PIG-NI NEWSPain Interest Group Nursing Issues

NEWSLETTERDecember 2012

IMPORTANT DIARY DATES 2012-2013Annual General Meeting October 18th 2013, Le Montage, Lilyfield, Sydney Committee Meetings Mondays at 5pm Royal Prince Alfred Hospital. 18th February, 15th April, 20th May, 17th June, 15th July,

19th August, 16th September, 14th October, 18th November, 9th DecemberForums Committee State Pain Forms meeting same day as committee meetings but start 3pm3-7 February 2013 Asia – Oceania Society of Regional Anaesthesia and Pain Medicine, Sydney Convention Centre

For more information wwwcrapt2013.com4-14 February 2013 Pain Management Multidisciplinary Workshop. University of Sydney Pain Management Research Institute

http://sydney.edu.au/medicine/pmri/education/continuing/index.php17-20 March 2013 33rd Annual Scientific Meeting - Australian Pain Society

For more information see www.dcconferences.com.au18-21 April 2013 New Zealand Pain Society 38th Annual Scientific Meeting – Acutely Chronic: Chronically Acute –

Bridging the Divide. For more information http://nzps2013.org.nz7-11 October 2014 15th World Congress on Pain - Buenos Aires, Argentina. For more information http://www.iasp-pain.org If you wish to advertise an event please send details to the editor.

CHAIRPERSON’S MESSAGE

Firstly, I’d like to introduce myself to those of you who don’t know me.I’ve been involved in acute and chronic pain service at the Prince ofWales Hospital for over 20 years as a Clinical Nurse Consultant, andcurrently as a Clinical Nurse Manager. I’m very honoured to have beenelected as the Chairperson for PIG-NI at the October AGM.

Secondly, I would like to say a big thank you to the prior Chairperson, Emily Edmonds, for heroutstanding leadership over the last three years. Emily’s report is included in this newsletter. It outlines the key projects and main accomplishments of last year which, you must agree withme, illustrate Emily’s exceptional abilities to diligently pursue PIG-NI goals and achieve results.Luckily for us, Emily will remain a member of the Executive Committee, taking the role of the Chairperson Elect. She will also continue putting her talents to good use by facilitating theenormous task of developing and implementing standardised pain forms for NSW.

Thirdly, I feel compelled to mention our last conference, “Inside Pain”, and declare it as “thebest ever”. We, the PIG-NI committee members, are very happy with how it turned out on theday. The feedback from participants is being collated and we will share it with you in the nextnewsletter. The planning for the 2013 PIG-NI conference has already started – pencil the 18thOctober 2013 into your calendars!

Finally, I’d like to acknowledge the dedication of PIG-NI committee members and associateswho, year after year, devote their personal time to going the extra mile in the quest of raisingthe profile of pain speciality and promoting optimal care for patients with pain. And of course,a big thanks to all PIG-NI members, for your support and commitment to pain management.Each of you makes the organisation stronger and more capable of achieving our goals.

I wish you and your families all the best for the festive season, and a prosperous New Year.

Grazyna JastrzabChairperson, Pain Interest Group Nursing Issues

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THIS EDITION

• Chairperson's Message• Important Diary Dates• Annual General report 2012• Winners of Rural Scholarship to

attend Annual Pigni Conference• PIGNI Conference Photos • Coming Meetings• ACI Update • Did You Know?• Media Release - Pregabalin• Pain Nurse In Profile• IASP - Global Pain

Awareness Year• Become a Member

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Thank you to our sponsor

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All correspondence tonewsletter editors:Sandra Tutt sandra.tutt@swsahs.nsw.gov.auStuart Leckiestuart.leckie@gawahs.health.nsw.gov.auDenise WilsonDenise.Wilson@sswahs.nsw.gov.au

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Please do not be shy in sending in any worksof interest. This does not need to be research itmaybe just a poem or cartoon. We lookforward to your thoughts. Many thanksSandraChief Newsletter EditorSandra.tutt@swsahs.nsw.gov.au

ANNUAL GENERAL REPORT 2012This is my final report to the AGM – after3 years in the Chairperson committeeposition it is time to hand over to the nextChair. I have enjoyed the challenge that therole provides and am very grateful to allthe committee members who haveprovided encouragement, support sharingtheir expertise and knowledge without thatfunctioning in the role would not bepossible. There is great commitment bycommittee members evidenced by strongattendance at the monthly meetings despiteeveryone having extremely busy

schedules. The teleconference facility has provided greateropportunity for the committee to participate in the monthly meetingswhen travel to RPA is geographically impossible for those who arerural but also for those living in Sydney where distances can still beproblematic.

• Once again the annual conference has been a great success. Thisyear we had 200 delegates and a total of 221 attendees. This wasdespite a modest increase in the registration fee. The actual costper head for the day exceeds this fee so we depend on sponsorshipto ensure that the conference is not out of the financial reach ofdelegates. Our Gold sponsors this year Hospira, MedicalDevelopments and Pfizer.

o Hospira remain our corporate sponsor and continue to providesupport throughout the year with the printing of the PIGNInewsletter and also the annual education meeting for painnurses in the middle of the year.

• In addition to conference planning, the major project lead by thePIGNI committee since 2009 has been facilitating thestandardisation and development of pain forms for NSW.Consultation has been extensive and sometimes exhaustivehowever it has certainly been productive. We have now completed4 charts – PCA for adult patients, neuraxial opioid single dose, aketamine infusion chart and an epidural infusion chart. The laterwill be trialled early next year. A significant milestone was therecent endorsement of the chart from the Medication safety expertadvisory committee 2 weeks ago. The neuraxial opioid andketamine chart were approved for use with condition that thosefacilities utilising provide evaluation of the forms 6 months postintroduction.

o This project is extremely grateful for the collaborative supportof the ACI (Agency for Clinical Innovation) particularly JenniJohnson the Pain Network Manager. Jenni facilitates valuablecommunications between the consultative group and the CECin addition to planning and implementing the trial of charts.

o We are also very grateful for the ongoing support from DrRichard Halliwell from Westmead hospital. He hasparticipated in all of the high level meetings with the CEC, hiscontributions at those meetings have been extremely valuable.

o Louise Cope the Clinical Trials co-ordinator from Westmeadhospital has provided her expertise in conducting the trial ofthe PCA chart which included implantation plan, audit designand outcomes which was meticulously summarised in acomprehensive report and presentation. The outcomes of thetrial enabled the consultative group to make decisions aboutimprovements and alterations to the chart and will continue to

shape the education and implementation strategy which is nowbeing developed.

o We are now preparing for the trial of the epidural / PCEA chartto commence early next year and we look forward todeveloping an obstetric epidural chart in 2013.

• Life time membership award was created this year. The firstrecipient being Susie Kerr. Imelda Mason has also received theaward for her contributions to the pain specialty and the PIGNIcommittee.

• The annual half yearly education meeting for pain nurses was wellattended by pain nurses from all over NSW. We were delighted tohave the eminent Professor Stephan Schug as our keynote speakerwith a polished presentation on the transition of acute to chronicpain.

• That week was a particularly important week for Chronic Pain inNSW, and Jenni Johnson briefed the group on the funding strategyfor enhancement of chronic pain services for NSW which wasannounced by Gillian Skinner the Health Minister. Thisannouncement came after taskforce conducted a substantial reviewof chronic pain tertiary and rural services. This taskforce led bythe ACI Pain Management network included a number of PIGNIcommittee members including Fiona Hodson, Amal Helou, LeeBeeston who contributed their time, experience and expertise indeveloping a plan for managing chronic pain across all of NSW.

• A review of pain management education for nurses has been onthe PIGNI agenda over the past year. After a number of postponedmeetings with the Chief Nursing Officer for NSW, we have ameeting scheduled at the end of this month and we hope that nextyear will bring a strategy to embrace pain management as aspecialty in nurse education.

• I would like to once again take this opportunity to thank all thePIGNI committee members who without their dedication andsupport, PIGNI would not be able to continue. As chair, I havebeen so very fortunate to have so many specialists from suchdifferent clinical backgrounds and holding vast array of experienceto have guided me in the position over the past 3 years.

THANK YOU EMILY EDMONDSHANDOVER AND THANKS

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WINNERS OF RURAL SCHOLARSHIP TO ATTEND ANNUAL

PIGNI CONFERENCE 2012By Elizabeth Tighe

RN Tamworth Base Hospital Successful applicant for theScholarship

I found attending the PIG-NI “InsidePain” Development Day on the 19th ofOctober a wonderful opportunity tolisten to professional speakers sharetheir knowledge on pain in acomfortable, sophisticated environment.Being rather new to the nursing worldI found it inspiring to be surrounded byother keen nurses and healthprofessionals who all shared a genuineinterest and passion for patient care and pain management. The topicson the days program were very varied, ranging from learning about“Qi”- the mind and body connection in which we can use TraditionalChinese Medicine management techniques to learning about“Persistent pelvic and perineal pain” which went into some intricatedetail on pain syndromes and symptoms, some of which I never evenknew existed! It gave me a base of excellent references to delve furtherinto the particular topics which are of interest to me or relevant to mywork place. One of these include Dr Charlotte Johnstone’s talk on“Acute pain, drugs and alcohol”, which I think that almost every nursethere could relate too due to having exposure to this challenging issueat their work place. Thank you to PIG-NI for allowing me theopportunity to travel to Sydney to attend this day and I will be sure to share my experience and knowledge with my colleagues back in Tamworth.

By Ros Oakey CNS Case Worker

MERIT Program Drug and Alcohol ServiceMid North Coast Local Health District

Successful applicant for the Scholarship

I again wish to thank PIG-NI for awarding a Rural Scholarship to meto attend the conference at Le Montage on Friday 19.10.12The quality of the speakers was exceptional and I was enthralled bythe information.It was all incredibly interesting.I was so impressed by Dr Charlotte Johnson’s empathy for the“Difficult Patient” and the practical approach she provided for theirmanagement.I have summarized her talk from my perspective as a Drug and AlcoholNurse-Counsellor using her notes/references.I hope this was what you were hoping for from me.As the age of the clients presenting to our service increases so doestheir potential for both acute and chronic pain issues.This clientele is often poorly nourished, suffer many physical injuriesand have long standing (often childhood) trauma which plays out asComplex PTSD (aka Borderline Personality Disorder) or some otherpsychiatric label which then sets them up as the “difficult patient”.They sustain their physical injuries (and hence their acute and chronicpain issues) through life experiences such as hard manual labour, poorimpulse control leading to multiple MVAs/ MBAs, falls and/or fights. This is in addition to injury specifically from their drug use (infection,overdose, liver disease, lung disease etc) plus the ever possibleSubstance/Alcohol Related Brain Impairment (SRBI / ARBI) whichcompounds their poor decision making potential leading back toputting themselves at risk of physical injury and recurrent painscenarios.The most obvious challenge for this service is ensuring acute pain in

our clients is managed appropriately by advocating for them in thehospital setting. In addition it is important that this service diverts patients withsubstance abuse issues and co-morbid chronic pain away from illicitopiate use and into a more holistic treatment plan which aims atimproving quality of life.Thank you again for the opportunity to attend this fantastic day.

Ros Oakey report on

Session 1: Acute paindrugs and alcohol

Presented by Dr Charlotte JohnsonThe presentation by Dr Charlotte Johnsonon the issues surrounding the managementof acute pain in the patients who have a co-morbid issue with alcohol and other drugswas most perceptive and instructive inrelation to the development of effect copingstrategies for staff and better outcomes forthis profile of patient. From the perspectiveof a Drug and Alcohol Nurse this issue isone that our service is constantly battling.We know these patients can be difficult tomanage and that they are often poor historians in relation to providinga clear and concise drug and alcohol history to staff pre-operatively.Dr Johnson drew attention to the Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition (DSM-1V) criteria for OpioidWithdrawal (292.0) and Alcohol Wthdrawal (291.8). The relevance ofthese for medical and nursing staff managing acute pain situations isthat many of the symptoms of withdrawal are also pain symptoms. Forexample in opioid withdrawal there is dysmorphic mood, nausea orvomiting, muscle aches, fever and insomnia while with alcoholwithdrawal there is autonomic hyperactivity (eg sweating, pulse rategreater than 100), insomnia, nausea or vomiting, psychomotor agitationand anxiety. Effective perioperative pain management of these patientsrequires treatment of the withdrawal symptoms in addition toappropriate pain medication. For example Clonadine 75mg bd forsweating and agitation while those with an opiate tolerance needgenerous opiate dosing. Unfortunately determining the exact opiatethresh-hold is difficult as the conversion scales are inaccurate.Gabapentin can be useful here as, although it is not an analgesic per se,it reduces opiate requirements in major surgery. However, it has a shorthalf life so needs to be given QID.Ketamine is another drug which assists in reducing opiate requirements.This drug has a “shot-gun” effect as it acts on multiple receptors in the central and peripheral nervous systems. That means it workseverywhere in the body and in sub anaesthetic doses in peri operativepain management it has been demonstrated to be helpful in reducingopiate consumption. Hence it is useful in those patients who are alreadyon opiates or for those patients who have had major surgery. Ketamineshave been demonstrated to be very useful with amputations and spinalsurgery when used as a bolus intraoperatively followed up by infusion post-operatively. However it has been described as a chemical“straight-jacket” confining the patient to the ward and it impacts bothphysically and psychologically due to the GABBA blocking activityaffecting receptors. Some very interesting research by Pomarol-Clotett E. et al(Psychological effects of Ketamine in Healthy Volunteers:Phenomenological study. The British Journal of Psychiatry 2006. Vol189(2), 173-179) was cited. It relates to a potential link with theglutamate receptor theory of Schizophrenia. In this research thepsychological effects of Ketamine in healthy volunteers was examined.The healthy volunteers were placed on a Ketamine or placebo infusionfor 2 hours. Target concentrations of 100 and 200ng/ml wereadministered. Neuropsychiatric testing and functional MRI wereperformed during the infusions and those receiving Ketamineexperienced signs and symptoms of Schizophrenia such as • Inefficient thinking and poverty of speech• Subjective nervous tension• Altered perception ‘everything looks rounded’ ‘My hands look

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small’’ I feel like I am shrunken inside’• Slowed time• ‘I couldn’t move when I tried to’• ‘The people in the scanner were spies’• Thought blocking- ‘I felt as though there were no thoughts at all’• There were no auditory or visual hallucinations described. This research highlighted the potential for postoperative medication tocreate complex psychological responses in the patient and dove tailedquite well from the an overview of the Evidence Based informationabout analgesia into the "Fluffy Stuff" related to the management ofdifficult patients. According to Dr Johnson it is the triggering of a variety of defencemechanisms that defines this profile of the “difficult patient”. Thesedefence mechanisms primarily include Denial, Projection and Splitting.Both Mental Health Nurses and Drug and Alcohol Nurses are familiarwith, and frequently encounter, this behaviour which can play out witha lot of discord between staff as well as between staff and patient. Whenthis behaviour is recognised and met with compassion and respect(versus resistance or reactive responses) there are some strategies thatcan be employed to ameliorate the situation. Some of the practical tipsfor managing these clients offered by Dr Johnson include:1. Finding out as much background information regarding these

patients as possible 2. Visit the patient with another staff member (the “Team approach”) 3. Make physical contact with the patient to overcome their

"rejection radar"4. Sit at eye level5. Convey empathy6. Summarize/ feedback what they have said 7. Acknowledge their emotion (identify fear, anxiety, anger, sadness

etc) 8. Listen attentively by freeing up your own thoughts so you can

hear what they are really saying. Convey respect (versus disregard/ disdain).

Overall, from a Drug and Alcohol perspective, I found this presentationvery refreshing and encouraging as these patients are oftenmisunderstood and consequently mismanaged. This creates a dilemmanot just for patient but for all the staff needing to interact with them.Developing a conversational style that can elicit a comprehensive,accurate drug and alcohol and psychosocial history is in everyone’s bestinterests.The references included1. Russ Harris "The Happiness Trap" on Acceptance and Commitment Therapy2. Srous Rael D Ulman Anne-Marie Ko Her Moshe "The hateful patient revisited:

Relevance for the 21st Century Medicine" European Journal of Internal Medicine2006:17,387-393

3. Wasan Ajay D, Wootten Joshua, Jamison R "Dealing With Difficult Patients inYour Pain Practice" Regional Anaesthesia

PIGNI Conference Photos

Lucky door prizes were announced byDr Richard Halliwell following his talkthe launched the IASP Global YearAgainst Pain Theme for 2012-2013Visceral Pain

COMING MEETINGS Australian Pain Society

33rd Annual Scientific Meeting17-20 MARCH 2013 • CANBERRA

For more information see www.dcconferences.com.au

7th ANNUALCONFERENCE 2013

PAIN INTEREST GROUP – Nursing Issues

Planned date October 18th October 2013 will hold their 7th annualconference at Le Montage, Lilyfield, Sydney

WORLDCONGRESS 2014

The International Association forthe Study of Pain will hold its 15thWorld Congress on PainOctober 7-11, 2014, in BuenosAires, Argentina! The Congresswill attract more than 6,000 painspecialists from all over the world who will converge on Buenos Airesand present the most up-to-date information on the field of pain, fromlaboratory science to clinical diagnosis, management, and prevention.

For more information http://www.iasp-pain.org

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ACI UPDATE

There is good news across the state as the recent announcement offunding enhancements for pain services from the Minister for HealthJillian Skinner comes to fruition.Last month, 6.5 Million dollars was disseminated across hospitalsalready providing services in pain to increase capacity, and to somehospitals in rural areas that will be providing new services. Thisunprecedented funding will assist in the implementation of the ACImodel of care for pain management and provide some solutions towaiting lists, early intervention and more effective monitoring of theinterventions provided. In addition, some short term project funding has been allocated todevelop new primary care resources, and I am delighted to inform youthat Fiona Hodson has been appointed to the position of part time projectofficer for the 'chronic pain toolkit'. She will commence at the ACI inChatswood on Monday 10th December in this role in a temporarycapacity till June next year, and will carry the primary responsibility forthe development of the primary care education resources: a fundedaspect of the NSW pain plan. A project plan has been developed andendorsed by the Executive to progress and guide the activities.The Primary Care working group has identified 3 priority areas: thedevelopment of some on line modules for paediatric pain management,the collation of a series of GP tools, and identification of some consumertools. It is the intent that all of these tools will be developed and availableon the ACI website later next year after a process of needs analysis,focus groups, validation and testing.Unfortunately the time frame is short, being determined by governmentfunding, however we are hopeful that all 3 aspects will provide muchneeded information and resources for a range of clinicians form variedbackgrounds in the primary care sector and that health professionalsworking in the tertiary services will be able to direct interested partiesto the website for information and support.The work and progress in this area will be overseen by the Primary careWorking group which Ian Thong and Sonia Markocic are kindly cochairing. Our next meeting is on the 11th December from 1:00-3:00 atthe ACI.If you wish to have further information regarding the activities of theworking group or the project officer or you would like to becomeinvolved, please feel free to contact either myself or Fiona.I would like to congratulate Fiona on her success and look forward toworking with her over the next 7 months for a promising, but gruellingschedule!Please contact Jenni Johnson at Jenni. Johnson@aci.health.nsw.gov.auPh 8644 2186 or 0467 772 406

DID YOU KNOW?Extended-release formulation of paracetamol marketed in Australiahas in each tablet 665 mg paracetamol; 31% of the dose is releasedimmediately, while the remaining 69% is released over 6–8 hours attherapeutic doses.

eMIMS. Sydney: CMPMedica Australia, 2007.http://www.mims.com.au (accessed Feb 2008).

MEDIA RELEASE GREAT NEWS!

The Hon Tanya Plibersk MP (Minister from Health) announced onNovember 16, 2013 that PREGABALIN (Lyrica) has been PBS listedReport below….http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr12-tp-tp099.htm“Around 270,000 Australians will benefit from a medicine used totreat chronic nerve pain, which will be listed on the PharmaceuticalBenefits Scheme (PBS). Health Minister Tanya Plibersek today announced the GillardGovernment’s decision to subsidise the medicine pregabalin (Lyrica®)through the PBS at a cost of $447 million over five years. “This listing will be a great relief to hundreds of thousands ofAustralians who suffer from chronic nerve pain,” said Ms Plibersek. “Sufferers of chronic nerve pain complain of a severe burning,shooting pain, like an electric shock. It can be so debilitating that itaffects people’s capacity to work and go about their daily lives.” Ms Plibersek said pregabalin was the first PBS listing specifically forthis condition, which has a variety of causes and symptoms, and whichcan be difficult to treat. “The medicine provides an alternative treatment to opioid medications,which can have significant side effects, and are considered a lastresort.” The listing comes on top of new and extended listings for 10 medicinesannounced on 24 October, and is in addition to 100 new medicines orextensions to medicines that the Government approved last financialyear at a cost of $546 million over five years.”

GLOBAL PAIN DAY REPORTThe Albury Wodonga Private Hospital was once again host to a paineducation day that is held annually at the Commercial Club in Albury.160 nurses from Albury, Wodonga, Melbourne, Wagga, Shepparton,Wangaratta, Mt Beauty, Beechworth, and Corowa attended the day.

The IASP (International Association for the Study of Pain) promotesthe initiative to enable better management and awareness of Visceral

pain. As Visceral pain is the mostcommon form of pain and is feltby a person at one time or anotherit is the number one reason thatpeople seek medical attention. TheGlobal Year against Visceral Paincommenced in October and factsheets are available on the website.The day included presentationsrelating to Visceral Pain and guestspeakers included Fiona HodsonCNC, Hunter Integrated PainService) from Newcastle, Dr JohnStuchbery (General SurgeonAlbury) Dr Luke Baitch(Anaesthetist Albury) Dr Michael

Pamela Goldspink and CEO Doug McRae

Lisa Gephart (Northeast HealthWangaratta) Kellie Jackson(Albury Wodonga Health)

Gerardine O’Brien (AWPH )and Pamela Goldspink.

AWPH Staff

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Thomas (GP Albury),Rhonda Edwards (EducatorAWPH), Kellie Jackson(Albury Wodonga Health)Lisa Gephart (North EastHealth Wangaratta) andPamela Goldspink (AlburyWodonga Private Hospital).Pamela Goldspink, CNSAcute Pain Service, fromthe Albury Wodonga PrivateHospital has organised theGlobal Pain Education dayfor the past 8 years. Nextyear the education day willbe held on Monday 21stOctober and the focus is onOrofacial Pain.

IASP – GLOBAL PAIN AWARENESS YEAR

www.iasp-pain.org/GlobalYear/VisceralPainDid you know it is 2012-2013Global Year Against VisceralPain was launch on Monday,October 15, 2012. The theme thisyear is to focus on pain thatoriginates in or near the internalorgans of the body.Visceral pain is the most frequentform of pain, felt by most peopleat one time or another, the

number one reason for patients to seek medical attention, and yet itis insufficiently treated as it is considered just a symptom of anunderlying disease: if we treat the disease the pain will go away - anapproach that ignores that many forms of visceral pain are diseasesin their own right and require focused and specific therapies.Visceral pain includes conditions such as irritable bowel syndrome,kidney stones, chronic chest pain, period pain and bladder pain, butthe most common condition is chronic pelvic pain, whichencompasses a complex range of painful symptoms in both womenand men.Fact sheets examining the many aspects of visceral pain, a poster,and other resources are available to download at no cost. There areavailable in five World Health Organization (WHO) languages(English, French, Spanish, simple Chinese, and Arabic). Later in theyear, IASP there will post additional fact sheets and translations.

Pamela Goldspink (AWPH) MeganYeomans (Austin Hospital), Frances

Pontonio Austin Hospital) Fiona Hodson(Hunter Integrated Pain Service) and

Gayle Claxton (Austin Health).

Doug McRae, CEO AWPHOpened the day.

160 attendees.

Committee 2013

Hospira Corporate ProfileHospira is a global specialty pharmaceutical and medication delivery company dedicated to AdvancingWellness™ by developing, manufacturing and marketing products that improve the productivity, safety andefficacy of patient care. Created from the core global hospital products business of Abbott Laboratories in April2004, Hospira has a 70-year history of service to the hospital industry.

In February 2007, Hospira acquired Mayne Pharma Limited to become the world leader in specialty generic injectable pharmaceuticals.Through its offering of high-quality, lower-cost alternatives to proprietary medications, Hospira continues to help reduce the overall costsof healthcare – to improve both the affordability of care for patients and the financial strength of the global healthcare system. The companyalso is a pioneer in providing innovative solutions to improve patient and healthcare worker safety. Its portfolio includes one of the industry’sbroadest lines of generic acute-care and oncology injectables, and integrated solutions for medication management and infusion therapy.

Grazyna Jastrzab (Chairperson)Grazyna.Jastrzab@sesiahs.health.nsw.gov.auLee Beeston (Secretary) lbeeston@nsccahs.health.nsw.gov.auSue Lee (Treasurer/Mailing List Co-ordinator)Susan.Lee@sesiahs.health.nsw.gov.auToula Kranitis (Public Relations Officer)toula.kranitis@sswahs.health.nsw.gov.auSandra Tutt (Newsletter Editor)sandra.tutt@swsahs.nsw.gov.auDenise Wilson (Assistant News Letter Editor)roberttwilson@optusnet.comLinda Pope (Education Officer)linda.pope@avondale.edu.auVickie Croker (Committee Member)vickie.croker@hnehealth.nsw.gov.auLynda Gundry (Committee Member)lgundry@nsccahs.health.nsw.gov.auNikki Smith (Committee Member)nicsmith@nsccahs.health.nsw.gov.au

Emily Edmonds (Alternate Chairperson)Emily.Edmonds@swahs.health.nsw.gov.auBernadette Bugeja (Alternate Secretary)Bernadette.Bugeja@sesiahs.health.nsw.gov.au Sonia Markocic (Alternate Treasurer

Mailing List Co-ordinator)Sonia.Markocic@sesiahs.health.nsw.gov.auFiona Hodson (Alternate Public Relations Officer) Fiona.Hodson@hnehealth.nsw.gov.auStuart Leckie (Alternate Newsletter Editor)Stuart.Leckie@gwahs.health.nsw.gov.auAmal Helou (Committee Member)amal.helou@sswahs.nsw.gov.au David Lehmann-Monck (Committee Member)david.lehmann-monck@email.cs.nsw.gov.auKathie Baker (Committee Member)kathleen.moore@hnehealth.nsw.gov.au David Beveridge (Committee Member)David.Beveridge@ncahs.health.nsw.gov.au

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