FocusWest Coast District Health Board onPeople QUALITY ACCOUNTS 2020

Introducing the 5R’s Escalation Pathway West Coast Facilities helps to detect consumer update pg 8-10 deterioration earlier pg 4-5 Testing for COVID-19 Addressing the inequities – an integral part of of access to health care the West Coast DHB’s for Coast Māori pg 7 pandemic response pg 12

We can all A quick word slow the Welcome to Focus on People: Quality Accounts publication spread which aims to provide you We all need to work together if we want to slow the spread of COVID-19. Unite against the virus now. with a snapshot of the work we have been doing over

Be kind. Check-in on the elderly Washing and the past year to improve drying your hands Cough or sneeze or vulnerable into your elbow Stay home the health and wellbeing Wash & dry kills the virus if you are sick of Coasters. your hands Find out more at This year has had its challenges Covid19.govt.nz and, as always, in true West Coast STS_A4_20/03 style we have risen to them which is reflected in the number of quality improvements implemented across our health system. colleagues who, although they did health care services during the exactly what was expected of them, COVID-19 pandemic. The COVID-19 pandemic and its went above and beyond the call of ongoing effects on the health and Good access to general practice duty to ensure that the health care wellbeing of our communities services, to hospitals and specialists, needs of the 32,600 Coasters living have dominated the year. Our to mental health care and to oral West Coast Health System has between Karamea and Haast health care; for ourselves, our been instrumental in the success were met. families/whānau, our friends and of our regional response to date Focus on People draws together neighbours, our colleagues and – highlighting the benefits of our examples of initiatives undertaken people we see in the streets is an integral part of ensuring that we integrated health model and the by our staff throughout the year. The receive the care we need. Taking value of a whole of system response. common themes highlighted are the care of our own individual health way staff have improved systems None of what has been achieved and wellbeing needs like exercising and processes to enhance patient would have happened without the regularly, eating healthy food and input of both our own West Coast care as well as ensuring Coasters taking time out to do the things that DHB teams and our health system were able to continue to access make us happy is also essential. We hope you find the stories interesting and informative, and that Front cover photo courtesy of the Greymouth Star by the time you are reading this that Front (left to right) Back (left to right) you have plans in place to take a Dorothy O’Connor, Nurse Consultant Nurse Miriam Purcell, Registered Nurse Paediatrics Specialist Paediatrics Janely Sagayno, Registered Nurse Paediatrics well-earned break. Thank you! Bridget Foote, Registered Nurse Emergency Remya Lathika Mohanan, Registered Nurse Department Emergency Department Andrew Brant Noelene Thomson, Environmental Services Cleaner Acting Chief Executive West Coast DHB

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 3 Manaakitanga Inpatient Unit 5R’S Escalation Pathway Introducing the 5R’s Escalation Has something changed? Take action!

1.Healthy Recognise Pathway helps to detect 16+ adult A trigger for further investigation Complex What is healththe deterioration needs thatModerate has been to recognised? high complex Critically ill / consumer deterioration earlier health needs near end of life Over the past year, the West Coast DHB’s 2. Respond Manaakitanga Inpatient Mental Health team has Graded response actions What immediate actions can I take? been focused on developing a more proactive and responsive approach to detecting the deterioration 3. Request in a consumer’s presentation earlier. As a result, Graded response to request help the team developed and tested the 5R’s Escalation Who is help requested from? Pathway which provides clear, objective criteria that prompts staff to call for help when they, 4. Report Identify roles and responsibilities of all consumers or family/whānau are concerned response providers about a consumer’s acutely deteriorating Who is coordinating the response? physical and/or mental health.

5. Record Escalation Pathway care and response to be This work forms part of the Mental of incidents where completed promptly following activation Provides guidance on recording processes Health and Addiction Quality deterioration was Improvement Programme – an indicated occurred ongoing programme of quality after hours improvement initiatives undertaken (4.30pm–8.00am by all DHBs and supported by the and weekends Health Quality & Safety Commission and public holidays), New Zealand (HQSC). HQSC so developing a robust tool that identified five key project areas: would help prompt and guide staff handover processes by providing in recognising and responding to • minimising restrictive care (zero deterioration was vital.” all relevant information including seclusion by 2020) previous observations and clinical The tool had to incorporate several • improving service transitions history at handover. We also needed important criteria for it to be viable. (connecting care) to ensure that staff receiving the It needed to: handover information responded • learning from serious adverse • be user friendly, clinically useful with the appropriate level of urgency events and consumer experience and able to be used 24/7 and that they had confidence in the • improving medication response system,” says Jenny. • be a trigger for further management and prescribing investigation and assessment The 5R’s Escalation Pathway uses a • maximising physical health. simple formular to recognise and • be considerate of clinical history Jenny MacFadgen Quality Facilitator and current clinical presentation respond to deterioration. – Mental Health Services says, • identify indicators of 1. Recognise – what is the “We needed to ensure that any deterioration and appropriate deterioration that has been deterioration would trigger an early, escalation response recognised? timely and appropriate clinical response. Deterioration can happen • identify roles and responsibilities 2. Respond – what immediate at any time so by ensuring we have of response providers. actions can I take? a timely recognition and response “What we also learnt was that 3. Request – who is help requested system helps improve our consumer the lack of escalation didn’t seem from? care and results in a safer ward to be related to any one specific environment for both consumers 4. Report – who is coordinating the factor, but instead to a number of and staff.” response? contributing factors. For example, “When we looked at the data, it we identified that we needed to 5. Record – provides guidance on clearly showed that over 70 percent improve our communication and recording processes.

4 | WEST COAST DISTRICT HEALTH BOARD “Although it is early days, we are starting to see the results especially in the more proactive and responsive approaches being taken by our staff when recognising and responding to deterioration. In the long term, we expect to see more effective care and better health outcomes for consumers as well as a reduction in serious events and the impact these have on consumers, family/whānau and staff.” “We are really pleased with the outcome. What’s also exciting is that not only has this model been recognised by the HQSC, it has also piqued the interest of the Ministry of Health. The reality is this in the design and implementation Has something changed? Take wouldn’t have come to anything if of the pathway to ensure that our action! it wasn’t for all the hard work and consumers receive the appropriate effort Manaakitanga staff invested level of care,” says Jenny.

Supporting Parents Healthy Children programme helps strengthen parent- child relationships Over the past year, the friendly appointment times and West Coast DHB has been meeting spaces. Parent and children’s implementing the Ministry of wellbeing are becoming a more Health’s ‘Supporting Parents regular part of our conversations. The reality is that all families have different Healthy Children’ (SPHC) needs so it’s important that we work initiative which aims to with each family to identify what these improve adult mental health are and tailor their support needs the Salvation Army – to ensure that and addictions services for accordingly.” parents and their families have parents, their children and access to additional support and “Children can also be offered their resources if needed,” says Kelly. families/whānau across own resources and support while New Zealand. their parent(s) are unwell. Training “A range of new resources have Supporting Parents Healthy opportunities are available to our been created and made available Children Coordinator Kelly Shaw workforce that highlight the unique across NZ to support this new way says, “That all parents deserve to needs and pressures of parenting of working. The booklets, worksheets feel valued and children should with mental illness or addictions. The and tip sheets all provide useful feel safe, supported and reassured. training encourages staff to consider information for parents, children and The SPHC programme focuses the needs and safety of children in families from pregnancy through to on strengthening the parent-child all treatment planning.” teenage years and beyond.” relationship and improving the long- “We also have the ability to link If you would like additional term health and wellbeing of the with our community partners – information, or to see some of whole family.” Homebuilders West Coast Trust, the resources created to “As a DHB, we have been working Pact West Coast, Cornerstone Family support this work, please visit towards offering family/whānau Support, Family Start, Emerge and www.supportingparentsnz.org

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 5 (Left to right) Debriefing service team members Registered Nurse - Crisis Response Team Mark Fusco and Quality Facilitator – Mental Health Services Jenny MacFadgen. Debriefing service introduced across the West Coast DHB In early 2019, the West It is a psychological intervention Coast DHB implemented a and is separate from our internal debriefing service designed investigation/review process.” to support staff to manage Debriefing sessions are designed and prepare for any to evaluate the emotional and stressful reactions they physical impact on staff involved in may experience following a an incident; to provide support to help reduce the isolation of the staff serious clinical incident or and to provide an opportunity for traumatic experience. understanding and learning. The Quality and Patient Safety Manager focus is to help validate what staff Rosalie Waghorn says, “As have experienced and to ensure professionals working in health and there is a safe place available for social care our desired outcome for staff to voice their concerns and consumers and their families/whānau express their reactions. may interfere with your daily life.” is always to provide the best possible “Everyone reacts to these types care. However, there are many “Stress, threat or loss can cause of incidents differently and your variables to our work and sometimes, people to react in ways that may be past experiences and individual despite our best intentions and distressing for themselves or others perceptions all contribute to how efforts, things can go wrong.” around them and it may take some you react. Learning to recognise time to work through and recover “If you’ve been affected by a clinical your reactions and emotions can from this. Stress reactions can incident or traumatic event at help you feel more at ease with appear immediately after a traumatic work it may have a negative impact what has happened and assist you event, or they can appear hours or on your life. In addition, your to gain a better understanding and days later,” says Rosalie. colleagues, family and friends may insight into the situation. If you feel also be affected in some way. Even “We offer a confidential debriefing debriefing may be required, talk with though the event may be over, it session to all staff following a your line manager or another senior is not unusual to be left ‘shaken’ serious work-related incident to staff member who will contact the or ‘worried about the future’ or to assist them to manage and prepare DHB’s Debriefing Team Coordinator,” experience increased stress that for possible stressful reactions. says Rosalie.

6 | WEST COAST DISTRICT HEALTH BOARD Addressing the inequities of access to health care for Coast Māori The national COVID-19 Alert Level 4 lockdown provided a unique opportunity for the West Coast DHB’s Hauora Māori team to look at creative ways to engage with Coast Māori to ensure that they continued to access health care during lockdown. One area of focus was to look (Left to right) CBU Receptionist Melissa McMillan and CBU Team Leader Michelle Rooney confirming appointments. at how to improve access to services by addressing the ‘did not attend’ (DNA) rates 1. Understanding health that the best solution was not to which are higher for Māori inequalities. simply rely on appointment letters or text messages but to phone than for non-Māori. 2. Designing interventions to reduce people who hadn’t confirmed their Hauora Māori Portfolio Manager inequalities. Outpatient appointments.” Marion Smith says, “We have known 3. Reviewing and refining “What we learnt was that often for some time that in too many interventions. areas Coast Māori have worse there were good reasons for not health outcomes than the rest of 4. Evaluating the impacts and confirming ranging from family/ our communities. As a DHB, we outcomes of interventions. whānau issues to not knowing are committed to eliminating these about the appointment. It was not “The number of Māori who DNA at uncommon to learn that someone inequities so it’s particularly important our Outpatient clinics has been a that we look at everything we are hadn’t confirmed their Outpatients concern for many years. Data shows appointment because the time didn’t doing to ensure that we achieve this.” the DNA rate has been consistently fit in with childcare arrangements “We use the Health Equity over 10 percent for the past 5 years, or that they didn’t have reliable Assessment Tool (HEAT) to help at times showing Māori are three transport,” Michelle Rooney says. us highlight and address health times more likely to DNA than non- “The extra effort made by Michelle inequities when making health Māori and although not high when and her team to contact people who decisions. HEAT is a planning tool you consider the total number of hadn’t confirmed their appointments used to identify areas of change patients, we wanted to reduce this has started to pay off. The data and help improve programmes rate. During lockdown, we worked from the past four consecutive and services to promote health with our Central Booking Unit (CBU) months shows that the DNA rates equity. It enables us to assess health to look at interventions we could for Māori have dropped under 10 initiatives for their impact on health implement to encourage Māori to percent which has not happened equity. The best bit is that it’s a really attend their appointments.” over the last five years. Through this easy tool to use.” CBU Team Leader Michelle simple change in process, we have HEAT consists of a set of 10 Rooney says, “Until Marion came been able to look at how we can questions that help health care and presented the data for the make it work including whether any staff assess policies, programmes Māori DNA rates, we hadn’t given additional support is needed to help or service interventions for their this issue much consideration. someone get to an appointment. It current or future impact on health As a team, CBU is responsible just goes to show that with a little inequalities. The questions cover for booking all Outpatient and bit of initiative, plenty of passion and four stages of policy, programme or Surgical appointments – so it’s enthusiasm you can make a real service development. a busy department. We decided difference,” Marion Smith says.

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 7 West Coast Facilities update TE NĪKAU HOSPITAL & HEALTH CENTRE UPDATE Te Nīkau Hospital & Health Centre was officially opened on Friday 25 September 2020, by the Rt. Hon Jacinda Ardern PM. The opening attended by approximately 250 people provided an opportunity to formally celebrate the completion of and migration into West Coast DHB’s new facility. With a building footprint of 8,500 square metres, the facility has been designed to support flexible ways of working. We see people for planned appointments, respond to people with urgent needs, admit and monitor patients that are more seriously unwell and stabilise emergency patients that require critical or specialist care. The range of services includes an integrated family health centre providing primary care and outpatient services, a radiology Sterile Services. Radiology CT Scanner. department, laboratory services, an allied health hub, three operating TE NĪKAU HEALTH CENTRE SERVICES theatres, 56 inpatient beds and four transitional care units. Other General Practice provides over twenty different clinical services include urgent care, specialities, for example, General Practice is where emergency department, critical General Medicine, General you will come to see one care unit, paediatric and maternity Surgery, Rheumatology, of our doctors or Nurse services, as well as, planned and Orthopaedics, Gynaecology, Practitioners for all general acute medical and surgical services Cardiology and Nutrition and practice (GP) services. For and older persons’ health, including Dietetic Services. You may have example, management of long- assessment, treatment and been referred by your GP or term health conditions, ACC rehabilitation services. other Health Care Professional. consultations, vaccinations, Clinics for the majority are cervical smears, smoking held Monday to Friday with the cessation programmes, occasional weekend clinic – cardiovascular disease risk depending on the speciality. assessments and diabetes reviews. Infusion Services Outpatients Department Infusion Services provides infusion and chemotherapy The Outpatients Department services for a range of is where you will come for medical conditions such as your specialist appointments. rheumatoid arthritis, cancer Outpatients Department and Crohn’s disease. Dental room in the Allied Health Hub.

8 | WEST COAST DISTRICT HEALTH BOARD West Coast Facilities update cont’d

In Te Nīkau Hospital & Health Centre, there is a handful of spaces designed for some of our most precious patients, our tamariki (children). We have adopted a Matatiki theme across all child health services. From the decals on the walls to

the curtains around the beds, Western side of Te Nīkau. our young patient spaces are designed to be low-stress Hours and comfortingly • Hospital services, such as, Emergency Department and Inpatient familiar – providing Wards are available 24/7. a welcome distraction while we • Planned care is available between 8am – 8pm; Monday to Friday. provide the best Visiting hours possible care. General Ward 10:00am – 2:00pm 4:00pm – 8:00pm Critical Care Unit 10:00am – 1:00pm 3:00pm – 8:00pm Maternity Unit 10:00am – 12:00pm 4:00pm – 8:00pm No children under the age of 16, apart from siblings are to visit. Matatiki curtains add lively colour to the children’s areas. Children’s Ward Whānau/parents/caregivers are welcome at any time, but only one person can stay overnight. All other visitors are welcome between 8:00am – 8:00pm. Entry and Parking Enter the hospital and health centre site off High Street, up over the bridge and turn right. Access to all services is via the main entrance on the Ground Floor. Please go to the Main Reception on arrival. Bedroom in Children’s Ward. Parking is available on campus with mobility parks close to the main entrance. Please arrive early to your appointment to secure a park. Contact us Te Nīkau Hospital and Health Centre, 71 Water Walk Road, Greymouth Phone: • 03 769 7400 general enquiries • 03 769 9300 general practice

Keep up to date at www.wcdhb.health.nz or follow us on Facebook. Te Nīkau Hospital & Health Centre plaque in the main entrance.

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 9 West Coast Facilities update cont’d

BULLER HEALTH CENTRE to start work. The request for proposal was released to the The planned demolition shortlisted contractors for the main SOUTH WESTLAND that’s needed to make way contract work on Thursday, 12 CLINIC for the new Buller Health November 2020 with a closing date Construction work to of Wednesday, 16 December 2020. Centre is well underway with fit out the new Haast construction of the new Buller The 12-bed 2,360m2 facility has been Health Centre was Health Centre expected to designed to support an integrated completed in early model of care and will house a range start early in 2021. December with the of services including general practice, The removal of asbestos containing inpatients, primary birthing and move into the new material (ACM) and demolition work postnatal care, palliative care, urgent facility undertaken on commenced at the end of July 2020 care and dental services. The DHB’s Tuesday, 15 December. with an anticipated completion community services, Hauora Māori The new clinic is co- date of February 2021. This work service and mental health service has involved the removal of all located with St John will also be located within the Buller internal furniture and fittings, floor in the existing St John Health Centre. coverings and internal linings; premises in Haast disconnection and removal of all Clinical services will be supported Township. services including electrical, central by radiology and laboratory support The facility has a similar heating, fire alarms, sprinklers; set services on the same site. The co- number of rooms as the old up of decontamination units for location of services will facilitate a clinic in Hannahs Clearing, asbestos removal and the removal of collaborative approach to providing but the rooms are larger in various types of asbestos containing health care services, with a focus on size. It includes an accessible materials throughout the buildings. improving the patient experience. toilet, waiting room, consult This month will see the removal of The current floor plans are available room, treatment room and roofing material along with some on our website– Buller Health multiuse storage/utility room demolition work. floorplan and you can also view the with staff amenities being Site clearance and earthworks are 3D video of the new Buller Health shared with St John staff. also underway, to ensure that the facility online – 3D video There is direct access from site is ready for the main contractor the clinic into St John, to facilitate patient transfer. The move to the new premises provides several improved clinical safety benefits such as better internet services, increased reliability for mobile phone coverage and increased coordination with St John in the event of a local Waiting room. level emergency. The new location not only results in the largest population in the wider Haast area having easier access to a safer and more sustainable health clinic, it also provides an opportunity for the DHB to improve the resiliency of health care service for the Haast community.

Workspace.

10 | WEST COAST DISTRICT HEALTH BOARD ePharmacy now live across the five South Island DHBs An electronic pharmacy management solution is now live across the five South Island DHBs, enabling hospital pharmacy inventory to be managed within a single system, improving service delivery and saving time. ePharmacy provides full inventory management, dispensing, compounding, and repacking functionality for hospital pharmacy services, and integrates with patient management systems, financial (Left to right) Pharmacy Team Leader Lisa Jackson, Intern Pharmacist Alex Henkel, Pharmacy Technician John Hutt and Pharmacist Tracey Makinson. systems, and MedChart prescribing and administration software. Marlborough Health and West Anna Mitchell, Regional ePharmacy Developed in close consultation Coast DHB, the project involved Programme Specialist, South Island with hospital pharmacy expertise, ‘on-boarding’ to a Canterbury DHB Alliance, says despite project delays ePharmacy replaces end-of-life hosted instance of ePharmacy, due to COVID-19, the go-lives across software, WinDose. The upgrade will which was already live. The Southern the South Island went smoothly allow more efficient and productive DHB and South Canterbury DHB and are a credit to the dedication ways of working, improved ePharmacy projects were configured of the teams. “The project involved functionality and regional patient separately and hosted by Southern a real regional collaboration and I information sharing to pharmacy DHB. Pharmacy workflows and personally formed valuable working services. business requirements were relationships with the project teams. Since August, all five DHBs are standardised and aligned across the It was nice to share the knowledge now using ePharmacy. For Nelson regional instances. I gained with others and learn technical aspects of the software, and also learn how other DHB pharmacies work. The project teams worked really hard to configure the software, which involved setting up each medicine kept at their pharmacy, testing the software multiple times and implementing it on top of their regular work.” Lisa Jackson, Pharmacy Team Leader at Te Nīkau Hospital Pharmacy, says the go-live process went smoothly, which was down to the hard work and planning put in by everyone in the team. “The connections and support networks that have come out of this project are incredibly valuable, and we are excited about future opportunities to work collaboratively as a region.”

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 11 Testing for COVID-19 – an integral part of the West Coast DHB’s pandemic response As part of the national COVID-19 pandemic response, the West Coast DHB set up four COVID-19 West Coast DHB Registered Nurse Chris Hallaran assessing long-haul Truck Driver, Philip at the Community-based Springs Junction mobile CBAC. Assessment Centres (CBACs) – in Westport, Reefton, possible a drive through model was we were able to get the samples to established,” Mr Smith says. Christchurch in time for the main Greymouth and Hokitika – batching analysis. A great example of “To determine the presence of along with mobile testing good team work,” Mr Smith says. stations at various locations COVID-19 on the Coast, the DHB’s across the Coast. COVID-19 Emergency Operations “As we head into the holiday season, Centre (EOC) made the decision it’s important that we remain David Smith Manager of Integrated to set up mobile testing clinics focused on keeping ourselves, our Services – Southern says that across the Coast. The planning and family/whānau and friends safe. We “Setting up the CBACs seemed like implementation of this testing was can all continue to help reduce the a fairly straight forward exercise significant and included how we spread of any infections by practicing except we needed to ensure that would manage traffic flow, where we good hand hygiene, appropriate all the relevant processes were in would set up the stations and working coughing or sneezing etiquette and place and that we had the people with Police and Fire & Emergency to safe physical distancing.” available to staff them. One of the support the mobile clinics. If you have the COVID-19 Tracer challenges was that information The first mobile testing clinics app installed on your phone or about COVID-19 including the case were held in Haast and Bruce Bay device, please scan the QR code definition was regularly changing and provided a great opportunity each time you visit somewhere new. which meant we had to continually to connect with South Westland This helps make contact tracing review our processes to ensure that residents. The team was able to easier. As always, if you are unwell they were up-to-date.” promote public health messages please stay at home. “In the week before Alert Level 4 and to provide flu jabs to anyone at Please call your general practice lockdown, the Greymouth CBAC was greatest risk of serious illness from team or Healthline on 0800 358 up and running which provided the influenza. We subsequently held 5453 for advice (a free, 24/7 service opportunity we needed to finalise clinics in Franz Josef, Fox Glacier, with interpreters available) if you our processes. We developed Arahura, Reefton and Springs have any symptoms of COVID-19 guidelines that included everything Junction.” – high temperature (at least 38°C), from testing procedures, use of “During all this, we had to get the cough, shortness of breath, sore Personal Protective Equipment (PPE), swabs to Christchurch by the end throat, sneezing and runny nose, reporting and staffing requirements of each day for laboratory analysis temporary loss of smell. These through to communication with the by Canterbury Health Laboratories. symptoms do not necessarily mean community and information leaflets.” With limited courier and other you have COVID-19. The symptoms “The other three fixed CBACs were transport services available, we had are like other illnesses that are much established during the first week to find a suitable solution. A list of more common, such as cold and of ‘lockdown’. Each of the CBACs DHB staff that were able to flex from flu. Shortness of breath is a sign of needed to be set up in a location their usual roles due to COVID-19 possible pneumonia and requires that didn’t require community restrictions was compiled and immediate medical attention. members to enter other areas using this we establish a transport Remember, if it is an emergency – within any of our facilities. We later roster. With occasional support phone 111. refined our processes and where from West Coast Civil Defence staff,

12 | WEST COAST DISTRICT HEALTH BOARD Infection Prevention and Control – gloved up and ready to go The Infection Prevention and Control (IP&C) Service are trained specialists with expertise in stopping the spread of infections. A handy superpower to have in these challenging times. As early as January, the team developed COVID-19 Preparedness/ personal protective equipment (PPE) training resources and started delivering education sessions for staff. As the Pandemic unfolded and evolved, a multitude of emails and phone calls from across the West Coast Health System flooded in, says Clinical Nurse Specialist – Infection Prevention & Control Julie Ritchie. (left to right) Members of the Greymouth CBAC’s multi-disciplinary team – Lynette Skeats, “Working with our Emergency Ann Knipe, Lisa Smith, Tena Wilson, Nyoli Waghorn-Rogatski, Sue Donaldson, Raelene Holden, Operations Centre (EOC) colleagues, Sheila Stopher, Vani Kantamnani. we provided in-depth education flow and Isolation/PPE procedures. worked in this unit initially did so on sessions for all staff about COVID-19 We were fortunate to have access a voluntary basis.” and what infection prevention & to resources such as guidelines for control precautions were necessary. In conjunction with the EOC team, we managing COVID-19 through the These sessions were followed up with completed COVID-19 preparedness Canterbury IP&C service,” says Julie. practical PPE education sessions to assessments of all aged residential ensure that all staff were competent In ‘normal’ times, the West Coast DHB care (ARCs) facilities across the West with the relevant procedures.” has the continual challenge of relying Coast. This included ensuring that all on transportation for all supplies ARCs had access to adequate PPE “Early on during the pandemic, so managing the procurement supplies and that visitor restrictions the COVID-19 case definition was and distribution of PPE during the were implemented to ensure that the regularly changing which meant pandemic was often quite a challenge number of people entering facilities that the IPC team was very active which our amazing supply team was limited. The value of video across the West Coast health rose to. Their input enabled us to conferencing became very apparent system assisting with patient obtain critical stock items, especially during this time and even more so management, staff safety, patient PPE stock, cleaning and disinfection when New Zealand was in ‘lockdown’. products and waste management “It was a really challenging and supplies during a turbulent emotional time especially given that international supply environment. the first recorded COVID-19 death in “We were involved in setting up New Zealand was here on the Coast. our Community-based Assessment The amazing way everyone stepped Centres (CBACs) where staff from up to take on this work was incredible across the health system such – it was a fantastic example of all of as Population Health Nurses, health system team work.” Physiotherapists, District Health “A positive spin off of the pandemic Nurses and Clinical Nurse Specialists is that it really highlighted the were redeployed during Alert Level importance of hand hygiene. Our 4 lockdown to undertake COVID-19 message to our colleagues and to testing. The team also supported our the public is keep up the good work trades and nursing staff in the set and remember if you need IP&C up and management of the Isolation advise and support we’re here to Ward, which was no mean feat help,” says Julie. especially given that the staff who

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 13 Using telehealth for group programmes during the COVID-19 pandemic lockdown

Knotted stomach, rapid were not allowed at a time heartbeat, sweaty palms and when people needed support to scrambled thoughts – the “unknot” more than ever. However, experiences of people facing from a place of restriction, new opportunities are birthed, and anxiety. People experiencing the fledgling “Virtually Unknot Me” anxiety often wonder if they programme began. are going mad and feel alone The team developed an online in a world that appears to programme, while keeping the be coping. ethos of Unknot Me’s user-friendly, Feedback showed delivering the Recognising the need to share approachable, and straightforward online group was worthwhile. stories, connect, and give people approach. Zoom was the platform of While challenging for facilitators, it tools to manage fears, the West choice due to its usability, and ideal allowed for geographically or socially Coast DHB’s Mental Health Service features for group activities. isolated people to access supports and develop helpful strategies and partnered with Pact in 2014, Participants from across the Coast networks. Attending from the privacy delivering the successful anxiety were encouraged to self-reflect and of their own home, the ability to management programme “Unknot assess the intensity and impact of choose a pseudonym or disable Me”. The group is facilitated in their anxiety before commencing. their camera, added an optional Greymouth by Occupational Some rated their anxiety as very layer of emotional safety. Therapist Rachelle Hunt, Consumer disruptive to their relationships and Advisor Joe Hall, and group alumni usual tasks. Virtual programmes don’t replace Mark Crashley; with Social Worker in-person groups, and won’t work • “I want to feel like I’m not Jose Timmerman facilitating for everyone, however sometimes alone” Hokitika groups. we need to challenge traditional The global pandemic added a new • “I’m worried about being seen settings. Group telehealth appears layer of anxiety for many and the as weak” to be a promising resource for addressing geographical inequities lockdown restrictions brought new • “I want to learn simple ways and improving the health of our challenges for groups. Gatherings to cope”. wider West Coast population.

14 | WEST COAST DISTRICT HEALTH BOARD Catch up on your free vaccination to avoid catching measles If you’re between 15 and 30 years old and haven’t had your MMR (measles, mumps, rubella) vaccine, or you’re not sure, get your free immunisation now. Last year more than 2,000 Kiwis got sick from measles and more than 700 needed hospital treatment, while 80 people in Samoa, mostly children, died from the disease. Young man taking part in the MMR vaccination catch-up campaign. West Coast Medical Officer of Health Dr Cheryl Brunton says last year’s measles outbreak and this year’s “Ask your doctor, parents or caregiver “Getting a catch-up MMR vaccination COVID-19 pandemic have shown the if you had two doses of MMR as a now will make sure you and those impact infectious diseases can have kid, and if you didn’t or aren’t sure, around you are protected in the when we are not immune. it’s a good idea to get one MMR dose future,” says Dr Brunton. now,” says Dr Brunton. “Now is the time to catch up on the MMR is also part of the childhood vaccinations we have easy access General Practice teams across the immunisation schedule (which to, such as MMR, to protect our Coast have started inviting people in moved to 12 and 15 months from community and whānau in the this age group to come in for their 1 October). Anyone born after 1969 future,” Dr Brunton says. free measles catch up. You can also continues to be eligible for two free get an MMR catch up from some MMR doses. People born between 1990 and 2005 pharmacies if you are aged over 16. have the lowest immunity against For more information about measles measles and are most at risk of “Measles is more than eight times and the MMR vaccination, visit catching it because a higher than more infectious than COVID-19. It the Ministry of Health’s website – usual proportion of this age group can make you very sick and affect protectagainstmeasles.org.nz. didn’t have their scheduled childhood your health for the rest of your life. MMR vaccinations. This group is not only more likely to catch measles but also spread it to others, which is why there is now a national catch-up Aged 15–30? programme focusing on improving the immunity of this group. If you haven’t had two doses of MMR or aren’t sure, In most people, one dose of MMR get a free vaccination. vaccine ensures about 95 percent protection from measles, while Available now from GPs two doses provide around 99 and most pharmacies. percent protection. The vaccine also protects against mumps and GET YOUR FREE rubella. It is safe to have an MMR IMMUNISATION even if you are unsure if you have been fully immunised. “We’re urging everyone aged 15 to 30 years old to get at least one MMR vaccination to help prevent future outbreaks of measles.

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 15 The grubby days before hand washing, and how something so simple can stop infectious disease in its tracks Ignaz Semmelweis (1818 foul vapours). The treatments of the – 1865) was a Hungarian day for childbed fever for example obstetrician who worked were induced vomiting, bloodletting in maternity wards, (using non-sterile equipment), enemas, and the use of leeches to where typically one in ten ‘purge’ the sickness from the body. women died from childbed (puerperal) fever. At around the same time a British doctor, John Snow, didn’t subscribe Following the death of a close friend to the ‘miasma’ theory either. from an infected wound, he blamed dirty, unwashed hands for the death Dr Snow was a London-based and set about testing his theory. physician when a cholera outbreak Within three months Semmelweis killed tens of thousands, at a time had reduced the number of when human waste was still dumped deaths from childbed fever to one in the street where the next rain in a hundred. Still dire by today’s would wash it into drains and rivers. standards, but ten times better than Almost nobody washed their hands it had been. and perhaps unsurprisingly, children had only a 50 percent chance of John Snow memorial. Many medical professionals making it past their fifth birthday. considered the new idea to be out, in stopping the spread of cholera ‘quackery’ (a kind of 19th century He suspected that the cholera in that area almost overnight. medical ‘fake news’). It would be outbreak was somehow connected While medical knowledge and years before the majority of the to London’s drinking water. Using sanitation have both taken huge scientific community accepted the hospital records and morgue reports leaps over the past 200 or so years, idea and began to take steps to he created a map of where cholera the basics are as true as ever – improve hand hygiene. deaths were occurring. He found a cluster of 500 deaths that could cleaning your hands thoroughly Back then, clinicians didn’t know be traced directly back to one area saves lives. Washing for 20 seconds about bacteria. People often surrounding the Broad Street public with soap or using a 70 percent described illnesses as being caused pump, a frequently-used drinking alcohol hand sanitiser kills viruses by by ‘humours’ or ‘miasmas’ (bad air or water source in that part of the city. breaking down the layer of fat and protein that protects them. Drying hands completely is also important,

wet hands spread germs more easily. EDITORIAL CREDIT: SERGEY GORYACHEV / SHUTTERSTOCK.COM / GORYACHEV SERGEY CREDIT: EDITORIAL Snow thought that pump might have COVID-19 will be with us for something to do with how cholera some time yet, but there are was passed from person to person. simple things you can do to He managed to convince local take some control. One of the officials to remove the Broad Street most effective ways to protect A stamp printed by Austria shows pump handle, a crude but effective yourself and others is, and has Ignaz Philipp Semmelweis – Hungarian way of stopping people from using it. always been, quite literally, in physician, now known as an early pioneer your hands. of antiseptic procedures. It was also just as effective as it turns

16 | WEST COAST DISTRICT HEALTH BOARD Urgent after-hours care Call your General Practice team first. After hours call your own general practice team and follow the instructions to be put through to a nurse for health advice.

When admitted to hospital On admission, please nominate a preferred contact as your key point of contact for hospital staff.

In an emergency, call 111.

Lemon Yoghurt Cake Serves 10-12 / vegetarian-friendly option

INGREDIENTS METHOD 1 ¾ cups sugar (white) 1. Heat oven to 180 degrees Celsius. Grease round 20cm 2 lemons grated cake tin, then line base and sides with baking paper. 2 Eggs Alternatively, use a 20cm spring- ¾ cup oil (Canola) form cake tin. ½ teaspoon salt 2. Combine sugar and lemon rind in a bowl. 1 cup yoghurt (plain) 3. Add the eggs, oil, and salt and 3 teaspoons lemon juice mix together until thick and smooth, then add the yoghurt 2 cups self-raising flour and lemon juice and blend until smooth. ICING 4. Add the flour and mix just 1 ¾ cups icing sugar enough to combine with the rest We welcome of the mixture. Lemon juice – enough to create your feedback desired consistency 5. Pour into baking tin and bake for 30-35 minutes until golden Email: wcdhbcomms@ brown. wcdhb.health.nz 6. Make icing by combining the Or write to: icing ingredients together. Pour Communications team icing over the cake. West Coast District Health Board PO Box 387 7. Serve with plain yoghurt. Greymouth 7840 For more information about the West Coast DHB, visit www.wcdhb.health.nz

FOCUS ON PEOPLE: QUALITY ACCOUNTS 2020 | 17 HOW TO HAND WASH

1 2 3

Wet hands with water and Rub hands palm to palm, Right palm over back of apply enough soap to cover up to and including wrists left with linked fingers all hand surfaces and vice versa

4 5 6

Palm to palm with Backs of fingers to opposing Rotational rubbing of left fingers linked palms with fingers interlocked thumb held in right palm and vice versa

7 8 9

Rotational rubbing firmly, with Rinse your hands Dry hands thoroughly closed fingers of right hand in with water with a paper towel left palm and vice versa

40–60 SECONDS HH2 APRIL 2019