EMHS Excellence Awards

At this year’s East Metropolitan Health Service Excellence Awards,  two nursing research projects were finalists.

The Nurse Led Glaucoma Assessment Project

This project evaluated a nurse led clinic  to address a back log in glaucoma patients receiving specialist eye care.

The clinic at RPH provided an extra 512 appointments for non complex glaucoma patients which then allowed 512 more complex glaucoma patients to be seen by our ophthalmologists.

 

East Metropolitan Health Service
Excellence Symposium
Nurse-Led Glaucoma Assessment Clinic
Jean-Louis Desousa, Lauren Entwistle, Jeanne Young, Meredyth Haigh, Fiona MacDonald, Neil Cowan

The Mental Health Emergency Response Programme

The Mental Health Emergency Response Programme provides nurses and doctors with simulation education to help staff develop their skills in dealing with emergency mental health situations.

 

East Metropolitan Health Service
Excellence Symposium
Mental Health Emergency Response Project (MHERP)
Lucia Gillman, Jeanne Young, David Stevens, Kylie Fawcett, Danen Engelenberg, Hannah Midani, Jess Vinci, Jasmine Trethewey

 

Congratulations to both research teams!

N. May, J. Young & L. Gillman 

Focus on Health Professional Education Journal. 22;2.2021

Abstract

Introduction:

Ongoing professional education is an essential activity to ensure that hospital staff are using the best available evidence to deliver healthcare. Hospital staff from a range of professional groups cite increasing work volume and being too time poor to complete or attend education. To address this issue, a new 5-minute online education format (Take 5) was developed.

Methods:

A descriptive study using a short evaluation survey was undertaken at Royal Perth Hospital in Perth, Western Australia, to evaluate interprofessional healthcare staffs’ levels of engagement with the new education format.

Results:

The Take 5 education format facilitated the development of over 120 topics available via an intranet library page. During the study, it received 26,623 hits, averaging 19.3 visits per day. Topics were downloaded 45,611 times. Medication discrepancies (n = 1,326) and personal protective equipment (PPE) conservation (n = 1,115) were the most frequently downloaded. A total of 2,001 evaluation surveys were received, with nursing and medicine having the highest participation. The majority of staff (n = 1,895; 94.4%) rated the resource as having “good” to “high” quality content. Qualitative data showed that the topics were informative, easy to access and understand and perceived to help the participants change their clinical practice.

Conclusion:

The Take 5 uptake has been strong and sustained, as highlighted by the substantive utilisation and evaluation. The concept was not designed to replace formal education but to act as an adjunct, providing key education to meet staff demands. It provided immediacy of information and quality evidence-based content and directed the learner to more formal learning content and resources.

Can you identify a sepsis symptom?

A new nursing research project at Royal Perth Hospital is aiming to help more patients spot the signs of this life-threatening condition which accounted for 19.7% of all global deaths in 2017.

RPH Emergency Department Nurse Jonathon ‘Jono’ Burcham received the Doreen McCarthy Nursing Research Grant ($20,000) to study the level of sepsis awareness in patients attending ED.

The Doreen McCarthy Nursing Research Grant  is a jointly funded initiative between the RPH Nursing Research Foundation and the RPH Research Foundation.

Jono’s project will explore how to maximise patients’ retention of vital health information about sepsis.

Signs and symptoms of sepsis include:

  • rapid breathing.
  • rapid heart rate.
  • confusion, slurred speech or disorientation.
  • fever or shivering.
  • muscle pain.
  • not passing urine.
  • discoloured skin.

Congratulations Jono, we look forward to hearing about your research findings!

Glaucoma Grant Funding

Grant Funding Received for a RPH Nurse Led Glaucoma Assessment Clinic Project

The WA Nurses Memorial Charitable Trust has awarded $14,960 to Jeanne Young, Lauren Entwistle, Jean-Louis DeSousa, Meredyth Haigh, Fiona MacDonald, Kim Hill to evaluate a Nurse Led Glaucoma Assessment Clinic Project.

Glaucoma is a serious, irreversible optic neuropathy that can result in permanent loss of vision (Tham et al, 2015). Glaucoma is known to increase with age with an estimated 1:200 Australians over the age of 40 years having the condition, with this increasing dramatically to 1:8 Australians who are aged over 80 years.

Alarmingly, 50% of people with glaucoma are not aware they have the condition (Glaucoma Australia, 2020). Given the slow progression of this disease, early diagnosis along with appropriate monitoring coupled with tailored education are integral requirements to preserving vision.

Research evaluating Nurse Led Clinics for ophthalmology patients is very limited but available findings have demonstrated the safety and effectiveness of a nurse led clinic (Sandinha et al; 2012; Slight et al., 2009; Kirkwood et al, 2005).

Research Aim

This project at Royal Perth Hospital will evaluate a nurse led assessment clinic for glaucoma patients.  Only non-complex patients, who have been deemed suitable by an ophthalmologist will continue to attend these clinics.

Objectives are to:

  • Develop a training programme to upskill an ophthalmology RN to run a NLGAC and undertake the approved ophthalmic assessments
  • Improve patients’ knowledge, understanding and management of glaucoma through the provision of individualised glaucoma education
  • Improve non-complex glaucoma patients’ waitlist times by attending a NLGAC at RPH
  • Improve wait times for complex glaucoma patient to be seen by an Ophthalmologist
  • Evaluate the cost benefits of implementing of a NLGAC at RPH

 

Three NLGAC will be run per week with a total of 288 patients seen by the nurse over the course of four months.

Remote Monitoring

Remote Monitoring of Critically ill Patients Project (RMCIP)

Congratulations to Mr Timothy Leen, Ms Kylie Fawcett, Ms Jeanne Young, Dr Heather Kidd, Dr Timothy Bowles, Ms Katie Khoury who were awarded a $137,323 Clinical Simulation and Training Research Grant.

The research funding from the Department of Health in conjunction with the WA Simulation in Healthcare Alliance will support the development of an immersive insitu simulation education project for the remote monitoring of critically ill patients at RPH.

Currently, the EMHS are implementing a Health in a Virtual Reality Environment (HIVE) Service to remotely monitor 50 critically ill ward-based patients using artificial intelligence (AI) software, overseen by HIVE acute care clinicians.

Funding will allow for an additional HIVE ward based “room” that will be used to provide insitu immersive simulation education to staff, with the “room” also available when clinically required.

The purpose of this project is to develop and evaluate an ongoing advanced Remote Monitoring of Critically Ill Patients (RMCIP) simulation programme that will further develop the workforce with regard to effectively using HIVE technology to deliver high quality patient care.

The RMCIP programme will build on current HIVE training to allow clinical staff to fully experience caring for a critically unwell patient.  The programme will provide ward staff with an opportunity to master their communication and collaboration skills with both the patient and virtually with HIVE clinicians, whilst being immersed in real life clinical deterioration scenarios.

The course will commence in April 2021.

Amazing Nursing and Midwifery Care Group

Amazing Nursing and Midwifery Care Project Update September 2020

The Amazing Nursing and Midwifery Care project is our promise to our profession and our patients that we are committed to no patient harm and delivering what matters most.
The program looks at how we as nurses and midwives can better work together with clinical and support teams to improve our patient’s healthcare journey.

The following five program components make up the Amazing Nursing and Midwifery Care project:

  • Team Nursing – Care is delivered by a team of nurses with a variety of skills and knowledge who work together under the leadership of an appropriately skilled nurse or midwife to meet the needs of their patients.
  • Bedside Handover – Bedside Handover increases opportunity for patient engagement by ensuring handover is conducted at the bedside and involves the patient.
  • Safety Shift Huddle – A process conducted at the start of each shift where the oncoming nursing and midwifery team and the outgoing shift coordinator meet prior to bedside handover to review key safety risks and patients of concern on the ward.
  • No Pass Call Zone – A means of ensuring that a patient’s request for assistance is answered in the shortest timeframe and that no staff member passes a patient who is asking for help
  • Care Rounding – a member of the team visits the patient

Four of the five strategies have been established at Royal Perth Bentley Group. Care Rounding is currently in phase 1 of implementation, commencing in a stage approach in November 2020 at Royal Perth Hospital.

Since the commencement of the Amazing Nursing and Midwifery Care project the Patient Experience has demonstrated an increasing trend in the Net Promoter Score and placing RPBG in the ‘excellent’ category.

A recent re-evaluation of staff perspective of Team Nursing has demonstrated a shift in perspective. Prior to the implementation of Team Nursing 89% of nurses preferred the patient allocation model of care. Recent findings reveal 66% of nurses are satisfied with the Team Nursing model of care. Ongoing change management strategies are being implemented to support staff to embrace and embed the Team Nursing model of care.

The evaluation process for all strategies is ongoing with staff feedback demonstrating some inconsistencies across clinical areas. Ongoing support is required to embed all strategies across the organisation to support a strong, safe and efficient culture.

The Department of Health, Clinical Simulation and Training Grants

awarded to RPBG Nursing and Medical Education Team.

Chief Medical Officer, Dr Michael Levitt presented a $50,000 Clinical Simulation and Training Grant to Dr Lucia Gillman, Ms Kylie Fawcett, Dr Richard Stewart, Ms Alex Knowles, Ms Jeanne Young and Mr David Bruce.

The funding from the Department of Health in conjunction with the WA Simulation in Healthcare Alliance will support the development of a mental health emergency response simulation education programme (MHERP).

This research project will evaluate the effectiveness of simulation education to support inter-professional clinical staff in recognising and responding to acute deterioration and violence in a mental health context.  This advanced MHERP will use scenario based learning to immerse inter-professional staff in high risk acute MH situations delivered in a low risk educational environment.

Staff from RPBG MH wards, MH Emergency Centre, City East, Midland and BHS Community MH Services will be invited to participate.

The MHERP will allow staff to master MH emergency skills, deal with unanticipated clinical events, enhance team work, communication skills, increase confidence and improve performance to prevent/manage MH clinical deterioration.

In its first year, 200 staff will be trained with evaluations conducted at 3 times points over five months. The program will include elearning modules, MH clinical deterioration and Crisis Resource Management pre reading and the development of several realistic MH emergency scenarios.

By upskilling MH staff expected outcomes include:

  • Enhanced management of a clinically deteriorating MH consumer (earlier intervention).
  • Prevention of incidents escalating into aggressive and violence acts.
  • Decreased need for Code Black security responses.
  • Increased staff confidence in their skills/role in responding to or leading a MH emergency response.
  • Increased staff knowledge with regard to responding to a MH emergency response.

 

 

 

 

Congratulations to the Royal Perth Bentley Group CoBRA Project team, whose work has just been published by the international Journal of Nursing Care Quality.

The CoBRA project, led by Dr Heather Kidd, RPBG Nursing Director, Safety, Organisational Learning and Development developed and evaluated the online CoBRA audit tool that is in use across the RPBG.

 

Developing the Next Generation in Electronic Clinical Auditing: CoBRA Tool

 

Background: While auditing is embedded into clinical culture, data collection tends to be retrospective, requires expertise and is time consuming.

Local Problem: Clinical audit data is needed in real time to manage patient safety issues.

Methods: An iterative approach was undertaken to develop the electronic audit tool with a cross sectional survey used for evaluation.

Interventions: The Combined Bedside and Risk Assessment (CoBRA) audit tool captures patient safety risk and compliance such as falls, pressure injuries and infections.

Results: Over 17,956 safety audits were collected on randomly selected inpatients. Monthly audits completion average is 96% (n=614). Patient safety risk mitigation is available in real time.  Stakeholders stated the CoBRA tool was useful in educating patients on risks (n=141; 78.3%), improved patient care (n=120; 67.4%) and prompted staff to modify patient care based on CoBRA findings (n=98; 54%).

Conclusions: The electronic CoBRA process facilitates patient safety risk mitigation and data transparency.

 

 

 

Best available evidence shows that the decision to delivery interval (DDI) and emergency caesarean section (CS) should be no more than 30-60 minutes if maternal or fetal compromise is to be prevented.

Bentley Health Service (BHS) identified delays in getting Category 1 and 2 patients to theatre for emergency CS. Audit results for Sept 2018 to February 2019, showed that 22 Category 2 patients were over the recommended 60 minutes DDI and two Category 1 patients were over the 30 minute DDI for an emergency CS.

Aim

To decrease DDI for Category 1 CS patients to less than 30 minutes and Category 2 CS patients to less than 60 minutes.

Method

Implementation of a comprehensive bundle of RAPID interventions included:

  • Staff education using high fidelity simulation scenarios and power point presentations with embedded procedural videos.
  • The development of a Standard Operational Procedure (SOP)
  • a dedicated flexible theatre
  • Assigned emergency theatre team in-hours
  • Introduction of new paging distribution group for Category 1 and 2 CS
  • Modifications to theatre infrastructure to create a ‘RAPID’ bay
  • Streamlined after hours communication processes.

 

Results

Overall

  • 31% (n=258) of births (pre/post) resulted in a C Section
  • 46% (n=52) required an ECS at pretest
  • 33% (n=47) required an ECS at posttest.

 

Category 1 Patients:

  • Average RAPID time from DDI to ECS was 35 mins
  • Only 1 ECS was required at pretest
  • 38% (n=3) of RAPID Cat 1 patients had a DDI < 30 mins.

 

Category 2 Patients:

  • Average RAPID time from DDI to ECS was 53 mins
  • 51% (n=20) of RAPID Cat 2 patients had a DDI < 60 mins

 

Conclusion

  • All intervention strategies were successfully implemented.
  • RAPID practice has now been established at BHS.
  • Cat 1 and 2 caesarean now seen as an emergency (call 55)
  • Results showed slight improvement from DDI to ECS but further embedding of RAPID is required.

Jude Cuff, Royal Perth Bentley Group, Perth WA. Judith.Cuff@health.wa.gov.au

Jo Cable, Royal Perth Bentley Group, Perth WA.  Jo.Cable@health.wa.gov.au

Erin Ashbolt, Royal Perth Bentley Group, Perth WA. Erin.Ashbolt@health.wa.gov.au