Venue: University of Gibraltar, Seminar Room 05

Transcription

1 GHA BOARD MEETING AGENDA Venue: University of Gibraltar, Seminar Room 05 Wednesday 26 th July 2017 at 2pm 1. Apologies for absence 2. Minutes of the meeting held on Friday 2 nd June Matters arising 4. Statement by Minister 5. Matters for report 5.1 Report: Executive Summary - Medical Director 5.2 Report: Director of Public Health 5.3 Report: Medical Director 5.4 Report: Head of Estates and Clinical Engineering 5.5 Report: Director of Nursing 5.6 Report: Director of Human Resources 5.7 Report: SBH Operations Manager 5.8 Report: Primary Care Services Deputy Medical Director 5.9 Report: Mental Health General Manager 5.10 Report: Director of Information Management and Technology 5.11 Report: School of Health Studies 6. Date and time of next meeting 7. In Camera session GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 1

2 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 2

3 Minutes of the meeting held on Friday 2 nd June 2017 GIBRALTAR HEALTH AUTHORITY Minutes of Meeting held on Friday 2 nd June 2017 at 2.30 pm in the Charles Hunt Room, John Mackintosh Hall. Present: The Hon. N F. Costa (MH) - Chairman Dr F Morillo (FM) - Medical Member Mr J Zammit (JZ) - Medical Member Mr E Gomez (EG) - Chief Secretary Mrs P Galliano (PG) - Non-Executive Member Mr E Lima (EL) - Non-Executive Member Apologies: Mr C Lavarello (CL) - Non-Executive Member Mr A Mena (AM) - Financial Secretary Mr L Gonzalez (LG) - GTC Member In Attendance: Mrs Jessica Montado - Director of Finance & Procurement (Ag) Mr A Wink - General Manager Primary Care Centre Mr H Watson - Director IM&T Mr Christian Sanchez - Director of Human Resources Mr C Chipolina - General Manager Mental Health Dr Krish Rawal Deputy Medical Director Mrs Evelyn Cervan Principal Secretary Dr Danny Cassaglia Medical Director Mr Darion Figueredo - SBH Operations Manager Mr Tony Dolding - Head of Estates and Clinical Engineering Secretary: Miss N Alvarez (NA) and Mr David Santos (DS) 1. Apologies for absence: Mr C Lavarello (CL) - Non-Executive Member Mr A Mena (AM) - Financial Secretary Mr L Gonzalez (LG) - GTC Member Welcome from Chairman: The GHA Chairman opened meeting. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 3

4 2. Minutes: Minutes of meeting held Wednesday 21 September 2016 approved as a true record. 3. Matters arising: No matters arising. 4. Statement by the Minister: Welcomed new board members to the team Mr Fabian Morillo and Mr Jonathan Zammitt. Apologies given for the absence of meetings since September 16 so the reports cover July 16 to March 17. Apologies also given to Board members for the late submissions of the GHA board papers. The next meeting will take place on Wednesday 26 th July 2017 at the University of Gibraltar. 5. Matters for Report: Chief Executive s Report: (As per published in Board Report) The Medical Director went through the July 2016 to September 2016 executive summary report that had been devised by the previous CEO. s sent to Minister Costa with respect to new services mentioned how staff were doing an excellent job on this. With respect to the Early Pregnancy Unit, there is a UK trainer who will be delivering training for this. Bed Management weekly bed management meetings are taking place and there has been a great improvement throughout. There is a need to use resources as effectively and efficiently as possible and meet the clinical demands to reduce waiting lists. Day Surgery is seeing huge success rates with 90% of all surgeries completed via Day Surgery with a very high satisfaction rate. Early Warning Signs (EWS) this has been implemented resulting in the improvement of patient safety. Increasing repertoire of detecting problems in pregnancy. WIFI system up and running. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 4

5 The Medical Director went through the October 16 to March 17 executive summary report. There has been significant improvements with respect to Primary Care, including a repeat prescription service and a telephone service for sick notes. The Patient Advocacy and Liaison Service (PALS) was launched on 30 th November 2016, which provides advice, support and information to patients, service users and the public. Chemotherapy Unit became fully operational during October 2016 providing local, in-house treatment and support for cancer patients. Elderly Residential Services three part time doctors were appointed to work in the elderly residential service to provide personalised care to all residents of Mount Alvernia, John Macintosh Wing, Hillside Dementia Residential centre and Bella Vista Day Centre. All Directors Reports were taken as accepted. Question Time: None this meeting Meeting ended with agreement to reconvene on Wednesday 26 July 2017 at 2pm. With no further business, the meeting closed. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 5

6 April to June Executive Summary - Medical Director Mr Chairman, Board members, this report refers to the 2 nd quarter of 2017 (April to June) and the 1 st quarter for financial year 2017/2018. The following is a summary of the Director s reports, which are enclosed in the main body of this document. 1) GHA Management A Bill was published on 18 th May 2017 to amend the Medical (Gibraltar Health Authority) Act 1987 in line with the Government policy to abolish the post of Chief Executive of the GHA. This change will lead to significant restructuring of the GHA management team. The Bill will be read and debated in parliament on 12 th July ) Primary Care Centre The improvements in Primary care continue with consolidation of the repeat prescription and sick note telephone line service. This initiative is releasing on average = 658 extra GP appointments per month. The scanning of all paper notes in primary care is continuing with over 2000 notes now in digital format and accessible to the GPs on the Electronic record system. 3) New GHA Website The new look GHA website was launched on 13 th June Redesigned and developed in-house, it provides information on all aspects of healthcare available at the GHA. It was developed using the latest website technology available. This includes a news feed on GHA related matters, availability of useful information (e.g. contact information, guides, information leaflets). A new careers section will publish GHA job vacancies and will allow applicants to interact with the HR department online. 4) Medical Regulation From 1 st April 2017, all doctors in Gibraltar are required to have up to date registration with the General Medical Council UK (GMC) with a licence to practise. GMC registered doctors are required to revalidate every 5 years, this requires proof that the doctors are up to date and fit to practise. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 6

7 5) Sponsored Patients All sponsored patient referrals now need to be processed through a new IT system when the decision is made to refer a patient out of the GHA. As from 4 th May 2017, all new referrals are reviewed by the Tertiary Referrals Board (composed of a group of senior medical & nursing clinicians) before the referral is allowed to proceed. This process ensures that patients are referred appropriately and to the best possible partner hospital/centre. 6) Bed Management This quarter marked the consolidation of the active bed management process and weekly bed management meetings. Bed occupancy decreased significantly with the transfer of over 40 elderly, long-stay patients to the Hillside Dementia residential unit. Ward bed numbers have returned to normal levels and the temporary 7-bedded unit will be converted back to a Gym. There have been no operations cancelled due to lack of beds this quarter and the numbers of patients admitted for major surgery have approximately doubled compared to the same period last year indicating greater patient throughput and more efficient use of theatres. 7) School of Health Studies An awards ceremony was held in May for a wide range of staff across the GHA. They received a range of vocational awards. The GHA is committed to on-going education and training for all its staff. I would like to personally congratulate all those members of staff who received an award and also encourage all staff actively engaged in education and training to continue with their personal and professional development. 8) Repatriation of Services Work continues to expand our locally available clinical services to enable as many patients as possible to receive the care they require close to home and avoid the need to travel abroad. This is particularly important in the light of Brexit and the need to modernise our clinical services in order to become as self-sufficient as possible in the coming years. Respectfully Submitted - Dr D Cassaglia, Medical Director, July 2017 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 7

8 5.2 Director of Public Health April to June 2017 Screening Programmes Colorectal Cancer During the period spanning the months of April to June, a total of 806 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. In addition, 5 persons over the screening age limit (75+ years) requested to participate in the programme as a result of the bowel health awareness campaign. During this same period, 866 test-kits were prepared and mailed to the participants and 393 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows: 309 Negative for occult blood 59 Inconclusive for occult blood 25 Positive for occult blood Of those who underwent endoscopy, 11 Adenomas were found in this period. Of those participants invited to participate, 5 categorically refused to participate in the screening programme. In accordance with the protocol, the person will be reinvited to participate in two years if they are still within the eligible age range. A small number of participants continue to visit the screening office seeking replacement test-kits or clarification on the method. Bowel health Awareness day was held on 23 rd May 2017 and the Screening Administrator was available to explain the different aspects of the Colorectal Cancer Screening Programme to the visitors and to answer questions. Following on from this experience, the Public Health directorate has produced a Frequently Asked Questions leaflet to dispel the many myths and misunderstandings that people have about the programme. This leaflet is now included with the test-kits and it is hoped that it will help increase the uptake of participation in the programme. The Uptake of the programme since its inception in Gibraltar is overall around 42.9%, which is disappointing when compared to that of the UK, which is around 60%. However, the uptake for this quarter was around 48.5% and this hopefully marks an improving trend. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 8

9 Abdominal Aortic Aneurysm During the period of April June 2017, a total of 96 invitation letters were mailed to eligible participants and 49 accepted their invitations, an uptake of 51%. All these participants were issued with ultrasound appointments. No expressed refusals were recorded during this period. However, 58 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as Inactive and notified. One individual, whose age was above the upper limit, requested screening and was admitted to the programme. During this period, 59 men were screened. No new aneurysms were found, but one case was listed as undecided and a repeat appointment has been arranged. Persons with previously diagnosed small and medium aneurysm continue to be monitored. Health Improvement Public Events The Health Promotion Officers led or participated in the following events: A multi-disciplinary campaign for World Health Day on Friday 7th April, focusing on the campaign theme depression. Professionals from several departments were present on the day, and provided several articles that formed a series in the Chronicle, covering concerns of depression across the lifespan. A Skin Cancer Screening Day held on Saturday 22th April The event was covered by the Chronicle and GBC TV. The Yellow Walk on Saturday May 14th in continued support of Clubhouse. The Stay Safe campaign for senior citizens of the South District, organised by the Citizen s Advice Bureau covering healthy living considerations for the elderly (Tuesday 30th May). The World Environment Day (5th June) event in the commonwealth park, this year s focus being connection with nature, liaising with the Environmental Agency and the Alameda wildlife park, both of whom are involved in the conscious eating initiative. The Conscious Eating stall at Calentita (10th June), providing several posters highlighting the health benefits of eating a diet full of vegetables. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 9

10 The Cervical Screening Awareness week (12-16th June) in the Primary Care Centre, providing posters and leaflets for the event. The Breastfeeding Awareness day 22nd June at the ICC, alongside the Health Visitors, Midwives and the Gibraltar Breastfeeding Association. The Mental Health week 12th May presenting a stand in Westside school. The pitch was well received and many girls were interested in information on stress and depression. The Med Step Challenge event organised by Cancer Relief Gibraltar supporting with sun awareness leaflets. The World No Tobacco Day (31st May), which was well received and had coverage from GBC TV. Networking activities The Health Promotion Officers met with the following agencies as part of their networking initiatives: The Youth Service, to discuss potential collaborative projects such as producing infomercials using youth that attend the service. The Alameda Wildlife Conservation Park, to discuss the healthy meat free initiatives, providing resources on improved heart health, mood, reduction of cancer and sustainable farming. Cancer Relief, to discuss collaborative projects. The Department of Environment, to discuss the beach ashtrays initiative. The School of Health Studies, to launch a new men s health initiative, commencing with a publicity event at the Piazza. The newly established charity the Gibraltar Cardiac Association 31st May. St Paul s and St Bernard s First Schools on 26th June, to explore health promotion in diet, exercise, dental health, sun awareness and personal hygiene. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 10

11 The Ministry of Environment and MeteoGib to discuss collaborative working with a focus on environmental pollutants. Teaching and Learning The Health Promotion Officers attended the following training: Safeguarding Children on 28th June, in preparation for the summer sports program provided by the GSLA. Presentation on Air Quality on 6th June delivered by Ricardo Energy and Environment for the Ministry of Environment. The Health Promotion Officers delivered the following teaching: For the Diploma in Life Skills course at the Gibraltar College on the 26 th May, 30th May and 2nd June, sessions on Healthy Lifestyle, Hygiene and Mental Health. For the Inter-Island Public Health Conference in Jersey, a PowerPoint presentation Health Eating for Healthy Living. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 11

12 Media Health topics covered on Radio Gibraltar s Health File included o Sun awareness o World immunization week o Osteoporosis o Bowel health o Water o World no tobacco day o Cervical screening. Articles for the Gibraltar Chronicle included: o World Allergy Week (4th-10th April 2017) with focus on Pollen Allergy o World Health Day (7th April 2017) featuring a series of releases focused on depression in adolescents and depression in older people. o Workplace Stress Awareness Day o World Immunisation Week o Bowel Health Awareness o World Meat free day and Meat Free Mondays o Cervical Screening Awareness Week (12th-16th June 2017) o Osteoporosis Article for Insight Magazine on Diet and Mental Health, jointly with Dietetics. New Resources The following new resources were produced for use in Gibraltar: A new leaflet on Water was designed and printed. A new leaflet on Hand-washing was designed and printed. A new leaflet on Diabetes was designed and printed. Two new bowel health posters were designed, printed and used for the awareness event (looking at bowel health in adults and children respectively). Six new boards (3 large, 3 small) were purchased for the PCC, the large boards replaced the older ones and the 3 smaller ones are yet to be installed. Discussions are underway to produce two new infomercials o stroke o cancer prevention o sun awareness Information Analyst The Information Analyst is currently working on a number of areas: Immunisation uptake in Gibraltar. As the GHA does not collect computerised data on immunisation, an attempt is being made to do this manually. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 12

13 Bowel Health Awareness Day: at the event, Cancer Relief and GHA Public Health staff distributed questionnaires to the public, which were returned for analysis to the Information Analyst. The Information Analyst has continued to service the Monthly Reporting of Government statistics. Infection Control This section of the Department consists of two Infection Control Practitioners, who oversee the functions of infection prevention, control and preparedness. They also provide training to health-care staff, advise other government and non-government staff and participate in public education programmes on matters of infection prevention and control. The following are some of the activities undertaken by them during this quarter: Public campaign World Hand hygiene 5 th May: A general campaign was undertaken to educate the public on the importance of washing hands. Within the organisation, the Handwashing practices of nurses, doctors and allied health professionals were audited on the general wards and further training given where errors were identified. Surveillance Daily surveillance of high risk bacterial groups like MRSA, CRE & ESBL. All patients are returning from tertiary hospitals are screened for MRSA and CRE. Sexually Transmitted Diseases: 25 cases seen in this quarter. Clostridium difficile: 8 cases seen in this quarter. An alert system was introduced in the Symphony A&E system to identify known colonisers of the above pathogens, allowing for early precautions for admission. Monthly meetings of the Infection Control Committee and occasional meetings of Clinical Governance committee and Antimicrobial Stewardship group. Environmental audits were carried out on six wards / locations in St Bernard's Hospital and reports of findings discussed with ward managers. Clinics The Infection Control Practitioners also support the Bi-monthly Blood Borne Virus Infections clinic held by the visiting specialist to review patients with chronic infections like HIV and Hepatitis C. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 13

14 Training Mandatory Training sessions for GHA staff on 11th, 17th and 19th May Dr Giraldi Home staff training on 27th April and 26th May at Bleak House. Manning Work station for BSc intake. ANTT training for Enrolled Nurse intake 31st May & 7th June Outbreaks and Events There were no significant infection control events with public health implications during this quarter. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 14

15 5.3 Medical Director April to June 2017 Education & Training Regular Continuous Professional Development sessions for all medical staff continue on the first Friday of each month. Friday 7 th April 2017: Session led by Prof Derek Burke, Responsible Officer for the GHA and GMC Suitable Person. All available GHA doctors attended this session (repeated in the afternoon) to ensure maximum attendance. Three key areas covered Revalidation, Reflection and Patient Safety. Doctors had the opportunity to meet their Responsible Officer. Friday 2 nd June 2017: The Health of Doctors led By Professor Clare Gerada, previous president of the Royal College of GPs. Professor Gerada is currently the Medical Director of the Practitioner Health Programme (PHP), a service based in London for doctors and dentists with mental health and substance misuse problems. The session explored why doctors become unwell and why they find it so difficult to seek help. Professor Gerada was supported by Dr Shivanthi Sathanandan, General Adult Psychiatry fellow at PHP. The session was repeated at the primary Care Centre at lunchtime for the GP team. Tuesday 20 th June 2017: Neonatal Life Support Course (UK Resuscitation Council accredited): The annual NLS course was held at St Bernard s. Experienced neonatal teaching faculty came from the UK to deliver the course. This regular course ensures new borns receive the highest quality care possible at birth. Medical Regulation From 1 st April 2017, all doctors in Gibraltar are required to have up to date GMC registration with a licence to practise. Transitional arrangements were put in place for those doctors who were in the process of applying and had yet been unable to obtain their GMC registration (for administrative reasons). These transitional arrangements will last until April 2018 at which point it is expected that all doctors will be GMC registered with a licence to practise. Quality Improvement An i-stat machine was presented to Rainbow Ward by the Gibraltar Lifesaving Association. This machine will allow immediate bedside testing for basic blood tests including blood gases which will help in the medical care of the most critically ill babies and children. The Gibraltar Prostate Cancer Support Group has donated a new Nexam Pro urodynamics machine to the GHA. This machine will enhance the service delivered by the Urology team and more importantly will repatriate a service that has GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 15

16 previously been provided at Xanit Hospital in Spain. This will allow approximately 115 patients per year to have the necessary testing and treatment in Gibraltar. Tertiary Referrals The GHA Sponsored Patients programme allows for referral of patients outside of Gibraltar for treatments and tests not available locally. All referrals now need to be processed through a new IT system when the decision is made to refer a patient out of the GHA. As from 4 th May 2017, all new referrals are then vetted by the Tertiary Referrals Board (composed of a group of senior medical & nursing clinicians) on a weekly basis before the referral is allowed to proceed. This process ensures that patients are referred appropriately and to the best possible partner hospital/centre. All emergency referrals proceed as normal to avoid any unnecessary delay and are reviewed retrospectively by the Board. This process will ensure that the GHA is able to closely monitor all external referrals and ensure patients access the care they need in a timely manner. The Ayling-Buttigieg Chemotherapy Day Unit This unit has now been open and active for nine months. In that time, 47 adult patients have been treated/are being treated with Chemotherapy infusions for solid tumours. Additionally, cancer patients requiring intra-venous antibiotics, zometa treatments, blood transfusions, blood taking and portacath flushes are also being accommodated. The specialist Pharmacist has also accommodated some Chemotherapy mixing for patients being looked in other areas of the GHA. Most of the patients treated have been discussed and referred through the GHA s new Oncology MDT, which meets on a weekly basis. In nine months, 240 patients have been discussed in the Oncology MDT meetings. Patients have been repatriated from tertiary centres outside of Gibraltar, e.g. the Royal Marsden Hospital has diagnosed, provided surgery and recommended specific adjuvant Chemotherapy to patients, which is now being administered at the GHA Chemotherapy Unit. Some current Clinica Radon patients have also asked for their Chemotherapy treatment to be transferred to our Unit. There have been over 700 patient contacts: treated in the unit, seen in clinic by the Oncologists, seen on a drop-in basis or visits to patients on the wards. The A&E Department has access to updated clinic information of all patients attending the Chemotherapy unit. This information is updated by the Cancer Services Coordinator. Additionally, A&E s Symphony programme has all Chemotherapy/Immunotherapy and Palliative patients flagged, enabling clinical staff to identify oncology issues and deal with them accordingly. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 16

17 5.4 Head of Estates and Clinical Engineering April to June Department Strategic Plan work-streams Over the last 15 months, the department has been developing our quality manual based on ISO9001:2008 requirements. In conjunction to this, we have also been updating our core procedures, which will underpin this. 2. Medical Devices Based on the asset registers formulated within our CAFM system, a bespoke 10 year Lifecycle plan is in place. This is a live working document, which will clearly identify and track each assets lifecycle plan and prioritise replacement based on age, risk and cost. It is therefore a significant step forward to have reformulated the Medical Devices Committee. The 3 main types of medical devices and their associated directives are: active implantable medical devices: The Active Implantable Medical Devices Directive 90/385/EEC in vitro diagnostic medical devices (IVDs): The In Vitro Diagnostic Medical Devices Directive 98/79/EC general medical devices: The Medical Devices Directive 93/42/EEC 3. Clinical Engineering Training Two members of the team are attending management courses A training course on profiling beds and wheelchairs has been arranged Medical Device Alerts and Recalls Attended in the last 3 Months Completed: 5 In-Progress: 6 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 17

18 In-House Scheduled Maintenance PPM Status Medical Gases completed April Fluid Warmers completed May Electrosurgical Units In-Progress June Patient Beds In-Progress June Completion Date Reactive works attended over the period covered by this report % Difference from Previous Quarter Ticketing System Phone Jobs s Jobs Call- Outs Total Breakdown Completed Jobs Pending Jobs Not Captured Commissioning of Medical Equipment Qty Equipment Date 2 Powered Wheelchair April Qty Equipment Date 2 Philips Monitors 1 Digital Clock & Stopwatch Display 1 Ophthalmic Tonometer 2 Heraeus Benchtop Centrifuge 1 Portable Headlight 30 Sleepcube CPAP May 1 ISTAT 1 Analyser & Printer 1 Philips Image Intensifier 1 UPD-3 Scope Guide and Monitor 1 Embedding Station 4 Wheelchair 1 Baby Weighing Scale May GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 18

19 5 Portable Suction Units 1 Patient Bed Low Profile June 2 Air Purifier 3 Patient Trolleys Corrective Maintenance under Contract - Service Provider Equipment Repairs Month Philips Medical Radiology Equipment 2 April Olympus Endoscopes 2 Philips Medical Radiology Equipment 1 May GE Healthcare GE Healthcare Ultrasound and Radiology Equip. 2 Ultrasound and Radiology Equip. 2 June 4. Electrical Engineering The following items have been the main focus this quarter: Planned and reactive maintenance works; 2nd QUARTER 2017 TICKET CALLOUTS April May June PAT testing PAT testing of our portable appliances; planned on-going; Continue the upgrade of lighting to LED technology as required and under lifecycle replacement; Project support; installation of LED lighting, bedhead trunking services and nurse call for the new A+E Infusion Room; The refurbishment of the old A+E Minors - support for these works, including the installation of new LED lighting; GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 19

20 Support for the on-going upgrade of the access control system; Electrical auditing and control of Solar HWS project electrical installation. 5. Mechanical Engineering Progress for the reporting period is as follows is as follows: Reactive works - All service and maintenance requirements Continued routine sampling of the dialysis treatment plant water has taken place with remedial works carried out as required Air handling units remedial works are on-going this is picking up defects raised within the annual verification reports carried out by AirisQ last year Major repair on the west wing cooling cool in February, resulted in the precautionary purchase of spare coils for our critical AHU s Decommissioning of the temporary ward Install refurbished A/C System for mental welfare offices PCC. Install new A/C in Dental clinic, 4th Floor Block 2 Supply Drugs refrigerator for Home care patient along with uninterrupted power supply Mechanical General Reactive Calls 2nd QUARTER 2017 TICKET CALLOUTS Mechanical Section April 5 8 May 10 9 June Planned Preventative Maintenance Major Air Handling units Service completed in this quarter; April = 7; May = 3; June = 4 Extra works repairs due to failures for this quarter; April = 67; May = 23; June = 38 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 20

21 External Specialist Maintenance completed in the last 3 months: Month Due Equipment Service Provider April Lifts Otis Escalators Otis BMS Systems Emblem Theatre Equipment and Wards Draeger WP9 Water Purifier Abatron May Lifts Otis Escalators Otis Emergency Lighting Thomas & Betts Emergency Generators Versetec Roof Man-Safe Systems PTSG GE Ultrasound - Radiology GE CPR Training Mannequins Laerdal June UPS systems Upsmeir Main LV Elect - Air circuit breakers In House 6. Projects Completed and On-Going Solar PV Installation of Photo Voltaic panels on the roof of link block 2. These will drive heat pumps, which will in turn supply LTHW to the hospital existing Hot Water calorifiers. This should help to reduce the hospitals fuel bills and add to the Governments commitments to CO2 reduction/management. This will also improve further the hospital DEC energy performance in buildings score, and contribute to our obligations under the EU Energy Efficiency Directive (2012/27/EU known as ESOS). This project is in the final stages of snagging and commissioning. However, we are already getting the benefit of solar energy being fed directly into our electrical infrastructure. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 21

22 Temporary Ward This has now be decommissioned and has been reverted into the Physio Gym. Server Room A/C install fit for purpose A/C and UPS resilience into block 1. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 22

23 5.5 Director of Nursing Services April to June 2017 Child Health The child health team was introduced to the signs of safety protection practise framework in accordance with UK policies. The signs and safety is an innovative strength based, safety organised approach to child protection casework. From the month of April to June, the child health clinic staff nurses administered the Diphtheria, Tetanus and Polio booster vaccine to year 9 Westside and Bayside school in the school premises. The process was well organised. The child health clinic team provided extra clinics at the PCC to administer the Diphtheria, Tetanus and Polio vaccine to year 9 Prior Park and Hebrew school. The process was well organised. The child health care team has re-introduced education talks for all parents whose children will be commencing the reception year in September The talks were about the role of the child health care team and how to seek advice and support if any matter of concern arises concerning the health of their children and how to prevent, treat and manage head lice spread in schools. Head lice Patient information packages were distributed to all parents who attended the talks. Influenza vaccination programme The influenza vaccine campaign is now finished however there are still patients who are referred from a consultant or GP. EHR Improvements continue to be made to the working processes and templates that have been incorporated within the electronic health system. As of recent, we are now working with the appointment reporting system to be able to audit all our statistics as appropriate. Dermatology April was the commencement of the sun awareness campaign and commenced with its Bi-annual visit to the Cancer Relief Centre. A talk was given by the Clinic Nurse Specialist on the importance of sun protection especially for those people who have suffered from cancer and who may have had chemotherapy or radiotherapy. It was followed by a short clinic to check the skin of those who may have had any concerns. On Saturday 22 nd April 2017, the dermatology department held its 4 th skin cancer screening day. The outcomes are listed below GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 23

24 Breakdown Urgent Biopsies *those sent to Surgeons o Facial Maxilla Surgery 1 o General Surgery 3 o Plastic surgery 0 Referred to dermatology services o CNS 0 o Dr Ferrera 1 o Cryotherapy 14 o Hyfrecation 1 o PCC Minor ops 4 o Punch biopsy 0 o Dermoscopy/Photography 16 o Derm Clinic (Consultants) 2 o Patch test 0 Advised to get an appointment with their GP 0 Reassurance: o Patients who were reassured that the lesion(s) presented were benign and that no further action(s) were required 99 o Unregistered patient 1 Diabetic Service Progress of the Diabetes Team in PCC from March 2017 to June 2017 Two part time qualified nurses, one Enrolled Nurse and one Registered Nurse joined the Diabetes team in the Primary Care Centre to undertake Annual Diabetic Review Clinics (ADRC). A pilot for carrying out annual reviews to members of the elderly community took place on the 20 th and 23 rd June at Albert Risso and Bishop Canilla House for those patients with impaired mobility. In total, 26 patients were reviewed. The feedback was extremely positive and the team are looking forward to repeating this exercise again next year to include Albert Bruzon House and Sea Masters Lodge. Both nurses spent one month each working with the Diabetes Nurse Specialist learning about Diabetes Pathophysiology, diet and exercise in the management of diabetes. They looked at biochemical parameters to assess diabetes control, identifying factors, which enhance the cardiovascular risk, which complications associated with diabetes. In April 2017, the Diabetes Nurse Specialist provided a one-day teaching session for year 2 students in the School of Health studies on the management of diabetes and diabetic emergencies. On the 11 th May 2017, the Diabetic team carried out Diabetes education for members of the Moroccan community at the Europa Point Mosque whereby 28 people attended. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 24

25 Second year student nurses undertook a placement with the diabetes team at the PCC to have first-hand experience of diabetes and its complications, as well as having a real life scenario of what it is like for people to live with diabetes. The DESMOND course took place in May with an attendance of 7 participants. There was a GP CPD session on insulin pump therapy, which took place on 21 st June. The Diabetes Nurse Specialist circulated the information materials to all GP s and Nurse Practitioners in the PCC and offered to repeat the session if there is an interest. Nurse Practitioners Cervical Screening Awareness Day Outcomes for week June 12 th 2017 The first Cervical Screening Awareness week was held at the Primary Care Centre from the 12 th of June to the 16 th of June. Clinics were held daily from 1.30pm- 3.30pm and were carried out by two Nurse Practitioners. In the main waiting area, a counter was staffed specifically for the purpose of information sharing and appointment facilitation by 2 Administrators. This is the first time this screening week has been held in Gibraltar. The outcomes were as follows: Attendees: 75 First time cervical screening (25-30) years of age: 5 First time cervical screening (31-65) years of age: 10 Cervical screening carried out over 3 years ago: 13 Cervical screening carried out over 10 years ago: 5 Cervical screening carried out over 20 years ago: 3 Cervical screening due during this period: 13 Patient concerns advance cervical screening appointment given: 2 Patient concerns GP/NP appointment given: 3 Advise that a recall appointment will be sent: 15 Recall appointment given for within 3 months: 3 Appointment given for routine women s Health issues: 2 In total, 34 patients received cervical screening and there are 13 pending to be done by the end of June. The patient satisfaction survey showed that there was only one patient that felt not all of their questions had been answered. All said they would encourage others to attend this screening. Although not covered in the questionnaire, it was expressed by many women that not enough media coverage had been available prior to the commencement of the Awareness week. A Nurse Practitioner attended a one-day Primary Respiratory Academy road show on Friday 16th of June in UK. The topics covered included: GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 25

26 Fundamentals in getting the diagnosis right Spyrometry Hot topics in asthma Smoking cessation and the role of the e-cigarette Inhaled medication- safety and practice Hot topics in COPD District Department The district team are currently undertaking the annual mandatory course in basic life support. In addition to this, they are also undertaking their annual review training programme in managing the care of porta-cath lines. Primary Care Clinics The department has initiated a new point of care testing service (POCT) for patients who are currently on the warfarin anticoagulant medication. POCT is a medical diagnostic testing done in the phlebotomy clinic where results are available relatively quickly so that they can be acted upon without delay. The purpose is to transfer all the patients currently attending the hospital laboratory for testing to be done in the PCC and community. However, there is a need to implement a CDSS system (computerised decision support software for anticoagulation). This system will facilitate a standardized dosing recommendation and will help the workflow processes for this service and will facilitate patient s journey through the service. A Primary Care Sister participated in the men s health awareness events in combination with the School of Health Studies on the 22 nd May at the leisure centre. This was the first session on Male Health initiative where the speaker and public raised concerns about the lack of screening processes for men s health. The sick note line service continues to be used widely by the community of Gibraltar and since its introduction we have provided a total of approximately 599 medical certificates. The Hypertension Screening Clinic Hypertension is the most commonly diagnosed condition at the GP S practice in Gibraltar. We currently have approximately 5,000 patient diagnosed with hypertension. We are managing clinics to screen and advice as appropriate, however the number of patients attending is growing. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 26

27 The modern western diet and lifestyle is one of the most important and potentially modifiable risk factors that most patients and many doctors ignore. For this reason it is easier to accept medication other than adopt healthy life style changes. Although it takes a lot of work to change our lifestyle, the potential rewards are great; therefore as health professionals we must raise awareness and make this our goal and objective. In the Primary care, we have set out objectives to promote health education and prevent secondary effects Objectives of the hypertension clinic To promote the primary prevention of hypertension and cardiovascular disease by changes in the diet and lifestyle of the whole population To increase the detection and treatment of undiagnosed hypertension by routine screening and increase awareness of hypertension among the public To ensure that patients taking antihypertensive drugs are controlled to optimal blood pressure levels To reduce the risk of cardiovascular disease of treated hypertensive patients by non-pharmacological measures, and by appropriate use of statin and aspirin treatment To increase the identification and treatment of patients with mild hypertension who are at high risk of cardiovascular disease for example, elderly patients, patients with ischemic heart disease, people with diabetes, people with target organ damage, or people with multiple risk factors To promote continued adherence to drug treatment, by optimizing the choice and use of drugs, minimizing side effects, and increasing information and choice for patients. Cardiac rehab Cardiac rehabilitation is defined by the World Health Organization (1993) as activities that favorably influence the underlying cause of the disease and provision of the best possible, physical, mental, and social conditions, so that patients may, by their own efforts, resume as normal a place as possible in the community. WHO suggests rehabilitation must be integrated within secondary services, of which it is only one facet. The cardiac rehab services are divided into four phases. Phase 1: identify patients who may benefit from the cardiac rehab services who may be in CCU or the medical wards, referred from Xanit or UK hospitals or patients visiting the cardiologist who may be eligible to join the CRS programme. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 27

28 Discuss issues of importance with the patient and allow patients to raise concerns and views and advice as appropriate. Phase 2: Expediting patient discharge. In this phase, the cardiac rehab nurse should be undertaking risk stratification. A platform to identify which patients need to be prioritized according to presentation and risks involved. A holistic patient assessment will be undertaken during a face-to-face consultation where the nurse will determine whether the patient qualifies to be in the programme or whether they require other form of rehab within a home environment, which can be organized by the community physiotherapists. The patients will need to sign a contract to be able to be part of the programme. This will ascertain compliance during the eight-week programme. The CRS nurse should be planning and organizing all the CRS educational talks to be delivered to the patients. One of the subjects to introduce into the talks will be smoking cessation. Phase 3: the patient will now be ready to start the programme and will be booked for his first joint assessment in the gymnasium The CRS physio and cardiac rehab nurse will work together to ascertain level of fitness. A plan of care according to policy will then be discussed with the patient. That same day the patient will also be assessed by the dietician and information provided as required. Phase IV: Community based assessments should be carried out by a phase 4 instructor. Surgical Directorate Operating Theatres With Mr Antequera as an Upper GI specialist, there have been new surgical interventions offered for our patients. Three members of staff from main theatres, visited Mr Antequera s previous place of employment to identify specific requirements to cater for the Upper GI interventions. Specific surgical instruments and items have been procured for this speciality. This has resulted in surgeries being performed for the first time in Gibraltar (Gasterectomies, Gastric bypass, Fundoplication (Anti-Reflux Surgery). The Gibraltar Health Authority in collaboration with Edge Hill University were able to deliver locally an acclaimed academic module to four Registered Nurses / experienced Theatre Practitioners. All four candidates have successfully passed the part 2 Enhanced Surgical skills module (HEA 3056) which allows them to become advanced practitioners in wound closure, Knot tying / suturing, direct Diathermy, wound infiltration (LA) as well as the academic aspects of the legal, ethical and GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 28

29 professional issues associated with surgery and have received their Surgical First Assistant (HEA 3055) part 1. A further five members of staff from both Main Theatres and Day Surgery will undertake (HEA 3055) in September One of the mentors in Theatres has now extended her role to become a sign-off mentor. As a result, third year nursing students can now carry out their management placement within the perioperative environment. The Gibraltar Health Authority, Nurse Management and the School of Health studies are still exploring the possibility of introducing the Operating Department Practitioner (ODP) training locally. Day Surgery The Day Surgery Unit continues to undertake on average 90% 95% of all elective patients requiring surgical procedures of all sub specialities with even more complex surgical procedures. With the Day Surgery Theatres performing more extensive surgeries, the team are gradually enhancing their intraoperative skill in collaboration with team members for main theatres. During the period of January 2017 March 2017 a total of 709 patients have been admitted through Day surgery with 611 surgical procedures undertaken within the Day Surgery Theatres its self. DSU Monthly Statistics 2017:- Total DSU % April May June Out Patients Department There will be a bespoke training focused on transforming the way that outpatient services are delivered. This will be tailored to meet the need of the organisation and will consist of a three session course scheduled for 1 st September, 3 rd November and 1 st December. This will be directed for: Endoscopy (MIU) Urology Cardiology Respiratory Ophthalmics ENT GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 29

30 The plan for the three days is to base the three sessions on Kotter`s Eight Step Process of Creating Change. Each session would build on the last session so; Session stages Session stages Session stages Urology Two nurses will be carrying out competency based learning in the field of urology. This will cover tasks such as assisting with supra-pubic catheterisation, urodynamics, obtaining biopsies. This training is due to take place in October 17. This training will allow for the urology nurse to: Provide clinical management and independent care for Urodynamics, Uroflows, reporting of results to consultants for interpretation. Perform Prostate TRUSS biopsies Provide clinical care and education for the patient with catheter changes, selfcatheterisation, and trial without catheter. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 30

31 Orthopaedics An Enrolled Nurse will be a full time plaster technician as from mid-july. A further two members of staff (one Enrolled nurse from Orthopaedics and one Staff nurse from A/E) will be undertaking this module accredited by the British Association of Plaster Technician in February 2018 enabling them to become plaster technicians. Once they become qualified, there would be a total of three plaster technicians within the organisation. Endoscopy We now have a third appointed endoscopy technician and another Staff Nurse has completed his training from the JAG/GETS programme for endoscopy at St Georges. Surgical Out-Patient Department The surgical outpatient department will be taking lead in the Vac Pump wound care management of the outpatient. A Staff Nurse will be leading with the responsibility of the Mini pumps whilst CCU will keep the large pumps. We are communicating with KCI (Vac Pump Company) to provide further pumps and training sessions on dressing application). TSSU Department With the increase of elective Day Surgery Procedures and provision / utilisation of Theatre 3, TSSU / CSSD has had to undergo modification and development of its services at many levels. Educationally, three members of the team have undergone SSD Manager / Supervisors (DTM HTM) training at Eastwood park hospital in the UK as part of the natural progression in CFPP practices and E.U requirements. The Department has recently undergone refurbishment and updating of its Steris automated washers and decontaminations units to enable to continue to provide a streamlined service to its users, which include: Operating Theatres Day Surgery Unit Maternity Accident & Emergency Department Ambulance Services Radiology Department Dialysis All Wards & Clinics in SBH PCC ECA Ocean Views HMS Prison GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 31

32 RGP & City Fire Brigade St Johns Ambulance Dudley Toomey Ward All registered nurses have carried out the NEWS training session in order to update their knowledge on the use of using the NEWS observation charts, which went live on the 21 st May. Members of staff attended a Gynaecology Module provided by Salford University. This focused on the management of early pregnancy loss. Due to improvements in bed capacity, the ward has returned to becoming a solely substantial surgical ward. It has since been divided into a purely ortho-trauma wing in an effort to minimise potential risks of surgical site infections. The remaining half of the ward caters for all other surgical patients. Medical Directorate Victoria Ward Ward Activity: April & May continued to see a continued high inpatient capacity catering for 36 complex/long stay patients. 10 th & 11 th June saw the successful transfer of 14 Patients to Hillside Dementia Unit, thus by the end of June inpatient capacity dropped to 27. These last 3 months has also seen 2 nursing staff successfully qualify and take up posts as Enrolled Nurses. Current Inpatient status: Total Long stay patients/ Palliative 2 Rehabilitation 7 Long stay 18 Training: Mandatory Training with 10 staff members completed this in-house training which included Infection Control updates, Introduction to NEWS, BLS & Manual handling 2 Staff Nurses completed a 2 day Triage Course 3 Enrolled Nurses completed a 5 Day Dementia Course 2 Staff Nurses completed the Immediate Life Support (ILS) Adult Safeguarding Training a total of 2 staff members attended John Mackintosh Ward Staff are working hard to make patient safety a top priority on John Ward. Everyone is becoming much more conscious in areas such as pressure area care and skin inspection on admission and daily thereafter. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 32

33 Ward Activity: April June showed a high inpatient capacity. Environmental safety checks are being accomplished. JMW Monthly Statistics 2017:- Month Total Admissions: April 31 May 23 June 32 Critical Care Unit Ward Activity - This period has seen a reduction in admissions to the unit. During the period of April 2017 June 2017, 195 patients have been admitted via A&E. The department has developed the NEWS implementation for patients transferred out of CCU. In June 2017, the Hon Minister for Health gave approval for CCU s development plan. Training Five staff members completed a Bespoke training programme in April, subjects covered: Ventilation and Respiratory care. Care needs surrounding the cardiovascular system / ECG Interpretation. The Renal system & Hemofiltration. Trauma/ Head injury. Other training completed by the team between April June: CRIPA Bariatric Training Session Alert Transfer of the critically ill patient ILS Mentorship Sign-off mentor CCU Statistics April June 2017:- Total Admissions 195 Deaths 10 Patients requiring 4 Renal Replacement Therapy GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 33

34 Ventilated patients 13 Non Invasive 15 ventilation Accident & Emergency Department Department Activity: April saw the Minister of Health announce the commencement of 2 New Department managers. April also saw the reorganisation of 2 areas within the department: 1. The Minor Injury Unit (protocols, guidelines, stock) 2. Ordering, procurement and store room Throughout April to June, Department works continue allowing for improved patient care. Training: The team have continued to keep updated and have attended Mandatory Training, which include: Work Based Learning Module ALERT Course Advance Life Support Instructor ILS Gynae study day Suturing course completed by all staff in A+E department. Advance Trauma Instructor Course A& E stats for the period 01/04/2017 to 30/06/2017: New Attendances 6146 Planned Return Attendances 403 Unplanned Return Attendances 357 Clinic Attendances (Arrived) 807 Total Attendances 7713 Injury at Work Attendances 54 Visitor Attendances 438 Attendances for Children 15< (non 1174 MOD) Attendances for MOD 16> 13 Attendances for MOD 15< 51 Total Attendances 1730 Ape/Monkey Bite 23 Dog Bite 28 Insect Bite 77 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 34

35 Human Bite 2 Cat Bite 5 Total Attendances 135 Sting Fish 1 Sting Jelly Fish 2 Total Attendances 3 Chest Pain / Palpitations 250 Intoxication Alcohol 7 Cardiac/Respiratory Arrest 6 Overdose 12 Road Traffic Collision 26 Referral 115 Total Attendances 416 Ambulance Non Urgent Ambulance 40 Total Attendances 1052 Surgical Admissions 118 Medical Admissions 316 Paediatric Admissions 50 Gynaecology Admissions 10 Orthopaedic Admissions 46 Total Admissions 540 Mental Health Admissions 9 Anaesthetics Admissions 5 ENT Admissions 6 Ophthalmology Admissions 2 Total Admissions 22 Referral to Trauma Clinic 256 Total Referrals 256 Phlebotomy & Blood Donation Department Department activity: The department continues benefiting from the implementation of an appointment system, with the system proving to be a success. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 35

36 Training: Staff Nurse continues to train all grades within the GHA in the theory and practical competences in two main areas: Venepuncture & Phlebotomy i.e. drawing blood & its storage & transport it for testing. Rainbow Ward Ward Activity: There has been a steady flow of children admitted and seen in Rainbow. Training: In-house training continued with 5 staff completed the Paediatric Intermediate Life Support (PILS). Mandatory training was also attended by 5 staff. In May 2017, the Care Agency inducted the Signs of Safety. To enable clear communication between the agencies, 2 of the Paediatric team completed Child protection training at tier 2. Paediatric Statistics April June Paed HDU ENT Dent al Ortho Eye Surg Total Ward Attender Clinic Total activity April May June Maternity Ward Activity: Following training in early June, the Early Pregnancy service commenced. The Hon Minister for Health introduced the new Early Pregnancy Assessment Service for expectant mothers to staff from A&E, Dudley Toomey Ward, & Day surgery. This initiative has been supported by the School of Health Studies. Training: A bespoke Gynaecology module was designed to instruct staff nurses from A&E, Dudley Toomey and Day Surgery as well as the midwives in the hospital, to enhance and update vital skills in this key area of healthcare in Gibraltar. Anna Sherliker, BSc (Hons) Midwifery from the University of Salford, Manchester will be leading the programme. The objective was to empower staff when dealing with pregnancy loss, and explained that the training has been tailor made to give staff the proficiency to deal clinically with all aspects of such a difficult experience, including psychological and emotional care. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 36

37 Maternity statistics April 2017-May 2017 Total Nº Total births 100 Male 46 Female 54 Premature <37 4 IOL 17 EM LSCS 3 URG LSCS 8 SCH LSCS 3 EL LSCS 17 Total LSCS 31 Ventouse 4 Forceps 0 Twins LSCS 4 sets 8 Midwives Deliveries 65 Transfer to Spain in Utero 6 Transfer to Spain Neonates 0 SCBU Admissions 4 Ward Attenders 416 Practice Development Dementia Training Week for Enrolled Nurses This took place between 3 rd 7 th April in the School of Health Studies with 9 Enrolled Nurses attending the weeks training plus 3 Enrolled Nurses and other MDT staff who became Dementia Friends following a session given by GADS (Gibraltar Alzheimer and Dementia Society). Relative s stories about family experiences of dementia care were particularly moving and made a big impact. Practice Development from GHA and ERS delivered sessions on the Programme with input from Medical Staff, Physiotherapy, Occupational Therapy, Pharmacy, Mental Health and Palliative Care. Feedback for the programme was generally excellent with the visits to the Bella Vista Day Centre, John Mac Wing and Ocean Views giving a great insight into more Dementia Friendly environments and highlighting the need for St Bernard s to become more Dementia Friendly as there are so many people living with dementia and receiving care in St Bernard s Hospital. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 37

38 World Health Week Depression Awareness Day This awareness event took place in the lobby area of the ICC on April 7 th and was well supported by Multi-Disciplinary/ Agency staff including health promotion, practice development, nursing and midwifery staff from St Bernard s Hospital, community & voluntary workers. The media/ GBC interviewed staff regarding stress and depression and highlighted the need to speak out, get support and reduce stigma. Mandatory Training This took place on 11 th, 17 th & 18 th May in the School of Health Studies 36 staff members completed their up-dates in Basic Life Support, Moving & Handling, Infection Control and National Early warning Scores (NEWS). Further provisional dates have been pencilled in for 30th and 31 st August & 28 th and 29 th September these will need to be confirmed with Instructors and organised through Practice Development. NEWS Launch Practice Development and other members of the NEWS Steering Group have participated in training staff, raising awareness and the implementation of the National Early Warning Scores within St Bernard s Hospital the launch took place on 21 st May. The introduction of the National Early Warning Score (NEWS) to clinical areas throughout the GHA in a stepwise fashion is an important milestone as for the first time there is a common language and approach to assessment of a patient s condition. Application of this common approach should eradicate variation in practice and reduce harm to patients. (Dr Richard Roberts, NEWS steering group ). NEWS resource files have been placed in wards with information about NEWS including the policy being made available to all staff. Dignity in Care Training This took place week beginning 5 th June in the School of Health Studies and Bleak House and was attended by 23 nursing staff members including the new Pupil Nurses who are carrying out their Enrolled Nurse training. This focused on providing safe, compassionate, person-centred care, exploring ways to support staff and enhance practice. Suturing in A&E This course was delivered during 3 one day workshops in the Multi-Skills Room in the School of Health Studies for 21 A&E staff members. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 38

39 Safeguarding Adults at Risk - Training for Managers This training was delivered for 8 senior nursing staff and 3 medical staff on 20 th June in the School of Health Studies. Bed Management Report for period April 2017 The month of April 2017 has demonstrated a slight decrease in bed occupancy for adult patients at SBH. Extra beds have still been used during the month. CMW and VMW continue with the increased bed capacity as per Bed Management Escalation Policy. A positive approach was undertaken on the 22 nd April whereby 14 patients from SBH were transferred to the new Hillside Dementia Home. Bed management meetings continue to be held weekly with a proactive team approach. Total admissions for April 2017 for SBH are as follows: Admissions all areas 243 Admissions via A&E 183 Admissions Adult & CCU 187 Admissions via A&E 154 Paediatrics 51 Admission via A&E 17 Maternity 55 Non elective 12 April continues to see high bed occupancy with the average adult occupancy at 101.5%. There has been a slight decrease from March (109%) Bed Management Report for period May 2017 The month of May 2017 has demonstrated a very slight increase in bed occupancy for adult patients at SBH. Extra beds have still been used during the month. CMW and VMW continue with the increased bed capacity as per Bed Management Escalation Policy. Bed management meetings continue to be held weekly with a proactive team approach. Total admissions for May 2017 for SBH are as follows: Admissions all areas 347 Admissions via A&E 209 Admissions Adult & CCU 205 Admissions via A&E 158 Paediatrics 74 Admission via A&E 41 Maternity 67 Non elective 10 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 39

40 May continued to see high bed occupancy with the average adult occupancy at 102.5%. There has been a very slight increase from April (101.5%) The following efforts successfully continue throughout the hospital: MDT working both on acute & long stay wards (rehab) improving patient flow Proactive approach to the discharge process with dedicated hospital social worker and escalation of bed management meetings with closely followed up action points. Domiciliary hours availability to support discharge. Close integration with the ERS (availability of long-term beds in order to expedite patient flow). Transfer of patients to the temporary ward (interim measure) Transfer of patients to Hillside It was unfortunate that the number of beds were reduced when the old St Bernard s Hospital was moved to the new St Bernard s Hospital back in This had a grave effect on bed occupancy rates, which caused pressure on bed availability and patient flow. If the same level of beds had been kept as per clinician s advice at the time, the average bed occupancy rates would have been far better. However, I am happy to announce that during this quarter, the bed occupancy audits have shown a tremendous increase of available beds at St Bernard s Hospital. A snapshot in April showed a recording of 26 beds available that day, in May, a recording of 28 beds available that day and in June, a recording of 44 beds available that day. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 40

41 Fig 1: Occupancy levels (adult wards & CCU 30 & 10 beds respectively) Jan May % % % % 95.00% 90.00% 85.00% Ja n- 15 Fe b- 15 M ar- 15 Ap r- 15 M Ju ay- n Ju l- 15 Au g- 15 Se p- 15 O ct- 15 Average Occupancy Adults N ov D ec- 15 Ja n- 16 Fe b- 16 M ar- 16 Ap r- 16 M ay- 16 Ju n- 16 Ju l- 16 Au g- 16 Se p- 16 O ct- 16 N ov- 16 D Ja ec- n Fe b- 17 M ar- 17 Ap r- 17 M ay- 17 Note: 85% ceiling for occupancy as per DOH 2001 recommendations Fig 2 Distribution of elderly long stay/dementia/complex by 05/6/2017 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 41

42 Total Number of Patient's Fig 3 Distribution of elderly long stay/dementia long stay/complex & Palliative by 05/6/2017 Fig 4: The collective breakdown of this cohort of patients is as follows. Complex Discharges 27 Elderly Long-Stay 28 Average age 85 years Dementia Long-Stay 24 Palliative 5 Total Beds Held adult beds SBH 84= 46 acute beds available (plus 19 extra beds)= 65 Fig 5: Total Cancellations elective inpatient surgery January 2015 to May 2017 due to bed shortage 18 8 Total cancellations due to beds Jan-Feb- Ma Apr- Ma Jun-Jul- Aug- Se Oct- No De Jan-Feb- Ma Apr- Ma Jun-Jul- Aug- Se Oct- No De Jan-Feb-Ma Apr Ma Cancellation due to unavailability of bed There have been 0 cancellations of elective inpatient surgery specifically due to bed unavailability in May GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 42

43 5.6 Human Resources April to June EXECUTIVE SUMMARY The department s new focus and direction continues to be guided by principles of helping others, whilst contributing to the strategic HR objectives of the GHA. This is helped by supporting line managers and building strong working relationships with the range of professional groups; alignment with the business and service needs of the organisation and developing the HR experience and perceptions of our ultimate customers, our GHA staff. Throughout this second quarter, the department has made progress in significant areas of our recruitment and selection, advertising and holding successful interviews, including the use of technology for remote interviewing, for clinical vacancies within Medicine, Nursing and Allied Health Professionals. The use of conferencing technology in interviewing brings about both cost and time savings to the process, ensuring a more efficient service to our customer base. The successful recruitment of Medical grades has signified a reduction in prolonged locum requirements. In addition, we have successfully negotiated short term contracts for 5 locum staff members, where we have anticipated a minimum of 3 months of continuous employment requirements. The department has been working in close collaboration with the trade unions, developing positive Industrial Relations. Together, we have managed to regularise longstanding supply positions for our General Operative Labourers, as well as resolved numerous longstanding professional claims from staff that have promoted employee wellbeing. Professional relationships and communication with clinical and non-clinical heads of departments continues to develop. This is resulting in improved integration and a partnership approach towards the operational management of core HR functions such as recruitment planning, contract renewals, conduct and behaviour and employee wellbeing. In addition, the department s renewed commitment to providing HR support to line managers has been evident, where HR Managers visited our Mental Health facility, to offer line managers HR advice on policies and practices relating to the preventative management of disciplinary proceedings, sickness management, employee wellbeing and occupational health. Our HR staff continues to be fully engaged with the ongoing review of the department and value the direction and support provided by the Public Sector HR Business Support Unit. Their HR expertise has been a welcomed addition and a noticeable resource, utilised by both HR staff and GHA line managers, especially when managing complex HR matters. Our department has also welcomed three new members of staff. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 43

44 To conclude, I would like to add that there is a noticeable rise in the gratifying feedback and praise from line managers and GHA staff alike, received by HR staff. This, although intangible, gives the department increased motivation and a sense of purpose and reassurance that our collective efforts make a positive difference to the wellbeing of GHA employees and to our healthcare service delivery. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 44

45 5.7 SBH Operations Manager April to June 2017 Introduction The New Look GHA website was launched on the 13 th June The new website has been re-designed and developed completely in-house and provides information on all aspects of the healthcare services available to visitors, patients and health professionals in Gibraltar. The revamped website also contains general contact information, guides, forms, information leaflets and other up to date health related news that patients, visitors and service users will find both useful and informative. The website is further designed to work on multiple platforms, web browsers & mobile devices and now includes a new careers section where vacancies will be published and applicants can interact online with the Department of Human Resources There is an automated news feed on GHA related matters and departments can now administer the content of their sections individually. The original website launched in July 2013 has served well for the past three years, but it needed to be refreshed and built using the latest software and technology available. Since the launch in 2013, the website has generated 289,392 Unique User Visits, 860,582 Page Views and the GHA has received 992 Cancellations of Appointments, 2483 HR Enquiries and 1356 General Enquires via the online forms. The Estates and Clinical Engineering team have also completed the installation of the first Photo Voltaic panels on the roof of link block 2. These will drive heat pumps which will in turn supply LTHW to the hospital existing Hot Water calorifiers. This should help to reduce the hospitals fuel bills and add to the Governments commitments to CO2 reduction/management Facilities Management Fire Prevention The GHA Health and Safety at Work Policy was approved by the GHA Board on 2 nd June The new committee, terms of reference, risk assessments and training programme will be reviewed in line with the new policy. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 45

46 Patient Advocacy & Liaison Service The service was created during October 2016 and is managed by the Medical Records Manager together with a full time GHA Clerk. Case Activity for PALS for 2017 JANUARY FEBRUARY MARCH APRIL MAY JUNE 35 CASES 33 CASES 73 CASES 43 CASES 56 CASES 55 CASES Medical Release of Records Office STATISTICS 2017 APRIL Patients: 93 Lawyers: 9 RGP: 2 D.S.S: 0 Insurance Company: 5 MAY Patients: 99 Lawyers: 11 RGP: 7 D.S.S: 0 Insurance Company: 4 JUNE Patients: 75 Lawyers: 10 RGP: 4 D.S.S: 4 Insurance Company: 5 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 46

47 Minor Works A total of 487 work tickets excluding those arising from department/ward inspections have been received this period, 1 st January 2017 to 30 th June The figure for this quarter has again increased to 75.6 requisitions/defects per month, which shows the system is now being used by most departments. Compared to the previous reporting system were the average was 28 requisitions/defects per month. This quarter we have managed to again analyse the TMV system as the hot water pumps are fully operational. This has amounted to an excess in works carried out as the whole hospital has been re-checked in order to safely commence the routine programme of maintenance. Shower flexi and heads together with the inspection of all ward gullies continue to be done as part of the maintenance regime. Dudley Toomey ward, CSSD and Calpe Ward together with other common areas have been inspected and completed during this period. The Estates Manager continues to be involved in all new design schemes pertaining to both major and minor works and all matters which in any way require technical input regarding decisions affecting the building use, both structural and aesthetically, liaising with private contractors, conducting inspection/surveys to areas as instructed by the UGM to St Bernard s, CMHT and the PCC. The section was heavily involved in the creation of a new temporary ward in the rehabilitation department which was required as a result of bed management issues. These works have now been dismantled and the ward removed allowing for the gym to be in use again. Routine repairs and maintenance continues throughout the estates. Catering Services The Catering Unit is generally performing well. A new cook was employed last month of May through the services or MEDDOC and the Assistant Associate Director is now undertaking his role. Quality and service improvements A deep clean of the facility was carried out during June GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 47

48 Red trays Patients that require assistance to eat have had red trays allocated and this has been piloted with great success and the aim is to commence this initiative with all words, the cost is insignificant. Offer sandwiches to patients waiting outside A&E twice a day, some patients suffer from diabetes or other ailment and cannot be long periods of time without any food. We already provide sandwiches for A&E, but now we will off to patients outside waiting as well as patients inside. Meals Provided during April and June 2017 Ambulance Service New Ambulance Recruits On 8 th May, new Ambulance Care Assistants commenced employment and are currently undergoing induction training. They have completed their ACA course and are currently competing blue light driving instruction and C1 Driving license. Government Agencies Training The GHA Ambulance Service continues to develop strong links with different Government Agencies. As a result Emergency Medical Responder Courses were delivered by our instructors to the following agencies: Gibraltar Fire and Rescue Service Airport Fire and Rescue Service New Emergency Ambulance Two new Emergency Ambulance vehicles are expected to be commissioned this year. The first unit is due to arrive in July 2017 with the second unit in December This is part of the transfer of the 3 rd ambulance responsibilities from the GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 48

49 Gibraltar Fire and Rescue Services to the GHA planned to take place with the 3 rd Quarter of AMBULANCE SERVICE OPERATIONS Emergency Ambulance Deployments Month Total Average per day Apr May Jun Main Zone Deployments Month Apr May Jun Total Gib Port North Area Eastside Area Westside Area South District Upper Town Town Area Frontier/Airport Nature Reserve Gib Dock Maritime GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 49

50 AMBULANCE ROUTINE TRANSFERS OPERATIONS Summary of Patient taken for Scans and or Transfers to Spain Destination Apr May Jun Algeciras Benalmadena (Xanit) Cadiz Gibraltar La Linea Malaga Seville Jerez Marbella Totals Summary of Local Patient Transfers Month Total Average per day Apr May Jun GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 50

51 Pathology Services During this quarter, the Department of Pathology, in collaboration with A&E clinicians, has introduced the parameter, Lactate, to its repertoire of parameters available on its main biochemistry analyzers. Lactate is of value as a parameter in various settings. Two major ones are: (1) conditions associated with hypoxia, e.g. shock, congestive heart failure, myocardial infarction, blood loss and pulmonary oedema, and, (2) Metabolic or drug/toxin related disorders. Examples of metabolic disorders include diabetes mellitus, hepatic disease, and neoplasia. Sponsored Patients Services The Sponsored Patients Department actively responds to the demand for tertiary services. This quarter, the Sponsored Patients team has also been involved in the review of tertiary referrals and service arrangements in UK and Spain together with the Medical Directorate team and a new referral software application developed by the IMT Dept. has already been implemented. The application will assist in the capturing of information and requests for referrals from Consultants which are then reviewed by the newly formed Tertiary Services Review Board. GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 51

52 GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 52

53 April to June Deputy Medical Director - Primary Care Services This reporting period has been characterised by a consolidation of services and ensuring the new initiatives are established in to regular daily practice. This Board submission also heralds the start of a more accurate system of data collection in terms of services provided and numbers of patients seen in the different subdepartments. 1. Update from the reporting period March to June 2017 The Main Counter is working well and is allowing far better patient flow within the department as signs are clearer and clerks are more readily available. Patients now seek assistance at the Main Counter for Repeat Prescriptions, Appointments and Registration matters related to self-employment. The Repeat Prescription system continues to work well with increasing numbers of patients accessing this service daily as people become more aware of the service on offer and how to access it. The Medical Certificate Telephone Service also continues to go from strength to strength with increasing awareness of the service on offer and patients are reporting high (anecdotal) levels of satisfaction with these two services with no reported problems or complaints so far. The scanning and uploading of patient records also continues well albeit somewhat slower than originally anticipated. The GP lead Baby Clinics have now caught up with waiting times such that all babies are seen at the 6 week point for their scheduled check. 2. Administration All clerks attended a training session for CAMIS with the EPR team. Five admin officers attended the Frontline Staff Disability Awareness Training Seminar on the 24 th May 2017 at the University campus. One member of the team also attended the Management Interpersonal Skills course from the 5 th to the 7 th of June The Last Prescription Service has helped 1329 patients over the last three months as follows, representing an average of 443 GP appointments saved per month: Repeat Prescription Service Apr May Jun Total Totals GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 53

54 Note Scanning and Uploading Patient Notes Scanned Apr May Jun Total Totals So far since inception 2376 sets of patient notes have been scanned and uploaded and the paper record archived. 3 Registration Department Patients seen at the Registration Counter Apr May Jun Total Totals General Practitioners Activity Statistics The full range of clinic activities is included to demonstrate the wide range of services on offer and the numbers of patients seen. Clinic/Appointment Type Apr May Jun Total 2 Year Check (chronic disease) Admin Repeat Prescriptions Patient Administration Advanced Appointments Reports/Letters/Referrals Critically Ill Patient General Appointment Dermatology (Review) Dermatology New - Routine Dermatology WSI Session Dermoscopy Discharged Patients Elderly Care Agency Emergency Emergency Overflow Home Visits Last Prescription Reviews Medicals (Govt/LAC) Minor Surgery Dr Vassallo Specific Palliative Care Postnatal Prison Released On The Day Review: To Be Booked By Clinician Only Women s Health Totals GHA Board Report 2nd Quarter 2017 (April to June 2017) Page 54

55 GHA Board report April 2017 to June Nursing Services Activity Statistics Apr May Jun Total Child Health Department Health Visitors/Nurse team Newborn hearing test Social services attendances HV Primary visits HV 8 weeks Eneuresis Clinic Weighing clinic, feeding advice Immunisation Clinic 331 1, Totals Cardiac Rehab Nurse Inpatients visits Pre clinics post clinics Cardiac rehab programme Self-help group Community Drop-in Totals Diabetic Specialist Nurse ADRC Other (comment/default) Diabetic Review Diabetic ward patients Diabetic ward/ antenatal patients Glucose assessments Clerical meetings Unscheduled consultations Telephone consultations Totals Nurse Practitioner Smoking Cessation clinic review Smoking Cessation clinic new Asthma Clinic/COPD Driving medical Emergency clinic P a g e

56 GHA Board report April 2017 to June 2017 Spirometry Review clinic Women s health Cervical Smears Comment/admin Totals Practice Nurses Phlebotomy Clinic Ear Syringing Clinic ABPM Clinic ECG Clinic House call telephone calls General wound Lymphoedema clinic Leg Ulcer Clinic Doppler Clinic Blood pressure check Hypertension clinic Triage Blood Glucose Admission to A/E Telephone consultations Injections/ urinalysis/nebs Nursing admin patient contacts Reception nurse admin 0 1, duties Sick note line consultations Flu vaccines Totals Dermatology Nurses Cryotherapy Light therapy Photos clinic Pre- derm clinic Ancillary see and treat Telephone consultations Minor-ops Hyfrecator Patch testing CDM Totals Mental Welfare Officers P a g e

57 GHA Board report April 2017 to June 2017 District Nursing Team Diabetic/Insulin Dressings Injections Baths/General Care Visits- Support/Monitoring Terminal Care Catheter Care INR and Blood Samples Admissions Discharges Flu Vaccinations Totals Grand Monthly Total Dental Department Activity Statistics April DNA May DNA June DNA A Dental Officer visits HMP on a regular basis and has attended on 24 April and 23 May for this reporting period. 7. Allied Health Professionals i. Community Physiotherapy Apr May Jun Total (PHYSIOTHERAPIST) (PHYSIOTHERAPIST paeds) (PHYSIOTHERAPIST paeds) (PHYSIOTHERAPIST) Totals P a g e

58 GHA Board report April 2017 to June 2017 ii. Speech and Language Apr May Jun Total (Speech and Language Therapist) (Speech and Language Therapist) (Speech and Language Therapist) (Speech and Language Therapist) Totals The department has delivered a 4 th NAS Earlybird Parent Training programme for parents of pre-school children with Autism. This 12-week Programme is run co-jointly with the Occupational Therapy Department. Service initiatives include a triage neurodevelopmental assessment clinic run by two senior therapists with the aim of identifying children with pervasive developmental disorders and the delivery of weekly neurodevelopmental therapy sessions working closely with these parents in meeting these children s communication needs. A total of 8 children with ages ranging from 18 months to 6 years have accessed this provision during the period April to June iii. Occupational Therapy Apr May Jun Total (Occupational Therapist) (Occupational Therapist) (Occupational Therapist) (Occupational Therapist) Totals P a g e

59 GHA Board report April 2017 to June 2017 April to June 2017 Introduction 5.9 Mental Health General Manager There has been a number of initiatives developed over this period, which will be extended over the coming months / years. The aim of mental health services as always is about recovery and a seamless journey through the services, during a period in one s life, which can be very difficult at times. The focus of multi-disciplinary, multi-agency working we believe goes a long way to achieving this goal and is something we will continue to strive for. Inclusion rather exclusion must always be seen as the way forward and we believe that joint training initiatives such as we have had over the last few months will definitely aid this idea. Also presented are our plans for the coming months with respect to service delivery the implementation of community outreach/ crisis work and phone lines will move the service forward and meet the needs of patients and carers who access our services. Section one monthly activity Community Mental Health Team (CMHT) Patient contact/staff activity 59 P a g e

60 GHA Board report April 2017 to June 2017 Psychology therapy offered with mental health services Primary Care CMHT CAMHS External Secondary Care Monthly Total April May June Totals As in previous reports, the figures illustrate that most of the referrals made to the Department of Clinical Psychology and Counselling are from General Practitioners in Primary Care. These referrals are usually made on behalf of patients who are most appropriately allocated to the Counsellor but the excess referrals have until now been allocated to the Clinical Psychologists. In-patient data and activities Horizon - Sky / Dawn - Flats / Sunshine / ARC In-patient quarterly data Horizon / Sky 60 P a g e

61 GHA Board report April 2017 to June 2017 Month Number of patients admitted on section Section / appeals / outcomes April - June 2017 Number of Gender Outcome appeals / Section April M Section upheld. May M Section resinded and patient discharged. June F One section was resinded and patient remained informal on ward One awaiting outcome of tribunal. 61 P a g e

62 GHA Board report April 2017 to June 2017 Other groups / activites held on the Horizon and Sky Presented in boxes below are: (1) the patient admission and discharges for Dawn ward, primarily from Horizon ward over the 3 month period covered in this report. This movement from Horizon to Dawn clearly demonstrates the work carried out in the in-patient settings in order that recovery and reintegration back into community settings is happening. (2) The level of dependency and (3) the current risks identified for patients within the service. Arts and crafts x2 sessions every week Interactive games x2 every week Ladies pamper groups Relaxation groups Painting weekly Commuity escorted leave, these will be for access to social events and for collection of fortnightly benefits. Rehabilitation in-patient services - Dawn Ward Data (Inc flats) 62 P a g e

63 GHA Board report April 2017 to June 2017 As the above data indicates, Dawn ward has seen a total of 6 patients discharged from the in-patient services back to their home environment. The ward staff have achieved this through outreach work that they are currently offering to patients that may have been in hosptial for more than 13 years. They are currently also working with 3 in-patients providing support in the community in order to promote independent living over the last few months through Multi team working with ARC and CMHT. The outreach offered has covered aspects of overnight leave at the 2 bed Community flat whereby patients are utilising 2-3 nights leave a week in increasing days / nights in order to faciliate a smooth reintgration back to the community. This has also included outreach from 20:00 00:00 during the night and 08:00 10:00 in the mornings, in order to observe concordance with medication, support with ADLs, assess mental state and social needs (budgeting, shopping etc) and environmental checks. The nursing staff on Dawn also work very close with the ARC team to offer support with ensuring accommodation is suitable for the patient once discharged or for Rehabilitation/ Outreach requirements. This includes home visits as assessment, meeting with source providers, ie electrics, water, housing departments. The ward has continued to take seriously the physical well being of patients also with a number of health checks co-ordinating throughout the month (see below). Daily outings/ activities on and off the ward to develop social skills and community skills for the patients both in group settings and 1:1s. Our patients are now benefiting from the ward team being able to provide assistance with benefits applications and payments of bills. Due to the better liaison with housing, patients are now benefiting from home improvements that in turn lead to better living conditions and an improved pathway to recovery. 63 P a g e