Southern Queensland Clinical Networks Showcase The ... · The Showcase was the vehicle for the official launch of the Southern Queensland Child Protection Medical Education Program

Southern Queensland Clinical Networks Showcase &

The official launch of the Child Protection Medical Education Program

Report

Hilton Hotel Brisbane

Thursday 10 February 2011

Southern Queensland Clinical Networks

1. Introduction.............................................................................................3 2. Program of events ..................................................................................4 3. SQ Maternity and Neonatal Clinical Network .......................................4

3.1. Network History ...............................................................................4 3.2. Retinal Imagery Service ..................................................................4 3.3. Standardisation of documentation.................................................5

4. SQ Child Protection Clinical Network ...................................................5 4.1. Child Protection Medical Education Program...............................5

5. Launch SQ Child Protection Medical Education Program ..................6 6. SQ ICU Clinical Network.........................................................................6

6.1. Network History ...............................................................................6 6.3. Inter-Hospital Transport..................................................................7

7. SQ Cardiac Clinical Network..................................................................7 7.1. Standardisation of Clinical Competencies for Cardiac Nurses ...8 7.2. Heart Failure DVD ............................................................................8 7.3. Echo Work Group ............................................................................8 7.4. Satellite Arrhythmias Clinics ..........................................................8

8. SQ Renal Clinical Network.....................................................................8 8.1. Enrolled Nurse Advanced Practice (ENAP) Resource..................9 8.2. Chronic Kidney Disease Resource ................................................9 8.3. Home Dialysis DVD .........................................................................9

9. Southern Queensland Clinical Network Team ...................................10 10. Evaluation ..........................................................................................10 11. Conclusion.........................................................................................11 APPENDIX A: Showcase Program..............................................................12 APPENDIX B: Evaluation Survey................................................................14

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1. Introduction The Southern Queensland Clinical Networks group is comprised of the following five clinical networks:

• Southern Queensland Cardiac Clinical Network • Southern Queensland Child Protection Clinical Network • Southern Queensland Intensive Care Unit Clinical Network • Southern Queensland Maternity and Neonatal Clinical Network • Southern Queensland Renal Clinical Network.

Until the Queensland Health organisational restructure of August 2008 these clinical networks were under the governance of the former Southern Area Health Service. However, following the restructure governance for these networks was transferred to Metro South Health Service District. Clinician commitment and involvement in these networks remains strong. This Showcase provides an opportunity to highlight the past and current activities of these networks and demonstrate that clinical networks are an effective method of achieving clinical improvement.

The Showcase was the vehicle for the official launch of the Southern Queensland Child Protection Medical Education Program (the Education Program), a landmark activity of the Southern Queensland Child Protection Clinical Network. The Honourable Paul Lucas, Deputy Premier and (then) Minister for Health had accepted the invitation to officially launch the Program, however, due to the disastrous cyclone Yasi, which devastated much of North Queensland, the Deputy Premier was unable to attend and Mr Murray Watt, MP Parliamentary Secretary for Healthy Living, officiated on the day.

The event was Chaired by Dr David Theile Snr, District Chief Executive Officer, Metro South Health Service District, and attended by 68 participants and included representatives from all Southern Districts, Corporate Office, Mater Health Services, Statewide and Central Clinical Networks.

Dr Theile with Clinical Chairs, Project Officers, and Network Coordinators

Back row: Daniel Dobbyn, Andrew Haddock, Dr David Theile Snr, Dr Steve McTaggart, Dr Sudhir Wahi Front row: Kimberley Byrnes, Joan Kennedy, Edwina Smith, Dr John Hill, Christine Sullivan, Dr Jan Connors, Robin Turnbull


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2. Program of events Dr David Theile Snr, District Chief Executive Officer Metro South Health Service District opened the morning’s program tracing the history of these clinical networks and recognising the importance of collegiate networking.

3. SQ Maternity and Neonatal Clinical Network 3.1. Network History

Dr Bob Baade, Co Chair SQ Maternity and Neonatal Clinical Network, reflected on the long history of this network which has been in existence in various forms since the 1990’s, but which was formalised as a clinical network under the Quality Improvement and Enhancement Program (QIEP) in 2000.

The network has retained strong clinician participation and has been instrumental in the development of activity which has been taken up by the Statewide Maternity and Neonatal Clinical Network.

The Pregnancy Health Record (also referred to the patient hand held pregnancy record) was developed and implemented by this network as early as 2006. This provides standardised documentation of the woman’s antenatal, history which she carries and is used by both GPs and hospital staff. The Statewide Maternity and Neonatal Clinical Network now has carriage of progressing a Statewide Pregnancy Health Record under the chairmanship of Dr Baade.

A standardised Intrapartum Record is another activity of this network which has been taken up by the Statewide Network also under the stewardship of Dr Baade.

Dr Baade outlined the characteristics of this successful network which includes an annual clinical forum to inform priorities, and a strong focus on quality and safety activity which is clinician led. Other activity of the network includes:

• Consultation on and Input in to the development the Clinical Services Capability Framework (CFCS)

• Development of Patient Education Pamphlets which have now been taken on by the Queensland Centre for Mothers and Babies

• Development and trialing of Breastfeeding protocols which have since informed the statewide policy and clinical guideline

• Financial support for RANZCOG accredited Fetal Surveillance Education • Financial support and delivery of Continuous Positive Airway Pressure

(CPAP) workshops.

3.2. Retinal Imagery Service Dr Jan Cullen, Director Paediatrics, Logan Hospital, described the need for a Newborn Retinal Imagery Service.

The current procedure is to transfer newborns to the Mater Hospital for retinal imagery and ophthalmology consultation. This is expensive as each baby needs a nursing escort and QAS transport and poses risk to the health and wellbeing of the newborn, and can result in an increased length of stay.

The Network undertook a feasibility study to establish an outreach service provided by trained Mater Hospital Neonatal Nurses who would travel to the baby to take retinal images which could be transmitted back to the Ophthalmologist for review and assessment screening.

The Network is keen to progress and develop this service and is seeking funds to purchase the retinal camera.


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3.3. Standardisation of documentation Ms Robin Turnbull, Network Coordinator, reported on the suite of standardised documents that the network has championed, these include:

• Antenatal Pregnancy Health Record • Intrapartum Record • Postnatal Clinical Pathways.

The initial development of the Intrapartum Record was carried out in 2008 with a staggered implementation across the Southern Districts in 2009 which was accompanied by an education program. During 2010 an audit was undertaken in five birthing facilities with a view to inform the statewide development and roll out. Ms Turnbull also outlined the collaboration between the Statewide Maternity and Neonatal Clinical Guidelines Program and the Network to support and encourage the implementation of the clinical guidelines. The aim is to develop and implement guideline specific education packages, and the development of an audit tool for clinicians to use statewide.

4. SQ Child Protection Clinical Network 4.1. Child Protection Medical Education Program

Dr Jan Connors, Chair SQ Child Protection Clinical Network, identified the origins of this network from the 2004 Crime and Misconduct (CMC) Enquiry into Child Abuse. Dr Connors outlined the new clinical roles that were created in response to this enquiry, the Child Protection Liaison Officer (CPLO) and the Child Protection Adviser (CPA). Recent network activity includes: • Mapping of child protection service provision and resourcing across SQ • Identifying inconsistencies in practice and utilisation of resources • Identifying the need for better data collection for meaningful comparisons • Development of standardised work instructions for CPLOs. Further, the SQCPCN identified the need for a well documented framework for standards of education and professional support for all levels of medical staff. This led to the development of the Child Protection Clinical Service Capability Framework which has been endorsed by the Patient Safety and Quality Executive Committee and is now ready for implementation. This document outlines the need for education of medical staff having first line contact with children and which led to the development of the Southern Queensland Child Protection Medical Education Program (the Program) that is to be launched at this showcase.

This Program aims to: • Develop a comprehensive and sustainable child protection training package • Facilitate access to best practice based training in child protection • Improve knowledge and skill levels in the identification and management of

paediatric inflicted injuries • Improve child protection workforce capacity. Dr Connors spoke about the evaluation of the two programs that have been piloted to date and thanked the Clinical Skills Development Service for partnering in the delivery of this Program.


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5. Launch SQ Child Protection Medical Education Program Mr Murray Watt, MP Parliamentary Secretary for Healthy Living, reiterated the need for and importance of protecting children from child abuse.

Mr Watt congratulated the network on the development of such a landmark Program. He noted that this education program will build capacity in the child protection medical workforce and assist in improving the health of vulnerable children.

Mr Murray Watt MP, Dr Jan Connors, Dr David Theile Snr.

6. SQ ICU Clinical Network 6.1. Network History

Associate Professor Brent Richards, Chair SQ ICU Clinical Network, traced the history of the QS ICU Network which began under the Quality Improvement and Enhancement Program (QIEP) of 2000 with a focus on ‘people’, that is patients, staff, referring teams, and the community across Southern Queensland.

Key issues addressed in the early years include: • Intensive Care capacity planning • Recruitment and retention • Nursing transition program • OT cancellation due to lack of ICU beds.

The Network has been instrumental in bringing ICUs together and markedly decreasing parochialism. Collaborative efforts, forged by networking, are clearly demonstrated by the collaboration and coordination of the H1N1 virus which challenged many ICUs.

The network also acts as a sounding board for clinicians and administration.

6.2. Standardisation of nursing procedures Ms Heather Hoey, RN Toowoomba ICU outlined the scope of the nursing procedures standardisation project. The stated aims are:

• To deliver a suite of Evidenced-Based ICU Nursing Procedures • To standardise work practices across SQ ICU’s, with reference to best

practice and utilisation • Promote best practice outcomes.


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It is hoped that the project may also deliver efficiencies in endorsement processes as Districts accept the Network’s endorsement of best practice.

Standardising practice will support and promote confidence to RNs as they move between ICUs which will have a positive effect upon individual patient’s health outcome.

6.3. Inter-Hospital Transport Mr Andrew Haddock, CN Logan ICU, summarised the problems being addressed and key features of the pilot inter-hospital road transfer (IHT) of critically ill patient’s project.

Transferring a critically ill patient by road virtually means that one has to ‘cram an ICU bed configuration, patient and staff into an Ambulance’ which not only creates a challenging environment for staff, but is known to be a key contributor to serious adverse outcomes.

Patient Safety and Quality data reveals that over five years there were 64 adverse events directly relating to road IHT which included 13 deaths and 51 instances of actual or potential serious harm.

To address these issues the project aims to build on the work of the collaboration between the Statewide ICU and Statewide ED Network to improve road transport by:

• Trialing of a dedicated inter-hospital transfer service • Standardising protocols relating to transport • Implementing and refining equipment restraint systems • Developing and education and training resources.

7. SQ Cardiac Clinical Network Dr John Hill Chair SQ Cardiac Clinical Network described the focus of the SQ Cardiac Network as:

• Clinical practice • Workforce planning • Workload management • Service planning and infrastructure

He also described the engagement of cardiac clinicians in the Southern Queensland region by using their strengths and talents to achieve better health outcomes for cardiac patients.

Dr Hill identified some of the major achievements of the network during 2006 – 2010 with a focus on strategies for better patient access including:

• Development of Cardiology Spokes to the Hubs • Outreach Clinics • Investing in local leadership, training, mentoring • Encouraging the sharing of resources and training • Utilising the Healthy Hearts budget and MSOAP funding for positions,

services and equipment. Current network activity includes:

• Cherbourg Cardiac Outreach Clinic; an investigation of the issues related to service improvement of the clinic.

• Southern Qld Acute Coronary Syndrome Audit; assessing the ability of all SQ facilities to achieve best practice in Acute Coronary Syndrome management.

• ECG interpretation for junior doctors; contribute to the improvement of vital ECG skills.


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• Emergency Reperfusion Strategy for Metro South Catchment; collaboration between Emergency, Cardiology and QAS at multiple facilities.

7.1. Standardisation of Clinical Competencies for Cardiac Nurses The Network aimed to improve patient care by:

• enhancing nurses knowledge on cardiac conditions • promoting evidence based care • addressing learning needs at rural centres, large metropolitan, tertiary

hospitals, from novice to specialist nurse.

This resulted in a suite of 15 standardised evidence-based cardiac clinical skills assessments for Registered Nurses. These tools are now being considered in the development of the Transition HDU/CCU.

7.2. Heart Failure DVD Ms Mary Boyde, Nurse Educator and Research PAH led the audience through the development of the Heart Failure DVD, a resource for patients diagnosed with heart failure.

Evaluation of the resource demonstrated that, when combined with the Self-Care Manual, knowledge levels improved and self care abilities improved.

7.3. Echo Work Group Dr Sudhir Wahi Consultant Cardiologist, PAH explained the benefits of sharing echo images between sites. The Digital Echocardiogram management system has been expanded to five sites with a central image server housed at PAH with all modalities in all centres archiving and retrieving data from this server. The participating sites include:

• Princess Alexandra • Logan • Redlands • Ipswich • Toowoomba.

This imaging system facilitates improvement in patient care and clinical workflow between all the linked centres. It enables remote access to expertise and more rapid clinical decision making. In addition the Network has supported and implemented the role of Regional Echo Coordinator to:

• Identify and address service gaps of cardiac scientists across the region • Coordinate training and education needs of sonographers from regional

centres • Define the term ‘waiting list’, audit waiting times and address issues.

7.4. Satellite Arrhythmias Clinics Dr John Hill, Consultant Cardiologist, PAH described the development of the satellite clinic which aims to improve non-metropolitan patient access to advanced technologies in heart rhythm procedures. This strategy is designed to improve continuity of care and reduce unnecessary patient travel, as well as building supportive relationships with colleagues.

8. SQ Renal Clinical Network Dr Steve McTaggart Chair SQ Renal Clinical Network identified the activity of the SQ Renal Network under the five broad headings of:

• Standards and Governance • Planning • Workforce


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• Quality • Research.

The Network has been very active in all of these areas and is currently funding three (3) projects, and is collaborating with the Health Planning and Infrastructure Division (HPID) to use the lessons learnt from recently developed renal units to inform guidelines for future builds. Current projects include:

• Zero tolerance to MRSA in the Renal Ward – Gold Coast Hospital • Clexane trail; different methods for dialysis anticoagulation – Gold Coast

Hospital • Patient information DVD to assist with decision making about live donor

donation.

The Network recognises the importance of water quality for dialysis treatments and has previously funded and produced the Haemodialysis Water Sampling Handbook, which has been commissioned and reworked by the Statewide Renal Clinical Network.

Continuing with the water quality theme the Network is collaborating with Biomedical Technological Services (BTS) to explore options for a Statewide Water Quality Resource.

8.1. Enrolled Nurse Advanced Practice (ENAP) Resource Ms Gayle Frohloff, Network Coordinator, outlined the work done on the Enrolled Nurses Advanced Practice Resource (ENAP). Enrolled Nurses (EN) can offer valued service in renal units but need additional support and competencies. This Resource provides all the information Nurse Unit Managers require to facilitate the employment of ENs. This guide has been developed in consultation with the Office of the Chief Nursing Officer. Ms Frohloff also spoke about the successful submission for ‘Closing the Gap’ funds to undertake a feasibility study to develop a volunteer buddy service to support indigenous patients with chronic disease navigate the health care system and improve their patient journey.

8.2. Chronic Kidney Disease Resource Ms Anne Revell of Kidney Health Australia, who partnered in the development of the Chronic Kidney Disease Resource, explained how many consumers have difficulty knowing about and accessing appropriate resources where they live.

The purpose of this resource is to itemise health and social services in each District, including contact details. The booklet is useful for both consumers and health professional alike. Consumers can find services available in their locality and health professionals can ensure they are referring to the most appropriate and convenient service.

The Northern and Central Networks see the value in the resource and are considering something similar.

8.3. Home Dialysis DVD Rodney Brickle A/Nurse Unit Manager, Home Haemodialysis Unit PAH, described the importance of providing adequate information to assist patients to make choices about the various dialysis modalities. Currently only 12% of people dialyse at home as many express concerns about not being able to cope by themselves at home.

The Networks is seeking to support strategies that help patients to make informed decisions. To do this the Network commissioned a DVD and engaged a professional


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actor to portray an ‘average bloke’ who steps patients through the home dialysis option.

9. Southern Queensland Clinical Network Team Ms Joan Kennedy, Manager Southern Queensland Clinical Networks, provided a brief overview of the team that supports the networks and outlined three major goals for the team:

Improve project sustainability Improve project completion report writing by adopting the Standardised

Quality Improvement Reporting Excellence (SQUIRE) framework Successful journal publication.

10. Evaluation Sixty-nine (69) people attended the Showcase. The Network Support Team would like to thank all participants.

A short evaluation survey was returned by 53% of participants. The results indicate that most responders believe that networks are an effective method for achieving clinical improvement, that they liked hearing about the activity of other networks, that they took home information to share and that the three and a half hour time frame was sufficient. In addition most responders thought that having an official launch was an effective method of promoting network activity.

The results of the survey are provided below. Q1. The showcase demonstrated that networks are an effective method for achieving clinical improvement.

Strongly Agree Agree Neutral Disagree Strongly Disagree

76% 23%

Q2. I liked the opportunity to hear about the activity of different clinical networks


50% 42%

Q3. I have new information to share with my colleagues


26% 65% 3%

Q4. The launch of the Child Protection Medical Education Program was an effective method of promoting network activity


34% 57% 3%

Q5. The duration of the Program was too short


50% 31% 18%

Free text comments included: Fantastic idea to showcase, impressive buy in from executive Southern is a

very productive network. Well done. Thank you for the opportunity to attend. It is a credit to see the

multidisciplinary teams within the networks and clinical respect demonstrated as a team within the teams.


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Would have been good to hear about some less successful projects i.e. lessons learnt on project management.

An informative morning and a great networking opportunity. Of particular interest is the chance to hear the achievements of the other networks.

The whole format was excellent. Would it be easier not to have this in the city which is difficult to get to (traffic terrible) costly too park. Takes clinicians away from their own hospitals for longer than necessary with the extended travel.

Timeframe perfect. Great diversity in information. Great selection of presentations. Well done. Fabulous morning plus great coffee, food and venue.

Efficient and effective use of valuable time to promote collectively SQ clinical networks activity and achievements.

11. Conclusion The Southern Queensland Clinical Networks Showcase was a successful method of demonstrating the activities of all participating clinical networks, and an effective way of marketing and promoting new initiatives.


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APPENDIX A: Showcase Program

2


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A

PPENDIX B: Evaluation Survey

Documents

Southern Queensland Clinical Networks Showcase The ... · The Showcase was the vehicle for the official launch of the Southern Queensland Child Protection Medical Education Program