060308 06 Showcase Book -...

Victorian Public Healthcare Awards 06

Showcase

060308_06 Showcase Cover.indd iiii060308_06 Showcase Cover.indd iiii 29/9/06 3:41:43 PM29/9/06 3:41:43 PM

VictorianPublic

HealthcareAwards

Showcase

Department of Human Services

Message from the Premier of Victoria

Victoria’s health system is one of the best in the world.

Our health services are at the forefront of healthcare delivery. In many areas, we are leading the way both in Australia and internationally.

Through the Victorian Public Healthcare Awards we celebrate and pay tribute to the people at the heart of our health system, a dedicated and highly skilled workforce.

The commitment of our healthcare professionals saves the lives of countless Victorians, and enhances the quality of life for many more.

Across our healthcare system, organisations large and small are approaching health from every angle with one common aim: to make the lives of Victorians better.

Building and improving our world-class public health system is one of the most effective ways we as a government can make Victoria the best place to live, work and raise a family.

As a community, we can take enormous pride in the expertise, ingenuity and dedication of our healthcare workforce and the organisations in which they work.

The Victorian Government is proud to honour the achievements of our public healthcare providers. Congratulations to you all.

The Honourable Steve Bracks MP Premier of Victoria

The Victorian Public Healthcare Awards recognise the dedication of our healthcare professionals and their commitment to quality, innovation and excellence.

In 2006, the Awards reveal an inspiring array of programs that are improving the lives of many Victorians.

What emerges is a picture of a health system that addresses the needs of the whole person, reaches out to those most in need, and continues to develop creative strategies that have profound and positive outcomes. We see primary and acute services working together, and healthcare providers investing in education and prevention with impressive results.

In this showcase you will learn how music and pagers can ease the distress of sick children and their families, how a learn to swim program for babies can improve the health of a community, and how bicycles can revolutionise emergency response times.

Congratulations to the winners and fi nalists. Your commitment is reaping enormous rewards for the individuals touched by your work, and for the community as a whole.

The Honourable Bronwyn Pike MPMinister for Health

Message from the Minister for Health

Introduction

The aims of the 2006 Victorian Public Healthcare Awards are to celebrate quality, innovation and excellence in public healthcare and to honour the dedication and expertise of the people who provide that care to the Victorian community.

With 10 categories plus the Minister’s and Premier’s awards, the annual Victorian Public Healthcare Awards offer healthcare providers an opportunity to be recognised for their commitment to providing the best possible care to the people of Victoria.

It is an opportunity the healthcare sector has embraced with great enthusiasm. After a successful debut in 2005 when 203 entries were submitted, this year the fi eld put forward more than 260 initiatives, organisations, teams and individuals for consideration.

The selection of fi nalists was undertaken by 86 judges drawn from Victoria’s health sector, led by the Chair of Judging, Dr Norman Swan. The judges gave generously of their time to complete the substantial task of assessing the entries. The careful consideration they gave to each entry is refl ected in the calibre of the 2006 fi nalists and winners.

Thank you to the judges of the 2006 Victorian Public Healthcare Awards: Clare Amies, Colin Batrouney, Leanne Beagley, Belinda Berry, Anthony Black, Christopher Bladin, Colleen Boag, Stephen Bolsin, Lyn Bongiovanni, George Braitberg, Chris Brook, Jan Brownrigg, Susan Brumby, Jill Butty, Tanis Cameron, Debra Cerasa, Julianne Clift, Lauren Cordwell, Philip Cornish, Wallace Crellin, Shane Crowe, Maree Cuddihy, Claire Culley, Kay Currie, Sue Daly, Karella de Jongh, Lisa Delaney, Paul Denborough, Sharon Donovan, Cynthia Dowell, Wendy Dunn, Lesley Dwyer, Simon Fraser, Craig French, Jane Gilchrist, Jenni Gratton-Vaughan, Sabine Hammond, Jane Hendtlass, Jon Hilton, Carolyn Hines, Denis Hogg, Dan Hourigan, Wendy Hubbard, Robyn Humphries, Brian Jackson, Sue Kearney, Anne-Maree Kelly, Christine Kilpatrick, Rob Knowles, Demos Krouskos, Terry Laidler, David Lee, Sandra Leggat, Kris Lomax, Trevor Matheson, Tony McBride, Bernadette McDonald, Fiona McKinnon, Sue Nesbit, Robin Ould, Linda Pandita, Sonia Posenelli, Merrin Prictor, Miles Prince, Graeme Roberts, Robyn Rourke, Alison Rule, Katherine Simons, Tony Snell, Mary-Jane Stolp, Michael Summers, Norman Swan, Joanne Sweeney, Felicity Topp, Stephen Vale, Tony Walker, Lance Wallace, Marg Way, Rob Weller, Jane Widdison, Maureen Williams, Beth Wilson, Libby Wilson, Mark Yates, Greg Young and Simon Young.

The 2006 Victorian Public Healthcare Awards Showcase gives readers a brief insight into the breadth, diversity and quality of the work happening every day to enhance the health and wellbeing of the Victorian community.

For more information about the

Victorian Public Healthcare Awards visit www.health.vic.gov.au/healthcareawards

Contents

Category 1 Excellence in care and service delivery 7

Category 2 Innovation in access to healthcare 15

Category 3 Innovation in models of care 23

Category 4 Excellence in safety of care 31

Category 5 Excellence in continuity of care 39

Category 6 Excellence in consumer and carer participation 47

Category 7 Excellence in community engagement 57

Category 8 Excellence in prevention and early intervention 65

Category 9 Innovation in information technology 73

Category 10 Innovation in workforce design 81

Minister’s Award for outstanding staff achievement 89

References 102

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Showcase summary

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Category awards

Category 1: Excellence in care and service delivery

Winner

Cardiac arrest success

Metropolitan Ambulance Service

Highly commended

ALERT: Assessment, liaison

and early referral team

St Vincent’s Health

The Gestational Diabetes

Ambulatory Care Program:

An innovative approach

Barwon Health

Category 2: Innovation in access to healthcare

Winner

The Antenatal Outreach Service

Yarra Valley Community Health, Eastern Health

Highly commended

Transforming access in mental

health services

Southern Health

Violence against women:

A health responsibility

The Royal Women’s Hospital

Category 3: Innovation in models of care

Winner

The Bicycle Response Unit


Highly commended

Day surgery for children having

bone marrows and lumbar punctures

The Royal Children’s Hospital

Diabetes Direct delivers

Northern Division of General Practice and Plenty Valley Community Health

Using systems redesign to improve

the care of people with type-2 diabetes

Westbay Alliance and Western HARP Consortium

Category 4: Excellence in safety of care

Winner

Improving the treatment of patients

at risk of bleeding from warfarin

over-anticoagulation

Peninsula Health

Highly commended

Obstetric ‘Code Green’

Eastern Health

Preparing children for

magnetic resonance imaging


Safety in the operating suite

Austin Health

Category 5: Excellence in continuity of care

Winner

Improving diabetes care

Austin Health in partnership with the Northern Division of General Practice, North East Valley Division of General Practice, Banyule Community Health Service, Darebin Community Health and Nillumbik Community Health Service

Highly commended

Food.Com.Play: A family-based

intervention for childhood obesity

Frankston Community Health Service, Peninsula Health

An integrated experience

for persons living with diabetes

cardiovascular disease

Dandenong District Division of General Practice

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Improving communication

and hand-over between police

and the emergency department

for patients with acute behavioural

disturbance detained under Section

10 of the Mental Health Act.Western Health

Category 6: Excellence in consumer and carer participation

Joint winner

Respecting patient choices

in residential aged care

Austin Health

Joint winner

The Consumer Participation Program


Highly commended

A comprehensive model to encourage

consumers of aged mental health

services to participate in the quality

improvement process

Bayside Health

Category 7: Excellence in community engagement

Winner

The Community Group Program


Highly commended

Food Talks: An interactive

community lunch program

Cobaw Community Health Service in collaboration with the VCAL programs of Macedon Ranges community, Kyneton Secondary College and Sacred Heart College

Ambulance in Schools:

‘Emergency…deal with it!’


Category 8: Excellence in prevention and early intervention

Winner

Koori Bubs Swim Program

Gippsland Lakes Community Health

Highly commended

SHARE: Sharing health

and recovery experience

Western Region Health Centre

Core of Life

Peninsula Health

Category 9: Innovation in information technology

Winner

Guidance DS: A web-based

computerised decision support

system to facilitate implementation

and governance of clinical guidelines

and better use of medicines

Melbourne Health

Highly commended

RIMS: Referral information

management system

Grampians Health Information and Communications Technology Alliance

Use of SMS text message reminders

to improve outpatient attendance


Check Your Risk: Personalised sexual

health advice at the click of a mouse

Melbourne Sexual Health Centre, Bayside Health

06Category 10: Innovation in workforce design

Winner

Nurse-led eczema workshops


Highly commended

A multi-skilled workforce

with work–life balance

Alexandra District Hospital

The ED Logistics Coordinator

Eastern Health

STAR: Support team

action response

St Vincent’s Health 04

Minister’s Award for outstanding individual achievementWinner

Dr Catherine Crock

Physician in Haematology and Adolescent HealthThe Royal Children’s Hospital

Highly commended

Professor Samuel F Berkovic

Director, Comprehensive Epilepsy ProgramAustin Health

Associate Professor Peter Doherty

Director, Alfred PsychiatryBayside Health

Dr Eugenie Tuck

Director, Clinical Services, Correctional Health Service, St Vincent’s Health

Minister’s Award for outstanding team achievement Winner

Northern Assessment, Referral and Treatment

Team: Crossing the boundaries from the

justice system to the healthcare sector

Plenty Valley Community Health

Highly commended

Dr Amanda Scott and Ms Leora Benjamin

Speech Pathology Department Bayside Health

Clinical Governance Team: Learning from

error to save lives

Austin Health

Minister’s Awards for outstanding staff achievement

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Category 1Excellence in care

and service delivery

Providing high quality care through the delivery of effective and appropriate services is the central aim of public healthcare organisations. Drawing on evidence to do the right thing for the right person at the right time is an essential element of quality care. This award recognises initiatives associated with tailoring care and services to the needs of individuals and communities to produce demonstrable health benefi ts. 06

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The Metropolitan Ambulance Service (MAS) set out to achieve the highest ‘cardiac arrest survival to hospital’ rate in Australia. It has reached this objective and ranks among the best in the world for cities similar in size to Melbourne. MAS’s cardiac arrest survival rates are at 47 per cent (edging closer to 50 per cent). By comparison the next best Australian service is achieving 18 per cent (Brisbane).

MAS’s success stems from a combination of complementary initiatives addressing critical success factors identifi ed in research: the links in the ‘chain of survival’. Research shows that factors contributing signifi cantly to survival from out-of-hospital cardiac arrest include brief duration of arrest, early recognition of cardiac arrest (bystander witnessed), early use of cardio pulmonary resuscitation (CPR), early defi brillation, advanced paramedic treatment and rapid transport to appropriate coronary care facilities.

Cardiac survival rates decrease by 10 per cent per minute up to eight minutes and then a further 4 per cent per minute (Dr Ray Brindle, Adjunct Associate Professor, Transport Systems Centre, University of South Australia). Hence the programs initiated by MAS are more cost effective than funding an ambulance on every street corner. Given that the MAS response time is an average nine minutes for cardiac arrests and that a massive investment in new ambulances is only likely to trim a small amount off response times, and given that research indicates brain injury occurs between three and four minutes after cardiac arrest, the community is best positioned to play a critical role in achieving better outcomes. A number of programs initiated by MAS prepare the community to be partners in dealing with cardiac arrest.

Abstract

MAS targeted cardiac arrest survival rates as a priority because they are an internationally used measure of ambulance performance, using the Utstein model of measurement, and sudden cardiac arrest is a leading and feared cause of death.

The MAS approach includes programs to increase bystander-administered CPR and to encourage bystanders to give CPR with over-the-phone assistance. Other programs increase early access to defi brillation and ensure optimal treatment by paramedics.

WinnerCardiac arrest success


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Background

Recognising limitations of even the fastest emergency services, MAS set out to increase the broader community’s capacity to be prepared for medical emergencies. A primary objective is to help the public to be more effi cient in responding to medical emergencies. Another objective is to enable the community to be more effective at providing accurate information when they are phoning triple-0.

A number of educational programs, including Ambulance in Schools and programs for culturally and linguistically diverse (CALD) communities, provide advice on when to call triple-0 and how to manage the call. Supporting this, the triple-0 and dispatch procedures have been refi ned, providing pre-arrival instructions so that bystanders can be coached over the phone to provide CPR while an ambulance is en route.

The 4 Steps for Life program teaches over-50s how to perform CPR. This takes place in supportive community groups, a setting in which they are more likely to remember what they are taught. More than 9,000 sets of the video-based self-education package (in 11 languages) have been sent to community groups, promoting the message that any CPR is better than no CPR.

MAS supports community fi rst responder initiatives, with community emergency response teams (CERTs) in Craigieburn, Kinglake and Lang Lang. They are made up of volunteers, trained and equipped by MAS. Each team carries semi-automatic defi brillators.

The fi rst responder partnership with the Metropolitan Fire Brigade (MFB) reduces the response time to patients in sudden cardiac arrest. MAS trains and supports dispatch of fi refi ghters to triple-0 calls, with the MFB arriving fi rst on scene around 50 per cent of the time. There were 2,961 cases to which both MFB and MAS were dispatched in 2004–05.

Through the public access defi brillator (PAD) program, MAS continues to encourage major public venues to install defi brillators. Training and service delivery are supported at 15 PAD sites.

Every ambulance in the MAS fl eet, including non-emergency vehicles, carries a defi brillator and a crew trained to use it.

Advanced life support (ALS) is the fi nal pre-hospital link in the chain of survival. In 2001, MAS began advanced life support training for qualifi ed paramedics. Today, 81 per cent of the workforce is ALS trained, excluding MICA (intensive care) paramedics whose skills already exceed ALS.

A dual response strategy is used for all cardiac arrests cases. This can sometimes mean that a fi re crew, road and MICA crew are all dispatched to a case.

Objectives

MAS cardiac arrest outcomes are tracked through the Victorian Ambulance Cardiac Arrest Registry (VACAR). The aim has been to overcome technical and cultural challenges to attain the best survival rates for out-of-hospital cardiac arrest in Australia and to compare with the best ambulance services in the world.

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Other key objectives have been to embrace world’s best practice for clinical management of cardiac arrest and to promote whole of health system management and measurement of positive outcomes from cardiac arrest, both in terms of survival and quality of life.

Methods

MAS built its suite of programs around the best available evidence. Research review also underpinned the planning and development of specifi c programs such as 4 Steps to Life. MAS also undertook a detailed comparative analysis of performance of ambulance services in Australia.

To attain best clinical practice MAS has engaged in relevant randomised pre-hospital clinical trials; for example, rapid infusion of cold Hartmann’s. There has also been regular review of ALS and MICA training.

To ensure collection and utilisation of best available data for reviewing clinical practice, MAS developed the Victorian Ambulance Clinical Information System (VACIS) – an electronic data collection system – to generate sophisticated analysis and reports. Development of this system will facilitate data exchange with hospitals, ensuring accurate monitoring of cardiac arrest outcomes to hospital discharge and development of cooperative ambulance–hospital clinical regimes.

The information derived from the MAS systems also provides evidence for improved deployment and dispatching processes. The fl exibility of MAS fl eet management has seen signifi cant developments in the area of rostering to ensure paramedics are in the right place at the right time for emergencies.

A specialist MAS community education division developed all community education programs and a CALD coordinator facilitated effective CALD education programs. Both operated via extensive community consultation and used third party independent research.

Outcomes

MAS attained steady improvements in measured cardiac arrest outcomes reaching a resuscitation rate from cardiac arrest of 47+ per cent, with 22 per cent of those patients being discharged from hospital. This demonstrates signifi cant value for the community and their loved ones and for the Government that funds a large proportion of MAS activities.

Lessons learned

The key strengths of the MAS approach have been a willingness to go beyond traditional ambulance thinking, to pursue a holistic evidence-based solution and to recognise the importance of community engagement and community partnerships. MAS made rapid progress by recognising there was no single strategy that would guarantee results. MAS has displayed courage in accepting that the aggregated impact of a number of parallel initiatives would yield dividends, even though each could not be easily measured and despite cultural opposition to involving the community in assisting MAS to meet its ambulance responsibilities.

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Conceptually MAS had to move beyond the role of simply responding in fast vehicles and to support the value of other players, including the wider public, in achieving outcomes. The annual Community Heroes Awards are proof that MAS has learned and values this lesson.

Status and sustainability

MAS commissioned a third party specialist organisation to design market research identifying factors infl uencing members of the community to learn CPR. The results will inform further community-oriented programs.

The VACIS project will support cooperative management of cardiac arrest by Australia’s ambulance services, standardised and consistent measuring regimes, best practice national clinical guidelines and optimised cooperation with hospitals. This is evidenced by the commitment of the national ambulance body, the Council of Ambulance Authorities, to the application of VACIS in their services and the agreement to focus on cardiac arrest data standardisation and collection.

The project is fully sustainable and will continue to evolve with VACIS-generated data paving the way for a national approach toward securing the theoretically achievable 30–70 per cent survival rate of cardiac arrest victims to hospital.

Budget

The various aspects of the MAS package of initiatives occur within different divisions and have their own budgets. Effectively, no separate cardiac arrest budget was required: costs were covered within the evolution of MAS’s approach to operations, paramedic training, demand management, community education and CALD initiatives.

Contact

Kevin BroadribbManager, Corporate CommunicationsMetropolitan Ambulance ServiceT: 9840 3344F: 9840 2622

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ALERT is a multidisciplinary team that coordinates care for people with complex needs who frequently present to St Vincent’s Hospital emergency department. Characteristically, these people have complex needs arising out of medical and social issues that interact with and compound each other. People will often be confronting underlying issues of poverty and homelessness, psychiatric illness and drug and alcohol misuse.

Screening for risk is undertaken in the emergency department. Where people do not meet the criteria for recruitment to ALERT but require intervention, allied health staff provide assistance to coordinate existing community services or referral to appropriate services.

It is essential that the underlying causes of homelessness, mental illness, drug and alcohol use and other social factors are identifi ed and addressed. Formal partnerships have been developed with services that have expertise and existing relationships with the people targeted by ALERT.

To ensure dedicated capacity exists in community providers for people who are recruited to ALERT, positions are funded at three community health centres and the Royal District Nursing Service. In addition, ALERT funds two beds in Ozanam House (a night shelter) for men who are homeless and a further two beds for older people who require short-term accommodation and care are funded in a low-care residential facility managed by the Brotherhood of St Laurence.

Community agencies responding to a survey indicated that ALERT had improved the long term health outcomes for people targeted. This is demonstrated by a 41 per cent decrease in presentations to the emergency department and a 46 per cent decrease in admissions to hospital for people recruited to ALERT.

Contact

Sue NesbitManager, ALERTSt Vincent’s HealthT: 9288 2266E: [email protected]

Highly commendedALERT: Assessment, liaison and early referral team


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The impetus to starting the gestational diabetes program stemmed from the expertise Barwon Health had in the organisation and that the service being offered to women did not include managing those with gestational diabetes. Barwon Health worked collaboratively with the obstetricians, midwives and Diabetes Referral Centre staff to improve management of these women, which was later reinforced by the appointment of an expert endocrinologist in pregnancy, Dr Chris Nolan. Dr Nolan was part of a group which wrote The Australasian Diabetes in Pregnancy Society guidelines, which are nationally recognised. Initially the service met some opposition, but the team pressed on to provide the highest international and national standard of professional excellence.

Pregnant women with gestational diabetes have their Diabetes Referral Centre appointment linked with their pregnancy care appointment, which reduces the occasions the woman has to attend the hospital. The increasing challenge of gestational diabetes has been successfully met and is now evidence-based practice which shows treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’s health-related quality of life.

Contact

Pamela JonesManager, Diabetes Referral CentreBarwon HealthT: 5226 7304E: [email protected]

Highly commendedThe Gestational Diabetes Ambulatory Care Program: An innovative approach

Barwon Health

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Category 2Innovation in access to healthcare

Public healthcare organisations strive to offer equitable and timely access to their services on the basis of greatest need, irrespective of geography, socioeconomic group, ethnicity, age or gender. This award recognises innovative ways of managing and facilitating access to healthcare services.

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There can be no worse feeling than to be pregnant, with no family or partner support, no job or income, and no transport to get you to or from a hospital or doctor. A signifi cant number of mainly young women in the outer eastern areas of Melbourne were experiencing this very dilemma and presenting to hospitals in labour, with no prior doctor or midwife antenatal care.

The Outreach Antenatal Service was initiated to provide an otherwise inaccessible service to expectant mothers fi nding themselves in this situation.

Currently, screening processes exist in hospitals for women with physical health risks during their pregnancies, but very few processes focus on the social risk factors that can infl uence the progress of pregnancy and early parenthood.

The Antenatal Outreach Service offers expectant mothers and partners access to midwifery, medical, social work, education and other allied health services in a location accessible by public transport and which provides bulk-billed medical services.

Both before and after birth there are clinical assessments, social work assistance, education programs, breastfeeding help and access to services that may well have been unknown to the new mothers and partners prior to this initiative.

One of the midwives involved in the service says this about the program: ‘It’s really rewarding to see the mums blossom and grow with the arrival of their new babies. It’s great to keep in contact with them after the baby arrives and support them into parenthood.’

Abstract

The Antenatal Outreach Service was a Best Start Initiative developed by Yarra Valley Community Health (YVCH) and Angliss Hospital as a response to a signifi cant number of young mums attending acute maternity services in the eastern metropolitan region to give birth and who had little or no antenatal care during their pregnancy.

The program is a partnership initiative with Yarra Ranges Best Start and brings acute maternity providers and community services together to respond to an urgent need in the Upper Yarra region. The program has been running since July 2005, every Wednesday, with two alternating midwives and a GP or obstetrician available fortnightly.

WinnerThe Antenatal Outreach Service

Yarra Valley Community Health, Eastern Health

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The Antenatal Outreach Service provides families and parents with psychosocial support, parenting skills and access to community services. Through these strategies families are enabled to nurture, protect and promote their child’s developmental progress. This builds resilience and social and educational skills in readiness for a confi dent entry into school.

The service has registered 21 clients between July 2005 and May 2006, ahead of its original target of 20 women in the fi rst 12 months. Of the registered mums, 53 per cent are under 21 years, 86 per cent have transport problems, 80 per cent come from low income families and 76 per cent are socially isolated.

Ten of the 21 registered clients have delivered successfully to date and have maintained contact with the outreach service midwives, with positive outcomes for the new mothers and babies.

Background

YVCH services almost 2,500 square kilometres, with a population of around 140,000 people. It services a mix of urban and rural communities with high levels of poverty and disadvantage, limited public transport, signifi cant geographic divisions and barriers between townships.

Socially and economically disadvantaged pregnant women needed an accessible service. Signifi cant public transport system shortfalls inhibited their access to appropriate care. They also needed medium term care planning beyond the birth process.

Lessons from Canada suggest that a key requisite for optimal child development is secure attachment to a trusted caregiver with consistent caring support and affection early in life. A child’s, adolescent’s and, ultimately, an adult’s emotional health and habitual way of reacting to new situations have their basis in early relationships between the infant/toddler and the people primarily responsible for their care.

Objectives

The outreach service aims to provide accessible, timely antenatal care to mothers with additional support needs. Its purpose is to prevent socially vulnerable women being admitted to hospital for delivery with little or no antenatal care or education and facilitate better health outcomes for mums and babies.

The foundations of this model of prevention and early intervention are:

• Families with ‘at-risk factors’, for whom there are concerns about the development of a child, are identifi able during antenatal care.

• The antenatal system is the ideal time to identify mothers and families in need of supplementary support services because the birth of a baby is described as a positive experience for mothers who feel that they were shown interest and community support when they were pregnant.

• Children born to high-risk mothers need tailored family support plans to prevent mortality, neglect and abuse.

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• Nurse-based visiting services have proven successful in identifying and improving health outcomes for infants 0–3 years of age.

• Early intervention programs should ‘create growth-promoting environments for young children whose development is threatened by biological vulnerability or adverse life circumstances.’

The Antenatal Outreach Service is aware that parents in its target group have diminished parental motivation and capacities, because of many barriers. These barriers include social isolation, poverty, inadequate infrastructure, limited extended family support, alcohol and other drug addictions, mental health issues, unsafe home environments and lifestyle behaviours that lead to intergenerational patterns of negative behaviour.

Methods

The Outreach Advisory Group consists of stakeholders from a variety of service providers including YVCH, Eastern Health obstetric units, the Department of Human Services, Yarra Ranges Best Start, Connections, Shire of Yarra Ranges Maternal and Child Health Service (MCHS), Yarra Ranges Integrated Family Services and Upper Yarra Community House.

Referrals come from a variety of service providers such as Upper Yarra Community House JPET and VCAL Young Mums Program, maternal and child health services, Upper Yarra Secondary College, local general practitioners (GPs), acute hospitals and self referrals. The target group focuses in particular on teenage mums who cannot gain access to doctors or antenatal care or are vulnerable under the MCHS and child protection guidelines as having signifi cant risk.

Under the care of midwives and a bulk-billing GP or obstetrician, the model of care includes social work assessment, inter and intra agency referrals, nursing antenatal care and education programs and obstetric GP care, working toward enabling better health outcomes for both mothers and babies.

The program was presented to the community by means of fl yers to households, media coverage of the new service, and close communication with local GPs, schools and maternal and child health services in the catchment area.

Outcomes

The aim of the outreach service is to provide accessible and timely antenatal care to mothers who have additional support needs. The service has registered 21 clients between July 2005 and May 2006, ahead of its original target of 20 women in the fi rst 12 months.

Of the registered mums, 53 per cent are under 21 years. Data collected from registered mums indicates:

• 86 per cent have transport problems

• 80 per cent come from low income families

• 76 per cent are socially isolated

• 48 per cent are single parents

• 28 per cent are adolescents

• 19 per cent have mental health care needs

• 14 per cent are unsupported

• 9 per cent are homeless

• 3 per cent are Indigenous

• 3 per cent are students.

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The targeted outcome of the service is to prevent admissions of socially vulnerable women to hospital for delivery having had little or no antenatal care or education, leading to better health outcomes for mums and babies. Prior to the implementation of the program, up to 20 young local women per annum were presenting to Eastern Health obstetric services with limited antenatal care and education.

As noted, 21 women with identifi ed antenatal support needs have registered with the outreach service between July 2005 and May 2006, with 10 successful deliveries to date. The midwives have maintained contact with the delivered mothers and partners, with positive outcomes for the new mothers and babies.

Lessons learned

The number of women registering with the program has exceeded expectations, indicating a greater need within the community for the program than anticipated.

Possible complications of birthing and early parenting are being significantly reduced with both the clinical and social supports that are being offered for these new families.


The service continues to operate in its initial form. Midwives conduct the clinics weekly, with the GP attending fortnightly. New referrals are being received on a regular basis, and most mothers who have delivered under the program continue to receive social support from the fl ow-on services provided by YVCH.

Budget

The program received an initial grant of $20,000 from Best Start, and this has been used to establish the program and employ the midwives for 12 months. The GP generated income from the bulk-billed Medicare rebate process. The continued overhead costs of the program will be sourced from YVCH operating costs, with support currently being sought to maintain midwife wages on an ongoing basis.

Contact

Jill HunterTeam Coordinator, Family and Child Health TeamYarra Valley Community HealthEastern HealthT: 5969 9937E: [email protected]

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The Southern Health Mental Health Program recognised the need to improve timely access for patients with mental health problems to appropriate care in the emergency department, and the inpatient units. The Patient Flow Initiative (PFI) was developed in mid–2005 and identifi ed new ways to improve patient care through improved communication and agreed processes in relation to coordinated care management.

The Patient Flow Initiative identifi ed three key areas – care management, bed management and emergency care – and established multidisciplinary teams to fi nd solutions to the challenges identifi ed through the review of present systems and outputs. Following implementation of the agreed changes, the following improvements have been achieved:

• reduced length of stay for mental health consumers in the emergency department

• responsive and coordinated management of the inpatient beds

• coordinated planned discharges from the inpatient units

• admission and discharge occurring at more suitable times for the consumers

• positive consumer and staff feedback in relation to access to services

• a small team developed to disseminate improvements to other mental health services in the state.

Contact

Associate Professor Alex CockramExecutive Director, Mental HealthSouthern HealthT: 9594 7795E: [email protected]

Highly commendedTransforming access in mental health services

Southern Health

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In 2004 a women’s support and safety survey was completed at the Royal Women’s Hospital. Four hundred women attending antenatal clinics were interviewed about their experience of violence during pregnancy. An earlier survey had indicated that women who had been sexually assaulted as adults or children experienced considerable distress when having pap tests. A survey of 6,000 Australian women in 2002 suggested that as many as one in two women have experienced physical or sexual violence, actual or threatened, during their lifetime. This is likely to have an impact on their use of healthcare and their degree of comfort in accessing some forms of healthcare, particularly that which is invasive or involves considerable touch.

It is therefore incumbent upon health services to ensure that they are providing a safe and supportive environment where women can access appropriate healthcare that is sensitive to the impact of violence and where they can seek support for dealing with the violence, whether it is current or a past experience.

In taking on this challenge, the Royal Women’s Hospital has sought contemporary evidence of best practice and consulted with victims and survivors of violence and hospital staff to develop a clinical practice guideline to assist practitioners provide healthcare that helps women access high quality healthcare. The aim of this work is to ensure that the Royal Women’s Hospital provides gynaecological and obstetric care that minimises further trauma or distress and maximises the possibility for recovery.

Contact

Marg D’ArcyProgram ManagerThe Royal Women’s HospitalT: 9344 2271E: [email protected]

Highly commendedViolence against women: A health responsibility

The Royal Women’s Hospital

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Category 3Innovation in models of care

Health services continuously seek ways to optimise how they deliver care and services, for the benefi t of both consumers and the organisation. Innovations may be unique – a world fi rst – or adapted from other settings to meet local needs. This award recognises outstanding achievement in embracing new approaches to care which enhance the health and wellbeing of individuals or communities. 06

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The Bicycle Response Unit (BRU) is helping the Metropolitan Ambulance Service (MAS) cut through crowds at Melbourne’s major sporting and cultural events. The time taken to reach patients is often paramount to saving lives but sending ambulance vehicles through dense crowds is challenging and they are usually delayed.

Getting paramedics to the scene quickly also assists demand management. Triage can be undertaken promptly and this often avoids the need for an ambulance to be dispatched or reduces the number of ambulances dispatched.

The BRU attends events such as New Year’s Eve celebrations, the Big Day Out, Anzac Day and the Formula 1 Grand Prix. Equipment carried is light, compact and functional. It includes fi rst aid gear,

a ventilator and a small defi brillator the size of a CD case, which can help restart the heart of a person in cardiac arrest.

BRU paramedics wear highly visible vests and their bikes have fl ashing lights and sirens to warn people they are on their way to an emergency.

The BRU is an innovative and cost-effective method of improving the response to people who require pre-hospital emergency care in environments where motor vehicle access is impeded. The BRU is also an effective demand management tool that increases the availability of emergency ambulances to attend critical patients.

Abstract

The Metropolitan Ambulance Service established the BRU to provide rapid casualty access in crowded areas. The BRU also provides rapid feedback from the scene to reduce unnecessary dispatch of ambulances.

As the sporting and cultural capital of Australia, Melbourne is host to a range of large events. It is important that these events are kept safe so that Melbourne’s event management reputation is protected. Reaching patients quickly is paramount to saving lives but moving quickly through dense crowds has always proven to be a challenge.

With the 2006 Commonwealth Games approaching, MAS investigated alternate forms of transport for crowded venues. Previously MAS has used ambulance vehicles, triage paramedics and golf carts. While patient care, using this mix of resources, was of a high standard, crowd density slowed ambulances and golf carts.

WinnerThe Bicycle Response Unit


25

Although triage paramedics generally moved freely through crowds on foot, their response could be slow and the number of paramedics required for large spaces became unfeasible. For occupational health and safety reasons (OHS), paramedics could not carry the required response equipment.

The BRU was an instant success when paramedics fi rst rode onto the scene during the 2005 Spring Racing Carnival. Over four days at Flemington, it took an average of just two minutes for crews to reach 39 emergencies; in one case reaching a patient 17 minutes before a road ambulance dispatched at the same time.

Carrying just 14kg of essential fi rst aid equipment including a pocket-sized defi brillator, bike paramedics have since attended more than 170 cases at major events.

During the Commonwealth Games, the Bicycle Response Unit travelled more than 1000km – about the distance from Melbourne to Sydney – and was fi rst on scene at 78.65 per cent of cases. The unit responded to 90 per cent of cases within six minutes with an average response time of just 3.3 minutes.

Cases included collapse, trauma, assault, chest pain and cardiac arrest. The high level of mobility and visibility of bike paramedics in crowded areas meant that they attended 27 of these cases before triple-0 was even called.

Background

Careful planning for major sporting and cultural events is essential to ensuring there is minimal impact on normal ambulance business so the safety of the wider public is protected. Also, participants and spectators at major events are entitled to high levels of safety. The development of special access units such as the BRU means good service can be provided at crowded venues while protecting the fast response times delivered across the rest of Melbourne.

Objectives

MAS sought to:

• improve response times

• improve service effi ciency

• increase vehicle availability

• reduce vehicle costs

• enhance public profi le

• minimise impact on normal business.

MAS investigated alternate methods of paramedic access to crowded events. Motorcycles were excluded due to costs of purchase, maintenance, uniforms, training and petrol. Similarly, golf carts carried cost, mobility and speed limitations.

26

Methods

The major challenges included:

• Bicycles needed to be durable and cost effective.

• Equipment had to be light, compact and functional.

• Uniforms had to meet OHS regulations and MAS guidelines for use at public events.

• Bicycle response paramedics needed emergency riding training for safety and to ensure a consistent approach.

MAS consulted with Australian and international emergency services. Following a rigorous tender process, the Kona Caldera bicycle was chosen and fi tted with blue and red fl ashing lights and a siren.

Equipment transported in ambulances is usually heavy and bulky. New technologies were explored and tested. Two bags at the rear of each bicycle contain just 14kg of vital equipment including a lightweight defi brillator, ventilator, drugs and fi rst aid equipment.

The uniform had to be visible, functional and comfortable for use in all conditions. It features multiple pockets for small equipment, radios and water bladders.

Manoeuvring through crowds is not often practised by recreational riders. BRU paramedics took part in Victoria Police’s nationally accredited training course that was modifi ed for ambulance needs. It covered all aspects of emergency riding including road laws and regulations, group riding rules, safety, slow riding skills and braking technique.

Finally, a team of enthusiastic, healthy, clinically sound and professional role models was required. The team of 22 paramedics was chosen from more than 80 applicants.

Outcomes

The BRU has provided a rapid response to more than 200 emergencies including collapses, traumatic injuries, drug and alcohol use and cardiac arrests.

At the 2005 Spring Racing Carnival, bicycle response paramedics had an average response time of just two minutes, reaching a dozen emergencies in less than a minute.

During the Commonwealth Games, the unit:

• was fi rst on scene 78.65 per cent of the time

• reached 90 per cent cases within six minutes

• had an average response time of 3.3 minutes

• attended 27 of cases before triple-0 was notifi ed.

Of the 89 cases attended by bike paramedics about 60 per cent required ambulance transport to hospital. Bicycle response paramedics generated many of their own cases, with people having phones in their hands and about to call triple-0 when they arrived.

27

The BRU has been able to provide early situation reports and medical assessment of patients, allowing ambulances to respond less urgently or be cancelled, making them available for emergencies elsewhere. Other benefi ts include increased public awareness and engagement, strong team morale and healthy lifestyle promotion.

Lessons learned

With the BRU reaching patients in crowds even more rapidly than expected, it has been trialled in Melbourne’s central business district and proven to be effective.

Community support for the BRU has been pleasing; the increased level of community engagement leads to greater understanding of emergency issues.


The BRU will continue to feature at major events and has the potential to further enhance paramedic response to the community.

In the two weeks leading up the Commonwealth Games, the unit was deployed within the Melbourne CBD with good results.

The unit has the potential to be used along the Mornington Peninsula during summer months when beach crowds swell.

Budget

The BRU is very cost effective. The cost of equipment per team of two paramedics is less than one tenth the cost of an ambulance crew.

Contact

Paul HolmanOperations Manager, Emergency ManagementMetropolitan Ambulance ServiceT: 9321 5900E: [email protected]

28

Before 1998, children with cancer were having bone marrow aspirates (BMAs) and lumbar punctures (LPs) in procedure rooms or ward areas. These procedures were distressing and at times painful. Many children and parents were fearful and stressed prior to having their LP or BMA. One child said: ‘It writes off my whole weekend when I know I have a lumbar puncture next week’.

Clearly there was a need to improve this service. The Royal Children’s Hospital (RCH) looked at the literature and found evidence of long term emotional side effects for children having repeated painful procedures. In the course of this review it was also discovered that some hospitals were changing their sedation and analgesia practices for these procedures.

A team of experienced healthcare professionals at the RCH became passionate about making a difference.

In 1998, the team looked at providing general anaesthetics for these procedures and ‘The LP/BMA list’ was born. Families are contacted by the oncology coordinator and booked onto the list a week in advance. Oncology, pharmacy and laboratory services staff work together to ensure the appropriate chemotherapy and test results are provided in a timely way.

Admission times are staggered to eliminate long waiting times. When families arrive they are greeted by a familiar admissions clerk, the oncology nurse, the doctor from laboratory services who will perform the LP/BMA and the anaesthetist. The children, siblings and parents are entertained by the music therapist. If there is an unavoidable delay, this is explained to the parents and they will be offered a pager, allowing them to leave the department until they are required for theatre.

When it is time for theatre, the child walks into the theatre with their parents, who stay with them until they are anaesthetised. The relaxing tones of the RCH’s Hush Collection CDs are played in the theatre. With very few treatment choices usually available to children, here they are offered a selection of fl avours for their anaesthetic mask, and a choice about whether they sit in a chair, in their parents lap or on the bed. Once the child is asleep the parents are shown to the waiting area where they can have a drink or snack.

Contact

Paula HowardNurse Unit ManagerThe Royal Children’s HospitalT: 9345 5386

Highly commendedDay surgery for children having bone marrows and lumbar punctures


29

Diabetes Direct is a successful community-based diabetes screening and treatment program servicing the ethnically diverse population of northern Melbourne. Working closely with more than 160 local general practitioners, Diabetes Direct provides a suite of specialist services that support general practitioners (GPs) and patients to successfully manage diabetes. This service, based in a GP clinic, has become a model for other regional programs to support the diagnosis and self-management of diabetes.

Diabetes Direct is run by a partnership of the Northern Division of General Practice and Plenty Valley Community Health. It has seen more than 600 patients and lowered presentations to local emergency departments. General practitioners and local people from a variety of nationalities alike have embraced Diabetes Direct with enthusiasm – because it works. The program works closely with other services, including The Northern Hospital, and maintains strong links with the endocrinology unit within the emergency, inpatient and outpatient departments.

Diabetes Direct is having a profound impact on managing diabetes in this growing corridor. Emergency department presentations for diabetes and unplanned diabetes-related admissions at The Northern Hospital have not increased in line with anticipated growth and growth in other disease categories. To date, Diabetes Direct achieved a median HbA1c reduction of 1.7 per cent in patients entering with suboptimal glucose control (baseline HbA1c > 8 per cent). This reduction in blood glucose levels translates to a 50 per cent reduction

in the risk of such patients developing microvascular complications such as vision-threatening retinal vessel disease and diabetes-related kidney disease.

Diabetes Direct’s best outcome may be best expressed by one of the people to benefi t from the program: ‘Before I went to Diabetes Direct I felt pretty crook. I had to go to the hospital twice in three months and stay there for a week each time. I was down in the dumps. But now I’m out of it. They really motivated me, and plenty of good has come out of it all, and it’s because all of us are a team.’

Contact

Jacinta CollinsManagerPlenty Valley Community HealthT: 8480 4612E: [email protected]

Highly commendedDiabetes Direct delivers

Northern Division of General Practice and Plenty Valley Community Health

30

By 2010, the incidence of type-2 diabetes is expected to double, exacerbated by an ageing population, increasingly sedentary lifestyles and obesity. Type-2 diabetes is a complex illness that requires continuous management. Effectively responding to these needs requires a systems-wide approach to how models of care are planned and delivered in partnership with people who have type-2 diabetes.

The WestBay Alliance and Western HARP Consortium developed a model of care that builds upon existing services while improving the effectiveness of the system to respond to and meet consumer needs. Underpinning this model was process re-design, best practice interventions, and self-management. Effective partnerships provide a foundation for this work to occur.

Multiple health professionals from different agencies participate in the care of people with diabetes throughout their lifetime. The WestBay Alliance and Western HARP Consortium approach increased the capacity of agency teams to enhance diabetes care at regional and organisational levels. A network of more than 70 health professionals guided local adaptation through clinical leadership to implement key project interventions.

The design and implementation of this work has enabled people with type-2 diabetes to achieve better and more integrated care.

Key partners for this project include WestBay Alliance, Western Health, Djerriwarrh Health Service, ISIS Primary Care, Royal District Nursing Service (Sunshine and Altona), Western Region Health Centre, Western Melbourne and Westgate Divisions of General Practice, Chronic Illness Alliance, Diabetes Australia Victoria and Brimbank/Melton Primary Care Partnership.

Contact

Naomi KubinaProject Offi cerWestBay AllianceT: 9398 0718E: [email protected]

Highly commendedUsing systems redesign to improve the care of people with type-2 diabetes

WestBay Alliance and Western HARP Consortium

0

31

06Category 4

Excellence in safety of care

All healthcare providers seek to ensure the safe progress of consumers through all parts of the system. This award recognises initiatives which enhance safety and reduce risk to healthcare consumers in all settings, whether it be acute, sub-acute, ambulatory, primary health, home-based or residential care.

06

32

WinnerImproving the treatment of patients at risk of bleeding from warfarin over-anticoagulation

Peninsula Health

Frankston Hospital is the major provider of acute secondary and tertiary hospital services on the Mornington Peninsula. Each year, about 270 patients require warfarin reversal at the hospital.

Warfarin is a ‘blood thinner’ that helps prevent blood from excessive clotting or forming harmful clots. Its use has grown in the past few years due to strong evidence of its benefi t.

Unfortunately, due to the wide variation in individual dosage requirements, the risk of major bleeding leading to death or hospitalisation occurs in 1.2–8.1 per cent of patients.

In October 2004, the pharmacy department decided that a highly visible education campaign would be launched at Frankston Hospital to improve awareness of this complex medication.

Compliance with the national warfarin reversal guidelines was chosen as the outcome indicator. The target was to increase compliance by at least 50 per cent.

The slogan ‘Be aware’, based on the legendary Dracula movie theme, was chosen as the theme for the campaign.

A range of unique but practical initiatives were implemented as part of the campaign;

all targeted to educate and remind doctors of desired messages.

The effectiveness of the initiative was monitored for a year. A total of eight audits were completed during that period to track the outcome indicator.

The campaign far exceeded its target. By September 2005 there was a 105 per cent improvement (from 43 per cent to 88 per cent) in the compliance rate. In June 2006, a repeat audit showed a compliance rate of 83 per cent.

Proving the initiative’s success, since the ‘Be aware’ campaign other quality improvement activities modelled on this initiative have been implemented at Frankston Hospital.

33

Abstract

The major complication of warfarin is the risk of major bleeding. This initiative successfully improves the treatment of patients with warfarin over-anticoagulation who were actively bleeding or potentially at risk of bleeding. Compliance with the Australian Society of Thrombosis and Haemostasis warfarin reversal guidelines, an outcome indicator, improved by 105 per cent; from 43 per cent in September 2004 to 88 per cent in September 2005. The improvement is sustained, as demonstrated by the compliance rate of 83 per cent in June 2006.

The initiative applied communication and marketing principles used by pharmaceutical manufacturers in infl uencing prescribing practices. The Plan-Do-Check-Act quality cycle was used to coordinate the continuous improvement efforts.

Background

Due to the wide variation in individual dosage requirements for warfarin, the risk of major bleeding leading to death or hospitalisation occurs in 1.2–8.1 per cent of patients.

One study identifi ed overdoses of anticoagulants or insuffi cient monitoring resulting in haemorrhages as one of the three high priority preventable adverse drug events.

In November 2004, the Australasian Society of Thrombosis and Haemostasis updated its warfarin reversal guidelines. However, there were numerous reports that patients did not always receive appropriate treatment.

An audit of patients who required warfarin reversal from 1 January 2003 to 31 December 2003 at Frankston Hospital established that only 52 per cent of patients were treated according to the previous guidelines. Anecdotal evidence suggested that the practice did not improve in 2004.

Frankston Hospital is the major provider of acute secondary and tertiary hospital services on the Mornington Peninsula. With over 300 beds, it provides general and specialty medical and surgical services, mental health, maternity, and paediatric services. Each year, about 270 patients require warfarin reversal at the hospital.

Objectives

The aim of this quality improvement initiative was to improve the treatment of patients with warfarin over-anticoagulation who were actively bleeding or potentially at risk of bleeding. Compliance with the national warfarin reversal guidelines was chosen as the outcome indicator. The target was to increase compliance by at least 50 per cent.

34

Methods

The implementation strategy applied some of the theories and principles of communication and behaviour changes used by pharmaceutical manufacturers in infl uencing prescribing practices. The Plan–Do–Check–Act (PDCA) quality cycle was used to coordinate the continuous improvement efforts.

The baseline compliance rate of 43 per cent measured in September 2004 was worse than the 2003 results and was used to motivate a sense of urgency for change.

Key opinion leaders on the Drugs and Therapeutics Committee endorsed the national guidelines for use at Frankston Hospital. An emergency department consultant was recruited as the clinical champion for the initiative.

A highly visible promotional campaign with the slogan ‘Be aware’ was launched in October 2004; it was based on the Dracula movie theme.

A total of 52 ‘movie posters’ located around the hospital advertised the new guidelines. Simultaneously, continuing the movie theme, the hospital intranet home page featured a moving image of a bat accompanied by the phrase ‘Catch me if you can’. When the user mouse-clicked on the bat, the guidelines were displayed. The pathology reports on clotting times also directed doctors to use the guidelines. Also, identifi cation-badge sized versions of the guidelines were distributed to all doctors offering point-of-care information and 12 education sessions were conducted for doctors and nurses on the use of the guidelines.

In the audits, it was noted that high doses (10mg) of Vitamin K were prescribed to many patients, potentially resulting in an overcorrection and a subsequent increase in clotting risk and warfarin resistance for up to a week.

A decision was made to remove 10mg Vitamin K ampoules from the fl oor stock of all wards and replace them with 2mg ampoules. This is an example of forcing functions, which are the most effective medication error prevention tools. Their use results in lasting changes because errors are virtually impossible or diffi cult to make. The 10mg amps were supplied, after pharmacist review, on an individual patient basis.

By November 2004, a month after the campaign launch, the compliance rate had improved to 56 per cent. Further training sessions at clinical meetings was conducted. The emergency department consultant also provided positive reinforcements, counselling non-compliant doctors identifi ed by the audits.

Following the change in medical staff rotation at the beginning of the year, the new staff were targeted for training. The identifi cation-badge sized versions of the guidelines were also given out at medical staff orientation.

Outcomes

The initiative was implemented to reduce the high risks of bleeding in patients requiring warfarin reversal as reported in the literature. The implementation of the guidelines also ensures the adoption of best evidence into practice and consistent treatment approaches by different doctors. Junior doctors also appreciate the information provided by the guidelines.

35

The effectiveness of the initiative was monitored for a year. A total of eight audits were completed during that period to track the outcome indicator.

The initiative has exceeded its target. By September 2005 there was a 105 per cent improvement (from 43 per cent to 88 per cent) in the compliance rate. In June 2006, a repeat audit showed a compliance rate of 83 per cent.

Lessons learned

One lesson learned is to always confi rm outcomes after implementing a change. The compliance rate of 56 per cent achieved two months after the campaign launch was initially disappointing. Now, in all quality improvement activities, there are continuous checks to see if key activities are working. Several PDCA cycles might be needed to achieve the outcomes expected.

The key strengths of the initiative were: the strong partnership between medical and pharmacy staff, strong commitment and support from key opinion leaders, repeated and regular feedback on performance of outcome indicators, the emphasis on educational rather than punitive measures and the application of quality tools such as the PDCA cycle and use of forcing function.


The guidelines were fi rst introduced in October 2004. There have been two junior medical staff intakes since then; in early 2005 and 2006. The latest compliance rate of 83 per cent in June 2006 demonstrates that the initiative is sustainable. The reason is that many of the components of the initiatives are still in place:

training on the use of the guidelines is provided during medical staff orientation, the ID-badge sized versions of the guidelines are still provided and pathology forms continue to direct doctors to the guidelines (which are available on the intranet).

Since the ‘Be aware’ campaign, other quality improvement activities modelled on this initiative have been implemented. These include ‘Don’t be a clot’ to improve rates of medical thromboprophylaxis and ‘Do the write thing’ to decrease the use of dangerous abbreviations.

In 2006, Peninsula Health launched the ‘Warfarin dose. Get it just right’ campaign to introduce a complete set of guidelines on the prescribing of warfarin. The guidelines now include the initiation and maintenance of warfarin therapy. This year a DVD was produced as an aid to ensure that timely, consistent and accurate medication information is provided to warfarin patients.

Budget

No additional staffi ng or external funding was required for this initiative. A pharmacy undergraduate student completed many aspects of the initiative as part of their diploma thesis project. The student was supervised by senior pharmacy staff.

Contact

Skip LamDirector of PharmacyPeninsula Health T: 9784 7606E: [email protected]

36

September 2006 marked the completion of a three year cycle of improvement to plan, implement, review and incorporate into ongoing practice the ‘Code Green’ response for emergency caesarean section at Box Hill Hospital.

Code Green was the new initiative developed and implemented in the Birralee Maternity Service in September 2003 to facilitate an obstetric emergency requiring immediate emergency caesarean section. An organised plan was developed for staff to follow when calling a Code Green. The process aims to achieve a ‘decision to delivery interval’ (DDI) time of less than 30 minutes, to facilitate an emergency birth of a baby or manage a life threatening clinical condition of the mother. This expedites the birth of the baby to optimise neonatal and maternal wellbeing.

As a consequence of developing an obstetric Code Green, a new categorisation for caesarean section based on the degree of urgency was created to improve communication and streamline processes between Birralee Maternity Unit, the theatre suite and special care nursery.

Since its introduction the multidisciplinary, interdepartmental communications and improved relationships between theatre, obstetrics and special care nursery have resulted in fi ne tuning and improving emergency caesarean sections conducted under Code Green.

The 2005–06 review has shown that the system is working well. To date the Birralee Maternity Service has had 63 Code Greens with an average DDI time of 29 minutes. This compares to an estimated average time of between 45–60 minutes prior to the implementation of the Code Green initiative.

Contact

Gail WilkinsonAssistant Director of Nursing Women’s and Children’s Services Box Hill HospitalEastern HealthT: 9895 3333

Highly commendedObstetric Code Green

Box Hill Hospital, Eastern Health

37

Highly commendedPreparing children for magnetic resonance imaging


The unique Practice MRI Imaging Preparation Project at the Royal Children’s Hospital was developed by the hospital’s Department of Educational Play Therapy and the Children’s MRI Centre.

The aim of the program is to equip children with the skills required for magnetic resonance imaging (MRI) and to reduce the number of children who require a general anaesthetic for the procedure.

The project team was convinced that children who were adequately prepared would be less anxious and more likely to be able to undertake an MRI.

A practice MRI, being an MRI shell providing a similar experience for the child without the technical constraints and costs, was built and a trial program was conducted.

The trial program had early success in helping children to cope with an MRI without the need for a general anaesthetic. The effi cacy of the program was further tested and validated by including a number of children with reported anxiety.

Children as young as three years and seven months of age have been able to undertake an MRI scan and many older children, who have been reported as highly anxious or who have repeatedly had a general anaesthetic for their scans, have been able to cope.

‘You mean I don’t have to have a GA any more? That is awesome.’ 12 year old girl who had multiple MRI scans under a general anaesthetic.

‘This is such a wonderful idea. It is really making a difference for my daughter.’ Father of a fi ve year old child.

The program supports children in developing skills of coping and relaxation to allow them to overcome a potentially anxiety-provoking medical intervention and can be translated into other areas of their medical care.

Contact

Leanne HallowellChief Educational Play TherapistThe Royal Children’s HospitalT: 9345 5423E: [email protected]

38

0Highly commendedSafety in the operating room

Austin Health

In response to a sentinel event in November 2003, Austin Health convened an Operating Suite Incident Review Group. Representatives from surgery, anaesthesia, clinical governance and the operating theatres were invited. The objective of the group was to improve safety in the operating suite.

Over nearly four years the group has documented and categorised more than 4,000 patient and equipment related incidents. These incidents are reported by all disciplines working within the operating suite.

The major achievements have included Austin Health becoming the fi rst major Victorian hospital to introduce ‘Time Out’ as a mandatory process for all surgery. Time Out requires that, immediately prior to surgical incision, the theatre team undertake a fi nal checking procedure to ensure the right operation is being

undertaken on the right patient and that all required equipment and X-rays are present. Currently there is 100 per cent compliance with this initiative. A unique aspect of Time Out at Austin Health is the inclusion of checks for deep vein thrombosis prophylaxis and prophylactic antibiotic requirements.

To ensure appropriate preparation of the patient on the day of surgery and subsequent passage through admissions, anaesthesia room, operating theatre and recovery, the concept of the ‘Operating Room Passport’ was developed. The passport ensures a formal approach to patient handover during their movement from admission to the ward post-surgery. The initiative requires that specifi c criteria, such as fasting confi rmed, allergies checked and required X-rays present, be met before the patient can be taken from the admissions area into the operating theatre complex. By keeping the patient in the admissions area until these criteria are met, processes that are only initiated in the theatre area; for example, sedation or anaesthesia; will not occur until the preoperative checks have been completed.

Contact

Associate Professor Larry McNicolMedical Director, Anaesthesia, Perioperative and Intensive Care ServicesAustin HealthT: 9496 5429E: [email protected]

39

06Achieving effective continuity of care entails services working together to provide a seamless experience for healthcare consumers. This award recognises initiatives which improve outcomes for consumers and communities by taking a coordinated approach to care design and delivery.

Category 5Excellence in continuity of care

06

40

The Improving Diabetes Care program was established under the Hospital Admission Risk Program (HARP), and is a collaboration between Austin Health, the Northern and North East Valley divisions of general practice and the Banyule, Darebin and Nillumbik community health services. The program aims to improve health outcomes for people with diabetes and reduce the preventable use of the emergency department and inpatient services at Austin Health.

The program model integrates the services of hospital, community and general practice by creating two main streams which are interconnected by referral and communication pathways: an ambulatory care stream and an acute stream.

Abstract

The HARP-funded Improving Diabetes Care program has resulted in two important initiatives:

• The ambulatory-care-based Diabetes Complications and Assessment Service (DCAS), which provides an annual ‘one stop shop’ assessment and screening service for diabetes and its complications. It also provides diabetes education, nutrition and podiatry services, and operates at fi ve sites across Melbourne’s north-east.

• The Austin Health inpatient Diabetes Care Coordinator role, which is a unique role that coordinates inpatient diabetes care and discharge planning.

Outcomes of the program include a reduction in hospital utilisation, improvement in all main clinical indicators, a strong level of patient satisfaction and positive stakeholder evaluation. Specifi c strengths of the program are in the areas of general practitioner (GP) engagement, consumer participation, self-management, community collaboration and service integration.

Background

Diabetes is one of the fastest growing chronic health conditions in Australia and is a signifi cant health issue in the northern metropolitan region. Analysis of Austin Health patient data between 1 July 2000 and 31 December 2001 identifi ed patients with diabetes as high users of hospital services with frequent emergency department attendances and a high number of inpatient episodes. The Hospital Admission Risk Program provided Austin Health with the opportunity to respond to this aspect

WinnerImproving diabetes care


41

of hospital demand. Initial planning was undertaken by a working group with representatives from all collaborating organisations. It was agreed that early risk identifi cation through annual complications screening, in addition to intensive diabetes self-management education, should be the focus.

Objectives

The program aimed to establish a comprehensive, patient-focused, best practice diabetes care program for the residents of Melbourne’s north-east, integrating the services of primary, secondary and tertiary care providers. Anticipated outcomes include improvement in diabetes-related health outcomes and a reduction in the preventable use of emergency department and inpatient services at Austin Health.

Methods

The Improving Diabetes Care program focuses on the early identifi cation and management of diabetes complications through risk screening, adherence to best practice guidelines, improvement in health-related behaviours and sector collaboration.

The entry point to the program is DCAS, where patients receive an annual assessment of their diabetes. This includes complications screening and assessment of self-management behaviours. Speedy access to diabetes self-management education, nutrition education and podiatry services is then provided.

A report is sent to the referring doctor outlining the fi ndings and any management recommendations.

Strategies that have strengthened the program include:

• An extensive consultation phase from the outset, with GPs, community partners and consumers. Ongoing consultation continues through regular community and GP meetings and the Consumer Advisory Group.

• Maintaining the role of the GP as the primary care coordinator, which has ensured strong GP engagement.

• Introduction of the Diabetes Care Coordinator role, which targets inpatients at higher risk of hospital usage.

• Integration of the program into existing services within the region.

• Development of the Diabetes Health Record self-management tool.

Key indicators used to evaluate the program include clinical data, self-management behaviour data, hospital usage data and patient satisfaction and referral numbers.

42

Outcomes

The following indicators were used as outcome measures:

Clinical indicators

a) There have been reductions in the following clinical indicators: HbA1c (a measure of diabetes control) 7.1 per cent, blood pressure 4.4 per cent, total cholesterol 8.5 per cent, LDL (bad) cholesterol 5.7 per cent, triglycerides 32.4 per cent, urine albumin (protein) 45.9 per cent, plasma urea (9.4 per cent). In addition, there has been an increase (improvement) in HDL (good) cholesterol 6.3 per cent. Of note is that of the 10 clinical indicators, only two were within target at baseline, and fi ve were within target by visit three.

b) The number of patients having a urine albumin test as a screen for kidney disease has increased from 37.2 per cent to 58.1 per cent.

c) The number of people having regular eye screens for eye disease has increased by 28.4 per cent.

Self-management behaviour indicators

• The percentage of people returning for annual review who showed improvement in the following self-management behaviour indicators: physical activity (21.1 per cent), eating (40.8 per cent), blood glucose monitoring (32.1 per cent), risk factor reduction (53.6 per cent), quality of life (53.1 per cent).

Hospital utilisation data

• Number of ED presentations has reduced by 19.4 per cent.

• Number of unplanned admissions has reduced by 17 per cent.

Patient satisfaction

• A high level of satisfaction with the service was recorded by a mean of 94.6 per cent of patients.

• High level of satisfaction with service communication and cohesion was recorded by a mean of 97 per cent of patients.

Referral numbers and source of referral

• Total number of referrals March 03 to March 06 = 975.

• Percentage of referrals from GPs remains high at 89 per cent.

Lessons learned

There were many lessons learned in undertaking this program, including:

• the importance of undertaking extensive consumer consultation in order to develop the most appropriate model. Despite initial concern about delaying the project’s implementation, the consultation phase was particularly benefi cial in directing the development of the model in areas where opinions of stakeholder organisations differed

• the importance of establishing links with the divisions of general practice. With GP engagement being one of the project’s critical success factors, the enormous

43

contribution of the collaborating divisions to engage GPs in the consultation and implementation phases has been invaluable

• time involved in establishing relationships with key stakeholders, both internal and external

• time involved in managing the needs of stakeholders, which is particularly relevant considering there were fi ve external stakeholders, several internal stakeholders and participating professional groups

• the benefi ts of establishing the Consumer Advisory Group. This group was fundamental in helping to make decisions that impacted on consumers.

As a result of these lessons the program has evolved with specifi c strengths, including:

• strong GP engagement, consumer involvement and community collaboration

• service integration

• a workforce model that encourages multi-skilling and cross-sector secondment

• the establishment of a regional network of diabetes professionals who share resources, professional development and knowledge.

In hindsight, the following could have been considered to further enhance the program’s success:

• more ongoing marketing to GPs in the earlier stages of the program as a means of reminding GPs of the program’s existence

• a re-design of the DCAS model in order to make it less reliant on the presence of the endocrinologist. There have been several periods of shortage of available endocrin-ologists, which has impacted negatively on the program.


An important element in sustaining the program is integrating it into existing services. To date it is fully integrated into the diabetes education service at Austin Health and partially integrated into the services of collaborating community organisations. Over the coming year it is anticipated that DCAS will become an important entry point for all diabetes referrals to Austin Health, which will provide a more streamlined approach to diabetes management and ultimately show a greater improvement in the indicators above. From 1 July 2006 the program received recurrent funding through the HARP Chronic Disease Management program.

Budget

For the duration of the program, funding has been provided by the Department of Human Services through HARP in the order of approximately $500,000 annually. In order to achieve some degree of sustainability in the future, the DCAS clinic operates as a private clinic with an average revenue of approximately $40,000.

Contact

Carolyn HinesDiabetes Program ManagerAustin HealthT: 9496 5439E: [email protected]

44

Food.Com.Play is an innovative program tackling childhood obesity in Frankston and the Mornington Peninsula. Obesity in children cannot simply be addressed with a strict diet or exercise regime, because with obesity often comes issues of self-esteem, bullying, physical activity, family relationships, poor nutrition skills and lack of physical activity.

Food.Com.Play involves a multidisciplinary team including paediatric nurses, physiotherapists, family therapists, dietitians and a play therapist. Food.Com.Play is a collaboration between Frankston Hospital paediatric staff and Frankston Community Health staff and focuses on positive development, healthier eating, positive parenting, socialisation skills, self-esteem, exploration of food, and whole family active play.

The children who attended the program have reported having a ‘fantastic’ time and wanted the program to continue well beyond its six week duration. They enjoyed making friends and learning to ‘eat healthy and play more active games, like charades’. They tried many new healthy foods and were surprised that they were ‘yummy’.

However, the problems faced are not the child’s alone, but the whole family’s. Food.Com.Play provides parents with support, parenting skills, and advice on bullying, health, nutrition and physical activity. Feedback from parents noted both family and individual change. The children requested less junk food and were choosing more active play, families bought less high fat, high sugar food, communication around healthy choices improved, and portion sizes of meals decreased. One parent summed up the program, saying it gave her child ‘a very good lifetime of knowledge’.

Contact

Alison WheelerDietitianPeninsula HealthT: 0418 323 515E: [email protected]

Highly commendedFood.Com.Play: A family-based intervention for childhood obesity

Peninsula Health

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The aim of the diabetes cardiovascular program is to provide a consumer-focused, integrated disease management and preventative program for individuals with type-2 diabetes and high cardiovascular risk or established disease. The diabetes cardiovascular project began in January 2004 with referrals from Dandenong Hospital and local general practitioners (GPs).

The program has developed a range of specialised services to enhance the care of diabetes cardiovascular disease. A centralised coordination and assessment service has been developed to receive and assess consumers and work with them to arrange a mix of appropriate services. The centralised coordinating service also assists the consumer in navigating the service system and tracks their progress along the way. The service then facilitates appointment arrangements with the designated services and communicates with service providers where necessary.

A diabetes cardiovascular advisory service led by an endocrinologist and multidisciplinary team of healthcare professionals has been established to support GPs in the management of this complex disease. In addition, tailored diabetes cardiovascular self-management programs are available to enable consumers to be actively involved in their care.

While these services are offered from healthcare providers from the acute and primary care service system, enormous effort has been invested to ensure the experience for consumers is of an integrated system. This has necessitated practice and culture change within participating organisations and, importantly, recognition of the importance of involving consumers in the design and implementation phases.

Contact

Christine CrosbieProject Manager Diabetes Cardiovascular Risk Management ProjectDandenong District Division of General Practice T: 9706 7311E: [email protected]

Highly commendedAn integrated experience for persons living with diabetes cardiovascular disease

Dandenong District Division of General Practice

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0Victoria Police often come into contact with people who have disturbed behaviour. Often these people require mental health assessment and emergency departments are often used to achieve this. Until recently there was no way of formally documenting individual patient issues raised by the police. The only way of relaying information between police and emergency department staff was by an unstructured verbal handover. In addition, the reception, triage and treatment of disturbed patients remained inconsistent. Overall, the care of this vulnerable group was not as effective as it could be because key personal information was not determined.

Recently, Western Health has headed a multidisciplinary team, including representatives from Victoria Police, Metropolitan Ambulance Service, local mental health services and emergency departments, to develop

a structured process for triage, reception and handover of disturbed patients. Process changes included:

• development of a police referral form to capture key information

• pre-notifi cation of the emergency department

• standardised multidisciplinary reception, triage and assessment process within the emergency department

• feedback to police.

During the three-month trial, there were 127 Section 10 presentations, representing 30 per cent of non-toxicology mental health presentations. The median age was 34 years, 58 per cent were male, 87 per cent had a completed referral form, 39 per cent were admitted to an acute psychiatric facility and a further 38 per cent had community psychiatric care after emergency department assessment. In 84 per cent of cases there has been formal feedback to the police.

The new process has been strongly received by all stakeholders and is likely to be adopted statewide.

Contact

Karen WarneckeOperations Manager of Access and EmergencyWestern HealthT: 8345 0412E: [email protected]

Highly commendedImproving communication and hand-over between police and emergency department for patients with acute behavioural disturbance detained under section 10 of the Mental Health Act

Western Health

0647

Category 6Excellence in consumer and carer participation

In order to deliver healthcare services that meet community needs, it is essential that consumers and carers participate in the planning and decision-making in a health service. This award recognises the formal processes, policies and programs instituted by services to engage consumers and carers at an organisational level, and to ensure that consumers are effectively informed and involved in all aspects of their own care.

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The Respecting Patient Choices (RPC) program is an advance care planning program whereby an individual is able to make decisions about his or her future healthcare in consultation with their healthcare providers, family members and other important people in their lives. The process enables individuals to refl ect on what is important to them, on their beliefs, values, goals and preferences in life, and how they want to be cared for if they reach a point where they cannot communicate decisions about medical care or if they are dying.

The RPC program was implemented in 17 residential aged care facilities in the Austin Health catchment area in 2003–05. Evaluation found that advance care planning

had a signifi cant impact on the level to which consumers were involved in choices regarding their future care and on the skill, confi dence and involvement of health service providers in facilitating the process. The program provided evidence that if a person’s end-of-life wishes were discussed in a sensitive and supported manner, and documented clearly and consistently within and between service sectors, then they received healthcare in their place of choice and avoided receiving unwanted and often burdensome treatments.

The perception of the patients or residents, their families and the health professionals is that the process of advance care planning improves quality of care and increases awareness of, and respect for, patient autonomy and human dignity.

Abstract

The Respecting Patient Choices (RPC) program was implemented in 17 residential aged care facilities (RACF) in the Austin Health catchment area from 2003–05.

RACFs facility managers, staff and those residents and their families that have been interviewed all reported that the program has had a positive impact, complemented currently existing models of care and addressed important and diffi cult issues that were often not canvassed until a later stage in a resident’s illness.

Evaluation of resident deaths found that all (100 per cent) residents introduced to RPC with an Advance Care Plan had their end-of-life wishes respected.

Joint winnerRespecting patient choices in residential aged care

Austin Health

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Background

Caring for people at the end of their lives is an inseparable part of quality healthcare. Integral to this is respecting a patient’s wishes regarding their end-of-life care. There is widespread community support for this concept, which is founded upon the principles of autonomy and human dignity.

There is, however, a large gap between the expressed support for this ideal and its actual delivery. This is partly due to advances in medical technology, raised expectations in the community and health profession about what can be achieved with medical treatment, and the understandable human desire to ‘hope for the best’. It is also due to community reticence to talk about death and dying. Patients, their families and health professionals struggle to talk about what to do when the treatment is not working, when the patient is deteriorating or when the benefi ts of the treatment are outweighed by the burdens. For this reason the RPC program was developed by Austin Health.

This project was developed from the RPC program fi rst introduced to Austin Health in 2002, and is based on the Respecting Choices™ Program from the Gundersen Lutheran Medical Foundation in La Crosse, Wisconsin, USA. The Respecting Choices™ Program is recognised as ‘best practice’ by The National Coalition on Health Care (United States) and the Institute for Healthcare Improvement.

Objectives

The project had a number of objectives:

• to respect resident’s wishes as they near the end of their life

• to encourage participation in advance care planning by residents and families

• to educate key staff to facilitate the advance care planning process

• to involve general practitioners (GPs) in the advance care planning process

• to develop a sustainable model of advance care planning in residential aged care

• to implement best practice in end-of-life care planning and processes

• to evaluate the community pilot and develop a program that can be implemented in other RACFs across Australia.

Methods

The fi rst step in the project involved providing staff with training, skills and knowledge to facilitate discussions with residents and their families on advance care planning. An education and training program was developed for RACFs based on the program fi rst developed and implemented at Austin Health for inpatients in 2002. A total of 158 staff from the 17 RACFs were trained to facilitate the advance care planning process from March 2004 to June 2005.

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Trained staff introduced advance care planning to residents and their families. Residents and families who wanted to participate in the program were assisted to complete a Statement of Choices form indicating their end-of-life wishes. This form was placed in their fi le in their RACF in a ‘green sleeve’ to clearly identify the form, and copies were provided to the resident’s GP and any other people the resident or family requested.

RACF managers were also supported to implement organisational and system changes necessary to support the RPC program. These included documentation and communication processes.

RACF staff and GPs completed surveys at a number of time points. Data was collected to evaluate process outcomes and end-of-life outcomes.

Consumers and carers were interviewed regarding their advance care planning experiences.

For residents who completed a Statement of Choices form and who died during the evaluation period, an assessment of their medical treatment at their end-of-life was reviewed to determine if their wishes had been met.

Outcomes

Evaluation of the program clearly showed that participation in the RPC program increased consumers’ and families’ involvement in refl ecting upon, communicating and documenting requests for future medical treatment.

The evaluation demonstrated that:

• 51 per cent (565 residents from a possible 1108) of residents across the 17 RACFs were formally introduced to the program during the evaluation period with the rate varying from 17 per cent to 97 per cent at different facilities.

• Only 37 per cent of the residents were identifi ed as being competent to make medical decisions for themselves, however families and carers of residents were able to document the choices they believed their family member would have made.

• Residents who participated in the program were given the opportunity to record their advance care planning choices on a Statement of Choices form – 296 (26.7 per cent) such forms were completed.

• 100 per cent of RACF residents who had completed a Statement of Choices form indicating their end-of-life wishes and who died during the project had their medical treatment wishes respected at their end-of-life.

• 88 per cent of those residents with an advance care plan in place died in their homes, receiving palliative care at their request. This compares to between 59–70 per cent of residents who had not made their future treatment requests known dying in hospital.

• Consumers’ values and beliefs were respected at the end of their lives. Facilities provided extensive evidence of the way in which residents’ psychosocial end-of-life wishes were warmly regarded and valued highly during the delivery of care.

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Lessons learned

Several factors worked synergistically to enable successful program implementation, including:

• leadership from managers

• commitment from the organisation’s governing body

• training of adequate numbers of appropriate staff in advance care planning

• provision of consultation and support to facilities and trained RPC consultants

• comprehensive system changes to documentation and communication processes

• the best practice RPC program is suitable for residential aged care facilitates and is well accepted by staff, GPs, residents and their families.


Residents, or families of residents who lack decision-making capacity, at the 17 RACFs continue to have the opportunity to participate in advance care planning. Facility staff continue to be trained by Austin Health and continue to introduce advance care planning to residents, families, facilities, staff and GPs.

Further implementation at other RACFs is planned; however, additional resources are required to provide training to staff. The program materials have been developed so that they can be used in other RACFs, but it requires an initial training period from experienced RPC trainers and implementation of a number of system changes.

The RPC program has been implemented in one lead hospital in each state and territory across Australia, clear evidence that the program is innovative, best practice and well accepted nationally as a leader in its fi eld.

Budget

Funding of $470,000 over two years was provided by the Commonwealth Department of Health and Ageing for two full-time project offi cers. Funding also supported a program director and program manager to oversee the community pilot and roll-out of the RPC Program to seven interstate sites.

Contact

Liz SticklandRPC Program ManagerAustin Health T: 9496 6651E: [email protected]

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The Consumer Participation Program of the Royal Children’s Hospital Mental Health Service is a forum for clients, parents and carers to share their views about the service and for the service to be better informed about its clientele. It began as a pilot project in 1996 and was the fi rst consumer participation program in child and adolescent mental health services in Australia. Since then it has been fully integrated into the operation of the service and the value of consumer participation is widely accepted within the organisation.

Consumers value the opportunity to participate and are proud to see their input creating changes that will benefi t clients and families in the future.

‘I’m impressed that something happens with the survey feedback, that it’s taken seriously and changes are made.’

‘If I can help the service and others then that’s something positive to come out of a very diffi cult experience.’

Abstract

The Consumer Participation Program of the Royal Children’s Hospital Mental Health Service is an innovative program that engages parents and carers in partnership to ensure the best service delivery for those accessing the service.

The program is led by a parent ‘consumer consultant’ who is a former user of the service. The consultant engages other consumers through participation in satisfaction surveys, focus groups and involvement in the development of new initiatives.

Feedback from consumers ensures that the consumer perspective informs decision-making, staff training and service improvement. The program has been fully integrated into the operation of the service through the consultant’s membership at senior management forums.

The success of the Consumer Participation Program can be judged on the signifi cant cultural change within the organisation. Consumer-driven service improvements have created a more user-friendly service and the consumer perspective is now well integrated into clinical service delivery.

Background

This initiative began in 1996 with the service’s Community Reference Group (CRG) which has representation from a wide range of organisations working with children and young people, and includes consumers.

Joint winnerThe Consumer Participation Program


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The CRG identifi ed that its consumer members needed networking opportunities with other consumers. It also felt that broader consumer participation was necessary to ensure quality of care.

A successful proposal was submitted to the Victorian Health Promotion Foundation and in 1997–98 the service conducted the fi rst consumer participation pilot in a child and adolescent mental health service (CAMHS) in Australia. This pilot project informed the ongoing development of consumer participation, leading to the current program.

The Royal Children’s Hospital Mental Health Service (RCH MHS) is an integrated service for children and young people in the Melbourne western metropolitan region. Given the age of our clients, families and carers are signifi cantly involved in their care. Working with these clients generally involves working with parents and carers who are the decision-making adults in their life.

Objectives

The overall aim of the program is to increase sensitivity to the consumer experience by promoting a culture of consumer participation as a tool for enhancing service delivery.

The overall improvements the service was striving for was recognition that consumers have rights and a vital role to play as partners in improving clinical care. The key objectives in achieving this were to:

• ensure that the program was well integrated into the key decision-making structures of the organisation

• provide a framework for consumer participation within the service

• develop and maintain structures and policies and a consumer-friendly culture appropriate to the service.

Methods

The employment of a consumer consultant in 2000 was a pivotal point in the development of the program. This process created authenticity, integrity and facilitated a process for consumers to be able to give honest feedback about their experience. This was achieved through consumer access mechanisms such as focus groups, phone surveys, written surveys and utilisation of the complaints mechanism.

Concurrent with this process has been ongoing work to assist staff in dealing with challenges associated with consumer participation. Professional development sessions and presentations to registrars and new staff are aimed at raising awareness of the consumer perspective and experience.

A further strategy has been the integration of consumer participation into the structure and functioning of the service. This has been achieved by:

• addressing consumer participation at a policy level

• consumer representation on strategic planning and management committees

• clear positioning within the organisational structure

• establishment of processes for generating action in response to consumer input.

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The development of a charter of rights and responsibilities for children and parents by the service in 2003–04, endorsed by the Department of Human Services, has also been a key strategy in the program.

Outcomes

Effective consultation with consumers enables continuous monitoring of consumer satisfaction. Consultation processes include:

• feedback mechanisms such as focus groups and satisfaction surveys

• hosting consumer forums with a specifi c focus.

Signifi cant consumer-driven service improvements have been generated, for example:

• a Charter of Rights for parents or carers and children

• user-friendly written information for families

• formal complaints and feedback processes

• exit reports providing a treatment record.

A gradual culture shift within the organisation has occurred as the profi le of the consumer perspective has been raised. Increased sensitivity contributes to a more effective service and greater consumer satisfaction.

The program, including its key initiatives, is evaluated on an ongoing basis. Regular strategic planning considers these evaluations and sets future directions. A 2005 external accreditation review of the service awarded the Consumer Participation Program the second highest rating of ‘extensive achievement’. This affi rmed the value and success of the program within the service.

Lessons learned

Cultural change is a gradual process so working slowly and steadily is more likely to ensure sustainable integration and outcomes.

The organisation also needs to be fl exible enough to embrace consumer participation and willing to be critiqued by clients in order to engage with them honestly. As well, not all consumers want to be involved. In this service consumer involvement is often short term and clients prefer to disengage once discharged, so continually contacting new consumers is important.

The service began this program as a pilot 10 years ago when the concept was unheard of. Its progression from a pilot project to now being integrated in the service highlights the value of this developmental approach.

The strengths of the program include:

• management commitment to and integrationof the consumer program into the service

• integration of consumer participation and the consumer perspective into the organisation

• collaboration and consultation with all stakeholders

• a consumer consultant with personal experience facilitates contact with consumers and encourages honest feedback

• use of consumer feedback in service improvement.

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Learnings from the pilot project informed future planning and the current program has been operating increasingly successfully for six years. Its ongoing success can be attributed to:

• using an appropriate model and structure for our context

• the commitment of management to the program and its integration within the service

• ongoing resourcing and support

• supportive partnerships and collaboration both internal and external to the service

• regular review and evaluation of program

• strategic planning for future

• perceived value of the program and its contribution among internal and external stakeholders.

The tools of the program, particularly the development of a charter of rights and responsibilities, have been disseminated to other CAMHS around the state. As well, this charter has been included in the ‘CAMHS in community’ policy document (2005).

Budget

The initial funding came from Vichealth for the pilot project. This enabled the employment of consumer consultants for 11 hours per week each over eight months, along with the time of senior staff in supervision.

Following this, the service made a commitment to allocate funds for the employment of a permanent part-time consumer consultant and to resourcing the Consumer Participation Program from its own budget. This includes funding of consumers involved in focus groups and other feedback mechanisms. Funding has also been allocated to service improvement initiatives generated by the program.

Contact

Rosemary LawtonConsumer Consultant, Mental Health ServiceThe Royal Children’s Hospital T: 9345 6011E: [email protected]

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Aged psychiatry consumers are traditionally disempowered and have little say in the services provided for them. Contributing factors include the combination of medical and psychiatric co-morbidities, their age and the social implications of their mental illness (for example, families are often ostracised and no longer provide active advocacy).

In an effort to provide services that are person-centered and meet the needs of consumers, as identifi ed by them, the Aged Psychiatry Service at Bayside Health developed a comprehensive range of opportunities for consumers and carers to participate in the quality improvement cycle.

Unique to this project was the development of monthly consumer forums and consumer bulletins. After initial attempts failed to engage consumers, assistance was

sought through the Bayside Adult Psychiatry Consumer Program. Two paid consumer consultants were appointed and forums commenced in 2005. These are now well established and well attended.

Other factors crucial to the success of the project were the availability of a staff ‘champion’, executive support and education for clinicians.

Interestingly, issues identifi ed by consumers often differed from those identifi ed by clinicians. This has resulted in more client-centred quality initiatives such as an increased focus on ‘mental health’ through activity programs and improved communication practices, particularly with regard to patient rights and treatment planning.

While consumer participation programs in adult psychiatry are government funded, consumer programs in aged psychiatry are not. This project has demonstrated that such programs need not be expensive, are sustainable and bring about rewarding results for both consumers and the service.

Contact

Elizabeth RandQuality Coordinator, Caulfi eld Aged Psychiatry ServiceBayside HealthT: 9276 6600E: [email protected]

Highly commendedA comprehensive model to encourage consumers of aged mental health services to participate in the quality improvement process

Bayside Health

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06Health services occupy an important position in their communities and, as such, have a responsibility to build relationships and be active and positive contributors to their local community or service population. This award recognises excellence in engaging local communities, through external relations and activities such as community education and awareness programs.

Category 7Excellence in community engagement

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The Community Group Program (CGP) is communal in name and in nature. It is about capacity building, forging connections and forming relationships with local schools and community organisations. Since 1999 the CGP has provided 432 group work programs to nearly 3,000 children, worked in over 200 schools and a dozen community organisations. Its work involves engaging other organisations and professionals in collaborative service delivery, providing train the trainer opportunities and developing educational programs aimed at promoting social inclusivity for children and young people struggling with mental health diffi culties and the trauma of family violence. These programs have been awarded ‘good practice’ status by Commonwealth bodies.

The CGP has developed leading training group work packages and produced professional manuals and books about its work. It has been involved in campaigns to raise community awareness and been represented

on committees aimed at promoting mental health and addressing family violence. Through this work, the CGP has grown into a multi-award winning, evidence-based community innovation that is unique to the Royal Children’s Hospital Mental Health Service.

Essentially the role of the CGP is to engage children with their families, their families with their school, schools with their community and communities with one another.

As one mother simply said: ‘My child had developed very good socialising skills this year. He now has a group of friends at school and he is getting lots of invites to play.’ (CGP Report 2003)

From little things big things grow.

Abstract

As part of the Royal Children’s Hospital Mental Health Service (RCH MHS), the Community Group Program essentially provides three related but discrete services.

The fi rst works predominantly with the state Department of Education and provides social skills group work programs in local schools. Operating from a train the trainer model, our aim is to not only provide direct service delivery to these children, but enhance the whole school community by ‘skilling up’ their staff to continue running these programs once the CGP has departed.

The second is the Addressing Family Violence Program (AFVP) which targets one of the most vulnerable and isolated groups in society; infants and children affected by family violence. These specialist mental health programs aim to address the detrimental impact

WinnerThe Community Group Program


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of violence, to connect their mothers and carers into ongoing community support and to enhance these children’s peer relationships.

The third is Operation Newstart Western, a collaborative Victoria Police, Department of Education and Training and RCH MHS adventure-based counselling initiative that works with disconnected young people who are at signifi cant educational, psychological and criminal risk.

All programs are comprehensively evaluated and demonstrate a signifi cant reduction in emotional symptoms, conduct problems, and overall diffi culties among participants following their involvement in these programs (CGP progress reports 2003, 2001, 2000, 1999). Follow-up train the trainer evaluation showed ongoing and sustained positive differences to the welfare of their students and school community in general.

Background

The RCH MHS, covering western and north western metropolitan Melbourne, is for children and adolescents aged 0–15 and their families who are in need of mental health services. The CGP consists of a small team of mental health clinicians and teachers (total of seven EFT) who, up until 1999, ran group work programs for inpatient clients of the service only. This previous program, known as the modular group program, serviced approximately 30 clients a year.

In response to feedback that the mental health service failed to provide timely and accessible services to the local community, this program was restructured and

the CGP was born. The central objective was to address the mental health and wellbeing of at-risk children and adolescents through an integrated, innovative and clinically evaluated therapeutic response by implementing the strategic directions of the Mental Health Promotion and Prevention National Action Plan (1998–2003) and the Framework for Student Support Services (1999). This meant working collaboratively with our local community and by the end of the fi rst year of the CGP, the number of students receiving these services within their own schools had risen to well over 200.

Objectives

• Increase access to clinically-focused specialist group work in school and community settings relevant to children’s needs.

• Build capacity for school and community workers to promote positive mental health and reduce protective/risk factors among children, young people and their families.

• Establish a partnership with mainstream schools in order to collaboratively run mental health related group work programs in school communities.

• Provide direct skills-based training and expertise through our train the trainer model of intervention.

• Build strong, healthy and accessible connections between the education and child and adolescent mental health sectors.

• Design and deliver professional development training that promotes evidence-based, best practice models of group work intervention within local communities.

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Methods

Between 1999 and 2005, 2,059 young people have been assessed via the Strengths and Diffi culties Questionnaire in CGP programs (SDQ; Goodman, 1999). The SDQ is a brief behavioural and emotional screening measure that is completed by parents, teachers and students (if aged between 11 and 16) prior to and following their CGP program.

Programs have also included post consumer satisfaction questionnaires for children, parents, teachers, schools and referrers. Operation Newstart has used additional questionnaires and run groups with students. The AFVP uses specifi c family violence measures and questionnaires.

Outcomes

The most recent six year clinical evaluation demonstrated that children within the CGP post group had an improvement in pro-social behaviours and signifi cant reduction in:

• emotional symptoms

• conduct problems

• hyperactivity

• peer problems

• overall total diffi culties.

A fi ve year follow-up survey of co-facilitators (school personnel participating in the train the trainer programs) found that 94 per cent found the groups made a signifi cant and positive difference to the welfare of their students and increased the students’ feelings of connection to the school community.

Statistical analysis of the AFVP found that parents and teachers found an overall improvement in total diffi culties. Both parents and teachers reported a reduction in emotional symptoms, a signifi cant improvement in hyperactivity, and parents reported signifi cantly less peer problems.

Operation Newstart Western’s 2006 progress report demonstrates that it has a signifi cant positive effect on participants, improving:

• social and emotional wellbeing

• physical health

• scholastic achievement

• vocational opportunities.

Participants attending Operation Newstart Western report, through consumer satisfaction surveys and focus groups, that the program promoted:

• feelings of success, pride and achievement

• improved self-awareness and self-control

• development of positive relationships with others

• decreased confl icts and negative attitudes toward others.

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Lessons learned

The most signifi cant strength of this model has been working collaboratively with other services and organisations within the community to enhance, strengthen and extend the range, capacity and effectiveness of these programs for infants, children and young people with mental health diffi culties.

Another important learning was that there are multiple entry points and methods of engaging dislocated, traumatised and marginalised children and young people as well as providing support and expertise to different parts of a service system in order to provide these clients and their families with ongoing support.


The CGP, AFVP and Operation Newstart are all award- winning programs in their own right. They are highly respected, well utilised and evidence-based service delivery programs with proven track records of engaging multiple community players in the care and support of infants, children and young people who present with mental health issues.

These programs have been running for seven, ten and six years respectively. The RCH MHS is committed to their longevity and the work of all three programs has now been replicated by other regions (Operation Newstart models based on the western region model are now running in the north and south east, AFVP programs are being run across Australia and CGP programs are being replicated throughout the western region and the state).

Budget

The operating budget of the RCH MHS for the CGP is approximately $430,000. The in-kind resources of other community partners is diffi cult to determine but would run into the hundreds of thousands of dollars.

Contact

Wendy Bunston, Manager Tara Pavlidis, Deputy ManagerMental Health ServiceThe Royal Children’s Hospital T: 9345 6011E: [email protected], [email protected]

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The initial impetus for Food Talks was in 2003, with an increasing number of young people presenting to Cobaw Community Health Service for food vouchers. A problem-solving discussion between the Cobaw housing worker and dietitian led to students from the Sacred Heart College VCAL program (a vocational, practical alternative to the VCE) investigating issues around homelessness and how to obtain value from food vouchers. In the process they realised this only scratched the surface of the real issue; lack of access to the knowledge and resources required to meet nutritional needs. They recognised too that there was no welcoming place to share a nourishing meal.

So all three VCAL programs – the community-based VCAL, Sacred Heart College and Kyneton Secondary Colleges – set out to create the place. They developed and implemented a pilot community lunch program at Cobaw Community Health Service. It was a resounding success, providing meals to more than 50 people each week. In the process, students honed their hospitality skills and chipped away at some myths around homelessness.

The project has proven its capacity to bring together diverse groups and to link them to programs like the Community Garden and the Men’s Shed and this year will focus on strengthening relationships and community connectedness.

Food Talks is a unique homelessness prevention social justice model driven by the students, supported by teachers and the health service. Students problem solve each barrier, proving their ability to achieve. There is now a waiting list for project participation and feedback from students confi rms that their involvement in this project is one of their most positive school experiences.

Contact

Liz BurnsDietitianCobaw Community Health ServiceT: 5421 1666E: [email protected]

Highly commendedFood Talks: An interactive community lunch program

Cobaw Community Health Service in collaboration with the VCAL programs of Macedon Ranges community, Kyneton Secondary College and Sacred Heart College

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Highly commendedAmbulance in Schools: ‘Emergency…deal with it!’


The Metropolitan Ambulance Service’s new and interactive Ambulance in Schools program has been tailored for upper primary school students, their teachers and parents. Its aim is to enable them to identify environments and behaviours that are hazardous, identify a medical emergency, call an ambulance and provide accurate information and use basic life support skills including resuscitation.

The program, titled Emergency…deal with it!, has being developed in consultation with schools, teachers, parents and students to ensure that it fully complements the school curriculum.

An integral component of the program is a school visit by a paramedic and an ambulance (modifi ed for interactive activities). The paramedic delivers a hands-on three hour program involving:

• interactive discussion and demonstration utilising student volunteers

• role plays for all students, working in pairs to practice skills in emergency management using resuscitation mannequins

• guided discovery activity using the interactive display ambulance and support of classroom teachers.

Each child is provided with a workbook to use during the paramedic visit and a take home family activity pack. This contains a letter to parents about the program and key messages, a CD Rom game, a DVD and a series of activities for students and parents to complete together.

The response to Emergency…deal with it! from school communities has been tremendous. Feedback given to paramedics and community education staff are along similar lines to these comments:

‘The students gained so much understanding of the importance of knowing how to deal with a medical emergency and how a few easy skills can be the difference between someone surviving or not. ’ J Jones, Penleigh and Essendon Grammar School

Contact

Helen NeelyManager, Community Education and DevelopmentMetropolitan Ambulance ServiceT: 9840 3314E: [email protected]

0665

Category 8Excellence in prevention

and early intervention

Effective prevention and early intervention programs can signifi cantly enhance quality of life, life expectancy and reduce the burden of disease across the population. This award recognises initiatives which seek to prevent the onset of disease or intervene at the earliest signs of illness to maximise the health and wellbeing of individuals and communities.

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Monday is ‘the best day of the week for all of us’ according to Wilma from the Bung Yarnda Indigenous Childcare Centre at the Lake Tyers Trust, East Gippsland.

This is the day that Koori children aged between 0–5, along with their mums, aunties and childcare workers gather up their swimming gear and come to the local YMCA swimming pool to have fun in the water, socialise and enjoy a shared lunch.

Over the past two years, Koori youngsters and their carers have got into the habit of weekly swimming, feeling good about coming to the YMCA and generally being more engaged with the community.

Prior to the commencement of this program this group were not using the YMCA at all, and now they are participating regularly at this venue in both mainstream community events , school swimming programs and independently.

Koori mothers report that their children now have fewer colds, are far more confi dent in the water, and are also benefi ting socially from this group interaction.

Gippsland Lakes Community Health (GLCH) coordinate the program in partnership with Bung Yarnda Childcare, as part of their broader Indigenous capacity building health promotion strategy.

The YMCA management and staff are now more inclusive, and have recently won an award for family water safety in recognition of their pro-active support for the Koori Bubs Swim Program.

This program has now expanded. With the Koori Family Swim program well established in Lakes Entrance it was timely to expand the program to the neighbouring community of Bairnsdale.

Abstract

By participating in the weekly Koori Bubs Swim Program (KBSP), pre-school Koori children and their carers from Lake Tyers Aboriginal Trust (LTAT) and Lakes Entrance community are gaining the well known benefi ts of increasing their level of physical activity and social connectedness and have now formed regular patterns of participation in swimming activities.

The need was identifi ed through consultation with the local Koori community, a review of local and national burden of disease data and review of GLCH service data. Through funding opportunities afforded by Go For Your Life, GLCH established the KBSP.

WinnerKoori Bubs Swim Program

Gippsland Lakes Community Health

67

Each Monday YMCA instructors work alongside GLCH and Bung Yarnda childcare staff to encourage the children to play in the water and to teach them water safety skills.

Participant feedback has been excellent, with the parents and carers reporting that the children’s enjoyment and skills in both physical and social activities have increased signifi cantly.

The program has positively impacted upon the local Koori population’s capacity to identify and address their own health needs, and has increased their access to other services within GLCH.

Relationships between the Indigenous and wider community have improved in many areas, with partnerships with a range of stakeholders increasing and strengthening.

The program is continuing to develop, with many unexpected outcomes. The health gains to this community are continuing to be supported with ongoing commitment from our organisation with state and federal funding ensuring this commitment is supported.

Background

East Gippsland has an Indigenous population fi ve times higher than the state average, at 2.7 per cent of the total population.

There is solid evidence for promoting and enhancing physical activity opportunities for the whole community, with the health gains well documented. This evidence is supported by burden of disease data for the Indigenous population showing a higher than average incidence

of diseases associated with physical inactivity such as type-2 diabetes and cardiovascular disease. Furthermore, drowning rates for Indigenous children are three times higher than for the general population, making it the second most common cause of injury death in the 0–5 age group. These statistics inspired the development of the KBSP program.

Consultation with local Koori mothers identifi ed a desire for their children to learn to swim and become more active.

GLCH developed a Koori population profi le and identifi ed this group as one of high need. GLCH has long-established health promotion priorities to improve the physical activity levels of the whole community.

The Koori Bubs Swim program was one strategy developed to address this priority within the Koori population.

Objectives

Goal

Improving the health and wellbeing of the local Indigenous communities of Lake Tyers Aboriginal Trust and Lakes Entrance.

Objectives

• The local Koori community increases its capacity to identify and address their health needs.

• Local health services increase their capacity to work with their local Koori communities addressing these health needs.

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• Participants increase their levels of physical activity and social connectedness and form regular patterns of participation.

• Increase water safety skills and reduce the incidence of drowning among the Indigenous 0 –5 age group.

• Increase the confi dence of the local Indigenous community to access the YMCA facility and increase its participation in swimming independently of the program.

Methods

2001

• Burden of disease data established the need and infl uenced objectives and strategies.

• A Koori Liaison worker was employed.

• The need was identifi ed for recreation and community activities for young people and families addressing health issues.

• The GLCH Koori Liaison worker established links within the local Koori community and GLCH services.

2002

• A Koori population profi le was developed, supporting the identifi ed need.

• Formal agreement was arrived at between GLCH and LTAT, articulating a commitment to work together to improve Indigenous health and access to services.

• Koori workers and elders assisted with engaging stakeholders for the program.

2003

• Consultation with East Gippsland Primary Care Partnership, Koori Health Promotion Project and GLCH.

• Identifi cation of initial strategies supporting capacity building objectives including improving physical activity opportunities in community settings, and targeting families rather than individuals.

• The Koori Family Swim program was developed and successfully piloted.

2004

• Further partnerships with stakeholders developed to include Victoria Police, the YMCA and others.

• The Koori Bubs Swim Program began.

2006

• New partnerships developed in Bairnsdale to enable expansion of the KBSP.

Ongoing

• Strengthened partnership with Bung Yarnda Childcare and GLCH facilitating the weekly swimming program.

• Continuing development and expansion including land-based Koori Kinda Gym.

• A shared lunch is instrumental in increasing social interaction and modelling healthy eating habits during both sessions.

Outcomes

• Kooris using the YMCA facility has increased from three in 2003 to more than 100 individuals within two years.

• Participants’ water safety skills have improved.

• Participation rates improved from 33 per cent in 2004 to 100 per cent in 2006.

• Self-esteem and physical activity levels have increased among the adult carers.

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• Adult participation rates in the water increased by 200 per cent since inception of the program.

• The partnership with Bung Yarnda childcare has strengthened, with responsibility for program tasks being transferred from GLCH.

• Participants and families are swimming outside the program times and attending other YMCA community activities.

• Wider community awareness, nurtured through positive local media profi le and a range of training and employment opportunities; for example, lifeguard training and tertiary education uptake by Koori youth, and cultural diversity awareness for YMCA and GLCH staff.

• Local health services have improved access to families during the program times in an informal way, enabling appropriate referrals where required; for example, allied health, SAAP and disability services.

• Koori attendances at GLCH have increased by 7 per cent since the program commenced.

Lessons learned

• A steering committee should have been established with the Lakes Entrance Indigenous stakeholders in the establishing phase. This has been a learning carried forward to Bairnsdale, strengthening this initiative.

• In Bairnsdale the KBSP organisers met with Gippsland and East Gippsland Aboriginal Cooperative (GEGAC) to plan the program and continue to meet with this steering committee regularly.

• A stronger sense of program ownership is already evident in this program, and GLCH is devolving

responsibility to GEGAC for the ongoing support of their program. This took two years to occur in Lakes Entrance.

• Koori initiatives develop slowly. Cultural awareness training has given GLCH the insight to be persistent and patient and are now, along with the Koori community, reaping the benefi ts of this program.


Go For Your Life funding will support the program until 2008. GLCH has ongoing commitment, recently expanding to Bairnsdale where GEGAC and Kilmany Uniting Care have committed resources and funding for the program.

Capacity building within the Koori community is being enhanced through the program, strengthening their partnership with the YMCA and ensuring sustainability.

Budget

In its fi rst year the program received a Go For Your Life grant of $17,300, GLCH contributed more than $11,000 and in-kind support exceeded $10,000, making a total program budget of $36,671. All parties increased their commitment in year two, with the budget expanding to $42,506.

Contact

Angela Ellis, Director Community Health ServicesJane Christie, Health Promotion CoordinatorGippsland Lakes Community HealthT: 5155 8300E: [email protected], [email protected]

70

Sharing Health and Recovery Experiences (SHARE) is a mental health promotion initiative of Western Region Health Centre. It has been operational since November 2004. The project is a collaboration between staff and clients and aims to minimise the stigma of mental illness in the community, help people to recognise the symptoms of mental illness and provide information about how to access services.

During 2005 SHARE presented dramatised and non-dramatised personal consumer stories and provided community education about mental health to secondary school students in middle and upper year levels. It gives people with fi rst-hand knowledge of mental illness an opportunity to share their stories, a process which is empowering for the consumers taking part and provides an enlightening educational experience for school students. Presentations were given at six schools in

western Melbourne. In 2006 SHARE has so far presented to three schools. The SHARE project has now reached an audience of more than 800 secondary school students.

The commitment and ownership of the project by consumers has driven the success of SHARE. Their comments have included:

‘I wanted to make high school students more aware of mental health. It was in high school that I was fi rst sick.’

‘I was nervous about their reactions and opinions – whether they’d like it or not. That’s what I worry about with my paranoia – how people see me. I fi nd it most rewarding when the kids don’t make fun of you and they ask you sensible questions and they get something out of it.’

‘It’s been very cathartic for me. I think I’ve learnt something about myself, that I’m capable of doing something that’s really hard. If I can do what I did with SHARE, I can do other hard things.’

Contact

Barbara HillGeneral Manager, Community Services and IntegrationWestern Region Health CentreT: 8398 4106E: [email protected]

Highly commendedSHARE: Sharing health and recovery experiences

Western Region Health Centre

71

An innovative life education program has reduced teen pregnancies on Victoria’s Mornington Peninsula and prepared 30,000 young Australians to make decisions about pregnancy, parenting and giving a baby the healthiest possible start in life.

Education sessions team midwives, health workers, educators and youth service providers to help teenagers learn the realities and responsibilities of parenthood. More than 1,000 professionals have been trained to present sessions which highlight the physical, emotional and social consequences of giving birth and parenting.

In the fi rst three years of the program, developed by two Peninsula Health midwives, birth rates for women aged under 20 on the Mornington Peninsula fell from 6.6 per cent to 3.2 per cent.

Program managers have presented to national and international conferences and undertake regular assessment to ensure the ongoing effectiveness and relevance of the initiative. A study by Monash University’s School of Nursing determined the sessions challenged students’ attitudes, clarifi ed misconstrued ideas about childbirth and were presented in a format that students could understand.

Seed funding from the Department of Human Services helped establish the program in 1999. Last year the Federal Government, through its ‘Stronger Families Early Childhood’ initiative, funded Core of Life’s nationwide expansion in order to maximise positive health outcomes for young and future Australian families.

Strategies specifi c to working with Indigenous communities have since commenced development. Following a presentation at the May 2006 ‘Start Out Strong’ national symposium in Perth, Core of Life facilitator training programs are scheduled for Kalgoorlie, Kununurra and Cape York Peninsula.

Contact

Elizabeth WilsonExecutive Director, Nursing and Community ParticipationPeninsula HealthT: 9784 7720E: [email protected]

Highly commendedCore of Life

Peninsula Health

0673

Delivering high quality health services is critically dependent on the availability of appropriate and timely information to clinicians, clients, patients and communities. Such information is vital to decision-making about prevention, diagnosis and appropriate management of care. This award recognises innovative use of information technology to improve services and care for clients, patients and communities.

Category 9Innovation in information technology

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The Victorian Infectious Diseases Service has been developing computerised decision support systems (CDSS) since 1999. The ADVISE tool was the fi rst of its kind in Australia, providing decision support for antibiotic prescribing for clinicians at the bedside in intensive care units (ICU). Its introduction led to a reduction in antibiotic prescription, improved choice of antibiotic and reduced drug costs. ADVISE was in continuous use from 2001–06 and became an integral part of ICU workfl ow.

In 2002 the project group obtained a Commonwealth Biotechnology Innovation Fund grant. The aim was to create a generic decision support tool that could harness the power of the web, provide active rather than passive decision support, and be compatible with any clinical information system. It had to be easy to use and able to be administered by clinicians rather than the organisations information technology service.

The result, Guidance DS, has several functions including a restricted drug approval system (currently antibiotics), an electronic guideline component and a microbiology CDSS that assists with antibiotic prescribing. The drug approval system (iApprove) was deployed in January 2005 and has been taken up with enthusiasm. Independent usability surveys have found 84 per cent of clinicians fi nd the system extremely useful.

Guidance is now being implemented at Peter MacCallum Cancer Centre and is sought after by national and international institutions.

Some user comments:

‘This is the answer I’ve been looking for, I could do so much with this.’ Clinical trials researcher

‘iApprove is easy to use and fl exible.’ Intern

‘I like the information provided and the links to the Therapeutic Guidelines.’ Intern

Abstract

Objectives: To develop a transferable, web-based computerised clinical decision support system to monitor use of restricted drugs, to improve access to information at the point of care, to make information ‘usable’, and to facilitate good clinical governance.

Target population: Resident medical staff, registrars, consultants, pharmacists, medical students, allied health and nursing staff in the inpatient, outpatient and emergency departments of hospitals.

WinnerGUIDANCE DS: A web-based computerised decision support system to facilitate implementation and governance of clinical guidelines and better use of medicines

Melbourne Health

75

Methods: Building upon the experience with two pilot projects, the project group gathered clinicians and pharmacists to collaborate with software developers to design a new web-based generic program that can be tailored to suit any content.

Outcomes: Successful implementation of the system at Royal Melbourne Hospital; increasing use by resident staff; general satisfaction with the usability of the system; increased data available on the use of restricted drugs; low levels of restricted drug use compared with other hospitals; cost savings demonstrated in ICU; transfer of existing guidelines to Guidance format to increase usability at the point of care; better access to educational material; improved ability to govern guidelines; ongoing assessment to look for changes in prescribing practices, for example reduce medication errors. The system is now being implemented at other sites.

Background

Computerised decision support systems (CDSS) will be increasingly used to bridge the ‘knowledge–performance gap’ between best evidence and clinical practice as we enter the era of electronic medical records and electronic prescribing. The Victorian Infectious Diseases Service at the Royal Melbourne Hospital (RMH) has been developing and implementing CDSS since 1999. The fi rst pilot system – ADVISE – received the Quality Award at the Royal Australian College of Physicians Annual

Scientifi c Meeting 2004. The Guidance project team also includes the members of the RMH Antimicrobial Subcommittee who successfully introduced a pilot version of a web-based antibiotic approval system at RMH in 2002.

In 2002 the team was successful in obtaining a Commonwealth Biotechnology Innovation Fund grant, and the goal was to develop a CDSS that could be used in other clinical areas and institutions. The focus shifted from the ICU to the whole hospital and from isolate specifi c antibiotic prescribing to improving prescribing of all medicines using electronic guidelines and drug approvals.

Guidance DS has been developed as a long-term sustainable model for guideline-based CDSS that can be interfaced with existing clinical information systems.

Objectives

Our mission was to create a generic web-based tool that allowed clinicians and pharmacists to create, update and manage electronic guidelines and restricted drug approvals for their own institutions. The aim was to support good clinical governance and improve prescribing.

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Methods

The strategy was to develop a modular system that could be used either standalone, or integrated with existing hospital databases. Guidance DS has been developed using the ASP/Microsoft.NET framework. The system is made up of three modules:

1. iApprove: An electronic drug approval system that guides users to the appropriate indication and dose and generates an electronic approval that permits ongoing dispensing of the drug. Doctors/pharmacists can view approvals, and perform queries. Super-prescribers (specialist consultants) may create ‘authorised’ approvals that fall outside of standard indications. An auditor function generates detailed reports for drug usage evaluation studies.

2. iGuide supports guidelines, pathways and algorithms.

3. iMicro uses pathology results and allergy profi le to assist with antibiotic prescribing. The system is able to utilise data from any external databases and its own clinical data repository to provide patient specifi c decision support. Each module can function separately.

Our target users are junior medical staff (residents and registrars) and ward pharmacists. The multidisciplinary development team consists of infectious diseases clinicians, epidemiologists and senior pharmacists. An external reviewer from the College of Pharmacy has performed an important role interviewing clinical and pharmacy staff and feeding back both positive and negative comments to the development team.

This has ensured that the ease of use and usefulness of the system at RMH has been maximised. Finally, the clinical guidelines working group at RMH has endorsed the use of iGuide for publishing clinical guidelines and recommendations.

Outcomes

Qualitative work to assess iApprove is being undertaken by an external reviewer using surveys, interviews and focus groups. The early results indicate that clinicians and pharmacists are generally pleased with the system.

The number of approvals generated by iApprove has increased steadily. The use of restricted antibiotics at RMH has been compared against other tertiary hospitals and remains among the lowest levels in the country.

Research is currently being carried out to evaluate the impact of Guidance on prescribing for particularly problematic drugs and conditions; for example, gentamicin and community-acquired pneumonia. For gentamicin, the pre-implementation audit highlighted inappropriate drug dosing. For community-acquired pneumonia, the pre-implementation audit has shown problems with failure to acknowledge patient allergies, appropriate choice of initial antibiotics and failure to identify severely ill patients. The guideline has been authored to specifi cally address these problems and the impact will be evaluated. The potential benefi ts are reduced prescribing errors and an improvement in clinical practice to better match evidence-based recommendations. Access to educational material for residents is enhanced and improved time management for pharmacists and clinicians is expected.

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Lessons learned

One of the key strengths has been that a continual dialogue has been maintained between users and developers. Being in collaboration with the developers provided the scope to change the specifi cations as we obtained user feedback.

Clinicians appreciate the ability to author their own content, to ensure that it suits their institution. Guidelines are more likely to be used if there is local ownership of content, rather than ‘hard-coded’ content that relies on external experts. This is an important feature of this CDSS.

As Guidance is a generic program, it can grow as large as an individual institution requires. It has been exciting to fi nd that different hospitals have had new ideas about ways to use the system that were not originally anticipated by the developers.


iApprove and iGuide are fully functional at RMH. iMicro is close to completion.

Peter MacCallum Cancer Centre is currently implementing Guidance. Several other sites in Victoria, as well as interstate and international sites, have expressed interest in acquiring Guidance.

Guidance has its own guideline builder, which allows content to be developed and maintained locally. The scope for new content is therefore unlimited.

RMH has set up a clinical guideline governance group to encourage guideline development and set standards for endorsement by the hospital before they are deployed on Guidance.

The potential for iApprove to be used to manage patients on trials for medical oncology is currently being explored.

Budget

The pilot program, Advise, was funded by a Department of Human services grant of $350,000, not including physician resources. Guidance DS was partly funded by a grant from the Biotechnology Innovation Fund via AusIndustry with in-kind resources from the clinician developers at RMH. Medseed, a software development company was a collaborator in both projects. One pharmacist, two clinicians (working a total 0.8 EFT) and one public health physician, all employed by Melbourne Health, have worked on Guidance for the past three years. A full-time developed has recently been employed.

Contact

Dr Karin Thursky and Ms Kirsty BuisingInfectious Disease Physicians and Clinical Research FellowsCentre for Clinical Research Excellence in Infectious DiseasesRoyal Melbourne HospitalT: Karin 9342 7212/9656 1111E: [email protected], [email protected]

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Client services coordination for individuals is a major Department of Human Services strategy for effi cient delivery of quality health services from hospital to general practitioner care. Experience in the Grampians region is that electronic referral is essential to the realisation of effi cient service coordination but a lack of integration between the information systems involved has been inhibiting progress.

RIMS started as a proof-of-concept pilot project to address such issues within the Rehabilitation Unit of Ballarat Health Services (BHS). Recognising the potential of the concept, Grampians Health Information and Communications Technology Alliance provided funding and assumed responsibility for the software development and the pilot.

A distinctive feature of RIMS is that it advises the user on which information is mandatory in the specifi c context of the type of referral, who is sending and who is receiving.

By integrating with existing systems RIMS removes data entry repetition, provides accurate client information, accurate service provider details and secure email delivery. The system can print, fax or email a form in statewide standards based or agency-defi ned formats.

Due to popular demand RIMS is now used in BHS wards, sub-acute and rehabilitation areas, with roll-out to psychiatric services and allied health planned. Also, RIMS is implemented in several health services in the Grampians Region with more roll-outs planned during 2006–07.

RIMS has delivered considerable benefi ts for senders, receivers and ultimately for clients through practitioners having quality information that allows them to target appropriate services for the client in a timely manner without repeated requests for information between agencies or to the client.

Contact

Janine CarterPatient Information Systems Project ManagerGrampians Health ICT AllianceT: 5320 6426E: [email protected]

Highly commendedRIMS: Referral information management system

Grampians Health Information and Communications Technology Alliance

79

Highly commendedUse of SMS text message reminders to improve outpatient attendance


For a long time the Royal Children’s Hospital experienced a very high proportion of patients failing to attend scheduled outpatient appointments. This resulted in wastage of hospital resources but, more importantly, has unnecessarily extended the amount of time all patients must wait for an outpatient appointment.

Previous attempts to address this issue, by sending reminder letters or making reminder telephone calls prior to appointment dates, had been diffi cult due to the amount of staff resource required and the expense of postage and telephone calls.

Based on the high number of patients and carers routinely registering their mobile telephone numbers with the hospital and the existence of technology that allows batches of SMS messages to be sent to multiple mobile telephones, it was decided to conduct a project to assess the effi ciency and effectiveness of sending outpatient reminders as SMS text messages.

In September 2004 a trial was conducted to assess the impact of sending SMS text messages to the mobile telephone numbers of patients with appointments in one of fi ve outpatient clinics. The results of this trial were very positive; families indicated that they appreciated being reminded of their appointment and medical staff in the clinic were appreciative that patient throughput was increasing.

Based on the results of the initial trial, a second trial was conducted which included all clinics over a three month timeframe. The results of this trial were again successful. Based on the overwhelming success of both trials itwas decided to send SMS text message reminders to all patients with a scheduled outpatient appointment.

The fail-to-arrive rate for outpatient appointments prior to the introductions of SMS reminders was 19 per cent, it is now down to 11 per cent.

Contact

Sean DownerManager, Decision SupportThe Royal Children’s HospitalT: 9345 4728E: [email protected]

80

0Rates of a number of sexually transmitted infections (STIs) in Australia are rising. One of the most important factors that determines the rates of STIs is access to healthcare for testing and treatment. However, Australia is currently experiencing a shortage of doctors, particularly in rural and remote areas.

Considerable barriers exist to the provision of sexual health services, such as the embarrassment and stigma which patients may experience. General practitioners may also be uncomfortable dealing with sexual health issues.

To help overcome these barriers a team at Melbourne Sexual Health Centre (MSHC) has developed a service to improve public access to STI services and advice.

A novel online service, Check Your Risk, has been developed and implemented by researchers at MSHC. Check Your Risk allows users to enter data relating to their sexual behaviour and, by using specially developed evidence-based algorithms, outputs ‘printer-friendly’ recommendations on sexual health check-up requirements.

This project effectively combines a web application to deliver health services to at-risk members of the public and encourages communication between GPs and their patients. It also promotes sexual health awareness and health seeking behaviour to the broader community.

The feedback received from users and GPs has been very positive. Some examples:

‘Good wake-up call despite the fact that I consider myself very low risk – I will get my Hep B cover checked on my next visit to the GP.’

‘Good service to have available. It has helped me understand better what I need to discuss with my GP. Thanks.’

Contact

Christopher FairleyDirector, Melbourne Sexual Health CentreBayside HealthT: 9341 6236 E: [email protected]

Highly commendedCheck Your Risk: Personalised sexual health advice at the click of a mouse

Melbourne Sexual Health Centre, Bayside Health

0681

New approaches to staff and role development can promote greater work satisfaction for healthcare professionals, contribute to more effi cient and sustainable services and, most importantly, lead to better outcomes for clients, patients and communities. This award recognises innovative approaches to workforce design.

Category 10Innovation in workforce design

06

82

When a patient and their family tells you that you have changed their life as a result of the care you have given them, there is nothing more rewarding. It is this that gives us satisfaction and drives our passion.

This is made possible with the development of the nurse-led Eczema Workshop. At these workshops patients are admitted for three hours and are provided with a service previously not available in healthcare in Australia.

Eczema is a chronic, debilitating illness where the sufferer experiences an intractable itch, poor quality of life and body image, low self-esteem and disruption to normal childhood and family life. The Royal Children’s Hospital’s (RCH) aims in providing the workshops in addition to standard eczema management are to provide optimal management while improving the child’s eczema, quality of life, empowering the parent to feel more confi dent and competent at home, improving access to healthcare and improving consumer satisfaction.

Some feedback from consumers:

‘I feel I am fi nally getting some help with my child’s eczema.’

‘The eczema nurse is wonderful! She is professional, caring, and very easy to talk to. She has made me not only feel more comfortable with coping, managing and treating my son’s eczema, but has individually also raised my own confi dence with the fact that we can stay on top of it, rather than the condition control us.’

‘Thank you for giving my baby back.’

‘Mummy, I don’t wake up itchy anymore.’

As a result of publishing results of the Eczema Workshop this model has been duplicated within Australia and globally.

Abstract

The Eczema Workshop was initiated as a result of the Victorian Nurse Practitioner Project in 1999. It provides an adjunct to care and a model of healthcare not previously available. The workshop admits 250 children with eczema per year, these patients are admitted for three hours and are managed by the dermatology nurse consultants. The workshop delivers eczema assessment, extended quality education, demonstration of treatments with the aim to improve eczema and quality of life for the patient and family, empower parents to feel confi dent and competent to effectively manage their child’s eczema at home and improve satisfaction of services provided by the dermatology department and the RCH.

WinnerNurse-led eczema workshops


83

Background

In 1996 the role of the dermatology nurse coordinator was instituted to provide management, support and education for children with eczema and their families. This role was initiated to provide an adjunct to care that was not provided previously. Eczema is a chronic illness that effects up to 30 per cent of children in Australia and the incidence is progressively increasing. This disease is often physically and psychologically disabling and has been shown to be more stressful and costly than asthma and type-1 diabetes.

The Department of Human Services funded 10 projects in 1999 to evaluate the role of the nurse practitioner. The nurse practitioner functions at the apex of clinical nursing with their scope of practice extended beyond that of a division one nurse, in areas such as limited prescribing and ordering of diagnostics. The dermatology department at the RCH was granted funding to evaluate the role of the dermatology nurse consultant/practitioner and the development of clinical practice guidelines.

The Eczema Workshop is a nurse-led clinic and was developed as a result of the nurse practitioner project. Prior to the development of the Eczema Workshop children with eczema attending the RCH were managed in outpatient clinics. It was established that these clinics did not meet the requirements for these patients and thus the workshop was set up to provide an addition to this model of care. The benefi ts are as follows:

• extended education

• demonstration of treatments

• support from the nurse and other families

• decrease outpatient clinic waiting lists

• extended nurse consultations

• individualised care and treatment plans

• experienced nursing care

• continuity of care

• improved family-centred care

• phone support

• provides education for inpatients, families and health professionals

• follow up arranged within two weeks.

Objectives

• To provide eczema management, support and extended education to patients and their families at the RCH. That in turn improves disease severity, improves quality of life for the patient and their family, reduces the waiting time for an appointment, decreases patient reviews, decreases inpatient admissions and enables parents to feel competent and confi dent in managing the eczema at home.

• To maximise an important hospital resource – experienced nursing staff – in a senior and educative role, thereby improving patient care and education.

• To provide job extension for senior nurses, providing job satisfaction and career specialisation opportunities.

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Methods

The Eczema Workshop is accessible to all patients in Victoria and Australia referred to the RCH dermatology department for eczema management.

The Eczema Workshop program is as follows:

• the workshop is run by two dermatology nurse consultants

• two hundred and fi fty patients are seen in the Eczema Workshop each year

• patients are admitted for three hours

• individual patient history and assessment

• group education and discussion, Powerpoint presentation, video and booklet

• individual management plan developed and explained

• demonstration and application of topical treatments and wet dressings

• upon discharge patients proceed to the equipment distribution centre and pharmacy to obtain products to use at home

• follow up arranged for two weeks after the workshop and contact numbers provided.

Outcomes

Patient and family

The Eczema Workshop was evaluated for patient outcomes and service delivery via questionnaires and the severity of eczema assessment tool (SCORAD). The results are as follows:

• Severity of eczema: Overall signifi cant improvement of eczema, when comparing nurse-led eczema workshop outcomes to clinician-led outpatient clinics. 73 per cent of patients experienced an improvement from the baseline of moderate to severe eczema to mild eczema, compared to a rate of 40 per cent improvement from the clinician-led clinics.

• Quality of life: Overall signifi cant improvement in quality of life for the child and their family.

• Satisfaction of service: High parental satisfaction with the care provided, with parents reporting 86 per cent satisfaction ratings versus 44 per cent for the clinician-led clinics.

• Greater parental competence and confi dence in managing their child’s eczema in the home.

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The organisation

• Higher standard of eczema education for the patient and family.

• Model of care that can be implemented within hospitals in Victoria, Australia and globally.

• Improved patient access to services.

• Higher satisfaction of care provided by the dermatology department and RCH.

• Overall immense satisfaction from doctors referring patients to the nurses providing the workshops.

• Financial benefi t; allowing WIES funding for nursing work, making the program sustainable.

Lessons learned

This initiative has highlighted the importance of educating children and families in ongoing care of chronic conditions. The creation of the nurse practitioner role has been instrumental in the success of the program by elevating the role of the nurse and giving formal structure to the education process, thereby increasing effectiveness.


The program is now ongoing and sustainable due to nurse practitioner status allowing the workshop to attract WIES. The increasing demand may lead to pressure for more workshops.

Budget

The nurse practitioner project was funded by the Department of Human Services. The RCH obtains a WIES payment for each patient admitted to the Eczema Workshop. The nurses and clerk are paid via the dermatology department operating budget.

Contact

Emma King and Liz MooreDermatology nurse consultantsThe Royal Children’s HospitalT: 9345 5510E: [email protected], [email protected]

86

Highly commendedA multi-skilled workforce with work–life balance

Alexandra District Hospital

Alexandra District Hospital is a small rural health service in north-east Victoria comprising 30 acute beds and a rapidly expanding community health service across three sites.

The dawn of the new century heralded the need for a different approach to address the workforce crisis the Hospital was facing. The departure of several key personnel highlighted the defi ciencies in succession planning. It was apparent that if the organisation was to survive, let alone grow, a more fl exible and multi-skilled workforce was required.

The Hospital now employs 115 staff (an increase of 50 per cent since 2000) and has expanded both its acute and community health services. It is committed to training local people where possible and have a 100 per cent success rate in completion of 12 traineeships with eight Division 2 nurses, three allied health assistants and a receptionist. Ninety-two per cent of these individuals continue to work locally.

As a growing number of employees are responsible for caring for parents, children or grandchildren, fl exible work options are essential to the retention of staff. Based on employee preferences, more than 90 per cent of employees are engaged in part-time employment. In some situations, job sharing and other arrangements are possible. The Hospital has one staff member who performs most of her work from home several hundred kilometres away.

The introduction of an ‘open door’ policy by management as well as regular opportunities for the communication of individual and organisational objectives has led to major successes. Hospital employees have responded with great enthusiasm to the opportunity to be trained to perform a variety of roles within the organisation. The Hospital is very proud of the fact that one of our employees can now work in six different roles and do an excellent job in all of them.

By recognising that ‘there is more to life than work’ and ‘variety is the spice of life’, Alexandra District Hospital not only created a vibrant learning culture, but also a more stable and happy workforce focused on meeting the health needs of its community.

Contact

Heather ByrneChief Executive Offi cer and Director of NursingAlexandra District HospitalT: 5772 0900E: [email protected]

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Highly commendedThe ED Logistics Coordinator

Eastern Health

Emergency departments are busy places. They rely on large amounts of resources and infrastructure to be available and functional so that staff can provide quality care in a timely manner to patients.

Patients accessing emergency departments for the fi rst time often fi nd them to be alienating, chaotic and frightening places, so the Angliss Hospital sought to introduce a role in the emergency department to assist in re-organising the physical workplace and to coordinate workfl ow processes. The aim was to create an environment that was visually calming for staff and patients, organised and uncluttered so as to create an environment which would facilitate the provision of effi cient, safe and timely care to patients.

The project was titled ‘The Logistics Coordinator’. The role aimed to address the problems of missing or poorly located equipment, ineffi cient processes, clutter in the department and poorly coordinated workfl ow processes using a number of principles adopted from the manufacturing industry – LEAN production, incorporating the tools of ‘5S’ and visual management systems. The long-term goals were to create a workplace that was supportive, self-explanatory, self-ordering, self-improving and sustainable and to free up emergency department staff for patient care.

The success of the initiative was the result of efforts, ideas and energy from the emergency department staff. Five-S and visual management systems were successfully implemented, tracking systems for equipment and books were implemented and the philosophies of LEAN management were integrated into staff job descriptions.

Contact

Jacqui AllenNurse Unit Manager, Emergency DepartmentThe Angliss HospitalEastern HealthT: 9759 1944E: [email protected]

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0The Support Team Action Response (STAR) is a shining example of workforce innovation at St Vincent’s Health.

STAR is a peer support program of a multidisciplinary and occupational staff team trained to help manage critical incidents and stress across the organisation. Program members, called STARs, undertake accredited training to provide fi rst line psychological assistance to colleagues. STARs contribute, on a voluntary basis, to a 24-hour on-call roster.

In the healthcare environment, where emotional and physical demands can be high, it is vital staff are supported to deal with normal reactions to stressful situations. Research increasingly points to the value of timely support in the prevention of emotional stress following a traumatic event and supports the value of having peers or colleagues provide that support.

Aiming for a ratio of one STAR to every 50 employees, STAR now comprises 80 program members from a diverse range of occupations, professions and directorates. Since its inception nine years ago, STAR has led to signifi cant improvements in workplace performance, forging strong collegial relationships and reducing workplace stress.

On completing training one participant said: ‘The training gave me the incentive to learn more about stress and trauma. I now have a different and healthier perspective on my workplace environment.’

STAR underpins St Vincent’s Health’s strategicapproach to staff support and embodies its values of compassion, justice, human dignity, excellence and unity. St Vincent’s Health recognises the strong link between a satisfi ed, valued and supported workforce and the ability to achieve its mission of providing the best possible health care.

Contact

Jacqueline BloinkStar Coordinator and Specialist HR ConsultantSt Vincent’s HealthT: 9288 3945E: [email protected]

Highly commendedSTAR: Support team action response


0689

Minister’s Award for outstanding staff achievement

The Minister’s Awards recognise exceptional dedication to delivering the best possible care for consumers and communities.

Two awards are presented:

• The Minister’s Award for outstanding achievement by an individual

• The Minister’s Award for outstanding achievement by a team.

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Minister’s award for outstanding individual achievement

Dr Cathy Crock is a mother of fi ve children and works at the Royal Children’s Hospital (RCH). Part of her work is with troubled adolescents at the Centre for Adolescent Health, Melbourne. Most of her work is with the Department of Laboratory Haematology. For seven years she has worked closely with many families of hospital patients to identify their problems and possible solutions. The ideas for many of the changes she has introduced have come from these families, and often the solutions have as well. The Royal Children’s Hospital awarded her a Chairman’s Medal in 2004 in recognition of her role as an agent of change in the hospital. This award recognised her role as creator of the Hush project and many other innovations.

Nomination

Dr Cathy Crock has worked in the haematology department for more than seven years and has become a wonderful advocate for patients and families.

Dr Crock continually strives to enhance services to patients. She is an outstanding role model. She has willingly accepted invitations to talk to large groups of adults and adolescents about juggling careers and family and about her work. She is much loved by the parents of the children she helps care for. More than 20 of them have volunteered to help her in her various endeavours. She is self-effacing and humble but with a strength that enables her to be unyielding in her determination to bring about change when it is needed. It is easy to measure one aspect of her achievements, namely that in her own time she has raised over $850,000 for the RCH and for other Australian children’s hospitals.

WinnerDr Catherine Crock

Physician in Haematology and Adolescent Health, Department of Laboratory Haematology, The Royal Children’s Hospital

91

The families she works with would rate another achievement more highly, namely the changes she has made to their lives in so many small ways.

Community benefi ts

Dr Crock was instrumental in organising music and play therapy to relax and distract patients while they waited for procedures in the day surgery department at the RCH. Dr Crock didn’t stop there; she convinced friends from classical music circles to perform on two CDs, Cello Lullaby and The Hush Collection, and oversaw production and promotion. The income from the sale of these CDs is used for research into pain management. They are played in various areas around the hospital to relax and calm children. Dr Crock negotiated with children’s hospitals around Australia and The Hush Collection is now marketed nationally and benefi ts many paediatric centres across the country.

Dr Crock conducts bone marrow and lumbar punctures for oncology patients, procedures that can cause children a certain amount of pain and distress. In an effort to minimise this distress, Dr Crock negotiated to provide an anaesthetic list for her patients. This list is extraordinary in its child-friendly approach. One visiting specialist from a major oncology centre in Toronto said he was ‘blown away’ by the sight of children smiling and skipping into theatre for their procedures, still dressed in their street clothes and shoes.

Dr Crock’s main aim has been to improve pain management for children in hospital. Proceeds from Hush CD sales have enabled the RCH to develop an institutional initiative looking at all aspects of pain management in the hospital.

Parents of children with cancer expressed concern about the long waits in crowded waiting rooms with children who have lowered immunity, as they needed regular blood tests. Dr Crock began working with the pathology department to review the collections system. This resulted in the pathology collection service now coming to the oncology clinic, rather than the patients going to pathology. The parent feedback has been very positive.

Dr Crock’s belief in the benefi ts of music have led her to work with several parents in fundraising for music at the RCH. She has set up a Live Music in Hospitals committee, which has run a series of events and raised over $300,000 for the hospital. About 60 per cent of all music therapy at the RCH is being funded through this work.

Dr Crock used her negotiation skills to have pagers donated for families to use so they don’t have to remain in waiting rooms for procedures. This system now extends to all outpatient services and operating theatres. This is very important in a hospital where patients often have multiple appointments in a day. She has developed the concept and directed a video for oncology parents and patients to explain outpatient bone marrow procedures and lumbar punctures to reduce their fear and anxiety.

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As an agent for change Dr Crock is unstoppable. She has also taken the lead in improving other areas around the hospital such as:

• the development of a business centre and resources, from donations, for parents who are trying to manage a business or continue to work while having a child in hospital

• the introduction of video phones for the use of patients who are in hospital for a long time and a long way from home

• provision of exercise equipment in the family resource centre for parents whose children spend a long time in the hospital with a chronic illness to the detriment of their own health, wellbeing and fi tness

• the upgrading of the in-house television system and creation of a separate classical music channel and a separate parent information channel.

Dr Crock has identifi ed the need to address other issues related to pain management in children. She has developed several research projects aimed at reducing procedural pain for children; this research has been published in peer reviewed journals.

Dr Crock also coordinates a popular annual reaching seminar on paediatric and obstetric haematology. Laboratory scientists and haematology registrars from around Australia and New Zealand attend this seminar, which is now in its ninth year. As part of this seminar, Dr Crock has co-authored several publications about aspects of paediatric and obstetric haematology.

Contact

Dr Catherine CrockT: 9345 5522E: [email protected]

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Highly commendedProfessor Samuel F Berkovic, Director, Comprehensive Epilepsy Program

Austin and Heidelberg Repatriation Hospitals, Austin Health

Professor Sam Berkovic fi rst came to the Austin Hospital as a fourth year medical student in 1975. Since then he has become a world-renowned specialist in epilepsy, winning a slew of awards and making great strides in the clinical diagnosis, imaging and genetics of epilepsy.

From 1978 to 1984 Professor Berkovic worked as part of the junior medical staff at the Austin Hospital, completing his basic training in neurology and his MD thesis on epilepsy. He spent three years at the Montreal Neurological Institute at McGill University in Canada before returning as a Fellow in the University Department of Medicine at the Austin Hospital. He was promoted to Associate Professor in 1995 and awarded a Personal Chair in Medicine in 1998.

In 1995, Professor Berkovic became Director of the Comprehensive Epilepsy Program. He fused the efforts in epilepsy within the hospital and university departments and the Brain Research Institute to form the Epilepsy Research Centre at Austin Health. Today, it is regarded as one of the world’s leading epilepsy centres.

Professor Berkovic has made major contributions to the neuroimaging of epilepsy. His team are the leaders in the application of magnetic resonance imaging, single photon emission tomography and molecular genetics to the bedside. Novel approaches to the investigation of ‘fi rst seizure’ patients have been developed and emulated across Australia and the world.

In 1995 Professor Berkovic discovered the fi rst gene for epilepsy and he and his colleagues have been involved in the discovery or co-discovery of most of the known epilepsy genes since. These genetic discoveries have changed thinking about the causes of epilepsy and continue to have a major impact on research and strategies for new treatments.

Professor Berkovic deftly combines the role of researcher with that of fi rst-rate clinician; in his treatment of patients he sees the whole person rather than just a medical condition, with patients and carers commenting on his direct and warm approach.

Contact

Professor Samuel BerkovicT: 9496 2330E: [email protected]

94

Associate Professor Peter Doherty has been a leader in psychiatry in Victoria for more than 20 years. He played a key role in de-institutionalising psychiatry and developing new ways of delivering services that were at the leading edge of thinking in terms of integrating institutional and community-based care. It was his initiative that saw the development of the crisis assessment teams and mobile support and treatment services, models which are now in place in all psychiatric services.

Over the past eight years, as the Director of Alfred Psychiatry, Associate Professor Doherty has created something in public psychiatry that is unique and, in many areas, is setting the standard for what a

contemporary public psychiatry service should look and be like. Alfred Psychiatry has been able to attract specialist clinical staff of all disciplines to the specialty with the medicine and nursing disciplines having waiting lists of people seeking positions. Over this time the service has undergone tremendous change in areas of open and transparent reporting, quality improvement processes, community consultation and clinical research. Associate Professor Doherty has consistently demonstrated a commitment for psychiatry to be very much part of The Alfred and its range of highly regarded specialties. Alfred Psychiatry is now well known for its training programs, developing clinicians for the future, working in the public sector, promoting a strong ethos of learning, research and improving clinical standards.

Associate Professor Doherty was the inaugural recipient of the Margaret Tobin award in 2004 for excellence in administration of public mental health services. The award is presented by the Royal Australian and New Zealand College of Psychiatrists. Peter was also awarded a Public Service Medal for services to mental health services, particularly with regard to the implementation of crisis services.

Associate Professor Doherty is highly respected for his vision and knowledge and has contributed as a member of key advisory and review panels. He is involved with community organisations in the mental health arena including memberships of the Mental Health Foundation, Association of Relatives and Friends of the Emotionally and Mentally Ill and Victorian Schizophrenic Fellowship.

Highly commendedPeter Doherty, Director, Alfred Psychiatry

The Alfred, Bayside Health

95

Highly commendedDr Eugenie Tuck, Director of Clinical Services

Correctional Health Service, St Vincent’s Health

After working in general practice for more than 20 years, Dr Eugenie Tuck became involved in correctional health in 1987 and 10 years later became the Director of Clinical Services at St Vincent’s Correctional Health Service.

Dr Tuck is based at the Port Phillip Prison, which has 764 beds, and has responsibility for patient-oriented clinical services, clinical coordination for all prisoner admissions requiring secondary or tertiary healthcare, development and updating of policies and procedures and providing supervision and training of healthcare professionals.

Dr Tuck leads from the front and is an extremely dedicated doctor. She not only provides a very high standard of care to her correctional service patients but makes

a substantial contribution to transforming the way in which correctional health services are delivered across Victoria. Dr Tuck established the Hepatitis C treatment program at Pentridge Prison and maintained advocacy for the adoption of new Hepatitis C policies following the privatisation of correctional health in 1997.

Working in arguably one of the least attractive and most stressful healthcare settings, Dr Tuck treats patients and their families with respect and compassion, building a climate of trust which in turn contributes to fewer aggressive incidents in the correction health service prisons in which she works. Additionally, Dr Tuck’s holistic and caring approach to correctional health service patients enables them to return to the community fi tter and stronger and with a greater sense of self-esteem. Dr Tuck has implemented initiatives to clear prisoners of Hepatitis C and educating them to avoid re-infection, address prisoners’ mental health issues to give them the skills to better manage their behaviour, and to help patients understand their addictions in order to become drug free. Such initiatives benefi t the prisoner and their family but also have benefi ts for the wider community.

In 2004 Dr Tuck was awarded an Medal of the Order of Australia for service to the welfare of prisoners.

Contact

Dr Eugenie TuckT: 9217 7210E: [email protected]

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WinnerNorthern Assessment, Referral and Treatment Team: Crossing the boundaries from the justice system to the healthcare sector

Plenty Valley Community Health

Minister’s award for outstanding team achievement

Raul Foglia, Clinical Coordinator, Counselling and Support Team

Rory Ford, Senior Practitioner, Drug and Alcohol Team

Eve Jansen, Social Worker

Fotini Hatzis, Youth Worker

Mary-Anne Barclay, Counselling Support Worker

The Northern Assessment, Referral and Treatment Team (NARTT) is a unique program funded to provide a specialised clinical approach to working with offenders. The model is characterised by a strong partnership with the police and justice system, based on the highly successful ‘arrest referral’ model of substance abuse treatment operating in the United Kingdom. Early service statistics have shown NARTT has been highly successful in both engaging offenders and reducing recidivism in northern Melbourne.

The team focuses on addressing health, social and interpersonal issues which are having a causal effect on participants’ criminal behaviour. The program works directly with participants’ families to minimise the impact of criminal behaviour on the family unit. A key feature of the program is to improve the capacity of the mainstream health service system to respond to this group by the development of pathways and referral processes between health services and the police.

Participation in the program is voluntary, it is targeted at re-offenders who have either substance abuse problems, are perpetrators of domestic violence or have committed a violent crime.

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Nomination

The team was founded in mid-2003 and is now an integral part of Plenty Valley Community Health (PVCH) Drug and Alcohol Program. PVCH is a provider of primary care and disability services to the residents of outer growth corridors of northern metropolitan Melbourne. The team was formed in response to concern from local police to the ever-increasing rate of criminal behaviour associated with substance abuse and domestic violence.

The team has been nominated for continued excellence in providing crisis intervention, treatments and preventative services to a clientele and their families who present with an extensive range of complex psychological issues.

The team is characterised by:

• a range of therapeutic services

• a rapid and fl exible response time

• support for victims and their families

• outreach services

• the development of health promotion and preventative services for both offenders and their families

• the engagement of the health and welfare sector in the program

• a unique partnership with Victoria Police in which the police have become an active partner in the provision of health services. The educational component of NARTT’s work has effectively assisted the police to develop an understanding of harm minimisation, substance abuse and causal factors leading to domestic violence. This has led to a change in local policing

• a high rate of successful interventions including 91 per cent of clients achieving treatment outcomes and 50 per cent reduction of clients’ re-offending patterns.

The service model is unique in providing a continuum of care between two diverse public sector organisations – the police and justice system and primary health.

NARTT is staffed by psychologists, social workers and drug and alcohol counsellors who are highly skilled in a range of therapeutic interventions.

Treatment plans are developed for all clients outlining goals, treatment and follow up, providing a clear direction for clients and enabling effective evaluation of treatment intervention modalities. All clients are entered on the NARTT database, enabling tracking of clients over time.

Health promotion programs have been developed for families and a new program aimed at breaking generational patterns of domestic violence is presently being developed for children who have experienced domestic violence.

The team are contactable by police for emergencies 24 hours a day. All referrals to the program are followed up within 30 hours.

The team has shown great willingness to provide a fl exible and rapid response to a most challenging client group. No client is ever refused treatment no matter how personally challenging some of their presenting behaviours may be.

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Community benefi ts

Through both internal and external evaluation processes the NARTT program has clearly shown a direct benefi t not only to clients and their families, but also to the general public by a signifi cant reduction in the rate of re-offending by clients of the program. Group behavioural programs are conducted to address major causes of domestic violence and substance abuse.

The NARTT program involves police, offenders, courts and support systems. The program is well known to people who work in the service system. NARTT also has the support of the families of those referred to the program.

NARTT’s intensive multidisciplinary approach is gaining exposure to the wider community through extensive coverage in local newspaper articles. The program was also presented to a number of conferences in the area of health and crime, including the 2005 Australian and New Zealand Society of Criminology (ANZSOC) Conference. As a result of exposure at the ANZSOC Conference, the Western Australian Offi ce of Crime Prevention has expressed interest in trialling the concept in Perth.

The work of the NARTT program has led to increased scope of practice for drug and alcohol and general counselling teams, particularly in the treatment of both perpetrators and victims of domestic violence; funding from the Federal Attorney-General to develop a range of health promotion programs to reduce criminal behaviour; and development of effective pathways of care between the justice, health and community care sectors.

The program receives funding from both the justice system and Department of Human Services and was granted a Federal Crime Prevention Award.

Evaluation at a glance1 January 2006 to 30 June 2006

Average monthly referral rates 72 (433 total)

Engagement rate, number of clients seen 201

Number of police referring to program 87

Number of clients reaching treatment goals 191

Response time 1.2 days

Referrals out 216 days

Contact

Raul FogliaClinical Coordinator, Counselling and Support TeamPlenty Valley Community HealthT: 9409 8787E: [email protected]

99

Dr Amanda Scott is a speech pathologist with extensive experience as a specialist clinician, researcher and lecturer in neurosciences. She has worked at Bayside Health for the past fi ve years and is currently the Research and Quality Coordinator for the Bayside Health Speech Pathology Department. Leora Benjamin is also a speech pathologist of more than 20 years experience. Ms Benjamin has worked in the Residential Care Unit at Caulfi eld General Medical Centre (CGMC) for fi ve years, during which time she has established a critical role in the assessment and management of elderly residents with swallowing problems.

Dr Scott and Ms Benjamin have substantially improved the quality of life of the people in their care. Together they have introduced an innovative evidence-based

program in the Residential Care Unit at Caulfi eld General Medical Centre which allows residents who were normally permitted only thickened fl uids (because of swallowing problems – dysphagia – that could lead to aspiration of thin fl uids into the lungs and the attendant risk of pneumonia) to be able to drink free fl uids such as water, tea of coffee. Previously, the ‘claggy’ consistency of thickened fl uids led to considerable non-compliance, resulting in medical consequences such as dehydration.

After an extensive review of the literature Dr Scott and Ms Benjamin adapted a similar program which had been developed in the United States. The Free Fluid and Oral Health Program, which is the fi rst of its kind in Australia, allows dysphagic residents in the Residential Care Unit to receive thin fl uids in accordance with strict guidelines to minimise their aspiration risk.

Since the introduction of their Free Fluid and Oral Health Program a year ago, the results have been very positive. Of the 26 residents who have taken part, none has developed aspiration pneumonia. The program is currently being introduced at the Alfred and Sandringham hospitals and adapted for use in four other healthcare settings in Victoria.

Contact

Dr Amanda Scott, Speech Pathologist,Research and Quality Coordinator

Leora Benjamin, Speech PathologistBayside Health

T: 9276 6281E: [email protected], [email protected]

Highly commendedDr Amanda Scott and Ms Leora Benjamin

Caulfi eld General Medical Centre, Bayside Health

100

The Clinical Governance Team consists of senior clinicians and senior managers supported by dedicated clinical governance program staff.

Key senior clinicians

Professor Chris Christpohi

Professor Jeff Zajac

Assoc Prof Larry McNicol

Assoc Prof Rinaldo Bellomo

Assoc Prof Duncan Macgregor

Other members of the Clinical Outcome Review Committee

Assoc Profs George Braitberg, Lindsay Grayson, Gavin Fabinyi, Mal Douglas, Sue Liew

Senior managers/executive team

Dr Mark Garwood

Mr Mark Petty

Ms Ann Maree Keenan

Clinical Service Unit directors

Key Clinical Governance Unit team members are:

Ms Margaret Way, Director Strategy, Risk and Clinical Governance

Clinical governance clinical leaders

Dr Andrea Kattula, Medical Director, Clinical Governance Unit

Dr Michael Yeoh, Emergency Department Physician

Dr Jenepher Martin, Breast Surgeon

Clinical governance staff

Ms Leanne Toby, Clinical Governance and Risk

Ms Alicon Bennie, Clinical Policies and Projects

Ms Veronica Strachan, Clinical Governance, Projects Manager

The role of Austin Health’s Clinical Governance Team is to provide a framework for continuously improving the quality of services and safeguarding high standards of care by creating an environment in which excellence in clinical care will fl ourish.

The Clinical Governance Team has been working together since 2000. Austin Health’s executive team recognised the potential for clinical governance to change an organisation’s culture. Clinical governance promotes openness and participation, a ‘no blame’ culture which shifts the emphasis from ‘who went wrong’ to ‘what went wrong’.

Through its commitment to clinical governance Austin Health has taken leadership roles at state and national levels in the areas of root cause analysis, pressure ulcer prevention, infection control through the hand hygiene program, respecting patient choices, medication safety, blood and organ donation.

The team’s work has led to tangible benefi ts: a reduction in prevalence of pressure ulcers from 34 per cent in 2003 to 21 per cent in 2006; a 25 per cent reduction in medication error arising from incorrect patient identifi cation. Also, following implementation of a patient identifi cation and specimen labelling protocol for all pre-transfusion blood samples, an improvement from 83 per cent to 93 per cent compliance with the protocol.

The ACHS Accreditation Periodic Review in May this year recognised the work of the team as outstanding and a national leader.

Contact

Dr Andrea KattulaMedical Director, Clinical Governance UnitT: 9496 5343E: [email protected]

Highly commendedClinical Governance Team: Learning from error to save lives

Austin Health

Thank you to all who participated in the2006 Victorian Public Healthcare Awards

102

The Antenatal Outreach Service,Yarra Valley Community Health, Eastern Health p.16-19

D Winnicott. Child Inquiry Analysis Report Summary Who’s holding the baby? August 2000

Improving the intersectorial relationship between Maternity and Protective Services. An analysis of Child Protection Infant Deaths 1995–1999

Tomlinson. A . Preventing child abuse changes in family support in the 21st century. Child Abuse Prevention Issue 17 Summer 2002

Shonkoff and Phillips – 2000: 32 From Nerons to neighbourhoods – The science of early childhood development. National Academy Press, Washington DC

Dalgleish & Drew 1986, Dagleish 1997 Heatherington 1998, Tomlinson 2002

The Victorian Risk Framework 2000 Human Services

Human Service 2000 Safe from harm the role of professionals in protecting children and young people

Improving the treatment of patients at risk of bleeding from warfarin over-anticoagulation,Peninsula Health p.32-35

Gallus AS, Baker RI, Chong BH, et al. Consensus guidelines for warfarin therapy. Med J Aust 2002; 172: 600-605.

Baker RI, Coughlin PB, Gallus AS, et al. Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. Med J Aust 2004; 181: 492-497.

AG Winterstein, RC Hatton, R Gonzalez-Rothi, TE Johns, and R Segal. Identifying clinically signifi cant preventable adverse drug events through a hospital’s database of adverse drug reaction reports. Am. J. Health Syst. Pharm., Vol 59, Issue 18, 1742-1749

Lousberg TR, Witt DM, Beall DG, et al. Evaluation of excessive anticoagulation in a group model health maintenance organisation. Arch Intern Med 1998;158:528–34.

Wilson SE, Douketis J, Crowther MA. Treatment of warfarin-associated coagulopathy: a physician survey. Chest 2001;120:1972–6.

Fan J, Armitstead JA, Adams AG, Davis GA. A retrospective evaluation of vitamin K1 therapy to reverse the anticoagulant effect of warfarin. Pharmacotherapy. 2003 Oct;23(10):1245-50.

Roughead EE, Harvey KJ, Gilbert AL. Commercial detailing techniques used by pharmaceutical representatives to infl uence prescribing. Aust N Z J Med. 1998 Jun;28(3):306-10.

Improving diabetes care p.40-43


Department of Human Services, North-Eastern Health Care Network Health Needs Study 1998.

References

103

The Consumer Participation Program,The Royal Children’s Hospital p.52-55

Spink, J. 1998. Helping the service listen to you, evaluator’s report. Melbourne: The Royal Children’s Hospital Mental Health Service.

The Royal Children’s Hospital Mental Health Service. 25 May 2006. Charter for parents and carers of young people who use a Child and Adolescent Mental Health Service. [Online]. Available: www.rch.org.au/emplibrary/mhs/DL_brochure_Patient_rights.pdf 4 July 2006.

The Royal Children’s Hospital Mental Health Service. 25 May 2006. Kid’s Rights. [Online]. Available: www.rch.org.au/emplibrary/mhs/Card_Patient_rights.pdf 4 July 2006.

The Community Group Program,The Royal Children’s Hospital p.58-61

Community Group Program (2003) Create-Evaluate: Community Group Program Five Year Progress Report, Royal Children’s Hospital Mental Health Service/Travancore School, Melbourne.

Community Group Program (2001) Connecting Education and Mental Health: Community Group Program Progress Report, Royal Children’s Hospital Mental Health Service/Travancore School, Melbourne.

Community Group Program (2000) Getting Results: Community Group Program Progress Report, Royal Children’s Hospital Mental Health Service (MHSKY)/Travancore School, Melbourne.

Community Group Program (1999) A Broader Partnership: Community Group Program Progress Report, Mental Health Service for Kids And Youth/Travancore School, Melbourne.

Goodman, R. (1999) The extended version of the Strengths and Diffi culties Questionnaire as a guide to child psychiatric caseness and consequent burden, Journal of Child Psychology and Psychiatry and allied Disciplines, 40,5:791-799.

Operation Newstart Western Progress Report (1999-2006) Vic Police/DE&T/RCH MHS report: Melbourne.

Reynolds, C, & Kamphaus, R. (1992) BASC, Behaviour Assessment System for Children, American Guidance Service: Circle Pines, MN.

Koori Bubs Swim Program,Gippsland Lakes Community Health p.66-69

GLCH IHP 2004-06

GLCH Koori Population Profi le

Mackie I, Tebb N, Eady T, National Drowning Study. Royal Lifesaving Society Australia, 1993

Moore T. 2004 ‘Working with Koori families’

Royal Children’s Hospital Melbourne Vic

National Rural Health Alliance

Victorian Government 2004, Planning for Healthier Communities : Reducing the risk of type 2 diabetes and cardiovascular disease through healthier environments and lifestyles

104

GUIDANCE DS: A web-based computerised decision support system to facilitate implementation and governance of clinical guidelines, and better use of medicines, Melbourne Health p.74-77

Buising KL, Thursky KA, Bak N, Skull S, Street AC, Presneill JJ, et al. Antibiotic prescribing in response to bacterial isolates in the intensive care unit. Anaesth Intensive Care 2005; 33: 571-577.

Thursky K, Buising K, Black JF, Jones N, Richards M, Roberston M, et al. The Experience with Web-based Computerised Decision Support Systems at the Royal Melbourne Hospital- The search for transferability and Maintainability. In: ICAAC, Washington; 2004.

Thursky KA, Buising KL, Bak N, Macgregor L, Street AC, Macintyre CR, et al. Reduction of broad-spectrum antibiotic use with computerised decision support in an intensive care unit. Int J Qual Health Care 2006.

4Thursky K. The Use of Computerised Decision Support Systems to Improve Antibiotic Prescribing. Expert Reviews of Anti-infective Therapy 2006; In press.

Richards MJ, Robertson MB, Dartnell JG, Duarte MM, Jones NR, Kerr DA, et al. Impact of a web-based antimicrobial approval system on broad-spectrum cephalosporin use at a teaching hospital. Med J Aust 2003; 178: 386-90.

Leong CL, Buising KL, Thursky KA, Street AC. Providing education and guidelines is not enough. An audit of gentamicin use. Internal Medicine Journal Jan 2006

Buising KL, Thursky KA, Black JF, MacGregor L, Street AC et al. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax. 2006 May;61(5):419-24.

Nurse-led eczema workshops,The Royal Children’s Hospital p.82-85

Broberg, A., Kalimo, K., Lindblad, B., & Swanbeck, G. (1990). Parental education in the treatment of childhood atopic eczema. Acta Derm Venereol (Stockh), 70, 495-499.

Cheigh, N.H. (2003). Managing a common disorder in children: atopic dermatitis. Journal of Pediatric Health Care, 17(2), 84-88.

Cork, M.J., Britton, J., Butler, L., Young, S., Murphy, R., & Keohane, S.G. (2003). Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. British Journal of Dermatology, 149, 582-589.

Foley, P., Zuo, Y., Plunkett, A., & Marks, R. (2001). The frequency of common skin conditions in preschool-age children in Australia. Arch Dermatol, 137, 293-300.

Hanifi n, J.M., Cooper, K.D., Ho, V.C., Kang, S., Krafchik, B.R., et al. (2004). Guidelines of care for atopic dermatitis. J Am Acad Dermatol, 50(3), 391-404.

Hanifi n, J.M., & Tofte, S.J. (1999). Patient education in the long-term management of atopic dermatitis. Dermatology Nursing, 11(4), 284-289.

105

Hoare, C., Li Wan Po, A., & Williams, H. (2000). Systematic review of treatments of atopic eczema. Health Technol Assess 4(1), 1-191.

Leung, D.Y.M., Nicklas, R.A., Li, J.T., Bernstein, I.L., Blessing-Moore, J., et al. (2004). Disease management of atopic dermatitis: an updated practice parameter. Annals of Allergy, Asthma, and Immunology, 93, S1-S21.

Long, C.C., Funnell, C.M., Collard, A., & Finlay, A.Y. (1993). What do members of the national eczema society really want? Clin Exp Dermatol, 18(6), 516-522.

Lubkin, I.M. (1995). Chronic illness: impact and interventions. London: Jones and Bartlett.

Marks, R., Kilkenny, M., Plunkett, A., & Merlin, K. (1999). The prevalence in common skin conditions in Australian school students: atopic dermatitis. British Journal of Dermatology, 140, 468-473.

McHenry, P.M., Williams, H.C., & Bingham, E.A. (1995). Fortnightly review: management of atopic eczema. BMJ, 310(6983), 843-847.

McMahon, R. (1998). Therapeutic nursing: theory, issues and practice. In R. McMahon, & A. Pearson (Eds.), Nursing as Therapy (2nd ed. pp.1-20) Cheltenham: Stanley Thornes.

Moore, E. (2006). A comparison of a nurse-led clinic and dermatologist-led clinic in reducing severity of atopic eczema in infants, children, and adolescents. Unpublished Master’s Thesis. The University of Melbourne, Melbourne, Australia.

Nicol, N. (2000). Managing atopic dermatitis in children and adults. Nurse Practitioner, 25(4), 58-69.

Robertson, C.F., Dalton, M.F., Peat, J.K., Haby, M.M., Bauman, A., et al. (1998). Asthma and other atopic diseases in Australian children. MJA, 168, 434-438.

Shum, K.W., Lawton, S., Williams, H.C. Docherty, G., & Jones, J. (2000). The British association of dermatologists audit of atopic eczema management in secondary care. Phase 3: audit of service outcome. British Journal of Dermatology, 142, 721-727.

Vaughan, B., & Pearson, A. (1998). Patient education in therapeutic nursing. In R. McMahon, & A. Pearson (Eds.), Nursing as Therapy (2nd ed. pp.76-91) Cheltenham: Stanley Thornes.

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