Orientating Nurses to General Practice - General Practice Queensland

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TABLE OF CONTENTS• INTRODUCTION ..............................................................................1SECTION 1: COMPONENTS OF GENERAL PRACTICE .......................... 2• HUMAN RESOURCE MANAGEMENT3Orientation Template..................................................................4• THE ROLE OF THE PRACTICE NURSE ................................................7Triage........................................................................................8Immunisation.............................................................................8Wound Management ................................................................16Preparation for Minor Procedures ..............................................16Sterilisation..............................................................................16Information Management..........................................................19General Practice Accreditation ...................................................20Health Assessments..................................................................21Case Conferencing....................................................................22Chronic Disease Management ...................................................23Chronic Disease Initiatives ........................................................24Home Medicines Review............................................................28• INFECTION CONTROL ....................................................................30Spills Kit...................................................................................30Handwashing ...........................................................................30Cleaning the Practice Environment ............................................31Needle Stick Injury ...................................................................32• RECALL AND REMINDER SYSTEMS..................................................34• THE PRACTICE INCENTIVES PROGRAM (PIP) ..................................36• GENERAL PRACTICE ACCREDITATION ............................................38• MEDICARE AND THE MEDICARE BENEFITS SCHEDULE ....................40• PROFESSIONAL ISSUES..................................................................41• COMMON ACRONYMS USED IN GENERAL PRACTICE........................43SECTION 2: INTEGRATING WITH DIVISIONS..................................45• DIVISIONS OF GENERAL PRACTICE OVERVIEW...............................46• BRISBANE SOUTH DIVISION OF GENERAL PRACTICE ......................47

• INTEGRATING WITH THE BRISBANE SOUTH DIVISION ...................49SECTION 3: EDUCATION AND PROFESSIONAL DEVELOPMENT .......51• EDUCATION OPPORTUNITIES WITH THE DIVISION ........................52• EDUCATION OPPORTUNITIES VIA EXTERNAL ORGANISATIONS.......54SECTION 4: COORDINATING PATIENT SERVICES ...........................56• COMMUNITY SERVICES..................................................................57Aged Care Assessment Team (ACAT).........................................57Alzheimer’s Australia.................................................................58Brisbane City Council Call Centre ...............................................58Brisbane South Diabetes Referral Service ...................................59Centrelink Helpline....................................................................59Commonwealth Carelink Centres................................................59Commonwealth Carer Resource Centre ......................................61Commonwealth Carer Respite Centres........................................61Community Health Services .......................................................62Community Hospital Interface Program (CHIP) ...........................63Department of Veterans Affairs..................................................64Disability Services Queensland...................................................64Home and Community Care (HACC)...........................................64National Continence Helpline .....................................................65Palliative Care Queensland ........................................................65Transport .................................................................................66• COMMUNITY ALLIED HEALTH SERVICES .........................................67Brisbane South Allied Health Referral Service..............................67Domiciliary, Allied Health, Acute Care & Rehabilitation Team(DAART) ..................................................................................67• DOMICILIARY NURSING.................................................................68• ADDITIONAL INTEGRATION OF PATIENT SERVICES........................70Criteria for calling an Ambulance ................................................70Doctors Priority Line – Translating and Interpreting Service .........70Meals on Wheels.......................................................................71Multicultural Directory................................................................71The Qld Integrated Refugee Community Health Service Clinic ......72Queensland Poisons Information Centre......................................72• COMMONLY USED PHONE NUMBERS ..............................................74• COMMONLY USED WEBSITES .........................................................77

• REFERENCES .................................................................................79APPENDIX 1APPENDICES• USEFUL RESOURCES......................................................................80

INTRODUCTIONThis manual has been designed specifically to assist and orientate nursesnewly employed in the general practice setting, but will also support currentlyemployed nurses. It has been developed in collaboration by Brisbane SouthDivision of General Practice, South East Alliance Division of General Practiceand Logan Area Division of General Practice and provides useful and practicaltips.We would like to acknowledge all previous work done by Hunter UrbanDivision of General Practice, Melbourne Division of General Practice and GPNorth Division of General Practice, Tasmania.The role of the practice nurse is unique in that it involves both preventativeand acute care and differs from the community health or hospital setting. Itis also diverse and is an integral part of the General Practice team.Definition of General Practice in AustraliaGeneral Practice is part of the Australian health care system and operatespredominantly through private medical practices, which provide universalunreferred access to whole person medical care for individuals, families andcommunities. General practice care means comprehensive, coordinated andcontinuing medical care drawing on biomedical, psychological, social andenvironmental understandings of health (Royal Australian College of GeneralPractitioners).Definition of a Practice NurseA Practice Nurse can be defined as a Registered Nurse or Enrolled Nurseworking in the General Practice setting.The creation of a user-friendly reference document will mean the orientationprocesses for the new practice nurse will not need to solely rely on mentoringand will assist to make the transition into General Practice as smooth aspossible.1

SECTION 1COMPONENTS OF GENERALPRACTICE2

HUMAN RESOURCE MANAGEMENTORIENTATIONProviding orientation to new members of the practice team is imperative toassist the new staff member so they can confidently commence theiremployment. Induction programs are now an essential indicator for all newstaff in the 3 rd edition RACGP standards for General Practice Accreditation. Inline with this requirement, it is essential that each Practice has acomprehensive orientation for each new staff member. It is also paramountthat the Nurse has a clearly defined position description to work to.The components, format and timeframe of the orientation can becustomised to suit the practice’s needs.Below is an example of the components of the orientation that could beaddressed by the practice. Some of the items may have been addressed preemployment.1. Terms and conditions of employment2. Welcome and introduction to the practice3. Personnel administration / Human Resource Management4. Administration Issues5. Introduction to Role at the Practice / Individual tasks relevant to therole6. Occupational Health & Safety Issues7. Other Relevant IssuesBelow is an example Orientation Checklist which the practice may like toadapt to suit their needs.3

ORIENTATION PROGRAM FOR PRACTICE NURSE TEMPLATE(Can be modified by the Practice)NAME: ___________________________POSITION: ________________________DATE COMMENCED EMPLOYMENT: _________________Unit Number Components of Unit PersonInvolvedOne Stress the importance of feeling free to askquestions at any timeWelcome & introduction to the Practice- Explain your own role in the Practice- Introduce the Doctors and staff- Tour of the Practice environment includinglocation of facilities (toilets, emergency exits,lunch/staff room, consulting rooms, treatmentroom, pathology, fire extinguishers)- Outline the organisational structure of thepractice – briefly outline the role of other teammembers- Provide an overview of the Practice culture –philosophy of the practice, mission, vision andvalues of the practice- Provide an overview of the patient demographice.g. number of patientsPracticeManager /Supervisor ofnew staffmemberCompletedDate/signTwoPersonnel Administration / Human ResourceManagement- Detail letter of appointment, positiondescription, contract and confidentialityagreement- Ensure that staff member understands majorterms and conditions of employment, hourlyrate\salary, hours to be worked- Outline reporting responsibilities and chain ofcommand for decision making- Name of direct supervisor or clinical mentor- Explain timesheet, time keeping procedures- Paper work for tax, superannuation, bankaccount details- Staff uniforms, name badges- Explanation of Leave entitlements- Outline Grievance proceduresPracticeManager /Supervisor ofnew staffmember4

Unit Number Components of Unit PersonInvolvedSixOther Relevant Issues- Accreditation – define stage of process andnew employees involvement in this process- Contact your local Division – Brisbane SouthDivision to make contact with your AreaManager and Practice Nurse Program Manager- Professional Development opportunities andperceived training needs if anyCompletedDate/signComments:6

THE ROLE OF THE PRACTICE NURSEA Nurse working in general practice has a unique role and there are a numberof ways to describe the role. Certainly, the role of one Nurse working in oneGeneral Practice setting may be very different to another. This may be inpart due to the:1. Practice geographical location2. Patient demographics3. Qualifications, experience and competencies (e.g. Registered Nurseversus Enrolled Nurse)4. Full time versus part time capacity5. Utilisation of the Nurses skill set e.g. generalist role versus anenhanced role6. Requirements / philosophy of the Practice7. National incentives and programsIn the General Practice setting, Nurses1. Provide clinical nursing services2. Manage the clinical environment3. Provide health promotion and patient education4. Coordinate patient services, and5. Improve health outcomesMore recently, there have been three distinct models of Practice Nurseutilisation defined. They are the:Generalist Practice Nurse ModelSpecial Sessions ModelAdvanced Practice Nurse ModelThe Generalist Practice Nurse is a Nurse employed by the Practice whoprovides a clinical support role delegated by the GP. This may include suchtasks as assisting with Health Assessments, Diabetes Annual Cycle of Care,creating disease registers and managing recall systems, EPC, WoundManagement, ECGs. This model has direct advantages of freeing up GPstime, enhancing the management of chronic disease patients and increasingthe range of services provided by the practice.The Special Sessions Model refers to contracting specialist nursing servicesfor specific sessions in the practice e.g. four hour session run by aCredentialed Diabetes Nurse Educator conducting a Diabetes Clinic.Advantages of adopting this model would be to focus on disease specificareas and streamline and better manage patient care.The Advanced Practice Nurse Model is a Nurse employed by the Practicewho undertakes Nurse led specialist clinics and advanced clinical support with7

significant involvement in complex care needs. One example is an AsthmaManagement Nurse led clinic e.g. detailed patient history, clinical assessment,spirometry, use of inhalers, patient education input in Asthma Action Plan,monitoring of disease.Within these models, the nurse working in general practice performs anumber of tasks. The role of the Practice Nurse can include, but is not limitedto the following:Main Duties:TriageImmunisationWound ManagementPreparation for minor procedureSterilisationGeneral Duties:Information ManagementGeneral Practice AccreditationOther Key Duties:Health AssessmentsCase ConferencingChronic Disease Management (GP Management Plans, Team CareArrangements)Chronic Disease Initiatives (Diabetes, Asthma, Cervical Screening)Home Medicine ReviewsMain Duties:TRIAGEPractices are required to arrange for patients with urgent or serious medicalproblems to obtain medical care as soon as possible. Triage is performed bycategorising patients into different levels of priority according to the degree ofurgency for treatment. This assessment is brief, systemic and determined bypriority of need and individual practice protocols.The Practice Nurse is responsible for providing first line treatment asappropriate e.g. oxygen and maintaining the emergency equipment and orthe emergency trolley.IMMUNISATIONAn MBS item number (10993) can be claimed when an immunisation isprovided by a practice nurse on behalf of a medical practitioner, and underthe supervision of a medical practitioner in the consulting rooms of a generalpractice, or in a residential aged care facility, during a home visit to theperson or in an institution (other than a hospital or day hospital facility).8

The involvement of the Practice Nurse may include:• Administering vaccines in a safe and timely manner according to thecurrent schedule• Knowing how to identify and manage an anaphylactic reaction• Helping to maintain practice immunisation rate above 90% bypromotion and information to patients• Maintaining an active vaccination recall system e.g. for the currentchildhood vaccination schedule or 65 year old flu vaccinations• Ensuring Cold Chain maintenance (vaccines maintained at atemperature between 2 to 8 degrees centigrade)• Ordering vaccinesThe Practice Nurse could work in conjunction with other practice staff to:• Complete ACIR recording requirements• Check monthly ACIR statements and undertake data cleansing asnecessary• Ensure daily vaccine fridge monitoringImmunisations on average make up to 5% of a General Practice’sconsultations. Their importance is twofold:• They provide huge public health benefits. “More than any othermedical intervention in Australia, immunisation has reduced sufferingand death from infectious diseases”.• They also allow practices to earn revenue through the General PracticeImmunisation Incentive (GPII) Program.About the GPII ProgramThe GPII Program provides financial incentives to GPs who monitor, promoteand provide immunisation services to children under the age of seven years.The GPII scheme is made up of three components:• A Service Incentive Payment (SIP) – an $18.50 (not GST inclusive)payment to GPs and Other Medical Practitioners (OMPs), who notifythe Australian Childhood Immunisation Register (ACIR) of a vaccinationthat completes an immunisation schedule;• An Outcomes Payment – practices that achieve 90% or greaterproportions of full immunisation providing the practice attains 10SWPEs (Standardised Whole Patient Equivalents); and• Immunisation infrastructure funding – which provides funds toDivisions of General Practice, State-Based Organisations and fundingfor a National GP Immunisation Coordinator to improve the proportionof children who are immunised at local, State and national levels.The overall aim of the GPII scheme is to encourage at least 90 per cent ofpractices to achieve 90 per cent proportions of full immunisation. This9

milestone was accomplished in the May 2003 quarter. For information onyour practices percentage please contact the Division.֠TIPFor information on the GPII payment scheme refer tohttp://www.medicareaustralia.gov.au/providers/incentives_allowances/gpii_scheme.htm֠TIPThe practice may have a copy of ‘National Vaccine Storage Guidelines – Strivefor 5’. If not, you could obtain a copy by phoning 1800 671 811.֠TIPFamiliarise yourself with the conscientious objector process and reportingadverse events.֠TIPLocate the current version of the Australian Immunisation Handbook in thepractice.Definition of COLD CHAINVaccines need to be kept between 2°C and 8°C AT ALL TIMES to maintainthe potency of the vaccine. Cold Chain is the process of maintaining thetemperature of vaccines between 2°C and 8°C. Vaccines must be keptbetween these temperatures at each stage of their journey from manufactureto the point of immunisation of the patient.When vaccines arrive at the surgery they will be packed with a ColdMarkmonitor, if they are delivered in an esky with ice bricks or a CSL TimeTemperature Indicator (TTI) Label colour guide, if they are delivered in acardboard box from a refrigerated truck.ProcessEnsure Cold Chain process has not been broken10

1. Unpack vaccines immediately after they are delivered and check thatice packs have not completely thawed for vaccines that are delivered ineskies.2. Check the ColdMark monitor or Time Temperature Indictor Lable fortemperature.3. Store immediately in the vaccine dedicated refrigerator.4. Rotate stock.Your practice should have a system in place to record stock ordered andreceived.If at any stage you believe that vaccines have been compromised in any wayat all, contact Qld Health Immunisation Program (QHIP) previously known asVaccination Information and Vaccine Administration Services (VIVAS) on3234 1500.Strive for 5: The National Vaccine Storage Guidelines forImmunisation Providers on Maintaining the Cold Chain gives furtherinformation about cold chain and vaccine storage. These guidelines can beobtained from www.immunise.health.gov.au/publications.Vaccine RefrigeratorsTraditionally general practices keep vaccines in various types of domesticrefrigerators. However, recently it has been shown that temperatures indomestic refrigerators fluctuate greatly outside of the range of 2°C – 8°C andpotency cannot always be assured. A great number of practices are replacingtheir domestic refrigerator with purpose built vaccine refrigerators.Queensland Health state that bar refrigerators are considered too small andinappropriate to store vaccines.The following standards for vaccine refrigerators are in place for Queensland:• National Health and Medical Research Council (NHMRC) TheAustralian Immunisation Handbook 8 th Edition 2003, page 54.Purpose built vaccine refrigerators are the preferred refrigerators forvaccine storage. It is recommended that if possible, purpose-builtvaccine refrigerators are used by larger vaccination services, includinghospitals, pharmacies, larger community health centres and largergeneral practices.11

• Royal Australian College of General Practice (RACGP)Standards for General practices 2 nd EditionCriteria 5.2.4 Page number 53The practice has appropriate vaccine storage which maintains vaccinesat temperatures between 2°C and 8°C. The temperature iscontinuously monitored and is checked and recorded daily.Purpose Built Vaccine RefrigeratorsThere are several manufacturers and/or distributors of purpose built vaccinerefrigerators in Australia. For a list of suppliers contact Queensland Health orthe Division.Purpose built vaccine refrigerators are programmed to maintain an internaltemperature between 2°C to 8°C. The benefits of having a purpose builtvaccine refrigerator are that it:• is designed especially for vaccines;• automatically defrosts;• has an external temperature reading display;• has a maximum/minimum temperature continuous display; and• has an alarm for deviations outside the programmed temperaturerange.Refrigerator MaintenanceRefrigerator breakdowns should be repaired immediately. The door sealsshould be in good condition so that the door closes securely. Refrigeratorsthat are not ‘frost free’ should be defrosted regularly to prevent ice build-up.Ice build-up can reduce the efficiency and performance of a refrigerator.During defrosting or cleaning of the refrigerator, move the vaccines to asecond refrigerator ensuring the cold chain procedure. This temporary storagerefrigerator must also be monitored to ensure the correct temperaturesbetween 2°C and 8°C is maintained. Alternatively the vaccines can be storedin a pre-cooled, insulated container with ice packs or ice until the normalvaccine refrigerator is ready for use again. (The Australian ImmunisationHandbook 8 th Edition, page 56 - Also see section on “Transporting vaccines ininsulated containers, page 60).Temperature MonitoringVaccines must be monitored daily with a minimum and maximumtemperatures recorded. Temperatures can be recorded on a graph which canbe obtained from Queensland Health by calling 3234 1500.Refrigerators used for vaccines must have a minimum/maximum thermometerprobe placed on the middle shelf and temperatures should be checked andrecorded daily prior to patients being seen. Therefore if there has been a12

cold chain beak overnight then this can be dealt with prior to vaccines beingadministered. The most effective minimum/maximum thermometer is a digitaltype with a probe. Vaccine fridge thermometers can be obtained free fromQueensland Health by calling 3234 1500.Place the probe directly in contact with a vaccine vial or package. Do not putthe probe into fluid. The recommendation of keeping the vaccine storagetemperature at 2°C to 8°C is based on air, not fluid temperatures.The refrigerator temperature should be read at the same time each day,preferably prior to each working day. Twice daily temperature checks will giveyou a better indication of any problems in your refrigerators function andtemperature fluctuations over the course of the day. The new Min/Maxtemperature chart available from QHIP (previously VIVAS) has provision forAM and PM recordings. One person only should be responsible for adjustingthe refrigerator to maintain the temperature in the recommended range of2°C to 8°C.Refrigerators used for vaccine storage should have an uninterrupted powersupply, and door openings should be kept to a minimum. (The AustralianImmunisation Handbook 8 th Edition page 56)Power FailureDuring a power failure of 4 hours or less, the refrigerator door should be leftclosed and the vaccines should be left in the vaccine refrigerator. If the powerfails for more than 4 hours, store vaccines in a pre-cooled, insulated containerwith ice packs to keep them cool. For further information on what to do in apower failure see page 53 of the 8 th Edition Immunisation Schedule andcontact VIVAS on 3234 1500.Transporting VaccinesTransporting vaccines in insulated containers• Before packing ice packs with vaccines, remove the ice packs from thefreezer at least 30 minutes prior to packing and allow them to ‘sweat’.A ‘sweated’ ice brick is one that has been removed from the freezerfor about 30 minutes. This action reduces the risk of freezing vaccinessince the ice brick temperature is about -20°C when it is first taken outof the freezer.• Place vaccines (and time-temperature monitors and freeze monitor asrequired) in a small Styrofoam container (‘six-pack’ container). Closethe lid and secure with tape. Pack the small Styrofoam container insidea larger insulated container (a ‘cooler’ such as the Esky) andsurround it with ice packs. Close and secure the lid of the largecontainer. The vaccines must not be in direct contact with the icepacks because of the risk of freezing.13

• If the vaccines are not packed using the above technique, analternative method is to pack the vaccines inside a pre-cooled cold box(e.g. Esky). Place the ice packs on top of the vaccines, ensuring theyare separated from the vaccines by a layer of polystyrene foam,shredded paper or bubble-wrap plastic. Ensure the vaccines, coldchain monitor (CCM), ice packs and ‘filler’ material are packed toensure they do not move around during transport. Vaccines must bepacked to ensure the ice packs do not come into direct contact withthe vaccines or CCM, and the cold air can circulate freely around thevaccines.• Remove vaccines only as they are required, making sure the lids arereplaced on both the small and large containers each time (if this isthe method of transport). If the time-temperature monitors and/orfreeze indicators (or alternatively, the min/max thermometer in anoutreach situation) are used, they should be checked beforeadministering the vaccine. If the time-temperature monitor indicatesthat vaccine is being subjected to temperatures above 10°C whilebeing transported, use more freezer blocks to reduce and maintain theinternal temperature at the correct level.(Reference: The Australian Immunisation Handbook 8 th Edition,page 60-63)Vaccine OrderingVaccines as per the latest schedule can be ordered by phoning VIVAS on3234 1500.The Australian Standard Vaccination ScheduleThe Australian Standard Vaccination Schedule (ASVS) is recommended by theNHMRC. Each practice should have a copy of the 8 th Edition Handbook.Further copies can be obtained at http://www.immunise.health.gov.au14

The immunisation schedule incorporates all vaccines recommended as 'bestpractice'. Immunisation providers are responsible for advising patients andparents/caregivers of available vaccine choices at the time of consultation,including those provided free under the National Immunisation Program. Notall vaccines are funded by the Commonwealth.֠TIPFor information about the National Immunisation Program visit ImmuniseAustralia at http://immunise.health.gov.au, contact the Immunisation Infolineon 1800 671 811, contact VIVAS on 3234 1500 or contact the Division on3274 1886.֠TIPChanges to the 8 th Edition Immunisation Handbook (effective 1 November,2005) will be incorporated into the electronic version athttp://www.immunise.health.gov.au/handbook_changes.pdfTravel VaccinationsFor information on travel vaccinations see pages 77-89 of The AustralianImmunisation Handbook 8 th Edition.The role of the Australian Childhood Immunisation Register (ACIR)The ACIR is central to the effectiveness of the GPII scheme. It beganrecording details of all immunisations provided to children under seven yearsof age from 1 January 1996.The ACIR enables more effective management of the National ImmunisationProgram at National, State and Territory levels. It allows measurement ofimmunisation coverage rates in children as well as providing parents with animmunisation history statement when their children turn 1, 2, and 4 years ofage and also on completion of the 4 to 5 year vaccination schedule. Parentscan also request a statement at any other time.The ACIR information is used to determine the immunisation status ofchildren and accordingly the amounts paid under the GPII scheme. GPs willappreciate the importance of providing timely and accurate information to theACIR. Not only does it generate a payment for notification but, through thisscheme, will directly affect the amount of payment GPs will be eligible toreceive. It is best practice to notify ACIR weekly. Please check with yourpractice protocol on this.15

The following ACIR Forms can be downloaded athttp://www.medicareaustralia.gov.au/providers/forms/acir.htm• Immunisation history form used to report immunisation details to theACIR when another immunisation provider performed the vaccinationservice.• NT, QLD Stationery Re-order form used by Northern Territory andQueensland immunisation providers to order immunisation stationery.• Application to Transmit Immunisation Data Electronically must becompleted before immunisation data will be accepted via ElectronicData Interchange (EDI).• Medical Contraindication form used to record a reason why a vaccineshould not be given to a child.• Conscientious Objection form used to record a parent or guardian'sconscientious objection to their child being immunised.WOUND MANAGEMENTAn MBS item 10996 can be claimed where treatment of a persons wound(other than normal aftercare) is provided by a practice nurse on behalf of,and under the supervision of a medical practitioner AND the person is not anadmitted patient of a hospital or day hospital facility.The General Practitioner (GP) does not need to be present during thetreatment of the wound however an initial assessment must have beenundertaken by the GP and instruction given regarding the treatment of thewound.For more information please refer to your local Wound Care Advisor.PREPARATION FOR MINOR PROCEDURESEach doctor within the practice will generally have their own requirements forsetting up for minor procedures; otherwise there will be a specific practiceprotocol.STERILISATIONSterilisation is a validated process used to render a product free from allforms of viable micro organisms. The nature of microbial death is describedby an exponential function and although the probability can be reduced to avery low number, it can never be reduced to zero. (Sterilisation/DisinfectionGuidelines for General Practices, RACGP 3 rd edition, 2000, page 3).Sterilisation is a process defined by several acts requiring standards to be metto achieve a level of safe infection control. These acts must be undertakenunder strict protocols as outlined in the practices’ Policy & Procedure Manualaccording to RACGP guidelines.16

֠TIPIt may be your role in the practice to have the steriliser calibrated. If this isthe case, ask which company usually does the calibration and note when thisis next due. This should be done annually.18

General Duties:Depending on the job description the Practice Nurse may be asked toundertake the following:• Clinical collections e.g. swabs, urine/faeces specimens and perhapsvenipuncture. Your practice will have a nominated pathology providerwho will collect specimens on a regular basis.• ECG• Ear syringing• Injections• Urinalysis• Musculo-skeletal plastering• Maintain and restock doctor’s bag• Maintain practice S8 drug register• Maintain and rotate medication supplies• Maintain and restock medical supplies• Maintain cryotherapy equipment• Occupational Health and Safety• Infection Control e.g. maintain spills kit• Order nitrous oxide and oxygen as required• Check and restock emergency equipment• Spirometry• Pregnancy Tests• Minor procedures e.g. removal of sutures• Coordinate patient services by networking with other services e.g.Community Health Services and integrating service delivery• Patient education and health promotion particularly in the areas ofchronic disease managementINFORMATION MANAGEMENTThe use of the computer and medical software may be expected. This mayinclude:• Establishing a particular patient disease register e.g. Diabetic patientsfor annual cycle of care• Using the recall/reminder system as specified in the Practice’s Policyand Procedures Manual• Clinical data management e.g. entering and extracting data• Searching the database• Making appointments (if computerised, the practice may use e.g.Medical Director for its Clinical software and Prac Soft for its practicesoftware).19

֠TIPIf the practice uses Medical Director as their clinical software, you can accessquality consumer health information. Medical Director offers MIMS consumermedicines information directly from the main tool bar (a blue circle with CMIin it). John Murtagh’s patient education leaflets are easily accessible byclicking on ‘resources’ and then ‘patient education’.GENERAL PRACTICE ACCREDITATIONIf your practice is accredited, you will be involved in maintaining the cycle ofquality improvement in your practice and ensuring that the practice is readyfor a formal assessment of standards when this falls due.It will be of benefit to know where in the accreditation cycle your practice ise.g. registered to become accredited, accredited, preparing for reaccreditationand what your role is or is likely to be in this process.֠TIPThe Division and your Area Manager can assist you to prepare foraccreditation. The Division also conducts mock survey visits in preparation foryour actual survey visit by your nominated accreditation body. Contact us atleast two months in advance to arrange a time for a visit.֠TIPVisit your accreditation provider’s website (Agpal http://www.agpal.com.au orGPA ACCREDITATION plus http://www.gpa.net.au) for useful fact sheets.20

Other Key Duties:The Enhanced Primary Care Package (EPC)The Enhanced Primary Care incentive package was launched by the FederalGovernment in the 1999-2000 budgets. The goal of this package is toimprove the health and quality of life for older Australians and people withchronic conditions and multi-disciplinary complex care needs, throughenhancing the quality of primary health care. The major elements of thispackage are Health Assessments, Care Plans and Case Conferences.From 1 July 2005, new Chronic Disease Management (CDM) items in the MBSwere introduced to make it easier for GPs to manage the health care ofpatients with chronic medical conditions, including those patients who needmultidisciplinary care. For the first time, GPs have access to Medicare rebatesfor preparing and reviewing GP management plans for patients with chronicmedical conditions. For patients requiring multidisciplinary care, GPs can alsoclaim from Medicare for coordinating team care planning and review services.The CDM items apply to the treatment of people with asthma, cancer,arthritis, diabetes, heart disease, mental illness and other chronic conditions.The new items replace the existing EPC care plans, which are phased out andwithdrawn from 1 November 2005.֠TIPTwo useful websites to refer to for EPC are the RACGP site athttp://www.racgp.org.au and the Department of Health and Ageing athttp://www.health.gov.au/epc/HEALTH ASSESSMENTSAnnual Health Assessments are for people aged 75 years and over (55 yearsand over for people of Aboriginal and Torres Strait Islander descent).The Practice Nurse role may include the following:• Implement and maintain a systematic approach towards thisinitiative, including promotion and an active recall and remindersystem• Collect mandatory information and record• Refer to appropriate service providers as requested and agreed toby the GP and the patientHealth Assessments can be conducted in the practice, in the patient’s home,or a combination of both. GPs can engage the services of the Practice Nurseto collect some of the information or to conduct the Home HealthAssessment.21

In summary,• MBS Item Numbers 700 and 704 – in consulting rooms• MBS Item Numbers 702 and 706 – all or part of Health Assessment inpatient’s homeOn completion of the Health Assessment, it may also be apparent that thepatient would benefit from a GP Management Plan or Team CareArrangement or a Case Conference. Discuss this with the GP.֠TIPFamiliarise yourself with the MBS requirements for Health Assessments byreading the explanatory notes in the MBS Schedule to be confident in theprocesses. If computerised, familiarise yourself with the assessment tool tobe used on your medical software.֠TIPTo obtain information in relation to services available in the community, referto the “Coordinating Patient Services” section.֠TIPThe Department of Veterans Affairs is also a very useful website. Visithttp://www.dva.gov.au or phone 13 32 54.CASE CONFERENCINGThis is a meeting of at least three health care providers to plan care forindividual patients with chronic and complex conditions and multi-disciplinarycare needs. They may either be undertaken for patients in the community orin a residential aged care facility, or patients being discharged into thecommunity from a hospital. Case conference meetings can be face to face,via telephone or video conference.A case conference usually involves immediate management plans to developshort term or urgent solutions and must be at least fifteen minutes induration. A practice cannot claim more than five case conferences for apatient in a twelve month period. Item payments vary depending on 1) thelength of the conference, 2) whether the GP organised or coordinated theconference or was a participant and 3) the location of the conference.22

The Practice Nurse role may include:• Identifying eligible patients who would benefit from a caseconference• Understanding and promoting the process of a case conference• Assisting with the organisation and facilitation of the case conference• Assisting in the implementation of the short term management plan֠TIPFamiliarise yourself with the MBS requirements for Case Conferences byreading the explanatory notes in the MBS Schedule to be confident in theprocesses.CHRONIC DISEASE MANAGEMENT ITEMS:(GP Management Plans and Team Care Arrangements)GP Management Plans (GPMP)GP Management Plans are written comprehensive plans for the care of anindividual patient of any age, with a chronic or terminal condition. Therecommended frequency is once every two years, supported by regularreview services. The Practice Nurse can assist in preparing or reviewing aGPMP on behalf of the GP. The GP must review and confirm assessmentsconducted by the Nurse and must see the patient as part of the service.The Practice Nurse role may include:• Identifying eligible patients who would benefit from a GPManagement Plan• Assessing the patient• Agreeing management goals for the patient• Identifying actions to be taken by the patient• Identifying treatment and ongoing services to be providedand make arrangements for these servicesTeam Care Arrangements (TCA)Team Care Arrangements is team assisted care planning for patients with achronic or terminal condition AND who require ongoing care from amultidisciplinary team of at least two other care or service providers. Therecommended frequency is once every two years, supported by regularreview services.23

The Practice Nurse role may include:• Identify eligible patients who would benefit from a TeamCare Arrangement• Assess the patient• Agree management goals for the patient• Identify actions to be taken by the patient• Identify treatment and ongoing services to be provided andmake arrangements for these services by collaborating withthe participating providersInteractive templates for GP Management Plans, Team Care Arrangementsand the review of these plans have been developed by the AustralianDivisions of General Practice (ADGP). These templates can be downloadedfrom the ADGP website at www.adgp.com.au and installed into MedicalDirector. If you have trouble installing or using these templates please emailcdm@adgp.com.au.֠TIPFor comprehensive information relating to the Chronic Disease ManagementItem numbers access the BSDGP website at http://www.bsdgp.com.au Clickon Resources, then chronic disease management items. Here you will findgeneral information and fact sheets, MBS explanatory notes, frequently askedquestions, case scenario, interactive templates for Medical Director, Proformasand checklists, Allied Health and Dental Referral Forms.֠TIPYour Area Manager can also assist you with the Chronic Disease ManagementItem numbers.CHRONIC DISEASE INITIATIVES:DiabetesThe aim of the diabetes incentive is to enhance prevention, earlier diagnosisand management of people with established diabetes mellitus. The role of thePractice Nurse is to support the GP in the task of prevention, promotion andmaintenance of diabetes health issues.GPs may choose to enrol their patients in the 12 month Annual Cycle of Care.The Annual Cycle of Care is based on guidelines developed by the RACGP and24

Diabetes Australia. This allows them to claim a Service Incentive Payment(SIP) on completion of the patient’s cycle of care.Below is a quick reference to the Diabetes Annual Cycle of Care.1. Register the practice for one-off ‘sign-on’ payment ($1 perStandardised Whole Patient Equivalent (SWPE) is paid to the practiceor around $1000 per Full Time Equivalent (FTE) GP) for establishing aregister of all known patients with diabetes attending the practice(minimum information should be included) as well as developing arecall system2. Complete an Annual Cycle of Care for patients with Diabetes Mellitus3. Claim MBS item 2517 or 2521 or 2525 at final consultation to triggerService Incentive Payment (SIP) of $40. The SIP is payable to the GPonce per year per patient4. An additional PIP Outcomes payment of $20 for each diabetic singlewhole patient equivalent who had a HbA1c in the previous 2 years.The target is 20% of patients who have had an annual cycle of carecompletedThe Practice Nurse role may include:• Establish/validate and maintain a diabetes register• Conduct diabetic foot assessments• Conduct education• Undertake BP, height, weight and calculate BMI• Ensure patient has full eye examination every 2 years• Establish a Diabetic Clinic• Ensure correct MBS item numbers are claimedFor a list of the minimum requirements for the Annual Cycle of Care forDiabetes, refer to the appendix.֠TIPDiabetes Australia (Qld) has excellent information and resources to assist youin your role. Visit their website at http://www.daq.org.au or contact DAQ at1300 136 588.25

AsthmaThe asthma initiative, the Asthma 3+ Visit Plan, aims to encourage andsupport GPs to better manage their patients with moderate to severe asthma.The role of the Practice Nurse is to support the GP to better manage theclinical care of patients.GPs may choose to enrol their patient in the 3+ Asthma plan. This providesopportunity for specific aspects of asthma management to be discussed overat least three visits in a short period of four months. At least two of the threevisits to the GP should be planned in advance. The visits incorporate:• Diagnosis and assessment (including appropriate spirometry tests)• Development of a written asthma management plan• Patient education and review of asthma managementThe Practice Nurse role may include:• Establishing, validating & maintaining an asthma practice register ifthe practice has one• Maintaining a recall system• Investigating and maintaining supplies of resources and patientliterature• Assisting GP/s in providing the care requirements of the 3+ plan• Spirometry• Asthma education e.g. types of medication, correct use of inhalers• Ensure correct MBS Item numbers are claimedBelow is a quick reference to the Asthma PIP initiative:1. The practice receives an initial sign on payment (an average of $250per GP) paid to the practice. This sign on payment may be used e.g.to purchase equipment such as a spirometer or for education. Whensigning on, practices agree to have their details forwarded to theNational Asthma Council and the Division of General Practice so theycan receive information regarding the GP Asthma initiative.2. A Service Incentive Payment (SIP) of $100 per patient is paid to the GPon completion of the requirements of the Asthma 3+ Visit Plan(payable once per year per patient). The item numbers 2546 or 2552or 2558 are used to trigger the SIP payment.The three asthma related consultations in a time period of 4 weeks to 4months are for patients with moderate to severe asthma. At least two of thethree visits are planned recalls and the three visits must cover diagnosis,development of a written asthma action plan, and education and review.26

֠TIPYou can access excellent resources and patient information from The NationalAsthma Council of Australia. Visit http://www.nationalasthma.org.au/ orphone 1800 032 495.֠TIPFor further information about the Asthma 3+ Visit Plan you can also contactAsthma Foundation of Queensland on 1800 177 948 or visit their website athttp://www.asthmaqld.org.au/ or refer to the Department of Health andAgeing website at http://www.health.gov.au/pq/asthma֠TIPAsthma Action Plans are available from National Asthma Council athttp://www.nationalasthma.org.au or Commonwealth Department of Healthand Ageing at http://www.health.gov.au/pq/asthmaCervical ScreeningThe aim of the cervical screening incentive is to assist general practices toincrease rates of participation of female patients in the National CervicalScreening Program. This will improve early detection of cervical abnormalities.Practice nurses potentially have a role in supporting GPs in their efforts tomaintain and improve screening rates.The Practice Nurse role may include:• Identify high risk women in the practice community and promotebenefits of cervical screening in collaboration with the GP• Maintain cervical screening recall register• Investigate and maintain supplies of resources and patient literature(Queensland Cancer Council and Queensland Health has excellentresources).• Ensure correct MBS item number is claimed27

The components of the Cervical Screening payments are:1. One-off sign on payment of approximately $250 per Full TimeEquivalent GP.2. Service Incentive Payment (SIP) of $35 to GP provider for each highriskwoman screened 20 – 69 years of age who has not had a papsmear in the past 4 years. Use item numbers 2501 or 2504 or 2507(levels B, C and D respectively) to trigger the SIP payment.3. Outcomes payment for practices who have met agreed targets forscreening all women between age 20 and 69 years.To meet the eligibility criteria, women need to:• Be aged between 20 and 69 years• Have a cervix• Have had intercourse• Have not had a pap smear in the last 4 yearsHOME MEDICINES REVIEWA Home Medicines Review (HMR) is a service to patients living at home in thecommunity. The goal is to prevent medication related problems and to ensurepatients are receiving optimal benefit from their medication.The HMR ProcessThe GP uses the GP Referral Form to refer an eligible patient to theirpreferred community pharmacy. The community pharmacy organises for apharmacist to conduct the HMR in the patient’s home. The accreditedpharmacist identifies and assesses the patient’s medication managementissues and writes a report for the GP. Following discussion with thepharmacist, the GP generates a medication management plan with the patientusing the Medication Management Plan Form.The Practice Nurse role may include:• Identifying eligible patients and promote the benefits of HMR• Managing the process under the GPs supervision by arrangingconsultations and implementing agreed actions• Ensuring patients go on to the practice recall system28

֠TIPFamiliarise yourself with the HMR requirements and explanatory notes in theMBS Schedule. The Division website also has succinct, informativeinformation.֠TIPRefer to the HMR flow chart in the appendix.29

INFECTION CONTROLInfection Control is a “whole of practice” approach. Each practice will have aPolicy and Procedures Manual which lists Infection Control Procedures for thepractice. Some excellent references include the Infection Control GuidelinesQueensland Health, November 2001 and Sterilisation/Disinfection Guidelinesfor General Practice, RACGP 3rd Edition, 2000.Spills KitA spills protocol must be easily accessible by all staff. Having a kit available atthe front reception area provides staff with a quick and safe way to clean upany body fluids.A spills kit should include• A small bucket to contain all requirements• Heavy duty gloves• Safety glasses• Forceps – for picking up glass etc• Medical detergent• Paper towel• Firm cardboard – a few pieces for scraping up• Small dustpan• Biohazard bags• Granules for large spillsEach time a spills kit is used it should be immediately restocked for the nexttime it is required. Other useful equipment to have on hand could include:• A caution sign "slippery when wet" – to use after cleaning up a spilluntil the area is dry• Vomit bowl left at the front desk – for quick access• Disposable gloves – to use to apply pressure to a wound if requiredHand washingHow to wash hands (routine/social hand wash)• Remove watch and jewellery, roll sleeves up above elbow (improvesthe ability to wash the hands and wrists thoroughly)• Wet hands with water (avoid hot water which can dry skin)• Place a small amount of soap on your hands (3-5 mls is enough; toomuch can be drying to the skin)• Rub hands together vigorously to create a lather, making sure to cleanunder fingernails, and wash fingertips, in between and around fingers,30

the palms and tops of the hands, and around the thumbs. Do this foraround 10-15 seconds (or longer if hands appear dirty)• Rinse all surfaces of the hands well, using plenty of running water(removing all of the soap prevents skin irritation from residualchemical)• Pat hands dry carefully with a paper towel (rubbing with paper towelcan damage the skin)• Use the paper towel to turn off the tap to avoid contaminating cleanhands• Use moisturiser following hand washing to replace some of the oilsremoved from the skin surface during washing (micro-organismsadhere more readily to dry, cracked skin)Cleaning the practice environmentRegular and conscientious cleaning of the practice assists in infection controland maintains a pleasant surrounding for both patients and staff.Routine cleaning with detergent and water is sufficient for almost all surfaces.Damp wiping of surfaces and damp mopping of smooth floors is the preferredmethod as dry dusting and sweeping will cause airborne bacteria levels torise.Written protocols for in house staff and/or external cleaning contractorsshould be documented.Staff training and an understanding of Standard Precautions such as how toremove sharps are essential for effective decontamination and cleaning of thepractice environment.A daily cleaning routine should include:• All bench tops, trolleys, examination and treatment couches, protectiveeyewear, reusable aprons, sinks, floors, toilets, bathrooms, foodhandling and eating areas.Weekly routine should include:• Waiting room and office furniture, waiting room toys.Other factors to consider:• Alcohols have an important role in skin disinfection but are notrecommended for surface cleaning in general practice.• Disinfectants can be problematic and are not usually a necessary partof routine cleaning.• The practice should not use cleaning agents that could be toxic to theuser and damaging to the surfaces, such as products containing bleachor glutaraldehyde.31

• All cleaning agents required to be mixed, should be discarded at theend of the day. Spray bottles should be emptied at the end of the day,rinsed and left to dry upside down overnight.(Reference: Sterilisation/Disinfection Guidelines for GeneralPractice, RACGP 3rd Edition, 2000).Needle Stick InjuryFollowing a needle stick injury or other exposure to a body substance:1. Clean/decontaminate• Skin: wash with soap and water• Mouth, nose, eyes: rinse well with water or saline2. Report the incident immediately to your supervisor and a medicalpractitioner3. Complete an incident report4. If the incident occurred during a procedure, you must documentwhether or not after the injury if any of your blood went into thepatient or onto instruments that were then used. If the patient hasbeen exposed to your blood from the injury, then you also have a dutyof care for the patient.5. Obtain informed consent from the source patient for testing forHepatitis B, Hepatitis C and HIV. The source patient’s confidentialitymust be maintained. Do not interview the source patient in front ofrelatives. Reassure the patient that he/she is not responsible for theaccident and that he/she has not been exposed.Explain to the source patient that you want to do the tests because:• Every healthcare facility follows this protocol after an exposure of ahealth care worker to blood or body fluids• All source patients are asked to be tested, there is no discriminationand you have a duty of care to the exposed person.Most patients will agree to a blood test if they are approached in asensitive manner. Ask the source patient about at-risk activities,especially in the past 6 months.6. Have the source patient’s blood tested as soon as possible7. Obtain informed consent from the exposed practice worker for testingfor Hepatitis B, Hepatitis C and HIV. These baseline tests establishwhether the health care worker has previously acquired an infectionfrom other exposures or at-risk activities. The health care workers32

confidentiality must be maintained and staff may choose to have thesetest performed at a different general practice or at a hospitalemergency room. Give the health care worker the phone number forthe National Needle Stick Hotline (NNH) 1800 804 823 (24 hours).8. If you anticipate that the source patients HIV results will not beavailable within 24 hours and if either:• The source patient is likely to be positive or in the window period;or• It was a high-risk injury from an unknown source; thenchemoprophylaxis should be commenced and then reassessedwhen test results become available. For advice about this pointconsult the NNH 1800 804 823.9. The exposed practice worker must be referred for immediateconsultation with an infectious disease specialist if:• the injury is classified as high risk or• the source patient has had at-risk activities or• the source patient has a positive blood test10. If the health care worker does not know their Hepatitis B status,request urgent results for Hepatitis B on the health care worker andthe source patient. Remind the injured health care worker that theymust return within 48 hours of the incident to find out their Hepatitis Bimmune status. If the source patient’s Hepatitis B result will not beavailable within 24 to 48 hours and if the health care workers HepatitisB status in not documented then give:• Hepatitis B immunoglobulin and• Hepatitis vaccine (first dose)11. If the needle had been in rubbish or on the floor, also consider thehealth care worker’s tetanus status. Administer ADT (adult diphtheriaand tetanus) if necessary.33

RECALL AND REMINDERS SYSTEMSPatient Registers / Patient Database:A patient register is a complete and ordered list of patients in the practice. Apractice register helps the practice to systematically target all of the patientsin a particular group. Registers can be paper based or computerised.The practice needs to identify the target groups for reminder, e.g.• Over 60 year olds (flu vaccines, HMRs)• Over 75 year olds (health assessments)• Women (cervical screening)• Diabetics (Annual Cycle of Care Requirements)• Asthmatics• Patients with other chronic conditions.There are several forms of the register:1) Age & gender register. For example patients over 60, children under 5,women over 50, etc. The accounting packages used by the practiceshould contain most of the required demographic information neededto develop an age sex practice register.2) Disease register. Examples include asthma, diabetes and CoronaryHeart Disease. This type of register needs to be developed by thepractice. Suggestions as to how the practice might develop this registerinclude:• If you are using a clinical software program such as MedicalDirector and type in a diagnosis (e.g. Diabetes, asthma) for thepatient then you can search for all the patients in that diagnosistarget group.• Searching files for medications prescribed is another way ofstarting a disease register. It should be noted however that notall patients within a particular disease group will have hadmedication prescribed, e.g. not all diabetics are prescribedhypoglycaemic medication. This method is only a starting pointand other methods need to be used to develop a completeregister.• As patients visit the practice, the GP notes that the patient is tobe placed on a particular register. These registers are paperbased and are kept at the front office. The demographics of thepatients are recorded in the specific register. It should be notedthat this method only identifies those patients that visit thepractice and that infrequent visitors may be left off the register.Other methods will need to be used to develop a completeregister.34

• To assist with the development of a diabetes register thepractice can write to their local pathology service and ask for alist of names of patients for whom an HbA1C has beenrequested in the last three years by each of the GPs in thepractice. Please note each GP needs to sign the request letter.There can be problems with this method if any of the GPs in thepractice have used the HbA1C test as a screening tool.The development of an accurate register may involve a combination of any orall of the above suggestions. It is important that the Practice has an agreedpolicy on how the register is maintained and validated on a regular basis aswell as the person at the practice who is responsible for doing this.35

THE PRACTICE INCENTIVES PROGRAM (PIP)The Practice Incentives Program (PIP) aims to recognise General Practicesthat provide comprehensive, quality care with additional income based onachieving specified standards and outcomes. Since 2002, accreditation is theonly gateway to the PIP scheme i.e. only practices which are accredited orregistered and working towards accreditation are eligible. PIP payments aretherefore an added incentive for General Practices to be accredited.The PIP is part of the blended payment approach for General Practice.Payments made through the program are in addition to other income earnedby the GPs and the practice, such as patient’s payments and Medicarerebates.In general, there are three types of payments made under PIP:1. Sign-on payments2. Service Incentive Payments (SIP)3. Outcomes PaymentsPayments focus on aspects of general practice that contribute to quality care.These include the use of IMIT, provision of after hours care, teaching ofmedical students, employing a Practice Nurse, chronic disease managementand better prescribing. A rural loading is paid to practices in rural and remotelocalities.Practice Nurses – Urban Area of Workforce ShortageThe Practice Nurse initiative aims to build on the current PIP Practice Nurseincentive by providing additional practice nurses to work in PIP generalpractices. This initiative allows for additional full time practice nurses by 2007funded through PIP grants in areas of urban workforce shortage, as definedby the Department of Health and Ageing (DoHA). Guidelines for the eligibilitycriteria, employment criteria and incentive payments can be sighted in theStrengthening Medicare Fact sheet in the appendix.Practice Nurses can play a vital role in contributing to the PIP payment forchronic disease management. The targeted areas for this incentive arediabetes management, asthma management and cervical screening. Formore information on these incentives and the Practice Nurses’ role in theseincentives refer to ‘The Role of the Practice Nurse in General Practice’section.36

֠TIPFor further information on the PIP phone 1800 222 032, go tohttp://www.medicareaustralia.gov.au/providers/incentives_allowances/pip.htm“An Outline of the Practice Incentive Program July 2001”37

GENERAL PRACTICE ACCREDITATIONIn 1991 The Royal Australian College of General Practitioners (RACGP), withthe support of the Australian Medical Association (AMA) and CommonwealthGovernment, resolved to develop a set of national Standards for GeneralPractice, with the aim of engaging the profession in a comprehensive processof continuous quality improvement.Throughout the initial planning process, the Interim Steering Committee madeit clear that an independent and voluntary system of practice accreditationshould be developed to enhance the delivery of services and facilities bygeneral practices through a process of continuous quality improvement(RACGP, 2000).The guiding principles on how Standards are applied to the accreditationprocess suggests that accreditation should:• Aim to attain the highest quality of general practice in an achievableand gradual manner• Provide a publicly recognisable measure of quality in general practice• Be voluntary but should have tangible benefits• Be for a defined period• Be an educational and developmental process and not a punitive one• Be in the hands of the profession(RACGP, 2000)There are two accreditation providers for Australia’s General Practices:• Australian General Practice Accreditation Limited (AGPAL)• GPA ACCREDITATION plus.Accreditation involves a three year cycle where the practice:• Performs self-assessment against The RACGP Standards for GeneralPractice• Undergoes a survey visit facilitated by your peers• Commences a continuous quality improvement cycle towards bestpractice• Receives documentary validation and recognition as an accreditedgeneral practice.Most practices have undergone or will be undergoing accreditation/reaccreditationat some stage. Accreditation is a voluntary process but with theintroduction of the link by the Commonwealth Government to the PracticeIncentives Program (PIP), this has encouraged more practices to becomeaccredited.38

Practice Nurses can contribute to the accreditation process in a variety ofways, according to their role within the practice.֠TIPThe practice will/may have a Policy and Procedures Manual which documentsthe Practice Policies. Familiarise yourself with this document. If the Practicedoes not, contact your Area Manager. The Division has a template which canbe customised by the Practice.֠TIPThe AGPAL website has a comprehensive registry of resources to assist withpreparing for accreditation / reaccreditation. Visit the AGPAL website athttp://www.agpal.com.au, click on qbay in the top left hand corner followedby General Practice and refer to the relevant section.֠TIPAGPAL’s website now contains a new feature called QexCHANGE. This facilityof their website allows you to post a brief question and invite other practicesto offer their feedback. You can also click on specific topics to browse otherquestions and answers of interest from your peers.39

MEDICARE AND THE MEDICARE BENEFITS SCHEDULEMedicare Australia (previously called the Health Insurance Commission (HIC))is responsible for:• Ensuring Medicare benefits are paid to eligible health care consumersfor services provided by eligible medical practitioners, and• Assessing and paying Medicare benefits for a range of medicalservices, whether provided in or out of hospital, based on a schedule offees determined by the Australian Government Department of Healthand Ageing in consultation with professional bodies.The Australian Government Department of Health and Ageing (DoHA) isresponsible for the policy development of Medicare and the Medicare BenefitsSchedule.The most common methods of billing in General Practice are:• Private Bill all patients• Bulk Bill all patients• Combination of bothProcess• Regardless of which method your practice uses, each patient is billedwith item numbers so the patient or the practice can claim fromMedicare• The Medicare Benefits Schedule book lists information on all itemnumbers and is updated on November 1 st each year. Each GP willreceive a copy• Copies can be obtained from http://www.health.gov.au/pubs/mbs orby phoning 1800 020 103. If you have a question interpreting theMedicare items please phone Qld Medicare Australia Branch on3004 5450• Each consultation has an item number which is charged and mostprocedures also have an item number attached to them• Common item numbers for consultations are:o Level A Consultation: item number 3o Level B Consultation: item number 23o Level C Consultation: item number 36o Level D Consultation: item number 44• Examples of item numbers for common procedures are:o ECG (12 lead): item number 11700o Pregnancy test: item number 73806o Wound care: item number 10996o Immunisation: item number 1099340

Competency StandardsPROFESSIONAL ISSUESThe development of competency standards for nurses working in generalpractice was funded by the Australian Government Department of Health andAgeing (DoHA) and managed by the Australian Nursing Federation (ANF).The competencies provide a framework that reflects nursing in the generalpractice setting.Competency Standards for the registered nurse in general practicehttp://www.anf.org.au/nurses_gp/resource_04.pdfRole statement for the registered nurse in general practicehttp://www.anf.org.au/nurses_gp/resource_06.pdfCompetency Standards for the enrolled nurse in general practicehttp://www.anf.org.au/nurses_gp/resource_05.pdfRole statement for the enrolled nurse in general practicehttp://www.anf.org.au/nurses_gp/resource_20.pdfThe Australian Nursing & Midwifery Council (ANMC) develops NationalStandards for professional nursing practice.ANMC National Competency Standards for the Registered Nursehttp://www.qnc.qld.gov.au/upload/pdfs/practice_standards/ANMC_National_Competency_Standards_for_the_RN.pdfANMC National Competency Standards for the Enrolled Nursehttp://www.qnc.qld.gov.au/upload/pdfs/practice_standards/ANMC_National_Competency_Standards_for_the_EN.pdfThe Code of Professional Conduct for Nurses in Australiahttp://www.qnc.qld.gov.au/upload/pdfs/practice_standards/Code_of_professional_conduct_for_nurses.pdfThe Code of Ethics for Nurses in Australiahttp://www.qnc.qld.gov.au/upload/pdfs/practice_standards/Code_of_Ethics_for_Nurses_in_Australia.pdf֠TIPTo access these Standards you can log onto the Brisbane South Division ofGeneral Practice website at http://www.bsdgp.com.au and click on thePractice Nurse section of the website.41

Join a Professional OrganisationAustralian Practice Nurse Association (APNA)The Australian Practice Nurse Association is recognised by the AustralianGovernment Department of Health and Ageing as the peak National body forPractice Nurses working in General Practice.For further details on the APNA, log onto their website athttp://www.apna.asn.au or phone the APNA on (03) 9682 3820.Australian Nursing Federation (ANF)The State Branch of the Australian Nursing Federation is the QueenslandNursing Union (QNU).To find out more about QNU and membership, visit their website athttp://www.qnu.org.au/joining_the_qnu or contact the QNU on 3840 1444 orfreecall 1800 177 273.Royal College of Nursing Australia (RCNA)To find out more about the Royal College of Nursing Australia, phone(02) 6283 3400 or freecall 1800 061 660 or visit the website athttp://www.rcna.org.auQueensland Nursing Council (QNC)The Queensland Nursing Council (QNC) is an independent statutory bodyresponsible for the regulation of nursing and midwifery in Queensland. It istheir role to ensure, as far as practicable, that nurses and midwives inQueensland are safe and competent to practise. Visit the website athttp://www.qnc.qld.gov.au or phone 3223 5111.42

COMMON ACRONYMS USED IN GENERAL PRACTICEThe following is a list of some of the common acronyms used in GeneralPractice. There is also room at the end of this list for you to add in furtheracronyms to assist you in your role.ACATACIRADGPADTAGPALAMAQANFAPNAASVSBSDGPCCMCCPCHIPCIUDAARTDGPDoHADVAEACHEDIENEPCFTEGPAGPIIGP/sHACCHICHMRIMITMBSNACNHMRCNNHOMPPCQPIPPNQASQDGPQIRCHAged Care Assessment TeamAustralian Childhood Immunisation RegisterAustralian Division of General PracticeAdult Diphtheria and TetanusAustralian General Practice Accreditation LimitedAustralian Medical Association of QueenslandAustralian Nursing FederationAustralian Practice Nurse AssociationAustralian Standard Vaccination ScheduleBrisbane South Division of General PracticeCold Chain MonitorCommunity Care PackageCommunity Hospital Interface ProgramCentral Intake UnitDomiciliary, Allied Health, Acute Care and Rehabilitation TeamDivisions of General PracticeDepartment of Health and AgeingDepartment of Veteran AffairsExtended Aged Care at HomeElectronic Data InterchangeEnrolled NurseEnhanced Primary CareFull Time EquivalentGeneral Practice AustraliaGeneral Practice Immunisation IncentiveGeneral Practitioner/sHome and Community CareHealth Insurance CommissionHome Medicines ReviewInformation Management/Information TechnologyMedicare Benefits ScheduleNational Asthma CouncilNational Health and Medical Research CouncilNational Needle Stick HotlineOther Medical PractitionersPalliative Care QueenslandPractice Incentive ProgramPractice NurseQueensland Ambulance ServiceQueensland Division of General PracticeQueensland Integrated Refugee Community Health Service43

QMLQNCQNFRACGPRCNARNRRMASIPSNPSWPEVIVASWPEQueensland Medical LaboratoriesQueensland Nursing CouncilQueensland Nursing FederationRoyal Australian College of General PracticeRoyal College of Nursing AustraliaRegistered NurseRural, Remote & Metropolitan AreaService Incentive PaymentSullivan and Nicolaides PathologyStandardised Whole Patient EquivalentVaccine Information and Vaccine Administration ServicesWhole Patient Equivalent44

SECTION 2Integrating With Divisions45

DIVISIONS OF GENERAL PRACTICE OVERVIEWDivisions of General Practice were set up in 1991 by the CommonwealthGovernment initially to encourage General Practitioners (GPs) to work withother health professionals in order to improve the quality of health servicedelivery at the local level, as part of the broader General Practice Reforms.Divisions have evolved considerably since their inception and will continue todo so in the ever-changing health care arena. Part of the Division’s continualchallenge is to remain abreast of new developments and initiatives andensure General Practice is well placed to take full advantage of suchopportunities.Divisions enable GPs and general practice as a whole, to improve local healthcare delivery by:• Meeting local health care needs;• Helping general practice to link in with other health care services, likehospitals, private Allied Health Professionals and community services toensure continuity of care;• Promoting preventative care;• Responding to rapidly changing community needs; and• Providing opportunities for GP and practice staff “ProfessionalDevelopment”.Divisions of General Practice are principally funded by The AustralianGovernment Department of Health and Ageing.There are five Divisions in the Brisbane metropolitan area: Brisbane SouthDGP, Logan Area DGP, South East Alliance of General Practice, GP Partners(formerly Brisbane North DGP) and Redcliffe Bribie Caboolture DGP.Each State also has a State Based Organisation (SBO).Queensland Divisions of General Practice (QDGP).This is theThe peak National body is the Australian Divisions of General Practice (ADGP).46

BRISBANE SOUTH DIVISION OF GENERAL PRACTICEContact Details:172 Evans RoadPO Box 211Salisbury Q 4107Tel: 3274 1886Fax: 3274 1930Email: info@bsdgp.com.auWeb: www.bsdgp.com.auYour local Division is Brisbane South Division of General PracticeThe Brisbane South Division of General Practice is a GP-run membershiporganisation that provides services, education and assistance to generalpractices and health care providers. This will improve the health of thecommunity in the Division’s area.The Brisbane South Division of General Practice:1. Supports general practice and primary health care in providing qualitycare to the community2. Develops sustainable programs that make continuous small stepstowards better business outcomes for general practice and betterhealth outcomes for local residents3. Provides support to GPs, allied health professionals and specialists, andapproximately 100 general practices, in an area spanning 18 postcodesand 50 suburbs, with a residential population of 276,218Our Vision• To lead and support general practitioners and general practice inproviding quality patient care in an integrated local health community• To be an integrative link between general practitioners, local healthproviders, and the community• To enhance the professional satisfaction of our members and their staff• To provide on-going community directed education to develop animproved understanding of the role of general practice in primaryhealth care services and to develop better health outcomes in thecommunity47

Our Strategic DirectionThe Brisbane South Division of General Practice aims to provide a corporateidentity for our General Practitioners and their practices and to improveintegrated primary health care services to our community.As a part of the corporate identity the Division is moving to become moreinvolved in developing corporate relationships both in and out of the primaryhealth arena. As a consequence the direction of attention will be foundedupon a “whole of life” approach in support of general practice.48

INTEGRATING WITH THE BRISBANE SOUTH DIVISIONPractice NursesBrisbane South Division of General Practice aims to support the role of nursesworking in general practice by providing access to education and professionaldevelopment opportunities, resources and information pertinent to thegeneral practice nurse, information on professional issues, assistance inchronic disease management and general support to facilitate the enhancedrole of the Practice Nurse.Practice Assistance Program / Practice Visiting ProgramThe Brisbane South Division delivers services to all practices in the division’scatchment area. Practice Visiting Consultants visit the practice to detailvarious initiatives and deliver services and resources throughout the year.Your practice also has a dedicated Area Manager who you can contact forassistance.֠TIPContact the Division on 3274 1886 to find out who your Area Manager is.You can call the Division to ask for assistance in all aspects of GeneralPractice.WebsiteThe Brisbane South Division of General Practice has a website which willprovide you with a wealth of information to assist you in your role. Thewebsite link is http://www.bsdgp.com.au. In the practice support sectionthere is a dedicated Practice Nurse section where you will find informationregarding education opportunities offered by the Division as well as links toexternal organisations, information regarding MBS Item Numbers,competency standards, latest news and resources and useful websites.The Resources tab of the website will also be very useful in your role. Theresources are categorised for ease of reference.ResourcesThe Practice has a dedicated Practice Resources Folder which was providedby the Division to assist the practice to collate resources in one folder. Thefolder is divided into different sections e.g. Aged Care and Chronic DiseaseManagement.49

Resources can also be sourced via the Division’s website and delivered as partof the Practice Visiting Program.֠TIPAsk your Practice Manager where the Practice Resources folder is kept withinthe practice. You may wish to add resources to this or access existingresources. This may save you time.5 minute factsThe Division sends out a fax to all practices in the Division (usually on aMonday on a weekly basis). This is succinct snippets of information pertinentfor general practice. Information relevant to nurses in general practice isdisseminated from time to time via this communications channel.Southside Snippets – Divisional NewsletterThe Division produces a monthly newsletter called “Southside Snippets”. Thepractice will receive a copy each month for you to access relevant informationfrom the Division. Regular updates are provided on various initiatives andprograms and are GP related issues.Educational and professional development opportunitiesFor information relating to education and professional developmentopportunities, see Section 3.Membership of the DivisionThe Division has an annual Practice Staff Program registration, themembership year running from 1 July to 30 June. All new members receive aprofessional development portfolio at the time of sign up. For a full list ofprogram benefits contact the Division or talk to your Area Manager to receivea Registration Form.50

SECTION 3Education and ProfessionalDevelopment Opportunities51

EDUCATION OPPORTUNITIES WITH THE DIVISIONPractice ForumsPractice Forums are quarterly education meetings organised by the Divisionspecifically tailored to Practice Staff needs. Guest speakers are chosen topresent information and education on issues directly related to the day to dayrunning of general practice.Forums are held after hours from 6.30 – 9.00pm at a central venue within theDivision and all staff receives invitations to attend.֠TIPWatch the 5 minute facts and newsletter date claimers for upcoming events.Practice Staff Network GroupsPractice Staff Network Groups are small local groups of 6 – 10 practice staffwho meet on a regular basis (e.g. monthly / every 6 weeks), depending onthe groups needs. Meetings are generally of a one hour duration.The networks enable Practice Managers, Practice Nurses and Reception staffto:• Meet to discuss and share ideas• Participate in education sessions on topics of interest• Network with peers• Network with external organisations• Debrief with peers to assist in reducing professional isolationTopics for discussion or education are decided by participants that mayinclude sharing concerns or insights from peers within other practices,obtaining advice or opinions about certain issues concerning their dailyactivities in general practice, or inviting a presenter to speak about aparticular area of interest. Sharing ideas and debriefing with peers is also anintegral part of the network focus and will compliment the wide range ofeducation and professional development opportunities that are made availableto staff.֠TIPContact the Division if you would like to find out more about the networkgroups.52

Brisbane South Nursing Forums – Practice Nurse/CHIP nightsThe Brisbane South Nursing Forums are coordinated by Brisbane SouthDivision of General Practice, South East Alliance Division of General Practiceand the Community Hospital Interface Program.The audience for the Forums are CHIP Nurses from the Brisbane SouthCommunity Health Service and Practice Nurses from across the Southside ofBrisbane.Sessions are held in series and previous series have included Dementia andPalliative Care.All Practice Nurses in the Division receive notification of these educationforums via invitation and the usual Division communication channels such asthe 5 minute facts and monthly newsletter.֠TIPWatch the 5 minute facts and newsletter date claimers for upcoming events.Endorsed provider of Education3LP is Australia’s first national life long learning program for nurses,introduced in 2003 by the Royal College of Nursing Australia. There areapproximately 5000 nurses enrolled nationally. 3LP’s primary goal is to assistnurses in developing their own learning needs. Enrolment entitles nurses to anumber of benefits.Brisbane South Division of General Practice is an authorised provider ofendorsed activities which allows us to allocate Clinical Nurse Education (CNE)points as part of the 3LP program. The program recommends nursescomplete 30 CNE points per year which equates to approximately 30 hours ofcontinuing education.֠TIPIf you would like to know more about the 3LP Life Long Learning Program orto download the enrolment form, visit the Royal College of Nursing website athttp://www.rcna.org.au53

EDUCATION OPPORTUNITIES VIA EXTERNAL ORGANISATIONSThere are a number of organisations who provide education and professionaldevelopment opportunities to Practice Nurses.This is not an exhaustive list, but offers some alternatives to source for yourongoing career and education needs.AMAQ Training ServicesTo find out more about AMAQ Training Services and the courses on offer,phone 3872 2214, visit their website athttp://www.amaqservices.com.au/train/courses.html or emailtraining@amaq.com.auAPNATo find out more about APNA and the education / courses on offer, visit theirwebsite at http://www.apna.asn.au or contact APNA on (03) 9682 1276.AUSMEDAUSMED Conferences run a series of workshops in Brisbane throughout theyear. For all enquiries contact AUSMED at (03) 9375 7311 or downloadupcoming programs from their website at http://www.ausmed.com.auRoyal College of Nursing Australia (RCNA)Royal College of Nursing Australia conducts workshops and conferences bothin Queensland and Interstate. To access education conducted by the RCNA,visit their website at http://www.rcna.org.au.Australian Catholic University – Program for Nurse ImmunisersAustralian Catholic University runs a Program for Nurse Immunisers. Thecourse covers content such as legislation, policies & ethical principles, healthpromotion, competency in administration and outcomes of vaccinationprocess. The program is approximately 40 hours of self paced, guidedlearning in conjunction with workbook and readings, clinical observationpractice and assessment with an endorsed nurse immuniser (6 hours).To find out more about this course, contact Australian Catholic University on3623 7293 or visit the website at http://www.acu.edu.auWound Management CoursesBlue CareBlue Care conducts a 2 day face to face Wound Management Course.Content includes anatomy and physiology of the skin, healing process andtypes of healing, factors that affect healing, management of infected wounds,the importance of wound assessment and documentation, dressing selectionand cost effectiveness, management of acute wounds, skin tears, burns,54

flaps, grafts and donor sites, management of malignant wounds and pressureulcers, complex wound management issues in the community.To find out more about this course and when it is conducted, contact BlueCare at 3722 1790 or visit the website at http://www.bluecare.org.auAUSMED ConferencesAUSMED Conferences conducts a 2 day face to face Wound Management“The Next Step” course. Content includes evidenced based practice, woundassessment skills, documentation and auditing, advanced dressing products,complex wound management issues, bandaging techniques, the person withthe diabetic foot, the emotional impact of wounds.To find out more about this course and when it is conducted, contact AusmedConferences at (03) 9375 7311 or visit their website athttp://www.ausmed.com.auScholarships – Nursing in General PracticeAustralian Government Wound Management and Immunisation Training forPractice Nurses Scholarships have become available in the past as part of anAustralian Government Initiative. This initiative has been in association withAustralian Practice Nurses Association (APNA) and Australian Divisions ofGeneral Practice (ADGP).The Division assists in promoting scholarships when they become available toPractice Nurses and can also assist in providing any related informationnecessary for you to apply within the given timeframe.55

SECTION 4COORDINATING PATIENTSERVICES56

COORDINATING PATIENT SERVICESThe Practice Nurse is often the key point of contact between general practiceand other providers.This section provides a short brief on Community Services, Community AlliedHealth Services, Domiciliary Nursing and additional patient services that maybe of use in your role in coordinating the care of patients in your practice. Itis by no means an exhaustive list, but one which you could build on whennetworking with other services to integrate service delivery.COMMUNITY SERVICESIn this section, the following organisations are listed:Aged Care Assessment Team (ACAT)Alzheimer’s AustraliaBrisbane City Council Call CentreBrisbane South Diabetes Referral ServiceCentrelink HelplineCommonwealth Carelink CentresCommonwealth Carer Resource CentreCommonwealth Carer Respite CentresCommunity Health ServicesCommunity Hospital Interface Program (CHIP)Department of Veterans AffairsDisability Services QueenslandHome and Community Care (HACC)Mental Health Referrals (Princess Alexandra Hospital)National Continence HelplinePalliative Care QueenslandTransportAGED CARE ASSESSMENT TEAM (ACAT)Phone: (07) 3275 6700Fax: (07) 3275 6711Aged and Community Care Information Line: 1800 500 853www.seniors.gov.auAged Care Assessment Teams (ACAT) assesses specific care and health needsto advise on Government Funded services.ACAT accepts referrals for people who are seeking approval for entry topermanent residential care or respite, Community Aged Care Packages(CACPs), Extended Aged Care at Home Packages (EACH), InnovativeDementia Care Packages and Retirement Village Packages. This approvalshould be used within 12 months and upon assessment of the client, willexplain the assessment results and discuss the best type of care.57

CACPs are Community Care Packages designed for more complex care needsand provides access to a range of services that can help people to continue tolive in their homes. Assessment by ACAT is required prior to receiving CACPs.EACH enables frail elderly people to remain in their homes by providing careat the level currently provided in a high care residential aged care facility.Assessment by ACAT is required prior to receiving EACH.ALZHEIMER’S AUSTRALIATo contact Alzheimer’s Australia (Queensland) Inc.Alzheimer's Australia (Queensland) IncUnit 8, Norwich Centre5 Frigo CourtBundall Qld 4217Postal Address: PO Box 9360 GCMCQueensland 9726Phone: (07) 5538 8221Fax: (07) 5538 8225Email: info@alzQld.asn.auAlzheimer’s Australia is the peak body providing support for Australians livingwith dementia and it’s mission is to reduce the impact of dementia on thecommunity.Alzheimer’s Australia (Queensland) provide support to people with dementia,their families and their carers and also raise public awareness of dementia inthe wider community.Alzheimer’s Australia (Queensland) has a network of regional memberorganisations who also work with their local communities to offer support,information and referrals and education.BRISBANE CITY COUNCIL CALL CENTREAll enquiries: 303 8888 or log onto http://www.ourbrisbane.com.auBrisbane City Council Call Centre provides assistance with all Brisbane Councilservices, e.g. In-home bin collection program.58

BRISBANE SOUTH DIABETES REFERRAL SERVICEPhone: (07) 3275 5411The overall aim of the service is to integrate GPs with diabetes serviceproviders in both the public and private sectors in the community and toenhance consumer access to diabetes specialists.GPs can refer clients to the service using the services’ generic referral form.(See Appendix).As soon as a referral has been received from a GP, staff from the BrisbaneSouth Diabetes Service can link the client into all services nominated by theGP.Both private and community options for allied health services will be offeredto the client and the GP will receive comprehensive feedback regarding theclient.Brisbane South Diabetes Service offers:• One access number for all areas 3275 5411;• Individual consultation with a Diabetes Nurse Educator;• Individual consultation with Allied Health Professionals e.g. Podiatrist,Dietician, Physiotherapist;• Group education sessions; and• Client access to, and education on current resources for themanagement of diabetes e.g. insulin pens, blood glucose meter.CENTRELINK HELPLINEFreecall 1300 788 118Services include Carer Allowance, Pension Forms, etc.COMMONWEALTH CAREKLINK CENTRESFreecall 1800 052 222 http://www.CommCarelink.health.gov.auThe Commonwealth Carelink Centre operates from 21 Jaybel Street,Salisbury. The Commonwealth Respite Centre is also housed at this address.When you call the 1800 number, your call is automatically directed to yourlocal Commonwealth Carelink Centre.Commonwealth Carelink Centres will provide GPs and other healthprofessionals, service providers, carers and the general public, with a singlepoint of access for information about, and referral to, Community CareServices.59

Commonwealth Carelink Centres help patients live independently in their ownhomes by providing them with free information about community aged care,disability and other support services. They also help you match your patient’sneeds to care services or you can refer your patients, their carers or familymembers to a Centre.Your local centre can assist with local knowledge about:• The range of services available and how to contact them• Who is eligible to receive the services• Whether there are any costs associated with receiving these services• Aged care assessment services for access to Community Aged CarePackages or entry into aged care homesWhen you contact your local Commonwealth Carelink Centre, they will be ableto provide you with information in your region about the following:• Household help, home modification and maintenance• Personal, nursing and respite care• Transport and meal services• Disability services• Day care and therapy centres• Assessment, including Aged Care Assessment Teams• Special services for dementia• Continuance assistance• Support for carers• Community Aged Care Packages• Aged care homes• A range of Allied Health care (e.g. podiatry, physiotherapy etc.)• Support groupsThe Commonwealth Carelink Centre information service can be used byanyone, and this free information service is offered to:• Older Australians• People with disabilities• Families and carers• GPs• Other service providers• People of Aboriginal & Torres Strait Islander descent• People from culturally & linguistically diverse backgroundsThey can put people in touch with:• Government & Non-Government services• Aged Care services• Services for veterans & their families• Allied Health services• Medical Services• Funded & user-pay services• Disability services60

• Support groups• Vision/hearing impaired services• Culturally & ethically appropriate services• Social support• Carer support• Residential services• Legal & advocacy services• Volunteering organisations֠TIPBenefits in summary:Saves you timeOne phone call links you to listings of local community, disability andother support servicesUp to date information on current services, entry periods, eligibilitycriteria and contact phone numbersPersonal, free and confidential serviceAccessible to patients with sight, hearing or speech impairmentsCOMMONWEALTH CARER RESOURCE CENTREFreecall 1800 242 636 http://www.careraustralia.com.auBy accessing the freecall number, carers can obtain information and advice toassist them in their caring role, including the services and assistance availableto them. This may include information on topics, referrals, support,counselling and resources. The Commonwealth Carer Resource Centre alsomanages the National Carers Counselling Service for Queensland which allowscounselling and support for carers. Carer information packs provide valuableinformation.֠TIPSee the appendix for a copy of the Commonwealth Carer Resources Centrebrochure.COMMONWEALTH CARER RESPITE CENTRESFreecall 1800 059 059The Commonwealth Carer Respite Centre is co-located at 21 Jaybel Street,Salisbury with the Commonwealth Carelink Centre.61

Commonwealth Carer Respite Centres help when carers need to take a breakfrom their caring role and they can:• Organise programs to suit individual’s circumstances;• Provide information on respite care;• Make a referral to an appropriate respite service for regular ongoing respitecare (home or centre based);• Can assist carers to access periods of block respite via residential carefacilities; and• Provide education programs and emotional support to carers.Aside from emergency situations, a person must first be assessed by an ACATprior to entering into respite care.COMMUNITY HEALTH SERVICESCentral Intake Unit:Brisbane South Community Health ServiceAddress: 64 Wirraway Parade, Inala 4077Phone: (07) 3275 5411Fax: (07) 3278 7086Brisbane South Community Health Services include: Mt Gravatt Community Health Centre Annerley Road Community Health Centre Coorparoo Community Health Centre Inala Community Health Centre Corinda Community Health Centreand provide a number of services in the community including:1. Adult Health Services (e.g. Aged Care and Assessment Team (ACAT),Chronic Disease Self Management Programs, Diabetes Services,General Assessment/Support – nursing, Allied Health)2. Child, Youth and Family Health Services3. Community Access and Integration Services (e.g. Community HospitalInterface Program (CHIP), Palliative Care Services)4. Specialised Community Services (e.g. Alcohol & Drug Services,Indigenous Health)5. Other Services (e.g. Breast Screen Queensland)To refer your clients to any of the range of health services that are provided,either fax or mail the Brisbane South Community Health Service GP genericReferral Form to the Central Intake Unit (CIU) at: (07) 3278 7086.62

֠TIPFor an extensive profile of the Brisbane South Community Health Service,refer to the QEII Hospital Health Service District Services Profile in theappendix. This gives you a clear, simple guide to assist you in referringclients. The services profile is to be used in conjunction with the communityhealth generic referral form (also in the appendix).COMMUNITY HOSPITAL INTERFACE PROGRAM (CHIP)The Community Hospital Interface Program (CHIP) is a joint initiative betweenthe Mater Misericordia Hospitals, Princess Alexandra and QEII Health ServicesDistricts and is managed by the Brisbane South Community Health Services.CHIP facilitates the smooth transition from hospital discharge to thecommunity / home from the QEII Jubilee, Mater and Princess AlexandraHospitals.Contact Details:QEII Jubilee HospitalEmergency Department: 3275 6112Mater Adult HospitalEmergency Department: 3840 8111Princess Alexandra HospitalEmergency Department: 3240 2111CHIP nurses are based in the Emergency Department of the MaterMisericordia Adult and Mothers’, PA and QEII Hospitals.CHIP nurses undertake the following to help practices and patients: Act as a central contact point for local Doctors, Practice Staff andcommunity providers referring people to the Emergency Department Work closely with elderly and/or younger disabled people who present atthe hospitals, to ensure they return to the community with adequateservices and support Undertake discharge planning while the patients are still in the emergencyDepartment Identify people who have had, or are at risk of falls, and arrange forfurther assessment and adviceThe Mater Mothers’ Hospital CHIP nurse also provides information regarding: Local Child Health Nurses Child Health Services Immunisation Clinics Breastfeeding support services Personal Health Record63

Using their community health experience the CHIP nurses aim to: Smooth the transition for clients between hospital and home; Arrange appropriate community services for clients; Arrange modifications and aids to create a safe home environment; Provide a key role/resource regarding discharge planning; and Prevent inappropriate admissions and/or readmission to hospital.DEPARTMENT OF VETERANS AFFAIRSAll enquiries 13 32 54 http://www.dva.gov.auDISABILITY SERVICES QUEENSLAND (DSQ)DSQ Central office in BrisbaneGPO Box 806, Brisbane, Queensland, 4000Level 3A Neville Bonner Building75 William StreetBRISBANE Q 4001Brisbane callers (07) 3224 8031Toll Free 1800 177 120Fax (07) 3224 8037Disability Services Queensland provides various services for people with adisability both directly and indirectly. This includes programs, funding andgrants and access to a complaints process.For an up to date list of these programs, key projects, patient eligibility andcontacts, log onto their website at http://www.disability.Qld.gov.au/If you wish to contact the department to find out information about supportand services for people with a disability in Queensland, you can emaildisabilityinfo@disability.Qld.gov.auHOME AND COMMUNITY CARE (HACC)For information on HACC services and eligibility call the Carer Resource CentreInformation and Support Line on 1800 242 636.(http://www.hacc.health.gov.au)The Home and Community Care (HACC) Program in Queensland is fundedjointly by State and Federal Governments, Queensland Health and theCommonwealth Department of Health and Ageing and was established toprovide support services for frail aged people, younger people withdisabilities, and their carers in their own homes.The program aims to assist clients to be more independent and prevents theirinappropriate or premature admission to long term residential care.64

The varieties of services which can be provided under the HACC programinclude:• Domestic assistance• Social support• Personal care• Food services• In home and centre based day respite• Transport• Home maintenance or modification• Community nursing• Allied health such as physiotherapy, podiatry, occupational therapy• Information and support for CarersEach HACC Service has its own policy on fees, but most services require asmall contribution, depending on the situation. Special consideration is givento people with limited finances.NATIONAL CONTINENCE HELPLINEFreecall 1800 330 066The helpline is staffed by continence nurse advisors who provide confidentialinformation on incontinence and continence products.Services include:• Bluecare Continence Advisory Service• MASS (Medical Advisory Subsidy Scheme) for continence and mobilityaidsPALLIATIVE CARE QUEENSLANDFreecall 1800 772 273Palliative Care Queensland Inc. Brisbane Office2/71 Old Cleveland RoadStones Corner Q 4120Phone: (07) 3394 3466Fax: (07) 3394 3488Email: admin@pallcareQld.comPalliative Care Queensland Inc. (PCQ) is the independent voice for palliativecare in Queensland and provides a point of contact for palliative patients,their families, carers and health professionals.Palliative Care Queensland aims to:• Create a strong organisation producing an independent voice onpalliative care issues;• Meet the needs of PCQ members;• Improve equity and access to palliative care across Queensland65

• Improve the quality of palliative care in Queensland; and• Reaffirm that death is a natural part of life.PCQ works to achieve these aims through community development, advocacy,education, support and best practice.What assistance can Palliative Care Queensland provide?• A point of contact for palliative patients, their families, carers, andhealth professionals.• A state-wide community resource centre providing palliative careinformation for patients, their families and carers and the generalcommunity. This resource centre is available on-line or through thePCQ Brisbane office.• Accurate and comprehensive information on palliative care services inQueensland.• A state-wide register of specialist doctors and nurses, therapists,counsellors GPs, social workers, chaplains, volunteers and familycarers.• Access to, and support for the facilitation of, community developmentand health promoting palliative care initiatives and models.• Relevant, up-to-date information and education in palliative care forhealth professionals and volunteers.• Support for research into the needs and treatment of palliative patientsand their carers.• Advocacy for the ongoing development of palliative care services inQueensland.TRANSPORT“Transport Options and Access Guide” books are available at a cost of $2 +postage & handling. The guide covers community transport options for allBrisbane suburbs including pick up and drop offs for shopping centres, socialand recreational activities, hospitals and medical facilities and council cabs.For further information, call 3253 0532.Council Cabs booking line 13 62 9466

COMMUNITY ALLIED HEALTH SERVICESIn this section, the following organisations are listed:Brisbane South Allied Health Referral ServiceDomiciliary, Allied Health, Acute Care & Rehabilitation Team (DAART)BRISBANE SOUTH ALLIED HEALTH REFERRAL SERVICE (BSAHRS)Linking Allied Health Services to the HACC eligible people in the community.Referral Number: (07) 3840 1763Fax: (07) 3840 1767This is a collaboration of HACC funded Allied Health Service Providers acrossthe QEII Health Service District. The service is available to HACC eligibleclients only living within the QEII Health Service District.The types of services available are Dieticians, Occupational Therapy,Physiotherapy, Podiatry, Psychology, Speech Pathology and Social Work.It allows clients to access any allied health in a timely manner and serviceproviders to collaborate to provide an efficient service to clients.Referrals are accepted by individuals, families, Doctors, Nurses and otherhealth professionals.Depending on the Allied Health Service Provider, clients may have to make aco-payment of between $5 and $10.DOMICILIARY ALLIED HEALTH ACUTE CARE & REHABILITATIONTEAM (DAART)Ground Floor, Mater Community Services Building, Raymond TerraceSouth BrisbanePhone: (07) 3840 1760Fax: (07) 3840 1767Email: 1darap@mater.org.auHours of operation: Monday to Friday 8.00am to 4.30pmThe DAART service is a domiciliary allied health professional service deliveredto clients residing in the Brisbane Metropolitan Area including Bayside with apurpose of contributing to the continuum of care of clients. The home visitingto assess and manage clients is undertaken by Dieticians, OccupationalTherapists, Physiotherapists, Psychologists, Social Workers and SpeechPathologists. Referrals for the DAART Service are accepted from Doctors,Hospitals, Community Health Centres, domiciliary service providers, family,self and other health professionals.67

DOMICILIARY NURSINGIn this section, the following organisations are listed:Blue CareOzcareSt. Luke’s Nursing ServiceBLUE CAREBlue Care provides care to all members of the community. Referral is from anindividual, carer, hospital, GP, health agency or ACAT (Aged Care AssessmentTeam).Services provided by Blue Care include:• Allied Health Services• Blue Nursing – home and community nursing• Community Care Packages (CCP)• Disability Services• Palliative Care• Pastoral Care and Counselling• Residential Aged Care Services• Respite Services• Commonwealth Carer Respite Centres• Volunteer ServicesFor a full list of services see http://www.bluecare.org.au.of your closest Blue Care branches.Following is a list• Regional Office – Brisbane Central, 16 Bendena Tce, Carina Heights.Tel. 3213 7311• West End Respite Centre, 53 Thomas Street, West End. Tel. 3844 5450• Salvin Park Complex, 840 Creek Road, Carina. Tel. 3213 7311OZCAREOzcare provides a wide range of community and health services that areavailable to all members of the community. Their clients range from motherswith new babies, adolescents, through to people in the workplace the elderly,frail, people with disabilities and rural families. Their services include:• Community Nursing• Community Packages• Community Support Services• Drug and Alcohol Services• Ipswich Community Access Disability Services• Bush Connection68

For a full list of services see http://www.ozcare.org.au Following is a list ofyour closest Ozcare branches.• 38 Warry Street, Fortitude Valley, 4006.( Phone 3246 2777).ST LUKE’S NURSING SERVICEFor Referrals call 1300 785 853Central Office Contact details:138 Juliette StreetGreenslopes Q 4120PO Box 167, Stones Corner 4120Phone: (07) 3421 2800Fax: (07) 3421 2888St Luke’s Nursing Service provides a range of caring services to clients livingat home within Queensland. Services are provided by clinical nurses,physiotherapists, personal care workers, respite carers and volunteers and aresupported by a team of management and education personnel.Referrals to St Luke’s Nursing Service are accepted from GPs, Hospitals,Individuals (client/carers/family/friend) or Health Care or CommunityOrganisations. Written referrals from a GP are necessary for the complex careneeds and the dispensing of medication as well as for DVA (Department ofVeteran Affairs) patients.69

ADDITIONAL INTEGRATION OF PATIENT SERVICESThe following organisations are listed in this section:Criteria for calling an AmbulanceDoctors Priority Line – Translating and Interpreting ServiceMeals on WheelsMulticultural DirectoryThe Qld Integrated Refugee Community Health Service Clinic (QIRCH)Queensland Poisons Information CentreCRITERIA FOR CALLING AN AMBULANCEFor non-urgent bookings phone 13 12 33, > 24 hours in advance ofneed. Also have the medically authorised ambulance transport form in handwhen calling.Community Ambulance Cover Info line 1300 304 274Life threatening or immediate need for an ambulance call 000The Queensland Ambulance Service (QAS) provides fully assisted, door todoor, non-urgent health transport service to individuals who meet theeligibility criteria and have been so authorised by a Registered MedicalPractitioner who completes a Medical Authorised Ambulance Transport Form.The eligibility categories for this form of transport assistance are:• Requires stretcher transport;• Requires active management or monitoring in transit;• Has a condition that could cause them to be either gravely embarrassedor unacceptable to other people in public e.g. incontinence or bowel orbladder;• Has a disfigurement which could cause embarrassment;• Intellectual disability causing behavioural problems resulting in sociallyunacceptable behaviour requiring constant assistance; or• Any temporary disability consistent with any of the above.DOCTORS PRIORITY LINE – TRANSLATING AND INTERPRETINGSERVICE (TIS)Phone: 1300 131 450In order to provide better access to health care for certain non-Englishspeaking people, there is a fee-free service to help doctors communicate withtheir non-English speaking patients. The Doctors Priority Line is open toeligible medical practitioners in private practice by calling 1300 131 450, 24hours a day, 7 days a week, anywhere in Australia for the cost of a local call.70

MEALS ON WHEELSMeals on Wheels programs have a specific geographic area and assumeresponsibility for intake, client assessment, and the day-to-day tasksnecessary to provide meals. They deliver meals, recruit volunteers, and seekfinancial support from within their local communities.The purpose of Meals on Wheels is to organise, plan, and administer theservice of delivering well-balanced, nutritious meals at the lowest possiblecost to the recipient. These meals are provided for those clients who areunable to plan, shop or prepare such meals due to illness, disability oradvanced age.Meals-on-Wheels programs provide help, autonomy and security for seniors,their families, and caregivers.Following is a list of your closest Meals on Wheels branches within ourDivision:Suburb Address Phone FaxAcacia Ridge 13 Coley Street 3275 1860 3275 1860Carina Edmond Street 3398 7438 3843 0531(Centenary) Sinnamon Road (Cnr Yallambee 3279 1974 3279 1974Jindalee Road)Holland Park 49 Abbotsleigh 3397 9150 3394 1262Inala Wirraway Parade 3372 5276 3372 3980Mt Gravatt 19 Miandetta 3343 6026 3411 3658Sherwood Keble Street 3379 7715 3379 6206SunnybankSalisburyLister Street 3345 3795 3345 3795MULTICULTURAL DIRECTORYThe Directory of Resources for Multicultural Health 10 th Edition January 2005compiles a wealth of resources (agencies, programs, reports, and multilingualmaterial) related to multicultural health.The Directory is updated annually and can be accessed either online or byrequesting a hard copy.Queensland Health Internet site: Anyone can access the directory onlineat http://www.health.Qld.gov.au/71

Select Health information – Health Topics Index, enter ‘Multicultural Health’ inthe ‘Search by Health Topic’ box and click ‘Submit Query’. The site also storesMultilingual Health Information.Alternatively, you can request a hard copy of the Directory to be posted out.THE QUEENSLAND INTEGRATED REFUGEE COMMUNITY HEALTHSERVICE CLINIC (QIRCH)Ground FloorCommunity Services Building39 Annerley RoadWoolloongabba QLD 4102Phone: (07) 3840 2880Fax: (07) 3840 8455Opening Hours: Monday to Friday 9am – 4pmThe QIRCH Clinic was established out of the common recognition by keyservice providers, that health services to refugees and refugee claimants needbetter coordination and integration.QIRCH provides services to:• Refugee claimants;• Refugees with permanent residence arrived in Australia for less thanthree months and/or not successfully matched with a GP; and• Temporary protection visa holders not successfully matched with a GP.QIRCH Clinic provides initial health assessments and short term treatment forcomplex psychological and physical health needs and then facilitates thetransfer of the patients’ health care to a community based General Practice.֠TIPFor further information about the QIRCH Clinic, contact the Clinic Coordinatoron 3840 2880. See the QIRCH Clinic brochure in the appendix.QUEENSLAND POISONS INFORMATION SERVICEIn an emergency call 13 11 26Health professionals, including Practice Nurses, can access the PoisoningAdvice Line which is available on 13 11 26 anywhere in Australia 24 hours aday, 7 days a week.72

The role of the Centre is to provide the public and health professionals ofQueensland with prompt, up-to-date and appropriate information, and adviceto assist in the management of poisonings and suspected poisonings.When accessing this information line, Health Professionals will be giveninformation about product formulations and poisoning advice that may assistin the management of poisoned patients.73

COMMONLY USED PHONE NUMBERSFollowing is a list of commonly used phone numbers which you may like to add to.AACAT (Aged Care Assessment Team) 3275 6700Aged and Community Care Information line 1800 500 853Alzheimers Australia (Qld) Inc. (07) 5538 8221Ambulance:Community Ambulance Cover Info line 1300 304 274Non-urgent Ambulance Bookings 13 12 33Life threatening / immediate need 000Australian Nursing Federation – contact Qld branch,Queensland Nursing Union 3840 1444Australian Practice Nurse Association (03) 9682 1276BBlue Care Central 3213 7311Blue Care Respite Centre, West End 3844 5450Brisbane City Council Call Centre 3403 8888Brisbane South Allied Health Referral Service 3840 1763Brisbane South Community Health Service (Central Intake) 3275 5411Brisbane South Diabetes Referral Service 3275 5411Brisbane South Division of General Practice 3274 1886Brisbane South Public Health Unit 3000 9148CCentrelink Helpline 1300 788 118CHIP Nurse Service Manager 3275 6795CHIP Nurse Team Leader 3275 6733Commonwealth Carelink Centre 1800 052 222Commonwealth Carer Resource Centre 1800 242 636Commonwealth Carer Respite Centre 1800 059 059Community Hearing Services 1800 500 726Council Cabs Booking Line 13 62 94DDAART 3840 1760Department of Health and Ageing 1800 020 103Department of Veterans Affairs 13 32 54Diabetes Australia – Queensland 1300 136 588Disability Services Queensland 3224 8031Doctors Priority Line - Translating & Interpreting Service 1300 131 450GGPII general enquiries 1800 246 101HHACC Services 1800 242 63674

IImmunisation Australia Infoline 1800 671 811MMeals on WheelsAcacia Ridge 3275 1860Carina 3398 7438Jindalee 3279 1974Holland Park 3397 9150Inala 3372 5276Mt Gravatt 3343 6026Sherwood 3379 7715Sunnybank / Salisbury 3345 3795Medicare Australia 1300 550 017Medicare Australia (Queensland Branch) 3004 5450Mental Health Referrals (PAH) 1300 858 998NNational Dementia Helpline 1800 100 500National Continence Helpline 1800 330 066National Needle Stick Hotline 1800 804 823OOzcare 3246 2777PPalliative Care Queensland 1800 772 273PIP 1800 222 032Princess Alexandra Hospital 3240 2111QQueen Elizabeth II (QEII) Hospital 3275 6111QIRCH 3840 2880QML 3840 4555Queensland Health Immunisation Program (QHIP) formerlyKnown as VIVAS 3234 1500Queensland Nursing Council 3223 5110Queensland Nursing Union 3840 1444Queensland Nursing Union (Toll Free) 1800 177 273Queensland Poisons Information Centre 13 11 26RRoyal College of Nursing Australia (02) 6283 3400Royal College of Nursing Australia Free Call 1800 061 660SSalvin Park Complex 3213 7311SNP 3377 8555St. Luke’s Nursing Service75

Central Office 3421 2800Referrals 1300 785 853TTransport Options & Access Guide 3253 0532VVIVAS (now known as QHIP) 3234 150076

COMMONLY USED WEB SITESAged and Community Care InformationLineAusmed PublicationsAustralian Catholic UniversityAustralian Divisions of General PracticeAustralian General PracticeAccreditation LimitedAustralian Government – Health InsiteAustralian Nursing FederationAustralian Practice Nurse AssociationBlue CareBrisbane City CouncilBrisbane South Division of GeneralPracticeCommonwealth Carelink CentresCommonwealth Carer Resource CentreCommonwealth Department of Healthand AgeingDepartment of Health and AgeingDepartment of Veteran AffairsGeneral Practice AustraliaGPA ACCREDITATION plusHome and Community CareImmunise AustraliaMedicare AustraliaNational Health & Medical ResearchCouncilNational Immunisation Programhttp://www.seniors.gov.auhttp://www.ausmed.com.auhttp://www.mcauley.acu.edu.auhttp://www.adgp.com.auhttp://www.agpal.com.auhttp://www.healthinsite.gov.auhttp://www.anf.org.auhttp://www.apna.asn.auhttp://www.bluecare.org.auhttp://www.ourbrisbane.com.auhttp://www.bsdgp.com.auhttp://www.CommCarelink.health.gov.auhttp://www.careraustralia.com.auhttp://www.health.gov.auhttp://www.health.gov.auhttp://www.dva.gov.auhttp://www.gpa.org.auhttp://www.gpa.net.auhttp://www.hacc.health.gov.auhttp://www.immunise.health.gov.auhttp://medicareaustralia.gov.auhttp://www.nhmrc.gov.auhttp://www.immunise.health.gov.au77

Nursing ReviewOzcarePalliative Care QueenslandPractice Incentive ProgramQueensland Divisions of GeneralPracticeQueensland Health Internet SiteQueensland Nursing CouncilQueensland Nursing UnionRoyal Australian College of GeneralPractitionersRoyal College of Nursing Australiahttp://www.nursingreview.com.auhttp://www.ozcare.org.auhttp://www.pallcareqld.comhttp://www.hic.gov.au/piphttp://www.qdgp.org.auhttp://www.health.qld.gov.auhttp://www.qnc.qld.gov.auhttp://www.qnu.org.auhttp://www.racgp.org.auhttp://www.rcna.org.au֠TIPYou may want to save some of these websites in your favourites list to referto them frequently78

REFERENCES1. National Health and Medical Research Council (NHMRC), The AustralianImmunisation Handbook, 8 th Edition, 20032. The Royal Australian College of General Practitioners,Sterilisation/Disinfection Guidelines for General Practice, 3 rd Edition, 20003. The Royal Australian College of General Practitioners, Standards forGeneral Practices, 2 nd Edition 20004. Infection Control Guidelines, Queensland Health, November 200179

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