gha board report – july 2019-september 2019 · 2020. 6. 16. · gha board report – july...

GHA Board Report – July 2019-September 2019

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GHA BOARD MEETING AGENDA

Venue: Charles Hunt Room, John Mackintosh Hall

Wednesday 17th June 2020 at 11.00hrs

1. Apologies for absence

2. Minutes of the meeting held on 31st July 2019

3. Matters arising

4. Statement by the Minister for Health

5. Matters for the report

5.1 Report: Medical Director and Executive Summary

5.2 Report: Director of Public Health

5.3 Report: Head of Estates and Clinical Engineering

5.4 Report: Director of Nursing Services

5.5 Report: Human Resources Manager

5.6 Report: Hospital Services – General Manager

5.7 Report: Primary Care Services – Deputy Medical Director

5.8 Report: Mental Health – General Manager

5.9 Report: Director of Information Management and Technology

5.10 Report: School of Health Studies

6. Date and time of next meeting

7. In-Camera session


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5.1 Executive Summary – Medical Director

Please see 2019 Quarter 4 Board Report for Executive Summary


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5.2 Director of Public Health

This has been a busy time, despite the fact that summer is traditionally quiet. The Island Games created both opportunities and pressures on resources but has helped us continue to develop good relationships across many sectors. The hospital remains a focus of intense activity in terms of infection control. A Hospital is a safe environment for sick people, and therefore they should be protected from infections that could be prevented.

Activities of the Health Promotion Department July – September 2019

Main Public Health Events of this Quarter

Building Health & Wellbeing data

Sun Safety at Gibraltar Calling Music Festival

Mental Health Campaign

Public Events

Island Games: Health Promotion supported the Island Games during the

week commencing 6th July 2019. The provision of sun cream was welcomed

by organisers, participants and visitors to events.

Health and Wellbeing workshop at Dr Giraldi Home: The HPOs organised and

conducted a workshop on health concerns of service users and families of Dr

Giraldi Home; data collected was collated and will be used to guide the

formulation of the forthcoming health and wellbeing strategy for Gibraltar.

Child Friendly City: the HP team are working with Dr Annie Dai and other core

members of CHAMP to look at obtaining UNICEF’s ‘Child-Friendly Status’ for

Gibraltar.

World Mental Health Day Campaign: HPOs have contacted GHA staff and met with several interested charities to co-ordinate efforts for WMHD, the focus being suicide prevention. Also contacted GFA to discuss collaborative health promotion:


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Gibraltar Football Association: The HP team met with Steven Gonzalez from

the GFA, discussed collaborative working on production of media clips

involving the team members on suicide and other relevant health issues for

the next year.

Hot School Lunches: The Health Promotion team attended presentations by

a number of applicants for the provision of hot school lunches in schools. HP

also worked with the Dietetic Department to create a nutritional standard for

schools.

Organ Donation: The Health Promotion team met with members of the

Gibraltar Cardiac and Dialysis Association to discuss future campaigns in

regard to organ donation

Department of Education: The HP team remains in communication with Ms

Kerri Scott in regard to having a presence in schools on a regular basis.

Suicide Prevention Week: HP joined several other local charities to support

GibSams on Saturday 31st August at their awareness event at Casemates.

Gibraltar Calling Music Festival (Sep 7th,8th): The HP department once again

joined UNITE the Union to promote sun safety at the music festival at Europa

Point.

Flu Campaign: The HP team is currently working with several other

departments to prepare for the forthcoming Flu season. New leaflets have

been designed, radio ads have been commissioned and an infomercial is in

production.

Meeting with Radio Gibraltar Team: The HP team met with Ian Daniels and Joanne Wilson from GBC to discuss development of radio ads and jingles with key health messages. A short radio ad on the forthcoming flu season is already on air.


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Facebook posts attracting most attention: o Feeling the heat, take care of yourself (619 reach, 3 shares) o Enjoy a healthy summer (1632 reach, 14 shares) o NatWest Island Games Sun Safe (166 reach, I share) o Sun safety at Gibraltar Calling (4515 reach, 1 share) o Organ Donation Week (149 reach, 4 shares) o WHO Vaccines save lives (157 reach, 1 Share) o WHO Healthy Lifestyles (316 reach, 1 share)

Health Promotion at Private Companies:

o HP were invited to a lunch and learn event at Hambros Bank to discuss general health and well-being issues.

o HP joined the Advantage Insurance Wellfest event and presented key issues regarding healthy lifestyles, blood pressure & cholesterol, diabetes and sun awareness.

Articles for the Gibraltar Chronicle included: o Stay healthy this summer

New Resources

Table /stand and 2 new pop up banners (CHAMP and healthy lifestyle)

Radio: o Purchased a block of slots on Rock Radio to relay a variety of health

messages for the forthcoming year. Sent material for ads covering Breastfeeding, Sexual Health, Flu, Diabetes, Physical Activity, and Mental Health.

o Agreed purchase of slots on GBC TV & Radio for the forthcoming year. Working on ads for Bowel Screening and preparing for Flu.

Leaflets: revamp of leaflets used by the Child Health Department o Rotavirus o Meningitis o MMR o 6-in-1 vaccine o HPV vaccine o Flu (2)

On-going

Public Health Website .

Health and Well-being Strategy

Meeting with CHAMP core meeting to discuss aims for future and event for 2020.

Infomercials under production –


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o Healthy Portion Sizes

o Suicide prevention

o flu campaign

Training/CPD

Digital Media Course ongoing

In-house – Non-Invasive Ventilation, Basic Life Support, Infection Control

Seminar of Dyslexia

Dementia Awareness conference

Infection Prevention and Control Report

July – Sept– 2019

Infection Prevention and Control board report for the period form the 1st July – 30th Sept 2019.

Daily surveillance of MRSA, CRE & ESBL. All patients are returning from tertiary Hospitals are screened for MRSA and CRE.

o 6 monthly screening undertaken on long stay wards. Positive patient decolonised.

1st July- Known CRE+ positive patient taken to theatre from A&E with # NOF. Theatre staff followed Infection Control practitioner instructions to declutter theatres and remove all none essentials. Staff followed IC theatre flowchart and post op cleaning and fogging arranged.

30th July – CRE+ (urine & rectal swab) patient identified in VMW. Patient isolated and contact tracing undertaken on all patients on that ward. Through contact tracing 3 other patient were identified as positive. Decision to cohort 3 + patients was taken after discussion with consultant Microbiologist due to lack of side-room availability. Staff were briefed on importance of using contact precautions PPE and Hand hygiene. Contacts monitored throughout August as per PHE guidance tool –no further contacts found to be positive.


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Training:

o Mandatory Training for sessions;

o 9th July & 10th July –GHA staff. o 19th July – Bleak House –Dr Giraldi staff. o 21st August –Bleak House-Dr Giraldi staff. o 6th Sept- GHA staff. o 13th Sept – Bleak House- Dr Giraldi staff.

Attended meetings;

o Infection Control Committee meetings (Monthly) o Nursing Clinical Governance meeting (Monthly). o Public Health Meetings (weekly). o Influenza Campaign meetings (on going with all stakeholders).

Attended 6 Hats thinking Seminar.

Monthly BBV clinic held twice a month with visiting consultant Dr Garcia. Reviewing HIV patients and Hep C patient to see if require treatment.

Following plan of CRE + patient in community, currently homeless with no fixed abode. Third and fourth screen undertaken both- Negative. Patient currently in Ocean views.

Environmental re-audits for Cochrane and Calpe ward were also undertaken; o Calpe ward- 61% Minimal Compliance initial audit- Re-audited-.4th July -

95% Compliance.

o Cochrane Ward- 61% Minimal Compliance initial audit- Re-audited- 4th July- 92% Compliance

o Rainbow ward-81% Partial Compliance second audit- 3rd Re audited 9th

July -93% Compliance. o John ward – 79% Partial Compliance initial audit- Re audit- 24th July-96%

Compliance.

o A&E- 80% Partial Compliance initial audit- Re audit 24th July 91%

Compliance.


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Environmental audits carried out on floor 1,2.3 & Jewish Home & Theatre. o Floor 1- 99%Compliance o Floor 2- 97% Compliance o Floor 3- 97% Compliance o Jewish Home- 97% Compliance o Theatre audit - undertaken- findings still pending to be reported.

August- Influenza Campaign (On going) - Preparations for 2019/2020 GHA Influenza Campaign. Weekly meeting to discuss strategy for delivery of Influenza vaccine with stakeholders in order to obtain accurate data on uptake from staff and community. This year’s campaign will be consisting of offering;

o Adjuvanted trivalent flu vaccine (aTIV) - This is licensed for people aged 65 years and over and is the vaccine recommended by the Joint Committee on Vaccination and Immunisations (JCVI) for this age group.

o Quadrivalent vaccine (QIV) - This is recommended for children aged from 6 months to 2 years and in adults from 18 years to less than 65 years of age who are at increased risk from flu because of a long term health condition.

o Fluenz Tetra Nasal spray suspension Vaccine (live attenuated nasal) – will be offered for the first time in Gibraltar to children aged from 2, 3 & 4 years old will be offered.

2nd August- IT developed programme to raise ALERTs of micro resistant organisms on HIS so patient highlighted in case needed admission or went for surgery. All MRSA colonisers, C.Difficile and CRE imputed on alert system.

6th August – Infection Control Practitioners underwent “FIT testing course” to become accredited to train staff. Fit testing we were assessed and trained using Draegar masks which have various sizes and our accreditation only covers the use of these masks.

7th August- Stock control of personal protective equipment undertaken to establish numbers remaining and whether fit for purpose. PPE count;


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SIZES

Suits with Boots

Suits without Boots

Goggles

Overshoes

XXXL 89

XXL 50 66

XL 75 64

L 69 28

M 66 35

S 72 42

535 350 (approx)

TOTAL 332 324 535 350 (approx)

Grand Total

656

o Fluid repellent coverall suits, anti-fog goggles and over shoe covers that we bought for the Ebola crisis in 2014.

o Anti-Fog goggles have an expiry date (and they expired in 2017).

o Organisation needs to consider changing our FFP3 respirators as the

one we use now (Meddop) is one size only and we cannot offer an alternative size if this does not fit.

20th August- Endoscopy final rinse water issues raised as in breach of best guidance and placing patients at risk, as not being undertaken for last 8-9 months. No clear definition of whose role and responsibility it was to undertake water sampling. Same has now been addressed and agreement reached by Endoscopy team, Public analyst and Clinical Engineering who have agreed to undertake water sampling every Wednesday morning. Endoscopy to submit SOP for water sampling to present to ICC and governance.

28th August - Mattress audit undertaken by ICP and practice development nurse and TALLY representative. (Audit report attached). Same to be presented at next ICC meeting.


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11th August - BAL from patient positive for MTB – Rifampacin sensitive. PHx – Admitted via A&E 26/06/2019 – poly trauma call after falling from a window. Intubated in A&E – CT scan performed and there were changes? cavitation on Chest. Patient conveyed to Quiron Malaga via ambulance with escorts. 6 weeks in Malaga and repatriated back to SBH. Patient with trachy and ventilated; respiratory precautions and isolation maintained since admission Quiron Malaga was contacted via email from Dr Nick Cortes (06/08/2019) alerted Quiron Palmones to contact Malaga to alert staff of result. Contact tracing was carried out on all staff who undertook airway management. All staff deemed at risk were Mantoux tested- results all negative and BCG will be offered.

21st 25th Sept- Infection Prevention Society annual conference- Both Infection Control Practitioners attended IPS conference in Liverpool for insight into updated practices and equipment.

Sandra Netto Nathan Lightbody Infection Prevention and Control Department

Cancer Screening Programmes delivered by Public Health

Colorectal Cancer Screening Programme

During the period spanning the months of July to September 2019, a total of 779 invitations were mailed to eligible participants inviting them to take part in the Colorectal Cancer Screening Programme. During this same period 798 test-kits were prepared and mailed to the participants and 382 samples were returned to the hospital laboratory for analysis. The breakdown of the results is as follows:

317 Negative for occult blood results

20 Inconclusive for occult blood results

15 Spoilt / Technical fail

30 Positive for occult blood results

Of those participants invited to participate, 5 categorically refused to participate in the screening programme. In accordance with the protocol, the individuals will be re-invited to participate in two years.

Of the 32 invitations extended to eligible participants residing in Spain, 6 individuals expressed interest in participating in the screening programme.

During this time frame, 4 individuals aged over 74 and therefore not a routinely invited group, approached the screening office requesting to be included electively in the Bowel Screening programme.


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During these months the Screening Office has received 0 reports from the Endoscopy / Surgical Out-Patient Department with regards the screening colonoscopy outcomes performed on Bowel Screening participants.

The bulk of visits have related to the requesting of replacement test-kits or enquiries related to the sample collection method.

During this time frame a number of initiatives have been commenced with the hope that these could elevate the current level of participation. These measures include:

The Screening Administrator continues to affix inspirational testimonials to the outer surface of the test-kits as a means of enticing invitees to participate in the programme.

The invitation letter has been redrawn, keeping the text more streamlined, making it easier to read. For the last 3 months, participation has risen to 47.9% compared to 38.0% in the last quarter. The initiatives undertaken over this period may have contributed to the apparent rise in the participation rate, though trends will have to be maintained over time to confirm this.

Abdominal Aortic Aneurysm Screening Programme

During the period of July - September 28 invitation letters were mailed to eligible participants and 17 accepted their invitations. In addition, 13 gentlemen accepted their invitation after receiving reminder correspondence over a 6-month period. The participation rate for 2019 currently stands at 69.0%.

All these participants were issued with ultrasound appointments.

A total of 39 reconsider letters were issued to participants who did not reply.

0 expressed an explicit refusal to participate in the AAA programme during this period. However, 35 invitees, who did not respond to either the invitation letter or the reconsider letter were marked as ‘Inactive’ and notified.

0 requests were received from individuals aged 66-74+ years (outside the invitation range) to take part in this initiative as elective cases.

During this period, 46 men were screened and 41 Normal Aorta results were issued. 3 known small aneurysm were re-tested on a yearly basis.

Following protocol, the gentlemen who were retested for a small aneurysm will be issued with an appointment to be tested once again in 12 months’ time.

In order to boost participation rates, champion requests continue to be issued to all participants that are currently taking part in the programme. In addition testimonials are now included with the initial invitation letter as well as any reconsider letters issued.

Respectfully Submitted Dr Sohail Bhatti Director of Public Health


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5.3 Estates and Clinical Engineering

1. Department Strategic Plan.

Over the last few years the department has shifted from a level where we were

developing a quality manual based on ISO9001:2008 requirements and building a

department looking to ensure quality and excellence across all areas and disciplines,

to a department struggling even to meet our operational requirements. This has been

largely due to the lack of succession planning through a period where we have seen

very experienced engineers retire without the ability/opportunity to pass on their

valuable knowledge and skills to younger engineers coming through. As a result we

have only been able to concentrate on delivering our statutory and reactive duties

operationally, therefore strategically we have been working hard to try and at least

re-establish our full complement of technical staff.

Within the first quarter of this year the Estate and Clinical Engineering Department,

in its entirety, officially moved across to the Gibraltar Electricity Authority. This has

presented some additional challenges to us operational, but has also given us the

opportunity to raise awareness about our viability to operate as a department moving

forward; given our reduced numbers and ever decreasing level of expertise. I am

therefore pleased to report that within this quarter the CEO of the GEA has been

able to release all of our vacancies, with permission to advertise outside of the

limited GEA pool of engineers. One area of expertise we have been struggling to find

engineers for is within our clinical engineering team, where we need multi-

disciplinary engineers with an Electrical/Electronics background with the ability to

diagnose faults accurately and quickly; as the work is primarily complex high risk

medical devices.

2. Medical Devices.

Capital for FY 2019/20 has now been released, and within this quarter the medical

devices committee has met to determine what budget will be available for both new

equipment and critical ‘Life Cycle Replacement’; particularly in terms of key high to

medium risk medical devices requested within our estimates.


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Unfortunately over the last couple of years the hospital has been building an ever

increasing list of equipment that requires replacement, the effect of this is three-fold;

risk to patients, risk to service continuity, and increased capital budget requirements.

With regards to the FY 19/20 budgets, the committee has asked for the medical

devices (new equipment/lifecycle) budgets to be ‘ring fenced’ so that the committee

can prioritise the purchase of critical new equipment, and the life-cycling of old

equipment in accordance with the risk. Further to this, for items that become critical

and in desperate need for replacement the committee has added an impact risk

assessment for each item.

From our recent meeting it was determined that capital budgets were one again

extremely stretched and the committee were restricted to a limited budget for critical

items only. On this basis the committee has been determining priorities for

immediate purchase.

3. Clinical Engineering –

Over the last three months, the Clinical engineering section has been heavily

involved in the commissioning and setup of medical devices to equip the new child

CPCC (CHC) and the PCCC, adult primary care units.

Our team has also been assisting our specialist dental suppliers during and after

working hours on the setup of systems for all 7-Suite Dental clinics and their

respective plant rooms.

Further to this we have also managed to assist our specialist medical gas suppliers

with the pipework and pendent installation for medical gases within the new theatre 5

suite, along with the build and installation of other system within the suite, including a

new surgeon’s panel and LED theatre light.

The extra workload relating to projects has impacted on both the department’s

operational productivity, and its ability to perform critical planned preventive

maintenance. It has not been possible to maintain critical equipment and this has

unfortunately resulted in an increase to our backlog maintenance. IT must be

highlighted that increased backlog unfortunately leads to increased risk to our

patients.


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As already highlighted strategically the current situation in terms of our inability to

recruit suitable engineers has a bearing on our viability as a clinical engineering

department, and we are being forced to work outside the box in order to function day

to day.

However the department continues to perform to the best of its ability to meet all the

reactive works, unfortunately at the cost of planned preventative maintenance. This

lack of manpower and decreasing level of skills set is forcing us to look at

outsourcing more and more maintenance, and in light of BREXIT this strategy its

own risks (due to us being more reliant on Spanish expertise) .

During this period little progress has been made on departmental development in

order to improve operational efficiencies and standard of work. Due to the lack of

personnel on the ground it has also remained extremely difficult to ensure CPD and

training is implemented effectively. However with the potential for new staff coming

on board, following the current recruitment drive, training will, and must be,

fundamental in bringing the skills sets and expertise back up to acceptable levels.

Medical Device Alerts and Recalls Attended in the last 3 Months –

Equipment Affected Description of problem

Philips TC50 ECG Risk of Batteries Overheating or Igniting

Omni Diagnost Eleva Locking Plate Inspection – Arrangement made with Philips UK for upcoming Visit

Alaris Pumps Module Weak Construction of Bezel posts. May Break and result in inaccurate dosage

Philips VS3/4 Vital signs Monitors Pulse rate Software upgrade – Arrangement made with Philips Iberia for Upcoming Visit

External Service Provider – Completed PPM’s –

Service Provider Equipment completion Date

GE Healthcare Ultrasounds Machines July

Atlas Copco Medical Air Compressors August

Envair Cytotoxic Dispenser Cabinet

Philips UK Radiology Modalities

Steris Iberia Autoclaves and Washer Disinfectors September


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External Service Providers - Corrective Maintenance –

Service Provider Equipment Repairs Month

Atlascopco Medical Air Compressor 1 July

Steris Autoclave 1

Olympus Endoscopes 2

Philips UK Radiology Equipment 2

Philips Iberia Monitoring Equipment 1

Steris Sterilizers 2 August

Philips Iberia Monitoring Equipment 1 Siemens Ultrasound Machine 1

Philips Iberica Monitoring Equipment 4 September

Graham Parsons Dental Equipment 2

Steris Autoclaves and Washer Disinfectors 4

Topcon Ophthalmic Equipment 1

GE Healthcare Anaesthetic Machine 1

Medical Device Alerts and Recalls Attended in the last 3 Months –

Equipment Affected Description of problem Status

Stryker Lifepak-15 Defibrillator

May fail to work after first delivery shock Resolved

Encor Breast Biopsy Probe

Risk of Leak onto the driver and Minimal Suction

Resolved

Philips TC50 ECG Risk of Batteries Overheating or Igniting In-Progress

Omni Diagnost Eleva Locking Plate Inspection – Arrangement made with Philips UK for upcoming Visit

In-Progress

Alaris Pumps Module Weak Construction of Bezel posts. May Break and result in inaccurate dosage

In-Progress

Philips VS3/4 Vital signs Monitors

Pulse rate Software upgrade – Arrangement made with Philips Iberia for Upcoming Visit

In-Progress

In-House Scheduled Maintenance –

PPM Status Completion Date

Patient Lungs Ventilators completed June

Syringe Drivers completed June

Suction Pumps completed June

Reactive works attended over the period covered by this report –


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% Differenc

e from Previous Quarter

Carried Over from

Previous

Quarter

Ticketing

System

Phone

Jobs

Emails

Jobs

Call-Out

s

Total Breakdow

n

Completed Jobs

Pending Jobs

0% 68 420 21 55 56 552 554 66

Commissioning of Medical Equipment -

Qty Equipment Date

1 Low Profiling Beds July

1 Optical Testing Chair 1 AED

2 Static Bike August

2 Manual Wheelchairs 4 Nebulizers

10 Tympanic Thermometers

14 Examination Couches September

2 Manual Wheelchairs 2 Surgery Trolleys 2 VAC Units

1 Therapy Chair

4 TC50 ECGs

Projects and Departmental Developments -

CPCC

a) Acceptance and Commissioning of Medical Equipment well

Progressed.

The duplex AGSS for the new dental (7 off Suites) is currently on transit - Due to

arrive by mid next week.

PCCC

a) Acceptance and commissioning of Medical equipment are being carried

out as they are received – In Progress (Early Stages).

Theatre 5

a) Surgical Lamp has been sent twice with wrong configuration – Waiting

for the 3rd attempt from Steris.

b) Steris have supplied Pendant on site. AGSS was found to be not

compatible with our system – Currently liaising with Steris and Midland

Medical to resolve this issue ASAP.


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c) The material for the Medical Gas Installation was shipped from UK on

Monday 1st July.

d) Manufacturing of Surgeon Panel is pending arrival of the digital and

analogue clock from the same supplier. We are expecting a two-week

lead time after receiving these items.

CCU Isolation Rooms (PPVL - Positive Pressure Ventilated Lobby)

a) 6 off Lockable line isolation valves to be fitted at the supply line for the

isolation rooms.

Datix –

We have been responding to Datix as and when appointed as handlers, this is an

extremely good system for ensuring that investigations are governed correctly and

that route cause analysis is employed and followed through.

4. Electrical Engineering –

During this quarter we have carried out a very limited amount of scheduled

maintenance. Although we have been involved with an extensive amount of new

works they have not generally interrupted our daily routines as these have mainly

been completed after hours.

The department’s main output activity this quarter has predominantly been dealing

with reactive maintenance issues. Unfortunately a limited amount of hours have

been dedicated to preventative maintenance.

Staff manning levels remains a concern as another member of the team retired

within this quarter (Manning levels are down to three electricians) with two others to

follow within the next quarter. As per the rest of the department’s recruitment issues

there has been no opportunity for succession planning and as a result we have lost

the opportunity for retiring staff to pass on their valuable site and systems

knowledge.

The on-call roster of one in four has one week without cover due to the retirement of

one operative. So there is one week in four without electrical on call cover. For this

next period will see a second retirement and the cover will be reduced further

resulting in two out of four weeks covered with the electrical on call staff only.


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Internal Planned Preventative Maintenance -

Planned maintenance activity in the quarter has been minimal due to the high levels

of reactive calls, along with critical projects.

Planned maintenance this quarter has been restricted to the following:

Service Provider System Month

Otis Lifts & Escalator July

Otis Lifts & Escalator August

Otis Lifts & Escalator September

UPSMEIER UPS & IPS

Reactive Works

Reactive maintenance is ongoing and will increase if planned maintenance regimes

are not undertaken. Reactive works this quarter are as follows:

Month Ticket

System Phone Jobs

Email Jobs

Call-Outs Total Breakdown

July 70 - - 13 83

August 42 - - 12 54

September 47 - - 13 60

Projects / New Works –

Location July – September 2019 Projects

St Bernard Secure level 2 corridor with access control

St Bernard New infection control area outside ITU

St Bernard Porta cabin Installation for records completion

St Bernard Outpatients modifications for new PCC requirements

St Bernard OP/TH 5 Project & plant room works

St Bernard Medicom Nurse call system upgrade

St Bernard Grd, 1st, 2nd B4 floors removal of services for new PCCC project.

St Bernard Dialysis Conversion/Expansion on-going

St Bernard A+E Containment suite access control and electrical services

St Bernard Basement Access via lift lobbies access control


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St Bernard Stores Conversion, lighting and access control, on-going

St Bernard Facilitate the replacement of the Hospital front (circular) doors

St Bernard UPS installation works for new PCCC & CPCC

Electrical Training -

To date, technical training of the electrical department staff has been virtually non-

existent. However two members of the team have participated in the BS ISO 7671

IEE Regs 18th edition course this year to date (Q1).

Technical Training Required: in keeping with progress and new technology, and the

consequential upgrade to hospital’s systems year on year, there is a need to

organize a number of courses for our staff which include the following;

• First aid at work (electrical) in accordance with HTM06-02

• Fire Safety in accordance with HTM05

• AutoCAD

• UPS/IPS systems in medical locations to HTM06-02

• Data Centre Course

• UPS design for IM&T in accordance with HTM06-02 and BS7671

• Electrical Authorized Person (AP) HTM06-02

• Lifts trapped passengers to HTM08-02

• Electrical testing in accordance with BS7671 IEE 17th Edition

• PAT testing

• GENT fire systems in accordance with HTM05

• CEM access control (technical)

• Austco Nurse Call system (programming) to HTM08-03

• Lift management (AP) to HTM08-02

• Solar Power systems

Degree courses in hospital engineering foundation are also something that we would

like to aspire to in the future.


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5. Mechanical Engineering –

Within this quarter the division has generally concentrated its time between projects

and maintenance works. As the completion dates for each phase of the projects

approaches, this exacerbates the need to sacrifice maintenance work for project

works. This coupled with our staff shortages (annual and sick leave) inevitably

results in staff pressure, and areas of important planned maintenance being

deferred.

A good 80% of our work is currently of a REACTIVE nature; careful analysis of this

work reveals that there is a close correlation between reduced planned maintenance

works and the types and number of callouts we receive. Equipment and/ or system

serviced or maintained at the correct frequency will break down more often and

usually with a more severe consequence.

Within the quarter we have had one member of staff retire, with two members

expressing a request to transfer within the GEA. This is extremely concerning, with

no light at the end of the tunnel in terms of succession planning and / or recruitment.

Jobs raised as on-line tickets -

Total tickets received

Tickets completed Tickets Pending

April 26 26 0

May 5 5 0

June 16 14 0

Total 47 47 0

Jobs raised by Phone call -

Jobs Raised Jobs Completed Jobs Pending

April 3 3 0 May 2 2 0 June 1 1 0 Total 6 6 0

Jobs raised by verbal reports -

Jobs Raised Jobs Completed Jobs Pending

April 7 7 0 May 6 6 0


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June 7 7 0 Total 20 20 0

Out of Hours Callouts -

Ward filter cleaning /Replacement -

number of filters cleaned

April 268 May 277 June 292 Total 837

Other Reactive works carried out -

Replacement of Drive belts ongoing.

Ongoing AHU Pre filter replacement.

A total of 11 Clinical beds have been assembled and dismantled by Danny on

behalf of Cancer.

Relief Service.

Ongoing Fan deck replacement.

Planned Preventative Maintenance -

24 Air Handling units have been serviced and we are almost to schedule.

We are slowly bringing the Fan coil servicing up on line started mid-

September and we have carried out - total of 18 units.

Ward filter cleaning is ongoing.

Inlet station chlorine tank and injection point service ongoing.

We have been assisting our specialist HVAC contractors with the annual

checks of ductwork fire dampers, and the AHU plant verification reports.

number of callouts

April 13 May 22 June 24 Total 59


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Projects -

There has been a lot of works involved with enabling B4 for the PCCC - in

terms of removing redundant mechanical services.

A&E containment suite is progressing well, we are currently commissioning

the HVAC for this area.

Ongoing Theatre 5 works – installation of laminar flow hood and plant room

ductwork.

Dialysis – works is progressing well; the new plant is installed and we are

about to commission the 8 bed temporary area from the new plant room. We

are awaiting delivery and installation of the new isolation room AHU.

Family’s room outside Critical Care unit has had a DX Air-conditioning unit

installed.

Specialist Visits -

Fresenius on various occasions to install the new dialysis water plant and

advise us.

AirisQ came to inspect our Fire Dampers and carry out some validation work

Wheis Klimatec for theatre 5 project will need to visit again.

Fuel Oil -

The fuel is monitored on a daily self-built programme, this is now starting to bear fruit

and we are slowly building up a historical record of consumption, which can then be

reconciled with delivery data.

Fuel oil consumption -

Total for the month Average consumption per day

July 19676 litres 634.7L/day August 19093 litres 615L/day September 21324 litres 710.8L/day Total 60093 litres

We had 2 fuel deliveries, on the 30th Aug and 02 Sep 2019 a total of 66,000 litres were purchased


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6. Projects Completed and On-Going – (main projects only – this does not

include strategic reactive projects)

A huge amount of our time has been invested this quarter managing the three

significant primary care projects; including the new children’s hub in building 9

ground floor, the new 3 level extension to block 4 (south) to house adults primary

and community care, and a new 2 level extension to the north of block 4 to enable a

separate entrance to the new PCCC. Also related to these projects there has been

some sub-projects which include the moving of records into porta-cabins between

blocks 1 and 3, this was to enable pharmacy to move out of the ground floor of block

4 and enable the continuation of primary care services within the ground floor

(consisting of registration, lymphedema clinic, the ulcer clinic, PCCC admin and

community OT).

I am pleased to say that significant milestones have been achived this quarter in

terms of these projects, with the opening of the CHC (CPCC) within block 9, the

moving of records in its entirety, and the completion of both the PCCC entrance

extension and practical completion of the main PCCC building. A MASSIVE

ACHIEVMENT.

Opening of the new

Children’s Health

Centre (CHC) on July

16th.

https://www.chronicle.gi/childrens-health-centre-unveiled/


26

A massive achievement

by my team, the design

and management of the

dental infrastructure

systems to facilitate the

moving of our

pharmacy to the

second floor of block 4.

7. New dental clinics within the CHC.

As part of the B4 works we

included the installation of a large

air conditioned and secure space

to house our patient records. This

was to facilitate the moving of our

pharmacy to the second floor of

block 4.

The Children’s Health

Centre (CHC) opened

on 16th July.

https://www.chronicle.gi/childrens-health-centre-unveiled/


27

The Adults Primary

Care Centre is

opened on Monday

14th October.

New Theatre 5 – Theatre 5 will be located within main theatres and within the West

wing, mirroring the position of theatre 3. This theatre is being built as a Laminar Flow

theatre and will only consist of a main theatre with separate scrub.

This project is under way;

we anticipate the theatre

to become operational by

early next year. This

project is a challenge in

terms of engineering due

to the limited space within

the plant room above,

and the ceiling void within

the proposed space. To

this end we are adopting German technology which will provide a state of the art

compact solution.


28

New MRI suite – This is a complex

project that requires careful

consideration in terms of its location and

proximity to other services that may

have a detrimental to performance. This

is ‘turn-key’ project; procurement, design

and installation. We are currently in the

design stage of the project with the

preferred supplier.

Enabling works have commenced in order to prepare the space. The enabling works

involve the stripping out of old services and the waterproofing of the road above the

space; located within block 2 within the basement area, ideally suited for this type of

equipment. This project is likely to commence within the next few months.

Cardiac Catheter suite – Like the MRI project we are working with three suppliers in

terms of feasibility, location and logistics. Again this is a highly complex project which

required careful consideration, particularly in terms of adjacent services. This is also

likely to be a ‘turn-key’ project. An ideally suited location has yet to be finally agreed

and confirmed. It is hoped that this project will also commence before the end of the

financial year.


29

Dialysis Expansion – due to pressures in terms of the

number of patients requiring dialysis we have been

asked to look into the expansion of the department.

This is another challenging project which will require

several critical stages in order to enable the

continuation of the service throughout the works.

Phase 1 – installation of new water treatment plant

capable of expansion to up to 25 stations.

95% complete

Phase 2 – the creation of a temporary dialysis suite for use during the expansion of

the existing space. This also involves the moving of infection control and the dialysis

staff facilities to create the space.

40% complete

Phase 3 – removal of the existing water treatment plant and the creation of an

expanded ward.

0% complete

Phase 4 – removal of the temporary ward and the creation of an isolation room,

along with dialysis staff facilities.

0% complete

Dialysis Associated Works –

Works were required within MIU to create temporary space for Infection Control and

Dr Simon Lines, who needed to move out of Dialysis during the expansion works.

A new space for Infection Control will be created in the old relative’s room at the

entrance to ICU. The relatives room has now been relocated, so this works is ready

to commence.

Whilst doing these works we created more space for visiting consultants.

100% complete


30

A&E Containment/Isolation Suite – We have

commenced the building of a new containment suite

within A&E, this is for the isolation of patients with

suspected contagious diseases. This is designed to

cope with all possible scenarios providing negative

pressure isolation for up to CAT4 level. Although not

built in accordance with HBN4 it provides a negative

pressure suite of rooms with the capability of

controlled containment pre diagnosis.

Oxygen generator/concentrator – in light of Brexit we have investigated and

subsequently procured a new oxygen generation plant. This system will supplement

the existing VIE and reserve backup systems and provide an ‘island mode’ capability

such that we would not be relient on liquid oxygen deliveries from Spain. Although

we will need to retain the current bulk storage and rotate the storage capacity this

new plant will provide much greater resilience in terms of our oxygen supplies (Bulk

Storage Only; although we would also have the capability to fill cylinders, due to

legal implications this would only be used in extreme emergencies).


31

Projects – Presently at Design / Feasibility stages -

SBH A+E Phase 3, Ambulance entrance Canopy – These works are

required to ensure protection of patients and the department from severe

weather, particularly westerly and south westerly storms.

This

project has

been

presented to planning and is in the final stages of approval prior to tender and

financing.

SBH Sponsored Patients – Redevelopment of unit, to improve patient access and

data protection. Currently on hold pending funds and a permanent location.

Electrical and Mechanical Resilience - We continue to look at ways of increasing

resilience for our electrical infrastructure; particularly in terms of UPS provision and

the protection of vital electrical components. To this end have been looking at

installing a 80 KVA UPS as part normal lifecycle replacement within one of our

critical server rooms.

6 No. additional Solar PV arrays - to reduce our demand on the grid, our carbon

footprint, and reduce our revenue spend on electricity. A business case has been

prepared within the previous quarter and submitted to both the ministries for health

and the environment.

2 x 6.1 x 4.2 m

Cabins Housing

Duplex Oxygen Generators


32

Block 1 Podium Overhang Extension – Planning permission was submitted and

approved in 2015 to fill in the overhang

between podium level and first floor level.

Various options are being considered for this

extension but it is likely to become a

permanent solution for Ambulance Services. It

is likely that this project will commence before

the end of this year.

Expansion and relocation of ENT department – this is planned to go within the

new extension of block 4 on the 1st floor, this will house all ENT services including

adults and children.

Please also see Appendix 1 which includes a full list of projects either in

progress or under investigation this quarter.


33

Appendix 1 –

Respectuflly Submitted

Tony Dolding MARU MSc, MIHEEM

No Project Principal Contractor Status Cost Estimates Notes Risk Status

1 CPCC / CHC CASAIS

Official opening for phased occupation 16th

July - dental at least one clinic by 12th August,

all services operational by 1st week in

September

2 CHC Canopy WSRM priced by CASAIS

3 PCCC CASAIS

Construction phase, internal fitout, due for

handover on 16th September

4

PCCC Main Entrance B4 Extension - shell and

core CASAIS 80% Complete

5

PCCC Main Entrance B4 Extension - Ground

floor entrance lobby reception and link CASAIS 30% Complete

6

PCCC Main Entrance B4 Extension - Move of

B4 records to enable pharmacy move - cabins

between B1 and 3 CASAIS plus Balat

Cabins and infrastructure in place 100%

Complete, waiting for the transfer of records

once GDPR signed off by ministry - estimated

move date 9th August

Move of records is likely to

take 5-7 days

7

PCCC Main Entrance B4 2nd floor -

Installation of HVAC Services to new PCCC

building CASAIS 10% Complete

8

PCCC Main Entrance B4 2nd floor - Build new

pharmacy B4 2nd floor CASAIS 0% Complete

9

PCCC Main Entrance B4 2nd floor - Strip out

of old pharmacy and complete ground floor

(registration, lymphodema, ulcer clinic CASAIS 0% Complete

10

PCCC Main Entrance B4 1st floor extension

shell and core - Build new ENT department Tender 90% Complete

11

PCCC Main Entrance B4 1st floor extension -

1st floor moves to establish orthopedics

department Tender and In- house 0% Complete

12 Old PCC the ICC reinstatement

CASAIS looking at providing a design

build cost With CASAIS

13 New Laminar Flow Theatre 5 IAC, Midland Med, Weiss, In-house 70% Complete - HVAC 30% Complete

14

Dialysis - Expansion of dialysis to 10 couches -

pre works - 8 bed temp unit plus new PPVL

Isolation room, New RO plant room Fresenius, IAC and In-house

New RO plant room 100% complete, temp 8

bed bay and isolation room 30% complete

15 Containment Suite within A&E IAC, Site Trading and In-house 90% complete

16 MRI

Managed Service and Turn-key

project with Phillips Waiting for instruction

17 Cardiac Cath Suite

Managed Service and Turn-key

project - NOT Appointed Waiting for instruction

18 Detox Unit Design stage Waiting for instruction

19

Move of Cardiac Rehab to enable the Detox

unit - possible location basement of Atlantic

suites Design stage Waiting for instruction

20

Isolation Rooms - within ITU, Victoria and

John Bioquell - In-house

Bioquell PODs installation within ITU 100%

Complete, budget required for additional true

isolation (PPVL)

21 New Ambulance Centre

In design stage and planning with

WSRM Waiting for instruction

22 Oxygen Generator Order placed - due on site November 19 BREXIT ITEM

23 Garden disabled lift

Tender stage - Principal Contractor

enable construction and appoint lift

contractor Waiting for instruction

24 Stem Cell Cryo unit - rear garden

Design stage with Gov appointed

Architects Waiting for instruction

25 Chemo unit expansion

WSRM to be part of the ambulance

centre extension to B1 overhang Waiting for instruction

26 Chemo/Pharmacy Aseptic Suite

In design stage - issued drawings to

Envair as a Turn-Key Waiting for instruction

27

PATHOLOGY - BSL3 for microbiology lab: BSL3

cabinet refresh or BSL3 room & lab redesign

Recommendations received from

Nicholas Cortes - need to look at

HVAC and installation as a whole

Waiting for initial design and specification for

tendering

TD to prepare Spec and

Tender

28

Pathology Lifecycle replacement of main

AHU Obtain a 'Flat Woods' quote

29 Coaling Island expansion works In-house Waiting for instruction

30 CSSD Expansion

With Steris - looking at a managed

service OFF SITE Waiting for instruction

31 Sponsored Patients expansion Waiting for instruction

32 Expansion of Opthomology Waiting for instruction

33 Move of IT to building 9 Waiting for instruction

34 Expansion of Endoscopy Waiting for instruction

35 Generator Testing 100% site load Versetec ( Emergency Generators)

Generators currently tested OFF LOAD need to

test them monthly ON LOAD

Resiliance in light of the

recent UK network failure

and NHS generator failures

36 A+E Canopy Tendered - Site Trading and JBS

37 A+E Ambulance Bay Works H&S Kenneth internal Quote Waiting for instruction

Capital Projects - 2019 -20


34


35

5.4 Director of Nursing Services

Ambulance

Emergency Ambulance Deployments - July 2019 – September 2019

Main Zone Deployments

Month Total Average per day

July 491 16

August 518 17

September 491 16

Month Jul Aug Sep Total

Gib Port 10 10 10 30

North Area 63 62 59 184

Eastside Area 18 20 21 59

Westside Area 173 191 143 507

South District 93 115 122 330

Upper Town 31 25 28 84

Town Area 99 116 116 331

Frontier/Airport 14 12 4 30

Nature Reserve 10 4 6 20

Gib Dock 0 0 0 0

Maritime 0 2 0 2


36

Ambulance Routine Transfers Operations

Summary of Patient taken for Scans and or Transfers to Spain - July 2019 -September 2019

Summary of Local Patient Transfers - July 2019 – September 2019

Destination July August September

Algeciras 75 82 94

Benalmadena

(Xanit)

1 3 4

Cadiz 0 0 1

Gibraltar 31 13 19

La Linea 3 8 2

Malaga 33 17 3

Sevilla 0 0 0

Platelets 6 1 0

Marbella 6 8 5

Totals 155 132 128

Month Total Average per day

July 381 18

August 429 19

September 363 16


37

Breast Care Clinical/Patient Care:

218 Patients have been seen in breast clinic in this quarter

108 New patients referred via HIS to Breast Clinic

4 New patients diagnosed primary/secondary breast cancer

90 patient contact (patient telephone calls/appointments /visits) SOPD/Ward

3 Lymphedema patient appointments + admin/ ordering garments

5 Prosthesis fitting clinic patient appointments

12 Wound care +seroma care appointments

6 Home visits

10 Patients referred with Family History concern; Questionnaire + IBIS software calculation-outcome letter and patient information posted and/or referral for additional breast screening

5 Patients seen by CNSPam Estella deemed ‘high risk’, in line with the to IBIS calculation

On-going Education CPD/Teaching/Training:

CNS Estella Online Post Graduate Diploma in oncology (Newcastle University)

Breast examination and Client Communication Course Jarvis Centre UK Dec 2019 1 week CNS Christine Gill (cancelled May 2019)

Policies/Clinical meetings:

Attendance at weekly Breast radiology MDT

Attendance at weekly Oncology MDT

Weekly patient updates with Breast consultant

Attendance Oncology Clinical Governance meetings organized by Cancer Services coordinator

Innovations:

GHA Breast Cancer Register to track patient’s pathway and follow-up.

At printers - Patient information booklet - GHA Breast Clinic Discharge Following 5 year follow-up for breast cancer.

At printers Patient information GHA Breast Cancer Related Lymphedema

Breast Cancer Family History Service

Palliative Care Total of New Referrals to GHA Palliative Specialist Nurses: 31 in this quarter Total Nurse Specialist consults: 174 (Inpatients: 158/ Home visits: 10/ Oncology appointments: 6) Hospital deaths with specialist input: 24 Home deaths with specialist input: 2 Total: 26


38

Infection Control

Continued daily surveillance of MRSA, CRE & ESBL across SBH. All patients are returning from tertiary Hospitals are screened for MRSA and CRE, as a matter of routine. Mandatory 6 monthly screening undertaken on long stay wards and positive patients decolonised. Raising infection control protocols and proactively manage high risk areas. 1st July- Known CRE+ positive patient taken to theatre from A&E with # NOF. Theatre staff followed Infection Control practitioner instructions to declutter theatres and remove all none essentials. Staff followed IC theatre flowchart and post op cleaning and fogging arranged. 30th July – CRE+ (urine & rectal swab) patient identified in VMW. Patient isolated and contact tracing undertaken on all patients on that ward. Through contact tracing 3 other patient were identified as positive. Decision to cohort 3 + patients was taken after discussion with consultant Microbiologist due to lack of side-room availability. Staffs were briefed on importance of using contact precautions PPE and Hand hygiene. Contacts monitored throughout August as per PHE guidance tool –no further contacts found to be positive. On-going training: Mandatory Training for sessions;

9th July & 10th July –GHA staff.

19th July – Bleak House –Dr Giraldi staff.

21st August –Bleak House-Dr Giraldi staff.

6th Sept- GHA staff.

13th Sept – Bleak House- Dr Giraldi staff. Attended meetings in line with Clinical Governance

Infection Control Committee meetings (Monthly)

Nursing Clinical Governance meeting (Monthly).

Public Health Meetings (weekly).

Influenza Campaign meetings (on going with all stakeholders). Attended 6 Hats thinking Seminar. Monthly BBV clinic held twice a month with visiting consultant Dr Garcia. Reviewing HIV patients and Hep C patient to see if require treatment. Following plan of CRE + patient in community, currently homeless with no fixed abode. Third and fourth screen undertaken both- Negative. Patient currently in Ocean views.


39

Environmental re-audits for Cochrane and Calpe ward were also undertaken in this quarter:

Calpe ward- 61% Minimal Compliance initial audit- Re-audited-.4th July -95% Compliance.

Cochrane Ward- 61% Minimal Compliance initial audit- Re-audited- 4th July- 92% Compliance

Rainbow ward-81% Partial Compliance second audit- 3rd Re audited 9th July -93% Compliance.

John ward – 79% Partial Compliance initial audit- Re audit- 24th July-96% Compliance.

A&E- 80% Partial Compliance initial audit- Re audit 24th July 91% Compliance

Environmental audits carried out on floor 1,2.3 & Jewish Home & Theatre.

Floor 1- 99%Compliance

Floor 2- 97% Compliance

Floor 3- 97% Compliance

Jewish Home- 97% Compliance

Theatre audit - undertaken- findings still pending to be reported. August- Influenza Campaign (On going) - Preparations for 2019/2020 GHA Influenza Campaign. Weekly meeting to discuss strategy for delivery of Influenza vaccine with stakeholders in order to obtain accurate data on uptake from staff and community. This year’s campaign will be consisting of offering; Adjuvanted trivalent flu vaccine (aTIV) - This is licensed for people aged 65 years and over and is the vaccine recommended by the Joint Committee on Vaccination and Immunisations (JCVI) for this age group. Quadrivalent vaccine (QIV) - This is recommended for children aged from 6 months to 2 years and in adults from 18 years to less than 65 years of age who are at increased risk from flu because of a long term health condition. Fluenz Tetra Nasal spray suspension Vaccine (live attenuated nasal) – will be offered for the first time in Gibraltar to children aged from 2, 3 & 4 years old will be offered. 2nd August- IT developed programme to raise ALERTs of micro resistant organisms on HIS so patient highlighted in case needed admission or went for surgery. All MRSA colonisers, C.Difficile and CRE imputed on alert system. 6th August – Infection Control Practitioners underwent “FIT testing course” to become accredited to train staff. Fit testing we were assessed and trained using


40

Draegar masks which have various sizes and our accreditation only covers the use of these masks. 7th August- Stock control of personal protective equipment undertaken to establish numbers remaining and whether fit for purpose. PPE count;

Sizes Suits with Boots

Suits without boots

Goggles Overshoes

XXXL - 89

XXL 50 66

XL 75 64

L 69 28

M 66 35

S 72 42

TOTAL 332 324 535 350

GRAND TOTAL

656

Fluid repellent coverall suits, anti-fog goggles and over shoe covers that we bought for the Ebola crisis in 2014.

Organisation needs to consider changing our FFP3 respirators as the one we use now (Meddop) is one size only and we cannot offer an alternative size if this does not fit.

20th August- Endoscopy final rinse water issues raised as in breach of best guidance and placing patients at risk, as not being undertaken for last 8-9 months. No clear definition of whose role and responsibility it was to undertake water sampling. Same has now been addressed and agreement reached by Endoscopy team, Public analyst and Clinical Engineering who have agreed to undertake water sampling every Wednesday morning. Endoscopy to submit SOP for water sampling to present to ICC and governance. 28th August - Mattress audit undertaken by ICP and practice development nurse and TALLY representative. (Audit report attached). Same to be presented at next ICC meeting. 11th August - BAL from patient positive for MTB – Rifampacin sensitive. PHx – Admitted via A&E 26/06/2019 – poly trauma call after falling from a window. Intubated in A&E – CT scan performed and there was changes? cavitation on Chest. Patient conveyed to Quiron Malaga via ambulance with escorts. 6 weeks in Malaga and repatriated back to SBH. Patient with trachy and ventilated; respiratory precautions and isolation maintained since admission Quiron Malaga was contacted via email from Dr Nick Cortes (06/08/2019) alerted Quiron Palmones to contact Malaga to alert staff of result. Contact tracing was carried out on all staff who undertook airway management.


41

All staff deemed at risk were Mantoux tested- results all negative and BCG will be offered. 21st 25th Sept- Infection Prevention Society annual conference- Both Infection Control Practitioners attended IPS conference in Liverpool for insight into updated practices and equipment. Practice Development Mandatory training session attendance (medial, nursing and AHPs) Infection control: 35 Moving and handling: 24 Blood transfusion safety: 21 Pain and dementia: 21 Palliative hour revision sessions: 13 Paediatric masterclass: 27 3-day paediatric update: 25 Paediatric medical emergency training: 14 Adult medical emergency training: 159 Talley group pressure area care: 13 EPALS: 12 Moving and handling: 8 members of staff, 1x OT, 1x physio, 1x MET, 5x nurses successful completed a 5 day moving and handling course enabling them to deliver in moving and handling training throughout the GHA and provide support at clinical level. Nursing assistants: All the April 2019 nursing assistant intake allocated to SBH & PCC have successfully completed their 12-week induction programme and competency booklet. Tracheostomy care: Online modules from tracheostomy.org.uk have been made available to all staff alongside clinical support from PD and the weekly altered airway round. Mattress audit: The first hospital mattress audit was completed with assistance from the Talley group Stoma care: Access to online training course arranged via stoma specialist nurse Post on-line completion practical sessions on going On-going projects: Working groups established for documentation and fluid administration


42

Resuscitation Officer

Basic Life Support (BLS) is a mandatory requirement for all grades of clinical staff. In

the period July to September 2019 159 staff have attended a 2 hour Adult BLS

course with a further 14 the Paediatric BLS one. EventBrite is being used so that

staff may book these sessions more easily.

7 doctors and five nurses successfully completed the European Paediatric Life

Support Course (Resuscitation Council UK) with 3 of the medical staff chosen to

become Instructors in the future.

One Paramedic attended the Generic Instructors Course run by the Resuscitation

Council UK in order to instruct on the Advanced Life Support Course in Gibraltar.

A simulated cardiac arrest was run in the Children’s Health Centre to identify areas

of risk and training needs.

ENT Consultant, Speech & Language Therapy, Matron, Practice Development Sister

and Resuscitation Officer have initiated a weekly Altered Airway Round where in-

patients with a tracheostomy are reviewed and plans of care updated as appropriate.

The Resuscitation Officer has a regular involvement in multidisciplinary team

meetings (MDT) in order to give advice on resuscitation decisions and treatment

escalation planning.

The Resuscitation Officer sees both patients and relatives to discuss Do Not Attempt

Resuscitation (DNACPR) decisions.

DNACPR policy has been reviewed and will be considered by the Resuscitation

Committee in October.

Audit and debrief of emergency calls/ cardiac arrests is now a routine occurrence.

Emergency equipment has been reviewed and the Emergency Trolleys will be

updated in October.

Ambulance Patient Record Forms are now reviewed whenever a patient has

suffered an out of hospital cardiac arrest or the A&E department has been alerted

prior to arrival that the patient is seriously unwell.


43

Matrons ‘Safeguarding Adults’ training on basic awareness continues to be a success with GHA staff attending on a monthly basis. Furthermore, it has been included in the Mandatory training policy that all staff must attend and will updated on a three-year cycle. The Matrons conducted a Ward Accreditation Audit in line with Essence of Care benchmarks. The Audit has shown that the Hospital Wards did not meet the relevant benchmarks. As a result, an action plan has been drawn up with the Ward Managers to ensure all Wards can work towards becoming compliant. Measuring the quality of the Nursing Care that is being delivered means that we can cross reference this with evidence based practices as patient safety and quality assurance is the one of the GHA’s core principles. The Matrons continue to be part of the Datix Incident Grading group. Datix is a patient safety quality improvement tool that produces incident reporting and risk management for the GHA. Datix is widely used by staff, including clinicians, to report all clinical incidents. Staff are trained in using Datix as part of the GHA’s Mandatory Training policy. The system can be used to manage incident reporting, risk registers, complaints, claims, requests for information, safety alerts and benchmark against standards in the UK. The Matrons continue to attend the Maternity Clinical Risk monthly meetings. A case is reviewed and statistics are benchmarked against UK. Matron Orfila-Gonzalez organised the Workplace and Wellbeing interviews. A visiting team from UK met up with Nurses to discuss their experience and career journey with the GHA. This is part of the GHA’s Values strategy. Charge Nurse Salcedo has put together the Pressure Ulcer Steering group. All pressure ulcer reports are investigated and measures are put in place to minimise the risk of the patient developing any further injuries. The group will be presenting a new pressure ulcer prevention tool to aid the nurses in assessing patients and identifying those patients at risk. Matron Orfila-Gonzalez has written a new Transfer and Escort of Patients Policy. The purpose of this policy is to provide a standard GHA-wide procedure that will ensure the safe transfer of all patients internally between departments. The level of escort provision that is necessary for effective risk management and the care of patients is also defined in this policy. In conjunction with the in-patient Falls policy, Charge Nurse Salcedo is establishing a falls pathway for A&E with the Community Occupation Therapists primarily focusing on patients who have fallen, people who are a falls risk and are being discharged from A&E. This initiative will safeguard this group of patients which are currently falling through the gaps.


44

Matron Orfila-Gonzalez attended the Pressure Area Workshop delivered by the Talley rep. A mattress audit was conducted following this workshop. Matron Ag Salcedo teamed up with Lea Fountain, Communications Manager, to deliver the Values workshops. This initiative will be part of the GHA communications strategy. The Difficult Airway round was established following the rise in patients with tracheostomies within SBH. This was set up by Dr Danino (ENT Consultant) with an MDT approach. The airway rounds are conducted on a weekly basis with Dr Danino, Matrons, Practice Development Nurse, Resus Officer, Physios, Dietitians, Occupational Therapists and the Speech and Language team. All patients are assessed with their parent team and an action plan is conveyed to all members of the MDT. The Matrons set up the quarterly DNS, PD, Matrons and Ward Managers meeting. All Quality Improvement projects are discussed in this meeting. The Ward Managers use this forum to discuss any concerns or initiatives that they have. Charge Nurse Salcedo has been working alongside the Hospital Social workers and Rainbow Ward Sister to devise a document called ‘Passports’ for those patients who are unable to communicate effectively their medical conditions. These passports are then uploaded onto Symphony in A&E to ensure the nursing team are informed. On-going projects:

Majax Planning Group – reviewing the clinical guidelines

NOF pathway – introduction and monitoring compliance

Domestic Abuse Policy – multi agency project

PCC relocation – working in partnership with the PCC to ensure a smooth transition takes place when the PCC move into their new site

Palliative care workshop – patient pathway

Antibiotic Stewardship Group – introduce Point of care testing at the PCC

Electronic document management system (EDMS)

NEWS 2 – launch NEWS 2 and MEOWS

Outreach and NEWS team

Language Line – telephone interpretation awareness

Holistic nursing care project – remove task orientated care on the wards.

Self-discharge Policy

Consent Policy

Record keeping / documentation and Kardex project

NMP – scope of practice

Quality Improvement initiate in theatres – KPI, case reviews and audits


45

Medical Directorate Victoria Ward:

July 2019 seen Victoria undergo the re-audit of the Environmental audit

report, the score reached was 97% and therefore, fully compliant (as per IPS

scoring system) with most aspects of the Environmental Audit. The team can

be congratulated in their compliance to the GHA uniform & bare below the

elbow policy. They continue to work extremely well in raising the ward’s

compliance by ensuring all staff working in Victoria as well as visitors are

conscious of the GHA’s infection control policy, the foodborne infection Policy,

with displayed instructions for relatives/patients and staff on how to label and

date food as well as the acceptable use of the kitchen area.

Victoria Ward Activity:

July August September

Admissions 2 13 11

Discharges 3 6 7

RIP 0 4 5

New Staff * 0 0 0

Maternity: Between July and September an increase has been noted to the admission rate into the EPAU: A total of 12 admissions, all early miscarriages were delivered by medical management. One 33-week gestation of twins & a pneumothorax neonate transferred to Cadiz. Study days utilised by the Midwives between July and September:

Course Staff Attendees

Adult safeguarding 2

NLS resit 2

Management master classes 3

K2: all midwives have access and is on-going No new initiations have been commenced in the unit, although the team continue to await Ministerial consideration to consider an effort to improve current services.


46

Maternal Statistics:

July August September

Total Total % Total Total %

Total

Total %

Total births 31 100 39 100 36 100

Male 15 48.4 23 59.0 19 52.7

Female 16 51.6 16 41.0 17 47.2

Premature


47

Paediatric Services – Rainbow: Between July & September has seen staff move on to new horizons – Paediatric Diabetic Nurse Specialist Cynthia Maoko transferred her services the new Child Health Centre. Rainbow Ward Statistics:

July August September Total

Paed Medical 44 46 38 128

HDU 1:1 2 3 5 10

ENT 6 7 2 15

Dental 8 5 5 18

Ortho 2 7 9 18

Eye 0 0 0 0

Surgical 9 3 5 17

Adult Patients 16+ 4 2 0 6

Total Admissions 75 73 64 212

Ward Attenders ** 72 68 89 229

Total Ward Activity

(Admissions &

Ward Attenders)

147 141 153 441

SCBU 1:1 0 0 1 1

Clinics * 191 164 129 484

Total Departmental

Activity (Total

Ward Activity &

Total Clinic

Activity)

338

305

282

925

* Clinics: Rapid access, Learning, Multi-disciplinary, Diabetes, Down Syndrome, Visiting Consultants: Neurologist, Endocrine, Psychiatrist, Genetics (15-90 minute slots) All admin completed by nursing staff (notes / results / issuing appointments etc.) ** Ward Attenders: Skin prick testing, events monitoring, surgical pre-assessment, Dr review (emergency GP / urgent follow-up), jaundice screen, bloods, wound checks, procedures under sedation, injection administration, MCUG catheterisations, replacing NGT / gastrostomy devices, flushing of CVAD, ECG’s (15-90 minute slots)

Course Staff Attendees

EPALS 3

Paediatric 3 day course 4+1 Bank RSCN

Paediatric 1 day course 3

Management master class 2


48

Accident & Emergency:

Attendances:

Total Number of attendances in A&E: 8129. Admissions:

General Medicine - 353.

Gynaecology - 3.

General Surgery - 140.

Orthopaedic – 44.

ENT – 6.

Paediatrics – 79.

Anaesthetics – 0. Referrals to other specialities.

Trauma Clinic – 246

Mental health – 83 Courses:

DATE NAME COURSE

10/07/2019 Raquel Gavira Blood Transfusion Update

10/07/2019 Jordanna Clinton Workforce and Wellbeing Strategy Meeting

10/07/2019 Calynn McLaren Workforce and Wellbeing Strategy Meeting

25/07/2019 Laura Valcarcel Blood Transfusion Update

18/07/2019 Justine Rovegno Joanna Muñoz Ferran Cañadillas

Triage course

02/09/2019 – 04/09/2019 KJ Salcedo Tara Ferrary Jordanna Clinton Stephanie Stevens Maria Rodriguez

Paediatric Course

05/09/2019 Sean Whitfield Rafael Leon Calynn McLaren Cristina Vega

Paediatric Course

Elaine Ferro KJ Salcedo

Nuclear Response Training

Natalie Dignam Nurse Prescriber

23-24/09/2019 Stacie Rothwell Fernando Lara

EPALS


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Staffing:

KJ Salcedo was acting Matron finishing period on 18/08/2019, during that time A&E Acting S/R post covered by:

o Justine Rovegno finished acting period on 06/07/2019. o Jordanna Clinton started acting on 07/07/2019 finished 18/08/2019.

Maternity: o Maria Cantador was on Maternity Leave and on 04/08/2019 started

Unpaid Leave o Maryanne Dunham and Cherylanne Sheppard have been on

Unpaid Leave after Maternity. o Melissa Lucas started Maternity leave on 25/08/2019

1 Staff Nurse covering Night Sister as an Acting Post.

1 Enrolled Nurse transferred to St. Anne’s School on 08/09/2019. Events support.

A&E nursing and Medical staff has supported several events (Monkey Rocks

Festival, Andrea Bocelli Concert, Island Games, GFA matches) with Polyclinics in

situ.

Developments:

Pending finish of Isolation Area (Observation Bay 2) Surgical Directorate Dudley Toomey Ward There continues to be no cancellations of elective surgery as a result of our bed management practices which continue to have a positive impact on scheduled elective surgery, patient-flow and the discharge process. The staff continues to identify critically ill patients early on and transfer to CCU in a timely manner. Changes in working practices and skill mix have moved us away from task-orientated care towards a more patient-centred care. With regards to succession planning, we currently have 5 senior staff nurses acting as Sister / Charge nurse on a rotational basis, as part of a development programme to replace SR Sandra Dean and Caron Fennelly. They have all attended a series of leadership and management master classes developed by Dr Jacqueline Leigh from the University of Salford in conjunction with the Gibraltar School of Health Studies. Interviews for the Sister/Charge Nurse post will take place this month. Captain Murchison Ward The rehabilitation/stroke unit is not only alleviating beds within the acute setting but is also providing safe and timely discharges. The staff rotation system together with the training and development program continues to ensure staff develops the necessary skills to care for our stroke and rehabilitation patients. The Ward


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Managers have also commenced the much awaited appraisal system/performance management in order to meet individual staff personal/professional development needs. Operating Theatres Major works continue underway to create a new trauma theatre. This will create more opportunities to increase the throughput of surgical cases and conduct two orthopaedic lists simultaneously. Day Surgery Unit The Day Surgery Unit continues to undertake on average 90% – 95% of all elective patients requiring surgical procedures of all sub specialities with even more complex surgical procedures. There are on-going discussions to incorporate elective cardiology patients through a streamlined DSU Care Pathway. Dialysis

. Phase two of major works is complete with the Dialysis expansion project. Following careful consideration to risk and infection control management, patients continue to receive their treatments in the department with adjustments to the patient flow/traffic through the department. The extension of opening times for Dialysis provides greater flexibility to patients who require dialysis treatments. This has resulted in service users having better balance between their clinical needs and their daily lives. Stoma Care Nurse specialis Stoma Services Our Stoma Nurse Specialist has filled a much needed gap in the service provisions for our patients with stomas. The current services the stoma team highlighted as providing: • Pre assessment citing & education (before elective stoma surgery) ensuring that the stoma is placed in the best area • Post-operative follow ups- teaching patients how to apply their bag, education on diet, exercise and going back to work • Daily Stoma management (new appliances, tissue viability) • Stoma complications (e.g formation of hernia, refashioning of wound) • Check-ups (daily, weekly month and yearly reviews) • Home visits sometimes (elderly or immobile) • Education to GHA Staff Out patients Orthopaedics A spinal clinic initiative aimed to reduce the waiting times has commenced. These clinics are aimed to eliminate waiting times for those patients that are awaiting spinal review. waiting


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Endoscopy Unit Recent statistics collated by Mr Aidan Lane (SRN, NP, Jag accredited Endoscopist) demonstrate a sharp increase in the throughput of patients undergoing endoscopic procedures.

Outpatient Services The recent data collated illustrates that the repatriation of services has resulted in an increase in service demand and patient throughput in the outpatient clinic setting over the last three years.


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Bed Management Below you can find a snapshot of how the Nurse Management team are capturing the daily Bed Census.


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The Clinical Nurse Managers have been actively involved with our EHT Officers in the re-design of the electronic Bed Management Programme to tie in with the Hospital at night initiative and documentation in line with Clinical Governance standards. PCC

Child Health Nurses The Child Health Team Have Successfully moved to the Child Health Centre and are running all clinics. The have been preparing for the new Influenza initiative which commences late October for 2-4 year olds. Additionally: • They have introduced an 18-month assessment • Had a further BCG catch up • Developed a new system on E-MIS • Organised appointments on E-MIS for all Reception children District Nurses Dementia Conference held on September 30th: Rebecca Parslow Ann Marie Hemmi Selena Victory


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Dermatology CNS Nuria Campos has completed all of her written assignments and is waiting for the external boards final marking for the prescribing programme. She has presented the matrons with her Intended Scope of Practice for the first year. Staff Nurse Theresa Cardoso is the successful candidate for the succession planning for CNS Castro who finishes early 2020. Two weeks ago Theresa Cardoso commenced 2 days a week training in Dermatology as part of the succession planning. Waiting to be released full time. EN Ilyanna Ramirez Has passed her competency training for both patch testing and Cryotherapy for benign lesions already diagnosed by a member of the team. She runs small clinics alongside the CNS clinics. She is also running patch test clinics as required. Well person unit Staff Nurse Laura Netto continues with her on-going training as part of a Professional Developmental Programme to equip her to become a specialised sexual health nurse. Following the successful completion of the STIF foundation course and BASHH Sexual Health Course, she is still waiting to see if she will be considered to enrol on a non-medical prescribing course in March 2020. SN Netto has successfully passed her summative assessment in cryotherapy for Condylomata Acuminate and is now fully assessed NP Vannan is still pending her formative assessment. We are currently in the process of recruiting a Specialist Sexual Health Nurse that will commence on January 13th. Community Midwife CM Naomi Gross continues covering post-natal clinics for patients discharged from the Maternity ward and into the community. She continues to work closely with the clinical Governance team to develop care pathways for expecting mothers who are suffering from domestic violence, drug and in rehabilitation programme. The aim is to provide protection and support through their pregnancy. At present she is working on a business case to improve and expand maternal and baby care services at the GHA. The proposal is in the early stages and costing is being prepared for the estimates. Approved Mental Health Professionals The Mental Health professionals continue to work hard to implement the New Mental Health Act and The Mental Capacity act and Lasting power of attorney within the GHA and ECA, under their new roles as Approved Mental Health Professionals ( AMHP-Best Interest Assessors (BIA.) Danny and Paul have been carrying out intensive Mentoring of the new recruits additional to their normal workload.


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The new recruits have integrated well to the team. They are in the process of developing a New Mental Health strategy which is currently in the early stages working alongside The Clinical lead in Psychiatry, Dr Ashim Bettadapura The team are working closely with the 3 newly appointed Liaison Officers to close the gaps in waiting times and assist in early intervention. The team continue to manage the 24 HOUR Mental Health Crisis line. Also they have a new drop in service in clinic hours where they provide advice, awareness and guidance on how to access Mental Health services within the GHA. Nurse Practitioners Lynn Angove and Elizabeth Borges attended a prescribing up-date at SBH in April, and Elizabeth Borges attended the annual Respiratory Conference at Telford in September. CNM Suzanne Romero CNM Romero is currently working together with other stakeholders, co-ordinating the project management for the new adult and children PCC. The Inauguration will be held on October 7th. The Nursing strategy 2020-20-22 has been submitted.

July '19 August '19 September’ 19

Child Health Dept

Attended

Dr's Clinic 22 24 38

Health Visitors/Nurse team

New born hearing test 35 38 36

Social services attendances 78 104 130

Primary Visits 28 28 33

HV Assessments @ 8 weeks 27 29 21

HV Assessment 8 months 22 29 31

13 month development assessment 17 14 48

No children seen in school 0 0 0

Eneuresis Clinic 0 1 3

weighing clinic, feeding advice 378 392 621

seasonal flu vaccine 0 0 0

pre-school assessments 0 0 24

Referral to clinic 10 0 0

HPV Vaccines 2 7 15

Immunisation Clinic 399 394 519

Total 1,018 1,060 1,519


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Cardiar Rehab. Nurse

Attended

Ward visits 5 5 9

phase 2 screening clinics 12 8 12

Pre and post clinics 15 11 8

Cardiac rehab programme 78 78 90

self help group 412 367 432

community 0 0 0

Annual Reviews 4 6 4

Referrals 15 9 14

Drop in 35 40 63

Total 576 524 632

Diabetic specialist Nurse

Attended

ADRC 109 109 204

Other (coment/default) email 229 115 139

Diabetic Review 259 259 275

Diabetic ward patients 122 122 68

Diabetic ward/ antenatal patients 35 22 62

Diabetes education 10 10 32

Glucose 22 0 1

admin repeat prescritption 31 145 34

Emergencies 0 0 0

CDM 4 0 8

Tel consults 118 118 160

Total 939 900 1100

Nurse Practiti

gha board report – july 2019-september 2019 · 2020. 6. 16. · gha board report – july...

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