In the patient’s shoes QUALITY ACCOUNT 2017
Addressing family violence (pg 08)
Everyone Smart Meals has a voice for Mums (pg 22)
(pg 32)
Providing great care, everywhere, every time
Eastern Health is one of Melbourne’s largest metropolitan public health services. We provide a range of emergency, surgical, medical and general healthcare services, including maternity, palliative care, mental health, drug and alcohol, residential care, community health and statewide specialist services to people and communities that are diverse in culture, age, socio-economic status, population and healthcare needs.
Eastern Health Catchments
Localities Eastern Health Sites Primary Catchment Secondary Catchment
Buxton
Glenburn
Woods Point
Kinglake
Marysville Cambarville
Narbethong Steel Creek
Matlock
Chum Creek Healesville Hospital and Yarra Valley Health
Yarra Glen
Reefton Kangaroo Ground Eltham Templestowe
Warrandyte
Wandin Kew
Box Hill Hospital Glen Iris
Peter James Centre
Mulgrave
Warburton
Yarra Ranges Health Woori Yallock
Maroondah Hospital Hoddles Creek Wantirna Health
Olinda
Angliss Hospital Rowville
Powelltown Emerald
Lysterfield
Gembrook Upper Beaconsfield Garfield
Eastern Health acknowledges the traditional custodians of the land upon which our health service is built, the Wurundjeri people, and pays our respects to their elders past and present. The term Aboriginal used throughout this publication is inclusive of people of Aboriginal origin, Torres Strait Islander origin and those of both Torres Strait Islander and Aboriginal origin. 02
Toorongo
2016-17 at a glance
1,222,461 episodes of patient care up 4% or 47,212 more episodes than the previous year
166,554
emergency department presentations up 5.7% – that’s one person every 3.2 minutes
5026 babies born
one baby every 102 minutes
45,055
ambulance arrivals to our three emergency departments
36,032 operations
a record 16,959 were elective surgeries
254,437 specialist clinic appointments
up 12% or 27,216 more appointments
About Eastern Health Caring for 773,992 people Services located across 2816 square kilometres – the largest geographical area of any metropolitan health service in Victoria
1514 beds – 7 hospitals and 3 emergency departments *
9437 employees, 63% of whom live within the community we serve
Our larger sites Angliss Hospital Box Hill Hospital Healesville Hospital and Yarra Valley Health Maroondah Hospital Peter James Centre Wantirna Health Yarra Ranges Health
Statewide Services Spectrum Turning Point
Corporate functions Information, Technology and Capital Projects Finance, Procurement and Corporate Services Fundraising, Legal Counsel and Corporate Governance People and Culture Learning and Teaching, Nursing and Midwifery Quality, Planning and Innovation Research and Medical Services * Source: Victoria in Future 2015 ** As at 30 June 2017. Bed numbers are subject to change depending on activity and demand.
Eastern Health Quality Account 2017
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CONTENTS 05 Welcome
26 Hearing the specific needs of our Aboriginal community
29 Avoiding errors in blood sampling 30 Recognising confusion: a significant factor in falls prevention 31 Flu Fighters return 31 Providing a safe workplace for staff, volunteers, patients and visitors 32 Actively involving women in their care 32 Smart meals for mums 34 Patient care hotline 35 What’s in a name? 36 All avenues of safety considered 38 Specialised residential care for the older person 40 A focused approach to pressure injury prevention 42 A record breaking year in surgical access 42 Keeping patients safe from infection 43 Catching kids early 44 Hearing our patients’ wishes 45 Supporting staff to support patients during end of life care 46 Help at hand 47 At Eastern Health we welcome your feedback 47 In the Patient’s Shoes
28 Medication safety
48 Eastern Health
05 This is patient-centred care that goes “above and beyond” 06 What does consumer participation at Eastern Health look like? 08 Addressing family violence 10 Language services and the in-house team 12 Supporting, celebrating and responding to a diverse community 13 Rainbow eQuality Working Group 13 Pride Cup 2017 13 Celebrating International Women’s Day 14 Accreditation – what is it? 16 Cued up for support 17 What our staff are telling us 18 Observing, listening, hearing and responding 20 Patient feedback: compliments, recommendations and complaints 22 Everyone has a voice 23 Developing consumer quality and safety information 24 Progress towards Closing the Health Gap
Professor Ian Frazer with Eastern Health’s Executive Director Quality, Planning and Innovation, Gayle Smith.
In May 2017, the inaugural Australian Patients Association awards night was held in Melbourne to honour those organisations and health professionals who have made an outstanding contribution to Australian patients.
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Eastern Health was delighted to receive the “Most outstanding city hospital in Australia” award. Professor Ian Frazer presented the award to Eastern Health’s Executive Director Quality, Planning and Innovation, Gayle Smith.
36 24 38 04
Eastern Health named most outstanding city hospital in Australia by the Australian Patients Association
For further information, visit www.patients.org.au
Welcome
S
ince it was established in 2000, Eastern Health has played a key role in the provision of public health services in Melbourne’s eastern suburbs. We work with community healthcare providers, such as general practitioners, community health services and affiliated healthcare agencies, and we partner with our community of healthcare consumers – our patients, clients, residents and carers – to provide a service that is responsive and meets the ever-changing needs of a diverse population. As demonstrated throughout this report, our community plays an integral role in the development of our services as we strive to provide great care, everywhere, every time.
Consumer participation is active and strong. We proudly engage with our patients, carers and the broader community, and we listen, hear and act upon their recommendations. Consumers are involved in 60 committees across Eastern Health, including program quality and strategy committees, expert advisory committees and working groups. We are an innovative healthcare service that is always seeking ways to do things differently, more efficiently and with patients at the heart of everything we do. From introducing “Smart Meals for Mums” for our maternity patients to the introduction of in-house interpreter services, including Chin Hakha (first health service in Victoria) and developing consumer-focused education materials, we work closely with our consumers across a broad spectrum of programs and services. This report showcases Eastern Health’s performance in a number of key clinical areas as well as our commitment to providing healthcare excellence. We commend our staff and volunteers for their ongoing commitment to the provision of quality, safe and innovative healthcare. And we acknowledge our community for its ongoing support, participation and robust engagement with us. We look forward to strengthening these partnerships in the future. We trust you find this report informative and that it demonstrates our continuing commitment to the provision of quality and safe healthcare services and our focus on improving performance in areas of challenge.
This is patientcentred care that goes “above and beyond” Eastern Health received this feedback, which was then delivered in person to the staff involved at Box Hill Hospital by our Chief Executive, Adjunct Professor David Plunkett.
“
I conducted a small, intimate, wedding ceremony in the Intensive Care Unit at Box Hill Hospital as the mother of the bride was gravely ill and expected to pass away. Naturally, she wanted to witness the wedding of her daughter. The wedding was originally planned for January 2018 but there was now some urgency and we had to step in and help. I expected a bedside ceremony but what I got was a private room in the intensive care ward where the staff had gone to considerable effort and trouble to decorate it as though it were a chapel, complete with candles and flowers. There is not much in this life that brings this grizzly old 71-year-old to tears but that did. It was so special and I will never forget that as long as I live. The nurses and the doctors were just so accommodating and absolutely lovely. It is those who go “above and beyond” what is required and/or expected of them and that, the staff did; and they did it beautifully. They certainly made one mother and one daughter so very happy at almost the very last minute and I cannot thank you enough for employing such wonderful staff.
Adjunct Professor David Plunkett Chief Executive Eastern Health
Professor Pauline Nugent Chair Quality Committee
Chaplain
”
Eastern Health Quality Account 2017
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Representatives of the Eastern Health Community Advisory Committee: Sue Emery, Shan Thrairajah, Manager of Consumer Participation and Patient Experience Melissa Elliot, Seated L-R Diane Fisher, Raj Liskaser and Kathy Collet
WHAT DOES CONSUMER PARTICIPATION AT EASTERN HEALTH LOOK LIKE? C
onsistent with Victorian Government policy and the Australian Commission for Safety and Quality in Health Care Standard “Partnering with Consumers�, Eastern Health is committed to ensuring effective consumer, carer and community participation at the individual, program and organisation levels. As part of this commitment, Eastern Health develops and implements a Community Participation Plan.
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Pictured here is a diagram of how we have implemented consumer participation through multiple endorsed standards* across the three levels.
Organisational Level Program Level Individual Level
Partnering with Consumers Standard Partnering with Consumers Standard Partnering with Consumers Standard Patient and Family-Centred Care Standard Complaints Resolution Standard Open Disclosure Standard
Our Community Participation Plan 2017-2020 has been developed to continue driving meaningful community engagement. Development of the plan included: A review of the Australian Commission for Safety and Quality in Health Care Standards National Safety and Quality Health Service Standard 2 – Partnering with Consumers, conducted by the Patient Experience of Care Expert Advisory Committee to ensure we continue to meet the requirements of the standard. Input and improvement suggestions from our consumer register members and Community Advisory Committee (CAC)** at the annual Consumer and Carer Forum in February 2017. A review of the elements of the Disability Action Plan. A record, known as the Eastern Health Register of Consumer Participation, is maintained to track all activities of the consumer register and CAC members. * An Eastern Health Standard is a statement of intent that defines the requirements for an individual component of a policy. It describes the minimum mandatory performance and behaviour that will ensure Eastern Health achieves and delivers the policy intent. The performance and behaviour requirements are set out in accordance with the capability framework, including processes, skills, knowledge and competencies, tools and techniques, roles and responsibilities, and measures. ** The Community Advisory Committee is an advisory committee of the Eastern Health Board. Its role is to advise the Board on the integration of community views into all levels of operations, planning and policy development and to advocate on behalf of the community, consumers and carers.
In 2016-17, approximately 60 committees and working groups included consumer representatives.
Consumer information and health literacy Eastern Health’s Consumer Information Document Development Practice Guideline details the process to commission, develop, review and approve consumer information, including brochures, information sheets, booklets and posters.
Co-ordinator, the Manager Language Services and the Associate Director Allied Health (Speech Pathology). Between 1 July 2016 and 30 July 2017, the CIC: Reviewed 117 consumer information documents
To provide a centralised review mechanism that ensures the organisation is providing high-quality, standardised and consumer-friendly information, a Consumer Information Committee (CIC) has been established.
Published 96 consumer information documents Reviewed the process of consumer escalation for clinical deterioration Provided consumer input into the electronic medical record surgical tracking board
The committee ensures consumer information is as free as possible from jargon and technical language, written in plain language and is easily understood by the general public.
Provided consumer input into the “Assessing and Preventing Harm from Falls in Bed-Based Services” Practice Guideline
Committee membership consists of seven community members, Eastern Health’s Manager Consumer Participation and Patient Experience, our Diversity
Reviewed the tools that guide and assist staff in the development of consumer information.
“
Six years ago I joined the Eastern Health Community Advisory Committee (CAC) not knowing what to expect or how I might advocate for and contribute to increasing consumer participation in healthcare. What I soon learned was that the staff at Eastern Health were very welcoming and eager to expand consumer involvement in all aspects of their service. And so my journey began. For me, the most outstanding experience has been to witness the commitment and passion of staff and my fellow consumer representatives as we strive to improve the patient experience. Witnessing the integration of consumer involvement and participation in all aspects of the health service has been a highlight for me. While I have now completed my term on the CAC, I retain the passion and I will continue to advocate for users of healthcare through the consumer register. Jan Wirth Community Advisory Committee Member (Six years)
”
Eastern Health Quality Account 2017
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Family Violence Project Co-ordinator Katherine Dowson with Consumer Representative Nicole Simpson
ADDRESSING FAMILY VIOLENCE E
astern Health is committed to ensuring a comprehensive system is in place to identify, report and respond to suspected and confirmed instances of family violence.
Guided by the Victorian Department of Health and Human Services’ Strengthening Hospital Responses to Family Violence framework, we have established a Responding to Family Violence Reference Group, with membership from all Eastern Health clinical programs, People and Culture (formerly Human Resources) teams and our community partners, including Eastern Domestic Violence Service, Eastern Community Legal Centre and the Eastern Metropolitan Region Family Violence Partnership. A consumer representative is a member of the reference group, providing a lived experience* perspective. Following the group’s establishment in 2016, we have achieved the following
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key milestones towards addressing and responding to family violence: We were privileged to be advised by Rosie Batty (2015 Australian of the Year) during her visit to Eastern Health where she addressed more than 300 staff about the impact of family violence. Supported staff forums to raise awareness of family violence. Developed guidelines and procedures guide staff when responding to family violence that impacts staff and/or patients. Through our partnership with Eastern Domestic Violence Service, introduced a family violence specialist worker to provide confidential support to staff experiencing family violence.
“I lost who I was and what it meant to be me…” A story that informed service improvement through consumer engagement For years, Nicole endured psychological, verbal and physical abuse at the hands of the man she loved. Today, Nicole is a survivor and brings to Eastern Health, through her lived experience, a passion and commitment to education and prevention of family violence. “Over the years I became conditioned to living like a hostage; always wondering when and waiting for the moment I was going to be verbally or physically attacked,” Nicole recalls. Following what Nicole describes as “a mental slap in the face”, the reality of her situation became clear: “I realised then that he would never stop and it would only get worse if I did nothing about it.” With the support of her GP, psychologist and support services, Nicole left the destructive relationship and while her recovery and rediscovery of herself has not been easy, she focuses on educating, influencing and driving lasting change to policy and strategies that aim to prevent violence against women and champion gender equality. “I currently have the privilege of sitting on the Eastern Health Response to Family Violence Reference Group, working with staff to improve the lives of my own community. I am also a member of the Yarra Ranges Council Gender Equity Working Group to engage, educate and drive change,” Nicole says.
“I have really valued being involved with the group and their recent work in the development of the staff family violence training packages.” (More than seven per cent of our staff reported they had experienced family violence during the past 12 months in the 2016 Staff Wellbeing Survey.) Implemented training for People and Culture (Human Resources) staff, emergency department staff and mental health services staff on how to identify and respond to people who are at risk or who are victims of family violence. This training will be provided to all staff. Supported a major health promotion initiative titled “Be the Change”, working with football and netball clubs in the Eastern and Yarra Ranges region to create positive culture change for gender equality and the prevention of violence against women. * The term “lived experience” is used to describe first-hand accounts and impressions.
– Nicole
“
The abuse and violence I endured stole so much from me. My experiences have also given me things I could never have imagined. I can say, hand on my heart, that if I hadn’t gone through absolutely everything I went through, I would not have had some of the most meaningful, profound, humbling and rewarding experiences of my life – and met some of the most wonderful, inspiring and committed people working hard to change our community, society and world for the better. For that I am truly grateful. Family violence survivor Nicole
”
If this story brings up issues for you that are related to current or past experiences with family violence, please ensure you seek support by calling 1800 RESPECT. Eastern Health Quality Account 2017 09
Interpreters Arthur Zantidis (Greek) and Florence Wong (Chinese)
LANGUAGE SERVICES AND THE IN-HOUSE TEAM E
astern Health provides services to a culturally diverse community that includes a large number of patients with a primary language other than English. Good communication with consumers, whether it is verbal, written or visual through images, is a key priority for us. We employ an in-house team of interpreters accreditated by the National Accreditation Authority for Translators and Interpreters who provide support in the languages of highest demand: Mandarin, Cantonese, Greek and Chin Hakha. We are the first metropolitan health service in Victoria to provide interpreter services in Chin Hakha, which is a language spoken in southern Asia.
On an as-needs basis, interpreters are available for other languages, including Burmese, Italian, Chin languages, Persian, Khmer, Korean, Spanish and Arabic. About 60 per cent of interpreter services are provided by our in-house team, with agency accredited staff providing support when necessary. 10
Growing demand for language services In 2016-17, Eastern Health’s in-house team registered a record 23,017 occasions of service, which is a 19 per cent increase on the previous year, or 3601 more occasions. In order to meet this demand across a geographically large catchment, our language services team has started exploring alternative methods of delivering support to improve access at all our sites. A potential solution may be the integration of telephone and video (telehealth) options. Eastern Health already has 24-hour access to telephone interpreting services through a direct line to an external service provider.
5.81% Patients requiring an interpreter
8.67%
Patients with a primary language other than English
On-site (face-to-face) occasions of service 14,000 10,000 8000 4000 0
10,504
8,912
2015-2016
13,100
9,917
In-House Agency
2016-2017
Top 10 languages in 2016-17
3% Italian 3% Arabic 2% Korean 2% Karen 46% Mandarin
The highest number of on-site occasions of service in 2016-17 were:
8784 Mandarin 3187 Cantonese 2146 Greek 1441 Chin Hakha
17% 11% 8% 4% 4%
Cantonese Greek Chin (Hakha) Persian Vietnamese
Student placements Students from Monash University’s Master of Interpreting and Translation Studies have undertaken observational training at Box Hill Hospital where they observed interpreter services in action in the medical setting, providing them with a rewarding and valuable professional experience. Eastern Health Quality Account 2017
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Supporting, celebrating and responding to a diverse community
A
t Eastern Health, just over one in four patients admitted to our hospitals (26 per cent) originates from a country where English is not the predominant language. Furthermore, the proportion of people in our catchment aged 60 and over continues to increase. Our catchment has over 20 per cent more people in the over 60 age group than the average for metropolitan Melbourne. The diverse nature of our patient population presents us with many challenges, as well as opportunities, as we seek to deliver innovative models of care that best meet their varying needs.
Our community
Our patients
Our workforce
773,992 1,222,461 people
episodes of care in 2016-17
9,437 staff
34%
born overseas
34%
born overseas
80
217
nationalities
countries of birth
78% female
200+
countries of birth
Aboriginal and Torres Strait Islanders
860 volunteers
70
consumer representatives
29%
speak a language other than English at home
0.54% 0.58% inpatients
outpatients
60
committees with consumer representatives
Sources: 2016 inpatient, outpatient, emergency patient data, excluding Healesville Hospital and Yarra Valley Health; Victoria in Future 2015
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Joining the Rainbow working group
“
When I was asked by a friend to become a community representative on a working group for Eastern Health, I was less than enthusiastic. I had recently retired and wanted to be thoughtful about how I allocated my time. I decided to go through with the first stage of the orientation process which involved an introductory meeting with the Manager of Consumer Participation and Patient Experience. My induction was excellent and by the end of this meeting, I was hooked. This was definitely a group from which I could learn more about Eastern Health and the community it serves.
Rainbow group representatives Clinical Nurse Educator Mala Kumar, Consumer Representative Liz Hooper, Mental Health Program Case Manager/Nurse Chris McKenna, Learning and Teaching Advisor Isobel Ursich, Manager Health Information Services Lynette Devalle and Diversity Co-ordinator Sandy Ashton
Rainbow eQuality Working Group Eastern Health has established a Rainbow eQuality Working Group to ensure we provide safe and inclusive services that are responsive to the health and wellbeing needs of lesbian, gay, bisexual, transgender and intersex (LGBTI) people. Following a gap analysis using the Rainbow Tick Audit Tool (as per the Victorian Governments Rainbow eQuality Guide), an action plan is being developed to support Eastern Health to focus our efforts on continuing to improve our services for the LGBTI community. Two consumer representatives are members of the working group. In addition to delivering 15 diversity and inclusion training workshops, in-service or managing diversity sessions, in the past 12 months the Group has supported the following activities: Eastern Health’s library service has prioritised LGBTI content for acquisition, adding to the existing resources, including the Gen Silent training kit – a documentary film about older LGBTI people and their fear of, or experience with, discrimination in healthcare. The Adult Mental Health Service is developing, in consultation with subject matter experts, a range of model of care packages to better support LGBTI and culturally-diverse consumers.
I was excited about the first committee meeting. It involved more people than I had expected, with about 30 in total. I was impressed with the quality of conversation around the table, the level of debate, the degree of knowledge and awareness of LGBTI issues, and the sheer enthusiasm and commitment to ensuring LGBTI needs were fully addressed. Everyone participated, no exceptions. I was confident about speaking up within the group and felt that my contribution was understood and well received. I look forward to being a contributing member for the next two years and am very thankful that my friend offered me this exciting opportunity for community engagement.
”
(Consumer Representative, Liz Hooper)
Pride Cup 2017 For the third year running, Eastern Health was a key sponsor of the annual Pride Cup, hosted by Yarra Glen Football and Netball Club. The Pride Cup celebrates diversity and inclusion in sport for LGBTI communities by tackling homophobia in netball and Australian rules football. The Pride Cup is a family and community day, attended by more than 1000 people.
Celebrating International Women’s Day As one of the largest employers of women in Melbourne’s East, we celebrated International Women’s Day in March 2017 by attending a community breakfast in Box Hill. Executive Directors Gayle Smith, Kath Riddell and Karen Fox hosted 30 of our outstanding female staff, as nominated by their colleagues or managers, at the breakfast with proceeds going to “Project Respect*”. Sites across Eastern Health also celebrated by hosting local events to recognise the work of women in the organisation and throughout our community. * Project Respect is a support and referral service for women trafficked for sexual exploitation and women in the sex industry www.projectrespect. org.au/
Representatives who attended the Project Respect breakfast Executive Director Learning and Teaching/Nursing and Midwifery Kath Riddell; Executive Director, Quality Planning and Innovation Gayle Smith; Associate Director Nursing/Midwifery Workforce Sally Kelly; Executive Director Surgery, Women and Children and Acute Specialist Clinics, Mental Health, Medical Imaging and Statewide Services Karen Fox; Allied Health Manager Workforce Development and Education Cathryn Baldwin; and Stomal therapy / wound Clinical Nurse Consultant Wendy Sansom Eastern Health Quality Account 2017
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ACCREDITATION – WHAT IS IT?
A
ccreditation is achieved via a formal survey process in which an organisation is assessed against a range of industry-specific criteria by an external authority or authorities.
Eastern Health is a complex, progressive and innovative organisation that is accredited under a variety of industry standards. All clinical aspects of the organisation are regularly assessed to ensure we maintain services, systems and performance against industryspecific criteria. Eastern Health maintains full accreditation against the: National Safety and Quality Health Service Standards The Australian Council on Healthcare Standards (ACHS) Evaluation Quality Improvement Program (EQuIP) National Standards National Standards for Mental Health Services Department of Human Services Standards.
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Acting Second in Charge of Computed Tomography (CT), Medical Imaging Box Hill Hospital Kathleen Hocking
Successful accreditation surveys for the following services were completed in 2016-17:
In March 2018, we will undertake an organisation-wide accreditation survey (conducted every four years) and be assessed against the following standards: Australian Council on Healthcare Standards EQuIP National Standards: organisation-wide survey
BreastScreen
Breast Screen Australia’s National Accreditation Standards, assessed by the National Quality Management Committee
National Standards for Mental Health
Medical imaging, echo-cardiology services (Angliss, Box Hill and Maroondah hospitals) and the cardiac catheterisation lab at Box Hill Hospital
National Association of Testing Authorities, Diagnostic Imaging Accreditation Scheme for a number of services
Pathology laboratory accreditation against ISO 15189
National Association of Testing Authorities
Eastern Health’s four residential aged care facilities
Support/unannounced visits by the Australian Aged Care Quality Agency
Sleep laboratory at Box Hill Hospital
Australasian Sleep Association Standards for Sleep Disorder Services
Eastern Centre Against Sexual Assault
Department of Health and Human Services Standards (mid-cycle review)
Department of Human Service Standards: full survey of the Eastern Centre Against Sexual Assault During 2017-18 accreditation surveys will also be undertaken by: Australian Aged Care Quality Agency: full survey of residential aged care services Postgraduate Medical Council of Victoria: intern training program Palliative Care Australia National Standards Assessment Program
Understanding why things happen Eastern Health is committed to providing safe, high-quality care and one of the most important aspects is knowing when things can go wrong and making sure we prevent them from going wrong. We have expert advisory committees that work on improving care in specific areas across the organisation. Some of these areas include falls, pressure injuries, medication errors and infections. As well as this, when things go wrong it is necessary to investigate and understand what happened and how we can prevent it from occurring again. All staff across Eastern Health are required to report incidents and participate in the investigation and improvement of systems. We provide a safe environment for incident reporting and sharing lessons learnt.
Investigations of incidents identified the following five main contributory factors which are priorities action areas for improvement:
In 2016, Eastern Health improved its processes for investigating, analysing and learning from errors. Where an incident results in harm, the Eastern Health Executive Committee and relevant managers receive immediate notification. A daily patient safety meeting is also undertaken, where all incidents are discussed and any immediate actions implemented while awaiting the formal investigation. In 2016, the top four most reported incident types were: 1. Falls 2. Medication errors 3. Skin-related injuries 4. Aggression
Non-compliance with guidelines Lack of or inadequate guidelines Gaps in education and training Lack of documentation Poor communication/handover Eastern Health reported six serious incidents to the Department of Health and Human Services. Some of the findings included a need for improved supervision of students/junior staff and legibility of medication prescribing. Significant work has commenced in managing students and junior staff supervision, and with the implementation of electronic medication charts, the issue of legibility will decrease.
Eastern Health Quality Account 2017
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CUED UP FOR SUPPORT
I
n addition to the provision of accredited interpreter services (see page 10), Eastern Health’s “cue cards” are one of the most popular resources on the Victorian Health Translations Directory, which provides direct links to more than 13,000 accurate and reliable multilingual resources.
Launched by Eastern Health more than 10 years ago, the cue cards are a downloadable resource* available in more than 70 languages. Developed in collaboration with consumers and community groups to assist health professionals and clients/carers who may have communication difficulties, the cards convey simple instructions or messages through pictures. These include identifying whether someone is hungry, thirsty or in pain. They are not intended to be used in lieu of accredited interpreters. www.healthtranslations.vic.gov.au * To access the cue cards, visit the Eastern Health website at www.easternhealth.org.au and go to Language Services – Cue Cards
27% Other Australia 18% Victoria 8% USA, Canada 5% United Kingdom 2% Eastern Health 1% Other countries 40% Not known
800
average monthly downloads
Cue card downloads*
country of origin (cue cards are used internationally) * Figures from Eastern Health website only.
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10,000
average annual downloads
What our staff are telling us
T
he People Matter Survey is an employee opinion survey, co-ordinated by the Victorian Public Sector Commission, and includes questions about how staff view patient safety within their workplace.
Eastern Health performed above our comparator group average in 2017 on every patient safety item as reflected in the results presented to the right.
Every Minute Matters – staff identified improvement initiatives Eastern Health is continuously striving to improve access to services. “Every Minute Matters” is a program of improvement work aimed at addressing the issues that prevent us achieving the four-hour length of stay target in our three emergency departments. Twenty-one improvement projects, as identified by staff, commenced across the organisation in 2016, using Eastern Health’s improvement methodology. These projects were not limited to the emergency departments. Instead, they were targeted across the whole patient journey.
Eastern Health 2017 Agreement %
2017 Benchmark Average Agreement %
1. Patient care errors are handled appropriately in my work team
79
72
2. This health service does a good job of training new and existing staff
66
62
3. I am encouraged by my colleagues to report any patient safety concerns I may have
84
81
4. The culture in my work area makes it easy to learn from the errors of others
72
69
5. Trainees in my discipline are adequately supervised
69
64
6. My suggestions about patient safety would be acted upon if I expressed them to my manager
77
75
7. Management is driving us to be a safety-centred organisation
77
74
8. I would recommend a friend or relative to be treated as a patient here
77
76
TOTAL AVERAGE
75
72
Patient Safety Statement
Project addressed: Short-stay unit utilisation Admission processes for patients presenting via the emergency department Processes for patients moving between care settings Ensuring effective and efficient discharge processes To promote communication and escalation, and resolution of issues related to patient flow, quality, safety and staffing at all levels of the organisation.
Since the commencement of the Every Minute Matters projects, the following results have been achieved: Quarter 4 2015-16
Quarter 4 2016-17
Percentage of patients who present to Eastern Health emergency departments that are seen and leave the department within four hours
67%
76%
Percentage of patients who present to Eastern Health emergency departments and are admitted to hospital within four hours
58%
67%
Percentage of patients who present to Eastern Health emergency departments and go home (i.e. are not admitted) within four hours
83%
85%
Measure
85%
Patient experience of care: How would you rate the care received in ED?
(average of three sites Quarter 4 2015-16)
88%
(average of three sites Quarter 3 2016-17*)
As part of Eastern Health’s continuous improvement approach, Every Minute Matters will continue in 2017-18, with the launch of 10 new improvement projects. Health Assistant Karen Bakker with nurses Steven Abbott and Debbie Spurrell
* Most up to date data available at time of publication. Eastern Health Quality Account 2017
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OBSERVING, LISTENING, HEARING AND RESPONDING
Eastern Health seeks to hear the voice of the consumer in three different ways.
Patient Michael Hurley with nurse Mark Edwards
E
astern Health’s Patient Experience of Care Policy outlines our commitment to providing a great patient experience and is driven by the following principles: Our patients’ needs, wants, preferences and values are known and taken into account. Our patients are partners in decision-making about their care. Our patients have access to safe, effective and high-quality healthcare delivered by skilled staff. There is clear information that helps patients understand and manage their health as independently as possible.
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The consumer perspective Our communication is open, honest and respectful, ensures confidentiality and is responsive to individual needs. Our physical environment promotes healing, is comfortable, clean, safe and allows privacy. Staff listen, provide emotional support and treat patients, their families and carers with dignity and compassion. Family and friends are involved in care, in accordance with the wishes of the patient. Our care is well co-ordinated to ensure that the patient experiences continuity and smooth transitions. Meals provided are enjoyable and nutritious.
We actively seek feedback and use the voice of our consumers to inform service improvement through mystery shopping, shadowing, consumer forums and rapid improvement events. Mystery shopping and shadowing strategies involve observing the patient experience and further understanding this from the consumer’s perspective. Consumer forums and rapid improvement events provide an opportunity for consumers to talk to Eastern Health more broadly and are not necessarily about an individual experience.
Patient experience feedback/stories We want people to tell us of their specific issue, be it a complaint or compliment. Patient stories are when we invite people to tell us about their experience and are usually a more open-ended description of their experience than a specific complaint and/or compliment.
Patient surveys Surveys used at Eastern Health are designed to capture the voice of patients and carers, and are targeted to discrete issues and elements related to the patient experience that we want to specifically learn about.
Patient feedback leads to consumer participation
Patient Opinion
408
Eastern Health stories read
206,206 times
Patient Opinion is a not-for-profit social enterprise that enables people to openly share their experience online and potentially help health services make positive changes. In 2017, Eastern Health received 408 stories that were read 206,206 times.
In 2017, following feedback from a carer James* and subsequent follow-up and action by us in response to the concerns raised, we extended an invitation to James to join the Eastern Health Consumer Register to work with us to identify and develop further opportunities for service improvements. James has since joined a key clinical governance quality and strategy committee, and attended several meetings. James is now a contributing consumer at Eastern Health. After his first meeting, James provided written feedback about the data presented and how we could further improve our services. A committee member has commented to the Manager of Consumer Participation and Patient Experience that his input “is gold�. * To protect the privacy of the consumer, James is not his real name.
Examples of how we responded to feedback from Patient Opinion in 2016-17 You said
We did
A patient told us about their sensitivity
Response (extract) from Eastern Health CEO: I wanted to provide you some feedback and advise we are currently working through an improvement project to create additional capacity within our ultrasound services, especially for pregnant women. While the issues are complex to resolve, we are doing all we can to make this vital service more accessible to our community and have taken your feedback very seriously.
A patient queries access (or lack thereof)
Response (extract) from Eastern Health CEO: Eastern FM has been added as an option to the Patient Entertainment System at Box Hill Hospital.
A patient shared their story about the
Response (extract) from Eastern Health CEO: Feedback has prompted some changes in the way we will be doing things at Maroondah Hospital in the future.
and anxiety following the loss of a previous pregnancy. Upon booking into Eastern Health’s maternity services for her current pregnancy, she expressed distress at being told she was unable to access an ultrasound within an appropriate timeframe. to local community radio station Eastern FM via the Patient Entertainment System, noting Eastern Health has a regular radio spot on this station.
time they spent waiting for surgery at Maroondah Hospital. In brief, they arrived at 7.30am and were still waiting and fasting at 12pm. They were disappointed with the booking system and felt sorry for the other patients waiting, as well as the busy staff. It was not a pleasant experience for the patient and their family on Mother's Day.
A patient visited Angliss Hospital and
told us it took an extremely long time to have an x-ray. They rang the bell several times and waited for 60 minutes to be acknowledged and seen by staff.
The following changes are being implemented: Staged admission times Order of scheduled surgery confirmed on the day prior to surgery Improved communication with patients in the Day Procedure Unit regarding delays. Response (extract) from Eastern Health CEO: We have been focusing heavily on staff exercising courtesy and kindness at all times. As a result of this feedback, changes have been made in the x-ray department at Angliss Hospital. We have introduced a new buzzer that patients/family can activate when they arrive, alerting staff that they are there. This buzzer activates a red light which remains active until staff acknowledge it, thereby making sure they are aware and respond to patients as they arrive. Eastern Health Quality Account 2017
19
PATIENT FEEDBACK: COMPLIMENTS, RECOMMENDATIONS AND COMPLAINTS From July 2016 to June 2017, we received:
1,184
F
eedback is important to us and we take it seriously. There are many ways in which we seek feedback from our patients and carers (see page 47).
compliments and
1,380 complaints
Compliments and complaints by quarter – January 2012 - June 2017
Number of feedback items
500 400 300 200 100 0
Jan-Mar 2012
Oct-Dec 2012
Jul-Sep 2013
Apr-Jun 2014
Jan-Mar 2015
Oct-Dec 2015
Jul-Sep 2016
Compliments
20
Apr-Jun 2017
Complaints
Examples of VHES reporting data
How Eastern Health celebrated Patient Experience Week Eastern Health celebrated Patient Experience Week* in April 2017 by encouraging staff to promote how their care impacts on the patient experience every day. More than 30 stories were submitted by staff acknowledging about 65 staff members and teams for their efforts to make the patient experience at Eastern Health “GREAT”.
Cleanliness of toilets and bathrooms
How clean were the toilets and bathrooms that you used in hospital? 75 70 65 60
The Victorian Healthcare Experience Survey
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 2015 2015 2015 2015 2016 2016 2016 2016 2017
The Victorian Healthcare Experience Survey (VHES) is a statewide survey of people’s public healthcare experience. An independent contractor, conducts the survey on behalf of the Victorian Department of Health and Human Services. Questions are based on the internationallyrecognised work of the Picker Institute**, with questionnaires distributed to a randomly-selected group of eligible people from our health service in the month following a hospital discharge or emergency department attendance.
Eastern Health State
The cleanliness of toilets and bathrooms across Eastern Health was rated significantly above the statewide average consistently throughout 2016.
Patient and family involvement in decision-making
Were you involved, as much as you wanted to be, in decisions about your care and treatment? 70 60 50 40 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 2015 2015 2015 2015 2016 2016 2016 2016 2017
Eastern Health State
Eastern Health’s overall satisfaction score remained steady at 91 to 93 per cent for each quarter in 2016-17, against a target of 95 per cent.
Involvement of patients in decisions about their care and treatment was rated significantly below the statewide average throughout 2016 and is a focus of improvement work in 2017-18.
April to June 2016
91%
Respect and dignity
July to September 2016
91%
October to December 2017
91%
Overall, did you feel you were treated with respect and dignity while you were in hospital?
January to March 2017
93%
93 88
The VHES questions measure patients’ experiences of care. The results are used to highlight aspects of care that need improvement and to monitor performance and quality of care. * Patient Experience Week is an annual event that is recognised internationally ** For more information, visit www.picker.org/Patient Centred Care Improvement
83 78 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 2015 2015 2015 2015 2016 2016 2016 2016 2017
Eastern Health State
During the past 12 months, we have seen an incremental improvement and we aim to continue on this positive path. We will continue to monitor and implement strategies to successfully embed respectful and dignified care across our organisation.
Kindness and courtesy All core common questions are important to our organisation but one that we have focused on in our new strategic plan is centred on kindness. Providing “a great patient experience” is one of Eastern Health’s strategic goals. A working group has been established to strengthen our communication with patients and their families, and a program of work has been developed to progress this important initiative in 2017-18. Eastern Health Quality Account 2017
21
Speech Pathologist Carmen Zheng and client Peter Kelso
EVERYONE HAS A VOICE S
peech Pathology Australia estimates that more than 1.1 million Australians (>5%) have a communication difficulty. Yet, this group is largely invisible. Their needs are poorly understood and rarely addressed in local healthcare policy.
Anecdotal evidence indicates the care experience of consumers with communication difficulties is significantly poorer than other patients and their participation in their own healthcare decision-making may be unnecessarily reduced. This vulnerable group is routinely excluded from consumer feedback processes because of their limited proficiency in verbal or written communication. In partnership with Eastern Health’s Centre for Patient Experience, the Speech Pathology Department developed a strategy to enable these consumers to participate in our patient experience surveys. 22
For a health service to improve the consumer experience, they must first understand what that experience is.
How we now engage consumers with communication difficulties to have their say: Speech pathologists now conduct ward surveys with consumers with communication difficulties, as we know that until now they have been excluded due to their communication difficulties. This allows us to compare their experience with other Eastern Health consumers and to learn from them. Adding their voice ensures it is truly representative of our diverse patient population. Speech pathologists support members of the senior leadership team to conduct “walkrounds” with these consumers. Consequently, even patients dependent on an augmentative communication device (technology devices such as computers or handheld devices, or low technology such as picture communication systems) are now able to “have their say”.
Speech pathology is now represented on the Patient Experience of Care Expert Advisory Committee to ensure the needs of consumers with communication difficulties are raised. A research project is underway comparing the patient experience of people with communication difficulties and those without. By understanding the care experience we will be able to improve it. By empowering patients to tell us, in their own words, about how their experience of care can be improved, we hope to enable them to participate more fully in their own healthcare decisions, to raise awareness of their needs and to improve equity.
Patient Services Assistant and cartoonist Taehoon Gwag
DEVELOPING CONSUMER QUALITY AND SAFETY INFORMATION I
n response to consumer and staff feedback about the number and variety of brochures and education materials distributed to patients upon admission, Eastern Health produced a single patient handbook called Welcome to Eastern Health – Important information to help you during your stay in 2013.
Historically, patients would receive more than 10 brochures upon admission, informing them about how to stay safe in hospital. These were based on the Australian Commission on Safety and Quality in Healthcare’s 10 National Safety and Quality Health Service Standards. Following an internal review of the handbook in 2015 and with the support of members of the Consumer Register who conducted face-to-face surveys with patients in wards across Eastern Health, we identified that only a small number of patients were receiving information about staying safe in hospital. Furthermore, our community services were not disseminating the booklet because the content was not relevant to non-bed based services. Reviewing Welcome to Eastern Health – Important information to help you during your stay
What we needed to know When patients receive the booklet Usefulness of content Missing content Challenges using the booklet Distribution methods Stock levels Internal ordering process
What consumers and staff told us Patients do not understand the purpose of the booklet There is no time to read it It could be reduced in size with dot points Sometimes the cleaner hands it out There is a big difference on how it is given out on the wards Patients are too unwell or tired to read it Patients find the information uninteresting 0% community patients receive the booklet
In total, the consumer auditors spoke to 117 patients and the survey results found:
In March 2016, a Patient Information Handbook Working Group, including members from all areas of the organisation and consumers, was established. This group has developed two new “Partners in Care” resources to replace the handbook – one for inpatients and one for the community setting – with each booklet complementing the other one. The Partners in Care patient cards are designed to support patients to play an active role in their care. They provide advice in plain English and through animation on how to prevent falls and pressure injuries, how they can raise concerns, manage their medications and other avoidable complications. Taehoon Gwag, a talented cartoonist and patient support assistant at Box Hill Hospital, worked with staff and consumers to develop illustrations for the resources. Eastern Health will commence the distribution of these new resources in 2017-18.
65% did not receive a copy of the handbook 47% did not read any part of the handbook
Audit results also showed that many areas did not routinely provide patients with the handbook and some were unaware of its existence.
Eastern Health Quality Account 2017
23
PROGRESS TOWARDS CLOSING THE HEALTH GAP
E
astern Health continues to build on our successful implementation of the Closing the Health Gap program of work to establish culturally safe practices for people who identify as Aboriginal. Our framework includes the development of culturally appropriate welcoming patient environments and specialist training programs for all Eastern Health staff.
24
Our Closing the Health Gap improvement plan addresses the four priority areas of the Koolin Balit, the Victorian Governments Aboriginal Health Strategy. Engagement and partnerships Systems of care Organisation development Workforce development In the past 12 months actions completed against the Closing the Health Gap improvement plan has included: A review of organisational governance structures to ensure the organisation wide operating systems support the achievements of the Closing the Health Gap actions.
Netballers and footballers join together at the annual Closing the Gap Sports Day
The completion of a cultural safety audit of high priority patient/service areas to ensure our services are welcoming. Progress in analysis and reporting of performance to inform improvement initiatives. Monitoring the sustainability of the "Asking the Question" strategy. A Community Advisory Committee of local Aboriginal Community people, including Elders, has been established who meet quarterly and provide an avenue for the Aboriginal Community to participate in, and provide feedback on, relevant aspects of the Aboriginal Health Team service.
Hospital Admission Risk Program (HARP) care co-ordinator appointment An Aboriginal care coordinator position has been established in the Hospital Admission Risk Program service to improve ATSI client’s self-management of chronic conditions. Aiming to foster connections and engagement with the local community whilst enhancing the cultural competency of the workforce, this position supports the identification of people who identify as ATSI origin and assists in developing strategies to ensure all patients who attend hospital, in particular after-hours, are followed-up in a routine, proactive way to develop rapport and trust with ATSI clients.
Establishment of child youth programs Child and Youth programs have been established to improve youth outcomes through the provision of activities promoting cultural connection and engagement with the health service. This has involved running school holiday activities, youth camps and an afterschool youth group in partnership with Healesville Indigenous Community Service Association (HICSA). Forty-five youth group sessions were held in 2016-17 with 311 attendees, more than any other year.
In the January 2016 to June 2017 reporting period, Eastern Health received 85 new counselling referrals from sources including our local Aboriginal Hospital Liaison Officer, community members, family and self-referral and Boorndawan Willam Aboriginal Healing Service. A total of 54 other referrals were recorded to other organisations including Link-Up Victoria, Australian Hearing and other Eastern Health programs including Yarra Valley Community Health (community health program and GP clinic), mental health and drug and alcohol services.
Social and Emotional Well-Being Service The Social and Emotional Well-being (SEWB) service of which 50 per cent of staff employed are of ATSI origin, has worked with 14 clients impacted by past Government-forced removal policies. SEWB staff most frequent contacts involved yarning (an Aboriginal cultural form of conversation), welfare checks and advocacy/liaison for Bringing Them Home.
The Bringing Them Home service has involved assisting clients to access family tracing services, obtain records from other agencies, such as Births Death and Marriages, supporting the accessing and confirmation of Aboriginality and referring clients to counselling or other supports. The SEWB staff most frequent contacts were for care planning activities, individual counselling sessions and advocacy/liaison for mental health. A senior SEWB Counsellor has also been appointed to provide professional supervision and support to the SEWB staff. This newly appointed role is also providing counselling to clients with a focus on family violence, family relationship issues and trauma-related work.
Statement of Commitment to The Belonging Place Eastern Health has signed A Statement of Commitment to The Belonging Place being led by HICSA and which has been a long held vision of the Aboriginal community at Healesville in Melbourne’s outer-east. The vision statement is: A healthy, strong, and skilled ATSI community in Melbourne’s outer-east A place of connection, learning and healing The signing of this statement shows Eastern Health supports the development of a Belonging Place which will operate on the principles of ‘community control’ and ‘selfdetermination’ to offer and support a broad range of integrated health and community service and program options for the ATSI community in the outer-east. It is one way to make a significant contribution to Closing the Gap and improving health outcomes for the ATSI community.
Eastern Health Quality Account 2017
25
HEARING THE SPECIFIC NEEDS OF OUR ABORIGINAL COMMUNITY E
astern Health recognises the complex issues of intergenerational trauma, family disharmony and economic disadvantage which may adversely affect the cultural and spiritual, emotional and physical wellbeing of Aboriginal people in our region. 26
Aboriginal consumers who do access acute health services experience a “revolving door” which involves a relatively short admission to one of the inpatient units followed by discharge back into the community before sufficient time for rehabilitation and recovery.
We recognise this can result in mental health and drug and alcohol issues, and more typically as co-occurring problems. With funding support from Koolin Balit (the Koolin Balit is the Victorian Government's strategic direction for Aboriginal health), our mental health program has embarked on a project to “open doors” to appropriate recoveryoriented treatment and rehabilitation options for our Aboriginal community. During the initial phases of this initiative, we established that: Aboriginal clients consider the mental health program’s bed-based environment as “culturally unsafe” and as a result, are poorly engaged with services and unlikely to seek early support for clinical mental health treatment.
A key aim of the “open doors” project is to improve the cultural safety of Eastern Health’s Prevention and Recovery Care (PARC)* services and to improve awareness within the Aboriginal community of the value of these services and how to access them. Strengthening relationships with key Aboriginal organisations, as well as having a presence at key Aboriginal events, has helped create
an improved understanding of the services which is demonstrated by an increased number of admissions of Aboriginal people during the first year of the project. These early improvements in access to clinical mental health services are encouraging and we hope to continue seeing more Aboriginal clients using our step up/step down services. Further improvements to bed-based environments through ongoing engagement and consultation with the Aboriginal community are planned. In turn, we hope to improve recovery outcomes of Aboriginal clients, reduce the trauma associated with acute inpatient admissions and significantly reduce the health gap for Aboriginal people in the east.
In 2016-2017, five per cent of total admissions identified as Aboriginal compared to zero per cent during the previous year.
Maroondah PARC Admissions 2015-2016 Debbie** is a proud Aboriginal woman, mother and partner. She also lives with ongoing symptoms related to a major mental health condition. Debbie has had seven inpatient admissions in the four years preceding 2015, a number of which were involuntary.
Number of admissions
250 200 150 100 50 0
0
232
Aboriginal
Non-Aboriginal
Maroondah PARC Admissions 2016-2017 Number of admissions
250 200 150 100 50 0
11
205
Aboriginal
Non-Aboriginal
Aboriginal Hospital Liaison Officer Jo Voce and Aboriginal Engagement Clinician Kate Locastro
As part of the “open doors” clinical engagement project, a strong relationship was forged between Maroondah PARC and a key community worker supporting the mental health needs of the Aboriginal community. This relationship provided Debbie with timely access to Maroondah PARC in 2016. Debbie described the environment and staff at Maroondah PARC kind and supportive. After her first successful admission, she sought a subsequent PARC admission when experiencing early warning signs of deterioration in her mental health. Since becoming aware of PARC and using the service, she reports feeling more empowered to manage her mental health condition. She is also hopeful about avoiding inpatient admissions in the future. * PARC - Prevention and Recovery Care ** Name changed to protect privacy
Eastern Health Quality Account 2017
27
Patient Gaenor Laurence with nurse Anne Weber and Dr Nicola Hogan
MEDICATION SAFETY Preventing inappropriate use of antibiotics is a key patient safety issue and a national health priority.
Helping patients understand antibiotic use
2 in 5
hospital patients is prescribed antibiotics
A
ntimicrobials (or antibiotics) play a vital role in the recovery of patients with infections. They are also sometimes used to prevent infections, such as around the time of surgery.
Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic and occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals or other agents designed to cure or prevent infections1. Educating patients and their carers about the role they can play in reducing the emergence, spread and control of antibiotic resistance will help ensure antibiotics continue to work in the future. Eastern Health recognises that it is important for our patients to understand when and why antibiotics 1
are needed, or not needed, and their potential side effects, as well as giving them the opportunity to ask questions when they are prescribed. Our antimicrobial stewardship team has been asking patients what antibiotic information they and their carers have access to and understand, when they receive information on why they have been prescribed a specific medication, and what the potential side effects may be. The team has also explored what type of information patients and carers want about their antibiotic treatment.
www.cdc.gov/getsmart/community/about/antibiotic-resistance-faqs.html
28
Our patients told us that information on receiving antibiotics in hospital was widely available however there was limited information available in different languages.
79%
Seventy-nine per cent of patients in our survey were satisfied with the information they received.
A large group of patients were surveyed, including those admitted for surgery, medical conditions and rehabilitation. Our patients had good awareness that they were receiving antibiotics while in hospital and both doctors and nurses provided information to them. Importantly, we also identified opportunities to improve the quality of information provided, including written information. The team is responding to patient feedback and developing specific written information for patients that come from non-English speaking backgrounds. The patient survey results are also helping us to identify further areas for improvement in patient education and the patient experience in the treatment of infectious diseases.
Avoiding errors in blood sampling A Wrong Blood in Tube incident is when the labelling on the tube and request slip has perfectly matching patient identifiers but the blood in the tube is from another patient Patients in our hospitals may require a blood transfusion during their stay. Before receiving blood, samples are collected and processed in the laboratory blood bank to ensure the right blood is given to the right patient. Wrong Blood in Tube is a near-miss incident identified in the laboratory. It is a critical error during the sample collection process and can have serious consequences for patients. Wrong Blood in Tube incidents are particularly dangerous because: Blood looks the same. You cannot tell who it is from by looking at it and we rely on the patient identification sticker on the tube to tell us whose blood is in the tube. If the patient sticker is wrong, we may not know until we process the blood in the laboratory. This is why labelling the tube with the correct patient details is vital. If the blood specimen is from a different patient with a different blood group, this may lead to a transfusion of the wrong blood type, which can be fatal. Fortunately, this is very rare. Eastern Health gathered data on our rate of Wrong Blood in Tube in 2016 and found that the incidence was less than observed in an international collaborative study published in the haematology journal vox sang. This is good news for our patients but we remain committed to ensuring continuous improvement in support of patient safety.
Top: Phlebotomist, Pathology Collection Services Parminder Kaur with patient Marlene Sanderson Bottom: Laboratory Assistant from Central Specimen Reception Daniel Whittaker
What we did to better educate our staff
Wrong Blo od In Tube (WBIT) Err a large Met ors: Five-ye ropolitan P ar data from ublic Healt Zhu M , Ca rnell J , He h Service nnessy C , Liu F , Conne ll A , O’Nei 1,2
2
2 1,2 Faculty of Me dicine, Nursi 2 Department ng and Healt ll A 2, McGr of Pathology h Sciences, M ath P 2, Boros , Box Hill Ho ak M 1,2 spital, Easte onash University, Vic toria, Austra rn Health, V lia, ictoria, Aus tralia
1
2
ND
RESULTS (con tinued)
• Number of WBITs involving consistentl blood-bank y low each specimens year (n = 6, was frequently 6, 5, 7 and involving cord 6, respectivel samples. y), • Bloods collected in the ED were WBITs than associated ‘non-ED blood with highe r rates of s’ [ED: 145/4 non-ED: 384/1 82,876 (0.03 ,558,469 (0.02 0%) vs. 5%), p = 0.04] • Specimens . (Fig. 2a) collected by medical & significantl nursing staff y more WBIT resulted in s than those staff [noncollected by phlebotom phlebotom ist: 491/1 phlebotom y ,292,443 ist: 38/748,902 (0.038%) (0.0051%), vs. p < 0.001]. (Fig. 2b)
AIM
METHODS
• Retrospect ive audit of WBIT event December s, from Janua 2016, at Easte ry 2012 to rn Health. • A ‘WBI T error’ was defined as Transfusion (SHOT) schem 1 per the U.K Serious Hazards of e. (Fig. 1) • We sub-c lassified data by year; blood blood-bank -bank specim specimen; en vs. nonbloods collec departmen ted in the t (ED) vs. non-E emergency D; & blood phlebotom s collected y staff vs. non by dedicated phlebotom y staff.
Blood take n from the w rong patient & label led with th e intended p atient’s de tails
WBIT
Figure. 1: Defin ition
Blood take n from the intended p atient, but labelled w ith another patient’s d etails of wrong b lood in tub e (WBIT) 1
RESULTS
• Blood collec tions from over 2-million screened from patient encou our AUSLAB nters were Database. • Incidence of WBIT errors from n=176/383, 813 2012-2016 (0.046%), were: n=98/426,9 n=67/386,7 94 (0.02 24 3%), n=77/ (0.017%), n=111/427, 416,807 007 (0.026%), (0.018%) respectivel and y. • Average incidence of WBITs was 1 in 3859 samp les. (continued, to p of next colum n)
tests
p = 0.04
0.01
0.04
p < 0.001
ED
Non-ED
Request slip wa s not taken ‘Three-point’ po to bedside sitive identificat (right patie ion not conduc nt, right I.D ted , right test /request sl Patient in oppo ip) site bed bled in stead
WBIT confirmed in lab Blood-grou p mismatch: his oratory. torica this sample B+. l group O+;
0.03 0.02
Ward notif ied im Correct pat ient re-bled and mediately. correct spe cimen sent blood-bank to .
0.01
0.00
a)
0.05
tests
0.04 0.03
0.02
CASE STUD Y
Blood-bank specimen staff member a collected by t 0956 hou rs
Pathology c ollector arr ives at ~10 routine blo 30 hours to ods. Patien collect t who was that they h wrongly bl ad already been bled earlied advises er.
0.05
No. WBIT s per 100
• To invest igate the rates and clinica WBIT errors l patterns at our large associated metropolita with n public health service.
No. WBIT s per 100
BACKGROU
• ‘Wrong blood in tube’ (WBIT) errors lead to seriou are critical s adverse outco errors that may mes. 1 • The estim ated incide nce of WBIT 1:2000 to 1:360 s may be 0 blood collec in the order tions. 2 of • Proposed strategies to reduce mandatory the rate of WBIT three-poin s include: t identificati auditing, and on, ‘zero targeted educa tolerance’ tion for clinica incidences of error. 3,4,5 l areas with high • The gravit y of the problem is continues to gaining recog be under-reco nition, but gnised due reporting, to ‘silent-erro & the limita tions of system rs’, underatic data collec tion. 5
0.00
b) Doctor/ PhlebCollection Nurse locat otomist Figure. 2: ion Proportion a) location of WBITs b Collector of collecti y: on and b) c ollector de ED = Emerg nominatio ency Departm n
Outcome: N Avoided se ear-miss rious trans fusion react ion, but tra delayed by nsfusion six hours
ent
From June 2016, the Eastern Health Blood Transfusion Expert Advisory Committee developed three special edition transfusion newsletters focusing on Wrong Blood in Tube which included data, case studies and other critical information. Our Transfusion Nurse Consultants also conducted an intensive education campaign reaching 351 staff members via 35 face-to-face presentations. With the implementation of an electronic medical record in late 2017, which will include electronic pathology test ordering, the rate of Wrong Blood in Tube incidents is expected to further decrease. We will continue to monitor rates and address any areas of concern as this process is implemented.
DISCUSSION
• In late 2016, a detail ed review number of of WBIT cases episodes relate revealed a d to MET collectors calls and were prone that docto to this type were also noted r of error. Simila in the 2015 r findings UK ‘SHOT’ • A series report. 1 of WBIT news letters at Easte increase staff rn Health have awareness aimed to of WBIT prevalence errors, includ & dangers. ing its The news vignettes and letters provid highlight factor e clinical avoidance s that may of) WBIT errors contribute to (or based on review • Study of cases. (Fig. Strengths: 3) Longitudin specimen collec al data from tion centres all hospitals within the & • Study Limita Eastern Healt h Service. tions: 1) Existe nce of ‘silen be routinely t errors’, which detected, leading to cannot Potential for under-repo incomplete rted WBITs. data: review & many 2) due to retros pective natur different staff e of contributin g to data collec tion.
REFERENCES
1.Bolton-Maggs 12 May 2017, PH, Poles D, Thomas [online] available D, et al. The Annual-Report-W at https:// 2015 Annual eb-Edition-Final 2.Dzik WH, -bookmarked-1.www.shotuk.orgSHOT Report UK: (2016). Murphy MF, /wp-content/up pdf Accesse collection from Andreu G, loads/SHOT-2015d patients. Vox et al. An internat Sang. 2003;85 3.Ning HC, (1):40-7. ional study of the identificationLin CN, Chiu DT, performance errors followin et al. Reductio of sample PLoS One. g process interven n in hospital 2016;11(8):e016 0821. tions: a 10-year-wide clinical laborato 4.Lippi G, retrospective ry specime laboratory Mattiuzzi C, Bovo C, n observational medicine. Clin et al. Managin study. Biochem. 2017. g the patient 5.Bolton-Maggs identification PH, Wood outcomes: crisis in healthca EM, Wiersum can it be prevent re and -Osselton JC. ed? Br J Haemat ol. 2015;16Wrong blood in tube 8(1):3-13. - potential for serious
Figure. 3: Posit ive clinical beha (Source: Ea stern Health Tra viours for reducing ri sk of WBIT nsfusion Newsle s tter, May 20 17)
CONCLUSION
• WBITs are relatively comm on errors serious harm with poten to patients. tial to cause • Continued longitudina l auditing, essential for discussion identifying & education, the impact are & for devel & patterns oping strate of WBIT errors gies to reduc WBITs. , e the rate & burden of • Electronic systems to assist with wristband positive patien reading and t ID; barco bed-side ded implement label printi ed at Easte ng rn will Healt h later this to provide be year. This is a major expected advance in reductions safety with in WBITs and substantial identificati on errors.
Eastern Health presented this poster on Wrong Blood in Tube at the first Australasian Diagnostic Error in Medicine Conference 2017. This was well received with interest from many attendees.
ACKNOWLEDG
EMENTS The authors wish to thank & specimen reception staff Janet Steele, Jennifer Antonino & of the core the scientific laboratories across Easter n Health.
Eastern Health Quality Account 2017
29
Clinical Nurse Educator Penny Casey with patient Anne Nitz
Recognising confusion: a significant factor in falls prevention
P
reventing falls and harm from falls is one of Eastern Health’s key priorities. Falls can lead to significant complications for a patient and may result in a longer stay in hospital.
There are many factors that can cause a person to fall, including (but not limited to) unsteady balance/walking, some medicines, poor eyesight, dim lighting, confusion, inappropriate footwear, foot pain, urgent or frequent need to go to the toilet, not eating or drinking enough fluids and environmental hazards. In response to research and our own data showing that our current approach to reducing falls in hospitals needs improvement, a group of consumer representatives, expert clinicians and clinical teachers have worked together to improve how we identify patients at risk of falls and how we can keep them safe in hospital.
Our focus To reduce falls with serious injury by 20 per cent from 2015-16 to 2016-17. Following a comprehensive analysis of our falls incidents, staff views, patient feedback and falls prevention projects, our data indicated that patients who were confused in our hospitals were at a much greater risk of falls. In collaboration with Monash University, a major research project was conducted across our hospitals and revealed that significantly more of our patients were confused than what our data systems told us. With patient confusion a significant indicator of falls risk, major changes were made to our policies and procedures to recognise and manage patients who are confused, as well as how we prevent and manage falls. In addition, two Clinical Nurse Educators (Delirium and Falls
Prevention) were appointed to develop teaching resources for all clinical staff and further support education across the clinical environment. Improving the care and safety of all patients, particularly those who are confused, remains a priority and we are ensuring all clinical staff are educated and updated with the most recent research and improvements to our policies and procedures. We are also working with staff and consumers to update our teaching and consumer resources. Recognising that consumers see, hear and understand information differently to health practitioners, we have worked with our consumer to develop two patient fact sheets – Staying Safe and Steady at Home and Staying Safe and Steady in Hospital.
Recognising that consumers see, hear and understand information differently to health practitioners, we have worked with our consumer to develop two patient fact sheets – Staying Safe and Steady at Home and Staying Safe and Steady in Hospital.
Patient falls resulting in serious injury by month (compares 2015-16 and 2016-17) 400 300 200 100 0
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Current year actual Last year actual Current year target
There was a 68 per cent reduction in the rate of falls with serious injury from 0.322 falls per 1000 occupied bed days in 2015-16 compared to 0.122 falls per 1000 occupied bed days in 2016-17. This is a significant reduction in the number of patients who have experienced a fall resulting in death, head injury or severe fracture while receiving care through an Eastern Health service. 30
Flu Fighters, Infection Prevention and Control Clinical Nurse Consultants Helen Marquand and Jane Stafford
E
astern Health’s Flu Fighter campaign returned in 2016-17 to prepare for seasonal influenza.
All Eastern Health staff are encouraged to receive an annual free flu vaccination. Due to the nature of their work, hospital staff are at high risk of influenza exposure. Maintaining a level of immunity in the healthcare workers benefits our patients, colleagues and visitors and reduces the risk of influenza transmission.
Percentage of Eastern Health staff given flu vaccination 100
FLU FIGHTERS RETURN
80 60 40 20 0
2010 2011 2012 2013 2014 2015 2016
Providing a safe workplace for staff, volunteers, patients and visitors
A
n Occupational Violence and Aggression Taskforce, led personally by the Chief Executive, was established in the wake of the death of one of Eastern Health’s surgeons in June 2017 after an altercation with a member of the public. An urgent review of practices, including training, policies, processes and procedures, was also commissioned to ensure they were relevant and appropriate.
There have been a number of actions and recommendations implemented following this review, including a renewed focus on Code Grey and Code Black emergency procedures as well as emphasising the importance of reporting all incidents of aggression and violence – not just physical incidents. Eastern Health is working closely with our staff and their representatives to ensure we have the right strategies and approaches. A number of initiatives are planned in early 2017-18, including equipping our community workers with personal safety devices and providing staff with personal safety sessions run by Victoria Police. Eastern Health’s focus throughout 2016-17 remained
on key organisational OHS risks related to aggression management, manual handling and slips, trips and falls. Eastern Health has continued to receive strong support from the Victorian Government’s Health Service Violence Prevention Fund. Service improvements include an upgraded duress system at the Maroondah Community Care Unit and a redesign of the Murnong Clinic and Chandler Clinic to improve safety and security for clients and staff. In addition, CCTV systems will also be enhanced at the Angliss Hospital Emergency Department, Box Hill Hospital Emergency Department, Yarra Ranges Health, Peter James Centre South Ward and Upton House at Box Hill.
The number of occupational violence incidents* reported per 100 full time staff is
4.08 16% with
resulting in staff injury or illness * Any incident where an employee is abused, threatened or assaulted in circumstances arising out of or in the course of their employment. Eastern Health Quality Account 2017
31
Actively involving women in their care
SMART MEALS FOR MUMS
E
astern Health provides birthing services at the Angliss and Box Hill hospitals. We provide appropriate care in partnership with women, who are actively involved throughout their pregnancy, birth and postnatal period.
According to the Victorian Perinatal Services Performance Indicators 2014-15, Eastern Health continues to perform as one of the most favourable sites for the initiation of breastfeeding. The 2014-15 indicators also identify Eastern Health as having one of the lowest induction of labour rates in women who are giving birth for the first time. Eastern Health uses the Victorian Perinatal Services Performance Indicators and other maternity benchmarks, to continuously improve the care provided to mothers and families.
Associate Director Allied Health (Dietetics) Erin Brennan with Sharndelle Fernandez and baby Valentin
32
M
aternity patients are usually quite well with reasonable appetites and are looking for a responsive, varied menu which meets their appetite and nutritional needs.
From May 2015 to July 2016, 58 per cent of patients on the maternity ward at Angliss Hospital rated their meals as enjoyable always or most of the time. By December 2016, following the implementation of â&#x20AC;&#x153;Smart Meals for Mumsâ&#x20AC;?, 100 per cent of maternity patients at Angliss Hospital rated their meals as enjoyable always or most of the time.
Meal orders were required 24 hours in advance and with no menu monitor service (a menu monitor is a food services staff member who assists a patient to order their meals), patients were rarely given the opportunity to choose their meal at all. Food choices were limited with two hot selections for lunch and dinner, and we found that only 24 per cent of patients ate 100 per cent of their meal.
How did we reach 100 per cent patient satisfaction with meals?
Under the guidance of the Nutrition Expert Advisory Committee*, which includes consumer representation, we piloted Smart Meals for Mums, a program that included Smartpack meals, and the allocation of a dedicated menu monitor for the maternity ward at Angliss Hospital.
Before Smart Meals for Mums was introduced, the food service model for the maternity ward was rigid and designed to meet the food services department schedule. For example, lunch was served at 12.30pm and dinner at 5.30pm.
Smartpack meals are ready-made frozen meals that reheat exceptionally well and retain flavour, moisture and colour. They look appealing and allow for a more flexible, responsive meal delivery service to be provided.
Smart Meals for Mums offers patients increased menu choices and the ability to place meal orders when they are ready to eat. For example, a mum who gives birth at 2pm can have a hot meal of her choice delivered within 50 minutes. This model is designed to meet the patientâ&#x20AC;&#x2122;s schedule. During the trial, a menu monitor was available to assist patients with their menu choices, which included 20 hot meal selections at lunch and dinner. During this time, more than 70 per cent of patients ate 100 per cent of their meal. Patient meal satisfaction also reached 100 per cent. Smart Meals for Mums highlights the importance of putting the needs of our patients first when it comes to the design of food services. Planning is underway for ongoing implementation in our maternity wards at both Angliss and Box Hill hospitals.
Before the introduction of Smart Meals for Mums, patient meal satisfaction was poor
Very happy
Happy
In between
Unhappy
Very unhappy
Post implementation of Smart Meals for Mums, patient meal satisfaction reached 100 per cent
Very happy
Happy
In between
Unhappy
Very unhappy
* The role of the Nutrition Expert Advisory Committee is to: Embed best-practice international standards in nutritional care across Eastern Health Develop implementation plans for deploying nutrition standards, including roles and responsibilities Monitor organisation-wide performance against standards in nutritional care Make recommendations to improve performance that will address identified gaps in nutrition care. Eastern Health Quality Account 2017
33
PATIENT CARE HOTLINE
W
ho knows a patient best? Families and carers are ideally placed to identify subtle signs of medical decline in patients because more often than not they know what is usual as they spend more time with and observing patients.
The 2015 pilot project evaluation found that:
40% 25% 76%
Families and carers can escalate or trigger an “escalation of care” when they are concerned about a patient’s decline in medical wellbeing. Following the evaluation of a pilot project at Angliss and Healesville hospitals in 2015, it was evident that there was an opportunity for Eastern Health to work with consumers and their healthcare team to develop resources and education about the escalation of care process.
of patients did not receive information about consumer escalation of care of staff did not know about the consumer escalation of care process of staff had not been educated about the consumer escalation of care process Staff would benefit from the development of a patient story to better understand the benefit of hearing consumer concerns
Eastern Health’s Clinical Deterioration Expert Advisory Committee engaged with consumers and members of the healthcare team to redesign the process for escalation of care. A three-tier process was implemented for patients, families and carers to escalate their clinical concerns. Through the development of consumer-focused “Are you worried” resources, including posters and postcards in multiple languages, patients, families and carers are encouraged to use this process to seek help when they are concerned about a patient in hospital who appears to be deteriorating, not doing as well as expected or not improving at all.
Consumer triggered escalation of care
Step 1 Step 2 Step 3 Speak to any member of the healthcare team about your concerns
if not satisfied
if still not satisfied
Speak to the nurse/ midwife in charge
Call the Patient Care Hotline, 9975 6789, a dedicated priority hotline where details are taken and forwarded to the site nursing co-ordinator as a priority. Once the nursing co-ordinator receives the notification, they review the patient with the nurse in charge and inform the Medical Emergency Team (MET) of concerns raised. Following a review by the MET, the caller is contacted to let them know the plan for the patient's care.
Following implementation of the new escalation of care process and promotion of resources, there have been a number of concerns raised and managed by the healthcare team. There have also been a handful of activations from the Patient Care Hotline, ensuring that families and carers are having their concerns heard and appropriate action taken.
34
Escalation of care resources For consumers “Are You Worried?” posters are displayed in clinical areas, including patient lounges and/or sitting areas. “Are You Worried?” postcards are given to all patients on admission. They are also available in outpatient clinics, short-stay units and emergency department waiting areas. “Are You Worried?” postcards are available in English, Vietnamese, Chinese (traditional and simplified), Greek and Chin Hakha. Information for consumers is available on the Eastern Health website www.easternhealth.org.au in multiple languages. d? Are you worried about your chil look, they way the in nge cha a Is there w. kno us let se feel or behave? Plea
Are you Is there worried abou t feel or ba change in the your relative? ehave? w Please le ay they look, t us kno w.
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Deterioration.
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If you ar Speak toe worried plea s team ab a member of th e don’t delay – out your e concern healthcare s
Recognisin g and Res ponding to Clinical Det erioration.
For staff The observation chart (clinical form), which is a tool to monitor and document clinical changes, incorporates the “Family Worry” question: If yes, a medical review is requested. Information is available on the intranet. Information is included in the Eastern Health policy system. Escalation of care is promoted at senior leadership and managers forums. Use of a video telling the story from a family’s perspective of not having concerns heard and the consequences.
What’s in a name? Staphylococcus aureus (S. aureus) or SAB Staphylococcus aureus (S. aureus) is a bacterium often found on the skin of healthy people and is relatively harmless unless it causes infection. Ensuring clinicians are trained and practice aseptic technique when inserting devices or undertaking invasive procedures reduces the risk of patients developing a Staphylococcus aureus bloodstream infection (SAB). Eastern Health’s SAB rate in 2016-17 was 0.8 which is less than the Statewide target of <2/10,000 per occupied bed days. This is a good outcome for our patients and a reflection of our infection prevention and control practices. Other measures to reduce the risk of patients acquiring an SAB infection include hand hygiene before and after performing procedures and cleaning of equipment and the patient care environment.
A central line-associated bloodstream infection (CLABSI) A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (bacteria) enter the bloodstream through the central line. Eastern Health did not achieve the target of zero CLABSI following two infections in 2016-17. Further investigation found that other factors were involved in these infections, not just the central line itself. Our Intensive Care Unit is leading improvement initiatives to reduce the risk of patients contracting a CLABSI by ensuring staff follow a strict protocol when inserting the line to ensure it remains sterile, undertake appropriate hand hygiene and use surgical aseptic technique during insertion and management of the line, as well as removing central lines as soon as they are no longer required.
Eastern Health Quality Account 2017
35
ALL AVENUES OF SAFETY CONSIDERED A
dmission into an acute mental health unit can be highly distressing for many individuals. Restriction on movement within a mental health setting is used as a last resort and only to ensure the immediate safety of the individual concerned, or other individuals within these settings.
All staff within our mental health service are skilled in using a range of strategies to support individuals during difficult times. Using sensory equipment such as weighted blankets or animals, music, sensory gardens, quiet spaces and meditation are all preferred methods of supporting someone.
reduce seclusion and restraint, and successfully reduced the use of these interventions in 2016-17. Our service has employed a peer worker with a lived experience of admissions to a mental health unit to support this work. We have also started another piece of work called â&#x20AC;&#x153;Safewardsâ&#x20AC;?, which has been successfully implemented in the United Kingdom and aims to improve the experience and safety of consumers and staff. This approach aims to reduce distress and improve outcomes during admissions.
Our service monitors all instances of seclusion and restraint, and undertakes comprehensive reviews of mechanical restraint as this is the most restrictive intervention. All instances are reported monthly to a quality and strategy committee, and actions to address the use of seclusion or restraint are agreed by that committee.
Decisions to use a restrictive intervention, such as secluding someone in a room or restraining them, are only made when all other avenues of safety have been considered and they are used as an emergency procedure to prevent imminent harm.
Our service provides a monthly report to the Victorian Chief Psychiatrist, detailing all seclusion or restraint episodes, and we routinely work with the Chief Mental Health Nurse and Chief Psychiatrist to improve the quality of our service.
Eastern Health has undertaken a comprehensive program to
Seclusion episodes 2016-17 25 20 15 10 5 0
Jun 2016
Jul 2016
Aug 2016
Sep 2016
Oct 2016
Nov 2016
Dec 2016
Jan 2017
Feb 2017
Mar 2017
Apr 2017
May 2017
Adult Aged CYMHS
Jun 2017
Total seclusion episodes for 2016-17 across all age groups (i.e. the number of times seclusion was used): Group
Jul 2016
Aug 2016
Sep 2016
Oct 2016
Nov 2016
Dec 2016
Jan 2017
Feb 2017
Mar 2017
Apr 2017
May 2017
Jun 2017
Total
TOTAL
25
24
47
44
43
27
6
9
18
17
19
20
256
Restraint episodes 2016-17 25 20 15 10 5 0
Jun 2016
Jul 2016
Aug 2016
Sep 2016
Oct 2016
Nov 2016
Dec 2016
Jan 2017
Feb 2017
Mar 2017
Apr 2017
May 2017
Adult Aged CYMHS
Jun 2017
Total restraint episodes for 2016-17 across all age groups (i.e. the number of times bodily restraint was applied): Group
Jul 2016
Aug 2016
Sep 2016
Oct 2016
Nov 2016
Dec 2016
Jan 2017
Feb 2017
Mar 2017
Apr 2017
May 2017
Jun 2017
Total
TOTAL
19
13
17
20
22
9
19
6
5
6
3
9
148
36
The following feedback from a carer who used COPES best describes the value of peer support:
Peer workers Namoi Fryers (L) and Stacey Noble (R) with Manager, Consumer and Carer Workforce Cate Bourke
A client’s reflection…
New peer workers support hospital discharge An unplanned admission to a mental health inpatient unit can turn a person’s life upside down and be distressing for family and friends, even though it is the right place to be when someone’s mental health is seriously challenged. A new initiative to provide additional support for consumers and carers started at Eastern Health in March 2017. The Post Discharge Peer Support Service employs trained peer workers who have a lived experience of being an inpatient with mental illness or have a family member admitted to a mental health unit. They help with the discharge process by connecting with patients before discharge and making contact in the early days post discharge. Peer contact has been shown to reduce the likelihood of a future unplanned readmissions and helps with recovery from mental illness.
“
Consumers and their family and friends gain much-needed hope and practical guidance by connecting with peer workers who have a lived experience as a consumer or carer. When peer workers are involved, they are able to communicate concerns and suggest ideas based on their own experience of mental illness and recovery. Peer workers complement clinicians and collectively help to change the culture towards a recovery-focused approach. Ten Post Discharge Peer Support Workers are employed across Eastern Health’s Mental Health Program, in adult, aged and child and youth inpatient units. They have supported more than 70 individuals since the program started and work alongside Carers Offering Peers Early Support (COPES), which supports up to 40 family carers every month.
Quite often, peer workers are introduced to consumers and carers at a traumatic, confusing, frightening and devastating time in their lives. It is during this challenging time, we need to connect and to do our work. I have encouraged carers to care for themselves to ensure they retain their health and are able to cope with the demands of caring for someone post discharge. Di, Carer Peer Worker
“
”
A peer-style approach to communication often leads to conversations rich in information sharing, which can improve quality of service provision, as well as safety outcomes for consumers and carers. Naomi, Consumer Peer Worker
“I found that she (the COPES worker) was not only very professional, she was also very caring, patient and very easy to approach. She listened to my story with deep understanding and empathy. Though we have not met and this was the first time we talked on the phone… I felt that I had known her for a long time. Somehow there was a connection between us which was very special and warm. I was so grateful to know her and have her to support me through this very difficult time in my life.”
”
“In 2013, I was hospitalised after I relapsed after being a flood-affected victim, moving nine times in nine months, and was also injured in a motor vehicle accident. The stress and pain of dealing with it all and the lack of support made things severely stressful. After my hospitalisation, I moved to the Prevention and Recovery Centre and was able to re-establish basic skills like cooking and shopping. I went home a week later and took a year to get back on my feet. This included driving, shopping and working. It takes discipline to stay well. I find that by working and socialising, my communication skills have improved. My memory and concentration have taken time to return but it is getting better every day. Recovery occurs every day. There are still some days when I don't have the same spark and on those days I rest and relax at home or go window shopping. Sometimes the way to resolve things is by simply sitting and having a cup of tea. Staying well takes a lot of work, persistence and finding new ways to actively engage in life. Sometimes things go okay and sometimes things go backwards. The idea is to hope that things never get to the final urgent stages of my plan but if that occurs there is a plan in place to seek professional help.” As extracted from a mental health program client feedback story. Eastern Health Quality Account 2017
37
SPECIALISED RESIDENTIAL CARE FOR THE OLDER PERSON E
astern Health has a range of fully-accredited residential aged care services and facilities. Residents are provided with a home-like environment where their independence, friendships and participation in the local community are encouraged. An open door philosophy also exists for family and friends to visit.
Leisure and Lifestyle officer at Edward Street Nursing Home Christine Elder with residents Sydney Mackenzie and Mary Cooper and Leisure and Lifestyle Officer Marian Rodwell
Our facilities Edward Street Nursing Home is co-located on the Angliss Hospital site in Upper Ferntree Gully, providing individualised care to residents. Monda Lodge Hostel is located in Healesville and offers a care setting for residents who are independent but choose to receive some support with their care needs. Mooroolbark Residential Aged Care Facility is a high-care specialised psychogeriatric nursing home in the suburb of Mooroolbark. Northside Residential Aged Care Facility is also a high-care specialised psychogeriatric nursing home located at the Peter James Centre in Burwood. 38
Mooroolbark and Northside are secure transitional care facilities for people over 65 who require nursing home care but cannot access mainstream nursing homes due to identified behavioural disturbances associated with mental health needs. Residents remain at the facility until their behavioural problems have resolved through management and treatment or their physical health has deteriorated to a point where their needs will be better met in a mainstream facility. Since July 2006, Public Sector Residential Aged Care Services in Victoria have participated in the collection, reporting and benchmarking of data for a set of quality of care performance indicators.
These indicators are designed to assist in monitoring and improving care provided to residents in the following areas:
1 2 3 4 5
Incidence of pressure injuries Incidence of falls and fall-related fractures
Incidence of use of physical restraint Incidence of resident poly-pharmacy (more than nine prescriptions)
Incidence of unplanned weight loss
Our data is compiled monthly and submitted quarterly to the Department of Health and Human Services. It is then converted from raw data to rates and returned to us with the particular service rate, overall statewide rate and metropolitan rate for comparison.
The following data reflects the 2016-17 quality indicators for Quarter 3 (January â&#x20AC;&#x201C; March 2017)
Pressure injuries Pressure injuries are assessed through a quarterly audit of all residents, including pressure injuries that were present on arrival, as well as those acquired in care. The clinical indicators collect data on Stage 1 to 4* pressure injuries. All four facilities were below the statewide average rate for the third quarter in 2016-17.
Facility Edward Street statewide average Monda Lodge statewide average Mooroolbark statewide average Northside statewide average
Stage 1 Stage 2 Stage 3 Stage 4 0.00 0.40 0.00 0.00 0.37 0.48 0.08 0.02 0.00 0.00 0.00 0.00 0.15 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.37 0.48 0.08 0.02 0.00 0.00 0.00 0.00 0.37 0.48 0.08 0.02
In the third quarter of 2016-17, Edward Street Nursing Home had one resident assessed with a Stage 2 pressure injury. Residents with any pressure injury receive assessments and prescribed care from an Eastern Health Wound Nurse Consultant and dietitian.
Falls The occurrence of falls and fall-related fractures is identified through quarterly analysis of resident falls data. All four facilities were below the statewide average rate for the third quarter in 2016-17.
Facility Edward Street statewide average Monda Lodge statewide average Mooroolbark statewide average Northside statewide average
Falls Facility rate 3.62 7.73 2.16 5.87 4.53 7.73 6.71 7.73
Falls Fracture rate 0.00 0.15 0.00 0.21 0.00 0.15 0.00 0.15
Physical restraint Data on the use of physical restraint is collected monthly. It is routine practice within Eastern Health residential aged care facilities to not use physical restraint. There have been no occasions of physical restraint.
Residents in all four facilities are reviewed by their GPs and review pharmacist with the aim of reducing medications, where appropriate, and ensuring that the risk of drug interaction is minimised. In addition, all residents receive a comprehensive medication review that is funded by Medicare and is conducted by the visiting pharmacist.
Unplanned weight loss Information about the frequency of unplanned weight loss and trends is recorded by auditing the monthly weight records of all residents. If, over a three-month period, a resident shows a significant unplanned weight loss (greater than three kilograms) then the change is recorded. Weight loss greater than three kilograms
Facility Edward Street Monda Lodge Mooroolbark Northside
Facility rate 0.40 1.30 2.72 2.10
Statewide average 0.96 0.63 0.96 0.96
Unplanned weight loss of any amount every month over three consecutive months
Facility Edward Street Monda Lodge Mooroolbark Northside
Facility rate 0.00 0.40 1.36 0.42
Statewide average 0.82 0.92 0.82 0.82
Residents are referred to an Eastern Health dietitian and speech pathologist, as required, to ensure they receive adequate nutrition and hydration. Relevant assessments and care plans are developed for these residents, with additional strategies such as the prescription of appetite stimulants, dietary supplements and weight monitoring. If any resident shows an unplanned weight loss of any amount, every month over three consecutive months in a quarter, this is also recorded. * As defined by the National Pressure Ulcer Advisory Panel (2009). There are six pressure injury stages (Stage 1, Stage 2, Stage 3, Stage 4, Unstageable and Suspected Deep Tissue Injury) and are described as Stage 1: Non-blanchable erythema. Stage 2: Partial thickness skin loss. Stage 3: Full thickness skin loss. Stage 4: Full thickness tissue loss. Unstageable: Depth unknown. Suspected Deep Tissue Injury: Depth unknown.
Occurrence of poly-pharmacy
New improvement initiatives introduced in 2016-17
The occurrence of poly-pharmacy (residents using nine or more medicines), and trends in this, are collected through a quarterly audit of resident medication charts. All four facilities were below the statewide average rate for the third quarter in 2016-17.
Our residential aged care services appointed a spiritual care practitioner who provides spiritual support for our residents and families. For most residents and their families, this includes emotional support, bereavement support, grief and loss counselling, spiritual, religious and sacred texts, ceremonial events and rites, pastoral counselling and religious care (sacraments, prayer, religious ministers). Our service has also recruited a consumer representative, who is provided with meaningful opportunities to be involved in planning services, decisionmaking, monitoring and evaluation within the service.
Facility Edward Street Monda Lodge Mooroolbark Northside
Facility rate 3.62 4.33 2.72 3.36
Statewide average 4.60 4.79 4.60 4.60
Eastern Health Quality Account 2017
39
A FOCUSED APPROACH TO PRESSURE INJURY PREVENTION
P
ressure injuries are a major risk for hospital patients, especially those patients who are restricted to a bed or chair. On admission, all patients are reviewed for evidence of existing pressure injuries and assessed for pressure injury risk. In 2016-17, Eastern Health’s pressure injury rate was 0.889 per 1000 bed days, or less than one pressure injury per 1000 days. While not considerably different to other health services, this represents a 12 per cent increase when compared to previous years. In an effort to decrease pressure injuries, we have undertaken a number of key initiatives in high-risk areas.
Patient and carer education
Risk assessment and care planning
A new patient information booklet that features simple tips on what patients and families need to know about pressure injuries and what they can do to support the clinical team to prevent pressure injuries. This will be launched in 2017-18.
A pilot project was undertaken in some of our surgical and medical wards, around simplifying the approach to pressure injury assessment and management. Following positive feedback from clinicians, a recommendation was made to utilise this new approach across the health service.
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rns: Other Conce … …..................….... Nil identified
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40
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INTEGRATED
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Date of Birth:
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39 08/17 EHVGXFMR05
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Introduction of specialised beds for our highest risk patients A 35 per cent decrease in pressure injuries was noted in palliative care following the purchase of two specialised tilting beds that are specifically used to manage high-risk patients through regular rotation and turning, minimising pain and discomfort while still achieving repositioning.
Spike in device-related pressure injuries in intensive care With a sharp increase in pressure injuries in one of our intensive care units from devices such as tubes used to assist a patient to breathe, which may stay in one place for an extended period, we commenced an improvement project within the department. An action plan and strategies to manage the increase were developed and a change in practice resulted in an overall reduction across the unit.
Number of pressure injuries
The introduction of multi-disciplinary pressure injury “rounding” on one of the wards resulted in a reduction in pressure injuries during the last four months of 2016-17. This initiative involved reviewing each patient on the ward who was at high risk of developing a pressure injury. The review team included their doctor, nurse unit manager, wound care nurses and allied health staff, such as podiatrists and occupational therapists.
Geriatric evaluation management ward multi-disciplinary rounding – incidence of pressure injuries 2016-17 Improvement initiative commenced
8 6 4 2 0
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Care Unit incidence of pressure injuries 2016-17
Number of pressure injuries
Multi-disciplinary pressure injury rounding
Improvement initiative commenced
8 6 4 2 0
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Improved focus on the standard work for health assistants Health Assistants in Nursing (HANs) commenced at Eastern Health in 2013. HANs support the nursing team by helping with patient care activities under the supervision of a registered nurse. A program of work was introduced (May 2016) on one of our medical wards by the nurse unit manager that focused on risk assessment and interventions, and defined the
routine work for health assistants to support efforts to reposition patients and raise awareness of high-risk patients. Following introduction of the improvement initiative, the ward recorded no incidence of pressure injury harm over a seven month period. The ward further reported one of the lowest incidences of pressure injuries in 2016-17.
Eastern Health Quality Account 2017
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A record breaking year in surgical access Last year, Eastern Health performed just over
34,000 surgical procedures of which
16,959
were elective procedures
This was a record for Eastern Health Clinical Nurse Specialist Operating Suite Liz Webber
Keeping patients safe from infection
P
roviding a safe environment across Eastern Health is everyoneâ&#x20AC;&#x2122;s responsibility and hand hygiene is a key measure in providing a safer environment for patients and visitors.
Surgery brings with it inherent risk and at Eastern Health we constantly review our surgical practices to be sure that they are as safe as they can be. If a patient dies during surgery, it is imperative that the circumstances are reviewed to identify whether the outcome could be prevented to ensure it is not repeated in the future.
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in the veins of the leg) was identified as an area requiring improvement. In response we implemented processes to ensure earlier diagnosis by involving medical sub-specialities and the use of more focused investigations.
Eastern Health reports adverse surgical outcomes to the Royal College of Surgeons which administers the Victorian Audit of Surgical Mortality Register.
The Victorian Audit of Surgical Mortality Register report received in February 2017 confirms that the management processes implemented over the past 12 months to prevent deep vein thrombosis have been effective, with no case of inappropriate management.
In 2016 a delay in the time to diagnosis to prevent deep vein thrombosis (a clot that forms
The report also confirms a continuing downward trend in the number of post-operative complications.
Hand hygiene is one of the single most important measures that our staff, patients and visitors can undertake to avoid the spread of infection. Visual cues are displayed across our hospitals to remind us all to wash our hands and help prevent infection. Clinical areas regularly measure compliance with hand hygiene, with Eastern Healthâ&#x20AC;&#x2122;s compliance rate greater than 80 per cent for all audit periods. This information is submitted to the Department of Health and Human Services three times a year, with results showing improvement from 85.5 per cent in the first audit period to 88.0 per cent in the third audit period. Compliance above the target of 80 per cent has been achieved as an overall rate and at all sites across Eastern Health.
CATCHING KIDS EARLY I
dentifying young people at risk of developmental delay in their pre-school years is essential as we support children through early childhood development. For the past six years, Yarra Valley Health has facilitated an Early Skills Check program for pre-school aged children. This is a play-based assessment that provides parents with concerns about their child’s development an opportunity to have their children “checked” in a child-friendly group environment.
Specialist allied health professionals, including speech pathologists, dietitians, occupational therapists, physiotherapists and children’s counselling services, co-ordinate the program that is designed to increase access to services for vulnerable families in the Upper Yarra area. The Early Skills Check is a great way of identifying children who may have considerable developmental vulnerability. Following a reduction in referrals to the program in 2016, a redesign project was undertaken to support greater accessibility. Changes included: Increasing the frequency of the group from once a month to fortnightly with dates and times more predictable and memorable for referrers, allowing for “drop ins” where parents who have questions can access health professionals without needing a referral or booking. Developing processes for trans-disciplinary screening by improving the way the different professional groups work together by sharing assessment information.
From January to June 2017 24 children were “checked” through the Early Skills Check program. Three children were considered developmentally vulnerable in two or more areas, and referred to an Early Childhood Intervention Service for specialist treatment. 25 referrals (some children required multiple referrals) were made to clinicians in the Child and Family Team for further assessment and therapy. Those not needing ongoing support had their questions or concerns heard, were reassured that their child was developing normally and provided with some strategies to manage their concerns. This program has the potential to prevent further developmental delay, alleviate concerns for families and support healthy childhood development. It also provides clinicians with a way to screen children for ongoing intervention eligibility before booking in for a full assessment, improving efficiency and reducing wait times. Eastern Health Quality Account 2017
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Hearing our patients’ wishes
E
ngaging with patients through meaningful conversation and fully understanding their wishes in all aspects of healthcare are the cornerstones of patient-centred care.
More and more people want to be involved in decisions about the healthcare provided to them, and Eastern Health is committed to achieving this wherever possible. One way we are approaching this is by educating and providing information to staff, families and carers, and the broader community, about the development of Advance Care
Plans through our specialist team of clinicians. In 2016-17, we started capturing data on the percentage of patients over 75 who had an Advance Care Plan (ACP) or had identified a Substitute Decision Maker (SDM) should they not be capable of making decisions about the care they wanted.
Eastern Health’s non-bed based admissions: Patients 75 years or over with an Advance Care Plan (ACP) or Substitute Decision Maker (SDM) 2016-17 Data source VINAH*
Number with an ACP
Number of admissions
Percentage with an ACP
Quarter 1
645
2749
23%
Quarter 2
723
3082
23%
Quarter 3
576
3334
17%
Quarter 4
568
2754
21%
* VINAH – Victorian Integrated Non-Admitted Health
Eastern Health bed-based admissions: Patients 75 years or over with an Advance Care Plan (ACP) or Substitute Decision Maker (SDM) 2016-17 Data source VAED*
Number with an ACP
Number of admissions
Percentage with an ACP
Quarter 1
129
11,080
1.2%
Quarter 2
91
11,536
0.8%
Quarter 3
240
11,077
2.2%
Quarter 4
194
11,453
1.7%
* Victorian Admitted Episode Dataset ^ An Advance Care Plan details decisions about the care you would want to receive if you become unable to speak for yourself. These are your decisions to make, regardless of what you choose for your care, and the decisions are based on your personal values, preferences, and discussions with your loved ones.
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Working together to make a difference for a loved one Joan (name changed to protect her identity) is a middle-aged woman who was referred to the residential in-reach team at Eastern Health by the residential aged care facility where she lives. While Joan is supported by her family, she has a complex medical history that includes a past history of brain injury, treatment-resistant depression, heart disease and vascular insufficiency. She has a permanent tracheostomy and tube for feeding. Prior to the brain injury, Joan appointed a Medical Power of Attorney. The complexity for those caring for Joan includes:
1 2 3
Does Joan have capacity to make decisions? Is depression or other medical problems impacting on Joan’s decision-making?
How do we as healthcare professionals support Joan, her family and the care facility?
Following a family meeting facilitated by Eastern Health, an Advance Care Plan was developed, focusing on Joan’s quality of life, symptom management and family support.
There has been a significant increase in Advance Care Plans completed for residents, supported through our residential aged care services. This is attributed to an increase in training and support for specific service “champions” who have been trained by the Advance Care Planning team.
Supporting staff to support patients during end of life care
E
astern Health’s End of Life Care Expert Advisory Committee has now finalised and endorsed an organisation-wide standard (policy) that aligns with the guiding principles in high-quality end of life care, as described in the Australian Commission for Quality and Safety in Health Care. This is consistent with the 2015 National Consensus Statement: Essential elements for safe, high-quality end of life care.
A range of policies has been revised and updated in accordance with the consensus statement. Our overarching principle is to ensure the patient remains at the centre of decision-making about end of life care and that patients are empowered to direct their own care, whenever possible.
Furthermore: Eastern Health staff will be aware that patient’s needs, goals and wishes at the end of life may change over time and patients will be supported to review their wishes. Integrated care will be provided in an effective, co-ordinated, timely and culturally-sensitive manner.
Vivian Bullwinkel Chair in Palliative Care Nursing and Clinical Lead for End of Life Care Eastern Health has partnered with Monash University to recruit and appoint Professor Claire Johnson in the role of the Vivian Bullwinkel Chair in Palliative Care Nursing and Clinical Lead for End of Life Care. Prof Johnson will lead the work of the End of Life Care Expert Advisory Committee to ensure the best possible care is provided to our patients at all stages of their life.
The consumer voice in end of life care Supporting development of the End of Life Care Standard: A consumer’s reflection
“
I have been blown away by Eastern Health’s commitment to listening to the views and opinions of people who have stories to share about the service they received at Eastern Health. That shows real courage and a willingness to exceed expectations. And it gives me great comfort to know that the painful experience I encountered with the death of my father at Box Hill Hospital will potentially make a difference to another family in a similar situation. As a result, Eastern Health has converted me from a disgruntled consumer to a passionate advocate. Consumer feedback is knowledge, knowledge is power and that's what you need to improve the quality of the service you provide to the community.
”
Sia Papageorgiou Consumer representative End of Life Care Expert Advisory Committee
Prof Johnson’s appointment was made possible by the generosity of the philanthropic community, which recognised that as our population gets older, demand for palliative and end of life care will increase. More than $180,000 was raised from donors, including Box Hill RSL and the Australia Macau Business Council, and the inaugural Searchlight Dinner in 2016 to support the establishment of this role. Chief Executive Adjunct Professor David Plunkett and Professor Claire Johnson
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HELP AT HAND
Turning Point Counsellor Debbie Taylor
T
urning Point continues to support people from all backgrounds, with a broad range of assessment and treatment services available that are responsive to the needs of consumers and the broader community. From a clinical perspective, clients can have access to counselling which utilises a range of evidencebased approaches. This can be in a traditional one-to-one office setting, in group settings or over the telephone. A residential unit such as Wellington House in Box Hill can provide support to those with alcohol or other drug disorders in a safe, comfortable, home-style environment.
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It is staffed by health professionals who are able to take a family, gender and culturally sensitive approach, with a focus on recovery. Phone and online services such as Ice Advice Line, Counselling Online and DirectLine operate 24-hours a day, seven days a week. They continue to be an accessible treatment option for people concerned about their own substance use, as well as others. They are of particular help to those who are geographically isolated or where support services may be limited. Beyond treatment, our education initiatives are also benefiting the broader community. The MAKINGtheLINK program was recognised at the 2017 National Alcohol and Other Drugs Excellence and Innovation Awards. The program provides students with skills such as knowing how to seek help and also effectively support their peers.
“
I initially thought counselling would be a waste of time. However, as my treatment progressed, I began to look forward to my weekly counselling session. Mick counselling client*
“
”
My experience is that the counsellors are always patient, non-judgmental and well informed. All this support has been paramount in helping me stay clean. Ron Ice Advice Line caller*
”
* full names withheld due to client privacy
At Eastern Health we welcome your feedback There are a number of ways to provide your feedback Speak with a member of our team next time you visit Fill in our online feedback form at www.easternhealth.org.au/contact-us/complaints-compliments-and-comments Contact one of our Patient Relations Advisors on 1800 327 837 Patient Relations Advisors are available Monday to Friday from 9am to 5pm Send an email to feedback@easternhealth.org.au Write to us at: The Centre for Patient Experience Wantirna Health 251 Mountain Highway Wantirna South VIC 3152 Via the Patient Opinion website at www.patientopinion.org.au
es nt’s sho e i t a p e In th Y QUALIT
T ACCOUN
In the Patient’s Shoes
2017
We would like to hear from you Eastern Health’s Quality Account, titled “In the Patient’s Shoes”, is produced for consumers in collaboration with consumers and staff across the organisation and is guided by reporting guidelines provided by Safer Care Victoria.
ing Address ence ol family vi (pg 08)
eals Smart M Everyone e for Mums ic has a vo (pg 32) (pg 22)
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Printed copies of this publication are available throughout our facilities It is online at www.easternhealth.org.au We would welcome your feedback on In the Patient’s Shoes via email to feedback@easternhealth.org.au or post to The Centre for Patient Experience Wantirna Health 251 Mountain Highway Wantirna South VIC 3152
Eastern Health Quality Account 2017
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EASTERN HEALTH Location 5 Arnold Street, Box Hill, Victoria
Postal address PO Box 94, Box Hill, Victoria 3128
General inquiries 1300 342 255 www.easternhealth.org.au
Telephone Interpreter Service
131 450
Eastern Health Foundation 03 9895 4608 fundraising@easternhealth.org.au www.easternhealth.org.au/foundation
Š Eastern Health 2017
For more information about Eastern Health, visit www.easternhealth.org.au or follow us on Twitter and Facebook @easternhealth.au www.facebook.com/easternhealthau