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Quality of Care News
Wuman njinde...welcome.
Improving care for Aboriginal people
Strengthening relationships between our health service and and developing and trialling a consumer brochure and information
our Aboriginal community is an important step in starting to sheets aimed specifically at Aboriginal people.
bridge the health gap for Aboriginal people. The cultural awareness education sessions provided staff with:
G a moving first hand account of the local Aboriginal
The Department of Human Services (DHS) Improving Care
for Aboriginal People (ICAP) program was established community life in the 1930’s to the 1960’s through stories
and an award winning film produced about Jackson’s Track
in July 2004. It amalgamated different funding programs
G current health issues within the community
and focused on cultural change in health services
G strategies to help break down barriers; and
through improving health care and identification of
G an opportunity to ask questions of Aboriginal elders.
aboriginal people under four key areas identified
for improvement. Relationships with Aboriginal Comments during the sessions went a long way to breaking
communities, culturally aware staff, discharge planning down barriers and build an understanding between nurses
and primary care referrals. and the Aboriginal community.
These four areas provide the framework for the work Also under the guidance of Linda and Kaylene, we have
WGHG has been implementing to assist in bridging the gap. been working towards making the hospital more welcoming
to Aboriginal people.
In general Aboriginal people are reluctant to present to
hospital and have limited contact with doctors. For an Aboriginal Transfers of the blue wren, the totem of the local Aboriginal people
person, attending the hospital’s Emergency Department is a have been placed at all entrances to West Gippsland Healthcare
daunting experience tinged with fear. Waiting in the waiting room often Group buildings and paintings by local artists have been purchased
becomes emotionally overwhelming and many leave without being seen and placed throughout West Gippsland Hospital.
by a doctor. To improve the care provided to Aboriginal patients after they are discharged
Those who do come often have complex medical needs and are very from hospital, a health record booklet was developed this year for Aboriginal
sick having had little preventative medical intervention. The average life patients to take home. This provides a record of their health management
expectancy for an Aboriginal person is 20 years less than that of the general plans, details of referrals to General Practitioners and other health
Australian population and across Victoria about half the Aboriginal deaths professionals and will improve communication to all health providers
are of persons under 55 years. involved in their care.
For this reason, it is very important that our staff have an understanding Under-identification of Aboriginal patients continues to hamper planning
of the Aboriginal culture and the feelings they have towards hospital. In of health services based on a complete picture of Aboriginal health. The
March this year WGHG was one of four pilot sites selected by DHS to Aboriginal Hospital Liaison Officer provides orientation to staff to ensure they
run a funded project Improving Experiences of Aboriginal People in the are aware of the mandatory requirements for all Victorian hospitals to ask if a
Emergency Department. Peta McGregor was appointed project officer patient is of Aboriginal or Torres Strait Islander descent.
and a steering group was established. Drouin residents Linda Mullett and In another popular project, the Community Kitchens program was extended
Kaylene McKinnon are members of our Community Advisory Council (CAC) this year with the commencement of a group for young Aboriginal people.
and provide us with a direct link to the Aboriginal community. Both were The program teaches participants about preparing healthy, budget friendly
pivotal in working with Peta in rolling out a series of cultural awareness meals in a welcoming, social environment. The knowledge they gain will
education sessions for doctors and nurses in our Emergency Department not only benefit the participants but also their families. And they love it!
CEO Ormond Pearson, artists Lionel Rose Junior and Dale Hayes and Education Centre
Peta McGregor Emergency Department nurse and Dot Mullett Aboriginal Hospital Liaison Officer Gippsland ‘Brayakoloong’ Art Project Coordinator Maryanne Meyer with artwork painted specially
standing beside the Aboriginal land map in the Emergency Department corridor at WGH. for the West Gippsland Hospital.
2009 Regional Health Service of the year
PAGE 1 QUALITY OF CARE NEWS
About your health service
From the CEO Our service area...
On behalf of the West Gippsland Healthcare Group (WGHG) who we care for
team, welcome to our 2009 Quality of Care Report.
West Gippsland Healthcare Group is a customer focused health organisation
This Report provides us with the opportunity to inform you
providing hospital, residential and community health care to 38,500 people in
of how we monitor, compare and act to improve the safety
the rural, urban residential, agricultural and industrial areas located within the
and quality of our services. It details highlights as well as
Baw Baw Shire and beyond.
areas we need to improve.
We employ 1,064 staff and treated 10,910 hospital patients, provided 80,485
The Report is prepared by a team of staff and Community Advisory Council
outpatient services and cared for 225 aged care residents during the year.
members who:
G review minimum reporting guidelines While most people in the Shire speak English, 5.3% of our population are
G listen to feedback from multi-cultural and non-English speaking backgrounds. In addition to this
G collate data from across West Gippsland Healthcare Group; and 1.5% of our population is Aboriginal.
G work with staff in all departments to provide ideas for stories and photos.
Caring for our migrant community
Each year Quality of Care Reports from around the State are reviewed by a Even though only a small percentage of our population come from culturally
panel of experts who provide feedback on a variety of criteria. Their comments and linguistically different (CALD) backgrounds, we recognise the importance
together with your feedback are used to continually improve our Report. of equipping our staff to understand what is needed to provide the appropriate
At WGHG we strive to ensure every one of our stakeholders has the opportunity services and care for people from other cultures.
to hear about our health service. It is for this reason this publication is WGHG has an established cultural diversity policy promoting the benefits
distributed to every household in the Baw Baw Shire through the local free of cultural diversity. Each year we develop a Cultural Diversity plan with the
newspaper and available to read at doctors’ surgeries and in waiting rooms assistance of the Community Advisory Council and the Gippsland Multicultural
at all WGHG facilities. Resource Centre. The plan involves gathering data on our local population,
Our sincere appreciation is expressed to our Community Advisory Council skilling staff, and engaging people from culturally diverse backgrounds to
members, staff and the community for their contribution to making this Report contribute to the WGHG planning processes.
an informative, valuable and enjoyable publication for our stakeholders. Our organisation has established links with the Gippsland Multicultural
I would also like to take this opportunity to congratulate our staff for the very Resource Centre and is planning to develop connections with new migrants
positive manner in which they address the many challenges of delivering high from diverse backgrounds and provide them the opportunity to input directly into
quality health services to meet the growing demands of our community. service planning
Their energy, enthusiasm and focus on continuous quality improvement is Staff have access to a kit which is regularly updated and provides information
outstanding. on access to interpreter services, translated information, and important cultural
Ormond Pearson information for each cultural group. They also attend cultural training days
Chief Executive Officer appropriate to their service to ensure they are responsive to cultural needs.
Access to interpreters is an important part of cultural responsiveness. This year,
data from the Patient Satisfaction Monitor showed that we must provide further
Vision staff training to ensure patient access to interpreters.
One strategy that is proving to be very effective is the visit to West Gippsland
To improve the health and wellbeing of our community.
Hospital by participants in the English as a second language course conducted
by the Education Centre in Warragul. Participants enjoy a tour of the WGH site
Mission and are provided with information as to where to come in an emergency, what
they should bring with them and what is provided to them as hospital patients.
West Gippsland Healthcare Group is committed to the provision of high quality, Information packages containing brochures, contact numbers and interpreter
integrated health care that meets the changing needs of individuals and our services are provided as well as an opportunity to have any questions
community. answered.
Hospital (acute) Support Services (cont’d)
Anaesthesia
Breast Surgery
Our Services: What we do Engineering
Environmental Services
Community Rehabilitation Centre Sub-acute Community Services (cont’d) Finance
Day Surgery Cognitive Dementia and Memory Service Rural Allied Health Service Food Services
Dental Surgery (CDAMS) Self Help and Support Group Facilitation Health Information
Diabetes Education Continence Sustainable Farm Families Infection Control
Ear Nose and Throat Surgery Geriatric Evaluation and Management Women’s and Men’s Health Information Technology
Emergency (GEM) Youth Services Library
Endoscopy Hospital Admission Risk Program (HARP) Occupational Health and Safety
Allied Health
General Medicine Interim Care Payroll
Cardiac Rehabilitation
General Practice Palliative Care Public Relations
Chronic Obstructive Airway
General Surgery Quality and Customer Service
Aged Care Disease (COAD) Program
Haemodialysis Staff Development Unit
Aged Care Assessment Diabetes
High Dependency Supply
Andrews House Aged Care Facility Nutrition and Dietetics
Library Business Units
Cooinda Lodge Aged Care Facility Occupational Therapy
Midwifery Consulting Suites
Home and Community Care Services Pharmacy
Neurology Meals on Wheels
Respite Care Physiotherapy
Obstetrics/Gynaecology Salary Packaging
Community Services Physiotherapy
Oncology Warragul Linen Service
Aboriginal Liaison Podiatry
Ophthalmology
Adolescent Health Social Work Diagnostic Services (Contract Services)
Orthopaedic Surgery
Asthma Education Speech Pathology BreastScreen
Paediatrics
Bushfire Recovery Counselling Home Nursing Service Endoscopy
Paediatric Surgery
Counselling District Nursing Service Lung Function Testing
Plastic Surgery
Diabetes Education Hospital in the Home Medical Imaging
Post Acute Care
Emergency Relief Palliative Care Nursing/Volunteers Pathology
Pre-admission
Falls Prevention Stress Electro Cardiography
Rheumatology Support Services
Family Counselling Stress Echo Cardography
Stomal Therapy Administration
Urology and Urodynamics Health Education/Promotion
TRIVIA QUESTION 1: How many face washers are cleaned in the Warragul Linen Service each year? ANSWER ON PAGE 12.
PAGE 2 QUALITY OF CARE NEWS
Special Projects
It’s all about the kids!
Water recycling...
it’s a triple treat!
West Gippsland Healthcare Group is committed to minimising
the impact we have the on the environment. Where possible,
systems are in place to improve water and energy conservation
and waste recycling and management. One component of our
water recycling program is highlighted in this Report.
750,000 litres of water is recycled each year from
the Haemodialysis Unit. This water is caught and
pumped to a water storage area located in the roof
at West Gippsland Hospital.
Students listen attentively as Operating Theatre Nurse Unit Manager Daniel Scholtes tells the kids
what they can expect when they wake up after an operation.
Frank Gallagher is one of
Coming to hospital can be a apply back slab plasters on each 14 patients who attend
daunting experience. Even for small arm in the treatment room! the Haemodialysis Unit
most adults it’s difficult. Imagine It’s then off to the Recovery Room three times per week to
undergo a process of
what it’s like when you’re a small to meet Dan, the Theatre Manager,
being connected to a
child. That’s why at West Gippsland who shows the kids where they will machine that performs
Hospital we do as much as we can wake up if they ever need to have an the function of the kidney
to allay fears and to make it loads of operation. to clean the blood.
fun. The play room and treatment room in
One way we do this is by offering Kid’s Ward is next. Here there’s loads
tours of our Emergency Department of distraction with dinosaurs, robots,
(ED), Operating Theatre Recovery colourful murals and even a driveable The water is then redirected for use in the
Room and the Paediatric Ward for four wheel drive.
Central Sterilising Services Department located
kindergarten groups and prep grade Of course, there will always be the on Level 2 at the Hospital.
classes from the Baw Baw Shire. monitoring, medicine and mash, but
Our tours begin at the ED. Doctors at least the kids will have something
and nurses greet the kids, show them to look forward to when they know
around, visit the ambulance bay even they have to come to hospital.
Approximately 60,000
pieces of equipment
are sterilised at West
Gippsland Hospital
every year.
The water is again redirected back to the storage tanks
in the roof and used for a third time to flush toilets
across West Gippsland Hospital.
West Gippsland Hospital
has 67 toilets flushed
using recycled water.
The saving...a massive
4,832 kilolitres of water
per year! Congratulations to
WGHG Engineering Services
Manager Peter Jayaweera and
his team for their innovation in
developing this system.
ED nurse Trish Blair shows St Paul’s Anglican Grammar Junior School students the vital signs monitor
in the treatment room.
TRIVIA QUESTION 2: How many toilet rolls are bought each year? ANSWER ON PAGE 12.
PAGE 3 QUALITY OF CARE NEWS
Patient Safety
Falls prevention
Time out! The falls prevention program at an individualised care plan
Did you know that our operating written consent given by the WGHG aims to minimise the risk of implements measures to prevent
theatre team calls ‘Time Out’ even patient. Adopting this team falling for all patients and residents. a fall or reduce injury from falls.
before an operation begins? approach significantly minimises There are factors however that can 4. Process to manage a fall
The reason...it is the final stage of the risk of the wrong operation increase the risk of someone falling. if it occurs
a thorough checking process to being performed. These include: Should a patient or resident continue
ensure the correct operation is We are pleased to report that the G people who are unwell
to fall, after the implementation of
being performed on the correct operating theatre team achieved G people recovering at home after
measures in Step 3, an investigation
part of the body, at the correct site, 100% compliance for ‘Time Out’ being discharged from hospital; and
G old age and frailty.
is conducted to identify opportunities
and on the correct patient. audits this year and the correct to prevent further falls.
While ultimately it is the surgeon’s operation was performed on every Falls prevention strategies provide a
safety net for those at risk by early 5. Reassess and modify care plans
responsibility to make sure the patient who underwent surgery at
identification, personalised care plans The patient is then reassessed and
correct operation is performed, West Gippsland Hospital.
and investigation of falls aimed at the care plan adjusted to include
the surgeon, anaesthetist and A total of 3,207 operations were
further prevention. additional or changed prevention
nursing team come together to performed for the year, 77 more
These five steps are: strategies.
check these details against the than last year.
1. Risk screen After leaving hospital, patients at risk
of falling are referred to appropriate
All patients over 65 and all aged care
services including physiotherapy,
residents are screened by staff at their
podiatry or to an optometrist.
initial entry or point of contact. The risk
Working with a physiotherapist
screen tool identifies people requiring
can improve strength and balance
a more detailed assessment.
which aids in reducing the risk of
2. Risk assessment falling.
If the risk screen indicates a positive
Despite an increase in the number of
risk of falling, a more detailed risk
high care residents in our aged care
assessment is completed. Audits
facilities, there was an18% decrease
conducted in September and March
in falls. Falls with a minor outcome
resulted in an average of 99% of
increased and are investigated as part
patients identified as being at risk
of the falls prevention plan. While falls
undergoing a more detailed
with a minor outcome did increase
assessment.
by 15%, the percentage of falls
3. Care plan to reduce risks resulting in a major outcome
Once the assessment is completed, remained steady at 2%.
Number of Falls West Gippsland Hospital
200
180
180
Surgeon Mr Paul Ah-Tye (right) and the theatre team stop for ‘Time Out’ before commencing 160
an operation.
160
159
140
The graph shows an
136
135
120 overall decrease in the
130
number of falls at West
100 Gippsland Hospital over
the last four years.
94
80
60 2009
40 2008
20 2007
28
24
22
5
17
2
3
0 2006
Falls
with no
adverse
outcome
Falls
with
minor
outcome
Falls with
major
outcome
Total
falls
G Be actively involved in your own health care
G Speak up if you have any questions or concerns Number of Falls Residential Aged Care (RAC)
G Learn more about your condition or treatments 500
519
G Keep a list of all the medicines you are taking 450
455
453
465
G Make sure you understand the medicines you 400 Note: Andrews House at
are taking Trafalgar extended
386
350
from 30 residents
376
G Get the results of any test or procedure
to 50 residents
339
300
G Talk about your options if you need go into hospital in 2007 with
an increased
G Make sure you understand what will happen if you
272
250
number of high
need surgery or a procedure 200 care residents.
G Make sure you, your doctor and your surgeon
150 2009
all agree on exactly what will be done
100 2008
G Before you leave hospital, ask your health care
102
101
61
professional to explain the treatment plan you will 50 2007
52
12
50
use at home.
8
4
0 2006
Falls
with no
adverse
outcome
Falls with
minor
outcome
Falls with
major
outcome
Total
falls
TRIVIA QUESTION 3: How many babies were born at West Gippsland Hospital in 2008/2009? ANSWER ON PAGE 12.
PAGE 4 QUALITY OF CARE NEWS
Patient Safety
Medication safety The prescription, dispensing and
administration of medications are
Examples of these types of errors
include:
G writing the letter ‘u’ instead of the
high risk areas. While no medication
error brought harm to any patient whole word ‘unit’
or resident this year, medication G prescribing a product name like
management is taken very seriously. panadol rather than the medication
Of all incidents reported across the name paracetamol
G unclear hand writing which is
Group, medication errors remain one
of the most reported with an average difficult to read and understand.
of one reported every day. This year, a comprehensive review
The reporting of medication errors was undertaken of insulin, heparin
followed by the close analysis of and administration of oral drugs, all
why they occurred is very important. considered to be high risk
This enables us to implement medications. As a result:
G medical and nursing guidelines
strategies to prevent future errors
for insulin were reviewed to ensure
and to improve medication safety
best practice
overall. All staff are actively G high dose insulin syringes were
encouraged to report all medication removed from the general wards
incidents. This year 364 incidents to reduce the risk of high doses
were reported, 149 more than last of insulin being given by mistake
year with the majority relating to G the ‘PINCH’ strategy was introduced
Pharmacist Kenneth Ch’ng errors in documentation. and promoted as a reminder to
shows the new orange
As a proportion of the overall staff to stop and consider the risk
oral dispensers introduced
this year to avoid oral before prescribing or administering
number and variety of medications
drugs being administered high risk drugs
administered at different times and G orange oral dispensers were
intravenously.
in varying ways throughout the day, introduced this year to replace
the number of reported medication clear dispensers to reduce the risk
errors is relatively small. of liquid based oral drugs being
Documentation related errors are given intravenously. The intravenous
the highest recorded, with 126 errors attachment does not connect to the
in documentation reported this year. orange dispenser.
Taking the pressure off you
Pressure Ulcer Stages Percentage of Inpatients with Pressure areas on residents in our
documented Risk Assessment: residential aged care facilities are
Stage 1 Redness with skin in tact April 2009 - WGH measured differently than in the
Stage 2 Abrasion, blister or shallow crater on the skin surface hospital setting. Some residents
WGH (Group B Hospital) 100%
come into our care with existing
Stage 3 Deep crater into skin surface State average 81% pressure areas.
Stage 4 Full thickness skin loss and muscle or bone damage Other Group B Hospitals 82% These are measured as well as
pressure areas acquired while in
Laying in the hospital bed can pressure area. In this case, the main Pressure area data is reported to DHS. our care. Both Andrews House
bring some risks. focus is to heal any pressure areas Three measurements are reported: and Cooinda Lodge reported low
already present, while also avoiding G Patients with a documented numbers of pressures areas this
Who would have thought that
staying still can be harmful? the development of new pressure assessment of risk year with results rating similar to
areas. G Pressure areas acquired in hospital
It can result in developing a other aged care facilities when
G Pressure areas acquired in Cooinda
pressure area. Pressure areas The severity of a pressure area measured as a rate per thousand
Lodge and Andrews House. bed days.
can occur when there is not is measured in four stages
much movement, and pressure demonstrated in the table above. Our data is then compared with other
is placed on a specific part of the health services from across the State. Pressure Areas - Residential
The following practices help us to
body. minimise the risk of pressure ulcers: Aged Care 2008-2009
G A pressure ulcer prevention policy Hospital acquired pressure areas 1.20
So our elderly, and the less mobile
1.21
are at risk. Preventing pressure guides staff 12 1.00
G Nursing staff and Personal Care
area points is part of our patient 2008/09
safety program. Workers trained to identify 10 0.80
and assess people at risk 8
2007/08
0.60
Factors such as the inability to
0.67
G Regular assessment of all
0.65
2006/07
move, poor nutrition, smoking, Cooinda Lodge and Andrews 6
0.51
0.40
0.45
age and illness increase the House residents
0.11
0.34
4 0.20
chance of someone developing G Classifying all pressure areas
0.04
0.09
0.17
2 0
a pressure area. according to severity scale
STAGE 1 STAGE 2 STAGE 3 STAGE 4
Pressure ulcers used to be called G Commencement of immediate 0
STAGE 1
STAGE 2
STAGE 3
STAGE 4
bedsores, and range from a treatment and management Andrews House
reddened area, to a deep ulcer strategies using latest techniques Cooinda Lodge
that eventually affects muscle and products
The number of hospital acquired pressure areas State Average
G Specialist wound management
and bone. increased slightly this year prompting an
program provided by highly trained increased focus on education for nurses The graph above shows the rate of pressure
Some people come into hospital Clinical Nurse Specialists and orientation of new staff. areas on residents per thousand bed days.
or into an aged care home with a
TRIVIA QUESTION 4: What is the most common first name of staff? ANSWER ON PAGE 12.
PAGE 5 QUALITY OF CARE NEWS
Accessing our health service
The Emergency Department
Last year we reported that we were National Institute of Clinical Studies G communication to General
Emergency Department Attendances
bursting at the seams and this year “Evidence in Action Prize” for best Practitioners regarding what
has seen no change in the trend. 17,000 practice evidenced based happened during the patients
17,058
assessment process at the National stay in hospital, and what referrals
The Emergency Department has 16,500
Conference College of Emergency were made to other services.
again broken attendance records
16,497
16,000
and seen an increase in the number Nurses. Nurse Unit Manager Sue
of presentations. A total of 17,058 15,500 Colby was invited to sit on the
15,554
patients were seen this year, 561 15,000
Department of Human Services state DHS pleased with
more than last year, a 3% increase 15,074 steering committee for improving the elective surgery progress
14,949
14,500
and a 9% increase over the last 2 assessment of people with chest pain
Managing the elective surgery
years. 14,000 in the Emergency Department.
waiting list continues to present
This demand places staff and 0 We continued the project, this year many challenges. Irrespective
and achievements include:
2005
2006
2007
2008
2009
the physical environment under of the challenges, our staff
G revision of the chest pain worksheet
enormous pressure to meet the continue to identify areas to
admission. Data has been collected to provide staff with prompts to
stringent DHS acceptable waiting make the operating theatre lists
to enable staff to analyse where time ensure care is delivered in a timely
times for patients guidelines. It is more efficient and to reduce
can be saved. A redesigning care manner and improve
not uncommon for all cubicles, the elective surgery waiting times.
project worker has been appointed documentation
corridor and waiting room to be full This has been achieved by
and trained in techniques that identify G improvements to discharge
at any one time. offering extra theatre time to
areas where we can improve work documentation
While demand has increased, we G a new data base as been
surgeons to perform surgery,
flow and reduce waiting times for
can report: established to collect additional data performing routine general
patients.
G waiting times for category 3 patients G the number of measures to monitor surgery in the morning instead
Other improvements include: of the afternoon so patients
improved with 2% more patients performance and adherence to best
G The establishment of a safe room
seen within the required time frame practice have been increased and can be admitted as day cases
to care for patients with challenging rather than staying overnight
G continued improvement in waiting strengthened so we can target more
behaviors
times for category 4 patients with areas for improvement. and by extending the length
G Increased nursing and senior
3% more patients seen within the In a separate but related project, of lists to operate on more
medical staff hours
required time frames WGHG participated with 48 other patients in a day.
G 90% of category 5 patients seen
To address unsafe capacity levels,
hospitals, in a national project The DHS allocated an
within the required time frame a tiered critical capacity process
focusing on the discharge additional 409 WIES this year
G 3% less category 2 patients were
was implemented this year to provide
management of patients with of which 139 were for the
seen within the 10 minute time an early warning and to alert senior
acute coronary syndrome. Project Commonwealth Government
frame than last year, however this staff to expedite actions to assist in
initiatives include: elective surgery initiative to
is still 2% better than previous years. relieving pressure on the department
G surveying General Practitioners reduce the length of elective
The length of time a patient stays in during peak times
to identify issues with discharge surgery waiting lists.
the Emergency Department until a Planning has commenced on the management This funding coupled with
bed becomes available in a hospital refurbishment of the Mary Sargent G surveying patients to identify
strategies contributed to an
ward is an ongoing concern. This building to improve capacity for day issues associated with medication
overall reduction in the waiting
difficulty in getting a bed is related to procedures and free up bed capacity. management and their ability to
list with 638 patients listed at
the increase in presentations and the attend cardiac rehabilitation.
Improving the management the end of the year, 16 less than
high occupancy rate in the hospital WGHG results indicated that we last year. This is an excellent
of people with Chest Pain
and other related issues. provided good discharge information result considering 3,207
Last year we reported on the work and follow up. Two areas targeted for
In an effort to cope with the increasing operations were performed this
being done through the Acute improvement were:
demands and to reduce waiting times year, 77 more than last year.
Coronary Syndrome Project to G to improve the documentation
for patients, the Emergency We are pleased to report that
improve the management of people of risk factors
Department and the Medical Ward all revised elective surgery
with chest pain.
are working together to redesign and targets set by DHS were met
improve the patients experience and This project won the National Health Total Operations Performed 2008/2009
and Medical Research Council, with 100% of all category one
care journey for patients requiring 3,500
(the most urgent) patients
3,000 waiting less than the
3,207
Percentage of patients for admission to Ward
3,107
3,130
recommended 30 days for
2,943
2,889
2,500
2006/07 2007/08 2008/09 State average surgery and a 50.9% reduction
2,000 in ‘long wait’ patients to the end
Admitted within 12 hours 78% 81% 81% 87%
1,500 of December.
Admitted within 8 hours 64% 68% 67% 75%
1,000
The table above shows the percentage of people that required admission to a hospital bed that were
500
found a bed within 12 hours and 8 hours of attending the Emergency Department.
0
Percentage of patients seen within the recommended time The table shows an additional 77 operations
2009
2008
2007
2006
2005
were performed this year.
Most urgent Category 1 100% 100% 100% 100%
Waiting List as at 30 June 2009
Category 2 85% 90% 87% 86%
Category 3 67% 69% 71% 79% Urgency Count of Waiting Episodes
The table shows the number, in three categories,
1 25 of people on the elective surgery waiting list as
Category 4 62% 63% 66% 73%
2 282 at 30 June, 2009 and the average waiting times
Least urgent Category 5 84% 90% 90% 89% for surgery. Category 1 patients are the most
3 331 urgent and should receive surgery within 30
The table above shows the percentage of people attending the Emergency Department in each Total 638 days, Category 2 within 90 days and Category 3
triage category that were seen within recommended time frames. within 365 days.
TRIVIA QUESTION 5: How many meals were prepared this year by the Food Services Department? ANSWER ON PAGE 12.
PAGE 6 QUALITY OF CARE NEWS
Infection Control
Hand hygiene
Hand hygiene is the most important G by conducting regular awareness
Cleaning standards
component of preventing infection. campaigns
Our staff focus on cleaning their G by completing regular audits and
hands thoroughly with audit results comparing results with targets set
indicating consistent performance by DHS
G by reporting audit results back
above expected targets.
to staff and advising where
The Victorian Quality Council hand improvements can be made.
hygiene project implemented at Hand hygiene audits involve
WGHG in 2007 continues and is observing the number of times staff
an integral part of the infection use hand hygiene products such
control program. With the support as special alcohol hand rubs, against
of the Infection Control team, hand the number of opportunities for hand
hygiene principles, education and hygiene eg the use of alcohol hand
performance are demonstrated: rubs before and after touching
G as part of the staff orientation
a patient or the equipment beside
program their bed.
Hand Hygiene Compliance
100%
COMPLIANCE SET BY DHS: 55% The graph shows the
90%
overall results of hand
80% hygiene audits in the
85%
81%
81%
different departments.
79%
77%
70%
All departments were Having a clean hospital is conducted. High risk areas such
75%
73%
73%
71%
70%
70%
well above the target
69%
important to reduce the risk of as the operating room are
68%
67%
60%
of 55% set by DHS
64%
people developing infections. measured differently as they
59%
with an overall average
57%
50%
improvement of 7%. Some superbugs, that are require a higher level of cleanliness
40% difficult to treat, live in dust and than for example corridors. In
March 2009
30% can easily spread to people addition to these regular internal
February 2008
on hands and equipment, so it is audits, audits are conducted by
20%
November 2007 important that we make sure our external auditors with the results
10% hospital is as clean as possible. reported to DHS.
0 To ensure cleaning standards are Pictured above, Environmental Services
Ward 2 Ward 3 Emergency High Ward 5 Average met, regular cleaning audits are staff Dianne, Elaine, Sue, Margaret, Renee
Department Dependency
are part of a highly trained team who ensure
Unit Graph below, shows for the past five years,
we achieve outstanding results in periodic
cleaning standards have remained well
Infection Control cleaning audits.
above benchmarks set by DHS.
staff Karenne
Nielsen (left) and
Coralie Tyrrell Cleaning Standard Score
(right) take a
novel approach to SCORE SET BY DHS: 85% SCORE SET BY DHS: 80%
‘testing’ staff hand 100%
hygiene practices.
80%
Medical students
Sarah Cain (left) 60%
and Jet Driver
(right) prepare to 40%
place their cleaned
95.20%
95.50%
92.40%
91.40%
hands under the 20%
95%
ultra violet light to
0
reveal how well
2009 2008 2007 2006 2005
they cleaned their
hands.
Managing H1N1(swine flu)
With the dire warnings about admission for patients at risk
the potential severity of the of having H1N1 to limit and
H1N1 epidemic earlier this year, a minimise the risk of exposure
comprehensive management plan to other patients, staff and
was activated to manage the public in the Emergency
situation. Strategies implemented Department
G public posters were updated
included:
G a patient screening system to
regularly and alcohol hand
identify potential H1N1 cases rubs were provided at main
entrances for public use
G any identified patients were
G Infection Control staff meeting
isolated to protect exposure to
other patients, staff and the regularly with the Executive
public to reduce the risk of team for updates and to monitor
further spread and plan for the potential impact
on the Emergency Department Infection Control Clinical Nurse Specialist Coralie Tyrrell points out the poster reminding the
G a hospital room was also public to clean their hands during the H1N1 pandemic earlier this year and is happy that visitor
workload and staffing levels.
dedicated to streamline direct Brian Brewer is applying the alcohol hand rub as he enters West Gippsland Hospital.
TRIVIA QUESTION 6: How many operations were performed this year? ANSWER ON PAGE 12.
PAGE 7 QUALITY OF CARE NEWS
Getting you involved
Your care and you
Community Being involved in and understanding Our results are above the state
Advisory Council your daily care is important. The more
you understand what is happening to
average and support the importance
we place on consumer participation.
At WGHG we are committed to G development of this Report you the better you are able to cope
working with patients, their families, G improving relations with the with your treatment. To help you Consumer participation Indicator -
carers and the community to Aboriginal community VPSM
understand, specific information
improve the delivery of health care. G participation on the Ethics relating to your care it is recorded, WGHG 81% satisfaction
WGHG works in partnership with committee, Hospital Admission and updated daily, in your ‘Patient
consumers at many different levels Risk Program, Redesigning Care Pathway’. State average 79% satisfaction
Care project and Improving
and a consumer participation The Pathway provides guidance on
policy has been in place for a
Care for Aboriginal People Please tell us
project. what we do for you each day eg any
number of years. At times when things don’t seem
specific dietary requirements, your
One way this is achieved is As part of the formal, periodic to go as they should, we want you
mobility or tests required to be
through the Community Advisory accreditation process, external to tell us. This provides us with the
undertaken. Pathways are written
Council. The Council meets surveyors from the Australian opportunity to look into what
in patient friendly language and
monthly and actively seeks Council of Healthcare Standards happened, work out why, and try
(ACHS) review how we involve mirror the Pathways used by nurses to ensure it doesn’t happen again.
consumer input in relation to
consumers. We are pleased to to plan and record your care. We like being told and we encourage
people’s experiences, service
delivery and strategic planning. report all requirements are met For patients with complex needs, it.
This is achieved by: by the Group and an ‘extensive formal meetings are held with family Some people may seem like they’re
G reviewing consumer related
achievement’ rating was awarded members and the medical team complaining, but it does help us to
policies for how well our consumers and looking after you. improve systems and processes.
G reviewing and recommending
patients are informed of their Patient satisfaction We would rather know about any
changes to written patient rights and responsibilities. concerns, so we can prevent them
Departments regularly conduct
information The surveyors verified that we surveys to gather your thoughts from occurring again.
G reviewing patient satisfaction seek input from consumers, on the types and quality of services When you make an official
surveys carers and the community in they deliver. One survey type that complaint, it is reported to our
G reviewing patient care pathways the planning, delivery and we rely upon is the Victorian Patient executive management team and
G improving the web page evaluation of the health service Satisfaction Monitor (VPSM), an registered on a formal data base.
G development of a cultural and also make provision independent survey conducted This is so that any trends can be
diversity plan for consumers and patients throughout the year by an external established. This year 95 complaints
G organisation planning by with special needs and body appointed by the DHS. were registered.
participation in the Board from culturally and linguistically
The survey provides data on our There are many ways for you to tell
planning day diverse backgrounds.
performance and is then compared us your concerns. Please speak
to all other Victorian Hospitals. to one of our staff members, fill
in a Compliment and Complaint
Victorian Patient Satisfaction brochure available at all of our sites,
Monitor WGHG results write us a letter, or email us at
info@wghg.com.au.
2006/07 79.9%
All complaints are investigated
2007/08 80.4% and followed up, where possible,
2008/09 78.2% with the complainant and senior
management and/or the most
State average 77.6% appropriate person.
Of course you’re also welcome
Outstanding achievements include:
to tell us what you liked too!
G response time of nurses - 96%
G helpfulness of staff in general - 99%
Areas we need to improve:
G providing access to interpreters
G improving discharge information.
These areas are targeted for further
education and review in the coming
year.
Measuring your satisfaction as to
how we involve you in your care is
also achieved using the consumer
participation indicator of the VPSM
by asking the following questions:
G Did you have the opportunity to
ask questions about your condition
or treatment?
G Were you happy with the way staff
involved you in decisions about your
care?
Community Advisory Council members (L-R) Theresa Walker-Hassett, Laele Pepper,
G Did you find hospital staff listen to
Angela Greenall, Bev Dowie, CEO Ormond Pearson, Richard Morris, Michael McGuire, For a copy of our Compliments and Complaints
Linda Mullett and Kaylene McKinnon. Absent: Rosemary Joiner. your health concerns? brochure, please telephone 5623 0631.
TRIVIA QUESTION 7: How many loaves of bread were eaten this year? ANSWER ON PAGE 12.
PAGE 8 QUALITY OF CARE NEWS
Improving Care
Improving care
for older people
The Hospital Admission Risk Program
(HARP) was introduced last year to
improve health outcomes for clients
who meet specific criteria and have
chronic health conditions. By working
with them, General Practitioners and
other support people, clients are
assisted to better self manage their
condition and thus reduce hospital Kids-Life! MEND (Mind,
admissions and presentations.
An extension to this program this Exercise, Nutrition, Do It!)
year is the Improving Care for Older
Kids-Life! MEND (Mind, Exercise, towards a healthier lifestyle with
People (ICOP) project. The ICOP
Nutrition, Do It!) is a fun program nutritious foods, active living and
project includes improved staff
offered FREE to families with importantly developing the self
knowledge of person centred
children aged between two and confidence and self esteem of
care through education and the
Physiotherapy assistant Adele Whelan 12 who are interested in becoming the children and family.
commencement of the Functional
assists patient Maureen Davies to do more healthy and active.
Maintenance Program on the MEND (Mind, Exercise,
walking exercises as part of the inpatient
Medical Ward. Delivered in functional maintenance program. The program teaches children Nutrition, Do It!) is a 10 week
conjunction with allied health staff, and their parents the importance group program with two sessions
sessions where it is appropriate.
clients are encouraged to remain of good nutrition and the benefits per week for children and their
Family and friends are also
active and prevent functional decline of being active through lots of fun parents to attend together. All
encouraged to help with activities
while in hospital. games and activities. Families can reports from participants who
and exercises. They can be as
attend either a group or individual recently completed their 10 week
The program uses exercises and simple as going for a walk
program, depending upon their program are that they are now
activities that help keep patients together, doing a puzzle or
needs.The benefit of the individual eating better, their relationships
active during their stay in hospital discussing the latest news.
sessions is the tailored approach with each other had improved
and is delivered in addition to the Progress is monitored during the to suit each unique family. Some and their physical activity had
physiotherapy programs that are patients stay in hospital and is sessions include picnics in the increased significantly.
part of the planned care provided measured against a ‘six minute park, playing games in your own Pictured above, new friends! Children
to patients. walk’ test and the ‘time to up and who recently completed the MEND
neighbourhood, home visits after
Activities are supervised by an Allied go’ test which measures how long school and some in school
(Mind, Exercise, Nutrition, Do It!) program
during one of their pool based exercise
Health Assistant, usually on a one it takes for a patient to get up and sessions. Each family works sessions.
to one basis with some group start walking.
If you would like more information about the Kids-Life! Program
please telephone the Community Services Division on 5623 4500
Bev’s story and ask for the Kids-Life! Coordinator. Bookings are now being taken
for Term 1 next year. Remember it’s FREE!
Drouin resident Bev Miller knows only and support. After going home from
too well the benefit of the continuing hospital, Bev was visited regularly
care journey at West Gippsland
Hospital.
at home by the District Nurses who
changed her wound dressings and Accreditation update
Following a routine mammogram made sure she was going along okay. Accreditation processes are in place The project, while designed to identify
early in 2009, Bev was diagnosed A side effect of breast surgery can to ensure that healthcare the benefit of short notice survey
with breast cancer for the second be the retention of fluid known as organisations meet industry standards methodology, provided the
time. For Bev, this started a journey lymphoedema which can be helped and continually improve their systems opportunity to identify gaps in
that saw her utilising a number of by massage. Bev experienced this and processes. The achievement of a our quality improvement processes.
our services in the hospital and side effect and attended the successful accreditation is mandatory Two days notice is provided to health
community settings. lymphoedema massage clinic also for all health services and aged care services undergoing short notice
Bev underwent surgery the following run by the District Nursing Service. facilities. Accreditation surveys surveys. We are pleased to report
week at the hospital to have the Visiting Oncologist, John Scarlett, was are conducted at regular intervals that our robust continuous quality
breast removed and was immediately Bev’s next port of call for follow up depending on the type of survey. improvement systems supported
referred to the McGrath breast care and review as well as ongoing three Each accreditation survey identifies our current accreditation status and
nurse, located at the Warragul District monthly check ups with the surgeon. areas for improvements which are all evidence that was required
Nursing Clinic, for follow up care reviewed at the next survey. This year met all requirements.
We are pleased to report Bev is ‘doing
really well’ and is an we have been focussing on The Warragul Linen Service is
active member of the improvements to our patient flow surveyed annually and holds
West Gippsland We through Emergency Department and AS:NZS ISO 9001:2008 certification.
Insist on Good improving some of our documentation Cooinda lodge and Andrews House
Support (WIGS) in preparation for the periodic review underwent full accreditation with
Cancer Support in October. the Aged Care Standards Agency
Group. WGHG has also been at the forefront in December and successfully
McGrath Breast Care of evaluating National Accreditation achieved compliance with the 44
Nurse Annette Houlahan Methodology. This year we criteria surveyed. West Gippsland
chats with patient Bev Miller Hospital and the Community
participated as one of 20 healthcare
following her surgery for
breast cancer. organisations nationally in a project to Services Division are fully
evaluate the potential of “short notice” accredited by the Australian
surveys. Council of Healthcare Standards.
TRIVIA QUESTION 8: How many litres of milk are consumed in one week? ANSWER ON PAGE 12.
PAGE 9 QUALITY OF CARE NEWS
Clinical Governance
Clinical governance is the process attendances at 182 different education Risks identified are then directed Development of formal guidelines
where the Board of Directors monitor topics. to the most appropriate committee outlining conditions where referral
that we have the right people doing Staff take compulsory annual training or persons for action. Strategies to a paediatrician is mandatory.
the right thing at the right time in the aimed at risk prevention are
in their area of expertise. 350 nurses RISKMAN incident recording
best and right way. It involves: identified, implemented and
completed a total of 2,640 different
G ensuring an effective and safe
reported to the monthly Clinical A new electronic risk management
competency tests, a significant Quality Committee.
workforce; system, RISKMAN, was introduced
increase on last year. These
G monitoring clinical effectiveness; Clinical Risk and Evaluation this year to record all reported
competencies include:
incidents. It provides real time
G managing clinical risks; and G basic life support Council (CARE)
reporting to managers and other
G consumers in their own care. G drug dose calculations CARE discusses an average of senior staff responsible for
Right people G hand hygiene 26.5 issues per month. This year investigating incidents using
G manual handling saw a 38% reduction in the number automated electronic alerts. The staff
New staff undergo rigorous selection
G falls of complaints discussed and a 50% member who generated the incident
to ensure they have the correct
G neonatal resuscitation for midwives reduction in the number of issues report is able to see an outcome of
qualifications, experience and
G fire safety
related to policies and procedures. the investigation and the action taken.
credentials to undertake the tasks
However analysis of data shows an Details are recorded on each incident
they are employed to do. Current G food safety.
emerging trend pointing to the need enabling us to get more refined
staff have their credentials and
The best care...how we do it to prevent delays in care reports and quickly discover
registration checked annually.
To ensure clinical effectiveness we: management. emerging trends.
G enrol in projects to implement best The work of CARE has resulted in The most common types of incidents
100% of nurses have current practice a range of recommendations being reported are falls, medication and
practicing certificates G support our staff to learn about best implemented to reduce risk. Some aggressive behaviour incidents. We
practice of these improvements are: recognise that it is difficult to ensure
100% of doctors are credentialed G foster and encourage ideas to G setting up an “early warning critical
according to best practice that every incident is reported but we
improve care delivery capacity process” to implement have worked hard to encourage our
guidelines G involve staff in planning and actions to improve access to
staff to report incidents and near
100% of doctors have current redesigning systems and process services in the Emergency
misses so we can learn from them.
registration with the Medical Board that improve the way we do things Department at times when the
G undertake a large number of audits department is critically overloaded
of Australia Incidents reported at WGHG
and clinical indicators that measure G revising processes to improve
100% of staff have satisfactory and monitor our clinical our response when a patient’s 2006/07 1730
police checks including working performance, compared to condition is deteriorating
with children checks standards, and report these to the G revising consent policies 2007/08 1502
Clinical Quality Committee, G revising medication protocols 2008/09 1378
A new project commenced this year is Standards Committee and Board. G a range of targeted education
the credentialing and defining scope This helps ensure we are improving campaigns to improve staff
of practice for staff in Allied Health performance and aiming for best knowledge eg improving the % of types of total
areas. practice care management of arterial lines. reported incidents
G constantly review our
Right thing, Serious incidents have a high level
documentation to ensure care is 2006/07 Falls 42%
right time, of investigation, including root cause
accurately documented and Medication and
right way communicated analysis. During this process every
detail of the incident and events IV related 15%
Our staff are guided by policies, G involve patients and family in their
leading up to the incident are Aggresive
procedures and protocols that are care.
analysed to identify causes. The team behaviour 13%
regularly reviewed reflecting best Managing risks then develops recommendations to 2007/08 Falls 45%
practice and supported by the latest
Our comprehensive clinical risk prevent the incident occurring again.
literature and research. Medication and
management program which includes: This year we completed two Root IV related 13%
Staff rostering is organised and takes G a commitment by the Board of Cause Analyses. Recommendations Aggresive
into consideration an appropriate mix Directors and Executive team included: behaviour 11%
of skill and experience. to a safety first environment G improvements to operating suite
Orientation programs provide G encouraging staff to report clinical count sheets 2008/09 Falls 37%
important information to all new risks and incidents, to learn from G development of a formalised Medication and
staff. General orientation was provided them and prevent them from process of self-assessment in IV related 22%
for 121 new staff members this year occurring again competence and confidence in Aggresive
and 68 new nurses were provided G investigating incidents, relation to scope of practice behaviour 13%
with additional nursing orientation. identifying underlying causes G revision of nursing roster system
and implementing strategies to to reduce times of extended shifts
Experienced staff supervise and Below, Heather Gillespie and Di More
reduce risks when overtime is worked in the
mentor students. 120 staff completed demonstrate the electronic risk management
G utilising technology to design operating room.
a preceptorship program to build skills system implemented this year.
out or minimise errors
in supervising and guiding new staff
G regular reviews of policies,
and 32,000 hours of student clinical
procedures, guidelines and
placement were undertaken this year.
protocols to ensure they reflect
New graduate staff are mentored current best practice
by senior staff to guide them through G having in place and constantly
their first year in the workplace. Ten revising programs to manage
nurse graduates completed their known clinical risks (such as
graduate year this year. Infection Control risks)
G a weekly meeting of the Clinical
Extensive ongoing education extends
scope of practice and keeps staff Risk and Evaluation (CARE)
up to date with best practice. During Council to discuss clinical
incidents, complaints and issues.
the year there were 2,566 staff
TRIVIA QUESTION 9: How many paracetamol tablets are dispensed each year? ANSWER ON PAGE 12.
PAGE 10 QUALITY OF CARE NEWSCare in the community
The best of both worlds
Black Saturday...
our response
On Saturday February 7 our health
service announced a Code Brown,
external disaster alert. Baw Baw
Shire was ringed with fire, and the
Princes Highway blocked in both
directions. With the outstanding
support of staff, emergency
procedures swung into action.
The day room at Cooinda Lodge
Nursing Home was cleared to
make way for residents evacuated
from Neerim South Nursing Home.
The Emergency Department
prepared for fire victims affected
community members still need
by burns, smoke and minor
our help and we are assisting
injuries. The hospital kitchen
When the time comes that your loved Above, a highlight of the week for Cooinda them through our Community
Lodge residents is the art program. Working on provided meals to ambulance staff,
ones moves into one of our residential Services division. The Baw Baw
their masterpieces are residents (L-R) Sophia, and the Warragul Linen Service
aged care facilities, Cooinda Lodge Margaret, Joahanna, Billie and Marie with
Bush Fire case management
made linen available to emergency
in Warragul or Andrews House at Lifestyle Coordinator Pauline Boorer and Art team is located at our Community
relief centres. The Community
Trafalgar, you can rest assured Therapist Joan Bognuda. Health Centre in Gladstone in
Service counselling team arrived
knowing they’ll continue to be raised is then used to buy supplies to Warragul and is working closely
at the relief centres by mid
part of the wider community. make items to donate or to make a with the other support services
afternoon to provide support.
monetary donation to a charity. we provide from that Centre.
An ongoing highlight for residents The bushfires were devastating Above, Louise helps defend the Labertouche
is the diversity of lifestyle enjoyed Donations made this year included:
for our community. Even though property of Liz Winkel and Leigh Bedson.
through programs organised G 50 calico dolls to the St John’s Liz and Leigh are receiving ongoing support
several months have passed since
“in-house” as well as those designed Ambulance needles and thread from the Bushfire Case Management team
program those fateful days, the support located at our Warragul Community
to involve them in the wider we provide is ongoing. Countless Services Division.
G A slab of beer for local fire fighters
community.
who helped on Black Saturday
An art program was commenced this
year at Cooinda Lodge to provide the
G Groceries to fire victims
G $95.00 to the Cancer Council
Providing the essentials
opportunity for residents to express Biggest Morning Tea
their thoughts, feelings and memories G West Gippsland Healthcare Group
of days gone by through painting. Murray to Moyne Cycle Relay team
The year culminated in the unveiling G A box of groceries for the Salvation
of a painted collage entitled ‘Moments Army to help a local family in need
in Time’ that depicts a special memory Another special project is the
in time from each resident. Measuring ‘Operation Christmas Child
4.5 x 1.5 m and with a central theme Samaritan’s Purse’. To help children
of the bubbling water fountain in in overseas countries caught up in
the Cooinda garden , the collage the midst of war, famine, natural
encapsulates memories of gardening, disasters and extreme poverty,
pets, children and family, horse riding, residents fill shoe boxes with school
growing up in Europe, the beach, supplies, toys and personal items Thanks to the ongoing generous the Australian Government for
farming, working days, cooking and that will be distributed to children donations of local churches, funding an additional $34,000 to
the war years. Residents are looking at Christmas. These boxes become service clubs and individuals, our meet this demand. At Christmas
forward to hosting their own exhibition treasured gifts to children who have Emergency Relief program is able time, the Emergency Relief
at the West Gippsland Arts Centre in never received gifts before. to provide practical help to local Coordinator works closely with
the coming year. families in need. the Warragul Gazette, Salvation
“Enjoyment and satisfaction in
Following the Black Saturday Each week around 20 people are Army and the Christian Family
remaining an active member of the
bushfires residents had a great desire assisted in a practical way through Church food bank to prepare
wider community is the best part of
to be able to help so a “yellow day” the program which is another part over 120 Christmas hampers to
these programs”, said an Andrews
was held. Residents and staff enjoyed of our community health service brighten the Christmas of many
House resident.
making and eating yellow cup cakes provided at Gladstone Street in families. For further information
with the funds raised donated to the Warragul. about the Emergency Relief
Drouin West Fire Brigade. Food, petrol vouchers, assistance program telephone the Warragul
with utility bills and general Community Services Division on
The “Random Act of Kindness”
household expenses is available 5623 4500.
program at Andrews House provides
residents with the opportunity to to assist people in difficult Pictured above, the wonderful team of
volunteers and staff preparing to pack
consider people and groups in the circumstances. The demand for Christmas Hampers are back row (L-R)
wider community who need a helping this service increased significantly Alice Faragher, Margaret Lawrence,
hand. With the support of volunteers, this year following the Black Rodney Dyson, Kate Palmer, Tanaya
McKinnon, Lauren Gordon, Anita Hermans,
staff and family members, residents Saturday bushfires with 898
Sam Stephens and Julie Ettery. Front row
get together at the in-house “café” occasions of service, 192 more (L-R) Major Warren Elliott, Anne Pascoe,
Above, Andrews House resident Gwen Higgins
once a month where they enjoy stuffs a calico doll for the Random Act of than last year. We are grateful to Lauren Roche and Stephanie Keeble.
cappuccinos and cake. The money Kindness program.
TRIVIA QUESTION 10: How many units of blood (around 300ml) are used in one year? ANSWER ON PAGE 12.
PAGE 11 QUALITY OF CARE NEWSYou can also read
