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Monash Health Prevocational (Intern/HMO) Unit Information Unit: Casey Rehabilitation/GEM (Ward H)ContentsMonash Health Prevocational (Intern/HMO) Unit Information.............................................................1

Unit: Casey Rehabilitation/GEM (Ward H).............................................................................................1

Overview of Unit................................................................................................................................2

Orientation........................................................................................................................................2

Roster................................................................................................................................................2

Key staff.............................................................................................................................................4

Who to contact for a sick patient......................................................................................................4

Contacts for leave, over time and Kronos..........................................................................................5

Other useful contact numbers, access codes or passwords..............................................................5

What do you expect the JMS to learn and manage?.........................................................................6

Learning objectives........................................................................................................................6

Unit Information................................................................................................................................7

Facilities.........................................................................................................................................7

Ward patient profile......................................................................................................................8

Ward culture..................................................................................................................................9

Referrals to Ward H.....................................................................................................................10

Orientation process and swipe card access.................................................................................10

Emergency procedures and information.....................................................................................10

Unit meetings..............................................................................................................................12

National Standards quality data boards and portfolios...............................................................14

Consumer participation...............................................................................................................15

Prevention of infection................................................................................................................18

Medication safety........................................................................................................................19

Patient identification...................................................................................................................19

Clinical handover.........................................................................................................................20

Blood and blood products...........................................................................................................21

Prevention of pressure injuries....................................................................................................21

Deteriorating patient...................................................................................................................22

Preventing falls and harm from falls............................................................................................23

OHS..............................................................................................................................................24

Document last updated 26/09/2019 by Dr Jian Wey Chin

Stationary and building issues.....................................................................................................24

Meals and groups........................................................................................................................25

Medical staff specific information...............................................................................................28

Allied health services...................................................................................................................29

Other specialist services/programs.............................................................................................29

Overview of UnitWelcome to our purpose built Sub-Acute ward and most recent extension to Casey Hospital. Ward H is a 30 bed sub-acute ward with 4 x 2 bedrooms and 22 single rooms.

Patients in our new ward environment will enjoy mostly single rooms with pleasant views out of their rooms and, for the first time on the Casey site, openable windows in a number of rooms. There is a fantastic outdoor mobility garden for therapy practice of outdoor surfaces and is wheelchair friendly, this area includes a lovely space with seating for patients to be able to enjoy some fresh air and sunshine.

You will find in this orientation package some self-directed tasks where you need to wander around the ward and get to know your environment whilst identifying the areas and objects listed. The Environmental Orientation Checklist must be completed and is attached to this Welcome Package.

As we work through establishing the ward and new processes together, we welcome you on this exciting journey to make Ward H a caring and professional place to work and a positive and productive rehabilitation environment for our patients.

Orientation Unit orientation is provided on day 1 by consultants and Senior Allied Health.

Ward orientation is provided by the NUMs on day 1 following unit handover.

A detailed orientation pack is emailed to all interns in two weeks prior to commencement.

Policies and guidelines are all provided on Prompt as per hospital network guidelines.

RosterWork rosters are provided via the Monash Doctors Workforce.

The Intern/HMO is rostered for 38 hours per week – Monday to Friday 8:30 – 4.30 with one afternoon off.

Inclusion in Casey Weekend cover roster.

Each Intern/HMO has one afternoon off per week. Both Registrars have one afternoon off AND one teaching afternoon per week (on condition that both registrars are not off the ward at the same time):

Tuesdays o Rehabilitation registrar PM off

Wednesdays o GEM/Pall Care intern PM offo Rehabilitation registrar teaching PM off

Thursdays o Gem/Pall Care Registrar teaching PM off

Fridays o Rehabilitation Intern PM off o GEM/Pall Care Registrar PM off

There is some allowance for the occasional swap but the Nurse Unit Manager and/or Unit Head must be informed beforehand to ensure the ward continues to have appropriate cover.

Monday Tuesday Wednesday Thursday FridayAM 0800 Nursing to

Medical handover

0820 Journey Board Meeting

GEM0830-0900 Pall care RWR

0900 GEM CWR

Pall care CWR timing TBC depending on who is on

Rehab0930 Rehab CWR

1130-1200 Rehab secondary team meeting

1200 CWR cont.

0800 Nursing to Medical handover

GEM0830-0900 Pall care RWR, thenGEM RWR

Rehab0830 RWR

(1000-1020 GEM and Rehab registrar attends LOS meeting)

Rehab0830 RWR

GEM0830-0900 Pall care RWR

0830-0845 GEM secondary team meeting, then GEM CWR

RehabIntern to do rounds (Rehab registrar and consultant at Clayton for consults)

Rehab0830 RWR

Lunch 1200-1300 Medical Grand Round with General Medicine with Lunch

1200-1245 Combined Unit Education session with GEM unit - Case based education, journal review and informal teaching

1300-1400 Prevocational Teaching Time for Interns

PM (GEM registrar consults in the acute wards)

1400-1530 GEM main team meeting

1230 Rehab CWR, review new and sick patients

1330-1530 Rehab main team meeting then CWR review of

(Rehab Intern PM off & GEM Registrar PM off)

(Rehab registrar at outpatient clinic with consultant every fortnight)

(Rehab registrar PM off)

(GEM Intern PM off & Rehab registrar training PM off)

new and sick patients

(GEM registrar training PM off)

Intern Protected Time: This uninterrupted time occurs daily between 1300-1330. To minimise the risk of errors, interns must use this time to re-write medication charts, and complete discharge summaries.

Education opportunities

Intern Teaching Thursday 1230-1330 Ward A Clinical Meeting Room

Medical Grand Round Tuesday 1200-1300 Meeting room beside library

Ward H combined unit education meeting

Wednesday 1200-1300 Ward H Meeting Room

Weekend medical cover

Ward H and B will have registrar cover each Saturday from 0800-1400. The GEM/Pall care registrar and Rehabilitation registrar cover alternate Saturdays. HMO’s will cover alternate Sundays from 0800-1400. The shift should commence by taking handover at the Casey Site morning handover meeting

in the Ward C handover room at 0800 followed by handover from the ward H and Ward B Nurse in Charge.

At the end of the shift, handover should be given to the General Medical Registrar and/or HMO rostered on rostered on for Ward cover.

Med Reg on site is also 1st contact for supervision of HMO’s.

Key staff Head of Ward H Dr Dean Everard Dean.Everard@monashhealth.orgGeriatrician Dr Jian Wey Chin JianWey.Chin@monashhealth.orgRehabilitation Physician/Intern Supervisor

Dr Asha Mathew Asha.Mathew@monashhealth.org

Who to contact for a sick patient Ward consultant is available via phone from 0830 hours on Monday until 1700 hours on

Friday, and should be contacted if there are any concerns about a patient. After hours on weekdays from 1700 until 0830 the next morning, Dr Asha Mathew and Dr

Jian Wey Chin rotate being on call on a weekly basis. From 1700 hours on Friday, until 0830 hours on Monday, there is a Consultant on-call

available via switch (according to a rotating roster). If the ward or on-call consultant cannot be reached and the matter is urgent, then Professor

Barbara Workman can be contacted via switchboard.

Contacts for leave, over time and KronosAnnual leave changes/ personal leave/Kronos management

MDW via Switchboard 9594 6666

Sick leave MDW via Switchboard 9594 6666 & Consultant/Nurse In ChargeOvertime claims http://prompt/Search/download.aspx?

filename=1826085\4571160\11971310.pdf

Annual leave is allocated before you commence your rotation. Additional Conference or Study Leave should be discussed with your Consultant and application made to Medical Workforce Unit by completing an Application for Additional Leave Form and attaching the appropriate evidence for the request.

Sick leave: Ring as soon as you realise that you are unwell and unable to work. The earlier we hear, the greater chance we have of finding a swap or locum, and avoiding calling in the on-call staff member. You must contact your Consultant and nurse in charge with as much notice as possible and at least 2 hours prior to the start of your on-call period. Telephone the Monash Medical Workforce Unit (ask for on call phone through Switchboard if after hours). Ask Switchboard to divert your pager to your equivalent colleague.

Forward Medical Certificate or other documentation if possible to Medical Workforce Unit immediately upon return to work. Please note that you are only entitled to 3 single days a year without a certificate (including staff on rotation).

Reminder that if you are on-call standby, please ensure that you remain contactable and available to cover any sick leave required within one hour of a call. When rostered on-call, junior medical staff must not consume alcohol or be under the influence of alcohol (or other CNS depressants or stimulants).

Other useful contact numbers, access codes or passwordsNurse Unit Manager Sarah Jenkins Sarah.Jenkin@monashhealth.org / Ext 82411ANUMs Ext 82402Administration Michele Ah-fat Michele.Ahfat@monashhealth.orgWard Clerk Deb Steel Tel 8768 2400 Fax 8768 2531Physiotherapy Ext 82124Occupational therapy Ext 82129Speech pathology Ext 82121Dietitian Ext 82132Social work Ext 82125Clinical psychology Ext 82137Clinical neuropsychology P 2507

JMS Coordinator (Noelene Nelson) 9594 4897 /

MonashDoctors_Operations@monashhealth.orgRiskman (death certificate) Username: Geriatric Medicine

Password: Death

What do you expect the JMS to learn and manage?Learning objectivesAt the end of this rotation, the Intern/HMO, under supervision, will be able to:

1. Science and Scholarship

Consolidate, expand and apply knowledge of the aetiology, pathology, clinical features, natural history and prognosis of common and important medical presentations at all stages of life with emphasis on old age.

Access and use relevant treatment guidelines and protocols

Seek and apply evidence to medical patient care

2. Clinical Practice

Assess and contribute to the care of patients with a broad range of medical conditions including:

a. exacerbations of chronic conditions

b. critically ill patients, both at presentation and as a result of deterioration during admission

Demonstrate appropriate history taking, physical examination and mental state examination skills

Develop management plans for medical patients

Order and interpret investigations

Access clinical management resources, making referral and monitoring progress

Observe and perform a range of procedural skills (IV cannulation, catheterisation, venupuncture, blood gases, pleural/ascetic taps, lumbar punctures)

Develop knowledge and skills in safe and effective prescribing of medications including fluids, blood and blood products

Develop effective communication skills including:

a. interactions with peers (particularly through clinical handover)

b. supervisors

c. patients and their families

d. other health care workers involved in inpatient and ambulatory care

Develop advanced skills in spoken, written and electronic communication

Develop skills in obtaining informed consent, discussing poor outcomes and end of life care in conjunction with experienced clinicians

Develop written communication skills including:

a. entries in paper and electronic medical records,

b. admission notes,

c. progress notes

d. discharge notes

e. letters to other health care professionals

Develop knowledge and skills in the disciplines of Rehabilitation Medicine and Geriatric Medicine.

3. Health and Society

Discuss allocating resources in providing medical care

Participate in quality assurance, improvement, risk management processes and/or incident reporting

Screen patients for common diseases, provide care for chronic diseases and discuss healthcare behaviours with patients

Develop knowledge about how patient care interacts with sub-acute, community and ambulatory care facilities, including appropriate discharge destinations and follow-up

4. Professionalism and leadership

Develop skills in prioritising workload to maximise patient and health service outcomes

Demonstrate an understanding of roles, responsibilities and interactions with various health professionals in managing each patient

Participate actively in the multi-professional/disciplinary team

Develop and reflect on skills and behaviours for safe professional and ethical practice consistent with the Medical Board of Australia’s Good Medicine Practice: A Code of Conduct for Doctors in Australia.

For information on this unit collated by your peers see the rover

Unit Information

FacilitiesThere is a dedicated trial of care area comprising of a kitchenette area with table and chairs to be used when the team feel the goal is to trial managing care prior to the decision for discharge destination.

There are 2 specifically appointed bariatric rooms with bariatric overhead hoists and tracking installed to accommodate patients up to 450kg. A further 4 rooms with overhead hoists weight limited to 300kg and tracking for ease and safety of transferring those patients not yet able to weight bear.

The ward has its own gym area and allied health OT kitchen space to cater for breakfast groups and occupational therapy sessions, a patient dining and lounge room area and a number of smaller lounge areas for patients and their visitors to sit together.

There are 2 nursing staff bases; Staff Station A & Staff Station B.

Staff Station A houses patient histories for patients in Beds 1 -15 and the ANUM desk and computer area with all roster, allocation, sick leave, RDNS and orientation folders along with any extra management resources required for the in charge to manage the shift.

There are 3 more computers and phones in this area for staff to utilise as required. All MR forms and admission packs, referral forms, patient ID bands etc., are found in the pedestal under desk file drawers which are labelled clearly.

Staff Station B houses patient histories for patients in Beds 16 - 30, this area also has a private area at the rear of the desk area with a sliding glass door for privacy. The front desk area has 3 computers and phones for staff use with the same setup for MR forms as mentioned for Staff Station A.

The private area has 3 computers and phones with another area dedicated to the nurse in charge as required, the Ward Support has a base in here as well with communication diary and paperwork set up for their use.

There are a number of write up bays at entry to patients rooms often there is one between 2 single rooms. These write up bays have a computer for use of all staff which are all connected to the ward printer if printing is required. These areas also contain 2 drawers for storage of PPE (personal protective equipment) such as gowns gloves eye protection and disposable microfibre cloths for use when patients require Standard or Additional Precautions.

The large multipurpose room with installed Smartboard is a fantastic resource for Ward H staff of all disciplines. This is the main area where nursing handovers and ward meetings, multidisciplinary daily discharge planning handovers and team meetings and education sessions will be held.

Ward patient profileGEM – 14 patients, Rehabilitation – 16 patients

Ward H accommodates patients for sub-acute treatment and our cohort will includes neurological and stroke conditions and orthopaedic conditions accepted under the Rehabilitation team. The Geriatrician accepts patients under the GEM (geriatric evaluation and management) team with varied conditions requiring slower stream rehabilitation, assessment and management often with multiple comorbidities.

RehabilitationRehabilitation is designed to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible. The purpose of rehabilitation is to restore some or all of the patient's physical, sensory, and mental capabilities that were lost due to injury, illness, or disease. Rehabilitation includes assisting the patient to compensate for deficits that cannot be reversed medically. It is prescribed after many types of injury or illness. The rehabilitation patients we care for include:

Aged orthopaedic patients Post stroke patients

Those with functional decline from an acute illness, cardiac event, or surgery

This unit is headed by the Rehabilitation Consultant, Dr Asha Mathew. Consultant ward rounds – Monday AM, Wednesday PM, and Thursday PM.

GEMGEM is the acronym for Geriatric Evaluation and Management, which involves elderly patients needing assessment and treatment post illness or injury, in relation to the appropriate discharge destination. The primary aim of the service is to assist our patients in returning home with an optimal level of health and independence.

This unit is headed by a Geriatrician Consultant, Dr Jian Wey Chin. Consultant ward rounds – Monday and Thursday AM.

The GEM registrar and HMO are also responsible for looking after 4 palliative care beds. There is a rotating consultant responsible for these palliative care patients, together with a palliative care CNC.

Ward cultureIn the Allied Health Team, we are committed to working together as an interdisciplinary team. Interdisciplinary care seeks to obtain the best outcome for the patient through greater integration of disciplines within the team. One of the features of this model is joint assessment, diagnosis, and goal setting in a single, non-discipline specific session, where there is a focus on involvement of the patient in this process. During this session, individuals from different disciplines, as well as the patient, are encouraged to question each other and explore alternate avenues, stepping out of discipline silos to work toward the best outcome for the patient. This model encourages greater communication between disciplines and increased collaboration, recognising the overlap in knowledge within the team, but with the resultant problem solving being greater than that which could be achieved by a single individual’s discipline-specific knowledge base.

Our team takes a holistic approach to patient care. We take a ‘positive and solution focused approach’ to our services and ensure that referrals to other agencies/disciplines are made on time. We are a team that supports and encourages each other throughout our daily practice.

Team behaviors:

Our team carries out joint assessments and flag referrals for our colleagues When one of our team mates is particularly busy we will assist as best we can to triage

patients to determine if other disciplines are indicated We communicate our discharge plans to each other promptly We never disagree or challenge others opinions in a public forum We are a team that respect one another and value each team member’s time, by turning up

to meetings on time We have a strong focus on learning and share knowledge and information throughout our

stream

Person centered care

As a team we practice person centred care. This involves treating patients as they wish to be treated. Further information can be found on the principles of person centred care at the Department of Health website: http://www.health.vic.gov.au/older/toolkit/02PersonCentredPractice/index.htm

Referrals to Ward HRehabilitation and GEM patients are referred through the Access Unit at Kingston Centre. Our patients are mainly from acute wards at Monash Health sites. We also have patients referred from private hospitals in the area and occasionally from external large public hospitals. Patients are given priority for referral generally based on the area they live in.

Orientation process and swipe card accessThe orientation folder is kept at the ANUM desk area in Staff Station A. All staff must be aware of the orientation process for ALL Bank, Agency, CPO, Medical, Allied Health staff – whether they are permanent, casual, students placement, they must be orientated to the ward using the checklist and then signed off by the staff member and the Ward H staff member providing the orientation.

Policies and procedures are on Prompt as well as in the orientation folder.

Swipe card access for bank/agency/CPO staff

There are dedicated swipe cards kept in the Medication Room, these swipe cards are all labelled as follows:

2 x Registered Nurse Access Swipe Cards

1 x Endorsed Enrolled Nurse Access Swipe Card

1 x Non Endorsed Enrolled Nurse Access Swipe Card

1 x CPO Swipe Card

The Swipe Card Access Register Folder is kept in the Medication Room, all swipe cards must be signed OUT & returned and signed IN at end of shift.

It is the responsibility of the NUM/ANUM or staff in charge of the shift to check at the end of the shift that the swipe cards are returned and signed back in.

Emergency procedures and informationEmergency number 999

State location and code

Emergency Codes

Red = Fire/Smoke

Orange = Evacuation

Purple=Bomb Threat

Black=Personal Threat

Grey=Occupational Threat

Yellow=Internal Emergency

Blue = Medical emergency

Brown=External Emergency

(Please refer to the emergency procedures handbooks located near each phone for further information).

Zone warden

The Zone Warden is generally the NUM or ANUM on Ward H and in charge of the shift. You will find a list of Zone Wardens on the whiteboard located in the Stationary Room and it will be noted each day on the same whiteboard for the shift allocations. In the event of an emergency the Zone Warden will be wearing a high visibility vest for ease of identification.

The Zone Warden equipment – high visibility vest, emergency cards and torch are located at each Staff Base in the fire extinguisher cupboard below the histories pigeon holes. This cupboard is clearly signed.

Meeting & egress points

When the emergency tones are sounded through the hospital the meeting point is at the Staff Station A desk, the Zone Warden will be at this location and will direct you as to what is occurring and what you are required to do, the zone warden will be identifiable by the high visibility vest that he/she will be wearing.

At this time no one is permitted to leave or enter the Ward.

There are a number of signs around the ward mapping the different egress pathways, the zone warden will be the person directing you if evacuation is required.

Break glass/fire extinguishers/fire hoses/WIP phone

There are a number of WIP phones, hoses, extinguishers and break glass alarms around Ward H. Please complete the environmental orientation to become familiar with these locations.

Ward based emergency nurse call system

If staff find they are concerned about a patient and they require assistance from the wider nursing and medical team, then they should push the NURSE ASSIST button located at the patient bedsides and ensuites, the dining room and in some therapy areas. If staff find they have an unresponsive patient or the matter is extremely urgent then the EMERGENCY BUTTON should be used, again these are located in all patient rooms and ensuites and in all Ward H therapy areas and Consult rooms.

The tone for Assist and Emergency Alarms are different to the Nurse Call so staff must familiarise themselves with these tones during orientation.

There are numerous annunciator panels around the ward that sound and display which room/area the call is from.

Duress alarms

Red buttons located underneath the desks at the nurse bases, ward clerk/reception desk, gym area, consult rooms, and inside the medication room. When these buttons are pressed, this alerts Security only to an issue on the ward and they will attend as a matter of urgency. These alerts would be utilised when staff are feeling there is a threat to their safety and require Security support. This

alarm is not sent through to any of the emergency Zone Warden pagers. Please ensure you are familiar with these duress alarm locations.

Riskman reporting

Ward H promotes a culture of reporting. Please ensure you discuss all risk issues and incidents with the Nurse in Charge promptly. When completing a Riskman incident report, please ensure the Nurse in Charge has observed the Riskman prior to submitting to ensure as much detail of the incident as possible has been included at time of reporting.

Unit meetingsDaily handover meetings

Daily handover meetings are attended by allied health and the medical teams. The Nurse in Charge will chair and run through each patient via the journey board (not team-specific) facilitating communication from the team of relevant information only as per set criteria. Each discipline of the Allied Health Team is rostered to update the journey board and KCP (key contact person) list daily. You must review the board to see when your discipline is rostered on. Information to be updated on journey board includes KCP, any investigations/appointments, referral to ACAS/TCP/RDNS, home visits and D/C dates.

Coloured traffic light system is used to show referrals:

Green indicates the patient is ready for discharge/transfer from that discipline;

Yellow indicates that the patient has ongoing therapy/needs for discharge; and

Red indicates that the discipline is yet to see this patient but a referral is required.

White = not required by that discipline at that stage.

The Nurse in Charge will briefly discuss or inform team of:

Appointment of Key Contact Person

Acute medical issues affecting or preventing therapy or planned discharge

New barriers to discharge

Confirmation of planned discharge date and transport home

Handover relevant issues from preceding weekend (Mondays)

Discuss planned weekend/overnight leave/trial of care

Essential information for communication outside of primary and secondary team meetings

Guidelines for the sub-acute handover can be found on the Monash Health intranet: Clinical services / Rehabilitation and Aged Services / Patient First Sub-acute 2- 2012.

Team meetings

Multidisciplinary meeting where each patient is discussed, goals are set or reviewed, and discharge dates are planned for. All treating team members are required at this meeting and need to be on time and prepared. These meetings are held in the multipurpose meeting room

Rehabilitation meetings

Main meeting – Thursdays 2:00 – 3:30 PM

Secondary meeting – Mondays 11:30 AM – 12:00 PM

GEM meetings

Main meeting – Thursdays 2:00 – 3:30 PM

Secondary meeting – Thursdays 8:30 – 8:45 AM

Nursing staff ward meetings

Nursing staff ward meetings are scheduled to occur monthly with more frequent meetings as deemed necessary by the Nurse Unit Manager.

An agenda will be posted in the staff locker room a week prior to the meeting. Minutes will be posted in the Staff Locker Room and emailed to all ward staff; minutes will also be saved to the Ward H Folder (Nursing Staff Meeting Minutes folder). All staff are expected to keep themselves updated by reading minutes when not at meetings.

Multidisciplinary subacute stream meetings

Ward H has a scheduled monthly meeting with all disciplines combined. Nursing, allied health, and medical are expected to attend. The focus is on communication of changes, issues, staffing, and quality improvement to ward processes, and a professional development component occurring on a fortnightly basis. The meeting is held in Multipurpose Meeting Room on Wednesdays monthly from 2:00 – 3:00 PM. It is important to attend this meeting on time due to the tight timeframe allocated for the agenda and also due to competing pressures for all staffs time during a shift. Minutes will be posted in Ward H Nursing staff Locker Room and saved (G:\casey_alliedhealth\ADMINISTRATION\MINUTES\STREAMS\SUB ACUTE).

Areas of discussion:

Completion of admission or discharge FIM

Risk screen

Identification of goals or progress on current goals

Identified issues impacting on discharge

Services or supports required on discharge and status of these referrals

Projected discharge plan including discharge date, discharge destination and proposed actions

Two team members must volunteer to scribe at the meetings as per 20/20 team meeting guidelines

The ward clerk is responsible for collecting the patient histories for the team meeting and placing them in the handover room. Minutes are saved (G:\casey_alliedhealth\PROCEDURES & PROTOCOLS\STREAMS\SUB ACUTE\Ward D Multidisciplinary Team Meeting Guidelin.doc).

Treatment planning meetings (TPM)

TPMs are scheduled for those patients who are complex and need longer discussion than a team meeting can provide, or require a consistent team approach to facilitate an effective multidisciplinary treatment plan. It is essential that the nursing staff attend and contribute to the plans and discussion around patient issues. Nursing staff are pivotal in all areas of patient care plans. (Please familiarise yourself with the TPM guidelines: G:\casey_alliedhealth\PROCEDURES & PROTOCOLS\STREAMS\SUB ACUTE\TPM protocol 2011.DOC.)

These meetings occur in the Multipurpose Meeting Room and are scheduled on particular regular days as per the Meeting Diary which is located in the Meeting Room pigeonholes.

Family meetings

Meetings are required for patients and families when discharge destination is complex or varies from pre-morbid living arrangements. Nursing staff are required to be at these meetings to assist in providing a complete picture of the patient function and ability impacting on discharge destination The entire team needs to be providing the same message of concerns and ideas for the patient and their families to assist them in their decision-making processes. These meetings will be held on Ward H in the allocated Interview Room in the Linkway or another room nominated. Meetings are offered on particular days and times and recorded in the Meeting Diary kept in the Meeting Room pigeonholes.

National Standards quality data boards and portfoliosAll Quality Improvement and Surveillance Data Boards are located in the corridor leading to the dining room on Ward H. All standards audit results and action plans will be located on these boards for staff awareness and action as required.

All staff are involved in the Quality Improvement process on the ward. The entire nursing team are expected to be actively engaged in the implementation, embedding, and auditing of the 10 National Standards on Ward H. Each staff member is allocated a National Standard and joins a team of nursing staff with an ANUM as lead portfolio holder. Expectations of this role include completing audits for the ward and providing ward based feedback and education about the allocated National Standard. This process is monitored by the Nurse Unit Manager and is discussed as a part of each staff member’s performance enhancement annually.

The subacute team continually conducts quality projects. The subacute quality leaders consist of a member of Allied Health and Nursing. Please enquire about our projects and find out how you can become involved. If you are part of a rotation, please find out if your predecessor was involved in any quality activities. A subacute planning session is held annually and projects are identified. All projects are recorded on the projects register on the intranet.

Consumer participationOn arrival to the ward, staff will orientate patients to their new environment and ward processes.

a. Rounding

Ward H promotes this routine of interacting with our patients at least every hour by nursing staff during day shift and ensure observation if not interaction whilst patients are sleeping, hourly overnight. This process is an expectation of Ward H and Casey Site and must be explained to the patient when you introduce yourself at the beginning of your shift. All staff will ask patients if they need anything, pain relief/toileting, ensure pressure relief is attended to, encourage fluid intake, and ensure belongings and frame are in reach. Observe the patients environment – it is essential that the environment is safe for the patient. All patients must have easy reach of their call bell, bed in lowest position required and cot sides (at least 1) down.

b. Patient bedside information

Laminated information sheets located by bedside are to be explained to patient on admission for patient and/or families to be aware of. Staff are to provide this information via laminated sheets and explanation to their patients on admission to ward and include this in the admission notes. These information sheets include:

Patient rights & responsibilities

Falls prevention

Mobility chart

Pressure injury prevention

Hand hygiene

Bringing food to hospital safety

What can I do if a patient is becoming unwell?

c. Mobility charts

Mobility charts identify patient’s bed mobility, ambulation and transfer status during their admission. This chart is displayed above (or opposite) every inpatient’s bed. Patient’s mobility status is regularly reviewed and the status may change several times during admission. Mobility Charts must be updated by the patients Physiotherapist or Occupational Therapist. ALL staff should refer to the chart BEFORE attempting to move patients in/out of bed/chair for assessment or treatment.

d. Up and go

This is where all allied health staff work with the nurses to ensure that patients are out of bed and dressed in the their own clothes before 1000. See: G:\casey_alliedhealth\PROCEDURES & PROTOCOLS\STREAMS\ACUTE\Up and Dressed\Up and Dressed by 10am.DOC

e. Timetable

Patients will be provided with a timetable from Allied Health to enable them and staff to have an awareness of the coming week therapy plan. This encourages the patient to be involved in their treatment plan. A blank timetable must be provided to a new patient at the time of the initial contact assessment for therapists to fill out prior to the electronic version being completed.

An electronic diary system operates to schedule patient therapy times. Allied Health therapists must update prior to 12pm on Friday. The administration assistant will print patient timetables weekly and the AHA’s will place these in the patient’s room. See: G:\casey_alliedhealth\ADMINISTRATION\ROSTERS\Subacute\Sub-Acute Timetabling Dos and Donts.doc

f. Interpreters

We are committed to providing allied health services in a culturally sensitive and appropriate manner. Bookings for interpreting services are available via the Monash Health Intranet. Bookings

must be made more than 24 hours in advance – use the “Request an Interpreter” link for bookings on the intranet or call 9554 8429 for a telephone interpreter. There is an online interpreter awareness training package that we would recommend you undertake. A Cultural Sensitivity Folder is available in the allied health department which is a collection of information that will help you with being culturally sensitive and appropriate in your interventions.

g. Goal setting/key contact person

Patients are allocated a multidisciplinary team member to act as their main contact person on admission. This role involves the KCP maintaining closer contact with the patient and next of kin to enable discussion with the patient about their goals whilst an inpatient on Ward H and what they think they need to achieve to enable discharge. Areas of importance that you are to ask the patient and family are: a) Can the family provide assistance at home, b) Were there any continence issues prior to admission, c) Can the family assist with light meals? d) Were there any problems with medication prior to admission? e) Can the family assist with showering and dressing on discharge? The KCP also is expected to update the patient and the team of each other’s thoughts and plans, and also to flag any concerns that arise. Also, it is important to complete a follow up phone call 7-10 days after patients discharge, document and feedback to the team. It is important to complete the 20:20 paperwork when you are seeing the patient.

h. 20/20 KCP documentation

MRI 106 Patient Communication List is divided in to three sections. In the first column, the KCP asks the patient their goals for rehab and records these here. Key questions/prompts to ask include:

Does the patient need to manage their own medications at home or does someone help them?

What mobility can the patient manage at home with?

Does the patient need to be able to prepare simple meals?

Does the patient need to dress themselves?

Does the patient need to independently manage their continence?

These goals are communicated to the team in the team meetings. The predicted discharge date and destination are recorded on the lower section of the form.

After the first team meeting where the patient is discussed, the team’s goals and time frames, treatment plans or other communication are recorded (refer to MRI 108 form) in the second column. The KCP communicates this information to the patient and NOK after the team meeting.

If the patient accepts or declines the goals, the patient signs in the third column. A photocopy of the MRI106 form is provided to the patient.

MRI 108 Goal Setting sheet – expected status at discharge is recorded at the front. Inpatient rehab goals, long term goals, and time frames are recorded on page 2. The KCP should also provide the patient with their contact details. The patient’s therapy timetable should be updated weekly with the clinician’s name.

After each weekly team meeting, the KCP should update the patient on their progress and if they are on track for discharge. Patients that may require rehabilitation for longer may need to be discussed at the secondary meeting, and if complex issues arise, a TPM may be needed.

i. Follow up phone calls

If a patient is discharged home, all KCP’s are required to conduct follow up phone calls for their patient 7-10 days post discharge. The outcome of the follow up call is communicated to the team at

the primary or secondary team meeting. See: G:\casey_alliedhealth\PROCEDURES & PROTOCOLS\STREAMS\SUB ACUTE\Follow up phone calls

j. Patient day or night leave

Some patients may have day leave or overnight leave, as well as a trial-of-care at home. Any leave is to be discussed at team or handover meetings and must be approved by medical and therapy staff. Ensure pharmacy are notified early of any leave to ensure medication is organized in a timely manner. No more than two nights’ leave may be approved at any one time.

k. Patient discharge

Discharge planning begins on admission. Ward H utilises an Event Driven Discharge Process which involves setting goals for every patient. The discharge goals will be set at the team meeting and documented on the 20/20 Goal Setting Sheet by the treating team. Once the patient has met these criteria and they are ticked off as achieved, the patient is able to be discharged without medical review.

Early referrals to Allied Health and flagging discharge services such as RITH, TCP or RDNS for wound care is important to facilitate a streamlined discharge. The KCP should ensure both the patient and their families are aware of the course and anticipated length of stay. Refer to the Discharge Planning Folder located in handover room for further information on referrals to community services.

Discharge time is 0900 hours and patients should always be collected by discharge time by family. All requests for ambulance transport must be approved by the NUM/ANUM.

For nursing staff: when a patient is to be discharged home, it is important to document in their history, the time they left the ward, who they left with, whether medications are required and in the patient’s possession. Also document what follow-up the patient will be receiving. Ensure that the discharge sections are completed on the Discharge Risk Screen and the FIM assessment. If the patient requires dressings on discharge (for example with post-acute care or RDNS), they are to be sent home with three days’ worth of supplies. If patients are discharged with a catheter in-situ, there must be the appropriate equipment sent home with the patient. Once the patient has been discharged, strip their bed, discard all disposables and alert the ward support person as well as the person-in-charge, of the need to clean the bed area.

Once patients are discharged from the ward, the progress notes folder/observation charts/medication charts etc. are to be taken to the ward clerk for sorting and to enable the patient to be discharge off the iPM system. Out of hours, the discharge forms (found in the iPM folder) must be faxed by the nursing staff to Admissions at the time of discharge for all patients.

l. Summary of follow up referral

A blank Patient Discharge Letter is placed in the patient’s medical history upon admission. When a patient is ready for discharge, all relevant staff must complete this letter with contact details for follow up services/programs (e.g. RDNS, PCA, CRC physio, etc.). A photocopy of the completed letter is provided to the patient on the day of discharge and the original is placed in the medical history – this can later be located on SMR under Correspondence section.

Staff are required to complete their relevant referrals. Nursing staff will provide a summary to the patient on discharge.

Blank Patient Discharge letters are located in the dividers with the 20/20 paperwork in the handover room.

m. FIM assessment tool

These are to be completed for every rehabilitation and GEM patient who is admitted to the ward. For all admissions, please check if the FIM form has been commenced. The FIM assessment is an

important assessment that allocates the length of stay for a patient relating to their score and the category they fall into. This assessment should be completed within the first 48-72 hours of admission. The assessment is taken from the patients worst function ability in the first 24 hours of admission. There are laminated sheets outlining each assessment category for staff to use to ensure the assessment is correct.

FIM assessment is recorded and discussed at the team meeting with Consultant input.

FIM training is completed within Monash Health and all staff involved with patient assessment and discussion at team meetings should have completed the training and exam. This is required to be renewed every 2 years.

The patient must be reassessed prior to discharge ideally completed over the final 24-48 hours again at patient’s worst function. It is important to ensure an accurate assessment on admission and equally on discharge. Ask for assistance if unsure.

Prevention of infectionPPE (personal protective equipment)

Write up bays by each entrance to a patients room contain 2 drawers designed to store all PPE for patients on Standard or Additional Contact Precautions. These drawers should hold gowns, gloves, eye protection, and tuffie wipes when required during a patient’s admission. These drawers are NOT to contain any extra stock at any time, and are wiped out on a weekly basis as per the ward cleaning schedule.

PROMPT – policy and procedures to be aware of and follow:

Occupational Exposures

Antimicrobial Stewardship

Aseptic Technique

Intravenous Vascular Devices Insertion & Management

Standard & Transmission Based Precautions

Hand hygiene: Ward H has a number of Hand Hygiene Auditors who perform audits every month. All staff must know their 5 moments of Hand Hygiene and comply with the Infection Control uniform policy. No long sleeved shirts/tops to be worn when performing clinical care, no wrist jewellery and no rings other than wedding band. Uniform must be clean and tidy with safe footwear. The NUM and ANUM team will request you adhere to the policy.

Ward H has 2 areas for clinical stock: Sterile and Non Sterile

Ordering for weekly imprest closes on Thursday at 0930 and delivery is lunchtime Fridays. If items needed prior to this please let Ward Clerk and NIC know and record on whiteboard in sterile room: date and item and name reported to and then initial. Please DO NOT move anything around whilst we are settling into the new environment

The STERILE area located opposite the Medication Room contains dressings, intravenous and urinary catheter insertion and management consumables, wound care products, oxygen, suction and respiratory consumables, syringes, needles, cannulas and nasogastric tubes, feeding sets, etc. All IV fluids are stored in this area.

The NON STERILE area is located opposite Bed 16-17. Items found in here include urinary continence pads, blood tubes, gloves, digital thermometers and covers, heat packs, blueys, torches, batteries, emesis bags, unistix needles for glucometers, avaguard hand rub and soap for dispensers, eye protection, masks. You will also find the IV Poles and IV pumps on the wall poles plugged in, the nasogastric feed pump also plugged in.

Medication safetyMedication storage

Patients’ own medications are kept in the cupboards below the bench in baskets – organised alphabetically by patient surnames. These medications are returned to patients on discharge by pharmacy or ward staff if out of hours. Patient Own Medication Bags (green and red) can be found in the Medication Room in signed drawer.

Medication Fridge is checked by night staff daily and recorded on the graph located on the side of the fridge. Checking is as per protocol on PROMPT – please ensure awareness of policy and procedure.

Weekend Discharge and Weekend Leave medications are left by pharmacy in the basket on the bench top in the medication room. Nursing staff are then to provide to patient/family prior to them leaving the ward.

Computer Access is available in the Medication Room for information and access to pharmacy intranet site, PROMPT protocols and procedures, online medication resources – MIMS online. There is also easy access at entry to all rooms at write up bays if medication information is required from online sites.

Medication cupboard and swipe tags

The Medication Swipe Tag Register Folder is kept in the Medication Room and all medication swipe tags must be signed OUT & IN after shift has completed. If you do take a tag home you will be required to return to the Ward to return it to the key register.

Prior to using the medication cupboards and swipe tag process you must complete the orientation sign off to ensure all staff are competent and safe.

Schedule 8 & 11 DD cupboard

On Ward H the DD cupboard is accessed via swipe card so no DD keys are required. All Ward H medication endorsed staff have access to the DD cupboard. Bank staff are NOT to be given access to the Ward H DD cupboard via swipe card access, however are able to have swipe access to the Medication Room.

Schedule 8 &11 tamper proof bags are found in the Medication Room in a signed drawer

Patient identificationPatient ID Bands – Red for allergy/alerts and white bands are both kept in labelled drawers in each Staff Station. All patient Bradma labels are kept in each patient’s own progress notes in a protective plastic sheet. All documentation is required to have Bradma labels attached front AND back.

All staff are recommended to complete the ID online e-learning package found on MH Learning Management System.

Patients’ names and Unit Consultant should be recorded on the whiteboard dedicated area at each patient’s bedside. Please ensure this is kept current and is legible. Food monitor and kitchen staff will rely on this information for correct meal delivery.

Clinical handoverIt is essential to be on time or a few minutes early for handover. Handover is not a time for debriefing or discussion of irrelevant information. It must be patient centred and use the ISBAR format.

Medical histories

Medical Histories are located in the pods near the patient rooms. Please ensure all medical histories are placed in their correct position after use and not left lying around.

Staff Base A 1 -15

Staff Base B 16-30

Team In-Charge handover

Duration: 5-10 minutes

Location: Multipurpose Meeting Room

Attendees: Outgoing In Charge & Incoming shift team

Handover Content: ISBAR format - New Admissions, Unwell or medically reviewed patients, Discharges, Appointments, Risk factors for patients

Bedside handover

Duration: 10 minutes

Location: Patient Bedsides

Attendees: Outgoing & Incoming allocated nursing staff

Handover Content: Introduce self as looking after patient for shift. Follow ISBAR format, ensure all clinical risks are highlighted and strategies to manage. All charts to be checked and reconciled with outgoing shift nurse. IV therapy/Syringe Drivers/Nasogastric feeds etc. all must be checked to orders. Include the patient in the handover process. ALL staff are expected to follow the bedside handover process for all shifts.

Handover sheet: Ward H handover sheet is recorded in the ISBAR format for staff to ensure handed over follow easily during handover process. The handover sheet has an area where staff can use a prompt guide on the front page to ensure all expected information. This handover sheet is saved on The G Drive – Casey all – Ward H folder. Handover sheets are printed daily at 8.00am and are available in the printer room near to staff base A on the ward. These are updated over the course of the day by relevant staff members and reprinted for each nursing shift. Please ensure all relevant information is communicated to the nurse-in-charge.

Nursing notes: Nursing notes are to be completed for every patient for every shift for the first 48 hours of admission. The nursing care plan is a legal document and forms part of the patient’s medical history. Please do not fill out the nursing care plan in advance, as patient circumstances may change, and there may be serious legal ramifications if an adverse incident was to occur. An entry into the progress notes is necessary at least once in 24 hours and then by exception. Night staff are expected to document nightly. Remember the legal requirements for documentation in the nursing progress notes; if you have not documented your care or observations, then it did not happen. Your entry must have a date and time of entry, it must be legible, and at the end, it must contain your signature, printed surname and your designation.

Observations: Baseline observations are completed and recorded for all patients admitted to Ward D. Neurovascular observations, neurological observations or a baseline ECG may be required depending on the patient diagnosis.

Lanpaging/Phoning: All staff are expected to inform NUM/ANUM of changes to patient’s condition immediately using phone system. Phone number for NUM and Nurse in Charge can be found on handover sheet. When paging Medical teams please ensure the lanpage urgency process is used. This information can be accessed on PROMPT.

Blood and blood productsAll 5 required MR forms relating to Blood & Blood Products are located in the Stationary Room in the under-bench cupboard. This cupboard is well signed with the National Standard 5 icon to identify easily.

Prevention of pressure injuriesWard H is very well-resourced with pressure prevention equipment. This equipment can be located in the Allied Health Store Room A. Ward stock includes heel wedges of 2 sizes for the beds, bed cradles, Macmed foot rests for patients sitting out of bed and a number of foot stools. These items are kept in Storeroom A near the Staff locker room. Please ensure you utilise all available equipment for your patients. The Occupational Therapists will assess patients as needed for prescription of Roho and pressure relieving cushions for chairs and wheelchairs.

Air mattresses can be hired from Pegasus once skin assessments and risk assessments are completed. Daily assessment and review of patients pressure injury risk and skin condition is a standard requirement whilst an inpatient on Ward H. This continued process of assessment of mobility, risk and condition of skin will indicate the type of equipment and length of time equipment will be required.

Ward H has an Admission Skin Check Sticker for all staff to use when patients are admitted. This tool was a Quality Project some years ago and is an important part of the Ward admission documentation process. Please ensure you are aware of this sticker.

There is an orange sticker to be placed in the progress notes as well to indicate a patient being admitted WITH a pressure injury OR if one develops. Note: There is no need for a Riskman if it is a stage 1 pressure injury. Please inform yourself of the policy and protocols for Pressure Injury Prevention and Management.

Deteriorating patientStaff must always let the in charge nurse know if patients have recorded any observations which fall into the yellow Medical Review Criteria area on the Observation Chart. This information must be handed over as soon as practical and can be sent via lanpage using the many computers at the patient’s rooms. The in-charge nurse can always be contacted on the Dect phone no 82081 or lanpage # 2498. Numbers are recorded on Allocation whiteboard in Stationary Room and on the handover sheet for easy access.

Escalation of care

Monash Health has an Escalation of care brochure, policy and protocol. Please ensure you are aware of this policy and make available and explain the brochure to the patients on or during admission and to their families. These brochures are available on the ward and laminated by the bedsides. Please ensure you make patients/families aware of this process on admission. If you are unaware of or find you have difficulty with this, please talk to Nurse Unit Manager or the ANUM in charge.

Resuscitation Trolley: Resus Bay next to Staff Station A.

HeartStart XL AED and Monitor: This monitor requires a check on a daily basis along with the regular trolley check, use the checklist how to card located with the daily checklist. Each Sunday the complete resuscitation trolley equipment checking and clean of all the surfaces and drawers is scheduled. Use the standard Monash Health checklist to tick off and sign. 2 staff are required to complete this weekly check designated for Sundays on Ward H. In the event of a Code/Met Call with use of the resuscitation trolley it is a Monash Health requirement that a full check is completed and signed off/recorded as post met call check.

ECG Machine: Resus Bay next to Staff Station A. The ECG machine should be kept plugged in at all times when not in use and ensure when checked there is spare paper and dots for when required, also tuffie wipes should be available on the trolley. ECG machine and trolley is noted on ward cleaning schedule. ECG paper – NON Sterile store room 1st compactors. ECG dots – NON Sterile store room 1st compactors.

IV Insertion Trolley

IV Trolley No 1: Resus Bay next to Staff Station A.

IV Trolley No 2: Small Bay opposite Dirty Utility 2 near Staff Base B.

IV Trolley is to be checked every PM and ND shift, restocked and signed off. This is essential for safety reasons so when an emergency occurs that the IV Trolley is stocked sufficiently. IV Trolley equipment list should be adhered to when stocking trolley if the list needs changing please speak to the NUM.

Bedside emergency equipment: Ward H nursing staff are required to check oxygen and suction equipment at each bedside daily 1400. The check includes everything being correctly connected and a test that it is in working order. The resuscitation equipment is stored in a zip lock bag and is opened monthly to check expiry dates and then resealed and tagged. During the daily check staff must ensure the bag has not been opened and contents remain intact and it is in date – expiry dates

checked on 1st of each month and redated and sealed. Staff must initial the checklist as completed for the date and the bed number. This checklist is audited on a monthly basis and results are reported and monitored with the CPR - Casey Site meeting monthly. The checklist for each group of beds is kept on a clipboard and housed in a hooked basket on the side of the Observation Trolley.

Observation trolleys & bedside O2/suction checklist

There are a number of observation trolleys on Ward H. These trolleys are set up with observation equipment for staff use. The trolley is set up with the following equipment:

1 x Tympanic thermometer and 1 box of probe covers

1 x Portable Oxygen saturation machine

1 x Glucometer station

1 x Bottle Avaguard

1 x Container of disposable Microfibre Cloths and water bottle

1 x Hooked Basket containing Clipboard/Emergency O2 & Suction daily checklist

These trolleys are NOT for storage of any other equipment. These trolleys are on the ward cleaning schedule checklist.

Oxygen Cylinders: Spare oxygen cylinders are stored in the cylinder trolley under the bench located outside the Medication Room. These are checked weekly and empty cylinders are replaced with full ones. Please ensure you highlight to the nurse in charge if a patient of yours is using an increased amount of cylinders.

Preventing falls and harm from fallsThe bedhead behind each patient bed is a whiteboard; this enables staff to attach the laminated mobility charts firmly for each patient under the patient’s identification/name area. This Mobility Chart is completed by the treating physiotherapist on admission and is reviewed and updated when a change in mobility status occurs or weekly, whichever occurs first. All staff must ensure that this mobility chart is kept current and does reflect the patient’s mobility status. If a change in condition and/or function occurs out of hours it is the nursing staffs’ responsibility to update the chart. Once updated this must be recorded in the progress notes and on the patient care plan and put a referral for review by physiotherapy.

Proximate alarm

Ward H has purchased 2 Proximate Alarms for our use, and will be kept in the Non Sterile Store in a basket labelled Proximate Alarm. This is not for use on any other ward unless approved by the Nurse Unit Manager.

There is a folder at the Ward Clerk reception desk where the patients name/UR/Bed No and the alarm asset number and date of use must be recorded. Include whether it is a Ward H alarm or hired Keystone Health alarm.

To hire alarms there is a process and an online system – please liaise with nurse in charge to assist you.

Low low beds

Ward H has 15 beds that lower all the way to the floor. These beds do have cot sides, however these should not be used when patients are assessed as a high falls risk and are confused. These are the Human Care beds and will need to be used for our falls risk patients.

OHSBiomedical Equipment: Folder to record biomedical equipment needing repair is located in Equipment Store C on shelf. Please ensure you stick a note on equipment to explain issue and also complete all required details in the folder. Leave equipment on shelf or larger equipment under shelf or leave note where item to be found. Biomedical staff service Ward H weekly on a Friday. If there is an urgent issue, the contact number can be found in the folder located with the box in equipment store C.

OHS Board is located opposite the Locker Room on Ward H and provides information in relation to OHS. Please familiarise yourself with the relevant Monash Health policies and procedures and any alerts or risks to be aware of. The current representative name is recorded on the OHS Board. If you have any concerns regarding OHS on Ward H you would report to the representative and the Nurse Unit Manager immediately.

Smartmove/manual handling: Online education and practical sessions are available and staff are to discuss with the NUM to organise a date for the practical sessions. These occur within double staff time and are accessible at Casey Site.

Over lead and mobile hoist machines: YOU MUST HAVE HAD APPROPRIATE TRAINING BEFORE USING ANY OF THE HOIST EQUIPMENT.

There are a number of overhead hoists with tracking installed in patient rooms which can provide ease of transferring in and out of bed, chairs and into and out of the toilet/ensuites. The slings for these hoists are kept in the (Storeroom A) Allied Health Equipment Store on labelled hooks. The Bariatric Slings are located in the same store area but on the compacters shelving. They are made with blue mesh so you can tell the difference. Please ensure that the overhead hoists are placed back into the charging areas in the ensuites.

The mobile hoists and slings are located in Equipment Store B which is nearby Staff Station B. The slings for the mobile hoists are located in this store area with the Mobile Hoist and are hanging on labelled hooks.

Please ensure when using these slings and hoists that they ae returned to the appropriate areas and hoists are plugged back into mains power. Slings need to be marked Ward H before sent to laundry

Pat slide

1) Resus Bay on Hook near Staff Station A.

2) Small Bay on Hook opposite Dirty Utility 2 near Staff Station B.

Stationary and building issuesStationary room – at entrance to Ward H

Location of: Printer/Fax/Scanner & Label Printer

Allocation Whiteboard

MR forms – stock

Medical Referral Pads – numerous

Whiteboard Markers & Dusters

Confidential Bin

Handover Sheets

Pens/Pencils

Staples/Tape/Corkboard Pins etc.

Building Issues: As a site, we are managed by Brookfield, therefore nil changes are to be made to any equipment or fixtures on Ward H. If any issues arise on the ward with the building such as water, heating, lighting, nurse call, doors etc., staff should call Helpdesk on ext. 81838. Alternately, please email Helpdesk and cc Nurse Unit Manager also and inform of issues.

Meals and groupsRed tray

A Red Tray system is in place on the ward. This highlights to staff all patients that may require assistance with their meal. Research indicates that a Red Tray identification system increases the nutritional intake of patients at risk of malnutrition. Nursing and allied health are required to make a clinical decision about who requires red tray, it is not just the responsibility of dietetics. This is ordered on the electronic meal ordering system (Delegate) and recorded on the handover sheet. Meals will be provided on a red tray for persons requiring the following:

full assistance; set up assistance; supervision/assistance due to texture modified diets/fluids; impaired thinking skills; and risk of malnutrition.

A Red Tray indicator card is placed on the notice board at the patient’s bedside to indicate level of assistance required.

Protected mealtimes

The Protected Mealtimes initiative is a means of improving nutritional intake. The aims of Protected Meal Times are:

to prevent interruptions to meals; to allow time to provide additional assistance and socialisation during meal times; to increase the potential for improved food intake for at risk patients; and to support and encourage consumption of between meal snacks and fluids.

Protected Meal Times are:

Breakfast 08:00am – 08:30am Lunch 12:00pm – 12:30pm Dinner 18:00pm – 18:30pm

During protected mealtimes, wards should be closed to non-critical functions over meal times. Consider closing ward to visitors except those assisting with meals and staff rostered on the ward during this time to assist with meals.

Staff external to ward to consider reviewing ward work flow procedures to support implementation of ward protected mealtimes. Exceptions include:

Critical functions Lifesaving interventions Medications Therapeutic assessments relating to meal times

Urgent pathology collection, diagnostic imaging procedures and administration of oral medications may still occur within the protected meal time but all other functions should be limited unless the patient is acutely ill.

Chair scales are available on the ward. All new admissions (except PCU) must have a Nutrition Risk Screening completed within 48 hours of admission. All patients should be weighed on admission and repeated at least weekly, unless requested otherwise. Hoist scales are available for use from ward C.

Stroke Education Group

A monthly stroke education group is conducted by allied health, for all new patients and families admitted to the subacute unit post stroke. Staff are rostered each month to conduct the group. A copy of the roster can be found at: G:\casey_alliedhealth\QUALITY\STREAMS\SUB ACUTE\Projects\Stroke Resources\Casey Stroke Education & Support Group

The aim of this group is to:

Increase awareness and understanding of stroke and the impact it can have on patients and families.

Provide a supportive environment where patients and families can meet with others in similar circumstances.

Educate patients and families about the roles of each discipline involved with rehabilitation. Enable patients and families to take an active role within their therapy. Empower patients and families to actively continue their recovery after discharge.

e-Stroke is an online learning resource improving workforce knowledge, confidence, capability and access to evidence-based stroke specific education (www.estroke.com.au).

Breakfast and lunch group

Breakfast group occurs Monday, Wednesday, Thursday and Friday at 0800 in the Allied Health kitchen. Lunch Group occurs on Tuesdays at 11.00 in the Allied Health Kitchen. (G:\casey_alliedhealth\ADMINISTRATION\FORMS\DISCIPLINES\OT\Breakfast Group\breakfast group clinical guideline template.doc )

Please remember to check with the ward staff and other allied health staff that a patient is suitable to attend the group before you refer them. The staff must write the patient’s attendance on the timetables so meals will be cancelled and to advise staff.

Leisure group

Usually occurs Mondays, Wednesdays and Fridays at 1100 in dining room. Tasks aim to increase socialization and participation of patients (sing-a-long, bingo, word searches). (G:\casey_alliedhealth\ADMINISTRATION\FORMS\DISCIPLINES\OT\Leisure Group )

Balance group

This group is held on Tuesdays, Wednesdays and Thursdays at 1100 in the allied health gym. It is conducted by one Physiotherapist and one Allied Health Assistant. The aim of the group is to improve balance and reduce the risk of falls. (G:\casey_alliedhealth\PROCEDURES & PROTOCOLS\DISCIPLINES\PHYSIO\Clinical P & P\Balance Group\Balance Group Guidelines(updated Feb10).doc)

Exercise groups

This is an informal group run by AHA’s according to patients needs

U pper limb g roup Upper limb group is held on Tuesdays and Fridays at 1400. The aim to improve upper limb function and retraining. (G:\casey_alliedhealth\PROCEDURES & PROTOCOLS\STREAMS\SUB ACUTE\New UL guidelines for the group.doc )

DADL and CADL groups Run according to patient needs on the ward. Activities include community shopping and walking activities.

Other Specialist services/programs

Aged care and Cognition CNC Breast Care Nurse Diabetes Nurse Educator Domicialiary Oxygen Palliative Care Nurse Consultant Pastoral Care RDNS Stomal/Wounds/Breast consultant

Medical staff specific informationDischarge summaries and discharge medication must be completed the day before discharge.

Progress notes to be completed on “JMS Checklist” forms.

There is an on-site consultation service for Casey sub-acute patients in:

Endocrinology (via Gen Med Unit 2 Reg);

Neurology consultation service (via Gen Med Reg Unit 1); and

Infectious Diseases via Gen Med 3.

Psychiatry is accessed by paging the Liaison Psychiatry through switch.

Surgery via the Gen Surgery Reg. Please note there is no on-site surgical cover after hours at Casey.

The ISBAR referral form needs to be completed for all specialty consults.

Any patients scheduled for transfer off site for appointments should be discussed with either the Unit Consultant or Nurse Unit Manager prior to transport being arranged. This is to avoid potential unnecessary transfers of our frail older patients. Often opinions can be sought over the phone or on-site.

Medically unstable patients:

Ensure early and clear communication with family/next of kin, nurse in charge/NUM.

Notify registrar and/or consultant to help guide decisions about escalation of treatment.

Ensure Nursing Co-ordinator notified if patient is for transfer to an acute unit.

MET/code blue: MET calls are attended by the Medical Registrar and those on the MET pager list. There is no overhead paging at Casey. ED will attend only if needed. Nursing coordinator can assist. Code blue will also be attended by ED staff and anaesthetics.

Limitations of treatment: Please review this regularly for all patients and clearly document any decisions made. Any change in MET criteria needs to be discussed with consultant first.

Drug charts

Please ensure that when writing drug charts you always complete the following:

Drug charts are numbered;

Ensure you sign and print your name and record your pager number;

Do not write on a drug chart without a label or a URN and patient details; and

If drugs are ceased, added or stat orders are written always ensure this is verbally handed over to the nurse in charge or nurse giving the medications – NOT just documented in the notes.

Patient histories:

If you remove a patient history from the pigeon hole i.e. ward round, please make sure it is returned as soon as possible after you have finished with it.

Histories are not to be left on desks, trolleys or in offices.

If a history needs to be taken from the area, then a note stating where the history is and a pager number must be left in the pigeon hole.

White bedside folders:

White folders are kept at the end of the patient beds unless the patient is in a room under precautions i.e. MRSA/VRE then it will be kept directly outside the patient’s room in the drawer.

Please ensure that the white folders are placed back at the correct patients bed end immediately after use.

Observations: If you find that observations are reportable and have not been reported to you (medical staff), please liaise with the nurse in charge to be followed up further.

Allied health servicesAllied health services include clinical neuropsychology, clinical psychology, dietetics, occupational therapy, physiotherapy, podiatry, social work, and speech pathology. See http://intranet.southernhealth.org.au/ambulatory_and_community_care/MHCAH/homepage/default-home-page_new.html for more information.

Other specialist services/programsAged Care and Cognition CNC

The Aged Care and Cognition CNC play an active role in assisting patients and families during the residential aged care placement process. The CNC can also provide advice and management for difficult patients with cognition issues.

Breast Care Nurse

The Breast Care Nurse consults with all patients, pre and post operatively, undergoing surgery for breast cancer. Please notify the Breast Care Nurse of any in-patient who has breast cancer. It enables assessment regarding whether or not they or their family need any form of support.

Diabetes Nurse Educator

The Diabetes Educator performs a number of roles:

Planning, implementing and monitoring diabetes care with the team of Medical Registrar, Resident and Endocrinology Consultant.

Staff Education: available for any questions or concerns regarding the care of the patient with diabetes, including in-services and one to one support.

Patient Education about the self-management of diabetes including blood glucose monitoring and insulin administration, preventing Type 2 diabetes, complications screening, safety issues, and health promotion activities.

Involvement in developing diabetes care policies and procedures in the hospital setting, monitoring diabetes quality activities, discharge planning and steering change in practices based on current evidence.

When to refer to the Diabetes Educator:

All patients taking insulin - Type 1 and insulin requiring Type 2.

If the patient has unstable BGLs, frequently above 12 mmol/L or below 3.5 mmol/L.

Any patient admitted with hypoglycaemia, diabetic ketoacidosis or HONK.

Advice regarding pre and post-operative management of the patient with diabetes.

Assessment of a patient’s ability to self-manage diabetes at home.

At the patient’s request.

Commencement of insulin or blood glucose monitoring, e.g. newly diagnosed.

The Diabetes Educators at Casey Hospital are:

Amy Cowan Mondays, Tuesdays, Wednesdays Pager: #2437

Joanna Kapusta Thursdays Pager: #2437

Domiciliary Oxygen

Patients that require domiciliary oxygen need to be deemed appropriate for it by the medical staff. A physiotherapy assessment can then be conducted. Please see the intranet for further guidelines: http://intranet/respiratory/o2guidelines.pdf

Palliative Care Nurse Consultant

The role of the palliative care nurse consultant is:

to offer support for optimal control of symptoms such as dyspnoea, pain, nausea and vomiting;

offer assistance with revision of goals of care from active treatment to palliative care;

liaise with community palliative care regarding: referring a patient to them, discharge planning or giving them a progress report on an inpatient;

to see all patients known to South East Palliative Care;

attend family meetings if appropriate;

support family/carers when a patient has been made palliative;

provide education to staff on palliative care;

attend team meeting on WDC; and

discuss with patient/carer/family re: transfer to Ward D if appropriate

When the Palliative Care Nurse is on site (Monday, Tuesday, Thursday), please page #2354. The patient and or family can usually be seen on the same day. When the Palliative Care Nurse is off site, referrals can be made using the inpatient referral form and faxed to 8768 1985. These referrals will be followed up on the next scheduled working day.

Pastoral Care

Pastoral Care services meet the emotional, personal and spiritual needs of patients, their families and friends, including all staff. At its core, pastoral care is about spirituality (meaning much more than a focus on religious/faith matters). Pastoral care supports people who wish to discuss:

personal concerns;

the experience of illness, loss and grief; relationships; and

their life, values, spirituality and faith.

Pastoral care will listen, reflect, and offer acceptance, empathy and encouragement. Pastoral Care will maintain patient confidentiality, refer as appropriate, and be sensitive to cultural and religious diversity.

In addition to pastoral care staff, the department includes:

Chaplaincy visitors who support people of a specific Christian tradition; and

‘On call’ chaplains from most faith traditions who offer care to people of their own faith.

Casey Hospital conducts programs of Clinical Pastoral Education.

A sacred space and quiet room is provided for anyone seeking a place for reflection, prayer, or a place just to be still.

Royal District Nursing Service (RDNS)

Royal District Nursing Service (RDNS) has a well-established reputation as Australia's leading home nursing and healthcare provider, delivering well over one million visits each year across Greater Melbourne. RDNS seeks to ensure that clients receive a high level of general and specialised nursing care delivered by a highly qualified team of healthcare professionals.

RDNS care is based on a philosophy that the wellbeing of clients is enhanced by the client’s choice to receive care in the comfort of their own home. We also recognise that continuity of care between the hospital and home is an essential component in achieving positive health outcomes and promoting the wellbeing of clients.

Major services provided by RDNS:

Aged care

Support and rehabilitation

Support and technical care to clients on HITH, PAC and other programs

Administration of medications

Wound management

Diabetes management

Continence management

Palliative care

Specialist services in: HIV/AIDS, breast cancer, stomal therapy, aged care and cystic fibrosis

Homeless Persons Program

Allied health including social work, physiotherapy and music therapy

Personal care assessment and assistance

RDNS Hospital Liaison Service

The RDNS Liaison Service operates in all major public hospitals across Melbourne providing the vital bridge for clients moving from the hospital setting back into their home. RDNS Liaison Clinical Nurse Consultants work with hospital staff and other health care services and providers to achieve best health outcomes for clients. This is achieved through:

providing community focused nursing assessments for patients;

collaborating with hospital staff for discharge planning. This includes discussion of patients’ on-going needs and ensuring that all equipment, supplies and information has been provided prior to discharge;

participation in family case conferences;

coordinating admission to RDNS including the scheduling of home visits by specialist and general nursing staff; and

assistance in arranging other community services as needed e.g. Home Help, Meals on Wheels

Stomal/Wounds consultant

Stomal: Please notify the stomal therapy nurse of all patients with a stoma, regardless of how long they have had it. It is an opportune time to check that they are managing at home, and that they have an adequate amount of appropriate supplies. Sometimes illness or medical intervention can cause alterations in bowel pattern which may necessitate change of appliance for a short time. As the onsite stomal appliance supply is limited, timely referral is imperative.

Wound/Pressure area: All wounds below the ankle should be referred to the Podiatrist who is on site Tuesday and Friday. It is not necessary for the wound consultant to see every wound or pressure area; it is preferable for wards to use local clinical expertise to manage these if possible. Senior ward nursing staff may be able to advise and manage the situation. Part of the wound consultant’s role is to educate staff in wound and pressure management techniques; this will facilitate ward nursing staff to develop skills of their own in wound/pressure management. It is not the wound consultant’s role to “do the dressing/assess the pressure area”.

o The wound referral chart (found in Wound Management folder) directs appropriate wound referrals. The wound/pressure area must be assessed by ward clinician before calling the wound consultant, using the wound assessment chart (MRK40). All assessment sections should be completed, including measurements, aetiology, length of time it has been present etc. This information is available in the patient’s history or by questioning patient, family or RDNS.

o Appropriate analgesia must be administered to enable examination of the wound if a consultation is necessary.

o The wound is taken down and cleaned in preparation for consultation. A clinician must be available to help position a patient (if necessary) for examination of a wound/pressure area.

o Clinician must be prepared to attend to the new dressing regimen after consultation.

o Clinician must be in attendance during the consultation to understand why a regimen is chosen and to assist if necessary

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