2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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Our People, Our Stories 2019
Healthcare initiatives in the Nelson Marlborough region Quality Account
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 1
CONTENTS
Welcome to our 2019 Quality Account.....................................................................3
A day in the life of Nelson Marlborough Health.....................................................4
Nelson Hospital palliative care service in place.....................................................5
Health targets....................................................................................................................6
Putting wheels in motion – bikes in schools..........................................................7
Adverse events: Improving patient care one review at a time.........................8
Stressbusters: Supporting Colombian refugees in Nelson................................9
Murchison Well Child Facebook group offers
support to rural women...............................................................................................10
Our Region........................................................................................................................11
Ending eczema-related hospitalisation.................................................................12
Make a plan and stick with it.....................................................................................13
Hapū Wānanga (wānanga hapūtanga) –
Kaupapa Māori pregnancy and parenting programme....................................14
Quality and Safety markers........................................................................................15
Cough reflex test picks up swallowing difficulties.............................................16
The Models of Care Programme
Health Care Home.............................................................................................18
MAPU: Aiding acute healthcare....................................................................19
Virtual consultations........................................................................................20
Future focus.........................................................................................................22
We have endeavoured to ensure that
information in this publication is accurate at the
time of printing (November 2019).
2 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.
WELCOME TO OUR 2019
QUALITY ACCOUNT
The Quality Account informs our communities about some of the
health and quality improvements delivered by Nelson Marlborough
Health (NMH) each year. It is also an annual report on the progress
against national targets for the Health Quality & Safety Commission.
Message from the Nelson Marlborough I am constantly impressed with the With increasing pressure to change the
District Health Board wonderful people we have working across way healthcare is delivered, and a move
the organisation. Their commitment to to new, innovative models of care, you
I am proud to present the 2019 Quality seeing where improvements are needed and can be assured our commitment to
Account: Our People, Our Stories where we putting changes in place enable us to deliver continuous evidence-based quality
share some of the many health initiatives safe, quality healthcare to our communities. improvement is steadfast.
and innovations happening across Te Tauihu
(Nelson Marlborough). In 2018 the Nelson Marlborough Health For more stories about healthcare initiatives
Innovation Awards attracted a record at NMH go to
NMH’s vision is ‘All people live well, get well, number of entries, all focussed on www.nmdhb.govt.nz/our-stories
stay well. Kaiao te tini, ka ora te mano, ka improving patient experiences in our
noho ora te nuinga’ and high-quality care is a healthcare system. Over 30 initiatives
central priority. were celebrated at the awards ceremony,
and as one of the judges I was truly
To help us to deliver high-quality care that
impressed with the commitment, passion Jenny Black MNZM, Chair
is safe, effective, equitable and makes the
and care that went into the initiatives. Nelson Marlborough District Health Board
best use of resources, we need consumer
I look forward to seeing new initiatives
feedback. This essential ingredient helps
showcased in the 2020 awards.
us to continuously improve the way we
do things so we can provide a great This Quality Account is an opportunity for
patient experience. us to focus on the quality of our services,
and to share a few of the changes we have
I am grateful to the members of the public,
made that make a difference to our patients,
our Consumer Council, community advisors
families and whānau. It also provides
and the wider health sector for sharing their
updates on our performance against
experiences and knowledge.
national targets.
Hapū Wānanga is a kaupapa vulnerable populations to Māori
Māori pregnancy and parenting traditions and support wāhine
programme that covers who are about to have a pēpi, by
mainstream practices within a providing antenatal education.
kaupapa Māori context.
Read more about the Hapū
Hapū Wānanga is designed Wānanga programme on
to reintroduce whānau from page 14.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 3
A DAY IN THE LIFE OF NELSON
MARLBOROUGH HEALTH
4 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.
NELSON HOSPITAL PALLIATIVE
CARE SERVICE IN PLACE
The introduction of a new hospital palliative care service
means patients with a serious illness now receive more
support from palliative care specialists.
Palliative care provides relief from the The hospital palliative care service includes “This is a living manifestation of the ‘one
symptoms and stress of a serious illness, input from a senior medical officer to team’ strategy, focussed on the patient’s
with a goal to improve quality of life for both support the CNS and the medical team. needs. Previously the acute clinical team
the patient and their family. could refer a person to hospice but they may
Palliative Care Specialist Dr Jodie Battley or may not get to see the person prior to
The service is offered in partnership with supports palliative care CNSs Zarina their discharge.”
Nelson Tasman Hospice and followed a six Palamountain and Annie Wallace to see
month pilot in 2016. patients at Nelson Hospital during the week. The new hospital palliative care service
was recommended by the end-of-life care
Cathy O’Malley, General Manager Strategy, Cathy says the hospital multidisciplinary group within the Models of Care programme.
Primary & Community, says the new hospital teams have responded well to the service
palliative care service is very similar to the as it enables positive outcomes for complex
pilot but with extended hours and senior palliative pain care in an acute setting.
medical involvement. She says it’s designed
to get the right clinical expertise to the right
person at the right time, avoiding delays at a
period when time is of the essence.
“A clinical nurse specialist (CNS) in palliative
care can support the clinical team with
advice on symptom management, or they
can help facilitate quicker discharge planning
for the patient, either back to the hospice or
their home, ensuring community follow-up
is in place,” Cathy says.
“The CNS also discusses end-of-life
plans, including developing an advance
care plan, and they support the person
and their whānau with the bereavement
and grief process.” Palliative Care Specialist Dr Jodie Battley, CNSs Zarina Palamountain and Annie Wallace.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 5
HEALTH TARGETS
Nelson Marlborough Health reports its progress on five health targets to the
Ministry of Health four times a year: 30 September, 31 December, 31 March and 30 June.
The targets are a set of national measures and provide a focus for action.
Here is how we are performing against those targets:
Nelson Marlborough Health results
Quarter 4 (April – June) 2019 Target Achieved
Shorter Stays in ED
95 per cent of patients will be admitted, discharged, or transferred from an
Emergency Department (ED) within six hours. This target measures the flow of 95% 93%
acute (urgent) patients through public hospitals and home again.
Faster Cancer Treatment
85 per cent of patients receive their first cancer treatment (or other management)
within 62 days of being referred with a high suspicion of cancer. 90% 90%
Increased Immunisation
95 per cent of infants aged eight‐months will have completed six weeks,
three months and five months immunisation events on time.
95% 89%
Better Help for Smokers to Quit
90 per cent of PHO enrolled patients who smoke have been offered help to
quit smoking by a health care practitioner in the last 15 months.
90% 81%
Raising Healthy Kids
95 per cent of obese children identified in the B4 School Check programme
will be offered a referral to a health professional for clinical assessment and
family-based nutrition, activity and lifestyle interventions.
95% 92%
6 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.
PUTTING WHEELS IN MOTION –
BIKES IN SCHOOLS
In 2018 the pupils at Broadgreen Intermediate School
watched the gradual transformation of an unused school
field into an awesome bike track.
The track, and the shed full of new bikes The pump tracks allows students of all “Biking is particularly
and helmets, were put into prompt use, levels to enjoy riding a bike.
to the delight of Aaryn Barlow, Public good for students
Health Promoter. “Biking is particularly good for students
who need ways to use their energy,
who need ways to
Broadgreen is one of three schools in the and this supports their learning skills in use their energy, and
Nelson Marlborough region to benefit the classroom.” this supports their
from the national Bikes in Schools initiative
where Nelson Marlborough Health works Parklands School in Motueka, Nelson learning skills in the
with the Bike On New Zealand Charitable Intermediate School and Broadgreen
Intermediate School are all on board. To
classroom.”
Trust and local councils to put bikes,
helmets and tracks into schools. see video of their tracks in action, visit
www.nmdhb.govt.nz/bikes-in-schools
Aaryn says that the beauty of the initiative
is that it provides children with regular and
equal access to bikes, within their own
school. This has huge advantages.
“Being active and physical, and
getting bike skills at an early age,
has tangible benefits for both
kids’ health and for the wider
community,” he says.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 7
ADVERSE EVENTS: IMPROVING PATIENT
CARE ONE REVIEW AT A TIME
Nelson Marlborough Health (NMH) is dedicated to providing the
very best in healthcare. While everything is done to ensure our
care is safe and effective to all patients, sometimes things go
wrong. We refer to these incidents as adverse events and we
take them very seriously.
Adverse events are rarely due to a single Here is a sample of some of the
cause. They are often the end result of improvements made following reviews of
a number of causes. An adverse event adverse events at NMH:
investigation is therefore not a tool for
investigating the professional competency Event Improvement(s)
of individual staff members, but a way for us
Patient risks not fully 1. Improved handover procedure for general surgery patients developed in
to identify where things have gone wrong by identified prior to relation to nurse to nurse, surgeon to surgeon, physician to surgeon and
looking at all of the factors that contributed procedure surgeon to GP handovers
to the event. 2. Identify, Situation, Background, Assessment and Recommendation (ISBAR)
handover tool process from ward nurse to other speciality
It is important that we learn as much as we nurses implemented
can from events and put that learning into 3. Transfer of patient to and from operating theatre policy updated to
change and improvement. By implementing clarify that patients transferring from the wards to endoscopy require a
corrective actions that are identified as a nurse escort
result of our investigation into an incident, Disability & Support 1. Review of recruitment processes and skill level within DSS and the
we aim to prevent recurrences and make our Services (DSS) – development of a number of frameworks to support the determination of
highlighted some safe staffing and skill mix
care safe and more effective.
specific opportunities
to improve systems in 2. Risk management and plans to provide detailed information about all risks
the areas of managing associated with a client’s particular needs
medical events, risks • Risk management is now written in a way that a first-time reader
and staff. will understand all risks and have a step through process to follow or
reference to other documentation.
Paediatrics – concern 1. Increase education to all staff around paediatric early warning score (PEWS)
around management and escalation process to ED/paediatric ward staff
and escalation of care
2. Increase frequency of auditing of PEWS charts and provide feedback to
staff if not being utilised correctly
Mental health – 1. Mental Health Service clinical staff to ensure accuracy of documentation.
ongoing care and In particular, staff reminded of the importance of key transfer, leave
1. ISBAR (Identify, Situation, Background,
Assessment and Recommendation) is a support of client on and discharge documentation and checking accuracy of information,
mnemonic created to improve safety in the weekend leave for instance medication dosages, against source documents, such as
transfer of critical information medication charts
2. Vital signs and observations are essential Escalation of 1. Development of new clinical guidelines for ‘non-invasive positive pressure
to assess the child’s clinical status; using
paediatric early warning score (PEWS) care following ventilation’ (NIPPV)
system enables the early recognition of deterioration of
sick patients and management of any patient 2. ‘Handover of care’ policy developed, aids process with regards to escalation
deterioration in their health and notification to senior clinician
3. Non-invasive ventilation is the use of 3. Patient track system has been introduced into NMH. Fluid Balance Chart
breathing support administered through a (FBC) is one of the documents within this system.
face mask or nasal mask.
8 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.
STRESSBUSTERS: SUPPORTING
COLOMBIAN REFUGEES IN NELSON
Forced displacement, trauma, kidnappings, homicides,
violence and loss are common experiences for Colombian
refugees prior to coming to New Zealand.
Since 2017 more than 200 Colombians have the development of group bonding and
resettled in Nelson from exile in Ecuador. interdependence.
They often arrive with complex histories
of trauma, loss and grief and there was an The five structured sessions, with written
increasing number of GP referrals to and visual resources in Spanish, include a
Nelson Marlborough Health Mental Health shared lunch. A final session, offered by
& Addictions Services (MHAS) for treatment. the Whenua-iti Outdoor Pursuits Centre,
enables the group to put into practise the
Rather than individual therapy, Deb skills they’ve learned, and build trust in
Moore, Nelson Marlborough Health (NMH) each other.
Professional Psychology Leader, looked for
ways to support the former refugees and Gillian Taylor, a registered psychologist
build trust, skills and resilience within their with previous experience working with
own community. refugees, was contracted to coordinate and
run the course, along with Nikau House
The Stressbusters group programme, occupational therapist Clive James.
based at Victory Community Centre,
approaches stress as a normal human Red Cross interpreter Fernando Hurtado
response to a refugee’s situation rather assisted with translation and interpreter
than as mental illness. services, and a steering group met regularly.
The key objectives of Stressbusters are The first group was held from August to
anxiety management, building resilience, November 2017 with two more groups held
enhancing self-esteem, and supporting in 2018.
Feedback and future developments
There was high attendance for all the Victory Community Centre and NMH’s Those likely to benefit from the
Stressbusters group sessions and Directorate for Vulnerable Populations is Stressbusters course are now referred
course evaluations were very positive providing support for ongoing Stressbusters directly from the Mangere Refugee
and encouraging. groups, including interpreter funding and Resettlement Centre to Victory Community
primary care-based counselling. Centre rather than requiring a visit to the GP.
When asked what was the most important
thing they learned in the course, one Refugees as Survivors has commended the The Stressbusters initiative was the winner
participate wrote: To control my anxiety and Stressbusters course, and the resources are of the Darcy Christopher Excellence Award at
manage the pain that I brought with me being made into an electronic package that can the 2018 Health Innovation Awards.
from Colombia. be adapted for other refugee populations and
shared nationally.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 9
MURCHISON WELL CHILD
FACEBOOK GROUP OFFERS
SUPPORT TO RURAL WOMEN
Providing women with postnatal care and
support can be challenging in remote rural
areas, such as Murchison.
The Murchison Hospital and Health Centre in “It’s a safe place for support and discussions
the rural town services a 50 kilometre area between parents and caregivers of children
and has almost 1100 enrolled patients. under five, who might be going through
similar experiences,” Nicky says.
A 2017 audit found the majority of women
received three or less postnatal home visits, Nicky moderates the page and initially put
even though they were entitled to eight. tight controls on the settings. However,
she’s since relaxed the controls and says
Nicky Cooper, a Well Child Nelson she is heartened with the respect everyone
“It was really nice to have
Marlborough Health registered nurse in shows each other. you watch him grow.
Murchison says there are many aspects of
rural life, including social isolation, that “Women are encouraged to open up, they
I really couldn’t have done
result in higher levels of postnatal also share tips and stories about what works this without you. You are
depression and anxiety. for them. amazing at your job! Thank
To help address this, in May 2016 Nicky “This open discussion has helped me pick up you.” Amy (mother)
created a private Facebook group, Murchison an issue which may not have been brought
Well Child. up otherwise, and it enables me to book
appointments for Well Child checks.” She says the page has created a ‘virtual
She says the idea for the group came after village’ which helps reduce the triggers
she noticed unread leaflets falling out of Nicky has acted as a support person to for postnatal depression, reduces social
the Well Child/Tamariki Ora books when many women in consultations with the GP isolation, and increases access to reliable,
mothers brought their children in for their or nurse practitioner and in early childhood trustworthy parenting information in
health assessments. education settings for a range of emotional, Murchison.
wellbeing or mental health issues.
“The Facebook page can store resources “A group member commented ‘It’s like I
electronically so parents can access the The results have this envelope of love around me’, which
information when they need it. made me feel very proud of the support
As at November 2018 there has been 100 the group gives to a section of our small
per cent engagement and participation in community.”
the Well Child/Tamariki Ora programme, and
no new diagnoses of postnatal depression The membership of the Facebook group
requiring medication or counselling in the 18 continues to grow.
month period after the page started.
Nicky was a Child and Adolescent category
Dr Ros Gellatly presents Nicky Cooper with her Breastfeeding and immunisation rates have winner in the 2018 Health Innovation
Health Innovation Award also increased. Awards for her work.
10 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.OUR REGION
NELSON MARLBOROUGH HEALTH
IS RESPONSIBLE FOR ALMOST
PEOPLE ACROSS TE TAUIHU
(NELSON–MARLBOROUGH) THAT’S 3% OF
NEW ZEALAND’S
POPULATION
OUR COMMUNITY
IS GROWING...
REGIONAL GROWTH 1997-2018
1.4% 0.9%
NELSON TASMAN MARLBOROUGH
AND AGING...
BY 2028 OF THE
AND 1/3 POPULATION IN
TE TAUIHU IS
PROJECTED TO
CHANGING...
65+
BE AGED
50%
OF OUR MĀORI
18%
OF OUR CHILDREN
AND YOUNG
POPULATION PEOPLE IDENTIFY
AS MĀORI
IS UNDER 25
87% BY 2033 THE POPULATION
1%
EUROPEAN IS EXPECTED TO INCREASE
PASIFIKA
10% BY AN ADDITIONAL
14,000
MĀORI
3%
ASIAN
OUR PEOPLE
DEMOGRAPHICS
Sources: Nelson Marlborough Health Needs and Service Profile 2015,
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people
stats.govt.nz live well, get well, stay well.
and infometrics.co.nz 11ENDING ECZEMA-RELATED
HOSPITALISATION
Seeing an unsettled youngster flourish once his climate like New Zealand’s, where there are
a lot of wind-borne allergens.
eczema was brought under control inspired public
health nurse Pam Manley to set up the South Island’s The eczema clinics are based at Richmond’s
first outpatient, nurse-led eczema clinic. Health Hub and Wairau Hospital’s
paediatric ward. GPs, nurses, dieticians and
The clinic has dramatically reduced the behavioural issues. She visited him at school paediatricians can all refer to the clinic, with
number of children whose eczema gets so and found a miserable, aggressive child with GPs and Plunket nurses being the main
bad they end up in hospital. In just two years, ‘head to toe’ eczema. source of referrals.
the numbers of children admitted to Nelson
Hospital with eczema has dropped from Pam acted quickly, picking up prescription “Quite often a dietician will refer a child to
78 to 3. skin creams and visiting the boy’s family the clinic to get the eczema under control
to show them how to administer the before they can start looking at the potential
Pam was motivated to set up the clinic when cream correctly. causes,” Pam says.
she met a 5 year-old boy referred to her for
“I got him going really well with his creams, “It’s just so rewarding seeing children getting
got the school on board, and things better, staying out of hospital and not having
changed,” Pam says. to go to their GP every other week.”
“It was when the school principal told me Associate Director of Nursing and Operations
later than the boy had grown into a confident Manager Jill Clendon is responsible for Well
class leader with lots of friends, I realised Child and community public health nursing
that the eczema wasn’t just about his skin, services at Nelson Marlborough Health.
it was about his behaviour, his self-esteem,
how others treated him, how the condition Jill says the eczema clinic is a great example
affected his play, everything. Eczema is an of how nurses support people to manage
underrated disease.” their health needs in the community, in
many different ways.
Eczema is a chronic skin disease, a
dysfunction of the skin barrier. Allergens “Nurses competently lead care for many
from the outside get in through the skin and patients with chronic conditions including
create an intensely-itchy rash that can keep diabetes, heart conditions, palliative needs,
people awake at night. continence needs and chronic wounds.
“It’s like having a million sandfly bites,” “They visit people in their home to provide
Pam says. care, offer clinics to support people manage
specific health needs such as eczema and
Eczema is often an inherited condition, but diabetes, immunise people in schools and GP
it also develops in new migrants who are clinics and facilitate access to other health
have not grown up with a temperate, windy services,” Jill says.
12 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.MAKE A PLAN AND
STICK WITH IT
The younger a person starts drinking alcohol,
the more likely it is that they will go on to drink
harmfully in their late teens and adult life.
Even though parents don’t want their They also asked parents what kinds of tools
children to use drugs, many introduce their they’d find useful to stimulate conversations
teens to alcohol before they reach the about alcohol and to help create plans for
legal purchase age — whether offering their families.
sips in supervised settings, or providing What has The Plan achieved?
large amounts of high-strength alcoholic As a result of these discussions the team
chose to focus on influencing parents Social change does not happen
beverages that are consumed unsupervised.
who want to teach their teens to drink quickly, nor is it easy to measure.
As reported to the Adolescent Health responsibly because these parents are However, feedback from parents has
Research Group (2013) around 60 per cent already thinking about what they do to shown that they have learnt new and
of under-18s who drink alcohol get it from support their child to make good choices. important information and The Plan
their parents. has been a good reminder for what
From here the two key aims became: they need to do as a family. Parents
In 2015 Hilary Genet, Mental Health have found it useful to talk with other
Promoter and Carol McIntosh, Alcohol 1. to delay parental supply as long as
parents, and find out what they were
Licensing & Health Promotion, both from the possible (rather than simply asking
doing. Parents report that they feel
Public Health Service, joined Rosey Duncan, them to not provide alcohol at all),
assured and confident to tackle the
Community Action Youth & Drugs (CAYAD) issues and not feel pressured by
2. to create family plans.
coordinator with the Health Action Trust, their teens.
to look at youth access to alcohol. Out of this emerged the initiative brand
The Plan with the strapline ‘Delay teen The team is now working to extend
Their response was to start asking parent the reach of The Plan beyond
drinking. Make a plan and stick with it’.
focus groups, innovators and young people Nelson Tasman.
about their knowledge, experiences, Since then the team has developed a range
attitudes and opinions regarding alcohol. of interactive resources, worked with bottle Parental supply of alcohol is also
stores, connected with being evaluated nationally by the
parents via high schools Health Promotion Agency. Over time
and workplaces, advertised, it is expected national surveys such as
promoted, and presented the Attitudes and Behaviours towards
The Plan extensively across Alcohol Survey, and the Lifestyle
the Nelson Tasman region. Survey, will indicate changes in New
Zealanders’ attitudes and behaviours
around alcohol.
The Plan won the Best Poster
category in the 2018 Health
Innovation Awards.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 13HAPŪ WĀNANGA (WĀNANGA HAPŪTANGA)
– KAUPAPA MĀORI PREGNANCY AND
PARENTING PROGRAMME
Results to June 2019:
Hapū Wānanga have been
11 held for 76 people: four in
Blenheim, four in Nelson
and three in Motueka.
Around
80% of attendees identify
as Māori, with
Pakeha and Pasifika whānau making
up the non-Māori participants. In
Hapū Wānanga is a kaupapa Māori pregnancy and
less than a year there was more than
parenting programme that covers mainstream practices a 1000 per cent increase in Māori
within a kaupapa Māori context. uptake of the programme.
The programme, launched in Marlborough Strong engagement and linking to local
in November 2018, operates in multiple support services is important to the ethos The average age of
26.5
locations across the Nelson Marlborough of the wānanga – with local presenters and wāhine attending
district. It is a partnership between Nelson services such as smoking cessation and Hapū Wānanga
Marlborough Health’s Te Waka Hauora Māori whānau support services attending. is 26.5, which is
health team, Maternity Services, local Māori younger than women attending
providers and community. It is the first of its At the end of the programme wāhine are mainstream pregnancy and parenting
kind in Te Tauihu (top of the South Island). given a wahakura woven by local weavers programmes, and increasing numbers
to support the safe sleep message. It comes of mums who have previously had
Hapū Wānanga is designed to reintroduce with a mattress, sheets, merino blankets, babies are also attending.
whānau from vulnerable populations to baby clothes, accessories and an aroha pack
Māori traditions and support pregnant filled with items for māmā and pēpi.
At the completion
60%
wāhine who might not otherwise engage
with antenatal education. Hapū Wānanga supports Māori whānau and of the programme
not just first-time parents and mothers — 60 per cent of the
Over two days Hapū Wānanga embraces partners and wider whānau are welcome. mothers attending who were smokers
the principles of te reo, tikanga and To help remove any barriers to whānau when they registered joined either the
mātauranga Māori to share knowledge accessing the programme, there is no cost, Pēpi First or Stop Smoking Service.
and key messages around immunisation, kai is provided and also transport if required.
labour and birth options, safe sleep, gentle
handling of pēpi and other issues identified
by whānau attending, in a way that upholds
and acknowledges Te Ao Māori.
14 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.QUALITY AND SAFETY MARKERS
The Health Quality and Safety Commission drives improvement
in the safety and quality of New Zealand’s healthcare.
Quality and safety markers (QSMs) help us to evaluate and determine whether we have
achieved a desired change in practice and harm reduction.
Quality and safety markers update, Q2 April to June, 2019
Surgical site infection improvement (SSII) – orthopaedic surgery
Process marker 1: Antibiotic administered in the right time Goal
Process marker 2: Right antibiotic in the right dose 100%
100
80
60
40
20
98% 98% 100% 99% 100% 97% 100% 100%
0
Q1 Q4 Q3 Q2
2019 2018 2018 2018 2017
Hand Hygiene Falls Prevention
Good hand hygiene prevents healthcare-related infections. This This measures our rate of assessing older
measures compliance with five hand cleansing moments: before patients’ risk of falling. Goal
patient contact; before a procedure; after a procedure; after 90%
patient contact; and after contact with patient surroundings. 100
Hand hygiene national compliance data is reported three times 90
every year, not quarterly. 80
70
Goal 60
100 75% 50
80 40
30
60 20 73% 67% 65% 73%
10
40 0
81% 85% 88% Q2 Q1 Q4 Q3
20 2019 2019 2018 2018
0
Q2 Q3 Q1
2018 2018 2019
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 15COUGH REFLEX TEST
PICKS UP SWALLOWING
DIFFICULTIES
An acid which occurs naturally in citrus fruit is helping the
Nelson Marlborough Health speech language therapy (SLT)
team perform a simple test to detect whether a patient is likely
to cough if something goes down the wrong way.
Nebulised citric acid irritates a person’s Although 10 per cent of the regular population “When someone passes the test it gives
larynx and makes them cough, won’t react to citric acid, Michele says the test us a lot more confidence that they are not
simulating the same effect as food or acts as a good screening process. silently aspirating.”
fluid touching the vocal cords.
“Just because someone fails the test it doesn’t Michele says since they started using the
SLT team leader, Michele Cunningham mean 100 per cent that their cough reflex is test approximately 20 per cent of patients
says a cough reflex test may be done on compromised but it does mean we manage fail, although some will subsequently pass
patients who have had an acute stroke them more cautiously, and it gives better when the test is re-administered in the
or a neurological condition that might information to the medical team,” she says. next day or two.
affect their swallowing.
“We put citric acid through a nebuliser
and the patient breathes it in,” she says.
“If they cough it tells us the sensation in
their larynx is intact and they will be able
to feel if food or fluid has gone down the
wrong way. If they don’t cough it could
mean the sensation in their larynx is
affected, meaning they may not feel it
and therefore won’t cough it up.”
Michele says this is known as silent
aspiration, and the patient may not
know it’s occurring, putting them at
increased risk of developing
aspiration pneumonia.
In May 2019 the SLT department added
the cough reflex test as an additional
tool to some swallowing assessments.
16 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.INITIATIVE HELPS STREAMLINE
X-RAY EXAMINATIONS
If a patient fails a cough reflex test or is “The radiology team is often under pressure,
having swallowing problems due to head and room availability is tight and it can be
neck cancer, stroke or a neurological disease, difficult to line up a MIT and a radiologist
they may be sent for a videofluoroscopy at the same time,” says Freya. “While we
(VFS), a moving x-ray examination of their appreciate having radiologists with us this
swallowing action. can sometimes impact on the timeliness of
getting a VFS done.”
During the procedure barium sulfate, a
metallic compound that shows up on The radiology team leader assisted in
x-rays, is mixed with food. This allows the determining which patient groups would
speech language therapist (SLT) to analyse be suitable for VFS without a radiologist
the complex muscle movements involved present. Collaboration with the lead MIT was
in swallowing and assess whether food or also important as their role also changed
liquid is entering a person’s lungs. with this new process.
A recent initiative, led by SLT Freya Davison, During the transition period the SLT team
has made the process for getting a VFS more was well supported by the radiologists who
streamlined for patients. checked the images and reports.
Previously a videofluoroscopy involved “Having one less person to schedule
the presence of a radiologist, along with a for a VFS has improved access for
medical imaging technician (MIT) and an SLT. low-risk patients,” says Freya. “Patients
can be seen sooner and this means we
Freya’s initiative meant a radiologist was no can get on to rehab programmes sooner
longer required to be present for a VFS on and be more confident in our treatment
low-risk patients. recommendations.”
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 17The Models of Care Programme aims to make the system more responsive
and patient-centric. Health Care Home and the Medical Admissions and
Planning Unit (MAPU) are two of the initiatives within the programme
that will lead to this transformation.
THE MODELS OF “I rang for an appointment and
was advised that there were no
CARE PROGRAMME routine appointments available.
I was happy to wait until the
following day, but the receptionist
journey, providing greater accessibility to suggested that I could be called
HEALTH CARE HOME care closer to home, though technology and by a GP to be triaged. I spoke to
The first place most people look to for efficient ways of working. Interdisciplinary the GP who felt that with the
their healthcare needs is their local general healthcare teams will also be easy to access symptoms I had, it was better
practice or GP. to work with patients and their whānau. that I was seen today. This is an
excellent service.” Patient Mr MH.
These practices are coming under increasing The initiative began in the Nelson
pressure as people’s lifestyle choices and Marlborough region in October 2018, “The team huddles have
an aging population result in more complex and there are now nine HCH practices, provided an excellent addition to good
health issues and a greater demand for care. representing 42 per cent of enrolled Nelson practice communication, particularly during
Without a solution this situation will Marlborough patients with more joining the implementation of our new patient
become unsustainable. early in 2020. The aim is to have 80 per cent management system, and a period when flu
of the enrolled population registered with a vaccine became restrictive. The huddles are
Health Care Home (HCH) is designed to help HCH practice. always well-attended and have become an
general practice teams remain responsive integral part of the day.” GP
through new and sustainable ways of Health Care Home aims to:
working. The Health Care Home practices will also
• Improve patients’ access to healthcare be the launch pad for a number of other
The aim of HCH is to strengthen the services through virtual consultations and Models of Care initiatives including:
at the beginning of a person’s healthcare alternative appointment formats,
online booking capability and phone Strengthening Coordinated Care:
triage services. Supporting health professionals to
coordinate services for people with
• Increase the capacity of the complex health needs.
practice team.
Virtual Health: Enabling off-site
• Reduce the demand on the hospital consultations and eventually remote
emergency departments and monitoring, reducing the need for travel
unplanned care by proactively for those unable to do so or based in
managing people with complex isolated areas.
health needs.
Shared information: Will enable the
A Primary Care Practice Assistant takes dermoscopy Feedback on the HCH initiative so far has sharing of electronic care plans across the
skin photos during a virtual consultation been overwhelmingly positive. health system.
18 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.MAPU: AIDING ACUTE HEALTHCARE
The MAPU team (July 2019)
Emergency departments are often the Some people are referred to the hospital by
pressure point in a hospital. As more their GP and fast-tracked through ED into
patients pour through the ED doors, there’s the unit. Other patients are admitted to the
pressure on staff to manage their care and unit from ED. This takes the pressure off ED
move them through the department. and also means that patients can receive
care sooner.
Demand for acute healthcare rises each
year, but Nelson Hospital has a low Decongesting ED for new arrivals helps
number of medical beds available for reduce the time people spend in ED bays or
patients in need of short-term urgent care. corridors, and ensures the ‘right’ patients
are in ED.
In order to reduce congestion in ED,
deliver more effective and efficient care, While it is still too early to make a definitive
and improve the patient journey in to assessment on the impact MAPU is having
hospital care a Medical Admissions and on waiting times in ED and overall lengths of
Planning Unit (MAPU) was established and stay in hospital, the indications are positive.
successfully trialed between August and
October 2018.
The 10-bed unit, in close proximity to ED,
the Intensive Care Unit and Radiology
Department, is a place where patients
with serious health conditions are
assessed and observed. MAPU brings
together the skills of a specialised group
of health professionals.
Feedback about MAPU during a trial from
Jodie Winwood, Associate CNM, Sharon Scott, Charge Nurse
staff and patients was positive, and on 1 Manager ED & MAPU, Sonja Van Alphen, Team Leader
July 2019 a permanent MAPU was opened. Pharmacy, Deidre Crichton, Team Leader Physiotherapy.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 19The Models of Care Programme virtual health initiative, uses communication
technologies to provide healthcare when patients and care providers are not in
the same physical location. Thereby avoiding the stress and travel that
comes with having to attend appointments in person.
VIRTUAL
CONSULTATIONS
A SPECIALIST’S VIEW A PATIENT’S VIEW
Dr Saxon Connor, a specialist surgeon Mr La Pang was a patient who required
at Christchurch Hospital says we can’t advice and treatment from a specialist in
underestimate the impact travel has on Christchurch and was able to attend his
The relative simplicity of
patients. He regularly consults with patients appointment from Nelson via a the technology and the
from Nelson and says it’s often those who
have to travel that are in poorer health.
video consultation.
opportunity to interact
Originally from Burma, Mr Pang now lives in with it have all helped to
“Technology is at a level now where, other Nelson with his wife and family. Following
than a physical presence, there is very little a diagnosis, he was faced with having to
create a level confidence
difference between a virtual consultation travel to Christchurch to attend specialist in video consultations.
and a face-to-face appointment,” Dr appointments. Neither he nor his family
Connor explains. “Before a consultation all speak English, so for the 75 year-old the
the assessments have been done so the logistics of travel were quite daunting. On “I am a lot happier with local appointments
meeting is about the conversation. In my top of this, Mr Pang’s condition affected and for me I didn’t feel much different — as
experience, a nurse or GP is always present his mobility, meaning standing or sitting for long as I have an interpreter,” Mr Pang says.
with the patient, so I am comfortable that extended periods was difficult.
the patient is being supported.” The relative simplicity of the technology and
“The long distance to travel, so much the opportunity to
He says his role is to talk to the patient time waiting and also the need for a lot interact with it have
about their situation and treatment plan and of people to help with interpreting and all helped to create
this can be done via video as effectively as movement made it very difficult last time,” a level confidence in
meeting in person and it is less exhausting Mr Pang explained. video consultations.
for the patient.
Mr Pang was identified as a suitable The initiative
Dr Connor is heartened with the steady candidate for a virtual consultation. will eventually
increase in the number of So for his next appointment, rather than extend into other
virtual consultations and undergoing the discomfort of another trip to community
encourages all patients to Christchurch, his sons were able to drop him settings as well
take up the opportunity off at Nelson Hospital where he met with as into people’s
of a video consultation if a translator and public health nurse. With homes — bringing
their health allows for it. their help, he spoke to his neurologist at care truly closer
Dr Saxon Connor Christchurch Hospital via video link. to home.
20 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.A VIRTUAL VIRTUAL SPEECH-LANGUAGE
CONSULTATION THERAPY CONSULTATION WELCOMED
JOURNEY
When Ann Lewis started having trouble “There was a slight glitch with the sound in
Despite the excellent healthcare facilities
with her voice, a specialist diagnosed the first session but we muddled through,”
and support available in Golden Bay many
a lack of collagen in her vocal cords she says.
patients have to complete
and referred her to speech-language
a 100 kilometre trip, Michele admits there are still some
therapist Michele Cunningham.
traversing the winding teething issues with the technology, but
Takaka Hill, to see a “I saw Michele on one of her regular she’s had great support from Nelson Bays
medical specialist in visits to Golden Bay and she raised Primary Health Organisation and Golden
Nelson. An appointment the option of doing the therapy Bay Community Health staff.
may be brief or require via virtual consultation,” says Ann.
no physical examination, yet “I thought it was a splendid idea. Why Despite the issues both Ann and Michele
it involves a lengthy trip, which travel over the hill if I don’t have to?” agree their virtual health experience has
can be costly and taxing for older or post- been a success. Ann says although she is
surgical patients. Michele initiated a pilot virtual health quite comfortable driving over the hill she
programme in Golden Bay as part of her resents having to spend a whole day away
Some small but exciting steps have been career and salary progression project. from home.
made towards using virtual consultations
in the bay. General Manager of the “I spent awhile exploring and trialing “If we hadn’t done a virtual health
Golden Bay Community Health Centre technology and settled on using the consultation there wouldn’t have been as
(Te Hauora o Mohua), Linzi Birmingham, video conferencing platform ZOOM,” many sessions and the therapy would’ve
is part of the national Ministry of Health Michele says. been harder to do,” she says. “I think it’s a
Telehealth Leadership Group which fantastic idea and I didn’t feel it was less
advises on deployment priorities, technical Michele did an initial assessment of a session because of the technology.”
considerations, barriers and other matters with Ann and then set up a therapy
relating to virtual consultations. Linzi programme using virtual health where “Some people my age may not be
believes the introduction of virtual health appropriate. comfortable with the technology — but
will be transformational for the bay. in another ten years it might be different,”
“Speech-language therapy sessions she says. “It wasn’t an issue for me and it
“The use of virtual consultations don’t always need to be face-to-face. certainly beats travelling.”
is a significant initiative,” she says. But you do need good equipment as
“It’s about valuing our patients’ voice therapy is about
time as much as we value our own.” sound and whether
the pitch is stable and
She says it would mean a change sometimes that can be
of thinking for many people but it is hard to tell on a video link,”
very exciting. she says.
“Once all the barriers around Ann says Michele prepared
connectivity and security have been her before their sessions
removed it will become a valuable started and she knew what
tool for us to use in the provision to expect.
of healthcare in Golden Bay. Watch Ann Lewis and Michele Cunningham.
this space.”
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 21FUTURE FOCUS
HOW THE MODELS OF CARE PROGRAMME IS DELIVERING
THE PRIMARY AND COMMUNITY STRATEGY.
The Primary and Community Strategy,
developed in 2016, gives a clear
direction for the future of our
region’s healthcare services.
MODELS OF CARE
Through a series of public meetings,
Nelson Marlborough’s community
PROGRAMME
validated the strategy and its
direction for a ‘people-centred
healthcare system that will provide a
proactive and collaborative approach
to care, and use technology and
information to reduce barriers and
improve health outcomes.’ SHARED
INFORMATION
The next challenge was to create
an action plan – to transform Sharing health information
the status quo and deliver the between health professionals to
vision. Working with health
HEALTH CARE ensure consistency of care.
professionals across the system,
HOMES
a significant amount of work went Improving access to health care and
into understanding the vision and better care coordination and delivery
translating it into real outcomes and by strengthening general practices.
initiatives. This became the Models
of Care Programme.
Through the programme, nine
initiatives were prioritised to lay the
groundwork for the vision and to
enable future initiatives: VIRTUAL HEALTH
Implementing virtual technology to
improve care and reduce the physical
barriers to healthcare.
22 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.The level of commitment shown by
health practitioners across the region
and the enthusiasm of the community
members already experiencing the
services (through trials and initial
STRENGTHENING rollouts) suggests that the future of
COORDINATED CARE the Nelson Marlborough healthcare
system will more than live up to the
Providing better care for people with vision laid out in the Primary and
complex needs by supporting health Community Health Strategy.
professionals to work in teams.
WORKFORCE
DEVELOPMENT For more information about any of
these initiatives visit www.nmdhb.
Growing a flexible, skilled health
govt.nz/models-of-care
workforce to meet the future
healthcare demands of the
community.
ACCESS TO MEDICAL ADMISSION
TIMELY ADVICE AND PLANNING UNIT
(MAPU)
Supporting health
professionals to give and Improving immediate access to
receive advice to improve specialists in Nelson hospital for the
patient care. acutely unwell patients.
FIRST 1000 DAYS
HAUORA DIRECT Supporting vulnerable people
Proactively assessing the to develop the crucial parenting
health of vulnerable people skills they require to improve
and providing services where the health and wellbeing of their
they are. young children.
Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well. 23Tell us what you think Website: www.nmdhb.govt.nz/feedback
Email: feedback@nmdhb.govt.nz or quality@nmdhb.govt.nz
We need your suggestions about how we can Mail:
improve the quality and safety of services. The Chief Executive
Tell us what matters to you by contacting us. Private Bag 18, Nelson 7042
Or
Quality Team
Private Bag 18, Nelson 7042
Telephone: (03) 546 1800 and ask for extension 7866
24 Nelson Marlborough Health Quality Account 2019 | Our Vision: All people live well, get well, stay well.You can also read
