Published on March 10, 2014
The Lone Ranger – Maintaining staff safety Prepared by Claire Blackburn The Sydney Childrens Hospital Network Randwick and Westmead SCHN CAPAC
The SCHN: who are we • In July 2010 the Sydney Childrens Hospital Network (SCHN) was established. • This joined The Childrens Hospital at Westmead and the Sydney Childrens Hospital (Randwick) together. • The Childrens Hospital at Westmead is located West of Sydney Metro and the Sydney Childrens Hospital is located South East of Sydney Metro.
• The SCHN has both paediatric Tertiary and Quaternary facilities. Comparison of Australia and New Zealand Children’s Health Services Organisation Sydney Children's Hospitals Network Royal Children's Hospital, Vic. Starship Children's Hospital, NZ Royal Children's Hospital, Qld. Child Youth & Women's Health Service, SA Princess Margaret Hospital, WA John Hunter Children's Hospital, NSW ED Separations Bed Days Presentations ED Admissions 44497 136790 85162 19577 34070 98735 67573 13272 27629 81626 31861 16785 20668 48435 28989 6817 18632 51431 42638 9472 16629 45281 61283 8806 7907 27197 18378 5035 Source: Data drawn from Women’s and Children’s Hospitals Australasia Reporting 2011/2012
Definition Community Acute and Post Acute Care (CAPAC) services including Hospital in the Home (HITH) are defined as acute hospital substitution and/or hospital avoidance services. This means if this service wasn’t offered the child would be admitted to or stay in hospital. Ongoing community nursing is excluded. The aim is to provide multidisciplinary care to allow the patient to be managed in their own home.
CAPAC: Then • 2008 The Children’s Hospital at Westmead opened CAPAC. On a 12 month trial • Initial models were CF and Eczema • Established with a Nursing Unit Manager, 1 FTE Physiotherapist and 1.6 FTE Registered nurses
• The evaluation after 12 months highlighted high levels of satisfaction • Cost equal to inpatient services • But families needed flexibility with visiting times including afterhours and models of care needed to expand
CAPAC: Now • Network service, one management structure including a NUM and part time Staff Specialist • Located within both hospitals • Dedicated Models of care, using the hospital avoidance or substitution • Treating paediatric patients who live with a hours drive of either hospital
Service Description SCH RN/CNS 1.47 FTE Operational hours SCH CHW 0830-1700 0730-2130 CHW RN/CNS Physio CNE Admin Staff Spec 4.2 FTE 1.32 FTE 0.30 FTE 1.0 FTE 0.2 FTE Virtual Beds 2 8
Background to project • In 2010 the CAPAC service was allocated enhancing funding. • The aim was to increase the HITH activity. • For many of our families evening visits would suit them.
The Project!! Let the journey begin
Aim To have a system that can help protect staff working alone outside the hospital, especially after dark or on weekends/Public holidays 14
Nature and extent of the problem The plan to extend CAPAC service hours potentially increased the risk to staff who are alone out in the community after dark and on weekends. With more staff joining the team and the department’s hours being extended, safety risks were significantly increasing. Staff reported feeling unsafe going out into the community into potentially risky situations out-of-hours without a system in place, which could closely monitor their safety. 15
Strategic importance The project meets a major objective of any health care system, which is to ensure its staff members’ safety at all times. The system reduces the risk of harm to staff by having early notification of potentially risky situations and promotes a safer environment for staff 24 hours a day. 16
Planning & implementing solutions Mapping ideas, risks and current issues with procedure Policy allows for no supervision Some suburbs more unsafe than others CAPAC extending hours Uniforms identify us as hospital staff Difficulty in contacting hospital Staff identified risk factors Entering homes at night Seen sitting in car with light on First visit after dark CHW managers busy Delays in getting help if in a potential risk environment More family members in homes
Planning & implementing solutions • Develop the team and gain support from CHW Program Chair and Executives • Project Sponsor Dr Bruce Lord Program Chair • Monthly reports to sponsor and brief to the executive • Review hospital policy on home visiting • Survey staff pre and post implementation • Seek alternative solutions to monitor staff safety • Network with other community services to discuss management of staff safety • Educate staff on new system • Trial new system • Evaluate changes • Report to the executive 18
Outcomes & evaluation Project Plan, implementation and evaluation Policy reviewed and updated to Review of ways to monitor incorporate the changes required for community visits out of hours. Policy title changed to risk management, rather than home visiting. All staff in CAPAC have read and agree to practice according to the policy and manage staff safety. Other community services contacted and information shared. Review included double staff visiting, no first visits after hours, use of security staff, use of a computer operated system. Policy review How to monitor staff Education Staff surveyed Marked increase in staff feeling safe. Efficiency of system Time saving Staff satisfaction increase Cost effective Trial & outcomes Evaluation Staff in-serviced on Lone Worker Program. Education on monitoring own safety and Two week trial of lone worker system. Evaluation by CAPAC staff was very positive all staff felt changes to policy. more safe when out visiting. The system was easy to use and cost effective. Cost was only $1 per day of use. Communication with staff 19
Sustaining change • The Lone Worker Service has now been incorporated into the CAPAC orientation program and all new staff are appropriately educated before using the system for the first time • Staff have been using the Lone Worker Service for all shifts since 2010. • The guidelines for using the speed dial feature are in the folder taken out on home visits and the response centre procedure is very user-friendly. • Staff are all conscious of the need for safety, especially as they go into homes alone at all times of the day and evening. 20
Lessons learned • That staff safety can be improved when providing care in the community. • The importance as health managers to act on the concerns of staff before problems occur. • When developing a service think of all potential risks and embrace the opportunities that present themselves. 21
Transferability and Future Scope • This program could be implemented to promote staff safety in other hospital departments and services where staff leave the hospital during their working hours or work in isolation. • The Lone Worker is a cost effective method of monitoring staff safety outside of the hospital environment. 22
Claire Blackburn Nursing Unit Manager|SCHN CAPAC- Hospital in the Home Randwick & Westmead Email: Claire.Blackburn@health.nsw.gov.au Tel: 02 9845 3857 Mobile: 0409 830 213
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