2017 WSLHD Quality Awards

Western Sydney Local Health District

2018 Quality Awards

Each year, WSLHD hosts the Quality Awards as an opportunity to harness the creative and innovative ideas of staff, who are committed to making a difference to patient care and health outcomes.

The benefits of the Quality Award projects extend to patients, carers and their families, as well as to staff and the community.

This year, staff and community members will have the opportunity to vote on all 45 submissions – not just the finalists.
So make your vote count!

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1. Patients as Partners:
How consumers are transforming design of the new centre acute services building

Feedback from consumers has directly influenced the design of the new centre acute services building at Westmead Hospital, including carer zones, a patient’s retreat, waiting areas and the cultural gathering place.

More than 60% of the inpatient rooms in the new hospital building will be single rooms with a dedicated carer zone and the number of entry doors to the new building have been reduced, with changes to main entrance signage to reduce confusion at pedestrian and car entry points.

Consumer and community engagement is embedded with the design, governance and evaluation methodology implemented by the Westmead Redevelopment project team. The team builds, nurtures active and collaborative relationships with consumers and community.

2. Patients as Partners:
IPOP – Interpreter Project in Outpatient clinics

IPOP is the first WSLHD partnership between patients, the Health Care Interpreter Service, University Clinics and Innovation and Redesign.

The aim is to reduce average wait time for booking interpreters by phone by 50 per cent.

Solutions were tailored to address issues affecting CALD patients. They included SMS follow-up phone calls by interpreters for appointment confirmation, and improved check-in including designated interpreter waiting area, a dedicated phone line for on-the-day enquiries and additional block bookings for interpreters.

3. Patients as Partners:
My midwife – Westmead caseload midwifery. Connecting the families of WSLHD to midwifery ledcontinuity of care via social media

Midwifery caseload practice established a Facebook Page entitled My Midwife-Westmead Caseload Midwifery. The Facebook site has instructions on how to self-refer to the program, with the phone number and a link to the Women’s and Newborn Health website which explains more about how the program works.

Women in the program were invited to comment on their experiences to help other women gain confidence in the program.

The Facebook site improved the partnership with patients and the community as evidenced by the participation in sharing, liking and commenting on posts. Many women commented upon their positive experience of midwifery caseload practice.

4. Patients as Partners:
SMS appointment reminders: even my Labrador receives them

The implementation of Community Health and Outpatient Care (CHOC) Cerner in August 2016 led to the opportunity to extract appointment information from the electronic scheduling system. An SMS appointment reminder system was implemented for Child and Family Health Services. It used an existing message delivery solution (MDS) platform.

The SMS appointment reminders improved consumer experience, saved staff time and reduced no-show rates as well as improving attendance at Child and Family Health (CFH) services.

5.Delivering integrated care:
GREAT (Geriatric Rapid Evaluation and Treatment) service

The GREAT (Geriatric Rapid Evaluation and Treatment) service is an outreach program provided to local aged care facilities (ACF) during working hours.

It receives referral from ACFs and acute hospitals. Referred patients receive a face-to-face assessment at the ACF. A management plan is developed in collaboration with GPs, ACF staff and the patient’s family.

The GREAT service has established partnerships between local ACFs, the primary care sector and Westmead Hospital to provide timely, safe and effective clinical care for the older person in an ACF. It reduces avoidable hospital admissions and helps prevent potential adverse outcomes associated with hospitalisation. It supports the older person’s choice for treatment in their own home and empowers ACF staff to continue to look after residents in their own environment.

 

6. Delivering integrated care:
HOTTeR West (HCC outcomes through translational research in western Sydney)

HOTTeR West is a public health program focused on a cancer prevention strategy that seeks to optimise chronic hepatitis B (CHB) management in WSLHD.

This nurse-led, community-based program supports GPs in western Sydney with significant CHB patient loads. It provides rapid access care to patients receiving antiviral treatment and specialist care to facilitate treatment/management pathways.

Since the implementation of HOTTeR West in 2015, 358 patients have been diverted from hospital clinics and managed within the community.

7. Delivering integrated care:
Partnering for justice and health

The onsite family law solicitor works in partnership with hospital staff to provide specialty services for the most vulnerable. The solicitor assists in resolving or reducing legal issues or referral to other legal support.

The NSW Work and Development Order (WDO) scheme allows vulnerable people to reduce unpaid fines through participation in suitable treatment and health promoting programs. A health project officer worked in partnership with Legal Aid NSW to engage WSLHD to become a WDO sponsor, to develop resources and to provide ongoing support.

Patients have received improved access to legal services with 630 instances of legal advice/assistance provided over two years. Of those instances, 50% of clients disclosed family violence. This project increased the number of WDO sponsors by 35% and cleared over $8.5M in debt. This was the highest clearance in NSW for any participating organisation in the scheme.

8. Keeping people healthy:
A novel approach to health – library partnership

An innovative partnership with libraries from four local government areas within WSLHD established Library Health Month. Set up in July 2017, the program aimed to encourage library users and staff to ‘make healthy normal’, by increasing awareness of Making Healthy Normal (MHN) and Get Healthy Information and Coaching Service (GHICS). The program also encouraged access to a range of free health programs through tailored resources and activities.

A total of 20,471 promotional items were distributed with 31 of the planned activities attracting 593 participants. There was also significant CALD community engagement.

9. Keeping people healthy:
Antipsychotic polypharmacy; ‘never say never, but never say always’

A clinical audit of patients (99) within Cumberland Hospital Recovery Services conducted in July 2016 identified that 30 patients (30.3%) were prescribed more than two concurrent regular antipsychotic medications. Forty nine patients (49.5%) were on chlorpromazine equivalent doses of 1000mg/day or more. Consequently, a three-pronged intervention strategy for antipsychotic polypharmacy reduction was adopted. It consisted of an educational programme, network-wide recommendation, and the introduction of polypharmacy as a permanent item for discussion and presentation in the Safe Use of Medicines Committee.

A re-audit of 105 patients in June 2018 demonstrated that the use of more than two concurrent antipsychotics was dramatically reduced. Only two patients (1.9%) were found to be on three or more antipsychotics. Further, the proportion of patients on chlorpromazine equivalent doses of 1000mg/day or more was reduced to 33.3%.

10. Keeping people healthy:
Hepatitis C project

Collaboration between Cumberland Hospital, the Department of astroenterology and Hepatology at Westmead Hospital and The Institute for Clinical Pathology and Medical Research (ICPMR) was streamlined screening and treatment. Nominated staff from each unit at Cumberland were educated about Hepatitis C Virus (HCV) screening by a hepatology nurse specialist from Westmead.

The overall screening rate increased from 3% to 78% in three months. Twelve of the 186 patients screened were diagnosed with HCV. These patients received fibroscan and HCV assessment and treatment during their stay at Cumberland Hospital. Successful treatment of patients prevents transmission to others.

11. Keeping people healthy:
Promoting protecting and supporting breastfeeding for lifetime health

The pilot breastfeeding drop-in sessions started in August 2017 to encourage breastfeeding as the best way for a woman to feed her infant. The sessions also provided additional, flexible support to women in the early weeks of breastfeeding.

A child and family health nurse secondary specialist or a clinical nurse consultant were the main facilitators. All the nurses have successfully gained the International Board Certified Lactation Consultant qualifications or have demonstrated advanced knowledge and skills in breastfeeding.

The clinics were well attended. Women reported a high level of satisfaction with the service to support breastfeeding within the community. Evaluation phone calls at six weeks and six months indicated an increase of breastfeeding duration and satisfaction with the additional support following discharge from hospital.

12. Keeping people healthy:
SMS – strengthening our message service

The Physiotherapy Department utilised a patient messaging system which obtained appointment information and patient contact details from the scheduling system iPM and used to send an SMS appointment reminder.

Volunteers reviewed contact details of patients on the physiotherapy outpatient waiting list to ensure the SMS appointment reminders could be sent.

Following a correction of patient phone details, the did not attend (DNA) rate dropped to 9.46% which was sustained for a second month at 9.87%. This initial reduction in the DNA rate correlates to up to 22 clinical hours/month saved and a labour efficiency cost saving of up to $1000/month. In the third month, the DNA rate increased to 14.69% which led to a re-audit of mobile phone details across waiting lists. It was determined that the accuracy of data for patients added to the waiting list had not improved.

13. Keeping people healthy:
The X-men – exercise classes for prostate cancer

The X-men, an 8-week program of cardiovascular and resistance training, was made available to all males under the care of WSLHD oncologists and was recommended for males who reported deconditioning, weakness or did not participate in regular exercise.

A recognised consumer provided advice pre-implementation while a group of consumers provided advice on the creation and design of program educational resources. Sixty two males have been referred by oncologists with 47 completing the program. Ten are currently in the program or waiting to commence and five participants declined to commence after referral. Participant surveying found 86% had no falls in the past six months, 71% felt steadier and 61% had less fear of falling. Post X-men surveys show positive results with program recommendation (98%), satisfaction (95%), level of education (97%) and educational understanding (97%).

14. Collaborative teams:
CHOC errors: down, down, the errors are down and staying down

In October 2017, an internal audit of CHOC entries (clinical data entries) revealed more than 450 errors. The errors meant that clinicians viewing the record could not clearly identify which episodes of care were linked to which patient.

Blacktown Opioid Substitution Treatment Unit was the first clinic in WSLHD to mandate drug and alcohol assessments for all patients and develop intake rules.

Outcome measures using objective data on the reduction of CHOC errors were reported and clinical outcomes were assessed. At the end of the three month project, trial reports indicated a 90% reduction in errors in CHOC. Process measures indicated completion of drug and alcohol assessments improved from about 66% to 95%. 100% of case management allocation occurred within one week, a reduction of three weeks from base line.

15. Collaborative teams:
Optimising medication reconciliation within the new era of electronic medication system

The project team used the Driver Diagram methodology following brainstorming sessions to map the current process of medication reconciliation for patients transferred to pilot ward from the emergency department. The project team designed a patient medication reconciliation form for patients to complete upon arrival at the pilot ward and the form was refined using PDSA cycles. This was followed by patient interviews conducted by the pharmacist or medical team within 24 hours of admission.

The number of admitted patients with a completed medication reconciliation form within 24 hours of admission increased from 50% within one month of implementation to 100% within two months of implementation. Patient engagement during medication reconciliation increased from 36% in 2014 to 100% in July 2017.

16. Collaborative teams:
Pack and go! Take home medications with a difference

The Patient Pack Project aims to provide a safe and standardised way of medication handling in the community for the Access and Assessment Mental Health team when they’re providing home treatment for patients that are acutely unwell. Each Patient Pack contains a small quantity of psychiatric medication packaged with clearly-labelled directions of use, in various strengths and quantities, manufactured by pharmacy staff. AAMH team clinicians and prescribers keep records of what has been used.

The Patient Pack Project has been well received by both patients and clinicians, with more than 20% of patients utilising Patient Packs in the past six months. The team aimed to expand the selection of medications available to Patient Pack in the next 12 months, subject to prescribing trend and need.

17. Collaborative teams:
Protecting our Aboriginal kids, now and into the future

An Aboriginal immunisation healthcare worker was employed to engage parents/carers of Aboriginal children in their children’s immunisation journey. A purpose built database assisted the worker to plan and record children’s follow-ups, send letters, text messages and telephone parents/ carers of overdue children. The worker also promoted/distributed resources to community members and trained service providers.

The Australian Immunisation Register (AIR) WSLHD quarterly report - December 2017 showed 95.1% of Aboriginal children fully immunised - 1 year of age (93.3 % non-Aboriginal) and 98.5% of Aboriginal children fully immunised - 4 years of age (93.8 % non-Aboriginal). The Gap is not only closed for Aboriginal children immunisation but coverage has exceeded that of non-Aboriginal children.

18. Collaborative teams:
PUMP (partnering with a university to maximise projects)

Students were invited to participate in a volunteer capacity to engage in quality improvement activities. Students were placed on one project team and performed roles including data collection, project planning, implementation and evaluation. The students were supervised by a senior clinician with quality improvement experience who provided guidance. Currently 16 Master of Public Health Students work in a volunteer capacity on quality improvement with a focus on consumer engagement and data collection.

This project provides about 100 hours/month of additional quality project work in Blacktown Hospital, with at least 50 of these hours performed on allied health projects. All volunteers report feeling their role makes an improvement in the hospital and that volunteering has helped with their studies and/or job prospects.

19. Collaborative teams:
Ready steady scope

This project demonstrates the concept of the enhanced recovery after surgery model of care, as an evidence based series of interventions that improves surgical patient outcomes by shortening the length of recovery and promoting early return to normal function.

Pre and post project implementation audit data, together with patient and staff evaluation, identified a significant increase in the number of patients required to stay less than one hour in post anaesthetic recovery unit, an improvement in bed access, and a decrease in staff conflict and patient complaints.

20. Collaborative teams:
RED(i), set, go for ETP – a whole of hospital project improving access, patient flow and performance

Multiple initiatives were undertaken which included visible executive leadership and supportive staff, staff participation in redesign and capability building workshops and a communication and branding strategy to strengthen engagement and commitment through peer recognition of achievements. A comprehensive emergency treatment performance recovery plan was developed and discussed weekly with key Ministry of Health experts in emergency care, patient flow and system performance. Collaborative partnerships with Ambulance NSW aimed to improve efficiency in commencing rapid care for patients presenting to hospital and managing flow in peak activity periods.

Engagement and collaboration of staff achieved significant, sustained improvements in timely access to care in the ED and patient flow despite increased demand (>10% growth in ED presentations) and constrained fiscal resources. Blacktown Hospital’s ETP improved from 56% to 74%. Mount Druitt Hospital went up from 69% to 84%.

21. Collaborative teams:
There’s a hole in my revenue bucket

A range of solutions were implemented including increased frequency of invoices raised and subsequent follow up, identification of barriers for late payment and equipment return, implementation of EFTPOS in the delivery van and at Blacktown and Mount Druitt hospitals, and thematic review of patient complaints and subsequent solutions.

As a result of a range of strategies implemented:

  • $32,600 worth of high cost items were returned after being on loan for more than 12 months
  • Cost saving of $4,400 per year through the implementation of EFTPOS
  • Volume of hire fees collected increased from 29% in 2015 to 71.6% by December 2017 – an increase of 42.6%
  • Patient complaints were reduced and now all WSLHD inpatients have direct access to equipment for loan, increasing their safety post discharge.

22. Collaborative teams:
Think before you bin it

In October 2017, Auburn General Services noticed a marked increase in the number of plastic items being discarded by the operating suite. Areas were set aside as collection points for reusable plastic items and out of date or no longer required consumables and bins were placed in the best place to collect bottles and cans. Appropriate items were sent to Doctors Assisting in South-Pacific Islands (DAISI) and other charitable organisations.

Building on the successful ‘Cans for Kids’ project, the team began collecting and redirecting reusable items. This reduced the waste management budget from $9,000 to $6,500 within one month. Since November 2017, the staff have recycled: 12,000 plastic bowls, 6,000 kidney dishes and galley pots, 20,000 items of out of date stock, 21,000 pieces of kimguard (non-absorbent material used for wrapping sterile operating packs), 18 large bins of cans and bottles for ‘Cans for Kids’ (NSW Government Recycle Initiative), 20,000 articles of clothing, a delivery suite bed and baby warmer.

23. Collaborative teams:
Together we can break the barriers through a whole family approach

Whole Family Team (WFT) provides specialist mental health, drug health and parenting interventions to vulnerable and at risk families involved with Family and Community Services (FaCS). These interventions aim to facilitate improvements in parental and family functioning by targeting parental mental and drug health concerns to provide safe and stable homes for their children.

Independent evaluation of WFT found that completion of the program led to clinically significant improvements in parents’ mental health, parental drug and alcohol outcomes, family functioning (including parenting, family relationships and child wellbeing), and child safety (with a substantial reduction in the number of children being re-reported to FaCS).

24. Collaborative teams:
We’ve got your back

A range of solutions were implemented including establishment of Blacktown and Mount Druitt hospitals physiotherapy led clinics to provide early access to care, consistent triaging guidelines, SMS appointment reminders, reallocation of administrative staff and implementation of a multidisciplinary team case conference for spinal services.

The project resulted in an increase in monthly new appointments from 21 to 60 and a reduction in did not attends (DNA) from 29% to 16%. Patient feedback resulted in a score of 98/100 for patients feeling they were treated with kindness and respect. There was also projected savings/revenue of $500,000 per annum by August 2019.

25. Collaborative teams:
Wrapped in MaSH

The Making a Safe Home (MaSH) program provides intensive multi-agency support while leaving at-risk children with their primary carers. The program is an individualised, family-centred program that balances intensive practical support for families with parental acceptance of accountability. Caseworkers and parents co-design family goals and put in place sustainable and empowering supports.

With the implementation of the MaSH program and other joint Family and Community Service/ health programs, WSLHD has achieved a 41% reduction of first time entries into care from 2015/16 to 2016/17. This is in contrast to the state average of a 25% reduction.

The MaSH program has also seen a significant reduction in the number of reports received for children in the program.

26. Education and Training:
Clinical supervision for TPP nurses: a new era

New clinical supervisors complete an eight day training program to develop new skills, knowledge and expertise in the provision of high quality clinical supervision to transitional to professional practice (TPP) registered nurses at Westmead Hospital.

Each supervisor provides supervision to a group of 10 TPP nurses on a monthly basis. The program complements the clinical supervision models used for clinical supervision at the bedside by providing a link between bedside clinical practice and reflective practice (and vice versa).

Evaluation occurred at six and twelve months, with a questionnaire at session one to gain insight into the TPP program nurses’ understanding and expectations of clinical supervision. Comments received pre-program varied. Some nurses did not know what to expect. Others had a good understanding.

27. Education and Training:
Genograms – a picture’s worth a thousand words

Embedding documentation of a family genogram into initial assessments is an innovative approach to documentation. It can help with client engagement, enable efficient and clear understanding of family dynamics and relationships and positively contribute to collaborative care planning. Face-to-face education was implemented and amendments were made to the WSLHD family genogram form.

Audits were conducted pre and post implementation of health records to determine the percentage of records with a three-generational family genogram present.

The number of health records containing a family genogram following education and provision of resources has increased. 100% are three generational and significant formatting errors have reduced.

28. Education and Training:
Increasing dysphagia awareness in mental health

The incidence of dysphagia in the mental health population is higher than the general population due to a number of factors including: effects of medication, presence of co-morbidities and behaviour-related eating habits.

A referral pathway, dysphagia strategy flow chart and education guide were developed along with the provision of in-services to staff at Cumberland Hospital.

Three speech pathology staff members provided seven in-services to Cumberland staff across a year on speech pathology and basic dysphagia management in the mental health setting. A total of 97 staff attended the training sessions. Referrals to speech pathology increased over the twelve month period after the staff education program. The project results suggest that increased nursing awareness of dysphagia and speech pathology services resulted in increased number of appropriate speech pathology referrals for mental health patients.

29. Education and Training:
Increasing staff confidence to support breastfeeding in the NICU

A one day workshop was developed to provide breastfeeding and lactation education in the Westmead Neonatal Intensive Care Unit (NICU). The program was developed based on feedback from staff and the consumer representative, including stories and images from the consumer as examples of the benefits of ‘kangaroo’ care.

83% of NICU registered nurses and a dietician have completed the workshop. Completed evaluations reveal that most staff rate the presentations as either very good or excellent. Comments indicate that the workshop is informative and that it will aid staff in clinical practice.

Participants said images, videos and resources used in the workshop assisted their learning and clarified confusion on certain topics. 93% of staff also indicated they have used the workshop information in daily clinical practice and to support and educate their fellow colleagues.

30. Education and Training:
Person-centred learning for person-centred care

This project is based on the existing four week online course from the NSW Health Dementia Care Competency and Training Network. Participant needs and models of dementia training were reviewed to deliver a participant centred program using a computer training room. It was held over two days with interactive activities.

There was a 100% participant completion rate. Facilitator time spent running the course was also decreased by four hours. Participants who completed the pilot course provided feedback via two evaluations. Both reported that participants felt well supported and learned through the blended method.

31. Education and Training:
Please ASSIST me

In 2016, the Acute Screening of Swallow in Stroke/TIA (ASSIST) tool was introduced in the Blacktown Hospital Stroke Unit. Speech pathologists provided education to registered nursing staff which included an education session and assessment of theoretical and practical skills in order to achieve competency. Registered nurses are now trained on administering ASSIST which allows timely screening without the requirement of referral to speech pathology.

The ASSIST has allowed for time effective measures as patients admitted to the stroke unit at Blacktown Hospital are now able to have their swallowing function screened by nursing staff. This minimises the need for a comprehensive speech pathology assessment for patients deemed not at risk of dysphagia. This allows for significant savings in time involved in speech pathology interventions as only patients with dysphagia are seen for assessment and treatment.

32. Education and Training:
To mix or not to mix

A drug compatibility chart was adapted from Gippsland Region and other referenced sources. It was used as a reference and resource tool to provide education to staff and potentially patients and families. The chart was kept in the syringe driver box as a reference and nurses were given a copy to increase autonomy and productivity.

The clinical nurse specialist observed a reduction in consultations with regards to drug compatibility prior to commencing a syringe driver. Community nurses acknowledged an increase in confidence and knowledge. Feedback indicated a reduction of medication errors caused by drug precipitation. This resulted in a reduction of drug wastage leading to saving medication stock and cost savings for the LHD, patients and families.

33. Research and innovation:
6S Success! A Westmead Redevelopment lean storeroom initiative. Building capability and collaboration to ensure a successful transition

The 6S program provides staff with training on Lean methodology combined with practical application thereby supporting the development of shared organisational capability for change and implementation.

The aim is to apply the 6S methodology and transform 36 store rooms by June 2018 to prepare to move into the new Central Acute Services Building at Westmead.

This project resulted in 36 storerooms transformed across 14 services, more than $97,000 worth of stock reallocated and/or disposed of and $230,000 in productivity savings annually.

34. Research and innovation:
Electronic legislative compliance register (e-LCR)

The e-LCR provides a structured framework in which legislation and associated regulations, policies, codes and standards are registered, analysed for gaps and evaluated for the degree of compliance. Areas of non-compliance are risk managed by the organisation. Risk management of target areas occurs by developing action plans to address arising risks.

The program has an embedded system that allows for notifications to be sent to the responsible officers of all new relevant legislative requirements. They are required to login and action to ensure the organisation is kept abreast of all relevant legislative changes and is compliant with them.

35. Research and innovation:
Emergency treatment performance (ETP) daily review dashboard

The objective of this dashboard is to replace the existing manual data extraction process conducted by the emergency department data managers. This dashboard reports on KPIs including ETP All Admits, ETP Non Admits, and Total Discharges.

Emergency department ETP performance has improved significantly and many data and workflow improvements have been identified and implemented. The performance of Blacktown and Mount Druitt hospitals has improved from being lower performing sites in NSW to be being among the best performing sites within six months of implementation.

36. Research and innovation:
FASTER screening for stroke

The FASTER screening protocol (Fast, Affordable, Safe and True assessment in the Emergency Room) has been established for stroke presentations using a single DWI MRI sequence and an open access policy. The patient can be sent to MRI with a completed safety checklist to be scanned before the next booked patient, generally completed within 5 minutes.

All potential stroke cases were accepted for DWI MRI and reported urgently. In 996 MR screening cases, 20% (202) were positive for stroke. The impact on patient outcomes has been dramatic. Prior to this project, patients (particularly if young), were often told that stroke was unlikely based on a normal non-contrast CT and were discharged from ED with no firm diagnosis. Now, all stroke episodes are now identified using FASTER and at a higher rate than originally anticipated. On discharge, the GP now has a firm diagnosis of a stroke episode versus “possible migraine” or “query TIA”.

37. Research and innovation:
Innovation in reducing seclusion and restraint use

This project utilised a number of strategies that were consistent with the six core strategies of seclusion reduction in WSLHD Mental Health Services including a focus on the development, maintenance, use and collaboration with patients in management plans, care plans and safety plans as well as use of a range of sensory modulation activities and resources.

Through utilising a multifaceted adaptive approach, WSLHD demonstrated a decrease in the total number of seclusion incidents per month in excess of 10% per annum since July 2014. There has also been a marked decrease in the proportion of time seclusion rooms are being utilised, with the observed reduction in seclusion duration about 37% per annum since July 2014.

38. Research and innovation:
Mobile phone – use of SMS

In line with the Corporate Services postage reduction initiative, the department’s aim was simply to minimise current Australia Post expenditure. The method was to nominate and work alongside one department that expressed a keenness for innovation to address the need over time to minimise postal fees. For this pilot study, two mobile handsets were purchased and used specifically for booking appointments for the Westmead Hospital Women’s Health Clinic.

Data results from this simple initiative have been impressive due to the diligence of both parties. Comparison over a five month period for this one department showed a 50% decrease which is a saving of more than AUD$2500.

39. Research and innovation:
Pharmaceutical supply chain and medicines optimisation

The pharmaceutical supply chain initiative aimed to standardise procurement processes, optimise contract negotiations through supply chain and inventory management, and improve responsiveness to changes in the market. It would secure the supply chain by working with industry to enable better prediction of medicines demand and forecast requirements for WSLHD with patient care and safety in mind.

This project has resulted in significant financial efficiencies across WSLHD, reduced pharmaceutical waste and created a medicines supply chain that has been minimally impacted during a period of extraordinary pharmaceutical shortages across Australia thereby ensuring continuity of patient care.

40. A safe and healthy workplace:
A state of Biopreparedness

Westmead Hospital recognised gaps in its preparedness to respond to an outbreak similar to the Ebola 2014 outbreak in West Africa. A fragmented system was identified. A survey targeting staff competence and confidence in biologically hazardous infection management was conducted. Semistructured interviews explored staff experiences and perspectives of biopreparedness response. Nine simulation drills assessed readiness and evaluated performance.

Integrating disaster management processes with clinical protocols had a positive impact on the hospital’s biopreparedness response, with all but one staff member understanding their expected role in a post-implementation survey.

41. Patient safety first :
A spoonful of “Med Rec” helps the medicine go down

Blacktown and Mt Druitt hospitals (BMDH) are one of the first sites in the state and the first in WSLHD to become a fully integrated electronic facility.

A retrospective baseline audit of 171 discharge summaries found discrepancies in 28% of discharge summaries. A post-intervention repeat audit of 211 discharge summaries found a reduction of discrepancies to 1.4%. Of 680 medications supplied in the baseline audit, 98 (14.4%) did not match the documented medication list in the final discharge summary. The main discrepancy was of omission. Of 573 medications supplied in the repeat audit, only four (0.7%) did not match. An improvement in discharge reconciliation resulted in 98.6% consistency.

42. Patient safety first :
Fundus photography in the ED: saving lives, eyes and time

Current standards of care in EDs around the world miss up to 13% of patients with clinical signs of life and vision-threatening pathologies because fundoscopy (looking at the back of the eye) in the ED is technically challenging. A portable non-mydriatic camera (NMC) was introduced in ED and the photos taken were uploaded to the eMR and reviewed by the ophthalmology team within 24 hours.

A retrospective audit of clinical practice in the corresponding period last year was conducted. The fundoscopy rate at Westmead Hospital improved from 6.4% to 89.5% during the trial. This was the first portable NMC fundus photography program in Australia and demonstrated the value of collaborative fundus imaging for the safety of patients presenting to ED.

43. Patient safety first :
HOPE: Healing Openness Person-centred Empowerment

Prior to June 2017, Redbank Acute Adolescent Unit had one of the highest rates of seclusion and restraint of all NSW child and adolescent mental health service units, resulting in significant trauma and complaints. Subsequently, we aspired to reduce our rates of seclusion and restraint to maximise patient safety. To achieve this, we collaborated with our patients to formulate a new model of care and incorporated The Six Core Strategies © to generate a culture change.

The results indicate our project was a significant success with a reduction in both seclusion and restraint. Patient and carer feedback was positive with appreciation shown for the involvement patients and carers had in their treatment and discharge planning.

44. Patient safety first:
Keeping patients safe in dental conscious sedation

A nine question cross-sectional staff survey and dental record audit were undertaken in January 2017 to assess gaps in knowledge and implementation of policy. Based on thematic analysis of this data, and with reference to NSW Health policy and existing surgical checklists, a project working party was established. A context-specific Time-Out Checklist was designed and implemented by the WSLHD dental conscious sedation service.

Statistical analysis demonstrated 20% or more improvement in most patient safety domains, as reported by clinical staff. The project improved staff engagement, teamwork and safety. These improvements were sustainable over a six month period. Staff agreed that the tool provided adequate opportunity to ask patient safety questions, supported patient safety and covered all time-out checks. All staff reported that the tool promoted better culture on the clinical floor.

45. Patient safety first:
Team Heart, we are here for you

Bleeding-related issues are an ongoing issue during heparin infusion. Improvements were made to handover procedures, clinical practice and documentation which resulted in a 100% reduction in bleeding-related issues in heparin infusion over a six month period at Blacktown Hospital.

A learning package was developed for all new staff to improve knowledge in the titration and management of heparin infusion. Heparin infusion protocol, titrations, current activated partial thromboplastin (APTT) time and next APTT due time were included in nurses’ bedside clinical handover. WSLHD heparin infusion management form was developed to improve the efficiency of documentation and transfer of information (clinical handover).

A post-implementation audit of heparin infusion management at one, three and six month periods showed 100% staff compliance with transfer of information via clinical handover and documentation. There have been no bleeding incidents related to heparin infusion reported in IIMS from July 2017 to April 2018 in Blacktown Hospital Cardiology.