervention, and her care team wantsto be prepared.

Risk Assessment

Family Fare


GENTLY, GENTLYNew Practices Protect Premature Infants

It is no wonder that babies cry when they are born.

For months they have been cuddled in a soft,warm, quiet place. Suddenly they are being pulledand prodded amid blazing lights and loud noiseswhile they struggle to breathe for the first time.Talk about rough starts!

Luckily, nature has prepared infants for all thechallenges of life on the outside. They have had 40 weeks to fully develop inside Mum, enoughtime for their lungs, brains and other organs togrow strong enough to tackle the world.

Which is why babies that are born early haveproblems. Their tiny bodies have not had a chanceto fully develop, making them more vulnerable tothe stresses of life.

Their ears are more easily damaged by noise.Bright lights can interfere with the development of natural diurnal (day/night) rhythms. Too muchstimulation and handling causes stress that affectsoxygen levels and heart rates. The stress negativelyaffects the development of their brains. It alsokeeps them from the sleep and rest they need to grow.

Long term studies of babies born with very lowbirth weights indicate that they may go on todevelop learning problems, attention disorders,difficulties with language and sight or movementimpairments.

So at Peninsula Health we have introducedDevelopmental Care to our Special Care Nursery.The Nursery provides high dependency care forinfants born up to six weeks early and newbornswith medical problems. The unit treats between450 and 500 infants a year.

Some of the routines now being established in ourNursery include:

• Instituting a daily ‘quiet time’• Reducing light levels• Covering incubator hoods• Removing bubbling water in

oxygen/ventilator tubing• Closing incubator portholes gently (to a baby in

an incubator the sound of a porthole snappingshut can reach 80 decibels, which is loud evenfor an adult!)

• Clustering care regimens (bathing, weighing,etc) to reduce handling times

• Dimming the lights and turning off the radio atnight

• Avoiding routine care at night• Helping parents to learn to interpret stress

behaviour in their infantsFurther international studies have shown that theseinterventions reduce developmental delay, improveweight gain and decrease the length of time thetiny patients spend in hospital.

Now that is a great development.


CHECKING UP ON CHILDBIRTH SKILLSOur maternity services run a special, in-house designedprogram of competency testing for our midwives. In additionto normal recertification requirements, our midwives mustpass yearly exams that evaluate their skills.

Nurse educators run scenarios, especially involvingemergency situations, and assess each midwife’s response.

The Australian Nursing Federation has provided input to ourCompetency Testing, and during our recent AccreditationPeriodic Review, the evaluators commended the program.

Nurse Unit Manager of the SpecialCare Nursery, Dianne Macfarlane,was a member of the Editorial Boardthat put together the manual forDevelopmental Care. The manual isnow used across Victoria.

CAESAREAN SECTIONS - % OF BIRTHSState rate = 19% Frankston Hospital rate = 17%(Women needing Caesarean Section at RosebudHospital are transferred to Frankston)

INDUCTION OF LABOUR - % OF BIRTHSState rate = 22% Frankston Hospital rate = 24%Rosebud Hospital rate = 35% (We expect that new guidelines for low-risk births atRosebud Hospital will reduce this figure in the 2004statistics. See ‘ Risk Assessment’ page 71)

KEY OBSTETRICINDICATORS

WE DELIVERPeninsula Health birthing statisticscompared with Victorian rates

The following chart shows that PeninsulaHealth compares favourably with otherhospitals in four areas – stillbirths,neonatal deaths, Caesarean Sectionsand induction of labour. These fourfactors indicate how a health service isperforming in its maternity services.

STILLBIRTHS PER 1000 BIRTHS

State rate = 8.2Peninsula Health rate = 2.8

NEONATAL DEATHS PER 1000 BIRTHS

State rate = 3.8Peninsula Health rate = 0 .9

Family Fare


PLANNING AHEADFamily planning services

There is a big demand for PeninsulaHealth’s Family Planning Clinic, whichcan handle eight appointments aweek. A General Practitioner andSpecialist Nurse provide a wide rangeof services for women and couples.

• Contraception advice for thosewanting to delay pregnancy

• Advice and assistance forcouples wishing to conceive

• Screening and treatment forsexually transmitted diseases

• Testing for cervical cancer

• Assistance with unplannedpregnancies

• Referral service for IVF (medicalspecialty that assists couplesunable to conceive) and GeneticCounselling for people concernedabout passing on geneticdiseases.

SMOKE OUTMany babies smoke. Even before they are born.

When pregnant women and new parents smoke, their babies aresmoking, too. Whether the harmful poisons from cigarettes comethrough the bloodstream or the lungs, the babies of smokers share inthe damage smoking causes. They are, from conception, passivesmokers.

At birth, babies of smoking mothers are more likely to be underweightand more vulnerable to infections. Their blood, which they share withMum, is full of toxic chemicals. They also get less oxygen and fewernutrients through the umbilical cord, since smoking narrows all of awoman’s blood vessels.

As if that were not enough, statistics show that babies whose motherssmoked during pregnancy have a greater chance of suffering suddeninfant death syndrome (SIDS or ‘cot death’).

After birth, babies in a smoking environment are more likely to developpneumonia, croup and bronchitis and to need admission to hospital. Asthey grow, their chances of getting asthma, ear problems andmeningococcal disease are increased, and their breathing capacity islower than in children of non-smokers.

Long term, a child growing up in a household with smokers is morelikely to develop heart disease and lung cancer.

ASK . . . AND ASK AGAINOur Frankston and RosebudHospitals are strong supportersof QUIT smoking programs andthe Government’s push toreduce smoking in pregnancy.It is now required that maternityhospitals report on how oftenthey ask newly pregnantwomen if they smoke, advisethe women about the dangersand assist women who want tostop. The hospitals must alsorecord how often they repeatthe process for women in their20th week of pregnancy.

Frankston and RosebudHospitals both rank above theaverage for Victorian Hospitals.


TEEN TRIALSHelping teenage mothers

The teen years – time for exploring options, testingabilities, broadening experiences and building selfconfidence. This is the time when young people canmove gradually from childhood to adultresponsibilities.

For pregnant teenagers, however, the transition mustbe a lot quicker. Suddenly they are no longerchildren but the mother of children.

They are going from hamburgers and chips at themall to eating healthy food for two. From theiruntidy, teenage bedroom to a baby’s nursery. Fromfretting over pimples to worrying about colic.

Finances . . . housing . . . education . . . childcare . .. the pressures are tremendous. But as hard as thissituation is, it is made much worse by the stigma of being a teenage mother. It seems that thecommunity sits in judgement at the young woman’scondition, and the verdict is usually negative.

The midwives of Peninsula Health understand thedilemma these young women face. For these healthproviders, the crucial focus is on the health of bothmother and baby. So staff from our Frankston andRosebud Hospitals offer special support andassistance to pregnant women under 20.

Our midwives provide pregnancy care to young,pregnant women through the Youth Resource Centrein Frankston and at Rosebud Hospital.

The midwives enlist the help of dieticians, socialworkers and maternal health nurses to help youngwomen prepare for a safe birth and a healthy baby.They provide pre-birth care and education, help tolink the young women with appropriate communityagencies, work with partners and families and bookthe clients into hospital for the birth.

All this is done in a supportive and non-judgementalmanner so that the young women do not feelthreatened and so that their babies get the bestpossible care.

Following the birth, we continue support programsfor teenage mothers through our Community HealthService.

DEALING WITH ANOREXIAThe Duchess of Windsor is credited with sayingin the 1930s that “you can never be too rich ortoo thin.” Today most of the media is saying thesame thing.

Magazines, films, billboards, music videos,television – they all inundate the community withimages of emaciated people who are said to beboth successful and happy. It is no wonder thatachieving the thinnest possible body can become,for some people, an obsession.

Especially for teenage girls and young women,being fat is a terrifying prospect. One study foundthat teenage girls were more afraid of gainingweight than of cancer or nuclear war. (F. Berg, Afraidto Eat) That is why young women experience themental illness, Anorexia Nervosa, more than anyother group in the population.

Anorexia is an eating disorder characterised bysevere restriction of food intake, loss of bodyweight to an unhealthy level, a distorted bodyimage and an intense fear of getting fat.

But an obsession with thinness can cause havoc ina human body. Just a handful of the serious effectscaused by Anorexia include:

toa body

‘DIE’for

Family Fare


• kidney failure• heart irregularities• muscle wasting• anaemia (iron deficiency)• infertility• reduced concentration and memory.

Some people who suffer from Anorexia do not gethelp in time and actually starve to death.

Our Paediatric Unit has a special program for youngpeople experiencing Anorexia. Sadly, the program isvery busy.

Patients with Anorexia must agree to be treated andare asked to sign a contract to come into hospital.The normal length of stay is two weeks. During thattime the young person receives nursing care,nutritional guidance and individual mental healththerapy.

Patients are expected to eat three meals and threesnacks every day. If they cannot do this, it mightbecome necessary to start naso-gastric feeding(giving liquid nourishment through a tube threadedthrough the nose and into the stomach). Anorexiawill have made these patients very undernourished.Close monitoring of their health status is essential.

Only one patient with Anorexia can be on the wardat any one time. This removes the stress of

competition with others to ‘be the thinnest’. Thepatient must stay in bed resting. She (all ourpatients with Anorexia have been female) can read,watch TV or listen to music, but schoolwork is notallowed. Malnutrition will have affected thesepatients’ ability to think and concentrate, soschoolwork could be too stressful.

She is not allowed to leave the ward for any reasonand visitors are confined to immediate family. Phonecalls are limited to one incoming call a day. As timegoes on, patients are encouraged to expressthemselves through craft, personal diaries and opendiscussion.

The two weeks in hospital is designed to start theseyoung people on the road to recovery. Weeks andeven years can be required for full recovery. Asecond two week stay in the Paediatric Unit isallowed, and if further hospitalisation is needed, thepatient must be referred to a psychiatric service.

This cruel and complex illness is growing andcreeping further into what should be childhood.Recently we had a patient in our Eating DisordersProgram who was only 11 years old.

We have had more successes than failures with thisprogram and have many patients who are stillmaintaining a healthy weight. We are encouragedby their progress and return to normal life.


Family Fare


SPECIAL PROTECTIONCare for Children with Special Needs

Nurses in our Paediatric Unit often feel veryprotective when caring for their patients withspecial needs.

This is not because these children are moresusceptible to infections or are ill more oftenthan other children. They are NOT.

Our staff want to shield these little patientsfrom the reactions that can come from otherpatients and their families.

“Families who do not have a child withspecial needs sometimes find these childrenconfronting,” says Children’s Ward ManagerHelen Hutchins. “Many people are unfamiliarwith conditions such as Downs Syndrome andcan react negatively.”

“We do not want our special kids dealing withrejection on top of being sick.”

Helen and her nursing staff have a longhistory of treating children with special needs.

The Peninsula region has several excellentdevelopmental schools such as NepeanSpecial School and Naranga School forchildren with mild intellectual disabilities.These schools attract families needing theirspecial education, and when these childrenare ill they come to Frankston Hospital. Foryears Helen has worked closely with theseschools, meeting regularly with theiradministrators, teachers and therapists.

Our Paediatric Unit nursing staff are skilled atproviding care and support for these specialneeds children and have earned the trust ofparents throughout the community.

Paediatrics FOR WOMEN ONLYGynaecology Services at Peninsula Health

We have expanded our Gynaecology service over the last two years by:

• re-introducing specialist services at Rosebud Hospital

• augmenting our staffing with two newgynaecological surgeons

• and performing more minor gynaecologicalsurgery in our Day Surgery Unit

In 2003/04 we treated 1,046 women forgynaecological conditions at Frankston and RosebudHospitals and over the last twelve months weprovided treatment and care for another 1,007.

The Department of Human Services has recentlyfunded the Royal Women’s Hospital to take on extragynaecological surgery through the Elective SurgeryAccess Service (see more about this service onpage 32).

Over the next year we will be able to send 20 of thelong-waiting elective surgery patients on ourGynaecology list to the Royal Women’s for theirprocedures. These operations include proceduressuch as hysterectomy, laparoscopy (‘keyhole’surgery for ovarian cysts, sterilisation, etc) andgynaecological repairs.

These places will be offered to patients who havewaited longer than 90 days for their operations.

Gynaecologythe field of

medicine dealingwith the female

reproductive system

Hysterectomyremoval of female

reproductive organs


DEVELOPING SERVICES THROUGH OURCOMMUNITY PARTNERSHIPS Partnerships with our community

are managed by our mostsenior executives, who are

responsible for making sureconsumers have a voice in the careprovided at Peninsula Health.

Consumers are represented at thehighest level on Board committees,including the Community AdvisoryCommittee, the Quality and ClinicalGovernance Committee, theMedication Safety Collaborative andthe Research and Ethics Committee.

Consumers are also active oncommittees working with communityeducation, infection control, agedcare, psychiatry and communityhealth. They are consistentlyinvolved in helping us get feedbackfrom our community.

This year we have appointed one ofour senior executives, Ms ElizabethWilson, Executive Director Nursing,to coordinate and enhance consumerparticipation in all of PeninsulaHealth’s services.

Ms Wilson will be driving our effortsto include consumers in planning,evaluation and decision making atPeninsula Health. She will alsooversee our expanding VolunteerProgram.

We are working to strengthen linkswith our community in several ways.

Communication...

Collaboration...COMMUNITY...

Several individuals and organisations from ourcommunity helped us prepare our 2005 Quality of CareReport. Thanks to Shannon, Liam and Laura Anastasio,Gus de Groot, Marilyn Rowe, Tim and Karen Chesterfield,Louis and Ellen Malan, Frank and Josephine Bonnici,Gavin Carter, George Haddon, the Mornington PeninsulaDivision of General Practice, the Brotherhood of St Laurence,Aboriginal Affairs Victoria, the Royal Flying Doctor Service,On Call Interpreters, PeninsulaHealth Auxiliary groups, ourpatients and their families.

Elizabeth Wilson

Community


GROUPS WITH SPECIAL NEEDSOne component of Ms Wilson’s new portfolio is to workwith consumers who have special needs. She is developingClinical Pathways for people with disabilities.

“As clinicians we get so focused on the medical needs of apatient, we sometimes do not consider how they perceivethe situation,” says Ms Wilson. “For example, when adisabled person comes to the Emergency Department, theircarer is usually asked to leave while the patient isexamined. This is very distressing for most of thesepatients because their carers provide comfort and security.

“A very simple but beneficial policy is to allow carers tostay,” adds Ms Wilson. “We call this a ‘patient friendly’initiative.”

Some other patient friendly initiatives under study include –

• providing sign language or hearing devices for deafwomen watching childbirth videos in antenatal classes.

• putting an alert on the medical record of disabledpatients who come frequently to Emergency.The alert could give a brief summary of the patient’shistory or a note that the parents or partners are veryknowledgeable about care needs. This could save tests,time and frustration for the patients and their families.

• Making our Emergency Department waiting roomsmore user friendly.

HOUSE NUMBERINGCAMPAIGNFor example, two years ago our Southerngroup initiated a project to gethomeowners on the Southern Peninsula tomake their house numbers more visible incase an ambulance needed to find them.The Committee sent out noticesexplaining how important this was andused the media to spread the message.The group is currently working alongsideAustralia Post to notify Shire residents oflocal government regulations regardingthe numbering of houses.

KITCHEN GARDEN PROJECTPeninsula Health Community Advisory Committeemember, Ms Shannon Anastasio, is working with the staffand students of Mount Eliza Primary School on an excitingproject for grades two and three. The children will plantand tend a vegetable garden on school grounds, givingthem hands-on experience with fresh foods. It is hopedthat harvesting their garden for cooking into tasty disheswill encourage them to eat more vegetables. Parents, too,can participate in discussions with a dietician about theirchildren’s eating habits and ways to improve nutrition.A student-published cook book is being developed.The Kitchen Garden Project, which was launched on May 11th, is also supported by local businesses.

COMMUNITY ADVISORYCOMMITTEES We have enhanced our CommunityAdvisory Committees during the past year.We appointed additional members andnow have 25 people from the communitywho bring us ideas, feedback and newperspectives. Our three committees coverPeninsula Health’s geographical area withmembers coming from 11 differentsuburbs in our service area. Thecommittee members help us to evaluateprojects and often suggest new ones.


‘HUG A BUB’aims to train carefullyselected volunteers who, withparents’ permission, wouldrock and cuddle restlessinfants in our MaternityServices. According to MarilynRowe, the CAC memberdriving the project, “The‘grandmotherly’ volunteers werecruit would comfort our tinypatients, afford staffmore time for theirclinical work andgive new mumsmore chancesto rest.”

INVITING VIEWPOINTS . . .Creating links with communitygroups, service clubs, schools andother organisations is an importantpart of Ms Wilson’s role. We wantour community participation to beinclusive, so that we get feedbackand suggestions from as manypeople as possible.

. . . AND GETTING OURMESSAGES OUT TO THECOMMUNITY

These links will also help us todistribute information about healthcare issues to a wider audience.Recently we held a public forum onways in which people can participatemore actively in their health care.Experts advised a number of stepspeople can take such as asking theirdoctors more questions, being sureall directions for taking theirmedications are well understood andlearning what will happen during anoperation or other procedure. Forumslike this encourage consumers tohave more SAY in their health care.

‘TWILIGHT TIME’volunteers would providecompanionship anddistraction for our clientswith dementia. Dusk is thetime when these clientsoften become restless andagitated. Volunteerswould come eachday at dusk to read to residents, walk andtalk with them, playboard games or othercalming activities.

REDCROSSvolunteerswill soon besupporting ourbusy EmergencyDepartment staff. Detailsare being finalised on theproject in which volunteersfrom the Australian RedCross will assist in thewaiting rooms of ourEmergency Departments.

COMMUNITYPARTICIPATION PLANMembers of the CommunityAdvisory Committees, otherconsumers and some staffparticipated in a workshopon 25 August 2005 todevelop a CommunityParticipation Plan forPeninsula Health. We willreport on the plan andactions taken in our nextQuality of Care Report.

Focus groups are currently helping us todevelop several new volunteer projects.

Volunteers as part of

Care Teamthe

Community


1. You would be most likely to develop a pressure ulcer by

a) eating spicy foodb) being in bed for two weeks with pneumoniac) trying to meet a deadline at the office

2. According to the Victorian Quality Councilthe six Dimensions of Quality are

a) Safety, Access, Effectiveness, Acceptability,Appropriateness and Efficiency

b) Physical inactivity, high blood pressure, obesity,smoking, poor diet, high cholesterol and alcohol

c) GPs, Registrars, HMOs, Interns, Nurses andPhysiotherapists

3. Which of the following groups wouldbenefit from No Lift Training

a) health workers who care for bedridden patientsb) people with phobias about closed in spacesc) hitch-hikers

4. A discharge summarya) is required to retire from the Navy b) is quicker and more complete when

done on computerc) starts in December when the children

get out of school

5. A chronic conditiona) is when you’re in a very bad moodb) means you’ve been to the gym enough

to get really toned upc) is a long-term health problem that

must be managed

You can help us to prepare a better report fornext year by completing our light-heartedQuality Quiz and providing some comments.

Just circle your choice of answer (answers appearon the next page under the fridge magnet) andthen fill out the evaluation at the end of the quiz.

You could win one of three HEALTH BONANZABASKETS full of nutritious goodies, a first aid kit,exercise equipment and more healthy and helpfulitems for the whole family.

There is plenty of time to read this report and send in your entry – winning entries will be drawn December 14, 2005. All winners will be notified.

ONLY TWO QUESTIONS TO GO :(Please fill in the blanks)

I enjoyed didn’t enjoy reading this

Quality of Care Report because:

_____________________________________

_____________________________________

_____________________________________

_____________________________________

In next year’s Quality of Care Report I would

like to see:

_____________________________________

_____________________________________

_____________________________________

_____________________________________

THAT’S IT ! Now fill in your details (below), snipout this page and mail your entry to:

Quality Quiz, Peninsula Health, PO Box 52,Frankston, Victoria 3199.for a chance to win a HEALTH BONANZA BASKET.

Name: ________________________________

Address: ______________________________

_____________________________________

Daytime Phone No: _______________________

Email: ________________________________

QUALITY QUIZ We would like 10 minutes of your time.

www.phcn.vic.gov.au











Frankston Hospital








ultrasounds, etc)



No Lift procedures

0 105SCALE

KILOMETRES

Chelsea

Carrum

Seaford

CranbourneFrankston

Mornington

Baxter

Dromana

RosebudSorrento

Flinders

Portsea

Hastings

Mount Eliza

PENINSULA HEALTHPO BOX 52, FRANKSTON, VICTORIA 3199PH: (03) 9784 7777For those outside the MelbourneMetropolitan Area PH: 1800 858 727

www.phcn.vic.gov.au

CARINYA RESIDENTIAL AGED CARE UNIT125 Golf Links Road Frankston Vic 3199Tel: (03) 9783 7277 Fax: (03) 9783 7515

CHELSEA COMMUNITYREHABILITATION CENTRE8 Edithvale Road Edithvale Vic 3196Tel: (03) 9772 6099 Fax: (03) 9772 3042

COMMUNITY CARE UNIT4 Spray Street Frankston Vic 3199Tel: (03) 9781 4288 Fax: (03) 9781 4393

FRANKSTON COMMUNITYREHABILITATION CENTRE125 Golf Links Road Frankston Vic 3199Tel: (03) 9783 7288 Fax: (03) 9770 5459

FRANKSTON HOSPITALHastings Road PO Box 52 Frankston Vic 3199Tel: (03) 9784 7777

FRANKSTON REHABILITATION UNIT125 Golf Links Road Frankston Vic 3199Tel: (03) 9784 8666 Fax: (03) 9784 8662

FRANKSTON INTEGRATED HEALTH CENTREHastings Road Frankston Vic 3199Tel: (03) 9784 8100

Community Health ServiceTel: (03) 9784 8100 Fax: (03) 9784 8149

MICHAEL COURT RESIDENTIAL AGED CARE UNIT32 Michael Court Seaford Vic 3198Tel: (03) 9785 3744 Tel: (03) 9785 3739Fax: (03) 9782 4434

MOUNT ELIZA CENTREJacksons Road PO Box 192 Mount Eliza Vic 3930Tel: (03) 9788 1200 Fax: (03) 9787 9954

PENINSULA COMMUNITY MENTAL HEALTH SERVICE15-17 Davey Street Frankston Vic 3199Tel: (03) 9784 6999 Fax: (03) 9784 6900

PENINSULA HEALTH PSYCHIATRIC SERVICEHastings Road PO Box 52 Frankston Vic 3199Tel: 1300 792 977 Fax: (03) 9784 7192

ROSEBUD COMMUNITY REHABILITATION SERVICE288 Eastbourne Road Rosebud Vic 3939

Community Rehabilitation CentreTel: (03) 5986 3344 Fax: (03) 5981 2267

Inpatient UnitTel: (03) 5981 2166 Fax: (03) 5982 2110

ROSEBUD HOSPITAL1527 Pt. Nepean Road Rosebud Vic 3939Tel: (03) 5986 0666 Fax: (03) 5986 7589

ROSEBUD RESIDENTIAL AGED CARE SERVICES1497 Pt. Nepean Road Rosebud Vic 3939

Jean Turner Community Nursing HomeTel: (03) 5986 2222 Fax: (03) 5982 2762

Lotus Lodge HostelTel: (03) 5986 1011 Fax: (03) 5982 2762

Rosewood HouseTel: (03) 5982 0147 Fax: (03) 5982 0378

S.H.A.R.P.S.35-39 Ross Smith Avenue Frankston Vic 3199Tel: (03) 9781 1622 Fax: (03) 9781 3669

TATTERSALLS PENINSULA PALLIATIVE CARE UNIT125 Golf Links Road Frankston Vic 3199Tel: (03) 9784 8600 Fax: (03) 9784 8674

The production of this report has been supported by the Rosebud HospitalOpportunity Shop and the Frankston Hospital Pink Ladies.

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Chelsea PENINSULA HEALTH PO BOX 52, FRANKSTON, … · Tel: (03) 9784 8600 Fax: (03) 9784 8674 The production of this report has been supported by the Rosebud Hospital Opportunity