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Health Service Review and Evaluation

staysafe@hole pre-study trial evaluation
Funding Body: Nurse Maude and St John
Project Description/Update: Nurse Maude (NM and St John have collaborated to design a person-centred, technology-assisted home-care service model which can support mutual clients with a dementia/memory loss diagnosis to stay at home safely for longer, with reduced carer stress.  It involves St John installing monitored devices into the home of clients living alone who have cognitive impairment.  The activations from the devices ( a smart pendant, fire and smoke alarms) are shared with Nurse Maude to enable enhanced case management.

Phase 1 included detailed design of all associated processes, policy, documentation, and data infrastructure for ongoing monitoring.   The Institute evaluated the pre-trial and provided recommendations for changes/enhancements for the second phase.  Phase 2 is a full research study of 100 new NM clients which is being evaluated by Sapere, with support from the Institute to manage data collection, carry out questionnaires and conduct interviews with clients and their support people.
Project Outcomes: An evaluation report provided to Nurse Maude and St John .
Further Information: Contact gill.coe@nzichc.org.nz
Diabetes Service Review
Funding Body: Nurse Maude and University of Otago
Project Description/Update: The Institute collaborated with the Otago School of Nursing to design and conduct a rapid, but multi-dimensional and detailed examination of Nurse Maude’s Community Diabetes Service (NMCDS), informed by evidence.  The approach involved conducting a systematic review of the evidence and undertaking a study into clinicians’ experiences of the current model of care provided by NMCDS. 

The review aimed to identify and clearly articulate any unique value that the Service in its current form contributes to the integrated system of diabetes care in Canterbury, and the attributes of the Service model that particularly delivered that value.  It also looked to identify gaps or weaknesses in the model, and any further development opportunities. The aim was to provide evidence that could support the development of the service in order to:

 

  • Best meet the needs of patients with diabetes in the community, and
  • Best support the current primary care model in Canterbury.
Project Outcomes: The report identified a number of themes that came through in the literature that supported the NMCDS model of care, including improving access to care for people with diabetes, providing access to expert nurses / dietitian enhances clinical practice and patient outcomes, and that the collaborative style enhances success.
Further Information: Contact gill.coe@nzichc.org.nz
Support Worker Satisfaction
Funding Body: Nurse Maude
Project Description/Update:

In 2015, Nurse Maude employed approximately 475 support workers.  The main aim of this project was to undertake a study of Nurse Maude’s Support Workers to inform strategies to develop and strengthen this workforce into the future.

To undertake this, the project included:

  • A review relevant literature on the support worker workforce
  • Development of the Nurse Maude support workers’ demographic profile
  • Analysis of support worker payroll data to determine working patterns
  • Analysis of staff engagement survey responses from support workers
  • A summary of the findings from the above information to identify key themes to explore with key informants, including support workers
  • Develop a final report on the project with recommendations for further service development and positive engagement of the support worker workforce
Project Outcomes: The report identified a number of areas where support workers' satisfaction could be enhanced, including improving communication, focusing on retention of specific age groups within the workforce, the support workers working more in a team environment, including involving them more in planning their work.
Further Information: Contact gill.coe@nzichc.org.nz
Evaluation of the Care Capacity Demand Management Programme
Funding Body: Safe Staffing Healthy Workplaces Unit
Project Description/Update: This evaluation provided an overview, feedback and recommendations on the Care Capacity Demand Management programme (CCDM).

The Care Capacity Demand Management (CCDM) programme was initiated in response to the 2006 Safe Staffing Healthy Workplaces' Committee of Inquiry Report. The report identified strategies to address concerns that hospitals were inadequately staffed by nurses and midwives to meet the increasing complexity of patients.

The CCDM programme is designed as a whole of (hospital) system approach that focuses on the provision of tools, processes and organisational support systems to undertake three key functions: Matching the workforce availability and skill mix to patient acuity in each ward on the day; Providing a suite of indicators that enable a ‘real time’ view of the patient, the ward and the hospital in relation to workforce availability and patient acuity, in order to identify any gap between demand and capacity; Providing tools that enable variance in the predicted workforce availability, skill mix and patient acuity to be managed safely and efficiently on the day, using standard operating responses (SORs). The CCDM programme provides a comprehensive infrastructure for a whole of hospital approach to managing the nursing and midwifery workforce to better meet the needs of patients, staff and the organisation as a whole. It enables critical analysis of historical hospital staffing resource allocation, fully supported by both the DHB executive team and unions.
Project Outcomes: The evaluation recommended that:
  • The programme continue.
  • The SSHW Unit's role be maximised and formalised
  • The CCDM tools and processes be enhanced
  • There be a focus on completing the current roll-out in hospital wards in participating DHBs.
  • Support processes be developed for those implementing change
Further Information: The report is available on the HIIRC site here or contact gill.coe@nzichc.org.nz
Evaluation of the Gerontology Acceleration Programme (GAP)
Funding Body: Ministry of Health
Project Description/Update: This project is an evaluation of the Canterbury District Health Board's Gerontology Acceleration Programme which was introduced in July 2013.  The programme is aimed at supporting the growth of nursing leadership in the aged care sector.

The evaluation's objective is to determine the personal and professional impact of the programme on participants; its impact on the wider nursing workforce of participants' organisations and the impact on service delivery and relationships across organisations. 
Project Outcomes: The evaluation began in October 2014 and the final report was delivered to the Ministry of Health in July 2105.
Further Information: gill.coe@nzichc.org.nz
Evaluation of a hospital in the home service for the frail elderly
Funding Body: Nurse Maude Association
Project Description/Update: This project evaluated the Nurse Maude Complex Restorative Care Service (TotalCare) which commenced in May 2011 with the main aim of providing a responsive community based health service to patients who would otherwise have required hospitalisation and/or admission to a rest home. The Canterbury District Health Board (CDHB) funded this service which is based on the Integrated Community Services model, with care coordinated by a registered nurse who assesses and case manages the patient’s service care needs, then oversees support workers who provide the majority of personal cares for the patient. Patients also have access to:
 
  • Occupational therapy and Physiotherapy services
  • Respite beds for crisis care
  • Laundry services
  • Meal services.
Project Outcomes: Overall the evaluation indicated that the patient profile matched those for whom the service was planned, i.e. those who require a high level of care and monitoring to remain in their own homes. The evaluation report was provided to Nurse Maude in November 2012.
Further Information: gill.coe@nzichc.org.nz
Audit of acute cellulitis patients receiving IV therapy in the home
Funding Body: Nurse Maude Campbell Ballantyne Fellowship
Project Description/Update: In mid 2007 Canterbury District Health Board funded the establishment of an Acute Demand Service to support general practice to safely manage people in the community during an acute episode, reduce inappropriate ED attendance, reduce hospital admissions, and support the transfer of patient care from the Emergency Department.

The service was provided by Nurse Maude in partnership with Pegasus Health and St John's Ambulance service. The acute community nursing team provided an intravenous antibiotic programme for patients with acute cellulitis who would normally require treatment in hospital. 

Cellulitis is ranked third in the leading causes of avoidable hospitalisation in New Zealand (SISSAL 2008). Over a 12 month period from 16 April 2009, of the 2565 admissions to the acute community nursing service, 947 (36.9%) admissions required IV antibiotic treatment for acute cellulitis. This project involved analysis of this client group and production of a report that profiled these patients including their outcomes.
Project Outcomes: The final report was presented to Nurse Maude in 2010.
Further Information: gill.coe@nzichc.org.nz
Cost utility of a continence training programme in rest homes in Canterbury
Funding Body: Canterbury District Health Board
Project Description/Update: The Institute provided the project management functions for this clinical research carried out by Professor Ted Arnold and Research Nurse Dot Milne. It was designed to estimate the efficacy of a 12-week course of conservative therapy for incontinence tailored to the needs of each participating female rest home resident and devised by a qualified continence advisor.  A second aim was to relate any benefit to its cost.
Project Outcomes: In total, residents from 26 resthomes around Canterbury recruited for this project.  The outcomes of this project will be published in the New Zealand Medical Journal.
Further Information: gill.coe@nzichc.org.nz
Feasibility study to investigate options for primary maternity services in Morrinsville and Te Awamutu
Funding Body: Waikato District Health Board
Project Description/Update: The main aim of this project was to undertake a feasibility study to ascertain the clinical safety and acceptability of continuing to deliver primary maternity services from the Matariki facility in Te Awamutu and the Rhoda Read facility in Morrinsville, compared to consolidating those services in Hamilton.  The process was designed to identify:
 
  • options for reconfiguration and cost/benefit analysis for each and potential financial impact
  • other primary maternity options for service users from these populations
  • potential impact(s) on Waikato Hospital and mitigations and overall
  • issues and risks/mitigations.
To analyse the findings of this study we developed a 5 point assessment matrix that allowed us to measure the outcomes and provide recommendations to the DHB.
Project Outcomes: The final report and recommendations were presented to the Waikato DHB in December 2013 and formed the basis of community consultation early in 2014.
Further Information: http://www.waikatodhb.govt.nz/assets/directory-of-our-services/womens-health/findings-of-a-feasibility-study.pdf
Evaluation of Creon for Treatment of the Symptoms of Pancreatic Cancer
Funding Body: Canterbury Medical Research Foundation
Project Description/Update: Pancreatic enzyme supplementation is part of standard treatment for patients with pancreatic cancer in the United States (NCCN Guidelines, 2011) and in the United Kingdom (Pancreatic Section of the British Society of Gastroenterology, 2005).  At the present time it is not routinely prescribed for patients with pancreatic cancer in New Zealand. Nurse Maude Hospice palliative care service proposes to survey its’ current management of patients with pancreatic cancer in an evaluation study with two phases.

The first phase of this study involved a retrospective audit of patient’s case records to establish symptomology and current practice in the management of symptoms over the last 12 months. 
 
The second phase involved a prospective study of patients who are routinely prescribed pancreatic enzyme replacement therapy (PERT), given education about the symptoms of pancreatic insufficiency, and followed up to monitor symptom management.  In phase 2, the same audit tool was applied both before and after enzyme replacement to see if symptoms had been influenced and quality of life was measured measured. The study results were positive,
Project Outcomes: The second phase study results were positive and an article was published in the BMJ Supportive and Palliative Care Journal. Landers, C., Muircroft, W., Brown, H. Pancreatic enzyme replacement therapy (PERT) for malabsorption in patients with metastatic pancreatic cancer.  BMJ Support Palliat Care doi:10.1136/bmjspcare-2014-000694
Further Information: Contact:  amanda.landers@nursemaude.org.nz
Audit of nurse led specialist wound clinic patient profiles and care outcomes
Funding Body: NZ Wound Care Society
Project Description/Update: The New Zealand Institute of Community Health Care completed an audit of data collected by the Nurse Maude Specialist Wound Management Service over a period of 23 months between April 2009 and February 2011. During this time, 562 patients had data on their wound care assessment entered into SilhouetteMobile which had been developed by a local vendor, Applied Research Associates of New Zealand (ARANZ Medical). Data from this tool was extracted from a central database and analysed by a Statistician using Microsoft Access and Excel.
The audit was designed to achieve four main functions:
 
  1. Profile the patients using the service.
  2. Identify the complexity of the wounds.
  3. Test the integrity and completeness of the data.
  4. Recommend changes to the system and/or process to enhance the quality of information available to the service.
Project Outcomes: A report was developed profiling this client group for Nurse Maude. Also recommendations were made over the type of information that needed to be captured to more fully inform service development and client outcomes.
Further Information: http://www.nursemaude.org.nz/nursing/nursing-services
Evaluation of health care needs of patients with advanced COPD in Canterbury
Funding Body: Nurse Maude Campbell Ballantyne Fellowship
Project Description/Update: Patients with advanced chronic obstructive pulmonary disease (COPD) experience physical and psychosocial stresses such as breathlessness, depression, anxiety, often leading to a poor quality of life.  Studies have identified unmet physical and psycho-social needs and difficulty accessing aids and financial benefits for these patients (Fitzsimmons et al, 2007; Gruffydd-Jones et al, 2007). We have limited evidence about the healthcare needs of people with advanced lung disease in Canterbury. This collaborative research will involve the Nurse Maude Hospice palliative care service, CDHB Respiratory Service and the NZ Institute of Community Health Care (NZICHC). 

This study was designed to identify the health care needs of people with severe COPD by:
  1. assessing their anxiety level
  2. assessing health related quality of life
  3. documenting their service usage
  4. assessing social support networks
  5. exploring their views on advance care planning.
The study will inform us about the role and need for palliative care in this patient group with advanced COPD in Canterbury.
Project Outcomes: Recruitment and analysis of information was completed in mid 2013.  One article has been published to date and is available here.
Further Information: amanda.landers@nursemaude.org.nz
Review of District Nursing Services in New Zealand
Funding Body: Ministry of Health
Project Description/Update: This project was developed to provide evidence and recommendations to inform the future development of DNS across NZ in order to maximise the use of the workforce and to optimise patient outcomes.  This project will also provided a benchmark against which the impact and outcome of different community based DNS models can be measured in terms of both patient outcomes and workforce utilisation in order to guide further development of services.

Essentially the research team including District Nurses from Capital and Coast and from MidCentral District health Boards systematically carried out a national stocktake of all District Nursing services in the country with a brief description of the populations they served.
Project Outcomes: Two publications emerged out of this 15 month project; one that profiled the district nursing workforces and services by DHB for the entire country and the other identifying innovations in practice and service delivery that were found during the stocktake.
Further Information: The reports are available through the link below.
http://www.health.govt.nz/publication/district-nursing-service-development-new-zealand
Evaluation of the Role of Nurse Practitioner (Older Adult) Service
Funding Body: Nurse Maude Campbell Ballantyne Fellowship & Canterbury District Health Board
Project Description/Update: Nurse Maude and the Canterbury Clinical Network, with support from Canterbury District Health Board, established a pilot Older Adult Nurse Practitioner (NP) service to support a group of seven General Practice teams in a part of Christchurch, to work with community care services and local pharmacists. This role took a restorative focus for clients aged 75 years and over (excluding those with palliative needs). It provided case management and support for those with complex sub acute care needs to assist them to stay at home longer and reduce inappropriate hospital admissions. The service was co-located with Nurse Maude District Nursing and Home Support services but worked collaboratively with all providers of district nursing and homecare services. The service was planned for commencement in November 2010, however unavoidable delays meant that the NP commenced recruiting her caseload in February 2011.

An evaluation process, using a prospective clinical audit and survey method, was developed to identify which patients were referred to the NP service, their health status, how this role developed and service delivery outcomes.  A patient satisfaction survey and a survey of the perceptions of general practice teams about the NP service were conducted. The direct, indirect, and service related activities undertaken by the NP were identified, along with issues in service delivery and identified gaps in community support services.
Project Outcomes: An evaluation report was developed and presented to the Canterbury District Health Board to inform decision making over the role.
Further Information: http://www.insitemagazine.co.nz/issues/may-2010/the-growth-of-an-np/
Development of a Nurse Maude Services Annual Clinical Activities and Outcomes Report
Funding Body: Nurse Maude
Project Description/Update: Nurse Maude provides a district nursing, nurse specialist, hospice and hospital service to about 13,000 clients annually. These activities generate a significant amount of information that can be de-identified and used for a quality assurance processes including:
 
  • Profiling the client group to identify any potential service gaps
  • Identifying the impact of service changes on the volume and profile of service users
  • Measuring any changes in service access and workforce requirements
  • Monitoring any ‘outliers’ in length of service need and/or multiple service users
  • Establishing annual benchmarks against which further annual report data can be measured
  • Any workforce changes over time.
The Institute has worked with the organisation to identify the key indicators they would like to track over time and have used these to frame up and complete an annual activities and outcomes report which is being produced annually.
Project Outcomes: Reports have been made available to Nurse Maude for the 2012/13, 2013/14 and 2014/15 years and is summarised in Nurse Maude's annual reports.
Further Information: gill.coe@nzichc.org.nz
Utilisation of Wound Care Products by District Nurses by Service Locality Over a 12 Month Period
Funding Body: Nurse Maude
Project Description/Update: Nurse Maude keeps records on the use of wound care products by its 250 District Nurses. This information was de-identified and analysed to profile:
 
  • The types of product being used
  • Volume and length of time used by clients
  • Differences in product usage by District Nursing Team.
A set of indicators against which any changes in service delivery can be measured in future.
Project Outcomes: The report on this project was shared with the District Nurses and used by them to reflect on their current practices and a re-run of the data will be used to map the impact of changes over the following 12 months.
Further Information: gill.coe@nzichc.org.nz
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