QUALITY OF CARE REPORT

Transcription

1 QUALITY OF CARE REPORT

2 Vision Mission and Values OUR VISION To Excel as a Rural Community Health Provider. OUR MISSION To Provide High Quality and Effective Health Services. STRATEGIC ASPIRATIONS 1. Make The Greatest Possible Impact On Our Community s Health 2. To Achieve Continual Financial Viability 3. To Develop And Utilise Partnerships That Add Value To Our Efforts 4. To Develop Strong Operational Practices Throughout The Organisation 5. Build A Workplace For The Future OUR VALUES Willingly Being Accountable Valuing People Achieving Results Through Teamwork Integrity In All We Do Respect For Others At All Times

3 Introduction Welcome to the Tallangatta Health Service (THS) Quality of Care Report for This report highlights our achievements throughout the past year and is produced in conjunction with our Annual Report. This report provides us with an opportunity to showcase the many services that we provide and highlight some of the numerous improvements that we have made throughout the year that enhance patient care and safety. The Annual Report focuses on the financial areas of our service. Tallangatta Health Service is a small rural health service providing a broad range of services to a wide range of people within our community. The report covers services provided by THS from residential aged care, acute services, community based health promotion to our organisational support services. Responding to the challenges that we as a rural Victorian Health Service face; we must continue to work and think differently about how we ensure patients continue to have safe and high quality care. We hope that you enjoy reading about our achievements and find the contents informative and interesting. This year there is a range of information about our services and performances against required standards. The development and production of this report was from a THS multidisciplinary team. On behalf of the Board of Management, Executive and staff we would like to acknowledge all who have assisted us throughout the past year, and we hope you enjoy reading the Quality of Care Report. Robyn Gillis CEO Andrew Brown Board Chair Index Introduction 2 Our Service & Organisational Structure 3 Our Community & Community Profile 4 Statistics 5 Improving Care for Aboriginal and Torres Strait Islanders Health Promotion 6 Service Satisfation 7 Satisfaction Survey 8-9 Staff Health & Safety 10 Life in Residential Aged Care Stan s Story Accreditation Preventing Falls 15 Managing Pressure Injuries 16 Medication Safety 17 Patient Identification 17 Preventing Infections 18 Clinical Deterioration 19 Clinical Governanace 19 Partnering with Consumers 20 Volunteering Education 23 Professional Development 24 Home and Community Care 25 Community Participation 26 New Facilities Residential Aged Care Quality Indicators 29 Transition Care Program 30 Auxiliary Helps 31 Awards 32 Distribution / Evaluation Years Celebration

4 Our Service In July 1997 the Tallangatta Hospital and Tallangatta & District Extended Care Centre Inc. merged as one organisation to be renamed as the Tallangatta Health Service. This resulted in the integration of Bolga Court Residential Aged Care Facility into the management structure of the health service. Tallangatta Health Service (THS) has 66 registered beds 15 state funded acute care beds; these beds are utilised for: General /sub-acute care Medical care Post-surgical care Respite care Palliative care Transition Care Program There are 51 Residential Aged Cared Beds across two onsite aged care facilities which include: Lakeview which is a 15 bed fully accredited facility providing high residential aged care and respite care services. Bolga Court is a 36 bed fully accredited facility providing low and high residential aged care and respite care services. Organisational Structure BOARD OF MANAGEMENT CEO DIRECTOR OF MEDICAL SERVICES DIRECTOR OF NURSING * ACUTE/SUB ACUTE WARD DIRECTOR CORPORATE SERVICES * FINANCE QUALITY AND RISK MANAGER EXECUTIVE SUPPORT * RESIDENTIAL AGED CARE (LAKEVIEW NURSING HOME & BOLGA COURT) * MAINTENANCE * HOTEL SERVICES GP * MEDICAL CENTRE * VISITING CLINICAL SERVICES * HUMAN RESOURCES * PAYROLL * COMMUNITY HEALTH * INFORMATION TECHNOLOGY * ALLIED HEALTH * ORGANISATION SUPPORT * HEALTH PROMOTION * MEDICAL RECORDS * HACC * EXTERNAL CONTRACTS * PLANNED ACTIVITY GROUPS * MEN S SHED 3

5 Our Community Tallangatta Health Service provides services to the communities and people of Bellbridge, Bethanga, Dartmouth, Eskdale, Granya, Mitta Mitta and Tallangatta and all areas in between. This makes up part of the Western Region of the Towong Shire in the North East of Victoria. Known as being one of Victoria s best kept secrets! Nestled in a valley surrounded by beautifully sculptured hills, the township is situated on the banks of Lake Hume. The new town was planned and built in the 1950s when the Old was flooded due to the height of the Lake Hume Dam wall being raised to increase storage. Tallangatta Health Service (THS) is one of the larger employees within the local community with 150 staff being equivalent to as at 30 June Community Profile The estimated resident population of the Towong Shire is 5,891 which equates to 2,976 males and 2,915 females as reported by the Australian Bureau of Statistics (ABS) in The median age of 47 is greater than the Victorian median age of 37. The highest proportion of the population, 44.2%, is aged between years with 21.7% of the population aged 65 years or more. It is predicted that by 2016 persons aged 65 years or more will have increased to 27.4%, which is greater than for the state of Victoria, which is anticipated to be 15.9%. The majority (93%) of residents are from an English speaking background born either in Australia, England, Scotland or New Zealand with 96.1% of people reporting they only speak English at home. Other languages spoken at home include German 0.5%, Italian 0.2% and French, Spanish & Polish 0.1%, (ABS, 2011). During there were no admissions to the health service or residential aged care facilities that indicated or were identified that they required the services of an interpreter. Tallangatta Health Service in July 2012 reviewed the Cultural & Spiritual Diversity Policy for the organisation, ensuring that it considers the needs of minority groups; and is responsive and appropriate to the needs of our community. Summary of key achievements in Staff recruitment to key positions Creation of staff education room Embedding & establishing new community partnerships Occupancy of 100% for Residential Aged Care Facilities Capital Works: Kitchen Laundry Student Accommodation Our Plans for the Future Accreditation for the Medical Centre Refurbishment of further modules Increase Health Promotion activities Waste management review Fire Safety upgrades New Equipment: Bladder Scanner Wheelchair movers Bed, chair, floor sensors Facility upgrades & refurbishments Successful grant submissions New clinical care equipment Security improvements Increase in volunteers New volunteer positions Improved compliance with mandatory education Menu / meal review seasonal rotation 4

6 Statistics Acute Inpatients Treated In patient bed days 2, Residential Aged Care Low Care Bed Days 3,562 3,203 High Care Bed Days 7,440 9,207 Total Bed Days Aged Care 11,092 12,410 PROGRAM HOURS Home Care 3317 Personal Care 773 Respite care 262 Assessment 777 District Nursing 1876 Property Maintenance 186 Planned Activity Groups Core 4338 High 362 Total Hours 11,891 Meals on Wheels are delivered to clients throughout the catchment including the areas of Dartmouth, Mitta Mitta, Bethanga, Talgarno, Koetong, and places in between. Improving Care for Aboriginal and Torres Strait Islanders The 2011 Census data reveals 1.4% of the population has identified themselves as being an Aboriginal or Torres Strait Islanders. During there were no patients or aged care residents admitted to Tallangatta Health Service (THS) who identified themselves in this group, nor to the Medical Centre. Currently the Home and Community Care program has one client identified as being Aboriginal. The Mungabareena Aboriginal Corporation Closing the Health Gap Manager provided staff at THS with education on cultural awareness for Aboriginal and Torres Strait Islander people, and how to appropriately address, Asking the question. The purpose of this session was to create cultural awareness among staff, to assist in providing a continuum of care for Aboriginal patients, residents or clients. The staff found this information and the details provided clear, concise and relevant to their work. The session also highlighted the importance of collecting information and provided clarity with the use of this data. Further information sessions will be provided for staff. Making Two Worlds Work A project initiative of Mungabareena Aboriginal Corporation and Women's Health Goulburn North East. It is supported by the Upper Hume Primary Care Partnership and Albury Wodonga Health - Wodonga Campus. THS shall utilise the checklist produced from this project in providing care for Aboriginal and Torres Strait Islanders. THS plans to undertake a health and community services audit using the tool Working with Aboriginal people and communities - later this year. This audit tool is to help assess access and quality of care at our service for Aboriginal people. This audit can serve as a prompt to encourage us to challenge existing cultural norms and values which can limit our ability to make services and programs accessible, responsive and accountable to those with the greatest need in our communities. It has been designed by both Aboriginal and non-aboriginal workers, from a range of local services, that ensures it is both relevant and useful. Small changes can make a big contribution to providing better care. 5

7 Health Promotion Staff Immunisation Staff have supported and embraced the influenza immunisation program this year with our vaccination rate being the highest ever recorded and above the expected state rate. The improvement in the increased rate has been attributed to increased advertising across the organisation, and increased scheduling of immunisation availability throughout the organisation , 52% of staff members were immunised against influenza , 65% of staff members were immunised against influenza. Sue Reid Women s Health Nurse with Louise Bowran Infection Control Coordinator Sue Reid Community Health Nurse Women s Health with Breast Screen Victoria Nurse Breast Screen Victoria Van Visit The Breast Screen Van arrived at Tallangatta Health Service (THS) in October following advertising of their proposed visit. A record of 160 women were able to be screened which greatly exceeded the Breast Screen Victoria s goal for our area. It was thought that the response was due not only to the recall notices being sent out from Breast Screen Victoria, but also through the opportunistic health promotion from THS staff and promotion through local media. Women were also informed by word of mouth or asked to bring a friend. In a small township such as Tallangatta and surrounding areas it is thanks to the support from the community that continue to see our number of women screened grow, and we look forward to Breast Screen Victoria s return in The Tallangatta women reported they were very happy with their appointments, and commented that the experience was far better than they expected and it was wonderful to have this service visit. 6

8 Service Satisfaction Feedback Tallangatta Health Service (THS) endeavours to improve the services that it delivers by listening carefully to the feedback that is provided by patients, residents, staff, volunteers, and visitors. We welcome consumer feedback as it provides us with an opportunity to review our services. A complaint is an expression of dissatisfaction and can be about any aspect of our services. THS aims to support those who provide feedback by being fair and responsive. We encourage consumers wherever possible to try and resolve the issue directly with the service provider. Should the complaint be unable to be resolved at this level than it can be lodged with an Executive staff member. Consumers have access to feedback forms which are located throughout our facility (for example at the front office, entry to both aged care facilities, the Medical Centre, and at the bed side). Reminders about the process are placed regularly in staff and residents newsletters and discussed at staff and resident, family and friends meetings. Patients, residents and carers are encouraged to discuss any concerns regarding their clinical care with their treating Doctor. All feedback is responded to and reported back through the Quality Committee Quarterly Feedback Jul - Sep Oct - Dec Jan - Mar Apr - Jun Compliments Complaints In THS received a total of 21 complaints which was 25% of our total feedback. Of these complaints all were answered within 30 days. There were 64 written compliments received which was across all sectors of the organisation. Improvements in Education to staff on the Comment, Compliments & Complaints Policy Review of the Telephone Effective Discharge Questionnaire Form Review of the employee handbook to include information on the feedback process New reading lights for residents Into the Future Compliments and complaints process to be included into mandatory education To continue to monitor post discharge telephone calls to patients Monitoring of feedback from respite residents Annual Residential Satisfaction Survey Feedback process incorporates Department of Health and Ageing Better Practice Guide to Complaint Handling in Aged Care Services

9 Satisfaction Survey Results Residential Aged Care Tallangatta Health Service undertakes an annual internal residential satisfaction survey of all residents or their representatives which provides them all with another opportunity to provide feedback. Comments or suggestions from our residents or their families through this survey help to guide us to areas that may need improving. The return rate of completed surveys in 2012 was 53%. Five questions from the total of 23 questions included in the survey had a response rate of less than 90% complete satisfaction, these included: Does the laundry system return clothes in a timely fashion? Are there adequate clergy or religious services? Are there adequate food choices? Have you received information on your rights & responsibilities? Is Feedback managed in a timely fashion? The invaluable information that our residents provided us with has led to further opportunities for improvement including: Successful grant application leading to upgrade of the laundry, & equipment Increased advertising & signage regarding the religious services Menu content and meal choices (seasonal cyclic reviews) and kitchen upgrades Employment of dietician commenced in August 2012 working with both residents and food services staff Consumer Information regarding rights & responsibilities discussed at residents and friends meeting and displayed Review of the Residential Aged Care Facility meetings Terms of References with feedback to be included as a standing agenda item Acute Care Tallangatta Health Service participates in the Victorian Patient Satisfaction Monitor (VPSM) program run by the Department of Health that allows organisations to compare their performance with similar sized & type of health services. This is a state wide satisfaction survey for acute care patients. Reports are available six monthly, although we are able to access data monthly for more timely and meaningful reviews. As there have been low numbers of acute care patients we have been unable to obtain statistical results for July 2012 June 2013 that would provide adequate comparable data. Included are some verbatim comments we have received to the following questions which have been forward to departments and where applicable reviews and actions are implemented. What was the best thing about your stay in hospital? What were the worst things about your stay in hospital? What could the hospital do to improve the care and services it provides to better meet the needs of the patients? Friendly, attentive, helpful & caring staff Cleanliness of room and surrounds Wonderful views of the weir from my window, peaceful and quiet Some meals were repetitive Two way shared bathroom, used by both genders Bed too short I don t know of any way my stay could have been improved Employ more staff where needed Not leave you for so long on arrival to complete admission 8

10 Discharge Telephone Calls to Acute Care Patients Tallangatta Health Service aims to contact all discharged patients to check on their wellbeing and also to ensure that they were happy with both their care whilst in hospital and with any discharge care arrangements that were made. Telephone calls are made by a Registered Nurse 3 5 days after discharge. The Effective Discharge Survey form was reviewed this year and now allows staff to ask more meaningful questions in relation to patient in hospital care and their preparedness for discharge. The feedback from our patients and their families helps guide us in areas such as discharge planning and support service arrangements. Medical Clinic Patient Satisfaction Survey Results The Tallangatta Health Service Medical Clinic patients were invited to complete the external Practice Accreditation and Improvement survey which concluded in March The survey results have been benchmarked against other Australian General Practices and highlight and identify areas for review and improvement. Examples of areas where the Medical Clinic has scored in the highest percentile include: Appointment satisfaction Information on fees Comfort of waiting room Reception staff Examples of areas where the Medical Clinic results have fallen in the lower percentile include: Second opinion Home or other visits After-hours choice Reassurance Explanations Verbatim comments included: Employment of more and permanent doctors Happy as the service is great Open on weekends or later at nights as I work in another area so I have to take a day off to see the local Doctor This practice is as good as any practice I have experienced Always courteous, efficient and I have left the centre satisfied with the visit Welcome to our new Doctor Tallangatta Health Service and the Tallangatta community welcomed our new General Practitioner Dr Anne McMahon to the Tallangatta Medical Centre. Dr McMahon has joined the practice permanently. Dr McMahon has moved from Tasmania where she had lived for nine years and is happy to have returned to Victoria which she calls home, Describing herself as a country girl at heart Anne is settling in well to her new home with her family of horses, dogs and cats. She also hopes to further pursue her interests in horse riding, bush walking, and choir singing. Staff members at Tallangatta Health Service are excited to have Dr McMahon commence. Her strong interests in preventative health, aged care, and palliative care will complement her commitment to country medicine. As this report has just been received, key staff members are to meet to review the results and develop actions to implement improvements. Domain THS Mean Score % Benchmark % per Number of FTE GPs Access & Availability Information Provision to Patients Privacy & Confidentiality Continuity of Care Communication Skills of Clinical Staff Interpersonal Skills of Clinical Staff Overall Score Dr Anne McMahon 9

11 Staff Health and Safety Tallangatta Health Service (THS) has an Occupational Health & Safety (OH&S) Program which is designed to provide a safe working environment for all staff and volunteers whilst promoting a positive health and safety culture. The program is about: Reducing risks to staff, volunteers and visitors and eliminating hazards By providing training and education for staff Completing workplace safety audits and risk assessments Reporting staff incidents and hazards Monitoring and reviewing OH&S through continuous improvement programs Improvements in Continuation of the replacement program of floor coverings to aid in the wheeling of equipment Annual audit of all patient/resident equipment Annual workplace safety inspections of all areas. Purchase of a specifically designed golf buggy to facilitate the safe delivery of meals between The Hospital Kitchen and Bolga Court Residential Aged Care Facility. Training for a further two staff members in OHS completion of 5 day course Upgrade of the laundry and kitchen facilities and equipment For the future Further staff to attend OH&S external training and refresher courses Implementation of MEX software for scheduled maintenance and management of equipment and facilities. MEX is an on line data base for all assets of THS that will provide reminders until scheduled maintenance is completed. 10 Total OH&S Incidents Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 10

12 Life in Residential Aged Care Stan s Story Stan had never thought nor had much time to think about what he would do and where he would live should he be left alone. The past eight years had been busy, spent caring for his loving wife who sadly passed away in the May of 2012 after 54 years of marriage. Stan was born in Old Tallangatta, and grew up in the surrounding district; he had been involved in sporting clubs, playing football and cricket locally. He had a few jobs over the years working on the railways, building bridges, dairy farming, and bus driving so was an identity in the local community with many and varied networks of contacts and friends. With all this Stan still found the grieving process just so hard, whilst the day time was pretty good and I could keep myself occupied, coming home to an empty house, preparing meals and eating by yourself is just so lonely. Stan has lots of family around, children and grandchildren as well, who often dropped in to see him and help out, but you know they are busy, have their own lives to lead. It was suggested after becoming unwell himself that he look at the local Residential Aged Care Facility Bolga Court, so he decided that he should come in for a spell and took up the opportunity of having a few weeks respite in the facility to see what it was really like. After settling in a few weeks of respite stretched on and Stan and his family decided that it was for him and he became a permanent resident. I d have been dead today if I hadn t come in here. I feel as though I don t have a worry in the world. The benefits for Stan, he feels, have been enormous; it s a big change, getting looked after and I feel just so supported by everyone, all the staff have been wonderful especially with the grieving process. Stan has even been reconnected with friends and acquaintances, even living in the same module as another resident he used to work for many years ago and they had lost contact, even though they had both continued to live in the district. 11

13 Stan still has his house in town and visits regularly to do some gardening and potter around in the shed. To be able to return whenever I want is important to me with the grieving process all those memories.. At Bolga Court I can still keep my car so have the opportunity to continue to do some of my own things; like play some golf, go and watch some local football games, and meet my daughter weekly for lunch; but more importantly I can participate in activities organised at the facility. There are so many things on and happening, the timetable is put up and we get to choose from bus trips to luncheons and the exercise groups; I am kept pretty busy but I like it that way Not having to worry about preparing and cooking meals and to sit around the meal table with lots of others and have a laugh over an enjoyable meal is a great way to end the day, and the views are pretty good too. 12

14 Accreditation Status Tallangatta Health Service (THS) is required to achieve and maintain accreditation with approved accrediting bodies. Currently our Acute services of THS are accredited until April 2015 from the Australian Council on Health Care Standards Evaluation and Quality Improvement Program 5 th Edition. From January 2013 all Health Services will be required to meet the newly implemented National Safety & Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Health Care. THS has been preparing to meet these new standards by appointing senior staff as portfolio champions to each of these standards. These leaders and their teams, by conducting gap analysis against the standards have been able to develop action plans to address any identified areas for improvement. Accreditation is one tool, in a range of strategies, which can be used to improve safety and quality in hospitals. It is a way of verifying: Actions are being taken Systems data is being used to inform activity Improvements are made in safety and quality. The National Safety and Quality Health Service Standards Include: Standard 1 Governance for Safety & Quality in Health Service Organisations Standard 2 Partnering with Consumers Standard 3 Prevention and Controlling Healthcare Associated Infections Standard 4 Medication Safety Standard 5 Patient Identification and Procedure Matching Standard 6 Standard 7 Standard 8 Clinical Handover Blood and Blood Products THS has an exemption from this standard as we do not administer blood or blood products Preventing and Managing Pressure Injuries Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care Standard 10 Preventing Falls and Harm from Falls 13

15 The table below outlines all of the accreditation processes that are in place across THS and the status of each as at June Residential Aged Care Facilities Aged Care Standards and Accreditation Agency Ltd General Medical Practice Royal Australian College of General Practitioners (RACGP) Standards Acute / Home & Community Care (HACC) Australian Council on Healthcare Standards (ACHS) EQuIP 5 Last Audit August 2012 Support visit April 2013 November 2010 November 2012 Accreditation Achieved Yes Yes Yes Next Audit August 2015 November 2013 November 2013 Self-assessment report Comment Expect one support (unannounced) visit annually Desk top audit to be submitted July 2013 Self-Assessment Report will be against the National Safety & Quality Health Service Standards that became effective in January 2013 The residential aged care facilities of Lakeview and Bolga Court both underwent Accreditation in August 2012 conducted by representatives of the Aged Care Standards Agency. There are four standards as listed which cover 44 outcomes that have been assessed: Standard 1 Management systems, staffing and organisational development Standard 2 Health and personal care Standard 3 Resident lifestyle Standard 4 Physical environment and safe systems THS met all the expected outcomes with both facilities being granted full accreditation. A wonderful result for all the dedicated staff, volunteers, carers and the residents who call THS home The Tallangatta Medical Centre shall undergo re-accreditation with the Royal Australian College of General Practitioners in the second half of Our staff members are working towards preparing the report to be submitted prior to the surveyors visit later in the year. 14

16 Preventing Falls and Harm from Falls Falls and fall related injuries are one of the leading causes of harm in older Australians. At Tallangatta Health Service (THS) all staff are responsible for falls prevention and it is a significant priority across the organisation. Patients and residents are assessed for their fall risks on admission and on a regular basis thereafter; the rating for each demonstrates the extent of supervision and/or assistance they may require with transfers and mobility. Definition: Fall: An event which results in a person coming to rest inadvertently on the ground or floor or a lower level. Interventions that have been utilised at THS to prevent falls and the impact of falls have included: Residents participation in strength and exercise classes A multidisciplinary team approach in assessment and management Medication management and review by the Medical Officer Use of equipment (ie: hip protectors) & motion aids (ie: bed & chair sensors) Falls reporting through the electronic reporting tool (VHIMS) External reporting to the Department of Health for Aged Care residents. Review of falls data at Quality & Clinical Review meetings. Submission of Clinical Indicators for Acute and Aged residents. Improvements in the prevention and management of falls in World Health Organisation Staff education and training on falls prevention and management Identification and audits of equipment needs to prevent falls (ie; floor sensor mats, shower seating ) Multidisciplinary team involved in the care of residents/patients identified as a high falls risk and referral post fall Falls prevention information provided at the patient s bedside Risk assessment of grounds to identify potential trip hazards PREVENTING FALLS AT HOME Wear safe shoes and have foot problems treated Keep your home and garden safe and free of clutter Maintain good vision and have regular eye checks Adequate lighting Find out more about your medications from your Doctor or Pharmacist Discuss any changes or concerns in your balance or mobility with your Doctor. Report any feelings of dizziness or unsteadiness Participate in Community Strength and Balance Groups Occupational Therapist referrals to assess for home hazards & identification of equipment needs Continence Management consult your Doctor or Incontinence Nurse 15

17 Preventing and Managing Pressure Injuries Pressure injuries may develop due to immobility, such as sitting or lying in the one position for long periods. They are a common complication in health care settings, are often difficult to treat and are recognised as one of most common causes of harm to patients. Residents and patients that are at the greatest risk of developing pressure injuries are those who are immobile for long periods of time, the elderly, smokers and those with a poor nutritional intake. THS recognises that prevention and management of pressure injuries is an important safety issue for our residents and patients and remains a priority for staff. THS uses a range of strategies to prevent and manage pressure injuries which includes: A multidisciplinary team approach in the prevention and management of pressure injuries The use of pressure-reducing support surfaces and equipment The reporting of pressure injuries at Quality and Clinical Review meetings The external reporting to the Department of Health To be able to compare the incidence of pressure injuries developed in hospital with other like sized organisations, for the first time THS submitted deidentified data to The Australian Council on Health Care Standards on the incidence of pressure injuries developed in the acute ward. This data identified that for the reporting period of Jul 2012 Dec 2012 we had a rate of 0.32%, whilst this result was at the lower end of the confidence interval, the rate was greater than the aggregate rate for like sized organisations which recorded 0.10%. THS shall continue to monitor the rate of pressure injuries acquired in hospital, and strategies to prevent and manage these occurrences. Definition: Pressure Injury: A localised injury to the skin and / or underlying tissue, usually located over a bony prominence. As a result of pressure, shear, and / or friction or a combination of these factors damage occurs to the skin, muscle and / or bone. Australian Commission on Safety and Quality in Health Care October PREVENTING PRESSURE INJURIES - WHAT CAN YOU DO? Move Move Move Keep active and move frequently whether in a chair or bed to relieve pressure Look After Your Skin Keep it dry, clean and moisturised. Report any concerns you may have however minor Eat a Balanced Diet If you need to know more ask your nurse or Doctor 16

18 Medication Safety Medicines are the most common treatment used in health care. As they are so commonly used they are associated with a higher incidence of errors. The safe and appropriate use of medications in the acute and residential aged care facilities is an important area for quality improvement at Tallangatta Health Service (THS). The minimisation of errors is important for the safety of our residents and patients. Medication errors are reported on the electronic reporting tool Victorian Health Information Management Systems (VHIMS). This enables the service to monitor events or circumstances and supports change processes. Each incident is reviewed to see if improvements can be made to prevent a recurrence. Incidents are reviewed by the Quality and Clinical Review Committees which track trends, system failures and promotes activities to prevent reoccurrences. For there were 34 medication-related incidents reported across the Health Service. A number of strategies have been implemented to reduce errors such as: Staff education and training Development of supportive documentation to assist staff with medication management Regular contact with external pharmacist Resident medication reviews by the Medical Officer THS has identified the need for continued work to reduce the number of medication incidences reported. Patient Identification and Procedure Matching Registered Nurse Biji Kuttiyil Jose checking patient records Patient identification and the matching of a patient to an intended care process such as administering medication is an activity that is performed routinely in all care facilities. Identification of patients whilst performed so regularly can sometimes be seen as unimportant. The development of safety routines for tasks that are commonly performed such as patient identification provides a defence against simple mistakes. THS through a gap analysis of the Patient Identification and Procedure Matching Standard that came into effect in January 2013 identified areas for improvement which have included: Development of Identification of a Patient / Resident / Consumer Policy Review of the Photograph Resident Procedure for Aged Care Use of standardised data to be included on patient name tags Residents identification photographs audited to ensure compliance they are attended to annually Audit of Acute Patients to ensure patient identification name tags are insitu with correct data 17

19 Preventing and Controlling Healthcare Associated Infections Maintaining a safe environment for our patients, residents, staff, volunteers and visitors is a core business of the Infection Control Program. All staff have an active role in the infection and prevention strategies for Tallangatta Health Service (THS). One strategy implemented is Hand Hygiene. This is a simple, low cost strategy that plays a major role in keeping everyone safe by preventing the spread of most organisms that cause healthcare associated infections. Hand hygiene audits are attended quarterly and submitted to the Department of Health. Our compliance rate of 76.6% for the reporting period July 2012 June 2013 is in excess of the Department of Health target of 70% for the acute care areas. We have made alcohol based hand rub available throughout THS and we recommend our visitors use it during their visits. Regular audits are attended across the organisation to ensure easy availability of this product. Our Environment The THS cleaning audit results indicate that we exceed the Victorian Public Health Services cleaning standards: External Cleaning Audit results. July % July % July % July % Residents provided feedback through our annual residential aged care survey indicated their satisfaction regarding the cleanliness of the environment with results: Public areas are kept odour free? Yes = 90% Cleanliness of resident s rooms? Yes = 95% Food Safety Our food safety program is maintained and monitored in a variety of ways including: External Food Safety Audit attended in July 2013 where THS was found to be compliant. The audit did suggest some recommendations which are being implemented including: Updating documentation to reflect the new cook /chill process Cooling record documentation for the new blast chiller Improved labelling for the Meals on Wheels meals Maintenance program for Bolga Court Kitchen for conversion to a servery Current pest control documentation Residents provided feedback through our annual residential aged care survey indicated their satisfaction regarding their meals with results including: Is the food appetising? Yes =90% Are there adequate food choices? Yes = 85% 18

20 Recognising & Responding to Clinical Deterioration in Acute Health Care To support the provision of appropriate and timely care to patients whose condition may be deteriorating Tallangatta Health Service developed the Recognising and Responding to Clinical Deterioration procedure in line with best practice evidence to support clinical staff providing care in the acute ward. This document was developed by a multidisciplinary team and is supported by the use of a coloured coded observation chart for recording observations, which was commenced in July Prior to the implementation of the coloured coded observation chart, numerous education and training sessions were held to support staff in the transition from one form to another and of the correct way to document. The intention of this form is to ensure that a patient s deterioration is recognised promptly and appropriate action is taken. Currently feedback is being gathered from care staff in the ease of use of the observation chart both in the acute ward and urgent care room. The use of this chart across the facility has also decreased the need to have numerous other observations charts. Clinical Governance Clinical governance is about being accountable for providing good safe care and is fundamental to providing and improving patient safety at Tallangatta Health Service (THS). Clinical governance is the system by which the Board of Management, Executive, workforce and stakeholders share responsibility and accountability for the quality of care given to patients, residents and clients. It is a system that ensures we are continuously improving, minimising risks, and fostering an environment of excellence in care. THS has developed, and the Board has endorsed, through our Strategic Plan a Framework that focuses on areas to ensure that we provide adequate care which include: Strong operational practice Developed partnerships Continual financial viability Workforce for the future Positive impacts on community health At THS the Clinical Review Committee and Quality Committee are the key bodies for monitoring and identifying risks and providing directions for clinical quality and safety. These committees report to the Board of Management. 19

21 Partnering with Consumers Effective engagement by health service organisations with consumers and the community is integral to better, more transparent healthcare for consumers, their families and carers. Engagement enables consumers to work actively as partners with clinicians in their healthcare, and empowers local communities to have a greater say in the planning, design, delivery and evaluation of their health services, contributing to more efficient and effective healthcare delivery. Partnering with our consumers provides a better health service and lifestyle outcomes for our community. Our strategic aspirations- Make the greatest possible positive impact on our community s health and develop and utilise partnership that add value to our effort - are our guiding principles to develop a robust and sustainable community engagement strategy and framework. Our consumers input will enable us to make more informed decisions for future service planning, guide us to think critically about the models or care and service we provide, and assist us in measuring our service and evaluating our systems of care and service. This consumer centered approach changes the service delivery paradigm from one of doing to to that of working with. This is a critical cultural shift in health care and paves the way for fostering a collaborative approach to care decision making and evaluation. Tallangatta Health Service (THS) is currently reviewing systems to ensure that they enable partnering with patients, carers and other consumers to improve the safety and quality of care. This is an important direction to ensure that the health service is hearing what is important for to their consumers. A Board Member Jean Teek, CEO Robyn Gillis, and staff member Denise Gigliotti serving fruit salad at the Tallangatta 50 s Festival as part of the Healthy Eating Initiative. 20

22 Volunteering in our Community A Volunteer Coordinator position was established with an appointment made in July 2012 Whilst the role of the Volunteer Coordinator is to coordinate the volunteers, the identification of volunteer roles and their support on a day to day basis is carried out by Tallangatta Health Service (THS) staff including Clinical Care, Lifestyle, Home and Community Care (HACC) and Hotel Service staff. Actions undertaken by the Volunteer Coordinator have included: Review of volunteer roles within the THS & development of positions descriptions Meetings with all volunteers to identify their interest in continuing as volunteers Recruitment of new volunteers Electronic database of registered volunteers Identification of the need to develop volunteer information packs Identification of new volunteer roles Outcomes Develop electronic database for the recording of volunteer numbers, participation hours and roles Currently there are 45 registered volunteers with approximately 30 active in any one month In June % of registered volunteers were active within the month Volunteer roles have been clarified and position descriptions developed Volunteers are now active in twenty program areas Creation of new volunteer roles throughout (see table) Staff education on the role of the volunteer advocates Meals on Wheels now delivered only by volunteers Monthly reports of volunteer participation Future To ensure volunteers receive copies of their position description / role and have input into the ongoing reviews of the roles New volunteer information packs finalised & distributed by the second half of To continue to look at opportunities for other volunteer roles to support THS To promote the role of the volunteer Existing volunteer roles New volunteer roles created Meals on Wheels Support with activity groups such as Mailmen, Mixed Community Group, Lunch & Laughter, and singing groups Drivers both locally and for appointments in Albury Wodonga. Visitors to residents in both Lakeview and Bolga Nail care Shopping support Paper delivery Canteen trolley Podiatry porter Lifestyle club facilitators Massage Auxiliary members who raise funds, and undertake sewing to improve the comfort of residents Special occasion support such as Christmas, Easter, Melbourne Cup, Mother s Day Exercise pole walking, tai chi Reviewing publications such as Quality of Care Report Bolga Walking group (currently in recess) Facilitation of group meetings with Bolga residents about the sorts of things they would enjoy to do. Volunteer Advocates If you would like to join the dynamic volunteering team at Tallangatta Health Service, or know someone who would, please phone and ask for the volunteer coordinator. 21

23 Volunteer Celebration The volunteer celebration luncheon was held in May and was attended by 22 volunteers. All volunteers registered with THS received certificates recognising their service and Volunteering Australia 2013 pins. For the many times she has been available with a few minutes notice to drive, or deliver Meals on Wheels: Yvonne Bament For tireless work behind the Meals on Wheels scene completing rosters: Olive Milsom For undertaking at least five different volunteer roles, sometimes in the same week!! Judy Cochrane For managing in most weeks to contribute five hours to the Mixed Community Group (MCG): Sue Hurley For her reliability in contacting community members on behalf of staff and being the go to girl in Bethanga: Dianna Schmidt SPECIAL AWARDS FOR VOLUNTEERS Judy Cochrane undertaking her trolley run to residents in Bolga Court THS VOLUNTEERS HOURS SEP JUN 2013 Volunteers Registered Volunteers utilised Volunteer hours provided 0 Sept Oct Nov Dec Jan Feb March April May June 22

24 Education Group photograph of LASA education participants Advanced Aged Care Funding Instrument Training In March 2013 Tallangatta Health Service (THS) provided the venue for Advanced Aged Care Funding Instrument Training from Leading Aged Services Australia (LASA) where key personnel from THS along with staff from four other Aged Care Facilities in the region attended the two day course. The course is designed to provide a comprehensive understanding of the funding process and documentation ensuring that we are able to maximise claims. Whilst this course not only provided invaluable information to the attendees, it also gave five Residential Aged Care facilities the opportunity to network and share information. All participants either strongly agreed or agreed that the information was adequate and relevant. Feedback from the training: Great to work with our neighbours Excellent learning opportunity Great sessions Informative and useful to our work practices Mr Leigh Wellings (LASA) presenting details around ACFI documentation to an attentive audience of care staff from THS and other Aged Care Facilities in the region. 23

25 Credentialing & Professional Development Credentialing refers to the formal process used to verify the qualifications, experience and professional standing and other relevant professional attributes of clinicians. Scope of practices outlines what is appropriate practice for a clinician within work environments, based on their qualifications and organisational needs. The credentialing system at Tallangatta Health Service ensures that all clinician s qualifications are verified on appointment and that where applicable provision of proof of ongoing registration. All staff are required to have a current Police check. Processes are adhered to at the employment commencement phase to ensure that these checks are completed and then at three yearly intervals. Professional development support is provided to staff within the organisation to attend courses, conferences and study days to ensure that they remain up to date with best practice and assists in adhering to professional development requirements with registration bodies. Lenore Rhodes Director of Nursing volunteering at the International Nurses Conference in Melbourne. Feedback from our Staff - People Matter Survey 2013 Tallangatta Health Service (THS) Staff participate in the People Matter Survey what our employees think about THS as a place to work. The results identify where our employees consider that the organisation is performing well or above expectations and also areas where improvements may be required and actions to improve designed. The survey results are compared with similar like sized organisations. THS completes the survey bi - annually which provides the service with an opportunity to implement strategies for improvements and have them embedded prior to the next survey. Whilst the survey provided us with information such as 94% of the workforce is female, 89% work part time and 63% have been employed for greater than six years, other data collected is across a variety of focus areas including values, employment principles, work environment, patient safety. Results included: Received a formal performance appraisal 95% (2011= 71%) Aware of organisations code of conduct 100% (2011= 88%) In my organisations there are clear procedures & processes for resolving grievances = 85% (2011= 65%) Opportunities for development 67% (2011= 50%) and the average for health services = 59% Overall job satisfaction 67% - slightly lower than the average for health services = 75% People Matter Survey Results -Values Average 24

26 Home and Community Care The Home and Community Care (HACC) staff from Tallangatta Health Service (THS) provides a range of support services to frail older people and younger people with a disability and their carers, who wish to continue living at home and need some extra support in managing daily tasks. Clients receiving HACC services provided by THS have diverse backgrounds and needs. Assessment and care planning is the foundation for individualised high-quality interventions, support and assists people to navigate through HACC and the broader service system. HACC Living at Home Assessments and the Active Service Model (ASM) use a strength-based partnership approach to develop individual solutions to optimise health and wellbeing. Recognising diversity and using culturally acceptable practice is essential. From February this year we are now delivering HACC services in runs which means that each staff member has been allocated a run. Runs have been created based on the needs of a certain area within our catchment. The implementation of a run structure was based on feedback from both our clients and staff. The new runs are a six hour day. If permanent staff are sick or on leave, a casual staff members picks up the whole run. One of the drivers for the implementation of this model was to reduce the amount of changes to days and times to our clients receiving care. In addition this new model has also allowed: THS provides cars to HACC staff thus reducing the use of their own vehicles Balanced rosters for staff: Incorporate home care, personal care, respite care & shopping into runs Improved cost effectiveness A sign out / in sheet to monitor that staff have arrived back safely to the office Improving communication between Assessment Officers and Personal Carers Provision of HACC services contact number to clients who can leave messages 24 hourly Our new wheels Recently the HACC department at Tallangatta Health Service purchased a Barina Spark for use by staff members. In the past, HACC staff members may have used their own cars to visit clients in the community. The service was revised and changes made to improve efficiency. Staff members in most of the catchment areas now use a THS vehicle which is more cost effective. The Barina can be seen buzzing around the town as staff members undertake their work. The new vehicle has been very popular and by all reports is great to drive, has been a comment from staff. Andrea Croucher (Community Intake and HACC Assessment Officer) and Penny Paton (HACC Team Leader) with the new Barina Spark. 25

27 Community Participation District Nursing Home visits from the District Nurse team are necessary for many community members to maintain their independence, while having their overall health supervised by trained and caring staff. Tallangatta Health Service s District Nursing is available five days per week and on call on weekends for palliative clients in the final stage of their illness. Our District Nurse team is comprised of highly qualified registered nurses devoted to the care of community members of the Towong Shire. Our District Nursing team provided 1876 hours of nursing care to members of our community this year. District Nurses work with their clients supporting them to develop a care plan that meets individual care needs. They monitor general health, including blood pressures, blood sugars, pathology collection and wound management. Referrals to district nursing can be made by a doctor, a hospital, a family member with the client s consent, or self-referral. District Nurses may also connect clients to other support services such as home and community care, physiotherapy, occupational therapy, social worker, financial counsellor, podiatry, dietician, diabetes nurse, women s health and palliative care. If you have any questions or would like to self refer to the District Nursing Team, contact for further information. Case Conferencing In 2013 we introduced a more structured case coordination and case conferencing program to assist the District Nurse Team with improved care and service coordination. Using a case coordination approach has enabled improved communication, information sharing, and collaboration, and occurs regularly with other staff serving the client within and between agencies in our community. Our coordination activities may include directly arranging access; reducing barriers to obtaining services; establishing linkages; and other activities recorded in the client s progress notes. Case conferencing is implemented when a more formal, planned, and structured collaboration is required to meet the complex care needs of clients. The goal of case conferencing is to provide holistic, coordinated, and integrated services across providers internal and external to the health service, and to reduce duplication. Case conferences are usually interdisciplinary, and include one or multiple internal and external providers and, if possible and appropriate, the client and family members/close supports. We use case conferences to identify or clarify issues regarding a client status, needs, and goals; to review activities including progress and barriers towards goals; to map roles and responsibilities; to resolve conflicts or strategize solutions; and to adjust current service plans. WOUND MANAGEMENT District Nurses Rosalie Jeffery and Elaine Mason with administration staff during case conference meeting. This year The District Nursing team have worked more closely with the Wound Management Clinical Nurse Consultants for the Hume region. They provide support across the catchment for the Wounds in Hume Improvement Program (WHIP) and have been highly supportive to the District Nurse team in managing a number of complex wounds with positive health outcomes for the clients. 26

28 New Facilities Kitchen Services Earlier in 2013, Tallangatta Health Service was successful in receiving a grant from the Victorian Government for one hundred and twenty two thousand dollars to upgrade our kitchen facilities. Work began on the upgrade in June and was completed within the month During the renovation period, the kitchen had to relocate to makeshift premises to continue service delivery to residents and patients. The Tallangatta Secondary College provided support to the health service through the use of their Hospitality on Wheels van enabling catering staff to cook on site. This partnership assisted the renovation process to run smoothly and efficiently Hotel staff members embraced a few small inconveniences during the renovation, although meal delivery flowed with no interruption to patients or residents; and no complaints were received during this time. The new kitchen is more energy efficient to operate & includes new equipment such as: Equipment - Larger Oven, Blast Chiller, Commercial Planetary mixer, and television Improved and larger storage areas Freezer, Dry & Cool rooms Larger food preparation areas Food transportation vehicle (specifically designed) Designated office area within kitchen Emma Nankervis Manager Hotel Services shows Board Members the new kitchen renovations (Left to Right) Emma Nankervis, Rob Lees, Andrew Brown, Faye Cornish and Craig Heiner. Tallangatta Secondary College Hospitality on Wheels Van on site during June. 27

29 Laundry Services Tallangatta Health Service was successful in receiving a capital grant of seventy thousand dollars to update the onsite laundry, so in November 2012 the renovation journey began. The existing laundry structure was remodelled to improve functionality and improve compliance. New machinery was installed which consisted of two commercial washing machines and commercial tumble dryers which has increased our capacity four fold. With the introduction of these machines and the renovations we have been able to deliver a more efficient and professional service to our increasing number of residents. The renovations offer many great improvements to our service including: Greater capacity and efficiency with improved turnaround times Improved staff safety through automatic chemical dispensing Cost savings on water, gas, chemicals, electricity and labour Improved Infection control measures Introduction of environmentally sustainable equipment. Reduction of risks such as manual handling Rod Bramich (Director Corporate Services) and Estelle Star (Environmental Supervisor) in the upgraded laundry. Our Environmental Impact Energy Audit In May 2013, Tallangatta Health Service (THS) completed an independent review of energy usage at the Service and our environmental impact. The audit was conducted over two days and a comprehensive report delivered in June This has provided THS with several recommendations as to how we can reduce energy usage, save energy costs, and improve on its environmental impact. The recommendations include: 1. Upgrading air-conditioning and heating systems. 2. Consider the utilisation of solar energy for long term cost savings. 3. Upgrade of lighting systems. THS plans to implement some of these recommendations during the year. Priority will be given to those that can be funded within the Capital Plan for the year, provide the best operating cost saving and greenhouse emission reduction. 28

30 Residential Aged Care Quality Indicators Tallangatta Health Service (THS) submits data quarterly to the Department of Health from the two on site Residential Aged Care facilities. A range of data which compares THS with other organisations within Victoria is submitted including: the prevalence of pressure injuries prevalence of falls and fall related fractures incidence of physical restraints incidence of residents prescribed nine or more medications incidence of unplanned weight loss Pressure Injuries Lakeview Nursing Home There were ten pressure injuries reported during the year, with most reported to heal quickly. The rates were comparable to the Statewide High Care Rates. Bolga Court There were eight pressure injuries reported during the year. These rates were slightly higher or comparable to the State-wide High / Low Mixed Rates. Falls Physical Restraint Medications Weight Loss The prevalence of falls and fall related fractures. There were reported falls per quarter of between 5 11 falls which placed THS below the State-wide High Care Rates for all but one quarter. There were three fractures related to falls. No restraints were used for the year. Therefore THS is below the state wide rates in all reporting quarters. For each quarter we had up to 3 residents prescribed nine or more medications. For each quarter THS was below the Statewide High Care Rate There were three residents reported over the year with weight loss >3kg, which meant our rates were below the State-wide High Care Rates. The prevalence of falls and fall related fractures. There were reported falls per quarter of between falls which placed us below the State-wide High / Low mixed rates. There were two fractures related to falls. Increase in falls may be related to increased occupancy from 70% to 100% May 2013 No restraints were used for the year. Therefore THS is below the state wide rates in all reporting quarters. For each quarter we had up to 12 residents prescribed nine or more medications. These rates were comparable to State-wide High / Low Mixed rates There were five residents reported with weight loss > 3kg which was comparable to other organisations in the State-wide High / Low Care Mixed Rates, Tallangatta Health Service shall continue to submit data quarterly to the Public Sector Residential Aged Care Quality Indicators and where results are outside expected parameters develop action plans to implement changes for improvement. These results are reported quarterly at the Quality Committee and Clinical Review meetings. 29

31 Transition Care Program The Transition Care Program (TCP) commenced in 2011 a partnership between Tallangatta Health Service (THS) and Albury Wodonga Health Wodonga Campus. The aim of this program is to assist older people in their recovery after an acute hospital admission through offering a combination of therapies; for example occupational therapy, physiotherapy and coordinated care. This program also provides patients, their families and carers the opportunity to consider long term care arrangements and options which may include living independently at home with support services or looking at permanent care options. The provision of the TCP at THS means that locals have the opportunity to continue their treatment close to family, friends and home, which is important within rural communities. The TCP assists patients and their families to make appropriate decisions about long term care plans and may prevent premature admission to permanent care. The majority of admissions to THS on the TCP program return to their home and communities on successful completion of the programs. Other local community support systems may also be deemed necessary on discharge. The average length of stay on the program for patients is six to eight weeks. Support and care planning for the patients is provided by a combination of allied health from AWH and nursing care from THS. The total bed days of TCP patients for was 559 which is an increase from the 359 bed days in Ulysses Club Connects with Tallangatta Health Service The Albury Wodonga Ulysses Club kindly donated one thousand dollars towards the purchase of two IPADs for Tallangatta Health Service. The IPADs have been utilised by our staff to conduct audits against Cleaning and Hand Hygiene Standards which has made the task more efficient for data collection and reporting. In the future our Lifestyle staff aim to use these devices with the Residents to connect with their family and friends via SKYPE. Ulysses Club Members visit Tallangatta Health Service 30

32 Auxiliary Members Make a Difference Tallangatta Health Service (THS) has been ably supported by a small group of dedicated community members who make up the THS Auxiliary. Many of their hours are spent fundraising, or sewing items to support patients and aged care residents. These tireless workers have been able to assist in areas which are not always funded through regular streams. Since 2007 they have donated items to the value of over $33,000, which have included clinical care equipment, activity equipment and outdoor furniture items. This has been of benefit not only to our Aged Care Residents in Lakeview and Bolga Court, but also to community health programs like the Men s Shed. The Auxiliary also hand craft items of need such as curtains and bedspreads and they assist in labelling items of residents clothing. In August 2012, the Auxiliary purchased blinds for the Lakeview lounge windows and bed screens for the Lakeview bedrooms. These are made of fire retardant fabric and now comply with Aged Care Standards. In total this donation came to over $5,800. The staff members and Executive extend their sincere thanks and appreciation to the dedicated Auxiliary members. Auxiliary members left to right: Carol Ludbrook, Eileen Hange, and Elaine Ledingham Rotary Protecting Local Lives The Rotary Club of Tallangatta donated $2000 towards the purchase of an Automated External Defibrillator (AED) for the Tallangatta Health Service Medical Centre. This vital piece of equipment will be used in times of emergency in the Medical Centre, and throughout the Tallangatta Health Service organisation. The whole community will benefit from the AED thanks to the generous donation by the Rotary Club of Tallangatta. Manny Chessari and Rob Caddell from Tallangatta Rotary Club with CEO Robyn Gillis (middle) showing the new defibrillator. 31

33 Awards The following dedicated staff received awards for service during the year. 10 Years 15 Years Cheryl Vance Rosalea Jeffrey Kathie Vines Kate Lewis Cheryl Lonergan Margaret Vance Cheryl Piper Louise Thornton 20 Years 25 Years Angela Stevenson Elaine Mason Chairman of the Board of Management Andrew Brown and Elaine Mason Associate Nurse Manager on her 25 years of service Distribution The Quality of Care Report is distributed to all residents, patients, families, carers and visitors to our facilities, including the Medical Clinic and to public offices of Tallangatta. Copies are distributed to our Board of Management, Auxiliary & key personnel. The report is tabled at our Annual General Meeting. It can also be found at the THS website or by contacting administration Evaluation An invitation for readers to provide feedback on last year s report was supplied with both hard and electronic copies of the distributed report. Formal responses were received and included responses such as: The report was interesting and informative to the reader The report was easy to read The length of the report was adequate Suggestions for the next report were to include more details on volunteers. We have endeavoured to capture this important group with more details included within our report. Feedback The Quality of Care evaluation form is available within this report; we would like to hear from you, we value our readers opinions. Feedback allows us to provide information that is of interest to our readers. If you have any ideas, comments or suggestions for the format of next year s Quality of Care report, please contact or write to us. Tallangatta Health Service 25 Barree Street, Tallangatta, 3700 PO Box 77 Tallangatta, 3700 Phone: Fax: THS@ths.vic.gov.au 32