Daphne Perry Aboriginal & Torres Strait Islander Remote Area Clinical

Liaison Nurse for Cardiac Surgery

I acknowledge this land is the Traditional Lands of the Kaurna People & that I

respect their spiritual relationship with their Country. I also acknowledge the

Kaurna People as custodians of the Adelaide region & that their cultural &

heritage beliefs are still as important to the living Kaurna People today.

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Discussion

The Patient Pathway (in brief)

A pathway which allows us to focus on the patients journey

from the time of their acceptance by FMC for surgery until they

arrive back in the community.

Elective Patients - those patients who require non-emergency admission to hospital -

who have been placed on the hospitals waiting list.

Inter-hospital Transfers & Emergency cases

Patients admission

Discharge Planning

• In 2007 research by Monica

Lawrence found that 28 out

the 40 patients who were

booked for surgery failed to

attend with many being

repeat offenders -

• In 2010 – 1/65

2011 - 2/66

2012 - 1/77

Improved bed management

Reduced

numbers of

no-shows

Increased involvement of

Aboriginal Liaison Officers

Continuity of Care

Co-ordinated discharge

planning

Continual Quality

improvement – community

and patient involvement

Increased culturally specific

education resources

medication management

Increased support for patients

and escorts during the

patients admission

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> Patients come from the NT, Torres Strait Islands, Remote and

Country SA & Metropolitan Adelaide.

> Travel between 5 and 7,800km return – in order to obtain surgery.

> Coronary Artery Bypass Grafts

> Valve replacement/Repairs

> Combination.

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Screening tool

Outlines required pre-surgical

preparation

Contact numbers

Provides Rationales

Outlines D/C and referral

processes

• Infections

Dental Clearances

Urinary Tract Infections

Infected Wounds

• MRSA

VRE

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• Medications - Ensure

anticoagulant (blood

thinners) - are ceased 7

days before surgery.

• Cultural obligations

funerals

All test results are assessed (Echo, Angio’s, TOE’s) and the time they were

completed noted – further testing is booked if required – eg Carotid Ultra-sounds.

Blood tests are completed and that all abnormal tests

are followed up

Rational:

All blood test results are sent to and reviewed by FMC’s Remote Area Liaison nurse and

the RDH’s Cardiac co-ordinator who will discuss any abnormal results. FMC’s IRALN will

then discuss the abnormal results with the cardiac surgical team who will determine if any

further investigation is required prior to the patient leaving the community. The RDH’s

Cardiac Co-ordinator will inform the appropriate Cardiologist in the NT.

A list of all the patients’ current medications.

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Special Needs • Wheelchairs, side rooms, cot for

baby

Skin Conditions

• Treatment prior to leaving the

community

Escorts

• Organize a GP if they are unwell or

need further medication

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Travel

• Education

• Pick-up by corporate shuttle,

• Reporting safe arrival to CHC

– NT cardiac coordinator).

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Ward Rounds -

• Direct clinical care,

• Allows staff education (cultural

safety).

• Early Referrals,

• Allows accurate daily ward reports

to be sent to consented parties

(CHC, co-ordinators etc.)

On arrival to FMC –

• Meet the patient as soon as

possible.

• Orientate patients to the

ward and services available.

• Ensure informed consent

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Providing culturally appropriate education

to ATSI patients and families, pre and post cardiac surgery.

• Sourcing and utilizing Culturally

appropriate resources.

• Ensuring that Aboriginal Liaison Officers

are involved and consulted in all aspects

of patient care.

In hospital care also encompasses -

Female to male patient education should always be

done with male Aboriginal Liaison Officer

Provision of one to one Cardiac Rehabilitation

education rather than to mixed gender groups

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Discharge Planning

Ensures that plans are put into place

for a patient r/v at the RDH or ASH

prior to the patient returning to a

remote community

Commenced Early – often with

referrals into other disciplines prior to

surgery (Heart Failure unit @ RDH)

Allows for planning re: Rehabilitation

Allows planning for transfer needs –

wheelchairs at airports

30 day & 6 Month phone follow-up

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Discharge Summary Medication Lists

are Audited for Accuracy

Discharge Medications are in format

that meets the needs of the patient &

CHC

Discharge Planning

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Discharge Planning – for inter-hospital transfers

Increased communication

Timely acceptance of patients

Allows for bed management

Allows timely booking of nurse

escorts

Timely completion of paper-work –

Qantas Clearance To Fly forms

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Referrals for follow-up care

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Positives - for patients, CHC, families, FMC.

Reduced in-hospital length of stay.

Inclusion of ALO’s in patient care.

Increased support for patients and escorts during the patients admission.

Informed consent prior to surgery and cardiac procedures.

Increased communication with and access to feedback from Remote CHC,

patients and families.

Positive message sent back to Communities (more people willing to travel

for procedures and surgery).

Increased referrals to specialist services.

Culturally appropriate Cardiac Rehab.

Screening – patients treated in the community by people they know.

Increased in-hospital cultural awareness training for staff.

Greater collaboration with the Rheumatic Heart Disease Registry

(prophylaxis, update of RHD Registry data).

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Negatives

When a patient passes or when they need to stay in Adelaide for extended

periods of time negative messages are sent back to the community.

Huge difficulties in clearing patients dentally for valve procedures.

Plans for the future

To continue to build our capacity for pre-admission screening, education and

patient preparation.

To increase our consultation with patients, Communities, CHC’s and our ALO’s

in relation to the care of our patients.

To review and to continue to change our practice according to the needs of the

patient, communities and CHC’s.

To work with Dr. Janet Kelly (Flinders Uni) to map the dental preparation of

patients in order to see where the problems lie and find solutions.

Build in sustainability within the Hospital and care systems (including funding).

Thank You

Flinders Medical Centre