[state/nz] regional committee-committees-and... · work continued on the perioperative nurses...

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Australian and New Zealand College of Anaesthetists

NEW ZEALAND NATIONAL COMMITTEE Annual Report to NZ Fellows for January 1 to December 31, 2014

New Zealand National Committee membership

Committee role Name

Chair Dr Nigel Robertson

Deputy Chair Dr Gary Hopgood

Formal Project Officer Dr Jennifer Woods

Quality and Safety Officer Dr Geoff Laney

Education Officer Dr Indu Kapoor

Deputy Education Officer Dr Sally Ure

Fellowship Affairs Officer Dr Kerry Gunn

Accreditation Officer Dr Geoff Long

Other elected member(s)

Dr Sabine Pecher Dr Malcolm Stuart (until June) Dr Brent Waldron (from June)

Appointed member Dr Peter Doran (until June)

Councillors (ex officio) Dr Vanessa Beavis Professor Alan Merry

Co-opted New Fellows representative Dr John Smithells (until June) Dr Rachel Dempsey (from June)

Trainee Committee Chair (ex officio) Dr Rochelle Barron

Co-opted Faculty of Pain Medicine representative Dr Kieran Davis

Co-opted NZSA representative Dr Ted Hughes (President)

Co-opted CICM NZNC representative Dr Shawn Sturland (Chair)

Other national roles

Chair, NZ Panel for Vocational Registration Dr Geoff Long

NZNC representatives to external committees and organisations

Dr Kerry Gunn and Dr Jennifer Woods – NZ Anaesthesia Education Committee Dr Geoff Long – NZ Anaesthetic Technicians’ Society Dr Malcolm Stuart – NZ Resuscitation Council Dr Sabine Pecher – CICM NZNC

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New Zealand National Office staff

General Manager, NZ National Office Heather Ann Moodie

Communications Manager, NZ Susan Ewart

Policy Adviser, NZ Brigid Borlase (to January) Virginia Lintott (from April)

Training & Education Coordinator Alison McKessar

NZNCs Administrator Anna Pears (to February) Karen Hearfield (February to September) Jo Young (from October)

Finance Manager Melissa Chang (to July)

Administrator, Facilities & Events Finance Assistant

Louise Soulsby (from June)

Assessments Coordinator CICM NZNC Administrator NZ Anaesthesia Education Committee Administrator

Rose Chadwick

Although 2014 was an election year for NZNC membership, no election was required, with 10 nominations received for the 12 places. Dr Malcolm Stuart was farewelled after completing the maximum 12 years’ service.

Annual General Meeting The AGM for NZ Fellows was held on Saturday, August 23, 2014 at the Millennium Hotel, Queenstown, with nine Fellows attending.

CHAIR REPORT – Dr Nigel Robertson

The principal matters for the NZNC in 2014 were:

The anaesthesia workforce In 2014, the tightening employment market in Australia reduced the outflow of New Zealand new Fellows to Australia, with a resulting increase in the number of applicants for positions in New Zealand. However, there was still some maldistribution, with some rural hospitals finding it difficult to attract sufficient specialist staff.

In April and May, it became apparent that the NZSA and ANZCA held different views of what was happening in the workforce and what needed to be done about it. In particular, NZSA considered that reducing funding for training would lead to a decrease in the number of trainees while ANZCA saw the number of trainees as being determined by the needs of their employing hospitals. The issue was discussed robustly at the annual joint meeting between the NZNC and the NZSA Executive in June. The two groups decided to form a small working group to gather authoritative data and to formulate recommendations on how the New Zealand anaesthesia workforce could be sustained to meet the health needs of New Zealanders to present to Health Workforce NZ (HWNZ) and the Government. That work continues, and has included the development of a draft census to be used for collecting data directly from hospital departments.

ANZCA NZ also worked through the Council of Medical Colleges (CMC) and with HWNZ (including supplying data and information) to provide medical students and pre-vocational doctors with as accurate a picture as possible of the current and likely future workforce situation so that they can make their career choices accordingly.

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Assistants to the anaesthetist Work continued on the Perioperative Nurses College (PNC) proposal for a separate education pathway and assessment framework for registered nurses working as assistants to the anaesthetist, to be provided by the Auckland University of Technology (AUT). In 2014, the NZNC submitted on this, and had meetings with the Ministry of Health, PNC and AUT. The AUT course is being piloted in 2015 with eight registrants. Anaesthetists will be involved in delivering course content and the exit assessment.

The NZNC has also been involved in the review of the length of training for anaesthetic technicians.

The NZNC’s stance is that anaesthetists need to be confident that any assistant meets standardised, minimum requirements (as in PS08 Recommendations on the Assistant for the Anaesthetist) irrespective of the training pathway to reach those standards.

In September, Dr Geoff Long and ANZCA staff met with HWNZ and other anaesthesia stakeholders to discuss the anaesthesia support workforce, and the shortage of assistants to anaesthetists in New Zealand, more flexible models of care, and the training pathways. All parties agreed the bottom line is that patient safety and competence needs to be ensured irrespective of training pathway. HWNZ undertook to gather more data on the assistant to the anaesthetist workforce and all parties are to reconvene in April 2015 to reassess the situation and discuss progress.

Doctor competence The NZNC followed up its 2013 paper on “New Zealand medical colleges’ roles and responsibilities regarding competence, compliance and delivery of safe care by Fellows and trainees” with direct discussions with the Medical Council of New Zealand (MCNZ) and the Ministry of Health in March, making it clear that ANZCA’s CPD Program is not intended as a competence assessment tool. The MCNZ has amended its original three-stage proposal and is working with the CMC, Ministry of Health, employers and colleges to develop a fit-for-purpose framework for regular practice review, credentialing, appraisal and recertification. The NZNC continues to contribute to this process and the NZNC Chair, Dr Nigel Robertson, is a member of the Expert Advisory Group on this work. The aim is to keep duplication of assessments to a minimum.

MCNZ memorandum of understanding The MCNZ held its annual update for Vocational Education Advisory Bodies (VEABs) on October 22. Discussions covered:

Recertification: general registrants; the joint performance assessment framework project; the Regular Practice Review (RPR) evaluation programme.

The MCNZ’s memorandum of understanding with VEABs, including managing concerns of conduct and competence (the NZNC is working with head office on its response to the proposed changes).

Risk factors: aging doctors; working in isolation.

Prevocational training changes: e-portfolio; accreditation requirements; community experience.

Endoscopy services With the Government proposing to extend endoscopy services and have nurse endoscopists, Dr Emma Patrick is representing both ANZCA and NZSA on an advisory group that HWNZ has established to develop a training program for nurse endoscopists.

Political meetings and work On March 6, CEO Linda Sorrell, NZNC Chair Dr Nigel Robertson, FPM NZNC Chair Dr Kieran Davis and GM NZ Heather Ann Moodie met with the Minister of Health and the Opposition Spokesperson on Health. These meetings provided an excellent opportunity in election year to discuss pertinent topics, including

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workforce issues and doctor competency.

The NZNC also contributed to a CMC briefing document for the new Minister and both the ANZCA and FPM NZNCs sent letters of congratulation and introduction to the new Minister (Dr Jonathan Coleman) after the General Election in September.

Clinical directors’ meeting On September 26, the NZNC facilitated a highly-rated meeting in Wellington to update the clinical directors of New Zealand anaesthesia departments. The all-day meeting included an update on ANZCA matters, group discussions on the anaesthesia workforce, anaesthetic assistants and industrial challenges, and an afternoon workshop on the utility of system tools in healthcare. However, the most appreciated aspect was the chance to meet colleagues in person and to benefit from collective experience.

Anaesthesia Research Workshop Another innovation from NZNC in 2014 was the inaugural ANZCA NZ Anaesthesia Research Workshop held at Auckland City Hospital on December 4. Convened by Dr Tom Fernandez, this proved very popular with 49 registrants keen to learn from the faculty of eminent New Zealand researchers.

National Anaesthesia Day – October 16 The National Anaesthesia Day promotion on October 16, with its theme on the benefits of stopping smoking before surgery, attracted strong support from Fellows and hospital departments and satisfying interest from the media. The new Minister of Health visited the excellent Auckland City Hospital display and demonstrations. There were also public displays at Dunedin and Wellington Hospitals with the posters and patient information being displayed at a number of other hospitals around the country.

Extended prescribing rights for midwives As from July 1, 2014, midwives have been able to prescribe morphine and fentanyl as well as pethidine for pain relief during labour (previously, they could prescribe only pethidine). The NZNC had submitted a response to these proposed extended prescribing rights for midwives agreeing to some extension but not as much as proposed. This matter was also discussed at a meeting in April with the Ministry of Health and Medsafe involving representatives from midwifery, obstetric and anaesthesia organisations. The Midwifery Council has sought ANZCA’s advice to help with the development of practice guidelines. Education, training and accreditation will occur to ensure mothers and neonates receive safe and effective care.

Council of Medical Colleges NZNC representatives and NZ office staff attended all four CMC meetings in 2014. Staff also regularly take part in CMC policy group meetings. As well as doctor competence mentioned above, a key issue for CMC in 2014 was the medical workforce pipeline.

The Society of Anaesthetists The NZNC’s annual joint meeting with the NZSA Executive, held on June 27, saw robust discussion on workforce issues, developments with the assistant to the anaesthetist role and the use of single ampoules for multiple patients (see items below). There were also reports and discussion on the MCNZ’s desire to see greater college involvement in identifying and addressing poorly performing doctors and on joint activities including the NZ Anaesthesia Education Committee, the Part 3 Course as well as ANZCA’s role in the NZSA’s Part 0 Course.

As well as the matter of the anaesthesia workforce, the NZNC and the NZSA worked jointly on a number of issues in 2014 including nurse endoscopists, assistants to the anaesthetist, advice on ampoule splitting and dental sedation.

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CPD The MCNZ accepted that ANZCA’s revised CPD Program meets its recertification requirements for specialists as well as for those general registrants enrolled in the College’s CPD Program as at March 14, 2012.

Submissions and policy work During 2014, submissions or comments were made on the following:

Ministry of Health

Proposed amendments to midwives' and nurse practitioners' prescribing of controlled drugs

Confirming ANZCA’s endorsement of the “New Zealand Guidelines for Helping People to Stop Smoking“

Minister of Health

Congratulatory letters to the incoming Minister of Health from the ANZCA NZNC and the FPM NZNC

Input into a briefing to the incoming Minister led by the Council of Medical Colleges

NZ House of Representatives

Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill

Medical Council of New Zealand

Guidelines on advertising by doctors

Registration pre-requisites for doctors who have obtained registration through NZREX Clinical

Review of locum tenens approved qualifications list

Medical Sciences Council of New Zealand

Guidelines for the professional relationship between anaesthesia technicians and anaesthetists

Maternity Monitoring Group

2012 Guidelines for Consultation with Obstetric and Related Medical Services

Pharmac

Decision criteria

Proposed approach for managing hospital medical devices

Feedback on requests from DHB hospitals for Pharmac to list glucose 4% sodium chloride 0.18% solution on the Pharmaceutical Schedule

2014/15 invitation to tender

Proposals on: o wound care products by W M Bamford & Co Ltd o ferric carboxymaltose o preoperative carbohydrate 0.5 kcal/ml oral feed o erythropoietin

Perioperative Nurses College

Draft “Knowledge and Skills Framework for the Registered Nurse Assistant to the Anaesthetist”

Post Anaesthesia Nurses of New Zealand

Draft “Professional Framework and Practice Standards” for Post Anaesthesia Care Unit nurses

Australia and New Zealand College of Perfusionists

Supporting its application for regulation under the HPCA Act 2003

PQAA status ANZCA’s revised CPD Program was given protected quality assurance activity (PQAA) status under the

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Health Practitioners Competence Assurance Act 2003, effective from May 2, 2014 for five years. The Australian and New Zealand Tripartite Anaesthetic Data Committee (ANZTADC) had its PQAA status renewed for five years from March 28, 2014. The Cases and Procedures section of the Training Portfolio System (TPS) was given PQAA status last year.

From December 2014, all PQAA annual reports are being published on the Ministry of Health website

Dr David Sage (Auckland) succeeded Dr Steuart Henderson as ANZCA’s responsible person for the CPD Program and ANZTADC PQAAs in New Zealand. Dr Ian Graham succeeded Dr Genevieve Goulding as the responsible person for the TPS PQAA.

Communications and media work Media work in 2014 has included:

A media release about the New Zealand-based winner of the 2013 ANZCA media award – Virginia McMillan for a feature she wrote on pain medicine in NZ Doctor.

Comment to the NZ Herald about a disciplinary case involving a trainee.

Comment on the new formulation of oxycodone, designed to prevent misuse.

Comment on a media release from the ANZCA Annual Scientific Meeting in Singapore about nitrous oxide being found safe for use.

A media release supporting the NZMA’s major policy statement on obesity.

Media training was provided for the ANZCA NZNC Chair and Deputy Chair, and for the FPM NZNC Chair.

The NZNC e-newsletter Gasbag was published in February, May, June, September and December with all issues exceeding the targets for being delivered, opened and having links clicked. No one unsubscribed.

New Zealand contributes regular news and features to ANZCA’s monthly E-Newsletter, the quarterly ANZCA Bulletin, Synapse and other College publications as appropriate. Tony Ryall was interviewed for the September College Conversations CD as he was retiring as the Minister of Health.

INTERNATIONAL MEDICAL GRADUATES (IMGs)

The New Zealand Panel for Vocational Registration assesses international medical graduates, through interview, on behalf of the MCNZ as part of the council’s registration processes. The panel also assesses IMGs as part of the ANZCA process for FANZCA.

Dr Geoff Long became panel chair at mid-year, with the following Fellows serving on panels during the year: Dr Leona Wilson, Dr Vaughan Laurenson, Dr Mohua Jain and Dr Sabine Pecher.

In 2014, 21 interviews were held at the request of MCNZ. Of those, 12 IMGs had done their specialist training in the UK, with the remainder coming from USA, Ireland, Finland, South Africa, India and Germany. Fifteen IMGs were assessed as substantially comparable and six as partially comparable (A).

Twelve preliminary assessments of IMGs were completed for MCNZ by Dr Vaughan Laurenson, Director of Professional Affairs.

There were six workplace-based assessments, three at Auckland Hospital, two at Middlemore Hospital and one at Wellington Hospital. All were successful. Assessors were Dr Vaughan Laurenson, Dr Leona Wilson, Dr Geoff Long, Dr Malcolm Stuart and Dr Sally Ure.

Renee McNamara, Manager, IMGS Accreditation, in the ANZCA office in Melbourne, visited the NZ Office in November, and worked with Rose Chadwick, NZ Assessments Coordinator (IMGs), to rationalise processes and update documentation related to the ANZCA IMGS assessment pathway.

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EDUCATION OFFICER, NEW ZEALAND REPORT – Dr Indu Kapoor

Dr Indu Kapoor returned to the Education Officer NZ role in June 2014. During her absence, Dr Sally Ure, Deputy Education Officer NZ, fulfilled the Education Officer role.

Training Program Both trainees and supervisors of training have become more familiar and comfortable with the 2013 curriculum.

The Workplace-Based Assessment process has not been as beneficial as intended and it was noted that a comprehensive review is being conducted (information from South Island Trainee Survey and from Central Rotation trainees’ feedback; information transmitted to the relevant committees by EO and NZNC Chair).

TPS continued to provide challenges for trainees and supervisors of training. It was heartening to hear that its weaknesses have been acknowledged and a number of enhancements are planned.

Volume of Practice for procedures not performed in most New Zealand hospitals remains an issue. However, trainees are now aware that they need to apply individually for dispensation from the DPA Assessor.

It was pleasing to note that an evaluation of the 2013 curriculum would be undertaken to ascertain what was and wasn’t working well.

Examination remediation interviews, although logistically challenging, have proved helpful for trainees.

Feedback interviews have been extremely difficult to arrange.

Education Sub-Committee meetings and SOT workshop The Education Sub-Committee met by teleconference on May 19 and in person on October 20. The October meeting included an address by the new Dean of Education, Dr Ian Graham, who joined the meeting via Skype. Dr Graham outlined his methodologies around governance and answered questions from the floor. General Manager Education, Oliver Jones, attended in person and presented the proposed schedule of improvements to the TPS system. He also advised that the TPS database was being looked at by an independent IT provider with a view to increasing its operating speed. SOTs appreciated the fair and open discussion around the TPS and welcomed the outcome of the workshop planned for the following month. Ms Lee-Anne Pollard, General Manager Training & Assessments, updated the meeting via telephone.

Intensive care training In 2014, the College of Intensive Care Medicine withdrew accreditation for the Auckland City Hospital and Dunedin Hospital intensive care units. This information was conveyed to the individual units and not to the EO or the rotation supervisors of the region. The trainees placed at these ICUs will have their training recognised if undertaken in the first half of the 2015 hospital employment year (as these placements were effective before the withdrawal). In the event of the accreditation not being re-instated, no anaesthesia trainees will be placed in these ICUs and alternative sites will be identified to help fulfil the ICU SSU training requirements. The EO and DPA Assessor are monitoring the situation.

Supervisors of training

Whangarei Hospital Dr Susan Gathercole Dr Andrew Childs

North Shore Hospital Dr Clare Fisher

Auckland City Hospital, L4 Dr Mike Gillham (to September)

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Dr Sarah Allen

Auckland City Hospital, L8 Dr Sarah Nicolson (to June) Dr Colin King Dr Nadia Forbes Dr Ivan Bergman (from July) Dr Amber Chisholm (from July)

Auckland City Hospital, L9 Dr Tim Skinner

Starship Children's Health Dr Peggy Yip

Middlemore Hospital Dr Matthew McGill Dr Jennifer Taylor Dr Alison Kirkman Dr Damian Simpson Dr Alastair Ineson (from April)

Waikato Hospital Dr Alan Crowther Dr Kelly Byrne Dr Nicola Whittle

Rotorua Hospital Dr Mandy Perrin (to December) Dr Shane McQuoid

Tauranga Hospital Dr Caroline Zhou Dr Thomas Main (deputy) (to July)

Taranaki Base Hospital Dr Charlie Brown

Hawke’s Bay Regional Hospital Dr Tony Diprose

Palmerston North Hospital Dr Vikram Singh Dr Maria Au-Young

Hutt Hospital Dr Neroli Chadderton Dr Philip Eames

Wellington Regional Hospital Dr Kirsten Cunningham Dr Nicola Moore

Nelson Hospital Dr Gareth Harris

Christchurch Hospital Dr Ashley Padayachee Dr Ben van der Griend (deputy)

Timaru Hospital Dr Peter Doran

Dunedin Hospital Dr Jason Henwood Dr Matthew Jenks (deputy)

Southland Hospital Dr Roger Wandless

Rotational supervisors

Northern Rotation Dr Craig Birch (to June) Dr Lance Nicholson Dr Sarah Nicolson (from June)

Midland Rotation Dr David Williams

Central Rotation Professor Sandy Garden

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Southern Rotation Dr David Bain

Second deputy education officer A second deputy education officer, Dr Brent Waldron from Hutt Hospital, was appointed, effective from December 2014.

Hospital inspections After a further assessment, Hutt Hospital achieved formal accreditation through to 2021. It is acknowledged that this was the result of a lot hard work by several people.

Exams The primary exams, in February, saw 30 candidates sit under the 2013 curriculum format. At the second sitting in September, there were 42 candidates.

The March sitting of the final exam was held at Wellington Hospital with 16 candidates. The August sitting saw a record-breaking 35 candidates sit the written exams with an additional three IMGs joining them for the medical/clinical exam at North Shore Hospital.

Scholar role Trainees are completing requirements for the scholar role without too many problems. Some hospitals have had to define what they will reimburse trainees for with regard to Option B. For instance, trainees who choose to enrol in high-priced tertiary courses/qualifications will need to do so at their own expense, as there are several other option B choices that are free to complete.

Courses A full-day Foundation Teacher Course was held in Wellington in September. The course was well received and included participants from Australia.

The Part 3 Course returned to Middlemore in November this year and was, again, ably convened by Drs Dimech and Depuydt. Participant numbers were one short of the maximum 24.

The Part 0 Course was held over two days in December at Auckland City Hospital.

The NZNC supports the Annual Registrar Meeting held in Auckland on December 5. The ANZCA Prize for the Best Scientific Presentation was awarded to Dr Jeyanjali Jeyerajah for her presentation on Restricting oral intake and antacid use in labour - an audit and guideline proposal.

New Fellows Conference The New Zealand representatives at the Singapore New Fellows Conference in May 2014 were Dr Rachel Dempsey and Dr Nicola Broadbent.

Acknowledgements The EO(s) are grateful to all those who work hard to make the FANZCA Training Program a success.

In particular, I acknowledge the work of supervisors of training and rotational supervisors, all those involved in trainee assessment, the convenors of the exam courses and exam sittings, and the Part 3 Course convenors.

My thanks, too, to our NZ Trainee Committee, which continues to provide valuable liaison between the College and its New Zealand trainees.

I would like to specially acknowledge the enthusiasm of the New Zealand trainees for the way in which they have engaged with the revised curriculum, and for their patience and perseverance with the TPS.

I would like to personally thank the office staff, especially Alison McKessar and Heather Ann for their ever ready support.

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Finally, a big thank you to Dr Sally Ure for stepping into the EO role for when I was away despite her other (very busy) work commitments and a very warm welcome to Dr Waldron in the new role.

FORMAL PROJECT OFFICER’S REPORT 2014 – Dr Jennifer Woods

With the new curriculum bedded in and most trainees expected to undertake the scholar role activities, 2014 was the penultimate year for formal projects. This was reflected in the number of projects registered and assessed by the Formal Project Assessment Committee (FPAC): 10 new Formal projects were registered and 23 were assessed; 22 were signed off by the FPAC and approved by the DPA Assessor. Two projects were returned to trainees for revision and have not yet been resubmitted.

By November 2014, there were still 19 trainees who had registered formal projects and had not yet submitted them for assessment.

The overall standard of formal projects was very good this year and there were some outstanding efforts. Dr Olivia Albert's formal project, "An exemplar video of teamwork and communication in a resuscitation scenario" was awarded the ANZCA NZNC Formal Project Prize. Dr Jeffrey Reddy’s formal project was recently published in Anesthesiology (2015; 122:39-45)

It is encouraging to see a number of interesting papers and research projects being undertaken and hopefully some of these individuals will continue to pursue research interests in the future.

I am very appreciative of Alison McKessar's contribution to the formal project portfolio over the past year. As the first contact for trainees, Alison has done a great job reassuring and educating trainees about the process and advocating on their behalf when they have submitted work and are awaiting an outcome.

I am also very thankful for the consistent and considered feedback from Dr Hamish Gray, the Deputy Formal Project Officer, over the past three years. Hamish has reviewed all of the projects submitted since early 2011 and it would not have been possible to get through all of these in such a timely manner without his input. Thank you, Hamish!

Projects completed 2014 Dr Olivia Albert An exemplar video of teamwork and communication in a resuscitation scenario

Dr Cameron Anderson Intravenous regional anaesthesia: past, present and future

Dr Tristan Bennett Evaluation of Side Effects from Rapid Infusion of Iron Polymaltose in Pregnancy – A Clinical Audit

Dr Grace Chang Audit of oxytocin use after elective Caesarean sections in Auckland City Hospital

Dr Aimee Clark An analysis of patients with aortic stenosis presenting for surgery at Nelson Hospital and suggestions for improved preoperative assessment

Dr Richard Cooper Rapid infusion through a multi-lumen central line: development and testing of the M-LID Multi-Lumen Infusion Device

Dr Joachim Dieterle Prospective audit of epidural steroid injections for sciatica and spinal stenosis

Dr Lindsay Gray Intralipid for Ropivacaine toxicity and the use of adrenaline for resuscitation in patients with age related hypertrophic cardiomyopathy

Dr Samuel Grummitt Utility of the Pleth Variability Index in detecting hypovolaemia in spontaneously breathing blood donors

Dr Kerry Holmes Unexpected VT/VF in an eight month old boy undergoing caudal anaesthesia

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Dr Robin Kang Prognostic implications of elevated preoperative high-sensitivity troponin T in vascular surgery patients

Dr Chang Kim Prevalence of preoperative anaemia in patient having first-time cardiac surgery and its impact on clinical outcome vascular surgery patients

Dr Andrew Martin Broken spinal needles: A case series and literature review

Dr Richard More An audit of changes in ventilatory practice over the last decade

Dr Loretta Muller Posterior Ischemic Optic Neuropathy: A Clear View of Perioperative Visual Loss

Dr Jaime O'Loughlin Postpartum haemorrhage at Middlemore Hospital 2008 - a retrospective audit

Dr Ayantha Ranasinghe Haemoglobinopathies and anaesthesia management: a case report and discussion

Dr Jeffrey Reddy Anaphylaxis is more common with rocuronium and suxamethonium than with atracurium

Dr Era Soukhin A single centre audit of outcomes from fractured neck of femur

Dr Louise Speedy The effects of night shift on driving

Dr Heng-yi Wu Difficult Airway in the Intensive Care Unit: Equipment and Management Algorithm

Dr Yiyi Zhang Standardisation of propofol-remifentanil co-induction for electroconvulsive therapy – a single centre’s report

NEW ZEALAND TRAINEE COMMITTEE (NZTC) REPORT – Dr Rochelle Barron

The NZTC spent much of the year becoming familiar with and navigating the 2013 ANZCA curriculum. Time and effort was dedicated to collecting and summarising issues arising for trainees and providing feedback to the College to help identify priority areas for enhancement.

2014 NZTC office bearers and members Chair Dr Rochelle Barron, Wellington

Deputy Chair Dr Ruth Brown, Christchurch

Members Dr Charlotte Adamson, Christchurch Dr Thomas Burrows, Hamilton Dr Thida Ching, Auckland Dr Lizi Edmonds, Wellington Dr Julia Foley, Auckland Dr Chang Kim, Auckland Dr Laura Kwan, Wellington Dr Ghassan Talab, Auckland

NZSA representatives Dr Kerry Holmes, Auckland Dr Kate Romeril, Whangarei

Ex-officio

Dr Nigel Robertson, Chair, ANZCA NZNC Dr Indu Kapoor, Education Officer NZ Dr Sally Ure, Deputy Education Officer NZ

For 2014, Dr Rochelle Barron and Dr Ruth Brown retained the posts of chair and deputy chair respectively.

Elections Elections were not necessary for the 2014 committee as the number of new applications matched the

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number of vacancies. An election was necessary to determine the 2015 committee, with 10 nominations received for nine places. The new committee consists of a good mix of basic and advanced trainees, with three members having been involved last year. The new chair is Dr Lizi Edmonds from Wellington.

NZTC meetings Four well-attended NZTC teleconferences were held in 2014 (January, April, June and September) with the annual face-to-face meeting held in December. As well as the regular updates from around the country, the foremost topics of discussion at most of the meetings were Volume of Practice requirements, the usefulness of WBAs, and TPS.

Other meetings attended By the chair, deputy chair and other members:

ANZCA Trainee Committee teleconferences – February, June and November

ANZCA Trainee Committee face-to-face – April and September

ANZCA NZNC meetings – March, June and November

Education Sub-Committee meetings – May and October

DiTC (Doctors in Training Council) forum – September

Activities Trainee welfare: Work on the trainee welfare scheme was minimal due to Dr Cath Purdy, the project’s initiator, completing her provisional fellowship year in Melbourne. It is hoped that her return to New Zealand in early 2015 will revitalise this worthwhile endeavour.

Part 3 Course: The joint ANZCA/NZSA-hosted Part 3 Course returned to Middlemore hospital in 2014. Of a maximum 24, there were 23 participants. Feedback has suggested that trainees just beginning their advanced training would benefit enormously from the course, before they are at the stage of applying for provisional fellowship positions. NZTC thanks the convenors for putting together another successful course.

Part 0 Course: While this is not an ANZCA course, ANZCA participates in the section on training. Again, Dr Foley represented the NZTC on the course organising committee. As Dr Barron was unavailable, Dr Jonathan Panckhurst (from the 2015 committee) stood in for the NZTC presentation.

NZ trainee handbook: Work on the NZTC Anaesthesia Training in New Zealand Made Easy handbook was revived and Dr Burrows did a significant amount of work on updating the handbook to encompass the changes for the 2013 curriculum.

The NZTC’s quarterly newsletter for trainees was discontinued (to help reduce email overload) with the committee’s news now being reported through Gasbag.

CONTINUING EDUCATION REPORT

Local meetings and workshops

Date Title and theme Main speakers Notes (e.g. prizes presented)

December 4, 2014

ANZCA NZ Anaesthesia Research Workshop

Convenor: Dr Tom Fernandez Presenters: Professor Alan Merry, Associate Professor Tim Short,

New NZNC initiative, success indicates it should be an annual event.

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Professor Brian Anderson, Professor Jamie Sleigh, Dr Doug Campbell, Dr Johan Van Schalkwyk, Associate Professor Jenny Weller.

With the NZSA committed elsewhere, there was no joint annual scientific meeting in 2014. Nor will there be in 2015 but the NZNC is hosting its own annual scientific meeting in 2015 in Wellington with the organising committee drawn from the Wellington Regional Hospital with Dr Graham Sharpe convening.

NEW ZEALAND ANAESTHESIA EDUCATION COMMITTEE (NZAEC)

The NZAEC is a joint ANZCA/NZSA committee responsible for overseeing organisation of the joint NZ Anaesthesia Annual Scientific Meetings (ASMs), and administering the BWT Ritchie Scholarship for New Zealand trainees and the annual NZ Anaesthesia Visiting Lectureships.

Membership In 2014, the NZAEC membership comprised NZSA representatives Dr Graham Roper (Chair), Dr Rob Carpenter and Dr Ted Hughes (as NZSA president) and NZNC ANZCA representatives Dr Kerry Gunn, Dr Jennifer Woods and Dr Nigel Robertson (as Chair of NZNC ANZCA). There are two observers: Dr Paul Hardy (FPM NZNC) and Janelle Cutting (NZATS).

NZ Anaesthesia ASM There was no joint annual scientific meeting in 2014. The next one due is in 2017. Waikato Hospital’s Department of Anaesthesia has formed an organising committee, convened by Dr Kevin Arthur, to host NZ Anaesthesia ASM 2017. The most likely venue will be the Rotorua Energy Events Centre with preferred dates of November 7-11.

NZA Anaesthesia Visiting Lectureships 2014 The NZ Anaesthesia Visiting Lectureships promote sharing of knowledge and experience by funding lecturers to present nominated outstanding presentations in anaesthesia departments and practices to anaesthesia departments in regional centres. In 2014, lectures were presented by:

Dr Colin Marsland from Wellington Hospital, who presented his topic of Emergency transtracheal ventilation and bronchoscopic airway management, at Hawke’s Bay and Tauranga.

Dr Jane Torrie, from Auckland Hospital, who spoke about her specialist areas of emergency management of anaesthetic crises, simulation and team work, at Tauranga and Palmerston North;

Dr Nav Sidhu from Auckland Hospital who presented on the topic of CICO and the Surgical Airway: A Personal Account, which uses a case study with particular focus on cricothyroidotomies, at Palmerston North and Invercargill (this latter presentation deferred to February 2015).

The meetings at Palmerston North and Tauranga were regional meetings to which anaesthetists from other nearby centres were invited, a format that is proving popular and makes better use of the visiting lectureship resource.

Five Visiting Lectureships have been awarded for 2015, to Dr James Cameron (Hutt), Dr Douglas Campbell (Auckland), Dr Ben Griffiths (Auckland), Dr Emma Patrick (Taranaki) and Dr Jeanette Scott (Middlemore).

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BWT Ritchie Scholarships Recipients of the BWT Ritchie Scholarships for 2013 were announced early in 2014.They were Dr Kathryn Hagen (Auckland), Dr James Moore (Wellington) and Dr Sam Grummitt (Christchurch). The 2014 recipients were Dr Kerry Holmes (Auckland), Dr Ross Scott-Weekly (Dunedin), and Dr James Broadbent (Hutt).

ANZCA and the NZSA are grateful to the BWT Ritchie Scholarship trustees for providing the generous funding for these annual scholarships.

FACULTY OF PAIN MEDICINE REPORT

The work of the Faculty of Pain Medicine’s New Zealand National Committee (FPM NZNC), established in 2013, continues to grow in significance. Its members are:

Committee role Name

Chair Dr Kieran Davis

Deputy Chair Professor Ted Shipton

Hon Secretary/Treasurer Dr Paul Hardy

Appointed member Dr Lorna Fox

Co-opted New Fellow Representative Dr Tipu Aamir (from November)

The FPM NZNC held three meetings in 2014, in Dunedin on March 20 (in association with the NZ Pain Society’s ASM), by teleconference on July 15 and in Wellington on November 10.

A major issue for the committee is the serious shortage of pain medicine specialists, especially given the place of chronic pain in the New Zealand health statistics. Along with this is the matter of funding for training. The FPM NZNC is researching data to assist discussions it has been having with the Ministry of Health and HWNZ on these matters.

Key activities in 2014 included:

Welcoming the NZ Pain Society President to the March meeting to discuss how the two groups could best work together on pain medicine issues in New Zealand.

Chair Dr Kieran Davis meeting with the Minister of Health, Tony Ryall, and Opposition Spokesperson on Health, Annette King, to outline the role of pain medicine specialists and emphasise the need for more specialist and trainee funding in New Zealand.

Chair Dr Kieran Davis meeting with Dr Don Mackie, CMO for the Ministry of Health, and Dr Ruth Anderson, Health Workforce NZ, to make the case for funding for pain medicine trainees, followed by a further very useful meeting with Ruth Anderson to explore the issues in more detail.

Submission to the review on advertising by doctors, given that some musculoskeletal doctors advertise themselves as pain specialists.

Dr Paul Hardy being appointed to represent the FPM NZNC on the NZ Anaesthesia Education Committee.

Monitoring the development of the revised FPM training program and its introduction in New Zealand.

Working with the Accident Compensation Corporation on its review of its pain services.

Submitting a referral to the National Health Committee (NHC) proposing that the NHC add an assessment of a national paediatric pain service to its 2015 assessment work programme.

In New Zealand, seven candidates sat the FPM examination in November.

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QUALITY AND SAFETY OFFICER’S REPORT – Dr Geoff Laney

The NZNC continued its strong commitment to quality and safety – having it as a regular item on its agenda and featuring relevant items in a dedicated quality and safety section in its bi-monthly e-newsletter Gasbag, as well as in other College publications and on its website as appropriate. In 2014, this saw reports on:

The work of New Zealand’s Health Quality & Safety Commission (HQSC) and its Perioperative Mortality Review Committee (POMRC), which are led by ANZCA Fellows, Professor Alan Merry and Dr Leona Wilson respectively.

Coverage of three Health & Disability Commissioner cases where anaesthetists were involved in the provision of inadequate patient care.

Publicising a coroner’s finding that has implications for those prescribing pain relief for patients being discharged from hospital.

Publicising an alert from the Health Quality & Safety Commission about the risks associated with the use of transdermal patches.

Checking with Medsafe and providing information about the New Zealand situation after two batches of propofol were quarantined in Australia because of possible contamination.

Publicising a Medsafe review of its alert concerning the use of hydroxyethyl starch solutions.

An article in the September Bulletin by Professor Alan Merry in his HQSC role calling on anaesthetists to lead more effective use of the WHO surgical safety checklist.

Other work in the quality and safety area included:

In January, NZNC Chair Dr Nigel Robertson presented and answered questions from an anaesthesia perspective during a webinar on reducing surgical site infection.

The Q&S Officer’s attendance at the Perinatal & Maternal Mortality Review Committee and the Perioperative Mortality Review Committee annual workshops in June, and at the HQSC workshop on patient safety, led by Professor James Bagian from the US, in November.

Submissions on issues with a quality and safety focus including: o The assistant to the anaesthetist o Pharmac’s accepted uses for Sugammadex o Providing a joint statement with NZSA on the current place of synthetic colloids in

anaesthesia practice

Following the receipt of letters about sharing single-use ampoules among multiple patients, the NZNC wrote to Southern Cross Hospitals advising on the correct single use ampoule safe medication and infection control practice in line with ANZCA’s PS28 Guidelines on Infection Control in Anaesthesia.

Working with NZSA on the issue of dental practitioners using a propofol-remifentanil infusion technique that does not appear to align with PS09m, including meeting with the Health and Disability Commissioner in November and meeting with dental practitioners using the technique to find out more about their method. ANZCA and the NZSA plan to jointly approach the Dental Council to instigate an open discussion.

NEW ZEALAND OFFICE

The New Zealand office staffing allocation was increased to enable employment of a part-time Events & Facilities Administrator for 23 hours a week. Responsibility for the New Zealand finance function moved to head office.

The landlord completed refurbishment of the national office resulting in much better meeting space, another office and upgraded toilets. Following re-assessment after earthquakes in Wellington, the

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building has been assessed at 85 per cent of the building code, which is classified as grade A or “low risk”.

ACKNOWLEDGEMENTS

Congratulations go to:

Dr Tristan Bennett (Auckland) for winning the ANZCA prize for the best scientific presentation at the 2013 Annual Registrar Meeting and to Dr Jeyanjali Jeyerajah for winning the same prize at the 2014 Annual Registrar Meeting.

Dr Olivia Albert for winning the NZNC Formal Project prize for 2014.

Dr Bryce Curran (Christchurch) for being awarded the New Zealand Bravery Decoration for the part he played in operating on and saving the life of a man trapped in a building that had collapsed in the February 2011 earthquake in Christchurch.

Professor Alan Merry for being elected a fellow of the Royal Society of New Zealand for showing exceptional distinction in research, particularly in relation to anaesthetics and patient safety, and the influence of the law on medical practice.

New Zealand Fellows who died in 2014 were:

Dr Desmond (Des) Alexander McQuillan, of Auckland, on March 28 aged 88

Dr Patricia Rae McDonald, of Auckland, on July 8 aged 96

Dr Richard (Dick) Rawstron, of Christchurch (formerly Palmerston North), on November 2, aged 98

Dr Jennifer (Jen) Best, of Dunedin and Auckland, on December 19 (11 days after receiving her FANZCA), aged 31

[state/nz] regional committee-committees-and... · work continued on the perioperative nurses...

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