Our Services RIPERN’s at CDHIn 2014-2015, three registered nurses from Cobram District Health undertook a certificate in advanced practice nursing through the University of Southern Queensland. The qualification is commonly known as Rural Isolated Practice Endorsed Registered Nurse (RIPERN). The certificate of advanced practice defines a level of nursing practice that utilises extended and expanded skills, experience and knowledge in patient assessment, diagnosis, planning, implementation and evaluation of the care required. Nurses practicing at this level can, by law, supply a limited number of medications in accordance with regulatory guidelines, and undertake more complex treatments such as wound suturing, immunisations and application of plaster for fractures.

The academic component of the course was supported by Kaye Ervin from the University of Melbourne with practical mentoring by local general practitioners. Completion of the 12 month course allows endorsement by the Australian Health Practitioner Regulation Agency (AHPRA).

The extended scope of the RIPERNS aims to assist in providing improved work/life balance for the general practitioners after hours through reduced callouts for presentation of patients to the Urgent Care centre, as well as providing an extended service to the local community.

Director of Clinical Services David Gullick said “The community will now have increased access to care at their local hospital with the new RIPERN role, It is a great achievement for three of our local nurses to complete this training”. The RIPERN complements and supplements existing medical and nursing services. Formal evaluation of the RIPERN role is currently being undertaken to determine the benefits of this service to our rural community and health professionals.

Chair / CEO ReportThe 2014 / 2015 year has involved the integration of new services implemented at Cobram District Health.

The Community Rehabilitation Centre has now been operating for over 12 months and has commenced providing outreach services to both Numurkah and Yarrawonga, providing an invaluable service to the local communities.

Three Registered Nurses at Cobram District Health completed the RIPERN course which will allow them to provide advanced care to Triage Category 4 and 5 patients which will ease the pressure on the after hour requirements for our ‘on call’ General Practitioners.

In January 2015, our aged care facility, Irvin House, successfully completed accreditation ensuring the best possible care is provided to our residents.

Where previously we have had rotating Dental Graduates, this year it was decided we would have a Dental Graduate for the whole year. This has been a significant success allowing for greater continuity of the dental service.

Our operating theatre has remained busy as we have continued to support Numurkah District Health Service by undertaking their theatre work while their health service has been out of action due to flooding. Also, negotiations have commenced with Goulburn Valley Health with regards to doing some theatre work on their behalf.

Overall, this year has been rewarding and successful and we look forward to continuing to provide a quality and responsive health service to our community.

Craig De Lacy Jennie Gould Chief Executive Officer President

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Recognising our volunteersThe Cobram District Health volunteer program aims to assists patients/residents in the health service (both acute and aged care) who have been identified by nursing staff as having special care needs. Our volunteers help make the experience of being in hospital or our aged care facility a little nicer for everyone. Recently one of our volunteers, Helena Logan was nominated for the 2015 Minister for Health Volunteer Awards. Helena

was recognised for her commitment to volunteering at Cobram District Health for over 6 years. Helena frequently participates in activities with nursing home residents and supports residents emotionally and with her bright, friendly approach. Helena attended a function with the Health Minister and was awarded a badge to acknowledge her nomination in the awards.

Along with supporting residents in the nursing home our volunteers have also assisted with conducting patient surveys on the acute ward of the hospital. The survey results were used to provide feedback on patient interactions with nursing students on the acute ward.

Hospital12 Acute bedsOperating Theatre & Day Procedure Unit • Endoscopy • General surgery • Orthopaedics • Minor GynaecologyPalliative CareTransitional Care BedsUrgent Care CentreRadiology

Irvin House29 High Care Beds1 High Care Respite BedGeriatrician Assessments

Community HealthCommunity Aged CareAllied Health ServicesDistrict NursingHospital in the HomeChronic Disease ManagementHealth Promotion

SuperclinicGP ClinicVisiting Medical SpecialistsDentists

Moira CommunityRehabilitation CentreIndividual & Group RehabilitationMultidisciplinary Team

Cobram provides Theatre Service for Numurkah

ViCTOR observationcharts, keeping kids safe

AccreditationIn January 2015 Irvin House successfully achieved three years of accreditation from the Australian Aged Care Accreditation Agency. The accreditation process reviews the quality of care provided, the physical environment, resident lifestyle and management systems. CEO Craig De Lacy said “The staff in Irvin House work very hard to ensure residents receive high quality care in a home like environment and it was a great achievement to receive 3 years of accreditation.”

Cobram District Health also is currently accredited against the National Safety and Quality Health Standards (EQuiP National) by the Australian Council on Healthcare Standards until 2017.

The medical clinic has current accreditation with Australian General Practice Accreditation Limited until March 2018. The Community Aged Care Packages and Home and Community Care services are also currently accredited until September 2017. The accreditation process ensures the services we provide are at a high standard.

Numurkah District Health Service (NDHS) was significantly affected following flooding to its buildings in March 2012. NDHS had to close its operating theatre following the floods. Cobram District Health was able to assist NDHS by providing surgery for Numurkah patients from mid 2012 until June 2015. During this time over 500 people from Numurkah had surgery in the Cobram theatre.

Dr Roly Hunt, who provided general surgery once a fortnight said “At all times I was treated very well, with a high degree of friendliness and efficiency”. Mr Hunt thanked the staff at Cobram along with the board, “The ward staff and the theatre staff proved to be very professional and adaptable”.

Patients also highly value the theatre service at Cobram with one consumer providing this feedback through the Victorian Health Experience Survey. “For my procedure I had the best attention and felt completely safe and comfortable the whole time; reception, operating staff and doctors were all the best and caring people any one could wish for.”

End of life careIrvin House Aged Care facility has been implementing the Palliative Approach Toolkit over the past twelve months. The toolkit provides resources and training to assist staff in caring for residents towards the end of their life. The program has included implementing an end of life pathway, staff education and case conferences between staff and residents families.

In early 2015, Irvin House also had a review of palliative care services undertaken by Hume Palliative Care Consultant, Annette Cudmore. The review and the toolkit have resulted in improved comfort for residents in their last days. Audit results indicated that 94% of residents were prescribed appropriate pain relief at the end of life and a decrease in residents experiencing symptoms such as nausea and shortness of breath. The end of life pathway has now been rolled out in the acute ward.

Cobram District Health is one of nine pilot sites involved in testing a new observation chart for use with all ages of children. The project is supported by Monash Children’s Hospital, the State Government of Victoria and The Royal Childrens Hospital.

ViCTOR is the acronym for Victorian Childrens Tool for Observation and Response.

The charts provide a standard way for staff in the Urgent Care Centre to record heart rate, breathing rate, temperature and other vital signs in children. The charts allows for staff to easily recognise when a child is unwell and when to notify a senior nurse or the doctor. Acute ward staff member Gabrielle Ransley who has been a champion of the project said “The charts are easy to use and provide good prompt for staff to be aware of the normal ranges of vital signs in children”.

The Urgent Care Centre treats over 75 children per month on average. The ViCTOR Paediatric Observation Chart project is expected to be completed in September and the charts will then be rolled out across the state.

CDH is committed to providing high quality health care. In order to provide such care it is important to continually improve our services to the community.Consumer feedback is used to assist in driving safety and quality imporvement around the organisation.

CDH Encourage consumers, carers and the community to provide feedback about Cobram District Health Services, including complaints, compliments and suggestions.

There are a number of ways feedback can be provided including but not limited to: • Compliments, complaints and suggestion form• Informal conversations with consumers and carers• Website link• Email based feedback• Phone based feedback• Postal based feedback• Interviews where requested.

An example of feedback leading to change in service delivery in 2014-2015 include:• Audit of the Website – Assisting the community in

easily navigating the website to best suit consumer and community needs. Visit our website at www.cobramdistricthealth.org.au

Consumer, Carer and Community ParticipationStandard 1 – Demonstrate a commitment to consumer, carer and community participation appropriate to its diverse communities.

This is evidenced in the organisations consumer and community participation framework, policies and procedures, CDH Diverstiy plan, Consumer Participation Advisory Committee and consumer committee membership.

CDH meets the victorian public health services target of 75% of the requirements for standard 1.

Standard 2 – Consumers, and, where appropriate, carers are involved in informed decision making

about their treatment, care and wellbeing at all stages and with appropriate support.

Consumer Advisory Committee Member, Kate Lebner spoke of her recent experience with CDH complaints, compliments and suggestions system “A well organised followed through process, professional and confidential system.”

Standard 3 – Consumers and, where appropriate, carers are provided with evidence-based, accessible information to support key decision making along the continuim of care.

CDH now ensures 100% of consumer information developed within the service reviewed by consumers.

CDH have enlisted the use of policies that direct staff to approved sites where information available in other languages is availble to print out for consumers and utilise where appropriate.

Standard 4 – Consumers carers and community members are active participants in the planning, improvement and evaluation of services and programs on an ongoing basis.

Cobram District Health consumer advisory committee have been involved with a number of improvements. Currently consumers are invovled in the development of the strategic plan and have had input into the development of the CDH website.

Consumers are represented as members on the Safe Practice and Environment Committee, Medication Safety Committee and the Clinical Governance Committee.

Consumer committee member Malcolm Kerr explained his role:

“I attend committee meetings, providing input into how services provided can be improved from a consumer point of view. I also feel I am able to ensure decisions /recommendations made are in the best interests of the community and are safe for all concerned. This is an opportunity to become involved in our community’s development. The committee members listen readily to

my input and are always prepared to provide explanations where my understanding is lacking”

Standard 5 – The organisation actively contributes to building the capacity of consumers, carers and community members to participate fully and effectively.

The organisation actively encourages consumer members and volunteers by ensuring all relevant education opportunities within the health service are available for consumer participation.

Dental ClinicCobram Dental Clinic complements a training program for students from the University of Melbourne studying the degree Doctor of Dental Surgery or Bachelor of Oral Health.

90 students rotate through the clinic from January – October each year for a 5 week placement program working in conjunction with GVH.

While the students are at Cobram Dental Clinic they are learning essential factual knowledge to become a general dentist and leaders of the oral health team. As part of the four year full-time degree, students spend significant time in provision of patient care, using advanced materials and clinical methods. The students have the unique opportunity to experience working in a private/ public practice setting, and they learn how to communicate effectively with patients and their relatives, also with professional colleagues and members of other health professions.

They are expanding their skills with eligible patients who have Health Care cards or pension cards who consent to free dental treatment. Dr Herb Barlow is their clinical supervisor and mentor. This program has been running successfully for the past 5 years and is growing from strength to strength, allowing our community to have access to free public dental services.

Cobram Medical Clinic has a number of visiting specialists and health workers.

Visiting specialists to the medical clinic include:• Mr. Muhammad Abdullah – Mr. Abdullah is a general surgeon who

visits the practice monthly.• Mr. Ian Critchley – Mr Critchley is an orthopeadic surgeon and visits

the clinic monthly.• Dr. Peter Dewez – Dr. Dewez is a Paediatrician who visits monthly.• Dr. Terry Stubberfield – Dr Stubberfield is a Paediatrician who visits

monthly.• Dr Siddhartha Dutta – Dr. Dutta is a visiting psychiatrist. Dr Dutta

visits on a weekly basis. Dr Dutta also performs telehealth consults with clients.

• Dr Judith Krones – Dr. Krones is a gynaecologist who visits monthly.• Dr Bhattacharya – Dr Bhattacharya is a geriatrician who visits twice

monthy.• Angela McPherson, Bonnie Crothswaite and Michelle Eldridge are

visiting psychologists• Andrew Nunn – sleep studies/CPAP visits fortnightly.

Consumer Feedback

Medical Clinic – Providing quality care in a friendly relaxed environment

Medical Clinic staff are always studying to ensure the best quality care. Dr Yue Chen has just completed his RACGP fellowship in March 2015. Dr Chen has also completed a dermatology course this year.

Cobram Medical Clinic participates in the John Flynn Placement Program (JFPP). The program was established in 1997 and is funded by the Department of Health. The program is part of the Australian Governments strategy to attract more Doctors to rural and remote areas to address workforce shortage and improve the quality of healthcare for local rural communities. Duncan Lyons is the John Flynn Medical Student associated with Cobram Medical Clinic. Duncan is from the University of Tasmania and undertakes a 2 week placement each year for 4 years with GP mentor Dr Michael Chabbou.

Healthcare Experience at CDH

Patients are surveyed on their experience using the statewide Victorian Healthcare Experience Survey. Feedback is used to improve the service we provide. Some of the results are presented here.

Rural Health Academic Centre research at Cobram District HealthCobram District Health’s collaboration with the University of Melbourne continues through 2014-2015. The University of Melbourne undertook a population health study, surveying over 500 Moira Shire residents in late 2014 about their health conditions, health behaviours and use of health services. Results are available on the CDH website.

CDH were the successful applicants for a study regarding mature age nurses. In collaboration with

the University of Melbourne, three registered nurses are undertaking research training to conduct a small research project each at CDH. The projects are aimed at workforce health and wellbeing, and service delivery.

A study of Cancer Survivors is also underway at two of CDH’s major referral centres of Albury Wodonga Health and Goulburn Valley Health. The study aims to improve service delivery for cancer survivors in the Hume region.

Aged Care IndicatorsCobram District Health provide a 30 bed aged care facility to the community called Irvin House. This facility is designed to offer a homelike environment for the Residents.

This year the staff at Irvin House has implemented an auditing system to ensure continuous improvement within the facility. As audits are completed actions to improve are implemented immediately, actions are monitored to ensure improvement.

Irvin house also monitors a range of indicators to ensure the highest quality of care is implemented. This assists using monitoring where changes may need to be made to our systems.

FallsIrvin House has seen a reduction in falls over the year with 24 falls in the first quarter and 21 falls in the fourth quarter, and no resulting fractures. Irvin House is

constantly implementing patient centered care strategies to reduce falls in the home.

Pressure Injuries Irvin House is required to monitor and report on the number of pressure injuries residents’ acquire. There has been a reduction in the number of pressure injuries across the year.

Where did you get this report?

Cobram Courier

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Feedback (tell us what you think)Please send completed form to

Craig De Lacy Chief Executive Officer PO Box 252 Cobram, Vic 3644

Thankyou

Your feedback helps the development of future Quality of Care reports.

Restraint Irvin House monitors the usage of restraints. The use of physical restraint is considered a last resort when caring for those at risk of self harm. At Irvin House, there was only one incident of restraint for the year.

MedicationsThe Number of Residents taking 9 or more medications has decreased over 2014 – 2015.

Unplanned Weight LossAt Irvin House, all residents are closely monitored for weight loss. If a resident does experience unplanned weight loss, they are referred for specialised assessment by a dietician and other allied health professionals.

Residents may also be given supplements, high calorie snack foods, increased frequency of food and drinks, and have their diet further modified to suit their needs. All residents are weighed regularly to monitor their progress.

Did you know?• in 2014/2015 CDH had 22 Compliments,

18 complaints and 2 suggestions

• 84% of staff at CDH had their flu vaccination in 2015

• Hand hygiene compliance of staff at CDH was 83%

• 10% of CDH staff can speak multiple languages

• CDH hosted 1035 days of student placement (Nursing and Allied Health), this is an increase of 195 days from the previous year