NOVA - Oct.fh9 - Auckland District Health Board

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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. 6
An author in our midst Learning and Development Administrator Wheldon Curzon- Hobson has published his second novel Near a Canal, with a portion of proceeds from the book going to UNICEF’s Child Friendly Schools in the Solomon Islands. Wheldon’s love of literature developed as he studied an English degree at the University of Auckland. While at university he performed in several theatre productions, curated art and photo exhibitions, then worked at Youthline and wrote and directed a play Flight. He married in 1996 and moved to London with his wife in early 1997, where he worked for a street homeless charity in Camden for three years, and had his first novel The Journey Home published. Wheldon returned to Auckland in 2000 and now has two children. He keeps active in the arts, hosting The Chocolate Fish Sessions author evenings in 2005 with local and international authors in Parnell. Wheldon’s novel develops around the theme of ‘magical optimism’. This view sees the world filled with wonderful possibilities, discovering the extraordinary in what many would ignore as the humdrum of everyday existence. Set in London by the canal that stretches from Camden Lock up past Regents Park, the novel is about Charles Latimer, who works for a successful publisher in London. Charles witnesses the murder of a stranger who is helping the poor. He decides to give up his job and befriends an American couple living on a canal boat who introduce him to an extraordinary society of artists, poets and the homeless. Sleeping on a bench beside the canal, Charles begins a new life as a journalist writing about the artists and poets and the remarkable lives they lead. Charles discovers romance, CETU seeks feedback wonderful friends, and publishes their work to undreamed of acclaim. Wheldon says proceeds from the book will go to UNICEF’s Child Friendly Schools in the Solomon Islands because “what they are doing is magical optimism, they are giving these communities a real chance at education.” “In New Zealand we have fantastic opportunities for learning through libraries and bookshops and schools. UNICEF is helping to give these children this opportunity in the Solomon Islands.” Wheldon is taking Near a Canal on the road, visiting bookshops and libraries throughout New Zealand for author readings and signings. Near a Canal retails for $24.95 and can be purchased at your local bookshop or online at www.justbooks.co.nz. For more information on Child Friendly Schools in the Solomon Islands, visit http://www.unicef.org.nz/projects/ solomonis.html. Wheldon Curzon-Hobson with his novel Near a Canal. Once again the Clinical Education & Training Unit (CETU) at Auckland District Health Board wishes to advance the education and learning of junior doctors to improve the care of patients in the Auckland region. CETU has recently written a proposal in which they are inviting feedback for the introduction of Personal Learning Portfolios for house officers at ADHB. Medical Education, traditionally, has been purely apprenticeship based. This means that medical learning has occurred in a somewhat serendipitous fashion with RMOs learning from those patients that they are exposed to on various clinical attachments. With the increasing complexity of the modern healthcare system, international literature has suggested that apprenticeship style learning may not allow doctors to achieve all competencies required of the modern medical practitioner. As a baby step towards changing this education paradigm, CETU is proposing the introduction of Personal Learning Portfolios for house officers. This would allow them to record their attendance, experiences and achievements but would also contain a section inviting feedback on their procedural and communication skills from colleagues and patients respectively. This would represent a New Zealand first for postgraduate medical house officer learning but requires careful introduction and support. Dr Stephen Child from the Clinical Education & Training Unit has recently distributed material regarding this initiative and would welcome all verbal and written comments prior to a suggested implementation date of December 2006. Integrity Respect Innovation Effectiveness “Kia u ki te tika me te pono” ADHB PEOPLE From the bench to the bedside: Clinical Genetics “There has been an explosion in the availability of genetic testing in recent years,” says new Clinical Geneticist, Dr Ian Hayes. “A major challenge for clinicians is considering how to translate this new information from research to improvement of patient management.” “One of the major issues regarding genetic testing is the fact that genetic conditions often involve not only the individual patient, but the extended family. This is one of the unique challenges faced in clinical genetics and many issues may arise in relation to the familial nature of genetic disorders”. The Clinical Genetics Department comprises of 3 Consultant Physicians, 4 Genetic Counsellors, a Co-ordinator for the National Gastrointestinal Cancer Registry and Co-ordinator for research in familial breast cancer (KConfab). The Genetic Counsellors have Post Graduate Diplomas in Genetic Counselling and are particularly skilled in discussing the unique issues that are posed to families with potential genetic disorders. They see referrals from a large variety of sources. Referrals may involve anything from abnormalities concerning the fetus, child, adult (often with concerns about hereditary breast or bowel cancer) and neurogenetics patients. The genetics team is moving to a new location within the Auckland Hospital complex in October. This is located directly behind the A+ Laboratory. The genetics team are responsible for providing genetic services to the upper half of the North Island. Auckland clinics include: Manukau SuperClinic, Auckland Hospital and Greenlane Clinical Centre. Regular outreach clinics are held in Whangarei, Hamilton and Gisborne. Dr Ian Hayes is involved with several multi-disciplinary clinics throughout the hospital. An example is involvement with the Cardiac Inherited Disease Group (CIDG). This team comprises cardiologists, clinical geneticists, researchers and A+ lab staff, utilising genetic testing for conditions (such as long QT syndrome) to improve patient care. Ian is a trained General Paediatrician. His advanced training in clinical genetics was mostly in Melbourne and Toronto. Ian has a particular interest in Paediatric Dysmorphology. Rotary awards recognises outstanding contributions to nursing Three Auckland hospital nurses, Stacey McLachlan, Cath Byrne and Barbara Ferguson were recently honoured for their contribution to nursing at the annual Auckland and Newmarket Rotary awards. Stacey McLachlan, CCU Cardiac Nurse Educator, was awarded the Trophy of Tradition for personifying the spirit of nursing. Stacey received a nomination on the basis of her highly developed clinical skills and experience, as well as her commitment to providing research-based theory and expert nursing knowledge to nurses within the critical care environment. Lynne Belz, the CCU Cardiac Charge Nurse who nominated Stacey, said: “It is my belief that nurse educators, though not on the ‘shop floor’ are the unsung and often overlooked heroes in the nursing world. Stacey’s ability to increase nursing knowledge, clinical skills and nursing practice of the CCU nurses, and the contribution this has made to quality patient care, is not only invaluable but also incredibly challenging.” Starship Children’s Hospital nurse Cath Byrne was also honoured at the recent Newmarket Rotary award ceremonies with the Anne Craig Memorial Medal which recognises excellence in paediatric care. Cath, Charge Nurse in the Daystay Unit, leads the team in the busy nursing unit providing comprehensive short-term care for children requiring on-going treatment on a day-stay basis. “It is an honour to receive the award of the Anne Craig medal. We all work together as part of a team and I am just one of many nurses who are dedicated and focused on providing exceptional care to patients and patients’ families,” said Cath. Newmarket Rotary also awarded the Alistair Macfarlane Memorial Medal for excellence in obstetrics and gynaecology this year to Barbara Ferguson, Auckland City Hospital Charge Midwife, Wards 96 and 98. Barbara has been involved in a range of initiatives that demonstrate her leadership abilities including managing the move of the High Risk Unit that specialises in pre and post-natal care of women with complex medical and obstetric conditions from National Women’s to Auckland City hospital, as well as being involved in the implementation of Baby Friendly, the World Health Organisation’s initiative to assist primary healthcare providers in promoting, protecting and supporting breastfeeding in the community. 7
Page 1 and 2: THE OFFICIAL OFFICIAL STAFF NEWSPAP
Page 3 and 4: Quality healthcare takes on new mea
Page 5: Leading the way Encouraging quality

NOVA - Oct.fh9 - Auckland District Health Board

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