NOVA - Oct.fh9 - Auckland District Health Board

PROJECTS & EVENTS
Caremap helps track progress of
prem and sick term babies from
birth till discharge
A new multidisciplinary Newborn Service Infant Caremap has been devised to track care
of each infant from admission to discharge and on out into the community.
The Neonatal Intensive Care Unit (NICU) cares for pre-term babies, complex term babies
and their families. Their stay in NICU may be anything from a few days to a few months.
The multidisciplinary document means that all information, whether from nursing staff,
medical staff, lactation consultant, dietician or social worker, is all held in one place.
The Caremap, kept at the baby’s cot side, compliments other documentation already in
place, eliminating any unnecessary duplication of information. It takes a family-centred
care approach, with parents contributing to planning the care for their baby and also taking
part in documenting the information they gather during their time in NICU.
The Ministry of Health initiatives, Smokefree Babies and Family Violence screening have
also been included in this document. This ensures families are not questioned unnecessarily
and auditing of compliance is easy.
Overall the Caremap will streamline discharge planning. While this has been done very
well in the past, gathering all the necessary documentation required was time consuming.
The new Caremap will improve this.
Introduced in August, the tool has already resulted in improved efficiencies, which will
increase over time, says Dale Garton, charge nurse of NICU.
The care map has been widely publicised in the department with all disciplines on board.
Improving our databases
There are many different Microsoft Access
and other databases across the organisation
containing all manner of clinical and
administrative data. Many of these databases
are unsupported, or are maintained by one
or two key people. Few, if any, are linked to
a legitimate source of patient demographics
and all involve re-entering at least some data
that is already contained in other hospital
information systems.
The Speciality Clinical Databases (SCD)
project will provide clinical staff with all the
tools that they need to:
1. Design electronic forms specific to their
needs
2. Safely store their data
3. Perform simple queries on their data
4. Design and run reports based on their data
SCD is fully integrated with the Concerto
Clinical Workstation so users will already be
familiar with the look and feel of the new
application. SCD will provide a wide range of
functionality including automatic completion
of patient demographics, predefined ‘lookup’
tables containing reference data such as
diagnosis codes and the ability to ‘send’
completed forms to the patient’s clinical record
if appropriate.
In the long term it is planned to use the health
data dictionary functionality in SCD to
consistently capture data from services across
the organisation.
Services wishing to set up new databases will
(L-R)
Nurse Educator
Jean Bertram,
Family Liaison Nurse
Moira Malarkey, and
NICU Charge Nurse
Dale Garton.
be asked to follow a simple application process
and to undertake basic training. Forms that
will be included in the patient’s clinical record
will also need to be formally approved by the
Forms Committee.
Information Services will provide access to a
Functional Application Support team that can
provide assistance, but it is expected that
individual services will be largely responsible
for designing their new forms and reports and
for ensuring that resources are available to
enter the data.
Orion Systems and ADHB have been jointly
working on the new application over the past
nine months. Testing of the first release is
currently underway.
As part of the testing strategy, SCD will be
piloted in four clinical services to ensure that
it meets the needs of the users. Following
further development two additional pilot sites
will be set up before making the application
more generally available late this year.
SCD will be the first application in ADHB that
can truly be configured by clinicians to meet
their own needs without compromising the
speed of introduction, integration with existing
systems or the safety of the data.
SCD is expected to be available for services
outside of the pilot sites early in 2007,
according to priority of need.
Further information on the SCD project can
be obtained from John Cox, Project Manager
(email johncox@adhb.govt.nz).
Healthy Communities, Quality Healthcare “Hei Oranga Tika mo, te Iti me te Rahi”
Managing quality
improvement at ADHB
NOVA talks to two key people in the Quality team at ADHB.
Vanita Hira
Having worked as a Quality Manager
since 2000, Vanita Hira understands the
importance of the ADHB quality
framework, and enjoys supporting and
guiding services across the organisation
to make improvements in quality.
Since she joined ADHB, Vanita has been
involved in three full accreditations and
two certification surveys, developing
policies, procedures and quality plans,
along with educating staff in quality
concepts. She brings to the role a wealth
of experience in the aged-care industry
quality standards, and the Royal College of General Practitioners
standards.
As part of a five-strong team of Quality Managers, Vanita values the
role of assisting services to comply with standards and legislations such
as the Code of Consumer Rights and Health Information Privacy. She
also helps services to identify areas for quality improvement, and
provides advice and guidance on adopting the right tools for development.
“My work involves a myriad of different tasks. Although there are set
forums for discussion of quality issues, a large part of my role is about
being available and prioritising things as they evolve. The challenge
is the constant back-log of work that needs to be tackled on quiet days,
but which never seems to make the priority list,” said Vanita.
“Quality managers don’t do things in isolation and each project is reliant
on, and part of another unit or service. For example, the follow -up on
body parts tissue management has required a large amount of support
and input from theatres. With the organisational focus on risk
management and process improvement, quality managers are now
using a formal Root Cause Analysis (RCA) and this requires the support
of key staff and managers to allow the investigation to happen,”
she said.
Yvonne Kaepelli
With a solid background in nursing,
Yvonne Kaeppeli, Quality Manager,
Starship Children’s Hospital and National
Women’s Health, knows the importance
of events such as delays in service,
medication errors and patient falls being
reported and also fed-back to senior
management promptly.
Since March this year such incidents
have been lodged and reported more
quickly than ever before following the
implementation of the RiskMonitor Pro
reportable events system which Yvonne
assisted in introducing to ADHB.
According to Yvonne, the beauty of the online events reporting system
is that information can be collated and relevant departments and
individuals can be informed of events quickly, leading to unsafe situations
being addressed as soon as possible.
A Quality Manager since 1998, Yvonne said that the system, which is
in its sixth month of operation, is already contributing to ADHB’s quality
framework as information is being communicated faster to areas where
improvements are needed.
“In the past, with the former paper based system, there was often a six
to eight week delay from reporting events to information being fed-back
to staff. Risks and trends can now be identified much more quickly. A
new initiative in National Women’s and Starship is a fortnightly meeting
which provides senior clinical and management staff with an opportunity
overview the events of the previous fortnight and to ensure that the
trends and issues of concern are identified and are addressed
appropriately.”
Waitemata DHB introduced the same reportable events system last
year and Counties Manukau will implement Risk Monitor Pro in near
future. Testament to the success of the new online events reporting
system is the fact that other DHBs are now also looking to apply the
system and are building on the experience of ADHB and Waitemata in
the implementation.
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