Introducing the 5R's Escalation Pathway Helps to Detect Consumer

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.

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