RNSH Nursing and Midwifery Newsletter - March

RNSH Nursing and Midwifery Newsletter - March

Volume 10, Issue 2

Royal North Shore Hospital Nursing and Midwifery NEWSLETTER

March 2021

Pages 4-5: Happy Easter!

Inside this issue:

Message from the DoNM

2

Service Improvement

3

RNSH N&M Workforce Updates 3

Happy Easter!

4-5

Infection Prevention and Control 6-7

Fire Training Update

7

NSLHD Libraries Update

8

Drug Burden Index Pilot Project 9

International Nurses and Midwives Week Update

10-11

EAP

12

CNC Bio— Vanya Ripley, CNC General Medicine and AAu Team Spotlight—NICU: Neonatal Intensive Care Unit

13

Page 9: Read about the upcoming Drug Burden Index Pilot Project

14-19

Carer Support Service Update

16

Nurses and Midwives Health

17

Page 2

Royal North Shore Hospital Nursing and Midwifery

Message from the DONM

Tracey Gray, Director of Nursing and Midwifery, RNSH

most staff now but if you haven’t heard from us and would like an appointment please call the RNSH CoVID Booking Team on 99264299. The bookings team led by Rhi Campton and Anna Linfield-Kent have been doing an amazing job fielding and making a huge volume of calls. They have remained calm, kind and professional throughout a number of challenging interactions for which I thank them enormously. Some very good news is that we are recruiting strongly at the moment and our nursing vacancies have fallen for the third month in a row. It has been a tough month with patient acuity high and sick leave up relating to post vaccination malaise. At least we can say that as our vacancies reduce and the vaccination program winds up you may all finally get a breather.

April is the month we turn our attention to all things falls prevention. “Safe activity for everyone” is the theme for 2021 following a year that saw many people decrease their physical activity due to the need to maintain a safe distance from others to protect themselves from CoVID-19. Remaining physically active is an important part of recovery from illness and something nurses can and should promote to ensure your patients have the best chance of achieving wellness. In so doing we are always mindful of ensuring patients can do so safely by completing a falls risk assessment no matter at what point they enter the health system and then provided with advice and support to mobilise safely. On April 1 it was great to see so many orange t-shirts being worn by our nurses to fly the flag of falls prevention . When my husband wears mine in the garden it always makes me smile. Most units have now received their Performance Boards to display clinical audit results in a standardised way. They look great and summarise the results of audits under each accreditation standard. In line with this the new audit schedule has been released and should also be on display in your clinical areas. Every month we will produce reports that summarise the results across the organization and as any areas for focus emerge you may be engaged in projects to improve our performance. The CoVID-19 vaccination program is now well underway with most staff who have been categorized in the 1a group having already been vaccinated. The number of appointments that Westmead will offer for 1a staff will reduce over the next 2 weeks so if you are yet to be vaccinated and you would like to be please call our booking centre promptly to ensure you secure an appointment. For staff in the 1b group the program will continue for some weeks yet . We think we have contact details for

Thank you all once again for the significant contribution you make to the health of our community. It is very much appreciated.

Page 3

Royal North Shore Hospital Nursing and Midwifery

Service Improvement Three exciting projects have now commenced at RNSH, focused on improving experience and outcomes, for patient and staff, across very different areas of the hospital. Each of these project are led by multidisciplinary project teams and will use redesign and accelerated implementation methodology. A key element of the approach for these three projects will be INVOLVEMENT- making the time to listen to, understand and involve staff in designing and implementing improvements that are meaningful and useful to them. Let me introduce you to….

for people with Parkinson’s Disease who are admitted via our Emergency Department or are inpatients on specific Division of Medicine wards over the next 12 months. Embedding My Virtual Care in high use specialties in RNSH Ambulatory Care Clinic (ACC), led by our NSLHD Telehealth Project Officer Bruno Villamea Santos and two allied health clinicians with experience working in clinic environments. This project, sponsored by ACC Ops Manager, Jessica Drysdale, in collaboration with the RNSH Division of Medicine, will work with clinical and admin teams from three specialties to refine our approach to using

3.

1.

The Holy Grail: Perioperative Care for the Frail project, led by Anaesthetists Andrew Marks & Chris Kay, Physiotherapist Judy Wong and RN from SSSU Alana Maky. This project, sponsored by Michelle Mulligan (Clinical Director Surgery & Anaesthesia RNSH), will improve how we prepare frail people for elective surgery over the next 12 months. Optimising the experience of being an inpatient with Parkinson’s Disease at RNSH, led by Parkinson’s Disease CNS Sue Williams and pharmacist Marissa Sakiris. This project, sponsored by Margie Webster (Nurse Manager, Division of Medicine), will improve how we care

Telehealth for outpatient appointments. COVID saw a rapid installation of Telehealth across most clinics with limited support. Now that we have room to breathe, we will focus on ensuring Telehealth processes and experience works optimally for our staff and patients over the next 6 months. For further information on any of the above projects or for assistance with any service improvement project, or

2.

idea, please get in touch with me via: [email protected]

RNSH Nursing and Midwifery Workforce Updates

New Appointments / Secondments

Successful CNS Applications

Jacqueline Hickey—A/NUM SSSU (part-time temporary). Courtney Abbott—NUM SSSU has returned to work part-time.



Rachel Clarke—Endoscopy Unit



Monica Xu—Ward 8F



Kirsty Brown – NUM Patient Flow / Bed Manager



Tegan McDonald—A/CNE (Th/F) Child & Adolescent Unit



Ashley James—CNC Cardiology



Julia Stuart – CNC2 Trauma



Jess Madden—CNS Trauma



Jane Jiang—A/CNC ARRT (March 2022)



Cristina Atayde—A/CNC ASU (June 2021)



Congratulations!

Emily MacNaught—CNC3 Neonatology



Page 4

Royal North Shore Hospital Nursing and Midwifery

Happy Easter!

Wishing everyone a safe and happy Easter!

Thank you to the good eggs at Lindt who kindly provided a large donation of chocolate Easter eggs for our staff to enjoy. As you can see by the photos below, the donation was well received!

Pictured left: NAMO and Transit Lounge staff

Pictured left: Nursing staff from 7B

Volume 10, Issue 2

Page 5

Happy Easter!

Easter eggs donated by Lindt

Pictured above left and below: Staff members from ICU

Page 6

Royal North Shore Hospital Nursing and Midwifery

Infection Prevention and Control

Reprocessing of reusable medical devices (Standard 3: Action 3.14)

The intent of this Standard 3 action is to minimise infection risks to patients and the workforce by having assurance that all reusable equipment, instruments and devices are appropriately reprocessed.

Terminology:

Reprocessing

Activity required to ensure the RMD is safe for its intended use

RMDs

Reusable medical devices

Single Use Items

Symbol found on all single use items Only be used once on one patient

Single Patient Use items

Can be used multiple times on ONLY one patient and then discarded when visibly soiled/ when patient is discharged

Cleaning

Removal of contamination for an item to be used again

Disinfection

Reduction of viable microorganisms to a level to be used again

Sterilisation

A validated process to render a product free from viable microorganisms

Critical Item

A medical item that comes into contact with the vascular system or sterile tissue (eg) Surgical instruments, diagnostic or interventional radiology catheters A medical device that comes into contact with mucous membranes or non-intact skin (eg) mouth shutters, vaginal ultrasound transducers A medical device that only comes into contact with intact skin and not mucous membranes (eg) BP cuffs, thermometers, bedpans Single use sterile or non-sterile material that covers the RMD. Even if the cover/sheath is used the RMD still require reprocessing.

Semi-Critical Item

Non-Critical Item

Covers and Sheaths

What equipment, instruments and devices require reprocessing? All medical equipment, devices and instruments re- quire reprocessing. Some are only single use OR single patient use. The level of reprocessing is depended on the equipment, devices or instrument being used. Most ward based RMD are non-critical and require a clean and disinfection before and after use (ie) with a 2 in 1 wipe – Steri7, Clinell. Devices and instruments that need to be sent to Sterilising Services (SS) should

be rinsed after use to ensure any contaminants are removed, or sent immediately following use to SS. This minimises the risk of drying of contaminants. Storage areas should store clean items (ie) IV poles, pumps, wheelchairs, bed slings, emesis bags, unused sharps bins, incontinence pads.

Page 7

Royal North Shore Hospital Nursing and Midwifery

Ultrasound Probes

All wards that have an ultrasound probes must ensure that the device is registered. If any of these devices have visible body fluids/ blood they must be sent to SSD with the manufacturer’s recommendations for appropriate reprocessing. A cover or sheath is recommended to re- duce the contamination risk. There is a QARS audit for the registration of all ultrasounds that needs to be re- viewed on an annual basis For any further information on Standard 3, 3.14 please speak to Sterilising Services or IPAC. Register your ultrasound probes with SS, to ensure there is a record if the probes requires reprocessing by SS.

with non-sterile items. Sterile items that have been opened and not used must be discarded. Dirty utility rooms should only store bedpans & urinals, wash bowls, urine testing, linen skips, pan covers, rub- bish bags and PPE – for use in the dirty utility only. Stor- age areas should store clean items (ie) IV poles, pumps, wheelchairs, bed slings, emesis bags, unused sharps bins, incontinence pads.

For any further information on Standard 3, 3.14 please speak to Sterilising Services or IPAC.

Storage of Stock

Sterile stock must be stored out of direct sunlight, in dedicated sterile storage areas that are clean daily and are free from dust, insects and vermin, and not mixed

Fire Training

Practical Fire Training has now recommenced

Sessions



Fire Training are being conducted four days a week and four sessions are provided:

Days

Session Times

Mondays, Tuesdays, Thursdays and

8:30am, 11:00am, 11:45am, 2:30pm.

Location



Practical Training will be conducted on the Kolling Building Forecourt.

Wet weather days: practical fire training will be held under the Kolling Building Awning which is located on Westbourne Street.

To Register



Fire Safety and Evacuation - Practical Classrooms My Health Learning

Attendance



There are a significant number of people to train so please ensure you attend the training that you register for. Ensure you have your attendance recorded while at the training.

Page 8

Royal North Shore Hospital Nursing and Midwifery

NSLHD Libraries Update

NSLHD Library Bumper Book sale The much awaited book sale is on! Douglas Piper Library 17 th -21 st May 2021. COVID-19 safety rules will apply.

Are you updating a clinical guideline, procedure or Quality improvement project?

 NSLHD Libraries have updated the Clinical Guidelines, policies and procedures Library guide: https://nslhd.libguides.com/clinicalguidelines

Volume 10, Issue 2

Page 9

Drug Burden Index Pilot Project:

Go Live: 24th March 2021

Royal North Shore Hospital’s (RNSH) Aged Care and General Medicine service has been selected to pilot a new enhancement of the NSW Health eMR which supports reduction of polypharmacy in older patients, called Drug Burden Index (DBI). The eMR DBI is a clinical risk assessment tool to measure the functional burden of an older person’s medications developed by Professor Sarah Hilmer’s research team. It is a pharmacological measure of a person’s total exposure to medications with anticholinergic and sedative effects. Cumulative effects of these medicines contribute to falls, frailty and cognitive impairment in older people. Old age and polypharmacy are major risk factors for adverse drug events and can lead to poorer health outcomes for older inpatients. Reducing inappropriate polypharmacy for older inpatients should reduce adverse events, including falls and cognitive impairment, and improve the quality of life in older people. Clinicians can weigh up the risk of this exposure against any potential benefit for the patient Drug Burden Index (DBI) is a new functionality in the Cerner Electronic Medical Record (eMR) which supports clinicians (e.g. doctors, pharmacists, nurses) in considering DBI when performing medication reviews for older inpatients in hospital.

The DBI project will pilot and evaluate the new DBI solution to ensure it further supports clinicians in providing safe and high-quality patient care and enable availability for wider use across NSW.

The pilot will run for 90 days only within the Aged Care & General Medicine Inpatient Services ONLY.

At the time of go-live, all other clinicians across Northern Sydney may be able to see aspects of the new features in the eMR, however, will not be using it as part of this pilot. Training has been targeted to the key stakeholders in two clinical areas Aged Care and General Medicine within RNSH utilising existing departmental/ educational sessions to the following groups:

RNS CNEs RNS JMOs

   

General Medicine Departmental Meeting

Aged Care Departmental Meeting

For more information contact:

Zoe Howard, Change Manager, eMeds Enhancements: [email protected] or visit our Intranet Site Here

Page 10

Royal North Shore Hospital Nursing and Midwifery

To begin the celebrations, nominations for the RNSH International Nurses and Midwives Week Recognition Awards are now open! Each year, RNSH employees are invited to recognise and nominate exceptional Nursing and Midwifery Staff in the four categories below. Please click on the below links to nominate: Nominate a Nurse of the Year

Nominate a Midwife of the Year

Nominate a Nursing or Midwifery New Graduate of the Year

Nominate a Nursing or Midwifery Team of the Year

Nominations will close Friday, 23 rd April 2021

Page 11

Royal North Shore Hospital Nursing and Midwifery

Page 12

Royal North Shore Hospital Nursing and Midwifery

WELLNESS AND STRESS

Can wellbeing and stress be balanced or coexist? When we focus on our ability to manage stress in a positive and empowered way, it can be a real boost as it helps release endorphins and we gain a mood boost. However where stress is experienced as negative, acute or unrelenting, it can have a profound impact including sleep disturbance, weight gain, anxiety and fatigue. Feeling you have lost control and of not fully enjoy life are also consequences. To improve your stress resilience firstly take the time to STOP - stop, tune in, observe and then develop a plan of action. Prioritise well by assessing your demands and planning how to use your time and resources. Before you agree to taking something new on also consider if this is the best use of your time. Tasks that are both urgent and important should be addressed first. Keep an eye on these as a day filled with only urgent and important tasks can be a crisis day and you may be left feeling depleted. Next devote your time and resources to what is important but not urgent . Plan and be strategic so that you feel in charge of your role and get to what will add value to your day. Urgent but not important is a harder area to deal with but needs attention. Examples of item that fall into this group are calls, meetings, some emails etc. Consider saying no, being unavailable if there are important tasks to get to. Perhaps someone else would like the opportunity to extend their skills by attending to something for you so that your time is freed up. Any Items on your list that are not urgent and not important should be delegated or dropped. Don’t multi-task. Multi-tasking involves moving your attention from one thing to another without being very effective or productive. It is also distracting, stressful and anxiety provoking with the unfortunate impact of reducing our happiness level as well. Prioritise and delegate so that you can devote your attention fully and feel calm and in control. Boost your self-care with a healthy sleep patter, regular nutritious diet, exercise and most important strong connection with the people who are important in your life – family, partner, friends and colleagues. Mindfulness helps train our brains to be in the present and observe what is happening so that we can influence our lives in a goal directed way. A helpful exercise to train your attention is using the GLAD approach. Each day identify one thing to be grateful for, one thing you have learnt, one thing you have achieved and one thing that delighted you. This approach keep you on the lookout for the GLAD foursome and trains you to be more positive and optimistic as well. Strengthening your strengths and adding useful approaches to your daily living will help you manage your stressors more effectively and help build your wellbeing one step at a time.

Volume 10, Issue 2

Page 13

Clinical Nurse/Midwife Consultant Biography

Name: Vanya Ripley Role Title: Clinical Nurse Consultant Grade 2 (CNC2) Specialty: Genera Medicine Location: AAU, Level , ASB, RNSH Contact Numbers: Ext. No.: 32269. Pager No.: 45809 Email Address: [email protected]

Past Experience: ~25 years at Royal North Shore Hospital

Main Interests:

Multi System Complex Disease General Medicine Patients Complex and Long Stay Discharge Planning Management of the General Medicine Patient. The Acute Assessment Unit Model of Care which aims to improve the coordination and quality of care , to increase the efficiency in inpatient management and improve patient flow across the hospital for our adult medical patients. The utilisation of the Patient Flow Portal to minimise delays in patients’ hospital care.



2015- present – General Medicine CNC, RNSH 2010-2015- Acting Medical Assessment Unit CNC, RNSH 2008- 2010- APAC Hospital Liaison Nurse (RN) and Acting APAC Clinical Coordinator (A/NUM Level 1) 1998- 2008- Emergency Department RN, RNSH 1997-1998- Casual Pool RN, RNSH C3 intern covers AAU on nights 1996-1997- Agency RN working in London, UK



















1995-1996 – Neurosurgical ICU RN, RNSH



Available for mentoring staff across the hospital:

1994-1995- New Graduate RN, St George Hospital.



 Yes List below the CNC/CMC’s you have connected with both within RNSH and externally on various projects:

Post Graduate Studies:

Completed Postgraduate Certificate in Emergency Nursing, NSW College of Nursing, 2001. Completed Masters in Quality Services (Health and Safety), UTAS, 2019.



Suzy Russell CL Psych CNC – Implementation of The Wellness TV Channel. Russell S, Ripley V, Elliott R, et al Patient and nurse perceptions of an innovative TV wellness channel in an acute medical ward: a feasibility study BMJ Innovations 2021;7:87-94.





Volume 10, Issue 2

Page 14

NICU - Neonatal Intensive Care Unit

Team Spotlight of the Month

Vision/mission statement

Nurturing the future Inclusive of all Compassionate Care United in excellence

Our mission statement comes from the acronym N. I. C. U. This is supported by our NICU team goals:

Strive for clinical excellence



Inspire and foster a passion for learning



Empower families and peers



Promote collaborative team work



Zero tolerance of bullying



Around the NICU you will see images of butterflies, as this best portrays the journey of our babies. A small or fragile baby is born (represented by the caterpillar). We protect the baby as it develops in our humidicribs and cots (represented by the cocoon). A precious and much-loved baby finally goes home (represented by the butterfly).

Volume 10, Issue 2

Page 15

LDU wall decal

NICU wall decal

What are some things that your unit does differently to other wards/units?

Our mostly commonly used enteral feeding tube size is 5Fg inserted only 13cm deep. We insert 1Fr (28G) central lines, and use endotracheal tubes as small as 2.0mm diameter secured at just 5.5cm at the lips. Our babies wear the world’s smallest nappies and blood pressure cuffs. In the NICU parents aren ’ t visitors, they are part of the family unit we care for. A current NICU mum says “you have great space here and modern equipment and great parent facilities”. Our Parent Lounge offers a place to relax, unwind and have some food, away from the clinical environment.

Do you celebrate any health promotion days?

World Prematurity Day is November 17 th



 ‘Miracle Babies’ provide us with a Thankyou NICU Nurses day annually

Annual “World Breastfeeding Week” August 1-6



Volume 10, Issue 2

Page 16

NICU - Neonatal Intensive Care Unit

Team Spotlight of the Month

Has your ward completed any fundraising or have you received donations that have been used towards helping improve your area?

The “Humpty Dumpty Foundation” supports us very well and is the reason we have such modern equipment. We have a great partnership and we thank them for their continued support. “Food from the Heart” provides breakfast and snacks for our parents. They also provide hot meals donated by local restaurants so that parents do not have to leave their babies to seek out food.

Festive raffles to raise money for the NICU:

“Life’s Little Treasures” donated many books to fill our NICU Parent Library after we won the 2020 “Read-a-thon” for most hours read by parents to their babies. Parents spend long days in the NICU and reading to their baby supports bonding and the babies’ neurodevelopment.

How many staff do you have that are completing further studies?

 Many of our nurses have completed neonatal intensive care specific post-grad studies from Graduate Certificate to Masters Level. We currently have 5 nurses undertaking post graduate Certificates or Diplomas in Advanced Nursing with neonatal specialty, both through ACNN & UTAS. We also have 1 nurse undertaking a Master’s degree in Advanced Nursing through UTS, with a neonatal speciality.

Volume 10, Issue 2

Page 17

Has your ward or any staff members received any recent awards?

We are very proud that 2 of our most recent CPI projects have gone on to win several reputable awards. Firstly, “Walking the Milky Way” won the NSLHD Quality and Improvement awards in the Quality and Safety category, then went on to win the NSW Health Quality and Improvement award in the Patient Safety First category.

Secondly, “Keeping Sweethearts Together” won the NSLHD Quality and Improvement awards in the Health Research and Clinical Practice category, then went on to be nominated for a NSW Health award and NSLHD ACHS Quality and Improvement award.

Both of these projects have also been presented at the ANZNN conferences.

NSW Health QI awards night – winners in the category “Patient Safety First”

What projects are your team currently working on?

In 2020 we completed 4 amazing CPI projects involving intubation, skin care, nursing education and lighting in the NICU. We have several new CPI projects in the works for 2021 – these are displayed on our CPI Board “In the pursuit of excellence” with new ideas reviewed when our CPI Club meets monthly.

Volume 10, Issue 2

Page 18

NICU - Neonatal Intensive Care Unit

Team Spotlight of the Month

Does your ward/unit have any specialty area educational courses?

We have individualised orientation programs to ensure that each new staff member has education targeted to their level of neonatal experience.

We also run an annual Neonatal Nursing Series, which is a more in depth program for nurses within NSLHD with a little more NICU experience to come and further develop their knowledge of neonatal intensive care and explore how it has progressed over the years with new technologies and advancements. We hold Advanced Resuscitation of the Newborn education and simulation days 4 times a year for medical, nursing and midwifery clinicians within NSLHD, to ensure that all staff attending deliveries of newborns or working in areas caring for newborns are confident in these skills.

All of our nurses progress (climb!) through our “Clinical Skills Tree” with support of the Education Team.

What does your team do for team building?

We continuously work collaboratively with our multidisciplinary team given the fast pace and high acuity of an intensive care unit. We have a “good news board” for anyone to write any thank you messages, particularly after very busy periods in the NICU. We write up any professional achievements, celebrations, engagements, weddings, births etc. so everyone gets a sense of what we are all achieving in both our professional and personal lives!

Volume 10, Issue 2

Page 19

Getting to know the team:

Who in your team would be most likely to… ...Win an Olympic gold medal? In what event?

 Van, our Biomedical Engineer, would win the Decathlon! He is Mr Fix It with so many skills and always willing to try and help no matter what we ask him to trouble shoot!

...Become famous? What for?  An ARIA award would be given to Yukie and Sarah C for their musical talents in saxophone and flute, who also happen to be in a band together!  We also have many dedicated arts and craft nurses who could easily win a prize in this year’s Royal Easter Show, with their beautiful individually hand crafted name cards for all of our babies cots.

….Save the planet? - Fiona G is our Recycling Champion and loves to organise (and minimise) our waste! Who is the team’s:

 Head chef? - Stephen, he bakes the world’s best blueberry cheesecake. Everyone should employ a pastry chef in their ward! Master Chef goes to Kath D for her amazing scones and organising ongoing tea room supplies. Animal whisperer? - Alexis, who’s garage is often a NICU for native bird rehabilitation. Who could we not be without? - OUR SSOs, Cleaners and Ward Clerks!! 

A parent ’ s perspective of the NICU team: “You are baby whisperers. Our baby Tom born 15 weeks early did not come with an instruction manual. We were not expecting everyone to be so nice. We thought you would be tired of babies. There’s a holistic approach, a human approach. The nursing and medical team, physio, social worker, you just have good quality people here. We would not want to be anywhere else. The continuity of nurses means they know our baby so well. And Shyny (RN), she has a magic touch, Tom responds to her so well.” A new NICU staff member ’ s perspective: “Being a new staff member anywhere brings a whole array of challenges but doing it following an international move has had me confronted with some additional tests! Fortunately staff have been welcoming while the education and leadership team have been accommodating of the extra requirements I have had both professionally and personally. When you spend so much time at work, you need colleagues who provide the smiling face and offer a lending hand when you need one and I have found this evident within RNSH NICU. I'm looking forward to continuing to grow as a NICU nurse and learn from my nursing and medical colleagues as well as the babies and parents I care for.”

Volume 10, Issue 2

Page 20

NSLHD Carer Support Service Update

Volume 10, Issue 2

Page 21

RNSH Nursing and Midwifery Executive Team

Tracey Gray Director of Nursing and Midwifery Ph: 9463 1901 (EA: Hayley Johnson)

Fiona Carmichael Deputy Director of Nursing and Midwifery Ph: 9463 1901 (EA: Hayley Johnson)

Margie Webster Divisional Nurse Manager Division of Medicine Ph: 9463 1906 (EA: Rhi Campton)

Sophie Lange Divisional Nurse Manager Division of Surgery and Anaesthetics Ph: 9463 1905 (EA: Michelle Harding)

Laura Dangerfield Divisional Nurse Manager Division of Women’s, Children’s and

Family Health Ph: 9463 9692 (EA: Insu Lobo)

Rowena Broadbent Nurse Manager Cancer and Palliative Care Ph: 9463 1200 (EA: Sarah Hockey)

Deb Mayall Nurse Manager Patient Flow Ph: 9463 2260 (CSO: Jennifer Waters)

Larissa Monney Nurse Manager Workforce Ph: 9463 1583