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 2022
EDITION 17
NSLHD CONSUMER FORUM 2022 Our Consumers Advisors are highly valued, and the role they play within our NSLHD is respected at the highest level. The inaugural NSLHD Consumer Forum on 21 September provides an opportunity for our consumers to reconnect and network whilst providing an opportunity to contribute strategies and generate ideas that will underpin innovation and solutions in our health service. Key initiatives will be presented from a state and local level, including virtual health and health literacy, Elevating the Human Experience, NSLHD Standard 2 accreditation feedback and engaging consumers in research. The Forum will be interactive, and workshops will be facilitated after the presentations with our consumer advisors to assist with the identification of themes and development of actions for NSLHD. The actions will provide a focus for continued collaborations with consumers over the next twelve months and beyond. “I started as a Consumer Advisor for the Research Committee at NSLHD in early 2021. Like many during Covid-19, I have felt the isolation of working remotely and relish the idea of getting up to speed with the latest developments affecting consumers in the district. The Consumer Forum will give me insight into work at NSLHD that impacts consumers, and I can work out how I can best contribute and provide value. I’m also excited to finally meet people with my same passion, network and collaborate face to face. Bring it on!” - Sonia (NSLHD Consumer Advisor)
IN THIS EDITION:
NSLHD Consumer Forum 2022 Comprehensive Care Pilot Project: Post-Implementation Launch of the Low Back Pain Clinical Care Standard Where to find the latest PPG Communique Wound Awareness Week Project Spotlight: Developing a novel ICU follow-up service for our sickest patients Improvement Science Workshop
What did you think of this issue? Give us your feedback.
Partnering with Consumers Standard
AUGUST 2022
EDITION 17
COMPREHENSIVE CARE PILOT PROJECT: POST-IMPLEMENTATION The eMR Comprehensive Care Pilot Project rolled out on 7 June 2022 across Northern Sydney and Central Coast Local Health Districts. This pilot project is in collaboration with the Australian Commission for Safety and Quality in Healthcare, Clinical Excellence Commission, Agency for Clinical Innovation and eHealth NSW’s eMR Connect Program. Two pilot solutions have been implemented as part of the Project.
Part 2 - Documentation Workflow for Medical Officers/Nurse Practitioners and Allied Health Clinicians The Documentation Workflow is the second solution rolled out as part of the Comprehensive Care Pilot Project. It is a new workflow page in which clinicians can review medical records and create a draft progress note on one page. Clinicians are also able to order treatments and consults as well as check pathology and medical imaging results. This enhancement can capture the current diagnosis and chronic problems accurately and more timely.. SMOKING CESSATION PILOT PROJECT: POST IMPLEMENTATION In parallel to the Comprehensive Care Pilot Project, the Smoking Cessation Pilot Project also rolled out in eMR on 7 June 2022. This project is in collaboration with the Cancer Institute NSW and eHealth NSW. Smoking Management Pathway is available for patients and consumers in the Emergency Department, inpatients settings and select community services. It allows clinicians to capture information on smoking, e-cigarette and vape use. The pathway provides rapid access to nicotine-replacement therapy for the ED and inpatients to prevent nicotine withdrawal- associated discomfort and behaviour whilst smoking is banned in the health facilities as per NSW Health policy. The clinicians can also refer patients and consumers to Quitline NSW through the pathway for follow up.
This solution aims to combine the traditionally used risk screening tools into one for clinicians to holistically assess and identify any clinical risks, such as falls, pressure injuries, malnutrition and delirium. It allows clinicians to implement clinically appropriate, individualised care for all patients in the inpatient and Emergency Department settings. Clinicians can reassess the patient’s risks and adjust care appropriately using the same RSA throughout the patient’s journey. The solution provides continuity and visibility of clinical changes and care adaptions to meet patients' individual needs. Part 1 - Risk Screen and Assessment (RSA) solution
The four steps involved:
Save
Assess (using the same RSA)
Save the RSA. Compare with the previously saved RSA.
Commence RSA at pre-admission and within 8 hours of admission
Re-assess at transfer, discharge or change in clinical condition. Review at every change of shift. Document Create a documentation based on the RSA. Mobility and Self-care are documented in iView.
Order Order nursing care tasks, clinical review, alerts and order Allied Health consults.
Refer: Risk Screening and Assessment Comprehensive Care Pathway Adult /Paediatric - NSLHD Guideline
Comprehensive Care Standard
AUGUST 2022
EDITION 17
The Australian Commission on Safety and Quality in Health Care (ACSQHC) will soon release the first national Low Back Pain Clinical Care Standard Low back pain is a leading cause of disability worldwide. This burden is increasing despite a burgeoning number of treatment options. Back problems and back pain are the second most common reason Australians seek care from their general practitioner and one of the top five presentations to emergency departments. Early appropriate management of people experiencing an acute episode is important to reduce the chance of developing chronic low back pain. ACSQHC will be hosting a webcast to launch the new clinical care standard. A panel of experts will discuss the challenges presented by this common condition and how the standard will improve patient-centred care while reducing investigations and treatments that may be ineffective or unnecessary. This event is relevant to all healthcare professionals involved in the early management of people with low back pain, especially general practitioners, physiotherapists and other allied health professionals, emergency physicians, nurses and nurse practitioners. LOW BACK PAIN CLINICAL CARE STANDARD LAUNCH
The National Clinical Care Standards (ACSQHC) Describe the care patients should be offered by health professionals and health services for specific clinical conditions or defined clinical pathways in line with current best evidence. Play a vital role in reducing unwarranted variation. Are developed in collaboration with a topic working group of clinicians, researchers and consumers. Public consultation is also conducted before finalisation. Describe high-priority areas for quality improvement. They are based on areas of current variation, information about what we know works in terms of treatments, procedures and processes, and what care should be offered to a patient. Visit the Commission's website for a full list of National Clinical Care Standards in use and in development (ACSQHC)
Thursday 1 September 2022
12:00pm – 12:45pm AEST
Register to join this event
the extent of this hidden affliction vulnerable cohorts most at risk warning signs (pain, fluid, smell, over 30 days to heal) treatment options where to go for education and resources the economic and social cost of chronic wounds. Wound Awareness Week is a national campaign held annually to target awareness of chronic wounds among health care professionals and the general public, highlighting: Visit the Skin Integrity intranet site for helpful information and resources to prevent pressure injury, maintain patient's skin integrity, manage wounds and ostomies and more.
The NSLHD Weekly Bulletin dropped into your email inbox is where you will find the latest policies, procedures and guidelines (PPG) Communique. WHERE DID THE PPG COMMUNIQUE GO? Released weekly, the Communique provides information on; Recently published NSLHD PPG, Recently rescinded NSLHD PPG, Most recently published MoH Directives, Guidelines and Information Bulletins, NSLHD PPG Drafts for comment, NSLHD PPGs approved to start development.
Contact: NSLHD-Policies@health.nsw.gov.au
Comprehensive Care Standard
Clinical Governance Standard
AUGUST 2022
EDITION 17
Partnering with Consumers Standard
Project Spotlight
NSLHD is committed to learning from adverse events and serious clinical incidents to improve patient safety and care outcomes. All staff involved in any serious clinical incident and or adverse event should understand what 'privilege' is and the process of a privileged investigation. What is privilege? When a reportable incident [1] occurs, it is important that staff feel safe to speak frankly about what happened and what they observed. Health Services can then learn from such incidents. Privilege supports people who feel concern for their confidentiality when asked for their recollections of an incident. DEVELOPING A NOVEL ICU FOLLOW-UP SERVICE FOR OUR SICKEST PATIENTS Patients discharged from the intensive care unit and their families are at risk of experiencing physical, cognitive and psychological health problems collectively termed Post Intensive Care Syndrome (PICS). Staff at Royal North Shore Hospital’s Intensive Care Unit developed a patient-centred multidisciplinary follow-up service to support patients and their primary caregivers by better understanding their experience in the ICU and early recognition and management of their PICS. Statutory privilege protects Preliminary Risk Assessment (PRA) and Serious Adverse Event Review (SAER) team members and documents they produce during a review from use as admissible evidence in any legal proceedings. PRA and SAER team members are bound by strict confidentiality requirements, making it an offence for them to disclose information obtained during the PRA or SAER, unless it is for the purpose of the PRA or SAER or in other limited defined circumstances. The service was developed in response to an identified need. The team hosted a series of community engagement forums where surviving patients described ongoing physical and psychological problems. Patients fed back that their GPs were unaware of PICS and ill- equipped to manage their ongoing needs without support. The ICU follow-up service is comprised of a multidisciplinary team of intensivists, nurses, pharmacists and social workers. Patients and their carers meet with the entire team. This collaboration allows partnered decision-making with patients, their GPs and the multidisciplinary team.
Intensive Care Unit, RNSH Transforming the Patient Experience Award Winner
Watch video showcasing this project and all the award-winning projects: 2022 NSLHD Quality and Improvement Awards How do I start an improvement project? Find out more from the Clinical Governance Quality Improvement Intranet site, NSLHD Innovation Hub or contact your local facility or service Quality Advisor
Enrol in one of the Improvement science training offerings - see below.
IMPROVEMENT SCIENCE TRAINING OFFERINGS
DROP-IN CLINICS
Monthly "drop-in" clinics are open to anyone undertaking an improvement project or have an interest in resources and tools to run a successful improvement project. Staff can join in virtually via the MS teams meeting (see the link to the flyer below). The first 30-40 minutes will be dedicated to a specific topic and the following 20-30 minutes will be open to staff who have any questions or concerns about their projects, the direction the project is heading, or barriers they have come across and how to overcome them. Refer to the Drop-in clinics 2022 flyer to access links to join online MS teams meetings on upcoming sessions addressing various topics. The next session is on 9 September 14.00hrs – 15.00hrs and will focus on " Creative thinking for change and innovation " Watch previously recorded drop-in clinic
Ever wanted to improve an area of your work but didn’t know where to start? Join virtually in the next one-day facilitated Improvement Science workshop on 6 September Spaces are limited. Enrol via My Health Learning (MHL) course code 42956746. Alternatively, the Introduction to Improvement Science learning pathway online modules is available on MHL for completion at your own pace. Completion of either of the Improvement Science training offerings in combination with the Readiness to Lead for Safety and Quality learning pathway in MHL makes up the intermediate level capability of the Safety and Quality Essentials pathway
sessions focusing on topics such as " How do I know if my changes are an improvement? " or "Understanding Project Success" Contact: Cathy.Vinters@health.nsw.gov.au or Catherine.Rosario@health.nsw.gov.au (Clinical Reliability Improvement Facilitators)
AUGUST 2022
EDITION 17
NSLHD CLINICAL AUDIT SCHEDULE
The NSLHD Clinical Audit Schedule has been developed for all sites and services within NSLHD to support the monitoring and evaluation of clinical care processes and to provide support for clinical quality improvement activities across NSLHD. Download the complete 2022-23 NSLHD Clinical Audit Schedule. Note: The Schedule is divided into three categories (NSLHD acute, sub-acute, MHDA and PACH). Visit the clinical audit intranet page for more information.
Clinical audits required to be completed this month and next month are listed below.
August 2022 QARS Audits (entry links)
September 2022 QARS Audits (entry links)
NSLHD_03_Peripheral Intravenous Cannula (PIVC) Insertion & Management - NEW VERSION NSLHD_4_Monthly Accountable Drug (S4D_S8) Register Audit (RNSH | HKH | Ryde | MV | MHDA)
St 3
NSLHD_03_Aseptic Technique
St 3
NSLHD_4_Monthly Accountable Drug (S4D_S8) Register Audit (RNSH | HKH | Ryde | MV | MHDA)
St 4
St 4
NSLHD_06_Clinical Handover - all Clinical Disciplines NSLHD_06_Handover; Nursing Shift to Shift 2021 MHDA_Clinical Handover PACH Communicating for Safety Audit Tool NSLHD_06_Consent Audit (RNSH | HKH | Ryde | MV) (RNSH | HKH | Ryde | MV) NLSHD_08_Monthly inspection for resuscitation trolley/ Resuscitaire equipment checklists NSLHD_8_Resuscitaire Checklist NSLHD_8_MHDA_Engagement and Observation Audit_2022 (RNSH | HKH | Ryde | MV | MHDA | PACH)
NSLHD_07_Patient Blood Management - MEDICAL 2022
St 7
St 6
NLSHD_08_Monthly inspection for resuscitation trolley/ Resuscitaire equipment checklists (RNSH | HKH | Ryde | MV | MHDA | PACH)
St 8
St 8
POLICIES, PROCEDURES AND GUIDELINES New, updated and recently published district-wide PPGs.
Clinical Governance Standard
Click on the links below to download documents from the Prompt document system. Refer to the NSLHD weekly bulletin in your inbox to access the most up-to-date list of PPGs
Risk Screening and Assessment Comprehensive Care Pathway Adult /Paediatric - NSLHD Guideline Early Diagnosis and Management of Children with Possible Surgical Abdomen Children with Acute Scrotal Pain - Early Diagnosis and Management - NSLHD
LESSONS LEARNED FROM SERIOUS ADVERSE EVENT REVIEWS
Clinical Governance Standard
Did you know that the Clinical Excellence Commission shares findings from serious incidents that have occurred across NSW to aid in reducing preventable risk of a similar event occurring to another patient? Recent publications include:
Unrecognised oesophageal intubation - Paediatric Watch 2/2022 Human factors and health workers - Lessons for learning More publications are available from the lessons learned intranet page.
The scenarios depicted in the publications have been drawn from a variety of cases across NSW in order to maintain the confidentiality of consumers and staff. It is acknowledged that the issues identified in these cases represents a small portion of care.
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