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2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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.
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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.
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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.
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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.
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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
2019 Our People, Our Stories - Healthcare initiatives in the Nelson Marlborough region - Nelson Marlborough District Health ...
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                            11
ENDING 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.     13
HAPŪ 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.     15
COUGH 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.   17
The 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.            19
The 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.          21
FUTURE 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.   23
Tell 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.
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