Remote cardiac device monitoring program in QueenslandAuthor/s
I started my nursing career in Cairns and obtained my nursing registration in 1987. Post registration I worked in many areas within the hospital inclusive of thoracic, intensive care, paediatrics and emergency. On moving to Brisbane I worked at the Mater Adult Hospital in intensive care and coronary care before deciding to obtain my midwifery certificate at The Royal Women’s Hospital. I then moved to The Prince Charles Hospital and worked in the paediatric cardiac ward and obtained my nursing degree around this time also. I have been fortunate to travel and work overseas in cardiac areas before again returning and continuing at The Prince Charles Hospital. I have worked in many roles from ward based to then onto to the wider care of the cardiac patient in the role of cardiac care coordinator. My present role is Cardiac Care Coordinator with my portfolio being with the Electrophysiology patient. I have met and worked with many amazing and inspiring families which give me great pleasure in my working life. The rolling out of the home monitoring program is just a small part of the advancing opportunity within our ever expanding cardiac service.
Mary has nursed in a variety of paediatric settings over the last 25 years including paediatric intensive care, post-operative cardiac surgical intensive care, neonatal intensive care and cardiac surgical/medical ward. She has a particular interest in nursing education and has spent the last 10 years as the Paediatric Cardiac nurse educator for the Queensland Paediatric Cardiac Service.
The Queensland Paediatric Cardiac Service reviews over 5000 cardiac children and their families per year in an outpatient setting. Approximately 200 of these patients, ranging from infants to adolescents, have an implantable cardiac device e.g. internal cardiac defibrillator, permanent pacemaker or internal rhythm- recording device. Families in Queensland needing cardiac review may have to travel up to 3000 kms to the appropriate tertiary-referral hospital. The financial and psychological cost of this can be considerable (Searle, 2014).
In 2009 after collaboration with the lead electrophysiologist, cardiac scientist, nurse care coordinator and a leading medical industry provider, a remote monitoring program was developed in Queensland. This remote monitoring service consists of families taking home laptop sized monitors so that data from the implanted device can be downloaded and transmitted to the tertiary centre. The wireless monitor is placed within 10 meters of the patient and data is then transmitted to the clinic at the scheduled time. This data is reviewed by the care coordinator, analysed by the cardiac scientist and then reported by the electrophysiology group. For example, a patient with a permanent pacemaker will provide data that describes battery status, lead status or any detected abnormality in cardiac rhythm or rate. All results are discussed with the families by the nurse care coordinator. Telephone support is provided weekly to discuss any concerns, compliance issues and technical matters such as connectivity.
Since the introduction of the remote cardiac home monitoring program approximately 90% of patients now only require yearly review at the tertiary centre. Family feedback regarding this program has been overwhelmingly positive with particular respect to convenience, financial savings and reduced disruption to family life.
Botulinum toxin injection clinical follow-up: improving access and empowering local therapistsAuthor/s
Katie has been working as a Consultant in Paediatric Neurodisability since 2008, originally working in the UK and subsequently since 2013 working in Sydney in the field of Paediatric Rehabilitation. She has worked nationally to improve the care of disabled children with physical, cognitive, sensory impairments and behavioural difficulties in her position as Regional Representative for the British Academy of Childhood Disability.
Katie returned to Sydney in 2013 to pursue her passion for Rehabilitation, working in the areas of paediatric brain injury, spinal cord injury, cerebral palsy, musculoskeletal disorders, limb deficiency, metabolic conditions and spina bifida. She now works across the two specialist Children’s Hospitals in Sydney; the Children’s Hospital at Westmead (CHW) and Sydney Children’s Hospital (SCH).
Katie has recently joined the Cerebral Palsy team at SCH who have been exploring different models of care to improve patient attendance, reduce transport costs, and empower family and local therapists whilst maintaining a high quality and responsive service for children with complex and lifelong medical conditions such as cerebral palsy.
Access to specialised children’s services can be a challenge for rural and remote children and their families.
The Cerebral Palsy Service at Hospital is one of 3 tertiary centres in offering Botulinum Toxin injections to children and young people with movement such as spasticity or dystonia. Injections are performed within the hospital either under General Anaesthesia or Nitrous Oxide gaseous sedation.
Follow up assessment response occurs at 4-6 weeks post injection. Patients have a clinical reassessment with their Rehabilitation Specialist and hospital based therapists. A combination of history taking, static and active examinations are performed along with observational gait analysis in ambulant children.
Follow up appointments focus on assessing response, goals achieved, and potential side effects of toxin or sedation method is imperative to guide future interventions, further injections and ongoing therapy provision.
Children accessing our service often have complex care needs such as seizures, sensory impairments, behavioural difficulties and intellectual disability. Their additional health needs mean that optimising skin pressure care and maintaining comfort in seating for long journeys can be difficult. Children often require an overnight stay just to attend one hospital appointment and this involves further time away from school and their peer group. Effective communication with the child’s local therapists is important for timely post injection support and intervention to maximise the effects of Botulinum Toxin.
We are piloting a telehealth follow up model of care incorporating history taking and clinical examination with the child’s local therapists assisting. We anticipate that this would reduce burden on families of travel and expense of hospital attendances, as well as engaging and supporting therapists. We also hope it will promote seamless transition of care from hospital to and provide a consistent, accessible and responsive service for rural patients.
Of the 109 children scheduled for Botulinum Toxin Injections over the time period 20/10/15 to 20/12/15 we are offering this new service to 44 families who live in rural or remote areas. We will present our findings on quantitative data (time and expense) and qualitative data (satisfaction, communication) from specialists, local therapists and the families involved.
Supporting students with healthcare needs in New South Wales public schoolsAuthor/s
Trish has been a paediatric nurse for many years and has worked in a range of settings in both the acute and community sector, in tertiary and non-tertiary hospitals as well as internationally. Having consolidated her paediatric skills in ward-based positions, Trish spent 15 years in a range of positions including Clinical Nurse Consultant at Fairfield Hospital, where she established one of the first paediatric outreach services in NSW. Once that was fully established she moved to Nepean Hospital where she was responsible for developing paediatric services across four hospitals in the Western Cluster of the Area Health Service. After 5 years she moved on to work with NSW Health where she was the Acting Program Manager for Paediatrics. This role involved contributing to strategic development and policy for children, from a broader, state-wide perspective. In 2013 she moved to the Department of Education and continued to provide state-wide support in a newly created position, Complex Support Disability & Health. The position was created to provide advice to schools who are working with families and school communities to implement adjustments for children with disability or health needs. Trish has also held several university affiliations teaching both undergraduate and post-graduate nursing subjects. Trish has presented at many nursing conferences both nationally and internationally, and has a number of publications.
Kylie Pennell is the Executive Principal of Bourke Public School situated in rural remote North West New South Wales. Kylie strongly believes in providing disadvantaged students with different forms of academic development to ensure their success. She is a proud Wirradurri woman who originates from Coonamble New South Wales.
Kylie has been a Principal for the past 13 years and worked with the Department of Education for 16 years. Kylie has been involved in various rural and remote schools across the Western region as the Principal and has excelled in implementing programs specifically aimed to improve outcomes for Aboriginal and Torres Strait islander Education.
During her career, Kylie has been involved in Aboriginal and Torres Strait Islander Education groups/committees to ensure that she is involved in the decision making and ideas the Department of Education and Communities implement for students. She displays a real passion towards promoting Education in rural and remote communities and involving parents and the wider community in student’s daily learning.
As Executive Principal of Bourke Public School she has worked with the wider community to develop a broad range of educational programs aimed towards improving educational outcomes for all students.
Kerrie has worked in public education in NSW for over 38 years and has been committed to supporting students with disabilities and additional support needs across a wide range of environments in NSW.
She has held positions with the NSW Department of Education as a classroom teacher, support teacher in regular and special schools, ED/BD outreach teacher, Special Education Consultant, Assistant Principal Behaviour and the principal of special schools for 11 years. For the past 8 years Kerrie has held executive positions with Learning and Wellbeing Directorate. She has lead teams responsible for the support of schools across NSW where students with complex needs are enrolled. These complexities include healthcare support during school hours. The teams work in collaboration with parents/carers and educational services teams local to the school to ensure the necessary adjustments are in place to support the student and their family. This support includes the training of school staff who have responsibility of implementing individual healthcare procedures according to the student’s healthcare plan. Kerrie is committed to supporting all students, staff and school communities, regardless of their geographic location, to access current information, quality professional learning and point in time support.
When thinking about meeting the healthcare needs of kids, school is not the first service provider that comes to mind. But children spend around 30 hours a week at school. The health care needs of many children cannot be scheduled to occur outside the hours of 9am to 3pm. The Disability Discrimination Act 1992 is national legislation intended to ensure that students with a disability can access and participate in education on the same basis as other students. Under that Act, the definition of disability is very broad and includes illness.
In NSW, approximately 740,000 students attend more than 2,200 public schools. About 51% of these schools is classified as rural or remote. Due to advances in science and technology, increasing numbers of children with chronic and or complex medical conditions attend NSW public schools. At any one time, approximately 5% of students receive targeted support. This can vary from assistance with activities of daily living such as toileting (for example they may need catheterisation) or feeding (they may require tube feeds), through to students that require the administration of medication or tracheostomy management, as well as support for students’ learning.
All schools are required by legislation and policy to provide reasonable adjustments to facilitate the access and participation of students with disability, illness and or complex healthcare needs. However, the availability of health staff with specialist health knowledge to support school staff decreases the further one moves from the large metropolitan hubs. This increases the challenges on schools in rural and remote NSW to meet the healthcare needs of their students.
To meet this challenge, particularly for rural and remote NSW public schools, the NSW Department of Education has developed a range of resources including an online training calendar, healthcare kits and healthcare procedure training, and dedicated specialist positions in State Office. The Department has initiated a strategy that supports eleven of the most complex communities in rural and remote NSW. Connected Communities is an innovative strategy that is driving educational outcomes for Aboriginal children and young people and all students, by positioning schools as community hubs, where schools facilitate access to services such as health, welfare and early childhood education and care.
A number of resources are currently under development including an interactive decision tree to support to meet healthcare needs; a new Wellbeing Framework for Schools; and Networked Specialist Centres which will provide schools with additional specialist assistance in supporting students whose needs are complex, and will create better linkages between schools and other services, including health services.
This easy to access digital poster will allow delegates to interact with the poster to explore the resources available in NSW public schools to support children with chronic and or complex health care needs, their families and the school community, regardless of their knowledge of, or confidence with, technology.
What does access and inclusion look like in a rural NSW town?Author/s
Associate Professor Chris Boyle lectures in Inclusive Education and Psychology in the School of Education. His main research interests are in the area of teacher perceptions of inclusion and students attributions for success and failure in learning. Previously Chris has worked as a secondary school teacher and as an educational psychologist in Scotland. He is currently editor of the Australian Educational and Developmental Psychologist and he has published widely in psychology and education.
Introduction: When communities are considering services aimed towards people with physical and intellectual disabilities, children can be an easily overlooked population outside educational and therapeutic environments. Ageing Disability and Home Care (ADHC), Department of Family and Community Services, commissioned a project to investigate how families and community members perceived how and whether services in a rural town in outer-regional NSW was accessible for and inclusive of children with additional support needs aged 0 to 8 years and their families.
Objectives: This study aimed to understand issues around accessibility and inclusivity of children with additional support needs from two perspectives: community leaders and service providers, and the parents of these children. In this way, the study aimed to create a community map of what was perceived to be accessible and effective, and what was perceived to be non-inclusive and judgmental.
Methods: Fourteen people participated in structured in-depth interviews. Interviews were transcribed and then imported into NVivo11. All 14 interviews were explored using interpretive thematic analysis. They were initially coded into broad themes, and then the broad themes analysed interpretively to uncover finer narratives.
Relevance: Over the past 20 years, rural towns in Australia have faced threats to their survival as young people and families leave, in part due to a lack of services and opportunity. As the NDIS is rolled out across NSW, it is vital to ensure that funding is targeted in a way that is not only both cost-effective but also of tangible benefit to those who are most in need of support.
Results: While the narratives of the parents, the community leaders and service providers converged when discussing the negative impacts of travel and expense connected to accessing necessary services and facilities outside the community, they also diverged based on practical experiences. Community leaders and service providers saw issues around funding, training, and perceptions of the community by others as significant barriers to effective and cohesive service provision. In contrast, parents’ narratives were grounded in experiences of social isolation and negative reactions of people within services and schools. Further, while some services were perceived positively, parents also named seemingly simple facilities, such as parks, as the most accessible and inclusive.
Conclusion: Findings from this study demonstrate how service providers and community leaders are attempting to support families of children, but that these attempts may not actually be appropriate to the needs of families with children who have additional support needs. There is significant need to include the families of children with additional support needs in discussions around what services and facilities would be most appropriate and effective.
Food security: setting children up for a healthy lifeAuthor/s
Fiona Brooke is Policy Advisor with the National Rural Health Alliance and prior to joining the Alliance spent 23 years working in the Health Department, including the last three years in Rural Health, where she had responsibility for Outreach programs and has also worked on Infectious diseases, blood borne viruses, health workforce issues and aged care planning. She has a strong interest in social justice issues.
Australia is regarded as one of the most food secure nations globally, producing over 90% of local domestic food needs. But why is it that in a nation that is so food secure, we have distinct communities that are food insecure?
Food insecurity impacts on children from conception. This paper will explore the harms arising from food security—varying from maternal depression to anxiety, sleeplessness, obesity, type 2 diabetes and school absenteeism in children.
- In remote Australia, 23 percent of Aboriginal and Torres Strait Islander people ran out of food at least once in 2012-13. Almost half of those people went hungry.
- The cost of a healthy basket of food can vary enormously across rural and remote Australia, adding to food insecurity in some remote communities.
- In 2009, COAG found that Aboriginal and Torres Strait Islander children aged under 4 were 29.6 times more likely to have diet related anaemia or malnutrition.
The paper will discuss how food insecurity underlies the gap in health for Aboriginal and Torres Strait Islander people and will discuss the effectiveness of measures taken to date to address food insecurity in rural and remote locations and how greater focus on addressing food insecurity will enable faster gains in closing the gap.
Finally, the paper will draw these discussion lines together to propose options for action.
Children’s Advice and Transport Coordination Hub (CATCH)Author/s
Stephanie Caterson is a clinical nurse at Lady Cilento Children's Hospital in Brisbane.
The innovative new service was borne out of the acknowledgment that there is inconsistent availability of expert paediatric medical advice throughout the state. This particular service applies a two-pronged approach to the problem by providing expert paediatric advice to regional, rural and remote areas of the state, and by coordinating transport of paediatric patients into and out of tertiary paediatric inpatient beds.
While there are well-established and well-utilised services for seeking advice regarding the care and transport of critically ill paediatric patients, this new service provides access to a 7-days a week, 7am-11pm advice line for assistance in caring for ‘low acuity, non-time critical’ paediatric patients. Placing children and their families at the centre of care, the provision of support to keep these patients in their local regions keeps families together. Additionally, the service assists in maintaining and supporting improvement of the clinical skills of clinicians in regional centres, and offers financial benefits by preventing unnecessary patient transfers to limited tertiary paediatric beds which could be used more appropriately.
To ensure patient safety, each call for advice is ‘triaged’ using a locally, collaboratively developed triage tool based on CEWT, ENOT, and condition triggers. Optimally, advice is provided by the closest paediatric expert to the location of the child via the use of Telehealth, with teleconferencing used as a minimum where Telehealth is unavailable. Should transportation to tertiary care be required, this is coordinated by the service, which provides a single point of communication, improving access to the right care, in the right place, at the right time.
Enhancing the patient journey from primary through secondary to tertiary care—and back again all transfers are governed by process maps. These maps ensure consistency of service provision and documented inclusion of clinician-to-clinician SBAR handover. The service is the single port of entry and exit to the tertiary inpatient beds, and ensures a closed loop of communication is used with all advice and transport it coordinates.
Commencing in February 2015, data collection illustrates the rapid uptake of the use of the service. Service growth continues with a collaborative approach with other state-wide initiatives, such as STORK and support for high-observation models of care in regional inpatient facilities keeping kids being cared for in their communities whilst building the capacity of rural, regional and remote health workforce teams to care for children locally.
Closing the gap for Aboriginal children and immunisation ratesAuthor/s
Alena Cement is married with four sons aged 22, 19, 14 and 13. She lives on five acres beside a creek just outside Goondiwindi, QLD.
She has been working with Aboriginal Child and Family Health for the past 3 years in the Moree, Boggabilla and Toomelah Communities. She worked with an Aboriginal Health Education Officer, Sharlene and their main focus is working in partnership with families ensuring they have necessary supports and providing education around growth and development, feeding guidelines, immunisations and safety. Most recently one of their main focusses has been on immunisation and decreasing the number of children with incomplete immunisation histories.
Prior to working with Aboriginal Child and Family Health she was an Advanced Care Paramedic with the Queensland Ambulance Service in Brisbane, Hervey Bay and Goondiwindi. Prior to working with the Queensland Ambulance Service, she was a Clinical Nurse in Accident and Emergency at the Goondiwindi Hospital.
Her interests include spending time with my family and friends, watching my boys play sport, playing touch footy, league tag, bike riding and reading and gardening.
I come from Moree NSW. I’m from the Kamilaroi nation tribe. I grew up on the Mehi Mission were we had a white Manager. My Grandmother did not like this so moved her Family onto the Common. We had a big flood so had to move back to the Mission and lived in a Caravan until my Mum and Dad moved into town. I have two sisters and two Brothers. I also have two daughters Jahlinta 26 and Jaimee-lee 24 and son Tully 22 and two Grandson Jirahn and Jyhmahl who are three and I love just sitting and watching them play.
I went to St Philomena’s which is a Catholic School and then onto Moree High School which I attended to year 10. Mum and Dad said I had to go to Moree Tafe if I left school. I attended there doing a Secretarial course. I felt that I needed to do more so went to Sydney to be a Hairdresser but still felt this is not what I wanted to be doing, it was too far away from my mob. So a Child Care Bridging course came up in Moree - so I thought I might try this as I love kids – looking after my younger brothers, sisters and cousins. I really loved learning about Child Development. I got a job in a Long Day Care Service which I studied for four years while I worked. I was there for about 10 years. I then went on to working at our Aboriginal Preschool. I knew that’s what I wanted to do being able to help our aboriginal children and teach our Mothers and Fathers about Early Childhood Development and show them Activities to stimulate their little brains. I was there again for around 10 years. Then went on to work at Moree Family Support to also again working with Aboriginal children setting up Playgroups around town and doing Parenting Programs to Parents that needed too and had to do for FACS. I then went on to Moree Community Health working with AMIHS (Aboriginal mothers Service) that looks after Pregnant women in our Community giving them information and education to make sure they had healthy babies and transporting them to their Dr’s appointments and Midwife appointments. I now work with OATSIH were I work with a beautiful Nurse called Alena to do Health checks on our Aboriginal children and follow up with Immunisations. We also have a clinic once a month to do overdue Immunisation. Our stats showed we had one of the highest for overdue’s in the state and now with doing our Immunisation clinic it as dropped dramatically. I have been working in early Childhood for over thirty years and loved every minute of it and will be doing this I think until I retire. I have been very lucky to have worked with such lovely beautiful women that have had big influence on my life over the thirty years that I have worked.
Hunter New England Public Health identified that the Aboriginal children of the Moree district were amongst the highest in the state for not being fully immunised. For this reason the Moree Child and Family Health Nurses and the Aboriginal Health Education Officer (AHEO) for Aboriginal Child and Family Health devised a plan to increase this rate and to put our Aboriginal children on par with the rest of the state or better still, higher.
Appointment availability, accessibility, transport and family commitments were all identified as being barriers for families not being able to achieve the goal of having their children fully immunised. Our first plan was to conduct an overdue immunisation clinic once a month at our Child and family health clinic. The Aboriginal health Workers from Hunter New England Public Health would send us a list of the overdue and incomplete immunisations and then our AHEO would go out to the families offering appointments for our clinic. The AHEO would also offer to pick the families up on the day of their appointments. While this process started to decrease the number of children on the overdue list, there were still quite a number of children who were still unable to make it to the clinic due to their parent’s commitments with other family members. For this reason the AHEO and the Child and Family Health Nurses packed an esky of vaccines and all other consumables required to immunise and we went to the houses. Immunisation took place in the homes, on the front lawn or in our bus.
It is now very pleasing to say that our rates are up there with the highest in the state and our beautiful Aboriginal children are being protected against preventable diseases.
Paediatric incidents in NSW: what happens where?Author/s
Dr Dalton is a Consultant in Paediatric Emergency Medicine at The Children’s Hospital at Westmead as well as Clinical Director at the Clinical Excellence Commission. She is a President-Elect for the Division of Paediatrics and Child Health at the Royal Australasian College of Physicians and holds a Masters in Applied Management in Health.
Dr Dalton has a long-standing interest in the translation of evidence into practice, and is a strong advocate for improving Quality and Safety in Healthcare. She has a particular interest in Clinical Leadership and was recently awarded a Fulbright Scholarship to evaluate Clinical Leadership Development Programs in the United States.
Outlining the trends and differences between serious incidents reported through the IIMS (Incident Information Management System) in NSW over a one-two year period. Data will explore the differences between incidents in rural and regional areas compared with metropolitan areas. Analysis will cover SAC 1-4 incidents.
Medicines on admission: a paediatric perspectiveAuthor/s
Renee Dimond is Deputy Director of Pharmacy – Clinical Services and Paediatric Clinical Pharmacist at Ballarat Health Services in Victoria. Renee is a graduate of the Victorian College of Pharmacy, Monash University, where she received a Bachelor of Pharmacy (Honours) in 2001 and Master of Clinical Pharmacy in 2006.
After graduation, Renee worked as a clinical pharmacist at The Royal Children’s Hospital, Melbourne until 2008 when she moved to Ballarat Health Services to implement a clinical pharmacy service to the Paediatric and Adolescent Unit and Special Care Nursery.
Renee also lectures undergraduate pharmacy students in Paediatric and Neonatal Pharmacy Practice at RMIT University, Bundoora, is a Pharmacy Registration Examiner for the Australian Health Practitioner Regulation Agency (AHPRA) and a clinical reviewer for the AMH Children’s Dosing Companion and SHPA Don’t Rush to Crush handbook.
Renee has presented at the Society of Hospital Pharmacists of Australia National Medicines Management Conferences in 2012 and 2014 in the areas of medication dosing in overweight and obese patients and promoting breastfeeding friendly prescribing.
Renee is a member of the Children’s Healthcare Australasia Medication Safety Special Interest Group, the Neonatal and Paediatric Pharmacist Group (NPPG) and is a Meds IQ Champion for paediatric medication safety.
Background: Medication use is most often associated with older adults or those with chronic medical conditions. As a result, safe medication practices including medication history interview and medication reconciliation are not always enforced in paediatric healthcare settings, despite the clinical significance to paediatric patients being clearly demonstrated. The incidence of preadmission medication use by paediatric patients is less clear particularly for those children requiring hospital admission outside of tertiary paediatric centres.
Aim: To determine the proportion, and to characterise the use of, preadmission medications amongst paediatric patients admitted to a regional, general hospital.
Methods: All patients admitted to a paediatric and adolescent unit who received clinical pharmacy review during an 8-month period were included. Preadmission medication use was determined by clinical pharmacist interview of the patient and/or their parent/carer including prompting for recently commenced therapies, ‘when required’ items, non-prescription and complimentary and alternative medicines. Confirmation with a second source was sought when deemed necessary. Additional information including patient age and admitting medical unit was gathered. Patients were excluded if their preadmission medication status was unable to be determined or if a second or subsequent admission occurred during the study period and preadmission medication status was unchanged. Paracetamol and ibuprofen were only included if used regularly and immediately prior to admission. Data was analysed by age bands corresponding to key developmental stages as well as use of regular medications, prescription only items and admitting medical team.
Results: A total of 474 patients were assessed for preadmission medication use. The mean age was 7.5 years (range 4 days to 18 years). One in every two patients reported use of preadmission medications prior to hospital admission. The infant age group most commonly received preadmission medications (60%) followed by adolescents (57%) and middle childhood (56%). Of the patients receiving preadmission medications, 65% reported use of regular medications and 65% reported use of prescription only items. The most commonly reported preadmission medications were asthma therapies followed by complimentary and alternative medicines, analgesics and antibiotics. Preadmission medication use by patients admitted under the paediatric medical team was (63%).
Conclusion: The present study results suggest the use of medicines by paediatric patients prior to hospital admission is common. It is therefore essential for healthcare providers to ensure a thorough medication history is obtained, and medication reconciliation occurs, for paediatric patients of all ages to assist with safe delivery of care at each stage of the healthcare journey.
Supporting it locally: implementing a locally run RMDP for paediatrics courseAuthor/s
Louise Dodson a Nurse Educator with Simulation Training on Resuscitation for Kids team (SToRK) and a background in paediatric emergency nursing.
I have an interest in simulation training as a catalyst for behavioural change through reflection with the goal of improving outcomes for sick children under our care.
Over the past 2 years I have had the pleasure in meeting and working with likeminded clinicians and educationalists across the state of Queensland. In working with these clinicians, I have gained a huge respect for the highly skilled clinicians who work in rural and isolated locations and a humble appreciation for the challenges they face.
The ability to recognise deterioration, escalate concerns and implement resuscitation procedures is crucial for positive outcomes for the sick child. Paediatric resuscitation is a rare event in most regional, rural and remote clinicians’ practice and therefore the opportunity to develop skills is limited.
A standardised, time efficient, low cost, paediatric life support course was developed for all healthcare workers caring for sick children. As well as standard basic paediatric life support the course covers paediatric assessment, use of an early warning tool, airway management, vascular access, defibrillation, the principles of clinical handover and human factors training using simulation.
A cost efficient train-the-trainer (TTT) model for course delivery was designed to increase the confidence and capability of local clinicians and educators to deliver the course within their healthcare service, including:
- the simulation education team travelling to regional, rural and remote facilities to deliver the TTT
- ongoing mentorship and equipment support for initial courses run by local faculty
- an In-reach program at a large paediatric teaching hospital for up to 2 weeks.
Implementation state-wide commenced in March 2014. As of August 2015, 321 staff have been trained as trainers. 123 courses have been delivered in 34 different sites across the state. 1731 clinical staff have completed the course, 9141 people have completed the e-learning modules.
Immediately post TTT course 93% of trainers indicated that they felt confident to deliver all elements of the course.
Developing capacity for paediatric oncology service provision across QueenslandAuthor/s
Rachel Edwards is a registered nurse with 21years experience providing care to patients with haematology and oncology conditions. Rachel currently works as a Nurse Educator for the Queensland Paediatric Palliative Care, Haematology and Oncology Network, and the tertiary Oncology Services at the Lady Cilento Children’s Hospital, Children’s Health Queensland, Hospital and Health Services (CHQHHS). In this role Rachel provides educational leadership, develops curriculum, and facilitates training programs for staff employed in the CHQHHS and across the State in the Regional Paediatric Shared Care Units. Rachel is the current Chair of the Nursing Sub-Group of the Australian and New Zealand Children’s Haematology and Oncology Group (ANZCHOG) and is providing nursing leadership to the group as they develop a nursing research agenda and embark on nursing research activities.
Despite cancer diagnosis being a relatively rare occurrence in children aged between 0-14 years, it remains the second leading cause of death in this age group following accidental death. Approximately 150–160 children aged 0-14 years are diagnosed with Cancer in Queensland every year. The challenge of coordinating safe and reliable care for these children across Queensland and Northern New South Wales is a healthcare priority being undertaken by the Queensland Paediatric Palliative Care, Haematology and Oncology Network (QPPHON), allowing patients and families to receive services as close to home as possible. QPPHON’s model of service delivery includes a clinical network of ten regional paediatric oncology shared care units, and the Queensland Children’s Cancer Centre located at Lady Cilento Children’s Hospital. QPPHON supports this model through the provision of a state-wide curriculum of education and training which builds capacity in metropolitan, rural, and regional health care teams to care for children locally.
QPPHON Education support is provided by a consortium of staff including: an Allied Health Workforce Development Officer; State-wide Educator; Nurse Educator; and Clinical Practice Facilitators. These staff plan, develop and facilitate curriculum in conjunction with the local interdisciplinary health care teams, based on the learning needs analysis of each staffing group and service. The QPPHON education curriculum provides education support to clinicians through a learning pathway allowing for development of staff from novice to expert.
The curriculum provides a variety of interdisciplinary programs with delivery modes ranging from face to face workshops to facilitated clinical placements, self-directed learning packages, and local regional workshops. The use of technology has further enhanced the availability and access of training for regional staff with on-line tutorials, video conferenced competency assessments, and videoconference lectures being made available.
A professional development program is also provided by QPPHON where regional staff are encouraged to apply for scholarships to attend professional development opportunities, including conferences and workshops. This program has enabled regional staff the opportunity to attend the Australian and New Zealand Children’s Haematology and Oncology Group annual scientific meeting, and collaborate with colleagues from this professional network.
Each year over 1000 staff access education opportunities provided by the combined QPPHON and QCCC Education curriculum. The curriculum builds knowledge and skill in the local regional health care teams enabling consistent and reliable care to be delivered to paediatric oncology patients and their families across Queensland.
End of life resource—comfort care caseAuthor/s
Maria has a Masters in Nursing Education and currently works as a Clinical Nurse Consultant in Paediatric Palliative Care. She is passionate about health care for people with disabilities and is a board member with the New South Wales Council for People with Intellectual Disability. She is also a co-chair of the New South Wales Agency for Clinical Innovation intellectual Disability Network, is a member of the City of Botany Bay Access Committee and is on the New South Wales Carers Advisory Council. Finally she was the 2012 NSW Carer of the Year.
The Sydney Children’s Hospital Paediatric Palliative Care Service created a resource called, the Comfort Care Case for use during the end stage of a child’s life. It was an interdisciplinary effort with input from medical, nursing and allied health members of the team.
As health professionals we are trained in how to care for sick children. Sadly, despite modern technology and the provision of excellent medical care, some children will still die. This dying process - sometimes referred to as the terminal phase - can be short within in hours or over days and weeks. Comments are made during this time that ‘nothing can be done’ which is not true. Care at the end of life focuses on active total care incorporating the physical and emotional care of the child and family, supporting visitors and supporting each other as clinicians.
The Comfort Care Case is designed to:
- support the child as they approach death
- create a home like environment
- symptom management and prevention
- support those surrounding the child, parents, carers, siblings, grandparents
- enhancing their physical well being
- create tangible and intangible memories (if appropriate)
- provide staff with resources to enhance the care of the dying child
This resource was piloted in the children’s intensive care unit and is a quality project that was conducted with the help of a working party over a 2 year period. We have done a literature review, provided education to 142 staff (our aim was to cover at least 50%) before the pilot was launched, conducted a 3 month pilot and has evaluated the education and the pilot and would like the opportunity to share our journey.
Quality of Care Collaborative for Paediatric Palliative Care in Australia (QuoCCA)Author/s
Dr Anthony Herbert is a paediatrician who has specialized in paediatric palliative care and is based at the Lady Cilento Children’s Hospital (LCCH), Brisbane.
He trained in both oncology and palliative medicine and completed a 2 year fellowship at the Children’s Hospital at Westmead, Sydney. His research interests include communication, telehealth and the role of music therapy in palliative care. He is an active collaborator in the Quality of Care Collaborative of Australia (QuoCCA) – for Paediatric Palliative Care Education. This project is based at the LCCH and is facilitating educational activities in each state and territory of Australia.
Background: Geography and population distribution present challenges to the care of children with life-limiting conditions (LLC) within Australia. Children and young people have unique needs in relation to the provision of palliative care within Australia.
Aims: This project aims to improving the quality of care provided to children in close proximity to their home through educational initiatives.
Methods: Key activities of the project include
- Developing a ‘pop-up’ model of palliative care education. This will enable health professionals working in regional, rural and remote locations to receive education and support around the care of children with LLC conditions in a timely and responsive manner.
- Development of Nurse Educator roles within Paediatric Palliative Care services and the development of web-based educational resources.
- Provision of training in PPC for medical trainees in paediatrics and palliative medicine at 3 sites.
Pop-up education: ‘Pop-up’ education usually occurs (face-face or telehealth) when a specialist service is building capacity within a child and family’s local community and creating a paediatric network. The education provided can be specific to symptom management, end of life care, physical aspects of patient care according to their individualised need and diagnosis and psychosocial needs.
Evaluation: The project is being evaluated using pre and post intervention questionnaires completed by participants in the ‘pop-up’ educational initiatives. Evaluation will consider factors such as knowledge, confidence and efficacy around providing care for children with LLC. Other outcomes include the number and location of individual pop-up educational initiatives. Interviews with health professionals and families impacted by the interventions will also be undertaken. A learning needs analysis is also being undertaken throughout Australia.
Results: At the time of presentation, progress data on number of educational visits, cost effectiveness and results of questionnaires will be presented. An update on the learning needs analysis will also be provided.
To date there has been an improvement in the knowledge and confidence of participants to:
- manage symptoms (pain, nausea, dyspn0ea, seizures, and anxiety),
- manage a new referral,
- be aware of available resources
- be confident in how to help a family prepare for a child’s death
- confidence in the provision of medications to children’s reciving palliative care (including subcutaneous delivery)
Conclusion: A collaboration of paediatric palliative care services providing education in a planned and coordinated way shows promise in increasing capacity for paediatric palliative care within Australia, and should assist achieving goals of the National Palliative Care Strategy 2010.
Acknowledgements: This project was funded by the Commonwealth Department of Health through the National Palliative Care Projects.
Outreach services improving access to healthcare in rural, remote and Indigenous communitiesAuthor/s
Aidan has worked in remote Aboriginal communities across Queensland for over five years as both an Accredited Podiatrist and Health Service Manager. During this time he has developed a passion for comprehensive Primary Health Care, recognising that quality health services must be appropriate and accessible for all members of the community – not only for those who seek them out, but most critically for those who don’t. In his current role, Aidan coordinates the planning, monitoring and control of over $18 million of Commonwealth funded health Outreach services across Queensland.
On average, people living in rural Australia do not always have the same opportunities for good health as those living in major cities (AIHW, 2015). Funded by the Australian Government’s Department of Health and Ageing, as a statewide organisation we lead a strong, effective consortium in delivering outreach services to urban, rural and remote locations and high-need populations throughout Queensland.
Rural remote and Indigenous communities are often underserviced when it comes to allied health and specialist medical support compared to their metropolitan communities. Outreach services aim to increase access to medical specialist, GP and allied health professionals in regional, rural and remote Queensland locations, particularly to Aboriginal and Torres Strait Islander communities.
We support the delivery of a broad range of services specifically targeted towards children and adolescents, these include but are not limited to:
- the delivery of specialist paediatric services for children, ranging from neonatal to adolescents, living in Dalby, Biloela, Gladstone, Rockhampton, Emerald and Hervey Bay. The paediatrician works with the child’s parent/carer to assess, identify and treat concerns, including delays in development, autism assessment and management, learning difficulties and cognitive testing. The paediatrician works closely with allied health professionals to support an integrated and comprehensive approach to patient care
- the delivery of speech therapy services to children in primary and secondary schools in Blackwater, Gladstone and Toowoomba. Working collaboratively with the child and the teachers, the speech therapist addresses issues that may be impeding the child’s communication, such as developmental delays, learning disability, intellectual disability, cerebral palsy and hearing loss
- the delivery of a specialist paediatric Cardiology service, that provides Rheumatic Heart Disease checkups and diagnostic testing treats indigenous children in Mornington Island and Normanton communities. The service is supported by an advanced child health worker who provides transport for the children and parents to the service
- the delivery of a much needed ear nose and throat surgery services on the Sunshine Coast has provided surgery for Aboriginal and Torres Strait Islander children, who would otherwise be on 2-3 year waitlist.
The delivery of outreach services provides the community with local access to health services without having the expense, the apprehension and the hassle of travelling to receive treatment. We continue to actively working with local communities to improve access and address service need, resulting in improved health outcomes for children in communities across Queensland.
Stronger communities for children: promoting wellbeing in remote Aboriginal communitiesAuthor/s
Ingrid Johanson has worked with Ninti One on Stronger Communities for Children since 2013, as part of the integrated support for the program across all 10 SCfC sites. Ingrid has a background in international development and human rights law, and previous to living in Alice Springs has worked in the Kimberley, Northern India and New York.
In early 2013, the Australian Government committed to a flexible community development initiative, working with Aboriginal people in the Northern Territory to build sustainable opportunities for children and families to thrive.
Funded until June 2018 under the Indigenous Advancement Strategy’s Children and Schooling Programme, Stronger Communities for Children (SCfC) is under way in twelve Northern Territory communities. SCfC is broad-reaching, and corresponds closely with other programs and initiatives within the community health, education, employment and justice/safety space. Wherever possible, local people are supported to gain sustainable employment through SCfC programs and services.
The SCfC model puts decision making about priorities and service delivery in the hands of local community members. SCfC Decision Making Groups consult broadly within their community in order to respond to the local needs, taking a ‘strengths-based’ approach.
SCfC Decision Making Groups also collaborate with lead organisations and external specialists to engage with available evidence, in order to develop strategies and make informed decisions around the delivery of programs and services. SCfC Decision Making Groups (along with local non for profit ‘Facilitating partner’ organisations) then identify and implement local, integrated services and activities that create a safe and positive environment for children and families.
The potential for SCfC to positively impact on the wellbeing of Aboriginal children and families in remote communities is multifaceted. Aside from the inherent benefits to wellbeing that stem from having localised governance and decision making, emergent priorities (and resultant choices in service delivery) have, in many SCfC communities, focused directly on improving the wellbeing of children and families.
SCfC participants have the ongoing task of upholding community ownership and participatory practices within SCfC, whilst implementing evidence-informed services and activities that benefit kids and families. Due to the ‘ground up’ and place-based nature of SCfC service development and implementation, the objectives and targeted outcomes relating to wellbeing are taking shape in various and differing forms, with valuable learnings along the way.
In this presentation, conference participants will have the opportunity to hear from individuals who have played key roles in implementing SCfC. Particularly, presenters are able to share their experiences as to what approaches have been effective in maintaining strong local Aboriginal ownership and control, and the outcomes being generated from services and activities directly focused on wellbeing.
The presenters would invite a question/answer session after the presentation and would welcome any ‘follow up’ conversations after the event.
Ensuring excellent resuscitative care for country kids—an educational rationaleAuthor/s
Ben Lawton is a paediatric emergency physician based at Lady Cilento Children’s Hospital and Logan Hospital. He is director of Children’s Health Queensland’s Simulation Training on Resuscitation for Kids (SToRK) program. Ben is interested in simulation, education and retrieval medicine. He is a section editor of Emergency Medicine Australasia and edits a paediatric emergency blog at www.dontforgetthebubbles.com. He lives in Brisbane where he enjoys falling off his mountain bike and being outsmarted by his preteen children.
Paediatric resuscitation is an infrequent but critical component of delivering excellent care to rural children. Resuscitation education for rural clinicians presently relies heavily on externally delivered structured resuscitation courses, which have been demonstrated to lead to improvement in the knowledge and skills of participants (1), but are not generally accessible with the frequency required to maintain those knowledge and skills at their peak. Environmental cues are key drivers of performance and deliberate application of knowledge at spaced intervals is an effective way of re-enforcing factual knowledge. Regular in-situ simulation allows rural clinicians to use distributed practice and experiential learning techniques to ensure these low frequency, high stakes episodes of care are managed optimally in any environment. This presentation will outline the educational theory underlying the assertion that regular in-situ simulation is a vital part of the delivery of excellent paediatric resuscitative care in the rural environment.
1. Mosley C, Dewhurst C, Molloy S, Shaw BN. What is the impact of structured resuscitation training on healthcare practitioners, their clients and the wider service? A BEME systematic review: BEME Guide No. 20. Med Teach. 2012;34(6):e349-85. doi: 10.3109/0142159X.2012.681222.
Paediatric type 1 diabetes care in a regional setting: parent and carer perspectivesAuthor/s
Associate Professor Tim McCrossin has been a consultant paediatrician in Bathurst for 20 years and Clinical Dean for Western Sydney University Bathurst Rural Clinical School since 2009. Whilst functioning primarily as a busy regional general paediatrician, interests have of necessity diversified to include service development, education, research and rural health issues. Research pursuits continue to include the broad scope of general paediatrics and rural health.
Aims: To investigate parent/carer views of services provided at a regional Paediatric Type 1 Diabetes Mellitus (T1DM) clinic, particularly telehealth, and explore associations with their general and diabetes-specific well-being.
Methods: A mixed-methods approach was used to explore parent/carer views of current paediatric T1DM service delivery. An anonymous survey identified issues and perspectives that have been explored in greater detail using individual interviews. Parent/carer self-reported general well-being and diabetes-specific well-being was assessed using validated questionnaires. Interviews were transcribed verbatim and subject to thematic analysis to draw out common themes and significant perspectives.
Relevance: Like many regional clinics, the Bathurst Base Hospital Paediatric T1DM clinic has evolved and expanded in recent years to provide advanced care to an increasing patient cohort. A multidisciplinary team has been brought together, with access to support and advice from a tertiary centre diabetes team now provided by telehealth. An evaluation of the effectiveness of these service changes from the parent and carer perspective is timely.
Results: Participants (n=20) expressed general satisfaction with offered services, though tended to be more accepting of the face-to-face local multidisciplinary clinic than telehealth clinics. Half of respondents had general distress levels in the moderate/high/very high range and this was also reflected in a spread of scores for diabetes-specific psychological well-being spanning from low to very high. Acceptance of insulin administration, ease of insulin use, and current treatment satisfaction levels were average to very high in all participants. Parent/carer recommendations for improvement that have emerged from the interviews include: scheduling routine appointments for children of similar ages at the same time so that they can see they are not alone and there are other children their age with diabetes; enhancing the local multidisciplinary team through the addition of a psychologist, podiatrist and/or exercise physiologist; and enhancing the way in which the specialist presented themselves during the telehealth consultation, as it was felt that often their friendliness was lost by the process and this made it difficult for the parent/carer and the child to engage with them.
Conclusion: Regional paediatric type 1 diabetes clinics can provide multidisciplinary care that meets the needs of parents and carers of children with diabetes. Recommendations arising from this research will be presented to the local clinic for consideration. Future research will examine if the psychological needs of parents and carers of children with diabetes are being addressed in a timely and effective manner in this regional centre.
A retrospective analysis of newborn pulse oximetry screening at Bathurst Base HospitalAuthor/s
Associate Professor Tim McCrossin has been a consultant paediatrician in Bathurst for 20 years and Clinical Dean for Western Sydney University Bathurst Rural Clinical School since 2009. Whilst functioning primarily as a busy regional general paediatrician, interests have of necessity diversified to include service development, education, research and rural health issues. Research pursuits continue to include the broad scope of general paediatrics and rural health.
Aims: Undertake a review of universal pulse oximetry screening (POS) at Bathurst Base Hospital (BBH) for congenital heart defects in newborn infants. Specifically:
- assess uptake of POS for 2011-2013, and examine the frequency and type of congenital heart defects detected
- determine whether a new method of recording POS in the BBH ObstetriX Clinical database system improved screening rates.
Methods: A retrospective analysis of all neonates born at the BBH (Central West NSW) was completed for the periods 01/03/2011 to 01/03/2013 and 01/01/2014 to 30/06/2014. POS is routinely performed by midwives at BBH on neonates within 48 hours of life. Saturation levels at or above 95% are a pass; if less than 95% a repeat reading is performed within 2-3 hours or paediatric review is requested. For 2011-2013, BBH medical record data was cross-checked with the Children’s Hospital of Westmead Cardiology Database and BBH paediatric clinic records to identify potential false negative screening results. For 2014, data was collected from the BBH ObstetriX database.
Relevance: Congenital heart disease (CHD) is the leading cause of infant deaths and critical congenital heart disease (CCHD) occurs in 1-3 per 1000 live births. Early detection improves outcomes. Most CCHDs can be diagnosed with echocardiography (the Gold Standard), but this is not a feasible routine screening strategy. POS is a simple, non-invasive method of detecting CCHD suitable for routine use.
Results: The routine POS completion rate for 2011-2013 was 74% (n=1062). As admission to the special care nursery precedes routine POS, total POS rates are likely to be higher. Of the 17 neonates that had an initial abnormal POS, 14 passed on repeat. The remaining three had borderline (94%) saturations and a normal clinical examination. From 2011-2013, two babies were diagnosed with CCHD. Both were left-sided lesions, which are typically missed on POS. Six other infants were diagnosed with a CHD. Five had saturation levels at or above 95% and represented CHD cases for which normal saturations can be expected to be found within the first 48 hours of life. The remaining infant was premature and found to have intermittent low saturations in the special care nursery, which was subsequently identified as being secondary to a respiratory diagnosis.
Conclusion: Pulse oximetry screening can successfully be implemented as a universal procedure in a regional hospital and along with clinical examination may improve early diagnosis of neonatal CHD in regional and rural populations.
Rural paediatric healthcare: an example of a multidisciplinary, technology-supported integrated modelAuthor/s
Glen McIntyre graduated from the University of Queensland in 2000 with a Bachelor degree in Occupational Therapy. He has subsequently completed graduate level training in Soft Tissue Therapy and Business Administration, and is currently undertaking a Masters degree in Business Administration/ Community Leadership (Rural and remote communities). Glen is a practising member of Occupational Therapy Australia, as well as a Consortium Lead for the Better Start and HCWA Provider Panels.
Glen gained experience within hospital and community settings in a rural location before moving to work in private practice in 2004. Since that time, he has lived and worked within LTTS in rural settings including Moranbah, Dysart, and Blackwater. More recently he has provided clinical services into remote locations including Doomadgee, Bamaga, Lockhart River and Kowanyama.
Glen’s professional interests include paediatrics, soft tissue, adult physical, chronic disease and generalist community services. He also has a keen commitment to providing and developing quality local health services in rural and remote settings with the implementation of technology to support rural communities.
This paper provides a current example of the implementation of a rural paediatric healthcare model to various remote towns in Queensland. This model implementation and review is currently being undertaken to provide supportive data for evidence-based health care in rural Australia. Currently, there are minimal ongoing recorded practical examples of models of evidence-based allied healthcare in rural Australia to Aboriginal and Torres Strait Islander communities within a paediatric setting.
The examples discussed in this paper outline a multi-disciplinary Allied health team approach (consisting of a combination of Clinical Psychology, Registered Psychology, Occupational Therapy and Speech Pathology) within an educational and community-based environment. This multi-disciplinary approach was utilised within multiple Aboriginal and Torres Strait Islander communities experiencing complex healthcare crises amongst their children and young peoples. The paper examines the strengths and weaknesses encountered by the implementation of the multi-disciplinary healthcare approach, and discusses the opportunities and threats that this model faces when applied to these communities within both the educational and community-based environments.
This paper will also outline the unique integrated technology approaches that successfully support the implementation of the multidisciplinary healthcare model undertaken within the various remote communities. These integrated technology approaches enable clients to access quality healthcare within an appropriate timeframe, as well as manage chronic and complex care needs across a broad spectrum of Allied Health therapy intervention. Furthermore, these technological approaches have enabled the development of an efficient allied healthcare service that meets the needs of Aboriginal and Torres Strait Islander children and families whilst partnering with local community services and individuals.
Insights from this model implementation within the various communities are discussed to outline and define the improvement activities that were undertaken during the trial and implementation stages of the service delivery. Further recommendations for service delivery application will be presented to provide opportunities for increased discussion around evidence based paediatric healthcare in rural Australia. Finally, learning’s from the implementation of the multidisciplinary, technology-supported integrated model will be used to identify further areas of research and study required.
Health outcomes of infants whose mothers have diabetesAuthor/s
Maggie-Kate Minogue is a 5th year medical student at the University of New South Wales. After completing the first two years of her Bachelor of Medical Sciences/Doctor of Medicine (BMed/MD) in Sydney, Maggie-Kate moved to Wagga Wagga, NSW, to continue her degree at the UNSW Rural Clinical School, where she will complete her undergraduate studies in 2017.
In 2015, Maggie-Kate completed an Independent Learning Project (ILP) under the supervision of A/Prof John Preddy, as part of the UNSW BMed/MD program. The research project looked at the outcomes of babies whose mothers had diabetes during pregnancy and delivered in a regional centre.
Prior to commencing her university education, Maggie-Kate’s interest in rural health was initiated through growing up in the small town of Harden-Murrumburrah, NSW. Maggie-Kate continues to support her interest in rural health and plans to invest her future career in this area of health.
Objective: To compare the neonatal outcomes among infants whose mothers have gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), and those with a normal glucose tolerance (NGT) during pregnancy in a regional area.
Methods: A retrospective audit was conducted at WWBH looking at women who had delivered within the previous five years. Patients were identified using the Obstetrix database and then randomly selected; both paper-based and electronic records were used to collect patient information. Women were placed into three groups: gestational diabetes (GDM), pre-gestational diabetes (PGDM), and NGT.
Results: We found that PGDM was more strongly associated with large for gestational age LGA infants, prematurity, admission to special care nursery, and transfer to a tertiary hospital compared to GDM. Neonatal hypoglycaemia was significantly more common in infants whose mothers had diabetes of any type. Women with PGDM were more likely to have a CS than women with a NGT. We found that the need for resuscitation at birth was greater in the non-diabetic cases than the GDM cases, and there was no significant difference in resuscitation at birth among infants of mothers with PGDM and NGT.
Conclusions: Pregnancies affected by PGDM are associated with a higher risk of poor neonatal outcomes compared to GDM, and thus should be more closely monitored. There is a minimal increased risk in neonatal outcomes in pregnancies affected by GDM. Our results suggest that women with diabetes in pregnancy are at no higher risk of needing resuscitation at birth, and can thus deliver at smaller hospitals provided there are no other risk factors. We now have baseline data of the short-term infant health outcomes of diabetic pregnancies and thus are able to investigate the effectiveness of resource allocation and predict future health outcomes to optimize patient care.
Outreach—exploring the role and impact of Captain StarlightAuthor/s
Sarah Moeller is the Manager of Research and Evaluation at the Starlight Children’s Foundation. In her role at Starlight she is responsible for undertaking and developing evaluations and research projects in partnership with the National Starlight team.
Since 1988, the Starlight Children’s Foundation (Starlight) has been delivering programs in partnership with health professionals which support the total care of children, young people and their families who are living with a serious illness or a chronic health condition.
Starlight’s Captain Starlight Program has been operating in the Northern Territory for 10 years. In 2014, Captain Starlight undertook over 80 trips to 35 different communities and reached over 300 children per month. The program places children and their families at the centre of care and is based on the evidence that early intervention is critical in preventing life-long chronic health conditions and the associated psychological, educational and financial risks. The Outreach Program is delivered in a number of ways; Health Professional Outreach, Healthy School Aged Screening Programs, Starlight led Outreach and ongoing visits to the Royal Darwin Hospital.
The Captain Starlight program is delivered by professional performers known as ‘Captain Starlight’. Captain Starlight comes from a wide range of backgrounds including actors, clowns and comedian. They engage with children and young people through activities such as art, music, story-telling, comedy and games to alleviate boredom and supporting children in both inpatient, outpatient and remote communities. Captain Starlight also performs shows and leads activities that help to deliver key healthy living messages such as washing your hands and face, brushing your teeth, keeping your community clean, and developing healthy eating habits.
This paper will explore the role of Captain Starlight in improving healthcare outcomes for Aboriginal and Torres Strait Islander children, including increasing their access to care, enhancing the patient journey and building the capacity of rural, regional and remote health workforce teams to care for Indigenous children locally. The paper will highlight lessons learnt, the importance of meaningful partnerships, building sustainability and developing Starlight’s understanding of indigenous culture.
Feedback from health professionals working with Starlight regularly has highlighted that Captain Starlight’s presence in the health clinics encouraged attendance and reduced anxiety. In the past few years, there has also been an increased demand for the program, with Starlight receiving additional requests by health professionals to visit communities.
Currently, Starlight uses both qualitative and quantitative research methods to establish the impact of its Outreach Program and in the future is planning to expand this evidence base to ensure the program is meeting the needs of children and young people living in country Australia.
Supporting best practice care for kids with clubfoot in NSWAuthor/s
Jenny Nicol is an Allied Health Educator with the NSW Children’s Healthcare Network. She works with three other allied health educators as part of Allied to Kids, which aims to ensure that allied health professionals are educated and supported to provide children and families with the right care, in the right place, at the right time. Jenny’s clinical background is in paediatric speech pathology, although over the past 15 years she has predominantly worked and studied in the fields of health service management and education. Jenny works closely with clinicians in the tertiary children’s hospitals as well as regional and rural facilities to coordinate education and clinical support for allied health professionals who work with children across NSW.
Background: In New South Wales (NSW), the assessment and management of children with structural Congenital Talipes Equinovarus (CTEV) or clubfoot, is undertaken by clinicians in both tertiary and non-tertiary hospitals. Referral to one of the three tertiary children’s hospitals is recommended for the management of complex cases. However, there are recognised benefits of providing ongoing services as close as possible to the child’s home. The experience and expertise of clinicians in the management of CTEV varies. Many physiotherapists working in rural facilities have limited access to ongoing education and clinical support.
Method: In response to the identified variability in the management of babies and children born with CTEV in NSW, the NSW Children’s Healthcare Network Allied Health Educators worked in partnership with the NSW CTEV Network Group to develop and implement a CTEV education program available to physiotherapists across NSW Health. Educational content was based on the best available research evidence and was developed around best practice in using the Ponseti Method to treat babies and children with CTEV.
The CTEV education program utilises a blended learning approach to increase access to, and engagement of physiotherapists in the education and clinical support initiatives. Physiotherapists can access one or all of the components based on their learning needs. The program comprises the following components: eLearning module; education day; evidence-based guideline; CTEV clinic visits; clinical support networks; and clinical resources.
Results: Uptake of the CTEV education program by physiotherapists has been strong. The individual components of the program have been evaluated with positive outcomes demonstrated by participants.
Ongoing review and evaluation will focus on the impact on assessment and management of CTEV in non-tertiary facilities.
Conclusion: The CTEV education program is an effective means of providing education and clinical support to physiotherapists in non-tertiary facilities. The blended learning approach enables clinicians to engage in educational opportunities that are flexible, accessible and relevant to address their varying learning needs in this specialised area of paediatric patient care. The success of the CTEV education program warrants consideration of this type of blended learning approach to education targeting other areas of clinical practice.
Ongoing education for Shared Care Centres via videoconferenceAuthor/s
Nicola Scott is currently employed as the Clinical Nurse Manager of Paediatric Outpatient and Outreach service at Christchurch Public Hospital. In this role she has reviewed the model of care for ambulatory patients with a specific focus on the following: Children with complex care needs – new model of care; family nursing and building family resiliency; “Did Not Attend” project to reduce our DNA rate from 6-8% to 2-4%; and improving the interface between primary and secondary care to benefit the family and child.
Nicola has been nursing for 33 years and has a background in primary, secondary and tertiary care, all within the field of paediatrics. She spent 16 years as a Practice Nurse in two very different settings – central city and suburban family practice. She has also worked in the Children’s Haematology and Oncology Centre at Christchurch Public Hospital as the Clinical Nurse Specialist and Shared Care Co-ordinator for 13 years prior to commencing my current role. This experience has given her a huge respect for primary, secondary and tertiary services and the people working within these fields.
Purpose: To optimise education and resources for the teams in shared care centres. Constraints to education are nursing shortage and minimal financial support. Networking of staff from all centres also important to facilitate. Efficacy of providing education via regular videoconference initiated and programme has been audited.
Method: Case review to evaluate the impact of providing improved access to learning opportunities for education. Use resources which are easily accessed and require minimal disruption to patient focus. This information needed to be at beginner, intermediate and advanced level for nurses. Each centre presents in group videoconference to provide ongoing education and networking opportunities.
Results: Education provided using:
- Videoconference - education attached to usual videoconference times for each centre. More interactive learning facilitated. Focus for the month agreed upon by all participants.
- Monthly article which is emailed out on topic of interest - can be critiqued for PDRP.
Conclusion: Audit of education is done yearly as part of Shared care guidelines audit with each centre. Each nurse has input into topics covered and topics are grouped together to give direction and focus e.g. Transplant - reasons for, types, GVHD - acute and chronic, responsibilities of shared care centre. Audit has been done with results available in poster.
Goulburn Valley Homeless Youth Dual Diagnosis InitiativeAuthor/s
Kevindev Singh is a nurse currently in the role of the Homeless Youth Dual Diagnosis Initiative (HYDDI) at Goulburn Valley Health. Mr. Singh originally grew up in Melbourne, however now resides in the regional city of Greater Shepparton, Victoria. Mr. Singh has worked in mental health for over 10 years across multiple service programs within both metro and rural settings. Mr. Singh has developed a passion for working with the youth and has continued to expand his knowledge and skills within this field. He has completed a Postgraduate in Mental Health Nursing, Developmental Psychiatry Course, is Dual Diagnosis and Autism Diagnostic Observational Schedule (ADOS) trained. Mr. Singh is a strong advocate for positive physical and mental health, as he is a fully qualified personal trainer, and is completing his Masters in Mental Health Nursing (Nurse Practitioner). Mr. Singh wishes to help clinicians identify the youth who may be falling through the gaps within the homelessness sector, as this youth cohort maybe some of the most unsupported and transient in their lifestyle that services are unable to reach them. To be placed within this sector and providing appropriate education and support, has the potential to make positive change for all involved.
Strong sustainable communities depend on the wellbeing of their children and young people. Early Intervention with young people with emotional and behavioural difficulties has been proven to be most effective in improving social wellbeing outcomes.
HYDDI is a project funded by the Homelessness sector and introduced into the Goulburn Valley, where a sole clinician primarily supports the homelessness sector on all three tiers (primary, secondary and tertiary) to navigate and engage with appropriate services and prevent disengaged youth falling through service gaps due to their transient lifestyle. The role is serviced through the local Child & Youth mental health service (CYMHS), however based within the community and local youth homeless refuge network. A youth friendly pathway to service has been developed so the young person only needs to tell their story once to the HYDDI worker who then supports their access to appropriate services thus eliminating the barriers to service usually experienced by disengaged youth.
Feedback thus far has been positive in relations to access to psycho-education on mental health and AOD needs to the youth on an as needed basis, as well as linking the youth into appropriate support services in a timely manner. Access by community groups in relations to mental health and AOD education has been highly sort after from a number of different programs, such as; the homeless and youth sectors, ethnic community leaders for/to local families and youth, local schools and police.
The HYDDI role has the capacity and requirement to provide tertiary support to at least 16 young people through-out a year, however within the first 3 months the role had already picked up 6 clients needing close support with their mental health and alcohol & drug (AOD) use. This demonstrates there is a need for dual diagnosis support within the homelessness sector as these 6 would not have accessed traditional services due to their transient lifestyles if not picked up through the refuge until a crisis point later in their lives.
The HYDDI role has networked with youth and AOD services within the local community establishing a new secondary consultation process within the sector and streamlining referral pathway between programs ensuring improved access to service for this cohort. The role is currently funded until July 2017, our hope is that the data will support recurrent funding of the position.
ViCTOR ‘back to basics’ videos: supporting best practice paediatric vital sign measurementAuthor/s
Jen Sloane is the Project Coordinator of the Victorian Children’s Tool for Observation and Response Project, known as ‘ViCTOR’. ViCTOR offers clinicians a standardised package that focuses on the early recognition and response of the deteriorating paediatric patient.
Jen has been instrumental in getting the ViCTOR program implemented throughout Victoria. To date Jen has facilitated the release of educational packages, videos and the following ViCTOR charts; paediatric inpatient, paediatric urgent care/rural and paediatric neurological charts, with special care nursery, postnatal and fluid balance charts currently in development.
Jen joined the ViCTOR team from its inception in 2013 with over a 12 years’ experience in critical care paediatrics, community adolescent health and statewide preventative health programs. Jen has been a regular tutor for Masters of Nursing and Masters of Public Health students at both the University of Melbourne and La Trobe University and has a passion for developing and delivering innovative and quality health care initiatives. Jen has a particular interest in quality improvement, human factors research and health-related project management.
Aims: The Victorian Children’s Tool for Observation and Response (ViCTOR) aims to provide a standardised approach to paediatric vital sign charting as well as the detection of, and response to the deteriorating paediatric patient. In 2015, when piloting and evaluating ViCTOR charts suitability in rural settings, nurses reported anxiety when paediatric patients presented to urgent care centres. These staff identified a need for reinforcement of basic paediatric skills and education to; support the correct use of ViCTOR, standardise care, improve their paediatric clinical skills and the recognition of deteriorating patients within their rural health service.
Methods: The ViCTOR project team engaged five paediatric nurse educators (representing two tertiary paediatric services and a private hospital) to assist in developing the content for a series of videos. The rural sector were engaged via an online survey to determine the style and format of content and delivery that best suited their requirements. The videos were aimed at outlining best practice paediatric vital sign measurements, dispelling myths relating to paediatric observations and become a potential base for future paediatric education.
Relevance: The ViCTOR ‘back to basics’ video series aims to build capacity of any staff member working with paediatric patients however has particular applicability in the rural, regional and remote health workforce teams by providing free, easily accessible, standardised and non-intensive resources to improve basic paediatric observation skills, decrease clinician anxiety and overall improve the care for children locally.
Results: At a cost of $5500, a total of six videos were developed and launched in October 2015. The main video (11 minutes) demonstrates broadly how to conduct paediatric vital signs and the following five videos (~2 minutes each) show observations based on each of the ViCTOR age groups (0–3 months, 3–12months, 1–4 years, 5–11 years, 12–18 years). All videos were made freely available via the ViCTOR webpage and a dissemination and launch plan was prepared by project staff. Preliminary informal feedback has been very positive with a formalised evaluation pending.
Conclusions: The use of innovative and easily accessible educational tools that are identified by rural clinicians and developed with specialist educators, are a cheap and effective way of reinforcing and upskilling best practice paediatric vital sign measurement in the rural setting. These simple educational tools may decrease anxiety for rural and remote clinicians working with paediatric patients however further evaluation is required in this area.
Life is like a box of chocolates, not sure what to expectAuthor/s
My story is a simple one which involved knowing what I wanted to be and working over seven years to become a Division 1 nurse in 1973-1979 in Victoria.
In this time I failed 2nd year in Geelong Hospital and started from first year in Warrnambool Hospital 1976 to get what I wanted.
1980—Camperdown Hospital employed me as Single Certificate Graduate Nurse working in the aged and acute wards.
1982—I graduated in Midwifery at Launceston Tasmania which was very special because as a Division 2 nurse in 1975, I worked in an antenatal clinic and assisted midwives in maternity wards at The Geelong Hospital.
1982-2004—I returned to Camperdown Hospital as midwife and run the antenatal bookings and did the acute wards as well as midwifery. Managing to do district nursing and acute as well as midwifery focus.
2001—Commenced Secondary School Nursing .5 at rural school Derrinallum College P-12 as well as working at the local hospital in Camperdown.
2002— Hospital became ‘Baby friendly’ with my assistance, educating staff and introduce a new policy within the hospital to encourage mothers to breast feed and give mothers better understanding and choices.
2004—I left the hospital setting and became a full time Secondary School Nurse working in 2 rural schools Derrinallum and Cobden Technical Schools in Victoria. I left Derrinallum College in 2010 and took up the same position at Camperdown College in the same state working full time.
2010–2011—Achieved a sponsorship to join the ‘Australian Rural Leadership Program’ for over 16 months. Attending 56 days of education with 30 people from around Australia focus on leadership, ethics, values, understanding yourself and others you work with.
2011—Retired for 12 months and found I wanted to achieve more.
2012-2016—Started back in Victoria as Secondary School Nurse with Terang College year 5-12 Campus. I have passion, to achieve more with students and the community in the Western District.
Must add- that I managed to have 5 children under 5 during 1984 and 1989- working occasionally on Nurse-Bank at the Hospital in Camperdown.
Hormones change you for ever and you don’t know when the change will occur or exactly what you will get, but it will be the right time for each individual.
Importance of understanding physical and emotional changes through adolescent years. Adolescents all have rights to be comfortable with the changes and knowledge of what is happening.
Out fastest growth occurs as babies then the next biggest change we have is during our teenage years. It is during this time we need increased nurturing and acknowledgement of significant life changes.
I take health and human development classes from year five to year ten and reinforce the celebration of how wonderful and amazing their bodies are physically changing. Chemical changes also impact their lives, when they find it hard being themselves.
Rural and remote schools have less access to family planning education and social workers coming to the school teaching respectful relationships etc., due to distance and expense required to gain their expertise.
With the knowledge they will look after their bodies and make healthy choices when they choose to have a physical relationship with the opposite sex or same sex.
Adolescents know what a good relationship is and what an unhealthy relationship looks like by the end of the classes.
Health professionals can assist young people to get up to date information and form partnerships with other health workers eg Dr, Clinic nurse or nurse on call, websites which assist with answering questions.
The information is evidence based and uses active learning strategies to build on student’s early learning and experiences about gender, bodies and relationships.
Classes from year 5-10 have access to a puzzle to name the anatomy of male and female. It is also used in later years to explain conception, contraception and where sexually transmitted diseases are found to cause disease.
DVDs are also used to reinforce education websites for students and parents to reduce cyber bullying due to e-mails and texting causing various issues.
Time needs to be available to answer any questions from students and follow up individually and refer to school counsellors or other appropriate support services.
For children’s health and wellbeing throughout school years, education must be ongoing and consistent when it involves sexual health education consistent with the state school and tertiary standards of best practice.
Koala Hold from downunder, another choice in a breastfeeding positionAuthor/s
Shannon Thomson lives in a rural area of NSW, Australia. She is a Child and Family Health Nurse, Midwife, Clinical Nurse Specialist and an International Board Certified Lactation Consultant for the Bega Valley.
One of Shannon’s areas of speciality is in Tongue Tie and she has given education in Vancouver, Canada as well as presentations at the Annual International Lactation Consultants Association Conference, Orlando, USA, in 2013.
Her main role is working with breastfeeding mothers in the home, clinic or group setting and she is passionate in her endeavour to support them. Shannon has published in the Journal of Human Lactation in which she shared her ‘Insights in Practice’, with the poster of a uniquely Australian upright breastfeeding position entitled “Koala hold from down under, another choice in a breastfeeding position”.
While there are no set rules in breastfeeding positions, our lactation practice has traditionally recommended and named a few established positions. A different position called the “Koala Hold” is an upright position being used in Australia. Difficulties in positioning can lead to poor attachment, damaged nipples and blocked ducts. The Koala Hold mimics the suckling of a koala bear from its mother with the baby straddled skin to skin in the upright position on the mother’s knee. As the baby’s head in is the neutral midline position, it can be effective for babies who may have residual head or neck discomfort as a result of traumatic birth such as forceps or vacuum extraction. It may also be useful for babies who are fussing at the breast or have a breast preference. Additionally, mothers with nipple vasospasm may find this position more comfortable or mothers with large breasts having difficulty aligning the baby’s mouth with her nipple. In the same way, mothers may find increased comfort by positioning the baby away from her suture line following a caesarean section. This breastfeeding position is usually short term but can be used in conjunction with other preferred positions with the aim of draining all milk ducts of milk. It does not require any special equipment and so can be easily adapted in any setting, particularly in the rural and remote areas of Australia.
A major role for the health professional is to support the mothers and babies through the challenges that can accompany the early days of a newborns life. The Koala Hold is a simple and effective breastfeeding position that can change the motivation to breastfeed, particularly if other breastfeeding positions are unsuccessful or problematic. Mothers can have improved comfort with breastfeeding which can result in an increase in confidence to try other more conventional breastfeeding positions. Infants can suck and swallow well, detach more easily to facilitate burping which could reduce some symptoms of gastro oesophageal reflux. The Koala Hold can be successfully implemented with term babies by providing an alternative for mothers experiencing difficulty with conventional breastfeeding positions.
An innovative initiative for social change: delivering preventative healthcare services by physician assistantsAuthor/s
Ankur Verma has been working in the disability sector in Townsville since 2013, and is currently employed with CPL –Choice, Passion, Life. His commitment to rural health has been sharpened by positive rural placement experiences, including in Mount Isa, Queensland and Emerald, Central Queensland. He also sits on the Executive Committee for National Rural Health Students’ Network (NRHSN) as an Allied Health Officer with an aim to provide voice for students who are interested in improving health outcomes for rural and remote Australians and to promote rural health careers to students and encourage students who are interested in practicing in rural health care. Ankur has been active through the NRHSN Allied Health Portfolio where he has established connections with stakeholders such as Services for Australian Rural and Remote Allied Health (SARRAH). Through this engagement, Ankur also sits on the SARRAH Advisory Committee as a Student Network Coordinator where in 2015 he was involved in providing a consultation response on the National NDIS quality and safeguarding systems developed by the Australian Government and state and territory governments. In 2015, he began to undertake studies in the Bachelor of Physician Associate course at James Cook University, and in future wants to pursue a Management/Coordinator and leadership role in the Disability sector.
Background: It is important to promote understanding on an innovative initiative that invests in one’s capability to successfully progress innovative solutions to social challenges at a local, state or national level in Australia.
Aim: The innovative initiative aims to introduce and implement a chronic disease preventative health care initiative in the home and community environment, with a focus on Aboriginal and Torres Strait Islander children with disabilities. A student-led program, with health professional supervision, utilising the physician assistants (PA) workforce model, to provide local access to early intervention services.
Method: A literature review was conducted looking at ‘addressing health workforce maldistribution in rural and remote areas of Australia through provision of Physician Assistants’. Consultation paper on Integrated Market, Sector and Workforce Strategy for the NDIS was also reviewed. Survey data and report from rural high school visits undertaken by JCU’s rural health club, RHINO, were also used to further support this initiative focusing on alternative service reviews.
Social Issues considered:
1. Difficulty in providing early intervention services to children due to lack of services and resources.
2. Gaps in primary health checks for Indigenous children living with disability, and those living in rural/remote settings.
3. Mortality rate of adult Indigenous Australian in Northern Queensland 20-years earlier than non-Indigenous Australians with 80% of these deaths due to chronic diseases.
4. Preventative work for chronic diseases and social wellbeing is undermined in Indigenous communities
The innovative PA-model of healthcare supports the development of the National Disability Insurance Scheme (NDIS) market in 2016 where people with disability will exercise choice, control and have access to a full range of quality support providers. The model provides advice through on-going care, non-face-to-face services (Tele-health), coordination activities, family & buddy support, health promotion activities, self-management, and education. The model focuses on improving preventative health care services, and empowering Indigenous people to take control over their health through the PA workforce model and in consultation/partnership with Cerebral Palsy League (CPL).
Conclusion: The program can further extend in disability sector through the provision of early intervention services by health professionals like Physician Assistants after the NDIS implementation in 2016 which will reduce the impact in acute health care setting throughout developmental years. Thereby, this initiative will increase social wellbeing, productivity of doctors and allied health professionals by enabling equilibrium between demand and supply.
Building capacity in the rural health workforce: the Pēpi-pod ProgramAuthor/s
Karen Watson is a registered nurse who works as a research assistant in the School of Nursing, Midwifery and Paramedicine at the University of the Sunshine Coast, Queensland. She has worked in the area of maternal and child health research for the last 12 years and is currently undertaking her PhD evaluating the efficacy, feasibility and acceptability of the Pēpi-pod© Program in enabling safe infant sleep for Indigenous families and carers.
Introduction: Rural and remote children have poorer health outcomes, including increased infant mortality, compared to their metropolitan counterparts. Indigenous Health Workers (IHW) have an integral role in health promotion and reducing morbidity and mortality for children and families in Aboriginal and Torres Strait Islander communities. The Pēpi-pod® Program, a safe sleep enabler program, was introduced in 2013 in several Queensland communities as a strategy to address higher rates of infant mortality. Program integration into service models was achieved at varying levels across government and nongovernment organisations. This study aimed to examine IHW perspectives of the impact of the Pēpi-pod® Program on their health promotion role and in the communities they work.
Methods: The study design employed a mixed methodology to report on the experiences and impact of the Pēpi-pod® Program amongst Indigenous Health Workers who had integrated the Program into their Maternal and Child Health service. The first phase, survey feedback of the program from service sites, will be reported here. Participants were asked to respond to open ended questions during scheduled Program competency testing. Questions related to how well the program supported their practice in health promotion, facilitated safe sleep conversations and if the program increased awareness of safe infant sleep in community.
Results: All participants felt that the Pēpi-pod® Program should be integrated into their service. Participants identified that the Program allowed for non-judgemental presentation of safe sleep information, and appreciated Program demonstration of a safe sleep alternative for families. Completion of the Pēpi-pod® Program training was reported by participants to provide them with greater confidence as their awareness of infant safe sleep and risk factors had increased and they felt comfortable translating those key messages in the communities they work.
Relevance: Indigenous Health Worker perspectives indicated that involvement in the Pēpi-pod® Program had facilitated building their capacity to undertake safe sleep health promotion and assist families in providing safe sleep environments for babies at high risk for SUDI. All participants identified the Program as worthwhile and saw value in it continuing within their communities.
Conclusion: Indigenous Health Workers are integral members of the rural and remote health workforce. These findings, along with those from a Photovoice examination and focus group interview exploration of the impact of the Pēpi-pod® Program, will be used to inform future initiatives which aim to improve rural and remote health service delivery for infants and children.
Supporting rural health services for childrenAuthor/s
Les White was appointed as the inaugural NSW Chief Paediatrician in September 2010. He was Executive Director of Sydney Children’s Hospital from 1995 to 2010, following a clinical and academic career, with emphasis on childhood cancer. Other positions have included President of Children’s Hospitals Australasia (1999-2004) and the John Beveridge Professor of Paediatrics (2005-2010). He has over 120 publications and many more abstracts, awards, grants and invited presentations in his CV. He serves on 9 not-for-profit boards relating to children’s health or medical research. He was awarded a Doctorate of Science for research contributions related to childhood cancer and holds a Master of Health Administration. In 2007 he received an Order of Australia award for service to medicine, medical administration and the community in the field of paediatrics. He has championed the rights of children and young people in healthcare in the Australian setting. His current interests include childhood injury, intellectual disability, health services research and state-wide networking of paediatric services.
Margaret has over 25 years’ experience as a paediatric nurse in the UK and Australia. In addition to many years of clinical practice in paediatric intensive care settings, she has held roles in facilitation of workplace culture change, practice development, research and coordination of a Child Health Network in NSW, Australia. She is enrolled in a PhD at the University of Technology, Sydney exploring the nature of skilled facilitation and how people become skilled. In her current role of Senior Manager for Paediatric Healthcare, Margaret leads a team which provides support in: strategy, policy, guidance, resources, facilitation, advocacy and standardisation for paediatric healthcare. The team leads on delivery of initiatives that promote the health, wellbeing and provision of high quality healthcare services for infants, children and young people in NSW.
Background: In NSW, approximately 80% of paediatric presentations to emergency departments occur outside the specialist children’s hospitals, with about 30% presenting in Regional areas of NSW. The Supporting NSW Paediatric Service Capability Project is taking a whole of system and long term approach to improving paediatric care state-wide as well as targeting priority initiatives for immediate action. One such initiative for action is Caring for Country Kids which aims to ensure optimal local care and timely, stepped escalation for children in rural/regional settings.
Approach: A working group was established to drive the initiative and 3 agreed key deliverables. The first deliverable was the development of a self-assessment tool which is centred on the implementation of the Guide to Paediatric Clinical Emergency Responses (CERs) and Beyond Facility Escalation Documentation contained within NSW Health Policy Directive PD2013_049. This tool was developed to support Local Health Districts (LHD’s) in assessing their paediatric escalation documentation and process with the emphasis on the importance of a consistent stepped approach to escalation of care.
The second deliverable was intended to assist LHD’s in ensuring paediatrician input in the management of children admitted under non-paediatric clinicians and/or identified to be above agreed thresholds for complexity or duration of stay within the facility or the LHD. The working group has described various models as a safety net in ensuring these children are reviewed by a paediatrician if required. These models range from an outlined governance structure for monitoring all children admitted within the LHD, to empowering parents and other clinicians to initiate a request for consultation by a paediatrician.
The working group has also been supporting the work of the NSW Regional Paediatrics Peer-group Network to describe the principles for sustainable workforce planning in regional/rural NSW.
Outcomes/results: The deliverables described are encompassed in the NSW Paediatric Services Capability Framework. This presentation will report on the specific outcomes of the Caring for Country Kids working group, including activities, tools and resources to support their implementation, local adaptation and further progression.
Take home message: A consistent, stepped approach to escalation of care for children across regional/rural NSW will enhance safety and support appropriateness of care as close to home as possible.
Transportable and targeted simulated learning in paediatrics for allied healthAuthor/s
Sarah Wright is a physiotherapist who has worked in the UK, Australia and also countries such as Mozambique, Jamaica and Ukraine, providing specialist paediatric cardio respiratory physiotherapy. Having lectured across the world she is now a Physiotherapy Consultant based at Lady Cilento Children’s Hospital, Brisbane and the Consultant for the SLiPAH Program.
Simulated Learning in Paediatric Allied Health (SLiPAH) was established in 2012 to target training needs for students and workforce across Queensland. The focus of the Program is to provide realistic and evidence based experiences to therapists (occupational therapy, physiotherapy, speech pathology), to equip them with the non-technical and technical skills to treat infants and children. In 2015 over 500 hours of training was supplied to regional and remote allied health practitioners, with significantly positive responses from therapists. SLiPAH is committed to providing equitable training across the continuum of care to allied health therapists to ensure the children of Queensland have the best possible health care.
Sarah’s key drive is to inspire the therapists of tomorrow, she also has a love for travel, wine, sport and where ever possible a combination!
Background: Today’s children are not as healthy as previous generations with children from rural, remote locations, particularly those who are indigenous and of lower socioeconomic status ,at greatest risk (Armstrong et al 2007). Access to effective, appropriate and sustainable allied health care service for these children and their families is contingent upon developing and sustaining a skilled, well supported local workforce with the capacity and capability to provide a broad range of integrated paediatric services (both public and private sector) across geographically and culturally diverse communities.
Traditional approaches to developing paediatric capability depend upon didactic teaching and apprenticeship-style learning which exposes children, families and practitioners to considerable risk with limited opportunity to gain the broad clinical experience and ongoing collaboration required to build and sustain competency. The result has been attenuation in paediatric capability across Queensland with uneven distribution of highly skilled practitioners to metropolitan areas. For rural and regional practitioners to access training and support at metropolitan hospitals, absence from duties and considerable travel has been necessary, with no guarantee that clinical experiences will be adaptable to local needs. Hence, increasingly limited opportunities exist to acquire and maintain the unique clinical skills required to meet the needs of children and families in regional and remote areas. With Australia’s largest population growth centred on regional and coastal areas of Queensland (NSFRR 2012), innovative and locally responsive approaches to providing training and support for regional and remote practitioners are vital.
Method: The SLIPAH (Simulated Learning in Paediatrics for Allied Health) program provides transportable, standardised paediatric clinical training using simulation-based methods for allied health practitioners, from student to clinician. By combining e-learning and simulated clinical experiences, it provides local access to specific educational support required by regional and remote occupational therapy, physiotherapy and speech pathology students/practitioners. The simulated scenarios allow participants to develop safe, effective performance through application of the National Health and Safety standards and professional standards and evidence based practice, using realistic mannequins and environments to facilitate the translation from theory to practice. For rural and remote workforce, it provides opportunity for deliberate practice of specific clinical skills and competencies as well as adaptation and refinement of existing skills. Collaboration with subject matter experts provides the unique opportunity to develop and implement innovative solutions to meet local challenges and to identify potential issues, prevent adverse events and improve patient flow. Ongoing impact evaluation aims to ensure targeted, locally driven content development and delivery. Participant and line manager feedback serve to refine of the Program in terms of accountability, performance, responsiveness and dissemination of outcomes.
Results: SLIPAH has been embedded into 14 Programs across 6 state-wide universities. Direct collaboration and partnership with Queensland Health regional and rural facilities to provide locally responsive paediatric simulation based training to the workforce across Queensland was instituted.
Delivery (Sept 2014-Sept 2015)
PFASE (since Mar 2015)—speech pathology feeding
regional and remote
31 = 18%
42 = 70%
regional and remote
420 = 13%
128 = 68%
regional and remote
810.5 = 16%
534 = 63%
Discussion: The data shows this is an efficient training model across the continuum of education. Positive feedback on evaluation is mirrored in the uptake. Partnership with regional and remote centres directs delivery of education in response to local paediatric capability requirements. Ongoing analysis and synthesis of the data will ensure effective response to the changing requirements of students and workforce. The aim is to provide a foundation to equip Queensland allied health professionals with the skills required for safe and equitable paediatric healthcare.
Acknowledgment: Funding from HWA/DoHA
National Strategic Framework for Rural and Remote Health. 2012 Standing Council on Health. Commonwealth of Australia
Armstrong BK, Gillespie JA, Leeder SR, RubinGL & Russell LM. 2007 Cheallenges in health and healthcare for Australia. Medical Journal of Australia. 187 (9): 485-489.
Advice to action: enabling safe sleeping for rural and remote babiesAuthor/s
Professor Jeanine Young, University of the Sunshine Coast, is a registered nurse, midwife and neonatal nurse with adjunct positions at Sunshine Coast Hospital and Health Service, Griffith University, University of Queensland and Children’s Health Queensland.
Jeanine has a special interest in infant care practices, breastfeeding and safe infant sleeping. She works closely with SIDS and Kids to ensure infant sleeping recommendations are evidence-based and was asked by SIDS and Kids to launch the 2012 Sleep Safe, My Baby public health campaign.
Jeanine is a current member and the former Chair of the SIDS and Kids National Scientific Advisory Group (2008-2015), member Australian College of Midwives Scientific Review and Advisory Group, Queensland Paediatric Quality Council and Queensland Child Death Review Committee.
Jeanine is currently leading a research program that includes a research study investigating the acceptability and feasibility of using safe sleep enablers in high risk Aboriginal and Torres Islander families, across several communities in Queensland.
Background: Infant deaths experienced in regional and remote areas of Australia are almost double when compared to metropolitan areas while infant mortality rates to sudden unexpected death in infancy (SUDI) are four times higher for Indigenous compared to non-Indigenous babies. Co-sleeping is a culturally valued practice by many Indigenous families however is associated with SUDI in hazardous circumstances. Portable sleep spaces have been used successfully in high risk populations in New Zealand, with infant mortality reductions observed. Indigenous communities have identified this area as a priority for investigation.
Aim: This study aims to determine the acceptability, feasibility and safety of the Pēpi-pod Program, a portable infant sleep space embedded within safe sleep health promotion, within Queensland Aboriginal and Torres Strait Islander families.
Methods: The Pēpi-pod Program, comprising a safe sleep enabler, safe sleeping parent education and safety briefing; and family commitment to share safe sleeping messages in social networks, was delivered to Aboriginal and Torres Strait Islander families with identified SUDI risks, recruited through Queensland maternal and child health services (n=10 services, 25 communities) across metropolitan, regional and rural/remote areas. Parent questionnaires administered face-to-face or by telephone within 2 weeks of receiving the Pēpi-pod; then monthly thereafter until pod use ceased. Health service feedback was conducted via survey and focus group at participating sites.
Results: A total of 111 recruited families meeting eligibility criteria have completed data collection by August 2015. All families recruited had identified SUDI risk factors; 80% had ≥2 known risk factors. Pēpi-pod acceptability as a safe sleep space for babies was supported by parent responses that related to three key themes: safety, convenience and portability. Awareness of safe sleeping messages has been raised within families and through community social networks. Midwifery and health worker feedback relating to implementation of the program indicated that the program was feasible, accessible, flexible, sustainable, and built local workforce capacity with integration into current service models.
Relevance: This is the first evaluation of a safe sleep enabler in Australia. Indigenous babies are over-represented in SUDI deaths associated with hazardous sleep environments. The Pēpi-pod program was accepted and used appropriately by parents living in Queensland Indigenous communities. Program principles are applicable to mainstream services which care for vulnerable families.
Conclusion: Innovative strategies which allow for co-sleeping benefits, respect cultural norms and infant care practices, whilst enabling safe sleep environments are necessary to further reduce SUDI.
Pregnancy, birth and baby: national care for country kids and families locallyAuthor/s
Dianne Zalitis is a midwife with over 25 years practice, having worked the majority of her career in rural New South Wales—first as a clinical midwife at Wagga Wagga Base Hospital and then for 10 years as the Clinical Midwifery Consultant for the area health service.
After a city change move to Sydney motivated by an enhanced career opportunity for her husband’s– the move has in fact enhanced her career opportunities as well. Dianne worked in delivery suite at Prince of Wales Private, with 6 months as the Unit Manager.
Dianne now works as the Clinical Lead for the Pregnancy, Birth and Baby services at Healthdirect Australia—a COAG funded company charged with procuring and providing online and telehealth services to all Australians. Dianne oversees the services provided by Healthdirect that relate to expecting and parents of children under 5 years.
The Pregnancy, Birth and Baby service is funded by the federal government and operated by Healthdirect Australia to provide telephone and online support services to expecting and new parents nationwide. The service began in 2010 and in 2012 a comprehensive evaluation of the service was conducted that involved consultation with consumers and stakeholders. The major objective of the evaluation was to ensure that this service continues to meet the needs of parents as described by them and reiterated by child and family health stakeholders.
This presentation will demonstrate how the insights, lessons learned and identified actions from these evaluations led to the evolution and development of a National Pregnancy and Parenting Service. This will include data from a call review of 500 calls that demonstrates the breadth of reasons a parent contacts a telephone support service.
As well as presenting the evaluation results this presentation will contrast the previous service model with the new enhanced pregnancy and parenting service. The presentation will include the rationale for the changes and the evaluation research currently underway. The evaluation research will continue throughout the development, implementation and operational stages continuously informing the service provision.
The remit in the evolution of the existing service was and is to provide a national service that has as its core the health and wellbeing of rural, remote and Aboriginal Torres Strait Islander children and families. The new service will provide people in remote locations ‘ease of access’ to services and health advice around the clock regardless of their location, utilising available technology including telephone, video and web.
Through leveraging all of Healthdirect Australia’s products the service has the capacity to provide parents with linkages back to relevant local services and in a manner that is timely and supportive. When parents want a face to face support service and they cannot access one locally this service can meet that need through the video consulting capability. When parents are struggling to find the right health service for this point in time, this service locates child health providers and guides parents through the health maze.