This followed the censuring last year of another nurse who, in a rush, mixed up one of the vaccines for a 15-month-old after she couldn’t find the yellow card (the Ministry of Health’s National Immunisation Schedule reference card) that spells out which vaccines to deliver at each age milestone.
Neither child was harmed, but sadly, in Samoa, two nurses are awaiting trial after the tragic deaths of two infants following MMR vaccinations. The cause of the deaths is still unknown, but Samoa’s use of multi-dose vials of the MMR vaccine raises questions over dilution errors.1
New Zealand uses the single-dose MMR vaccine with the diluent provided in a prefilled syringe in the same package. This minimises the risk of dilution errors, but other minor errors remain a risk – the same as in any medication administration environment. This is particularly the case for busy practice nurses juggling elderly patient phone calls, GP requests to squeeze in patients’ blood tests or wound dressings, plus waiting rooms of stressed mums with restless toddlers and crying babies.
New Zealand’s immunisation standards for vaccinators are provided in the appendix of the Immunisation Handbook 2017 to guide nurses and other vaccinators on competent deliveries of safe and effective immunisation services so a patient doesn’t receive the wrong vaccine at the wrong age or by the wrong route or at the wrong interval. The handbook also provides, in another appendix, specific instructions for the preparation (including the reconstitution) and the administration of vaccines.
Nursing Review talked to Immunisation Advisory Centre (IMAC) education coordinator Trish Wells-Morris and checked out Health Quality & Safety Commission advice for tips on safe vaccination and infection control for busy nurses.
Wells-Morris says New Zealand has access to very good quality vaccines that are supplied ready for use and delivered via pre-filled syringes. “So the opportunity for contamination or to make a mistake is minimised.”
When a very occasional vaccination error occurs, she says New Zealand’s open and voluntary approach to incident reporting means nurses will often ring IMAC’s 0800 IMMUNE number to discuss concerns and whether any further action is needed.
“Organisations have quality systems to follow up and investigate any incidents and it’s a non-punitive system that works best.”
These errors usually don’t cause harm; for example, a lack of documentation resulting in a child inadvertently receiving the same vaccine twice. “So the nurse is concerned about any harm to the baby… that the baby has had an extra vaccine and will they suffer… fortunately, babies are very resilient.”
But it’s a given that no nurse wants to cause anxiety or the risk of harm to a patient through avoidable human error.
Don’t shortcut pre-vaccination checks
Following a clear pre-vaccination check list, including gaining informed consent, helps to ensure the right vaccines are given to the right child or adult.
But a rushed nurse – working with a mother distracted by tired and fractious children – can miss a check and risk an error happening.
“Take a few breaths, slow down, and follow the process,” recommends Wells-Morris. “The potential for error increases if corners are cut.” This is particularly the case when everybody is busy, children are crying and a hard-working practice nurse is under pressure.
The pre-vaccination check includes not only screening to check there is no reason why the vaccine/s shouldn’t be given that day but also which vaccine the child or adult is due to have and what their current vaccination status is.
In the case of a child, Wells-Morris says that may involve checking firstly their Well Child record; secondly the practice’s electronic patient management system record; and thirdly, the National Immunisation Register.
Checking is particularly important if the family are new or infrequent visitors to the practice and they may have had an opportunistic vaccination at another practice by an outreach nurse or during a hospital visit. With no national register for adults, nurses must rely on patient recall.
When the vaccines are taken out of the vaccine fridge, the vaccine expiry date is checked and the nurse visually checks the vials for any contaminants; for example, if anything has broken off the rubber seal that could be drawn up into the syringe.
Wells-Morris says ideally at this point the vaccinator would check the selected vaccines with another vaccinator using the yellow card to ensure that they are the correct vaccines for the child in question.
In the two recent Health & Disability Commission complaints mentioned in the opening paragraphs, the vaccinating nurses’ errors were not picked up. In one case, they had mislaid the card and failed to correctly inform the checking nurse of the child’s age. In the other case, the checking nurse was told the 12-year-old girl was having her 11-year-old Boostrix vaccine rather than the requested Gardasil.
The HDC’s expert nurse advisor in the Gardasil case suggested that the vaccine check should have been done in the same room as the patient and, if working alone, a nurse could use the caregiver or patient to confirm the vaccine. Wells-Morris agrees that, in the right circumstances, nurses may wish to ask a parent or caregiver to check the vaccines against the Ministry’s yellow card.
Gaining informed consent from the caregiver or adult to each vaccine administered is also another safeguard.
Once the right vaccine is consented and confirmed, the nurse draws up and mixes the vaccine and administers it as directed on the vaccine’s data sheet. They then document the vaccine details, including on the National Immunisation Register and Well Child book if vaccinating a child, to complete the records.
FURTHER RESOURCES:
The WHO-approved MMR vaccine used in Samoa is delivered in multidose vials containing five doses, and vaccines from the same batch have been used safely around the world. (The only multidose vial vaccine used in New Zealand is the BCG vaccine, which is only administered by specially trained vaccinators.) Samoa’s Commission of Inquiry into the deaths of two infants who died after being administered the MMR vaccine in July was adjourned in September until after the court case of the two nurses charged with manslaughter is heard early next year. The cause of the deaths is still unknown, but there have been calls in Samoa for ongoing nurse training, with indications that human error may have been involved in the dilution of the multidose vaccine.
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The aim of reducing the harm of surgical site infections (SSIs) – and the estimated millions of wasted health dollars through readmissions – led to a targeted SSI monitoring and improvement programme, focusing first on hip and knee replacement surgery, being launched in 2012 in public hospitals across the country.
Because SSIs are the cause of nearly all the healthcare-associated infections (HAIs) in private elective surgical hospitals, the 10 Southern Cross hospitals began much earlier monitoring and reporting results on not one but 10 surgical procedure groupings. An increased focus on the problem saw the Southern Cross SSI rate start to fall and an active quality improvement programme started in 2010 saw the rate fell even further.
Recently published research in the New Zealand Medical Journal (NZMJ)1 shows that the Southern Cross campaign made a significant impact, with the number of patients experiencing an SSI within a month of their surgeries reducing from 3.5 per cent in 2004 down to 1.2 per cent in 2015.
Nurses, particularly the network’s infection prevention and control nurses, played a major role in introducing the interventions, monitoring changes in practice and collecting data on the nearly 43,000 patients whose surgeries were part of the study.
Rosaleen Robertson, Southern Cross Chief of Clinical Governance and a registered nurse, says it was a real team effort and not without its challenges – including getting everybody on board. “It is quite resource-intensive, but when you see the results it makes it all very rewarding.”
The two main evidence-based interventions of the programme introduced in 2010 were delivering pre-surgery prophylactic antibiotics more often at the right time and at the right dose, as well as encouraging a shift on the operating table to using alcohol-based surgical site skin preparation.
Also impacting on SSI rates was ongoing work on hand hygiene compliance, nurse-led pre-admission screening and education, raised awareness of the increased SSI risk for patients who are obese or have diabetes, plus good blood glucose and patient temperature control pre- and post-surgery.
Pre-admission challenges
A particular challenge for private surgical hospital nurses is the tight time frame they have to educate patients about the risks of infection, says Robertson. Most patients come into hospital almost immediately before their operations.
This makes the assessment by pre-admission nurses of the comprehensive patient health questionnaire even more important. The questionnaire is part of a patient’s pre-admission pack and is required to be sent in at least a week before their surgery so any patients with higher needs or greater risks of SSIs can be contacted as early as possible and, if needed, brought in for pre-admission consultations.
Southern Cross engaged with patients using a co-design method to improve how it communicated one piece of pre-admission advice: the request for patients not to remove hair from surgery sites.
“It’s really important that the patient avoids any method of removing hair themselves from their operation site before coming into surgery,” says Robertson. “Any breach of the skin caused by shaving – and they may only be micro-breaches of the skin – can provide an opportunity for pathogenic organisms to grow.”
She says the few patients that do so are generally trying to be helpful, but any hair removal should be left up to health professionals because of the heightened
SSI risk if patients do it themselves.
Although little can be done about some of the SSI risk factors in the usually short lead-up to elective surgery, patients can be educated about hair removal, hand hygiene, pre-op showering and hair washing, and advised that having their diabetes under good control and stopping smoking will help their surgical wounds heal faster.
Obesity, smoking and diabetes
The patients at greater risk of a surgical site infection include those who are obese, smoke, have higher surgical risk scores or have diabetes.
And while the Southern Cross statistics indicate the number of surgical patients who smoked decreased between 2004 and 2015, the numbers who were obese, had high surgical risk scores or had diabetes all increased. The proportion of surgeries on people with a body mass index (BMI) over 30 grew from 29 per cent to 36 per cent of
all surgeries.
The Southern Cross research confirmed the findings of Health Quality & Safety Commission’s public hospital SSI reduction programme, with both finding that obesity is a key SSI risk factor.
Dr Arthur Morris, a clinical microbiologist and lead author of the NZMJ’s Southern Cross article, says while the average SSI rate for orthopaedic surgery is about 1 per cent, if a patient is morbidly obese (a BMI of 40 or more), the infection risk may be four or five times higher. Morris is an infection control advisor to Southern Cross Hospitals and also clinical lead for the Commission’s public hospital SSI improvement programme.
He says for smokers, people with diabetes and the obese the common risk is poor vascular supply affecting their bodies’ abilities to fight any bacterial contamination of wounds. For the morbidly obese, in addition to the problems caused by restricted blood supply to the wound are issues like less mobility and how well the wound edges can adhere to each other.
With an obese person, it can be harder to get the skin edges on either side of the wound to be evenly matched, says Victoria Aliprantis, a registered nurse, who is Southern Cross’s Chief of Risk and Quality. She says that uneven wound edges can create gaps where the skin is not touching, which increases the chance that bacteria can enter the wound and cause infection.
Aliprantis says nurses need to be mindful of the risks and build it into their monitoring and care of wounds post-op. She says that if a wound is not closing particularly well then this should be escalated to the surgeon, but nurses can also use steri strips and other wound care dressings to pull the wound together and improve how the wound edges meet.
Antibiotics use: right time and right amount
For nurses to be as influential as they want to be in reducing SSIs, they need the time to be able perform their roles well, says Robertson.
This includes their important role in supporting the ‘sign-in’ and ‘time-out’ safety checklist procedure in the operating room that includes prompts over the timing of when prophylactic antibiotics are given.
Antibiotics timing is one of the key interventions in the SSI reduction strategy, with the aim of intravenous antibiotic cefazolin being given at the optimal time more often, to ensure enough antibiotic is in the tissue close to the surgery incision site before ‘knife to skin’, says Robertson. The optimal window of time is from one hour before surgery or, ideally, at least five minutes before ‘knife to skin’.
The study found that on-time antibiotic delivery improved from 72 per cent of the time in 2004 to 95 per cent by 2015 and the better timing had helped to reduce the SSI rate. Morris says in the last 10 minutes before ‘knife to skin’ there are many things going on and sometimes ensuring the patient is properly anaesthetised and is breathing properly overrides the timing of the antibiotic. Their new guidelines are now recommending that the antibiotic is given at least 10 minutes before ‘knife to skin’ to avoid it being missed before the focus shifts to critical procedures like intubation.
The right dose of antibiotic was another focus, says Morris, with a recommendation to use 2g or more of cefazolin for every patient to prevent the risk of the increasing number of obese patients receiving a dose that is too low.
Nurses ‘nudge’ shift to alcohol-based skin cleansing
In another of the major interventions – increasing the use of alcohol-based skin preparation – nurses are in key position to influence a surgeon’s choice.
The Southern Cross research confirmed that using an alcohol-based skin preparation can help reduce the SSI rate by almost 50 per cent and is ideal for most operations.
But some surgery areas and some surgeons have protocols that still favour using aqueous-based skin preparations.
Morris says some people are “a bit nervous” about using alcohol preparations as they are worried about a fire risk or a harm.
“Though if it is properly applied and left to dry, there is no risk or danger, but people have their preferences,” he says.
Aliprantis says there is a lot of ritual in theatre and it can be a challenge to ‘nudge’ people who have developed a preference for one method to change to another.
Robertson and Aliprantis say nurses are encouraged to be proactive in starting conversations and presenting the evidence to doctors to encourage them to consider change or to discuss it peer-to-peer with Dr Morris.
The research shows the use of alcohol-based skin preparation increased over the study period from 63 to 84 per cent, but a 2016 audit showed that there is still room for improvement as in 60 per cent of the time an aqueous skin preparation was used, an alcohol product should have been used instead.
Another area where it believes there is an opportunity to further reduce the SSI rate is targeting the most common bacteria causing SSIs – Staphylococcus aureus. A recent literature search for the Health Quality & Safety Commission (HQSC) showed using a proven ‘anti-staph bundle’, involving antiseptic nasal swabbing and antiseptic skin solutions to decolonise S. aureus from the skin and nose could reduce orthopaedic SSIs by about half.
“We are piloting [the bundle] in one of our hospitals that was part of the HQSC bundle collaborative,” says Muriel McIntyre, a registered nurse who is a Southern Cross Clinical Safety Quality Risk Coordinator.
“This is another initiative that is very much a collaborative process with nursing and doctors following through from pre-admission to admission services,” she says.
These are some of the findings of the new national quarterly survey of general practice patients being carried out by the Health Quality & Safety Commission and Ministry of Health alongside their hospital patient experience survey that has been running since 2014.
About 20 per cent of general practice patients respond to the quarterly survey that is emailed or texted to selected patients following their visit to see their GP, NP or registered nurse. The survey was piloted for several years while it was rolled out nationally to all practices. The Commission has now started publicly releasing selected findings of the extensive patient survey which asks about their recent experience with their GP or nurse, their medication, medical tests, long-term conditions, their interactions with allied health professionals and specialist doctors, and about any visits to emergency departments or hospital stays.
The three questions that received the highest positive responses from patients nationwide were:
The three questions that received the lowest positive responses from patients nationwide were:
Richard Hamblin, the Commission’s director of health quality intelligence, said until now New Zealand did not have a consistent national approach to collecting information on patients’ experience of primary care on a regular basis.
“Patient experience is central to quality improvement. By focusing on the coordination and integration of care, rather than just the latest visit to a GP’s surgery, this survey uses primary care as a window into people’s experience of the whole health care system.
“It enables patients to have a voice that the health teams that care for them can hear in a direct and timely manner. The survey results will be a vital tool for practices to use in their quality improvement activity to improve patient outcomes,” said Hamblin.
]]>Helen Garrick, chair of the NZNO’s mental health section, said the combination of a decade of underfunding, growing demand and increasingly complex needs means the mental health nursing workforce was at ‘breaking point’ and feeling increasingly unsafe.
She is urging members to take part in the Commission’s Ngā Poutama Oranga Hinengarosurvey of staff in district health board, non-government organisation and primary care mental health services across the country– particularly as nurses make nearly half of the mental health and addiction workforce.
The commission survey, which is not designed to be part of the government’s current Mental Health and Addictions Inquiry, is looking to set a benchmark for the current quality and safety culture in services.
Garrick said a recent survey of members – held for the current Inquiry – found member’s main concerns were high caseloads, low staffing levels, inadequate community and inpatient services and insufficient inpatient beds.
“We also call for the working environment and overall environment for inpatients to be better suited to modern-day needs and believe this will make the environment safer for all.
“The workplace nurses are coming into is too often unsafe. Over 71% of survey respondents report feeling unsafe at work, this survey will be a good way to examine this further,” she said.
The Commission survey comes at a time when both staff, service users and families have been speaking out during the current Inquiry about safety concerns with reports of assaults on both staff and patients.
Dr Clive Bensemann, clinical lead for the Commission’s Mental Health and Addictions (MHA) quality improvement programme, said the national survey would play an important part in shaping future sector improvements, with organisations’ quality and safety cultures affecting the quality of care, the experiences of consumers and families, plus health outcomes. The survey invite is due to go out in August and can be done anonymously.
The survey will include questions about staff beliefs, attitudes and behaviours in regards to quality and safety. The aim is to establish a baseline of information about the quality and safety culture in services to inform the design of quality improvement initiatives and to monitor change with the survey to be repeated every two to three years.
Results are expected to be confirmed by late 2018, and findings will be made available on the Commission’s website, as well as provided to key stakeholders and survey participants.
]]>May 5 is World Hand Hygiene Day with the World Health Organization (WHO) choosing “It’s in your hands – prevent sepsis in health care” as this year’s theme.
Dr Sally Roberts, the clinical lead of the Health Quality & Safety Commission, says the number of children being admitted to New Zealand paediatric intensive care units with severe infections, including sepsis, has increased over the last 10 years. About four per cent of these children die. She said the international evidence was clear that improved hand hygiene practices help to reduce healthcare-associated infections.
“Hand hygiene is the simplest, most effective way to prevent the spread of healthcare-associated infections, so it’s important that everyone working in the health sector practises good hand hygiene. Clean hands save lives,” said Roberts.
In 2011 the Commission started working in partnership with Auckland District Health Board to improve hand hygiene amongst healthcare workers via the Hand Hygiene New Zealand (HHNZ) quality improvement programme.
As part of the HHNZ programme, regular spot audits are carried out across the 20 DHBs to monitor how many healthcare workers at each DHB are complying with the Five Moments of Hand Hygiene (see below) that include cleaning your hands (either with soap and water or hand-rub gel) before touching a patient and after touching a patient.
The latest hand hygiene compliance report – released in the lead-up to World Hand Hygiene Day –shows that in the audit round to March 31 2018 that 14 DHBs met the 80 per cent compliance target and national compliance now sits at 85.3 per cent.
Other positive trends included improvements in hand hygiene in areas where patients are at high risk of infection – including emergency departments.
The report says it was good to see ‘continued, ongoing improvement” in better glove use and hand hygiene when gloves were put on. But inappropriate use of non-sterile gloves “remains a barrier to excellent hand hygiene practice”.
Back in 2014 hand cleaning moments were missed 33.3 per cent of the time when gloves were put on and this reduced to 22.6 per cent in 2015 and 13.2 per cent in the latest audit. But the latest audit shows there remains a large gap between good hand hygiene when gloves are put on and when gloves are taken off.
The latest glove statistics are:
Across the board all health professional groups have improved their hand hygiene compliance when working with patients – phlebotomists lead the rankings with 90 per cent compliance, followed by nurses and midwives at 88 per cent. Most health professionals’ and students’ compliance levels are now 80 per cent or above, but currently medical practitioners lag behind with 77.5% compliance and student doctors fell back from 80 per cent in October 2017 to 67.2 per cent in March 2018.
Roberts says the biggest increased in children admitted to paediatric ICU were babies aged less than 28 days because they were too young to be vaccinated against vaccine-preventable diseases.
“One reason for the increase in severe infections in older children is an increase in the number of invasive skin and soft tissue infections.”
She said advances in paediatric cancers and haematological malignancies were also leading to more severe immunosuppression and therefore increased infection risk, and there are also more children with co-morbidities.’
Dr Roberts said about 10 percent of adults admitted to intensive care units have severe sepsis.
“For the majority, sepsis developed before they were admitted to hospital. While the rate of death from severe sepsis or septic shock in adults has decreased over the last couple of decades, it’s still around 4.6 percent.”
Dr Roberts said with sepsis it was not uncommon for someone to seem completely well one day, and be very sick with sepsis, or even septic shock, 48 hours later. “The risk of death is significant if sepsis leads to septic shock, with approximately 40 percent of septic shock patients dying, even with treatment.”
One Waikato study found 10 percent of patients admitted to hospital because of infection had sepsis. Around 17 percent of these patients were admitted to intensive care units and nearly 34 percent of them died.
See more at: www.handhygiene.org.nz
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Increased reporting of patients suffering delayed diagnosis and pressure injuries were largely behind an increase in public hospital adverse events, shows the the 2016-17 Learning from adverse events report released today by the Health Quality and Safety Commission. But the number of falls leading to injuries continues to decrease.
Jane McGeorge, the NZNO’s nursing and professional services manager said it was pleased to see the small decrease in patient falls. But it was concerned about the number of reports of nurse sensitive indicators like the failure to respond to deteriorating patients and the increase in reports of other indicators like pressure injuries and hospital acquired infections.
The Commission report records the health care adverse events reported to them by district health boards (DHBs) and other health care providers.
A total of 542 non-mental health* adverse events were reported by DHBs in 2016–17 up from 520 in 2015–16, 525 in 2014-15 and 454 in 2013-14. Of the 542 adverse events reported by DHBs, 79 people died however the Commission said the deaths were not necessarily directly related to the adverse event. (*Mental health and behaviour-related adverse events are now reported via the Office of the Director of Mental Health annual report).
Commission chair Professor Alan Merry said the adverse events report reflects a steady improvement in reporting culture towards increased transparency and taking action based on learnings from system failings. The Commission also believed that at present New Zealand’s adverse event levels were “broadly comparable” to Australia and the United Kingdom.
Merry believed the steep upswing in reported pressure injuries – from about 15 last year to 51 this year – might reflect a “concerted effort across the sector to raise awareness of the impact and devastating harm of those injuries”. “This attention is particularly important given evidence shows pressure injuries are highly preventable.”
He also believed the increase in healthcare associated infections (HAIs) – up from three last year to 16 this year – was due to the Commission highlighting the issue leading to additional reporting.
“This may reflect both an improvement in reporting culture and awareness-raising through the work the Commission and sector are doing as part of the Surgical Site Infection Improvement programme.”
The adverse event statistics also showed for the second year running an increase in clinical management events and a decrease in falls adverse events
The largest sub-group of clinical management events is delayed diagnosis or treatment – including delays in referrals and follow-up by specialty services – with 70 reports. Thirty of those reports related to cancer or suspected cancer with the majority of DHBs having reports in these areas. There were also 24 events relating to ophthalmology from a number of DHBs. In the separate reporting area of failing to recognise, rescue or manage deteriorating patients there were 26 events reported.
MacGeorge said NZNO believed indicators like pressure injuries, deteriorating patients and HAIs needed to be monitored specifically, “not as part of a homogenous group as they are barometer of quality of care and typically observed in an under-resourced system”. She said NZNO was working to have the safe staffing Care Capacity Demand Management system operating in all DHBs to ensure hospitals were safe for patients and staff.
“The underfunding of the health service has led to understaffed hospitals and lean resources but with a new government promising reinvestment we expect the situation for patients and health staff to improve,” Jane MacGeorge said.
Harm from falls still make up the majority of adverse events reported by DHBs – making up 39 per cent of all adverse events reported – but the number has fallen to 210 after peaking at around 275 in 2014-15. “The Commission recognises the tremendous effort across the sector in achieving an ongoing improvement in falls figures; reducing harm from falls is not easy to achieve and sustain as there is no single solution,” said the report.
2016-2017 DHB Adverse Event Reports:
Other providers reported 86 adverse events in 2016–17:
Merry said adverse events in health care can have a huge impact on the person involved and their whānau, family and friends.
“I would like to acknowledge the people affected by the tragic events outlined in this report. Partnering with consumers and whānau in the review and learning process is pivotal to improving quality and safety.”
Prof Merry says research shows consumers who have been affected by an adverse event offer a unique perspective on that event. “Consumers may be able to perceive care transition and process issues, including service quality, that occur before, during and after adverse events, that are less likely to be identified by providers”.
MacGeorge said NZNO thanked the Commission for their work to produce recent and relevant data and said the changes to the national adverse events reporting policy – which came into effect on July 1 this year – were also progressing well. She congratulated the Commission on the increased focus on outcomes of serious events for the consumer, increased engagement with whānau and extending coverage to the whole health and disability sector.
“We appreciate the culture of learning that allows us to find meaningful ways to improve patient safety while identifying workforce and, resource and system issues that are a barrier to safe care and safe staffing,” she said.
A copy of the full adverse events report is available online at https://www.hqsc.govt.nz/our-programmes/adverse-events/publications-and-resources/publication/3111/
HQSC “Q & A” on Adverse Events
What is an adverse event?
An adverse event is an incident that results in harm to people using health and disability services. Adverse events resulting in serious harm or death are reported by health and disability providers, guided by the Commission’s National Reportable Events Policy.[1] The policy was updated on 1 July 2017, but adverse events discussed in this year’s report are based on the 2012 policy.
Are providers required to report?
DHBs are required to report adverse events to the Commission in accordance with the policy guidance. Many non-DHB health providers – such as private surgical hospitals, aged residential care facilities, disability services and hospices – voluntarily provide information.
How accurate is the adverse events data?
The 2016–17 report explains the process for adverse events reporting to provide clarity and context to the numbers reported. The Commission believes that in some categories the number of reported adverse events is an increasingly accurate picture of the actual number of adverse events that occur. The number of broken hips in hospital reported by DHBs in this report, for instance, closely aligns with numbers included in the NMDS (National Minimum Dataset), which records information produced by public hospitals when a patient is discharged.
The adverse events reported increasingly reflect the evolving maturity of organisations to include broader types of events and to recognise the systemic influences contributing to their occurrence.
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Angelene Williams, who works for Wairarapa District Health Board was presented her Open for Leadership award by the Health Quality & Safety Commission chief executive Dr Janice Wilson for her work developing an educational pamphlet for her patients.
‘Leaky legs’ is the nickname given to lower-limb lymphovenous disease and lymphorrhoea, when extensive oedema (swelling) is caused by fluid leaking into the tissue for a variety of reasons including problems with blood circulation and lymphatic drainage.
“I noticed there was an amount of stress among these patients, which affecting their quality of life. I just thought, ‘How can we improve this?’” said Williams.
In response, she designed an educational pamphlet for patients and introduced a new long-term review model of care so the patients are now assessed every few months.
Williams said the pamphlet helps patients in their self-care between visits from their nurse, and improves their health literacy as it helps them and their families to better understand the condition. Information in the pamphlet includes advice for patients on how to elevate their legs and what foods to eat.
‘I recently visited one of these patients and she recognised that I was the person who created the form,” said Williams. “We were then able to talk about how much extra protein she needed to improve, including via supplements, in a very engaged way. She seemed to be very interested and understood a lot more as a result of the pamphlet.”
“Patients need this kind of education and support. If they aren’t on board and aware of how to improve their health, they are unlikely to improve, so the pamphlet helps them know what to do and how to do it.”
The Open for Leadership awards are coordinated by the Commission to recognise and celebrate health professionals who demonstrate excellent practice, quality improvement and leadership skills. Dr Wilson gave Williams a trophy and she will be sponsored to attend a Commission event of her choice.
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