Concurrent Speakers

Introduction: Rural and remote children post burn injury are geographically disadvantaged compared to their regional and metropolitan counterparts in Australia. Studies have shown rural and remote children are more likely to have increased complications following a burn injury. Specialist services for burn management are located in tertiary hospitals and rarely available in rural and remote areas.

Children with deeper burns often require complicated rehabilitation to achieve optimal outcomes. The North Queensland Paediatric Burns Service (NQBPS) at the Townsville Hospital established the Occupational Therapy Led Paediatric Burns Telehealth Clinic (OTPBTC) to reduce rural disadvantage. In this model, the occupational therapist takes on the responsibility of monitoring children undergoing active burn rehabilitation rather than a Paediatric Surgeon. Clinical indicators have been written as part of the new model of care which guides the re-engagement of the surgeon when a review is indicated.

Since its inception, OTPBTC has reviewed over 86 families. This model has increased the frequency of clinical reviews and saved up to 12 hours travel time per appointment for families.

Aim: The aim of this research is to gain an understanding of the experiences had by families and clinicians utilising the OTPBTC.

Methods: This qualitative research study has been undertaken with an interpretive phenomenological approach to explore family’s and clinician’s experience of OTPBTC. Families who had received telehealth reviews were purposefully selected for interview. Rural and remote clinicians involved were also interviewed.

Result: Initial themes emerging from the interviews show that families value health care services that enables them to remain close to home. Staying close to home results in reduced time off work and school with minimal disruption to day to day life. Families and clinicians highlighted their confidence in the occupational therapist’s ability to manage the child’s rehabilitation via telehealth and act as the sole point of contact for their ongoing care. Clinicians found benefit in seeking specialist advice and knowledge for their own skill development.

Conclusions: The importance of evaluating new health care initiatives from the participants perspective is highlighted in this research. It demonstrates that expanded scope roles for Allied Health Professionals can improve access to quality patient centred care for rural and remote communities. This research demonstrates the value families place on receiving care close to home and the role telehealth plays in supporting this.

Success of this local study provides an opportunity to implement this service in other health services across Australia.

Background: In rural Australia, there is unmet need for knowledge and support by informal carers of people living with dementia. Multiple factors affect the lived experience of carers during caregiving, and the success of transitioning through the post-care period. During the caregiving period, socioemotional support from family and friends plays an important role in sustaining caregiving activities. Post-care, strong social networks facilitate adjustment to role change and dealing with grief. Developing and improving access to peer support to enable carers to effectively cope with the challenges of caring may positively influence their caring experience.

Aims: The primary objective of this project is to connect isolated rural carers for older people with dementia with each other, using a videoconference-based peer support and information program. This paper examines how we recruit carers to the program, an essential task for progress of the project.

Methods: A total of 30 groups of 6-8 participants is planned over the period June 2018 to June 2019. Participants are being recruited to the project using a range of strategies at the macro, mesa and micro levels, with varying success.

Results: This paper will discuss the recruitment strategies used, and their varying success, and provide an estimate of cost per person signed up to the program.  

Conclusion: In the face of unmet needed, and continued reinforcement of that need when we do connect with carers, being able to connect with isolated carers by any mode can be challenging.

Background: Agriculture has the highest fatality rate of all industries in Australia. Added to this, most agricultural enterprises are family owned and operated. Farms are unique in that they are a place of work and a home for many Australian children which poses many potential hazards. Children are at high risk of coming in contact with farm structures (dams, water storages), farm vehicles (quads, motorcycles), mobile farm machinery (tractors) and animals (horses, cattle). The aim of this study was to describe the non-intentional fatal injury patterns and casual agents associated with these deaths of children which occurred during 2001-2017 in Australia and to assess trends over time.

Methods: Data on farm-related incidents involving children were extracted from the National Coroners Information System (NCIS) for the study period.

Relevance: While child injury is both predictable and preventable, there is little current child specific data on the situation in Australia to assess progress and to determine further scope for interventions to reduce fatal incidents in this cohort.

Results: Of the 1352 non-intentional fatalities on farm between 2001 and 2017, 15% (n=202) involved a child 14 years or less. The annual number of child injury fatalities has reduced from an average of 28.7 per year (1989-92) 11.8 per year (2001-17). The majority of cases 66% (n=134), involved children that resided on the farm at the time of the incident. Children in the 0-4 years category (n=105), accounted for more than half (52%) of the incidents, with males being involved in over two-thirds (n=148) of all cases. Where the level of supervision was documented (n=180), 56% of cases (n=114) had no active parent supervision. Farm Vehicles (n = 76) and Farm Structures (n = 73), were responsible for over two thirds of the cases. Dams (n=43) and quads (n=30) were identified as the leading causes of injury.

Conclusion: The study is currently in the preliminary stage and will be finalised in the coming months. Early indications demonstrate that children 14 years of age and under made up almost 15% of all farm-related fatalities in Australia during 2001-2017. The number of children fatality injured on an annual basis has reduced, nonetheless the patterns and agents of fatal injury remain similar to the earlier 1989-92 data. Recommendations to address relevant issues identified in the study have the potential to further reduce these incidents.

Partners in Health is about a collaborative relationship between the Country Primary Health Alliance (WAPHA) and Country Health Service (WACHS). It explores:

• how a learning gap in aged care become evident and the subsequent call to action from the two agencies to address this. 
• where collective impact was demonstrated through the development of on-line learning modules with the in-kind expertise provided through WACHS and the input for community home care through the Primary Health Network.

This journey began with a need being identified in 2017 for Aged Care Unregulated Health Workers(UHW) to obtain competency in medication management in community and residential aged care.

WACHS as the largest providers of Aged Care within country WA approached the WA Primary Health Alliance (WAPHA) seeking funding to support the purchase of eLearn Australia and agreement to work collaboratively in customising the E learning modules for the aged care sector in rural and remote areas.

Agreed contract deliverables included:

• support provided to facilitate the implementation of the UHW online module with interactive content and assessment in a safe learning environment.
• the improvement of UHW skills and competency when assisting with medication administration. Compliance being required with the National and Safety Quality in Healthcare Service Standard 4 and Aged Care Accreditation Standard 2.7.

This agreement between WACHS and WAPHA was founded on the principle that the E-learning was available for all NGO aged care providers within WA and that there was the establishment of a working group (WACHS, WAPHA and NGO) to cover a trial period over three regions of Great Southern, Kimberley and Wheatbelt. These regions were chosen due to number of Multi-Propose Service (MPS) facilities (Great Southern), the number of small residential facilities both Government and NGO (Wheatbelt) and high degree of remoteness (Kimberley).

The working group supporting the E Learning modules consisted at various stages of WACHS user experts within clinical nursing, allied health, staff development, community /hospital pharmacy with a balanced lens on community and residential care.

Following the trial and satisfactory evaluation within these three regions it was agreed the E Learning would progress to all the seven regions across county WA.

Further to be explored in the paper Partners in Health will be the collective learning around the valued resource of collaboration in creating a Better Together! culture in the system.

Objective: To investigate the work climate of nurses and midwives in the Country Health South Australia Local Area Health Network (CHSALHN) in the context of major health system reform to understand how nurses and midwives assess their work environment, the quality of care delivered, the impact of direct and broad healthcare changes and reforms, and perceptions of organisational change and support.

Introduction: An effective and sustainable nursing and midwifery workforce is vital to ensuring a fit-for-purpose health system for country residents in rural, regional, and remote areas. Significant healthcare system changes in South Australia mean that country nurses and midwives must adapt to new healthcare models, processes, and technologies along with service relocation. Such events put substantial strain on nurses and midwives and could be linked to the recruitment, sustainability and retention of the country nursing and midwifery workforce as well as changes in the effectiveness and safety of care. It is vital to understand how these changes have impacted the nursing and midwifery workforce to inform the development of effective responses.

Methods: A seventy-one item online survey was conducted between August and October 2017 using an adapted tool from the RN4CAST studies. Quantitative and qualitative responses were collected across four domains: organisational factors, practice environment, individual outcomes, and patient quality of care.

Results: Three hundred and forty-five respondents from CHSALHN filled out the survey including registered and enrolled nurses and midwives representing a wide spectrum of ages, education, and years of experience. Participants reported having to do more with less in an environment where they feel unsupported by management and organisations. Although many nurses and midwives are satisfied with the profession, fewer were satisfied with their current position and aspects of their work environment – specifically chronic under-staffing. Nearly half of the respondents indicated that they were looking for another job or for opportunities outside the profession. There is a noted risk of burnout with nurses and midwives reporting emotional exhaustion. Feelings of personal accomplishment and positive work aspects like a supportive team environment were reported, which may reflect satisfaction with the professions and interactions with patients, irrespective of the broader workplace issues.

Conclusion: The results suggest that country nurses and midwives have been negatively impacted by recent changes to the health system, their organisations, and work units. This study examines what participants perceive to impact their workplace culture and offers recommendations for addressing identified issues and challenges.

East Grampians Health Service (EGHS) is located in Ararat in western Victoria and provides a range of acute, primary and aged care services to a community of approximately 11,000. Our population is aging and more and more people are choosing to remain in their homes as they age, despite in some cases being geographically and socially isolated. This is placing strain on primary care systems compounded by a shortage of health care clinicians. Service system re-design is required to manage a growing demand for home care services.

In late 2017 the hospital negotiated with the Department of Health and Human Services to convert 50 WIES (acute bed based funds) into a flexible model of home care and early intervention services for people at risk of a hospital presentation.

Healthy@Home is identifying the most vulnerable people in our community who are at risk of an unplanned presentation or re-admission into the health service. These people are enrolled into the service and receive regular phone calls from a telehealth assistant each week to check on their health. The telehealth assistant is not a clinician but uses a software program—Patient Journey Record System (PaJR)—to aid regular telephone conversations. PaJR supports the early detection of deterioration in health. Conversations are organised into narratives about illness, medication and medical care, social support and environmental and care giver experiences. Flags indicate problems or potential problems that may need intervention. A clinical care coordinator then reviews any flags created during the calls and follows up with the client or their carer.

There are currently 50 people enrolled and receiving regular phone calls. Nearly eleven months of service delivery has identified a reduction in these people attending urgent care and/or being admitted to hospital.

The service makes the best use of clinical skills ensuring clinical intervention is provided as clinically indicated.

The funding is available until June 2019 at this stage and the service is being evaluated by Federation University. The preliminary evaluation conducted towards the end of 2018 identified evidence of patient and clinician satisfaction; reduced hospital presentations; and cost benefits.

Background: Aboriginal children in the Kimberley/Pilbara region of Western Australia (WA) experience dental decay at more than 3 times the rate of non-Aboriginal children, the majority of which remains untreated. A simple alternative, Atraumatic Restorative Treatment (ART), approach to manage dental decay using principally hand instruments to prepare the cavity and without local anaesthesia in children has been shown to be successful. The approach reduced the need for specialist care, and was clinically successful, acceptable by children and parents, and cost-effective. This approach has implications for dental services delivery in rural and remote communities where access to dental care is poor. The aim of the study was to test the feasibility of the ART model of care in rural and remote communities of the Kimberley in WA.

Methods: The study design was a pragmatic two-armed, delayed intervention, cluster RCT. Communities with the expected number of children (n=15) in the target age (0-6-year-old) were invited to participate. Participating communities were randomised into the early intervention (test) or delayed intervention (control) arm of the study. Participating parents completed a questionnaire and the children provided with a baseline dental health assessment. Early intervention children were offered dental treatment. Delayed intervention children were advised to seek care through the standard care options available to the community and will be offered dental treatment as part of the study at the 12-month follow-up. The primary outcome was the number of children provided with the needed dental treatment and/or referred for specialist dental care.

Results: Twenty-six communities were selected and the majority of communities (n=25) have agreed to participate. Wide ranging community consultation and presentation of the study proposal was undertaken which included face-to-face meetings with the CEOs of the Aboriginal Controlled Health Organisations in the Kimberley as well as Chief Executive Officers (CEO) of the selected communities and Chairpersons of the community councils. An Aboriginal study reference group was formed with representation from the local Aboriginal Health Organisations. As at the end of June 2018 recruitment has occurred in 12 communities (n=150) with participation ranging from 6-24 children.

Challenges: Consultations with the community representatives and the CEOs and the community councils was well-received and the study proposal was supported, however, engagement at the individual level remains challenging. High mobility of the families also presented challenges in the provision of treatment and for follow-up.

Background: In 2014, an accreditation consultancy identified gaps not being assessed in residential aged care sections of Multipurpose Services (MPS) and the NSW Agency for Clinical Innovation (ACI) were asked to develop a process to bridge the gaps. Diagnostics revealed that the physical environment and routines of MPS tended to be clinical and institutional, making residents feel like they were patients in hospital rather than people living at home. Residents stated they were bored and lonely, families stated they had minimal involvement in decisions about residents’ care, and staff reported that care plans did not address the social and emotional needs of residents.

Aim: Eight Principles of Care for Living Well in MPS were developed aiming to improve the quality of life and homelike environment for residents and help staff deliver flexible, person-centred care.

Method: Over 2017, 25 NSW MPS sites participated in a State-wide Collaborative to implement the Principles of Care and to leverage off each other with 360 small-scale strategies embedded. Examples implemented include:

• social profiles  highlighting residents’ likes, dislikes and interests
• care plans based on lifestyle and routines, not clinical need
• facilities being more homelike through  artwork, plants, vegetable gardens and pets
• recreation and leisure activities involving the community
• replacing tray service with communal table dining and menus
• using telehealth for allied health reviews
• aged care specific education for staff.

Results: The final evaluation in January 2018 revealed aggregated state-wide improvement. On self-assessments, improvements of 20-40% were achieved across all Principles of Care; with greatest improvements being ‘recreation and leisure’ increasing from 6% to 39%, and ‘homelike environment’ increasing from 7% to 21%. Outcome measures showed residents’ physical wellbeing, comfort, mood and relationships (between staff and residents) had improved by 10%.

Successful strategies are now available online in the Principles in Practice Report as part of the Living Well in MPS Toolkit to spread these small, powerful ideas across NSW. The Principles of Care are now embedded in the revised National Safety and Quality Healthcare Standards (NSQHS) Version 2, to assist MPS teams in meeting Standard 5, Comprehensive Care Planning.

Conclusions: Success relied on the hard work, good will and motivation of staff, residents, families and the community to co-design strategies that positively impacted residents and staff, with no additional staffing or funding. The result is a transformation in the way NSW provides aged care in MPS, shifting the culture of care from clinical need to quality of life for residents.