Innovation through implementation of a bundle of care to reduce risk of infection associated with Peripheral Intravascular Devices in THS North West

Mrs Anne Jong1, Ms  Tana Clark, Ms Heather Craigie1

1Mersey Community Hospital, Latrobe, Australia

Abstract:

Introduction:
Peripheral Intravenous Catheters (PIVC) are inserted in up to 70% of hospital inpatients.  Up to 69% of these experience premature failure due to complications, the most serious is Staphylococcus Aureus Bacteraemia (SAB) which can have fatal outcomes. In 2018-19 we identified a rise in SAB’s associated with PIVC.  Evidence shows that implementing a bundle of care is more effective than introduction of a single action.

Method:
A working party was established comprising Clinical Nurse Consultants across both regional sites and a Clinical Nurse Educator with responsibility for Vascular Access (NQSHC Standard 2).  A bundle of care a was developed that built on existing improvement strategies and included the I-DECIDED Intravenous Assessment and Decision Tool, developed by Dr Gillian Ray-Barruel from the AVATAR group from Griffith University.

The acronym HANDS was adopted,

  • Hand Hygiene
  • Antisepsis & Standardised Equipment
  • Non-Touch Technique
  • Documentation and Observation (I-DECIDED Intravenous Assessment and Decision Tool)
  • Staff

Preliminary planning included approval to use the I-DECIDED tool, stakeholder engagement and education, updating of current protocols to reflect the introduced bundle of care, plan for rollout, and an evaluation plan

Results:
The bundle of care was rolled out over second half of 2019 and we are currently in the evaluation phase of the project.

Discussion:
THS-NW is one of the first health services to introduce I-DECIDED.  Coupled with a bundle of care and a planned implementation, we found clinical staff have been receptive to change and rollout has been uncomplicated. Planned auditing will show if this change has been effective.

Reference

  1. Ray-Barruel G, Cooke M, Mitchell M, et al. Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study. BMJ Open 2018;8:e021290. doi:10.1136/ bmjopen-2017-021290

Biography:

Anne works at the Mersey Community Hospital in Latrobe. Has been a surgical Clinical Nurse Educator for 10 years with interests in acute pain management, wound management, vascular access and infection control. Currently working in the THS north west Infection Prevention and Control department.

Collaborative leadership: development of a state-wide Healthcare Associated Infection Prevention Strategy

Ms Annie Wells1, Ms  Dana Gray1

1Public Health Services, Department of Health , Hobart, Australia

Abstract:

Healthcare Associated Infections (HAIs) are a common complication affecting patients in and out of hospital.  HAIs contribute to morbidity, mortality and excess healthcare expenditure.

The Tasmanian Infection Prevention and Control Advisory Committee (TIPCAC) is a state-wide group whose purpose is to reduce the risk of HAIs in healthcare, and to reduce the risk of infection during public health threats in the community and other settings.

In 2018 TIPCAC committed to develop a state-wide Tasmanian HAI Prevention Strategy.

The strategy was developed collaboratively and informed by the TIPCAC strategic priorities and the results of a statewide survey of senior managers and/or those responsible for the Infection Prevention and Control portfolio in their health service.  The strategy has seven core strategic objectives, each with focus areas, outcome measures and practical examples of success.  Each strategic objective belongs to one or more of the strategy’s three framework pillars: Governance, Surveillance and Education.

The Tasmanian HAI Prevention Strategy demonstrates leadership and provides a strategic perspective of Infection Prevention and Control priorities in Tasmania.  It aims to improve health outcomes of individuals who receive health care in our state and benefit the health and wellbeing of the Tasmanian community.


Biography:

Annie Wells is the Assistant Director of Nursing, Public Health Services Tasmania where she has worked since 2008 initially as a clinical nurse consultant – infection control.  She has a post graduate Master’s Degree in Advanced Practice (Infection Control & Prevention) and her interests include infection surveillance and support of novice practitioners.  Annie was the 2018 recipient of the Australasian College for Infection Prevention and Control Claire Boardman Medal for leadership in infection prevention and control.

Dana Gray is a Project Nurse, Public Health Services Tasmania where she has worked since January 2019.  She has experience in clinical, education, management and quality roles.  She has a post graduate Master Degree in Business Administration, a Graduate Diploma in Nursing and a Bachelor of Nursing.  Dana is passionate about quality, innovation, learning and promoting positive patient outcomes.

A collaborative approach leads to reinstatement of the On-Campus clinic in 2019

Mrs Kiona Fitzpatrick1, Dr Jane Cooper2, Mr Wayne Frost3

1Tasmanian Health Service, Ulverstone, Australia, 2Don Medical Clinic, Devonport, Australia, 3Cornerstone Youth Services, Devonport , Australia

Abstract:

In 2013 an on-campus clinic was established at a public education institution. It was open to 12 -24 year olds. This was managed by a private general practice clinic, that was unable to continue managing the clinic in late 2018 due to increasing cost and the inability to access any other funds or grants aside from Medicare rebate for consultations. Cornerstone Youth Service were approached to take on the management of the clinic in 2019. Cornerstone manage Headspace in Launceston and Burnie and after collaborations with Primary Health Tasmania were able to access funds under Headspace to support the clinic in 2019.

THS NW has a youth health nurse who is autonomous and mobile and has worked in schools seeing clients for group and individual education and care. The nurse was approached to join the team. Several meetings were conducted with the team including the social worker from the school to discuss the diagnostic analysis of the clinic when managed by the private sector.

Elements of the prior model were incorporated into new model and the clinic re-opened in the second term of the school year. Several meetings were then conducted to analyse the processes and procedures in place bearing in mind both administrative and clinical governance. A new team is evolving and a mutual passion toward creation of a sustainable model is evolving as obstacles and change take place.

This is an exciting new pathway and we hope it will be rolled out in other education institutions throughout Tasmania.


Biography:

Kiona is a Clinical Nurse Specialist who works as a member of the Primary Health Services, Tasmanian Health Service, NW. Kiona has worked for five years in this role, and prior to that worked at the North West Regional primarily in Paediatrics and also in the Outpatients Department. Kiona has completed and a diploma in Paediatrics, and recently has completed a Diploma in Adolescent Health and Wellbeing via University of Melbourne.

Why cultural visibility matters: journeys from a booth

Ms Jane Springall1, Ms Jeanette Kelly1

1Department of Health Tas, Hobart, Australia

Abstract:

The Department of Health was the host organisation for the Australian College of Nursing’s National Nursing Forum in Hobart in August 2019. The Departments role included sponsorship and manning an exhibitor’s booth.

The evolution of this booth is the topic of this talk. The booth had two key foci: firstly, living and working in Tasmania as a nurse, and cultural visibility. The community was consulted for structure and content to represent the unique Tasmanian landscape. Feedback encouraged us to consult with key Aboriginal leaders to provide an authentic cultural representation. This is what the community had told us the 600 interstate visitors would be interested in learning more about.

We were guided by our new Professional Practice Framework, PERL (People, Engagement, Regulation and Learning); and our teams core values in our consultation with key cultural partners. Our moral compass was the motivator, and collaboration was our tool.

Collaboration included using the expertise of the Aboriginal community and key organisations to walk with us and advise us. Creating positive energy and trust, and people would could not do more for us. Including setting up the booth, bring culturally appropriate information and resources, manning the booth and engaging in rich conversations about the vibrant contemporary Aboriginal community.

We strengthened our cultural competence, and through trust and respect built solid stakeholder relationships. This set a standard that aligns to the Nurses and Midwives Code of Conduct and the National Safety and Health Quality Services Standards.


Biography:

Jeanette is a Project Manager in the Office of the Chief Nurse and Midwife, Tasmania. Jeanette is a Member of the Australian College of Nursing (MACN) and holds a Master of Clinical Nursing. Areas of interest professional interest include women and children’s health, strategic leadership, diversity, Aboriginal health and supporting nurses and midwives.

Jane is a Project Manager in the Office of the Chief Nurse and Midwife, Tasmania. Jane is a Member of the Australian College of Nursing (MACN), she is a registered nurse and midwife, with a Bachelor of Teaching. She is passionate about working with young people and growing the nursing profession.

Fast track patients’ satisfaction, compliance and confidence with emergency department discharge planning

Mrs Leahanna Stevens1, Ms Margaret Fry2, Mr Michael Browne3, Mr  Arthit Barnes1

1Mersey Community Hospital, Latrobe, Asutralia , 2University of Technology Sydney, Sydney, Australia , 3Royal Hobart Hospital , Hobart, Australia

Abstract:

Background:
Across Australia over one million patients are discharged from the emergency department (ED) back to their place of residence. Discharge planning involves the communication of healthcare information to optimise patient safety, self-management, and understanding and compliance with ongoing treatment. Inappropriate discharge planning or patient healthcare information understanding could result in worsening of a patient’s presenting condition, illness and/or injury, or lead to avoidable deterioration. Little is known about the adequacy of discharge planning or delivery of health care information to patients in the ED. Therefore, the aim of this study was to explore the experience, confidence, satisfaction and perceptions of patients recently discharged from ED.

Methods:
The descriptive exploratory study was conducted in one district Tasmanian hospital. Data collection involved patient telephone interviews and a retrospective medical record audit.

Results:
A convenience sample of 100 patients was used for the study. Overall, the majority (93%) of patients understood their ED treatment, were confident to be discharged home (88%), and satisfied (90%) with ED care. The majority of patients’ understood their discharge diagnosis (86%) and were  provided with verbal (84%) discharge information. Discharge referral instructions were followed up by 60% of patients with 26% of patients re-presenting to ED.

Conclusions:
The study highlighted that the majority of patients were satisfied with ED care, complied with discharge healthcare information and confident to be discharged. However, a number of patients failed to adhere to discharge follow up advice and re-presented to the ED.

Key words:
Emergency Medicine; discharge instructions; compliance; satisfaction; patient communication; discharge planning


Biography:

Leahanna Stevens, originally from the Gold Coast QLD has over 20 years of experience in Emergency Nursing. She was one of the first Nurse Practitioners to go through the QUT program in 2007 for the Masters of Nursing Science, NP and pioneered the position in the Gold Coast Hospital ED. She has remained an Emergency NP for the past 12 years.

Three years ago, she left the busy trauma ED on the Gold Coast for a more relaxed easy-going lifestyle for herself and her young family in Tasmania. She loves to run and explore the island wineries in her free time whilst spending quality time with her family.

Leahanna now works in the smaller regional ED of the Mersey Community Hospital with two other fellow NPs. Together they coordinate and run the often very busy Fast Track area. Their focus is on the ambulatory care however they also flex into the acute and resuscitation zones when their expertise is needed.

Leahanna has a keen interest in the communication and discharge process. She believes that by empowering her patients with the education and knowledge of their healthcare conditions can only be beneficial in potentially improving compliance, wellbeing and reducing ED representation and utilising GP services.