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HEYWOOD RURAL HEALTH

Excellence in Rural Health

2014 ANNUAL REPORT

Specprint(03) 5572 1011

QUALITY OF CARE REPORT

We acknowledge the traditional owners of the land, the Gunditjmara people and pay our respect to the Elders, past and present.

VISION MISSION & VALUE STATEMENT:

Excellence in Rural Health – accessible quality healthcare

OUR MISSION:

To deliver a person centred, accessible, quality service that is valued by our diverse community

OUR VALUES:

• Our community

• We are committed to their health and wellbeing, rights and responsibilities as consumers and their participants in creating a quality local health service that they value

• Strong leadership & Governance

• We are committed to governance and management demonstrating leadership through strategic planning, accountability and innovation

• Our staff and volunteers

• We are committed to our communities’ health and wellbeing, supporting their professional development and training, ensuring that they are resourced and activated

• Continuous Quality Improvements & best Practice

• We support culture of commitment to continuous quality improvement, safe practice and innovation

AND OUR VISION FOR THE FUTURE MEANS THAT WE WILL BE:

• Delivering sustainable, integrated and innovative programs & services

• Striving to become an ‘employer of choice’

• Developing stronger partnerships & collaborations

• Achieving positive outcomes that are improving the health & wellbeing of residents, community, staff and volunteers

• A leader in the provision of integrated, quality and safe care that is valued by all who access our acute, primary & residential care services

AND A MEASURE OF SUCCESS IN ACHIEVING THIS VISION WILL BE:

• Person centred care is provided that is ‘evidence based’ and ‘best practice’ in order to meet quality standards of care

• Patients/Clients and their family demonstrate enhancedhealthliteracyandselfefficiency

• Residents and their family, acute and community clients are able to actively participate in their assessment, care planning and review

• Strengthened partnerships and relationships with our health service is valued as meeting the needs of our rural community

• Staff and volunteers are supported through ongoing professional development and /or training, and acknowledged for their ongoing commitment to quality service provision

• Support services are delivered by a prepared and proactive practice team to support people living with chronic and complex issues

• Innovative systems and processes underpin the delivery of improved services throughout the continuum of care

• Enhanced awareness of services and capacity by HRH staff and volunteers to deliver them is achieved through improving relationships with residents and their families, community and other service providers.

HEYWOOD RURAL HEALTHExcellence in Rural Health

HEYWOOD RURAL HEALTH | EXCELLENCE IN RURAL HEALTH 3

CONTENTS

Introduction & About our Organisation ...........................................................................................4

Key Achievements ...........................................................................................................................6

A Personal Journey by Bruce & Stellie ............................................................................................8

Community Projects & Volunteers ...................................................................................................9

Services to our community ............................................................................................................ 10

Quality & Safety ........................................................................................................................... 13

Education ...................................................................................................................................... 18

OFFICIAL ADDRESS AND TELEPHONE NUMBERHeywood Rural Health21 Barclay StreetP.O. Box 159Heywood Victoria 3304

Telephone: (03) 5527 0555

Facsimile: (03) 5527 1900

Website: www.swarh2.com.au/hrhABN: 13 439 112 909

HEYWOOD RURAL HEALTH QUALITY OF CARE REPORT 2014

HEYWOOD RURAL HEALTH | EXCELLENCE IN RURAL HEALTH4

Quality of Care Report 2013-2014

IntroductionThe Board of Management and staff of Heywood Rural Health (HRH) are proud to present to our community this Quality of Care report providing information on the quality improvements we have undertaken to deliver safe care to our community for 2013-2014 year.

This report is prepared from the guidelines provided by the Department of Health (DOH) and is distributed to all areas of HRH with copies also going to community groups, local medical clinics, residents & families, volunteers and Department of Health (DOH). This year the report has not be included in the main body of the annual report but as a separate document, emphasising on ‘stories’ experienced by our consumers, carers, and volunteers.

A feedback page asking you the community to tell us what you thought of the information provided has been included in the report. HRH are always striving towards continuous improvement and feedback about the report from the readers would be supportive to make this happen. The annual report from last year received no feedback or evaluation from the community.

About our organisationHeywood Rural Health is funded by the Victorian Department of Health under the Small Rural Health Services flexible funding model. In addition tofunding received from the State, we receive funding from the Commonwealth Department of Social Services for aged residential care and community based services.The Hospital is governed by a (Volunteer) Board of Management appointed on a triennial basis by the Governor in Council (Victorian Minister for Health), currently we have 8 Board Members.Heywood Rural Health employed 121 people at 30 June 2014The workforce is made up of predominately part time & casual staff, the equivalent full time (EFT) number of staff being 72 .1

The Senior Staff at Heywood Rural Health include:• ChiefExecutiveOfficer• Director of Nursing • Nurse Unit Manager - Acute and Residential

Services • Director of Primary Care - currently appointed

to role until June 2015• Nurse Unit Manager – District Nursing Service • Quality and Risk Manager • Domestic Services Supervisor • MaintenanceOfficer• FinanceOfficer• DMS services via Western District Health

Services (WDHS) agreement

Hospital services At the 30th June 2014 our hospital services include:• 5 Acute hospital beds• 12 Nursing Home beds• 33 Hostel beds - Including dementia specific

beds• Nurse based Urgent Care Service – 2 Trolleys• Clinical Nurse Education programs for staff• Community Activity Group• Speech therapy for residents• Continence Nurse for residents• Resident Podiatry services• Wound Care consultancy• Our Chronic & Complex Care Services include:• District Nursing (Home & Community Care,

Hospital• In the Home, Palliative Care, Post-Acute Care)• 7 Community Aged Care Packages for general• Community care clients• 5CommunityAgedCarePackagesspecifically• For Aboriginal & Torres Strait Islander use• IntakeSupportLiaisonOfficer• LiaisonOfficer• Occupational Therapy – Heywood, Casterton,• Merino & Dartmoor• Physiotherapy• Social Worker & Counselling Service• Psychologist (Casterton)• Continence Nurse Advisor Service• Asthma Education Service• QUIT (Smoking) Facilitator• Dietitian Service – Heywood, Merino & Dartmoor


• Diabetes Education – Heywood & Dartmoor• Community Health Nurse – Integrated Chronic• Disease Management; Heywood & Dartmoor• Early Intervention in Chronic Disease• Coordination – Type 2 Diabetes• Podiatry Services; Heywood, Merino &

Dartmoor• Meals on Wheels• Assistance with Community Transport (RSL

Community Bus & motor vehicle)

Our Health Promotion Services Include:

• Community Health Nurse - Children’s &• Adolescent Health; Heywood, Casterton, Merino• & Dartmoor• Physical Activity Program 1:1 Group walking,• Strength & balance Training, Rehabilitation –

Heywood & Dartmoor• Men’s Health & Wellbeing (Supporting the• Heywood Men’s Shed Project)• Women’s Health & wellbeing – Heywood,• Casterton, Dartmoor & Merino• Mental Health & wellbeing – Social programs –

Heywood & Merino• Community Gymnasium

ADVANCED CARE PLANNINGAdvanced care planning – Respecting patient choices is an initiative that was developed by Austin Health in 2002. It is a process for making and writing down decisions regarding your future health and medical care in advance.Advanced care planning aims to keep you involved in your medical decisions both now and in the future whether you are healthy or are experiencing an illness. Advanced care planning is founded on respect for personal autonomy and is especially important during any period of temporary or permanent impaired decision making capacity, and not only at the end of life. Advanced Care planning is intended to ensure your preferences are honoured as your doctors and family have an understanding of how you would like to be cared for. HRH have an advanced care planning program in place, with a number of health care practitioners available to assist the consumer to work through this

conversation. You may wish to make an appointment with one of the Advance care planners by contacting reception at HRH.

COMMUNITY PARTICIPATION - Doing it with us, not for us

HRH is committed to consumer, carer and community participation and is always looking at how we can improve the services within Heywood. It is important that the consumer is encouraged to be inclusive in all aspects of the service and here are just some of the ways we do this:• Consulting and involving consumers, carers &

community members through: 3 Community members on our Board of Governance 3 Monthly consumer advisory committee meetings 3 Carers group facilitated & supported by Heywood Rural Health 3 Regular resident meetings 3 Volunteer meetings• Suggestion boxes strategically placed at each

entrance to our services to gather community comment/input into improvements we could make to our services

• SuggestionBoxplacedatlocalPostOfficeforcommunity feedback

• TV screen installed at the local bakery to keep everyone informed of HRH’s activities and future events

• Compliments, complaints, & suggestions are reported monthly via our Quality & Risk Committee & bimonthly to the Board Quality Committee with information on outcomes fed back to staff & consumers

• Evaluation and feedback from comment cards, complaints & compliments and ‘opportunity for improvement’ form

Planned• Results from Press Ganey Satisfaction survey

that was sent out to the aged care residents andcarerswillbefinalisedandtheinformationcollated in order to complete an action plan for improvement



CLINICAL GOVERNANCEThisClinicalGovernanceframeworkisdefinedasanorganisational approach that supports the overall management and improvement of quality health services at Heywood Rural Health. ClinicalGovernanceisdefinedas‘thesystembywhichthe Board of Management, Department heads, clinicians and staff share responsibility and accountability for quality care, continuous improvement, minimisation of risks and fostering environments of excellence in caring for patients and residents’.

DEFINITIONS Consumer participation includes community consultation and consumer partnership throughout all levels of the organisation. It includes, but is not limited to; community needs surveys, participation on committees and interest groups, complaints and compliments systems and other feedback processes. Clinical effectiveness is ensuring the right care is provided to the right patient who is informed and involved in their care at the right time by the right clinician with the right skills in the right way. Effective workforce is ensuring all staff employed within health services have theappropriateskillsandknowledgerequiredtofulfiltheir role and responsibilities within the organisation. Risk management and Clinical risk management is part of a broader organisational risk management system which integrates the management of organisational, financial, occupational health and safety, plant,equipment and patient safety risk.

KEY ACHIEVEMENTS DURING 2013-2014This year has been a dynamic year full of change.Progress has been made through:Unification of our allied health service into onebuilding –helping to bring all Primary Care services together.

Air conditioning

Following the recent installation of Air Conditioning units to all the Nursing Home and Hostel rooms our residents are now able to enjoy a comfortable environment at the touch of a button.

Indigenous garden and plant use signage

With the support and guidance from our local Indigenous cooperative Windamara, Heywood has been able to improve the front entrance of the facility, leading buildings and pathways. The previous garden was replaced with significantplants from Seawinds Nursery in Portland under the guidance of the Budj Bim Natural Heritage Group who chose and planted Native plants. The culmination of the planting is a beautifully depicted sign on the West facing walkway identifying the plants used in the garden and their native use as natural remedies, basket weaving resource and as food product. The garden is now looking full and starting to explode with colour due to the appropriateness of the plantings.


Indigenous flag poles

Recognition of our Indigenous settlement of Australia was an important heritage reminder. As a community role model HRH felt it important to show support of our Aboriginal and Torres Strait Islander people throughtheerectionofadditionalflagpolesinthecourt yard front entrance. This initiative is a mark of respect to our First Peoples.

Photo: A big thank you to our volunteers for preparing and serving hot food following the drill

Winning the Wood, Rose & Wine display

In February 2014 our residents and staff participated in the annual local event of “Wood Wine&RosesFestival”by creatingamagnificentdisplay in the foyer of the Heywood Rural Health.Thecompetitionhasmanyaclassificationwithprizesbeing awarded to the winning entrants.The HRH residents were delighted to be awarded themajorprizeforthe“BestOveralldisplay”.Theentry this year was titled the ‘Wedding scene’ and they were presented with a cheque for $600.00Theprizeincludedavoucherfor3HA/MixFMradioairtime.Residents and staff came together to determine how best to use this voucher and chose to use it to enhance the public awareness of the reputation of their home.In June 2014 a series of voice recordings from individual residents were made which represented personal testimonials of their time within HRH.The individual reflections have been played overthe radio across the Heywood, Portland and Hamilton communities. The recordings demonstrate

the positive experiences the residents have had during their stay at Heywood Rural Health – this has been a successful marketing opportunity for HRH.

Photo: Wood, Wine & Roses foyer display

The planned restoration of Heywood Memorial gates

The existing gates at the entrance to HRH were built with the support of the local community. The memorial stone has engraved names of those soldiers from the community who contributed to the First World War and were killed in action. HRH initially sought to renovate the gates with minor repairs however after structural review a full restoration was recommended. Plans are in place to complete the works by April 2015 through funding from the RSL, local community donations and HRH funding.

Photo: Memorial gates project-Originally built in 1957



Picture: Names of the soldiers who were killed in action

Vintage Cars Visit Heywood Rural Health

OnafinesunnydayinMaythisyearanumberofVintage cars visited Heywood Men’s shed.The sound of these older cars coming into the driveway of Heywood Rural Health raised the interest of residents, visitors and staff and off they went to investigate. Heywood Men’s shed volunteers, residents, patients; staff and many visitors enjoyed a scrumptious afternoon tea and shared many conversations and memories over the vintage cars.

Photo: Mr Max Murray (resident) and Mr Terry Sparrow (Heywood Men’s Shed) share memories over Terry’s 1936 Dodge

GOLDEN COMMUNITY CAPERSA small but robust group of aged community members attend Heywood Rural Health every Friday. This program is a social activity for those in the community who may be isolated or to meet the needs and interest of people in the community to promote their participation and enjoyment. If you are interested in joining this small group of people on a Friday, please contact the Activity department and join in.

A PERSONAL JOURNEY OF TRANSFERRING FROM ONE HOSPITAL TO HEYWOOD RURAL HEALTH SERVICES

BRUCE

Heywood Rural Health (HRH) has given my Bruce back to me and for that I am forever grateful.In January 2014, Bruce suffered a catastrophic health event, which required intensive care and management at Royal Adelaide Hospital (RAH). When it became evident that Bruce would not be able to return home, we had to seek long term care for him. This was not an easy experience as every place we approached refused our request as they were frightened of Bruce’s care needs. A contact that we had in Mount Gambier suggested we approach HRH, I could not believe that a small rural health facility would actually consider Bruce when larger places had said no.“I was totally gobsmacked to learn that HRH had said yes and that it was actually going to happen”.In July 2014 Mandy and Kat, two nurses from Royal Adelaide Hospital (RAH) spent a week at HRH upskilling the care team to be able to meet the needsofBruce’sspecificclinicalneeds.Kat & Mandy delivered education through knowledge, skills and the use of equipment offering support to the staff with great energy and passion. Kat & Mandy stayed at HRH and they became part of the welcome team for Bruce’s arrival and continued to offer support to the staff during his settling in period.Since Bruce arrived at HRH in July 2014, with the ongoing care and support of Dr Fox, nursing, personal care and environmental teams I have seen a great improvement in Bruce’s condition. The enthusiasm and encouragement that I see every time I visit Bruce is wonderful. Bruce coming to Heywood


has allowed our relationship to reconnect after a 6 month hiatus while Bruce was in Adelaide as I was only able to visit him there infrequently.HRH have not only welcomed Bruce, they have also extended this to include Bruce’s’ other family members. “Go team Heywood”Thank you HRH, from the bottom of my heart.Stellie

Photo: Bruce & Stellie

Community Projects - Heywood Euchre groupA community group activity that has been meeting regularly and continue to encourage community connectedness. The group not only enjoys a get together and a social game of cards, they raise money and support other local projects. Recent donations included the Heywood District Nursing service, the Heywood Chronic disease management nurse for equipment and the HRH memorial gates project.

Recycling of BicyclesThe project started by a member of the community suggesting such a project as an idea. News of the idea soon developed within the community and families started to access bikes that had been recycled using spare parts. Stuart Wells is a passionate community member with a love of working with groups, school children and community members to improve their knowledge on bikes. Some days are quiet but the work continues and bikes have been provided to outreach communities in Merino and locally to Heywood. The warmer weather sees improved access and together with the Heywood Bicycle maps the project remains a positive fun activity, at whichever stage people enter.

Get active” exercise group -A community idea by Gwen Finck for a much needed and sustainable community exercise program was

developed by HRH in conjunction with United Way who provided funding. This enabled community member Kellie Finck to progress through her training for Certificate 3 and 4 in fitness, supported byPortland YMCA. The class currently averages 15 participants-both male and female who exercise one hour per week within their local community. Kellie has plans to sustain this “Get Active” exercise class and to expand the program for younger people and out of hours training in 2015.

Photo: Kelly Finck “Local people, Local Activity”

Heywood Men’s shedThe group have been involved with building raised planter beds for residents and the community. The group have supported the residents of Heywood Rural Health to access the shed and have improved overall access by building footpaths.

Photo: Residents can now visit the volunteers without having to combat unstable surfaces

In 2014 the Men’s Shed Health forum was coordinated by a team of over 50 male volunteers. Over 50 individuals, including women attended the event at HRH.There were presentations and opportunities for attendees to ask questions to the presenting speakers



– speakers included the renowned Oncologist Ian Collins - Continence Nurse and Educator Rosa Vaughan, Mel Braithwaite – Hearing Australia and Claire Atchison – Pharmacist.There was an opportunity for people to mingle - socialise during the provision of a healthy meal.Heywood Men’s Shed Inc. proudly exhibits their logo-‘Pursuing Men’s Health’ which stands strong throughout Victoria.

Heywood’s Men Shed- known as one of the most active sheds within Victoria, and opens 7 days a week and is known to have the kettle connected to the doorbell.

Photo: The Men’s shed is situated on the hospital grounds

SERVICES TO OUR COMMUNITY

POLICY & RESEARCH

TIME SPENT CARING FOR OLDER PEOPLE OR WITH A DISABILITY ON THE RISE – AUSTRALIAN BUREAU OF STATISTICS (ABS)

In Australia 12% of people provide informal care to an older person or to someone with a disability or long-term health condition, according to the latest figuresfromtheAustralianBureauofStatistics(ABS).In 2012 2.7 million people provided informal care and around 29 % of these carers were primary carers. The proportion of primary carers who were spending 40 hours a week or more providing care has increased.

In 2009 35% of primary carers were spending 40 hours a week or more providing care for 2012, this hasincreasedto39%,orabouttwoinfive.Women were both more likely to be carers, and more likely to be primary carers. The ABS found that there were 1.5 million female carers, and of these 536,700 were primary carers, compared to 1.2 million male carers and 233,100 male primary carers. The ABS survey found that caring duties can impact on their social life, health and wellbeing. About half the primary carers reported they had experienced feeling weary, often feeling angry, resentful, worried, depressed, and/or having a stress-related illness as a result of their caring role. Carers were also less likely to be participating in the labour force (56%) than those who do not have caring responsibilities (69%). It’s therefore vital that Heywood Rural Health continues to provide support to the carers in our community and to those who visit loved ones within residential care. Identifying needs of families and carers is imperative and staff who work within HRH teams are skilled and trained to recognise when someone may need that little more support to help them in their home. Below are just some of the services that are available in the community.


ENHANCED MENTAL HEALTH SERVICES TO HRH AND COMMUNITYA ‘community needs analysis’ coordinated by Warrnambool Medicare Local demonstrated that our community’s top 3 health priorities are: Obesity/Type 2 diabetes, Lung health and smoking cessation, Mental Health and Alcohol and other drugs. Mental health accessibility is a priority and work has been done to reduce the tyranny of distance for Mental Health sufferers by supporting a clinical psychologist to base themselves at HRH once a fortnight for clients under a mental health plans. This service compliments our social worker and encourages clients to seek local help in their local community early. Robert Jack acts as an advocate, assists with advanced care planning, health decision considerations and transitions.

Photo: Robert Jack – social worker at HRH

Enhanced management for long term health issues

Progress has been made with the ongoing development of the Integrated Chronic disease management model of care. Clients who may otherwise rebound into hospital, be prematurely admitted to residential aged care or have an unnecessary fall, are referred with consent to our Intake staff for prioritisation and referral to services. These services include:• Chronic disease management – This service is

coordinated by Tracy Stafford who has vast experience with nursing health and health promoting activities. This service and Tracy’s dedication has had a massive impact for her clients. Feedback has demonstrated that all the clients are grateful for the service and feel this service has enabled them to stay at home safer and longer. Tracy advocates on behalf of the client, assisting with referral to relevant services, and offering education to the clients on disease management in the home

• Occupational therapy services - Prior to the outreach service being introduced, Glenelg shire had a 6 month waiting list for assessment. Jane Reynolds commenced at HRH and this service has since seen a 45% increase since 2013. Jane operates from HRH and often travels around Glenelg shire to provide timely advice, equipment and support

• Community health nurse Leonie Bartlett has been instrumental in her role and works collaboratively with other services to maintain effective services. Leonie has also been involved with Heywood Secondary College Standing Tall program, Better Health self-Management and the HEAL program, encouraging community to take control through health literacy and confidence building which ispertinent in health management.

Photo: Leonie Bartlett – Community Health Nurse

Person Centred Care

Our district nurses presented at the Regional HACC forum with work they had completed in implementing consumer directed care through regionally developed care plans and documentation. Luise Macklin (RN DNS) believes “the process takes in the person’s whole needs and gives them a chance to say what is important to them-their goals, and we work with that!”Kerry Finck works in reception at Primary Care and holds “Many Hats” and assists with intake, community transport, appointment booking, administrative and marketing tasks. Kerry’s role involves being responsive to individuals needs when accessing primary care services – a recent visitor expressed the following:“Thank you so much for your help-I didn’t know where to go... I really appreciated the little things too, like the toothpaste in the food hamper-that just got me through.”



Physiotherapy servicesOur physiotherapist Jess Fishburn started in 2014 making a marked difference in service satisfaction. The service now has a 4 week wait list and is looking for ways of effectively reducing. With a passion for women’s health and prevention of incontinence, Jess was presented with a Dean’s award during her University Degree. Jess currently works with acute injury and chronic injury, post-surgical procedures, strength and balance through fall prevention programs and pulmonary rehabilitation.

Photo: Jess Fishburn (Physiotherapist)

Meals on wheels The volunteer program was nominated as being one of the top 3 projects in the Victorian Regional Achievement and Community awards in Bendigo for 2013/2014. Well done to all the volunteers, a great achievement for HRH and its community.

Photo: Proudly representing HRH volunteers

Volunteer ProgramThe volunteer program is a vital resource for our local community with a stable number of locals involved and interested in activities to support the facility. Through community transport, meals on wheels, administrative support, feedback, information and ideas-all aspects of the program are encouraged. Training is provided twice yearly with CPR, food handling and safety aspects of volunteering.

Photo: Education trainer Rosa Vaughan and Tonia McMahon – Quality & Risk Manager demonstrating the CPR recovery position to the volunteers


Catering servicesA small but energetic catering team lead by Christine Duyvestyn spend many hours creating delightful foods for residents, patients and the meals on wheels customers. All meals produced at HRH are freshly cooked on site. Feedback from all of the residents and patients is continuously encouraged during meetings and comment cards. The catering team work closely with the Speech therapist and Dietitian to ensure all foods produced meet the dietary and texture needs of the consumers.

Students & Placements – How these benefit all During the year HRH accommodates University, Tafe and School students participate in a number of clinical placements. Students who have been placed at HRH often return to us upon completion of their studies to seek employment at HRH if and when then are vacancies. It was and is important to have students here for experience to learn about the health industry. Students are orientated at the start of their placements in order to inform them of the needs of the residents, respecting the rights to privacy and ensuring that they are aware of safety and risk when working in the health care setting.The resident, patients and staff enjoy showcasing their skills and their environment; with positive feedback being received form the students about their time at HRH.We welcome the interaction of students at HRH, as their questions and interest keep the health care workers current in their thinking and alert. At a resident meeting in July this year it was communicated by a majority of the residents that they enjoyed having the students here at their home.

QUALITY & SAFETY HRH has a Quality and Safety Committee which includes members of the senior management, staff and OH&S representative from across the organisation. The committee meet monthly and complete building inspections to monitor safety and areas of improvement.

Continous ImprovementRISKMAN is a risk management system that HRH use to reduce the risk of harm to patients, residents, clients and staff.All health care involves some level of risk and therefore the clinical risk management policy and plan outlines what HRH employees should do in our everyday work to minimise these risks. The Risk Register is one of a number of strategies involved in risk management, rating high level clinical and non-clinical risks based on the risk likelihood and consequence. The risk register is continually reviewed and then reported to the Quality and Risk Committee every three months. Risk management activities focus on system deficiencies rather thanblaming individuals so staff are able to discuss concerns, incidents and errors in a just, open and supportive environment. The incident reporting system is a key mechanism for risk identification.Heywood uses the Risk Man database to report incidents including falls, pressure ulcers, medication errors, safety issues and workplace injuries. Once documented, incidents are investigated and our processes examined so we can make improvements.



OCCUPATIONAL HEALTH & SAFETYOur Quality & Risk Committee has continued with the monthly walk around inspections of the facility prior to each meeting. This group walk around has provenbeneficialinidentifyingimprovements,manyof which were able to be quickly implemented. ACHS Surveyors in March commented “There is a very good awareness of OH&S across the organisation & significant resources & equipmentare in place to ensure the effectiveness of the safety management system”In May 2012 we participated with Worksafe in a review of our facility with the Consultant stating she was impressed with the systems we had in place. From the visit we have developed a Safety Action Plan to further strengthen our systems.

MAKING SAFETY A PRIORITY - MOCK EVACUATION at HEYWOOD The Mock fire evacuation drill held on 15th July2014 at 6.30pm involving CFA, SES, Ambulance, staff, residents and volunteers gave everyone an opportunity to practice and learn how evacuations can be completed in preparation for a real event.A planning meeting was held a few weeks prior to the drill which helped identify everyone’s role and responsibility.The drill assisted all services that were involved including Heathmere to develop plans that included improvement and further training for staff. The whole event gave staff, residents and volunteers a talking point which highlighted the importance of safety.We would like to take the opportunity to thank all the residents, volunteers, staff and emergency services for their time to make this happen.

Photo: Gary Harker (Portland Fire Captain) giving a debrief to everyone following the drill

COMMENTS AND COMPLIMENTSFeedback provides HRH the opportunity to review our services and address areas for improvement. The complaints process is clearly articulated, open and accountable to staff and consumers.Minor or point of service complaints are usually verbal and are dealt with promptly at the point of service. The issue is handled by the consumer speaking directly to management. Written complaints are managed through the CEO or senior management. A copy of the complaint is placed on riskman with written acknowledgement provided to the complainant within 48 hours of the complaint being received. The Chief Executive or relevant senior manager commences the investigation and depending on the nature of complaint, may contact the department of health to inform them a complaint has been received. Staff are invited to respond to the complaint, records are reviewed and witnesses contacted. A response to the complainant is then communicated in writing to them within 30 working days. Details relating to the Health Services Commission are included in the response. Heywood Rural Health strives to improve the services to the consumers and welcome all aspects of feedback and use this as a framework for continuous quality and safe improvement.

Quality Improvement, Standards and AccreditationThe Australian Council on Healthcare Standards (ACHS) isanindependent,not-for-profitorganisation,dedicatedto improving the quality of Acute and Community based health care in Australia through the continual review of performance, assessment and accreditationAccreditation for the Acute and Community services is a formal process to assist in the delivery of safe, high quality health care based on standards and processes devised and developed by health care professionals for healthcare services. In December 2013, HRH Acute and Community services were surveyed by the Australian Council on Healthcare Standards against the 10newNationalStandards.Thiswasthefirsttimethatwe had been reviewed against these new Standards, with a good outcome achieved.

Accreditation status:• The Australian Council on Healthcare

Standards(ACHS) EQUiP/National for the acute hospital and primary care & allied health services to the 27th June 2016

• The Commonwealth Aged Care Standards Agency Program for the Heywood Nursing


Home to 18th June 2015• The Commonwealth Aged Care Standards

Agency Program covering the Sydney-Lynne Quayle&FitzroyLodgeHostelsto21stAugust2016

• The new Common Community Care Standards Program – which now encompasses the Quality Reporting Program for HCP (Home Care Packages) and the (HACC) funded District

• Nursing Service took place for HCP on the 24th October 2013 while HACC District Nursing took place on 17th December. Both of these service reviews were completed and successful with no recommendations

• In addition to the above, HRH does provide\ some assistance to Heywood Medical Service to support the clinic with their GPA (General Practice Australia) Accreditation status

Resident Ron Carter celebrated his 90th birthday in March with family and friends. Ron is pictured here with Navreet, one of the nursing staff who contributes to providing a caring environment for the residents at HRH.

PUBLIC SECTOR RESIDENTIAL AGED CARE QUALITY INDICATORSEach quarter we submit data to the Department of Health on five key risk areas for aged careresidents and we are then benchmarked with results from across the state aged care facilities.The key areas measured are:1. Pressure Ulcers2. Falls3. Physical Restraint4. Residents Prescribed Nine or More medications5. Unplanned Weight Loss among residents

Aged Care Clinical Indicator Results for HRH 2009 - 2014. The following graphs indicate where we currently sit compared to the clinical indicator ranges for each indicator.

PRESSURE INJURIESIn residential care we have many pressure injury prevention practices in place. Some are standard for all residents and others are used for residents at higher risk of developing pressure injuries. We monitor the number of pressure injuries occurring within our aged care facility. Overall the number of pressure injuries in HRH has been low throughout 2013-14. We had no serious Stage 3 or 4 pressure injuries develop. When a pressure injury develops, we investigate the cause of the pressure and take steps to remove the cause. We use photographs and measuring devices to monitor the injury to ensure that we are managing it appropriately. There is an extensive array of products available to assist in pressure injury healing, such as wound products and nutritional supports. We also link in with the Sub Regional Wound consultant, should we have a more serious wound requiring advanced knowledge. These are some of the pressure injury prevention and management practices we implement.

• Repositioning of residents is a very simple but important measure to minimise pressure build up

• Regular maintenance of resident aids and equipment reduces the risk of pressure injuries developing.

• Maintaining personal hygiene and using moisturising or barrier type creams.

• Providing good nutrition

• All beds have pressure relieving mattresses to prevent pressure from building

• Some residents at higher risk of pressure injury have air mattresses on their beds.

• We also have special chairs with air cushions built in for use by less mobile residents.



Pressure Injuries Stage 1 Nursing Home now trending down to the acceptable range however there is an increase among Hostel residents.

Pressure Injuries Stage 2 trending up for both Nursing Home and Hostel residents

Stage 3 & 4 show no changes due to data difficulties

FALLSMany of our patients and residents are elderly, frail and at risk of falls that could cause them serious injury. We defineafallasaneventwhichresultsinapersoncomingtorestinadvertentlyonthegroundorfloororatalowerlevel. Many people consider falls an accident, however

falls rarely occur through being accidental and there are usually a number of factors which increase the risk of falls:• Poor balance • Incontinence• Unfamiliar environment • Poor eyesight, unsafe footwear • Some medications contribute to a person’s risk of fallingDespite our best efforts, it is not always possible to eliminate the risk of falls for our residents as we need to consider residents independence, dignity and freedom of choice.

Here at Heywood, we understand that a successful falls prevention program uses a combination of strategies including:• screening and assessing all residents for their falls risk• Implementation of a range of standard

precautionary strategies• Development of an individualised care plan

focusing on falls prevention and addressing the resident’s unique combination of falls factors

• Falls prevention strategies include: – multidisciplinary team input, including nursing, physiotherapist, occupational therapist, activities coordinator, podiatrist, Dietitian. – comprehensive assessment and regular review of care plans and identificationofrisks• environmental modifications including low-

low beds, appropriate seating, appropriate footwear

• Mobility / balance exercise –physiotherapy input aimed to improve gait, balance and coordination

• Medication review• wearing hip protectors• nutritional review with Dietitian to ensure

maximum nutrition for good health is achieved• We monitor the number of falls occurring with

our health serviceThe number of resident falls in HRH have increased from 21 to 31 in 2013-14, we are investigating the reasons for this and we will implement additional measures as needed to decrease the rate of falls .11 of these fall episodes can be attributed to one individual resident, who has significant co-morbidities and we are challenged in balancing his independence, along with his safety.


MEDICATION MANAGEMENTHRH has medication systems and processes in place to ensure that safety is improved. Staff are required to complete ongoing competency training for medication administration. Medication management is reviewed and improved at regular Quality & Risk meetings. 9 or more medications are trending down for Nursing Home but Hostel has seen an increase

WEIGHT LOSSWe monitor the number of residents with an unplanned weight loss and report the data every three months to the Department of Health. Over the 12 month period 6 residents demonstrated an unplanned weight loss of more than 3kg. Some of this weight loss can be attributed to the palliative phase for 3 residents, we have reviewed how food is prepared and provided to the residents. We have introduced a food monitor to ask individual residents their food choices. The meals are brought to the residents and served by catering staff, which allows residents to ask forspecificfoodsorsizeofmeals.This enables the catering team to receive feedback directly from the residents on meals and servings. The Speech therapist visits Heywood weekly and is constantly reviewing the texture and type of foods that residents are choosing, and having this support helps the resident to be able to consume their food with comfort.Weight Loss greater than 3kg has increased in Nursing Home residents as has weight loss by month.

EXTERNAL REVIEWS - QUALITY & RISKEnvironmental cleaning results and improvements – changingtomicrofiberEvery year at Heywood Rural Health an external auditor visits to complete an audit of the cleanliness of the facility; this is then submitted to the Department of Health.Internal audits are completed monthly and the results submitted to the Quality and Risk Committee.A recent unannounced visit by the Aged Care surveyors complimented HRH and the staff on how the facility was presented; it was clean and free of odours.

Photo – Lisa one of the many environmental staff

Cleaning Audit:A clean and safe environment is inevitable to provide quality care and sense of security to the patients/residents. HRH complies with the Department of Health auditing process of conducting 3 reportable audits which includes both external audit & internal audits. We have always excelled in our cleaning Audits with an overall compliance of 93.44 % from January till September 2014.

INFECTION CONTROL The Infection control programme at HRH aims at maintaining a safe and healthy environment for patients, staff, visitors which is obtained by effective governance and regular surveillance in order to provide the highest quality in patient care. Our hospital participates in the surveillance programme under the VICNISS (Victorian Acquired Infection Surveillance) for hospital acquired infections including various multi drug resistant organisms like the Methicillin Resistant Staphylococcus Aureus,ClostridiumDifficile,andVancomycinResistantEnterococci. Reporting to the VINISS provides HRH an opportunity to benchmark against the various hospitals in the state or with the national data.



Our infection rates continue to be low which a great outcome is for HRH. HRH is currently preparing towards accreditation with the Australian Council on Health Care standards in 2015 and this incudes Standard 3-Prevention and Control of Healthcare acquired infections. HRH will undertake Aged Care accreditation in March 2015 (Standard 4.7 – Infection control). The various areas of focus include:

Hand Hygiene:Education on hand hygiene is completed through online training and on Compulsory Training Days. Our average hand hygiene compliance rate for the year 2014 is 76% and we continuously strive to aim at achieving a higher percentage.

Staff Vaccination:Staff are encouraged to obtain their yearly fluvaccinations by the staff immuniser and the data is submitted to VICNISS in the month of September. The latest compliance percentage was 58 % which is below the national Bench mark of 70% and hence identified as a significant area for improvement.Thetrendoffluvaccinationdatafor thepastfiveyears is as follows:

Aseptic technique: Aseptic technique focuses on following the best practice guidelines for all the Clinical procedures completed at HRH and aim at minimal infection rate. This was a primeareaof focus identifiedasagapduring theACHS Periodic survey in December 2013. Measures have been taken to improve our practices, enhance compliance, and improve the skills and competency of the staff. Regular audits are being complete. The latest audit showed 88 % compliance of the staff for Aseptic technique which is commendable.

Promotional Activities: To help promote ‘Infection Control’ week which was held during the week of 20th – 28th October 2014, HRH produced additional posters, quizzes andpuzzlesforstafftocomplete.

EducationStaff education at HRH has continued to be refreshed throughout the year. The continuation of“on line” and “self-directed” learning packages which is available for all staff.SpecificeducationhasbeendeliveredtoHRHstaffthis year including:• Comprehensive Health Assessment• Diabetes management in residential care• Recognising the deteriorating patient• Wound care• Managingdifficultbehaviours• Palliative care• Tracheostomy care• Medication managementAll mandatory areas of education continue to be delivered (fire training, basic life support, backinjury prevention, infection control) we continue to support many students of health care over the past12months.WewelcomeCertificate3and4in Aged care students from TAFE. We require staff to undertake compulsory training in fire, manualhandling and CPR each year. For the next 12 months we aim to achieve minimum 90% compliance with all compulsory training.

Hamish the Resident CatPhoto: Hamish the Cat

In April 2014 Heywood Rural Health saw the sad passing of their special friend ‘Hamish the resident cat’ Hamish had been a loving and giving member of the all the residents at HRH for more than 10 years.He was often found spending time with his favourite people, residents, visitors and staff. Hamish was a

gifted cat with an inner sense of being needed, as often he was found alongside a resident who was entering their final journey. Farewell Hamish andwe thank you for your support, comfort and quirky ways. We all will miss you.

HEYWOOD RURAL HEALTH

Excellence in Rural Health

2014 ANNUAL REPORT

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