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QUALITY REPORTIntroduction page 34Australian Council on Health Care Standards 34Aged Care Standards 34National Healthcare Standards 35Recognising and Responding to Clinical Deterioration 35Palliative Care 35Clinical Handover 35Safe Use of Blood and Blood Products 36Evidence Based Contemporary Care 36Education 36Falls Prevention 36Pressure Injury Prevention 36Safe Medication Management 37Preventing and Controlling Infections 37Restraint 38Unplanned Weight Loss 38Risk Management 38Workforce Satisfaction 38Safe Environment and Staff Wellbeing 39Victorian Patient Satisfaction Monitor 39Consumer, Carer and Community Participation 39Please Tell Us 40

Operations Report pages 1 - 32Quality Report pages 33 - 40Finance Report pages 41 - 76LE

GEND

Hesse Rural Health 19th Annual Report 2012 - 2013 34

Australian Council on Health Care StandardsHesse continues to be fully accredited across several quality frameworks.

Australian Council on Healthcare Standards periodic review was held in November 2012, the surveyors endorsing the rating of Marked Achievement across the fifteen clinical, support and corporate criteria. The survey team found ‘much evidence of organisational commitment to delivering high quality, safe and appropriate services to local communities, which are experiencing significant growth,’ also making particular mention of the ‘collaborative and innovative approach used to acquire a building and commence primary care and community health services at Moriac.’

A small number of recommendations were made for improvement, including widespread education of the principles of open disclosure and ensuring patients, carers and residents are all informed about the organisation’s incident management system.

Quality of Care ReportHesse Rural Health is proud of its reputation and commitment to quality service provision. Underpinning this commitment is a firm belief that quality is everyone’s responsibility. Whether the gardener, receptionist, cook, cleaner, nurse or volunteer, everyone has the power to make an impact on the service experienced by our consumers. Understanding that quality means change necessitates the continual identification of ways to improve the care we provide.

The Quality and Ethics Sub-Committee of the Board of Management plays a key clinical governance role to set our quality framework and ensure our activities are monitored and evaluated. While we strive to meet the expectations and standards set by external accreditation agencies, the ultimate judge of our services are the consumers themselves. From 2013 we embark on another challenge to embrace the new National Health Standards set by the Australian Commission on Safety and Quality in Healthcare.

This 2012-2013 Quality of Care Report provides an overview of a number of quality initiatives, projects currently underway and the ways in which their outcomes will improve our service for our community.

It is with great pleasure that I recommend this report to you.

Aged Care StandardsIn January the Residential Aged Care Standards Agency conducted an unscheduled visit to Hesse Lodge, Chelsea Lodge and Werruna. A successful outcome was achieved along with some pleasing comments about the organisation’s commitment to person centred care, and the ‘relaxed atmosphere in the dementia environment with a focus on activities of meaningful engagement.’

Recommended areas of improvement included procedures for maintaining an accessible and current resident list in the case of evacuation, changes to the electrical tag and testing schedule, clinical audit and care planning schedules.

190 MealsPreparedAn Average

Day at Hesse

1 Urgent & 2Acute Patients

Cared For

55 Residents &19 District NursingClients Cared For

976 KmTravelled

57 PrimaryCare Contacts

Made

Donald Lang, ChairpersonQuality and Ethics Sub-Committee

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Palliative CarePatients and residents in the end stages of life deserve quality, respectful and dignified care. The use of the evidenced based Liverpool Care Pathway to promote positive end of life care increased from 60 to 70% of all palliative episodes. Assessment tools from the Palliative Care Outcomes Collaboration (PCOC) have been implemented. The number of residents with Advanced Care Plans rose to 90% following staff training in the Respecting Patient Choices Advanced Care Planning Program. Six staff have also been trained as Palliative Link Nurses to promote best practice palliative care and share information with colleagues.

Clinical HandoverTo enable effective 24 hour care, clinical information transfer is critical. In addition to the implementation of ISBAR (Identify, Situation, Background, Assessment, Recommendation) as a guide for priority information exchange, changes to the shift times have allowed for a more generous handover timeframe.

National Healthcare StandardsWith new National Healthcare Standards introduced in January 2013, the standard remains high for retaining accreditation in small rural hospitals. Hesse has opted for assessment against five more than the mandatory 10 National Safety and Quality Healthcare Standards using the EQUiP National Program. A number of new initiatives are already underway to ensure compliance to the National Quality Standards. These include: Recognising and Responding to Clinical Deterioration, Palliative Care, Clinical Handover and the Safe Use of Blood and Blood Products.

Recognising and Responding to Clinical DeteriorationConsiderable efforts have been directed to the development of new guidelines for responding to clinical deterioration. In preparation, a number of nursing staff across the organisation have attended training in Comprehensive Health Assessment of the Older Adult.

The employment of a Nurse Practitioner Candidate to work within the rural aged and primary care setting together with participation in the Regional and Isolated Practice Endorsed Registered Nurse (RIPERN) Project are both initiatives aiming to improve acute nursing skills and responsiveness to clinical change.

UnplannedWeightLoss

StaffInjuries

MedicationErrors

FeedbackReceived

StaffTraining

FallIncidents

Use ofRestraint

TotalIncidents

PressureUlcers

At a Glance

Hesse Rural Health 19th Annual Report 2012 - 2013 36

Safe Use of Blood and Blood ProductsHesse participates in the ‘Blood Matters Program,’ undertaking an annual audit and ensuring staff education regarding the safe administration of blood and blood products is aligned with current guidelines. In 2012-13 one blood transfusion was undertaken. The appropriate consent was obtained and there was no adverse reaction.

Evidence Based Contemporary CareParticipation in on the ground research is an excellent way for staff to engage with contemporary clinical best practice. Hesse is actively participating in the McKellar Guidelines project for Managing Diabetes in Small Rural Residential Aged Care Facilities (see also p. 22). In addition, through the Wounds West Project, direct care staff have received specialist consultancy, education and in-service in contemporary wound assessment and treatments.

Education A concerted effort has been made to ensure our staff have access to a variety of ways to improve their knowledge and skills. The introduction of an additional one hour of double staffing through shift length changes in the residential areas has allowed greater focus on professional education and training. Online learning topics have included clinical care, safe food handling, preventing elder abuse, open disclosure, person centred care, hand hygiene, fire and evacuation and manual handling. Recording systems have also been improved and now more effectively capture all internal and externally conducted education. There were 556 recorded occasions of training in 2012-2013.

Falls PreventionOlder people are at a higher risk of falling, and this can have serious health consequences. Falls risk screening is conducted at the time of admission. This allows appropriate strategies to be put into place to help prevent injuries from occurring. The number of overall falls reduced from 139 to 136 during the year. Two resident falls resulted in a fracture. Improvements have included audits of staff falls awareness, review of risk assessment tools, increased use of protective clothing and provision of floor level beds.

Pressure Injury PreventionPressure injuries occur when an area of skin is damaged from prolonged periods of unrelieved pressure. They are largely preventable due to the range of contemporary strategies available to health professionals and patients. Pressure injuries are graded in terms of Stages 1 to 4. Hesse had four instances of the least serious Stage 1 pressure injuries, an improvement from the six Stage 2 wounds last year.

Fall Locations

66%

10%

7.5%

7.5%1.5%

7.5%

Bedroom

Lounge / Dining

Bathroom

Grounds

Off Site

Other

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Preventing and Controlling InfectionsEffective infection control is essential to support good clinical care. A registered nurse is allocated the portfolio to manage the infection control program at Hesse which includes high standards of hygiene, immunisation, education and environmental cleaning. A total of 48 infections were recorded in 2012-2013, a reduction from the prior year. An overarching infection prevention risk management program contains a comprehensive set of actions and performance measures to prevent and reduce infection rates. Strategies AchievementsHand Hygiene Compliance 79.1%Influenza Vaccination Program - Residents

91%

Influenza Vaccination Program - Staff

40%

External Cleaning Audit Report 98%Aged Care Infection Control Audit 94%LGA Food Premises Audit Compliant

Safe Medication Management The safe administration of medications is crucial for quality health care and any inaccuracies in dispensing or recording are closely monitored. A Medication Advisory Committee involving clinical staff, GPs and pharmacists plays an oversight role.

While the 59 reported errors are an increase from 22 recorded last year, they are related to improved awareness about reporting requirements and the implementation of the electronic Riskman incident management program. Accurate reporting leads to better outcomes.

The National Inpatient Medication Chart has been implemented for acute inpatients and Hesse is participating in the Resident Medication Management Reviews and Quality Use of Medications Program. The community nursing program has implemented guidelines and consent for the safe use of narcotic analgesia for people being treated at home.

Hesse is required to report to the Department of Health the number of high care residents prescribed nine or more medications. On average there were five residents in this category and this is consistent with the state average (4.45) for similar facilities.

Eye UTI Chest Other

Infections

21

17

10

0

5

10

15

20

25

Hesse Rural Health 19th Annual Report 2012 - 2013 38

RestraintHesse Rural Health considers restraint free options to ensure resident and patient safety at all times. Restraint is closely monitored and minimised. A comprehensive patient assessment, care planning and consent process is followed to ensure Commonwealth guidelines and mandated reporting requirements are met.

Family consent was provided for the use of a restraint device on one occasion during the year. This was identified, after careful consideration, as the least restrictive option for ensuring safe mobilisation. In the previous year there were two occasions of restraint.

Unplanned Weight LossAs older people are vulnerable to weight loss, which may be a catalyst for further deterioration, resident weight is closely monitored. In the case of trends of greater than three kilograms lost over three months, care pathways are implemented. This involves dietitian review and meal plan development. Eight residents were reviewed as a result of these pathways.

Risk ManagementHesse applies a risk management framework that complies with Australian Standard for Risk Management AS/NZS IS0 31000:2009 and is overseen by the Board of Management Quality and Ethics Sub-Committee. The organisational risk register captures key risks using a consequence and likelihood descriptors to predict impact. Incident and near miss reporting accounted for 353 incidents recorded using the Riskman electronic management system and staff are now proficient in its application.

Workforce SatisfactionHesse participates in the State Services Authority People Matter Survey which collects employee perceptions of the public sector values and principles applied at their workplace, including commitment and job satisfaction. The response rate for the 2013 survey was 22% with satisfaction levels noted in all areas across the domains.

09/10 10/11 11/12 12/13

Total Incidents

353

0

100

50

200

150

300

250

400

350

Safe Environment and Staff WellbeingProviding a safe environment is a priority focus for the organisation. An Occupational Health and Safety (OHS) committee with designated work group representatives meet second monthly to discuss relevant personal workplace safety and environmental issues. The staff health program is a key element outlined by the annual OHS Action Plan and included free Worksafe sponsored Employee Health Checks, bulk billed medical care, subsidised allied health consultations, Quit smoking programs and an employee assistance program for psychological support. Reported staff injuries reduced for the second consecutive year from ten to nine. Mandatory smart lift and fire and emergency training also ensure staff remain alert to safety issues.

Victorian Patient Satisfaction MonitorOf the 34 patients treated and discharged at Hesse between July and December 2012 ten have provided feedback to the Department of Health regarding their experience of their hospital stay via the Victorian Patient Satisfaction Monitor (VPSM). While insufficient patient admissions allowed a valid overall care index rating, especially high performance scores were obtained for ‘personal safety’, ‘cleanliness of rooms’, ‘privacy of rooms’, ‘courtesy of nurses’ and ‘responsiveness of nurses’.

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09/10 10/11 11/12 12/13

Aged Care Occupancy96.75%

0

20

40

60

80

100

Consumer, Carer and Community ParticipationCaring for Rural Communities is Hesse’s vision for ensuring our programs are relevant to the needs of consumers, carers and the public we service. We welcome and actively listen to feedback from patients, carers, visitors, staff and the broader community about the services we offer and the ways they may be improved. We received 107 items of feedback during the year.

Satisfaction rates recorded by users of primary care and domiciliary post natal services yielded a pleasing 95.8% and 97.1% overall service satisfaction rate from 70 and 10 returned surveys respectively.

The Victorian Government’s Doing it With Us and Not For Us consumer participation policy provides a framework to ensure we are actively involving consumers in all aspects of the care pathway. Partnering with Consumers is also a key element of the new National Health Standards, and Hesse will be increasing the avenues available to our consumers to participate in their health service experience to meet these national expectations. Community consultations will also inform our renewed strategic planning process in late 2013.

Hesse Rural Health 19th Annual Report 2012 - 2013 40

Please Tell UsWe hope you found the Quality of Care Report relevant and informative. We would be pleased to hear your feedback and suggestions regarding the report or the services of Hesse Rural Health.

You may direct your responses to: The Chief Executive Officer, Hesse Rural Health, 8 Gosney St. Winchelsea, VIC 3241 or submit them via our website:www.hesseruralhealth.org.au