Nursing & Midwifery News – April 2024

From Shane

One of the best things about working at Western Health is that we are surrounded by inspirational people that really excel at what they do, and who go above and beyond to deliver or support Best Care. We all know someone that inspires us and who really makes a huge difference. These people demonstrate a deep commitment and sense of purpose, and usually do not work here for accolades or glory – however, isn’t it wonderful when we can recognise and celebrate them! Here’s your chance. Nominations for our annual Inspire Awards are currently open and are an excellent opportunity to recognise our very own super-stars and let them know just how much they are appreciated. I encourage you take some time to nominate that special person, people or team prior to 12 April, ahead of the ceremony later this year.

Unfortunately, occupational violence and aggression (OVA) continues to be a significant risk for healthcare professionals. We take this risk extremely seriously at Western Health, as all of our people deserve to be safe at work. Over the past years we have made some impressive inroads on decreasing the number and severity of OVA incidents across our hospitals, through the Predict Prevent Priority: Safety campaign and tools and Safewards. I’m excited that after a couple of years of development, our next important initiative is finally here. Our innovative new ‘Reframe your response’ virtual reality training package simulates real-world scenarios in a healthcare setting to demonstrate how self-awareness and emotional regulation during difficult situations can shape and influence a safe and effective outcome. Virtual reality is demonstrated to achieve enhanced focused learning, helping learners to get more out of the training and have better outcomes. This new package has been custom built for Western Health, and I encourage you to book in and experience it for yourself!

Towards the end of March we were notified that Western Health received our accreditation for 3 years. This is the first time that we have undertaken the new short-notice accreditation survey since it was introduced in 2023, and I was so immensely proud of how Best Care at Western Health was demonstrated to the 12 surveyors.  My sincere thanks to everyone for your tireless dedication in continually delivering or supporting the provision of Best Care to our community every day. We now have 6 months where we cannot be surveyed again, however our next short-notice accreditation survey can be any time after that! I am confident that the systems and processes we have in place will ensure that we are always ‘accreditation-ready’ going forward.

Our Employee-centered Rostering steering committee has begun to meet and is busy getting everything finalised ahead of the upcoming implementation. The draft guideline will be approved and published over the coming couple of weeks, together with educational material and a communications plan. The implementation will commence in our pilot areas, which include all our Joan Kirner Women’s & Children’s maternity wards, Ward 1A, Ward 3B and Ward 3F. This initial implementation will give us a chance to finesse things prior to a wider implementation across all our wards and departments over the coming months. This incredibly important project aims to support our nurses and midwives to balance their lives inside and outside of work through enhanced flexibility, enhancing fairness and decreasing fatigue by optimising rosters and break periods.

Changes to the care and governance requirements under the Mental Health & Wellbeing Act 2024 were implemented in our Emergency Departments and Urgent Care Centres on 1 April 2024, whereby the use of all restrictive interventions (including bodily restraint, chemical restraint and seclusion) for consumers receiving care under that Act are reportable to the Chief Psychiatrist.

If you are a point-of-care nurse or midwife who has played an active role leading a quality improvement initiative within your ward or department, I encourage you to apply for a Joy Turner Memorial Scholarship. Ther are 5 scholarships of up to $2,000 to support you to attend any health-related conference of your choosing.

The ANMF held a report back meeting on 21 March 2024 regarding the status of the nurses and midwives enterprise agreement negotiations. The offer made by the Victorian Government was presented, and whilst there was support for the progress made on non-cost items, a Resolution was made at the meeting to reject the offer and make an application for a protected industrial action ballot order in the Fair Work Commission. In the meantime, when an application for protected industrial action is made, the Fair Work Commission insists on compulsory conciliation between the parties to discuss the impact of the proposed industrial action. Any industrial action cannot occur until after the current enterprise agreement expires on 30 April 2024. I will continue to keep you all informed as things progress.

Finally, my congratulations to Wendy Watson who has recently be recognised by Deakin University by being awarded an Adjunct Associate Professor title. Well done Wendy!

Shane Crowe
Executive Director, Nursing & Midwifery

This month we are focusing on...

Standard 7: Blood Management

An ongoing Standard of the Month program has been introduced to support us to remain ‘accreditation ready’ at all times. This involves a focus on one Standard per month, with communications and walkarounds to help staff be aware of how Best Care at Western Health reflects this Standard, to ask staff possible Surveyor questions and answers, and to walk in a Surveyor’s shoes to see what our practice at Western Health looks like.​

We are excited that NSQHS Standard 7: Blood Management is to be the focus of April’s Standard of the month. This will run from Tuesday 2 April to Friday 26 April. Look out for friendly Fab 5 Team Members, Best Care Co-ordinators, and other staff who will visit clinical areas/departments to discuss Blood Management with you.

Click here to view a calendar of Blood Management Standard of the Month activity.​

Our aim is to have every clinical department/service across Western Health visited within the month. Click here to access the NSQHS Standard 7 Walkaround template that includes Q&As plus a checklist of ‘what can you see’. This template can be used at any time by staff to keep Accreditation Ready for NSQHS Std Accreditation Survey.

To get up-to-date with accreditation readiness and Blood Management, read the NSQHS Standard 7: Blood Management Bulletin. An ‘at a glance’ one pager on the Standard is also available and will be distributed on walkarounds.

Registration Renewal time

Awesome Accreditation outcome

Changes to restrictive intervention requirements in Western Health EDs and UCCs

New Footscray Hospital clinical move planning underway

Enterprise Agreement update

Reframe your response - new virtual reality OVA training

Nominate our Inspiring nurses and midwives

Joy Turner Memorial Scholarships now open

Nursing Trailblazer Award nominations now open

National Maternity Workforce Review Project update

Congrats to these notable appointments

Deputy Director, Nursing & Midwifery Workforce

We’re pleased to announce the appointment of Rohan Kan as Deputy Director of Nursing and Midwifery Workforce after a highly competitive recruitment process.

Rohan brings a wealth of nursing and leadership experience having worked as a Nurse Manager, Critical Care Educator, Assistant Director of Nursing and Director (Pandemic Response) with Tasmanian Health Service.

Having recently worked in centralised staffing roles, he brings a sound knowledge of supporting managers with workforce planning, recruitment and operational leadership of supplementary staffing and allocations.

Rohan will commence in the role on Tuesday 2 April 2024.

CPO Environmental Risk Factors

The transmission of highly resistant pathogens such as Carbapenemase-producing organisms (CPO), other multi-resistant organisms, Clostridioides difficile and norovirus can have significant impacts for the patient and on the healthcare facility in its ability to provide patient services.

CPOs are highly resistant bacteria found in the human bowel, including Klebsiella, E. coli, Acinetobacter, and Pseudomonas. They have previously been referred to as CRE or CPE but now are collectively known as CPO. Some CPOs have acquired genes that make them resistant to antibiotics, including carbapenems. When people get serious infections from CPO, there can be limited antibiotic treatment with associated high mortality rates.

Stringent hand hygiene, equipment cleaning and environment cleaning are the cornerstone for the prevention of disease transmission and protection of patients in healthcare settings.

The use of WoW’s and LoW’s can be a source of environmental transmission to the patient and the environment. A Victorian public hospital identified the introduction of mobile computer stations as one of the key factors associated with increased CPO cases and transmission of CPO in their facilities stemming from one clinical area. The nature of WoWs is that they are highly mobile, go from patient to patient and across areas, and are used for other purposes than just as a computer station, which then increases transmission risk to patients.

WOW’s are a high use piece of communal equipment, entering multiple patient areas and handled by numerous staff members. They are not a part of the patient zone so hand hygiene and cleaning between contact with the patient zone (inside the bedside curtain or room) and the WOW is essential. Pathogens can have significant survival times in the environment – ranging from hours up to over 48 months (depending on the pathogen)!

Current Concerns

Alertness level: High, with a moderate to high level of concern. Sunshine Hospital has 4 declared Victorian Transmission Risk Areas (TRA) which means Sunshine patients admitted elsewhere across Victoria are screened and isolated by other organisations with follow up to Western Health’s Infection Prevention team for 12 months. The first transmission triggered 1,600 contacts for tracing and following up including post-discharge, one of the more recent cases has had 1,000 contacts. This volume of contacts puts significant pressure on the organisation for single rooms, striction isolation, additional cleaning, and increased infectious risk alerts.

Sunshine Hospital currently has 3 different strains of CPO with 2 of these unique to Sunshine that have not been identified elsewhere in Victoria and are imported from overseas healthcare treatments with ongoing unidentified chains of transmission to other patients. Patients are also highly mobile within wards, across wards and across our hospitals which increases risk of transmission. There has been an increase in cases with international travel post borders opening.

Review of WoWs and LoWs at Sunshine Hospital: Sunshine Infection Prevention team have undertaken audits of WoWs and LoWs both ward based and medical based after identifying several practice issues that could be contributing to transmission with wards and across wards. There has been noted improvement in the cleanliness and usage of WoWs from January to current. The common issues observed are:

• Lack of Clinell Disinfectant wipes and alcohol hand rubs on the WoWs,
• Lack of cleanliness of the WoWs surfaces,
• Sterile equipment stored on surfaces, in empty Clinell holders
• IV infusions and IV medication on contaminated, unclean surfaces
• Medicine cups stored in contaminated mouse holders, spoons, jelly on WoWs which increases risk of patient ingestion of such pathogens directly into the patient’s mouth from such contaminated surfaces.
• Occasional coffee cups and several water bottles of staff
• Patient equipment, shared equipment used on patients, stethoscopes, tendon hammers,
• Watches, phones, messenger bags, masks
• WoW surface being used for aseptic procedures such as taking blood, drawing up medication etc.

Infection Prevention has also done ultraviolet maker (UV) testing to check for effective cleaning by placing UV dots on WoWs and then reviewing the WoW 24-48 hours post to check if cleaning has occurred and the dot removed by examining it under a UV torch. Asset numbers are recorded to track down the marked WoW.

How can I help stop the transmission?

Good WoW practice:

• Local monitoring and communication to staff at huddles and handovers about cleaning requirements is important. They must be cleaned at a minimum at the start of the shift or round by the doctor or nurse using the WoW and at the end. Areas and teams should develop a local process.
• Make sure no items such as sterile stock, personal clothing, medicine cups, spoons, staff drink bottles and food are placed on the WoW
• A small number of medicine cups and spoons can be placed in kidney dish for a medication round and then returned to treatment room at end of session, or they can be kept in the patient’s own medication drawer.
• Ensure Clinell wipes and hand rub are available on WoW for routine use.
• Do not eat or drink in the clinical areas.
• Ensure keyboard is cleanable and cleaned regularly as debris and soil become embedded in the keyboard grooves.
• Do not take WoWs and LoWs into isolated patient rooms or inside the bedside curtains as these curtains frequently come into direct contact by multiple hands and equipment, please use the dedicated PC in single rooms and managers ensure they are functioning.
• Do not set up for sterile procedures on the WoW, use a dressing trolley.
• Do not attach tapes to the WoW or tape paper towel to the WoW for use as a mouse pad, specific cleanable infection prevention mouse pads are available.
• WoWs are not part of the patient zone so hand hygiene must be performed between touching the patient and the WoW. If the WoW then does encounter the patient environment, then it must be cleaned.
• WoWs should be thoroughly cleaned at the end of each round, including the keyboard, mouse, and surfaces.
• Don’t place personal items on the WoW or hang it off them.

Other environmental requirements:

• Clean all shared patient equipment, stethoscopes, tendon hammers, shower chairs, hoists etc after each use on patients.
• Ensure patient rooms are not cluttered and therefore not easily cleaned.
• Patients are provided with hand wipes with their meals, encourage them to use them to reduce that oral ingestion.
• Ensure contaminated equipment, linen skips, clinical waste bins are not in close proximity to isolation trolleys, so PPE is not contaminated.
• Do not place food trays on isolation trolleys therefore contaminating PPE and surface.
• Clean isolation trolleys at beginning of each shift and don’t place sterile items on them, along with cleaning of any equipment attached to patients such as pumps, monitors, ventilators etc. which are frequently touched by multiple hands.
• Remember to always practice good hand hygiene including before and after glove use, wearing gloves does not negate the need for hand hygiene.
• Gloves should be readily available in the room and not stored outside on the isolation trolley to ensure hand hygiene is performed and gloves donned after touching the curtain or opening the door, immediately before touching the patient.
• Ensure all CPO rooms have a terminal clean with UV markers used and steam cleaning of their sinks prior to room being used again.

Communicating risk:

• Always fully complete the infectious risk screening tool on each admission and check if patients have been overseas or within another TRA declared hospital in Victoria. If yes, please refer to the CPO procedure and let Infection Prevention know.
• Always check patient infectious risk alerts on presentation and admission as there are several thousand CPO different alerts in place, read the comments in the alert and the Infection Prevention notes in EMR for guidance, never cease or resolve an infectious risk alert or cease CPO screening orders, only ID or IP undertake that. There are 2 different clearance regimes required depending on the level of contact and within set timeframes.

Bill introduced to enhance Nurse Practitioner autonomy

The Commonwealth has been undertaking work to recognise the role Nurse Practitioners and participating midwives play in the delivery of health care services, contributing to the bigger goals of the Strengthening Medicare Taskforce and the Nurse Practitioner Workforce Plan.

Nurse Practitioners are experienced registered nurses who have completed a Master’s degree. They work independently to assess and diagnose patients, request and interpret tests, prescribe medication and therapies and make referrals to other health practitioners.

Currently, nurse practitioners and endorsed midwives are prevented from autonomously providing services under Medicare and prescribing PBS medicines, without the supervision of a medical practitioner – known as a Collaborative Arrangement. An independent review found this legislated requirement creates several barriers to accessible, high-quality care for patients, particularly in rural and remote communities where it can be harder to see a doctor.

The Professional Standards for Practice, and Safety and Quality Guidelines issued by the Nursing & Midwifery Board of Australia already requires registered nurses, midwives, and nurse practitioners to engage in collaboration with other health professionals.

The Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024 was introduced to Federal Parliament on 20 March 2024. If passed by Parliament, the Bill will remove the legislative need for collaborative arrangements to provide MBS services and prescribe PBS medications.

The Bill aims to:

• remove barriers to care provided by nurse practitioners and participating midwives, particularly in rural and remote areas where there:
  – is a smaller healthcare workforce
  – are challenges attracting and retaining GPs.
• provide nurse practitioners and participating midwives more autonomy in their scope of practice
• increase use of participating midwives in First Nations settings
• support our goal of health care professionals being able to work to their full scope of practice.

Subject to passage through Parliament, the change will come into effect from 1 November 2024.

IV Paracetamol shortage

The current shortage of IV Paracetamol 1000mg/100mL vials/bag in Australia is anticipated to continue until June 2024 due to unexpected increase in demand and production delays.

Clinicians are requested to consider alternative routes of administration and to reserve the use of IV vials for situations where alternative routes are not suitable.

Western Health has limited stock available, and hence usage of stock is being monitored closely. Over the past week usage of this product has not reduced sufficiently despite various interventions, and subsequently our projected stock holdings continue to decline. Hence, we are now taking the measure of removing stock from additional Western Health imprest sites except for ICU, Theatre and Emergency Department locations.

Paracetamol suppositories have been added to all imprests currently/previously stocking IV preparations and should be used as a first-line alternative for patients unable to have oral preparations.

Please contact Pharmacy for individual requests for paracetamol IV supply in locations where it has been removed from imprest.

Our Commitment to Close the Gap

National Close the Gap Day was recently held on 21 March 2024, and recognises the national agreement to overcome inequality experienced by Aboriginal and Torres Strait Islander people and achieve life outcomes equal to non-Indigenous Australians.

Each year progress on the 19 national socio-economic targets across areas that have an impact on life outcomes for Aboriginal and Torres Strait Islander people is reported.

They range from ensuring babies are born at a healthy birthweight, supporting children to thrive, and ensuring there are appropriate pathways for education and employment.

Progress has been made, but it has been too slow and the gap is still too wide. For instance, Aboriginal and Torres Strait Islander people still have a life expectancy that is 10-11 years less than non-Indigenous Australians!

Western Health has a growing Aboriginal and Torres Strait Islander community and is committed to self-determination. As part of our efforts to close the gap we are incredibly proud of the culturally responsive care options we have designed to ensure that Aboriginal and Torres Strait Islander patients receive respectful, high-quality care with greater access and choice. These include:

A small team of dedicated midwives and doctors, who provide culturally-safe continuous care to Aboriginal and Torres Strait Islander families and babies. You can read more about how this service is improving outcomes for our community on our website.

A program promoting the health and developmental outcomes of First Nations children in Melbourne’s Western Suburbs (the City of Melton and Moorabool Shire). Establishing and building on strong networks, the program supports children and their families in their engagement with child health and promotes cultural safety in health.   

It won the Excellence in Aboriginal Health and Wellbeing Award at the Victorian Public Healthcare Awards in 2023.  Read more.

A culturally safe, general medicine stream clinic for Aboriginal and Torres Strait Islander adults with chronic health conditions who do not require urgent care.

It is designed to provide a wrap-around service for patients with longer appointment times, a multidisciplinary focus, assistance with any barriers to attending and the individualised support and advocacy of an Aboriginal Hospital Liaison Officer (AHLO). Read more.

Wilim Berrbang Manager (Acting) Ashleigh Vandenberg and Wiradjuri woman said that everyone has a part to play in helping us achieve health equity for all Australians. “We all have a role to play in closing the gap and our actions can have a positive impact on the health and wellbeing of Aboriginal and Torres Strait Islanders and society more broadly,” Ashleigh said.

New support for Aboriginal Menal Health consumers

To improve the way we support consumers and their families seeking support with their mental health and wellbeing, Western Health has appointed our first Aboriginal Mental Health Liaison Officer in Wilim Berrbang.

Maddie DePetro (pictured right) is from the Yorta Yorta & Dja Dja Warrung clan and is passionate about ensuring Aboriginal and Torres Strait Islander patients feel heard within the healthcare system.

Referrals can be made to Maddie via the Wilim.Berrbang@wh.org.au, via phone on 0482 130 724, or on EMR select: Aboriginal health- Other- Request AMHLO support.

How can I make a difference?

You can make a difference by being educated and informed on ways you can provide culturally-safe care:

• Read more about Closing the Gap on its website. The latest report was released on 21 March.
• Read Western Health’s Cultural Safety Plan.
• Complete our cultural awareness training on WeLearn to improve your understanding of Aboriginal and Torres Strait Islander cultures, histories and successes.
• Visit the Wilim Berrbang team staff intranet page.

Benchmarking Best Care

The latest benchmark reports from the Health Roundtable that go up to September 2023 have recently been released, that show how our delivery of Best Care compares to other health services across Australasia.

Let’s look at how we perform in the area of Medication complications, which include drug related respiratory complications/depression, haemorrhagic disorder due to circulating anticoagulants, movement disorders due to psychotropic medication and serious alteration to conscious state due to psychotropic medication.

Medication Complications:

At Western Health as a whole the rates of medication complications per 10,000 episodes has been consistently green. We are amongst some of the best outcomes in Australia. This is a wonderful result.

The last quarter this has decreased again to green.

Well done to all of our Western Health teams.

Educational Opportunities

Are you ready to embark on an exciting educational journey in 2024? Please click here for details on how to apply.

Refer to the Department of Health links below to see if you qualify for the 2024 DHS Scholarships:

• Post Graduate Nursing/Midwifery scholarship information
• EN to RN DHS scholarship information
• Mental Health Post Graduate Scholarship information
• Aboriginal Nursing and Midwifery Postgraduate Scholarship Program information.

Upcoming courses being offered to Western Health nurses and midwives:

April 2024 

18 – Diabetes Study Day
23 – Deteriorating Patient Study Day
23 – Stroke Study Day
24 – Preceptorship Study Day (Williamstown)
29 – Excel Introduction (9am-12pm)
29 – Excel Introduction (1pm-4pm)
30 – CVAD Workshop
30 – Surgical Advanced Study Day 

May 2024

1 – Preceptorship Study Day (Bacchus Marsh)
10 – The 3’D’s – Dementia, Delirium and Depression Study Day
15 – Heart failure study day

Please visit the Education and Learning link for more courses.