Clinical Services Director Report for End of Financial Year 2019
Service Review and Development
Triaging of Referral Pilot Project - February-May 2019
A review of the processes involved in triaging of incoming referrals was piloted from mid-February 2019 and ran for 3 months. It provided effective evaluation of current processes and trial of new processes, aimed at managing patients with more complex needs. Referrals for patients with non-malignant diagnoses is of concern as the projected illness trajectory can mean services are needed to be used differently than for those patients with a malignant illness. The creation of a category of patients under the term 'episodic care' allows these patients to be fully registered by means they will phone in when they need care, rather than being part of a routine home visit schedule or Wellness Clinic follow-up. The project also looked at workload management to ensure the most efficient processes for all staff involved with referrals. The Triaging of Referrals project has been adopted and is embedded into normal practice now.
Chronic Illness Management Project - November 2018 - ongoing
A working party was formed in late 2018 involving the Medical Team Leader, Clinical Services Director and four nurses with advanced nursing skills. The purpose of the project was review of referrals for patients with non-malignant illnesses and review the care provided to this group of patients. It is recognised nationally and internationally that an aging population with multiple chronic illnesses will put pressure on hospice services in the future. The brief of the working party was to research an alternative model of care for these patients. The adoption of the 'episodic care model' as part of the Triage project in 2019 partially addressed the needs of these patients. Further work will be completed and will be aimed at promoting self-management strategies. Progress of the working party was halted during the Triaging of Referrals Project. It is envisaged that this work will begin again once the 2019 IT project has been completed.
Equipment Review and Replacement - January 2019-July 2019
The review of pressure relieving devices was completed and new air mattresses purchased to replace old devices. The purchase of these mattresses has been successfully reviewed in relation to the development of pressure injuries by vulnerable patients. A further review of equipment has occurred during 2019 and included identification of equipment needing replacement.
Auditors visit in March 2019
The service was audited in March 2019 for compliance with health sector standards. Some variances were noted and work has been undertaken to address these variances. A Medication Management Committee has been formed to guide the service in the management of medication related issues.
Staff Changes
During the period of this report there has been a number of nursing staff changes as staff retired or resigned to pursue other areas of nursing. Recruitment of new staff included a new palliative care community nurse for Central Taranaki, a new Clinical Nurse Educator and new Clinical Nurse Specialist for the hospital palliative care in-reach team.
Hospice Taranaki's model of nursing team development is based on the new nurse commencing work in the inpatient unit and after a period of time, will then orientate to the community setting. This rotation of inpatient and community nurses ensures a flexible and skilled workforce who can apply their skills in any setting. This also means that newer staff in the inpatient unit can be mentored by the community nurses on the rotation schedule. Nurses with advanced nursing skills have had the opportunity to step up into leadership roles as vacancies have occurred.
A continuation of the 2017-2018 Values based organisational learning has continued with values being practices in daily care processes and teamwork activities. This was part of the Education programme for all staff in 2018.
Professional Development
Professional development at post graduate level is a goal for all new staff. The time-frame for completion of this is negotiated on an individual basis. Financial support of this post-graduate study is via the Health Workers N Z Fund and to a lesser degree, Hospice Taranaki Inc.
A number of staff attended the Hospice N Z Conference in September 2018. This was seen as an opportunity to keep abreast of new developments in the field of palliative care. Two registered nurses have completed their post-graduate certificates in Health Science from the University of Auckland during 2018/2019.
Inpatient and community team leaders were very fortunate to participate in a Leadership Development programme facilitated by Staples Rodway and completed in November 2018. The Team Leaders were very appreciative of this opportunity and were very complimentary in regards to the programme and what they gained by attending. Team Leaders have shown increased skills and confidence in managing their teams.
Maori Health Services
The Kaiawhina and Kaitakawaenga (Maori Liaison) roles continue to grow in strength and versatility. Attendance at multi-disciplinary team meetings at Oncology allows these staff to identify patients who may need referral to hospice services at an earlier stage. The pounamu taonga has gained a display case in the inpatient unit and a special waiata is being used at formal occasions. Progress on the Waitara Project involving Clinical Nurse Educator and Kaitakawaenga Paula King has been slow due to circumstances outside of her control. A plan is in place to pilot the first Carer Programme in Waitara in November this year.
Staff attended a visit to Oakura marae for two day workshops aimed at broadening knowledge and understanding of tikanga Maori. The visit was appreciated by all staff who attended.
Community Partnerships
WITT and Massey University Bachelor of Nursing Students (BN)
We have supported BN students from WITT and Massey in previous years. In 2018, some concerns were raised with WITT in relation to the nursing programme and a review of the programme occurred. A decision was made to concentrate on the newer nursing staff members' induction, therefore we did not participate in any WITT or Massey University student placement in 2019. WITT has subsequently adopted a new nursing programme which will commence at the beginning of 2020. We will participate in the programme again from this date.
Aged Care Facility Support (ACF)
The Service Innovation Project funded by the Ministry of Health (MOH) in 2016 has continued. In December 2018, the Clinical Nurse Specialist (CNS) for Aged Care in South and Central Taranaki resigned from the role. The North Taranaki CNS began visiting this area from January 2019. She currently visits aged care facilities with registered patients and also provides a 'consult' service for residents who may have palliative care needs, but are not needing the full hospice service support. There is an expectation that all health services involved in end of life care adopt the principles and practices of the Te Ara Whakapiri End of Life Care Plan. Nurses educators completed the roll-out of information and education to all aged care facility staff in December 2018. Our responsibility was to introduce and educate staff and it was the facilities' responsibility to implement the programme.
There has been ongoing education programmes for ACF staff including Syringe Driver management, Fundamentals of Palliative Care and sessions on topics which have been requested by the facility staff. The ACF CNS also provided ongoing education on her visits to facilities and provides bedside mentoring to individual staffat this time.
Conclusion
It has been a revitalising experience leading the nursing team this year. Integration of new staff into well established teams has presented challenges at times but with new staff comes new ideas and new energy. The year has presented opportunities to examine how we provide care and whether long-standing processes are still the best in the changing health care environment. We have managed to identify the challenges and actively pursue solutions using the resources within the organisation.
Heather Koch, Clinical Services Director