HIQA REPORT KEY ACTIVITIES

Transcription

1 September 2014 Issue 7 HIQA REPORT KEY ACTIVITIES INSIDE HIQA Report 1 New ED Paediatric Unit 3 UHL Welcomes the Daffodil Centre UL Hospitals Outreach Programme PALS Volunteers Save more lives; smoking cessation The Amulet Following the publication of the HIQA Report of the review of the governance arrangements in UL Hospitals in June, a comprehensive Quality Improvement Plan has been put in place to address the findings. The report highlighted a series of risks and challenge areas that require focused attention by UL Hospitals with the support of the HSE nationally. The following provides a high level overview of some of the key activities that have taken place over the summer to address issues raised in the report. This overview is not designed to offer a full and comprehensive view, as space in this publication is limited, it will however highlight some of the priority actions undertaken since the publication of the report. Action Improve quality and safety of healthcare delivered to service users in Emergency Department Numerous improvements have been made to our physical environment since the completion of the report, including the opening of a new segregated ED Paediatric Unit with a separate child friendly waiting area and toilet facilities. Five beds have opened in 1C Monday Friday to accommodate day of surgery admissions and 11 extra inpatient medical beds have been added to ward 3A along with the opening of a dedicated Stroke Unit. A specific area has been identified for ambulance handover and construction plans are well underway for our state of the art new ED due to open in From a staffing perspective new roles have been added including the appointment of three Registered Advanced Nurse Practitioners, two ANPs, a Clinical Facilitator for Nursing and Research Nurse. Three Acute Medicine Physicians have been recruited along with three patient flow managers and the addition of ten nursing staff to ED to support the paediatric unit and triage. ED middle grade tiers have been expanded by one Registrar and all vacant posts have been filled. Pastoral Care Integrated Laparoscopy Surgery Respiratory Service s in Ennis Infection Preventio n & Control HMI Awards Children's Ark: Live 95 FM Annual Review 2013 Annual Research Symposium UHL Gardens End of Life Awaren ess : Ennis Hospital UL Collaboration Projects ipms: ULH Implementing New Patient Administrat ion system Major Trauma Aud it UL researcher wins Irish Heart Foundation Award Official Ark School Opening UL Hospitals 5K Run: Fundraising 22 Press Cuttings 23 From the Editor 23

2 Issue 7 September 2014 page 2 Hand hygiene training and audits are ong oing and a lead Consultant has been identified for all patients throughout their pathway. To improve the flow of patients the CDU has been relocated within ED. A Navigational Hub has been established to improve patient flow and bed capacity usage and a new Visual Board has been set up in Nenagh Hospital. The Huddle is now well established which improves the communication regarding capacity challenges and helps identify proactive actions to mitigate risk and improve patient flow across all sites. OPAT has now been implemented for patients of UHL and St John s. A range of process improvements continue to be implemented prior to and post HIQA visit. These include but are not limited to: The establishment of a Governance Committee for unscheduled care The corporate Risk Register includes risks relating to overcrowding and is reviewed by the Executive Management Team on a monthly basis. Submission of data to National levels to enable performance measure (KPIs) Protocol for Management of Ventilated patients in ED has been implemented Case Manager facilitates effective use of the Acute Medical Assessment Unit (UHL) and the Medical Assessment Units in Ennis and St. Johns Hospitals. Clear pathway for stroke patients and STEMI has been established Process mapping exercise has commenced for the patient journey from presentation to discharge Review of Hygiene accountability/governance is in progress in ED Hygiene Audits are ongoing Ambulance handover times are being monitored in ED through audits A number of actions have been agreed to improve communication, including daily communication of bed occupancy and number of patients awaiting beds to key stakeholders. Patient Flow Managers provide a report each evening highlighting transfers between sites and daily bed occupancy. Promotion of the LIUs and MAUs in Ennis, Nenagh and St John s Hospitals has taken place with GPs. Posters and information sheets are also on display in waiting areas to encourage appropriate patients to use facilities on other sites. Action Optimise use of resources across the group with specific focus on bed availability for patients with complex needs To help optimise the use of resources across the group, the following activities are in place: Weekly Complex Discharge Meetings Daily Huddle Home before 11am policy rolled out Inter hospital transfer policy implemented Pre op assessment for complex surgical procedures Day of Surgery day beds opened imews in use on pregnant and post partum in patients Unscheduled Care Governance Group review patient experience OPAT launched Additional consultant appointed to oversee MAU in Ennis & St Johns Three patient flow managers appointed New ICU opened in Dec 2013 Six bedded HDU operational Eight Cardiology Step Down beds opened in January PPCI service extended to 24/ 7 Action Improve performance against national targets impacting on patient waiting times, length of stay and inpatient bed availability Key Performance Indicators (KPIs) are reviewed regularly in conjunction with SDU as part of Unscheduled Care Group. Data is being submitted for national analysis and monthly reports are circulated to the board. Monthly Performance Assurance meetings take place with the management of the Acute Hospitals Division and a monitoring structure is in place in UL Hospitals. Action Improve corporate and clinical governance particularly in the Intensive Care Unit and High Dependency Unit Implementation of NCC Programme Guidelines in progress. Action Review practice of caring for patients aged between 14 and 16 years in the Emergency Department for extended periods UL Hospitals has engaged with national colleagues regarding current best practice.

3 Issue 7 September 2014 page 3 Action Increase awareness and discussion of patient complaints, trends in incidents, Action Introduction of Health & Safety Committee adverse events and the prevention and An evaluation of health & safety carried out by control of Healthcare Associated Infections at external Consultant and the report has been Board Level completed providing recommendations. This has Quality and Patient Safety stand ing item on Monthly Board Meeting agenda been reviewed and guided the establishment of a H&S Committee which is in progress. Board Sub Committee for Quality and Patient Action Implement consistent integrated care Safety established Q pathway for hip fracture patients Infection Prevention and Control figures reported to the Board monthly Governance Process to embed Assurance pathways has been agreed In order to consistently improve the care pathway for hip fracture patients a number of actions were taken including a revision of the care pathway and an audit of Peri operative Action Improve patient record keeping in Medical Records for patients with Neck Of Femur line with the HSE s national policy Fracture. Communication with NCHDs regarding UL Hospitals Governance Policy for Management utilising the pathway has occurred and new of Healthcare Records has been implemented. An NCHDs are introduced to the pathway when audit has also been conducted in Peri Operative Directorate for management of healthcare records, with a UL Hospitals HCR audit currently in progress. Action Consistent implementation of National Policy and Procedure for Safe Surgery starting their orthopaedic rotation. Ongoing communication with national HIPE regarding data collection is also taking place. Whilst the HIQA report highlighted some key areas for improvement, it also acknowledged the commitment that our staff have to providing good safe care and to improving the services. Staff have been exceptional in their drive to make Agreement has been reached to support our hospitals the best they can be and we will implementation of the National Policy and continue to focus on our Continuous Quality Procedure for Safe Surgery through Peri Op in Improvement Plan to deliver the changes conjunction with RCPI and NMPDU. required to improve the quality and safety of the Communication in relation to completion of the service we provide to our patients and their checklist is ongoing. families. Contributor: Noreen Spillane Acting CEO, UL Hospitals NEW ED PAEDIATRIC UNIT A ED Paediatric Team, the new waiting room and ED. In 2012 the National Emergency Medicine Programme (EMP) presented a framework for optimising the treatment of children presenting to Irish Emergency Departments. That vision, underpinned by a solid international evidence base, demanded a standardised approach that would improve the experience and clinical outcomes of children requiring urgent care. In recognition of the uniqueness of Paediatric Emergency Medicine (PEM) and in response to the core recommendations of the EMP, the audio visually separate Paediatric Unit in the

4 Issue 7 September 2014 page 4 Emergency Department at University Hospital The Emergency Department extends a warm Limerick was opened in April welcome to all our new staff including the Paediatric and PICU trained nurses. The ability to Without doubt, PEM is a multifaceted and tap into an enhanced level of knowledge, skills complex field and further development is and competence will undoubtedly assist in the required in the attainment of service excellence. quest to revolutionise our paediatric pathways. Albeit this, the new unit amplifies the commitment and willingness of staff to deliver The future for paediatric healthcare in this high quality care to sick and injured children. Emergency Department is looking bright. As highlighted by the EMP (2012) and the Royal In this child friendly environment the emphasis is College of Paediatricians and Child Health (2012), on supporting robust engagement between the focus now must be on fostering a families and healthcare professionals. The new collaborative network approach whilst unit boasts an isolation cubicle and a dedicated strengthening links with the ambulance service paediatric waiting area. Spacious cubicles in a and those involved in community follow ups. b right, airy environment afford the necessary privacy and dignity during assessment and Contributor: Sarah Watkins, Staff Nurse, ED examination. UNIVERSITY HOSPITAL LIMERICK WELCOMES THE DAFFODIL CENTRE The Irish Cancer Society has opened its new Daffodil Centre in University Hospital Limerick in August 2014, bringing the total number of centres nationwide to 12. What are Daffodil Centres? Daffodil Centres are drop in information centres for people with cancer and their families, healthcare professionals and anyone who needs cancer advice or support. The Centres are mainly based in hospitals and are staffed by Cancer Information Service Nurses, supported by specially trained volunteers. What do Daffodil Centres offer? Daffodil Centres provide a wide range of cancer information, advice, help and support to patients, relatives, healthcare professionals and the general public. Visitors can browse our publications or talk to a staff member, in private if they wish. Services are free, confidential and no appointment is necessary. Daffodil Centre Information Some common enquiries staff in Daffodil Centres deal with are: Early detection/ reducing cancer risk, including breast screening Symptoms and warning signs Cancer treatments and side effects Coping with the cost of cancer financial entitlements, insurance, travel Coping with life after cancer treatments How to care with someone who has a cancer diagnosis Local cancer support services Hospital and community services

5 Issue 7 September 2014 page 5 Noreen Twohill: Cancer Information Service Nurse Anyone affected by cancer or with cancer related questions can drop in. Healthcare professionals can refer people who may need cancer related information and support to Daffodil Centres. The Daffodil Centre in University Hospital Limerick is open Monday to Friday 8:30am 4:30pm. Feel free to drop in and meet Noreen, the Cancer Information Service Nurse and our Daffodil Centre volunteers. Ann McDermot, Volunteer The contact details for the centre are: Tel: ntwohill@irishcancer.ie Contributor: Catherine Hand, Nurse Service Manager Cancer Services UL HOSPITALS OUTREACH PROGRAMME The UL Hospitals Outreach Programme is designed to share the hospital resources and expertise with local community groups to improve health awareness and education. Run by a group of volunteers from UL Hospitals, the group dedicate their free time to manage and run the programme. The Outreach Programme aims: To promote health and wellbeing initiatives To improve education of individuals participating in the programmes To develop links with local Primary Care Services To share UL Hospitals resources and expertise that benefit the health and wellbeing of the local community To raise awareness of the services provided by UL Hospitals The outreach programme has three pillars under which they provide support: 1. Geriatrics 2. Paediatrics & Parenting 3. Education The group held their first meeting in November 2013 and since that time have developed the following programmes which run at the Moyross Regeneration Community Enterprise Centre. These include talks aimed at older people on a range of subjects including Arthritis/ Musculoskeletal conditions, COPD, Osteoporosis,

6 Issue 7 September 2014 page 6 Stroke, Blood pressure, Mental Health and Depression, Falls and Cholesterol. Talks for parents have also been taken place around subjects including, healthy eating, childhood obesity, mental health and depression, meningitis and management of viral infections as well as information sessions around the benefits of breast feeding. Corpus Christi Primary School The group has met with the Principals of two local schools Corpus Christi Primary School, Moyross and St Nessans Community College and they are working with them to design a programme of talks and work experience projects which will roll out during the 2014/15 school year. The Outreach Programme Members meet after hours on the first Tuesday of every month and would be delighted to welcome new team members on board. If you are interested in joining the group, please contact Hugh Brady. St Nessans Community College Crest The Outreach Programme Members are: Chairman (secretary) Hugh Brady, CFO Tiernan O Neill UL Board member Liam Casey, Chief Operations Manager Dr. Catherine Peters (Consultant Geriatrics) Dr. Roy Philip (Clinical Director Maternity & Child) Anne Harnett Chief Pharmacist Barbara Slevin Infection Prevention & Control Marion Commane Infection Prevention & Control Jean Quinn McDonogh Head of Physiotherapy Alanna O Beirne Community Health Promotion Nora Cunningham CNM Stroke Sheila Bowers Head of Dietetics Katie Sheahan ADON Contributor: Hugh Brady, CFO PATIENT ADVOCACY LIAISON SERVICE (PALS) VOLUNTEERS One of the key initiatives in the Patients Advocacy Liaison Services (PALS) programme, led by Miriam McCarthy, PALS Manager, this year has been the roll out of the Volunteer programme. In May, the first Volunteers started in UHL. Seven members of the public commenced as Wayfinder volunteers, having successfully completed the recruitment and induction process. Coming to the hospital can be an emotional and vulnerable time for people. Wayfinder volunteers welcome patients and visitors to University Hospital Limerick and assist them with directions, helping them find where they need to go in the hospital. They also help patients and members of the public with any general queries they may have such as arranging a taxi, where hospital facilities are located, how to give feedback on their experience. Anne Quigley & Peg Grimes Tom Quigley & Margaret Irwin

7 Issue 7 September 2014 page 7 Volunteers attend an induction programme which provides education sessions on data protection, infection, prevention & control, dignity at work and trust in care as well as a tour of the hospital and introduction to staff members. The feedback from service users, both patients and members of the public, has been overwhelmingly positive and shows the hugely positive impact the role of the volunteers is having on people s experience in UHL. allow patients to let the staff know about the positive impact their work has on their hospital experience. This initiative commenced in August, with Wards 2C and 3D agreeing to be part of the pilot. Visitor Feedback Caity Della Pria & Martha Glynn Tom Quigley & John Brown The experience is equally rewarding for volunteers: It is so rewarding to help people in the hospital, people really appreciate our help and it s just great to be part of the hospital and I really enjoy my volunteering role. As well as assisting with way finding, volunteer roles are being developed to proactively gather patient feedback on their experience in hospital. This will help us ensure that the services we provide will have a real and meaningful impact on patients. This feedback opportunity will also The volunteers are based at the Out Patients easily identifiable entrance of the hospital and are in their red sleeveless fleeces. They are present from Monday to Friday mainly during the morning. As the numbers of volunteers grow, the service will roll to the afternoon too. It is also planned to develop Volunteer roles in Nenagh and Ennis Hospitals over the coming months. If you d like to be involved, or know anyone who would like to be part of the Volunteer programme here at UHL, please contact the PALS Manager, Miriam McCarthy on or volunteers.ulhospitals@hse.ie Contributor: Miriam McCarthy, PALS Manager SAVE MORE LIVES..TALK ABOUT SMOKING CESSATION Nicotine addiction is classified as a nicotine use disorder in the Diagnostic and Statistical Manual (DSM 1V TR) of the American Psychiatric Association(APA), and the International Classification of Diseases(ICD Nicotine withdrawal is classified as a nicotineinduced disorder by the DSM IV TR. Most smokers are nicotine dependent and for these people, smoking can be thought of as a chronic medical illness that requires ongoing care. (Foulds 2010) Brief Intervention for smoking cessation, at every contact with hospital health care professionals is an important part of therapy for smokers. Key Facts: Cigarette smoking prevalence was 21.5%(Slan Dec 2013) About 4 out of 10 smokers (40%) have tried to quit in the previous 12 months(cooper 2011)

8 Issue 7 September 2014 page 8 Only 3 5% of unaided attempts, are successful 6 12 months later.(hughes 2004) 52% of smokers say that they are 'cutting down' Data from 2008 estimated that approx 18% of expectant mothers smoked. Smoking causes over 2,200 people In Ireland to die from cancer each year The risk of lung cancer is 15 times greater for a smoker than a non smoker. Average smoker has approx twice the risk of developing heart disease prematurely compared to someone who has never smoked. 36% of adults with mental illness smoke cigarettes (CDC 2013) Smoking is linked to a large number of cancers including lung cancer, throat and mouth cancer, bladder cancer, kidney cancer, stomach cancer, and pancreatic cancer. After the age of about 35, on average three months of life are lost for each year of continued smoking.(doll 2004) The British doctors study found that male doctors who stopped smoking before the age of 35 survived about as well as those who had never smoked.(doll 1995),. Compared to patients who receive no assistance from a clinician, patients who receive assistance are times more likely to quit successfully for 5 or more months,(fiore 2008). Additionally smokers who stop smoking with specialist support and medication are up to four times more likely to successfully stop compared to smokers who stop without any form of support. (West 2010) Tobacco dependence is most effectively treated with a comprehensive approach involving behavioural support and pharmacotherapy. Brief Intervention employs the skills of motivational interviewing to effect behaviour change in smoking cessation. This is a collaborative approach, where patient and healthcare practitioner combine their expertise to plan for behaviour change. Brief Intervention training sessions are scheduled to take place at the following times and locations: Brief Intervention training Dates Time Venue Thurs Derg Centre, Nenagh 25 th Sept Mon. 10 th HSE Building, Nov Ballycummin, Limerick Mon. 01 st St Josephs, Ennis Dec A Quality and Patient Safety audit was carried out in UHL in June. Services selected for audit were Standard 4 of the European Network of Smoke and free Hospitals Standards (Identification Cessation Support); and also that services were meeting the targets as identified in the HSE National Service Plan Areas requiring attention in this audit included: More health care professionals should enrol for training in Brief Intervention for smoking cessation Details of Brief Intervention to be documented in the medical and nursing notes. An example of B.I.documentation designed by the Respiratory Department team, UHL, is illustrated below. Smoking Status Smoker, ex smoke r, non smoker Verbal Advis e given: Literature given: Pharmacotherapy offered/prescribed: Referred to Tobacco Cessation Specialist Accepted: Refused: Signature.Date

9 Issue 7 September 2014 page 9 Key Contacts: Who Mary T Burke, Smoking Cessation Specialist, UHL Kim Coughlan, Tobacco Cessation Specialist, St John s Hospital Mary Mc Mahon, Tobacco Cessation Specialist, Slainte Offices, Francis Street, Ennis Contact Details Bleep 340, For further support go to: National Quitline Freephone: Visit your GP or Pharmacist for advice Contributor: Mary T Burke, Smoking Cessation Facilitator THE AMULET A unique and pioneering audio visual art exhibition that explores the symbolism of the amulet. An amulet can be described as an object imbued with feeling with an inherent property of safeguarding. Artist Marie Brett worked with bereaved parents to locate an amulet or token they possessed which had significance in relation to the loss of their baby, a visible, tangible keepsake which serves as a representation of their child. Marie photographed each item and PASTORAL CARE What is Pastoral Care? The word care derives from the Gothic word kara, meaning to accompany, to journey with, to be with. This is the very core of pastoral care; it is about being with the other person through the ups and downs of life, on his/her journey as one who cares. Quality pastoral care may enable the person to get in touch with his/her spirit and to gain a sense of peace. It is often described as holding up a mirror to the other person, reflecting back to the person the feelings which are being heard in an empathic manner. This allows the person to see clearly and to acknowledge his/her feelings so as to grow and move on in a way that brings peace in his/her life. recorded a conversation with the parents who shared details about the object and its significance to them in respect of their lost child. The Amulet is a moving tribute of family loss that links the powerful artwork with compelling, personal stories. The exhibition will be held in the University Maternity Hospital Limerick on Thurs 25th & Fri 26th September. A panel discussion event will take place on Thurs 25th Sept at 6pm at University Maternity Hospital Limerick. The Amulet Exhibition Tour is funded through The Arts Council Touring and Dissemination of Work Awards Contributor: Margaret Quigley, Directorate Nurse Midwifery Manager It is more about being rather than doing; something which many people in our fast paced world are unaccustomed to. There are often times when just sitting with a person, offering a listening presence can be more helpful than rushing around doing something. It can be an alien feeling to those in the healthcare sector, where medical interventions and science often supersede the psychological and the spiritual. It is a challenge to provide a holistic viewpoint of healthcare in a world where at times illness and in particular death, are deemed as a failure. What does a Chaplain do? Chaplains offer emotional, psychological, social and spiritual support and care for patients, family members and staff; endeavouring to provide a space for the person to say whatever he/she wishes without judgment. Chaplains accept each

10 Issue 7 September 2014 page 10 person unconditionally and this gives the person the opportunity and freedom to explore and share feelings which may never before have been discussed. There are currently three chaplains in the pastoral care department within University Hospital Limerick Fr. James O Donoghue, Fr. Eamon Purcell, and Ms. Joyce O Sullivan. All chaplains provide bereavement support and accompaniment during life limiting conditions, acute illness, terminal illness, dying and death and are involved in trauma and crisis intervention. Pastoral care should be available to those who seek it and should be offered to patients by staff during crisis times. It is important to highlight that pastoral care is available also to staff, whether it be to do with personal or professional life. Part of the role of the chaplain is to provide a supportive presence throughout the hospital to all staff members. Everyone has challenges and difficulties in their lives; this can often be heightened by the stressful work involved in dealing with patients, families and members of the public on a daily basis. As members of multidisciplinary team, chaplains uniquely bring a competence in Pastoral Theology to the holistic care of patients. The team recognize that religious freedom is a fundamental human right, respecting a person s right to choose whether or not they wish to participate in religious activities and to have access to a minister of their own religion/denomination if they choose. The Pastoral Care service offered in UHL is interdenominational. It is available to people of all faiths and none. Pastoral Care incorporates the ministry of counselling, support and sacraments in a faith context. Sacramental duties included in the chaplain s daily role include daily distribution of Holy Communion throughout the hospital, Sacrament of the Sick, Confession and Daily Mass in the hospital chapel. How do I refer someone to the Pastoral Care team? Chaplains rely heavily on referrals from various staff members throughout the hospital. If you are unsure whether or not a particular person requires their services please contact them to discuss further. The priest can be contacted on bleep 232 and the lay chaplain can be contacted on bleep 009 ; there is an office on the ground floor beside the chapel for those who wish to speak with any of the chaplains in privacy. The pastoral care department can be contacted directly on Extension # 2192 or via reception. The following is a guide of when a referral should be made to the pastoral care team. Please note, the list is not exhaustive and serves solely as a guide. Referrals to be made when: a patient is very down or upset a patient wishes to talk/discuss something which may be bothering them patients who are dying those who have received bad news patients with social issues there are family issues/ difficulties families of patients needing support families of patients who are dying or who have received bad news families or patients struggling to cope in some way times of crises or trauma those who wish to receive a sacrament i.e. confession, Sacrament of the Sick, Holy Communion those who wish to meet with a priest or other faith leader Contributor: Joyce O Sullivan, Hospital Chaplain

11 Issue 7 September 2014 page 11 INTEGRATED LAPAROSCOPIC SURGE RY AT UNIVERSITY HOSPITAL LIMERICK. Creating a centre of excellence reducing cost. The overall aim is to improve patient outcomes and reduce morbidity. Integration is now the key word in operating theatre design, especially where minimally invasive surgery (MAS) is concerned. The integrated theatre, called the I suite, enables broadcasting and video conferencing to anywhere in the world with high definition imaging. This enables our surgical teams to consult by live conference calls and educate and train medical students off site. This also creates exciting new opportunities for nursing such as offsite training and education of Peri operative theatre nurses. L to R: Lisa O'Malley, CMN1, Celia O'Dwyer Dillon, SN, Marie Byrne CM2, Sheila Sheehan ADON Peri- Operative In 2013 the Minister for Finance Mr Michael Noonan officially opened a fully integrated laparoscopic theatre at University Hospital Limerick. It is the first voice activated integrated operating theatre of its type in Ireland. The Mid in service education on integrated technology took place in December 2013, for all nursing staff within the department. This was facilitated by our Western Hospitals Development Trust contributed to its development. A comprehensive Operating Theatre Clinical Educator Ms Katie Tierney. The 8 th of January 2014, saw the arrival of the first patient. In the late 1980s, the successes of Laparoscopic surgery for gallbladder disease laid the foundations on the modern use of this surgical technique, in a variety of diseases (Biondi et al 2013). The range of surgery varies from Laparoscopic Herniorrhaphy, Ovarian Cystectomy to complex Nephrectomy and Colorectal surgery including performing Trans Anal Microsurgery. For patients the advantages include avoiding large open wounds or incisions thus decreasing blood loss, pain and discomfort (Agha et al 2003). High risk patients can now be operated on with less likelihood of requiring an intensive care bed post operatively. Although procedure times are somewhat longer, hospital stay is less inevitably isuite Theatre The operating cameras, lights, recording printing and storage of data are centrally controlled by touch screen computer technology or by voice control, with the operator wearing a headset. Compliments for the theatre team can be recorded and played post operatively. This can motivate staff and create good theatre team spirit. The Boom holds all necessary operating equipment such as the diathermy unit, light source and C02 which is piped centrally and helps to reduce the footprint of equipment within the theatre. This results in faster set up and turnaround times, ultimately creating more efficiency and productivity. Theatre is reconfigured faster for different surgical teams, creating greater theatre versatility. Light can increase visual performance and with that, enhance work performance (Bommel et al

12 Issue 7 September 2014 page ) supported by (Julsen2006). The lighting in the I suite has taken into account three aspects of light, visual, emotional and biological. The Operating theatre lights are LED, creating maximum brightness. The theatre lighting can be raised to 100% and dimmed as required to mood lighting which is blue in colour. It has been suggested that blue enriched white light in the workplace improves self reported alertness, performance and sleep quality (Viola et al 2008). University Hospital Limerick is one of 8 designated cancer centres in the country. There are 2,400 colorectal cancers diagnosed each year in Ireland and out of those approx 1,600 patients require surgery. Over 400 of these Bowel Cancer operations are undertaken within UL Hospitals annually. Having a designated Hi Tech operating theatre enhances surgical outcome. We will soon be attracting our first international patient, who is coming here specifically to have a Laparoscopic ileal Pouch Formation. In order to promote our success here in the University Hospital Limerick Katie Tierney, Celia O Dwyer Dillon and Marie Byrne, presented on the integrated laparoscopic surgery at the annual INMO Operating Department Nursing Conference in Limerick in March Driving improvements in healthcare for all can help us to sustain improvements in the laparoscopic service at University Hospital Limerick, and create a centre of excellence. Thanks to all the theatre/recovery nursing teams, nursing management, clinicians, and ancillary staff, without whose help and commitment to high standards, this success would not have been possible. References Agha, R. and Muir, G. (2003) Does Laparoscopic surgery spell the end of the open surgeon? Journal of the Royal Society of Medicine, 96, Biondi,A.Grosso,G.,Mistretta,A.,Marventano,S.,Tos cano,c.,drago,f.,gangi,s. and Basile,F.(2013) Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery Bio Med Central Surgery. Bommel WJM. and Beld GJ van den (2004) Lighting for work: visual and biological effects Lighting Research and Technology, 36(4) Julsen, H. (2006) Light and productivity in the industrial working place. In Proceedings of Lighting Engineering 2006 conference Bled,Slovenia: Viola, AU. James, LM. Schlangen, LJM. And Dijk,DJ (2008) Scandinavian Journal of Work Environment and health,34 (4) Contributor: Ms Marie Byrne, RGN, RM, Clinical Nurse Manager 2 Integrated Laparoscopy Theatre and ENT Theatre RESPIRATORY SERVICES IN ENNIS Ennis Respiratory Team Carmel McInerney, Clinical Nurse Specialist Respiratory has been running a nurse led Pulmonary Rehabilitation Programme since The clinic offers help, support and education to COPD patients on their illness and it also acts as a first response for patients with potential exacerbations. Carmel supports the work of Dr Aidan O'Brien and Dr Brian Casserly dedicated Respiratory Consultants who focus on improving the service for Respiratory patients in the region. In 2011 a Pulmonary Rehabilitation Programme was added to the service. Carmel and Mary Dervan, Senior Physiotherapist, Ennis Hospital

13 Issue 7 September 2014 page 13 developed this highly successful programme which continues to run four times a year. Polysomnography (PSG), the ultimate test to diagnose Obstructive Sleep Apnoea, was commenced in This highly specialised test requires an in hospital overnight stay and presently the hospital accommodates two tests per week. A fully functioning Pulmonary Function Lab was also established in 2013 offering a full range of Spirometry, Diffusion Capacity and Lung Volumes tests. The Lab is currently staffed from the Unit in Limerick and testing is offered one day a week. The development of Respiratory services in Ennis Hospital is on going with plans including the instigation of respiratory clinics and the expansion of the services. Contributor: Carmel McInerney, Clinical Nurse Specialist Respiratory COPD SUPPORT GROUP A new Clare COPD support group has been established, the first of its kind in the Mid West region. The group has been set up to support anyone living with or caring for someone affected by COPD. The group is run by people with COPD and will be discussing the issues that affect them. If you would like to attend please contact James Gallagher on or Damien Peelo on INFECTION PREVENTION & CONTROL UPDATE Education is the main focus for the IPC Team for the coming months. The rollout of the new hand hygiene Train the Trainer Programme in conjunction with the Centre for Nurse and Midwifery Education (CNME) will provide participants with an in depth knowledge on the elements of hand hygiene and the skills to educate all levels of staff. Participants are required to attend one of the education days on the 11th of September, 16th of October or the 4th of December in UHL. To compliment the education days, the Infection Prevention & Control study day, in conjunction with the CNME, continues on the 18th September and the 1st of October. The day includes; management of multi drug resistant organisms, decontamination and management of invasive medical devices. These one day courses have proved popular amongst participants and places still remain. Both course are NMBI accredited and carry CPD points. Applications can be sent to the CNME in UHL. The HPSC National Hand Hygiene audits were completed in June. While the national target of 90% was not reached by the group, eight areas were successful and achieved the target. Congratulations to; 3C UHL, CCU UHL, 1D UHL, 2B UHL, 2D UHL, Surgical Day Ward EGH, M3 UMHL & Rainbow UHL. Hand Hygiene Resu lts per D irectorate. Directorate Result Maternal & Child Health Directorate 88.1% Peri Operative Directorate 87.6% Medicine Directorate 85.2% Contributor: Infection Prevention & Control Team

14 Issue 7 September 2014 page 14 HMI AWARDS The Health Management Institute of Ireland (HMI) established an annual Leader s Award in 2014, to acknowledge and celebrate the leadership contribution of individuals, work units and interdisciplinary teams in the development of the Irish health services. In its inaugural year, we are delighted to announce that Mark Ryans (ICT Department, UHL), e referral project was shortlisted from 149 applicants nationally and he received a commendation from the Institute. The new system allows more efficient referrals by the medical/ surgical teams to AHPs via ihub. Mark will be presented with his certificate at the HMI annual conference on the 23rd of September. Congratulations Mark on this great achievement. LIVE 95 FM 95 STOP TOUR: A GR KIDS Live 95FM s 95 Stop Tour is an annual charity event that takes place in Limerick every September. Organised by Limericks Live 95FM its aim is to raise much needed funds for Limerick kids. EAT FUNDRAISING INITIATIVE FOR LIMERICK During times of budgets constraints, such fundraising events are important and bring communities together in a positive way. For the first time this year, the funds raised will also be allocated to support our Neonatal unit in the University Maternity Hospital mainly for the purchase of new critical care equipments to support our newborn babies, commented Dr. Roy Philip, Clinical Director for Maternity & Child Health. Ms. Beryl Carswell, Play Specialist, Dr. Roy K Philip Consultant Paediatrician with Live 95 FM s team The main beneficiaries from the fundraising are The Children s Ark unit at the University Hospital and CARI foundation, Limerick. Funds raised last year have bought vital medical equipment for The Paediatric High Dependency unit (PHDU) and the decoration and creation of child friendly environment for our new Paediatric section and children s waiting area of the Emergency Department. CARI put the funds towards many uses including providing additional precious, important hours of therapy for kids. A 26 week gestation baby girl weighing only 680 gm being cared for in our neonatal unit in UMHL Various events and fundraisers will take place all over Limerick city and county between now and early October. Volunteers are always needed and to publicise and support local events and if you would like to get involved contact live95fm.ie

15 Issue 7 September 2014 page 15 Contributor: Dr Roy Philip, Clinical Director for ANNUAL REVIEW 2013 The first Annual Review for the UL Hospitals Group was published recently. The review provides an overview of the key achievements of the Hospital Group during Key Report highlights include: Interim Board appointed and a new executive team recruited Four Clinical Directorates established Formalised relationship with academic partner, University of Limerick Achieved patient treatment list (PTL) targets for elective outpatient consultations, in patient treatments and endoscopy Maternity & Child Health Successfully inaugurated our PCI Service for STEMIs, thrombolysis for stroke and OPAT for long term parenteral antimicrobial therapy UL Hospitals has undergone unprecedented changes and the successful implementation of these is a testament to the excellence and dedication of our staff. Whilst challenges remain particularly regarding capacity and facilities in the long term our capital programme will address these areas. We remain committed to achieving our vision of becoming one of the top three university hospitals in the country by Annual Review url: bout/opplans/ ANNUAL RESEARCH SYMPOSIUM Friday October 24th 2014, Strand Hotel, Limerick This symposium will provide opportunities for individuals at all stages of their research career and research teams to come together, explore mutual interests, identify synergies and build stronger research programmes. Our confirmed invited speakers include: Dr Graham Love CEO of the Health Research Board, Ireland Professor Colin Baigent Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford UK Professor Robert Foley Associate Professor of Medicine and Former Deputy Director of the US Renal Data System University of Minnesota School of Medicine, Minneapolis, Minnesota USA Dr Michael Walsh Senior Lecturer, Biomedical Engineering Joint Director, Centre for Applied Biomedical Engineering Research Department of Mechanical, Aeronautical and Biomedical Engineering, University of Limerick

16 Issue 7 September 2014 page 16 UHL HOSPITAL GARDENS Noreen O Carroll, Manager, Training Services Limerick; Noreen Spillane, Acting CEO, UL Hospitals; Adrian Cahill, Trainee & Volunteer; and Senior Operations Manager, Primary Care at the officially opening of the gardens Early this year, work started on improving the outdoor facilities for patients, visitors and staff at University Hosptial, Limerick. The vision was to provide a pleasant outdoor environment, where people could sit in comfort and enjoy some fresh air and sunshine. The areas identified for improvment were: Front entrance to hosptial Outside the ED The island at the taxi rank In front of the church Outpatient entrance including the roundabout The group of trainee volunteers and staff from Training Services Limerick This project has been a collaborative effort with Training Services Limerick HSE who were asked to become involved. They provide Rehabilitatve Training for people with disabilities at their Dooradoyle Centre located opposite the hospital which is managed by Noreen O Carroll. The team have a vibrant horticultural section and together a plan was formulated to implement the proposed changes and create a special garden area within UHL. The work was carried out by the trainees, who were supervised by their Horticulture Training Instructor Seamus DIlleen. In early April the ground preparation commenced, this involved clearing away the existing shrubbery to allow the team to properly landscape the grounds. Large planters were placed by the entrance, a pergola was constructed by an external provider to create a seating area to the side of hospital entrance. Planting of ivy s, clematis and roses help to create a sense of peace and privacy. Benches and flowers were also placed in front of the church and the volume of the tannoy was reduced. In the OPD and A&E areas gardens were created to enhance views from within the hospital along the corridors and the coffee shop. Jeff Murphy, Trainee & Volunteer, Training Services Limerick Since the works have been completed the garden areas have been in constant use by patients, visitors and staff, providing a much needed pleasant outdoor space for everyone to enjoy. During the autum it is planned that the work will continue, the trainee s from Training Services Limerick are planning to ensure that the colour continues into the spring by planting a variety of bulbs. It has been a very beneficial experience for the trainees working on this project, they were amazed at the sense of excitement and positive comments from both the public and staff at the hospital throughout this project. They thoroughly enjoyed the feedback and are very proud at having achieved a beautiful space for everybody to enjoy. Thanks to everyone who supported the project.

17 Issue 7 September 2014 page 17 The next stage of development includes working with the Hospital Project Arts Committee to install the winning art piece from the Per Cent for Arts Scheme. The wining art piece will be announced shortly. Contributor; Hugh Brady, Chief Financial Officer END OF LIFE CARE AWARENESS: ENNIS HOSPITAL The Ennis Hospital End of Life Care Committee recently ran an Awareness Week on site. A range of people participated in the event including PHNs, Psychiatry, PCC, Private Nursing Home employees and CIT. Brid Canny, ADON commended everyone for their participation and highlighted how running these events identified how working together, supporting and learning from each other can improve service delivery, strengthen links and ultimately provide an enhanced service and experience for all concerned. A range of new printed materials produced by the End of Life Committee was welcomed by the participants and these are available for use across the Hospital Group. Patricia Buckley, Hospital Clinical Placement Coordinator recommended the current nursing students to attend the session. Fee dback from participants was very positive and they found the learning hugely beneficial and helpful towards their development and practice. Thanks to the Committee members, contributors/facilitators for their participation and sharing of expertise, knowledge and experience and to staff members to helped organise the successful event. End of Life Care Team, Ennis The next project for the group is the completion of the Family Room and the commencement of the Viewing Room. Contributor; Brid Canny, Acting Operational Director UL COLLABORATION PROJECTS Fostering a Culture of Quality Improvement in UL Hospitals UL Hospitals strives to foster a culture of continuous quality improvement. The HSE National Quality Improvement Programmes recommend a suite of methodologies to foster a culture of continuous quality improvement in healthcare. One such methodology is Collaborative. What is a Collaborative? A collaborative is a multifaceted, multistakeholder method of testing, refining and implementing evidence based Directorate or organisation. practices across a Collaboratives enable multidisciplinary teams come together to customise and implement solutions aimed at managing specific risks or problems. This model for improvement uses a series of plan do study act (PDSA) cycles to identify a problem that requires improvement, agree and implement measurable interventions, track and measure progress.

18 Issue 7 September 2014 page 18 UL Collaboratives Medicine Directorate In March 2014, UL Hospitals celebrated the completion of a very successful Falls Collaborative which is the first of a series of three Collaborative commissioned by the Chief Director of Nursing and Midwifery. The Falls Collaborative enabled teams from the Medicine Directorate to use the PDSA cycle to test, refine and implement initiatives / programmes from Falls Prevention Strategies. together to introduce Falls Prevention Programme based in The Derg Centre Gortlandroe, Nenagh.The initiative was led by Fiona Steed, A/Physiotherapy Manager, Nenagh Hospital, Alice McGinley, Primary Care Development Officer and Pascal Moynihan, Specialist Services for Older People along with the support of Maura Cleary, Senior Physiotherapist in PCCC and PCCC teams. Nenagh Falls Team and service users UL Hospitals Medicine Directorate continues to use the PDSA cycle to Test the Falling Star initiative which stemmed from this collaborative. The Falling Star initiative identifies patients at risk of falls. Patients identified as being at risk of falls have orange stickers on their notes, an orange magnet placed over their bed and they wear an orange bracelet. This initiative has further advanced and is in the Test phase of using Intentional Rounding. The CNM2s from 20 departments across the Medical Directorate and their teams lead this initiative and are to be commended for their enthusiasm, commitment and dedication to patient Quality & Safety. The Falling Star initiative is supported by Mary O Brien, Directorate Nurse Manager, Medicine Directorate; Noreen O Regan, UL Hospitals Quality Nurse/Midwife Manager; Mary McNamara, Specialist Coordinator, CNME and Annette Ridley, A/Quality & Safety Manager, Medicine Directorate. UL Hospitals Nenagh successful reduced inpatient falls by 40% through their Falls Collaborative Programme. As a result of this success, the Physiotherapy Department in UL Hospitals Nenagh and the North Tipperary PCCC came Nenagh Falls Team and service users The programme has both education and exercise elements and runs for 8 weeks. Clients are referred from both the acute sector following discharge and from Health Professionals in PCCC. The programme is targeted to people residing in their own home in North Tipperary Network 9, 65 years. Both hospital and PCCC physiotherapy staff assist with the pre and post assessment process of participants and patient satisfaction to date have been excellent. There has been an 8.3 point increase on the 56 point Berg balance scale which represents an increase of 14%. Timed Up and Go measuring general mobility has increased by 30.9% and an 18.62% increase has been seen in the Five Times Sit to Stand Test. The Falls Prevention initiatives are affiliated to the National Affinity Project which it is envisaged will be progressed throughout UL Hospitals and the Mid West PCCC area in Maternal & Child Health Directorate On November 20 th the Maternal and Child Health Director will celebrate the completion of the second Collaborative. This Collaborative enables teams to test, customise and implement the ISBAR communication tool. The tool offers multidisciplinary teams a structured method of communicating critical and other information that requires immediate attention. The Communication Collaborative enabled teams from the Maternal & Child Health Directorate to

19 Issue 7 September 2014 page 19 use the Plan, Do, Study, Act (PDSA) cycle to test, refine and implement ISBAR. The Maternal & Child Health Collaborative will feature in our next news letter following their celebration event. Peri operative Directorate In December 2014, the final in the current series of collaboratives will see teams from the Peri utilise the Operative Directorate who will collaberative to examine quality improvement strategies to manage risks associated with Safe Surgery. IPMS: UL HOSPITALS IMPLEMENTI Project plans are underway for the implementation and roll out of a new integrated Patient Management (ipm) system across the acute sites in UL Hospitals. The approach of UL Hospitals will be to implement a single system with a unique patient About IPMS NG NEW PATIENT ADMINISTRATION SYSTEM identifier across all the acute sites in the UL group. ipm will replace the ageing patient administration systems currently in use throughout the organisation. I.Patient Manager (ipm) supplied and support by CSC, is an integrated patient management system that will allow every aspect of a patient s journey to be managed and tracked across UL Hospitals. It is a well established and proven solution providing efficient and effective patient management services. Already implemented in a number of HSE regions and hospital sites, this system will support UL Hospitals requirement for the management of patients and achieve the UL Hospitals strategic objective in the provision of a unique patient identifier for use by clinicians and administrative staff. IPMS benefits to UL Hospitals The full benefits and capabilities of the IPM project will only be realised with the support and cooperation of all staff across UL hospitals. A single patient identifier across UL Hospitals Patient level bed management Replacement of current end of life product with internationally robust proven system Enables faster access to current and historic episodic information Once only patient registration in the UL Hospitals Supports patient safety Configured to healthcare business flows Integrates billing and reimbursement features Improves the accuracy of data across the organisation Effective tracking of case notes with audit trail Appointment of IPM Project lead Lesley Foley has been appointed ipm Project lead and will work to ensure all aspects of the project are delivered. Lesley has worked on the SAP project since 2004 and was involved recently with the implementation of the SAP system for the Child and Family Agency in the South and South East. We wish Lesley every success in her new role. Contributor: Alfie Jones, ICT Manager

20 Issue 7 September 2014 page 20 MAJOR TRAUMA AUDIT Commenced April 1st 2014, University Hospital Limerick The Major Trauma Audit commenced in UHL on 1st April this year. This is a national audit run under the auspices of NOCA (National Office of C linical Audit) based in Dublin. Information is g athered where people who sustain serious injuries are admitted. In this audit, we collect information on; The injuries sustained How the patient gets to hospital Care in hospital including the emergency department, operations, x rays and/or the Intensive Care Unit Where and when a patient goes leave the hospital when they Patient personal details are not included ex name, address or chart number. The information collected for the major trauma audit is used to monitor the care delivered not only in UHL but also other hospitals across Ireland. The findings are used to make improvements in our health service and improve standards of care to our patients. The information collected is sent to the Trauma Audit and Research Network (TARN) based in the United Kingdom. Contributors: Mike Fitzpatrick ED nurse UHL & Eoin Barry HCA Data collectors for the Major Trauma Audit UL RESEARCHER WINS IRISH HEART FOUNDATION AWARD TO SUPPORT MAJOR NATIONAL STUDY University of Limerick Foundation Chair of Medicine and Consultant Nephrologist at University Hospital Limerick (UHL) Professor Austin Stack MD, was recently awarded a bursary by the Irish Heart Foundation (IHF) at a ceremony at the Royal College of Physicians in Dublin. The award will be used to support a major national study entitled: Cardiovascular Disease in Men and Women who develop End Quality of Care and Clinical Outcomes led by Stage Kidney Disease: A Comparison of Risk, Professor Stack and his team. We believe that major differences exist in the rates of heart attacks and strokes, their risk factors and the clinical outcomes between men and women with kidney failure said Professor Stack. However, we know very little about the frequency of heart attacks and strokes in this high risk population and even less about the quality of care they receive after starting dialysis. Dr Angie Brown, Medical Director, Irish Heart Foundation, Professor Austin Stack University of Limerick Foundation Chair of Medicine and Consultant Nephrologist at University Hospital Limerick and Professor Declan Sugrue, President, Irish Heart Foundation. To improve our understanding in this area, we will analyse data in over 1.5 million patients from the US Renal Data System, a national registry that collects detailed information on all patients who

21 Issue 7 September 2014 page 21 begin dialysis treatment in the United States. We will 1) determine the frequency of heart attacks, strokes and peripheral vascular disease events; 2) determine the risk of dying from premature cardiovascular deaths, and 3) explore differences in the use of major diagnostic and treatment intervention procedures like angioplasty, stents and coronary bypass procedures. According to Professor Stack the results of this study are anticipated to hugely improve our understanding of cardiovascular disease in kidney failure and its treatment. It will also allow us to identify and target risk groups and support changes in clinical practice and shape future policy. Dr Angie Brown, Medical Director of the Irish Heart Foundation and consultant cardiologist said: Innovative thinking has produced some of the major advances in medicine but modern research funding is often geared towards major academic institutions, rather than towards young people with bright ideas. The Irish Heart Foundation Research Bursaries awarded for 2014 illustrate the value of taking this approach and we are grateful to our donors and Daiichi Sankyo for supporting these pioneering projects." University of Limerick News Centre OFFICIAL OPENING OF NEW PURPOSE BUILT CHILDREN S ARK SCHOOL BY DR. LIAM CARROLL AND JAYDEN CONWAY WOOD having such a quality school on site and I want to acknowledge and thank the Board of Management and their staff for all the work they have done to make this school a reality" Dr. Liam Carroll, founding member and former Chair of the Children's Ark School Board of Management and Jayden Conway Wood, officially opened the new purpose built Children's Ark School on Thursday, May 29th, The school provides multi denominational primary and secondary level education for students attending University Hospital Limerick. The new facility comprises a large classroom for primary students, a second classroom for secondary students, toilets, office space a nd an outdoor learning area. The Department of Education and Skills has approved the installation of 100MB fibre broadband to enable access to the most up to date technology to support the education of the students. The school is managed by a Board of Management and has two teachers. Both teachers, Mary Carr and Margaret McCarthy are members of HOPE, the organisation for hospital teachers in Europe. Speaking at the opening, Ms. Ann Doherty, former CEO, UL Hospitals, said, "we are very proud of Mstr Jayden Conway Wood, patient and Dr. Liam Carroll, founding member and former Chair of the Board of Management at the unveiling of the plaque to officially open the school The Children's Ark School was originally the brainchild of Dr. Liam Carroll, Consultant Paediatrician, who got sanction from the Department of Education and Skills to establish a school to cater for the ongoing education of children in University Hospital Limerick. The school commenced in 2006 and originally operated from the dining room of the Sunshine Ward in the Children's Ark Unit. Mr. Frank Keane, Chair, Board of Management, commented that "the new school is a wonderful new development, encompassing the best

22 Issue 7 September 2014 page 22 available information technology to assist in providing continuity for those young people unlucky enough to be ill and requiring hospital care. Meeting the young person's educational needs is a vital part of the holistic approach required to put them on the road to recovery." Mr. Keane also wanted to acknowledge the hard work of everyone involved but said that "a huge thank you must go to my predecessor as Chair of the Board of Management, Dr. Liam Carroll, who was the true visionary who had the foresight to get the concept of education while in hospital off the ground back in December 2006." The school's ethos is that 'no child in the Mid West will be at a disadvantage educationally if in UL Hospital'. Press Release from the Communications Office 05/06/2014 UL HOSPITALS 5K RUN: FUNDRAIS ED FO R SPECIAL OLYMPICS IRELAND The Team would like to congratulate the winners on their excellent performances: Men 1 st Tyler Hynes 2 nd Joe Coffey 3 rd Tim Scanlon Women 1 st Deirdre Nally 2 nd Marie Keane 3 rd Eva Fitzgerald UL Hospitals 5K run organisers: From Left Dr Catherine Peters, Michelle English and Libby Sweeney On Friday the 6th of June 67 participants, predominantly hospital staff, took part in a 5km run from University Hospital Limerick to raise money for the Special Olympics Ireland games. These games took place in Limerick over the summer. The Charity 5k Team would like to thank all friends and colleagues that contributed to the success of the 5k run that took place on Friday June 6th from University Hospital Limerick. Together they raised just over 2100 for the Special Olympics Ireland Games The Team would like to congratulate the on their excellent performances: winners On Friday the 6th of June 67 participants, predominantly hospital staff, took part in a 5km run from University Hospital Limerick to raise money for the Special Olympics Ireland games. These games took place in Limerick over the summer. The Charity 5k Team would like to thank all friends and colleagues that contributed to the success of the 5k run that took place on Friday June 6 th from University Hospital Limerick. Together they raised just over 2100 for the Special Olympics Ireland Games Photos of some of the participants who took part in a 5km The Charity 5k Team would also like to thank their sponsors for their generosity: Hi way Bar and Restaurant, Dooradoyle Delish Restaurant, Raheen Topaz Collins and Quinlan Service station, Dooradoyle Maxol Mace Service station, Dooradoyle Collins Bar, Dooradoyle Contributors: The Charity 5k Team Michelle English, Catherine Peters, Libby Sweeney

23 Issue 7 September 2014 page 23 PRESS CUTTINGS FROM THE EDITOR Thank you to everyone who contributed to this edition of the Newsletter. Editor: Elaine Connolly, Communications Officer Designer/Publisher: Aoife Hilton, Consumer Affairs Please forward any feedback on the Newsletter or any suggestions for future editions to mailto:elainem.connolly@hse.ie