1. Home
2. Projects
3. Projects 2005-07
4. Hunter New England - Project Officer: Area Guidelines, Standards and Protocols

Hunter New England - Project Officer: Area Guidelines, Standards and Protocols

Aims and Objectives

1. Assist with the implementation of the 12 NSW Health Paediatric Clinical Practice Guidelines (CPGs) to pilot and non pilot sites
2. Develop, disseminate & implement new policies and guidelines relating to the HNE paediatric services
3. Develop effective links with health care providers (including GPs) throughout the merged HNE Health Service
4. Continue to liaise with key groups to develop/review existing area guidelines

Description of Project

The secondment of Project Officers (PO) responsible for area guidelines, standards and protocols for an additional two years to expand on current achievements.

The PO are currently actively involved in the roll out of a major 3-year project relating to the 12 most common presentations to Emergency Departments. The PO will also commence a new project relating to the development of guidelines for the transfer of non-acute patients.

The PO will expand their roles/services to cover the Northern and Southern Sectors of Hunter New England Health (HNEH). One project officer is based in the Manning Area. Workforce issues and capacity building are an established deficit in this area of disadvantage. This project officer will also work closely with the local Aboriginal Health Service to provide smooth transition through emergency and the acute paediatric unit.

Expected outcomes

• Area wide:
  • 6 area-wide policies will be developed and implemented for emergency, inpatient and community, including:
    • Collocation adults and children in HNE facilities
    • IV Cannulation policy
    • Pain Management
    • Transfer of children from emergency to inpatient paediatric care in higher-level hospitals
• Manning:
• Evidence of local directives/clinical competencies implemented into clinical areas of MRRH
• Policy compliance procedures developed and implemented addressing the 12 Paediatric Clinical Practice Guidelines (CPGs) to pilot and non-pilot sites.
• Development of expert steering committee to guide the development of area wide policies and protocols.
• Development of framework for the process of policy and protocol development and implementation.

Performance indicators

The following performance indicators are being used to measure the success of the project:

• Area:
  • Evidence of 6 area-wide policies developed and implemented for emergency, inpatient and community, including:
    • Collocation adults and children in HNE facilities
    • IV Cannulation policy
    • Pain Management
    • Transfer of children from emergency to inpatient paediatric care in higher-level hospitals.
• Manning:
  • Evidence of local directives/clinical competencies implemented into clinical areas of MRRH
• Evidence of policy compliance procedures developed and implemented addressing the 12 Paediatric Clinical Practice Guidelines (CPGs) to pilot and non-pilot sites.
• Evidence of development of expert steering committee to guide the development of area wide policies and protocols.
• Evidence of development of framework for the process of policy and protocol development and implementation.

Progress

Area

• Area Policy Procedure and Guideline development
  • Continuing to work with experts and working parties and consult across the area to guide the development of area wide policies and protocols. Consultation with specialist topic experts throughout the development of policies and policy compliance procedures including Pain Management, Infection Control, Migrant Health, Aboriginal Health, Communication and Nursing Management. Divisions of GPs.
• Procedures and Guidelines completed now available on the web site
  • IV Potassium
  • Clinical Management of Isolated Closed Paediatric Femoral Shaft Fractures in Rural Referral Hospitals and Community and District Hospitals
• Area wide policies, procedures which have been through the process of discussion with working party or consultation with HNE staff and key external stakeholders and are now with the Children Young People and Families Clinical Network for ratification with the CYPFCN
  • Security of children in HNE facilities
  • IV Cannulation
  • Escalation of Care of Children in HNE hospitals, including Criteria for transfer to Tertiary Hospital - Physical Abuse and Neglect
  • Written Information for Parents
  • Under development
    • CPG Tracheostomy Care and Management
    • CPG Tonsillectomy Care and Management
    • Interfacility of transfer of paediatric patients Guidelines
    • Pain Management, including pain assessment, the use of oral sucrose and non-pharmacological strategies
• Under development with the representative from the Three Children’s Hospitals
  • Photography and Video of Paediatric Patients
• Policy compliance procedures developed and implemented addressing the 12 Paediatric Clinical Practice Guidelines (CPGs) to pilot and non-pilot sites.
  • CNC Paediatrics had implemented the CPG’s in all HNE sites
  • Review conducted of Seizure and Croup Guidelines
  • Audit commenced on Fever CPG across HNE Health
  • Commenced review of Fever CPG
• Ensuring support for area policy development
  • Teleconferences organized and conducted with Working Party
  • Participation in working parties across HNE to ensure representation and consultation, including
    • Kaleidoscope Lower Hunter
    • Upper Hunter Cluster
    • Kaleidoscope Quality
    • CPG Steering Committee
    • MRRH Paediatric Working Party
    • Draft process for on-going area policy procedure and guideline development

 

Manning

• Review and completion of 12 local CPG pathways for initial assessment and management of the following presentations:
  • Recognition of the sick child,
  • abdominal pain,
  • asthma,
  • bronchiolitis,
  • croup,
  • bacterial meningitis,
  • fever,
  • head injury,
  • gastroenteritis,
  • seizures,
  • sore throat,
  • otitis media.
  • Conducted in collaboration with 3 staff Paediatricians, Director of Clinical Services, NUM of ED and Paediatrics.
  • Pathways modified for Bulahdelah and Gloucester Hospitals
  • All 12 pathways implemented into the ED at MRRH and Bulahdelah Hospitals
  • 12 PCP’s developed in relation to the above pathways
• 6 Local directives developed at MRRH, implemented and ratified by local directives committee at MRRH:
  • Intra-hospital transfer of paediatric patients from the emergency department to the paediatric unit
  • Admission of a paediatric patient to MRRH
  • Medical Early Response Intervention System (deteriorating patient)
  • Nasopharyngeal aspirate
  • Criteria for admission of an adult patient to the paediatric unit in times of extreme bed crisis.
  • Adolescent admission to the Paediatric Unit.
  • Under development
    • Paediatric ED assessment form
    • Paediatric observation form
• Education provided
  • 42 Paediatric Education sessions provided
  • 23 Different topics
  • Total of 267 staff attended Paediatric in-service
  • Staff attendance- Nursing, RMO’s, Interns, Medical students, Management, Intensivist, GP’s
  • 3 monthly inservice on the CPG’s at RMO education sessions.
  • 1 full day CPG workshop with the CEC
  • Regular weekly in service education on the CPG’s to ED staff: Nursing, medical staff and students
  • Ongoing RMO orientation in-service in regard to the CPG’s
  • Development and implementation of Paediatric Advanced Life Support program including in service, written examination and practical competencies test. Developed in consultation with ED CNE and Critical Care CNE
    • 25 staff attended education session with 4 staff successfully completing competency test and written examination.
• Meetings:
  • Local MRRH Paediatric Working Party established and bi-Monthly multidisciplinary meetings held of MRRH Paediatric Working Party, including management, executive, local community health services, allied health services, acute care services, HNEAHS Paediatric Network representation, area CNC, NCHN representation, medical and nursing staff and CAMHS services.
  • MRRH Local Directives Committee
• Implementation plan developed in regard to paediatric issues identified from an internal review carried out in December 2006
  • 23 out of 27 recommendations have been full achieved with the remaining 4 partially achieved and ongoing with support. (See attached report)
  • Submission for HNE Quality Awards send re the above project-Awaiting result
  • Local directives/protocol/guidelines developed where indicated in the implementation plan
  • Review and updating of existing MRRH paediatric unit protocols occurring in consultation with NUM paediatrics, CNS Paediatrics, Project Officer, MO Paediatricians, and other experts and key stakeholders where required. Current evidence reviewed and protocol updated accordingly, using MRRH local directive template.
  • New protocols developed through consultation of members of the MRRH Paediatric Working Party and wider consultation where necessary with other key stakeholders.
  • All updated existing and new MRRH protocols ratified through the local MRRH local directive committee.
  • PCP’s and area policies that relate to the care of children discussed, reviewed and implemented by the MRRH Paediatric Working Party.
  • Development of local protocols decided through review and update of current protocols and new evidence as well as RCA recommendations and IIMS trends.

Discussion

HNE Area Challenges

• Need to encourage small local working parties, while incorporating into wider framework
• New area wide HNE policy development framework, which is not widely known among those currently preparing local procedures
• Development of an IT method to ensure easy access to current, evidence based practise for procedures and guidelines.

HNE Area Successes

• Good working relationship continues between NCHN and the HNE Paediatric services with strong links to Southern, Northern and Manning
• Acceptance by many individuals, units and committees, of the Project officer/ Policy Officer position and willingness to be involved in the policy making decisions.

Local MRRH Challenges

• High staff turnover in the ED and paediatric unit
• Busy ED makes education difficult at times
• Locum Medical Officers in the ED and Paediatric unit who are unfamiliar with local protocols
• Continuation of Paediatric education program when project officer position completed
• Ensuring all staff are aware of new and updated paediatric guideline and protocols.
• Project Officer position 2 days per week so difficult at times to be flexible in education, both scheduled and opportunistic and to be able to meet with key stakeholders and staff.
• Ensuring sustainability of achievement when there is no longer a project officer to drive initiatives

Local MRRH Successes

• Established links between acute, community and allied health paediatric services.
• Regular meetings with above key stake holders developed
• Higher profile and interest of paediatric service provision at MRRH.
• Executive and management support for all paediatric projects
• Interest and attendance at regular paediatric education sessions
• Development of effective local protocols and guidelines
• Networks established within MRRH and with NCHN and HNEAHS
• Development of paediatric education program and APLS program

The MRRH component of this project is now complete.

Contact

For further information on this project contact:

Hunter New England Health Lucy Bates Policy Officer, Area Guidelines, Standards and Protocols 02 4939 2469 lucy.bates@hnehealth.nsw.gov.au

Manning Rural Referral Hospital Sandra Babekuhl Project Officer, Guidelines, Standards and Protocols 0400328696 sandra.babekuhl@hnehealth.nsw.gov.au