Embed Size (px)
Citation preview
QualityAccount
Albury Wodonga Health 2016-2017
Albury
Wodonga
Health
Albury Wodonga HealthQuality Account 2016-17
Our VisionAlbury Wodonga Health - The Best of Health
Our PurposeTo deliver safe, reliable, responsive patient care
Our ValuesPatient & Client Focused, Equity, Trust, Ethical, Respect,
Compassion, Accountability, Teamwork
Each year Albury Wodonga Health (AWH) produces the Quality Account (formerly Quality of Care Report) to inform the community about the measures we take to ensure the services we provide are of a high standard. The report is prepared in accordance with the Victorian Department of Health and Human Services (DHHS) Quality Account Guidelines. Contributions: This year’s report was produced with the assistance of a Working Group of staff and community members. Our thanks go to everyone for their willing participation. Special thanks go to the Community Advisory Committee (CAC) members who gave us timely and useful feedback in the production of the report. Quality Account Working Group: Lynnette Ford, Angela Wood, Pauline Brandon, Daniel Baxter, Janet Chapman, Rachael Andrew, Kim Cole, Kerry Hall, Amanda Tonks, Kathleen Habel, Julie Wright, Kerrie Brown, Milton Jacob, Elisha Bolton, Suzanne Nelson, Holly Clarke, Jenny Love, Jane Howell. Distribution: Our Quality account is available at the reception area of any AWH location. Electronic copies have been distributed to local community groups and health services across the region. The report is also available at www.awh.org.au Description of Cover Image: Albury Wodonga Regional Cancer Centre, picture taken by Ian Ten Seldam Photography
Contents
05WELCOME MESSAGEProfessor Julia Coyle and Leigh McJames
08STATEWIDE PLANS & STATUTORY REQUIREMENTSImproving care for Aboriginal and Torres Strait IslandersReaching our diverse communityDental care for refugees
12CONSUMER, CARER & COMMUNITY PARTICIPATIONSupporting disabilityCancer wellness programsChronic disease programs
20QUALITY & SAFETYUtilising feedback for improvementReducing errorsInfection PreventionMedication safetyResponding to violence
38CONTINUITY OF CARESupporting children and families with Type 1 Diabetes MellitusEnd of Life conversations
Supporting new parents
CONT
ENTS
3
06ABOUT USOur regionOur services
WelcomeProfessor Julia Coyle, Chair Board Quality CommitteeLeigh McJames, Chief Executive OfficerAlbury Wodonga Health (AWH) operates across North East Victoria and Southern New South Wales. Straddling the great Murray River our health service is unique in that it is the only cross-jurisdictional health service in Australia. This allows us to bring together the best of healthcare policies and guidelines from Victoria and NSW, nationally and internationally to implement what we call our “gold standard”. Our strong clinical policy base is good for our community as it underpins our commitment to provide the best and safest care possible. The purpose of this Quality Account 2016 – 2017 is to provide information about the quality and safety of our healthcare services in an understandable and engaging way. At AWH we define high quality care as being safe, effective and person-centred. You will read stories told by actual patients and staff and see data portrayed in a manner that is easy to understand.AWH is governed through the Victorian Department of Health and Human Services (DHHS). Funding comes from various sources, but primarily from the Victorian and NSW state governments. The Victorian government oversees the performance of our health service by setting annual activity and patient safety targets. From the data presented in this report you can see how well we met some of our quality and safety targets and how we intend to improve where we are below the target. In 2016 – 2017 the Victorian DHHS restructured its services and commenced an overhaul of its performance monitoring system in response to a review into a cluster of perinatal deaths at Djerriwarrh Health Service and a subsequent review of safety and quality in Victorian health services. The commissioning of the Albury Wodonga Regional Cancer Centre in September 2016 (as featured on the front cover) was a major initiative to improve person-centred care, especially accessibility and affordability of cancer treatments in the region.
In the last twelve months, AWH once again focused on making our services more accessible to the community. We highlight some of our achievements below.
• An ongoing program of reviewing information brochures and handouts ensures they are simple and easy to understand. We refer to this as “health literacy”. We have a process whereby some of our volunteers read and comment on the literacy of the brochure before they go to print.
• Refugee groups were invited to walk around our hospitals and community health centre to familiarise them with our facilities, and we boosted the interpreter services.
• As evidenced in the Koolin Balit evaluation, which include Case Management and Care Coordination models, we made significant progress implementing our Aboriginal and Torres Strait Islander plan to improve services and accessibility for this population group. This includes identification processes, referrals to community programs and development of a targeted follow-up service model.
• Training our staff to “listen well” to patients and their carers is important for overcoming misunderstandings and for conveying technical information in everyday language.
• Inpatient services were made more accessible for visitors from out of town. In response to a patient and carer survey we retained patient rest periods and increased flexibility of visiting times.
• The Rural Access and Support Initiative (RASI) commenced to provide support to our dairy farming communities and access to specialist mental health care in a difficult economic period. The RASI was nominated for a 2017 Victorian Public Healthcare Award.
WEL
COM
E MES
SAGE
• Our Rehabilitation team developed a new sensory and mobility garden for rehabilitation patients to further enhance their therapy.
We are proud of our patient safety record, and this is due to our focus on continual quality improvement and surveillance.
• We worked tirelessly to reduce red blood cell wastage when giving blood transfusions. In 2016 – 2017 we only wasted 4 bags out of 2649 at Albury Hospital and none (0%) at Wodonga Hospital. This result was better than our peer group hospitals across the nation!
• Since 2015, with the introduction of the new comprehensive pressure injury program, hospital acquired pressure injuries at Albury Hospital decreased by 33% and between 58 - 79% at Wodonga Hospital.
• Only six (6) staphylococcus aureus bacteraemia infections in our hospitals (0.5 SaB infections per 1,0000 occupied bed days) were discovered in 2016 – 2017 which is less than the Victorian 5 year aggregate rate of 0.8 per 10,000 occupied bed days. Our infection prevention and control program continues to minimise the risk of healthcare associated SaBs.
• Despite our best efforts at preventing patient falls and medication errors, we have not been able to significantly reduce the incidence of falls and medication errors, so we initiated quality improvement projects which will continue in the next financial year to reduce the rates.
• We strengthened our commitment to improving safety & quality of care for patients with cognitive impairment by both joining the Australian Commission on Safety and Quality
in Health Care’s (ACSQHC) Caring for Cognitive Impairment campaign & ongoing development of internal auditing systems which improves profiling of our performance to direct future action.
• AWH is a leader in our Victorian peer group health services in facilitating discussion with patients and their carers about their end of life preferences to avoid unnecessary procedures and improve quality of life. We will continue to provide staff with training in how to hold these conversations in a sensitive and meaningful way.
In featuring the quality and safety achievements of AWH during 2016 - 2017, in this publication we acknowledge the significant contribution of our staff and volunteers to delivering first class health care. We hope this report will give you greater insights in to the range and quality of our services.
Julia Coyle Leigh McJames Chair, Board Quality Committee Chief Executive Officer
5
About Us
Albury Wodonga Health (AWH) operates within the responsibility of the Victorian Department of Health and Human Services. AWH offers the sophistication of health services found in the metropolitan environment. AWH has grown to be a major regional health service supporting a large catchment. AWH is a 337 bed health service that treated 35,368 inpatients, triaged 62,943 emergency presentations and welcomed 1,639 babies in the 2016-17 financial year. The services are provided utilising 30 sub acute beds, 95 mental health beds, 5 intensive care beds, 7 operating rooms, and 117 general beds in partnership with a range of community based residential facilities and community health centres. AWH now delivers care and services from 17 different sites across North East Victoria and Southern NSW. The community we serve is graphically* represented below within the local government areas, in both NSW and Victoria. The catchment area is estimated at 250,000 people.
MURRAY RIVER
EDWARD RIVER JERILDERIE
FEDERATION
LOCKHART
GREATER HUME SHIRE
TOWONGINDIGO
ALPINE
BENALLA
WANGARATTA
MANSFIELD
TUMBARUMBA
BERRIGAN
MOIRA
Albury
Wodonga
Primary Catchment
Regional Catchment
Specialist Catchment
*Depicts Total percentage of Acute public separations by LGA in 2015/16.
ABOU
T US
7
Our sites
L-R: Community Health (Albury), Benambra House (Wodonga), Community Mental Health (Albury), NECAMHS & Adult Mental Health (Wangaratta), Older Persons Mental Health (Wangaratta), Blackwood Cottage (Beechworth), Kerferd Unit (Wangaratta), Community Mental Health (Wangaratta), Adult Mental Health (Wodonga), Dental (Wodonga), Wodonga Hospital, Albury Wodonga Regional Cancer Centre, Parents & Babies Unit (Wodonga), Albury Hospital, Jarrah Retreat (Wodonga); Not pictured: Willows (Beechworth)
Statewide Plans & Statutory RequirementsVictoria has a number of statewide plans in place that have bearing on the work of public health services and community health services. Here we discuss implementation and action against some of those plans.
Koolin BalitIn 2012 the Victorian Government made a commitment to improve the length and quality of life for Aboriginal People within a decade. Albury Wodonga Health signed a Statement of Intent to work towards the Victorian Government strategic directions for Aboriginal health 2012-2022 – Koolin Balit (meaning healthy people in Boonwurrung language).Ovens Murray and Goulburn (formally the Hume Region), have been working towards achieving the identified strategic directions with hospitals, Aboriginal community controlled organisations and community health services. There have been a range of initiatives identified and AWH has taken part in three specific areas. These are, managing illness better with effective health services, cultural responsiveness and the Aboriginal employment plan.
Managing illness better with effective health services.The Client Journey Program has been implemented at AWH for the past 4 years. The Aboriginal Health Transition Officer has supported many Aboriginal and Torres Strait Islander patients with their journey from accessing the emergency department to the right care after leaving. Having the program at AWH has helped to identify Aboriginal and Torres Strait Islander patients that have or are at risk of a chronic condition and link them into specific health programs. The focus is on prevention of hospital admissions, re-presentations and of the illness becoming more advanced. Right care, in the right place, at the right time.
Cultural ResponsivenessAWH participated in an Aboriginal Health Cultural Competence Audit facilitated by an external agency. This resulted in the development of the Aboriginal Health Cultural Competency Action Plan 2017-2020 which will underpin the work we do across AWH at all levels by enabling our service to be one that provides culturally safe, accessible and inclusive care.Key priorities within the action plan are:• Listening and forming relationships with
our Aboriginal community.• Building on our partnership with our local
Aboriginal organisations.• Ensuring your health care journey is a
positive one.• Ensuring our environment is one that is
culturally safe and welcoming to all.
STAT
EWID
E PLA
NS A
ND S
TATU
TORY
REQ
UIRE
MEN
TSStaff Story
Hello, my name is Charmaine... ... and I am the Aboriginal Health Transition Officer (AHTO). I am currently undertaking my Bachelor of Health Science
- Mental Health degree with Charles Sturt University. As part of my studies I am required to participate in placement in Mental Health Services. From November 2016 to June 2017, I underwent placement in various AWH - Mental Health Services and underwent competency assessment within each mental health clinical placement site as well
as achieving above the minimum levels of professional practice expected of a degree level.
Completing the clinical placement within the workplace certainly helped me in my role of AHTO. Meeting, liaising, networking and raising the profile of the Aboriginal health within AWH complimented the success of the clinical placement.Aboriginal and Torres Strait Islander people and community see mental health as holistic health encompassing spirituality as well as the physical, social, and emotional wellbeing of the individual and community. I believe establishing trust, providing a flexible service and working together help to achieve the best health outcome for all.
9
Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP)Key Result Area Achievement1. Engagement
and Partnerships
The Albury Wodonga Aboriginal Health Reference Group continues to meet on a quarterly basis. There is a current Memorandum of Understanding between all agencies represented. Close the Gap day was held in Wodonga Sumsion Gardens proving to be a success with all agencies working together. It also included speakers from a local school.
2. Organisational Development
AWH has participated in an Aboriginal Health Cultural Competency Audit resulting in an action plan that sets out what we are working towards for the next 3 years. Working on the implementation will strengthen our partnerships with consumers, staff and external organisations as well as complementing the ICAP key result areas.
3. Workforce Development
The revised and updated Aboriginal Employment plan (2016-2019) is available on our Internet Page.
4. Systems of Care An emphasis has been placed on asking patients if they identify as Aboriginal and or Torres Strait Islander origin. By providing correct information we are able to ensure culturally safe care and the correct pathways of care.A review has been conducted of the current process and pathways to ensure we provide contact to all identified Aboriginal and Torres Strait Islander patients that have consented.
Our data says...320 Aboriginal and Torres Strait Islander patients were provided with follow up care through the Client Journey Program in the 2016-17 year.
Migrant Familiarisation TourOn 6 December 2016 a migrant familiarisation tour was conducted of Albury Hospital and the Albury Wodonga Regional Cancer Centre (AWRCC). The tour was arranged to familiarise recent migrant arrivals with our facilities and provide them with information on what to expect if they need to come into hospital. The tour was arranged in collaboration with the Albury Wodonga Volunteer Resource Bureau.The group of over 140 Bhutanese and Congolese visitors included a wide range of ages from young to mature aged people with some wearing their traditional clothes. The participants toured the hospitals in small groups lead by AWH staff each with an interpreter and member of staff from the Bureau. They visited the emergency department, medical and surgical wards,
operating theatre and cancer centre. Staff from each area spoke to the groups and explained what our visitors can expect if they ever need to come to hospital. A range of topics were discussed including what to wear in hospital, nutrition requirements, medication management, interpreter availability and our care of them as our patients. AWH staff were keen to reassure and encourage the participants about coming to hospital if they need to.A final question and answer session gave the AWH staff involved insight into some of the experiences the refugees had come through, some of whom had been waiting in camps for more than 20 years. The tour was extremely well received and the feedback at the time from those attending was very positive.
Regional Assessment Management PanelsAWH mental health service is fully engaged with the regional Risk Assessment and Management Panel (RAMP). RAMPs have been set up to maximise the health, safety and welfare of women and children at high risk of serious injury or death from family violence. This is achieved through sharing information and taking action.Women who are referred to a RAMP are identified as being at high and imminent risk of serious harm from family violence. They require an immediate risk assessment and action plan to lessen or prevent the threat to her (and her children’s) life, health, safety and welfare. Each RAMP is jointly chaired by a senior member of Victoria Police and a senior manager from a specialist family violence
agency. Core RAMP members include women’s family violence services, the Department of Justice & Regulation, mental health services, Victoria Police, housing, drug and alcohol and child protection services. Two senior AWH mental health managers (1 core member and 1 delegate) are trained in RAMP/family violence response, and are able to provide the RAMP with pertinent information and expertise to support comprehensive safety planning and response for referred women and children. This multi-agency response is a huge step forward in keeping women and their children safe from the effects of high risk family violence.
STAT
EWID
E PLA
NS A
ND S
TATU
TORY
REQ
UIRE
MEN
TSThe Dental Service - Refugee Clinic‘Striving to improve the oral health of some of our most vulnerable patients’The Dental Service is an integrated oral health program providing general, emergency and denture services to eligible patients. Under the Victorian DHHS public dental service policies, refugee and asylum seeker patients are treated as priority one access patients. Priority one patients must be seen as soon as possible; they are not put on a waitlist and they are entitled to the next available general care appointment. An assessment of oral health is particularly important for people of refugee and asylum seeker background, with reports indicating high levels of untreated caries or dental decay compared to the general population.How did the ‘Clinic’ concept arise? When we received notification that we were to receive in excess of 80 refugee patient referrals, we saw an opportunity to tailor care and service delivery and work collaboratively with the referral organisation, the Multicultural Centre. Our vision to develop a culturally appropriate model of care and facilitate a ‘Refugee Clinic’ involved ongoing collaboration within the dental team and the Multicultural Centre. Some of the steps in our planning and service development included: • Capacity building within the Dental
Team;• With the assistance of the Multicultural
Centre, we held a cultural awareness workshop for our staff prior to the commencement of the clinic;
• Dental team members were encouraged to provide feedback regarding the appointment schedule and the administration team coordinated the provision of on-site VITS Interpreter services.
Collaboration with our service partnersWe continued to work closely with the Multicultural Centre throughout the whole journey as they had an established rapport with the patients and were able to assist us as we were confirming appointments and coordinating patient transportation. With
two main cultural referral groups, Nepalese and Congolese, we facilitated the Refugee Clinic over two days, Nepalese patients on the first day and Congolese patients on the next. In total, we treated 25 Nepalese patients and 24 Congolese patients. General Observations from the team• Some of the patients may never had
brushed their teeth, yet are in relatively good oral health. This is due to their previous diets, but we are noticing the western influences on dietary choices, without the knowledge of oral hygiene practices leading to oral health concerns and the need for modified oral health instructions.
• Cultural considerations regarding body language, communication and previous trauma experiences.
• Patients may not know their own date of birth, or have any up to date knowledge regarding their regular medications or medical history.
Positive Feedback“On-site VITS interpreters were fantastic, oral hygiene instruction was easy to deliver and the service was efficient, it allowed for the clinician and patient to ask additional questions.” “The interpreters were very professional and helpful”“A positive first dental experience”The FutureOur future proposal is to facilitate a refugee clinic for 2 days every quarter with 6 week follow up appointments if required. “We would like to continue to form local community partnerships to the success of this very rewarding initiative!”
11
Consumer, Carer & Community ParticipationConsumers, carers and community members are all part of our diverse community.
Building the capacity of consumers, carers and community members to participate fully and effectively in their healthcareThe AWH Consumer and Community Engagement Framework provides AWH with a roadmap to help AWH engage and have more meaningful relationships with its consumers and its community. The Framework was developed with significant contribution from Robyn Raine, a consumer who has had a long history of working with AWH to improve patient care. Robyn’s individual support has included helping to redesign the AWH rehabilitation ward and assisting in the development of a volunteer led patient experience survey which was piloted in early 2017 and is available now. The Framework is implemented across AWH in a number of ways including:
• Members of the AWH Community Advisory Committee (CAC) were consulted in the development of the AWH strategic services plan;
• Consumers and community members undertook an audit of the display of information and promotional materials as well as signage throughout AWH. The results of the audits will be used to make changes across campuses to ensure that consumers have access to the information they need and can easily find their way around;
• All volunteers at AWH receive orientation to the organisation and to their roles;
• Volunteers were key to the
development and piloting of a patient experience survey in two wards of AWH. The pilot was seen as very valuable by all involved and the survey will be rolled out across AWH with the on-going assistance of volunteers;
• Staff in the maternity unit regularly invite consumers in to share their stories to support staff training.
CONS
UMER
, CAR
ER A
ND C
OMM
UNIT
Y PA
RTIC
IPAT
ION
Community Advisory CommitteeThe AWH Community Advisory Committee (CAC) is a legislated and strategic advisory committee to the AWH Board of Directors (Board). We have had an active program of recruitment to the CAC over the past 12 months, resulting in 5 new members who bring a range of skills to the group including business, law, community development, strategic planning, communication, Aboriginal health, and consumer experience. The AWH CAC has two critical roles:• To advocate to the Board on behalf of
the community, consumers and carers.• To provide direction and leadership in
relation to the integration of consumer, carer and community views into all levels of health service operations, planning and policy development.
In 2016/17 the AWH CAC has:• Supported the development of the
2015/16 Quality Account;• Participated in consultation sessions for
the AWH Service Plan;• Played a key role in the pilot of the
volunteer-led patient experience survey;
• Developed the AWH Community Participation Plan (available now);
• Provided advice in relation to the accreditation periodic review;
• Provided community/consumer members for key AWH committees including Board Quality, Board Primary Care and Population Health and the Person-centred Care Committee.
The AWH Disability Action PlanWe are committed to providing a safe and accessible health service to everyone who uses our service. We are also committed to breaking down barriers that prevents them from accessing appropriate services. The AWH Disability Action Plan was developed with the aim of preventing discrimination and providing holistic care to all people who use our health service who have a disability. The achievements this year include:• The inclusion of a high needs accessible
toilet in the refurbished Rehabilitation Consultations building;
• The installation of a hoist for the hydrotherapy pool, the hoist makes it possible for our clients with significant mobility challenges to be transferred into and out of wheelchairs and water wheelchairs, thus enabling them to enjoy the benefits of water therapy;
• The development of a partnership with AIDA Care which enables patients who need equipment on discharge to have it delivered to their home;
• Involvement in the Best Evidence for Stroke Care (BEST) Study. The study is a joint partnership with CSU, AWH and the Murrumbidgee Local Health District.
13
Albury Wodonga Regional Cancer Centre - Wellness CentreIn April 2017 the Wellness Centre opened its doors within the Albury Wodonga Regional Cancer Centre to provide cancer patients and their families
with a relaxed, comfortable setting away from the hospital environment. The centre, funded by the Albury Wodonga Regional Cancer Trust Fund, is managed on a day to day basis by a Wellness Coordinator with oversight by the Wellness Centre Governance Sub-Committee.Prior to opening, community forums were held and a survey conducted to better understand what consumers would like the centre to offer, in terms of information, services and therapies. A wide variety of ideas were proposed such as carers forums, guided meditation and health promotion. The Wellness Centre Governance Committee - includes community representatives, Ramsay Health, GenesisCare, Visiting Medical Officers, AWH, and Hume Regional Integrated Cancer Services (RICS). It provides oversight and determines what is safe, appropriate and evidence based practice for wellness. The suggestions made by the community were
considered by the committee and many have been used to inform the centre’s business plan and determine what services are provided.The centre currently offers a range of activities and programs including: • Brave Hearts Wig library;• Information hub and reading area;• Oncology massage; • Support programs such as pastoral care;• Art Therapy groups;• Women’s wellness group;• Cancer Council NSW and Vic Health
promotion education programs; and• “Look Good Feel Better” program.
Health Promotion (Nutrition, Exercise, Sleep)
Meditation / Mindfulness / Relaxation
Counselling
Massage
Yoga
Support Groups
Art Therapy
Wellness Centre Community Consultation
/ Survey, Services to be offered. April 2017
Our data says... Health Promotion programs for advice on Nutrition, Exercise and Sleep are considered the most vital service for those with cancer, their carers and families within the AWRCC Wellness Centre
CONS
UMER
, CAR
ER A
ND C
OMM
UNIT
Y PA
RTIC
IPAT
ION
Border Pride Fair Day 2016Clinic 72 is a Sexual Health clinic that provides services to priority populations within Albury, Wodonga and local surrounds. These populations are Aboriginal and Torres Strait Islanders, commercial sex workers, young people, people living with HIV / AIDS, people recently released from custodial sentence and the LGBTIQ community. In an effort to address the known poor health outcomes for the LGBTIQ community, a number of local health organisations got together and planned an event to offer sexual health and general health information / screening to this community. The Border Pride Fair was held in November 2016 at QEII Square. It was a fun event with entertainment, including singers, performers, local business and NGO trade and community stalls. There was also a very popular “Doggywood”, a glamorous puppy fashion parade.
Clinic 72 had a tent with health promotion resources and a pop-up STI testing space available to anyone on the day. This was staffed by clinical and health promotion staff, as well as staff from other organisations. Albury Community Health Centre also had a trade stall, which enabled staff to offer other services to attendees. Border Pride Fair Day was a successful event advertising the Clinic 72’s profile within the LGBTIQ community and also raising Albury Community Health’s profile also. This event is likely to continue next year with plans organised for it to be held in May 2018.
15
In 2016, AWHs community rehabilitation programs received 1899 new referrals where the main diagnosis was a pulmonary condition. A significant increase on prior years, where the average had been 1024 referrals per year.
Our data says...
Community Health Priority Group Report: Rural and Regional People with a Chronic Disease - Buster’s ExperienceBuster was diagnosed with Asthma as an infant and has been in and out of hospital with respiratory exacerbations for as long as he can remember. Buster worked in furniture restoration for 35 years and during this time developed Chronic Obstructive Pulmonary Disease (COPD), which he and his doctors believe is likely related to occupational exposure to sawdust, chemical fumes, mould and mildew. Buster’s JourneyIn August 2016, Buster was admitted to Albury ICU for approximately ten days. During his stay he was stabilised and received care and education from doctors, nursing and allied health staff. Buster reported that while he was in ICU the Respiratory Nurse advocated for him to be referred to a respiratory specialist team so he could receive optimal care. After ten days in Albury ICU Buster was transferred to the respiratory specialist team in Wagga Wagga.Buster was an inpatient in Wagga Wagga Base Hospital for six weeks where the clinical optimisation process was progressed to the point that he could be discharged. He was then referred to a respiratory specialist team in Sydney to explore more advanced treatment options. In May 2017, Buster was referred to the Albury outpatient Pulmonary Rehabilitation (PR) Program. Buster currently attends PR twice weekly and has a home exercise program which he completes three to four days per week. Community Rehabilitation Centre PR ProgramFor the past six weeks Buster has been attending PR at the Albury Hospital for two hours of exercise and one hour of pulmonary education each week. Since commencing
PR Buster’s exercise tolerance has improved significantly. Personally, Buster attributes his overall functional improvement and stablisation of his condition to the following factors: • High levels of motivation which have
grown from a sense of control over his own health outcomes;
• Independence and self reliance in the completion of activities of daily living;
• Optimisation of medications and medical treatment of exacerbations;
• A commitment to follow medical professional’s advice;
• Support from friends and relatives; • Stringent adherence to home exercise and
pulmonary rehabilitation programs. Outcome MeasuresBuster’s commitment to optimising his care has enabled him to increase his 6 minute walk test from 285 metres in May 2017 to 362 metres in August 2017 - an excellent outcome due to his hard work relating to all aspects of his respiratory care.
Albury 60 clients
Referrals to the PR program
Wodonga 90 clients
Age Range 40 88
CONS
UMER
, CAR
ER A
ND C
OMM
UNIT
Y PA
RTIC
IPAT
ION
Use of interpretersAcross AWH’s regional catchment, most people speak English as their primary language. The Alpine local government area (LGA) has the highest percentage of households where a language other than English is spoken at home (10.4%), compared with Albury (8.0%) and Wodonga (7.7%). The most common languages other than English include Nepali (1.0% in Albury), Italian (3.6% in Alpine LGA), and German (0.7% in Alpine and 0.5% in Greater Hume and Towong).
As good communication between staff and patients is essential for us to provide safe, appropriate care language interpretation is sometimes required. The language service provider used by AWH is the Victorian Interpreting and Translating Service (VITS). It provides telephone and onsite interpreting including spoken languages and Auslan as well as translations.
Parkinson’s Exercise GroupStaff in the Rural Allied Health Team (RAHT) have been running the local community Parkinson’s Support Group since it’s
establishment, ten years ago. Towards the end of 2016, a lack of Parkinson’s specific services in the region was identified and it was decided to trial a regular group that incorporated exercise and education. In February and March of 2017, eleven willing participants attended the 8 week program. Each participant completed various exercise stations designed to improve muscle strength, balance and fitness. At each session a minimum of three RAHT staff were present to provide assistance to those who needed it. At the end of the course participants were informed of local exercise groups where they could continue with their exercise regime.The program consisted of a variety of different exercises followed by either a presentation by one of the health professionals or an informal session where participants could share tips and advice on how they were managing their symptoms. Discussions included topics such as dealing with emotions, strategies for better sleep and how to avoid falls.
In order to help participants, their partners or carers were encouraged to join them and assistance was provided in organising transport to and from the venue to those who needed it.Each participant was assessed at the start and finish of the program. One assessment was the “Timed Get Up and Go” test which measures walking speed, lower body strength and turning ability by timing participants walking three metres from their chair and back. This enabled both the staff and participants to see the improvements they had made through the program. At the end of the program the participants were asked to provide some feedback and this showed that it had been an overwhelming success. The participants thoroughly enjoyed all aspects of the program and made it very clear they would like it to continue. As a result of the program several participants have been inspired to start their own peer support catch ups while others are exercising together in the community. A positive outcome of the program has been to empower people with Parkinson’s to take charge of their health and wellbeing.
AWH utilised interpreters through VITS on 410 occasions for 27 different languages. The most commonly utilised were Nepalese interpreters at 63%.
Our data says...
“The opportunity to discuss issues and share solutions with people in similar circumstances was very enabling for me.” - Judith“The group exercises became better as the course went on; it was certainly well run, and those running the group were enthusiastic.” - Jeff
17
ConsumerFeedback
Victorian Healthcare Experience Survey The Victorian Healthcare Experience Survey (VHES) is a state-wide survey that collects information about the experience of people attending Victorian public health services. Each month a selection of patients who have been discharged from our health service are invited by the DHHS to anonymously participate. Information is collected on a wide range of topics such as coming in to hospital, communication, pain control, tests and procedures, food, cleanliness and leaving hospital. We receive the survey results from DHHS on a quarterly basis. The results identify what we do well and opportunities to improve. The detailed results and comments are provided to senior management, and the clinical and operational directors of the clinical service streams. AWH aims to achieve the DHHS target of 95% or higher for adult inpatients who rate their overall experience as ‘very good’ or ‘good’. Whilst we didn’t always achieve the target, we consistently achieved the same or a higher result than the state average.
What we did well in 2017The Quarter 4 results show a pleasing result for our hospital inpatients and the care they receive from their doctors and nurses.
Doctors NursesAdult inpatients 96% 99%Paediatric Inpatients 98% 98%
Improvements: Making visitors feel welcomeAWH recognises that family and friends are important to a patient’s health, comfort and recovery and welcome them to visit. However, the VHES results suggested that we could make some improvements in this area. To better understand patient, visitor and staff perceptions of visiting hours AWH conducted a survey. The volunteers spoke to patients and visitors whilst staff participated in an on-line survey.
As a result of the findings a number of recommendations were implemented in early 2017. Existing visiting hours were maintained with some flexibility to acknowledge different patient needs. Carers are now permitted to visit at any time as are visitors of patients who live out of the immediate Albury Wodonga area. In addition to this, the end of visiting hours announcement was altered to be more friendly in tone and create a more welcoming environment for patients and visitors.
Percentage of Adult inpatients who rate their overall experience as ‘very good’ or ‘good’. VHES 2016-2017
Visiting Hours Survey results and feedback 2016-2017
Percentage of inpatients who rate the care they receive from their doctors and nurses as ‘very good’ or ‘good’ VHES Q4 2016-17.
Our data says...
As the patient do
you feel friends and family were
welcome to visit?
As the visitor do you feel you are welcome to
visit?
Do the current visiting hours meet patients
needs?
Should visitors be present during handover times?
Should primary carers
have restrictions when they can
visit? YesNoDon’t know
“it is important to be flexible when people are visiting from out of town”
In January 2017, Community Health services were included in the survey for the first time. 100% of community patients stated that their overall experience with the services was ‘very good’ or ‘good’.
100%
90%91%92%93%94%95%96%
Q1 Q2 Q3 Q4
AWH Target State Average
ConsumerFeedback
CONS
UMER
, CAR
ER A
ND C
OMM
UNIT
Y PA
RTIC
IPAT
IONBuilding teamwork in Emergency
Our Emergency Departments (ED) are very busy. During 2016-17, 62,943 emergency presentations were recorded. It is therefore very important to have a stable workforce. During the year we made a conscious decision to provide greater support for our nurses and doctors. It is generally understood that safer and better care for patients can be achieved by changing medical workforce models of care in EDs.During the year, a targeted recruitment drive for permanent positions for senior, experienced ED doctors resulted in a reduction in the number of locum positions at the Albury and Wodonga EDs. Our community noticed the improvement. In the 4th quarter of 2016-17 people who attended our EDs rated, on average, their care higher than other large regional health services in Victoria.
19
Rating of care provided (%)
Comparison to other regional
EDs
Albury ED 89%83.62
Wodonga ED 82%
Leaving Hospital
The DHHS combined four questions that focus on the process of leaving hospital to produce a transitions index. The index score is produced from the average of the positive results of these four questions and our results are compared with a state target of 75%. The score provides us with an overview of how we are performing with regard to the discharge process.
The questions:
1. Before you left hospital, did the doctors and nurses give you sufficient information about managing your health and care at home?
2. Did hospital staff take your family or home situation into account when planning your discharge?
3. Thinking about when you left hospital, were adequate arrangements made by the hospital for any services you needed? (e.g. transport, meals, mobility aids)
4. If follow up with your General Practitioner (GP) was required, was he or she given all the necessary information about the treatment or advice that you received while in hospital?
The results show that for each of the four quarterly periods AWH exceeded the state wide target and also achieved results higher than the state average. Despite these very pleasing results we are still working to improve our service to patients when they leave hospital.
In May this year a new document was introduced to provide patients with important information when they leave hospital. The form provides the patient with the details of any follow up appointments that have been made, further tests that need to be performed and any referrals to other services that have been organised. It also includes any nursing or allied health recommendations or important instructions for the patient when they go home.
% very positive results
Target - 75%
State average results
Quarter 1 77% Met 76%Quarter 2 81% Met 77%Quarter 3 79% Met 76%Quarter 4 81% Met 76%
Rating of care provided by AWH Emergency Departments compared to other regional EDs, VHES, 2016-2017
Leaving Hospital Transitions Index VHES, 2016-2017
Quality & SafetyQuality and Safety - consumer and staff experience
FeedbackFeedback is a valuable source of information about how we are performing and so AWH welcomes patients, their families or carers and members of the community to give us feedback.
Feedback comes to us in a number of ways as compliments, complaints or suggestions. At various positions throughout the health service there are brochures and comment cards available. These can be completed and put into one of the feedback boxes. Other ways we receive feedback is by phone, email, in person or in writing.
All feedback is welcomed as it provides us with the opportunity to improve our service whether by changing the way we do things or building on what we do well. During 2016 – 2017 there were a number of times where we have sought and responded to feedback.
ComplaintsAWH strongly encourages anyone with a concern to raise it as soon as possible with the frontline staff providing the care. Often issues can be resolved quickly in this way. However, if they can’t be resolved by the manager at the time, they can be referred to the Clinical Governance Unit (CGU). Any complaints received by the CGU are reviewed and investigated through an independent process. The people who made the complaint are then provided with information from the review which generally offers them a satisfactory outcome.
If concerns are still not able to be resolved by our health service complainants are informed that they can take their concerns to an external complaints resolution agency.
While we aim to close all complaints within 28 working days, sometimes they take longer to complete in order to ensure they are thoroughly investigated and actioned.
Complaints provide us with the opportunity to address problems so that others don’t have a similar experience. People who have lodged a complaint often say once it is resolved they don’t want anyone else to experience the same problem. We understand this and for
this reason we try hard to eliminate risks. In 2017 we received several complaints from patients who had come into the Emergency Department (ED) and were discharged home but had to make a return visit within a few days as their problem persisted or had got worse.
Unplanned returns to the ED are a serious patient safety concern. We now have a new protocol that states that any patient who returns to the ED within 72 hours must be assessed by a senior emergency physician.
Percentage of complaints closed within 28 days, 2016-2017
Our data says...During 2016-17 the CGU received 384 complaints. AWH recorded 35,368 episodes of inpatient care in this time, which means that 1.1% of our admitted patients made a complaint.
0%
20%
40%
60%
80%
100%
JUL
AU
GSE
PO
CT
NO
VD
EC JAN
FEB
MA
RA
PRM
AY
JUN
% of complaints closed Target
QUAL
ITY
AND
SAFE
TY
ComplimentsAWH staff strive to do their best for the patients in our care and so it is always appreciated when they are paid a compliment.
On average the CEO’s office receive 22 formal letters of appreciation each month. Many compliments were received by the wards and units directly.
“Staff are all wonderful, room looked 5 star, service with a smile, genuine care, capable and professional, prompt and considerate”
“Exceptionally
caring, competent and patient”
“I have received the most A1 professional health
care and during a holiday period, my care is still ongoing.
Cleanest hospital ever, excellent team work, I was treated with
respect, a very happy customer”
Earlier this year we received feedback from some patients and relatives who told us that they didn’t feel that they were being heard or that anyone cared.
Since then we have spent a lot of time researching, reading and thinking about how we can use this feedback to improve patient experience and care. A small group got together to develop a planned education simulation session for allied health and nursing staff. The result is that staff will be involved in ‘Building a culture of listening – the patient experience’.
At the session attendees will reflect upon and discuss the following:
• What is caring?
• What does caring look like from their own and the patient’s perspective?
• What does caring cost us? What are the barriers to caring?
• What happens when we don’t care for ourselves, each other and our patients?
• What strategies can we identify that can assist us with caring?
The first session was conducted at the inter-professional allied health and nursing study day on 18th September 2017.
We will report in next year’s Quality Account Report how this session went so watch this space!
Building a culture of listening - the patient experience
21
ConsumerFeedback
Volunteer-Led Patient Experience Survey Pilot ProjectAWH is always interested in patient’s experiences and identified an opportunity to gather ‘real-time’ feedback from patients while they were in the health service by undertaking a pilot volunteer-led patient survey in two wards.
The survey was administered by volunteers using simple hand held devices with access to a survey located on the “Survey Monkey” website. Volunteers were trained in the use of the survey and in how to work with patients in the ward including how to respond if the patient wished to make a complaint.
The pilot project took place 2 days a week over 4 weeks, in two wards – the rehabilitation ward in Wodonga and medical ward 2 in Albury. Volunteers and Nurse Unit Managers (NUMs) were involved in the design of the survey and process.
Information from the survey was provided to the respective Nurse Unit Managers by the morning of the day following the survey. The NUMs were then able to display the information gathered in the survey and respond quickly to any issues raised.
The pilot was judged a success and will be rolled out across AWH wards in 2017-18. Our volunteers, Robyn, Jeremy and Herman, provided great input into this initiative.
95.8 % of patients described their care as good or very good
80% of patients felt they were always treated with respect and dignity
66.5% of patients felt they were able to talk with staff about their concerns
59.1% of patients felt their care was always well coordinated
64.8% of patients always received consistent messages from staff
72.8% of patients described the hospital food as excellent or good
87.3% felt they were always or mostly involved in decisions about their care
94.6% of patients described the physical environment as excellent or good
Volunteer Patient Experience Survey - 2017
Reducing errors through the study of surgical casesAWH participates in the Victorian Audit of Surgical Mortality (VASM), a national program that monitors deaths associated with surgical care. Information about patients who have had surgical treatment or are admitted under a surgical unit is submitted to VASM by AWH. Each case is reviewed independently. The aim of this audit program is to provide information to health services so they can improve the quality of care.Each year the VASM office sends AWH a summary report and the 2016-17 report shows that AWH compared favourably with similar Victorian and interstate hospitals. The report is presented and discussed at our surgical and management committee meetings.
Types of issues that VASM focus on include delay in surgical diagnosis, delay in transfer to another facility, surgical complications, unplanned returns to the operating theatre and fluid management. AWH rated better than or on par with like state hospitals and the national average in all these areas. All the information collected by VASM is protected by Commonwealth Qualified Privilege legislation and individual cases are not reported to hospitals or the families of deceased persons.
QUAL
ITY
AND
SAFE
TYImproving staff wellbeingThe Board and management gave priority to strengthening the workplace culture. It was reassuring to see that the results of the 2016 People Matter Survey indicated that staff have a strong commitment to patient care, quality and service delivery. It did indicate, however, that a proportion of staff lacked confidence in senior management and some governance processes. A range of strategies were implemented to improve staff communication and engagement, and strengthen leadership. A series of leadership development workshops was commenced and will continue into 2018. The People and Workforce team strategically led the review of the Work Health and Safety Management Committee which was in recess, and refreshed the Health and Safety Representative Committees across all sites. We have improved consistency in our workers compensation arrangements and increased employee reporting of near misses and occupational health and safety incidents.
An early intervention program was introduced that assists injured employees with both work related and non-work related illness. This program can prevent long-term absence from work and the development of chronic illness by regular checking in with staff and alternative role design. Early contact with the staff member is made to offer assistance and then they and their supervisor are involved in developing an agreed plan to enable the staff member to remain at work or return to work. Flexible workplace solutions are used to give as much support as possible to the staff member. The focus is on happy and safe employees which contributes to better care for our patients. The results of the 2017 People Matter Survey indicate that these actions are having a positive impact on workplace culture, with overall improvement of 2 – 10% recorded against almost all criteria.
2017
2016
75%
69% My organisation provides a safe
work environment
77%
69% In my
organisation, improper conduct
is not tolerated
70%
67% I have a clear
understanding of how my job contributes to
my organisations stated outcomes
81%
80% My job allows me to utilise my skills,
knowledge and abilities
77%
69% People in my
work-group treat each other with
respect
VPSC People Matter Survey Results - 2016 / 2017
23
Hello, my name is Jono...... working as an OT, I was walking with a patient who was an inpatient on the Rehabilitation Ward. This person caught their foot when we
were turning to walk from the hallway to another room for therapy. She was falling away from me and as I was assisting her
to fall safely my wrist was twisted underneath her. I felt okay for the rest of the shift and kept working. It wasn’t until I woke the next day that my wrist was sore. I managed myself for a few days but when I didn’t get any better I decided to
contact the Early Intervention team.
The early intervention coordinator was able to suggest an appropriate private physiotherapist locally who specialised in hand and wrist injuries. AWH covered the 3 therapy sessions I needed as well as a wrist brace for support. It took a month or so to get back to my full range of duties but happily I didn’t need to take any time away from work. The rehab team was flexible in assisting me with some of the tasks I couldn’t do within the restrictions advised by my treating physio. I was happy that I was able to manage my injury without much fuss and get back to my normal routine as soon as possible.
Staff Story
Albury Wodonga Domestic & Family Violence ResourceDomestic violence knows no borders or socio-economic classes within our community. Families, women and girls, and to a lesser extent men, of all ages or cultures across our community are affected by domestic or family violence. In response to escalating community concern over domestic violence (DV), AWH has taken a lead role in the development of local resources and education. In May 2017 AWH hosted an inter-professionals forum with presentations on domestic violence from a broad range of perspectives:• lived experience of violence - a community
members story;• Community health and sexual assault;• Hospital emergency department
perspective;• Mental health;• Maternity and parenting services. This session was well attended and highlighted the complexity of family and domestic violence. In addition to the multifaceted nature of DV, the local challenges of providing and navigating support services accurately in a cross border location was emphasised.Concerned about this added complexity, AWH social workers developed a partnership with, youth emergency services, the Zonta Club of Albury Wodonga, and the Border Trust, white ribbon ball to support the development and funding of a safety and support resource in the form of a discreet brochure to assist individuals impacted by domestic and family violence. This brochure provides awareness and education to professionals and the general public around the issue. The new Albury Wodonga domestic and family violence resource will enable health professionals throughout the hospital along with police and community services on both sides of the border to better help and support people at risk. The resource has been developed to be handed out to identified victims, family and friends of people at risk of family and domestic violence. The information within the resource has been developed to meet the local need of a cross border area and aims to educate and explore;
• causes of domestic and family violence;• key questions and a relationship checklist; • 24 hour emergency Albury and Wodonga
phone numbers. The format and design allows for discreet personal use. A culturally sensitive version specifically for aboriginal people has also been designed. This resource was launched for public use at Albury Community Health Service where the Albury City Deputy Mayor spoke to 50 service providers and community members. To date, 15,000 brochures have been printed and distributed to health professionals, services and police in Albury Wodonga and the surrounding towns. The aim of this project is to ensure that all professionals have accurate, accessible information to provide to community members where there is an identified need.
1 in 4 Australian women experience intimate partner violence
Victoria Police familyviolence incidentreports aregoing up
2012 2013 2014 20162015
47k59k
64k69k
77k
One woman is killed in Australia by a partner or ex almost every week
1
8
22
2
9
1615
25
5
17
24
3
11
18
12
19
26
6
13
27
7
14
21
28
Children are present in1 out of every 3 family violencecases reported to police
3 women are hospitalised each week in Australia with a traumatic brain injury caused by their partner or ex
death,
Intimate partner violencecontributor
Victorian women
the is
in
leading
& illnessdisability
to
aged 15–44
Aboriginal women are 35x more likely to be hospitalised by family violence than other women
35x
A woman faces an increased risk of being killed or seriously injured when she leaves or is separating from an abusive partner
CALD women face additional barriers to safety:languageisolationstrict cultural beliefsfear of police & courtsimmigration risks
financial support
Violence against womencosts the Australianeconomy
2009
$13.6b2015
$21.7b
Women and girls with disabilities are twice as likely to experience violence as those without
2x
33%are
escapingfamily
violence
Of clients accessing specialist homelessnessservices …
Sources (from top, left to right): 1. Cox, 2015; 2. Cussen & Bryant, 2015; 3. Department of
Human Services, Victoria, 2012; 4. Brain Injury Australia, 2015; 5. Crime Statistics Agency, 2016;
6. Crime Statistics Agency, 2016; 7. Aboriginal and Torres Strait Islander Health Performance
Framework Report, 2012; 8. Women With Disabilities Victoria, 2014; 9. Dimopoulos & Assifiri, 2004;
10. Australian Institute of Health and Welfare, 2014; 11. VicHealth, 2004; 12. PwC, 2015.
© 2016 Domestic Violence Resource Centre Victoria
More information: www.dvrcv.org.au
Living in fearDVRCV FACTS ON FAMILY VIOLENCE 2017
QUAL
ITY
AND
SAFE
TYWodonga District Nursing Service Staff SurveyThe Wodonga District Nursing Service (DNS) staff were asked to voluntarily participate in an anonymous and confidential satisfaction survey. The aim was to gain information to improve the service to ensure a safe, supportive and productive work place environment for staff. The small team of 10 nurses were sent surveys and 9 responded. The results indicate that the DNS staff feel physically safe in their office environment. Not one staff member indicated that they had been bullied or harassed in the workplace (100%), but, if necessary, they would feel comfortable reporting such incidents (89%). It was pleasing to note that all staff feel they are treated with respect by their peers and management.The dangers for staff working out in the community can be higher than working in
an office environment. The service strives to provide staff with safety mechanisms such as mobile phones in good working order, tracking system and navigation in the vehicles. Other measures include recording car and phone numbers in a log, maintaining a patient list with expected visit times and whereabouts so that staff can be easily traced. To enhance this, the DNS will be trialling a personal duress alarm system. It is concerning that 45% of staff indicated that they have experienced occupational violence (OV) from DNS clients. To help staff gain skills to manage violence and aggression in the workplace they attended the “Preventing and Managing Occupational Violence in the Health Care Setting” workshops. Staff were also shown how to use the AWH occupational violence hotline.
Have you experienced bullying or harassment in the work
environment?
Would you feel
comfortable and know how to report
any bullying and harassment in the
workplace?
Have you ever experienced Occupational
Violence from DNS clients?
Do you believe
DNS provides adequate safety
mechanisms whilst working in the
community setting?
Yes
Sometimes
No
25
Mental Health Service - use of Restrictive InterventionsSeclusion and physical restraint are called restrictive interventions. Whenever possible we try to avoid using these measures, however sometimes it is necessary to keep the patient or those around them safe. Each month AWH mental health services report all restrictive interventions to the Department of Health and Human Services (DHHS). Our use of restrictive intervention rate is compared to the performance of all other Victorian health services. AWH is committed to reducing restrictive intervention in accordance with best practice and Victorian Government policy. Our seclusion rates are monitored through the DHHS statement of priorities and performance is reviewed every month by AWH senior management and the Board of Directors. In addition, when seclusion and restraint are used, the treating team will review the appropriateness of the
intervention soon after the event. The decision to seclude or restrain is always based on an assessment of the person and their need for protection and privacy.In early 2016, AWH re-committed to the SafeWards Victoria program. We are now working with the SafeWards Victoria provider for the roll out and refreshment of the program in mental health services. SafeWards is a model of care and training aiming to reduce the likelihood for conflict and containment in the acute settings through engagement, support and early intervention.
2016-2017Seclusion per 1000 occupied bed days 14.95Restraints as % of total discharges 7.46%
DNS Staff Survey Results - 2016 / 2017
NEBMHS, use of restrictive interventions 2016 -2017
AccreditationAWH is required to meet several healthcare standards and accreditation surveys. There are regular reviews and evaluations completed to ensure that we meet the requirements of these standards throughout each year. National Safety and Quality Health Service StandardsAWH was successfully accredited for 4 years against the 15 ACHS EQUiPNational Standards in 2015. In 2017, we will undertake a mid-way assessment called ‘Periodic Review’. Four (4) surveyors will visit AWH and speak with staff and consumers to evaluate how we are meeting the standards. Home Care StandardsThe Home Care Standards Quality Review took place in November 2016. This quality review assessed AWH’s Rural Allied Health Team and the Community Nursing Team for compliance with 18 expected outcomes of Home Care Standards – Quality of Care Principles 2014.Our service met all expected outcomes with no recommendations for improvement being made during this review. The services will be re-assessed in 2019.
Aged Care StandardsAWH Blackwood Cottage is a 15 bed psychogeriatric unit based on the site of Beechworth Hospital. Blackwood Cottage was re-accredited by the Australian Aged Care Quality Agency for compliance with 44 expected outcomes in September 2016. In May 2017 Blackwood Cottage had a follow up survey against the 44 expected outcomes. The survey team made four (4) recommendations for improvement which are being addressed. Improvements include:• Introduction of Nurse Practitioner rounds
to oversee patient care; • Streamlined processes to the delivery of
meals by Beechworth Health;• New décor, blinds, furniture and carpet;• Painting of interior walls;• Additional support staff to assist with
maintenance and cleaning.
Preventing blood stream infectionsStaphylococcus aureus are bacteria that cause infections and are frequently found in the nose, respiratory tract and on the skin. Healthcare associated Staphylococcus aureus bacteraemia (SaB) blood stream infections are a significant risk and can lead to poor outcomes for patients. Our SaB rates are reported to the Victorian DHHS on a quarterly basis and monitored by our senior management team and Board of Directors. In 2016 - 2017 AWH reported 6 staphylococcus aureus bacteraemia infections to the DHHS. Our overall rate for the year is 0.5 infections per 10,000 occupied bed days which is less than the Victorian 5 year aggregate rate of 0.8 per 10,000 occupied bed days. Our infection prevention and control program aims to minimise the risk of healthcare associated SaBs.
AWH Hospital Acquired SaBs, 2016/17
0
0.5
1
1.5
2
2.5
Q1 Q2 Q3 Q4
AWH TARGET
QUAL
ITY
AND
SAFE
TY
27
Hand HygieneHand hygiene is one of the most effective ways of preventing infection. Our team of hand hygiene auditors regularly check staff hand hygiene compliance using the World Health Organisation’s 5 moments for hand hygiene. The results of the audits are sent to Hand Hygiene Australia and reported back to us three times a year. The results are then used to drive improvements to enhance patient safety. Current audits show our hand hygiene rate is 83% compared with the Victorian state target of 80%. We continue to work toward consistently improving our hand hygiene rates and aim to exceed the national average.
Start fighting flu now before it arrives“Start fighting flu now before it arrives” was the theme of the 2017 influenza (flu) vaccination campaign.Every year a significant number of people acquire influenza. It is an extremely infectious virus and can be spread before you even know you are sick. Complications of the flu can be extremely serious if you already have a medical condition, you are pregnant, or have a weak immune system. As healthcare workers are at risk of both getting influenza and passing it onto their patients we encourage all our staff to have an annual flu vaccination which this year covers four strains of the virus. To promote safer care for our patients AWH make vaccinations available for staff in all areas and on all campuses. The Department of Health and Human Services set an annual
target that at least 75% of our workforce receive the vaccine. This year 77% of AWH staff were vaccinated.
Hand Hygiene Compliance, 2016/17
60%
65%
70%
75%
80%
85%
NHHI Audit 3(2016)
NHHI Audit 1(2017)
NHHI Audit 2(2017)
AWH TARGET
Reporting and Responding to incidentsAWH has a robust method for monitoring and reviewing adverse outcomes related to patient care. Any staff member can report an actual or potential adverse event in the state wide database system - VHIMS (Victorian Health Incident Management System). Since the introduction of the VHIMS the number of incidents reported in the database has continued to increase. This indicates not only greater staff awareness about their responsibility to report incidents and near misses but also an improving patient safety culture. This positive patient safety culture is reflected in the 2017 People Matter Survey where the measures of patient safety, including reporting and learning from errors, are steadily increasing.
All incident notifications are monitored by the Clinical Governance Unit, ward/department managers and the relevant service stream clinical governance meetings. Regular
reports on incident data and concerning trends are presented for discussion at senior management team meetings and the Board Quality Committee. Based on a risk assessment, various levels of investigation are undertaken with the most serious, sentinel events, requiring a report to the Department of Health and Human Services. Improvement actions resulting from formal investigation of the most serious incidents are monitored for implementation and together with the completed case reviews, forwarded to the most senior patient safety committees in the organisation. At AWH for the period 2016-17 there were no sentinel events and the majority of the reported adverse events that involved patients were near misses or minor incidents.Here are some of our more significant improvements: • Review of the processes for transfer of
patients between campuses; • Appointment of a falls prevention project
officer to help reduce falls, with a specific focus on hospital patients with delirium;
• Standardisation of how patients with acute behavioural disturbances are managed in the Emergency Department;
• Changes to how muscle relaxant medications are labelled and stored;
• Implementation of a medication administration project to reduce errors in high risk medications.
AWH Incident Reporting Rates, 1 July 2012 - 30 June 2017*Amalgamation of Victorian Mental Health Services
**Amalgamation of NSW Mental Health & Community Health Services
0
500
1000
1500
2000
2500
2012 2013 2014 2015 2016 2017
Clinical OH&S Non-Clinical
* **
QUAL
ITY
AND
SAFE
TY
29
Medication SafetyAWH is targeting zero errors when medications are given to patients (medication administration). It was within this context that AWH conducted a pilot project to gain a greater understanding of the medication administration practices and factors that contribute to the occurrence of medication administration errors. The focus of the project was the administration of APINCH drugs. APINCH is an acronym for a group of medications that pose a high risk to patient safety if an error occurs. A – Anti-infectivesP – Potassium and other electrolytes (mineral components of blood plasma)I – InsulinN – Narcotics and other strong pain killers/sedativesC – Chemotherapy drugsH – Heparin and other blood thinning drugsThe decision was made to conduct a follow on project with the aim of achieving the goal of zero APINCH medication administration errors.
The recommended actions cover a number of areas:Clinical governance - review the current policy and procedure documents; Education - ensure the nursing workforce receives standardised, comprehensive orientation and education; Workflow and Time - improve bedside facilities to support medication administration. Review the medication cupboard locations and workspace in the clinical areas;Communication – identify ways to keep clinical staff informed of medication safety updates and other items such as new equipment;The project identified the need for two dedicated medication safety practitioners to accomplish the actions; a pharmacist and a nurse. Two practitioners have been employed and their role is to promote safe administration practices and reduce the influences that contribute to potential errors.
Medication Administration incident rates (per 1,000 bed days) 2016-17 Number of Drug Administration Incidents involving APINCH
Drugs 2016-17
0
0.5
1
1.5
2
2.5
3
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
02468
101214
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
Prevention of FallsBeing unwell and in an unfamiliar environment are factors that increase the possibility of patients falling in hospital. Muscle weakness, poor balance and the effect of some medications also contribute to the risk. Not only is a fall more common for older people but they also have a greater risk of injuring themselves when they do fall. AWH aims to minimise the number of falls in hospital and the harm caused by putting into place strategies to reduce patients’ risk. Each fall that does occur is reviewed to find out what strategies were used to try and prevent it and whether any other strategies need to be put into place.Our records showed that in 2016 despite introducing some improvement strategies the number of falls across the organisation was not reducing.
At the beginning of 2017 a new falls prevention project officer was appointed on a trial basis for 6 months. The role was to work with staff to help put systems and processes in place that might help to reduce the risk of patients falling. On reviewing current practices the project officer found that more than 41% of falls occurred when patients were going to, using or returning from the toilet/bathroom. It was thought that there were a number of reasons for this.Attempting to walk unaided when patients require assistance increases the likelihood of a fall. Sometimes the patients who needed assistance to walk to the toilet or bathroom were unable to or didn’t call for help. Some said that they didn’t want to interrupt the busy nurses. The importance of asking for help is emphasised to all patients who need assistance to walk. Whether some patients were not able to reach the call bell or didn’t know how to use it, was also considered a possible cause of the falls. The project officer looked at the call bell systems that were being used and found that some were more complicated to use. Some of these have now been changed to a more simplified system to make it easier for patients. Also, for the patients who cannot always remember to ask for assistance a visual prompt has been introduced to act as a reminder.
0102030405060
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
2015-16 2016-17
April Falls MonthThe aim of this annual initiative is to promote falls prevention to both staff and patients. The theme for this year’s campaign was ‘Moving right to stay upright’. The month included a range of events such as staff education sessions, simulation exercises and focused on dizziness and vertigo. There was also a more light-hearted themed staff morning tea with information provided on falls prevention.During the month there were 9 education sessions conducted and a total of 72 staff members attended. The range of topics included medications and the risk of falls, first time fallers, postural hypotension and fainting. Many of the sessions featured a video, entitled “Barbara’s Story”, produced by the British National Health Service that presents the story of a patient who fell in hospital.On April Falls Day (3rd April 2017) the “Falls Fairy” visited the wards of both Albury and Wodonga hospitals to raise
awareness of falls prevention. Each patient was given a brochure providing tips for “staying steady on your feet”. The brochure also included the contact details for the AWH and Mercy Health Strength and Balance Groups. These low cost or no cost groups aim to help people with mobility and balance issues. AWH and Mercy Health Strength and Balance GroupsAWH – Wodonga Campus: Phone: (02) 6051 7400 AWH – Albury Campus: Phone (02) 6058 4830Mercy Health Service – Albury Phone: (02) 6042 1439
Number of Falls, 2015-16 & 2016-17
QUAL
ITY
AND
SAFE
TY
31
Pressure Injury Prevention ProgramA pressure injury, also known as a bed sore, is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Pressure injuries are recognised as a worldwide patient safety issue and a major challenge for health care professionals and health care facilities. Pressure injuries extend the length of hospital stay, and it’s estimated that 389,432 bed days were lost between 2001 and 2002, incurring opportunity costs of $285 million in Australian public hospitals. Apart from the financial impact on the health system pressure injuries have a real and negative impact on patient and care-giver wellbeing. Some patients present to hospital for treatment of pressure injury wounds and some patients that are at risk may develop a pressure injury while staying in hospital. Albury Wodonga Health’s comprehensive pressure injury prevention program aims to reduce the number of pressure injuries occurring in hospital. Patients admitted to AWH are routinely screened on admission to determine their level of risk of developing a pressure injury. Skin is also assessed on admission for any pressure injuries and pressure related skin changes. Risk screening and skin assessment compliance has improved across AWH since the introduction of a new pressure injury prevention program in 2015 This
leads to prevention strategies being implemented promptly and an overall reduction in pressure injuries at Albury Wodonga Health. Since the introduction of the new comprehensive pressure injury program hospital acquired pressure injuries at Albury campus have decreased by 33% and between 58- 79% at the Wodonga campus.Staff education, pressure injury awareness and ongoing improvements are made to the pressure injury prevention program each year.Key improvements and activities include:• Updated wound management chart
highlighting pressure injury assessment & management;
• Risk screening and skin assessment within recommended time frames;
• Prompt implementation of prevention strategies;
• Patients are provided with clear and easy to understand facts about pressure injuries;
• 2 day AWH Wound Management Conference with over 110 participants;
• Worldwide “STOP” pressure injury day promotional activities;
• AWH Pressure Injury Prevention Program presented at the Hume Region Allied Health & Nursing Conference.
AWH Hospital Wide Skin Assessment & Pressure Injury Risk Screening, % of patients, Jan 2014 - 2017
Total number of Hospital Acquired Pressure Injuries from 2014 - 2017
Our data says...Since the introduction of the new comprehensive pressure injury program hospital acquired pressure injuries at Albury campus have decreased by 33% and between 58- 79% at the Wodonga campus.
0
20
40
60
80
100
Skin Assessment Pressure Injury Risk Screen(8hrs of admission)
2014 2015 2016 2017
0
20
40
60
80
100
2014-15 2015-16 2016-17
AWH Albury Wodonga
Induction of LabourSome women do not go in to labour naturally and some need to give birth before labour starts spontaneously. When labour is not spontaneous and is started by other methods it is called ‘induction of labour’.
Induction of labour is recommended when a woman or their baby will benefit from birth being brought on sooner, rather than waiting for labour to start on its own. Standard 1a of the Victorian Perinatal Performance Indicators is the rate of inductions in standard primiparae (a woman who is giving birth for the first time). A standard primipara refers to a woman 20–34 years old who is giving birth for the first time. The woman is free of medical complications and is pregnant with a single baby that is growing normally and is born head-first between 37 and 40 weeks. This indicator focuses on low-risk and uncomplicated pregnancies; therefore, medical intervention for this group of women is expected to be low. Induced labour can increase the risk of complications, which may lead to longer recovery times for women. Therefore, hospitals with levels of induction above the state-wide rate are encouraged to review their practices and processes.Intervention(s) during labour and birth, particularly for women having their first birth, can occur at different stages and should be limited to women who have a clear medical (or psychosocial) indication.In Victoria in 2015-16, 3 per cent of labours in standard primparae were induced. At AWH during the same period 4.6% of labours in standard primaprae were induced. The graph below shows the steady decline in the AWH induction of labour rate for standard primiparae as compared to the state average.
Induction of labour should be clinically justified, weighing the risks of induction against those of continuing the pregnancy.There are guidelines that make recommendations about when to induce labour and there are different methods of induction. The decision is guided by the clinical picture, and the clinician recommendations that involves consultation
with the woman. Updated Victorian guidelines have recently been released, these guidelines and flow charts produced by Victorian Maternity and Newborn Clinical Network Maternity eHandbook (as part of Safer Care Victoria) assist decision-making and care of a woman undergoing induction of labour. This information aims to ensure a consistent approach to induction of labour and care of the woman undergoing induction of labour across the state. Additionally information has been developed with consumer input and is provided as part of the induction of labour suite of information. Women are freely encouraged to talk to their Doctor or Midwife about induction of labour, when it may be recommended and the risks and benefits to assist in making informed decisions. Expectations for performance improvement in relation to the induction of labour include: • undertaking regular multidisciplinary
audits and reviews of the indications for induction of labour;
• ensuring the information (verbal and written) provided to women regarding the benefits and risks of induction are based on scientific evidence.
1a - Rate of inductions in standard prmiparae, 2010-2016
0
5
10
15
20
2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
1a - AWH Rate of inductions in standard primiparae
1a - Rate of inductions in standard primiparae
Linear (1a - AWH Rate of inductions in standard primiparae)
Linear (1a - Rate of inductions in standard primiparae)
QUAL
ITY
AND
SAFE
TY
33
Rate of smoking during pregnancy before and after 20 weeksSmoking in pregnancy is considered to be the biggest contributing factor to the development of complications during pregnancy. Cigarettes contain thousands of chemicals including nicotine, carbon monoxide and cyanide. Tobacco causes long-term damage to the lungs, brain and blood of an unborn child and can cause complications in the mother during pregnancy as the amount of oxygen and nutrients an unborn baby needs for healthy development is reduced. The benefits of quitting prior to or during pregnancy include
• less risk of premature of labour;
• baby is less likely to die at or shortly after birth from Sudden Infant Death Syndrome (SIDS);
• baby is more likely to be born a healthy weight;
• baby is likely to be more settled and feed better;
• baby is less like to need specialised care at birth.
A baby exposed to tobacco smoke in-utero and through second-hand smoke as an infant, is more likely to develop type 2 diabetes, heart disease, kidney disease and obesity as an adult.Women during pregnancy are asked at their first visit to the Doctor or Midwife if they smoke. If a woman declares she is a smoker she is provided with education about the risks associated with smoking and the benefits of giving up smoking.
Women who smoke cigarettes are referred to QUITLINE with their consent. Alternatively women can find their own strategy for quitting as different strategies suit different people. It is important that the quitting method chosen suits the woman, and that she feels comfortable with it and the strategy suits her lifestyle. This approach leads to the woman feeling more in control of her life.
Women who declared they were a smoker early in pregnancy are asked at stages throughout the pregnancy if they have continued to smoke or stopped smoking. Collection of data on smoking during pregnancy and on successful quitting of smoking is documented and reported as part of the Victorian Maternity Performance Indicators.
The rate of women who smoke during pregnancy before 20 weeks is reviewed annually. At AWH, the rate improved over the last 5 years and was better than the state-wide average.
Educational information on quitting smoking and the QUITLINE contact number is included on the Pregnancy Care Record that each woman carries throughout her pregnancy.
QUITLINE 137848
Residential Aged Care IndicatorsAWH’s Blackwood Cottage is a 15 bed inpatient unit located at Beechworth Health Service. It cares for older people who have complex mental health conditions. As an aged care facility Blackwood Cottage is required to submit data to the DHHS on a range of safety and quality indicators. The table below notes how Blackwood Cottage is performing against the set range and state wide targets for the DHHS indicators. The results show that while some areas did not achieve the target all except one area were within the acceptable range. The elderly residents at Blackwood Cottage have a higher risk of falling due to their fragility and falls prevention is a priority for the staff. Unfortunately one resident did sustain a
small broken bone from a fall. Consequently, there has been a focus on falls prevention at Blackwood Cottage. This has included comprehensive falls training for staff and Occupational Therapy and Physiotherapy assessment of residents who are prone to falling.
The residents at Blackwood Cottage have complex care needs and many require a number of medications to manage their conditions. Sometimes the residents continue to take medications that are no longer required. A nurse practitioner has been appointed, whose role includes monitoring the residents’ medications and where possible reduce the non-essential medications.
We still don’t waste a dropAvoiding blood wastage is a priority for both AWH and our transfusion service provider Dorevitch Pathology. For the past 5 years we have worked tirelessly with staff to try and achieve a zero waste target. Through the diligent work of our transfusion service provider to balance our blood supply (which comes from Melbourne and Sydney) with our demands locally, coupled with our staff commitment and respect of donor blood, we have now achieved a wastage rate of 0.15% overall.
This means that in 2016-17 only 4 bags out of 2649 issued to our blood banks were not able to be used. An amazing result for a regional health service and pathology provider.
AWH rates per 1000 bed days
Upper Range Limit Target Result
Pressure Injuries Stage 1 0.22 1.20 0.00 Pressure injuries Stage 2 0.45 0.80 0.00 Pressure Injuries Stage 3 0.00 0.00 0.00 Pressure Injuries Stage 4 0.00 0.00 0.00 Suspected deep tissue injury 0.00 0.00 0.00 Unstageable Pressure injury 0.00 0.00 0.00 Falls 7.80 11.00 3.30 Fall related fractures 0.22 0.00 0.00 Intent to restrain 0.00 0.00 0.00 Physical restraint devices 0.00 0.00 0.00 9 or more medicines 3.12 3.50 2.10 Significant weight loss (>3kgs) 0.22 1.00 0.20 Unplanned weight loss 0.45 1.00 0.00
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
Albury Wodonga PeerGroup
State National
Red Blood Cell Waste, 2016-17
QUAL
ITY
AND
SAFE
TY
35
We take your concerns seriouslyREACH - patient and family escalation of care
To support patient and family engagement within AWH, a process called REACH has been introduced. It aims to provide patients and their families with an avenue to alert staff to a deterioration in the patient’s condition. The process recognises that patients and families can often detect deterioration before signs are clinically evident.
REACH is a communication process that helps patients, their families and carers to raise their concerns about a worrying change in their condition while they are in hospital.It is a way of partnering with patients and families as important members of the care team to escalate care which casts the safety net further and helps avoid critical delays in clinical care.
R.E.A.C.H In practiceR. The patient, or their family, may recognise a worrying change in their condition. E. We encourage patients and their families to engage with the treating nurse or doctor who may be able to help to resolve these concerns. A. If the concern is not responded to, or the patient gets worse, act. The patient or their loved ones can ask to speak to the nurse in charge and request a ‘clinical review’. This review should occur within 30 minutes.C. If the patient or their family is still very concerned they can call 333 for the Medical Emergency Team (MET). The team will arrive within minutes. H. Patients can be assured that Help is on its way.The Medical Emergency Team (also called the MET team) is a group of highly trained hospital staff that can be called if it appears that the patient is getting sicker very quickly. The team works with your doctors and nurses in urgent situations to address worrying concerns.REACH Posters are displayed throughout the hospitals and brochures about the process are available for patients and their families/carers.
HOW DO I CALL FOR AN
EMERGENCY RESPONSE?
If you have engaged with your
treating nurse and doctor, have
acted by requesting a clinical
review and continue to be
seriously worried…
Call 333 for an Medical
Emergency Team response.
WILL I OFFEND STAFF IF I
R.E.A.C.H OUT?
No. Staff in this facility support
patient and carer involvement.
You know how you feel or how
your loved one usually behaves.
We also encourage you to raise
your concerns with us during
times of handover between staff
shifts. Speak to the nurse in
charge for these times.
We want you to work with us to
create the best experience for
you or your loved ones.
Are you worried
about a recent
change in your
condition or that
of your loved
one?
R.E.A.C.H
out to us
R.E.A.C.H out
to us.
Together we
make a great
team.
SEPTEMBER 2015
W H AT I S R.E.A.C.H ? We know that you know yourself or your loved one best. This is why we want you to let us know if you notice a worrying change.
R..E..A.C.H is a communication process which will help you share your concerns with us.
R.E.A.C.H will help with worrying concerns that have not yet been addressed or acted on by staff.
W H AT D O E S R.E.A.C.H S TA N D F O R ? R.E.A.C.H R.E.A.C.H has been formed from the initial letters of these steps:
The letters in R. E. A. C. H can remind you of the steps to take to help in your care, or the care of your loved one.
R.E.A.C.H I N P R A C T I C E You may recognise a worrying change in your loved one’s condition or, if you are a patient, you may recognise a worrying change in yourself. If you do recognise a worrying change, engage with the nurse that is looking after your loved one or you. Tell the nurse or doctor your concerns.
If your concern is not responded to, or you or your loved one is getting worse, act. Ask to speak to the nurse in charge and request a ‘clinical review’. This should occur within 30 minutes. If you are still very concerned call 333 for the Medical Emergency Team or MET. The team will arrive within minutes.
Help is on its way.
R
E
A
C
H
Recognise Engage Act
Call
Help is on its way
SEPTEMBER 2015
Are you worried about a recent change in your condition or that
of your loved one?
Ask your nurse for an urgent ‘clinical review’
If you remain concerned dial 333 to call the medical
emergency team.
We know that you know yourself or your loved one best.
R.E.A.C.H out to us if you are worried. Together we make a great team.
Have you spoken to your nurse or doctor about this worrying change?
Have your concerns been followed up? Are you still concerned?
Peer Support Breaks New GroundThe Peer Support Program, introduced in March this year, provides a unique opportunity for clients of the mental health service to experience hope and support by having access to a peer support worker. A peer support worker is a person who has first-hand knowledge of the challenges of living with a mental illness and of the recovery journey.‘Peer support workers are becoming more common in mental health services’ said Karen, peer support worker at AWH Mental Health Services. ‘Research overseas is indicating that there are benefits for individuals and for the team by including the perspective that people with lived experience can bring. This research reflects improvements in readmission rates, situations like awareness of medication and overall improvement in measurable health outcomes’. Anecdotal evidence shows that people ‘feel better’ when they can talk to someone who has had a similar experience to themselves.Peer support is a new process in clinical services and it is a quality improvement. It was introduced as part of the Victorian Government’s 10 year Mental Health Plan which outlines strategies to improve mental health services across the state. This particular program targets the time immediately after people are discharged from hospital. ‘It is recognised that this time is a period when people can be vulnerable’, said Karen, ‘and being supported by a peer worker for that immediate transition is quite helpful’. Clinical services have been doing much of the ‘heavy lifting’ in providing service to people who experience mental health challenges. By introducing peer workers to the work force, support is being enhanced and clients are being engaged in their own care.Travelling into the unknown can be a daunting task. Not knowing where a journey will take us is part of life, but it never hurts having a voice of guidance along the way. Having family and friends to support us is important, as is having someone who has been down the path before. This is why the benefits of having a peer support worker alongside you are second to none.Karen believes her role is one that doesn’t just benefit the patients and consumers.
‘Peer support workers enhance the delivery of the service. They are not only a resource for clients, this worker is a resource for the other staff members in the team. They are available to consult around their lived experience.’For Karen, her experiences as someone living with bipolar disorder has shaped her life dramatically. She has lived with the condition for over 40 years and says the lack of knowledge around mental illnesses when she first had a “breakdown” as an 18 year old made life extremely difficult.
‘For many years I was undiagnosed and I was going through episodes of mood swings and periods of being really unwell and not coping. I would become well but then I would have another episode. It wasn’t until
“The role of the peer support worker is becoming increasingly
popular in the mental health care sector. Karen, is using her past
experiences to empower mental health consumers.”
“Sharing my own experiences has empowered patients and
consumers to open up about their own experience”
- Karen
QUAL
ITY
AND
SAFE
TY
37
2001 when I had a major panic episode in Melbourne that I was diagnosed with bipolar and all of a sudden it made sense. I was able to get treatment and because bipolar is a life-long condition, I’ll have to continue treatment with medication and counselling for the rest of my life. But I’m able to work now whereas as I wasn’t able to work for quite a while’.Karen’s peer support work is personalised towards supporting people whose lives have been severely affected by mental illness. ‘Instead of focusing on people’s deficits, we look at what they are able to achieve. We encourage them to look at what their strengths are, which may be that they have a family, for example. If you’ve got a family then how can your family actually assist you in your recovery? You may be able to keep in touch with your family more and that may lessen your sense of isolation. So that would be an example of using a personal strength to overcome something that you’re finding difficult to deal with’.Since becoming a peer support worker, Karen has been able to give back to the mental health community. She says she has always been interested in advocacy work and providing a voice for people who may not feel comfortable or able to speak up.‘This role now fits with my own personal goals, to contribute to society. Sharing my own experiences has empowered participants to connect and open up about their own experience. It has
stimulated ideas about recovery and proved that it is possible. The empathy that is experienced when you share with someone who knows the landscape from their own experience is really valued’.Peer support plays an integral part in the mental health structure. Karen believes that more mental health services should embrace the role of the peer support worker.
Continuity of CareAn important aspect of continuity of care includes how services ensure discharge or transfer practices meet the needs of consumers.
Supporting Children and Families with Type 1 Diabetes MellitusThe Albury based diabetes educators work closely with families, paediatricians, allied health services and schools to support children with type 1 Diabetes Mellitus (diabetes) and their family to navigate the challenges of diabetes management. The relationship begins at diagnosis of type 1 diabetes when the diabetes educator visits the child and their family in the hospital paediatric ward. Their role is to educate, provide support and guide them through the emotional journey they are experiencing. For many, this relationship continues through to adulthood and beyond. The diabetes educators work closely with the Community Health team of dietitians and the Albury Wodonga Paediatric Group to provide a positive team environment for families managing type 1 diabetes. This includes weekly clinics at the Albury Wodonga paediatric rooms where the diabetes educators and paediatricians work together with families to develop plans to support independent diabetes management. Through a team approach to diabetes management these clinics provide:• Physical assessments;• Emotional assessments;• Support with decisions such as
transitioning from insulin injections to insulin pump therapy;
• Ongoing education and support;• onsite HbA1c (glucose assessment)
pathology testing. In addition to the regular paediatric clinics the community diabetic educators liaise and work closely with paediatricians and dietitians to provide regular reviews, education, support and guidance through all aspects of diabetes care including challenging life stages such as
schooling, puberty, transitioning to adulthood and managing illness. Significant education is required in many areas of a child’s life and schools particularly need support. The team run a series of education programs for schools and teachers at the beginning of each school year to ensure students with diabetes have support outside the family home to self-manage their condition. HbA1c pathology testingThe HbA1c test is a valuable blood test that provides a good indication of how well the person’s diabetes is being controlled. Thanks to our partnership with the Albury Wodonga Diabetes Support Group (Community Support Group) and a grant they received from Albury Commercial Club we have the use of an HbA1c machine. This onsite HbA1c testing allows for quick pathology results via a simple finger prick of blood rather than traditional venous blood collection which children often find traumatic.
CONT
INUI
TY O
F CAR
E
39
Case Study - Wodonga Community HealthType 1 diabetes accounts for 15% of the Australian population who are living with diabetes. Even though we don’t hear about type 1 diabetes as often as we do type 2, the complications associated with type 1 diabetes can be dire. For a person living with type 1 diabetes, a hospital presentation can be quite complex, and involves input from a number of health care professionals to ensure the best outcomes can be achieved.Story from Katie an AWH Diabetes EducatorI would like to share a story about a young 24 year old woman who presented to hospital following multiple hypoglycaemic seizures. She also experienced a stroke and other complications which required input from a neurologist. When I first met this young patient, her motivation to engage in conversation about her diabetes was challenging, and she had very little intent to focus on improving her diabetes management. She had experienced learning difficulties for most of her life and didn’t finish her schooling. She also had problems obtaining a job due to her poor diabetes management and had to rely on the disability pension for income. She did not drive which meant she had very little independence and limited ability to integrate into the community or attend appointments. It was identified during her hospital admission that a more coordinated approach to her diabetes management in the community would be beneficial and a referral to the Health Coordination Team (formerly HARP) was placed. Being involved with this team became the foundation for change for this young woman, where she learnt vital skills and strategies to gaining a better understanding of her diabetes and how she could consider looking at the challenge of this condition in a different light. She was able to have one-on-one education sessions with the diabetes educator, and it was here that she started to show signs of change.
Due to her marked progress, this young woman transitioned from the Health Coordination Team to the community health diabetes education and dietetics services, where she continues to have regular review appointments, as well as involvement with the AWH endocrinologist. With access to the latest technology in diabetes management such as continuous glucose monitoring, the team in community health have been able to fine tune her insulin regimen and identify problem areas in her control that hadn’t been picked up previously. This technology, much of which has been donated through funding applications from the Albury Wodonga Diabetes Support Group, has had a considerable impact on her diabetes management by improving her knowledge of how she can control her diabetes. She now has more insight and understanding of her diabetes which has improved her motivation and willingness to learn. This has seen her diabetes control improve and her risks of complications significantly reduce. This young lady now has a stable job that she loves, has recently obtained her driving license and couldn’t be happier. “I think about my diabetes differently, now. I know that it’s up to me to look after my health, but I feel with the support I have around me, I can see better results with my diabetes. I’m not so scared of failing anymore”.
Have you had the conversation? Advanced Care Planning - it’s everybody’s businessAWH has committed considerable resources to promoting the value of the advanced care planning to enable better end of life decision making for clients. Advanced care planning has been shown to improve the quality of care people receive at the end of their life. However effective conversations about ACP require skill and empathy. To facilitate this AWH has provided regular advanced care planning training opportunities for staff. In 2015-2016 the DHHS reported that 38% of sub-acute ambulatory care clients had an advanced care plan.
Anne and Brian’s StoryAnne and her husband Brian decided it was important that they
both complete their advance care plans. Anne believes completing their plans has ‘lifted a weight off their shoulders’. She believes that making decisions about preferences for treatment and end of life care will reduce the anxiety and stress for her family.
Advanced Care Planning Simulation Training for AWH staffAdvanced Care Planning is the process of discussing and planning for your future health and personal care needs, and involves documenting your wishes and sharing this information with your loved ones and healthcare organisations such as AWH. Advanced care planning (or advanced care directives as they are sometimes known) gives those caring for you the ability to know and respect your wishes, values and beliefs in relation to your healthcare. They guide future treatments and clinical decision making if you are unable to speak for yourself due to serious illness or injury. They can be changed, updated or withdrawn at ANY time by the person who the plan relates to. Anyone over the age of 18 can make an advanced care plan. Initiating a conversation with a patient or client about advanced care planning can sometimes seem daunting or difficult for staff. Therefore, a simulated scenario was designed and delivered to staff to increase their knowledge and skills around this important subject and improve their confidence in initiating an advanced care planning conversation. Simulation is an educational method that helps healthcare professionals learn through participation in specially developed scenarios that replicate real life encounters between staff and patients. The advanced care planning scenario involves a healthcare professional meeting with a simulated patient (a volunteer
actor who has been trained to portray the role of a patient). The staff member actively listens to the patient’s concerns regarding their health and utilises the conversation to uncover their values and beliefs and discuss advanced care planning. Following the scenario, a group discussion is held with all simulation participants, including those who observed the scenario, and learnings are shared and explored. In 2017 four advanced care planning simulation sessions were conducted with 53 staff and students attending. Feedback from the participants was very positive and they reported that the sessions were extremely useful and effective for increasing their knowledge. One staff member reported that the simulation increased their skills to the level that they were able to initiate a conversation about advanced care planning with one of their clients in the weeks following the scenario.
CONT
INUI
TY O
F CAR
E
41
End of Life CareAWH’s End of Life (EOL) Care Working Party meet regularly to ensure that we are delivering and improving care for patients and their families at the end of life.In 2017, an end of life clinical service plan was developed that will ensure that AWH is providing care in line with the Australian Commission for Safety and Quality in Health Care’s national consensus statement: Essential elements for safe and high-quality end of life care and Victoria’s end of life and palliative care framework. The 10 key elements that are addressed include:1. Patient Centred Care2. Teamwork3. Goals of Care4. Using Triggers5. Responding to concerns6. Leadership & Governance
7. Education & Training8. Supervision & Support9. Evaluation & Feedback10. Supporting SystemsAn end of life clinical pathway was developed and has been reviewed. The clinical pathway standardises care reducing variability in practice and ensures the patient receives the best possible care.
The results have shown that care is delivered to a very high standard with patients and families receiving end of life care that is patient centred and meets their individual needs at very a difficult time. Other priorities for the Palliative Care Working Group has been focused on meeting the key areas under the Victorian End of Life & Palliative Care Framework.
Priority Area What the Framework recommends What we did
3
People experience services that are coordinated and designed locally.
The EOL clinical pathway ensures that each patient has access to many health professionals. Not just nurses and doctors but a whole team.
Early discussion, referral, planning and coordination occurs.
We have processes in place to ensure we give families time to plan and make decisions about care and treatment options with the treating team.
The primary, hospital, palliative and aged care sectors connect effectively to respond to care needs.
Our Nurse Practitioner works across the Hume region with many health services and professionals to ensure that we are effectively responding to the needs of our community.
4
Knowledge is increased across the healthcare sector to provide safe, quality care.
Many staff have received education and information to support them to provide best practice care.
End of Life care is consistent across the healthcare system.
The pathway reduces variation in care ensuring that care is provided to the highest standards.
Healthcare staff are equipped to communicate and deliver the benefits of palliative care.
Communication is key in healthcare. Effective communication between staff, patients and their families ensures that end of life care is effective and appropriate.
Organisations actively support their staff in the delivery of quality end of life care.
AWH has systems in place to support staff to care for patients at the end of their life.
Supporting Parents from Pregnancy to ParenthoodSarah and Scott were looking forward to becoming parents for the second time. They knew that being parents was rewarding although hard work but they had always been a great team and supported each other well. As a busy working mum, Sarah still found time to have a close and nurturing relationship with two-year-old Kayden. This pregnancy was hard and uncomfortable for Sarah, as she experienced hyperemesis gravidarum a severe form of pregnancy sickness. Sarah gave birth at the Maternity Unit at AWH to a healthy baby boy, Spencer. Sarah was pleased that feeding was going well as it had taken some time to get it “right” first time round. The domiciliary midwife visited two days after their discharge from hospital and noted that Sarah and Spencer were progressing well.Over the next month Spencer became more unsettled and both Sarah and Scott struggled to get adequate sleep. Sarah found it difficult to cope, especially when Scott returned to work. She was low in mood, had little appetite or energy. She found it hard to let their family and friends know what was happening for her.Knowing that this was more than the normal tiredness Sarah called on Kate her trusted AWH Child and Family Health Nurse. Kate promptly referred Sarah to the Perinatal
Emotional Health Program (PEHP). The PEHP is an AWH specialist early intervention service supporting emotional health during pregnancy and early parenting 0-12 months. The role of the program staff is to assess, provide treatment and support to women with perinatal mood disorders. After assessing Sarah and talking to Scott it was apparent that Sarah was suffering Postnatal Depression (PND). PEHP nurse Kerry liaised with Sarah’s GP and she commenced treatment. Sarah said Kerry was a wonderful support “to help me work on me”. A big worry for Sarah was how this illness could impact upon her bonding with Spencer. She was keen to be referred to the Early Intervention Home Visiting Program (EIHVP). The EIHVP is a service of the AWH Parents and Babies Service in partnership with Tresillian Family Care Centres, which works with families in their home to help support, strengthen and develop the infant-parent relationship. The EIHVP nurse works with the family identifying strengths, promoting understanding of infant communication cues and awareness of developmental needs as well as supporting parents to respond sensitively to their infant. Sarah states “coming to my home was the best thing”.
CONT
INUI
TY O
F CAR
E
43
The EIHVP nurse Lisa supported Sarah in building on her incredible strengths as a mother to help her understand Spencer’s communication cues, his individual needs and the challenges of parenting. Sarah states that “the most helpful thing was having someone objectively looking in, who was genuinely there to help me and my family; you gave me the tools I needed to move forward, pointing out the little things that I wasn’t aware I was doing making me feel like I was actually doing a good job”. Sarah was able to develop skills and strategies to adapt to the ever evolving changes of being a parent. She was able to use her new found tools to read Spencer’s cues, understand his needs and work with him throughout his developmental changes strengthening a unique and loving relationship. Sarah felt that the program helped build her confidence, by showing her she was more resilient than she thought she was, it gave her new abilities and tools to work with”.Sarah was eager to learn more to assist her recovery from PND. As part of her treatment Sarah decided to attend the Getting Ahead group, a therapeutic program run by a partnership of clinicians from AWH, Tresillian and the City of Wodonga. Sarah found this extremely
helpful to explore her amazing journey through her recovery from PND.Sarah has now returned to work and is proud to talk of “how far she has come in her journey.” She is very pleased about her sense of closeness with Spencer. She has decided to attend the Circle of Security group which will be provided through the Parents and Babies Service, to build upon her understanding of her children’s emotional needs and how to support their development. She and Scott work together to manage the everyday ups and downs of parenting.
GlossaryGlossaryTerm DefinitionACHS Australian Council of Healthcare StandardsACP Advanced Care PlanningAcute Brief and severe
Acute Care Providing emergency services and general medical and surgical treatment for acute disorders rather than long-term residential care for chronic illness
Allied HealthA group of health-care services, such as occupational therapy, speech pathology and physiotherapy, provided by appropriately qualified professionals
APINCH drugsAn acronym for certain high risk medications. A = Anti-infectives; P=Potassium and other electrolytes, I = Insulin; N = Narcotics (strong pain killers); C = Chemotherapy drugs; H = Heparin and other anti-coagulants (blood thinning drugs)
AWAHS Albury Wodonga Aboriginal Health ServiceAWH Albury Wodonga Health
Bipolar disorder A mental health condition that causes periods of depression and periods of elevated mood
CACCommunity Advisory Committee, an advisory committee to the Board and one way in which we actively involve community members in improving the services we provide
Carers Paid or unpaid people, including families and friends providing care to consumers
CGU Clinical Governance Unit
Clinical Pathway A clinical tool for standardising care that reduces variability in practice and improves patient outcomes
Consumer People who are current or potential users of our service
Continuity of Care Uninterrupted health care for a condition from the time of first contact to the point of resolution or long-term maintenance
COPD Chronic Obstructive Pulmonary Disease, a term used for a number of lung diseases that limit proper breathing
Delirium A serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment.
DHHS Department of Health and Human Services (Victoria)DNS District Nursing ServiceED Emergency Department
Endocrinologist A doctor specialising in treating people with conditions caused by problems with their hormones. This includes diabetes.
EOL End of LifeHARP Hospital Admission Risk Program
Term DefinitionHbA1c A measure of the longer term trend (similar to an average) of how high blood
sugar levels have been over a period of timeHyperemesis Gravidarum A complication of pregnancy characterised by severe nausea, vomiting and weight
lossHypoglycaemic seizures Low blood sugar levels resulting in seizure
Inpatient Someone who requires an overnight stay at the hospital
Koolin Balit Koolin Balit means healthy people in Boonwurrung language
KPI Key Performance Indicator
LGBTIQ Lesbian, Gay, Trans, Intersex and Questioning
Maternity The care of women at childbirth and their newborn babies
MET Medical Emergency Team - a group of highly trained hospital staff who respond to admitted patient medical emergencies
Midwifery The practice of assisting childbirth
NEBMHS North East Border Mental Health Service
NSQHCS National Safety & Quality Health Care Standards
NUM Nursing Unit Manager
OHS Occupational Health and Safety
Patient Experience Survey
Any survey conducted to ascertain information on a patient’s experience within the health service
Physical Restraint The restriction of patients movement or behaviour in order to maintain their safety or the safety of those around them
Primiparae A woman who is giving birth for the first time
Psychogeriatric The branch of health care concerned with mental illness in elderly people
RAHT Rural Allied Health Team
REACH A communication process for patients and their families to escalate concerns about a worrying change in condition
Seclusion The isolation of a patient in a special room to decrease stimuli that might be causing or exacerbating their emotional distress
Type 1 Diabetes Mellitus A chronic condition in which the body is unable to produce insulin resulting in high blood sugar levels
VASM Victorian Audit of Surgical Mortality
VHES Victorian Health Experience Survey
VHIMS Victorian Health Incident Management System
Albury Wodonga
Health
Contact UsAlbury Wodonga Health
PO Box 326Albury, NSW 2640
ABN: 31 569 743 618www.awh.org.au
Albury HospitalBorella Road
Albury, NSW 2640Phone: (02) 6058 4444
Fax: (02) 6058 4680
Wodonga HospitalVermont Street
Wodonga, VIC 3690Phone: (02) 6051 7111
Fax: (02) 6051 7477
We need your feedbackWe rely on feedback to ensure the Quality Account continues to provide the information you want about the safety and quality of our health services. Please complete the feedback form below. Tear out this page and fold as an envelope. Then either: • Post to: AWH, Clinical Governance Unit, PO Box 326, Albury NSW 2640• Return in person to any AWH reception point.
1. What did you think of the information in this report?
2. What did you think of the presentation of this report?
3. Did you like the magazine format?
4. Did you find the articles to be:
5. The report gave me a better understanding about the services AWH provides:
6. Please tick the age range that applies to you:
Poor 1 2 3 4 5 ExcellentComment
Poor 1 2 3 4 5 ExcellentComment
Not interesting 1 2 3 4 5 Interesting
Strongly Disagree 1 2 3 4 5 Strongly Agree
<20 21-30 31-40 41-50 51-60 60+
Yes No Indifferent
7. Would you please tell us which suburb / town / rural area you live in?
8. Do you have any suggestions for improving this report? What would you like to see more of? What would you like to see less of?
8. Are you interested in being part of a committee preparing next year’s AWH Quality Account?
Yes (include contact details) No
Name:
Address:
Postcode: Phone:
