Helping everyone to be and stay healthy
Annual and Quality of Care Report 2012 Echuca Regional Health Purpose ‘Helping everyone to be and stay healthy’
Guiding Principles
Respect and Honesty Treat people with dignity and be truthful
Inclusion Include everyone
Empathy and Compassion Understand other people’s needs and feelings Excellence and Best Practice Aim high Access and Equity Open to everyone – same for all Commitment and Accountability Work hard, be loyal and responsible for own actions
Incorporation The Governor-in-Council issued an order on 26 October 1993 declaring Echuca Regional Health to be a public hospital. The order took effect on 1 November 1993 and Schedule 1 of the Health Services Act 1988 was amended accordingly.
The health service is established under the Health Services Act 1988. The responsible Minister during the reporting period was the Honourable David Davis MP.
1 www.erh.org.au Contents
Page Our Community ...... 3 Reporting against our Strategic Priorities ...... 4 Our Profile ...... 7 History ...... 8 Year in Review ...... 9 Performance Measures ...... 11 Review of Operations – Acute Hospital, Residential Aged Care Services and Primary Care Services ...... 15 Improving the Quality of Services and Patient Safety ...... 28 Communicating with our Community ...... 46 Support from our Community...... 49 Board of Management...... 50 Board Committees...... 51 Organisation Chart...... 52 Staff ...... 53 Statutory Reporting ...... 56 Disclosure Index ...... 57 Index ...... 59
annual and quality of care report 2 Artist’s Impression of the new and expanded Echuca hospital
Our Community
Echuca Regional Health is located approximately 180 kilometres directly north of Melbourne in the Shire of Campaspe (Victoria), adjacent to the community of Moama (Murray Shire, New South Wales). Echuca-Moama is surrounded by the majestic Murray River, which provides for an area prosperous with agriculture, tourism, industry, development and new residents.
The Shire of Campaspe is home to 35,398 people and is a predominantly rural area, covering 4,517 square kilometres. Located on the New South Wales/Victorian border, Moama is the Murray Shire’s main township. The combined catchment areas for the Shire of Campaspe and Murray Shire serve an estimated 44,269 people.
The health service has an operating budget of $46 million and a staff base of 528, representing 379 equivalent full time staff.
Our Future Reporting Against Strategic Priorities
Echuca Regional’s Health Strategic Plan 2012 – 2014 lays the pathway for the future direction of the health service. Listed over page are the five strategic priorities, together with the milestones achieved during the last year.
3 www.erh.org.au Our Future
Reporting Against Strategic Priorities
Strategic Priority 1 Develop services to meet community need
Strategies Actions Milestones 2012
1.1 Enhance range and 1.1.1 Implement recommendations of Priority one (1) specialist appointments specified sustainability of services Clinical Services Planning Framework and recruitment strategies implemented available at Echuca (Dr H Wellington August 2011) Regional Health
1.1.2 In collaboration with GPs and Service delivery framework developed and midwives, develop and implement a implemented MoU signed with sub-regional sub-regional obstetric service partners including Deniliquin
1.1.3 Determine feasibility of providing Feasibility of providing psycho geriatric aged specialist mental health residential aged care determined care services (psycho-geriatric)
1.1.4 Continue to expand and enhance Complete detailed prioritised service plan increased specialist Primary Care services Implement Specialist Continence Clinic
Implement a Paediatric Clinic
Strategic Priority 2 Develop a sustainable and fulfilled workforce
Strategies Actions Milestones 2012
2.1 Plan and manage for 2.1.1 Develop workforce plans for all Workforce plans finalised for medical and allied sustainability divisions and departments that includes Health as required for expanded hospital recognition of the service needs of Echuca Regional Health
2.1.2 Prepare a comprehensive plan, Appoint a project worker to develop detailed incorporating a clinical workforce plan, for implementation plan for sub acute services. the design and delivery of a substantially expanded sub-acute service to be commissioned in June 2014
2.2 Develop the workforce 2.2.1 Enhance customer service training, Identify customer service training programme to its optimal capacity including cultural awareness training for all including formalising a staff recognition new and existing staff, board members and programme clinicians
2.2.2 Continue to build and increase Indigenous ‘virtual’ unit established comprising Indigenous workforce at least four (4) Indigenous positions
2.3 Increase clinical 2.3.1 Increase opportunities for secondary Student placement numbers and accepting placement opportunities for school students to experience placement at departments confirmed as base students Echuca Regional Health
2.3.2 Offer quality placements to under- Formalise agreements for student placements graduate and post-graduate students with partnering institutions across disciplines and settings utilising Echuca Regional Health Education Centre
annual and quality of care report 4 Strategic Priority 3 Develop appropriate infrastructure to support the delivery of quality services
Strategies Actions Milestones 2012
3.1 Optimise opportunities 3.1.1 Redevelopment of Echuca hospital Early Works - Completed offered by the occurs consistent with the approved redevelopment programme and budget Main Works - Construction - Commenced
3.1.2 Optimise information and Implement robust data storage and back-up communications technology as a system (SAN) component of the redevelopment Implement guest LAN making internet access available to students, private patients and contractors
3.1.3 Develop a strategy to optimise Develop social media policy use of information and communication technology applications Implement hospital redevelopment website
Communicate with our community via Facebook and Twitter
3.1.4 Seek funding opportunities to Prioritise areas for redevelopment including cost implement remaining sections of master estimate plan not included in the new Echuca Hospital redevelopment
3.1.5 Develop a ‘best practice’ fleet 10% of the fleet sponsored management strategy Implement automated car booking system
3.1.6 Seek opportunities to purchase Prioritise areas of land for purchase and additional land bordering ERH to ‘future estimated cost proof’ service delivery at Echuca Regional Health
Marking the site of our new hospital
5 www.erh.org.au Strategic Priority 4 Develop collaborative partnerships to enhance service delivery and development
Strategies Actions Milestones 2012
4.1 Formalised 4.1.1 Negotiate Memorandum of MoU signed with: Memorandum of Understanding (MoU) with key service • Bendigo Health Understanding delivering partners • Austin Health • Njernda
4.2 Increase provision of 4.2.1 Consult with neighbouring health Ensure sustainability of ‘Central Loddon Mallee support to the sub-region services to determine needs and Medical Workforce Group’ to ensure continuation in accordance with Health aspirations for sub-regional partnerships of sub-regional partnerships Service needs and Echuca Regional Health capability
4.3 Develop Echuca 4.3.1 Develop a formal research Appoint a RHAN coordinator at ERH Regional Health’s academic program at ERH and research base Research policy in place
Formal links with an NHMRC committee are established
Establish governance structure for research
4.4 Partner with GPs to 4.4.1 Develop and implement, in Develop framework for ERH to be a GP training establish Echuca as a best partnership with GPs, a comprehensive site practice example of GP strategy for GP participation, education training and GP led care and training
Strategic Priority 5 Enhance governance, management and innovation
Strategies Actions Milestones 2012
5.1 Demonstrate best 5.1.1 Develop and implement an A documented framework is in place which practice governance Echuca Regional Health quality and risk clearly articulates the components of quality and framework risk at Echuca Regional Health
5.1.2 Provide training for staff in A comprehensive training plan has been the quality framework and quality developed arrangement principles, ensuring practicality and relevance
5.1.3 Develop a strategy to ensure Training has been undertaken for key managers there is a Board Member succession Develop plan that identifies priority for Board plan to ensure appropriate skill mix is succession plan that is consistent with maintained Government Guidelines
5.1.4 Implement appropriate financial Financial improvement strategies identified improvement strategies to ensure financial sustainability
annual and quality of care report 6 Performance at a Glance
Performance Indicators
2011/2012 2010/2011 Change %
Inpatients treated - 9,523 9,117 4.5 separations
Inpatients average length 4.1 4.1 - of stay (excluding same day discharges)
Inpatient bed days 20,104 19,299 4.2
Nursing Home bed days 25,688 25,616 0.3
Total non admitted patient 85,246 86,077 -0.9 services
Emergency attendances 16,463 15,257 7.9
Staff
2011/2012 2010/2011 Change %
Number of staff employed 528 524 0.8
Equivalent full time 379 370 2.4 Our Profile Acute Hospital Facilities Services Provided • Hospital Admission Risk Program 67 Acute beds • Aboriginal Liaison • Health Promotion • Medical • Alcohol and Other Drugs Services • Infection Prevention and Control • Surgical • Ambulatory Services Unit • Meals on Wheels • Haemodialysis • Antenatal Classes • Occupational Therapy • Obstetric • Asthma Education • Palliative Care • Palliative Care • Cardiac Rehabilitation Program • Pathology • Paediatric • Chemotherapy/Cancer Support • Perioperative Unit • Rehabilitation • Community Health Nursing • Pharmacy • High Dependency • Community Rehabilitation • Physiotherapy • Dental Services • Podiatry Residential Aged Care • Diabetes Education • Preoperative Clinic Glanville Village Aged Care Service • Dietetics • Primary Care Clinic • 70 High Care Beds • Discharge Planning • Quality and Safety Unit • 2 Low Care Beds • District Nursing Services • Radiology • 7 Transition Care Program (TCP) • Education Department • Renal Dialysis Unit Beds • Emergency Department • Social Services • Finance • Speech Pathology • Glanville Village Aged Care Service • Transition Care Program • General Counselling • Volunteers
7 www.erh.org.au History
1882 First patient admitted to hospital
1890 New south wing of the hospital was built
1907 Operating Theatre, Nurses Home and Doctors’ accommodation constructed
1925 Installation of the first x-ray plant
1938 Opening of Camray Ward
1962 Construction of Midwifery Unit - Rose Baker Wing
1965 Soldiers’ Memorial Wing refurbished to geriatric ward
1970 Physiotherapy and Occupational Therapy services commenced
1975 Establishment of the new Day Hospital
1978 Lumeah Nursing Home opened
1993 Echuca District Hospital became Echuca Regional Health
1999 Completion of the Primary Care Centre
2003 Glanville Village aged care service opened
2006 The Alan Henry Thrum Operating Theatre was officially opened
2008 Official opening of the Community Rehabilitation Centre
2009 Commencement of Master Plan process
2010 Feasibility study and schematic designs commenced
2011 $65.6 million funding secured for hospital redevelopment
2012 Commencement of preparation for the ERH redevelopment
Demolition works begin
annual and quality of care report 8 Year in Review
Board of Management Report Echuca Regional Health Education Centre In accordance with the Financial Management Act 1994 I am The development and commissioning of this facility has pleased to present the report of operations for Echuca Regional continued to occur over the past year with the opening of the Health for the year ended 30 June 2012. first twenty (20) beds of a total of 43 beds in October 2011. We secured further additional funds to complete this Mrs Judy Cook redevelopment which is a strategic project in the delivery of President health services in Echuca-Moama. Echuca Regional Health Board of Management We express our appreciation to La Trobe University, Health Workforce Australia and the Department of Health for their significant financial support during the last twelve (12) months. Chair and Chief Executive Report The project will be completed in September 2012 and will have On behalf of the Board, Management and staff we are pleased to 43 single rooms including ensuites and a range of clinical training present the 130th Annual and Quality of Care Report of Echuca rooms. The Board is delighted with the utilisation of the facility to Regional Health for the year ended 30 June 2012. date which is assisting with the recruitment and retention of staff.
The report highlights another busy year of development and Strategic Plan change particularly with the continued growth in demand for our The Board, with the assistance of Dr Heather Wellington and services consistent with the population growth in our catchment Echuca Regional Health senior staff developed a strategic plan area. The other highlight was the continued positive progress in to guide the health service’s priorities and development. The four the planning for our new and expanded hospital. (4) year plan details five (5) priorities with strategies, actions and milestones proposed for each of these five (5) priorities. The plan Providing Service and Care may be viewed at www.erh.org.au. In a large number of areas there has been a steady increase in demand for services highlighted by; hospital admissions The Board is delighted with the progress of a number of increased by 5% to 9,523; Emergency Department presentations objectives included in the Strategic Plan. increased by 8% to 16,463; theatre procedures increased by 3% to 3,822; babies born increased by 4% to 301 and in In particular the signing of a Memorandum of Understanding excess of 86,000 occasions of service were provided to clients (MoU) with Njernda Aboriginal Corporation on 1 June 2012. The by our community based and ambulatory care services. It is purpose of the MoU is to promote the partnership; improve the also important to note that 30%, nearly 1 in 3, of our hospital understanding of health needs; improve coordination of care; admissions have New South Wales postcodes; 25% in 2010. and increase access and the utilisation of health services. The Board looks forward to supporting and achieving the objectives To assist in meeting this increasing demand we will have a new outlined in the MoU. and expanded hospital early in 2015. A significant focus of the Board and Executive is to strengthen the medical services in preparation for the expanded hospital New and Expanded Hospital in 2015. Dr Heather Wellington completed a ’Clinical Services As announced in last year’s report we have secured $65.6m in Planning Framework’ in August 2011 which was endorsed by government grants to rebuild and expand the Echuca hospital both the Medical Staff Group and the Board. This framework including new wards and a new Emergency Department. During prioritises the clinical positions that need to be established prior the past twelve (12) months, we have made positive progress to 2015 which include appointments of General Surgeons, with the planning phase and are now on schedule for the main Director of the Emergency Department, Clinical Leader of the construction works to commence in September 2012 and High Dependency Unit, increase frequency of Oncologist visits conclude in early 2015. The first phase of the redevelopment and identify a clinical leader of the new 24 bed rehabilitation unit began in February 2012 with the awarding of the ‘early works’ that will be opened in June 2014. contract to Hansen Yuncken. The Board is also pleased with the establishment of the This package of works will prepare the site for the main works ‘Central Loddon Mallee Medical Workforce Group’ comprising and includes demolition of houses, closing a section of Francis representatives from our neighbouring health services to support Street, removal of the old infectious disease building and the establishment of clinical services and exchange of medical diversion of in-ground services. The Board wishes to record its resources in the sub-region. thanks to the Shire of Campaspe for the ongoing support and assistance it has provided to this significant redevelopment project.
9 www.erh.org.au Glanville Village Accreditation Vale Glanville Village (79 bed residential aged care facility) was The Board of Management, Executive and staff were saddened subject to a scheduled audit in October 2011 by the Aged Care by the death of Aileen Whittle. Aileen was a member of the ERH Standards and Accreditation Agency. The nursing home was Ladies Auxiliary, working tirelessly through her volunteering awarded full accreditation for a further three (3) years having to raise funds for ERH. Our condolences are extended to the been found compliant in all 44 standards. We acknowledge and Whittle family. thank all staff for achieving this excellent and well deserved result.
Leadership and Management We would like to thank Cr Peter Williams for his eleven (11) years as a Board member which included a term as Chairman of the Board. In addition, we would like to welcome Dr John Christie as our Director of Medical Services. Dr Christie’s time is shared with Swan Hill Hospital and Rochester and Elmore District Health Service. Dr Jane Greacen resigned her position after twelve (12) months valued time as our Director of Medical Services.
Thank You We wish to record our thanks to the many individuals and groups who have supported this health service in many different ways over the past year. The support of our community for the redevelopment of our hospital has been sustained over many years and is greatly appreciated and valued.
We have an increasing number of volunteers, 153 currently, who assist in our Emergency Department, hospital wards and Glanville Village. Without their support and dedication, we would not be able to achieve what we do. We also wish to record our thanks to the Medical Practitioners and other contractors who assist us in providing a broad range of high quality health care. Our thanks also to the Board Members, Executive and all the staff at Echuca Regional Health for their ongoing dedication. We would like to record a particular thanks to all staff for their contribution to the redevelopment planning process.
We appreciate the ongoing support of the Department of Health, our political representatives, the local media and our valued auxiliaries and community organisations.
We trust you find this report interesting and informative.
Mrs Judy Cook President Echuca Regional Health Board of Management
Mr Michael Delahunty Hansen Yuncken were awarded the ‘early works’ Chief Executive contract for the hospital’s redevelopment Echuca Regional Health
annual and quality of care report 10 Performance Measures
Attestation on Data Integrity I, Michael Bernard Delahunty certify that Echuca Regional Health has put in place appropriate internal controls and processes to ensure that the Department of Health is provided with data that reflects actual performance. Echuca Regional Health has critically reviewed these controls and processes during the year.
Mr Michael Delahunty Chief Executive Echuca Regional Health
Service Performance
Admitted Patients Acute 2011/2012 2010/2011
Same day 6,028 5,842 Multi day 3,495 3,275
Total Separations 9,523 9,117
Emergency 2,654 3,188 Elective 6,208 5,355 Other – including maternity 358 574 Public separations 7,468 7,256 Total WIES 5,020 4,778 Total bed days 20,104 19,299
Non Admitted Patients
Emergency medicine attendances 16,463 15,257 Other services – occasions of service • After-Hours Clinic - 1,580 • Dental 4,621 6,515 • Primary Care 47,883 46,170 • Palliative Care 2,775 1,909 • Community Nursing 9,345 9,325 • Radiology 20,622 20,261
Other services – occasions of service (sub-acute) 3,635 3,562
Total occasions of service 105,344 104,579
11 www.erh.org.au Definitions
Acute care: • Manages the delivery and aftercare of mothers and their babies; • Cures illness or treats injuries; • Performs surgical operations; • Relieves symptoms of illness or injury; • Prevents the worsening and/or complications of an illness and/or injury which could be life threatening or which may affect the quality of normal daily life; • Carries out investigations or therapeutic procedures such as blood transfusions.
Sub Acute is care which includes: • Designated Rehabilitation Program – designed to help people who are recovering from injury or illness to recover as much function as possible; • Geriatric Evaluation and Management Program – older people with complex, chronic or multiple health care conditions requiring treatment and stabilisation. • Interim Care - provides temporary support and care of older people whilst longer term care arrangements are being finalised. • Palliative Care Program - the specialised care of someone suffering from an advanced, progressive, terminal illness.
Performance Statistics – last five financial years
2011/2012 2010/2011 2009/2010 2008/2009 2007/2008 Total separations 9,523 9,117 9,286 9,160 9,307 Average length of stay (excluding same day discharges) 4.1 4.11 3.83 3.97 3.85 Theatre procedures 3,822 3,705 3,720 3,637 3,743 Emergency Department attendances 16,463 15,257 15,973 14,961 15,478 Births 301 289 272 301 303
Performance Statistics – last five financial years
10000 8000 6000 4000 2000 0 2007 / 2008 / 2009 / 2010/ 2011 / 2008 2009 2010 2011 2012
Patient separations increased by 406 this year.
annual and quality of care report 12 Emergency Department Attendances Births
20000 350 300 15000 250 200 10000 150 5000 100 50 0 0 2007 / 2008 / 2009 / 2010/ 2011 / 2007 / 2008 / 2009 / 2010 / 2011 / 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Emergency Department attendances Birth numbers increased by 12 this year. increased by 1,206 this year.
Separations by top 10 Diagnosis Related Groups
Haemorrhoidectomy Endoscopy Cataract Removal
Vaginal Delivery Renal Dialysis Same Day Gastroscopy
Anaemia / Blood Transfusion
Newborn Baby Greater Than 2499g
Chemotherapy Same Day Colonoscopy
Diagnosis Related Group (DRG) is a grouping of diseases or conditions which are of similar characteristic or severity. Renal Dialysis is the most frequently occurring DRG at Echuca Regional Health.
What age are our patients?
0.1.80 0.46 0.02 6000 5000 4000 2007/2008 3000 2008/2009 2009/2010 2000 2010/2011 1000 2011/2012 0 0-14 15-29 30-44 45-59 60+
An age profile of admitted patients during the last five (5) years shows that the majority of patients treated are greater than 60 years of age.
13 www.erh.org.au Where do our patients come from?
Top 10 Separations Separations Separations Localities 2011/2012 2010/2011 2009/2010
Echuca 4,433 4,717 5,066 Moama 1,697 1,542 1,480 Rochester 473 470 495 Deniliquin 1,013 644 495 Tongala 207 274 303 Kyabram 179 317 228 Lockington 164 131 156 Nathalia 25 13 102 Gunbower 176 64 64 Leitchville 40 38 46
Patient separations by top 10 localities
Emergency Department attendances increased by 1,206 this year.
annual and quality of care report 14 Risk Framework for the organisation which provides a clear Review of Operations structure for quality governance. Other key achievements this year include the introduction of PROMPT, a new policy and Acute Hospital, Residential Aged Care procedure system that provides improved oversight and access to ERH policies and procedures and C.Gov, a system which Services and Primary Care Services manages clinical governance, performance management and quality improvement activities. Profile Echuca Regional Health has 67 acute beds providing a Aboriginal Chronic Illness Coordinator comprehensive range of services including emergency, Our partnership with Njernda Aboriginal Corporation was medical, surgical, maternity, paediatric, urology, orthopaedic, further strengthened this year with the appointment of Barbara ophthalmology, dental, chemotherapy and haemodialysis Gibson-Thorpe to the newly created role of Aboriginal Chronic services. Glanville Village aged care service accommodates 70 Illness Coordinator. This innovative role was developed as high care, two low care residential beds together with seven part of the regional Aboriginal partnership group and funded transition care beds. by Njernda through ‘Closing the Gap’ funding. The focus is on chronic illness management and specifically, care planning A range of primary and continuing care services are provided and coordination of care for our Aboriginal community. Barb comprising: aboriginal liaison, allied health, cancer support, is based at ERH and has been a highly valued addition to our community nursing, community rehabilitation programs, chronic team providing a responsive and culturally appropriate service disease management, transition care, dental clinic, drug and for our patients. alcohol counselling, general and family counselling, health promotion, general practice and specialist medical consulting. Inaugural Aboriginal Health Conference We were privileged to be invited to present the work of our Medical Suites are available in the hospital grounds to regional partnership group at the inaugural Aboriginal Health accommodate visiting specialists, providing a wonderful local Conference held in May 2012. A joint presentation by Njernda, service to the community and allowing patients to remain close ERH and Primary Care Partnerships showcased our partnership to their families during difficult circumstances. and our achievements in the areas of health promotion, support for high risk pregnancies and improvements in chronic illness Nursing Division Report management. Our theme that ‘working together as a team, This has been a busy and exciting year for the nursing division. much more can be achieved’ was well received.
Glanville Village Accreditation Two Aboriginal traineeship positions, (receptionist role in the ERH Education Centre and a further Aboriginal Hospital Liaison We are delighted to report that Glanville Village underwent Officer trainee) has been a great addition to our team. Aged Care Accreditation on 11 and 12 October 2011 and were found to have met all 44 standards. Our assessors were very thorough and commended our quality plan and processes, staff McGrath Foundation - Breast Care Nurse education and training, the high standard of clinical care, the Funding new meal service, comprehensive range of activities and the We are delighted to report that our application for funding for overall care for residents. a dedicated Breast Care Nurse submitted in June 2011 was successful. Bianca Fleming has been appointed to the position A further unannounced support visit from the Agency on 21 which is a three year appointment. This new role provides February 2012 reviewed the living environment and quality support, education and care coordination to women and their systems where we received very positive feedback. Of note, families who are living with breast cancer. residents told the assessors they were very happy, felt safe, supported and cared for and were full of praise for our staff. Three Postgraduate Nursing and Midwifery Scholarship worth Staff were also interviewed and were very positive about their $3,500 were awarded to ERH nurses to assist with their studies workplace. The assessors were particularly impressed with in Oncology, Wound Management and Perioperative Nursing. our quality systems and calm, happy environment. Our staff The Horizon Committee provided a further oncology scholarship particularly Danielle and Darren Clark, are to be commended of $5,800 and awarded fourteen Prostate scholarships worth for their work and commitment to residents and the highly $4,200 each to nurses. professional manner in which our service was presented; a great result. Emergency Department Upgrade Emergency Department renovations this year have provided Quality Unit a more efficient reception, triage and waiting room area and Helen Thomson, Deputy Director of Nursing commenced the new ‘fast track’ consulting rooms have greatly assisted in oversight of the Quality Unit in August 2011. Helen and managing the increase in activity we have experienced this year. the Quality Unit team have developed a formal Quality and
15 www.erh.org.au Stroke Coordinator Position and dedicated nurses working in our organisation. This year We have been successful in gaining funding to appoint a project a new ‘Miracle Worker Award’ was presented to a non-nurse worker to develop a stroke care pathway for acute stroke recognised for their exemplary support for nursing. Michelle patients presenting to ERH. Scali was the worthy recipient.
Northern Rivers (Regional) Graduate Nurse Productive Ward – Releasing Time to Care The ‘Productive Ward – releasing time to care’ is a National Program Health Service program that has been developed to assist ERH successfully applied for funding to assist in developing health services in developing a more systematic, consistent a regional early graduate nurse program. Partnering with and efficient model of patient care. The primary aim of the Rochester and Elmore District Health Service, Boort and program is to support nurses in re-organising their workplace Cohuna, the program aims to increase the number of graduate and communication processes to ensure patients are better nurse placements in the region and assist smaller health informed about what is happening to them and more nursing services in attracting and supporting additional graduate time is spent caring for patients. The program is being nurses. The partnership model is well advanced and an progressively rolled out across the organisation with nurses additional five graduate nurse positions have been made taking the lead role in the implementation. available for 2013. June Dyson Enhanced Maternity Program Executive Director Nursing Services The Enhanced Maternity Care Program continues to develop and grow with an increasing number of high risk women Service Planning referred to the Program. Our team, Sue Eade, Fiona Clark With planning for the hospital’s redevelopment well underway, and Amanda Murphy are working with clinicians, community it was timely for a review to be undertaken of the current providers and the Department of Health to develop clear, scope of services provided to members of our community and consistent referral pathways and formal structures for the accordingly a Clinical Services Review was undertaken. development of multidisciplinary management plans and mandatory reporting requirements. Sue Eade and Fiona Clark Supported by the Department of Health and conducted by presented some of the achievements to date at a Department DLA Piper the review commenced on 23 August 2011. The of Health sponsored forum held in Melbourne. The presentation main focus of the review was to closely examine the scope of entitled, ‘Koori Maternity Program – Echuca Regional Health services currently provided by ERH and to determine whether and Njernda Aboriginal Corporation’ was very well received and any changes may be required to meet the community’s growing ERH commended on achievements to date. needs.
Regional Obstetric Model The review consisted of an evaluation of relevant policies, ERH is working closely with Deniliquin Hospital and Goulburn a comprehensive analysis of inpatient and Emergency Valley Health to assist in the development of a low risk birthing Department activity data, and extensive consultation with model for Deniliquin. A ‘shared care’ obstetric model between key stakeholders; including clinicians and Managers of ERH, ERH and Deniliquin is also being developed for those women Bendigo Health, Goulburn Valley Health, Department of Health requiring a higher level of care. personnel and Medical Managers at two similar health services; Wimmera Health Care Group and Bairnsdale Regional Health Seniors Advisory Group (SAG) Service. Our SAG group continues to provide valuable input to ERH regarding the care and services seniors want to see in our The review identified a number of areas where changes could health service. ERH and SAG were delighted to be asked to be implemented to enable ERH to better serve members of present at the inaugural Consumers Reforming Health Care the Echuca-Moama community. These included an increase in Conference held in Melbourne this year. Our presentation, specialist support to complement the excellent general practice ‘Guided through the eyes of wisdom’ outlined the formation of services already provided locally. The review also identified our SAG and achievements to date. This was very well received a number of recommendations and as a result a Clinical and we have had a number of requests from other agencies Development Project Officer was appointed to assist ERH in around Australia for copies of our presentation. developing its clinical services prior to moving into the new hospital. Annual Nursing Excellence Awards Nursing excellence was once again celebrated on International Nurse’s Day with the Nurses Excellence Awards presented to nurses nominated by their peers as exemplars in nursing practice. We are very fortunate to have such experienced
annual and quality of care report 16 Emergency Services Due to an increase in patient presentations the Emergency Department (ED) has once again experienced a busy year. With the assistance of Department of Health funding the ED underwent refurbishment this year in an effort to assist with the ever increasing demand whilst awaiting the hospital’s redevelopment.
In 2011 the ED experienced a slight downturn in patient presentations but this decrease has not continued. During the last financial year 16,463 patient presentations were made to the ED; representing an increase of 1,205 patients. The trend of approximately 25% of patient presentations being children continues.
The ‘Redesigning Care’ Project undertaken during 2011 which focussed on patient flow through the ED proved to be very A major refurbishment of the Emergency Department included a successful. The Project was designed to improve the patient larger office space for staff journey by increasing the number of patients being transferred from the ED to the ward areas within four hours. The Director of Pharmacy has worked very hard during the last Three main focus areas for change included early allocation 12 months to implement an automated medication dispensing of in-patient beds, early clerical admission, which allowed unit into the ED. The unit consists of a fully automated faster processes such as drug ordering and timely review dispensing system designed specifically to enhance patient of pathology results. The ED Redesigning Care Project has safety. It is anticipated the system will be operational by the end been instrumental in the planning phase of the hospital’s of July 2012. redevelopment. Due to the appointment of Dr Bob Allan and more recently Dr Boris Molodov, senior medical coverage has been significantly enhanced during the last year. Plans are underway to appoint Length of Stay in ED < 4 hours 2011/2012 - a further two Senior Medical Officers later this year which will Target 72 % allow the ED to provide members of the community with senior medical expertise from 8.00 am to 10.00 pm seven days per 100 week. 95 90 85 80 75 70 65 Emergency Department Presentations 60 55 50 July Aug Sept Oct Nov Dec Jan Feb Mar Apr May 2009/2010 2010/2011 2011/2012
The above graph shows a sustained trend of patients being 15,973 15,257 16,463 discharged from the ED to either their home or inpatient ward areas within four hours of presentation.
Department of Health funding has allowed the completion of a major refurbishment of the ED. Patients and visitors can now enjoy an improved and larger waiting room, a private and purpose built triage room, a more modern reception area and the addition of two new fast track rooms. A larger office for staff completes the renovation. An air conditioning upgrade was also undertaken during the year, making life more comfortable for patients, staff and visitors to the ED, particularly during the summer months.
17 www.erh.org.au General Ward (Camray/Johnstone/High community groups such as the ERH Ladies Auxiliary, Nicely Ageing Girls Society (NAGS), the Barry Beehag Ski Race and Dependency Unit) those who wish to remain anonymous. Significant gains have ERH’s General Ward is a 32 bed medical/surgical unit which been achieved through the purchase of a television equipped to includes a three bed High Dependence Unit. The General Ward play music and display photographs, Niki pumps to administer provides care to a variety of medical patients; predominantly pain relief for palliative patients, electric recliners, patient chairs, respiratory, cardiac and palliative. Staff also provide high quality chair scales and lifting slings. Without the continued support care to patients following a comprehensive range of surgical of these groups the General Ward would not be able to provide procedures including gynaecological, orthopaedic and ear, nose equipment to meet the needs of patients. and throat. As the building of the new hospital approaches at a rapid pace, The General Ward has experienced change and the need the General Ward are passionate about their role in helping to for adjustment during the last year. Changes have been shape the new facility; a facility that is state of the art and that made to the staffing structure, drug room and imprest room, continually evolves to meet the needs of an ever expanding together with centralisation of the nurses’ station and the community, and delivers the highest standard of care with a decommissioning of a portion of the ward in preparation for friendly touch. Staff accept that the compromises experienced demolition and building of the new hospital. during the last year will lead to a great outcome. Condensing of the ward in preparation for the demolition has proven particularly challenging for both staff and patients. Bed What is ‘Productive Ward – Releasing Time numbers remain the same within the General Ward but due to to Care’? the loss of four single rooms, those beds have been absorbed into the remaining ward area. The ward now continues to ‘Productive Ward – Releasing Time to Care’ is a quality operate with only five single rooms and some of the remaining improvement system that provides staff with the skills to shared accommodation is less spacious. examine their own work practices and provide the solutions that work best for them in the ward. The program focuses on key Although change and condensing of the ward has been a real ward processes such as the delivery of meals, the planning of challenge for staff, they have worked proficiently as a team, admission and discharge, staff handover, patient hygiene and embracing the opportunity to challenge existing practices. improving the supporting processes for nursing procedures Centralisation of the drug and imprest rooms, together with the to ensure they are consistent. The aim of the program is to reviewing and refining of current stock items and quantities has improve efficiency to allow staff to spend more time at the led to significant savings. bedside with the patient.
The year has seen the introduction of both the ‘Productive ERH launched the ‘Productive Ward – Releasing Time to Care’ Ward – Releasing Time to Care’ Program and the General in February this year commencing with a two day master Ward Volunteer Program. The Productive Ward Program is training session for approximately sixty staff. The program made up of several modules. The first module ‘Well Organised has three foundation modules: Well Organised Ward (WOW), Ward’ (WOW) has been embraced by staff. Staff have How It Is (HII) and Patient Status at a Glance (PSAG). Once the excelled in applying the following simple concepts into the foundation modules are embedded there are a further eight Ward, empowering staff to make decisions about their work modules which examine the core processes in patient care environment: delivery.
• Clean and organised. This year ERH began implementing the WOW module in • Only keep what we use. April and the HII module in June with the roll out of the PSAG • Everything has a place. module expected to commence in August. Each module has • Frequently used items are easily found and accessible. a dedicated team who are released from their ward duties • Safe environment for patients and staff. to work through their module. Improvements in reduction of excess stock and equipment placement have already been ERH has seen a successful implementation of volunteers experienced which have seen significant reductions in cost, into the Emergency Department and this program has been time and an improved work environment. transitioned into the General Ward. Although in the early stages, the group of wonderful volunteers have imprinted onto the Ward environment and are proving to be a great source of support for both patients and staff. The enthusiastic nature of the volunteers is appreciated, together with their desire to provide a more supportive environment for patients.
Challenges to provide equipment to enhance the experience and comfort level of patients and their families during their stay have been assisted through the generosity of donations from
annual and quality of care report 18 Jessie Ross Wing (Camray East) April saw the commencement of the electronic tracking process A portion of the General Ward known as Camray East and prior for patient records. This involves recording, via the iPM patient to that, the Jessie Ross Wing, will be demolished in September management system, each time a medical record changes 2012 to make way for our new hospital. location. This tracking process was further expanded in May to include ED records and will assist in the process of integrating The Jessie Ross Wing has had a long and varied past, ED records into inpatient records. beginning life as a medical ward before being converted to the Children’s Ward, or Kid’s Ward as it was known. The Children’s HIS staff have spent a significant amount of time preparing for Ward closed in the early 1990’s when the paediatric unit was the commencement of Activity Based Funding (ABF) on 1 July incorporated into the Midwifery Unit. The area was then home 2012. to chemotherapy and the palliative care nurses before being converted back to medical wards and renamed Camray East in The National Health Reform Agreement aims to: approximately 2005. • Share the future cost of growth in the efficient price and service provision equally between the State and In a farewell bid to this building an event is planned for August Commonwealth Governments. 2012 when staff, both past and present, will be invited to leave • Establish a national approach to activity based funding a farewell message on the walls prior to demolition. for public hospitals, with the provision for block funding smaller rural hospitals where required. • Ensure strong national standards to improve clinical safety and quality in hospitals and health care settings. • Enhance transparency on the performance of hospitals and health care services.
The goal is to move as much funding as possible to an activity base and away from block funding. Due to changes in the Department of Health Admission Policy the first impacts are likely to be experienced in the Emergency Department. Shadow funding will be applied for the 2012/2013 financial year to allow health services to come to terms with both changes and the financial implications of these funding arrangements.
Radiology The Department of Health contributed significant funding through the Targeted Equipment Program (TEP) this year to Health Information purchase new fluoroscopy and general x-ray equipment. The Health Information Services is responsible for all patient Radiology Department have been without this equipment medical records, together with admissions and discharges. The since November 2010 due to an electrical fire, however, the department reports the Victorian Admitted Episode Dataset fluoroscopy service will return at the end of July 2012. (VAED) on admitted inpatient information to the Department of Health. Since the fire, the Radiology Department has been operating with only one general x-ray room. This has created numerous The last financial year has seen much activity in Health challenges within the Department however the Radiographers Information Services (HIS). September 2011 saw the have been working exceptionally hard to maintain the service commencement of renovations in the Emergency Department for members of the community. There was an increase in the (ED) and a considerable period of disruption for HIS. total number of patients x-rayed this financial year, which just Throughout the dust, noise and regular relocations, staff goes to show how dedicated and skilled the Radiographers are. managed to maintain their normal, efficient provision of service. The total number of x-rays performed during the last financial year was 13,940. In December 2011 HIS underwent their biggest VAED audit to date. This involved the auditing of 220 records. The results Several changes were implemented within the ultrasound were pleasing and the recommendations made provide the service to decrease the waiting time for appointments, resulting opportunity for HIS to further improve coding and processes. in the reduction, from three to four weeks. Compared with other ultrasound services this is an extremely good outcome. In March 2012 the Victorian Patient Satisfaction Monitor (VPSM) The Sonographers have been working very hard to optimise for Emergency Department presentations commenced. This is the service and have been working closely with medical staff to an extension of the VPSM program that has been conducted ensure the appropriate examination is being performed in the over many years for inpatients. HIS eagerly await their first set appropriate timeframe. Some patients are required to travel of results for this process. out of town for some ultrasound procedures, however these
19 www.erh.org.au services will return in the future once existing staff are trained Farewell Chief Radiographer Chris Levick and following the appointment of an additional Sonographer. After more than 30 years of service, Chief Radiographer Chris One of the ultrasound machines has been replaced to Levick has retired from ERH. The familiar face that has greeted provide better quality imaging as well as the ability to perform members of the community when undergoing an x-ray for so examinations on small anatomy with a specialised transducer. many years officially retired on Friday 11 May 2012. The total number of ultrasounds performed during the last financial year was 6,682. Chris’ association with ERH commenced when she worked as a locum Radiographer in 1979; when the hospital had only one Throughout the year several Radiography students have x-ray room and when ultrasound and mammography weren’t completed their placements under the guidance of Hayden even available locally. Back in the days when digital imaging Read. Although Echuca Radiology is a small department, was not even contemplated; the days when after your x-ray had the students are able to be involved with a wide variety of been taken you were given an enormous envelope containing examinations and gain valuable experience. Students from the black and white images. University of Newcastle, Charles Sturt University Wagga Wagga and Curtin University Perth have all undertaken placement at Chris considers the increase in demand for tests as one of ERH this year. Work experience students from various local the most significant changes she has witnessed during her 30 schools have also been able to spend some time within the plus years as a Radiographer. “Clinicians now order tests for a Radiology Department to assist their career decisions. wide variety of things” she said. “If you go to visit the Doctor today, it is very likely you will undergo some form of test”. When For the first time Echuca Radiology has been able to offer a asked what were some of the things that hadn’t changed whilst National Professional Development Program (NPDP) placement working at ERH during the past 30 years Chris laughed. “There this year. This 12 month position, which is partially funded, is is quite a lot at ERH which hasn’t changed at all, but hopefully compulsory for Radiography students nearing the completion the redevelopment will fix that”. of their degree, providing full qualification on completion. The Department was very excited to accept Louise Teasel for this When questioned about what she will miss the most a show of position as she has now made Echuca her home. tears moistened Chris’ eyes. “Contact with people, particularly the x-ray staff who have become just like members of my Other staff changes within the Department include Susan Cox family” she said. Being on-call every third or fourth weekend joining the team as a Radiographer in July 2011. Susan has was the one thing Chris declared she would not miss in her worked for many years at the Western and Austin Hospitals retirement. In years gone by, on weekends such as Southern in Melbourne, bringing with her extensive experience in many 80, Chris reflected she may get called in 15 or more times; “and areas of Radiography. Susan will continue to perform the role of nearly always in the middle of the night” she smiled. Chief Radiographer. Together with her young family, Susan has now made Echuca her home. What plans does Chris have for her retirement? “Spending time with my family and travelling north for the winter” are both very Suzanne Brinkman accepted a full time permanent position as high on Chris’ retirement agenda. a Sonographer in December 2011 after completing numerous locum positions within the Department. Suzanne is very passionate about patient care and brings many years of experience with her.
Ultrasounds Performed
2009/2010 2010/2011 2011/2012 5690 6607 6682
X-Rays Performed
2009/2010 2010/2011 2011/2012 Chief Radiographer Chris Levick retired this year 14554 13654 13940
annual and quality of care report 20 Pharmacy The internship usually takes a year to complete and may be The Pharmacy Department has been involved in a number of undertaken in a hospital, community or industry setting. initiatives and quality activities this year with the following areas being of particular interest. This is the seventh year that ERH has provided internships and, while it is primarily hospital based, the opportunity to experience community practice as a major part of the program Automated Dispensing Machines (ADMs) makes it different to programs offered by other hospitals. ADMs are like sophisticated vending machines for authorised A number of different models have been tried and the best hospital staff to access medications and in recent years many appears to be one day a week in a community Pharmacy. hospitals have installed them to improve stock management and reduce medication errors. ERH has attracted a high calibre of Pharmacy graduates to its program over the years, and its high regard was In an exciting project for ERH the ‘MedDISPENSE’ ADM system demonstrated this year by a number of applicants choosing is to be installed in the Emergency Department (ED) to replace ERH as first preference. The program organisers are grateful the current ED medication cupboard, together with the after- to local community Pharmacies who take on the responsibility hours cupboard and medication fridge. It is anticipated the of providing their component of the Hospital/Community system will be operational by the end of July 2012. Pharmacy Internship Program and who act as great role models for the next generation of Pharmacists. To store the 400+ items on the stock list there will be 120 drawers (each of which can be divided into six), three shelving units for bulky items, and a fridge. When the medication Maternity Services required is selected from the touch screen the appropriate The ERH team of Midwives work closely with the ten General drawer opens. However, in what is believed to be a first for an Practitioner Obstetricians to provide care for women birthing Australian hospital, the ADM will be linked to ‘Medchart’ which in Echuca-Moama. During the last financial year a total of 301 is ERH’s electronic medication management system. births were recorded at ERH; 137 female and 164 male babies were born. This means that the inpatient’s current medications will appear on the ADM touch screen so when the nurse selects the drug required, the drawer will open on the basis of the prescriber’s Births order itself and not an interpretation of the order. This new process is expected to be much more reliable in terms of correct medication selection. 2009/2010 2010/2011 2011/2012 272 289 301 Expiry date control proves very difficult in the hospital environment and one of the major aims of the project is to ensure that no out of date item will ever be stored in the machine. Run in conjunction with La Trobe University Bendigo ERH is currently in its fifth year of employing Post Graduate Midwifery If the ED/after-hours project proves successful it is planned students. To date ERH has retained all of the Midwives who to implement ADMs in the acute wards of the new hospital have qualified through this program. The ERH Midwifery where these machines will be integrated with mobile pedestal team also support medical students as part of the University units with drawers allocated to patients, replacing the current of Melbourne rural cohort, to gain birthing experience. Staff bedside locker storage. All will be linked to the Medchart have also worked closely with Kyabram and District Health electronic medication management system – another likely first Service and Deniliquin Hospital to assist with the development for an Australian hospital. of models to enable both organisations to maintain birthing services.
Pharmacy Students and Interns With the aim of enhancing the care provided to this group The Pharmacy Department has long provided hospital of women and their families, the Midwifery Unit undertook a pharmacy experience for undergraduate students but a closer collaborative project with the ERH Social Services team this relationship with La Trobe University Bendigo has been fostered year to identify and manage high risk pregnancies with complex in recent years. The commitment varies depending on what medical and social needs. This was based on recognition of year of the Pharmacy course is being undertaken but the view improved outcomes for mother and baby if early intervention is of the ERH Pharmacy staff remains; that providing a positive provided. experience will pay dividends in future years in terms of staff recruitment. The project was developed in 2011 as a result of care issues identified through ‘Closing the Gap’; a previous project which Following their four year Pharmacy undergraduate course, looked at the care and outcomes of Indigenous women and graduates are required to satisfactorily complete an intensive their children. As a result, the Enhanced Maternity Care Clinic internship before they can become registered Pharmacists.
21 www.erh.org.au was developed with the aim of supporting communication her Masters in Perioperative Nursing with a focus on between midwives, family services and General Practitioners/ education. Rebecca was the recipient of the Victorian Nursing Obstetricians and clients who have complex medical and social Perioperative Group Marea Fennel Scholarship to assist her needs, to ensure optimal care is provided. with continuing studies.
To enable consistent care to be provided, care plans are Medical Day Treatment Unit developed to meet the individual woman’s and her family’s (Comprising Renal Dialysis, Medical Day Unit, Chemotherapy needs. Accordingly, it is vital for staff to establish a rapport with Unit, Cancer Support Nurse and McGrath Breast Care Nurse) the woman and her family.
A review of outcomes following the Clinic’s development has Renal Dialysis Unit shown an increase in the support and care provided, together The Renal Dialysis Unit at ERH accommodates 12 patients with increased support for midwives caring for the women each Monday, Wednesday and Friday. The Unit is affiliated and their families. An increase in communication between the with Austin Health who provide oversight of the care given, various professionals involved in the woman’s care has also and Renal Physicians from Austin Health conduct outpatient been noted. Continued and ongoing review of Clinic’s outcomes clinics at ERH on a regular basis. They facilitate note reviews will ensure these women’s needs continue to be met. and clinical discussions with the Renal Dialysis nursing team to ensure that care is appropriate and of the recommended standard. Surgical Services The combined Operating Theatre Suites and Day Surgery Unit The nursing staff received training this year in haemodiafiltration continue to provide a comprehensive range of surgical services. which is a specialised dialysis treatment considered to have additional benefits in some clinical circumstances. This therapy ERH extended a very warm welcome to Mr Dan Fletcher, a can be offered by the Renal Physician. Consultant General Surgeon who joined the team this year. Originally from the UK, Mr Fletcher relocated to Victoria with Where vacancies occur, the Unit also offers holiday dialysis for his wife and three young children. He spends his time working clients wishing to visit the area. between ERH and Bendigo Health.
Locum General Surgeon Mr Richard Arnot continues to provide an experienced elective and surgical cover to the local community. Mr Stephen Scott, General Surgeon has also been providing locum services during the busy Christmas and Easter holiday periods. Together with the two local medical practices, Central Victorian Anaesthetic Service continues to provide anaesthetic services.
A total of 3,822 patients presented to the Perioperative Unit during the last financial year. This is an increase of 117 for the same period last year; an average of 74 patients per week.
On the recommendation of the Royal Australian College of Surgeons, this year saw a trial of the ‘Post Op Orders’ form. Surgeons complete the form to provide nursing staff with concise and legible instructions for a specific patient’s post surgery care. The trial has proven very effective and it is anticipated use of the form will be implemented in July 2012. Renal Dialysis staff celebrate Red Undies Week Two members of the Perioperative Unit travelled to Darwin this year for the National Australian College of Operating Room Nurses Conference. Diversity of rural nursing and the education Medical Day Unit of operating room nursing staff were the key topics of interest. The Medical Day Unit offers medical infusions and other Both staff returned enthusiastic with a wealth of knowledge and day treatments under the direction of the patient’s GP or new ideas to enhance patient care in the ERH Perioperative Physician and also provides day treatment to people where Unit. clinically appropriate. This streamlined admission process is readily accepted by patients as most are generally well and In February 2012 staff member Rebecca East completed the accordingly do not require bed care. Postgraduate Diploma in Perioperative Nursing. Rebecca has continued in her student role and is currently undertaking
annual and quality of care report 22 Chemotherapy Unit The Chemotherapy Unit operates two days per week with treatments given under the medical direction of Dr Ivon Burns, Dr Rob Blum and Dr Mark Warren. Dr Burns conducts an outpatient clinic once a month and provides clinical oversight of chemotherapy treatments.
This year the nursing staff in the Unit reviewed some aspects of clinical care and introduced improvements such as streamlined admission, patient identification and medication checking processes. This ensures that all clients are correctly identified, all medications are checked at the patient’s side and the patients, together with their partners, are included in their care plan. The Unit also identified a need for standardised chemotherapy treatment information for clients and Clinicians. On hand to welcome Bianca Fleming (centre) on her first day in eviQ cancer treatments online (https://www.eviq.org.au/) was her new role are (left) Laura Gane, McGrath Breast Care Nurse identified and ratified by both ERH’s Medication Safety Advisory Programme Manager and (right) Lyn Jeffreson, Medical Day Committee and Dr Burns as a useful and appropriate resource. Treatment Unit Manager at ERH. This online service provides accurate and relevant evidence based information to assist with patient care. Clients can access the Cancer Support Nurse and McGrath Breast Care Nurse services regardless of where they are The Cancer Support Nurse Service has undergone an internal receiving their cancer treatment. Clients may self-refer or be review of the model of care provided this year. The service referred by a medical practitioner. Both services provide care, aims to define the processes and pathways for clients entering, education and information in a community setting as well as receiving care and leaving the service to ensure that all clients during treatment. Cancer Support Nurses and the McGrath receive standardised and quality care. The Cancer Support Breast Care Nurse services are integral to the Cancer Services Nurses are trained in cancer care and offer support, education, offered at ERH. care coordination and assistance to members of the community who are living with a cancer diagnosis. Community Nursing Services ERH Cancer Support Nurses are also trained in supportive care Community Nursing Services (CNS) operates seven days screening as initiated by the Department of Health. Following per week providing various aspects of nursing care to clients screening the Cancer Support Nurses work with the client and in their home. During the last year the eight (8) Community their family to address their supportive care needs. This may be Nursing staff provided care to 389 patients who reside within by way of referral to other services such as allied health, mental a 20 kilometre radius of ERH; a total of 9,364 contacts. health and community services. Nursing staff provide a range of assistance including wound care management, medication administration, injections, the ERH has secured McGrath Breast Care Nurse funding for administration of intravenous antibiotics, shower and personal a three year period with the position commencing in April hygiene, and monitoring of blood pressure and blood sugar 2012. The McGrath Breast Care Nurse provides support, levels. education and care coordination to women and their families who are living with breast cancer. The team are developing this CNS is able to provide services through funding from the service and working to define the model of care, together with Home and Community Care (HACC) Program. For a minimal pathways and processes to ensure clients have standardised contribution the service is available for older, frail people quality care throughout their cancer journey. The McGrath and also young people with disabilities to assist them in the Breast Care Nurse integrates with the Cancer Support Nurses community. to provide non admitted cancer care to members of our community. In March of this year CNS were very fortunate to receive a brand new vehicle sponsored by Echuca Toyota to assist in ERH staff member Bianca Fleming was appointed to the providing essential services to members of the Echuca-Moama position in April of this year. Bianca is an experienced nurse and surrounding community. with a broad range of nursing skills. Bianca believes that through her position as a McGrath Breast Care Nurse she can Staff also relocated into a larger office space this year which contribute positively to her local community, providing support is now shared with the Palliative Care Nursing team. This will to women experiencing breast cancer, and their families. enhance the already strong links between the two units and facilitate effective and productive communication.
23 www.erh.org.au Hospital in the Home (HITH) Over three days staff immersed themselves in all aspects of Hospital in the Home (HITH) is a form of inpatient admission palliative care including education on the how, when and where where patients receive ongoing treatment in their own home to die, national standards and also music therapy. Staff were for acute medical conditions which would otherwise require privileged to be involved in discussions with not only Australian hospitalisation. experts, but some outstanding international speakers also. Staff took full advantage of the ‘hands on’ learning opportunities, Each patient is assessed to determine his or her needs and exciting presentations and valuable networking. The conference suitability for admission to the HITH program and a plan of care provided staff with the ideal opportunity to not only learn more is developed in consultation with a team of health professionals. but to clarify the vision of the service they provide, in particular Whilst undertaking this program the client is considered an looking at advanced care planning and end of life pathways. inpatient of ERH, resulting in no cost to the patient for the care and treatment received. The Echuca Community Palliative Care team celebrated National Palliative Care Week in May 2012. The team hosted a During the last financial year HITH staff carried out 534 hours of daily morning tea during the week to help promote the theme home nursing care. ‘Let’s chat about dying’. A competition titled ‘Six Words’ provided morning tea attendees with the opportunity to choose six words they would say to their loved ones. The competition Stomal Therapist/Wound Care Nurse produced some humorous entries together with some In September 2011 a Stomal Therapist and Wound Care Nurse inspirational ones. commenced at ERH. Since the recent introduction of this role 140 contacts have been provided to 56 patients.
This appointment has also been responsible for providing education to staff at both ERH and surrounding aged care facilities. To both complement this newly introduced role and to further develop their skills in the treatment and management of chronic wounds, three members of the Community Nursing team attended Wound Resource Education Nurse training this year. ERH is now able to offer a compression therapy service to patients who require compression garments/dressings to their legs to assist in wound healing.
Community Palliative Care Echuca Community Palliative Care Service provides specialist palliative care nursing to clients with progressive and advanced illnesses in their own home. The service delivers care to patients, families and carers to assist with the preservation of both comfort and dignity. Members of the ERH Palliative Care team celebrated National The Palliative Care Service provide a team approach to holistic Palliative Care Week in May this year care, including Social Workers, Occupational Therapists, Physiotherapists, Nurses and others professionals as needed. The Community Palliative Care nurses provide advice and During the year the Palliative Care team have also hosted two support in relation to symptom management, education of the coffee shop morning teas to recognise and support carers of disease process and also bereavement counselling. The team palliative care patients, and to also provide support to bereaved also assist with the hiring of aids and equipment, oxygen and carers who may have lost a family member during the past 12 the many other requirements necessary to the care of the client months. The gatherings were an excellent opportunity to have a at home. chat, a coffee and share a scone. New friendships were made, and memories shared. During 2012 the two members Palliative Care team saw 146 clients, carried out 2049 contacts and provided 1,037 hours of direct contact to members of the community.
The Palliative Care team were extremely fortunate to receive funding from the Loddon Mallee Regional Palliative Care Consortia to attend the National Palliative Care Conference which was held in Cairns in August 2011. The conference provided opportunities to share knowledge, leadership, inspiration and information about palliative care with delegates from around the world.
annual and quality of care report 24 New Director of Medical Services • Once a week transfer of funds to the Practitioner, ERH welcomed Dr John Christie as Director of Medical accompanied with a remittance advice for Simplified Billing. Services this year. Appointed on a part time basis Dr Christie is also employed as a Medical Administrator at Swan Hill Simplified Billing undertake invoicing and receipting for 24 District Health. Dr Christie brings a wealth of knowledge and doctors, surgeons and specialists at ERH. Since the beginning experience to ERH having worked at several other regional of the service $1,624,476.82 of private, Department of Veterans’ Victorian hospitals. Affairs, Workcover and self funded inpatient services have been billed on behalf of the doctors, surgeons and specialists.
Visiting Medical Specialists Private patient Simplified Billing offers incentives for all private Operating out of the ERH Medical Suites 23 visiting medical insured patients. These incentives have directly attributed to the specialists provide patients with local access to expert advice increase of private patient admissions once again this year. including: general surgery, urology, ear nose and throat surgery, ophthalmology, endocrinology, rheumatology, renal specialty, cardiology, gynaecology, paediatrics, physicians and Private Patient Bed Days anaesthetics.
The total number of patients presenting for consultations with Year Private Same Private Over Total visiting specialists during the last financial year was 18,151. Day Night
Patient Consultations 2010/2009 1,039 1,771 2,810 2010/2011 1,169 1,970 3,139 2009/2010 2010/2011 2011/2012 2011/2012 1,175 2,231 3,406 13,641 15,291 18,151
Since inception in May 2010 patients classified as Private Same Central Victoria Cardiology provide a visiting service Day have increased by 13%; and patients classified as Private for Transthoracic Echocardiogram, Stress Treadmill Over Night have increased by 26%. Echocardiogram, ECG’s, together with holter and 24 hour blood pressure monitoring which complements the wide range of speciality services already offered by the Medical Suites. Glanville Village Aged Care Services Management, staff, residents and relatives at Glanville Village This visiting service has increased from three to five days aged care facility were pleased to receive full accreditation per week this year. Two consulting rooms are required on a following a two day Site Audit in October 2011. To verify aged fortnightly basis to cater for the ever increasing demand for this care facilities provide quality care and services for residents, all service, eliminating the need for members of the community facilities must be accredited through the Aged Care Standards to travel to Bendigo or Shepparton to undergo this type of and Accreditation Agency. surveillance monitoring. Unannounced support visits also form part of the accreditation Echuca Primary Care Clinic process. As a result of an unannounced support visit in Dr Boris Molodov joined the Echuca Primary Care Clinic this February 2012, Glanville Village was awarded full compliance year to enable expansion of the Pharmacotherapy Prescribing with all Standards reviewed. Service. Dr Molodov joins Dr Peter Nesbitt, Dr BK Pillai, Dr Kate Schultz and Dr Bob Allan in providing a comprehensive service Each year Glanville Village residents or their relatives are to these clients. forwarded a Satisfaction Survey in order to determine areas in which Glanville Village are doing well and also areas Australian General Practice Accreditation Limited granted a which require improvement. This year’s survey indicated further three year Accreditation to the Clinic this year. that overall, Glanville Village does very well in being friendly, treating residents and their belongings with respect, allowing Simplified Billing independence, making people feel welcome and safe and Since inception in May 2010 Simplified Billing has offered a free providing good care and privacy. service to doctors, specialists and practitioners working within The survey also showed that Glanville Village could improve ERH with a view to ultimately increasing private patient bed in the areas of informing residents how to make complaints, revenue. allowing residents to have a say about things, providing more choice about who is involved in care, the variety of food, and The service includes: clothes returning from the laundry. • Online billing and receipting to and from Medicare and the health insurance funds on behalf of the doctors and practitioners for their private patients.
25 www.erh.org.au Standard 4 To ensure residents receive the very best of care, staff at Physical environment and safe systems – to ensure residents Glanville Village work tirelessly to make sure continuous live in a safe and comfortable environment which ensures their improvement plans are implemented. During the past year quality of life and welfare. in excess of 50 items have formed part of that continuous • Major environmental review of Hotel Services involving food improvement process, some of which include: and cleaning services. • Friends of Glanville - purchase of plants, pots and outdoor Standard 1 furniture for Loddon House, Mother’s Day presents, baking Management systems, staffing and organisational development - equipment and tables for Coffee Shop. to ensure systems are responsive to the needs of residents and • Review of Occupational Health & Safety inspection system. staff. • Purchase and installation of two new air conditioners in • Trial and purchase of new equipment provided by a resident kitchenettes in both Loddon and Waranga Houses. bequest. • Renovation of two bathrooms in Murray and Campaspe • Purchase of equipment as listed on the replacement Houses. program through the operational budget. • Introduction of an Equipment Register. The Leisure and Lifestyle Program, including the wonderful, • Analysis of Clinical Governance systems in Glanville Village. highly valued Volunteers, at Glanville Village ensures that • System for Volunteer/Contractor Statutory Declarations/ residents enjoy an active and fulfilling life on a day to day basis Police Checks. through exercises, bingo, coffee shop and newspaper reading. The residents have also experienced many exciting and hilarious Standard 2 activities, some of which include: Health and personal care – residents’ physical and mental health • ‘Happy Hour’ Friday afternoons in which Leisure and is promoted and achieved. Lifestyle staff and residents dress up for themes such as: • System for after-hours supply of medications for Glanville school days, pirates, masquerade, country and western, Village. rock n’ roll and circus extravaganza have provided residents • Review of heat pack system for residents. with many hours of fun, laughter and social activity. • Review and purchase of new sensor mats. • The Cooked Breakfast Program continues to be a highly • Development of Diabetic Management Policy and successful program which enables residents to enjoy a hot Procedure. breakfast and the aroma of bacon and eggs throughout the • Increase in visits from Nish Street Practice General facility is wonderful. Practitioners. • Themed lunches with staff dressing up for the occasion, • Review of Aged Care Medication Policy; combined into ERH decorating dining rooms and cooking and serving a variety Policy. of culturally specific food. • Repair of Loddon House bath for hydrotherapy and • Outings to various local eateries and restaurants such as aromatherapy. Beechworth Bakery where the residents participated in making bread; the Purple Fig, Morrison’s Winery, Madison Standard 3 Spa and the Echuca RSL. Resident lifestyle – residents retain their personal, legal and • The highly successful Men’s Group have enjoyed outings to consumer rights and are assisted to achieve active control of all of the Clubs in Echuca-Moama throughout the year. their own lives. • Development of policy and assessment for residents who smoke. • Donation of 16 seat dining table and chairs for Loddon House dining room. • Pilot Project - Spirituality in Aged Care. • Supply of culturally appropriate meals and language assistance for new resident. • Application for ACCV Better Practice Awards – Person Centred Care. • Development of photo memory books for residents. • Friends of Glanville - purchase of new bedspreads for each house. Leisure and Lifestyle staff ensure residents enjoy an active and fulfilling live at Glanville Village
Glanville Village management and staff continue to strive to ensure that residents who come to live in the homelike facility do exactly that; live a fulfilling and happy life with a high standard of quality care.
annual and quality of care report 26 Glanville Village Accreditation already occurring. A total of 1,917 student days were facilitated The Honourable Dr Sharman Stone MP Member for Murray and during the last year. Shire of Campaspe Mayor Kevin Simpson joined the ERH Board of Management, Executive, staff, volunteers and the residents of Department of Health funding enabled the purchase of simulation equipment for the Education Centre’s skills lab this year. Formal Glanville Village to celebrate the aged care facility’s Accreditation. alliances with the University of Melbourne Medical School and Go TAFE Shepparton campus have resulted in students What is Accreditation? now being able to undertake their Diploma of Nursing at ERH. To verify that aged care facilities provide quality care and services Department of Health and Ageing funding to expand clinical for residents, all facilities must be accredited through the Aged teaching at Glanville Village aged care facility from one to three Care Standards and Accreditation Agency. days each week has also contributed to the significant increase in student numbers. There are a total of 44 ‘Standards’ which facilities must meet comprising things such as management systems, staffing and The Vocational Education Training in Schools (VETiS) program organisational development; health and personal care; resident developed in 2011 with St Joseph’s College and Victoria lifestyle; and physical environment and safe systems. University included 37 participants this year. By the year 2014 it is anticipated 120 students from our local community will A site audit was conducted on 11 and 12 October 2011 which participate in this well received program. The ‘home grown’ entailed members of the assessment team speaking with concept remains a priority for members of the ERH Education residents and staff, a review of documentation and observation team; providing an environment where students are both of the day to day happenings within the facility. Accreditation encouraged to enter the health workforce and also return to ERH is granted for a period of four years. Prior to expiration of to undertake placement. that period an accredited facility must once again reapply for accreditation. After meeting all 44 Standards, Glanville Village ERH was fortunate to be selected as one of 11 health services aged care facility received full Accreditation to 4 January 2015. across Victoria to be involved with the Best Practice Clinical Learning Environment (BPCLE) Pilot Project this year. A “This result reflects our commitment to excellent resident care Department of Health initiative, BPCLE was developed to which can only be achieved through the passion and hard work promote quality clinical education and to ensure that an of all Glanville Village staff and volunteers, and the wonderful emphasis on increasing clinical placement does not adversely contribution that our residents, relatives and representatives impact the quality of clinical education provided. BPCLE is make to life here at Glanville Village” said Darren Clark, Nursing designed as a guide for health and education providers to Director – Aged Care Services. “I would like to take this coordinate and deliver high quality clinical placements for health students. opportunity to congratulate the entire team for this outstanding achievement. Well done and congratulations”. Participating in the Pilot Project provides an ideal opportunity for the Education team to examine and analyse systems for managing clinical placements at ERH and also identify goals and systems to improve the learning environment. The ERH Education team will then be better prepared to support students on clinical placements and participate in future quality initiatives.
The ERH Education team have this year been able to deliver the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) Aboriginal Health Care Worker’s Course. This course aims to recognise and develop the skills of Aboriginal health workers to enable the participants to improve the health outcomes for their local Indigenous communities.
Darren Clark – Nursing Director Aged and Community Services, Judy Cook – Chair ERH Board of management, the Honourable Dr Sharman Stone MP and Mayor Kevin Simpson with Glanville Village’s Certificate of Accreditation Education The ERH Education Centre celebrated its first birthday this year and demand for use is increasing for the state of the art equipped facility, its clinical skills lab, meeting and lecture rooms. The Centre provided 282 education sessions to students, staff and members of the wider community during the last financial year.
Student numbers continue to increase at a rapid rate with bookings for Nursing, Physiotherapy, Occupational Therapy, The official opening of the ERH Education Centre included a Speech Pathology and Medical student placements for 2013 performance by Baby Dhungulla Dancers
27 www.erh.org.au Renovation work continues on the student accommodation This year ERH converted to a ‘LITE’ template reducing staff area within the Education Centre. Demand has certainly time to enter data into VHIMS. ERH plans to further refine exceeded supply for the Centre’s 20 student accommodation VHIMS management processes during the next financial year. beds during the last year. Works are still progressing to refurbish an additional 23 student accommodation beds which Managing Risk is expected to be operational in September 2012. ERH was awarded a further four year’s accreditation by the Australian Council on Healthcare Standards (ACHS) in 2011. Improving the Quality of Services and Accreditation is about establishing a structure and putting processes in place to ensure patients receive the very best Patient Safety quality health care.
Improving Health Services for During the accreditation process recommendations are made to assist with the implementation of any required improvements. Aboriginal People Recommendations from the organisation wide survey Improving health services for Aboriginal people is the aim undertaken in 2011 included: of a new partnership between ERH and Njernda Aboriginal Corporation. Recommendation No 20 EQuIP Criteria 2.1.2: Signing of a Memorandum of Understanding (MoU) took place Use a risk management approach in the 2011 strategic planning, in June this year in an effort to achieve better health outcomes whereby organisational risk profile is analysed using a risk for Aboriginal people in our community. The partnership will tolerance matrix to identify appropriate levels of management focus on chronic kidney and respiratory disease, alcohol and and monitoring. drugs, diabetes and asthma, together with mental health and palliative care. What did ERH do? Two Risk Register electronic tools were evaluated in September An advisory group comprising two directors, together with the 2011. The VMIA Risk Register tool was chosen due to the ability CEO of each organisation will oversee the MoU. to configure it to individual organisational requirements and to link risks directly to strategic objectives.
The Strategic Plan for 2012 - 2014 was completed in December 2011. The configuration of the Risk Register has been developed to ensure that each risk in the Register is linked to the finalised Strategic Plan. Executive staff has reviewed risks related to each of the strategic priorities and the Risk Register content has been updated accordingly.
Recommendation No 21 EQuIP Criteria 2.1.2: Implement a risk management approach in all major projects to ensure that key deliverables are achieved and risks in meeting the objectives of the project are managed effectively. Signing of the Memorandum of Understanding (from Left) Denise Morgan, ERH Chief Executive Michael Delahunty, Barbara Gibson-Thorpe, Mavis Egan, ERH Board of What did ERH do? Management Chair Judy Cook (seated), Barbara Day, Melva Increasing organisational awareness of risk management Johnson (seated), Kevin Williams, John Mitchell and Karlene principles and incorporating into the normal way of doing Dwyer (seated). business will be multifaceted and occur over a sustained period of time. Organisational capacity building will occur through the provision of education in project management and risk Incident Reporting management frameworks for both the Quality Unit and other Incident reporting is a key component of informing ERH’s risk key staff. management process and is managed through an electronic reporting system (VHIMS). Increased Equivalent Full Time (EFT) resourcing of the Risk Management Coordinator occurred in December 2011 with Management of the system is overseen by the Quality Unit to restructure of the Quality Unit. ensure incidents are reported and appropriately investigated. Quality Unit staff have this year been working with the The Risk Management Framework has been redeveloped and ‘Productive Ward’ team to further educate staff in incident the Risk Matrix aligned with the VMIA Risk Register software. reporting. Electronic reports are communicated to the various All ERH committees now have a standing agenda item titled committees for the identification of risks and trends requiring ‘Emerging Risks’. further action.
annual and quality of care report 28 Recommendation No 22 EQuIP Criteria 2.1.2: Hand hygiene audits are performed to monitor staff Review the risk management policy and framework to ensure performance. Results of these audits indicate that ERH has there is a process to analyse effectiveness of controls via audits, exceeded the Victorian Department of Health target of 60% management review or agreed indicators. and the Australian average of 68% compliance. Visitors to the hospital are encouraged to use an alcohol hand rub solution What did ERH do? called DeBug™. VMIA formally evaluated the Risk Management Framework in April 2011. The recommendations have been incorporated Cleaning and Sterilisation of Equipment into the revised Risk Management Framework Policy. The All instruments used during surgical procedures are sterilised Risk Management Coordinator will facilitate focus on the to prevent possible infections. Sterilisation is a process to kill implementation of the revised Policy. VMIA conducted a micro organisms. Prior to sterilisation, instruments are cleaned Site Risk Survey in April 2012 with ERH receiving a rating of to ensure debris does not form a protective barrier, shielding ‘Good’. ERH received medium to low risk recommendations the germs from the sterilisation process. Care is also taken which are currently being addressed via an action plan and after sterilisation to ensure sterile instruments do not become funding submissions to assist ERH in addressing those contaminated prior to use. recommendations. Attestation on Compliance with AS/NZS ISO Sterilisation Audits 31000:2009 Risk Management Standard The Sterilisation Audit results for the last year provide evidence that ERH maintains a high standard for sterilisation processes and accordingly patients can remain confident. I, Michael Bernard Delahunty certify that Echuca Regional Audits are conducted annually against the Australian and New Health has risk management processes in place consistent with Zealand 4187 Standard for the sterilisation of reusable clinical the Australian/New Zealand Risk Management Standard and an internal control system is in place that enables the executives to instruments to ensure that reusable equipment is sterile and understand, manage and satisfactorily control risk exposures. safe for use during patient care and surgery. ERH results are The Audit and Risk Committee verifies this assurance and that benchmarked against other hospitals in the Loddon Mallee the risk profile of Echuca Regional Health has been critically region and also regional Victorian hospitals. During the last year reviewed within the last 12 months. ERH has maintained an excellent level of compliance with the sterilisation standards. Mr Michael Delahunty Chief Executive Vaccination Echuca Regional Health Since 2009 the incidence of whooping cough (pertussis) in Victoria has increased dramatically. Whooping cough is a highly Infection Prevention and Control contagious respiratory infection and babies under the age of Maintaining a safe environment for patients, staff and visitors six months are most susceptible. Adults are the main source of remains the key focus for ERH’s Infection Prevention and infection due to waning immunity after childhood vaccination, Control program. Staff are extremely vigilant in their aim to keep which means that transmission from adults to unvaccinated patients safe by preventing the spread of organisms that cause babies can occur. To decrease the risk of whooping cough hospital associated infections. transmission to newborn babies, ERH participates in the Department of Health funded ‘New Parent Program’ which Hand hygiene is a simple, low-cost and extremely effective provides free whooping cough vaccine for new parents. ERH approach used to prevent infections. ERH actively participates also offers free whooping cough vaccine to all clinical staff. in the World Health Organisation’s ‘SAVE LIVES: Clean Your Hands’ campaign and use the ‘Aussie 5 moments for hand Influenza commonly known as the flu is caused by a contagious hygiene’ as a reminder regarding the importance of cleaning virus that is spread by coughs and sneezes or by direct contact hands. with respiratory secretions. Every year the flu causes severe respiratory illness in the community. Influenza viruses change frequently, therefore the influenza vaccine is updated every year. Hand Hygiene Compliance ERH promotes influenza vaccination to all staff and residents of our aged care facility. 100
80
60 % 40
20 79.40% 80.90% 87.70% 84.90%
0 1st Audit 2nd Audit 3rd Audit 1st Audit 2011 2011 2011 2012 ERH Hand Hygiene Audit Result *Statement of Priorities Benchmark (requires 65% or more)
29 www.erh.org.au Staff Influenza Vaccination Rates (CDI) was that higher rates can be attributed to the overuse of antibiotics, ineffective infection control processes such as poor 100 levels of hand hygiene and environmental cleanliness, and to 2012 90 have an early warning system for severe strains of CDI already 80 2011 present in Europe and North America, which have significantly 70 2010 higher morbidity and mortality. 60 50 2009 40 30 20 Clostridium Difficile Infections 10 0 Nursing Medical Allied Other Cat B 4.5 Aggregate rate 4.0 3.5 ERH rate per bed days The above graph indicates the influenza vaccine uptake 3.0 by ERH staff. ERH No. Infections 2.5 2.0 1.5 Health Care Associated Infections 1.0 Watching for infection risks is another major part of ERH’s 0.5 infection prevention and control program. ERH participates in 0.0 Q3 10/11 Q4 10/11 Q1 11/12 Q2 11/12 Q3 11/12 Cumulative the Victorian Hospital Acquired Infection Surveillance System Data (VICNISS) and review all caesarean4.5 sections and blood stream Aggregate rate infections caused by the germ Staphylococcus4.0 aureus. While ERH strives for and frequently achieves3.5 zero infections, reports ERH rate per bed days indicate that ERH infection rates 3.0continue to remain very ERH No. Infections low and compare favourably with2.5 the Statement of Priorities benchmark of less than 2 in 10,0002.0 bed days. The above graph demonstrates the rate of Clostridium 1.5 difficile (diarrhoea) infections detected at ERH per 10,000 Staphylococcal Aureus1.0 Bloodstream (SAB) occupied bed days compared with the aggregate data for 0.5 type B health services in Victoria. Infection Rates 0.0 Q3 10/11 Q4 10/11 Q1 11/12 Q2 11/12 Q3 11/12 Cumulative Data ERH SAB Rates - per 10,000 bed days 5.0 Medication Safety Aggregate 4.5 Medication incidents and incident trends are reviewed monthly 4.0 ERH SABby Rate the Medication Advisory Committee and recommendations 3.5 * Statementfrom of Priorthisoties Committee are forwarded to the Quality and Risk 3.0 BenchmarkCommittee. (requires less Any issues/trends identified, form the basis for 2.5 than 2 in 10,000 bed days) 2.0 2 2 further staff education and training. A bimonthly medication 1.5 education newsletter is published by the Pharmacy Department 1.0 which incorporates information based on issues identified Rate per 10,000 bed days 0.5 through analysis of medication incidents. Reported medication- 0.0 Oct-11 Dec-11 Mar 12 Cumalitive Data related incidents increased this financial year from 96 to 118. Audit Period This increase is partly due to vigilance of staff in reporting. ERH SAB Rates - per 10,000 bed days 5.0 Aggregate 4.5 4.0 ERH SAB Rate A Venous Thromboembolism (VTE) Prophylaxis Policy has 3.5 * Statement of Prioroties been developed this year in line with latest National Health 3.0 Benchmark (requires less and Medical Research Council Guidelines to ensure at risk 2.5 than 2 in 10,000 bed days) 2.0 2 2 patients receive appropriate VTE prophylaxis. Associated risk 1.5 assessment tools to support this Policy have been developed 1.0
Rate per 10,000 bed days and are being trialled prior to rollout across ERH. 0.5 During the last financial year there have been no 0.0 readmissions for women with infections post caesarean Oct-11 Dec-11 Mar 12 Cumalitive Data section. Audit Period
The beginning of 2011 saw the introduction of surveillance of Clostridium difficile (a germ that causes diarrhoea). This module was endorsed by the State Health Ministers in 2008; their recommendation for surveillance of Clostridium difficile infection
annual and quality of care report 30 Reported Medication Related Incidents, July 2011-June 2012 Reported Falls Incidents, July 2011-June 2012 (Excluding Aged Care) (Excluding Aged Care but inclusive of TCP) 16 12 No. of Reported Medical No. of Reported Falls 14 Related10 Incidents 12 8 10 8 6
ported incidents 6 4 4 umber of falls incident s 2 N No. of re 2 0 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Reported Medication Related Incidents, July 2011-June 2012 11 11 11 11 11 11 12Reported 12 12Falls 12 Incidents, 12 12 July 2011-June 201211 11 11 11 11 11 12 12 12 12 12 12 (Excluding Aged Care) (Excluding Aged Care but inclusive of TCP) 16 12 No. of Reported Medical No. of Reported Falls 14 Related10 Incidents 12 8 10 8 6 ported incidents 6 The above graph demonstrates the number of falls during 4 the last financial year. February 2012 saw a significant spike 4 Medication Related Incidents as
Proportionsumber of falls incident s of Total Clinical Incidents in falls incidents due to one patient falling six times over
No. of re 2 2 N (Excluding Aged Care) a five week period. (All possible falls prevention measures 0 40 0 were implemented, however management of this patient was Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar AprTotal May Clinical Jun Incidents 11 11 11 11 11 11 12 12 12 12 35 12 12 11 11 11 11 11 11 12 12 12 challenging12 12 12 due to cognitive impairment). Medication Related Incidents 30 The majority of falls this year occurred in the General Ward due 25 to patient demographics including age over 65 years, multiple 20 co-morbidities and history of previous falls. Of these falls, 15 36% resulted in some form of injury. Minor injuries included 10 bruising, skin tear or laceration, pain and soreness. One patient sustained a fractured neck of femur requiring transfer to an 5 external facility. 0 Medication Related Incidents as Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Proportions of Total Clinical Incidents 11 11 11 11 11 11 12 12 12 12 12 12 (Excluding Aged Care) 40 Falls by Ward Area as % of Total Total Clinical Incidents (Excludes Aged Care) 35 Medication Related Incidents 5.6% Other 30 1.4% 25 ED 20 Loddon (TCP) 25% 15 Falls Prevention and Injury Minimisation 59.7% Rose Baker Wing 10 A fall is defined as ‘an event which results in a person coming General Ward 5 to rest inadvertently on the ground or floor or other lower level’. 8.3% Patients at risk of falling are identified through a process of 0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apscreeningr May Jun and risk assessment at first point of entry to ERH. 11 11 11 11 11 11 12 12 12 12 12 12
%
31 www.erh.org.au Patient Manual Handling and Bariatric Patients Percentage of Falls Resulting in Injury Patient manual handling is well recognised as a hazardous (Excluding Aged Care) task for staff. In preparation for the new hospital a great deal of Jun 12 research has gone into sourcing the most suitable equipment for patient lifting ensuring the best possible outcome for staff Mar 12 and patient safety as well as patient comfort. Overhead tracking 30.8% (patient lifting system) will be incorporated into the majority of 50% Dec 11 bedrooms in the new hospital, eliminating the need for mobile Sep 11 hoists which are difficult to push and require significant areas of
41.7% storage space. 22.2% With the current trend of increasing obesity in the population, a number of bariatric rooms have been incorporated into the design of the new hospital. This will ensure that the safety, % comfort and dignity of patients in this category are maintained throughout the duration of their admission. Preventing Pressure Ulcers Pressure ulcers develop as a result of prolonged unrelieved Planning for an Emergency pressure, friction or shear. ERH is committed to ensuring its emergency preparedness at all times. The Emergency Planning Committee (EPC) meets on a monthly basis to plan for emergencies such as fire and Reported Pressure Ulcers July 2011-June 2012 external disaster and to review emergency code incident (Excluding Aged Care) reports to ensure that any gaps in the emergency response are 4.5 addressed. Unspecified 4.0 This year the EPC reviewed 17 ‘Code Red’ (activated when Acquired Care 3.5 fire or smoke is detected), two ‘Code Black’ (any situation 3.0 wherePr thereesent ison a admissio threat ofn injury by a person or others or to 2.5 themselves) and one ‘Code Yellow’ (internal emergency) report 2.0 which resulted in an ‘In Depth Case Review’ as a result of an 1.5 Information, Communication and Technology systems failure event. 1.0 0.5 The EPC revised its Terms of Reference this year to ensure 0.0 its role and function is aligned with AS4083 Planning for Reported Pressure Ulcers July 2011-June 2012 Jul-Sep 11 Oct-Dec 11 Jan-Mar 12 Apr-Jun 12 Emergencies – health care facilities. Membership of the EPC (Excluding Aged Care) was also revised this year to include representation from the 4.5 Unspecified Primary Care division. Appropriate medical staff representation 4.0 is currently being determined. 3.5 Acquired Care 3.0 Present on admission The EPC monitors emerging risks related to emergency 2.5 planning. This year the Committee identified the need to 2.0 improve the accuracy of staff training records which has resulted in the formation of a working party to develop options 1.5 Screening of all admitted patients identifies those at risk of developing a pressure ulcer, then a further more in-depth risk for improvement. Any emerging risks related to the hospital 1.0 redevelopment are reported to the Internal Project Control 0.5 assessment is carried out and suitable prevention strategies are developed and implemented. Group for resolution. 0.0 Jul-Sep 11 Oct-Dec 11 Jan-Mar 12 Apr-Jun 12 Incidence of pressure ulcers are reported via VHIMS and results The EPC continues to revise its emergency procedures on an are monitored monthly by the Skin Integrity Committee. annual basis to ensure they are relevant to current standards and keep pace with organisational redevelopment. The EPC A Pressure Ulcer Point Prevalence Survey (PUPPS) will be is also seeking to invite agencies with recent emergency carried out in the month of July 2012 and results will be experience to attend ERH and communicate their emergency compared with previous results of surveys conducted in 2004, experience together with any learning. The EPC Chair 2006, and 2011. participated in a multi-agency desktop drill prior to the Southern 80 ski race this year which subsequently improved outcomes from the event.
annual and quality of care report 32 with this Australian Council on Healthcare Standards During the last year the following policies and procedures have recommendation is monitored by the OH&S Coordinator. been revised and implemented: A procedure has also been implemented to ensure that all • Code Orange has been updated to reflect evacuation for persons booking into the accommodation area of the Education each of the Emergency Codes and evacuation processes in Centre receive initial instruction in emergency procedures the event of structural damage to buildings. irrespective of their time of arrival. • Code Red Policy and Procedures including updated Action Cards for switchboard staff, Chief and Area Wardens and Three desktop evacuation drills have been held for Glanville specific procedures for the Education Centre and Glanville Village aged care facility staff with continuing education in Village aged care facility. emergency response held each clinical skills day. Evacuation • Chemical Biological Radiological (CBR) and Management procedures are revised according to staff feedback. of Organophosphate Poisoning Policies and Procedures. • Code Brown has been revised to reflect sequential stages Setup of the Incident Control Centre has been completed this of ERH response to an external disaster and Action Cards year with the installation of a television, radio, whiteboard added for the role of ERH Volunteers, Information and and emergency box containing tabards, action cards and Communications Technology and Human Resources staff. documentation templates. • Catastrophic (Code Red) Day policy has been updated to reflect alert processes and changes to power line settings. The ECP has met its external reporting and compliance • Extreme Heat Policy has been revised in accordance with requirements in both the VMIA Client Engagement Survey the updated Heat Wave Plan for Victoria. and the Department of Health Seasonal Preparedness Self Assessment Tools. Plans are also underway to further review the Business Continuity Plan and the ERH Emergency Management Plan The recommendations from the Fire Audit are monitored for during the coming year. timely completion and funding submissions made to the Rural Capital Support Fund to support recommendations for fire The following Capital Projects have been addressed as safety upgrades. previously planned: • Review and upgrade of the emergency room and its The Emergency Coordinator also attended the Emergency contents. Management Forum conducted by the Department of Human • CBR Management Plan to ensure appropriate facilities are Services Emergency Management Branch in November 2011. considered in the redevelopment. • Overhead paging in Perioperative Unit corridors and offices. Occupational Health and Safety • Relocation of an emergency phone to the Perioperative Unit. The Occupational Health and Safety (OH&S) Committee convened monthly throughout the last financial year. Chaired Planning for the replacement of the duress alarm system is by the Director of Nursing, Acute Care the Committee currently in progress. Demonstrations by two vendors has been increased to twelve health and safety representatives with the held with further hospital visits planned to witness the products appointment of a representative from the newly established in use before a final decision is reached. Education and Accommodation Designated Work Group. Five management representatives also make up the Committee. The ECP receives reports from the Medical Emergency Committee which reviews all ‘Code Blue’ (when any person During the year the Committee reviewed and approved within ERH is unresponsive and not breathing) and ‘Medical a range of OH&S policies and procedures as well as Emergency Team’ (MET) calls. The Medical Emergency actively participating in the development of the 2012 OH&S Committee is also monitoring compliance with the MET call Management Plan and the ongoing implementation of ERH’s evaluation reports. The training schedule in Basic (BLS) and OH&S Management System. Advanced Life Support (ALS) is also undergoing review to include a monthly allocation schedule for each individual Policies and procedures reviewed by the Committee during the department. The ECP is also monitoring compliance with year include Hazard Management, Management of Weapons standardisation of resuscitation equipment. and the Asbestos Policy.
Following restructure of the Quality Unit in 2011 the A key OH&S goal for ERH has been to support strong responsibility for staff fire training has been reallocated consultative arrangements that encourage staff to contribute to to the recently appointed OH&S Coordinator. The OH&S and participate in safety initiatives. This has been particularly Coordinator reports to the EPC on fire training compliance. important in ensuring the valued contribution of staff to the A pre-employment checklist was implemented this year to redevelopment of the new hospital. educate employees to consult with their Manager to undertake fire training prior to commencing work at ERH. Compliance
33 www.erh.org.au Management and staff have been actively working together to ensure that the new hospital is a safe place for everyone. Incident Data Various strategies for consultation have been established including the formation of working groups to focus on specific areas. One group in particular focussed on patient lifting Incident Type 2010/2011 2011/2012 systems in an effort to minimise the manual handling risks staff are exposed to when providing patient care. Manual Handling 19 31 Aggression 18 18 A third party audit of ERH’s OH&S Management System was conducted by the Victorian Health Industry Association (VHIA) Needle Stick 2 2 during the year and the resulting corrective actions were Lacerations 3 4 incorporated into the 2012 OH&S Management Plan, which is Trips/falls 11 14 currently being implemented. Some of the key areas of the plan Chemical splash 6 2 include: • Training in hazard identification and incident reporting Security 16 14 including implementation of participative processes to Hazards 15 13 manage OH&S risks. Other 16 7 • Integrating safety considerations into procurement processes. • A further review of policy and procedures pertaining to chemical management. There have been no serious incidents during the last financial • Guidance and training in the use of personal protective year that required reporting to Worksafe under Part 5 of the equipment. OH&S Act 2004. • Implementation of ‘Smoke Free Workplace’. • Establishment of OH&S performance measures. Director of Primary Care The year has been another busy and exciting one within the Other safety initiatives implemented during the year include: Primary Care Division. Staff from across a range of services • Accredited safety training for management and health and have been actively involved in planning for the new health safety representatives. service and in particular, the sub-acute (rehabilitation) service. • Training in fire awareness and evacuation for all staff. There has been much healthy debate and discussion about the • Accredited training for Chief Wardens. new facilities which will certainly ensure ERH will have buildings • Training in manual handling. that enhance and facilitate care delivery. This process was • Revised environmental inspection audits. further strengthened with a successful submission allowing • Increased focus on risk identification and management ERH to undertake some detailed planning for the model of care processes. for the new sub-acute service. • Establishment of a corrective actions database. • Establishment of a centralised chemical register. A number of new Primary Care services have commenced • Revised procedures for managing contractor safety. during the year. The Specialist Continence Service now provides a much needed clinic in Echuca. The Children’s A manual handling project was established to address ERH’s Allied Health team is a multidisciplinary clinic which allows most prevalent hazard. The project included providing tailored children with special needs to access a range of allied health training for all staff in correct manual handling technique and practitioners. Pleasingly, a number of the ERH staff who improving staff skills in identifying and assessing manual completed the Specialist Certificate in Rural Paediatric Practice handling risks at the local level. Some achievements to are now working in this team. This demonstrates the real value date include the purchase of a new podiatry chair which is of the training facilitated at ERH. electronically adjustable and improvements made to the way new staff are orientated to manual tasks. The focus on coordinating referrals across the Division has continued this year with more departments joining the referral The occurrence of manual handling incidents has continued to and intake service. This is a highly successful process which be the main contributor to injury. ERH continues to benchmark ensures all referrals go through a streamlined acceptance safety performance with Rochester, Kyabram and Castlemaine and triage process. During the year the Primary Care Division Hospitals. reviewed its compliance with internal triage guidelines and the results are now being used as part of the quality improvement cycle. During the year ERH allied health departments were also required to provide the Department of Health with waiting list data. This is not normally collected in the format requested but ERH was complimented on the accuracy and presentation of the data we provided. Our ability to do this was largely due to the background work of the referral centre processes.
annual and quality of care report 34 There has been continued pressure on all services with demand The HARP team assist with disease management strategies growing across the board. In the absence of additional funding, and care coordination to prevent avoidable hospital admissions waiting lists continue to grow in a number of areas. This is a and presentations to the Emergency Department (ED). To help continuous challenge for clinicians. The introduction of Activity clients manage their own care and retain their independence Based funding for a number of our services is firmly on the HARP also plays an important role in linking clients to horizon and considerable clinician time has gone into providing community services. Utilising a holistic client centred framework information as part of the preparation for this introduction. strengthened by the use of a multidisciplinary team the program aims to assist clients to achieve their individual goals. During the year our Rural Academic Health Network (RAHN) Coordinator was appointed. As part of the ERH strategic Since July 2011 the team have been involved in a number of priorities this role will ensure that the structure and governance projects to improve the quality of care to clients. HARP now of research will be enhanced at ERH. The role is also expected utilises its own assessment tool to capture information required to provide much needed support to staff as well as undertaking for an assessment, reduce the duplication of paperwork and research. in terms of care planning to meet industry standards. This replaced the Service Coordination Template (SCTT) the program Quality initiatives continue to be a priority for the Division. was previously utilising. The program still utilises the format and A number of our staff have also presented at conferences, venue for the Multi-Disciplinary Case Conference and both are contributing to the body of knowledge on rural and primary care still proving to be successful. HARP has continued its presence services. There has also been a strong focus on community in the Emergency Department and this has led to a more regular participation and partnerships across the Division. flow of referrals from this source.
The Echuca-Moama community is very fortunate to have so Since October 2011 the service has had a full complement of many dedicated and high quality staff in the Primary Care staff and this has led to increased discussion with regard to Division. service and being able to see clients in a timely manner. All staff completed an Online Chronic Disease Self Management Merrin Prictor Course this year. This proved successful and will become part Director of Primary Care of training for all new HARP staff.
Dental Clinic During the last financial year the HARP team recorded 1,314 The ERH Dental Clinic offers the services of two Dental direct client contacts. Longer term clients are invariably seen Therapists, a Dental Clinic Coordinator and five Dental less often than the clients who have been with the service in Assistants. Senior Dentist Dr John Goodley relocated from the short or medium term. These clients are now progressively Echuca in August 2011. being discharged. Although there has been a reduction in client contacts, the figures are still above the trial key performance During the 2011/2012 period a total of 2,607 general patients indicators that have been set by the Department of Health. were seen at the ERH Dental Clinic; this number includes both adults and children. Emergency treatment was provided to 820 patients at the Clinic, with 857 patients receiving treatment externally under the Victorian Emergency Dental Scheme (VEDS). When dental care is not available at ERH, the VEDS allows patients to receive treatment from private Dentists in the area.
A total of 1,677 patients requiring emergency care were treated during the last year. A total of 243 patients received prosthetic care during the year. Of these, 113 patients received care at the ERH Dental Clinic, and 130 via the Victorian Denture Scheme.
Hospital Admissions Risk Program The Hospital Admissions Risk Program (HARP) provides care in the community for people with chronic and complex health needs. Since July 2010 it has been recurrently funded by the Department of Health and now caters for the needs of all age Dental Health Week 2011 groups.
35 www.erh.org.au The HARP team were the grateful recipients of a brand new Community Rehabilitation Centre Toyota Corolla this year which was kindly sponsored by the During the past year the Community Rehabilitation Program Moama Bowling Club. The vehicle will assist the HARP team in has experienced growth in a variety of services provided to providing essential services to members of the Echuca-Moama community clients. community. The financial year commenced with Department of Health Walking the journey with members of our funding to establish a Specialist Continence Clinic. A Clinical Aboriginal community Nurse Consultant and a Continence Physiotherapist conduct “Taking a holistic approach which is culturally appropriate for the Continence Clinic on a weekly basis and liaise with visiting Aboriginal and Torres Strait Islanders” is what Barbara Gibson- specialists in the assessment, diagnostic investigations and Thorpe sees as a key priority in her role as the Aboriginal care planning of clients attending the Clinic. Chronic Illness Coordinator appointed this year.
Through the Australian Government ‘Closing the Gap’ initiative, a commitment to improve the lives of Indigenous Australians, and as a direct result of the strong partnership between ERH and Njernda Aboriginal Corporation, the position aims to support Aboriginal and Torres Strait Island people who are suffering with chronic illness.
“Through my role with Njernda and Echuca Regional Health I am able to walk the journey with members of our Aboriginal community who are suffering from chronic illness, providing support and assisting with the coordination of professional health care services.
Barb is both an experienced and respected professional who has held a number of senior advisory positions within the health sector and played an important role in improving outcomes for Members of the Rochester and District branch of the Aboriginal people at both a regional and state wide level. ERH Heart Support Association present ERH with the electronic welcomes Barbara Gibson-Thorpe defibrillator The scope of the Community Rehabilitation Program expanded further this year with the formation of the Children’s Allied Health team, an interdisciplinary team of Allied Health clinicians who provide a fortnightly service to paediatric clients. The Clinic is conducted to coincide with the days Dr Andy Lovett, Paediatrician is consulting at ERH which has enhanced the care available locally to this young client group.
The Community Rehabilitation Program continued to conduct orthopaedic, rehabilitation, pulmonary, cardiac and falls and balance groups to in excess of 500 clients this year. Community Rehabilitation staff have also enjoyed conducting a ten week weight loss and education program titled the ‘Pound it Program’, whilst another small focus group concentrated on useful strategies to manage memory loss.
Department of Health funding of $57,000 was utilised to purchase much needed diagnostic equipment to set up the Specialist Continence Clinic, together with additional therapy equipment for the gymnasium.
Aboriginal Chronic Illness Coordinator Barbara Gibson-Thorpe The Rochester and District Branch of the Heart Support Association very kindly donated the sum of $4,460 and also an automated electronic defibrillator to the Program. This support assisted with essential staff education which was undertaken at the ERH Education Centre and made available to staff from other local health services.
annual and quality of care report 36 term, child and family focussed therapy in the local area. This year did contain one major disappointment for the Physiotherapy team with the closure of the local hydrotherapy pool resulting in the cessation of the aquatic therapy program. Unfortunately this has affected many members of the community as they can no longer access this valuable service locally. The nearest hydrotherapy pools are located in Deniliquin and Bendigo.
The Physiotherapy Department continues to benefit from the centralisation of referrals through the Primary Care Integrated Referral Centre. During the last year the Physiotherapy Department received an average of 57 new referrals per month. This is a 30% increase in the number of referrals compared with the previous year. Waiting lists remain in place for community Physiotherapy and a triage system for determining the priority Celebrating World Continence Week of need continues to apply.
Newly Established Continence Clinic The Physiotherapy team have been heavily involved with the Currently 4.8 million Australians suffer from incontinence. It can planning for the new rehabilitation ward as part of the hospital affect both men and women, regardless of age or background. redevelopment and much time and effort has gone into carefully In 2010 the total financial cost of incontinence (excluding the thought out plans for the gymnasium. The team have also been burden of disease) was estimated to be $4.29 billion (source: active participants in working towards establishing philosophy, Continence Foundation of Australia 2012). models of care and the delivery of rehabilitation programs in preparedness for the hospital’s redevelopment. The Specialist Continence Clinic at ERH began in March 2012 following Department of Health funding. This is a new Transition Care Program service offered at ERH, eliminating the need for members of The Transition Care Program (TCP) was first introduced at the community to travel to Bendigo to access assistance. The ERH in 2008. The aim of the program is to reduce the number Clinic accepts referrals from specialist medical practitioners. of older people experiencing inappropriate extended hospital stays and being prematurely admitted to residential aged care. The Clinic has been fortunate to receive funding to assist The Program is jointly funded by the Department of Health and with the purchase of several equipment items integral to its Ageing and the Department of Health, together with some client service. A bladder scanner, ‘uroflow’ machine and pelvic floor contribution. rehabilitation system all assist to provide a high standard of care for clients. The Program provides goal focussed, low level therapy and care for up to 12 weeks for people over the age of 65 years who The Clinic has treated in excess of 60 men, women and require more time and support in a non-hospital environment at children during its short period of operation. An afternoon tea the conclusion of a hospital admission. TCP allows people the and information session was held on Monday 25 June 2012 opportunity to complete therapy and achieve optimal levels of to celebrate world Continence Week and well attended by function, allowing clients and their families the necessary time members of the Echuca-Moama community. to consider and access longer term care arrangements which may include residential aged care. Physiotherapy A commitment to education has continued this year in The ERH Program forms part of a formal partnership with the Physiotherapy Department. Staff have supported Bendigo Health Care Group. ERH offers two streams of undergraduate Physiotherapy student placements from La transition care; a bed based facility in Glanville Village and Trobe and Charles Sturt Universities, together with placements a community based program where therapists travel to for exercise science students. The Physiotherapy Department the client’s own home. The initial allocation to ERH at the remains a popular request amongst VET and work experience commencement of the Program in 2008 was four residential students. Two Allied Health Assistants from the Physiotherapy based places, together with two community places. Since Department have also achieved their Certificate IV in Allied it began there has been a continued high demand for the Health Assistance through BRIT this year. Program with occupancy rates of 99.6% during the last financial year. The Program once again expanded during Further enhancement of services to both children and their this year by two additional places; one residential and one families has continued with the establishment of the Children’s community. ERH now offers seven residential places and five Allied Health Team (CAHT). Three Physiotherapists holding their community TCP places. Specialist Certificate in Rural Paediatric Practice now support the CAHT team for a total of 12 hours per fortnight. They form Feedback from clients who have been admitted to the Program part of the multi-disciplinary team that aims to provide short has been overwhelmingly positive. The Program continues to
37 www.erh.org.au achieve great outcomes. Last year there were 72 clients who Final year students (both from the 4 year Double Degree and participated in the Program resulting in a large percentage of the Graduate Entry Masters Program) have also enjoyed time clients being assisted to return to their homes in the community working alongside the Speech Pathology team. Some of their who may otherwise have been looking at the prospect of reflections have been captured: permanent residential care. “As final year Speech Pathology students at La Trobe University, Occupational Therapy Bundoora, we undertook a six week paediatric placement. Occupational therapy (OT) offers a wide range of quality We were given the opportunity to complete this placement at services including rehabilitation, home based assessment and Echuca Regional Health. We were both interested in gaining hand therapy. The Department provides support to numerous experience in a rural setting because of the great variety of members of the community in their own home. cases we hoped to encounter.
During the year the Department identified a manual handling Our knowledge about ERH and Echuca in general was minimal, issue regarding the fitting of ‘bed blocks’ which are used by and with this came some nerves and a lot excitement. In no time patients following total hip replacement surgery. Following total we settled in to our temporary home with help from each other hip replacement surgery patients quite often need to raise the and our supervisors. height of their bed to comply with postoperative hip restrictions. In most circumstances family members and carers are able Our time was divided between community paediatrics, to fit ‘bed blocks’ to adjust the height of the bed themselves. the hospital wards, the specialist school and local primary But patients who may live alone or do not have access to the schools. This variety was exactly what we had hoped for! The support of family and friends, require assistance to carry out Speech Pathology staff always provided us with the guidance the task. Historically it takes two OT staff members to fit ‘bed to confidently work between these different settings. One blocks’ due to the weight of the bed. This task also places staff of the most interesting aspects of our placement was the at risk of injury due to awkward body positioning. opportunity to witness the beginnings of the Children’s Allied Health Team. It was great to see how an interdisciplinary team A manual handling assessment was conducted during a home can work effectively and to see the roles of other allied health assessment visit to a patient who had undergone a total hip professionals including physiotherapists and occupational replacement this year. It was ascertained that the patient’s therapists. queen size bed was too heavy for the two staff members to lift and awkward posture also presented a high risk of back injury Upon reflection, we had a memorable experience meeting and for staff. working with a variety of families of the region. Our perspective on the profession in a rural setting has been enhanced. To minimise the risk of musculoskeletal injury to staff a trial was We now know, after chatting with fellow students, that our carried out using a car jack to lift the bed before positioning the varied experience was unique and will be beneficial when ‘bed blocks’ underneath the castors. The result proved to be we begin our professional careers as Speech Pathologists. both effortless and safe as minimal strength was required to lift Our only disappointment was not taking a ride on one of the the bed this way. After adopting this simple method staff are paddle steamers! Despite this we will definitely encourage now able to assist patients to comply with postoperative hip other students to take on the challenge of rural or regional restrictions without any risk of injury. placement”.
Staff education has remained a priority for the OT team this year with one staff member completing a Specialist Certificate in Rural Paediatric Practice through the University of Melbourne.
Speech Pathology
Student Education 2012 has been a busy year for Speech Pathology students locally. The La Trobe University Regional Clinical School in Bendigo taught its first cohort of third year students this year. After four years studying, the students graduate with a Bachelor of Health Sciences and a Master of Speech Pathology. There are several young members of the local community currently enrolled. ERH is fortunate to be one of the organisations in the region to provide support to these students as they gain their first significant experience working directly with clients. Final year Speech Pathology students Sonya Pang The contribution of the numerous local children and their and Hayley Millard families who have been the students’ clients has been greatly appreciated.
annual and quality of care report 38 Speech Pathologists in Rehabilitation Children’s Allied Health Team With planning for a new rehabilitation ward for the new hospital For some families, navigating the systems to identify and in full swing, the Speech Pathology team have been building address their children’s special needs can be frustrating. expertise in working with others to improve quality of life for With great enthusiasm, a team of allied health staff has adults in the region. established a new Program within the Community Rehabilitation Service. Speech Pathologists, Occupational Therapists and Speech Pathologists often say that they do their best work in Physiotherapists work closely together to deliver a coordinated multidisciplinary teams. In the Community Rehabilitation Centre multidisciplinary service for children and families. Sometimes at ERH, the opportunities for teams of therapists and nurses to children are already known to other ERH staff who can then work together with clients are many. The aim is to assist people participate in the team approach to care. This might include to be as independent as possible and to promote participation Social Workers, Dietitians and others. This care can take in everyday activities. many forms, with highly individualised therapy developed in partnership with parents. The Speech Pathology team hope that Difficulties involving communication are common within the the next year will bring opportunities to expand this service to community. The ability to speak clearly, understand others further meet the needs of the Echuca-Moama community. or express wants and needs may be reduced as a result of diseases such as stroke, dementia or Parkinson’s Disease. Dietetics Along with this, many older people may suffer multiple medical ERH provides a dietetic service to the acute sector of the problems. Changes to memory and thinking are also common hospital, aged care residents and members of the community. among these populations. During the past 12 months funding has been allocated to provide dietetic services to both the Community Rehabilitation The term ‘dementia’ is used to describe widespread program and, due to an increase in bed numbers, the Transition deterioration in mental skills. It is more than simple Care Program. ‘forgetfulness’. Dementia can result in difficulties in reasoning, judgment and emotional control as well as memory loss. The dietetic services at ERH are provided by Accredited The person with dementia may find it difficult to formulate a Practising Dietitians who assist clients with all areas of nutrition sentence, understand what is said to them, or even remember and dietary requirements. The Dietitian also provides sessions how to swallow. for cardiac and ante-natal groups and the ‘Pound It’ program through Community Rehabilitation. ‘Pound It’ participants Speech Pathologists have an educational and therapeutic have come together over a period of ten weeks to receive role with clients and carers of people who have changes education and exercise sessions to achieve weight loss and to their memory and thinking. They can advise regarding waist reduction. Data collected via both pre and post Program simplifications to the person’s environment to help maintain surveys confirmed that as a result the participants were able to successful relationships and facilitate independence. The improve their nutrition choices, enhance their quality of life and Memory Group was developed this year by Speech Pathology participate in more physical activity. staff in the Community Rehabilitation Centre to target this population. The group aimed to provide education, therapy A continuation of last year’s malnutrition sessions led to the and compensatory strategies in order to help these clients cope completion of the Acute Admissions Malnutrition Management with their memory difficulties. The Memory Group was a small Project Proposal 2011/ 2013. The aim of the proposal was group consisting of five clients with memory difficulties, two of to highlight patients at risk of malnutrition who had not been which came along with their carers. The group dynamic was referred to a Dietitian. An audit was conducted where Dietitians varied with people’s ages ranging from 40 to 80 years of age screened and assessed patients in the ERH General Ward and not one client presented with the same diagnosis. for two weeks to determine the percentage of patients with malnutrition, at risk, or the percentage referred to a Dietitian. The group ran over four sessions and covered a range of The Project has affirmed the importance of screening and different topics while allowing plenty of time for discussion. assessment for recognition of malnutrition. Clients and carers were educated on how the brain works to create memories and why changes to memory may occur. The A flow chart at Glanville Village aged care facility provides importance of keeping the brain active and how to do this was direction for the commencement of nutritional support for discussed along with strategies to help cope with memory residents who may fall into an ‘at risk’ group for malnutrition. difficulties that impacted on their ability to carry out everyday One of the markers is unplanned weight loss. Nursing staff tasks. A multidisciplinary approach was also taken by including can commence nutritional fortification as indicated on the flow the involvement of a Social Worker to promote discussion chart. about how to cope with change as well as helping the clients find ways to empower themselves and feel more independent, A review of the flow chart and nutritional fortification of despite their problems. Overall, the group received positive all resident’s meals was undertaken this year. The Food feedback and Speech Pathology staff are hoping to keep Fortification Chart (a section of the nutrition flow chart providing this group service to clients in the future. documenting nutritional support to be undertaken) had not been utilised. A variety of alternative methods had been undertaken to provide nutritional support. This has resulted in
39 www.erh.org.au significant change. Each area within Glanville Village aged care They are also at greater risk of displaying anti-social behaviours facility now has a simplified flow chart for unplanned weight and contact with the criminal justice system in later life, and at loss, together with a standardised format for fortification of food greater risk of chronic disease and depression. and fluids for residents based on the most common approach There have been 38 referrals into the Clinic since it commenced which had been undertaken by nursing staff. Nursing, Food in September 2011, which have resulted in early intervention by Services and Dietetic staff were involved in producing a referral to other support agencies. uniform system. Documentation is based on the Management Advantage electronic information system used by aged care Social Services have also reinforced its commitment to staff. Nursing, food Services and Dietetic staff now utilise palliative care this year by providing counselling and links within the same information regarding what nutritional supplements both the community and acute services. are being provided to residents, with the combined goal of preventing unplanned weight loss. Aboriginal Liaison Services has continued to provide support to our Indigenous community, as well as ensuring that ERH Throughout the year two carbohydrate counting education continues to demonstrate a commitment to ‘Improving the sessions were provided to Food Services staff. Patients Care of Aboriginal Patients’; acting in a way that is culturally receiving intensive insulin therapy for treatment of diabetes safe for all Indigenous people. ERH’s Aboriginal Liaison Officer adjust their pre-meal insulin doses based on the carbohydrate has played a key role in strengthening the relationship between content of meals. It is important that Food Services staff who ERH and Njernda Maternity Services to ensure that Indigenous take meal orders are aware of foods that are carbohydrate women’s health needs are addressed in a culturally sensitive choices. Each education session also provided Food Services manner. staff with information on how to calculate the amount of grams of carbohydrate in foods. Following these education In an effort to improve the identification of ATSI patients, sessions, results have indicated a 22% increase in recognising ERH received Department of Health project funding this year. carbohydrate food which will benefit both patients and The aim of the Project is to record and report statistics and residents who require assistance to control their carbohydrate data, as well as ensuring Aboriginal patients’ needs are met. intake. Funding for an additional Aboriginal Liaison Officer trainee was also received this year. The Trainee Aboriginal Liaison Officer Intake and triaging for dietetic community clients has continued arranged this year’s morning tea in celebration of NAIDOC week this year resulting in a waiting period for some clients. Meetings at ERH. This showcased Aboriginal culture through dance and and education sessions have been attended to obtain current art work, and provided an historic account of NAIDOC together knowledge in all areas of nutrition and an Accredited Practising with an explanation of the NAIDOC week theme. Dietitian status has been achieved for the current year.
Social Services To improve patient care and ensure the physical, psychological, emotional and spiritual needs of patients are met, Social Services have continued to maintain and consolidate relationships throughout ERH as well as the wider community this year.
The relationship between ERH’s Midwifery Unit and Social Services has seen some positive advancement in care for women who have been identified as being at risk due to medical and social issues. This has been achieved through the Enhanced Maternity Care Clinic which has also further strengthened links with Njernda Maternity Services.
The aim of the Clinic is early intervention for women and children. The latest research into early childhood development Echuca East Primary School students participated in a colouring (Dr Jack Shonkoff; Frank Oberklaid et all; the Centre for competition to celebrate NAIDOC Week this year. Pictured Early Childhood Development) shows that the period from above are some of the entries. conception to six years of age are crucial for the neurological and social development of young children. Children in this age group, without support and nurture to allow appropriate development, or through experiencing neglectful or poor parenting and/or trauma, are at far greater risk of low literacy, impaired neurological and social development.
annual and quality of care report 40 Alcohol and Other Drug Services QUIT Alcohol and Other Drug (AOD) Services provide programs The AOD Services also have a registered QUIT Smoking across the Shire of Campaspe with outreach based in Facilitator. neighbouring Rochester, Kyabram, Tongala and Rushworth. Annual Provisions The three funding streams are: The AOD team were also successful in obtaining funding to Counselling Consultancy and Continuum of upgrade security in the reception area of the Kinsey House Care (CCCC) building which enabled the installation of clear glass in entry Counselling is provided for individuals and families with doors, together with a lock down button and a security screen associated drug dependency issues. at reception.
Rural Outreach Diversion Worker (RODW) Promoting Health in the Community Case coordination is also available through the Rural Outreach The Health Promotion team have been busy building new Diversion Worker, providing counselling and support primarily to partnerships and engaging community members to develop people aged between 12 – 25 years who are either involved or and participate in a Community Kitchen this year. at risk of being involved in criminal activity. Community Kitchens involve a group of people who come together to socialise and cook nutritious affordable meals. Withdrawal – Rural Withdrawal Program The kitchen is open to anyone in the community, however has The program includes patient withdrawal at Echuca and targeted single men and women who want to socialise and Rochester hospitals, home based withdrawal and referral to learn new skills or provide more nutritious food for themselves specialist detoxification units in Bendigo and Melbourne. The and their children. Withdrawal Program has supported the Pharmacotherapy Program. The Community Kitchen is currently operating on a weekly basis and has a number of regular participants who are A needle syringe program is available during business hours benefiting from the outcomes of attending. Members come and operates from ERH’s Emergency Department after hours. together to cook, eat, prepare and take meals home for The AOD team also provides support to medical staff with the their family and decide what recipes they will be cooking the prescribing of pharmacotherapy and addiction medicine. following week. Participants also develop skills regarding food safety and handling, budgeting, modifying recipes to make Seeds of Change Program them healthier and more nutritious as well as healthy eating The ‘Seeds of Change’ is a new group work program available related topics. for people with drug dependence issues, depending on the cycle of change. The cycle of change refers to: someone not The Community Kitchen is being evaluated through a number wanting to alter their drug use; someone who is thinking about of methods. A weekly summary sheet captures how many changing but has not taken steps to change; a person who is community members participated and the number of recipes trying to make changes but has not achieved this and people cooked, as well as recording any feedback. Participant who have ceased drug or alcohol use and are working at satisfaction with the session is also documented. Outcome sustaining their abstinence. evaluation data is being collated via surveys which gather information about the development of skills around budgeting, Between three to eight sessions are conducted weekly for cooking, knowledge and food behaviours as well as frequency one hour. Sessions include things such as providing harm of meals prepared at home, shopping lists, budget preparation minimisation for people who do not want to change their drug and any other activities engaged in as a result. use, to goal setting for people who have ceased drug use. The Program has been piloted by Southern Area Alcohol Drug Service. Evidence to date has indicated a positive change to people’s behaviour.
Community Education and Training During the year AOD staff have provided education for the Nursing Clinical Skills sessions at ERH, Men’s group at Tongala and Girls Health Forum in Echuca. The Alcohol and Other Drugs team have hosted a Social Work student who was subsequently employed by ERH. During the year the AOD Manager has conducted group supervision sessions for the development of skills for AOD, generalist and Family Services staff.
Members of the Community Kitchen come together to cook, eat and disuss recipes.
41 www.erh.org.au ERH has continued to deliver the ‘Smiles 4 Miles’ Program Following the appointment of a dedicated OH&S Officer, within Pre Schools and early childhood settings across the extensive training and information has been provided across the Shire of Campaspe. This year saw 100% of the centres organisation this year. ERH recognises an ageing workforce and engaged achieve the ‘Smiles 4 Miles’ award status. This is as a result, ensures that a ‘no lift’ policy is enforced, together attained through nutritional policy development, education with better work practices. sessions delivered in partnership with Dental Clinic staff, together with staff and parent engagement in promoting the Workcover claims have remained at similar levels during the key messages of ‘eat well, drink well, clean well’. Surveys past four years with injuries commonly relating to back and determined the frequency of high fat, high sugar snacks and shoulder incidents. drinks brought to preschools both before and after the team’s interventions and education sessions. Evaluation results are reported to Dental Health Services Victoria. Standard Workcover claims by year ERH continues to provide Worker Health Checks, an initiative of Worksafe Victoria. This year has seen an increase in demand which now encompasses the entire Shire of Campaspe. 2012 2011 2010 2009 During the last year checks were delivered to approximately 39 businesses; reaching close to 250 individuals. To assist in 12 12 12 13 meeting demand, two staff members have been trained in the delivery of worker health checks this year. A number of Workcover claims have no time lost as staff are undertaking alternative or modified duties.
The Payroll Department has remained constant throughout the year. The four part time staff members continue to manage all payroll duties for both ERH and Rochester and Elmore District Health Service. A number of Awards and Agreements have been negotiated this year resulting in an extensive amount of work being completed to ensure that all interpretations and increases are completed in a timely manner. Processes continue to be refined. Employment forms are currently undergoing review to allow for on-line completion.
Finance The Finance Division is responsible for all internal and external reporting and analysis, together with day-to-day transaction processing. The portfolio also includes key support functions of information and communication technology, fleet management, Approximately 250 individuals underwent Worker Health Checks property management and main reception/switchboard during the last year operations together with the business operations of the Medical Suites, including the Echuca Primary Care Clinic and the Human Resources and Payroll Simplified Billing service for private patients. A Staff Wellness Program was initiated at ERH this year with a number of staff throughout the organisation putting forward David Thompson many suggestions and ideas for consideration. The Health Chief Financial Officer Promotion team is responsible for the delivery of a healthy work environment, together with encouraging wellness for all staff. A number of new strategies were identified for implementation to support staff through this Program.
The Human Resources Manager completed a number of presentations to various staff groups throughout the year. These included performance appraisals, bullying and harassment, guiding principles, selection and recruitment, code of conduct, ‘maintaining the holiday glow’ - how to manage the festive season and presentations to local secondary school students regarding scope of employment at ERH and information relating to the employment process.
annual and quality of care report 42 Information Communication and • Internal Security Services 24 hours per day seven days per Technology Department week. ERH’s Information Communication and Technology (ICT) • Internal patient transfer services. Department operates and maintains the organisation’s • Supply services and procurement. information, communications and data systems which include • The provision of meal components to clients, patients, approximately: residents and staff. • Provision of ‘Meals on Wheels’ to the Echuca community • 500 IP telephony devices. and outlying areas. • 300 desktop and laptop computers. • Provision of meals to Echuca Day Centre. • 90 printers and multifunction devices. • The daily cleaning of all functional areas within the ERH • Wired and wireless network infrastructure. campus including the new ERH Education Centre. • Microsoft Windows and Unix servers, both physical and • Waste and linen collection and distribution. virtual. • Functions. • Management of Pest Control Contract. During the past year the ICT Department has responded to in excess of 6,000 internal requests for assistance. The The Department allows for the additional provision of the Department has also been involved in a number of projects following professional services within the realm of expertise and which has resulted in the extension and upgrade of the ERH consists of the following: computer network, provisioning of a wireless internet service • Management of the Food Safety Program and consultative for private patients, the decommissioning of the previous services to all ERH facilities. Patient Information System and the implementation of the • Cleaning Audit Services and consultative services to ‘MedDISPENSE’ medication dispensing unit for the Emergency internal and external businesses within the region. Department. • Management structure strives to operate the Department with a total focus and emphasis on quality and financial The core of the ERH data and information systems was also considerations. upgraded this year, a major project that saw the virtual server • Internal and external training in both food safety and environment completely refreshed with two new physical cleaning streams. servers, a new backup solution and a Storage Area Network (SAN) implementation. The new servers provide significantly Training and Development more processing power than their predecessors, while the To enable staff to provide services in a professional, efficient implementation of the SAN has provided a nine terabyte and productive manner staff have undergone specific job increase in data storage. The new backup solution is capable training to ensure a very high standard of service provision is of backing up the entire ERH data and information systems in achieved. During the last financial year all staff have undertaken 20% of the time than that required by the previous system. Food Safety updates and the entire Security team have completed their Certificate II in Security Operations. These upgrades, together with other network infrastructure upgrades are paving the way for the new ICT systems which Victorian Cleaning Standards for will be deployed in the coming years to coincide with the Public Hospitals building of the new hospital. Independent external third party and internal cleaning audits reveal continued compliance with Department of Health Hotel Services Cleaning Standards for Public Hospitals. Both external and The Hotel Services Department at ERH operates using a part non-external Cleaning Audits are conducted and reported each time, full time and casual flexible staff base to provide a variety April, August and November. of services seven day per week, 24 hours a day.
The Department has successfully undergone a major restructure this year and is responsible for the provision of a wide range of internal services:
Victorian Cleaning Standards for Public Hospitals
Risk Area March 2011 August 2011 November 2011 March 2012 AQL (Acceptable Quality Level)
Very High 97% 97% 98% 93% 90% High 98% 98% 91% 92% 85% Moderate 97% 88% 88% 92% 85% Low 98% 85% Internal Audit Program Compliance Compliant Compliant Compliant Compliant Audit Type Non External External Non External Non External
43 www.erh.org.au Food Safety Program ERH Natural Gas Consumption (MJ) External third party audits are conducted each year and Comparative - 2010/2011 - 2011/2012 3000000 determine compliance with both the Victorian Food Act 1984 2011 - 2012 ERH Natural Gas Consumption (MJ) and FSANZ (Food Standards Code) for 2009. During the 2500000 2010 - 2011 ERH Natural Gas Consumption (MJ) 2011/2012 period ERH has once again been compliant against all standards. 2000000 Monthly Gas Consumption Target (1 656 750MJ)
(MJ) 1500000 Some Interesting Facts For the month of May 2012 Food Services staff prepared and 1000000 delivered in excess of 15,432 meals. 500000
0 Meal Tally for May 2012 ERH Natural Gas Consumption (MJ) Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Comparative - 2010/2011 - 2011/2012 3000000 2011 - 2012 ERH Natural Gas Consumption (MJ)
Patient Meal Tally 2500000 3972 2010 - 2011 ERH Natural Gas Consumption (MJ) Aged Care Meal Tally 2000000 7161 Monthly Gas Consumption Target (1 656 750MJ) (MJ) Day Centre Tally 1500000 146 ERH Electricity Consumption (kWh) 1000000 Dining Room Tally 2604.6 Comparative - 2010/2011 - 2011/2012 300000 500000 2011 - 2012 ERH Electricity Consumption (kWh Meals on Wheels Tally 1,085 0 250000 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2010 - 2011 ERH Electricity Consumption (kWh) Internal Functions 464 200000 Monthly Electricity Consumption Target Meal Production Total 15432.6 (212 001 kWh) kWh 150000 Average daily meal production 498 100000
50000
Our Environment 0 ERH Electricity Consumption (kWh) Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun ERH is committed to protecting the environment.Comparative When - 2010/2011 - 2011/2012 developing changes or making300000 improvements, consideration 2011 - 2012 ERH Electricity Consumption (kWh is given to conserving energy and water, reducing greenhouse 250000 emissions and improving waste management. 2010 - 2011 ERH Electricity Consumption (kWh) 200000 Monthly Electricity Consumption Target (212 001 kWh) ERH GeneralkWh 150000Waste (Landfill) 1 March 2011 -100000 31 March 2012) ERH Water Consumption (kl) 10 50000 Comparative - 2010/2011 - 2011/2012 ERH Actual 10000 0 2011-2012 ERH Water Consumption (kl) 8 Jul Aug Sep Oct Nov Dec Jan Feb Mar ApERHr9000May EnviJunronmental Management Plan8000 Monthly Benchmark 2010-2011 ERH Water Consumption (kl) 6 es) (7.1227000 Tonnes) 6000 Quarterly Consumption Target (6,417kl) 4 5000 ter (kLitr 4000 Wa 2 3000 2000 0 1000 ERH General Waste (Landfill) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 0 11 11 11 11 11 11 11 11 11 12 12 12 12 Jul-Sep Oct-Dec Jan-Mar Apr-May 1 March 2011 - 31 March 2012) ERH Water Consumption (kl) Comparative - 2010/2011 - 2011/2012 10 ERH Actual10000 9000 2011-2012 ERH Water Consumption (kl) 8 ERH Environmental Management 8000 2010-2011 ERH Water Consumption (kl) Plan Monthlyes) 7000 Benchmark 6 (7.122 Tonnes)6000 Quarterly Consumption Target (6,417kl) 5000 The increases outlined inter (kLitr the above graph are indicative 4 4000
Wa The increases outlined in both electricity and of increases in activity3000 and overall growth. water consumption graphs are due to an 2000 2 1000 increase in service delivery. 0 0 Jul-Sep Oct-Dec Jan-Mar Apr-May Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 11 11 11 11 11 11 11 11 11 12 12 12 12 annual and quality of care report 44 Consumer and Community Participation Complaints by Department ‘Doing it with us not for us’ In 2006 the Victorian Government launched ‘Doing it with General Medical us not for us’, a policy on consumer, carer and community Obstetrics participation to aid and improve health outcomes and the Aged Care quality of health for our communities. Community Nursing Services Emergency Department ERH recognises the significance of consumer participation Hotel Services Medical Suites in planning services appropriate to meet the needs of the Occupational Therapy community. Providing services that meet community need is Perioperative Services identified as a key priority in ERH’s strategic plan. Podiatry Social Services ERH has a consumer focussed approach to the planning of Other care and services and actively encourages consumer, carer and None Entered community input through: 0510 15 • Community forums; • Strategic planning processes; A total of 46 complaints were received during the last • Seniors Advisory Group; year. All complaints are acknowledged and investigated • Community partnership programs; thoroughly to ensure a timely resolution. • Service club forums; • ERH Volunteer Programs; 0510 15 • Consumer satisfaction surveys; We Value Your Opinion • Suggestions, compliments and complaints feedback The Victorian Patient Satisfaction Monitor (VPSM) was system; introduced by the Department of Health to do just that, monitor • Aged care resident meetings; patient satisfaction with the care and services they receive in • Consumers, carers and community members are involved Victorian public hospitals. in the development of consumer health information. The survey is sent to patients at random following their ERH is committed to continuing to participate in the principles discharge from hospital. Participation is both voluntary and of ‘Doing it with us not for us’ to aid and improve health anonymous. Surveys are analysed by the Department of Health outcomes and the quality of health care for the Echuca-Moama and reports provided to all Victorian public hospitals. This community. feedback allows ERH to compare results with other hospitals and also assists to improve the services we provide.
Benchmark data comparing Echuca Regional Health with Compliments and Complaints Category B and Statewide hospital benchmarks Compliments by Department Counsumer Participation Echuca Regional Health Discharge and Follow up Category B Hospitals Physical Environment All Hospitals General Medical Complaints Management Obstetrics Treatment and Related Information Aged Care General Patient Information Alcohol and Other Drugs All of Hospital Access and Admission Community Nursing Services Overall Care Community Rehabilitation Centre Education Unit 60 65 70 75 80 85 90 Emergency Department Benchmark data comparing Echuca Regional Health with Health Promotions Category B and Statewide hospital benchmarks Hospital Admission Risk Program Counsumer Participation Echuca Regional Health Medical Day Procedure Unit Medical Suites Discharge and Follow up Category B Hospitals Occupational Therapy Physical Environment Perioperative Services All Hospitals Complaints Management Physiotherapy Services Primary Care ReceptionTreatment and Related Information Social Services General Patient Information The above graph shows ERH’s result for each of the eight key Speech Pathology Access and Admission Transition Care Program categories and compares these results to the average of similar Other Overall Care sized hospitals and also the state wide average. None Entered 60 65 70 75 80 85 90 01020304050 Results of the VPSM conducted during July – December 2011 were consistent with previous surveys. Participants revealed the A total of 212 compliments were received during majority of patients felt they were helped a great deal by their the last year. stay in hospital and that the length of stay was about right.
45 www.erh.org.au High performance scores were achieved for the following Through feedback, negotiation, education and the individual questions: implementation of strategies to facilitate better care for the • Courtesy of nurses. older person, the SAG assist to create a pathway between ERH • Being treated with respect. staff and older members of the Echuca-Moama community. • Helpfulness of hospital staff in general. During the past two years members of the SAG have been • Responsiveness of nurses. continuously involved in numerous projects such as the • Helpfulness with pain. development of evidence based posters to promote person centred care, together with community information brochures The lowest scoring items related to overall satisfaction were: about hospital transport options. Through their eyes of wisdom • Waiting room comfort. the SAG pool their skills and resources to assist management • Facilities for storing belongings. and staff to ensure that issues impacting upon the care • Quality of food. provided to older members of our community remains a • Temperature of hot meals. continued focus for identification and address. • Explanation of side effects of medicines
As a result of the VPSM quality improvement efforts will now focus on improving the quality and temperature of meals, and providing patients with more information regarding medication side effects. ERH’s planned redevelopment will certainly address the negative feedback received relating to waiting room comfort and facilities for storing belongings. Distribution Distribution is ongoing throughout the year as ERH responds to requests. Copies of the 2012 Annual and Quality of Care Report will also be available in waiting areas throughout the health service.
This year’s combined Report will once again be distributed to: • Attendees of Echuca Regional Health’s Annual General Meeting; • Members of staff; • The health service’s 150 volunteers; Through their eyes of wisdom members of the ERH Seniors • Members of the Senior’s Advisory Group; Advisory Group assist ERH to identify and address issues • Local General Practitioners; impacting on older members of our community. • Patients and visitors of ERH.
A copy of this Annual and Quality of Care Report will also be readily accessible on ERH’s website www.erh.org.au . Approach to Cultural Responsiveness
Suggestions on ways to improve our Annual and Quality of Care According to the Australian Bureau of Statistics 2006, 5.8% of Reports are always welcome and can be forwarded to the Chief the Shire of Campaspe’s population (2,067 people) were born in Executive, Echuca Regional Health, 17 Francis Street, Echuca a country other than Australia with 92% of our residents born in 3564 or via email [email protected] English speaking countries. Italian is spoken at home by 0.9% of the Shire residents, with other languages (0.1%) being Greek, Communicating with our Community Filipino, German, Dutch, Arabic and Spanish. ‘Keeping the Community Informed’ has continued this year with twice monthly advertisements in the local newspaper Approximately one in five people in our community have either designed to do just that, keep the community informed by one or both parents who were born in a country other than communicating up to date and regular information about what Australia. A large proportion of these people settled in the is going on at ERH. area after World War II. It has been estimated that by 2011 approximately 17% of our community aged 65 years or older Guided Through the Eyes of Wisdom will have a cultural background other than Australian. (Martin ERH is committed to involving the community by encouraging Bonato and Associates HACC Demand Management Study for participation in decision making processes. The ERH Seniors Loddon Mallee Regional Councils 2003). Advisory Group (SAG) comprises a group of local community members who do just that.
annual and quality of care report 46 ERH Volunteers – Ordinary People Doing Extraordinary Things Volunteers are a powerful force in our society, united in their desire to help others to achieve a better quality of life for individuals and their communities. A strong and engaged volunteering sector is vital to building more cohesive and resilient communities, providing pathways to inclusion and participation, both for the Volunteer and members of the community.
ERH is very fortunate to have a group of community minded volunteers who continue to give back to their community, volunteering their time to ensure the visit to hospital by patients, residents, friends and family is as best as it can be.
ERH has in excess of 150 volunteers which is indicative of the ‘Closing the Gap’ Celebrations local community spirit to ensure its fellow community members are well cared for. Tasks undertaken by the volunteers vary Congratulations to our 2011 Life Governorship from making cups of tea to assisting patients with packing their Recipient belongings prior to discharge. A Life Governorship Award is the single largest honour the ERH Board of management can bestow on an individual in recognition Over two years ago the volunteers in the Emergency Department of their contribution to the health service. At ERH’s 2011 Annual Program was introduced at ERH. The program has now General Meeting one member of the Echuca-Moama community expanded to other areas of the hospital including the General who the Board considered to have made an outstanding Ward and Glanville Village aged care facility. contribution to the health service, was acknowledged with a prestigious Life Governorship Award: In conjunction with National Volunteer Week 2012 and in recognition of their dedication and commitment, ERH once Mr Fred Bridgewater again hosted a morning tea. Chief Executive Michael Delahunty Fred Bridgewater has a long association with ERH as a member attended the function and thanked each and every volunteer of the community and through the Echuca Cemetery Trust. Fred for the time and effort they dedicate to ERH, reiterating how was a Board Member from 1993 to 2004 and subsequently was a important their contribution is. member of various other hospital committees.
Fred was a member of the Aged Care Committee and an initiative from this committee included the introduction of the Webster Pack medication system and purchase of the Glanville Village aged care facility bus. Fred has also assisted the hospital in fundraising efforts with an active involvement for many years in the Murray to Moyne bike ride.
For his dedication and commitment to ERH the Board of Management were delighted to award Mr Fred Bridgewater with a Life Governorship.
ERH Volunteers celebrate National Volunteer Week 2012
Fonterra generously allocate money annually to support local sporting and not for profit groups and once again selected ERH’s volunteers as a worthwhile recipient for funding this year. The sponsorship has allowed the purchase of bright red uniforms, which the volunteers wear with pride, and also ensure ERH volunteers are easily identifiable. The volunteer uniforms have Life Governor Fred Bridgewater celebrates with wife Shirley been so well received and recognised that funding is being
47 www.erh.org.au sought to provide them to each and every ERH volunteer. Pastoral Care Volunteers are an essential ingredient for any community and Once again the contribution to ERH through the support like many organisations ERH would struggle to function without received from the Pastoral Care and Chaplaincy visitors is vital. their support. The volunteers are true ambassadors for both This team of visitors not only look after the patients in hospital the hospital and the wider community. but extend their care to their families also. Pastoral Care is available to all patients, relatives, friends and hospital staff ERH Ladies Auxiliary irrespective of their own faith or religion. Every year, thanks to the tireless fundraising efforts of the ERH Ladies Auxiliary, ERH is able to purchase much needed items Volunteers in the Emergency of equipment. This year was no exception with the ladies Department (ED) donating in excess of $10,000 to purchase a range of medical After two years, the Volunteer Program in ERH’s ED continues chairs to assist patients in the General Ward. to enhance the patient/visitor experience. Each year as the number of presentations to the ED increase, so do the number The ERH Ladies Auxiliary formed in 1990 and to date have of patients and visitors assisted by the ED volunteers. raised approximately $250,000 for the hospital. For every single day during the year there are two volunteers assisting in the ED; one each morning and one each afternoon, with a handover in between to ensure continuity of care for patients during their visit. The ED staff not only recognises but rely heavily on the assistance provided by the volunteers, enabling the doctors and nursing staff to concentrate on the clinical tasks at hand.
As seen in previous years, particularly during the festive season and special event periods, volunteers have sacrificed time with their own families to attend their shift at the hospital.
General Ward Volunteers This is ERH’s most recent Volunteer Program which commenced in the General Ward in May 2012. The General Members of the ERH Ladies Auxiliary Ward has 32 beds and in order to ensure each patient is adequately attended to, two volunteers are rostered on each Friends of Glanville morning to visit patients, help friends and families and assist Glanville’s ‘guardian angels’ have once again been working nursing staff. Although in its infancy, the program has been well tirelessly This year they raised in excess of $15,000. From received by both patients and staff. these funds the Friends of Glanville (FOG) have purchased items such as electric mixers for the residents’ kitchens and new bed coverings for residents’ rooms. The ladies are currently investigating the replacement of bedspreads and throws.
One fundraising event held during the year was the annual ‘Garden Walk’ where members of the community open their garden for the general public to enjoy. The FOG organise the entire event, conduct a raffle and also provide tea and coffee to garden visitors.
Aside from the FOG fundraising efforts, other activities undertaken by volunteers at Glanville Village include teaching residents how to use the internet, outings, companionship, reading, Friday afternoon ‘happy hour’, craft, gardening, cooking, indoor activities and the weekly café morning which attracts a large crowd. All of these activities contribute to the health and wellbeing of Glanville Village residents and also provides an ideal opportunity for friends and family to come together.
General Ward Volunteers Pam Collard and Peter Graham
annual and quality of care report 48 Support from our Community Thanks to the generosity of the Moama Bowling Club and Sponsorships and Donations Echuca Toyota this year, ERH now has two brand new $50,000 and over Toyota Corolla outreach vehicles to support members of the Victoria Police Blue Ribbon Foundation Echuca Branch community in the prevention and early intervention of a wide range of chronic disease conditions. $30,000 and over Moama Bowling Club $20,000 and over Echuca Toyota Estate of Mr Charles McGillivray Port to Port Cyclists Rich River Golf Club $10,000 and over ERH Ladies Auxiliary Friends of Glanville Girls Night Out Committee Riverine Herald Simplot $5,000 and over Members of the ERH Hospital Admission Risk Program (HARP) NAGS Committee team with the new Moama Bowling Club Toyota Corolla. $1,000 and over Community support is vital for the growth and redevelopment Mr Henry Bacon of our health service and due to the generosity of the Moama Mrs Helen Bassett Bowling Club and Echuca Toyota, the two new vehicles will Biggest Morning Tea Group assist to meet the ever increasing demand for community Border Inn Hotel Motel based services. Mr Ray Burgman and Ms Judy Holland Charles L King and Co. Echuca CWA Echuca Town and Country Supplies Fonterra Girls Ride Out GOK Foundation Heart Support Australia Rochester Branch Miss Sarah Kelsey Leanne Whitely Photography Moama RSL Mr B Peace Rich Rivers Radio Pty Ltd $500 and over Mr and Mrs Ian Addicott In memory of Mr Nick Bravo Miss Rita Bull Mrs Judy Cantwell Echuca Racing Club In memory of Mr Max Flynn Mr John Howe Lions Club of Echuca In memory of Mr Hugh McCallum Members of the ERH nursing team, Executive Director of Mumpreneurs Nursing June Dyson and Echuca Toyota’s John Cunningham and Steven Zandt with the Echuca Toyota sponsored Corolla.
49 www.erh.org.au Events Cr Di MacFarlane The Echuca Branch of the Victoria Police Blue Ribbon Appointed - 16 October 1985 Foundation raised in excess of $46,000 this year: Member of Audit and Risk Committee and Echuca Regional • Blue Ribbon Ball $35,000; Health Foundation • Inside Story events totalled $11,108. Number of Board of Management meetings attended: 8/13
All proceeds from the Blue Ribbon events assist with the Alan Whitten purchase of vital equipment for ERH’s Emergency Department. Appointed – 1 November 1993 Member of – Quality of Care Committee, Project Control With the assistance of six support crew, forty cyclists Group/Education Centre and Echuca Regional Health participated in the Port to Port Cycling Tour to once again Foundation raise funds for the ERH Education Centre this year. Over two Number of Board of Management meetings attended: 13/13 days the team wound their way 400 kilometres along the banks of the Murray River commencing in Mildura, stopping overnight John Kenley in Swan Hill and eventually finishing in Echuca. Appointed – 3 October 1996 Member of – Quality of Care Committee, Project Control This outstanding team effort raised $25,000 for the ERH Group/Hospital Redevelopment Education Centre. Number of Board of Management meetings attended: 5/13
The Girls Night Out Committee have been busy once again Handel Aubrey this year raising funds for the ERH Supportive Care Fund which Appointed 1 November 2005 supports members of the community throughout their cancer Member of – Project Control Group/Hospital Redevelopment journey. The Committee raised in excess of $13,300 this year. Board of Management meetings attended: 7/13
The Girls Ride Out team put foot to pedal once again this year Peter Birnie raising $4,400 from their charity bike ride. Appointed 1 November 2008 Member of – Echuca Regional Health Foundation, Finance and Audit and Risk Committee Number of Board of Management meetings attended: 11/13
Board of Management Louise Hall Appointed 1 July 2009 Member of – Quality of Care Committee, Governance President Committee and Echuca Regional Health Foundation Judy Cook Number of Board of Management meetings attended: 12/13 Appointed – 1 November 2001 Member of – Quality of Care Committee, Governance Committee, Finance and Audit and Risk Committee Number of Board of Management meetings attended: 11/13 The ten (10) volunteer members of the Board of Management are responsible for setting the strategic direction of Echuca Senior Vice President Regional Health within the framework of Government policy. Mary Boek Appointed – 1 November 2004 They are accountable for ensuring Echuca Regional Health: Member of – Quality of Care Committee, Governance • Is efficiently managed; Committee, Finance and Audit and Risk Committee • Provides high quality care and service delivery; Number of Board of Management meetings attended: 12/13 • Meets the needs of the community; and • Meets financial and non-financial performance targets. Junior Vice President Chris Bilkey Members are appointed for three year terms by the Governor Appointed 1 July 2010 in Council on the recommendation of the Minister for Member of – Quality of Care Committee, Project Control Health. They are required to declare a pecuniary interest Group/Hospital Redevelopment and Project Control Group/ when applicable, during Board debate and withdraw from Education Centre, Finance and Audit and Risk Committee proceedings. Number of Board of Management meetings attended: 13/13
Treasurer Greg Dwyer Appointed – 1 July 2010 Member of – Finance and Audit and Risk Committee Number of Board of Management meetings attended: 13/13
annual and quality of care report 50 Board Committees Quality of Care Audit and Risk Committee The Quality of Care Committee oversees the quality of care The Audit and Risk Committee reports to and assists the program at Echuca Regional Health, taking an active role in Board in fulfilling its corporate governance and oversight planning, monitoring and evaluation. responsibilities in relation to Echuca Regional Health’s financial reporting, internal control structure, risk management systems, Six (6) meetings were held during the last financial year. A and the internal and external audit functions. Quality Report to the Board of Management is provided every four (4) months. During the last financial year three Reports were Four (4) meetings were held during the last financial year. provided to the Board of Management.
Medical Staff Group Governance Committee The Medical Staff Group provides a forum for local medical The Governance Committee was formed in June 2009. The practitioners and visiting specialists to advise and make purpose of the Committee is to make recommendations to the recommendations to the Board of Management regarding Board on specific matters relating to Corporate Governance clinical services and related matters (eg review of By-Laws and Governance Policies), manage the process of recruitment and retirement/resignation of Board The Committee also provides advice regarding policies and members and oversee the induction of new Board members. procedures, workforce issues and the development of best practice care models. Three (3) meetings were held during the last financial year. Six (6) meetings were held during the last financial year.
Credentials, Scope of Clinical Practice and Project Control Group/Hospital Appointments Committee for Medical Staff Redevelopment The purpose of the Credentials, Scope of Clinical Practice The Project Control Group oversees the hospital redevelopment and Appointments Committee for Medical Staff is to review project including monitoring costs and budgets and oversees credentials to ensure that only medical practitioners with the performance of consultants and building contractors. appropriate qualifications, skills and experience are appointed to ERH and to recommend their scope of clinical practice. Eleven (11) meetings were held during the last financial year. One (1) meeting was held during the last financial year.
Project Control Group/Education Centre The Project Control Group oversees the hospital education centre redevelopment project including monitoring costs and budgets and oversees the performance of consultants and building contractors.
Seven (7) meetings were held during the last financial year.
Finance Committee The Finance Committee oversees the financial affairs of the organisation including the operating and capital budgets, finances, accounts, investments, property and insurance.
Ten (10) meetings were held during the last financial year.
51 www.erh.org.au Echuca Regional Health Organisation Chart
Board of Management
Chief Executive Michael Delahunty
Chief Financial Director Executive Director of Director of Officer of Medical Nursing Services Primary Care Hotel Services June Dyson Merrin Prictor Services David Thompson - Supply Dr John Christie • Finance Services • Nursing Director • Alcohol and Other Services • Information • Health Information -Acute Services Drugs Communication Services • Quality • Community • Pharmacy • Nursing Director Rehabilitation Technology Engineering Department – Aged and Community Centre • Medical Suites Services • Radiology • Acute Inpatient Services • Dental Clinic Department - General Medical and • Dietetic Services • Resident Medical Surgical Unit • Health Promotion Staff - High Dependency Unit • Hospital • Visiting Medical - Obstetric and Paediatric Admission Risk Human Staff Unit Program Resources • Bed Management and • Occupational Post Acute Care Services Therapy Services • Community Nursing • Physiotherapy Services Services New Echuca • Podiatry - Cancer Support Hospital - Community (District) • Primary Care Nursing Reception - Community Palliative Services Care • Rural Health - Hospital in the Home Academic • Education Unit Network • Emergency Department • Social Services • Infection Prevention and - Aboriginal Control Liaison Officer • Medical Day Procedure - Family Unit Counselling - Renal Dialysis - General - Oncology/ Counselling • Chemotherapy • Speech Pathology • Perioperative Services • Transition Care - Day Surgery Unit Program - Operating Theatre - Theatre Liaison
annual and quality of care report 52 Our Staff
Ongoing Fixed Term Casual Total Year Number FTE Number FTE Number FTE Number FTE Headcount Headcount Headcount Headcount
June 2011 392 277.52 93 68.93 39 9.81 524 356.26 June 2012 399 298.26 89 69.15 40 11.67 528 379.08
Active staff in last pay period June 2012
Ongoing Fixed Term and Casual Headcount FTE Headcount FTE
Gender Male 48 42.77 18 12.43 Female 351 255.49 111 68.39 Age Under 25 8 5.82 18 13.09 25 – 34 41 27.34 34 22.09 35 – 44 92 59.58 21 13.00 45 – 54 139 111.85 38 22.56 55 - 64 115 90.67 16 8.85 Over 64 4 3.00 2 1.23
*FTE - full time equivalent
Awarding Excellence in Nursing Staff Nurses Excellence Awards 2012 Recipients In an award ceremony celebrated on International Nurses Day, Aged Care the ERH Nurses Excellence Awards are awarded to nursing staff Winner – Necie Bradley members who are judged by their fellow nursing staff members Necie is a dedicated and willing worker, who is also a great team to best embody all of the values of an ‘excellent nurse’. One member. She is always cheery and positive. She works above who: and beyond expectations and is always flexible at late notice to • Is consistently a valuable contributor to the team; help out with roster changes. • Brings a positive attitude and enthusiasm to work each day; • Has a high level of up to date knowledge and skills; Runner up – Maree Madigan • Continues to seek new learning opportunities which will benefit patients; Surgical • In conjunction with the patient or carer, determines each Winner – Megan Farrell individual patient’s physical and psychological needs; Megan is an expert surgical nurse who provides above average • Is committed to meeting the needs of the patient each day; care. She is professional in all aspects of her work and is always • Is a positive role model and shares their knowledge with cheerful and motivated. She is keen to mentor students and their team. new staff and is both practical and displays lots of common sense.
Runner up – Lyn Colvin
53 www.erh.org.au Community Staff Winner – Kath Formica Echuca Regional Health applies principles of merit and equity Kath is a committed and dedicated nurse who works well as in recruitment, promotion, staff development, access to part of the team. Her commitment to patient care is excellent. facilities and treatment of staff. There is nothing Kath will not do for her patients. Finance Manager Midwifery S Jakobi Winner – Cathy Fraser Financial Accountant Cathy is a reliable and pleasant midwife who is prepared to K Garrow take on responsibility and work across the spectrum. Medical Suites Practice Manager T Cartledge Runner up – Mandy Maxwell Human Resources Manager R Lewandowski Medical Hotel Services Manager Winner – Deb Weatherhead K Bennetts Deb delivers patient focused care and is a committed team Information, Communications and Technology Manager player. B Colbert Payroll Manager Runner up – Cassie Adams D Mulcahy Facilities Manager Emergency Department J Quincey Executive Project Manager Winner – Leona Smith M Hooper Leona is friendly, dedicated, approachable and Communication Manager knowledgeable. She has good leadership skills and is able D Madill to work across multiple nursing roles. She is always willing to help and share her knowledge. She is approachable and Nursing patient, and puts her patients and others first. Nursing Director Acute Services H Thomson Runner up – Liz Arthur Nurse Unit Managers Care Coordinator Glanville Village Aged Care – J Payne Clinical Consultant Community Nursing Services - D Gowty Winner – Kim Ives Emergency Department - C Frew Kim is a very caring and devoted nurse. She is approachable General Ward - H Smith and always goes to the next level of caring and compassion General Ward – J Carey towards her fellow colleagues, students and patients. Kim Medical Day Treatment Unit - L Jeffreson has educated herself to achieve the highest levels of nursing Perioperative Services - T Burke throughout her career. Rose Baker Wing - A Murphy Bed Managers Inaugural Award A Hancock 2012 International Nurses Day Miracle Worker Award M Hyden This is awarded to a staff member for exceptional and tireless After Hours Managers support and assistance to ERH nursing staff. V Bowes Winner - Michelle Scali G Holding G Haswell L Kingston J O’Nial H Strawford P Taylor Education Manager J Carey Infection Prevention and Control L Golden Nursing Director Aged and Community Services D Clark
Chief Medical Imaging Technologist C Levick (to 11/5/2012) S Cox (from 11/5/2012) Director of Pharmacy Excellence in Nursing Awards 2012. C Turner
annual and quality of care report 54 Primary Care J W Quayle MB BS DRCOG DCH FACRRM Aboriginal Liaison Officer J P Teh MB BS DROCG DA N Wright (to 25 May 2012) S U Gough MB BS MBA FRACGP DRANZCOG FACRRM Alcohol and Other Drugs Manager J A Azzopardi MB BS DA (UK) DRACOG FRACGP N Woodward P J Nesbitt MB BS DRACOG FRACGP FACRRM Manager Occupational Therapy Services K Schultz MD FMOBS C Leung Y Y Ong MB BS DA (UK) FRACGP Manager Physiotherapy Services C J Hunt MB BS DRCOG DA ACRRM J Stephens A Waldron MB BS FRACGP DRACOG Manager Speech Pathology Services S Kennedy MB BS DRANZCOG FRACGP N Baldwin C Goodman MB BS DRANZCOG Community Rehabilitation Centre Manager F Henry MB BCh C Cross R Rifat MD Dental Clinic Coordinator P Grover MB BS (Advanced GP Registrar) C Beck C Taverna MB BS (GP Registrar) Dietitian K Puri MB BS (GP Registrar) R Nasveld B Mudugamuwa MB BS (GP Registrar) HARP Manager B Molodov MD (from Dec 2011) M Pugh Consultant Surgeons Health Promotion Manager L P Cheah MB BS FRACS J Warnecke (to 11 January 2012) P Chu MB BS FRACS FRCS FACS D Patterson (from 28 January 2012) B Penington MB BS FRACS Podiatrist D Fletcher MB BCh FRCS L Farrant (to 11 May 2012) Locum Surgeon Primary Care Reception Services R Arnot MB BS FRCS FRACS G Pell S Scott MB ChB FRACS Rural Health Academic Network (RHAN) Coordinator Consultant Anaesthetists E Williams (from 9 May 2012) P Mazur MB BS FANZCA Social Services Manager A Bradshaw MB BS FANZCA F Clark P Buncle MB BS FANZCA Transition Care Program Coordinator L Hamond MB BS FANZCA M Howard (to 19 March 2012) M Shapiro MB BCh H DA FANZCA S Jilbert (from 19 March 2012) D Noble MB BS FANZCA A Purcell MB BS DA (UK) Dip Obs RACOG FANZCA Medical J Harding MB BS FANZCA HMO Manager / FoI Officer S Hams MB BS FANZCA J Phyland M Nerlekar MB BS DA MD FANZCA Manager Health Information Services B Hindson MB BS J Webster Consultant Physicians Implementation Manager, ERH Clinical Services/ D Power MB BS FRACP Research Officer, Central Loddon Mallee Medical R McLean MB BS FRACP MD Workforce Group J Eapan MBBS DGM L Gillard K Carroll MB BS FRACP Resident Medical Staff C De Neef MB BS Dip RANZCOG FACRRM FFPM ANZCA Director of Emergency (from June 2012) Dr Robert Allan MB BS FAFOM Ear Nose & Throat Surgeon Interns S P Smith MB BS FRACS (Four rotate approx every ten weeks from Austin Health) Gynaecologists PGY2s J Cullen MB BS FRACOG (Four rotate approx every ten weeks from Austin Health) G Dennerstein MB BS FRACOG FRCOG MRCOG PGY3s Oncologists (Two rotate approx every ten weeks from Austin Health) R Blum MB BS FRACP NSET (Non-Accredited Surgical Trainee from Austin Health) I Burns MB BS FRACP (One rotates every three months) A Dowling MB BS FRACP Emergency Senior Medical Officers (Locums) K Puri MB BS (to Feb 2012) Ophthalmologists R Patenkar MB BS (from Feb 2012) P Burt MB BS FRACO FRACS N Rana MB BS (ERH PGY3 from Feb 2012) J San Laureano MB BS FRANZCO B Burt MB BS FRABZCO (from June 2012) Visiting Medical Officers Orthopaedic Surgeon General Practitioners M Pavlovic MD Mmed(Orth) PhD(Orth) S M Harrison MB BS DA Paediatrician G C Hay MB BS DRACOG FRACGP A Lovett MB BS B K Pillai BA MB BCh DRCOG FACRRM
55 www.erh.org.au Pathologist The Act’s key objectives are to: S Rambaldo BMed (Sci) MB BS MAACB MASM MIAC MRACMA • Promote a culture in which people feel safe to make FRCPA disclosures; Radiologists • Protect these people from recrimination; I Barker MB BS FRACR • Provide a clear process for investigating allegations; and G Miller MB BS FRACR • Ensure that investigated matters are properly dealt with. I Alexander MB BS FRACR DDR J Wong MB BS FRACR Echuca Regional Health has a prescribed procedure in place W Lees MB BS FRACR for dealing with disclosures made under the Act. A copy of the P Neerhut MB BS FRACR procedure is available from Mrs Jenny Phyland, HMO Manager Rheumatologist who is the nominated Protected Disclosure Officer and to whom D Baraclough MBBS FRACP all enquiries on this matter should be directed. Urologist In the year ended 30 June 2012 there were no disclosures made M McClatchey MB ChB BAO FRCS FRACS to Echuca Regional Health under the Whistleblowers Protection J Brennan MB BS FRACS Act. Visiting Dental Surgeons L A Hall BD Sc LDS Contracts – Victorian Industry Participation D Lavery BD Sc LDS Policy Act 2003 M Aw BD Sc Echuca Regional Health abides by the principles of the Victorian D Chin BD Sc Industry Participation Policy Act 2003. During the financial year Y Ong BD Sc ended 30 June 2012 this agency completed no contracts to J Hong BD Sc which the VIPP applied. Consultancies There were two consultants engaged during the year whose fees were less than $10,000. Statutory Reporting The following information is provided in accordance with the Aquenta Consulting Pty Ltd - $3,000 requirements of the Financial Management Act 1994 (the Act), Submission to Health and Hospitals Fund to improve mental section 4.2 of the Standing Directions of the Minister for Finance health infrastructure at Echuca Regional Health. under the Act, Financial Reporting Directions and the Australian Health Care Agreement (AHCA). Victorian Hospitals Industrial Association - $1,000 Occupational Health and Safety Audit Publications Echuca Regional Health produces a number of information There were three consultants engaged during the year whose brochures relevant to the services we provide which are fees were in excess of $10,000 per consultancy. distributed to members of the community. This Annual Report together with other publications and information dealing with Cappela Consulting Pty Ltd - $53,260.03 the functions and activities of the organisation are available by Investigate establishment of sub-acute service contacting the Chief Executive on (03) 5485 5037. at Echuca Regional Health commencing June Information is also available on the Echuca Regional Health web 2014. site www.erh.org.au. DLA Piper - $88,200 Regulations Review clinical workforce requirements for new and expanded The current regulations administered by Echuca Regional Health Echuca hospital. are contained in the Constitution, Objects and Bylaws of Echuca Regional Health Inc, dated 7 December 2006. These Bylaws Write Outcomes - $11,200 were developed by the Board of Management in accordance Submission to Health and Hospitals Fund to improve mental with the Department of Human Services Model Bylaws and health infrastructure at Echuca Regional Health. subsequently approved by that authority. The total cost of consultancies during the financial year ended Freedom of Information (FOI) 30 June 2012 amounted to $156,500. There are no future In accordance with the Freedom of Information Act 1982, Mrs commitments relating to the above Consultants. Jenny Phyland, HMO Manager is the organisation’s Freedom of Information Officer and requests for information are processed Building and Maintenance in accordance with the legislation. Echuca Regional Health complies with the Building Act 1993. In 2011/2012, 93 formal requests were processed under FOI. Competitive Neutrality Whistleblowers Protection Act 2001 Echuca Regional Health complies with National Competition The Whistleblowers Protection Act is designed to protect people Policy, including compliance with the requirements of the policy who disclose information about serious wrong-doing within statement ‘Competitive Neutrality Policy Victoria’. the Victorian public sector and to provide a framework for the investigation of these matters. Privacy Echuca Regional Health is committed to the protection of privacy of information for all patients, residents, clients and staff.
annual and quality of care report 56 Disclosure Index The Annual Quality of Care Report of Echuca Regional Health is prepared in accordance with all relevant Victorian legislation. This index has been prepared to facilitate identification of the Department’s compliance with statutory disclosure requirements.
Page Charter, Purpose and Structure FRD 22B Manner of establishment and the relevant Ministers...... Inside Front Cover FRD 22B Objectives, functions, powers and duties...... 9 FRD 22B Nature and range of services provided...... 7
Management and Structure FRD 22B Organisational structure ...... 52
Financial and other information SD 4.2(j) Report of operations, Responsible Body Declaration...... 9 SD 4.5.5 Attestation on Compliance with Australian/New Zealand Risk Management Standard...... 29 FRD 22C Operational and budgetary objectives and performance against objectives...... Financial Report FRD 22C Statement of merit and equity...... 54 FRD 22C Workforce Data Disclosures...... 53 FRD 22C Occupational health and safety...... 33 FRD 22C Summary of the financial results for the year ...... Financial Report FRD 22C Significant changes in financial position during the year ...... Financial Report FRD 22C Subsequent events ...... Financial Report FRD 22C Major changes or factors affecting performance...... 7 FRD 22C Application and operation of Freedom of Information Act 1982...... 56 FRD 22C Compliance with building and maintenance provisions of the Building Act 1993...... 56 FRD 25 Victorian Industry Participation Policy disclosures...... 56 FRD 22C Statement on National Competition Policy...... 56 FRD 22C Application and operation of Whistleblowers Protection Act 2001...... 56 FRD 22C Details of consultancies over $10,000...... 56 FRD 22C Details of consultancies under $10,000...... 56 FRD 22C Statement of availability of other information...... 56 FRD 10 Disclosure index ...... 57 FRD 11 Disclosure of ex-gratia payments ...... Financial Report FRD 15B Executive Officer disclosures...... Financial Report FRD 21A Responsible person and Executive Officer disclosures ...... Financial Report
Financial statements required under Part 7 of the Financial Management Act 1994 SD 3.4.13 Attestation on Data Integrity...... 11 SD 4.2(b) Balance sheet ...... Financial Report SD 4.2(b) Operating Statement ...... Financial Report SD 4.2(a) Statement of Changes in Equity...... Financial Report SD 4.2(b) Cash Flow Statement ...... Financial Report SD 4.2(c) Accountable officer’s declaration...... Financial Report SD 4.2(a) Compliance with Australian accounting standards and other authoritative pronouncements...... Financial Report SD 4.2(c) Compliance with Ministerial Directions...... Financial Report SD 4.2(d) Rounding of amounts ...... Financial Report
57 www.erh.org.au Legislation Audit Act 1994 Building Act 1993 Financial Management Act 1994 Freedom of Information Act 1982 Health Records Act 2001 Information Privacy Act 2000 Ombudsman Act 1973 Public Administration Act 2004 Public Records Act 1973 State Owned Enterprises Act 1992 Victorian Industry Protection Act 2003 Whistleblowers Protection Act 2001
Quality of Care Report Minimum Reporting Guidelines Consumer, carer and community participation Doing it with us not for us Strategic Priorities...... 4 Productive Ward – releasing time to care...... 18 Communicating with our patients...... 46 Promoting health in the community...... 41 Compliments and complaints...... 45 Communicating with our community...... 46
Improving care for Aboriginal and Torres Strait Islander patients Improving health services for Aboriginal people...... 28 Walking the journey with members of our Aboriginal Community...... 36 Approach to cultural responsiveness ...... 46 Enhanced maternity care clinic...... 40
Quality and Safety Preventing and controlling healthcare associated infections...... 31 Medication Safety...... 30 Preventing falls and harm from falls ...... 31 Preventing and managing pressure injuries...... 32 Cleaning standards for Victorian Health facilities...... 43
Continuity of Care Continuous improvement plans at Glanville Village...... 26 Hospital Admission Risk Program...... 35 Rehabilitation ...... 36 Newly established Continence Clinic ...... 37 Transition Care Program...... 37 Speech Pathologists in Rehabilitation...... 39 Worker Health Checks ...... 42
annual and quality of care report 58 Index Page Page M A Maternity Services...... 21 Alcohol and other drug services...... 41 Medical Day Treatment Unit...... 22 Medication Safety...... 30 B Medical Suites ...... 25 Board Committees ...... 51
Board of Management ...... 50 O Occupational Health and Safety ...... 33 C Occupational Therapy ...... 38 Community Nursing Services...... 23 Organisation Structure ...... 52 Community Palliative Care...... 24 Community Rehabilitation Centre ...... 36 P Compliments/Complaints Management ...... 45 Performance at a Glance ...... 7 Perioperative Unit...... 22 D Pharmacy...... 21 Dental Clinic ...... 35 Physiotherapy ...... 37 Dietetics...... 39 Disclosure Index...... 57 R Donations ...... 49 Radiology ...... 19 Review of Operations ...... 15 E Risk Management ...... 28 Education ...... 27 Environment...... 45 S Service Performance ...... 11 G Services Provided ...... 7 General Ward (Camray/Johnstone/HDU)...... 18 Social Services...... 40 Glanville Village Aged Care Services ...... 25 Speech Pathology ...... 38 Staff ...... 53 H Statutory Reporting ...... 56 Health Information...... 19 Strategic Plan/Priorities ...... 4 Health Promotion...... 41 Surgical Services...... 22 History ...... 8 Hospital Admission Risk Program...... 35 V Hotel Services ...... 43 Vale...... 10 Human Resources and Payroll ...... 42 Visiting Medical Officers ...... 55 Volunteers ...... 47 I Incorporation ...... 1 Y Incident Reporting...... 28 Year in Review ...... 9 Infection Prevention...... 29 Information Communication and Technology...... 43
L Life Governorship...... 47
59 www.erh.org.au Echuca Regional Health (ERH) Acronyms:
ABS...... Australian Bureau of Statistics HIS...... Health Information Services ACAS...... Aged Care Assessment Services HITH...... Hospital in the Home ACHS...... Australian Council on Healthcare Standards HMO...... Hospital Medical Officer ACHSE...... Australian College of Health Service Executives HMR...... Home Medication Review AGM...... Annual General Meeting HMS...... Health Management System AH...... Allied Health HP...... Health Promotion ALO...... Aboriginal Liaison Officer HPV...... Health Purchasing Victoria ALOS...... Average Length of Stay IC...... Infection Control ANUM...... Assistant Nurse Unit Manager ICS...... Integrated Care Services AOD...... Alcohol and Other Drugs ICT...... Information Communications and Technology ASU...... Ambulatory Services Unit Isoft iPM / HealthSmart...... Patient Information System BEIMS...... Engineering Maintenance Software IV...... Intravenous BOM...... Board of Management KPI...... Key Performance Indicator BOS...... Birthing Outcome Suite LOS...... Length of Stay CALD...... Cultural and Linguistically Diverse LSL...... Long Service Leave CEO...... Chief Executive Officer MET...... Medical Emergency Team CNS...... Community Nursing Services MRSA...... Methicillan-Resistant Staphylococcus Aureus CPCM...... Complex Pregnancy Care Model NDAS...... Nursing Director Acute Services CQI...... Continuous Quality Improvement NHS...... National Health Service CRC...... Community Rehabilitation Centre NIKKI...... Volumetric Infusion Pump CSSD...... Central Sterile Supply Department NUM...... Nurse Unit Manager DHS...... Department of Human Services ORACLE...... Electronic Ordering and Purchase System DHSV...... Dental Health Services Victoria OT...... Occupational Therapy DMS...... Director of Medical Services PC...... Primary Care DN...... District Nurse PCP...... Primary Care Partnership DoH...... Department of Health Peri Op...... Peri Operative DOPC...... Director of Primary Care QSU...... Quality and Safety Unit DRG...... Diagnosis Related Group RBC...... Red Blood Cell ED...... Emergency Department RBW...... Rose Baker Wing EDON...... Executive Director of Nursing TCP...... Transition Care Program EPCC...... Echuca Primary Care Clinic VAED...... Victorian Admitted Episodes Data Set ERH...... Echuca Regional Health VAGO...... Victorian Auditor General’s Office FOI...... Freedom of Information VEMD...... Victorian Emergency Minimum Dataset FTE...... Full Time Equivalent VHIMS...... Victorian Health Incident Management System GP...... General Practitioner VMO...... Visiting Medical Officer HACC...... Home and Community Care VPSM...... Victorian Patient Satisfaction Monitor HARP...... Hospital Admission Risk Program WHC...... Work Health Check HATRIX...... Integrated Electronic Medication System HDU...... High Dependency Unit
annual and quality of care report 60 Cover The front cover depicts ERH staff Jamalie Day and Sissy Cooper, together with members of the Baby Dhungulla Dancers who performed at the official opening of the ERH Education Centre. Thank you to the Riverine Herald newspaper for allowing the use of the photograph.
Suggestions This Report has been designed to be both informative and easy to read. Suggestions on ways to improve our report are welcome and can be forwarded to the Chief Executive, Echuca Regional Health, 17 Francis Street, Echuca 3564 or via email [email protected].
Acknowledgements The Annual Report was compiled by Deidre Madill with the support of numerous Echuca Regional Health staff. We thank everyone for their assistance and involvement in the production of this report. Thank you also to the Riverine Herald for providing the photograph displayed on the front cover.
Printing and Production Add Print, Echuca www.addprint.com.au
Financial Report The Financial Report which forms part of this Annual Report can be found in the rear sleeve. If the Financial Report is not attached, a copy can be obtained from www.erh.org.au
61 www.erh.org.au
Echuca Regional Health Incorporating: Echuca Hospital, Glanville Village, Primary Care
17 Francis Street, Echuca, Vic 3564 Telephone: (03) 5485 5000 Facsimile: (03) 5482 5478 Email: [email protected] Website: www.erh.org.au