Government of Western AustraliaDepartment of HealthNursing and Midwifery Office

CONFERENCE HANDBOOK

SPONSORS & EXHIBITORS

Government of Western AustraliaDepartment of HealthNursing and Midwifery Office

Conference Host

Host of Conference Dinner

Delegate Satchel Sponsor

Conference Sundowner Sponsor

Tea Break Sponsors

Exhibitor Listing

GESB Booth 2HESTA Superfund Booth 4St John of God Health Care Booth 1WA Nursing and Midwifery Office Booth 3

1

PRESENTING AUTHOR INDEX

2

Alexander, Annemarie........... Barratt, Catherine..................Bayes, Sara...........................Burns, Jille............................. Cameron, Carol.....................Charlwood, Gillian.................Clark-Burg, Karen..................Clarke, Anita..........................Clarke, Karen......................... Cooper, Kristy........................ Cutler, Glenda.......................Dillon, Michelle......................Eaves, Jodee.........................Faranda, Connie....................Fereday, Elizabeth.................Ferri, Lisa..............................Finlay, Susan.........................Fletcher, Caroline..................Geraghty, Sadie.....................

HW131041 Ramsay WA A5 Ad RFP.indd 1 29/10/13 1:27 PM

Giles, Murray.........................Gillen, Gerry...........................Goodrum, Belinda.................Gough, Peta..........................Hanna, James.......................Hansen, Leah........................Harvey, Abigail.......................Hauck, Yvonne......................Herbert, Pia...........................Horsham, Alana..................... Kendrick, Helen.....................King, Anne............................. Kitchen, Su............................ Lambert, Sarah......................Leece, Tracey........................ Lison-Pick, Mandy.................MacDonald, Fiona.................Mackell, Jodie........................ Matthews, Anne.....................

May, Nick............................... McDowall, Judith...................Monisse-Redman, Michael.... Morey, Pam...........................Morgan, Patricia....................O’Connor, Angela..................O’Nions, Pam........................Parkins, Naomi......................Pickles, Sharon.....................Piercey, Carol........................Reynolds, Kate...................... Reid, Gill...............................Siffleet, Joanne..................... Slater, Marie...........................Stokes, Scott.........................Walker, Sarah.......................Watts, Janine........................ Zanik, Kimberley....................Zappia, Tessie.......................

7231491930145102022117172426262530

631316132713 3271131185, 19241821121619

21181320412248482829221517962915

Surname, First Name # Surname, First Name # Surname, First Name #

Session 1 - Organisation & Systems

Growing the Blue

James Miller, Organisational, Development Manager Joondalup Health Campus, Ramsay Health Care, Perth Western Australia. millerjames@ramsayhealth.com.au

Belinda Goodrum, Clinical Nurse Manager Public Surgical Joondalup Health Campus, Ramsay Health Care, Perth Western Australia goodrumb@ramsayhealth.com.au

Statement of Aims: Delegates will learn about the organisational need for engaging with frontline staff on culture, leadership and team work to positively impact patient care through staff practices. Delegates will hear about JHC’s need, solution development and implementation of this initiative.

Developing a constructive culture and workplace at Joondalup Health Campus (JHC)Endorsed by the Executive and developed by JHC’s Grow Team, workshops were designed and implemented to help staff understand the connection between our vision, values, hospital goals and priorities, developing a constructive culture, their personal and professional leadership, teamwork for improvement in patient care.

What are the qualities that were designed into these experiential workshops?The experience must be seen to be and experienced as being;• Facilitative and not instructional• Interactive and contain group discussion and activities• Cross functional • Important • Realistic• Valuable at a personal level• Authentic and not “preachy”• Clinical staff receive certificates noting the Royal College of Nursing Australia logo and contains 3 CNE points towards ongoing professional development and portfolios.

Facilitated: fortnightly since July 2012 Attendance: 440 to dateAttendance as at November 2013: 650.

96% of participants state the workshop will positively

impact their practice, 3% saying unsure1% saying it would not

Delegates will leave recognising the importance of culture as an underpinning organisational system that will support or work against improvement in patient care and what can be done to positively improve it at a frontline level.

Promoting Future Leaders in Midwifery Research: Sharing the Experience of King Edward Memorial Hospital’s Graduate Midwifery Research Intern Program

Professor Yvonne HauckKing Edward Memorial Hospital & Curtin UniversityEmail: yvonne.hauck@health.wa.gov.au

Dr Lucy LewisMidwifery Research FellowKing Edward Memorial Hospital & Curtin UniversityEmail: lucy.lewis@health.wa.gov.au

Dr Sara BayesSchool of Nursing and MidwiferyEdith Cowan Universitys.bayes@ecu.edu.au

LouiseKeyesClinical Midwifery ManagerKing Edward Memorial HospitalEmail: louise.keyes@health.wa.gov.au

ABSTRACTNationally and internationally, there is a recognised need to increase the research capacity of midwives who can subsequently actively contribute to our expanding professional body of knowledge. The purpose of this presentation is to share the experience of one Western Australian research capacity building initiative: the King Edward Memorial Hospital midwifery graduate research Intern Program. The program aim is to provide graduate midwives with an opportunity to engage in activities/projects to develop research skills. Program expectations include developing midwives with appropriate research skills who will return to clinical practice with a clearer understanding of the research process; confirm their intent to conduct further quality and safety improvement initiatives and stimulate an interest in pursuing a higher

3

degree by research in the future. A final expectation is that midwives completing the program will have a heightened sense of ‘research-mindedness’ or a midwifery practice ‘lens’ through which clinical practice would be critiqued for further investigative opportunities. Ideally, the program will produce future midwifery leaders with the knowledge, skills and positive attitudes towards research will be role models for their colleagues thereby building research capacity by increasing the numbers of Western Australian midwives engaged in research.

The Department of Nursing and Midwifery Edu-cation and Research (DNAMER) at King Edward Memorial Hospital (KEMH) has been offering the Intern Program since 2009. The intern who must be enrolled in the KEMH graduate program and working a minimum of 0.6 FTE is employed one day a week for a 6 or 12 month period to work with the midwifery research team. To date, 11 interns have completed or are currently involved in the program. An overview of their research activities and skill development will be presented as well as their outcomes.

Learning Leadership Skills in the Real World: A Student Project on Quality Improvement

Dr Carol PierceySenior LecturerUniversity of Notre Dame Australia

All nurses need to be leaders especially in today’s complex health care environment in which they practice. To move forward nurses need to embrace the culture of continuous innovation and quality improvement. Learning the skills of leadership begins in the preparation time before entering the clinical arena. Nurse education is obligated to provide the knowledge and facilitate a sound understanding of concepts related to leadership. Often these concepts are gained from a theoretical background, but to apply them in the real world relies on good role models and expert mentors. Recently, third year students at the Broome campus of University of Notre Dame Australia were given the unique opportunity to undertake a quality improvement (QI) project in the community. Since QI is embedded in all aspects of a health care organisation’s activities, nurses need to know how to collect and analyse data to compare to the ANMC standards of practice. This paper will describe this project and discuss the outcomes in terms of the leadership skills the students learnt.

Session 2 - Patients

Meet and Greet: An Opportunity to Improve Patient and Family Satisfaction

Patricia Morgan, Clinical Nurse Manager, Ward 5, Osborne Park Hospital, Osborne Place, Stirling, WA. Email address Patricia.Morgan@health.wa.gov.au

BackgroundOsborne Park Hospital is a secondary public hospital that provides comprehensive specialist health care services to the northern metropolitan suburbs.

Patient satisfaction surveys have historically revealed areas for improvement and it was felt that some complaints were generated from unmet or unrealistic expectations.

AimI was inspired by NSQHS standards and Strategic objectives for OPH to increase patient satisfaction to above the 80 percentile using the DoH Survey to trial a Meet and Greet Program. The aim was to welcome patients and their relatives to Ward 5 creating a positive impression; explain the purpose of rehabilitation and addressing immediate concerns. This provided the opportunity to provide my contact details and a means to receive feedback. MethodA quality improvement project was registered for Ward 5; previous numbers of positive and negative commentsobtained as a baseline; letter of welcome to Ward 5 created incorporating a feedback slip; comments box and further feedback slips placed on ward; spreadsheet tracks feedback. The QI was discussed at various stakeholder meetings from which changes and suggestions were incorporated. The program was well received by the Community Advisory Council representative.

Results and DiscussionPreliminary results captured through patient and carer feedback were highly positive; reduction in anxiety; number of minor complaints increased but thus far no serious issues have arisen. It is anticipat-ed that the number of formal complaints will reduce as data analysis continue. It allows a visible presence of the CNM on the ward who role models expected behaviours.

4

ConclusionThe program has been well received by patients and relatives and the majority of issues are dealt with quickly and informally.

Patient Resources; Supporting the Patient’s Access to Information

Clarke, A.MWA Cancer and Palliative Care Network, Department of Health, Western Australia.Anita.Clarke@health.wa.gov.au

IntroductionIn Western Australia in 2010 the overall incidence of Urological Cancers was 2464 urological malignancy cases. This number reflects 22.5% of all cancers (Male & Female) diagnosed in Western Australia1. Treatments for urological cancers include Surgery, Chemotherapy and Radiotherapy including Brachytherapy and Hormone Treatment. The anxiety a patient feels following their initial diagnosis of cancer can inhibit understanding and retention of information2 which is a real and significant obstacle in care coordination.3Therefore a patient held written information tool was developed and piloted across two metropolitan hospital sites over a twelve month period An audit was then completed to identify the percentage of patients who retained and referred to the guide.

Aims• To determine whether the guide to appoint ments was retained and referred to by patients.• To identify if patients felt any changes to the guide would improve its level of use.

MethodologyQualitative data was collected from fifty patients over a period of twelve months. They were given the guide prior to commencing treatments. A questionnaire was sent out to each patient 12 months later to survey the use of the guide. The results were collated and evaluated with regards to retention of and referral to the guide for scheduling of appointments.

FindingsTwenty-five completed forms were returned and these surveys were audited. Overall the results showed that the guide had a positive impact on patients with 24 (96%) patients still retaining the guide and 18 (72%) patients attending all the appointments written on the guide.

ConclusionThe audit clearly showed that the guide was positively received, retained and referred back to. The audit although small provides positive evidence to support the continued production of this resource thus supporting the patient’s access to information and also has the potential to be adapted for other tumour groups.

References:1. Threlfall , T.J., Thompson J.R. (2010) WA Cancer Registry. DOH, WA.2. Mann , K,S. (2011) CJON, Vol.15, p55-613. NBCNCC (2003) Camperdown, NSW.

Reducing the Risk of Falling While in Hospital – Patient Education Available on Hospital Televisions

Su Kitchen, SirCharlesGairdnerHospital, Nedlands, Western Australia, Su.Kitchen@health.wa.gov.au

Thuy Le, Sir Charles Gairdner Hospital, Nedlands, Western Australia

ABSTRACTThe aim of this project has been to develop and refine falls prevention education for patients. Our team first developed the education in slide format and presented it on the hospital’s television network in 2009. Four hundred and forty patients and visiting family members wereasked about the innovation in face-to-face interviews and 268 (61%) were aware of the slides, with 255 (58%) having watched them at least once. From this group, 212 (83%) found the information useful and/or relevant and 71 (28%) suggested changes. One suggestion was for language translation. Captions in additional languages were added to the slides in 2011. Later that year, 399 patients and visiting family members were interviewed, 215 (54%) of whom had watched the slides. One hundred and eighty five interviewees (86%) found them useful and/or relevant and more changes were suggested by 28 (13%). Suggestions included adding sound, reformatting the design, and simplifying the wording. Revisions based upon this feedback are planned for later in the year. This project has addressed the needs of hospital patients for greater awareness of falls prevention using the existing hospital television network. Patients’ and families’ input has underpinned subsequent revisions to help ensure the accessibility and impact of the education.

5

Session 3 - Staff

Recruiting with Games: Activities for Finding a Good Fit

Presenting Author: Murray Giles, Staff Development Educator, Fremantle Hospital and Health Service

Abstract

Traditionally we recruit our nursing staff using the sit down panel interview method. Faced with a high volume of candidates to interview and a short list of available trained panel members; the costs in time and resources increases drastically. Are we really getting the best results for our investment?

In Western Australia’s public health system, as reported by the WA State Government Performance, Activity & Quality division, over the 2012 period there were over 3,000 new starting nurses. It is difficult to determine exactly how many interviews went into appointing these new starters, however this figure points to a significant recruitment resource demand for our clinical leaders.

The opportunity arose for Fremantle Hospital and Health Service to investigate and implement alternative methods for short listing candidates for the Assistants in Nursing (AIN) 2013 traineeship. This group historically has attracted many applicants from varied and diverse backgrounds, so the opportunity to delve into behavioural and situational interview techniques was too good to pass up.A Group Assessment Activity (GAA) was developed which enabled the AIN candidates to be assessed using ice breaker techniques, group team build-ing games and guided discussions. The process still leant heavily on tried and tested situational and behavioural interview techniques, but in the format of group activities and guided discussion. The initial and most evident positive aspect of the new process was that it required less time and fewer panel members.

When designing the GAA we had to ensure that the:• applicant was engaged and able to demonstrate their skills.• interviewing panel could get an insight into the candidates motivation, teamwork ability and emotional intelligence (selection criteria requirements).• process was more time and resource efficient than the traditional method.

Preliminary audits have been undertaken to assess if the process is preferred by both applicants and interviewers. Outcomes of the review can be used to develop alternate recruitment methods that can be applied to a range of employee groups in a resource and cost effective manner.

Staff Engagement X Factor–Ideas to Intrigue Staff in a Safety and Quality Agenda

Janine Watts, Albany Health Campus, WACHS Great Southern, WA. Janine.Watts@health.wa.gov.au

ABSTRACTHigh impact, visually stimulating short term projects, have had sustained benefits on the busy general surgical ward at Albany Health Campus. A wide range of quality projects, and learning and development activities, have been promoted over the past twelve months utilising artistic skills and presentation skills, honed over a number years in the safety and quality workforce, elsewhere in Western Australia. Projects have utilised media that is specifically appealing across the range of workforce age groups currently employed in the ward, ranging from baby boomers to X/Y and next generation. This presentation showcases a range of these projects and presents DIY ideas suitable to take back to other work sites, based on the successes and lessons learned in Albany. The range of quirky safety and quality projects devised by the CNM to engage and involve staff, also captured the imagination of other members of the multi-disciplinary team and even engagedpassing patients and families. The effects of demonstrable compliance to staff education initiatives and trainings, enhanced knowledge and ability to acess information, and improvement in auditable safety and quality improvement projects, are discussed during this presentation. Utilisation of elements of peer pressure to ensure less compliant staff engage in ward activities has been one effect of this management strategy, as well as an increasing sense of belongingness trust and teamwork are also presented using direct staff comment and feedback. Staff have begun to look forward to the “fun” activities and have begun to develop their own visual displays in order to grab the attention of their colleagues. Some of the ideas generated by staff are also showcased in this presentation: including Hand Hygiene and Management of Patient Controlled Analgesia.

6

Professional Development Framework- “If you don’t know ASK”

Jodee Eaves, Child and Adolescent Health Service (CAHS), Subiaco, WA, jodee.eaves@health.wa.gov.au

Anne Bourke, CAHS, Subiaco, WA, anne.bourke@health.wa.gov.au

Annette O’Mahoney, CAHS, Subiaco, WA, annette.o’mahoney@health.wa.gov.au

Joanne Siffleet, CAHS, Subiaco, WA, joanne.siffleet@health.wa.gov.au

Gillian Charlwood, CAHS, Subiaco, WA, gillian.charlwood@health.wa.gov.au

In the context of the global nursing shortage, skill mix issues, increasing patient acuity and complexity and the move to a new children’s hospital in 2015 there is an imperative to develop and implement clinical reform and a contemporary model of care within Princess Margaret Hospital for Children (PMH).

The Professional Development Framework (PDF) is a component of that larger concept of clinical reform for the nursing service. This clinical reform incorporates the Nursing Models of Care project, Practice Development and cultural change.The purpose of the PDF is to define the essential attitudes, skills and knowledge (ASK) required by a competent nursing workforce thereby guiding safe and high quality nursing care. The PDF will provide the necessary tools to support nurses to attain these essential competencies and will clearly outline the expected standard of nursing care at PMH.

The PDF will incorporate:• Generic nursing competencies for nurses caring for patients at PMH• Specialised nursing competencies – ward/ unit specific• Standardised orientation at unit level which enhances Generic and Nursing Induction• Mandatory annual competencies

The essential attitudes, skills and knowledge (ASK) required for the generic nursing competencies for PMH nurses were identified by the nursing workforce at PMH, during focus groups. The results from the focus groups were grouped into major

themes, inclusive of positive attitudes, profession-alism, change, communication, assessment, team work, specialised clinical care, child development, paediatric differences and policies and procedures.

The above themes have been incorporated into competency statements with clearly defined elements. These will build on the National Competency Standards and the minimum standard for nurses caring for children and young people (ACCYPN 2009). The competency statements will be presented in a format to allow each nurse to assess themselves against the individual elements. The nurse will then be able to identify the gaps in their ASK and, with support of their CNM and Paediatric Nursing Education, will provide the basis of their performance contract for the next appraisal period. Implementation for the Framework is planned for late 2013 and will be trialled with the new Graduate Nurses commencing in August.

Session 4 - Organisation & Systems

Using Lean Thinking to Develop and Retain Staff, to Meet the Growing Demand, though Transition and Decommission

Alexander A1, O’Nions P1,2, Halliday J1, Julifff D11 Swan Kalamunda Health Service2 Lean Healthcare Consultants

The Swan Kalamunda Health Service has under-gone many changes and challenges over the last decade, transitioning from district to general health service status with future transition to the St John of God Midland Public & Private Hospital in 2015. This current challenge requires an innovative approach to retain staff to meet the growing demands of the service, achieve the strategic goals and accreditation requirements whilst also preparing staff for future employment.

The SKHS Nursing Executive has invest-ed in their staff ambitiously introducing Produc-tive Ward, The Productive Operating Theatre and Lean Enterprise Wide. Whilst the 3 programs are independent the underpinning philosophy is Lean Thinking. Using Lean Thinking staff are empowered to systematically improve processes and systems in their workplace which will realise tangible benefits for the health service; staff and consumers. The concurrent roll out of the programs creates a

7

powerful synergy building the culture of continuous improvement.

Evaluation of the culture of continuous improve-ment uses a balanced score card measuring and evaluating team performance and staff wellbeing, patient experience and satisfaction, safety and reliability of care, and value and efficiency. An extensive baseline data set has been collected which is being continuously monitored. In addition the staff intention survey and Lean Barometer® provide both qualitative and quantitative measures of the continuous improvement culture.

This unique and ambitious approach using Lean engages staff at all level in all areas. With the support of the Executive the improvement activities have made a substantial impact saving thousands of dollars, releasing many hours to care, whilst improving quality and safety for patients. The growing culture of continuous improvement is impacting on everyday practice and equipping staff with a skill set that is highly valued by employers. This investment in staff has made this group of people highly employable and sought after by employers in WA Health and beyond.

Clinical Service Re-Design – Midwifery Style!

Kate Reynolds, WA Country Health Service - SouthWest, Bunbury, WA, kate.reynolds@health.wa.gov.au

ABSTRACT

Objectives:1. Leading great care – patients

• How can we introduce midwifery led models of care that improves maternal satisfaction, decreases length of stay, reduces birth interventions, improves breastfeeding outcomes and post-natal depression rates using our existing resources??

2. Leading great care – Organisation and systems

• How can midwives and obstetric doctors work together to provide consumer focused safe, cost-effective, sustainable maternity services closer to home that will attract midwives to our workplace?

Midwifery led continuity of carer models can easily be implemented within your maternity services and here is why:Doctors will happily collaborate with clear referral pathways and they are freed up for other work that requires their expertise (they also get less call-outs at night!) You don’t need any increase in midwifery fulltime equivalent (FTE), these models are really just clinical service re-design – midwifery style. You can utilise a percentage of your existing FTE to do a percentage of your current business differently. Midwifery caseload models respond to activity rather than being roster drivenYou will attract more midwives into your service as they experience the health benefits of working in a rewarding and satisfying model of care using their full scope of midwifery skills and have control over when they conduct their work (except for the odd birth call-outs). Engaging with women and their families early, means midwives are working with women are more empowered and satisfied with their experience no matter what the eventual outcome.The organisation is happy as the length of stay is reduced significantly improving capacity fo those who need beds, there are less expensive birth interventions, less re-admission, the ‘madwives’ are happier and so are the consumers.Midwifery led continuity of carer models are not just about what women and midwives want; as a clinical service re-design initiative they are now an organisational must!

NORM – Nursing Online Roster Manager Project

Naomi Parkins, Sir Charles Gairdiner Hospital, Nedlands, WA naomi.parkins@health.wa.gov.au

The Relief Staffing office, manages over 300 relief and temporary nursing staff. These staff are called upon to fill all shortages. The communication of shortages and the corresponding backfilling, is vital to the efficient service of the wards and ultimately, best patient care.In 2009, The Relief Staffing Manager identified many problems with the communication system. After at least 5 years in use, the excel program was showing signs of inaccuracy. After NEC approval, the Relief Staffing Manager worked together with an IT expert, to create a system that would be organized and proficient in providing this vital communication, across

8

the site. Over a 4 month period, all the shortfall data was collated, ideas were tested, information and requirements of the users, were sought. The final program was ready for trial in April 2009.

Today, the NORM system:- automatically creates roster templates which correlate with pay periods- allows users to enter shortfalls for up to 3 months in advance- provides an alert record system for the relief staff i.e. APHRA registration expiry and core competencies- is web-based - each user entry is ‘he’ number stamped - is HIN supported- has multiple reporting mechanisms- NORM currently has over 80 users including NM’s/ CNM’s, Executive/Corporate Business and Finance Officer and the Informatics NM.

Future plans for NORM:- interact with Rostar/future pay systems- give relief staff, modified access so that they can enter their availabilities and eventually book and confirm their own shifts- have reports that interact with other programs

The NORM system has been a great success at Charlies. In providing proficient communica-tion across the site, it has also allowed for more accurate statistics and reports, past trends analysis and accountability.

Session 5 - Patients

Improving End-of-life Care for Bereaved Parents in a Tertiary Paediatric Hospital

Dowden, Stephanie; Nield, Kate; Walker, Sarah.Paediatric Palliative Care, Princess Margaret Hospital for Children, Perth, Western Australia

Over recent years, staff and families at Princess Margaret Hospital (PMH) for Children in Perth have raised concerns about lack of resources and inconsistent support offered to families at end-of-life (EOL).

In response, the PMH Paediatric Palliative Care, Grief and Loss Committee formed a sub-committee (including palliative care, social work and bereaved

9

parent representatives) to explore these concerns and develop a plan for a hospital-wide EOL Care model. Following an initial fact-finding phase and a review of current practice, two main areas were identified for attention: the physical environment during end-of-life and materials for memory making. Meetings were held with key stakeholders and a series of focus groups were held to inform participants about current practice and possible improvements.

A new way of interacting with families has evolved aiming for consistent EOL care across the whole hospital. In addition changes were made to the physical environment, which have also informed planning for the new children’s hospital.

This presentation will discuss the process, findings and the development of the EOL Care model at PMH. The benefit of strong partnerships between consumers and health professionals to improve care delivery will be discussed and the applicability of these findings for other health care and support settings.

SmartHeart- Living Well with Heart Failure in the Community

Julie Barber, SmartHeart-Curtin Interprofessional Health and Wellness Clinics, Bentley,Western Australia, Julie.Barber@curtin.edu.

Jille Burns. SmartHeart-Curtin Interprofessional Health and Wellness Clinics, Bentley,Western Australia, Jille.Burns@curtin.edu.

Andrew Maiorana. SmartHeart-Curtin Interprofession-al Health and Wellness Clinics, Bentley,Western Australia,A.Maiorana@curtin.edu.au

ABSTRACT

BackgroundHeart failure admissions (HF) are a substantial burden to Western Australian hospitals resulting in nearly 4000 separations annually, 30,314 bed days with a mean length of stay of 7.73 days (HF Model of Care, WA Health,2008). Readmission with this chronic condition is common. With improved post-discharge community support, up to 2/3 of these readmissions may be preventable.

ImplementationIn 2011, the South Metropolitan Health Service designed an integrated service model (SmartHeart)

10

linking patients with HF to specialist nurse support in primary care, the first of its kind in WA.The service provides evidenced based heart failure interventions shown to improve outcomes for people living with heart failure. Referrals areaccepted from hospitals, GPs, medical specialists and allied health staff. In partnership with Curtin University, nurse led clinics are run from Bentley, Cockburn, Peel, Rockingham and Pinjarra with adjunct home visits and telephone follow-up.Patients enrolled in SmartHeart receive HF management education,a HF action plan (for early identification and treatment of clinical deterio-ration) and a care management plan. Education in self-management is a core element of the service, as is providing easily accessible care in the community.

ResultsThe objectives of the project are to: reduce unplanned hospital admissions; reduce length of stay and improve quality of life for patients in the community. During the first 3 months of the program 136 patients were referred to SmartHeart (April n=25; May n=46; June n=65).

Patients from general medical wards made up 53% of referrals.An evaluation of project outcomes will be undertaken at the end of 2013.

ConclusionsSmartHeart provides an example of how collaboration across an Area Health Serviceand with a community partner can facilitate HF management in primary care. This is especially relevant to patients discharged from general medical wards who may not receive HF specific education.

Paediatric Aboriginal Ambulatory Care - Providing Choice, Partnerships, Coordination and Outreach Services

Karen Clarke; Child and Adolescent Health Service (CAHS); Subiaco WA; Karen.Clarke@health.wa.gov.au

Alan Kuipers-Chan; CAHS Subiaco WA; Alan.Kuipers-Chan@health.wa.gov.au; Sue Peter; CAHS Subiaco WA Sue.Peter@health.wa.gov.au;

Karen Edmond; CAHS Subiaco WA; Karen.Edmond@health.wa.gov.au

ABSTRACTAboriginal children in Western Australia continue to have increased morbidity and mortality compared to non-Indigenous children. Primary Health Care Providers identified a need for services for high risk Aboriginal children to improve health outcomes. High risk groups included preterm infants and children with chronic medical with or without complex social circumstances. In July 2012 PMH obtained funding from the COAG Closing the Gap initiative to conduct a 12 month pilot project across 3 WA sites to improve ambulatory care for WA Aboriginal children. The Aboriginal Ambulatory Care Coordination (AACC) Program improves access to services by providing :• care and investigations closer to home through outreach clinics• coordination of outpatient appointments• timely communication between primary health care providers and PMH• telehealth consults• education programs

The AACC Team comprises Senior Aboriginal Project Officer, Paediatric Nurses, Paediatricians and Administrative staff. Governance, advice and cultural and technical expertise is provided by a steering committee comprised of members from WA Health and NGO’s. An interim evaluation was conducted in Decem-ber 2012 and at that stage, there were 271 children on the program. Referrals were made by Aboriginal health worker’s, GP’s, nurses, Paediatricians and families. Medical conditions included developmental, neurological and ophthalmic issues, orthopaedics and nutritional concerns. Non-attended appointments were reduced by 50%, ED presentation mean rates decreased from 1.9 to 1.2 presentations per child and the mean rates for hospital length of stay reduced from 3.3 to 1.1 days. Patient assisted travel trips were reduced by 49 with a cost saving of $97, 111.06.

Other improvements to care coordination included increased consumer confidence, improved commu-nity engagement and interactions with Aboriginal Medical Services and participation in ongoing professional development for Aboriginal Health Workers. AACC has the unique ability to combine primary, secondary and tertiary prevention strategies within the Outreach Clinics.

Session 6 - Staff

Midwest Student Nurse Placement Reform

Christine Cream, WACHS Midwest, GERALDTON WA 6531; Christine.cream@health.wa.gov.au

ABSTRACT

SUMMARY: In 2011 financial funding was secured for 2 years (2012 & 2013) to allow the implementation of a vision to increase Rural and Remote Nursing Student Placements in the Midwest by 72% percent, an additional 2000 placements days over the 2 year period. The use of innovative measures have resulted in successful achievement of this goal with additional benefits to recruitment concurrently developing.

DESCRIPTION:The forecasted 2025 healthcare worker crisis study completed by Health Workforce Australia (HWA) – Doctor’s, Nurses and Midwives (HW2025) indicated a significant shortfall of nurses quoted as 109,490 by 2025. This study resulted in a substantial growth in Commonwealth funding for health workforce programs. This funding commitment has provided opportunities for health professional students to gain clinical experience and education through additional placement positions. The WA Country Health Service Midwest Region embraced this challenge and secured funding with the commitment of increasing Undergraduate Student Nurse clinical placements from 2765 student days over the 2 year period to 4765. While potentially ambitious in nature careful planning and a team commitment to ensuring health workforce sustainability the Midwest Region is on line to meet this goal and possibly exceed. Extensive consultation with internal and external key stakeholders has provided increased opportunities for Nursing Clinical placement in all Midwest sites. Examination of the situation in 2011 focused on the quality and culture of places being offered and the sustainability of a new model with current staffing levels. Review of published literature has focused the program design utilising belongingness as a key guiding principle.The Midwest model provided increased leadership coordination roles including the provision of staff development nurses in all sites. A focused goal of increasing Clinical Supervision education and

management commitment has increased the scope of the clinical nursing staff to support and mentor undergraduate nurses in the clinical setting. Multidisciplinary collaboration and consolation has ensured lessons learnt can be replicated throughout the organisation and further opportunities embraced. The Midwest’s achievement has provided the additional benefit of an increased interest in the offered graduate program and direct employment enquiries. With 2014 rapidly arriving the Midwest is now focused in working with key stakeholders to ensure model sustainability and further increase clinical placements as HWA funding ceases December 2013.

GREaT – Nursing Work Experience Program for Year 10 School Students

Michelle Dillon Nursing and Midwifery Office – Presenter

Celia Lloyd - NurseWest

The Health Work Force Australia report released in 2012 identifies a nationwide shortage of 109 000 Nurses by the year 2025. In WA, the Nursing and Midwifery Office (NMO) has collaborated with Health Corporate Network, NurseWest, and the Department of Education to develop and implement a centralised Program for Year 10 School Students, to gain experience within the nursing profession. This will be undertaken in a variety of clinical settings at WA Health sites. The GREaT Nursing (Get Real Experience and Try – Nursing) program has been developed in consultation with WA Health sites, and Department of Education and Training to provide 5 days of supported work-place experience. This consists of a half day orienta-tion and overview, four days in the healthcare setting, rotating through a variety of acute care and specialist areas, and concluding with a half day debriefing and discussion on pathways into nursing as a career.

Coordination and support for the students throughout the program is provided by NurseWest ensuring that all compliance issues for schools and sites are met, while funding and resources are provided by NMO.

Initial feedback from sites, schools and students has been extremely positive in providing ‘real’ experience to assist Year 10’s in choosing Nursing as a career option. Evaluation of the program will be re-

11

ported to NMO and incorporated into the workforce strategy for WA Health, with longitudinal follow-up planned to monitor the effectiveness of the program in the progression of students into Nursing careers.

What Makes a Student Led Ward Work – Sharing a Nursing Facilitator’s Experience

Fiona MacDonald, Royal Perth Hospital, Perth, WAFiona.macdonald@health.wa.gov.au

ABSTRACT

BackgroundSince 2010, a tertiary hospital and tertiary education providers have collaborated to provide an inter-professional education (IPE) program for students of nursing, medicine, occupational therapy, physiotherapy, social work and pharmacy interns. The Student Training Ward (STW) is a unique learning environment in which a maximum of eight students provide high quality care for six patients over two weeks under supervision. One of the key factors to its success lies with the facilitators of this program.

PurposeTo share a nurse facilitator’s inter-professional experience, involved with the student led ward over the last two years.

MethodTheoretical knowledge of inter-professional ed-ucation was gained at an IPE workshop and an opportunity to meet current IPE facilitators was provided. The structure of the inter-professional placement includes an orientation day that is mandatory followed by nine days of clinical practice on a short stay medical ward. Promoting the development of an effective team is integral to the success of the STW. This fosters a feeling of safe-ty and trust that promotes effective inter-professional working relationships.

ResultsKey challenges experienced are the socialization and engagement of team members, communication and inter-professional facilitation. Providing a safe environment has allowed the students to explore each other’s roles, gain an appreciation and respect for each profession and build confidence in their own professional abilities.

ConclusionWhat makes the STW work is the strong sense of collaboration between the facilitators that allows an atmosphere of partnership and cooperation between team members with the focus on the patient and patient safety.

Session 7 - Organisation & Systems

Service Redesign to Initiate and Set up the First Post Natal Follow up Service in WA, for Women with Alcohol and Other Drugs Issues and Who Attend a Specialist Service

Angela O’Connor & Renate McLaurin

King Edward Memorial Hospital (KEMH) provides tertiary care to women with pregnancy compli-cations through dedicated general and specialist antenatal clinics and has on average 6,500 births per year. The Women and Ne born Drug and Alcohol Service (WANDAS) at KEMH is a service providing care to women dealing with alcohol and other drugs (AOD) use and related issues. It is the largest Drug and Alcohol obstetric service in Australia. WANDAS provides outreach service to pregnant incarcerated women.

Background: WANDAS is a multidisciplinary team. The service is led by a consultant midwife. Until mid 2012 WANDAS was only available to women throughout pregnancy and up to five days post delivery. After the five day discharge there was no systematic process in place to monitor or follow up to ensure that the mothers and babies were continuing to engage with the maternal, child health and community services.

Service Redesign the service set up the first Post Natal service with no cost to the hospital using the LEAN Methodology. Maternal AOD use is correlated with indicators of poor health. Births from AOD using women were associated with a range of poor neonatal outcomes. Attendance for Maternal and Neonatal Follow-up is crucial for WANDAS clients in order to gain access to timely diagnostic expertise, psychosocial support, and referral to services. This redesign has demonstrated clinical leadership and innovation in redesigning a service to include a woman centred model and set up a Post Natal service without increasing the staffing levels. The leadership demonstrated in forming a collaborate relationship with other services and agreeing on shared goals to

12

improve outcomes for the woman and her family are evident.The staff used innovative branding of the service by organising a pregnant staff member to have body art painted on her pregnant abdomen to demonstrate a woman centred approach.

Innovative Research Partnerships in Management and Leadership: Implementation of the Doctor of Health Science

Dr Michael Monisse-RedmanCourse Coordinator (Doctor of Health Science)School of Nursing and MidwiferyEdith Cowan University270 Joondalup Drive, Joondalup, Western Australia, 6027

ABSTRACT

Edith Cowan University’s Doctor of Health Science (Clinical Leadership and Management) course connects directly with industry through a reciprocal agreement that ensures all course content is designed to address specific, relevant clinical leadership and management issues. The course is designed to advance students’ knowledge of leadership theories, concepts and techniques to produce positive and innovative organisational outcomes, meet organisational goals and objectives, and support research and collaborative experiences in line with national health reforms.The course encompasses areas such as contemporary leadership roles, strategic vision and planning, and interpretation of clinical data and ethical leadership in healthcare. In addition health management concepts and practices are applied. Students will participate in authentic learning and assessment activities, giving them the opportunity to apply their knowledge and skills in a healthcare set-ting. Comprising coursework and research components, including four compulsory units to be completed as a prerequisite to the student’s individual research project, leading to the submission of a thesis. The thesis unit develops the students’ personal competencies in critical analysis and scholarly writing relevant to their clinical area. This presentation will focus on (1) the develop-ment phase of this new degree, a process that was conducted over 12 months and included

an industry reference group; (2) the implementation phase of the course, including student experiences of the first 12 months of operation and the proposed industry research collaborations that are underway; and, (3) the benefits that this course can provide industry (organisations, services, staff and patients), including the establishment of collaborative industry research partnerships. This degree provides, through its contemporary and health specific focus on management and leadership, a unique opportunity for improvement to overall service provision to patients within Western Australian Health facilities and services and provides a strong foundation for the future workforce.

The Continuum of Care, Leadership, Management and Support: The Role and Perspective of an After Hour Clinical Nurse Specialist Service in a Tertiary Hospital Setting

Mr James Hanna, Sir Charles Gairdner Hospital, Nedlands, WA, james.hanna@health.wa.gov.auMs Abigail Harvey, Sir Charles Gairdner Hospital, Nedlands, WA, abigail.harvey@health.wa.gov.au

ABSTRACTAfter hours refers to operating after normal or conventional closing time for business or usual hours of work. Within terms of a tertiary healthcare setting such as Sir Charles Gairdner Hospital, the core business of patient care never stops but remains as a continuum of service delivery.

The After Hours Clinical Nurse Specialist team is derived of nurses who are expert clinicians with extensive critical care and leadership backgrounds and have an essential role in optimising safe and effective high quality patient care. The team are the first line of leadership accountability for clinical issues that arise out of hours within the organi-sation. This is achieved through positive clinical leadership; role modelling, education and managing staff performance and compliance with patient care delivery.

Two current members of the team will put forward their perspectives regarding their individual thoughts and beliefs about this dynamic leadership role and service provision. During this presentation they will look at the service model utilised within the tertiary hospital setting and comprehensively outline the

13

achievements, difficulties and challenges faced as a consequence of health care evolution, service impact as a result of the introduction of federal and state initiatives, organisation expansion and redevelopment with resource limitations after hours. The presentation will also explore the diversity of future risk and strategic planning associated with the progression of service and ultimately for the continuum of safe, effective and high quality patient care out of hours.

Quality and Safety Improvement in Health Care: Development of an Effective Universal Strategy for the Implementation of Research Evidence into Practice

Dr. Sara Bayes PhD RN RM, Senior Lecturer (Midwifery) at Edith Cowan University, Perth, WA

Ms. Jodie Atkinson, Research Assistant at Edith Cowan University, Perth, WA

BackgroundThe challenges associated with introducing evidence-based change into health care practice are a source of well-recognised frustration for both researchers and practitioners, particularly when it is clear that evidence-based findings from original health research would undoubtedly improve the care experience and outcomes of service users. Effective methods for moving research evidence into health care practice are required that both take account of individual health services’ contextual characteristics and are universally applicable.

AimsThe aims of this two-phase study were to1: analyse a range of health services’ readiness to implement evidence-based change2: develop and feasibility test a novel universally applicable ‘evidence uptake’ methodology

MethodsThis mixed methodology study was conducted in two Australian states across a sample of eight very different health care settings. For stage 1, a simple-to-use electronic application was used to collect and analyse organisations’ contextual ‘change readiness’ factors. In stage 2, the results and findings from stage 1 were utilised to develop an implementation strategy for each service. Permission

to conduct this project was obtained from Edith Cowan University Research Ethics Committee.

Key findingsThe context assessment method tested in phase 1 was found to be both effective and efficient for identifying common and unique barriers to and drivers of new evidence uptake in a range of health services; in addition the evidence implementation process we developed in phase 2 was evaluated by participant organisations as both approachable and practical.

Implications for theory development, education, practice, policyAlthough further effectiveness testing of our strategy is necessary, the findings from this feasibility study provide new knowledge about a promising new method for facilitating the movement of research evidence into health care practice. The informationwill be of interest to health service leaders, health service researchers, policy and strategy developers, and clinicians at all levels.

Nurse Manager’s Decision-making Styles

Karen Clark-Burg, University of Notre Dame Australia, Fremantle, Western Australia, karen.clark-burg@nd.edu.au

Professor Selma Alliex, University of Notre Dame Australia, Fremantle, Western Australia, selma.alliex@nd.edu.au

ABSTRACTNurse managers make decisions on a daily basis on a multitude of managerial tasks and activities that they are responsible and accountable for. Paliadelis (2008) states that the first-line management role encompasses both clinical aspects such as co-ordination of patient services and clinical care and managerial functions including unit management and nursing staff management. The aim of this presentation is to share the research findings of a recent study on nurse managers of Western Australia. Using the qualitative research method of grounded theory, this research study explored the role of the nurse manager and their approaches in decision making. The participants of this study revealed that the decisions they have to make on the ward were hindered by various constraints that they face in their daily work and these are the lack of resources, a culture of

14

resistance within the workplace and certain barriers that existed which the participants described as internal barriers and external barriers. It was found that the nurse managers utilised various approaches when dealing with staffing decisions and decisions about resources. This paper will provide insight into the different forms of decision making styles described by participants and the intervening factors. The theory that eventuated from the studys’ data is an original contribution to the understanding of the work of nurse managers in both the private and public hospitals in Western Australia.

Going for Gold! Our Pathway to Excellence Journey

Marie Slater, Nurse Co-DirectorOsborne Park HospitalOsborne PlaceSTIRLING WA 6021Marie.Slater@health.wa.gov.au

Lorraine Beaty, Coordinator of NursingOsborne Park HospitalOsborne PlaceSTIRLING WA 6021Lorraine.Beaty@health.wa.gov.au

Osborne Park Hospital is a 207 bed secondary hospital specialising in maternity, elective surgery and rehabilitation. It will be the first hospital in Australia to receive Pathway to Excellence designation in 2014.The American Nurses Credentialing Centre (ANCC) Pathway to Excellence Program recognises an organisation’s commitment to creating a positive environment for nurses and midwives to work.The journey designation involves meeting 12 standards that demonstrate an ideal workplace where nurses and midwives can excel.As nursing and midwifery engagement and satisfaction are pivotal to delivering quality care and retention a Pathway designation provides a framework for enhancing patient outcomes.This program is an innovative way to retain a competent, happy workforce in these times of intense change.

The 12 Standards include titles such as:• Orientation prepares Nurses and Midwives for the work environment• The work environment is safe and healthy• Systems are in place to address patient care and practice concerns• The Nurse Co-Director is qualified and

participates at all levels of the organisation• Nurses and Midwives are recognised for achievements• Nurse managers are competent and accountable

Attendees will be informed of the journey of participating in such a program and the challenges the organisation faced on that journey. Included will be an outline of the leadership actions required to achieve the designation. Osborne Park Hospital will be submitting its final documents to the ANCC on 1 October 2013 to receive designation in early 2014.

Nursing Practice Partnership Model ‘More Time to Care’

Tessie Zappia, Princess Margaret Hospital for Children (PMH), Subiaco, WA, Tessie.Zappia@health.wa.gov.au

Angela Shah, PMH, Subiaco, WA,Angela.Shah@health.wa.gov.au

Joanne Siffleet, PMH, Subiaco, WA, Joanne.Siffleet@health.wa.gov.au

Amanda Newell, PMH, Subiaco, WA, Amanda.Newell@health.wa.gov.au

The Nursing Models of Care (NMOC) Project was launched in 2011 with the remit to improve the safety and quality of nursing care throughout the Child and Adolescent Health Service (CAHS). The initial focus was to implement, in collaboration with six inpatient wards at PMH an innovative model of nursing carethat would; optimise skill mix, enhance the practice environment and facilitate the transition into Perth’s new Children’s Hospital.The initial process involved observation and tracking of nurses and coordinators ‘in action’ to determine current work practices. The data collected during the tracking exercises represented a snapshot of nursing activities. It wascategorised as either a Direct Care or Non-Direct Care Activity and coded to enable the observers to define and capture the work and tasks undertaken by nursing staff, minute by minute without having to interrupt the nurses. This data was utilised to create a baseline prior to the implementation of a Nursing Practice Partnership Model (PPM), adapted tosuit the needs of the paediatric setting. The modelincluded nursing practice partnerships, geographical patient allocation and devolved nurse’s stations. Post implementation

15

further observation and tracking of nurses ‘in action’ was undertaken to ascertain whether the model of care had in fact realised ‘more time to care’ by modifying or changing nursing activities so as to maximise time efficiencies and allow nurses more time for direct patient care.

To date findings have been encouraging the model of care has enabled nurses to spend more time at or near the bedside, at the devolved nurse’s stations and less time in motion ‘hunting and gathering’. It has promoted active communication within a partnership whereby both nurses are cognisant of all their patient’s needs and are able to support each other throughout the shift.

Session 8 - Patients

Moort Boodjari Mia- Take My Hand, Our Journey

Jodie MacKell,Moort Boodjari MiaMidland, Western Australiajodie.mackell@health.wa.gov.au

Alison GibsonMoort Boodjari MiaMidland, Western Australiaalison.gibson@health.wa.gov.au

Moort Boodjari Mia is an innovative service providing culturally appropriate maternity care through the development and implementation of client journeys specifically designed for Aboriginal women. The journey allows for a holistic, woman centred continuum of care where the woman is supported by her immediate family, community and a dedicated team of health professionals. The journey allows for continuity of maternal care that empowers Aboriginal women to improve their maternity outcomes through engagement with appropriate health care providers. With the provision of this culturally appropriate care, Aboriginal women are able to access maternity care safely, knowing there is respect and understanding which in the past have proven to be major barriers to the access of maternal care.

The programs’ design which incorporates Aborigi-nal values, Aboriginal ways of working and a unique blend of Aboriginal and non-Aboriginal health professionals is largely responsible for the exceptional outcomes achieved in the program.

16

Throughout the entire program Aboriginal health perspectives are valued and included, thereby providing maternity care that is relevant, meaningful and effective. Together with a Midwife, an Aboriginal Health Officer and an Aboriginal Liaison Grandmother, each woman is offered spiritual, cultural, social, and psychological care, as well as clinical health care.

Many Aboriginal women are presently at risk of poor maternity outcomes due to socio-economic stressors, the high incidence of perinatal infections, poor nutritional status and chronic diabetes throughout the Aboriginal community. Our specific client journeys enable us to work together with other agencies and health care providers to ensure the best evidence based practice is provided to Aboriginal women.

Moort Boodjari Mia is a unique service that is underpinned by an inventive model of care that is structured on client journeys that are proving to be instrumental in improving maternity care to Aboriginal women.

If You Can’t Get Them Out Then You Can’t Get Them In! Reducing Length of Stay for Mental Health patients with Accommodation Related Delayed Discharges at Sir Charles Gairdner Hospital (SCGH)

Peta Gough, State-wide Mental Health Patient Flow, Perth, WA, Peta.Gough@health.wa.gov.au

Kieran Byrne, Sujuk Lay, Sue Bright, Jacqueline Baynes, Rachel Rowe, Ian Watson, & Tracy Coward

Organisation: State-Wide Patient Flow Coordinators & A/CNS SCGH Ward D20 Perth, WA.BackgroundThe average length of stay for mental health patients is 12 days at a daily cost of $1126.00.Accommodation can be a particular challenge for this cohort and may result in extended lengths of stay despite the patient being ready for discharge. This project looks at early identification of patients with accommodation issues with the intention of significantly reducing their length of stay

AimTo determine, with regard to discharge planning, whether early identification of accommodation issues on admission will significantly reduce the length of stay for patients in the mental health setting at SCGH.

17

Method:All members of the multidisciplinary treating team were included in the implementation process of accommodation detection strategies. This included promotion of early referral to Social Worker and Welfare Officer, the use of traffic light colour codes to highlight the priority on the Patient Journey Board.

Data collection for patient’s length of stay and accommodation status continued and outcome results were presented back to ward staff on a monthly basis.

Results:In May 2013 an average of 4.6 patients per day were ready for discharge yet awaiting accommodation resulting in an average of only 2.5 patients being discharged per day. Following implementation of the accommodation problem detection strategies, by June 2013 an average of 2.5 patients per day were waiting for accommodation and the average of discharges per day had risen to 3.7 patients. This resulted in a significant cost saving initiative for the health service

SignificanceThe results from this initiative are extremely promising and, if implemented in other inpatient areas, could significantly decrease occupancy rates across the mental health service, creating capacity for the continuing high demand for inpatient beds.To this end, these strategies and the study results will be promoted across all mental health units within the Perth metropolitan area via a “road show”.

Minimally Invasive Respiratory Support for Infants and Children in a Non-tertiary Regional Environment: a Nurse Practitioner Led Initiative

Scott Stokes, WACHS-Kimberley (Broome Hospital), Broome, Western Australia. scott.stokes@health.wa.gov.au

ABSTRACTRespiratory illness is the leading cause of paediatric inpatient morbidity, and attracts enormous social, financial and resource burden. This effect is amplified in the non-tertiary regional setting, where complicating factors include geographic remoteness, staffing levels and timely access to specialist expertise. This paper outlines a Nurse

Practitioner (NP) led program introducing minimally invasive respiratory care (MIRC; Humidified High Flow Oxygen and Bubble CPAP) for infants and children in a regional setting. Oxygen delivery and modes of respiratory support in the neonatal and paediatric setting are now well described and evidenced-based. Methods previously available only in tertiary intensive care units can now be implemented in regional newborn nurseries and general paediatric wards. We present results from the introduction of MIRC to a remote paediatric service in the Kimberley region of WA. These outcomes are comparable to those of tertiary paediatric centres and provide evidence that therapeutic MIRC can be safely supported and sustained, with a significant improvement to outcomes for the patient, family and health system. NP-initiated protocol formation, site education, and clinical implementation of paediatric MIRC commenced in January 2012, with 40 infants/children having utilised the service. The ability to provide care locally and avoid transfer to distant tertiary centres has resulted in reduction of clinical risk; improved health outcomes; enhanced skills and satisfaction for nursing and medical staff; facilitated culturally sensitive support to families and circumvented social dislocation. Health system cost savings are >$800,000. The initiative has been embraced widely by hospital staff and executive, and aligns with the strategic direction and vision of the WA Country Health Service.The paediatric MIRC program within the Kimberley has had a substantial benefit to the quality of service provision for patients within the most remote region of Australia. This NP-led initiative sets a precedent for further expansion of clinical care models.

Implementation of Enhanced Recovery Program for Primary Hip Arthroplasty at Hollywood Private Hospital

Connie Faranda Clinical Pathways Coordinator Hollywood Private Hospital, Nedlands, Western Australia farandac@ramsayhealth.com.au

Judith McDowall Clinical Nurse Orthopaedic Surgery Hollywood Private Hospital, Nedlands, Western Australia

Tracey Leece Clinical Nurse Orthopaedic Surgery Hollywood Private Hospital, Nedlands, Western Australia

18

ABSTRACTEnhanced Recovery Programs (ERP) for orthopae-dic surgery has been successfully implemented in the UK, Scandinavia and Australia since early 2000. These programs aim to improve patient outcomes and reduce length of stay by optimising preparation for surgery and speeding up recovery by initiating early mobilization, diet and fluids, removal of drips and drains, as well as reducing the use of opioids for pain management. These programs promote the wellness model encouraging patient involvement, independence and early discharge.Whilst some aspects of fast track surgery are being implemented in WA, Hollywood Private Hospital recognised that by introducing other aspects of the enhanced recovery program, better patient outcomes would be achieved. A multidisciplinary project team was formed in 2012 to develop and pilot an ERP for primary hip arthroplasty. This presentation will discuss considerations for developing and implementing the program such as:• Reviewing admission processes to ensureearly optimisation of patient health and identification of any discharge issues.• Developing a new clinical pathway to incorporate current best practice and standardisation of protocols.• Developing patient education strategies to better prepare patients and their support person for self-care and early discharge.• Providing education to staff as the ERP program involved changes to current clinical practice such as fasting protocols, early mobilisation and pain management, including patient self-medication.

Four surgeons were involved in the pilot program with the first patient admitted for surgery in January 2013. Evaluation of the pilot program included collection of data regarding LOS, clinical indicators (such as unplanned readmissions within 28 days and transfers to theRehabilitation Unit), staffing hours, post discharge phone call, patient satisfaction survey and staff satisfaction survey. Based on the results of this pilot, Hollywood Private Hospital is now planning to expand this programme to include other major orthopaedic surgeries and all orthopaedic surgeons.

A Clinical Audit of High Grade Glioma Patients to Assess Improvement in Needs and Distress, through Introduction of a Nurse Led

Neurosurgical Oncology Clinic

Anne King, WACPCN East Perth, WA, anne.king@health.wa.gov.au

ABSTRACT

IntroductionHigh grade gliomas (HGGs) are debilitiating, with a rapid progression and a poor prognosis with a median survival of one to three years and a five year survival of only 10%. A previous audit identified a gap in care between patients discharged from hospital and input from the neurology cancer nurse coordinator (NCNC). An early post discharge nurse led neurosurgical oncology clinic (NLC) was developed to increase patient support and to address the identified gap in service delivery.

Aim To evaluate the NLC by establishing if early NCNC assessment of HGG patients improved gaps in care and patient distress.

MethodologyA retrospective audit was performed on 25 randomly selected patients over a six month period after introduction of the NLC. Data was collected from the NLC and the first medical oncology outpatient appointment, including patient needs identified by distress thermometer, value of information given and referrals to allied health. Those patients who did not attend the NLC were assessed when they first presented to medical oncology.

ResultsThe NLC allowed 60% of patients to be seen at diagnosis. Patients expressed unmet needs in so-cial (76%), emotional (72%), family (52%) and phys-ical domains (40%) soon after diagnosis. Distress and unmet needs recorded at the medical oncology appointment were reduced in 15 patients previously seen in the NLC. Ten patients asessed in medical oncology without an initial NLC appointment had distress levels similar to the initial NLC patient scores. Information packages were found valuable in 60% of patients.

ConclusionThe nurse led neurosurgical-oncology clinic has improved service delivery and patient outcomes through earlier access to the NCNC for holistic assessment, support and information and to facilitate direct referral to allied health.

An Audit of Upper Gastrointestinal Cancer (UGI) Incidence and Cancer Nurse Coordinator (CNC) Involvement in WA, by Patient Residential Health Region, July 2011 – June 2012

Carol Cameron, WACPCN East Perth, WA, carol .cameron@health.wa.gov.au

ABSTRACTThe volume of new referrals to the UGI CNC service has increased by 87% since 2008 to 495 cases in 2010-13. Despite this, more that half those diagnosed have no CNC involvement. The service is unlikely to ever have the nursing resources to assist these patients; however it is important that they have equivalent care – timely diagnosis, correct treatment pathways and access to supportive services. Identifying this group of patients is the first step in ensuring resources are developed to meet their needs.

Aims• Compare the number of new UGI cases referred to the CNC service to the actual incidence of UGI cancer• Identify groups with the least CNC involvement, by region and diagnosis• Develop a HDWA ethics application for data linkage to identify UGI incident cases with no CNC contact

MethodsA retrospective comparison of UGI Cancer regis-try data was made with new referrals to the CNC service for the same time period (July 2011-Jun 2012). This included cancers of the oesophagus, stomach, small bowel, primary liver, pancreas, biliary ducts and gallbladder. Descriptive statistics were generated using Microsoft Excel.

ResultsThere were 813 cases of UGI cancer identified during the time period. Fifty-four percent ofUGI cancer patients in WA had no CNC involvement in their care (n=440). Rural areas with low cancer incidence had proportionally more cases with CNC involvement than those with a higher incidence. The North metro health region had the highest incidence of any health region (n=353) but had a low CNC input (n=120). Cases of oesophageal and biliary cancers had higher CNC input than primary liver and gastric cancers.

An application for data linkage will now proceed to identify those cases with no CNC input by; diagnosis, postcode of residence, treatment, place of primary treatment

Development and Implementation of a Nurse Led Frequent Faller & Injury Reduction Programme

Su Kitchen, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Su.Kitchen@health.wa.gov.au

Anne Matthews, Sir Charles Gairdner Hospital, Nedlands, Western AustraliaAnne.Matthews@health.wa.gov.au

ABSTRACT

AimA Frequent Faller and Injury Reduction Programme has been introduced in a tertiary hospital by a Clinical Nurse Specialist (CNS).The programme aims to reduce inpatient risk of falls and/or injuries. It targets patients considered at high risk and those who have fallen at least twice in hospital.

MethodEvidenced based guidelines and falls experts assisted with programme development. The multidisciplinary team refers patients to the Falls Management CNS. Detailed patient reviews examine the physical, psychological, environmental risk factors and interventions a ready implemented. Additional tailored interventions are then applied. Extensive collaboration and referrals to members of the Multidisciplinary Team are initiated. Patient, family/carer and primary nurse are active participants in this process.

ResultsResults from the first 12 months of implementa-tion showed that 57 patients were reviewed and that 49 (86%) had not re-fallen during their hospital admission. Eight (14%) had fallen again but sus-tained no injuries. Interventions addressed elimination issues (54% of patients) or cognition (50%), or the need for patient education (46%). Results of a small staff survey demonstrated a high level of satisfaction with the programme. It is considered a relevant part of the care of the High Fall Risk Patient. The programme is in its second year and referrals con-tinue to increase.

19

Conclusions and Implications for PracticeThis is an innovative programme and despite staffing constraints, it has proved successful in both reducing falls and the injury risk of patients who fall frequently. A detailed review of risk factors combined with establishing effective and appropriate interventions, indicates there are improved outcomes for patients. This is expected to lead to reduced care burden.

Session 9 - Staff

A Collaborative e-Health and Educational Intervention to Improve Wound Care and Clinical Outcomes in Rural and Remote Settings

Pam Morey, NP PhD candidate 1,2, Dr Jenny Prentice 1, Prof. Gavin Leslie 2, Prof. Nick Santamaria 3

1 WoundsWest, Como, WA. pam.morey@health.wa.gov.au; 2 Curtin University WA, 3 Melbourne University Vic.

In rural and remote regions, the delivery of evidence-based wound care can be restricted by limited access to education, resources and suitably qualified health practitioners. WoundsWest, in partnership with the Wound Management Innovation Cooperative Research Centre, is evaluating the effectiveness of an innovative strategy incorporating e-Health and web-based learning to reduce these geographical barriers. This study aims to identify the effect of online and skill-based wound education and an e-Health based wound advisory service, on staff knowledge and wound outcomes in selected rural and remote regions within Australia. In particular, the utility of these interventions, and the barriers and enablers associated with the implementation of these strategies will be explored.

This twelve month pre-post intervention design encompasses two strategies: one which utilises blended learning; and a second which provides a remote Wound Advisory Service (WAS) by a Nurse Practitioner and Nurse Consultant experienced in wound management. The sample includes six rural or remote health care services within Queensland, Victoria, and Western Australia. Wound education consists of web-based interactive online

20

modules developed by WoundsWest, supplemented by face-to-face wound education and skill-based workshops. Half the sites have access to a remote Wound Advisory Service which utilises e-Health and a clinical information system.

The study evaluation encompasses wound outcomes and staff wound management knowledge. Pre/post test results at commencement (nurses and Aboriginal Health Workers) demonstrated an improve-ment in mean scores from 42% to 82% respectively. A knowledge deficit was identified for lower leg ulcer assessment and management. Preliminary review of referrals to the WAS have identified wounds on the lower leg as the most common (87%, n=20).

Preliminary data analysis has confirmed a knowledge and practice gap related to evidence-based prac-tice of leg ulcer aetiologies in this population at study commencement. This finding supports the need for both education and e-Health wound advice.

Orientation to Remote Area Nursing: What’s all the Fuss, What’s Really Happening Out There and What do RANs Really Want?

Kristy Cooper, Western Australian Country Health Service, Coral Bay Nursing Post, Coral Bay, WA, kristy.cooper@health.wa.gov.au

Dr Raeleene Gregory, Flinders University, Centre for Remote Health Alice Springs, Alice Springs, NT, raeleeneg@gmail.com

ABSTRACT

Remote area nurse (RAN) practice is a unique speciality. Australian RANs are at the forefront of health care system caring for the sickest and most disadvantaged populations. Their practice is not only characterised by its geographic location but additionally by its professional isolation, extended scope of nursing practice, increased clinical responsibility, cultural diversity and primary health care approach. Effective role preparation has been debated by remote health experts who emphasise that the process of workplace orientation is a key priority to effectively prepare novice nurses for success within the multifaceted role and unique context of prac-tice.

This session will present an overview of the key findings of a small scale Master’s research project which aimed to explore the lived experiences of Australian RANs related to work place orientation and identify their expectations and preferences related to this process. The findings give insight into the stark reality of current workplace orientation practices, what RANs want in relation to orientation content and structure andhighlight their perceptions related to its importance and its implications on practice such as RAN success, patient safety and RAN retention. Brief conclusions related to the need for further research and innovative solutions will be proposed. The aim of this session will be to primarily raise awareness of this key remote health issue. It will present the voice of Australian RANs and stimulate attendees to consider contemporary orientation processes and recognise the value of investing in comprehensive workplace orientation in order to achieve and sustain a well-equipped RAN workforce. This session will be of interest to any remote health practitionersand will provide a valuable insight for staff development specialists, remote health leaders, researchers and policy makers.

Minimising Medication Errors: A Fresh Look at Teaching Medication Safety

Nick MayStaff Development EducatorRoyal Perth Hospital

A recent review of existing medication administration Self Directed Learning Packages (SDLP) provided an opportunity to align priorities to the new national accreditation standards.

During the review process, concerns emerged that the traditional education approach did not optimize medication safety. Were we guilty of teaching the wrong material? Previously, these SDLP focused heavily on factual, pharmacology knowledge and not the root cause of medication errors. However - “Knowledge prevents errors” ….Or does it?

Further research revealed that only 9% of medication errors are directly related to a knowledge deficit. Over 53% are caused by a breakdown in process, caused by a multitude of operational and environmental factors.

The learning package was comprehensively re-de-signed, incorporating a new emphasis on critical thinking, environmental risk assessment, situational awareness and the promotion of self-awareness and behavioural change. The partnership of clinicians with the clinical pharmacist is strongly encouraged. Teamwork and interprofessional collaboration to achieve consistent standards of assertiveness and reflective practice exercises are integrated into the SDLP, together with the comprehensive National Prescribing Service E-learning promoted by the Federal Government.

The “6 Rights” of medication management are expanded with critical thinking questions developed to challenge the operational understanding of the reader to expect much more than simple rote recall of the concept headings. Risk management activities and harm minimization strategies are aligned to 5 key areas – The 5 ‘P’s – The Prescription, The Process, The People, The Place and The Patient.

In short, instead of a learning package to assess the ability to recall abstract facts, RPH now has a “medication defensive driving course” approach for clinicians. Whilst directed primarily at nurses, this resource is applicable to all professions.The resource was launched in late May 2013 and has been well received by nursing colleagues.

To view the learning package Click Here

Developing Pain Resource Nurses: A Hospital-Based Approach

Mandy Lison-Pick Joondalup Health Campus Perth WA, Lison-PickM@ramsayhealth.com.au

Introduction To obtain efficient and effective pain medicine so a patient can have a positive experience in their hospital journey nurses must be proactive regarding their knowledge, attitudes and practices of pain management.

AimTo enable nurses to become more positive and show leadership when managing pain at the Joondalup Health Campus (JHC), an innovative development package has been designed for senior Registered Nurses. This package allows them to become nurse leaders of pain management equipping them with advanced knowledge and skills in pain assessment,

21

pain relief and commonly used analgesic prescribing practices. Completion of the course of study leads to recognition as a Pain Resource Nurse.

MethodThe nurse education package consists of seven two-hour education sessions running over seven consecutive weeks. To gain recognition as a Pain Resource Nurse participants are required to attend all sessions. A supporting course booklet provides key information to the learning program conducted by the JHC Pain Service medical specialists and Nurse Consultant of the Acute Pain Service (APS).

Results A pre/post test survey of nurse’s knowledge is administered to assess the effectiveness of the learning package. The practical impact of the course is also assessed by comparing the number of ward-based pain management referrals to the APS post-education with the same period the previous year. Pre and Post-test education shows a marked improvement in nurse’s knowledge of pain management and there is evidence of a reduction in the number of ward referrals to the APS.

Conclusion This new Pain Resource Nurse education package has positive impacts on the skills and knowledge of senior nurses establishing a new ward-based leadership role. It also improves pain management practice, enhancing patient outcomes, bringing efficiency and effectiveness gains to the APS.

Why are Some Patient Diagnostic Related Groups (DRG) Continually Staying Over 3 Times Longer than the WA Average Length of Stay?

Glenda Cutler (Nurse Educator WACHS - South West)

Patients with an increased length of stay can put patients at a greater risk of hospital acquired complications, which can lead to further extended stays and increased costs to the community (Forster et al, 2012). However discharging patients before all supports are in place can lead to readmission within 28 days which impacts on Emergency Departments and staffing.WACHS SW population is growing by 3.5% per year and up to 40% of SW Hospitals are caring for people that have potential for treatment in the community, which has an impact on acute beds available in the

SW area.The Quality Incentive Program(QuIP) project wanted to look at the top DRG groups who continually appeared in data at staying greater than 3 times the WA Average length of stay, to determine if these patients were getting” the right care, at the right time, in the right place , by the right people” (Department of Health 2009). By reviewing the process of selected diagnostic groups 9 conditions were isolated and a clinical design methodology was used to identify potential gaps and bottlenecks of care. The team engaged with multiple stakeholders to determine root causes and measured and analysed the impact of numbers of patients which were affected.The team identified 4 key areas of concern, Discharge planning was not occurring early enough, clinical handover didn’t include the patients as per best practice, referral processes were highly variable and the final diagnostic group assigned to the discharge patient was often at a lesser level of acuity through lack of medical documented discharge and.With the key issues identified solutions were implemented to improve patient discharge, and improve staff/patient communication, working with the staff locally to find what suited them best.

(Em)powering Up for Change: Preparing to Move into a New Children’s Hospital

Joanne Siffleet, Child and Adolescent Health Service (CAHS), Subiaco, WAjoanne.siffleet@health.wa.gov.au

Anne Bourke, CAHS, Subiaco, WA, anne.bourke@health.wa.gov.au

Tessie Zappia, CAHS, Subiaco, WA, tessie.zappia@health.wa.gov.au

Jodee Eaves, CAHS, Subiaco, WA, jodee.eaves@health.wa.gov.au

Annette O’Mahoney, CAHS, Subiaco, WA, annette.o’mahoney@health.wa.gov.au

Sue Peter, CAHS, Subiaco, WA sue.peter@health.wa.gov.au

The new children’s hospital planning provided the impetus to implement a contemporary nursing model of care in preparation for transition to a new practice environment. Implementing change is dependent on the practice environment

22

culture and skilled facilitation to guide individ-uals and teams to not only embrace change, but to build and improve the foundation work. To achieve this, the focus of improving patient safety and the quality of care has been used alongside Practice Development methodologies to develop a culture of frontline accountability.

The aim is to prepare nursing staff to embrace and drive the changes required to enable them to provide quality care in the New Children’s Hospital.

An action research methodology is being used. A program of facilitated workshops employing practice development strategies has been implemented. The methods have been chosen to create a fundamental understanding of the CAHS vision and facilitate the discovery of pathways to promote the vision both now and when moving into the new hospital.

To date, expectations for staff engagement have been surpassed. Requests for workshops and ward based activities have increased to a point where members of the facilitation team are now exploring alternatives ways to meet demand. Workshop evaluations have indicated that the content and timing have met the needs of nurses during a time of unprecedented demand for change on many fronts.

Thorough preparation and planning which identified staff needs provided direction to select appropri-ate methodologies to engage with nurses. This has contributed to a successful partnership between nursing executive, research, education and clinical nursing staff at PMH.

WA Health Refresher Pathway for Nurses and Midwives: A Flexible Pathway for Nurses and Midwives Returning to the Workforce

Catherine Barratt, Nursing and Midwifery Office, East Perth, Western Australia.Catherine.barratt@health.wa.gov.au

Donica Skeggs, Nursing and Midwifery Office, East Perth, Western Australia.Donica.skeggs@health.wa.gov.au

Sheralee Tamaliunas, Nursing and Midwifery Office, East Perth, Western Australia.

Sheralee.tamaliunas@health.wa.gov.auMichelle Dillon, South Metropolitan Health Service, Mt Pleasant, Western Australia.Michelle.dillon@health.wa.gov.au

Susan Greyling, Royal Flying Doctor Service, Jandakot, Western Australia.Susan.Greyling@rfdswa.com.au

IntroductionThe Nursing and Midwifery Office (NMO), Western Australian Department of Health, has been proac-tive in utilising refresher programs to facilitate the up skilling and education of nurses and midwives looking to return to the workforce. The NMO provides funding, management and administration of programs. A review of structure and content of refresher programs was conducted by the NMO in 2012 with an alternative model of delivery linked to employment proposed.

ObjectivesThe aim of the NMO in proposing “Refresher Pathway Connect” was to create a paid employment education model to support nurses and midwives to return to work in the acute care setting, allowing them to update skills and knowledge to assist in a smooth transition to the clinical environment with confidence and competence.

DescriptionThis state wide initiative has been developed by the NMO in consultation with health services to allow participants:1. To update their knowledge and clinical skills by undertaking online study modules.2. To access a flexible option for full or part time employment to refresh and consolidate clinical skills and complete the assessment of clinical competencies.3. To select their preferred health site and negotiate with the recruiting Nurse Manager a mutually convenient start date.4. Have a pathway to permanent employment on completion of the Refresher Pathway fixed term employment contract.

Participants must be currently registered with the Nurs-ing and Midwifery Board of Australia.

ConclusionRefresher Pathway Connect for registered and enrolled nurses has been launched successfully, with online applications now open.

23

Poster Presentations

Poster Display 1: Everything has a Place and a Place for Everything - Improving Staff Satisfaction and Quality of Care through a Well-organised Ward

Halliday J1, O’Nions P1,2, Watson E1, Juliff D11 Swan Kalamunda Health service2 Lean Healthcare Consutlants

The Productive Ward ‘releasing time to care program has been implemented on East Wing (Surgical and Medical patients) at Swan District Hospital. The program has been exceptionally successful in empowering the ward team to identify areas for improvement by giving the staff the information, skills and the time they need to improve the way they work and care for their patients.Baseline data using activity flows demonstrated that on average nurses on East Wing were spending only 27% of their shift on direct patient care. With motion being the predominant reason for taking nurses away from direct patient care; nurses on East Wing spend 23% of their shift walking, looking and searching for poorly located supplies, equipment and paperwork.The staff have used innovating and engaging approaches to making and sustaining change. The use of group walk through to involve staff and encourage those who work in the area everyday to really look at the location and storage of supplies and equipment to identify areas for improvement. Hundreds of ideas were generated which were then ranked using the benefit versus effort matrix using a voting system; they began by implementing the quick wins, those changes that will have a large benefit at little or no cost. For example taking the doors off the cupboards, creating an alcove for the hoist so it is located at point of care for medical overflow patients, storage of like items together i.e. IV fluids and IV consumables. Engineering has been involved and engaged installing hooks and shelving, removing doors and painting. The changes have made a mea-surable difference to the workplace and efficiency which has led to approval for funding of additional items and works. Using the Productive Ward the ward team has released time to care by redesigning and streamlining the way they manage and work. Improvements have demonstrated benefits in staff satisfaction, increased direct care time which is reflected in improved patent experience and reduced harm events. Inventory costs with stock reduction and inventory control saving.

24

Poster Display 2:Recovery Patient Flow Nurse at Royal Perth Hospital

Sarah Lambert RN. Royal Perth Hospital, Wellington Street, Perth, WA, 6000. Sarah.lambert@health.wa.gov.au ABSTRACT

The patient flow nurse role was established at Royal Perth Hospital recovery January 2009, in response to the problem of access block affecting theatre utilisation. Data collected exposed a culture of delayed collection times after discharge criteria were met. With the potential and actual effect of delays causing wasted theatre time and cancellation of surgery, access block for theatres needed to be addressed. The full time registered nurse was funded by surgical services which presented the opportunity to redesign the internal recovery processes. The role has emerged as a valuable resource in the management of daily bed occupancy issues. The nurse is a point of contact enhancing departmen-tal communication channels. The nurse provides a resource with the knowledge required to interpret clinical issues in the recovery patient population related to discharge and continuity of care. Administrative duties are also conducted by the patient flow nurse which makes for a busy challenging role. Responsibilities revolve around activities on the recovery floor, communicating with the multidisciplinary team and escorting patients to wards. The impact of the nurse has been to maintain the discharge flow of patients’ from recovery by early identification of problems and timely communication. Relationships between nurses, wards, departments and multi-disciplinary teams have im-proved due to the customer service approach and con-tinuity the role provides. Recovery productivity and safety is improved because the coordinator is released to embrace their expert clinicians’ role. Addressing patient flow is-sues using principles of L.E.A.N thinking improve util-isation of hospital resources and key performance in-dicators.

Poster Display 3:Post Anaesthetic Care Unit Escalation Plan

25

Elizabeth Fereday, Clinical Nurse Specialist Post Anaesthetic Care Unit, Sir Charles Gairdner Hospital Perth, Western Australia

BackgroundThe Post Anaesthesia Care Unit (PACU) bed escalation plan was first introduce into the department in 2009. It aimed to improve: patient safety, health care service delivery and throughout the patient’s perioperative journey.

Initially a PACU escalation plan was developed to engage Anaesthetics, Theatre staff and bed management in order to raise awareness that PACU bays were at capacity for two reasons: patients in the department who were receiving Post Anaesthetic Care and not fit for discharge, or patients who were deemed fit for discharge from PACU but due to high bed capacity with the hospital unable to be moved onto a designated receiving area. Both of these situations may result in a post anaesthetic patient being denied admission in the unit.

Patients who are unable to be moved out of PACU present several issues including deprivation of dignity, sleep and reduced contact with relatives (who are not usually permitting into the PACU).

AimsThe PACU bed escalation plan aims to: improve our health care delivery service by focusing on a more efficient service delivery and maintaining patient safety during times of high acuity and increase departmental flow.

DiscussionThe bed escalation plan is designed to improve patient flow and ensure patients are provided with appropriate primary clinical care.The Plan is aligned with the traffic light system to assist staff in determining the current status of the department; it includes colour coded actions which require implementation by key stakeholders at each level of escalation: GREEN, AMBER, RED and BLACK. The PACU bed escalation plan no aligns with the bed management and Hospital Bed Capacity Status document 2013 to support patient flow into theatre and our of PACU.

ResultPost Anaesthetic Care Unit Escalation Status

GREENAll patients with the department have a dedicated nurseThe department has a designated co-ordinatorThere is a bed available, or contingency plan in place, to enable the admission of any emergency

AMBERPACU is full but has beds blocked by patients ready for transfer to ward bedsorCode Blue situation is causing minor/temporary disruption to PACU or Theatre

REDThere is a patient with the department who has no dedicated nurseAll options (agency, casual, theatre trained PACU nurses) to cover staffing have been exhaustedor PACU is full but stable ICU/NOSA patients who could be transferredorA Code Blue situation is causing significant disruption to the department

BLACKMultiple patient with a dedicated nurseorPACU is fullWard beds blockedNo patients suitable for transferHigh acuity unstable patients in PACUNo ware staff to accept stable patientsorA Code Blue situation is causing complete disruption to the department

OutcomeThe PACU bed escalation plan has improved patient flow and safety within the unit by facilitating timely dis-charge of stable patients into designated receiving ar-eas.The escalation plan is global notification system used to alert other wards and departments of the current PACU bed status. The plan demonstrates accountability to all departments/stakeholders issues affecting the PACU service delivery.

Poster Display 4:Twinning – It all Began with a Vision

Caroline Fletcher, Sir Charles Gairdner Hospital, Nedlands, WA, caroline.fletcher@health.wa.gov.au

26

ABSTRACTThe main purpose of ‘twinning’ is to bring together 2 areas to support the primary values of the hospital, teamwork, integrity, respect, care, leadership and excellence.

Patient Safety Team members in Theatre, PACU and G74 collaborated and identified that by using some of the ‘Keys to Success’ identified in the post WW2 European twinning movement it would enable us to share problems, exchange views and understand different view points on any issue where there is a shared interest or concern, for us the surgical patient.

We choose 6 keys to success based on 4 C’s – Coaching, Collaboration, Communication, Change and 3 S’s – Support, Sustainable Change and Success.

In the Beginning:1. Find the Right Partner – Twinning is an opportunity to support each other with improving outcomes for surgical patients and sharing with others in the wider hospital community.2. Involvement – increased staff engagement and empowerment based on patient centred care.3. Inclusion – creating the link – Enabling staff to experience ‘A Day in the Life Of’ another Nurse which will provide greater communication and understanding with the aim of improving patient outcomes.4. Defining common objectives – links establish what is to be achieved from the twinning, types of activities to be undertaken and establish clear lines of communication.5. Support – Patient Safety Teams are an established platform for sharing and supporting with the patient as the primary focus.6. Sustainable relationships – developing strong professional friendships with like minded teams.

Twinning will establish strong partnerships with Nursing Teams during all stages of a patients Peri-operative journey through a mutual understand-ing and respect for each other.

Poster Display 5:Prostate Cancer Specialist Nurse – Role and Implementation of this New Service at Hollywood Private Hospital

Lisa Ferri, Prostate Cancer Specialist NurseHollywood Private Hospital, Nedlands, WA, FerriL@ramsayhealth.com.au

ABSTRACTAccording to the Australian Institute of Health and Welfare, 2010, Prostate Cancer is the most common, newly diagnosed cancer in Australian men. It is the second leading cause of death, with Australia and New Zealand having the highest incidence world wide.The Prostate Cancer Specialist Nurse national pilot program is part of a collaborative project between the Prostate Cancer Foundation of Australia and the WA Cancer and Palliative Care Network. It involves 13 specialist nurses in host hospitals in metropolitan and rural areas across all states and territories across Australia. The project is supported by the Prostate Cancer Foundation of Australia and funded by the Wylie Foundation and Movember. Hollywood Private Hospital was successful in becoming a host Hospital with the Prostate Cancer Specialist Nurse commencing in late May 2012.Receiving a Prostate Cancer diagnosis involves significant psychosocial and physical morbidity, treatment decisions, significant side effects and impacts on the patient and their partner’s quality of life. Prostate cancer treatment now adopts a multimodality approach of surgery, hormones, radiotherapy and chemotherapy. The Prostate Cancer Specialist Nurse assists patients in being a single point of contact, providing psychosocial and clinical support, assisting patients and their partners in accessing resources and streamlining the process for the patient when they are referred to other treatment providers.The Prostate Cancer Specialist Nurse pilot program is a new concept in Australian health care, this presentation will focus on:• The Prostate Cancer Specialist Nurses role• Implementation of the Prostate Cancer Specialist Nurse role at Hollywood Private Hospital.

Poster Display 6:Improving Safe Swallowing Strategies

Susan Finlay, Bentley Health Service, Bentley, WA – susan.finlay@health .wa.gov.auSuzie Craigie, Bentley Health Service, Bentley, WA – suzie.craigie@health.wa.gov.au

ABSTRACTFollowing several incidents and near misses relating

to patients with swallowing deficits it was highlighted by the Clinical Nurse Manager (CNM) that targeted patient safety initiatives were required to improve patient outcomes. The CNM and Clinical Nurse Consultant Clinical Governance convened a multi- profession working party to address concerns and to work collaboratively to improve outcomes and reduce incidents. We started by conducting a thorough investigation of all incidents in that previous 6 months, identify-ing all contributing factors. These included inade-quate communication, incorrect diet texture, clinician and catering staff knowledge deficit and inadequate patient safety mechanisms.A process mapping exercise was undertaken to identify gaps in our practice. Several redundant steps were identified in the process, these were eliminated to streamline and improve communication with all members of the team and patients relatives. As part of the working group we developed an action plan with some of the strategies being:• Education for all groups of staff• Reduced formats of communication • Implemented additional safety measures for High Risk patients• Empowered patients and carers to be actively involved at meal times• Dissemination of “3 Rights of Food Administration” posters following education• Collaboration between kitchen and ward catering staff with food textures• Improved signage above beds• Changes to nursing handover documentation• Ongoing incident monitoring and trend analysis

Incidences of (1) the provision of incorrect diet and/or fluids and (2) inadequate clinical care or supervision during meals have significantly decreased demonstrating that the strategies implemented have been effective. Nursing staff are empowered to report near misses and these are used as educational case studies for the ongoing education programme.

Poster Display 7:NPs – New Aged Care Leaders

Leah Hansen MN NP, Brightwater Care Group, 31 Mildenhall St Huntingdale WA 6110Leah.hansen@brightwatergroup.com0410539761

Lorraine Martin MN NP, 30 Regents Park Road

Joondalup WA 6027Lorraine.martin@brightwatergroup.com0420343556

ABSTRACTLeadership is often confused with management roles; the traditional view of leadership is often limited to a set of functions or qualities. Clinical leadership of the Nurse Practitioner (NP) is multifaceted and results in change at policy level, professional level, and patient level. NP practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The NP demonstrates professional efficacy, an extended range of autonomy and legislated privileges, along with being a clinical leader with a readiness and an obligation to advocate for their clients and their profession at all levels of health care.This paper will discuss the leadership influence that Aged Care NPs have brought to the RACF in its 18 months of clinical infancy. The NPs show a commitment to leadership both in the clinical role and in the health delivery system, focused on the concept of pioneering the NP position and continuing to advance and push autonomy to make a difference. To break free of the traditional nursing roles and limitations in Aged Care nursing. Vital to the NP leadership is forging new partner-ships and relationships, NPs are in a key position to mentor clinical staff allowing the other to extend practice in a safe supported environment and foster change in traditional health care delivery. We are often defining practice, advocating for patient rights, and implementing evidence based practice. NPs set as an example to others of responsible, accountable and commendable leadership to which others may aspire.

Poster Display 8:Great Expectations

Pia Herbert, North Shore Private Hospital, St Leonards, NSW, HerbertP@ramsayhealth.com.au

Stephanie Virgona, North Shore Private Hospital, St Leonards, NSW, VirgonaS@ramsayhealth.com.au

ABSTRACTConsistent with our philosophy that maternity services are relationship based, North Shore Private Hospital has recently implemented a number of new services to enhance our strong commitment to patient

27

care and satisfaction. Principal among these was the appointment of a specialist Patient Relations Coordinator to attain the highest possible maternity patient satisfaction. In conjunction with this innovative role, optional packages were developed to complement our existing services. These packages were tailored in partnership with our consumers to provide exclusive benefits for those who sought a more comprehensive experience.

AimsProvide a detailed description of how the Maternity Patient Relations Coordinator role was implemented and has evolved; as well as the challenges, benefits to our patients and the lessons learned by the organ-isation.

Present preliminary quantitative and qualitative data encompassing the efficacy of the additional maternity services packages and the Maternity Patient Relations Coordinator in enhancing patient satisfaction.

Profile private sector opportunities developed by a competitive market leader striving to provide unique and optimal services.

ConclusionHigh quality clinical and personal care go hand in hand to create both a safe and comfortable maternity experience. North Shore Private Hospital has created both an innovative role and extensive additional services to meet the needs of our patients in a diverse demographic. We are constantly striving to ensure the most positive experience for our patients in a challenging and competitive environ-ment.

The introduction of the Patient Relations Co-or-dinator and associated packages has provided a personal contact for patients throughout their maternity experience to ensure a constant point of reference beyond clinical needs. Our commitment to providing patients with a personal element ensures that they always remain our primary focus and their ‘great expectations’ are consistently exceeded.

Poster Display 9:Orthopaedic Nurse Practitioner - The First in WA and the First in Australia in an Acute Care Environ-ment. – Improving Patient Outcomes

Sharon Pickles MNurse(Nurse Practitioner) GradDipEdSir Charles Gairdner Hospital, Verdum Street Nedlands WA 6009 Sharon.pickles@health.wa.gov.au

ABSTRACTThe increased complexity of orthopaedic patients, the demand for greater clinical expertise and support led to advanced practice, and the development of an Orthopaedic Nurse Practitioner (NP) at Sir Charles Gairdner Hospital. While this collaborative care model is in its infancy it is believed the role will have significant benefit in better clinical outcome for patients and families, and ultimately reduce length of stay. Predominately the NP plays a significant role in coordination of clinical management and discharge planning of all minimal trauma fracture patients. Through the implementation of Clinical Practice Guidelines and Drug Formulary the NP can initiate clinical management of specific clinical conditions and assist in improving compliance of prophylactic orthopaedic protocols and commence treatment in a timely manner. The role provides specialist clinical support and consultation to patients admitted within SCGH, their families, staff and in addition provide an outreach service externally to other health services, secondary sites and residential care facilities including ongoing education and support to expedite discharge.

This presentation outlines the implementation of the Orthopaedic NP, the role in the acute care environment and the benefits to ensuring continuity and improved quality care through a dedicated and coordinated nurse led service in collaboration with the interdisciplinary team (Medical staff, surgeons, geriatrician, allied health).

The presentation will briefly discuss aspects of the role including: coordination of care and clinical management of all patients with a minimal trauma fracture including hip fracture patients; facilitating discharges; rehabilitation referrals; clinical man-agement of a number of associated complications; assessment of osteoporosis (OP) and treatment plan; falls assessment and referrals; education to patients aged 50-65 years who have sustain minimal trauma fracture and referral for osteoporosis investigation and management; implement of Hip # Pathway and National Data Collection; and research to provide better outcomes for both patient and the organisation.

28

Poster Display 10:An Innovative Approach to the Implementation of Identification Situation Observations Background Assessment and Action Responsibility (ISOBAR)

Gill Reid, Joondalup Health Campus, Joondalup, Western Australia. Email: ReidG@ramsayhealth.com.au

Caris Nelson, Joondalup Health Campus, Joondalup, Western Australia. Email: NelsonC@ramsayhealth.com.au

Sian Maslin-Prothero, Edith Cowan University, School of Nursing &Midwifery,Edith Cowan University, Joondalup, Western Australia. Email: s.maslin-prothero@ecu.edu.au

The recent introduction of the National Safety and Quality Health Service (NSQHS) standards firmly has the patient as its primary focus and as such is impacting on new and innovative practices being developed. This paper focuses on Standard 6 and Clinical Handover,which not only impacts on direct patient care but also the clinical workforce providing this care. It has been highlighted that clinical handover is a high risk scenario for patient safety (Wong et al 2008); the intention of the standard is to ensure timely, relevant and structured clinical handover that supports patient care as well asimproving patient safety and health outcomes. Clinical handover is the transfer of professional responsibility and accountabilityof care to anotheron a temporary or permanent basis (ACSQHC 2010).To adhere with this standard and ensure that the clinical workforce had the necessary resources to understand the requirements of clinical handover we collaborated with a higher education institute to develop an interprofessionaleducation interven-tion. Using the ISOBAR acronym (Identifica-tion Situation Observations Background Assess-ment and action Responsibility) pre and post test questionnaires were administered, a DVD devel-oped to support learning, and focus groups run to ascertain how change in practice occurred.This paper will focus on the DVD and how the patient is at the centre, offering the opportunity for themto be engaged in their care. Through staff and patient interaction there is an opportunity for the patient to participate and articulate concerns or suggestions

to their current plan of care. Using the DVD as an educational resource tool will allow the clinical workforce to implement the ISOBAR consis-tently, across the disciplines, which ensures the patient receives consistency in critical conversations (ACSQHC2010).

Poster Display 11:Constipation Risk Assessment Tool

Kimberley ZanikBroome Hospital, WACHS Kimberley, W.AKim.zanik@health.wa.gov.au

AIM: To reduce the risk of developing constipation while in the acute care setting through utilisation of a constipation risk assessment protocol.

A constipation risk assessment protocol has been designed and trialled in Broome Hospital as a result of research, evidence based practice and observation that constipation in the acute care hospital setting is poorly managed by health professionals. There is a distinct knowledge deficit into the risk factors of constipation development and best treatment modalities. An ingrained culture exists that bowel management is a nursing duty despite the need for medical collaboration regarding pharmacological intervention and physiological considerations. The disconnect and under recognition of constipation and management strategies is linked to a shift in nursing culture away from basic care towards task driven outcomes. By having a standardised assessment tool available with clear guidelines for the healthcare team, consistent evidence based care in the management of constipation can be delivered. The burden of hospital induced constipation on individuals includes discomfort, embarrassment, pain, headache, confusion, electrolyte imbalance and potentially severe medical complications. The direct and indirect costs of constipation on the healthcare system can be widespread including increased staffing, drug therapy, imaging, and intervention. Untreated constipation in the acute care setting can culminate in increased length of hospital stay and cost of care and places additional burden on an already pressured healthcare system.

The Constipation Risk Assessment Protocol is an integrated tool used collaboratively by Medical and Nursing staff to assess an individual’s risk of developing constipation while in the acute care setting. The Protocol identifies risk factors for an individual

29

developing constipation while hospitalised and places pharmacological interventions pre-emptively in place. By reducing the incidence of constipation there are significant cost savings for the healthcare facility in addition to a reduction in length of stay, and improved quality and health outcomes for patients.

Poster Display 12:Leadership, Confidence and Teaching: The Experience of Faculty Practice for Nursing and Midwifery Academics in Western Australia

Melanie BakerEdith Cowan UniversityNursing Lecturer & Coordinator of Faculty Practicemelanie.baker@ecu.edu.auBSc (Hons), GradCertEd, Dip Nursing, RN

Sadie GeraghtyEdith Cowan UniversityMidwifery lecturer &Coordinator Master of Midwifery Practices.geraghty@ecu.edu.auBA (Hons), BSc (Hons), MMid, MEd, GradCertEd, GradCertERM, RM

Amanda FowlerEdith Cowan UniversityNursing LecturerAmanda.fowler@ecu.edu.auBN, GradCertCritCare, MEd, RN

AbstractThe faculty practice model provides dedicated time for lecturers to work with supervision in the clinical environments for an agreed amount of time each year. Allowing academics to partake in clinical practice this way has been shown to update skills and retain clinical competency. Some Nursing and Midwifery academics believe it is essential to remain clinically current and up-to-date with professional issues in the clinical environments, whereas other academics believe reading current research and not partaking in actual clinical practice maintains clinical competency. The authors of this paper chose to explore their own experiences of faculty practice before going on to research the subject with other academics. Time spent in the clinical areas was invaluable as it allowed the academics to become part of the health professional team; refine clinical skills, gain clinical confidence and share knowledge. This

in turn impacted upon the academic’s teaching style and most reported that they redefined their teaching style by introducing incidents and stories from their experience. It has been concluded by the authors that faculty practice allows academics to increase confidence, encourages leadership skills and improves their teaching abilities in their clinical area of expertise.

We are happy to make this a poster presentation.

Poster Display 13:Fostering Paediatric Nursing in a Developing Country: A Collaborative Professional Development Program

In July 2013 Princess Margaret Hospital for Children was invited to participate in the ongoing professional development of Registered Nurses nursing children and their families at the Hospital Nacional Guido Val-deres, Dili, the national hospital of Timor Leste. The focus of this initiative is to build capacity in the Timorese nurses to effectively care for their paediatric patients.

To achieve this end, four Timorese nurses were selected to participate in the St John of God Hospital’s Nursing Development Program (NDP). This program required nurses to identify an area of clinical care that required practice development to bring about a positive change in the culture of service delivery in their clinical setting.

As a follow up to a fact finding visit to the hospital in Dili in July, the chosen nurses will visit Western Australia for three weeks in September where they will be provided with opportunities to develop their nursing knowledge and skills, as well as their leadership capabilities at both the St John of God Hospital Murdoch and Princess Margaret Hospital. On return to Timor Leste it is anticipated that these nurse will motivate their paediatric nursing teams to develop sustainable improvements in patient care.

This presentation will outline the process related to facilitating the partnership between the three health services. It will include details of the site visit to Hospital Nacional Guido Valderes to identify the local nursing environment, and the preparations undertaken at PMH specific to the education of the nursing staff regarding the nursing environment and nursing culture of the Dili nurses. An account of the Timorese nurses visit to PMH comparing achievements against the stated aims will be provided. The presentation

30

will conclude with an outline for the future of this partnership.

Poster Display 14:Introduction of Assistant in Nursing Trainees into the Emergency Department – The Fremantle Experience

Gerry Gillen, Trish Mc Kinlay , Janelle Hartnett, Fremantle Hospital & Health Service Fremantle, Western Australia

Fremantle Hospital and Health Service is a tertiary teaching hospital in the historic port town of Fremantle. The 37 bed Emergency Department is a major referral centre for many peripheral hospitals and receives approximately 55,000 presentations annually, providing a 24 hour service to both Adult and Paediatric patients. Presentations include a variety of illnesses, injuries and medical conditions with a large proportion of high acuity presentations such as traumatic injury, severe cardiac conditions, paediatric and toxicology emergencies.The nursing model of care was restructured last year to a team based model, to better utilize nursing staff, improve patient care and improve staff satisfaction. However, high ongoing use of non establishment nursing and non nursing staff continued to affect budget and raised concerns regarding quality of care. We also identified that the majority of consumer complaints we received, were directly related to quality of care and patient comfort. This led us to establish a training program in the Emergency Department for Assistants in Nursing, to provide us with an adjunct workforce to support our nursing staff and to improve patient safety and quality of care. Our ultimate goal being, to embed Assistants in Nursing into the clinical care team in the Emergency DepartmentThis presentation will provide an overview of:• Challenges and barriers identified.• Engagement of key stakeholders• Identification of the Role of AIN Trainees in Emergency Care• Education of current staff• Where are we now

Poster Display 15:Reach Population Health Checks from the Student Perspective

Annie Dixon and Helen Kendrick, Central Institute of Technology, Mt Lawley, Western Australia, annie.dixon@central.wa.edu.au and helen.kendrick@central.wa.edu.au

ABSTRACTThis poster will illustrate the effectiveness of a mobile population health check clinic in providing valuable training for student enrolled nurses. In 2012 funding was provided through an Australian Government initiative - Health Workforce Austra-lia, to create additional training capacity in response to the National Partnership Agreement for Hospital and Health Workforce Reform. REACH (Roaming Education and Community Health) was developed to meet this need. REACH has provided an innovative option for the delivery of Primary Health Care (PHC) services to groups within the community. The population health check ‘arm’ of Reach is a mobile service which takes up to 12 students to various sites in the community. During the week long program, students have the opportuni-ty to practice their communication and clinical skills. The students have to complete a self-assessment on these skills on the first and last day, which encourages the students to reflect on their abilities and to see their own professional development over the week. The Registered Nurses who are closely supervising the students also formally assess them on these skills and provide feedback at the end of the week. The clinical skills practiced by the students during the health checks are:- TPR; BP and Oxygen saturation- Blood glucose levels- Total cholesterol levels- Girth (waist) measurements- Communication and health education

The student’s role within the clinic is vital as they perform the health checks. From the student’s perspective it has been, and continues to be, a positive experience. The population health check clinics have been effective in providing invaluable clinical experience. The students are learning in an environment where they are a valued member of a team providing a much needed primary health care service.

31

303LOWE ECU10591 CRICOS IPC 00279B

★★★★★ TEACHING QUALITY★★★★★ GRADUATE SATISFACTION

the good Universities guide 2014reachyourpotential.com.au

E: futurestudy@ecu.edu.au Tel: 134 ECU (134 328)

THAT’S HOW UNIVERSITY SHOULD BE

Apply Now for NURSING & MIDWIFERY

The need for quality healthcare is only growing, which is why we’ve developed courses that focus on the changing needs of healthcare in Australia. We also work closely with both the nursing and midwifery industries

to ensure that courses are relevant and practical. You’ll have access to state-of-the-art facilities, including clinical practice wards, where you’ll learn through simulated scenarios, as well as practicum placement opportunities

with a range of healthcare providers. So you’ll graduate with the skills and confidence to make a difference.

Learning that extends beyond cLassrooms

NOTES

32