NSLHD’s Safety and Quality Newsletter provides information on new and upcoming activities, programs and initiatives within the district that aim to improve the safety of our patients and the quality of our care.
AUGUST 2 0 2 1
ED I T I ON 8
Useful Information and resources for patients and families to better understand delirium is now available on the NSLHD website.
IN THIS ISSUE :
Cognitive Impairment 'Real-time' patient experience survey Consumer and patient experience resources Quality Improvement Toolkits Project Spotlight - The ARRT of Telehealth Prompt is now operational What did you think of this issue? Give us your feedback.
Comprehensive Care Standard
COGNITIVE IMPAIRMENT
Patients with a cognitive impairment are at increased risk of preventable complications and adverse events, such as falls and pressure injuries, and require precautions to prevent harm. Cognitive impairment is not confined to older people and can result from various causes. People might be cognitively impaired due to younger onset dementia, delirium due to critical illness, an acquired brain injury, a stroke, a medical condition, a psychiatric condition, intellectual disability or substance use disorders. Any form of cognitive impairment needs to be recognised, the causes of it understood, any risks of harm identified, and action is taken to prevent harm from occurring. The emphasis for managing delirium at NSLHD has been placed on early detection and partnering with consumers to help improve health literacy around delirium. There has been a focus on increasing clinical staff knowledge of risk factors and presenting behaviours of delirium with targeted education involving case studies to give clinical relevance.
The following guidelines have been updated to meet the changing needs of the patients of the district. 1.
Delirium in Adults - Clinical Practice Guidelines for the Management of- NSLHD The Cognitive Impairment (Delirium, Mental Disorders, Intellectual Disability, Dementia) – Clinical Practice Guidelines for Care of Adults in NSLHD Hospitals
2.
The main changes include:
Reducing the initial delirium screening window down to eight hours from 24 hours. The six item screener (SIS) has also been replaced with the Abbreviated Mental Test Score (AMTS) as the preferred cognitive screening tool for NSLHD. The AMTS should be attended for all adults aged 65 and above and also attended for all Aboriginal and Torres Strait Islander peoples over the age of 45.
AUGUST 2 0 2 1
ED I T I ON 8
Partnering with Consumers Standard
IMMEDIATE PATIENT FEEDBACK - 'REAL-TIME' PATIENT EXPERIENCE SURVEY
Capturing immediate feedback from patients following discharge in near 'real-time' to drive service improvement, is planned to be trialled in a small number of wards across our hospitals over the coming months. Discharged patients will receive a text message inviting them to rate how likely they are to recommend the health service to friends and family members and the reason for their answer. There is the opportunity for the feedback to be followed up by the nursing unit manager on a timely basis and provides opportunities for improvement. This approach will enable NSLHD to elevate the human experience for our patients and staff. NSLHD has partnered with the Clinical Excellence Commission to develop the survey tool and reporting dashboards housed in the Quality Improvement Data System (QIDS). QIDS is a user-friendly interactive system that provides clinicians and health managers with a single point of access to data, information and tools for the purpose of improving the quality and safety of health service delivery. The data can be reported by ward, service, facility or district level and allows for comparison or benchmarking. The initiative has already received much interest from other NSW local health districts. Contact Daniel.Searle@health.nsw.gov.au for further information.
NEW RESOURCES: CONSUMER AND PATIENT EXPERIENCE New consumer engagement and health literacy resources and learning tools are now available on My Health Learning: 7 Habits of Highly Engaged Committees (Course Code 305574382), learn more about how we can engage effectively with consumers. This is a WSLHD resource that has been shared with NSLHD. Health literacy and Teachback (Course Code: 241744958) - podcast series on health literacy featuring Professor Don Nutbeam. A new QARS audit tool to measure if the Australian Charter of Healthcare Rights (the Charter) has been received and understood by patients and consumers within NSLHD. NSLHD_02_Australian Charter of Healthcare Rights (QARS audit ID: 19850). Developing new consumer resources? The Consumer and Community Partnerships intranet site will guide you through the process of developing health literate consumer resources. The Consumer and Carer Tick will let patients and carers know that the resources have been reviewed and co-designed with consumers who have a lived experience.
CALLING ALL CONSUMER ADVISORS
If you know of a Consumer Advisor who is on your committee (outside of the Consumer Participation/Consumer Advisory Committee/ MHDA Peer Workforce Committee), we want to hear from you. We are strengthening the support we provide to new and existing Consumer Advisors and would like to evaluate Consumer Advisors on their levels of participation and engagement. Please email ThePatientExperience@health.nsw.gov.au for further details.
QUALITY IMPROVEMENT TOOLKITS
The Clinical Excellence Commission has recently launched a series of Quality Improvement Toolkits to support local healthcare teams start and sustain a quality improvement (QI) project focusing on clinical areas where the risk of harm is well recognised. The toolkits, ideal for beginners in improvement science methodology, enable teams to have the capability and confidence to run a quality improvement project. The toolkits include step by step guides to solve small or large problems using the improvement science methodology The first Toolkits available from the Clinical Excellence Commission’s website are:
Amber Care Comprehensive Care - Minimising Harm Last Days of Life Medication Reconciliation Sepsis Venous Thromboembolism (VTE) Prevention
Each toolkit is linked to a Quality Improvement Community of Practice (CoP) that can be accessed through the Quality Improvement Data System (QIDS). Joining a QI CoP allows you to record and track your quality progress and share learning with other teams in NSW.
AUGUST 2 0 2 1
ED I T I ON 8
PROJECT SPOTLIGHT -
Comprehensive Care Standard
THE ARRT OF TELEHEALTH
ARRT has since initiated a collaborative project with NSW Ambulance to enable all general paramedics to videoconference with ARRT, further preventing avoidable hospitalisations. The success of the project has seen an expansion to two other geriatric outreach teams in NSLHD. The project was selected as an exemplar for 'Telehealth models of care' by the Agency for Clinical Innovation, allowing other teams to replicate improvements elsewhere using existing NSW Health technology. Complimentary to this initiative is the development of an innovative clinical decision tool website: www.detect.snhn.net, by ARRT in partnership with the Primary Health Network, and the NSLHD aged care outreach teams: Beaches Rapid Access Care of the Elderly (BRACE) and Geriatric Rapid Acute Care Evaluation (GRACE). The DETECT website provides advice on how to detect, manage and seek help for an unwell resident at risk of hospitalisation. The ARRT of Telehealth project won the Local Solutions Award in this year’s NSLHD Quality and Improvement Awards and is nominated for the 2021 Premier's Awards.
Rapid specialist geriatric multidisciplinary videoconferencing for unwell residents of residential aged care facilities has led to improved efficiency by enhancing triage and capacity to assess more patients. Initially starting as a six-month videoconferencing pilot in 2019 to six residential aged care facilities, expedited by the COVID-19 outbreak, the service has expanded to all residential aged care facilities in the Lower North Shore and Ryde / Hunters Hill regions. Due to the overwhelming success of the project, videoconference consultation is now core business for the Aged Care Rapid Response Team (ARRT). The project led by Dr James Hardy and Clinical Nurse Consultant Therese Jepson has resulted in a statistically significant reduction in avoidable hospital presentations despite a reduction in home visits, indicating more people were treated safely in their usual environment and not transferred to hospital. The number of ARRT interventions resulting in hospital avoidance has increased by ~17% from 32.8 per cent in 2018 to 49.6 per cent in 2020-2021. Avoidable ED presentations from residential aged care facilities declined from an average of 28 presentations per month to 17.65, a 37% reduction. This has led to an estimated annual cost savings of $669,190.
How do I start an improvement project? Find out more on the Clinical Governance Quality Improvement Intranet site, Innovation Hub or contact your local facility or service Quality Advisor Check out the video showcasing the ARRT of Telehealth project and all the finalist projects on the 2021 NSLHD Quality and Improvement webpage
Aged Care Rapid Response team, North Shore Ryde Service
TRIAL ACCREDITATION ASSESSMENTS (UPDATE)
NSLHD has engaged independent, experienced Assessors to conduct Trial Accreditation Assessments against the National Safety and Quality Health Service (NSQHS) Standards, at Ryde (3 - 4 August) and Hornsby (31 Aug – 2 Sept 2021) hospitals. Within a virtual environment, the Assessors will assist our accreditation preparations by; observing practice, talking to staff and patients, reviewing evidence and identifying and reporting any areas for improvement, to ensure our patients receive the standard of care as defined by the National Standards.
For further information contact your local Quality and Safety or Clinical Governance Unit, or Annette.Penney@health.nsw.gov.au (National Safety & Quality Health Service Accreditation Manager)
AUGUST 2 0 2 1
ED I T I ON 8
Clinical Governance Standard
IS OPERATIONAL
NSLHD policies, procedures, guidelines, standing orders and NSW Health policy directives are now accessible via the Prompt documents system and to date, the staff feedback has been positive. Please continue to tell us what you think of Prompt.
In addition to the Prompt FAQs , there are a number of staff training resources available on the Policies & Procedures Intranet page and the message board on Prompt documents. These include the following:
A six minute Staff Training Video How to access and search for documents - Quick Reference Guide (QRG)
Prompt – Search Tips and Tricks Prompt – Phone or Tablet Access How to create hyperlinks to Prompt - QRG PPG Communique
Planned ongoing enhancements include creating a link from eMR to Prompt. Please contact email Nitisha.Bangera@health.nsw.gov.au for more information and to tell us what you think of Prompt documents.
POLICIES, PROCEDURES AND GUIDELINES New, updated and recent ly publ ished distr ict wide PPGs The fol lowing l inks to documents from the PROMPT document system.
Clinical Governance Standard
Clinical Governance Standard SAFETY ALERTS New , u p d a t e d a n d r e c e n t l y p u b l i s h e d SI:007/21 - Safe use of medications with multiple concentrations in Electronic Medication Management (EMM) systems- Issued 9 July SN:015/21 - Philips Sound Abatement Foam on selected sleep and respiratory devices – Product Defect Correction - Issued 5 July Admission and Discharge Criteria For NSLHD Subacute Inpatient Rehabilitation Units - NSLHD Bedrails Use of for Adult Inpatients NSLHD Methadone and Buprenorphine/Buprenorphine-Naloxone Prescribing and Dispensing for Opioid Dependent Inpatients of NSLHD Vitamin K (phytomenadione) administration in newborn infants - NSLHD Single Use of elastomeric infusion devices for the subcutaneous management of symptoms at end of life Treatment of hyperkalaemia in adult patients - NSLHD
SN:014/21 - 25C-NBOMe toxicity in patients who used powder thought to be MDMA - Issued 2 July SN:013/21 - Changes to COVID-19 vaccine access and indications (updated) - Issued 1 July SI:06/21 - Patient identity checks before administration of blood products - Issued 21 June SN:012/21 - Enoxaparin 20 mg and 40 mg syringes: Disruption to supply - Issued 1 June
Safety Alert (SA) - Requires immediate attention and action Safety Notice (SN) - Requires risk assessment at the district level Safety Information (SI) - Ensuring that lessons learned from state-wide, national or international sources are shared actively across NSW health system Medication Safety Updates Medication Safety Updates including medication shortages are available on the CEC website. Most recent medicines affected include Tocilizumab, Azathioprine injection (50mg), Nitrofurantoin, Etacrynic acid, Flucytosine and Promethazine
For more information, contact: NSLHD-SafetyAlert@health.nsw.gov.au
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