DEC 2020 - Foresight Newsletter

DEC 2020 - Foresight Newsletter

DECEMBER 2 0 2 0

I SSUE 4

Clinical Governance Standard

Changes to Incident Management Safety and Quality Account eMR Advance Care Planning (ACP) pilot evaluation Shared decision making Project spotlight - Patient led handover ims+ review...8 months on What did you think of this issue? Give us your feedback IN THIS ISSUE :

The Safety and Quality Account is produced annually and showcases the district’s activities, achievements and priorities in relation to patient safety and clinical quality during the preceding year; and identifies priorities to improve safety and quality for the forthcoming year. The account also provides a report against key safety and quality performance indicators and aligns with requirements for accreditation purposes under elements of the National Safety and Quality Healthcare Standards (NSQHS) 1 and 2. Within NSLHD there is no higher priority than the on-going assurance and improvement of patient safety and the quality of care we deliver. In relation to performance measurements for 2019-20, it is not clear what, if any, effect the pandemic has had on the activities and subsequent performance results within NSLHD and these factors should be kept in mind when reviewing performance results. It is important we acknowledge the outstanding contribution made by our consumer representatives across NSLHD that facilitates this process. SAFETY AND QUALITY ACCOUNT

Clinical Governance Standard

CHANGES TO INCIDENT MANAGEMENT All serious harm incidents that occur within our health service warrants a mandatory investigation or review. The revised NSW Health Incident Management Policy (PD2020 047) improves the way we manage serious incidents.

Changes from 14 December 2020

The change reinforces our commitment to immediacy, accountability and kindness in response to incidents in healthcare. From December 14, management of serious (Harm Score 1) incidents will change to enable more timely investigations completed and greater involvement of the patient or consumer’s family in the process.

The NSLHD Board and Executive are very proud of the dedication and resilience demonstrated by all staff who have worked hard to ensure the very best care is delivered safely for our patients and community.

How can I find out more?

Speak to a Quality Manager in your local clinical governance or safety & quality unit. Fact sheets, updated templates and other resources can be found in the new look patient safety and incident management intranet site. Read more on the changes to incident management aligned with legislation across NSW by visiting the Clinical Excellence Commission website. Contact: [email protected] (A/Patient Safety Improvement Facilitator) or Virginia Armour @health.nsw.gov.au (Patient Safety Manager)

Read the full NSLHD Safety and Quality Account 2020

Contact [email protected] (Clinical Reliability Improvement Faciltator) for more information

I SSUE 4

DECEMBER 2 0 2 0

Comprehensive Care Standard

PILOT EVALUATION REPORT THE EMR ADVANCE CARE PLANNING (ACP) SOLUTION

The ACP solution is a major update to the functionality of the electronic medical record (eMR) used across NSW Health, designed to support clinicians through documentation of a patient’s advance care needs, and facilitate discussions with the patient, families, and/or their carers.

Recommendations Throughout the pilot the project team were provided with feedback on concerns and recommendations from clinicians regarding all aspects of the ACP platform. The final recommendations with associated actions were categorised under five (5) areas:

The ACP solution is comprised of three components;

the electronic resuscitation plan, the AMBER care bundle and the advance care planning documentation.

1. 2. 3. 4.

Resuscitation Plan AMBER Care Bundle Advance care Documentation Reporting (Discern Analytics extract reporting) Resuscitation Plan Policy Directive

The ACP solution was piloted in Northern Sydney and Central Coast LHDs over eight weeks (July 14 2020 to September 7 2020). With the conclusion of the pilot, the ACP platform tools now form part of the ‘business as usual’ approach to ACP in the eMR. Findings There were three domains identified in the ACP pilot evaluation. The key findings in each of those domains include: 1. Improved clinical safety and quality Increased appropriateness and compliance of electronic resuscitation plans Increase in compliance with good documentation practices Increased appropriate use and compliance of the AMBER care bundle Improved clinician experience Increased satisfaction with handover procedures 2. Improved patient and provider experience 3. Increased efficiencies for sustainable health services

5.

Some recommendations have were addressed during the Pilot phase, others were considered out of scope and have been referred to the product owner (eHealth) for further development.

Read the full ACP Pilot Evaluation Report

Further information is available on the eMR Advance Care Planning Support page

Reduced expenditure on clinical paper forms

DECEMBER 2 0 2 0

I SSUE 4

Partnering with Consumers Standard

Shared decision making features throughout the National Safety and Quality Health Service Standards usually under Action items X.3c. Shared decision making involves discussion and collaboration between a patient or consumer and their healthcare provider. It is about bringing together the patient or consumer's values, goals and preferences with the best available evidence about benefits, risks and uncertainties of treatment, in order to reach the most appropriate healthcare decisions for that person [i]. Shared decision making is a process which can result in optimal patient care. For more information on the benefits of shared decision making for both the patient/consumer and the healthcare professional, please take some time to watch these three excellent, short videos produced by the Australian Commission Safety and Quality in Health Care and Bond University. SHARED DECISION MAKING

Project Spotlight

PATIENT LED HANDOVER Mona Vale Hospital, Rehabilitation

The patient-led handover initiative aims to enhance engagement with patients by partnering with them to personalise and lead the nursing handover process. The staff at Mona Vale Hospital (MVH) Rehabilitation units recognised handover had become focused on computers and completing paperwork. Primarily viewed as a nursing activity, 45 per cent of rehabilitation patients surveyed felt they were not listened to and 85 per cent felt excluded from the handover process. The team collaborated with staff in the design of the new patient-centred handover process. Patients are invited to participate in the handover process and provided with prompt sheets to help guide them lead the handover of their care. The prompts included the reason for admission, how they are feeling, what they need help with and what cares/therapy they received that day. Staff feedback indicated that the initiative created openness with patients and allowed the nurses to identify knowledge or information gaps in their patients, and provide patients with the correct information relating to their journey. This project created a culture shift where patients drove the handover process and in turn transformed the patient experience from nursing focused to patient focused, with 100 per cent of patients surveyed saying they now felt heard

An overview on shared decision making 1. (You tube 1min 48sec)

2.Challenging myths about shared decision making in practice (You tube 1min 52sec)

Suggestion View these videos in a team meeting and discuss how your team is practising shared decision making.

3. How to use patient decision aids and where to find them (You tube 3min 34sec)

Winner in this year’s NSLHD Quality and

Improvement Awards for Patients as Partners and finalist at the NSW Health Awards for Transforming Patient Experience

Check out this video showcasing their project

Additional videos from the Commission's Shared Decision Making Symposium: Developing tools and skills for clinical practice , is available on: https://www.safetyandquality.gov.au/our-work/shared- decision-making/shared-decision-making-symposium [i] Australian Commission Safety and Quality in Health Care: Shared Decision Making. Available at https://www.safetyandquality.gov.au/our- work/partnering-consumers/shared-decision-making. [accessed 26 November 2020].

How do I start an improvement project? Find out more on the Clinical Governance Quality Improvement Intranet site, Innovation Hub or contact your local quality advisor.

DECEMBER 2 0 2 0

I SSUE 4

Clinical Governance Standard

Notification of clinical incidents is down by 26 per cent However the numbers are trending upwards. Notification of Harm Score 1 and 2 incidents have remained stable which means we are continuing to manage the most serious incidents well. There are now over 11,000 incidents notified in ims+. Approximately 70 per cent of staff have completed the ‘How to notify an incident’ module. The principal incident types most frequently notified are Concerning Behaviour (2082), Skin Integrity (2100) and Falls (1383). There have been 27 Harm Score 1, 164 Harm Score 2, 2578 Harm Score 3 and 6182 Harm Score 4 incident notified. The remaining incidents have not been nominated a Harm Score. ims+ is constantly evolving to respond to the needs of local health districts and NSW health staff as we enhance how we manage all incidents and ultimately improve patient safety. Contact: [email protected] (Patient Safety Manager, NSLHD) ims+ resources and training information can be accessed via the NSLHD ims+ intranet page

8 MONTHS ON..... A QUICK LOOK AT HOW WE ARE GOING The new incident management system (ims+) went live across NSLHD on 16 March 2020. This was two days before NSW went into COVID-19 lockdown. We are now eight months on. The journey from pre- implementation to implementation to business as usual has been challenging but also exciting. This is a snapshot of how we are going.

POLICIES, PROCEDURES AND GUIDELINES New , u p d a t e d a n d r e c e n t l y p u b l i s h e d d i s t r i c t w i d e PPGs PR2009_075 - Blood - Emergency Release of Blood Products - NSLHD PR2013 075 - Graduated Compression Therapy Procedure GE2020 020 - Treatment of hyperkalaemia in adult patients - NSLHD

Clinical Governance Standard

PR2020_015 - Diabetes Mellitus: Capillary Blood Ketone Monitoring in Adults- NSLHD PO2020_005 - Inter-Hospital Transfer (IHT) Governance for Adult patients -NSLHD PR2016_006 - Carers: Procedure for recognising and supporting families and carers of people in NSLHD GE2007_005 - Wound Culture Guidelines - NSLHD PR2009_299 - External Service Providers, Engagement / Management / Evaluation – NSLHD PR2015_033 - Safe Handling and Storage of Breast Milk in Paediatric Wards – NSLHD PR2015_001 - Management of Children with Minor Burns up to 16 Years of Age- NSLHD Check out the NSLHD Policies Procedures Intranet site for more information.

SAFETY ALERTS New , u p d a t e d a n d r e c e n t l y p u b l i s h e d

Clinical Governance Standard

Medication Safety Standard

Safety Alert RED - Requires immediate attention and action Safety Notice AMBER - Requires risk assessment at the district level Safety Information GREEN - Ensuring that lessons learned from state-wide, national or international sources are shared actively across NSW health system SN:009/20 - Acetylfentanyl and fentanyl in non-opioid illicit drugs - Issued 16 Oct 2020 SN:011/20 - Heroin and cocaine containing fentanyl and acetylfentanyl - Issued 26 Nov 2020

For more information, contact: [email protected]