Casterton Memorial Hospital Victorian Quality Account...Casterton Memorial Hospital Strategic Plan...

Casterton Memorial Hospital

Victorian Quality Account

2017-2018

Serving the Casterton & District Community Since 1908Our values Welcoming | Excellence | Accountable | Respect | Empathy & Compassion

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Casterton Memorial Hospital Victorian Quality Account 2017-2018 |

Victorian Quality Account | 1

ContentsStrategic Plan Inside front coverPresident & Executive’s Report 2-4Hospital Officers 5Demographics of our Service Area 6Strategic Planning 6Service Model 7Our Supportive Community 8Services to our Community 9Strengthening Hospital Response to Family Violence 10LGBTI Community 10Improving Care for Aboriginal Consumers 10Culture, Diversity and Language 11Victorian Experience Healthcare Survey 12Accreditation 13Consumer Feedback 14People Matter Survey Results 15-16Adverse Events 17Preventing and Controlling Healthcare Infections 18Healthcare Worker Influenza Vaccination 19Maternity Care 20Community Health Improving Consumer Experiences The Casterton Fun Run 21-22Strength & Balance Exercise Groups 23Just Move Exercise Group 24

Case Study – Continuum of Care 24 Improving the Community’s Access to Healthcare Pacemaker Clinic 25Community Transport 25Case Study – Extra Time in Community Home Nursing 26

Improving the Health Service Experience for a Community Health Priority Population Pink Breakfast and Breast Screen Bus 27

Residential Aged Care Quality Indicators 28-30Escalation of Care Processes 31Friends of Glenelg House 31-32Advance Care Planning & Directives 32-33End of Life Palliative Care 34Workforce Information 35Finance & Activity Overview 36-37Employee List 38Feedback Form 39Functional Organisation Chart Inside back coverCommittee Composition Chart Inside back cover

2 | Victorian Quality Account

| Casterton Memorial Hospital Victorian Quality Account 2017-2018

President’s Report It is with great pleasure, on behalf of the Casterton Memorial Hospital Board of Directors and employees, volunteers and consumers that I present to you our 2017/18 Quality Account.

2017/18 continued on from previous years in striving to meet the Casterton Community needs with a diverse range of services

from community to urgent care, inpatients and permanent residential care. Every year brings with it different challenges and rewards and this year has not been any different in this regard.

I therefore commend to you and invite you to read our Quality Care Account that demonstrates a strong commitment to managing the affairs of Casterton Memorial Hospital effectively and most importantly meeting the Casterton and District Community health care needs.

Financial Sustainability

Casterton Memorial Hospital vigilantly maintains systems and processes that ensure sustainability, accountability and responsibility for the delivery of safe, responsive consumer-centred care services.

This year we have sustained a deficit, before capital and specific items, of ($41,352.00) whilst still continuing to meet service demands and our Model of Care for the Casterton Community. This financial deficit is predominantly a result of not achieving Department of Veteran Affairs inpatient activity targets, and as a result cash flow provided by the Department for this set target will be re-called. Expenditure levels have been well controlled for the year and it is mainly the revenue side of the equation which has let us down. Glenelg House Residential Care’s occupancy rate of 99.86% has been a positive contribution once again and this recognises the need for this quality high care service for the community.

Casterton Memorial Hospital has continued to maintain a very solid balance sheet with a current asset ratio of 1.31% and with sufficient cash to meet current liabilities.

Community Service Provision

Casterton Memorial Hospital’s Home and Community Services continue with Community Home Nursing, Health promotion, Community Health education, delivery of Home maintenance, Meals on Wheels and a Community transport program to support access to essential medical and health services.

This year has seen the expansion of the home nursing service hours with an evening service being created. Community Health has also employed a new program and Health Promotion Officer Ms Lucinda Jenkins in recognition of the increased demand from our community.

Our specialist visiting services and allied health personnel from physiotherapists to dental clinicians and surgeons to podiatrists continue to provide a strong level of service and commitment to our Community.

Governance

Casterton Memorial Hospital has met its obligations to the Statement of Priorities 2017/18 with the Department of Health and Human Services. This contract is negotiated annually between the Casterton Memorial Hospital Board of Directors and the Department and results in funding for service delivery.

Casterton Memorial Hospital now has in place a new three year Strategic Plan 2017-2020 and this can be viewed at our Website. The previous plan is being signed off with a large proportion of the Key Performance Indicators achieved and many others well on the way. Details of the current Strategic Plan are found on the inside cover of this report.

The Board has also processed and governed the implementation of many improvements during the 2017-2018 year including, and not limited to;

• Strengthened Partnerships with Clinical Governance Collaborative within the region formalised.

• Air-conditioning System replacement stage 1 completed.

• Nurse Call System replacement.• 99KW Solar Power Plant Installation

Mr. Peter GreenBoard Chair



planning.• Electronic Health Record working toward

electronic medication module at the end of 2019.

• Dr Floyd Community Room & Medical Precinct up-grade planning.

• Board Education Clinical Governance, new board member orientation.

• Murray to Moyne Team recognition artwork.• 97% CMH Influenza Vaccination Top in the

State.• Fun Run / Colour Walk with over 200

participants.

The Casterton Memorial Hospital Team

Casterton Memorial Hospital has a diverse team of employees and volunteers who ensure safe, consistent and efficient care across the three domains of Community, Acute and Aged Care. These employees and volunteers work in teams of catering, environmental services, maintenance, administration and clinical services. Each area is committed to the person-centred care approach both to the consumer and to the Casterton Memorial Hospital team.

The Board of Directors would like to acknowledge the continued excellence in service provided by employees and volunteers. I would like to specifically acknowledge the 61 years of combined voluntary service to the CMH Board of Dr Tim Halloran (32yrs) and Mr Graham Sheppard (29yrs). Their work on the Quality Team and Finance and Management is to be commended and will be missed by all.

The continued successful outcomes for consumers is maintained through the support of contracts especially the Casterton Coleraine Medical Clinic Partners, Dr Brian Coulson and Dr Greta Prozesky. Dr Prozesky has since retired from the Practice and on behalf of the Community and CMH Team we thank Greta for her amazing time with us in Casterton. We thank the Medical Team for their 24 hours coverage for all of the Casterton Community. It is a wonderful service and the support shown to CMH through their attendance and active clinical governance

role in administration is well evidenced. CMH is supportive of their continued ongoing recruitment and succession planning.

CMH is proud of the continuing clinical care provided by the nursing team. As a Small Rural Health Service the nurses are skilled to provide care to a wide range of presentations and conditions from Urgent Care, to Aged, Acute and Community. Maintaining clinical excellence in care, clinical competence, continuing professional development and ensuring clinical supervision of students and graduates are all part of the broad role that nurses undertake at CMH.

CMH’s nursing team maintain a close working relationship with external education providers to facilitate student placement, support the post- graduate nurse entry to practice program and to ensure that this clinical supervision meets best practice standards. CMH is proudly supported by Barwon Health with both clinical and education support through the use of real time video conferencing and clinical practicums and regular “in person” visits both to Barwon and to Casterton.

To the service divisions employees from catering, environmental services, maintenance and administration, CMH has continued to have outstanding results in external cleaning audits, maintenance of the facility and a cohesive and organised administration system. Consumers also praise the catering department with the quality of their product and this is of particular importance to consumers who are unwell and who genuinely appreciate nutritious and appealing meals cooked and served quickly.

CMH continues to have an amazing relationship and strong support from the community who provide additional funding and a wonderful sense of wellbeing by participating in voluntary groups to fundraise. These groups include the Murray to Moyne Cycle Relay Team, Casterton Memorial Hospital Ladies Auxiliary, Hospital Social Club, Friends of Glenelg House and staff.

Volunteering for the hospital has many benefits, not only for the consumers who reap the reward of the additional equipment but also the sense of

President’s Report continued



Works proceeding on the air conditioning upgrade

John Carmichael, Peter Green, Owen Stephens and Barb Toma inspect the new Murray to Moyne artwork

wellbeing and participation that improves small communities to become strong communities. Well done for another great year.

Finally to my fellow Board Directors and the Executive Management team of Owen and Mary-Anne; your input, vision and support of CMH for and on behalf of our community is to be commended. The future for CMH continues to be progressive while we all team together as a

cohesive unit and work in collaboration with our partners across the Barwon Southwest Region.

In conclusion, I commend the 2017/18 Quality Report to you the community and request your ongoing support of CMH and its hard working team.

Mr Peter GreenBoard Chair23rd August, 2018

President’s Report continued



Hospital OfficersThe Casterton Memorial Hospital is a public health facility established under the Health Services Act 1988. The responsible Ministers are detailed below:

Casterton Memorial HospitalABN 62 051 291 134

Responsible MinistersCommonwealth Government AustraliaThe Hon Greg Hunt MP, Minister for Health Senator the Hon Bridget McKenzie, Minister for Rural HealthThe Hon Ken Wyatt AM MP, Minister for Aged Care, Minister for Indigenous Health

State Government VictoriaThe Hon Jill Hennessy, MP, Minister for Health, Minister for Ambulance Services The Hon Martin Foley, MP, Minister for Housing, Disability and Ageing, Minster for Mental Health

Hospital Board of Management

PresidentP. Green

Vice PresidentG. Smith

MembersG. SheppardT. HalloranJ. KensenM. RoweB. RobertsJ. Crowle

Audit CommitteeG. Sheppard – ChairP. Green – Independent MemberT. Halloran – Independent MemberL. Hulm - Independent MemberB. Toma – Independent MemberO. Stephens - Chief Executive OfficerM. Betinsky – Finance Officer

Visiting Medical StaffDr. B. S. Coulson: M.B.B.S., D.R.O.G., F.A.C.R.R.M.

Dr. M. Prozesky: M.B., ChB, (South Africa)

Dr. T. N. Halloran: B.D., B.Sc. (Hons)

Mr. P. H. Tung: M.B., B.S., F.R.A.C.S.

Mr. S. Clifforth: M.B., B.S., F.R.A.C.S.

Mr. R. H. Moore: M.A.(Camb.), MB., BCHIR., S.R.C.S.

Dr. C. de Kievit: M.B., B.S., D.R.A.N.Z.C.O.G., F.A.C.R.R.M.

Dr. K. Fielke: M.B., B.S., D.R.A.N.Z.C.O.G., F.A.C.R.R.M.

EmeritusDr.A. F. Floyd: M.B., B.S., D.Obst, R.C.O.G.

Principal OfficersChief Executive OfficerO. P. Stephens: B.Bus., A.C.H.S.E.

Manager Nursing ServicesM.A. Betson: N.P.,R.N., R.M., Cert. Critical Care, Nurse Immuniser, Cert IV Training & Assessment, MNsg.MNP,FACN

Infection Control/ AHSH. Gill: R.N, Cert Infection Control & Sterilisation, Nurse Immuniser, MACN

Nurse Unit Manager Acute Ward/AHSS. Gill: R.N, Cert Aged Care

P. Gunning: R.N.

Nurse Unit Manager Residential CareK. Sealey: R.N., Cert IV in Frontline Management, MACN

Nurse Unit Manager Community Health / Education Officer P. Layley-Doyle: R.N., R.M., Cert IV Training & Assessment, MACN

Nurse Unit Manager Community NursingC. Mahanda-Makore: R.N.

Night Nurse in Charge /Quality ImprovementH. Dillon: R.N.,R.M.Grad Cert Ad Nsg Practice (Rural Remote)

After Hours SupervisorsS. Dehnert: R.N., R.M., Nurse Immuniser, Grad Dip Child Maternal Health

A. Jenkins: R.N., Grad Dip Pall. Care, Grad Cert Ad Nsg Practice (Rural &

Remote), Grad Cert Gerentology

S. Bryan: R.N. B.N. Grad Cert Ad Nsg (Emergency Nursing)

M. Makore*: R.N., B.N. Grad Cert (Rural & Remote)

C. Jose: R.N., B.N. *

Planned Activity Group Co-ordinatorB. Bryan: E.N., Cert IV in Leisure & Lifestyle

Corporate Services Officer / HRL. Hulm

Finance OfficerM. Betinsky

Health Information / Quality ImprovementH. Rees: Clinical Coder

Catering Services SupervisorM. Nolte: Trade Cooking, Cert IV Workplace Training & Assessment

Environmental Services In ChargeJ. East

Maintenance Coordinator / SafetyS. Zippel: Trade Carpenter/Builder

Meals on Wheels CoordinatorV. Ross

* Resigned during the year



Casterton Memorial Hospital - Small Rural Health Service (SRHS)

Demographics and Service profileCasterton Memorial Hospital was established in 1908 and is situated in the northern sector of the Glenelg Shire within the township of Casterton. Nestled amongst rolling hills and river red gums of the Glenelg River valley, it is located on the Glenelg Highway, 359 kilometres west of Melbourne and 42 kilometres east of the South Australian border.

The Shire has a total population base of 19,520 and Casterton rural north has a catchment population of 3,500. Our catchment area includes the townships of Digby, Merino and Sandford and the surrounding rural localities. Casterton Memorial Hospital provides services to all within its population base as well as neighbouring shires.

As a Small Rural Health Service, the hospital is provided flexibility in its funding base to ensure that the services provided directly to our community are within budget and will best meet the needs of our community. The Board utilises local area information and community input to

plan for and provide the most appropriate care and intervention options for our local catchment area to maximise health gains and status for our community.

The Hospital provides a range of acute health, aged residential care and primary healthcare services incorporating 15 medical/surgical inpatient beds, operating theatre, 2 bay urgent care centre, 2 dialysis chairs and 30 bed residential care facility ‘Glenelg House’. The Hospital also provides an extensive range of allied and primary healthcare personnel and programs along with visiting consultant services. All of these services are provided from our facility ensuring effective triaging and access of best care in best possible time for our consumers.

The Board of Management and employees at the Casterton Memorial Hospital are committed to providing strong and efficient health and community services to meet the needs and expectations of the community it serves.

Strategic Planning Casterton Memorial Hospital strategic plan 2017-2020 can be found inside the front cover

of this publication, or visit our website www.castertonmemorialhospital.com.au

Dergholm

Balmoral

Cavendish

Ararat

Ballarat

Glenthompson

Hamilton

Dunkeld

ColeraineCasterton

Merino

Penshurst

Heywood

Dartmoor

Nelson

PortlandWarrnambool

Geelong

MelbourneMt. Gambier SA

Hamilton



Service ModelAcute Service• Acute Beds (Gen. Medical and Surgical)• Theatre with two bed recovery• Urgent Care – two bay (24/7)• Satellite Dialysis (Royal Melbourne)• Domiciliary / Midwifery• Nursing Home Type• Palliative Care• Infection Control / CSSD• Infection Control Officer

Visiting Consultants / Practitioners• General Practitioners (Private Practice)• Physicians General Medicine• Surgeons• Ophthalmologist• Specialist Anaesthetist• Digital Radiology Services – Bendigo Radiology• Community Rehabilitation• Chiropractic Service• Physiotherapy• Psychologist• Occupational Therapy• Dietetics• Audiology• Mental Health Team• Podiatry

Aged and Residential Care• 30 Bed High Care Residential Facility• Support Groups / Resident’s Committee• Diversional Therapy

Education and Workforce Development• Clinical Nursing Student Placements - Flinders University - Deakin University - Latrobe University - Uni SA - South West TAFE - TAFE South Australia - IHNA - ETEA • Medical Clinical Placements - Deakin University Medical School - Royal Adelaide Hospital Intern Rotations• Work Experience Placements• In-House Education and Competencies

Primary Care• Social Support Group (3 days)• Community Health Programs - Diabetes Education, Monitoring and Support Group - Women’s / Men’s Health Programs - Drug Awareness and Education - Osteoporosis / Falls Risk Prevention - Alcohol and Drug Information - Asthma Education and Mentoring - Primary Mental Health Team Counsellor - Better Health Self-Management Program - Strength and Balance Programs - Walking Group - Cardiovascular Disease Circuit Program - Carer Support Groups• Community Home Nursing Service• Meals on Wheels• Home Maintenance Services• Community Bus and Car Transport Service• Community Room Facilities• Advance Care Planning

Infrastructure Services• Administration / Financial / Secretarial• Maintenance Personnel• Catering Services (Functions)• In-House Laundry• Meeting and Function Facilities• Consulting Rooms• Short Term Accommodation• Video Conferencing/Telehealth Facilities• Community Transport• SWARH IT Alliance Network• Ambulance Service• Ambulance Victoria Fixed Wing• Helicopter Emergency Service (HEMS)• Medical Specialists Video Conferencing



Our Supportive Community Casterton Memorial Hospital is well supported by its staff and the community. We offer our sincere thanks to employees, the Hospital Ladies Auxiliary, Hospital Social Club, Murray to Moyne Cycle Relay team, Friends of Glenelg House and the Wando Vale Ladies Auxiliary for their support and fundraising contributions. We also acknowledge the various businesses, community groups, estates, families and individuals who continue to support us financially and by way of in-kind donations.

During the 2017/18 financial year, fundraising contributions and donations totalled $32,974.29. These valuable funds assist with the upgrading of equipment and the maintenance and furnishing of our modern hospital, aged care facility and community health development.

Our many volunteers provide purposeful activities and roles, and as such are greatly appreciated by staff and the community we serve. We extend our sincere appreciation to the community volunteers who assist with the delivery of meals on wheels, bus driving, visiting, outings, entertainment, diversional and lifestyle activities. Our volunteers assist us to meet the needs of our community and foster community connections for our residents and their families.

The Hospital also appreciates the input and contributions from the businesses and the broader community through our community surveys, questionnaires and Hospital Card Program. This community spirit contributes to Casterton Memorial Hospital being a proud facility and also supports our continual effort to provide the best quality services to meet the changing needs of our community.

The Board of Management sincerely thanks all Casterton Memorial Hospital supporters for their generous, tireless and invaluable support during 2017/18 year.

Acknowledging 2017/18 donations Fundraising CommitteeCasterton Memorial Hospital Staff 1473.65

Casterton Memorial Hospital Ladies Auxiliary 1759.90

Casterton Memorial Hospital Social Club 1000.00

CMH Murray to Moyne Cycle Relay 17004.63

Hospital Card Progam 3950.00

Community Member SupportAnonymous 598.80Casterton Kelpie Association 847.00Casterton Safety House Committee 405.10Ex Casterton Residents Picnic Day 150.00Knit and Natter Group 666.00Memory of Alex Boyd 40.00

Memory of Mark Newton 80.00Memory of Merrilyn Wombwell 430.00Memory of Mr R A Coulson 100.00Memory of Maisie Humphries 35.00Carol McKinnon-Ward 50.00Jeffrey Arnall 100.00Elise Louden 10.00Helen Powell 50.00Jeffrey & Phyllis Arnall 100.00Betty Martin 20.00Cliff & Jan Tischler 50.00Gail Kelly 10.00R & B Harnetty 30.00I D Issell 100.00EstatesEquity Trustees - Estate Lousie Henty 789.21Equity Trustees - Estate William Heath 1125.00Equity Trustees - John Russell MacPherson 2000.00Total Donations 32,974.29

Gifts in Kind:Foster Family - Bariatric Bed

Acknowledging our Life GovernorsRecognised for Service and Dedication to Casterton Memorial Hospital

Baker, Mr. T. Collins, Mrs. B.Cowland, Mr. R. Edge, Mr. E.Flanders, Mrs. E. Floyd, Dr. A. F.Halloran, Dr. T. McKinnon, Mrs. C.

Moffatt, Mrs. M. Nicol, Mr. R.Ross, Mrs. J. Sandow, Mr. P.L.

Simson, Mr. C. R. Simson, Mrs. K. L.



Services to our Community

HOSPITAL 2016/17 2017/18Total Multistay Inpatient Separations* 232 264

Total Same Day Separations* 245 235

Bed Days* 2548 2512

Total WIES 413.06 382.77

% Occupancy Rate Staffed Beds 47% 46%

Average Length of Stay** 5.0 4.15

% Public Bed Days 74% 94%

% Private Bed Days 26% 6%

Obstetrics / Gynaecology 12 14

Operations / Procedures 70 100

Urgent Care Presentations 1190 1192

Glenelg House Residential CareResidents Accommodated 42 38

Bed Days 10898 10909

Average Daily Occupancy 29.86 29.89

% Occupancy Rate Full Year 99.53% 99.63%

Planned Activity GroupAttendances 829 1164

Community Home NursingHome Visits 5660 4955

Kilometres Travelled 23751 19981

Community HealthAttendance (contacts) 374 244

Allied HealthPhysiotherapy Attendance *** 1159 1145

Speech Therapy Attendance *** 0 0

Dietetics *** 74 61

Meals ProducedHospital / Residential Care / Other 66231 64876

Meals on Wheels (HACC Assessed) 6161 6681

Home Maintenance Program (HACC Service)Number of Clients 99 101

Number of Visits 1081 1216

Number of Hours 1154 1242* Does not include Newborn transfers

** Excludes Nursing Home Type

*** Includes inpatients



Strengthening Hospital Response to Family Violence2016-2017 saw the introduction of formalised training for all employees on recognising and responding to family violence both in the workforce and in the community. This initial organisation wide training provided a great introduction into increasing awareness and also the marked number of incidents which occur in most communities. Continuing work on this over the 2017-2018 year has extended collaboration with the South West Strengthening Hospital Responses to Family

Violence program which is focusing on employees and responding to disclosure in the workplace. Further training for line managers will occur in the coming months to support the training undertaken last year. Policies and procedures are being finalised and combined with more community education and support should provide a solid foundation for early identification, referral and improved outcomes.

LGBTI Community Over the past 12 months the strategy for increasing inclusive practice principals continued with changes to policies and procedures and building on the education undertaken by Transgender Victoria. CMH is working hard to ensure the three overarching principles and standards are reflected at CMH. Affirming the dignity and value of the LGBTI Community, ensuring freedom of discrimination

and providing inclusive access and equity in health care. The next round of organisation wide training is due at the end of this year, and the redesign of signage for the facility is underway. CMH would like to thank National LGBTI Health Alliance for support and training and for assisting CMH in progressing towards meeting all the standards.

Improving Care for Aboriginal Consumers The collaborative partnership CMH has with the Grow Healthy Together Indigenous Advisory Committee continues to develop. The group meets every two months and continues to identify gaps and strategies to continue its work. Feedback from these meetings are provided to senior management.

The development of an online education program which is compulsory for all employees

has been developed, with completion expected by the end of 2018.

We have an Acknowledgement of the Aboriginal Community in all meeting rooms, Aboriginal posters, artwork and Aboriginal health literacy in waiting areas. The admission system has also been updated to identify the Indigenous status of all consumers presenting to CMH to ensure they are provided the most appropriate services for their healthcare needs.



A display of cultural dress in Glenelg House

Culture, Diversity and LanguageThe Casterton community continues to have low numbers of consumers who have English as a second language, but CMH does have a significant number of employees who speak other languages.

There are currently 12 languages spoken by CMH employees, these are:

• Shona• Ndebele• Afrikaans• Polish• Ukrainian• Hindu

• Punjabi• Malayalam• Mandarin• German• English• Filipino

A focus of aged care is the celebration of culture and diversity. Over the last year there have been many feast days celebrated, including

food, costumes and trivia days. There were also some amazing displays of different wedding attire. We thank the residents, and employees who always engage so fully in these days which really enriches the experience for everyone in the home and in the workplace.

Throughput of consumers in aged, acute and community care who require interpreters is very rare at CMH. However, should the occasion occur, CMH is supported through a language service line funded through the Department of Human Services. This program allows telephone link up with an interpreter who can assist in ensuring the consumer is understood and able to be active in their care. Due to the low usage of this scheme nurses are provided with updates and guidelines are checked to ensure they are functioning if needed immediately.



Victorian Healthcare Experience Survey

The Victorian Healthcare Experience Survey (VHES) is a survey run by the Department of Health & Human services which collect feedback from consumers on their experience in receiving a range of care and services at Victorian public hospitals.

Gaining feedback from consumers through the VHES allows CMH clinicians the availability to review processes and identify gaps in service delivery. For the 2017-2018 year CMH identified three priority improvement areas based on the previous year’s feedback.

These were:

• Improving communication and education to consumers to ensure they engage in their health care and health services.

Action: Nurse and medical officers discussed strategies to increase the communication between the medical officers and consumers in a way that they understand. The VHES data from 2016 identified 94% of consumers happy with the way this occurred, and in 2017 this increased to 99%.

• Reviewing discharge protocols to ensure that all consumers receive a copy of the discharge correspondence sent to GP’s on discharge.

Action: CMH works with Medical Officers to support the completion of the discharge summary at the time of discharge. However consumers report through the survey that they received a copy in only 20% of cases. This low score could possibly be because the information provided to the consumer on discharge is the same information that is provided to the GP caring for the consumer. There may be some confusion to the consumers on what this information is. CMH has since made it very clear to consumers that this information is passed on to their GP as well as to themselves. We will await the next data to identify if this strategy is working.

• Reviewing the documentation and processes for gaining consent from consumers when students are involved in their care.

Action: CMH developed a set of guidelines which were provided to all nurses supervising and mentoring students, and for students to clearly understand the process of requesting consent from consumers before being involved in their care. Number of consumers who noted this consent in 2016 was 67%, and after the education and explanation the 2017 data increased to 95%. CMH will continue to work with students and consumers to ensure that this continues.

CMH goals for the coming year are to address our poorest performing areas from the 2017-18 VHES results.

• Overall, how would you rate the care and treatment you received from other healthcare professionals? 65%

Action: CMH will be working with other health care professionals to identify how we can improve their communication with consumers.

• Did you see hospital staff wash their hands, use hand gel to clean their hands, or put on clean gloves before examining you? 64%

Action: CMH has identified that the handwashing facilities are outside of the line of sight of most consumers in their beds, CMH has since moved the hand wash to line of sight so that this can be seen to be occurring.

• Did you receive sufficient information about any medication you were given while in hospital (e.g. purpose, side effects and how to administer the medication)? 75%

Action: CMH has since commenced a new system for medication information for consumers prior to discharge which involves the local pharmacist providing an up to date information sheet explaining medications. This is very clear and concise and will support consumers understanding of medications.

After you are discharged from hospital, you may receive a survey in the mail asking for your opinion regarding your experience as an inpatient at CMH, or you may also be asked to complete a Community Health based survey.



Accreditation

There are a range of both Commonwealth and State Accreditation Quality frameworks that hospitals are required to participate in to demonstrate their commitment to quality and

safety in healthcare. These frameworks are designed to ensure the highest standards of quality and safety are being achieved through rigorous external evaluation processes.

Aged Care Accreditation

In April 2018 Glenelg House underwent an Assessment Contact visit by the Australian Aged Care Quality Agency. Residential Care homes receive at least one of these unannounced visits per year which are also called “Spot Visits”. We don’t know when these visits are to happen so the home is assessed during normal day-to-day functioning. This latest “Spot Visit” was very successful and we were able to highlight some improvement actions taken over the year which included improving participation in leisure

activities for residents with sensory problems such as poor sight through improved bingo resources. Further improvement opportunities for future action were identified, including use of electronic information systems to record wound management.

Glenelg House are also welcoming the upcoming re-accreditation process planned for later in 2018. This process is a full re-accreditation visit to review compliance to the full 44 Aged Care Quality Standards.

Hospital Accreditation

CMH is accredited through the Australian Council on Healthcare Standards, against the National Safety and Quality Healthcare Standards and the EQuIPNational Standards. CMH is looking

forward to a further re-accreditation survey planned for later in 2018 to again demonstrate our commitment to ongoing Safety and Quality in Healthcare.

Compliance Programs Status

National Safety and Quality Healthcare Standards Accredited

Australian Council on Healthcare Standards EQuIPNational Accredited

Commonwealth Home Support & HACC Programs Quality Standards (Home Care Standards) Accredited

Australian Aged Care Quality Agency Residential Aged Care Accreditation AccreditationRe-confirmed

Food Safety Accreditation Achieved



Consumer FeedbackCMH values all feedback received, both positive and negative. We encourage consumers to advise us of their concerns, suggestions and other feedback

on the quality of our care and services so that we may improve along the way and continue to meet community needs where possible.

There are a number of ways to provide feedback at CMH

Suggestions / Compliments:

Suggestion forms are widely available throughout the Hospital and Glenelg House. These can be anonymous or if you would like us to send you a response, just provide your details.

Point of Care / Service Concerns:

Consumers are encouraged to raise routine concerns directly with care staff. These may be promptly dealt with at the point of service.

Complaints needing more investigation:

These are more serious or complex matters and are referred to the Chief Executive Officer or Manager Nursing Services. Formal complaint forms are widely available throughout the facility.

Satisfaction Surveys:

Consumers are encouraged to provide their feedback from a range of internal and external service questionnaires. Examples of these include Meals on Wheels, “Seasons”, Community Home Nursing, Inpatient and Residential Aged Care as well as the external DHHS Victorian Healthcare Experience surveys.

We encourage all consumers who receive these surveys to complete them as they provide us with valuable information on your experience using our healthcare services.

Contacts:

• CMH – 03 5554 2555 • Health Complaint Commissioner 1300 582 113

• Aged Care Complaints Commissioner 1800 550 552

YOU SAY – WE DID!

• Re-introduction of hens in Glenelg House. • Upgrade to the hospital air conditioning systems.• Upgrade to Glenelg House double rooms.• Improvements to organisation brochures and leaflets from consumer input.



People Matter Survey ResultsCasterton Memorial Hospital (CMH) employees annually participate in the Victorian Public Sector Commission, People Matter Survey. This survey is designed to capture employee perceptions of their workplace in order to gauge organisational workplace culture.

The survey focuses on how well CMH:

• Upholds the public sector values: responsiveness, integrity, impartiality, accountability, respect, leadership and human rights.

• Upholds public sector employment principles:

merit, fair and reasonable treatment, equal employment opportunity and avenues of redress.

• Uses supporting measures to assist employees: job satisfaction, employee engagement, feedback, effective promotion of the code of conduct, role clarity, reward and empowerment, discrimination, bullying and patient safety.

In the 2018 survey, Casterton Memorial Hospital maintained its 2017 result of an average of 82% positive response to the questions relating to patient safety and workplace culture.

KEY PERFORMANCE INDICATOR TARGET 2017/18 RESULT

Patient Safety

People Matter Survey – percentage of staff with an overall positive response to safety and culture questions 80% 82%

People Matter Survey – percentage of staff with a positive response to the question, “I am encouraged by my colleagues to report any patient safety concerns I may have”

80% 85%

People Matter Survey – percentage of staff with a positive response to the question, “Patient care errors are handled appropriately in my work area” 80% 79%

People Matter Survey – percentage of staff with a postive response to the question, “My suggestions about patient safety would be acted upon if I expressed them to my manager”

80% 75%

People Matter Survey – percentage of staff with a positive response to the question, “The culture in my work area makes it easy to learn from the errors of others”

80% 85%

People Matter Survey – percentage of staff with a positive response to the question, “Management is driving us to be a safety-centred organisation” 80% 88%

People Matter Survey – percentage of staff with a positive response to the question, “This health service does a good job of training new and existing staff” 80% 79%

People Matter Survey – percentage of staff with a positive response to the question, “Trainees in my discipline are adequately supervised” 80% 77%

People Matter Survey – percentage of staff with a positive response to the question, “I would recommend a friend or relative to be treated as a patient here” 80% 88%



Case Study – Patient Safety People Matter Survey

Employees in the Environmental Services Department identified a risk to consumers, especially those in the residential care facility. The cleaning products used in consumer care areas were kept on cleaning trolleys that did not have any lockable storage on them. This posed a risk of consumers accessing these products if these trolleys were ever left unattended. Employees reported to their supervisor that they felt there was a greater chance of an incident occurring due to the change in consumer abilities in the residential care facility.

This risk was discussed at their department

meeting and raised via the Department Heads and OH&S Committees where approval was given for a new trolley to be trialled by the Environmental Services Department. A suitable trolley was sourced and trialled over a 4 week period by all staff within the Department who all reported feeling a lot safer with the secure storage on the new trolley and that the risk of consumers being able to access cleaning products was all but eliminated.

At the conclusion of the trial all of the cleaning trolleys throughout the facility were replaced with the newer secure storage trolleys.

Environmental service employees with the new secure trolleys



Adverse EventsCMH as a public health care facility utilises a reporting system and register called the “Victorian Health Incident Management System”. This system allows employees to log any incident or event out of the norm, including near misses. An adverse event is where there is unintended and or unnecessary harm. This may or may not be related to the healthcare service, but will be reported. The purpose of monitoring and reporting these events is to work towards finding ways in which to prevent further negative outcomes. This continuous quality activity then assists in identifying how we can reduce adverse events and harm. CMH employees undertake mandatory training on how to report adverse events. Serious adverse events are notified to the Department of Health and Human Services and/or other bodies immediately and are referred to as a “Sentinel Event”. Part of the process is working back through the event with the employee and

the consumer to identify what could have been done to either prevent it from occurring, or what can be done to minimise the risk in the future of a recurrence.

Quality actions that have been undertaken as a result of incidents during 2017/18 are:

• Upgraded call bell system to decrease time from call bell to pager, alerting nurses to consumers’ needs.

• Increased number of flat to floor beds and sensor alarms to alert nurses of consumers’ movements.

Consumers or their delegate are informed of any events that are out of the normal for that person.

Being open and transparent, and ensuring that carers and consumers are working together and listening to each other can reduce adverse events considerably.

Incidents are categorised according to severity of outcome. ISR4 means no harm, ISR 3 means minor harm, ISR 2 means some harm and ISR 1 means significant harm experienced.

CMH recorded zero ISR 1 incidents for 17/18.

Critical Incidents by ISR rating 2017/18

ISR2 0.38%

ISR3ISR2ISR1 ISR4

ISR361.22%

ISR4 38.40%



Preventing and controlling healthcare associated infectionsWhilst this year has shown an overall increase in the amount of infections treated at CMH there have not been any healthcare associated infections (i.e. infections contracted whilst an inpatient of CMH). There has been an increase in the number of infections treated in Glenelg House but this increase can be mainly put down to two residents with a recurrent infection which was successfully treated when this trend was noted.

Again there have not been any Staphylococcus Aureus bloodstream (SAB) infections detected in any of the consumers of CMH. This data is reported to the Department of Health via VICNISS on a monthly basis. Comparative Victorian data is reflected in the below graph. The extremely

low infection rate within CMH is reflective of the employees and volunteer’s dedication to ensuring that Infection Prevention and Control is paramount in their everyday practice including continuing high rates of hand hygiene compliance and compliance with all other infection control policies and guidelines.

Monitoring of infections and antimicrobial use continues on a monthly basis as part of the Infection Control practitioner’s role and this data is reported to the highest level of governance (Board of Directors), to the Quality and Clinical committees, to the Medical Officers and to relevant employees through their staff meetings.

Kathy McArlein, Debbie Gartlan and Vanessa Sheahan demonstrate visitor flu precautions

Staphylococcus Aureus Bacteraemia Numbers by Victorian Hospitals (2017/18 - 2017/18) - All consumers

Year Healthcare Associated Healthcare Associated at a non-public hospital

Community Associated

No. of SAB No. of MRSA



2017/18 - CMH 0 0 0 0 0 0

Total 0 0 0 0 0 0

VICNISS 5 year Aggregate(n=97)

1992 371 186 23 4393 653



Healthcare Worker Influenza VaccinationThe annual influenza vaccination program was again rolled out this year, commencing in April and continuing to the present. Influenza vaccination is offered to all employees, volunteers, students and agency nurses who are part of the CMH workforce. Again, it is evident that we have a very high level of uptake of this vaccine with only 3 employees and 1 volunteer declining the vaccine, with the status of 1 volunteer remaining unknown giving us an overall vaccination rate of 97%.

Initially the two nurse immunisers offer vaccination clinics in the hope of ensuring most of the workforce is vaccinated in this period and then we offer ad-hoc vaccinations to those that were unable to attend one of the clinics.

All members of the workforce are offered the vaccine and are asked to sign a declination form

and provide a reason for declining this vaccine. This is a Department of Health Victoria requirement as they actively encourage all persons working within a healthcare environment to be vaccinated to protect both themselves and the person within their care.

This year the SWARH Health Accord CEO’s made an agreement to also actively encourage vaccination and to try to increase the overall vaccination rate within the region, to protect our communities. All employees who have not received the vaccine have met with the CEO and an agreement made that a mask is to be worn by the employee when in consumer areas. Signage has been posted at all public entrances to the facility encouraging all families and visitors to be vaccinated, to wear masks if unwell and to practice hand hygiene on entering and exiting the facility.

2018 Influenza Vaccination

Staff Group Total staff number

Vaccine Administered

Vaccine Declined

Percentage Vaccinated

Nursing 57 57 0 100%

Allied Health 7 7 0 100%

Administration 13 11 2 85%

Environmental Services 11 10 1 91%

Catering 15 15 0 100%

Maintenance 4 4 0 100%

Total CMH employees 107 104 3 97%

Ambulance Service 10 10 0 100%

Dental Clinic 3 3 0 100%

CMH Volunteers 23 21 1 91%

Students – nursing (YTD) 13 13 0 100%

Agency nursing staff 1 1 0 100%

Board of Management 7 7 0 100%

Casterton Pharmacy 6 6 0 100%

Total Non CMH Employees 63 61 1 97%

Total vaccinated 170 165 4 97%



Maternity CareCMH is not a birthing facility but works collaboratively with neighbouring birthing facilities to enable mothers to have post-natal care provided as close to home as possible.

In some instances this is as an inpatient postnatally to support breastfeeding, or as a domiciliary visiting service in their home.

During the period 2017-2018 CMH had 14 mothers and their new babies visit as a post-natal inpatient, and midwives undertook domiciliary visits to 21 new parents’ homes.

Midwife Mary-Anne Betson with Chiedza Mahanda-Makore and daughter Nakai

Newborn Screening sample collection within recommended timeframes

100%

95%

90%

85%

80%State

97%

CMH

100%

Recommended Quality Level, 95%

“A big thank you to all of the staff for their care of both

myself and my baby boy. Everyone was friendly and went above and beyond

to ensure we were comfortable”



Community Health

Improving consumer experiences

This year CMH’s Community Health team have continued to develop and enhance programs that support developing sustainable healthy lifestyle

choices and engaging with others using a collaborative approach with local partners.

Some of the highlights of the year were as follows:

Fun Run organisers Berni Bryan, Stewart Bryan, Di McKinnon, Paula Layley Doyle and Lucinda Jenkins

The Casterton Fun Run

On Sunday the 6th May 2018, 251 participants, with 120 doing the colour run, were joined by 40 volunteers at Island Park.

This event was a collaboration between CMH, Casterton Secondary College (Live4Life) and the Glenelg Shire Council.

The event was an overwhelming success and feedback received from participants indicated 96% are planning to return next year.

Although the Fun Run is a fundraiser for CMH it brings the community together for some physical activity which caters for all levels and may encourage more people to engage in some healthy activities.

The Live4life Glenelg Crew was established in 2017 and is made up of students from across four schools. The Crew coordinate several activities throughout the year and demonstrate how capable our young people are.

Some of the comments on the day were: “Loved the Colour Run”, “So much fun”, “Such a top morning out, had a blast”, “Fantastic morning”, “Great morning at the fun run/colour run”, “Very well organised by CMH and Live4Life crew…something for everyone”, “Fun morning had by all. Great work to all the organisers”, “Great family activity”, “Great community event, well done CMH” and “Real community spirit”.



And they’re off! (Photos courtesy of Casterton News)



Community Health continued

Strength & Balance Exercise Groups

Falls are one of the leading causes of injury and death for the elderly. However, you can reduce your risk of falls and slips by exercising. Exercising improves your balance and strength so you can stand tall and feel more confident when walking.

Starting with one class a week, the rapid increase in numbers saw a need to expand. The addition

of a new class that is more chair-based supports those with different needs. This class has been a great success attracting 12 to 14 consumers a week. This additional class is now able to cater for another cohort of the community and hopefully prevent falls and improve independence to maintain people in their home longer.

Members participating in exercise classes



Strength & Balance Group


Just Move Exercise Group

The Just Move exercise group caters for clients that are more mobile and are looking for some activity that is not as intense as a normal fitness class may be. This group aims to encourage clients to exercise

without putting any expectations on themselves, with the attitude that by just moving there will be a benefit and thus eliminating the stress of trying to perform at an unrealistic expectation.

Case Study - Continuum of care

An 87 year old consumer, who is widowed and living alone on a farm approximately ten kilometres from Casterton. They are unable to drive due to vision problems and require the use of a walking stick. Community Home Nurses visit weekly and they receive a telecare call every morning. They also have a tele-link alarm to press if there is an emergency, a supportive family who live away from the area and they also benefit from some home help once a fortnight through the local shire.

They commenced using the Community Home Nursing service after an injury to their leg. This developed into a wound that became infected and eventually required surgical treatment. This required hospitalisation and on discharge was required to have ongoing treatment through the Community Home Nursing service.

During this time the community nurses became aware of the consumers’ social isolation and discussed about attending the local planned activity group “Seasons”. The consumer agreed and the community bus now picks them up for each session. Initially they attended Mondays “Knit & Natter” group which are

mainly a group who knit and socialise. This group either sells or donate items that they make (also as the name suggests there is plenty of talk to be had). It was not long before the consumer started to attend the Thursday session as well.

Nurses also saw a need to reduce the risk of falls and suggested that the consumer start attending the Strength & Balance session on a Wednesday, again making use of the bus service.

After speaking to this consumer, they expressed that without these services they would not be able to continue to live at home alone. They gave an example where they can ring the supermarket and place an order and they will pack it up and then this would be picked up on the way home from “Seasons”. The driver will bring the shopping in to their house. They have also started using the community car a couple of times a month to attend medical and private events.

This consumer wanted everyone to know how appreciative they are to have these services and the benefits of having them support them to stay at home.



Denise Houlihan awaits David Richardson to take her home following an appointment at CMH


Improving the community’s access to healthcare

Pacemaker clinic

One of the most difficult problems for consumers in rural areas is being able to access health services nearby.

It was identified by consumers that one of the biggest issues was getting their pacemakers checked on a regular basis. With the retirement of

the previous physician, the service was likely to be lost. CMH in collaboration with Dr Andrew Bowman from Hamilton Medical Group commenced a twice yearly pacemaker clinic at CMH. This saves at least 30 return trips per year to Hamilton or Geelong for local consumers.

Community Transport

CMH provides a Community Transport Service for Casterton and surrounding district. The objectives for the service are as follows;

1. To improve the health of the population group currently disadvantaged through lack of access to suitable transport options within the town and associated catchment area.

2. Improve community access to Health and Primary Care services to support our ambulatory care model of support.

3. Reduce relative socio-economic disadvantage score for our health population area.

4. Improve social inclusion of target groups as identified and therefore improving overall mental health indices for the population target groups.

5. Effective utilisation of existing government infrastructure to support community needs as in the personnel and facility of CMH to manage the program safely and efficiently.

6. Effectively address and reduce a real gap in our community services brought about by lack of existing town and district transport resource for our demographics.

During the 2017/18 year CMH Community Transport has provided 1186 trips with an average of 52 clients a month using the service.




Case Study – Extra Time in Community Home Nursing

Casterton Memorial Hospital provides Community Home Care nursing services equivalent to EFT 2.5. Hours of operation were 7.30am – 4pm daily, with one full-time and one part-time nurse. The two nurses previously started and ended their day at the same time, therefore the operating hours to the community were fixed.

Community care needs outside of the fixed operating hours were increasing, and the challenge to meet these demands resulted in the whole of the organisation looking at the way services were delivered. For these reasons, the Community Home Care nursing services was expanded to have one nurse working from 7.30am – 4pm and the other working 9.30am – 6pm.

The motivating factors were increased community need to meet consumer service delivery needs outside the standard operating hours. Adequate time also was needed to be given to the nurses to ensure that the schedule included clinical handover time. Palliative care

consumers with increasing acuity often required two daily visits to best meet their care needs, as well as post-acute care consumers requiring more flexibility, e.g. twice daily subcutaneous medications / pumps.

To support the change, the following strategies were implemented:

• Changes in clinical handover times and processes.

• Increased use of diary and phone to ensure continued good communication between nurses.

• Engagement with all clinicians, hospitals and consumers.

Several meetings were undertaken with all clinicans to discuss strategies and offer suggestions to improve our existing model to best meet our current and future consumer needs. Feedback was also offered from consumers who were generally happy to have their service given at different times to suit their particular needs.

CMH Community Home Nurses (absent Kathy McArlein)




Improving the health service experience for a community health priority population

Pink Breakfast and Breast Screen Bus

Metastatic (secondary) breast cancer is the leading cause of breast cancer deaths. The direction is to strive towards zero deaths from breast cancer. By hosting a Pink Ribbon Breakfast and raising funds, the community is taking a stand against breast cancer and are helping to fund world-class research to find lasting solutions and ultimately - save lives.

By holding this function it enables CMH to promote awareness and promote the twice yearly

breast screen bus. This is a bus provided by CMH, and takes a group of women to have a breast screen in our area. A breast screen (mammogram) is an X-ray picture of the breast. Breast screens can find cancers that are too small to see or feel. The May 2018 bus had 11 participants attend; there is also a chance for participants to socialise with each other on the day.

More women survive breast cancer today thanks to early detection and better treatments.

Pink breakfast attendees and Breast Screen awareness



Residential Aged Care Quality IndicatorsA key initiative to promote quality care in Aged Care is the Public Sector Residential Aged Care Services Quality Performance Indicators. These indicators focus on five areas of clinical care. These are pressure injuries, use of physical restraint, use of nine or more medications, falls and fractures,

and unplanned weight loss. Public sector facilities monitor performance against these indicators regularly to identify potential areas for improved practices and compare performance against other like size facilities.

Falls

CMH continues to have a proactive approach to reducing falls across the facility. The guidelines in place rely on best practice to support early intervention and assessment as well as clinical skills to alert nurses of episodic risks, such as infections, pain or change in routines. CMH uses a multidisciplinary approach to fall reduction, with physio, OT, dietetic and medical support and the nurses undertaking assessments and implementing programs. Recent improvements to support nurses in reducing fall risks has been with the consumer / nurse call bell system which has seen a major upgrade. This upgrade in technology has led to improved nurse response

times to call bells / sensor mats / chair alerts which contributes to a reduction in incidents such as falls.

Nurses continue to monitor consumers at risk of falls through care plan reviews and the future introduction of rounding into Residential Aged Care, and by referring to the falls risk assessment in conjunction with recent falls risk data. Nurses perform frequent physical and visual checks on "at risk" consumers and document relevant information. Data is reviewed through all levels of clinicians and consumers to support identification of ways to further reduce risk and harm.

Jul-Sep16

Oct-Dec16

Jan-Mar17

Apr-Jun17

Jul-Sep17

Oct-Dec17

Jan-Mar18

Apr-Jun18

15.012.0

9.0

Glenelg House Rate Peer Group Rate

6.0

3.00.0

Incidence of Falls per 1000 bed days

Jul-Sep16

Oct-Dec16

Jan-Mar17

Apr-Jun17

Jul-Sep17

Oct-Dec17

Jan-Mar18

Apr-Jun18

1.000.800.60


0.40

0.200.00

Incidence of Fall related fractures per 1000 bed days

0.13

0.36 0.36 0.36

0.17

0.16 0.15 0.13

0.15 0.14

0.15

0.74

0.0 0.0 0.0 0.0

7.99

6.18

8.64

4.73 4.08

7.40 7.64

4.81 4.43

10.91

7.73 7.78

8.12

7.84 7.40 8.71

The Falls Fairy makes a visit to Glenelg House



Medication management

Introduction of drugs of addiction (pain medication) into Webster packs and storage in the consumer’s individualised medication drawer in their room is a change in practice in Glenelg House. Two nurses are required to check, sign and observe administration of drug of addiction as ordered by Medical Officer on resident’s medication chart. The outcome of this implementation is that the medication is administered in a timely manner closer to the administration time, residents’ pain is managed more effectively and a reduction in medication incidents by nurses checking and administering one at a time in the consumers’ room.

Medication reviews are undertaken with a

pharmacist, nurse, medical officer and the consumer or their family regularly throughout the year. The process allows consumers and health professionals to understand the purpose of their medication and to support a collaborative approach to consumers medication needs. Medication reviews ensure that consumers are taking the most appropriate medication for each individual. Medication management is managed by the Medication Advisory Committee who meet bi-monthly to discuss safety and medication management. Glenelg House will continue to review medications with a view to further reducing the number of consumers using 9 or more medications where possible.

Residential Aged Care Quality Indicators continued

Pressure Injuries

Pressure Injuries are graded from stages 1 to 4, with stage 1 being redness, stage 2 being broken skin and stages 3 and 4 being the most serious. Glenelg House has not recorded any Stage 3 or 4 pressure injuries since 2016. Pressure injuries are more likely to occur in those consumers who are in the last

days of life if they are unable to move themselves or take nutrition which is needed to keep skin healthy and intact. CMH uses many aids to assist in minimising this happening by using equipment, pressure relieving mattresses and frequent position changes as well as moisturising the skin.

Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 Apr-Jun 17 Jul-Sep 17 Oct-Dec 17 Jan-Mar 18 Apr-Jun 18

0.50.40.30.20.10.0


Incidence of Pressure Injuries per 1000 bed days

0.27 0.27

0.37

0.09

0.00

0.36

0.19 0.190.26 0.29 0.24

0.22 0.23

0.25

0.25 0.27

5.81

4.084.44 4.36 4.00 2.96

3.324.73

4.60 4.51 4.32 4.65 4.81 5.00


6.00

5.00

4.00

2.00

3.00

1.00

0.00


Incidents of consumers using 9 or more medications per 1000 bed days

4.41

5.07



Residential Aged Care Quality Indicators continued

Unplanned weight loss

Unplanned weight loss can occur among older people for a number of reasons including dementia, chronic disease process, and poor dental condition. Glenelg House regularly measures resident weight to identify residents who have unplanned weight loss so that management practices such as dietician referrals,

diet supplements and dental reviews can be arranged to assist in maintaining adequate levels of nutrition. Nurses refer to these specialists to ensure that we can accommodate the caloric needs of the consumer in a variety of ways both suitable and palatable.

Physical Restraint

A restraint free environment is the recommended standard of care. Glenelg House does not utilise restrictive devices or equipment such as bedrails,

safety vests and seatbelts to intentionally restrict consumer movement.

Jul-Sep16

Oct-Dec16

Jan-Mar17

Apr-Jun17

Jul-Sep17

Oct-Dec17

Jan-Mar18

Apr-Jun18

1.201.000.80


0.600.400.200.00

Use of Physical Restraint Devices

0.680.81

0.93

1.120.99

0.750.87 0.89

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.37 0.37

1.09

0.73 0.74 0.74


1.50

1.00

0.50

0.00


Rate of Unplanned Weight Loss per 1000 bed days

0.89

1.10

0.820.94

0.85

0.82 0.850.92

0.36

0.00

0.74

0.37

0.73

0.00

0.74


1.50

1.00

0.50

0.00


Rate of Significant Weight Loss > 3 kg per 1000 bed days

1.02 0.990.84 0.94

0.960.86

0.74

0.92

1.45



Escalation of Care ProcessesProviding a safe environment and evidence based care to consumers is paramount in any health care setting. CMH has continued to monitor, evaluate and implement changes to support clinicians, consumers and carers to recognise and act on concerns/clinical deterioration in a timely and effective manner. Clinicians use many tools to provide an early alert system, this commences with understanding and having a thorough history and story of the consumer so that the correct care can be planned. High risk consumers with complex conditions only need a small change in their clinical status to significantly decrease their well being. Some of

the tools CMH uses are the initial “getting to know your patient” electronic record, understanding history, medications reconciliation and using observation trackers such as the Victor charts for children, and the electronic TRAK observation charts. Prompts and alerts come up when observations are out of range and these require immediate action.

Consumers and their carer’s are provided orientation to CMH and signage at the end of every bed is explained with newly developed “picture based” information on how to alert clinicians to any concerns.

Friends of Glenelg HouseIn November 2017 the Friends of Glenelg House (FOGH) celebrated its 30th year of continuous voluntary work for the residential care unit. Since its inception an amazing group of volunteers have undertaken programs and activities which have improved the quality of life for those living in residential care.

Initially the group was formed with support from the then Nursing Home Charge Nurse Sister Judy Stewart. The founding group were Des Collins, Betty Collins, Ruby Gill, Peg Johnson, Vera Madex, Sue Jacobs, Lyn Tait, Helen Baker, Tanya Simpson,

Jean Martin, Doreen Spratling and June Harris. They enthusiastically ran concerts, “100” clubs, trips to surrounding areas, social gatherings, bingo, cards, Christmas shopping trips and of course the Winter Christmas event. This event is still held each year in August and as many people as possible from residential care are assisted to join in this wonderful community event.

Alison Jenkins took over the role of Residential Care Nursing Unit Manager (NUM) in 1988 and continued to support the group, and eventually formally joined as a member in 2011. The current NUM,

Nurses doing Advanced Life Support training with trainer Stewart Bryan



Karen Sealey, says the residents and employees eagerly look forward to the days that the FOGH members visit.

As of June 2018 two foundation members continue to support the group, Betty Collins and Vera Madex.

Each week they facilitate cards, bingo and bi-weekly activities including outings. Betty Collins notes that although many supporters have come and gone over the years (some for short periods some with long affiliations), all have supported improving the quality of life for consumers, families and the employees. Most recently the “barbeque days” are a real success with the group, as are the lunches which are held around the town regularly. The outings locally are small groups of consumers who are taken out for dinner rotating through to

share the experiences.

Currently the group comprises of 10 active members, Betty Collins and Vera Madex with 30 years of service in 2017, Betty Martin with 30 years’ service in 2018, Margaret Wood with 17 years of service. Other active members are Eunice Carn, Alison Jenkins, Gail Bandel, Helen Kirby, Cathy Parfrey and the newest recruit Mary-Anne Allen.

On behalf of all the Glenelg House consumers, employees and Board of Directors we would like to thank the Friends of Glenelg House for their continued support and assistance in making Glenelg House a “better place to live in”. Well done for such a great commitment and service to this community.

Friends of Glenelg House: Cathy Parfrey, Eunice Carn, Alison Jenkins, Helen Kirby, Margaret Wood, Betty Collins, Vera Madex. Seated: Betty Martin. (Absent Mary-Anne Allen and Gail Bandel)

Advance Care Planning and DirectivesThe Medical Treatment Planning and Decisions Act 2016 came into effect during March 2018. The legislation enshrines advance care directives in Victorian law and creates clear obligations for health practitioners caring for people who do not have their own decision-making capacity.

Changes to the previous process are:

1. Supporting people to identify who their Medical Treatment decision maker is. Your medical

treatment decision maker is the person with legal authority to make medical treatment decisions for you, if you do not have decision-making capacity or are unable to make the decision(s).

2. The development of a values directive which is a statement of your values and preferences for your medical treatment. Your medical treatment decision maker will use your values directive to guide them when they make decisions for you.



Advance Care Planning and Directives - Case Studies

In the past most people thought of the Advance Care Directive (ACD) as targeting those with palliative diseases or aged persons. In reality these groups are usually the ones on the ball with planning for their future. The groups where we need to focus more are on the younger consumers who have left home recently, have moved in with a new partner, or have a new family. This group often overlooks simple things like who will make decisions for them.

This year we had several case studies that bought home the importance for all people to consider who will be your medical treatment decision maker.

In this case a younger person had a devastating accident that left them with a major disability where they could not speak or explain their wishes. Their family were left with trying to decide what was in the best interests of this person. There were complex decisions to be made such as where would they live, who would make medical decisions for further medical

intervention, and on top of that the family had no idea what this person wanted. They were devastated to see their loved one unable to communicate and not know what they would have wanted done.

In the second case a gentleman who had completed his advance care directives years earlier and appointed a medical treatment decision maker, presented with a minor ailment for treatment and unexpectedly had a cardiac arrest. His advance care directive was for full resuscitation which was undertaken, his medical treatment decision maker was in full agreeance with his wishes and he was revived and transferred to a major hospital for treatment and returned home well.

Having these plans in place provide health professionals with some guidance as to what the consumer wants after weighing up all the options and in this case, even though the consumer was unable to speak at the time, has his wishes followed.

3. The instructional directive which is a legally binding statement in which you consent to, or refuse, future medical treatment.

Your instructional directive takes effect as if you had consented to, or refused the treatment.

You can choose to complete either or both directives.

Having this information shared with your loved ones, and those who provide your treatment can support everyone in making the decision you want for your health care.

CMH continues to have very strong supportive advance care plan facilitators who discuss the issues and provide the documentation for follow up by consumers’ doctors.

100%

80%

60%

40%

20%

0%

Jul-Sept Oct-Dec Jan-Mar Apr-Jun

Discharged Inpatients Aged >75 years with an Advance Care Directive or Medical Power of Attorney

2017/18

57% 73% 57%36%



End of Life Palliative CarePalliative care is supported by CMH across the spectrum of care - from home nursing and community health to urgent and acute care. CMH collaborates with the consumer, their families, health professionals including, general practician specialists, oncology units and palliative care teams to work with the clinicians providing direct care including nurses and carers.

Palliation is a unique and individualized process. A well-developed Care Plan supports a holistic, pro-active approach to meeting the consumer and family needs and wishes.

CMH, and the communities’ palliative care team utilise the “Victoria’s end of life and palliative care framework: A guide for high quality end of life care for all Victorians”.

CMH is also working with the Regional Telehealth Program to support and encourage use of telehealth for those palliative and end of life consumers and families who elect not to travel for ongoing appointments. The increase in oncology services in the region at Hamilton have also supported this local model of care when possible to keep consumers closer to home and therefore reducing the interruption to their and their families life during these times.

End of life care can be provided at home, in acute care or in aged care dependant on the consumer and their preference’s. The regional palliative care team visit Casterton regularly and together with the home nursing team provide home based care.

Information is provided proactively, and once recognised by the clinicians that death is imminent,

the ‘Care Plan for the Dying Person’ Brochure is

given and explained to the individual and/or family and friends. This brochure provides a thorough

explanation regarding the changes that may

occur with their loved one during the dying

process, and how they may feel once their loved one has passed away. The recognition of the dying stage enables carers, the dying person and those important to them, to focus, prepare and plan for their impending

death. It is crucial to discuss, review and explain palliative care, advance care directives and end-

of-life care preferences.

As consumers approach their end of life, the care plan is used at

the bedside to ensure that the consumer receives consistent, high quality care during the last days of their life which reflect their wishes and their changing health care needs.

The dying person’s wishes and needs are respected, and

all decisions made and actions taken are in accordance with the

individual’s requests. Nurses and medical officers at Casterton Memorial

Hospital provide the catalyst for sensitive communication between the dying person and their loved ones. Dignity and

privacy are ensured at all times during discussions and care. Emphasis

is placed on communication, involvement and support of all concerned. Daily revision of the dying person’s condition, needs and wishes is undertaken by care staff, and all clinical decisions are made in the best interest of the dying person. Medical, physical, emotional, spiritual and cultural factors are all of immense importance and are always taken into consideration.

"Musicwas providedand we were

allowed to stay24/7"

"Overall,the staff were

wonderful andtreated everyone

with respect"

"Need to improvecommunication"

"Thanks to all staff for the

wonderful care that was shown and given to Dad

during his time at Glenelg House"



Workforce InformationCasterton Memorial Hospital is committed to the provision of a safe and healthy work environment for all employees, contractors and visitors.

Workforce data

During the 2017/18 year Casterton Memorial Hospital employed a total of 114 staff, 37 full-time and 77 part time / casual across the labour categories as detailed in the following table. Statistics provided are consistent with information provided in the entity’s MDS/F1 datasets which are

reported on a monthly basis to the DHHS. Condition of employment is that Casterton Memorial Hospital employees will adhere to the values as outline in the Code of Conduct for Victorian Public Sector Employees 2015 and CMH Code of Conduct Policy.

Labour Category JUNE Current Month FTE JUNE YTD FTE

2017 2018 2017 2018Nursing 39.56 40.74 44.28 41.79Administration & Clerical 10.02 9.42 9.23 9.95Hotel & Allied Services 23.15 23.19 23.32 23.75

EMPLOYEE RECOGNITION YEARS OF SERVICE 2017-2018

Name Years of Service Name Years of ServiceElizabeth Craig 5 Patricia Tait 10Patricia Jones 5 Diane Southern 15

Barry Kent 5 Helen Dillon 30Anne Beever 10 Debra Gartlan 30

Carol Northcott 10 Robyn Reilley 30Teresa Sealey 10 Wendy Tibbles 30

Employee of the Year Heather Gill



Finance & Activity Overview

Net Result Operating Result

This year Casterton Memorial Hospital’s Comprehensive Operating Statement reports a deficit before capital and specific purposes items of ($41,352). This result can be attributed to an overall revenue decrease of 6% due to a 40% down turn of admitted patient fees, a recall amount of $175,396 for under achieving activity targets, a decrease in DHHS LSL debtor of $11,194 and a revaluation of LSL liabilities of $14,120. On a more positive note, responsible maintenance of operating expenditure to budget across all levels has produced a decrease of 1.13% on previous year, while salaries and wages were kept in line with budget expectations.

Total salaries & wages have been contained as per budget expectations.

Entity/Comprehensive ResultEntity Comprehensive Result of $1,106,798 is an increase $1,517,241 on the prior year result $410,443.

This result is impacted by building revaluation of $1,999,710 and unfunded depreciaton expense of $1,053,827.

LiquidityCasterton Memorial Hospital financial postion is stable with current assets exceeding current liabilities by $1,685,076 as at 30 June 2018.

Our current asset ratio stands at 1.37. Casterton Memorial Hospital has consistently over the past 5 years recorded an asset ratio well above DHHS benchmark of 0.7.

Cash Flow

Casterton Memorial Hospital has generated a positive operating cash flow of $315,101 for the financial year. Net cash flow was $545,116 due to transfer of $700,000 to TCV investment. Casterton Memorial Hospital remains in a secure postion with cash and cash equivalents totalling $5,156,908 as at 30 June 2018. This amount includes $2,041,572 in accommodation bonds.

• Cash & Cash Equivalents movement due to $700,000 transfer to TCV investment.

• Revenue decrease due to dowturn in admitted patient fees and under achieveing activity targets.

• Asset value increase directly due to revaluation of buildings.

• Liability decrease due to decrease SWARH liabilty provisions.



Finance & Activity Overview continued

Revenue by Source 2018 2017 $ Variance % Variance

Operating Grants 6,922,826 6,936,619 -13,793 -0.2

Patient and Resident Fees 951,755 872,243 79,512 9.1

Donations and Bequests 32,974 37,151 -4,177 -11.2

Interest 131,336 83,507 47,829 57.3

Other Receipts 830,185 1,278,208 -448,023 -35.1

Capital Purpose Income 182,729 426,735 -244,006.29 -57.2

Share Joint Venture 6,024 1,217 4,807 395.0

Total 9,057,829 9,635,680 -577,851 -6.0

Employee Expenditure 2018 2017 $ Variance % Variance

Salaries & Wages 6,028,619 5,692,096 336,523 5.9

Superannuation 573,272 558,527 14,745 2.6

Workcover 79,093 64,194 14,899 23.2

Total 6,680,984 6,314,817 366,166.85 5.8

Five Year Financial Comparative Statement

2018 2017 2016 2015 2014

Total Revenue 8,836,102 9,171,794 8,829,428 8,483,467 8,677,638

Total Expenditure 8,877,454 8,891,525 8,752,953 8,344,052 8,658,469

Share of Comprehensive Income Joint Venture

6,024 1,217 925 6,560 2,978

Operating Result -41,352 281,486 75,550 132,855 16,191

Total Assets 29,433,598 28,620,775 28,657,681 28,465,333 27,469,692

Total Liabilities 4,815,705 5,109,680 4,736,143 3,782,067 2,257,529

Net Assets 24,617,893 23,511,095 23,921,538 24,683,266 25,212,163

Total Equity 24,617,893 23,511,095 23,921,538 24,683,266 25,212,163

Summary of Changes 2018 2017 % Variance

Cash & Cash Equivalents 5,156,908 5,492,459 -6.1

Revenue 9,057,829 9,635,680 -6.0

Expenses 9,949,010 10,062,443 -1.1

Assets 29,433,598 28,620,775 2.8

Liabilities 4,815,705 5,109,680 -5.8



Employee ListENROLLED NURSESBeever, A. Benson, A. M. *Bogie, R. M.*Condon, C. A.Irving, A. P.Jacobs, A. M.James, C.Jarrad, L. J.*Jepchirchir, D.Kaur, S.Killey, R.McArlein, K. M.McCabe, J. A.MeenaNesbitt, D. A.Parsons, K. L.Pratt, D. J.Russell, M. R.Smith, G. J.*Tait, P. M.Tibbles, W. K.Wombwell, S. M.

ADMINISTRATIONBetinsky, M. J. Carmichael, P. G.*Crowle, C. E.Harvey, V. E.Hulm, L. S.MacFarlane, J. L.Rees, H. Rees, K.Richardson, J. F.Shone, C. M.Stephens, O. P.Toma, B. G.Whitchurch, L.

DIVERSIONAL THERAPYPerry, K. M.Roberts, C.

COMMUNITY HEALTHLayley-Doyle, P. L.Jenkins, L. J.

PERSONAL CARE ATTENDANTSBalzan, A.Jackson, A. M.Naylor, S.Reilley, R. F.Sealey, T. B.Tucker, R.

ENVIRONMENTAL SERVICESBellinger, C.Bunnik, I.Carr, K. East, J. A.Jamieson, R.Jones, P. A.Kerr, L. M.Louden, D. J.*McCalman, J.McDonald, L.O’Connell, S. J.Shore, K. M.*Smith, C. L

CATERINGClode, J. M.*Craig, E. A.Goodwin, S. M.Gould, D. A.Green, J. R.Kensen, M. D.Luers, S.*McPeake, M. L.Murrell, J. A.Naylor, J. H.Niewand, S. J.Nolte, M. R.Northcott, C. J.Robinson, B.*Ross, V. L.Sealey, D. J.Smith, J.Southern, D. L. Stanislawski, H.Wombwell, J*

HEALTHCARE ATTENDANTKent, B. M.

SOCIAL SUPPORT GROUPBryan, B. H.

REGISTERED NURSESBetson, M.A.Bryan, S.Clutterbuck, M. P.Dehnert, S. D.Dillon, H. V.

Drogemuller, S. J. *Duerden, S.Freeland, J.Gartlan, D. A.George, A. A. Gill, H. L.Gill, S. M. D.Gunning, P. S.Jenkins, A. J.Jose, C.Koenig, T.Kosgei, C. J.*Mahanda-Makore, C.Makore, M.*Makwati, O. Matthews, J. A.McKinnon, D. R.Sealey, K.Shaw, A.Sheahan, V. J.Siemon, R. Stephens, R. C.*Taylor, A. C.Thomas, J.Thomas, J. M.Young, J. L.Zippel, W. J.

MAINTENANCEHill, M. C.Naylor, M. L. Richardson, D. J.Zippel, S. J.

* Resigned during the year



What information would you like to see in next year’s report?

Community input is necessary to continue to provide a Quality Account which meets the needs of our community. We need your comments to help us ensure

that the next year’s report contains information that is important to you.

Please take the time to provide suggestions below. Drop this page in to the Hospital reception, email or post it back to the address below.

Thank You.

WE NEED OUR COMMUNITY’S HELP!!

Casterton Memorial Hospital63 - 69 Russell Street, Casterton, Victoria 3311

Phone: (03) 5554 2555 Fax: (03) 5581 1 051 Email: [email protected]

Acute CareOperating Room

Planned Activity GroupCommunity Health /

Health PromotionInfection Control

Home NursingUrgent CareEducation

Visiting Medical ServicesDirector Medical Services

PharmacistAllied Health

Principal Committees• Executive• Audit• Quality Committee• Visiting Medical Officers• Credentials• Medical Appointments• Facility, Fabric & Assets• Environmental

Management

Residential Aged Care Finance ReportingIT/Information Systems

Health InformationReception

Human ResourcesPayroll

Supply ServicesRisk Management

ContractsAged Care Entry

CateringLinen

Waste DisposalLaundry

HousekeepingMeals on Wheels

Plant & Equipment Building & Maintenance

Garden & GroundsEssential Services

Home MaintenanceFleet Management

Committee Composition

Functional Organisational ChartCasterton Memorial Hospital

Casterton Memorial Hospital

BOARD OF DIRECTORS

DEPARTMENT OF HEALTH & HUMAN SERVICES

BOARD OF DIRECTORS

CHIEF EXECUTIVE OFFICERMANAGER NURSING SERVICES

SAFETY / CONTINUOUS QUALITY IMPROVEMENT / OH&S / RISK

EXECUTIVE

BOARD SUB-COMMITTEES

ExecutiveAudit

QualityMedical Appointments

Credentials Facility / Fabric and Assets

Environmental Management

CLINICAL SERVICES

Clinical Services CommitteeAcute Nursing Staff

Residential Care StaffSenior Nursing Staff

Primary Care StaffMedication Advisory Committee

Minimal HandlingVisiting Medical Officers

Midwifery Staff

CLINICAL & COMMUNITY

SERVICES

RESIDENTIAL CARE

ADMINISTRATIVE SERVICES

HOTEL SERVICES

MAINTENANCE SERVICES

CORPORATE SERVICES

Department HeadsOccupational Health & Safety

Legislative ComplianceInformation, Communication &

TechnologyAdministration

Environmental ServicesCatering

Procurement

OTHER

Consumer ForumsResident’s Committee

Planned Activity GroupPerson Centered Care

Working Groups

Casterton Memorial Hospital63 - 69 Russell Street, Casterton, Victoria 3311

Phone: (03) 5554 2555 Fax: (03) 5581 1 051 Email: [email protected]

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Casterton Memorial Hospital Victorian Quality Account...Casterton Memorial Hospital Strategic Plan...

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