GETTING BETTERIMPROVEMENTS TO HEALTHCARE IN NELSON MARLBOROUGH

2 | SMOKING CESSATION

These pages tell the story of how well Nelson Marlborough District Health Board has done over the past year, and where we need to do better.

We have a responsibility to deliver and provide funding for the healthcare you receive in virtually all publicly funded services, including hospitals, general practices, pharmacies and rest homes.

It is important that healthcare is provided in the most appropriate setting as close to home as possible. Our highly skilled workforce is committed to delivering this care.

We are always trying to find better and more innovative ways of working. This report looks at some of the ways we have tried to do this.

We welcome your feedback and suggestions as to how we can do even better.

Chris FlemingChief Executive

A DAY IN THE LIFE OF THE NELSON MARLBOROUGH DHB

4BABIES BORN

214PEOPLE WITH

DISABILITIES IN HOME CARE

WEBSITE www.nmdhb.govt.nz/Feedback_Form.aspx

EMAIL feedback@nmdhb.govt.nzquality@nmdbh.govt.nz

MAIL The Chief ExecutivePrivate Bag 18, NelsonorPatient Relations Coordinator Private Bag 18, Nelson

TELEPHONE 03-546-1800

TELL US WHAT YOU THINK

A DAY IN THE LIFE OF THE NELSON MARLBOROUGH DHB

We need your suggestions about how we can improve the quality and safety of services. Tell us what matters to you by contacting us using one of the methods shown here.

4933LABORATORY

TESTS

244RADIOLOGY

EXAMINATIONS

4967PRESCRIPTIONS

FILLED

36SURGERIES

1666GP VISITS

New Zealand’s Health Targets are set each year by the Ministry of Health. The targets represent areas of health care that will have the maximum impact on our community’s health.

This year Nelson Marlborough did well in ‘Shorter Stays in Emergency Departments’ and ‘Better Help for Smokers to Quit.’

We have room for improvement in ‘Heart & Diabetes Checks.’

Nelson Marlborough performs better in some areas than others, but there is little variation overall between DHB performance across the country.

Communities throughout New Zealand can expect their DHBs to be focussed on the same targets and to use health care dollars to the best effect.

NATIONAL HEALTH TARGETS

JULY 0 JANUARY 1

AUGUST 1 FEBRUARY 0

SEPTEMBER 0 MARCH 1

OCTOBER 0 APRIL 0

NOVEMBER 0 MAY 1

DECEMBER 0 JUNE 2

SERIOUS & SENTINEL EVENTS JULY 2012-JUNE 2013

Despite our best efforts, things occasionally go wrong. When things go severely wrong in health care they are called Serious and Sentinel Events. NMDHB reported six events in the 12 months ending 30 June 2012.

An event is considered serious if a patient has been harmed, but has not died or lost the ability to use their limbs or one of their senses.

An event is considered sentinel when a patient’s life has been put at risk, they have lost the ability to use their limbs or senses, or they have died.

WHEN THINGS GO WRONG

Falls are the most common serious or sentinel event in our region. Find out more about what is being done to prevent Falls on page 10.

4 | NATIONAL HEALTH TARGETS / SENTINEL EVENTS

National target 95%NMDHB result 96%

National target 100%NMDHB result 100%

National target 95%NMDHB result 93%

National target 85%NMDHB result 87%

National target 75%NMDHB result 56%

National target 100%NMDHB result 100%

WHOOPING COUGH | 5

Complications from whooping cough include severe coughing bouts that result in vomiting, weight loss, broken ribs, pneumonia and may lead to death. It is spread by coughing and sneezing and people are infectious for around three weeks but the cough can last for months.

AXEL’S ORDEALRebecca Barber clearly remembers driving her six week old baby Axel to the After Hours clinic in December 2011; she was crying as she feared her baby would not survive the trip. She had sought medical advice on two previous occaisions, but this time the doctors realised that Axel was seriously ill with whooping cough, and he was hospitalised for a week.

Rebecca says that she first noticed her own cough on leaving hospital after giving birth to her third child Axel by Caesarean section. She says the agony every time she coughed left her unable to sleep and it felt like her chest was closing up. She definitely recommends that pregnant women be immunised against whooping cough.

Rebecca’s other two children were fully immunised, but the vaccination for pregnant women was only introduced from January 2013. “It takes a very long time to recover, and to see my baby gasping for breath and on occasion turning blue was horrific.”

“The most frightening thing of all was when he couldn’t get his breath and he wasn’t able to cough.”

IMMUNISATIONGetting immunised is the most important factor in controlling the spread of Whooping Cough.

On-time immunisation is the best protection and it is free for children at: six weeks, three months, five months, four years and eleven years. Boosters are required to maintain immunity. Immunity only lasts up to 10 years. Vaccination is also recommended for anyone in regular contact with babies under six months of age.

OUTBREAK RESPONSENMDHB notifications of whooping cough cases per month from August 1998 to June 2013.

Public Health staff have collected and analysed information that has helped shape the response for this outbreak.

Public Health encourages the early treatment of cases because this reduces the infectious period. Hospital staff provide clinical support for those who are hospitalised with serious complications. Some infants require hospitalisation, from a few days, to several weeks.

WHOOPINGCOUGHWHOOPING COUGH (PERTUSSIS) IS A SERIOUS

ILLNESS THAT USUALLY STARTS OFF WITH

A DRY COUGH WHICH THEN PROGRESSES

TO MORE SEVERE SYMPTOMS. THE CURRENT

OUTBREAK STARTED IN AUGUST 2011 AND

CONTINUES INTO JULY 2013. BABIES AND

PEOPLE WITH LOW IMMUNITY ARE THE MOST

SEVERELY AFFECTED.

6 | SMOKING CESSATION

Elaine attempted to stop smoking many times. She was offered quit support in 2011 prior to knee surgery, but the timing of the intervention meant she didn’t quit until one week before surgery. “I was proud of myself, really pleased. My knee healed beautifully.”

But smoking still had a hold on her. She started sneaking cigarettes, and eventually she was back to smoking full-time.

The pre-admission process had changed in 2013 when Elaine found herself needing surgery again. Support was offered earlier this time, and Elaine accepted referral to the Hospital Quit Coach before she had a date for her surgery.

She questioned if the Quit Coach would want to see her again, but she was reassured that she could get help any time, and that being smokefree would help with healing and recovery.

SMOKEFREE AT NMDHBNMDHB offers quit smoking support to pre-surgical

patients to promote faster healing and decrease the chances of surgical complications. Elaine has now been smoke free for 12 weeks using nicotine

patches and support. Research shows that people who smoke need longer hospital stays and are more likely to develop pneumonia after surgery; their bones are slower to heal, or may fail to heal, and wounds are more likely to get infected. They are also likely to experience more pain after surgery.

ABCThe New Zealand Smoking Cessation guidelines encourage the ‘ABC’ approach to smoking cessation. The ABC program aims to increase both the number of quit attempts and the number of quit attempts that use a cessation support treatment (such as nicotine replacement gums, patches and lozenges) and/or cessation services.

A Ask all people about their smoking status.

B Provide Brief advice.

C Make an offer to provide Cessation treatment.

HOW WE ARE IMPROVINGThere is now a health quality project underway to extend smoking cessation support to those under consideration for major joint replacement surgery. Smokers will be encouraged to quit when they are identified for surgery, optimising their smoke free time.

SMOKEFREE IS BEST FOR YOUR HEALTHFor Quit Support contact your GP Practice, Quitline 0800 778 778 or local Aukati Kaipaipa Service (Nelson – 546 9097 / Motueka 528 6061 / Blenheim 577 8404).

It is not always possible to plan ahead and stop smoking before surgery. Support is available in hospital and after surgery. If a patient does not stop smoking the operation will still go ahead as long as it is clinically safe to do so.

One in every 40 smokers will make a quit attempt simply as a result of receiving brief advice. - Ministry of Health 2011

BETTER HELP FOR SMOKERS TO QUIT IS ONE

OF NMDHB’S HEALTH TARGETS. ELAINE

MARGARET DELLA-ROCA WAS OFFERED HELP

TO QUIT SMOKING WHEN SHE CAME TO

NELSON HOSPITAL NEEDING SURGERY. THIS

IS HER EXPERIENCE WITH NMDHB’S SMOKING

CESSATION PROGRAMME.

SMOKING CESSATION

TE TAURA TIEKE | 7

THE HE TAURA TIEKE PROGRAMME PROMOTES

CULTURALLY ACCEPTABLE PRACTICES IN

HOSPITAL, SUCH AS THE APPROPRIATE USE

OF A BLUE PILLOWCASE TO SUPPORT LIMBS.

A WHITE PILLOWCASE IS USED TO SUPPORT

THE HEAD, WHICH RESPECTS THE HEAD AS THE

INTELLECTUAL POWERHOUSE OF THE BODY.

HE TAURATIEKE

The pillow initiative is part of Nelson and Wairau Hospitals’ He Taura Tieke programme that encourages culturally acceptable practices.

WHAT IS HE TAURA TIEKE?He Taura Tieke is a tool designed to:

• Provide a culturally acceptable service in an environment that respects cultural beliefs

• Enhance the patient’s hospital experience through greater participation in their own care and treatment options

• Improve the access rates of Maori to hospital services through appropriate and effective engagement processes.

A POWERFUL TOOLDuring the past four years Nelson and Wairau Hospitals have been piloting He Taura Tieke as a tool that enables staff to work more effectively in certain situations. The programme fosters positive outcomes for patients by encouraging staff to acknowledge cultural perspectives and diversity.

He Taura Tieke was introduced by the Ministry of Health in 1996. Translated, it means “a measuring rope” in reference to the plumb line previously used to check the symmetry of the foundations of a building.

As illustrated in Te Whare Tapa Wha (right) we know that a physical injury that restricts independence and activity can lead to boredom, changed appetite, poor sleep and a reduced sense of wellbeing. This illustrates how phyiscal injury also affects spiritual, mental and social wellbeing.

POSITIVE GAINS FOR MAORI Through cultural self assessment services people are better able to see how their actions affect people from other cultures. This programme is about transforming attitudes, structures, policies and services.Ongoing support for this initiative is provided through the Wellington School of Medicine and Professor Chris Cunningham.

TE WHARE TAPA WHAThe most widely known Maori model of health is Te Whare Tapa Wha, pictured below, to illustrate the correlation between wellness and the walls of a building.

When one wall is uneven the remaining three are weakened and at risk of failure or collapse.

This framework measures the quality of the services or the strength of each wall.

8 | PATIENT FOCUSED BOOKINGS

PATIENT FOCUSED BOOKING IS A METHOD

OF BOOKING OUTPATIENT APPOINTMENTS

THAT ALLOW THE PATIENT TO BE INVOLVED IN

BOOKING THE TIME OF THEIR APPOINTMENT.

PATIENT FOCUSED BOOKING

If a patient required a hospital appointment in the past, they were given a date and time, and were expected to attend. Sometimes this appointment would clash with the patient’s schedule, resulting in a high rate of missed appointments and wasted resources.

TESTING IN WAIRAU HOSPITALWairau Hospital Outpatients Department decided to run a trial of Patient Focused Booking, starting with clinics where attendance rates were very low. Patients were sent a letter telling them they had reached the top of the waitlist and inviting them to call the department to book an appointment time.

Patient Focused Booking helps to ensure that valuable clinic time is utilised as productively as possible. There seem to be only benefits from this initiative. - Trudy Tardieu, Administration Support,

Outpatients, Wairau Hospital

As clinic times have to be very well organised for this system to work we have been able to plan our workload better for urgent cases.

NMDHB is now working towards implementing Patient Focused Booking across all services.

“PATIENT AND STAFF REACTIONSPatients are pleased to have input into the day and time for their appointment. They are able to fit appointments around work, school holidays, other appointments, travel from the Sounds and more.

Dawn French, Speciality Clinical Nurse Diabetes, noticed a big improvement using the system in her clinic.

“Patient Focused Bookings reduced a failure to attend rate from 22% to 1-2% in the Diabetes Clinic. This obviously had a positive impact on clinicians’ valuable time. The service users were happy as they felt involved in decision making in appointment times and dates to fit around their lifestyle. With an estimated 7% of New Zealand population having been diagnosed with Diabetes it is most important we capture these individuals and explore their health needs. I believe Patient Focused booking assists us to help individuals in a timely manner within their Diabetes Journey.”

- Dawn French, Speciality Clinical Nurse Diabetes

The incidences of cancellations and non attendance is considerably reduced when patients agree to an appointment in person or over the phone. When the patient is arranging their appointment at a time that suits them, approximately six weeks into the future, they are less likely to forget their appointment.

SEEING RESULTSInitially Patient Focused Booking sounded like a lot of work for our clerical team however they have found it actually results in less work as they are not cancelling and rebooking missed appointments as often. Only appointments that the patient can actually attend are booked.

EMERGENCY DEPARTMENT FREQUENT USERS | 9

ED Multiple Presenters Management Group from ED Multiple Presenters Management Group from left to righ: Tom Morton (Clinical Director), Jan Mitchell (Charge Nurse Manager), Debbie Hollebon (Social Worker), Diane McLeod (Registered Nurse)

Emergency departments are very busy and high volumes can cause delays. This can lead to frustration for patients and the emergency team.

MULTIPLE PRESENTERS PROJECTThe Multiple Presenters project was started in 2011 by a small group of Emergency Department staff. The project aims to improve the treatment and reduce the number of visits by patients who make multiple presentations to the ED.

Individualised patient centred care plans provide consistency of management from the time the patient presents at ED. The majority of patients are fully involved and aware of the plan, the expectations and the limitations. Some patients have complex health needs and their patient plans aim to ease the way by providing direction to the ED staff.

WORKING AS A TEAMOther health professionals are involved in the development of the plan as appropriate, for example the General Practitioner, the Community Pain Clinic, the Mental Health Team, Diabetes and Respiratory nurses, Maori Health Workers and St John ambulance.

If desired a copy of the plan is sent to the patient and the primary caregiver who has been involved in formation of the plan. The St John ambulance service also has a copy of some patient plans, so that individualised care can be initiated from their point of contact.

SEEING RESULTSThe project has been underway for 20 months now and appears to have had a dramatic effect on reducing presentations from many previous multiple presenters.

Feedback has mostly been very positive from patients, nursing and medical staff and primary care providers. The nurses and doctors in the ED, especially, have stated how helpful the management plans are in providing clear guidelines and consistency of treatment for patients.

EMERGENCY DEPARTMENT FREQUENT USERS

PLAN IN ACTIONPatient “B” stated “My plan has changed my life. I don’t have to worry about being in pain and what will happen when I turn up to ED.

I know that there is a plan to help me, although it does not include everything I would like to see in it.

It can be very humiliating to come into the department so distressed and feeling at the end of my tether. The last few times I have left with less pain and feeling much happier. I also realise that I will not die from pain, that there are things I can do to manage my pain better”

INDIVIDUAL CARE PLANS HAVE PROVEN

EFFECTIVE IN REDUCING FREQUENT ED VISITS.

10 | FUTURE FOCUS: FALLS

PREVENTING FALLSThere is a falls initiative in hospital to have nursing staff visit patients every hour to check that their needs are being met, and the environment around their bed is safe.

In the community, falls programmes aim to keep people active and mobile. Vitamin D is also prescribed to those who need it.

Nelson Bays Primary Health has an initiative in place to prevent future falls. The initiative in now being trialled for 3 months but will extend to 3 years if it is successful.

NELSON MARLBOROUGH DISTRICT HEALTH

BOARD, NELSON BAYS PRIMARY HEALTH AND

MARLBOROUGH PRIMARY HEALTH ARE PART

OF A GROUP THAT AIMS TO REDUCE FALLS FOR

THE OLDER PERSON.

FUTURE FOCUS: FALLS

NON-INJURY FALLSSt John ambulance receive a significant number of 111 calls and medical alarm activations from people who have fallen, but not sustained an injury, and do not require transportation.

Nelson Bays Primary Health, St. John and ACC have formed a new partnership and now provide St.John with a referral option so people who fall can be referred to NBPH Community Care Coordination Centre for Falls Prevention triage if they choose to do so. Previously if people fell with no injury, they were left at home with advice only.

Patients receive a Falls Risk Assessment when they are admitted to hospital.

This begins in the Emergency Department to ensure their safety during their stay. Patients are asked if they have a history of falls or balance difficulties, which are key factors in determining how at risk they are of falls.

COLOUR SYSTEMColoured cards are used to signal a patient’s falls risk. Red is for high risk, orange for medium risk and green for low risk. This clearly communicates a patient’s falls needs to staff involved in their care.

The cards are placed above the patient’s bed, on walking aids, and on the patient information board in easy view for staff, family and visitors.

Falls for older people is a significant health and social issue. Up to a third of older people aged over 65 years will fall within the coming year.

Depending on the type of fall and injury the impact not only affects their health and well-being but also their ability to remain independent and active within their own home and community. The vast majority of falls are avoidable and because of this there is a national and local focus on falls prevention.

Falls are everyone’s business.

| 11

LEADING THE WAY TO HEALTH

CONSCIOUS FAMILIES

GETTING BETTERNMDHB QUALITY REPORT 2013

WWW.NMDHB.GOVT.NZ