Nurse Endoscopy

In June I attended the Victorian Health Care Quality Association showcase on award winning innovative practice. My previous report is on the HCCA blog.

The innovation showcase was an event put on by the Victorian Healthcare Quality Association, the Centre of Research Excellence in Patient Safety, the Victorian Department of Health and the Australasian Association for Quality in Health Care. It was held in St Kilda over two days, and show cased quality improvement initiatives which have won major awards across Australia over the previous 12 months

Sylvia Constantinou, a Nurse Endoscopy at the Austin Hospital, gave an overview of the nurse endoscopy services in Victoria. This is related to the Health Workforce Australia work on Extended Scope of Practice for health professionals.

In the state of Victoria endoscopy nurses are advance practice nurses and have been credentialed to deliver this service. They scope independently and with access to gastroenterologists. They are not nurse practitioners. This is a new pathway for nurses in Australia but has been happening overseas for some time (the UK has been doing this for 20 years.)

Why nurse endoscopists?

Bowel cancer is a preventable disease. Early detection results in cure. There has been a bowel cancer screening program put in place but there I an increasing number of requiring screening with a colonoscopy. There is a growing awareness in the community of familial links. Yet with this awareness it is the second most common cancer in men and women in Australia.

Austin Health was part of the National Bowel Cancer Screening Program since 2002, when the pilot. In Victoria there were 188,000 screened. 6000 were faecal occult blood positive. Of these one third will show cancerous cells.

This year there will be 4.8 million people eligible for screening.

Austin, Alfred, Monash and Western have all been implementation sites as part of Health Workforce Australia program. The Victorian Government funded the State Endoscopy Training Centre (SETC) and the goal is to train 15 nurse endoscopists to work at ten public hospitals.

The Austin Hospital has a large gastro hospital and perform almost 3000 colonoscopies per year with more than 2000 people waiting. At the Austin 12% of colonoscopies are completed by the There are 29 doctors and colorectal surgeons and they perform 79% of the colonoscopies

There are two nurse endoscopists in Victoria and independently practices and there are three trainees as part of the HWA project. The theoretical training is provided by University of Hull in the UK.

Austin Health have a useful FAQ on nurse endoscopy online.

It seems clear that there is a role for nurses working in this area with extended scope. We need them to be safe and procedurally efficient. We also need a career path as well as need for education, support and supervision.  With the demise of HWA I hope this program of work is not shelved as the functions are absorbed into the Department of Health

Darlene Cox

Managing and Enhancing Care Co-ordination in Chronic Disease Management

Speaker: Jan Ironside

June 20 2014

On Friday 20 June, HCCA in collaboration with the Chronic Care Program at the Canberra Hospital hosted a health issues group on how to better manage your chronic conditions and what services the Chronic Care Program provide to the community in order to achieve this.

The growing ageing population has led to an increase in the number of people developing and living with chronic conditions. This has brought up global concerns as there are limited resources to accommodate for the increase in patients. In response to this growing health issue, the Clinical Care Program has trialled a successful project that focuses on better self-management and person centred care.

The project works to maintain patient safety, ensuring that people are informed decision makers and more in control of their health. The Chronic Care Program categorises people using their level of need; category 1 for high needs and category 2 for low needs. This enables staff to prioritise and appoint the appropriate amount of time to each of their patients, improving efficiency but not decreasing the quality of care received.

All people referred to the program by nurses or general practitioners are contacted immediately by an assigned care co-ordinator and are categorised as category 1. The care co-ordinator assesses the living environment of the person through a home visit and helps them to create a care plan that is specific to their needs. They can also make any appointments the person may need and can accompany them for extra support. Phone calls are made regularly to the person to ensure they are on track with their plan and self-managing their condition.

Once the person has become familiar with their care plan and have gotten into a regular routine, the person graduates from category 1 to category 2. Category 2 allows people to have more independence with managing their condition. Phone calls become less regular and the care co-ordinator slowly becomes less involved in their care routine.  Once the person feels in control of managing their condition without much assistance from their care co-ordinator, either the co-ordinator or the person can recommend to be taken off the program.  

Alongside this project, the Chronic Care Program have collaborated with the CSIRO in a nationwide trial of the Tele-health home monitoring devices that further educates and supports people with chronic conditions to manage their health and improve their quality of life. The devices allow people to self-monitor and measure their blood pressure, blood sugars, lung capacity, body weight and temperature and perform a basic Electrocardiogram (ECG). This information can then be transmitted securely through a high-speed internet connection (provided by the CSIRO) to health professionals who can assist the person with any concerns they may have via a telephone call. This helps to reduce the number of unnecessary hospital and doctor visits and the costs that are associated.

With the success of their trial, the Chronic Care Team hope to increase their capacity to expand this promising program. For more information, contact the Chronic Care Program on 02 6244 2222.

By Khalia Lee

HCCA Administration Assistant

Job Vacancy

Project Officer

Health Infrastructure Program

(SCHADS Community Worker Level 5)

Do you care about the quality and safety of health services? Are you interested in planning and project management? Can you work independently and use your initiative? Are you resourceful and like a challenge?

We are looking for someone to  join our staff team working on the Health Infrastructure Program (HIP).

The Project Officer will work under limited supervision by the HIP Coordinator to

• Support Consumer Representatives on a range of committees involved in decision making for the HIP;
• Represent HCCA on a range of committees involved in decision making for the HIP;
• Network with consumer and community groups to further consumer involvement in informing decisions regarding the HIP.  This will include outreach to marginalised and vulnerable communities (including but not limited to: people living with chronic conditions, who have low socio economic status or are disadvantaged, are from culturally and linguistically diverse backgrounds, have a disability, young people and children);
• Liaise with ACT Government about opportunities for consumer involvement in HIP activities; and
• Work closely with consumer and community organisations to ensure opportunities for engagement of health consumer representatives in HIP activities.
• Help ensure the work of HCCA on the HIP is effective and meets the requirements of the Service Funding Agreement with the ACT Government.

This is a full time position but there is potential to negotiate on hours. This is a contract position until 30 June 2016, in line with our Service Funding Agreement with the ACT Government. Other conditions of employment will be based on the Social, Community, Home Care and Disability Services Industry Award 2010 (SCHADS).

HCCA promotes a healthy work-life balance and is committed to offering employees a supportive family friendly working environment.

Selection Criteria

1. Excellent communication and interpersonal skills to effectively communicate information and ideas, work cooperatively with others, and negotiate and advocate on behalf of consumers. 
2. Demonstrated ability to manage complex projects effectively including experience in project management
3. Excellent time management skills and demonstrated ability to manage competing priorities and achieve work outcomes
4. Understanding of governance principles and committee processes
5. Strong understanding of community development and experience in community engagement, including the capacity to represent the organisation in public forums and facilitate meetings, information sessions and workshops
6. Demonstrated ability to plan, organise and facilitate workshops, information sessions, discussion groups and public meetings.
7. Proven ability to develop and maintain strong networks and partnerships with key stakeholders including people from diverse language and cultural backgrounds.
8. Demonstrated understanding of the barriers and opportunities which exist in achieving systemic change
9. Computer literacy including experience with MS Office and Internet research skills

DESIRABLE QUALIFICATIONS:

10. Relevant tertiary or other recognised qualifications
11. Current drivers licence.

All applications must include:

1. A covering letter stating your intention to apply for the position and addressing the selection criteria listed below.

2. A current CV.

3. Information for two Referees. (Name, Title and Organisation, Relationship to applicant, contact telephone, contact email address)

Applications close on Monday 21 July 2014 and should be addressed to:

Darlene Cox

Executive Director, HCCA

100 Maitland St Hackett ACT 2602

Full details are on the HCCA website:

http://www.hcca.org.au/about-hcca/staff

National Blood Authority Transfusion (NBA) Update Melbourne 15 May 2014 By Jo Bothroyd

I attended the day-long Clinical Practice update session of this event as the Consumer Lead on the ACT Standard 7 Blood and Blood Products Committee.  HCCA sponsored my registration.

Most presentations were very well received and focused on projects or programs designed to help health services develop their Transfusion Quality Improvement Systems so that they comply with Standard 7 which requires;

“Clinical leaders and senior managers of a health service organisation implement systems to ensure the safe, appropriate, efficient and effective use of blood and blood products. Clinicians and other members of the workforce use the blood and blood product safety systems.”

and on the accreditation criteria listed at the bottom of the post.*

Both the Australian Red Cross Blood Service and the National Blood Authority have developed of smart phone/IPad applications (apps) to provide information and support for transfusion services. A WA Red Cross Blood Service app designed for services treating people with high iron/ferritin levels was reported as achieving reduced times from referral to treatment and cost savings for health services.  High iron and related conditions are apparently becoming more common because people are living longer and are more readily diagnosed.

Through the NBA app transfusion service can access information about:

1. Use and management of blood and blood products in accordance with national evidence-based guidelines.

2. Risk mitigation, education and safety and quality improvement programs for the management and use of blood and blood products.

3. Reporting and feedback mechanisms into risk management processes for adverse events, incidents and near misses relating to transfusion practice.

4. Policies, procedures and protocols for documenting transfusion details in the patient clinical record.

5.  Appropriate management of blood and blood products.

6. Informed consent is documented for transfusions.

From my point of view development of smart technology apps will provide a new level of immediate access to evidence based information and therefore should reduce delays in determining the best approach to treatment. The alternative up until now (when beside computers were not available) was access to information via a desktop.

A presentation on informed consent revealed that there is no agreed approach to obtaining consent in terms of blood and blood products.  Some services get separate consent for each type of blood product; some services appear to use the general consent signed on admission to hospital as consent for blood and blood products; and some presenters suggested their organisation is considering getting separate consent for each unit of blood or blood product given to a consumer.

My impression was that there is good communication between the NBA and State Based Transfusion Services and between individual State and Territory services.

Participants did say that they valued the opportunity to network and develop links with other services and individual clinicians.

Jo Bothroyd

*Standard 7 four key Accreditation Criteria

Governance and systems for blood and blood products prescribing and clinical use - Health service organisations have systems in place for the safe and appropriate prescribing and clinical use of blood and blood products.

Documenting patient information - The clinical workforce accurately records a patient’s blood and blood product transfusion history and indications for use of blood and blood products.

Managing blood and blood product safety - Health service organisations have systems in place to receive, store, transport and monitor wastage of blood and blood products safely and efficiently.

Communicating with patients and carers - Patients and carers are informed about the risks and benefits of using blood and blood products, and the available alternatives when a plan for treatment is developed.

Innovation in health care - conference report (Part 1)

The Victorian Health care Quality Association committee decided to bring people into one room to share their award winning innovative practice. The papers focused on the acute health sector.

The innovation showcase was an event put on by the Victorian Healthcare Quality Association, the Centre of Research Excellence in Patient Safety, the Victorian Department of Health and the Australasian Association for Quality in Health Care. It was held in St Kilda over two days, and show cased quality improvement initiatives which have won major awards across Australia over the previous 12 months.

The day started with a short introduction by Prof Chris Brook, the Chief Advisor on Innovation, Safety & Quality. He has responsibility for quality and safety in health care and clinical trials in Victoria, no small task. 

He declared that working in quality and safety in health care in not for the faint hearted and went on to give three examples:

In the 1880s Semmelweis noticed that women giving birth at home had a much lower incidence of childbirth fever than those giving birth in the doctor's maternity ward. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%. He published his findings and was scorned by the medical profession. He died in poverty and misery.

In the 1920s a US surgeon, Codman was concerned that the rate of adverse events is too high and wanted to standardise practice. He developed the grand results idea in which he was focussed on measuring outcomes. And for this he was he was kicked out of Harvard, his hospital, and died in misery.

And finally, Dr Barry Marshall in WA who showed that  peptic ulcers were in fact a result of bacteria and not caused by stress, spicy foods, and too much acid. No one believed him as it would have meant stoping endoscopies! He won a Nobel Prize for his work. His work was incredibly important and changed the world yet he struggled, lost friends along the way...

Prof Brook also challenged participants to describe the notion of quality of health services in a way to make it understandable and meaningful for all parts of the system - for staff, patients and the community. There are lots of words to describe quality – but the more you have the harder it is to get people to commit to them and own them. How do you give ownership to different groups? How do you get clinicians to own the appropriateness and effectiveness of care and for consumers to own the patient engagement?

Dr Cathy Balding Governance for creating great consumer experience and governance for great care.

In the last few years, and particularly with the introduction of the national standards, Dr Cathy Balding has been interested about how to take governance form a thing that people have to do to something the fosters great care. Clinical governance is not something to endure but rather it is something to drive good practice and safe care.

Cathy spoke about the many dimensions of quality care and the complicated approach some organisations take in t developing their safety and quality frameworks and clinical governance structure. She said quite clearly that we spend too much time and energy focussing on the process rather than the end product. Ie, patient centred care, safe care.

There is an important role for maintenance in quality and safety, just like the airline industry. The foundation work is the monitoring of care, ensuring standards are met and that policies are implemented. And as for accreditation, Cathy Balding relayed a story from a colleague in which they likened accreditation to an exam – it is important to pass but it is not a means in itself.

Balding talks about quality governance and develop these systems with concrete purpose and show a concrete relationship between our quality governance systems and quality of care. There is nothing secret about how to create great consumer experiences. Balding refers to Mid Staffordshire as highlighting the key aspects of care. Now in the past year or so there has been lots of discussion and consideration of the findings of the public inquiry into Mid Staffordshire Trust in the NHS (UK), and for good reason. There were significant failings in governance and as a result a failure to deliver good, safe patient care.

Balding emphasised the importance of fostering a common culture shared by everyone in the service of putting the patient first. It is jargon- what does it mean? I agree with her on this. Patient Centred Care sounds good but it is an empty term and so we need to challenge the rhetoric.  For example, that someone who lives on the south coast and has to drive 3 hours away from the outpatients department at a large hospital. They then wait a long time in a crowded waiting room and then given an 8am appointment in month’s time. That happens all too regularly and with little (or no) consideration of what is involved for the consumer in getting there.

Balding also referred to the Picker Institute eight domains of care . We have been suing these in consumer training for many years and they make sense.  

We now have the Standards 1 and 2 so we now know that governance matters. There are five aspects that the standards cover:

•     Governance and quality improvement
•     Clinical practice
•     performance and skills
•     incidents and complaints – reporting and investigation systems, complaints systems and open disclosure
•      patients rights and engagement – charter of healthcare rights, patients as partners, confidentiality, patient feedback

Pillars of quality governance

•      Strategic planning leadership and culture
•      Consumer participation
•      Effective and accountable workforce
•     Compliance good practice risk and improvement

Balding asked the audience: what do you want every one of your consumers and their families to experience every time?

We want care that is responsive to the individual, care that is connected, care that is safe and effective for everyone, every time. And we will be a hospital that supports our staff to deliver this.

And the executive leadership team need to commit to supporting staff and provide for this. We need to hear statements from them like: we will give you direction knowledge resources and support to make this happen.

Balding went on to talk about the framework for quality, safety and the patient experience at Western Health. There are four questions they ask:

•   Were you seen and treated as a person?
•   Did you receive help, treatment and information in a coordinated way
•   Did you feel safe? Were you safe?
•   Did your treatment have the desired effect?

These are great questions and I think more of us need to ask them.

Darlene Cox
Executive Director