Health Times June Edition

June 2016

Regional and Remote Feature + Dialysis in the desert - an innovative model of care for Aboriginal communities + Indigenous meals a recipe for good health + Successful team building in healthcare

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HealthTimes - June 2016 | Page 03

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June 2016 We hope you enjoy perusing the range of opportunities included in this Issue.

If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au

Advertiser list AHPRA Australian Catholic University Barwon Health Best Practice Nursing Agency Bio Oil

DISTRIBUTION 46,300 The HealthTimes magazine is the most widely distributed national nursing and allied health publication in Australia.

For all advertising and production enquiries please contact us by telephone on 1300 306 582, email contact@healthtimes.com.au or visit www.healthtimes.com.au

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Cleveland Clinic Abu Dhabi is now hiring Critical Care & Ambulatory Nurses Cleveland Clinic Abu Dhabi (CCAD), part of Mubadala’s network of world-class healthcare facilities, is a multispecialty hospital on Al Maryah Island in Abu Dhabi, UAE. Cleveland Clinic Abu Dhabi is a unique and unparalleled extension of US-based Cleveland Clinic’s model of care, specifically designed to address a range of complex and critical care requirements unique to the Abu Dhabi population.

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www.ccmrecruitment.com HealthTimes - June 2016 | Page 09

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Now taking enrolments. For more information or to enrol now, visit www.fpnsw.org.au/courses or email education@fpnsw.org.au Page 10| www.HealthTimes.com.au

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HealthTimes - June 2016 | Page 11

Nurses speak out on international stage

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urses have a strong voice on the world stage for addressing global health issues such as violence, antimicrobial resistance, promoting the health of migrants, and healthy ageing, says Australian College of Nursing (ACN) CEO Adjunct Professor Kylie Ward.

Adjunct Professor Ward recently joined a contingent of Australian and New Zealand nurses, midwives and health leaders, including ACN president Kathy Baker, former New Zealand Chief Nurse and new ICN CEO Dr Frances Hughes and Commonwealth Chief Nursing and Midwifery Officer Adjunct Professor Debra Thoms, attending a series of International Council of Nurses’ (ICN) meetings and the 69th session of the World Health Assembly (WHA) held in Geneva, Switzerland.

ICN, a federation of more than 130 national nursing associations including ACN and the Australian Nursing and Midwifery Federation (ANMF), joined the International Confederation of Midwives (ICM) and WHO to host the sixth Triad meeting.

The meeting focused on the future of the nursing and midwifery workforces with HRH Princess Muna al Hussein of Jordan launching the WHO global strategic directions for strengthening nursing and midwifery from 2016-2020.

The ICN then led a delegation of 69 participants to the WHA, the decision-making body of the World Health Organisation, where it made

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interventions and statements including the first Global Strategy and Plan of Action on Healthy Ageing and the Draft Global Plan of Action on Violence.

Adjunct Professor Ward said the events showed nurses, as the world’s largest health profession with an estimated 16 million nurses, have a voice in high-level decision-making and policy development that influences the world stage.

“Nurses should know and should understand that we have a voice, we have a strong voice and united our voice is very powerful and that’s what we saw…nursing was very prominent in this World Health Assembly,” she said.

“We need to be at the table, we need to be present and we need to make our voice heard about what we need as a profession for the betterment of the community.”

Speaking on the Draft Global Plan of Action on Violence, ICN highlighted the leading role that nurses play in tackling violence as the first point of care for elder abuse, partner violence, conflict, post-conflict and humanitarian settings.

The action plan calls for better access to quality health care through eradicating discrimination and violence in health workplaces, patient-centred and gender sensitive services, and the promotion of human rights.

For the full article visit HealthTimes.com.au

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HealthTimes - June 2016 | Page 13

Indigenous meals a recipe for good health Kangaroo lasagne and kangaroo rendang curry with bush tomatoes.

These dishes are proving to be a key ingredient to healthy living for some of Australia’s Aboriginal communities.

Integratedliving Australia, a New South Wales-based home care provider, has teamed with renowned Indigenous chef Clayton Donovan, the star of ABC television program Wild Kitchen, to prepare culturally-appropriate dishes for older people living in Indigenous communities.

The unique frozen meals program, launched late last year, is now reaching about 70 Aboriginal clients a week in NSW and Queensland.

There are also plans to grow the initiative after the provider’s clinical service team recently won the Team Excellence Award in the 2016 HESTA Australian Nursing Awards.

Integratedliving national clinical manager Bron McCrae, a nurse of almost 40 years, said the idea for the Indigenous meal program began when she met Clayton at a barbecue.

“I said - ‘I work in aged care and we have a meals program. It would just be so lovely to be able to come together and do something absolutely innovative’.

“We have a lot of difficulty getting meals into the Aboriginal community because they are just not suitable for them.

“These meals are actually far more nutritious with the bush tucker in them. We are using a lot of kangaroo meat so it’s a lot leaner and it gives the meal a lot more flavour.”

The menu, filled with bush tucker ingredients merged with western cuisine, has been a hit with the provider’s Indigenous and other consumers.

“The feedback from the elders was really fascinating they indicated that most Aboriginals

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will add a lot of salt to the western meals because they find them fairly bland,” Ms McCrae said.

“When we did the tastings with the meals that Clayton has prepared, they said - ‘this is what food should taste like; it’s flavoursome, it’s full bodied and it’s rich’. They said - ‘we want this for our communities - this is far healthier than what we are eating now’.

“When you actually taste what Clayton does compared to what we would be used to - the flavours just explode in your mouth.”

The team has expanded the program into a community initiative that connects Aboriginal elders, schools and communities over culture and good nutrition, which aims to improve Indigenous health outcomes.

“We wanted the older people and younger people coming together and having a bit of a yarn about the meal that was being cooked in cooking class, reflecting on culture, talking about bush tucker, talking about the elders’ young days and what that was like in their community and going through gathering and hunting when they were younger,” Ms McCrae said.

“They have a bit of a yarn in circle with the elders and the kids absolutely love it.”

Ms McCrae said the meals also help the provider to start the conversation with Indigenous residents, aged over 50, about good health.

“We look at our meals program as our first point of contact with people,” she said.

“And if you think about health, it all starts with nutrition - if you haven’t got the nutrition you are not going to have good health.

“Through our meals program, we can say hey, how about some other services?

For the full article visit HealthTimes.com.au

Help Keep The Army In Good Health As A Nursing Officer

T

erranora local, Jamie Clarke, has always led an active lifestyle and knew that she wanted the opportunity to challenge herself physically. Looking for a sense of adventure, she originally planned on joining the Australian Army Reserve but after learning more about the opportunities a full-time military career offered she decide to join the Army as a Nursing Officer.

“The Army requires Nursing Officers to practice outside their normal clinical environment and thus require us to perform extended clinical skills or roles that are not normally undertaken by a civilian registered nurse,” Jamie said.

For Jamie, the Army holds a unique responsibility to its members and their families; to prepare soldiers for war-like operations and care for the physically and/ or psychologically wounded soldiers, either on operations or upon their return to Australia.

The importance of this was reiterated when students she had taught on a Combat First Aid Course were the soldiers who initially treated her younger brother when he was injured overseas.

“I now feel a great sense of responsibility and gain an enormous amount of enjoyment and personal satisfaction from teaching, preparing and conducting training for the Combat First Aiders and other soldiers,” Jamie said,

“The most memorable moments in my career would be deploying to Afghanistan where I worked with a professional and skilled medical team. We provided medical training and care to Australian, Coalition and Afghani soldiers and locals.

“The Army provides an opportunity for a sense of adventure. The main reason I would recommend anyone to join the Army would be for the professional diversity and camaraderie that are just not found within the civilian workforce,” Jamie said.

“Additionally, the Army will fund and allow you to develop and refine your clinical skills and knowledge along with your leadership and management qualities.”

Nursing Officers are employed across a range of clinical, clinical management and broader health management duties. The Army has built a formidable reputation based on the core values of courage, initiative, respect and teamwork.

The Army is currently recruiting for Nursing Officers. For further information on military training and careers in the Army visit: defencejobs.gov.au/army or call 13 19 01.

For more articles visit HealthTimes.com.au HealthTimes - June 2016 | Page 15

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HealthTimes - June 2016 | Page 17

Dialysis in the desert - an innovative model of care for Aboriginal communities

O

utside a small, purple building in Alice Springs, a group of men are sitting around a camp fire, playing and singing My Island Home on their guitars.

It’s not your normal camp fire sing-along. And it’s not your average building.

One of the guitarists is Brian Butcher from the 1980s country and Aboriginal rock group, Warumpi Band.

The trio has come to play a few tunes for the staff, patients and their family members at the Aboriginal-led model of care known as ‘the Purple House’.

It’s a special performance but it’s just one of a range of remarkable activities that take place within and outside the bright purplehued walls of this unique dialysis unit.

Here, the focus is not only on making Aboriginal families well but on making this life-prolonging environment as non-clinical and holistic as possible.

Purple House provides renal dialysis six days a week but, just as importantly, it’s a place that patients can call their own.

Patients pop in to have a cuppa, make bush medicine, sing karaoke, do their washing, cook damper and kangaroo tails on the camp fire, and organise hunting trips.

The initiative is such a success, its attendance rates hover at around 99.8 per cent

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while patients and their family members will regularly turn up on their non-dialysis days.

“People vote with their feet and the biggest compliment for us in town, is that people on their non-dialysis days choose to come and hang out at the Purple House,” says CEO of the Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation, also known as Western Desert Dialysis, and remote area nurse Sarah Brown.

“People tell us they appreciate us by choosing to spend time with us when they don’t have to. You don’t tend to get people turning up to other dialysis units on their non-dialysis days to hang out and have a cuppa and a chat with you.”

Equipped with two dialysis machines, the Purple House offers Indigenous employment.

It also enables patients to see a GP, access social support, health and wellbeing services.

But there’s nothing ordinary about any of it.

“We’ve had ‘knickers off Thursday’ at the Purple House, where we kicked all of the blokes out of the house for the day,” Ms Brown says.

“It was a women’s health day but it included hair cuts and colours, chin plucking and face packs, manicures and pedicures and cooking rabbits and tails on the fire, and everyone climbed up and had their pap smears.

“We have funny, amusing things like that but every day here is funny.”

The reach of Western Desert Dialysis and its Purple House headquarters extends far beyond Alice Springs.

There are now 370 dialysis patients in central Australia, where rates of kidney disease are between 15 and 30 times higher than the national average.

The Aboriginal community-controlled venture has 24 dialysis machines at 11 places, from Wanarn and Warburton in Western Australia to Yirrkala in Arnhem Land. And it has a mobile dialysis unit, the Purple Truck, which rolls out to visit other remote communities.

It’s also working to expand with plans to open the doors to two more dialysis units at Ampilatwatja, in the Utopia region of the Northern Territory, and at Ernabella in South Australia.

As it works to grow, Purple House has partnered with Remote Area Health Corps (RAHC) to ensure it continues to recruit dialysis nurses to the nation’s red centre.

“We’re always looking ahead to attract the right sort of adventurous nurses with their heads on their shoulders to come and think about helping us and maybe coming up to help us set up some of these new units in places where people have never got on dialysis before,” Ms Brown says.

Purple House has come a long way since the Pintupi Luritja people at Kintore dreamt of having a dialysis unit on-country, in a bid to prevent family members from travelling hundreds of kilometres to receive dialysis treatment, three days a week, in Alice Springs.

The community raised more than $1 million, creating and selling four collaborative Aboriginal paintings, before using the funds to open their first dialysis unit at Kintore in 2004.

Kintore dialysis patients have since remained on-country, where they are cared for

by family members while continuing to participate in a culturally-rich community life.

Ms Brown says Western Desert Dialysis is giving Aboriginal people some agency over their lives and hope for the future of their communities.

“It’s a significant project - they had a problem and came up with a solution and fought really hard to make it work,” she says.

“That is particularly significant in terms of wellbeing and people having pride and something to look forward to.”

A non-Indigenous nurse, who was born in England and grew up in Queensland, Ms Brown has worked at Western Desert Dialysis for more than 13 years, where she has a team of about 20 dialysis nurses on the books.

She loves the innovative model of care that is changing the face, heart and soul of Indigenous health care and treatment - in more ways than one.

“Because we are an Aboriginal NGO, we’re not government, we can really look at what are people’s cultural priorities and work out a way that we can incorporate all of the clinical governance and hard stuff about doing good clinical dialysis but within a family and cultural context which is meaningful to people, so there’s lots of opportunities for creativity to say ‘yes’ instead of ‘no’,” Ms Brown says.

“We want to keep growing and learning and sharing. In this environment, the opportunities for cross-cultural dialogue and building strong relationships and understanding between Aboriginal people and their families and non-Aboriginal professionals and volunteers and other people who come into our orbit is huge.

“We’d like to think that we have an influence beyond getting people home to country, that we can influence a different way of working and sharing an optimism about Aboriginal health and Aboriginal affairs.”

HealthTimes - June 2016 | Page 19

Dunedin Study funded in health research grants Pioneering New Zealand research based on the internationally-renowned continuing study of 1037 children born in Dunedin in the early 1970s will continue after the project received more than $6 million in grants.

The major health and development study was one of 52 health research projects that received a total of $60 million in funding from the Health Research Council of New Zealand (HRC).

The Dunedin Study, led by University of Otago Department of Psychology Professor Richie Poulton, will examine ageing processes of the study’s participants to inform early intervention strategies.

The research, conducted out of the Dunedin Multidisciplinary Health and Development Research Unit (DMHDRU), will use biomarker data collected from the same 1000 people at ages 26, 32, 38, and 45 to track the pace of their biological ageing.

The project will investigate why some people age faster or slower than their age-peers, with the findings expected to support interventions to slow ageing, prevent age-related diseases, and enhance preparedness for wellbeing in later life.

Another research project will examine ways to reduce fatigue in hospital-based nurses in a bid to improve patient safety coupled with the health, safety, quality of life and retention of nurses.

Professor Philippa Gander, director of the Sleep/Wake Research Centre at Massey University, said the project will assist District Health Boards (DHBs) and nurses to manage shift work and fatigue - a cause of workplace hazards, after receiving more than $890,000 in funding.

“District health boards currently rely primarily on the traditional approach to managing fatigue, which is to limit maximum work hours

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and minimum breaks within and between work periods, by industrial agreement,” she said.

“However, workplace fatigue is now understood to be caused primarily by sleep loss, extended wakefulness, working and sleeping at suboptimal times in the circadian body clock cycle, and workload – both mental and physical.

“Limits on work hours don’t adequately address this combination of causes of fatigue.”

The New Zealand Nurses Organisation (NZNO) will work with Dr Gander as part of the three-year research project.

NZNO principal researcher Dr Léonie Walker said the research is the first of its kind in New Zealand and follows on from Dr Gander’s previous research which revolutionised the way airlines and pilots worked together to reduce the risks of fatigue.

“The potential for this collaborative research to create positive change is great,” she said.

“The opportunity to create safer and healthier work environments for nurses and other shift workers will create flow-on benefits for patients and employers.”

Associate Professor Beverley Lawton has received a $4.7 million grant to assist young pregnant Māori women and their children improve their health and wellbeing as part of a five-year research program.

Director of the Women’s Health Research Centre at the University of Otago, Dr Lawton is lead researcher on the Whānau Manaaki program, which will investigate the health care delivery system and the structural determinants of health, such as housing, racism, transport, income and education, that impact on the health of Māori women, their babies and whānau.

For the full article visit HealthTimes.com.au

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Associate Nurse Unit Manager Dialysis/Chemotherapy Part time (0.8FTE) Applicants are invited from suitably qualified and experienced RNs interested in an ANUM position within the Dialysis/Chemotherapy unit.

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Applications should include names of three referees. A copy of the Position Description and HOW TO APPLY information is on our web site www.shdh.org.au Completed ‘Application for Employment’ form should be forwarded to the Human Resources department, Swan Hill District Health, PO Box 483, Swan Hill 3585, Victoria or email: hrmanager@ shdh.org.au

606-028 1/2PG FULL COLOUR CMYK PDF Mallacoota District Health and Support Service Inc Physiotherapist Grade 2

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HealthTimes - June 2016 | Page 21

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HealthTimes - June 2016 | Page 23

Successful team building in healthcare

By Karen Keast

E

ffective healthcare teams have been linked to an increase in job satisfaction, more productive staff, fewer clinical errors, greater staff retention, and improved patient care and outcomes.

The move to create successful team-based care is not new. But despite growing recognition and acceptance of the importance of building successful teams in recent years, team building initiatives often fail to transition into practise in traditionally silo-based healthcare organisations.

Australian College of Nursing (ACN) CEO Adjunct Professor Kylie Ward says while there are numerous challenges in developing teams in the 24/7 fast-paced, complex and demanding healthcare environment, successful teams are vital for leading change and innovation, bolstering the workforce and improving patient care.

“When you build a great team and you’ve got people who are happy, feeling healthy from a wellness perspective and wanting to come to work and feel like they’re fulfilling their purpose and they’re part of something, then that directly contributes to optimal patient care,” she says.

“I think at the end of the day what we’re here for is to serve the community and the patients

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and residents and clients, and when the workforce feels valued and part of something important in the sense of a team then that has a positive effect on the community and patients.”

High-performing healthcare teams often showcase qualities such as shared goals, clear roles and responsibilities, open and clear communication, an ability to quickly adapt, access to mentoring and continuous learning, as well as balanced participation.

Other key elements are a positive working atmosphere with mutual trust, cooperative relationships, and an environment where staff are appreciated for their contribution.

Adjunct Professor Ward, who has 25 years’ experience in nursing, health management, academia and nurse leadership, says the key to developing a successful nursing team is to build it on a foundation of effective leadership.

She says leadership has become an intrinsic requirement for today’s healthcare managers.

“Once upon a time you could have been a manager and been process-driven and not so much people-focused,” she says.

“Now if you want to be in a formal position of influence with leadership, you need to know that a passion for people is an imperative and it’s not an option.”

Adjunct Professor Ward says team leaders should first focus on themselves.

“You need to challenge yourself and keep evolving,” she says.

“It’s not that people work to our style, we need to understand how to bring the best out in the whole team and that might require five or 10 different ways of doing things to get everybody engaged in the one goal.

“The one-size-fits-all model is outdated and you will disengage some of your workforce, if not all, by being traditional and not evolving and developing yourself as a leader.”

Adjunct Professor Ward says effective nurse leaders should be able to listen, have compassion and empathy, and demonstrate a drive to invest in and work with their staff to create great teams.

“As a leader, whether I’ve been a Director of Nursing or in another position, I can’t possibly have all of the skills and the knowledge,” she says.

“So, it’s knowing the people in your team, having that desire to want to get to know them, not just on a clinical or a professional level, but what personally motivates and drives them, and then getting the power of the team.

“It’s making sure that everybody feels valued, we work to their strengths and we develop the areas that need to be strengthened.

“Staff also need to know that the environment is safe, that it’s okay not to be perfect.

It’s not acceptable to make mistakes in the clinical area but in concept and ideas - well, that’s okay, we’ll learn.”

Adjunct Professor Ward says it’s paramount health organisations and providers first invest in advancing nurse leadership through professional development and education while introducing more opportunities for mentoring and coaching as well as reflective practice.

And she advises nurse leaders preparing to embark on developing successful teams to equip themselves with qualities such as tenacity and perseverance.

“Don’t be surprised - know when you walk in to build a team and to take the team somewhere that there will be resistance,” she says.

“You don’t back down, you actually work with people in steps alongside them and take them through that to another place.

“One of the things that I always say and that I said to my team here is - ‘we will be uncomfortable, we will not be unsafe but if we don’t challenge, we don’t change’.

“So being uncomfortable is okay, we would never be unsafe because we work in a valued environment.”

Extremely good leadership is obvious in how innovative healthcare teams perform, Adjunct Professor Ward adds.

“People love what they’re doing, they go above and beyond, you have a vibrant workforce who want to share ideas - that’s the best kind of leadership.”

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HealthTimes - June 2016 | Page 25

Physiotherapists test exercise for bone marrow transplant patients

P

hysiotherapists are trialling a unique outpatient exercise program that aims to improve the recovery of bone marrow transplant patients.

The Royal Melbourne Hospital is examining whether an eight-week hospital and homebased exercise program will strengthen and boost the outcomes of 40 cancer patients who have received an allogeneic transplant, where stem cells are matched from a donor.

Shaza Abo, a grade two physiotherapist in oncology and palliative care, said the program comes amid a growing body of evidence that shows exercise can benefit patients and improve the debilitating side effects of cancer treatments.

“Some of those symptoms are quite significant in a bone marrow transplant, things like fatigue and muscle weakness, reduced activity, reduced quality of life, those sorts of things,” she said.

“From our experience and from the evidence out there, they tend to have quite significant side effects…they could have something called graft-versus-host disease.

“The side effects stick around for potentially months and years after the transplant, because it’s quite an aggressive form of treatment.”

Under the initiative, physiotherapists prescribe outpatients with tailored exercise programs, spanning 30 minutes, five days a week, with one session a week completed in hospital.

Participants also attend education sessions every second week, covering nutrition, sexual health, returning to work, financial advice, and embracing a healthy lifestyle routine.

Recruitment for the trial began in August 2015. The trial team, which also includes a research physiotherapist, a bone marrow transplant physician and a nurse practitioner,

Page 26| www.HealthTimes.com.au

perform activity testing on patients ahead of their allogeneic transplant. The team then reassess the patient after their transplant.

Patients capable of participating in the trial usually begin their targeted exercise program two months post-transplant.

“It’s a combination of aerobic exercise - so walking, stationary cycling that sort of thing,” Ms Abo said.

“The other component is that it’s a resistance program, so we use hand-weights or elastic therapy bands for resistance or the patient’s own body weight, whatever is most appropriate.

“The point of it is to be quite individualised and targeted at what the patient can tolerate and then we increase it.”

Ms Abo said the trial, which is now nearing completion, has been a hit with patients.

“The patients are reporting that they’re really enjoying it…they come to the exercise class and even if they’re not feeling a 100 per cent, they still might feel a little bit better after the class, like a little more energised.

“Some people have even said it’s helped them get to work much faster than they think they would have otherwise.

“It’s all positive so far and we haven’t had negative side effects as yet.”

Ms Abo said it’s rewarding to see patients improve their recovery through “a simple form of medicine”.

“I can see them actually making quite significant gains from week one in the program to week five or six, and they’re feeling so much more confident that they’re just happy,” she said.

“Everybody thought that cancer patients were really quite fragile and they are to a degree.

For the full article visit HealthTimes.com.au

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HealthTimes.com.au HealthTimes - June 2016 | Page 27

Improving nutrition outcomes for hip fracture patients

By Karen Keast

E

arly dietetic assessment and intervention in managing the nutrition of hip fracture patients at a Melbourne hospital has improved rates of malnutrition, pressure injuries and length of stay.

Austin Health has introduced a new nutritional care guideline that requires all hip fracture patients to receive a dietetic assessment within 48 hours of admission, with dietary strategies then implemented to prevent or treat malnutrition.

Research evaluating the impact of the new guideline, which was presented at the Dietitians Association of Australia’s (DAA) recent National Conference and published in Nutrition and Dietetics, found dietetic intervention occurred an average of three days earlier.

The intervention also decreased length of hospital stay an average of five days for acute and subacute patients, significantly reduced the incidence and severity of pressure injuries, and decreased the number of malnourished patients.

The intervention has been such a success, the health service has since introduced another dietetic initiative to further improve the nutritional status of hip fracture patients.

Research shows hip fracture patients have a high prevalence of malnutrition and pressure injuries. Most hip fracture patients are older people who are more likely to be at risk of malnutrition or malnourished on admission to hospital.

There’s also a strong link between nutrition and pressure injuries, with annual audits at Austin Health indicating about 60 per cent of hip fracture patients with pressure injuries are malnourished.

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Immobility due to injury and surgery, incontinence problems which put patients at risk of skin breakdown, and poor nutrition leads to pressure injuries - all are common issues for older hip fracture patients.

Accredited Practising Dietitian Jacqui Bailey, a senior dietitian at Austin Health, who worked with a study team including research nutritionist Haydn Klemm, says the intervention was prompted by a rise in hospital-acquired pressure injuries in the subacute ward in 2012.

“On top of that, dietitians at the subacute site expressed concerns about patients being transferred to the subacute ward who were quite malnourished,” she says.

“Questions were raised about why these patients had not been referred to the acute dietitian despite the existence of nutrition risk screening, and a care pathway for hip fracture patients that involved minimising unnecessary fasting for patients awaiting surgery, and monitoring food intake of patients.”

At the time, nutrition risk screening was based on the Malnutrition Universal Screening Tool (MUST).

Ms Bailey says the previous standard care pathway for hip fracture patients involved nursinginitiated food charts to monitor food intake.

“It was hoped that this would prompt nursing staff to refer to a dietitian when intake was notably low. However, the completion rate of the food charts was poor, and those that were documented still relied on interpretation by staff with no nutrition expertise.

“Dietitians responded to referral only, relying upon referral by other staff, and nursing staff completing a risk assessment. This risk assessment was poorly completed and rates of

referral were low and/or delayed by many days, even when the nutrition risk was correctly identified.”

An audit showed less than 20 per cent of patients who were detected as being at risk of malnutrition were actually referred.

In addition, Ms Bailey says the screening tool failed to detect patients with chronic malnutrition.

“For instance, if patients were already malnourished, the screening tool did not prompt a referral if they had been recently weight stable, even if the weight was very low.”

Ms Bailey says Austin Health dietitians developed the clinical nutrition guideline for hip fracture patients, which was implemented in January 2014.

The research team examined and compared data between 110 patients admitted with a hip fracture between January and June, 2013, in the pre-guideline group and 113 patients admitted with a fractured hip between January and June, 2014, for the post-guideline group.

Mr Klemm says the team, which used a proxy measure of length of stay, found earlier dietetic assessment and intervention decreased the incidence of pressure injuries from 41 per cent pre-guideline to 29 per cent post-guideline, while the number of pressure injuries per patient also fell, and there were significantly fewer malnourished patients in the post-guideline group.

“Over this time, there was no change in surgical or nursing care, so we feel that this change can be related to the guideline,” he says.

Ms Bailey says Austin Health has since amended the guideline to further reduce patient delays to receiving optimal nutrition.

“We found that in the majority of cases where dietetic intervention occurred, it included the provision of additional menu options, snacks or supplements,” she says.

“Rather than wait until a dietitian has seen a patient, we now initiate the offer of high-protein dairy-based snacks to all patients with the diagnosis of a fractured hip on our orthopaedic ward.

“We aim to screen all patients, explain the reason for mid-meal snacks they are being offered and encourage patients to accept them.”

Dietitians tailor the snacks to suit personal preference or special dietary needs where required while written information is left at the bedside for patients, to alert both staff and visiting family members to encourage oral intake.

“We aim to empower patients and their families to fuel their recovery by eating small, frequent meals and requesting assistance when they have concerns about nutrition,” Ms Bailey says.

A full nutritional assessment takes place when the patient is considered to be at risk of nutritional decline or when the patient has a compromised nutritional status.

The study also collected data on mealtime practices of the ward that affected patients’ oral intake, including the provision of appropriate positioning for meals, mealtime assistance, and mealtime disruptions.

For the full article visit HealthTimes.com.au HealthTimes - June 2016 | Page 29

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HealthTimes - June 2016 | Page 31

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