Collaborative Clinical Pathways (CCP) Progress to August 2016The current focus is on:

supporting implementation of system wide infrastructure including; resource allocations, sustainable workforce, IT system development and workforce sustainability for pathways that are under development or that have recently been implemented, ie COPD , CKD and

developing and implementing the Cancer Pathways as part of the CCN Priority Cancer Pathways Implementation Project , and

ongoing work on mental health, stroke, commencing Congestive Heart Failure, Cellulitis, Fitness for Surgery and reviewing Dementia.

The CCP Programme Facilitator role has been appointed. His name is Gerard Gregory. Gerard comes with extensive knowledge on computer systems, systems analysis and project management/business analysis. He replace Alaina Glue as the key contact person for the Whanganui District. Gerard’s email address is ggregory@wrhn.org.nz, phone 06 3480109 ext 738.

A solution to the Internet Explorer 11 and Map of Medicine single ‘sign-on’ (direct access from Medtech to Map of Medicine) incompatibility issue has been achieved.

PATHWAYS UNDER DEVELOPMENT TENTATIVE DATESPublication Launch

Stroke

Dr Alan Mangan; Dr Jan Gregson; Amanda VanElswijk

Suspected Pathway developed; awaiting publication and launch alongside rehab pathway.

October NovemberRehabilitation

A project is currently underway to review existing hospital provision of community rehabilitation services including contracts. The Stroke Rehabilitation Pathway development will align with this review and will focus on how co-ordinated community stroke rehabilitation will be provided in the future. Ongoing. The community rehabilitation project has identified service provision gaps particularly in the Allied Health domain. A central triaging referral system has been established to streamline complex discharges. Alongside this access to community physiotherapy and occupational therapy are being streamlined. Referrals and responses are being monitored to identify service improvement opportunities. This has been reported in the quarterly MOH report. Further collaboration is required between secondary care services and community agencies. The stroke discharge project is particularly streamlining stroke prognostic indicators and discharge destination planning process. The expectation is that in September the project reports will be completed for both project which can then inform the completion of the community rehabilitation map leading to publication in October and launch in November 2016.

Heart Failure (HF)

Paul Boden, Nafiz Ghamri

HF Suspected Localisation of heart failure pathways is underway. Draft pathways for both Suspected and Management are near completion with work to begin on acute exacerbation of heart failure pathway.

TBA TBAHF Management

COPD

Dr Kevin Jones; Chris Rothman; Dr John Cantillion

COPD Suspected Work will now concentrate on the implementation plan. With the new appointment of the clinical nurse specialist, work can now progress on the primary model of care to support diagnosis management and acute exacerbation of COPD.

TBC TBCCOPD: Stable ManagementCOPD: Acute Exacerbation

PATHWAYS UNDER DEVELOPMENT TENTATIVE DATESPublication Launch

Adult Mental Health PresentationAlex Loggie; Dr Tony FrithWork is progressing on the development of the collaborative pathway and associated infrastructure including advanced form, data collection supporting model of care and primary workforce development.

November 2016 TBA

Asthma in AdultsDr Kevin Jones; Chris RothmanChronic Draft pathways generated ongoing work to be aligned with COPD

implementation. TBC TBCAcute

First Trimester for Pregnant Women – Early Booking During PregnancyDr John McMenamin; Cheryl BennPathway has been developed sub-regionally with MidCentral. Pathway is being reviewed by Maternal Quality and Safety Group in Whanganui with local adaptations made prior to publication. Advanced form in place to support the pathway. Localisation of pathway to occur along with incorporating advanced form. Education roll out to happen October to December 2016.

October 2016 N/A

Hepatitis C

Dr Merchant , Rick Nicholson A regional Hepatitis C Pathway is completed and has been published in the central view. The Pathway will inform GP practices and other users on how to identify the at risk groups, use targeted testing to diagnose people with chronic Hepatitis C and either refer them into the specialised service or, if they refuse, manage them in a primary care setting. It is expected that a single clinical pathway for Hepatitis C care should be implemented across all regions of New Zealand to provide consistent services which maximise the wellbeing of all New Zealanders living with Hepatitis C. This will be reviewed locally and any local editions added.

October 2016 TBC

Cancer – Sub Regional and LocalAll cancer pathways are initially developed in a sub regional level with local participation on the pathway group. These are then amended for local application.

Breast Sub-regional Suspected Breast Cancer and Breast Pain Pathways has been pulished and is now being localised for Whanganui.

October2016 TBC

Gynaecology

Work continues on development of a sub regional pathway with localisation commencing October 2016. Expression of interest has been sent out for clinicans wishing to particapte in the localisation of this pathway.

December 2016

Prostate

The development of this pathway will commence following the Gynacological Cancer Pathway/s. MoH guidlines circulated June 2016.Expression of interest will be circulated November with sub regional pathway development work beginning November 2016.

TBC TBC

Head & Neck National tumor standards review is due to commence October 2016. Sub regional development of pathways will commence following the standards service review.

TBC TBC

Upper GI TBC TBC

Cellulitis

This pathway commenced in August 2016. Pre work is being undertaken to identify best practice, model of care approach and options for workforce upskilling. TBC TBC

Fit for SurgeryThis pathway is under development with feedback being sought from Gp teams on how information is gained from patients on their lifestyle and what options are available in the community now to support individuals.

TBC

PUBLISHED PATHWAYSTENTATIVE DATES

Review Publication

DementiaDr Lachie Smith; Dr Jan GregsonAssessment The pathway and associated advanced form has been

reviewed and amendments made. The amended document is now out for consultation and feedback being sought from NGO providers, consumers their families and GP teams.

July/August 2016

October 2016 Management

CardiologyFiona Corbin; Dr Dave MundellAcute Chest Pain – Assessment

Reveiwed with minimal change and republished. June 2016 TBCACS – SuspectedAF - Suspected & Ongoing Management Accelerated Chest PainDr David Mundell; Dr Chris CresswellReview has commenced alongside review of Cardiology Pathways and development of Heart Failure Pathways. June 2016 TBC

Advance Care Planning (ACP)Dr Alan Mangan; Jennie Fowler

Pathway has been published and ACP is in use.

Chronic Kidney Disease (CKD)Dr Norman Panlilio; Dr Tom Thompson; Lois Nikolajenko; Dr Rick NicholsonCKD Management Dashboard tool and national BPAC tool now accessible in

all general practices. Ben McMenamin will be activating it in all practices over the coming 4 weeks.

June 2017Increased Creatinine / Renal Impairment: ManagementStrokeDr Alan Mangan; Dr Jan GregsonImmediate Management of Ischaemic Stroke

In-patient pathways published and available on Map of Medicine. May 2017 TBC

Immediate Management of Intracerebral HaemorrhageOngoing Management of Ischaemic StrokeTIA & Secondary Prevention of stroke Colorectal CancerDr John McMenamin; Dr Marianne LillColorectal Symptoms & Suspected Colorectal Cancer February

2017April 2017Surveillance Colonoscopy –

Personal & Family HistoryFalls Prevention and ManagementDr Willem van Niekerk; Sandy BlakeThe falls prevention team continue to receive referrals since the launch of this pathway with the falls prevention nurse receiving an average of 7 referrals a week. There continues to be a number of operational challenges for this team in using information systems that are not integrated in their application across the sector.

March 2017 May 2017

Osteoporosis & Fragility FracturesDr Jan Gregson; Kerry Watson

As above this pathway has been published and launched. March 2017 May 2017

PUBLISHED PATHWAYSTENTATIVE DATES

Review Publication

Deep Vein Thrombosis (DVT)

Dr Englebrecht; Dr Chris Cresswell; Louise Allsopp

The first patient has used the pathway with positive feedback on process and timeframe. March 2017 May 2017

Lung Cancer – SuspectedDr Kevin Jones; Andrea Dempsey-Thornton

Pathway has been published. February 2017

April 2017