Albury Wodonga Health Quality of Care Report 2010

Albury Wodonga Health Purpose

Our purpose is to deliver quality healthcare services in unique models of partnership to improve our regions’ health.

Vision

Albury Wodonga Health – the best of health

Values Ethical: Both in our clinical endeavour and our business practices we will be just in all our dealings.

Teamwork: Esprit de corp, harmony, partnership and unity are valued. Respect: Appreciation of the worth of others and regard for their contribution is inherent.

Trust: Confidence that all are doing their best, honestly and positively. Accountability: Understanding that all bear a personal responsibility to our community.

Compassion: Consideration, empathy and humanity are given freely to our patients and staff alike.

Equity: Fairness, integrity and justice are apparent in our actions. Patient and Client Focussed: Our purpose is to serve our patients and clients in order to achieve the Vision and Purpose of Albury Wodonga Health.

Printed on Re-Art Gloss, certified 100% recycledcoated paper Contents

From the Chairman of the Board and the CEO 2 About Albury Wodonga Health 3 Nature and range of services 4 The community we serve 5 Community Participation at AWH 6 “Doing it with us, not for us” Participation in your health service system 2006-2009 6 AWH’s Community Advisory Committee 7 Improving Care for Aboriginal and Torres Strait Islander Patients 8 Cultural Diversity at AWH 10 Volunteers – Community Supporting Community 11 AWH taking care of the whole patient 12 Involving Carers in Mental Health Services 13 Infection Control Measures at AWH 14 Ensuring quality of care through Accreditation 16 Medication Safety at AWH 17 Ensuring safe systems: Clinical Governance 18 Staying upright: falls prevention 19 Improvements to observation monitoring: Colour Coded Observation Charts 21 Pressure ulcer monitoring and prevention 22 Ensuring appropriate professional qualifications and experience: Credentialing and certification of staff 23 Dental Services at AWH 24 Your feedback: Improving our service 26 Maternity: Working with the community to improve our service to you 27 The Cardiac Rehabilitation Program – improving all the time 30 AWH: improving the region’s paediatric services 32 Improving Care for our older patients 33 Hospital Admission Risk Program 33 Long Stay Older Patient Project 33 Aged-care Services in Emergency Teams 34 Improving care at critical moments 35 Risk Screening: ensuring an holistic approach to ED presentations 36 Preparing for surgery 37 Health Promotion – keeping you healthy 38 Healthy food choices – AWH leading the way 38 Reducing stress through Pet Therapy 39 Pole Walking: regaining health after your hospital visit 39 Glossary 40

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 1 From the Chairman of the Board and the CEO

The Quality of Care Report is written to provide the local community and the Department of Health Victoria with information regarding the quality of service provision at Albury Wodonga Health (AWH) over the first year of its operation. AWH is proud of the achievements of its staff in improving quality of care and is committed to transparency. The Quality of Care Report is also an opportunity for the health service to provide information on the various types of community participation that occur within the service. We are always open to new ideas for partnership and see this report as an opportunity to engage with our local communities.

To this end the report is widely distributed to local medical clinics, councils, other health services, community health centres, neighbourhood centres, libraries and consumer groups. It is also available in the Main Reception areas and waiting areas of both hospitals and can be downloaded from the AWH Internet site at www.awh.org.au.

The report was written with the assistance of a range of people across the organisation, both staff and community members, with special mention going to the Community Advisory Committee Working Party who provided valued editorial advice.

We will appreciate your feedback regarding this report. Should you have any suggestions for improving next year’s report, we would love to receive them. Feedback can be made via email to [email protected] with Quality of Care Report in the title, or by phoning the Quality and Clinical Governance Unit on 02 6051 7546. Feedback received regarding last year’s Wodonga Regional Health Service Quality of Care Report has been incorporated into the design of this year’s report, including widening the range of topics presented, ensuring the report is more widely distributed, but in a targeted way, and improving the layout of the report.

Constant monitoring of the quality of our service is inherent to the way we work throughout all areas of AWH; Visiting Medical Staff, Hospital Medical Staff, Clinical Nursing, Allied Health professionals and in all support departments.

“Constant The Board and Senior Management are actively involved in supporting those monitoring of working on the quality of our care at the patient level.

the quality of This report does a wonderful job in canvassing the specific programs across AWH. our service is inherent to the way we work throughout all

areas of AWH” Mr Ulf Ericson Dr Stuart Spring Chairman Chief Executive Officer Board of Directors

2 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 About Albury Wodonga Health

Albury Wodonga Health (AWH) is unique. Established on 1 July 2009, it is the first cross border public health service to exist in Australia. Under an inter-governmental agreement between the NSW and Victorian Governments, the Albury Base Hospital and Wodonga Regional Health Service merged to create one of the largest regional public health services between Sydney and Melbourne.

AWH has a total budget in the order of $140m and a workforce approximating 1000 full time equivalent employees, the second largest employer in Albury Wodonga. Combined, AWH provides 260 beds.

The integration of Albury and Wodonga public health services has long been seen as a logical step to achieving a number of benefits for the residents of the region, including: • the delivery of an improved model of healthcare; • ready access to one of the largest health services between Sydney and Melbourne; • improved continuity of care and more equitable access to health services for the whole community regardless of their residential location; • the delivery of more effective health services; • better training opportunities for clinical staff; • greater recognition and visibility of the combined health service, leading to improved recruitment and retention of the health workforce; • greater “critical mass” assisting in attracting a greater range of specialist services to the region; and • provision of a strong foundation for service growth to match population growth in the region.

AWH provides a comprehensive and growing range of health services spanning the primary, sub-acute and acute needs of regional residents. Some services, such as emergency, are offered at both the Wodonga and Albury Hospital locations. Others are concentrated at a single AWH location to optimise the delivery of specialist care. For example, the Wodonga Hospital specialises in obstetrics and neonatal care. The Albury Hospital provides the region’s trauma and intensive care services.

Given the size of the health service and the region served by AWH, we expect to see the range of services we provide expand. Broadening of the Health Service’s responsibilities to include community and mental health in both States will follow over time after consultation with stakeholders.

AWH aims to integrate with the local community on as many fronts as possible, and connect with various groups as appropriate. To that end, AWH has a number of partnerships with various groups in multiple areas, such as with universities and other educational providers in the area of clinical education, local councils and community, emergency services, volunteers, local Members of Parliament and service groups, local interest and cooperative groups, General Practitioner networks and health services. Through these connections, AWH strives to serve and involve its local communities. We value our partnerships and are thankful for the interest of these groups in AWH and in improving health care for our communities.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 3 Table 1: Specialties Outpatient and Allied Health • Anaesthetics • Aboriginal Health Nature and Range of • Breast Surgery • Aged Services Emergency Team (ASET) Services • Cardiology • Antenatal Classes • Chemotherapy • Cardiac Rehabilitation • Colorectal Surgery • Chronic Disease Management (CDM) • Critical Care • Community Midwife Program • Day Procedure Unit • Community Health & Health Promotion • Dialysis Unit • Community Packages • Dental • Community Rehabilitation • Diagnostic GI Endoscopy • Continence Clinic • Ear, Nose & Throat • Diabetes Education • Emergency Medicine • Dietetics • Facio-maxilliary Surgery • District Nursing • Gastroenterology • Fracture Clinic • Geriatric Medicine • Health Information Management • Gynaecology • High Dependency Unit • Haematology • Hospital Admission Risk Program (HARP) • Head and Neck Surgery • Hospital in the Home • Intensive Care • Hydrotherapy • Medical Diagnostic Clinics • Immunisation • Medical Imaging Services • Inpatient Allied Health Services • Medical Oncology • Lymphoedema Clinic • Mental Health • Meals on Wheels • Obstetrics • No Falls Program • Ophthalmology • Occupational Therapy • Orthopaedics • Pacemaker Clinic • Paediatric Medicine and Surgery • Pain Management Program • Pain Management • Palliative Care • Palliative Care • Perioperative Service • Plastic and Reconstructive Surgery • Pharmacy • Pre-admission Clinic • Physiotherapy • Neonatology • Podiatry • Rehabilitation Medicine • Post Acute Care Program • Renal Medicine • Pre-Admission Services • Respiratory Medicine • Public Dental Service • Surgery • Pulmonary rehabilitation • Trauma centre • Regional Communication Service • Upper GIT Surgery • Rehabilitation Clinic • Urology • Rural Allied Health Team • Social Work • Speech Pathology • Sexual Health/Family Planning Clinic • Stomal Therapy • Transition Care Program • Upper Limb and Hand Therapy

4 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 The community we serve

Figure 1 below graphically represents those communities Albury Wodonga Health serves.

TEMORA

LEETON COOTAMUNDRA

NARRANDERA COOLAMON COLEAMBALLY JUNEE

WAGGA WAGGA

LOCKHART

THE ROCK

JERILLDERIE URANA ADELONG

HENTY DENILIQUIN OAKLANDS

FINLEY CULCAIRN BERRIGAN

HOLBROOK

TOCUMWAL TUMBARUMBA

COBRAM WALWA MULWALA COROWA NATHALIA RUTHERGLEN NUMURKAH YARRAWONGA THURGOONA TOWONG ALBURY WODONGA CHILTERN CUDGEWA CORRYONG TALLANGATTA YACKANDANDAH

KYABRAM BEECHWORTH SHEPPARTON WANGARATTA

N SCALE 1:1,000,000 0 10 20 30 40 50 60 Kilometres

Primary Catchment supporting approximately 125,000 people - Acute, sub-acute and ambulatory services

Secondary Catchment supporting approximately 165,000 people - Acute/specialist treatment

Outer Catchment supporting approximately 320,000 people - Specialist referral (eg. Urology/Facio-maxillary)

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 5 Community Participation at AWH

Participation Indicators The Participation Indicators give “Doing it with us, not for us” Participation AWH a standard for measurement. The Indicators are in your health service system 2006-2009 grouped into three areas – governance, accountability and health care and treatment. In 2006 the Victorian Department of Human Services released the policy document Doing it with us not for us: Participation AWH meets the accreditation standard for in your health service system 2006-2009. Albury Wodonga Governance consumer participation as set out in the Australian Council Health (AWH) is committed to the priority actions and the for Healthcare Standards’ Evaluation and Quality Program. participation indicators outlined in the document. Our This standard states that the governing body is committed progress against these indicators is reported below. to consumer participation. AWH has yet to be assessed as a single organisation, however, Wodonga Regional Health Priority Actions The priority actions fall into three broad levels, Service and Albury Base Hospital both met this standard in with key implementation tasks assigned to each level. At the their separate assessments. individual care level, AWH has adopted the Australian Charter of Patient Rights as its charter and makes this charter freely AWH has consumers, carers and community members on available to all patients. Consumer information is checked by key governance and clinical governance structures. The consumer representatives prior to printing to ensure it is easily CAC has been established in accordance with Victoria’s understood by consumers. Carers and consumers are actively Health Services Act 1988, and is reported on separately in involved in decisions regarding their treatment and care, as this document. AWH is extremely thankful for each of the appropriate. Staff members have a focus on making sure that consumers, carers and community members who give their all consumers and carers are communicated with clearly and time to work with AWH to make their health service the best respectfully, and this approach is emphasised in orientation it can be. and ongoing staff training. Where there is a complaint or positive feedback staff are informed and appropriate actions AWH reports openly to our communities on are delivered. Accountability quality and safety and on participation and this report is one of the mechanisms used to do this. Other methods used At the program or department level, AWH is in the process include consumer representation on the Quality and Clinical of developing a Community Participation Plan which will Governance Committee, and regular reporting provided be finalised by 30 November 2010. This process is being through the CAC. AWH is in the process, with the CAC, driven from the Community Advisory Committee (CAC). A of developing its first Community Participation Plan. This key element in the plan will be providing training for staff will be provided to the Department of Health Victoria by 30 across the organisation in how to involve consumers, carers November 2010. and community members in service planning and evaluation. Another key component of the plan will be engaging with the local community to assess how they would like to participate Health care and treatment AWH has consumer, and where with AWH in the provision of health services. AWH has an appropriate, carer participation in clinical care. Consumer existing range of partnerships with formal and informal links participation in decision making about their care and with various community organisations and groups, including treatment is assessed on the Victorian Patient Satisfaction educational institutions, local councils, other health service Monitor’s (VPSM) Consumer Participation sub-index. At this providers and networks, consumer groups and interest stage, Wodonga Hospital alone is being monitored through groups. We will be maintaining and further developing these the VPSM, with work in progress to move Albury Hospital to links going forward. The Community Participation Plan will the same reporting system. In the most recent report, the link with the Cultural Diversity Plan and both will assess how VPSM found “Patients were very satisfied with most aspects welcoming and accessible AWH is to a diverse community of their stay at Wodonga Hospital” and that “the hospital is and where we can make improvements. typically performing in line with the B Category average.” (Hospitals are categorized according to size, and Wodonga At the health service organisational level, AWH engages Hospital is in the B Category.) with consumers, carers and community members through Consumer Representatives and a Patient Advocate Officer on Relevant information is available to enable all consumers and key committees, including the Quality and Clinical Governance carers, where appropriate, to choose to share in decision Committee, and works with the CAC in organisational planning making about their care. and development.

6 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 The Consumer Advisory Committee members and AWH support – left to right – standing: CAC MEMBERS ABSENT: Ms Joan Simms, Dr Stuart Spring (CEO), Ms Sue Thomas (support) Ms Natashia Allitt (Project Officer), (OAM): Mr Martin Butcher Mr Eric Turner, Mrs Robyn Raine, Mr Vic Issell (Chair) Mr Frank Kelly, Mr Ulf Ericson (Chairman of the Board, AWH) sitting: Mr John Pitman, Ms Bev Hoffmann, Ms Elizabeth Hare

AWH’s Community Advisory Committee

In accordance with Department of Health Victoria requirements, Albury Wodonga Health (AWH) established a Community Advisory Committee (CAC) in January 2010.

This Committee currently comprises nine members representing the interests of the community to AWH’s Board and Executive. The positions are voluntary and provide a consumer and carer perspective to the organisation.

The Committee has the following major roles: • to provide direction and leadership in relation to the integration of consumer, carer and community views into all levels of health service operations, planning and policy development; and • to advocate to the Board on behalf of the community, consumers and carers.

The CAC is a high level committee, which is appointed in an advisory capacity to the AWH Board: • The Committee has responsibility to advise the Board on consumer, carer and community views so they are recognised and reflected in service delivery, planning and policy development; • Identify and advise the Board on priority areas and issues requiring consumer and community participation; • Participate in AWH’s strategic planning process; • Develop a strategic Community Participation Plan for approval by the Board and monitor and participate in the implementation and effectiveness of the approved plan; • Advocate on behalf of the community including promotion of greater attention and sensitivity to the needs of the disadvantaged, isolated and marginalised consumers and communities; • Facilitate two-way communication between consumer, carer and community groups and AWH; • Participate in the monitoring of key performance indicators for AWH service quality; • Participate in the development of AWH’s Quality of Care Report; • Assist in the identification of development and training needs in relation to consumer, carer and community participation in AWH, and make recommendations to the Board on how to meet these needs.

Committee meetings are chaired by a member of the Board and executive support is provided by the Project Officer. The CEO attends the meetings together with other staff as appropriate.

The Committee has already provided valuable input into the AWH Strategic Plan and will be the driving force behind the development and implementation of the Community Participation Plan.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 7 Improving Care for Aboriginal and Torres Strait Islander Patients

In order to provide improved health care services appropriate to the Aboriginal and Torres Strait Islander (ATSI) population, the then Department of Human Services developed four Key Result Areas within a program called Improving Care for Aboriginal and Torres Strait Islander Patients. By making progress in these four Key Result Areas, AWH will be able to assess whether we are providing quality care for ATSI patients. AWH’s progress against these areas in 2009-10 is provided below:

Establish and Maintain Relationships with Aboriginal communities and services: Over the past twelve months AWH has continued to work to maintain partnerships with Albury Wodonga Aboriginal Health Service (AWAHS) and Mungabareena Aboriginal Corporation, as well as the Wiradjuri Home Care Service (WHCS). The Albury Wodonga Aboriginal Health Reference Group (AWAHRG) continues to meet every second month with coordination and administrative assistance from AWH. AWAHRG has developed an Albury Wodonga Strategic Health Plan that will assist the six organisation members work towards the three health priority areas identified by Aboriginal workers and the data collected from the organisation members.

This year for the National Aboriginal and Islander Day of Celebration (NAIDOC), AWH held a flag raising on the Monday morning where more than 50 people attended. On the Tuesday an afternoon tea was held. This year’s theme was ‘Unsung Hero’s, closing the gap by leading their way’.

In conjunction with AWAHS and WHCS, Albury Hospital runs Aunty Jean’s Health Team program (see text box on page 9) and an exercise program.

8 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Aunty Jean’s Health Team Program

Every Monday Aunty Jean’s Health Team meets. The program is designed for those with chronic illnesses, and involves a basic weekly health check, a light exercise program, a healthy lunch, and a seminar or workshop on health topics of interest to participants. AWH works with AWAHS and WHCS to provide the program. Participants can be referred from their local doctor or self referred, with the aim being to improve the health of those living with chronic illnesses.

Provide or coordinate cross-cultural training for hospital staff: AWH has been developing a cross cultural training package with the assistance of Robynne Nelson, an Aboriginal consultant. We have had four community consultations to incorporate a local package. This training package is nearly completed. The aim of the package is to have AWH Aboriginal workers alongside community members deliver the cross cultural training workshops to all AWH employees and volunteers.

AWH - Wodonga has conducted specific education sessions this year; “Communicating effectively with Aboriginal people”, ‘Sorry Business’, provided information session for Emergency Department doctors and conducted two ‘Asking the question’ sessions so far this year. At the Albury Hospital, a component of the monthly orientation day is focused on health provision to ATSI patients.

Service Planning and Evaluation Processes: The Aboriginal Service Development Worker is continuing to represent AWH on the Closing the Health Gap Hume Region Steering Committee and also is currently on the ‘Client journey’ working group. Albury and Wodonga Aboriginal Liaison Officers work closely together and with AWH to ensure appropriate policies are developed and implemented across both hospitals.

Referral Arrangements to support all hospital staff: The Aboriginal Service Directory on the AWH intranet is kept up to date. AWH has actively pursued Aboriginal and Torres Strait Islander participation on the Community Advisory Committee.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 9 Cultural Diversity at AWH

At its commencement, Albury Wodonga Health (AWH) adopted the Wodonga Regional Health Service Cultural Diversity Plan, and is currently developing a new AWH plan. Our current plan complies with the six reporting requirements of the Victorian Department of Health’s Cultural Diversity Plan Guidelines in a way that is appropriate for the people of Albury Wodonga and its surrounds.

Nancy Askovic, an accredited translator, working with a patient.

Examples of ways in which AWH complies with the six reporting requirements include:

Understanding clients and their needs: Education sessions targeted at medical professionals were held in order that our medical workforce could gain a better appreciation of the importance of considering cultural differences when treating their patients, particularly when working in a busy emergency department environment.

Partnerships with multicultural and ethno-specific agencies: The Memoranda of Understanding with Mungabareena Aboriginal Corporation and the Albury Wodonga Aboriginal Health Service continue to be of importance to the newly formed AWH. The health service works with the local government agencies that support newly-arrived people from diverse cultural backgrounds. Our Home and Community Care Services have developed a cultural diversity plan in order to promote their services to local ethno- specific agencies.

A culturally diverse workforce: AWH follows an equal employment opportunity employment policy. Our workforce comprises staff from a number of different nationalities and backgrounds.

Using language services to best effect: The utilisation of interpreter services at both hospitals of AWH continues to grow. Commonly used languages are Croatian, Serbian, Italian, Thai and Auslan (Australian sign language).

Encouraging participation in decision-making: AWH has established a Consumer Advisory Committee which meets every second month. As outlined in the Community Advisory Committee article (page 7), this committee has the important role of advising the Board on consumer, carer and community views so that they are recognised and reflected in service delivery, planning and policy development.

Promoting the benefits of a multicultural Victoria:AWH recognises the benefits of multiculturalism. Our Diversity Policy reflects our commitment to respect diversity within our community and within our workforce.

10 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Volunteers – Community Supporting Community

Albury Wodonga Health (AWH) has a thriving volunteer community. More than 250 volunteers give their time and energy in twelve different volunteer programs across the two hospitals. The service and support provided by our volunteers is greatly valued by our patients, families and staff.

In the past twelve months we have commenced a new Volunteer Newspaper Trolley, opened an Opportunity Shop run solely by volunteers and introduced a Palliative Care Volunteer Hand and Foot Massage Service. AWH is constantly on the look out for new ways in which we can involve community members in the care and support of our patients and families. We are also always interested in hearing from members of the public who are seeking a volunteer role.

It is not just our patients, families, carers and staff who benefit from our volunteer programs. Some quotes from some of our volunteers include:

“I enjoy the contact with different people and the knowledge that I can help people.” Pink Ladies, Enid Antone and Helen Martin

“It is satisfying to be able to help others and to put something back into the community.” Albury Wodonga

“Having lost a family member to cancer, I felt this was a good area to Health Volunteer volunteer for. It was a bonus to become a member of such a great Programs volunteer team.” • Pink Ladies • Ward Volunteer Program Getting involved (includes Newspaper Trolley) • Palliative Care Volunteer Program Should you be interested in volunteering at AWH, we • Pastoral Care Volunteer would love to hear from you. Our Coordinator – Clinical Program Volunteer Program, Stacey Heer can be contacted on 02 • Fundraising Volunteers and 6051 7560 or by email at [email protected]. Stacey Auxiliary • Opportunity Shop Volunteers will be able to provide you with information on volunteer • Pets for Therapy Program opportunities and how to join the appropriate volunteer • Heart Foundation Walker team for you. Program • Heart Support Albury Wodonga • Ronald McDonald Family Room • AWH Community Advisory Committee members and Consumer Representatives

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 11 AWH taking care of the whole patient

Albury Wodonga Health (AWH) supports the “whole of being” health philosophy by supporting a Hospital Chaplain and a Pastoral Care Department. 2009-10 has seen the development of a full time Chaplain role, not only covering both sites of AWH, but also serving the two private hospitals in Albury Wodonga. We see this unique shared arrangement as both improving care for our patients as well as fostering healthy relationships within the local hospital community.

At AWH we have a team of trained visitors who are rostered on to selected wards one or two days each week to visit and support patients and/or family.

Volunteers are carefully selected and trained through an eight week program to meet the emotional and spiritual needs of patients. All come under the supervision of the Chaplain, who is an ordained Priest.

Pastoral Care visiting requires the ability to be focused and attentive to concerns and emotions of patients, and to help them come to terms with their feelings. This often requires a degree of skill and experience, and being prepared to sit in silence to witness and share the grief or emotional pain with the patient. To have someone really listen to their story with interest, patience, understanding or empathy, can be important in helping a patient understand themselves, and thus be more at peace.

Our mission in Pastoral Care is in some measure to leave each patient Rev Arthur Martin, Chaplain at AWH more at peace after our visit than before our arrival.

If patients have a spiritual need for prayer or faith counselling, our volunteers are trained and able to do so. Even for patients with little understanding of religion, this experience of prayer at the bedside is often very profound.

Care is taken not to cross certain boundaries, and referrals may be required to the Chaplain, Social Workers or other professional service providers.

The Hospital Chaplain is also available to counsel and support staff within AWH.

12 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Involving Carers in Mental Health Services

The Victorian Better Health Outcomes policy ensures Mental Health Services promote consumer and carer participation. In September 2009 the Mental Health Service Carer Consultant convened the first Carer’s Focus Group meeting which was repeated in March this year. Ten carers (of mental health consumers) were invited to share the opportunity to discuss their experience of health service involvement along with raising issues of concern directly with the Director of Mental Health Services. Both carer focus meetings were very successful. These meetings are scheduled for every six months.

Participants of the Carers’ Focus Group are representative of our diversity, including carers who live in Wodonga, or surrounding rural areas, carers for younger or older age groups, carers of a person with dual diagnosis, as well as carers of a person who was new to the service, or was about to have been discharged or re-entered the service.

Feedback assists us with planning for service delivery and implementation, along with resource allocation and development. Examples of issues raised include difficulty in accessing information about mental illness, education for the carer and consumer about mental illness, and finding out how to contact the case manager. One outcome from this process is that all consumers of adult mental health services now receive Information Folders on admission.

The Carer Focus Group meeting provides the opportunity to reduce stigma, discrimination and challenge attitudes. At times carers can feel blamed, silenced, and misunderstood. However, this group is very enthusiastic to contribute, and strongly value their comments being ‘heard’. Carers interested in participating in the Carer Focus Groups are encouraged to speak with their Carer Consultant.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 13 Infection Control Measures at AWH

Albury Wodonga Health (AWH) is committed to maintaining a safe environment for our patients, staff and visitors. This commitment includes adopting an infection control program that minimises the risk of patients and staff acquiring a healthcare associated or occupational infection.

With integration, there is now a single governing committee which oversees the Infection Control program in our health service. The AWH Infection Control Committee is multidisciplinary and has representation from both hospitals.

“Hand hygiene Consistent with national requirements, a two-tiered approach to infection control is recognised is used in the health service. The first tier is known as standard precautions and is designed for the care of all patients, regardless of their diagnosis or presumed as the most infection status. The second tier is referred to as additional or transmission based significant precautions that are applied when patients have a specific transmissible disease. practice to Hand hygiene is recognised as the most significant practice to reduce the numbers reduce the of infections acquired in health care facilities. Both AWH facilities use the World Health Organisation’s Five Moments for Hand Hygiene. These moments have been numbers of identified as the important times when hand hygiene should be performed. We use infections this program to monitor and report on hand hygiene compliance. acquired” Our latest combined hand hygiene compliance rate of 75% is again in excess of the Victorian Department of Health’s target of 60%. We have maintained the availability of alcohol based hand rubs throughout both facilities and we recommend that visitors use these products regularly during their visit to the hospital.

Graph: Hand Hygiene audit results

90% Wodonga 80% Albury 70% 60% AWH 50% 40% 30% 20% 10% 0% Audit 2 2009 Audit 3 2009 Audit 1 2010 Audit 2 2010

Audit 2 2010 was AWH’s first combined audit, rather than reporting two separate sets of data.

14 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 We review data on the numbers of multi-resistant Staphylococcus aureus (MRSA) infections occurring within AWH including those that present from our community. There has been only one MRSA bloodstream infection detected since 2007.

We annually assess our compliance with the Commonwealth Department of Health and Aging Infection Control Guidelines, the Australian Standards that govern cleaning and sterilisation of instruments, the Victorian cleaning standards, food safety guidelines and the recommendations for clinical waste disposal. Reviewing our performance and the recommendations from these audits allows us to identify risks and implement changes where needed. The Executive and staff are informed of the outcomes and actions required as well as how our performance compares with other Victorian hospitals.

Both facilities now participate in the Victorian Hospital Acquired Infection Surveillance System (VICNISS) with targeted surveillance of all major joint replacements (hips and knees), caesarean sections and gall bladder surgery. This is an established process for the Wodonga Hospital but new for Albury, as previously this type of data was reported to New South Wales Health by the Albury facility. Reports indicate that infection rates remain low and compare favourably with other Victorian hospitals, indicating that we have an effective infection control program. Wodonga also monitors haemodialysis in the surveillance program because these patients are at high risk for blood stream infections, vascular access site infections and multiple hospitalisations.

Continuous monitoring of the rate of exposures to blood and body fluids allows us to identify areas of risk for staff and to implement changes that may be needed. Once again our Executive has shown support for our Influenza Vaccination program across both sites and our numbers of staff undertaking vaccination has again increased on previous years.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 15 Ensuring quality of care through Accreditation

Accreditation is a process that health services use to ensure the delivery of safe, high quality health care to their patients. It is the public recognition of achievements by a health care organisation.

All public health services must complete and maintain accreditation with an approved accrediting body, such as the Australian Council on Healthcare Standards (ACHS). The ACHS is an independent organisation, which is dedicated to improving the quality of health care through the continual review of performance, assessment and evaluation. It is based on standards and processes devised and developed by health care professionals for health care services.

Wodonga Regional Health Service and Albury Base Hospital were both accredited health services with the ACHS when integrated to become Albury Wodonga Health (AWH) on 1 July 2009. AWH has negotiated with the ACHS to align the accreditation cycle across the whole organisation. The next Organisation-Wide Survey is scheduled to occur in August 2011.

Yearly reviews from the ACHS for AWH ensure that we remain accountable for the quality of care provided to our patients. Feedback provided following each review allows us to improve systems and processes of the health service. In addition to ACHS accreditation, a range of different accreditation surveys for various services or programs are conducted. The accreditation processes that are in place and status of each as at 30 June 2010 is described in the below table.

Type of Accreditation Status Next Review

Australian Council on Healthcare Standards Full accreditation Next cycle review (ACHS) in October 2010

National Standards for Mental Health (In- Wodonga Hospital Full four year accreditation August 2011 Depth Review against National Mental Health achieved in October 2006 Standards by the ACHS)

Royal Australasian College of Surgeons – Full three year accreditation achieved May 2010 May 2013 Surgical Registrar Post Accreditation

Postgraduate Medical Council of Victoria – Full three year accreditation achieved August 2008 August 2011 Intern Post Accreditation

Diagnostic Accreditation Scheme for Medical Accreditation confirmation achieved in December June 2010 Imaging (ACHS) – Wodonga 2009 for six months

Home and Community Care (HACC) Full accreditation achieved in February 2009 February 2013 Standards- Wodonga

Baby Friendly Hospital Initiative – Full three year accreditation achieved in June 2008 2011 WHO and UNICEF

Department of Human Services review of Full accreditation achieved in 2008 2010 Level 2 Nursery

NSW Institute of Medical Education And Full three year accreditation achieved September July 2010 Training (IMET) – Intern & Resident – Albury 2007

Royal Australasian College of Physicians Full three year accreditation achieved August 2006 August 2010

Royal Australasian and New Zealand College Full three year accreditation achieved September September 2011 of Obstetricians and Gynaecologists 2008

Urological Society of Australia and New Full three year accreditation achieved 2009 2012 Zealand

Australia and New Zealand College of Full three year accreditation achieved 2008 2011 Anaesthetists

16 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Medication Safety at AWH

We aim to use medication safely and appropriately for maximum benefit to patients while reducing any unwanted side effects to these medications.

To assist improving medication safety an electronic system is available for staff to report any medication incidents or near misses. These reports are then reviewed and action taken to improve our systems.

Our Pharmacy Advisory Committee for Albury Wodonga Health (AWH) commenced in 2009 with the formation of the Health Service. One of the functions of this committee, which includes medical, nursing and pharmacy staff, is to review the reports of medication incidents and ensure that systems are implemented to reduce the risks of recurrence. Medication errors are monitored and analysed by the Committee with 09/10 results below:

Medication Errors AWH 2009-10

35 Medication and iv incidents 30 Drug administration errors 25 20

Total 15 10 5 0 July Sept Nov Jan Mar May Month

One way to reduce errors is to standardise the way drugs are administered. To assist this, a range of drug protocols have been developed that apply across AWH for key drugs used in the health service.

There are a number of drugs that require careful monitoring when prescribed for patients, to ensure that dose levels are not too high. Warfarin is an example of this type of medication requiring daily blood tests to ensure drug levels are appropriate. To reduce the risk associated with using this drug, the Ward Pharmacist reviews daily dosages of Warfarin to ensure they are appropriate for the test results. This provides another check in the system to improve patient care and safety.

For patients with infections, it is important that the correct antibiotic is prescribed. The Ward Pharmacist reviews the daily report from pathology that indicates which antibiotics infections are sensitive to. This is reviewed to ensure that the correct antibiotic is prescribed.

There are a range of other new initiatives aimed at improving medication safety including improved labeling, better access to medication charts for doctors and nurses and regular critical education provided to nursing and medical staff.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 17 Ensuring safe systems: Clinical Governance

Clinical Governance is about the organisation having systems in place to manage the risks associated with delivering clinical care.

Strong clinical governance systems provide: • support to staff • safety to patients and • assurance to external parties such as the Department of Health and accreditation bodies that clinical risks are actively managed.

The Clinical Governance structure and program at Albury Wodonga Health (AWH) is guided by the Victorian clinical governance policy framework.

Elements of AWH’s clinical governance system include: • processes to check clinicians’ credentials and to define their scope of practice according to their qualifications and experience • routine monitoring and reporting of key performance indicators (for example of infection rates and unplanned readmissions within 30 days of discharge) • a demonstrated commitment to continuous improvement of quality and safety through a strong culture of: - reporting - investigation and - monitoring of the recommendations made as result of unexpected incidents • compliance with mandatory reporting requirements to authorities such as the Victorian and NSW Coroners and the Victorian Department of Health • consumer involvement

Quality and safety is a component of every staff member’s responsibilities and every department’s business plan. The Quality and Clinical Governance program is coordinated by the Quality and Clinical Governance Unit and is overseen by the Board Quality Committee.

AWH Clinical Governance processes are scrutinized by independent external authorities such as the Australian Council on Healthcare Standards and the Victorian Managed Insurance Authority.

18 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Staying upright: Falls Prevention

Falls are a common problem for older people and are often the reason people are admitted to hospital. Falls within hospital can cause additional complications and increased lengths of stay.

Preventing falls and minimising harm from falls has been a sustained area of focus for both Albury and Wodonga Hospital over a number of years. The mix of patients is different between hospitals and has influenced both falls rates and approaches to prevention strategies. Since integration, both hospitals are working together to incorporate the best elements of each hospital’s falls program into an organisation- wide management system.

Wodonga Hospital In October 2009 The Falls Reduction Working Party completed the rollout of the Victorian Quality Council inspired program, Minimising the Risk of Falls and Fall-Related Injuries. The program has four key components; risk screening, falls assessment, falls care planning, and reporting of falls events.

The program has been well supported by clinicians and has helped to maintain the low number of inpatient falls (at an average of around two falls per 1000 bed days for 2009- 2010, compared to rates of around 3.95 falls per 1000 bed days in other Australian Council of Healthcare Standards accredited hospitals).

Important risk-factor information is being gathered each time a patient fall occurs. This information is being communicated to the clinicians as an alert to the type of patient most likely to be at risk of falls.

Albury Hospital Albury Hospital has a very comprehensive falls reduction program, which has run over a number of years. The aim is to reduce patient falls and to minimise injuries sustained from falls. There is marked evidence of a reducing trend for 2009-2010. This has been achieved by the implementation of a range of strategies within the hospital setting.

The goals of the Falls Program are to develop a proactive approach to falls which includes recognition of, identification and prevention of falls. Accompanying this is a process of monitoring and evaluation of intervention and prevention strategies.

Reporting and monitoring of fall incidence and fall injuries is continuous; our recent results showing a reduction in patient falls at the Albury Hospital to equal the existing Wodonga Hospital rate.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 19 AWH Falls 2009-10

6.0 5.0 “Education 4.0 3.0

relating to the Falls 2.0 causes of falls 1.0 0.0 and strategies July Sept Nov Jan Mar May to reduce Month falls is also Patient falls per 1000 bed days WH an important 2009 ACHS rate part of the Patient falls per 1000 bed days AH

program” Future Directions 2010-2011 will see a greater emphasis on comprehensive reporting and communication of the findings of falls data. Feeding this information back to the clinicians will reinforce the value of the Falls Prevention Program and help to maintain low levels of patient falls.

Interventions to prevent falls Some important interventions in place across both hospitals include: • Identification of patients with a high risk of falling. (The Traffic Light System for identifying the patients at risk is being trialled on the Rehabilitation Ward.) • Raising awareness, by the use of an orange theme, gel bracelets, bed signs, handover sheets and shift to shift communication. • Accommodating patients deemed to be at high risk near the nursing station for close observation. • The use of High/Low beds that reduce the impact of falls for repeated fallers. • Consumer information designed to inform the patient and carers of interventions that can be practiced at home to reduce the risk of falls.

Preventing Falls In The Community

In addition to monitoring falls and seeking to reduce the incidence of falls for inpatients, both hospitals also run an outpatient No Falls program. The program aims to increase lower limb strength, core strength, balance and co-ordination through exercise. Tasks and weights increase in difficulty each week. Education relating to the causes of falls and strategies to reduce falls is also an important part of the program.

The No Falls Programs run over ten weeks, for one and a half hours twice a week, three to four times a year.

20 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Improvements to observation monitoring: Colour Coded Observation Charts

Regular measurement of patient observations such as respiratory rate, blood pressure, heart rate and temperature are routine and common activities in any acute Australian hospital, and provide important diagnostic information on the health of our patients. Nationally and internationally there is a significant amount of work in progress to develop tools to ensure; • consistent recording of observations • timely recognition of abnormalities • timely response to any abnormal observations

Albury Hospital implemented a colour coded observation chart in 2009 to optimise the recording of observations and the recognition of the patient with abnormal observations.

The use of the chart acts as a flag to nursing staff for when a patient may require more frequent observations, or require further treatment. A formal communication strategy and escalation plan was implemented to support the bedside nurse to escalate the care of patients to the doctors for review. Albury Hospital was amongst the first hospitals in NSW to utilise colour codes in observation charts, with the work being in line with recommendations and work in progress in NSW at the Clinical Excellence Commission and nationally at the Australian Commission on Safety and Quality in Health Care. The charts are already leading to improved care for our patients and the hospital is proud of the way nursing and medical staff have embraced the changes involved.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 21 Pressure ulcer monitoring and prevention

Pressure ulcers, which may also be known as bed sores or pressures sores, are defined as any lesion caused by unrelieved pressure resulting in damage of the skin and underlying tissue. Pressure ulcers can develop as a result of sitting or lying in one position for long periods. Of all pressure ulcers, 95% are largely preventable and can be viewed as an adverse outcome of health care. They have been recognised as a common complication in health care and once they have developed may be difficult to treat. Pressure ulcer prevention and management remains a priority at Albury Wodonga Health (AWH).

AWH Pressure Ulcers by hospital for 2009-10 The patients who are at the greatest risk of developing pressure ulcers are people who are immobile for long periods of time, the elderly, smokers or people with Albury Hospital Acquired Pressure Ulcers poor nutritional intake. Pressure ulcers most commonly

4 occur over bony areas such as toes, heels, elbows and buttocks. All pressure ulcers that are identified 3 on admission or presentation or are acquired in our 2 facilities are reported appropriately and intervention is 1 commenced. Pressure Ulcers Pressure 0 July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June Both hospitals of AWH participate in surveillance Month programs specifically monitoring the incidence of pressure ulcers in our health service. The graphs on this page show the incidence of pressure ulcers acquired Wodonga Hospital Acquired Pressure Ulcers at both Wodonga and Albury Hospital. The data is 6 presented as two graphs because the definitions that 5 were used for reporting have been different across states. 4 The 2010-11 data will be measured the same way, and 3 we look forward to another step with integrating the two 2 hospitals. 1 Pressure Ulcers Pressure 0 July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June AWH recognises that preventing pressure ulcers is an Month important patient safety issue and remains committed to continually improving processes around the prevention, assessment and management of pressure ulcers. Strategies that have been used to achieve this include: • Screening all patients on admission for the risk of developing pressure ulcers. • Encouraging the reporting of all pressure ulcers acquired in or out of hospital. • Using pressure reducing support surfaces and equipment to reduce the likelihood of pressure areas developing. • Collection and reporting of data on pressure ulcers internally at the Quality & Clinical Governance Committee and AWH Board Quality Committee meetings. • Using a multidisciplinary team approach in the management of patients identified as being at risk of developing, or who have developed, pressure ulcers.

22 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Ensuring appropriate professional qualifications and experience: Credentialing and certification of staff

Credentialing is the formal process used to verify the qualifications, experience, professional standing and other relevant professional attributes of health professionals for the purpose of forming a view about their competence, performance and professional suitability to provide safe, high quality health care services within specific organisational environments.

Albury Wodonga Health (AWH) adopted the policy and guidelines which existed at Wodonga Regional Health Service and which were compliant with the Victorian Department of Health’s “Credentialing and defining the scope of clinical practice for medical practitioners in Victorian health services” guidelines.

The membership of the Committee which oversees the credentialing and scope of practice process for medical specialists was reviewed to ensure that there was appropriate membership across the range of specialties which exist at the new health service.

Credentialing is not limited to medical practitioners with processes in place to ensure that nursing, allied health and dental professionals are appropriately qualified and registered with their professional body if such a system exists. Processes include annual checks of nursing board registration and initial checks and regular reviews of qualifications for other health professionals as part of performance review programs.

Three of AWH’s International Medical Graduates: Dr Sajee Fernando, Dr Kathy Ebert and Dr Anuradha Tillekeratne

AWH employs many medical practitioners who have gained their qualifications in a country other than Australia. There is a complex process in place which is coordinated within the Health Service but managed through the Australian Medical Council, the relevant State medical registration boards and the International English Language Testing System to ensure that these medical practitioners are appropriately qualified and experienced in order to fulfill their roles with AWH.

We are very proud of our International Medical Graduates (IMGs), many of whom are now practicing as General Practitioners in the Albury Wodonga area after having worked at AWH for many years. Recently we have also had several of our IMGs accepted into specialist training to become Emergency Medicine Specialists.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 23 Dental Services at AWH

Albury Wodonga Health (AWH) integrated Adult and Child Dental Service provides emergency and general dental care to eligible Victorian residents. Four main programs provided are: • Early Childhood Oral Health Program • School Dental Service • Youth Dental Program • Community Dental Program

Dental Students from the Latrobe University School of Science in Dentistry at work in the new Dental Clinic.

The first half of the 2010 calendar year has seen the development of a new 10 chair dental facility at 155 High Street, Wodonga. This has provided an upgrade to the Community Dental Facility and a training facility for Latrobe University School of Science in Dentistry Bendigo.

AWH provide data about three main performance indicators to Dental Health Services Victoria (DHSV). With the introduction of state-wide computer based dental records, DHSV is able to provide quality reports allowing individual agencies to compare their performance against region and state wide data. In each of the three indicators it is more desirable to have a lower return rate.

24 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Restorative re-treatment within 6 months Restorative re-treatment within 6 months Restorative dentistry aims to preserve tooth structure, protect the 10% dental pulp, eliminate decay and replace missing tooth structure. 10.0% Correct diagnosis, treatment planning, case selection and material 8.0% selection are required for a successful restoration. 5.90% 6.0% 4.80% 5.10% 4.0% 2.0% 0.70%

Percentage of Patient of Percentage 0.0% Year to date

Repeat Emergency Care within 28 days Repeat Emergency Care within 28 days

The aim of providing treatment to patients presenting for emergency 15.50% care is to address the immediate presenting emergency problem 15.0% (eg pain). An appropriate measure of quality in this area would be to identify patients where care has failed to resolve the initial 10.0% emergency problem. 5.90% 5.30% 5.0% 4.70%

0.70% Percentage of Patient of Percentage 0.0% Year to date

Unplanned return after 7 days subsequent to dental Unplanned return after 7 days subsequent extraction to dental extraction Complications following tooth extraction generally occur within 7 days of the extraction. Such complications can be minimised 15.0% by actions taken by the dental team before, during and after the procedure. Such measures include the checking of the medical 10.0% history, minimising operative trauma, providing the patient with 4.80% 5.0% post operative instructions and where required, the prescribing of 2.60% 2.40% 1.00% antibiotic and/or analgesics. 0.00% Percentage of Patient of Percentage 0.0% Year to date

AWH Region State State highest results State lowest results

Dental Students from the Latrobe University School of Science in Dentistry at work in the new Dental Clinic

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 25 Your feedback: Improving our service

Feedback from patients, families, carers, members of the public and strategic partners helps us to examine how effectively AWH is performing and how we are meeting the needs of these groups. We therefore welcome both positive and constructive feedback in our quest to continuously improve. Feedback ranges from informal discussion between a patient and carer to formal complaints received via independent authorities such as the Health Care Complaints Commission (HCCC).

There are a number of principles that underpin our approach to feedback: • We aim to make it easy for people to provide feedback. (Compliments, complaints and suggestions can be made directly to staff members, via feedback forms placed in public areas, via telephone, via letter or e-mail and via the feedback link on our website.) • We respond to people who provide feedback as promptly as possible. • We address complaints and concerns at the most immediate level possible but escalate issues to the appropriate level of authority to provide a meaningful response. • We provide to anybody making a complaint, details of how to escalate their concerns if they are not satisfied with our response, including contact details for independent bodies such as the HCCC and Health Services Commissioner. • We record, report and analyse feedback. Feedback is reported to the Executive Committee, the Board Quality Committee, relevant individuals and departments, the Community Advisory Committee and operational management committees such as senior nursing meetings.

Examples of improvements over the past year arising from feedback from patients and families include: • Increased disabled parking • Commitment to increase the numbers of toilets available in Surgical ward and • Improvements to discharge processes

26 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Maternity: Working with the community to improve our service to you

The Maternity Unit at Albury Wodonga Health (AWH) has had a record breaking year with 1661 deliveries which is an increase of 80 on the previous financial year and four more deliveries than the previous record set in the 2006-07 financial year.

The Maternity Unit provides the following services: Antenatal bookings and classes, Midwifery Care in the Home where the midwife visits pregnant women when requested by the doctor, Midwife Care Program for women with uncomplicated pregnancies, six modern birth suites, a 30 bed ward accommodating antenatal and postnatal women, a special care nursery that can comfortably house 13 babies requiring additional care, and a Domicillary Midwifery program where a midwife visits mothers and babies at home after discharge. The Maternity Unit continues to support a student Midwifery program in conjunction with Charles Sturt University.

February 2010 saw the opening of the Ronald McDonald Family Room that was built with extensive community support and after many years of negotiation. The Room is a wonderful example of supportive collaboration between the Ronald McDonald Organisation, AWH and the Community.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 27 Sarah and Ian with Chelsea and Joshua

Improving care for new families – Sarah’s story

After waking up from an afternoon snooze late in my pregnancy, I was shocked to realise that my waters had broken. As I was only thirty three and a half weeks pregnant I went to see my local doctor to ask what I should do. After being advised to go to the hospital where I was booked to deliver, my husband Ian and I packed a couple of bags of clothes and began driving in from Jerilderie. As we drove to Wodonga I phoned the obstetrics ward to let them know my situation and that I was on my way. After arriving at the hospital and being assessed, I was advised that I would not be leaving hospital until after I had delivered my baby.

Early the next morning I started having contractions and my labour progressed very quickly. Sally, the midwife who was looking after me on the ward at the time was extremely helpful and very kind, she offered to come with me to the birthing suite and assist in the delivery of my son, Joshua. It was comforting to know that I was going to be helped by someone I felt I knew. Ian arrived a short time after I was moved to the birthing suite and Joshua was born an hour and fifty minutes later. After Joshua was born we had a quick cuddle and he was taken to the special care nursery. We were able to visit him soon after.

Later that morning Ian and I met Maureen, Coordinator for the Ronald McDonald Family Room at the hospital. She offered us a room in the Ronald McDonald Family Room while Joshua was admitted to the Special Care Nursery. Maureen gave us our keys and helped us settle in, giving us a tour of Ronald McDonald Family Room. The facilities are fantastic, it is just like being at home. I stayed in the Ronald McDonald Family Room for 22 nights, my husband travelled back and forth between work commitments. During my stay there were constant volunteers visiting the Ronald McDonald Family Room who were there for a chat, cooking, cleaning and offering to help in any way possible. My husband and I made some great friends who we still keep in contact with and get updates on how their babies are progressing.

As Joshua improved and needed to be breast fed throughout the night I was able to do this and feel safe, as the Ronald McDonald Family Room is connected to the Maternity Ward.

We really appreciate being given the opportunity to use the facilities at the Ronald McDonald Family Room as it made the whole experience of having a baby that is being cared for in the Special Care Nursery less stressful. It meant we did not need to spend a fortune on hotel accommodation and have to travel to and from the hospital everyday. My daughter, Chelsea who is two and a half, was able to visit and stay when my husband came over for a couple of nights through the week and on weekends. She had a great space to play with the toys provided and run around in a safe environment. Other family members and friends were allowed to come and visit me in the Ronald McDonald Family Room throughout the day so we were able to catch up without being in the hospital environment. I really felt as though the Ronald McDonald Family Room was a home away from home and has helped my family return home more quickly. I do not know how I would have coped if these facilities were not available to us.

28 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Ronald McDonald Family Room

The Ronald McDonald Family Room opened to guests in mid March and accommodated the first overnight guest on 29 March 2010. Since then; 149 nights accommodation have been provided to 20 families. These families have stayed at the Family Room for between one and 29 nights and have been from towns as far away as Deniliquin, Tocumwal, Jerilderie, Benalla and Yarrawonga. Forty local Albury Wodonga families have also made use of the family room during their child’s stay at the Wodonga Hospital. Most families have had a baby in the Special Care Nursery, however several families with older children admitted to the medical or surgical wards have also made use of the facilities.

Ronald McDonald Family Room volunteers Don Dover and Vicki Winnell with Volunteer Coordinator Maureen Nicholls.

The Ronald McDonald Family Room is a home away from home for families who have a baby in the Special Care Nursery or a sick child receiving treatment at Wodonga Hospital. The facility has all the comforts of home including full size kitchen and living rooms, laundry and bathroom facilities as well as two bedrooms for overnight accommodation for families who live out of town.

Families can make use of the facilities including cooking, tea & coffee, laundry, TV, Wii console, computer, telephones, library, outdoor area, toys for children and a place to catch up on sleep.

The Ronald McDonald Family Room provides a comfortable, communal environment where supportive friendships are formed between parents. The Family Room also provides a non-threatening environment away from the hospital wards where parents can meet with doctors and social workers to discuss their child’s progress.

The goal for the Ronald McDonald Family Room is to make a difficult and stressful time in an unfamiliar place as normal as possible for families. A team of volunteers spend time each week making the Family Room a pleasant place to be. It’s thanks to their tireless efforts that parents are able to focus on caring for their new baby or sick child.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 29 The Cardiac Rehabilitation Program – improving all the time

“If you were walking down High St and someone collapsed what would you do?” In order to provide an answer to this question, Cardiopulmonary Resuscitation (CPR) training was introduced into the Cardiac Rehabilitation Program. The CPR sessions are open to patients and their families.

Over time, the format has been adjusted, utilising client feedback and evaluation. Today the format includes two sessions – a theoretical and a practical. The CPR theory session takes half an hour and is run by the Cardiac Nurse. The inspiration behind CPR in cardiac outcomes is acknowledged and clients’ background experience and knowledge is explored. CPR is discussed in a very simple format and the group steps through DR ABC (Danger, Respond, Airway, Breathing, Circulation) with simple tips such as “use a shoe or a handbag under the neck to open the airway”. The practical session involves hands on resuscitation experience with a special training mannequin, Resusci Anne.

The entire program was developed in reaction to client feedback and then improved in response to ongoing feedback. Feedback from clients involved in the program has included: • I learnt: don’t be afraid to have a go • Think I can resuscitate someone by myself • Should be compulsory in every household • Not to be afraid if someone is in need Cardiac Rehabilitation • How simple CPR is now

Just recently the Cardiac Rehabilitation team presented information on the Albury Wodonga Health’s (AWH) inclusion of CPR in their program at the 21st Australian Cardiovascular Wodonga Hospital runs an eight Health and Rehabilitation Conference, in a poster format. This won “Best week Cardiac Rehabilitation Program for clients who have had Poster” at the Conference, an award the entire organisation is proud of. a heart attack or heart surgery or who have multiple heart risk factors. Risk factors include being a smoker, lack of exercise, high blood pressure, being overweight or being depressed. The program aims to provide information to the participants to enable them to recognise the risk factors that lead to their heart event and make appropriate lifestyle changes. The information covered in the program includes topics such as medication, diet, exercise, and risk factor management. Group discussion is encouraged as by sharing their experiences and knowledge the participants support and learn from each other. There is also an exercise component to the twice weekly sessions.

30 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Walking your way back to health

As part of the Cardiac Rehabilitation program at Albury Hospital, a walking track was developed around the grounds of the hospital. The track was built with the assistance of the local community. The aim of the walking track is to provide an affordable form of exercise that people can easily continue away from the hospital setting.

Our walking track is currently utilised by a variety of heart outpatient groups and rehabilitation inpatients. Patients are given strict guidelines as to how hard they should push themselves in a controlled environment. After a cardiac event they can gain confidence in getting back to their daily living and activity levels.

It is largely an all weather concrete surface that is easily accessed from the gym and includes a ramp and stairs. Patients can be monitored from the gym door whilst other patients remain exercising inside the gym. Staff and patients have a choice of two tracks. Firstly a short circular course, in total view of the gym including ramp and stairs. This then leads onto a longer course that winds around the back of the hospital ending up at the far western doors of the hospital building.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 31 AWH: improving the region’s paediatric services

With the integration, Albury Wodonga Health (AWH) has opportunities to maximise patient care by concentrating some services at one Hospital or the other. Paediatric inpatients are just one example of how AWH is improving quality of care through the possibilities involved in the merger. The following patient story illustrates how this process works.

Marko Stanojevic is a three year old boy who presented to AWH Wodonga Hospital late one evening with his mother. He arrived with difficulty breathing and possible pneumonia, and was unable to tolerate oral medications at home.

Marko’s mother was very pleased with how quickly he was seen in the emergency department at AWH Wodonga Hospital and with the interventions given to Marko to relieve his distress and make him feel better. She was very positive with feedback on the explanation given to her and her husband and their understanding of the situation that Marko would have to be transferred to AWH Albury Hospital to the paediatric unit there.

Mrs Stanojevic was kept up to date with the time that the ambulance was to pick Marko up, and was very pleased that it arrived on time to take herself and Marko to Albury. Both mother and child were very comfortable on the trip from AWH Wodonga Hospital to the Albury Hospital, with the ambulance officers explaining the process clearly and patiently. On arriving at the Paediatric Unit at Albury Hospital, Mrs Stanojevic and Marko were promptly settled into Marko’s room and Mrs Stanojevic was given a bed to sleep next to her son. As Mrs Stanojevic’s main concern had been where she would be able to sleep for the night, she was very grateful with this outcome.

Marko’s treatment was continued from that begun in the Wodonga Hospital Emergency Department, and a very smooth transition from there to Albury was experienced by both Mrs Stanojevic and her son Marko.

32 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Improving Care for our older patients

A HARP worker with AWH clients

Hospital Admission Risk Program Long Stay Older Patient Project

Hospital Admission Risk Program (HARP) is a community The Long Stay Older Patient (LSOP) project aims to improve based program that has been successfully preventing care for older people in hospital. Research has found that unplanned hospital admissions. Based in Wodonga, HARP the longer an older person is in hospital, the more difficult it staff provide care coordination to clients who frequently use is for them to perform the same activities of daily living upon hospitals or are at risk of hospitalisation. HARP services discharge as before being admitted (clinically known as are client centred, based on meeting the individual needs of functional decline). A Best Care for Older People Everywhere people with chronic health conditions (Chronic Obstructive toolkit has been published by the Department of Health. The Pulmonary Disease, Chronic Heart Failure, or Diabetes) and aim of the toolkit is to assist clinical staff to minimise this complex needs. functional decline. The LSOP project has been implemented over the last four years at Wodonga Hospital. A core focus of HARP is to enhance a client’s capacity to self-manage their health. This involves providing education, Some of the outcomes from the project have been increasing self management skills, regularly assessing improvements made to environments for older people whilst progress, helping set goals, improving or developing in hospital. For example, patient beds have been purchased problem solving skills and encouraging ownership and that can be lowered to floor level to reduce the risks of falls responsibility for their health. To do this successfully means from bed. using service coordination and an integrated and flexible approach to address the social determinants of health. Education sessions for staff have promoted the principles of care from the Best Care for Older People Everywhere toolkit.

Case study: Rosy’s experience with HARP An expo focusing on minimising functional decline in the Rosy is a 72 year old referred with a complex elderly was developed. It is an interactive program which mix of heart problems, depression, hypertension, has five skill stations. The skill stations focus on key areas of high cholesterol and diabetes. Rosy had been importance in caring for older people: nutrition, continence, admitted to hospital 3 times in 12 months. cognition, mobility and self care. The expo has been a successful staff education initiative with very positive She was assessed by the HARP team and then participant feedback. assisted to liaise with various agencies to implement strategies for improved health. HARP staff support lifestyle behavior changes and empowered Rosy to adhere to medical advice and assist with developing self management skills by ensuring she knew what symptoms to monitor and what actions to take when changes were noted. Best of all Rosy has not been admitted to hospital in 14 months!

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 33 Aged-care Services in Emergency Teams

Aged-care Services in Emergency Teams (ASET) work to provide a specialist comprehensive aged care assessment and referral service to older people in public hospital emergency departments (EDs). The goal is to promote and support the client’s independence to assist them to live in an environment appropriate to their functional ability. Following assessment the ASET would perform one or more of the following functions providing; • Family support • Community support • Implementation of support services • Respite or permanent residential placement • Access to ongoing supports in the community • Education for patients, family and other health care professionals.

AWH ASET is based at the Albury Hospital and consists of a Coordinator with a background in social work and nursing and a Clinical Nurse Consultant. In 2009 ASET assessed or followed up on 20% of the 4176 patients over 70 years of age that presented to the Albury ED. Of these patients, 70% were discharged home or to a facility that was most appropriate to the individual at that time.

ASET at work in Albury Hospital ED

Case Study: Bill’s Story Bill is an 80 year old man who presented to Albury ED with a fractured arm after having tripped over a mat at home. He had a plaster applied to his fracture and was then seen by the hospital ASET worker who included his wife and son in the assessment interview. The ASET assessment identified a number of other issues as impacting on Bill’s health and lifestyle.

Of major concern was a decline in his memory and concentration. He was becoming easily lost and was scared to be left alone. His wife Beth was finding this increasingly stressful as whilst she was happy to care for her husband she felt she had lost her independence and her social life and friendships were suffering. Bill had also recently developed some incontinence which he was finding extremely embarrassing.

The ASET worker discussed the supports and services available with the family and collaboratively developed a plan of care for Bill that also supported Beth in her role as carer. This plan involved an appointment to see the continence nurse, coordination of some respite services to allow Beth some time to recharge her batteries, and a discussion with Bill’s General Practitioner to arrange for some further assessment of his cognitive function by a geriatrician. The ASET worker also arranged for some support to help Bill with his showering and dressing until his plaster was removed.

34 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Improving care at critical moments

Whilst the aim of hospital care is to improve a patient’s health there are times when it may deteriorate rather than improve. Patients recently discharged from intensive care, or patients who are exhibiting signs of deterioration in their health are at higher risk for suffering a serious adverse event (an event relating to a patient’s health which has serious consequences, up to and including death). These patients obviously require specialised care. The Critical Care Liaison Nurse Practitioner (CCLNP) role commenced at Albury Hospital to attempt to manage this increased risk by facilitating timely and appropriate treatment for this patient group.

The CCLNP works with ward areas to ensure patients recently discharged from the critical care unit receive appropriate care. She also ensures assessments and referrals to the right service or treatment for deteriorating patients are occurring in a timely manner. The CCLNP provides ward nurses with access to expert knowledge and skills specifically relating to patients whose condition is deteriorating rather than improving.

The overall aim of the position is to avoid or reduce the risk and impact of clinical deterioration on patients and the health service through early recognition, timely intervention and appropriate referral. AWH is excited by the possibilities inherent in this position for improved patient care.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 35 Risk Screening: ensuring an holistic approach to ED presentations

The Emergency Department (ED) Risk screen has been an initiative to improve care for patients 65 years old and over or those who have complex needs who are discharged home from the ED. Follow up support of elderly patients when they are discharged home can improve independence and health, and also prevent readmissions to the ED.

The Risk Screen was developed to identify the risks that impact on elderly people after an illness or injury. These factors include; falls, mobility, home safety, social and emotional factors, cognition, medications, nutrition, continence, skin integrity and chronic disease.

The Risk Screen is completed in the ED and faxed to Allied Health. The risk screen is reviewed and a telephone call made to the patient or family. Areas where extra support is required for patients are identified and referrals are made to various internal and external services.

For the period of July 2009 to June 2010 654 risk screens were attended which resulted in 209 referrals being made to internal services as diverse as podiatry to palliative care and 27 referrals to external services including organisations such as the Aged Care Assessment Service and the Community Legal Service amongst others.

36 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Preparing for surgery

The Prehabilitation Clinic was initially trialed in 2009 to improve pre-operative assessment and treatment for patients undergoing elective joint replacements.

Prehabilitation is “a proactive, preventative approach to exercise, diet, and lifestyle changes, designed to maximise health and wellness”. This project complements the NSW government’s future directions goal to ‘prevent disease and injury and intervene early to reduce impact.’

There is substantial evidence demonstrating that exercise, weight control and functional intervention is beneficial for patients with arthritis. Allied health involvement usually begins at pre-admission clinics, just prior to the planned surgery. Prehabilitation occurs at least weeks, but usually months prior to the patient’s admission. This project is aimed at promoting health and education through earlier intervention, with anecdotal evidence suggesting this would improve outcomes, both for the patient and the organisation.

The physiotherapist and occupational therapist (OT) conducted a clinic assessing those patients on the orthopaedic wait list. The physiotherapist provided information on post-operative procedures (e.g. exercises, mobilisation and most importantly, expectations of the patient) while the OT targeted current occupational performance and home set-up. If necessary the patient was given a specific exercise program and follow-up physiotherapy or hydrotherapy organised.

All outcomes were encouraging. Patients reported feeling better prepared, with a comprehensive knowledge of the procedures, and were very positive about their interaction. Clinicians involved reported improvement in managing their post-operative clinical caseload and enhanced therapist/ patient rapport. The post-operative data showed reduced length of stay for participants and improved physical outcomes.

Due to the positive outcomes for all stakeholders, this clinic is now an ongoing service offered to all patients awaiting joint replacement.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 37 Health Promotion – keeping you healthy

Healthy food choices – AWH leading the way

Wodonga Hospital introduced the Healthy Food Choices Policy in 2009 and implemented healthier choices into the hospital’s café and vending machines using a traffic light system of identification. This system classifies food and drink items based on their nutritional value as: Green – everyday foods; Amber – select carefully; and Red – occasionally. Since the introduction of the policy Wodonga Hospital has increased green items by 20% and reduced red items by 21%.

In December 2009 the Victorian Department of Health unveiled their own draft guidelines requesting input from Public Hospitals. In his address, Health Minister the Hon Daniel Andrews stated: “It is appropriate that hospitals demonstrate leadership in creating healthy environments that both reinforce nutrition messages provided by clinical staff and other health professionals and address the lifestyle risk factors for chronic disease.” The success of the policy at Wodonga Hospital has been showcased in the ‘Healthy choices: food and drink guidelines for Victorian public hospitals Toolkit’ released in May 2010. The Wodonga case study can be viewed on page 20 of the Toolkit, located at the following website: www.health.vic.gov.au/healthychoices

38 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Reducing stress through Pet Therapy

Albury Hospital runs a Pet Therapy program in several wards on a weekly basis. Pet Therapy is the use of trained animals with handlers to visit children and adults in hospitals, rehabilitation centres and residential care facilities. It is well known that contact with animals can improve human wellbeing. Visiting therapy dogs can reduce stress, lower blood pressure, motivate and encourage the elderly to stay healthy and exercise, and generally enhance the quality of patients’ and residents’ lives.

John & Phyl Bower visit Albury hospital weekly with their sheltie called Paddywak and Lucy who is a Foxy whippet cross. Both dogs are extremely well behaved and staff and patients look forward to their visit. AWH is encouraged with the improvement in patients’ health as a result of the visit. Just one story of the success of the program involves a brain injured patient with cognitive (memory) problems. Whilst unable to retain a lot of information, this patient treasures the dogs, and can John and Phyl Bower with their Pet Therapy dogs, Lucy and Paddywak. tell you their names even several days after their last visit.

Pole Walking: regaining health after your hospital visit

Pole walking, which is also known as Nordic Walking, is regular walking that is enhanced by using a pair of hand-held poles as you would when doing cross- country skiing, applying force to the poles with each stride. Pole Walking can be taken up by Albury Wodonga Health clients following completion of the Cardiac Rehabilitation program. It runs each Thursday morning, rain, hail or shine, leaving at 9 am from Australia Park, Albury. The walk takes an hour and follows the scenic concrete bike track along the Murray River. The session is followed by a quick cuppa and an opportunity to socialise. Most weeks a Cardiac Rehabilitation staff member is present for the opportunity to follow up with ongoing health issues. There are currently 18 regular Pole Walkers. Benefits of Pole Walking

• Burns up to 40% more calories. • The benefits of running without the high impact or effort. • Uses 90% of total body muscles. • Increases fitness (oxygen uptake) by 20-46% on normal walking. • Increases muscle tone and stamina in your shoulders, back, chest and arms. • Reduces stress and removes 23% of impact off joints. • Relieves neck and shoulder pain. • Poles provide balance and stability. • Enhances mood and is a safe form of outdoor activity.

ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 39 Glossary

Accreditation: A process of regular independent assessment that identifies whether an organisation is meeting the required performance standards and striving for continuous improvement.

Audit: An examination of an activity or of documentation to check whether things are being done as expected.

Benchmarking: When one organisation compares its performance, systems and practices with other organisations (especially industry leaders) and uses the information gained to make improvements.

Clinical governance: The system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

Complaint: An expression of concern or dissatisfaction by (or on behalf of) a health care consumer or group of consumers about any service offered. Complaints can be formal (written) or informal (verbal).

Compliance: The level achieved by an organisation against accepted standards.

Corporate governance: the system by which companies are directed and managed. It influences how the objectives of the company are set and achieved, how risk is monitored and assessed, and how performance is optimised.

Credentialing: The formal process used to verify the qualifications, experience, professional standing and other relevant professional attributes of health professionals for the purpose of forming a view about their competence, performance and professional suitability to provide safe, high quality health care services within specific organisational environments.

Evaluation: The collection and examination of information to identify the outcome of an activity, intervention or service.

Health promotion: The process of enabling people to increase control over the determinants of health and thereby improve their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and realise aspirations, to satisfy needs and to change or cope with the environment.

Incident: An event or circumstance in the provision of care that is not the result of a person’s medical condition, in which harm, loss or damage resulted (ie adverse event) or could have resulted (ie near-miss).

Performance (or clinical) indicator: A measurable occurrence that demonstrates the extent to which a health service is doing what is expected.

Risk management: The culture, processes and structures that are directed towards realising potential opportunities while managing adverse effects.

Standard: A statement about the level which organisations and their staff within a particular industry are expected to achieve.

40 ALBURY WODONGA HEALTH QUALITY OF CARE REPORT 2010 Contributions This report was written and edited by many people, and our thanks go to everyone for their willing participation. Special thanks go to the AWH Quality of Care Report Steering Committee, and the Community Advisory Committee Quality of Care Report Working Party.

Photography credits We give our thanks to everyone who willingly acted as a model for these photographs, both patients and staff.

All images captured by Ellen Lister, with the exception of page 7 (Andrew Brown and uncredited), 8 and 18 (Natashia Allitt), pages 13, 28 and the photograph of Sarah and Joshua on 27 (Stephanie Simmons), the apples on page 38 (stock image) and the image of entrances to Wodonga Hospital on page 3 and page 4 (Linda Moon).

Case Studies All case studies included in this document are fictional, and are not intended to represent any patient of AWH.

Enquiries Any enquiries regarding any information presented in the Quality of Care Report can be directed to AWH via email at [email protected] or via telephone on 02 6051 7546. Albury Wodonga Health PO Box 326 Albury NSW 2640 ABN: 31 569 743 618

Albury Hospital Borella Road Albury NSW 2640 Ph: 02 6058 4444 Fax: 02 6058 4528

Wodonga Hospital Vermont Street Wodonga VIC 3690 Ph: 02 6051 7111 Fax: 02 6051 7477