Quality of Care Report 2010 - 2011 - Wimmera Health Care Group

About UsContentsHorsham CampusDimboola CampusWimmera Health Care Group is based in the Wimmerasub-region of the Grampians, 310 km west of Melbourneand in close proximity to the Grampians National Park.With a budget of approximately $65 million, WimmeraHealth Care Group is the major specialist referral centrefor the Wimmera and Southern Mallee region of Victoria.Our campuses in Horsham and Dimboola service anarea of 61,000 square kilometres and a population ofapproximately 54,000.The Horsham campus features 84 acute and sub-acutebeds and 102 aged care beds. In Dimboola, there are30 acute and aged care beds.We employ 800 staff who provide a range of acute,sub-acute and community based acute, allied healthand primary care services to our community.This year we treated 11,813 acute inpatients, 15,911emergency presentations and approximately 40,000outpatients.HOW TO CONTACT USp: 03 5381 9111f: 03 5382 0829e: info@whcg.org.aum: Baillie Street, Horsham, Victoria 3400w: www.whcg.org.auOUR MISSIONWe are committed to achieving thebest health for all the Wimmera.OUR VISIONTo be the leader in rural health deliveringcaring services with respect,reliability and integrity.TERMINOLOGYThroughout this report, you may come acrossterminology that is unfamiliar to you, and whilst we havetried to simplify the wording so that you can understandthe information presented, it is not always possible toachieve this. Below are some definitions of commonwords and phrasing that will hopefully add meaning tothe text within the Quality of Care Report.Acute CareShort-term medical treatment, usually in a hospital,for patients having an acute illness or injury or recoveringfrom surgery.The American Heritage® Medical Dictionary Copyright ©2007, 2004 by Houghton Mifflin Company.Allied Health ServicesServices such as Occupational Therapy,Speech Pathology, Physiotherapy, etc.ClientsThose people accessing community care.Community CareHelp available to persons living in their homes, ratherthan services provided in residential institutions.Collins Collaborative DictionaryPatientPerson receiving acute care services.ResidentA special-purpose facility which providesaccommodation and other types of support, includingassistance with day-to-day living, intensive forms of care,and assistance towards independent living, to frail andaged residents.Australia Government– Institute of Health and Welfare 2010Photographs courtesy of The Wimmera Mail-Times, The Weekly Advertiser, Department of Health, Graeme Exell and Wimmera Health Care Group staff.About UsInside front coverForeword 2About This Report 3A Snapshot Of Our Year 4Our Strategic Plan 6INVOLVING THE WHOLE COMMUNITY 8Understanding You And Your Needs 8Person-Centred Care 8Respecting Patient Choices 10Cultural Awareness 11Caring For Our Aboriginal & Torres Strait Islander Community 12Disability Action Plan 13Community Advisory Committee 14Sujatha Umakanthan: Her Experience On The Community AdvisoryAnd Cultural And Linguistically Diverse Committee 15The Community That Supports Us 16Healthy Communities 18Patient Satisfaction 20Listening To Our Consumers Complaints, Suggestions And Complaints 21CONTINUITY OF CARE 22Don’t Smoke It’s Just Not Worth It! 22Hospital Admission Risk Program (HARP) 24Important Facts Your Should Know About Smoking 24Do You Need Help To Stop Smoking? 25Trish Milton’s Breast Cancer Journey 26Welcome To Our New Oncology Nurse Practitioner 28George Bannister’s Story 29MONITORING QUALITY AND SAFETY 30Clinical Risk Management 31Clinical Pathways Award 31Accreditation 32Monitoring Patient Care 33Infection Control 33Medication Safety 36Falls Monitoring And Prevention 40Pressure Ulcer Monitoring And Prevention 42Dental Services 44Safe Use Of Blood And Blood Products 45Redesigning Care 47Our Staff 48Staff Uniform CodeInside back coverPursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/2011

INVOLVINGTHE WHOLE COMMUNITYConsumer, Carer And Community ParticipationUnderstanding You And Your NeedsWimmera Health Care Group gathers information in a number of ways to ensure consumers, carers andthe community receive quality care that aligns with our value -“We believe that our customers are entitled to quality health care that respects their dignity,beliefs and rights, regardless of their cultural, spiritual or socio- economic background”The booklet is available to all Wimmera Health CareGroup patients, clients and residents and aims to helpthem and their families become more informed and moreinvolved in their care.The “Nothing About Me Without Me” communicationbooklet can be used in many ways, such as:• a communication tool between staff and patients;• a family communication booklet;• somewhere to record your medical historymedications or appointments;• a key contact book;• a diary of your stay in hospital; or• a reminder for the questions the patient needs to askor the tasks they need to complete.This year we also introduced the “Nothing About MeWithout Me” patient communication booklet to subacutecare patients and outpatients.“This means I won’t have to leave yellow stickynotes on lockers and hope relatives find them,so they can bring clothes in for the patients.”– staff member“What a wonderful idea, I had a lovely Doctor tosee me this morning and I don’t know his name.When he comes back I’ll get him to write in here”- patient“Great to provide a book for patients andtheir families to write their questions for medicalstaff and the answers” – family member“Because of my memory loss it has been wonderful.I write all my medical tests results and questionsI would like answered in it. Anyone who has memoryproblems should have one of these books” - patientConsumer participation at Wimmera Health Care Group is guided by the Department of Health’s “Doing ItWith Us Not For Us” policy. Consumers, carers and the community play an important role by providing uswith valuable feedback and advice about our services. Wimmera Health Care Group advocates for activeconsumer involvement in planning and service improvement based on the philosophy that we can learnand gain a greater understanding of consumer expectations and needs by actively evaluating their personalexperiences of care.Person-Centred CareWhat is Person-Centred Care?The Victorian Department of Health definesperson-centred care as:Wimmera Health Care Group’s Proclamation for Patient-Centred CareTo commemorate patient-centred care awareness,we proclaim to our patients and community these truths, which we hold to be self-evident:A patient is an individual to be cared for, not a medical condition to be treated.Each patient is a unique person with diverse needs.Each staff member is a caregiver, whose role is to meet the needs of each patient.Our patients are our partners and have knowledge and expertise that is essential to their care.Our patients’ family and friends are also our partners and we welcome their involvement.Tracey Daffy, Care Continuim Coordinator, highlights the benefits of the “NothingAbout Me Without Me” book to Oxley Ward Clerk Sue Gilsenan.Treatment and care provided by health services[that] places the person at the centre of theirown care and considers the needs of the olderperson’s carers’. Person centred care is abouttreating people as individuals and enabling themto make choices about their care.At Wimmera Health Care Group, we believepatients and their families are essentialmembers of the health care team. A coreprinciple of providing person-centred careis sharing information and communicatingeffectively between patients, their familiesand the service provider.Taking this into consideration, Wimmera HealthCare Group has developed the “Nothing AboutMe Without Me” patient communicationbooklet.Access to understandable health information is essential to empower patients to participate in theircare and it is our responsibility to provide access to that information.The opportunity to make decisions is essential to the wellbeing of our patients. It is our responsibilityto maximise patients’ opportunities for choices and to respect those choices.Our patients’ wellbeing can be enhanced by an optimal healing environment, including access to musicand the arts, satisfying food and complementary therapies.In order to effectively care for patients, we must also care for our staff members by supporting themin achieving their highest professional aspirations, as well as their personal goals.Patient-centred care is the core of a high quality health care system and a necessary foundation forsafe, effective, efficient, timely and equitable care.Wimmera Health Care Group exists to serve our patients and our community.We are honoured to be here for you.© Planetree 2007 – all rights reserved8Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/20119

The Community That Supports UsAt Wimmera Health Care Group, we are very gratefulfor the enormous support we receive from thecommunity. Details of some of the groups that supportus and how you can become involved are providedbelow:Their major fundraising activities include an annual galaball and crime night.For further details, please contact the CommunityLiaison Officer on ph. 5381 9309.Lesley Mckenzie, Elly McDonald, Shirley Kemfert, Doss Borgeltand Ada Ritchie at the Lochiel Wayside Stop.Dimboola Campus Appeals Auxiliary meets on the lastWednesday of every month at 8.00 pm at the DimboolaCampus. This group raises funds to support theDimboola campus. Their major fundraising activity is theLochiel Wayside Stop Driver Reviver Program whichraises over $7,000 each year.For further details, please contact Greg onph. 5389 1297.Dimboola East Ladies Auxiliary meets on the firstFriday of every month at 2.00 pm at the DimboolaCampus. This group raises funds for the Dimboolacampus.Volunteers play an important role in enhancing theservices we provide.For further details about the volunteering opportunitiesavailable at Wimmera Health Care Group, pleasecontact the Community Liaison Officer onph. 5381 9309.Wimmera Base Hospital Ladies Auxiliary meets on thefirst Monday of every month at 1.30 pm in the ArapilesBuilding Board Room. They run an opportunity shop inHorsham and a uniform shop for Wimmera Health CareGroup staff with all funds raised directed towards thepurchase of lifesaving equipment for our hospital.The Horsham branch of the Police Blue Ribbon Foundation has raisedmore than $120,000 over the past five years.Wimmera Health Care Group Foundation Trustees. Back -Michael Ryan, Penelope Manserra, Alison Butler and BruceJohansen. Front - Denise Leembruggen, Don Johns (Chairman)and Graeme Hardman.Members of the Kurrajong Lodge Support Group.For further details, please contact Lesley onph. 5389 1284.Friends of the Foundation is the newly formedfundraising arm of the Wimmera Health Care GroupFoundation. Following on from the success ofMasterCook in early 2011, MasterCook2 will be one oftheir major fundraising activities for the coming year.For further details on how you can support Friends ofthe Foundation, please contact Allison onph. 0407 565 103.Kurrajong Lodge Support Group provides supportand company to residents at our 36-bed hostel.The Kurrajong Lodge Support Group meets on thefourth Monday of every month at 1.30 pm atKurrajong Lodge Hostel.For further details, please contact Marlene onph. 5382 6763.Victoria Police Blue Ribbon Foundation meets on thefirst Tuesday of every month at 7.30 am in the ArapilesBuilding Board Room. This group raises funds forthe Emergency Department in memory of ConstableGeorge Howell who passed away in the line of duty on30 January 1952 at the age of 25.For further details please contact Lorna on ph. 5382 1608.Wimmera Health Care Group Foundation, establishedin 1990, is a public charitable fund. The aim of theFoundation is to raise money through donations andbequests to fund special projects within our campusesthat will directly benefit people of the Wimmera,guaranteeing the highest quality of health care.The Foundation is managed by a skills based Board ofTrustees from our local community. Donations to theFoundation are invested and only the interest is usedto fund projects. The Wimmera Health Care GroupFoundation has set a target to raise $1 million in capitalby 2014. This year, the Foundation made a significantcontribution towards a Children’s Mobility Garden tosupport our Allied Health Services, which was openedin November.To find out how you may support the WimmeraHealth Care Group Foundation, please contact theAdministrator on ph. 5381 9309.Wimmera Hospice Care Auxiliary meets on the thirdTuesday of every month at 10.00 am in the UnitingChurch Hall in Horsham. All funds raised go towards thepurchase of equipment to support clients of WimmeraHospice Care.For further details, please contact Lorraine onph. 5382 7123.Wimmera Base Hospital Ladies Auxillary Oppurtunity Shop ManagerBeverley Reynolds and President Betty White present a cheque toDon McRae, Director of Clinical Services. This year, the auxiliary haspurchased lifesaving equipment worth almost $90,000.The Wimmera Hospice Care Auxiliary purchased new chairs and asofa bed for the palliative care sitting room this year. Seated in thenew chairs are auxiliary members Joan Harrison, Marion Barber andAgnes Seater with Wimmera Hospice Care Co-ordinator MelanieHahne (kneeling) and Janette McCabe (Oxley Nurse Unit Manager).16Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201117

CONTINUITY OF CAREAt Wimmera Health Care Group, we are committed to responding to the needs of our consumers,their families/carers and the community. This section provides a snapshot of some of the ways we do thisin a safe and effective, person-centred, integrated and co-ordinated manner.Don’t Smoke It’s Just Not Worth It!When Doug Vincent took up smoking 55 years ago,he had no idea that the consequences of his actionswould come back to haunt him later in life.My father walked out on our family in 1956 when I was11½, leaving mum to raise three young boys. That’s whenI started working to help put food on the table and pay thebills. I would get up early (around 3.30 am), in time to startmy cleaning job at the bakery at 4 am, where I worked forthree hours, and then I did a paper round before heading offto school.Soon after my father left I tried my first cigarette, just half acigarette at first, then it progressed up to 2-3 a day. By thetime I was 12, I was addicted. I was working hard and I wastired all the time, smoking helped me get through the day.I didn’t know the dangers of smoking, there were nowarnings on the packet. It was cheap too, I could buy apacket of cigarettes for around 15 cents!As I got older, football came along, a sport I played for14 years. At 20, I got married and we went on to have threesons.I worked in the tyre industry for most of my working life.I ran my own business in Warracknabeal for many yearsuntil I sold up and retired when I was 55. I worked longhours and used nicotine to help me get through the day.I would arrive at work at 6.30 am and by the time I openedup at 8 am, I had managed to squeeze in 8-12 cigarettes and8 cups of coffee.I was as fit as a scrub bull until I turned 52. I played golfand pool and drove racing cars in my spare time. But thenI started to lose my breath and lose energy quickly.I put it down to getting older and working hard.In September 1999, I was diagnosed with emphysema.I had no choice, I had to stop smoking or I would die.I started with patches, but ended up quitting cold turkey.It took three months and I was not a nice person to bearound. I was bad tempered and moody, couldn’t sleep andwas eating the wrong food. Once I gave up smoking, mysense of smell and taste returned and my skin improved.After 40 years of marriage, my wife left. I was depressedand the staff from the Hospital Admission Risk Program(HARP) helped me get through a very difficult period in mylife. I had lost the two best friends I would ever have, mywife and cigarettes.In June 2000, I was to face another setback. I woke up at5 am one morning feeling strange. I couldn’t see anythingfor 15-20 seconds, but I thought nothing of it. I turned thelight off and went back to bed. By 6 am I was feeling verysick so I called for an ambulance. By the time they arrived,I was on the floor. The ambulance took me toWarracknabeal hospital. They then sent me to WimmeraBase Hospital for a CT scan and I had a seizure on the way.I was in the Intensive Care Unit for the next nine days.If I hadn’t been a smoker, I am certain I wouldn’t have hadthe stroke.With the help of the wonderful team at HARP, and a lot ofexercising and walking, I got back on track. They gave meadvice on what I needed to do and how I needed to go aboutit. I was able to get back to playing golf and I even went onto win three B-grade championships. As time went on, itbecame harder to play golf because every time I started toswing I would become breathless. Eventually I had to giveit up.I was gradually becoming more breathless. By 2006, I couldonly walk 38 metres at a time and by 2007, I was on oxygenfor 16-18 hours a day and could only walk 20 metres.To top things off, in 2008, I contracted pneumonia twice andhad three infections.In 2009, I saw a program on television about an operationwhere they could fill holes in your lungs. After talking itover with the staff at HARP, I decided it was worth a try toimprove my quality of life and the promise of another 5 to12 years. I had the operation 12 months ago at the AlfredHospital and was in Melbourne for seven weeks. I was sentback to Horsham and under the excellent care of HARPonce again. Unfortunately, the surgery wasn’t as successfulas I would have liked, but at least it has given me someextra time. Without the operation, I doubt that I wouldhave lasted until Christmas last year. I am too old for a lungtransplant and there’s not much more that can be done forme. I will be on painkillers for the rest of my life.These days, I can only walk for 15 metres at a time and I’mon oxygen for 14 hours each day. I can only drive the car forabout an hour or so before I become exhausted and needoxygen. Everywhere I go, my oxygen tank comes with me.I have 40% lung function on one side and 60% on the other.I get about five hours sleep at night and am on oxygen from6 pm to 8 am every night.To the outside world, I look normal, but my life is far fromnormal - people with emphysema don’t look any differentto anyone else.When I first lose my breath, I start to breathe heavily, thenpanic hits and I start to gasp. This can go on for two orthree minutes and I lose all the energy in my body, I cannotmove. This happens two or three times a day for me.I am lucky I still live at home. I have a Mepac button thatI can press and it will alert an emergency contact straightaway. I still shower myself and I have a wonderful homesupport worker who does my cleaning. I try to be asindependent as possible, but my social life is non-existentbecause I’m limited in what I can do. I spend as much timeas I can in my garden, and every day I go up the street on mygopher just to get out of the house.The HARP team have organised rehabilitation sessions inthe swimming pool for me. Its fantastic, but I’m afraid toput my head under water because I can’t hold my breath forlong enough. I have my own exercise bike and weights athome. I go on the bike for about 20 minutes every day andtry to use the weights whenever I’m feeling up to it.Over the years, the HARP staff have been fantastic.I truly believe I wouldn’t be here today without them.I know the next 12 months will be a struggle andrealistically I don’t have much longer to live, but they keepme motivated and positive.If you smoke, the damage is done and the sooner youstop the better. It doesn’t matter how long you smoke orwhat age you start, it will come back to bite you in someway. Emphysema is cruel, it’s a slow moving disease buteventually it will take over.The message I want to get across to people is,Don’t Smoke. Look what happened to me,it’s just not worth it!Doug chats with Heather Macdonald from the HARP team.Doug is on oxygen for 14 hours each day.The message Doug wants to get across to people is,Dont’ Smoke, it’s just not worth it!22Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201123

Hospital Admission Risk Program (HARP)Do You Need Help To Stop Smoking?Wimmera Health Care Group HARP is a community based program aimed at supporting people with chronicillness by co-ordinating health services to help them to better manage and maintain their own health.Giving the right care in the right place at the right time may reduce the need to go to hospital.The target population for HARP is people with chronic diseases and complex needs who are most likely tobenefit from co-ordinated care. This includes:• people with chronic heart disease;• people with chronic respiratory disease;• people with diabetes;• older people with complex needs; and• people with complex psychosocial needs.HARP co-ordinates essential partnerships between the general practitioner, community, hospital staff and theclient and their carer. Care planning involving the client, carer, clinicians, care coordinators, the client’s generalpractitioner and other medical specialists are key components of the program.For further information about HARP, please contact ph. 5381 9022.There are a number of options available to help people stop smoking. Patches, combination medications andother pharmaceutical options are readily available through GPs and Pharmacists.QUITLINE*Call the Quitline on 137 848 (13 QUIT)Quitline is a confidential telephone information and advice service, available throughout Australia.For the cost of a local call (except mobiles) professional telephone advisors provide encouragement and supportto help you quit.For callers who would prefer Quitline support in a language other than English, Quit uses the TranslationInformation Service. Ask about this at your first call.QUITCOACHGo online at www.quitcoach.org.auQuitCoach is an internet-based computer program that helps you quit by giving free personal advice tailoredto your needs.Important FactsYou Should Know About SmokingQUIT COURSESQuit courses are run in workplaces and the community. If you are interested in attending a course,call the Quitline (137 848) to find out where courses are running or go to www.quit.org.au.*Quit Victoria 2009• Smoking kills more Victorians every year than road accidents, alcohol and other drugs combined• Quitting before middle age reduces the risk of lung cancer by 90%• Smoking kills more men than women• Cancer is the No 1 cause of tobacco related deaths in men (57%)• Lung cancer causes the most cancer deaths in Australia and is mostly due to smoking• 21% of males and 18% of females smoke• In 2007, 61% of people who had ever smoked had quit• Deaths due to tobacco use account for 11% of deaths from all causes• Smoking remains the only product that when used as the manufacturer’s intended,will kill half of its regular consumers(Australian Institute of Health and Welfare, Centre for Behavioural research in Cancer, Tobacco in Australia:Facts and Issues US Dept of Health & Human Services)24Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201125

Trish Milton’s Breast Cancer JourneyIn September 2009,Trish Milton looked in themirror and noticed that herleft breast had changedshape. She was 48 years oldand married to Jeff, with twodaughters, Madeleine andStephanie who were 13 and 11at the time.I went to my GP straight away,who referred me to Mr Kitchen,a local surgeon who retired lastyear. He took two biopsies and anultrasound, but the results wereinconclusive.I was admitted to Wimmera BaseHospital where another biopsywas taken and sent away fortesting. Two years earlier, I hada lump in my right breast andthe mammogram taken at thetime didn’t show any evidence ofcancer. I got the shock of my lifewhen the results of the biopsycame back positive and the lump was 5 cm in diameter.I had two options - I could have a partial mastectomy,where just the lump and surrounding tissue would beremoved, or I could opt for a full mastectomy, removalof the entire breast. I opted for a full mastectomy.Whilst I was having the surgery, my lymph glands wereremoved and a biopsy of my right breast was also taken.I couldn’t believe my bad luck when results from thebiopsy came back positive, I had a cancerous lump in myright breast too!As soon as I was well enough, I was admitted to theDay Procedure Unit at Wimmera Base Hospital to havethe lump in the right breast removed. It was 6 cm indiameter. Because the lump was so large, Mr Kitchenrecommended that I have a full mastectomy of my rightbreast.After the surgery, I was referred to an Oncologist,Professor George Kannourakis. I can’t speak highlyenough of George, he has been fantastic. At my firstappointment, I was very upset and thought I was goingto die, but George gave me some options which made mefeel positive about the future. I was determined to beatthis disease, I was not going to give up without a fight.I had six months ofchemotherapy in Horsham,followed by five weeks ofradiotherapy in Ballarat.With the support of my familyand friends, we travelled toBallarat for treatment everyday.Professor Kannourakis wasfantastic with my daughterstoo. He explained the cancerand what my treatment wouldentail. It really helped them todeal with the situation.It is now over a year sinceI finished radiotherapy. I amnow on Tamoxifen, an oralform of chemotherapy, whichI will take for five years. I seeProfessor Kannourakis everysix months and he is verypleased with my progress.During my treatment,I attended a Look Good … Feel Better Programco-ordinated by the Community Health Nurses.Look Good … Feel Better is a pamper program for womenundergoing cancer treatment to help restore theirself-confidence. I was lucky enough to have mymake-up done and even got to take some fantasticmake-up home. It was great to meet other women goingthrough a similar experience to me.Elizabeth King, the McGrath Breast Care Nurse atWimmera Health Care Group, has been a wonderfulsupport to my family, I don’t know how we would havecoped without her.After the first mastectomy, Elizabeth visited me inhospital and she has been there for us ever since. I feelcomfortable asking her about anything I need to knowand if she doesn’t know the answer she will find out forme. When we told our daughters I had breast cancerthey were upset, but Elizabeth explained everything tothem in way they could understand. It was comforting toknow she was there whenever we needed to talk.Elizabeth organised a resource kit containing lotsof helpful information about breast cancer from theBreast Cancer Network of Australia. She also organiseda special bra that I could wear after the surgery.We still catch up for a coffee and chat from time to time.The McGrath Breast Care Nurse program is a wonderfulservice and a godsend for anyone going through breastcancer.Throughout the journey I couldn’t have asked for bettersupport. Everything has been up front right from thestart and the staff at Wimmera Health Care Group havebeen wonderful.My message to women is to make sure you checkyour breasts regularly. No-one knows your bodythe way you do and if you feel that something’swrong, keep pursuing it until you get an answer.MCGRATH BREAST CARE NURSEElizabeth King is Wimmera Health Care Group’sMcGrath Breast Care Nurse. This service, whichcommenced in August 2009, is made possible withfunding from the McGrath Foundation and the FederalGovernment.Elizabeth is specially trained and registered as a BreastCare Nurse. This service provides physical, psychologicaland emotional support for women diagnosed with breastcancer and their families, from the time of their diagnosisand throughout their treatment.The program also aims to promote a greater level ofself breast awareness in women. Whilst nine out of tenbreast lumps are not cancerous, it is important to noteany changes as soon as they occur.The service is provided across the Grampians regionfrom Stawell to the South Australian border, through toHopetoun and Edenhope. Elizabeth is also available totalk to groups about breast self awareness.For further information about theMcGrath Breast Care Nurse, please contactElizabeth King on ph. 0428 210 105.BEING “BREAST AWARE”Because breast cancer affects women of all ages,it is important that all women, including young women,examine their breasts regularly to detect any changes.Self examination is important. If you are aware of howyour breasts normally look and feel, you’re more likelyto notice a change if it develops.In addition to seeing your doctor each year for abreast examination, you need to check your breastsregularly. A good time to do this is after the last dayof your menstrual cycle or, if you do not have periods,the same date each month. Most women find thattheir breasts are easier to examine just after theirperiod when any premenstrual pain and lumpiness hassettled.You may check your breasts standing up, for example,in the shower, or lying down, for example, in bedbefore going to sleep. Your partner should also bealert and look for changes in your breasts.You can check your breasts by:• Looking at the shape and appearance of yourbreasts and nipples in the mirror with your handsby your sides.• Raising your arms above your head and lookingfor a change in the shape of the breasts.• Feeling for lumps in the breasts either whilelying down or standing.• Feeling for lumps in the nipple area and in thearmpits.You should look out for the following changes:• A lump or lumpiness, or even a change in shape orappearance of your breast such as dimpling,redness and the appearance of veins.• An area that feels different to the rest of yourbreast or any pain in your breast.• Any change in the shape or appearance of yournipple, such as your nipple being pulled in or thedevelopment of a rash.• A discharge from your nipple, particularly if itis bloody.If you find a change in your breast, don’t panic.Most changes in the breast are not related to breastcancer. However, if you do find a change in yourbreast or a lump, it is important to visit your Doctorimmediately.McGrath Foundation– together we can make a difference26Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201127

Welcome To Our NewOncology Nurse PractitionerGeorge Bannister’s StoryThis year we welcomed Ms Carmel O’Kane to the excitingnew position of Oncology Nurse Practitioner Candidate.Carmel is a highly skilled nurse who, as an OncologyNurse Practitioner, has an expanded scope of practiceenabling her to provide specialised care to cancerpatients. Her role includes assessment and managementof patients using nursing knowledge and skills and mayinclude but is not limited to the direct referral of patientsto other health professionals, prescribing medicationsordering diagnostic investigations and supportive care.Carmel’s appointment has comefrom a joint initiative betweenWimmera Health Care Group,Stawell Regional Health andEast Grampians Health Servicein Ararat, with the supportof the Grampians IntegratedCancer Service (GICS), toexpand Oncology services andpatient care.Carmel’s focus is to improve thecontinuity of care for Oncologypatients in the Wimmera withparticular focus on patientswith complex needs.Carmel O’Kane, Oncology Nurse Practitioner.The Oncology nurse practitioner role is also one of clinicalleadership providing specialist Oncology support andmentoring to the nursing and medical teams in Horsham,Stawell and Ararat.Carmel works closely with the Medical Oncology teamthat provides services to the Wimmera which has alsobeen expanded this year and includes Professor GeorgeKannourakis and Doctors Craig Carden and JohnSycamnias, who, together provide an increased visitingservice to the Wimmera.George Bannister is 80 years oldand lives in Horsham.In April this year, he had a cardiac arrest andpresented to the Emergency Department at theWimmera Health Care Group. Once his conditionwas stabilised, George was airlifted to BarwonHealth in Geelong where he was placed underthe care of a cardiologist. After several weeksin hospital, he was transferred to the MackellarRehabilitation Centrewhere his rehabilitationjourney commenced.After 10 weeks in Geelong,George was transferredback to Horsham toWimmera Health CareGroup’s Wyuna Wing,under the Transition CareProgram.The Transition CareProgram (TCP) providescare and restorativeservices for a short termfor older people who havebeen in hospital.The program allows forlow level therapy andsupport, allowing people tobe discharged quicker andcontinue their recoveryoutside the hospital system,whilst appropriate longterm care can be arranged.TCP services can beprovided in the person’shome (community TCP) orin designated beds (bedbased TCP), located in theWyuna Wing.When he first returned to Horsham, George wasusing a wheelie frame to assist with his mobilityand, although he was able to eat small quantitiesof vitamised food, he required a feeding tube in hisstomach.George remained in the Wyuna Wing for the nextfour weeks. During that time, he underwent arehabilitation program aimed at assisting him toregain his functional independence. The programincluded arm and leg weights, exercise bike, outsidewalks and a swallow rehabilitation program withthe Speech Pathologist.George is now backhome in communityTransition CareProgram andprogressing well.His feeding tubehas been removedas he is able to eatsufficient quantitiesof food. George canshower himself,walk independentlywithout a walking aidand pedal for19 minutes on theexercise bike. Georgesays that the programhas been very good.“I like doing theexercises, especiallywith that madGeelong supporter”(Jenny Moeller, theWyuna Allied HealthAssistant).As part of theCommunity BasedTransition CareProgram, George works out in the rehabilitationgym twice a week and is gradually building up hisstrength and endurance levels. He has made someimportant lifestyle changes and is hoping to moveinto cardiac rehabilitation soon (an exercise andeducation program aimed at preventing furthercardiac events).George works out in the rehabilitation gym under the watchful eye ofMonash University Physiotherapy Student, Alana McDonald.28Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201129

MONITORING QUALITY AND SAFETYClinical Risk ManagementCare provided at Wimmera Health Care Group is underpinned by a strong and effective clinical governance framework.It is through this framework that we are accountable for monitoring and continually improving the quality and safety ofour service. The Clinical Governance Committee which consists of Board members, the Executive and key members of theQuality and Safety team, is responsible for ensuring implementation of the framework. The Clinical Governance Committeehas also developed a Quality and Safety Strategic Plan to assist in the process and monitor a number of key performanceindicators which provide a view of the whole health system and measure all dimensions of quality.View of Health System using Whole System MeasuresDimensions of QualitySafeEffectiveAppropriatePatient with HealthNeedsPatient-CentredEfficientAccessibleProcess of ProvidingServicesPatient with HealthNeed MetNumber of fallsresulting infractureNumber ofpressure ulcers bygrade% of patients aged ≥65 years readmittedwithin 28 daysIncidence of nonfataloccupational injuriesand illnessesClinicalOutcomesDaily improvement infunctional activity rate(GEM patients)Averageimprovement inBarthel Score(GEM patients)FunctionalOutcomesNumber ofclinicians attendededucationsessionsNumber of opendisclosureoccurrencesSatisfactionAll Wimmera Health Care Group staff aim to provide thebest possible care to our patients, residents and clients,however, healthcare in the 21st Century is very complexand even with the best intentions, there are times whensomething goes wrong resulting in an adverse event.An adverse event is an incident which results in harm to aperson receiving health care. Examples of adverse eventsare a wound infection after surgery, an allergic reactionto a medication and the development of a pressureulcer. Not all adverse events are preventable, but a largenumber are.Clinical Pathways AwardWimmera Health Care Group’s Clinical Risk ManagementProgram aims to reduce the chance of individuals in ourcare experiencing an adverse event.There are currently a number of individual projects beingundertaken as part of Wimmera Health Care Group’sClinical Risk Management Program. You can read aboutsome of our projects in the following articles in thisreport:• Medication Safety• Falls Prevention• Pressure Ulcer Prevention• Blood TransfusionsAccessTime betweenreferral &assessment forACAS clientsDays to third nextavailable PodiatryappointmentEnd of LifeTime spent in hospitalin last 6 months of life(palliative care only)% residents withweight loss ≥ 3kg% residents withunplanned weight lossover 3 consecutivemonthsOur staff understand that everyone, not just the ClinicalGovernance Committee, is responsible for quality andsafety within the health service. This means that staffact in the right way as part of a safe quality program withappropriate accountability to patients, management andthe community.Adverse eventrate (LAOSScreening)% STEMI patientscompliance with4 processes% Stroke patientscompliance with4 processes% with fallsassessment &appropriateintervention% with pressureulcer assessment& appropriateinterventionCostsWIES per bed day≥ 65 year oldpatients with LOS> 5 daysPatientSatisfaction withCare ScorePatientExperience Scoreis given to the right patient, at the right time, in theright way, by the right clinician. We have many waysof monitoring that this occurs from the accreditationprocess to monitoring clinical indicators and undertakingclinical audits. Some of these activities are presentedthroughout this report.Our clinical pathways program received one of theState’s highest healthcare awards, being jointly awardedthe Minister for Health’s Award for Improving QualityPerformance at the annual Victorian Public HealthcareAwards, held in October 2010.The Improving Quality Performance Award recognisesoutstanding initiatives using evidence-based treatmentoptions that result in the best clinical outcomes, improvedconfidence and patient experience. Wimmera HealthCare Group was recognised for using clinical pathways toimprove and sustain quality patient care.Clinical Pathways act as the patients’ medical record,with all health professionals involved in the patientscare having agreed actions to be checked off each day oftheir stay in hospital. Clinical Pathways have key processindicators, documentation and are multidisciplinary,meaning the Doctor, Pharmacist, Physiotherapist,Speech Pathology, Nurse and all other relevant healthprofessionals use the same Clinical Pathway for thediagnosed problem.In summary, clinical pathways work to:• achieve quality standards of care;• improve communication between healthcaredisciplines;• improve patient involvement in plan of care;• reduce practice variation;• allow auditing of clinical practice;• enhance documentations; and• allow implementation of local pathways based onevidence based clinical guidelines and facilitiesavailable at our health service thereby providing“optimal care” for the patient.At Wimmera Health Care Group we also achieve thisby working with our staff and patients in key areas thatassist to enhance the delivery of clinical care.Consumer ParticipationConsumers are involved and engaged with WimmeraHealth Care Group through the Community AdvisoryCommittee and the Cultural and Linguistically Diverse(CALD) Committee. Consumer complaints, compliments,suggestions and surveys are used to enhance the qualityof care we provide.Clinical EffectivenessClinical effectiveness is ensuring that the right careEffective WorkforceWe have systems in place to ensure that staff employedat Wimmera Health Care Group have appropriate skills,qualifications and experience to provide safe high qualitycare. These include: credentialing and scope of practice;clinical practice and education programs; and mandatorycompetencies.Risk ManagementWimmera Health Care Group has a robust riskmanagement system which involves managing clinicalrisk to patients as part of the broader organisationalrisk management system which includes corporate andoccupational health and safety risks.Alan Wolff, Janette McCabe, Sally Taylor, Alicia McGrath, Sammy Sordello and Ian Campbell accept the Victorian Public Healthcare Award.30Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201131

AccreditationMonitoring Patient CareAccreditation is a measure of accountability. It is the formal process that is used to determine how well we are performingagainst standards that are set by governing agencies to ensure healthcare services such as Wimmera Health Care Groupdeliver quality care that is safe and appropriate to the needs of the individual. The accreditation process involves a writtensubmission of achievements against the standards and independent assessors from the accreditation body visiting ourhospital and conducting a thorough assessment. The thorough assessment can include: talking with patients, residents,clients and their relatives; interviewing staff and checking documentation and observing care, service delivery and theenvironment.Because Wimmera Health Care Group provides acute, aged care and community services, the organisation has beensuccessfully accredited under a number of accreditation agencies.AGENCY HOSPITAL AREA STATUSThis section presents a snapshot of how the principles of quality and safety are used to continuously monitorpatient care. We collect and monitor our care delivery as part of our strategic goal to pursue excellence in care.We also collect and report data to external organisations, including the Department of Health.Infection ControlInfection prevention remains a constant goal for Wimmera Health Care Group. Many strategies are used to minimisethe risk of infection: careful placement of patients at risk of infecting others or who are at increased risk of an infectionthemselves, auditing of processes, staff immunisation, and good hand hygiene, to name a few.Australian Council on HealthcareStandards (ACHS)Wimmera Health Care Group(excluding residential / aged carefacilities)Full four-year accreditation July 2009,successful self-assessment 2010.Periodic Review due July 2011.Infection control is a mandatory standard to be achieved in both Aged Care and Acute accreditations. Our Horsham andDimboola sites were assessed and accredited in 2009, with reassessment and accreditation to occur in 2011.Aged Care Standards AccreditationAgency (ACAA)Wimmera Nursing HomeKurrajong LodgeDimboola Residential ServicesWimmera Nursing Home and Kurrajong Lodgeachieved compliance May 2010, and thereforegranted full three year accreditation status.Two year accreditation for Residential Servicesat Dimboola granted in 2009.Wimmera Health Care Group staff are educated in the Five Moments of Hand Hygiene. Audits of hand hygiene complianceare regularly conducted with the results forwarded to the Department of Health. The latest audit showed an overallcompliance rate of 72.4% compared to the National compliance rate of 71.3%.Home and Community Care (HACC)Home and Community Care AlliedHealth Services - WimmeraCommunity Options and DistrictNursingFull four-year accreditation granted inAugust 2009.OVERALL COMPLIANCE RATE JUNE AUDIT 2011Correct HHMomentsMomentsObservedComplianceRateLower 95%CIUpper 95%CINational 214,685 301,175 71.3% 71.1% 71.4%Victoria 32,912 45,142 72.9% 72.5% 73.3%“Wimmera Health Care Group hasreceived continuous accreditation bythe Australian Council on HealthcareStandards since 1975, a track recordwe are very proud of.Our accreditation outcomes send amessage to the community thatWimmera Health Care Group, itsmanagement and staff, are committedto excellence in healthcare with a strongand continuing focus on safety, qualityand performance.”Mr Chris Scott, Chief ExecutiveWimmeraHealth CareGroup147 203 72.4% 65.9% 78.1%Mr Chris Scott, Chief Executive, shows off the hospital accreditation plaque.32Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201133

Infection Control cont.Hand Hygiene Compliance AuditPercentage %9080706050403020100P1-09 P2-09 P3-09 P1-10 P2-10 P3-10 P1-11 P2-11Audit Period• YANDILLA • OXLEY • HOSPITAL WIDE • VICTORIA• AUSTRALIAVisitors are encouraged to use the alcohol hand rub which is available in all areas of Wimmera Health Care Group.Hands of visitors can innocently contaminate equipment, furniture, etc., which can later contaminate a surgical wound or causeinfection elsewhere. This is particularly important for friends and relatives handling newborn babies.Cleaning audits are regularly conducted by both internaland external auditors. The 2010 External Audit scorefor Horsham was 91% and Dimboola’s score was 96.5%.Staff in the Environmental Services department are to becongratulated on these achievements.GASTROENTERITISWe have recently seen gastroenteritis (gastro) hit ourregion in a big way. Gastroenteritis can be caused bybacteria, viruses and parasites. Symptoms can includeone or more of the following: diarrhoea, nausea, vomiting,abdominal pain, fever and lethargy. Gastroenteritis isspread by direct person to person contact or via spraysfrom vomiting or eating contaminated food. Onset of theillness (incubation period) can range from a few hours toa few days.There has been an increase in outbreaks across hospitalsand residential aged care facilities. People in thesefacilities are at increased risk due to contributing healthfactors. Patients and residents can suffer increasedseverity and longer duration. Contributing factorsinclude: shared bedrooms and bathrooms, low mobilityand incontinence. Given the high susceptibility ofresidents and patients, it is essential that outbreaks arecontained as quickly as possible. We aim to minimise thenumber of patients, residents and staff affected.This year we had one outbreak of gastroenteritis inour Residential Aged Care Facility. As a result, handhygiene education increased, visitors were restricted atconfirmation of the outbreak and a very strict cleaningregime was implemented using chlorine based cleaner.We are aware that it can be an inconvenience ifvisitors are restricted to wards and aged care facilities,however, we are attempting to minimise the effect thata gastroenteritis outbreak can have on our frail andcompromised residents and patients.It is also important that you as friends and familyrecognise that if you have been unwell withgastroenteritis you should not visit residential agedcare facilities and hospitals for 48 hours after your lastsymptom.All gastroenteritis outbreaks are reported to theDepartment of Health who monitor the situationclosely. In accordance with recommendations from theDepartment of Health, at the conclusion of an outbreak,a final clean is done to the whole area after 48 hours withno symptomatic cases. The facility is then reopened to thepublic.The year has at times been challenging with thepresentation and frequency of new Multi ResistantOrganisms to Wimmera Health Care Group.The emergence and increase in the rates of theseorganisms reinforces the importance that:Hand hygiene is the single most important weaponagainst infection!Our involvement in the collection of data for VICNISS(Hospital Acquired Infection Surveillance) during the lastyear has shown:Registered Nurse Joy Thomas performing hand hygiene.• 85.3% compliance in the correct use of prophylacticantibiotics prior to surgery;• one new MRSA (Methicillin Resistant StaphylococcusAureus) infection occurring after 48 hrs ofhospitalisation;• two blood stream infections caused by the organismStaphylococcus Aureus;• one new case of Vancomycin Resistant Enterococci(VRE); and• three cases of Clostridium Difficile.All results are either comparable or better than Stateaverage figures.Source:Grampians Regional Infection Control Group.34Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201135

Medication SafetyThe safe and appropriate use of medicines is vital to ensure patient safety in hospitals. A 2002 report from the AustralianCouncil for Safety and Quality in Healthcare estimated that 2-3% all of hospital admissions (ie. approximately 140,000 in1999/2000) are related to problems with the use of medicines. These problems may start within the community or withinthe hospital. The cost of these problems was estimated at $380 million per year in public hospitals alone. Problems mayarise due to errors in:• prescribing (for example, an inappropriate medicine is prescribed);• administration (for example, an incorrect medicine is given to a patient);• dispensing (for example, an incorrect medicine is dispensed for a patient); and• documentation and communication (for example, a patient receives a medicine to which they have previouslyhad an allergic reaction, as the allergy was not recorded on the patient’s medication chart).Number of Medication Incidents2520151050June2010July2010Aug2010Sept2010Oct2010Nov2010Dec2010Jan2011Feb2011Mar2011Apr2011May2011June2011Wimmera Health Care Group has a designatedcommittee, the Pharmaceutical Advisory Committee,which governs medication safety. It’s responsibilitiesinclude:• the analysis of medication incidents and medicationperformance indicators;• making recommendations for health care deliverysystem change when required; and• reviewing all medication procedures.Improving medication safety is complex as there is nosingle solution to reduce all problems. Wimmera HealthCare Group has introduced medication safety initiativeswhich improve patient care and reduce the risk of errors.1. Performance IndicatorsThe Department of Health has provided the ‘Indicatorsfor Quality Use of Medicines (QUM) in AustralianHospitals’ manual to assist in improving medicationsafety. The manual provides a set of performanceindicators for medication safety. Performance indicatorsare useful quality improvement tools as they assist inidentifying and measuring areas for improvement. Whenremeasured, over time, they can assess the effectivenessof quality activities.Wimmera Health Care Group routinely monitors someof the indicators listed in the ‘Indicators for the QUM’manual.ACUTE MYOCARDIAL INFARCTIONAcute Myocardial Infarction (AMI) refers to the death ofa part of the heart muscle caused by a block in the artery(ie. heart attack). There is much evidence to supportthe use of certain medicines following an AMI. Use ofthese medicines, along with other measures, has beenassociated with improved outcomes. The recommendedmedicines are:• an anti-platelet, such as aspirin (to thin the blood);• a beta-blocker, such as atenolol or metoprolol(to reduce the workload of the heart);• a statin, such as simvastatin or atorvastatin(to lower cholesterol); and• an ACE inhibitor, such as ramipril or perindropil(to reduce blood pressure and prevent heart failure)The AMI Performance Indicator measures the percentageof patients who have an AMI who are prescribed the fourrecommended medicines at discharge (ie. an anti-platelet,a beta-blocker, a statin and an ACE inhibitor).The indicator does not look at each medicine individually,as the use of all four medicines together is consideredto be best practice. The indicator excludes patients whohave a valid reason for not taking the medicine (eg. allergyto the medicine).This graph shows the recorded medication incidents for each month in the 12 months between July 2010 and June 2011. The grey line shows thenumber of incidents is trending downwards.Type of Medication Incidents80706050403020100PrescribingproblemDispensingproblemDeliveryproblemAdministrationproblemStorage,wastage, securityproblemThis graph shows the common types of medication incidents reported during the period July 2010 and June 2011.Other typeof problemTimeline of proportion of patients with ST-elevation acute myocardial infarction whoreceived key interventions before and after introduction of the clinical paythway10080604020Pre-Pathway(n=42)2002(n=58)2004(n=26)• Antiplatelet agents continued at discharge• Beta Blockers continued at discharge*• Statins commenced pre-discharge2006(n=21)2008(n=21)2010(n=15)• ACE inhibitor continued at discharge*• Compliance with all processesResultsData for AMI has been collectedsince 2000, when a ClinicalPathway was implemented atWimmera Health Care Groupto improve the managementof these patients. The ClinicalPathway provides a procedureand check-list for staff to followto ensure all patients receivethe same high standard of care.Performance indicator data showsan improvement in the prescribingof appropriate medications toeligible patients on discharge sinceintroduction of the pathway.*Measurement of ACE inhibitor datacommenced in 2002 and thereforeexcluded from pre-2002 data.This graph shows percentage of patients who receive all the required medications after suffering an AMI.Importantly Wimmera Health Care Group has been continually able to maintain this result for 10 years.36Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201137

Medication Safety cont.DOCUMENTATION OF ALLERGIES AND SENSITIVITIESIt is important to document any allergies and/or sensitivities a patient has previously experienced. Current and completeinformation being available at the time of prescribing, dispensing and administration reduces the risk of the patient havinganother reaction to that medicine or a similar medicine.The medication chart is one of the tools used to communicate information about allergies and sensitivities betweenclinicians. Data from New South Wales audits has shown that completion of allergy documentation occurs 49-85% ofthe time¹. Wimmera Health Care Groups results presented in the graph show that allergy documentation is being wellundertaken, however, in our pursuit of excellence in care we will be focusing on improving this rate.1009080706050403020100b. HeparinHeparin decreases the ability of your blood to clot. It is usedto prevent blood clots forming and to treat diseases causedby blood clots. Heparin is considered a “high risk medicine”because if it is administered inappropriately the risk ofbleeding can be increased. In response to an alert issued bythe Department of Health, Wimmera Health Care Group hasreviewed the guidelines used to administer heparin, basedon the latest evidence. The form of heparin we stock, whereit is stored, and the way use is documented, has also beenreviewed.c. Medication ReconciliationMedication Reconciliation is a standardised process ofobtaining a complete and accurate list of a patient’s currentmedications and, in the context of the plan for the patient’scare, comparing it to medication orders documented onthe medication chart and prescriptions. The purpose ofmedication reconciliation is to ensure patients receiveall intended medicines and avoid errors of transcription,omission, duplication of therapy, drug-drug interactions anddrug-disease interactions.A Medication Reconciliation process was implemented atWimmera Health Care Group in 2009. Since January 2011,a pharmacist has been rostered to work in the EmergencyDepartment (staff levels permitting) to conduct MedicationReconciliation and thus further improve the process.d. Intravenous Fluids in Paediatric PatientsIn response to an alert issued by the United KingdomPatient Safety Agency, measures were introduced atWimmera Health Care Group to reduce the risk ofa particular intravenous fluid being administered topaediatric patients. Serious incidents have been reportedinternationally when children have been administered thisintravenous fluid.e. National Labelling RecommendationsThe Australian Commission on Safety and Quality in HealthCare has developed national standards to promote the saferuse of injectable medicines. Wimmera Health Care Group iscurrently implementing the standards, which provide minimumrequirements for the labelling of injectable medicines. Theirimplementation will reduce the risk of a medicine beingadministered incorrectly and will improve safety for patients.July2010Aug2010Sept2010Oct2010Nov2010Dec2010Jan2011Feb2011Mar2011Apr2011May2011June2011WHAT CAN YOU DO TO HELP US PREVENT MEDICATION ERRORS? 1 39This graph shows the percentage of patients who have completed allergic reaction status documented on their current medication chart.2. High Risk MedicationsSometimes Wimmera Health Care Group is providedwith information on medication adverse events that haveoccurred somewhere else. When this happens we askourselves “Could this happen here?” If we think it couldhappen at Wimmera Health Care Group, then we makeDarlene Smith, Medication Safety Pharmacist, Patrick Moroney,Nurse and Fiona Williams, Sir Robert Menzies Nurse UnitManager with a large mock amber oral dispenser.1. Indicators for Quality Use of Medicines in Australian Hospitals: NSW Therapeutic Advisory Group, 2007.changes to try and prevent that type of error occurring.This year, Wimmera Health Care Group has been workingtowards reducing the risk associated with the followinghigh risk medication areas.a. Wrong route administration of oral liquid medicinesSome serious incidents have occurred in Australia andoverseas when oral liquid medication has been injected bymistake. Wimmera Health Care Group introduced amberoral dispensers in 2009 to prevent these types of errorsoccurring. The oral dispensers cannot be connected toneedles and are an amber colour, so are clearly differentfrom intravenous syringes.Nursing staff were asked to complete a survey on the useof oral liquid medicines in 2010. Information obtainedfrom this survey identified further areas for improvementwith the use of amber oral dispensers. In 2011, a furthersurvey was conducted, which showed sustained high useof amber oral dispensers and a decrease in the use ofintravenous syringes for the administration of oral liquidmedicines.Be actively involved in your own health care• Taking part in decisions that are madeabout your treatment is the single mostimportant way to help prevent things fromgoing wrong and to get the best possiblecare for your needs.Speak up if you have any questions or concerns• Remember that you have a right to askquestions and to expect answers that youcan understand.Keep a list of all the medicines you are taking• You can use the list to let your doctor andpharmacist know about anything youare taking, and about any drug allergiesyou may have. Remember to includeprescriptions, over-the-countermedicines and complementary medicines(such as vitamins and herbs) on your list.If you are admitted to hospital please bringall the medications you are taking with youplus your medication list.Make sure you understand the medicines you are taking• When you get your medicine, read thelabel, including the warnings. Make sure itis what your doctor ordered for you.• Ask: Do you have any written information aboutthis medicine?- What do the directions on thelabelmean?- How much should I take, and whenshould I take it?- What are the common side effects?- What should I look out for?- How long before it starts to work?- Will this medicine interact with theother medicines that I’m taking?- Are there any foods or other thingsthat I should avoid while I’m on thismedicine?- How long do I need to take thismedicine?1. Extracts reproduced from 10 Tips for Safer Health care published by Australian Council for Safety and Quality in Health Care (2003).HIGHLIGHTPharmacist rostered to work in the Emergency Department to conduct Medication Reconciliation.38Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/2011

Falls Monitoring And PreventionFalls are one of the most widespread and serious injury problem faced by the elderly in our community. Each year, one thirdof people aged over 65 will experience a fall. People in hospitals and residential facilities have even higher fall rates as aresult of sickness and frailty, altered routines and surroundings.The frequency of falls is made worse by the greater vulnerability of the elderly and infirm, to serious injury. In older people,even comparatively small falls can result in death and significant injury. People who experience falls also suffer increasedanxiety levels and social withdrawal¹.Wimmera Health Care Group has been actively monitoring and managing falls for a number of years. Sometimes we are notable to prevent somebody from falling – for example a resident with dementia and who is unsteady when walking is at highrisk of falling, however the only way to stop this resident from falling is to restrain them. As restraining people is dangerouswe would instead try to minimise the harm to the resident if they did fall. The organisation has also been working with staff,patients, residents, families and carers to prevent falls where possible and minimise harm to those people in whom fallscannot be prevented.The falls reduction and harm minimisation strategies implemented are ongoing and have included:• Earlier recognition of those patients and residents who are at high risk of falling and using strategies to reduce this risk;• Planning patient and resident care according the patients residents risk of falling;• Use of sensor mats, which alert staff when a patient and resident has moved from their bed or chair;• Use of lift care beds, which lower the mattress to floor level which reduces the risk of injury as the person rolls outof bed, rather than falling from a height; and• Use of hip protectors. Hip protectors are plastic shields or foam pads which provide substantial protection againsthip fracture during a fall or impact onto the hip.Reference:1. Preventing falls and harm from falls in older people. The Australian Council for Safety and Quality in Health Care, 2005.6050403020100July2010Aug2010Sept2010Oct2010Nov2010Dec2010Jan2011Feb2011Mar2011Apr2011May2011June2011This chart is an example of information available for people at risk of falling.This graph shows the recorded incidents of falls for each month in the 12 months between July 2010 and June 2011. The number of falls is trendingdownwards as can be seen on the trend line (grey line).(Source: http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/1D340710CCBB1C40CA25744F001DE63E/$File/FP-brochure.PDF)40Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201141

Pressure Ulcer Monitoring And PreventionA pressure ulcer is a sore, an area of skin that has been damaged due to unrelieved and prolonged pressure. Pressure ulcersare also known as pressure sores or bed sores. 1 Pressure ulcers are recognised internationally as a leading cause of harm inpatients and residents and are largely preventable. 2There are four stages of pressure ulcers, which depend on how deep the ulcer is. A stage 1 ulcer is less severe than a stage 4.People at risk of developing pressure ulcers are those who:• are confined to a bed or chair and unable to move independently or have limited movement;• have loss of sensation or poor circulation;• have skin that is frequently moist through perspiration or loss of bowel or bladder control;• have poor nutrition; and• are unwell. 1Commonly used strategies used to prevent pressure ulcers in those patients/residents admitted to Wimmera Health CareGroup are:INPATIENTSANNUAL RATE(per 1000 bed days)Stage 1 0.16Stage 2 0.41Stage 3 0.25Stage 4 0RESIDENTIAL SERVICESThe tables above demonstrate the annual rate of pressure ulcers per 1,000 bed days for each pressure ulcer stage for the period from July 2010to June 2011.PROCESS FOR MINIMISING THE RISK OF PRESSURE ULCERSANNUAL RATE(per 1000 bed days)Stage 1 0.22Stage 2 0.15Stage 3 0Stage 4 0• Earlier recognition of those patients/residents who are at high risk of developing pressure ulcers– each patient/resident is assessed to identify the level of pressure ulcer risk and their specific risk factors;• Planning patient/resident care according the patient’s/resident’s risk of developing pressure ulcers – specific riskreducing strategies are implemented which target the person’s individual risk factors;• Access to a range of special equipment that can be used for those patients/residents at high risk of developingpressure ulcers. This includes special air mattresses, cushions and heel wedges;• All hospital beds and trolleys now have specially designed pressure reducing mattresses on them;• Staff education programs include pressure ulcer monitoring and prevention; and• Information brochures are available for people at risk of developing pressure ulcers.References:1. Preventing Pressure Ulcers – an information booklet for patients. Victorian Quality Council 2004.2. PUPPS 3 – Pressure ulcer point prevalence survey, Statewide report 2006. Department of Human Services 2006.WIMMERA HEALTH CARE GROUP MONITORS THE NUMBER AND STAGE OF PRESSURE ULCERS.80706050403020*Modified from Victorian Quality Council (2004) minimising the Risk Falls & Fall - relatedinjuries: Guidelines for Acute, Sub-acute and Residential Care Settings.100July2010Aug2010Sept2010Oct2010Nov2010Dec2010Jan2011Feb2011Mar2011Apr2011May2011June2011This graph shows the recorded incidents of pressure ulcers for each month in the 12 months between July 2010 and June 2011. The number ofpressure ulcers is trending downwards as can be seen on the trend line (grey line).This chart explains the four steps used in minimising the risk of developing pressure ulcers.42Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201143

Dental ServicesSafe Use Of Blood And Blood ProductsOur two dentists, dental therapist, dental prosthetist, trainee dental prosthetist (also a technician) and support staffprovide a wide range of oral health services to eligible patients including emergency care, dentures and non-urgenttreatment. During 2010-11, the Dental Services provided 4,143 general dental appointments and 1,647 emergency dentalappointments.A blood transfusion can be lifesaving, however, there can be risks associated with the use of blood and blood products.The Red Cross Blood Bank constantly strives to have one of the safest blood supplies in the world 1 . There are numerousstandards and guidelines based on best evidence that promote effective management systems in hospitals for thetransfusion of blood and blood products².Along with providing care and treatment, the Dental Service also educates pre-school children on oral health. Once ayear, kindergarten groups visit the Dental Service and each child undergoes a quick mouth check. If they appear to requireadditional dental services, parents are informed via the kindergarten teacher. Children are shown how to correctly cleantheir teeth and a sample bag is sent home with them. The aim of kindergarten visits is to educate children and their parentson dental hygiene and hopefully reduce the need for dental services.The red cells from your donations are used in the following ways:34% Cancer and blood diseases19% Other causes of anaemia18% Surgical patients including open heart surgery and burns13% Other medical problems including heart, stomach andkidney disease10% Orthopaedic patients including fractures and jointreplacements4% Obstetrics, including pregnant women, new mothers andyoung children2% Trauma including road accidentsOUR FANTASTIC PERFORMANCEOur Dental Services care is well above the Grampians and State average• Emergency dental care provided with retreatment required within 28 daysDuring July to December 2010, 431 emergency dental services were performed, 21 patients requiredretreatment within 28 days, which is 5.1% of the total. This rate is lower than the Grampians region(6.6%) and the state (5.5%).• Unplanned return within 7 days after tooth extractionThere were 537 extraction episodes during July to December 2010, of which, there were twounplanned returns. This was 0.4% of the total, lower than the Grampians region (1.9%) and stateaverage (1.1%).These figures are provided to Wimmera Health Care Group from Dental Health Services Victoria based on our reporting.Reference:Australian Red Cross Blood Service, How Donated Blood is Used.http://www.donateblood.com.au/all-about-blood/how-donated-blood-used,accessed 1st September 2011At Wimmera Health Care Group, we have a number of strategies that promote safe use of blood and blood products.We work closely with the St John of God laboratory. The Transfusion Committee, made up of staff from Wimmera HealthCare Group and St John of God Pathology, is responsible for ensuring that that blood is used safely and appropriately withinthis organisation. Some of the other strategies used are outlined below.Reference:Department of Health, Safe Use of blood and blood products 2010-11 Quality of Care Report.http://docs.health.vic.gov.au/docs/doc/Safe-use-of-blood-and-blood-products-2010-11-Quality-of-care-report, accessed 1st September 2011Peter Daffy, a Dental Technician at Wimmera Health Care Group, works on a set of dentures.44Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201145

Safe Use of Blood And Blood Products cont.Redesigning CareThe Transfusion Nurse at Wimmera Health Care Group is an important resource for our staff. Her role is to:• promote good transfusion practices amongst the staff;• assist in the development of policies relating to blood and blood products; and• encourage staff to participate in ongoing education and training in transfusion procedures.Blood Safe e-learning is an online educational program that staff are able to complete. This national program was developedby clinical experts in the area of transfusion and provides staff with an opportunity to develop their knowledge of blood andto foster safe transfusion practice and the appropriate use of blood components. Our Transfusion Policy and ProcedureManual is based on national guidelines and outlines the expected process for the many procedures necessary for thetransfusion of blood and blood products. These procedures include pre-transfusion testing, prescribing and administrationuse of blood and blood products. We also need to ensure that the administration of blood and blood products is appropriate.Blood is a valuable community resource and we don’t wish to waste it. If administered inappropriately – it may meanthat the product is not available for someone else that does need it. It can also expose the patient to risks of a transfusionwithout offering a corresponding health benefit.Appropriateness audits are undertaken to monitor the percentage of patients who meet the Clinical Practice Guidelinesfor Appropriate Use of Red Blood Cells developed by the National Health and Medical Research Council (NHMRC)/Australasian Society of Blood Transfusion (ASBT). As you can see, the graph below shows that at Wimmera Health CareGroup all patients since September 2010 have had an appropriate indication for a blood transfusion.This year, Wimmera Health Care Group commenced a two year redesigning care project to evaluate and improve patient carewith the overall purpose to reduce non-value adding activities and increase efficiency and quality of care. The initial focus of theproject is on the Emergency Department and within the Oxley Ward. The aim is to reduce the length of stay in the emergencydepartment and to have the most adequate length of stay for patients in Oxley.A project manager and two project nurses have undertakena significant review of processes. Staff and patients havealso been involved in the review. Staff have followed otherstaff members to review processes and systems (includingdocumentation and referral) that occur in their own work.Patients have been surveyed to gauge their experiences of thecare received.Wimmera Health Care Group is looking forward to seeing theoutcomes of this project and we trust that patients will alsonotice the improvements.Percentage of patients with an appropriate indication for blood transfusion100806040200Jan 2010(n=17)Feb 2010(n=19)Mar 2010(n=31)Apr 2010(n=19)May 2010(n=22)June 2010(n=24)July 2010(n=23)Aug 2010(n=22)Sep 2010(n=19)Oct 2010(n=25)Nov 2010(n=20)Dec 2010(n=17)Jan 2011(n=19)Feb 2011(n=21)Mar 2011(n=16)Apr 2011(n=15)May 2011(n=27)Janette McCabe, Oxley Nurse Unit Manager uses the patient’s boardimplemented as part of the redesigning care program.References:1. Australian Red Cross Blood Service, Safety andTesting. http://www.donateblood.com.au/all-aboutblood/safety-and-testing,accessed 1st September 20112. Reference: Department of Health, Safe Use ofblood and blood products 2010-11 Quality of CareReport.http://docs.health.vic.gov.au/docs/doc/Safe-useof-blood-and-blood-products-2010-11-Quality-of-care-report, accessed 1st September 2011Anne Cress, Blood Transfusion Nurse, reviews the BloodTransfusion Manual.46Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/201147

Our StaffStaff Uniform CodeAt Wimmera Health Care Group, our most valued resource is our staff. They play a vital role to ensure that we are pursuingexcellence in care. From the staff in our Medical and Clinical Divisions, to those that work in the Finance, Administration,Food Services, Environmental, Engineering and Linen Departments, each and every one of our staff has an important job todo to ensure that our health service runs effectively and efficiently.To help patients and visitors identify the different staff at Wimmera Health Care Group,we have the following staff uniform code:35 YEARS SERVICE 30 YEARS SERVICE 25 YEARS SERVICE 20 YEARS SERVICE 10 YEARS SERVICEPhillip IrvinHeather MerrettLance SmithMary WilkieGaylene BakerBruce GreigWendy KingLois MulquinyMargaret ScottTrevor SpencerLynette TaylorLeonore UebergangPamela CooksonJennifer DumesnySimone DuncanKerry FlynnElaine KelmStuart KingWendy KingRosalie LienertMargaret McDonaldMaree MarkbyAntoinette PlushFiona SchneiderJoyce SluggertAileen WardAngela DrumCathryn HarmerSusan HeronRobyn LucasGail PollardJudy WoodVicki ArnottDarren BarnettDianne BrownJoanne CarrollRhonda CarsonJennifer CritchleyChristine DumesnyBriana FarrLynne FraserPatricia HateleyKaren HawkesJanine HobbsNadine HoffmannKaren HollierJillian JanetzkiBeverley JenkinsCassandra KellyMaria KrauseMaureen Lister-WarrickSusan MayGeoffrey McIntyreHelen McMasterNicole McMasterElizabeth McVittyTheresa MellingsDeborah NortonAntoinette PlushJane RentschKaren SandersonKaylene SchultzShannyn ScottDarlene SmithSamantha SordelloDebbie StackTracey StoryVicki TuckerChristine TylerSusan WilliamsNursing staff – red and white shirts, navy lower garments, jackets and vests.Support staff (Food Services, Environmental Services,Linen Services, etc) – blue shirts, navy lower garments, jacketsand vests.Administration staff – grey and white shirts, charcoal lowergarments, jackets and vests.Allied Health staff (Physiotherapy, Speech Pathology,Occupational Therapy, Podiatry, Dietetics, etc) – chambrayblue and white shirts, navy lower garments, jackets and vests.48Pursuing excellence in careWimmera Health Care Group Quality of Care Report 2010/2011

Incorporating:Wimmera Base HospitalDimboola HospitalWimmera Nursing HomeKurrajong Lodge HostelBaillie StreetHorsham Victoria 3400p: 03 5381 9111f: 03 5382 0829e: info@whcg.org.auw: www.whcg.org.auWimmera Health Care Group prides itself on beinga leader in rural health through delivering caringservices with respect, reliability and integrity.Scott Walker (Boilerman), Alisa Smithyman (DentalTechnician), Ellie Rook (Administration Officer),Stephen Hill (Head Chef), Leanne Taylor (RegisteredNurse) and Kristen Coats (Chief OccupationalTherapist) are some of our valued employees whoensure that we are pursuing excellence in care atWimmera Health Care GroupA Marketing Business Production 11-8319