Last November, Catholic Health Australia and the Australian Catholic University issued the first round of grants as part of the Nurse and Midwifery Unit Managers Development Program. The grants were established in response to the 2010 publication of the CHA Nurse and Midwifery Project report, which recommended a focus on providing professional development options for senior nurses and midwives. The grants have funded the cost of visiting other like facilities, including Catholic Health Australia facilities, to observe and seek ways to implement good practices in the nurse or midwife s own facility. Included in this brochure are testimonials from the recipients of the first round of grants. 1
Elizabeth Thomas Mater Hospital Mackay Site visited Mary Potter Hospice, Adelaide As the Nurse Coordinator of a 9 bed inpatient palliative care/oncology/medical ward, I have used the grant to visit 2 Catholic inpatient palliative care units and learn how they implement the national standards for palliative care in their service. My visit was to the Mary Potter Hospice in Adelaide and the Cabrini Palliative Care Unit in Melbourne. Although these services are operated by different catholic organisations, they share many similarities. Both are specialist units under the direction of specialist palliative care physicians and have a structured admission and referral process. Both provide a liaison home nursing service as well as the inpatient care. Whilst Mary Potter is 16 dedicated beds attached to the main hospital, Cabrini is a stand alone unit that has 22 beds. Both have extensive pastoral care and social work support. The bereavement counselling is coordinated by the social worker at Mary Potter, whilst the pastoral care team provide this at Cabrini. The follow up to family members are both carried out within a well structured plan and both places provide remembrance evenings at 3-4 months. The role of the volunteer is more structured and they provide significant support to the nursing staff in caring for the patients and their families. Programs such as biographies, art therapy, music therapy are all carried out by the volunteers under the direction of the volunteer coordinator. Both units provided me with a wonderful insight to how they are able to successfully meet the National Standards for Palliative Care. It was also a great opportunity to network regarding the use of the Palliative Care Outcomes Collaborative assessment tool for palliative patients. I would like to thank the staff at both units for their time and making me feel so welcome. 2
Grace Loh Nurse Unit Manager Mercy Hospital, Perth. Completion of a Graduate Diploma in Health & Aged Care Management I would like to take the opportunity to thank Catholic Health Australia, Australian Catholic University and MercyCare for the generous encouragement and support towards the completion of a Graduate Diploma in Health and Aged Care Management in 2011. The units I chose to study have improved my knowledge and skills to meet the changing dynamics of health care management in important areas such as: o resource management o people management o managing and using information technology o quality and safety in health and aged care management o law and ethical issues I believe that continuing my professional development and learning allows me to understand my role and responsibilities better, for the benefit of not only myself but the patients, staff and colleagues I interact with on a daily basis. In addition my role involves not only clinical leadership, quality and safety but stretches beyond organisational functions to maintain a strong sense of commitment to the core Mission and Values of our Organisations. 3
Shirley Lechmere Nurse Unit Manager St John of God Hospital Bendigo Site visited Calvary North Adelaide Hospital My professional development grant was used to visit Calvary North Adelaide Hospital. (Sisters of the Little Company of Mary). St John of God Healthcare is currently enhancing patient-centred models of care. I was keen to gain some insight in the areas of Bedside Clinical handover and the introduction of Team nursing to enable me utilise and develop appropriately educated and skilled caregivers. Midwifery Unit Manager Liz Kleinig welcomed me to the Maternity floor and openly shared ideas on how she managed her Unit. I was given a tour of the 150 bed Hospital, invited to a Maternity Education Evening, spent some time with the domiciliary midwife and attended a Standards Workshop Meeting. The Education evening included a case study on a patient who had survived an Amniotic Fluid Embolism. (A reportable event for the AMOSS study) The presentation was given by Associate Professor John Svigos. PPH was covered by Liz Kleinig NUM. This presentation was well attended by Midwives, CCU staff and theatre staff. The standards workshop covered clinical bedside handover and other areas of great interest. Due to a midwife shortage, team nursing is working well with the inclusion of both RN Div1 and RN Div2 s included on the team. I found this time spent at Calvary Hospital was of a great benefit. It has certainly fostered a professional relationship and a spirit of co-operation between our hospitals. The ideas obtained for implementation of bedside handover and team nursing will be of great assistance in my unit. Also ideas obtained re post natal care were invaluable. Shirley Lechmere & Liz Kleinig NUM Maternity Unit Calvary Hospital North Adelaide. 4
Emma Daley Nurse Manager Cabrini Prahan Erasmus Mundas Advanced European Bioethics Course The opportunity to attend the Erasmus Mundas Advanced European Bioethics Course: Suffering, Death And Palliative Care was an extraordinary experience. Thank you again to CHA of the support which enable my attendance. The course was attended by 40 participants from across the world. Many of the personal where health professionals from a variety of disciplines. Others with theological or philosophical backgrounds. Many of the presentations explored issues in which we are frequently presented with, in the daily delivery of care to our patients within our environment at Cabrini Palliative Care Services. What was of particular interest to me was the extend of ethical deliberation that was undertaken in order to protect the cultural identify of individuals and families. The notion of Autonomy and dependence within the Dutch culture was very interesting. Much discussion took place exploring the relationship between autonomy and culture and the role of healthcare in delivering services that respect and respond the cultural diversity of patients. I have reflected much on this since my return from the course, in doing so I am reminded of the complexities of the daily decisions in which we make in health care within Australia given the cultural diversity of our patient group. I am increasingly aware of the core values of Catholic Health Care particular given the organisation in which I work. The Ethos of Cabrini and care to our services is respect for life is clearly, evident within the care we provide to our patients. Separating ethical deliberation from daily care delivery is not necessary for us, as the ethos by which we work delivers respectful and culturally appropriate care simply as an expression of our values. The course offered a great experience to here from a hugely diverse group of people. Hearing of the complexity of care delivery with different parts of the world provided much fruitful discussion. 5
Helen McAllister Deputy Director of Nursing St John of God Murdoch Hospital Site visited Mater Mothers Hospital Brisbane The Mater Mothers Hospital in Brisbane, is a large Catholic hospital that has a reputation of excellence in care for maternity patients and delivers approximately 9 000 babies every year: 4 500 public patients and 4 500 private patients. The Neonatal Critical Care Unit provides 79 cot spaces including intensive care, high dependency and special care cots, making it one of the biggest neonatal critical care units in Australia During my time at The Mater I toured the postnatal, birth suite, neonatal and women's health units I also spoke to a lot of caregivers about their roles and collected lots of information, forms and charts, with the idea of adapting some of these for use at Murdoch. Although The Mater is a very big campus it still had a great people culture. The caregivers were very welcoming and very generous with their time, the campus itself is a nice blend of old and new buildings and was easy walking distance from the train station. Not to mention you could get a great cappuccino from the coffee shop! I gained a lot of benefits from my Mater visit they include: Met lots of new people Experienced another hospital Healthy exchange of ideas and processes Shared printed information brochures, forms, policies and guidelines Travelled to work on public transport Shared information with Murdoch colleagues. The following initiatives at Mater were new to me and provided a great learning experience and offered future ideas for implementation at Murdoch: "SafeQuest" hospital wide strategy to improve safety Clinical Nurse Consultant responsible for venous thrombosis prevention only Service Improvement Coach role Leader Rounding to patients and caregivers as KPI's for all managers Volunteer Nannies Baby Care Assistants Patient Flow Manager managing bed allocation with clerical support for staffing replacement Bladder scanning on midwifery patients Patient Experience Plan Special thanks: Thank you to everyone for giving up their time and energy to ensure my visit was so successful. I would like to make special thanks to the following people: Mish Hill Director of Nursing Maree Reynolds - Director of Nursing Women s Health Services Sally Cowan Deputy Director -Maternity Inpatient and Gynaecology Services Susie Wilson - Director Clinical Safety and Quality Kylie Gregory - CNC VTE Prevention Sam Drew - Midwifery Unit Manager- Ambulatory Service Robyn Allen - Mater Mothers Hosp Service Improvement Coach It was also fantastic to renew friendships with midwives Sally Cowan and Debi Crimp who worked at Murdoch years ago. All of this would not have been possible without Catholic Health Australia and Australian Catholic University, so thank you for the Nurse and Midwifery Unit Manager Professional Grant 2011 6
Helen McAllister, Deputy Director of Nursing, St John of God Murdoch Hospital 7
Penny Spencer Nurse Unit Manager, Critical Care St John of God Hospital Bendigo Site visited Epworth Hospital, Richmond, Melbourne. My objectives for this project were to investigate: How to support a outreach service within the current structure of the WHPPD target How to optimise the service within the private sector Identify referral systems to assist with recruitment of patients Optimising Consultant interest and support for nurse led service Identify barriers which may limit the performance of the outreach service within the private sector. Identify the potential of incorporating this role in the existing educator position already offered in CCU I met with the Liaison Nurse from The Epworth; she spent time with me showing me the process of targeting patients and strategies for discharge. Their role also includes ward education and support for the ward staff in reference to the specific patient care and issues. This aims to optimise the ward care and prevent readmissions to the ICU. Their role is currently split with the role of organ transplant coordinator and is about to be reviewed. The role will develop into involving the quality and risk responsibilities. Epworth had a combined role for the liaison service and had been implemented 2-3 years ago. The liaison service is supported by 2 FTE working between the hours of 0800-2200 Monday to Friday. There primary responsibility was to support the transition of the ICU patient from ICU to the ward. The ward rounds identified the patients that were nearing discharge from ICU, this enabled the team to work the patient up to discharge and transition the patient to the ward. Clinical support for ward nurses was also offered to help any concerns about managing the higher acuity patients in the ward setting. Once the patient is on the ward the Liaison nurse will review once or twice per day to ensure the patients is making the care goals and review for any patient deterioration. The frequency is determined by patient condition. The liaison nurse can be called to review a patient however there is the other tier of patient safety net with the Medical Emergency Team (MET) response. During liaison business hours they will also attend any MET calls. TPN ward round. There is also a TPN round offered by the intensive care team comprising of a Intensivist, Liaison Nurse and the Dietician. This service has been implemented to help monitor patients on TPN on the ward for adequate nutrition, organ dysfunction, and line sepsis. This round has financial billing potential so also helps support the liaison role. No CVC round. At this stage there are no available resources to support a round to monitor and manage CVC lines in the ward setting. SJOG Geelong- Has no formal role as such but will apply an adhoc approach for follow up on the ward of complex patients that have been discharged. This is done by the ANUM or educator Freemasons part of Epworth Health is putting a business plan together to try and implement a role within the 13-14 financial year. This role will incorporate a quality and risk role as well. The NUM reported there was a strong commitment from the executive to support the role to work toward achieving standard nine of the new national standards. John Faulkner- Has no formal role as such but will apply an adhoc approach for follow up on the ward of complex patients that have been discharged. This is done by the NUM, or ANUM Cabrini - Has no formal role as such but will apply an adhoc approach for follow up on the ward of complex patients that have been discharged. This is done by the NUM, or ANUM. IMPRESSIONS TO CONSIDER: The size of the organisation and the impact it had on the decision to roll out this role. Larger patient admission rates will favour the new role and the efficiency when measured against the work hours per patient day (WHPPD) model. Investigations into how the role can be developed and sustained revealed it is most likely involving a duel role scenario. This will enable the efficiency be optimised while the demand of the role is unknown. There needs to be a cost analysis into bed availability and refused admission due to bed unavailability. Length of stay could also be considered when analysing the benefits of such a role as potentially the Liaison Nurse may reduce morbidity and potentially improve length of stay. Unfortunately these factors are problematic in interpreting as they are difficult to determine the effect. OUTCOMES: Established the importance of such a role within our organisation. Understanding that the financial impact on developing and implementing the role may be a heavier burden on smaller private hospitals. 8
Potential for implementing an adjunct service for the Liaison nurse role to help revenue for the service such as TPN rounds. Understanding of the systems that are applied to ease the ICU patient transition from ICU to the ward Able to understand the paperwork and data collection systems that are required to track patient progress and movement. 9
Judelle McFarland NUM Postnatal Services,St Vincent s Private Fitzroy Site visit St John of God Hospital Subiaco I travelled to St John of God in Subiaco with my colleague, Jody Olorenshaw (Delivery Suite Manager) at St Vincent s Private and we met up with Heather Marim, the NUM of postnatal and Eileen, the NUM of Delivery Suite. This hospital was of great interest to me as their Maternity Service was in a similar situation to us in 2009, with a need to change the staff culture, but since then have taken their Units from Not just good very good. St John of God, is a large not for profit organisation with a comprehensive range of clinical specialities and on site diagnostic services. Its mission and values are steeped in the history of the Sisters of St John. The hospital now responds to the community s needs and experiences. Everyone has a voice. Opportunities for feedback are promoted, well advertised and provided for patients, at various stages throughout their stay in the hospital. Constructive feedback is seen as a learning opportunity by both staff and the Organisation. Staff work well in a team environment that promotes the client journey and individualised care. Staff well being is seen as an Organisational priority The trip highlighted for me, that our theme back to basics is vital to our success in the future. At St John of God, their attention to detail is exactly what we need to focus on for continued improvement of work place culture, customer service, staff and patient satisfaction. It was pleasing to me, to see that we at St Vincent s are moving in a positive direction. Areas that have been earmarked for continued improvement now are 1. Patient involvement in their care. 2. Bedside handover. 3. Use of white boards in patient rooms. 4. Rounding with staff and patients. 5. Patient and staff satisfaction surveys. 6. Team nursing. 7. Staff reward and recognition. At St John of God, they are now focused on maintaining the momentum of their hard work. Continued reinforcement of a range of new practises continues. We thoroughly enjoyed our visit to St John of God Subiaco; found it very informative, inspiring in many ways and we have made many new friends. We brought with us several of our new initiatives which interested them for continued improvement, shared some of our ideas and documents, and hope to maintain a relationship with them into the future. Left to right myself, Heather Marim (NUM Postnatal St John) Jody Olorenshaw (NUM Delivery Suite) St Vincent s. We are standing at the entrance of the hospital, with the lead light window depicting St John 10
11
Wendy Chamberlain ACM Acute Surgical Unit - Calvary Healthcare Tasmania Site Visited: ST Vincent s Private Hospital, Sydney I observed a number of things that are done particularly well at St Vincent s, including the following: Approximately 90 per cent preadmission of patients, with informative sessions for patients undergoing certain procedures and meetings with relevant health professionals; Efficient patient flow; Excellent staff culture and morale; Excellent staff education facilitated by the unit-specific clinical nurse educator; A career structure that allowed staff to feel valued and rewarded; Efficient discharge planning. Changes I think we can implement at Calvary Team nursing to support our current lack of skill mix; Increasing the number of beds; The development of an internal stoma therapy service to provide consistent and improved care for patients and provide ongoing education, support and resources for staff. 12
Maryanne Attard Perioperative Services Manager at Calvary Central Districts Hospital (CCDH) The Clinical Management team at Calvary Central Districts Hospital (CCDH) have been awarded an ACU-CHA Nurse and Midwifery Unit Manager Professional Development Grant to spend time in like facilities within the Catholic Hospital network to gain an insight into how Day of Surgery Admission (DOSA) units are run. HOSPITAL PROFILE CCDH is an acute care hospital, established in 1980 and is located north of the city at Elizabeth Vale within close proximity to the Lyell McEwin Hospital. CCDH is one of four Calvary hospitals in Adelaide and is a service of the Little Company of Mary Health Care which provides a broad range of health, aged and community care services in six states and Territories. CCDH is the only private hospital North of Adelaide CBD and serves a metropolitan and regional population of 500,000. The hospital has 60 overnight beds, including a 4 bed HDU and 5 bed Supportive Care Unit, 9 chairs for day chemotherapy, 11 day beds, 4 operating theatres and an endoscopy suite. Approx 4500 surgical procedures are performed pa. Surgical services include: Endoscopy Gynaecology General Bariatric Colorectal Ear, Nose and Throat Orthopaedics Urology Plastics Oral Maxillary & Dentistry Ophthalmology DOSA UNIT Within the next 6-12 months it is our aim to have a fully functional DOSA unit ensuring that all surgical patients are efficiently and effectively admitted to our facility. The Hospital Executive Team is enthusiastic and eager to develop a DOSA unit in an effort to provide excellence in customer service to both patients, their significant others and Visiting Medical Officers. They are committed to ensuring that the DOSA unit becomes an integral part of our core services by allocating and educating a core group of specialised staff to work within the department. The advantages of implementing the DOSA Unit will include: o o o o o o o A more streamlined, comfortable admission process for all surgical patients Waiting time for surgery will be decreased as admission times will be staggered according to the theatre list Nursing admissions will be completed by nursing staff who are experts in the admission process Close proximity to the theatre complex: Allowing VMO s easy access to see their patients pre-operatively Decreasing the need for patients to wait in the holding bay as staff can collect patients directly from DOSA unit Ward staff can concentrate on providing expert post-operative care ensuring patients are discharged as efficiently as possible By incorporating a preadmission and discharge planning centre in the DOSA unit patients will be provided with a ready for surgery plan that will include fasting instructions, self-administered pre-medications, transport to and from hospital and presentation time. This will eliminate the need for surgery to be cancelled due to patients not fasting or having no one to look after them post operatively. An anticipated post-surgery plan will also be provided to patients pre operatively thus preparing them for discharge on admission and promoting that they will heal quickly and be able to return to their homes in a timely manner. 13
The area marked for the DOSA unit will allow direct access for the patients from the hospital car-park and internally has direct access to the theatre complex. The ACU-CHA Nurse and Midwifery Unit Manager Professional Development Grant will assist us to ensure all the planning required for the unit can be done prior to opening hence we will have a smooth and trouble free implementation. 14