2017 WSLHD Quality Awards

Western Sydney Local Health District

2019 Quality Awards Submissions

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 submissions – not just the finalists.
So make your vote count!

Patients as Partners:
An ECT Teaching Program for Patients

This project aimed to explore the patient perception of electroconvulsive therapy (ECT) in order to understand and overcome barriers to treatment. Five patients receiving treatment in Willow Unit took part in group education sessions and one-on-one sessions with nurses to discuss and address their fears. Every patient improved their therapeutic communication with nursing staff, and four out five changed their views on ECT and were subsequently able to be discharged from hospital.

Patients as Partners:
Partnering with young people in western Sydney to plan for the future of healthcare

Integrated and Community Health sought to engage young people in service design, delivery and evaluation with a strategy that went beyond a Youth Council. The project included a WentWest Collaborative Pairs program, which enabled health professionals and consumers to collaborate on embedding the consumer voice in service planning. The key outcome was the design and delivery of the Centre for Adolescent and Young Adult Health as part of the Westmead Redevelopment.

Patients as Partners:
Physical Health Promotion Project

People with a serious mental illness have a significantly reduced life expectancy compared to the general population. The ‘My Health Passport’ sought to empower mental health patients to be partners and leaders in their own healthcare with access to a wide range of physical healthcare services and screening opportunities. Outcomes included 19 patients undergoing breast screening, of which one was diagnosed with breast cancer for which she is now receiving treatment.

Delivering Integrated Care:
EBM24

Research shows that preterm infants do much better with breastfeeding in the long-term if they receive their mother’s expressed breast milk (EBM) within 24 hours of birth. The project saw the creation of an educational resource kit, a eMR patient journey form and a screening system. Outcomes included a reduction in mean time to first EBM to 7.8 hours, 100% success rate for preterm babies receiving EBM within 24 hours, and improved staff education and communication.

Delivering integrated care:
Providing Antenatal Care in an Outreach Setting

The clinic at Riverstone Neighbourhood Centre is the first time the Women’s Health Clinics at Blacktown Hospital has partnered with a non-government organisation to provide antenatal services in the community. The clinic removes the barrier for women who may find it difficult to get to Blacktown Hospital due to lack of transport, or personal or financial difficulties. More than 615 women have attended the clinic so far, which has led to it expanding from one to two days per week. Consumer-reported benefits include receiving care closer to home, free parking, no stairs, welcoming staff and accessibility of community support services from one location.

Delivering integrated care:
‘Wrapped’ about Rapid Access Stabilisation Services (RASS)

RASS aims to reduce hospital presentations and admissions by providing rapid access to specialists, so patients can return to their primary care team sooner. The project sought to improve the health of patients, enhance patient experience, reduce healthcare costs and better support health providers. Results include a 20-40% reduction in emergency department presentations and a 20-30% reduction in unplanned hospital admissions.

Delivering integrated care:
Pregnancy Family Meetings

The meetings have so far engaged 74 families with child protection concerns early in their pregnancy, using problem solving and independent facilitators with the aim of reducing the number of infants placed into out-of-home care. 47 of the families involved retained care of their infants at birth. The meetings have increased understanding of and trust in the child protection system, and helped identify kinship placements where necessary.

Keeping people healthy:
Don’t Fall For It! A Falls Prevention Initiative

This project sought to reduce falls risk and hospital admissions for falls-related injuries for all patients admitted to Westmead Outpatient Physiotherapy. Initiatives included the implementation of the first outpatient falls risk screening tool in Western Sydney Local Health District, regular staff education sessions, and falls prevention strategy meetings with staff, patients and family. Outcomes for participants included no falls-related hospitalisations, a reduced average falls risk from moderate to low, and 80% compliance with a home exercise program.

Keeping people healthy:
Physiotherapy Weighs In

Overweight and obesity is a well-known issue in Australia, affecting roughly one in two adults. Over the course of a month, 57 out of 59 overweight clients of the Blacktown Hospital physiotherapy outpatient service who completed a survey indicated they’d like to have a healthy lifestyle. Physiotherapists referred 23 clients to the Get Healthy service, and a further 25 indicated they intended to self-refer.

Supporting Our Teams:
Supply, Storage and Administration of Medications (SSAM)

The project introduced a basket storage system in the medication room for non-imprest medications on Blacktown Hospital surgical unit, as opposed to using bedside drawers for each patient. Nurses saved an average of almost 60 minutes to complete the round, which improved overall productivity and morale. There is now extra space available on benchtops to prepare medications, and patients are less susceptible to risks as the ability to self-administer medications has been removed.

Supporting Our Teams:
Emergency Care to the Sound of Music

The unexpected increase in drug-related deaths and injuries at NSW music festivals required an effective and rapid response. Western Sydney was the first local health district to apply disaster management principles and deploy a team to festivals using self-developed equipment, resources and medication kits. The early recognition and management of severe drug toxicity at festivals led to reduced illness and no further deaths after deployment.

Supporting Our Teams:
Thinning the Bins

Staff at Auburn Hospital are committed to reducing their carbon footprint and saving money, with the lofty goal of recycling 100% of salvageable items. Since 2017 this campaign has achieved milestones including 99.9% of cans and bottles and 98% of plastic bowls being recycled. Out of date stock and equipment that was previously sent to landfill is now inspected and donated to charities including MedEarth, which distributes equipment to hospitals in the developing world.

Supporting Our Teams:
Improving Cognitive Outcomes – A Partnership Approach

Few services target cognitive deficits, which are features of serious mental illness. In partnership with external stakeholders, WSLHD teams used technology and tools such as iPads to make local interventions possible. Greater access to training and resources led to improved understanding about the connection between mental illness, cognition and functioning. 56 clinicians were trained with 93% indicating they were now confident in providing social cognitive remediation.

Supporting Our Teams:
It Takes Two – A partnership approach between WSLHD and Blacktown City Council

Munch & Move is a NSW Health program that aims to reduce childhood obesity by 5% by 2025. By December 2018, 100% of Blacktown City Council’s early learning childhood services had adopted the program – an increase from 17% in July 2017. Outcomes included significant improvements to food menu compliance, staff training, reduced food waste and colloquial evidence children were enjoying more vegetables.

Supporting Our Teams:
Patient Safety Video

The video engages patients in their own care and raises awareness of potential risks related to a hospital admission. 85% of nurses who saw the video rated it useful, and 75% supported rollout to other wards. Translations have been made into seven additional languages, with plans for a district-wide rollout on patient entertainment systems in 2019.

Education and Training:
Getting the basics right: Supplemental oxygen

This is the first program to address supplemental oxygen compliance in a non-respiratory service. Audits and questionnaires allowed staff to acknowledge their own deficiencies, then generate and implement solutions based on their own learning styles. Significant improvements included an increase in prescribing compliance from zero to 100% and increase in target oxygen saturation range documentation from 14% to 86%.

Education and Training:
Detecting a wee difference

The clinical emergency response system (CERS) improves early detection and treatment of deteriorating patients. Renal and Urology Services used creative team building exercises to improve their knowledge of the procedure, including a ‘Wee News’ staff newsletter. Procedure knowledge improved by 14%, which led to a 50% rise in patient with acute condition for escalation (PACE) calls after 17 months.

Education and Training:
Yaralla Unit – innovative education delivery

Prior to implementing this initiative, Yaralla Unit nursing staff had a 15% attendance rate for attending the ‘Clinical De-escalation’ course. The team created an education space within Cumberland Hospital to facilitate the delivery of learning, including large screen televisions to display relevant education material. Within three months the course attendance rate had risen to 90% and attendees indicated they felt more comfortable interacting with colleagues.

Education and Training:
Joining the I and MI in IMI: Muscle Matters!

Drug concentration is altered if depot injections are administered at an unlicensed muscle site. A baseline 12-month audit in June 2018 found only 83.6% of long-acting antipsychotic depot administrations were being given correctly. After implementing all the strategies, this improved to 92.3% by October 2018 and 100% by April 2019.

Education and Training:
ECAV – Graduate Certificate in Medical and Forensic Management of Adult Sexual Assault

This graduate certificate is the first and only nationally accredited competency-based qualification of its kind in Australia. The blended online and face-to-face teaching program covers the following job roles: sexual assault response, multidisciplinary work, Aboriginal cultural competency, trauma-informed response and injury interpretation. Over the past five years there has been 94 graduates, including 19 new sexual assault nurse examiners and more workers in rural and remote areas.

Health Research and Innovation:
Digital Operating Rooms

The installation of cameras and supportive hardware and software allows real time video streaming of every surgery done in Blacktown and Mount Druitt Hospitals operating rooms. This was the first digital operation room implementation for NSW Health which integrated surgical images and videos with electronic medical records. Videos and images are also safely stored and can be accessed for future training and education purposes.

Health Research and Innovation:
Blood Management in the Perioperative Period

Iron deficiency can cause serious complications during an operation. Blacktown and Mount Druitt Hospitals department of anaesthetics, pharmacy and laboratory established an active screening program to supplement 100% of iron deficient patients six weeks prior to elective joint surgery. The program is now being rolled out to other areas of surgery with similar expected blood losses.

Health Research and Innovation:
First Warning: an adult sepsis alert system for ED

First warning is an Australian-first electronic medical record algorithm that alerts clinicians to signs of potential blood infection. During the testing period, the system detected 1600 potential cases of sepsis that were initially missed. Results suggest the system is a significant step forward for emergency clinicians to correctly place septic patients on the pathway to early treatment, and it is now being tested for the feasibility of state-wide implementation.

Health Research and Innovation:
eCAG: Safe, Collaborative and Quality Governance for eChemo

Western Sydney is one of the first local health districts to formalise an eChemo governance model, ensuring chemotherapy protocols are consistent, relevant to need, organised and available in a timely manner, and remain evidence-based, approved for use, current and reliable. The team delivered effective governance during and after transition from paper-based to electronic systems for prescribing, dispensing and administration of chemotherapy at Westmead Hospital.

Health Research and Innovation:
Streamlining Bowel Cancer Screening

The nurse-led rapid access clinic for bowel cancer screening patients is an original and effective approach to the growing clinical problem of bowel cancer. The faecal occult blood test (FOBT) clinic significantly reduces the burden on gastroenterology clinics and provides a streamlined, accessible, patient focused service for FOBT-positive patients. The nurse specialist provides rapid triage, initial consultation, education on diet and bowel preparation, and liaises with GPs regarding outcomes.

Health Research and Innovation:
The NICE clinic: a nurse-led cataract examination clinic

The NICE clinic is the first nurse-led clinic that enables ophthalmic nurses to assess, review and discharge patients after routine cataract surgeries. The clinic encourages collaboration between patients, carers, nursing and medical staff to work towards optimising clinical standard and patient care in Westmead Eye Clinic. The main systematic outcomes are better patient flow in the clinic, improved nursing retention, reduced patient clinic wait time and reduced patient complaints.

Health Research and Innovation:
Shorter Pregnancy Blood Pressure Profile (BPP) Duration

This project assessed whether shortening the outpatient pregnancy blood pressure profile (BPP) from three hours to one would yield clinically equivalent results while delivering psychosocial and financial benefits to patients. The one-hour BPP was proven to be a highly efficient practice improvement with only positive consequences and significant benefits for both pregnant patients and the service.

Health Research and Innovation:
MR screening for appendicitis: faster, better and safer

This project established the use of magnetic resonance (MR) as a faster, better and safer radiation-free imaging tool to diagnose appendicitis in any young or radio-sensitive patient with abdominal pain. The eight-minute non-contrast screening protocol achieves the same negative appendectomy rate reduction as computerised tomography with no radiation burden. This innovation has strengthened ED assessment, reduced unnecessary surgery, and improved efficiency and patient outcomes.

Health Research and Innovation:
ODDS: Ensuring right stock, right amount, right place

The project utilised diagnostic research methods to determine the root causes of overstocking and waste issues, which led to an innovative redesign of the practice by which procurement of consumable stock is managed and reviewed for the in-scope wards at Blacktown Hospital. Results included a 30% improvement in time taken to locate stock, $81,746 reduction in the imprest basket valuation of in-scope wards, and expenditure savings of $39,025 over four months.

A Safe and Healthy Workplace:
Relocate and be Safe: Relocating the Schedule 4 (D) and Schedule 8 drug safe in Emergency Department

The relocation of the Auburn Hospital ED drug safe inside the medication room was necessary for compliance with the Medication Administration Compliance Procedure. It also led to improvements including reduction in time spent checking drugs by almost 50%, fewer distractions for nursing staff when checking drugs, and increased nursing efficiency leading to more time spent with patients. The project involved collaboration among nursing staff which led to change in practice when checking and recording Schedule 4 and Schedule 8 drugs.

A Safe and Healthy Workplace:
Westmead Brilliance Box

The brilliance box is a simple concept: people leave positive feedback for their colleagues whenever they have found them to be particularly helpful or kind. The feedback is collated and distributed both to the person nominated and their supervisor. The result has been that staff feel more appreciated and are thus more engaged, and other departments receiving the feedback are very appreciative and view ED in a more positive light.

A Safe and Healthy Workplace:
Make it safe, keep it clean and clutter free: Reorganising the ED Utility Room

While reorganising a room is neither uncommon nor innovative, the use of the online Survey Monkey application transformed the process into something fun and creative. The project improved efficiency as nurses are now able to work safely from an uncluttered, unobstructed utility room. Staff can access areas faster and easier, resulting in improved productivity. The project also improved staff ownership and adoption of workplace health and safety practices.

A Safe and Healthy Workplace:
Food for thought: ‘Didn’t think we do healthy in the west’

Cultural attitudes and food habits in adults are difficult to shift. This project aimed to improve food outlet staff engagement to promote healthy food and drink choices. The stakeholder engagement model worked with small scale businesses such as Mount Druitt Kiosk and large businesses such as Coca-Cola Amatil. At Mount Druitt Kiosk, compliance with the Healthy Food and Drink framework rose from below 20% to 100% in one year.

Patient Safety First:
Have you had your BRAN

Benefits, risks, alternatives and if nothing was done (BRAN) is a new acronym formulated as a simple way to remember the mandatory fields to complete to ensure verbal consent is obtained. Audit compliance within the Auburn Hospital Gynaecology Outpatients Clinic improved from zero to 90% to within two months of the project implementation. Patient outcomes and doctor productivity also improved through the use of a standardised procedure.

Patient Safety First:
Pharmacists in ED: Keeping our patients safe

The implementation of a 1.5 full-time equivalent clinical pharmacist service in the Westmead Hospital ED led to a total of 3304 clinical interventions, avoiding adverse outcomes including 58 potentially severe life-threatening events. The pharmacy education model was transformed and delivered to medical and nursing staff using an alternative social media platform to ensure improved communication regarding medication-related issues, updates and clinical pearls for staff working overnight shifts.

Patient Safety First:
Community Health Nursing Templates for Clinical Documentation

Chronic and complex (CAC) nursing templates were uniquely designed to meet the scope of community nursing practice including palliative care, continence, wound care, dementia and chronic illness management. Documentation significantly improved in the areas of standardisation, meeting legal requirements, recognising and responding to clinical concerns, and continuity of care. Nurses’ task-oriented approach to clinical activity was changed to a patient-centred approach leading to optimal outcomes for clients.

Patient Safety First:
Saving Lives: Priorities in Action

A child and youth navigation project was designed to reform the mental health model of care in Westmead Hospital ED, with the aim of reducing non-urgent presentations by 50%. The navigator saw 71% of young people who presented to Westmead ED during the week, leading to a reduction in re-presentation rates from 20% to 3%. Sustained evaluation demonstrates decreasing wait times, effective links with GPs and service providers after discharge, and the potential to improve outcomes for the youth.

Patient Safety First:
FLASH – Falls Admission Safety Huddle

The falls admission safety huddle (FLASH) is a redesign of the falls prevention management plan, including a universal falls prevention strategy and a simple falls risk screening tool. High risk patients take part in a multidisciplinary pre-fall bedside safety huddle within 24 hours, with a personalised falls management plan documented in eMR and on bedside whiteboard. The project led to a reduction of falls and serious harm from falls by 50% compared with the baseline data from May 2016 to November 2017. There were no extreme or high risk fall incidents.