The online immunisation catch-up calculator for immigrant or refugee children took out the $8000 Clinician’s Challenge* New Idea award presented last week. The project was co-lead by nurse Jillian Boniface, the Southern District Health Board’s Programme Leader for Vaccine Preventable Disease and DHB public health analyst Dr Leanne Liggett.
Boniface, formerly a practice nurse, said she and Liggett worked together as a team to turn a nursing issue and a good idea into a proposal for a nursing tool that won over the judges at their presentation at the Health Informatics New Zealand (HiNZ) conference in Rotorua last week.
Leanne Liggett said the Invercargill-based pair’s aspiration was for the tool to become a national tool for everyone to benefit from.
The $8000 prize would be used to fund a feasibility study for the calculator and the pair would then knock on doors seeking the extra funding needed to develop and pilot the calculator in the Southern region before rolling it out nationwide.
The idea came about in response to the increasing workload faced by nursing staff to calculate the ‘catch-up’ immunisations required by new migrants and refugee children to bring them in line with the national immunisation schedule.
Boniface said with each country having different schedules and different vaccine combinations it was a time-consuming, manual task for a practice nurse to work out how many antigens a migrant child had received to date and then to calculate how many vaccinations they needed in the future – and when they should receive them and in which combination – to gain the same immunisation coverage as Kiwi-born children.
The complex task could also cause hiccups in clinical records in practice management systems that weren’t flexible enough to cope with the ‘catch-up’ process. So the Southern DHB decided several years ago that practices should send migrant children’s immunisation records to the DHB’s immunisation co-ordinators who would manually calculate the catch-ups required and then the child’s record and catch-up programme would be manually entered into the National Immunisation Register (NIR) where the general practice could access the accurate details and enter it into their own systems.
Growing migrant numbers in the deep south – from an increasing diverse range of countries drawn to the region for different reasons – had seen the co-ordinator’s workload grow. “We’ve got the dairy industry families coming into Otago and Southland, we’ve got families coming to the tertiary education institutions in Dunedin, we’ve got offshore families attracted to SIT’s free fees and we’ve got the Queenstown/Central lakes (tourism industry) migrant population,” pointed out Boniface.
Further highlighting the need – and kick-starting the project – was Dunedin last year becoming a refugee resettlement city with the first group of 205 refugees – mostly from Syria – arriving in April 2016. Liggett, a public health analyst involved in the region’s Refugee Strategy Evaluation discovered how much Dunedin general practices valued the ‘catch-up’ service when she asked nurses, GPs and administrators what was hindering and helping their work with the refugees. “One of the first helping ‘angels’ identified by practices was Gillian’s team helping with the immunisation calculations,” said Liggett.
Boniface said she was grateful to hear from Liggett that practices were singing the praises of her team. “I said that’s really great but I told her it was just about drowning my staff and what’s more the refugee component is only one component of the ‘catch-ups’ needed.”
She estimated her staff were doing about 600 ‘catch-up’ complex calculations a year – and that didn’t include the ‘quick, easy ones that probably didn’t hit the radar’. So they started to discuss finding a solution which prompted public health physician Dr Naomi Gough to ask them why they didn’t use a catch-up calculator like the South Australia one. “And we said ‘what South Australia calculator?’” The team went online and discovered an “amazing” online calculator available in South Australia where you entered the child’s birthdate, ticked off which antigens they had received and it calculated what the child needed.
Boniface said they approached the Ministry-funded Immunisation Advisory Centre (IMAC) about it developing something similar for New Zealand. She said IMAC agreed it was a great idea but didn’t have the capacity to take on another project.
The pair then heard applications were open for this year’s Clinician’s Challenge and decided to give it a go and put together a submission seeking funding for a feasibility study into developing, piloting and ultimately incorporating the tool into the NIR. “So it became part and parcel of the national immunisation programme.”
Boniface and Liggett’s proposal was selected as one of two finalists for the New Idea category (the $2000 runner-up prize went to a proposal for secure web and mobile app called GreenHub) got to fly to Rotorua to the HiNZ conference and give their winning presentation.
Two of the four finalist proposals in the clinician’s challenge were co-lead by nurses and Boniface said the proposal she and Liggett – neither of whom “were IT people” – had developed with the support of the other nurses in the immunisation team, was to create a tool to help resolve a nursing issue.
“This would be a tool that would empower practice nurses to be able to take the child’s overseas (immunisation) history, plug-it into this online tool, create the catch-up programme and deliver the first event of that catch-up knowing that the information they had inputted would be sent off to the NIR and sit in the patient’s record.”
Boniface said she would encourage other nurses to enter the Clinician’s Challenge. “You’ve just got to come up with a good idea and nurses always have good ideas – it’s how you move it to the next step.” In her case she worked in partnership with Liggett’s analyst skills to help frame a good idea into a meaningful package and a winning presentation.
She added that while Liggett and her had put together the proposal – the idea itself had stemmed from the work that her team had done and the “incredible work that practice nurses do”.
*The Clinicians Challenge is an annual joint initiative by the Ministry of Health and Health Informatics New Zealand (HiNZ). There are two main awards – New Idea and Active/Project Development with the winner of each award getting $8000 and the runner-ups $2000.
The other $8000 Clinician’s Challenge prize – for an already active project – was won by the DermNetNZ.org team for its work on adding a skin disease image recognition tool to the internationally successful online skin resource website founded by dermatologist Associate Professor Amanda Oakley with the support of her daughter Emily Oakley. The $2000 runner-up prize went to the Ask Ruru app – designed to help support young people in crisis that was created by Wellington mental health nurse Dion Howard, working with development team Jaymesh Master, Michael Smith and Rosie Parry.
]]>
The software platform Anthropometrics was introduced across the South Island last year enabling nurses and other clinicians to enter and view height, weight and other key body measurements electronically.
Anthropometrics (or eGrowth Charts) is a shared system developed in Southern District Health Board was rolled out across the region by the South Island Alliance, with access provided via the South Island’s electronic health record, Health Connect South.
In September an announcement was also made of a research project to develop and trial an interactive growth chart that parents can use on their smart phone to monitor their babies and young children growth. That project is being undertaken by Precision Driven Health, combined with child health research funder Cure Kids and the National Science Challenge A Better Start, with one aim being to help reduce childhood obesity rates by providing parent’s accurate information about their child’s growth rates.
Barry Taylor, Professor of Paediatrics and Dean of the Dunedin School of Medicine, University of Otago, collaborated with Lance Elder, Solution Architect at Southern DHB, to develop the South Island’s Anthropometrics (eGrowth Charts) tool. To date the tool has been used to record the body measurements of 55,638 South Islanders (the vast majority children but just over 8000 were of patients aged over 18).
Taylor, who is also leading the combined South Island district health boards’ childhood obesity strategy, told Nursing Review last year that he believed it was time for a culture change to shift the focus from children failing to thrive to children growing too fast. He said if height and weight measurements and BMI calculations were routine and regular through a child’s life, nurses and others could pick up if the trajectory of growth started to accelerate too fast and show parents what was happening on their child’s BMI chart.
Anthropometrics records height, weight, waist and head circumference measurements at all ages, calculates BMI, provides eGrowth charts for children, and stores blood pressure readings. It compares the data against the ideal growth for the patient’s age and sex. Taylor said another feature of the tool is the ability to predict a child’s final height from their parents’ heights. It also takes into account gestational age and automatically adjusts for children who were born prematurely.
He said to see growth pattern trends it was no use looking at the data once, it had to be observed over a period of time. “Growth rate is a very important measure of health, whether it’s under or over the average, and the tool provides a useful picture over time.”
Dr Nicola Austin, neonatal paediatrician at Christchurch Women’s Hospital, said having weight measurements charted by nursing staff before the child enters the clinic room was really helpful. “I’ve also been adding weight measurements from previous visits into the system, as it’s the in-between visit growth that’s important. One child I saw had grown up in the southern district, so I was able to see all his previous growth measurement since he was born – this made discussing the current growth with his parents so much more meaningful.”
Taylor as chair of the South Island Clinical Advisory Group for Childhood Healthy Weight, learned of the ongoing requests across the region for an electronic growth system.
The South Island Alliance also recognised the need for a South Island-wide solution to store data more efficiently. Taylor said a number of competing systems were independently reviewed and Anthropometrics proved to be the best tool available. “A good system needs to be intuitive and make your job quicker and easier, so there is more time for the patient.”
Taylor described Anthropometrics – as a ‘Swiss army’ tool. “It’s simple, easy to use and fits into the workplace. It was designed with what I require as a paediatrician in mind.” He said it was a joint effort with IT and took six to nine months of interaction back and forward to develop and refine.
The A Better Start project team says the two-year research project was to get underway in September with the aim of providing a smartphone tool that was easy for families to use but also filled data gaps for health providers.
The team says research shows that a majority of New Zealand parents are limited in their ability to interpret what the current standardised growth chart information in their child’s Well Child (‘Plunket’) book means.
The study’s Principal Investigator Gayl Humphrey said that the project aimed to help increase health literacy among parents and families, while also providing greater awareness of healthy growth patterns in their children. She said the ultimate goal was that supporting the development of knowledge and skills of parents would in the long run contribute to reducing rates of obesity in children.
“Moving to an electronic and interactive growth chart will eventually help us to understand the New Zealand-specific growth patterns across our diverse population, and be able to personalise the delivery of relevant information direct to parents and families when they need it.”
Cure Kids’ CEO Frances Benge said assisting parents to better engage with monitoring their child’s growth would help them to understand and manage their children’s eating, activity, sleeping and related behaviours.
]]>
We know that nurses along with other health professionals, are innovative and skilled at providing ‘workarounds’ to meet the needs of those they serve. These innovations, however, often rarely make it out of the service in which they were created. This is recognised and celebrated in the US by the MakerNurse (a subsite of MakerHealth) website, launched in September 2013 with the support of the Robert Wood Johnson Foundation. The site was created with the goal of empowering nurses and to encourage nurse ‘making’ to change the face of healthcare. The site links to MakerHealth, which contains useful tools and resources that could help more nurses bring their ideas to fruition and lead improvements in patient care.
Site accessed 6 April 2017.
Support your innovative practice by accessing this website created by American nurses for nurses. The longstanding site is a great portal destination for peer-reviewed nursing journals and continuing education resources. Joining the centre is free (just choose a login and password) and you can then access peer-reviewed journals, with more than 1,900 continuing education activities. Twice each month, the site features a nursing journal from the more than 70 nursing journals available on the site, enabling free online access to every article in the latest issue (the current one is Journal of Addictions Nursing). You also have access to free eNewsletters focused on your areas of interest, drug news updates, patient education materials and more.
Site accessed 6 April 2017.
]]>