Mareeba Hospital Orientation Manual

Welcome to Mareeba Hospital, a 40-bed Level 3 rural hospital with twenty doctors (ten senior, ten junior). This document is designed to provide A-Z ‘at a glance’ information about our facility, services, processes and procedures. We encourage you to speak with your supervisor and peers for additional information or clarification.

Address details: Mareeba Hospital, 21 Lloyd Street, MAREEBA 4880 Tel: (07) 4092 9333 Fax: (07) 4092 9160

Table of Contents

About Mareeba Hospital ...... 3 Allied Health Services/Contacts ...... 3 Assistance ...... 3 Baby Friendly Health Initiative (BFHI) Accreditation ...... 4 Doctors - Daily Doctor’s Meeting ...... 4 Clinical Handover ...... 4 Shift to Shift Clinical Handover Policy ...... 4 Doctors – List of Mareeba Hospital Doctors ...... 5 Doctors – List of Mareeba General Practitioners ...... 5 Doctors – Education Sessions ...... 5 Doctors - Rosters ...... 6 Doctors – Timesheets/AVACs/MEDAVACs ...... 6 ED/OPD – Patient/chart management...... 6 Haematology ...... 7 Hand Hygiene ...... 7 Mandatory Reporting ...... 8 Medical Imaging ...... 8 Medical Records ...... 8 Mental Health ...... 8 Nursing Staff ...... 9 Obstetric Doctors ……………………………………………………………………………9 Pathology ...... 9 Pharmacy ...... 10 Sexual Assault Medical Examinations ...... 10 Ward Rounds ...... 10 Inpatient Services ...... 10 Outpatient Services ...... 10 Occupational Therapy Home Visits ...... 11

Mareeba Hospital Orientation Manual

About Mareeba Hospital Mareeba Hospital is a 40-bed Level 3 general hospital servicing some 20,000 residents and visitors to the Mareeba district, including a large Indigenous population.

We provide outreach services to the township of Dimbulah, as well as a nearby Correctional Centre (Lotus Glen Correctional Centre).

Our case load includes emergency presentations with trauma and acute illnesses, care of inpatients including paediatrics and a general practice outpatient clinic. There are also regular theatre lists, a maternity unit and weekly doctor education program. We host specialist outreach services provided by Cairns Base Hospital.

Hospital services include Emergency Department, Outpatients Clinics, a General Medical and Surgical Ward, Maternity and Paediatrics Unit, Operating Theatre, Community Health Unit, Indigenous Health, Mental Health, Dental Services, Alcohol Tobacco and Other Drugs Service (ATODS) and Tablelands Aged Care Health Service (TACHS).

Several specialist outpatient services are provided including surgical gynaecology, paediatrics, thoracic medicine, psychiatry, foot clinic and anaesthetics. Specialist support services at the hospital include pharmacy and x-ray departments.

Our Maternity unit offers an innovative midwifery led model of care in conjunction with a medical model of care, and the Older Persons Evaluation, Rehabilitation and Assessment (OPERA) unit is a valuable addition to our service offering.

Mareeba Hospital is accredited under the Institute of Health Communities Australia Quality Improvement Council (QIC) Standards and Accreditation Program, and is recognized as an accredited Baby Friendly Facility. We are an Accredited Teaching Hospital of James Cook University (Medical and Registered Nursing students) and the Generalist Medical Training (Australian College of Rural and Remote Medicine Provisional Fellows). Moreover, we work with TAFE Queensland in the training of Enrolled Nursing students.

Allied Health Services/Contacts For information regarding Allied Health please contact the following staff: • Aneka Colleson, Speech Pathologist • Will Geddes, Radiographer • Aneta Thompson, Dietitian • Vanessa Key, Social Worker • Rhonda Gilbo, Indigenous Health • Andy Harris, A/Director of Pharmacy Assistance Options for assistance and information include: • Executive Support Office tel 4092 9159 • Nursing staff • Cairns Base Hospital) - ask for Emergency Department Registrar or on-call Registrar for required specialty • SMO on call – available for help until 22h00 at night and from then on the telephone • QCC (1 300 799 127) can provide telephone advice

Mareeba Hospital Orientation Manual

Baby Friendly Health Initiative (BFHI) Accreditation

Mareeba Hospital is Baby Friendly Health Initiative (BFHI) Accredited. It is a requirement that all Medical staff that work in the Maternity Unit abide by the 10 steps to initiate breastfeeding.

Ten Ways We Support Mothers and Babies to Breastfeed 1. Staff are guided by a current breastfeeding policy 2. Staff are provided with up-to-date information and education to help you breastfeed 3. We provide opportunities during your pregnancy for you to learn about breastfeeding 4. We encourage you to hold your baby in skin-to-skin contact and, help you to recognise when your baby is ready to feed (baby feeding cues) 5. We will help you to breastfeed and show you how to express your breast milk, even if you are separated from your baby 6. Your baby will only be given your breast milk, unless there is a medical reason 7. We encourage you and your baby to be together at all times 8. We encourage you to breastfeed in response to your baby’s feeding cues 9. We discourage the use of dummies and teats as they can interfere with establishing breastfeeding 10. We will help you find local breastfeeding supports

Babies who are sick or premature may require additional support It is expected that all Medical staff working in maternity unit (Group 2) attend a yearly Breastfeeding education session that includes the BFHI curriculum. It is expected that you do the first education session within six months of commencing work at Mareeba Hospital. Alternatively the Education module - Establishing Breastfeeding in the Queensland Clinical Guidelines site can be completed.

Doctors - Daily Doctor’s Meeting All doctors meet at 08:00 daily in the executive meeting room for a handover session: Clinical Handover This policy was developed in consultation with Mareeba hospital SMOs and commenced May 2014. It is to be reviewed at least annually, with last review in February 2017. The review must take regular audits and any adverse incidents documented into account.

The aim is for all medical officers to participate in effective handover resulting in transfer of responsibility and accountability for patient care. Shift to Shift Clinical Handover Policy At 08h00 every morning the night duty medical officer meets with the incoming day staff to handover, using the written SBAR format, patients admitted overnight and any patients that required medical review. Patients admitted the previous day are also discussed using the same format. Any patients currently in the Emergency Department are also handed over using the SBAR format.

At 09h00 every weekday morning there is a full interdisciplinary team clinical handover using SBAR in East Ward.

Mareeba Hospital Orientation Manual

Throughout the day ED medical officers will also perform a telephone SBAR handover of any newly admitted patients to the ward medical officer SMO or PHO. This fact is to be documented in admission notes.

At 17h30 daily, the ward medical officer hands over patients who will require review overnight, using the written SBAR format, to the late SMO or PHO. This medical officer in turn will hand over these patients and any further patients requiring review to the night duty medical officer at 21h00.

Obstetric SMOs will handover clients at 08h00. If the SMO on call is different to the day Obstetric SMO, a further handover will occur at 18h00. Doctors – List of Mareeba Hospital Doctors • Dr Tjaart Grobbelaar, A/Rural Director Medical Services (Anaesthetics/ED) • Dr Toby Hopton A/Medical Superintendent, Mareeba Hospital (Anaesthetics/ED) • Dr Dottie Prinsloo SMO (ED) • Dr Margaret Purcell SMO (Indigenous Health, Lotus Glen and Methadone) • Dr Peter Arnold-Nott (Obstetrics and Anaesthetics) • Dr Merrilee Frankish SMO (Obstetrics) • Dr Andrew Mason SMO (Anaesthetics/ED) • Dr Cassandra McKay SMO (Obstetrics/ED) • Dr Brian Treanor SMO (Anaesthetics/ED) • Dr Renee Guli SMO (Obstetrics/ED) • Dr Sarah Farlow SMO (Obstetrics/ED) • Dr Eliza Spann SMO (Obstetrics/ED) • Dr Philippa Mason SMO (Obstetrics/ED) • Dr Riley Savage SMO (Obstetrics/ED) • Dr Neil Beaton SMO (Anaesthetics/ED)

• Dr Marcella Seve PHO • Dr Lyndelle Barry PHO • Dr Andrina Penfold PHO • Dr Lee Wanstall PHO • Dr Lucy Morris PHO • Dr Sahaana Rajenthiran PHO • Dr Emma Clow PHO, Part Time • 2 x Resident from Cairns Hospital on rotation • 2 x Interns

Your official nominated supervisor for your term in Mareeba Hospital will be Dr Hopton – Medical Superintendent, but all SMO’s can supervise when Dr Hopton is unavailable. Doctors – List of Mareeba General Practitioners Amaroo Medical Centre, Karobean Drive, Mareeba 4880 Ph 4092 5900 (speed dial 2740)

Mareeba Medical Clinic PO Box 1117, Mareeba 4880 Ph 4092 2877 (speed dial 2739)

Mulungu Aboriginal Corporation Medical Centre PO Box 2297, Mareeba 4880 Ph 4092 3428 (speed dial 2860) Doctors – Education Sessions Monday, Wednesday and Friday mornings Lunch time education sessions are held in one of the meeting Rooms at 12:30 each Wednesday.

Mareeba Hospital Orientation Manual

Lunch is provided. Doctors - Rosters The daily roster is written up on whiteboard at ED control desk. Daily shifts are: • Ward/Ward: full day in the Ward 08:00 – 16:30 • E: early shift, 08:00 – 19:00 (1 hour lunch break) • L: late shift, 10:00 – 21:00 (1 Hour lunch break) • Night: night shift 21:00 – 09:00 (1 hour meal break)

The monthly roster is stored G:\Common\Doctor Rosters. Any questions regarding the roster can be directed to the Medical Superintendent. Roster abbreviations are: • Ward: ward rounds/inpatient care • AD: administration session • E: ED: early shift in the Emergency Department from 08:00 – 19:00, lunch break 12:00 – 13:00, see acute presentations • L10: ED: late shift in the Emergency Department from 10:00 – 21:00, lunch break 16:00 – 17:00, see acute presentations • L12: ED: late shift in the Emergency Department from 12:00 – 23:00, lunch break 17:00 – 18:00, see acute presentations • Note that lunch breaks are flexible and can be arranged between the doctors on duty each day • DIMB: Dimbulah clinic 09:00 to 15:00, covered by SMO Dr Margaret Purcell • GP: booked Out-Patient General Practice-type clinics. • LG: Lotus Glen Correctional Centre clinic 09:00-16:00 on Monday and Fridays/ 9:00 to 12:00 Wednesdays • Mat: Maternity Case Load Meeting (Tuesdays 09:00 to 10:00) • NIGHT: night shift from 21:00 – 09:00 • PNC: “Ante-natal” clinic (baby checks, Implanon insertions, or pregnancy checks), return to ED on completion of clinic • Anaes: anaesthetic checks for upcoming theatre lists

Roster abbreviations continued: • 08:00 – 12:00: GP Cover in ED on weekends and public holidays • 23:00 – 08:00: SMO on standby - period covering the hospital wards and ED • PDL: Professional Development Leave • RL: Recreational Leave Doctors – Timesheets/AVACs/MEDAVACs Blank timesheets (AVACs/ MEDAVACs) are available via QHEPS.

The night PHO is to report to ED at 20:50 for handover. If there are no patients to attend to, the night PHO can help clear any backlog of discharge summaries. SMO back-up is available within 10 minutes from 21:00 – 08:00. The SMO should be called for resuscitation/procedural sedation, and should be informed of very sick patients for admission or patients referred to Cairns Base hospital. The SMO is also available for general advice.

Ward PC login details are updated regularly – check with Ward Clerk for log-in details ED/OPD – Patient/chart management Patients are triaged by nurses and charts are placed in boxes at end of ED control desk.

Pick up charts in triage category order then time order. Update EDIS (the IT Triage system) as soon as you are in the examination room with the patient to reduce confusion for other doctors and allow for more compilation of accurate waiting time statistics.

Mareeba Hospital Orientation Manual

The patient’s location is indicated on the Triage sheet (usually the waiting room). Mobile patients can be treated in any available room.

Place finished charts in the box to the left of triaged charts.

If a patient needs outpatient clinic follow up, ask patient to arrange this at the Medical Records counter before they leave the hospital. To make this process easier, provide the patient with an orange slip (available in the Exam Rooms). Note the timeframe for review, and whether any specific doctor needs to see the patient.

If a patient is provided with a referral to a specialist, please provide a copy of the referral to Specialist Appointment officer Tanya Croucher so that she can arrange appointment bookings and manage waiting lists.

Ask the Ward Clerk, nurses, or other doctors for assistance with any of these matters. Haematology Dr Ketan Bavishi provides haematology services at Atherton District Hospital each month. Dr Andrew Shearer, an associate of Dr Bavishi, provides a weekly chemotherapy clinic at Atherton District Hospital so some patients do not have to travel to Cairns for treatment. Hand Hygiene Improving Hand Hygiene among healthcare workers is currently the single most effective intervention to reduce the risk of hospital-acquired infections in Australian hospitals.

We are regularly audited on hand hygiene so please always remember to follow the five moments below.

Five Moments for Hand Hygiene have been identified as the critical times when Hand Hygiene should be performed.

Mareeba Hospital Orientation Manual

Mandatory Reporting New mandatory reporting laws requiring doctors to report certain types of misconduct committed by their colleagues commenced on 1 January 2010.

The new laws require a doctor who is aware, or reasonably suspects, that another doctor has engaged in reportable misconduct, to inform the Board in writing as soon as possible.

Reportable misconduct includes:

• engaging in sexual misconduct while practising practising while intoxicated by a drug or alcohol practising while affected by a physical or mental impairment, or other health condition, other than intoxication by a drug or alcohol; and • causes, or is likely to cause, harm to a person receiving professional services from the doctor practising the profession • practice of the profession in a way that significantly departs from accepted standards of the profession; and • causes, or is likely to cause, harm to a person receiving professional services from the doctor practising the profession.

More information, including an information sheet, FAQs and the updated Notification Form are available online at http://www.medicalboard.qld.gov.au/reporting.html Medical Imaging X-Ray services are available 08:00 – 16:30. The radiographer is on-call 24/7 for X-Rays when a positive finding will change management. The nurses can contact the radiographer for you. There is generally only one radiographer available to Mareeba Hospital so please consider whether the X-ray will change management (if not, it’s preferable to do the X-ray next morning).

Ultrasound is also available from Monday – Thursday 08:00 – 16:30 at Mareeba Hospital. CT scans are available at Atherton District Hospital on Tuesdays only. For appointments contact the Medical Imaging department Tel: 4091 0226.

MerlinWeb is a district-wide system. Medical images from Mareeba Hospital are viewable at Cairns Base Hospital. To open MerlinWeb: Ctrl+Alt+M, log in details are: User id: doctor, Password: doctor. X-ray report are viewable on MerlinWeb (open study then click ‘Report’ icon at bottom right). An online MerlinWeb tutorial is available at: http://qheps.health.qld.gov.au/cairns/docs/pacs_merlinweb_intro.pdf Medical Records It is imperative for Patient Safety that all movements of patient charts are accurately recorded on HBCIS so that we can promptly retrieve charts. Charts should not be moved to another room or location without notifying the Medical Records team. Mental Health Senior Medical Officers

Access to Mental Medical Health notes is available through CIMHA. All Senior Medical Officers have been processed to enable access to CIMHA. To access CIMHA, click on the Viewer on the desktop of QH computers. Login and Password are your Novell username and password. - For those computers where the Viewer is not accessible via the desk top the following URL will show the log in screen. http://eds.health.qld.gov.au/emr

Mareeba Hospital Orientation Manual

Nursing Staff Ward and ED nurses can cannulate and take blood. Some ED nurses can suture and prescribe. Key contacts:

• Vickye Coffey, Director of Nursing & Facilities Manager • Rose Vallier, NUM ED/OPD • Robyn George, NUM East Ward • Michelle Bombardieri, NUM Maternity • Kerry Grigg, NUM Community Health • Tanya Barker, NUM West Ward • Sheila Hicks, ATODS Coordinator

Obstetric Doctors It is recognised that a thorough clinical handover is essential for good patient outcomes. Given that we have many medical officers, some part time, who cover obstetrics at Mareeba Hospital, we have developed these recommendations

Electronic Obstetric hand-over sheet on G:drive A file has been created on G Drive-Common-Mareeba Doctors File- Maternity Medical Handover. There is a section for inpatients, a section for booked inductions and a section ‘to be aware’. Hopefully that way if we don't get a chance to update the next on call SMO, then there should be enough information available.

Whoever is on Obstetrics for the morning (even if you are the same person on that day and night) walk past maternity at 8:30, sort out anything urgent, clarify who is on call for the day, their hours, (as it may be two people over the day) and ensure the on-call board is accurate. Let them know the obstetric SMO will be back at lunch time for the ward round. The obstetric medical officer on call that night, will do a lunch time ward round, attending between 11-1. Prescriptions, signing of path forms and imaging forms and other little things could all be grouped together.

If an induction is booked when another Obstetric SMO is on, formally hand over the patient via text or phone call. Any unstable patients the same. For CS- we follow our own patient at least once a day for the first 3 days. If we are going on days off, hand them over.

If the ward doctor is on call, ED SMOs have often kindly covered obstetrics until lunchtime.

Case reviews will be held after Maternity Case Conference on Wednesday mornings, unless by other arrangement.

Pathology • iStat (Hb, U&E, Troponin, INR) • 2 x pathology runs/day (11:00 & 15:00) • Auslab/Auscare to view results

If patient requires admission, please list pathology investigations ordered when writing admission notes in order to avoid double requests for investigations.

Please consider whether an investigation will change the management of the patient. I.e. If the patient clearly has cellulitis or other bacterial infection, requesting a CRP is not beneficial.

Mareeba Hospital Orientation Manual

Pharmacy The hospital Pharmacist attends ward rounds in the mornings and can provide detailed information about pharmacy services. • Please provide a sample signature to the Pharmacy on commencement of duties using the Memo provided. • Mareeba Hospital is a PBS hospital. • All prescriptions should be written according to PBS and LAM rules (list of approved medicines – formerly the SDL). This is important as the majority of our patients take their prescriptions to community pharmacies for dispensing. • Website links for further information: www.pbs.gov.au, http://qheps.health.qld.gov.au/hsq/medicines/lam/home.htm

Medication can only be supplied after hours from the List of Approved Medicines (LAM). All medications (antibiotics and analgesics) are kept as per PBS pack sizes to simplify writing of scripts.

If you prescribe a different quantity of medication, you will have to break the pack yourself as nurses cannot dispense medication.

There is an Antimicrobial Stewardship Pharmacist available to consult with if you have any queries regarding the prescribing of antibiotics. Sexual Assault Medical Examinations Any qualified Medical Officer can do Sexual Assault Forensic Medical Examinations, but given the legal ramifications, court appearances and testimony regarding training and evidence collection involved, it is inadvisable for specifically our junior medical staff to get involved with this. QPS can be referred to Cairns as there normally is a trained doctor available to do these examinations. Ward Rounds • Ward PC login details are updated regularly – check with Ward Clerk for log-in details • Patient charts are stored in shelves at the nurses station • Old notes are stored on shelves above patient charts • Several local GPs have admitting rights to Mareeba Hospital. Private patient charts have a coloured spine (public patient charts have a white spine) • Change of episode forms: please complete a Change of Episode form when a patient is no longer being treated acutely and is awaiting placement or rehab (forms available from nurses)

Inpatient Services Ward cover is daily provided, 24/7 with SMO and PHO cover.

If a patient requires allied health services on the ward, please make a written referral by completing a red referral form (located in the nurses station) with contact details of the patient, contact details of the referrer and information regarding the reason for referral and pin onto the allied health referral board which is located in the computer room on East Ward. Outpatient Services For patients requiring outpatient services, please make a written referral on a yellow (located in OP department or in the filing cabinet in East Ward) or blue form including contact details of the patient, contact details of the referrer and information regarding the reason for referral. Please note that referrals are prioritised according to the information provided therefore detailed information is much appreciated.

Due to the demand for allied health services there is limited capacity for staff to see outpatients on the spot. If a patient has an appointment at the outpatient clinic or dressing clinic and is likely to require an urgent review please phone in advance to organise a mutually convenient day/time.

Mareeba Hospital Orientation Manual

* Please note that a written referral from a doctor is required for all patients requiring compression therapy from Occupational Therapy. Occupational Therapy Home Visits Occupational Therapy home visits for both inpatients and outpatients are conducted on Wednesday and Friday afternoons between 12:30 and 4:00pm.

If an inpatient requires a home visit please phone ext. 9320 or complete a written blue referral. Due to the extra time involved inpatients are not generally taken on home visits unless there is a need for them to be present. Please advise the Occupational Therapist at the time of referral if you recommend an inpatient to be present during the home visit.

Occupational Therapy Occupational Therapy service hours for Mareeba Hospital are Monday - Friday from 8:00am – 4:30pm. Paediatric outpatient hours are 8:00- 4:30pm on Wednesdays.

Ward cover is provided in the mornings and outpatients are seen in the department in the afternoons.

Speech Pathology Speech Pathology service hours are from 8:00am- 4:30pm Monday – Friday. Ward cover is provided in the mornings and outpatients are seen in the department in the afternoons.

Physiotherapy Physiotherapy service hours are 8:30am- 4:30pm Monday- Friday. Ward cover is provided in the mornings and outpatients are seen in the department in the afternoons.