A picture of heAlthQuality accounts 2014/15

P a t i e n t e x p e r i e n c e29

Mikaela Shannon, Charge Nurse Manager, Short Stay Unit (SSU)

Contents

contAct us: email: feedback@ccdhb.org.nz phone: 04 385 5999 Wellington hospital, riddiford st, newtown, Wellington 6021.

folloW us:

www.twitter.com/CCDHB www.facebook.com/CCDHB

A picture of healthIntroduction 2Health targets 3Primary & secondary clinical Governance Group 4Quality and safety Markers 5

Patient experienceNursingpracticepartnership 6consumer experience 7Communicationskillsdevelopment 8

Community safety initiativescommunity based care without the wait 9Pathways to good health 10the shared care Record 11Disability services 12advance care Planning 13Immunisation 14ChildHealthServiceOutpatientLiteracyReview 15

Patient safety initiativesTheOPENcampaign 16Preventingpatientfalls 17Reducinginfections 18improving surgical safety 19Improvingmedicationsafety 20adverse Event reviews 20a caREFul approach in Emergency Department 21staRt 22Early Warning score improvement Project 23

Looking forward looking forward 24CCDHBPriorities 25

Cover image: Creekfest ‘14

A p i c t u r e o f h e a l t h2

Welcometothesecondeditionofour Quality accounts, an annual publicationaimedatprovidingourconsumers with a snapshot of how capital & coast District Health Board (CCDHB)hasbeensupportingtheirhealth needs during 2013/2014.

During the past six years we have witnessed a growing change in directionawayfromhospitalcaretoa greater focus on community care. We believe hospitals should be used as a last resort, a place where people gowhenallotheroptionshavebeenexplored. in order to deliver our services and to help people stay well, werelyonourGeneralPracticeandother agency partners in order to provide more care where it is needed – in the home and in the community.

CCDHButilisestheHealth,Quality& safety commission’s new Zealand triple aim for quality improvement:

From this we have created our vision (inpartnershipwithHuttValleyandWairarapa DHBs as part of our sub-region) of providing: ▪ Quality hospital care and complex

care for those who need it. ▪ Preventivehealthandempowered

self care ▪ Provision of relevant services close

to home

Ourgoalistoprovidebetterhealthand independence for people, familiesandcommunities,withaparticularfocusonreducingdisparityand the incidence and impact of chronicdisease.Wecontinuetostrive to improve against these in timesoffinancialchallenges,growingcomplexity and an increasing and ageingpopulation.

We trust that you enjoy reading our Quality accounts and gain some insight into the commitment of our staffthatprovidesthoseservicestocontinuallyimproveourconsumer’shealthcare experience and achieve our vision.

Pat ient

Po

pula�on

System

● Shorter and safer pa�ent journeys● More certainty of treatment● One point of contact and entry to access services● Preventa�ve health, empowered self-care

● Improved equity of access● Address service vulnerability● Clinical needs based access● Consistant care for the sub-region● Provision of relevant services close to home● Quality hospital care, including high complex care for those who need it

● Planned approach to acute care● Best use of collec�ve resources● Uninterrupted elec�ve services● Sustainable sub-regional services ● Improved workforce flexibility● Consistent systems, process, prac�ces

Introduction

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 3

HealthTargetsarenationalperformancemeasuressetbytheMinistryofHealthto track how well your district health board (DHB) is providing services. DHBs are ranked on their performance quarterly to show how they are performing against the targets.

heAlth tArget target

2012/13 performance

2013/14 perforMAnce AchieVeMent

Increased immunisation

90% 92% 93%achievedthe percentage of eight month olds fully

vaccinatedBetter help for smokers to quit

95% 95% 92% not achieved

the percentage of hospitalised smokers receiving advice and help to quit

Better help for smokers to quit

90% 66% 72% not achieved

ThepercentageofenrolledpatientswhosmokeandareseeninGeneralPracticewhoareofferedbriefadviceandsupporttoquitsmoking

More heart and diabetes checks

90% 76% 85% not achieved

ThepercentageoftheeligiblepopulationassessedforCVDriskinthelastfiveyears

shorter stays in the Emergency Department

95% 87% 92% not achieved

Thepercentageofpatientsadmitted,discharged or transferred from ED within six hours

improved access to elective surgery 8,630 8,360 8,734

achievedThenumberofsurgicalelectivedischargesshorter waits for cancer treatment

100% 100% 100%achieved

Thepercentageofpatients,readyfortreatment, who wait less than four weeks for radiotherapy or chemotherapy

Health Targets

A p i c t u r e o f h e a l t h4

Primary & Secondary Clinical Governance Groupthe group meets regularly to share informationandopportunitiesfocussed on quality improvement andpatientsafety,whichcanbeusedtoimprovepatientexperienceand

“ Having passed out in a cafe in cuba street i was taken to the Emergency Department at Wellington Hospital and admittedtoMAPU.Ihaveneverbeenadmittedtohospitalinmylifebeforeandwas overwhelmed by the kind, professional supportIreceivedfromallofthestaffwhoattendedtome.Whatanamazingplace.”Emergency Department

“ the physio i have seen has been excellentwithtreatmenttomyleftshoulder.Shehasalsonoticedmyothershoulderwasbad and has been helping me with that. she has been so kind to me having two bad shouldersandhashelpedmealot.KapitiHealthCentreisgoodforKapiti.”Kapiti Health Centre

health outcomes. its membership is drawn from the local primary (general practitioners)andsecondary(hospitalclinicians) health sectors to ensure careisconsistentasthepatienttravelsbetween hospital or the community.

“ My son was delivered into your care from Masterton Hospital. He arrived on lifesupportandwasinisolation.Fromthe moment you all began your care of him,ourwhānauexperiencedthemostamazing,dedicatedteamworkimaginable.you all need to be told how incredible you are. your skill, your empathy and most of all your genuine kindness and love shone through. We thought he was going to die, and i believe that may have been your belief also. But despite the odds, you pulled him through.

Please believe that you are all, without exception,extra-ordinarypeople.Ablessingto all who come into your lives.”Intensive Care Unit

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 5

Quality and Safety Markers

the Health Quality and safety commission quality and safety markers (QsMs) assistDHB’sinmonitoringthesuccessoftheireffortinfocusedimprovementdriventhroughthe“OpenforBetterCare”campaign.

HQSC - QualIty anD SafEty MarkErS goal

Jul to sep

2013 (Q1)

oct to Dec

2013 (Q2)

Jan to Mar 2014 (Q3)

Apr to Jun 2014 (Q4)

nZ average

(Q4)

CCDHB comparison

with nZ Average (Q4)

fAlls: Percentageofpatientsaged75andover(MāoriandPacificIslanders55and over) that are given a falls risk assessment.

90% 74% 77% 85% 78% 89%Below

fAlls: Percentageofpatientsassessed as being at risk have an individualised care plan which addresses their falls risk.

100% 71% 97% 80% 92% na na

perioperAtiVe hArM: Percentageofoperationswhere all three parts of the surgical checklist were used.

90% 98% 98% 98% 99% 95%above

ClaB: icu central line insertionscompliantwithgoodpractice

90% 100% 100% 100% 100% 95%above

HanD HyGIEnE: Percentage of opportunitiesforhand hygiene

70% 75% 71% 75% 75% 73%above

surgicAl site infections: Antibioticgiven(0-60minutes before “knife toskin”(baselinedateJanuary to March 2014)

100% na 93% 96% 93% 92%above

P a t i e n t e x p e r i e n c e6

Nursing Practice PartnershipPeople with diabetes are receiving better, sooner, and more convenient care thanks to a Nursing Practice Partnership (NPP) between primary health organisations and CCDHB.

Thisnewmodelpairstheexpertiseofhospital-based diabetes nurse specialists withGeneralPracticenurses,enablingthemtomanagepatients’carecloserto home. Karori Medical centre has been trialling the model since May 2012.Ofthe55patientswhotookpartinthepilot,nearly80%havedroppedtheir HBa1c glucose levels to a more manageable level.

Having a lower HBa1c level means diabeticpatientsareatlessriskofmicrovascularcomplicationssuchasimpairedvision, kidney problems, ulcers, and lowerlimbamputations.

“it’s about using the nursing workforce inadifferentway.We’renottalkingprimary or secondary diabetes care, just diabetes care. We believe that’s the future,”saysGPDrJeffLowe.

KaroriMedicalCentrepracticenurseJacqui levine said the opportunity to work with ccDHB diabetes nurse specialist lorna Bingham has increased herconfidenceinworkingwithpatientswith diabetes. “lorna has given us a lot ofskillsandknowledge”.

Managingpatientsinthecommunityprovidescontinuityofcareforpatientsandstaffalike,sayspracticenurseHeather Wilson. “it means knowing

thepatient,knowingwherethey’reat and working with them to get their diabetes under control. it’s having the opportunity to ring them up if they haven’t had their blood test done, so we arekeepingintouch.”

PatientChrisWard,whowasabletostartinsulinmedicationinthecommunity rather than the hospital during the pilot, said the partnership is“brilliant”andknowingthathecancontacthisnurseatanytimemeansthathefeelsmoreconfidentmanaginghisdiabetes.

“StartingInsulinwassomethingIwasconcerned about but i learnt how to doitall.NowIcandelivertheinjectionmyself and it’s just a quick phone call to Heather if i have a problem. i feel more incontrolnow,”saysChris.

More than 243,000 Kiwis have been diagnosed with some form of diabetes, and 22,593 of those live within the greater Wellington region of capital &Coast,HuttValleyandWairarapadistricts. ccDHB is currently rolling out this model of care to a further 15 generalpracticestoprovidebettersupport for people with diabetes.

Patient Chris Ward explains the NPP Model to Minister of Health Tony Ryall

c c D H B Q u a l i t y a c c o u n t s 2 0 1 4 7

Consumer ExperienceThis year we took a major step forward in the way we collect feedback from our consumers about their experience by emailing the patient satisfaction survey to those who provided us with an email address.

Sofar12,000patientshavebeensentthe survey, with approximately 25% returnedeachweek.Theinformationis used to help us improve our inpatientexperienceandthequalityofcarewegive.Patientsarealsogiventheopportunitytospeaktoapatientexperience facilitator, if they wish to provide further feedback.

Wecontinuetoreceivevaluableinformationfromourownfeedbacksystem. all compliments received by the Quality and Risk unit are sent to theareasconcerned,whileaselectionarealsopublishedinournewsletterChangingTimes.Thismeansallstaffcan read some of the compliments we receive.

“ i received excellent service over a periodofoneweekandthedifferentstaffmembers and students were very friendly, professional and provided me with excellent care and endless smiles and humour. they helped me to improve my state of mind with a lot of respect, humour and interest in my person.”Regional Acute Day Service – Mental Health

“ My sincere thanks to all of the team. Inparticularthestellarcareandsupportprovidedbymynurses.Thesestaffmadethedays and nights shorter, with their engaging andwarmpersonalities.Acredittotheirprofessionandwhose‘influence’duringmystaywillnotbeforgotten.Myhusbandwas transported to Wellington Hospital last Mondaybyambulance.Hewasadmittedto short stay unit overnight. My thanks toallstaffforthoroughandprofessionaltreatment. Every single person we spoke to was courteous and helpful - this does not happenbychance-congratulations.Allcareandexplanationswerereassuring.”Ward 6 North

Early next year we will establish a consumer council. this will be a part ofourDHBfocusonpatientsandwhānaucentredcareandwillofferconsumerinputintomanyactivitiesincluding service planning and development, and improvement and safetyactivities.

“ i have just been discharged from this ward and i would like to say how impressed i was with the care i received. never was a requesttoomuchforthestaff.Mynurse….Formostofmystaffwaswonderful.Alsothenightstaffandtheotherswhocaredforme,no problems at all.”Kenepuru Surgical Unit

P a t i e n t e x p e r i e n c e8

improvedandfine-tuned,justlikefor example, a surgeon can work on improving their surgical technique. During the workshops, research, experiences, discussion, and group workareusedtoequipstaffwithpracticaltoolsandideasforthemto use in their day-to-day work. Workshopscovercommunicationwithpatientsandfamilies,communicationskills for nursing, midwifery and allied healthstaff,difficultinteractions,opencommunication,coaching,andfeedback.

Inthepastyear340staffcompletedone of the half day workshops. at these, each person takes away an actionplanforthemselvesidentifyingat least two things they will either strengthen or start using in their own practice.

services and teams that grapple with challengingordifficultinteractionsandwanttodobetteratmanagingtheseevents can also get expert advice, facilitationandon-goingdevelopmentworkfromtheDHB’spatientsafetyofficer.

Communication Skills DevelopmentCCDHB is unique in offering all staff access to a programme of five highly regarded, evidence-based communication skills workshops.

Theworkshopslookatdifferenthealthcarecommunicationsituations,recognisingthatcommunicationskillsare as important as clinical skills. How we communicate has a profound impactonpatientandwhānauexperience, understanding of their situationandabilitytoworkwithus.Being consistently compassionate, respectful,kindandcourteousarecoreexpectations.

Recognising the impact of communicationonwhatitisliketobea user of our services is at the heart of ourpatientandwhānaucentredcare.ThisworkledtotheDHBinvestinginstaffbydevelopingtheirskillsandexpertiseinthisarea.

During the facilitated workshops a mixofstaffexplorecommunicationas a skillset that can be developed,

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 9

Community based care without the waitOur community teams are aligning to reduce waiting lists, by scheduling patients’ appointments closer to the receipt of referrals.

Thiswillenabletimelyresponsetoreferralsandsupportingdischarge.

Inparticular,wearenowassessingpatientsintheirownhomeupondischarge, rather than in hospital. this is known as the ‘discharge to assess’ processandhasenabledpatientstogetbacktohealthy,activelivesearlier.

this approach builds on several projects underway between ccDHB andprimaryhealthorganisation(PHO)compass Health to integrate the way healthcare is delivered, removing the traditional‘split’betweengeneralpracticesandhospitalclinicians.Bysharinginformationandproactively

workingtogetheroninitiativeslikeHealthPathways and the shared CareRecord,clinicalstaffwillbeabletodeliverbettercaresoonerandmoreconvenientlyforpatients.Bothinpatientandcommunityteamsareinvolved in this work.

this coming year, compass Health PHOandCCDHBarestartingprojectstosupportclinicalstaffacrossprimaryand secondary services to deliver care in a more joined up and integrated manner. the focus will be on sharing information,proactivecareplanning,and delivering community based care without the wait.

there are a number of health pathways implemented and under way includingcellulitis,sepsis,fasttrackstroke, chest pain (suspected acute coronary syndrome), and more will be developed in the coming year.

Occupational therapist Helen Clarke providing an in-home cognitive assessment service for her patient.

C o m m u n i t y s a f e t y i n i t i a t i v e s 10

Pathways to good healththe 3DHB Health Pathways project was launched in February 2014. this projectbetweenGeneralPracticesand DHBs has seen care pathways developed to take the uncertainty out ofpatientcare.

in doing so, health professionals fromacrossdifferentsectorsandorganisationshaveagreedupononthebestpracticetreatmentguidelinesanddiscussedanyexistingbarrierstoimplementation.

there are currently 95 pathways on the work programme. an example of the co-design approach is the local pathway under development to treat carpal tunnel syndrome, a disabling conditionthatcauseswristpainandnumbness. ccDHB’s orthopaedic department has agreed to accept surgical treatment referrals directly from GPs, provided the treatment stepsoutlinedinthepathwayarefirstfollowed.Thismeanspatientscango to their GP, who will perform the appropriate treatment steps, and if surgical treatment is necessary, give certainty that they will receive it.

“that’s a really powerful thing to say ‘I’mreferringyouforanoperation’,not‘i’m referring you to see a specialist first’,”saysLowerHuttGPDrChrisMasters,oneoffive‘clinicaleditors’who have been appointed to work with hospital and community-based specialists as part of the integrated approach.

“While hospital treatment may be necessary for some complex conditions,peopledon’twanttogoto hospital when they can come and see their local family doctor or medical centre to get treatment that is closer tohomeandmoreconvenient,”DrMasters says.

Thenewgeneralpracticemodelrecognisesthatlong-termconditionsrequire coordinated care from differenthealthservices.Practicenurses and community health providers such as physiotherapists are seen as key to this.

Whiletheprojectisstillinitsinitialstages,continueddevelopmentisapriority for the coming year.

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 11

undertaken X-rays or blood tests and meansthatapatient’smedicalhistoryis available if they are unconscious.

Patientscanchoosetooptoutofthesystem,butabetterknowledgeofpatients’medicalhistoriesmakesfor treatment that is safer, faster, andeasiertodispense.SensitiveinformationcanalsobewithheldfromhospitalaccessbyGPs,ifpatientswould prefer to share certain details only.

the development of the shared care Record was managed by capital & coast and local PHo compass Health, who maintain responsibility forauditingandmaintenanceoftherecord.

The Shared Care RecordIn April the Shared Care Record was launched. This new system enables hospital staff to access primary care health records from Wellington, Porirua and the Kāpiti Coast.

By using the shared care Record, health record summaries from general practicesareimmediatelyavailableto hospital clinicians through a secure connection.Accesstothisinformationis restricted to authorised health professionals only, which ensures it remainsconfidential.

intensive care specialist Dr Peter Hicks sayswhilesomeclinicalinformationwas already shared using paper systems, this meant it was not always available when it was needed.

“the shared care Record allows hospitalclinicianstocheckpatientmedical histories from their on-screen hospital record. this clinical informationcanmakearealdifferencetothequalityandsafetyofcare.”

WellingtonGPRichardMedlicottisequallypositiveaboutthebenefitsforpatientsofthenewsystem.“Ifanelderlypatientsuddenlygoesintohospital at night, the hospital doctors can get a more complete view of that person’s medical history and easily see whatmedicationtheyaretakingandifthereareanyrecenttestresults.”

the shared care Record removes the need to duplicate previously

C o m m u n i t y s a f e t y i n i t i a t i v e s 12

Disability ServicesThe work to improve services for people of all ages who have disabilities has stepped up at CCDHB during 2013/14, including a focus on improving the patient journey, from booking an appointment through to discharge.

InDecember2013,thefirstsub-regional new Zealand Disability StrategyImplementationPlanwasagreedbytheWairarapa,HuttValley,andCapital&CoastDHsattheirfirstcombinedmeeting.Tosupportthisand to provide a voice at governance level, the sub-regional Disability advisory Group was formed for people withdisabilitiestogivetheirfeedbackontheimplementationofthesub-regional disability plan.

a Disability alert icon was also launchedatCCDHBandHVDHB.Staffhavebeentrainedtousetheicon,whichalertsthemtopatients’particularneedswhenusinghealthservices. there are now more than 4,000 people with alerts in the system and at least 10,000 people with health passports.

CCDHB’s Disability Action Group Champion Network

other Disability service highlights include: ▪ the Health Passport is now embeddedintoWairarapa,HuttValleyandCapital&CoastDHBs.the Health Passport assists health providerstobetterunderstandthecareandcommunicationneedsofpeople who experience long-term impairments / disability.

▪ a disability champion / facilitator networkmadeupofstaffacrossallthree sub-regional District Health Boards and community services was launched to help improve servicesandinformationtohealthstaffandpeoplewithdisabilities.

▪ the champion network was established. this compromises of morethan35staffmembersfromacross the three District Health Boards who have made themselves available to provide support navigationandadvicetopeoplewho have more complex support needs.

Formoreinformationgoto: www.ccdhb.org.nz/planning/disability

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 13

Advance Care PlanningAdvance Care Planning is a process of discussion and shared planning for future health care and is particularly relevant to those who have long-term conditions.

advance care Planning (acP) is about patientsandthoseclosesttothediscussing diagnoses and preferences fortreatmentpossibilitieswiththeirclinicians.

Overthepast18months,CCDHBhas developed an advance care Planning framework with guidelines to determine to provide the most effectiveandtargetedhealthcareforpatientswhobecomeseriouslyunwell,particularlyinthelastyearand months of their life. these guidelines are intended to be used in secondary and primary healthcare settings,sothatpatientscanhaveconsistent discussions with hospital andgeneralpracticeclinicians.

Keyachievementsoverthepast18months have been: ▪ acP guidelines endorsed and

approved ▪ SupportiveCareprogramme

developed by our renal service ▪ 14CCDHBstaffattendedNationalCooperativeTrainingProgrammetobuildconversationsaboutACPintotheirdailypractice

▪ Pilot undertaken for acP in the generalpracticesetting

"What a relief to finally talk about what I was afraid of. My daughter and I now have a plan to make sure

I am not alone."

It’s not easy to talk about planning for your future and end-of-life care, but it is important. Maybe you could start a conversation with your partner, a mate, with the girls over lunch, or around the barbie. Talk about what’s important to you as you get older, how you want to live the rest of your life and your future healthcare needs.

These conversations are part of Advance Care Planning which is a process of thinking about, talking about and planning for future health care and end of life. To help break the ice and start one of these Conversations that Count we have designed some postcards.

To send an e-postcard and to learn more about Advance Care Planning please visit: www.conversationsthatcount.org.nz CONVERSATIONS

THAT COUNT DAY

16 APRIL IS CONVERSATIONS THAT COUNT AWARENESS DAY

with your girlfriends

CTCDAY_Postcards_ƒ.indd 2

over coffeewith the whanau

CTCDAY_Postcards_ƒ.indd 4

at the kitchen table

Start a conversation that counts is about raising awareness of advance care planning so that people start thinking, talking and planning for their future and end of life care. It’s not easy to talk about planning for your future and end-of-life care, but it is important. Maybe you could start a conversation with

your partner, a mate, with the girls over lunch, or around the barbie. Talk about what’s important to you as you get older, how you want to live the rest of your life and your future healthcare needs.

These conversations are part of Advance Care Planning which is a process of thinking about, talking about and planning for future health care and end of life.

“What a relief to finally talk about what I was afraid of.

My daughter and I now have a plan

to make sure I am not alone. ”

It’s not easy to talk about planning for your future and end-of-life care, but it

is important. Maybe you could start a conversation with your partner, a mate, with the girls

over lunch, or around the barbie. Talk about what’s important to you as you get older, how you want to live the rest

of your life and your future healthcare needs.

These conversations are part of Advance Care

Planning which is a process of thinking about,

talking about and planning for future health care

and end of life. To help break the ice and start

one of these Conversations that Count we have

designed some postcards.

To send an e-postcard and to learn more

about Advance Care Planning please visit:

www.conversationsthatcount.org.nz CONVERSATIONS THAT COUNT DAY

16 APRIL IS CONVERSATIONS THAT COUNT AWARENESS DAY

with your girlfriends

CTCDAY_Postcards_ƒ.indd 2

over coffee

with the whanau

CTCDAY_Postcards_ƒ.indd 4

at the kitchen table

Start a conversation that counts is about raising awareness of advance care planning so that people start thinking, talking and planning for their future and end of life care.

It’s not easy to talk about planning for your

future and end-of-life care, but it is important.

Maybe you could start a conversation with

your partner, a mate, with the girls over lunch,

or around the barbie. Talk about what’s important to you as you get older, how you

want to live the rest of your life and your future

healthcare needs.These conversations are part of Advance Care

Planning which is a process of thinking about,

talking about and planning for future health

care and end of life.

C o m m u n i t y s a f e t y i n i t i a t i v e s 14

Immunisation Immunisation is a vital tool to prevent the spread of infectious diseases. Vaccinations are offered to babies, children and adults to protect against serious and preventable diseases throughout life.

accordingly, the Ministry Health has asked every DHB to ensure at least 95% of eight month olds have thevaccinationstheyneed,whichinvolves them having their primary courseofimmunisationatsixweeks,threemonthsandfivemonths.Themost recent results for 2014 show we achieved this for 95% of eight month year olds and two year olds, with highcoverageforMāoriandPacificchildren.

Someinitiativestoimprovecoverageinclude; ▪ Children’s Ward opportunistic

immunisations –Staffareinformeddaily of children that are due/overdueforvaccinationswhoareinpatientsonWards1&2.

▪ neonatal Intensive Care – two dedicated Registered nurses have ensured 100% coverage for our mostvulnerableyoungpatients,along with free Whooping cough andfluvaccinationsforparentsandfamily members.

▪ Improving Workforce Influenza Coverage – More than 40 staffmembersvolunteeredas‘ImmunisationChampions’

resultingina20%increaseinworkforce coverage overall.

▪ free influenza vaccinations for discharging patients – ccDHB offeredfreefluvaccinestodischargedpatients65+years(NZEuropean)or55+years(Māori/Pacific)topreventunnecessaryhospital readmissions.

▪ Whooping Cough and Influenza vaccination for ‘High-risk’ Pregnant Women – three Midwife vaccinators in the Women’s Health Department have given nearly 400 vaccinationstohigh-riskpatientsthis year, with a commitment tooffereverypregnantwomenimmunisationbytheendof2014.

▪ Education and Promotional activities – ccDHB promoted the benefitsofWhoopingCoughandInfluenzaimmunisation,WorldImmunisationWeek,theNationalImmunisationSchedulechangesandRotavirusVaccination.

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 15

Health Literacy Review – Child Health Service outpatientsThis year the Child Health Service and Māori Health Development Group undertook a systems review to improve attendance at outpatients’ clinics.

Missed clinic appointments can have asevereadverseeffectofpatients’health and chances for recovery, so thisreviewlookedatusingapatientandwhānau-centredcareapproachtoimproveattendance,andhealthoutcomes in the long run.

Missed clinics are coded as ‘Did not Attend’–CCDHB’soverallDNArateisaroundsixpercent,butMāoripatientsdonotattendupto14%oftheirclinicsandMāoriDNAratesforsomechildhealth clinics can be as high as 29 percent. to address this, child Health andtheMāoriHealthDevelopmentGroup at ccDHB looked at how policiesandcommunicationmethodssupportedpatientsinhospitalandpost-discharge in the community.

as part of this review, interviews were conducted with clinicians, administrationstaffandwhānau,whoidentifiedissuescontributingtonon-attendance.Thereviewfoundthatwhānauaccessingchildren’soutpatientservicesfoundthemselvesdealing with a host of unfamiliar health processes in new environments, with many separate services involved betweenhospitalandgeneralpractices

inthecommunity.Coordinationandcommunicationissuesweretheleadingfactorsidentifiedinnon-attendance.

CollaborativeworkwiththeDHB’sQuality improvement team and the PatientAdministrationServiceisnowunderwaytosimplifyexistingreferralprocesses, so that they meet the needsofpatientsandtheirwhānau.

“ Ihadaroughtimewithbreastfeedingdue to my baby being in neonates for two weeks so we didn’t get the chance topracticeafterIstartedusingashield.Iwasn’t going to go to the clinic but i’m so glad i did. i felt welcomed straight away. it was so busy when i was there but the ladies stillcomeovertogivemeoneononehelpand made sure i was oK. Ever since that day i have never used the breast shield again which feels like absolute freedom. as a mum this is an invaluable service.”Porirua Breastfeeding Clinic

P a t i e n t s a f e t y i n i t i a t i v e s16

The OPEN CampaignAspartofourcommitmentto“zeropatientharm”,CCDHBworkscloselywith the Health Quality & safety Commission’s(HQSC)“Openforbettercare”patientsafetycampaign,whichisfocussed on four key areas: ▪ Preventingpatientfalls ▪ Reducinginfections ▪ improving surgical safety ▪ improving medicine safety

“ Iwritetoyouwithappreciationfollowingthemeetingheldbetweenour family and all key members of the Department. i especially want to acknowledgeeveryactionandfollow-throughsinceourmeetingandthework already in-progress within your department to improve your services to all.Asaresultofourmeetingwithyouall our family are pleased to advise that it provided us with closure. Firstly - that you were all willing to meet with us meant everything. (i really want to stress to you how important it was to us, it meant the world). We felt as though we as a family were being listened to and that your department cared about our wellbeing.””Letter from a family member after a “challenging conversation” meeting.

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 17

Preventing patient falls and reducing harmFalls prevention has always been a focus within the DHB with a culture for reporting fall incidents as a mandatory reportable event.

In2013/14theFallsPreventionGrouptook part in the Health Quality and SafetyCommission’snationalReducingHarm from Falls Programme. a system trialled by the six central Region DHBs has now been introduced to replace green wrist bands used previously to identifypatientswereatriskoffalling.

Thepatient-centredsystemsignalsthe level of mobility assistance a patientneedsandsupportspatient’sinvolvement in keeping safe when

mobilising. the system reinforces the messagethat“it’sOKtoaskforhelp”.

this new system is now part of the standardisedfallspreventionapproachthat has been achieved across adult inpatientareasTheendresulthasincreasedstaffandpatientawarenessaround the risks of falling.

Thisyearhasseenasignificantimprovement in the percentage (from71%to92%)ofpatientsassessed as being at risk that have an individualised care plan which addresses their falls risk. We aim to steadily improve in all our falls preventioninterventionworkoverthecoming year.

P a t i e n t s a f e t y i n i t i a t i v e s18

Reducing infectionsThe Infection Prevention & Control service won the 2014 National Hand Hygiene Quality Improvement Award for a DHB with more than 300 beds. This is an excellent achievement and the team thoroughly deserved this accolade.

Handhygieneisavitalpatient-focussedinitiativetopreventthespreadofinfectioninhospital.TheservicehaveactivelyengagedwithbothstaffandpatientsinpromotingtheWorldHealthOrganisation’s‘Five Moments for Hand Hygiene’ topreventthespreadofinfectiousmicrobes.

in the last quarter, ccDHB’s compliance for the ‘Five Moments’

increased from 71% to 75%, ahead of thenationalaverage,butwerecognisethat there is always room to improve.

OurcomplianceforgoodIVlinepracticetopreventCentralLineassociated Bacteraemia (claB) infectionsremainedat100%.CLABscontinuetobeveryrare,atwellunder1 per 1000 line days. Based upon an initialestimate,theHealth,Quality&SafetyCommission(HQSC)estimatesover180CLABshavebeenavoidedinjust under two years; a saving of more than $3.5m.

Wearealsodoingbettertopreventsurgicalsiteinfections,withantibioticsgiven0–60minutesbeforesurgicalincision96%ofthetime.Wecontinueto be the leading DHB when it comes

Clinical nurse specialist James Robertson and Infection control nurse Viv McEnnis

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 19

Improving surgical safetyThe World Health Organisation’s three-phase Surgical Safety Checklist (SSC) it is a comprehensive document that acts as a reference for all members of the surgical team.

it has been designed to prevent perioperativeharm,whichreferstoharmcausedduringoraftersurgery,e.g.surgicaltoolsaccidentallyleftinpatients,wrongsitesurgeryoraccidental punctures or cuts.

ccDHB is the most compliant DHB in new Zealand when it comes to use of the surgical safety checklist. We are also the only DHB that completes observationalauditstoensuregoodpracticeisfollowed.

Moresystematicuseofthechecklistisanticipatedtoreduceavoidablehealthcomplicationsby21%to36%,savingnew Zealand’s public health system an estimated$5.7millionperannum.

SURGICAL SAFETY CHECKLIST

SIGN IN before induction of anaesthesia - DO NOT PROCEED WITHOUT COMPLETING

Patient / parent / guardian / interpreter has verbally confirmed:

Identity Site / side

Procedure

Consents Allergies

Site marked Exempt

If prosthesis/special equipment/instruments are to be used in theatre, have they been checked and confirmed?

Yes - name:

Not applicable

Blood availability: valid group and screen/blood available? Yes Not applicable

Anaesthetic safety check: equipment checked and ready? Yes

Anticipated complex airway/aspiration risk? Yes - equipment and assistance available No

Print name and designation:

Signed:

TIME OUT before skin incision - DO NOT PROCEED WITHOUT COMPLETING

Confirm all team members have introduced themselves by name and role Yes

Surgeon, anaesthetist and nurse verbally confirm

Patient identity Site/side

Procedure

Allergies Imaging

Position

Metalware Transdermal patch

Pacemaker/ICD/other implants

Any critical events anticipated by surgical, anaesthesia and nursing teams? Yes No

Has antibiotic prophylaxis been given within the last 60 mnutes? Yes Not applicable

Has thromboprophylaxis been considered? Yes Not applicable

Print name and designation:

Signed:

SIGN OUT before patient leaves operating room - DO NOT PROCEED WITHOUT COMPLETING

The name of the performed procedure recorded

Instrument, sponge, needle and other count correct

The specimen/s dated and labelled correctly

The specimen/s in the correct medium

If the specimen/s tissue is for return to patient, correct protocol followed. All labels applied and forms sent

with specimen.

Team members clarify the key concerns for recovery and management of this patient.

Print name and designation:Signed:

Date: / /

AMBULANT SURGICAL

Patient bed Chair Number:

notes:

Print name and designation:Signed:

Date: / /

DISCHARGE SUMMARY

Patient fulfils discharge criteria Yes No - state action:

IV cannula removed Discharge information given Prescription given

Personal belongings returned Follow up appointment booked Escort with patient

Medical /ACC certificates required Yes N/A Given to patient Discharged from IBA

Other / comments:

Print name and designation:Signed:

Date: / /

Page 2 of 8

Page 7 of 8

Surname: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NHI: . . . . . . . . . . . . . . . . . . .

F i r s t Names: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of B i r th: . . . . . . . . / . . . . . . . / . . . . . . . . Sex: . . . . . . . . . . . . . . . . . . . . .

PL ACE PATIENT ID HERE

Surname: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NHI: . . . . . . . . . . . . . . . . . . .

F i r s t Names: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of B i r th: . . . . . . . . / . . . . . . . / . . . . . . . . Sex: . . . . . . . . . . . . . . . . . . . . .

PL ACE PATIENT ID HERE

toprovidingtherightantibioticforroutineantibioticprotection(Cefazolin,2g)98%ofthetime,and provide the appropriate skin distinfectantspriortosurgery100%ofthetime.

other key achievements from the InfectionPrevention&ControlserviceandtheOccupationalHealthserviceinclude: ▪ Staffinfluenzavaccinationrate:

57% ▪ Orthopaedicsurgicalsiteinfectionprocessfiguresshowed96-100%compliance.

▪ the central line acquired Bacteraemia Zero Programme continuestobeasuccess,withtheDHBcontinuingtohaveonly1-2cases per year in the intensive care unit.

▪ the neonatal intensive care unit andrenalservicescontinuedtohave extremely low incidence and ratesoflineinfections.

▪ Isolationsignageandprovisionofadditionaltrainingandeducationonisolationpracticeswereallupdated.

▪ Theinstallationofalcoholbasedhand rub at the foot of every bed.

P a t i e n t s a f e t y i n i t i a t i v e s20

abletocontactthepatient’sGPandcommunity pharmacy to determine the correct doses, thus ensuring safe treatment.

Adverse Event reviewsTo ensure we are doing all we can to reduce patient harm, we regularly review incidents where it has occurred to see where we can improve. A strong focus in the past year has been notifying patients and their whānau earlier if something goes wrong.

Casesofdelayednotificationinsuddendeteriorationhavebeenusedtohighlighttostafftheeffectthiscanhave on friends and family members with regard to grief and coping.

ccDHB recognises that excellent communicationisacriticalskillforhealth care professionals, and our patientsafetyofficeralsoprovidesspecifictrainingandleadershipinthisareatostaffacrosstheorganisation.

Improving medication safetySafe and proper use of medicines is another key strategy for us to reduce avoidable patient harm, especially around the use of opioids.

opioid medicines like morphine are highly-effectiveatprovidingpainreliefbut must be used carefully due to theiraddictivenature.Toassisthealthprofessionals with safe prescribing, ccDHB has introduced a new acute Pain Management guideline and revisedtheinformationweprovidetopatientstoensuretheyarefullyawareof what they can do to avoid becoming dependent on opioids.

MedicinesReconciliationisanotherkey safety strategy at ccDHB, given thatmedicinescaninteractdifferentlywitheachother,withpotentiallyadverse consequences. safe and effectivecarereliesonknowingapatient’smedicationhistory,andMedicinesReconciliationallowsaclinically-trained pharmacist to access thisinformationfromgeneralpracticeor community pharmacist databases, withoutrelyingonthatpatient’smemory.

Thisisparticularlyimportantifpatientsareunconsciousorunabletoprovidethisinformation.Forexample,apatientinhospitalknewnamesoftheir medicines but not the doses.ThehospitalpharmacistinitiatedMedicinesReconciliationandwas

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 21

A CAREFul approach in Emergency DepartmentOne part of this project will see Wellington Emergency Department initiate a Frailty Screening Tool from the end of July 2014.

this quick screening tool will be used on anyone over the age of 75; and allowsfortheearlyidentificationofpatientswhoarevulnerabletosuddenchanges in their health, which may be caused by small events such as a minor infectionorchangeinmedication.Patientsidentifiedas‘frail’arethenreferred to the caREFul team (caring for the at Risk Elderly person who is Frail).

TheCAREFulTeamisamulti-disciplinaryteamconsistingofanurse, pharmacist, geriatrician and physiotherapist. this team works in

collaborationwithoneanotherandED to create care plans for those being admittedanddischargedhome.Thiscanincludeconsultationsandreferralsfrom specialist services, for example physiotherapy, geriatricians, rehab to outpatientcommunitysupport,andin-home services.

Theobjectiveisthatpatientswillreceive a geriatric assessment and plan, as early as possible. this assists inidentifyingpatientswhocanavoidahospitaladmissionandcoordinatingcommunity support and follow-up.

P a t i e n t s a f e t y i n i t i a t i v e s22

The START Team

STARTin May the Emergency Department piloted a new model of care provided by a ‘senior treatment assessment Referral team’ or staRt. the aim of the trial was to see whether this approach was feasible and whether it could improvepatientcareatWellingtonHospital.

the trial ran for one week from 12pm –5pmandwastargetedatpatientswho were triaged as requiring ‘less-urgent care’. the team was comprised ofaseniormedicalofficerandseniornurse,whowouldseepatientsassoon as possible, to provide earlier

specialistassessment,initiateurgenttreatment if necessary (e.g. pain relief orantibiotics)andrapidlyobtainbloodor radiology results.

Afterthisinitialassessment,patientswouldbedirectedtoEDforfurther assessment, transferred to a specialist assessment unit within the hospital, or discharged directly. the trial was considered a success, withresultsindicatingthisdedicatedearly assessment team enabled morepatientstobeseenwithintherecommendedtimeframeofsixhours,reducingtotalwaittimeforpatients.

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 23

Early Warning Score Improvement projectThe Early Warning Score (EWS) was introduced in June 2011 and is a simple colour-coded chart that helps staff identify deteriorating patients to ensure they recieve early intervention.

the EWs is a scoring system based onthepatient’svitalsigns(bloodpressure, heart and breathing rate etc).Thescorehelpsstaffknowwhentogetapatientreviewed,whentocallonmoreseniorstaff,orwhentocallaMedical Emergency team (MEt).

ccDHB set up a project team to help improvepatientsafetybyincreasingmedicalandnursingstaffcompliancewith the Early Warning score (EWs).

the team’s audit showed while there were some areas of high compliance (suchasconsistentlyrecordingpatientheart rate and blood pressure), there were also areas of low compliance

(such as recording urine output, the patient’slevelofconsciousnessandthe EWs score itself). the results areavailabletoallstaffandinformeducationandfollow-upbyseniornurses on the ward.

numbers of cardiac arrest and Medical Emergency team (MEt) calls across the hospital were compared with earlier data. the number of MEt calls to the ward is increasing, which means patientswhoaregettingsickeraregettingearlierreviewandcare,thanksto a greater use of the EWs.

Theprojectgroup’sworkandauditingwillcontinue.Thelongertermplanisthat the audit will become business as usual in all DHB wards that use EWs.

L o o k i n g f o r w a r d24

Looking forward improved access to services and waitingtimesforpatientshasbeenamajorfocusforallstaff,withmanysuccessfulresults;forelectivesurgery,orthopaedics, cardio thoracic, and vascularservices.Theelectivesurgeryteamdeliveredanadditional226discharges in 2013/14, which again exceededourtargetforelectivesurgery discharges.

Wehavecontinuedtoinvestinlargecommunity projects including aged residentialcarea,diabetesnursepracticepartnership,andtheSharedCareRecordforallpatients.

Health Pathways began this year and this is designed to provide GPs with quickaccesstorelevantinformationabout how to manage common conditions,andhowandwhentorefer to hospital. this is another 3DHB integrated project with the Wairarapa andHuttValleyDHBs.Localpathwayshave already been developed for conditionslikecellulitis,deepveinthrombosis,diabetesnutrition,anddementia.Thisisasignificantpieceofwork,whichwillcontinuetobeapriority for the coming year.

Part of this new approach to health care has seen a closer alignment of hospital, community and primary care services, and the building of a stronger relationshipwithoursub-regional3DHBpartners.Thiscollaborativeapproachwillcontinueinthecoming

year,aswelooktooptimisetheuse of our resources to ensure a more sustainable, safer and more convenientpatientjourneysforthepeople of our region.

improving our consumer engagement

TheHQSCispromotingconsumerengagement at all levels, as a key way to improve quality outcomes for patients.

ccDHB is in the process of establishing a consumer council, which we hope to establish by early 2015.

Based on the feedback from our PatientExperienceSurvey,weare also focusing on improving ourcommunicationfromhospitalto home, with a focus on follow up appointments and discharge information.

looking forward for 2014/15 ccDHB hasidentifiedsixkeyprioritiesasoutlined in blue opposite:

Ultimately,wewanttoensurethatourconsumersaregettingtheservicestheywantandneed,withbetteroutcomes,andlesswasteoftimeandresources.

C C D H B Q u a l i t y A c c o u n t s 2 0 1 4 25

CCD

HB

Pri

orit

ies 2

014/

2015

Safe

ty

Patie

nt

expe

rienc

e

Effec

tiven

ess

Equi

ty

Acce

ss

Effici

ency

Zero

pati

ent h

arm

Patie

nt &

whā

nau

cent

red

care

Opti

mum

pe

rfor

man

ce

Redu

ced

heal

th

disp

ariti

es

Effec

tive

serv

ices

Regi

onal

col

labo

ratio

n

Qua

lity

hosp

ital c

are

and

com

plex

ca

re fo

r tho

se

who

nee

d it

Impr

oved

qu

ality

, saf

ety

and

expe

rienc

e of

car

e

Prev

entiv

e he

alth

and

em

pow

ered

self

care

Impr

oved

hea

lth

and

equi

ty fo

r all

popu

latio

ns

Prov

isio

n of

rele

vant

se

rvic

es c

lose

to

hom

e

Best

val

ue fo

r pu

blic

hea

lth

syst

em re

sour

ces

CCDH

B Ac

tions

�O

pen

Cam

paig

n

(Qua

lity

and

safe

ty m

arke

rs)

�Im

prov

e pa

tient

safe

ty

and

redu

ce h

ealth

care

har

m

(Qua

lity

Impr

ovem

ent/

Awar

ds)

�Be

nchm

arki

ng �

Certi

ficati

on

�St

reng

then

clin

ical q

ualit

y an

d pa

tient

safe

ty fr

amew

ork

3DHB

(Risk

Fra

mew

ork/

Cont

rolle

d do

cum

ents

/Go

vern

ance

/Ser

vice

cr

eden

tialin

g) �

Audi

t Fra

mew

ork

�Q

ualit

y Ac

coun

ts �

Nati

onal

Exp

erie

nce

Indi

cato

rs

�Co

nsum

er C

ounc

il �

Cons

umer

stor

ies

HEa

ltH

tar

gEt

s �

acce

ss to

ele

ctive

surg

ery

�In

crea

se im

mun

isatio

n ra

tes

�He

art &

dia

bete

s che

cks

�Ac

cess

to c

ance

r tre

atm

ent

�6

hour

rule

ED

�He

lp to

stop

smok

ers t

o qu

it

syst

Em IN

tEg

ratI

oN

�

Diab

etes

and

long

term

co

nditi

ons

�St

roke

, acu

te c

oron

ary

synd

rom

e (A

CS)

�Im

prov

ed a

cces

s to

diag

nosti

cs

�Fa

ster

can

cer t

reat

men

t �

Card

iac

�Pr

imar

y ca

re �

Heal

th o

f old

er p

eopl

e �

men

tal H

ealth

ser

vice

De

velo

pmen

t Pla

n �

mat

erna

l & C

hild

Hea

lth

BEtt

Er P

uBl

IC s

ErvI

CEs

�re

duci

ng rh

eum

atic

feve

r �

yout

h m

enta

l Hea

lth P

roje

ct �

Child

ren’

s acti

on P

lan

�W

hāna

u o

ra

� Im

prov

ed le

ngth

of s

tay

(lo

s) �

redu

ction

acu

te a

dmiss

ion

�Cl

inic

al p

athw

ays

�Cl

inic

ally

led

3DHB

sing

le

serv

ice

�m

odel

of c

are

�St

ewar

dshi

p

�Bu

ildin

g ca

pabi

lity

�St

reng

then

ing

our w

ork

forc

e

CCHD

B

Prio

rities

HQSC

In

dica

tors

Sub

Regi

on

3DHB

vis

ion

Trip

le A

im

Out

com

esG

over

nmen

t G

oals

New

Ze

alan

ders

liv

e lo

nger

, he

alth

ier

and

mor

e in

depe

ndan

t liv

es

New

Ze

alan

d’s

econ

omic

gr

owth

is

supp

orte

d

vers

ion

6 - J

une

2014

Mothers with babies born at Kenepuru Maternity Unit, which celebrated its

10 year anniversary this year