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What About RAN Safety? – NT 2016 Review Implementation Progress

Heather Keighley – A/Chief Nursing and Midwifery Officer NTG Department of Health

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I would like to acknowledge the traditional owners of the land on which we gather, and pay my respects to the elders past, present and future.

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Background

In memoriam Gayle Woodford

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Health Department undertaking urgent review of safety procedures for remote health workers in NT ZACH HOPE, NT News March 30, 2016 2:12pm

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The Review Questions used to guide the review process:

1. Is the current policy framework relating to staff safety and security in remote health facilities operated within NT Health effective, contemporary and appropriate to provide safe working environments as far as practicable?

2. Are remote PHC managers and staff compliant with the policy framework and are there identified barriers to compliance?

3. Are the current governance structures for work health and safety effective, including policy development and implementation?

4. What security and safety infrastructure and equipment measures are in place and if deemed necessary what are the options for enhancement?

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Second responder policy The recommendation was dated March 20 last year and signed by A/Chief Nursing and Midwifery Officer Heather Keighley, after growing concerns from remote nurses about their safety.

It stated a “community person” should be employed by clinics on a casual basis to act as driver and chaperone and to help as needed with loading patients onto a stretcher and into an ambulance.

Territory Health Minister John Elferink told the NT News “the current policy requires a second person or driver to accompany a nurse after hours on call…..”

ZACH HOPE, NT News March 30, 2016 2:12pm

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Education and training O

rient

atio

n Cultural knowledge

Policies and procedures

Local induction

Man

dato

ry T

rain

ing WHS requirements

De-escalation procedures / management of aggression

Advanced practice courses

Emergency care

Maternity care

Pharmacotherapeutics

Recr

uitm

ent &

Ret

entio

n Short term casual and

agency nurses

RAN tertiary qualifications

Value of scholarships

Education support

Professional Development

Framework

Education strategy

Aboriginal workforce

training and support

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Communication and Infrastructure Technology • Phone systems • Back-up technology • Electronic systems • Internet Buildings • Security • Repairs and maintenance • Lighting • Doors • Locks • Security screens

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14 Key Recommendations Relating to evaluation questions:

1. Policy Framework

2. Compliance with the Policy Framework

3. Governance structures

4. Infrastructure & Equipment

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Overview of Recommendations 1. Mandated Second Responder Policy – preferably a respected community member

2. Review of standardised NT wide Governance and Policy processes including On-Call Safety, Risk Assessment and Management

3. Re-establish a pool of senior RAN’s to provide clinical support and annual leave relief

4. Provide standardised on-line orientation and induction programs that include safety and de-escalation / aggression management procedures

5. Reduce Agency use and incentivise recruitment and retention through post-graduate education pathways, scholarships and education support

6. Review and upgrade communications equipment as required and ensure that back-up systems are in place

7. Undertake a comprehensive review of safety equipment, and infrastructure repairs and maintenance

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Overview of Recommendations 8. Improved community engagement approaches including optimal employment and

training opportunities for local Aboriginal community members

9. Provision if internet access in all nurses staff accommodation

10. Improved inter-agency partnerships and collaborations in particular with police regarding safety practices and procedures

11. Investigate and increase opportunities for personal skills development to optimise resilience and team work capacity

12. Access to client records in on-call staff accommodation to optimise callout decision making

13. Implementation of GPS monitoring systems

14. Establish WHS Advisor and review Infrastructure Coordinator positions and processe

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Work commences now and is finalised within four months, by 31 March 2017

Work commences now and is finalised by 30 September 2017

Work commences now and is finalised by March 2018

TOP PRIORITY

MEDIUM TERM

LONGER TERM

Priorities Relating to each evaluation question:

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Progress Update Four Working Groups have been established, reporting to an Executive Steering Committee (Chair DCE): 1. Second Responder

2. Orientation, Induction and Education

3. Workforce

4. Infrastructure and Communications Equipment

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What has been achieved so far? All 51 NTG communities have implemented a second responder many of whom are

local community members Updated safety policy guidelines are under final review by the Best Practice Policy

Group Approvals given and Job Analysis completed to re-establish the RAN Relief Pool Job descriptions finalised for Second Responders and RAN Relief Pool, recruitment

underway Position reviews in process for Infrastructure and WHS positions Orientation, induction and essential training guide now updated and available online Draft Transition to Remote Practice Education Policy completed Infrastructure survey completed and report under consideration Infrastructure trials for upgraded sat phones, personal GPS systems and two way radios

are in process Proposal completed for internet access in all RAN houses and with the executive for

funding consideration

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What happens next? • Endorse revised safety policies • Establish new positions • Consider findings of Infrastructure Survey • Upgrade communications systems • Partner with CSB in procurement of

recommended upgrades • Finalise a single orientation portal • Establish education policy • Partner with services to review Atlas

Governance and processes

Update from CE

Update from Minister

Internal communications

External communications

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Questions?