Orientation Information For Ambulatory Care/

Faculty Medicine, Dentistry & Health Science

Orientation Information – IPE Placement Outpatients SCGH 2013 Introduction

Interprofessional Education is a critical component of education in terms of students learning with, from and about each other. Interprofessional learning (IPL) embraces a life- long, active learning process between different cultures and healthcare disciplines(1)IPL philosophy supports health professionals working collaboratively in a health care setting, though a purposeful interaction with service users and carer, to produce quality patient centered care. All students should have reviewed the UWA FMDHS IPL handbook and pre-readings on the relevant unit Learning Management System (LMS- www.lms.uwa.edu.au). The handbook describes the learning outcomes for the placement and the expected capabilities that are required as an outcome of the placement. In addition to the specific IPE capabilities this placement will also provide learning opportunities for the development of skills and practice important for your future medical, nursing and pharmacy careers. Ambulatory Care The majority of patient care in hospitals is delivered in the outpatient setting as this is an advantage for patients in terms of social dislocation and hospital acquired infections associated with inpatient care. Most community based care is provided by GPs and community services such as Silver Chain. Being able to adapt clinical assessments to chronically ill patients, often with multiple problems, rather than acutely ill ward patients is vital. Many allied health professionals are involved in the care of patients accessing services in outpatients to ensure best patient care is delivered and to bridge the gap between community and hospital. This placement will provide opportunities to experience an ambulatory care setting and model of care, engage as a member of an interprofessional team and also gain discipline specific knowledge and skills. Placement Program: The orientation for the IPE placement will be held in the Respiratory Outpatients clinic, Ground floor B block Hovea street at 08.00 on the first day of your placement (see appendix 1 below). The timetable for the placement is provided in appendix 2 and further explanation will be given at the outpatient orientation.

Learning Outcomes of the IPE Outpatient Placement Specific learning outcomes for students engaged in interprofessional clinical attachments that assist the development of the UWA interprofessional capabilities are to: 1. Discuss the importance of team work to delivery of effective patient care 2. Compare the different professional roles of team members 3. Compare and contrast the different skills of team members 4. Discuss the importance of handover and techniques for effective handover 5. Discuss the importance of placing the patient’s views at the centre of care planning and team working 6. Engage in a review of the management of an individual patient with members of their own/other profession(s)

By the end of the placement the student will:

 Improve general clinical skills (knowledge, practical & presentation skills)

 Gain confidence in performing full patient assessment within a short time frame

 Gain an understanding of the role of outpatients and the patient pathway through the system, including understanding the roles of General Practitioners, community and hospital based nursing and allied health professionals and medical specialists.

 Develop awareness of both patient and referrer wishes/expectations

 Improve communication skills with patients, colleagues and community (verbal & written)

 Understand the importance of and participate in patient education

These outcomes can be achieved through:

 Active involvement at each clinic (direct patient contact/assessment, organising and following up investigations, taking responsibility for letters to GPs, referrals, allied health)

 Time spent with multiple allied health professionals (in OP and community settings)

 Regular opportunities for feedback, debriefing, presentation and case discussion

 Reflective and self-directed learning

 Appraisal and assessment throughout the attachment (CPAT, ICAT, PSL or DoCs)

Specific Clinic Information and Learning Outcomes Pleural Clinic: The focus of this clinic is the investigation and management of pleural disease.

 Gain knowledge of different pleural pathologies and their investigation

 Increase confidence with CXR recognition and interpretation  Understand how to approach management and care of pleural effusion

 Practical experience of thoracocentesis and indwelling pleural catheters

Cystic Fibrosis Clinic: This clinic is the centre for management of Cystic Fibrosis in WA. Most patients are referred from PMH for ongoing treatment. This is a multi disciplinary team and consists of medical staff, nurses, physiotherapist, dietician, occupational therapist, pharmacist and social work.

 Understand the pathophysiology behind the genetic abnormality in CF

 Understand and assess for complications of CF

 Become familiar with CF medications

 Understand the importance of multidisciplinary care

 Understand importance of patient education and patient led care Interstitial Lung Disease Clinic: This clinic focuses on the investigation and management of a range conditions which cause inflammation and scarring to the lung lining.

 Be able to assess and investigate patients presenting with breathlessness

 Be able to interpret pulmonary function tests and 6 Minute Walk test

 Know the common causes of ILD

 Gain experience of appropriate management strategies, in particular oxygen therapy

 Gain insight into living with chronic/disabling disease

 Monitoring of oxygen therapy Lung Cancer Clinic: The focus of this clinic is the investigation, diagnosis and management of lung cancer.

 Develop an organised approach to investigating patients with an abnormal CXR

 Gain experience in reviewing abnormal CXR

 Gain confidence in effective communication & experience breaking bad news

 Understand the patient pathway (from referral to diagnosis) Asthma Clinic/Asthma Educator: The focus of this clinic is the education and management of patients with Asthma

 Identify and understand different inhaled therapy

 Be able to perform spirometry, peak expiratory flow measurements and interpret the results

 Assess adequacy of patient’s inhaler technique and educate patients on best practice

 Gain in depth knowledge of managing acute and chronic airway disease

 Gain experience in Respiratory Assessment Diabetic Clinic/Diabetic Nurse Educator: This clinic is a multi-disciplinary clinic providing a broadly based diagnosis and management service. The unit has access to excellent facilities in the area of diabetes education, dietetics and podiatry, and is active in diabetes research and in teaching, including nurse educators.

 Be able to take a problem orientated, comprehensive history and perform physical examination on a diabetic patient

 Perform and interpret BGL

 Have a framework for assessing diabetic patients covering current control, complications and co-existing risk factors

 Understand why and when different hypoglycaemic agents are used

 Assess patients technique of self administering insulin, provide education on best practice

 Initiate patient education (BM monitoring, nutrition, insulin therapy)

Pain Management Department

This clinic is a multi-disciplinary clinic comprising staff from medical, nursing, physiotherapy, clinical psychology and occupational therapy clinical streams and supported by an administrative staff of six (including HSA) officers. The clinic provides outpatient and inpatient services accepting 1200 referrals a year to the service from General Practitioners, Specialists and Inpatient sources. The Department is accredited by the Faculty of Pain Medicine of the Australian & New Zealand College of Anaesthetists for advanced training in pain medicine. The Department offers medical training for anaesthetic trainees studying for Fellowship of the Australian & New Zealand College of Anaesthetists and provides support for them during module 10 of their training. UWA, Curtin and Murdoch Universities regularly place advanced trainees in Clinical Psychology in the Department. The Pain Management Department regularly welcomes and hosts visiting staff from within the SCGH campus, state-wide, national and overseas visitors to gain knowledge and experience in ways to manage chronic pain

 The Pain Management Department has 6 procedure sessions per week primarily run as a day procedure clinic where patients are admitted and discharged on the same day but with enough flexibility to cope with additional inpatients as required.  Intrathecal Pump refill patients are also admitted as day patients for refilling of their pump and medical review by their treating Consultants on their respective procedure session

 Review of inpatient consultation requests are attended on a daily basis whenever possible by one of the clinical fellows on a rotational basis. Written ward consults average 10-15 per week but telephone consultations re inpatients would average 25-30 per week. If patients need a procedure they can generally be added into a routine procedure list within the week.

Tips for seeing patients in the outpatients department When reviewing a patient in the OPD setting it is useful to consider these points:

 When is referral to outpatients (or a private specialist) necessary?

 Why has this patient been referred/what is the purpose of today’s outpatient visit? Patients are referred for many reasons e.g.:

 Referral for a specialist review - to make a diagnosis or plan management

 Referral for nursing or allied health review (i.e. physiotherapist, speech therapist)

 Follow up by a specialist of clinical progress, results and planning further treatment

 Managing patients with complex chronic problems which requires specialist input (i.e. Cystic Fibrosis, transplantation)

 Management of complex problems that require an Interprofessional team

 Does this patient need to continue to be seen in outpatients and who should provide follow-up care? IPE Assessment Requirements Assessment for the Interprofessional placement is the Interprofessional Capability Assessment Tool. The ICAT assessment is to be completed by the end of the clinical placement by you and your IPE facilitator. Students are required to complete reflective entries that show evidence of having met the interprofessional capabilities and IPE facilitators will complete a rating of capability according to the rubric in the assessment.

Placement Evaluation As part of an ongoing educational evaluation strategy we encourage all students to participate in evaluation activities. All students have been forwarded a link to a survey (via Survey Monkey). Please complete the pre-test Interprofessional Socialisation and Valuing Survey prior to starting this attachment. In order to measure a change in knowledge, attitudes and behavior with regard to interprofessional capabilities you will also be asked to complete post-test Interprofessional Socialisation and Valuing Survey on completion of your placement.

Key Contacts for Placement : If you require any further information during the placement please contact the discipline specific coordinator as per below or contact the unit coordinator as per LMS information. Rachel Latham/Helen Dugmore (Nurse 0409 889 940 Educator)

Elisabeth Feher (Medical Education Registrar) 0421 556 820 Natalia Forrest (Pharmacist) 0417 986 043 or pg 4242 through SCGH switch,93463333 Respiratory Clinic, Ground floor, B Block Consultant lead: Fiona Lake Contact through SCGH switch 9346 3333 Respiratory Nurse Practitioner: Sue Morey 9346 2318 Respiratory Homelink: Barbara Stubber 0410 447 416 Diabetes Clinic, Level 1, Main OPD, E block Consultant lead: Joey Kaye Contact through SCGH switch 9346 3333 Diabetes Nurse Educator: Gwen Babel 9346 2678

Pain Management Clinic , Lower Ground Floor, G Block, Next To Podiatry (Via The Green Lifts) Head of Department: Dr Mark Shultze Contact through SCGH switch 9346 3333 Clinical Nurse Manager: Denise Fairclough Contact through SCGH switch 9346 3333

Appendix 1: SCGH Map

Appendix 2: Placement Program AMBULATORY CARE STUDENT PLACEMENT PROGRAM 1

Program 1 Respiratory and Diabetes

Student 1 MONDAY Week 1 (Resp) Week 2 (Diabetes) 08.00-09.00 Orientation; Introduction to the IPE 09.00- Diabetic clinic – Dietician(Level 1 OP) team, overview of IPE, Team building 12.30 activity, site tour and introduction to key staff 08.30-12.30 Pleural clinic (Prof Lee) 13.30 -16.00 CF clinic 13.30- Diabetic Nurse Educators 16.00 15.00 – Specialty tutorial (MS only) 15.00 Specialty tutorial (MS only) 17.00 -17.00 TUESDAY 08.30-09.00 Meet with IPE facilitators, discuss 08.30- ILD clinic (Prof Lake) objectives for clinical attachment, 12.00 concerns, other info 0.900-17.00 Home Visiting with Barb Stubber 12.30- PGME meeting (Joske Level 8) 14.00 14.00- Lung Cancer clinic (M. Phillips) 17.00 WEDNESDA Y 07.45 Intern teaching (Joske room) 07.45 Intern teaching (Joske room) 0.900-12.00 Asthma clinic (Prof Thompson) 09.00 Free: Reflective learning -12.00 13.00-14.00 Student Tutorial 13.00- Student Tutorial 14.00 14.00 -16.00 General Respiratory clinic 14.00 Interventional bronchoscopy –Theatres. -1600 If no cases join in the General respiratory clinic 15.00-17.00 Specialty tutorial (MS only) 15.00- Specialty tutorial (MS only) 17.00 THURSDAY 09.00-12.00 Bronchoscopy (Ward G75) 09.00- Asthma Educator (S. Coleman) 12.00 14.00-16.00 CF clinic 13.30 Diabetic nurse educators -16.00 16.00-17.00 IPE CBD – all students Discuss patients 16.00- IPE CBD – all students Discuss patients seen, seek advice from each other 17.00 seen, seek advice from each other where where required for management or required for management or referral referral FRIDAY 07.45 Lung Cancer Multi-disciplinary team 07.45 Lung Cancer Multi-disciplinary team meeting meeting 0.900-12.00 Lung Ca F/U clinic (M. Phillips) 0.900- Lung Ca F/U clinic (M. Phillips) 12.00 12.00-13.00 Respiratory radiology meeting 12.00- Respiratory radiology meeting 13.00 14.00-15.00 Student Tutorial/Debrief 14.00- Student Tutorial/Debrief 15.00 15.00-17.00 Specialty tutorial (MS only) 15.00- Specialty tutorial (MS only) 17.00

AMBULATORY CARE STUDENT PLACEMENT PROGRAM 2

Program 2 Diabetes and Chronic Pain Service

Student 2 MONDAY Week 1 (Diabetes) MONDAY Week 2(CPS) 08.00-09.00 Orientation; Introduction to the IPE team, 08.00-09.00 Orientation to CPS with Denise Fairclough overview of IPE, Team building activity, (CNM) site tour and introduction to key staff

09.00-12.30 Diabetic clinic Dietician (Level 1 OP) 13.30 -16.00 Diabetic Nurse Educators 09.30-15.30 Introduction to Pain Management (IPM) program - coordinated by Lisa Olsen (OT) 15.00 – Specialty tutorial (MS only) 15.00–17.00 Specialty tutorial (MS only) 17.00 TUESDAY TUESDAY 08.30-09.00 Meet with IPE facilitators, discuss 07.30-09.00 Education Meeting objectives for clinical attachment, concerns, other info 08.30-12.00 ILD clinic (Prof Lake) 12.30-14.00 PGME meeting (Joske Level 8) 09.00-12.00 Physiotherapy with Bri Tampin or Jan Mountford (NS Triage) 14.00-17.00 Lung Cancer clinic (M. Phillips) 12.00-13.00 Multidisciplinary Case Conference 14.00-17.00 Physiotherapy and Neurosurgeon clinic WEDNESD WEDNESDA AY Y 07.45 Intern teaching (Joske room) 07.45 Intern teaching (Joske room) 0.900-12.00 Free: Reflective learning 0.900-12.00 Interventional pain management procedures 13.00-14.00 Student Tutorial 13.00-14.00 Student Tutorial 14.00 -16.00 Interventional bronchoscopy –Theatres. 14.00 -17.00 Pain Management Outpatients Clinic (Dr If no cases join in the General respiratory Goucke) clinic 15.00-17.00 Specialty tutorial (MS only) 15.00-17.00 Specialty tutorial (MS only) THURSDAY THURSDAY 09.00-12.00 Asthma Educator (S. Coleman) 08.00-12.00 NSG: Interventional pain management procedures MED: Bronchoscopy (Ward G75) or interventional pain management procedures 13.30-16.00 Diabetic nurse educators 14.00-16.00 NSG: Pain Management Outpatients Clinic (Dr Majedi) MED: CF clinic or Diabetes nurse educator 16.00-17.00 IPE CBD – all students Discuss patients 16.00-17.00 IPE CBD – all students Discuss patients seen, seek advice from each other where seen, seek advice from each other where required for management or referral required for management or referral FRIDAY FRIDAY 07.45 Lung Cancer Multi-disciplinary team 07.45- Lung Cancer Multi-disciplinary team meeting meeting 0.900-12.00 Lung Ca F/U clinic (M. Phillips) 0.900-12.00 Free: Reflective learning 12.00-13.00 Respiratory radiology meeting 12.00-13.00 Respiratory radiology meeting 13.00-15.00 Student Tutorial/Debrief 13.00-16.30 15.00-17.00 Specialty tutorial (MS only) 15.00-17.00 Specialty tutorial (MS only)

AMBULATORY CARE STUDENT PLACEMENT PROGRAM 3

Program 3 Chronic Pain Service and Respiratory

Student 3 MONDAY Week 1(CPS) MONDAY Week 2 (Resp) 08.00-09.00 Orientation; Introduction to the IPE team, 08.30-12.30 Pleural clinic (Prof Lee) overview of IPE, Team building activity, site tour and introduction to key staff

08.00-0.900 Orientation to CPS with Denise Fairclough (CNM) 09.30-15.30 Introduction to Pain Management (IPM) 13.30-16.00 CF clinic program - coordinated by Lisa Olsen (OT) 15.00 – Specialty tutorial (MS only) 15.00 -17.00 Specialty tutorial (MS only) 17.00 TUESDAY TUESDAY 07.30-09.00 Education Meeting 09.00-17.00 Home Visiting with Barb Stubber

09.00-12.00 Physiotherapy with Bri Tampin or Jan Mountford (NS Triage) 12.00-13.00 Multidisciplinary Case Conference 14.00-17.00 Physiotherapy and Neurosurgeon clinic WEDNESDA WEDNESDA Y Y 07.45 Intern teaching (Joske room) 07.45 Intern teaching (Joske room) 0.900-12.00 Interventional pain management 09.00 -12.00 Asthma clinic (Prof Thompson) procedures 13.00-14.00 Student Tutorial 13.00-14.00 Student Tutorial 14.00 -17.00 Pain Management Outpatients Clinic (Dr 14.00 -1600 General Respiratory clinic Goucke) 15.00-17.00 Specialty tutorial (MS only) 15.00-17.00 Specialty tutorial (MS only) THURSDAY THURSDAY 08.00-12.00 NSG: Interventional pain management 09.00-12.00 Bronchoscopy (Ward G75) procedures MED: Bronchoscopy (Ward G75) or interventional pain management procedures 14.00-16.00 NSG: Pain Management Outpatients 14.00 -16.00 CF clinic Clinic (Dr Majedi) MED: CF clinic or Diabetes nurse educator 16.00-17.00 IPE CBD – all students Discuss patients 16.00-17.00 IPE CBD – all students Discuss patients seen, seek advice from each other where seen, seek advice from each other where required for management or referral required for management or referral FRIDAY FRIDAY 07.45- Lung Cancer Multi-disciplinary team 07.45 Lung Cancer Multi-disciplinary team meeting meeting 0.900-12.00 Free: Reflective learning 0.900-12.00 Lung Ca F/U clinic (M. Phillips) 12.00-13.00 Respiratory radiology meeting 12.00-13.00 Respiratory radiology meeting 13.00-16.30 14.00-15.00 Student Tutorial/Debrief 15.00-17.00 Specialty tutorial (MS only) 15.00-17.00 Specialty tutorial (MS only)